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Stcw 95 basic first aid june 13 Presentation Transcript

  • 1. STCW 95 Basic First Aid
  • 2. STCW 95 Basic First Aid: References • STCW95: Section A-VI, Table A-VI/1-3 • American Heart Association, Heartsaver AED • Ship Captain’s Medical Guide, 1999, MCA
  • 3. STCW 95 STCW-95 • Elementary First Aid: Table A-VI/1-3 – Immediate Care. Required training for all seafarers • Medical First Aid: Table A-VI/4-1 – “The first responder” required after 8/98 • Person in Charge:Table A-VI/4-2 – At least one per ship • Medical Care Onboard:Table A-II/2 – Master Chief Mate.
  • 4. STCW 95 Course Objectives • Define potential scene hazards, biohazards and methods to protect rescuers. • Demonstrate adult, single rescuer CPR and airway management. • Introduction to the use of the AED. • Response to bleeding, shock and burn emergencies. • Introduction to moving a patient.
  • 5. STCW 95 What are you required to do? Take immediate action upon encountering an accident or medical emergency. • Keep yourself safe! • Assess for injury or illness • Treat appropriately
  • 6. STCW 95 What are you required to do? – Proper patient positioning – Control the airway – Protect the spine – Maintain vital functions – CPR and AED – Control of hemorrhage and application of bandages – Immobilize when you suspect a bone injury – Treat burns, both thermal and electrical – Define, recognize and provide basic treatment for shock from any cause
  • 7. STCW 95 How will we be tested? • Written, CPR/First Aid • Skills, evaluations after through instruction
  • 8. STCW 95 Basic First Aid • The first responder makes a tremendous difference in patient outcome • What you do in the first 5 minutes can either help or doom a patient
  • 9. STCW 95 Onboard Resources Call for help early!
  • 10. STCW 95 You are Responsible for Protecting: • Self • Bystanders • Patient
  • 11. STCW 95 Protect Yourself First: Scene Hazards • HAZMATS • Confined spaces • Electrical hazards • Bloodborne pathogens • Airborne pathogens
  • 12. STCW 95 First: Know what chemicals you are carrying! Do not enter a possibly contaminated / confined area unprotected! Protect Yourself First: Scene Hazards
  • 13. STCW 95 Fire Hazard – Most combustibles will emit toxic smoke – Protect yourself and others from exposure to inhaled toxins Protect Yourself First: Scene Hazards
  • 14. STCW 95Biohazards / Infectious Diseases
  • 15. STCW 95 Biohazards / Infectious Diseases 1. Wash your hands 2. Wash your hands 3. Wash, Wash, Wash your hands
  • 16. STCW 95 Biohazards / Infectious Diseases • Use barrier devices such as: gloves, gowns, masks. • Wash hands after contact with a patient. • Have current vaccinations including Hepatitis B vaccine. Personal Protection: Bloodborne Pathogens
  • 17. STCW 95 Personal Protection-Gloves • Required for all patent contact. • If its wet and its not yours you don’t want it! • Gloves have small holes in them that we cannot see but they are there. • Change bloody gloves immediately!
  • 18. STCW 95 Biohazards / Infectious Diseases Airborne Pathogens; what can you catch ? • TB (HEPA Mask) • Measles/Chicken Pox • Meningitis • Mono • Upper respiratory infections including pneumonia
  • 19. STCW 95 Personal Protection: Airborne Pathogens • Use masks/ BVM for CPR/Rescue breathing. • Wear face mask in presence of person with cough. • Keep patients with productive cough in well- ventilated area. Biohazards / Infectious Diseases
  • 20. STCW 95 Biohazards / Infectious Diseases Stock a Broad range of Antibiotics
  • 21. STCW 95 Proper Waste Disposal
  • 22. STCW 95 Duty-to-Act • Legal obligation of certain persons either by statute, treaty or function to provide care • Shipboard: Duty as officer to care for crew • Shoreside: Protection through Good Samaritan Act
  • 23. STCW 95 Good Samaritan Act • Provides protection from law suit in non- employment situation • Must meet three criteria: • Acted within scope of practice or training. • No compensation received. • Patient turned over to competent provider.
  • 24. STCW 95Consent • Expressed Consent: Knowingly consents to being treated. • Implied Consent: Cannot consent but a reasonable person would assume that they would wish to be treated. (i.e.; unconscious or minor unable to legally consent. • Abandonment: Termination of care without patient’s consent.
  • 25. STCW 95"‫רעך‬ ‫דם‬ ‫על‬ ‫תעמוד‬ ‫"לא‬ ‫חוק‬ –‫התשנ"ח‬ ,‫רעך‬ ‫דם‬ ‫על‬ ‫תעמוד‬ ‫לא‬ ‫חוק‬1998-‫ב‬ ‫לתוקף‬ ‫נכנס‬ ,28/9/98. (‫אירוע‬ ‫עקב‬ ,‫עיניו‬ ‫לנגד‬ ‫הנמצא‬ ‫לאדם‬ ‫עזרה‬ ‫להושיט‬ ‫אדם‬ ‫על‬ ‫חובה‬ (‫א‬ ,‫לבריאותו‬ ‫או‬ ‫גופו‬ ‫לשלמות‬ ,‫לחייו‬ ‫ומיידית‬ ‫חמורה‬ ‫בסכנה‬ ,‫פתאומי‬ .‫זולתו‬ ‫את‬ ‫לסכן‬ ‫או‬ ‫להסתכן‬ ‫מבלי‬ ,‫העזרה‬ ‫את‬ ‫להושיט‬ ‫לאל-ידו‬ ‫כאשר‬ ‫העזרה‬ ‫את‬ ‫להושיט‬ ‫היכול‬ ‫אחר‬ ‫אדם‬ ‫המזעיק‬ ‫או‬ ‫לרשויות‬ ‫המודיע‬ (‫)ב‬ ,‫זה‬ ‫בסעיף‬ ;‫זה‬ ‫חוק‬ ‫לעניין‬ ‫עזרה‬ ‫שהושיט‬ ‫כמי‬ ‫יראוהו‬ ,‫הנדרשת‬ ‫הכבאות‬ ‫ושירות‬ ‫אדום‬ ‫דוד‬ ‫מגן‬ ,‫ישראל‬ ‫משטרת‬ - "‫"רשויות‬.‫זה‬ ‫חוק‬ .‫מחוק‬ ‫הנובעת‬ ‫לחובה‬ ‫לזולת‬ ‫עזרה‬ ‫של‬ ‫המוסרית‬ ‫החובה‬ ‫את‬ ‫הופך‬ ‫עונשו‬ ‫החוק‬ ‫הוראת‬ ‫על‬ ‫העובר‬‫קנס‬. :‫שמתקיימים‬ ‫במקרה‬ ‫תקף‬ •."‫עיניו‬ ‫לנגד‬ ‫הנמצא‬ ‫"לאדם‬ •."‫פתאומי‬ ‫אירוע‬ ‫"עקב‬ •."‫לבריאותו‬ ‫או‬ ‫גופו‬ ‫לשלמות‬ ,‫לחייו‬ ‫ומיידית‬ ‫חמורה‬ ‫"בסכנה‬ .‫מספקת‬ ‫כעזרה‬ ‫נחשבת‬ (‫וכיו"ב‬ ‫משטרה‬ ,‫)מד"א‬ ‫חיצונית‬ ‫עזרה‬ ‫*הזעקת‬
  • 26. STCW 95 Heartsaver AEDHeartsaver AED for the Lay Rescuer andfor the Lay Rescuer and First ResponderFirst Responder ©1998 American Heart Association1998 American Heart Association
  • 27. STCW 95 Extent of the Problem • 1.1 million heart attacks • 480,000 deaths due to coronary heart disease • 250,000 prehospital cardiac arrests In Israel: • 25,000 heart attacks a year • 7,000 deaths a year due to coronary heart disease
  • 28. STCW 95 Heart Attack • Heart Attack (Myocardial Infarction) – Blockage of blood flow. – Results in death of heart muscle. • Presentations: – Sudden death. – Massive chest pain. – Mild chest discomfort.
  • 29. STCW 95 Stroke: CVA Blockage of a cerebral artery Symptoms: • Dizziness, headache • One sided paralysis • Slurred speech • Unconsciousness, coma • Seizures
  • 30. STCW 95 “The first symptom of a heart attack is denial!”
  • 31. STCW 95 Heart Attack & Stroke: Risk Factors • Hypertension (high BP) • Smoking • Obesity
  • 32. STCW 95 • Excessive alcohol intake • Diabetes Heart Attack & Stroke: Risk Factors
  • 33. STCW 95 • Lack of exercise • High fat diet Heart Attack & Stroke: Risk Factors
  • 34. STCW 95 • Age • Gender • Family history • Race Heart Attack & Stroke: Risk Factors
  • 35. STCW 95 Heart Rhythm Sinus Rhythm is normal electrical conduction in the heart VF is a frequent initial rhythm in sudden cardiac arrest VF is a quivering of the heart with no blood flow Defibrillation is the only effective treatment for VF
  • 36. STCW 95 Other Heart Arrhythmias Ventricular tachycardia (shockable) Asystole (not shockable)
  • 37. STCW 95 Time and AEDs • Approximately 50% survival after 5 minutes • Survival reduced by 7% to 10% each minute • Rapid defibrillation is the key • CPR helps extend survival time minutes 0 20 40 60 80 100 1 3 6 10 Survival
  • 38. STCW 95 Basic Life Support: CPR • If neck injury suspected: – jaw thrust
  • 39. STCW 95 CPR IN THREE SIMPLE STEPS • CALL Check the victim for unresponsiveness. If there is no response, Call 911 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions.
  • 40. STCW 95 CPR IN THREE SIMPLE STEPS cont. • BLOW Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second.
  • 41. STCW 95 CPR IN THREE SIMPLE STEPS cont. • •PUMP If the victim is still not breathing normally, coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 30 times right between the nipples. Pump at the rate of 100/minute, faster than once per second.
  • 42. STCW 95 CPR IN THREE SIMPLE STEPS cont. • CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES NOTE: This ratio is the same for one-person & two-person CPR. In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.
  • 43. STCW 95 Basic Life Support: CPR If pulse & breathing are restored – but patient remains unresponsive Place in the recovery position.
  • 44. STCW 95 Basic Life Support: CPR When can CPR be discontinued? – Physically exhausted – Patient revived – Relieved by trained rescuers – Unsafe to continue
  • 45. STCW 95 When Can CPR be Discontinued?
  • 46. STCW 95 Basic Life Support: Obstructed Airway
  • 47. STCW 95Assessing the Patient Chief Complaint • Nature of the illness • A statement in the patients own words as to “what's wrong.” • Ask the patient what they think is wrong they may know.
  • 48. STCW 95
  • 49. STCW 95 Medical Alert Tags Patients Medications
  • 50. STCW 95 Adult Assessment • Form a general impression – does the patient look sick? • What is the mental status? – are they awake? Do they respond when you call their name? shake them or pinch them? • Can they speak? • are they breathing well or labored? – Can they complete a sentence without stopping or are they gasping? • What is their general color – is the skin warm and pink or pale, cold, wet? – Look around the face and mouth.
  • 51. STCW 95 Assess the Pulse
  • 52. STCW 95 Assess the Respirations
  • 53. STCW 95Bleeding • Types of bleeding: – Arterial: bright red, spurting: usually most serious – Venous: dark red, steady flow – Capillary: oozing • Signs of internal bleeding – bruising – fractured ribs or bruises on the chest or abdomen – vomiting or coughing up blood
  • 54. STCW 95 Usually looks worse than what it actually is. Methods to control bleeding: – direct pressure – elevation – pressure dressing – pressure point – Tourniquet Do not remove a dressing - reinforce Bleeding
  • 55. STCW 95 Bleeding : Direct Pressure
  • 56. STCW 95 Bleeding: Elevation and Direct Pressure
  • 57. STCW 95 Bleeding: Pressure Points Pressure Points - Compress the artery over the bone to stop bleeding.
  • 58. STCW 95Tourniquet Apply pad over artery - proximal to injury Wrap with wide material, apply leverage: “windlass” Tie down lever & secure tails
  • 59. STCW 95Punctures Harbor bacteria & are prone to infection • Soap and water • Use irrigation and soaking • Peroxide is useful – Careful monitoring after injury for signs of infection
  • 60. STCW 95 Lacerations: Rough Jagged Edges
  • 61. STCW 95 Abrasion: Scraping the top layers of skin
  • 62. STCW 95Shock Loss of circulating blood volume – present in all injuries – inadequate tissue perfusion
  • 63. STCW 95ShockSymptoms: • Rapid pulse • Pulse may be weak ("thready") • Rapid breathing • Anxiety, nervousness • Cool skin • Weakness, excessive tiredness • Pale skin, bluish skin ( cyanosis) • Sweating, moist skin • Low blood pressure
  • 64. STCW 95Shock Treatment • Give Oxygen • Reduce body’s workload • Keep patient warm & calm • Treat or manage underlying cause
  • 65. STCW 95 Burns: Thermal First degree: reddened skin (e.g, sunburn), painful – Cool with water
  • 66. STCW 95 Burns: Thermal Second degree; blistering of deeper layers of skin- painful – Cool with water, dry sterile dressing – Do not break blisters
  • 67. STCW 95Burns: Thermal Third degree: black charred, or hard white skin – Cool with water, dry sterile dressing – All layers of skin & underlying tissue are burned – May not be painful
  • 68. STCW 95Burns Burns – Often a very serious injury – Any significant burn requires evacuation
  • 69. STCW 95Burns: treatment Stop the burning process- cool the area with tepid water Assess the burn May give pain relief immediately Apply sterile dry non adherent dressing Always treat for shock Monitor for infection Don’t: •Use ice •Break blisters •Use butter or other home remedies
  • 70. STCW 95 Patients palm is equal to 1% of their Body Surface
  • 71. STCW 95 Burns: Thermal Other considerations: – Burns to face & neck: airway & vision compromise – Circumferential burns: impaired circulation – Patients are prone to Infection – Patients lose fluids - Hypovolemia – Patients lose heat - Hypothermia
  • 72. STCW 95Burns: Electrical • Turn off power • Check ABC’s – anticipate cardiac arrest – access AED • Consider spinal protection when moving patient
  • 73. STCW 95Burns: Chemical Liquid chemical - flush with water Dry chemicals (lime)- brush away before flushing Chemical burns to the eyes – flush for at least 20 minutes after burning stops – avoid contaminating non- affected eye
  • 74. STCW 95Splinting Never restrict blood flow Check for color, motion and sensitivity to affected limb (CMS) – before/after Immobilization prevents further damage Combine with elevation and application of ice Maintain position of function
  • 75. STCW 95Splinting • When splinting a broken bone- the splint should extend to immobilize also the joint above and below • When splinting a joint- the splint should extend to immobilize also the bone above and below
  • 76. STCW 95Splinting
  • 77. STCW 95 Sling and Swathe • Useful for upper arm, shoulder or collarbone • May also help in elbow fx. / dislocation • Not required for ALL upper extremity injuries!!
  • 78. STCW 95Open bone injuries 1. Apply a sterile dressing over the bone ends 2. Try to splint in a neutral position 3. Do not bring ends of the bone back under the skin unless advised to do so by the doctor
  • 79. STCW 95Proper Splinting?
  • 80. STCW 95Moving a Patient General Rule: Do not move patient until skilled help arrives • Exceptions: – Area unsafe to patient – Area unsafe to rescuer
  • 81. STCW 95 Moving a Patient: Blanket Roll Place a half-rolled blanket alongside the casualty
  • 82. STCW 95 Moving a Patient: Blanket Roll Roll the casualty gently onto his side: The attendant closest to the head, or a 3rd attendant, must support the casualty’s head
  • 83. STCW 95 Moving a Patient: Blanket Roll Roll the casualty gently over
  • 84. STCW 95 Moving a Patient: Blanket Roll Prepare the blanket for lifting the casualty by rolling the edges tightly
  • 85. STCW 95 Moving a Patient: Blanket Roll Lifting the casualty: Tension to all side of the blanket & traction applied to the head
  • 86. STCW 95 Moving a Patient: Backboard
  • 87. STCW 95 Moving a Patient: Two-Man Carry
  • 88. STCW 95 2-man drag through narrow space Moving a Patient: Two-Man Carry
  • 89. STCW 95 Moving a Patient: One-Man Carry One-man drag through narrow space
  • 90. STCW 95 Moving a Patient: One Man Drag
  • 91. STCW 95Summary • Be safe: don’t become another victim • Remember to call for help • ABC’s of first aid