ATLANTIAN BUSINESS SOLUTIONS  FIRST PERSON ON THE SCENE            F-POS   BASIC 10 Hours OF TRAININGINTERMEDIATE 30 Hours...
Pre – Hospital Environment Definition: Pre – Hospital Care Any Medical Intervention or procedure given prior to arrival of...
Role of the First Person On the Scene • To Help reduce the amount of Unnecessary   deaths and complications by providing M...
Role of the First Person On the Scene              Scene Safety              Danger               Look              Listen...
DANGERS•   Before undertaking any Patient Assessment•   Consider your own SAFETY•   Consider Safety at the SCENE•   Consid...
LOOK• Immediate dangers to yourself, patients and others   (Drivers, The Public & Bystanders)• Hazards – Electricity, Wate...
Listen• Use your ears – Traffic, Creaking  Buildings, Wind, even for the lack of noise, it all  tells a story• Listen to w...
THINK•   Think and Consider all you have Seen•   All you have heard•   Your Priorities•   What can be done to help the Pat...
VIOLENCE• Unfortunately people can turn violent even when  being treated by Medical Staff• Where always remain Calm yet As...
Minimising the Risk of InfectionUniversal Precautions•   Keep Cuts & Grazes Covered at all times•   Good Personal Hygiene ...
Blood & Body Fluids - Spillages• These are a potential Hazard from Infection and  may contaminate other equipment• Deal wi...
RESPONDING TO A CALLPLANNING IS ESSENTIAL :• Check: Mobiles, Pagers, Radios are Serviceable (Check for areas with poor rec...
EQUIPMENT – CHECKS (Demo)•   Personal Protective Equipment   •   Stiff Neck Collars (All Sizes)•   Identity Cards         ...
COMMUNICATING WITH PATIENTSDealing with patients who may be distressed becauseof their situation & who are suffering from ...
Behaviour – Medical Conditions• Hypoglycaemia (Low Blood Sugar) Inappropriate  behaviour, violence appearance of being dru...
PATIENT INTERACTION• Consent must be obtained from the Patient prior to  delivering any medical intervention• Approval/Con...
Language Barriers• Use Relatives or Bystanders (Avoid Breaking  Patient Confidentiality)• Allow more time so the patient c...
HAND OVER TO AMBULANCE CREW•   Any Dangers – immediate or in the future•   Patients Name•   Patients Age (Date of Birth)• ...
EXAMINATION & ASSESSMENT • Not all injuries are Obvious • History is as important as the application of   Immediate First ...
HISTORY OF THE INCIDENT • The Human body can be remarkably Resilient • As a Medic we need to understand the   possibilitie...
HISTORY OF THE INCIDENT Sudden illness • What is the main problem? (C-ABC) • What are the patients symptoms ? • Has the pa...
HISTORY OF THE INCIDENT•   Fall from Height•   Indirect pressure (Blast wave)•   Imbalance of weight (Tendon Strain)•   Wh...
MECHANISM OF INJURY• The Energy of any impact is transmitted and shared  between the bodies involved• The Energy of a Meta...
MECHANISM OF INJURY• RTC (Road Traffic Collision)      Whip Lash       Facial Injuries   Chest Compression      Fractures ...
MECHANISM OF INJURY•   Compression•   Acceleration•   Deceleration•   Low Energy•   Medium Energy•   High Energy•   Sheari...
MECHANISM OF INJURY• Body generating Opposing Directional forces
PRACTICAL ASSESSMENT• DANGER• PRIMARY SURVEY• AIRWAY• BREATHING• CIRCULATION• DISABILITY             A – ALERT            ...
Trauma Triage• Trauma triage is the prioritising of patients for  treatment or transport according to their severity of  i...
Trauma Triage • The primary survey aims to identify and   immediately treat life-threatening injuries and is   based on th...
Trauma Triage • Priority is given to patients most likely to   deteriorate clinically • Triage takes account of vital sign...
T - System • Immediate priority (T1): require immediate life-   saving intervention (Red). • Urgent priority (T2): require...
Trauma Triage• Smart Incident Command System (MIMMS)• Dead - patients who have a trauma score of 0 to 2  and are beyond he...
Sieve - Triage • Can the patient walk? (Yes): Is the patient   breathing? No/Minor Bleeding Priority 3 (Green) • Not Breat...
Fractures & Injuries     Radius       Ulna   Posterior dislocationof the radius and the ulna
Cervical/Spinal Injuries
24 Mobile vertebra in the spine & 5 Fused                                            7                                    ...
INJURY TO SPINAL CORDProtect the Patients Quality           of Life       IF IN DOUBT      Stiff Neck Collar            TE...
Incident Management Scene Management              Scene VisibilityScene management is one of the most important aspects  o...
Incident Management•   Look Behind – Front – Left & Right•   LOOK ABOVE & BELOW•   WHAT HAZARDS HAVE YOU SEEN ?•   Light u...
IMPACT ZONE       5 - 10 METRES                                   IMMEDIATE                                   BLOCK OFF   ...
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Fpos b-i

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Training now being delivered in Corby at Rubix Northampton, England

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  • First Aid – This can be requesting the person go to their GP, Hospital or Out Patients clinic, removing someone from the sun to prevent sun burn or sun stroke, first Aid is literally the first intervention anyone provides another with to prevent or aid in the prevention of illness or injury
  • Fpos b-i

    1. 1. ATLANTIAN BUSINESS SOLUTIONS FIRST PERSON ON THE SCENE F-POS BASIC 10 Hours OF TRAININGINTERMEDIATE 30 Hours OF TRAINING
    2. 2. Pre – Hospital Environment Definition: Pre – Hospital Care Any Medical Intervention or procedure given prior to arrival of the casualty in Hospital Definition: First Aid The First intervention of any person providing care to a person who has become ill through injury or illness (Including Mental Health) Definition: Paramedic Authorised person trained to provide Advanced Medical Intervention outside of a Hospital Environment (including the administration of some authorised Drugs) Definition: Hospital Care Any Medical intervention given within a Hospital environment (NHS Trust) which could be Out-Patients, In- Patients, Doctors Surgery or Out Reach Clinics (Hospitals provide Advanced Specialist Medical Treatment)
    3. 3. Role of the First Person On the Scene • To Help reduce the amount of Unnecessary deaths and complications by providing Medical Assistance prior to the arrival of Paramedics, Doctors or the Evacuation to Hospital facility • Provision of the - CHAIN OF SURVIVAL EARLY EMERGENCY SERVICE ACCESS EARLY BASIC LIFE SUPPORT EARLY DEFIBRILLATION EARLY ADVANCED LIFE SUPPORT
    4. 4. Role of the First Person On the Scene Scene Safety Danger Look Listen Think Violence
    5. 5. DANGERS• Before undertaking any Patient Assessment• Consider your own SAFETY• Consider Safety at the SCENE• Consider SAFETY - PATIENT• Consider the stability of the ENVIRONMENT The first few seconds of an incident will be confusing and dangerous for you or others Don’t become a Casualty yourself Or Endanger Others Lives
    6. 6. LOOK• Immediate dangers to yourself, patients and others (Drivers, The Public & Bystanders)• Hazards – Electricity, Water, Land Slides, Violence, Chemicals, The Environment, Vehicles and Gases• Incident – What has happened and what is about to happen• Mechanism of Injury – Fall from Height, RTC, Sharps Injury, Act of Violence, High/Low speed impact & Velocity• Position of Patient - Trapped, Lying Awkwardly, In Water, In Car, In between moving machines• How Many Patients: Is anyone missing, What are their Injuries• Triage injured C - ABC• What Assistance is already on the Scene (Police, Fire or other Trained Medic’s)
    7. 7. Listen• Use your ears – Traffic, Creaking Buildings, Wind, even for the lack of noise, it all tells a story• Listen to what bystanders or Witnesses telling you about How, when, where, who and any other possible dangers or injuries• Listen to Colleagues, Members of other Services
    8. 8. THINK• Think and Consider all you have Seen• All you have heard• Your Priorities• What can be done to help the Patients• What Additional YOU need• What was the cause of the initial injuries DON’T RUSH IN TAKE A MOMENT TO ASSESS THE SITUATION
    9. 9. VIOLENCE• Unfortunately people can turn violent even when being treated by Medical Staff• Where always remain Calm yet Assertive• Be Polite and Professional• Maintain a clear exit route whenever possible• If the Aggression becomes focused on you Leave immediately Contact your Supervisor/Police if in attendance• Use Conflict Management Skills – Rapport, Empathy and engagement to reduce the chain of frustration (Frustration – Anger – Aggression – Violence)
    10. 10. Minimising the Risk of InfectionUniversal Precautions• Keep Cuts & Grazes Covered at all times• Good Personal Hygiene (Regular Hand Washing)• Clean , Short finger nails• Wash hands Before, After and in between medical interventions or patient contacts• Wear PPE – Gloves, Eye Protection & Overalls• Dispose of Clinical Waste Appropriately (Such as bandages, Sharps and used equipment)• All re-usable Equipment must be sent for disinfecting and cleaning• Get Your immunisations up to date Tetanus & Hepatitis B (Minimum)• Wash all stained clothing at 60 degrees centigrade and separate from normal washes
    11. 11. Blood & Body Fluids - Spillages• These are a potential Hazard from Infection and may contaminate other equipment• Deal with caution – Gloves – Face Mask Etc.• Ensure their Safe Removal• Minimise the Risk of Infection to YOU & Others• Small amounts of fluids may be wiped up with paper towels or similar (Dispose in Clinical Waste bags)• If in Possession of Granules, absorbent powder, Verucidal disinfectant spray - use as per manufacturers instructions ALWAYS WEAR GLOVES WHEN DEALING WITH SPILLAGES
    12. 12. RESPONDING TO A CALLPLANNING IS ESSENTIAL :• Check: Mobiles, Pagers, Radios are Serviceable (Check for areas with poor reception on with your provider. Charged?)• Check all Medical Equipment (Spare Batteries, Inspected/Calibrated, Straps not worn, In Date, Clinically Sealed etc.)• Route Planning (Maps, Sat Nav, Weather, Accessibility & timings to RV points/Other Services, Vehicles)• Paper Trail (Medical Notes, Roma’s, Patient Forms, Incident Reports) *If it’s not written down it didn’t happen or it’s your fault*• Unless escorted you have NO EXEMPTION under the Road Traffic Act – Road Safety, Park Safely, light up the area – STAY ALIVE
    13. 13. EQUIPMENT – CHECKS (Demo)• Personal Protective Equipment • Stiff Neck Collars (All Sizes)• Identity Cards • Telford Extraction Device (TED)• Gloves • Spinal Boards (Head immobilisation)• Protective Overalls • OP Airways (Various Sizes)• Jackets • Oxygen Cylinder & Regulator• Torch • Bag Valve Mask• Pager • Oxygen Masks• Pocket Mask • Suction Equipment• Scissors/Cutting Shears• AED – (Charged) Incident Management Kit • Glow Lights/Beacons• Various Dressings • Ropes & Straps• Radio/Mobile Phones • Blankets• Maps • Police Cones• Patient Report Forms • Incident Tape
    14. 14. COMMUNICATING WITH PATIENTSDealing with patients who may be distressed becauseof their situation & who are suffering from Injuries, anillness and or Pain may be difficult to deal with; theymay be frustrated, verbally abusive, angry orviolent, invariably this is not directed at the Medic but isin fact a symptom of their situation.• Remain Calm and Professional• Speak Clearly in normal language (No Jargon)• Use Empathy & Rapport• Position yourself appropriately to the threat• Reduce the Pain (Entonox/Position/GTN)• Be truthful (Especially if a procedure hurts, Say so)
    15. 15. Behaviour – Medical Conditions• Hypoglycaemia (Low Blood Sugar) Inappropriate behaviour, violence appearance of being drunk• Stroke – Their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake and in mild cases my be frustrated and or Aggressive• Mental Health – Multiple conditions with multiple degrees of emotion, frustration, Anger or Violence• Heat Stroke (Hyperpyrexia) In severe heat stroke, they may be confused, hostile, or seemingly have intoxicated behaviour• Drugs Overdose – Varying behaviour types from passive to extreme violence and fear
    16. 16. PATIENT INTERACTION• Consent must be obtained from the Patient prior to delivering any medical intervention• Approval/Consent can be given in several ways – Verbal Consent, Non Verbal Consent and the Consent of an Authorised Carer• Where the Patient is Unconscious or in Cardiac Arrest & No Relative or Carer is present – You may commence treatment as delay could be fatal• Relatives can express a view but can NOT give LEGAL Consent• Whilst relatives cannot stop a Medic delivering care they may become aggressive if you do not stop when asked – Don’t endanger your own safety.
    17. 17. Language Barriers• Use Relatives or Bystanders (Avoid Breaking Patient Confidentiality)• Allow more time so the patient can understand• Use Non – Verbal methods to reassure them, hands, facial, Descriptive drawings• Never raise you voice in anger/frustration• Communicate information about what is happening• Make an effort to Pronounce the Patients name correctly• Find out if the Patients has any worries or concerns• Do Not maintain a Silence it may seem ignorant
    18. 18. HAND OVER TO AMBULANCE CREW• Any Dangers – immediate or in the future• Patients Name• Patients Age (Date of Birth)• Brief history of the event – Illness or Injury• Past Medical History• Allergies (Especially Anaphylaxis)• The Mechanism of Injury (Known or Suspected)• Injuries Found/Suspected• Signs & Symptoms• Any Treatment Given• Any Medication used/taken by Patient
    19. 19. EXAMINATION & ASSESSMENT • Not all injuries are Obvious • History is as important as the application of Immediate First Aid • Listening to the History prevents (?) FATAL mistakes in treatment • HISTROY can be from the: Patient, Bystander, Relative (if no one present – Visual) • Visual observation of the Patient/Scene • Listen carefully to How/When and What Happened • Always be calm, confident, Assertive and Professional
    20. 20. HISTORY OF THE INCIDENT • The Human body can be remarkably Resilient • As a Medic we need to understand the possibilities involved during impact, through the Transference of Energy • A severely damage Car is likely to have a Severely damaged person inside or outside of the Vehicle (Sometimes several metres away) • Conversely people have died or have been paralysed from falling/tripping a road kerb stone
    21. 21. HISTORY OF THE INCIDENT Sudden illness • What is the main problem? (C-ABC) • What are the patients symptoms ? • Has the patient had this before ? • Do they have Medication ? (GTN, Glucose) • When did the problem start ? (Original & New) • What changes if any since the symptoms began? • Monitor & Record – BP, B-sugars, Temperature Pulse, Respirations, Pain (0 = none 10 = unbearable) • Respond to monitored changes
    22. 22. HISTORY OF THE INCIDENT• Fall from Height• Indirect pressure (Blast wave)• Imbalance of weight (Tendon Strain)• Whiplash (Car Crash)• Sudden Impact (Hit by Object)• Gun Shot• Violence• Pressure (Crushing injury)• Insect (Bites & Stings)• Exposure (Gas, Poisons, Pathogens)• Environmental (Heat & Cold)
    23. 23. MECHANISM OF INJURY• The Energy of any impact is transmitted and shared between the bodies involved• The Energy of a Metal object strikes a human body, that energy doesn’t stop but transfers into the tissues, creating varying amounts of damage depending on the velocity, size and resistanceConsider:Type of Incident (A Fall down the Stairs)Forces Produced and Applied(Speed, Direction, Energy, Sudden Stop)Area of the body involved (Head, Body, Limbs)Nature of injuries likely to be produced (Dependent onobjects hit on the way down the stairs) , Wood, Concrete, Carpeted
    24. 24. MECHANISM OF INJURY• RTC (Road Traffic Collision) Whip Lash Facial Injuries Chest Compression Fractures Lower Limp Injuries Seat Belt Injuries
    25. 25. MECHANISM OF INJURY• Compression• Acceleration• Deceleration• Low Energy• Medium Energy• High Energy• Shearing (Change of Speed)• Stretch• Cutting• Cavitation• Thermal Injury
    26. 26. MECHANISM OF INJURY• Body generating Opposing Directional forces
    27. 27. PRACTICAL ASSESSMENT• DANGER• PRIMARY SURVEY• AIRWAY• BREATHING• CIRCULATION• DISABILITY A – ALERT V - VERBAL STIMULUS P – PAINFUL STIMULUS U – UNRESPONSIVE• MONITOR every 5 – 15 minutes
    28. 28. Trauma Triage• Trauma triage is the prioritising of patients for treatment or transport according to their severity of injury.• Primary triage is carried out at the scene of an accident• Secondary triage at the casualty clearing station at the site of a major incident.• Triage is repeated prior to transport away from the scene and again at the receiving hospital.
    29. 29. Trauma Triage • The primary survey aims to identify and immediately treat life-threatening injuries and is based on the ABCDE resuscitation system. • Airway control with stabilisation of the cervical spine. • Breathing. • Circulation (including the control of external haemorrhage) • Disability or neurological status. • Exposure or undressing of the patient while also protecting the patient from hypothermia.
    30. 30. Trauma Triage • Priority is given to patients most likely to deteriorate clinically • Triage takes account of vital signs, • Is a dynamic process and patients should be reassessed frequently. • In the UK, the T system is conventionally used at a major incident:
    31. 31. T - System • Immediate priority (T1): require immediate life- saving intervention (Red). • Urgent priority (T2): require significant intervention within two to four hours (Yellow). • Delayed priority (T3): require intervention, but not within four hours (Green). • Expectant priority (T4): treatment at an early stage would divert resources from potentially beneficial casualties, with no significant chance of a successful outcome (Blue).
    32. 32. Trauma Triage• Smart Incident Command System (MIMMS)• Dead - patients who have a trauma score of 0 to 2 and are beyond help• Immediate - patients who have a trauma score of 3 to 10 (RTS) and need immediate attention• Urgent - patients who have a trauma score of 10 or 11 and can wait for a short time before transport to definitive medical attention• Delayed - patients who have a trauma score of 12 (maximum score) and can be delayed before transport from the scene
    33. 33. Sieve - Triage • Can the patient walk? (Yes): Is the patient breathing? No/Minor Bleeding Priority 3 (Green) • Not Breathing (After opening airway)/Major Bleeding : Priority 1 (Red). • Breathing without resuscitation - What is the respiratory rate? Above 30/minute or less than 10/minute: Priority 1 (Red). • 10-30/minute: What is the pulse rate (or capillary refill time)? Less than 40 or more than 120 (or capillary refill time greater than 2 seconds): Priority 1 (Red). • Between 40 and 120 (or capillary refill time less than 2 seconds): Priority 2 (Yellow)
    34. 34. Fractures & Injuries Radius Ulna Posterior dislocationof the radius and the ulna
    35. 35. Cervical/Spinal Injuries
    36. 36. 24 Mobile vertebra in the spine & 5 Fused 7 12 5 5 Fused
    37. 37. INJURY TO SPINAL CORDProtect the Patients Quality of Life IF IN DOUBT Stiff Neck Collar TED Spinal Board Immobilisation HOSPITAL P1 (T1)
    38. 38. Incident Management Scene Management Scene VisibilityScene management is one of the most important aspects of First Aid – Never forget the stupidity of Humanity
    39. 39. Incident Management• Look Behind – Front – Left & Right• LOOK ABOVE & BELOW• WHAT HAZARDS HAVE YOU SEEN ?• Light up the Scene – HAZARD LIGHTS ON RED – BLUE - AMBER LIGHTS FLASHING• Considerations:• FIRE (Fuels, Fabrics, Toxic Gas/Materials)• SOURCES OF COLLAPSE (Loads, Trees, Mud, Water, Roofs, Vehicle Debris etc.)• SAFE - Exit & Entry Routes Patients have been thrown up to 20ft from impact Wondering injured 50 Metres plus
    40. 40. IMPACT ZONE 5 - 10 METRES IMMEDIATE BLOCK OFF 100ft Harbour AreaDiversion/HazardWarningMin 500ft 100ft

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