First Aid Tutorial - Basic Techniques To Handle Common Medical Emergencies


         
          
INTRODUCTION
ORDER OF TREATMENT PRIORITY
OBSTRUCTED AIRWAY
HEART ATTACK
BLEEDING
SHOCK
BURNS
EYE INJURIES
NOSE INJURIES
INSECT BITES
FRACTURES, SPRAINS & STRAINS
POISONING
DIABETIC EMERGENCIES
STROKE
SEIZURES
HEAT EMERGENCIES
COLD EMERGENCIES
LEGAL & ETHICAL CONSIDERATIONS
YOUR FIRST AID KIT
              
INTRODUCTION: This tutorial has been prepared by a
               Certified First Aid Instructor with many years
               experience teaching first aid, CPR and basic life
               support courses. While the material presented
               conforms to commonly accepted standards, it is
               not intended to substitute for formalized classroom
               instruction in first aid, as offered by many
               community groups and organizations. Nor should this
               tutorial be relied upon for use at the time of an
               emergency. The time to learn first aid is BEFORE you
               need to use it!

               Since you will probably use the skills
               presented on this disk only from time to
               time, it is a good idea to review its content
               every so often so you don't forget the valuable
               lessons.

               It is also strongly recommended you sign up for
               an inclusive first aid and CPR course.

SECTION I

ORDER OF PRIORITY

IN AN EMERGENCY



     In EVERY emergency situation, there is a logical
     order to be followed. First, it is important to
     carefully assess the scene of an emergency BEFORE
     any further steps are taken. The purpose of this
     assessment is to assure it is safe to provide
     first aid care. For example, an unconscious victim
     might be  lying on a live power line. If a rescuer
     were to touch the victim before the power could be
     shut off, the rescuer would become a victim as
     well! Always be sure it is safe before you attempt
     to help a victim!

     Once you determine it is safe for you to help a
     victim, you should immediately determine if the
     victim has any life threatening conditions.

     Begin by checking to see if the victim is
     responsive. Kneel and ask, " ARE YOU OK?" If there
     is no response, you must immediately summon an
     ambulance! Recent studies have conclusively shown
     that victims who are not breathing and do not have
     a heartbeat have a substantially greater chance for
     survival if they receive prompt advanced medical
     care in a hospital or by trained paramedics.

     Only after a call is placed for emergency medical
     services does a volunteer attempt to further help
     an unconscious victim.

     If there are bystanders on the scene, summon
     someone to your side to provide assistance.

     If the victim is on his stomach, first place the
     victim's arm closest to you above his head. Then
     turn him over by placing one hand on the victim's
     hip and the other hand at the victim's shoulder.
     Turn the body in a smooth, even straight line so as
     to not cause further injury in the event of
     existing spinal cord injury.

     With the victim now on his back, OPEN THE VICTIM'S
     AIRWAY by placing the heel of your hand on the
     victim's forehead and the tips of your fingers under
     the bony part of the jaw.

     Push down on the forehead while lifting up the chin
     until the jaw is pointing straight up. Now place
     your ear over the victim's mouth and LOOK, LISTEN &
     FEEL for breathing for 3 to 5 seconds. LOOK at the
     chest to see if it is rising, LISTEN for sounds of
     breathing and FEEL for air coming from the victim.

     IF THE VICTIM IS NOT BREATHING, RESCUE BREATHING IS
     REQUIRED IMMEDIATELY!

                             IMPORTANT

          WHILE THIS TUTORIAL IDENTIFIES LIFE THREATENING
          CONDITIONS REQUIRING RESCUE BREATHING OR CPR,
          THESE SKILLS REQUIRE INTENSIVE CLASSROOM SKILL
          DEVELOPMENT AND PRACTICE AND CANNOT BE
          EFFECTIVELY PRESENTED OR TAUGHT IN THIS
          TUTORIAL. THE AUTHOR STRONGLY ENCOURAGES
          EVERYONE TO ENROLL IN A CPR COURSE



          Rescue breathing will provide vital oxygen to
          a victim who cannot breath on their own. After
          giving a victim two breaths, the pulse is
          checked at the Carotid Artery to ascertain if
          the victim has a heartbeat. This artery is
          located on the side of the neck and is found by
          first positioning the fingers on the victim's
          Adam's Apple, then sliding the fingers down into
          the soft groove on the side of the neck. The pulse
          is checked for 5 to 10 seconds.

          If the victim has a heartbeat, but is not
          breathing, RESCUE BREATHING is required. If the
          victim is NOT breathing AND does NOT have a
          HEARTBEAT, CPR is required without delay!

          These initial steps of checking the AIRWAY,
          BREATHING and CIRCULATION (pulse), together
          with a check for major BLEEDING, constitute THE
          PRIMARY SURVEY, which looks for life-threatening
          conditions!

          In every instance where first aid is to be
          provided, it is important to always ask a
          conscious victim for permission to help them.
          If a victim is unconscious, it is presumed they
          have provided consent for you to assist them.


                        SECTION II

                 OBSTRUCTIONS IN THE AIRWAY



          [NOTE: Emergency treatment of airway
          obstructions is taught as part of CPR
          training and only through classroom
          practice can the necessary skills be
          mastered. The mechanics of handling
          airway obstructions are presented in
          this tutorial for background insight only]



          If an individual is choking - but can speak
          or cough forcibly - there is an exchange of
          air (although it might be diminished) and you
          should encourage the victim to continue coughing
          while you just stand by! On the other hand,
          if a victim is choking, but CANNOT speak or cough,
          an airway obstruction exists which must be treated
          immediately!

          The treatment for an obstructed airway in a
          conscious victim involves use of the HEIMLICH
          MANEUVER which is performed as follows:



          STAND BEHIND THE VICTIM

          WRAP YOUR ARMS AROUND THE VICTIM'S WAIST

          MAKE A FIST WITH ONE HAND AND PLACE THE THUMB
          SIDE OF THE FIST AGAINST THE VICTIM'S ABDOMEN,
          JUST ABOVE THE NAVEL AND WELL BELOW THE LOWER
          TIP OF THE BREASTBONE

          GRASP YOUR FIST WITH YOUR OTHER HAND

          WITH ELBOWS OUT, PRESS YOUR FIST INTO THE
          VICTIM'S ABDOMEN WITH QUICK, UPWARD THRUSTS

          EACH THRUST IS A DISTINCT, SEPARATE ATTEMPT TO
          DISLODGE THE FOREIGN OBJECT

          REPEAT THRUSTS UNTIL FOREIGN OBJECT IS CLEARED
          OR VICTIM BECOMES UNCONSCIOUS



          Emergency treatment of airway obstructions in
          an unconscious victim is taught in CPR classes.

                                       SECTION III

                                      HEART ATTACK


               Heart attacks are among the leading cause of death
               in the United States. A heart attack happens when
               one or more of the blood vessels that supply blood
               to the heart become blocked. When this occurs, cells
               in the heart begin to die when they cannot get blood
               for vital nourishment. If a large part of the heart
               is deprived of blood, the heart stops beating and
               the victim suffers CARDIAC ARREST!

               When a victim's heart stops beating, they require
               CARDIOPULMONARY RESUSCITATION (CPR) which provides
               vital oxygen through rescue breathing and which
               maintains circulation through chest compressions.

                                   ******

               PROPER TRAINING IS REQUIRED TO PERFORM CPR, HOWEVER
               ANY HEART ATTACK CAN LEAD TO CARDIAC ARREST AND IT
               IS THEREFORE VITAL FOR FIRST AIDERS TO BE ABLE TO
               RECOGNIZE THE EARLY WARNING SIGNS OF A HEART ATTACK
               SO THE VICTIM CAN RECEIVE PROMPT PROFESSIONAL
               ATTENTION!

                                   ******


               A heart attack victim whose heart is still beating
               has a much better chance of survival than a victim
               whose heart has stopped! Most heart attack victims
               who die succumb within 2 hours after having their
               heart attack. Many of these victims could be saved
               if bystanders recognize the symptoms of a heart
               attack and get the victim to a hospital quickly!
               Indeed, many victims of heart attacks think they are
               experiencing HEARTBURN or other minor discomfort
               when in fact their life is in jeopardy!


               The most significant sign of a heart attack is chest
               pain. The victim may describe it as pressure, a
               feeling of tightness in the chest, aching, crushing,
               fullness or tightness, constricting or heavy pain.
               The pain may be located in the center of the chest
               although it is not uncommon for the pain to radiate
               to one or both shoulders or arms or to the neck, jaw
               or back.


               In addition to pain, victims may experience
               sweating, nausea or shortness of breath. Many
               victims deny they may be having a heart attack.
               Others may have their condition worsened by fear of
               dying.


               With all victims of heart attacks - and with all
               victims receiving first aid for any condition - it
               is important for the rescuer to constantly reassure
               the victim and keep them as calm and relaxed as
               possible.

               The psychological value of reassurance is as
               important in first aid as any treatments!


               FIRST AID FOR A HEART ATTACK

                 1. Recognize the signs & symptoms of a heart
                    attack


                 2. Comfort & reassure the victim


                 3. Have the victim stop whatever they were doing
                    and sit or lie in a comfortable position


                 4. Summon emergency medical help quickly


                 5. If the victim become unconscious, be prepared
                    to perform CPR [IF YOU ARE TRAINED TO DO SO]



               All of us can reduce the risk of heart attack by
               controlling high blood pressure, limiting
               cholesterol in the diet, watching weight,
               exercising, giving up smoking and minimizing stress.

SECTION IV

                                  BLEEDING



               Major bleeding may be a life-threatening condition
               requiring immediate attention. Bleeding may be
               external or internal. Bleeding may be from an
               ARTERY, a major blood vessel which carries
               oxygen-rich blood from the heart throughout the
               body. It may be from a VEIN, which carries blood
               back to the heart to be oxygenated or bleeding may
               be from a CAPILLARY, the smallest of our body's
               blood vessels.


               ARTERIAL bleeding is characterized by spurts with
               each beat of the heart, is bright red in color
               (although blood darkens when it meets the air) and
               is usually severe and hard to control. ARTERIAL
               bleeding requires immediate attention!


               VENUS bleeding is characterized by a steady flow and
               the blood is dark, almost maroon in shade. Venus
               bleeding is easier to control than Arterial
               bleeding.


               CAPILLARY bleeding is usually slow, oozing in nature
               and this type of bleeding usually has a higher risk
               of infection than other types of bleeding.






               FIRST AID FOR BLEEDING IS INTENDED TO:


                     l. STOP THE BLEEDING


                     2. PREVENT INFECTION


                     3. PREVENT SHOCK





               HOW TO CONTROL BLEEDING:



            1. APPLY DIRECT PRESSURE ON THE WOUND. USE A DRESSING,
               IF AVAILABLE. IF A DRESSING IS NOT AVAILABLE, USE A
               RAG, TOWEL, PIECE OF CLOTHING OR YOUR HAND ALONE.


               IMPORTANT:

               ONCE PRESSURE IS APPLIED, KEEP IT IN PLACE. IF

               DRESSINGS BECOME SOAKED WITH BLOOD, APPLY NEW

               DRESSINGS OVER THE OLD DRESSINGS. THE LESS A

               BLEEDING WOUND IS DISTURBED, THE EASIER IT WILL BE

               TO STOP THE BLEEDING!



            2. IF BLEEDING CONTINUES, AND YOU DO NOT SUSPECT A
               FRACTURE, ELEVATE THE WOUND ABOVE THE LEVEL OF THE
               HEART AND CONTINUE TO APPLY DIRECT PRESSURE.



            3. IF THE BLEEDING STILL CANNOT BE CONTROLLED, THE NEXT
               STEP IS TO APPLY PRESSURE AT A PRESSURE POINT. FOR
               WOUNDS OF THE ARMS OR HANDS, PRESSURE POINTS ARE
               LOCATED ON THE INSIDE OF THE WRIST ( RADIAL
               ARTERY-WHERE A PULSE IS CHECKED) OR ON THE INSIDE OF
               THE UPPER ARM (BRACHIAL ARTERY). FOR WOUNDS OF THE
               LEGS, THE PRESSURE POINT IS AT THE CREASE IN THE
               GROIN (FEMORAL ARTERY). STEPS 1 AND 2 SHOULD BE
               CONTINUED WITH USE OF THE PRESSURE POINTS.



            4. THE FINAL STEP TO CONTROL BLEEDING IS TO APPLY A
               PRESSURE BANDAGE OVER THE WOUND. NOTE THE
               DISTINCTION BETWEEN A DRESSING AND A BANDAGE. A
               DRESSING MAY BE A GAUZE SQUARE APPLIED DIRECTLY TO
               A WOUND, WHILE A BANDAGE, SUCH AS ROLL GAUZE, IS
               USED TO HOLD A DRESSING IN PLACE. PRESSURE SHOULD BE
               USED IN APPLYING THE BANDAGE. AFTER THE BANDAGE IS
               IN PLACE, IT IS IMPORTANT TO CHECK THE PULSE TO MAKE
               SURE CIRCULATION IS NOT INTERRUPTED. WHEN FACED WITH
               THE NEED TO CONTROL MAJOR BLEEDING, IT IS NOT
               IMPORTANT THAT THE DRESSINGS YOU WILL USE ARE
               STERILE! USE WHATEVER YOU HAVE AT HAND AND WORK
               FAST!


               A SLOW PULSE RATE, OR BLUISH FINGERTIPS OR TOES,
               SIGNAL A BANDAGE MAY BE IMPEDING CIRCULATION.

               SIGNS AND SYMPTOMS OF INTERNAL BLEEDING ARE:



                 * BRUISED, SWOLLEN, TENDER OR RIGID ABDOMEN


                 * BRUISES ON CHEST OR SIGNS OF FRACTURED RIBS


                 * BLOOD IN VOMIT


                 * WOUNDS THAT HAVE PENETRATED THE CHEST OR ABDOMEN


                 * BLEEDING FROM THE RECTUM OR VAGINA


                 * ABNORMAL PULSE AND DIFFICULTY BREATHING


                 * COOL, MOIST SKIN



               FIRST AID IN THE FIELD FOR INTERNAL BLEEDING IS
               LIMITED. IF THE INJURY APPEARS TO BE A SIMPLE
               BRUISE, APPLY COLD PACKS TO SLOW BLEEDING, RELIEVE
               PAIN AND REDUCE SWELLING. IF YOU SUSPECT MORE
               SEVERE INTERNAL BLEEDING, CAREFULLY MONITOR THE
               PATIENT AND BE PREPARED TO ADMINISTER CPR IF
               REQUIRED (AND YOU ARE TRAINED TO DO SO). YOU SHOULD
               ALSO REASSURE THE VICTIM, CONTROL EXTERNAL
               BLEEDING, CARE FOR SHOCK (COVERED IN NEXT SECTION),
               LOOSEN TIGHT-FITTING CLOTHING AND PLACE VICTIM ON
               SIDE SO FLUIDS CAN DRAIN FROM THE MOUTH.

                                  SECTION V

                                    SHOCK




               SHOCK IS COMMON WITH MANY INJURIES, REGARDLESS OF
               THEIR SEVERITY. THE FIRST HOUR AFTER AN INJURY IS
               MOST IMPORTANT BECAUSE IT IS DURING THIS PERIOD THAT
               SYMPTOMS OF SHOCK APPEAR. IF SHOCK IS NOT TREATED,
               IT CAN PROGRESS TO CAUSE DEATH!


               SHOCK IS FAILURE OF THE CARDIOVASCULAR SYSTEM TO
               KEEP ADEQUATE BLOOD CIRCULATING TO THE VITAL ORGANS
               OF THE BODY, NAMELY THE HEART, LUNGS AND BRAIN.


               ANY TYPE OF INJURY CAN CAUSE SHOCK.


               SIGNS AND SYMPTOMS OF SHOCK INCLUDE: CONFUSED
               BEHAVIOR, VERY FAST OR VERY SLOW PULSE RATE, VERY
               FAST OR VERY SLOW BREATHING, TREMBLING AND WEAKNESS
               IN THE ARMS OR LEGS, COOL AND MOIST SKIN, PALE OR
               BLUISH SKIN, LIPS AND FINGERNAILS AND ENLARGED
               PUPILS.



               TREATMENT FOR SHOCK:


               A GOOD RULE TO FOLLOW IS TO ANTICIPATE THAT SHOCK
               WILL FOLLOW AN INJURY AND TAKE MEASURES TO PREVENT
               IT BEFORE IT HAPPENS!


               Putting a victim in a lying-down position improves
               circulation. If the victim is not suspected of
               having head or neck injuries, or leg fractures,
               elevate the legs. If you suspect head or neck
               injuries, keep the victim lying flat. If the victim
               vomits, turn on their side. If victim is
               experiencing trouble breathing, place them in a
               semi-reclining position. Maintain the victim's body
                                 

SECTION VI

                                    BURNS



               The severity of a burn depends upon its size, depth
               and location. Burns are most severe when located on
               the face, neck, hands, feet and genitals. Also, when
               they are spread over large parts of the body or when
               they are combined with other injuries.


               Burns result in pain, infection and shock. They are
               most serious when the victims are very young or very
               old.


               First degree burns are the least severe. They are
               characterized by redness or discoloration, mild
               swelling and pain. Overexposure to the sun is a
               common cause of first degree burns.


               Second degree burns are more serious. They are
               deeper than first degree burns, look red or mottled
               and have blisters. They may also involve loss of
               fluids through the damaged skin. Second degree
               burns are usually the most painful because nerve
               ending are usually intact, despite severe tissue
               damage.


               Third degree burns are the deepest. They may look
               white or charred, extend through all skin layers.
               Victims of third degree burns may have severe pain
               -- or no pain at all -- if the nerve endings are
               destroyed.


FIRST AID FOR BURNS;


FIRST DEGREE         FLUSH WITH COOL RUNNING
WATER, APPLY MOIST
DRESSINGS & BANDAGE LOOSELY



SECOND DEGREE        APPLY DRY DRESSINGS AND BANDAGE
LOOSELY. DO NOT USE WATER AS IT MAY INCREASE RISK OF SHOCK

THIRD DEGREE         SAME TREATMENT AS SECOND DEGREE



ALL VICTIMS OF SERIOUS BURNS
SHOULD SEEK PROFESSIONAL HELP QUICKLY!


               Burns may also be caused by chemicals. In these
               cases, it is important to remove clothing on which
               chemicals have spilled and flush the affected area
               with copious amounts of water for 15 to 30 minutes.

SECTION VII

                              EYE INJURIES



          Be extremely careful and gentle when treating eye
          injuries.


          Floating objects in the eye which can be visualized may
          be flushed from the eye with water. If the object cannot
          be removed in this manner, the victim should seek medical
          attention.

          -------------------------------------------------------

          Never attempt to remove objects imbedded in the eye!

          First Aid care for these injuries consists of bandaging
          BOTH eyes and seeking professional care promptly! An
          inverted paper cup covered with a bandage is appropriate
          for serious eye injuries while the victim is transported
          to the hospital.

          ---------------------------------------------------------



          For chemical burns of the eye, wash the eye with copious
          amounts of water for 15 to 30 minutes. Then wrap a
          bandage around both eyes and seek professional help.




          Eyes are delicate and sight is precious! Prompt
          professional attention to eye injuries is required to
          preserve sight!

                                

SECTION VIII

                                 NOSE INJURIES




               Severe nosebleed can be most frightening. It can
               also lead to shock if enough blood is lost! Many
               cases of nosebleed can be controlled simply by
               having the victim sit down, pinch the nostrils shut
               and lean forward (to prevent blood from running into
               the throat).


               Once the bleeding has been stopped, talking, walking
               and blowing the nose may disturb blood clots and
               allow the bleeding to resume. The victim should rest
               quietly until it appears the bleeding remains
               stopped.


               If it is suspected that the victim has suffered
               head, neck or back injuries DO NOT attempt to
               control the blood flow as they may cause increased
               pressure on injured tissue. All uncontrolled
               nosebleeds require prompt medical attention!


                             SECTION IX

                            ANIMAL BITES




                      ANIMAL BITES CARRY A

                      HIGH RISK OF INFECTION

                      AND REQUIRE PROFESSIONAL

                      ATTENTION PROMPTLY!




               Infection may develop hours, or days,
               after an animal bite. Signs and symptoms
               of infection are pain & tenderness at the
               wound site, redness, heat, swelling, pus
               at the wound site, red streaks in the skin
               around the wound and possible swollen
               glands closest to the wound.



               First aid care for animal bites includes
               washing the wound well with soap and

               water, if there is no heavy
               bleeding. Then cover the wound and seek

SECTION XI

               FRACTURES, SPRAINS, STRAINS & DISLOCATIONS


                    Fractures, sprains, strains and
                    dislocations may be hard for the lay
                    person to tell apart. For this
                    reason, first aid treatment of any of
                    these conditions is handled as though
                    the injury was a fracture.

                    Signs and symptoms of the above
                    conditions may include a "grating"
                    sensation of bones rubbing together,
                    pain, tenderness, swelling, bruising
                    and an inability to move the injured
                    part.

                    First Aid for any of these conditions
                    consists of:

                    * Control bleeding, if present.

                    * Care for shock.

                    * Splint affected area to prevent
                      further movement, but do so only if
                      possible without causing further
                      pain to victim.

                    * Cold packs may help reduce pain and
                      swelling.


                    Victims with traumatic injuries, such
                    as those caused by automobile
                    accidents, falls etc. should not be
                    moved except by trained rescue
                    workers. Head, neck and back injuries
                    are serious and require special care
                    for movement and transport of victims
                    with these conditions. In exceptional
                    circumstances, such as when a victim
                    is at risk of further injury unless
                    moved, the victim's head and neck
                    should be stabilized and the body
                    moved with minimal flexing of the
                    head, neck or spinal cord.



                    ALL VICTIMS WITH FRACTURES,
                    DISLOCATIONS, SPRAINS AND STRAINS
                    REQUIRE PROFESSIONAL MEDICAL
                    ATTENTION.

               professional attention. A serious wound

               should be cleaned only by

               trained medical personnel.

                               

 XII

                              POISONING

                    Over a million cases of poisoning
                    occur in the United States each
                    year, most involving young children.


                    PREVENTION of poisoning should be the
                    concern of every parent with young children.

                    Substances likely to cause poisoning
                    should be kept away from inquiring
                    youngsters!

                    Since various poisons cause different
                    symptoms, and because treatments vary
                    depending upon the substance
                    ingested, the first step in the event
                    of poisoning is to call the local
                    POISON CONTROL CENTER! DO NOT WAIT
                    FOR SYMPTOMS TO OCCUR! IDENTIFY THE
                    NATURE OF THE POISON AND RECEIVE
                    SPECIFIC CARE INSTRUCTIONS FROM THE
                    PROFESSIONAL STAFF AT THE CENTER!

                    All poisoning victims need to be
                    monitored carefully for signs of
                    shock or impaired consciousness.

                    Every household should keep ACTIVATED
                    CHARCOAL & SYRUP OF IPECAC on hand
                    for possible use in poisoning
                    emergencies, however they should
                    not be administered unless instructed
                    by the Poison Control Center
                    staff. Both of these items are
                    readily available, without
                    prescription, at any drug store.

                             XIII

                     DIABETIC EMERGENCIES



               Sugar is required in the body for
               nourishment. Insulin is a hormone
               that helps the body use the sugar.
               When the body does not produce enough
               Insulin, body cells do not get the needed
               nourishment and diabetes results.

               People with this condition take Insulin
               to keep their diabetes under control.

               Diabetics are subject to two very
               different types of emergencies:

               1. INSULIN REACTION (OR INSULIN SHOCK)

               This condition occurs when there is TOO
               MUCH INSULIN in the body. This condition
               rapidly reduces the level of sugar in the
               blood and brain cells suffer.

               Insulin reaction can be caused by taking
               too much medication, by failing to eat, by
               heavy exercise and by emotional factors.

               SIGNS & SYMPTOMS

               Fast breathing, fast pulse, dizziness,
               weakness, change in the level of
               consciousness, vision difficulties,
               sweating, headache, numb hands or feet,
               and hunger.


               2. DIABETIC COMA

               This condition occurs when there is TOO
               MUCH SUGAR and too little INSULIN in the
               blood and body cells do not get enough
               nourishment.

               Diabetic coma can be caused by eating too
               much sugar, by not taking prescribed
               medications, by stress and by infection.

               SIGNS AND SYMPTOMS

               Diabetic coma develops more slowly than
               Insulin shock, sometimes over a period of
               days. Signs and symptoms include
               drowsiness, confusion,deep and fast
               breathing, thirst, dehydration, fever, a
               change in the level of consciousness and
               a peculiar sweet or fruity-smelling
               breath.


               FIRST AID FOR INSULIN REACTION AND
               DIABETIC COMA

               Looking for the signs and symptoms listed
               above will help to distinguish the two
               diabetic emergencies. In addition, if the
               patient is conscious, you can ask two very
               important questions which will help
               determine the nature of the problem:


               1. ASK "HAVE YOU EATEN TODAY?"

                    Someone who has eaten, but has
                    not taken prescribed medication may
                    be in a diabetic coma.

               2. ASK "HAVE YOU TAKEN YOUR MEDICATION
                  TODAY?"

                    Someone who has not eaten, but did
                    take their medication, may be having
                    an Insulin reaction.


               DISTINGUISHING BETWEEN THE TWO TYPES OF
               DIABETIC EMERGENCIES CAN BE DIFFICULT.

               (Always look for an identifying bracelet
               which may reveal a person's condition)


                             ******

               OF THE TWO CONDITIONS, INSULIN SHOCK IS A
               TRUE EMERGENCY WHICH REQUIRES PROMPT
               ACTION!

                             ******

               A PERSON IN INSULIN SHOCK NEEDS SUGAR,
               QUICKLY! IF THE PERSON IS CONSCIOUS, GIVE
               SUGAR IN ANY FORM: CANDY, FRUIT JUICE OR
               A SOFT DRINK!


               SUGAR GIVEN TO A PERSON IN INSULIN SHOCK
               CAN BE LIFE-SAVING! IF THE PERSON IS
               SUFFERING FROM DIABETIC COMA, THE SUGAR
               IS NOT REQUIRED BUT WILL NOT CAUSE THEM
               FURTHER HARM.

               Monitor victims carefully. Seek
               professional help.
                            

SECTION XIV

                               STROKE

               Stroke occurs when the blood flow to the
               brain is interrupted long enough to cause
               damage.

               This may be caused by a clot formed in an
               artery in the brain or carried to the
               brain in the bloodstream, a ruptured
               artery in the brain or by compression of
               an artery in the brain, as found with
               brain tumors.

               First aid consists primarily of
               recognizing signs and symptoms and
               seeking professional attention.

               SIGNS AND SYMPTOMS OF A STROKE INCLUDE:

              * WEAKNESS AND NUMBNESS OF THE FACE, ARM,
                OR LEG, OFTEN ON ONE SIDE OF THE BODY
                ONLY.

              * DIZZINESS

              * CONFUSION

              * HEADACHE

              * RINGING IN THE EARS

              * A CHANGE OF MOOD

              * DIFFICULTY SPEAKING

              * UNCONSCIOUSNESS

              * PUPILS OF UNEVEN SIZE

              * DIFFICULTY IN BREATHING & SWALLOWING

              * LOSS OF BOWEL AND BLADDER CONTROL

          IF YOU SUSPECT A PERSON IS HAVING A
          STROKE, HAVE THEM STOP WHATEVER
          THEY ARE DOING AND REST.

          PROMPTLY OBTAIN PROFESSIONAL HELP. REASSURE THE
          VICTIM AND KEEP THEM COMFORTABLE. DO NOT GIVE
          ANYTHING BY  MOUTH. IF THE VICTIM VOMITS, ALLOW
          FOR FLUIDS TO DRAIN FROM THE MOUTH. OBSERVE
          CAREFULLY WHILE AWAITING PROFESSIONAL HELP AND,
          IF TRAINED TO DO SO, MONITOR THE AIRWAY,
          BREATHING AND CIRCULATION AND BE PREPARED TO
          ADMINISTER RESCUE BREATHING OR CPR, IF
          REQUIRED!

                            

SECTION XV

                              SEIZURES


          Seizures are fairly common occurrences, but are
          very misunderstood! Seizures, per se, are not
          a specific condition. Rather, they may be
          caused by many different types of conditions
          such as insulin shock, high fevers, viral
          infections of the brain, head injuries or
          drug reactions.

          When seizures recur with no identifiable cause,
          the person is said to have epilepsy.

          SIGNS AND SYMPTOMS

          Many individuals have a warning AURA (or
          sensation) before the onset of a seizure. Many
          times, a person about to have a seizure
          will physically move themselves from danger (as
          from the edge of a train platform) before the
          seizure begins.

          Seizures can range from mild to severe. Mild
          seizures may take place and end in a matter of
          seconds.

          Severe seizures may involve uncontrollable
          muscle spasms, rigidity, loss of consciousness,
          loss of bladder and bowel control, and in
          some cases, breathing that stops temporarily.

          Many epileptics carry cards or bracelets which
          identify their condition.


          FIRST AID

          Summon professional help. Prevent the person
          from injuring themselves by moving furniture or
          equipment.

          DO NOT ATTEMPT TO RESTRAIN A PERSON SUFFERING
          A SEIZURE AND DO NOT PUT ANYTHING IN THEIR
          MOUTH!

          Loosen clothing. If they vomit, turn on their
          side to allow fluids to drain. Stay with the
          person until they are fully conscious. If
          trained, administer rescue breathing or CPR, if
          required.

                       HEAT EMERGENCIES


          There are three types of heat emergencies you
          may be required to treat.

          1. HEAT STROKE

          This is the most serious type of heat
          emergency. It is LIFE-THREATENING and requires
          IMMEDIATE and AGGRESSIVE treatment!

          Heat stroke occurs when the body's heat
          regulating mechanism fails. The body
          temperature rises so high that brain damage
          --and death-- may result unless the body is
          cooled quickly.

          SIGNS & SYMPTOMS

          The victim's skin is HOT, RED and usually DRY.
          Pupils are very small. The body temperature is
          VERY HIGH, sometimes as high as 105 degrees.

          FIRST AID

          Remember, Heat Stroke is a life-threatening
          emergency and requires prompt action!
          Summon professional help. Get the victim into
          a cool place.

          COOL THE VICTIM AS QUICKLY AS POSSIBLE IN ANY
          MANNER POSSIBLE! Place the victim into a
          bathtub of cool water, wrap in wet sheets,
          place in an air conditioned room.

          Do not give victim anything by mouth. Treat for
          shock.


          2. HEAT EXHAUSTION

          Heat exhaustion is less dangerous than heat
          stroke. It is caused by fluid loss which in
          turn causes blood flow to decrease in
          vital organs, resulting in a form of shock.

          SIGNS AND SYMPTOMS

          COOL, PALE AND MOIST skin, heavy sweating,
          dilated pupils (wide), headache, nausea,
          dizziness and vomiting. Body temperature
          will be near normal.

          FIRST AID

          Get the victim out of the heat and into a cool
          place. Place in the shock position, lying on
          the back with feet raised. Remove or loosen
          clothing. Cool by fanning or applying cold
          packs or wet towels or sheets. If conscious,
          give water to drink every 15 minutes.

          IMPORTANT: WHILE HEAT EXHAUSTION IS NOT A LIFE-
          THREATENING EMERGENCY LIKE HEAT STROKE, IT CAN
          PROGRESS TO HEAT STROKE IF LEFT UNTREATED!


          3. HEAT CRAMPS

          Heat cramps are muscular pain and spasms due
          to heavy exertion. They usually involve the
          abdominal muscles or legs. It is generally
          thought this condition is caused by
          loss of water and salt through sweating.

          FIRST AID

          Get victim to a cool place. If they can
          tolerate it, give one-half glass of water every
          15 minutes. Heat cramps can usually be avoided
          by increasing fluid intake when active in hot
          weather.
                        

SECTION XVII

                        COLD EMERGENCIES

               HYPOTHERMIA

               SIGNS & SYMPTOMS

               Signs and symptoms of this dangerous
               condition which can become
               life-threatening are: shivering,
               dizziness, numbness, confusion,
               weakness, impaired judgement, impaired
               vision and drowsiness.

               Hypothermia victims pass through 5 stages,
               with each stage more serious and leading
               to death!

              STAGE 1      SHIVERING

              STAGE 2      APATHY

              STAGE 3      LOSS OF CONSCIOUSNESS

              STAGE 4      DECREASING PULSE AND BREATHING
                           RATE

              STAGE 5      DEATH


              FIRST AID

              Seek professional help. Get victim out of
              the cold and into dry clothing. Warm the
              body SLOWLY! Give nothing to eat or drink
              unless victim is FULLY CONSCIOUS!

              If trained, monitor airway, breathing &
              circulation.

                        

 SECTION XVIII

                 LEGAL & ETHICAL CONSIDERATIONS




                           DUTY TO ACT

             No one is required to render first aid
               under normal circumstances. Even a
                physician could ignore a stranger
                 suffering a heart attack if he
                         chose to do so.

                  Exceptions include situations
                  where a person's employment
                    designates the rendering
                     of first aid as a part
                    of described job duties.
                  Examples include lifeguards,
                    law enforcement officers,
                        park rangers and
                       safety officers in
                            industry.


                   A duty to provide first aid
                      also exists where an
                     individual has presumed
                   responsibility for another
                   person's safety, as in the
                    case of a parent-child or
                 driver-passenger relationship.


                 While in most cases there is no
                 legal responsibility to provide
                first aid care to another person,
              there is a very clear responsibility
                to continue care once you start.
                   You cannot start first aid
                      and then stop unless
                   the victim no longer needs
                      your attention, other
                     first aiders take over
                   the responsibility from you
                      or you are physically
                    unable to continue care.





                        NEED FOR CONSENT


                In every instance where first aid
                 is to be provided, the victim's
                consent is required. It should be
                 obtained from every conscious,
                     mentally-competent adult.
                    The consent may be either
                        oral or written.

                 Permission to render first aid
               to an unconscious victim is implied
                  and a first aider should not
            hesitate to treat an unconscious victim.

                 Consent of a parent or guardian
                  is required to treat a child,
                   however emergency first aid
                   necessary to maintain life
              may be provided without such consent.


                             ******


                   IT IS IMPORTANT TO REMEMBER
                   THAT A VICTIM HAS THE RIGHT
                  TO REFUSE FIRST AID CARE AND
                   IN THESE INSTANCES YOU MUST
                  RESPECT THE VICTIM'S DECISION.
                      YOU CANNOT FORCE CARE
                      ON A PERSON WHO DOES
                   NOT WANT IT ... REGARDLESS
                       OF THEIR CONDITION!


                             ******


                         LEGAL CONCERNS

               Some well-meaning people hestitate
                to provide first aid because they
                 are concerned about being sued.

                   THIS NEED NOT BE A CONCERN!


                Legislators in almost every state
                 in the country have passed GOOD
                SAMARITAN LAWS which are intended
                   to protect good people who
                 offer first aid help to others.




                 Most of the Good Samaritan Acts
               are very similiar in their content
                  and usually provide two basic
                   requirements which must be
                      met in order for the
                   first aider to be protected
                      by their provisions:

                  1. The first aider must not
                     deliberately cause harm
                     to the victim.

                 2. The first aider must provide
                    the level & type of care expected
                    of a reasonable person with the
                    same amount of training & in
                    similiar circumstances.



                             *******


             THERE SHOULD BE LITTLE, IF ANY, CONCERN
                ABOUT LEGAL CONSEQUENCES INHERENT
                     IN PROVIDING FIRST AID.

                 YOU NEED ONLY HAVE THE VICTIM'S
                   CONSENT AND THEN OFFER THE
                     LEVEL OF CARE FOR WHICH
                       YOU ARE QUALIFIED.

SECTION XVIX

                       YOUR FIRST AID KIT


               Everyone should have a well-stocked
                  first aid kit handy at home,
                in the car and in the workplace.

                    The contents of your kit
                    will vary depending upon
                     the number of people it
                    is designed to protect as
                  well as special circumstances
                     where it will be used.

                  For example, a first aid kit
                  in a factory where there may
                   be danger of flying debris
                   getting into the eye should
                certainly have a sterile eyewash
                      solution in its kit.
                  If a family member is a known
                diabetic, your kit at home should
                have a glucose or sugar solution.

               When assembling your first aid kit,
                whether for use in the home, car
                 or at work, you should consider
          possible injuries you are likely to encounter
                 and then select kit contents to
                     treat those conditions.

              It's also important to check your kit
                  periodically to restock items
                       that have been used
                    and to replace items that
                        are out-of-date.

                   It's also advisable at home
              and at work to have both a stationary
                    kit, stored in a cabinet
            or drawer, as well as a compact portable
                 kit that can be taken quickly
                  to the site of an emergency.



                           **********


                      RECOMMENDED CONTENTS
                       FOR A FIRST AID KIT
             {Modify to suit your particular needs]

               * Activated Charcoal (for poisoning emergencies)
               * Adhesive strip bandages - assorted sizes
               * Adhesive tape
               * Alcohol - rubbing 70%
               * Alcohol wipes
               * Antacid
               * Antibiotic ointment
               * Baking soda
               * Calamine lotion
               * Chemical ice packs
               * Chemical hot packs
               * Cotton balls
               * Cotton swabs
               * Decongestant tablets & spray
               * Diarrhea medication
               * Disposable latex or vinyl gloves
               * Elastic bandages
               * Face mask for CPR
               * First aid guide
               * Flashlight
               * Gauze pads - various sizes
               * Hot-water bottle
               * Household ammonia
               * Hydrocortisone cream .5%
               * Hydrogen Peroxide
               * Hypoallergenic tape
               * Ice bag
               * Insect repellent
               * Insect sting swabs
               * Matches
               * Meat tenderizer (for insect bites)
               * Moleskin
               * Needles
               * Non-adhering dressings [Telfa]
               * Oil of Cloves
               * Over-the-counter pain medication [aspirin]
               * Paper & pencil
               * Paper drinking cups
               * Roller guaze - self adhering
               * Safety pins
               * Salt
               * Scissors
               * Soap
               * Space blanket
               * Sam splint
               * Sugar or glucose solution
               * Syrup of Ipecac
               * Thermometer - oral & rectal
               * Tongue blades
               * Triangular bandages
               * Tweezers
               * Waterproof tape









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