I. Abrasions/Cuts/Bleeding

XI. Head Injuries

II. Bone and Joint Injuries

XII. Heat-Related Injuries

III. Burns

XIII. Poison Injuries

IV. Chemical or Body Fluid Spills

XIV. Psychotic/Emotionally Disturbed

V. Choking

XV. Puncture Wounds

VI. Convulsions/Seizures

XVI. Rape

VII. Diabetic Coma/Insulin Reaction

XVII. Respiratory Arrest/Cardiac Arrest

VIII. Drug! Alcohol Intoxication-Disruptive Behavior

XVIII. Shock

IX. Eye Injuries

XIX. Suicide Threats/Attempts

X. Fainting/Unconsciousness

I. Abrasions/Cuts/Bleeding

A. Superficial

Until help arrives:

• Stop bleeding by applyind direct pressure over wound.
• Clean wound with soap and water.
• Apply band-aid or dressing to wound

B. Deep

Until help arrives:

• Apply direct pressure over wound with gauze or clean cloth. Press hard enough to stop bleeding.
• Apply additional dressing and bandage snugly.
• Do not remove dressing.
• Refer victim for medical care.
  
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II. Bone and Joint Injuries

Until help arrives:

• Always suspect a fracture.
• Do not move the injured part.
• In case of major joint injury (knee, hip, shoulder, ankle or suspected back or neck injury), do not move the victim.
• Get medical help as soon as possible
  

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III. Burns

A. For non-severe burns, immerse affected area in cold water immediately; continue for 20 minutes.

B. For more severe burns, do not immerse in water; cover the area with sterile gauze or clean dressing then cold water may be poured over the dressing. If an extremity is involved, elevate the part. Do not open blisters. Do not apply ointment to area of burn. Seek medical attention as soon as possible.

C. Chemical burns should be washed immediately with large quantities of water. Cover with gauze dressing;do not open blisters. Seek medical attention as soon as possible

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IV. Chemical or Body Fluid Spills

A. Chemical spills may be toxic or give off toxic vapors especially if more than one chemical is involved.

1. Evacuate the area. DO NOT attempt to clean up or remove the chemical.
2. Notify the Fire Department
3. In case of injuries, administer first-aid procedures as outlined in this section. If a person has throat irritation, upset stomach, headache or shortness of breath, they should seek medical attention.

B. Body fluids (blood, vomitus, ete.) can carry the AIDS virus as well as other potentially dangerous elements.

1. To clean areas potentially contaminated with body fluids, first clean the area with large amounts of suitable cleaner before wiping up.
2. Wear gloves (rubber or latex) at all times.

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V. Choking

A. If the victim is coughing let him/her cough.

B. If the victim cannot cough, speak or breath, use the Heimlich Maneuver.

C. Steps of the Heimlich Maneuver

1. Victim Is Standing or Sitting

a. Tell victim to hold hand to neck if he/she is choking.

b. Stand behind the victim and pi ace hands around the victim's waist.

c. Make a fist with one hand and place thumb side against victim's abdomen, slightly above the navel and below rib cage.

d. Place other hand over fist and press into victim's abdomen with a quick upward thrust.

e. Repeat several times-you may have to use a rotating motion of the hands in an upward direction to assist in expelling the foreign object.

2. Victim Is Lying on Back

a. Facing victim, kneel and place your legs astride victim's hips.

b. Place heel of hand on victim's abdomen slightly above navel and below rib cage. Place other hand on top of first hand.

c. Press into victim's abdomen with a quick upward thrust.

d. Repeat this action several times if necessary.

D. If You Are Choking: Read the following material now, so that you will be prepared if you are choking and are by yourself.

When you are actually choking, it will be too late to read directions.

1. Place your fist below your rib cage and above your navel (same position as if you were performing this on another person).

2. Use your dominant hand over the fist and press quickly upward and inward. Do this repeatedly. If this action does not work, try:

3. Placing your abdomen against a firm object-a sink, chair back or table edge.

4. Use your full weight to press inward and upward-keep repeating until object is expelled.

A final alternative:
5. Lie down on stairs or over a bed in a face-down position so head is lower than feet.

6. Allow gravity to assist the food to fall out.

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VI. Convulsions/Seizures

A. Position the victim on his/her back, face turned to one side.

B. Do not restrain patient's movement any more than necessary to prevent
him/her from harming him/herself.

C. Do not place objects between the patient's teeth.

D. Do not try to revive the patient with fluids, stimulants, fresh air or walking.

E. Allow patient to rest quietly at least 30 minutes after the attack.

F. Check for breathing.

G. Seek medical attention

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VII. Diabetic Coma/Insulin Reaction

A. Signs and Symptoms

• Onset may be gradual or rapid.
• Skin may be hot and dry or pale, cold and clammy-perspiration.
• Breathing may be deep and labored or shallow and rapid.
• Nausea.
• Drowsiness, lethargy or mental confusion.
• Loss of consciousness or convulsions.

B. Until help arrives

• Lay the victim down.
• If victim is still conscious, administer a form of simple sugar such as sweetened orange juice, lumps of sugar, honey or candy.
• Seek medical attention immediately.
  
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VIII. Drug! Alcohol Intoxication-Disruptive Behavior

A. Approach the person calmly.

B. Ask the person to leave after describing the person's behavior to him/her (e.g., "You are loud and interrupting patrons.").

C. If the person is unable or refuses to leave, have someone contact Police

D. Alcohol or drug effects can result in violent behavior-protect yourself by not allowing yourself to get caught in a dangerous situation.

E. For severe intoxication with lethargy or confusion:

1. Before approaching or touching the person, explain what you intend to do.

2. Speak in a clear, firm reassuring manner.

3. Keep the patient still and comfortable.

4. Stay with an intoxicated person who is vomiting.

5. When laying the patient down, turn the head to the side and protect the person from choking on or swallowing vomit.

6. Monitor the patient's breathing. If you detect unconsciousness or respiratory problems, get immediate medical help.

7. DO NOT try to run, walk or exercise the patient.

8. DO NOT try to keep the patient awake.

9. DO NOT give the patient anything orally-food, liquid (coffee) or drugs-to sober the person up.

10. DO NOT give the patient a cold shower.

11. DO NOT attempt to constrain the patient without abundant assistance.

12. DO NOT let the person drive.

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IX. Eye Injuries

A. Foreign Object in Eye

1. Instruct the victim not to rub the eye. Have the patient close the eye gently in the hope that tears may wash the speck out or into view.

2. Flush the eye with plain water. Instruct the victim to hold face under running water and blink eye open and shut. If object does not easily wash out, cover eye with dry dressing and refer for medical care.

B. Chemical Burn to Eye

1. Wash eye immediately, thoroughly and repeatedly with large amounts of water. The patient may be instructed to hold face under running water and blink eye open and shut. Flush eye at least 15 minutes.

2. This type of injury must be seen by a physician.

C. Eye Wounds

1. Instruct the patient to close both eyes.

2. Apply sterile gauze dressing over both eyes.

3. Do not remove any protruding object.

4. Seek medical attention.

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X. Fainting/Unconsciousness

A. Fainting

Until help arrives:

• lay the victim flat or have him/her recline in a chair with the victim's head lower than his/her knees.
• A patient who has fainted, although appearing to have responded completely, should not be sent away without medical evaluation.

B. Unconsciousness

Until help arrives:

• Keep the patient flat with the patient's head turned to one side and keep the patient warm.
• Check to see that the patient is breathing.
• DO NOT move the patient.
• DO NOT leave the patient.
• DO NOT give an unconscious patient anything by mouth.
• Send someone to request medical assistance (Call 911)
  
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XI. Head Injuries

A. Until help arrives:

If unconsciousness, convulsions, bleeding or fluid from ears or nose occurs, DO NOT move patient. Seek medical attention.

If severe headache, nausea and/or vomiting, incoherence, sleepiness or dozed appearance exists, DO NOT move patient. Seek medical attention

B. For minor blow to the head:

Allow patient to rest.

Observe patient for symptoms noted above.

Caution patient against over activity.

Caution patient regarding delayed symptoms of internal head injury.

Seek medical attention.

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XII. Heat-Related Injuries

A. Heat Stroke

Signs and symptoms:
. High body temperature.
. Hot, red, dry skin.
. Rapid pulse.
. Unconsciousness.
NOTE: Heat stroke is an immediate, Iife-threatening situation.

B. Heat Exhaustion

Signs and symptoms:
. Skin is pale and clammy.
. Weakness, nausea, dizziness, cramps, possible fainting.
. Excessive perspiration.

C. Until help arrives:

. Give the victim sips of water.
. Lay victim down; elevate feet.
. Loosen clothing and apply cool, wet cloths to skin.
. Seek medical help.

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XIII. Poison Injuries

A. Inhaled Poison-Immediately get the person to fresh air. Avoid breathing fumes. Open doors and windows wide. If victim is not breathing, start artificial respiration.

B. Poison on the Skin-Remove contaminated clothing and flood skin with water for 1 a minutes. Then wash gently with soap and water, and rinse.

C. Poison in the Eye-Flood the eye with lukewarm (not hot) water poured from a large glass 2 or 3 inches from the eye. Repeat for 1 5 minutes. Have victim blink as much as possible while flooding the eye. DO NOT force the eyel id open.

D. Swallowed Poison-Unless victim is unconscious, having convulsions or cannot swallow, give milk or water immediately. Poison Control professional advice about whether or not you should make the victim vomit.

E. Getting Professional Help Fast

1. As soon as you have taken the emergency actions recommended above, call for professional help. (If possible, get someone else to make the
call immediately.) If the victim is having an acute medical problem, such as unconsciousness, seizures or acid burns, first dial 911-or Police- Then call Poison Control for further advice. Whether the situation is acute or moderate, accidental or deliberate, call the Poison Control Center.

2. Identify the poison involved; look for clues if necessary. Save any vomitus for emergency personnel to analyze.

3. Follow instructions of Poison Control as to counter agents.

4. Induce vomiting only on advice of Poison Control. Syrup of epicac is effective to induce vomiting. Currently, activated charcoal is preferred because it absorbs the poison.


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XIV. Psychotic/Emotionally Disturbed

Recognize that the ability of the disturbed person to deal rationally with his/her behavior is limited, therefore:

.Contact Police
. Do not argue with any ideas the person expresses, no matter how unusual.
. Make no threatening movements or comments to the person.
. Ask the majority of persons to leave quietly; ask a few to remain.
. Remain calm and unafraid in your conversation with the person; he is the one who is frightened.
. Remain with the person until help arrives, unless you and others feel an
immediate threat to your safety.

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XV. Puncture Wounds

Until help arrives:

. Allow the wound to bleed freely.
. Wash the wound with soap and water.
. Apply sterile gauze dressing.

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XVI. Rape

A. Brief questions should be asked or a general evaluation done to make sure that the person is medically stable (i.e., make sure the person is breathing normally and is not badly hurt or in need of immediate medical attention).

B. Call Police If immediate medical attention is required, call an ambulance (dial 911 or obtain/provide transportation to the Hospital.

C. If the person is stable, he/she should be taken to an area for primary supportive care. The area should be:

. Safe
. Quiet
. Comfortable
. Private-confidentiality and
respect for privacy should be maintained
. Nearby

D. A counselor should be called. This person shall go to the patient to provide initial support.

E. If the patient has famity, one or two close friends or significant others that he/she would want present, they may be notified. (Generally it is best to keep visitors to a minimum of close friends or family only.)

F. When the counselor arrives, a more involved discussion may be needed to obtain information and to give the patient information. This should include medical, psychological and legal aspects of the situation.

G. When the person involved feels comfortable, she/he should be instructed to speak with Police with the counselor present. If possible, this should be done before a rape examination to enable further investigation of the area.

H. The person may be transported to a Hospital for a formal rape examination.

I. After the medical examination, the patient may need further counseling or discussion with Police concerning the incident.

J. Follow-up counseling should be scheduled physician should be set up to answer any further specific medical questions or to provide continuing medical care.

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XVII. Respiratory Arrest/Cardiac Arrest

A. When you see someone who may be unconscious:
1. Call out for help as you approach the victim.

2. Check responsiveness by shaking shoulders and shouting "Are you OK?" This will help to determine whether victim is unconscious.

3. If no response, place victim on flat, firm surface and position self next to victim at about the same level. If victim is on the ground, kneel next to victim.

B. Rescue Breathing

1. Tilt head by placing palm of hand on victim's forehead.

2. Press backward on forehead to open airway.

3. Lift chin by placing fingers of other hand under bony part of jaw on side nearest you until teeth are nearly closed.

4. Assess breathing:

• Lean over victim's head and look at chest to determine if
  chest rises and falls.
• place ear and cheek near victim's mouth and nose to listen and feel for air movement.

5. If you see or suspect an object blocking the airway, immediately perform the Heimlich maneuver. If no object is suspected, begin mouth-to-mouth resuscitation.

6. Pinch victim's nostrils closed. 7. Fully cover victim's mouth with your own mouth to form a mouth-to-mouth seal. Do not let air escape around the seal.

8. Take a deep breath and expel air into the victim's mouth. Take 1to 11/2 seconds to expel breath until you see chest rise.

9. Release seal and turn your head to the side.

10. Take a fresh breath.

11. Watch for victim's chest to fall. 12. Give second breath-repeat cycle very 5 seconds.

13. Check neck pulse for 5 to 10 seconds.

14. If pulse is present, continue rescue breaths, one breath every 5 seconds (about 12 breaths per minute).

15. If no pulse present, administer CPR.

C. Administering CPR-One Person

1. Make sure you perform initial steps described above: open victim's airway, administer 2 full breaths with mouth-to-mouth breathing and check pulse.

2. If pulse is absent, begin CPR.

3. Run finger up rib cage until middle finger reaches place where ribs and sternum (breastbone) meet.

4. Position hands midline, lower half of sternum, two fingers above xiphoid. Using this location avoids damage to the liver.

5. Place heel of one hand on sternum; place other hand on top of first hand, with fingers of both hands pointing the same direction.

6. Interlace fingers and extend fingers off rib cage.

7. Administer chest compressions (press downward):

. Compress chest 11/2 to 2 inches.
. Do compressions at a rate of 80-100 per minute. Count compressions: one-and-two and. . . and so forth.
. Do 1 5 compressions.
. Release pressure between compressions for cardiac refilling but do not take heel of hand off chest. (Leaving the hand on the chest prevents malposition of hands between compressions which could result in injury to the patient.)

8. After 1 5 chest compressions, give 2 breaths using mouth-tomouth breathing. Continue this sequence: 15 chest compressions alternating with 2 breaths.

9. Check pulse after one minute.

10. Continue until help arrives.

D. Administering CPR-Two Persons

1. Rescuer A assumes position next to head of victim. Rescuer A performs initial steps described earlier: open victim's airway, administer 2 full breaths with mouth-to-mouth breathing and check pulse.

2. If no pulse, Rescuer A states, "No pulse," and team begins CPR. Rescuer B assumes position of compressor at level of chest and locates site for chest compression (described in one-person CPR).

3. Rescuer B begins compressions (described in one-person CPR).

4. Rescuer B completes 5 compressions at a rate of 80-100 per minute. Rescuer B counts "one-and-two-and . . ." to maintain smooth rhythm for CPR.

5. As soon as Rescuer B releases fifth compression, Rescuer A administers one breath. Rescuer A fits breath into the natural beat between compressions.

6. Continue at ratio of 5 compressions to 1 breath.

E. Continuing CPR.

1. Check pulse every few minutes during CPR. If pulse present, discontinue CPR.

2. Check breathing every 4 to 5 minutes. If no breathing, continue ventilation.

3. Observe for abdominal bloating. If evident, reposition airway and reduce force of venti lation.

4. Check neck pulse frequently between breaths to evaluate effect of CPR.

5. If pulse returns, continue mouth-to-mouth breathing until breathing returns. Check pulse after each minute (12 breaths) to confirm that heart has still continued to function. If no pulse, reinstate CPR.

6. Terminate CPR under the following conditions:

. The resuscitation is successful-patient is conscious.
. Return of vital functionsheart beats on its own.
. Paramedics or other trained personnel arrive and take over CPR.
. Patient is transferred to emergency vehicle.
. Patient is pronounced dead by physician.
. Rescuer is exhausted and cannot continue.

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XVIII. Shock

A. Signs and symptoms:

. pallor
. cold sweat on forehead
. cold, clammy hands
. nausea
. dizziness
. weakness
. ashen-gray appearance
. feeble, rapid pulse
. shallow, irregular breathing

B. Until help arrives:

. Keep the victim lying down in a warm place.
. Keep the victim comfortably warm.
. Lower the victim's head or elevate legs.
. .Avoid chilling.
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XIX. Suicide Threats/Attempts

A. In the case of a suicide or suicide attempt, the victim is stabilized and the area secured. Emergency personnel, police and appropriate administrative personnel will be notified immediately. If the patient is in need of medical attention either physically or emotionally (if the person is stiII adively suicidal or is not in complete control of his/her actions), they should be transported to Hospital or another suitable health care facility to receive medical attention. If in the observer's opinion there is significant potential risk of suicide or danger to another individual, the patient may be taken against his/her will for a medical evaluation. Contact Police for assistance and to notify authorities.

B. If a drug overdose has occurred, the individual should be transported to the nearest health-care facility no matter how insignificant the ingestion appears to be. If the patient is conscious, generally syrup of ipecac should be given followed by large amounts (at least six glasses) of water.

C. If caustic agents have been ingested (gasoline, acid, bleach, etc.), vomiting should not be induced. The patient may be given small amounts of milk.

D. If the patient has only expressed depression and/or suicide ideations, and if he/she is not in imminent danger, call Police. If the person in charge is unable to contact physician, the patient should be transported to a health-care facility for evaluation.

Note: All suicidal ideas should be taken seriously.

E. If the suicide is successful, Police should be notified.