BASIC LIFE SUPPORT

The Nature of Disasters

Goal
The goal of this chapter is to introduce the First Aiders the concepts behind the disasters, what they are, and how disaster response is organized.

Objectives
At the completion of this session, the First Aiders will:
discuss the concepts of emergency and disaster; describe the difference between a natural and man-made disaster; Perform the simplified Adult BLS Algorithm

INTRODUCTION

Disaster preparedness, whether it's in anticipation of potential weatherrelated incidents or terrorist incidents requires a skill set that in my mind someone has to be trained for.
~~Bennie Thompson

Emergency
Is a situation where a sudden incident or event has occurred and normally used, local responses will suffice to care for the situation without calling in outside help. -- WHO, 2005

Emergency
Natural Man-made
Examples: Car accident Water main breaking

Disaster
Any event that leads to a response beyond which the affected community can deal with locally. -- WHO, 2005

Disaster
Like emergency, Natural Man-made

Disasters
Are subset of emergencies and tax responding agencies beyond their capacities. Can be like a spreading ring of concentric circles, influencing the outer rings less and less. -- WHO, 2005

Local response

Provincial response

National response

Figure 1 - 1. As the level of response spreads out from the incident, the degree of severity decreases going from local disaster to national emergency.

Types of disasters
Natural disasters Man made disasters

Natural disasters earthquakes, tsunamis, pandemic flu and tornadoes

Man made disasters bioterrorisms, hijacking, and war

Types of response
Assess Contain Respond Recover

FIRST AID is an immediate care

given to a person who has been injured or suddenly taken ill. It includes self-help and home care if medical assistance is not available or delayed.

Objectives of First

Aid:

a. To alleviate suffering b. To prevent added/further injury or danger

Emergency action principles Do a primary survey: Check A airway Check B breathing Check C circulation

Do a secondary survey: Interview the victim. Check the vital signs determine radial or carotid pulse determine breathing (respiration rate) determine skin appearance

 Do a head-to-toe examination looking for DCAP-BTLS (Deformity, Contusion, Abrasion, Puncture, Burn, Tenderness, Laceration, Swelling)

 Golden Rules in Giving Emergency Care: What to DO Do obtain consent when possible. Do think the worst. Its best to administer first aid for the gravest possibility. Do remember to identify yourself to the victim.

 Do provide comfort and emotional support. Do respect the victims modesty and physical privacy. Do be as calm and as direct as possible. Do care for the most serious injuries first.

 Do assist the victim with his/her medication. Do keep onlookers away from the injured person. Do handle the victim to a minimum. Do loosen tight clothing.

What Not to DO:

Do not let the victim see his/her own injury. Do not leave the victim alone except to get help. Do not assume that the victims obvious injuries are the only ones.

 Do not make any unrealistic promises. Do not trust the judgment of the confused victim and require them to make a decision.

Cardiopulmonary Resuscitation (CPR) is the combination of

compression and rescue breathing. This must be confined for effective resuscitation of the victim of cardiac arrest.

Criteria for Not Starting CPR:

All patients in cardiac arrest receive resuscitation unless: The patient has a valid Do Not Attempt Resuscitation (DNAR) order. The patient has signs of irreversible death: rigor mortis, decapitation or dependent lividity.

 No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy for such conditions as progressive septic or cardiogenic shock.

 Withholding attempts to resuscitate in the delivery room is appropriate for newly born infants with: Confirm gestation <23 weeks or birth weight <400g. Anencephaly Confirmed trisomy 13 or 18.

Simplified Adult BLS Algorithm

Unresponsive, No breathing or no normal breathing [Gasping] Activate emergency response
Get defibrillator
Check rhythm/shock if indicated Repeat every 2 minutes

Start CPR
Push hard, Push Fast

Simplified Adult BLS Algorithm

Area safety scene survey
Rescuer: 90% Victim: 10%

BSI [Body Surface Isolation] Introduction of self Tap and shout

Sternal rub

Simplified Adult BLS Algorithm

Responsive Ok Unresponsive BSI if with blood

Airway
Head tilt, Chin lift [Maximum] Dont remove at forehead unless during CPR

Breathing Circulation

Simplified Adult BLS Algorithm

Breathing
Chest rise [Best indicator] Feel the air 5 10 seconds [not more than 10 sec]
Not breathing:
2 initial blows
6 min clinical or biological death, brain damage

Simplified Adult BLS Algorithm

Circulation
5 10 seconds [not more than 10 secs] CPR
Center of the chest Male nipple line
Heel sternum Dominant [handedness] sternum Non dominant above Hips fulcrum Longer muscular energy

Simplified Adult BLS Algorithm

Compression
30

Breaths
2

5 cycles for 2 minutes

Simplified Adult BLS Algorithm

2010
More than 100 beats/min Staying alive rhythm
CAB - compression, airway, breathing
5 cycles/ 2 minutes

When to STOP CPR:

S Spontaneous signs of circulation are restored. T Turned over to medical services or properly trained and authorized personnel. O Operator is already exhausted and cannot continue CPR. P Physician assumes responsibility (declares, death, take over, etc.)

fin
Domo Arigato Gozaimasu