React Right Instructor Manual

© Concept Systems International GmbH, 2012 | Pre
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REACT RIGHT INSTRUCTOR MANUAL
Table of Contents
1. Introduction
Introduction to SSI React Right First Aid and CPR
Emergency Scuba First Aid Teaching System
Prerequisite Information
Disease Transmission Prevention
The Good Samaritan Law
Introduction to the Human Body
Course Skills and Field Reference
2. Section 1
Primary Assessment
3. Section 2
Primary Stabilization Skills and Techniques
4. Section 3
Scuba First Aid Techniques
5. Section 4
Oxygen Provider
6. Section 5
AED
7. Appendix
Appendix 1 - Vital Signs Record Forms
Appendix 2 - First Aid Supplies and Checklists
Appendix 3 - Automated External Defibrillation & Personal Protection Equipment

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Disclaimer
Thisbookisareferencefordivingmedicalemergenciesandhasbeenreviewedby
medical professionals to ensure accuracy at the time of printing. The procedures
presented in this course are for victims at least 8 years of age and are not a
substitute for professional medical treatment. While the procedures presented
in this book will be helpful in an emergency, SSI disclaims any responsibility or
liability for any loss that may occur as a result of the information contained in
this program.
This manual is part of an entire diving related educational system designed to
train divers to render emergency aid to victims of the most common first aid
scenarios encountered at a dive site.

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For this class you need
❏❏ React Right Instructor Manual and Student Manuals
❏❏ SSI React Right PowerPoint
❏❏ Managing Cardiac Arrest Skill Sheet
❏❏ Oxygen Administration Skill Sheet
❏❏ Student Tests
❏❏ First Aid
❏❏ O2
❏❏ AED
Demonstration Aids
❏❏ CPR Manikin
❏❏ Non-Rebreather masks
❏❏ Pocket Masks
❏❏ Assorted First Aid Supplies
❏❏ Roll gauze
❏❏ Pads
❏❏ Splinting supplies
❏❏ Bag Valve Mask (optional)
❏❏ Demonstration AED (if AED use will be included in the program)

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Course Overview
Objectives
After this course the student should be able to recognize and respond to scuba
related first aid situations and avoid inappropriate actions that could make a
victim’s condition worse.
Academic Review
Correct and Discuss Review Questions for each section.
Presentation
Contains the notes and prompts to assist in your presentation of the necessary
material.

© Concept Systems International GmbH, 2012 | Introduction
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Introduction
IntroductiontoSSIScubaFirstAid&CPR
Objectives
After completing this section the student should be able to identify or have an
understanding of:
1. The Cycle of Life
2. The React Right Approach
a. Assessment
b. Stabilization
c. First Aid
3. The Three R’s
1) Recognize
2) Respond
3) Restrictions
4. Immediate Response vs Delayed Response
5. Procedures
6. Prerequisite Information
a. Disease Transmission Prevention
b. Minimum Personal Protection Equipment
c. Extra Recommended Personal Protection Equipment
d. While Rendering Aid
e. After Rendering Aid
f. The Good Samaritan Law

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Academic Review
I. Presentation
A. Cycle of Life
1. First Aid and CPR Responders. The system of emergency response
includes first responders that include fire and rescue personnel,
medically trained law enforcement officers, and trained medical
responders from the medical responder, to various levels of EMT
including Basic, Intermediate, and Paramedic. It also includes
untrained first responders and trained first responders which will
include you.
2. EmergencyDispatch:Police/FireDepartment/RescueProviders/
EMS. A call to a 911 center will provide the telecommunicators with
some critical information automatically (your location and phone
number if the system is an enhanced 911) and will have professional
resources dispatched to your location within in minutes. The
telecommunicators will need to ask question to aid in that response
so a calm caller is best.
3. Hospital or Medical Facility. The ambulance coming to you will
often know the best facility to take your patient to but they need your
help in gleaning early, on scene information.
B. The React Right Approach. SSI has developed an emergency response
system to help scuba first aid providers take control of any diving related
emergency situation and deliver First Aid until emergency medical
personnel can take over. The SSI React Right Approach is simple to follow
and incorporates all of the information an SSI React Right Provider needs
to appropriately respond to an emergency comfortably, competently
and successfully.

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1. Assessment
a. Scene and scene safety
b. Availability of medical professionals
c. Activating 911
d. Primary assessment of the victim is the first step of the SSI Scuba First
Aid program.
2. Stabilization. Responders must take the appropriate action to
stabilize any life-threatening problems. Primary stabilization is the
second step of the SSI React Right program.
3. First Aid. After the victim(s) have been stabilized, situations that are
not life-threatening need to be attended to next. First aid is the third
and last step of the SSI React Right program.
C. The Three R’s. Every emergency situation is unique.
To help you determine the type of emergency, the proper actions to take and
what actions to avoid, we will always refer to the three R’s of emergency action:
Recognize, Respond and Restrict.
1. Recognize what kind of diving emergency you are dealing
with and what, if any, potential hazards are associated with the
situation.
2. Respondwiththeappropriateactionstoimproveandstabilize
the situation and victim(s).
3. Understand the restrictions in order to avoid inappropriate
and unnecessary actions that may do further harm to the
victim(s) or endanger yourself.
Remember that multiple problems may occur at the same time with the same
victim; and that responding to only one of the problems does not necessarily
mean that you are responding to all of the problems.

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D. Immediate Response vs Delayed Response
1. Local responses
2. Offshore or remote sites
3. Mass casualty
4. You should consider emergency medical response time that
exceeds 30 minutes to be delayed response.
E. Procedures. This program consists of three main sections in the course
manual and The First Responder Response Algorithm.
1. Section one addresses the skills required to complete a
thorough primary assessment.
2. Section two covers the skills required to stabilize and manage
life-threatening emergencies.
3. Section three covers the skills and techniques required to
manage injuries and illnesses that are serious, but may not be
immediate threats to life.
F. Prerequisite Information. The information that follows is important to
your safety in any emergency situation. Remember that your NUMBER 1
priority is your own safety!
G. Disease Transmission Prevention
Personal Protection Equipment greatly reduces the risk of disease transmission
and bodily injury due to environmental conditions and scene.
If you ever come in contact with a patient’s bodily fluids or are stuck with a sharp
object, stabbed, or cut report it to the responding EMS personnel immediately.
Procedures can be set in motion to test the patient and prevent the contraction
of diseases.

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H. Minimum Personal Protection Equipment. You should have the
following items available at your workplace, your home and in your
vehicle.
1. Basic first aid kit (see appendix)
2. Latex gloves (store in a water tight container in your first aid
kit)
3. Mouth to mouth shield with a one way valve (pocket mask)
4. Eye protection
5. Disposable biohazard container or bag
I. Extra Recommended Personal Protection Equipment
1. Full frontal gown
2. NIOSH-Approved HEPA Respirator to remove airborne
pathogens such as tuberculosis (TB)
3. Full face shield
4. Bag-valve-mask (BVM)
Each piece of equipment listed above is readily available and can be donned
while you assess the scene for safety. Hypo-allergenic devices are also available
if you have allergies to plastics and/or latex.
You may not always be prepared for an emergency, or have PERSONAL
PROTECTION EQUIPMENT available.
It is your decision whether or not to render aid. Common pieces of equipment
can be used as substitutes:
1. Plastic bags can be substituted as gloves or mouth-to-mouth
barriers.
2. Tightly woven clothing, such as Gortex™, can provide a barrier
for your hands and skin.
3. Sunglasses and eyeglasses can be used if protective eye wear is
unavailable.

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J. While Rendering Aid
1. Do not touch items that may be used, by you or others,
after rendering aid without your PERSONAL PROTECTION
EQUIPMENT in place.
2. Do not bend, break or replace the caps of sharp objects as this
may lead to an unnecessary injury by a contaminated object.
3. Dispose of sharp items in a rigid, unbreakable container with a
lid.
4. When cutting always do so away from your body in a fashion
that prevents spraying or fluid movement in the direction of
you or others.
5. Do not touch unprotected areas of your body.
6. Avoid touching your face and mucus membranes.
7. Replace used latex gloves with new ones when giving care to
different victims.
8. Take latex gloves off so they turn inside out as you remove
them.
K. After Rendering Aid
1. Wash your hands and skin thoroughly with an anti-bacterial
soap.
2. Dispose of all contaminated materials.
3. Use biobags/containers. Give these to EMS personnel for
examination and disposal.
4. Notify EMS if you believe you may have come in contact with
the victim’s bodily fluids.
5. Document your actions.
6. Don’t become a victim.

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L. The Good Samaritan Law (not in all parts of the world). Most U.S.
states and Canadian provinces have enacted Good Samaritan Laws.There
are some rules care providers must abide by in order to be protected by
such laws.
In order to be protected
1. Stay within your level of training.
2. Obtain permission before providing care (for unconscious
victims permission is assumed).
3. Document every action.
4. Summon professional Emergency Medical Services even when
in doubt.
5. Provide care for life-threatening problems prior to treating less
serious problems.
6. Relinquish authority to individuals with greater training than
you.
7. Provide care until professional Emergency Medical Services
arrive and take over.
IntroductiontotheHumanBody
Objectives
After completing this section the student should be able to identify or have an
understanding of the components of
• Respiratory System
• Circulatory System
• Nervous System
• Digestive System
• Urinary System
• Skeletal System
• Muscular System

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Academic Review
I. Presentation
A. Respiratory system.
1. Consisting of the airway to the lungs, the lungs, and the
diaphragm.
2. Enables the exchange of gases within the body.
B. Circulatory system
1. Consists of the heart, blood and blood vessels
2. Carries gases, nutrients and essential elements to body cells
and transports gases and waste products away from the cells
for elimination.
C. Nervous system
1. The brain, spinal cord and peripheral nerves form the nervous
system.
2. Senses and regulates body functions and controls voluntary
and involuntary activity of the body.
D. Digestive system
1. Major components are stomach, intestines, gall bladder, and
pancreas.
2. Consists of the passage through which food travels and all of
the organs that help prepare food to be absorbed and used by
the body.
3. Only organs of this system not in abdomen are the mouth and
esophagus.
E. Urinary system
1. Filters and excretes waste products from the blood.
2. The kidneys, the bladder and the urethra are the primary
components of the urinary system.

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F. Endocrine system
1. Glands that regulate body functions.
2. Hormones—chemical substances secreted by the glands.
G. Skeletal system
1. Provides a structural framework
2. Bones made of calcium
3. Protects vital organs and allows the body to move.
4. The basic components are the skull, spinal column, thorax,
pelvis, upper extremities and lower extremities.
H. Muscular system
1. Enables the body to move
2. Three types of muscle tissue
a. Voluntary
b. Involuntary
c. Cardiac
I. The Skin
1. The largest organ.
2. Protects the body.
3. Regulates body temperature, certain fluids.
4. Senses heat, cold, touch, pain, pressure.
5. Nails, hair, sweat glands and oil glands are accessory structures
to the skin.

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J. Your System in Harmony
1. In the healthy person, all of the body systems work in harmony
to support body functions and activity.
2. Nutrients and chemicals absorbed and circulated by the blood
work with oxygen absorbed into the blood from the lungs to
provide energy to tissues.
3. The nervous system sends impulses that regulate voluntary
activities such as walking and involuntary activities such as
breathing.
4. Waste products are eliminated through the lungs, digestive
tract and urinary tract.
K. Respiration in Detail
1. The human body needs oxygen to sustain life.
2. The goal of first aid is to sustain life by assisting the body with
these vital processes.
3. Immediate life threats exist whenever:
a. An adequate supply of oxygen does not reach the lungs
b. The lungs do not deliver oxygen to the blood stream
c. An injured heart does not pump blood effectively
d. Blood volume is insufficient
e. The blood vessels relax and drastically lower blood pressure
4. The airway must be clear and free of obstructions.
5. There are many causes of respiratory arrest
a. Airway obstruction resulting from choking, trauma or other causes
b. Disease
c. Near drowning
d. Suffocation

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e. Strangulation
f. Poisoning
g. Electrocution
h. Stroke
i. Heart attack
j. Severe allergic reactions.
Note: At the 2002 World Congress on Drowning, it was decided to discard the terms near
drowning and all other secondary terms used to describe a person who has received a
respiratory impairment as a result of submersion in liquid. Moving forward it is likely that
this will be standard within the emergency medical community, however, at this time many
professionals still prefer the term “near drowning” when describing a person who suffers
a respiratory insult or impairment as a result of submersion in liquid but does not suffer
complete respiratory arrest or cardiac arrest and this is the definition that SSI has chosen
for use in this text.
A. Circulatory System
There is much discussion in the first aid community about the dramatic changes
that have taken place in CPR training over the past few years. There is also much
misinformation. Here are the issues for discussion. It is fairly well established
that most adults that suffer from sudden and unexplained collapse are generally
the victim of some form of heart related problems, research shows that most
of these suffer from ventricular fibrillation or pulseless ventricular tachycardia
(reported statistics put this percentage as high as 85%). Research also seems to
indicate that for these individuals compression only CPR may be more effective
than traditional compressions coupled with rescue breathing. This increased
effectiveness is reported to be due to several factors including:
1. The willingness of a trained rescuer to attempt rendering aid.
The risk of possible disease transmission and other social factors
make many rescuers resistant to providing rescue breaths, especially
to strangers.
2. The complexity of the shifts from breathing to compressions
may cause many trained lay rescuers to delay compressions too
long during the breathing cycle.
3. The compressions themselves may serve to exchange some
air in the lungs from the compression and expansion of the
chest cavity providing that the victims airway is in no way
compromised.

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The problem for divers is that the compressions only model (CABC model) is
not recommended for any victim with a potentially compromised airway, for
situations where EMS response time is likely to require CPR to continue for
more than 5 to 6 minutes or for children. The definition of child is extremely
variable with global agencies, with the age range defined as anyone under 8 by
at least one agency and as old as 17 by another agency. Common conditions
that can compromise the victims airway include: drowning, near drowning,
certain poisonings (including some drug overdoses), some medical conditions
such as severe asthma and a number of other conditions. Under any of these
last conditions the published data and recommendations indicate that the
compressions only method, while better than nothing at all will not be nearly as
effective at sustaining the victim’s life until EMS level support arrives.
Theproblemfordiverspreparingfordivingemergenciesisthatwearemorelikely
to encounter victims with a compromised airway (drowning, near drowning,
pulmonary embolisms, etc) while we are diving than any other scenario. So while
it makes sense to train the average person to respond to 85% of the problems
they are likely to encounter, it is also true that divers are more likely to encounter
the other 15% while they are diving and must be trained for those scenarios. As
a result the React Right Materials will address two methods of CPR the CABC or
compressions only method to be used when the victim has not encountered a
fluid filled environment, has limited probability of having a compromised airway
and will likely have an EMS response within the 5 minute window once CPR
starts and the traditional ABC method that includes rescue breathing as a part of
the scenario. Since this course is oriented specifically for divers we will cover the
more complex ABC method first.
Trauma or heart attack can physically damage the heart. When
the heart does not pump effectively, blood pressure decreases and less
oxygen reaches body tissues.
a. The result is a form of shock which is inadequate circulation in vital
organs.
b. Heart, brain and nerve tissues can survive only a few minutes without
oxygen and the result is clinical death.
c. Rescue breathing provides oxygen in the lungs for the blood to
absorb.
d. Chest compressions manually squeeze the heart and artificially
circulate the blood at about 25% of normal circulation.

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e. For short durations and on victims without a compromised airway
chest compressions alone can be as effective as CPR coupled with
rescue breathing. This is not true for drowning, near drowning and
other airway obstruction victims.
f. The combination of rescue breathing and chest compressions, called
cardiopulmonary resuscitation (CPR), can save the life of a victim in
cardiac arrest.
B. Nervous System
1. Severe blood loss causes shock — inadequate circulation in
vital organs.
2. A lack of oxygen to the brain causes tissue death in brain tissue
within minutes.
3. The brain regulates nerves and muscles in the blood vessels to
control blood pressure.
4. Damage to spinal tissue may damage nerves which transmit
the impulses that control breathing.
C. The Role of First Aid
1. First aid helps because it assists the body in its job of delivering
oxygen to the cells.
2. Emergency medical care helps with more advanced support
that increases the oxygenation of the body.
3. Medicaltreatmenthelpsrestorethebodytoitsnormalfunction.
4. Your actions as a first aid provider can save lives. Remember that
your goal is to assist the body in delivering oxygen.
D. Injury Effects on Body Systems
A serious injury, such as a severe burn, can affect many body systems. Damage
to the skin can allow germs to enter the body, fluids to escape and nerves to
be destroyed. Tissue swelling can cut off circulation. Fluid loss can cause life
threatening shock and chemical imbalances. Burns to the airway and/or chest
can affect breathing. Vital organs may be affected. The relationships between
body systems, when a person is injured or ill are important because they affect
the care that a victim should receive.

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There is a key relationship between the brain, the heart and the blood vessels.
1. The brain senses and regulates the pressure within the
circulatory system.
2. Regulation occurs by controlling the rate at which the heart
beats (cardiac output) and the size of the blood vessels through
which the blood is pumped (peripheral resistance).
3. Fluid loss (such as bleeding), pump damage (injured heart), or
blood vessel enlargement (relaxation of vessels from allergic
reaction, spinal cord injury or chemical substances) can
produce a condition of inadequate circulation to body organs.
This condition is called shock and can lead to death.
4. When the brain senses inadequate circulation, it compensates
by increasing the heart rate and reducing the size of the
peripheral blood vessels.
5. Compensationisasurvivalmechanismthatcirculatestheblood
only to the most vital organs
6. Prompt first aid for shock, to reduce its effects and rapid
transport to a medical facility, is essential to prevent the severe
complications that shock can produce.
7. Temperature extremes, chemicals, extreme pressure (crushing
or breaking), impact (bruising and rupturing organs),
penetrating objects, etc., can adversely affect vital body systems.
8. First aid for shock optimizes circulation in vital organs, helps
victims of minor shock recover and helps victims of severe
shock survive longer.

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Review and Questions
Introduction
1. What are the 3 components in the cycle of life?
P9 – First Aid and CPR Responders; Emergency Dispatch: Police/Fire Department/
Rescue Providers/EMS; Hospital or Medical Facility
2. What are the 3 Rs for the first responder?
P10 – Recognize, Respond and Restrict
3. What constitutes a delayed response?
P11 – a response time longer than 30 minutes
4. What are the three main components of the respiratory system?
P18 – the airway to the lungs, the lungs, and the diaphragm
5. What are the 3 components of the circulatory system?
P18 – Heart, Blood and Blood Vessels

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© Concept Systems International GmbH, 2012 | Section 1 - Primary Assessment
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Section 1
PrimaryAssessment
Objectives
After completing this section the student should have an understanding of the
following:
• Assessing The Scene
• Protecting Yourself and the Victim
• Summoning EMS
• Primary Assessment
• Assessing the Unconscious Victim
• Assessing the Conscious Victim
• Moving a Victim
• Positioning and Handling a Victim
• Vital Signs
• Multiple Victims
• Putting It All Together
Academic Review
I. Presentation
Assessing The Scene
Recognition
Signals of a medical emergency may include:
▲▲ Screaming, yelling or calls for help
▲▲ Diver in distress
▲▲ Diver missing

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▲▲ Fire, smoke or unusual odors
▲▲ A motor vehicle or boating accident
▲▲ Explosions or other loud noises
▲▲ Injury suspicion based on other events
Response
A. Initial actions: Pause 10 seconds before taking action and survey
the scene to determine:
1. If it is safe to approach the victim. If not, remain at a safe distance,
reassure victim, and summon emergency medical assistance.
2. The number of victims.
3. The cause of the injury or the nature of the illness.
4. The need for spinal immobilization.
5. Available resources: assistants, first aid equipment and nearest
telephone.
B. Follow-up actions:
1. Remain as calm as possible, speak in a firm voice and avoid
yelling.
2. Ask if bystanders know the victim or what happened.
3. Ask if any bystanders have medical training.
4. Delegate responsibilities specifically instead of generally.
5. Don protective equipment before touching the victim.
6. Relinquish responsibility to those who have a higher level of
training than you.
Restrictions
Do not allow bystanders to move an injured victim except when the
victim’s safety would be jeopardized if not moved.
Avoid remaining at the scene if the victim or bystanders are violent or
agitated. Summon law enforcement for these situations.

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Protecting Yourself And Victim Recognition
Examples of potential hazards include:
▲▲ Unstable structures or vehicles
▲▲ Fire, smoke or unusual odors
▲▲ Electrical wires
▲▲ Boating Traffic
▲▲ Back injuries from lifting and moving a victim
▲▲ Hazardous materials
▲▲ Violence or weapons
▲▲ Blood or other bodily fluids
▲▲ Legal liability
Response
A. Protect yourself against injury from hazards at the scene.
1. Survey the scene for potential hazards.
2. Minimize hazards as much as possible.
3. Approach the victim only if you will not jeopardize your safety.
4. If conditions are unsafe, remain at a distance, reassure the
victim and summon emergency assistance.
B. Protect the victim from further injury.
1. Determine if there is a need to move the victim out of danger
2. Protect yourself against legal liability
3. Obtain permission to help.
4. You do not need a conscious victim’s consent to summon
emergency medical assistance and you do not need consent to
provide first aid if a victim is unconscious.

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C. Protect yourself against diseases.
1. Wash your hands as soon as possible after providing first aid.
D. Protect the victim’s spine.
Restrictions
Do not enter or approach the scene without assessing potential
hazards.
Avoid acting hastily and failing to protect yourself or the victim.
Do not attempt to move power lines using branches, boards or other
extensions.
Avoidenteringaburningstructureorareasofavessel,whichprobably
contains fumes that are highly toxic.
Avoid eating, drinking, applying cosmetics or handling contact lenses
any time after handling a victim. There may be potential infectious
agents on your hands from a victim’s bodily fluids.
Remember
▲▲ You cannot help a person in distress if you become a victim yourself.
▲▲ Movingavictimwhenthereisnoneedmayresultininjuryandcouldhavelegalconsequences.
▲▲ Diseases can be contracted through breaks or tears in the skin or by touching contaminated
surfaces and transferring the infectious agents to mucous membranes of your body.
▲▲ Use protective equipment and wash your hands and all exposed skin as soon as possible
after providing care.

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Summoning Emergency Medical Services (EMS)
Emergency medical services / Coast Guard phone numbers and contact
information vary from country to country. It is the responsibility of the caregiver
to be familiar with the local emergency contact information in the event of an
emergency situation.
Recognition
IfyouhaveanydoubtabouttheneedtosummonEMS,doit!SummonEmergency
Medical Services (EMS) when a victim has:
▲▲ Breathing difficulty
▲▲ Drowning or near drowning
▲▲ Chest pain or pressure for more than a few minutes
▲▲ Severe abdominal pain
▲▲ Severe bleeding
▲▲ Lost consciousness
▲▲ Signals of an allergic reaction
▲▲ Signals of shock
▲▲ An abnormal mental status
▲▲ Suspected poisoning
▲▲ Possible broken bones
▲▲ Severe burns
Response
A. The Initial Sequence on a Scene.
1. Summoning EMS is the first step.
(Exceptions: Do one minute of CPR before phoning if the victim has nearly drowned, or is
known to have ingested poison or if they have overdosed on a drug.)
2. Identify yourself and your first aid qualifications.
3. Get permission if the victim is conscious.
4. If you take charge, designate a specific person to phone or

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contact EMS.
5. If you are alone, and the victim is unconscious and has no
spinal injury, place the victim in the recovery position, phone
EMS, return to the victim and provide first aid until emergency
medical personnel arrive.
6. Use the best available phone.
7. Tell the dispatcher your name, exact location, the problem, the
victim’s condition, the number of victims and what care the
victim is receiving.
8. Answer the dispatcher’s questions and talk calmly.
9. Have a person meet the emergency vehicles and lead the
emergency medical personnel directly to the victim.
Restrictions
Avoid saying, “Somebody call 911. Be clear in your instructions to
bystanders.
Avoid yelling at the dispatcher.
Primary Assessment
The purpose of a primary assessment is to identify problems that can cause
death in a matter of minutes.
A mental picture of the flow of procedures for a primary assessment will help
you recall what to do. (Refer to the First Responder Response Algorithm in the
Appendix)
No time for refresher in an emergency. You must be able to perform the skills.
Practice them often.
Recognition
▲▲ Your first priority is to assess the scene
▲▲ What happened?
▲▲ How many victims

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▲▲ Is it safe to approach the victim(s?)
▲▲ The nature of the injury or illness
▲▲ The resources available.
▲▲ Assess responsiveness
▲▲ Airway condition
▲▲ Breathing
▲▲ Pulse
▲▲ Bleeding
▲▲ Identify problems which are not immediate threats to life, but are serious and require
medical attention.
▲▲ Asecondarysurveyconsistsofahead-to-toephysicalassessmentandinformationgathering.
▲▲ It is important to obtain and record baseline vital signs initially and to re-evaluate and record
vital signs periodically until EMS personnel arrive.
▲▲ Do not allow bystanders to move an injured victim except when the victim’s safety would be
jeopardized if not moved.
Response
A. Initial actions: Pause 10 seconds before taking action and survey
the scene to determine:
1. If it is safe to approach the victim. If not, remain at a safe distance,
reassure victim, and summon emergency medical assistance.
2. The number of victims.
3. The cause of the injury or the nature of the illness.
4. The need for spinal immobilization.
5. Available resources
a. Assistants
b. First aid equipment
c. Nearest telephone.
6. An emergency action plan (see appendix).

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Follow-up actions
1. Remain as calm as possible, speak in a firm voice and avoid
yelling.
2. Ask if bystanders know the victim or what happened.
3. Ask if any bystanders have medical training.
4. Delegate responsibilities specifically instead of generally.
5. Don protective equipment before touching the victim.
6. Relinquish responsibility to those who have a higher level of
training than you.
Restrictions
Do not allow bystanders to move an injured victim except when the
victim’s safety would be jeopardized if not moved.
Avoid remaining at the scene if the victim or bystanders are violent or
agitated; summon law enforcement for these situations.
Rationale
▲▲ A First Aid Provider is of no value if he or she also becomes a victim.
▲▲ Safety is essential for both the provider and the victim.
▲▲ Clues from the scene and from bystanders can provide valuable information that affect first
aid procedures.
▲▲ One of the provider’s objectives is to bring order to a situation that usually is chaotic.
▲▲ Formulating a quick plan of action and acting calmly helps achieve the objective.
▲▲ Moving the victim, unless absolutely necessary, may cause permanent injury from spinal
cord damage.

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Assessing The Unconscious Victim
Recognition
▲▲ The victim appears to be unconscious and unresponsive.
Response
A. Tap the victim’s shoulder and shout,“Are you OK?”
B. If no response – assume permission.
C. Open the victim’s airway using a jaw-thrust maneuver.
Scuba related victims rarely have spinal injury, if no spinal injury is suspected, use head-tilt,
chin-lift technique.
D. If you suspect drowning, near drowning or airway compromise,
look, listen and feel for breathing for 5 to 10 seconds. For all other
victims move to the next step.
NOTE:Youwillneedtoclarifythisstepindetailforyourstudentstodispelthemisinformation
they will probably be exposed to regard CABC for everyone.
E. Check for a pulse.
For a drowning or near-drowning victim use the mnemonic ABC to help remember the
sequence: Airway, Breathing and Circulation. For other accidents use the mnemonic CABC,
Circulation, Airway, Breathing, and Circulation.)
F. Check for catastrophic bleeding. Controlling severe bleeding is one of
the highest medical priorities.
Follow-up actions
G. If there is time before emergency medical personnel arrive, keep
the victim still, expose all injured areas and assess the victim from
head to toe.
H. Use the mnemonic LAF4SWAT to help remember the sequence:
(Look And Feel for Swelling, Wounds, Abnormalities and
Tenderness.)
I. Look for medical alert bracelets or necklaces.
J. Assess pulses, motor function, and sensation in the extremities.
K. Physical Examination, ask:

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1. If the victim had any signs or symptoms before going
unconscious.
2. If the victim has any allergies.
3. If the victim takes any medications. If so, have someone locate the
medications and have them available for medical personnel when
they arrive.
4. If the victim has any pertinent medical history.
5. When and what the victim last ate and drank.
6. What events preceded the medical emergency?
L. The mnemonic SAMPLE
(Note: Use the mnemonic SAMPLE to help remember the questions to ask the victim:Signs,
Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events
preceding.)
M. No spinal injury – recovery position.
N. Spinal injury suspected, keep the victim in the position that you
found him or her and immobilize the victim’s head in a neutral
position.
O. Do not attempt to give any food or drink to an unconscious victim.
P. Begin Oxygen Administration as soon as possible.
Q. Look at and feel the skin.

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Assessing The Conscious Victim
Note: a person who is conscious and talking is breathing and will have a pulse but is not
necessarily stable.
Recognition
Signals that indicate a medical emergency may include:
▲▲ Unusual skin color or moisture
▲▲ Unusual vision or speech
▲▲ Clutching part of the body
▲▲ Weakness, numbness or paralysis
▲▲ Persistent pain or pressure in the body
▲▲ Visible physical injuries
▲▲ Abnormal behavior
Response
A. Obtain permission to help the victim.
B. Ask the victim to remain still and ask what happened.
C. A clear and open airway. Look in the mouth for swelling, blood, vomit,
soot or other material that might indicate a problem.
D. Assess the breathing effort.
E. Assess the pulse. Note its rate and quality.
F. Controlling severe bleeding is one of the highest medical
priorities.
G. Look at and feel the skin.
H. Check mental status.

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Follow-Up Actions
I. If there is time before emergency medical personnel arrive, keep
the victim still, expose all injured areas and assess the victim from
head to toe.
Use the mnemonic LAF4SWAT to help remember the sequence: Look And Feel for Swelling,
Wounds, Abnormalities and Tenderness.)
J. Look for medical alert bracelets or necklaces
K. Assess the hands and feet for:
1. Feeling
2. Movement ability
3. Strength (Have victim squeeze your hands and move his or her
feet.)
L. Use the mnemonic SAMPLE.
(Note: Use the mnemonic SAMPLE to help remember the questions to ask the victim:
Signs, Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events
preceding.)
M. No visible injuries, ask:
1. If the problem started gradually or suddenly
2. If anything, such as movement or deep breathing, makes the
problem worse
3. What the pain is like. Is it dull or sharp? Is it mild or severe?
4. Rate the pain. (On a 10 scale is it low – near 1 – or high – near 10)
5. Where is it located? Does the pain extend anywhere else?
6. The time that the difficulty began

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Restrictions
Avoid having a victim, with breathing difficulty or a head injury, lie
down. Sitting up slightly reclined is best, but listen to your patient.
Do not postpone the summoning of medical assistance when there are
signals of a serious medical problem, even when the victim denies
the problem and tells you not to call.
Never give medications to a victim when the medications are not
prescribed to that person.
Avoid moving victims any more than is absolutely necessary.
Rationale
▲▲ Your initial actions help identify life-threatening problems.
▲▲ Your follow-up actions help identify problems which may not be threats to life immediately,
but which may become life threatening. By using all of your senses, you can detect problems.
▲▲ Using the mnemonic LAF4SWAT helps you remember the correct assessment sequence. Use
the mnemonic SAMPLE helps you remember questions to ask the victim.
▲▲ Obtaining medical assistance when you have any doubt about a victim’s condition may save
the person’s life, while delaying medical assistance may have tragic consequences.
Moving The Victim
Recognition
Situations where it is appropriate to move a victim include:
▲▲ Immediate danger to the victim and rescuers (traffic, hazardous materials, etc.)
▲▲ Inability to provide essential care without moving the victim
▲▲ Removing a victim from harsh environmental conditions
▲▲ Gaining access to additional victims with life-threatening conditions
▲▲ Transporting a victim to a medical facility from a remote area

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Response
A. Tell the victim your plan before moving him or her.
B. If you must move a victim away from danger, keep the victim’s neck
and spine in a straight line to protect the spine.
C. If you must lift and carry the victim, get assistance whenever
possible.
D. If you must transport a victim to a medical facility from a remote
area, immobilize all injured body parts before and during
movement.
E. If possible practice the move using another person who is about
the same size as the victim.
F. Good lifting technique
G. Use an improvised stretcher whenever possible.
H. When rolling the victim onto his or her side, check the victim’s back
for injuries now, position the stretcher beneath the victim and roll
the victim onto the stretcher.
I. Spinal injuries, or possible spinal injuries, require special
techniques.
Positioning And Handling The Victim
Recognition
Factors that affect positioning include:
▲▲ Vomiting
▲▲ Loss of consciousness
▲▲ Fluids in the airway
▲▲ Respiratory or cardiac arrest
▲▲ High body temperature

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▲▲ Possible head, neck or back injury
▲▲ Poisoning
▲▲ Bleeding
▲▲ Bone and joint injuries
▲▲ Shock
▲▲ Childbirth
▲▲ Chest or abdominal injuries
▲▲ Venomous bites and stings
Response
A. Spinal immobilization is the number one factor affecting
positioning and handling.
B. Whenever possible, keep the victim in the position in which you
found him or her.
C. Positioning the victim on a firm surface for CPR to be effective.
D. Handle victims gently.
E. Tell the victim what you intend to do before you change his or her
position.
F. The recovery position.
G. If the victim has difficulty breathing, elevate the victim’s head and
shoulders.
H. If the victim has a head injury without signs of shock, or has signals
of heat stroke, place the victim in a semi-reclining position.
I. If the victim has a chest or rib injury, or numbness, weakness, and/
orparalysisononesideofthebody,positionthevictimhorizontally
on their back and protect the injured side.
J. Elevate wounds to help control bleeding.
K. Position snake bites and insect stings below heart level.

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L. Nosebleeds should sit down and lean forward.
M. When splinting suspected fractures, immobilize the joints above
and below the site of the injury.
Restrictions
Avoid elevating fractures, sprains and dislocations that are not
immobilized.
Avoid elevating the feet and legs of a victim who has any severe
injuries.
Do not omit treatment for shock when a severely injured person says
that he or she is OK.
Avoid changing the position of an injured limb or a part of the limb.
Avoid movements that twist the torso or a limb.
Vital Signs
Priority
Takeandrecordvitalsignsonlyaftercompletingtheinitialassessment,stabilizing
the victim and completing the physical exam. Record all vital signs on the Vital
Signs Record pages supplied in the appendix.
Components
A. Respiration rate and quality
B. Pulse rate and quality
C. Skin conditions
D. Eye conditions

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Taking & Recording Vital Signs
Evaluate breathing
A. Look for chest to rise and fall evenly.
B. Listen for breath sounds.
C. Feel for breathing.
D. Time respirations. Normal respiration is 10 to 30 breaths per minute.
E. Record your findings and the time.
Evaluate pulse
A. Assess the pulse on the victim’s wrist.
B. Time the pulse rate.
C. Determine the quality of the pulse.
D. Record your findings and the time.
Evaluate eyes
A. Are the pupils equal in size?
B. Do the pupils react equally to light?
C. Record skin conditions, color, temperature and moisture and the
time.
D. Re-evaluate and record vital signs about every 5 minutes until
emergency medical personnel arrive. Give your vital signs and patient
history information to the medical personnel.
Remember
▲▲ Take and record vital signs only after the victim has been stabilized and is in no further
danger.

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Multiple Victims
Recognition
Be alert for:
▲▲ Multiple visible victims
▲▲ Clues that indicate additional victims (clothing, purse)
▲▲ Information from victims and bystanders
Response
A. Summon emergency medical personnel immediately and report
the number of victims.
B. Realize that you may not be able to save or assist everyone.
C. Don’t develop tunnel vision. Be aware of your safety.
D. Delegate responsibilities to bystanders when possible.
E. Ask all victims who are able to walk to move to a designated area.
F. Rapidly assess all remaining victims. Assess unconscious victims for
breathing, pulse and indications of circulation.
G. If victims are not breathing, are breathing faster than 1 breath per
second, or lack indications of circulation, do not provide first aid
unless you have assistants who can attend to the victims.
H. Provide first aid to incapacitated victims who are breathing
adequately, are bleeding severely and/or have signals of shock.
I. Broken bones and minor wounds are low priorities at a multiple-
victim incident.
J. Reporttheconditionofthevictimstoemergencymedicalpersonnel
when they arrive.

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Follow-Up Actions
K. Be aware that you may experience stress following a multiple-
victim incident.
L. Do your best to avoid feelings of guilt for not being able to help
everyone.
M. Contact your local public service people and make arrangements
to attend a Critical Incident Stress Debriefing (CISD) if available.
N. Avoid providing first aid to one victim before you have assessed all
of them.
O. Do not remove victims from vehicles when there are no threats to
the victims.
P. Your safety is the first priority.
Restrictions
Be aware of potential hazards at the scene of a multiple-victim
incident.
Avoid providing first aid to one victim before you have assessed all of
them.
Do not remove victims from vehicles when there are no threats to the
victims.
Avoid entering a burning structure.
Avoid attempting to shut off utilities.
Do not attempt to move power lines.
remember
▲▲ Check the ABCs (for suspected drowning or near drowning victims) or the CABCs (for any
other victims) on everyone before helping anyone.
▲▲ Do the most good for as many as possible.
▲▲ You may not be able to save everyone when there are multiple casualties.
▲▲ Your safety is the first priority.

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Putting It All Together
Recognition
▲▲ Keep in mind that signals of a medical emergency often stem from suspicion based on what
you find at a scene.
▲▲ Be able to identify all of the 13 emergency medical conditions.
▲▲ Be able to identify the 8 signals that indicate a medical emergency for a conscious victim.
▲▲ Be familiar with the factors of positioning a victim.
▲▲ Be able to identify clues that may indicate multiple victims.
Response
A. Pause for a few seconds to evaluate a scene and formulate a plan
of action.
B. Protect the victim from further harm, especially spinal cord
injuries. Know when and how to move a victim.
C. Protect yourself from physical harm, diseases and legal
consequences.
D. Remain calm and help bring order to a situation that tends to
produce chaos.
E. Involve and question bystanders.
F. Know when to take charge and when to relinquish authority.
G. Know how to summon EMS and how to instruct someone to call for
help.
H. After summoning help for an unconscious victim, always begin
assessment with the ABCs (Airway, Breathing, and Circulation for
drowning or near drowning victims) or CABC for all other victims.
I. When assessing a conscious person, determine mental status and
the chief complaint while assessing the ABCs or CABCs
J. If there are no immediate threats to life, examine the victim from
head to toe for injuries.
K. Always expose injured areas.

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L. Do your best to obtain a detailed medical history of the victim.
M. Know when and how to obtain vital signs.
N. Know when and how to use the recovery position and a log roll.
O. Be able to determine the priority for care when there are multiple
victims.
Restrictions
Move victims only when it is absolutely necessary and avoid rough
handling.
Avoid endangering yourself unnecessarily.
Avoid giving food or drink to injured individuals.
Avoid having victims with head injuries or breathing difficulty lie
down.
Avoid giving un-prescribed medications to a victim.
Avoid omitting treatment for shock when an injured person says he or
she is OK.
Avoid providing first aid to a victim until you have assessed all of the
victims at a scene.

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Review And Questions
Section 1
1. What is the first step in the primary response?
P26 – Protect Yourself
2. State the purpose of the primary assessment.
P26 – The purpose of a primary assessment is to identify problems that can cause
death in a matter of minutes
3. What is your primary responsibility when you approach a victim?
P32 – When you approach a victim, you must protect the person from further injury
— especially spinal cord injury
4. Once you determine that oxygen may assist a victim when should it
be administered?
P33 – As soon as practical, once you have determined there is a need for medical
Oxygen you should begin administration.
5. What is the first step in assessing an unconscious victim?
P36 – check for responsiveness – shout“Are you OK”and if necessary make physical
contact

© Concept Systems International GmbH, 2012 | Section 2 - Primary Stabilization Skills and Techniques
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Section 2
CardiopulmonaryResuscitation
PrimaryStabilizationSkillsandTechniques
Objectives
After completing this section the student should have an understanding of the
following:
• Introduction: Respiration
• Rescue Breathing
• Cardiopulmonary Resuscitation (CPR)
• Shock
• Bleeding — Internal and External
Academic Review
I. Presentation
Airway Obstruction
Recognition
1. Signals of an airway obstruction in a conscious, adult victim
include:
a. Coughing
b. Clutching the throat with one or both hands
c. Inability to speak or breathe
d. Bluish skin color
e. Loss of consciousness

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2. Signals of airway obstruction in an unconscious, adult victim
include:
a. Absence of breathing
b. Inability to get rescue breaths to cause the victims chest to rise and
fall (after re-tilting the head).
REsponse
A. For a conscious, choking and coughing adult victim:
1. Encourage the victim to cough.
2. Encourage the victim to inhale as much as possible to make
coughs more effective.
B. For a conscious, choking adult victim who can not cough, speak or
breathe:
1. Confirm that the victim is choking (the victim can nod).
2. Summon emergency medical assistance immediately.
3. Obtain permission to provide assistance (the victim can nod
consent).
4. The Heimlich Maneuver.
C. For an unconscious, adult victim with an obstructed airway:
1. Inspect the victim’s mouth for foreign objects or fluids.
2. Assess breathing and summon medical assistance.
3. Describe rescue breathing.
4. The Heimlich Maneuver.
5. The recovery position.
6. Beginning CPR.

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Restrictions
Avoid slapping a choking person on the back.
Avoid blind sweeps.
Avoid allowing a victim to lose consciousness and fall unattended.
Remember
▲▲ An airway emergency is the number one medical priority.
Rescue Breathing
Recognition
Signals that indicate rescue breathing may be needed include:
▲▲ Unconsciousness
▲▲ Bluish skin on the lips, ear lobes, cheeks, fingers or toes
▲▲ Absence of breath sounds and chest movement
Response
A. Check the victim for responsiveness.
B. If you suspect a head or neck injury, open the victim’s airway using
the jaw-thrust maneuver. Do not tilt the victim’s head!
C. Ifyoudonotsuspectaheadorneckinjury,openthevictim’sairway
using the head-tilt, chin-lift maneuver.
D. Look, Listen, Feel.
E. The Rescue Breathing Process
F. If a pulse and indications of circulation are absent, begin CPR.
G. Aspiration of fluids, suctioning and patient rolling.
H. When the victim resumes independent breathing, place him or her
in the recovery position unless you suspect a spinal injury.
I. Taking care of breathing and circulation may be all that you can do
until help arrives.

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Restrictions
Avoid lifting the victim’s neck to open the airway.
Avoid pushing on the soft part of the chin or neck.
Try not to exhale too much air into the victim. Stop when the chest rises gently.
Do not give breaths when the victim is making gurgling sounds.
Do not depress a distended abdomen in an effort to force air out of the
stomach.
remember
▲▲ A - Open the Airway
▲▲ B - Assess Breathing
▲▲ C - Assess Circulation
▲▲ Give 1 breath every 5 seconds (after the 2 initial breaths)
▲▲ Reassess pulse and breathing every minute (12 breaths)
▲▲ Keep the airway clear
▲▲ Taking care of breathing and circulation may be all that you can do until help arrives.
CPR (Cardiopulmonary Resuscitation)
Recognition
For CPR, an adult is a person over 8 years of age. Signals that indicate CPR may
be needed include:
▲▲ Pale, gray skin color
▲▲ Absence of a pulse and indications of circulation (breathing, coughing or movement)
Reference the student manual and discuss:

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Response 1
Forpotentialdrowning,neardrowningandothersuspectedairwaycompromises
or delayed EMS response.
A. Determine the possibility of a spinal injury
B. Assess the victim and determine lack of breathing
C. If the two breaths caused the chest to rise and fall, assess the victim
for a pulse and indications of circulation for ten seconds.
D. If the first breath does not cause the chest to rise and fall, adjust
the victim’s airway and attempt another rescue breath.
E. If the victim lacks a pulse and indications of circulation, start CPR
F. One rescuer CPR, compress the chest at least 2 inches and at a rate
of 100 - 120 compressions per minute, give two breaths watching
the chest for movement. Repeat until help arrives or you are too tired
to continue.
G. Two rescuer CPR, divide the care, one rescuer will do chest 30
compressions and count them aloud, and the second rescuer
will give two rescue breathes immediately following the 30th
compression.
H. If the victim regains a pulse or indications of circulation and
resumes breathing, place the victim in the recovery position and
monitor the person closely until emergency medical personnel
arrive.
Response 2
To be used when there is no indication of airway compromise and professional
EMS is not likely to be delayed in responding.
A. Determine the possibility of a spinal injury
B. Open airway correctly
C. Assess the victim’s breathing. If needed initiate rescue breathing. See
the information in the preceding sections on Rescue breathing.
D. Discuss adequate pulses rates

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E. Rate of Compressions (rate of 100 - 120 per minute)
F. Proper technique
G. One rescuer CPR
H. Two-rescuer CPR
Restrictions
Avoid beginning CPR before confirming the absence of a pulse for at
least 10 full seconds.
Avoid compressing the chest too forcefully or too lightly. Depress the
chest of an adult victim at least 2 inches. (for children about 1/3 of the
victim’s body thickness)
Donotbounceoffthechestduringcompressions,remainingincontact
lightly with the chest at the top.
Avoid a pause of more than one second while giving rescue breaths
during chest compressions (2-rescuer CPR).
remember
▲▲ Check carefully for a pulse for 10 seconds before starting CPR.
▲▲ Reassess pulse and breathing after 2 minutes of compressions.
▲▲ If the victim does not regain a pulse after the first 2 minutes continue until medical
professionals arrived or until you are unable to continue.
▲▲ The compressions-to-breaths ratio is 30:2 for 2 rescuers but the rate of compressions is still
100 to 120 per minute.
▲▲ The rate of compressions in either response 1 or response 2 is 100 to 120 compressions per
minute.

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Shock
Recognition
Early signals of shock, which can become life threatening and must be treated,
include:
▲▲ Abnormal behavior (restless, irritable, anxious)
▲▲ Pale, cool, moist skin
▲▲ Nausea with possible vomiting
▲▲ Weak, rapid pulse
▲▲ Rapid breathing
Late signals of shock that has reached a critical stage include:
▲▲ Extreme thirst
▲▲ Dull, glazed eyes with dilated pupils
▲▲ Bluish skin
▲▲ Loss of consciousness
Response
A. Initial Actions:
1. Comfort and reassure the victim.
2. Control severe bleeding.
3. Handle the victim gently.
4. Helpthevictimliedownunlessheorshehasanyofthefollowing
problems: difficulty breathing, head, neck or back injury.
5. Elevatethevictim’slegsabout10inchesunlessheorshehasany
of the following problems: chest injury, back injury, abdominal
injury, pelvic injury or broken leg.
6. Insulate the victim from the ground and then from the air.
Maintain a normal body temperature. Your goal is to prevent the
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B. Alternate Actions:
1. If the victim has a head injury or difficulty breathing, place him
or her in a semi-reclining position.
2. Ifthevictimisunconsciousandbreathingandyoudonotsuspect
a spinal injury, place the person in the recovery position.
3. If you suspect an injury to the neck or back, do not move the
victim unless absolutely necessary and do not elevate the legs.
4. If the victim is pregnant, place her on her left side or tilt her to
the left and raise her feet.
C. For Delayed Response:
1. If medical care will be delayed an hour or more, allow conscious
victims, who are not nauseous and can swallow, to drink small
sips of water.
Restrictions
Avoid allowing the victim to eat, drink or smoke (see Delayed
Response).
Avoid making negative statements about the victim’s condition.
Avoid raising the feet only or raising the feet and legs more than 12
inches.
Do not incline the entire body—raise the feet and legs only.

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Putting It All Together
Recognition
Be able to rapidly identify the signs of an airway obstruction.
Be able to identify the signals of shock listed on page 2-9.
Response
1. Useabdominalorchestthruststocleartheairwayofaconscious
choking victim.
2. Remember to clear the airway before re-attempting rescue
breaths when an unconscious victim has an obstructed airway.
3. Know when and how to use the head-tilt, chin-lift and the jaw-
thrust maneuvers to open a victim’s airway.
4. Use barrier devices for rescue breathing and keep the airway
clear during rescue breathing.
5. Know how to select and apply the proper response to cardiac
arrest.
6. Know when and how to provide first aid for shock.
7. Use direct pressure, elevation and pressure points to control
severe bleeding.

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Review And Questions
Section 2
1. What are the 5 primary things that pose an immediate threat to life.
P57 – Immediate life threats exist whenever:
• An adequate supply of oxygen does not reach the lungs
• The lungs do not deliver oxygen to the blood stream
• An injured heart does not pump blood effectively
• Blood volume is insufficient
• The blood vessels relax and drastically lower blood pressure
2. True or False: In some cases compressions alone may be all that is
required for CPR.
P63–Notethatforvictimswhodonothaveacompromisedairwayortheprobability
of fluid in the lungs, compressions alone may serve to both exchange air in the
lungs and manually pump blood through the body.
3. What is the required depth of compressions when giving CPR to an
adult?
P66 – Depress the chest of an adult victim a minimum of 2 inches (at least 1/3 of the
victim’s body thickness)
4. What is the rate of compressions in CPR?
P66 – at the rate of 100 to 120 compressions per minute without stop
5. What is the ratio of compressions to breaths when delivering CPR to
a suspected drowning victim?
P66 – Continue the cycle by delivering at least 30 compressions at a rate of at least
100 compressions per minute followed by 2 full breaths. Each repeat cycle
should take about 20 seconds

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CPR Workshop
Situation: Upon surfacing from a dive, you find a diver face down motionless
in the water. After retrieving them from the water, you find the victim not
breathing and has no pulse.
Findings: After retrieving from the water, you find the victim is not breathing
and has no pulse.
Results: Check ABCs. Begin CPR, and complete compressions of 30/2 for 2
cycles. Pulse is regained, and breathing regains. Put the victim on oxygen
prepare for transport.
Suspected Problem: Near Drowning

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© Concept Systems International GmbH, 2012 | Section 3 - First Aid Techniques
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Section 3
FirstAidTechniques
Objectives
• Introduction: First Aid Techniques
• First Aid for Emergencies And Injuries
Academic Review
I. Introduction
A. First Aid Techniques
While many of the medical problems addressed in First Aid courses are serious,
they usually are not immediate threats to life. In this section we only focus on the
common first aid and diving related problems like:
▲▲ Bleeding
▲▲ Heat related Problems
▲▲ Cold related Problems
▲▲ Near Drowning
For any diving related problems like Decompression Sickness or Lung Expansion
injuriescheckyourDiverStressRescueMaterialsforamoredetaileddescription
of the proper response to diving related incidents.While the First Aid procedures
for both problems are the same:
1. Administer Oxygen near 100% as fast as you can.
2. Monitor the victim constantly
3. Activate the EMS system or the local Coast Guard and be sure
that they understand that the victim has been involved in a
probable diving related incident.

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For other injuries such as Envenomations and bites, do not spend time trying
to figure out what did it. The difference between a Barracuda bite and that of
a Moray Eel is hard to judge, even for the experts. However, a bite is a severe
laceration for treatment purposes and a fracture is a fracture. Treat these injuries
accordingly. There are various other treatments for injuries such as certain
jellyfish stings, (vinegar rinse and hot compresses) that you can use but are not
covered in detail here. First aid is the main rule - paying attention to airway and
circulatory maintenance. Any bleeding that could be considered life threatening
should be handled immediately.
Look the following signs and symptoms:
▲▲ Puncture or laceration
▲▲ Blisters
▲▲ Purple or black skin discoloration
▲▲ Nausea
▲▲ Vomiting
▲▲ Shock
▲▲ Swelling
▲▲ Cardiac Arrest
▲▲ Paralysis
▲▲ Speech and swallowing difficulty
▲▲ Respiratory distress or arrest
▲▲ Numbness and/or tingling around mouth, neck, and throat
▲▲ Loss of coordination

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Bleeding (External)
Recognition
Signs of severe bleeding, which can be life threatening and must be controlled,
include:
▲▲ Spurting blood
▲▲ Significant blood loss (more than 1 pt./500 cc from an adult, or more than 0.5 pt./250 cc from
a child
▲▲ Signals of shock
Response
Initial actions:
A. Use gloves or a protective barrier to avoid coming into contact
with bodily fluids.
B. Expose and look at the wound.
C. Placeasterileabsorbentdressingorcleansubstitute(handkerchief,
towel, etc.) firmly and steadily against the wound. Direct pressure stops
most bleeding
D. Elevate the wound above the level of the heart while maintaining
pressure.
E. If bleeding is moderate to severe, summon Emergency Medical
Services.
F. When bleeding slows or stops, wrap the dressing in place with a
bandage which should be snug, but not tight. Place the bandage
knot directly over the wound.
G. If bleeding continues, add additional layers of dressings and
bandages.
H. If bleeding persists in a limb, apply pressure to a pressure point.
I. If bleeding is from an object impaled in the body, do not remove
the object, bandage around the object.
J. Immobilization of an injured extremity can help control bleeding.
K. Follow steps 1 through 7 for minor or moderate external bleeding.

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Follow-up actions
L. Always treat victims of severe bleeding for shock.
M. Assess the injured person for additional injuries or illness.
N. Assess extremities for loss of circulation and/or nerve damage.
O. After bleeding stops, clean minor wounds with soap and warm
water, remove foreign material, treat with antibacterial ointment
(if available) and cover with a sterile dressing.
P. Save blood-soaked bandages and barrier devices for medical
personnel.(This helps estimate blood loss and ensures proper biohazard
disposal.)
Q. Clean the area and wash your hands thoroughly with anti-bacterial
soap, if available.
For Delayed Response:
A. If the wound is dirty and there is no running water available,
pressure rinse the wound using an irrigation syringe filled with
clean water.
Restrictions
▲▲ Avoidusingdirectpressureoneyeinjuries,woundswithembeddedobjectsorskullfractures.
▲▲ Do not tie a bandage so tight that it cuts off circulation.
▲▲ Do not remove blood-soaked dressings and bandages.
▲▲ Do not remove impaled objects.
▲▲ Avoid applying pressure to a pressure point for more than 10 minutes.
▲▲ Avoid attempting to clean severe wounds that will require medical care.
▲▲ Avoid applying a tourniquet unless all other attempts to control bleeding fail and medical
help will be delayed. If you do use a tourniquet, write the letter“T”and the time of application
on the injured person’s forehead and do not loosen the tourniquet.
Remember
▲▲ Platelets in blood can seal a broken blood vessel, form a clot and stop bleeding within
minutes in healthy victims as long as the blood is not flowing forcefully through the opening.
▲▲ Direct pressure reduces blood flow and allows the clot to form.

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▲▲ Elevation and pressure on pressure points reduce blood pressure on the wound and enhance
the clotting process.
▲▲ A tourniquet stops blood flow completely.
Bleeding (Internal)
Recognition
Signs of internal bleeding, which can be life threatening and requires rapid
evacuation to the nearest medical facility, include:
▲▲ Vomiting or coughing blood
▲▲ Blood flowing from body openings
▲▲ Swollen, tender areas of the body
▲▲ Rigid abdomen
▲▲ Pulsating masses in the abdomen
▲▲ Bruises— especially on the chest, abdomen, hips, or thighs
▲▲ Signs of shock when there are no external injuries
▲▲ Broken bones
Response
Initial actions for minor internal bleeding (bruise) on an extremity:
A. Minimize movement of the extremity.
B. Wrap a covered ice pack around the injured limb for 20 minutes.
C. Elevate the injured area.
Initial actions for severe internal bleeding signals:
A. Summon medical assistance immediately and tell the dispatcher
that you suspect internal bleeding.
B. Keep the victim as still and calm as possible.
C. Give first aid for shock.

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Follow-up actions
D. There is no field treatment for internal bleeding.
E. Be prepared for the victim to vomit.
A. If medical care will be delayed an hour or more, allow conscious
victims, who are not nauseous and can swallow, to drink some
water.
B. If medical assistance will be delayed, try to arrange a transfer point
and take the victim to the medical personnel, or to the nearest
medical facility.
Restrictions
▲▲ Avoid giving the victim anything to eat or drink unless response is delayed.
Remember
▲▲ Blood loss from internal bleeding may be enough to cause death quickly,especially when
the injured area is the head, chest, abdomen, pelvis or thigh.
Abdominal Emergencies
Recognition
Signs and Symptoms of abdominal emergencies include:
▲▲ Bruised abdomen
▲▲ Abdominal rigidity
▲▲ Tender, swollen abdomen
▲▲ Pulsating abdominal mass
▲▲ Intense abdominal pain
▲▲ Penetrating injury
▲▲ Protruding organs
▲▲ Impaled object
▲▲ Abdominal guarding (protecting the area)

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Response
Initial response:
A. Summon emergency medical assistance immediately.
B. Place the victim in the recovery position.
C. Be prepared for vomiting.
D. If organs protrude, cover them with a warm, wet dressing and
insulate the dressing to prevent heat loss.
E. If an object is impaled in the abdomen, bandage dressings around
the object to control bleeding and stabilize the object.
For delayed response:
A. If medical care will be delayed one hour or more, allow conscious
victims, who are not nauseous and can swallow, to drink sip small
amounts of water.
Restrictions
▲▲ Avoid giving food or drink unless response is delayed.
▲▲ Do not attempt to reinsert protruding organs.
Rationale
▲▲ There are more than 100 causes of abdominal pain.
▲▲ Abdominal emergencies can be life threatening.
▲▲ Field diagnosis is difficult. Prompt care at a medical facility is essential.
▲▲ The removal of impaled objects can cause severe, unstoppable bleeding.
▲▲ Protruding organs can be replaced at a hospital if they are kept moist and warm.

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Allergic Reactions
Recognition
Signs and Symptoms of allergic reactions, which can rapidly become life threatening,
may include:
▲▲ Sneezing and coughing; red, blotchy, flushed skin; swelling of face, lips, or tongue; ticklish
throat; or dizziness
▲▲ Breathing difficulty, bluish skin, unconsciousness, seizures or respiratory arrest (severe case)
(Note: Allergies to food, medications, insect stings, latex or fumes from burned poisonous plants or substances may
cause severe, life-threatening reactions.)
Response
A. Ask if the victim has a history of allergic reactions and observe the
victim for allergic reaction Signs and Symptoms.
B. Ask if the victim has prescribed medication for the condition and, if
possible, locate the medication and have it immediately available.
Familiarize yourself with the directions for use of the medication.
C. If you suspect an insect sting causedthe reaction, summon medical
assistance immediately and follow the first aid procedures for
Stings (Insect).
D. Iffoodormedicinecausesthereaction,summonmedicalassistance
immediately.
E. If the victim has Signs and Symptoms of severe reaction —
especially breathing difficulty — and has prescribed medication
with a valid expiration date, help the victim take the medicine.
Additional medication may be required within minutes, so do not
postpone medical assistance when administering medication.
F. Monitor the victim closely until medical assistance arrives. If
required, initiate rescue breathing or CPR.
Restrictions
▲▲ Never give medication that is not prescribed to the victim.
▲▲ Avoid giving prescribed allergic reaction medication when the Signs and Symptoms are not
severe, after the usable date has expired or when the medication is not clear.
▲▲ Do not delay medical assistance when the victim has allergic reaction Signs and Symptoms.

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Rationale
▲▲ Allergic reactions may become life threatening within minutes because they cause
respiratory and circulatory collapse.
▲▲ A medication called Epinephrine rapidly reverses the effects, but Epinephrine can be lethal
if it is given or taken when it is not required.
Amputation (Severed Body Part)
Recognition
Amputations may be partial or complete and clean-cut or crushed through.
Response
Initial Actions:
A. Control bleeding.
B. Provide first aid for shock.
C. Care for the amputated body part:
❏❏ Find the part and rinse it with clean water.
❏❏ Wrap the part in a clean, dry dressing.
❏❏ Place the wrapped part into a waterproof container.
❏❏ Write the victim’s name on the container.
❏❏ Place the container on (but not in) ice or a cold pack.
D. Take the victim and the amputated part to the nearest medical
facility as soon as possible.
E. If the body part is partially amputated, place the part as close as
possible to its normal position and bandage the part in place.
Restrictions
▲▲ Avoid scrubbing or washing the amputated part.
▲▲ Avoid keeping the amputated part moist.
▲▲ Avoid packing the amputated part in ice.
▲▲ Do not completely separate partial amputations.

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Rationale
▲▲ Amputated body parts may be reattached successfully hours after an amputation if the
parts are kept clean, dry and cool.
Bites Stings (Animal Human)
Recognition
Signs and Symptoms of bites, which usually are not life threatening, may include:
▲▲ Bite marks on unbroken skin (mild case)
▲▲ Broken, torn skin with bleeding
▲▲ Broken, torn skin and flesh (severe case)
Response
Initial Actions:
A. Immediately pour a one-part-soap to ten-parts-water solution into
the wound, rinse in pressurized tap water (or pressure rinse using
an irrigation syringe filled with clean water) and repeat several
times. Do not scrub a bite wound.
B. Control bleeding and cover the wound lightly with a sterile
dressing.
C. Notify police or animal control of the bite so they can capture the
animal and have it examined.
D. Obtain medical care immediately.
A. Irrigate the bite wounds with a disinfectant.
B. Take the victim to the nearest medical facility.
Restrictions
▲▲ Do not attempt to capture or kill the animal that has bitten the victim.
▲▲ Avoid scrubbing a bite wound.
▲▲ Avoid closing a bite wound.

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Rationale
▲▲ Bacteria from bites can cause infection.
▲▲ Animals may have rabies.
▲▲ Scrubbing causes additional damage to injured tissues.
C. Some Specific Notes:
1. For Stingrays:
a. Don’t pull barb out.
b. Remove visible pieces of spine or foreign matter with forceps
c. Do not remove larger spines embedded in chest wall, abdomen, or
neck
d. Immerse in hot water (113 degree max)
e. Scrub with soapy water
f. Irrigate vigorously with fresh water
g. Monitor for allergic reaction.
2. For Starfish and Sea Urchins
a. Soak in hot water. Do not burn skin
b. Clean with soap and water
c. Apply sterile dressing and bandage if required
d. Monitor for allergic reaction and / or infection
3. For Fire Corals, Anemone, Jellyfish
a. Flush injuries with large amounts of sea water to remove remaining
tentacles
b. Immerse the affected area in hot water for 30 to 90 minutes to
neutralize the unfired nematocysts
c. Remove the tentacles with forceps
d. Shave the area with shaving cream and safety razor

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e. Apply hydrocortisone lotion or cream
f. Allergic Reactions - Some divers will have acute allergic responses
to the some stinging organisms. If this condition is diagnosed they
may have a device called an Epi-pen available to treat themselves
in the event of a reaction. The use of an Epi-pen while desirable is
controlled by medical prescription. If one is available, you may only
assist the patient in its use.
Bites (Venomous Snakes)
Recognition
Signs and Symptoms of venomous snakebites, which usually are not life threatening,
may include:
▲▲ Puncture wounds
▲▲ Severe pain at bite site (unless the venom has desensitized the area)
▲▲ Rapid swelling of injured extremity
▲▲ Nausea, vomiting, sweating and weakness (severe cases)
Response
Initial Actions:
A. Reassure the victim.
B. Have the victim minimize movement.
C. Wash the bite area with soap and water.
D. Keep the bite at heart level.
E. Seek immediate medical attention.
F. Immobilizing a bitten extremity helps reduce pain.
G. Remove any restrictive clothing and/or jewelry.
H. Do not allow the victim to smoke or to consume coffee/caffeine or
alcohol.

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A. If you have, and can use a suction device within 3 minutes of the
bite, apply the device without cutting the skin.
B. Splint a bitten limb.
C. Take the victim to the nearest medical facility for anti-venin
treatment.
Restrictions
▲▲ If possible, identify but do not attempt to capture or kill the snake.
▲▲ Do not make incisions in the bite site.
▲▲ Do not apply oral suction to the bite.
▲▲ Do not apply ice or heat.
▲▲ Do not use a tourniquet.
▲▲ Do not allow the victim to be active.
Rationale
▲▲ Washing the bite area removes poison from the skin surrounding the bite mark and prevents
absorption.
▲▲ Incisions can cause infection.
Breathing Difficulties
Recognition
Signs and Symptoms of breathing difficulty, which can rapidly become life
threatening, may include:
▲▲ Coughing or wheezing
▲▲ Bluish skin color
▲▲ Difficulty speaking
▲▲ Extreme efforts to breathe
▲▲ Dizziness or light-headedness
▲▲ Rapid breathing rate

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▲▲ Respiratory arrest (severe case)
▲▲ Wheezing
(Note: There are many causes of breathing difficulty.)
Response
A. Summon medical assistance at the first Signs of breathing
difficulty. Ask if the victim has a history of breathing difficulty. If the
victim has prescribed medication for breathing difficulty, locate it, and
have it available for medical personnel.
B. Allow the victim to assume the position that permits the best
breathing possible.
C. If the victim has severe breathing difficulty and has prescribed
inhalation medication with a valid expiration date, and medical
personnel do not arrive promptly, you may help the victim take
the medicine.
D. Monitor the victim closely until medical assistance arrives. If
required, initiate rescue breathing.
Restrictions
▲▲ Avoid having the victim lie down (unless he or she loses consciousness).
▲▲ Avoid having the victim breathe into a sack.
▲▲ Avoid waiting to see if the victim improves before summoning medical assistance.
Rationale
▲▲ Breathing difficulty prevents adequate oxygen from entering the lungs.
▲▲ The condition may deteriorate rapidly and become life threatening.
▲▲ Emergency medical care that includes high-concentration oxygen is essential.

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Burns (Chemical)
Recognition
▲▲ An irritating substance in contact with the skin or eyes
▲▲ Pain
▲▲ Skin redness or discoloration
Response
Initial actions for wet-chemical burns:
A. Don protective gloves and, if available, eye protection and a facial
mask.
B. Flush the affected area immediately with lukewarm, low-pressure
water for 20 minutes. (Direct flow so that runoff does not carry the
chemical to unaffected areas)
C. If the chemical is in the eyes, have the victim blink the eyes or
repeatedly open and close the eyes during rinsing.
D. Remove all contaminated clothing from the victim.
E. Remove any jewelry from the affected area.
F. Summon medical assistance.
G. Initial actions for dry-chemical burns:
H. Don protective gloves and, if available, eye protection and a facial
mask.
I. Brush residue from the skin. Avoid breathing any particles.
J. Flush the affected area immediately with lukewarm, low-pressure
water for 20 minutes. (Direct flow so that runoff does not carry the
chemical to unaffected areas)
K. If the chemical is in the eyes, have the victim blink the eyes or
repeatedly open and close the eyes during rinsing.
L. Remove all contaminated clothing from the victim.
M. Remove any jewelry from the affected area.

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N. Summon medical assistance.
Follow-up actions
O. Locate the container or information about the chemical and give
the information to medical personnel.
P. Ask emergency medical personnel what to do with contaminated
clothing.
A. Take the victim to the nearest medical facility.
Restrictions
▲▲ Avoid using high pressure water.
▲▲ Avoid using hot water.
▲▲ Do not attempt to neutralize chemicals.
Rationale
▲▲ High-pressure water drives chemicals into the body.
▲▲ Cold water can cause heat loss.
▲▲ Hot water may accelerate the chemical reaction.
▲▲ Low-pressure water dilutes the chemical.
▲▲ Neutralizing chemicals can cause heat burns from chemical reactions.
▲▲ Swelling beneath jewelry can interrupt circulation.
Burns (Electrical)
Recognition
▲▲ Possible loss of consciousness with respiratory and cardiac arrest
▲▲ Charred entry and exit wounds
▲▲ Muscle twitching
▲▲ Seizures may occur

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Response
Initial actions:
A. Turn off the power source or call the power company. Do not
approach the victim until you are certain that it is safe. Keep other people
away from the victim.
B. Assess airway, breathing and circulation.
C. Suspect a spinal injury if the victim fell.
D. If possible, elevate the injured area.
E. Cover the burn wounds to prevent infection.
Follow-up actions:
A. Obtain medical assistance.
B. Provide first aid for shock.
C. Assess the victim from head to toe. There may be other injuries.
A. Monitor the victim continuously. Electrical current can cause fatal
heart rhythms hours after the accident.
B. Take the victim to the nearest medical facility.
Restrictions
▲▲ Do not attempt to move a power line wire with a stick, limb or other extension.
▲▲ Do not apply water when the burns are internal.
Rationale
▲▲ Electricity passing through the body may injure vital organs.
▲▲ Current flows through nerves and blood vessels and may cause nerve and circulatory
damage.
▲▲ 75% of the damage from a severe electrical burn is inside the body.
▲▲ Applying water to severe electrical burns increases the risk of infection.
▲▲ Medical attention is important because electrical injuries can cause heart rhythm problems
hours after the initial injury.

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Burns (Heat)
Recognition
Signs and Symptoms of heat burns include:
▲▲ For minor heat burns — Redness, moderate pain and swelling
▲▲ For moderate heat burns — Redness; blisters (may not develop immediately); wet, sticky
skin; and severe pain
▲▲ For severe heat burns — Dry, charred, leathery skin; only edges of burn are painful
Signs and Symptoms of critical heat burns, which require immediate medical
attention, include:
▲▲ Burns to the face, head, chest, hands, feet or genitals
▲▲ Minor burns that cover more than 50% of the body
▲▲ Moderate burns that cover more than 30% of the adult body (20% if over age 60)
▲▲ Severe burns that cover more than 10% of the adult body (less if over age 60)
Response
Initial Actions:
A. Extinguish flames or eliminate heat source. Remember that your
safety comes first.
B. Cool minor or moderate heat burns with cold water immediately.
Rinse or soak the injured area.
C. Cut clothing away from burned area. Cut around melted clothing
stuck to the skin.
D. Cool burn for up to 10 minutes. Stop cooling if victim begins shivering.
E. Remove any jewelry from the burned area.
F. If possible, elevate the burned area above the heart to reduce
swelling.
G. Cover the burned area with plastic food wrap or a clean cloth.
Follow-up actions
H. Provide first aid for shock.

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I. Monitor airway and breathing.
Restrictions
▲▲ Avoid tugging on clothing that is stuck to the skin.
▲▲ Do not use ice to cool burns.
▲▲ Do not apply anything to a moderate or severe heat burn except water.
▲▲ Avoid leaving moist dressings on a burn for prolonged periods.
▲▲ Avoid wrapping a burn tightly (allowance for swelling is essential).
▲▲ Do not break blisters.
Rationale
▲▲ Heat burns damage the skin and tissue and cause swelling, which can interfere with
circulation.
▲▲ Cooling reduces the amount of tissue damage.
▲▲ Elevation reduces swelling.
▲▲ Covering burns after cooling reduces pain, fluid loss and the risk of infection.
▲▲ Cutting around clothing stuck to the skin keeps the skin intact.
▲▲ Applying substances other than water can seal in heat and increase the risk of infection.
Burns (Sunburn)
Recognition
Signs and Symptoms of sunburn include:
▲▲ For minor sunburn — Redness, moderate pain, swelling
▲▲ For severe sunburn — Redness; blisters (may not develop immediately); wet, sticky skin; and
severe pain
Signs and Symptoms of sunburn that requires immediate medical attention include:
▲▲ Minor sunburn that covers more than 50% of the body
▲▲ Moderate sunburn that covers more than 30% of the adult body (20% if over age 60)

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Response
Initial Actions:
A. Get the victim out of sun to prevent further skin damage.
B. Cool the victim’s skin with a cool shower or a sponge bath.
Follow-up actions
C. Non-prescription sunburn sprays and ointments may be used for
minor sunburn only.
D. Non-prescription antihistamine medication may reduce itchiness.
E. Non-prescription ibuprofen helps relieve pain and irritation.
F. Keep blistered skin covered with clean dressings to prevent
infection.
Restrictions
Avoid the following actions:
▲▲ Breaking blisters
▲▲ Peeling sunburned skin
▲▲ Rationale
▲▲ Cooling reduces the amount of tissue damage.
▲▲ Covering blistered skin after cooling reduces fluid loss and the risk of infection.
Chest Injuries
Recognition
Signs and Symptoms of chest-injury emergencies include:
▲▲ Bruising
▲▲ Painful ribs
▲▲ Penetrating injury

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Response
Initial Actions:
A. Summon emergency medical assistance immediately.
B. Allow the victim to assume the position that provides the most
comfort.
C. If ribs are injured, have the victim hug a pillow or blanket against
the injury or lie down on a pillow to support the injured area.
D. If an object is impaled in the chest, bandage dressings around the
object to control bleeding and stabilize the object.
E. If the victim has a hole in the chest that is bubbling and whistling:
❏❏ Cover the hole with an airtight covering after the victim exhales.
❏❏ If breathing becomes difficult, remove the covering as the victim exhales, allow excess air to
escape, and then cover the wound again.
A. Encourage the victim to cough every hour to keep the lungs clear.
B. If the victim has thick secretions from the mouth, have him or her
inhale steam (if available).
C. Take the victim to the nearest medical facility.
Restrictions
▲▲ Avoid giving food or drink.
Rationale
▲▲ Chest injuries can collapse a lung, causing bleeding into the lungs or damage the heart.
▲▲ Removing an impaled object can cause unstoppable bleeding.
▲▲ Covering a hole in the chest can improve breathing, but a one-way valve effect in an injured
lung can build up pressure and interfere with breathing and circulation.
▲▲ Relieving the pressure may correct the problem temporarily.

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Diabetic Emergencies
Recognition
Signs and Symptoms of diabetic emergencies include:
▲▲ A rapid onset of the problem
▲▲ Pale skin color
▲▲ Abnormal mental status
▲▲ Lack of coordination
▲▲ Excessive sweating
▲▲ Trembling
▲▲ Unconsciousness (severe case)
▲▲ Headache
▲▲ Dizziness
Response
Initial response for a conscious victim:
A. Determine that the victim is diabetic (ask medical history; look for
medical tag)
B. Determine that the victim can swallow.
C. If victim can swallow, provide food or juice that contains real sugar.
D. If the victim does not recover fully within 20 minutes, seek medical
attention.
Initial response for an unconscious victim:
A. Summon emergency medical personnel immediately.
B. Assess ABCs.
C. Place victim in the recovery position.
D. Be prepared to manage vomiting.

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A. Take the victim to the nearest medical facility.
B. A victim who appears to recover needs to eat a meal and rest
before any activity.
C. If the victim does not recover and can swallow, provide water.
Restrictions
▲▲ Avoid giving food or drink to victims who are unable to swallow.
▲▲ Do not use foods that have sugar substitutes.
▲▲ Do not attempt to give insulin to the victim.
Rationale
▲▲ There are two diabetic emergencies: insulin shock and diabetic coma.
▲▲ When a victim has too much sugar and not enough insulin, the condition is serious, but will
not change rapidly.
▲▲ When a victim does not have enough sugar, brain damage can occur quickly.
▲▲ Giving sugar to a victim who has excess sugar will not hurt anything, but may prevent a
tragedy for the victim who needs it.
▲▲ Victims who are unable to swallow can aspirate food or drink and must be treated
intravenously by medical personnel.
Dislocated Joints
Recognition
Signs and Symptoms of bone dislocations, which occur at joints and can cause
permanent disability, include:
▲▲ Joint deformity
▲▲ Extreme pain
▲▲ Inability to use the injured body part

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Response
Initial Actions:
A. Assess the victim completely before concerning yourself with a
dislocation unless you are certain that there are no other injuries.
B. Expose the injured area when assessing the injury. Check feeling,
movement and strength in an injured extremity.
C. Provide first aid for shock.
D. Support the injured area until emergency medical personnel
arrive.
E. Improvise a splint and immobilize the dislocation only when
medical help will be delayed.
F. If you must splint a dislocation, immobilize the bones above and
below the injured joint in the position that you found it.
G. Applying a wrapped ice or cold pack for 20 minutes can help reduce
swelling and decrease pain.
A. If medical help is unavailable for hours, or there is no circulation
beyond a dislocated joint, attempt to put the following joints back
into place: finger, kneecap or shoulder. Slowly stretch the dislocated
part away from the joint and gently ease it back into position.
B. Do not attempt to put a dislocated knee or hip back into its normal
position.
Restrictions
▲▲ Avoid attempting to realign joints except in extreme situations.
▲▲ Do not elevate a possible dislocation.
▲▲ Do not apply heat.
▲▲ Avoid applying ice directly to the skin.
▲▲ Avoid applying a cold pack in excess of 20 minutes.

REACT RIGHT
INSTRUCTOR
PAGE
3-25
ENGLISH
Rationale
▲▲ Dislocations can pinch and damage nerves and blood vessels.
▲▲ Movement of dislocated joints can cause permanent disability.
▲▲ Whenever possible, allow emergency medical personnel to treat dislocations.
Eye Injuries
Recognition
▲▲ Bruising around eye
▲▲ Wound on eye
▲▲ Painful eye
▲▲ Visual changes or loss
▲▲ Extruding eye
Response
For bruising (black eye):
A. Apply wrapped ice or cold packs gently.
B. Seek immediate medical attention.
For cuts:
A. Place dressings over both eyes and bandage them in place gently.
B. Seek immediate medical attention.
For chemical irritation:
A. Flush the affected eye with lukewarm water for at least 20 minutes.
B. Open and close the eye repeatedly during rinsing. Instruct the victim
to roll the eye as much as possible.
C. Flush away from the unaffected eye.
D. Seek immediate medical attention.

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