First Aid - Emergencies

PARTICIPANT’S MANUAL
First Aid—Responding to Emergencies
I H AV E :
learned to program a computer,

passed chemistry with an A, and
saved a life.
Revised
Printing
2007
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FIRST AID—
Responding to
Emergencies
FIRST AID—
Responding to
Emergencies
Important certification information
American Red Cross certificates may be issued upon successful completion of a
training program, which uses this textbook as an integral part of the course.
By itself, the text material does not constitute comprehensive Red Cross training.
In order to issue American Red Cross certificates, your instructor must be autho-
rized by the American Red Cross, and must follow prescribed policies and proce-
dures. Make certain that you have attended a course authorized by the Red Cross.
Ask your instructor about receiving American Red Cross certification, or contact
your local chapter for more information.
Copyright © 2005 by The American National Red Cross. Revised edition 2007.
This participant’s textbook is an integral part of the American Red Cross

First Aid—Responding to Emergencies course. By itself, it does not
constitute complete and comprehensive training for first aid. Please contact
your Red Cross chapter for further information on this course.
The emergency care procedures outlined in this book reflect the standard
of knowledge and accepted emergency practices in the United States at the
time this book was published. It is the reader’s responsibility to stay informed
of changes in emergency care procedures.
All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior written
permission from American Red Cross National Headquarters, Products and
Health and Safety Services.
The updates to this program are based on the 2005 Consensus on Science
for CPR and Emergency Cardiovascular Care (ECC) and meet the 2005
Guidelines for First Aid.
Printed in the United States of America
Composition by Graphic World

Printing/Binding by Banta Book Group
StayWell
780 Township Line Rd.
Yardley, PA 19067
Library of Congress cataloged the 4th edition as follows:

American Red Cross first aid : responding to emergencies.— 4th ed.
p. ; cm.
ISBN 978-1-58480-400-0
1. First aid in illness and injury. 2. Medical emergencies.
[DNLM: 1. Emergencies—Programmed Instruction.
2. First Aid—Programmed Instruction. WA 18.2 A512 2005]
I. American Red Cross. II. American Red Cross first aid.
RC86.7.A477 2005
616.02'52—dc22
2005002263
10 / 9 8 7 6 5 4
Preface
This text is dedicated to the thousands of employees and volunteers of the
American Red Cross who contribute their time and talent to supporting and
teaching life-saving skills worldwide. And to the thousands of course partici-
pants and other readers who have decided to be prepared to take action
when an emergency strikes.
This Fourth Edition of the First Aid—Responding To Emergencies text
has been updated with the latest science for First Aid, CPR and Emergency
Cardiovascular Care (ECC 2005), and includes automated external defibrilla-
tion (AED) information and skills. The design has been significantly updated
with a new format for skill sheets, key terms, sidebars and more. Skill sheets
all now feature photos. Key content areas include a new Chapter 3, Before
Giving Care, and Child and Adult AED content and skills being added to
Chapter 7.
This text is part of an integral training program with certification avail-
able from your local American Red Cross chapter. CPR and AED certifica-
tions are valid for 1 year while first aid certification is valid for 3 years.
Contact your local American Red Cross at www.redcross.org for more
information on how you can receive American Red Cross life-saving
certification.
For more information about Red Cross training and services, visit
www.redcross.org. For ordering information contact your local American
Red Cross chapter or visit www.shopstaywell.com.
Acknowledgments
This textbook is the fourth edition of American Red Cross First Aid—
Responding to Emergencies. We have endeavored to improve and polish this
text and course, which continue to meet the 2005 Consensus on Science for
CPR and Emergency Cardiovascular Care (ECC) and meet 2005 Guidelines
for First Aid. Many individuals shared in the development and revision
process in various supportive, technical and creative ways. Each edition
could not have been developed without the dedication and support of
employees and volunteers.
Fourth Edition—Pat Bonifer, Director; Mike Espino and Emilie Sparks
Parker, Project Managers; John Beales, Ted T. Crites, CHES, Greg Stockton,
Managers; C.P. Dail, Marc Madden and Connie Harvey, Senior Associates;
Idabel Daly, Nancy J. Edmonds, Adreania McMillian, Mark Schraf and
Stephan Widell, NREMT-P, Associates; Greta Petrilla, Marketing Manager;
and Rhadames Avila and Betty Butler, Administrative Assistants.
The StayWell team for this fourth edition included: Nancy Monahan,
Senior Vice President; Bill Winneberger, Senior Director of Manufacturing;
Reed Klanderud, Marketing Director; Paula Batt, Sales Director; Shannon
Bates, Managing Editor; Pam Billings, Product Manager; Carolyn Lemanski,
Education Specialist/Higher Education; Jo Ann Emenecker, Editorial Project
Manager; Bryan D. Elrod, Senior Developmental Editor; Louise Quinn,
Publishing Coordinator; Stephanie Weidel, Senior Production Editor.
The American Red Cross and StayWell extend special thanks to Casey
Berg, Katherine George and Vincent Knows.
Members of the American Red Cross Advisory Council on First Aid and Safety (ACFAS) also provided
guidance and review—
Donald J. Gordon, PH.D., M.D. James A. Judge II, EMT-P, CEM

Professor and Chairman, DEMT Executive Director, Lake-Sumter EMS, Inc.
University of Texas Health Science Center at Committee Member, Advisory Council on First
San Antonio Aid and Safety (ACFAS)
Chair, Advisory Council on First Aid and Safety Mount Dora, Florida
(ACFAS)
San Antonio, Texas
viii Acknowledgments
The American Red Cross thanks the following individuals for their reviews of this text or previous editions:
Stuart A. Balter, ATC, EMT-D Lisa Anne Johnson, EMT-P

Hudson Valley Community College Illinois State University
Dayna S. Brown Constance S. LaBarbera, B.S., M.S., Ed.S., Ed.D.

Morehead State University Bossier Parish Community College
Kathleen C. Brown, MPH, BSN, CHES Louise Feasel Lindenmeyer

University of Tennessee Shoreline Community College
Les Chatelain Nancy S. Maylath, HSD

University of Utah University of Toledo
Verallyn M. Cline Carol G. McKenzie, PhD

University of Wisconsin California State University
Raymond A. Cranston Tim McQuade, NYS EMT-P

Farmington Hills Police Department Erie Community College
Susan T. Dempf, PhD Marshall J. Meyer

Canisius College American Red Cross Oregon Trail Chapter
Dean W. Dimke Anthony Museulino

American Red Cross West Ontario County Chapter
Ann E. Graziadei Sean E. Page, MSN, CRNP, APRN-BC, CSN

Gallaudet University American Red Cross York County Chapter
Arthur L. Grist, Sr. Deborah Radi

University of Southern Illinois at Edwardsville American Red Cross Greater Minneapolis Area
Chapter
Susan J. Grosse
Milwaukee High School of the Arts Catherine E. Rossilli
Westmont College
Kristen M. Haydon
American Red Cross Dallas Area Chapter Tom Schmitz, NREMT
American Red Cross Greater Minneapolis
Joyce Holbrook Huner Area Chapter
Macomb Community College
Barbara Ann Smink, RN, BSN
Laird Hayes, EdD Boerne High School
American Red Cross Orange County Chapter
Kemberley D. Wright
Richard C. Hunt, MD, FACEP American Red Cross Rockingham County Chapter
East Carolina University
Acknowledgments ix
The American Red Cross thanks the following organizations for their reviews of this text or previous editions:
American Camping Association Epilepsy Foundation for the National Capital Area
American College of Emergency Medicine Girl Scouts of the USA
American College of Emergency Physicians National Association of Emergency Medical

Services Physicians
American Lyme Disease Foundation, Inc.
National Diabetes Information Clearinghouse
American Society of Poison Control Centers
Practice Guidelines Wilderness Medical Society
Boy Scouts of America (WMS)
Emergency Trauma Services Children’s National Shenandoah Mountain Rescue Group

Medical Center
Veterans Administration Medical Center
Contents
About This Course, xxi
Health Precautions and Guidelines During First Aid Training, xxix
PART ONE INTRODUCTION, 1

1 If Not You...Who?, 2
2 Responding to an Emergency, 18
3 Before Giving Care, 26
PART TWO ASSESSMENT, 41

4 Body Systems, 42
5 Checking the Victim, 62
PART THREE LIFE-THREATENING EMERGENCIES, 85

6 Breathing Emergencies, 86
7 Cardiac Emergencies and Unconscious Choking, 114
8 Bleeding, 156
9 Shock, 168
Contents xi
PART FOUR INJURIES, 177

10 Soft Tissue Injuries, 178
11 Musculoskeletal Injuries, 204
12 Injuries to the Extremities, 224
13 Injuries to the Head, Neck and Back, 252
14 Injuries to the Chest, Abdomen and Pelvis, 270
PART FIVE MEDICAL EMERGENCIES, 283

15 Sudden Illness, 284
16 Poisoning, 302
17 Bites and Stings, 318
18 Substance Misuse and Abuse, 332
19 Heat- and Cold-Related Emergencies, 350
PART SIX SPECIAL SITUATIONS, 369

20 Reaching and Moving Victims in the Water, 370
21 People with Special Needs, 386
22 Childbirth, 402
23 Delayed-Help Situations, 414
PART SEVEN HEALTHY LIFESTYLES, 437

24 A Safer and Healthier Life, 438
Appendix A, Answers to Study Questions, 464
Glossary, 478
Sources, 489
Index, 492
Detailed Table
of Contents Recognizing Emergencies, 6
Unusual Noises, 6
Unusual Sights, 6
Unusual Odors, 7
TABLE 1-1: RECOGNIZING EMERGENCIES, 7
Unusual Appearance or Behavior, 8
Deciding to Act, 8
Overcoming Barriers to Action, 8
Taking Action, 10
The Emergency Medical Services (EMS) System, 10
When You Call 9-1-1, 10
Until Help Arrives, 12
Preparing for Emergencies, 12
SUMMARY, 13
APPLICATION QUESTIONS, 15
STUDY QUESTIONS, 16
Chapter 2: Responding To An Emergency, 18

SCENARIO, 18
PART ONE: INTRODUCTION OBJECTIVES, 19
INTRODUCTION, 20
Chapter 1: If Not You–Who?, 2 KEY TERMS, 20
Emergency Action Steps, 20
SCENARIO, 2
Check, 20
OBJECTIVES, 3
Call, 22
INTRODUCTION, 4
Care for the Victim, 24
KEY TERMS, 4
SUMMARY, 24
Types of Emergencies, 4
APPLICATION QUESTIONS, 24
Your Role in an Emergency, 4
STUDY QUESTIONS, 25
Contents xiii
Chapter 3: Before Giving Care, 26

PART TWO: ASSESSMENT, 41
SCENARIO, 26 Chapter 4: Body Systems, 42
OBJECTIVES, 27 SCENARIO, 42
INTRODUCTION, 28 OBJECTIVES, 43
KEY TERMS, 28 INTRODUCTION, 44
Preventing Disease Transmission, 28 KEY TERMS, 44
How Infections Occur, 28 Body Cavities, 44
How Bloodborne Pathogens Are Spread, 29 Body Systems, 45
Standard Precautions When Giving Care, 29 The Respiratory System, 46
If You Are Exposed, 31 The Circulatory System, 48
Legal Considerations, 31 The Nervous System, 49
Obtaining Consent, 31 The Musculoskeletal System, 51
Good Samaritan Laws, 32 The Integumentary System, 54
Reaching and Moving Victims, 32 The Endocrine System, 55
Gaining Access, 33 The Digestive System, 56
Emergency Moves, 33 The Genitourinary System, 56
SUMMARY, 35 TABLE 4-1: BODY SYSTEMS, 58
APPLICATION QUESTIONS, 35 Interrelationships of Body Systems, 59
STUDY QUESTIONS, 36 SUMMARY, 59
SKILL SHEET: REMOVING DISPOSABLE GLOVES, 38 APPLICATION QUESTIONS, 59
STUDY QUESTIONS, 60
Chapter 5: Checking the Victim, 62

SCENARIO, 62
OBJECTIVES, 63
INTRODUCTION, 64
KEY TERMS, 64
Checking for Life-Threatening Conditions, 64
Shock, 64
Checking for Consciousness, 64
Checking for a Pulse–Child and Infant, 65
Checking an Unconscious Person, 65
Airway, 66
Breathing, 66
Circulation, 67
Severe Bleeding, 67
Checking a Conscious Victim, 68
Interviewing the Victim and Bystanders, 68
Checking the Victim from Head to Toe, 68
Giving Care, 72
Contents xv
CPR for an Adult, 121 Chapter 8: Bleeding, 156

Chest Compressions, 121 SCENARIO, 156
Locate Proper Hand Position, 121 OBJECTIVES, 157
Position of the Rescuer, 122 INTRODUCTION, 158
Compression Technique, 122 KEY TERMS, 158
Compression/Breathing Cycles, 123 Blood and Blood Vessels, 158
Special Considerations, 123 What Is Blood?, 158
When to Stop CPR, 124 Blood Vessels, 159
Cardiac Emergencies in Children and Infants, 124 When Bleeding Occurs, 159
CPR for Children and Infants, 124 External Bleeding, 160
CPR for a Child, 125 Care for External Bleeding, 160
CPR for an Infant, 125 Internal Bleeding, 161
Unconscious Choking–Adult or Child, 126 Signals of Severe Internal Bleeding, 161
Unconscious Choking–Infant, 127 Care for Internal Bleeding, 161
Automated External Defibrillators (AED), 127 SUMMARY, 162
,
The Heart s Electrical System, 128 APPLICATION QUESTIONS, 163
When the Heart Fails, 129 STUDY QUESTIONS, 164
Defibrillation, 129 SKILL SHEET: CONTROLLING EXTERNAL BLEEDING, 166
Using an AED–Adult, 129
AED Precautions, 129 Chapter 9: Shock, 168
Special Resuscitation Situations, 132
AED Maintenance, 134 SCENARIO, 169
Using an AED–Child, 134 OBJECTIVES, 169
SUMMARY, 135 INTRODUCTION, 170
APPLICATION QUESTIONS, 136 KEY TERMS, 170
STUDY QUESTIONS, 137 Shock, 170
,
SKILL SHEET: CPR–ADULT, 140 The Body s Responses, 170
SKILL SHEET: UNCONSCIOUS CHOKING–ADULT, 142 TABLE 9-1: COMMON TYPES OF SHOCK, 171
SKILL SHEET: CPR–CHILD, 144 Signals, 171
SKILL SHEET: UNCONSCIOUS CHOKING–CHILD, 146 Care, 172
SKILL SHEET: CPR–INFANT, 148 Special Considerations, 172
SKILL SHEET: UNCONSCIOUS CHOKING–INFANT, 150 SUMMARY, 173
SKILL SHEET: USING AN AED–ADULT, 152 APPLICATION QUESTIONS, 174
SKILL SHEET: USING AS AED–CHILD, 154 STUDY QUESTIONS, 174
xx Contents
Chapter 23: Delayed-Help Situations, 414 PART SEVEN: HEALTHY

SCENARIO, 414
OBJECTIVES, 415
LIFESTYLES, 437
INTRODUCTION, 416 Chapter 24: A Safer and Healthier
KEY TERMS, 416
Types of Delayed-Help Situations, 416 Life, 438
Rural Areas, 416 SCENARIO, 438
Wilderness Areas, 416 OBJECTIVES, 439
Disaster Situations, 416 INTRODUCTION, 440
Taking Action in a Delayed-Help Situation, 417 KEY TERMS, 440
Check the Scene, 417 Injury, 440
Check the Victim, 417 Factors Affecting Risk of Injury, 440
Check for Resources, 419 Reducing Your Risk of Injury, 441
Call, 419 Reducing Your Risk of Illness, 450
Care, 423 Nutrition, 451
Difficult Decisions, 427 A Healthy Diet, 452
Protection from the Weather, 427 Weight, 455
Protecting the Victim, 428 Fitness, 455
Constructing Shelter, 428 Stress, 457
Preparing for Emergencies, 429 Smoking, 458
Types of Preparation, 430 Alcohol, 459
Ensuring Adequate Preparation, 431 SUMMARY, 460
SUMMARY, 432 APPLICATION QUESTIONS, 460
APPLICATION QUESTIONS, 433 STUDY QUESTIONS, 461
STUDY QUESTIONS, 434
Appendix A, Answers to Study
Questions, 464
Glossary, 478
Sources, 489
Index, 492
About This Course
WHY YOU SHOULD TAKE THIS COURSE HOW YOU WILL LEARN
People need to know what to do in an emergency Course content is presented in various ways. The
before medical help arrives. Since you, the citizen textbook, which will be assigned reading, contains
responder, are the person most likely to be first on the information that will be discussed in class. Your
the scene of an emergency, it is important that you instructor has the option to use video segments and
know how to recognize emergencies and how to re- power point display to support class discussions
spond. This course will prepare you to make ap- and other activities. These audiovisuals emphasize
propriate decisions regarding first aid care and to the key points that you will need to remember when
act on those decisions. making decisions in emergencies and will help you
The first critical step in any emergency depends give appropriate care. They also present skills that
on the presence of someone who will take appro- you will practice in class. Participating in all class
priate action. After completing this course, you activities will increase your confidence in your abil-
should be able to— ity to respond to emergencies.
• Recognize when an emergency has occurred. The course design allows you to frequently eval-
• Follow the emergency action steps: CHECK— uate your progress in terms of skills competency,
CALL—CARE for any emergency. knowledge and decision making. Certain chapters
• Provide care for injury or sudden illness until in the textbook include directions for skill practice
professional medical help arrives. sessions that are designed to help you learn specific
This course clarifies when and how to call for first aid skills. Some of the practice sessions require
emergency medical help, eliminating the confusion practice on a manikin. Others give you the oppor-
that is frequently a factor in any emergency. This tunity to practice with another person. This will
course also emphasizes the importance of a safe, give you a sense of what it would be like to care for
healthy lifestyle. The Healthy Lifestyles Awareness a real person in an emergency situation and help re-
Inventory, which your instructor will provide, produce any concerns or fears you may have about giv-
vides a means for you to evaluate your lifestyle, de- ing care. Your ability to perform specific skills com-
termine how you can improve it and help prevent petently will be checked by your instructor during
lifestyle-related illness and injury. the practice sessions.
Your ability to make appropriate decisions
when faced with an emergency will be enhanced as
you participate in the class activities. Periodically,
you will be given situations in the form of scenarios
that provide you the opportunity to apply the
knowledge and skills you have learned. These sce-
narios also provide an opportunity to discuss with
your instructor the many different situations that
you may encounter in any emergency.
xxii About This Course
REQUIREMENTS FOR COURSE If this course is taught at a college or university,

there may be additional academic requirements,
COMPLETION CERTIFICATE such as attendance and grading, that your instruc-
tor will explain to you.
When this course is taught by a currently authorized
American Red Cross instructor, you will be eligible
for an American Red Cross course completion cer-
tificate. In order for you to receive an American Red
TEXTBOOK
Cross course completion certificate, you must— This textbook has been designed to facilitate your
• Correctly answer at least 80 percent or better in learning and understanding of the knowledge and
the appropriate sections on the final written skills required to effectively respond to emergency
exam(s). situations. The following pages graphically point
• Participate in all skill sessions and scenarios. out how to use this text to your best advantage.
• Demonstrate competency in all required skills. Photographs, drawings, charts and graphs ap-
The final written exam is designed to test your pear in all chapters, which illustrate skills, concepts
retention and understanding of the course material. and anatomical features.
You will take this exam at the end of the course. If
you do not pass the written exam the first time, you
may take a second exam.
About This Course xxiii
Scenarios
Every chapter opener contains a brief
scenario that presents an event involving
some aspect of the chapter content. The
story in the scenario will be used to answer
the Application Questions in the chapter.
N o t You . . .
r a softb
all gam
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team’s
If
Who?
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n d s ar e dri Yo u ar e dis , yo ur
several
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You and fect afternoon s g
1
play off er
er u. It sw oncomin
was a p for making the r in front of yo ne to avoid an r
ec ts th e ca it s la , the ca
prosp wn to k into denly your
n is dra ers bac car. Sud ou park
attentio llow line and ve ce behind the a tree. Y As
double
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sa fe d istan sm as hes into e and get out. d in
keep a gn and t scen cracke
car. You , runs a stop si om the acciden windshield is
driver is
r
the
up fr
s
Objective
speeds nce away you notice that ou see that the to—
fe d is ta
car a sa ach the scene, d with blood. Y . be able
u should quire firs
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ro
you app rn, its edges
re
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d
is c h a pter, yo th at re
atte from th d in g th e n cies
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■ Descri n emerge in a non
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p o c a n h elp at th
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ays bys
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■ Identi ency.
emerg
Objectives
At the beginning of each chapter is a bulleted list
of objectives. Each item describes something you
should know or be able to do after reading the
chapter and participating in class activities. Read
this list carefully, and refer back to it as you read
the chapter. These objectives form the basis for
test questions on the final exam.
xxiv About This Course rce,
ternal fo n
m an ex ca
th e b ody fro . Emergencies ife-
age to a fall non-l
TROD UCTION ju ry is dam en bone from atening and an ill-
IN a brok life-thre ncy is
PART ONE such as tegorized as tening emerge ility to cir-
on
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immed
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Key Terms and strang er) and
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TYPES OF EM e first M S n th o nd
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Basic, E
SUMMARY
An em CHAPTER 1
ergency
and at ca
any tim n happen at
If Not You
(EMS) e. The any pla learnin
g
. . . Who?
sy emerge ce to recogniz 15
and med stem is a netw ncy med , to anyone to act (c
allin e an em
ic o ical serv g 9-1 erge
to victim al personnel rk of commu ices
and givi
ng care -1 or the loca ncy and dec
s of injury th at provides nity reso tim ) yo u ca l em iding
of injury ergency
EMS sy
st or su emerge urces or sudd n help save n
actions em cannot p dden illness. ncy care In the en il the life umber
of a tr ro H
ained ci perly functio owever, the manage following ch lness. of a vic-
d ap te
tizen re n
sponder without the learn em ifferent kind rs, yo
like yo ergency s of em u will learn h
any em o
u. By ergency action steps ergencies. Yo w to
life-thre situatio th u
atening n and h at you can ap will
and no ow to gi ply to
n-life-th ve
reatenin care in both
g situat
ions.
Application Questions
Application Questions, designated with a blue
heading in a pale gold box, challenge you to
apply the information you have learned and build
a solution. The questions are based on the
scenario that appears on the chapter-opening
APPLI page. These questions allow you to apply the
CATIO
1. Wha
t immed N QUE information you have been learning to a real-life
friends w ia te step
ho witnes s could you an STION situation. Answers to the Application Questions
sed the
car cras
d your
h take? 3. The
appr
S are found in Appendix A of this text.
oximate
nessed time of th
was e
not arrive 4:50 p.m. The crash you wit-
2. As yo un til 5: EMS pers
u approa arrive at 25 on
begin to ch the vi the hosp p.m., and the vi nel did
fe ctim have ca ital until ctim did
sure you el faint and naus of the car crash, us 6:
and gett ed this delay in 30 p.m. What m t
no
ca eated an you
still help n proceed any d ing him re
to the ho aching the vict ht
ig
? farther. H are not spital? im
ow can
you
About This Course xxv
Shock: The D CHAPTER 9
• An in
omino
jury caus
es severe
Effect
Shock 17
3
• The bleeding
heart
disruptio attempts to com .
n of bloo pe
• The d flow by nsate for the
victim fir be atin g
blood is st has a faster.
lo rapid pu
the puls st. As blood volu lse. More
e becom me drop
• The es weak s,
increa or hard
results in sed workload on to find.
an increa the
Therefor
e, breath se d oxygen heart
• To m ing beco demand.
aintai mes fast
to the vi n circulation of er.
tal organs blood
constric , blood ve
t in ssels
skin. Ther the arms, legs
ef an
pale or as ore, the skin ap d
• In re
sponse
hen and
heavily an to the stress,
fe els
pears
cool.
• More
blood
worsens is lost and the
Sidebars
d the sk the body . victim’s
• With condition
• Becau
se tissues
in feels
moist.
perspire
s out ox
properly ygen, the vital or
Feature articles called sidebars enhance the
without of the ar . gans fail
ms and
• The
oxygen,
brain no
ce lls start
to die.
legs are now • As th
e brai
to functio
n information presented in the main body of the text.
w sends restless, n is affected, th
the arm
s an
blood flo d legs in an at
a signal
to return consciou
drowsy
and even
e victim
becomes They appear in most chapters and have a purple
w te blood to sness. tually lose
vital orga between these mpt to balance • As th
e hear
s background. They present historical and current
ns. body pa
• Vital rts and th resulting t is affected, it
organs no
oxygen. w are no
t receivin
e in be
becomes an irregular pu ats irregularly,
chaotic ls
information and events that relate to the content
g adequa blood. and the e. The rhythm th
• The
heart trie
s to com
te • There ar
heart fails
to circul
en of the chapter. You will not be tested on any
even fast pensate e no long ate
er. by beatin
g
• When th
e heart st
er signs
of circul information presented in these sidebars as part of
• ops, brea ation.
The body
’s
for seve continuous atte
thing stop
s. the American Red Cross course completion
re blood mpt to co
SUMMARY loss even
tually re mpensate
sults in
requirements.
death.
Do no
t
care to wait for shock
a victim
follow
th of injury to develop b
ef
minimiz e general care or sudden il ore giving
e the p steps fo lness. A cies or
threaten ro r lw
ing con gression of sh any emergen ays non-lif
severe
ex
ditions, o cy e-threat ternal bleed
such as ck. Care for to key to ening co ing, bef
breathin life- manag o
g emer the loca ing sho nditions. Rem re caring for
gen- l emerge ck effect ember
as poss ively is 58 that
PAR
lling 9-1 thT eTWO
ible. ncy nu mber an ca ASSESSMENT
d givin
g care as -1 or
soon
Ta b le 4 -1 Body Systems
SYSTEM MAJOR HOW THE SYSTEM
STRUCTURES WORKS
PRIMARY FUNCTI
Respiratory ON WITH OTHER BOD
Airway and lun Y SYSTEMS
gs
Supplies the bod
y with oxygen
and removes car Works with the
Circulatory bon dio xide circulatory system
through breath to provide oxygen
Heart, blood and ing to cells; con-
blood Transports nutrien trolled by the ner
vessels ts and oxy- vous system
gen to body cell Works with the
s and re- respiratory sys
moves waste pro to provide oxygen tem
ducts to cells;
works in conjun
ction with the
urinary and dig
estive systems
to remove was
te products;
Tables Nervous
Brain, spinal cor
nerves
d and
One of two prim
systems in the
ary regulatory
helps give skin
by the nervous
Regulates all bod
color; controlled
system
body; trans- y systems
mits messages
Tables, on a light gold Musculoskeletal the brain
to and from thro ugh a network
of nerves
Bones, ligaments
, muscles
background, are included in many and tendons Provides body’s
protects interna
framework;
Provides protec
l organs and tion to organs
chapters. They summarize key other underlying
stru
allows movement ctures;
structures of oth
er body sys-
and
tems; muscle act
; produces ion is con-
concepts and information and Integumentary
heat; manufact
components
ures blood trol led by the nervous sys
tem
Skin, hair and nai
may aid in studying. ls An important par
t of the body’s
communication Helps to protec
network; t the body from
helps prevent infe disease-produci
ction and ng organisms;
dehydration; ass together with the
ists with circulatory
temperature reg system, helps to
ulation; aids regulate body
in production of temperature; und
certain er control of
vitamins the nervous sys
Endocrine tem; communi-
cates sensation
Glands to the brain
Secretes hormo through the ner
nes and other ves
substances into Together with the
Digestive blood and nervous system
onto skin coordinates the
Mouth, esopha activities of
gus, stom- other systems
ach, intestines, Bre aks down food
pan- into usable
creas, gallbladde form to supply Works with the
r and the rest of circulatory system
liver the body with ene to transport nut
Genitourinary rgy rients to the
body
Kidneys and bla
dder
Removes waste
from the circu-
latory system and
regulates
water balance
Uterus and gen
italia
Performs the pro
cess of sexual
reproduction
xxvi About This Course
FESTYLES
448 PART
SEVEN HEALTHY LI
Home Safety ent a sa s,
fety-
ts repres ce
statemen reduce your chan e.
Child Safety
w in g
The follo estyle that can ju ry in your
hom
s ou s lif , of in
arenes consci of others
ent an aw chances me are
ts repres ces of and the in my ho
llo w in g statemen reduce the chan that rw ay s and halls
The fo at can atement The stai
safety th Check each st fastened
of child ur child
. well lit. securely
ry to yo ns ki d tread or
inju
your lifes
tyle. tomobile I have no stairs.
reflects proved au s. my h of chil-
to an ap rugs on t of reac
le m y child in ak ing short trip l m ed ic ations ou t.
ck when m I keep al
I bu
at even fely in ed cabine e
safety se having sa in a lock out of th
child safe
ty by be dren and onous m
aterials binet.
h m y y po is lock ed ca
I teac ities. e is I keep an and in a
yday activ r he or sh tes children floor.
my ever wheneve reach of d to the
e my child nc es and ga m ly secure ed
I supe rv is
d m aint ai n fe
A ll ru gs ar e fir
ad ed , in a lock
ater an . s, un lo d am-
around w rrie rs to water ial fire st ore al l firearm h of ch ildren, an
as ba for potent alled
I reac
that act y home t of the ly.
ecked m s are inst place ou stored separate on the
I have ch detector and pans
Boxes ha za rd
w
s
or
and
king.
sm ok e
all items that

ca n
m un ition is
I keep th
e ha nd
in
le
w
s of po
ard whe
ts
n I am us ing them.
, you
an d s and sm h. stove tu
rn ed atements le
aced food her reac or two st ty
Boxes contain information that may I have pl ild ou t of his or , sc ho ol , ch ec ked one ge s in your lifes
y ch nter ly an
choke m da y-care ce child If you on ider making ch
e, ns
be useful or of interest to you. They I inspect
my ho m
rever m
e or whe fety and health
y should co
er’s hom l sa now.
appear throughout the textbook. babysitt fo r potentia
tim e
spends her and
ts , yo u tinguis
hazards. atem en st fire ex
d on e or two st ur lifes tyle n o f th e neare
ds
ly checke anges in
yo Locatio it e hazar
If you on ider making ch k t wher l-
co ns first aid en vi ronmen ment and fo
ip
should in an equ yers
If yo u work mended safety ). Both emplo by
now. ea r recom
(F le ig. 24-5 s issued
ould on
ly exist, w cedures llow safety ru
board sh velope (the fety pro
diving en low sa loyees must fo
iv ing from a a safe diving and to the and em
p
• D there is w
of, belo eep enough
occur if ater in front at is d
of w ard th om , re-
area g bo bott
f a divin rike the er or the
sides o er will not st e wat
d iv o f th
that a epth
of the d cy
gardless the pool). nce poli
of ’s insura
design h om eowner
yo ur
STUDY re
Make su e pool.
covers
th
QUES CHAPTER 24
A Safer an d of thei
r
1. Match
each term
with the
TIONS d oHerkalthie
Safety at W endrapLifeprox46
one-thir
im1ately ork, you shou
at w
ld
re-
correct de le sp fety ent are
a. Car finiti on. st peop
Mo prove sa
o im and/or
equipm
bohy
b. Obesi drates work. T following: othing
day at afety cl
ty ar e of the dures onse 24 -5 S
e. Aerob be aw Fi gu re r some jobs.
c. Stres n proce ncy resp l emer-
s ic
f. Satur exercise acuatio your emerge quired
fo
d. Cardi
orespira ated fat Fire ev tiva te -1 or the loca
ac -1
enduranc tory g. Calor
ie How to how to call 9
d
e team an mber
_____ A n cy n u
measure ge
of the en
_____ A ergy valu
physiolo e of food
physical gi ca l or .
, mental psychological re
or emotio sp
_____ Th
e ability nal bala onse to real or im
to take in nce. agined in
_____ Th , deliver fluences
e fat in an and extr that alte
im al ac t ox yg r an exis
_____ A tissues an en for ph ting stat
ctivities d produc ysical w e of
that requ ts. ork.
skeletal ire additiona
muscles l effort by
_____ A for oxyg the hear
condition en. t and lung
_____ C characte s to mee
ompoun rized by t the incr
ds that co excess of eased de
2. Fill in
functions
the blan
. nt ai n carbon
, oxygen
stored bo
and hydr
dy fat.
ogen; th
mand by
the
Study Questions
ks with e main so
the corr urce of en
The lead
ing caus
ect word
or words ergy for
all body At the end of each chapter are a series
e of deat .
of death
is _____
h in the
United S of Study Questions designed to test
_____. ta te s is ___
3. List th
ree way
The lead
ing caus
e of deat
______
_. The di
sease th
your retention and understanding of
s to redu h for pe at is the
ce your
risk of pe
rsonal in
ople ages
1 to 39
leading
cause the chapter content and key terms.
jury. is _____
_____.
4. List tw
Completing these questions will help
o motor-v
ehicle sa
fety guid you determine how well you understand
elines.
5. List fo
ur guidel
the material and also help you prepare
ines for
what to
do in ca
se the bu
for the final written exam. The answers
ilding yo
u are in
catches to Study Questions are located in
fire.
6. When
Jake lear Appendix A of this text. Write the
could do ne d
to make that his grandm answers in your textbook and use
make th it ot
e hall sa safer for her. W her had fallen
fer? hat haza in
rds might the upstairs ha additional paper, if necessary.
he have ll, he wen
discover t to
7. Your
2-year-o ed in the her house to se
hall? Wha e
ld nephew
is comin t could he what he
g to visi do to
t. What ca
n you do
to make
your kitc
hen safe
?
About This Course xxvii
108 PART THREE

LIFE-THREATENING EME
RGENCIES
SKILL SHEE
T Conscious
Choking—
Adult
Skill Sheets Step 1

CHECK scene, the
n CHECK person.
At the end of certain chapters, Skill
Sheets give step-by-step directions Step 2
for performing specific skills. Have someone
CALL 9-1-1.
Learning specific skills that you will Step 3
need to give appropriate care for 4
Obtain consent.
victims of sudden illness or injury is
an important part of this course. Step 4
Photographs enhance each skill Lean the person
forward and giv
sheet. Skill Sheets are presented on the heel of your
hand.
e 5 back blows
with
a purple background with their titles
in a pale gold border.
Step 5
Give 5 quick, up
wa rd abdominal thr 5a
usts.
NOTE: Give chest
thrusts to a chok
pregnant or too ing person who
big for you to rea is
ch around.
NOTE: You can giv
e yourself abdomi
using your hand
s, just as you wo nal thrusts by
person, or lean uld do to another
over and press
any firm object your
such as the back abdomen against
of a chair.
5b
Step 6
Continue back blo
ws and abdomina
l thrusts until—
• Object is for
ced out.
• Person can
breathe or cough
• Person becom forcefully.
es unconscious.
5c
HOW TO USE THIS TEXTBOOK

You should complete the following five steps for 5. Answer the Study Questions at the end of each
each chapter to gain the most from this course: chapter. Mark or write your answers in the text
1. Read the chapter objectives before reading the to facilitate your review or study. Answer as
chapter. many questions as you can without referring to
2. As you read the chapter, keep the objectives in the chapter. Then review the information cover-
mind. When you finish, go back and review the ing any questions you were unable to answer,
objectives. Check to see that you can meet them and try them again. Check your responses to the
without difficulty. questions with the answers in Appendix A. If
3. Review figures and illustrations. Read captions you have not answered a question appropriately,
and labels. reread that part of the chapter to ensure that you
4. Answer the Application Questions at the end of understand why the answer is correct. This exer-
each chapter. Check your answers with those in cise will help you gauge how much information
Appendix A. If you cannot answer or do not un- you are retaining and which areas you need to
derstand the answers given, ask your instructor review. If, after rereading that part of the chap-
to help you with concepts or questions with ter, you still do not understand, ask your in-
which you are having difficulty. structor to help you.
For the Instructor
Overview of Features
The following provides a preview for instructors of new features and
content in this fourth edition of Responding to Emergencies.
New Content:
• Adult Automated External Defibrillator (AED) focuses on typical
AED equipment, using an AED safely for a victim of sudden cardiac
arrest and working with EMS
• Child Automated External Defibrillator (AED) information, skills
and recognizing cardiac emergencies in infants and children under
8 years old
New Chapter:
• Before Giving Care gives you important information about legal
considerations, preventing disease transmission and emergency moves
New Skill Sheets provide a close-up perspective of the skill sequence being
taught providing an easy-to-use reference to keep skills sharp
Streamlined CPR skills increase the ability of the student to remember skills
when they are needed
Nationally recognized course completion certificate. American Red Cross

First Aid, CPR and AED training is standardized and recognized by many
national, state and local authorities
Courses developed by experts. American Red Cross materials are developed

in collaboration with leading educational and medical authorities and reflect
the most current information and techniques. Red Cross CPR and first aid
courses are based on the 2005 Consensus on Science for CPR and Emergency
Cardiovascular Care (ECC) and the 2005 Guidelines for First Aid.
Team Up with the American Red Cross—the Most Trusted Name in Health
and Safety Training for More than 90 years.
For additional health and safety and disaster preparedness resources, visit
www.redcross.org today or contact your local American Red Cross chapter.
Health Precautions xxix
Health Precautions
HEALTH PRECAUTIONS AND GUIDELINES not be asked to explain why in your request. The manikin will
not be used by anyone else until it has been cleaned according
DURING FIRST AID TRAINING to the recommended end-of-class decontamination procedures.

Because the number of manikins available for class use is lim-
ited, the more advance notice you give, the more likely it is that
The American Red Cross has trained millions of people in first you can be provided a separate manikin.
aid and CPR (cardiopulmonary resuscitation) using manikins
as training aids.
The Red Cross follows widely accepted guidelines for
cleaning and decontaminating training manikins. If these guide-
GUIDELINES
lines are adhered to, the risk of any kind of disease transmis-
sion during training is extremely low. In addition to taking the precautions regarding manikins, you
To help minimize the risk of disease transmission, you can further protect yourself and other participants from infec-
should follow some basic health precautions and guidelines tion by following these guidelines:
while participating in training. You should take precautions if • Wash your hands thoroughly before participating in class
you have a condition that would increase your risk or other activities.
participants’ risk of exposure to infections. Request a separate • Do not eat, drink, use tobacco products or chew gum dur-
training manikin if you— ing classes when manikins are used.
• Have an acute condition, such as a cold, a sore throat or • Clean the manikin properly before use.
cuts or sores on the hands or around your mouth. ■ For some manikins, this means vigorously wiping the
• Know you are seropositive (have had a positive blood test) manikin’s face and the inside of its mouth with a clean
for hepatitis B surface antigen (HBsAg), indicating that gauze pad soaked with either a fresh solution of liquid
you are currently infected with the hepatitis B virus. chlorine bleach (1⁄4 c sodium hypochlorite per gallon of
• Know you have a chronic infection indicated by long-term tap water) or rubbing alcohol. The surfaces should re-
seropositivity (long-term positive blood tests) for the he- main wet for at least 1 minute before they are wiped
patitis B surface antigen (HBsAg)* or a positive blood test dry with a second piece of clean, absorbent material.
for anti-HIV (that is, a positive test for antibodies to HIV, ■ For other manikins, it means changing the manikin’s
the virus that causes many severe infections including face. Your instructor will provide you with instructions
AIDS). for cleaning the type of manikin used in your class.
• Have had a positive blood test for hepatitis C (HCV). • Follow the guidelines provided by your instructor when
• Have a type of condition that makes you unusually likely practicing skills such as clearing a blocked airway with
to get an infection. your finger.
To obtain information about testing for individual health
status, go to: www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm
*A person with hepatitis B infection will test positive for

the hepatitis B surface antigen (HBsAg). Most persons infected
PHYSICAL STRESS AND INJURY
with hepatitis B will get better within a period of time. How- Successful course completion requires full participation in
ever, some hepatitis B infections will become chronic and will classroom and skill sessions, as well as successful performance
linger for much longer. These persons will continue to test pos- in skill and knowledge evaluations. Due to the nature of the
itive for HBsAg. Their decision to participate in CPR training skills in this course, you will be participating in strenuous ac-
should be guided by their physician. tivities, such as performing cardiopulmonary resuscitation
(CPR) on the floor. If you have a medical condition or disabil-
After a person has had an acute hepatitis B infection, he or ity that will prevent you from taking part in the skills practice
she will no longer test positive for the surface antigen but will sessions, please let your instructor know so that accommoda-
test positive for the hepatitis B antibody (anti-HBs). Persons tions can be made. If you are unable to participate fully in the
who have been vaccinated for hepatitis B will also test positive course, you may “audit” the course and participate as much as
for the hepatitis antibody. A positive test for the hepatitis B an- you can or desire. In order to audit a course, you must let the
tibody (anti-HBs) should not be confused with a positive test instructor know before the training begins. Be aware that you
for the hepatitis B surface antigen (HBsAg). will not be eligible to receive a course completion certificate.
If you decide you should have your own manikin, ask your
instructor if he or she can provide one for you to use. You will
Part
ONE
Introduction
1 If Not You . . . Who?
2 Emergency
Responding to an
3 Before Giving Care

Chapter 1 You and several friends are driving home after a softball game. It
was a perfect afternoon for a game. You are discussing your team’s
prospects for making the play-offs when, several times, your
attention is drawn to the car in front of you. It swerves across the
double yellow line and veers back into its lane to avoid an oncoming
car. You keep a safe distance behind the car. Suddenly, the car
speeds up, runs a stop sign and smashes into a tree. You park your
car a safe distance away from the accident scene and get out. As
you approach the scene, you notice that the windshield is cracked in
a star pattern, its edges red with blood. You see that the driver is
motionless and bleeding from the forehead.
If Not You . . .
Who?
Objectives
After reading this chapter, you should be able to—
■ Describe two types of emergencies that require first aid.
■ Describe your role in an emergency situation.
■ Identify the most important action you can take in a non-life-
threatening emergency.
■ List five common barriers to action that may prevent people from
responding to emergencies.
■ Identify six ways bystanders can help at the scene of an
emergency.
4 PART ONE INTRODUCTION
Introduction
jury is damage to the body from an external force,
such as a broken bone from a fall. Emergencies can
also be categorized as life-threatening and non-life-
threatening. A life-threatening emergency is an ill-
An emergency is a situation demanding ness or injury that impairs a victim’s ability to cir-
immediate action. An emergency can happen culate oxygenated blood to all the parts of his or
at any place (on the road, in your home, her body. A non-life-threatening emergency is a sit-
uation that does not have an immediate impact on
where you work), to anyone (a friend, relative,
a victim’s ability to circulate oxygenated blood, but
stranger) and at any time. This text provides still requires medical attention. You will learn more
you with basic first aid information and skills about caring for life-threatening and non-life-
so that you will recognize and respond to any threatening emergencies as you progress through
emergency appropriately. Your response may this text.
help save a life.
YOUR ROLE IN AN EMERGENCY
The emergency medical services (EMS) system is a
TYPES OF EMERGENCIES network of community resources and medical per-
sonnel that provides emergency care to victims of
There are two types of emergencies that require first life-threatening injury or sudden illness. Think of
aid: sudden illness or an injury. A sudden illness is the EMS system as a chain made up of several links.
a physical condition that requires immediate med- Each link depends on the others for success. With-
ical attention. Examples of sudden illness include a out the involvement of citizen responders such as
heart attack and a severe allergic reaction. An in- you, the EMS system cannot function effectively. As
K E Y T E R M S
Barriers to action: Reasons for not acting or for First aid: Immediate care given to a victim of in-
hesitating to act in an emergency situation. jury or sudden illness until more advanced care
Citizen responder: A layperson (someone who can be obtained.
does not have special or advanced medical First responder: A person trained in emergency
training or skill) who recognizes an emergency care that may be called on to give such care as
and decides to act. a routine part of his or her job.
Emergency: A situation requiring immediate Good Samaritan laws: Laws that protect people
action. who willingly give first aid without accepting
Emergency medical services (EMS) personnel: anything in return.
Trained and equipped community-based per- Injury: Damage that occurs when the body is sub-
sonnel who provide emergency care for ill or jected to an external force, such as a blow, a
injured victims and who are often dispatched fall, a collision, an electrical current or tem-
through a local emergency number. perature extremes.
Emergency medical services (EMS) system: A net- Life-threatening emergency: An illness or injury
work of community resources and medical that impairs a victim’s ability to circulate oxy-
personnel that provides emergency care to vic- genated blood to all the parts of his or her body.
tims of injury or sudden illness. Non-life-threatening emergency: A situation that
Emergency medical technician (EMT): A person does not have an immediate impact on a vic-
who has successfully completed a state- tim’s ability to circulate oxygenated blood, but
approved emergency medical technician train- still requires medical attention.
ing program. The levels of EMTs are the EMT- Sudden illness: A physical condition requiring
Basic, EMT-Intermediate and EMT-Paramedic. immediate medical attention.
CHAPTER 1 If Not You . . . Who? 5
The EMS System

EMS CALL TAKER
EMS call takers work in emergency
communications centers. When 9-1-1
is dialed, the call taker receives
the call and quickly determines
what help is needed. He or she
then dispatches the appropriate
EMS personnel. An increasing
number of call takers are trained
emergency medical dispatchers and can
provide instructions on how to help until
EMS personnel arrive.
FIRST RESPONDER
First responders are often the first people
you turn to for help at the scene of an emergency.
They may be firefighters, law enforcement officers,
lifeguards, industrial safety officers or people with
similar responsibility for the safety or well-being of
the community. Because of the nature of their jobs,
they are often close to the scene and have the
necessary supplies and equipment to give care. First
responders provide a critical transition between a and care for both life-threatening and non-life-
citizen responder’s basic level of care and the care threatening emergencies.
provided by more advanced EMS personnel.
Emergency Medical Technician-Intermediate
EMERGENCY MEDICAL TECHNICIANS An EMT-Intermediate has more advanced training
Emergency medical technicians (EMTs) are trained that allows him or her to perform techniques such as
medical professionals who are dispatched to an administering medications and intravenous fluids.
emergency by the call taker. Once the emergency
medical technicians arrive, they determine the EMT-Paramedics
victim’s condition and give advanced care. There are EMT-Paramedics are highly specialized emergency
three levels of training and certification—EMT-Basic, medical technicians. In addition to performing basic
EMT-Intermediate and EMT-Paramedic. life-support skills, paramedics can administer
medications and intravenous fluids, provide advanced
Emergency Medical Technician-Basic airway care and perform other advanced lifesaving
(EMT-Basic) techniques. They are trained to handle a wider range
In most of the United States, ambulance personnel of conditions. Paramedics function at the highest level
are certified at least at the EMT-Basic level. The of out-of-hospital care.
EMT-Basic is trained to assess a victim’s condition
a citizen responder, your primary role in an emer-

gency includes— Unusual Noises
Recognizing that an emergency exists. Unusual noises are often the first indicators that call
Deciding to act. your attention to an emergency. Some noises that
Taking action by calling 9-1-1 or the local may indicate an emergency include—
emergency number.
Giving care until medical help arrives. Screaming, yelling, moaning or calling for help.
Breaking glass, crashing metal or screeching
In the first few minutes of an emergency, a citizen tires.
responder trained in first aid can provide help Sudden, loud or unidentifiable sounds.
that can save a life or make the difference be- Unusual silence.
tween a complete recovery and permanent disability
(Fig. 1-1, A-D).
Unusual Sights
RECOGNIZING EMERGENCIES Unusual sights can also be a common indicator that
an emergency has occurred. Sights that indicate a
possible emergency include—
The ability to recognize that an emergency has oc-
curred is the first step toward taking appropriate A stopped vehicle on the roadside, especially in
action (Table 1-1). You may become aware of an an unusual position.
emergency from certain indicators, including un- Broken glass.
usual noises, sights, odors, appearance or behavior An overturned pot on the kitchen floor.
(Fig. 1-2, A-D).
A B
C D
Figure 1-1 The role of the citizen responder includes A, recognizing an emergency,
B, deciding to act, C, calling 9-1-1 or the local emergency number, and D, giving
care until EMS personnel arrive.
A spilled medicine container.

Downed electrical wires.
Sparks, smoke or fire.
Unusual Odors A
Odors are part of our everyday lives, such as gaso-
line fumes at gas stations or smoke from a bonfire.
However, when odors are stronger than usual, not
easily identifiable or otherwise seem inappropriate,
they may indicate an emergency. Always put your
own safety first if you smell an unusual or very
strong odor, because many fumes are poisonous. An
unusual odor on a person’s breath may also be a
clue to an emergency situation. A person experienc-
ing a diabetic emergency, for example, may have a
breath odor that can be mistaken for the smell of al-
cohol. You will learn about diabetic emergencies in
Chapter 15. B
Table 1-1 Recognizing Emergencies

COMMON
INDICATORS EXAMPLES
Unusual noises Screams, yells, moans or calls for

help
Breaking glass, crashing metal,
screeching tires
Sudden, loud or unidentifiable C
sounds
Unusual silence
Unusual sights Stopped vehicle on the roadside
Broken glass
Overturned pot in kitchen
Spilled medicine container
Downed electrical wires
Sparks, smoke or fire
Unusual odors Odors that are stronger than usual
Unrecognizable odors
Inappropriate odors
Unusual Unconsciousness
appearance Confused or unusual behavior D
or behavior Trouble breathing
Clutching chest or throat
Slurred, confused or hesitant speech
Unexplainable confusion or
drowsiness
Sweating for no apparent reason
Uncharacteristic skin color
Inability to move a body part Figure 1-2 A-D, Unusual sights may indicate an
emergency.
Unusual Appearance or Behavior These and other appearances and behaviors

may occur alone or together. For example, a heart
attack may be indicated by chest pain alone or may
It may be difficult to tell if someone’s appearance or
be accompanied by sweating and trouble breathing.
behavior is unusual, particularly if he or she is a
You will learn more about the signals of a heart at-
stranger. Certain behaviors or appearances could
tack in Chapter 7.
indicate an emergency (Fig. 1-3). If you see someone
collapse to the floor, he or she obviously requires
your immediate attention. You will not know if
your help is needed until you approach the victim.
He or she may merely have slipped and may not
DECIDING TO ACT
need your help. On the other hand, the person may Once you recognize that an emergency has occurred,
be unconscious and need immediate medical assis- you must decide to act. Calling 9-1-1 or the local
tance. Other behaviors and appearances that could emergency number is the most important action you
indicate an emergency may be less obvious. They and other citizen responders can take. Early arrival
include— of EMS personnel increases the victim’s chances of
Unconsciousness. surviving a life-threatening emergency.
Confused or unusual behavior.
Trouble breathing.
Clutching the chest or throat. Overcoming Barriers to Action
Slurred, confused or hesitant speech.
Unexplainable confusion or drowsiness. Sometimes people simply do not recognize that an
Sweating for no apparent reason. emergency has occurred. At other times, people rec-
Uncharacteristic skin color—pale, ashen, ognize an emergency but are reluctant to act. People
flushed or bluish skin. have various reasons for hesitating or not acting.
Inability to move a body part. These reasons are called barriers to action. Common
reasons people give for not acting include—
The presence of bystanders.
Uncertainty about the victim.
The nature of the injury or illness.
Fear of disease transmission.
Fear of not knowing what to do or of doing
something wrong.
Being unsure of when to call 9-1-1.
Thinking about these barriers and mentally
preparing yourself to overcome them will help you
respond more confidently when an actual emer-
gency occurs.
Presence of Bystanders
Bystanders can cause confusion at an emergency
scene. It may not be easy to tell if anyone is giving
first aid. In every emergency situation you should al-
ways ask if help is needed. Do not assume, just be-
cause a crowd has gathered, that someone is caring
for the victim. You may feel embarrassed about
coming forward in front of strangers. Do not let this
feeling deter you from offering help when needed.
You may be the only one at the scene who knows
Figure 1-3 Unusual appearance may indicate an first aid. If someone else is already giving care, offer
emergency. to help. Ensure that the crowd does not endanger it-
Figure 1-5 You may need to respond to an emergency

involving someone whom you do not know.
you can always take some type of action to help:

Figure 1-4 Bystanders can help you respond to call 9-1-1 or the local emergency number, volunteer
emergencies. to meet and guide EMS personnel to the scene or as-
sist those who are giving care.
Sometimes victims of injury or sudden illness
may act strangely or be uncooperative. The injury
self or the victim. Sometimes you may need to ask or illness, stress or other factors, such as the influ-
bystanders who are not helping to back away and ence of alcohol or other substances, may make peo-
give the victim and responders ample space. ple act offensively. Do not take such behavior per-
Bystanders can be of great help in an emergency sonally. Remember, an emergency can cause even
(Fig. 1-4). You can ask them to call for, meet and di- the nicest person to act angry or unpleasant. If the
rect the ambulance; keep the area free of unneces- victim’s attitude or behavior keeps you from caring
sary traffic; or help you give first aid. You might for him or her, you can still help. Call 9-1-1 or the
send them for blankets or other supplies. By- local emergency number. Once the EMS system has
standers may have valuable information about been activated, manage bystanders and attempt to
what happened or may know the victim’s medical reassure the victim. If at any time the victim’s be-
history. Bystanders can also help comfort the victim havior becomes a threat to you, you should with-
and others at the scene. draw from the immediate area.
Uncertainty About the Victim Nature of the Injury or Illness

Because most emergencies happen in or near the An injury or illness may sometimes be very unpleas-
home, you are more likely to give care to a friend or ant to handle. The presence of blood, vomit, un-
family member than to a stranger (Fig. 1-5). How- pleasant odors or torn or burned skin may disturb
ever, this is not always the case. You may not know you. You cannot predict how you will respond to
the victim and feel uncomfortable with the idea of these and other factors in an emergency. Sometimes
touching a stranger. You may hesitate to act because you may need to compose yourself before acting. If
the victim may be much older or younger than you, you must, turn away for a moment and take a few
be of a different gender or race, not speak the same deep breaths, then give care. If you are still unable to
language or have a disabling condition. However, give care, you can help in other ways, such as vol-
despite your reluctance, it is important to remember unteering to call 9-1-1 or the local emergency num-
that the victim is a person in need of help and that ber or managing other bystanders at the scene.
may think. In Chapter 3, you will learn how to take

Fear of Disease Transmission steps, such as hand washing and using protective
Today, many people worry about the possibility of barriers, to prevent disease transmission.
being infected with a disease while providing first
aid. Although diseases can be transmitted in a
first aid situation, the actual risk is far less than you
Fear of Doing Something Wrong
We all respond to emergencies in different ways.
Whether trained or untrained, some people are
afraid of doing the wrong thing and making the
situation worse. Sometimes people worry that they
might be sued. Do not be overly concerned about
this. Lawsuits against those who give emergency
care are highly unusual and rarely successful. All
states have enacted Good Samaritan laws that pro-
tect people who willingly give first aid without ac-
cepting anything in return. See page 32 for more in-
A formation on Good Samaritan laws.
It is not uncommon for people to have feelings
that make them hesitate or fail to help. These barri-
ers to action are personal and very real to the peo-
ple who experience them. The decision to act is
yours alone. Your decision to respond to emergen-
cies should be guided by your own values, as well as
by knowledge of the risks that may be present in
various rescue situations.
TAKING ACTION
The Emergency Medical Services
B
(EMS) System
The emergency medical services (EMS) system is a
network of community resources and medical per-
sonnel that provides emergency care to victims of
injury or sudden illness. As a citizen responder, you
are responsible for activating this system by calling
9-1-1 or the local emergency number.
When You Call 9-1-1

C When you call 9-1-1 or the local emergency num-
ber, your call will be automatically routed to the
police, fire or EMS system (Fig. 1-6, A). When
your call is answered, you will talk to an emer-
gency call taker who has had special training in
dealing with crises over the phone. The call taker
will ask you for a phone number and address of
Figure 1-6 A-C, Many call takers give instructions to the emergency and will ask other key questions to
citizen responders for what to do before EMS personnel determine whether you need police, fire or EMS
arrive. assistance (Fig. 1-6, B).
It may seem that the call taker asks a lot of ques- dispatchers today are also trained to give instructions
tions. The information you give helps the before EMS personnel arrive. These pre-arrival in-
dispatcher to send the type of help needed, based on structions, combined with your first aid training,
the severity of the emergency. Once the ambulance is help to ensure an effective emergency response.
on its way, the call taker may ask you to stay on the When using a mobile phone to call 9-1-1, it is
line and continue to talk to you (Fig. 1-6, C). Many important to know that the system that identifies a
Wireless 9-1-1: Hundreds of

Millions Served
The 9-1-1 service was created in the United States in 1968 as a
nationwide telephone number for the public to use to report
emergencies and request emergency assistance. It gives the
public direct access to an emergency communication center
called a Public Service Answering Point, which is responsible for
taking the appropriate action. The numbers 9-1-1 were chosen
because they best fit the needs of the public and the telephone
companies. They are easy to remember and dial, and they have
never been used as an office, area or service code. Today, an
estimated 200 million people call 9-1-1 each year. At least 99
percent of the population and 96 percent of the geographic
United States is covered by some type of 9-1-1 service. Give the emergency operator your wireless phone number
There are two types of 9-1-1 systems—Basic and Enhanced. so that if the call gets disconnected, he or she can call you
A Basic 9-1-1 system automatically routes the emergency call to back.
the Public Service Answering Point that handles the area where If your wireless phone is not “initialized” (i.e., you do not
the phone is located. An Enhanced 9-1-1 system automatically have a contract for service with a wireless service provider),
displays the telephone number, address and name in which the and your emergency call gets disconnected, you must call
phone is listed. If the caller is unable to remain on the line or is the emergency operator back because he or she does not
unable to speak or if the call is disconnected, the call taker can have your telephone number and cannot contact you.
still obtain enough information to send help. Some 9-1-1 Learn to use the designated number in your state for
systems can reconnect a caller and transfer callers to other highway accidents or other non-life-threatening incidents.
agencies or telephone numbers with a single button. Often states reserve specific numbers for these types of
According to the Federal Communications Commissions (FCC) incidents. For example, “#77” is the number used for
over 50 million people a year use wireless phones to call 9-1-1. highway accidents in Virginia. The number to call for non-
That is more than double the number of people who used a life-threatening incidents in your state can be located in the
wireless phone to activate the EMS in 1995. However, wireless front of your phone book.
phones are not associated with one fixed location or address, Refrain from programming your phone to automatically
which can make it difficult to accurately determine the location dialing 9-1-1 when one button such as the “9” key is
of the caller or the emergency. pressed. Unintentional wireless 9-1-1 calls, which often
Current and future development of the 9-1-1 system includes occur when auto-dial keys are inadvertently pressed, cause
initiatives to integrate the wireless technology more effectively. problems for emergency service call centers.
The FCC has adopted a variety of 9-1-1 rules aimed at improving If your wireless phone came pre-programmed with the
the system’s ability to locate wireless 9-1-1 callers. These rules auto-dial 9-1-1 feature already turned on, turn this feature
apply to all cellular phone licensees, broadband Personal off. Check your user manual to find out how.
Communication Service and certain Special Mobile Radio Lock your keypad when you are not using your wireless
licensees. phone. This action also prevents accidental calls to 9-1-1.
Because wireless 9-1-1 location information is not available
everywhere it is important to remember the following tips when SOURCES:
DISPATCH Monthly Magazine, www.911.dispatch.com. Accessed 6/24/04.
using a wireless phone to call 9-1-1: Federal Communications Commission, www.fcc.gov/911/enhanced .
Tell the emergency operator the location of the emergency Accessed 6/24/04.
right away. National Emergency Number Association, www.nena.org . Accessed 6/24/04.
caller’s location and telephone is still in its infancy

and is not available everywhere. Therefore, you
should tell the call taker the location of the emer-
gency and your mobile phone number in case you
are disconnected.
Until Help Arrives

There are many actions you, other citizen respon-
ders or bystanders can take before EMS personnel
arrive. Always follow the pre-arrival instructions
provided by the call taker. These instructions may Figure 1-7 Keep important information in handy
range from taking actions that make the scene safer places, such as in your car’s glove compartment.
and more accessible to EMS personnel (confining
household pets, turning on extra lights, gathering
the victim’s medications) to giving more advanced
care. You will learn to give more advanced care for
an ill or injured person as you progress through this
Find out if your community is served by the
course.
9-1-1 system. If not, look up the local emer-
gency number for police, fire, EMS services
and poison control. These numbers are usually
PREPARING FOR EMERGENCIES listed in the front of the telephone book.
Teach children how to call for help as soon as
they are old enough to use the telephone.
If you are prepared for emergencies, you can help
Keep emergency telephone numbers listed
ensure that care begins as soon as possible—for
in a handy place, such as by the telephone and
yourself, your family and your fellow citizens. Steps
in your first aid kit. Include the home and
you can take in preparing for an emergency include
office phone numbers of family members,
becoming trained in first aid and making or pur-
friends or neighbors who can help. Be sure to
chasing a first aid kit.
keep both the list and the telephone numbers
First aid training provides you with both the
current.
knowledge and skills necessary to respond confi-
Keep a first aid kit readily available in your
dently to emergency situations. Your training will
home, automobile, workplace and recreation
give you a basic plan of action to use in any emer-
area (Fig. 1-8). Store each kit in a dry place
gency. You will be better able to manage your fears
and replace used contents regularly. A first aid
and overcome barriers to action by knowing what
kit should contain the following:
to do. Your training will enable you to respond
• 2 absorbent compress dressings (5 9
more effectively in your role as a citizen responder.
inches)
You can be ready for most emergencies if you
• 25 adhesive bandages (assorted sizes)
do the following things now:
• 1 adhesive cloth tape (10 yards 1 inch)
Keep important information about you and • 5 triple antibiotic ointment packets
your family or household in a handy place, (approximately 1 gram each)
such as on the refrigerator door and in your • 5 antiseptic wipe packets
automobile glove compartment (Fig. 1-7). In- • 2 packets of aspirin (81 mg each)
clude your address, everyone’s date of birth, • 1 blanket (space blanket)
medical conditions, allergies, and prescriptions • 1 breathing barrier (with one-way valve)
and dosages. List everyone’s physicians’ names • 1 instant cold compress
and phone numbers. • 2 pairs of nonlatex gloves (size: large)
Keep medical and insurance records up to • 2 hydrocortisone ointment packets
date. (approximately 1 gram each)
MedicAlert is a Federally Registered Trademark and Service Mark. © 2006. All Rights Reserved.
Figure 1-8 It is important to keep a well-stocked
first aid kit in your home, automobile, workplace and
recreation area.
Figure 1-9 Medical ID tags and bracelets can provide
important medical information about a victim.
• Scissors
• 1 roller bandage (3 inches wide)
• 1 roller bandage (4 inches wide)
SUMMARY
• 5 sterile gauze pads (3 3 inches) An emergency can happen at any place, to anyone
• 5 sterile gauze pads (4 4 inches) and at any time. The emergency medical services
• Oral thermometer (nonmercury/nonglass) (EMS) system is a network of community resources
• 2 triangular bandages and medical personnel that provides emergency care
• Tweezers to victims of injury or sudden illness. However, the
• First aid booklet EMS system cannot properly function without the
Learn first aid and cardiopulmonary resuscita- actions of a trained citizen responder like you. By
tion (CPR) skills, and practice regularly. learning to recognize an emergency and deciding
Make sure your house or apartment number to act (calling 9-1-1 or the local emergency number
is easy to read. Numerals are easier to read and giving care) you can help save the life of a vic-
than spelled-out numbers. Report any tim of injury or sudden illness.
downed or missing street signs to the proper In the following chapters, you will learn how to
authorities. manage different kinds of emergencies. You will
Wear a medical ID bracelet if you have a po- learn emergency action steps that you can apply to
tentially serious medical condition, such as any emergency situation and how to give care
epilepsy, diabetes, heart disease or in both life-threatening and non-life-threatening
allergies (Fig. 1-9, A-B). situations.
Honoring Our Heroes:

The Red Cross
Certificate of Merit
The Certificate of Merit is the highest honor
that the American Red Cross awards to citi-
zens. The Red Cross confers this certificate
on individuals who are not part of the com-
munity’s emergency medical system but
who save or sustain a victim’s life with
skills learned in an American Red Cross
Health and Safety course.
Although the survival of the victim is not
a criterion for eligibility for the award, nomi-
nees for the award must have performed
every possible lifesaving skill prior to the
victim’s receiving medical care. Sometimes
team certificates are awarded. In such a
case, each member of the team must con-
tribute directly to the lifesaving act.
The Certificate of Merit program began in
1911 and was originally a cash award given
annually to four railway workers who per-
formed first aid. The next year, the Red
Cross decided to recognize four individuals
from the general public who demonstrated exemplary saving skills in a variety of different places and situations.
first aid skills. In 1915, water safety skills and rescues A 15-year-old gives rescue breathing to her father who
were included in the certificate criteria. From 1912 to suffers a stroke at home. A day-care worker gives ab-
1925, the Red Cross gave cash awards to 66 individuals. dominal thrusts to a 5-year-old who is choking on food
In 1928, the Red Cross reevaluated its cash award during lunch. A woman controls bleeding, cares for shock,
program. Because the cash awards could be given only to and checks breathing and signs of life for a victim of a
a few individuals a year and because the rescuers did not stabbing at a gas station. During a water emergency, a
receive any lasting reminder of the award, the Red Cross man frees a companion from underneath an overturned
decided to eliminate the cash award and institute the canoe, splints the victim’s broken leg, gives care for
present-day Certificate of Merit. The certificate is signed hypothermia and cares for shock.
by the President of the United States, who is also the Perhaps the one common element in all these cases is
honorary chairman of the American Red Cross (a tradition that the rescuer provided lifesaving skills in an emotion-
begun in 1913 by William Howard Taft), and often ally charged situation. These individuals demonstrate that
awarded in a local ceremony. Over 12,000 individuals life-sustaining first aid care can be rendered even when
have received a Certificate of Merit since 1911. the emergency threatens the life of a loved one, a child or
What kinds of people receive Certificates of Merit? A a badly injured stranger. An American Red Cross training
brief look at those individuals who were honored in previ- course can teach you the practical skills you need to help
ous years reveals that honorees come from all walks of a person in danger and can equip you to handle an emer-
life, are of all ages, from 4 to 76, and perform their life- gency even when you are frightened or feel panic.
STUDY QUESTIONS
1. In each of the following three scenarios, circle the indicators of a potential emergency.
a. I was fixing sandwiches and talking with my next-door neighbor, Mrs. Roberts, who had come by to
borrow a book. My 3-year-old, Jenny, was in the next room playing with some puzzles. As Mrs. Roberts
got up to leave, I heard a loud thump and a shriek from upstairs.
b. I was on the bus headed for work. A man from the back of the bus came down the aisle, and I noticed
that he was moving unsteadily. It was cold in the bus, but I noticed he was sweating and looked very
pale. “I don’t know where I am,” I heard him mumble to himself.
c. On my way into the grocery store from the parking lot, I heard the loud screech of tires and the crash of
metal. I saw that a car had struck a telephone pole, causing the telephone pole to lean at an odd angle.
Wires were hanging down from the pole. It was very frightening.
2. List five common barriers to taking action at the scene of an emergency.
3. How can a citizen responder overcome each of these barriers to action?

4. Match each term with the correct phrase.
a. First aid d. Sudden illness

b. Citizen responder e. EMS system
c. Emergency f. Barriers to action
_____ A situation that requires immediate action.
_____ A network of community resources and medical personnel that provides emergency care to victims
of injury or sudden illness.
_____ The immediate care given to a victim of injury or sudden illness until more advanced care can be
obtained.
_____ A physical condition, such as a heart attack, requiring immediate medical attention.
_____ A layperson (someone who does not have special or advanced medical training or skill) who
recognizes an emergency and decides to act.
_____ Reasons for not acting or for hesitating to act in an emergency situation.
5. Identify six ways bystanders can help at the scene of an emergency.
Answers are listed in Appendix A.

a er 2
CChapter You are meeting your Dad for breakfast at his house on a Sunday
morning and arrive about 5 minutes early. After knocking on the
door several times, you become concerned when no one answers.
You unlock the door, stick your head inside and yell for your father.
No answer. Stepping back outside, you see that the garage door is
closed and that your Dad’s antique car is not in the driveway. Maybe
he is working on the car in the garage, you think. You open the
garage door. Your Dad is lying on the floor. You run over to him and
shake him, but he does not move. What should you do?
Responding
to an
Emergency
Objectives
■ Identify and describe the three emergency action steps.
■ List the four conditions considered life threatening in an
emergency situation.
■ Explain when and how to call 9-1-1 or the local emergency
number.
Introduction
Look for anything that may threaten your safety
and that of the victim and bystanders. Examples of
dangers include downed power lines, falling rocks,
traffic, a crime scene, a hostile crowd, violent be-
An emergency scene can be overwhelming. havior, fire, smoke, dangerous fumes, extreme
It poses questions that demand immediate weather and deep or swiftly moving water (Fig. 2-1).
answers. What should I do first? Where can Do not approach the victim if any of these dangers
are present. Go to a safe place and call 9-1-1 or the
I get help? What can I do to help the ill or
local emergency number. Do not risk becoming a
injured person? By learning how to check an victim yourself. Leave dangerous situations to pro-
emergency scene and prioritize your actions, fessionals, such as firefighters and police officers,
you will be able to respond effectively in any who have the training to deal with them. Once they
emergency situation. make the scene safe, you can offer to help.
Find out what happened. Look around the scene
for clues about what caused the emergency and the
type and extent of the victim’s injuries. You may dis-
cover a situation that requires your immediate at-
EMERGENCY ACTION STEPS tention. As you approach the victim, take in the
whole picture. Nearby objects, such as shattered
The emergency action steps are three steps you glass, a fallen ladder or a spilled bottle of medicine,
should take in any emergency. These steps are— might tell you what happened. If the victim is un-
conscious, checking the scene may be the only way
CHECK the scene and the victim. to tell what happened (Fig. 2-2).
CALL 9-1-1 or the local emergency number. Look carefully for more than one victim. You
CARE for the victim. may not spot everyone who needs help at first. For
example, in a car crash, an open door may be a clue
that a victim has left the car or was thrown from it.
Check If one victim is bleeding or screaming loudly, you
may overlook another victim who is unconscious. It
This emergency action step has two parts—checking is also easy in any emergency situation to overlook
the scene and checking the victim. an infant or a small child. If you find more than one
victim, ask yourself if there are any bystanders to
Checking the Scene help you. Even an untrained bystander can assist
you by calling 9-1-1 or the local emergency number,
Before you can help the victim, you must make sure
retrieving first aid supplies and comforting and re-
the scene is safe for you and any bystanders. Take
assuring less seriously injured victims. A bystander
time to check the scene and answer these questions:
who knows the victim may know whether he or she
Is the scene safe? has any medical conditions or allergies.
What happened? As you move closer, continue to check the scene
How many victims are there? to see if it is still safe. At this point, you may see
Are bystanders available to help? other dangers that were not obvious to you from a
K E Y T E R M S
Consent: Permission to give care, given by the vic- Signs of life: Normal breathing or movement.
tim to the rescuer.
Emergency action steps: Three basic steps you
should take in any emergency: CHECK—
CALL—CARE.
CHAPTER 2 Responding to an Emergency 21
Figure 2-1 Check the scene for anything that may threaten your safety and that
of the victims and bystanders. Can you identify the hazards shown above?
distance. You may also see clues to what happened tell the victim not to move. Also tell bystanders not
or victims and bystanders you did not notice before. to move the victim.
If you find that the victim has any life-threat-
ening conditions, you must activate the EMS sys-
Checking the Victim tem as soon as possible (Fig. 2-3). Four of the con-
Do not move a victim unless he or she is in imme- ditions considered life threatening in an emergency
diate danger. If an immediate danger is present, situation are—
such as rising flood water, try to move the victim as
quickly and carefully as possible without making Unconsciousness.
the situation worse. If no immediate danger exists, Trouble breathing.
Figure 2-2 If the victim is unconscious, nearby objects Figure 2-4 If the victim is conscious and has no life-
may be your only clue to what has happened. threatening conditions, interview the victim and any
bystanders.
helps to ensure that the victim receives proper med-

ical care as quickly as possible.
When to Call
At times, you may be unsure if EMS personnel are
needed. Your first aid training will help you make
the decision. As a general rule, call 9-1-1 or the
local emergency number if the victim—
Is unconscious or has an altered level of con-
sciousness.
Figure 2-3 If the victim has life-threatening conditions, Has trouble breathing or is breathing in a
call 9-1-1 or the local emergency number immediately. strange manner.
Has chest discomfort, pain or pressure that
persists for more than 3 to 5 minutes or goes
away and comes back.
No signs of life (normal breathing or move-
Is bleeding severely.
ment) and, for children and infants, no pulse.
Has pressure or pain in the abdomen that does
Severe bleeding.
not go away.
If the victim is conscious and appears to have no Is vomiting blood or passing blood.
life-threatening conditions, introduce yourself and Has a seizure that lasts more than 5 minutes or
interview the victim and any bystanders to find out has multiple seizures.
what happened (Fig. 2-4). You must get consent Has a seizure and is pregnant.
from a conscious adult victim before you begin to Has a seizure and is diabetic.
give care. Detailed information about checking a Fails to regain consciousness after a seizure.
victim is described in Chapter 5. Has a severe headache or slurred speech.
Appears to be poisoned.
Has injuries to the head, neck or back.
Call Has possible broken bones.
Has a severe (critical) burn.
As a citizen responder, your top priority is to ensure
You should also activate the EMS system if any
that the victim receives more advanced care as soon
of the following situations exist:
as possible. The EMS system works more effectively
if you can give information about the victim’s con- Fire or explosion
dition when the call is placed. This information The presence of poisonous gas
Downed electrical wires

Swiftly moving or rapidly rising water
Motor vehicle collisions
Victims who cannot be moved easily
These conditions and situations do not comprise
a complete list. Trust your instincts. If you think
there is an emergency, there probably is. Do not hes-
itate to call EMS personnel if you are uncertain.
Making the Call

When calling 9-1-1 or the local emergency number,
give the call taker the necessary information. Most
EMS call takers will ask—
The exact address or location and the name of
the city or town. Be prepared to give the
names of nearby intersecting streets (cross
streets or roads); landmarks; and the name of
the building, the floor and the room number.
The telephone number and address from which
the call is being made.
The caller’s name.
What happened, for example, a motor vehicle
collision, a fall, a fire, sudden onset of chest pain. Figure 2-6 If possible, have a bystander call 9-1-1 or
The number of people involved. the local emergency number while you give care.
The condition of the victim(s), for example,
unconsciousness, chest pain, trouble breathing,
structions on how best to care for the victim until
bleeding.
help arrives (Fig. 2-5).
The care being given.
If possible, ask a bystander to call 9-1-1 or the
Do not hang up until the call taker tells you to. local emergency number for you (Fig. 2-6). Sending
Make sure the call taker has all the information someone else to make the call allows you to stay
needed to send the right help to the scene. Some with the victim. Tell the bystander the victim’s con-
EMS call takers may also be able to provide in- dition and the care being given. Tell him or her to
report to you after making the call and tell you
what the call taker said.
If You Are Alone

If you are in a situation in which you are the only
person other than the victim, you must make a de-
cision to Call First or Care First. You should Call
First, that is, call 9-1-1 or the local emergency
number before giving care for—
An unconscious adult victim or adolescent age
12 or older.
A witnessed sudden collapse of a child or infant.
An unconscious infant or child known to be at
a high risk for heart problems.
Figure 2-5 Some EMS call takers can provide instruc- Call First situations are likely to be cardiac emer-
tions on how best to care for the victim until EMS per- gencies, such as sudden cardiac arrest, where time is
sonnel arrive. critical.
Care First, that is, provide 2 minutes of care, then for changes in the victim’s level of consciousness
call 9-1-1 or the local emergency number for— and breathing. A change in the victim’s condition
may be a signal of a serious illness or injury. A con-
An unconscious victim younger than age 12
dition that may not appear serious at first may be-
when the collapse has not been witnessed.
come serious with time. Help the victim rest com-
Any victim of a drowning.
fortably, and keep him or her from getting chilled or
Care First situations are likely to be related to overheated. Reassure the victim. You will learn
breathing emergencies rather than sudden cardiac more about how to care for an ill or injured person
arrest. In these situations provide support for air- as you progress through this course.
way, breathing and circulation (ABCs) through res-
cue breaths and chest compressions, as appropriate.
SUMMARY
Care for the Victim Emergency situations are often confusing and
frightening. To take appropriate actions in any
Once you have checked the scene and the victim, emergency, follow the three basic emergency ac-
you may need to give care. Always care for life- tion steps: CHECK—CALL—CARE. CHECK the
threatening conditions before those that are not life scene and the victim, CALL 9-1-1 or the local
threatening. For example, a breathing emergency emergency number to activate the EMS system and
would take priority over an injured leg. While you CARE for the victim until more advanced medical
are waiting for more advanced medical help, watch personnel arrive.
APPLICATION QUESTIONS
1. What dangers could exist in the garage? 3. After checking the scene in the garage, what
would you do next? Why?
2. What specific factors in the garage could

influence your decision to move or not move
your Dad?
STUDY QUESTIONS
Answer the following questions based on the scenario below.
You are driving along the interstate. It is getting dark. Rain has been falling steadily, and is now beginning to
freeze. Suddenly the tractor-trailer in front of you in your lane begins to sway and slide, then jackknifes and
crashes onto its left side. Drivers put on their brakes and swerve, and by some miracle, everyone close by
manages to avoid crashing into the fallen truck or each other. You pull onto the median and stop a safe distance
behind the truck.
1. List the possible dangers to be aware of at the scene of this emergency.
2. Describe the actions you should take if you determine that the scene is unsafe.
You determined that the scene is safe and approach the tractor-trailer. You find the driver behind the wheel. You
check the driver for life-threatening conditions.
3. List four life-threatening conditions that you may find.
You check the driver and discover that he is unconscious. You tell a bystander to call 9-1-1 or the local emergency
number.
4. List the information that the bystander should have when calling EMS personnel.
5. Describe the actions you would take if no one else was available to help.

A female patron has collapsed on the pool deck. She is bleeding
Chapter 3 from the mouth and appears to be unconscious. Blood is on the

pool deck around her.“Her face hit the deck when she fell,” a
bystander says to the lifeguard.The lifeguard quickly responds.
Before Giving
Care
Objectives
■ List four conditions that must be present for disease
transmission to occur.
■ Identify two ways in which a pathogen can enter the body.
■ Describe how to minimize the risk of disease transmission when
giving care in a situation that involves visible blood.
■ Describe the difference between consent and implied consent.
■ Describe the purpose of Good Samaritan laws.
■ List six situations in which moving a victim is necessary.
■ List five limitations you should be aware of before you attempt to
move someone.
■ Describe how to perform four emergency moves.
After reading this chapter and completing the class activities, you
should be able to—
■ Demonstrate how to remove disposable gloves.
Introduction How Infections Occur

The disease process begins when a pathogen (germ)
gets into the body. When pathogens enter the body,
As a citizen responder, you have made an
they can sometimes overpower the body’s natural
important decision to help an ill or injured defense systems and cause illness. This type of ill-
person. However, in any emergency situation ness is called an infection. Most infectious diseases
your top priority is to ensure your own safety. are caused by bacteria and viruses.
In this chapter, you will learn how to protect
yourself from disease transmission and
properly move a victim. In addition, this Disease-Causing Agents
chapter provides you with some basic legal Bacteria are everywhere. They do not depend on
information you need to know before other organisms for life and can live outside the hu-
man body. Most bacteria do not infect humans.
giving care.
Those that do may cause serious illness. Bacterial
meningitis and tetanus are examples of diseases
caused by bacteria. The body’s ability to fight infec-
tion depends on its immune system. In a person
with a healthy immune system, a bacterial infection
is often avoided. However, another body may have
PREVENTING DISEASE TRANSMISSION difficulty fighting infection caused by bacteria.
When an infection is present, physicians may pre-
To help protect against disease transmission, you scribe antibiotics that either kill the bacteria or
first need to understand how infections occur, how weaken them enough for the body to get rid of
diseases pass from one person to another and what them. Commonly prescribed antibiotics include
you can do to protect yourself and others. penicillin, erythromycin and tetracycline.
Infectious diseases are those you can catch from Unlike bacteria, viruses depend on other organ-
other people, animals, insects or things that have isms to live and reproduce. Viruses can cause many
been in contact with the disease. Because some in- diseases, including the common cold (caused by the
fectious diseases like hepatitis and human immun- rhinovirus). Once in the body, viruses may be diffi-
odeficiency virus (HIV) are very serious, you must cult to eliminate because very few medications are
learn how to protect yourself and others from dis- effective against viral infections. Although there are
ease transmission. some medications that kill or weaken viruses, the
K E Y T E R M S
Consent: Permission to give care, given by the vic- Indirect contact transmission: Occurs when a per-
tim to the rescuer. son touches objects that have the blood or
Direct contact transmission: Occurs when in- body fluid of an infected person, and that in-
fected blood or body fluids from one person fected blood or body fluid enters the body
enter another person’s body at a correct entry through a correct entry site.
site. Personal protective equipment: The equipment
Disease transmission: The passage of a disease and supplies that help prevent the rescuer from
from one person to another. directly contacting infected materials.
Implied consent: Legal concept that assumes a Standard precautions: Safety measures taken to
person would consent to receive emergency prevent exposure to blood and body fluids
care if he or she were physically able to do so. when giving care to ill or injured persons.
CHAPTER 3 Before Giving Care 29
i b ili ty
ce p t
Pathogen Sus
Entry Site
Quantity
Figure 3-1 If any one of these conditions is missing, infection will not occur.
body’s own immune system is the main defense Direct contact transmission occurs when the
against them. infected blood or body fluids from one person
enter another person’s body at a correct entry site.
For example, direct transmission can occur
How Bloodborne Pathogens Are Spread through infected blood splashing in the eye or by
directly touching body fluids from an infected
For any diseases to be spread, including bloodborne person (Fig. 3-2, A).
diseases, all four of the following conditions must Some bloodborne pathogens are also transmit-
be met: ted by indirect contact. Indirect contact transmis-
sion can occur when a person touches an object that
A pathogen is present.
contains the blood or another body fluid of an in-
There is enough of the pathogen present to
fected person, and that infected blood or other body
cause disease.
fluid enters the body through a correct entry site.
The pathogen passes through the correct entry
These objects include soiled dressings, equipment
site.
and work surfaces that are contaminated with an
A person is susceptible to the pathogen.
infected person’s blood or other body fluids. For ex-
To understand how infections occur, think of ample, indirect contact can occur when a person
these four conditions as pieces of a puzzle. All the picks up blood soaked bandages with a bare hand
pieces have to be in place for the picture to be com- and the pathogens enter through a break in the skin
plete. If any one of these conditions is missing, an on the hand (Fig. 3-2, B).
infection cannot occur (Fig. 3-1).
Bloodborne pathogens such as hepatitis B virus
(HBV), hepatitis C virus (HCV) and HIV can Standard Precautions When Giving Care
spread from person to person through direct con-
tact transmission and indirect contact transmission Standard precautions are safety measures taken to
with infected blood or other body fluids. HBV, prevent exposure to blood and body fluids when
HCV and HIV are not spread by food or water or giving care to ill or injured persons. This approach
by casual contact such as hugging or shaking hands. to infection control means that you should consider
The highest risk of transmission is unprotected di- all body fluids and substances as infectious. These
rect or indirect contact with infected blood. precautions and practices include personal hygiene,
Figure 3-3 Thorough hand washing after giving care

helps to protect you against disease.
Personal Protective Equipment

B Personal protective equipment is the equipment
that helps keep you from directly contacting in-
fected materials. This equipment includes dispos-
able gloves (such as nitrile or vinyl) and breathing
barriers used when performing rescue breaths. To
reduce the risk of getting or transmitting an infec-
tious disease, follow these guidelines for the use of
Figure 3-2 A, Direct contact transmission. B, Indirect protective equipment:
contact transmission.
Wear disposable (single-use) gloves whenever
giving care, particularly if you may come in
contact with blood or body fluids (Fig. 3-4).
using personal protective equipment and equipment
Remove jewelry, such as rings, bracelets and
for cleaning and disinfecting contaminated surfaces.
watches, before putting on disposable gloves.
Cover any cuts, scrapes or sores prior to
Personal Hygiene putting on protective equipment.
Good personal hygiene habits, such as frequent
hand washing, help to prevent disease transmission.
You should always wash and scrub your hands af-
ter giving care, even if you never came into contact
with a victim’s blood or other body fluids (Fig. 3-3).
To wash your hands correctly, you should—
Wet your hands with water.

Apply antimicrobial liquid soap to your hands.
Rub your hands vigorously for at least 15 sec-
onds, covering all surfaces of the hands and
fingers.
• Use soap and warm running water.
• Scrub nails by rubbing them against the
palms of your hands.
Rinse hands with water.
Dry your hands thoroughly with a paper Figure 3-4 Personal protective equipment includes
towel. disposable gloves and protective barriers such as a face
Turn off the faucet using the paper towel. shield and resuscitation mask.
Figure 3-5 Remove disposable gloves without con- Figure 3-6 When cleaning up a blood spill, use pro-
tacting the soiled part of the gloves, and dispose of tective equipment and place all contaminated materials
them in a proper container. in a labeled biohazard container.
Do not use disposable gloves that are discol-

ored, torn or punctured. If You Are Exposed
Do not clean or reuse disposable gloves.
Change gloves before you give care to a differ- If you are exposed to blood or other body fluid,
ent victim. wash the exposed area as quickly as possible. Be
Wear protective coverings, such as a mask, sure to notify a police officer or other professional
eyewear or gown, whenever you are likely to on the scene, such as a firefighter or emergency
come in contact with blood or other body medical technician, that you have been exposed.
fluids that may splash. Seek medical attention.
Use breathing barriers, such as resuscitation
masks or face shields, when giving rescue breaths.
Remove disposable gloves without contacting LEGAL CONSIDERATIONS
the soiled part of the gloves, and dispose of
them in a proper container (Fig. 3-5). Obtaining Consent
Before giving first aid to a conscious adult victim,
Cleaning Up a Blood Spill you must get his or her permission to give care. This
permission is referred to as consent. A conscious
If a blood spill occurs—
victim has the right to either refuse or accept care.
Clean up the spill immediately or as soon as To get consent you must tell the victim—
possible after the spill occurs.
1. Who you are.
Use disposable gloves and other personal pro-
2. Your level of training.
tective equipment when cleaning up spills.
3. The care you would like to give.
Wipe up the spill with paper towels or other
absorbent materials. Only then can a conscious victim give you con-
After the area has been wiped up, flood the sent. Do not give care to a conscious victim who re-
area with a solution of approximately 11⁄2 c liq- fuses it. Even if a victim does not give consent, you
uid chlorine bleach to 1 gallon of fresh water should still call 9-1-1. If the conscious victim is an
(1 part bleach per 10 parts water). Let stand infant or child, get permission to give care from the
for at least 10 minutes. parent or guardian.
Dispose of the contaminated material used to If the victim is unconscious or unable to re-
clean up the spill in a labeled biohazard con- spond due to the illness or injury, consent is im-
tainer (Fig. 3-6). plied. Implied consent means you can assume that
if the person could respond, he or she would agree gal professional or your state attorney general’s of-
to be cared for. Consent is also implied for an infant fice, or check with your local library.
or child if a parent or guardian is not present or im-
mediately available.
REACHING AND MOVING VICTIMS
Good Samaritan Laws Usually, when you give first aid, you will not face
hazards that require moving the victim immediately.
All states have enacted Good Samaritan laws. These In most cases, you can follow the emergency action
laws give legal protection to people who willingly steps by CHECKING the scene and the victim,
provide emergency care to ill or injured persons CALLING 9-1-1 or the local emergency number
without accepting anything in return. and CARING for the victim where you find him or
When a citizen responds to an emergency and her. Moving a victim needlessly can lead to further
acts as a reasonable and prudent person would un- injury. For example, if the victim has a fracture of
der the same conditions, Good Samaritan immunity the leg, movement could result in the end of the
generally prevails. This legal immunity protects bone tearing the skin. Soft tissue damage, damage
you, as a citizen responder, from being sued and to nerves, blood loss and infection all could result
found financially responsible for the victim’s injury. unnecessarily.
For example, a reasonable and prudent citizen re- You should move a victim only when you can
sponder would— do so safely and when there is immediate danger
such as—
Move a victim only if his or her life was en-
dangered. Fire.
Check the victim for life-threatening emergen- Presence of toxic gas.
cies before giving further care. Risk of drowning.
Call 9-1-1 or the local emergency number. Risk of explosion.
Ask a conscious victim for permission before A collapsing structure (Fig. 3-7).
giving care. Uncontrollable traffic hazards.
Give care only to the level of his or her
training.
Continue to give care until more highly
trained personnel arrive.
Good Samaritan laws were enacted to en-
courage people to help others in emergency sit-
uations. They require that the “good Samari-
tan” responder use common sense and a
reasonable level of skill, not to exceed the scope
of the individual’s training in emergency situa-
tions. They assume that each person would do
his or her best to save a life or prevent further
injury.
People are rarely sued for helping in an
emergency. However, the existence of Good
Samaritan laws does not mean that someone
cannot sue. In rare cases, courts have ruled
that these laws do not apply when an individ-
ual responder’s response was grossly or will-
fully negligent or reckless or when the respon-
der abandoned the victim after initiating care.
Good Samaritan laws vary from state to
state. If you are interested in finding out about Figure 3-7 You should move a victim only if he or she
your state’s Good Samaritan laws, contact a le- is in immediate danger.
Before you act, consider the following limita- as reflective markers or flares and flashlights may
tions to moving one or more victims quickly and help keep you safe by alerting other drivers.
safely:
Dangerous conditions at the scene
The size of the victim
Emergency Moves
Your physical ability
You can move a person to safety in many different
Whether others can help you
ways, but no one way is best for every situation.
The victim’s condition
The objective is to move a person to safety without
Considering these limitations will help you de- injuring yourself or causing further injury to the vic-
cide how to proceed. For example, if you are in- tim. The following are four common types of emer-
jured, you may be unable to move the victim and gency moves:
will only risk making the situation worse. If you be-
Walking assist
come part of the problem, EMS personnel will have
Pack-strap carry
one more victim to rescue.
Two-person seat carry
To protect yourself and the victim, follow these
Clothes drag
guidelines when moving a victim:
All of these emergency moves can be done by
Only attempt to move a person you are sure
one or two people and without any equipment.
you can comfortably handle.
Bend your body at the knees and hips.
Lift with your legs, not your back. Walking Assist
Walk carefully, using short steps.
The most basic emergency move is the walking as-
When possible, move forward rather than
sist. Either one or two responders can use this
backward.
method with a conscious victim. To perform a
Always look where you are going.
walking assist, place the victim’s arm across your
Support the victim’s head, neck and back, if
shoulders and hold it in place with one hand. Sup-
necessary.
port the victim with your other hand around the
Avoid bending or twisting a victim with a pos-
victim’s waist. In this way, your body acts as a
sible head, neck or back injury.
crutch, supporting the victim’s weight while you
both walk (Fig. 3-8, A). A second rescuer, if present,
can support the victim in the same way on the other
Gaining Access side (Fig. 3-8, B). This assist is not appropriate to
use if you suspect that the victim has a head, neck
Sometimes you cannot give care because the victim or back injury.
is inaccessible. One example is a situation in which
someone is able to call 9-1-1 or the local emergency
number for help but is unable to unlock the door of
Pack-Strap Carry
the home or office. Victims may also be inaccessible The pack-strap carry can be used with both con-
in motor vehicle collisions. Vehicle doors are some- scious and unconscious victims. To use it with an
times locked or crushed, windows may be rolled up unconscious victim requires a second person to help
or the vehicle may be unstable. Fire, water or other position the victim on your back. To perform the
obstacles may prevent you from safely reaching the pack-strap carry, have the victim stand or have a
victim. second person support the victim. Position yourself
You must immediately begin to think of how to with your back to the victim, back straight, knees
safely gain access to the victim. If you cannot reach bent, so that your shoulders fit into the victim’s
the victim, you cannot check him or her or give armpits. Cross the victim’s arms in front of you and
care. But remember, when attempting to reach a vic- grasp the victim’s wrists (Fig. 3-9, A). Lean forward
tim, your safety is the most important considera- slightly and pull the victim up and onto your back
tion. Protect yourself and the victim by doing only (Fig. 3-9, B). Stand up and walk to safety. Depend-
what you are trained to do and by using equipment ing on the size of the victim, you may be able to
appropriate for the situation. In traffic, items such hold both of the victim’s wrists with one hand, leav-
A
A
Figure 3-8 The most basic emergency move is

the walking assist. A, The rescuer’s body supports
the victim’s weight. B, A second rescuer can
support the victim from the other side.
Figure 3-9 A, To perform the pack strap-carry,

ing your other hand free to help maintain balance, position yourself with your back to the victim. Cross
open doors and remove obstructions. This assist is the victim’s arms in front of you and grasp the victim’s
not appropriate to use if you suspect that the victim wrists. B, Lean forward slightly and pull the victim onto
has a head, neck or back injury. your back.
Two-Person Seat Carry

The two-person seat carry requires a second respon-
Clothes Drag
der. This carry can be used for any victim who is The clothes drag can be used to move a conscious
conscious and not seriously injured. Put one arm be- or unconscious victim suspected of having a head,
hind the victim’s thighs and the other across the vic- neck or back injury (Fig. 3-11). This move
tim’s back. Interlock your arms with those of a sec- helps keep the victim’s head and neck stabilized.
ond rescuer behind the victim’s legs and across the Grasp the victim’s clothing behind the neck, gath-
victim’s back (Fig. 3-10, A). Lift the victim in the ering enough to secure a firm grip. Using the
“seat” formed by the rescuers’ arms (Fig. 3-10, B). clothing, pull the victim (head-first) to safety.
Figure 3-11 Use the clothes drag to move a person

suspected of having a head, neck or back injury.
During the move, the victim’s head is cradled by

both clothing and the responder’s arms. This
emergency move is exhausting and may cause back
strain for the rescuer, even when done properly.
SUMMARY
B In any emergency situation, your top priority is to
ensure your own safety. Protect yourself from dis-
ease transmission by wearing personal protective
equipment, such as disposable gloves and breathing
barriers and following good personal hygiene prac-
tices, such as hand washing. Always check the scene
for safety before you approach a victim, and be sure
to obtain consent from an adult victim who is con-
scious and alert. Never move a victim unless the
Figure 3-10 The two-person seat carry can be used scene is or becomes unsafe. If you must move a vic-
for anyone who is conscious or not seriously injured. tim, be sure to do so in a manner that is safe for you
A. Lock arms under the victim’s legs and across the vic- and will not cause the victim any further harm. By
tim’s back. B, Lift the victim in the seat formed by the thinking before you give care, you will not only be
rescuer’s arms. ensuring the safety of the victim but also your own.
1. What steps should the lifeguard take before 2. What steps to prevent disease transmission?
giving care?
STUDY QUESTIONS
For Questions 1-5, circle the letter of the correct answer.
1. Disease transmission from a victim to a rescuer requires four conditions to be present. Which of the following
is NOT one of these four?
a. The victim may or may not be infected with the disease.

b. The responder must be exposed to the infected victim’s body substance.
c. There must be enough of the pathogen present to cause infection.
d. The pathogen passes through a correct entry site.
2. You are providing first aid to a child who has fallen off her bike. An untrained bystander picks up the gauze
with blood on it. He is not wearing gloves. His action is an example of exposure through—
a. Direct contact.
b. Bacterial contact.
c. Viral contact.
d. Indirect contact.
3. Safety measures you can use to prevent disease transmission include—
a. Calling 9-1-1 or the local emergency number.

b. Using personal protective equipment such as disposable gloves.
c. Wiping up a blood spill with a paper towel and placing the paper towel in the nearest wastebasket.
d. Monitoring the victim until EMS personnel arrive.
4. To obtain a victim’s consent to give care, you must tell the victim—
a. Your level of training.

b. Your age.
c. What you think is wrong.
d. Your job.
5. Which would you use to move a victim with a suspected head, neck or back injury?
a. Pack-strap carry
b. Walking assist
c. Clothes drag
d. Two-victim seat carry
6. List four situations in which it may be necessary to move a victim.

7. List four limitations you should consider before attempting to move a victim.
8. List four guidelines to follow when moving a victim.
9. Name four common types of emergency moves.

SKILL SHEET Removing Disposable Gloves
Step 1
Partially remove the first glove.
• Pinch the glove at the wrist, being careful to
touch only the glove’s outside surface.
• Pull the glove toward the fingertips without

completely removing it.
• The glove is now partly inside out.
Step 2
Remove the second glove.
• With your partially gloved hand, pinch the outside
surface of the second glove.
• Pull the second glove toward the fingertips until it
is inside out, and then remove it completely.
Step 3
Finish removing both gloves.
• Grasp both gloves with your free hand.
• Touch only the clean interior surface of the glove.
Step 4
After removing both gloves—
• Discard gloves in an appropriate container.
• Wash your hands thoroughly.
Part
TWO
Assessment
4 Body Systems
5 Checking the Victim

ter 4
Chapter
Cha
You and your friend Jim are painting the second-story trim on his
house. Jim suddenly loses his balance and falls to the ground.
When you reach Jim, he is unconscious. The only apparent sign of
injury is a cut on his head. No one responds to your shout for help.
You race into the house, call 9-1-1 and tell the call taker what
happened. The call taker tells you an ambulance is on the way. The
call taker also instructs you to take steps to control the bleeding,
monitor Jim’s breathing and keep him warm until EMS personnel
arrive. You put a blanket over Jim and a clean cloth over the cut.
“Why watch his breathing?” you wonder. He injured his head, as far
as you can tell, not his chest. But as you watch him, you can tell
that his breathing is changing, becoming faster, then slower. He
looks pale, too, and when you touch his face, the skin feels cold.
Body
Systems
Objectives
■ Identify the five body cavities and the major structures in each
cavity.
■ Identify the eight body systems and the major structures in each
system.
■ Describe the primary functions of each of the eight body
systems.
■ Give one example of how the body systems work together.
■ Describe conditions within each body system that require
emergency care.
44 PART TWO ASSESSMENT
Introduction
important reference points, terminology and the
structure and functions of eight body systems. Un-
derstanding the body systems and how they interact
and depend on each other to keep the body func-
The human body is a miraculous machine. tioning will help you give appropriate care to an ill
It performs many complex functions, each or injured person.
of which helps us live. You do not need to be
an expert in human body structure and
function to give effective care. Neither should BODY CAVITIES
you need a medical dictionary to effectively
A body cavity is a space in the body that contains
describe an injury. By knowing a few key
organs, such as the heart, lungs and liver. The five
structures, their functions and their locations, major cavities, illustrated in Figure 4-1, are the—
you can recognize a serious illness or injury
Cranial cavity, located in the head. It contains
and accurately communicate with EMS
the brain and is protected by the skull.
personnel about a victim’s condition. Spinal cavity, extending from the bottom of
the skull to the lower back. It contains the
spinal cord and is protected by the bones of
the spine (vertebrae).
To remember the locations of the body structures, it Thoracic cavity, located in the trunk. It con-
helps to learn to visualize the structures that lie be- tains the heart, lungs and other important
neath the skin. The structures you can see or feel are structures. It is protected by the rib cage and
reference points for locating the internal structures the upper spine.
you cannot see or feel. For example, to locate the Abdominal cavity, located in the trunk be-
pulse on either side of the neck, you can use the tween the diaphragm and the pelvis. It con-
Adam’s apple on the front of the neck as a reference tains many organs, including the liver, gall-
point. Using reference points will help you describe bladder, pancreas, intestines, stomach, kidneys
the location of injuries and other problems you may and spleen. Because most of the abdominal
find. This chapter provides you with an overview of cavity is not protected by any bones, the
K E Y T E R M S
Airway: The pathway for air from the mouth and Muscle: A fibrous tissue that is able to contract,
nose to the lungs. allowing and causing movement of organs and
Arteries: Large blood vessels that carry oxy- body parts.
genated blood away from the heart to the rest Nerve: A part of the nervous system that sends
of the body. impulses to and from the brain and all body
Body system: A group of organs and other struc- parts.
tures that work together to carry out specific Organ: A collection of similar tissues acting to-
functions. gether to perform specific body functions.
Bone: A dense, hard tissue that forms the Pulse: The beat you feel with each heart
skeleton. contraction.
Brain: The center of the nervous system; controls Skin: The tough, supple membrane that covers
all body functions. the surface of the body.
Cells: The basic units of all living tissue. Spinal cord: A bundle of nerves extending from
Heart: A muscular organ that circulates blood the brain at the base of the skull to the lower
throughout the body. back; protected by the spinal column.
Lungs: A pair of light, spongy organs in the Tissue: A collection of similar cells that act to-
chest that provide the mechanism for taking gether to perform specific body functions.
oxygen in and removing carbon dioxide during Veins: Blood vessels that carry oxygenated blood
breathing. from all parts of the body to the heart.
CHAPTER 4 Body Systems 45
Cranial cavity
Spinal cavity
Thoracic cavity
Diaphragm Diaphragm
Abdominal cavity
Pelvic cavity
Figure 4-1 The five major cavities of the body.
organs within it are especially vulnerable to

injury.
Pelvic cavity, located in the pelvis, the lowest
part of the trunk. It contains the bladder, rec-
tum and reproductive organs. It is protected by
the pelvic bones and the lower portion of the
spine.
Knowing the general location and relative size Organ
(Heart)
of major organs in each cavity will help you assess
a victim’s injury or illness. The major organs and Tissue
their functions are more fully described in the next
section of this chapter and in later chapters. Cells
BODY SYSTEMS
The body is made up of billions of microscopic
cells, the basic units of all living tissue. There are
many different types of cells. Each type contributes
in a specific way to keep the body functioning nor-
mally. Collections of similar cells form tissues,
which form organs (Fig. 4-2). An organ is a collec-
tion of similar tissues acting together to perform
specific body functions. Vital organs perform func-
tions that are essential for life. They include the Figure 4-2 Cells and tissues make up organs.
brain, heart and lungs.
A body system is a group of organs and other

structures that are especially adapted to perform
specific body functions. They work together to
Nose Upper carry out a function needed for life. For example,
Mouth airway
the heart, blood and blood vessels make up the cir-
culatory system. The circulatory system keeps all
parts of the body supplied with oxygen-rich blood.
For the body to work properly, all of the following
systems must work well together:
Respiratory
Circulatory
Nervous
Musculoskeletal
Integumentary
Endocrine
Digestive
Genitourinary
The Respiratory System

The body must have a constant supply of oxygen to
stay alive. The respiratory system supplies the body
with oxygen through breathing. When you inhale,
air fills the lungs and the oxygen in the air is trans-
ferred to the blood. The blood carries oxygen to all
parts of the body. This same system removes carbon
Figure 4-3 The respiratory system. dioxide, a waste gas. Carbon dioxide is transferred
from the blood to the lungs. When you exhale, air
is forced from the lungs, expelling carbon dioxide
and other waste gases. This breathing process is
called respiration.
Structure and Function

Nose
The respiratory system includes the airway and
Mouth Pharynx
lungs. Figure 4-3 shows the parts of the respiratory
system. The airway, the passage through which air
Epiglottis Larynx travels to the lungs, begins at the nose and mouth.
Air passes through the nose and mouth, through the
Esophagus
pharynx (the throat), larynx (the voice box) and
Trachea trachea (the windpipe), on its way to the lungs
(Fig. 4-4). The lungs are a pair of light, spongy or-
gans in the chest that provide the mechanism for
taking oxygen in and removing carbon dioxide dur-
ing breathing. Behind the trachea is the esophagus.
The esophagus is a tube that carries food and liq-
Lungs uids from the mouth to the stomach. A small flap of
tissue, the epiglottis, covers the trachea when you
swallow to keep food and liquids out of the lungs.
Air reaches the lungs through two tubes called
Figure 4-4 The respiratory system includes the bronchi. The bronchi branch into increasingly
pharynx, larynx and trachea. smaller tubes called bronchioles (Fig. 4-5, A). These
Bronchiole
Larynx (small bronchi)
Trachea
Alveoli
A B
Alveolar
sacs
Bronchi
Figure 4-5 A, The bronchi branch into many small tubes. B, Oxygen and carbon
dioxide pass into and out of blood through the walls of the alveoli and the capillaries.
tubes eventually end in millions of microscopic air Inhalation

sacs called alveoli. Oxygen and carbon dioxide pass
into and out of the blood through the thin cell walls Air flows in
of the alveoli and microscopic blood vessels called
capillaries (Fig. 4-5, B). Trachea
Air enters the lungs when you inhale and leaves
the lungs when you exhale. When the diaphragm Bronchi
and the chest muscles contract, you inhale. The Lung
chest expands, drawing air into the lungs. When the expands
chest muscles and diaphragm relax, pushing air
Diaphragm
from the lungs, the chest cavity becomes smaller contracts
and you exhale (Fig. 4-6). (The average adult
breathes about 12 to 20 times per minute, and a
child or infant, depending on age, breathes between
20 to 40 times per minute.) This ongoing breathing
process is involuntary—meaning you do not have to
Exhalation
think about it—and is controlled by the brain.
Air flows out

Conditions That Require Emergency Care
Because of the body’s constant need for oxygen, it is
important to recognize trouble breathing and to
provide emergency care immediately. Some causes
of trouble breathing include airway obstructions, Lung
relaxes
asthma, allergies and injuries to the chest. Trouble
breathing is referred to as respiratory distress.
If a victim has respiratory distress, you may Diaphragm
hear or see noisy breathing or gasping. The victim relaxes
may be conscious or unconscious. The conscious
victim may be anxious or excited or may say that he
or she feels short of breath. The victim’s skin, par- Figure 4-6 The chest muscles and the diaphragm
ticularly the lips and under the nails, may have a contract as you inhale and relax as you exhale.
blue tint. This condition is called cyanosis and oc-

curs when the blood and tissues do not get enough
oxygen.
A victim who stops breathing has respiratory
Carotid artery
arrest. Respiratory arrest is a life-threatening emer- Pulmonary artery
Jugular vein
gency. Without the oxygen obtained from breath- Superior vena cava
ing, other body systems cannot function. For exam- Heart
ple, without oxygen, the heart muscle stops Brachial artery
Aorta
functioning. The circulatory system will fail.
Respiratory problems require immediate at- Inferior
tention. Making sure the airway is open and clear Radial vena cava
artery
is critical. You may have to breathe for a non-
breathing victim or give care to someone who is
Femoral vein
choking. Breathing for the victim is called rescue and artery
breathing. These skills are discussed in detail in
Chapter 6.
The Circulatory System

The circulatory system works with the respiratory
system to carry oxygen-rich blood to every body
cell. It also carries other nutrients throughout the
body, removes waste and returns oxygen-poor Figure 4-7 The circulatory system.
blood to the lungs. The circulatory system includes
the heart, blood and blood vessels. Figure 4-7
shows this system.
heart must beat regularly to deliver oxygen to body
cells to keep the body functioning properly.
The heart is a muscular organ located behind the
sternum, or breastbone. The heart circulates blood
throughout the body through veins and arteries. The following circulatory problems threaten the de-
Arteries are large blood vessels that carry blood livery of oxygen to body cells:
away from the heart to the rest of the body. The ar-
Blood loss caused by severe bleeding, such as a
teries subdivide into smaller blood vessels and ulti-
severed artery
mately become microscopic capillaries. The capil-
Impaired circulation, such as a blood clot
laries transport blood to all the cells of the body
Failure of the heart to pump adequately, such
and nourish them with oxygen.
as a heart attack
After the oxygen in the blood is transferred to
the cells, veins carry the blood back to the heart. Body tissues die when they do not receive oxy-
The heart circulates this blood to the lungs to pick gen. For example, when an artery supplying the
up more oxygen before circulating it to other parts brain with blood is blocked, brain tissue dies.
of the body. This cycle is called the circulatory cy- When an artery supplying the heart with blood is
cle. The cross section of the heart in Figure 4-8 blocked, heart muscle tissue dies. This damage of
shows how blood moves through the heart to com- heart muscle is a life-threatening emergency—a
plete the circulatory cycle. heart attack.
The pumping action of the heart is called a con- When a person has a heart attack, the heart func-
traction. Contractions are controlled by the heart’s tions irregularly and may stop. If the heart stops,
electrical system, which makes the heart beat regu- breathing will also stop. When the heart stops beat-
larly. You can feel the evidence of the heart’s con- ing or beats too weakly to pump blood effectively,
tractions in the arteries that are close to the skin— it is called cardiac arrest. Victims of either heart
for instance, at the neck or the wrist. The beat you attack or cardiac arrest need immediate emergency
feel with each contraction is called the pulse. The care. Cardiac arrest victims need to have circula-
To
⫽
upper
body
⫽
From
Aorta
upper body
To To ⫽ Oxygen-poor blood pumped

lung lung from the body to the lungs
From
From ⫽ Oxygen-rich blood pumped
lung from the lungs to the body
lung
Right Left
Atrium Atrium
Right Left
Ventricle Ventricle
From To
lower lower
body body
(inferior (descending
vena cava) aorta)
Figure 4-8 The heart is a two-sided pump made up of four chambers. A system of one-
way valves keeps blood moving in the proper direction to complete the circulatory cycle.
tion maintained artificially by receiving chest The brain transmits and receives information
compressions and rescue breathing. This combina- through a network of nerves. Figure 4-9 shows the
tion of compressions and breaths is called car- nervous system. The spinal cord, a large bundle of
diopulmonary resuscitation or CPR. You will learn nerves, extends from the brain through a canal in
more about the heart and how to perform CPR in the spine, or backbone. Nerves extend from the
Chapter 7. brain and spinal cord to every part of the body.
The Nervous System Brain
The nervous system, the most complex and delicate

of all body systems, is one of the body’s two major
regulating and coordinating systems. (The other is
the endocrine system, discussed later in this chap-
ter.) The nervous system depends on a number of
different sensory organs in the body to provide in- Spinal cord
formation about internal and external conditions
that permit it to regulate and coordinate the body’s
activities.

The brain, the center of the nervous system, is the
master organ of the body. It regulates all body
functions, including the respiratory and circula-
tory systems. The primary functions of the brain
are the sensory, motor and integrated functions
of consciousness, memory, emotions and use of
language. Figure 4-9 The nervous system.
Brain
To brain
Connecting nerve cell
Motor nerve
Spinal
cord
Sensory nerve
Figure 4-10 Messages are sent to and from the brain by way of the nerves.
Nerves transmit information as electrical im- the brain is diseased or injured, a person may lose
pulses from one area of the body to another. Some the body functions controlled by that area of the
nerves conduct impulses from the body to the brain, brain. For example, if the part of the brain that reg-
allowing you to see, hear, smell, taste and feel. ulates breathing is damaged, the person may stop
These functions are the sensory functions. Other breathing.
nerves conduct impulses from the brain to the Illness or injury may change a person’s level of
muscles to control motor functions or movement consciousness. Consciousness may be affected by
(Fig. 4-10). emotions, in which case the victim may be intensely
The integrated functions of the brain are more aware of what is going on. At other times, the vic-
complex. One of these functions is consciousness. tim’s mind may seem to be dull or cloudy. Illness or
Normally, when you are awake, you are fully con- injury affecting the brain can also alter memory,
scious. In most cases, being conscious means that emotions and the ability to use language.
you know who you are, where you are, the approx- A head injury can cause a temporary loss of
imate date and time and what is happening around consciousness. Any head injury causing a loss of
you. Your consciousness level can vary. For exam- consciousness can also cause brain injury and must
ple, you can be highly aware in certain situations be considered serious. These injuries require evalu-
and less aware during periods of relaxation, sleep, ation by medical professionals because injury to the
illness or injury. brain can cause blood to form pools in the skull.
Pooling blood puts pressure on the brain and limits
the supply of oxygen to the brain cells.
Conditions That Require Emergency Care Injury to the spinal cord or a nerve can result in
Brain cells, unlike other body cells, cannot regener- a permanent loss of feeling and movement below
ate or grow back. Once brain cells die or are dam- the injury. This condition is called paralysis. For ex-
aged, they are not replaced. Brain cells may die ample, a lower back injury can result in paralysis of
from disease or injury. When a particular part of the legs; a neck injury can result in paralysis of all
four limbs. A broken bone or a deep wound can Structure and Function
also cause nerve damage, resulting in a loss of sen-
The musculoskeletal system performs each of the
sation or movement. In Chapter 13, you will learn
following functions: supporting the body, protect-
about techniques for caring for head, neck and back
ing internal organs, allowing movement, storing
injuries.
minerals, producing blood cells and producing heat.
The Musculoskeletal System Bones and Ligaments

The body has over 200 bones. Bone is dense, hard
The musculoskeletal system is made up of the tissue that forms the skeleton. The skeleton forms
bones, ligaments, muscles and tendons and com- the framework that supports the body (Fig. 4-11).
prises most of the body’s weight. Together, these Where two or more bones join, they form a joint.
structures are primarily responsible for posture, lo- Figure 4-12 shows a typical joint. Bones are usually
comotion and other body movements, but they are held together at joints by fibrous bands of tissue
also responsible for many other functions that are called ligaments. Bones vary in size and shape, al-
not as obvious. lowing them to perform specific functions.
FRONT VIEW BACK VIEW
Skull
Mandible
(jaw)
Clavicle
(collarbone)
Sternum
Scapula
(breastbone) Spine
(shoulder blade)
Humerus
Ribs
Carpal Radius
bones Pelvis
Metacarpal Ulna
bones
Sacrum
Phalanges
Coccyx
Femur
Patella
(kneecap)
Fibula
Tibia
Tarsal
bones
Metatarsal
bones
Phalanges
Figure 4-11 Major bones of the body.

The bones of the skull protect the brain. The

spine is made of bones called vertebrae that protect
the spinal cord. The ribs are bones that attach to the
Thigh bone spine and to the breastbone, forming a protective
shell for vital organs, such as the heart and lungs.
In addition to supporting and protecting the
body, bones aid movement. The bones of the arms
and legs work like a system of levers and pulleys to
Ligaments position the hands and feet so that they can func-
tion. Bones of the wrist, hand and fingers are pro-
Ligaments gressively smaller to allow for fine movements like
Leg bones writing. The small bones of the feet enable you to
walk smoothly. Together, the bones of the foot
work as shock absorbers when you walk, run or
Kneecap jump. Bones also store minerals and produce cer-
tain blood cells.
Tendon
Muscles and Tendons
Muscles are made of special tissue that can contract
THE KNEE
and relax, resulting in movement. Figure 4-13
Figure 4-12 A typical joint. shows the major muscles of the body. Tendons are
Face muscles
Neck
Neck
muscles
muscles
Deltoid Deltoid
Chest
muscles Back
Biceps Triceps
muscles
Extensors
Extensors Abdominal of wrist
of wrist muscles and
and fingers
Gluteus
fingers maximus
Hamstring
Quadriceps Groin muscles
muscles muscles
Patella
Extensors Calf
of foot muscles
and toes
Achilles
tendon
Figure 4-13 Major muscles of the body.

tissues that attach muscles to bones. Muscles band

together to form muscle groups. Muscles work to-
gether in groups to produce movement (Fig. 4-14).
Working muscles produce heat. Muscles also pro-
tect underlying structures, such as bones, nerves
and blood vessels. Muscle action is controlled by
the nervous system. Nerves carry information from
the muscles to the brain. The brain processes this
information and directs the muscles through the
nerves (Fig. 4-15).
Muscle actions are either voluntary or involun-
tary. Involuntary muscles, such as the heart, are au-
tomatically controlled by the brain. You do not
have to think about involuntary muscles to make
them work. Voluntary muscles, such as leg and arm
muscles, are most often under your conscious con-
trol but often work automatically. You are some-
times aware of telling them to move, but you do not
think about walking, for example, you just do it.

Injuries to bones and muscles include fractures, dis-
locations, strains and sprains. A fracture is a broken Figure 4-14 Muscle groups work together to produce
bone. Dislocations occur when bones of a joint are movement.
How Does a Person Catch a Frisbee?

A Frisbee slices the air as it spins in someone’s di-
rection. In a few seconds, it is in a person’s hands
and that person is tossing it back. But what really
happens? How does a person catch a Frisbee?
1. The left and the right eye each transmit
the Frisbee’s image to the brain through
electrical impulses that travel at a
speed up to 300 feet per second.
2. The brain receives the image and then
calculates the Frisbee’s path and the speed
at which it is traveling.
3. The brain transmits electrical impulses to muscles
in the arms and legs to reposition. As a person
reaches for the Frisbee, the pelvis and the verte-
bral column move to compensate for the change
in balance. Tiny muscles and bones in the hand
grasp the Frisbee as it sails within reach.
life-threatening emergencies. For example, torn liga-

ments in the knee can limit activity, and broken ribs
can puncture the lungs and cause trouble breathing.
When you provide emergency care, remember
that injuries to muscles and bones often result in ad-
ditional injuries. You will learn more about muscu-
loskeletal injuries and how to care for them in later
chapters.
The Integumentary System

The integumentary system consists of the skin, hair
and nails (Fig. 4-16). Most important among these
structures is the skin. The skin protects the body
and helps keep fluids within the body. It prevents
infection by keeping out disease-producing mi-
croorganisms, or pathogens.
Figure 4-15 The brain controls muscle movement.
The skin is made of tough, elastic fibers that stretch
moved out of place, which is usually caused by phys- without easily tearing, protecting the skin from in-
ical trauma. Strains are injuries to muscles and ten- jury. The skin also helps make vitamin D and stores
dons; sprains are injuries to ligaments. Although in- minerals.
juries to bones and muscles may not look serious, The outer surface of the skin consists of dead
nearby nerves, blood vessels and other organs may cells that are continually rubbed away and replaced
be damaged. Regardless of how they appear, these by new cells. The skin contains the hair roots, oil
injuries may cause lifelong disabilities or become glands and sweat glands. Oil glands help to keep
Nail
Hair
Skin
Pores
Hairs
Epidermis Hair root

Vein
Dermis
Artery
Hypodermis Fat
Oil gland
Nerve
Sweat gland
Figure 4-16 The skin, hair and nails make up the integumentary system.
the skin soft, supple and waterproof. Sweat glands

and pores help regulate body temperature by re-
Pituitary
leasing sweat. The nervous system monitors blood
temperature and causes you to sweat if blood tem- Parathyroids
(behind thyroid) Thyroid
perature rises even slightly. Although you may not
Thymus
see or feel it, sweat is released to the skin’s surface.
Blood supplies the skin with nutrients and helps
provide its color. When blood vessels dilate (become Adrenals
wider), the blood circulates close to the skin’s sur- Pancreas
Ovaries
face. This dilation can make some people’s skin ap- (in females)
pear flushed or red and makes the skin feel warm.
The reddening may not appear with darker skin.
When blood vessels constrict (become narrower),
not as much blood is close to the skin’s surface, Testis
causing the skin to look pale or ashen and feel cool. (in males)
In people with darker skin, color changes may be
most easily seen in the nail beds and the mucous
membranes inside the mouth and inside the lower
eyelids.
Nerves in the skin make it very sensitive to sen-
sations such as touch, pain and temperature.
Therefore, the skin is also an important part of the
body’s communication network and is a type of
sensory organ. Figure 4-17 The endocrine system.
Conditions That Require Emergency Care which all cells convert nutrients to energy. Other
Although the skin is tough, it can be injured. Sharp glands include the sweat and oil glands in the skin.
objects may puncture, cut or tear the skin. Rough
objects can scrape it, and extreme heat or cold may
burn or freeze it. Burns and skin injuries that cause
bleeding may result in the loss of vital fluids. Germs You do not need to know all the glands in the en-
may enter the body through breaks in the skin, docrine system or the hormones they produce.
causing infection that can become serious. In later Problems in the endocrine system usually develop
chapters, you will learn how to care for skin in- slowly and seldom become emergencies. Knowing
juries, such as burns and cuts. how hormones work in general, however, helps you
understand how some illnesses seem to develop
suddenly.
The Endocrine System For example, an emergency occurs when too
much or too little of a hormone called insulin is se-
The endocrine system is the second of the two reg- creted into the blood. Normally, insulin is secreted
ulatory systems in the body. Together with the ner- by small glands embedded in the pancreas. Without
vous system, it coordinates the activities of other insulin, cells cannot use the sugar they need from
body systems. food. Too much insulin forces blood sugar rapidly
into the cells, lowering blood sugar levels and de-
priving the brain of the blood sugar it needs to
Structure and Function function normally. Too little insulin results in too
The endocrine system consists of several glands high a level of sugar in the blood. The condition in
(Fig. 4-17). Glands are organs that release sub- which the body does not produce enough insulin
stances into the blood or onto the skin. Some glands and blood sugar is abnormally high is called dia-
produce hormones, substances that enter the blood- betes. Blood sugar levels that rise or fall abnor-
stream and influence tissue activity in various parts mally can make a person ill, sometimes severely so.
of the body. For example, the thyroid gland makes You will learn more about this kind of emergency
a hormone that controls metabolism, the process by in Chapter 15.
Table 4-1 Body Systems

HOW THE SYSTEM WORKS
SYSTEM MAJOR STRUCTURES PRIMARY FUNCTION WITH OTHER BODY SYSTEMS
Respiratory Airway and lungs Supplies the body with oxygen Works with the circulatory system
and removes carbon dioxide to provide oxygen to cells; con-
through breathing trolled by the nervous system
Circulatory Heart, blood and blood Transports nutrients and oxy- Works with the respiratory system
vessels gen to body cells and re- to provide oxygen to cells;
moves waste products works in conjunction with the
urinary and digestive systems
to remove waste products;
helps give skin color; controlled
by the nervous system
Nervous Brain, spinal cord and One of two primary regulatory Regulates all body systems
nerves systems in the body; trans- through a network of nerves
mits messages to and from
the brain
Musculoskeletal Bones, ligaments, muscles Provides body’s framework; Provides protection to organs and
and tendons protects internal organs and structures of other body sys-
other underlying structures; tems; muscle action is con-
allows movement; produces trolled by the nervous system
heat; manufactures blood
components
Integumentary Skin, hair and nails An important part of the body’s Helps to protect the body from
communication network; disease-producing organisms;
helps prevent infection and together with the circulatory
dehydration; assists with system, helps to regulate body
temperature regulation; aids temperature; under control of
in production of certain the nervous system; communi-
vitamins cates sensation to the brain
through the nerves
Endocrine Glands Secretes hormones and other Together with the nervous system
substances into blood and coordinates the activities of
onto skin other systems
Digestive Mouth, esophagus, stom- Breaks down food into usable Works with the circulatory system
ach, intestines, pan- form to supply the rest of to transport nutrients to the
creas, gallbladder and the body with energy body
liver
Genitourinary Kidneys and bladder Removes waste from the circu-
latory system and regulates
water balance
Uterus and genitalia Performs the process of sexual
reproduction
parts of the body, especially the cells of the vital or-

INTERRELATIONSHIPS OF gans. You will learn more about shock in Chapter 9.
Generally, the more body systems involved in an
BODY SYSTEMS emergency, the more serious the emergency. Body
systems depend on each other for survival. In seri-
Each body system plays a vital role in survival ous injury or illness, the body may not be able to
(Table 4-1). Body systems work together to help keep functioning. In these cases, regardless of your
the body maintain a constant healthy state. When best efforts, the victim may die.
the environment changes, body systems adapt to the
new conditions. For example, because your muscu-
loskeletal system works harder when you exercise, SUMMARY
your respiratory and circulatory systems must also
work harder to meet your body’s increased oxygen The body includes a number of systems, all of
demands. Your body systems also react to the which must work together for the body to function
stresses caused by illness or injury. properly. The brain, the center of the nervous sys-
Body systems do not work independently of tem, controls all body functions including those of
each other. The impact of an injury or illness is the other body systems. Knowing a few key struc-
rarely restricted to one body system. For example, a tures, their functions and their locations helps you
stroke may result in brain damage that will impair to understand more about these body systems and
movement and feeling. Injuries to the ribs can make how they relate to injuries and sudden illnesses. In-
breathing difficult. If the heart stops beating for any jury or illness that affects one body system can
reason, breathing will also stop. have a serious impact on other systems. Fortu-
In any significant illness or injury, body systems nately, basic care is usually all you need to give
may be seriously affected. The condition that results until EMS personnel arrive. By learning the basic
from a progressive failure of a body system or sys- principles of care described in later chapters, you
tems is called shock. Shock is the inability of the cir- may be able to make the difference between life
culatory system to provide adequate oxygen to all and death.
1. Why did the call taker tell you to watch Jim’s 2. Which body systems appear to have been
breathing? affected by Jim’s fall?
STUDY QUESTIONS
1. Complete the table with the correct system, structures or function(s).
Systems Structures Function

Supplies the body with the oxy-
gen it needs through breathing
Heart, blood and blood vessels
Integumentary
Musculoskeletal
Regulates all body functions; a

communication network
2. Match each term with the correct definition.
a. Arteries e. Tissue
b. Organ f. Spinal cord
c. Cell g. Respiration
d. Endocrine system h. Veins
_____ The process of breathing.

_____ A large bundle of nerves extending from the brain through the spine.
_____ A collection of similar cells that perform a specific function.
_____ A body system that regulates and coordinates the activities of other body systems by producing
chemicals that influence the activity of tissues.
_____ The basic unit of living tissue.
_____ Blood vessels that carry oxygenated blood from the heart to the body.
_____ Blood vessels that carry blood to the heart.
_____ A collection of similar tissues acting together to perform a specific body function.
In questions 3 through 9, circle the letter of the correct answer.
3. Which structure is not located in or part of the thoracic cavity?
a. The liver
b. The rib cage
c. The heart
d. The lungs
4. The two body systems that work together to provide oxygen to the body cells are—
a. Musculoskeletal and integumentary.

b. Circulatory and musculoskeletal.
c. Respiratory and circulatory.
d. Endocrine and nervous.
5. One of the main functions of the integumentary system is to—
a. Transmit information to the brain.

b. Produce blood cells.
c. Prevent infection.
d. Secrete hormones.
6. The function of the digestive system is to—
a. Perform the process of reproduction.

b. Transport nutrients and oxygen to body cells.
c. Break down food into a form the body can use for energy.
d. All of the above.
7. Which structure in the airway prevents food and liquid from entering the lungs?
a. The trachea
b. The epiglottis
c. The esophagus
d. The bronchi
8. If a person’s use of language suddenly becomes impaired, which body system might be injured?
a. The musculoskeletal system

b. The nervous system
c. The integumentary system
d. The circulatory system
9. Which two body systems will react initially to alert a victim to a severe cut?
a. Circulatory, respiratory
b. Respiratory, musculoskeletal
c. Nervous, respiratory
d. Circulatory, nervous

Chapter 5
You are riding along the bike trail on your way home. As you round
a sharp curve, you abruptly swerve. A person is sprawled face down
across the trail. The person lies motionless on the pavement. You
stop your bike. It is a very secluded area and no one else is around.
Checking
the Victim
Objectives
■ Describe how to check for life-threatening conditions for an adult,
child or infant.
■ Identify and explain at least three questions you should ask the
victim or bystanders in an interview.
■ Describe how to check for non-life-threatening conditions for an
adult, child or infant.
■ Demonstrate how to check an unconscious adult, child or infant.
■ Demonstrate how to check a conscious adult, child or infant.
Shock
Introduction When someone becomes suddenly ill or is injured,
normal body functions may be interrupted. In cases
In earlier chapters, you learned that as a of minor injury or illness, the interruption is brief
citizen responder trained in first aid, you can and the body is able to compensate quickly. With
make a difference in an emergency—you may more severe injuries or illness, however, the body is
even save a life. You learned how to recognize unable to meet its demand for oxygen. The condi-
an emergency and to follow the emergency tion in which the body fails to circulate oxygen-rich
blood to all the parts of the body is known as
action steps: CHECK—CALL—CARE. More shock. If left untreated, shock can lead to death.
importantly, you learned that your decision Always look for the signals of shock whenever you
to act can have a significant impact on the are giving care. You will learn how to recognize and
victim’s chance of survival. You can always treat a victim for shock in Chapter 9.
do something to help.
In this chapter, you will learn how
to check an injured or ill person for life-
Checking for Consciousness
threatening conditions. You will also learn First, determine if the victim is conscious. Tap him
how to interview a conscious victim and any or her on the shoulder and shout, “Are you okay?’’
bystanders, check for non-life-threatening For an infant, gently tap the infant’s shoulder or
conditions and give basic care in any flick the foot. Do not jostle or move the victim.
emergency until EMS personnel arrive. If the victim is conscious and alert, introduce
yourself, get the victim’s consent to give care and at-
tempt to find out what happened. Look for signals
of injury or illness, ask the victim to describe what
he or she is experiencing, for example, dizziness or
pain. Perhaps a bystander is available to help an-
CHECKING FOR LIFE-THREATENING swer questions and to call 9-1-1 or the local emer-
gency number if necessary.
CONDITIONS If the victim is unconscious, the situation is
different. Unconsciousness is always a life-threaten-
After checking the scene, you should check the ing condition. Call 9-1-1 or the local emergency
victim first for life-threatening conditions. Life- number immediately. Ideally, someone will be avail-
threatening conditions include— able to make the call while you care for the victim.
Remember that if you are in a situation in
Unconsciousness.
which you are the only person other than the vic-
Trouble breathing.
tim, you should—
No signs of life (normal breathing or move-
ment) and, for children and infants, no pulse. Call First, that is, call 9-1-1 or the local emergency
Severe bleeding. number before giving care for—
The actions you will take depend on the condi- An unconscious adult victim or adolescent age
tions you find. 12 or older.
K E Y T E R M S
Head-tilt/chin-lift technique: Technique used to Signs of life: Normal breathing or movement.
open a victim’s airway by pushing down on the
forehead while pulling up on the bony part of
the jaw.
CHAPTER 5 Checking the Victim 65
An unconscious infant or child known to be at A

a high risk for heart problems.
A witnessed sudden collapse of a child or
infant.
Care First, that is, give 2 minutes of care, then call
9-1-1 or the local emergency number for—
An unwitnessed collapse of an unconscious per-
son younger than 12 years old.
Any victim of a drowning.
If you must leave the scene to call 9-1-1 or the local B
emergency number, carefully position an uncon-
scious victim on one side in case he or she vomits
while you are gone. This position is called a recov-
ery position (Fig. 5-1). Roll the victim onto his or
her side, and bend the top leg and move it forward.
Position the head and neck so that the face is angled
toward the ground. Avoid twisting the neck and
back as you roll the victim onto his or her side. If
you suspect a head, neck or back injury and a clear,
open airway can be maintained, do not move the Figure 5-2, A-B Check for a pulse on a A, child or
victim unnecessarily. If a clear, open airway cannot B, infant.
be maintained or if you must leave the victim to get
help, move the victim onto his or her side while
keeping the head, neck and back in a straight line
by placing the victim in a modified High Arm In
Endangered Spine (H.A.IN.E.S.) recovery position. Checking for a Pulse-------Child and Infant
If the victim is conscious, tell him or her that
you are going to get help. Make the victim as com- To find out if the heart is beating, check for a pulse
fortable as possible. (Fig. 5-2, A-B) for no more than 10 seconds. To
After calling 9-1-1 or the local emergency num- check for signs of life, look for normal breathing or
ber, return to the victim, complete the check and movement, then check for a pulse for no more than
give care until EMS personnel arrive. 10 seconds for children and infants if no breathing
or movement is found.
CHECKING AN UNCONSCIOUS PERSON

If you find that the person is unconscious and
9-1-1 or the local emergency number has been
called, find out if there are other conditions that
threaten the person’s life. Always check to see if an
unconscious person—
Has an open airway.
Shows signs of life (movement or breathing).
Is bleeding severely.
An easy way to remember what you need to
check is to think of ABC, which stands for—
Airway—open the airway.
Figure 5-1 If you are alone and must leave an uncon- Breathing—check for movement or breathing.
scious victim, position the person on one side in case Circulation—check for signs of life (including a
he or she vomits while you are gone. pulse for a child or infant) and severe bleeding.
Figure 5-3 Open an unconscious person’s airway us- Figure 5-4 Look, listen and feel for movement and
ing the head-tilt/chin-lift technique. breathing for no more than 10 seconds.
Airway
Once you or someone else has called 9-1-1 or the
local emergency number, you must check to see if
the person has an open airway and is breathing. An
open airway allows air to enter the lungs for the
person to breathe. If the airway is blocked, the
person cannot breathe. This is a life-threatening
condition.
When someone is unconscious and lying on his
or her back, the tongue may fall to the back of the
throat and block the airway. To open an uncon-
scious person’s airway, push down on his or her Figure 5-5 Keep the airway open and give 2 rescue
forehead while pulling up on the bony part of the breaths.
jaw with two or three fingers of your other hand to
lift the chin (Fig. 5-3). This procedure, known as
the head-tilt/chin-lift technique, moves the tongue pulse for children and infants. In an unconscious
away from the back of the throat, allowing air to adult, you may detect an irregular, gasping or shal-
enter the lungs. low breath. This is known as an agonal breath. Do
not confuse this for normal breathing. You should
begin CPR immediately. Agonal breaths do not oc-
Breathing cur frequently in children.
Sometimes food, liquid or other objects will
After opening the airway, you must check an un- block the person’s airway. When this happens,
conscious person carefully for signals of breathing. you will need to remove whatever is blocking the
Look, listen and feel for these signals. Position airway.
yourself so that you can hear and feel air as it es- If air does go in but the child or infant is not
capes from the nose and mouth. At the same time, breathing, you may need to perform rescue breath-
look to see if the victim’s chest clearly rises and ing. Rescue breathing is a technique used to provide
falls. Look, listen and feel for movement and a non-breathing victim with oxygen. You will learn
breathing for no more than 10 seconds (Fig. 5-4). how to perform rescue breathing in Chapter 6.
If the person is not breathing, give 2 rescue breaths If the person is breathing, his or her heart is
with each breath lasting about 1 second (Fig. 5-5). beating and is circulating blood. In this case, main-
If the air goes in (chest clearly rises), check for a tain an open airway by using the head-tilt/chin-lift
Checking for a Pulse_

Child and Infant
For a child, feel for the pulse at either of the carotid arteries lo-
cated in the neck. To find the carotid pulse, feel for the Adam’s apple
and slide your fingers into the groove at the side of the neck. Some-
times the pulse may be difficult to find, because it may be slow or
weak. If at first you do not find a pulse, find the Adam’s apple and
again slide your fingers into place. When you think you are in the
right spot, take no more than 10 seconds to feel for the pulse. Feel
for the pulse on the side of the child’s neck closer to you.
For an infant, feel for the brachial pulse in the upper arm.
technique as you continue to look for other life-

threatening conditions.
Circulation
It is very important to recognize breathing emer-
gencies in children and infants and to act before the
heart stops beating. Adults’ hearts frequently stop
beating because they are diseased. Infants’ and chil-
dren’s hearts, however, are usually healthy. When
an infant’s or child’s heart stops, it is usually the
result of a breathing emergency.
If an adult is not breathing and you have given
him or her 2 rescue breaths, you must then assume
the problem is a cardiac emergency and begin CPR
immediately. Figure 5-6 Check for severe bleeding by scanning
If a child or infant shows no signs of life (move- from head to toe.
ment or breathing), you will have to check for a
pulse for no more than 10 seconds. If you find a
pulse but no breathing, give rescue breathing. If the
child or infant does not show signs of life or a pulse, Severe Bleeding
the heart is not beating properly.
You must keep blood circulating in the person’s After checking for signs of life, quickly check for se-
body until emergency medical help arrives. To do vere bleeding. Bleeding is severe when blood spurts
this, you will have to perform cardiopulmonary re- from the wound or cannot be easily controlled.
suscitation (CPR). Rescue breathing for infants and Look over the victim’s body from head to toe for
children is discussed in Chapter 6. CPR is discussed signals of bleeding, such as blood-soaked clothing
in Chapter 7. or blood pooling around the victim (Fig. 5-6).
Bleeding usually looks more serious than it is. A

small amount of blood on a slick surface or mixed
with water almost always looks like a great deal of
blood. Severe bleeding is not always easy to recog-
nize. You must make a decision based on your best
judgment. Severe bleeding must be controlled as
soon as possible. Make sure you protect yourself
against disease transmission by keeping a barrier
between you and the victim’s blood. You will learn
more about severe bleeding in Chapter 8.
CHECKING A CONSCIOUS VICTIM Figure 5-7 Parents or other adults may be able to give
you helpful information or help you communicate with a
Once you have determined that a victim is con- sick or injured child.
scious and has no immediate life-threatening condi-
tions, you can begin to check for other conditions
that may need care. Checking a conscious victim
with no immediate life-threatening conditions in-
volves two basic steps: or bystanders what happened. They may be able to
give you helpful information or help you communi-
1. Interview the victim and bystanders. cate with the victim (Fig. 5-7). You will learn more
2. Check the victim from head to toe. about communicating with people with special
needs in Chapter 21.
Write down the information you learn during
Interviewing the Victim and Bystanders the interview. If possible, have someone else write
down the information or help you remember it.
Ask the victim and bystanders simple questions to This information can be given to EMS personnel
learn more about what happened and to learn when they arrive. Providing this information may
about the victim’s condition. These interviews help EMS personnel to determine the type of med-
should not take much time. Remember to first iden- ical care the victim should receive. Information
tify yourself and to get the victim’s consent to give might include what medications the victim is taking
care. Begin by asking the victim’s name. Using the and any allergies he or she has.
victim’s name will make him or her feel more com-
fortable. Gather additional information by asking
the victim the following questions: Checking the Victim from Head to Toe
What happened?
Before you begin to check the victim, tell him or her
Do you feel pain or discomfort anywhere?
what you are going to do. Have the victim tell you
Do you have any allergies?
if any areas hurt. Avoid touching any painful area
Do you have any medical conditions, or are
or having the victim move any area that is painful.
you taking any medication?
Use your senses—sight, sound, touch and smell—
If the victim feels pain, ask him or her where the to detect anything abnormal. Think about how the
pain is located and to describe it. You can often ex- body normally looks. Be alert for any signals of
pect to get descriptions such as burning, crushing, injuries—anything that looks or sounds unusual. If
throbbing, aching or sharp pain. Ask when the pain you are uncertain, compare the injured side to the
started and what he or she was doing when it be- other side of the body. Watch for facial expressions,
gan. Ask the victim to rate his or her pain on a scale and listen for a tone of voice that may reveal pain.
of 1-10 (1 being mild and 10 being severe). Look for a medical ID tag or bracelet. This tag may
Sometimes a victim may not be able to provide tell you what might be wrong, who to call for help
you with the proper information. Infants or chil- and what care to give (Fig. 5-8).
dren may be frightened, or the victim may not Begin your check at the victim’s head, examin-
speak your language. Ask family members, friends ing the scalp, face, ears, eyes, nose and mouth.
MedicAlert is a Federally Registered Trademark and Service Mark. © 2006. All Rights Reserved.
Figure 5-9 Feel the skin with the back of your hand to
determine the skin’s temperature.
where it is easiest to check for breathing and signs

of life.
If you do not suspect an injury to the head, neck
Figure 5-8 Medical ID tags and bracelets can provide
important information about the victim. or back, determine if the victim has any specific in-
juries by asking him or her to try to move each body
part in which he or she feels no pain or discomfort.
To check the neck, ask the injured person if he or
Look for cuts, bumps, bruises and depressions. she has neck pain. If he or she does not, ask the per-
Look for signals that may indicate a serious prob- son to slowly move his or her head from side to side
lem. Watch for changes in consciousness. Notice if (Fig. 5-10). Check the shoulders by asking the per-
the victim is drowsy, not alert or confused. Look for son to shrug them (Fig. 5-11). Check the chest and
changes in or any trouble breathing. A healthy per- abdomen by asking the person to try to take a deep
son breathes regularly, quietly and easily. Abnormal breath and then blow the air out (Fig. 5-12). Ask if
breathing includes noisy breathing, such as gasping he or she is experiencing pain during breathing.
for air or making gurgling or whistling sounds; Check each arm by first asking the person if he or
breathing that is unusually fast or slow; and breath-
ing that is painful.
The skin’s appearance and temperature often in-
dicate something about the victim’s condition. Notice
how the skin looks and feels. A victim with a flushed,
pale or ashen (gray) face may be ill. Note if the skin
is reddish, bluish, pale or ashen. Darker skin looks
ashen instead of pale. Determine the temperature of
the skin by feeling it with the back of your hand
(Fig. 5-9). Skin that is cool, moist, warm or dry to the
touch may indicate a medical problem. In later chap-
ters, you will learn more about what these changes
may mean and what first aid to give.
If the victim becomes unconscious and the
call has not already been made, stop your check
and call 9-1-1 or the local emergency number im-
mediately. Return to the victim and continuously
check him or her for any life-threatening condi- Figure 5-10 Ask the victim to gently move his or her
tions that may appear. Remain at the victim’s head, head from side to side to check the neck.
she can move the fingers and the hand. Next, ask if If the victim can move all the body parts with-
he or she can bend the arm (Fig. 5-13). In the same out pain or discomfort and has no other apparent
way, check the hips and legs by first asking if he or signals of injury or illness, have him or her attempt
she can move the toes, foot and ankle. Then deter- to rest for a few minutes in a sitting position
mine if the victim can bend the leg (Fig. 5-14). (Fig. 5-15). Help the victim slowly stand when he or
Check one extremity at a time. she is ready (Fig. 5-16).
Figure 5-12 To check the chest and abdomen, ask

Figure 5-11 Ask the victim to shrug his or her shoul-
the victim to breathe deeply and then blow the air out.
ders to check the shoulders.
Ask if he or she is experiencing pain.
Figure 5-13 Check the arms by asking the victim to Figure 5-14 Check the legs by asking the victim to
bend his or her arms one at a time. bend his or her legs one at a time.
Figure 5-15 If there are no signals of obvious injuries, Figure 5-16 Help the victim slowly stand when he or
help the victim into a sitting position. she is ready.
From Horses to Helicopters----A History of Emergency Care

Emergency care originated during the French emperor ambulance workers and emergency department staffs, an
Napoleon’s campaigns in the late 1700s. The surgeon- improved communication network and the development
in-chief for the Grand Army, Dominique Jean Larrey, of regional units with specialized care.
became the first physician to try to save the wounded Today, the telegraph signal has been replaced by the
during battles instead of waiting until the fighting was telephone and mobile phone. Today more than 99 percent
over (Major R). Using horse-drawn litters, Larrey and of the U. S. population has access to basic 9-1-1 ser-
his men dashed onto the battlefield in what became vices. In some areas, a computer connected to the en-
known as “flying ambulances.” hanced 9-1-1 system displays the caller’s name, address
and phone number, even if the caller cannot speak.
Ambulance workers have changed from coachmen to
trained medical professionals who can provide life-saving
care at the scene. Horses have been replaced by ambu-
lances and helicopters equipped to provide the most ad-
vanced pre-hospital care available.
The EMS system has expanded in sheer numbers and
in services. Today, there are more than 800,000 EMS
providers delivering care. In addition, many organizations,
such as hospitals, have become more integrated with the
EMS system to ensure quality care. Physicians and nurses
continue the patient’s care after they arrive at the hospital.
By the 1860s, the wartime principles of emergency
care were applied to emergencies in some U.S. cities. In
1878, a writer for Harper’s New Monthly Magazine ex-
plained how accidents were reported to the police, who
then notified a local hospital by a telegraph signal. He de-
scribed an early hospital ambulance ride in New York City
(Rideing WH). “A well-kept horse was quickly harnessed
to the ambulance; and as the surgeon took his seat be-
hind, having first put on a jaunty uniform cap with gold
lettering, the driver sprang to the box . . . and with a
sharp crack of the whip we rolled off the smooth asphalt
of the courtyard and into the street. . . . As we swept If patients suffer from critical conditions, such as heart
around corners and dashed over crossings, both doctor attacks, burns, spinal cord injuries or other traumatic in-
and driver kept up a sharp cry of warning to pedestrians” juries or if the patients are children, the EMS system now
(Rideing WH). While booming industrial cities developed has developed regional centers where specialists and
emergency transport systems, rural populations had only specialized equipment are always available. In two cen-
rudimentary services. In most small towns, the mortician turies, the EMS system has evolved from horses to heli-
had the only vehicle large enough to handle the litters, so copters. As technology continues to advance, it is difficult
emergency victims were just as likely to ride in a hearse to imagine what changes the future will bring.
to the hospital as in an ambulance (Division of Medical
Sciences). SOURCES
Cars gave Americans a faster system of transport, but Division of Medical Sciences, National Academy of Sciences. National Research
Council: Accidental death and disability: the neglected disease of modern
over the next 50 years, car collisions also created the society, Washington, D.C., September 1966.
need for more emergency vehicles. In 1966, a major re- Major R, M.D.: A History of Medicine, Springfield, Ill. Charles C. Thomas, 1954.
port questioned the quality of emergency services (Divi- National Registry of Emergency Medical Technicians Web site.
sion of Medical Sciences). Dismayed at the rising death www.nremt.org/about/ems_learn.asp. Accessed 7/22/04.
National Emergency Number Association. www.nena.org. Accessed 6/24/04.
toll on the nation’s highways, the U.S. Congress passed Rideing WH: Hospital Life in New York, Harper’s New Monthly Magazine 57
laws in 1966 and 1973 ordering the improved training of (171), 1878.
If the person feels dizzy, is unable to move a

body part or is experiencing pain with movement,
SPECIAL CONSIDERATIONS
help him or her rest in the most comfortable posi-
tion. Keep the person from getting chilled or over-
Checking Infants and Children
heated, and reassure him or her. Determine what
Infants (age 0 to 1) and children (age 1 to 12) re-
additional care is needed and whether to call 9-1-1
ceive care that is slightly different from that pro-
or the local emergency number.
vided for adult victims.
When checking a child or infant for life-
Giving Care threatening conditions, follow the same steps as
for an adult. However, if you are alone and find
Once you complete the head-to-toe examination, an unconscious child or infant who is not breath-
give care for any specific injuries you find. To give ing, but does have a pulse, give rescue breathing
care for the victim until EMS personnel arrive, for about 2 minutes before calling 9-1-1 or the
follow these general guidelines: local emergency number. Providing 2 minutes of
rescue breathing will get oxygen into the child or
Do no further harm.
infant and may prevent the heart from stopping.
Monitor breathing and consciousness.
When checking a child for non-life-threatening
Help the victim rest in the most comfortable
conditions, observe the child before touching him or
position.
her. Look for signals that indicate changes in con-
Keep the victim from getting chilled or
sciousness, any trouble breathing, and any apparent
overheated.
injuries or conditions. All signals may change as soon
Reassure the victim.
as you touch the child because he or she may become
Give any specific care needed.
anxious or upset. If a parent or guardian is present,
ask him or her to help calm the infant or child.
Deciding Whether to Transport the Victim Parents can also tell you if the child has a medical
condition that you should be aware of (Fig. 5-17).
Whether you transport an injured victim or wait for
Communicate clearly with the parent or
EMS personnel depends on many factors, including
guardian and the child. Explain what you are going
the availability of advanced medical care, the sever-
to do. Get at eye level with the child. Talk slowly and
ity of the injury or illness, and your judgment. If
in a friendly manner. Use simple words. Ask ques-
you do decide to transport the victim yourself, ask
tions that the child can answer easily. Often a parent
someone else to come with you to help keep the vic-
or guardian will be holding a crying child. Check the
tim comfortable. Be sure you know the quickest
child while the parent or guardian holds him or her.
route to the nearest medical facility with emer-
When you begin the examination, begin at the toes
gency-care capabilities. Pay close attention to the
instead of the head. Checking in this order gives the
victim and watch for any changes in his or her
child the opportunity to get used to the process and
condition.
allows him or her to see what is going on.
Do not transport a victim—
When the trip may aggravate the injury or ill-
ness or cause additional injury.
When the victim has or may develop a life-
threatening condition.
If you are unsure of the nature of the injury or
illness.
With a life-threatening condition or if there is a
possibility of further injury, call 9-1-1 or the local
emergency number and wait for help.
Discourage a victim from driving himself or her-
self to the hospital. An injury may restrict move-
ment, or the victim may become groggy or faint. A
sudden onset of pain may be distracting. Any of Figure 5-17 Parents or other adults may be able to
these conditions can make driving dangerous for the give you helpful information or help you communicate
victim, passengers, other drivers and pedestrians. with a sick or injured child.
standing, offer an arm or hand. Remember that an

older victim may need to move very slowly.
Try to find out what medications the person is
taking and if he or she has any medical conditions
so that you can tell EMS personnel. Look for a
medical ID bracelet or necklace, which often pro-
vides you with the victim’s name and address and
information about any specific condition the victim
has. Be aware that an elderly person may not rec-
ognize the signals of a serious condition. An elderly
person may also minimize any signals for fear of
losing his or her independence or being placed in a
nursing home. You will learn more about commu-
Figure 5-18 Speak to an elderly victim at eye level so
nicating with older adults in Chapter 21.
that he or she can see or hear you more clearly.
SUMMARY
Checking Older Adults
Many variables affect dealing with emergencies. By
When checking an older adult (over 65), attempt to following the emergency action steps: CHECK—
learn the victim’s name and use it when you speak CALL—CARE, you can ensure that the victim re-
to him or her. Consider using Mrs., Mr. or Ms. as a ceives the best possible care. If possible, check vic-
sign of respect. Get at the victim’s eye level so tim in position found.
that he or she can see and hear you more clearly Determine if the victim has any life-threatening
(Fig. 5-18). If the victim seems confused, it may be conditions. Life-threatening conditions include un-
the result of vision or hearing loss. Someone who consciousness, trouble breathing, no signs of life
needs glasses to see is likely to be very anxious with- and severe bleeding. Call 9-1-1 or the local emer-
out them. If he or she usually wears eyeglasses and gency number if a victim appears to have any of
cannot find them, try to locate them. Notice if he or these signals.
she has a hearing aid. Speak a little more slowly and If you find no life-threatening conditions, inter-
clearly and look at the victim’s face while you talk. view the victim and any bystanders and perform a
If the victim is truly confused, try to find out if the head-to-toe examination (toe-to-head for a child or
confusion is the result of the injury or a condition infant) to find and care for any other injuries. If you
he or she already has. Information from family do not give care, these conditions could become life
members or bystanders is frequently helpful. The threatening.
victim may be afraid of falling, so if he or she is
1. What might you do to make the scene safe for 3. If the victim on the bike trail does not respond
you to check the victim? when you tap on his or her shoulder, what
would your next step be?
2. What kinds of injuries or other conditions might 4. If you find that the victim on the trail is con-
the victim on the bike trail have? scious, is breathing and has no severe bleeding,
what should you do next?
STUDY QUESTIONS
1. Match each emergency action step with the actions it includes.
a. Check the scene.

b. Check the victim for life-threatening emergencies.
c. Call 9-1-1 or the local emergency number.
d. Care for the victim.
_____ Open the airway.
_____ Look for bystanders who can help.
_____ Interview the victim and bystanders.
_____ Check for movement and breathing.
_____ Do a head-to-toe examination.
_____ Call 9-1-1 or the local emergency number.
_____ Look for victims.
_____ Check for severe bleeding.
_____ Look for dangers.
_____ Check for pulse (child or infant).
_____ Look for clues to determine what happened.
_____ Obtain the victim’s consent.
2. List four life-threatening conditions.
Use the following scenario to answer questions 3 and 4.
Several people are clustered in the middle of a street. A car is stopped in the right lane. As you approach the
group, you can see a mangled bicycle lying on the pavement. You see your neighbor sitting next to it. No one
seems to be doing anything. You approach your neighbor and kneel next to him.
3. What type of dangers could be present at the scene? What could you do to make the scene safer?
4. You determine that your neighbor has no life-threatening emergencies. What should you do next?
Use the following scenario to answer question 5.
You walk into your boss’s office for a meeting. You see a cup of coffee spilled on the desk. You find him lying on
the floor, motionless. What should you do?
5. Based on the scenario above number the following actions in order:

_____ Open the airway.
_____ Check the scene.
_____ Check for signs of life and severe bleeding.
_____ Check for consciousness.
_____ Call 9-1-1 or the local emergency number.
6. What is the purpose of your initial check of the victim?
a. To check for minor injuries

b. To determine if any life-threatening conditions need immediate care
c. To get consent from the victim before giving care
d. To ask for information about the cause of the injury or illness
7. Once you determine the victim has no life-threatening conditions, you should—
a. Call 9-1-1 or the local emergency number.

b. Transport the victim to the nearest hospital.
c. Check for other injuries or conditions that could become life threatening if not cared for.
d. Check for consciousness.
8. Before beginning a check for life-threatening conditions, you should first—
a. Position the victim so that you can open the airway.

b. Check the scene.
c. Check for bystanders.
d. Call 9-1-1 or the local emergency number.
9. After checking for consciousness, you determine that the victim is unconscious. What should you do next?

b. Give 2 rescue breaths.
c. Check for signs of life and severe bleeding.
d. Begin a check for non-life-threatening conditions.

SKILL SHEET Checking an Unconscious Adult

(Age 12 or Older)
Check the scene and the victim. Remember: Always follow standard precautions to prevent
disease transmission. Use protective equipment (disposable gloves and breathing barriers).
Wash your hands thoroughly after giving care.
CHECK scene, then CHECK person.
Step 1
Tap shoulder and shout, “Are you okay?”
Step 2
No response, CALL 9-1-1.
NOTE: If an unconscious person is face-down—roll face-up supporting head, neck and back.
Step 3
Open airway (tilt head, lift chin).
Step 4
CHECK for signs of life (movement and breathing)
for no more than 10 seconds. If no signs of life,
give 2 rescue breaths.
NOTE: Irregular, gasping or shallow breathing is

NOT normal breathing.
Step 5
If there is normal breathing, place the person in
recovery position and monitor Airway, Breathing
and Circulation (ABCs).
Step 6
If breaths go in—quickly scan the body for severe
bleeding and get into position to perform CPR or
use an AED (if AED is immediately available).
SKILL SHEET Checking an Unconscious Child

(Ages 1 to 12)
Step 1
CHECK scene, then CHECK child.
Step 2
Obtain consent from parent or guardian, if present.
Step 3 5
Tap shoulder and shout, “Are you okay?”
Step 4
If alone—
• Give about 2 minutes of CARE.
• Then CALL 9-1-1.
6
NOTE: If an unconscious child is face-down—
roll face-up supporting head, neck and back.
Step 5
Open airway (tilt head, lift chin), CHECK for signs
of life (movement and breathing) for no more than
10 seconds.
Step 6 7
If no breathing, give 2 rescue breaths.
Step 7
If breaths go in, CHECK for pulse (and severe bleeding).
Step 8
8
If breathing normally, place in recovery position and
monitor Airway, Breathing and Circulation (ABCs).
SKILL SHEET Checking an Unconscious Infant

(Under Age 1)
Step 1
CHECK scene, then CHECK infant.
Step 2
3
Step 3
Flick foot or tap shoulder and shout, “Are you okay?”
Step 4
If alone—
• Give about 2 minutes of CARE.
• Then CALL 9-1-1.
6
Step 5
If an unconscious infant is face-down—
roll face-up supporting head, neck and back.
Step 6
Open airway (tilt head, lift chin), CHECK for signs of life
(movement and breathing) for no more than 10 seconds.
Step 7 7
If no breathing, give 2 rescue breaths.
Step 8
If breaths go in, CHECK for pulse (and severe bleeding).
Step 9
If breathing normally, place in recovery position and 8
monitor Airway, Breathing and Circulation (ABCs).
SKILL SHEET Checking a Conscious Victim
Wash your hands immediately after giving care.
Step 1
Interview the person.
• Introduce yourself, tell him or her your level of
training, and get permission to give care.
• Ask—
• What is your name?
• What happened?
• Do you feel pain or discomfort anywhere?
• Do you have any allergies?
• Do you have any medical conditions, or
are you taking any medication?
Note: Send someone to CALL 9-1-1 or the local

emergency number any time a life-threatening
emergency becomes apparent.
Step 2
Check head to toe.
• Visually inspect the body.
• Before you begin, tell the person what you are
going to do.
• Look carefully for bleeding, cuts, bruises and
obvious deformities.
• Look for a medical ID bracelet or necklace.
Note: Do not ask the person to move any areas in

which he or she has discomfort or pain or if you suspect
injury to the head, neck or back.
Step 3
Check the head.
• Look at the scalp, face, ears, eyes, nose and
mouth for cuts, bumps, bruises and depressions.
• Notice if the victim is drowsy, not alert or
confused.
Step 4
Check skin appearance and temperature.
• Feel the person’s forehead with the back of
your hand.
• Look at the person’s face and lips.
• Ask yourself, is the skin—
• Cold or hot?
• Unusually wet or dry?
• Pale, bluish or flushed?
Step 5
Check the neck.
• If there is no discomfort and no suspected injury
to the neck, ask the person to move the head
slowly from side to side.
• Note pain, discomfort or inability to move.
SKILL SHEET Checking a Conscious Victim
Step 6
Check the shoulders.
• Ask the person to shrug his or her shoulders.
Step 7
Check the chest and abdomen.
• Ask the person to take a deep breath and
blow air out.
• Ask if he or she is experiencing pain during
breathing.
Step 8
Check the arms.
• Check one arm at a time.
• Ask the person to—
• Move hands and fingers.
• Bend the arm.
Step 9
Check the hips and legs.
Step 10
CARE for any conditions you find.
If the person can move all body parts without pain or discomfort and has no other
apparent signals of injury or illness—
• Have him or her rest for a few minutes in a sitting position.
• Help the person slowly stand when he or she is ready, if no further difficulty develops.
If the person is unable to move a body part or is experiencing pain on movement or dizziness—
• Help him or her rest in the most comfortable position.
• Keep the person from getting chilled or overheated.
• Reassure him or her.
• Determine whether to call 9-1-1 or the local emergency number.
Part
THREE
Life-Threatening
Emergencies
6 Cardiac Emergencies and
Breathing Emergencies
7 Unconscious Choking
8 Bleeding
9 Shock
Chapter 6 It’s a warm spring day. You and your friend Kevin are playing
basketball on the public courts in the park. The 10-year-old boy next
door, Steve, has tagged along. As you and Kevin attempt to play
one-on-one, Steve tries to steal the ball. At one point, he gets the
ball and dashes to the far end of the court. You and Kevin chase
Steve. Suddenly, Steve stops, lets the ball drop and brings his
hands to his chest. He is gasping and making a strange wheezing
sound. As you run to him, you see Steve is having trouble
breathing. As Steve struggles to catch his breath, you and Kevin try
to decide what to do.
Breathing
Emergencies
Objectives
■ Identify the causes of breathing emergencies.
■ Identify signals of respiratory distress.
■ Identify conditions that cause respiratory distress.
■ Identify common causes of choking for adults, children and infants.
■ Describe the care for a conscious choking adult, child and infant.
■ Describe the care for a victim experiencing respiratory distress.
■ Describe the care for a victim in respiratory arrest.
■ Describe when and how to use breathing barriers.
■ Demonstrate how to provide rescue breathing for a child or
infant.
■ Demonstrate how to provide care for a conscious choking adult,
child and infant.
■ Demonstrate how to give care for a victim in respiratory distress.
88 PART THREE LIFE-THREATENING EMERGENCIES
BREATHING EMERGENCIES
Introduction There are two types of breathing emergencies: res-
piratory distress and respiratory arrest. Respiratory
In this chapter, you will learn how to care for distress is a condition in which breathing becomes
someone who is having trouble breathing or difficult. Respiratory arrest occurs when breathing
who has stopped breathing. As you read in stops. Both of these emergencies are considered life
Chapter 5, you should follow the emergency threatening.
action steps: CHECK—CALL—CARE in
any emergency situation. Check to see if the
scene is safe and if the victim has any life-
Respiratory Distress
threatening conditions. If the victim appears Respiratory distress is the most common breathing
to have a life-threatening condition, send emergency. Respiratory distress can be caused by a
someone to immediately call 9-1-1 or the local variety of conditions including—
emergency number. Finally, care for any A partially obstructed airway.
conditions you may find. Illness.
Chronic conditions, such as emphysema or
asthma.
Electrocution.
THE BREATHING PROCESS Heart attack.
Injury to the head, chest, lungs or abdomen.
Allergic reactions.
As you read in Chapter 4, the human body requires
Drugs.
a constant supply of oxygen for survival. When you
Poisoning.
breathe air into your lungs, the oxygen in the air is
Emotional distress.
transferred to the blood. The blood transports the
oxygen to the brain, other organs, muscles and Respiratory distress can lead to respiratory arrest.
other parts of the body. Without oxygen, brain cells
can begin to die in 4 to 6 minutes (Fig. 6-1). Some
tissues, such as the brain, are very sensitive to oxy- Signals of Respiratory Distress
gen deprivation. Unless the brain receives oxygen
within minutes, permanent brain damage or death A victim of respiratory distress may show various
will result. signals. Victims may look as if they cannot catch
their breath, or they may gasp for air. They may
K E Y T E R M S
Airway obstruction: Complete or partial blockage Mechanical airway obstruction: Complete or par-
of the airway, which prevents air from reach- tial blockage of the airway by a foreign object,
ing a person’s lungs; the most common cause such as a piece of food or a small toy, or by flu-
of respiratory emergencies. ids such as vomit or blood.
Anatomical airway obstruction: Complete or par- Rescue breathing: A technique of breathing for a
tial blockage of the airway by the tongue or non-breathing child or infant.
swollen tissues of the mouth and throat. Respiratory arrest: A condition in which breath-
Aspirate: Inhalation of blood, vomit or other for- ing has stopped.
eign material into the lungs. Respiratory distress: A condition in which breath-
Cyanotic: Bluish discoloration of the skin around ing is difficult.
the mouth or the fingertips resulting from a Stoma: An opening in the front of the neck
lack of oxygen in the blood. through which a person whose larynx has been
removed breathes.
CHAPTER 6 Breathing Emergencies 89
0 minutes: Breathing stops. Heart will soon stop beating.
4–6 minutes: Brain damage possible.
6–10 minutes: Brain

damage likely.
Over 10 minutes: Irreversible

brain damage certain.
Figure 6-1 Time is critical in life-threatening emergencies. Unless the brain gets
oxygen within minutes of when breathing stops, brain damage or death will occur.
appear to breathe faster or slower than normal. trachea to the alveoli) or swelling of the bronchi
Breaths may be unusually deep or shallow. They themselves.
may make unusual noises, such as wheezing, gur- The Centers for Disease Control and Prevention
gling or high-pitched sounds like crowing. (CDC) estimated that in the year 2001, 20.3 million
The victim’s skin appearance and temperature Americans were affected by asthma. Asthma is
can also indicate respiratory distress. At first, the more common in children and young adults than in
victim’s skin may be unusually moist and appear older adults, but its frequency and severity is in-
flushed. Later, it may appear pale, ashen or cyanotic creasing in all age groups in the United States.
and feel cool as the oxygen level in the blood falls. Asthma is the third-ranking cause of hospitalization
Victims may say they feel dizzy or light-headed. among those younger than age 15.
They may feel pain in the chest or tingling in the Asthma attacks may be triggered by an allergic
hands, feet or lips. Understandably, the victim may reaction to food, pollen, a drug, an insect sting or
be apprehensive or fearful. Any of these signals is a emotional stress. For some people, cold air or phys-
clue that the victim may be in respiratory distress. ical activity may induce asthma. Wheezing, a com-
mon signal of asthma, is the hoarse whistling sound
made when exhaling. Wheezing occurs because air
Conditions That Cause becomes trapped in the lungs. Usually, people diag-
nosed with asthma control attacks with medication.
Respiratory Distress These medications stop the muscle spasm, opening
the airway, which makes breathing easier.
Asthma
Asthma is a condition that narrows the air passages
Emphysema
and makes breathing difficult. During an asthma at- Emphysema is a disease in which the lungs and
tack, the air passages become constricted, or nar- alveoli lose their ability to exchange carbon dioxide
rowed, as a result of a spasm of the muscles lining and oxygen effectively. Emphysema is a chronic
the bronchi (the air passages that lead from the (long-lasting or frequently recurring) disease and
Signals of Respiratory Distress

Trouble breathing.
Breathing is slow or rapid.
Breaths are unusually deep or shallow.
Victim is gasping for breath.
Victim is wheezing, gurgling or making
high-pitched noises.
Victim’s skin is unusually moist or cool.
Victim’s skin has a flushed, pale, ashen
or bluish appearance.
Victim feels short of breath.
Victim feels dizzy or light-headed.
Victim feels pain in the chest or tingling
in hands, feet or lips.
Victim feels apprehensive or fearful.
Figure 6-2 People who know they are allergic to cer-
tain substances or bee stings may carry an anaphylaxis
kit with medication that reverses the allergic reaction.
will worsen over time. The most common signal of
emphysema is shortness of breath. Exhaling is ex-
tremely difficult. In advanced cases, the victim may
feel restless, confused and weak, and may even go laxis may be caused by insect stings, food, other
into respiratory or cardiac arrest. allergens or certain medications. Signals of ana-
phylaxis include a rash; a feeling of tightness in
the chest and throat; and swelling of the face,
Bronchitis neck and tongue. The person may also feel dizzy
Bronchitis is a condition resulting in inflammation or confused. If not recognized early and cared for
of the lining of the trachea, bronchi and bronchi- quickly, an anaphylactic shock can become a life-
oles. This inflammation causes a buildup of mucus threatening emergency. Some people know that
that obstructs the passage of air and air exchange in they are allergic to certain substances or to bee
the lungs. Chronic bronchitis is most commonly stings. They may have learned to avoid these sub-
caused by long-term smoking; however, exposure to stances or bees and may carry medication to re-
environmental irritants and pollutants may also verse the allergic reaction (Fig. 6-2). People who
lead to bronchitis. A person with bronchitis will have severe allergic reactions may wear a medical
typically have a persistent cough and may feel tight- ID bracelet or necklace.
ness in the chest and have trouble breathing. As
with emphysema, the person may also feel restless,
confused and weak, and may even go into respira- Hyperventilation
tory or cardiac arrest. Hyperventilation occurs when breathing is faster
than normal. This rapid breathing can upset the
body’s balance of oxygen and carbon dioxide. Hy-
Anaphylactic Shock perventilation often results from fear or anxiety
Anaphylactic shock, also known as anaphylaxis, and is likely to occur in people who are tense and
is a severe allergic reaction. Air passages may nervous. It can also be caused by head injuries; se-
swell and restrict a person’s breathing. Anaphy- vere bleeding; or illnesses such as high fever, heart
failure, lung disease or diabetic emergencies. It can

also be triggered by asthma or exercise. A charac-
teristic signal of hyperventilation is deep, rapid
breathing. Despite their efforts to breathe, people
who are hyperventilating feel that they cannot get
enough air or that they are suffocating. Therefore,
they are often fearful and apprehensive, or they
may appear confused. They may say that they feel
dizzy or that their fingers and toes or lips feel numb
or tingly.
If the victim’s breathing is rapid and he or she
shows signals of an injury or an underlying illness or
condition, call 9-1-1 or the local emergency number
immediately. This person needs advanced care right Figure 6-3 A person who is having trouble breathing
away. If, however, the victim’s breathing is rapid and may breathe more easily in a sitting position.
you are sure that it is caused by emotion, such as ex-
citement, tell him or her to relax and breathe slowly.
Reassurance is often enough to correct hyperventila-
tion. If the breathing still does not slow down, the
person could have a serious problem. When breath-
ing is too fast, slow, noisy or painful, call 9-1-1 or • Loosen any tight clothing, especially
the local emergency number immediately. around the neck and abdomen.
• Open a door or window to provide fresh
air. You may also move the victim to fresh
Care for Respiratory Distress air if it is safe to do so and will not cause
further harm.
• Make sure someone has called 9-1-1 or the
Recognizing the signals of respiratory distress and
local emergency number for help.
quickly giving care is a key step to preventing other
• If the victim is conscious, check for other
life-threatening conditions, such as respiratory arrest.
life-threatening conditions, such as severe
You do not need to know the specific cause of a vic-
bleeding.
tim’s respiratory distress to effectively give care. To
• Interview the victim and any bystanders.
care for a victim of respiratory distress, you should—
As you check the victim, remember that a
CHECK the scene to ensure your safety before person who has trouble breathing may
you approach a victim. The victim’s condition have trouble talking. Therefore, talk to any
may have been caused by an unsafe environ- bystanders who may know about the vic-
mental condition, such as the presence of toxic tim’s condition. The victim can confirm an-
fumes. swers or answer yes-or-no questions by
CHECK the victim for consciousness. If the nodding. The victim can also write down
victim is conscious, you know that he or she is his or her answers.
breathing and that his or her heart is beating. • Continue to monitor the victim’s ABCs (air-
CALL 9-1-1 or the local emergency number. way, breathing and circulation). Watch for
Even though the victim is conscious, respira- additional signals of respiratory distress.
tory distress is a life-threatening emergency and • Calm and reassure the victim. Help main-
requires immediate care from EMS personnel. tain normal body temperature by prevent-
Send someone to call 9-1-1 or the local emer- ing chilling on a cool day or by providing
gency number. Continue to check for other life- shade on a hot day.
threatening conditions, such as severe bleeding. • Assist the victim in taking his or her
CARE for the conditions you find: prescribed medication for the condition
• Help the victim rest in a comfortable if trained and state or local regulations
position. In most cases, it is easier for allow. Medications may include oxygen,
the victim to breathe in a sitting position an inhalant (bronchial dilator) or
(Fig. 6-3). epinephrine.
Special Considerations that seals off the airway during swallowing. When
the epiglottis becomes infected, it can swell and
completely block the airway. A child with epiglotti-
Children and Respiratory Distress tis will appear ill and have a high fever and a sore
Infections of the respiratory system are more com- throat. He or she will often be sitting up and strain-
mon in children and infants than in adults. These ing to breathe. The child will be very frightened, so
can range from minor infections, such as the com- be sure to keep the child calm. Saliva will often be
mon cold, to life-threatening infections that block dripping from the mouth because swelling of the
the airway. Signals of respiratory distress in children epiglottis prevents the child from swallowing.
include— You do not need to distinguish between croup
and epiglottitis, because the care you give will be
Agitation.
the same. First aid for a child in respiratory distress
Unusually fast or slow breathing.
includes allowing him or her to remain in the most
Drowsiness.
comfortable position for breathing. If the child’s
Noisy breathing.
breathing does not appear to improve, or at the first
Pale, ashen, flushed or bluish skin color.
signal that the child’s condition is worsening, call
Breathing trouble increases.
9-1-1 or the local emergency number. Do not at-
Altered level of consciousness.
tempt to place any object in the child’s mouth. Be
Increased heart rate.
aware that a child’s airway may become completely
A common childhood illness that causes respiratory blocked as a result of epiglottitis. A child with a
distress is croup. Croup is a viral infection that blocked airway has a life-threatening emergency
causes swelling of the tissues around the vocal and needs immediate medical help.
cords. Besides the basic signals of respiratory dis-
tress and a cough that sounds like the bark of a seal,
croup is often preceded by 1 or 2 days of illness,
sometimes with a fever. Croup occurs more often in AIRWAY OBSTRUCTION------
the winter months, and its signals are more evident
in the evening. Croup is not generally life threaten-
CONSCIOUS VICTIM
ing but can be very frightening for the child and the
Airway obstruction is the most common cause of
parents or guardian.
respiratory emergencies. The two types of airway
Another childhood illness is epiglottitis, a bacte-
obstruction are anatomical and mechanical. A per-
rial infection that causes a severe inflammation of
son suffering from an anatomical or mechanical air-
the epiglottis. You may recall from Chapter 4 that
way obstruction is choking.
the epiglottis is a flap of tissue above the vocal cords
An anatomical airway obstruction occurs if the
airway is blocked by the tongue or swollen tissues
of the mouth and throat. This type of obstruction
may result from injury to the neck or a medical
Care for Respiratory Distress emergency, such as anaphylaxis.
A mechanical airway obstruction occurs when
the airway is partially or completely blocked by a
Check for life-threatening conditions.
foreign object, such as a piece of food or a small toy,
Call 9-1-1 or the local emergency number. or by fluids, such as vomit or blood.
Help the victim rest comfortably.
Check for non-life-threatening conditions.
Causes
Assist with medication. Common causes of choking include—
Keep the victim from getting chilled or Trying to swallow large pieces of poorly
overheated. chewed food.
Drinking alcohol before or during meals. Alco-
Monitor ABCs. hol dulls the nerves that aid swallowing, mak-
ing choking on food more likely.
Wearing dentures. Dentures make it difficult up the object. A victim who is getting enough air to
for the wearer to sense whether food is fully cough or speak also has enough air entering the lungs
chewed before swallowing. to breathe. Stay with the victim and encourage him or
Eating while talking excitedly or laughing or her to continue coughing to clear the obstruction. If
eating too fast. coughing persists, call for help.
Walking, playing or running with food or ob-
jects in the mouth. Complete Airway Obstruction
A partial airway obstruction can quickly become a
complete airway obstruction. A person with a com-
Signals pletely blocked airway is choking and is unable to
cough, speak or breathe. Sometimes the victim may
A person with an obstructed airway can quickly cough weakly and ineffectively or make high-
stop breathing, lose consciousness and die. You pitched noises. All of these signals tell you the vic-
must be able to recognize that the airway is ob- tim is not getting enough air to sustain life. Act im-
structed and immediately give care. A person who is mediately! If a bystander is available, have him or
choking may have either a complete or partial air- her call 9-1-1 or the local emergency number while
way obstruction. you begin to give care.
Partial Airway Obstruction Care for an Airway Obstruction

A victim with a partial airway obstruction can still
move air to and from the lungs. This air allows the A combination of 5 back blows followed by 5 ab-
victim to cough in an attempt to dislodge the object. dominal thrusts provides an effective way to clear the
The victim may also be able to move air past the vo- airway obstruction in an adult or child. Back blows
cal cords to speak. The victim may clutch at his or her are helpful in dislodging the object that is in the air-
throat with one or both hands as a natural reaction to way (Fig. 6-5). Abdominal thrusts compress the ab-
choking. This action is the universal distress signal for domen and create pressure that forces the diaphragm
choking (Fig. 6-4). If the victim is coughing forcefully higher into the thoracic cavity, thus increasing pres-
or wheezing, do not interfere with attempts to cough sure within the lungs and airway. This pressure simu-
lates a cough, forcing air trapped in the lungs to push
the object out of the airway, like a cork from a bottle
of champagne. Continue to provide 5 back blows and
5 abdominal thrusts until the person can cough force-
fully, speak or breathe, or becomes unconscious.
Figure 6-5 Provide 5 back blows and 5 abdominal

Figure 6-4 Clutching the throat with one or both hands thrusts until the person can cough forcefully, speak or
is universally recognized as a distress signal for choking. breathe, or becomes unconscious.
Firmly strike the person between the shoulder

blades with the heel of your other hand.
If the back blows do not clear the obstruction, give
abdominal thrusts.
To give abdominal thrusts to a conscious chok-
ing adult or child, stand or kneel behind the victim
A and wrap your arms around his or her waist. Make
a fist with one hand and place the thumb side
against the middle of the victim’s abdomen, just
above the navel and well below the lower tip of the
breastbone (Fig. 6-6, A-B). Grab your fist with your
other hand and give quick, upward thrusts into the
abdomen (Fig. 6-6, C). Each thrust is a separate and
distinct attempt to dislodge the obstruction. The
skill sheets at the end of this chapter show this
technique in detail.
Conscious Infant
B
An infant can easily swallow small objects, such as
pebbles, coins, beads and parts of toys, which can
then block the airway. Infants also often choke be-
cause their eating skills develop slowly. Therefore,
they can easily choke on foods such as nuts, hot
dogs, grapes and popcorn, which are often the per-
fect size to block their smaller airways.
If you determine that a conscious infant cannot
cough, cry or breathe, perform 5 back blows fol-
lowed by 5 chest thrusts. Position the infant face-
up on your forearm. Place your other hand on top
of the infant, using your thumb and fingers to hold
the infant’s jaw while sandwiching the infant be-
C tween your forearms. Turn the infant over so that
he or she is face-down on your forearm (Fig.
6-7, A). Lower your arm onto your thigh so that
the infant’s head is lower than his or her chest, then
give 5 firm back blows with the heel of your hand
between the infant’s shoulder blades (Fig. 6-7, B).
Maintain support of the infant’s head and neck by
Figure 6-6 Abdominal thrusts: A, Place the thumb firmly holding the jaw between your thumb and
side of your fist against the middle of the victim’s ab- forefinger. Each blow should be a separate and dis-
domen. B, Grab your fist with your other hand. C, Give tinct attempt to dislodge the object.
quick, upward thrusts into the abdomen. To give chest thrusts, you will need to place the
infant in a face-up position. Start by placing your
free hand and forearm along the infant’s head and
back so that the infant is sandwiched between your
Conscious Adult or Child two hands and forearms (Fig. 6-8, A). Continue to
A combination of 5 back blows followed by 5 ab- support the infant’s head between your thumb and
dominal thrusts is an effective way to clear an air- finger from the front while you cradle the back of
way obstruction. To give back blows— the head with your other hand. Turn the infant onto
Position yourself slightly behind the person. his or her back. Lower your arm that is supporting
Provide support by placing one arm diagonally the infant’s back onto your opposite thigh. The in-
across the chest and lean the person forward. fant’s head should be lower than his or her chest,
A A
B B
Figure 6-7 A, To give back blows, sandwich the infant

between your forearms. Support the infant’s head and Figure 6-8 To give chest thrusts, sandwich the infant
neck by holding the jaw between your thumb and fore- between your forearms. Continue to support the infant’s
finger. B, Turn the infant over so that he or she is face- head. A, Turn the infant onto his or her back and sup-
down on your forearm. Give 5 firm back blows with the port your arm on your thigh. The infant’s head should be
heel of your hand while supporting the arm that is hold- lower than the chest. B, Give 5 chest thrusts.
ing the infant on your thigh.
which will assist in dislodging the object. Give thigh. If the infant is large or your hands are too
5 chest thrusts. small to adequately support the infant, you may
To locate the correct place to give chest thrusts, prefer to sit. The infant’s head must be lower than
imagine a line running across the infant’s chest be- his or her chest. Continue back blows and chest
tween the nipples. Place the pads of two or three of thrusts until the object is forced out, the infant be-
your fingers just under this imaginary line. If gins to breathe on his or her own or the infant be-
you feel the notch at the end of the infant’s breast- comes unconscious.
bone, move your fingers up toward the nipple line
(Fig. 6-8, B).
Use the pads of the index and middle fingers to
compress the breastbone. Compress the breast-
Special Considerations
bone 1⁄2 to 1 inch; let the breastbone return to its
normal position. Keep your fingers in contact with
Chest Thrusts
the infant’s breastbone. You can give back blows In some instances, abdominal thrusts are not the
and chest thrusts effectively whether you stand or best method of care for a conscious choking adult or
sit, as long as the infant is supported on your child. For example, if you cannot reach far enough
Figure 6-9 Give chest thrusts if you cannot reach Figure 6-10 To give abdominal thrusts to yourself,
around the victim to give abdominal thrusts, or if the vic- press your abdomen onto a firm object, such as the
tim is noticeably pregnant. back of a chair.
around the victim to give effective abdominal Conscious Choking Adult or Child Who
thrusts, you should give chest thrusts. You should
also give chest thrusts instead of abdominal thrusts
Becomes Unconscious
to choking victims who are obviously pregnant or While giving abdominal thrusts to a conscious
known to be pregnant. choking adult or child, you should anticipate that
To give chest thrusts to a conscious victim, the victim will become unconscious if the obstruc-
stand behind the victim and place your arms un- tion is not removed. If the victim becomes uncon-
der the victim’s armpits and around the chest. As scious, carefully lower him or her to the floor. Call
with abdominal thrusts, make a fist with one 9-1-1 or the local emergency number if someone
hand and place the thumb side against the center has not already called.
of the victim’s breastbone. Be sure that your fist Open the victim’s airway using the head-
is centered on the breastbone, not on the ribs. tilt/chin-lift technique and attempt 2 rescue
Also make sure that your fist is not near the breaths. Often the throat muscles relax enough af-
lower tip of the breastbone. Grab your fist with ter a person becomes unconscious to allow air past
your other hand and thrust inward. Repeat these the obstruction and into the lungs. You will know
thrusts until the victim can cough, speak or air has made it successfully into the lungs if the vic-
breathe or until the victim becomes unconscious tim’s chest rises and falls with each rescue breath.
(Fig. 6-9). If air does not go into the lungs and the chest does
not rise, perform chest compressions. You will
learn more about performing chest compressions
If You Are Alone and providing care for an unconscious choking
If you are alone and choking and no one is adult or child in Chapter 7.
around who can help, you can give yourself ab-
dominal thrusts in one of two ways. Make a fist
with one hand and place the thumb side on the Conscious Choking Infant Who Becomes
middle of your abdomen slightly above your
navel and well below the tip of your breastbone.
Unconscious
Grasp your fist with your other hand and give If a conscious choking infant becomes uncon-
quick, upward thrusts. You can also lean for- scious, lower the infant to a table or the floor and
ward and press your abdomen over any firm ob- open his or her airway. Call 9-1-1 or the local
ject, such as the back of a chair, a railing or a emergency number if someone has not already
sink. Be careful not to lean over anything with done so. Open the infant’s airway. Then attempt 2
a sharp edge or a corner that might injure you rescue breaths. If air still does not go in, position
(Fig. 6-10). the infant for chest compressions. Give 30 chest
compressions followed by a visual check for an

object. If you see an object, try to remove it with Signals for Respiratory Arrest
your little finger (Fig. 6-11). If you do not see an
object, or after your attempt to remove an object Signals for a victim in respiratory arrest include—
with your little finger, give 2 rescue breaths. Con- Absence of breathing.
tinue the sequence of providing 30 chest compres- Skin color (ashen or cyanotic).
sions followed by an attempt to remove an object
if you see it, followed by attempting 2 rescue
breaths, until you are able to get air in or EMS
personnel arrive and take over (Fig. 6-12, A-B). If Care for Respiratory Arrest
you are able to get air into the infant, check for
signs of life and a pulse. You will learn more Rescue breaths are a way of breathing air into a
about caring for an infant with no signs of life in victim’s lungs to supply that person with the oxygen
Chapter 7. he or she needs to survive. Rescue breaths are given
as a part of CPR and to infants and children who
are not breathing but still have a pulse.
Rescue breaths work because the air you
RESPIRATORY ARREST breathe into the victim contains more than enough
oxygen to keep that person alive. The air you take
In respiratory arrest, breathing stops. The person
gets no oxygen. The body can function without
oxygen for only a few minutes before body systems
begin to fail. Without oxygen, the heart muscle
stops functioning, causing the circulatory system to
fail. When the heart stops, other body systems start
to fail. However, you can keep the person’s respira-
tory system functioning artificially by giving rescue
breathing.
Figure 6-12 A, If the breaths do not go in, reposition

Figure 6-11 Lift the jaw upward. If you see an object, the airway and give breaths again. B, If air still does not
try to remove it with your little finger. go in, position the infant for chest compressions.
in with every breath contains about 21 percent oxy- Rescue Breathing for an Infant
gen, but your body uses only 5 percent of that oxy- When giving rescue breathing to an infant, it is
gen. The air you breathe out of your lungs and into easier to cover both the nose and mouth with
the victim’s lungs contains about 16 percent oxy- your mouth than to pinch the nose (Fig. 6-14).
gen, enough to keep someone alive. Take a normal breath, not a deep breath, and give
1 breath every 3 seconds for an infant. Each
Rescue Breathing for Infants and Children breath should last about 1 second. Be careful not
to over-inflate an infant’s lungs. Breathe only un-
If you discover that a child or infant is unconscious, til you see the chest clearly rise. After 2 minutes of
not breathing and has a pulse and no one is avail- rescue breathing (about 40 breaths), recheck for
able to call 9-1-1 or the local emergency number, signs of life and a pulse for no more than 10 sec-
give 2 minutes of care and then make the call your- onds. If the child or infant has a pulse but is not
self. Rescue breathing for a child or an infant is per- breathing, continue rescue breathing. Recheck for
formed in much the same way as a rescue breath for signs of life and a pulse and breathing about every
an adult. However, there are some minor variations. 2 minutes.
These variations take into account the anatomical
and physiological differences between an adult and
a child or infant. Breathing Barriers
You may not feel comfortable with the thought
Rescue Breathing for a Child of giving rescue breaths, especially to someone
To provide rescue breathing for a child, use less air you do not know. Disease transmission is an un-
in each breath and deliver breaths at a slightly derstandable concern, even though the chances
faster rate. You do not need to tilt a child’s head as of contracting a disease from providing rescue
far back as an adult’s to open the airway. (Tilt the breaths are extremely low. CPR breathing barri-
head gently back only far enough to allow your ers, such as resuscitation masks and face shields,
breaths to go in (Fig. 6-13). Use the fingers and not create a barrier between your mouth and nose
the thumb to lift the lower jaw at the chin up and and the victim’s. This barrier can help protect
outward. Keep your fingers on the bony part of the you from contact with blood and other body flu-
jaw.) Tipping the child’s head back too far may ob- ids. Many barriers are small enough to fit in a
struct the airway. Take a normal breath, not a deep pocket, first aid kit or in the glove compartment
breath, and give 1 breath every 3 seconds for a of a car (Fig. 6-15, A-B). When using a CPR
child or infant. Each breath should last about breathing barrier during rescue breathing, follow
1 second. the same procedures already described. Depend-
Figure 6-14 Cover both the nose and mouth of the

Figure 6-13 Tilt the head and lift the chin to open the infant with your mouth when giving rescue breathing to
airway. an infant.
Standard One-way
coupling valve
assembly
Oxygen
inlet
A B
Transparent
pliable
material
Figure 6-15 A, A face shield or, B, a mask, when placed between your mouth
and nose and the victim’s, can help prevent you from contacting a person’s saliva
or other body fluids.
ing on the barrier, you may have to modify how

Air in the Stomach
you open the airway and maintain the correct The most common complication of rescue breath-
airway position. While the use of CPR breathing ing is air in the stomach. Air in the stomach can
barriers is preferred to mouth-to-mouth contact, cause gastric distention. Gastric distention can be
you should not delay rescue breathing while serious because it can make the victim vomit. If an
searching for a breathing barrier or learning how unconscious person vomits, he or she may aspi-
to use one. rate stomach contents or other material, such
as saliva or blood, which can hamper rescue
breathing.
When to Stop Care Common causes of gastric distention include—
Do not stop rescue breathing unless one of the fol- Breathing into the victim with too much force.
lowing situations occurs: This situation often occurs when the victim’s
head is not tilted back far enough and the air-
The scene becomes unsafe. way is not completely open.
The victim begins to breathe on his or her own. Breathing too quickly. This increases pressure
Another trained person takes over for you. in the airway, causing air to enter the
EMS personnel arrive on the scene and take over. stomach.
You are too exhausted to continue. Breathing into the victim longer than 1 second
in duration.
Special Considerations To avoid forcing air into the stomach, be sure to keep
the victim’s head tilted correctly for his or her size
Rescue breathing is a very simple skill to perform. and age. Breathe into the victim only enough to make
However, several situations exist that may require the chest clearly rise. Breaths should not be given too
special attention. Being familiar with these situa- quickly or too hard. Pause between breaths long
tions will help you give care for a person in respira- enough for the victim’s lungs to empty and for you to
tory arrest. take another breath.
Laryngectomies: electronically. The head of the instrument is held

against the neck and the sound vibrates through the
A Breath of Fresh Air neck and into the mouth. The person shapes the word
just as if the sound came from the vocal cords.
Sometimes the resulting sound from neck placement
Years ago a person diagnosed with cancer of the lar- is not satisfactory, in which case a cap with a small
ynx had a small chance of survival. Today, advances straw-like tube is put on the head of the instrument,
in drugs, surgical techniques and radiation therapy and the tube is placed into the corner of the mouth. In
have led to increased survival rates. Laryngeal cancer this way, the sound is delivered directly into the
is now one of the most curable cancers. mouth, and the person uses more normal pronuncia-
Cancer of the larynx may involve the vocal cords tion to shape the sound into speech.
and surrounding tissue, giving rise to signals such as Another way a laryngectomee makes sound is by
voice changes or trouble breathing or swallowing. using the same sound source we all use when we
Surgical removal of the larynx, known as a total laryn- burp. The location of the sound is the upper end of
gectomy, is a common procedure for treating laryn- the food tube, or esophagus. The laryngectomee
geal cancer. The person who has this procedure is a learns to move the air into the esophagus and make
laryngectomee. When the entire larynx is removed, a controlled sound, as the air comes back out. With
connection no longer exists between the mouth, the practice, the sound becomes refined and very effec-
nose and the windpipe. A surgical opening, called a tive for speech. This is known as esophageal speech.
stoma, is made in the front of the neck, and the wind- A variation of this form of communication is known as
pipe is attached to it. The patient breathes only tracheoesophageal speech. A small surgical opening
through the stoma and not through the mouth or is created between the windpipe and esophagus. A
nose. This person is called a “total neck breather.” valved tube is put in the opening. The tube allows air
Some people have a condition that hinders the ef- from the lungs to enter the esophagus, and the indi-
fectiveness of their airway, such as growths or vocal vidual produces esophageal speech by exhaling rather
cord paralysis. They can be assured of an adequate than by injecting air into the esophagus.
air supply by having an opening made from the out- The International Association of Laryngectomees
side of the neck into the windpipe. A tube is inserted (IAL) was formed in 1952 as an organization dedi-
to prevent the opening from growing together again. cated to supporting laryngectomees and their fami-
This opening is also called a stoma. Because these lies. There are nearly 300 member clubs located
individuals still have a larynx, they may be able to throughout the United States and in several foreign
breathe to some degree through the nose and mouth. countries. Supported by the American Cancer Society,
They are called “partial neck breathers.” the IAL is also a conduit for public information and
Although someone who has had a total laryngec- education regarding laryngectomees. The IAL has
tomy no longer has vocal cords, that person is still been dedicated to helping educate emergency and
able to speak. The only aspect of speech they no public workers on the special needs of neck breathers
longer have is the ability to generate sound. Many in certain emergency situations, such as respiratory
laryngectomees communicate using an instrument arrest. Through their efforts, many lives have been
called an artificial larynx, which generates sound saved.
Mouth-to-Nose Breathing
Sometimes you may not be able to make an ade-
quate seal over a victim’s mouth to perform a rescue
breath. The victim’s jaw or mouth may be injured
or your mouth may be too small to cover the vic-
tim’s. If so, provide mouth-to-nose rescue breaths as
follows:
Maintain the head-tilt position with one hand
on the forehead. Use your other hand to close
the victim’s mouth, making sure to push on the
chin and not on the throat.
Open your mouth wide, take a deep breath,
seal your mouth tightly around the victim’s
Figure 6-16 If the victim vomits, roll the victim on the nose and breathe into the victim’s nose
side and clear the mouth of any objects. (Fig. 6-17). Open the victim’s mouth between
breaths, if possible, to let air out.
Vomiting Mouth-to-Stoma Breathing

When you give rescue breaths, the victim may Some people have had an operation to remove all or
vomit, whether or not gastric distention occurs. If part of the upper end of their airway. They breathe
the victim vomits, roll him or her onto one side through an opening called a stoma in the front of
(Fig. 6-16). If the person vomits and is uncon- the neck (Fig. 6-18). Air passes directly into the air-
scious and lying down, position the person on his way through the stoma instead of through the
or her side. Avoid twisting the neck and back. mouth and nose.
This positioning helps to prevent vomit from en- Most people with a stoma wear a medical ID
tering the lungs. Quickly wipe the victim’s mouth tag or carry a card identifying this condition. You
clean, reposition the victim on his or her back, may not see the stoma immediately. You will prob-
reopen the airway and continue with rescue ably notice the opening in the neck as you tilt the
breathing. head back to check for breathing or move clothing.
Figure 6-17 For mouth-to-nose breathing, keep the Figure 6-18 You may need to give rescue breaths to
head tilted back, close the victim’s mouth and seal your a victim with a stoma, which is an opening in the front of
mouth around the victim’s nose. the neck.
stoma breathing, air may leak through the nose and

mouth, diminishing the amount of your rescue
breaths that reaches the lungs. If this occurs, you
need to seal the nose and mouth with your hand to
prevent air from escaping during rescue breaths.
A
Victims with Dentures
If you know or see that the victim is wearing den-
tures, do not automatically remove them. Dentures
help you give rescue breaths by supporting the vic-
tim’s mouth and cheeks during mouth-to-mouth
breathing. If the dentures are loose, the head-tilt/chin-
lift technique may help keep them in place. Remove
the dentures only if they become so loose that they
block the airway or make it difficult for you to give
breaths.
B Victims with Suspected Head, Neck or

Back Injuries
You should suspect a head, neck or back injury if
the person—
Was involved in a motor vehicle crash.
Was injured as a result of a fall from a height
greater than the victim’s standing height.
Figure 6-19 A, To check for breathing, look, listen and
feel for breaths with your ear over the stoma. B, To give Complains of neck or back pain.
rescue breaths, seal your mouth around the stoma and Has tingling or weakness in extremities.
breathe into the victim. Is not fully alert.
Appears intoxicated.
Appears to be frail or over 65 years of age.
If you suspect the victim may have a head, neck or
back injury, you should try to minimize movement
A stoma may be obscured by clothing, such as a of the head and neck when opening the airway
turtleneck, sweater or a scarf. with the head-tilt chin-lift method. Victims who
To give rescue breaths to someone with a stoma, have a suspected spinal injury should not be
you must give breaths through the stoma instead of moved. But if an open airway cannot be main-
the mouth or nose. Follow the same basic steps as tained or the responder must leave the victim to get
in mouth-to-mouth breathing, except— help, place the victim in a modified High Arm In
Endangered Spine (H.A.IN.E.S.) recovery position.
1. Look, listen and feel for breathing with your
You will learn more about caring for head, neck
ear over the stoma (Fig. 6-19, A).
and back injuries in Chapter 13.
2. Give breaths into the stoma, breathing at the
same rate as for mouth-to-mouth breathing
(Fig. 6-19, B).
3. Remove your mouth from the stoma be-
tween breaths to let air flow back out.
SUMMARY
If the chest does not clearly rise when you give Breathing emergencies are life-threatening condi-
rescue breaths, suspect that the victim may have tions. There are two types of breathing emergen-
had only part of the larynx removed. Some air thus cies: respiratory distress and respiratory arrest.
continues to flow through the larynx to the lungs Respiratory distress is a condition in which breath-
during normal breathing. When giving mouth-to- ing becomes difficult. Respiratory arrest occurs
when breathing stops. As a citizen responder, your care for breathing emergencies, you are now better
role is to recognize the signals of a breathing emer- prepared to care for cardiac and other emergen-
gency, call 9-1-1 or the local emergency number cies. You will learn about cardiac emergencies in
and give appropriate care. By knowing how to Chapter 7.
1. What signals was Steve exhibiting and experi- 4. If Steve went into respiratory arrest, what would
encing in the opening scenario? you do?
2. Would knowing the cause of Steve’s problem 5. Is it possible that Steve’s condition may lead to
change the care you give? Why or why not? an anatomical airway obstruction? Why?
3. Could the cause of Steve’s respiratory distress

lead to respiratory arrest? Why or why not?
STUDY QUESTIONS
a. Airway obstruction e. Epiglottitis

b. Head-tilt/chin-lift f. Respiratory arrest
c. Aspiration g. Anatomical airway obstruction
d. Rescue breathing h. Respiratory distress
_____ Inhaling blood, vomit or other foreign material into the lungs.
_____ Technique of breathing for a non-breathing child or infant.
_____ Blockage of the airway that prevents air from reaching the victim’s lungs.
_____ Condition in which breathing stops.
_____ Condition in which breathing becomes difficult.
_____ Technique for opening the airway.
_____ Occurs if the airway is blocked by the tongue or swollen tissues of the mouth and throat.
_____ Condition in which the epiglottis swells.
2. Circle four signals associated with respiratory distress that you find in the following scenario.
When Rita walked into Mr. Boyd’s office, she found him collapsed across his desk. His eyes were closed but she
could hear him breathing, making a high whistling noise. He was flushed, sweating and seemed to be trembling
uncontrollably. When he heard Rita, he raised his head a little, “My chest hurts,” he gasped, “and I feel dizzy and
can’t seem to catch my breath.” He looked frightened.
3. List three causes of choking.
4. Match each type of care with its purpose.
a. Back blows and abdominal thrusts

b. Recognizing and caring for respiratory distress
c. Giving rescue breaths
_____ Supply oxygen to the lungs when someone has stopped breathing.
_____ Force a foreign object out of the airway.
_____ May prevent respiratory arrest from occurring.
5. Which of the following is a signal of respiratory distress?
a. Gasping for air

b. Breathing that is slower than normal
c. Wheezing
d. All of the above
6. How are asthma, hyperventilation and anaphylactic shock alike?
a. They require rescue breathing.

b. They are forms of respiratory distress.
c. They are always life threatening.
d. They occur only in children and infants.
7. Care for victims of respiratory distress always includes which of the following?
a. Helping the victim rest in a comfortable position

b. Giving the victim water to drink
c. Giving rescue breathing
d. Delivering abdominal thrusts
8. Which of the following statements about rescue breathing is true?
a. It supplies the body with oxygen necessary for survival.

b. It always requires clearing the airway of foreign objects.
c. It is given to children and infants who are not breathing but do have a pulse.
d. It is given only when two rescuers are present.
9. For which condition would a child or infant need rescue breathing?
a. Unconsciousness
b. Unconsciousness and respiratory distress
c. Unconsciousness, respiratory arrest, with pulse.
d. Unconsciousness, respiratory distress, with no pulse.
10. When you give rescue breaths, how much air should you breathe into the victim?
a. Enough to make the stomach clearly rise

b. Enough to make the chest clearly rise
c. Enough to feel resistance
d. Enough to fill the victim’s cheeks
11. Which action is a part of the care for an unconscious adult victim with an obstructed airway?
a. Giving 2 rescue breaths

b. Giving chest compressions
c. Calling 9-1-1 or the local emergency number
d. All of the above
12. What should you do for a conscious infant who is choking and cannot cry, cough or breathe?
a. Give back blows and chest thrusts.

b. Give 1 rescue breath.
c. Give abdominal thrusts.
d. Lower the infant to the floor and open the airway.
13. After giving 2 rescue breaths to an adult victim with an obstructed airway who becomes unconscious, what
should you do next?
a. Give chest compressions if the chest does not rise.

b. Look for an object in the back of the throat and attempt to remove it if it is visible.
c. Check for signs of life, give 2 rescue breaths and look for and remove an object if it is visible at the
back of the throat.
d. Check for and remove an object if it is visible at the back of the throat and then check for signs of life.
14. After 2 minutes of rescue breathing, you check a child for signs of life including a pulse. The child has a pulse
but still is not breathing. What should you do?
a. Continue rescue breathing by giving 2 breaths.

b. Continue rescue breathing by giving 1 breath every 3 seconds.
c. Stop rescue breathing for 2 minutes.
d. Reposition the airway.
15. While eating dinner, a friend suddenly starts to cough weakly and makes high-pitched noises. What should
you do?
a. Lower him to the floor, check for and remove an object if it is visible at the back of the throat,
give 2 breaths and up to 5 abdominal thrusts.
b. Give back blows and abdominal thrusts until the object is dislodged or he becomes unconscious.
c. Encourage him to continue coughing to try to dislodge the object.
d. Open the airway using the head-tilt/chin-lift technique.
16. A woman is choking on a piece of candy but is conscious and coughing forcefully. What should you do?
a. Slap her on the back until she coughs up the object.

b. Give abdominal thrusts.
c. Encourage her to continue coughing.
d. Perform a check at the back of the throat.
17. Number in order the following actions for performing rescue breathing, starting from the time you discover
that an unconscious child victim is not breathing.
_____ Check for signs of life including a pulse and severe bleeding.
_____ Give 1 breath about every 3 seconds.
_____ Give 2 breaths.
_____ Recheck for signs of life and a pulse after 2 minutes.

SKILL SHEET Conscious Choking—Adult

(If person cannot cough, speak or breathe)
Step 1
CHECK scene, then CHECK person.
Step 2
Have someone CALL 9-1-1.
4
Step 3
Obtain consent.
Step 4
Lean the person forward and give 5 back blows with
the heel of your hand.
Step 5 5a
Give 5 quick, upward abdominal thrusts.
NOTE: Give chest thrusts to a choking person who is

pregnant or too big for you to reach around.
NOTE: You can give yourself abdominal thrusts by

using your hands, just as you would do to another
person, or lean over and press your abdomen against
any firm object such as the back of a chair.
5b
Step 6
Continue back blows and abdominal thrusts until—
• Object is forced out.
• Person can breathe or cough forcefully.
• Person becomes unconscious.
• If adult becomes unconscious, follow steps on
pp. 142-143.
5c
SKILL SHEET Conscious Choking—Child

(If child cannot cough, speak or breathe)
Step 1
CHECK scene, then CHECK child.
Step 2
Have someone CALL 9-1-1.
Step 3 4
Step 4
Lean the child forward and give 5 back blows with
the heel of your hand.
Step 5
Give 5 quick, upward abdominal thrusts.
NOTE: For a child, stand or kneel behind the child,

depending on his or her size.
5a
Step 6
Continue back blows and abdominal thrusts until—
• Object is forced out.
• Child can breathe or cough forcefully.
• Child becomes unconscious.
• If child becomes unconscious, follow steps
on pp. 146-147.
5b
SKILL SHEET Conscious Choking—Infant
Check the scene and the infant. Remember: Always follow standard precautions
to prevent disease transmission.
Step 1
Obtain permission to provide care (if parent or
guardian is present).
Step 2
If the infant cannot cough, cry or breathe, have someone
else call 9-1-1 or the local emergency number.
Step 3
Carefully position the infant face-down on your
forearm.
• Support the infant’s head and neck with
your hand.
• Lower the infant onto your thigh, keeping the
infant’s head lower than his or her chest.
Step 4
Give 5 firm back blows between the infant’s shoulder
blades with the heel of your hand.
• Each blow should be a separate and distinct
attempt to dislodge the object.
Step 5
Carefully position the infant face-up on your forearm.
• Support the infant’s head and neck with
your hand.
• Lower the infant onto your thigh, keeping the
infant’s head lower than his or her chest.
Step 6
Give 5 chest thrusts.
• Place two or three fingers on the center of the
infant’s chest, about 1 finger width below an
imaginary line between the nipples.
• Compress the breastbone 1⁄2 to 1 inch, 5 times.
Step 7
Repeat cycles of back blows and chest thrusts until—
• The object is expelled.
• The infant starts to breathe, cry or cough forcefully.
• The infant becomes unconscious.
If the infant becomes unconscious, follow the steps on pp. 150-151.
SKILL SHEET Rescue Breathing for a Child
Complete “Checking an Unconscious Child (Ages 1-12)” Steps 1-7 in Chapter 5, page 78.
Remember: Always follow standard precautions to prevent disease transmission.
If a child is not breathing but has a pulse—
Step 8
Give 1 rescue breath about every 3 seconds.
• Continue for about 2 minutes—about 40 breaths.
Step 9
Recheck for signs of life and a pulse about every
2 minutes.
• Continue rescue breathing as long as a pulse
is present but the child is not breathing.
SKILL SHEET Rescue Breathing for an Infant
Complete “Checking an Unconscious Infant (Under Age 1)” Steps 1-8 in Chapter 5, page 79.
Remember: Always follow standard precautions to prevent disease transmission.
If an infant is not breathing but has a pulse—
Step 9
Give 1 rescue breath about every 3 seconds.
• Continue for 2 minutes—about 40 breaths.
Step 10
Recheck for signs of life and a pulse about
every 2 minutes.
• Continue rescue breathing as long as a pulse is
present but the infant is not breathing.
er 7
Chapter As you come out of your house to run a quick errand, you see your
neighbor, Mr. Getz, enjoying his lunch out on his porch. He has been
very ill lately. “I am glad to see that you are feeling better,” you shout
across the driveway. Mr. Getz waves and says, “Now I can finally
mow the lawn,” as he points to the mower in the driveway. When
you return, you check your mailbox and notice Mr. Getz sprawled
face-down on the grass next to his lawn mower.
Cha
Cardiac
Emergencies
and Unconscious
Choking
Objectives
■ Identify the links in the Cardiac Chain of Survival.
■ List the signals of a heart attack for both men and women.
■ Describe the care for a victim of a heart attack.
■ Describe the role of CPR in cardiac arrest.
■ Describe defibrillation and how it works.
■ Describe the general steps for the use of an automated external
defibrillator (AED).
■ List the precautions for the use of an AED.
After reading this chapter and completing the appropriate class

activities, you should be able to demonstrate—
■ How to perform CPR for an adult, child and infant.
■ How to care for an unconscious choking adult, child and infant.
■ How to use an AED to care for an adult or child in cardiac arrest.
Introduction
each year. The principal components of cardiovas-
cular disease—coronary heart disease and stroke—
account for more than 40 percent of all deaths in
the United States.
Cardiovascular disease develops slowly. Fatty
In this chapter, you will learn how to
deposits of cholesterol and other material gradu-
recognize and give care for a victim of a ally build up on the inner walls of the arteries. This
cardiac emergency. This chapter also discusses condition, called atherosclerosis, causes a pro-
risk factors of cardiovascular disease—the gressive narrowing of blood vessels. Because ath-
leading cause of cardiac emergencies—and erosclerosis develops gradually, it can remain un-
what you can do to control those risks. detected for many years. Most people with
atherosclerosis are unaware of it. Fortunately,
Finally, you will learn what to do if an
atherosclerosis can be slowed or stopped by adopt-
unconscious victim is not breathing and the ing a healthy lifestyle. You will learn more about
rescue breaths you give do not go in maintaining a healthy lifestyle in Chapter 24 of
(unconscious choking). this text.
The most common type of cardiovascular dis-
ease is coronary heart disease (also called coronary
artery disease). Coronary heart disease occurs when
CARDIOVASCULAR DISEASE the arteries that supply oxygen-rich blood to the
heart muscle (coronary arteries) harden or narrow
Cardiovascular disease—abnormal conditions that from the build-up of fatty deposits (atherosclerosis).
affect the heart and blood vessels—is the leading As a result, the flow of oxygen-rich blood to the
cause of death for men and women in the United heart decreases. If the heart muscle is deprived of
States. An estimated 61 million Americans suffer this blood, it dies. If enough of the heart muscle
from some form of cardiovascular disease. About dies, the heart cannot circulate the blood effectively
950,000 Americans die of cardiovascular disease to other parts of the body (Fig. 7-1).
K E Y T E R M S
Angina pectoris: Chest pain that comes and goes Coronary heart disease (also called coronary
at different times; commonly associated with artery disease): Occurs when the coronary ar-
cardiovascular disease. teries that supply oxygen-rich blood to the
Asystole: A condition where the heart has heart muscle become hardened or narrowed
stopped generating electrical activity. from the build-up of fatty deposits.
Atherosclerosis: A condition in which fatty de- Defibrillation: An electrical shock that disrupts
posits build up on the walls of the arteries. the electrical activity of the heart long enough
Cardiac arrest: A condition in which the heart has to allow the heart to spontaneously develop an
stopped beating or beats too ineffectively to effective rhythm on its own.
generate a pulse. Heart attack: A sudden illness involving the death
Cardiopulmonary resuscitation (CPR): A technique of heart muscle tissue when it does not receive
that combines chest compressions and rescue oxygen-rich blood; also known as myocardial
breathing for a victim whose heart and breath- infarction.
ing have stopped. Risk factors: Conditions or behaviors that in-
Cardiovascular disease: Disease of the heart and crease the chance that a person will develop a
blood vessels. disease.
Cholesterol: A fatty substance made by the body Ventricular fibrillation (V-fib): An abnormal heart
and found in certain foods; too much in the rhythm characterized by disorganized electri-
blood can cause fatty deposits on artery walls cal activity, which results in the quivering of
that may restrict or block blood flow. the ventricles.
Coronary arteries: Blood vessels that supply the Ventricular tachycardia (V-tach): An abnormal
heart muscle with oxygen-rich blood. heart rhythm characterized by rapid contrac-
tions of the ventricles.
CHAPTER 7 Cardiac Emergencies and Unconscious Choking 117
Arteries of the heart
Unblocked Partially Completely

blocked blocked
Figure 7-1 Buildup of fatty materials on the inner walls of the arteries reduces
blood flow to the heart muscle and may cause a heart attack.
CARDIAC EMERGENCIES for a short period of time until oxygen is depleted.

This victim needs cardiopulmonary resuscitation
Two common cardiac emergencies are a heart at- (CPR), which is a combination of chest compres-
tack (also known as myocardial infarction) and car- sions and rescue breathing. (The term “cardio”
diac arrest. A heart attack refers to a condition in refers to the heart, and “pulmonary” refers to the
which the blood flow to some part of the heart mus- lungs.) Performed together, rescue breaths and
cle is compromised and the heart begins to die. If chest compressions artificially take over the func-
enough of the muscle dies, the heart cannot circu- tions of the lungs and heart, increasing the victim’s
late blood effectively. The term cardiac arrest refers chance of survival by keeping the brain supplied
to a condition in which the heart stops beating. with oxygen until advanced medical care can be
given.
However, even under the best of conditions,
The Cardiac Chain of Survival CPR only generates about one-third of the normal
blood flow to the brain. Therefore, CPR alone is
A victim who has no signs of life is said to be clin- not enough to help someone survive cardiac arrest.
ically dead (Fig. 7-2). However, the cells of the Early CPR given by bystanders, combined with
brain and other vital organs will continue to live early defibrillation and advanced cardiac life sup-
0 minutes: Breathing stops. Heart will soon stop beating. 3. Early defibrillation. Most victims of sudden
cardiac arrest need an electric shock called
4–6 minutes: Brain damage possible.
defibrillation. Each minute that defibrillation
6–10 minutes: Brain
is delayed reduces the chance of survival by
damage likely. about 10 percent.
4. Early advanced medical care. This is given by
trained medical personnel, who provide fur-
Over 10 minutes: Irreversible
brain damage certain. ther care and transport to hospital facilities.
HEART ATTACK
Heart attacks are caused by obstructions in the
coronary arteries. Most people who die from a
heart attack do so within 1 to 2 hours after the first
Figure 7-2 Clinical death is a condition in which the signals appear. Because the obstruction may be a
heart and breathing stop. Without resuscitation, clinical clot, early treatment with medication that dissolves
death will result in biological death. Biological death is clots can help in minimizing damage to the heart.
the irreversible death of brain cells. Many lives might have been saved if bystanders or
the victim had been aware of the signals of a heart
attack and acted promptly.
port by EMS personnel, give the victim of cardiac
arrest the best chance for survival. This concept is
known as the Cardiac Chain of Survival. Signals of a Heart Attack
The greatest chance of survival from cardiac
arrest occurs when the following sequence of The most prominent signal of a heart attack is per-
events—the Cardiac Chain of Survival—happens as sistent chest pain or discomfort. The pain can range
rapidly as possible (Fig. 7-3): from discomfort to an unbearable crushing sensa-
tion in the chest. The victim may describe it as an
1. Early recognition and early access. The
uncomfortable pressure, squeezing, tightness,
sooner 9-1-1 or the local emergency number
aching or constricting, or a heavy sensation in the
is called the sooner early advanced medical
chest. Often, the pain is felt in the center of the
care arrives.
chest behind the sternum. The pain may spread to
2. Early CPR. Early CPR helps circulate blood
the shoulder, arm, neck or jaw (Fig. 7-4). The pain
that contains oxygen to the vital organs until
is constant and usually not relieved by resting,
an AED is ready to use or advanced medical
changing position or taking medication. Any severe
personnel arrive.
chest pain that lasts longer than 3 to 5 minutes or
chest pain that is accompanied by other signals of a
heart attack should receive emergency medical care
immediately.
Another prominent indicator of a heart attack is
trouble breathing. The victim may be breathing
faster than normal because the body is trying to get
much-needed oxygen to the heart. The victim’s
pulse may be faster or slower than normal, or ir-
regular. The victim’s skin may be pale, ashen or
bluish, particularly around the face. The skin may
also be moist from perspiration. The victim may
feel nauseous and may vomit. These signals result
from the stress the body experiences when the heart
Figure 7-3 Use of a defibrillator and other advanced does not work effectively.
measures may restore a heartbeat in a victim of cardiac Nearly half of all deaths from heart attack are
arrest. women. As with men, the most common signal for
Aspirin Can Lessen Heart

Attack Damage
You may be able to help a conscious person
who is showing early signals of a heart attack
by offering him or her an appropriate dose of
aspirin when the signals first begin. However,
you should never delay calling 9-1-1 or the
local emergency number to do this. Always
call 9-1-1 or the local emergency number as
soon as you recognize the signals, and then
help the person to be comfortable before you
give the aspirin.
Then, if the person is able to take medicine by
mouth, ask if he or she—
Is allergic to aspirin.
Figure 7-4 Heart attack pain is most often felt in the Has a stomach ulcer or stomach disease.
center of the chest, behind the breastbone. It may
spread to the shoulder, arm, neck or jaw. Is taking any blood thinners, such as
Coumadin™ or Warfarin™.
Has been told by a doctor not to take
a heart attack in a woman is chest pain or discom- aspirin.
fort. But women are somewhat more likely than If the person answers no to all of these ques-
men to experience some other common signals, par-
tions, you may offer him or her two chewable
ticularly shortness of breath, nausea or vomiting
and arm, back, neck, jaw or stomach pain. (162 mg) baby aspirins, or up to one 5-grain
Many heart attack victims delay seeking care. (325 mg) adult aspirin tablet with a small
Nearly half of all heart attack victims wait 2 or amount of water. Be sure that you only use as-
more hours before going to the hospital. Victims pirin and not Tylenol, acetaminophen, Motrin,
often deny that they are having a heart attack. Advil or ibuprofen, which are painkillers. Like-
Some heart attack victims can have relatively wise, do not use coated aspirin products or
mild signals and often mistake the signals for
indigestion.
products meant for multiple uses such as cold,
fever and headache.
Care for a Heart Attack You may also offer these doses of aspirin if
you have cared for the person and he or she
The most important first aid measure is to be able has regained consciousness and is able to
to recognize the signals of a heart attack and take take the aspirin by mouth.
action. A heart attack victim may deny the seri-
ousness of the signals he or she is experiencing. Do
not let this denial influence you. If you think that
the victim might be having a heart attack, you
2. Have the victim stop what he or she is doing
must act. Make sure you follow the emergency
and rest comfortably. Having the victim rest
action steps: CHECK—CALL—CARE.
eases the heart’s need for oxygen. Many vic-
1. Send someone to call 9-1-1 or the local emer- tims find it easier to breathe while sitting
gency number. (Fig. 7-5).
1. CHECK the scene and the victim.

2. If the victim is unconscious, send someone or
Care for a Heart Attack CALL 9-1-1 or the local emergency number.
3. CHECK for signs of life for no more than
Recognize the signals of a heart attack. 10 seconds. If the person is not breathing,
give 2 rescue breaths.
Call 9-1-1 or the local emergency number. 4. If there are no signs of life (movement or
Help the victim rest comfortably. breathing), provide CARE by giving CPR.
Loosen any restrictive clothing. Begin CPR with chest compressions at a rate
of 100 compressions per minute. CPR can
Assist the victim with any prescribed help circulate blood containing oxygen
medication. through a combination of chest compres-
Monitor breathing and other signs of sions and rescue breaths.
life.
Be prepared to perform CPR or use an
AED if the victim’s heart stops beating.
Chest Compressions
Chest compressions are a method of making the
blood flow when the heart is not beating. Chest
emergency because the body’s vital organs are no compressions create pressure within the chest cavity
longer receiving oxygen-rich blood. that moves blood through the circulatory system.
For chest compressions to be the most effective, the
victim should be on his or her back on a firm, flat
Causes surface. The victim’s head should be on the same
level as the heart or lower. CPR is not effective if the
Cardiovascular disease is the most common cause victim is on a soft surface, like a sofa or mattress, or
of cardiac arrest. Drowning, suffocation and certain is sitting up in a chair.
drugs can cause breathing to stop, which will soon
lead to cardiac arrest. Severe injuries to the chest or
severe blood loss can also cause the heart to stop
beating. Electrocution disrupts the heart’s electrical
Locate Proper Hand Position
activity and can cause the heart to stop. Stroke or It is important to locate the correct hand position
other types of brain damage can also stop the heart. while performing chest compressions. The correct
In some cases a victim of cardiac arrest may not hand position allows you to give the most effective
have shown any warning signals. This condition is compressions without further injuring the victim.
called sudden death. To locate the correct hand position on an adult
victim—
Signals of Cardiac Arrest 1. Place the heel of one hand on the victim’s
sternum (breastbone), at the center of his or
A victim in cardiac arrest is unconscious and shows her chest.
no signs of life. The absence of signs of life is the 2. Place your other hand directly on top of the
primary signal of cardiac arrest. Signs of life in- first hand.
clude—normal breathing, movement, a pulse (chil- 3. Use the heel of your hand to apply pressure
dren and infants). The victim’s skin may be pale, on the sternum. Try to keep your fingers off
ashen or bluish, particularly around the face. The the chest by interlacing them or holding them
skin may also be moist from perspiration. upward. Applying pressure with your fingers
can lead to inefficient chest compressions or
unnecessary damage to the chest (Fig. 7-6).
CPR FOR AN ADULT If you have arthritis or a similar condition, you
may use an alternate hand position, grasping the
Follow the emergency action steps: CHECK— wrist of the hand on the chest with your other hand
CALL—CARE to determine if an unconscious adult (Fig. 7-7). You will find the correct hand position in
needs CPR. the same way.
Figure 7-6 Place the heel of your hand on the ster-

num. Place your other hand directly on top of the first
hand. Interlace your fingers and use the heel of your
bottom hand to apply pressure on the sternum.
Figure 7-8 With your hands in place, position yourself

so that your shoulders are directly over your hands,
arms straight and elbows locked.
Kneel beside the victim with your hands in the

correct position. Straighten your arms and lock
your elbows so that your shoulders are directly over
your hands (Fig. 7-8). When you press down in this
Figure 7-7 Grasping the wrist of the hand positioned position, you will be pushing straight down onto
on the chest is an alternate hand position for giving the sternum. Locking your elbows keeps your arms
chest compressions. straight and prevents you from tiring quickly.
Compressing the chest requires less effort in this
In most cases, the victim’s clothing will not in- position. When you press down, the weight of your
terfere with your ability to correctly position your upper body creates the force needed to compress the
hands on his or her chest. Sometimes a layer of thin chest. Push with the weight of your upper body, not
clothing will help keep your hands from slipping, with your arm muscles. Push straight down. Do not
because the victim’s chest may be moist with sweat. rock back and forth. Rocking results in less effective
If you cannot find the correct hand position, bare compressions and wastes much needed energy. If
the victim’s chest. You should not be overly con- your arms and shoulders tire quickly, you are not
cerned that you may not be able to find the correct using the correct body position. After each com-
hand position if the victim is obese, because fat does pression, release the pressure on the chest without
not accumulate as much over the sternum as it does removing your hands or changing hand position
elsewhere. and allow the chest to return to its normal position
before starting the next compression (Fig. 7-9).
Position of the Rescuer

Compression Technique
Your body position is important when providing
chest compressions. Compressing the victim’s chest Each compression should push the sternum down
straight down provides the best blood flow. The from 11⁄2 to 2 inches. The downward and upward
correct body position is also less tiring for you. movement should be smooth, not jerky. Maintain a
COMPRESS
11 2 –2 inches
for an adult
Figure 7-9 Push straight down with the weight of your body, then release, allowing
the chest to return to the normal position.
steady down-and-up rhythm, and do not pause be- reposition your hands correctly before continuing
tween compressions. Spend half of the time pushing compressions.
down and half of the time coming up. When you Give compressions at the rate of about 100 per
press down, the walls of the heart squeeze together, minute. As you do compressions, count aloud,
forcing the blood to empty out of the heart. “One and two and three and four and five and six
When you come up, release all pressure on the and . . .” up to 30. Counting aloud will help you
chest. This release lets the chambers of the heart fill pace yourself. Push down as you say the number
with blood between compressions. Keep your hands and come up as you say “and.” You should be able
in their correct position on the sternum. If your to do the 30 compressions in about 18 seconds.
hands slip, find the notch as you did before, and Even though you are compressing the chest at a rate
of about 100 times per minute, you will not actually
perform 100 compressions in a minute, because you
must stop compressions and give 2 breaths between
each set of 30 compressions.
Compression/Breathing Cycles
When you perform CPR, give cycles of 30 compres-
sions and 2 breaths. For each cycle, give 30 chest
compressions, then open the airway with the head-
tilt/chin-lift technique and give 2 rescue breaths
(Fig. 7-10). For each new cycle of compressions
and breaths, find the correct hand position in the
middle of the chest.
Multiple Responders
If two responders trained in CPR are at the scene,
you should both identify yourselves as CPR-trained
Figure 7-10 Give 30 compressions, then 2 breaths. responders. One of you should call 9-1-1 or the lo-
cal emergency number for help, if this has not been

done, while the other provides CPR. If the first re-
CARDIAC EMERGENCIES IN
sponder is tired and needs help, the first responder
should tell the second responder to take over. The
CHILDREN AND INFANTS
second responder should immediately begin CPR, Unlike adults, children do not often initially suffer a
starting with chest compressions. cardiac emergency. In general, a child or infant suffers
a respiratory emergency; then a cardiac emergency
develops. Motor vehicle crashes, drowning, smoke in-
When to Stop CPR halation, poisoning, airway obstruction, firearm in-
juries and falls are all common causes of respiratory
emergencies that can develop into a cardiac emer-
Once you begin CPR, you should try not to inter-
gency. A cardiac emergency can also result from an
rupt the blood flow being created by your compres-
acute respiratory condition, such as an asthma attack
sions. However, you can stop CPR if—
and severe epiglottitis. If you recognize that an infant
The scene becomes unsafe. or child is in respiratory distress or respiratory arrest,
The victim shows obvious signs of life. give the care you learned in Chapter 6.
An AED becomes available and is ready
to use.
Another trained rescuer arrives and takes over.
You are too exhausted to continue.
CPR FOR CHILDREN AND INFANTS
If the victim shows an obvious sign of life, keep As with an adult, for an infant or child, use the
the airway open and monitor ABCs closely until emergency action steps: CHECK—CALL—CARE
EMS personnel arrive. to determine if you need to perform CPR. Because
CPR SKILL COMPARISON CHART

Skill
Components Adult Child Infant
HAND Two hands in center of chest One or two hands in center of Two or three fingers on lower half
POSITION: (on lower half of sternum) chest (on lower half of sternum) of chest (one finger width
below nipple line)
COMPRESS: 11⁄2 to 2 inches 1 to 11⁄2 inches 1
⁄2 to 1 inch
BREATHE: Until the chest rises Until the chest rises Until the chest rises
(about 1 second per breath) (about 1 second per breath) (about 1 second per breath)
CYCLE: 30 compressions 30 compressions 30 compressions
2 breaths 2 breaths 2 breaths
RATE: 30 compressions 30 compressions 30 compressions
in about 18 seconds in about 18 seconds in about 18 seconds
(100 compressions per minute) (100 compressions per minute) (100 compressions per minute)
Figure 7-11 The technique for CPR differs slightly for adults, children and infants.
infants and children have smaller bodies and faster After giving 30 compressions, remove your com-
breathing and heart rates, the CPR techniques you pression hand(s) from the chest, lift the chin and
use will be different. You must adjust your hand po- give 2 rescue breaths. The breaths should last about
sition, the rate of compressions and the number of 1 second. Use the head-tilt/chin-lift technique to en-
compressions and breaths in each cycle. Figure 7-11 sure that the child’s airway is open. After giving the
compares CPR techniques for adults, children and breath, place your hand(s) in the same position as
infants. before and continue compressions.
Keep repeating the cycles of 30 compressions and
2 rescue breaths. Continue CPR until an AED be-
CPR for a Child comes available and ready, EMS or another trained
responder arrives and takes over or the child shows
To find out if an unconscious child needs CPR, obvious signs of life.
begin by checking for life-threatening conditions.
If you find that the child shows no signs of life
(movement and breathing) and no pulse, begin CPR CPR for an Infant
by performing chest compressions. To perform
chest compressions— To find out if an infant needs CPR, begin by check-
ing for life-threatening conditions. Start by checking
Locate the proper hand position on the
the infant’s signs of life. If the infant shows no signs
middle of the chest as you would for an adult.
of life (movement and breathing) and no pulse, be-
Alternately, you can use a one-handed tech-
gin CPR by performing chest compressions. Position
nique by placing one hand on the child’s chest
the infant face-up on a firm, flat surface. The infant’s
and the other hand on the forehead to main-
head must be on the same level as the heart or lower.
tain an open airway.
Stand or kneel facing the infant from the side. Bare
Place the shoulder(s) over the hand(s).
the infant’s chest. Keep the hand on the infant’s head
Compress the chest smoothly to a depth of
to maintain an open airway. Use the fingers of your
about 11⁄2 inches using the heel of the hand
other hand to give compressions.
(Fig. 7-12).
To find the correct location for compressions—
• Lift up, allowing the chest to fully return
to its normal position, but keep contact Think of an imaginary line running across the
with the chest. chest between the nipples (Fig. 7-13, A).
• Repeat compressions, performing 30 com- Place the pads of two or three fingers just be-
pressions in about 18 seconds. low the imaginary line on the sternum. If you
feel the notch at the end of the infant’s ster-
num, move your fingers up a bit (Fig. 7-13, B).
Use the pads of two or three fingers to compress
the chest. Compress the chest 1⁄2 to 1 inch. Push
straight down. Your compressions should be
smooth, not jerky (Fig. 7-13, C).
Keep a steady rhythm. Do not pause between
compressions except to give breaths. When
your fingers are coming up, release pressure on
the infant’s chest completely, but do not let
your fingers lose contact with the chest. Com-
press at a rate of about 100 compressions per
minute. That rate is slightly faster than the rate
of compressions for a child.
When you complete 30 compressions, give 2 res-
cue breaths, covering the infant’s nose and mouth
Figure 7-12 Alternate 1-handed technique: Place one with your mouth. The breath should take about
hand on the child’s chest and the other hand on the 1 second. Keep repeating cycles of 30 compres-
forehead to maintain an open airway. sions and 2 breaths.
Continue CPR until EMS or another trained

responder arrives and takes over or the child shows
obvious signs of life.
A
UNCONSCIOUS CHOKING—
ADULT OR CHILD
During your check for life-threatening conditions,
you may discover that an unconscious victim is not
breathing and the 2 rescue breaths you give do not
go in. In this case, reposition the victim’s airway
and give 2 breaths again. You may not have tilted
the victim’s head far enough back the first time. If
the breaths still will not go in, assume that the vic-
tim’s airway is obstructed. To care for a uncon-
B scious adult or child with an airway obstruction—
1. Locate the correct hand position for chest
compressions. Use the same techniques that
you learned in CPR.
2. Remove breathing barrier when giving chest
compressions. Perform chest compressions.
Compress an adult’s chest to a depth of about
2 inches 30 times in about 18 seconds.
Compress a child’s chest to a depth of about
11⁄2 inches 30 times in about 18 seconds
(Fig 7-14, A).
C 3. Look for a foreign object. Open the victim’s
mouth. Look inside the victim’s mouth for a
foreign object. If you see an object, remove it
with your finger (Fig. 7-14, B).
4. Give 2 rescue breaths (Fig. 7-14, C). If the
breaths do not go in, repeat cycles of chest
compressions, foreign object check and 2 res-
Figure 7-13 To locate compression position: A, imag- cue breaths until—
ine a line running across the chest between the infant’s • The scene becomes unsafe.
nipples. B, Place the pads of two or three fingers in the • The object is removed and the chest
middle of the chest. C, Use the pads of the fingers to clearly rises with rescue breaths.
compress the chest. • The victim starts to breathe on his or
her own.
• EMS personnel or another trained
responder arrives and takes over.
• You are too exhausted to continue.
5. If the breaths go in and the chest clearly
rises, check for signs of life (including a
pulse for children) for no more than 10 sec-
onds. Care for the conditions you find.
UNCONSCIOUS CHOKING—INFANT
If you determine an infant is unconscious, not
breathing and you cannot get air into the lungs,
reposition the airway by retilting the head and give
2 more rescue breaths. If you still cannot get air into
A the infant, assume that the airway is obstructed. To
care for a unconscious infant with an airway ob-
struction—
1. Locate the correct hand position for chest
compressions (Fig. 7-15, A). Use the same
techniques that you learned in CPR.
2. Remove breathing barrier when giving chest
compressions. Give 30 chest compressions
(Fig. 7-15, B). Each compression should be
about 1⁄2 to 1 inch deep.
3. Look for a foreign object. If the object is
seen, remove it using your little finger
(Fig 7-15, C).
4. Give 2 rescue breaths. If the breaths do not
B go in, repeat cycles of chest compressions,
foreign object check and 2 rescue breaths
until—
• The scene becomes unsafe.
• The object is removed and the chest
clearly rises with rescue breaths.
• The infant starts to breathe on his or
her own.
• EMS personnel or another trained
responder arrives and takes over.
5. If the breath goes in and the chest clearly
rises, check for signs of life (including a
pulse) for no more than 10 seconds. Care for
C the conditions you find.
AUTOMATED EXTERNAL
DEFIBRILLATORS (AED)
As stated earlier, most victims of sudden cardiac ar-
Figure 7-14 A, Compress an adult’s chest about 2 inches
rest need an electric shock called defibrillation.
30 times in about 18 seconds. Compress a child’s chest
about 11⁄2 inches 30 times in about 18 seconds. B, Look Each minute that defibrillation is delayed reduces
for a foreign object. If you see an object, remove it the chance of survival by about 10 percent. There-
with your finger. C, Give 2 rescue breaths. fore, the sooner the shock is administered, the
greater the likelihood of the victim’s survival. By
learning how to use an automated external de-
SA node
Atria
A AV node
Ventricles
Figure 7-16 The heart’s electrical system.

B
cells make up the conduction system. Electrical im-

pulses travel through the upper chambers of the
heart, called the atria, to the lower chambers of the
heart, called the ventricles (Fig. 7-16).
The normal point of origin of the electrical im-
pulse is the sinoatrial (SA) node above the atria.
This impulse travels to a point midway between the
C atria and ventricles. This point is called the atri-
oventricular (AV) node. The pathway divides after
the AV node into two branches, the right and left
ventricles. These right and left branches become a
network of fibers, called Purkinje fibers, which
spread electrical impulses across the heart. Under
normal conditions, this impulse reaches the muscu-
Figure 7-15 To care for an unconscious choking in- lar walls of the ventricles and causes the ventricles
fant, A, find the correct position for chest compressions. to contract. This contraction forces blood out of the
B, Compress the chest 30 times about 1⁄2 to 1 inch heart to circulate through the body. The contraction
deep. C, Look for an object in the mouth by lifting the of the left ventricle results in a pulse. The pauses be-
jaw. If you see an object, remove it with your little finger.
tween the pulse beats are the periods between con-
tractions. When the heart muscles contract, blood is
fibrillator (AED), you can make a difference before forced out of the heart. When they relax, blood re-
EMS personnel arrive. fills the chambers.
Electrical activity of the heart can be evaluated
, with a cardiac monitor or electrocardiograph. Elec-
The Heart s Electrical System trodes attached to an electrocardiograph pick up
electrical impulses and transmit them to a monitor.
The heart’s electrical system controls its pumping This graphic record is referred to as an electrocar-
action. In normal conditions, specialized cells of the diogram (ECG). Heart rhythms appear on an ECG
heart initiate and transmit electrical impulses. These as a series of peaks and valleys.
When the Heart Fails

Any damage to the heart from disease or injury
can disrupt the heart’s electrical system. This dis-
ruption can result in an abnormal heart rhythm
The Amazing Heart
Too often, we take our
that can stop circulation. The two most common
abnormal rhythms that initially present in sudden hearts for granted. The
cardiac arrest victims are ventricular fibrillation heart beats about
(V-fib) and ventricular tachycardia (V-tach). 70 times each minute or
V-fib is a state of totally disorganized electrical ac- more than 100,000 times
tivity in the heart. It results in fibrillation, or quiv- a day. During an average
ering, of the ventricles. In this state, the ventricles lifetime, the heart will beat
cannot pump blood and there are no signs of life,
including no pulse for a child or infant. V-tach
nearly 3 billion times. The heart circulates
refers to a very rapid contraction of the ventricles. about a gallon of blood per minute or
Although there is electrical activity resulting in a about 40 million gallons in an average life-
regular rhythm, the rate is often so fast that the time. The heart circulates blood through
heart is unable to pump blood properly. As with about 60,000 miles of blood vessels.
V-fib, there are no signs of life, including no pulse.
Defibrillation
In many cases, V-fib and V-tach rhythms can be one pad on the victim’s upper right chest and
corrected by early defibrillation. Delivering an the other pad on the victim’s lower left side.
electrical shock with an AED disrupts the electri- Plug the connector into the AED.
cal activity of V-fib and V-tach long enough to al- 3. Let the AED analyze the heart rhythm (Fig.
low the heart to spontaneously develop an effec- 7-17, C) (or push the button marked “ana-
tive rhythm on its own. If V-fib or V-tach is not lyze,” if indicated and prompted by the
interrupted, all electrical activity will eventually AED). Advise all responders and bystanders
cease, a condition called asystole. Asystole cannot to “Stand clear.” Do not touch the victim. If
be corrected by defibrillation. Remember that you the AED tells you “No shock advised,” begin
cannot tell what rhythm, if any, the heart has by CPR.
checking for signs of life. CPR, started immedi- 4. Deliver a shock by pushing the button
ately and continued until defibrillation, helps if indicated and prompted by the AED (Fig.
maintain a low level of circulation in the body 7-17, D). Ensure that no one, including you,
until the abnormal rhythm can be corrected by is touching the victim and that there are
defibrillation. no hazards present.
In some cases, defibrillation is not required and
USING AN AED—ADULT the AED will not prompt you to deliver a shock. If
no shock is indicated, give CPR. Leave the AED at-
tached to the victim. The skill sheets at the end of
With cardiac arrest, an AED should be used as soon
this chapter provide step-by-step practice of using
as it is available and safe to do so. Be sure to call
an AED.
9-1-1 or the local emergency number. CPR in
progress is stopped only when the AED is ready to
use. Most AEDs can be operated by following these
simple steps:
AED Precautions
1. Turn on the AED (Fig. 7-17, A). When operating an AED, you should avoid
2. Wipe the victim’s chest dry. Apply the pads certain actions and situations that could harm you,
to the victim’s bare chest (Fig. 7-17, B). Place other responders or bystanders and the victim. The
A Matter
of Choice
Instructions that describe a person’s wishes about
medical treatment are called advance directives.
These instructions are used when a person can no fered the opportunity to make these choices at the
longer make his or her own health-care decisions. time of admission.
If a person is able to make decisions about medical Conversations with relatives, friends or physi-
treatment, advance directives do not interfere with cians, while the patient is still capable of making
his or her right to do so. decisions, are the most common form of advance
The Patient Self-Determination Act of 1990 pro- directives. However, because conversations may
vides that adults who are admitted to a hospital or not be recalled accurately, the courts consider writ-
a health-care facility or who receive assistance ten directives more credible.
from certain organizations that receive funds from Two examples of written advance directives are
Medicare or Medicaid have the right to make fun- living wills and durable powers of attorney for
damental choices about their own care. They must health care. The types of health-care decisions cov-
be told about their right to make decisions and ered by these documents vary depending on the
about the level of life support that would be pro- state where you live. Talking with a legal profes-
vided in an emergency situation. They should be of- sional can help determine which advance directive
options are recognized in your state and what they A lawyer is not always needed to execute advance
do and do not cover. directives. However, if you have any questions con-
The instructions that are permitted in a living will cerning advance directives, it is wise to obtain legal
vary from state to state. A living will generally al- advice.
lows a person to refuse only medical care that Copies of your advance directives should be pro-
“merely prolongs the process of dying,” as in the vided to all personal physicians, family members
case of a terminal illness. and the person chosen as your health-care surro-
A person uses a durable power of attorney for gate. Tell them what documents have been pre-
health care to authorize someone to make medical pared and where the original and copies are lo-
decisions for him or her in any situation in which cated. Discuss the document with all parties so that
he or she can no longer make them. This autho- they understand the intent of all the requests. Keep
rized person is called a health-care surrogate or these documents updated.
proxy. This surrogate, with the information given by Keep in mind that advance directives are not
the patient’s physician, may consent to or refuse limited to elderly persons or people with terminal
medical treatment on the patient’s behalf. In this illnesses. Advance directives should be considered
case, he or she would support the patient’s needs by anyone who has decided on the care he or she
and wishes around the health-care decisions and would like to have provided. An unexpected illness
the advance directives. or injury could create a need for decisions at any
“Do not resuscitate” (DNR) orders mean that if a time.
person has determined that if his or her heartbeat Knowing about living wills, durable powers of at-
or breathing stops, he or she should not be resusci- torney for health care and DNR orders can help you
tated. The choice of DNR orders may be covered in and your loved ones prepare for difficult decisions.
a living will or in the durable power of attorney for If you are interested in learning more about your
health care. rights and the options available to you in your state,
Appointing someone to act as a health-care sur- contact a legal professional.
rogate, along with writing down your instructions, is
the best way to formalize your wishes about med- SOURCES
ical care. Some of these documents can be ob- Hospital Shared Services of Colorado, Stockard Inventory Program:
Your right to make health care decisions, Denver, 1991.2.
tained through a personal physician, an attorney or Title 42 United States Code, Section 1395 cc(a)(1)(Q)(A) Patient Self-
various state and health-care organizations. Determination Act.
A B
C D
Figure 7-17 To use an AED: A, Turn on the AED. B, Apply pads. C, Let the AED
analyze the heart rhythm. D, Deliver a shock if indicated.
following precautions should be taken when oper- Do not use an AED and/or electrode pads de-
ating an AED: signed for adult victims on a child younger
than age 8 or weighing less than 55 pounds
Do not touch the victim while the AED is unless pediatric pads specific to the device are
analyzing. Touching or moving the victim may not available. Local protocols may differ on
affect analysis. this and should be followed.
Do not touch the victim while the AED is Do not use an AED on a victim wearing a ni-
defibrillating. You or others could be troglycerin patch or other patch on the chest.
shocked. With a gloved hand, remove any patches from
Do not use alcohol to wipe the victim’s chest the chest before attaching the device.
dry. Alcohol is flammable. Do not use a mobile phone or conduct radio
Do not defibrillate someone around flammable transmissions within 6 feet of the AED. This
or combustible materials, such as gasoline or may interrupt analysis.
free-flowing oxygen.
Do not use an AED in a moving vehicle.
Movement may affect the analysis. Special Resuscitation Situations
Do not use an AED on a victim in contact
with water. Move the victim away from Some situations require you to pay special atten-
puddles of water or swimming pools, or out of tion when using an AED. Be familiar with these sit-
the rain before defibrillating. uations and know how to respond appropriately.
Always use common sense when using an AED and

follow the manufacturer’s recommendations.
AEDs Around Water

If a victim has been removed from water, remove
wet clothing, if possible. Dry the victim’s chest and
attach the AED. The victim should not be in a pud-
dle of water, nor should the rescuer be kneeling in a
puddle of water when operating an AED.
If it is raining, take steps to ensure that the
victim is as dry as possible and sheltered from
the rain. Ensure that the victim’s chest is wiped
dry. Minimize delaying defibrillation, though, Figure 7-18 Look for medication patches.
when taking steps to provide for a dry environ-
ment. The electrical current of an AED is very di-
rectional between the electrode pads. AEDs are
very safe, even in rain and snow, when all pre-
cautions and manufacturer’s operating instruc-
tions are followed.
Although these patches do not interfere with defib-
rillation, time may be wasted attempting to identify
AEDs and Implantable Devices the type of patch. Therefore, any medication
Some people whose hearts are weak and not able to patches that are on the victim’s chest should be
generate electrical impulse may have had a pace- removed.
maker implanted. These small implantable devices
may sometimes be located in the area below the
right collarbone. There may be a small lump that
Hypothermia
can be felt under the skin. Sometimes the pace- Victims of hypothermia have been resuscitated
maker is placed somewhere else. Other individuals successfully even after prolonged exposure. It will
may have an implantable cardioverter-defibrillator take longer to do your check, or assessment, of
(ICD), a miniature version of an AED, which acts the victim since you may have to check for signs
to automatically recognize and restore abnormal of life and/or a pulse for up to 30 to 45 seconds.
heart rhythms. If visible or you know that the vic- If you do not feel a pulse, begin CPR until an AED
tim has an implanted device, do not place the de- becomes readily available. If the victim is wet, dry
fibrillation pads directly over the implanted device. his or her chest and attach the AED. If a shock is
This may interfere with the delivery of the shock. indicated, deliver a shock. If there is still no pulse,
Adjust pad placement if necessary, and continue to continue CPR. Follow local protocols as to
follow the established protocol. If you are not sure, whether additional shocks should be delivered.
use the AED if needed. It will not harm the victim Continue CPR and protect the victim from further
or rescuer. heat loss. CPR or defibrillation should not be
withheld to rewarm the victim. Rescuers should
take care not to shake a hypothermia victim
AEDs and Nitroglycerin Patches unnecessarily as this could result in ventricular
People with a history of cardiac problems may use fibrillation.
nitroglycerin patches (Fig. 7-18). These patches are
usually placed on the chest. If you encounter a vic-
tim with a patch on his or her chest, remove it with
Trauma and AEDs
a gloved hand. Nitroglycerin patches pose a possi- If a person is in cardiac arrest resulting from trau-
ble absorption risk for rescuers, not an explosion matic injuries, an AED may still be used. Defibril-
hazard. Nitroglycerin patches look very similar to lation should be administered according to local
nicotine patches that people use to stop smoking. protocols.
AED Maintenance If at any time the machine fails to work prop-

erly or warning indicators are recognized, dis-
For defibrillators to perform optimally, they must continue use and contact the manufacturer im-
be maintained like any other machine. The AEDs mediately.
that are available today require minimal mainte-
nance. These devices have various self-testing fea-
tures. However, it is important that operators are USING AN AED—CHILD
familiar with any visual or audible warning
prompts the AED may have to warn of malfunction Most cardiac arrest in children is not sudden. The
or a low battery. It is important that you read the most common causes of cardiac arrest in children
operator’s manual thoroughly and check with the are—airway problems, breathing problems, trauma
manufacturer to obtain all necessary information or an accident (such as automobile accident,
regarding maintenance. drowning, electrocution or poisoning), a hard blow
In most instances, if the machine detects any to the chest (such as Commotio Cordis), congenital
malfunction, you should contact the manufacturer. heart disease or sudden infant death syndrome
The device may need to be returned to the manufac- (SIDS). AEDs equipped with pediatric AED pads
turer for service. While AEDs require minimal main- are capable of delivering lower levels of energy to a
tenance, it is important to remember the following: victim between 1 and 8 years of age or weighing less
than 55 pounds. Use the same general steps and
Follow the manufacturer’s specific recommen-
precautions that you would when using an AED on
dations for periodic equipment checks.
an adult victim.
Make sure that the batteries have enough
energy for one complete rescue. (A fully 1. Turn on the AED.
charged backup battery should be readily 2. Apply the pads to the child’s chest.
available.) • Make sure that you are using pediatric
Make sure that the correct defibrillator AED pads.
pads are in the package and are properly • Wipe the child’s chest dry.
sealed. • Place one pad on the child’s upper right
Check any expiration dates on defibrillation chest and the other pad on the child’s
pads and batteries and replace as necessary. lower left side (Fig. 7-19, A).
After use, make sure that all accessories are re- • Make sure the pads are not touching. If
placed and that the machine is in proper work- the pads are at risk of touching each
ing order. other, place one pad on the child’s chest
A B
Figure 7-19 A, Place one pad on the child’s upper right chest and the other pad
on the child lower left side, or B, place one pad on the child’s chest and the other
pad on the child’s back.
and the other pad on the child’s back • If the AED tells you “No shock ad-
(Fig. 7-19, B). vised,” give 5 cycles (or about 2 min-
3. Plug the connector into the AED. utes) of CPR.
4. Let the AED analyze the heart rhythm (or
push the “analyze” button if indicated and
prompted by the AED).
• Advise all responders and bystanders to
SUMMARY
“stand clear.” Do not touch the child.
Cardiac emergencies present a major health threat
5. Deliver a shock by pushing the “shock”
to our communities. By learning to recognize the
button if indicated and prompted by the
signals of cardiac emergencies and how to give care,
AED. Ensure that no one is touching the
you can make a difference.
child, including you, and that there are no
hazards present (such as standing puddles
of water).
1. Could atherosclerosis have led to Mr. Getz’s 4. Why is it important to know if Mr. Getz may be
collapse? suffering cardiac arrest?
2 If Mr. Getz had experienced chest pain, how 5. If Mr. Getz is in cardiac arrest, why will CPR
might stopping and resting have prevented his alone not sustain his life?
collapse?
3. Is it possible that Mr. Getz may have suffered a

cardiac arrest? Why or why not?
STUDY QUESTIONS
a. Cardiac arrest e. Heart

b. Cardiopulmonary f. Heart attack
resuscitation (CPR) g. Cardiovascular disease
c. Cholesterol h. Angina pectoris
d. Coronary arteries
_____ A muscular organ that circulates blood throughout the body.
_____ A fatty substance that builds up on the inner walls of arteries.
_____ The leading cause of death for men and women in the United States.
_____ Temporary chest pain caused by a lack of oxygen to the heart.
_____ Blood vessels that supply the heart with oxygen-rich blood.
_____ A combination of chest compressions and rescue breaths.
_____ Condition that results when the heart stops beating or beats too ineffectively to circulate blood.
_____ A sudden illness involving the death of heart muscle tissue caused by insufficient oxygen-rich blood
reaching the cells.
2. Identify the signals of cardiac arrest.
3. List the situations in which a citizen responder may stop CPR.
4. Describe the conditions that most often cause cardiac arrest in children and infants.
5. Which is the most common signal of a heart attack?
a. Profuse sweating
b. Persistent chest pain
c. Pale skin
d. Trouble breathing
6. Which of the following best describes the chest pain associated with heart attack?
a. An uncomfortable pressure
b. Persistent pain that may spread to the shoulder, arm, neck or jaw
c. Throbbing pain in the legs
d. a and b
7. What may happen as a result of a heart attack?
a. The heart functions inadequately.

b. The heart may stop.
c. Some heart muscle tissue may die from lack of oxygen.
8. Which should you do first to care effectively for a person having a heart attack?
a. Position the victim for CPR.

b. Begin rescue breathing.
c. Call 9-1-1 or the local emergency number immediately.
d. Call the person’s physician.
9. How can you know if a person’s heart is beating?
a. The person is breathing.

b. The person shows another sign of life.
c. The person is conscious.
d. Any or all of the above.
10. When is CPR needed for an adult?
a. When the victim is conscious

b. For every heart attack victim
c. When the victim shows no signs of life
d. When the heart attack victim loses consciousness
11. Which is the purpose of CPR?
a. To keep a victim’s airway open

b. To identify any immediate threats to life
c. To supply the vital organs with blood containing oxygen
d. All of the above
12. CPR artificially takes over the functions of which two body systems?
a. Nervous and respiratory systems

b. Respiratory and circulatory systems
c. Circulatory and nervous systems
d. Circulatory and musculoskeletal systems
Use the following scenario to answer questions 13 and 14:
It is Saturday afternoon; you and your mother are at home watching a tennis match on television. At the commer-
cial break, your mother mumbles something about indigestion and heads to the medicine cabinet to get an
antacid. Twenty minutes later, you notice that your mom does not respond to a great play made by her favorite
player. You ask what is wrong, and she complains that the antacid has not worked. She states that her chest and
shoulder hurt. She is sweating heavily. You notice that she is breathing fast and she looks ill.
13. List the signals of a heart attack that you find in the scenario.
While waiting for EMS personnel to arrive, your mother loses consciousness.
14. Number in order the following actions you would now take.
_____ Open the airway and check for signs of life. (There are none.)
_____ Give 2 rescue breaths.
_____ Check for responsiveness.
_____ Correctly position your hands.
_____ Give cycles of 30 compressions and 2 breaths.
15. Number in order the following actions for giving care to an unconscious choking infant, starting from the time
you first realize your breaths will not go in.
_____ Give 30 chest compressions.

_____ Check for an object.
_____ Repeat 2 rescue breaths.
_____ Reposition the infant’s airway.
_____ Remove an object if you see one.

SKILL SHEET CPR—Adult
Complete “Checking an Unconscious Adult (Age 12 or Older)” Steps 1-5 in Chapter 5, pages 76-77.
Remember: Always follow standard precautions to prevent disease transmission. Use protective
equipment (disposable gloves and breathing barriers). Wash your hands immediately after giving
care.
Step 6
If the victim shows no signs of life—
Place the heel of one hand on the victim’s sternum (breastbone) in the middle of the chest and place your
other hand directly on top of the first hand.
Step 7
Position the shoulders over the hands.
• Compress the chest smoothly to a depth of
about 2 inches—30 times at a rate of about 100
compressions per minute.
Step 8
Give 2 rescue breaths.
Step 9
Continue CPR.
Note: Continue CPR

until—
• The scene becomes
unsafe.
• The victim shows an
obvious sign of life.
• An AED becomes readily available and is ready to use.
• EMS personnel arrive and take over.
• Another trained responder arrives and takes over.
If there are signs of life—
Keep the airway open and monitor the victim until EMS arrives and takes over.
SKILL SHEET Unconscious Choking—Adult
Complete “Checking an Unconscious Adult (Ages 12 or Older)” Steps 1-5 in Chapter 5, pages 76-77.
care.
Step 6
If the rescue breaths do not go in—
Reposition the victim’s airway by tilting the head

farther back and try 2 rescue breaths again.
If breaths still do not go in—
Step 7
Find the hand position in the middle of the chest.
Step 8
• Compress the chest 30 times to a depth of
about 2 inches.
Note: Remove any breathing barriers when

giving chest compressions.
Step 9
Lift the jaw and tongue and look inside the mouth.
• If you see an object, remove it with a finger.
Step 10
Try 2 rescue breaths.
If the breaths still do not go in—
Step 11
Continue cycles of chest compressions, foreign object check and rescue breaths until—
• The object is removed and the chest clearly rises with rescue breaths.
• The victim starts to breathe on his or her own.
• EMS personnel or another trained responder arrives and takes over.
If breaths go in—
Step 12
Check for signs of life for no more than 10 seconds.
Step 13
If there are no signs of life—
Give CPR.
SKILL SHEET CPR—Child
Complete “Checking an Unconscious Child (Ages 1 to 12)” Steps 1-7 in Chapter 5, page 78.
care.
Step 8
If the child shows no signs of life and no pulse—
Step 9
• Compress the chest 30 times smoothly to a
depth of about 11⁄2 inches.
Step 10
Step 11
Continue CPR.
Note: Continue CPR until—

• The child shows obvious signs of life.
• An AED becomes readily available and is ready
to use.
SKILL SHEET Unconscious Choking—Child
Complete “Checking an Unconscious Child (Ages 1 to 12)” Steps 1-6 in Chapter 5, page 78.
equipment (disposable gloves and breathing barriers). Wash your hands immediately after giving care.
Step 7
If the rescue breaths do not go in, reposition the
child’s airway. Place the child’s head back into the
neutral position, then attempt the head-tilt/chin-lift
again.
• Try 2 rescue breaths again.
Step 8
Step 9
Position your shoulders over the hands.
• Compress the chest 30 times to a depth of
about 11⁄2 inches—at a rate of about
100 compressions per minute.
Note: Remove any breathing barrier when giving

chest compressions.
Step 10
• If you see an object, remove it with a finger.
Step 11
Step 12
• The child starts to breathe on his or her own.
If breaths go in—
Step 13
Check for signs of life and a pulse for no more than 10 seconds.
Step 14
If there is a pulse, but no breathing—
Give rescue breathing.
If there is no pulse—
Give CPR.
SKILL SHEET CPR—Infant
Complete “Checking an Unconscious Infant (Under Age 1),” Steps 1-8 in Chapter 5, page 79.
care.
Step 9
If the infant shows no signs of life and no
pulse—
Find the finger position in the center of the chest
over the breastbone.
• Place the other hand on the forehead to maintain
an open airway.
• Place the pads of two or three fingers just below
an imaginary line between the nipples.
• Place the pads of the two fingers next to your
index finger on the sternum.
Step 10
Compress the chest smoothly to a depth of about
1
⁄2 to 1 inch—30 times at a rate of about
100 compressions per minute.
Step 11
Step 12
Continue CPR.
Note: Continue CPR until—

• The infant shows obvious signs of life.
SKILL SHEET Unconscious Choking—Infant
Complete “Checking an Unconscious Infant (Under Age 1)” Steps 1-7 in Chapter 5, page 79.
care.
Step 8
If the rescue breaths do not go in, reposition the
infant’s airway by placing the infant’s head back into
the neutral position, then attempting the head-tilt/chin-
lift again. Try 2 rescue breaths again.
Step 9
Find the finger position in the center of the chest
over the breastbone.
• Place the pads of two or three fingers just below
an imaginary line between the nipples.
• Place the pads of these fingers next to your
index finger on the middle of the chest (sternum).
• Place the other hand on the forehead to maintain
an open airway.
Step 10
Compress the chest smoothly to a depth of about
1
⁄2 to 1 inch—30 times at a rate of about 100 com-
pressions per minute.
Note: Remove any breathing barrier when giving

chest compressions.
Step 11
• If you see an object, remove it with your
little finger.
Step 12
Step 13
• The infant starts to breathe on his or her own.
If the breaths go in—
Step 14
Check for signs of life and a pulse for no more than 10 seconds.
Step 15
If there is a pulse, but no breathing—
Give rescue breathing.
If there is no pulse—
Give CPR.
SKILL SHEET Using an AED—Adult (over age

8 or more than 55 pounds)
Complete “Checking an Unconscious Adult” Steps 1-5 in Chapter 5, pages 76-77. Remember: Always
follow standard precautions to prevent disease transmission. Use protective equipment (disposable
gloves and breathing barriers). Wash your hands immediately after giving care.
If the victim shows no signs of life—
Step 6
Turn on the AED and prepare it for use.
Step 7
Wipe the victim’s chest dry.
Step 8
Attach the AED pads to the victim.
• Peel the backing off one pad at a time and,
following the diagram, press the pad firmly to
the victim’s bare skin.
• Place one pad on the victim’s upper right chest
and other pad on the lower left side.
• Plug in connector, if necessary.
Step 9
Make sure no one, including you, is touching the victim.
• Say, “EVERYONE, STAND CLEAR!”
Step 10
Allow the AED to analyze the heart’s rhythm.
Step 11
Make sure no one, including you, is touching the victim.
Say, “EVERYONE, STAND CLEAR!”
• Deliver a shock if prompted by pushing the
“shock” button.
• Give 5 cycles, or about 2 minutes of CPR unless
there are obvious signs of life. Let AED reanalyze.
If no shock advised, give 5 cycles or about
2 minutes of CPR.
Note: When there are no signs of life and an AED

is on the way, give CPR until the AED is ready
to use. When the AED arrives, turn it on and follow
Steps 6 through 11.
SKILL SHEET Using an AED—Child (child ages

1-8 or less than 55 pounds)
Complete “Checking an Unconscious Child” Steps 1-7 in Chapter 5, page 78. Remember: Always fol-
low standard precautions to prevent disease transmission. Use protective equipment (disposable
gloves and breathing barriers). Wash your hands immediately after giving care.
If the child shows no signs of life and no pulse—
Step 8
Turn on the AED and prepare it for use.
Step 9
Wipe the child’s chest dry.
Step 10
Attach the pediatric AED pads to the child.
• Check to be certain that you are using
pediatric pads.
• Peel the backing off one pad at a time and,
following the diagram, press the pad firmly to
the child’s bare skin.
• Place one pad on the child’s upper right chest

and other pad on the lower left side.
Note: If the pads risk touching each other, place
one pad on child’s chest and other on child’s
back.
• Plug in connector, if necessary.
Step 11
Make sure no one, including you, is touching the child.
• Say, “EVERYONE, STAND CLEAR!”
Step 12
Allow the AED to analyze the heart’s rhythm.
Step 13
Make sure no one, including you, is touching
the child.
Say, “EVERYONE, STAND CLEAR!”
• Deliver a shock if prompted by pushing the
“shock” button.
• Give 5 cycles, or about 2 minutes of CPR unless
there are obvious signs of life. Let AED reanalyze.
If no shock advised, give 5 cycles or about
2 minutes of CPR.
Note: When there are no signs of life and an

AED is on the way, give CPR until the AED is
ready to use. When the AED arrives, turn it on
and follow Steps 8 through 13.
ter 8
CChapter Janelle and her friends are on a camping trip. Janelle
caught a half dozen trout in the lake and begins to clean
them for supper. Suddenly, the knife slips and cuts her
hand deeply. Blood flows steadily and Janelle cries out
in pain. The cut continues to bleed and Janelle becomes
upset. Breathing rapidly, she asks a friend to help her.
Bleeding
Objectives
■ Explain why severe bleeding must be controlled immediately.
■ Identify two signals of life-threatening external bleeding.
■ Describe the care for external bleeding.
■ Describe how to minimize the risk of disease transmission when
giving care in a situation that involves visible blood.
■ Identify the signals of internal bleeding.
■ Describe the care for internal bleeding.
should be able to demonstrate—
■ How to control external bleeding.
Introduction
clude red and white blood cells and cell fragments
called platelets.
Plasma makes up about half the total blood
volume. Composed mostly of water, plasma main-
tains the blood volume needed for normal function
Bleeding is the escape of blood from arteries,
of the circulatory system. Plasma also contains nu-
capillaries or veins. A large amount of trients essential for energy production, growth and
bleeding occurring in a short amount of cell maintenance; carries waste products for elimi-
time is called a hemorrhage. Bleeding is nation; and transports the other blood components.
either external or internal. External bleeding, White blood cells are a key disease-fighting
bleeding you can see coming from a wound, part of the immune system. They defend the body
against invading microorganisms, or pathogens.
is usually obvious because it is visible
They also aid in producing antibodies that help the
(Fig. 8-1, A). Internal bleeding, bleeding body resist infection.
inside the body, is often difficult to recognize Red blood cells account for most of the solid
(Fig. 8-1, B). Uncontrolled bleeding, whether components of the blood. They are produced in the
external or internal, is a life-threatening marrow in the hollow center of large bones, such as
emergency. As you learned in previous the long bones of the arm (humerus) and the thigh
chapters, severe bleeding can result in (femur). Red blood cells number nearly 260 million
in each drop of blood. The red blood cells trans-
death. In this chapter, you will learn how
port oxygen from the lungs to the body cells and
to recognize and give care for both internal carbon dioxide from the cells to the lungs. Red
and external bleeding. blood cells outnumber white blood cells about
1000 to 1.
Platelets are disk-shaped structures in the blood
that are made up of cell fragments. Platelets are an
BLOOD AND BLOOD VESSELS essential part of the blood’s clotting mechanism be-
cause of their tendency to bind together. Platelets
What is Blood? help stop bleeding by forming blood clots at wound
sites. Until blood clots form, bleeding must be con-
trolled artificially.
Blood consists of liquid and solid components and
Blood has three major functions:
comprises approximately 7 percent of the body’s to-
tal weight. The average adult has a blood volume of Transporting oxygen, nutrients and wastes.
between 10 and 12 pints. The liquid part of the Protecting against disease by producing anti-
blood is called plasma. The solid components in- bodies and defending against pathogens.
K E Y T E R M S
Arteries: Large blood vessels that carry oxy- Direct pressure: The pressure applied on a wound
genated blood from the heart to the rest of to control bleeding, for example, by one’s
the body. gloved hand.
Blood volume: The total amount of blood External bleeding: Bleeding that can be seen
circulating within the body. coming from a wound.
Capillaries: Microscopic blood vessels linking Internal bleeding: Bleeding inside the body.
arteries and veins; they transfer oxygen and Pressure bandage: A bandage applied snugly
other nutrients from the blood to all body cells to create pressure on a wound to aid in
and remove waste products. controlling bleeding.
Clotting: The process by which blood thickens at Veins: Blood vessels that carry oxygenated blood
a wound site to seal a hole or tear in a blood from all parts of the body to the heart.
vessel and stops bleeding.
CHAPTER 8 Bleeding 159
Artery Vein
Arterial Venous
capillaries capillaries
Figure 8-2 Blood flows through the three major types

of blood vessels: arteries, capillaries and veins.
B
pulses with the heartbeat; blood in the veins flows
more slowly and evenly.
WHEN BLEEDING OCCURS

Figure 8-1 A, External bleeding is more easily recog- When bleeding occurs, a complex chain of events
nized than B, internal bleeding. is triggered in the body. The brain, heart and
lungs immediately attempt to compensate for blood
loss to maintain the flow of oxygen-rich blood to
the body tissues, particularly to the vital organs.
Maintaining body temperature by circulating The brain, recognizing a blood shortage, signals the
throughout the body. heart to circulate more blood and to constrict blood
vessels in the extremities. The brain signals the
lungs to work harder, providing more oxygen.
Blood Vessels Other important reactions to bleeding occur on a
microscopic level. Platelets collect at the wound
Blood is channeled through blood vessels. The three site in an effort to stop blood loss through clotting.
major types of blood vessels are arteries, capillaries White blood cells prevent infection by attacking
and veins (Fig. 8-2). Arteries carry blood away from microorganisms that enter through breaks in the
the heart. Arteries vary in size. The smallest ones skin. Over time, the body manufactures extra red
carry blood to the capillaries. Capillaries are micro- blood cells to help transport more oxygen to the cells.
scopic blood vessels linking arteries and veins. They Blood volume is also affected by bleeding.
transfer oxygen and other nutrients from the blood Normally, excess fluid is absorbed from the blood-
into the cells. Capillaries pick up waste products, stream by the kidneys, lungs, intestines and skin.
such as carbon dioxide, from the cells and move However, when bleeding occurs, this excess fluid is
them into the veins. The veins carry blood back to reabsorbed into the bloodstream as plasma. This
the heart. The veins also carry waste products from reabsorption helps to maintain the critical balance
the cells to the kidneys, intestines and lungs, where of fluids needed by the body to keep blood volume
waste products are eliminated. constant. Bleeding that is severe enough to criti-
Because the blood in the arteries is closer to the cally reduce the blood volume is life threatening
pumping action of the heart, blood in the arteries because tissues will die from lack of oxygen. Life-
travels faster and under greater pressure than blood threatening bleeding can be either external or
in the capillaries or veins. Blood flow in the arteries internal.
In some cases, direct pressure may not immedi-

EXTERNAL BLEEDING ately control bleeding. This is an indication of se-
vere external bleeding. Signals of severe external
External bleeding occurs when a blood vessel is bleeding include—
opened externally, such as through a tear in the skin.
Each type of blood vessel bleeds differently. Arterial Blood spurting from the wound.
bleeding (bleeding from an artery) is often rapid and Bleeding that fails to stop after all measures
severe. It is life threatening. Because arterial blood is have been taken to control it.
under more pressure, it usually spurts from the A tourniquet, a tight band placed around an arm
wound, making it difficult for clots to form. Because or leg to help constrict blood flow to a wound, is no
clots do not form as rapidly, arterial bleeding is longer generally recommended for use by laypersons
harder to control. The high concentration of oxygen because it too often does more harm than good. A
gives arterial blood a bright red color. tourniquet can cut off the blood supply to the limb
Venous bleeding (bleeding from the veins) is below it and can damage skin, nerves and muscle by
generally easier to control than arterial bleeding. crushing the underlying tissue.
Veins are damaged more often because they are To give first aid for external bleeding, follow
closer to the skin’s surface. Venous blood is under these general steps:
less pressure than arterial blood and flows steadily
from the wound without spurting. Only damage to 1. CHECK scene, then CHECK person.
veins deep in the body, such as those in the trunk or 2. Obtain consent.
thigh, produces severe bleeding that is difficult to 3. Cover with a sterile dressing.
control. Because it is oxygen poor, venous blood is 4. Apply direct pressure until bleeding stops.
dark red or maroon. 5. Cover dressing with bandage.
Capillary bleeding, the most common type of 6. If bleeding does not stop—
bleeding, is usually slow because the vessels are • Apply additional dressings and
small and the blood is under low pressure. It is of- bandages and continue to apply pressure.
ten described as oozing from the wound. Clotting • Take steps to minimize shock, monitor the
occurs easily with capillary bleeding. The blood is ABCs.
usually a paler red than arterial blood. • CALL 9-1-1 if not already done.
Most external bleeding you will encounter Place direct pressure on the wound with a sterile
will be minor. You will be able to control it easily gauze pad or any clean cloth, such as a wash-
with pressure, and it usually stops by itself within cloth, towel or handkerchief. Press hard. Using a
10 minutes. Sometimes, however, the damaged pad or cloth will help keep the wound free from
blood vessel is too large or the blood is under too germs and aid clotting. Place your gloved hand
much pressure for effective clotting to occur. In over the pad and apply firm pressure (Fig. 8-3,
these cases, bleeding can be life threatening, and A). If you do not have disposable gloves or an
you will need to recognize and control it promptly appropriate barrier, have the injured person ap-
when you check for life-threatening conditions. ply pressure with his or her hand.
Apply a pressure bandage to hold the gauze
pads or cloth in place (Fig. 8-3, B).
Care for External Bleeding If blood soaks through the bandage, add more
pads and bandages to help absorb the blood.
External bleeding is usually easy to control. Gener- Continue to apply pressure. Do not remove
ally, the pressure created by placing a sterile dressing any blood-soaked pads. This can interfere with
and then a gloved hand, or even a gloved hand by it- clotting.
self, on a wound can control external bleeding. This Make sure to call 9-1-1 or the local emergency
technique is called applying direct pressure. Pressure number.
placed on a wound restricts the blood flow through Continue to monitor the victim’s airway, breath-
the wound and allows normal clotting to occur. ing and circulation. Observe the victim closely
Pressure on a wound can be maintained by applying for signals that may indicate that his or her con-
a bandage snugly to the injured area. A bandage ap- dition is worsening, such as faster or slower
plied snugly to control bleeding is called a pressure breathing rates, changes in skin appearance and
bandage. restlessness. Give additional care as needed.
A B
Figure 8-3 A, Apply direct pressure to the wound using a sterile gauze pad
or clean cloth. B, Apply a pressure bandage. The victim may be able to help you.
INTERNAL BLEEDING Nausea, vomiting or coughing up blood.

Abdominal pain.
Internal bleeding is the escape of blood from arter- Excessive thirst.
ies, capillaries or veins into spaces in the body. Decreased level of consciousness.
Severe internal bleeding can occur from injuries Severe headache.
caused by a blunt force, such as a driver being
thrown against the steering wheel in a car crash, or Many of these signals can also indicate a condition
a chronic medical condition, such as an ulcer. Inter- called shock. Shock is a progressive condition in
nal bleeding may also occur when an object, such as which the circulatory system fails to circulate
a knife or bullet, penetrates the skin and damages oxygen-rich blood to all parts of the body. You will
internal structures. A fractured bone, such as a rib, learn more about shock in Chapter 9.
could penetrate and damage vital organs. In any
traumatic injury, you should always suspect internal
bleeding. For example, if a motorcycle rider is Care for Internal Bleeding
thrown from a bike, you may not see any serious
external bleeding; however, you should consider First aid for controlling internal bleeding depends
that the impact may have caused internal injuries. on the severity and site of the bleeding. For minor
internal bleeding, such as a bruise on an arm, apply
an ice pack or a chemical cold pack to the injured
Signals of Severe Internal Bleeding area to help reduce pain and swelling. Always re-
member to place something, such as a gauze pad or
Severe internal bleeding is often difficult to recog- a towel, between the source of cold and the skin to
nize because its signals are not obvious and may prevent damage to the skin.
take time to appear. These signals include— If you suspect internal bleeding caused by seri-
ous injury, call 9-1-1 or the local emergency num-
Soft tissues, such as those in the abdomen, that
ber. You can do little to control serious internal
are tender, swollen or hard.
bleeding effectively. Activating the EMS system is
Swelling, tenderness or rigidity in the injured
the best help that you can give. EMS personnel
area.
must rapidly transport the victim to the hospital.
Anxiety or restlessness.
Usually, the victim needs immediate surgery. While
Rapid, weak pulse.
waiting for EMS personnel to arrive, follow the
Rapid breathing, shortness of breath.
general care steps for any emergency.
Skin that feels cool or moist or looks pale,
ashen or bluish. Do no further harm.
Bruising in the injured area. Monitor breathing and consciousness.
Help the victim rest in the most comfortable ternal bleeding is easily recognized and should be
position. cared for immediately by using direct pressure.
Keep the victim from getting chilled or over- Avoid contact with the injured person’s blood by us-
heated. ing standard precautions such as using disposable
Reassure the victim. gloves and washing your hands with soap and water
Give any specific care needed. immediately or as soon as possible after giving care.
Although internal bleeding is less obvious, it
can also be life threatening. Recognize when a seri-
SUMMARY ous injury has occurred, and suspect internal bleed-
ing. You may not identify internal bleeding until
One of the most important things you can do you check for non-life-threatening conditions.
in any emergency is to recognize and control life- When you identify or suspect life-threatening bleed-
threatening bleeding. Check for severe bleeding ing, activate the EMS system immediately and give
while checking for life-threatening conditions. Ex- care until EMS personnel arrive and take over.
STUDY QUESTIONS
a. External bleeding d. Internal bleeding

b. Direct pressure e. Arteries
c. Pressure bandage f. Veins
_____ Using your gloved hand to apply pressure on the wound to control bleeding
_____ Bleeding that can be seen coming from a wound
_____ The escape of blood from an artery, vein or capillary into spaces inside the body
_____ Blood vessels that carry blood from all parts of the body to the heart
_____ Vessels that transport blood to the capillaries for distribution to the cells
_____ A bandage applied snugly to maintain pressure on the wound to control bleeding
2. List two signals of life-threatening external bleeding.
3. Describe how to control external bleeding.
4. List five signals of internal bleeding.
5. Describe how to control minor internal bleeding.
Use the following scenario to answer questions 6 and 7:
The usual Saturday morning baseball game is in progress. A few spectators are standing around on the sidelines.
As Milo takes a swing at a curve ball, he loses his grip on the bat, which flies several feet, hitting Chris hard on
the thigh. Chris drops to the ground, clutching his leg. The skin where the leg was struck immediately becomes
red and begins to swell.
6. What type of bleeding do you suspect Chris has?
7. What steps would you take to care for Chris?

Circle the letter of the correct answer.
8. A child has a deep cut on his arm. His face is moist and very pale. What would you do first?
a. Have someone call 9-1-1 or the local emergency number.

b. Apply direct pressure to the wound with a dressing.
c. Place an ice pack on the affected arm.
d. Apply pressure at the closest pressure point.

SKILL SHEET Controlling External Bleeding
CHECK the scene for safety. CHECK the victim, following standard precautions. CALL 9-1-1 or the local
emergency number if necessary. To CARE for a victim who is bleeding—
Step 1
Cover the wound with a dressing and press firmly
against the wound with a gloved hand until bleeding
stops.
Step 2
Cover the dressing with a pressure bandage.
Step 3
If bleeding does not stop—
• Apply additional dressings and bandages.
• Take steps to minimize the effects of shock.
• Call 9-1-1 if not already done.
Chapter
pter 9
Shock Objectives
■ List two conditions that can result in shock.
■ Identify five types of shock and the conditions that cause each of
them.
■ List at least seven signals of shock.
■ Explain what care can be given to minimize shock.
10:55 p.m. On an isolated road, a large deer leaps into the path of an oncoming car
traveling 55 mph. The driver, a 21-year-old college track star, cannot avoid the
collision. In the crash, both of her legs are crushed and pinned in the wreckage.
11:15 p.m. Another car finally approaches. Seeing the crashed car, the driver stops
and comes forward to help. He finds the woman conscious but restless and in obvious
pain. He says he will go to call an ambulance at the nearest house, about a mile down
the road. He assures her that he will return.
11:25 p.m. When the driver returns, he sees that the woman’s condition has changed.
She is now breathing faster, looks pale and appears drowsy. He holds her hand to
comfort her and notices that her skin feels cold and moist.
11:30 p.m. The rescue squad arrives 10 minutes after receiving the phone call. The
man explains that the woman became drowsy and is no longer conscious. Her
breathing has become very irregular. The EMS personnel immediately go to work.
Introduction
just. When the body is unable to meet its demand
for oxygen because blood fails to circulate ade-
quately, shock occurs.
The driver in the scenario on the previous page ,

was a victim of a progressively deteriorating The Body s Responses
life-threatening condition called shock. When
You learned in Chapter 4 that the heart circulates
the body experiences an injury or sudden
blood by contracting and relaxing in a consistent
illness, the body triggers a series of responses rhythmic pattern. The heart adjusts its speed and
to compensate for any negative effects. When the force of its contractions to meet the body’s
the body’s attempts to compensate fail, the changing demand for oxygen. For instance, when a
victim can progress into shock. Shock is a person exercises, the heart beats faster and more
life-threatening condition. In this chapter, forcefully to move more oxygen-rich blood to meet
the working muscles’ demand for more oxygen
you will learn to recognize and give care to
(Fig. 9-1).
minimize shock. Similarly, when someone suffers a severe injury
or sudden illness that affects the flow of blood, the
heart beats faster and stronger at first to adjust to
the increased demand for oxygen. Because the heart
SHOCK is beating faster, breathing must also speed up to
meet the body’s increased demand for oxygen. You
When the body is healthy, three conditions are can detect these changes by observing and listening
needed to maintain adequate blood flow: to the victim’s appearance and breathing when you
check for non-life-threatening conditions.
The heart must be working well.
For the heart to do its job properly, an adequate
An adequate amount of oxygen-rich blood
amount of blood must circulate within the body.
must be circulating in the body.
The body can compensate for some decrease in
The blood vessels must be intact and able to
blood volume. Consider what happens when you
adjust blood flow.
donate blood. An adult can lose 1 pint of blood
Shock is a progressive condition in which the circu- over a 10- to 15-minute period without any signifi-
latory system fails to circulate oxygen-rich blood to cant stress to the body. (This amount is smaller for
all parts of the body. When vital organs, such as the children and infants.) Fluid is reabsorbed from the
brain, heart and lungs, do not receive oxygen-rich kidneys, lungs and intestines to replace lost blood
blood, they fail to function properly. When vital or- volume. In addition, the body immediately begins
gans do not function properly, a series of responses to manufacture the blood’s solid components.
is triggered in an attempt to keep them from failing. However, with severe injuries involving greater or
When someone is injured or becomes suddenly more rapid blood loss, the body may not be able to
ill, these normal body functions may be inter- adjust adequately. Body cells do not receive enough
rupted. In cases of minor injury or illness, this in- oxygen, and shock occurs. Any significant fluid loss
terruption is brief because the body is able to from the body, such as from severe bleeding or
compensate quickly. With more severe injuries or burns or even from diarrhea or vomiting, can lead
illnesses, however, the body may be unable to ad- to shock.
K E Y T E R M S
Blood volume: The total amount of blood circu- Vital organs: Organs whose functions are essen-
lating within the body. tial to life, including the brain, heart and lungs.
Shock: The failure of the circulatory system to
provide adequate oxygen-rich blood to all
parts of the body.
CHAPTER 9 Shock 171
Table 9-1 Common Types and

Causes of Shock
TYPE CAUSE
Anaphylactic Life-threatening allergic reaction to

a substance; may cause airway to
swell, affecting ability to breathe;
can occur from insect stings or
from foods and drugs.
Cardiogenic Failure of the heart to effectively
Increased exercise
circulate blood to all parts of the

body; occurs with heart attack.
Hypovolemic Severe bleeding or loss of blood
plasma; occurs with internal or
external wounds or burns or with
Increased heart rate severe fluid loss, as from vomiting
and diarrhea.
Figure 9-1 When a person exercises, the heart adjusts
its speed to meet the body’s changing demand for oxy- Neurogenic A disruption of the autonomic
gen. Blood flow is also affected when someone suffers nervous system, which results in
a severe injury or sudden illness—the heart beats faster the blood vessels expanding and
and stronger to adjust to increased oxygen demand. creating a drop in blood pressure;
can be caused by fluid loss, trauma
to the nervous system or emotional
Regardless of the cause of shock, any significant shock. Fainting is an example of
decrease in body fluids affects the function of the neurogenic shock.
heart. The heart will initially speed up to compen- Septic Toxins caused by a severe infection
sate for loss of body fluids and eventually will fail cause the blood vessels to dilate
to beat rhythmically. The pulse may become irregu- (expand).
lar or be absent altogether.
The blood vessels act as pipelines, transporting
oxygen and nutrients to all parts of the body and re-
to the vital organs. The body reduces the amount of
moving wastes. For the circulatory system to func-
blood circulating to the less important tissues of the
tion properly, blood vessels must remain intact, pre-
arms, legs and skin. This reduction in blood circu-
venting loss of blood volume. Normally, blood
lation to the skin causes the skin of a person in
vessels decrease or increase the flow of blood to dif-
shock to appear pale or ashen and feel cool. In later
ferent areas of the body by constricting (decreasing
stages of shock, the skin, especially the lips and un-
their diameter) or dilating (increasing their diame-
der the nails, may appear blue from a prolonged
ter). This activity ensures that blood reaches the
lack of oxygen. Increased sweating is also a natural
areas of the body that need it most, such as the vi-
reaction to stress caused by injury or illness, which
tal organs. Injuries or illnesses, especially those that
makes the skin feel moist.
affect the brain and spinal cord, can cause blood
vessels to lose this ability to change size. Blood ves-
sels can also be affected if the nervous system is
damaged by injury, infection, drugs or poisons.
Signals
If the heart is damaged, it cannot circulate
Although you may not always be able to determine
blood properly. If blood vessels are damaged, the
the cause of shock, remember that shock is a life-
body cannot adjust blood flow. Regardless of the
threatening condition. You should learn to recog-
cause, when body cells receive inadequate oxygen,
nize the signals of shock.
the result is shock. Table 9-1 summarizes common
The signals of shock include—
types of shock and their causes.
When shock occurs, the body attempts to prior- Restlessness or irritability.
itize its needs for blood by ensuring adequate flow Altered consciousness.
Pale or ashen, bluish, cool or moist skin.

Rapid breathing.
Care
Rapid and weak pulse. Follow the emergency action steps: CHECK—
Excessive thirst. CALL—CARE. CHECK the scene for safety
Nausea or vomiting. and then the victim. CALL 9-1-1 or the local emer-
Shock is a life-threatening condition. If any of gency number. CARE for the conditions you find
these signals are present, assume the victim has a (Fig. 9-2, A). Any specific care you give for life-
potentially life-threatening injury or illness. Give threatening conditions will help to minimize the
appropriate care. effects of shock. Make the victim as comfortable as
possible. Helping the victim rest comfortably is
important because pain can intensify the body’s
stress and accelerate the progression of shock.
Keep the victim from getting chilled or overheated
(Fig. 9-2, B). (In cooler environments this includes
insulating the victim from the ground.) Watch for
changes in the victim’s level of consciousness,
A breathing rate and skin appearance.
You can further help the victim manage the ef-
fects of shock if you—
Help the victim lie down on his or her back.
Elevate the legs about 12 inches to help blood
circulate to the vital organs (Fig. 9-2, C).
Do not elevate the legs—
• If the victim is nauseated or having trouble
breathing.
• If you suspect head, neck or back injuries
or possible broken bones involving the hips
or legs.
B • If moving causes more pain. If you are un-
sure of the victim’s condition or if it is
painful for him or her to move, leave the
victim lying flat.
Do not give the victim anything to eat or
drink, even though he or she is likely to be
thirsty. The victim’s condition may be severe
enough to require surgery, in which case it is
better if the stomach is empty.
C
Shock in Children
The signals of shock may be harder to detect in chil-
dren. Suspect that shock may develop if a child is
experiencing severe vomiting or diarrhea for an ex-
tended period of time (1 day). Replacing the fluids
Figure 9-2 A, Monitor the victim’s airway and breath- lost through vomiting or diarrhea is critical. Do not
ing. B, Keep the victim from getting chilled or over- hesitate to call 9-1-1 or the local emergency number
heated. C, Elevate the victim’s legs to keep blood for a child who has developed severe vomiting or
circulating to the vital organs. diarrhea.
CHAPTER 9 Shock 173
Shock: The Domino Effect

• An injury causes severe bleeding.
• The heart attempts to compensate for the
disruption of blood flow by beating faster.
• The victim first has a rapid pulse. More
blood is lost. As blood volume drops,
the pulse becomes weak or hard to find.
• The increased workload on the heart
results in an increased oxygen demand.
Therefore, breathing becomes faster.
• To maintain circulation of blood
to the vital organs, blood vessels
constrict in the arms, legs and • More blood is lost and the victim’s condition
skin. Therefore, the skin appears worsens.
pale or ashen and feels cool. • Without oxygen, the vital organs fail to function
• In response to the stress, the body perspires properly.
heavily and the skin feels moist. • As the brain is affected, the victim becomes
• Because tissues of the arms and legs are now restless, drowsy and eventually loses
without oxygen, cells start to die. consciousness.
• The brain now sends a signal to return blood to • As the heart is affected, it beats irregularly,
the arms and legs in an attempt to balance resulting in an irregular pulse. The rhythm then
blood flow between these body parts and the becomes chaotic and the heart fails to circulate
vital organs. blood.
• Vital organs now are not receiving adequate • There are no longer signs of life.
oxygen. • When the heart stops, breathing stops.
• The heart tries to compensate by beating • The body’s continuous attempt to compensate
even faster. for severe blood loss eventually results in death.
SUMMARY
Do not wait for shock to develop before giving cies or severe external bleeding, before caring for
care to a victim of injury or sudden illness. Always non-life-threatening conditions. Remember that the
follow the general care steps for any emergency to key to managing shock effectively is calling 9-1-1 or
minimize the progression of shock. Care for life- the local emergency number and giving care as soon
threatening conditions, such as breathing emergen- as possible.
1. Why did the woman go into shock? 2. What steps could the man have taken to mini-
mize shock until EMS personnel arrived?
STUDY QUESTIONS
Circle T if the statement is true, F if it is false.
1. Shock is a condition resulting only from severe blood loss. T F
2. List four signals of shock.
3. List two conditions that frequently result in shock.
Use the following scenario to answer question 4.
Tara saw her brother Daren fall out of the tree he was climbing. When she reached him, he was lying on the
ground, conscious but in pain. One leg was strangely twisted. Tara ran into the house, called 9-1-1 and told the
call taker what had happened. Then she ran back to Daren, who was pale, sweating and appeared restless.
4. What can Tara do to care for Daren until EMS personnel arrive?
CHAPTER 9 Shock 175
5. Which of the following can cause shock?
a. Bleeding
b. Bee sting
c. Heart attack
d. All of the above
6. When shock occurs, the body prioritizes its need for blood. Where does it send blood first?
a. The arms and legs

b. The brain, heart and lungs
c. The skin
d. The spinal cord
7. Why does the skin appear pale during shock?
a. Constriction of blood vessels near the skin’s surface

b. The majority of blood being sent to vital organs
c. Profuse sweating
d. a and b
8. Which of the following are included in the care for shock?
a. Controlling bleeding when present

b. Monitoring airway, breathing and circulation
c. Helping the victim rest comfortably
d. All of the above
9. Which body systems are affected by shock?
a. Circulatory and respiratory

b. All body systems
c. Circulatory, respiratory and nervous
d. Respiratory and nervous
10. Why is shock a life-threatening condition?
11. Why does elevating the victim’s legs help to manage shock?

Part
FOUR
INJURIES
10 Soft Tissue Injuries
11 Musculoskeletal Injuries
12 Injuries to the Head,

Injuries to the Extremities
13 Neck and Back

14 Abdomen and Pelvis
Injuries to the Chest,
Chapter 10 It is a hot, muggy day in May. The forecast for rain has not seemed
to dampen the spirits of the four beachgoers headed for the coast.
After a week of all-night studying and grueling exams, the soon-to-
be graduates are anxious to join their friends. As they approach the
bridge, Joe, the driver, decides he can no longer ignore the car’s
climbing temperature gauge. He pulls over to the side of the road,
explaining that at the end of the term, he had to decide between a
new radiator or a week at the beach. Despite his friends’ objections,
Joe takes off his shirt and wraps it around the radiator cap. Slowly
he releases the cap, a quarter turn at a time. Suddenly, the cap
blows off and scalding fluid and steam burst out of the radiator,
burning his chest and arms. As he spins away from the steam, his
Chapte
back is also burned.
Soft Tissue
Injuries
Objectives
■ List two signals of closed wounds.
■ List four main types of open wounds.
■ Describe how to care for open and closed wounds.
■ Describe how to prevent infection in an open wound.
■ Describe how burns are classified.
■ Describe the signals of a critical burn.
■ List four signals of an infected wound.
■ Describe how to care for thermal, chemical, electrical and
radiation burns.
■ Demonstrate how to control external bleeding.
180 PART FOUR INJURIES
Introduction WHAT ARE SOFT TISSUES?

The skin is composed of layers. The two primary
layers of the skin are the outer layer, the epidermis,
An infant falls and bruises his arm while
that provides a barrier to bacteria and other organ-
learning to walk, a toddler scrapes her knee
isms that can cause infection, and a deeper layer,
while learning to run, a child needs stitches called the dermis, that contains the nerves, hair
in his chin after he falls off the “monkey roots, sweat and oil glands and blood vessels. Be-
bars” on the playground, another child gets a cause the skin is well supplied with blood vessels
black eye in a fist fight, a teenager suffers a and nerves, most soft tissue injuries are likely to
sunburn after a weekend at the beach and an bleed and be painful. The hypodermis, located be-
neath the epidermis and dermis, contains fat, blood
adult cuts a hand while working in a
vessels and connective tissues. This layer insulates
woodshop. What do these injuries have in the body to help maintain body temperature. The
common? They are all soft tissue injuries. fat layer also stores energy. The amount of fat varies
The soft tissues include the layers of skin, among the different parts of the body and from per-
fat and muscle that protect the underlying son to person.
body structures (Fig. 10-1). Most soft tissue The muscles lie beneath the fat layer and com-
injuries involve the outer layers of tissue. prise the largest segment of the body’s soft tissues.
Although the muscles are considered soft tissues,
Organs, also composed of soft tissue, are
muscle injuries are discussed more thoroughly in
vulnerable to damage from blunt trauma and Chapter 11.
penetrating forces. Fortunately, most soft
tissue injuries are minor, requiring little
attention. However, some soft tissue injuries TYPES OF SOFT TISSUE INJURIES
can be severe and require immediate medical
attention. In this chapter, you will learn how Wounds
to recognize and care for various types of
A wound is defined as any physical injury involving
soft tissue injuries.
a break in the layers of the skin. Wounds are typi-
cally classified as either closed or open. In a closed
wound, the outer layer of skin is intact and the
K E Y T E R M S
Bandage: Material used to wrap or cover a part and may destroy underlying structures; it can
of the body; commonly used to hold a dressing be life threatening.
or splint in place. Dressing: A pad placed directly over a wound to
Burn: An injury to the skin or to other body tis- absorb blood and other body fluids and to pre-
sues caused by heat, chemicals, electricity or vent infection.
radiation. Open wound: An injury resulting in a break in the
Closed wound: An injury that does not break the skin’s surface.
skin and in which soft tissue damage occurs Soft tissues: Body structures that include the lay-
beneath the skin. ers of skin, fat and muscles.
Critical burn: Any burn that is potentially life Superficial burn: A burn involving only the top
threatening, disabling or disfiguring. layer of skin, the epidermis, characterized by
Deep burn: A burn that involves the two lower dry, red skin.
layers of skin, the dermis and the hypodermis, Wound: An injury to the soft tissues.
CHAPTER 10 Soft Tissue Injuries 181
damage to soft tissue layers and vessels beneath the

skin, causing internal bleeding. When blood and
other fluids seep into the surrounding tissues, the
area discolors and swells. The amount of discol-
oration and swelling varies depending on the sever-
ity of the injury. At first, the area may only appear
red. Over time, more blood and other fluids leak
into the area, causing the area to turn dark red or
purple. A significant violent force can cause injuries
involving larger blood vessels and the deeper layers
of muscle tissue. These injuries can result in profuse
bleeding beneath the skin.
Care for Closed Wounds

Many closed wounds do not require special medical
care. You can use direct pressure on the area to de-
crease bleeding that occurs beneath the skin. Ele-
vating the injured part helps reduce swelling. Ap-
plying cold can be effective early on in helping
Figure 10-1 The soft tissues include the layers of skin, control both pain and swelling. When applying ice
fat and muscle. or a chemical cold pack, place a gauze pad, a towel
or other thin cloth between the source of the cold
and the victim’s skin (Fig. 10-3). Leave the ice or
damage lies below the surface. A closed wound may
cold pack on the victim no more the 20 minutes.
bleed internally. With an open wound, the outer
Then remove it for 20 minutes, and replace it.
layer of skin is broken. External bleeding is often a
However, do not assume that all closed wounds
factor when treating open wounds.
are minor injuries. Take the time to evaluate
whether more serious injuries could be present.
Closed Wounds Seek immediate medical attention if—
The simplest closed wound is a bruise, also called a A victim complains of severe pain or cannot
contusion (Fig. 10-2). Bruises result when the body move a body part without pain.
is subjected to a force, such as when you bump your You think the force that caused the injury was
leg on a table or chair. This bump or blow results in great enough to cause serious damage.
Figure 10-2 The simplest closed wound is a bruise.

skin damage often occurs when a child falls and

scrapes his or her hands or knees. An abrasion is
sometimes called a scrape, a rug burn, a road rash
or a strawberry. An abrasion is usually painful be-
cause scraping of the outer skin layers exposes sen-
sitive nerve endings. Bleeding is not severe and is
easily controlled, since only the small capillaries are
damaged. Dirt and other matter can easily become
embedded in the skin, making it especially impor-
tant to clean the wound to prevent infection and aid
healing.
A laceration is a cut. The cut may have either
jagged or smooth edges (Fig. 10-5). Lacerations are
Figure 10-3 For a closed wound, apply ice to help commonly caused by sharp objects, such as knives,
control pain and swelling. scissors or broken glass. A laceration can also result
when a blunt force splits the skin. This splitting of-
ten occurs in areas where bone lies directly under-
Open Wounds neath the skin’s surface, such as the chin bone or
In an open wound, the break in the skin can be as skull. Deep lacerations can also affect the layers of
minor as a scrape of the surface layers or as severe fat and muscle, damaging both nerves and blood
as a deep penetration. The amount of bleeding de- vessels. Lacerations usually bleed freely and, de-
pends on the location and severity of the injury. pending on the structures involved, can bleed heav-
The following are the four main types of open ily. Lacerations are not always painful because dam-
wounds: aged nerves cannot transmit pain signals to the
brain. Lacerations can easily become infected if not
Abrasions
cared for properly.
Lacerations
An avulsion is an injury in which a portion of
Avulsions
the skin and sometimes other soft tissue is partially
Punctures
or completely torn away (Fig. 10-6). A partially
An abrasion is the most common type of open avulsed piece of skin may remain attached but
wound. It is characterized by skin that has been hangs like a flap. Bleeding is usually significant be-
rubbed or scraped away (Fig. 10-4). This type of cause avulsions often involve deeper soft tissue lay-
Figure 10-4 Abrasions can be painful, but bleeding is easily controlled.

Figure 10-5 A laceration may have jagged or smooth edges.
Figure 10-6 In an avulsion, part of the skin and other soft tissue is torn away.
ers. Sometimes a body part, such as a finger, may be A puncture wound results when the skin is
severed (Fig. 10-7). Such an injury is called an am- pierced with a pointed object, such as a nail, a piece
putation. Although damage to the tissue is severe of glass, a splinter or a knife (Fig. 10-8). A gunshot
when a body part is severed, bleeding is usually not wound is also a puncture wound. Because the skin
as bad as you might expect. The blood vessels usu- usually closes around the penetrating object, exter-
ally constrict and retract (pull in) at the point of in- nal bleeding is generally not severe. However, inter-
jury, slowing bleeding and making it relatively easy nal bleeding can be severe if the penetrating object
to control with direct pressure. In the past, a com- damages major blood vessels or internal organs. An
pletely severed body part could not be successfully object that remains embedded in the open wound is
reattached. With today’s medical technology, reat- called an embedded object (Fig. 10-9). An object
tachment is often successful. may also pass completely through a body part,
ing sizes of cotton gauze, commonly ranging from 2

to 4 inches square. Much larger dressings are used
to cover very large wounds and multiple wounds in
one body area. Some dressings have nonstick sur-
faces to prevent the dressing from sticking to the
wound (Fig. 10-10).
An occlusive dressing is a bandage or dressing
that closes a wound or damaged area of the body
and prevents it from being exposed to the air
(Fig. 10-11). By preventing exposure to the air, oc-
clusive dressings help prevent infection. Occlusive
dressings help keep in medications that are applied
to the affected area. They also help keep in heat,
Figure 10-7 In a severe avulsion, a body part may be body fluids and moisture. Occlusive dressing comes
completely severed. from the Latin word “occludere” meaning “to close
up,” and the Old French word “dresser” meaning
“to arrange.” Put the words together and you have
creating two open wounds—one at the entry point “to arrange to close up.” An example of an occlu-
and one at the exit point. sive dressing is plastic wrap. This type of dressing is
used for certain chest and abdominal injuries that
will be discussed in Chapter 14.
Care for Open Wounds A bandage is any material that is used to wrap
or cover any part of the body. Bandages are used to
Dressings and Bandages hold dressings in place, to apply pressure to control
All open wounds need some type of covering to bleeding, to protect a wound from dirt and infec-
help control bleeding and prevent infection. These tion and to provide support to an injured limb or
coverings are commonly referred to as dressings body part. Any bandage applied snugly to create
and bandages, and there are many types. pressure on a wound or an injury is called a pres-
Dressings are pads placed directly on the sure bandage. Many different types of bandages are
wound to absorb blood and other fluids and to pre- available commercially (Fig. 10-12).
vent infection. To minimize the chance of infection, A common type of bandage is a commercially
dressings should be sterile. Most dressings are made adhesive compress or adhesive bandage
porous, allowing air to circulate to the wound to (Fig. 10-13). Available in assorted sizes, adhesive
promote healing. Standard dressings include vary- bandages consist of a small pad of nonstick gauze
Figure 10-8 A puncture wound results when skin is pierced by a pointed object.
Figure 10-9 An object can become embedded in a wound.
Figure 10-10 Dressings are pads placed directly on Figure 10-12 Different types of bandages are used to
the wound. They come in various sizes. Some have sur- hold dressings in place, apply pressure to a wound, pro-
faces that will not stick to a wound. tect the wound from infection and provide support to an
injured area.
Figure 10-11 Occlusive dressings are designed to pre- Figure 10-13 A common type of bandage is an adhe-
vent air from passing through. sive compress.
30.5 centimeters) and lengths from 5 to 10 yards

(4.6 to 9.1 meters). A roller bandage is generally
wrapped around the body part. It can be tied or
taped in place. A roller bandage may also be used to
hold a dressing in place, secure a splint or control
external bleeding (Fig. 10-14). Follow these general
guidelines when applying a roller bandage:
Check for feeling, warmth and color of the
area below the injury site, especially fingers and
toes, before and after applying the bandage.
Secure the end of the bandage in place with a
turn of the bandage. Wrap the bandage around
Figure 10-14 Roller bandages can be used to secure the body part until the dressing is completely
a dressing in place. covered and the bandage extends several
inches beyond the dressing. Tie or tape the
on a strip of adhesive tape that is applied directly to bandage in place (Fig. 10-15, A-C).
minor wounds. Do not cover fingers or toes. By keeping these
The bandage compress is a thick gauze dressing parts uncovered, you will be able to see if the
attached to a bandage that is tied in place. Bandage bandage is too tight (Fig. 10-15, D). If fingers
compresses are specially designed to help control se- or toes become cold or begin to turn pale, blue
vere bleeding and usually come in sterile packages. or ashen, the bandage is too tight and should
A roller bandage is usually made of gauze or be loosened slightly.
gauze-like material. Roller bandages are available If blood soaks through the bandage, apply ad-
in assorted widths from 1⁄2 to 12 inches (1.3 to ditional dressings and another bandage. Do
A B
C D
Figure 10-15 A, Start by securing a roller bandage over the dressing. B, Use
overlapping turns to cover the dressing completely. C, Tie or tape the bandage in
place. D, Check the fingers for feeling, warmth and color.
snakebite (Fig. 10-16). However, an improperly ap-

plied elastic bandage can restrict blood flow, which
is not only painful but can also cause tissue damage
if not corrected. Always check the area above and
below the injury site for warmth and color, espe-
cially fingers and toes, after you have applied an
elastic roller bandage. Figure 10-17, A-D shows
some simple ways to ensure proper application of
elastic roller bandages.
Figure 10-16 Elastic bandages can be applied to con- Care for Minor Open Wounds
trol swelling or support an injured limb.
In minor open wounds, such as abrasions, damage
is only superficial and bleeding is minimal. To care
not remove the blood-soaked bandages and for a minor open wound, follow these general
dressings. Disturbing them may disrupt the guidelines:
formation of a clot and restart the bleeding.
Use a barrier between your hand and the
Elastic bandages, sometimes called elastic wraps, wound. If readily available, put on disposable
are designed to keep continuous pressure on a body gloves and place a sterile dressing on the wound.
part. Elastic bandages are available in 2-, Apply direct pressure for a few minutes to con-
3-, 4- and 6-inch (3.1, 7.6, 10.2 and 15.2 centime- trol any bleeding.
ter) widths. When properly applied, an elastic ban- Wash the wound thoroughly with soap and
dage can effectively control swelling or support an water. If possible, irrigate an abrasion for
injured limb as in the care for an elapid (coral) 5 minutes with clean, running tap water.
A B
C D
Figure 10-17 A, Start the elastic bandage at the point farthest from the heart.
B, Anchor the bandage. C, Wrap the bandage using overlapping turns. D, Tape
the end of the bandage in place.
Apply triple antibiotic ointment or cream to a

minor wound if the person has no known al-
lergies or sensitivities to the medication.
Cover the wound with a new sterile dressing and
a bandage (or with an adhesive bandage) if it is
still bleeding slightly or if the area of the wound
is likely to come into contact with dirt or germs.
If it is only a splinter in the surface of the skin, it
can be removed with tweezers.
After removing the splinter from the skin,
wash the area with soap and water, rinsing the
area with cold tap water for about 5 minutes.
After drying the area, apply a triple antibiotic
ointment or cream to the area, if there are no
Figure 10-18 Wrap a severed body part in sterile
known allergies or sensitivities to the medication. gauze, put it in a plastic bag and put the bag on ice.
Cover it to keep it clean.
If the splinter is in the eye, do not attempt to re- If the victim has an avulsion in which a body part
move it. Call 9-1-1 or the local emergency number. has been completely severed—
Call 9-1-1 or the local emergency number.
Put on disposable gloves.
Care for Major Open Wounds Wrap the severed body part in sterile gauze or
any clean material, such as a washcloth.
A major open wound has severe bleeding, deep de-
Place the wrapped part in a plastic bag. Keep
struction of tissue or a deeply embedded object. To
the body part cool by placing the bag on ice
care for a major open wound, follow these general
(Fig. 10-18). Do not place the bag on dry ice
guidelines:
or in ice water.
Call 9-1-1 or the local emergency number. Make sure the part is transported to the med-
Put on disposable gloves. If blood has the po- ical facility with the victim.
tential to splatter, you may need to wear eye
If the victim has an embedded object in the wound—
protection.
Control external bleeding using the general Put on disposable gloves.
steps below: Do not remove the object.
• Cover the wound with a dressing and press Use bulky dressings to stabilize the object. Any
firmly against the wound with a gloved hand. movement of the object can result in further
• Apply a pressure bandage over the dressing tissue damage (Fig. 10-19, A).
to maintain pressure on the wound and to Control bleeding by bandaging the dressing in
hold the dressing in place. place around the object (Fig. 10-19, B).
• If blood soaks through the bandage, do not Call 9-1-1 or the local emergency number if not
remove the blood-soaked bandages; add already done so.
more pads and bandages to help absorb Wash your hands immediately after giving care.
the blood and continue to apply pressure.
Monitor airway and breathing. Observe the
victim closely for signals that may indicate that Burns
the victim’s condition is worsening, such as
faster or slower breathing, changes in skin Burns are a special kind of soft tissue injury. Burns
color and restlessness. account for about 25 percent of all soft tissue in-
Take steps to minimize shock. juries. Thermal burns—burns caused by heat—are
Keep the victim from getting chilled or over- the most common.
heated. Burns first destroy the epidermis, the top layer
Have the victim rest comfortably and reassure of skin. As the burn progresses, the dermis, or sec-
him or her. ond layer, is injured or destroyed. Burns break the
Wash your hands immediately after giving care. skin and thus can cause infection, fluid loss and loss
A B
Figure 10-19 A, Use bulky dressings to support an embedded object. B, Use

bandages over the dressing to control bleeding.
A STITCH IN TIME
It can be difficult to judge when a wound requires stitches. A general rule of thumb is that stitches are
needed when the edges of skin do not fall together, the laceration involves the face or when any wound is
over 1⁄2 inch long. Stitches speed the healing process, lessen the chances of infection and improve the look
of scars. A health-care provider should apply stitches within the first few hours after the injury. The following
major injuries always require medical attention and often need stitches:
• Bleeding from an artery or bleeding that is
difficult to control
• Deep cuts or avulsions that show the
muscle or bone, involve joints, such as the
elbows, gape widely or involve the hands,
feet or face
• Large punctures
Jack Star/PhotoLink/Getty Images
• Large embedded objects

• Some human and animal bites
• Wounds that, if left unattended, could leave a
conspicuous scar, such as those that involve the
lip or eyebrow
If you are caring for a wound and think it may need
stitches, it probably does. If you are not sure, check with a health-care provider immediately. It can be dan-
gerous to close a wound after a delay because of the probability of infection. To care for stitches, follow the
instructions of your health-care provider. If the wound gets red or swollen or if pus begins to form, notify
your health-care provider.
Stitches are usually removed in 3 to 14 days, depending on where the wound is located. Some stitches
dissolve naturally and do not require removal.
of body temperature control. Burns can also dam- burn. Superficial burns generally heal in 5 to 6 days
age the respiratory system and the eyes. The sever- without permanent scarring.
ity of a burn depends on—
The temperature of the source of the burn. Partial-Thickness Burns
The length of exposure to the source.
The location of the burn. A partial-thickness burn (second degree) involves
The extent of the burn. both the epidermis and the dermis (Fig. 10-21).
The victim’s age and medical condition. These injuries may look red and have blisters. The
blisters may open and weep clear fluid, making the
Because their skin is thinner and more delicate, older skin appear wet. The burned skin may look mottled
adults and young children are particularly susceptible (blotched). These burns are usually painful, and the
to severe burns. People with chronic medical problems area often swells. The burn usually heals in 3 or
also tend to have more complications from severe 4 weeks. Scarring may occur.
burns, especially if they are not well nourished or have
heart or kidney problems. People with nerve damage
resulting from paralysis or other medical conditions Full-Thickness Burns
may have no sensation; therefore, they become burned
A full-thickness burn (third degree) destroys all the
more easily because they do not feel heat.
layers of skin, as well as any or all of the underlying
Burns are classified by their source, such as heat,
structures—fat, muscles, bones and nerves. These
chemicals, electricity or radiation. They are also classi-
burns look brown or charred (black), with the tissues
fied by depth. The deeper the burn, the more severe it
underneath sometimes appearing white (Fig. 10-22).
is. Generally, burns are classified into two categories:
They can be either extremely painful or relatively
superficial (first degree) burns and deep burns. Deep
painless if the burn destroyed nerve endings in the
burns are further classified into partial-thickness (sec-
skin. A third-degree burn is often life threatening
ond degree) and full-thickness (third degree) burns.
and can take longer to heal or result in scarring.
Superficial Burns Identifying Critical Burns

A superficial burn (first degree) involves only the A critical burn requires the attention of medical
top layer of skin (Fig. 10-20). The skin is red and professionals. Critical burns are potentially life
dry, and the burn is usually painful. The area may threatening, disfiguring and disabling. Knowing
swell. Mild sunburn is an example of a superficial whether you should call 9-1-1 or the local emer-
Alan Dimick, M D , Professor of Surgery,
Former Director of UAB Burn Center
Figure 10-20 A superficial (first degree) burn.


Figure 10-21 A partial-thickness (second degree) burn.

Figure 10-22 A full-thickness (third degree) burn.
gency number for a burn is often difficult. It is not Has burns to the head, neck, hands, feet or
always easy or possible to assess the severity of a genitals (Fig. 10-23).
burn immediately after injury. Even superficial Has a full-thickness burn and is younger than
burns to large areas of the body or to certain body age 5 or older than age 60.
parts can be critical. You cannot judge severity of a Has a burn resulting from chemicals, explo-
burn by the pain the victim feels because nerve end- sions or electricity.
ings may be destroyed. Call 9-1-1 or the local emer-
gency number if the victim—
Care for Burns
Has trouble breathing.
Follow these basic steps when caring for a burn:
Has burns covering more than one body part
or a large surface area. Check the scene for safety.
Has suspected burns to the airway. Note burns Stop the burning by removing the victim from
around the mouth and nose. the source of the burn.
burned face or other area that cannot be immersed.

Be sure to keep these compresses cool and moist by
adding more water. Otherwise, the compresses will
quickly absorb the heat from the skin’s surface, dry
out and perhaps stick to the burned area. Remove
any jewelry that the victim is wearing.
Allow several minutes for the burned area to
cool. If pain continues when the area is removed
from the water, continue cooling. When the burn is
cool, remove all clothing from the area by carefully
pulling or cutting material away. Do not try to re-
move any clothing that is sticking to skin.
Cover the burned area to keep out air and help
Figure 10-23 A critical burn to the face. reduce pain (Fig. 10-24, B). Use dry, sterile dress-
ings if possible and loosely bandage them in place.
Do not touch a burn with anything except a clean
Check for life-threatening conditions. covering. The bandage should not put pressure on
Cool the burn with large amounts of cold the burn surface. If the burn covers a large area of
running water. the body, cover the burned area with clean, dry
Cover the burn loosely with a sterile dressing. sheets or other cloth. Covering the burn also helps
Prevent infection. to prevent infection. Do not try to clean a severe
Take steps to minimize shock. burn.
Keep the victim from getting chilled or Do not put ointments, butter, oil or other com-
overheated. mercial or home remedies on blisters, deep burns or
Comfort and reassure the victim. burns that may require medical attention. Oils and
ointments seal in heat, do not relieve pain well and
Even after the source of heat has been removed, soft will have to be removed by medical personnel.
tissue will continue to burn for minutes afterwards, Other home remedies can contaminate open skin
causing more damage. Therefore, it is essential to areas, causing infection. Do not break blisters. In-
cool any burned areas immediately with large tact skin helps prevent infection.
amounts of cold water (Fig. 10-24, A). Do not use For minor superficial burns, care for the burned
ice or ice water except on a small, superficial burn area as you would for an open wound. Cool the
and then for no more than 10 minutes. Ice causes area. Wash the area with soap and water, and keep
the body to lose heat and further damages delicate the area clean. Apply a triple antibiotic ointment if
tissues. Use whatever resources are available—a the person has no known allergies or sensitivities to
tub, shower or garden hose. You can apply clean the medication, and watch for signals of infection.
soaked towels, sheets or other wet cloths to a A pharmacist or physician may be able to recom-
A B
Figure 10-24 A, Large amounts of cool water are essential to cool burned areas.
B, Cover the burned area.
mend products that are effective in caring for su-

perficial burns, such as sunburn.
Partial-thickness and full-thickness burns can
cause shock as a result of pain and loss of body flu-
ids. Have the victim lie down unless he or she is
having trouble breathing. Elevate burned areas
above the level of the heart, if possible. Burn victims
have a tendency to become chilled. Help the victim
maintain normal body temperature by protecting
him or her from drafts.
Burns can also be caused by chemicals, electricity Figure 10-26 Flush the affected eye with cool water in
and radiation. These burns have special require- the case of a chemical burn to the eye. Some facilities
ments for care. may have special eyewash stations.
Chemical Burns
Chemical burns are common in industrial settings of clean running tap water (under pressure) for at
but also occur in the home. Typically, burns result least 20 minutes. Do not use a forceful flow of wa-
from chemicals that are strong acids or alkalis. ter from a hose; the force may further damage
Cleaning solutions, such as household bleach, drain burned skin. If possible, have the victim remove
cleaners, toilet bowl cleaners, paint strippers, and contaminated clothes to prevent further contamina-
lawn or garden chemicals are common sources of tion while you continue to flush the area.
chemicals that can eat away or destroy tissues. If an eye is burned by a chemical, flush the af-
These substances can quickly injure the skin. fected eye with water until EMS personnel arrive.
As with heat burns, the stronger the chemical Tip the head so that the affected eye is lower than
and the longer the contact, the more severe the the unaffected eye as you flush (Fig. 10-26). This po-
burn. The chemical will continue to burn as long as sition helps prevent the chemical from getting into
it is on the skin. You must remove the chemical the unharmed eye. Flush from the nose outward. If
from the body as quickly as possible and call 9-1-1 both eyes are affected, direct the flow to the bridge
or the local emergency number. Flush the burn with of the nose and flush both eyes from the inner cor-
large amounts of cool, running water (Fig. 10-25). ner outward. Be aware that chemicals can be in-
Continue flushing the burn for at least 20 minutes haled, potentially damaging the airway or lungs.
or until EMS personnel arrive. If the chemical is dry Call 9-1-1 or the local emergency number if you be-
or in a powdered form, brush the chemical from the lieve chemicals have been inhaled. Let the call taker
skin with a gloved hand or a piece of cloth. Then know if you believe chemicals have been inhaled.
flush the residue from the skin with large amounts
Electrical Burns
The human body is a good conductor of electricity.
When someone comes in contact with an electrical
source, such as a power line, a malfunctioning
household appliance or lightning, he or she conducts
the electricity through the body. Electrical resistance
of body parts produces heat, which can cause burn
injuries (Fig. 10-27, p. 196). The severity of an elec-
trical burn depends on the type and amount of con-
tact, the current’s path through the body and how
long the contact lasted. Electrical burns are often
deep. The victim may have an entrance wound and
an exit wound where the current left the body. Al-
though these wounds may look superficial, the tis-
sues below may be severely damaged.
Figure 10-25 Flush a chemical burn with large Electrical injuries cause problems in addition
amounts of cool running water. to burns. Electricity running through the body
STRIKING DISTANCE
In medieval times, people believed that ringing of positive and negative particles. Most electrical
church bells would dissipate lightning during currents run between the layers inside the
thunderstorms. It was an unfortunate superstition cloud. However, occasionally, the negative charge
for the bell ringers. Over one period of 33 years, flashes toward the ground, which has a positive
lightning struck 386 church steeples and 103 bell charge. An electrical current snakes back and forth
ringers died (Kessler E). between the ground and the cloud many times in
Church bell ringers have dropped off the list of the seconds that we see a flash crackle down
people most likely to be struck during a thunder- from the sky. Anything tall—a tower, a tree or a
storm, but lightning strikes remain extremely dan- person—becomes a path for the electrical
gerous. On average, lightning causes more deaths current.
annually in the United States than any other Traveling at speeds up to 300 miles per second,
weather hazard, including blizzards, hurricanes, a lightning strike can hurl a person through the air,
floods, tornadoes, earthquakes and volcanic erup- burn his or her clothes off and sometimes cause
tions. The National Weather Service estimates that the heart to stop beating. The most severe lightning
lightning kills nearly 100 people annually and in- strikes carry up to 50 million volts of electricity,
jures about 300 others. enough to light 13,000 homes. Lightning can
Lightning occurs when particles of water, ice “flash” over a person’s body, or, in its more danger-
and air moving inside storm clouds lose electrons. ous path, it can travel through blood vessels and
Eventually, the cloud becomes divided into layers nerves to reach the ground.
Besides burns, lightning can also cause neuro- • Do not shower during a thunderstorm. Wa-
logical damage, fractures and loss of hearing or ter and metal are both excellent conductors
eyesight. The victim sometimes acts confused and of electricity.
may describe the episode as getting hit on the head • Do not use a telephone, mobile phone or
or hearing an explosion. radio transmitter except for emergencies.
Use common sense around thunderstorms. If you If you are caught in a storm outdoors and cannot
see a storm approaching in the distance, do not find shelter, avoid—
wait until you are drenched to seek shelter. If a • Water.
thunderstorm threatens, the National Weather Ser- • High ground.
vice advises you to— • Open spaces.
• Postpone activities promptly. Do not wait for • All metal objects including electric wires,
rain. Many people take shelter from the fences, machinery, motors, power tools, etc.
rain, but most people struck by lightning • Unsafe places, such as underneath
are not in the rain! canopies, small picnic or rain shelters or
• Go quickly inside a completely enclosed near trees.
building, not a carport, open garage or Where possible, find shelter in a substantial
covered patio. If no enclosed building is building or in a fully enclosed metal vehicle, such
convenient, a cave is a good option outside, as a hardtop car, truck or a van, with the windows
but move as far as possible from the cave completely shut.
entrance. If lightning is striking nearby when you are out-
• Watch cloud patterns and conditions for side, you should—
signals of an approaching storm. • Crouch down. Put feet together. Place
• Designate safe locations and move or evac- hands over ears to minimize hearing dam-
uate to a safe location at the first sound of age from thunder.
thunder. Every 5 seconds between the flash Avoid proximity to other people. Maintain a mini-
of lightning and the sound (bang) of thun- mum distance of 15 feet between people. If there is
der equals 1 mile of distance. a tornado alert, go to the location specified. This
• Use the 30-30 rule where visibility is good may be the basement or the lowest interior level of
and there is nothing obstructing your view a building.
of the thunderstorm. When you see light-
ning, count the time until you hear thunder. SOURCES
If that time is 30 seconds or less, the thun- Kessler E: The thunderstorm in human affairs, Norman, Oklahoma, Univer-
sity of Oklahoma, 1983.
derstorm is within 6 miles of you and is National Weather Service. www.lightningsafety.noaa.gov/outdoors.htm.
dangerous. Seek shelter immediately. The Accessed 10/25/04.
Randall T: “50 million volts may crash through a lightning victim,” The
threat of lightning continues for a much Chicago Tribune, Section 2D, August 13, 1989, p.1.
longer period than most people realize. Wait
at least 30 minutes after the last clap of
thunder before leaving shelter. Do not be
fooled by sunshine or blue sky! If inside
during a storm, keep away from windows.
Injuries may occur from flying debris or
glass if a window breaks.
Figure 10-27 An electrical burn may severely damage Figure 10-28 Solar radiation burns can be painful.
underlying tissues.
can make the heart beat erratically. As a result, Radiation Burns

the victim’s heart or breathing may stop. The vic- The solar radiation of the sun and other types of ra-
tim may also have fractured bones caused by diation can cause burns. Solar burns are similar to
strong muscle spasms. The signals of electrical in- heat burns. Usually solar burns are mild but can be
jury include— painful (Fig. 10-28). They may blister, involving
more than one layer of skin. Care for sunburns as
Unconsciousness.
you would any other burn. Cool the burn and pro-
Dazed, confused behavior.
tect the burned area from further damage by stay-
Obvious burns on the skin’s surface.
ing out of the sun. Do not break blisters. Intact skin
Trouble breathing or no breathing.
helps prevent infection. People are rarely exposed to
Burns both where the current entered and
other types of radiation unless working in special
where it exited the body, often on the hand or
settings, such as certain medical, industrial or re-
foot.
search facilities. If you work in such settings, you
Suspect a possible electrical injury if you hear a should be informed of the risks and will be required
sudden loud pop or bang or see an unexpected to take precautions to prevent overexposure. Train-
flash. Never go near a person with an electrical ing is also provided to teach you how to prevent
burn until you are sure the person is not still in con- and respond to radiation emergencies.
tact with the power source. In case of high-voltage
electrocution, such as that caused by down power
lines, call 9-1-1 or the local emergency number. All
people with electric shock require advanced medical
INFECTION
care. Any break in the skin can provide an entry point for
To care for a victim of an electrical injury, disease-producing microorganisms. Even a small,
make sure the scene is safe. Turn off the power at seemingly minor laceration or abrasion has the po-
its source and care for any life-threatening con- tential to become infected. An infection can range
ditions. Electrocution can cause cardiac and from being merely unpleasant to life threatening.
breathing emergencies. Be prepared to give CPR
or defibrillation, and care for shock and thermal
burns. Preventing Infection
In your check for non-life-threatening condi-
tions, look for two burn sites, one where the current The best initial defense against infection is to
entered and one where it exited. Check for addi- cleanse the area thoroughly. For minor wounds,
tional injuries, such as fractures. wash the area with plenty of soap and water. Most
Cover any burn injuries with a dry, sterile dress- types of soaps are effective in removing harmful
ing and give care for shock. bacteria. Wounds that require medical attention be-
An Ounce of Prevention
A serious infection can cause severe medical prob- condition called “lockjaw.” Once tetanus gets into the
lems. One such infection is tetanus, caused by the mi- nervous system, its effects are irreversible.
croorganism Clostridium tetani. This microorganism, The best way to prevent tetanus is to be immunized
commonly found in soil and feces of cows and horses, against it and then receive periodic booster shots. Im-
can infect many kinds of wounds. This probably ex- munizations assist the natural function of the immune
plains why the cavalry in the American Civil War had system by building up antibodies, which are disease-
higher rates of tetanus than the infantry. Worldwide, fighting proteins that help protect the body against
about 1 million people contract tetanus annually, with specific bacteria. Because the effects of immunization
20 to 50 percent of the cases resulting in death. In the do not last a lifetime, booster shots help maintain the
United States, only 25 cases were reported in 2002. antibodies that protect against tetanus. Booster shots
are recommended every 5 to 10 years or whenever a
wound has been contaminated by dirt or an object,
such as a rusty nail, that causes a puncture wound.
Most infants or young children in this country receive
an immunization known as DTaP, which includes the
tetanus toxoid. About 70 percent of a sample of Ameri-
cans 6 years of age or older were found to have anti-
bodies in their systems that protect against tetanus.
By age 60 to 69, however, the level of antibodies
dropped to less than 50 percent and to about 30 per-
cent by age 70. Fifty-nine percent of tetanus cases
and 75 percent of deaths from tetanus occur in people
60 years of age or older.
The first line of defense against tetanus is to thor-
oughly clean an open wound. Clean a minor wound
Tetanus is introduced into the body through a punc- with soap and water, and apply an antibiotic ointment
ture wound, abrasion, laceration or burn. Because the and a clean or sterile dressing. Major wounds should
organism multiplies in an environment that is low in be cleaned and treated at a medical facility. If signals
oxygen, puncture wounds and other deep wounds are of wound infection develop, seek medical attention im-
at particular risk for tetanus infection. The organism mediately. Infected wounds of the face, neck and head
produces a powerful toxin, one of the most lethal poi- should receive immediate medical care, because the
sons known, that affects the central nervous system tetanus toxin can travel rapidly to the brain. A health-
and specific muscles. People injecting themselves with care provider will determine whether a tetanus shot is
drugs, burn victims and people recovering from needed, depending on the victim’s immunization sta-
surgery have an increased risk of contracting the dis- tus. Always contact your health-care provider if you do
ease. Newborn babies can be infected through the not remember the date of your last tetanus immuniza-
stump of the umbilical cord. tion or booster shot.
Signals of tetanus include difficulty swallowing, irri-
tability, headache, fever and muscle spasms near the
SOURCE
infected area. As the infection progresses, it can affect Sanford JP: “Tetanus—forgotten but not gone,” New England Journal of
other muscles, such as those in the jaw, causing the Medicine 332(12):812-813.
cause of more extensive tissue damage or bleeding

do not need be washed immediately. It is more im-
Signals
portant to control bleeding. You can easily recognize the signals of an infection.
Puncture wounds do not bleed profusely and The area around the wound becomes swollen and
more readily become infected. Objects penetrating red. The area may feel warm or throb with pain.
the soft tissues carry microorganisms that cause in- Some wounds have a pus discharge (Fig. 10-29).
fections. Of particular danger is the microorganism More serious infections may cause a person to de-
that causes tetanus. Tetanus is a disease caused by velop a fever and feel ill. Red streaks may develop
bacteria that produces a powerful poison in the that progress from the wound in the direction of
body. This poison enters the nervous system and the heart.
can cause muscle paralysis (also known as “lock-
jaw”). Once tetanus reaches the nervous system, its
effects are highly dangerous and can be fatal. How-
ever, in many cases, tetanus can now be successfully
Care
treated with antitoxins.
Care for an infected wound by keeping the area
One of the ways to prevent tetanus is through
clean, elevating the area and applying warm, wet
immunization. Like all immunizations, the tetanus
compresses and an antibiotic ointment. Change
immunization helps the immune system defend
coverings over the wound daily. If a fever or red
against the invading pathogens that cause the dis-
streaks develop, the infection is worsening. Contact
ease. The immune system is the body system re-
your health-care provider to determine what addi-
sponsible for fighting off infection. Immunizations
tional care is necessary.
assist the natural function of the immune system
by building up antibodies. Antibodies are disease-
fighting proteins, which help protect the body
against specific infections. The tetanus immuniza-
tion is usually given in infancy. However, the effect
SUMMARY
of the immunization eventually wears off. Everyone Caring for wounds involves a few simple steps. You
should receive a booster shot at least every 10 years need to control bleeding and minimize the risk of
or whenever a wound is contaminated by dirt or an infection. Remember that with minor wounds, your
object, such as a rusty nail, that causes a puncture primary concern is to cleanse the wound to prevent
wound. infection. With major wounds, you should control
Figure 10-29 Close-up of palm of hand with infected cut.

the bleeding quickly and seek medical attention. personal safety. When the scene is safe, approach
Wear disposable gloves or use a barrier, such as the victim, check for life-threatening conditions
plastic wrap, dressings or clean folded cloth, to and for non-life-threatening conditions, if neces-
avoid contact with blood. Dressings and bandages, sary. Follow the steps for burn care. In addition, al-
when correctly applied, help control bleeding, re- ways check for inhalation injury if the person has a
duce pain and minimize the danger of infection. heat or chemical burn. With electrical burns and
Burns damage the layers of the skin and some- victims of a lightning strike, check carefully for ad-
times the internal structures as well. Heat, chemi- ditional conditions, such as trouble breathing, car-
cals, electricity and radiation all cause burns. When diac arrest and fractures.
caring for a burn victim, always first ensure your
1. Which type of burn has Joe sustained? Why do 3. What steps would you take to care for Joe’s
you think so? burns?
2. Will Joe’s burns require medical attention? Why

or why not?
STUDY QUESTIONS
a. Soft tissue
b. Open wound
c. Critical burn
d. Bandages
e. Closed wound
f. Deep burn
_____ Any burn that is potentially life threatening, disabling or disfiguring.
_____ A burn that destroys skin and underlying tissues.
_____ The layers of the skin, fat and muscles.
_____ Wrappings that hold dressings in place.
_____ Injury resulting in tissue damage beneath the skin’s surface, while the skin remains intact.
_____ Injury resulting in a break in the skin’s surface.
2. Match each type of injury to its example.
a. Abrasion
b. Puncture
c. Avulsion
d. Contusion
_____ Torn earlobe
_____ Black eye
_____ Scraped knee
_____ Gunshot wound
3. Match each type of wound with the appropriate care.
a. A major open wound

b. A minor open wound
c. A major open wound with an embedded object
d. A severed body part
_____ Cover with dressing and pressure bandage.
_____ Wash the wound thoroughly with soap and water.
_____ Wrap and place in plastic bag and then on ice.
_____ Use bulky dressings to stabilize.
4. List four signals of infection.
5. List two purposes of bandaging.
6. List and describe four types of open wounds.
7. List four sources of burns.
8. Describe the following types of burns:
a. Superficial burn
b. Partial-thickness burn
c. Full-thickness burn
9. To prevent infection of a minor open wound you should—
a. Wash the area with soap and water.

b. Apply a pressure bandage.
c. Remove all jewelry.
d. Wrap the affected area with moist sterile dressings.
10. A signal of an infected open wound is—
a. Red streaks from the wound in the direction of the heart.

b. Swelling and redness around the wound.
c. The affected area is cool to the touch
d. Fever and chills.
11. Which should you do to care for an infected wound?
a. Keep the area clean.

b. Apply warm, wet compresses and a triple antibiotic ointment.
c. Elevate the injured area.
12. Which statement applies to all open wounds?
a. They always bleed heavily.

b. They are at risk for infection.
c. They must always be cleaned immediately.
d. They are life threatening.
13. Which distinguishes major open wounds from minor open wounds?
a. The amount of dirt in the wound

b. The depth of tissue damage
c. The amount of pain that the victim is experiencing
d. The amount of blood lost
14. Which should you do in caring for a major open wound?
a. Apply direct pressure with a dressing to control bleeding.

b. Wash the wound.
c. Apply an occlusive dressing.
d. Apply an antibiotic ointment.
15. Which should you do when caring for an injury in which the body part has been completely severed?
a. Place the part directly on ice.

b. Seek medical assistance and make sure the part is transported with the victim.
c. Wash the body part thoroughly with soap and water.
d. Secure it back in place using sterile roller bandages.
16. It is important to keep your immunizations up to date because—
a. They provide lifetime protection against all threats of infection.

b. They prepare your body to defend against certain infections.
c. They stimulate the body to produce more blood.
d. They eliminate the need to clean the wound.
17. A 6-year-old girl falls on a sharp object. The object is sticking out of her leg. What should you do?
a. Allow the area to bleed freely.

b. Remove the object and control bleeding.
c. Wash the wound with soap and water.
d. Stabilize the object in the position in which you find it.
18. Which is the step you should take to control external bleeding (minor)?
a. Elevate the injured area.

b. Apply direct pressure.
c. Apply a pressure point.
d. Apply a tourniquet.
19. Which could swelling and discoloration indicate?
a. A closed wound
b. Damage to underlying structures
c. Internal bleeding
d. All of the above
20. Which action would you take when caring for a minor closed wound?
a. Use a warm compress over the wound.

b. Apply cold and elevate the injured area.
c. Keep the injured area below the level of the heart.
d. Call 9-1-1 or the local emergency number.
21. What is the first step you should take when caring for an electrical burn?
a. Check for life-threatening conditions.

b. Make sure the scene is safe (the power source is turned off).
c. Look for an entry and exit wound.
d. Check for non-life-threatening conditions.
22. Which burns require professional medical attention?
a. Burns that cover more than one body part.

b. Burns whose victims are having trouble breathing.
c. Burns resulting from electricity, explosions or chemicals.
23. The chemist at the lab table near you spills a liquid corrosive chemical on his arm. Which would you do first?
a. Remove the chemical with a clean cloth.

b. Put a sterile dressing over the burn site.
c. Flush the burn with water.
d. Have the victim remove contaminated clothes.
24. Luke’s grandmother was burned on one leg and foot when a pan of boiling water tipped off the stove. Which
should Luke have done first to care for her?
a. Put ice on the burned area.

b. Put a dry, sterile dressing on the burned area.
c. Help her put her foot and leg in the bathtub and flood it with cool water.
d. Wash the area and then apply a burn ointment.

hapter 11
Chapter
I never felt so helpless. Before I could even reach out to help her, my
sister Rita picked up her suitcase and started down the front steps
toward the street. She was talking to me and missed the first step. By the
time I reached her, I could see she was really hurt. She was conscious,
but she didn’t seem to be able to get up. She was lying down, holding
her left shoulder and moaning. Her left arm just hung there. “Help me,’’
she gasped. Not one other person was in sight.
Musculoskeletal
Injuries
Objectives
■ Identify four types of mechanical forces that can act upon the
body and how these forces can lead to injury.
■ Identify four basic types of musculoskeletal injuries.
■ List eight signals of a serious musculoskeletal injury.
■ Describe the general care for musculoskeletal injuries.
■ List the five purposes for immobilizing a musculoskeletal injury.
■ List four principles of splinting.
Introduction THE MUSCULOSKELETAL SYSTEM

The musculoskeletal system is made up of muscles
and bones that form the skeleton, as well as con-
Injuries to the musculoskeletal system are
nective tissues, tendons and ligaments. Together,
common. Millions of people at home, at work
these structures give the body shape, form and sta-
or at play injure their muscles, bones or joints. bility. Bones and muscles connect to form various
No age group is exempt. A person may fall body segments. They work together to provide
and bruise his or her hip. A person who body movement.
braces a hand against a dashboard in a car
crash may injure the bones at the shoulder,
disabling the arm. A person who falls while Muscles
skiing may twist a leg, tearing the supportive Muscles are soft tissues that are able to contract and
tissues of a knee and making it impossible to relax. The body has over 600 muscles (Fig. 11-1).
stand or move. Most are skeletal muscles, which attach to the
Although musculoskeletal injuries are bones. Skeletal muscles account for most of your
almost always painful, they are rarely life lean body weight (body weight without excess fat).
threatening when cared for properly. However, All body movements result from skeletal muscles
contracting and relaxing. Through a pathway of
when not recognized and taken care of
nerves, the brain directs muscles to contract, caus-
properly, musculoskeletal injuries can have ing movement. Skeletal muscle actions are under
serious consequences and even result in our conscious control. Because you move them vol-
permanent disability or death. In this chapter, untarily, skeletal muscles are also called voluntary
you will learn how to recognize and care for muscles. Skeletal muscles also protect the bones,
musculoskeletal injuries. Developing a better nerves and blood vessels.
Most skeletal muscles are anchored to bone at
understanding of the structure and function
each end by strong, cordlike, fibrous tissues called
of the body’s framework will help you tendons. Muscles and their adjoining tendons ex-
assess musculoskeletal injuries and give tend across joints. When the brain sends a com-
appropriate care. mand to move, nerve impulses travel through the
spinal cord and nerve pathways to the individual
muscles and stimulate the muscle fibers to contract.
K E Y T E R M S
Bone: Dense, hard tissue that forms the skeleton. Skeletal muscles: Muscles that attach to the
Dislocation: The displacement of a bone from its bones.
normal position at a joint. Splint: A device used to immobilize body parts; to
Fracture: A break or disruption in bone tissue. immobilize body parts with such a device.
Immobilize: Keep an injured body part from mov- Sprain: The stretching and tearing of ligaments
ing by using a splint or other method. and other soft tissue structures at a joint.
Joint: A structure where two or more bones are Strain: The stretching and tearing of muscles and
joined. tendons.
Ligament: A fibrous band that holds bones to- Tendon: A cordlike, fibrous band that attaches
gether at a joint. muscle to bone.
Muscle: A soft tissue that contracts and relaxes
to create movement.
CHAPTER 11 Musculoskeletal Injuries 207
Face muscles
Neck
Neck
muscles
muscles
Deltoid Deltoid
Chest
muscles Back
Biceps Triceps
muscles
Extensors
Extensors Abdominal of wrist
of wrist muscles and
and fingers
Gluteus
fingers maximus
Hamstring
Quadriceps Groin muscles
muscles muscles
Extensors Calf
of foot muscles
and toes
Achilles
tendon
Figure 11-1 The body has over 600 muscles, most of them attached to bones
by strong tissues called tendons. The shortening and lengthening of the muscles
are what make the body move.
Contract
Relax
Contract
Relax
Figure 11-2 Movement occurs when one group of muscles contracts and an
opposing group of muscles relaxes.
When the muscle fibers contract, pulling the ends of juries may affect only strength because adjacent
the muscle closer together, the muscles pull the muscles can often do double duty and take over for
bones, causing motion at the joint. the injured muscle.
Muscles in a group often pull at the same time.
For instance, the hamstring muscles are a group of
muscles at the back of the thigh. When the ham-
The Skeleton
strings contract, the leg bends at the knee joint. The The skeleton is formed by over 200 bones of vari-
biceps are a group of muscles at the front of the up- ous sizes and shapes (Fig. 11-3). These bones
per arm. When the biceps contract, the arm bends shape the skeleton, giving each body part a char-
at the elbow joint. Generally, when one group of acteristic form. The skeleton protects vital organs
muscles contracts, another group of muscles on the and other soft tissues. The skull protects the brain
opposite side of the body part relaxes (Fig. 11-2). (Fig. 11-4, A). The ribs protect the heart and lungs
Even simple tasks, such as bending to pick up an (Fig. 11-4, B). The spinal cord is protected by the
object from the floor, involve a complex series of canal formed by the bones that form the spinal
movements in which different muscle groups con- column (Fig. 11-4, C). Two or more bones come
tract and relax. together to form joints. Ligaments, fibrous bands
Injuries to the brain, spinal cord or nerves can that hold bones together at joints, give the skele-
affect muscle control. A loss of muscle movement is ton stability and, with the muscles, help maintain
called paralysis. Less serious or isolated muscle in- posture.
Skull
Mandible
(jaw)
Clavicle
(collarbone)
Sternum Scapula
(breastbone) (shoulder blade) Spine
Humerus
Ribs
Carpal Radius
bones Pelvis
Metacarpal Ulna
bones
Sacrum
Phalanges
Coccyx
Femur
Patella
(kneecap)
Fibula
Tibia
Tarsal
bones
Metatarsal
bones
Phalanges
Figure 11-3 Over 200 bones in various sizes and shapes form the skeleton.
The skeleton protects many of the organs inside the body.
Skull
Brain
Sternum
(breastbone)
Spinal
cord C
B Lung Ribs Spinal

column
Heart
Diaphragm
Figure 11–4 A, The immovable bones of the skull protect the brain. B, The rib
cage protects the heart and lungs. C, The spinal cord is protected by the vertebrae.
Bones
Bones are hard, dense tissues. The strong, rigid struc-
ture of bones helps them to withstand stresses that
Humerus
cause injuries. The shape of bones depends on what Femur
(upper arm
the bones do and the stresses placed on them. For bone) (thigh bone)
instance, although similar to the bones of the arms,
the bones of the legs are much larger and stronger
because they carry the body’s weight (Fig. 11-5). Radius
Bones have a rich supply of blood and nerves. Patella
Some bones store and manufacture red blood cells (kneecap)
Ulna
and supply them to the circulating blood. Bone in- (forearm
juries can bleed and are usually painful. The bleed- bones) Tibia
ing can become life threatening if not properly
Fibula
cared for. Bones heal by developing new bone cells
within a fibrous network of tissue that forms be-
tween the broken bone ends. Bone is the only body
FRONT
tissue that can regenerate in this way.
Bones weaken with age. Young children’s are
softer and more porous than adults’ bones, so they Figure 11-5 Leg bones are larger and stronger than
bend and break more easily. At puberty, a child’s arm bones because they carry the body’s weight.
Metacarpals
Sternum
Humerus
Face
IRREGULAR
SHORT
FLAT
LONG
Figure 11-6 Bones vary in shape and size. Bones are weakest at the points
where they change shape and usually fracture at these points.
bones become as hard as an adult’s. As people age,

their bones lose mass and density and bones are Joints
more likely to give way to even everyday stresses,
which can cause significant injuries. For instance, A joint is formed by the ends of two or more bones
an elderly person with significant bone loss can eas- coming together at one place. Most joints allow mo-
ily break the strongest bone in the body, the femur tion. However, the ends of the bones at some joints
(thigh bone), just by pivoting his or her weight on are fused together, which restricts motion. Fused
one leg. The gradual, progressive weakening of bones, such as the bones of the skull, form solid
bone is called osteoporosis. structures that protect their contents (Fig. 11-7).
Bones are classified as long, short, flat or irreg- Joints that allow movement are held together by
ular (Fig. 11-6). Long bones are longer than they tough, fibrous connective tissues called ligaments
are wide. Long bones include the bones of the up- (Fig. 11-8). Ligaments resist joint movement. Joints
per arm (humerus), the forearm (radius and ulna), surrounded by ligaments have restricted movement;
the thigh (femur) and the lower leg (tibia and joints that have few ligaments move more freely.
fibula). Short bones are about as wide as they are For instance, the shoulder joint, with few ligaments,
long. Short bones include the small bones of the allows greater motion than the hip joint, although
hand (carpals) and feet (tarsals). Flat bones have a their structures are similar.
relatively thin, flat shape. Flat bones include the Joints that move more freely, such as the ankle
breastbone (sternum), the ribs and the shoulder and shoulder, have less natural support, which
blade (scapula). Bones that do not fit in the other makes them more prone to injury. However, all
categories are called irregular bones, which include joints have a normal range of movement. When a
the vertebrae and the bones that make up the skull, joint is forced beyond its normal range, ligaments
including the bones of the face. Bones are weakest stretch and tear, making the joint unstable. Unstable
at the points where they change shape, so they usu- joints can be disabling, particularly when they are
ally fracture at these points. In children, the bones weight bearing, such as the knee or ankle. Unstable
are weakest at the growth plates, located at the ends joints are also prone to re-injury and often develop
of long bones. arthritis in later years.
Thigh bone
Ligaments
Ligaments
Leg bones
Kneecap
Tendon
Figure 11-7 Fused bones, such as bones of the skull, THE KNEE
form solid structures that protect their contents.
Figure 11-8 A typical joint consists of two or more
bones held together by ligaments.
INJURIES TO THE may be forced beyond its normal range of motion,

causing injury. Twisting injuries are not always this
MUSCULOSKELETAL SYSTEM complex. Twisting injuries more often occur from
simply stepping off a curb (ankle) or turning to
Injuries to the musculoskeletal system are most reach for an out-of-the-way object (back).
commonly caused by mechanical forms of energy Sudden or powerful muscle contractions can re-
but can also occur from heat, chemical or electri- sult in musculoskeletal injuries. These injuries com-
cal energy. Mechanical energy produces direct, in- monly occur in sports activities, such as throwing a
direct, twisting and contracting forces (Fig. 11-9). ball a long distance without properly warming up
These forces can injure the structures of the or sprinting when out of shape. However, our daily
musculoskeletal system. A direct force is the force routines also require sudden and powerful muscle
of an object striking the body and causing injury at contractions, such as when we suddenly turn to
the point of impact. Direct forces can either be catch a heavy object like a falling child. Although
blunt or penetrating. For example, a fist striking infrequent, sudden and powerful muscle contrac-
the chin can break the jaw, or penetrating ob- tions can even pull a piece of bone away from the
jects, such as bullets and knives, can injure struc- point at which it is normally attached.
tures beneath the skin at the point where they
penetrate.
An indirect force travels through the body and Types of Musculoskeletal Injuries
causes injury to a body part away from the point of
impact. For example, a fall on an outstretched hand The four basic types of musculoskeletal injuries are
may result in an injury to the shoulder or collar- fracture, dislocation, sprain and strain. Injuries to
bone. the musculoskeletal system can be classified ac-
In twisting, one part of the body stays in one cording to the body structures that are damaged.
position while another part of the body turns. The Some injuries may involve damage to more than
twisting action can force body parts beyond their one structure. For example, a direct blow to the
normal range of motion, causing injury. For exam- knee may injure both ligaments and bones. Injuries
ple, if a ski and its binding keep the lower leg in one are also classified by the nature and extent of the
position while the body falls in another, the knee damage.
DIRECT
INDIRECT
TWISTING CONTRACTING
Figure 11-9 Four forces—direct, indirect, twisting and contracting—cause 76 percent

of all musculoskeletal injuries.
Fracture Another example is when an object penetrates the

A fracture is a break or disruption in bone tissue. skin and breaks the bone. Bone ends do not have to
Fractures include bones that are chipped or be visible in an open fracture. Closed fractures leave
cracked, as well as bones that are broken all the the skin unbroken and are more common than open
way through (Fig. 11-10). Direct and indirect forces fractures. Open fractures are more serious than
commonly cause fractures. However, if strong closed fractures because of the risks of severe blood
enough, twisting forces and strong muscle contrac- loss and infection. Although fractures are rarely an
tions can cause a fracture. immediate threat to life, any fracture involving a
Fractures are classified as open or closed. Open large bone, such as the femur or pelvis, can cause
fractures occur when the skin over the fracture site severe shock because bones and soft tissue may
is broken. An example of an open fracture is when bleed heavily.
a limb is severely angulated or bent, causing bone Fractures are not always obvious unless a tell-
ends to tear the skin and surrounding soft tissues. tale sign, such as an open wound with protruding
The Breaking Point

Osteoporosis is a degenerative bone disorder. Re- are necessary to
search estimates indicate that among individuals bone building. The
over 50, osteoporosis can strike at any age. It is United States
estimated that one out of every two women and recommended
one in four men will be affected by osteoporosis in daily allowance
their lifetime. Fair-skinned women with ancestors (U.S. RDA)
from northern Europe, the British Isles, Japan or ranges from
China are genetically predisposed to osteoporosis. 1000 to 2000 mil-
Inactive people are more susceptible to osteo- ligrams of calcium each day for
porosis. adults over the age of 18. Three to four
Osteoporosis occurs when the calcium content daily servings of low-fat dairy products should
of bones decreases. Normally, bones are hard, provide adequate calcium. Vitamin D is also
dense tissues that endure tremendous stresses. necessary because it aids in absorption of cal-
Bone-building cells constantly repair damage that cium. Exposure to sunshine allows the body to
occurs as a result of everyday stresses, keeping make vitamin D. Fifteen minutes of sunshine on
bones strong. Calcium is vital to bone growth, de- the hands and face of a young, light-skinned indi-
velopment and repair. When the calcium content of vidual are enough to supply the RDA of vitamin D
bones decreases, bones become frail, less dense per day. Dark-skinned people and people over the
and less able to repair the normal damage they age of 65 need more sun exposure. People who
incur. do not receive adequate sun exposure need to
This loss of density and strength leaves bones consume vitamin D. The best sources are vitamin-
more susceptible to fractures. Where once tremen- fortified milk and fatty fish such as tuna, salmon
dous force was necessary to cause a fracture, and eel.
fractures now may occur with little or no aggrava- Calcium supplements combined with vitamin D
tion, especially to hips, vertebrae and wrists. Spon- are available for those who do not take in ade-
taneous fractures occur without trauma. The victim quate calcium. However, before taking a calcium
may be taking a walk or washing dishes when the supplement, consult your health-care provider.
fracture occurs. Some hip fractures thought to be Many advertised calcium supplements are ineffec-
caused by falls are actually spontaneous fractures tive because they do not dissolve well in the body.
that caused the victim’s fall. Exercise seems to increase bone density and
Osteoporosis can begin as early as age 30 to the activity of bone-building cells. Regular exer-
35. The amount of calcium absorbed from the diet cise may reduce the rate of bone loss by promot-
naturally declines with age, making calcium intake ing new bone formation and may stimulate the
increasingly important. When calcium in the diet is skeletal system to repair itself. An effective exer-
inadequate, calcium in bones is withdrawn and cise program, such as aerobics, jogging or walk-
used by the body to meet its other needs, leaving ing, involves the weight-bearing muscles of the
bones weakened. legs. If you have any questions regarding your
Building strong bones before age 35 is the key health and osteoporosis, consult a health-care
to preventing osteoporosis. Calcium and exercise provider.
bone ends or a severely deformed body part, is pre- Sprain

sent. But the way in which the injury occurred is of-
ten enough to suggest a possible fracture. A sprain is the partial or complete tearing or
stretching of ligaments and other tissues at a joint
(Fig.11-13, A). A sprain usually results when the
Dislocation bones that form a joint are forced beyond their
A dislocation is a displacement or separation normal range of motion. The more ligaments that
of a bone from its normal position at a joint are torn, the more severe the injury. The sudden, vi-
(Fig. 11-11). As with a fracture, a dislocation can be olent forcing of a joint beyond its range of motion
caused by severe direct, indirect or twisting forces. can completely rupture ligaments and even dislo-
A force violent enough to cause a dislocation can cate the bones. Severe sprains may also
also cause a fracture, as well as cause damage to involve a fracture of the bones that
nearby nerves and blood vessels. Some joints, form the joint. Ligaments may
such as the shoulder or finger, dislocate easily pull bone away from their point
because their bones and ligaments are small of attachment. Young children
and fragile (Fig. 11-12). Other joints, such as are more likely to have a
joints of the elbow or spine, are well pro-
tected because of the shape of the bones and
the way they fit together; therefore, they dis-
locate less easily.
Figure 11-11 A dislocation is a separation

of bone from its normal position at a joint.
COSF-Boston
Figure 11-10 Fractures include chipped or cracked bones Figure 11-12 Obvious deformity in thumb (dislocation).
and bones broken all the way through.
fracture than a sprain because their ligaments are

stronger than their bones.
Strain
Mild sprains, which stretch ligament fibers, gen- A strain is a stretching and tearing of muscle fibers
erally heal quickly. The victim may have only a brief or tendons (Fig. 11-13, B). A strain is sometimes
period of pain or discomfort and quickly return to called a muscle pull or tear. Because tendons are
activity with little or no soreness. For this reason, tougher and stronger than muscles, tears usually oc-
people often neglect sprains and the joint is often cur in the muscle itself or where the muscle attaches
re-injured. Severe sprains or sprains that involve a to the tendon. Strains often result from overexer-
fracture usually cause pain when the joint is moved tion, such as lifting something too heavy or work-
or used. The weight-bearing joints of the ankle and ing a muscle too hard. They can also result from
knee and the joints of the fingers and wrist are those sudden or uncoordinated movement. Strains com-
most commonly sprained. monly involve the muscles in the neck or back, the
Surprisingly, a sprain can be more disabling front or back of the thigh or the back of the lower
than a fracture. When fractures heal, they usually
leave the bone as strong as it was before, or
stronger, decreasing the likelihood that a second
break will occur at the same spot. On the other
hand, ligaments cannot regenerate. If the stretched
or torn ligaments are not repaired, they render the
joint less stable and may impede motion. The in-
jured area may also be more susceptible to re-injury.
Injured
Figure 11-13 A, Injuries to joints are usually sprains. muscle
B, Injuries to the soft tissue between joints, the muscles
and tendons, are strains.
Sprains
A B
Strains
Torn
ligament
Heat or Cold?
Spring is the season of flowers, trees, strains and
sprains. Almost as soon as armchair athletes come
How heat helps repair the tissue
A health-care provider will most likely advise apply-
out of hibernation to become intramural heroes, ing ice periodically to the injury for about 48 hours or
emergency departments see an increase in sprained until the swelling goes away. After that, applying
ankles, twisted knees and strained backs. So what heat is often the more appropriate care. Heat speeds
do you do when you attempt the first slide of the up chemical reactions needed to repair the tissue.
softball season and wind up injured? Should you ap- White blood cells move in to rid the body of infec-
ply heat or apply cold? tions, and other cells begin the repair process, expe-
The answer is both. First cold, then heat. And this diting proper healing of the injury. Applying heat too
treatment is the same whether the injury is a strain early, however, can cause swelling to increase, de-
or a sprain. laying healing. If you are unsure whether to use cold
or heat on an injured area, always apply cold until
How cold helps initially you can consult a health-care provider.
When a person twists an ankle
or strains his or her back, the
tissues underneath the skin are
injured. Blood and fluids seep out
from the torn blood vessels and
cause swelling to occur at the site of
the injury. Your initial first aid objective
is to keep the injured area cool to
help control internal bleeding and
reduce pain. Cold causes the broken
blood vessels to constrict, limiting
the blood and fluid that seep out.
Cold also reduces muscle spasms
and numbs the nerve endings.
STRAIN SPRAIN
An injury causes damage to blood Applying ice or a cold pack constricts Applying heat dilates blood vessels,
vessels, causing bleeding in the injured vessels, showing bleeding that causes increasing blood flow to the injured
areas. Injury irritates nerve endings, the injury to swell. Cold deadens nerve area. Nerve endings become more
causing pain. endings relieving pain. sensitive.
leg. Strains of the neck and lower back can be par- Loss of circulation or sensation in an extremity
ticularly painful and therefore disabling. (the shoulders to the fingers; the hips to the
Like sprains, strains are often neglected, which toes)
commonly leads to re-injury. Strains sometimes re- Tingling, cold or bluish color below the site of
cur chronically, especially to the muscles of the the injury
neck, lower back and the back of the thigh. Neck Cause of the injury, such as a fall or vehicle
and back problems are two of the leading causes of crash, suggests the injury may be severe
absenteeism from work, accounting annually for
Obvious deformity is often a signal of fracture
billions of dollars in workers’ compensation claims
or dislocation (Fig. 11-14). Abnormal lumps, ridges,
and lost productivity.
depressions or unusual angles in body parts are
Usually only a trained medical professional
types of deformities you may see. Dislocations are
can tell the difference between a sprain, strain,
generally more obvious than other musculoskeletal
fracture or dislocation. However, you do not need
injuries because the joint appears deformed. The dis-
to know what kind of injury it is to give the ap-
placed bone end often causes an abnormal lump,
propriate care. The primary goal of care is to pre-
ridge or depression. Comparing the injured part to
vent further injury and get medical attention for
an uninjured part may help you detect a deformity.
the victim.
Pain, swelling and discoloration of the skin
commonly occur with any significant musculoskele-
tal injury. The injured area may be painful to touch
Checking for Musculoskeletal Injuries and to move. Swelling and discoloration of the skin
surrounding the injury are caused by bleeding from
You identify and care for injuries to the muscu- damaged blood vessels and tissues in the injured
loskeletal system during the check for non- area. Swelling may appear rapidly at the site of in-
life-threatening conditions. Because musculoskele- jury, develop gradually or not appear at all. At first,
tal injuries look alike, you may have difficulty de- the skin may only look red. As blood seeps to the
termining exactly what type of injury has occurred. skin’s surface, the area begins to look bruised.
Do not worry if you cannot identify the exact type
of injury. It is more important to give proper care.
As you check the victim, think about how the body
normally looks and feels. Ask how the injury hap-
pened and if there are any areas that are painful.
Visually inspect the entire body, beginning with the
head. Compare the two sides of the body. Then,
carefully check each body part. Do not ask the vic-
tim to move any areas in which he or she has pain
or discomfort or if you suspect injury to the head,
neck or back. Start with the neck, followed by the
shoulders, the chest and so on. As you conduct
the check, look for clues that may indicate a mus-
culoskeletal injury.
Signals
Always suspect a serious injury when any of the fol-
lowing signals are present:
Deformity
Moderate or severe pain or discomfort,
COSF-Boston
swelling and discoloration

Inability to move or use the affected body part
Bone fragments protruding from a wound
Victim feels bones grating or felt or heard a Figure 11-14 Serious bone or joint injuries may appear
snap or pop at the time of injury deformed.
Care
CHECK for any life-threatening conditions and
give appropriate care. CALL 9-1-1 or the local
emergency number if necessary. Then check for any
non-life-threatening conditions and care for any
other injuries.
CALL 9-1-1 or the local emergency number if—
The injury involves the head, neck or back.
The injury impairs walking or breathing.
You see or suspect a fracture or dislocation.
You see or suspect multiple musculoskeletal
injuries.
Figure 11-15 A victim with a broken bone will usually The general care for musculoskeletal injuries in-
support the injured area in a comfortable position. cludes following RICE: rest, immobilization, cold
and elevation (Fig. 11-17).
A victim’s inability to move or use an injured Rest

part may also indicate a significant injury. The vic- Avoid any movements or activities that cause pain.
tim may tell you he or she is unable to move the Do not move or straighten the injured area. Help the
part or that moving the injured part is simply too victim find the most comfortable position. If you sus-
painful. Often, the muscles of an affected area con- pect injuries to the head, neck or back, it
tract in an attempt to hold the injured part in place. is best not to move the victim if the victim is un-
This muscle contraction helps to reduce pain and responsive and has difficulty breathing. If you are
prevent further injury. Similarly, a victim often sup- alone and have to leave to get help, place the
ports the injured part in the most comfortable posi- victim in a modified H.A.IN.E.S. (High Arm IN
tion (Fig. 11-15). To manage musculoskeletal in- Endangered Spine) recovery position.
juries, avoid any use of an injured body part that
causes pain. Immobilization
A lack of sensation in the affected part can also
If you suspect a serious musculoskeletal injury, you
indicate serious injury or injury in another area.
must immobilize the injured part (keep it from
Fingers or toes, for example, can lose sensation if
moving) before giving additional care, such as ap-
the arm or leg is injured. Also, check the victim’s
plying ice or elevation. The purposes of immobiliz-
skin below the injured site for feeling, warmth and
ing an injury are to—
color (Fig. 11-16). Skin that is cold to the touch or
bluish in color indicates a lack of or reduced cir- Lessen pain.
culation. Prevent further damage to soft tissues.
Reduce the risk of serious bleeding.
Figure 11-17 General care for all musculoskeletal

Figure 11-16 Check for feeling, warmth and color be- injuries is similar. Remember rest, immobilization, cold
low the site of the injury. and elevation.
A B
Figure 11-18 A, To immobilize a bone, the splint must include the joints above
and below the fracture. B, To immobilize a joint, the splint must include the bones
above and below the injured joint.
Reduce the possibility of loss of circulation to or by using a large bag of frozen vegetables, such as
the injured part. peas. Place a layer of gauze or cloth between the
Prevent closed fractures from becoming open source of cold and the skin to prevent damage to
fractures. the skin. Leave an ice or a cold pack on the victim
for no longer than 20 minutes. Remove the ice pack
You can immobilize an injured part by applying
for 20 minutes. Reapply a new ice pack for an ad-
a splint, sling or bandages to keep the injured
ditional 20 minutes. Do not apply a cold pack to an
body part from moving. A splint is a device that
open fracture. This could put pressure on the open
maintains an injured part in place. An effective
fracture site, which could cause discomfort to the
splint must extend above and below the injury site
victim and possibly make the injury worse.
(Fig. 11-18, A and B). For instance, to immobilize a
fractured bone, the splint must include the joints
above and below the fracture. To immobilize a
Elevation
sprained or dislocated joint, the splint must include Elevating the injured area helps slow the flow of
the bones above and below the injured joint. blood, reducing swelling. If possible, elevate the in-
When using a splint, follow these basic principles: jured area above the level of the heart. Do not at-
tempt to elevate a part you suspect is fractured or
Splint only if you have to move the injured dislocated unless it has been immobilized or if it
person and you can do so without causing causes the victim more pain.
more pain and discomfort to the victim.
Splint an injury in the position in which you
find it. Do not move, straighten or bend the in-
jured part.
Splint the injured area and the joints or bones
CONSIDERATIONS FOR
above and below the injury site. TRANSPORTING A VICTIM
Check for proper circulation (feeling, warmth
and color) before and after splinting. Some musculoskeletal injuries are obviously minor
and do not require professional medical care.
Keep the victim as comfortable as possible, and
Others may require you to call 9-1-1 or the
avoid overheating or chilling. Monitor the victim’s
local emergency number. If you discover a life-
ABCs. Chapter 12 discusses splinting in detail.
threatening emergency or think that one might de-
velop, call 9-1-1 or the local emergency number
Cold and wait for help. Always call 9-1-1 or the local
Cold helps reduce swelling and eases pain and dis- emergency number for any injury involving severe
comfort. You can make an ice pack by placing ice in bleeding; suspected injuries to the head, neck or
a plastic bag and wrapping it with a towel or cloth back; and possible serious injuries that may be
difficult to transport properly, such as to the back,

hip or legs, or that you are unable to adequately SUMMARY
immobilize. Remember that fractures of large
bones and severe sprains can bleed severely and Sometimes it is difficult to tell whether an injury is
are likely to cause shock. Some injuries are not se- a fracture, dislocation, sprain or strain. Because you
rious enough for you to call EMS personnel but cannot be sure which type of injury a victim might
still require professional medical care. If you de- have, always care for the injury as if it were serious.
cide to transport the victim yourself, always splint If EMS personnel are on the way, do not move the
the injury before moving the victim. If possible, victim. Control any bleeding. Take steps to mini-
have someone else drive you so that you can con- mize shock and monitor ABCs. If you need to trans-
tinue to give care. port the victim to a medical facility, be sure to im-
mobilize the injury before moving the victim.
1. What types of musculoskeletal injuries could 3. What can Rita’s sister do to make her more
Rita have as a result of her fall? comfortable?
2. What would indicate that Rita’s injury is severe? 4. Should her sister call EMS personnel? Why or
why not?
STUDY QUESTIONS
1. Match each item with the correct definition.
a. Bone g. Skeletal muscles

b. Dislocation h. Splint
c. Fracture i. Sprain
d. Joint j. Strain
e. Ligaments k. Tendon
f. Muscle
_____ Device used to keep body parts from moving.
_____ Displacement of a bone from its normal position at a joint.
_____ Tissue that contracts and relaxes to create movement.
_____ Broken bone.
_____ Dense, hard tissue that forms the skeleton.
_____ Injury that stretches and tears ligaments and other soft tissues at joints.
_____ Fibrous band attaching muscle to bone.
_____ Structure formed where two or more bones meet.
_____ Injury that stretches and tears muscles and tendons.
_____ Muscles that attach to bones.
_____ Fibrous bands holding bones together at joints.
2. List three common signals of musculoskeletal injuries.
3. List four principles of splinting.
4. Which should you do when caring for an injured joint?
a. Have the victim immediately move the injured area.

b. Straighten the injured area before splinting.
c. Apply cold to the injured area.
d. Keep the injured area below the level of the heart.
5. Signals of a serious musculoskeletal injury include—
a. Feeling, warmth and color below the site of the injury.

b. Deformity or bone fragments protruding from a wound.
c. The victim was hit in the thigh by a softball.
d. Ability to move the injured area.
6. You find a person lying quietly on the ground. Her right leg is twisted at an unusual angle and you can see
protruding bones and blood. Which do you do first?
a. Straighten the leg.

b. Check for life-threatening conditions.
c. Use direct pressure to stop the bleeding.
d. Look for material to use to immobilize the injured area.
7. Why should you immobilize a musculoskeletal injury?
a. To prevent further injury to soft tissues

b. To eliminate all discomfort or pain
c. To control serious bleeding
d. To help the victim to heal
8. Which step would you take before and after splinting an injury?
a. Tell the victim to move the injured area.

b. Check for feeling, warmth and color.
c. Slide the splint down to extend below the injured area.
d. Elevate the legs 8 inches.

Chapter 12 They were just getting into their regular morning workout. A recent
rainstorm must have made the path slippery. Mario didn’t see Sam
fall, but he certainly heard it. Sam let out a yell. Mario turned
around and jogged back to Sam. “It’s my knee,” Sam moaned. “I
don’t think I can stand up.” His face was twisted with pain. Mario
looked at the knee. It looked swollen.
Injuries
to the
Extremities
Objectives
■ Describe how to care for injuries to the shoulder, upper arm and
elbow.
■ Describe how to care for injuries to the forearm, wrist and hand.
■ List three specific signals of a fractured thigh bone.
■ Describe how to care for injuries to the thigh, lower leg and knee.
■ Describe how to care for injuries to the ankle and foot.
should be able to demonstrate—
■ How to effectively immobilize an injured extremity using an
anatomic, soft or rigid splint.
■ How to effectively immobilize an upper extremity injury using a
sling and a binder.
Introduction
Injuries to an extremity—an arm or leg—
are quite common. They can range from a
simple bruise to a dangerous or severely
painful injury, such as a fracture of the femur
(thigh bone). The prompt care you give can
help prevent further pain, damage and a life-
long disability.
IMMOBILIZING EXTREMITY INJURIES Figure 12-1 Soft splints include folded blankets, towels,
pillows and a sling or cravat.
If you suspect a serious musculoskeletal injury, you

must immobilize the injured part before giving ad-
ditional care, such as applying ice or elevating the
injured extremity. To immobilize an extremity in-
jury, you can use a splint. There are three types of
splints—soft, rigid and anatomic. Soft splints in-
clude folded blankets, towels, pillows and a sling or
folded triangular bandages (cravat) (Fig. 12-1).
Rigid splints include boards, metal strips and folded
magazines or newspapers (Fig. 12-2). Anatomic
splints use the body as a splint. For example, an
arm can be splinted to the chest. An injured leg can
be splinted to the uninjured leg (Fig. 12-3). Re-
member, splint only if you must move the victim
and you can do so without causing more pain or
discomfort.
Splints are commercially made or can be impro-
vised from materials at hand. Commercial splints Figure 12-2 Rigid splints include boards, metal strips
include padded board splints, air splints and spe- and folded magazines or newspapers.
K E Y T E R M S
Arm: The part of the upper extremity from the Lower leg: The part of the lower extremity from
shoulder to the hand. the knee to the ankle.
Extremity: The shoulder to the fingers; the hip to Thigh: The part of the lower extremity from the
the toes. pelvis to the knee.
Forearm: The part of the upper extremity from Upper arm: The part of the upper extremity from
the elbow to the wrist. the shoulder to the elbow.
Leg: The part of the lower extremity from the Upper extremity: The parts of the body from the
pelvis to the ankle. shoulder to the fingers.
Lower extremity: The parts of the body from the
hip to the toes.
CHAPTER 12 Injuries to the Extremities 227
B
Figure 12-3 An injured leg can be splinted to the
uninjured leg.
Figure 12-4 Commercial splints.
cially designed flexible splints (Fig. 12-4). As a citi-

zen responder, you are more likely to have access to Figure 12-5 A, Support the arm above and below the
triangular bandages to make cravats or other mate- injury site. The victim can help you. B, Pad a rigid splint
to conform to the injured body part. C, Secure the splint
rials you can use to make a soft or anatomic splint.
in place.
To splint an injured body part—
1. Support the injured part in the position in

which you find it. If possible, have the victim 4. Apply the splint to immobilize the joints or
or a bystander help you (Fig. 12-5, A). bones above and below an injured area. If
2. Cover any open wounds with a dressing and you are using a rigid splint, pad the splint
bandage to help control bleeding and prevent so that it is contoured to the injured part
infection. Use direct pressure unless the (Fig. 12-5, B). This padding will help prevent
bleeding is located directly over the sus- further injury.
pected fracture. Wear disposable gloves or 5. Secure the splint in place with cravats,
use a protective barrier. roller bandages or other wide strips of cloth
3. Check the area below the injury site for feel- (Fig. 12-5, C). Avoid securing the splint di-
ing, warmth and color. rectly over an open wound or the injury.
Clavicle Scapula
(collarbone) (shoulder
blade)
Humerus
(upper
arm bone)
Radius
Ulna
(forearm
bones)
Carpals
Metacarpals
(hand)
Phalanges
(fingers)
Median nerve
Brachial artery
Radial nerve
Ulnar nerve
Radial artery
Figure 12-6 The upper extremities include the bones of the arms and hands,
nerves and blood vessels.
6. Recheck below the injury site for feeling, or cloth between the source of cold and the skin.
warmth and color. Loosen the splint if the Help the victim rest in the most comfortable posi-
victim complains of numbness or if the area tion and reassure him or her. Prevent him or her
below the injury site is discolored or becomes from becoming chilled or overheated. Determine
cold. what additional care is needed. Continue to moni-
7. Elevate the splinted part if doing so does not tor the victim’s level of consciousness, breathing,
cause the victim discomfort. skin color and temperature. Be alert for any sig-
nals, such as changes in breathing rate, skin color
After the injury has been immobilized, apply or level of consciousness, that may indicate the vic-
ice or a cold pack to the injured area. This will help tim’s condition is worsening. Take steps to mini-
minimize pain and swelling. Be sure to place gauze mize shock.
SIGNALS OF SERIOUS EXTREMITY

INJURIES
The extremities consist of bones, soft tissues, blood
vessels and nerves. They are subject to various kinds
of injury. Injury can affect the soft tissues, resulting
in open or closed wounds. Injury can also affect the
musculoskeletal system, resulting in sprains, strains,
fractures or dislocations. Signals of a serious ex-
tremity injury include—
Pain or tenderness.
Swelling.
Discoloration.
Deformity of the limb.
Inability to move or use the limb.
Severe external bleeding.
Loss of sensation, feeling or tingling.
A limb that is cold to the touch.
UPPER EXTREMITY INJURIES

The term upper extremity, or arm, describes the
parts of the body from the shoulders to the fingers.
The bones of the upper extremities include the col-
larbone (clavicle), shoulder blade (scapula), bone
from the shoulder to the elbow (humerus), forearm
(radius and ulna), wrist (carpals), hand (meta-
carpals) and fingers (phalanges). Figure 12-6 shows
the major structures of the upper extremities. Figure 12-7 A clavicle fracture is commonly caused by
The upper extremities are the most commonly a fall.
injured areas of the body. The most frequent cause
of injury is falling on the hand of an outstretched
arm. Because a falling person instinctively tries
to break his or her fall by extending the arms and either end of the bone as a result of a fall (Fig. 12-7).
hands, these areas receive the force of the body’s An injury commonly occurs when the impact from a
weight, which can cause a serious injury. fall forces the outer end of the clavicle to separate
from the joint where it touches the scapula. The
victim usually feels pain in the shoulder area, which
Shoulder Injuries may radiate down the upper extremity. A person
with a clavicle injury usually attempts to ease
The shoulder consists of three bones that meet the pain by holding the arm against the chest
to form the shoulder joint. These bones are the (Fig. 12-8). The clavicle lies directly over major
clavicle, scapula and humerus. The most common blood vessels and nerves to the upper extremity. It is
shoulder injuries are sprains. However, injuries to especially important to immobilize a fractured clav-
the shoulder may also involve a fracture or disloca- icle promptly to prevent injury to these structures.
tion of one or more of these bones. Scapula fractures are not common. A fracture of
The most frequently injured bone of the shoul- the scapula typically results from a violent force,
der is the clavicle. Clavicle injuries are more com- such as a fall from a height or being hit by a car. Be-
mon in children than adults. Typically, the clavicle is cause it takes great force to fracture the scapula,
fractured or separates from its normal position at you should look for additional injuries to the head,
Figure 12-8 A victim with an injured clavicle will usually

support the arm against the chest
neck, back or chest cavity. The most significant sig-

nals of a fractured scapula are extreme pain and the
inability to move the shoulder. If the chest cavity is
injured, the victim may have trouble breathing.
A dislocation of the shoulder joint is another
common type of shoulder injury. Like fractures, dis-
locations often result from falls or direct blows
when the arm is in the throwing position. Such dis-
locations happen frequently in sports, such as foot-
ball and rugby, when a player attempts to break a
fall with an outstretched arm or gets tackled with
the arm positioned away from the body (Fig. 12-9).
This movement can result in ligaments tearing,
which displaces bones. Shoulder dislocations are
painful and can often be identified by deformity. As
with other shoulder injuries, the victim often tries to Figure 12-9 Dislocations are usually the result of a fall.
minimize the pain by holding the upper extremity in
the most comfortable position.
support for the injured area. Splint the upper ex-
tremity in place (Fig. 12-10). Remember to check
Care for Shoulder Injuries for feeling, warmth and color before and after ap-
To care for shoulder injuries, support the injured plying the splint. Place the upper extremity in a
part. If an injured person is holding the forearm se- sling and bind it to the chest with cravats to further
curely against the chest, do not change the position. stabilize the injury. Apply ice or cold pack. Take
Holding the arm against the chest is an effective steps to minimize shock.
method of immobilization. Allow the person to
continue to support the upper extremity in the po-
sition in which he or she is holding it, usually the Upper Arm Injuries
most comfortable position. Control any external
bleeding with direct pressure. Use direct pressure The upper arm is the area that extends from the
unless the bleeding is located directly over the sus- shoulder to the elbow. The bone of the upper arm is
pected fracture. Always wear disposable gloves or the humerus. The humerus is the largest bone in the
use another protective barrier. If the person is hold- arm.
ing the upper extremity away from the body, use a The humerus can be fractured at any point, al-
pillow, rolled blanket or similar object to fill the gap though it is usually fractured at the upper end near
between the upper extremity and chest to provide the shoulder or in the middle of the bone. The up-
Figure 12-10 Splint the arm against the chest in the position the victim is holding it,
using a sling, cravat, small pillow or a rolled blanket when necessary.
per end of the humerus often fractures in the elderly tremity in the position in which he or she is holding
and in young children as a result of a fall. Breaks in it. Control any external bleeding. Place the upper
the middle of the bone mostly occur in young extremity in a sling and bind it to the chest with cra-
adults. When the humerus is fractured, the blood vats to further stabilize the injury. You can also use
vessels and nerves supplying the entire upper ex- a rigid splint, if one is available, to provide support
tremity may be damaged. Most humerus fractures to the injured area (Fig. 12-11). Remember to check
are very painful and the victim will most likely not for feeling, warmth and color before and after ap-
be able to use the injured arm. Do not permit the plying the splint. Apply ice or a cold pack. Take
victim to use the arm. A humerus fracture can also steps to minimize shock.
cause considerable deformity.
Care for Upper Arm Injuries Elbow Injuries

Care for upper arm injuries in the same way as for The elbow is a joint formed by the humerus and the
shoulder injuries. Support the injured area. Allow two bones of the forearm, the radius and the ulna.
the person to continue to support the upper ex- Injuries to the elbow can cause permanent disabil-
splint is not available, secure the arm to the body

using two cravats (Fig. 12-12, C). Always be sure
the knots are tied against the splint and not di-
rectly on the arm. Remember to check for feeling,
warmth and color before and after applying the
splint. Apply ice or a cold pack. Take steps to min-
imize shock.
Forearm, Wrist and Hand Injuries

The forearm is the area between the elbow and the
wrist. The wrist is a joint formed by the hand and
forearm. Injuries to the wrist may involve one or
both of the two forearm bones, the radius and ulna.
The hand consists of many small bones—the
carpals, metacarpals and phalanges. Serious injuries
to the wrists and hands can significantly impact a
person’s daily activities.
If a person falls on an outstretched upper ex-
Figure 12-11 A short, padded splint can provide addi- tremity, both forearm bones may break. When both
tional support for an injury to the upper arm. forearm bones fracture, the arm may look s-shaped
(Fig. 12-13). Because the radial artery and nerve are
close to these bones, a fracture may cause severe
bleeding or a loss of movement in the wrist and
ity, because all the nerves and blood vessels to the hand. The wrist is a common site of sprains and
forearm and hand go through the elbow. Therefore, fractures. It is often difficult to tell the extent of the
treat elbow injuries seriously. injury.
Like other joints, the elbow can be sprained, Because the hands are used in so many daily
fractured or dislocated. Injuries to a joint like the activities, they are susceptible to injury. Most in-
elbow can be made worse by movement because juries to the hands and fingers involve minor soft
movement can easily damage the nerves and blood tissue damage. However, a serious injury may
vessels located in the elbow. An injured elbow may damage nerves, blood vessels and bones. Home,
be in a bent or straight position. recreational and industrial mishaps often produce
lacerations, avulsions, burns and fractures of the
hands.
Care for Elbow Injuries
To give care for elbow injuries, support the injured
area. Allow the person to continue to support
Care for Forearm, Wrist and Hand Injuries
the upper extremity in the position in which he or To give care for forearm, wrist or hand injuries, sup-
she is holding it. Control any external bleeding. port the injured area and control any external bleed-
Splint the arm from the shoulder to the wrist in ing. You can support an injured forearm or wrist by
the best way possible in the position you find it. placing a soft or rigid splint underneath the forearm,
The simplest way is to place the arm in a sling and making sure that it extends beyond both the hand
secure it to the chest. If placing the arm in a sling and elbow. If you are using a rigid splint, pad the
is not possible, immobilize the elbow with a rigid splint and place a roll of gauze or a similar object in
splint and two cravats. If the elbow is bent, apply the palm to keep the palm and fingers in a normal
the splint diagonally across the underside of the position. Check the fingers for feeling, warmth and
arm (Fig. 12-12, A). The splint should extend sev- color before and after splinting. Secure the splint
eral inches beyond the wrist and shoulder. If the with cravats or a roller bandage (Fig. 12-14, A). Put
elbow is straight, apply the splint along the arm. the arm in a sling and secure it to the chest with cra-
Secure the splint at the wrist and upper arm with vats (Fig. 12-14, B). Apply ice or a cold pack and el-
cravats or roller bandages (Fig. 12-12, B). If a evate. Take steps to minimize shock.
Figure 12-12 A, If the elbow is bent, apply the splint diagonally across the under-
side of the arm. B, If the arm is straight, apply the splint along the underside of the
arm. C, If a splint is not available, secure the arm to the body using two cravats.
Figure 12-13 Fractures of both forearm bones often have a characteristic

s-shaped deformity.
A B
Figure 12-14 A, If the forearm is fractured, place a splint under the forearm and
secure it with two cravats. B, Put the arm in a sling and secure it to the chest with
cravats.
Carpal Tunnel Syndrome

Elaine W. was a 14-year-old violin student when she tive hand motion for long periods of time without
first noticed problems with her hands. After long rest, such as long typing sessions, assembly-line
practice sessions, she felt a strange tingling sensa- tasks or, in Elaine’s case, practicing the violin, the
tion in the fingers of her left hand. Soon, she was nerves can become irritated, resulting in pain and
experiencing pain so severe that it woke her up at numbness. Carpal tunnel syndrome is now the most
night. Then, she states, “I woke up one November commonly reported on-the-job injury. If untreated, it
morning and I couldn’t move my left hand at all.” can cause permanent disability.
Frightened, she consulted her physician, who diag- The first signals of carpal tunnel syndrome include
nosed her with carpal tunnel syndrome. When rest hand and wrist pain and numbness. People with the
and splinting did not alleviate her symptoms, Elaine syndrome describe the pain as an “electric” sensa-
had surgery to correct the problem. Although the tion that may radiate to the arm, shoulder and back.
surgery eliminated the pain and tingling, she still— In time, the sufferer may lose grip strength in the
some years later—has trouble holding things. hand, making even everyday tasks awkward or im-
“Wet dishes are the worst,” she says. And at possible.
work, she uses a pencil to tap out words on her Although carpal tunnel syndrome is not a new
computer. condition (it was first described in 1854), it has only
Elaine is just one of many Americans who suffer recently become a serious occupational hazard. One
from carpal tunnel syndrome, a painful and debilitat- U.S. legislator describes carpal tunnel syndrome as
ing irritation of the nerves and tendons in the wrist. “the industrial disease of the Information Age.” If
The area for which the syndrome is named—the employers do not do something about it, some ex-
carpal tunnel—is the passageway formed by ten- perts foresee that half of every dollar earned by
dons and bones through which the nerves that sup- companies may go to treat carpal tunnel syndrome
ply the hand travel. When a person performs repeti- and its related disorders.
For a hand or finger injury, place a bulky dress-

ing in the palm of the victim’s hand and wrap the
hand with a roller bandage (Fig. 12-15). For a pos-
sible fractured or dislocated finger, you can make a
rigid splint by taping the injured area to a small ob-
ject, such as an ice cream stick or tongue depressor
(Fig. 12-16). You can also tape the injured finger to
the finger next to it. Do not attempt to put the
bones back into place if you suspect a finger or
thumb dislocation. Apply ice or a cold pack and el-
evate injuries to the forearm, wrist and hand. Take
steps to minimize shock.
Figure 12-15 A bulky dressing is an effective splint for

a hand or finger injury.
Many of today’s occupations involve constant clerks take some of the stress off wrists and hands.
repetitive motions of the hand and wrist done at In some companies, typists are required to take rest
faster and faster speeds. Technical innovations— breaks.
from grocery store scanners to computer These guidelines make sense for those who find
keyboards—also contribute to the increase in themselves working at a keyboard for long hours or
carpal tunnel syndrome. who perform the same task over and over. Identify
What can be done to treat carpal tunnel syn- early signals and take steps to prevent wrist strain.
drome? Individuals with the syndrome are treated Take frequent breaks, and for the marathon typist,
with physical therapy and elaborate wrist splints that make sure your chair is comfortable and that you
immobilize the affected area. Sometimes surgery is can reach the keyboard without straining. Your wrists
needed to correct the nerve damage. These treat- will thank you.
ments are often not effective
SOURCES
in alleviating all the signals, CTS: Relief at hand, The University of Califor-
and sufferers must learn to nia Berkeley Wellness Letter 11(4): 7, 1995.
Centers for Disease Control, “Carpal Tunnel
live with their disability. Syndrome” www.cdc.gov/niosh/ctsfs.html.
Accessed 10/15/04.
Because of the surge in Gabor A: On-the-job-straining: repetitive mo-
carpal tunnel syndrome tion is the Information Age’s hottest hazard,
US News and World Report 108(20): 51-53,
cases, the Occupational 1990.
Safety and Health Adminis- Katz RT: Carpal tunnel syndrome: a practical
review, American Family Physician 49(6):
tration (OSHA) has drafted 1371-1382, 1994.
Treating for carpal tunnel syndrome, Lancet
guidelines for certain occu- 338 (8765): 479-481, 1991.
pations, such as meatpack-
ing, designed to prevent the
onset of the syndrome. Spe-
cially designed desks, chairs
and other office equipment
for typists and data entry
so strong, they pull the ends of the broken bone to-

gether, causing them to overlap. This pulling may
cause the injured leg to be noticeably shorter than
the other leg. The injured leg may also be turned
outward (Fig. 12-19). Other signals of a fractured
femur include severe pain and inability to move the
lower extremity. Do not attempt to splint a sus-
pected femur fracture (this requires special training
and equipment). A fractured femur is a serious life-
threatening injury that requires immediate medical
attention.
Figure 12-16 An ice cream stick can be used to splint

Care for Thigh Injuries
a finger injury. Initial care for a victim with a serious injury to the
thigh is to support the injured area and stop any ex-
ternal bleeding. Call 9-1-1 or the local emergency
number immediately. EMS personnel are much bet-
LOWER EXTREMITY INJURIES ter prepared to care for and transport a victim with
a serious lower extremity injury. While waiting for
Injuries to the leg, or lower extremity—the part EMS personnel to arrive, immobilize the injured
of the body from the hip (pelvis) to the toes— area and help the victim rest in the most comfort-
can involve both soft tissue and musculoskeletal able position. If the victim’s lower extremity is sup-
damage. The lower extremity includes the pelvic ported by the ground, do not move it. Rather, use
bones, thigh bone (femur), kneecap (patella), two rolled towels or blankets to support the leg in the
bones in the lower leg (tibia and fibula), bones of position in which you found it. A fractured femur
the ankle (tarsals), foot (metatarsals) and toes (pha- can result in serious internal bleeding. The likeli-
langes). Figure 12-17 shows the major structures hood of shock is considerable. Therefore, take steps
of the lower extremities. to minimize shock. Keep the person lying down and
try to keep him or her calm. Keep the person from
becoming chilled or overheated, and make sure to
Thigh Injuries call 9-1-1 or the local emergency number. Monitor
breathing. Notice how the victim’s skin looks and
The thigh is the lower extremity from the pelvis to feels, and watch for changes in the victim’s level of
the knee. The thigh contains the femur. The femur consciousness. See Chapter 9 for more detailed in-
is the largest bone in the body. The femoral arteries formation on shock.
are the major supplier of blood to the lower ex-
tremities. Because of the size and strength of the fe-
mur, a significant amount of force is required to Lower Leg Injuries
cause a fracture. When the femur is fractured, the
blood vessels and nerves may be damaged. If a The lower leg is the area between the knee and the
femoral artery is damaged, the blood loss can be life ankle. The tibia and fibula are the two bones in the
threatening. lower leg. A fracture in the lower leg may involve
Thigh injuries range from bruises and torn the tibia, the fibula or both bones. Sometimes both
muscles to severe injuries, such as fractures or dis- are fractured simultaneously. However, a blow to
locations. Most femur fractures involve the upper the outside of the lower leg can cause an isolated
end of the bone where the femur meets the pelvis fracture of the smaller bone (fibula). Because these
at the hip joint (Fig. 12-18). Although the hip joint two bones lie just beneath the skin, open fractures
is not involved, such injuries are often called hip are common (Fig. 12-20). Lower leg fractures may
fractures. cause a severe deformity in which the lower leg is
A fracture of the femur usually produces a char- bent at an unusual angle (angulated), as well as pain
acteristic deformity. Because the thigh muscles are and inability to move the leg.
Femur
(thigh bone)
Tibia
Fibula
Patella (lower
(kneecap) leg bones)
Tarsals
(ankle bones)
Metatarsals
(foot bones)
Phalanges
(toes)
Care for Lower Leg Injuries

Support the injured area and control any external
Femoral artery bleeding. Call 9-1-1 or the local emergency number
immediately. While waiting for EMS personnel to
arrive, immobilize the injured area and help the vic-
tim rest in the most comfortable position. Do not
Sciatic nerve forget that the ground acts as an adequate splint. If
the victim’s lower extremity is supported by the
Pelvis
Femur
Figure 12-17 The lower extremities. Figure 12-18 The upper end of the femur meets the
pelvis at the hip joint.
Figure 12-19 A fractured femur often produces a characteristic deformity. The in-
jured leg is shorter than the uninjured leg and may be turned outward.
Figure 12-20 A fracture of the lower leg can be an Figure 12-21 To splint an injured leg, secure the
open fracture. injured leg to the uninjured leg with cravats. A pillow or
rolled blanket can be placed between the legs.
ground, do not move it. Rather, use rolled towels or splint. This device reduces the deformity of the
blankets to support the leg in the position in which lower extremity by applying traction to overcome
you found it. In other situations, such as when you the pull of the thigh muscles that are causing the
must transport the person, you can secure the in- bone ends to overlap. Apply ice or a cold pack.
jured lower extremity to the uninjured lower ex- Take steps to minimize shock.
tremity with several wide cravats placed above and
below the site of the injury. If one is available, place
a pillow or rolled blanket between the lower ex- Knee Injuries
tremities and bind them together above and below
the site of the injury (Fig. 12-21). Remember to The knee joint is highly vulnerable to injury. The
check for feeling, warmth and color before and af- knee comprises the upper ends of the tibia and
ter applying the splint. Do not be surprised if EMS fibula, the lower end of the femur and the patella.
personnel later remove the splint and apply a more The patella is a free-floating bone that moves on the
rigid splint or a mechanical device called a traction lower front surface of the thigh bone.
Figure 12-22 Support a knee injury in the bent posi-

tion if the victim cannot straighten the knee.
Sprains, fractures and dislocations of the knee

are common in athletic activities that involve quick
movements or exert unusual force on the knee.
Deep lacerations in the area of the knee can cause
severe joint infections. The patella is very vulnera-
ble to bruises and lacerations, as well as disloca-
tions. Violent forces to the front of the knee, such as
those caused by hitting the dashboard of a motor
vehicle or falling and landing on bent knees, can Figure 12-23 In a jump or fall from a height, the im-
pact can be transmitted up the legs, causing injuries to
fracture the kneecap.
the thigh, pelvis, head, neck or back.
Care for Knee Injuries

To care for an injured knee, support the injured
area and control any external bleeding. If the knee forces. Injuries range from minor sprains with little
is bent and cannot be straightened without pain, swelling and pain to fractures and dislocations.
you can support it on a pillow or folded blanket in Many common ankle and foot injuries are
the bent position (Fig. 12-22). If the knee is on the caused by severe twisting forces that occur when the
ground, the ground will provide adequate support. foot turns in or out at the ankle as a person steps
Call 9-1-1 or the local emergency number to have down from a height, such as a curb or step. Frac-
the victim transported to a medical facility for ex- tures of the feet and ankles can occur from force-
amination. Help the victim to rest in the most com- fully landing on the heel. The force of the impact
fortable position until EMS personnel arrive. If you may also be transmitted up the lower extremities.
decide to splint the injured area and the knee is This transmitted force can result in an injury else-
straight, you can secure it to the uninjured leg as where in the body (Fig. 12-23). Always suspect that
you might do for an injury of the thigh or lower leg. a victim who has fallen or jumped from a height
Check feeling, warmth and color before and after may also have additional injuries to the thigh,
splinting. Apply ice or a cold pack. Take steps to pelvis, head, neck or back. Foot injuries may also
minimize shock. involve the toes. Although toe injuries are painful,
they are rarely serious.
Ankle and Foot Injuries Care for Foot Injuries

The foot consists of many small bones—the tarsals, Care for ankle and foot injuries by supporting the
metatarsals and phalanges. The ankle is a joint injured area and controlling any external bleeding.
formed by the foot and the lower leg. Ankle and Immobilize the ankle and foot by using a soft splint,
foot injuries are commonly caused by twisting such as a pillow or rolled blanket. Check the toes
that any victim who has fallen or jumped from a

height may also have injuries elsewhere.
As with other musculoskeletal injuries, you can-
not always distinguish between minor and severe
injuries. You should initially care for all lower leg
injuries as if they are serious. If the victim cannot
bear weight on the injured area or the joint looks
swollen and too painful to move, call 9-1-1 or the
local emergency number.
SUMMARY
Figure 12-24 An injured ankle can be immobilized with a You can care for musculoskeletal and soft tissue
pillow or rolled blanket secured with two or three cravats. injuries to the extremities by giving care that fo-
cuses on minimizing pain, shock and further dam-
age to the injured area. Immobilize the injured
for feeling, warmth and color before and after area, apply ice or a cold pack and take steps to
splinting. Wrap the injured area with the soft splint, minimize shock. Control any external bleeding.
and secure it with two or three cravats (Fig. 12-24). Reassure the victim. Care for any life-threatening
Then elevate the injured ankle or foot to help re- conditions and call 9-1-1 or the local emergency
duce the swelling. Apply ice or a cold pack. Suspect number if necessary.
1. Could Sam have sustained a serious injury? 2. What steps should Mario take to help Sam?
Why or why not?
STUDY QUESTIONS
a. Upper arm c. Thigh

b. Forearm d. Lower leg
_____ The part of the lower extremity from the pelvis to the knee.
_____ The part of the upper extremity from the elbow to the wrist.
_____ The part of the lower extremity from the knee to the ankle.
_____ The part of the upper extremity from the shoulder to the elbow.
2. Identify the most frequent cause of upper extremity injuries.
Base your answers for questions 3 through 5 on the scenario below.
A person attempting to leap a 4-foot gate catches one foot on the gate and falls hard on the other side. He
appears to be unable to get up. He says his left leg and arm both hurt. When you check him, you find that he is
unable to move the leg, which is beginning to swell. The left arm looks deformed at the shoulder, and he has no
sensation in the fingers of that arm. The arm is beginning to look bruised and is painful. He says he feels a little
nauseated and dizzy, and he has a scrape on his hand.
3. What type of injury does the victim have?
4. Identify the signals that support your answer.
5. Describe the steps you would take to help the victim.
6. List two specific signals of a fractured femur.
7. List three types of splints used to immobilize an extremity.
In questions 8 and 9, circle the letter of the correct answer.
8. A man who has fallen down a steep flight of stairs is clutching his right arm to his chest. He says his shoulder
hurts, and he cannot move his arm. How should you care for him?
a. Give him some ice and tell him to go home.

b. Immobilize the arm in the position you found it.
c. Tell him to move the arm back to its normal position.
d. Check the stairs to see what caused him to trip.
9. A child has fallen from a bicycle onto the pavement and landed on her elbow. The elbow is bent and the girl
says she cannot move it. What do you do after calling 9-1-1 or the local emergency number?
a. Straighten the elbow and splint it.

b. Drive her to the hospital.
c. Immobilize the elbow in the bent position.
d. Ask her to continue to try to move the elbow.
10. An elderly woman has tripped and fallen over some gardening tools. She is lying on the ground, conscious
and breathing. Her lower leg is bleeding profusely from a gash and seems to be bent at an odd angle. List the
steps of care you should give.

SKILL SHEET Applying An Anatomic Splint
Check the scene and the victim. Call 9-1-1 or the local emergency number, if necessary.
Remember: Always obtain consent and follow standard precautions to prevent disease
transmission. Use protective equipment (disposable gloves and breathing barriers).
If you decide to use an anatomic splint to immobilize the injury…
Step 1
Support the injured area.
• Support the injured area above and below the
injury site.
• Let the ground support the injured area whenever
possible, or have the victim or bystander help you.
Step 2
Check for feeling, warmth and color.
• Check for feeling, warmth and color below the
injury.
• If you are not able to check warmth and color
because a sock or shoe is in place, check for
feeling (sensation).
Step 3
Place several folded triangular bandages above and
below the injured area.
• Thread several triangular bandages underneath
the legs at the knee or ankle.
• Position triangular bandages by sliding them
underneath the legs.
• Do not position a bandage at the injury site.
Step 4
Place the uninjured area next to the injured area.
• Carefully move the uninjured leg next to
the injured leg.
Step 5
Tie triangular bandages securely.
• Tie ends of each triangular bandage together
with knots. Check to see that triangular bandages
are snug but not too tight.
• If more than one finger fits under the bandages,
tighten bandages.
• The splint should be snug but not so tight that
blood flow is impaired.
Step 6
Recheck for feeling, warmth and color.
• If the area below the injury is bluish or cool,
loosen the splint.
• Reassure the victim and, if necessary, take
SKILL SHEET Applying a Soft Splint
If you decide to use a soft splint to immobilize the injury…
Step 1
injury site.
• Let the ground support the injured area whenever
possible, or have the victim or a bystander help
you.
Step 2
• Check for feeling, warmth, and color below the
injury.
Step 3
Place several folded triangular bandages above and
• Slide two folded triangular bandages underneath
the injured area at the ankle and lower calf and
position them above and below the injured area.
Step 4
Gently wrap a soft object (a folded blanket or pillow)
around the injured area.
Step 5
Tie triangular bandages securely with knots.
• Tie bandages around the foot, from the heel to
the front of the ankle.
• Check to see that triangular bandages are snug
but not too tight.
tighten bandages.
• The splint should fit snugly but not so tightly that
Step 6
• If area below the injury is bluish or cool, loosen
the splint.
• Reassure the victim and, if necessary, take steps
to minimize shock.
SKILL SHEET Applying a Rigid Splint
If you decide to use a rigid splint to immobilize an injury…
Step 1
injury site.
• Let the victim support the injured area or have a
bystander help you.
Step 2
site of the injury.
Step 3
Place the rigid splint under the injured area and the
joints above and below the injured area.
• Have the victim or a bystander hold the splint
in place.
• Pad the splint to keep the injured area in a
natural position.
Step 4
Tie several folded triangular bandages above and
• Check to see that triangular bandages are
snug but not too tight.
tighten the bandages.
• The splint should fit snugly but not so tightly that
Step 5
loosen the splint.
• Reassure the victim and, if necessary, take steps
to minimize shock.
If a rigid splint is used on a forearm, you must

also immobilize the elbow. Bind the arm to
the chest using folded triangular bandages,
or apply a sling.
SKILL SHEET Applying a Sling and Binder
If you decide to use a sling and binder to immobilize the injury…
Step 1
injury site.
• Let the victim support the injured area or have
a bystander help you.
Step 2
site of the injury.
Step 3
Place a triangular bandage under the injured arm,
across the chest and over the uninjured shoulder to
form a sling.
• Position the point of the triangular bandage at
the elbow.
• Bring the other end across the chest and over
the opposite shoulder.
Step 4
Tie the ends of the sling.
• Tie the ends of the triangular bandage at the
side of the neck opposite the injury.
• Place a gauze pad under the knot to make the
knot more comfortable.
Step 5
Bind the injured area to the chest with a folded
triangular bandage.
• Bind the injured arm to the chest using a folded
triangular bandage.
• Tie the ends of the binder on the side opposite
the injured area.
• Place a gauze pad under the knot to make the
knot more comfortable.
• The splint should fit snugly but not so tightly
that blood flow is impaired.
Step 6
loosen the splint.
• Reassure the victim and, if necessary, take
Chapter 13
It is spring break at the beach. High school and college students are
having fun in the sun. The weather is great, the water refreshing. The day
is perfect for a game of touch football on the beach. Players lunge into the
surf to catch passes and tag runners. As the game is about to end, the
quarterback throws a long pass. The receiver has the chance to score the
winning touchdown, or the defender can deflect the pass to guarantee
victory. Both players run into the surf and dive headfirst at the ball. As
they hit the water, a wave crashes over them. Both players strike their
heads on the sandy bottom and are pulled from the surf by their friends.
One player stands up and walks out of the water. The other cannot move.
Injuries to
the Head,
Neck and
Back
Objectives
■ Identify the most common causes of head, neck and back
injuries.
■ List nine situations that might indicate serious head, neck and
back injuries.
■ List the signals of head, neck and back injuries.
■ Describe how to effectively minimize movement of the victim’s
head, neck and back.
■ Know the situations in which you would hold the victim’s head in
the position found.
■ Describe how to care for specific injuries to the head, face, neck
and lower back.
Introduction RECOGNIZING SERIOUS HEAD, NECK

AND BACK INJURIES
Each year, nearly 11,000 people in the United
Injuries to the head, neck or back often damage
States are hospitalized with an injury to the both bone and soft tissue, including brain tissue and
head or to the most vulnerable part of the the spinal cord. It is usually difficult to determine
neck and back region—the spine. Most of the extent of damage in head, neck and back in-
these victims are males between the ages of juries, so treat all such injuries as serious.
15 and 30.
Motor vehicle collisions account for nearly
half of all head, neck and back injuries. Other
The Head
causes include falls, injuries from sports and The head contains the brain, special sense organs,
recreational activities and violent acts, such as the mouth and nose and related structures. It is
assault. Figure 13-1 shows the most common formed by the skull and the face. The broad, flat
causes of spinal injuries. bones of the skull are fused together to form a hol-
Today, hundreds of thousands of low shell. This hollow shell, the cranial cavity, con-
tains the brain. The face is on the front of the skull.
permanently disabled victims of head, neck or
The bones of the face include the bones of the
back injury live in the United States. These cheek, forehead, nose and jaw.
survivors have a wide range of physical and
mental impairments, including paralysis,
speech and memory problems and behavioral
The Brain
disorders. Fortunately, prompt care can often Injuries to the head can affect the brain. The brain
prevent head, neck and back injuries from can be bruised or lacerated when extreme force
causes it to move in the skull, stretching and tear-
resulting in death or disability. In this chapter, ing tissue or bumping against the skull. Extreme
you will learn how to recognize when a head, force, or trauma, can fracture the thick bones of
neck or back injury may be serious. You will the skull. The major concern with skull fractures
also learn how to give appropriate care to is damage to the brain. Blood from a ruptured
minimize the effects of these injuries. vessel in the brain can accumulate within the skull
(Fig. 13-2). Because the skull contains very little
free space, bleeding can build up pressure that can
further damage brain tissue.
K E Y T E R M S
Concussion: An injury to the brain caused by a vi- Spine: A strong, flexible column of vertebrae, ex-
olent blow to the head, followed by a tempo- tending from the base of the skull to the tip of
rary impairment of brain function, usually the tailbone (coccyx), that supports the head
without permanent damage to the brain. and the trunk and encases and protects the
Manual stabilization: A technique used to mini- spinal cord; also called the spinal column or
mize movement of the victim’s head and neck the vertebral column.
and keep them in line with the body to protect Vertebrae: The 33 bones of the spine.
the spine while giving care.
Spinal cord: A bundle of nerves extending from
the base of the skull to the lower back, pro-
tected by the spine.
CHAPTER 13 Injuries to the Head, Neck and Back 255
SPINAL CORD
INJURIES
Other 4.5% Sports

13% Acts of
Falls 21.7 % Violence 16%
Motor Vehicle
Accidents 44.8%
Figure 13-1 Motor vehicle accidents account for Figure 13-2 Injuries to the head can rupture blood
nearly half of all spinal injuries. vessels in the brain. Pressure builds within the skull as
blood accumulates, causing brain injury.
Bleeding within the skull can occur rapidly or

slowly over a period of days. This bleeding will af- The Back
fect the brain, resulting in changes in consciousness.
Unconsciousness, semiconsciousness or drifting in The back is made up of soft tissue, bones, cartilage,
and out of consciousness is often the first and most nerves, muscles, tendons and ligaments. It supports
important signal of a serious head injury. the skull, shoulder bones, ribs and pelvis and pro-
tects the spinal cord and other vital organs. The
part of the back that is most susceptible to severe
The Face injury is the spine.
The face contains both bones and soft tissues. Al-
though some injuries to the face are minor, many
can be life threatening. With a facial injury, consider
The Spine
that the force that caused it may have been suffi- The spine is a strong, flexible column of vertebrae,
ciently strong to fracture facial bones and damage extending from the base of the skull to the tip of
the brain or the spine. Facial injuries can also affect the tailbone. The spine supports the head and the
the airway and the victim’s ability to breathe. trunk and protects the spinal cord. The spine is also
called the spinal column or vertebral column. The
spine consists of small bones, vertebrae, with cir-
The Neck cular openings. The vertebrae are separated from
each other by cushions of cartilage called disks
The neck, which contains the larynx and part of the (Fig. 13-3, A). This cartilage acts as a shock ab-
trachea, also contains major blood vessels, muscles sorber when a person walks, runs or jumps. The
and tendons and cervical bones of the spine. Any in- spinal cord, a bundle of nerves, runs through the
jury to the neck must be considered serious. The hollow part of the vertebrae. Nerve branches ex-
neck can be injured by crushing or penetrating tend to various parts of the body through openings
forces, by sharp-edged objects that can lacerate tis- on the sides of the vertebrae.
sues and blood vessels or by forces that cause the The spine is divided into five regions: the cervi-
neck to stretch or bend too far. Injuries to muscles, cal (neck) region, the thoracic (upper and middle
bones and nerves can result in severe pain and back) region, the lumbar (lower back) region, the
headaches. sacrum (the lower part of the spine) and the coccyx
C1
C2 7
Cervical
C3
C4
C5
C6
C7
T1
12
T2 Thoracic
T3
T4
T5
Nerve branches T6
Spinal cord T7
T10
T11
A T12
C
L1
5
Intervertebral Lumbar
disk L2
Vertebrae L3
L4
L5
9
S1 Sacrum
and Coccyx
S2
S3 Sacrum
5 fused vertebrae
S4
S5
Coccyx
4 fused vertebrae
B
Figure 13-3 A, Vertebrae are separated by cushions of cartilage called disks.
B and C, The spine is divided into five regions. Traumatic injury to a region of the
spine can paralyze specific body areas.
(tailbone), which is the small triangular bone at the Signals

lower end of the spinal column (Fig. 13-3, B).
Injuries to the spine often fracture the vertebrae When you are checking a victim with a suspected
and sprain the ligaments. These injuries usually heal head, neck or back injury, look for any swollen or
without problems. With severe injuries, however, bruised areas, but do not put direct pressure on any
the vertebrae may shift and compress or sever the area that is swollen, depressed or soft. You may also
spinal cord. Both can cause temporary or perma- find certain signals that indicate a serious injury.
nent paralysis, even death. The parts of the body These signals include—
that are paralyzed depend on which area of the
Changes in the level of consciousness.
spinal cord is damaged (Fig. 13-3, C).
Severe pain or pressure in the head, neck or back.
Tingling or loss of sensation in the extremities.
Checking The Scene Partial or complete loss of movement of any
body part.
Unusual bumps or depressions on the head or
Evaluate the scene for clues as to whether a head,
neck.
neck or back injury may have occurred.
Sudden loss of memory.
Check the scene and think about the forces in-
Blood or other fluids in the ears or nose.
volved in the injury. Strong forces are likely to cause
Profuse external bleeding of the head, neck or
severe injury to the head, neck and back. For exam-
back.
ple, a driver whose head hits and breaks a car wind-
Seizures in a person who does not have a
shield in a crash may receive a potentially serious
seizure disorder.
head, neck or back injury. Similarly, a swimmer who
Impaired breathing or impaired vision as a
dives into shallow water and hits his or her head on
result of injury.
the bottom may sustain a serious injury (Fig. 13-4).
Nausea or vomiting.
You should consider the possibility of a serious
Persistent headache.
head, neck or back injury in the following situations:
Loss of balance.
Any motor vehicle crash Bruising of the head, especially around the eyes
A fall from a height greater than the victim’s or behind the ears.
standing height
These signals may be obvious or develop later.
Victim complains of neck or back pain.
Alone, these signals do not always suggest a serious
Victim has tingling or weakness in extremities.
head, neck or back injury, but they may when com-
Victim is not fully alert.
bined with the cause of the injury. Regardless of the
Victim appears to be intoxicated.
situation, always call 9-1-1 or the local emergency
Victim appears to be frail or over 65 years of age
number when you suspect a serious head, neck or
back injury.
Care
Head, neck and back injuries can become life-
threatening emergencies. A serious injury to the
head or neck can cause a victim to stop breathing.
Call 9-1-1 or the local emergency number. Always
give the following care while waiting for EMS per-
sonnel to arrive:
Minimize movement of the head, neck and
back. Because excessive movement of the head,
neck or back can damage the spinal cord irre-
versibly, keep the victim as still as possible
until EMS personnel arrive. Use a technique
Figure 13-4 Check the scene for clues as to whether called manual stabilization to minimize move-
a head, neck or back injury has occurred. ment of the head and neck.
Check for life-threatening conditions. Be sure which you perform this technique depends upon the
to maintain an open airway. position in which you find the victim (Fig. 13-5, A-
Monitor consciousness and breathing. C). Manual stabilization can be performed on vic-
Control any external bleeding with direct pres- tims who are lying down, sitting or standing.
sure unless the bleeding is located directly over Do not attempt to align the head and lower body.
a suspected fracture. Wear disposable gloves or If the head is sharply turned to one side, DO NOT
use another barrier. move it. Support it in the position found. Place the
Maintain normal body temperature. person in a modified H.A.IN.E.S. recovery position if
a head, neck or back injury is suspected and you are
unable to maintain an open airway or if you have to
Manual Stabilization leave to get help or an AED.
To perform manual stabilization, place your hands
on both sides of the victim’s head. Gently hold
the person’s head, in the position in which you
Check for Life-Threatening Conditions
found it and support it in that position until EMS As you learned in Chapter 5, you do not always
personnel arrive. Try to keep the person from mov- have to roll the victim onto his or her back to check
ing his or her lower body, since this movement will breathing. A cry of pain, chest movement as a result
change the position of the head and neck. Keeping of inhaling and exhaling or the sound of breathing
the head in the position you find it helps prevent tells you the victim is breathing, so you may not
further damage to the spinal column. The way in need to move him or her to check. If the victim
B C
Figure 13-5 A-C, Support the victim’s head in the position in which you find the
victim, using manual stabilization.
is breathing normally, support him or her in ies) and the jugular veins are located in the neck,
the position in which you found him or her. If the the victim can lose a significant amount of blood
victim is not breathing or you cannot tell, roll the quickly. If the victim is bleeding externally, control
victim gently onto his or her back, but avoid twist- it promptly with dressings, direct pressure and ban-
ing the spine. To open the airway and give rescue dages. Do not apply pressure to both carotid arter-
breaths, gently lift the chin to open the airway as ies simultaneously, and do not put a bandage
described in Chapter 6 to avoid moving the head or around the neck. Doing so could cut off or seriously
neck. diminish the oxygen supply to the brain.
If the victim begins to vomit, carefully roll him
or her onto one side to keep the airway clear. This
is more easily done by two people in order to main-
Maintain Normal Body Temperature
tain manual stabilization and minimize movement A serious injury to the head or spine can disrupt the
of the victim’s head, neck and back. Ask another re- body’s normal heating or cooling mechanism. When
sponder to help move the victim’s body while you this disruption occurs, the victim is more susceptible
maintain manual stabilization (Fig. 13-6). to shock. For example, a victim suffering a serious
head, neck or back injury while outside on a cold
day will be more likely to develop hypothermia be-
Monitor Consciousness and Breathing cause the normal shivering response to rewarm the
While stabilizing the head and neck, observe the body may not work. For this reason, it is important
victim’s level of consciousness and breathing. A se- to take steps to minimize shock by keeping the
rious injury can result in changes in consciousness. victim from becoming chilled or overheated.
The victim may give inappropriate responses to
name, time, place or when describing what hap-
pened. He or she may speak incoherently (in a way SPECIFIC INJURIES
that cannot be understood). The victim may be
drowsy, appear to lapse into sleep and then sud- The head is easily injured because it lacks the
denly awaken or completely lose consciousness. padding of muscle and fat found in other areas of
Breathing may become rapid or irregular. Because the body. You can feel bone just beneath the surface
injury to the head or neck can paralyze chest nerves of the skin over most of the head, including the
and muscles, breathing can stop. chin, cheekbones and scalp (Fig. 13-7). When you
are checking a victim with a suspected head injury,
Control External Bleeding
Some head and neck injuries involve soft tissue Skull
damage. Because many blood vessels are located in
the head and two major arteries (the carotid arter- Brain
Figure 13-7 The head is easily injured because it lacks

Figure 13-6 Maintain manual stabilization while rolling the padding of muscle and fat found in other areas of
the victim’s body. the body.
look for any swollen or bruised areas, but do not

put direct pressure on any area that is swollen, de-
pressed or soft.
Concussion
A concussion is a temporary impairment of brain
function. Any significant force to the head can
cause a concussion. It usually does not result in per-
manent physical damage to brain tissue. In most
cases, the victim loses consciousness for only an in-
stant and may say that he or she “blacked out” or
“saw stars.” A concussion sometimes results in a Figure 13-8 To avoid putting pressure on a deep scalp
loss of consciousness for longer periods of time. wound, apply pressure around the wound.
Other times, a victim may be confused or have am-
nesia (loss of memory). Anyone suspected of having
a concussion should be examined by a health-care
provider. If the condition occurred during a sport- Begin by examining both the outside and inside
ing event, the victim should not return to participa- of the cheek. To control bleeding, place several
tion until after seeing a health-care provider. dressings, folded or rolled, inside the mouth,
against the cheek. The victim may be able to hold
these dressings in place, or you may have to hold
Scalp Injury them with your gloved hand. If there is external
bleeding, place dressings on the outside of the cheek
Scalp bleeding can be minor or severe. However, and apply direct pressure (Fig. 13-10, A and B).
minor lacerations can bleed heavily because the If an object passes completely through the cheek
scalp contains many blood vessels. If the victim has and becomes embedded and you cannot control
an open wound, control the bleeding with direct bleeding with the object in place, the object should
pressure. Apply several dressings and hold them be removed so that you can control bleeding and
in place with your gloved hand. If gloves are not keep the airway clear. This circumstance is the only
available, use a protective barrier. Be sure to press exception to the general rule not to remove embed-
gently at first because the skull may be fractured. ded objects from the body. An embedded object in
If you feel a depression, spongy area or bone the cheek cannot be easily stabilized, makes control
fragments, do not put direct pressure on the wound. of bleeding more difficult and may become dis-
Attempt to control bleeding with pressure on lodged and obstruct the airway. You can remove the
the area around the wound (Fig. 13-8). Secure the object by pulling it out in the same direction it en-
dressings with a roller bandage or triangular ban- tered. Once the object is removed, fold or roll sev-
dage (Fig. 13-9, A and B). Call 9-1-1 or the local eral dressings and place them inside the mouth.
emergency number if you are unsure about the Also, apply dressings to the outside of the cheek. Be
extent of the injury. EMS personnel will be better sure not to obstruct the airway. Place the victim in
able to evaluate the injury. a seated position leaning slightly forward so that
blood will not drain into the throat. As with any
serious bleeding or embedded object, call 9-1-1 or
Cheek Injury the local emergency number.
Injury to the cheek usually involves only soft tissue.

You may have to control bleeding on either the out- Nose Injury
side, inside or both sides of the cheek. The victim
can swallow blood with bleeding inside the cheek. Nose injuries are usually caused by a blow from a
If the victim swallows enough blood, nausea or blunt object. A nosebleed often results. High
vomiting can result, which would complicate the blood pressure, changes in altitude or dry air can
situation. also cause nosebleeds. In most cases, you can con-
A B
Figure 13-9 A, Apply pressure to control bleeding from a scalp wound. B, Then
secure dressings with a bandage.
A B
Figure 13-10 A, To control bleeding inside the cheek, place folded dressings in-
side the mouth against the wound. B, To control bleeding outside the cheek, use
dressings to apply pressure directly to the wound. Bandage so as not to restrict
breathing.
trol bleeding by having the victim sit with the

head slightly forward while pinching the nostrils
together (Fig. 13-11). Have the victim apply this
pressure for about 10 minutes. Other methods of
controlling bleeding include applying an ice pack
to the bridge of the nose or putting pressure on
the upper lip just beneath the nose. Keep the vic-
tim leaning slightly forward so that blood does
not drain into the throat and cause the victim to
vomit.
Once you have controlled the bleeding, tell the
victim to avoid rubbing, blowing or picking the
nose, which could restart the bleeding. You may Figure 13-11 To control a nosebleed, have the victim
suggest applying a little petroleum jelly inside the lean forward and pinch the nostrils together until bleed-
nostril later to help keep the mucous membranes in ing stops.
the nostril moist. You should seek additional med-

ical care if the nosebleed continues after you use the
techniques described, if bleeding recurs or if the vic-
tim says the bleeding is the result of high blood
pressure. If the victim loses consciousness, place the
victim on his or her side to allow blood to drain
from the nose and mouth. Call 9-1-1 or the local A
emergency number immediately.
If you think an object is in the nostril, look into
the nostril. If you see the object and can easily grasp
it, while wearing disposable gloves, then do so.
However, do not probe the nostril with your finger
or another object. This may push the object farther
into the nose and cause bleeding, block the airway
or make it more difficult to remove later. If the ob-
ject cannot be removed easily, the victim should re-
ceive advanced medical care.
B
Eye Injury
Injuries to the eye can involve the bone and soft tis-
sue surrounding the eye or the eyeball. Blunt ob-
jects, like a fist or a baseball, may injure the eye
area, or a smaller object may penetrate the eyeball.
Injuries that penetrate the eyeball are very serious
and can cause blindness. Figure 13-12 A, Support the object with a paper cup.
B, Carefully bandage the cup in place.
Care for open or closed wounds around the
eyeball as you would for any other soft tissue injury.
Never put direct pressure on the eyeball. Follow
these guidelines when giving care for an eye with an
embedded object: First, try to remove the foreign body by telling
the victim to blink several times. Then try gently
1. Place the victim on his or her back.
flushing the eye with water. If the object remains,
2. Do not attempt to remove any object embed-
the victim should receive more advanced medical
ded in the eye.
care. The eye should be continuously flushed until
3. Wearing disposable gloves, place a sterile
EMS personnel arrive. Flushing the eye with water
dressing around the object.
is also appropriate if the victim has any chemical in
4. Stabilize any embedded object as best you
the eye (Fig. 13-13).
can. You can stabilize the object by placing a
paper cup around the object to support it
(Fig. 13-12, A).
5. Bandage loosely and do not put pressure on
Ear Injury
the injured eye/eyeball (Fig. 13-12, B).
External injuries to the ear are common. Open
6. Seek immediate medical attention.
wounds, such as lacerations or abrasions, can result
Foreign bodies, such as dirt, sand or slivers of from recreational injuries, for example, being
wood or metal, that get in the eye are irritating and struck by a racquetball or falling off a bike. An
can cause significant damage. The eye immediately avulsion of the ear may occur when a pierced ear-
produces tears in an attempt to flush out such ob- ring catches on something and tears away from the
jects. Pain from the irritation is often severe. The ear. You can control bleeding from the soft tissues
victim may have difficulty opening the eye because of the ear by applying direct pressure to the affected
light further irritates it. area with a gloved hand or other barrier.
If you do not suspect a serious head, neck or

back injury, place the victim in a seated position
with the head tilted slightly forward to allow any
blood to drain. If this position is not possible, place
the victim on his or her side to allow blood to drain
from the mouth.
For injuries that penetrate the lip, place a
rolled dressing between the lip and the gum. You
can place another dressing on the outer surface of
the lip. If the tongue is bleeding, apply a dressing
and direct pressure with a gloved hand. Applying
ice or a cold pack to the lips or tongue can help
reduce swelling and ease pain. Place gauze be-
Figure 13-13 If chemicals enter the eye, flush the eye tween the source of cold and the tongue. If the
continuously with water. bleeding cannot be controlled easily, the victim
should seek medical attention.
If the injury knocked out one or more of
the victim’s teeth, control the bleeding and save
the tooth or teeth for replantation. If the person is
The ear can also be injured internally. A direct conscious and able to cooperate, rinse out the
blow to the head may rupture the eardrum. Sudden mouth with cold tap water, if available. To control
pressure changes, such as those caused by an explo- the bleeding, roll a sterile dressing and insert it
sion or a deep-water dive, can also injure the ear in- into the space left by the missing tooth or teeth.
ternally. The victim may lose hearing or balance or Have the victim bite down on the dressing to
experience inner ear pain. These injuries require maintain pressure (Fig. 13-14). Carefully pick up
more advanced medical care. the tooth by the crown (not at the root end). If
A foreign object, such as dirt, an insect or cot- dirty, gently rinse off the root of the tooth in wa-
ton, can easily become lodged in the ear canal. If ter. Do not scrub the tooth or remove any at-
you can easily see and grasp the object, remove it. tached tissue fragments.
Do not try to remove any object by using a pin, Opinions vary as to how the tooth should be
toothpick or a similar sharp item. You could saved. One option is to place the dislodged tooth or
force the object farther back or puncture the teeth in the injured person’s mouth. This method,
eardrum. Sometimes you can remove the object if however, is not always the best approach because a
you pull down on the earlobe, tilt the head to the crying child could aspirate the tooth or the tooth
side and shake or gently strike the head on the af-
fected side. If you cannot easily remove the ob-
ject, the victim should seek more advanced med-
ical care.
If the victim has a serious head injury, blood or
other fluid may be in the ear canal or may be drain-
ing from the ear. Do not attempt to stop this
drainage with direct pressure. Instead, just cover the
ear lightly with a sterile dressing. Call 9-1-1 or the
local emergency number.
Mouth, Jaw and Neck Injuries

Your primary concern for any injury to the mouth,
jaw or neck is to ensure that the airway is open.
Such injuries may cause trouble breathing if blood Figure 13-14 If a tooth is knocked out, place a sterile
or loose teeth obstruct the airway. A swollen or dressing directly in the space left by the tooth. Tell the
crushed trachea may also obstruct breathing. victim to bite down.
could otherwise become an airway obstruction. The enough to call 9-1-1 or the local emergency number,
tooth could also be swallowed with blood or saliva. the victim should immediately see a dentist who can
In addition, you may need to control serious bleeding replant the tooth within 30 minutes to an hour after
in the mouth. Because of these concerns, simply place the injury. For the tooth to be successfully replanted,
the tooth in a closed container of cool, fresh milk un- time is critical.
til it reaches the dentist. If milk is not available, use Injuries serious enough to fracture or dislocate
water. If the injury is severe enough to call 9-1-1 or the jaw can also cause other head or neck injuries.
the local emergency number, give the tooth to EMS Call 9-1-1 or the local emergency number. Be sure
personnel when they arrive. If the injury is not severe to maintain an open airway. Check inside the
Now Smile
Knocked-out teeth no longer spell doom for pearly
whites. Most dentists can successfully replant a
knocked-out tooth if they can do so quickly and if
the tooth is properly handled. Replanting a tooth is
similar to replanting a tree. On each tooth, tiny root
fibers called periodontal fibers attach to the jawbone
to hold the tooth in place. Inside the tooth, a canal
filled with bundles of blood vessels and nerves runs
from the tooth into the jawbone and surrounding
tissues.
“When these fibers and tissues are torn from the
socket, it is important that they be replaced within
an hour,” says American Academy of Pediatric Den-
tists expert, Dr. J. Bogart. Generally, the sooner the
tooth is replanted, the greater the chance it will sur-
vive. The knocked-out tooth must be handled care-
fully to protect the fragile tissues. Be careful to pick special splinting devices. The devices keep the tooth
up the tooth by the chewing edge (crown), not the stable for 2 to 3 weeks while the fibers reattach to
root. Do not rub or handle the root part of the tooth. the jawbone. The bundles of blood vessels and
It is best to preserve the tooth by placing it in a nerves grow back within 6 weeks.
SOURCES
closed container of cool, fresh milk until it reaches American College of Emergency Physicians, Dental Emergencies.
the dentist. Because milk is not always available at www.acep.org. Accessed 10/25/04.
American Dental Association, Dental Emergencies and Injuries.
an injury scene, water may be substituted. www.ada.org/public/manage/emergencies.asp. Accessed 10/25/04.
A dentist or emergency room will clean the tooth, Bogart J, DDS: Executive Director, American Academy of Pediatric Dentists.
Interview April 1990.
taking care not to damage the root fibers. The tooth Medford H, DDS: Acute care of an avulsed tooth, Annals of Emergency Medicine
is then placed back into the socket and secured with 11:559-61, 1982.
mouth for bleeding. Control bleeding as you would This center part presses on a nerve, often caus-
for other head injuries. Minimize movement of the ing muscles to spasm.
head, neck or back.
Signals of lower back injury include—
A soft tissue injury to the neck can produce se-
vere bleeding and swelling that may result in air- Shooting pain in the lower back.
way obstruction. Because the spine may also be Sharp pain in one leg.
involved, care for a serious neck injury as you Sharp pain and tightness across the lower
would a possible spinal injury. If the victim has back.
struck his or her neck on a steering wheel or run A sudden, sharp pain in the back and a feeling
into a clothesline, the injury can be devastating. that something snapped.
The trachea may be crushed or collapsed, causing Inability to bend over without pain.
an airway obstruction that requires immediate
Regardless of the possible cause of back pain,
medical attention. While waiting for EMS person-
call 9-1-1 or the local emergency number immedi-
nel to arrive, try to keep the victim from moving,
ately if the victim has any of the following accom-
and encourage him or her to breathe slowly. Con-
panying signals:
trol any external bleeding with direct pressure,
wearing a glove or using another barrier. Be care- Numbness or tingling in any extremity
ful not to apply pressure that constricts both Difficulty moving
carotid arteries. For a large laceration to the neck, Loss of bladder or bowel control
apply an occlusive dressing to avoid the possibil-
These signals indicate possible damage to the
ity of air getting into a vein.
spinal cord. Wait for EMS personnel to arrive and
keep the victim warm and quiet.
A person with pain in one side of the small of
Lower Back Injury the back who also has a fever or feels ill should call
a physician. The victim may have a kidney infec-
Certain injuries to the neck and back are not life tion. Older adults with back pain may have a life-
threatening but can be extremely painful and threatening emergency—an aortic aneurysm. For
temporarily disabling and may occur without older adults with severe back pain, call 9-1-1 or the
warning. These injuries usually occur from forc- local emergency number.
ing the back beyond its limits in strength or flex- Because the care for lower back injury varies
ibility. Using improper lifting techniques when depending on the nature of the injury, the victim
lifting or moving heavy objects is one way to in- should consult a physician. Cold treatment is usu-
jure the back. Working in a cramped space in a ally recommended for musculoskeletal injuries ini-
bent-over or awkward position may cause back tially, followed by heat treatment. Bed rest and
pain, as can sitting or standing in one position for pain-relieving medications, such as acetaminophen
a long period of time. Often acute back pain that or ibuprofen, generally provide relief for strains
develops suddenly is a result of one of the fol- and muscle spasms. Exercises are frequently recom-
lowing causes: mended to strengthen the back and abdominal
muscles after the pain has gone and should only be
Ligament pulls and muscle strains—violent
done at the direction of a physician or physical
movement or unaccustomed effort stretches or
therapist.
tears muscles in the back or neck, or the liga-
ments that bind together or surround each sec-
tion of the spine.
Vertebrae displacement—twisting movement
causes two vertebrae to slip out of place, and
PREVENTING HEAD, NECK OR
facets (bony projections) lock in a position that BACK INJURIES
puts pressure on a nerve or irritates the joint,
often causing muscles to go into spasm. Injuries to the head, neck or back are a major cause
Slipped (prolapsed) disk—pressure and wear of death, disability and disfigurement. However,
and tear on one of the cartilage disks that sep- many such injuries can be prevented. By using
arate the vertebrae cause the soft center of the safety practices in all areas of your life, you can help
disk to protrude through the disk’s outer layer. reduce risks to yourself and to others around you.
A B
Figure 13-15 A-C, Wearing a helmet

C helps protect against head, neck or
back injuries.
Safety practices that can help prevent injuries to Taking steps to prevent falls.
the head, neck and back include— Obeying rules in sports and recreational
activities.
Wearing safety belts (lap and shoulder re-
Avoiding inappropriate use of alcohol and
straints) and placing children in car safety
other drugs.
seats.
Inspecting work and recreational equipment
When appropriate, wearing approved helmets,
periodically.
eyewear, faceguards and mouthguards
Thinking and talking about safety.
(Fig. 13-15, A-C).
SUMMARY injuries to the head, neck and back often involve

both soft tissue and bone. Often the cause of the in-
In this chapter, you have learned how to recognize jury is the best indicator of whether or not it is se-
and care for serious head, neck and back injuries; rious. If you have any doubts about the seriousness
specific injuries to the head and neck; and lower of an injury, call 9-1-1 or your local emergency
back problems. Like injuries elsewhere on the body, number.
APPLICATION QUESTION
1. Is it safe to assume that the football player who
walks out of the water does not have a head,
neck or back injury? Why or why not?
STUDY QUESTIONS
a. Concussion
b. Manual stabilization
c. Spinal column
d. Spinal cord
e. Vertebrae
_____ Technique used to minimize movement of the victim’s head and neck while giving care.
_____ Head injury that usually does not permanently damage the brain.
_____ Column of vertebrae extending from the base of the skull to the tip of the tailbone.
_____ The 33 bones of the spinal column.
_____ A bundle of nerves extending from the base of the skull to the lower back, protected by the spinal column
2. List five situations that might result in serious head, neck or back injuries.
3. List six signals of head, neck or back injuries.
4. List five ways to prevent head, neck or back injuries.
5. List the steps of care for an eye injury in which the eyeball has been penetrated.
6. Which are the most common causes of serious head, neck and back injury?
a. Motor vehicle accidents

b. Sports-related injuries
c. Falls
d. Violence
7. Serious injuries to the head, neck or back can damage—
a. Soft tissues.
b. Nerve tissues.
c. Bones.
8. Which of the following situations would cause you to suspect a serious head, neck or back injury?
a. A man complains of lower back pain after working out in the gym.
b. Two people bump their heads together while reaching for a piece of paper on the floor.
c. A high school football player is holding his neck after making a tackle.
d. A child trips and falls onto her hands and knees.
9. Which should you do when caring for a victim of suspected head, neck or back injury?
a. Help support the injured area by walking the victim to the nearest wall.
b. Call the victim’s physician for additional care.
c. Check for life-threatening conditions and maintain an open airway.
d. Have the victim lie flat and elevate the legs 8-12 inches.
10. At the scene of a car crash, a victim has blood seeping from his ears. Which should you do?
a. Loosely cover the ears with a sterile dressing.

b. Do nothing; this is a normal finding in a head injury.
c. Collect the fluid in a sterile container for analysis.
d. Pack the ears with sterile dressings to prevent further fluid loss.
11. Which is your primary concern when caring for an injury to the mouth or neck?
a. Infection
b. Airway obstruction
c. Swelling
d. Scarring
12. Caring for a penetrating injury to the eyeball includes—
a. Placing direct pressure on the eyeball.

b. Removing the object.
c. Washing the affected eye.
d. Stabilizing the object.
13. Which is a signal of an injured ear?
a. Hearing loss
b. Loss of balance
c. Inner ear pain
d. All of the above
14. As you begin to apply direct pressure to control bleeding for a scalp injury, you notice a depression of the
skull in the area of the bleeding. What should you do next?
15. What should you do for a victim of suspected head, neck or back injury whom you find lying on his side,
moaning in pain?
Answers are listed in Appendix A

pter 14 It was not anyone’s fault exactly. Mr. McGuffy should have known
better than to walk out from between two parked cars, but he was in
a hurry to mail off his rent money. Cora Markowitz was taking her
daughter, Lila, to day care and was distracted trying to explain what
clouds were made of. Her car struck Mr. McGuffy with a glancing
blow just as he stepped into the street and sent him sprawling. Cora
put on the brakes, jumped out of the car and ran over to Mr.
McGuffy, who was already sitting up and starting to get to his feet.
Chapter
“I’m OK,” he said, in a shaky voice, but Cora wasn’t so sure. He
looked sick, weak and as if he was in pain.
Ch
Injuries to
the Chest,
Abdomen
and Pelvis
Objectives
■ Explain why injuries to the chest, abdomen and pelvis can be
fatal.
■ List the seven signals of chest injury.
■ Describe how to care for rib fractures.
■ Describe how to care for a sucking chest wound.
■ List the signals of serious abdominal and pelvic injuries.
■ Describe the care for open and closed abdominal and pelvic
injuries.
■ Describe how to care for injuries to the genitals.
Limiting movement.
Introduction Monitoring breathing and signs of life.

Controlling bleeding.
Minimizing shock.
Many injuries to the chest and abdomen
involve only soft tissues. Often these injuries, This chapter describes the signals of different
like those that occur elsewhere on the body, injuries to the chest, abdomen and pelvis and
are only minor cuts, scrapes, burns and the care you would give for them. In all cases,
bruises. Occasionally, severe injuries occur, follow the Emergency Action Steps. Check the
such as fractures or injuries to organs that scene and the victim. Call 9-1-1 or the local
cause severe bleeding or impair breathing. emergency number. Care for the victim. Care
Fractures and lacerations often occur in motor for all life-threatening injuries first. All the
vehicle collisions to occupants not wearing injuries described in this chapter are serious
seat belts. Falls, sports mishaps and other and require advanced medical care. Always
forms of trauma, the violent force or call 9-1-1 or the local emergency number
mechanism that can cause injury, may also immediately.
cause such injuries.
Injuries to the pelvis may be minor soft
tissue injuries or serious injuries to bone and
internal structures. The pelvis is the lower part
INJURIES TO THE CHEST
of the trunk, containing part of the intestines, The chest is the upper part of the trunk. The chest
bladder and reproductive organs. It includes a is shaped by 12 pairs of ribs. Ten of the pairs attach
group of large bones that forms a protective to the sternum (breastbone) in front and to the
spine in back. Two pairs, the floating ribs, attach
girdle around the organs inside. A great force
only to the spine. The rib cage, formed by the ribs,
is required to cause serious injury to the pelvic the sternum and the spine, protects vital organs,
bones. such as the heart, major blood vessels and the lungs
Because the chest, abdomen and pelvis (Fig. 14-1). Also in the chest are the esophagus, the
contain many organs important to life, injury trachea and the muscles of respiration.
to these areas can be fatal. You may recall Chest injuries are a leading cause of trauma
deaths each year. Injuries to the chest may result
from the previous chapter that a force capable
from a wide variety of causes, such as motor vehi-
of causing severe injury in these areas may cle accidents, falls, sports mishaps and crushing or
also cause injury to the spine. penetrating forces (Fig. 14-2). Chest injuries may
General care for these injuries includes— involve the bones that form the chest cavity or they
Calling 9-1-1 or the local emergency may involve the organs or other structures in the
number. cavity itself.
K E Y T E R M S
Abdomen: The middle part of the trunk, contain- Rib cage: The cage of bones formed by the 12
ing the stomach, liver, intestines and spleen. pairs of ribs, the sternum and the spine.
Chest: The upper part of the trunk, containing Sternum: The long, flat bone in the middle of the
the heart, major blood vessels and lungs. front of the rib cage; also called the breast-
Genitals: The external reproductive organs. bone.
Pelvis: The lower part of the trunk, containing
the intestines, bladder and internal reproduc-
tive organs.
CHAPTER 14 Injuries to the Chest, Abdomen and Pelvis 273
Trachea
Collarbone
Lungs
Heart and major
blood vessels
Sternum
Ribs
Spine
Figure 14-1 The rib cage surrounds and protects several vital organs.
Figure 14-2 About one-third of the deaths from motor vehicle collisions involve chest
injuries. Crushing forces, falls and sports mishaps can also lead to chest injuries.
Chest wounds are either open or closed. Open breathing is shallow because normal or deep
chest wounds occur when an object, such as a knife breathing is painful. The victim will usually attempt
or bullet, penetrates the chest wall. Fractured ribs to ease the pain by supporting the injured area with
may break through the skin to cause an open chest a hand or arm. Rib fractures are less common in
injury. A closed chest wound does not break the children because children’s ribs are so flexible that
skin. Closed chest wounds are generally caused by they bend rather than break. However, the forces
blunt objects, such as steering wheels. that can cause a rib fracture in adults can severely
You may recognize some of the signals of a bruise the lung tissue of children, which can be a
serious chest injury from previous discussions of life-threatening injury. Look for signals, such as
respiratory distress, soft tissue injuries and what caused the injury, bruising on the chest and
musculoskeletal injuries. They include— trouble breathing, to determine if a child has poten-
tial chest injury.
Trouble breathing.
Severe pain at the site of the injury.
Flushed, pale, ashen or bluish skin. Care for Rib Fractures
Obvious deformity, such as that caused by a
If you suspect a fractured rib, have the victim rest in
fracture.
a position that will make breathing easier. Do not
Coughing up blood (may be bright red or dark
move the victim if you suspect a head, neck or back
like coffee grounds).
injury. Call 9-1-1 or the local emergency number.
Bruising at the site of a blunt injury, such as
Binding the victim’s upper arm to the chest on the
that caused by a seat belt.
injured side will help support the injured area
A “sucking” noise or distinct sound when the
and make breathing more comfortable. You can use
victim breathes.
an object such as a pillow or rolled blanket to
support and immobilize the area (Fig. 14-4). Moni-
tor breathing and skin condition, and take steps to
Rib Fractures minimize shock.
Rib fractures are usually caused by direct force to

the chest. Although painful, a simple rib fracture is
rarely life threatening (Fig. 14-3). A victim with a
fractured rib generally remains calm, but his or her
Figure 14-3 A simple rib fracture is painful but rarely Figure 14-4 When a rib fracture occurs, use a pillow
life threatening. or folded blanket to support and immobilize the injured
area.
Air from lung

filling space
around lung
Air from
outside
filling space
around lung
Damaged
blood vessel
Figure 14-5 A puncture wound that penetrates the lung or the chest cavity sur-
rounding the lung allows air to go in and out of the cavity.
Puncture Wounds tion will worsen. The affected lung or lungs will fail
to function, and breathing will become more diffi-
Puncture wounds to the chest range from minor to cult. Call 9-1-1 or the local emergency number.
life threatening. Stab and gunshot wounds are ex-
amples of puncture injuries. The penetrating object
can injure any structure or organ within the chest,
Care for Puncture Wounds
including the lungs. A puncture injury can allow air To care for a sucking chest wound, cover the
to enter the chest through the wound. Air in the wound with a large occlusive dressing, a dressing
chest cavity does not allow the lungs to function that does not allow air to pass through it. A piece
normally. of plastic wrap or a plastic bag folded several
Puncture wounds cause varying degrees of in- times and placed over the wound makes an effec-
ternal or external bleeding. A puncture wound to tive occlusive dressing. Tape the dressing in place,
the chest is a life-threatening injury. If the injury except for one side or corner that remains loose. A
penetrates the rib cage, air can pass freely in and taped-down dressing keeps air from entering the
out of the chest cavity, and the victim cannot wound when the victim inhales, and having an
breathe normally. With each breath the victim open corner allows air to escape when the victim
takes, you hear a sucking sound coming from the exhales (Fig. 14-6). If these materials are not avail-
wound. This sound is the primary signal of a pene- able to use as dressings, use a folded cloth. Call
trating chest injury called a sucking chest wound 9-1-1 or the local emergency number. Take steps to
(Fig. 14-5). Without proper care, the victim’s condi- minimize shock.
INHALATION EXHALATION
Lodged
bullet
Injured
lung
Figure 14-6 An occlusive dressing with one loose corner keeps air from entering
the wound when the victim inhales and allows air to escape when the victim ex-
hales. This helps keep the injured lung from collapsing.
INJURIES TO THE ABDOMEN Located in the upper right part of the abdomen,
the liver is protected somewhat by the lower ribs.
The abdomen is the area immediately under the However, it is delicate and can be torn by blows
chest and above the pelvis. The upper abdomen is from blunt objects or penetrated by a fractured rib.
partially protected by the lower ribs and spine. It is The resulting bleeding can be severe and can
protected in back by the spine. The muscles of quickly be fatal. When the liver is injured, bile can
the back and abdomen also help protect vital inter- leak into the abdomen, which can cause severe irri-
nal organs such as the liver, spleen and stomach tation and infection.
(Fig. 14-7). These vital organs are easily injured The spleen is located behind the stomach
and tend to bleed profusely when injured. The liver and is protected somewhat by the lower left ribs.
and spleen are less protected in children because Like the liver, this organ is easily damaged. The
the major part of the organ is positioned below the spleen may rupture when the abdomen is struck
rib cage and the abdominal muscles are not as forcefully by a blunt object. Because the spleen
strong as those of adults. stores blood, an injury to the spleen can cause a
Liver Spine
Stomach Spleen
Pancreas
Gallbladder
Large Kidneys
intestine
Large
Small
intestine
intestine
Small
intestine
Figure 14-7 Unlike the organs of the chest or pelvis, organs in the abdominal
cavity are relatively unprotected by bones.
severe loss of blood in a short time and can be life Thirst.

threatening. Pain, tenderness or a tight feeling in the abdomen.
The stomach is one of the main digestive or- Organs protruding from the abdomen.
gans. The upper part of the stomach changes shape Rigid abdominal muscles.
depending on its contents, the stage of digestion and Other signals of shock.
the size and strength of the stomach muscles. The
stomach can bleed severely when injured, and food
contents may leak into the abdominal cavity and Care for Injuries to the Abdomen
possibly cause infection.
Like a chest injury, an injury to the abdomen With a severe open injury, abdominal organs some-
may be either open or closed. Injuries to the ab- times protrude through the wound (Fig. 14-8, A).
domen can be very painful. Even with a closed To care for an open wound to the abdomen, follow
wound, the rupture of an organ can cause serious these steps:
internal bleeding that results in shock. It is espe-
cially difficult to determine if a person has an inter-
Put on disposable gloves or use another barrier.
nal abdominal injury if he or she is unconscious.
Carefully position the victim on the back.
Always suspect an abdominal injury in a victim
Do not apply direct pressure.
who has multiple injuries. Signals of serious ab-
Do not push any protruding organs back in.
dominal injury include—
Remove clothing from around the wound
Severe pain. (Fig. 14-8, B).
Bruising. Apply moist, sterile dressings loosely over the
External bleeding. wound (Fig. 14-8, C). (Warm tap water can
Nausea. be used.)
Vomiting (sometimes containing blood). Cover dressings loosely with plastic wrap, if
Weakness. available.
A B
C D
Figure 14-8 A, Severe injuries to the abdominal cavity can result in protruding or-
gans. B, Carefully remove clothing from around the wound. C, Apply a large,
moist, sterile dressing over the wound and cover it with plastic wrap. D, Place a
folded towel over the dressing to maintain warmth.
Cover dressings lightly with a folded towel to Fractured bones may puncture or lacerate these
maintain warmth (Fig. 14-8, D). structures, or they can be injured when struck a
forceful blow by blunt or penetrating objects. An
Shock is likely to occur with a serious abdomi-
injury to the pelvis sometimes involves the genitals,
nal injury. Call 9-1-1 or the local emergency num-
the external reproductive organs. Genital injuries
ber immediately, and take steps to minimize shock.
are either closed wounds, such as a bruise, or open
Keep the victim from becoming chilled or over-
wounds, such as an avulsion or laceration. Any in-
heated, and monitor breathing and how the skin
jury to the genitals is extremely painful.
looks and feels until EMS personnel arrive.
Signals of pelvic injury are the same as those for
To care for a closed abdominal injury—
an abdominal injury. These signals include—
Severe pain.
Carefully position the victim on the back unless
Bruising.
you suspect injury to the head, neck or back.
External bleeding.
Bend the victim’s knees slightly. This position
Nausea.
allows the muscles of the abdomen to relax. If
Vomiting (sometimes containing blood).
moving the victim’s legs causes pain, leave
Weakness.
them straight.
Thirst.
Place rolled-up blankets or pillows under the
Pain, tenderness or a tight feeling in the area.
victim’s knees.
Protruding organs.
Take steps to minimize shock. Keep the victim
Rigid abdominal muscles.
from becoming chilled or overheated, and
Other signals of shock.
monitor breathing and how the skin looks and
feels until EMS personnel arrive. Certain pelvic injuries may also cause loss of
sensation in the legs or inability to move them. This
loss of sensation or movement may indicate an in-
INJURIES TO THE PELVIS jury to the lower spine.
The pelvis is the lower part of the trunk. It contains

the bladder, reproductive organs and part of the large Care for Injuries to the Pelvis
intestine, including the rectum. Major arteries (the
femoral arteries) and nerves pass through the pelvis. Care for pelvic injuries is similar to that for ab-
The organs within the pelvis are well protected on dominal injuries. Do not move the victim unless
the sides and back but not in front (Fig. 14-9). necessary. If possible, try to keep the victim lying
Injuries to the pelvis may include fractures to flat. Otherwise, help him or her into a comfortable
the pelvic bone and damage to structures within. position. Control any external bleeding, and cover
FRONT VIEW
Ureter
Pelvis
Large intestine
Ovary
Fallopian
Bladder
tube
Femoral artery Uterus
Vas
deferens Vagina
Urethra
Scrotum
Testis
Female
Male
Figure 14-9 The internal structures of the pelvis are well protected on the sides
and back, but not in front.
any protruding organs. Always call 9-1-1 or the

local emergency number and take steps to mini-
SUMMARY
mize shock. Major bleeding can occur with pelvic Injuries to the chest, abdomen or pelvis can be seri-
injuries. ous. They can damage soft tissues, bones and inter-
Any injury to the genitals is extremely painful. nal organs. Although many injuries are immediately
Care for a closed wound to the genitals as you obvious, some may be detected only as the victim’s
would for any closed wound. If the injury is an condition worsens over time. Watch for the signals
open wound, apply a sterile dressing and direct of serious injuries that require medical attention.
pressure with your gloved hand or the victim’s Care for any life-threatening conditions, and
hand or use a barrier. If any parts are completely then give any additional care needed for specific in-
avulsed, wrap them as described in Chapter 10, juries. Always call 9-1-1 or the local emergency
and make sure they are transported with the vic- number as soon as possible. Have the victim remain
tim. Injuries to the genital area can be embarrass- as still as possible. For open wounds to the chest,
ing for both the victim and the responder. Explain abdomen or pelvis, control bleeding. If you suspect
briefly what you are going to do, then do it. Do a fracture, immobilize the injured part. Use occlu-
not act in a timid or hesitant manner. Hesitation or sive dressings for sucking chest wounds and open
shyness will only make the situation more difficult abdominal wounds when these materials are avail-
for you and the victim. able. Your actions can make the difference in the
victim’s chance of survival.
1. What steps should Cora take to care for
Mr. McGuffy?
STUDY QUESTIONS
a. Abdomen
b. Chest
c. Genitals
d. Pelvis
e. Sternum
_____ External reproductive organs.
_____ The middle part of the trunk, containing the stomach, liver and spleen.
_____ The upper part of the trunk, containing the heart, major blood vessels and lungs.
_____ Long, flat bone in the middle of the front of the rib cage, also called the breastbone.
_____ The lower part of the trunk, containing the intestines, bladder and reproductive organs.
2. List five general steps of care for injuries to the chest, abdomen and pelvis.
3. List four signals of chest injury.
4. A horse being loaded into a trailer kicks a man in the chest. He is clutching the left side of his chest and says it
hurts to breathe. What type of injury would you suspect he has, and what care should you give?
5. Name the primary signal of a sucking chest wound.
6. List four signals of abdominal and pelvic injury.
In question 7, circle the letter of the correct answer.
7. Care for injuries to the chest, abdomen and pelvis includes—
a. Watching for changes in a victim’s breathing.

b. Controlling internal bleeding.
c. Giving the victim fluids.
d. Minimizing bystander activity.
You arrive at the local convenience store late Saturday night to satisfy your frozen yogurt craving. As you enter,
you notice drops of blood on the floor. A robbery has just occurred—the store clerk appears to have been beaten
and stabbed. He is conscious but in considerable pain and is having trouble breathing. You hear a sucking sound
when he breathes.
8. What type of injury does the victim have?
9. Identify the signals that support your answer in question 8.
10. Describe the steps you would take to help the victim.

Part
FIVE
MEDICAL
EMERGENCIES
15 Sudden Illness
16 Poisoning
17 Substance Misuse
Bites and Stings
18 andHeat-Abuse
19 Emergencies
and Cold-Related
Chapter 115
Chapte
Jeff and Juanita were walking to the neighborhood theater to catch an

evening movie. “I hope this show’s as good as Tony said it is,” Jeff said.
“I spent all day helping my dad paint the trim on some windows.”
Suddenly, Juanita thought Jeff missed a step. He sort of stumbled or
tripped, and then he stopped altogether. He made a funny little noise.
“What’s the matter?” Juanita started to ask, but before she could say it
all, Jeff collapsed on the ground. His eyes rolled back, his body went
rigid and his arms and legs began to jerk uncontrollably. Juanita looked
frantically around for somebody, anybody, who could help.
Sudden
Illness
Objectives
■ List the general guidelines for giving care to a victim of a sudden
illness.
■ Recognize the signals of a sudden illness.
■ Describe how to care for a victim who faints.
■ Describe how to care for a victim of a diabetic emergency.
■ Describe how to care for a victim having a seizure.
■ Describe how to care for a victim of a stroke.
■ Identify five ways to reduce the risk of a stroke or transient
ischemic attack (TIA).
286 PART FIVE MEDICAL EMERGENCIES
Sudden illness may result from a condition that
Introduction has a rapid and intense onset and then subsides

quickly (acute), or it may result from a persistent
condition that continues over a long period of time
(chronic). In an emergency, you may not know what
While some illnesses develop over time,
caused the illness. However, you do not need to know
others can strike without a moment’s notice.
the exact cause to give appropriate care to the victim.
However, if you look closely, you may see the In this chapter, you will learn that following the
signals of a developing sudden illness. You emergency action steps: CHECK—CALL—CARE
may hear the person describe his or her signals is all you need to do to give first aid to a victim of
or you may notice a change in the person’s sudden illness.
Faced with a person who has an unknown ill-
appearance. By knowing the signals of sudden
ness, you may not be sure whether to call 9-1-1 or
illness and paying careful attention to details the local emergency number. In some cases, such as
at the emergency scene, you can determine fainting, the condition is momentary and the person
how best to help a victim of sudden illness. immediately recovers. In this situation, activating
the EMS system may not be necessary. However, if
the problem is not resolved quickly or if you have
any doubts about its severity, always call 9-1-1 or
the local emergency number for help. It is better to
SPECIFIC SUDDEN ILLNESSES err on the side of caution. Refer to Chapter 5 for
conditions and situations in which you should call
9-1-1 or the local emergency number.
Sudden illnesses become evident in a variety of Some of the sudden illnesses you may encounter
ways. Many different conditions, such as a diabetic include—
emergency, stroke, seizures, poisoning, heart attack
and shock, can all cause a change in a person’s level Fainting.
of consciousness. A victim of sudden illness may Diabetic emergencies.
faint or complain of feeling light-headed, dizzy or Seizures.
weak. He or she may feel nauseated or may vomit. Stroke.
Breathing, pulse, body temperature and skin color Poisoning.
may change. A person who looks or feels ill gener- Heart attack.
ally is ill. Shock.
K E Y T E R M S
Diabetes mellitus: A condition in which the body Hypoglycemia: A condition in which too little
does not produce enough insulin, or does not sugar (glucose) is in the bloodstream and the
use insulin effectively enough, to regulate the insulin level in the body is too high.
amount of sugar (glucose) in the bloodstream; Insulin: A hormone produced in the pancreas that
often referred to simply as diabetes. enables the body to use sugar (glucose) for en-
Diabetic emergency: A situation in which a per- ergy; frequently used to treat diabetes.
son becomes ill because of an imbalance of Seizure: An irregularity in the brain’s electrical
sugar (glucose) and insulin in the bloodstream. activity often marked by loss of consciousness
Epilepsy: A chronic condition characterized by and uncontrollable muscle movement; also
seizures that may vary in type and duration; called a convulsion.
can usually be controlled by medication. Stroke: A disruption of blood flow to a part of
Fainting: A partial or complete loss of conscious- the brain, which may cause permanent damage
ness resulting from a temporary reduction of to brain tissue; also called a cerebrovascular
blood flow to the brain. accident (CVA).
Glucose: A simple sugar found in certain foods, Transient ischemic attack (TIA): A temporary
especially fruits, and a major source of energy episode that, like a stroke, is caused by a dis-
for all living organisms. ruption of blood flow to the brain; sometimes
Hyperglycemia: A condition in which too much called a mini-stroke.
sugar (glucose) is in the bloodstream and the
insulin level in the body is too low.
CHAPTER 15 Sudden Illness 287
Follow these general guidelines for care: Any time changes inside the body momentarily re-
duce the blood flow to the brain, fainting may
Do no further harm.
occur.
Monitor breathing and consciousness.
Fainting may occur with or without warning.
Help the victim rest in the most comfortable
Often, the change in level of consciousness may
position.
initially make the victim feel light-headed or dizzy.
Keep the victim from getting chilled or over-
Because fainting is a form of shock, the victim
heated.
may show signals of shock, such as pale, cool or
moist skin (see Chapter 9). The victim may feel nau-
Give any specific care needed.
seated and complain of numbness or tingling in the
Depending on the condition in which you find fingers and toes. Other signals that precede fainting
the victim, you may be able to do little more than include—
help him or her rest comfortably until EMS person-
Sweating.
nel arrive. However, knowing enough about sudden
Vomiting.
illness to recognize when to call 9-1-1 or the local
Distortion or dimming of vision.
emergency number is your top priority as a citizen
Head or abdominal pain.
responder.
Some victims feel as though everything is going
dark just before they lose consciousness.
Fainting
One of the most common sudden illnesses is faint-
Care for Fainting
ing. Fainting (also known as syncope) is a partial or Usually, fainting is a self-correcting condition.
complete loss of consciousness. Fainting is caused When the victim collapses, normal circulation to
by a temporary reduction of blood flow to the the brain resumes. The victim typically regains con-
brain, such as when blood pools in the legs and sciousness within a minute. Fainting itself does not
lower body. When the brain is suddenly deprived of usually harm the victim, but related injuries, such as
its normal blood flow, it momentarily shuts down from falling, may occur. If you can reach the person
and the person faints. as he or she is starting to collapse, lower him or her
Fainting can be triggered by an emotionally to the ground or other flat surface. Position the vic-
stressful event, such as the sight of blood. It may be tim on his or her back, and elevate the legs about
caused by pain, specific medical conditions such as 12 inches to keep blood circulating to the vital or-
heart disease, standing for long periods of time or gans. If you are unsure of the victim’s condition or
overexertion. Some people, such as pregnant women if moving is painful for the victim, keep him or her
or the elderly, are more likely than others to faint lying flat. Loosen any restrictive clothing, such as a
when suddenly changing positions, such as moving tie or collar (Fig. 15-2). Check for any other life-
from sitting or lying down to standing (Fig. 15-1). threatening and non-life-threatening conditions. Do
Figure 15-1 A sudden change in positions can some- Figure 15-2 To care for fainting, place the victim on his
times trigger fainting. back, elevate the feet and loosen any restrictive cloth-
ing, such as a tie or collar.
not give the victim anything to eat or drink. Also, To function normally, body cells need sugar as a
do not slap the victim or splash water on his or her source of energy. Through the digestive process, the
face. Splashing water could cause the victim to as- body breaks down food into simple sugars such as
pirate the water. glucose, which are absorbed into the bloodstream.
As long as the fainting victim recovers quickly However, sugar cannot pass freely from the blood
and has no lasting signals, you may not need to call into the body cells. Insulin, a hormone produced in
9-1-1 or the local emergency number. However, it the pancreas, is needed for sugar to pass into the
may be appropriate to have a bystander or family cells (Fig. 15-3). Without a proper balance of sugar
member take the victim to a physician or emergency and insulin, the cells will starve and the body will
department to determine if the fainting episode is not function properly.
linked to a more serious condition. When diabetes is not properly controlled, one of
two problems can occur—the victim can have too
much or too little sugar in the bloodstream. This im-
Diabetic Emergencies balance of sugar and insulin in the blood causes ill-
ness. A situation in which a victim becomes ill be-
The condition in which the body does not produce cause of an imbalance of insulin and sugar in the
enough insulin or does not use insulin effectively bloodstream is called a diabetic emergency.
is called diabetes mellitus, commonly known as There are two major types of diabetes. In
diabetes. Diabetes mellitus is one of the leading Type I diabetes (also known as insulin-dependent
causes of death and disability in the United States diabetes), the body produces little or no insulin.
today. Consider the following facts and figures on Since Type I diabetes tends to develop in childhood,
diabetes: it is commonly called juvenile diabetes. Most people
who have Type I diabetes have to inject insulin
An estimated 18.2 million Americans currently
into their bodies daily. In Type II diabetes, (also
have diabetes.
called non-insulin-dependent diabetes), the body
Diabetes contributes to other conditions, such
produces insulin, but either the cells do not use the
as blindness; kidney, heart, and periodontal
insulin effectively or not enough insulin is pro-
(tooth) disease; and stroke.
duced. Type II diabetes, which is much more com-
Direct costs associated with diabetes were
mon than Type I diabetes, is also known as adult
$91.8 billion in 2002. For the same year, an
onset diabetes because it usually occurs in adults.
additional $39.8 billion in indirect costs was
Most people who have Type II diabetes can regulate
attributed to disability, loss of work and pre-
their blood glucose levels sufficiently through diet
mature mortality. For more information you
and do not require insulin injections.
can visit the American Diabetes Association’s
Anyone who has diabetes must carefully moni-
Web site at www.diabetes.org.
tor his or her diet and amount of exercise. People
NORMAL DIABETIC
Pancreas Pancreas
Insulin
Insulin Bloodstream
Sugar
m
Sugar Bloodstrea
Insulin
Sugar Sugar
Digestion
Body cells Digestion
Body cells
Figure 15-3 The hormone insulin is needed to take sugar from the blood into the
body cells.
However, converting fat to energy is less efficient,

produces waste products and increases the acidity
level in the blood, causing a condition called dia-
betic ketoacidosis. A victim with diabetic ketoaci-
dosis becomes ill. He or she may have flushed,
hot, dry skin and a sweet, fruity breath odor that
can be mistaken for the smell of alcohol. The
victim also may appear restless or agitated. If the
condition is not treated promptly, diabetic coma, a
life-threatening emergency, can occur.
On the other hand, when the insulin level in the
body is too high, the person has a low blood sugar
Figure 15-4 People who have insulin-dependent level. This condition is known as hypoglycemia
diabetes inject insulin to increase the amount of insulin (Fig. 15-5, B). The blood sugar level can become
in the body. too low if the diabetic—
Takes too much insulin.
Fails to eat adequately or due to sudden illness
who have insulin-dependent diabetes (and occa-
cannot keep food or liquids down.
sionally those who have non-insulin-dependent
Overexercises and burns off sugar faster than
diabetes) must also regulate their use of insulin
normal.
(Fig. 15-4). When diet and exercise are not con-
Experiences great emotional stress.
trolled, either of two problems can occur—too
much or too little sugar in the body. This imbalance In this situation, sugar is used up rapidly, so not
of sugar and insulin in the blood causes illness. enough sugar is available for the brain to function
When the insulin level in the body is too low, properly. If left untreated, hypoglycemia may result
the sugar level in the blood is high. This condition in a life-threatening condition called insulin shock.
is called hyperglycemia (Fig. 15-5, A). Sugar is pre- Many people who have diabetes have blood
sent in the blood, but it cannot be transported from glucose monitors that can be used to check their
the blood into the cells without insulin. In this con- blood sugar level if they are conscious. Many hypo-
dition, body cells become starved for sugar. The glycemic and hyperglycemic episodes are now man-
body attempts to meet its need for energy by using aged at home because of the rapid information
other stored food and energy sources, such as fats. these monitors provide.
A Insulin Sugar B
Insulin
Sugar
DIABETIC COMA (HYPERGLYCEMIA) INSULIN REACTION (HYPOGLYCEMIA)
Figure 15-5 A, Hyperglycemia occurs when there is insufficient insulin in the

body, causing a high level of sugar in the blood. B, Hypoglycemia occurs when the
insulin level in the body is high, causing a low level of sugar in the blood.
Innovations in the Treatment of Diabetes

Diabetes has no cure and is one of the leading Hopefully, like the process of sterilizing syringes
causes of death and disability in the United States. before an injection, sticking a finger to test a blood
In an effort to save lives and reduce medical costs, glucose level will soon fade into history.
companies, researchers and physicians have de-
voted their resources to developing innovative ways Insulin Replacement Therapy
to treat diabetes. The following information provides Most people who need insulin take insulin shots.
insight on medicines and technologies used to treat Other ways to take insulin include insulin pens, in-
diabetes. sulin jet injectors and insulin pumps. Someday peo-
ple with diabetes may no longer need needles or
Oral Medications shots to take insulin. Researchers are testing new
Oral medications to control diabetes work in one ways to deliver insulin into the bloodstream.
of three ways. They either stimulate the pancreas There are more than 20 types of insulin products
to release more insulin, increase the body’s sensitiv- available. The decision as to which insulin to choose
ity to the insulin that is already present or slow the is based on an individual’s lifestyle, a physician’s
breakdown of foods (especially starches) into glu- preference and experience and the person’s blood
cose. Only people with Type II diabetes can use pills sugar levels. Among the criteria considered in
to manage their diabetes. These medications work choosing insulin are—
most effectively when used in combination with • How soon it starts working (onset).
meal planning and exercise. • When it works the hardest (peak time).
• How long it lasts in the body (duration).
Minimally Invasive and Noninvasive Glucose
Monitors External Insulin Pumps
Many patients who have diabetes find it inconvenient Some people who have diabetes wear an external
or difficult to puncture their fingers several times a insulin pump, about the size of a deck of cards, that
day to monitor their blood glucose levels. Several weighs about 3 ounces and can be worn on a belt or
companies have developed noninvasive devices that carried in a pocket. The pump is programmed to give
would eliminate the need to puncture the skin. insulin throughout the day and can give additional
Potential ways to determine blood glucose amounts in a short time if needed, such as after a
levels include— meal. Frequent blood glucose monitoring is essential
• Shining a beam of light onto the skin or to determine approximate insulin dosages and to en-
through body tissues. sure that insulin is delivered.
• Measuring the energy waves (infrared radia-
tion) emitted by the body. Pancreatic Islet Cell Transplantation
• Applying radio waves to the fingertips. The pancreas makes insulin and enzymes that help
• Using ultrasound. the body digest food. Spread over the pancreas are
• Checking the thickness (viscosity) of fluids in cells called the islets of Langerhans. Islets consist of
tissue underneath the skin. two types of cells: alpha cells, which make glucagon,
currently under way and results will be announced in

several years.
Rejection is the biggest problem of the transplant.
A variety of immunosuppressive drugs are needed
to keep the transplanted islets functioning.
Researchers do not fully know what long-term
effects this procedure may have. Although very
encouraging, more research is needed to answer
Insulin injected
questions about how long the islets will survive
into port and how often the transplantation procedure will
Catheter
be successful.
Pump
Abdomen
REFERENCES AND SOURCES:

American Diabetes Association. www.diabetes.org
a hormone that raises the level of glucose (sugar) in FDA Consumer Drug Information. www.fda.gov/cder/consumerinfo/default.htm
the blood, and beta cells, which make insulin. Insulin Juvenile Diabetes Foundation International. www.jdrf.org
National Center for Chronic Disease Prevention and Health Promotion Centers
is a hormone that helps the body use glucose for en- for Disease Control and Prevention.
ergy. If beta cells do not produce enough insulin, dia- www.cdc.gov/nccdphp/bb_diabetes/index.htm
National Diabetes Education Program. www.ndep.nih.gov
betes will develop. National Diabetes Information Clearinghouse (NDIC).
Researchers at the University of Alberta in www.diabetes.niddk.nih.gov/dm/pubs/medicines_ez/specific.htm.
Accessed 08/12/04.
Edmonton, Canada, are using a procedure called the National Diabetes Information Clearinghouse (NDIC).
Edmonton protocol to transplant pancreatic islets www.diabetes.niddk.nih.gov/dm/pubs/insulin/index.htm Accessed 08/12/04.
National Diabetes Information Clearinghouse (NDIC).
into people with Type I diabetes. Islets are taken www.diabetes.niddk.nih.gov/dm/pubs/pancreaticislet.htm.
from a donor pancreas and transferred into another Accessed 08/12/04.
National Institute of Diabetes and Digestive and Kidney Diseases of the National
person. Once transplanted, the beta cells begin to Institutes of Health. www.niddk.nih.gov/
make and release insulin. Researchers hope that U.S. Food and Drug Administration FDA. www.fda.gov/diabetes/glucose.html.
Accessed 08/15/04.
islet transplantation will help people with Type I dia- U.S. Food and Drug Administration FDA. www.fda.gov/diabetes/insulin.html.
betes live without daily injections of insulin. Accessed 08/12/04.
U.S. Food and Drug Administration FDA. www.fda.gov/diabetes/insulin.html.
According to the Immune Tolerance Network, as of Accessed 08/12/04.
June 2003, about 50 percent of the patients have re-
mained insulin-free up to 1 year after receiving a
transplant. A clinical trial of the Edmonton protocol is
Signals of Diabetic Emergencies has diabetes will know what is wrong and will ask
for something with sugar in it. He or she may carry
Although hyperglycemia and hypoglycemia are dif- a readily available source of sugar for such situa-
ferent conditions, their major signals are similar. tions. If the victim is conscious but does not feel
These include— better approximately 5 minutes after taking sugar,
Changes in level of consciousness, including call 9-1-1 or the local emergency number immedi-
dizziness, drowsiness and confusion. ately. If the victim is unconscious, call 9-1-1 or the
Irregular breathing. local emergency number immediately. Do not give
Abnormal pulse (rapid or weak). the victim anything by mouth. Instead, monitor
Feeling or looking ill. signs of life and breathing and keep him or her from
getting chilled or overheated.
It is not important for you to differentiate be-
tween hyperglycemia and hypoglycemia because the
basic care for both of these diabetic emergencies is
the same.
Seizures
When the normal functions of the brain are dis-
Care for Diabetic Emergencies rupted by injury, disease, fever, poisoning or infec-
tion, the electrical activity of the brain becomes ir-
First, check and care for any life-threatening condi- regular. This irregularity can cause a loss of body
tions. If the victim is conscious, check for non-life- control known as a seizure.
threatening conditions by looking for anything vis- Seizures may be caused by an acute or chronic
ibly wrong. Ask if he or she has diabetes, or look condition. The chronic condition is known as epi-
for a medical ID tag or bracelet. If the victim tells lepsy. Today about 2.3 million Americans are
you that he or she has diabetes and exhibits the sig- affected by epilepsy. Epilepsy is usually controlled
nals above, then suspect a diabetic emergency. If the with medication. Most people who are seizure-free
conscious victim can take food or fluids, give him for 2 to 5 years can be taken off medication. The
or her sugar (Fig. 15-6). Most candy, fruit juices most clearly established risk factors for epilepsy
and nondiet soft drinks contain enough sugar to be- are severe head trauma, central nervous system in-
gin to reverse hypoglycemia. Common table sugar, fections, a stroke or having a family member who
either dry or dissolved in a glass of water, also has epilepsy. A large proportion of new cases of
works well to return the victim’s blood sugar to an epilepsy among the elderly is due to stroke. Stroke
acceptable level. If the victim’s problem is low is discussed later in this chapter.
blood sugar (hypoglycemia), the sugar you give will Before a seizure occurs, the victim may experi-
help quickly. If the victim’s blood sugar level is al- ence an aura. An aura is an unusual sensation or
ready too high (hyperglycemia), the additional feeling, such as a visual hallucination; a strange
sugar will do no further harm. Often, a person who sound, taste or smell; or an urgent need to get to
safety. If the victim recognizes the aura, he or she
may have time to tell bystanders and sit down be-
fore the seizure occurs.
Seizures generally last 1 to 3 minutes and can
produce a wide range of signals. When a victim has
a seizure, breathing may become irregular and even
stop temporarily. The victim may drool, the eyes
may roll upward and the body may become rigid.
The victim may also urinate or defecate. Seizures
that cause the victim to experience mild blackouts
that others may mistake for daydreaming are com-
monly known as nonconvulsive seizures because the
body remains relatively still during the episode.
More severe seizures, known as convulsive seizures,
may cause the victim to experience sudden, uncon-
Figure 15-6 If a victim of a diabetic emergency is controlled muscular contractions (convulsions), lasting
scious, give him or her food or fluids containing sugar. several minutes.
Care for Seizures The seizure lasts more than 5 minutes.

The victim has repeated seizures, one after
Although a seizure may be frightening to watch,
another, without regaining consciousness in
you can easily help care for the person. Remember
between.
that he or she cannot control the seizure and the
The victim appears to be injured.
violent muscular contractions that may occur, so do
The victim is not known to have a predispos-
not try to stop the seizure. Do not hold or restrain
ing condition, such as epilepsy, that could have
the person, because doing so can cause muscu-
brought on the seizure.
loskeletal injuries. As always, stay calm so that you
The victim is pregnant.
can give the most appropriate care.
The victim is an infant or child who is
Your objectives for care are to protect the victim
experiencing an initial febrile seizure
from injury and maintain an open airway. First,
(see below).
move nearby objects, such as furniture, that might
The victim is known to have diabetes.
cause injury. Protect the person’s head by placing a
The seizure takes place in water.
thin cushion, such as folded clothing, beneath it. If
The victim fails to regain consciousness after
possible, loosen any clothing that may restrict
the seizure.
breathing.
Do not try to place anything in the person’s
mouth or between his or her teeth. Contrary to the Febrile Seizure
myth, people having seizures do not swallow their Infants and young children may be at risk for
tongues. Seizure victims rarely bite their tongues or epilepsy, as well as for seizures brought on by a rapid
cheeks with enough force to cause any significant increase in body temperature, known as febrile
bleeding. However, some blood may be present. seizures. Febrile seizures usually affect young people
Position the victim on his or her side as soon as the younger than the age of 18 and are most common in
seizure ends, which will help blood or other fluids children younger than age 5. Febrile seizures are typ-
drain out of the mouth. Avoid direct contact with ically triggered by infections of the ear, throat or di-
any blood by using an appropriate barrier, such as gestive system and are most likely to occur when the
disposable gloves. infant or child runs a rectal fever of over 102° F
When the seizure is over, the victim will proba- (38.9° C). A victim experiencing a febrile seizure may
bly be drowsy and disoriented and will need to rest. experience some or all of the following signals:
If breathing becomes abnormal during the seizure,
it usually returns to normal soon afterward. Be sure A sudden rise in body temperature
to check for life-threatening conditions. Look for A change in level of consciousness
non-life-threatening conditions, checking to see if Rhythmic jerking of the head and limbs
the victim was injured during the seizure. Be reas- Urinating or defecating
suring and comforting. If the seizure occurred in Confusion
public, the victim may be embarrassed and self- Drowsiness
conscious. Try to provide a measure of privacy for Crying out
the person. Ask bystanders not to crowd around the Becoming rigid
Holding the breath
person. If possible, take the victim to a nearby
place, away from bystanders, to rest. If moving the Rolling the eyes upward
victim to a more secluded location is not possible, Care for an infant or child who experiences a
use your body or an object, such as a blanket, to febrile seizure is similar to the care for any other
shield the victim from onlookers. Stay with the vic- seizure victim. Immediately after a febrile seizure,
tim until he or she is fully conscious and aware of cool the body. Cool the body by removing excess
his or her surroundings. clothing and giving the victim a sponge bath in
Although most victims of seizure recover within lukewarm water. Be careful not to cool the infant
a few minutes after the seizure ends, actual recovery or child too much, because this could bring on
time depends on the type and severity of the seizure. another seizure. Contact your physician before us-
If the victim is known to have periodic seizures, ing a medication, such as acetaminophen, to con-
you probably will not need to call 9-1-1 or the trol fever. Giving aspirin to a feverish infant or
local emergency number immediately. However, call child under age 19 has been linked to Reye’s syn-
9-1-1 or the local emergency number for any of the drome, an illness that affects the brain and other
following situations— internal organs.
Parents should stay calm and carefully observe Fat deposits lining an artery (atherosclerosis) may
the child. To prevent accidental injury, the child also cause stroke. Less commonly, a tumor or
should be placed on a protected surface such as swelling from a head injury may compress an artery
the floor or ground. The child should not be held or and cause a stroke.
restrained during a convulsion. To prevent choking, A transient ischemic attack (TIA), often referred
the child should be placed on his or her side or to as a “mini-stroke,” is a temporary episode that,
stomach. When possible, the parent should gently like a stroke, is caused by a disruption in blood flow
remove all objects in the child’s mouth. The parent to a part of the brain. However, unlike a stroke, the
should never place anything in the child’s mouth signals of TIA disappear within a few minutes or
during a convulsion. Objects placed in the mouth hours of its onset. Although the indicators of TIA
can be broken and obstruct the child’s airway. If the disappear quickly, the victim is not out of danger at
seizure lasts longer than 10 minutes, the child that point. In fact, someone who experiences TIA
should be taken immediately to the nearest medical has a greater chance of having a stroke in the future
facility for further treatment. Once the seizure has than someone who has not had a TIA. Because you
ended, the child should be taken to his or her doc- cannot distinguish a stroke from a TIA, remember
tor to check for the source of the fever. This is es- to call 9-1-1 or the local emergency number imme-
pecially urgent if the child shows signals of stiff diately when any signals of stroke appear.
neck, extreme lethargy or abundant vomiting. If the
child has a febrile seizure at a later date that ends
quickly and is associated with another illness, the
Risk Factors
child should be checked by a physician or taken to The risk factors for stroke and TIA are similar to
an emergency department as soon as possible. those for heart disease (see Chapter 7). Some risk
factors are beyond your control, such as age, gen-
der, or family history of stroke, TIA, diabetes or
Stroke heart disease.
Hypertension (high blood pressure) increases
A stroke, also called a cerebrovascular accident your risk of stroke by approximately seven times
(CVA) or “brain attack”, is a disruption of blood over that of someone who does not have hyperten-
flow to a part of the brain, causing permanent dam- sion. High blood pressure puts pressure on arteries
age to brain tissue. Most commonly, a stroke is and makes them more likely to burst. Even mild hy-
caused by a blood clot, called a thrombus or embo- pertension can increase your risk of stroke. Have
lus, that forms or lodges in the arteries that supply your blood pressure checked regularly and, if it is
blood to the brain. Another common cause of high, follow your physician’s advice on how to
stroke is bleeding from a ruptured artery in the lower it. You can often control high blood pressure
brain caused by a head injury, high blood pressure by losing weight, changing your diet, exercising rou-
or an aneurysm—a weak area in the wall of an tinely and managing stress. If those measures are not
artery that balloons out and can rupture (Fig. 15-7). sufficient, your physician may prescribe medication.
Clot
Rupture
Figure 15-7 A stroke can be caused by a blood clot or bleeding from a ruptured
artery in the brain.
Cigarette smoking is another major risk factor

of stroke. Smoking is linked to heart disease and
cancer, as well as to stroke. Smoking increases
blood pressure and makes blood more likely to clot.
FAST Recognition of Stroke
If you smoke and would like to quit, many tech- For a brain attack, think FAST!
niques and support systems are available to help
you. Your physician or local health department can
assist you. The benefits of not smoking begin as F Face—Weakness on one side of the face.
soon as you stop, and some of smoking’s damage Ask the person to smile. This will show
may actually be reversible. Approximately 10 years if there is drooping or weakness in the
after a person has stopped smoking, his or her risk
muscles on one side of the face.
of stroke is the same as the risk for a person who
has never smoked. Even if you do not smoke, be
aware that inhaling secondhand smoke (from other
A Arm—Weakness or numbness in one arm.
smokers) is detrimental to your health. Avoid long- Ask the person to raise both arms to
term exposure to cigarette smoke and protect chil- find out if there is weakness in the
dren from this danger as well. limbs.
Diets that are high in saturated fats and choles-
terol can increase your risk of stroke by causing
fatty materials to build up on the walls of your
S Speech—Slurred speech or trouble speaking.
blood vessels. Foods high in cholesterol include egg
Ask the person to speak a simple sen-
yolks and organ meats, such as liver and kidneys. tence to listen for slurred or distorted
Saturated fats are found in beef, lamb, veal, pork, speech. Example: “I have the lunch
ham, whole milk and whole-milk products. Mod- orders ready.”
erating your intake of these foods can help prevent
stroke.
Diabetes is another major risk factor for stroke.
T Time—Time to call 9-1-1 or the local
emergency number if you see any of these
If you have been diagnosed with diabetes, follow
your physician’s advice about how to control it. If signals.
untreated, diabetes can cause damage to the blood Note the time that the signals began
vessels throughout the body. and call 9-1-1 or the local emergency
By paying attention to the signals of stroke number right away.
and reporting them to your physician, you can
prevent damage before it occurs. Experiencing a TIA
is the clearest warning that a stroke may occur. The FAST mnemonic is based on the Cincinnati
Do not ignore its stroke-like signals, even if they Pre-Hospital Stroke Scale, which was originally
disappear completely within minutes or hours. developed for emergency medical services (EMS)
workers in 1997. The scale was designed to
help paramedics identify strokes in the field, so
Prevention that they can prepare the emergency room be-
You can help prevent stroke if you— fore they arrive. The FAST method for public
Control your blood pressure. awareness has been in use in the community in
Do not smoke. Cincinnati, Ohio since 1999, and has since been
Eat a healthy diet. used in several other variations of the message.
Exercise regularly. It was validated by researchers at the University
Control diabetes. of North Carolina in 2003.
Regular exercise reduces your chances of
stroke by strengthening the heart and improving
blood circulation. Exercise also helps in weight
control. Being overweight increases the chance of
developing high blood pressure, heart disease and
atherosclerosis.
body. The victim may have difficulty talking or be-

Sudden Signals of a Stroke ing understood when speaking. Vision may be
As with other sudden illnesses, the primary signals blurred or dimmed; the pupils of the eyes may be of
of a stroke or TIA are looking or feeling ill or dis- unequal size. The victim may also experience a
playing abnormal behavior. Other signals of stroke sudden, severe headache; dizziness, confusion or
come on suddenly, including sudden weakness and change in mood; or ringing in the ears. The victim
numbness of the face, arm or leg. Usually, weak- may drool, become unconscious or lose bowel or
ness or numbness occurs only on one side of the bladder control.
The Brain Makes

a Comeback
About 700,000 Americans will have a stroke this
year. Neuroscientists are puzzled by the random
effects of stroke. Each stroke survivor has a unique,
perplexing set of problems, and physicians find
recovery equally unpredictable.
A stroke occurs when blood flow to the brain is
cut off. The most common, accounting for about
88 percent, is an ischemic stroke, caused by a blood
clot that blocks a blood vessel or artery in the brain.
The other major, but less common type, is a hemor-
rhagic stroke, caused when a blood vessel in the
brain ruptures and spills blood into the surrounding
tissue. Brain cells in the area begin to die because must be administered within a 3-hour window
they stop getting the oxygen and nutrients needed to from the onset of signals to be most effective.
function or they are killed by the vessel’s rupture and Preventive Treatment
sudden blood spill. • Anticoagulants/Antiplatelets
Ongoing research has provided physicians with Antiplatelet agents such as aspirin, and antico-
acute and preventive treatments. The most common agulants such as warfarin or heparin interfere
treatment for stroke is medication or drug therapy. with the blood’s ability to clot and can play an
The most popular classes of drugs used to prevent important role in preventing stroke.
or treat stroke are antithrombotics (antiplatelet • Thrombolytic
agents and anticoagulants), thrombolytics and Used to treat an ongoing, acute ischemic stroke,
neuroprotective agents. these drugs halt the stroke by dissolving the
blood clot that is blocking blood flow to the
Ischemic Stroke: Treated by removing obstruction brain. Recombinant tissue plasminogen activator
and restoring blood flow to the brain. (rt-PA) can be effective if given intravenously
Acute Treatment within 3 hours of the first signal of a stroke, but
• Clot-busters (such as t-PA) it should be used only after a physician has con-
A promising treatment for ischemic stroke is the firmed that the victim has suffered an ischemic
FDA-approved clot-busting drug t-PA, which stroke.
When possible, position the victim’s affected (para-

Care for a Stroke lyzed) side down. Doing so will prevent further in-
Call 9-1-1 or the local emergency number immedi- jury and aid breathing. You may have to remove
ately. If the victim is unconscious, make sure that he some fluids or vomit from the mouth by using one of
or she has an open airway and care for any life- your fingers. Stay with the victim and monitor his or
threatening conditions. If fluid or vomit is in the vic- her breathing and signs of life.
tim’s mouth, position him or her on one side to allow If the victim is conscious, check for non-
any fluids to drain out of the mouth (Fig. 15-8). life-threatening conditions. If you see signals of a
• Neuroprotectants quickly greatly increase the chances of receiving the

Medications that protect the brain from sec- most effective treatment for any type of stroke.
ondary injury caused by stroke. Although only a For more information on neurological disorders or
few neuroprotectants are FDA-approved for use advances in research visit the following organizations:
at this time, many are in clinical trials.
• Carotid Endarterectomy American Health Assistance Foundation
A procedure in which blood vessel blockage is www.ahaf.org
surgically removed from the carotid artery.
• Angioplasty and Stents American Stroke Association:
Physicians sometimes use balloon angioplasty A Division of American Heart Association
and implantable steel screens called stents to www.strokeassociation.org
treat cardiovascular disease in which mechanical
devices are used to remedy fatty buildup clog- Brain Aneurysm Foundation
ging the vessel. www.bafound.org
Hemorrhagic Stroke: Physicians introduce an ob- Children’s Hemiplegia and Stroke Association
struction to prevent rupture and bleeding of (CHASA)
aneurysms and arteriovenous malformations. www.hemikids.org
• Surgical Intervention
For hemorrhagic stroke, surgical treatment is Hazel K. Goddess Fund for Stroke Research
often recommended to either place a metal clip in Women
at the base, called the neck, of the aneurysm or www.thegoddessfund.org
to remove the abnormal vessels comprising an
arteriovenous malformation (AVM). National Aphasia Association
• Endovascular Procedures (such as coils). www.aphasia.org
Endovascular procedures are less invasive
and involve the use of a catheter introduced National Institute of Neurological Disorders
through a major artery in the leg or arm, guided and Stroke
to the aneurysm or AVM where it deposits a www.ninds.nih.gov
mechanical agent, such as a coil, to prevent
rupture. National Stroke Association
Strokes still present many mysteries, but scien- www.stroke.org
tists are learning more about stroke every day. With
SOURCES
about 4.8 million stroke survivors alive today, physi- American Stroke Association. www.strokeassociation.org
cians and patients are hopeful that new drugs and American Heart Association. Heart Disease and Stroke Statistics—
2004 Update. Dallas, Tex., 2003. www.americanheart.org
treatments may eventually eliminate the long-term National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov
effects. Knowing the warning signals and acting “Stroke: Hope Through Research”, NINDS. Publication date July 2004.
give him or her anything to eat or drink. Although a

stroke may cause the victim to experience difficulty
speaking, he or she can usually understand what you
say. If the victim is unable to speak, you may have to
use nonverbal forms of communication, such as
hand squeezing or eye blinking, and communicate in
forms that require a yes-or-no response (squeeze or
blink once for “yes,” twice for “no.”)
In the past, a stroke almost always caused irre-
versible brain damage. Today, new medications and
medical procedures can limit or reduce the damage
caused by stroke. Many of these new treatments are
time-sensitive; therefore, you should immediately
call 9-1-1 or the local emergency number to get the
best care for the victim.
Figure 15-8 Position a victim on the side to help fluids

or vomit drain from the victim’s mouth.
SUMMARY
Sudden illness can strike anyone at any time. Even
if you do not know the cause of the illness, you can
stroke, call 9-1-1 or the local emergency number im- still give proper care. Recognizing the signals of
mediately. A stroke can make the victim fearful and sudden illness, such as changes in consciousness,
anxious. Often, he or she does not understand what profuse sweating, confusion and weakness, will
has happened. Offer comfort and reassurance. Have help you determine the necessary care to give the
the victim rest in a comfortable position. Do not victim until EMS personnel arrive.
1. What were the signals of Jeff’s illness? 3. What should Juanita consider in her decision
whether to call 9-1-1 or the local emergency
number?
2. What could Juanita do to help Jeff during and

after the seizure?
STUDY QUESTIONS
a. Diabetic emergency f. Insulin

b. Epilepsy g. Seizure
c. Fainting h. Stroke
d. Hyperglycemia i. Transient ischemic attack (TIA)
e. Hypoglycemia
_____ A hormone that enables the cells to use sugar.
_____ A temporary reduction of blood flow to the brain, resulting in loss of consciousness.
_____ A disruption of blood flow to the brain that causes brain tissue damage.
_____ A disruption of the brain’s electrical activity, which may cause loss of consciousness and body control.
_____ A condition in which too little sugar is in the bloodstream.
_____ A condition in which too much sugar is in the bloodstream.
_____ A chronic condition characterized by seizures and usually controlled by medication.
_____ A temporary disruption of blood flow to the brain; sometimes called a mini-stroke.
_____ A situation in which a person becomes ill because of an imbalance of sugar (glucose) and insulin in
the bloodstream.
2. List four general signals of a sudden illness.
3. List four general guidelines of care that should be applied in any sudden illness.
4. List six instances in which you should call 9-1-1 or the local emergency number for a seizure victim.
5. List six ways to decrease the risk of stroke or TIA.
6. Describe how to care for a seizure victim once the seizure is over.
7. What signals of sudden illness do you find in the scenario that follows? Circle the signals in the scenario below.
I was at the grocery store with my grandmother. As the butcher reached over the counter to hand her a package
of steaks, my grandmother stumbled toward a nearby chair. She sat in the chair, looking confused. I noticed that
she was sweating profusely and her pupils were different sizes. I stood beside her and asked if I could help. At
first, she didn’t seem to recognize me. Then she mumbled something to me. I could not understand her very well,
but I think she was telling me that she felt weak and wanted me to let her rest for a few minutes.
8. What care would you give for the grandmother in the scenario?
9. If you were caring for someone who looked pale, was unconscious and was breathing irregularly, what should
you do?

b. Inject the victim with insulin.
c. Give sugar to the victim.
d. Let the victim rest for a while.
10. A friend who has diabetes is drowsy and seems confused. He is not sure if he took his insulin today. What
should you do?
a. Suggest he rest for an hour or so.

b. Tell him to take his insulin.
c. Tell him to eat or drink something with sugar in it.
d. Check his breathing and signs of life.
11. Your father has diabetes. He also suffered a stroke a year ago. You find him lying on the floor, unconscious.
What should you do after calling 9-1-1 or the local emergency number?
a. Call his physician.

b. Lift his head up and try to give him a sugary drink.
c. Check for breathing, signs of life and severe bleeding.
d. Inject him with insulin yourself, while waiting for EMS personnel to arrive.
12. In caring for the victim of a seizure, you should—
a. Move any objects that might cause injury.

b. Try to hold the victim still.
c. Place a spoon between the person’s teeth.
d. Splash the person’s face with water.
13. To reduce the risk of aspiration of blood or other fluids in a seizure victim—
a. Place an object between the victim’s teeth.

b. Position the victim on his or her side after the seizure ends.
c. Place a thick object, such as a rolled blanket, under the victim’s head.
d. Move the victim into a sitting position.
14. Controlling high blood pressure reduces your risk of—
a. Heart disease, stroke and TIA.

b. Seizure.
c. Diabetes.
d. Epilepsy.
15. At the office, your boss complains that she has had a severe headache for several hours. Her speech sud-
denly becomes slurred. She loses her balance and falls to the floor. What should you do?
a. Give her two aspirin.

b. Help her find and take her high blood pressure medication.
d. Tell her to rest for a while.
16. Which of the following is (are) included in the care you give for fainting?
a. If possible, help to lower the victim to the floor or other flat surface.
b. If possible, elevate the legs.
c. Give the victim something to eat or drink.
d. a and b.

hapter 16 Ashley never realized what a handful her little sister Kristen was to watch
until she had to babysit her. How did someone who wasn’t two yet move
so fast and so quietly? When she wasn’t grabbing an electrical cord, she
was busy emptying out her toy box. Luckily, Ashley was able to interest
Kristen in her favorite TV show, so Ashley had some time to herself. It
was only a minute or two—no more than five—that she left Kristen
there, but now Kristen was gone. Ashley checked each room of the
house, and when she reached the kitchen she knew there was trouble.
Chapter
Kristen was sitting on the kitchen table. The chair she’d used to climb up
had been knocked over. A bottle that had been filled with brightly colored
vitamin and mineral tablets was on the floor next to Kristen...empty.
Poisoning
Objectives
■ List the four ways poisons enter the body.
■ Identify the signals of poisoning.
■ Identify the general guidelines for care for any poisoning
emergency.
■ Describe how to care for a victim of a poisoning.
■ Identify the signals of anaphylaxis.
■ List eight ways to prevent poisoning.
Introduction
ways: inhalation, ingestion, absorption and injec-
tion (Fig. 16-1, A to D).
Chapter 15 described sudden illnesses caused

Inhalation
by conditions inside the body. Poisoning is Poisoning by inhalation occurs when a person
also considered a sudden illness. However, breathes in toxic fumes. Examples of inhaled poi-
unlike those conditions that have an internal sons include—
cause, such as fainting and stroke, poisoning Gases, such as—
results when external substances enter the • Carbon monoxide from an engine,
body. The substance could be a food that is kerosene heater or other sources of com-
swallowed, a pesticide that is absorbed bustion.
through the skin, or venom that enters the • Carbon dioxide, that can occur naturally
body through a bite or sting. Even certain from decomposition.
• Nitrous oxide, used for medical purposes.
plants and foods can be poisonous. In this • Chlorine, found in some commercial swim-
chapter and in Chapters 17 and 18, you will ming facilities.
learn how to recognize and care for various Fumes from—
kinds of poisoning emergencies. • Household products, such as glues and
Between 1 and 2 million poisonings paints.
occur each year in the United States. More • Drugs, such as crack cocaine.
than 90 percent of all poisonings take place
in the home. Unintentional poisonings far
outnumber intentional ones, and most
Ingestion
unintentional poisonings occur in children Ingestion means swallowing. Ingested poisons in-
younger than age 5. clude foods, such as certain mushrooms and shell-
fish; drugs, such as alcohol; medications, such as as-
pirin; and household items such as cleaning
products, pesticides and plants (Fig. 16-2).
HOW POISONS ENTER THE BODY

Absorption
A poison is any substance that can cause injury, ill-
ness or death when introduced into the body. Poi- An absorbed poison enters the body after it comes
sons include solids, liquids, sprays and fumes (gases in contact with the skin. Absorbed poisons come
and vapors). A poison can enter the body in four from plants, such as poison ivy, poison oak and poi-
K E Y T E R M S
Absorbed poison: A poison that enters the body drugs or misused medications injected with a
after it comes in contact with the skin. hypodermic needle.
Anaphylaxis: A severe allergic reaction; a form of Poison: Any substance that can cause injury, ill-
shock. ness or death when introduced into the body in
Ingested poison: A poison that is swallowed. relatively small amounts.
Inhaled poison: A poison that is breathed into the Poison Control Center: A specialized health-care
lungs. center that provides information in cases of
Injected poison: A poison that enters the body poisoning or suspected poisoning emergencies.
through the skin through a bite, sting or as
CHAPTER 16 Poisoning 305
B
A
Inhalation
Ingestion
D
C
Absorption Injection
Figure 16-1 A poison can enter the body in four ways: A, ingestion, B, inhalation,
C, absorption and D, injection.
son sumac, as well as from fertilizers and pesticides

used in lawn and plant care.
Injection
Injected poisons enter the body through the bites or
stings of certain insects, spiders, ticks, marine life,
animals and snakes, or as drugs or misused medica-
tions injected with a hypodermic needle. Poisoning
from bites and stings is covered in Chapter 17.
Many substances that are not poisonous in
small amounts are poisonous in larger amounts.
Medications (prescription or over-the-counter) can Figure 16-2 Many common household plants are
be poisonous if they are not taken as prescribed or poisonous.
directed. You will learn more about abuse and mis-
use of medications in Chapter 18.
Common Causes of Poisoning (by age group)

Younger than age 6 Ages 6 to 19 Older than age 19
Analgesic medications Analgesic medications Analgesic medications
Cleaning substances Bites and stings Antidepressant drugs
Cosmetics and personal Cleaning substances Bites and stings
care products Cosmetics Chemicals
Cough and cold remedies Cough and cold remedies Cleaning substances
Gastrointestinal medications Food products and food poisoning Food products and food poisoning
Plants Plants Fumes and vapors
Topical medications Stimulants and street drugs Insecticides
Vitamins Sedatives and hallucinogenic drugs
SIGNALS OF POISONING any drug paraphernalia or empty containers at the

As you approach the victim, be aware of any un- scene. Never jeopardize your safety to enter a scene
usual odors, flames, smoke, open or spilled con- that you know or suspect may be unsafe. Instead,
tainers, an open medicine cabinet, an overturned or immediately call 9-1-1 or the local emergency num-
damaged plant or other signals of poisoning. A vic- ber to assist any victims. If you have even a slight
tim of poisoning generally looks ill and displays sig- suspicion that the victim has been poisoned, seek
nals common to other sudden illnesses. You may medical assistance immediately. Signals of poison-
also suspect a poisoning based on any information ing include—
you have from or about the victim. Also look for
Nausea.
Vomiting.
Diarrhea.
Chest or abdominal pain.
Common Signals of Poisoning Trouble breathing.
Sweating.
Changes in consciousness.
Nausea Seizures.
Vomiting Headache.
Diarrhea Dizziness.
Chest or abdominal pain Weakness.
Trouble breathing Irregular pupil size.
Burning or tearing eyes.
Sweating
Abnormal skin color.
Changes in consciousness Burn injuries around the lips or tongue or on
Seizures the skin.
Headache
Dizziness
Weakness CARE FOR POISONING
Irregular pupil size
The severity of a poisoning depends on the type and
Burning or tearing eyes
amount of the substance; how and where it entered
Abnormal skin color the body; the time that elapsed since the poison en-
Burns around the lips or tongue or on the skin tered the body; and the victim’s size, weight, med-
ical condition and age. Some poisons act quickly
and produce characteristic signals while others act

slowly and cannot be easily identified.
If you think someone has been poisoned, call Poison Control Centers
the Poison Control Center (PCC) and follow their
directions. Poison control centers are specialized health-
After you have checked the scene and deter- care centers that provide information in cases of
mined that there has been a poisoning, follow these poisoning or suspected poisoning emergencies.
general care guidelines— A network of poison control centers exists
Remove the person from the source of poison. throughout the United States, as well as abroad.
Check the person’s level of consciousness and Some poison control centers are located in the
signs of life. emergency departments of large hospitals. Med-
If there is a life-threatening condition found ical professionals in these centers have access
(e.g., a person who is unconscious, not breath-
ing or a there is a change in consciousness),
to information about virtually all poisonous sub-
call 9-1-1 or the local emergency number first. stances and can tell you how to care for some-
Care for any life-threatening conditions. one who has been poisoned. You can obtain the
If the person is conscious, ask questions to get phone number from your telephone directory,
more information. your physician, a local hospital or your local EMS
Look for any containers and take them with system.
you to the telephone (Fig. 16-3).
Poison control centers answer over 2 million
Follow the directions of the Poison Control
Center or the EMS. poisoning calls each year. Since many poison-
ings can be cared for without the help of EMS
Do not give the person anything to eat or drink
personnel, poison control centers help prevent
unless medical professionals tell you to. If you do
not know what the poison was and the person vom- overburdening of the EMS system. If you think
its, save some of the vomit. The hospital may ana- someone has been poisoned, call the national
lyze it to identify the poison. Poison Control Center at 800-222-1222.
For more information visit the American Association of Poison Control
Centers Web site at www.aapcc.org.
Inhaled Poisons
When giving care to a victim of poisoning, you need
to follow precautions to ensure that you do not be-
come poisoned as well. This is particularly true with
inhaled poisons. Toxic fumes come from a variety of
sources and may or may not have an odor. If you no-
tice clues at the scene of an emergency that might
lead you to suspect that toxic fumes are present,
such as a strong smell of fuel or a hissing sound like
gas escaping from a pipe or valve, you may not be
able to reach the victim without risking your safety.
In cases like this, be prepared to call 9-1-1 or the
local emergency number instead of entering the
scene. Let the EMS professional know what you
have discovered, and only enter the scene if he or she
tells you it is safe to do so.
Figure 16-3 When you call EMS personnel, a call taker A commonly inhaled poison is carbon monox-
can link you with the Poison Control Center and send ide, which is present in substances such as car ex-
an ambulance if needed. haust and tobacco smoke. Carbon monoxide can
also be produced by fires, defective cooking equip- throat and mouth. Diluting the corrosive substance
ment, defective furnaces and kerosene heaters. decreases the potential for burning and damaging
Carbon monoxide is also found in indoor skating tissues. Do not give the victim anything to eat or
rinks and when charcoal is used indoors. It is a col- drink unless medical professionals tell you to do so.
orless, odorless gas. Carbon monoxide detectors, Foods can be another type of ingested poison.
which work much like smoke detectors, are now The U.S. Centers for Disease Control and Prevention
available for use in homes. (CDC) estimates that 76 million people suffer food-
A pale or bluish skin color, which indicates a borne illnesses each year in the United States. Ap-
lack of oxygen, may signal carbon monoxide poi- proximately 325,000 people are hospitalized and
soning. For years, people were taught that carbon more than 5000 die from food-borne illness. Two of
monoxide poisoning was indicated by a cherry-red the most common categories of food poisoning are
color of the skin and lips. However, new evidence bacterial food poisoning and chemical food poison-
shows that such redness occurs after most victims ing (also known as environmental food poisoning).
have died. It is highly lethal and can cause death af- Bacterial food poisoning typically occurs when bac-
ter only a few minutes of exposure. teria grow on food that is allowed to stand at room
All victims of inhaled poison need oxygen as temperature after it is cooked. The bacteria release
soon as possible. If you can remove the person from toxins into the food. Even when the food is reheated,
the source of the poison without endangering your- the toxins may not be destroyed. Foods most likely
self, then do so. You can help a conscious victim to cause bacterial food poisoning are ham, tongue,
by getting him or her to fresh air and then calling sausage, dried meat, fish products, and dairy and
9-1-1 or the local emergency number. If you find an dairy-based products. Chemical food poisoning typi-
unconscious victim, remove him or her from the cally occurs when foods with high acid content, such
scene if it is safe to do so and call 9-1-1 or the local as fruit juices or sauerkraut, are stored in containers
emergency number. Then give care for any other lined with zinc, cadmium or copper or in enameled
life-threatening conditions. metal pans. Another primary source of chemical
food poisoning is lead, which may be found in pipes
that supply drinking and cooking water.
Ingested Poisons
In some cases of ingested poisoning, the Poison
Control Center may instruct you to induce vomit-
Food Poisoning
ing. Vomiting may prevent the poison from moving One of the most common causes of food poisoning
to the small intestine, where most absorption takes is the Salmonella bacteria, most often found in
place. However, vomiting should be induced only if poultry and raw eggs. Proper handling and cooking
advised by a medical professional. of food can help prevent Salmonella poisoning. The
The Poison Control Center or medical profes- most deadly type of food poisoning is botulism,
sional will advise you exactly how to induce vomit- which is caused by a bacterial toxin associated with
ing. In some instances, vomiting should not be in- home canning. Before opening a canned or bottled
duced. These include when the victim— food, inspect the can or lid to see if it is swollen or
if the “safety button” in the center of the lid has
Is unconscious. popped up (Fig. 16-4). If either has occurred, throw
Is having a seizure. the food away.
Is pregnant (in the last trimester). The signals of food poisoning, which can begin
Has ingested a corrosive substance, such as between 1 and 48 hours after eating contaminated
drain or oven cleaner or a petroleum product, food, include nausea, vomiting, abdominal pain, di-
such as kerosene or gasoline. arrhea, fever and dehydration. Severe cases of food
Is known to have heart disease. poisoning can result in shock or death, particularly
in children, the elderly and those with an impaired
You can dilute some ingested poisons by giving immune system. Some victims of food poisoning
the victim water to drink. Examples of such poi- may require antibiotic or antitoxin therapy. Fortu-
sons are caustic or corrosive chemicals, such as nately, most cases of food poisoning can be pre-
acids, that can eat away or destroy tissues. Vomit- vented by proper cooking, refrigeration and sanita-
ing these corrosives could burn the esophagus, tion procedures.
Safe Food Handling Tips

• Wash hands thoroughly with soap and water
before preparing or handling food; between
handling raw and cooked foods; and when-
ever handling food preparation surfaces,
dishes and utensils.
• Thaw all frozen meats, poultry or fish in the
refrigerator, not at room temperature.
• Never put cooked meats back onto a surface
used to hold or store the meat before cooking
Figure 16-4 Inspect the safety button of the lid before
opening a canned or bottled food. unless the surface has been washed thor-
oughly.
• Rinse all raw fruits and vegetables thoroughly
before use.
Absorbed Poisons • Wash and dry tops of canned goods before
opening.
People often come into contact with poisonous sub-
• Keep cold foods in the refrigerator at or below
stances that can be absorbed into the body. Millions
of people each year suffer irritating effects after 40º F (4º C).
touching or brushing against poisonous plants such • Be sure hot foods are heated to and kept at or
as poison ivy, poison oak and poison sumac. Other above 140º F (60º C).
poisons absorbed through the skin include dry • Throw out all perishable foods not kept at
and wet chemicals, such as those used in yard and safe hot or cold temperatures. Dispose of all
garden maintenance, which may also burn the sur- perishable food left out at room temperature
face of the skin. To care for a victim who has for 2 or more hours.
come into contact with a poisonous plant, immedi-
• Store dry foods such as flour, sugar and ce-
ately rinse the affected area thoroughly with water
(Fig. 16-5, A). Using soap cannot hurt, but soap
real in glass, plastic or metal containers with
may not do much to remove the poisonous plant oil tight lids.
that causes the allergic reaction. Before washing the • Store all foods in containers that are clean,
affected area, you may need to have the victim re- have tight-fitting covers and are insect- and
move any jewelry. This is only necessary if the rodent-resistant.
jewelry is contaminated or if it constricts circulation • Store food items away from nonfood items.
due to swelling. If a rash or weeping lesion (an ooz-
ing sore) develops, seek advice from a pharmacist or Use an inventory system to rotate and use up
physician about possible treatment. Medicated lo- all food items.
tions may help soothe the area. Antihistamines may
also help dry up the lesions and help stop or reduce Source: Centers for Disease Control Web site,
itching. These over-the-counter products are avail- www.cdc.gov/ncidod.op/food.htm
able at a pharmacy or grocery store. If the condition
worsens and large areas of the body or the face are
affected, the victim should see a physician, who
may administer anti-inflammatory drugs, such as If wet chemicals contact the skin, flush the area
corticosteroids, or other medications to relieve dis- continuously with large amounts of cool running
comfort. water. Continue flushing at least 20 minutes or un-
If the injury involves dry chemicals, brush off til EMS personnel arrive.
the chemicals using a gloved hand before flushing If running water is not available, brush off dry
with tap water (under pressure). Be careful not to chemicals, such as lime, with a gloved hand. Take
get the chemical on yourself or the person. care not to inhale any of the chemical or get any of
the dry chemical in your eyes or the eyes of the vic-

tim or any bystanders. Many dry chemicals are ac- ANAPHYLAXIS
tivated by contact with water, but if continuous
running water is available, it will flush the chemical Severe allergic reactions to poisons are rare. But
from the skin before the activated chemical can do when one occurs, it is truly a life-threatening medical
harm. Running water reduces the threat to you and emergency. This reaction is called anaphylaxis and
quickly and easily removes the substance from the was discussed in Chapter 6. Anaphylaxis is a form of
victim. shock. It can be caused by an insect bite or sting or
contact with certain drugs, medications, foods and
chemicals. Anaphylaxis can result from any of the
Injected Poisons four modes of poisoning described in this chapter.
Insect and animal bites and stings are among the

most common sources of injected poisons. Chapter Signals of Anaphylaxis
17 describes the general signals of stings and bites
of insects, spiders, ticks, marine life, snakes, scorpi- Anaphylaxis usually occurs suddenly, within sec-
ons, animals and humans, as well as the appropri- onds or minutes after the victim comes into contact
ate care. Chapter 18 provides information about with the poisonous substance. The skin or area of
another common source of injected poisons—the the body that came in contact with the substance
use of injected drugs. usually swells and turns red (Fig. 16-6). Other sig-
nals include hives (reddish bumps on the skin), rash,
itching and burning skin and eyes, weakness, nau-
sea, vomiting, restlessness, dizziness, dilated pupils,
slurred speech, chest discomfort or pain, weak or
rapid pulse, and rapid or trouble breathing that in-
cludes coughing and wheezing. This trouble breath-
ing can progress to an obstructed airway as the
tongue, throat and bronchial passageways swell.
Death from anaphylaxis usually occurs because the
A victim’s breathing is severely impaired.
Care for Anaphylaxis

Call 9-1-1 or the local emergency number immedi-
ately. Anaphylaxis is a life-threatening condition.
Monitor the victim’s airway and breathing. Have the
Figure 16-5 A, To care for skin contact with a poiso-

nous plant, immediately rinse the affected area thor-
oughly with water. B, Whenever chemical poisons come
in contact with the skin or eyes, flush the affected area Figure 16-6 In anaphylaxis, the skin or area of the
continuously with large amounts of water. body usually swells and turns red.
Epinephrine Administration
Approximately two million people in the United States If the person is unconscious, has trouble breathing,
are at risk for anaphylaxis, and each year 400 to 800 complains of the throat tightening or explains that he
people in the United States die from anaphylactic reac- or she is subject to severe allergic reactions, have
tions. Insect stings; penicillin; aspirin; food additives, someone call 9-1-1 or the local emergency number.
such as sulfites; and certain foods, such as shellfish, • Determine whether the person has already taken
fish and nuts can trigger anaphylaxis in susceptible in- epinephrine or antihistamine. If so, do not
dividuals. These reactions may be life threatening and administer another dose.
require immediate care. A medical ID bracelet or • Check the expiration date of the auto-injector. If it
necklace should be worn by the individual at risk. has expired, do not use it.
Some possible signs and symptoms in anaphylactic • If the medication is visible, confirm that the liquid
victims include: is clear and not cloudy. If it is cloudy, do not use it.
• Swelling to the face, neck, hands, throat, tongue or Step 1: Locate the middle of one thigh or the up-
any body part. per arm to use as the injection site. Grasp
• Itching of tongue, armpits, groin or any body part. the auto-injector firmly in your fist and pull
• Dizziness. off the safety cap with your other hand.
• Redness or welts on the skin. Step 2: Hold the (black) tip near the person’s
• Red watery eyes. outer thigh so that the auto-injector is at a
• Nausea, abdominal pain or vomiting. 90-degree angle to the thigh.
• Rapid heart rate. Step 3: Swing out then firmly jab the tip straight
• Difficulty breathing or swallowing. into the outer thigh. You will hear a click.
• Feeling of constriction in the throat or chest. Step 4: Hold the auto-injector firmly in place for
Epinephrine is a prescribed medication of choice 10 seconds, then remove it from the thigh
to treat the signs and symptoms of these reactions. and massage the injection site for several
Call 9-1-1 or the local emergency number or summon seconds.
more advanced medical personnel immediately. Re-evaluate the ABCs and observe response to
If you know that a person has a prescribed epineph- epinephrine.
rine auto-injector and is unable to administer it him or
herself, then you may help the person use it if you are Step 5: Give the used auto-injector to the
trained and state and local regulations allow. emergency medical services personnel
when they arrive.
Note: Rescuers should follow local protocols or
medical directives when applicable. In all cases of epinephrine administration, follow-up
care and transport to a medical facility is needed.
Use an epinephrine auto-injector when a victim: The beneficial effect of epinephrine is relatively short
• Relates a history of allergies or allergic reactions. in duration. Victims having a severe allergic reaction
• Is having an allergic reaction. may require additional medications that can be admin-
• Requests assistance to administer epinephrine. istered only in a hospital.
• Provides the epinephrine auto-injector. SOURCE
• Has a family member who relates a victim history American Red Cross Advisory Council on First Aid and Safety (ACFAS), State-
ment on Epinephrine Administration, 2001.
of allergies or allergic reactions and provides the
victim’s epinephrine auto-injector.
Poisonous Plants
By the time we are adults, most of us are aware that eat-
ing an unidentified mushroom can be a one-way ticket to
the local hospital. We are rarely aware of the many poiso-
nous plants in our homes and gardens. Of the approxi-
mately 30,000 known plant species, only about 700 are
poisonous. But a number of these poisonous plants are not
located in the rain forest or on some tropical island; they
are quietly sitting in pots or vases in our living rooms.
Many poisonous household products now have some
sort of warning label, but we are rarely warned about the
dangers of a seemingly innocuous houseplant or shrub.
Take, for example, lily-of-the-valley, with its delicate,
sweet-scented, little white bells, which is a mainstay of
bridal bouquets. If you were to nibble the stem, flowers,
leaves or red berries of the plant, you would regret it. The
effects of the poison in this plant include burning of the
mouth and throat, vomiting, irregular heartbeat, coma and
circulatory failure. In Africa, lily-of-the-valley plants have
been used to poison the tips of arrows.
Be aware of certain plants associated with the holiday
season. Holly berries, if eaten, are sufficiently toxic to
cause illness, especially in a child. Eating mistletoe The most dangerous plant grown in the home or gar-
berries can result in vomiting, diarrhea, delirium, cardio- den is oleander. In the United States, oleanders are grown
vascular collapse and death. Skin contact with the sap of as houseplants in the north and as outdoor shrubs in Cal-
a poinsettia causes blistering. In fact, the sap of snow- ifornia, Florida and tropical areas. The leaves are stiff,
on-the-mountain, a relative of the poinsettia, is so potent narrow, dark green and shiny, and the flowers are pink,
it has been used in place of a hot iron to brand cattle. white or red. Drinking the water from a vase that has held
Several common houseplants are highly toxic. The oleander flowers can make a person violently ill, as will
philodendron is a popular plant for home and office be- eating the leaves, stems or flowers. People have been
cause it flourishes without direct sunlight and needs little poisoned from eating hot dogs roasted on sticks from an
care. The philodendron and other plants in the same fam- oleander bush as well as from inhaling smoke from the
ily have leaves of various sizes, shapes and colors. But burning foliage.
the plants in this family all have one aspect in common: A number of the plants we commonly grow in gardens
some parts contain needlelike crystals of a chemical— are poisonous if eaten, for example, the bulbs and other
calcium oxalate—that become embedded in the mouth parts of the narcissus, hyacinth and snowdrop. The
and tongue when plant parts are chewed, causing intense berries of English ivy and yew can cause vomiting, stom-
burning and severe swelling. The dieffenbachia, a large, ach pain, headache, diarrhea and convulsions. Foxglove
handsome houseplant related to the philodendron, has plants can cause heart failure. Eating the flowers of the
large bright green leaves striped with white. It is also lavender plant or the bulb of the autumn crocus can re-
known as “dumb cane” because chewing the leaves can sult in kidney damage, dehydration, abdominal pains and
make the mouth and tongue so swollen that speaking is shock. The castor plant is grown mainly for the oil pro-
impossible. Another houseplant to be aware of is the duced from its pleasant-tasting, shiny, black-and-brown
Jerusalem cherry, whose red or orange fruit look like seeds. It only takes one or two of those seeds, chewed
cherry tomatoes and are somewhat poisonous. and swallowed, to die.
Treat certain products of the orchard and vegetable convulsions, hallucinations, coma and death. Other poiso-
garden with caution. The seeds inside the pits of nous plants common in woods, fields, vacant lots or gar-
peaches, apricots, cherries and other fruit contain poten- dens include mountain laurel, deadly nightshade and
tially lethal cyanide. So do apple seeds. The leaves of Japanese honeysuckle.
rhubarb can damage the kidneys. Eating the raw shoots The most violently toxic plant that grows wild in the
and berries of asparagus can result in unpleasant skin Northern Hemisphere is the water hemlock. Hemlock acts
rashes and blisters. Even the potato plant is not entirely on the central nervous system in about 1⁄2 hour. The an-
safe; all the green parts of the plant are poisonous, and cient Greeks used an extract from another hemlock plant,
so are green areas on potatoes themselves. Always cut the poison hemlock, for executions, the most famous vic-
away the green spots and sprouts on a potato before tim being the philosopher Socrates.
cooking, and do not expose uncooked potatoes to sun- What precautions can you take to ensure against plant
light. The leaves and stems of the tomato plant, which is poisoning? First of all, learn about the plants you have in
related to the potato, are also poisonous. your home, office and garden. Nurseries and other places
Other poisonous relatives of the potato include to- that sell house and garden plants rarely provide warnings
bacco, jasmine and jimsonweed. Eating them can result about the possibilities of poisoning. Many poison control
in respiratory failure, headache, abdominal pain, delirium centers state that their most frequent calls concern chil-
and weakness. Skin contact can cause severe skin irrita- dren who have eaten plants. Keep plants you know are
tion. Jimsonweed was named after the Jamestown, Vir- toxic out of reach of infants and small children (or better
ginia, settlement where, in 1676, some soldiers sent to yet, keep toxic plants out of homes with children alto-
put down an uprising were poisoned by cooked jimson- gether); remove berries and leaves from the floor; and if
weed greens and fruit. A tall plant with thick stems, you don’t know whether a plant can be poisonous, con-
toothed leaves, trumpet-shaped white or lavender flow- sult a poison control center.
ers, and a fruit encased in a green, spiny husk, jimson- Do not store bulbs where they can be mistaken for
weed grows wild in fields, along roadsides and some- onions. Clean up any clippings and leaves from garden
times in backyards and gardens. If eaten, it can cause work, but do not burn them, because poisonous plants,
when burned, can produce poisonous smoke that is dan-
gerous if inhaled. Do not bite into an unfamiliar seed, no
matter where you find it. The rosary pea, a member of the
pea family that grows in the tropics, produces a black
and red seed that has been used in costume jewelry.
People have died from chewing or swallowing only one
rosary pea.
Learn about the weeds and wild plants that grow in
your neighborhood, and never eat any part of a plant you
cannot positively identify. Poison hemlock is also known
as fool’s parsley. If you have a yen to forage for wild plant
foods, take a field identification course taught by some-
one credentialed in the subject. Do not rely on field
guidebooks. Even the clearest photograph is no proof
against mistaking a “safe” plant for an unsafe one, and
that first bite of a water hemlock root that you mistook
for a wild carrot could be your last.
SOURCES
Coil SM: Poisonous plants, New York, 1991, Franklin Watts.
Lerner C: Dumb cane and daffodils: poisonous plants in the house and garden,
New York, 1990, William Morrow.
Westbrooks RG, Preacher JW: Poisonous plants of eastern North America, Co-
lumbia, South Carolina, 1986, University of South Carolina Press.
Woodward L: Poisonous plants: a colorful field guide, New York, 1985,
Hippocrene Books.
victim rest in a comfortable position. This position is

usually sitting upright or leaning forward. Comfort PREVENTING POISONING
and reassure the victim until EMS personnel arrive,
and continue to monitor the victim’s condition. The best approach to poisoning emergencies is to
People who know they are extremely allergic to prevent them from occurring in the first place. Pre-
certain substances may carry an anaphylaxis kit in vention is a simple principle, but often people do not
case they have a severe allergic reaction. Such kits take enough precautions. Of all the child poisoning
are available by prescription only. The kit contains a cases reported, the vast majority occurred when the
dose of the drug epinephrine (adrenaline) that can be child was under the direct supervision of a parent or
injected into the body to counteract the anaphylactic guardian. It takes only a brief lapse of supervision
reaction. If you are allergic to a substance, contact a for a child to get into trouble. Children are naturally
doctor to discuss whether you need such a kit. curious and can get into things in ways adults might
An auto-injector (Fig. 16-7) is another way to not consider possible. Many substances commonly
administer epinephrine. An auto-injector is a found in or around the house are poisonous. Chil-
spring-loaded needle and syringe system with a dren are especially vulnerable to these substances be-
single dose of epinephrine. Epinephrine is injected cause of their tendency to put everything in their
into the victim by firmly pushing the device against mouths. Extra care may be needed in monitoring the
the victim’s outer thigh. Like the anaphylaxis kit, actions of children in homes that are not childproof.
an auto-injector is available only through a pre- For example, in such homes, medications may not
scription. be stored in childproof containers.
In some cases you may need to assist the victim When giving medication to a child, do so care-
in using his or her kit. Assisting a victim with med- fully. Medicine is not candy and should never be
ication can include getting the pen or kit from a called candy to entice a child to take it. Cough
purse, car, home or out of a specially designed syrup may look like a soft drink to children, and
carrier or belt; taking it out of the plastic tube; or many coated medicine tablets look like candy. Some
assisting the victim with the injection. children’s medicine has a pleasant candy flavor so
that children will take it more easily. When giving
any of these substances, make it clear to the child
that it is medicine. Take care also to keep the med-
ication out of reach of children.
By following these general guidelines, you will
be able to prevent most poisoning emergencies:
Keep all medications and household products
well out of the reach of children. Special
latches and clamps are available to keep chil-
dren from opening cabinets. Use these or other
methods to keep children from reaching any
substances that may be poisonous. Consider all
household or drugstore products to be poten-
tially harmful.
Use childproof safety caps on containers of
medication and other potentially dangerous
products.
Keep products in their original containers,
with the labels in place.
Use poison symbols to identify dangerous sub-
stances, and teach children what the symbols
mean.
Dispose of outdated medications and house-
hold products properly and in a timely
manner.
Use potentially dangerous chemicals only in
Figure 16-7 Epinephrine auto-injectors. well-ventilated areas.
Wear proper clothing when work or recreation

may put you in contact with a poisonous
substance (Fig. 16-8). Your employer must
follow strict guidelines to protect you from
coming into contact with poisonous substances
in the workplace.
Immediately wash those areas of the body that
you suspect may have come into contact with
a poison.
One of the best ways to prevent poisonings is to
be aware of which common household items can be
poisonous. These include, but are not limited to, ac-
etaminophen, acids, ammonia, aspirin, bleach, cos-
metics, detergents, drain cleaner, heating fuel,
iodine, lye, lighter fluid, oven cleaner, paint, pesti-
cides, toilet bowl cleaner, turpentine and weed
killer. Some common household plants and garden
shrubs are also poisonous.
SUMMARY
Poisoning can occur in any one of four ways: in-
halation, ingestion, absorption and injection. The
severity of a poisoning depends on the type and
amount of the substance; how and where it entered
the body; the time elapsed since the poison entered
the body; and the victim’s size, weight and age. For
suspected poisonings, call the National Poison Con-
trol Center at (800) 222-1222. Poison control cen- Figure 16-8 Wear proper clothing for any activities that
ter personnel are specially trained to handle these may put you in contact with a poisonous substance.
types of emergencies. Call 9-1-1 or the local emer-
gency number if the victim has any life-threatening
conditions. Follow the directions of poison control ronment, such as household cleaners, plants and
center personnel or the EMS call taker. medications, that may pose a danger to you, your
Increasing your awareness and taking steps to family or co-workers. Learn to handle and store
reduce the risks is one of the best ways to prevent a these items properly by following the manufacturer’s
poisoning emergency. Identify items in your envi- directions.
1. What clues did Ashley find at the scene to alert 2. What should Ashley do to care for Kristen?
her that Kristen may have been poisoned?
STUDY QUESTIONS
a. Absorbed poison d. Inhaled poison

b. Anaphylaxis e. Injected poison
c. Ingested poison f. Poison control center
_____ A poison introduced into the body through bites, stings or a hypodermic needle.
_____ A life-threatening allergic reaction.
_____ A center staffed by professionals who can tell you how to give care in a poisoning emergency.
_____ A poison that is swallowed.
_____ A poison that enters the body through contact with the skin.
_____ A poison that enters the body through breathing.
2. List at least six common signals of poisoning.
3. List four factors that determine the severity of poisoning.
4. Describe how to care for a person who has spilled a poisonous substance on his or her skin or has touched a
poisonous plant, such as poison ivy.
5. Describe seven steps you can take to prevent poisoning emergencies in your home.
Beth was putting fertilizer on her favorite rose bush. She looked down and saw a strange plant that appeared to be
a weed. She leaned over and plucked the plant out of the ground with her bare hand. A little while later, her hands
started itching and burning. Her fingers became swollen, and red bumps began to appear all over her forearm.
6. Identify the signals that indicate that a poisoning emergency has occurred.
7. What kind of care would you give Beth?
8. What could Beth have done to prevent this situation from happening?
9. Your neighbor has accidentally swallowed some pesticide. He is conscious and alert. What should you do?
a. Give him something to drink.

b. Induce vomiting.
c. Call the Poison Control Center.
d. Have him lie down.
10. You walk into a room and find an unconscious child on the floor. There is an empty medicine bottle next to
her. What should you do first?
a. Call 9-1-1 or the local emergency number or the Poison Control Center.
b. Give rescue breathing.
c. Give her something to drink.
d. Check the airway.

“I’m exhausted,” Tonya moaned. “Look at the view,” Darrell said, trying
Chapter 17 to take his friend’s mind off her aching feet. From where they stood on a
cliff in the state park, the river flowed gracefully through the canyon and
around the next bend. “I’m too tired to enjoy the view,” Tonya said. She
slumped to the ground and pulled off her hiking boots and socks. “This
breeze feels great,” she sighed. Then Tonya screamed. “My ankle!” she
cried, scrambling to her feet. Darrel took only a few seconds to get to
her. Even though she was clutching her ankle, he could still see a
puncture wound and that the area was swelling. Tonya was obviously
in a lot of pain.
Bites and
Stings
Objectives
■ Identify five signals of the most common types of bites and
stings.
■ Describe how to care for insect, spider or scorpion stings.
■ Describe how to care for tick bites.
■ Describe how to care for snakebites.
■ Describe how to care for marine life bites or stings.
■ Describe how to care for domestic or wild animal bites.
■ Describe how to care for human bites.
■ Identify five ways to protect yourself from insect and tick bites.
Introduction CARE FOR SPECIFIC BITES

AND STINGS
Bites and stings are among the most common The following sections provide detailed instructions
forms of injected poisonings. In this chapter, on how to care for specific kinds of bites and stings.
you will learn how to recognize, care for and Table 17-1 highlights this information.
prevent some of the most common types of
bites and stings—those of insects, ticks,
spiders and scorpions, marine life, snakes, Insects
domestic and wild animals and humans.
Between .5 to 5 percent of the American population
Chapter 18 provides information on another is severely allergic to substances in the venom of
common form of injected poisoning—injected bees, wasps, hornets and yellow jackets. For highly
drug misuse and abuse. allergic people, even one sting can result in anaphy-
laxis. Such highly allergic reactions account for the
nearly 50 reported deaths that occur from insect
stings each year. When highly allergic people are
SIGNALS stung, call 9-1-1 or the local emergency number im-
mediately for medical care. However, for most peo-
As with other kinds of poisoning, poisons that are ple, insect stings may be painful or uncomfortable
injected through bites and stings may produce vari- but are not life threatening.
ous signals. Specific signals depend on factors such To give care for an insect sting, first examine the
as the type and location of the bite or sting; the sting site to see if the stinger is in the skin. If the
amount of poison injected; the time elapsed since stinger is still present, remove it to prevent any fur-
the poisoning; and the victim’s size, weight and age. ther poisoning. Scrape the stinger away from the
Less severe reactions to bites and stings may trigger skin with your fingernail or the edge of a plastic
signals including— card, such as a credit card (Fig. 17-1). Often the
venom sac will still be attached to the stinger. Do
A bite or sting mark at the point of injection
not remove the stinger with tweezers, because this
(entry site).
may put pressure on the venom sac, causing it to
A stinger, tentacle or venom sac remaining in
burst and release more venom into the skin.
or near the entry site.
Next, wash the site with soap and water. Cover
Redness at or around the entry site.
the site to keep it clean. Apply an ice or cold pack
Swelling at or around the entry site.
to the area to reduce the pain and swelling. Place a
Pain or tenderness at or around the entry site.
layer of gauze or cloth between the source of cold
Severe allergic reactions to bites and stings may and the skin to prevent skin damage. Observe the
bring on a life-threatening condition, a form of shock victim periodically for signals of an allergic reac-
known as anaphylaxis. The signals of and care for tion. Be sure to ask the victim if he or she has had
anaphylaxis are described in Chapters 6 and 16. any prior allergic reactions to insect bites or stings.
K E Y T E R M S
Antivenin: A substance used to counteract the Rabies: A disease caused by a virus transmitted
poisonous effects of snake, spider or insect through the saliva of infected mammals.
venom. Rocky Mountain spotted fever: A disease transmit-
Lyme disease: An illness transmitted by a certain ted by a certain kind of infected tick; victims
kind of infected tick; victims may or may not develop a spotted rash.
develop a rash.
CHAPTER 17 Bites and Stings 321
Table 17-1 Caring for Bites and Stings

DOMESTIC
INSECT MARINE AND WILD
BITES TICK SPIDER SCORPION SNAKE LIFE ANIMAL
AND STINGS BITES BITES STINGS BITES STINGS BITES HUMAN BITES
SIGNALS: SIGNALS: SIGNALS: SIGNALS: SIGNALS: SIGNALS: SIGNALS: SIGNALS:
Stinger Bull’s eye, Bite mark or Bite mark Bite mark Possible Bite mark Bite mark
may be spotted or blister marks
Local Severe pain Bleeding Bleeding
present black and
Local swelling and burning Pain
blue rash Pain Pain
Pain swelling
around bite Pain or Local Local
Local or on other Pain or cramping swelling and swelling
swelling body part cramping discoloration
Nausea and
Hives or Fever and Nausea and vomiting
rash chills vomiting
Trouble
Nausea and Flu-like Trouble breathing or
vomiting aches breathing swallowing
and swallow-
Trouble Profuse
ing
breathing sweating or
Profuse salivation
sweating or
Irregular
salivation
heartbeat
Irregular
heartbeat
CARE: CARE: CARE: CARE: CARE: CARE: CARE: CARE:
Remove Remove If black Call 9-1-1 Call 9-1-1 If jellyfish— If wound is If wound is
stinger; tick with widow or or local or local soak area in minor— minor—
scrape it tweezers. brown emergency emergency either vine- wash wound, wash wound,
away with a recluse— number. number. gar, alcohol control bleed- control bleed-
Wash the
plastic card call 9-1-1 or or baking ing, apply ing, apply triple
area with Wash wound. Wash wound.
or finger nail. local emer- soda paste. triple antibi- antibiotic oint-
soap and
gency num- Apply a cold Immobilize otic ointment ment and a
Wash warm water. If stingray—
ber immedi- pack. bitten part and a dress- dressing and
wound. immobilize
Apply anti- ately to have and keep it ing and get get medical
Get medical and soak area
Cover septic or antivenin ad- lower than medical attention as
care to have in nonscald-
wound. triple ministered the heart. attention as soon as
antivenin ing hot water
antibiotic and have soon as possible.
Apply a administered. Minimize until pain
ointment to wound possible.
cold pack. victim’s goes away. If wound is
wound. cleaned.
movement. If wound is severe—call
Clean and
Watch for Watch for severe—call 9-1-1 or local
bandage
signals of signals of 9-1-1 or local emergency
wound.
allergic infection. emergency number, con-
reactions; Call 9-1-1 number, control bleeding
Get medical
take steps or local trol bleeding and do not
attention if
to minimize emergency and do not wash wound.
necessary.
shock if number, if wash wound.
they occur. necessary.
Bernard Funival/Fran Heyl Associates

Figure 17-1 If someone is stung and a stinger is pres- Figure 17-2 A deer tick can be as small as the head
ent, scrape it away from the skin with your fingernail or of a pin.
a plastic card, such as a credit card.
Ticks much smaller than the common dog tick or wood

tick. They can be as small as a poppy seed, the pe-
Ticks can contract, carry and transmit disease to riod at the end of this sentence or the head of a pin
humans. Rocky Mountain spotted fever is caused (Fig. 17-2). Even in the adult stage, they are only as
by the transmission of microscopic bacteria from large as a grape seed. A deer tick can attach itself
the wood tick or dog tick host to other warm- and bite you without your knowledge. Many people
blooded animals, including humans. The disease who develop Lyme disease cannot recall having
gets part of its name from the spotted rash that ap- been bitten.
pears after a victim becomes infected. The rash may You can get Lyme disease from the bite of an in-
first appear on wrists or ankles, then spreads fected tick at any time of the year. However, the risk
rapidly to other parts of the body. Other signals of is greatest between May and July, when ticks are
Rocky Mountain spotted fever include fever and most active and outdoor activities are at their peak.
chills, severe headache and joint and muscle aches. To protect yourself from tick bites, wear repellent
Early treatment by medical professionals is im- and proper clothing, check and clean your clothes
portant because untreated victims die from shock or thoroughly after having been in wooded areas and
kidney failure. Although the disease was first diag- use precautions when removing a tick.
nosed in the western United States, Rocky Moun- The first signal of infection may appear a few
tain spotted fever cases continue to be reported days or a few weeks after a tick bite. Typically, a
throughout North and South America today. Rocky rash starts as a small red area at the site of the bite.
Mountain spotted fever is sometimes known by var- It may spread up to 6 to 8 inches across (Fig. 17-3).
ious regional names, such as black fever, mountain In fair-skinned people, the center of the rash is
fever, tick fever, spotted fever or pinta fever. lighter in color and the outer edges are raised and
Lyme disease, or Lyme borreliosis, is another red, sometimes giving the rash a bull’s-eye appear-
illness that people can get from the bite of an in- ance. In dark-skinned people, the rash area may
fected tick. Lyme disease is an illness that affects a look black and blue, like a bruise. A rash can appear
growing number of people in the United States. It is anywhere on the body, and more than one rash may
spread primarily by a type of tick that commonly appear on various body parts. However, you can
attaches itself to field mice and deer. It is sometimes even have Lyme disease without developing a rash.
called a deer tick. Like all ticks, it attaches itself to Other signals of Lyme disease include fever and
any warm-blooded animal that brushes by it, in- chills, headache, weakness or fatigue and flu-like
cluding humans. This tick is found around beaches joint and muscle aches. These signals may develop
and in wooded and grassy areas. slowly and may not occur at the same time as a rash.
Deer ticks are very tiny and difficult to see, es- The more severe signals of Lyme disease may appear
pecially in the late spring and summer. They are weeks, months or even years after a tick bite.
container for analysis. Wash the bite area with soap

and warm water. Apply antiseptic or triple antibi-
otic ointment to help prevent infection. If rash, flu-
like signals or joint pain appears, seek medical
Michael Weisman, M D /Fran Heyl Associates

attention. Wash your hands thoroughly. If you do
not have tweezers, use a glove, plastic wrap, a piece
of paper or a leaf to protect your fingers.
If you cannot remove the tick, obtain medical
care. Even if you can remove the tick, you may
want to let your physician know that you have been
bitten by a tick in case you become ill within the fol-
lowing month or two. Mouth parts of adult ticks
may sometimes remain in your skin, but these will
Figure 17-3 A person with Lyme disease may develop not cause disease. Check the site periodically there-
a rash. after. If a rash or flulike signals develop, seek med-
ical care. Redness at the site of a tick bite does not
necessarily mean you are infected with a disease.
A physician will usually use antibiotics to treat
Lyme disease and Rocky Mountain spotted fever.
Lyme disease can get worse if it is not treated. In Antibiotics work best and most quickly when taken
its advanced stages, Lyme disease may cause arthri- soon after the victim has been bitten. If you suspect
tis, numbness, memory loss, problems with vision or you may have been infected with Lyme disease or
hearing, high fever and stiffness in the neck. Some of Rocky Mountain spotted fever, do not delay seeking
these signals could indicate brain or nervous system treatment. Treatment is slower and less effective in
problems. An irregular or rapid heartbeat could oc- advanced stages.
cur, which can indicate heart problems. Additional information on Lyme disease and
If you find an embedded tick, with a gloved Rocky Mountain spotted fever may be available
hand, grasp the tick with fine-tipped pointed, non- from your state or local health department. You can
etched, non-rasped tweezers as close to the skin as also contact the American Lyme Disease Founda-
possible and pull slowly and upward (Fig. 17-4). Do tion, Inc., Web site www.aldf.com.
not try to burn the tick off. Do not apply petroleum
jelly or nail polish to the tick. These remedies are
not always effective in removing the tick and can
cause further harm to the victim. If you cannot re- Spiders and Scorpions
move the tick, or if its mouth parts remain embed-
ded, get medical care. Place the tick in a sealable Few spiders in the United States have venom that
causes death. However, the bites of the black widow
and brown recluse spiders can make you seriously
ill and are occasionally fatal. These spiders live in
most parts of the United States. You can identify
them by the unique designs on their bodies. The
black widow spider is black with a reddish hour-
glass shape on its underbody (Fig. 17-5, A). The
brown recluse spider is light brown with a darker
brown, violin-shaped marking on the top of its
body (Fig. 17-5, B).
Both spiders prefer dark, out-of-the-way places
where they are seldom disturbed. Bites usually oc-
cur on the hands and arms of people reaching into
places, such as wood, rock and brush piles or rum-
maging in dark garages and attics. Often, the victim
Figure 17-4 Remove a tick by pulling slowly, steadily will not know that he or she has been bitten until
and firmly with fine-tipped tweezers. signals develop.
The bite of the black widow spider is the more A brown recluse spider bite may produce little
painful and often the more deadly of the two, espe- or no pain initially, but localized pain develops an
cially in very young and elderly victims. The venom hour or more later. A blood-filled blister forms un-
of a black widow spider is even deadlier than that der the surface of the skin, sometimes in a target or
of a rattlesnake, although the smaller amount of bull’s-eye pattern. Over time, the blister increases in
venom injected by the spider usually produces a less size and eventually ruptures, leaving a black scar.
severe reaction than that of a snakebite. If the victim recognizes the spider as either a
The bite of a black widow spider usually causes black widow or brown recluse, he or she should
a sharp pinprick pain, followed by a dull pain in seek medical care as soon as possible. Health-care
the area of the bite. Other signals of this bite in- professionals will clean the wound and give med-
clude muscular rigidity in the shoulders, back and ication to reduce the pain and inflammation. An
abdomen; restlessness; anxiety; profuse sweating; antivenin, a substance used to counteract the poi-
weakness; and drooping eyelids. sonous effects of the venom, is available for black
widow bites. Antivenin is used mostly for children
and the elderly and is rarely necessary when bites
occur in healthy adults.
Scorpions live in dry regions of the southwest-
ern United States and Mexico. They are usually
about 3 inches long and have 8 legs and a pair of
crab-like pincers. At the end of the tail is a stinger,
used to inject venom. Scorpions live in cool, damp
places, such as basements, junk piles, woodpiles
Rob Planck/ Tom Stack & Associates
A and under the bark of living or fallen trees. They are

most active in the evening and at night, which is
when most stings occur. Like spiders, only a few
species of scorpions have a potentially fatal sting
(Fig. 17-6). However, because it is difficult to dis-
tinguish highly poisonous scorpions from the non-
poisonous scorpions, all scorpion stings should be
treated as medical emergencies.
Signals of spider bites and scorpion stings may
include—
A mark indicating a possible bite or sting.

Severe pain in the sting or bite area.
A blister, lesion or swelling at the entry site.
B
Ann Moreton/Tom Stack & Associates
Rob Planck/ Tom Stack & Associates
Figure 17-5 A, The black widow spider and, B, brown Figure 17-6 The stings of only a few species of scor-
recluse spider have characteristic markings. pions found in the United States can be fatal.
Nausea and vomiting. snake, have been discussed at length over the
Trouble breathing or swallowing. years. Of the estimated 7000 to 8000 people re-
Sweating or salivating profusely. ported bitten by poisonous snakes annually in the
Irregular heart rhythms. United States, fewer than five die. Figure 17-7
Muscle cramping or abdominal pain. shows the four kinds of poisonous snakes found in
the United States. Rattlesnakes account for most
If a person is bitten by a spider (i.e., brown snakebites and nearly all deaths from snakebites.
recluse or black widow) or stung by a scorpion, call Most deaths occur because the victim has an aller-
9-1-1 or the local emergency number. Wash the gic reaction, is in poor health or because too much
wound and apply an ice or a cold pack to the site to time passes before the victim receives medical care.
reduce swelling. Remember to place a layer of gauze Although advice to citizen responders has varied
or cloth between the source of cold and the skin to greatly over the years, elaborate initial care is
prevent skin damage. usually unnecessary because, in most cases, the
victim can reach professional medical care within
30 minutes.
Snakes Signals that indicate a poisonous snakebite
include—
Few areas of medicine have provoked more con-
troversy about care for an injury than snakebites. One or two distinct puncture wounds, which
Snakebite care issues, such as whether to use a may or may not bleed. The exception is the
tourniquet, cut the wound, apply ice, when to ap- coral snake, whose teeth leave a semicircular
ply suction, use electric shocks or capture the mark.
David M Dennis/ Tom Stack & Associates

John Shaw/ Tom Stack & Associates
A B
Rattlesnake Copperhead
David M Dennis/ Tom Stack & Associates

John Canalosi/ Tom Stack & Associates
C D
Water moccasin Coral snake
Figure 17-7 There are four kinds of poisonous snakes found in the United States:
A, Rattlesnake. B, Copperhead. C, Water moccasin. D, Coral snake.
Severe pain and burning at the wound site Do not apply ice.
immediately after or within 4 hours of the Do not cut the wound.
incident. Do not apply suction.
Swelling and discoloration at the wound site Do not apply a tourniquet.
immediately after or within 4 hours of the Do not use electric shock, such as from a car
incident. battery.
To care for a bite from a pit viper, such as a rat-
tlesnake, copperhead or cottonmouth, follow these
steps—
Marine Life
Call 9-1-1 or the local emergency number. The stings of some forms of marine life are not only
Wash the wound. painful but can also make you sick (Fig. 17-8). The
Keep the injured area still and lower than the side effects include allergic reactions that can cause
heart. If possible, carry a person who must be breathing and heart problems and paralysis. If the
taken to a medical facility or have him or her sting occurs in water, move the person from the wa-
walk slowly. ter to dry land as soon as possible. Call 9-1-1 or the
Do not apply ice. local emergency number if the victim does not
Do not cut the wound. know what stung him or her, has a history of aller-
Do not apply suction. gic reactions to marine life stings, is stung on the
Do not apply a tourniquet. face or neck or starts to have trouble breathing.
Do not use electric shock, such as from a car If you know the sting is from a jellyfish, sea
battery. anemone or Portuguese man-of-war, soak the in-
jured part in vinegar as soon as possible. Vinegar
Care for a bite from an elapid snake, such as a
often works best to offset the toxin and reduce
coral snake, is the same as for a pit viper, except
pain. Rubbing alcohol or a baking soda paste may
that after washing the wound you should apply an
also be used. Do not rub the wound or apply fresh
elastic roller bandage by following these steps
water or ammonia, because these substances will in-
(see Chapter 10 for more information on using an
crease pain. Meat tenderizer is no longer recom-
elastic bandage)—
mended because the active ingredient once used to
Check for feeling, warmth and color of the limb reduce pain is no longer contained in most meat
beyond where you will be placing the bandage tenderizers.
by noting changes in skin color and temperature. If you know the sting is from a stingray, sea
Place the end of the bandage against the skin urchin or spiny fish, flush the wound with tap wa-
and use overlapping turns. ter. Ocean water may also be used. Immobilize the
Gently stretch the bandage as you continue injured part, usually the foot, and soak the af-
wrapping. The wrap should cover a long body fected area in nonscalding hot water (as hot as the
section, such as an arm or a calf, beginning at person can stand) for about 30 minutes or until
the point farthest from the heart. For a joint the pain subsides. Toxins from these animals are
like a knee or ankle, use figure-eight turns to heat-sensitive, and dramatic relief of local pain of-
support the joint. ten occurs from one application of hot fluid. If hot
Always check the area above and below the in- water is not available, packing the area in hot sand
jury site for feeling, warmth and color, espe- may have a similar effect if the sand is hot enough.
cially fingers and toes, after you have applied Then carefully clean the wound and apply a ban-
an elastic roller bandage. By checking before dage. Watch for signals of infection, and check
and after bandaging, you will be able to tell if with a health-care provider to determine if a
any tingling or numbness is from the bandag- tetanus shot is needed. (Tetanus is discussed later
ing or the injury. in this chapter.)
Check the snugness of the bandaging—a finger
should easily, but not loosely, pass under the
bandage. Domestic and Wild Animals
Keep the injured area still and lower than the
heart. If possible, carry a person who must be The bite of a domestic or wild animal carries the
taken to a medical facility or have him or her risk of infection, as well as soft tissue injury. Dog
walk slowly. bites are the most common of all bites from domes-
Wendy Shattil, Robert Rozinski/Tom Stack & Associates

Denise Tackett/Tom Stack & Associates
Stingray Portuguese man-of-war
Gerald and Buff Corsi/ Tom Stack & Associates
Sea anemone
Tom Stack/ Tom Stack & Associates

Jellyfish
Figure 17-8 The painful sting of some marine animals can cause serious injury
and illness.
tic or wild animals. One of the most serious possi- If not treated, rabies is fatal. Anyone bitten by a
ble infections is rabies. Rabies is a disease caused by wild or domestic animal must get professional med-
a virus transmitted commonly through the saliva of ical attention as soon as possible. To prevent rabies
diseased mammals, such as skunks, bats, raccoons, from developing, the victim receives a series of vac-
cats, dogs, cattle and foxes. cine injections to build up immunity. In the past,
Animals with rabies may act in unusual ways. caring for rabies meant a lengthy series of painful
For example, nocturnal animals, such as raccoons, injections that had many unpleasant side effects.
may be active in the daytime. A wild animal that The vaccines used now require fewer and less
usually tries to avoid humans may not run away painful injections and have fewer side effects.
when you approach. Rabid animals may salivate; Tetanus is another potentially fatal infection.
appear partially paralyzed; or act irritable, aggres- Tetanus is caused by the transmission of bacteria
sive or strangely quiet. To reduce your risk of be- that produce a toxin, which can occur in wounds
coming infected with rabies, do not pet or feed wild created by animal and human bites. The toxin asso-
animals and do not touch the body of a dead wild ciated with tetanus, which attacks the central ner-
animal. vous system, is one of the most deadly poisons
known. Wounds to the face, head and neck are the take the victim to a physician or medical facility. If
most likely to be fatal because of the proximity of the bite is severe, control bleeding and call 9-1-1 or
these areas to the brain. the local emergency number. The wound will be
Signals of tetanus are irritability, headache, properly cleaned at a medical facility.
fever and painful muscular spasms. One of the most
common signals of tetanus is muscular stiffness in
the jaw, which is why tetanus is sometimes known
as “lockjaw.” It can take anywhere from 3 days to
PREVENTING BITES AND STINGS
5 weeks before these signals occur. Eventually, if the
Preventing bites and stings from insects, spiders,
condition is not treated, every muscle in the body
ticks, snakes and scorpions is the best protection
goes into spasms. Care for tetanus includes prompt
against the transmission of injected poisons. When
and thorough cleansing of the wound by a medical
in wooded or grassy areas, follow these general
professional, followed by a series of immunization
guidelines to prevent bites and stings:
injections. Care for tetanus is discussed further in
Chapter 10. Apply insect or tick repellent according to la-
If someone is bitten by a wild or domestic ani- bel instructions.
mal, try to get him or her away from the animal Wear sturdy hiking boots.
without endangering yourself. Do not try to restrain Wear long-sleeved shirts and long pants.
or capture the animal. If the wound is minor, wash it Tuck your pant legs into your socks or boots.
with soap and water, control any bleeding, apply Tuck your shirt into your pants.
triple antibiotic ointment and a dressing and take the Wear light-colored clothing to make it easier to
victim to a physician or medical facility. If the wound see tiny insects or ticks.
is bleeding heavily, control the bleeding but do not Use a rubber band or tape the area where
clean the wound. Seek medical care immediately. The pants and socks meet to prevent ticks or other
wound will be properly cleaned at a medical facility. insects from getting under clothing.
Contact animal control authorities, if possible Inspect yourself carefully for insects or ticks
and if necessary, and provide a description of the after being outdoors or have someone else do
animal and the area in which the animal was last it. If you are outdoors for a long period of
seen. In some jurisdictions, if you need to contact time, check yourself several times during the
EMS personnel about an animal wound, they will day. Check especially in moist, hairy areas of
also contact animal control authorities. the body (including the back of the neck and
the scalp line).
Shower immediately after coming indoors, us-
Human Bites ing a washcloth to scrub off any insects or
ticks. Carefully inspect yourself for embedded
Human bites are quite common. Human bites differ ticks and remove them appropriately.
from other bites in that they may be more contami- Keep an eye out for and avoid the nests of
nated, tend to occur in higher-risk areas of the body wasps, bees and hornets.
(especially on the hands) and often receive delayed If you have pets that go outdoors, spray them
care. At least 42 different species of bacteria have been with repellent made for your type of pet. Ap-
reported in human saliva, so it is not surprising that ply the repellent according to the label, and
serious infection often follows a human bite. Accord- check your pet for ticks often.
ing to the Centers for Disease Control and Prevention When hiking in woods and fields, stay in the
(CDC), human bites are not considered to carry a risk middle of trails. Avoid underbrush, fallen trees
of transmitting human immunodeficiency virus (HIV), and tall grass.
the virus that causes the acquired immunodeficiency Avoid walking in areas known to be populated
syndrome (AIDS). Children are often the inflictors and with snakes.
the recipients of human bite wounds. Make noise as you walk through areas that may
As with animal bites, it is important to get the be populated with snakes, because many snakes
victim of a human bite to professional medical care will retreat if they detect your movement.
as soon as possible so that antibiotic therapy can be If you encounter a snake, look around, because
prescribed, if necessary. If the wound is not severe, other snakes may be nearby. Turn around and
wash it with soap and water, control any bleeding, walk away, back on the same path you were
apply triple antibiotic ointment and a dressing and just on.
If you will be in a grassy or wooded area for protective footwear in the water—especially at
a length of time or if you know the area is highly times when or in areas where there is a high risk of
infested with insects or ticks, you may want to use such occurrences.
a repellent. Diethyltolumide (DEET) is an active in- To prevent dog bites, the Humane Society of the
gredient in many skin-applied repellents that are ef- United States offers the following guidelines:
fective against ticks and other insects. Repellents
Do not run past a dog. The dog’s natural in-
containing DEET can be applied on exposed areas
stinct is to chase and catch prey.
of skin and clothing. However, repellents contain-
If a dog threatens you, do not scream. Avoid
ing permethrin, another common repellent, should
eye contact, try to remain motionless until the
be used only on clothing.
dog leaves, then back away slowly until the
If you use a repellent, follow these general rules:
dog is out of sight.
Keep all repellents out of the reach of children. Do not approach a strange dog, especially one
To apply repellent to the face, first spray it on that is tied or confined.
your hands and then apply it from your hands Always let a dog see and sniff you before you
to your face. Avoid sensitive areas, such as the pet the animal.
lips, eyes and near the mouth.
Many of the dog bites that are reported in the
Never spray repellents containing permethrin
United States each year could have been prevented
on your skin or a child’s skin.
by taking these precautions.
Never use repellents on a wound or on irri-
tated skin.
Never put repellents on children’s hands. Chil-
dren may put their hands in their eyes or mouth. SUMMARY
Use repellents sparingly and according to label
instructions. Heavier or more frequent applica- Bites and stings are one of the most common types
tions will not increase effectiveness and may be of injected poisonings. For suspected injected poi-
toxic. sonings, call the local or national poison control
Wash treated skin with soap and water and re- center or local emergency number. Remember, the
move clothes that have been treated after you best way to avoid any kind of poisoning is to take
come indoors. steps to prevent it.
If you suspect you are having an allergic reac-
tion to a repellent, wash the treated skin im-
mediately and call a physician.
To prevent stings from marine animals, you
might consider wearing a wet suit or dry suit or
1. Given the details of the scenario, what do you 3. What should Darrell consider when deciding
think caused Tonya’s injury? how to get professional medical help for Tonya?
2. How should Darrell care for Tonya’s injury? 4. What could Tonya have done to help prevent her
injury?
STUDY QUESTIONS
a. Injected poison
b. Lyme disease
c. Antivenin
d. Rabies
e. Rocky Mountain spotted fever
_____ An illness people get from the bite of a specific type of infected tick; victims may or may not develop a
rash.
_____ A poison introduced into the body through bites, stings or a hypodermic needle.
_____ A substance used to counteract the poisonous effects of snake, spider or insect venom.
_____ A disease transmitted by a certain kind of tick; victims develop a spotted rash.
_____ A disease caused by a virus transmitted through the saliva of infected mammals.
2. List the steps of care for a tick bite.
3. Describe at least four ways to prevent bites and stings.
4. List three signals of common types of bites and stings.
5. List the steps of care for a snakebite.
6. You are playing with your 5-year-old sister at a neighborhood park. Suddenly, a dog runs out of the bushes,
jumps on your sister and bites her on the cheek. The wound is deep and bleeding heavily.
What should you do? Write your answer on the lines below the scenario.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
7. In caring for a bee sting, what should you do?
a. Remove the remaining stinger by scraping it from the skin.

b. Remove the remaining stinger using tweezers.
c. Pull the stinger out with your bare hands.
d. Rub over the stinger with an alcohol swab.
8. When spending time outdoors in woods or tall grass, what should you do to prevent bites and stings?
a. Wear light-colored clothing.

b. Use insect or tick repellent.
c. Tuck pant legs into boots or socks.
9. Which of the following are signals of Lyme disease?
a. Trouble breathing
b. Headache, fever, weakness, joint and muscle pain
c. Paralysis
d. Sneezing
10. Which of the following should you do to care for a scorpion sting?
a. Apply suction to the wound.

b. Wash the wound and apply a cold pack.
d. b and c.
11. Which of the following should you apply to a jellyfish, sea anemone or Portuguese man-of-war sting?
a. Vinegar
b. Meat tenderizer
c. Baking soda paste
d. a or c
12. Which of the following should you do to care for a severe human bite?
a. Wash the wound with an antiseptic.

b. Control bleeding and follow standard precautions to prevent disease transmission.
c. Call 9-1-1 or the local emergency number immediately.
d. b and c.

Chapter 18
As she entered the room, Susan felt nervous. In fact, she’d felt too nervous
to eat much all day. This was her first off-campus party. Luckily, she knew a
few people, and one of them, Alicia, spotted her and shoved a cold beer into
her hand. Susan gulped it gratefully and began to feel less nervous almost at
once. The next drink was something a little more exotic, but it tasted just
fine—so did the next one and the beer after that. “I’ve got to sit down,” she
muttered to the group. The room had begun to spin. Susan just made it to
the bathroom when she collapsed onto the floor. Two of her friends found
her and tried to rouse her, but Susan was totally limp and unresponsive.
Substance
Misuse and
Abuse
Objectives
■ Identify the six main categories of commonly misused or abused
substances.
■ Identify the signals that may indicate substance misuse or abuse.
■ Describe how to care for someone who you suspect or know is
misusing or abusing a substance.
■ Explain how you can help prevent substance abuse or misuse.
Introduction Because of the publicity they receive, we

tend to think of illegal drugs when we hear of
substance abuse or misuse. However, legal
substances are among those most often
Substance misuse is the use of a substance for
unintended purposes or for appropriate misused or abused. Such legal substances
purposes but in improper amounts or doses. include nicotine (found in tobacco products),
Substance abuse is the deliberate, persistent alcohol (found in beer, wine and liquor) and
and excessive use of a substance without over-the-counter medications, such as aspirin,
regard to health concerns or accepted medical sleeping pills and diet pills.
practices. Substance abuse and misuse cost the This chapter will address how to recognize
United States billions of dollars each year in common forms of substance abuse and
medical care, insurance and lost productivity. misuse, how to care for their victims and how
Even more important, however, are the lives to prevent substance misuse and abuse.
lost or permanently impaired each year from
injuries or medical emergencies related to
substance abuse or misuse.
K E Y T E R M S
Addiction: The compulsive need to use a sub- Narcotics: Drugs that dull the senses and are pre-
stance. Stopping use would cause the user to scribed to relieve pain.
suffer mental, physical and emotional distress. Overdose: An excess use of a drug, resulting in ad-
Cannabis products: Substances, such as marijuana verse reactions ranging from mania and hysteria
and hashish, that are derived from the Cannabis to coma and death. Specific reactions to an
sativa plant and can produce feelings of elation, overdose include changes in blood pressure and
distorted perceptions of time and space, and im- heartbeat, sweating, vomiting and liver failure.
paired motor coordination and judgment. Stimulants: Substances that affect the central ner-
Dependency: When one using a drug becomes vous system and increase physical and mental
physically and psychologically addicted to the activity.
drug. Substance abuse: The deliberate, persistent, exces-
Depressants: Substances, such as tranquilizers and sive use of a substance without regard to health
sleeping pills, that cause the central nervous sys- concerns or accepted medical practices.
tem to slow down physical and mental activity. Substance misuse: The use of a substance for un-
Drug: Any substance, other than food or water, in- intended purposes, or for intended purposes but
tended to affect the functions of the body. in improper amounts or doses.
Hallucinogens: Substances that affect mood, sensa- Synergistic effect: The interaction of two or more
tion, thought, emotion and self-awareness; alter drugs to produce a certain effect.
perceptions of time and space; and produce hal- Tolerance: The body becomes resistant to a drug
lucinations and delusions. Also known as psy- or other substance because of continued use.
chedelics. Withdrawal: The condition produced when a per-
Inhalants: Substances, such as glue and paint thin- son stops using or abusing a substance to which
ners, inhaled to produce a mood-altering effect. he or she is addicted.
Medication: A drug given therapeutically to pre-
vent or treat the effects of a disease or condi-
tion, or otherwise enhance mental or physical
well-being.
CHAPTER 18 Substance Misuse and Abuse 335
out of school; adolescent pregnancy; suicide; in-

EFFECTS OF SUBSTANCE MISUSE volvement in crime; and transmission of the human
AND ABUSE immunodeficiency virus (HIV), the virus that causes
acquired immunodeficiency syndrome (AIDS).
Substance abuse and misuse pose a very serious
threat to the health of millions of Americans. Ac-
cording to the Drug Abuse Warning Network
(DAWN), drug-related emergency department ad-
FORMS OF SUBSTANCE MISUSE
missions are at an all-time high. The number of AND ABUSE
emergency department patients who say that they
have used illegal substances has risen dramatically. Many substances that are abused or misused are not
The greatest increase is in the number of people illegal. Other substances are legal only when pre-
who admit to using cocaine and crack—more than scribed by a physician. Some are illegal only for
a 47 percent increase since 1995. underage users (for example, alcohol). Figure 18-1
According to the National Vital Statistics Re- shows some commonly misused and abused sub-
ports, over 40,000 Americans died as a result of stances that are legal.
drug- or alcohol-induced deaths in 2001. This figure A drug is any substance, other than food or wa-
does not include unintentional injuries, homicides ter, taken to affect body functions. A drug given
and other causes indirectly related to drug use. Ex- therapeutically to prevent or treat the effects of a
perts estimate that as many as two-thirds of all disease or condition or otherwise enhance mental or
homicides and serious assaults occurring annually physical well-being is a medication. Any drug can
involve alcohol alone. Other problems directly or in- cause dependency, when one using a drug becomes
directly related to substance abuse include dropping physically and psychologically addicted to the drug.
Figure 18-1 Misused and abused substances.

Figure 18-2 Substance abuse and misuse involve a broad range of improperly
used legal and illegal substances.
The victim feels that he or she needs the drug to The term withdrawal describes the condition
function normally. Those with a compulsive need produced when a person suddenly stops using or
for a substance and who would suffer mental, phys- abusing a drug to which he or she is addicted. Stop-
ical and emotional distress if they stopped taking ping the use of a substance may occur as a deliber-
it are said to have an addiction to that substance. ate decision or because the person is unable to
Figure 18-2 shows a variety of legal and illegal sub- obtain the specific drug. Withdrawal from certain
stances that are commonly misused. substances, such as alcohol, can cause severe men-
When one continually uses a substance, its ef- tal and physical discomfort. Because withdrawal
fects on the body decrease—the condition is called may become a serious medical condition, medical
tolerance. The person then has to increase the dose professionals often oversee the process.
and frequency of the substance to obtain the in-
tended effect.
An overdose occurs when someone uses an ex-
cessive amount of a drug. Adverse reactions range
from mania and hysteria to coma and death. Spe-
cific reactions include changes in blood pressure
and heartbeat, sweating, vomiting and liver failure.
An overdose may occur unintentionally if a person
takes too much medication at one time, for exam-
ple, when someone forgets that he or she took one
dose of a medication and takes an additional dose
too soon (Fig. 18-3).
An overdose may also be intentional, such as in
suicide attempts. Sometimes the victim takes a suf-
ficiently high dose of a substance to be certain to
cause death. Other times, to gain attention or help,
the victim takes enough of a substance to need med- Figure 18-3 Overdose can occur when a person unin-
ical attention but not enough to cause death. tentionally takes an extra dose.
A heightened or exaggerated effect may be pro-

duced when two or more substances are used at the
same time. This is called a synergistic effect. The
drug most commonly used in combination with
other drugs is alcohol.
MISUSED AND ABUSED SUBSTANCES

Substances are categorized according to their effects
on the body. The six major categories are stimulants,
hallucinogens, depressants, narcotics, inhalants and
cannabis products. The category to which a substance
belongs depends mostly on the way the substance is Figure 18-4 Medication used to treat asthma is a
taken or the effects it has on the central nervous sys- common legal stimulant.
tem. Some substances depress the nervous system,
whereas others speed up its activity. Some are not eas-
ily categorized because they have various effects or
may be taken in a variety of ways. Table 18-1 lists found in tobacco products. Other stimulants used
commonly abused and misused substances. for medical purposes are asthma medications or de-
congestants that can be taken by mouth or inhaled
(Fig. 18-4).
Stimulants
Stimulants are drugs that affect the central nervous Hallucinogens
system by increasing physical and mental activity.
They produce temporary feelings of alertness and Hallucinogens, also known as psychedelics, are
prevention of fatigue. They are sometimes used for substances that cause changes in mood, sensation,
weight reduction because they also suppress ap- thought, emotion and self-awareness. They alter
petite. one’s perception of time and space and may pro-
Many stimulants are ingested as pills, but duce visual, auditory and tactile delusions.
some can be absorbed or inhaled. Amphetamines, Hallucinogens often have physical effects simi-
dextroamphetamines and methamphetamines are lar to stimulants but are classified differently be-
stimulants. Their slang names include uppers, cause of the other effects they produce. Hallucino-
bennies, black beauties, speed, crystal, meth and gens sometimes cause what is called a “bad trip.” A
crank. One dangerous stimulant is called ice. Ice is bad trip can involve intense fear, panic, paranoid
an extremely addictive, smokeable form of meth- delusions, vivid hallucinations, profound depres-
amphetamine. sion, tension and anxiety. The victim may be irra-
Cocaine is one of the most publicized and pow- tional and feel threatened by any attempt others
erful stimulants. Cocaine can be taken into the body make to help.
in different ways. The most common way is sniffing Among the most widely abused hallucinogens
it in powder form, a practice known as snorting. In are lysergic acid diethylamide (LSD), called acid;
this method, the drug is absorbed into the blood psilocybin, called mushrooms; phencyclidine (PCP),
through capillaries in the nose. A purer and more called angel dust; and mescaline, called peyote, but-
potent form of cocaine is crack. Crack is smoked. tons or mesc. These substances are usually ingested,
The vapors that are inhaled into the lungs reach the but PCP also can be inhaled.
brain and cause almost immediate effects. Crack is
highly addictive.
Interestingly, the most common stimulants in Depressants
America are legal. Leading the list is caffeine, which
is present in coffee, tea, many kinds of sodas, Depressants are substances that affect the central
chocolate, diet pills and pills used to combat fa- nervous system by decreasing physical and mental
tigue. The next most common stimulant is nicotine, activity. Depressants are commonly used for med-
Table 18-1 Commonly Misused and Abused Substances

CATEGORY SUBSTANCES POSSIBLE EFFECTS
Stimulants Caffeine Increase mental and physical activity, produce temporary

Cocaine, crack cocaine feelings of alertness, prevent fatigue, suppress appetite.
Methamphetamines
Amphetamines
Dextroamphetamines
Nicotine
Over-the-counter diet aids
Asthma treatments
Hallucinogens LSD (lysergic acid diethylamide) Cause changes in mood, sensation, thought, emotion and
PCP (phencyclidine) self-awareness; alter perceptions of time and space; may
Mescaline produce profound depression, tension and anxiety, as
Peyote well as visual, auditory or tactile hallucinations.
Psilocybin
Depressants Barbiturates Decrease mental and physical activity, alter consciousness,

Narcotics relieve anxiety and pain, promote sleep, depress respira-
Alcohol tion, relax muscles and impair coordination and
Antihistamines judgment.
Sedatives
Tranquilizers
Over-the-counter sleep aids
Narcotics Morphine Relieve pain, may produce stupor or euphoria, may cause
Codeine coma or death and are highly addictive.
Heroin
Methadone
Opium
Inhalants Medical anesthetics Alter moods; may produce a partial or complete loss of
Gasoline and kerosene feeling; may produce effects similar to drunkenness,
Glues in organic cements such as slurred speech, lack of inhibitions and impaired
Lighter fluid motor coordination. Can also cause damage to the
Paint and varnish thinners heart, lungs, brain and liver.
Aerosol propellants
ical purposes. They relieve anxiety, promote sleep, amounts, its effects may be fairly mild. In higher
depress respiration, relieve pain, relax muscles and amounts, its effects can be toxic.
impair coordination and judgment. Like other sub- Alcohol is like other depressants in its effects
stances, the larger the dose or the stronger the sub- and risks for overdose. Frequent drinkers may be-
stance, the greater its effects. Common depressants come dependent on the effects of alcohol and in-
are barbiturates, benzodiazepines, narcotics and creasingly tolerant of those effects. Drinking alco-
alcohol. Most depressants are ingested or injected. hol frequently or in large amounts causes many
Alcohol is the most widely used and abused unhealthy consequences. Alcohol poisoning can oc-
substance in the United States (Fig. 18-5). In small cur when a large amount of alcohol is consumed in
Table 18-1 Commonly Misused and Abused Substances (Continued)

CATEGORY SUBSTANCES POSSIBLE EFFECTS
Cannabis products Hashish Produce feelings of elation, increase appetite, distort per-
Marijuana ceptions of time and space and impair motor coordina-
THC (tetrahydrocannabinol) tion and judgment. May irritate throat, redden eyes, in-
crease pulse and cause dizziness.
Other MDMA (methylenedioxymeth- Elevate blood pressure and produce euphoria or erratic
amphetamine or ecstasy) mood swings, rapid heartbeat, profuse sweating, agita-
tion and sensory distortions.
Anabolic steroids Enhance physical performance, increase muscle mass and
stimulate appetite and weight gain. Chronic use can
cause sterility, disruption of normal growth, liver cancer,
personality changes and aggressive behavior.
Aspirin Relieve minor pain and reduces fever. Can impair normal
blood clotting and cause inflammation of the stomach
and small intestine.
Laxatives Relieve constipation. Can cause uncontrolled diarrhea and
dehydration.
Decongestant nasal sprays Relieve congestion and swelling of nasal passages.
Chronic use can cause nosebleeds and changes in the
lining of the nose, making breathing difficult without
sprays.
Figure 18-5 Alcohol is the most widely used and

abused substance in the United States.
a short period of time. Alcohol poisoning can result B

in unconsciousness and, if untreated, death.
Chronic drinking can also affect the brain and
cause a lack of coordination, memory loss and apa-
thy. Other problems include liver disease, such as
cirrhosis (Fig. 18-6, A and B). In addition, many
psychological, family, social and work problems are Figure 18-6 A, Chronic drinking can result in cirrhosis,
related to chronic drinking. a disease of the liver. B, A healthy liver.
The Incalculable Cost of Alcohol Abuse

The hospital morgue is full: a teenager who drowned 25 years. Nearly one-third of all drownings involve
while boating, an elderly man who died of a chronic alcohol. In 2002, alcohol was involved in at least
liver disease, and a woman who was shot by her 39 percent of all boating fatalities, making alcohol
boyfriend. The victims seem to share no connection the ninth leading cause of boating accidents.
other than that each body lies in the same morgue. Studies have shown that reckless and violent be-
But there is a connection: alcohol. havior have been linked to alcohol abuse. Nearly
Public health officials are seeing a growing num- one-half of all homicides, one-third of all suicides
ber of injuries, illnesses and other social problems in and two-thirds of all assaults involve alcohol. One of
which alcohol plays a role. More than 100,000 peo- the best predictors of violence is alcohol abuse.
ple die each year from alcohol-related causes. From Crime and other social problems are also linked to
the child abused by her alcoholic parent to the driver alcohol. Social workers find alcohol abuse a factor in
who drinks and causes a six-car pileup, our country nearly 50 percent of child abuse cases. Alcohol
feels the impact of alcohol abuse. abuse ranges from 20 percent to 45 percent among
Each year, alcohol-related motor vehicle crashes the homeless.
result in approximately 17,500 deaths in the United These personal and social consequences to alco-
States. According to the Centers for Disease Control hol abuse create a tremendous economic burden.
and Prevention (CDC), alcohol impaired driving is the According to the National Institute on Drug Abuse,
highest among drivers ages 21 to 24 years, and is a the cost of alcohol addiction runs an estimated
leading cause of death among persons ages 16 to $118 billion annually. This cost is associated with
Narcotics
One of the most detrimental effects of long-term
Narcotics, derived from opium, are drugs that work heroin use is addiction. A person who uses heroin
on the central nervous system to relieve pain. Nar- on a regular basis develops a tolerance for the drug
cotics are so powerful and highly addictive that all and must use increasingly larger doses to achieve
are illegal without a prescription, and some are not the same intensity of his or her first “rush.” Over
prescribed at all. When taken in large doses, nar- time, the person becomes physically dependent on
cotics can produce euphoria, stupor, coma or death. the drug. In some cases, the dependency can be so
The most common natural narcotics are morphine strong that a person begins to experience signals of
and codeine. Most other narcotics, including withdrawal within hours after his or her last dose.
heroin, are synthetic or semisynthetic.
Heroin abuse is associated with serious health
conditions such as fatal overdoses, spontaneous Inhalants
abortion, collapsed veins and infectious diseases
such as HIV and hepatitis B. Other possible effects Substances inhaled to produce mood-altering effects
of long-term abuse include infection of the heart lin- are called inhalants. Inhalants also depress the cen-
ing and valves, abscesses and liver disease. In addi- tral nervous system. Inhalants include medical anes-
tion, street heroin may have additives that do not thetics, such as amyl nitrite and nitrous oxide (also
readily dissolve in the bloodstream, which could known as laughing gas), as well as hydrocarbons,
create a blockage in blood vessels leading to vital known as solvents. Solvents’ effects are similar to
organs, such as the lungs, heart or brain. those of alcohol. People who use solvents may ap-
time missed from work, reduced job productivity, SOURCES

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance
medical bills, support for families and property dam- System survey data. U.S. Department of Health and Human Services, 1999,
age. www.cdc.gov/brfss. Accessed 08/31/04.
Centers for Disease Control and Prevention, “Measures of Alcohol Consumption
In terms of economic cost, lives and productivity, and Alcohol-Related Health Effects from Excessive Consumption,” U.S. Depart-
alcohol abuse outdistances cocaine, heroin and all ment of Health and Human Services.
www/cdc.gov/alcohol/factsheets/general_information htm. Accessed 08/31/04.
other drugs. National Center for Injury Prevention and Control, Water Related Injuries Fact
Health-care costs account for $15 billion to $20 bil- Sheet, U.S. Department of Health and Human Services,
www.cdc.gov/ncipc/factsheets/drown.htm. Accessed 08/31/04.
lion of alcohol costs, and research documenting the United States Coast Guard, Boating Statistics—2003, U.S. Department of
detrimental health effects of alcohol is growing. Physi- Homeland Security. Accessed 10/08/04.
www.uscgboating.org/statistics/Boating_Statistics_2003.pdf. Accessed
cians now say that even moderate drinking increases 12/14/04.
risks of high blood pressure, cirrhosis of the liver and
decreased motor development for children whose
mothers drink while pregnant. Prolonged or heavy
drinking can cause serious long-term effects, includ-
ing risk of heart attack; many cancers; stroke; gas-
trointestinal bleeding; kidney failure; and problems of
the nervous system, such as tremors and dementia.
pear to be drunk. Solvents include toluene, found in throat; reddens the eyes; and causes a rapid pulse,
glues; butane, found in lighter fluids; acetone, found dizziness and often an increased appetite. Depend-
in nail polish removers; fuels, such as gasoline and ing on the dose, the user and many other factors,
kerosene; and propellants, found in aerosol sprays. cannabis products can produce effects similar to
The use of inhalants can damage the heart, those of other substances.
lungs, brain and liver. Abusing specific solvents can Marijuana, although illicit, has been used for
also lead to irreversible hearing loss and uncontrol- some medicinal purposes. Marijuana or its legal syn-
lable spasms in the arms and legs. thetic versions are used as an antinausea medication
for people who are undergoing chemotherapy for
cancer, for treating glaucoma, for treating muscular
Cannabis Products weakness caused by multiple sclerosis, and to com-
bat the weight loss caused by cancer and AIDS.
Cannabis products, including marijuana, tetrahy-
drocannabinol, or THC, and hashish are all derived
from the plant Cannabis sativa. Marijuana is the Other Substances
most widely used illicit drug in the United States. It
is typically smoked in cigarette form or in a pipe. Some other substances do not fit neatly into these
The effects include feelings of elation, distorted per- categories. These substances include designer drugs,
ceptions of time and space and impaired judgment steroids and over-the-counter substances that can
and motor coordination. Marijuana irritates the be purchased without a prescription.
lating weight gain for persons unable to gain

Designer Drugs weight naturally. They should not be confused with
Designer drugs are variations of other substances, corticosteroids, which are used to counteract the
such as narcotics and amphetamines. Through sim- toxic effects of and allergic reactions to absorbed
ple and inexpensive methods, the molecular struc- poisons, such as poison ivy. Chronic use of ana-
ture of substances produced for medicinal purposes bolic steroids can lead to sterility, liver cancer and
can be modified by chemists to produce extremely personality changes, such as aggressive behavior.
potent and dangerous street drugs; hence the term Steroid use by younger people may also disrupt
designer drug. When the chemical makeup of a normal growth.
drug is altered, the user can experience a variety of
unpredictable and dangerous effects. The chemist
may have no knowledge of the effects a new de-
Over-the-Counter Substances
signer drug might produce. One designer drug, a Aspirin, laxatives and nasal sprays are among the
form of the commonly used surgical anesthetic fen- most commonly misused or abused over-the-
tanyl, can be made 2000 to 6000 times stronger counter substances. Aspirin is an effective minor
than its original form. pain reliever and fever reducer that is found in a
One of the more commonly used designer drugs variety of medicines. People use aspirin for many
is methylenedioxymethamphetamine (MDMA), reasons and conditions. In recent years, cardiolo-
often called ecstasy. Although ecstasy is struc- gists have praised the benefits of aspirin for the
turally related to stimulants and hallucinogens, treatment of heart disease. As useful as aspirin
its effects differ somewhat from either category. is, misuse can have toxic effects on the body. Typi-
Ecstasy can evoke a euphoric high that makes it cally, aspirin can cause inflammation of the
popular. Other signals of ecstasy use range from stomach and small intestine that results in bleeding
the stimulant-like effects of increased blood pres- ulcers. Aspirin can also impair normal blood
sure, rapid heartbeat, profuse sweating and agita- clotting.
tion to the hallucinogenic-like effects of paranoia, Laxatives are used to relieve constipation. They
sensory distortion and erratic mood swings. come in a variety of forms and strengths. If used
improperly, laxatives can cause uncontrolled diar-
rhea that may result in dehydration. The very
Anabolic Steroids young and the elderly are particularly susceptible
Anabolic steroids are drugs sometimes used by ath- to dehydration.
letes to enhance performance and increase muscle The abuse of laxatives is frequently associated
mass (Fig. 18-7). Their medical uses include stimu- with attempted weight loss and eating disorders,
such as anorexia nervosa or bulimia. Anorexia
nervosa is a disorder that typically affects young
women and is characterized by a long-term refusal
to eat food with sufficient nutrients and calories.
Anorexics typically use laxatives to keep from
gaining weight. Bulimia is a condition in which vic-
tims gorge themselves with food, then purge by
vomiting or using laxatives. For this reason, the be-
havior associated with bulimia is often referred to
as “binging and purging.” Anorexia nervosa and
bulimia both have underlying psychological factors
that contribute to their onset. The effect of both of
these eating disorders is severe malnutrition, which
can result in death.
Antihistamines, such as decongestant nasal
sprays, can help relieve the congestion of colds or
Figure 18-7 Anabolic steroids are drugs sometimes hay fever (Fig. 18-8). If misused, they can cause
used by athletes to enhance performance and increase physical dependency. Using the spray over a long
muscle mass. period can cause nosebleeds and changes in the lin-
and breathing rates and poor coordination. A per-

son who abuses alcohol may smell of alcohol. A
person who has consumed a great deal of alcohol in
a short time may be unconscious or hard to arouse.
The person may vomit violently.
Specific signals of alcohol withdrawal, a poten-
tially dangerous condition, include confusion and
restlessness, trembling, hallucinations and seizures.
CARE FOR SUBSTANCE MISUSE

AND ABUSE
Figure 18-8 Antihistamines, such as nasal sprays, are
used to relieve the congestion of colds and allergies but, As in other medical emergencies, you do not have to
if misused, can cause dependency. diagnose substance misuse or abuse to give care.
Follow these general principles as you would for
any poisoning:
ing of the nose that make breathing difficult with-
Check the scene to be sure it is safe to help
out the spray.
the person. Do not approach the victim
if he or she is behaving in a threatening
SIGNALS OF SUBSTANCE MISUSE manner.
Call 9-1-1, the local emergency number or
AND ABUSE the poison control center.
Check for any life-threatening conditions.
Care for any conditions you find.
Many of the signals of substance misuse and abuse
are similar to those of other medical emergencies. Because many of the physical signals of sub-
You should not necessarily assume that someone stance abuse mimic other conditions, you should
who is stumbling, is disoriented or has a fruity, not assume that a victim has overdosed on a sub-
alcohol-like odor on the breath is intoxicated by stance. Always check for life-threatening conditions
alcohol or other drugs. Instead, he or she may be a and give care as you would for any victim of a sud-
victim of a diabetic emergency (see Chapter 15). den illness or injury.
The misuse or abuse of stimulants can have People who misuse or abuse substances may be-
many unhealthy effects on the body, which mimic come aggressive or uncooperative. If the person be-
other conditions. For example, a stimulant over- comes agitated or makes the scene unsafe in any
dose can cause moist or flushed skin, sweating, way, go to a safe place and wait for EMS personnel
chills, nausea, vomiting, fever, headache, dizziness, and the police. Give care only if you feel the person
rapid pulse, rapid breathing, high blood pressure is not a danger to you and others.
and chest pain. In some instances, a stimulant over- If possible, interview the victim or bystanders to
dose can cause respiratory distress, disrupt normal try to find out what substance was taken, how
heart rhythms or cause death. The victim may ap- much was taken and when it was taken. You may
pear very excited, restless, talkative or irritable or be able to find clues that suggest the nature of the
the victim may suddenly lose consciousness. Stimu- problem. Such clues may help you provide more
lant abuse can lead to addiction and can cause a complete information to EMS personnel. Look for
heart attack or stroke. containers, pill bottles, drug paraphernalia and sig-
Specific signals of hallucinogen abuse may in- nals of other medical problems. If you suspect that
clude sudden mood changes and a flushed face. The someone has used a designer drug, tell EMS per-
victim may claim to see or hear something not pre- sonnel. Telling EMS personnel your suspicions is
sent. He or she may be anxious and frightened. important because a person who has overdosed on
Specific signals of depressant abuse may include a designer drug frequently may not respond to usual
drowsiness, confusion, slurred speech, slowed heart medical treatment.
Steroids: Body Meltdown

If you think using steroids is the way to get those in larger doses than ever before and at younger ages.
sculpted, muscular bodies that are typical of body- Although both young males and females abuse
builders and many professional athletes, think again. steroids, the abuse of steroids among young males is
These drugs may build up bodies on the outside, but becoming as prevalent as eating disorders have be-
they can cause a body meltdown on the inside. Physi- come in young females.
cians and other public health officials warn of the Before you listen to another person’s justification of
dangers of steroid abuse and are particularly con- steroids, consider these effects:
cerned about the long-term effects of high doses. • Stunted growth. In children, steroids cause the
Anabolic steroids are synthetic chemicals that mimic growth plates in the bones to close prematurely.
the hormone testosterone. Testosterone gives a male As a teenager, you may have been destined to be
his masculine characteristics—deeper voice, beard 6-foot-4, but taking steroids can permanently stunt
and mustache and other sex characteristics. Anabolic your growth.
steroids have several legitimate, legal uses. They are • Heart disease and stroke. Steroids cause danger-
prescribed by physicians to treat skeletal and growth ous changes in cholesterol levels. One study found
disorders, certain types of anemia, some kinds of dramatic drops in the amount of good cholesterol or
breast cancer and to offset the negative effects of high-density lipoprotein (HDL), which helps remove
irradiation and chemotherapy. the fatty deposits on the artery walls, in steroid
Steroids are also used illegally to create proteins users. The research also shows dramatic increases
and other substances that build muscle tissue, which in bad cholesterol or low-density lipoprotein (LDL),
is why they are popular with some athletes and body- which clogs the arteries and causes heart prob-
builders. In recent years, several professional athletes lems. Your steroid-doped body may look fine on the
have made the headlines because of their abuse of outside, but inside it may look like the body of a
steroids. Physicians are now getting a better idea of man in his 50s whose arteries are so clogged that
the devastating effects that illegal steroids can have he needs heart surgery.
on the body. The problem is that some young athletes • Aggressive personality and psychological
and bodybuilders are listening to their gym buddies disorders. Some people who take anabolic steroids
rather than their physicians. Steroids are being used become unnaturally aggressive. A few have devel-
PREVENTING SUBSTANCE ABUSE have not by themselves proved particularly effec-

tive. To be effective, prevention efforts must address
Experts in the field of substance abuse generally the various underlying factors of and approaches to
agree that prevention efforts are far more cost ef- substance abuse.
fective than treatment. Yet, preventing substance The following factors may contribute to sub-
abuse is a complex process that involves many stance abuse:
underlying factors. Various approaches, including
educating people about substances and their effects A lack of parental supervision.
on health and attempting to instill fear of penalties, The breakdown of traditional family structures.
oped documentable mental disorders. In a Sports Steroids pose dangers beyond these physiological
Illustrated article, a South Carolina football player side effects. Because steroids are often sold on the
described his nightmare with steroids. He described black market, they are increasingly sold by drug traf-
pulling a gun on a pizza delivery boy in his dorm fickers who obtain their wares from unsanitary labora-
and how his family intervened when he began tories. Yet another danger comes from the fact that
threatening suicide. Many physicians feel the psy- sharing needles to inject steroids increases the trans-
chiatric effects of steroids may be their most mission of viruses such as HIV and hepatitis.
threatening side effect.
• Lowered white blood cell count. Taking steroids SOURCES
Altman L: New breakfast of champions: a recipe for victory or disaster?, The New
also reduces the number of white blood cells in York Times, November 20, 1988.
your body. With fewer white blood cells, your body Chaikin T, Telander R: The nightmare of steroids, Sports Illustrated, 69:18, 1988.
National Institute on Drug Abuse. “Anabolic steroids: a threat to body and mind.”
has fewer antibodies to fight off infections, includ- National Institutes of Health, No. 94-3721,1991. www.drugabuse.gov/
ing cancers and other diseases. ResearchReports/Steroids/AnabolicSteroids.html. Accessed 09/01/04.
USA Today, Vol. 121, No. 2573, February 1993.
• Sexual dysfunction and disorders. Synthetic
steroids cause your body to cut off its own natural
production of steroids, resulting in shrinking testi-
cles in men. Women may grow facial hair, breast
size may decrease and voice may become perma-
nently deeper. In both sexes, steroids may cause
sterility and reduced sexual interest.
• Impaired liver function and liver
disease. Steroids seriously
affect the liver’s ability to
function. They irritate
the liver, causing tissue
damage and an inability to
clear bile. Physicians also
have found blood-filled benign
tumors in the livers of steroid
users.
A wish to escape unpleasant surroundings and A history of substance abuse in the home or
stressful situations. community environments.
The widespread availability of substances.
Peer pressure and the basic need to belong. Recognizing and understanding these factors
Low self-esteem, including feelings of guilt or may help prevent substance abuse.
shame.
Media glamorization, especially of alcohol and
tobacco, promoting the idea that using sub-
stances enhances fun and popularity.
PREVENTING SUBSTANCE MISUSE

SOURCES OF HELP FOR VICTIMS Some poisonings from medicines occur when the
OF SUBSTANCE ABUSE victims knowingly increase the dosage beyond what
is directed. The best way to prevent such misuse is
Al-Anon Family Group Headquarters, Inc. to take medications only as directed. On the other
hand, many poisonings from medicinal substances
www.al-anon.org are not intentional. The following guidelines can
Alcoholics Anonymous help prevent unintentional misuse or overdose:
www.alcoholics-anonymous.org Read the product information and use prod-
Cocaine Anonymous ucts only as directed.
www.ca.org/phones.html Ask your physician or pharmacist about the in-
tended use and side effects of prescription and
Mothers Against Drunk Driving (MADD)
over-the-counter medications. If you are taking
www.madd.org.home more than one medication, check for possible
Narcotics Anonymous interaction effects.
www.na.org Never use another person’s prescribed medica-
tions; what is right for one person is seldom
National Council on Alcoholism and Drug right for another.
Dependence Helpline Always keep medications in their appropriate,
(800) 622-2255 marked containers.
Remove Intoxicated Drivers (RID) Destroy all out-of-date medications. Time can
alter the chemical composition of medications,
www.crisny.org/not-for-profit/ridusa
causing them to be less effective and possibly
Students Against Driving Drunk (SADD) even toxic.
www.saddonline.com Always keep medications out of the reach of
U.S. Department of Health and Human Services children.
Substance Abuse and Mental Health Services
Administration
www.samhsa.gov/index.aspx
SUMMARY
There are six major categories of substances that,
After a substance abuse emergency, the victim when abused or misused, can produce a variety of
may need additional support to overcome addic- signals, some of which are indistinguishable from
tion. If you know the victim, you may be able to those of other medical emergencies. Remember,
help him or her contact one of the many agencies you do not have to diagnose the condition to give
and organizations that offer ongoing assistance care. If you suspect that the victim’s condition is
caused by substance misuse or abuse, give care for
to victims of substance abuse. Community-based
a poisoning emergency. Call 9-1-1 or the local
programs through schools and religious institu- emergency number or poison control center per-
tions provide access to hot lines and local support sonnel and follow their directions. Also call the po-
groups. Some of the resources listed above may lice if necessary. If the victim becomes violent or
have facilities or contacts in your area. Look on threatening, go to a safe place and wait for EMS
the internet or in the advertising pages of the personnel and police to arrive.
telephone book under Counseling; Drug Abuse
and Addiction Information; Social Service Organi-
zations; or Clinics and Health Services for addi-
tional resources.
1. What are the signals of Susan’s condition? 3. Should Susan’s friends call 9-1-1 or the local
emergency number? Why or why not?
2. What do you think is the cause of Susan’s con-

dition? Can you be sure?
STUDY QUESTIONS
a. Addiction e. Overdose
b. Dependency f. Substance abuse
c. Medication g. Tolerance
d. Drug h. Withdrawal
_____ Deliberate, persistent, excessive use of a substance.
_____ A drug given to prevent or treat a disease, or otherwise enhance mental or physical well-being.
_____ Any substance other than food intended to affect the functions of the body.
_____ An excess use of a drug, resulting in adverse reactions ranging from mania and hysteria to coma and
death; specific reactions include changes in blood pressure and heartbeat, sweating, vomiting and liver
failure.
_____ The compulsive desire or need to use a substance.
_____ The condition produced when a person stops using or abusing a substance to which he or she is
addicted.
_____ A desire to continually use a substance, out of a feeling that it is needed to function normally.
_____ A condition that occurs when a substance user has to increase the dose and frequency of use of a sub-
stance to obtain the desired effect.
2. List four signals that might indicate substance abuse or misuse.
3. List four commonly misused or abused legal substances.
4. List four things you can do to prevent unintentional substance misuse.
5. Describe the care for a victim of suspected substance misuse or abuse.

6. Match each type of substance with the effects it has on the body.
a. Depressants d. Stimulants
b. Hallucinogens e. Narcotics
c. Inhalants f. Cannabis products
_____ Affect mood, sensation, thought, emotion and self-awareness; alter perception of time and space;
and produce hallucinations and delusions.
_____ Produce mood-altering effects similar to those of alcohol. Found in glues and solvents.
_____ Slow down the physical activities of the brain, producing temporary feelings of relaxation.
_____ Speed up the physical and mental activity of the brain, producing temporary feelings of alertness and
improved task performance.
_____ Relieve pain.
_____ Produce feelings of elation, disoriented perceptions of time and space and impaired judgment.
7. Which of the following is true of substance abuse?
a. It occurs only among the elderly who are forgetful and may have poor eyesight.
b. It is the use of a substance for intended purposes but in improper amounts or doses.
c. It is the use of a substance without regard to health concerns or accepted medical practices.
d. Its effects are minor and rarely result in medical complications.
8. The effects of designer drugs are—
a. Well-known.
b. Unpredictable.
c. Harmless.
d. Easily controlled.
9. Which of the following guidelines can help prevent unintentional substance misuse?
a. Read the product information and use only as directed.

b. Check for possible interaction effects if you are taking more than one medication.
c. Destroy all out-of-date medications.

hapte 199
Chapter
“Why did Mom decide the garden needed weeding today?” Cynthia
wondered to herself. “It must be in the 90s already and the humidity’s
awful!” “Oh well,” she thought, “I’ll help out here as long as Mom needs
me.” Then the phone rings and her mother, Louise, steps inside to
answer it. Still weeding, Cynthia begins to feel a little dizzy. Louise
returns to the garden to find Cynthia looking very pale. “Here, honey,”
Louise holds out her water bottle. “Take a little drink of water,” she
advises. Cynthia takes a sip. “It makes me feel sick,” she says.
Heat- and
Cold-Related
Emergencies
Objectives
■ Describe how body temperature is controlled.
■ Identify three main factors that influence how well the body
maintains its temperature.
■ Identify seven risk factors that increase a person’s susceptibility
to a heat- or cold-related emergency.
■ List the signals of heat cramps, heat exhaustion and heat stroke.
■ Describe the care for heat cramps, heat exhaustion and heat
stroke.
■ List the signals of frostbite and hypothermia.
■ Describe the care for frostbite and hypothermia.
■ Describe five ways to help prevent heat- and cold-related
emergencies.
Introduction its temperature by balancing heat loss with heat

production. The amount of heat exchanged be-
tween the environment and the body is determined
by the difference in temperature between the body
The human body is equipped to withstand and the environment.
extremes in temperature. Under normal Body heat is generated primarily through the con-
circumstances, its mechanisms for regulating version of food to energy. Heat is also produced by
body temperature work very well. However, muscle contractions, as in exercise or shivering. Be-
cause the body is usually warmer than the surround-
when the body is overwhelmed, a heat- or
ing air, it tends to lose heat to the air (Fig. 19-1). The
cold-related emergency can occur. A heat- heat produced in routine activities is usually enough
or cold-related emergency can happen to compensate for normal heat loss.
anywhere—indoors or outdoors and under a In a warm environment, a part of the brain
variety of conditions. The signals of a heat- or called the hypothalmus detects an increase in blood
cold-related emergency are progressive and temperature and sets a series of events in motion.
can quickly become life threatening. A person Blood vessels near the skin dilate, or widen, to bring
more blood to the surface, which allows heat to es-
can develop a heat- or cold-related emergency cape (Fig. 19-2, A). The body can also be cooled by
even when temperatures are not extreme. The sweat evaporating or by air moving over the skin.
effects of humidity, wind, clothing, living and When the body reacts to cold, blood vessels
working environments; physical activity; age; near the skin constrict (narrow) and move warm
and health all play a role in determining an blood to the center of the body. Thus, less heat es-
individual’s susceptibility. In this chapter, you capes through the skin, and the body stays warm
(Fig. 19-2, B). When constriction of blood vessels
will learn how to recognize and give care for a
fails to keep the body warm, the body shivers to
victim of a heat- or cold-related emergency. produce heat through muscle action.
Factors Affecting Body Temperature

HOW BODY TEMPERATURE IS Regulation
CONTROLLED Three main factors affect how well the body main-
tains its temperature:
In order to work efficiently, the human body must Air temperature.
maintain a constant temperature. Normal body Humidity.
temperature is 98.6º F (37º C). The body maintains Wind.
K E Y T E R M S
Frostbite: A condition in which body tissues Heat stroke: A life-threatening condition that de-
freeze; most commonly occurs in the fingers, velops when the body’s cooling mechanisms
toes, ears and nose. are overwhelmed and body systems begin to
Heat cramps: Painful spasms of skeletal muscles fail.
after exercise or work in warm or moderate Hypothalmus: Part of the brain that is responsible
temperatures; usually involve the calf and ab- for regulating body temperature.
dominal muscles. Hypothermia: A life-threatening condition in
Heat exhaustion: The early stage and most com- which the body’s warming mechanisms fail to
mon form of heat-related illness; often results maintain normal body temperature and the
from strenuous work or exercise in a hot envi- entire body cools.
ronment.
CHAPTER 19 Heat- and Cold-Related Emergencies 353
100
90
80
98.6F 72F
Body 70 Air temperature
temperature
60
50
40
30
20
10
Figure 19-1 Because the body is usually warmer than the surrounding air, it
tends to lose heat to the air.
A B
Skin surface Skin surface

Dilated l
b l o od vesse
Constricted blood vessel
Figure 19-2 A, Your body removes heat by dilating the blood vessels near the
skin’s surface. B, The body conserves heat by constricting the blood vessels near
the skin.
Relative humidity
20% 30% 40% 50% 60% 70% 80% 90% 100%
120
110 Extremely hot:

130 Heat stroke imminent.
Temperature (F)
100
If temperature is 85 105 Very hot: Heat cramps
and humidity or heat exhaustion
is 50%. . . likely.
90
90
Hot: Heat stroke, heat
cramps or heat
80 the temperature will exhaustion possible
feel as though it is 90. with prolonged
exposure, exercise.
70 Very warm: Fatigue

possible with
prolonged exposure.
Temperature (F)
50 40 30 20 10 0 10 20
0
Cold: Little danger of

hypothermia or frostbite
5 if properly clothed.
If temperature 9
10 is 30 and Very cold:
wind speed is Hypothermia and
15 mph. . . frostbite likely with
9 prolonged exposure.
15
Wind speed (mph)
the temperature will

32 feel as though it is 9.
20
25
Extremely cold:
30 Hypothermia and
frostbite imminent
without special
35 precautions.
40
Figure 19-3 Temperature, humidity and wind are the three main factors affecting
body temperature.
Extreme heat or cold accompanied by high hu- velop the first indications of illness. Many times,
midity or wind speed reduces the body’s ability to they may not even recognize the signals.
maintain temperature effectively (Fig. 19-3). Heat- or cold-related emergencies occur more
Other factors, such as the clothing you wear, frequently among the elderly, especially those living
how often you take breaks from exposure to ex- in poorly ventilated or poorly insulated buildings or
treme temperature, how much and how often you buildings with poor heating or cooling systems.
drink water and how intense your activity is, also Young children and people with health problems
affect how well the body manages temperature ex- are also at risk because their bodies do not respond
tremes. These are all factors you can control to pre- as effectively to temperature extremes.
vent heat- or cold-related emergencies.
People at Increased Risk

TYPES OF HEAT-RELATED EMERGENCIES
Heat cramps, heat exhaustion and heat stroke are
Although anyone can be at risk for heat- and cold- conditions caused by overexposure to heat. Heat
related illness, some people are at greater risk than cramps are the least severe but, if not cared for, may
others. People more susceptible to a heat- or cold- be followed by heat exhaustion and heat stroke.
related emergency include—
Those who work or exercise strenuously in a
warm or cold environment.
Heat Cramps
Elderly people.
Heat cramps are painful spasms of skeletal muscles.
Young children.
Heat cramps usually affect the legs and the abdo-
Those with predisposing health problems, such
men but they can occur in any voluntary muscle.
as diabetes or heart disease.
The exact cause of heat cramps is not known, al-
Those who have had a previous heat- or cold-
though it is believed to be a combination of loss of
related emergency.
fluid and salt from heavy sweating. Heat cramps
Those who have cardiovascular disease or
develop fairly rapidly and usually occur after heavy
other conditions that cause poor circulation.
exercise or work in warm or even moderate tem-
Those who take medications to eliminate wa-
peratures. The victim’s body temperature is usually
ter from the body (diuretics).
normal and the skin moist. However, heat cramps
Usually people seek relief from an extreme tem- may also indicate that a person is in the early stages
perature before they begin to feel ill. However, some of a more severe heat-related emergency.
people do not or cannot easily escape these ex- To care for heat cramps, have the victim rest
tremes (Fig. 19-4). Athletes and those who work comfortably in a cool place. Lightly stretch the mus-
outdoors often keep working even after they de- cle, then gently massage it (Fig. 19-5). Provide cool
Figure 19-4 In certain situations, it is difficult to escape Figure 19-5 Resting, lightly stretching and massaging
temperature extremes. the affected muscle and replenishing fluids are usually
enough for the body to recover from heat cramps.
water or a commercial sports drink that contains Heat exhaustion in its early stage can usually be
nutrients, such as carbohydrates, electrolytes and reversed with prompt care.
simple sugars, to replace those lost through heavy
sweating. Usually, rest and fluids are all the body
needs to recover. The victim should not take salt Late Stages of Heat-Related Illness
tablets or salt water. Ingesting high concentrations Heat stroke is the least common and most severe
of salt, whether in tablet or liquid form, can hasten heat-related emergency. Heat stroke most often oc-
the onset of heat-related illness. curs when people ignore the signals of heat exhaus-
When the cramps stop and no other signals of tion or do not act quickly enough to give care. Heat
illness are present, the person can usually resume stroke develops when the body systems are so over-
activity. The person should be watched carefully, taxed by heat that they begin to stop functioning.
however, for signals of developing heat-related ill- Sweating often stops because body fluid levels are
ness. He or she should continue to drink plenty of low. When sweating stops, the body cannot cool it-
fluids during and after activity. self effectively through evaporation. Body tempera-
ture rises quickly, soon reaching a level at which the
brain and other vital organs, such as the heart and
Heat-Related Illness kidneys, begin to fail. If the body is not cooled, con-
vulsions, coma and death will result. Heat stroke is
a serious medical emergency. You must recognize
Heat-related illness, if not cared for promptly, can
the signals of heat stroke and give care immediately.
get progressively worse in a very short period of
The signals of heat stroke include—
time. By recognizing the signals of the early stages
of heat-related illness and responding appropriately, Red, hot, dry or moist skin.
you may be able to prevent the condition from be- Changes in level of consciousness.
coming life threatening. Vomiting.
Early Stages of Heat-Related Illness

Heat exhaustion is the early stage and the most
Care for Heat-Related Illness
common form of heat-related illness. It typically oc-
Time is of the essence when caring for heat-related
curs after long periods of strenuous exercise or
illness. The longer a heat-related illness goes un-
work in a hot environment. Although heat exhaus-
treated, the worse the condition becomes. Specific
tion is commonly associated with athletes, it also af-
steps for care depend on whether you find a victim
fects firefighters, construction workers, factory
in the early or late stages of a heat-related illness.
workers and others who are very active and wear
heavy clothing in a hot, humid environment. How-
ever, strenuous activity is not a prerequisite for heat Care in Early Stages
exhaustion—it can happen when a person is relax-
If you recognize heat-related illness in its early
ing or standing still in the heat.
stages, you can usually reverse it. Follow these gen-
Heat exhaustion is an early indication that the
eral steps:
body’s temperature-regulating mechanism is becom-
ing overtaxed. It is not always preceded by heat Cool the body.
cramps. Over time, the victim loses fluid through Give fluids if the victim is conscious.
sweating, which decreases the blood volume. Blood Take steps to minimize shock.
flow to the skin increases, reducing blood flow to
Remove the victim from the hot environment
the vital organs. The circulatory system is affected,
and give him or her cool water to drink. Moving the
and the person goes into a form of shock (see Chap-
victim out of the sun or away from the heat allows
ter 9).
the body’s own temperature-regulating mechanisms
The signals of heat exhaustion include—
to recover, cooling the body more quickly. Loosen
Cool, moist, pale, ashen or flushed skin. any tight clothing and remove clothing soaked with
Headache, nausea, dizziness. perspiration. Apply cool, wet cloths, such as towels
Weakness, exhaustion. or sheets, to the wrists, ankles, armpits, groin and
Heavy sweating.
Although brief exposure to the Dermatology recommends year-

sun stimulates the skin to pro- round sun protection,
duce the vitamin D necessary including use of a high sun
for the healthy formation of protection factor (SPF) sun-
bones, prolonged exposure screen, for all individuals,
can cause problems such but particularly for those
as skin cancer and prema- who are fair-skinned and
ture aging—a classic case of sunburn easily. The Food and
too much of a good thing be- Drug Administration (FDA) has
ing bad. evaluated SPF readings and
There are two kinds of ultraviolet recognizes values between
(UV) light rays to be concerned about. 2 and 15. The American Cancer Society
Ultraviolet beta rays (UVB) are the burn-producing recommends an SPF containing a rating of 15 or
rays that more commonly cause skin cancer. These higher. To get a sense of the effectiveness of SPF, an
are the rays that damage the skin’s surface and SPF 4 blocks out 75 percent of the sun’s burning UV
cause blistering and perhaps peeling. The other rays, an SPF 15 blocks out 93 percent and an SPF
rays, ultraviolet alpha rays (UVA), have been her- 30 blocks out 97 percent of the burning UV rays.
alded by tanning salons as “safe rays.” Tanning For maximum effect, sunscreen should be applied
salons claim to use lights that only emit UVA rays. 20 to 30 minutes before exposure to the sun and
Although UVA rays may not appear as harmful as reapplied frequently. Swimmers should use sun-
UVB rays to the skin’s surface, they more readily screens labeled as water resistant and reapply them
penetrate the deeper layers of the skin. This in- as described in the labeling. Remember also to use
creases the risk of skin cancer, skin aging, eye lip balm with an SPF of 15 or higher.
damage and genetic changes that may alter the Choose sunscreen that claims to be broad
skin’s ability to fight disease. spectrum—protecting against both UVB and UVA
To avoid getting too much sun, avoid exposure rays. Carefully check the label to determine the
to the sun between 10:00 A.M. and 4:00 P.M. protection a product offers. Some products only of-
UV rays are most harmful during this period. fer protection against UVB rays.
Wear proper clothing to prevent overexposure. It is equally important to protect the eyes from
Also, take care to protect the sun damage. Wear polarized
skin and eyes whenever ex- sunglasses that absorb at
posure to the sun is ex- least 90 percent of UV sun-
pected. light. Polarized sunglasses are
Commercial sunscreens like sunscreen for the eyes
come in various strengths. and protect against damage
The American Academy of that can occur from UV rays.
Figure 19-6 For early stages of heat-related illness, Figure 19-7 To cool the body of the victim of heat-
apply cool, wet cloths and fan the victim to increase related illness, cover the body with cool, wet towels and
evaporation. Give cool water to drink. apply ice packs.
back of the neck, and fan the victim to increase

evaporation.
Frostbite
If the victim is conscious, slowly drinking cool Frostbite is the freezing of body tissues. It usually
water will help replenish the vital fluids lost through occurs in exposed areas of the body, depending on
sweating (Fig. 19-6). The victim is likely to be nau- the air temperature, length of exposure and the
seated. Water is less likely than other fluids to cause wind. Frostbite can be superficial or deep. In su-
vomiting and is more quickly absorbed into the perficial frostbite, the skin is frozen but the tissues
body from the stomach. Do not let the victim drink below are not. In deep frostbite, both the skin and
too quickly. Let the victim rest in a comfortable po- underlying tissues are frozen. Both types of frost-
sition, and watch carefully for changes in his or her bite are serious. The water in and between the
condition. A victim of heat-related illness should not body’s cells freezes and swells. The ice crystals and
resume normal activities the same day. swelling damage or destroy the cells. Frostbite can
cause the eventual loss of fingers, hands, arms,
Care in Late Stages toes, feet and legs.
The signals of frostbite include—
If you observe changes in the victim’s level of con-
sciousness, call 9-1-1 or the local emergency number Lack of feeling in the affected area.
and cool the body quickly by any means available. Skin that appears waxy.
Soak towels or sheets in cool water and apply them Skin that is cold to the touch.
to the victim’s body. Use a water hose, if one is avail- Skin that is discolored (flushed, white, yellow
able, to cool the victim. If you have ice or cold or blue).
packs, wrap them in a cloth and place them on each
of the victim’s wrists and ankles, on the groin, in
each armpit and on the neck to cool the large blood Care
vessels (Fig. 19-7). A person in heat stroke may ex- Get the person out of the cold.
perience respiratory or cardiac arrest. Be prepared to Do not attempt to rewarm the frostbitten
perform rescue breathing or CPR, if needed. area if there is a chance that it might
refreeze or if you are close to a medical
facility.
COLD-RELATED EMERGENCIES Handle the area gently; never rub the affected
area.
Frostbite and hypothermia are two types of cold- Warm gently by soaking the affected area
related emergencies. Frostbite occurs in body parts in warm water (100-105º F) until normal
exposed to the cold. Hypothermia develops when color returns and feels warm (Fig. 19-8, A).
the body can no longer generate sufficient heat to Loosely bandage the area with dry, sterile
maintain normal body temperature. dressings (Fig. 19-8, B).
A B
100-105F
Figure 19-8 A, Warm the frostbitten area gently by soaking it in water. Do not allow
the frostbitten area to touch the container. B, After rewarming, bandage the area with
a dry, sterile dressing. If fingers or toes are frostbitten, place gauze between them.
If the person’s fingers or toes are frostbitten, exercise, can develop hypothermia at higher tem-
place dry, sterile gauze between them to keep peratures. Certain substances, such as alcohol and
them separated. barbiturates, can also interfere with the body’s nor-
Avoid breaking any blisters. mal response to cold, causing hypothermia to occur
Take precautions to prevent hypothermia. more easily. Medical conditions, such as infection,
Call 9-1-1 or seek emergency medical care as insulin reaction, stroke and a brain tumor also
soon as possible. make a person more susceptible to hypothermia.
Anyone remaining in cold water or wet clothing for
a prolonged time may also easily develop hypo-
Hypothermia thermia.
Hypothermia is the general cooling of the entire

body. In hypothermia, body temperature drops be- Care
low 95º F (35º C). As the body cools, an abnormal
Gently move the person to a warm place.
heart rhythm (ventricular fibrillation) may develop
Care for life-threatening conditions.
and the heart eventually stops. The victim will die if
not given care.
Remove any wet clothing and dry the
The signals of hypothermia include—
person.
Shivering (may be absent in later stages of Warm the person by wrapping in blankets or
hypothermia). by putting dry clothing on the person (passive
Numbness. re-warming) (Fig. 19-9).
Glassy stare. If available, apply heat pads or other heat
Apathy or decreasing level of consciousness. sources to the body. Hot water bottles and
Weakness. chemical hot packs may be used when first
Impaired judgment. wrapped in a towel or blanket before applying.
Do not warm the person too quickly, such as
In cases of severe hypothermia, the victim may
by immersing him or her in warm water. Rapid
be unconscious. Breathing may have slowed or
warming may cause dangerous heart rhythms.
stopped. The body may feel stiff as the muscles be-
If person is alert, give warm liquids that do not
come rigid.
contain alcohol or caffeine.
The air temperature does not have to be below
freezing for people to develop hypothermia. Elderly Monitor ABCs and continue to warm the victim
people in poorly heated homes, particularly those until EMS personnel arrive. Be prepared to perform
who suffer from poor nutrition and who get little CPR if necessary.
High-Tech War Against Cold

In the past, humans depended entirely on nature for not forget your legs. Wool pants are a better choice
clothing. Animal skins, furs and feathers protected us than jeans or corduroys. Synthetic materials used in
from freezing temperatures. As long as seasonal jackets and pants include Thinsulate™, Quallofil®,
changes and cold climates exist, preventing cold- Polartec® and pile (a plush, nonpiling polyester fiber).
related illness, such as hypothermia, remains impor- Although down is an excellent lightweight insulator, it
tant when we work or play outside. Although natural becomes useless when wet, so a water-repellent or
fibers like wool and down are still practical, synthetic quick-drying fabric like pile may keep you warmer in
fibers are now used in clothing to make being out- a damp climate.
doors a lot more comfortable than in the past. Finish with a windproof, and preferably waterproof,
The best way to use outdoor fabrics is to layer shell layer. Synthetic, high-tech fabrics make a strong
them. Layering creates warmth by trapping warm air showing here. Windproof fabrics have names like Sup-
between the layers to insulate the body. Layering is plex, Silmond, Captiva or rip-stop nylon. Coatings,
an old concept. It enables you to regulate your body such as Hypalon, applied to jackets and pants are
temperature and deal with changes in the environ- completely water repellent. However, most waterproof
ment. By wearing several layers of clothing, you can fabrics are “breathable.” They repel wind and rain but
take clothes off when you become too warm and put allow your perspiration to pass through the fabric so
them back on if you get cold. that you stay dry and warmer. Gore-Tex®, Thintech,
Start off with an underwear layer. Commonly Ultrex, and Super Microft are some of the names given
called long underwear, it includes thin, snug-fitting to these fabrics. Pay close attention to vents and clo-
pants and a long-sleeved shirt. Underwear should sures in garments; they should seal tightly and open
supply you with basic insulation and pull moisture freely to adapt to changing activities and weather con-
away from your skin—damp, sweaty skin can chill ditions. It is also important to make sure your outer
you when you slow down or stop moving. Natural garments are big enough to fit over several layers of
fibers, such as wool and silk, can be quite warm and clothing.
are sufficient for light activity. For heavier exercise, A hat is vital to staying truly warm. Gloves, insulat-
however, synthetic fabrics absorb less moisture and ing socks, neck “gaiters” and headbands all protect
actually carry water droplets away from your skin. you from the cold. Visit your local outdoor store for
Polypropylene and Capalene are two popular syn- more information about the best clothing for your spe-
thetic fabrics for underwear. cific work or recreational activities.
Next, to provide additional warmth, add one or
SOURCES
more insulating layers. The weight of insulating National Ski Patrol,
www nsp.org/nsp2002/safety_info_template.asp?modedress.
clothing should be considered in relation to planned Accessed 10/29/04.
activities, weather conditions and how efficiently the Recreation Equipment Incorporated: Layering for comfort: FYI, an informational
brochure from REI, Seattle, 1991.
garment compresses to pack. Depending on the Recreation Equipment Incorporated: Understanding outdoor fabrics: FYI, An infor-
temperature, a wool sweater or a down jacket may mational brochure from REI, Seattle, 1991.
Recreation Equipment Incorporated: Outerwear product information guide,
provide an insulating layer for the upper body. But do Seattle, 1995.
Care for Heat- and Cold-Related Emergencies

HEAT EMERGENCIES COLD EMERGENCIES
HEAT CRAMPS FROSTBITE
Have the victim rest in a cool place. Get the person out of the cold.
Give cool water to drink. Do not attempt to rewarm the frostbitten area if
Lightly stretch and gently massage the muscle. there is a chance that it might refreeze or if you
DO NOT GIVE SALT TABLETS. are close to a medical facility.
Watch for signals of heat illness. Handle the area gently; never rub the affected
area.
HEAT-RELATED ILLNESS Warm gently by soaking the affected area in
Move the victim to a cool place. warm water (100-105° F) until normal color re-
Loosen tight or remove perspiration-soaked turns and feels warm.
clothing. Loosely bandage the area with dry, sterile
Apply cool, wet cloths to the skin or mist with dressings.
cool water and fan the victim. If the person’s fingers or toes are frostbitten,
If conscious, give cool water to drink. place dry, sterile gauze between them to keep
If the victim refuses water, vomits or loses them separated.
consciousness: Avoid breaking any blisters.
Send someone to CALL 9-1-1 or the local Take precautions to prevent hypothermia.
emergency number and place the victim on Call 9-1-1 or seek emergency medical care as
his or her side. soon as possible.
Continue to cool by placing ice packs or cold
packs on the victim’s wrists, ankles, groin, HYPOTHERMIA
neck and in the armpits. Gently move the person to a warm place.
If the victim becomes unconscious, give Care for life-threatening conditions.
rescue breathing or CPR if needed. Call 9-1-1 or the local emergency number.
Monitor ABCs.
Give rescue breathing or CPR if needed.
Remove any wet clothing and dry the person.
Warm the person by wrapping in blankets or by
putting dry clothing on the person (passive re-
warming).
Hot water bottles and chemical hot packs may
be used when first wrapped in a towel or blanket
before applying.
Do not warm the person too quickly, such as by
immersing him or her in warm water. Rapid
warming may cause dangerous heart rhythms.
An Icy Rescue than it does in the air. As the body’s core tempera-
ture drops, the metabolic rate drops. Activity in the
cells comes almost to a standstill, and the cells re-
quire very little oxygen. Any oxygen left in the blood
is diverted from other parts of the body to the brain
Rescuers who pulled and heart.
Michelle Funk from an This state of suspended animation allows hu-
icy creek near her home mans to survive underwater at least four times as
thought she was dead. long as physicians once believed possible. Nearly 20
The child’s eyes stared cases of miraculous survivals have been docu-
dully ahead, her body mented in medical journals, although unsuccessful
was chilled and blue and cases are rarely described. Most cases involve chil-
her heart had stopped dren who spent 15 minutes or longer in water tem-
beating. The 21⁄2 year-old peratures of 41º F (5º C) or lower. Children survive
had been under the icy better because their bodies cool faster than an
water for more than an adult’s.
hour. By all basic mea- Researchers once theorized that the physiological
surements of life, she responses were caused by a “mammalian dive re-
was dead. flex” similar to a response found in whales and
Years ago, Michelle’s family would have prepared seals. They believed the same dive mechanism that
for her funeral. Instead, paramedics performed CPR allowed whales and seals to stay underwater for
on Michelle’s still body as they rushed her to a chil- long periods of time was triggered in drowning hu-
dren’s medical center, where Dr. Robert G. Bolte took mans. Experiments have failed to support the idea.
over care. Bolte had been reading about a rewarm- Many researchers now say the best explanation for
ing technique used on adult hypothermia victims and the slowdown is simply the body’s response to ex-
thought it would work on Michelle. Surgeons some- treme cold.
times intentionally cool a patient when preparing for After being attached to the heart-lung machine for
surgery and use heart-lung machines to rewarm the nearly an hour, Michelle was moved into an intensive
patient’s blood after surgery. This cooling helps keep care unit. She stayed in a coma for more than a
oxygen in the blood longer. Bolte attached Michelle week. She was blind for a short period, and doctors
to the heart-lung machine, which provided oxygen were not sure she would recover. But slowly she be-
and removed carbon dioxide in addition to warming gan to respond. First she smiled when her parents
the blood. When Michelle’s temperature reached came into the room, and soon she was talking like a
77º F (25º C), the unconscious child gasped. Soon 21⁄2 year-old again. After she left the hospital, she
her heart was pumping on its own. suffered a tremor from nerve damage. But Michelle
Doctors once believed the brain could not survive was one of the lucky ones—eventually she regained
more than 5 to 7 minutes without oxygen, but sur- her full sight, balance and coordination.
vivals like Michelle’s have changed opinions. Ironi- Although breakthroughs have saved many lives,
cally, freezing water actually helps to protect the parents still must be vigilant when their children and
body from drowning. others are near water. Most near-drowning victims
In icy water, a person’s body temperature begins are not as lucky as Michelle. One out of every three
to drop almost as soon as the body hits the water. survivors suffers neurological damage. There is no
The body loses heat in water 25 to 30 times faster substitute for close supervision.
possible, wear light-colored clothing in the heat.

Light-colored clothing reflects the sun’s rays.
When you are in the cold, wear layers of cloth-
ing made of tightly woven fibers, such as wool, that
trap warm air against your body. Wear a head cov-
ering in both heat and cold. A hat protects the head
from the sun’s rays in the summer and prevents heat
from escaping in the winter. Also, protect other ar-
eas of the body, such as the fingers, toes, ears and
nose, from cold exposure by wearing protective
coverings.
You can take additional precautions, such as
changing your activity level and taking frequent
breaks. For instance, in very hot conditions, exer-
cise only for brief periods, then rest in a cool,
shaded area. Frequent breaks allow your body to
readjust to normal body temperature, enabling it to
better withstand brief periods of exposure to tem-
Figure 19-9 For a hypothermia victim, rewarm the perature extremes (Fig. 19-10). Avoid heavy exer-
body gradually. cise during the hottest or coldest part of the day. Ex-
tremes of temperature promote fatigue, which
hampers the body’s ability to adjust to changes in
the environment.
Whether in heat or cold, be sure to drink
PREVENTING HEAT- AND COLD-RELATED enough fluids. Drinking at least six 8-ounce (236.6
EMERGENCIES milliliters) glasses of fluids is the most important
way to prevent heat- or cold-related illness. Plan to
drink fluids when you take a break. Just as you
Generally, illnesses caused by overexposure to ex-
would drink cool fluids in the summer, drink warm
treme temperatures are preventable. To prevent
fluids in the winter. Cool and warm fluids help the
heat- or cold-related emergencies from happening
body maintain a normal temperature. If cold or hot
to you or anyone you know, follow these guidelines:
drinks are not available, drink plenty of plain
Avoid being outdoors in the hottest or coldest water. Do not drink beverages containing caffeine
part of the day.
Dress appropriately for the environment.
Change your activity level according to the
temperature.
Take frequent breaks by removing yourself
from the environment.
Drink large amounts of nonalcoholic or decaf-
feinated fluids before, during and after activity.
The easiest way to prevent illness caused by tem-

perature extremes is to avoid being outside during
the parts of the day when temperatures are most ex-
treme. For instance, if you plan to work outdoors in
hot weather, plan your activity for the early morning
and evening hours when the sun is not as strong.
Likewise, if you must be outdoors on cold days, plan
your activities for the warmest part of the day. Figure 19-10 Taking frequent breaks when exercising
Always wear clothing appropriate to the envi- in extreme temperatures allows your body to readjust to
ronmental conditions and your activity level. When normal body temperature.
or alcohol. Caffeine and alcohol hinder the body’s is not working efficiently. They may signal that the
temperature-regulating mechanism. person is in the early stage of a heat-related illness.
For heat-related illness, it is important for the
victim to stop physical activity. Cool the victim
SUMMARY and call 9-1-1 or the local emergency number.
Heat stroke can rapidly lead to death if it is left
Overexposure to extreme heat or cold may cause a untreated.
person to become ill. The likelihood of illness also Both hypothermia and frostbite are serious
depends on factors such as physical activity, cloth- cold-related conditions, and their victims need pro-
ing, wind, humidity, working and living condi- fessional medical care. Hypothermia can be life
tions, and a person’s age and physical condition. threatening. For both hypothermia and frostbite, it
Heat cramps are an early indication that the is important to warm the victim gradually and han-
body’s normal temperature-regulating mechanism dle him or her with care.
1. Why does Cynthia feel dizzy? 3. What could Cynthia have done to prevent heat
exhaustion?
2. What can Louise do to help Cynthia’s condition

improve?
STUDY QUESTIONS
a. Frostbite
b. Heat cramps
c. Heat exhaustion
d. Heat stroke
e. Hypothermia
_____ The early stage and most common form of heat-related illness.
_____ A life-threatening condition that develops when the body’s warming mechanisms fail to maintain
normal body temperature.
_____ A life-threatening condition that develops when the body’s cooling mechanism fails.
_____ The freezing of body tissues caused by overexposure to the cold.
_____ Painful spasms of skeletal muscles that develop after heavy exercise or work outdoors in warm or
moderate temperatures.
2. List four factors that affect body temperature.
3. List three conditions that can result from overexposure to heat.
4. List four signals of heat-related illness.
5. List two signals of a heat-related illness for which EMS personnel should be called.
6. List two ways to cool a victim of a suspected heat-related illness.
7. List two conditions that result from overexposure to the cold.
8. List four ways to prevent heat and cold emergencies.

9. To care for heat cramps—
a. Have the victim rest comfortably in a cool place.

b. Call 9-1-1 or the local emergency number.
c. Give salt tablets.
10. What should you do if the victim of a suspected heat-related illness begins to lose consciousness?
a. Cool the body using wet sheets and towels or cold packs.
b. Cool the body by applying rubbing alcohol.
d. a and c.
You and a friend have been skiing all morning. The snow is great, but it is really cold. Your buddy has complained
for the last half hour or so that his hands and feet are freezing. Now he says he can’t feel his fingers and toes.
You decide to return to the ski lodge. Once inside, your friend has trouble removing his mittens and ski boots.
You help him take them off and notice that his fingers look waxy and white and feel cold. Your friend says he
still can’t feel them.
11. Circle the signals of frostbite you find in the scenario above.
12. How would you care for your friend’s hands and feet?
You are working on a community service project delivering meals to elderly, homebound individuals. It is a blustery
winter day that has you running from the van to each front door. As you enter the last home, you notice that it is
not much warmer inside the house than it is outside. An elderly woman, bundled in blankets, is sitting as close as
possible to a small space heater. You speak to her, introducing yourself and asking how things are, but you get no
response. The woman’s eyes are glassy as she makes an effort to look at you. She seems weak and exhausted,
barely able to keep her head up. You touch her arm, but she does not seem to feel it.
13. Circle the signals in the scenario above that would lead you to suspect a cold-related illness.
14. Describe the actions you would take to care for the woman in the scenario.

Part
SIX
SPECIAL
SITUATIONS
20 Reaching and Moving
Victims in the Water
21 People with Special Needs
22 Childbirth
23 Delayed-Help Situations
pte 20
CChapter
You arrive at your boss’s house for a pool party. There you
find a group of your co-workers from the office standing by
the pool. Eric, from Accounting, wobbles over to the pool
edge and falls in the deep end. Although he tries to swim to
the side, he makes no forward progress. As he continues to
struggle, the crowd that gathers by the pool is pointing,
laughing and shouting.
Reaching
and Moving
Victims in
the Water
Objectives
■ Describe two out-of-water assists that you can use to help
someone who is in trouble in the water.
■ Describe how to perform an in-water assist that you can use to
help someone who is in trouble in the water.
■ List the general guidelines for caring for someone who you
suspect may have a head, neck or back injury and is in the water.
■ Describe two methods to support or stabilize a victim’s head,
neck and back in the water.
372 PART SIX SPECIAL SITUATIONS
Introduction
ming in any body of water (pools, lakes, ponds,
quarries, canals, rivers or oceans):
Always swim with a buddy; never swim alone.
Read and obey all rules and posted signs
Water provides people with some of the most (Fig. 20-1).
enjoyable recreational activities, but water can Swim in areas supervised by a lifeguard.
be dangerous. Drowning is death by Children or inexperienced swimmers should
take extra precautions, such as wearing a U.S.
suffocation in water. Drownings may occur
Coast Guard-approved life jacket when around
during swimming, boating, hunting, fishing or the water.
while taking a bath. Everyone should learn Watch out for the “dangerous too’s”—too
how to swim well. Everyone should know tired, too cold, too far away from safety, too
basic water rescue methods to help themselves much sun, too much strenuous activity.
or someone else in an emergency. In this Be knowledgeable of the water environment and
chapter, you will learn how to safely reach the potential hazards (deep and shallow areas,
currents, depth changes, obstructions and where
and assist victims in water without the entry and exit points are located).
endangering or injuring yourself. Know how to prevent, recognize and respond
to emergencies.
Use a feet-first entry when entering the water.
Enter head-first only when the area is clearly
THE RISK OF DROWNING marked for diving and has no obstructions.
Do not mix alcohol with swimming, diving or
Children younger than age 5 and young adults ages boating. Alcohol impairs judgment, balance and
15 to 24 have the highest rates of drowning. As coordination; affects swimming and diving skills;
frightening as the risk of drowning is, it can usually and reduces the body’s ability to stay warm.
be prevented. Regardless of where you are swim-
ming and what activities you may be involved in,
you can follow simple guidelines to reduce the risk
of drowning.
RECOGNIZING AN AQUATIC EMERGENCY
An emergency can happen to anyone in, on or
around the water, regardless of how good a swimmer
PREVENTING AQUATIC EMERGENCIES the person is or what he or she is doing at the time.
A strong swimmer can get into trouble in the water
The best thing anyone can do to stay safe in, on and because of sudden illness or injury. A non-swimmer
around the water is to learn to swim. The American playing in shallow water can be knocked down by a
Red Cross has swimming courses for people of any wave or pulled into deeper water by a rip current.
age and swimming ability. To enroll in a swimming The key to recognizing an emergency is staying alert
course, contact a local Red Cross chapter. Follow and knowing the signals that indicate an emergency
these general guidelines whenever you are swim- is happening. Use all your senses when observing
K E Y T E R M S
Active drowning victim: A person exhibiting Reaching assist: A non-swimming rescue in
universal behavior that includes struggling at the which one extends an object, such as an arm,
surface for 20 to 60 seconds before submerging. leg or tree branch to a victim.
Distressed swimmer: A victim capable of staying Throwing assist: A non-swimming water rescue in
afloat but likely to need assistance to get to which one throws a line with a floating object
safety. attached to a victim.
Passive drowning victim: An unconscious victim
face-down, submerged or near the surface of
the water.
CHAPTER 20 Reaching and Moving Victims in the Water 373
Figure 20-2 A distressed swimmer can stay afloat and

usually call for help.
Figure 20-1 Read and obey all rules and posted signs.
others in and around the water. A swimmer may be

acting oddly, or you may hear a scream or sudden
splash. Watch for anything that may seem unusual.
Being able to recognize a person who is having
trouble in the water may help save that person’s life.
Most drowning people cannot or do not call out for
help. They spend their energy just trying to keep
their heads above water to get a breath. They may
slip under water quickly and never resurface. There Figure 20-3 An active drowning victim struggles to
are two kinds of water emergency situations: a stay afloat and is unable to call out for help.
swimmer in distress and a drowning person. Each
kind poses a different danger and can be recognized
by different behaviors.
A distressed swimmer may be too tired to get to
shore or to the side of the pool but is able to stay
afloat and breathe and may be calling for help. The
victim may be floating, treading water or clinging to a
line for support (Fig. 20-2). Someone who is trying to
swim but making little or no forward progress may be
in distress. If not helped, a person in distress may lose
the ability to float and become a drowning victim.
An active drowning victim is vertical in the
water but unable to move forward or tread water.
The victim’s arms are at the side pressing down in an
instinctive attempt to keep the head above water to
breathe. All energy is going into the struggle to
breathe, and the victim cannot call out for help
(Fig. 20-3). A passive drowning victim is not mov-
ing and will be floating face-down on the bottom or
near the surface of the water (Fig. 20-4). Table 20-1 Figure 20-4 A passive drowning victim can be found
compares the behaviors of distressed swimmers and floating near the surface or submerged on the bottom of
drowning victims to those of swimmers. the pool.
Table 20-1 Behaviors of Distressed Swimmers and Drowning Victims Compared

with Swimmers
DISTRESSED ACTIVE PASSIVE
BEHAVIORS SWIMMER SWIMMER DROWNING VICTIM DROWNING VICTIM
Breathing Rhythmic breathing Can continue breath- Struggles to breathe; Not breathing
ing and may call cannot call out for
for help help
Arm and Leg Action Relatively Floating, sculling or Arms to sides alter- None
coordinated treading water; nately moving up and
may wave for help pressing down; no
supporting kick
Body Position Horizontal Horizontal or diagonal, Vertical Horizontal or vertical;
depending on face-down, face-up
means of support or submerged
Locomotion Recognizable Little or no forward None; has only 20-60 None
progress; less seconds before
and less able to submerging
support self
TAKING ACTION IN AN AQUATIC tim know that help is coming. If it is too noisy or if
the victim is too far away, use gestures. Tell the vic-
EMERGENCY tim what he or she can do to help with the rescue,
such as grasping the line, rescue buoy or any other
As in any emergency situation, follow the emer- floating device. Ask the victim to move toward
gency action steps: CHECK—CALL—CARE. safety by kicking or stroking his or her arms. Some
Make sure the scene is safe—do not rush into a victims have reached safety by themselves with the
dangerous situation where you too may become a calm and encouraging assistance of someone calling
victim. Always check first to see whether a lifeguard to them.
or other trained professional is present before help-
ing someone who may be having trouble in the wa-
ter. Do not swim out to a victim unless you have the
Reaching Assists
proper training, skills and equipment. If the appro- If the victim is close enough, you can use a reaching
priate safety equipment is not available and there is assist to help him or her out of the water. If avail-
a chance that you cannot safely help a person in able, use any object that will extend your reach,
trouble, call for help immediately. If you must assist such as a pole, an oar or paddle, a tree branch, a
someone who is having trouble in the water, you shirt, a belt or a towel (Fig. 20-5). Community
must have the appropriate equipment for your own pools and recreational areas, as well as hotel and
safety and the victim’s. Send someone else to call motel pools, often have reaching equipment beside
9-1-1 or the local emergency number while you the water, such as a shepherd’s crook (an aluminum
start the rescue. or fiberglass pole with a large hook on one end)
(Fig. 20-6). If using a rigid object, such as a pole or
oar, sweep it toward the victim until it makes con-
Out-of-Water Assists tact with an arm or hand. If using a shirt or towel,
lie down and flip it into the victim’s hands.
You can help a person in trouble in the water by If there is equipment available:
using reaching assists or throwing assists. Out-of-
water assists are safer for you. Whenever possible, 1. Brace yourself on a pool deck, pier surface or
start the rescue by talking to the victim. Let the vic- shoreline.
Figure 20-5 With a reaching assist, you remain safe Figure 20-6 A shepherd’s crook can be found at most
while reaching out to the victim. public swimming facilities.
2. Extend the object to the victim. 2. Extend your free hand or one leg to the vic-
3. When the victim grasps the object, slowly tim (Fig. 20-7, A and B). Do not let go of the
and carefully pull him or her to safety. Keep secure object or swim out into the water.
your body low and lean back to avoid being 3. Pull the victim to safety.
pulled into the water.
If there is no equipment available to perform a Throwing Assists
reaching assist, you should:
You can rescue a conscious victim out of reach by
1. Brace yourself on the pool deck or pier sur- using a throwing assist. Use anything that will
face. provide the victim support. A floating object with
2. Reach with one arm and grasp the victim. a line attached is best. The victim can grasp the ob-
3. Pull the victim to safety. ject and then be pulled to safety. However, lines
and floats can also be used alone. Suitable throw-
If you are already in the water:
ing objects include a heaving line, ring buoy, throw
1. Hold onto the pool ladder, overflow trough bag, rescue tube or homemade device (Fig. 20-8).
(gutter), piling or another secure object with You can use any object at hand that will float, such
one hand. as a picnic jug or life jacket. A throwing object
A B
Figure 20-7 When no object is available to extend to the victim, try to extend
your A, hand or B, foot to the victim.
Figure 20-8 Throwing devices.
with a coiled line should be kept in a prominent

location that is accessible to the water so that
anyone can quickly grasp it to throw to someone
in trouble.
A heaving line should float. It should be white,
yellow or some other highly visible color. Tying a
buoyant, weighted object on the end will make
throwing easier and more accurate. Hang about
half the coiled line on the open palm of your non-
throwing hand, and throw the other half underhand
to the victim.
A homemade heaving jug can be thrown to a
Figure 20-9 A heaving jug is a simple homemade victim. Put a half-inch of water or sand in a gallon
device that can be thrown to a victim. plastic container, seal it and attach 50 to 75 feet of
floating line to the handle. Throw it by holding the
handle and using an underhand swinging motion.
The weight of the water in the jug helps direct the
throw (Fig. 20-9).
A ring buoy is made of buoyant material and
weighs about 2 pounds. It should have a towline
or lightweight line with something at the end to
keep the line from slipping out from under your
foot when you throw it. Hold the underside of the
ring with your fingers, and throw it underhand
(Fig. 20-10).
The throw bag is a small, but useful rescue
device. It is a nylon bag containing 50 to 75 feet
Figure 20-10 A ring buoy is another piece of rescue of coiled floating line. A foam disk in the bag gives
equipment that is commonly found at public swimming it shape and keeps it from sinking. Throw bags are
facilities.
5. When the victim has grasped the object or the

line, slowly pull him or her to safety. Keep your
weight low and lean back. Lean away from
the water as you bring the victim to safety.
6. If the object does not reach the victim,
quickly pull the line back in and throw it
again. Try to keep the line from tangling, but
do not waste time trying to coil it. If using a
throw bag, partially fill the bag with some
water and throw it again.
If the throwing assist does not work and the wa-
ter is shallow enough for wading, try a wading as-
Figure 20-11 A throw bag is a compact rescue device sist with equipment.
that can be thrown to a victim.
often used in canoes and other boats. Hold the

In-Water Assists
end of the line with one hand and throw the bag
with your other hand, using an underhand swing Wading Assist with Equipment
(Fig. 20-11). If the water is shallow enough that you can stand
To perform a throwing assist, follow these with your chest out of the water, wade into the wa-
guidelines: ter to assist the victim using a rescue tube, ring
buoy, kickboard or a life jacket.
1. Get into a stride position: the leg opposite
A tree branch, pole, air mattress or paddle can
your throwing arm is forward. This helps
also be used (Fig. 20-12, A and B). If a current or
to keep your balance when you throw the
soft bottom makes wading dangerous, do not enter
object.
the water. If possible, wear a life jacket when at-
2. Step on the end of the line with your forward
tempting a wading assist with equipment.
foot. Avoid stepping on the coiled line with
To perform a wading assist—
your other foot.
3. Shout to get the victim’s attention. Make eye 1. Take a buoyant object to extend out to the
contact and say that you are going to throw victim.
the object now. Tell the victim to grab it. 2. Wade into the water and extend the object to
4. Bend your knees, and throw the object to the the victim.
victim. Try to throw the object upwind or up 3. When the victim grasps the object, tell him or
current, just over the victim’s head, so that her to hold onto the object tightly for support
the line drops within reach. and pull him or her to safety. Keep the object
A B
Figure 20-12 If you can enter the water without endangering yourself, wade in
and reach to the victim. If possible, extend your reach with a A, ring buoy, B, tree
branch or similar object.
between you and the victim to help prevent

the victim from grasping you.
A victim who has been lying motionless and
face-down in the water for several seconds is prob-
ably unconscious.
1. If the water is not over one’s chest, wade into
the water carefully with some kind of flota-
tion equipment and turn the person face-up.
2. Bring him or her to the side of the pool or
shoreline.
3. Remove the victim from the water.
4. Give care if needed.
Figure 20-13 When performing a walking assist, main-
tain a firm grasp on the victim while walking out of the
Submerged Victim water.
If a victim is discovered on or near the bottom of
the pool in deep water, call for trained help imme-
diately. If in shallow water less than chest deep and
a head, neck or back injury is not suspected—
1. Reach down and grasp the victim.
2. Pull the victim to the surface.
3. Turn the victim face-up and bring him or her
to safety.
4. Remove the victim from the water.
5. Give care if needed.
Helping Victims from the Water

Walking Assist
If the victim is in shallow water where he or she can Figure 20-14 When performing a beach drag, walk
backward slowly while dragging the victim toward shore.
stand, he or she may be able to walk out of the wa-
ter with some support. To perform a walking assist,
follow these guidelines:
2. While walking backward slowly, drag the
1. Place one of the victim’s arms around your
victim toward the shore (Fig. 20-14).
neck and over your shoulder.
3. Remove the victim completely from the wa-
2. Grasp the wrist of the arm that is over your
ter or at least to a point where the victim’s
shoulder, and wrap your free arm around the
head and shoulders are out of the water.
victim’s back or waist.
3. Maintain a firm grasp, and help the victim You may also use a two-person beach drag if
walk out of the water (Fig. 20-13). another person is available to help (Fig. 20-15).
Beach Drag Two-Person Lift

You may use the beach drag with a victim in shal- The two-person lift can be used for removing a per-
low water on a sloping shore or beach. This method son from the water if there is no slope for you to
works well with a heavy or unconscious victim. To easily remove the victim. Do not use the two-person
perform the beach drag— lift if you suspect the victim has a head, neck or
back injury. To perform the two-person lift—
1. Stand behind the victim, and grasp him or her
under the armpits, supporting the victim’s 1. Place the victim’s hands, one on top of the
head, when possible, with your forearms. other, on the deck or overflow trough (gutter).
5. If necessary, pull the victim’s legs out of

the water, taking care not to twist the
victim’s back. Roll the victim onto his or
her back. Support the victim’s head and
take care not to twist the victim’s body as it
is rolled.
Head, Neck or Back Injury

Most injuries to the head, neck or back occur in
shallow water. Many involve the use of alcohol or
other drugs. Diving into shallow water, diving from
Figure 20-15 Two-person beach drag. the deck into the shallow end of a pool, diving into
above-ground pools and unsupervised diving from
starting blocks cause most diving accidents. Injuries
can also result from head-first entry into the surf at
2. Take the victim’s hands and pull the victim a beach, off a pier at a lake, from a cliff into a
up slightly to keep the head above the water. water-filled quarry or from falling while surfing or
Be sure the victim’s head is supported so that boogie boarding.
it does not fall forward and strike the deck
(Fig. 20-16, A). Note: If in the water, climb
out to help the second person.
Recognizing a Head, Neck or Back Injury
3. Each person grasps one of the victim’s wrists Usually a head, neck or back injury is caused by hit-
and upper arms (Fig. 20-16, B). Lift together ting the bottom or an object in the water. Your ma-
until the victim’s hips or thighs are at deck jor concern is to keep the victim’s face out of the
level. water to let him or her breathe and to prevent the
4. Step backward and lower the victim to the victim’s head and back from moving further. Move-
deck. Be sure to protect the victim’s head ment can cause more injury and increase the risk of
from striking the deck (Fig. 20-16, C). the victim’s being paralyzed.
A B C
Figure 20-16 Two-person lift, A, One rescuer in the water supports the victim
while one rescuer grasps the victim’s hands. B, Both rescuers grasp the victim’s
arms and begin to lift. C, Rescuers removing the victim from the water.
Preventing Head, Neck and

Back Injuries in Water
Every year, there are approximately 11,000 spinal The presence of a diving board does not
cord injuries in the United States. About 9 percent necessarily mean it is safe to dive. Pools at
of these injuries occur during sports and homes, motels and hotels might not have a
recreation.1 Along with the risk of drowning, some safe diving envelope.
water activities also involve the risk of head, neck When diving from a deck, the area of entry
or back injury. When the injury damages the spinal should be free of obstructions (such as lane
cord, severe disability is likely, including permanent lines and kickboards) for at least 4 feet on
paralysis. This means the person may never be able both sides. For dives from a 1-meter diving
to move his or her arms or legs again. board, 10 feet of clearance is needed on
both sides.
Like drowning, head, neck or back injuries can
For springboard diving, use equipment that
be prevented by following basic guidelines such as
meets standards for competition.
these: Dive only from the end of a diving board.
Learn how to dive safely from a qualified Diving off the side of a diving board
instructor. might result in striking the side of the
Follow safety rules at all times. pool or entering water that is not deep
Obey “No Diving” signs. They are there for enough.
safety. Do not bounce more than once on the end of
Be sure of the water depth and ensure that a diving board to avoid missing the edge or
the water is free from obstructions. The slipping off the diving board.
first time in the water, ease in or walk in; Do not run on a diving board or attempt to
do not jump or dive. dive a long way through the air. The water
Never dive into an above-ground pool, the might not be deep enough at the point of
shallow end of any in-ground pool or at the entry.
beach. Swim away from the diving board after en-
Never dive into cloudy or murky water. tering the water. Do not be a hazard for the
In open water, always check first for ob- next diver.
jects under the surface, such as logs, Do not dive from a height greater than 1 me-
stumps, boulders and pilings. ter unless trained in elevated entry.
At lakes or rivers, enter head-first only Starting blocks should be used only by
when the area is clearly marked for trained swimmers under the supervision of a
diving. qualified coach.
Check the shape of the pool bottom to be Running into the water and then diving
sure the diving area is large enough and head-first into breaking waves is dangerous.
deep enough for the intended dive. If you are bodysurfing, always keep your
arms out in front of you to protect your head
and neck.
1
Spinal Cord Injury Information Network. Spinal Cord Injury, Facts and Never use alcohol or other drugs when div-
Figures at a Glance. August 2004. http://www.spinalcord.uab.edu/.
Accessed 11/01/04. ing and swimming.
If you suspect a head, neck or back injury and 1. Approach the victim from the side, and lower
the victim is in the water, your goal is to prevent yourself to chest depth.
any further movement of the head, neck or back 2. Slide one arm under the victim’s shoulders
and move the victim to safety. Always check first and the other arm under the hip bones. Sup-
whether a lifeguard or other trained professional is port the victim’s body horizontally, keeping
present before touching or moving a victim who the face clear of the water (Fig. 20-17).
may have a head, neck or back injury. 3. Do not lift the victim, but support him or her
in the water until help arrives.
General Guidelines for Care Head Splint

This method provides better stabilization than the
A victim’s head, neck or back can be stabilized
hip and shoulder support. Use it for a victim who is
in several ways while the victim is still in the
face-down at or near the surface of the water. To
water. These methods are described in the next sec-
perform the head splint technique—
tion. Follow these general guidelines for a victim
with a suspected head, neck or back injury in shal- 1. Approach the victim from the side.
low water: 2. Gently move the victim’s arms up alongside
the head by grasping the victim’s arms mid-
1. Be sure someone has called 9-1-1 or the local way between the shoulder and elbow. Grasp
emergency number. If others are present, ask the victim’s right arm with your right hand.
someone to help you.
2. Minimize movement of the victim’s head,
neck and back. Gently hold the victim’s
head in the position in which you found it
and support it in that position until EMS
arrives.
3. Position the victim face-up at the surface of
the water. Keep the victim’s face out of the
water to let the victim breathe.
4. Check for consciousness and breathing once
you have stabilized the victim’s head, neck
and back. A victim who can talk or is gasp-
ing for air is conscious and breathing.
5. Support the victim with his or her head, neck
and back immobilized until help arrives. If
the head is sharply turned to one side, DO
NOT move it. Support it in the position
found.
Specific Immobilization Techniques

The following sections describe two methods for
stabilizing the victim’s head, neck and back in the
water. These methods will allow you to care for the
victim whether he or she is face-up or face-down.
Hip and Shoulder Support

This method helps limit movement to the head,
neck and back. Use it for a victim who is face-up.
Support the victim at the hips and shoulders to keep Figure 20-17 The hip and shoulder support helps limit
the face out of the water. To perform the hip and movement of the head, neck or back, while keeping the
shoulder support— victim’s face clear of water.
Grasp the victim’s left arm with your left

hand.
3. Squeeze the victim’s arms against his or her
head. This helps keep the head in line with
the body (Fig. 20-18, A).
4. With your body at shoulder depth in the wa-
A ter, glide the victim slowly forward.
5. Continue moving slowly, and rotate the
victim until he or she is face-up. This is done
by pushing the victim’s arm that is closest to
you under water, while pulling the victim’s
other arm across the surface (Fig. 20-18, B).
6. Position the victim’s head in the crook of
your arm with the head in line with the body
(Fig. 20-18, C).
7. Maintain this position in the water until help
arrives.
B Helping Someone Who Has Fallen

Through Ice
If a person falls through ice, never go out onto the
ice yourself to attempt a rescue. This is a very dan-
gerous situation, and you are likely to become a vic-
tim too. Instead, follow these guidelines:
1. Send someone to call 9-1-1 or the local emer-
gency number immediately. Trained rescuers
may be needed to get the victim out of the ice,
and even if you succeed in rescuing the victim,
he or she will probably need medical care.
C 2. From a secure place on land, try a reaching
or throwing assist. Use anything at hand
that the victim can grasp for support, such
as a tree branch, pole, life jacket or weighted
rope (Fig. 20-19). Act quickly, because the
victim’s hands may become too numb to
grasp the object.
3. If it is possible to do so safely, pull the victim
Figure 20-18 When performing the head splint tech- to shore. If it is not, talk to the victim and
nique, A, Squeeze the victim’s arms against her head, make sure he or she is secure as possible with
B, Move the victim slowly forward and rotate the victim
the object until help arrives.
toward you until she is face-up, and C, Position the vic-
tim’s head in the crook of your arm with the head in line
with the body.
Figure 20-19 Use an object, such as a tree branch, to reach a victim who has
fallen through the ice.
SUMMARY
Many drownings can be prevented by following safe. If there is any chance that you cannot safely
simple precautions when in, on or around water. and easily help the victim in trouble, call for pro-
Use the basic methods of reaching, throwing or fessional assistance. Further training in water safety
wading to reach or assist a victim in the water with- and lifeguarding is available through the local Red
out endangering yourself. Always remember to stay Cross chapter.
1. What can you do to help Eric once he has fallen
into your boss’s pool?
STUDY QUESTIONS
1. List three methods of rescuing a distressed swimmer.
2. List four characteristics of an active drowning victim.
3. In which of the following situations would a wading assist be appropriate?
a. You can reach the victim by extending a branch from the shore.
b. You suspect or see strong currents.
c. The bottom is not firm.
d. The water is shallow, and you can stand with your head out of the water.
4. You see a man struggling in the rushing waters of a flooded creek. Which is the best way to try to rescue him
without endangering yourself?
a. Dive into the water and grab him.

b. Wade in and reach out to him with an object.
c. From the shoreline, extend an object for him to reach.
d. Yell to him to kick forcefully.
5. If a victim is unconscious and too heavy for you to carry, which method could you use to get the victim out of
the water?
a. A walking assist
b. A wading assist
c. The two-victim seat carry
d. The beach drag
6. Which two techniques can be used for stabilizing the head, neck and back of a victim with a suspected head,
neck or back injury?
a. Head and back support and head splint

b. Hip/shoulder support and head splint
c. Head splint and head/back immobilization technique
d. Head and chin support and head and back support

Chapter 21
I can’t believe it! One minute, this man is walking down the sidewalk
about 15 feet ahead of me, and suddenly he sort of lurches off the curb
and collapses. Cars are passing in all directions but not one even slows
down. When I reach him, I can see he’s elderly. His hat has fallen off
and there’s blood in his hair. His eyes are open but they don’t look very
focused. He looks dazed and frightened. I ask him if he’s OK. He looks
up at me, but I can’t tell if he knows what I said. Maybe he can’t hear
me. Perhaps he’s confused. I’m not sure what I should do next.
People
with Special
Needs
Objectives
■ Describe considerations for checking an infant, a toddler, a
preschooler, a school-age child and an adolescent.
■ Explain how to observe an ill or injured child and how to
communicate with the parents or guardian.
■ Describe how to check an older adult.
■ Describe four problems that can affect older adults and their
implications for care.
■ Explain ways of communicating with victims who have
hearing loss.
■ Explain options available when trying to communicate with a
victim and there is a language barrier.
■ Explain what you should do if you encounter a crime scene or
hostile victim.
Introduction Communicating with an Ill or

Injured Child
In an emergency, you should be aware of We tend to react more strongly and emotionally to
the special needs and considerations of a child who is in pain or terror. You will need to try
children, older adults, people with disabilities exceptionally hard to control your emotions and
and people who do not speak the same your facial expressions. Doing so will be helpful to
language you speak. Knowing these needs both the child and any concerned adults. To help an
and considerations will help you better ill or injured child, you also need to try to imagine
how the child feels. A child is afraid of the un-
understand the nature of the emergency and known. He or she is afraid of being ill or hurt, be-
give appropriate care. A young child may be ing touched by strangers and being separated from
terrified. An elderly adult may be confused. his or her parents or guardian.
A person with a disability may be unable to How you interact with an ill or injured infant or
hear or see you. A victim may not speak the child is very important. You need to reduce the
language(s) you speak. Being able to child’s anxiety and panic and gain the child’s trust
and cooperation if possible. Move in slowly.
communicate with and reassure people
The sudden appearance of a stranger may upset the
with special needs will help you to care for child. Get as close to the infant’s or child’s eye level
them effectively. as you can, and keep your voice calm (Fig. 21-1).
Smile at the child. Ask the child’s name, and use it
when you talk with him or her. Talk slowly and dis-
tinctly, and use words the child will easily under-
stand. Ask questions the child will be able to an-
swer easily. Explain to the child and the parents or
guardian what you are going to do. Reassure the
INFANTS AND CHILDREN child that you are there to help and will not leave
him or her.
Infants and children have unique needs and re-
quire special care. Assessing a conscious infant’s or
child’s condition can be difficult, especially if he Checking Infants and Children
or she does not know you. At certain ages, infants
and children do not readily accept strangers. In- To be able to effectively check infants and children,
fants and very young children cannot tell you what it is helpful to be aware of certain characteristics of
is wrong. children in specific age groups.
K E Y T E R M S
Alzheimer’s disease: A progressive, degenerative Motor function: The ability to move the body or a
disease that affects the brain, resulting in im- body part.
paired memory, thinking and behavior. Motor impairment: The total or partial inability to
Child abuse: The physical, psychological or sex- move or to use a body part.
ual assault of a child, resulting in injury and Sensory function: The ability to see, hear, touch,
emotional trauma. taste and smell.
Disability: The absence or impairment of motor, Sudden infant death syndrome (SIDS): The sudden
sensory or mental function. death of a seemingly normal, healthy infant;
Hearing loss: Partial or total loss of hearing. occurs during the infant’s sleep without evi-
Impairment: Damage or reduction in quality, dence of disease; sometimes called crib death.
quantity, value or strength of a function. Vision loss: Partial or total loss of sight.
Mental (cognitive) function: The brain’s capacity
to reason and to process information.
CHAPTER 21 People with Special Needs 389
Figure 21-1 To communicate with a child, get as close

to eye level as you can.
Characteristics of Infants and Children

Children up to 1 year of age are commonly referred
to as infants. Infants less than 6 months old are
relatively easy to approach and are unlikely to be B
afraid of you. Older infants, however, often show
“stranger anxiety.” They may turn away from you
and cry and cling to their parent or guardian. If a
parent or the guardian is calm and cooperative, ask
him or her to help you. Try to check the infant in
the parent’s or guardian’s lap or arms.
Children ages 1 and 2 years are often referred to
as toddlers. Toddlers may not cooperate with your
attempts to check them. They are usually very con-
cerned about being separated from a parent or Figure 21-2 A, Allow a parent to hold the child while
guardian. If you reassure the toddler that he or she you check him or her. B, Demonstrating first aid steps
will not be separated from a parent or guardian, on a stuffed animal or doll helps a toddler understand
the toddler may be comforted. If possible, give the how you will care for him or her.
toddler a few minutes to get used to you before at-
tempting to check him or her and check the toddler
in the parent’s or guardian’s lap (Fig. 21-2, A). A
toddler may also respond to praise or be comforted School-age children are between 6 and 12 years
by holding a special toy or blanket. of age. They are usually cooperative and can be a
Children ages 3, 4, and 5 are commonly referred good source of information about what happened.
to as preschoolers. Children in this age group are You can usually talk readily with school-age chil-
usually easy to check if you use their natural curios- dren. Do not let the child’s chronological age
ity. Allow them to inspect items such as bandages. influence you to expect an injured or ill child to be-
Opportunities to explore can reduce many fears and have in a way consistent with that age. An injured
provide distraction. Reassure the child that you are 11-year-old, for example, may behave more like a
going to help and will not leave him or her. Some- 7-year-old. Be especially careful not to talk down to
times you can show what you are going to do on a these children. Let them know if you are going to
stuffed animal or doll (Fig. 21-2, B). The child may do anything that may be painful. Children in this
be upset by seeing his or her cut or other injury, so age group are becoming conscious of their bodies
cover it with a dressing as soon as possible. and may not like exposure. Respect their modesty.
Adolescents are between 13 and 18 years of age Injury

and are typically more adult than child. Direct your
questions to an adolescent victim rather than to a Injury is the number one cause of death for chil-
parent or guardian. Allow input from a parent or dren in the United States. Many of these deaths are
guardian, however. Occasionally, if a parent or the result of motor vehicle crashes. The greatest
guardian is present, you may not be able to get an dangers to a child involved in a motor vehicle inci-
accurate idea of what happened or what is wrong. dent are airway obstruction and bleeding. Severe
Adolescents are modest and often respond better to bleeding must be controlled as quickly as possible.
a responder of the same gender. A relatively small amount of blood lost by an adult
is a large amount for an infant or child. Because a
child’s head is large and heavy in proportion to the
Interacting with Parents and Caregivers rest of the body, the head is the most often injured
If the family is excited or agitated, the child is likely area. A child injured as the result of force or a blow
to be too. When you can calm the family, the child may also have damage to the organs in the abdom-
will often calm down as well. Remember to get con- inal and chest cavities. Such damage can cause se-
sent to give care from any adult responsible for the vere internal bleeding. A child secured only by a lap
child when possible. Any concerned adults need belt may have serious abdominal or spinal injuries
your support, so behave as calmly as possible. in a car crash. Try to find out what happened, be-
cause a severely injured child may not immediately
show signals of injury.
Observing an Infant or Child To avoid some of the needless deaths of
You can obtain a lot of information by observing children involved in motor vehicle crashes, laws
the infant or child before actually touching him or have been enacted requiring that children ride in
her. Look for signals that indicate changes in the safety seats or wear safety belts. As a result, more
level of consciousness, any trouble breathing and children’s lives are saved. You may have to
any apparent injuries and conditions. Realize that check and care for an injured child while he or
the situation may change as soon as you touch the she is in a safety seat. A safety seat does not nor-
child because he or she may become anxious or up- mally pose any problems while you are checking
set. Do not separate the infant or child from loved a child. Leave the child in the seat if the seat has
ones. Often a parent or guardian will be holding a not been damaged. If the child is to be transported
crying infant or child. In this case, you can check to a medical facility for examination, he or she
the child while the adult continues to hold him or can often be safely secured in the safety seat for
her. Unlike some ill or injured adults, an infant or transport.
child is unlikely to try to cover up or deny how he
or she feels. An infant or child in pain, for example,
will generally let you know that he or she hurts and
Illness
the source of the pain as well as he or she can. Certain signals in an infant or child can indicate
Whenever possible, begin your check of a specific illnesses. Often these illnesses are not life
conscious child at the toe rather than the head. threatening, but some can be. A high fever in a
Checking this way is less threatening to the child child often indicates some form of infection. In
and allows him or her to watch what is going on a young child, even a minor infection can result in
and take part in it. Ask a young child to point to a rather high fever, which is often defined as a
any place that hurts. An older child can tell you the temperature above 103 F (40 C). Prolonged or
location of painful areas. If you need to hold an in- excessively high fever can result in seizures (see
fant, always support the head when you pick him Chapter 15). Your initial care for a child with a
or her up. high fever is to gently cool the child. Remove ex-
cessive clothing or blankets and sponge the child
with lukewarm water. Call a physician at once.
Special Problems Do not give the child aspirin. For a child, taking
aspirin can result in an extremely serious medical
Certain problems are unique to children, such as condition called Reye’s syndrome. See Chapter 6
specific kinds of injury and illness. The following for details on breathing emergencies in infants and
sections discuss some of these concerns. children.
Sudden Infant Death

Syndrome (SIDS)
“For the first few months, I would lie awake in bed at night
and wonder if she was still breathing. I mean you just never
know. I couldn’t get to sleep until I checked on her at least
once.” This is how one mother described her first
experience with parenting.
Sudden infant death syndrome (SIDS) is the sudden,
unexpected and unexplained death of apparently healthy
babies. It is the leading cause of death for infants between
the ages of 1 month and 1 year, with the greatest number
of deaths occurring in infants younger than age 6 months. In the United States,
SIDS, sometimes called crib death, is responsible for the death of about 7000 infants each year.
Because it cannot be predicted or prevented, SIDS causes many new parents to feel anxious. However
there are several things you can do to lower the risk of SIDS. These include—
• Placing an infant on his or her back while he or she is asleep.
• Placing an infant on a firm mattress. Placing an infant to sleep on soft mattresses, sofas, sofa cushions,
waterbeds, sheepskins or other soft surfaces greatly increases the risk of SIDS.
• Removing all soft, fluffy and loose bedding and stuffed toys from the infant’s sleeping area.
• Keeping blankets and other coverings away from an infant’s mouth and nose. The best way to do this is to
dress the baby in nightclothes so you will not have to use any other covering. If you do use a blanket or
other covers, make sure that the baby’s feet are at the bottom of the crib, the blanket is no higher than
the baby’s chest and the blanket is tucked in around the bottom of the crib mattress.
• Not allowing people to smoke around your baby.
• Preventing an infant from getting too warm during sleep. An infant’s room should be at a temperature that
is comfortable for an adult. Too many layers of clothing or blankets can overheat your baby.
The best prevention for SIDS, as well as many other infant diseases, is for women to practice healthy behav-
iors while pregnant. They should get proper prenatal care, eat a balanced diet, not smoke, not drink alcoholic
beverages and get adequate rest and exercise.
For more information on sleep position for babies and reducing the risk of SIDS, visit the National Institute
of Child Health & Human Development Web site at www.nichd.nih.gov.
SOURCES
National Institute of Health Web site, www.nichd.nih.gov/sids/reduce_infant_risk.htm#WhatCan. Accessed 10/8/04.
Child and Family Services or Child Protective Ser-

Poisoning vices. You may be afraid to report suspected child
Poisoning is the fifth-largest cause of unintentional abuse because you do not wish to get involved or
death in the United States for people ages 1 to 24. are afraid of getting sued. However, in most states,
For the youngest of these victims, mainly children when you make a report in good faith, you are im-
under 5 years of age, poisoning often occurs from mune from any civil or criminal liability or penalty,
ingesting household products or medications. Care even if you made a mistake. In this instance, “good
for poisoning is discussed in Chapter 16, and how faith” means that you honestly believe that abuse
to help prevent poisoning of children in the home is has occurred or the potential for abuse exists and a
discussed in Chapters 16 and 24. prudent and reasonable person in the same position
would also honestly believe abuse has occurred or
the potential for abuse exists. You do not need to
Child Abuse identify yourself when you report child abuse,
At some point, you may encounter a situation in- although your report will have more credibility if
volving an injured child in which you have reason you do.
to suspect child abuse. Child abuse is the physical,
psychological or sexual assault of a child resulting
in injury and emotional trauma. Child abuse in-
Sudden Infant Death Syndrome
volves an injury or a pattern of injuries that do not Sudden infant death syndrome (SIDS) is a disorder
result from an accident. Suspect child abuse if the that causes seemingly healthy infants to stop
child’s injuries cannot be logically explained, or a breathing while they sleep. SIDS is a leading cause
parent or guardian gives an inconsistent or suspi- of death for infants between 1 month and 1 year of
cious account of how the injuries occurred. age. By the time the infant’s condition has been
The signals of child abuse include— discovered, he or she will be in cardiac arrest. Make
sure someone has called 9-1-1 or the local emer-
An injury that does not fit the parent or
gency number or call yourself. Perform CPR on the
guardian’s description of what caused the injury.
infant until EMS personnel arrive.
Obvious or suspected fractures in a child
An incident involving a severely injured or ill in-
younger than 2 years of age; any unexplained
fant or child or one who has died can be emotion-
fractures.
ally upsetting. After such an episode, find someone
Injuries in various stages of healing, especially
you trust with whom you can talk about the expe-
bruises and burns.
rience and express your feelings. If you continue to
Bruises and burns in unusual shapes, such as
be distressed, seek some professional counseling.
bruises shaped like belt buckles or burns the
The feelings engendered by such incidents need to
size of a cigarette tip.
be dealt with and understood or they can result in
Unexplained lacerations or abrasions, espe-
serious stress reactions. For more information on
cially to the mouth, lips and eyes.
stress, see Chapter 24.
Injuries to the genitalia; pain when the child
sits down.
More injuries than are common for a child of
the same age.
Older Adults
When caring for a child who may have been Older adults, or the elderly, are generally considered
abused, your first priority is to care for the child’s those people over 65 years of age. They are quickly
illness or injuries. An abused child may be fright- becoming the fastest growing age group in the
ened, hysterical or withdrawn. He or she may be United States. A major reason is an increase in life
unwilling to talk about the incident in an attempt to expectancy because of medical advancements and
protect the abuser. If you suspect abuse, explain improvements in health care and knowledge. Since
your concerns to responding police officers or EMS 1900, life expectancy has increased by 57 percent.
personnel if possible. For example, in 1900, the average life expectancy
If you think you have reasonable cause to be- was 49 years. Today, the average life expectancy is
lieve that abuse has occurred, report your suspi- over 75 years.
cions to a community or state agency, such as the Normal aging brings about changes. People age
Department of Social Services, the Department of at different rates, however, and so do their organs
and body parts. A person may have a “young” son is truly confused, try to find out if the confusion
heart but “old” skin, for example, and someone is the result of the injury or a condition he or she al-
with wrinkled, fragile skin may have strong bones ready has. Information from family members or by-
or excellent respiratory function. standers is frequently helpful. The person may be
Overall, however, body function generally de- afraid of falling, so if he or she is standing, offer an
clines as we age, with some changes beginning as arm or hand. Remember that an older person may
early as age 30. The lungs become less efficient, so need to move very slowly.
older people are at higher risk of developing pneu- Try to find out what medications the person is
monia and other lung diseases. The amount of taking and if he or she has any medical conditions
blood pumped by the heart with each beat de- so that you can tell EMS personnel. Look for a
creases, and the heart rate slows. The blood vessels medical ID tag or bracelet that will give you the vic-
harden, causing increased work for the heart. Hear- tim’s name and address and information about any
ing and vision usually decline, often causing some specific condition the victim has. Be aware that an
degree of sight and hearing loss. Reflexes become elderly person may not recognize the signals of a
slower, and arthritis may affect joints, causing serious condition. An elderly person may also min-
movement to become painful. Four out of five older imize any signals for fear of losing his or her inde-
adults develop some sort of chronic condition or pendence or being placed in a nursing home.
disease.
Special Situations
Checking an Older Adult
Physical and mental changes can occur as a result of
To check an injured or ill older adult, attempt to aging. As a result of these changes, many older
learn the person’s name and use it when you speak adults are particularly susceptible to certain prob-
to him or her. Consider using Mrs., Mr. or Ms. as a lems. These problems may require you to adapt
sign of respect. Get at the person’s eye level so your way of communicating and to be aware of cer-
that he or she can see and hear you more clearly tain potential age-related conditions.
(Fig. 21-3). If the person seems confused at first, the
confusion may be the result of impaired vision or
hearing. If he or she usually wears eyeglasses and
Falls
cannot find them, try to locate them. Speak slowly Falls are the sixth-leading cause of death for people
and clearly, and look at the person’s face while you over 65 years of age. As a result of slower reflexes,
talk. Notice if he or she has a hearing aid. Someone failing eyesight and hearing, arthritis and problems
who needs glasses to see or a hearing aid to hear is such as unsteady balance and movement, older
likely to be very anxious without them. If the per- adults are at increased risk of falls. Falls frequently
result in fractures because the bones become weaker
and more brittle with age.
Head Injuries
An older adult is also at greater risk of serious head
injuries. As we age, the size of the brain decreases.
This decrease results in more space between the
surface of the brain and the inside of the skull. This
space allows more movement of the brain within
the skull, which can increase the likelihood of seri-
ous head injury. Occasionally, an older adult may
not develop the signals of a head injury until days
after a fall. Therefore, unless you know the cause of
a behavior change, you should always suspect a
head injury as a possible cause of unusual behavior
Figure 21-3 Speak to an elderly victim at eye level so in an elderly person, especially if the victim has had
that he or she can see or hear you more clearly. a fall or a blow to the head.
Memories Memories
Alzheimer’s disease affects an
Memories
such as nutrition and transportation. A
estimated 4 million American adults visiting nurse or nutritionist can help
and results in 100,000 deaths you, and a volunteer program like
annually. Most victims are older than Meals-on-Wheels may be helpful.
65; however, Alzheimer’s disease can Volunteer or paid transportation
strike people in their 40s and 50s. services may also be available to take
Men and women are affected almost Alzheimer’s disease victims to and
equally. At this time, scientists are from health-care facilities, adult day
still looking for the cause of care and other programs.
Alzheimer’s disease. A confirmed Visiting nurses, home health aides
diagnosis of the disease can only be and homemakers can come to your
made by examining the victim’s brain home and give help with health care,
tissue after death. While there are no bathing, dressing, shopping and
treatments to stop or reverse a cooking. Many adult day-care centers
person’s mental decline from provide recreational activities designed
Alzheimer’s disease, several drugs are available now to for people with Alzheimer’s disease. Some hospitals,
help manage some of its signals. nursing homes and other facilities may take in
Signals of Alzheimer’s disease develop gradually. Alzheimer’s disease victims for short stays. For
They include confusion; progressive memory loss; and Alzheimer’s disease victims who can no longer live at
changes in personality, behavior and the ability to think home, group homes or foster homes may be available.
and communicate. Eventually, victims of Alzheimer’s Nursing homes offer more skilled nursing, and some
disease become totally unable to care for themselves. specialize in the care of victims of Alzheimer’s disease
A number of disorders have signals similar to those or similar diseases. A few hospice programs accept
of Alzheimer’s disease. Some of them can be treated. Alzheimer’s disease victims who are nearing the end
Therefore, it is very important for anyone who is of their lives. Search to find out which, if any, services
experiencing memory loss or confusion to have a are covered by Medicare, Medicaid, Social Security,
thorough medical examination. disability or veterans benefits in your state. A lawyer
Most people with illnesses such as Alzheimer’s or a social worker may be able to help you.
disease are cared for by their families for much of their To locate services that can help you, the Alzheimer’s
illness. Giving care at home requires careful planning. disease victim and other family members, check the
The home has to be made safe, and routines must be yellow pages under Social Service Organizations and
set up for daily activities, such as mealtimes, personal state and local government listings in the phone
care and leisure. directory. You can also contact your local health
department, area office on aging, and department of
Services That Help social services or senior citizens’ services. Churches,
synagogues and other religious institutions may also
It is important for anyone caring for a person with have information and programs; so may senior
Alzheimer’s disease or a related problem to realize that centers and nursing home staffs, hospital geriatric
he or she is not alone. There are people and departments, physicians, nurses, social workers and
organizations that can help both you and the person counselors. You may have a nearby chapter of the
with Alzheimer’s disease. For health-care services, a Alzheimer’s Association. To locate a chapter near
physician—perhaps your family physician—or a you, call the association’s 24-hour, toll-free number:
specialist can give you medical advice, including help 1-800-272-3900 or log onto www.alz.org/overview.asp.
with difficult behavior and personality changes.
SOURCES
If you are caring for an Alzheimer’s disease victim American Red Cross, Caring for a Loved One with Alzheimer’s Disease or
living at home, you may need help with basic services Dementia, StayWell, Yardley, PA. 2004.
Confusion An elderly person may become chilled and suf-

fer hypothermia simply by sitting in a draft or in
The elderly are at increased risk of altered thinking front of a fan or air conditioner. Hypothermia can
patterns and confusion. Some of this change is occur at any time of the year in temperature that is
the result of aging. Certain diseases, such as 65 F (18 C) or less. People can go on for several
Alzheimer’s disease, affect the brain, resulting in im- days suffering from mild hypothermia that they do
paired memory and thinking and altered behavior. not recognize. The older person with mild hy-
Confusion that comes on suddenly, however, may be pothermia will want to lie down frequently, which
the result of medication, even a medication the per- will lower the body temperature even further. If you
son has been taking regularly. An ill or injured per- suspect hypothermia, feel the person’s skin to see if
son who has problems seeing or hearing may also it is cold. Take the person’s temperature. If his or
become confused when ill or injured. This problem her temperature is below 98.6 F (37 C), put the
increases when the person is in an unfamiliar envi- person in a warm room; wrap him or her in one or
ronment. A head injury can also result in confusion. two blankets; give the person warm, decaffeinated
Confusion can be a signal of a medical emer- and nonalcoholic liquid to drink; and call a physi-
gency. An elderly person with pneumonia, for ex- cian for advice. However, if the body temperature is
ample, may not run a fever, have chest pain or be below 95 F (35 C), call 9-1-1 or the local emer-
coughing, but because sufficient oxygen is not gency number immediately. This condition is life
reaching the brain, the person may be confused. An threatening. Do not apply any direct heat, such as a
elderly person can have a serious infection without heating pad, electric blanket turned high or a hot
fever, pain or nausea. An elderly person having a bath. Doing so will cause blood flow to increase to
heart attack may not have chest pain, pale or ashen the area being heated and take blood away from the
skin or other classic signals, but may be restless, vital organs.
short of breath and confused.
Depression is common in older adults. A de-
pressed older adult may seem confused at first. A
depressed person may also have signals, such as
PEOPLE WITH DISABILITIES
sudden shortness of breath or chest pains, with no
The absence or loss of motor, sensory or mental
apparent cause. Whatever the reason for any confu-
function is called a disability. Impairment is dam-
sion, do not talk down to the victim or treat the vic-
age or reduction in quality, quantity, value or
tim like a child.
strength of the function. People who have a disabil-
ity may be impaired in one or more functions. The
Problems with Heat and Cold Centers for Disease Control and Prevention esti-
mates that over 33 million people in the United
An elderly person is more susceptible to extremes in States have disabilities. With many disabled people,
temperature. The person may be unable to feel tem- communication can be a major challenge in finding
perature extremes because his or her body may no out what has happened and what might be wrong
longer regulate temperature effectively. Body tem- in an emergency situation.
perature may change rapidly to a dangerously high
or low level.
The body of an elderly person retains heat be-
cause of a decreased ability to sweat and the re-
Physical Disability
duced ability of the circulatory system to adjust to
Physical disability includes impairment of motor
heat. If an elderly person shows signals of heat-
function, or movement, and of sensory function,
related illness, take his or her temperature, and if it is
impairment of one or more of the senses—including
above normal, call 9-1-1 or the local emergency
sight, hearing, taste, smell and touch. People may be
number. Slowly cool the person off with a lukewarm
impaired in one or both of these functions.
sponge bath, and give care as described in Chapter
General hints for approaching an injured or ill
19. If you find an elderly person hot to the touch, un-
person who you have reason to believe is in some
able to speak and unconscious or semiconscious, call
way disabled include the following:
9-1-1 or the local emergency number immediately.
Put the person in a cooler location if possible, but do Speak to the person before touching him
not try to quickly cool the person with cold water or or her.
put him or her in front of a fan or air conditioner. Ask “How can I help?” or “Do you need help?”
Ask for assistance and information from the so clearly. If you have trouble understanding, ask
person who has the disability—he or she has the person to repeat what he or she said. Do not
been living with the disability and best under- pretend to understand. If the person cannot speak,
stands it. If the person is not able to communi- use written messages.
cate, ask any of his or her family members,
friends or companions who are available.
Do not remove any braces, canes, other physical
Vision Loss
support, eyeglasses or hearing aids. Removal of Vision loss is a partial or total loss of sight. Vision
these items puts the person at a disadvantage of loss can have many causes. Some people are born
losing necessary physical support for the body. with vision loss. Others lose vision as a result of dis-
Look for a medical ID tag at the person’s wrist ease or injury. Vision loss is not necessarily a prob-
or neck. lem with the eyes. It can result from problems with
A person with a disability may have an animal the vision centers in the brain.
assistant, such as a guide dog or hearing dog. People with vision loss are generally not embar-
Be aware that this animal may be protective of rassed by their condition. It is no more difficult to
the person in an emergency situation. Someone communicate orally with a person who has a partial
may need to calm and restrain the animal. or total loss of sight than with someone who can
Allow the animal to stay with the person if see. You do not need to speak loudly or in overly
possible, which will help reassure them both. simple terms. Checking a person who has a vision
loss is like checking a victim who has good vision.
The victim may not be able to tell you certain things
Hearing Loss about how an injury occurred but can usually give
Hearing loss is a partial or total loss of hearing. you a generally accurate account based on his or
Some people are born with a hearing loss. Hearing her interpretation of sound and touch.
loss can also result from an injury or illness affecting When caring for a person with vision loss, help
the ear, the nerves leading from the brain to the ear to reassure him or her by explaining what is going
or the brain itself. You may not initially be aware on and what you are doing. If you must move a vi-
that the injured or ill person has a hearing loss. Of- sually impaired person who can walk, stand beside
ten the victim will tell you, either in speech or by the person and have him or her hold onto your arm
pointing to the ear and shaking the head no. Some (Fig. 21-5). Walk at a normal pace, alert the person
people carry a card stating that they have a hearing to any obstacles in the way such as stairs and iden-
loss. You may see a hearing aid in a person’s ear. tify whether to step up or down. If the person has a
The biggest obstacle you must overcome in car- seeing eye dog, try to keep them together. Ask the
ing for a person with a hearing loss is communica- person to tell you how to handle the dog or ask him
tion. You will need to figure out how to get that or her to do it.
person’s consent to give care, and you need to find
out what the problem may be. Often the injured or
ill person can read lips. Position yourself where the
Motor Impairment
victim can see your face clearly. Look straight at the The person with motor impairment is unable to
victim while you speak, and speak slowly. Do not move normally. He or she may be missing a body
exaggerate the way you form words. Do not turn part or have a problem with the bones or muscles or
your face away while you speak. Many people with the nerves controlling them. Causes of motor im-
a hearing impairment, however, do not read lips. pairment include stroke, muscular dystrophy, mul-
Using gestures and writing messages on paper may tiple sclerosis, paralysis, cerebral palsy or loss of a
be the most effective way you can communicate in limb. In caring for an injured or ill person with mo-
an emergency. If you and the victim know sign lan- tor impairment, be aware that the person may view
guage, use it. Some people who are hearing im- accepting help as failure and may refuse your help
paired have a machine called a tele- to prove that he or she does not need it.
communications device for the deaf (TDD). You Determining which problems are pre-existing
can use this device to type messages and questions and which are the result of immediate injury or ill-
to the victim, and the victim can type replies to you ness can be difficult. If you care for all problems you
(Fig. 21-4, A-D). Many people who have hearing detect as if they are new, you can hardly go wrong.
impairments can speak, some distinctly, some not Be aware that checking one side of the body against
A B
C D
Figure 21-4 Communicate with a victim of hearing loss in the best way possible:
A, signing; B, lip reading; C, writing; D, TDD.
the other in your check for non-life-threatening

conditions may not be effective with a person with
motor impairment, since body parts may not look
normal as a result of a specific condition.
Mental Impairment
Mental, or cognitive, function includes the brain’s
capacity to reason and to process information. A
person with mental impairment has problems per-
forming these operations. Some types of mental im-
pairment are genetic, or, such as Down syndrome,
are genetic alterations. Others result from injuries
or infections that occur during pregnancy, shortly
after birth or later in life. Some causes are never de-
termined.
You may not be able to determine if a victim is
mentally impaired, or it may be obvious. Approach
the victim as you would any other person in his or
her age group. When you speak, try to determine
Figure 21-5 If a victim with a vision loss can walk, stand the person’s level of understanding. If the person
beside him or her and have the person hold your arm. appears not to understand you, rephrase what you
were saying in simpler terms. Listen carefully to cured. Do not enter the scene of a suicide. If you
what the person says. People who are mentally im- happen to be on the scene when an unarmed person
paired often lead very orderly and structured lives. threatens suicide, call 9-1-1 or the local emergency
A sudden illness or injury can disrupt the order in a number and the police. If the scene is safe, listen to
person’s life and cause a great deal of anxiety and the person and try to keep him or her talking until
fear. Take time to explain who you are and what help arrives. Do not argue with the person. Leave or
you are going to do. Offer reassurance. Try to gain do not enter any scene where there is a weapon
the victim’s trust. If a parent, guardian or caregiver or where a crime has been committed. Do not ap-
is present, ask that person to help you care for the proach the scene of a physical or sexual assault.
person. These are crime scenes. Call 9-1-1 or the local
emergency number and stay at a safe distance.
Sometimes a victim may be hostile or angry. A
LANGUAGE BARRIERS victim’s rage or hostility may be caused by the in-
jury, pain or fear. Some victims, afraid of losing
Another reason for an uncomprehending look when control, will act resentful and suspicious. Hostile
you speak to a victim is that the person may not un- behavior may also result from the use of alcohol or
derstand English or any other language you may other drugs, lack of oxygen or a medical condition.
speak. Getting consent to give care to a victim with Once a victim realizes that you are there to help and
whom you have a language barrier can be a prob- are not a threat, the hostility usually goes away. If a
lem. Find out if any bystanders speak the victim’s victim refuses your care or threatens you, withdraw.
language and can help translate. Do your best to Never try to argue with or restrain a victim. Call
communicate nonverbally. Use gestures and facial 9-1-1 or the local emergency number if someone
expressions. If the person is in pain, he or she will has not already done so.
probably be anxious to let you know where that Uninjured family members may also display
pain is. Watch his or her gestures and facial expres- anger. They may pressure you to do something im-
sions carefully. When you speak to the victim, speak mediately. Often this anger stems from panic, anxi-
slowly and in a normal tone. The victim probably ety or guilt. Try to remain calm, and be sympathetic
has no trouble hearing you. When you call 9-1-1 or but firm. Explain what you are going to do. If pos-
the local emergency number, explain that you are sible, find a way that family members can help,
having difficulty communicating with the victim such as by comforting the victim.
and say what nationality you believe the victim is or
what language you believe the victim speaks. The
EMS system may have someone available, such as a SUMMARY
call taker, who can help with communication. If the
victim has a life-threatening condition, such as se- No two emergency situations are alike. Situations
vere bleeding, consent is implied. The victim will involving people with special needs, problems and
most likely be willing for you to give care in such a characteristics require your awareness and under-
case anyhow. standing. To give effective care to an older adult, an
infant or child; a person with a disability; or anyone
with whom communication is a challenge, you may
SPECIAL SITUATIONS need to adapt your approach and your attitude.
Situations may also occur in which you should not
Special situations such as a crime scene or a hostile intervene. If a situation is in any way unsafe, do not
victim may arise that you should handle with ex- approach the victim and if you have already ap-
treme caution. In certain instances, your first reac- proached, withdraw. If the situation is a crime
tion may be to go to the aid of a victim. Instead, call scene, keep your distance and stay away and call for
9-1-1 and stay at a safe distance until the scene is se- appropriate help.
1. What steps should you take when you see the 2. What factors could have been responsible for
man fall? the man’s collapse and behavior?
STUDY QUESTIONS
a. Sensory function d. Disability

b. Child abuse e. Impairment
c. Alzheimer’s disease f. Motor impairment
_____ The absence or impairment of motor, sensory or mental function.
_____ A progressive, degenerative disease that affects the brain, resulting in impaired memory, thinking
and behavior.
_____ The total or partial inability to move or to use a body part.
_____ The physical, psychological or sexual assault of a child, resulting in injury and emotional trauma.
_____ Damage or reduction in quality, quantity, value or strength of a function.
_____ The ability to see, hear, touch, taste and smell.
2. You are walking to the mailbox. A child on a skateboard suddenly rolls into the street from between two parked
cars. A car, fortunately moving very slowly, strikes the child, knocking him to the pavement. Three people in the
vicinity run to the scene. The driver gets out of the car, looking shocked and stunned.
Describe in order the steps you should take.
3. A neighbor phones saying her grandmother has fallen and is lying on the bathroom floor. She asks you to come
help. When you get there, the grandmother is conscious but unable to get up. She does not recognize her
granddaughter. She says her left leg and hip hurt. What steps should you take?
4. In which of the following ways should you move a victim with vision loss who can walk?
a. Grasp the victim’s arm or belt, and support the victim as you walk.
b. Walk in front of the victim, and have him or her keep a hand on your shoulder.
c. Walk behind the victim with a hand on the person’s back.
d. Walk beside the victim, and let him or her grasp your arm while you are walking.
5. The best position you can take in talking to an ill or injured young child is—
a. Holding the child in your arms or lap.

b. Being at eye level with the child.
c. Standing up, looking down at the child.
d. Behind the child, out of direct sight.
6. Which should you do if an ill or injured elderly person appears to be confused?
a. Assume the person is in a permanent state of confusion.

b. Inquire about any medications the person is taking.
c. Assume the person has fallen and injured his or her head.
7. What should you do if you become aware that a physical assault has taken place?
a. Call 9-1-1 or the local emergency number and then approach the victim.
b. Call 9-1-1 or the local emergency number and do not enter the scene.
c. Approach the victim and have someone call 9-1-1 or the local emergency number.
d. Assess the victim for life-threatening conditions.
8. A small child in a car seat is in an automobile collision. How would you check the child?
a. Remove the child from the car seat.

b. Ask any relative of the child who is on the scene to remove the child from the seat.
c. Check the child while the child is in the car seat.
d. Wait until EMS personnel arrive.
In questions 9 through 11, write the correct answer on the line.
9. You enter the apartment of an elderly person and find him lying down and semi-conscious. His skin is hot to
the touch. The room is very warm and stuffy. This person could be suffering from
_____________________.
10. If an elderly person’s body temperature is below 95 F (35 C), you should immediately
___________________________.
11. A conscious person who does not appear to hear or understand what you say may be
_____________________, _______________________ or may __________________.
12. List four possible causes of confusion in an elderly person.

Chapter 22
You head out to check up on the wife of your best friend, Joe. Lisa is
expecting their first child in a couple of weeks. They live approximately
45 minutes out of town and Joe had to go away for a day or two.
You’ve been trying to call Lisa for hours, but all you get is a busy signal.
Getting there takes longer than usual because of a heavy thunderstorm.
As you approach the house, you notice that the front door is partly open.
“Lisa,” you yell. “I’m in here,” Lisa calls. You walk into the bedroom and
see Lisa lying on the bed. She grimaces with the beginning of the next
contraction. “I’m sure glad to see you,” she gasps. “The phone is not
working and this baby’s not waiting for her daddy to get home.”
Childbirth
Objectives
■ Describe the three stages of labor.
■ Identify six factors you need to know to determine the mother’s
condition before the birth.
■ Describe two techniques the expectant mother can use to cope
with labor pain and discomfort.
■ Identify equipment and supplies needed to assist with the
delivery of a newborn.
■ Describe how to assist with the delivery of a newborn.
■ Identify the two priorities of care for a newborn.
■ Describe three steps to take in caring for the mother after
delivery.
■ Identify four possible complications during childbirth that require
immediate medical care.
Introduction PREGNANCY
Pregnancy begins when an egg (ovum) is fertilized
by a sperm, forming an embryo. The embryo im-
Words such as exhausting, stressful, exciting,
plants itself within the lining of the mother’s uterus,
fulfilling, painful and scary are sometimes
a pear-shaped organ that lies at the top center of the
used to describe a planned childbirth: one pelvis. The embryo is surrounded by the amniotic
that occurs in the hospital or at home under sac. This fluid-filled sac is also called the “bag of
the supervision of a health-care provider. If waters.” The fluid helps protect the newborn from
you find yourself assisting with the delivery injury and infection.
of a newborn, however, it is probably not As the embryo grows, its organs and body parts
develop. After about 8 weeks, the embryo is called
happening in a planned situation. Therefore,
a fetus. To continue to develop properly, the fetus
your feelings, as well as those of the expectant must receive nutrients. The fetus receives these nu-
mother, may be intensified by fear of the trients from the mother through a specialized organ
unexpected or the possibility that something called the placenta, which is attached to the lining
might go wrong. of the uterus. The placenta is attached to the fetus
Take comfort in knowing that things rarely by a flexible structure called the umbilical cord.
go wrong. Childbirth is a natural process. The fetus will continue to develop for approxi-
mately 40 weeks, at which time the birth process
Thousands of children all over the world are
will begin (Fig. 22-1).
born each day, without complications, in areas
where no medical care is available.
By following a few simple steps, you can THE BIRTH PROCESS
effectively assist in the birth process. This
chapter will help you better understand the The birth process begins with the onset of labor.
Labor is the final phase of pregnancy. It is a process
birth process and includes instruction on how
in which many systems work together to bring
to assist with the delivery of a newborn, how about birth. Labor begins with a rhythmic contrac-
to give care for both the mother and newborn tion of the uterus. As these contractions continue,
after the delivery and how to recognize they dilate the cervix—a short tube at the upper end
complications requiring care from EMS of the birth canal, or vagina. The birth canal is the
personnel. passageway from the uterus to the vaginal opening.
K E Y T E R M S
Amniotic sac: A fluid-filled sac that encloses, Placenta: An organ attached to the uterus and
bathes and protects the developing newborn; unborn child through which nutrients are de-
commonly called the bag of waters. livered to the newborn; expelled after the new-
Birth canal: The passageway from the uterus to born is delivered.
the vaginal opening through which a newborn Pregnancy: Begins when an egg (ovum) is fertil-
passes during birth. ized by a sperm, forming an embryo.
Cervix: A short tube at the upper end of the birth Umbilical cord: A flexible structure that attaches
canal; the opening of the uterus. the placenta to the unborn child, allowing for
Contraction: The rhythmic tightening of muscles the passage of blood, nutrients and waste.
in the uterus during labor. Uterus: A pear-shaped organ in a woman’s pelvis
Crowning: The point in labor when the newborn’s in which an embryo forms and develops into a
head is visible at the opening of the vagina. newborn.
Labor: The birth process, beginning with the con- Vagina: See birth canal.
traction of the uterus and dilation of the cervix
and ending with the stabilization and recovery
of the mother.
CHAPTER 22 Childbirth 405
Figure 22-2 When crowning begins, birth is imminent.
Figure 22-1 Mother and fetus at 40 weeks.

and occurs 15 minutes to 3 hours after the newborn
moves into the birth canal. The mother makes push-
ing efforts by tightening the muscles to assist the
As soon as the cervix is sufficiently dilated, the newborn’s progress. The newborn’s head becomes
newborn travels from the uterus through the birth visible as it emerges from the vagina. The moment
canal. The newborn emerges from the vaginal open- during labor when the top of the head begins to
ing at the lower end of the canal. For first-time emerge is called crowning (Fig. 22-2). When crown-
mothers, this process normally takes between 12 ing occurs, birth is imminent and you must be pre-
and 24 hours. Subsequent births are usually quicker. pared to receive the newborn. Stage two ends with
the birth of the baby.
Labor
Stage Three—Delivery of the Placenta
Labor has three distinct stages. The length and in-
The third stage of labor begins after the newborn’s
tensity of each stage vary.
body emerges. During this stage, the placenta usu-
ally separates from the wall of the uterus and is ex-
Stage One—Preparation pelled from the birth canal. This process normally
occurs within 30 minutes of the delivery of the
In the first stage, the mother’s body prepares for the
newborn.
birth. This stage covers the period of time from the
After the placenta is delivered, the uterus con-
first contraction until the cervix is fully dilated.
tracts to control bleeding and the mother begins to
Most of the hours of labor are spent in stage one. A
recover from the physical and emotional stresses
contraction is a rhythmic tightening of the muscles
that occurred during childbirth.
in the uterus. It is like a wave. It begins gently, rises
to a peak of intensity, then drops off and subsides.
The muscles then relax, and there is a break before
the next contraction starts. As the time for delivery Assessing Labor
approaches, the contractions become closer to-
gether, last longer and feel stronger. Normally, when If you must care for a pregnant woman, you
contractions are less than 3 minutes apart, child- will want to determine whether she is in labor. If she
birth is near. is in labor, you should determine in what stage of
labor she may be and whether she expects any com-
plications. You should find out if anyone has called
Stage Two—Delivery of the Newborn 9-1-1 or the local emergency number; if not, imme-
The second stage of labor involves the delivery of diately call. You can determine these and other fac-
the newborn. It begins when the cervix is com- tors by asking a few key questions and making
pletely dilated and ends with the newborn’s birth some observations.
Ask the following questions:

Has 9-1-1 or the local emergency number been
Preparing the Mother
called? If so, how long ago and what was the Explain to the expectant mother that the newborn
response? is about to be born. Be calm and reassuring. A
Is this the first pregnancy? The first stage of woman having her first child often feels fear and
labor normally takes longer with first apprehension about the pain and the condition of
pregnancies than with subsequent ones. the newborn. Labor pain ranges from discomfort,
Does the mother expect any complications? similar to menstrual cramps, to intense pressure or
Is there a bloody discharge? This pink or light pain. Many women experience something in be-
red, thick discharge from the vagina is the tween. Factors that can increase pain and discom-
mucous plug that falls from the cervix as it fort during the first stage of labor include—
begins to dilate, also signaling the onset of
Irregular breathing.
labor.
Tensing up because of fear.
Has the amniotic sac ruptured (or water
Not knowing what to expect.
broken)? When the sac ruptures, fluid flows
Feeling alone and unsupported.
from the vagina in a sudden gush or a trickle.
Some women think they have lost control of You can help the expectant mother cope with
their bladder. The breaking of the sac usually the discomfort and pain of labor. Begin by reassur-
signals the beginning of labor, but not always. ing her that you are there to help. If necessary and
People often describe the rupture of the sac as possible, explain what to expect as labor pro-
“the water breaking.” gresses. Suggest specific physical activities that she
What are the contractions like? Are they very can do to relax, such as regulating her breathing.
close together? Are they strong? The length Ask her to breathe in slowly and deeply in through
and intensity of the contractions will give you the nose and out through the mouth. Ask her to try
valuable information about the progress of to focus on one object in the room while regulating
labor. As labor progresses, contractions her breathing. By staying calm, firm and confident
become stronger, last longer and are closer and offering encouragement, you can help reduce
together. When contractions are 2 to 5 minutes fear and apprehension. Reducing fear will aid in re-
apart and 45 to 60 seconds long, the newborn lieving pain and discomfort.
is beginning to pass out of the uterus and into Breathing slowly and deeply in through the nose
the birth canal. Labor may continue from and out through the mouth during labor can help
15 minutes to 3 hours. the expectant mother in several ways:
Does she have the urge to bear down, or It aids muscle relaxation.
push? If the expectant mother expresses a It offers a distraction from the pain of strong
strong urge to push, this signals that labor is contractions as labor progresses.
far along. It ensures adequate oxygen to both the mother
Is the newborn’s head visible? If so, begin and the newborn during labor.
preparing for the delivery—the newborn is
Taking childbirth classes, such as those offered
about to be born.
at local hospitals, helps people become more com-
petent in techniques used to help an expectant
mother relax. Many expectant mothers also partic-
PREPARING FOR DELIVERY ipate in such training, which could greatly simplify
your role while assisting with the birth process.
Although childbirth can be exciting, it can also be Many books and videos on the subject of childbirth
frightening to witness. Remember that you are only are available.
assisting in the process; the expectant mother is do-
ing all the work. Therefore, it is important that you
remain calm. Try not to be alarmed at the loss of ASSISTING WITH DELIVERY
blood. It is a normal part of the birth process. Take
a deep breath and try to relax. Prepare the scene by It is difficult to predict how much time you have be-
gathering your supplies and putting them where fore the newborn is delivered. However, if the ex-
they are easily accessible. pectant mother says that she feels the need to push
or feels as if she has to have a bowel movement, de- els or even clothes. Newspapers, which are very ab-
livery is near. sorbent, can be used if nothing else is available. To
You should time the expectant mother’s con- make the area around the mother as sanitary as pos-
tractions from the beginning of one contraction to sible, place these items over the mother’s abdomen
the beginning of the next. If they are less than 3 and under her buttocks and legs (Fig. 22-3, B). Keep
minutes apart and last for 45 to 60 seconds, prepare a clean, warm towel or blanket handy to wrap the
to assist with the delivery of the newborn. newborn. Because you will be coming in contact
Assisting with the delivery of the newborn is of- with the mother’s and newborn’s body fluids, be
ten a simple process. The expectant mother is doing sure to wear disposable gloves. If gloves are not
all the work. She will be pushing down, using cer- available, try to find some other item to use as a bar-
tain muscles. Your job is to create a clean environ- rier. For example, a plastic bag or plastic wrap may
ment and to help guide the newborn from the birth be secured around your hands. Put something on
canal, minimizing injury to the mother and new- over your clothing, if possible, to protect yourself
born. Begin by positioning the mother. She should from splashing fluids.
be lying on her back, with her head and upper back Other items that can be helpful include a bulb
raised, not lying flat. Her legs should be bent, with syringe to suction secretions from the infant’s nose
the knees drawn up and apart (Fig. 22-3, A). Posi- and mouth immediately after birth, gauze pads or
tioning the mother in this way will make her more sanitary pads to help absorb secretions and vaginal
comfortable. bleeding, and a large plastic bag or towel to hold
Next, establish a clean environment for delivery. the placenta after delivery.
Because it is unlikely that you will have sterile sup- As crowning begins, place a hand on the top
plies, use items such as clean sheets, blankets, tow- of the newborn’s head and apply light pressure
Figure 22-3 A, Position the mother with her legs bent and knees drawn up and
apart. B, Place clean sheets, blankets, towels or even clothes under the mother.
Figure 22-4 Place your hand on top of the newborn’s head and apply light pressure.
(Fig. 22-4). In this way, you allow the head to Guide one shoulder out at a time. Do not pull
emerge slowly, not forcefully. This will help prevent the newborn. As the newborn emerges, he or she
tearing of the vagina and avoid injury to the new- will be wet and slippery. Use a clean towel to catch
born. At this point, the expectant mother should the newborn. Place the newborn on his or her side,
stop pushing. Instruct the mother to concentrate on between the mother and you so that you can give
her breathing techniques. Ask her to pant. This care without fear of dropping the newborn. If pos-
technique will help her stop pushing and help pre- sible, note the time the newborn was born.
vent a forceful birth.
Once the head is out, the newborn’s shoulders
should rotate with another push. Support the head
(Fig. 22-5). This will enable the shoulders and the
rest of the body to pass through the birth canal.
CARING FOR THE NEWBORN
Slide your forefinger along the newborn’s neck to
see if the umbilical cord is looped around it. If the
AND MOTHER
umbilical cord is around the neck, gently slip it over Your first priority of care when the newborn arrives
the newborn’s head. If this cannot be done, slip it is to take some initial steps of care for him or her.
over the newborn’s shoulders as they emerge. The Once these steps are accomplished, you can care for
newborn can slide through the loop. the mother.
Figure 22-5 As the infant emerges, support the head.

Figure 22-6 A bulb syringe can be used to clear a newborn’s mouth and nose of
any secretions.
Caring for the Newborn heat quickly; therefore, it is important to keep him
or her warm. Dry the newborn and wrap him or her
The first few minutes of the newborn’s life are a dif- in a clean, warm towel or blanket. Continue to
ficult transition from life inside the mother’s uterus monitor breathing, circulation and skin color. You
to life outside. You have two priorities at this point. may place the baby on the mother’s abdomen.
Your first is to see that the newborn’s airway is open
and clear. Because a newborn breathes primarily
through the nose, it is important to immediately Caring for the Mother
clear the nasal passages and mouth thoroughly. You
can do this by using your finger, a gauze pad or a You can continue to meet the needs of the newborn
bulb syringe (Fig. 22-6). When using a bulb syringe, while caring for the mother. Help the mother to be-
make sure you compress the bulb before you place gin nursing the newborn if possible. This will stim-
it in the newborn’s mouth. Place the bulb syringe in ulate the uterus to contract and help slow bleeding.
and clean the mouth first, then in each nostril. The The placenta will still be in the uterus, attached to
tip of the syringe should not be placed more than the newborn by the umbilical cord. Contractions
1 to 11⁄2 inches into the newborn’s mouth and no of the uterus will usually expel the placenta within
more than 1⁄2 inch into the newborn’s nostril. 30 minutes. Do not pull on the umbilical cord.
Most babies begin crying and breathing sponta- Catch the placenta in a clean towel or container. It
neously. If the newborn does not make any sound, is not necessary to separate the placenta from the
stimulate the newborn to elicit the crying response newborn. In the event that you or another citizen
by flicking your fingers on the soles of the new- responder must transport the mother and child to
born’s feet. Crying helps clear the newborn’s airway the hospital, leave the placenta attached to the
of fluids and promotes breathing. If the newborn newborn and place the placenta in a plastic bag or
does not begin breathing on his or her own within wrap it in a towel.
the first minute after birth, begin rescue breathing. Expect some additional vaginal bleeding when
If the newborn does not have signs of life and a the placenta is delivered. Gently clean the mother us-
pulse, begin CPR. You can review these techniques ing gauze pads or clean towels. Place a sanitary pad
in Chapters 6 and 7. or a towel over the vagina. Do not insert anything
Your second responsibility to the newborn is to inside the vagina. Have the mother place her legs to-
maintain normal body temperature. Newborns lose gether. Feel for a grapefruit-sized mass in the lower
abdomen. This is the uterus. Gently massage the stressful and even life threatening for the expectant
lower portion of the mother’s abdomen. Massage mother and the newborn. More common complica-
will cause the uterus to contract and slow bleeding. tions include persistent vaginal bleeding, prolapsed
Many new mothers experience shock-like sig- umbilical cord, breech birth and multiple births.
nals, such as cool, pale, moist skin; shivering; and Learn to recognize the signals of a complicated
slight dizziness. Keep the mother positioned on her birth and give the appropriate care. Call 9-1-1 or
back. Keep her from getting chilled or overheated, the local emergency number immediately if you
and continue to monitor her condition. have not already done so. All of these conditions re-
quire the help of more advanced medical care.
SPECIAL CONSIDERATIONS
Persistent Bleeding
Most deliveries are fairly routine, with few if any
surprises or problems. However, you should be The most common complication of childbirth is
aware of certain complications or special situations persistent vaginal bleeding. While waiting for the
that can occur. ambulance to arrive, you should take steps to ab-
sorb the blood. Do not pack the vagina with dress-
ings. Try to keep the mother calm and take steps to
minimize shock, as explained in Chapter 9.
Complications During Pregnancy
Complications during pregnancy are rare; however, Prolapsed Umbilical Cord
they do occur. One such complication is a miscar-
A prolapsed umbilical cord occurs when a loop of
riage, also called a spontaneous abortion. Because
the umbilical cord protrudes from the vagina while
the nature and extent of most complications can
the unborn baby is still in the birth canal (Fig. 22-7).
only be determined by medical professionals during
This condition can threaten the unborn baby’s life.
or following a more complete examination, you
As the unborn baby moves through the birth canal,
should not be concerned with trying to diagnose a
the cord will be compressed between the unborn
particular problem. Instead, concern yourself with
baby and the birth canal, and blood flow to the un-
recognizing signals that suggest a serious complica-
born baby will stop. Without this blood flow, the
tion during pregnancy. Two important signals you
unborn baby will die within a few minutes because
should be concerned about are vaginal bleeding and
of lack of oxygen. If you notice a prolapsed cord,
abdominal pain. Any persistent or profuse vaginal
have the expectant mother assume a knee-chest
bleeding, or bleeding in which tissue passes through
position (Fig. 22-8). This will help take pressure off
the vagina during pregnancy, is abnormal, as is any
the cord.
abdominal pain.
An expectant mother showing these signals
needs to receive advanced medical care quickly. Breech Birth
While waiting for EMS personnel, place a pad or
other absorbent material between the mother’s Most babies are born head-first. However, on
legs. Also, take steps to minimize shock. These rare occasions, the newborn is delivered feet- or
include— buttocks-first. This condition is commonly called a
breech birth. If you encounter a breech delivery,
Helping the mother into the most comfortable support the newborn’s body as it leaves the birth
position. canal while you are waiting for the head to deliver.
Keeping the mother from becoming chilled or Do not pull on the newborn’s body. Pulling will not
overheated. help deliver the head.
Because the weight of the unborn baby’s head
lodged in the birth canal will reduce or stop blood
Complications During Childbirth flow by compressing the umbilical cord, the un-
born baby will be unable to get any oxygen.
The vast majority of all births occur without com- Should the unborn baby try to take a spontaneous
plication. However, this fact is reassuring only if the breath, he or she will also be unable to breathe be-
birth you are assisting with is not complicated. For cause the face is pressed against the wall of the
the few that do have complications, delivery can be birth canal. When the unborn baby’s head is deliv-
Figure 22-7 A prolapsed umbilical cord.
births. The mother will have a separate set of con-

tractions for each baby being born. There may also
be a separate placenta for each baby, although this
is not always the case.
Figure 22-8 The knee-chest position will take pressure

off the cord.
SUMMARY
Ideally, childbirth should occur in a controlled envi-
ronment under the guidance of health-care profes-
ered, check the infant for breathing and signs of sionals trained in labor and delivery. In this way, the
life, including a pulse. Be prepared to give rescue necessary medical care is immediately available for
breathing or CPR as necessary. mother and newborn should any problem arise.
However, unexpected deliveries may occur outside
of the controlled environment and may require your
Multiple Births assistance. To assess the mother’s condition before
Although most births involve only a single new- delivery and to assist in the delivery, be familiar
born, a few will involve delivery of more than one with the three stages of labor and understand the
newborn. If the mother has had proper prenatal birth process. By knowing how to prepare the ex-
care, she will probably be aware that she is going to pectant mother for delivery, assist with the delivery
have more than one newborn. Multiple births and give proper care for the mother and newborn,
should be handled in the same manner as single you can help bring a new child into the world.
1. Which stage of labor is Lisa in? Why do you 2. What information can Lisa give that will help
think so? you to assist with the delivery?
STUDY QUESTIONS
a. Amniotic sac e. Crowning

b. Birth canal f. Cervix
c. Placenta g. Contraction
d. Umbilical cord h. Uterus
_____ A pear-shaped organ in a woman’s pelvis in which a fertilized egg develops into a newborn.
_____ A rhythmic tightening of certain muscles during delivery.
_____ An organ attached to the uterus that supplies nutrients to the fetus.
_____ The appearance of the newborn’s head at the vaginal opening.
_____ The upper part of the birth canal.
_____ A fluid-filled structure that protects the developing fetus.
_____ A flexible structure that attaches the placenta to the fetus; it carries blood, nutrients and waste.
_____ The passageway from the uterus to the vaginal opening through which the newborn passes during birth.
2. Name and briefly describe the three stages of labor.
3. List the two priorities of care for a newborn.
4. List six factors in determining a mother’s condition before the birth.
You happen upon a small gathering of people only to discover a woman has gone into labor. The woman is
lying on the floor in pain. She says this is her first child. She tells you that her labor pains started about an
hour ago, but she thought it was only gas. She also says that the newborn is not due for another 3 weeks.
5. You are reassured that there is enough time for the ambulance to arrive because labor for a first newborn
usually lasts—
a. 4 to 8 hours.
b. 8 to 12 hours.
c. 12 to 24 hours.
d. 24 to 36 hours.
6. When the newborn’s head is crowning at the vaginal opening, you should—
a. Maintain firm finger pressure against the center of the skull.

b. Place your hand lightly on the top of the newborn’s head.
c. Place the palm of your hand firmly against the newborn’s skull.
d. Place one hand on either side of the newborn’s head.
7. If the mother has a breech delivery, what part of the newborn will be seen first?
a. Head
b. Arms
c. Foot (feet) or buttocks
d. b and c
8. If the newborn is not crying or does not appear to be breathing, you should first—
a. Hold the newborn up by its ankles and spank its buttocks.

b. Suction the newborn’s throat with the bulb syringe.
c. Flick the soles of the newborn’s feet with your fingers.
d. Begin rescue breathing.
9. To assist with delivery of the newborn, what preparations should you make?
a. Have someone start a large pan of water boiling on the stove.

b. Place clean sheets, blankets or towels under the mother’s buttocks.
c. Have the mother lie flat on her back with legs extended.
10. What can the woman do to help cope with the pain and discomfort of labor?
a. Focus on an object in the room while regulating her breathing.

b. Assume a knee-chest position.
c. Hold her breath then suddenly release it.
d. Alternately tense and relax all muscles in her body.

Chapter 23
You and your buddies Frank and Jeff are out enjoying a day of rock
climbing in the Evergreen Mountains. The sky is clear and the
temperature is warm. Dropping temperatures and rain are predicted
for the night, but by then you will be relaxing at home. Frank
comments how good it feels every time the three of you are out in
the mountains. Suddenly Jeff screams “Help!” He loses his balance,
slips and falls and lands on a ridge about 5 feet down. When you
and Frank make your way down to him, you can see that Jeff is in
excruciating pain.
Delayed-Help
Situations
Objectives
■ List three types of environments that could create a delayed-help
situation.
■ Describe the information you should gather in a delayed-help
situation before making a plan to get help.
■ List four ways to get help in a delayed-help situation.
■ Describe four of the options to consider in getting help in a
delayed-help situation.
■ List the steps to take before leaving a victim alone for an
extended period of time.
■ Describe how to protect a victim from heat or cold.
■ Describe four types of shelters you can use or construct.
■ List three general types of preparation for venturing into an
environment where help may be delayed.
Introduction
In rural areas, people are usually aware that
help may be delayed. If telephone or mobile phone
service is available, it may be possible to communi-
cate with an emergency call taker who can tell you
In previous chapters, you learned how to how to care for the victim until more advanced care
apply the emergency action steps: CHECK— arrives.
CALL—CARE. In some situations, however,
advanced medical care is not easy to contact
or is not nearby. Situations in which medical Wilderness Areas
care is delayed for 30 minutes or more are
called delayed-help situations. A wilderness is an area that is not settled, is uncul-
tivated and has been left in its natural condition.
This chapter provides information to A phone and emergency personnel may be miles
help you use the emergency action steps: away. Some people work in wilderness areas.
CHECK—CALL—CARE in delayed-help Others are drawn to wilderness activities because of
situations. You will also learn how to prepare the challenge, the adventure and the opportunity to
for such emergencies. discover the unknown. However, those same fea-
tures that attract people to the wilderness often pre-
sent barriers to getting help in an emergency.
If an emergency occurs in the wilderness, you
TYPES OF DELAYED-HELP SITUATIONS need to consider how you are going to get help and
what care you will give. If the victim cannot move
and you have no means of transport, you may need
Rural Areas to send someone to get help or go yourself. If the
victim is able to move or be moved, you need to de-
Rural areas include country and farm areas, which cide how to safely transport him or her. If he or she
are less settled and populated than cities and where cannot be moved, you will have to shelter the vic-
neighbors often live far away. Although it is usually tim from the elements to prevent his or her condi-
easy to communicate with emergency medical per- tion from deteriorating until you return.
sonnel, response time is often delayed because of
long distances and adverse road conditions. Tempo-
rary events, such as power outages and rising water, Disaster Situations
may cut off communication and access to EMS per-
sonnel. Disasters, such as hurricanes, earthquakes or mass
Emergencies that occur in a rural environment trauma (for example, explosions, acts of terror) are
usually involve equipment, animals, electricity, falls, likely to create delayed-help situations. Phone and
fires, overturned vehicles, chemicals or pesticides electrical services may be cut off or restricted; roads
and agricultural machinery mishaps, such as those may be damaged; and medical facilities may be
resulting from tractors, combines and augurs. It is crowded or destroyed. It is important to plan ahead
important to be aware of situations and circum- if you live, work or plan to travel in an area in
stances that may put you or someone else in danger. which such disasters may occur.
K E Y T E R M S
Delayed-help situation: A situation in which Wilderness: An area that is uninhabited by hu-
emergency assistance is delayed for more than man beings, is uncultivated and has been left in
30 minutes. its natural condition.
Tourniquet: A wide band of cloth or other mater-
ial that is wrapped tightly around an extremity
to control severe bleeding; used as a last resort
measure.
CHAPTER 23 Delayed-Help Situations 417
Figure 23-1 Check the scene for dangers that could threaten your safety or the
safety of the victim.
Boating activities may also involve delayed-help

situations. On the water, communication with med- Check the Victim
ical personnel may be possible, but transportation
to a medical facility may be limited or delayed. When you are sure it is safe, approach the victim
carefully and check for life-threatening conditions.
Check for loss of consciousness, signs of life and
TAKING ACTION IN A DELAYED-HELP severe bleeding (Fig. 23-2). If the victim has fallen
SITUATION
In a delayed-help situation, you may have to mod-
ify the emergency action steps: CHECK—CALL—
CARE to meet the specific needs of your situation.
Check the Scene

Check the entire scene to get a general impression
of what happened. Look for dangers that could
threaten your safety or the victim’s safety, such as
falling rocks or tree limbs (Fig. 23-1). If you see any
dangers, do not approach the victim until you have
carefully planned how you will avoid or eliminate
the danger. Note any impending problems, such as Figure 23-2 Check the victim for life-threatening
a threatening storm. conditions.
or if you do not know how the injury occurred, as- condition that you need to make a plan for getting
sume that he or she has a head, neck or back injury. help. Whenever possible, perform a head-to-toe
Give care for the conditions you find. check even if the victim is unconscious or has life-
Next, check the victim for any other problems threatening conditions. Write down the information
that are not life threatening but may become so that you gather so that you remember it (Fig. 23-3).
over time. In delayed-help situations, this check Make a mental note of the most important or un-
may need to occur before getting help. This ensures usual observations if you do not have anything to
that you have all the information about the victim’s write with.
The Unreckoned Cost

Rippling grain, cattle grazing by a stream, apple or- Children up to age 16 make up a disproportionate
chards in the spring, dark green fields of soy beans number of these farm fatalities and injuries. Nationally,
stretching as far as the eye can see—to many, a farm one in five agricultural fatality victims is under age 18.
or ranch may not seem a particularly dangerous place. Each year, approximately 33,000 children under 20
Yet historically, farming has been one of the most haz- years of age are injured on farms and over 100 are
ardous occupations in the United States. The death killed. Too often, these children lack adequate supervi-
rate for agricultural workers is five times the national sion or are doing a task beyond their capabilities.
average for all industries. Farm children tend to take on adult work at an early
The very nature of farming puts workers at risk. age. Children only 8 years old drive tractors. Five-
Crops must be planted and harvested under pressure year-olds feed farm animals, including animals with
from weather and time. Money is not always available young who therefore may be extremely aggressive
to make needed equipment repairs or hire necessary and protective. Children also play around machinery,
labor. Equipment tends to be large and heavy, and tools, wire, gasoline pumps and other potential haz-
much farm machinery is designed to chop, crush, cut ards in barns and other areas.
or compress. Although newer equipment usually in- Nowhere is the need for training to deal with
cludes some safety features, such as rollover protec- delayed-help emergency situations greater than in
tion structures on tractors, older equipment provides farming communities. Farms are often isolated, far
little, if any, built-in safety protection. from neighbors, towns or easily traveled roads. Many
There are many possibilities for injury. Equipment roads have no identifying signs. Injuries may occur in
turns over, crushing the driver or passenger. Machin- isolated areas of the farm where vehicle access is
ery traps arms and legs, mangling or amputating problematic. Weather may make reaching the injured
them. Gas generated by stored grain causes serious person difficult or even immediately impossible. Emer-
lung damage or death. Shifting grain buries people gency medical service is generally more limited than
alive. The list goes on and on. The greatest number of in urban areas. Responders are often volunteers who
deaths are caused by tractor overturns and runovers, have other duties and may be far from the scene of
followed by other machinery injuries, drowning, the emergency. The first person on the scene, often a
firearms, falls, fires, electric current, animals, poison- family member, is generally the person who gives the
ing, suffocation and lightning. initial care and whose actions often determine
whether the victim lives or dies.
any conditions that would make it difficult for you

Check for Resources to go get help. Consider whether you may have to
move the victim.
Check the scene for resources. Resources include
people available to help, communication or signal-
ing devices, food and water, shelter, first aid sup- Call
plies and means of transportation. Check the sur-
rounding environment for conditions or developing In a delayed-help situation, the Call step can be
conditions that could endanger you or the victim divided into two phases: making a plan for getting
during the time it will take to get help. Also, note help and executing the plan.
Various individuals, groups and tion Web site at www.minnesotafarm-

organizations have developed re- bureau.org.
sources to address the farm injury sit- Other organizations include Farm
uation. First Care is a program devel- Safety 4 Just Kids, an organization lo-
oped by Allen L. Van Beek, M.D., a cated in Earlham, Iowa, that works to
microsurgeon and plastic surgeon. prevent farm-related childhood in-
Raised on a farm, at age 13, he had a juries, health risks and fatalities. It
firsthand experience with farm in- puts out a variety of resource materi-
juries when a tractor ran over both his als and activity ideas, including a
legs. In 1968, as an army flight sur- catalogue of items to teach farm
geon stationed in Vietnam, he worked with Col. George safety. One of its efforts is to raise the awareness of
Omer, M.D., a hand surgeon who told him about mi- farm families about the developmental stages of chil-
crosurgery, a new form of surgery that had the poten- dren and how parents can apply that knowledge to
tial to save severed limbs. After Vietnam, Dr. Van Beek tailor farm tasks to a child’s skills, judgment and
studied reconstructive and plastic surgery. Performing maturity. To learn more about this program visit the
surgery with the aid of a microscope and microscopic Farm Safety 4 Just Kids Web site: www.fs4jk.org.
needles, he has repaired or reattached countless fin- FARMEDIC Training, Inc. is a nonprofit corporation
gers, hands, arms and legs mangled or severed in that has been training EMS personnel in responding to
farm injuries. Many of the victims are children. farm emergencies. FARMEDIC is currently working
Dr. Van Beek developed First Care to fill what he also to train farm families and workers who are the
felt was a huge void in the rural health-care system. first people on the scene of an emergency to respond
First Care is designed to teach the person who first appropriately. FARMEDIC has developed a program
comes upon a victim how to cope in those first min- called “First on The Scene.” This program is for farm
utes after an emergency and give care until advanced family members, farm workers, agricultural business
medical help can arrive. The program is sponsored by people and agricultural students. For more information
the Minnesota Farm Bureau Federation and The North visit the FARMEDIC Web site at: www.farmedic.com.
Memorial Medical Center. For more information about
this program, visit the Minnesota Farm Bureau Federa-
9-1-1 or the local emergency number as soon

as you have enough information about the vic-
tim’s condition and he or she is safe from dan-
gers at the scene. Emergency medical personnel
can tell you how to care for the victim and ad-
vise you about getting help.
If phone or radio communication is not possi-
ble, is there a way to signal for help? The ad-
vantages of signaling are that it is faster and
safer than going for help. The disadvantages
include not knowing if your signal has been re-
ceived and not being able to communicate to
the receiver the type of help you need.
If there is no way to call for help, is it possible
to go get help? Consider whether you can get
help safely while not jeopardizing the victim’s
safety. Carefully weigh the decision if going to
get help means leaving the victim alone.
Is there a way to transport the victim to help?
Consider whether you have a safe and practi-
cal way to transport the victim. Ask whether
Figure 23-3 Write down the information you gather the victim’s injuries allow for safe transport. If
while interviewing the victim. the victim cannot walk, it will be extremely
difficult to carry him or her any distance, even
if you have a large number of people to assist.
Unless a vehicle or other means of transporta-
Making a Plan tion is available, you probably will not be able
In a delayed-help situation, you have four options to transport the victim to help without great
for getting help: difficulty.
Is it possible to give care where you are until
Stay where you are and call, radio or signal the victim can travel? Think about the risks of
for help. caring for the victim without medical assis-
Send someone to go get help or leave the tance and the possibility that serious complica-
victim alone to get help. tions may develop. On the other hand, con-
Transport the victim to help. sider how quickly the victim may be able to
Care for the victim where you are until the recover, allowing you to safely transport him
victim has recovered enough to travel on his or or her to medical care.
her own. Is it safe to wait for help where you are? Envi-
ronmental hazards, such as a threatening
Consider all the information you have gathered
storm or falling temperatures, may make it un-
during the Check step about the conditions at the
safe to wait for help.
scene, the victim’s condition, the resources available
where you are and the available means for sum-
You may discover that there is no “best” plan
moning help. Discuss your options with others, in-
for getting help. You may have to compromise, re-
cluding the victim, if appropriate. To help decide on
ducing overall risk by accepting certain risks. For
the best approach, ask yourself and others these
example, you are hiking in a remote area late in the
questions:
afternoon on a cold, sunny day. One of your com-
Is advanced medical care needed and if so, panions injures an ankle. Generally, the safest thing
how soon? If you discovered any conditions to do for the victim would be to immobilize the an-
for which you would normally call 9-1-1 or if kle, send someone for help and wait with the victim
these conditions seem likely to develop, you until emergency transportation arrives. However, if
should plan to get help immediately. you know that it will take until nightfall for some-
Is there a way to call from the scene for help one to summon help and no one in your party is
or advice? If communication is possible, call dressed to survive the low temperatures overnight,
EMS personnel to the victim. Do not give mileage

approximations to the EMS call taker unless you
are sure of the distance.
Improvised Distress Signals

If you have no way to call for help and it is danger-
ous or impractical to use flares or send someone for
help, you may have to improvise. Two of the most
widely used general distress signals are—
Signals in Threes. A series or set of three sig-
nals can be used to signal “Help!” Three shots,
three flashes of light, three shouts, three
Figure 23-4 When calling for help, describe all impor- whistles or three smoky fires are all examples
tant aspects of the victim’s condition, your location and (Fig. 23-5). Use extreme caution when building
other information responders will need.
fires. Always remain near the fire and have
water or dirt close by to extinguish sparks. Do
not use fires in dry areas. A small fire can eas-
ily get out of control. Build your fires in a tri-
you may decide to immobilize the ankle and assist
angle at least 50 yards (45 meters) apart so
the victim in walking to shelter, even though follow-
that they are visible as separate fires.
ing this plan may cause further injury to the ankle.
Ground-to-Air Signals. To signal an aircraft,
Getting Help use either signals in threes (three fires or three
flashes of light) or else mark a large “X” on
Once you have a plan, you need to execute it. Get-
the ground. The X ground-to-air signal is a
ting help may mean calling or signaling for help,
general distress signal meaning “unable to pro-
sending for help, taking the victim to help or even
ceed” or “need immediate help.” If construct-
going without additional help until the victim has
ing an X signal, make sure that you choose a
recovered enough to travel.
large, open area and that the X you construct
Calling for Help stands out against its background. The X sig-
nal should be at least 20 feet (6 meters) across.
If you have some means of quickly calling for help,
such as a mobile phone or two-way radio, make In addition, smoke, mirrors, flare guns and
sure you have gathered all the necessary informa- whistles create visual or auditory signals to attract
tion about the victim’s condition and your location responders (Fig. 23-6). Smoke signals can be
so that EMS or rescue personnel will be able to effective because they can be seen for many miles.
plan their response (Fig. 23-4). Having essential If you are on a boat, making an urgent call over
information when you call reduces confusion marine radio indicates that you have an emergency.
and improves the likelihood that the right type of You should be familiar with various ways of
help will be sent to the right location. In addition, signaling that are appropriate for your location
if you include all essential information in your and environment.
first communication, emergency personnel will be
able to respond even if later communication at-
tempts fail. Sending for Help
Make sure you give the rescuers specific infor-
When you send someone to get help, he or she
mation about your location. Identifying prominent
should carry the following information:
landmarks and marking your area can help rescuers
find your location. Consider that some landmarks A note indicating the victim’s medical
are clearly visible during the day but are not visible condition.
at night. Flares are one way of marking your loca- A map indicating the location of the victim.
tion. Do not use flares in heavily wooded or dry ar- A list of other members in the group.
eas that could ignite. You may need to send some- A list of available resources.
one to meet EMS personnel at a main road or A description of the weather, terrain and access
easy-to-identify location and have him or her guide routes if known.
Figure 23-5 A set of three or an “X” is used to signal “Help.”
people to ensure the messenger’s safety and success

in delivering the message. If going for help involves
hazards or challenges, do not send people who are
not prepared to overcome these problems.
Another consideration in going for help is mak-
ing sure you can lead rescuers back to the victim.
When in the wilderness or on the water, the most
accurate way to describe your location is to use
compass readings. You should be trained in map
and chart reading and the use of a compass if you
travel or work in delayed-help environments.
Always mark your way so that you can find
your way back. Regularly look back at the area you
Figure 23-6 A mirror can be used to summon help. just traveled, which can assist you on your return
trip. What you see behind you may look different
from the area you are facing.
When sending someone for help, make sure that
This information will help emergency personnel you leave enough people to care for the victim while
determine their needs for the rescue. The informa- waiting for help. Those remaining with the victim
tion should be carried in writing in the event that should be those equipped to care for the victim.
the person becomes lost or something happens to Finally, before sending anyone for help, con-
him or her. sider whether tasks at the scene require everyone’s
The safety of the messenger seeking help is ex- help. For instance, moving a victim a short distance
tremely important. Make sure you send enough to a shelter is easier to do when everyone helps.
other means of transportation is available rather

Leaving a Victim Alone than simply carrying the victim. Carrying a victim is
Generally, it is not a good idea to leave a victim very difficult and can be hazardous, especially if the
alone. However, if you are alone with the victim, terrain is not smooth and flat.
have no way to call or signal for help and are rea- Factors to consider when deciding to move
sonably sure that no one will happen by, then you the victim include the extent of the injuries, dis-
may decide that it is best to leave the victim and go tance to be traveled and available help at the
get help. scene. Remember that excessive movement may
Plan the route you will follow to go for help. aggravate or worsen the victim’s condition. You
Make sure you know how to lead rescuers back to should not attempt to move or transport a
the victim. Write down the route, the time you are victim with a suspected head, neck or back injury
leaving and when you expect to arrive. Leave this unless the scene is not safe or a potential for
information with the victim. danger exists.
Be sure to provide for the victim’s needs while If you decide to transport a victim to help, plan
you are gone. Ensure that the victim has food, the route you will follow. Remember that you may
water and a container to use as a urinal or bedpan. need to travel more slowly to avoid further injury to
If the victim cannot move, make sure that these the victim. It is better to have a person besides the
things are within reach. driver who will care for the victim during transport.
Make certain that the victim has adequate cloth- If possible, inform someone else of your route and
ing and shelter and that he or she is protected from alternate plans.
the ground. See “Protection from the Elements” in Plan and rehearse how you will move the victim
this chapter for more information. Recheck any into the vehicle. To minimize pain and injury during
splints or bandages, and adjust them if necessary so the move, immobilize any possible bone or joint
that they are not too tight. If the victim is uncon- injuries before moving the victim to the vehicle. Se-
scious or completely unable to move, place him or lect a place in the vehicle for the victim that will be
her in the recovery position, lying on one side with as comfortable as possible and that will allow you
the face angled toward the ground, to protect the to give care during transport. Make sure he or
airway in case of vomiting (Fig. 23-7). Be careful to she will fit in the location you have selected. Use
keep the head and spine as straight as possible. an uninjured person as a “test victim” to make
Before you go, make sure that a conscious vic- sure the space is adequate. Transport the victim at a
tim understands that you are going to get help. Give safe speed following the route you have planned.
the victim an idea of when to expect a response. Be Monitor the victim’s condition and work with the
as reassuring and positive as the situation allows. driver to make any necessary changes in transport
conditions.
Transporting a Victim to Help
In situations involving injury or sudden illness, it is Care
usually best to have help come to you. Consider
transporting a victim to help only if a vehicle or In a delayed-help situation, you may need to care
for the victim for a long time. It is important that
you remain calm so that you can give the best care
possible, whether for a few minutes or a few hours.
Provide support and reassurance to the victim until
EMS personnel arrive and take over.
Monitoring the Victim

After you complete your initial check of the victim
and give care for the conditions found, continue to
monitor the victim’s condition while waiting for
help. Monitoring is especially important in a
Figure 23-7 If you must leave an unconscious victim delayed-help situation because the longer help is de-
to go get help, position the person on one side in case layed, the more time there is for the victim’s condi-
he or she vomits while you are gone. tion to change.
Continuously monitor the breathing of a victim tourniquet is very dangerous. When left in place for
who is unconscious or has an altered level of con- an extended period, uninjured tissues may die from
sciousness. Listen to and watch the victim’s breath- lack of blood and oxygen. Releasing the tourniquet
ing. If the victim stops breathing or vomits, you will increases the danger of shock, and bleeding may re-
need to give care. Otherwise, the victim should be sume. If a tourniquet is applied too loosely, it will
rechecked about every 15 minutes. If the victim not stop arterial blood flow to the affected limb and
can answer questions, ask the victim if his or her will only slow or stop venous blood flow from the
condition has changed. You should also watch for limb. Applying a tourniquet means risking the loss
changes in skin appearance and temperature and of a limb in order to save a life.
level of consciousness. Changes in these conditions To apply a tourniquet, place it just above the
may indicate developing problems, such as heat- or wound. Do not allow the tourniquet to touch the
cold-related emergencies and shock. Recheck any wound edges. If the wound is in a joint area or
splints or bandages, and adjust them if they are just below, place the tourniquet immediately above
too tight. the joint.
Keep a written record, noting any changes you
Wrap the tourniquet band twice tightly
find and the time the changes occur. Also note the
around the limb, and tie an overhand knot
care you give.
(Fig. 23-8, A).
Place a short, strong stick or similar object
Fractures and Dislocations that will not break on the overhand knot;
tie two overhand knots on top of the stick
In Chapters 11 and 12, you learned how to rec-
(Fig. 23-8, B).
ognize and give care for musculoskeletal injuries.
Twist the stick to tighten the tourniquet until
You should not attempt to move a person with a
bleeding stops (Fig. 23-8, C).
possible fracture unless it is absolutely necessary
Secure the stick in place with the loose ends of
or the injury does not affect the person’s ability to
the tourniquet, a strip of cloth or other mater-
walk. Do not attempt to move a person or have
ial (Fig. 23-8, D and E).
the person move without first splinting the in-
Make a written note of the location of the
jured part. If you must move or transport the vic-
tourniquet and the time it was applied, and at-
tim, splint the injured body part. Be sure to
tach the note to the victim’s clothing.
loosen the splint and recheck the limb about
Treat the victim for shock, and give first aid
every 15 minutes.
for other injuries.
Do not cover a tourniquet.
Bleeding Note the time the tourniquet was applied.
In delayed-help situations, use the same principles Loosen it after 5 minutes to determine if bleeding has
that you learned to control severe bleeding in stopped. If bleeding continues, tighten the tourni-
Chapter 8—apply direct pressure, first with your quet for another 5-minute period. Then, loosen
gloved hand after applying a dressing and then with the tourniquet and recheck bleeding. If bleeding
a pressure bandage. Take steps to minimize shock has stopped, leave the loosened tourniquet in place.
and call 9-1-1. Follow-up medical care is imperative.
Most external bleeding can be easily controlled.
Direct pressure should be maintained for at least
10 minutes to allow a blood clot to form. Burns
If bleeding cannot be controlled, consider ap-
General steps for caring for a burn in a delayed-help
plying a tourniquet in addition to maintaining di-
environment are the same as in any other situation:
rect pressure. A tourniquet is a wide band of cloth
or other material placed tightly just above a wound Stop the burning by removing the victim from
to stop all flow of blood beyond the point of appli- the source of the burn. Smother flames with
cation. Do not use a narrow band, rope or wire. blankets or other material if water is not
Application of a tourniquet can control severe available.
bleeding from an open wound of the arm or leg, but Cool the burn. Immerse the burned area in cold
it is rarely needed and should not be used except water until pain is relieved. However, using
in situations where other measures fail. Using a cold water on serious burns increases the possi-
A B
C D
Figure 23-8 Apply a tourniquet only as a last resort.

A, Wrap the tourniquet band twice tightly around the
limb, and tie an overhand knot. B, Place a short, strong
stick or similar article that will not break on the overhand
E knot; tie two overhand knots on top of the stick. C, Twist
the stick to tighten the tourniquet until bleeding stops.
D, Secure the stick in place with the loose ends of the
tourniquet. E, A strip of cloth or other improvised material
may also be used to secure the tightened tourniquet in
place.
bility of hypothermia and shock, especially in a that the gel on the dressing can easily be
cold environment. Be careful not to use more washed away with water.
water than necessary and to immerse only the Prevent infection. Since the danger of infection
burned area. is greater in delayed-help environments, apply
Cover the burned area. Once the burn has a thin layer of triple antibiotic ointment to the
been cooled, your main concern is keeping the cooled burn. Keep a dressing over the burn as
area clean. Use a clean, dry cloth or a sterile mentioned. If an emergency facility is more
burn dressing (such as one with a water-based than a day away, you must redress the burn
gel coating) to cover the burn loosely. Be sure daily. Redressing includes taking old dressings
off, cleaning the burned area with sterile water suspect any injuries or possible recurrence of the
and mild soap, reapplying a thin layer of triple seizure.
antibiotic ointment and covering with a clean
dressing. If none of these materials are avail-
able, leave the burn alone; it will form
Shock
a scab. In a delayed-help situation, it is likely you will
Minimize shock. Partial- and full-thickness have to give care for shock. Although treatment
burns, or burns covering more than one body for shock is carried out by advanced medical per-
part, can cause serious loss of body fluids. sonnel, you can do your best to minimize or delay
Give fully conscious victims water or clear its onset.
juices to drink. Adults should receive 4 ounces Remember that shock does not always occur
(1⁄2 cup) over a 20-minute period, sipping right away. It may develop while you are waiting
slowly. A child should receive 2 ounces for help. Check for signals of shock every time
(1⁄4 cup) and an infant 1 ounce (1⁄8 cup) over you check the victim’s condition. Be alert for con-
the 20-minute period. Elevate burned areas ditions that may cause shock to develop over
above the level of the heart and keep the time, such as slow bleeding, vomiting, diarrhea or
burned victim from becoming chilled. Always heat loss.
monitor breathing and consciousness. The If you or someone you are with is susceptible to
victim of serious burns requires transport to a a severe form of anaphylaxis or anaphylactic shock
medical facility as soon as possible. as a result of a bite or sting, be sure someone knows
the location of necessary medication, such as oral
antihistamines or injectable epinephrine, and
Sudden Illness knows how to use it. Anaphylactic shock can be life
When caring for a victim of sudden illness, such as threatening if the victim does not receive care im-
someone experiencing a diabetic emergency or a mediately. Quickly transport a person who shows
seizure, follow the same procedures as if you were signals of anaphylactic shock, such as swelling and
not in a delayed-help situation. However, there are trouble breathing, to a medical facility.
additional factors to consider when you are far If medical care is more than 2 hours away,
from help or transportation. you may need to give preventive care for shock by
A victim recovering from an episode of low giving a conscious victim cool water or clear juices.
blood sugar should rest after eating or drinking You can give an adult about 4 ounces (1⁄2 cup) or
something sweet. If he or she does not show signs more of water to sip slowly over a 20-minute pe-
of improvement within 5 minutes, you need to give riod. For a child, give 2 ounces (1⁄4 cup) and for an
the victim water in the amounts described in the infant, 1 ounce (1⁄8 cup) over the same 20-minute
following section on shock. Transport him or her period. Giving frequent, small amounts, rather
to a medical facility. Some wilderness first aid ex- than fewer large amounts, reduces the chance of
perts recommend rubbing small amounts of a vomiting.
sugar and water mixture (or some other sweet liq- Even in a delayed-help situation, do not give
uid, such as fruit juice or a sports drink) on the fluids if the victim is unconscious; is having
gums of an unconscious person. Remember, vic- seizures; has a serious head or abdominal injury; or
tims of diabetic emergencies need to get a sugary if vomiting is frequent and sustained. If you give
substance into their system immediately. However, fluids and the victim then starts to vomit, wait be-
never give an unconscious victim anything to eat fore giving the victim any more to drink. Remember
or drink. to keep the victim from becoming chilled or over-
To care for someone who has experienced a heated.
seizure in a delayed-help environment, do no fur-
ther harm and complete a detailed check for in-
juries after the seizure is over. Maintain the victim’s
Head, Neck and Back Injuries
body temperature and help to prevent shock by If you suspect a head, neck or back injury, the goal
putting some form of insulation between the victim and the care are the same as in any other emer-
and the ground. Cover the victim with a blanket or gency: prevent further injury by providing manual
coat if necessary. Consider ending the trip if you stabilization (Fig. 23-9).
Figure 23-10 Place an insulating barrier between the

victim and the ground.
simple answer to this question. In such a situation,

you will ultimately need to make your own deci-
sion. However, some general principles can help
Figure 23-9 Provide manual stabilization if you sus- you decide.
pect a head, neck or back injury. As you learned in Chapter 7, the purpose of
CPR is to partially and temporarily substitute for
Caring for a victim with a head, neck or back the functions of the respiratory and circulatory sys-
injury who will be outdoors for an extended period tems. However, CPR is not designed for and is not
of time may be even more difficult. The victim will capable of sustaining a victim’s life indefinitely.
not be able to maintain normal body temperature Usually, the longer CPR is continued, the less likely
without help. The person will need help with drink- the victim will survive.
ing, eating and going to the bathroom. If you are The victim’s survival depends largely on what
alone and need to free yourself from maintaining caused the heart to stop in the first place. If the
manual stabilization of the victim’s head and neck, cause was a direct injury to the heart, such as from
place two heavy objects wrapped in clothing next to a heart attack or from crushing or penetrating
each side of the head to hold it in line. trauma to the chest, little chance exists that the vic-
Help the victim maintain normal body temper- tim will survive in a delayed-help environment,
ature by placing insulation underneath him or whether or not CPR is performed. On the other
her or by providing shelter from the weather. If hand, if the heart is not injured but stops as a result
two or more people are available, roll the victim of hypothermia, lightning strike or drowning, the
onto one side to place insulation underneath the victim’s heart has a better chance of starting. CPR
body, being careful not to twist the head, neck or can limit brain damage in case the heart starts and
back (Fig. 23-10). may even improve the chance that the heart will
start. In such a case, CPR should be continued
until the heart starts beating, you are relieved by
DIFFICULT DECISIONS another trained responder, EMS personnel arrive
and take over, you are too exhausted to continue or
One of the most stressful and emotionally draining the situation becomes unsafe.
situations you can be faced with is dealing with a
life-threatening condition when advanced medical
care is not easily obtainable. In a delayed-help sit- PROTECTION FROM THE WEATHER
uation, you may be faced with the difficult ques-
tion of how long to continue resuscitation efforts if When caring for a victim in a delayed-help situa-
the victim’s condition does not improve and ad- tion, it is critical to protect the victim from envi-
vanced medical help is hours away. There is no ronmental conditions such as heat, cold, wind,
A B
C D
Figure 23-11 A, Natural shelter. B, Artificial shelter. C, Snow shelter. D, A pole tent.
easily assembled (Fig. 23-11, D). Although tents especially in the winter months, that you keep
will keep you dry, they are usually not warm in ex- your car in good working condition, filled with
treme cold. Bivouac sacs made from Gore-Tex® are gasoline and carry a vehicle survival kit. Whether
better at holding warmth. a shelter is natural or artificial, it should be well
A car can be an effective shelter. If you are ventilated to prevent buildup of condensation or
stranded, it is better to stay in your car than to go toxic fumes.
find help. If you need heat, you can to keep the
heater on for 15 to 20 minutes each hour. Make
sure snow or ice does not block the exhaust pipe PREPARING FOR EMERGENCIES
and cause carbon monoxide fumes to back up into
the car. Leave the window opened a little to pre- If you live or work in a delayed-help environment
vent carbon monoxide poisoning. You can also or plan to be in one, develop a plan for how you
use candles as a source of heat. It is important, will respond to emergencies that may arise.
Kit for Overnight Camping

CASE Sewing kit (safety pins, needle, thread)
Durable in temperature extremes Soap
Water and dust tight Cotton swabs
Sized to meet personal needs Tongue depressors
Eye drops
CONTENTS Disposable gloves
Scissors Allergy kit
Tweezers Water purification tablets or filter
Hypothermia thermometer (reads down to Knife
85° F (29.4° C) Waterproof container of matches, with flint bar
Over-the-counter pain medication or lighter
Over-the-counter antihistamine Extra socks
Antacids Heliograph mirror, whistle
Triple antibiotic ointment Flashlight and extra batteries
Sunblock (SPF 15 or higher) Foot powder
Sunburn lotion or cream Magnifying glass
Lip protection, such as ointment or cream Sheet of aluminum foil
Adhesive tape Nylon cord
Roller gauze, 2-inch, 4-inch Mosquito netting, emergency blanket
Sterile dressings, 4 x 4-inch squares Compass
Nonstick dressings Insect repellent
Adhesive bandages Towel
Types of Preparation Skills include proficiency in wilderness or sur-

vival techniques, and the technical skills necessary
There are three general types of preparation— to safely engage in certain activities, such as scuba
knowledge, skills and equipment. diving or rock climbing. For instance, if you plan to
Knowledge includes learning about the emer- use a two-way radio, you need to know how to op-
gency care resources available and how to access erate it and how to call for help. Rural inhabitants
them. It also includes finding out the local geogra- should know how to safely handle the hazards that
phy, including landmarks and hazards. For in- they encounter on a regular basis, such as pesticides
stance, if you are going on a hiking trip, talk with or farm machinery. Courses are available that ad-
park rangers or others who know the environment dress specific situations, such as wilderness first aid
(Fig. 23-12, A). Plan your route and decide when and farming emergencies.
and where you will check in (Fig. 23-12, B). If you Equipment includes appropriate clothing for
are planning a boating expedition, consult the your location and activities, first aid supplies suit-
Coast Guard about possible weather hazards for able for your activities and expected hazards, as
that time of year. If you will be boating on inland well as devices for signaling and communication.
waters, also consult with the local authority with Basic first aid supplies are listed in Chapter 1. The
control over dam water releases. People in rural ar- contents of a first aid kit should be modified to suit
eas should meet with local EMS personnel and ask your particular needs. For example, boaters should
what to do if an emergency occurs and estimated re- waterproof their kits by placing the contents in a
sponse time to their particular location. waterproof container. People driving on long trips
Being Prepared
When you are traveling in a wilderness or back-
country area, the Boy Scouts of America recom-
A mend having the following with you at all times:
1. Map, preferably a topographic map, of the
area in which you will be traveling.
2. Compass—and know how to use it before
you leave.
3. Matches in a waterproof container.
4. 24 hours of EXTRA high energy food.
5. Water, 1-2 liters (2-3 quarts).
6. Extra clothes, such as socks and a sweater.
7. Rain gear.
8. A pocket knife and whistle.
9. Sun protection such as a wide-brimmed
B
hat, sun glasses, and sun screen.
10. First-aid kit with an emergency blanket.
Figure 23-12 Appropriate preparation includes Group-related factors, such as pre-existing

A, talking to a park ranger who knows the environment, medical or physical conditions.
and B, using a map to plan your route. Requirements for special equipment and
supplies for high-risk or other specific
activities.
Group size. It is best to travel in a group larger
than two so that at least one person is always
may want to add flares, a blanket and a flashlight
available to stay with a victim.
to their kits.
The sooner you start to plan your trip, the more in-
formation you will be able to gather. You will also
Ensuring Adequate Preparation have more time to act.
Get trained. Take courses and talk to people
with experience. Professionals, such as guides, park
Planning for emergencies is an important part of
rangers and Coast Guard personnel, as well as en-
preparation for any trip or activity. Adequate
thusiasts of the activity you will be engaged in are
preparation will not only reduce the risk of certain
good sources of information. You may find experi-
problems, but will also help make your trip more
enced people in clubs or in stores that sell equip-
enjoyable. When planning a trip, several major con-
ment for the activity. Ask what preparations they
siderations will help you determine special safety
recommend to make your experience safe and en-
needs. These include—
joyable. If possible, talk to more than one person to
Level of first aid training among group get a range of viewpoints.
members. Look for books, magazines and Web sites that
Distance you will be from medical help. include information on your intended destination
Duration of the trip or activity. and activity. Find more than one source of written
Level of risk associated with the activity and information so that you get more than one author’s
environment. point of view.
Find out about local weather conditions for the As with all other emergency situations, use the
time you will be there. Make sure that you know emergency action steps: CHECK—CALL—CARE.
the environmental conditions you need to be pre- However, in a delayed-help situation, you will need
pared for. An atlas or reference book and people to check the scene and the victim in greater detail
knowledgeable about your destination may provide before getting help. You may also need to develop a
you with information about weather-related chal- more detailed plan for getting help and caring for
lenges for the area in which you will be traveling. the victim. Getting help may involve calling for
Find out about local emergency resources in the help, sending for help, leaving the victim alone and
area you will be, including how to call for help. going for help, transporting the victim to help or al-
Find out if the emergency number is 9-1-1; if it is lowing the victim to recover sufficiently so that he
not, find out what the local emergency number is. or she can walk to help.
Get other important phone numbers, such as hospi- In general, the care you give a victim in a
tals, clinics and law enforcement agencies. If travel- delayed-help situation is no different from what
ing to a foreign country, find out whatever details you have learned in previous chapters. How-
you can about the medical care that is available. ever, you will spend more time caring for the
Plan your route and write it down. Let others victim. Regularly checking the victim’s condition
know about your timing, routes, destination and while waiting for help and writing down any
companions. Letting others know your destination changes that you find are important in a delayed-
and estimated time of arrival may lessen the re- help situation. You may also need to protect the
sponse time in the event of an emergency. victim from heat and cold or construct a shelter if
help is delayed for an extended period of time.
If you are planning to venture into a delayed-
SUMMARY help environment or if you live or work in one, think
about how you can reduce the risk of emergencies.
Emergencies do not always happen where it is quick Adequately preparing yourself for a delayed-help
and easy for you to call 9-1-1 or the local emergency environment includes early planning, talking to
number, for advanced medical personnel to reach the people with experience, reading, finding out about
victim or for the victim to be transported to a med- local weather conditions and emergency resources,
ical facility. In these delayed-help situations, you will planning your route and constructing plans to deal
need to give care for a much longer time than usual. with emergencies should they arise.
1. Are you, Frank and Jeff in a delayed-help situa- 3. What do you think would be the best method for
tion? If so, what factors make it a delayed-help getting help in this situation? Why?
situation?
2. What dangers should you look for at the scene 4. What should you do to care for Jeff while Frank
of Jeff’s fall? What life-threatening conditions goes for help?
might Jeff have, and what conditions might
shortly become life threatening?
STUDY QUESTIONS
a. Tourniquet
b. Bivouac sac
c. Wilderness
d. CHECK—CALL—CARE
e. Delayed-help situation
_____ Emergency Action Plan
_____ A wide band of clothing placed above a wound to stop all blood flow as a last resort to control bleed-
ing in a delayed-help situation
_____ An emergency situation in which medical care is delayed for 30 minutes or more
_____ A lightweight single person shelter made of waterproof and insulating materials
_____ A delayed-help environment
2. List three types of problems that can create a delayed-help situation.
3. List two types of environments that can create a delayed-help situation.
4. List four options for getting help in a delayed-help situation.
5. Periodically rechecking the victim’s condition while giving care until help arrives is necessary because—
a. It helps you remember changes in his or her condition.

b. The victim may become hungry.
c. The victim’s condition may worsen.
d. The victim needs to be comfortable.
6. The type of shelter that can be built from readily available materials, such as branches and trees,
is called a(n)—
a. Natural shelter.
b. Artificial shelter.
c. Snow shelter.
d. Tent shelter.
7. Flare guns, whistles and mirrors are examples of—
a. Hunting gear.
b. First aid supplies.
c. Signaling devices.
d. Ground-to-air signals.
8. To prevent further injury to a person who may have a head, neck or back injury, you should provide—
a. Manual immobilization.
b. Manual traction.
c. Manual stabilization.
d. Manual reduction.
9. Which would you do if you would have to leave the victim alone for an extended period of time?
a. Give the victim instructions to give the rescuers.

b. Tighten any splints or bandages before you leave.
c. Write down the route you are going to take and the time you are leaving.
d. Do not leave any food within the victim’s reach.
10. In the following scenario, circle the information you should consider before making a plan to get help.
You are hiking with your hiking club in Greenleaf National Forest and are now on a trail about 5 miles from the
main road. As you are crossing a stream, a group member slips and falls into the icy water. You all help him out
and help him sit on the bank. He is shivering violently in the cool breeze. He says his right knee is very painful
and feels as if it is swelling. The sky is overcast and the temperature is about 50° F (10° C). The sun will begin to
set in about 4 hours. A group member gives you a sweater, which you substitute for the victim’s soaked jacket.
Other group members provide clothing.
11. To keep a victim from getting chilled or overheated, you would ___________.
12. Three general types of preparation that can help you plan for going into a delayed-help environment are
___________, ___________ and ___________.

Part
SEVEN
HEALTHY
LIFESTYLES
24 A Safer and Healthier Life
hapter 24
Chapter
Rosanna was excited to be entering her first 10K of the season. At the
registration tables, she was surprised to see a trim gray-haired woman
signing up. “Mrs. Gallagher!” she gasped. “What are you doing here?
I mean—well, I guess you’re here for the walk...”Mrs. Gallagher smiled.
“Why, Rosanna, I’m no older than your mother!” After warming up, they
joined the crowd at the starting line. Bang! The sea of people began to
move out. Rosanna managed to keep up for the first mile, but before long,
Mrs. Gallagher had moved so far ahead she was almost out of sight.
A Safer and
Healthier Life
Objectives
■ List three general strategies for preventing injuries.
■ List four steps you can take to reduce your risk of personal
injury.
■ List two steps you can take to help prevent personal injury
from a motor vehicle accident.
■ List four elements of a fire escape plan.
■ Identify five ways to improve safety at home, work or at play.
■ Describe the contents of a food label.
■ Identify six physical indicators of negative stress.
■ List five risks of smoking.
■ Identify five ways to keep alcohol consumption under control.
440 PART SEVEN HEALTHY LIFESTYLES
such as skateboarding and rollerblading, gain
Introduction and lose popularity, the injury statistics reflect the

changes.
Injury rates are highest among people younger
Injuries and illness have a significant than age 39. People ages 65 and older and
impact on our society. The costs in lost wages, people ages 15 to 24 have the highest rate of
medical expenses, insurance, property damage deaths from injury.
and other indirect costs are staggering—many Gender is also a significant factor in risk of in-
billions of dollars a year. But illness and injury jury. Males are at greater risk than females for
are not simply unpleasant facts of life to be any type of injury. In general, men are about
twice as likely to suffer a fatal injury as
shrugged off as inevitable. Often you can
women.
prevent them by taking safety precautions Many environmental factors influence injury
and choosing a lifestyle that promotes statistics. Whether you live on a farm or in the
optimal health. city, whether your home is built out of wood
or brick, the type of heat used in your home
and the climate all affect your degree of risk.
For instance, death rates from injury are higher
INJURY in rural areas. The death rate from injuries is
twice as high in low-income areas as in high-
income areas.
Each year in the United States an estimated one in
The use and abuse of alcohol is a significant
12 people require medical treatment for an injury.
factor in many injuries and fatalities, even in
An estimated 150,000 people die from the injuries
teenagers. In 2002, approximately 17,500 peo-
they receive. Injury is the leading cause of death for
ple in the United States died in alcohol-related
people ages 1 to 39 years.
motor vehicle crashes. This figure accounts for
41 percent of all traffic related deaths. It is
Factors Affecting Risk of Injury also estimated that a significant number of vic-
tims who die as a result of falls, drownings,
fires, assaults and suicides have blood alcohol
A number of factors affect risk of injury—age,
concentrations over the legal limit.
gender, geographic location, economic status and
alcohol use and abuse. Technology also affects the Figure 24-1 shows the leading causes of deaths
type and frequency of injury. As certain activities, from injuries in 2003.
K E Y T E R M S
Aerobic: Requiring additional effort by the heart Obesity: A condition characterized by excess
and lungs to meet the body’s increased demand body fat.
by the skeletal muscles for oxygen. Proteins: Compounds made up of amino acids
Calorie: A measure of the energy value of food. necessary to build tissues.
Carbohydrates: Compounds that contain carbon, Saturated fat: The fat in animal tissue and prod-
oxygen and hydrogen; the main source of en- ucts.
ergy for all body functions. Sodium: A mineral abundant in table salt; associ-
Cardiorespiratory endurance: The ability to take ated with high blood pressure.
in, deliver and extract oxygen for physical Stress: A physiological or psychological response
work; the ability to persevere at a physical task. to real or imagined influences that alter an ex-
Fat: A compound made up of carbon, hydrogen, isting state of physical, mental or emotional
oxygen and three fatty acids; a storage form of balance.
energy in the body; a type of body tissue com- Stressor: An event or condition that triggers the
posed of cells containing stored fat. stress response.
Nutrition: The science that deals with study of the
food you eat and how your body uses it.
CHAPTER 24 A Safer and Healthier Life 441
Thousands
50 Leading Causes of
40 Unintentional Injury-related
30
Deaths, 2003
20
10
0
cle ls ing ing ing es ion
ehi Fal son ok wn Fir c at
or-v Poi Ch Dro u ffo
t
Mo ical S
chan
Me Source: From National Safety Council,
®
Injury Facts, 2004 edition.
Figure 24-1 Leading causes of unintentional injury-related deaths, 2003.
Reducing Your Risk of Injury Take measures that make a difference. Change
behaviors that increase your risk of injury and
Despite the statistics showing that people of certain
risk injuring others.
ages and gender are injured more often than others,
Think safety. Be alert for and avoid potentially
your chances of injury have more to do with what
harmful conditions or activities that increase
you do than who you are. Injuries do not just
your injury risk. Take precautions, such as
happen. Many injuries are preventable, predictable
wearing appropriate protective devices—hel-
events resulting from the way people interact with
mets, padding and eyewear—and buckle up
the potential dangers in the environment.
when driving or riding in motor vehicles. Let
The following are general strategies for prevent-
your state and congressional representatives
ing injuries:
know that you support legislation that ensures
Encourage or persuade people at risk to a safer environment for us all.
change their behavior. Learn and use first aid skills. Despite dramatic
Require people at risk to change their behav- improvements in the last decade in emergency
ior, such as with laws requiring people to wear medical systems nationwide, the person who
safety belts. can often make the difference between life and
Provide products that offer automatic protec- death is you, when you apply your first aid
tion, such as air bags, designed to reduce the training.
risk of injury.
In addition, you can reduce your own risk of an Vehicle Safety
injury by taking the following steps:
When riding in a motor vehicle, buckle up. Al-
Know your risk. Complete the Health Check though more cars than ever are equipped with air
Boxes in this chapter. Note the areas that indi- bags, and many have air bags on the driver and pas-
cate where you are at risk. senger sides, wearing a safety belt is the easiest
and best action you can take to prevent injury in a the District of Columbia require the use of child
motor-vehicle collision. Always wear a safety belt, safety seats. Unsecured toys and other objects can
including a shoulder restraint when riding in the turn into high-speed missiles in a vehicle crash. Do
front or back seats. In all states, except for New not leave objects loose in your vehicle.
Hampshire, wearing a safety belt is a law. In 2002 Do not drink and drive. Plan ahead to find a
safety belts saved more than 14,000 lives. The eco- ride or take a cab or public transportation if you are
nomic cost of motor vehicle crashes (police-re- going to a party where you may drink alcohol. If
ported and nonreported crashes) that occurred in you are with a group, have a designated driver who
2000 totaled $230.6 billion. agrees not to drink on this occasion. Do not drink
Infants and children should always ride in ap- if you are in a boat. The U.S. Coast Guard reports
proved safety seats. Infants weighing less than 20 that more than 50 percent of drownings from boat-
pounds should ride in a safety seat facing the rear of ing incidents involve alcohol.
the vehicle to protect the infant’s head and neck.
For children, motor-vehicle crashes are the major
cause of death as a result of injury. All 50 states and
Fire Safety
Between 1999 and 2001, an average of 4266 Amer-
icans lost their lives and approximately 25,000
were injured annually as the result of fire. Cooking
is the leading cause of home fires in the United
States. Fires are also caused by heating equipment,
appliances, electrical wiring and careless smoking.
Vehicle Safety Regardless of the cause of fires, everyone needs to
The following statements represent an awareness

of vehicle safety that can reduce your chances, and
the chances of others, of injury in a vehicle crash.
Check each statement that reflects your lifestyle.
I put on a safety belt whenever I am a driver Fire Safety
or passenger in a motor vehicle.
The following statement represents an awareness
My vehicle is equipped with an air bag.
of fire safety that can reduce your chances, and the
I am alert to the actions of other drivers, chances of others, of injury from a fire. Check each
pedestrians, motorcyclists and bikers. statement that reflects your lifestyle.
I obey traffic rules.
I have a fire-escape plan for my home and
I use turn signals when turning or changing I practice it.
lanes, giving the driver behind me sufficient
I have fire extinguishers in at least two
warning.
rooms in my home, and the other occupants
I drive a safe distance behind the car in and I know how to use them.
front of me (10 mph 1 car’s length).
I have smoke detectors in my home, and I
I keep my vehicle in good working order. check the batteries every month and change
I do not drink and drive. them every 6 months.
I am aware of environmental and weather I keep irons and other heating appliances
conditions that increase driving risks. unplugged when not in use.
If you only checked one or two statements, you If you only checked one or two statements, you
should consider making changes in your lifestyle should consider making changes in your lifestyle
now. now.
be aware of the danger fire presents and act ac- children to the ground first before you go
cordingly. Install a smoke detector on every floor of out a window.
your home. Check the batteries once a month, and Get out quickly and do not, under any
change the batteries at least twice a year. circumstances, return to a burning building.
Plan and practice a fire escape route with your If you cannot escape, stay in the room and
family or roommates (Fig. 24-2). Gather everyone stuff door cracks and vents with wet towels,
together at a convenient time. Sketch a floor plan of rags or clothing. If a phone is available, call
all rooms, including doors, windows and hallways. the fire department—even if rescuers are
Include all floors of the home. already outside—and tell the call taker
Plan and draw the escape plan with arrows your location.
showing two ways, if possible, to get out of each
Contact your local fire department for addi-
room. Sleeping areas are most important, since
tional safety guidelines.
many fires happen at night. Plan to use stairs only,
Install a smoke detector on every floor of your
never an elevator. Plan where everyone will meet af-
home. Ninety percent of homes in the United States
ter leaving the building.
have smoke detectors, but half of them do not work
Designate who should call the fire department
because of old or missing batteries, according to the
and from which phone. Plan to leave the burning
International Association of Fire Chiefs. A good
building first and then call from a phone nearby, if
way to remember the batteries is to change them
possible. Many, but not all, locations in the United
twice a year when you reset your clocks for daylight
States use 9-1-1 for the emergency number. When
savings time.
you travel, take a moment to find out and write
Knowing how to exit from a hotel in a fire could
down the local emergency number.
save your life. Locate the fire exits and fire extin-
Remember and use the following guidelines to
guisher on your floor. If you hear an alarm while in
escape from fire:
your room, feel the door first and do not open it if
If smoke is present, crawl low to escape. Be- it is hot (Fig. 24-3). Do not use the elevator. If the
cause smoke rises in a fire, breathable air is of-
ten close to the floor.
Make sure children can open windows, go
down a ladder and lower themselves to the
ground. Practice with them. Always lower
Figure 24-2 Plan a fire escape route for your home. Figure 24-3 In a fire, do not open a door if it feels hot.
hall is relatively smoke free, use the stairs to exit. If Equip stairways with handrails, and use non-
the hall is filled with smoke, crawl to the exit. If you slip tread or securely fastened rugs.
cannot get to the exit, return to your room. Turn off Secure rugs to the floor with double-sided tape.
the ventilation system, stuff door cracks and vents If moisture accumulates in damp spots, correct
with wet towels and call the front desk or the fire de- the cause of the problem. Clean up spills
partment to report the fire and your location. promptly.
Keep medicines and poisonous substances sep-
arate from each other and from food. They
Safety at Home should be out of reach of children and in se-
About 8 million disabling injuries occur in homes cured cabinets.
each year in the United States. The three leading Keep medicines in their original containers,
causes of accidental death in the home are poison- with safety caps.
ing, falls and fire. Most falls occur around the Keep your heating and cooling systems and all
home. Young children and the elderly are frequent appliances in good working order. Check heat-
victims of falls. Removing hazards and practicing ing and cooling systems annually before use.
good safety habits will make your home safer Read and follow manufacturers’ instructions
(Fig. 24-4). Make a list of needed improvements. for electrical tools, appliances and toys.
Safety at home is relatively simple and relies largely Turn off the oven and other appliances when
on common sense. Taking the following steps will not using them. Unplug certain appliances,
help make your home a safer place: such as an iron, curling iron, coffee maker or
portable heater, after use.
Post emergency numbers—9-1-1 or the local Make sure that your home has at least one
emergency number, poison control center, working, easily accessible fire extinguisher and
physician, as well as other important everyone knows how to use it.
numbers—near every phone. Keep any firearms in a locked place, out of the
Make sure that stairways and hallways are reach of children and stored separately from
well lit. ammunition.
PREVENT ACCIDENTS AT HOME
Cleansers and
Appliances
Medicines stored in other poisonous
unplugged
secured cabinets, substances stored
when not
out of the reach out of reach
in use.
of children. Nonskid mat. of children.
Emergency
numbers Pot and pan
posted by handles
phone. turned in
Wall outlets when cooking.
not overloaded.
Loose rugs
secured. Water heater
Hazardous
set at 120⬚
substances
or less.
locked.
Manufacturers’
Smoke detectors
instructions
Stairs equipped installed on
read before
with handrails. all levels.
using electrical
tools, appliances
Stairways, passageways
and toys.
Heating and cooling Fire extinguisher and other dark areas
systems in good easily accessible. well lighted.
working order.
Figure 24-4 Follow home safety practices to prevent injuries at home.

Have an emergency fire escape plan and Never leave furniture or toys near the fence
practice it. that would enable a child to climb over the
Try crawling around your home to see it as an fence.
infant or young child sees it. You may become Keep toys away from the pool and out of sight
aware of unsuspected hazards. when it is not in use. Toys can attract young
Turn pot handles toward the back of the stove. children into the pool.
Ensure that cords for lamps and other items are Pool covers should always be completely re-
not placed where someone can trip over them. moved prior to pool use and completely se-
cured when in place.
This list does not include all the safety measures
Have an emergency action plan to address po-
you need to take in your home. If young children or
tential emergencies.
elderly or ill individuals live with you, you will need
Post CPR and first aid instructions.
to take additional steps, depending on the individ-
Post the emergency telephone number for
ual characteristics of your home.
the Emergency Medical Services (EMS) system
For an elderly person, you may need to install
by your telephone. Keep a telephone near
handrails in the bathtub or shower and beside the
the pool or bring a fully charged cordless
toilet. You may need a bath chair or bench. Always
or mobile phone poolside. Also post your
have mat with a suction base if your tub does not
address and the nearest cross streets so
have nonslip strips built in. A safe bath water tem-
that anyone can read them to an emergency
perature is 101° F (38° C).
call taker.
If you have a residential pool, you will need to
Always keep basic lifesaving equipment by the
take additional steps:
pool and know how to use it. A reaching pole,
Learn to swim—and be sure everyone in the rope and flotation devices, such as ring buoys,
household knows how to swim. rescue tubes and life jackets, are recom-
Never leave a child unattended who may gain mended. A well-stocked first aid kit should
access to any water. Even a small amount of also be available. Store the safety gear in a
water can be dangerous to young children. consistent, prominent, easily accessed location.
Teach your child not to go near the water A “safety post” may be used.
without you; the pool area is off limits without Learn Red Cross CPR and first aid. Insist that
adult supervision. babysitters, grandparents and others who care
Adult supervision is essential. Adult eyes must for your children know these lifesaving skills.
be on the child at all times. If a child is missing, check the pool first. Go to
Enclose the pool completely with a fence with the edge of the pool and scan the entire pool,
vertical bars (so that it is not easy to climb) bottom surface, as well as the surrounding
that has a self-closing, self-latching gate. Open- pool area.
ings in the fence should be no more than 4 Keep the pool water clean and clear. Water
inches wide. The house should not be part of should be chemically treated and tested regu-
the barrier. If the house is part of the barrier larly. If you cannot clearly see the bottom of
for an existing pool, an additional fence should the deep end, close the pool. Contact a local
be installed and the doors and windows lead- pool store or health department for informa-
ing from the house to the pool should remain tion and instruction.
locked and be protected with an alarm that Store pool chemicals—chlorine, soda ash,
produces sounds when the door is unexpect- muriatic acid, test kits—in childproof contain-
edly opened. ers and out of children’s reach. Clearly label
Post the rules for your pool and enforce them the chemicals. Follow manufacturer’s direc-
without exception. For example, never allow tions and safety instructions.
anyone to swim alone, do not allow bottles or Consult the National Spa and Pool Institute,
glass around the pool, do not allow running or state law and local building codes for pool di-
pushing and do not allow diving unless your mension guidelines to help you establish rules
pool meets the safety standards. for your pool to ensure safe diving activities.
Post depth markers and “No Diving” signs, as For example:
appropriate. Use a buoyed line to show where • Prohibit all dives into shallow water.
the depth changes from shallow to deep. Limit • Only allow dives from the edge of the pool
nonswimmer activity to shallow water. into deep water.
Make Your Home Safe for Kids

Use this checklist to spot dangers in your home. When you read each question, circle either the “Yes” box
or the “No” box. Each “No” shows a possible danger for you and your family. Work with your family to remove
dangers and make your home safer.
Storage Areas YES NO If you have a firearm, is it locked in a place

where your child cannot get it? Is the ammu-
YES NO Are pesticides, detergents and other house- nition stored separately from the firearm?
hold chemicals kept out of child’s reach? YES NO Are all purses, handbags, briefcases and
YES NO Are tools kept out of child’s reach? other packages or bags, including those of
visitors, kept out of child’s reach?
General Safety Precautions YES NO Are all poisonous plants kept out of child’s
reach?
Inside the Home YES NO Is a list of emergency phone numbers posted
near a telephone?
YES NO Are stairways kept clear and uncluttered? YES NO Is a list of instructions posted near a tele-
YES NO Are stairs and hallways well lit? phone for use by children and/or babysitters?
YES NO Are safety gates installed at tops and
bottoms of stairways?
YES NO Are guards installed around fireplaces, radia-
Bathroom
tors or hot pipes and wood-burning stoves? YES NO Are the toilet seat and lid kept down when the
YES NO Are sharp edges of furniture cushioned with toilet is not in use?
corner guards or other material? YES NO Are cabinets equipped with safety latches and
YES NO Are unused electric outlets covered with tape kept closed?
or safety covers? YES NO Are all medicines in child-resistant containers
YES NO Are curtain cords and shade pulls kept out of stored in a locked medicine cabinet?
child’s reach? YES NO Are shampoos and cosmetics stored out of
YES NO Are windows secured with window locks? child’s reach?
YES NO Are plastic bags kept out of child’s reach? YES NO Are razors, razor blades and other sharp ob-
YES NO Are fire extinguishers installed where they jects kept out of child’s reach?
are most likely to be needed? YES NO Are hair dryers and other appliances stored
YES NO Are smoke detectors in working order? away from sink, tub and toilet?
YES NO Do you have an emergency plan to use in case YES NO Does the bottom of tub or shower have rubber
of fire? Does your family practice this plan? stickers or a rubber mat to prevent slipping?
YES NO Is the water set at a safe temperature? YES NO Is the child always watched by an adult
(A setting of 120° F [49° C] or less prevents while in the tub?
scalding from tap water in sinks and in
tubs. Let the water run for 3 minutes
before testing it.)
Does the toy box have a secure lid and safe

Kitchen YES NO
closing hinges?
YES NO Do you cook on back stove burners when YES NO Are the toys in good repair?
possible and turn pot handles toward the YES NO Are toys appropriate for the child’s age?
back of the stove?
YES NO Are hot dishes kept away from the edges of
tables and counters?
Parents’ Bedroom
YES NO Are hot liquids and foods kept out of child’s YES NO Are space heaters kept away from curtains
reach? and flammable materials?
YES NO Are knives and other sharp items kept out of YES NO Are cosmetics, perfumes and breakable
child’s reach? items stored out of child’s reach?
YES NO Is the child’s highchair placed away from YES NO Are small objects, such as jewelry, buttons
stove and other hot appliances? and safety pins, kept out of child’s reach?
YES NO Are matches and lighters kept out of child’s
reach?
YES NO Are all appliance cords kept out of child’s
Outside the Home/Play Areas
reach? YES NO Is trash kept in tightly covered containers?
YES NO Are cabinets equipped with safety latches? YES NO Are walkways, stairs and railings in good
YES NO Are cabinet doors kept closed when not in use? repair?
YES NO Are cleaning products kept out of child’s YES NO Are walkways and stairs free of toys, tools
reach? and other objects?
YES NO Do you test the temperature of heated food YES NO Are sandboxes and wading pools covered
before feeding the child? when not in use?
YES NO Are swimming pools nearby enclosed with
Child’s Room a fence that your child cannot easily
climb over?
YES NO Is child’s bed or crib placed away from radi- YES NO Is playground equipment safe? Is it assem-
ators and other hot surfaces? bled according to the manufacturer’s instruc-
YES NO Are crib slats no more than 23⁄8 inches apart? tions and anchored over a level, soft surface
such as sand or wood chips?
YES NO Does the mattress fit the sides of the crib
snugly?
YES NO Is paint or finish on furniture and toys
nontoxic?
YES NO Are electric cords kept out of child’s reach?
YES NO Is the child’s clothing, especially sleepwear,
flame resistant?
Child Safety Home Safety

The following statements represent an awareness The following statements represent a safety-
of child safety that can reduce the chances of conscious lifestyle that can reduce your chances,
injury to your child. Check each statement that and the chances of others, of injury in your home.
reflects your lifestyle. The stairways and halls in my home are
I buckle my child into an approved automobile well lit.
safety seat even when making short trips. I have nonskid tread or securely fastened
I teach my child safety by behaving safely in rugs on my stairs.
my everyday activities. I keep all medications out of reach of chil-
I supervise my child whenever he or she is dren and in a locked cabinet.
around water and maintain fences and gates I keep any poisonous materials out of the
that act as barriers to water. reach of children and in a locked cabinet.
I have checked my home for potential fire All rugs are firmly secured to the floor.
hazards and smoke detectors are installed I store all firearms, unloaded, in a locked
and working. place out of the reach of children, and am-
I have placed foods and small items that can munition is stored separately.
choke my child out of his or her reach. I keep the handles of pots and pans on the
I inspect my home, day-care center, school, stove turned inward when I am using them.
babysitter’s home or wherever my child
If you only checked one or two statements, you
spends time for potential safety and health
should consider making changes in your lifestyle
hazards.
now.
now.
Location of the nearest fire extinguisher and
first aid kit
• Diving from a diving board should only If you work in an environment where hazards
occur if there is a safe diving envelope (the exist, wear recommended safety equipment and fol-
area of water in front of, below and to the low safety procedures (Fig. 24-5). Both employers
sides of a diving board that is deep enough and employees must follow safety rules issued by
that a diver will not strike the bottom, re-
gardless of the depth of the water or the
design of the pool).
Make sure your homeowner’s insurance policy
covers the pool.
Safety at Work
Most people spend approximately one-third of their
day at work. To improve safety at work, you should
be aware of the following:
Fire evacuation procedures
How to activate your emergency response
team and how to call 9-1-1 or the local emer- Figure 24-5 Safety clothing and/or equipment are re-
gency number quired for some jobs.
Workplace Safety Recreational Safety

The following statements represent a safety- The following statements represent a safety-
conscious lifestyle that can reduce your chances, conscious lifestyle that can reduce your chances,
and the chances of others, of injury at your work- and the chances of others, of injury during recre-
place. Check each statement that reflects your ational activity. Check each statement that re-
lifestyle. flects your lifestyle.
I know the fire evacuation procedures at my I follow the rules established for any sport in
workplace. which I participate.
I know the location of first aid supplies and the I wear the recommended safety gear, such
nearest fire extinguisher at my workplace. as a helmet or goggles, for any sport or
I wear the recommended safety equipment activity.
and follow all recommended safety proce- I wear a life jacket when I am in a boat.
dures. I enter the water feet-first to check unknown
I know how to report an emergency at work. water depths.
I know how to activate the workplace emer- I keep my recreational equipment in good
gency response team. condition.
If you only checked one or two statements, you If you only checked one or two statements, you
should consider making changes in your lifestyle should consider making changes in your lifestyle
now. now.
the Occupational Safety and Health Administration jured cyclists. Children should wear a helmet even
(OSHA). Anytime you operate machinery or per- if they are still riding along the sidewalk on training
form an activity that may involve flying particles, wheels. Some states have helmet laws that apply to
you should wear protective eyewear, such as gog- young children. Look for a helmet approved by the
gles. Inspect mechanical equipment and ladders Snell Memorial Foundation or the American Na-
periodically to ensure good working order. Check tional Standards Institute (ANSI), and make sure
for worn or loose parts that could break and cause the helmet is the correct size and that it fits com-
a mishap. Before climbing a ladder, place its legs fortably and securely. Keep off roads that are busy
on a firm, flat surface and have someone anchor it or have no shoulder. Wear reflective clothing, and
while you climb. Take workplace safety training make sure you have a headlight, taillight and reflec-
seriously. Ask your employer about first aid and tors on your bicycle wheels if you cycle at night.
CPR refresher courses. Make sure your bicycle and your child’s bicycle are
in good condition. Most bicycle mishaps happen
within a mile of home.
Safety at Play With any activity in which eyes could be in-
Make sports and other recreational activities safe jured, such as racquetball, wear protective goggles.
by always following accepted guidelines for the Appropriate footwear is also important in prevent-
activity (Fig. 24-6). ing injuries. For activities involving physical con-
Each year, approximately 500,000 people are tact, wear properly fitted protective equipment to
non-fatally injured while riding a bicycle. Ninety avoid serious injury. Above all, know and follow
percent of bicyclists killed in 2000 reportedly were the rules of the sport.
not wearing helmets. When cycling, always wear an If you do not know how to swim, learn how or
approved helmet. The head or neck is the most se- always wear an appropriate flotation device if you
riously injured part of the body in most fatally in- are going to be in, on or around the water. Many
Figure 24-6 Wear proper safety equipment during

recreational activities.
people who drown never intended to be in the take lessons to learn how to do the sport safely.
water at all. Be careful when walking beside rivers, Many mishaps result from inexperience. Make
lakes and other bodies of water. Dangerous under- sure your equipment is in good working order. Ski
currents in shallow water can catch even the best of bindings, for instance, should be professionally in-
swimmers. spected, adjusted and lubricated before each season.
If you are on a boat, always wear a flotation de- It is an added expense, yes, but far less than serious
vice. Never drink while you drive a boat and do not injuries.
travel in a boat operated by a driver who has been
drinking.
If you run, jog or walk, plan your route care- REDUCING YOUR RISK OF ILLNESS
fully. Exercise only in well-lit, well-populated areas,
and consider exercising with another person. Keep The choices you make about your lifestyle affect
off busy roads. If you must exercise outdoors after your health and general well-being. Informed
dark, wear reflective clothing and move facing traf- choices can reduce or eliminate your risk of cancer,
fic. Be alert for cars pulling out at intersections and stroke, cardiovascular disease, pneumonia, dia-
driveways. betes, HIV infection and disease of the liver. These
Whenever you start an activity unfamiliar to diseases are the leading causes of chronic illness and
you, such as boating, skiing or motorcycle riding, death in the United States.
Calories from fat—Fat is an important supplier

Nutrition of the body’s heat and energy. However, the
kind and amount of certain dietary fat in-
Nutrition is the science that deals with the food creases the risk of some cancers, coronary heart
you eat and how your body uses it. Studies indicate disease, diabetes and obesity. Fat should pro-
that poor diet is a contributing factor to many dis- vide no more than 25 to 30 percent of the daily
eases. Therefore, changing your diet to make it calories in a well-balanced diet—approximately
healthier and more nutritious is one of the lifestyle 65 grams per day for a 2000-calorie diet.
decisions you may decide to make. This chapter Total fat—The total fat includes the amount
touches on a few basic facts about nutrition; to un- of saturated and unsaturated fat. Overcon-
derstand this important subject in more detail, sumption of foods high in fat, especially when
you should take a nutrition course, consult a nutri- they replace healthier foods, such as carbo-
tionist or at least read a book or visit a Web site hydrates and fiber, is a major health concern
recommended by a health-care professional or a for Americans.
nutritionist. However, learning to interpret the nu- Saturated fat—Saturated fat is the fat in ani-
tritional information on packaged food labels is a mal tissue and products. It should make up no
basic and important step you can take toward en- more than 10 percent of daily calories. Satu-
suring that you eat a proper diet. rated fat is solid at room temperature. Eating
high levels of saturated fat contributes to high
levels of cholesterol in the blood and therefore
Food Labels to coronary artery disease. Foods high in satu-
rated fat include palm and coconut oil, butter,
Food labels describing a product’s nutritional value
ice cream, milk chocolate, cheddar and Ameri-
are required by law on most packaged food and be-
can cheese and beef hot dogs.
gan appearing on many food products in 1993. The
Trans fat—Trans fats are created when
labels provide specific information about certain
vegetable oil is heated in a process known as
nutrients, substances found in foods that are re-
hydrogenation. The consumption of trans fats
quired by the body because they are essential ele-
is linked to increasing the risk of heart disease.
ments of a nutritious diet. Weights and percentages
These types of fats can be found in commer-
are provided so that consumers can evaluate the nu-
cially fried foods and baked goods.
trients as to how they fit as part of a total daily diet.
Cholesterol—Cholesterol is a waxy chemical
Food is made up of six classes of nutrients—car-
substance found in animal tissue. It is not a
bohydrates, fats, proteins, vitamins, minerals and
fat, although it is chemically related to fat.
water. Food labels are now required to list the
High levels of cholesterol are considered to be
amounts per serving of the following in a packaged
a risk factor for cardiovascular disease. Foods
product (Fig. 24-7):
high in cholesterol include eggs, shrimp, meat,
Calories—A calorie is a measure of the energy fish, liver and kidneys.
value of a food. On some labels, they are Sodium—Sodium is a mineral abundant in
called kilocalories or kcalories (1000 calories table salt. The main health problem associated
of heat energy), the term used in nutritional with sodium is hypertension (high blood pres-
science. sure). Use salt only in moderation, and check
Amount/Serving % Daily value* Amount/Serving % Daily value* *Percent Daily Values are based on a 2,000 calorie
Nutrition Total fat 7 g 11% Total Carbohydrate 19 g 6%
diet. Your daily values may be higher or lower depend-
ing on your calorie needs:
facts Saturated fat 3 g 14% Dietary Fiber 1 g 4% Total Fat
Calories:
Less than
2,000
65g
2,500
80g
Serving size 7 slices (28g) Sat Fat Less than 20g 25g
Cholesterol 0 mg 0% Sugars 8g Cholesterol Less than 300mg 300mg
Servings per Container 5 Sodium Less than 2,400mg 2,400mg
Sodium 360 mg 15% Protein 2 g Total Carbohydrate 300g 375g
Calories 141 Dietary Fiber 25g 30g
Calories from Fat 57 Vitamin A 21% Vitamin C 27% Calcium 1% Iron 9% Calories per gram: Fat 9 Carbohydrate 4 Protein 4
Figure 24-7 Food label.

the sodium content of packaged food carefully. and calcium. It contributes to the formation of
Many foods contain surprisingly large amounts bones and teeth and aids in wound healing.
of sodium. High sodium content is found in Sources include citrus fruits, melons, broccoli,
smoked meat and fish, many canned and in- green peppers, spinach and strawberries.
stant soups, many frozen dinners and some Calcium—Calcium contributes to tooth and
canned or bottled sauces. bone formation and general body growth. It
Total carbohydrate—Carbohydrates are com- helps maintain nerve function, good muscle
pounds that contain carbon, hydrogen and tone and the regulation of normal heartbeat.
oxygen. In the body, they are easily converted Sources include dairy products, dried beans,
to energy and are the main source of energy dark green vegetables and shellfish.
for all body functions. Sources of carbohy- Iron—Iron aids in the formation of red blood
drates include grain and grain products, such cells, the production of antibodies and the use
as cereal, rice, pasta, baked goods, potatoes, of energy. It facilitates the transportation of
beans and peas, seeds, nuts, fruits, vegetables carbon dioxide and oxygen. Sources include
and sugars. lean red meat, seafood, eggs, dried beans, nuts,
Dietary fiber—Dietary fiber consists of the car- grains and green leafy vegetables.
bohydrates that are not broken down by the
The label information also shows the size of a
human digestive process. Soluble fiber, fiber
serving, given as a household measure, such as a
that dissolves in hot water, lowers blood cho-
piece or cup, followed by the metric weight in
lesterol levels and has other beneficial effects.
parentheses and the total number of servings per
Fruit, vegetables and grains are good sources
container. The term “Daily Value’’ relates the total
of soluble fiber. Insoluble fiber adds bulk to
nutritional value of the product to a 2000-calorie
the contents of the intestine and speeds the
daily diet and to a 2500-calorie daily diet. For ex-
transit time of undigested food through the in-
ample, using the label in Figure 24-7, a person on a
testines. Wheat bran, other whole grains, dried
2000-calorie daily diet consuming one serving of
beans and peas and most fruits and vegetables
that product would take in 19 grams of carbohy-
are good sources of insoluble fiber.
drates. This amount is 6 percent of 300 grams,
Sugars—Sugars are forms of carbohydrates.
which is the largest recommended daily amount.
Sugar should be used in moderation—no more
The person would also consume 7 grams, or 11 per-
than 10 percent of daily calories. Sugar con-
cent of the largest recommended daily amount of
tributes to tooth decay, and high sugar con-
fat (65 grams or less).
sumption is considered by some to be a con-
Next to oxygen, water is the substance we need
tributing factor to obesity, diabetes, heart
most to survive. Water regulates the body tempera-
disease and malnutrition. On lists of ingredi-
ture through perspiration and carries oxygen and
ents, sugar is often hidden by being listed as
nutrients to the cells as part of the blood. Water lu-
corn syrup, fructose or sucrose.
bricates the joints, removes wastes and aids in res-
Protein—Proteins are compounds made up of
piration by moistening the lungs, which facilitates
amino acids and contain the form of nitrogen
the intake of oxygen and the removal of carbon
most easily used by the human body. Protein
dioxide. Most health-care professionals advise
contains the basic material for cell growth and
drinking six to eight 8-ounce glasses of water a day
repair, but if you take in more than the 15 per-
and more if you exercise regularly or drink alcohol
cent of daily calories the body requires from
or caffeine.
proteins, the excess amount is converted to en-
ergy or stored as fat. Sources of protein in-
clude milk products, meat and fish.
Vitamin A—Vitamin A is essential for the
A Healthy Diet
growth of the cells of skin, hair and mucous ,
membranes. It contributes to bone and tooth
One size doesn t fit all
development and increases resistance to infec- USDA’s new MyPyramid (Fig. 24-8) symbolizes a
tion. Sources include milk, cheese, butter, eggs, personalized approach to healthy eating and physical
liver, carrots, cantaloupe, yellow squash and activity. The symbol has been designed to be simple.
sweet potatoes. It has been developed to remind consumers to make
Vitamin C—Vitamin C aids in protection healthy food choices and to be active every day. The
against infection and in the absorption of iron different parts of the symbol are described below.
Figure 24-8 MyPyramid. (U.S. Department of Agriculture. [on-line].

http://www.mypyramid.gov)
Activity Personalization
Activity is represented by the steps and the person Personalization is shown by the person on the steps,
climbing them, as a reminder of the importance of the slogan and the URL. Find the kinds and
daily physical activity. amounts of food to eat each day at MyPyramid.gov.
Moderation Proportionality
Moderation is represented by the narrowing of each Proportionality is shown by the different widths of
food group from bottom to top. The wider base the food group bands. The widths suggest how
stands for foods with little or no solid fats or added much food a person should choose from each
sugars. These should be selected more often. The group. The widths are just a general guide, not ex-
narrower top area stands for foods containing more act proportions. Check the Web site for how much
added sugars and solid fats. The more active you is right for you.
are, the more of these foods can fit into your diet.
Variety
Variety is symbolized by the 6 color bands repre-
senting the 5 food groups of the Pyramid and oils.
This illustrates that foods from all groups are
needed each day for good health.
Weight-Loss Strategies
Use some of the following strategies to help you
lose weight—
• Keep a log of the times, settings, reasons Nutrition and Weight
and feelings associated with your eating.
The following statements represent a healthy
• Set realistic, long-term goals (for example,
lifestyle that can reduce your chance of disease.
losing one pound per week instead of five
Check each statement that reflects your
pounds per week).
lifestyle.
• Occasionally reward yourself with small
amounts of food you enjoy. I eat a balanced diet.
• Eat slowly, and take time to enjoy the taste I read the nutrition labels on food products
of the food. to help me eat a balanced diet.
• Be more physically active (take stairs in- I monitor my intake of foods high in fats.
stead of elevators, or park in the distant part
I monitor my intake of sodium and sugars.
of the parking lot).
• Reward yourself when you reach your goals I do not fry foods.
(for example, with new clothes, sporting I maintain an appropriate weight.
equipment). If I need to lose weight, I use medically ap-
• Share your commitment to losing weight proved diet techniques.
with your family and friends who will sup- For snacks, I eat fruit, vegetables and other
port you. healthy food rather than “junk foods.”
• Keep a record of the food you eat each day.
I drink 6 to 8 glasses of water daily.
• Weigh yourself once a week at the same
time of day and record your weight. If you only checked one or two statements, you
• Be prepared to deal with occasional plateaus should consider making changes in your lifestyle
as you lose weight. now.
Gradual Improvement siderably heavier at 40 than at 20. It is more im-

portant as you grow older to eat foods that provide
Gradual improvement is encouraged by the slogan.
your body with essential nutrients but are not high
It suggests that individuals can benefit from
in calories.
taking small steps to improve their diet and
Pregnant women should follow their physician’s
lifestyle each day.
advice regarding diet. Severely limiting calories and
fat can be detrimental to the developing fetus.
Weight Fitness
Many adults are overweight. Some are overweight Many of us would like to be fit. In general, fitness
to the point of obesity. Obesity, defined as a condi- involves cardiorespiratory endurance, muscular
tion characterized by excess body fat, contributes to strength, muscular endurance and flexibility. You
heart disease, high blood pressure, diabetes and do not need to take part in sports, such as tennis,
gallbladder disease. For males, obesity is defined as basketball or soccer, to achieve fitness. You can be-
body fat equal to or greater than 25 percent of the come fit for health purposes by taking part in such
total body weight of the body and for females, it is activities as walking, jogging, swimming, cycling,
equal to or greater than 32 percent of total body hiking and weight training, among others.
weight. See your physician or health-care profes-
sional for help if you want to have your body fat Exercise
measured.
Losing weight, especially fat, is no easy task. The “no pain, no gain” theory is not a good ap-
Calories that are not used as energy are stored as proach to exercise. In fact, experiencing pain usu-
fat. Weight loss and gain depend on the balance of ally means you are exercising improperly. You
caloric intake and energy output. If you take in achieve the health benefits of exercise when it is
more calories than you use, you gain weight. If you somewhat uncomfortable, but not painful. Be sure
use more calories than take in, you lose weight. to warm up to prepare the body before vigorous ex-
There are several guides to weight control. ercise and cool down afterwards. Make flexibility
Day-to-day fluctuations in weight reflect exercises part of the warm-up and cool-down
changes in the level of fluids in your body. So, if you process. When possible, add exercises or activities
are watching your weight, pick one day and time that strengthen the muscles to your fitness routine.
per week as weigh-in time. Track your weight loss Turn your daily activities into exercise (Fig. 24-9).
based on this weekly amount, not on day-to-day Walk briskly instead of driving, whenever possible.
differences. Even better, have a body fat analysis Take the stairs instead of the elevator or the escala-
done. The term “overweight’’ does not take body
composition into account. Body composition is the
ratio of fat to all the tissues, such as muscles, that
are fat free. One person may weigh more than is
termed desirable for his or her height, but the
weight may be mainly in muscle rather than fat.
Someone else may be within an acceptable weight
range but have a large proportion of his or her
weight in body fat, which is not healthy.
Weight loss or gain should always be combined
with regular exercise—another part of a healthy life-
style. Any activity—walking to the bus, climbing the
stairs, cleaning house—uses calories. You even burn
off a few while you sleep. The more active you are,
the more calories you use. Activity allows you to eat
a few more calories and still maintain body weight.
Your eating habits should change as you grow
older. A person who eats the same number of calo-
ries between the ages of 20 to 40 and maintains the
same level of activity during this time will be con- Figure 24-9 Build exercise into your daily activities.
Cardiorespiratory Endurance
Fitness If you have limited time for limited exercise, it is
best to build up cardiorespiratory endurance, the
The following statements represent a healthy ability to take in, deliver and extract oxygen for
physical work. Cardiorespiratory endurance is the
lifestyle that can reduce your chance of disease.
foundation for total fitness. The best way to ac-
Check each statement that reflects your lifestyle. complish cardiorespiratory endurance is through
I set realistic exercise goals and aim to aerobic exercise. The term aerobic refers to activi-
ties that require additional effort by the heart and
achieve them.
lungs to meet the body’s increased demand by the
I exercise regularly for a minimum of 30 to skeletal muscles for oxygen. Aerobic exercise is sus-
45 minutes at least three times a week. tained, rhythmical exercise, using the large muscle
I warm up before exercise and cool down groups, for at least 30 to 45 minutes within your
target heart rate.
afterwards.
Taking part in aerobic exercise can—
I incorporate flexibility and muscle-strength-
Reduce the risk of cardiovascular disease.
ening activities into my fitness activities. Develop stronger bones that are less suscepti-
I use aerobic exercise to build cardiorespira- ble to injury.
tory endurance. Promote joint stability.
Contribute to fewer lower back problems.
I know my target heart rate range and exer-
Improve self image.
cise within it. Help control diabetes.
I walk or bike rather than drive whenever Stimulate other lifestyle changes.
possible.
If you only checked one or two statements, you Target Heart Rate Range
should consider making changes in your lifestyle To achieve cardiorespiratory endurance, you must
now. exercise your heart and lungs. To do this, you
should exercise at least three to five times a week
for a minimum of 30 to 45 minutes and at your
appropriate target heart rate (THR) range. Your
tor. Pedal an exercise bike while watching TV, lis- target heart rate range is 60 to 90 percent of your
tening to music or reading. maximum heart rate. To find your maximum heart
Many books and Web sites are available for rate, subtract your age from 220. To find your tar-
those who want to improve their fitness and develop get heart rate range, multiply that figure first by
an exercise program. You can become physically fit, 0.60 and then by 0.90. For example, if you are
regardless of the condition you are in when you 20 years old, 60 percent of your maximum heart
start. Set realistic goals and you will see regular rate would be 220 – 20 x 0.60 120 beats per
progress. A variety of training programs are avail- minute (bpm). This figure is the lower limit of your
able. Make a commitment to exercise each week. target heart rate range. To find the upper limit, mul-
Whatever activities you choose to achieve fitness, tiply 220 – 20 by 0.90, which is 180. Your target
you must exercise regularly and maintain a level of heart rate range is from 120 bpm to 180 bpm. You
activity to stay fit. You should exercise nonstop for should get your pulse up to between 120 and
a minimum of 30 to 45 minutes a day three to five 180 bpm and keep it there for 20 to 30 minutes. If
times a week. The many benefits include loss of you are age 20, with an average level of fitness, for
body fat, more resistance to disease, an ability to re- example, aim for 150 to 160 bpm. Keep below
duce the negative effects of stress and increased en- the upper limit. In general, to improve cardiorespi-
ergy. If you have been sedentary or have health ratory endurance, a person must exercise at least
problems, see your physician before starting an ex- 60 percent of his or her maximum heart rate.
ercise program. It is never too late to start exercis- As you exercise, take your pulse periodically at
ing. People in nursing homes, many of them in the wrist (radial artery) or neck (carotid artery)
wheelchairs, are able to experience and demonstrate (Fig. 24-10). Your exercise must be continuous and
the benefits of flexibility and strength training. vigorous to stay within your target heart rate range.
part of the experience of being in a play, making a

new friend or succeeding at a difficult task, for ex-
ample. Good stress can help you perform better and
be more efficient. Stress judged as “bad’’ (distress)
can result in negative responses, such as sadness,
fatigue, guilt and disease.
Most stressful situations involve harm and loss,
threat or challenge. Harm and loss situations, for
example, include the death or loss of a loved one,
physical assault and physical injury. Threat situa-
tions, real or perceived, can be frightening or men-
acing and make it more difficult to deal with life.
They can result in anger, anxiety or depression.
Challenging situations often involve major life
changes, such as moving, getting a new job, leaving
home and forming or leaving a close relationship.
The Effects of Stress

Any stressful situation has an effect on the body.
Figure 24-10 As you exercise, take your pulse periodi- Because it affects the immune system, stress can be
cally to see if you have reached your appropriate target a major contributor to disease. The effects of stress
heart rate. on body systems can result in increased suscepti-
bility to headaches, high blood pressure, clogging
of the arteries, cancer and respiratory problems.
When someone reacts to stress by over- or under-
As you build cardiorespiratory endurance, you will eating, overusing caffeine or alcohol, smoking or
eventually be able to exercise for longer periods of eating foods high in sugar and fat, for example,
time and at a higher THR. the physiological balance in the body is upset.
Stress
Everyone experiences stress. Stress in itself is not
harmful. How we deal with what we view as stress
Stress
is what determines whether it has a positive or neg- The following statements represent an aware-
ative effect on our lives. Stress is a physiological or ness of stress that can reduce your chance of
psychological response to real or imagined influ- disease. Check each statement that reflects your
ences that alter an existing state of physical, mental
or emotional balance. The reaction to stress can
lifestyle.
take such varied forms as muscle tension, dizziness, I am aware of the physical and mental
increased heart rate, acute anxiety, sleeplessness, signals of stress.
anger, excitement, energy and even joy. A stressor is
an event or condition that triggers the stress re- I know the effects stress has on my body.
sponse. Stressors may be as varied as taking a test, I would consult a professional counselor if
speaking in public, poverty, loneliness, poor self- necessary to help cope with stress.
esteem, being stuck in traffic or winning a prize. A
stressor for one person may not be a stressor for an- I am able to use several relaxation
other, although some stressors, such as injury or techniques to help manage stress.
loneliness, tend to stress everyone.
Positive, or “good,” stress is productive. Good
stress is the force that produces, for example, en- should consider making changes in your lifestyle
hanced thinking ability, improved relationships now.
with others and a greater sense of control. It can be
The first step in learning to deal with stress is chemicals. During the past few decades, studies
to become aware of the accompanying physical have made the negative effects of smoking clear. As
and mental signals. Some of the physical indi- a result, smoking has been banned or restricted in
cators of negative stress include severe headaches, many work sites and public places around the na-
sweating, lower back pain, weakness, sleep dis- tion. The nicotine in cigarettes is an addictive sub-
turbance and shortness of breath. Other indica- stance and a poison. The tars are carcinogenic (can-
tors, both emotional and mental, include depres- cer causing). Nicotine, carbon monoxide and tars
sion, irritability, denial that a problem exists, are all inhaled when you smoke.
increased incidences of illness, an inability to Next time you are tempted to light up, consider
concentrate, feelings of unreality, inability to that cigarette smoking is the single most pre-
relax and becoming “accident prone.” Becoming ventable cause of heart and lung disease. Cigarette
aware of how your body reacts to stress can help smoking is directly responsible for 87 percent of
you recognize situations and conditions that are lung cancer cases and causes most cases of emphy-
stressful for you. sema and chronic bronchitis. Cigarette smoking se-
verely narrows the coronary arteries, giving the cig-
arette smoker an increased risk of heart attack and
Managing Stress sudden cardiac arrest over the nonsmoker. Smokers
Stress management is a person’s planned attempt to are at risk for cancer of the esophagus, pancreas,
cope and deal with stress. Managing potentially bladder and larynx. A pregnant woman who
harmful stress may require using a variety of tech- smokes harms herself and her unborn baby. The
niques, including using time effectively, evaluating carbon monoxide in cigarettes travels to the fetus
the activities that are important for you and estab- through the umbilical cord and into the fetus’s cir-
lishing achievable goals. Perhaps the most difficult culatory system. Smoking mothers have more still-
form of coping is change. It is especially hard to births and babies with low birth weight and respi-
change an outlook or way of life, even if it has be- ratory problems than nonsmokers. Inhaling the
come unproductive and a source of negative stress. smoke generated by smokers is a health risk for
The advice and help of a professional counselor can nonsmokers, including infants and children.
be useful in such situations. Those who use smokeless tobacco also face se-
Relaxation techniques can also be helpful in rious risks. Nicotine is absorbed through the mem-
reducing or avoiding the negative effects of stress. branes of the mouth and cheeks. Chewing tobacco
A few of these techniques are exercise, yoga, medi- and snuff cause cancer of the mouth and tongue, so
tation, listening to quiet or soothing music and re- these products should also be avoided.
laxation exercises, including deep breathing and
muscle relaxation. Biofeedback, another technique,
involves using instruments that measure bodily
functions, such as heart rate and blood pressure. By
receiving immediate feedback on responses such
as muscle tension and skin temperature, the person
can learn to consciously control these reactions.
Sources of Help to Quit Smoking
Autogenics uses self-suggestion to produce relax- American Heart Association
ation, using deep breathing, a conscious effort to
www.americanheart.org
relax and repeated phrases that carry a message
of calming. Imagery involves using the imagination American Lung Association
to create various scenes and wished-for situations. www.lungusa.org
Commercial tapes of various relaxation exercises
American Cancer Society
and books on stress management are available.
www.cancer.org
National Cancer Institute
Smoking www.nci.nih.gov
Lungline National Jewish Center for Immunology
Every year, close to 342,000 Americans die of lung
disease. Smoking costs the United States over and Respiratory Medicine
$150 billion each year in health-care costs. Ciga- www.njc.org
rettes contain at least 69 distinct cancer-causing
Your risk of developing a disease or other con- As a host, have nonalcoholic beverages
ditions starts to go down as soon as you stop smok- available.
ing and eventually decreases to that of any non- Do not drink before a party.
smoker. Stopping smoking or stopping the use of Avoid drinking when angry or depressed.
smokeless tobacco can be difficult, but most ex- Eat plenty of food before and while drinking.
smokers and former users say they feel better phys- Avoid salty foods—they may make you thirsty
ically and emotionally. Many programs designed to and cause you to drink more. As a host, do
help the smoker break the habit are available. If you not provide foods that are high in salt.
want to quit smoking or know someone who does, Do not play or promote drinking games.
the agencies listed in the Sources of Help to Quit When mixing drinks, always measure the
Smoking box below may be able to help you. amount of alcohol. Do not just pour. As a
host, hire a bartender and give clear instruc-
tions about measuring drinks or mix all the
Alcohol drinks yourself.
As a host, do not have an open bar or serve
Alcohol is the most popular drug in Western society. someone who has had too much to drink.
In addition to the hazardous relationship between Stop drinking alcohol 1 hour before the party
drinking alcohol and driving, consuming alcohol is over. If you are a host, stop serving alcohol.
in large amounts has other unhealthy effects on Do not drink and drive. Have a designated
the body. nondrinking driver or call a cab.
A blood alcohol concentration (BAC) of 0.05
percent or higher impairs judgment and reflexes
and makes activities like driving unsafe (Fig. 24-
11). How much drinking leads to this blood alcohol
level? On an empty stomach, an average 160-pound
person can reach this level after just two ordinary-
Smoking and Alcohol Use
size drinks in an hour or less—2 bottles of beer, The following statements represent an aware-
10 ounces of wine or 2 drinks with 1 ounce of al-
cohol in each. The faster alcohol enters the blood-
ness of smoking and alcohol that can reduce
stream, the faster the BAC increases. A small your chance of disease. Check each statement
amount of alcohol enters the body quickly from the that reflects your lifestyle.
stomach, where food slows alcohol absorption. The
I am aware of the risks and negative effects
major portion passes into the bloodstream from the
small intestine, where food does not affect absorp- of smoking.
tion. From the bloodstream, alcohol goes directly to To prevent inhaling secondhand smoke as
the brain and to other parts of the body, such as the much as possible, I avoid being around peo-
liver. Because of the time it takes for the body to ple who are smoking.
process alcohol, you should always limit yourself
to one drink per hour. I do not use tobacco products.
Only time can make a person sober after hav- I drink alcohol in moderation or not at all.
ing too much to drink. Black coffee and a cold
Whenever I am in a group driving to a party
shower may make a person feel more alert, but the
body must process the alcohol over time for the im- where alcohol will be served, I make sure
pairment of judgment and coordination to pass. the group has a designated driver.
Therefore, any group driving to a party should al- I am aware of the rate at which alcohol
ways have a designated, nondrinking driver for the passes into the bloodstream.
return trip.
Whether hosting a party or participating in one, I do not drink more than one alcoholic drink
you can act responsibly by keeping alcohol con- per hour.
sumption under control. To do this, remember these
general principles:
Drink slowly. Have no more than one drink now.
per hour.
NUMBER OF DRINKS
1 2 3 4 5
The amount of
100 .04 .09 .15 .20 .25 alcohol in mixed
drinks varies
considerably,
120 .03 .08 .12 .16 .21
BODY WEIGHT
depending on the
recipe and type
of liquor used
140 .02 .06 .10 .14 .18
160 .02 .05 .09 .12 .15 Figures are rounded

to nearest .01.
BACs shown
180 .02 .05 .08 .10 .13 are approximate,
since they can be
200 .01 .04 .07 .09 .12 affected by factors
other than weight.
0 to .04 .05 to .09 .10 and above

Not legally under State laws vary. Presumed
the influence. Mental and physical intoxicated in all
Impairment impairment 50 states.
possible. noticeable.
National Clearinghouse for Alcohol Information
Figure 24-11 BAC chart.
For help with an alcohol problem, refer to important to take safety precautions in vehicles, at
Chapter 18 for a list of organizations that provide work, at play and in your home. To reduce your
help and support for substance abuse problems. risk of illness, you need to make choices about
your lifestyle. Making healthy choices will reduce
your chances of cancer, stroke, heart attack, cardio-
SUMMARY vascular disease and other diseases that are the lead-
ing causes of chronic illness and death. Eating a
You can help prevent injury and disease by taking healthy diet, exercising regularly, avoiding harmful
safety precautions and making lifestyle choices that substances and managing stress all contribute to a
promote health. To reduce your risk of injury, it is person’s health and well-being.
1. What might Mrs. Gallagher have done to
achieve her current state of fitness?
STUDY QUESTIONS
a. Carbohydrates e. Aerobic exercise

b. Obesity f. Saturated fat
c. Stress g. Calorie
d. Cardiorespiratory
endurance
_____ A measure of the energy value of food.
_____ A physiological or psychological response to real or imagined influences that alter an existing state of
physical, mental or emotional balance.
_____ The ability to take in, deliver and extract oxygen for physical work.
_____ The fat in animal tissues and products.
_____ Activities that require additional effort by the heart and lungs to meet the increased demand by the
skeletal muscles for oxygen.
_____ A condition characterized by excess of stored body fat.
_____ Compounds that contain carbon, oxygen and hydrogen; the main source of energy for all body
functions.
2. Fill in the blanks with the correct word or words.
The leading cause of death in the United States is __________. The disease that is the leading cause
of death is __________. The leading cause of death for people ages 1 to 39 is __________.
3. List three ways to reduce your risk of personal injury.
4. List two motor-vehicle safety guidelines.
5. List four guidelines for what to do in case the building you are in catches fire.
6. When Jake learned that his grandmother had fallen in the upstairs hall, he went to her house to see what he
could do to make it safer for her. What hazards might he have discovered in the hall? What could he do to
make the hall safer?
7. Your 2-year-old nephew is coming to visit. What can you do to make your kitchen safe?
8. Which best describes the purpose of the current food labels?
a. They compare the beneficial effects of the nutrients listed.

b. They point out the dangers of fat and sugar.
c. They provide a way to evaluate the nutritional value of the food product.
9. From which of these food groups should you get the majority of your daily nutrients?
a. Fruits and vegetables

b. Milk and cheese
c. Fats, oils and sweets
d. Bread, cereal, rice and pasta
10. Which of these statements is correct?
a. You can eat as much fat as you wish as long as it is not saturated fat.
b. Excess protein is always stored in the body as muscle.
c. Carbohydrates are the body’s main source of energy.
d. Dietary fiber has no value for the body, since it is not digested.
a. To be beneficial, exercise must cause pain.

b. Only vigorous activities burn off calories.
c. If you take in more calories than you use, you will not gain weight.
d. Too much body fat contributes to disease.
12. To improve cardiorespiratory endurance, which form of exercise is most effective?
a. Strength training
b. Flexibility training
c. Aerobic exercise
d. Vigorous walking
a. Stress can be positive as well as negative.

b. Receiving an unexpected award can cause stress.
c. Not all people are stressed by the same events.
14. Which is the addictive substance in cigarettes?
a. Tar
b. Nicotine
c. Carbon monoxide
d. All of the above
a. Cigarette smoking contributes heavily to lung cancer.

b. If you stop smoking, you remain at the same risk of heart attack as while you were smoking.
c. The tars and carbon monoxide in cigarettes are harmless.
d. Chewing tobacco and snuff are safe because you do not inhale smoke when you use them.
16. Which is the most effective way to sober up a person who has had too much to drink?
a. Give the person a lot of black coffee.

b. Put the person in a cold shower.
c. Have the person eat a lot of food.
d. None of the above.
17. List four ways in which you can be a responsible host.

Appendix A
CHAPTER 1 c. On my way into the grocery store from the
parking lot, I heard the loud screech of tires
and the crash of metal. I saw that a car had
Answers to Application Questions struck a telephone pole, causing the telephone
1. One person can find a phone and call EMS per- pole to lean at an odd angle. Wires are hanging
sonnel; another can look around for a nearby down from the pole. It was very frightening.
citizen responder. Someone can begin to give 2. Five common barriers to taking action at the
first aid. scene of an emergency are: the presence of by-
2. Although you may feel ill and be incapacitated standers; uncertainty about the victim; nature of
by the sight of blood or cries of pain, you can the injury or illness; fear of disease transmission;
still help. If possible, turn away for a moment and the fear of doing something wrong.
and try to control your feelings. If you are still 3. A citizen responder can overcome these barriers
unable to proceed, make sure EMS personnel to action by thinking about these barriers and
have been called. Then find other ways to help, mentally preparing himself or herself to face
such as asking bystanders to assist you or help- these challenges ahead of time.
ing to keep the area safe. 4. c, e, a, d, b, f
3. People delayed calling EMS personnel; the caller 5. Bystanders can help at the scene of an emer-
gave an incorrect location of the crash; the am- gency by calling, meeting and directing the am-
bulance was held up in traffic. EMS personnel bulance; keeping the area free of unnecessary
may have had to cut the victim out of the car; traffic; or giving first aid. Bystanders can go for
the location of the car was hazardous; they had additional supplies or give comfort to others on
to use special equipment; a helicopter may have the scene. Finally, bystanders may be able to
had to be called and would have had to land give you important information about the vic-
safely nearby; the hospital was far away. tim or what happened.
Answers to Study Questions CHAPTER 2

1 a. I was fixing sandwiches and talking with my
next-door neighbor, Mrs. Roberts, who had
come by to borrow a book. My 3-year-old,
Answers to Application Questions
Jenny, was in the next room playing with 1. The main danger in the garage could be the
some puzzles. As Mrs. Roberts got up to presence of carbon monoxide. Another danger
leave, I heard a loud thump and a shriek from could be fumes from a spilled toxic substance or
upstairs. an electrical hazard.
b. I was on the bus headed for work. A man 2. The presence of poisonous fumes would be the
from the back of the bus came down the aisle, major factor that could cause you to decide to
and I noticed that he was moving unsteadily. move your Dad immediately. Avoid breathing in
I noticed he was sweating and looked very poisonous fumes as you execute the move.
pale. “I don’t know where I am,” I heard him 3. You would shout for help. If no one came, you
mumble to himself. would go to the phone and call 9-1-1 or the
Appendix A 465
local emergency number. If the car is running, 9. Walking assist; pack-strap carry; two-person
you would suspect carbon monoxide, so you seat carry; clothes drag.
would turn off the engine and move your Dad
from the garage.
CHAPTER 4
Answers to Study Questions
1. Downed power lines; traffic; fire; dangerous
fumes; freezing rain; broken glass; metal shards; 1. His brain may have been injured by the blow to
spilled fuel. the head, and this damage to the nervous system
2. Do not approach the victim. Go to a safe place could affect breathing and perhaps cause it to
and call 9-1-1 or the local emergency number. stop.
3. Unconsciousness; trouble breathing; no signs of 2. Respiratory—his breathing is changing, becom-
life (movement or breathing); severe bleeding. ing faster, then slower. Nervous—he is uncon-
4. The victim’s condition, the care being given, scious. Integumentary—he has a cut on his head.
the location and type of emergency (auto acci- 3. Jim may have sustained damage to other sys-
dent). Tell him or her to report back to you tems, but these injuries are the most obvious.
after making the call and tell you what the call
taker said.
5. Call First, that is, call 9-1-1 or the local emer-
gency number before giving care. 1. (a) Respiratory (b) airway, lungs (c) circulatory
(d) transports oxygen and other nutrients to
cells and removes wastes (e) skin, hair, nails (f)
helps keep fluids in, prevents infection, sweat
CHAPTER 3 glands and pores in skin help regulate tempera-
ture, helps make vitamin D, stores minerals (g)
bones, ligaments, muscles, tendons (h) supports
Answers to Application Questions body, allows movement, protects internal or-
1. The lifeguard should take steps to prevent dis- gans and structures, produces blood cells, stores
ease transmission, such as wearing gloves to minerals, produces heat (i) nervous (j) brain,
avoid contact with the victim’s blood. spinal cord, nerves.
2. The lifeguard should immediately wash his 2. g, f, e, d, c, a, h, b
hands and check for any open sores or cuts in 3. a
his skin. 4. c
5. c
6. c
Answers to Study Questions 7. b
1. a. The victim may or may not be infected with 8. b
the disease. 9. d
2. d. Indirect contact.
3. b. Using personal protective equipment such as
disposable gloves. CHAPTER 5
4. a. Your level of training.
5. c. Clothes drag.
6. Fire; presence of toxic gas; risk of drowning;
risk of explosion. 1. In this particular emergency, you may not be
7. Dangerous conditions at the scene; the size of able to do much to ensure scene safety, beyond
the victim; your physical ability; the victim’s guarding against the possibility that another
condition. biker might round the curve and hit you or the
8. Only attempt to move a person you are sure you victim.
can comfortably handle; bend your body at the 2. A head, neck or back injury is certainly a possi-
knees and hips; lift with your legs, not your bility, as well as a sudden illness, such as an al-
back; walk carefully, using short steps. lergic reaction or a heart attack.
466 Appendix A
3. Shout for help. If no one responds and the vic- 2. No. The care for respiratory distress is basi-
tim is unconscious, position the victim on one cally the same, regardless of the condition that
side (recovery position) and find a telephone or caused it.
ask someone else to call 9-1-1 or the local emer- 3. Yes. If the passages narrow as a result of
gency number. After calling 9-1-1 or the local swelling, preventing air exchange, Steve may
emergency number, return to the victim as soon suffer respiratory arrest. The possibility of res-
as possible. You may be asked to meet EMS per- piratory arrest is the reason to call 9-1-1 or the
sonnel and take them to the victim. If you can- local emergency number right away.
not find a phone or someone to place the call, 4. Send Kevin to call 9-1-1 if someone has not al-
go get help. ready called. Your first step would be to open
4. Ask the victim what happened. Check for non- Steve’s airway and check for signs of life (move-
life-threatening conditions to find out if the vic- ment or breathing). If he is not breathing, give 2
tim has any problems that require you to call rescue breaths. If he is breathing, maintain an
9-1-1 or the local emergency number. If you do open airway.
not find life-threatening conditions, help the vic- 5. Yes, if Steve’s condition is asthma or a severe
tim gradually to his or her feet. allergic reaction, an airway obstruction could
occur. Also, if Steve became unconscious, his
tongue could fall to the back of his throat and
Answers to Study Questions block the airway. In Steve’s case, airway ob-
1. (a) Look for bystanders who can help, look for struction could be a serious emergency, be-
victims, look for dangers, look for clues to de- cause abdominal thrusts would not relieve this
termine what happened. (b) Open the airway, obstruction caused by swelling. Make sure to
check for signs of life (movement and breath- call 9-1-1 or the local emergency number im-
ing), check for severe bleeding. (c) Call 9-1-1 or mediately.
the local emergency number. (d) Interview the
victim and bystanders, do a head-to-toe exami-
nation, obtain the victim’s consent.
2. Unconsciousness; breathing in a strange way or 1. c, d, a, f, h, b, g, e
trouble breathing; no signs of life (movement or 2. High-pitched sounds; skin is unusually moist;
breathing); severe bleeding. fearful; skin has a flushed appearance; shortness
3. There’s a stopped car in the road and a mangled of breath; pain in chest.
bicycle. You can use bystanders to direct traffic. 3. Trying to swallow large pieces of poorly
4. If the victim is conscious and has no life-threat- chewed food; drinking alcohol before or during
ening conditions, you can begin to check for meals; wearing dentures; eating while talking
other conditions that may need care. Checking excitedly or laughing or eating too fast; walk-
a conscious victim with no immediate life- ing, playing or running with food or objects in
threatening conditions involves two basic steps: the mouth.
Interview the victim and bystanders and check 4. c, a, b 13. a
the victim from head to toe. 5. d 14. b
5. 4, 1, 5, 2, 3 6. b 15. b
6. b 7. a 16. c
7. c 8. a 17. 2, 3, 1, 4
8. b 9. c
9. a 10. b
11. d
12. a
CHAPTER 6
CHAPTER 7
1. Steve had signals of respiratory distress. Signals
of Steve’s emergency were holding his throat, 1. Yes. The exertion of mowing grass in the heat
pale skin and wheezing sounds when breathing. can add an extra burden on the body, increasing
Appendix A 467
its demand for oxygen. The heart works harder 12. b

to keep up with the body’s demand for oxygen, 13. Persistent chest pain associated with shoulder
increasing its own oxygen needs. If the arteries pain; perspiring heavily; breathing fast; look-
are narrowed as a result of atherosclerosis, the ing ill.
delivery of oxygen-rich blood to the heart is se- 14. 2, 3, 1, 4, 5
verely restricted or completely cut off, causing 15. 3, 4, 2, 1, 5
the heart to beat irregularly or stop beating.
2. Resting reduces the heart’s need for oxygen, al-
3.
lowing it to recover from the strain placed on it.
Yes. If Mr. Getz suffered a heart attack, he may
CHAPTER 8
go into cardiac arrest. A heart attack becomes
cardiac arrest when so much of the heart muscle
is destroyed that the heart is unable to contract 1. The bleeding from Janelle’s wound is probably
regularly and subsequently stops beating. There from a vein. The blood is flowing rather than
is no way to predict the extent of the damage spurting. Spurting would indicate that the bleed-
sustained by the heart during a heart attack or ing is from an artery.
to predict when a heart attack might become 2. Severe bleeding can reduce the blood volume in
cardiac arrest. Therefore, it is very important to the body and become life threatening. An ade-
recognize the signals of a heart attack and to quate amount of blood is needed to maintain
call 9-1-1 quickly. the flow of oxygen-rich blood to the body, par-
4. If Mr. Getz is suffering cardiac arrest, he needs ticularly to the vital organs.
defibrillation as quickly as possible. Someone 3. Janelle’s friend should first try to control the
must call 9-1-1 or the local emergency number bleeding by applying direct pressure to the
immediately and CPR must be started immedi- wound. She should then apply a pressure ban-
ately. dage and determine if the wound needs further
5. CPR—the combination of chest compressions medical attention.
and rescue breathing—sustains the vital organs, 4. Janelle’s friend should use a barrier, such as dis-
such as the brain, for a relatively short time. posable gloves or plastic wrap. If these items are
Prompt CPR, early defibrillation and other ad- not available, the friend could use a clean folded
vanced cardiac life support measures in combi- cloth or have Janelle use her hand to control the
nation are needed to sustain life. bleeding. The friend should wash her hands af-
ter giving care.
1. e, c, g, h, d, b, a, f
2. Absence of signs of life. The victim’s skin may 1. b, a, e, c, g, f, d
be pale, ashen or bluish, particularly around the 2. Blood spurts from the wound, making it diffi-
face. The skin may also be moist from perspira- cult for clots to form; bleeding that fails to stop
tion. after all measures have been taken to control it.
3. The scene becomes unsafe; the victim shows signs 3. Place direct pressure on the wound with a ster-
of life; an AED becomes available and is ready to ile gauze pad or any clean cloth, such as a
use; another trained rescuer arrives and takes washcloth, towel or handkerchief. Place your
over; you are too exhausted to continue. gloved hand over the pad and apply firm pres-
4. Motor vehicle crashes, drowning, smoke inhala- sure. If you do not have disposable gloves or an
tion, poisoning, airway obstruction, firearm inappropriate barrier, have the injured person ap-
juries and falls. ply pressure with his or her hand. Apply a pres-
5. b sure bandage to hold the gauze pads or cloth in
6. d place. If blood soaks through the bandage, add
7. d more pads and bandages to help absorb the
8. c blood and continue to apply pressure. Do not
9. d remove any blood-soaked pads. If bleeding
10. c continues, call 9-1-1 or the local emergency
11. c number.
468 Appendix A
4. Soft tissues, such as those in the abdomen, that If you suspect head, neck or back injuries or
are tender, swollen or hard; swelling, tenderness possible broken bones involving the hips or legs,
or rigidity in the injured area; anxiety or rest- if moving causes more pain, if you are unsure of
lessness; rapid, weak pulse; rapid breathing, the victim’s condition or if it is painful for him
shortness of breath; skin that feels cool or moist or her to move, leave the victim lying flat. Do
or looks pale, ashen or bluish; bruising in the in- not give the victim anything to eat or drink,
jured area; nausea or vomiting; vomiting or even though he or she is likely to be thirsty.
coughing up blood; abdominal pain; excessive 5. d
thirst; decreased level of consciousness; severe 6. b
headache. 7. d
5. Apply an ice pack or a chemical cold pack to the 8. d
injured area to help reduce pain and swelling. 9. b
Place something, such as a gauze pad or a towel, 10. Shock is life threatening because the circulatory
between the source of cold and the skin to pre- system fails to circulate oxygen-rich blood to all
vent damage to the skin. parts of the body, causing vital organs to fail to
6. Internal bleeding. function properly.
7. Get ice or a cold pack and apply it to the area. 11. Elevating the legs helps to maintain blood flow
If the injury appears to be serious, call 9-1-1 or to the vital organs.
the local emergency number.
8. a
CHAPTER 10
CHAPTER 9 Answers to Application Questions
1. Joe’s burn is probably a deep burn. The heat
from steam and scalding fluid is likely to dam-
Answers to Application Questions age more than the first layer of skin.
1. Her body could not compensate for her signifi- 2. Joe’s burns will require medical attention. His
cant injuries, which probably involved signifi- burns cover more than one body part.
cant bleeding. 3. Call 9-1-1 or the local emergency number. Find
2. The man could minimize shock by keeping the a source of cool water and cool the burn. Re-
woman from becoming chilled and by providing move any clothing from the burned areas.
reassurance. He could also control any external Cover the burned areas. Minimize shock by
bleeding and give any additional care that she having Joe rest and keeping him from getting
needed. chilled or overheated. Consider the possibility
of inhalation burns, and check for trouble
breathing.
1. f
2. Restlessness or irritability; altered conscious-
ness; pale or ashen, bluish, cool or moist skin; 1. c, f, a, d, e, b
rapid breathing, rapid and weak pulse; excessive 2. c, d, a, b
thirst; nausea or vomiting. 3. a, b, d, c
3. Severe injury or sudden illness. 4. Swollen, red area around wound; area may be
4. Care for life-threatening conditions. Make the warm or painful, possible pus discharge; fever
victim as comfortable as possible. Keep the vic- and feeling ill; red streaks from wound toward
tim from getting chilled or overheated. Watch heart.
for changes in the victim’s level of conscious- 5. Hold dressings in place; to protect a wound
ness, breathing rate and skin appearance. Help from dirt and infection.
the victim lie down on his or her back. Elevate 6. Laceration (cut); abrasion (scrape); puncture
the legs about 12 inches to help blood circulate (penetrates—sharp object); avulsion; (torn tis-
to the vital organs. Do not elevate the legs if the sue—may be torn completely away).
victim is nauseated or having trouble breathing. 7. Heat; electricity; chemicals; radiation.
Appendix A 469
8. a. Involves only the top layer of the skin (first Answers to Study Questions
degree). Skin is red and dry, and the burn is
1. h, b, f, c, a, i, k, d, j, g, e
usually painful. Heals in 5 to 6 days without
2. Pain; swelling; discoloration of the skin; inabil-
permanent scarring.
ity to use the affected part normally; loss of sen-
b. Involves the epidermis and dermis (second
sation in the affected part.
degree). May look red and have blisters.
3. Splint only if you have to move the injured per-
Blisters may open and weep clear fluid.
son and you can do so without causing more
Burned skin may look mottled. Burns are
pain and discomfort to the victim. Splint an in-
painful and often swell. Heals in 3 or 4
jury in the position in which you find it. Do not
weeks. May scar.
move, straighten or bend the injured part. Splint
c. Destroys all layers of the skin and any or all
the injured area and the joints or bones above
of underlying structures (third degree). Burns
and below the injury site. Check for proper cir-
look brown or charred (black). Tissues un-
culation (feeling, warmth and color) before and
derneath may appear white. Burns can be ex-
after splinting.
tremely painful or painless if burn destroyed
4. c
nerve endings. Burn is often life threatening,
5. b
takes a long time to heal and results in scar-
6. b
ring.
7. a
9. a 17. d
8. b
10. b 18. b
11. d 19. d
12. b 20. b
13. d 21. b CHAPTER 12
14. a 22. b
15. b 23. c
16. b 24. c
1. Yes; Sam’s knee hurts, he cannot use it, and it is
swelling.
2. He should make Sam as comfortable as possible
CHAPTER 11 and go find a phone to call 9-1-1 or the local emer-
gency number. If he uses a phone in a home or
business, he could ask for ice or a cold pack and a
Answers to Application Questions blanket or pillow to use to immobilize Sam’s knee.
1. Rita is obviously in pain—moaning and holding
her shoulder. She seems unable to get up. She
appears unable to move her left arm.
2. Rita could have a serious shoulder injury, possi- 1. c, b, d, a
bly injuring the bones, muscles, ligaments and 2. Falling on the hand of an outstretched arm.
tendons. She might also have injured her neck 3. A dislocation, separation, broken bone.
or back. 4. Unable to move the leg, which is beginning to
3. Help her find the most comfortable position; swell; left arm looks deformed at the shoulder;
keep from moving her head, neck and back as no sensation in the fingers of that arm; arm is
much as possible; immobilize her upper extrem- beginning to look bruised and is painful.
ity and apply ice to the injured area; prevent her 5. Call 9-1-1 or the local emergency number; im-
from becoming chilled or overheated to delay mobilize the injured part; apply ice; elevate the
the onset of shock; and keep her comfortable injured extremity; place gauze or cloth between
until EMS personnel arrive. the source of cold and the skin. Help the victim
4. Yes. Although the injury does not appear to be rest in the most comfortable position; prevent
life threatening—the victim is conscious, breath- him from becoming chilled or overheated; reas-
ing, has signs of life and is not bleeding se- sure him. Continue to monitor the victim’s level
verely—Rita is unable to get up and is in pain. of consciousness, breathing, skin color and tem-
She may have a fracture or dislocation and could perature. Be alert for any signals, such as
also have injured her head, neck or back. changes in breathing rate, skin color or level of
470 Appendix A
consciousness that may indicate the victim’s 3. Changes in the level of consciousness; severe
condition is worsening. If needed, take steps to pain or pressure in the head, neck or back; tin-
minimize shock. gling or loss of sensation in the extremities; par-
6. Injured leg is noticeably shorter than the other tial or complete loss of movement of any body
leg; injured leg is turned outward; severe pain; part; unusual bumps or depressions on the head
inability to move the lower extremity. or neck; sudden loss of memory; blood or other
7. Soft, rigid and anatomic. fluids in the ears or nose; profuse external
8. b bleeding of the head, neck or back; seizures in a
9. c person who does not have a seizure disorder;
10. Control any external bleeding. Wear dispos- impaired breathing or impaired vision as a re-
able gloves or use a protective barrier. Call sult of injury; nausea or vomiting; persistent
9-1-1 or the local emergency number immedi- headache; loss of balance; bruising of the head,
ately. Immobilize the injured area and help the especially around the eyes or behind the ears.
victim into the most comfortable position. If 4. Wearing safety belts (lap and shoulder re-
the victim’s lower extremity is supported by straints) and placing children in car safety seats;
the ground, do not move it. Rather, use rolled when appropriate, wearing approved helmets,
towels or blankets to support the leg in the po- eyewear, faceguards and mouthguards; taking
sition in which you found it. If one is avail- steps to prevent falls; obeying rules in sports
able, place a pillow or rolled blanket between and recreational activities; avoiding inappropri-
the lower extremities and bind them together ate use of alcohol and other drugs; inspecting
above and below the site of the injury. Check work and recreational equipment periodically;
for feeling, warmth and color before and af- thinking and talking about safety.
ter applying the splint. Apply ice or a cold 5. Place the victim on his or her back; do not at-
pack. Take steps to minimize shock. tempt to remove any object embedded in the
eye; wearing disposable gloves, place a sterile
dressing around the object; stabilize any embed-
CHAPTER 13 ded object as best you can; you can stabilize the
object by placing a paper cup around the object
to support it; bandage loosely and do not put
Answers to Application Questions pressure on the injured eye/eyeball; seek imme-
No. Signals could develop later. He did strike his diate medical attention.
head and could have injured his neck or back in do- 6. a 10. a
ing so. 7. d 11. b
8. c 12. d
9. c 13. d
Answers to Study Questions 14. Do not put direct pressure on the wound; at-
1. b, a, c, e, d tempt to control bleeding with pressure on the
2. A fall from a height greater than the victim’s area around the wound; secure the dressings
height; any diving mishap in which the person with a roller bandage or triangular bandage;
may have struck or otherwise injured the head, call 9-1-1 if you are unsure about the extent of
neck or back; a victim found unconscious for the injury.
unknown reasons; any injury involving a severe 15. Minimize movement of the head, neck and
blunt force to the head or trunk, such as being back; keep the victim as still as possible until
hit by a car or baseball bat; any injury that pen- EMS personnel arrive; use a technique called in-
etrates the head or trunk, such as a knife or gun- line stabilization to minimize movement of the
shot wound; a motor vehicle crash involving a head and neck; check for life-threatening condi-
driver or passengers not wearing safety belts; tions; maintain an open airway; monitor con-
any person thrown from a motor vehicle; any sciousness and breathing; control any external
injury in which a victim’s helmet is broken or bleeding with direct pressure unless the bleeding
cracked, including a bicycle, motorcycle, foot- is located directly over a suspected fracture;
ball or industrial helmet; anytime a victim is wear disposable gloves or use another barrier;
struck by lightning. maintain normal body temperature.
Appendix A 471
CHAPTER 14 CHAPTER 15
Answers to Application Questions Answers to Application Questions
She should have Mr. McGuffy lie down, and she 1. The signals of Julio’s illness include his body
should call or have a bystander call 9-1-1 or the lo- collapsing to the ground and becoming rigid, his
cal emergency number. She should keep Mr. eyes rolling back and his arms and legs jerking
McGuffy as still as possible. Because the injury was uncontrollably.
the result of trauma, she should apply manual stabi- 2. During the seizure, Michelle could protect
lization, watch for changes in his breathing and level Julio’s head, loosen any clothing that might re-
of consciousness while waiting for EMS personnel strict breathing and move any nearby objects
to arrive. She should also keep Mr. McGuffy from that could cause injury. After the seizure,
getting chilled or overheated. Michelle could ensure that Julio’s airway is
open, position Julio on his side so that any flu-
ids could drain, look and care for non-life-
Answers to Study Questions threatening conditions that may have occurred
1. c, a, b, e, d during the seizure, provide reassurance, main-
2. Calling 9-1-1 or the local emergency number; tain crowd control or find Julio a more se-
limiting movement; monitoring signs of life; cluded place to rest, stay with Julio until he is
controlling bleeding; minimizing shock. fully conscious and aware of his surroundings
3. Trouble breathing; severe pain at the site of the and call 9-1-1 or the local emergency number,
injury; flushed, pale, ashen or bluish skin; obvi- if necessary.
ous deformity, such as that caused by a fracture; 3. Michelle should call 9-1-1 or the local emergency
coughing up blood (may be bright red or dark number if Julio was injured when he fell or dur-
like coffee grounds); bruising at the site of a ing the seizure, another seizure immediately fol-
blunt injury, such as that caused by a seat belt; lows the end of the first one, the seizure lasted
a “sucking” noise or distinct sound when the more than 5 minutes, Julio is not known to have
victim breathes epilepsy, Julio is a known diabetic or Julio fails to
4. Rib fracture. Have the victim rest in a position regain consciousness after the seizure.
that will make breathing easier. Do not move
the victim if you suspect a head, neck or back
injury. Call 9-1-1 or the local emergency num-
ber. Bind the victim’s upper arm to the chest on 1. f, c, h, g, e, d, b, i, a
the injured side to help support the injured area 2. A victim of sudden illness may faint or complain
and make breathing more comfortable. Use an of feeling lightheaded, dizzy or weak. He or she
object such as a pillow or rolled blanket to sup- may feel nauseated or may vomit. Breathing,
port and immobilize the area. Monitor breath- pulse, body temperature and skin color may
ing and skin condition, and take steps to mini- change. A person who looks or feels ill generally
mize shock. is ill.
5. A sucking sound coming from the wound with 3. Do no further harm; monitor breathing and
each breath the victim takes consciousness; help the victim rest in the most
6. Severe pain; bruising; external bleeding: nausea; comfortable position; keep the victim from get-
vomiting (sometimes containing blood); weak- ting chilled or overheated; reassure the victim;
ness; thirst; pain, tenderness or a tight feeling in give any specific care needed.
the area; protruding organs; rigid abdominal 4. The seizure lasts more than five minutes; the vic-
muscles; other signals of shock. tim has repeated seizures, one after another,
7. a without regaining consciousness in between; the
8. A sucking chest wound. victim appears to be injured; the victim is not
9. Trouble breathing; severe pain at the site of the known to have a predisposing condition, such
injury; hear a sucking sound when victim as epilepsy, that could have brought on the
breathes. seizure; the victim is pregnant; the victim is an
472 Appendix A
infant or child who is experiencing an initial weakness; irregular pupil size; burning or tear-
febrile seizure; the victim is known to have dia- ing eyes; abnormal skin color; burn injuries
betes; the seizure takes place in water; the victim around the lips or tongue or on the skin.
fails to regain consciousness after the seizure. 3. Depends on the type and amount of the sub-
5. Control your blood pressure; do not smoke; eat stance; how and where it entered the body; the
a healthy diet; exercise regularly; control dia- time elapsed since the poison entered the body;
betes. and the victim’s size, weight, medical condition
6. Look for non-life-threatening conditions, check- and age.
ing to see if the victim was injured during the 4. Immediately rinse the affected area thoroughly
seizure; be reassuring and comforting; if the with water. Using soap cannot hurt, but soap
seizure occurred in public, try to provide a mea- may not do much to remove the poisonous
sure of privacy for the person; ask bystanders plant oil that causes the allergic reaction. If the
not to crowd around the person; if possible, victim is wearing any jewelry that is contami-
take the victim to a nearby place, away from by- nated or restricting circulation, ask him or her
standers, to rest; if moving the victim to a more to remove it. If a rash or weeping lesion (an ooz-
secluded location is not possible, use your body ing sore) develops, seek advice from a pharma-
or an object, such as a blanket, to shield the vic- cist or physician about possible treatment. If the
tim from onlookers. Stay with the victim until condition worsens and large areas of the body
he or she is fully conscious and aware of his or or the face are affected, the victim should see a
her surroundings. physician, who may administer anti-inflamma-
7. Confusion; profuse sweating; pupils of unequal tory drugs, such as corticosteroids, or other
sizes; speech difficulty; weakness or fatigue. medications to relieve discomfort. If other poi-
8. Call 9-1-1 or the local emergency number. Al- sons, such as dry or wet chemicals, contact the
low the victim to rest in a comfortable position. skin, flush the affected area continuously with
Do not give her anything to eat or drink. Stay large amounts of water. Garden hoses and
with her and offer comfort and reassurance un- showers suit this purpose well. Call 9-1-1 or the
til EMS personnel arrive. local emergency number immediately, then con-
9. a tinue to flush the area until EMS personnel ar-
10. c rive. If running water is not available, brush off
11. c dry chemicals, such as lime, with a gloved hand.
12. a Take care not to inhale any of the chemical or
13. b get any of the dry chemicals in your eyes or the
14. a eyes of the victim or any bystanders.
15. c 5. Keep all medications and household products
16. d well out of the reach of children. Special latches
and clamps are available to keep children from
opening cabinets. Consider all household or
CHAPTER 16 drugstore products to be potentially harmful.
Use childproof safety caps on containers of
medication and other potentially dangerous
Answers to Application Questions products. Keep products in their original con-
1. Ashley sees the chair used to climb up to the tainers, with the labels in place. Use poison
table and an empty vitamin container on the symbols to identify dangerous substances, and
table next to Kristen. teach children what the symbols mean. Dispose
2. Ashley should take the empty container to the of outdated medications and household prod-
phone, call the local poison control center and ucts properly and in a timely manner. Use po-
follow their directions. tentially dangerous chemicals only in well-venti-
lated areas. Wear proper clothing when work or
recreation may put you in contact with a poiso-
Answers to Study Questions nous substance. Immediately wash those areas
1. e, b, f, c, a, d of the body that you suspect may have come
2. Nausea; vomiting; diarrhea; chest or abdominal into contact with a poisonous plant.
pain; trouble breathing; sweating; changes in 6. Itching and burning hand; swollen fingers; red
consciousness; seizures; headache; dizziness; bumps all over her forearm.
Appendix A 473
7. Rinse the affected area thoroughly with water, shirt into your pants. Wear light-colored cloth-
and consult a doctor or pharmacist about possi- ing to make it easier to see tiny insects or ticks.
ble treatments. Use a rubber band or tape the area where pants
8. Wear protective clothing. and socks meet to prevent ticks or other insects
9. c from getting under clothing. Inspect yourself
10. a carefully for insects or ticks after being out-
doors or have someone else do it. If you are
outdoors for a long period of time, check your-
CHAPTER 17 self several times during the day. Check espe-
cially in moist, hairy areas of the body (includ-
ing the back of the neck and the scalp line).
Answers to Application Questions Shower immediately after coming indoors, us-
1. The sounds of hissing and dry leaves crackling, ing a washcloth to scrub off any insects or ticks.
as well as pain and bleeding at or near Tonya’s Carefully inspect yourself for embedded ticks
ankle, indicate that she was probably bitten by and remove them appropriately. Keep an eye
a snake. out for and avoid the nests of wasps, bees and
2. Darrell should use his mobile phone or contact hornets. If you have pets that go outdoors,
a park ranger to call 9-1-1 or the local emer- spray them with repellent made for your type of
gency number immediately. Then, if possible, pet. Apply the repellent according to the label,
Darrell should wash the wound, immobilize and check your pet for ticks often. When hiking
Tonya’s leg, keep her leg lower than her heart in woods and fields, stay in the middle of trails.
and minimize her movement. Avoid underbrush, fallen trees and tall grass.
3. Darrell should consider the distance to profes- Avoid walking in areas known to be populated
sional help, whether he can get Tonya to help with snakes. Make noise as you walk through
before help can get to her and whether he has a areas that may be populated with snakes, be-
way to transport her to a medical facility. cause many snakes will retreat if they detect
4. To prevent her injury, Tonya could have made your movement. If you encounter a snake, look
noise to scare away the snake, kept her socks around, because other snakes may be nearby.
and boots on and not used the log as a footrest. Turn around and walk away, back on the same
path you were just on. To prevent stings from
marine animals, you might consider wearing a
Answers to Study Questions wet suit or dry suit or protective footwear in
1. b, a, c, e, d the water. To prevent dog bites: do not run past
2. With a gloved hand, grasp the tick with fine- a dog. Avoid eye contact, try to remain mo-
tipped pointed, non-etched, non-rasped tweez- tionless until the dog leaves, then back away
ers as close to the skin as possible and pull slowly until the dog is out of sight. Do not ap-
slowly and upwards. Do not burn the tick off, proach a strange dog, especially one that is tied
do not apply petroleum jelly or nail polish to the or confined. Always let a dog see and sniff you
tick. These remedies are not always effective in before you pet the animal.
removing the tick and can cause further harm to 4. A bite or sting mark at the point of injection
the victim. If you cannot remove the tick, or if (entry site). A stinger, tentacle or venom sac re-
its mouth parts remain embedded, get medical maining in or near the entry site. Redness at or
care. Place the tick in a sealable container for around the entry site. Swelling at or around the
analysis. Wash the bite area with soap and entry site. Pain or tenderness at or around the
warm water. Apply antiseptic or triple antibiotic entry site.
ointment to help prevent infection. If rash, flu- 5. Call 9-1-1 or the local emergency number. Wash
like signals or joint pain appears, seek medical the wound, if possible. Immobilize the affected
attention. Wash your hands thoroughly. If you part. Keep the affected area lower than the
do not have tweezers, use a glove, plastic wrap, heart, if possible. Minimize the victim’s move-
a piece of paper or a leaf to protect your fingers. ment. If possible, carry a victim who must be
3. Apply insect or tick repellent according to label transported or have him or her walk slowly. If
instructions. Wear sturdy hiking boots. Wear you know the victim cannot receive medical
long-sleeved shirts and long pants. Tuck your care within 30 minutes, consider suctioning the
pant legs into your socks or boots. Tuck your wound using a snakebite kit.
474 Appendix A
6. Try to get your sister away from the dog with- all out-of-date medications. Time can alter the
out endangering yourself. Do not try to capture chemical composition of medications, causing
the animal. Control the bleeding and apply a them to be less effective and possibly even
dressing. Do not clean the wound. Call 9-1-1 or toxic. Always keep medications out of the
the local emergency number. In case animal con- reach of children.
trol personnel need to be summoned, try to de- 5. Check the scene to be sure it is safe to help the
scribe what the dog looked like and the area in person. Do not approach the victim if he or she
which it was last seen. is behaving in a threatening manner. Call 9-1-1,
7. a 10. d the local emergency number or the poison con-
8. d 11. d trol center. Check for any life-threatening con-
9. b 12. d ditions. Care for any conditions you find.
6. b, c, a, d, e, f
7. c
CHAPTER 18 8. b
9. d
1. The signals of Susan’s condition are dizziness,
nausea, vomiting, unconsciousness and unusu-
CHAPTER 19
ally pale skin.
2. The signals of Susan’s condition, along with the
fact that she has been drinking, seem to indicate 1. Cynthia feels dizzy because, in an effort to cool
a case of alcohol poisoning. Although you can- the body, blood flow to the skin is increased,
not be sure of the cause of Susan’s condition, the bringing warm blood to the surface and allow-
fact that she is unconscious means that she ing heat to escape. As more blood flows to the
needs immediate care. skin, blood flow to vital organs like the brain is
3. Yes, Susan’s friends must call 9-1-1 or the local reduced. This reduction of blood flow causes a
emergency number because EMS personnel lack of oxygen-rich blood in the brain, creating
should always be called in cases of uncon- a temporary decline in the level of consciousness
sciousness. and making the person feel weak and dizzy or
faint.
2. Louise should get Cynthia out of the sun imme-
Answers to Study Questions diately, then make sure that she rests in a cool
1. f, c, d, e a, h, b, g place and sips cool water.
2. Trouble breathing; chest pain; altered level of 3. Cynthia could have worn a hat, taken frequent
consciousness; moist or flushed skin; mood breaks and kept drinking liquids throughout her
changes; nausea; vomiting; sweating; chills; activity.
fever; headache; dizziness; rapid pulse; rapid
breathing; restlessness; excitement; irritability;
talkativeness; hallucinations; confusion; slurred
speech; poor coordination; trembling. 1. c, e, d, a, b
3. Stimulants; depressants; hallucinogens; nar- 2. Air temperature; humidity; wind; clothing you
cotics; inhalants; cannabis products. wear; how often you take breaks from exposure
4. Read the product information and use products to extreme temperature; how much and how of-
only as directed. Ask your physician or phar- ten you drink water; how intense your activity
macist about the intended use and side effects is; how well your body manages temperature
of prescription and over-the-counter medica- extremes.
tion. If you are taking more than one medica- 3. Heat cramps; heat exhaustion; heat stroke.
tion, check for possible interaction effects. 4. Changes in body temperature; changes in skin
Never use another person’s prescribed medica- temperature, color and moisture; headache;
tions; what is right for one person is seldom nausea; dizziness and weakness; exhaustion;
right for another. Always keep medications in progressive loss of consciousness; rapid, weak
their appropriate, marked containers. Destroy pulse; rapid, shallow pulse.
Appendix A 475
5. Changes in the victim’s level of consciousness.

6. Move the victim away from the heat source.
CHAPTER 20
Have the victim rest in a cool place and drink
cool water slowly. Loosen tight clothing. Re- Answers to Application Questions
move clothing soaked with perspiration. Apply 1. You can make a reaching assist by using rescue
wet towels or sheets to the victim’s body. Fan equipment that should be near the pool, such as
the victim. Apply ice and cold packs to the a shepherd’s crook. Other equipment available
wrists, ankles, armpits, neck and groin. may include a leaf skimmer attached to a pole
7. Frostbite; hypothermia. or a pole used to vacuum the pool. You may
8. Avoid being outdoors in the hottest or coldest also firmly brace yourself on the pool deck and
part of the day. Dress appropriately for the en- reach out to Eric, or you can extend your reach
vironment. Change your activity level according by using a towel or a shirt. You can also throw
to the temperature. Take frequent breaks, by re- items that float out to him, such as a picnic jug,
moving yourself from the environment. Drink an air mattress or an inflatable toy. Remember
large amounts of nonalcoholic or decaffeinated that your first priority is to stay safe. Rushing
fluids before, during and after activity. into the water to help a victim may cause you to
9. a become a victim too.
10. d
11. Lack of feeling in fingers; fingers look waxy and
white; fingers feel cold.
12. Call 9-1-1 or the local emergency number. At- Answers to Study Questions
tempt to remove jewelry or restrictive clothing. 1. Reaching assist; throwing assist; wading assist.
Handle the affected area gently; never rub the 2. Struggles to breathe; cannot call out for help;
affected area. Rubbing causes further damage. If arms to the sides pressing down; has no sup-
there is no chance that the frostbitten part will porting kick; body position is vertical in the wa-
refreeze, you may begin rewarming the affected ter; unable to move forward in the water.
area gently by soaking the affected part in water 3. d
(100º F to 105º F) until it appears red and feels 4. c
warm. Loosely bandage area with a dry, sterile 5. d
dressing. If fingers or toes are frostbitten, place 6. b
dry, sterile gauze between them to keep them
separated. Avoid breaking any blisters.
13. No response to your questions; glassy eyes;
seems weak and exhausted; does not feel your
touch.
14. Call 9-1-1 or the local emergency number. Care-
CHAPTER 21
fully remove any wet clothing and dry the victim.
Warm the body gradually by wrapping the victim
in blankets or putting on dry clothing and mov- 1. Check the scene for safety. If traffic is heavy or
ing him or her to a warm environment. If they otherwise threatening, you might have to help
are available, apply hot water bottles, chemical the man move onto the sidewalk. Ask a by-
heat packs or other heat sources to the body. stander to call 9-1-1 or the local emergency
Keep a barrier, such as a blanket, towel or cloth- number. Try to reassure the man and try to con-
ing, between the heat source and the victim to trol the bleeding if it is severe, keeping a barrier
avoid burning him or her. If the victim is alert, between yourself and the victim’s blood if possi-
give him or her warm nonalcoholic and decaf- ble. Try to keep the man from moving.
feinated liquids to drink. Do not warm the victim 2. Depending on the weather, he could have been
too quickly. Rapid rewarming can cause danger- affected by heat or cold. He could have a sud-
ous heart rhythms. Be extremely gentle in han- den illness, such as a heart attack, stroke or
dling the victim. Monitor signs of life, give rescue seizure. He could have fainted. He could be con-
breathing or CPR if necessary and continue to fused, mentally impaired, unable to hear or
warm the victim until EMS personnel arrive. have poor vision.
476 Appendix A
Answers to Study Questions 2. Stage 1: Preparation—the mother’s body pre-

pares for birth; from the first contraction until
1. d, c, f, b, e, a
the cervix is completely dilated.
2. Check the scene for safety. Have a bystander
Stage 2: Delivery—Begins when the cervix is
call 9-1-1 or the local emergency number. Intro-
completely dilated and ends with the birth of a
duce yourself as someone who knows first aid.
baby.
Find out if anyone on the scene is a parent or
Stage 3: Delivery of the Placenta—The placenta
guardian of the child and, if so, ask permission
separates from the wall of the uterus and is
to give care. Check the child for life-threatening
expelled from the birth canal.
conditions. If the child is conscious, try to reas-
3. See that the airway is open and clear; keep the
sure and comfort the child and ask the child’s
newborn from getting chilled.
name and address. Have someone try to locate
4. a. Has 9-1-1 or your local emergency number
the parents if they are not present.
been called? If so, how long ago and what
3. Introduce yourself and explain that you are
was the response?
there to help. Ask the woman her name and use
b. Is this the first pregnancy?
it when you speak to her. Tell her to lie still; try
c. Does she expect any complications?
to find out from the neighbor if the woman is
d. Is there a bloody discharge?
generally confused or is taking any medication,
e. Has the amniotic sac ruptured (or water
if you haven’t done so already. Have the neigh-
broken)?
bor call 9-1-1 or the local emergency number.
f. What are the contractions like? Are they very
Reassure and comfort the victim. Support and
close together? Are they strong?
immobilize the injured area, probably using
g. Does she have the urge to bear down, or
blankets and pillows.
push?
4. d
h. Is the newborn’s head visible? If so, begin
5. b
preparing for the delivery—the newborn is
6. b
about to be born.
7. b
5. c 8. c
8. c
6. b 9. c
9. Heat-related illness.
7. c 10. a
10. Call 9-1-1 or the local emergency number.
11. Hearing loss; confused or mentally impaired;
not speak the same language you speak.
12. Medication; infection; vision or hearing prob-
CHAPTER 23
lems; depression; Alzheimer’s disease; mental
impairment; shock. Answers to Application Questions
1. The mountains where you, Frank and Jeff are
located create a delayed-help situation. It will
CHAPTER 22 take more than 30 minutes for you and Frank to
get help to Jeff. The mountain environment will
also require specially trained rescue personnel to
Answers to Application Questions remove Jeff.
1. Because this is Lisa’s first pregnancy, she is 2. When checking the scene, you should check for
probably still in stage one, but getting close to dangerous conditions, such as loose or slippery
stage two. The bloody fluid on the bed is prob- rocks. You should be sure the area Jeff is lying
ably the mucous plug, and possibly the amniotic on is safe and stable. It appears that Jeff is con-
sac has broken. scious; however, if his injuries are not cared for,
2. Lisa can tell you how close the contractions are, he may develop shock, a life-threatening condi-
when she began to have them, if the water tion.
broke, where the clean sheets and towels are 3. Jeff slipped and fell. He may have a head,
and where to find gloves. neck or back injury, and you should not at-
tempt to move him unless necessary. In this
situation, because you are trained in first aid,
Answers to Study Questions you should stay with Jeff and Frank should go
1. h, g, c, e, f, a, d, b for help.
Appendix A 477
4. After checking for non-life-threatening condi- Answers to Study Questions

tions, you should give care and continue to
1. g, c, d, f, e, b, a
check Jeff. You should prevent Jeff from getting
2. Disease, heart disease, injury.
dehydrated, chilled or overheated.
3. Know your risk; change risky behaviors; think
about safety; take precautions; wear protective
Answers to Study Questions devices; wear a safety belt; learn first aid.
4. Wear a safety belt including shoulder restraint;
1. d, a, e, b, c
do not drink and drive.
2. Hurricanes; earthquakes; mass trauma.
5. Crawl low to escape smoke. Make sure children
3. Wilderness; rural.
can open windows. If you cannot escape down
4. Stay where you are and call, radio or signal for
a ladder, be prepared to lower children. Get out
help. Send someone to go get help or leave the
quickly and do not return to the building. If you
victim alone to get help. Transport the victim to
cannot escape, stuff wet towels, rags or clothing
help. Care for the victim where you are until the
into door cracks and vents. If a phone is avail-
victim has recovered enough to travel on his or
able, call the fire department.
her own.
6. Poor lighting; rugs that are not fastened down.
5. c
He could install bright lights, fasten down rugs,
6. b
place handrails if necessary.
7. c
7. Turn pot handles toward the back of the stove;
8. c
turn off the oven and other appliances when
9. c
they are not in use; lock up all cleaning products
10. He is shivering violently. His knee is very
and other poisonous items; clean up any spills
painful and feels as if it is swelling. The sky is
promptly; fasten down any rugs.
overcast. The temperature is about 50º F. The
8. c
sun will begin to set in 4 hours. Group members
9. d
provide various dry items of clothing.
10. c
11. Provide some type of insulation.
11. d
12. Knowledge; skills; equipment.
12. c
13. d
CHAPTER 24 14. b
15. a
16. d
Answers to Application Questions 17. Stop serving alcohol an hour before the party is
to end. Have nonalcoholic beverages available.
1. To have achieved her current state of fitness,
Do not promote or play drinking games. Do not
Mrs. Gallagher would probably have eaten a
have salty foods available. Do not have an open
healthy diet, exercised regularly, not smoked
bar or serve anyone who has had too much to
and drank alcohol only in moderation or not
drink. Measure drinks if you are serving.
at all.
Glossary
PRONUNCIATION GUIDE
The accented syllable in a word is shown in capital letters.
River = RIV er
An unmarked vowel that ends a syllable or comprises a syllable has a long sound, such as the o in
open and the i in silent.
O pen SI lent
A long vowel in a syllable ending in a consonant is marked --.
Snowflake = SNO fla–k
An unmarked vowel in a syllable that ends with a consonant has a short sound, such as the i in sis-
ter and the e in reset.
SIS ter re SET
A short vowel that comprises a syllable is marked ˘.
Decimal = DES ĭ mal
The sound of an unstressed vowel, such as the a in ago and the o in connect, is spelled.
Ahead = e HED
Abdomen: The middle part of the trunk, containing Adhesive compress: A small pad of nonstick gauze
the stomach, liver, intestines and spleen. on a strip of adhesive tape, applied directly to
Abdominal cavity: An area in the body that con- small injuries.
tains many organs, including the liver, pan- Advanced cardiac life support (ACLS): Techniques
creas, intestines, stomach, kidneys and and treatments designed for use with victims of
spleen. cardiac emergencies.
Abrasion (ah BRA zhun): A wound characterized by Aerobic: Requiring additional effort by the heart
skin that has been scraped or rubbed away. and lungs to meet the increased demand by the
Absorbed poison: A poison that enters the body skeletal muscles for oxygen.
after it comes in contact with the skin. Aerobic exercise: Sustained, rhythmical exercise,
Active drowning victim: A person exhibiting univer- using the large muscle groups, for at least
sal behavior that includes struggling at the sur- 20-30 minutes within one’s target heart rate
face for 20 to 60 seconds before submerging. range.
Acute: Having a rapid and severe onset, then Airway: The pathway for air from the mouth and
quickly subsiding. nose to the lungs.
Addiction: The compulsive need to use a substance. Airway obstruction: Complete or partial blockage
Stopping use would cause the user to suffer of the airway, which prevents air from reach-
mental, physical and emotional distress. ing a person’s lungs; the most common cause
of respiratory emergencies.
Glossary 479
Allergens: Substances that induce allergies. Ashen: A grayish color; darker skin often looks
Alveoli (al VE o li): Microscopic air sacs in the lungs ashen instead of pale.
where gases and wastes are exchanged between Aspirate: Inhalation of blood, vomit or other for-
the lungs and the blood. eign material into the lungs.
Alzheimer’s disease: A progressive, degenerative Asthma: A condition that narrows the air passages
disease that affects the brain, resulting in im- and makes breathing difficult.
paired memory, thinking and behavior. Asystole: A condition where the heart has stopped
Amnesia: Loss of memory. generating electrical activity.
Amniotic sac: A fluid-filled sac that encloses, Atherosclerosis (ath er o skle RO sis): A condition in
bathes and protects the developing baby; com- which fatty deposits build up on the walls of
monly called the bag of waters. the arteries.
Amputation: A type of avulsion injury in which a Aura (AW rah): An unusual sensation or feeling a
body part is severed. person may experience before an epileptic
Anaphylactic shock (an fiiLAK tik) shock: A severe seizure; it may be a visual hallucination; a
e
allergic reaction in which air passages may strange sound, taste or smell; or an urgent
swell and restrict breathing; a form of shock. need to get to safety.
Anaphylaxis (an fii LAK sis): A severe allergic reac- Autogenics: A relaxation technique that uses self-
e
tion; a form of shock. suggestion to produce relaxation.
Anaphylaxis kit: A container that holds the medica- Auto-injector: A spring-loaded needle and syringe
tion and any necessary equipment used to pre- system with a single dose of epinephrine.
sent or counteract anaphylactic shock. Automated external defibrillator (AED): An automatic
Anatomical airway obstruction: Complete or partial device used to recognize a heart rhythm that re-
blockage of the airway by the tongue or quires an electric shock and either delivers the
swollen tissues of the mouth or throat. shock or prompts the rescuer to deliver it.
Aneurysm (AN u rizm): A condition in which the Avulsion: A wound in which a portion of the skin
wall of an artery or vein weakens, balloons out and sometimes other soft tissue is partially or
and may rupture; usually caused by disease, completely torn away.
trauma or a natural weakness in the vessel
wall.
Angina (an JI n ) pectoris (PEK t ris): Chest pain Bacteria: Microorganisms capable of causing infec-
e e
that comes and goes at different times; com- tion.
monly associated with cardiovascular disease. Bandage: Material used to wrap or cover a part of
Anorexia nervosa: An eating disorder characterized the body; commonly used to hold a dressing or
by a long-term refusal to eat food with suffi- splint in place.
cient nutrients and calories. Bandage compress: A thick gauze dressing attached
Antibiotic: A medicine used to help the body fight to a gauze bandage.
bacterial infection. Barriers to action: Reasons for not acting or for
Antihistamines (an te HIS t menz): Drugs used to hesitating to act in an emergency situation.
e
treat the signals of allergic reactions. Biofeedback: A relaxation technique that uses in-
Anti-inflammatory (an te in FLAM tor e) drug: A struments to measure bodily functions, such as
e
substance used to reduce heat, swelling, red- heart rate and blood pressure.
ness and pain in a body area. Biological death: The irreversible damage caused
Antiseptic: A substance that inhibits the growth by the death of brain cells.
and reproduction of microorganisms or germs. Birth canal: The passageway from the uterus to the
Antitoxins: Antibodies capable of neutralizing spe- vaginal opening through which a baby passes
cific disease-producing poisonous substances. during birth.
Antivenin: A substance used to counteract the poi- Bivouac: A temporary shelter.
sonous effects of snake, spider or insect Bladder: An organ in the pelvis in which urine is
venom. stored until it is released from the body.
Arm: The part of the upper extremity from the Blood volume: The total amount of blood circulat-
shoulder to the hand. ing within the body.
Arteries: Large blood vessels that carry oxygenated Body composition: The ratio of fat to all the tissues,
blood away from the heart to the rest of the such as muscles, that are fat free.
body.
480 Glossary
Body system: A group of organs and other struc- Cardiac emergency: Sudden illness involving the
tures that work together to carry out specific heart.
functions. Cardiopulmonary (kar de o PUL mo ner e) resuscita-
Bone: A dense, hard tissue that forms the tion (re sus i TA shun) (CPR): A technique that
skeleton. combines chest compressions and rescue
Brachial (BRA ke l) pulse: The pulse felt at the breathing for a victim whose heart and breath-
e
brachial artery on the inside of the upper arm. ing have stopped.
Brain: The center of the nervous system; controls Cardiorespiratory endurance: The ability to take in,
all body functions. deliver and extract oxygen for physical work;
Breathing emergency: An emergency in which the ability to persevere in a physical task.
breathing is so impaired that life is threatened. Cardiovascular (kar de o VAS ku lar) disease: Disease
Breech birth: The delivery of a baby feet or but- of the heart and blood vessels.
tocks first. Carotid (k ROT id) arteries: Major blood vessels
e
Bronchi (BRONG ki): The air passages that lead from that supply blood to the head and neck.
the trachea to the alveoli. Carpals: The bones of the wrist.
Bronchioles: The air passage from the bronchi to Cells: The basic unit of all living tissue.
the lungs. Cerebral palsy: A dysfunction of the central ner-
Bronchitis: A disease resulting in inflammation vous system in which a person has little or no
of the lining of the trachea, bronchi and bron- control of the muscles.
chioles. Cervix (SERV ix): A short tube at the upper end of
Bronchodilator: A drug that widens the air passages the birth canal; the opening of the uterus.
that lead from the trachea to the alveoli. It Chest: The upper part of the trunk, containing the
most commonly is used for the treatment of heart, major blood vessels and lungs.
asthma. Child abuse: The physical, psychological or sexual
Bulimia: An eating disorder characterized by eating assault of a child, resulting in injury or emo-
excessively then purging unwanted calories by tional trauma.
vomiting or using laxatives. Cholesterol (ko LES ter ol): A fatty substance made
Burn: An injury to the skin or other body tissues by the body and found in certain foods; too
caused by heat, chemicals, electricity or much in the blood can cause fatty deposits on
radiation. artery walls that may restrict or block blood
flow.
Chronic: Persistent over a long period of time.
Calorie: A measure of the energy value of food. Circulatory (SER ku l tor e) cycle: The flow of
e
Cannabis products: Substances, such as marijuana blood in the body.
and hashish, that are derived from the Circulatory system: A group of organs and other
Cannabis sativa plant; can produce feelings of structures that carries oxygen-rich blood and
elation, distorted perceptions of time and space other nutrients throughout the body, removes
and impaired motor coordination and judg- wastes and returns oxygen-poor blood to the
ment. lungs.
Capillaries (KAP i ler ez): Microscopic blood vessels Citizen responder: A layperson who recognizes an
linking arteries and veins; they transfer oxygen emergency and decides to act.
and other nutrients from the blood to all body Clavicle: The collarbone; the slender, curved bone
cells and remove waste products. that extends from the sternum to the scapula
Carbohydrates: Compounds that contain oxygen, (shoulder blade).
carbon and hydrogen; the main source of en- Clinically dead: The condition in which the heart
ergy for all body functions. stops beating and breathing stops.
Carbon dioxide: A colorless, odorless gas; a waste Closed fracture: A fracture that leaves the skin un-
product of respiration. broken.
Carbon monoxide (CO): A clear, odorless, poisonous Closed wound: An injury that does not break the
gas produced when carbon or other fuel is skin and in which soft tissue damage occurs
burned, as in gasoline engines. beneath the skin.
Cardiac (KAR de ak) arrest: A condition in which Clotting: The process by which blood thickens at a
the heart has stopped or beats too ineffectively wound site to seal a hole or tear in a blood
to generate a pulse. vessel and stops bleeding.
Glossary 481
Concussion (kon CUSH n): An injury to the brain Dependency: When one using a drug becomes phys-
e
caused by a violent blow to the head, followed ically and psychologically addicted to the drug.
by a temporary impairment of brain function, Depressants: Substances that affect the central
usually without permanent damage to the nervous system and decrease physical and
brain. mental activity, such as tranquilizers and
Consciousness: The state of being aware of one’s sleeping pills.
self and one’s surroundings. Dermis: The deeper layer of skin; contains the
Consent: Permission to give care, given by the vic- nerves, hair roots, sweat and oil glands and
tim to the rescuer. blood vessels.
Contraction: The pumping action of the heart; the Designer drugs: Drugs that are chemically modified
rhythmic tightening of muscles in the uterus from medically prescribed substances to make
during labor. them more potent or alter their effects.
Contusion: A bruise. Diabetes (di BE tez): A condition in which the
e
Coronary (KOR ner e) arteries: Blood vessels that body does not produce enough insulin or does
e
supply the heart muscle with oxygen-rich not use insulin effectively enough to regulate
blood. the amount of sugar (glucose) in the blood-
Coronary heart disease (Also called coronary artery stream.
disease): Occurs when the coronary arteries Diabetes mellitus (mel I tus): See Diabetes.
that supply oxygen-rich blood to the heart Diabetic coma: A life-threatening emergency in
muscle become hardened or narrowed from which the body needs insulin.
the build-up of fatty deposits. Diabetic emergency: A situation in which a person
Corticosteroid (KOR ti ko STIR oyd): A hormone, becomes ill because of an imbalance of sugar
made synthetically or in the body, that is used (glucose) and insulin in the bloodstream.
in antiinflammatory medications. Diabetic ketoacidosis (KE to a si DO sis): A life-
Cranial cavity: An area in the body that contains threatening complication of uncontrolled dia-
the brain and is protected by the skull. betes mellitus.
Cravats: Folded triangular bandages used to hold Diaphragm: A dome-shaped muscle that aids in
dressings or splints in place. breathing and separates the chest from the ab-
Critical burn: Any burn that is potentially life domen.
threatening, disabling or disfiguring. Dietary fiber: The carbohydrates that are not bro-
Croup: An infection that causes swelling of the ken down by the human digestive process.
throat around the vocal cords. Digestive system: A group of organs and other struc-
Crowning: The point in labor when the baby’s tures that digests food and eliminates wastes.
head is visible at the opening of the vagina. Direct contact transmission: Occurs when infected
Cyanosis (si NO sis): A blue discoloration of the blood or body fluids from one person enter an-
e
skin around the mouth and fingertips resulting other person’s body at a correct entry site.
from a lack of oxygen in the blood. Direct pressure: The pressure applied on a wound
Cyanotic: Bluish discoloration of the skin around to control bleeding, for example, by one’s
the mouth or the fingertips resulting from a gloved hand.
lack of oxygen in the blood. Disability: The absence or impairment of motor,
sensory or mental function.
Deep burn: A burn that involves the epidermis and Disease transmission: The passage of a disease
the two lower layers of skin, the dermis and from one person to another.
the hypodermis, and may destroy underlying Dislocation: The displacement of a bone from its
structures; it can be life threatening. normal position at a joint.
Defibrillation (de fib ri LA shun): An electrical shock Distressed swimmer: A victim capable of staying
that disrupts the electrical activity of the heart afloat but likely to need assistance to get to
long enough to allow the heart to sponta- shore.
neously develop an effective rhythm on its own. Down syndrome: A condition caused by a genetic
Defibrillator (de FIB ri la tor): A device that sends an accident and characterized by varying degrees
electric shock through the chest to the heart. of mental retardation and physical defects.
Delayed-help situation: A situation in which emer- Dressing: A pad placed directly over a wound to
gency assistance is delayed for more than absorb blood and other body fluids and to pre-
30 minutes. vent infection.
482 Glossary
Drowning: Death by suffocation when submerged Endocrine (EN d crin) system: A group of organs
e
in water. and other structures that regulates and coordi-
Drug: Any substance, other than food, intended to nates the activities of other systems by produc-
affect the functions of the body. ing chemicals and hormones that influence the
Drug paraphernalia (PAR fer NAL y ): Devices used activity of tissues.
e e
to contain or administer various kinds of Epidermis: The outer layer of skin.
drugs, such as needles and syringes for drugs Epiglottis (ep i GLOT is): The flap of tissue that cov-
that are injected. ers the trachea during swallowing to keep food
and liquid out of the lungs.
Epiglottitis (ep i glot I tis): An infection that
Elapid snake: Family of venomous snakes that in- causes severe inflammation and potentially life-
clude coral snakes, cobras, mambas and oth- threatening swelling of the epiglottis.
ers, such as the Australian brown snake or Epilepsy (EP i lep se): A chronic condition charac-
death adder. terized by seizures that may vary in type and
Elastic roller bandage: A bandage designed to keep duration; can usually be controlled by medica-
continuous pressure on a body part; the fabric tion.
is made of a yarn containing rubber. Esophagus (e SOF gus): The tube leading from the
e
Electrolyte (e LEK tro LIT): A substance that, in a so- mouth to the stomach.
lution or in liquid form, is capable of conduct- Exhale: To breathe air out of the lungs.
ing an electric current. External bleeding: Bleeding that can be seen com-
Embedded object: An object that remains embed- ing from a wound.
ded in an open wound. Extremity: The shoulder to the fingers; the hip to
Embolus (EM bo lus): A sudden blockage of a blood the toes.
vessel by a traveling clot or other material,
such as fat or air, that circulates in the blood- Fainting: A partial or complete loss of conscious-
stream until it becomes lodged in a blood ness resulting from a temporary reduction of
vessel. blood flow to the brain.
Embryo (EM bre o): The early stages of a developing Fat: A compound made up of carbon, hydrogen,
baby in the uterus; characterized by the rapid oxygen and three fatty acids, a storage form of
growth and development of body systems. energy for the body; a type of body tissue com-
Emergency: A situation requiring immediate action. posed of cells containing stored fat.
Emergency action steps: Three basic steps you Febrile (FEB ril) seizure (SE zhur): A seizure caused
should take in any emergency: CHECK— by a sudden change in body temperature.
CALL—CARE. Femoral arteries: The arteries that supply blood to
Emergency medical services (EMS) the lower extremities.
personnel: Trained and equipped community- Femur: The bone of the thigh.
based personnel who provide emergency Fetus (FE tus): The developing unborn offspring af-
care for ill or injured victims and who are ter the embryo stage.
often dispatched through a local emergency Fibula: One of the two bones of the leg.
number. First aid: Immediate care given to a victim of in-
Emergency medical services (EMS) system: A net- jury or sudden illness until more advanced care
work of community resources and medical per- can be obtained.
sonnel that provides emergency care to victims First responder: A person trained in emergency care
of injury or sudden illness. that may be called on to give such care as a
Emergency medical technician (EMT): A person who routine part of his or her job.
has successfully completed a state-approved Food Guide Pyramid: A pictorial guide to the cur-
emergency medical technician training pro- rent five basic food groups.
gram. The levels of EMTs are the EMT-Basic, Forearm: The part of the upper extremity from the
EMT-Intermediate and EMT-Paramedic. elbow to the wrist.
Emphysema (em f SE m ): A disease in which the
e e
Fracture: A break or disruption in bone tissue.
lungs lose their ability to exchange carbon Frostbite: A condition in which body tissues freeze;
dioxide and oxygen effectively. most commonly occurs in the fingers, toes,
ears and nose.
Glossary 483
Gastric distention: A condition in which the ab- High blood pressure: A condition, often without
domen becomes swollen with air. any signals, of elevated blood pressure; also re-
Genitals: The external reproductive organs. ferred to as hypertension.
Genitourinary (jen i to UR ri nary) system: A group of Hormone: A substance that circulates in body flu-
organs and other structures that eliminates ids and has a specific effect on cell activity.
wastes and enables sexual reproduction. Humerus: The bone of the arm.
Glands: Organs that release fluid and other sub- Hyperglycemia (hi per gli SE me ): A condition in
e
stances into the blood or onto the skin. which too much sugar (glucose) is in the
Glucose: A simple sugar found in certain foods, es- bloodstream, and the insulin level in the body
pecially fruits, and a major source of energy is too low.
for all living organisms. Hyperventilation: Breathing that is faster than
Good Samaritan laws: Laws that protect people normal.
who willingly give first aid without accepting Hypodermis: A layer of skin located beneath the
anything in return. dermis and epidermis; contains fat, blood ves-
sels and connective tissues.
Hallucinogens (h LOO sin jenz): Substances that Hypoglycemia (hi po gli SE me ): A condition in
e e e
affect mood, sensation, thought, emotion and which too little sugar (glucose) is in the blood-
self-awareness; alter perceptions of time and stream, and the insulin level in the body is too
space; and produce hallucinations and delu- high.
sions. Also known as psychedelics. Hypothalmus: Part of the brain that is responsible
Head-tilt/chin-lift technique: A technique used to for regulating body temperature.
open a victim’s airway by pushing down on Hypothermia: A life-threatening condition in which
the forehead while pulling up on the bony part the body’s warming mechanisms fail to main-
of the jaw. tain normal body temperature and the entire
Hearing loss: Partial or total loss of hearing. body cools.
Heart: A muscular organ that circulates blood
throughout the body. Imagery: A relaxation technique that involves using
Heart attack: A sudden illness involving the death the imagination to create various scenes and
of heart muscle tissue when it does not receive wished-for situations.
oxygen-rich blood; also known as myocardial Immobilize: Keep an injured body part from mov-
infarction. ing by using a splint or other method.
Heat cramps: Painful spasms of skeletal muscles af- Impairment: Damage or reduction in quality, quan-
ter exercise or work in warm or moderate tem- tity, value or strength of a function.
peratures; usually involve the calf and abdomi- Implied consent: Legal concept that assumes a per-
nal muscles. son would consent to receive emergency care if
Heat exhaustion: The early stage and most common he or she were physically able to do so.
form of heat-related illness; often results from Indirect contact transmission: Occurs when a per-
strenuous work or exercise in a hot environ- son touches objects that have the blood or
ment. body fluid of an infected person, and that in-
Heat stroke: A life-threatening condition that fected blood or body fluid enters the body
develops when the body’s cooling mechanisms through a correct entry site.
are overwhelmed and body systems begin to Infection: The growth of disease-producing mi-
fail. croorganisms in the body.
Heaving jug: A homemade piece of rescue equip- Inhalants: Substances such as glue or paint
ment for throwing to a victim, composed thinners inhaled to produce mood-altering
of a 1-gallon plastic container containing effect.
some water, with 50 to 75 feet of floating line Inhale: To breathe air into the lungs.
attached. Ingested poison: A poison that is swallowed.
Heaving line: Floating rope, white, yellow or some Inhaled poison: A poison breathed into the lungs.
other highly visible color, used for water rescue. Injected poison: A poison that enters the body
e
Hemorrhage (HEM rij): A loss of a large amount through the skin through a bite or sting, or as
of blood in a short period of time. drugs or medications through a hypodermic
needle.
484 Glossary
Injury: Damage that occurs when the body is sub- Manual stabilization: A technique used to minimize
jected to an external force, such as a blow, a movement of a victim’s head and neck and
fall, a collision, an electric current or extremes keep them in line with the body to protect the
of temperatures. spine while giving care.
Insulin (IN su lin): A hormone produced in the Mechanical airway obstruction: Complete or partial
pancreas that enables the body to use sugar blockage of the airway by a foreign object,
(glucose) for energy; frequently used to treat such as a piece of food or a small toy, or by
diabetes. fluids, such as vomit or blood.
Insulin shock: A life-threatening condition in Medical emergency: A sudden illness requiring im-
which too much insulin is in the blood- mediate medical attention
stream. Medication: A drug given therapeutically to prevent
Integumentary (in teg YU men t re) system: The or treat the effects of a disease or condition or
e
skin, hair and nails; protects the body, retains otherwise enhance mental or physical well-being.
fluid and helps prevent infection. Membrane: A thin layer of tissue that covers a sur-
Internal bleeding: Bleeding inside the body. face, lines a cavity or divides a space.
Mental (cognitive) function: The brain’s capacity to
Joint: A structure where two or more bones are reason and process information.
joined. Metabolism: The process by which cells convert nu-
trients to energy.
Kidney: An organ that filters waste from the blood Metacarpals: The bones of the hand.
to form urine. Metatarsals: The bones of the foot.
Microorganism (mi kro OOR g nizm): A bacteria,
e
Labor: The birth process, beginning with the con- virus or other microscopic structure that may
traction of the uterus and dilation of the cervix enter the body. Those that cause an infection
and ending with the stabilization and recovery or disease are called pathogens.
of the mother. Miscarriage: A spontaneous end to pregnancy be-
Laceration (las RA shun): A cut, usually from a fore the twentieth week; usually because of de-
e
sharp object; may have jagged or smooth edges. fects of the fetus or womb.
Larynx (LAR ingks): A part of the airway connecting Motor function: The ability to move the body or a
the pharynx with the trachea; commonly called body part.
the voice box. Motor impairment: The total or partial inability to
Layperson: Someone who does not have special or move or to use a body part.
advanced first aid training or skills (also Mucous membranes: A thin sheet of body tissue
known as a citizen responder). that covers parts of the body.
Leg: The part of the lower extremity from the Multiple sclerosis: A progressive disease character-
pelvis to the ankle. ized by nerve degeneration and patches of
Life-threatening emergency: An illness or injury that hardened tissue in the brain or spinal cord.
impairs a victim’s ability to circulate oxy- Muscle: A soft tissue that contracts and relaxes to
genated blood to all the parts of his or her create movement.
body. Muscular dystrophy: A hereditary disease character-
Ligament: A fibrous band that holds bones together ized by progressive deterioration of muscles,
at a joint. leading to disability, deformity and loss of
Lower extremity: The parts of the body from the strength.
hip to the toes. Musculoskeletal (mus ku lo SKEL t l) system: A
e e
Lower leg: The part of the lower extremity from group of tissues and other structures that sup-
the knee to the ankle. ports the body, protects internal organs, allows
Lungs: A pair of light, spongy organs in the chest movement, stores minerals, manufactures
that provide the mechanism for taking oxygen blood cells and creates heat.
in and removing carbon dioxide during
breathing. Narcotics: Drugs that dull the senses and are pre-
Lyme disease: An illness transmitted by a certain scribed to relieve pain.
kind of infected tick; victims may or may not Nerve: A part of the nervous system that sends
develop a rash. electrical impulses to and from the brain and
all body areas.
Glossary 485
Nervous system: A group of organs and other Pharynx (FAR ingks): A part of the airway formed
structures that regulates all body functions. by the back of the nose and the throat.
Nitroglycerin: A prescribed medication, often in Placenta (pl CENT ): An organ attached to the
e e
tablet form, given for the prevention or relief uterus and unborn child through which nutri-
of angina pectoris. ents are delivered to the baby; expelled after
Non-life-threatening emergency: A situation that the baby is delivered.
does not have an immediate impact on a vic- Plasma: The liquid part of the blood.
tim’s ability to circulate oxygenated blood, but Platelets: Disk-shaped structures in the blood
still requires medical attention. that are made of cell fragments; help stop
Nutrients: Substances found in food that are re- bleeding by forming blood clots at wound
quired by the body. sites.
Nutrition: The science that deals with the study of Poison: Any substance that can cause injury, illness
food you eat and how the body uses it. or death when introduced into the body in rel-
atively small amounts.
Obesity: A condition characterized by an excess of Poison Control Center (PCC): A specialized health-
stored body fat. care center that provides information in cases
Occlusive dressing: A type of dressing that does not of poisoning or suspected poisoning emergen-
allow air or moisture to pass through. cies.
Open fracture: A fracture that involves an open Pregnancy: Begins when an egg (ovum) is fertilized
wound. by a sperm, forming an embryo.
Open wound: An injury resulting in a break in the Pressure bandage: A bandage applied snugly to
skin’s surface. create pressure on a wound to aid in control-
Organ: A collection of similar tissues acting to- ling bleeding.
gether to perform specific body functions. Prolapsed umbilical cord: A complication of child-
Osteoporosis (os te o p RO sis): The gradual, pro- birth in which a loop of umbilical cord pro-
e
gressive weakening of bone. trudes through the vagina prior to delivery of
Overdose: An excess use of a drug, resulting in ad- the baby.
verse reactions ranging from mania and hyste- Proteins: Compounds made up of amino acids nec-
ria to coma and death. Specific reactions to an essary to build tissues.
overdose include changes in blood pressure and Pulse: The beat you feel with each heart contrac-
heartbeat, sweating, vomiting and liver failure. tion.
Oxygen: A tasteless, colorless and odorless gas nec- Puncture wound: A wound that results when the
essary to sustain life. skin is pierced with a pointed object, such as a
nail, a piece of glass, a splinter or a knife.
Paralysis: A loss of muscle control; a permanent
loss of feeling and movement; the inability to Quarry: A deep pit where stone or gravel was once
move. excavated; when no longer in use, it may be-
Paramedic: A highly specialized EMT. come filled with water.
Passive drowning victim: An unconscious victim
face-down, submerged or near the surface of Rabies: A disease caused by a virus transmitted
the water. through the saliva of infected mammals.
Patella: The kneecap. Radius: One of the two bones of the forearm.
Pathogen: A disease-causing agent; also called a Reaching assist: A non-swimming rescue in which
microorganism. one extends an object, such as an arm, leg or
Pelvic cavity: The lowest part of the trunk, con- tree branch to a victim.
taining the bladder, rectum and female repro- Recovery position: The position of an unconscious
ductive organs. victim on his or her side in case he or she
Pelvis: The lower part of the trunk, containing the vomits.
intestines, bladder and internal reproductive Reproductive system: A group of organs and other
organs. structures that enables sexual reproduction.
Personal protective equipment: The equipment and Rescue breathing: A technique of breathing for a
supplies that help prevent the responder from nonbreathing child or infant.
directly contacting infected materials. Rescue tube: A vinyl, foam-filled, floating support
Phalanges: The bones of the fingers. used in making rescues.
486 Glossary
Respiration (res pi RA shun): The breathing process Skeletal muscles: Muscles that attach to the bones.
in which the body takes in oxygen and elimi- Skin: The tough, supple membrane that covers the
nates carbon dioxide. surface of the body.
Sodium: A mineral abundant in table salt; associ-
e ee
Respiratory (re SPI r to re) or (RES p r tor e) arrest:
A condition in which breathing has stopped. ated with high blood pressure.
Respiratory distress: A condition in which breath- Soft tissues: Body structures that include the layers
ing is difficult. of skin, fat and muscles.
Respiratory system: A group of organs and other Spinal cavity: An area of the body that contains the
structures that brings air into the body and re- spinal cord and is protected by the bones of
moves wastes through a process called breath- the spine.
ing or respiration. Spinal column: The spine.
Reye’s (raz) syndrome: An illness that affects the Spinal cord: A bundle of nerves extending
brain and other internal organs, usually found from the brain at the base of the skull to
in people under the age of 18. the lower back; protected by the spinal
Rib cage: The cage of bones formed by the 12 column.
pairs of ribs, the sternum and the spine. Spine: A strong, flexible column of vertebrae, ex-
Ribs: Bones that attach to the spine and to the tending from the base of the skull to the tip of
breastbone, forming a protective shell for vital the tailbone (coccyx), that supports the head
organs, such as the heart and lungs. and the trunk and encases and protects the
Ring buoy: A rescue device made of buoyant cork, spinal cord; also called the spinal column or
kapok or plastic-covered material attached to a the vertebral column.
line with an object or knot at the end to keep Splint: A device used to immobilize body parts; to
the line from slipping out from under your immobilize body parts with such a device.
foot when you throw it. Spontaneous abortion: A spontaneous or uninten-
Risk factors: Conditions or behaviors that increase tional ending of pregnancy before the fetus can
the chance that a person will develop a disease. be expected to live, which usually occurs be-
Rocky Mountain spotted fever (RMSF): A disease fore the twentieth week of pregnancy. Also
transmitted by a certain kind of infected tick; known as a miscarriage.
victims develop a spotted rash. Sprain: The stretching and tearing of ligaments and
Roller bandage: A bandage made of gauze or other tissue structures at a joint.
gauze-like material; generally wrapped around Starting block: Platforms competitive swimmers
a body part over a dressing. dive from to start a race.
Sternum: The long, flat bone in the middle of the
front of the rib cage; also called the breast-
Saturated fats: The fat in animal tissue and bone.
products. Standard precautions: Safety measures taken to pre-
Scapula: The shoulder blade. vent exposure to blood and body fluids when
Seizure (SE zhur): An irregularity in the brain’s elec- giving care to ill or injured persons.
trical activity, often marked by loss of con- Stimulants: Substances that affect the central ner-
sciousness and uncontrollable muscle move- vous system and increase physical and mental
ment; also called a convulsion. activity.
Sensory function: The ability to see, hear, touch, Stoma: An opening in the front of the neck
taste and smell. through which a person whose larynx has been
Shepherd’s crook: A long pole with a hook on the removed breathes.
end that can be used to either pull a conscious Strain: The stretching and tearing of muscle and
drowning person to safety or encircle a sub- tendons.
merged drowning person and pull the person Stress: A physiological or psychological response
to safety. to real or imagined influences that alter an ex-
Shock: The failure of the circulatory system to pro- isting state of physical, mental or emotional
vide adequate oxygen-rich blood to all parts of balance.
the body. Stress management: A person’s planned attempt to
Signals: Signs or indications of observable evidence deal with stress.
of injury or illness. Stressor: An event or condition that triggers the
Signs of life: Normal movement or breathing. stress response.
Glossary 487
Stroke: A disruption of blood flow to a part of the Tissue: A collection of similar cells that act to-
brain, which causes permanent damage to gether to perform specific body functions.
brain tissue; also called a cerebrovascular acci- Tolerance: The body becomes resistant to a drug or
dent (CVA). other substance because of continued use.
Substance abuse: The deliberate, persistent, Tourniquet (TUR ni kit): A wide band of cloth or
excessive use of a substance without regard other material that is wrapped tightly around
to health concerns or accepted medical an extremity to control severe bleeding; used
practices. as a last resort measure.
Substance misuse: The use of a substance for unin- Toxin: A poisonous substance.
tended purposes or for intended purposes but Trachea (TRA ke ): A tube leading from the upper
e
in improper amounts or doses. airway to the lungs; also called the windpipe.
Sucking chest wound: A penetrating chest injury Transient (TRANZ e ent) ischemic (is KE mik) attack
producing a sucking sound each time the vic- (TIA): A temporary episode that, like a stroke,
tim breathes. is caused by a disruption of blood flow to the
Sudden death: Death from cardiac arrest without brain; sometimes called a mini-stroke.
any prior signals of a heart attack. Trauma: The violent force or mechanism that can
Sudden illness: A physical condition requiring im- cause injury
mediate medical attention. Triangular bandage: A bandage in the shape of a
Sudden infant death syndrome (SIDS): The sudden triangle; used to hold a dressing or splint in
death of a seemingly normal, healthy infant; place or as a sling.
occurs during the infant’s sleep without evi- Trunk: The part of the body containing the chest,
dence of disease; sometimes called crib death. abdomen and pelvis.
Superficial burn: A burn involving only the outer
layer of skin, the epidermis, characterized by Ulna: One of the two bones of the forearm.
dry, red skin. Umbilical cord: A flexible structure that attaches
Syncope (sing k p e) : A brief lapse in conscious- the placenta to the unborn child, allowing for
e
ness; see Fainting. the passage of blood, nutrients and waste.
Synergistic effect: The interaction of two or more Upper arm: The part of the upper extremity from
drugs to produce a certain effect. the shoulder to the elbow.
Upper extremity: The parts of the body from the
Target heart rate range: Sixty to ninety percent of shoulder to the fingers.
your maximum heart rate. Urinary system: A group of organs and other struc-
Tarsals: The bones of the ankle. tures that eliminates waste products from the
Tendon: A cordlike, fibrous band that attaches blood.
muscle to bone. Uterus (U ter us): A pear-shaped organ in a
Tetanus: An acute infectious disease caused by a woman’s pelvis in which an embryo forms and
bacteria that produces a powerful poison; can develops into a baby.
occur in puncture wounds, such as human and
animal bites; also called lockjaw. Vagina: See birth canal.
Thigh: The part of the lower extremity from the Veins: Blood vessels that carry oxygenated blood
pelvis to the knee. from all parts of the body to the heart.
Thoracic (tho RAS ik) cavity: An area in the body Ventricular fibrillation (V-fib): An abnormal heart
that contains the heart and the lungs and is rhythm characterized by disorganized electrical
protected by the rib cage and upper portion of activity, which results in the quivering of the
the spine. ventricles.
Thrombus (THROM bus): A collection of blood com- Ventricular tachycardia (V-tach): An abnormal heart
ponents that forms in the heart or vessels, ob- rhythm characterized by rapid contractions of
structing blood flow. the ventricles.
Throw bag: A nylon bag containing 50 to 75 feet of Vertebrae (VER t bra): The 33 bones of the spine.
e
coiled floating line; used as a rescue device. Vertebral column: The spine.
Throwing assist: A non-swimming water rescue in Virus: A disease-causing microorganism that, un-
which one throws a line with a floating object like bacteria, requires another organism to live
attached to a victim. and reproduce.
Tibia: One of the two bones of the leg. Vision loss: Partial or total loss of sight.
488 Glossary
Vital organs: Organs whose functions are essential Withdrawal: The condition produced when a per-
for life, including the brain, heart and lungs. son stops using or abusing a substance to
which he or she is addicted.
Wheezing: Hoarse whistling sounds made during Wound: An injury to the soft tissues.
breathing.
Wilderness: An area that is uninhabited by human
beings, is uncultivated and has been left in its
natural condition.
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Index
A Angina pectoris, 116, 120
Angioplasty, 297
marine life, 326, 327
ABC (Airway, Breathing, Circulation), 65-67 snakes, 325-26
respiratory distress and, 91, 92 Animal bites, 310, 326-28 spiders and scorpions, 323-25
Abdomen, 272, 276 Ankle and foot injuries, 239-40 ticks, 322-23
checking, 69, 70 Ankles, 236 preventing, 328-29
Abdominal cavity, 44-45 Anorexia nervosa, 342 signals of, 230
Abdominal injuries, 276-78 ANSI. See American National Standards Institute summary of care for, 321
Abdominal thrusts, 93-94 Anticoagulants, 296 See also Poisoning
Abrasions, 182 Antihistamines, 308, 342-43 Black widows, 323-24
Absorbed poison, 304 Anti-inflammatory drugs, 309 Bladder, 56-57, 57
Active drowning victim, 372, 373, 374 Antiplatelets, 296 Bleeding, vaginal, 409-10
Acute illness, 286 Antivenin, 320, 324 Bleeding emergencies, 156-67, 424, 425
Addiction, 334, 336 Aortic aneurysm, 265 blood defined, 158-59
See also Substance misuse and abuse Appearances, unusual, 7-8 blood vessels, 158-59
Adhesive bandages, 184-86 Aquatic emergencies. See Water emergencies arteries, 158, 159
Adolescents, 390 Arm sling and binder, 250-51 capillaries, 158, 159
Adults Arms, 70, 226, 229 veins, 158, 159
AEDs and, 129, 132, 153-54 Arteries, 44, 48, 158 blood volume, 158
checking older, 73 Arteriovenous malformation (AVM), 297 dynamics of, 159
checking unconscious, 76-77 Aspiration, 88, 99 external bleeding, 158, 160-61, 166
conscious respiratory distress and, 94, 108 Aspirin care for, 160-61
CPR and, 121-25, 140-41 abuse of, 342 controlling, 166-67
unconscious choking and, 96, 126-27, 142-43 children and, 293, 390 functions of blood, 158-59
See also Checking the victim heart attacks and, 119, 342 internal bleeding, 158, 161-62
Advanced cardiac life support, 117-18 Asthma, 89 care for, 161-62
Advance directives (for health), 130-31 Asthma medication, 337 signals of, 161
AED. See Automated external defibrillators Asystole, 116, 129 severe, 64, 65, 67-68
Aerobic exercise, 440, 456 Atherosclerosis, 116, 294 Blood, 158-59
Aging, 392-93 Autogenics, 458 Blood alcohol concentration (BAC), 459-60
Agonal breaths, 66 Auto-injecting epinephrine, 314 Blood clots, 294
Air temperature, 352, 354 See also EpiPen Blood spill cleanup, 31
Airway, 44, 46 Automated external defibrillators (AED), 127-29, Blood volume
checking, 66 132-35 bleeding emergencies and, 158, 159
See also Airway obstruction adults and, 129, 132, 152-53 shock and, 170
Airway, Breathing, Circulation. See ABC around water, 133 Bloodborne pathogens, 29
Airway obstruction, 88 children and, 134-35, 154-55 Body cavities, 44-45
anatomical, 88, 92 directions for using, 132 Body composition, 455
back blows and abdominal thrusts for, 93-94 heart’s electrical system, 128 Body systems, 42-61
causes, 92-93 hypothermia and, 133 body cavities, 44-45
chest thrusts and, 95-96 implantable devices and, 133 circulatory system, 46, 48-49
complete, 93 maintenance of, 134 defined, 44-46
conscious adult or child, 94 nitroglycerin patches and, 133 digestive system, 56
conscious infant, 94-95 precautions, 129, 132 endocrine system, 55
mechanical, 88, 92 trauma and, 133 genitourinary system, 56-57
partial, 93 See also Cardiac emergencies integumentary system, 54-55
See also Breathing emergencies AVM. See Arteriovenous malformation interrelationships of, 59
Alcohol, 338-41 Avulsions, 182-83 musculoskeletal system, 51-54
choking and, 92 nervous system, 49-51
cost of abuse of, 340-41 B respiratory system, 46-48
in health and safety, 266, 459-60 Back blows, 93 summary of, 58
hostile behavior and, 340 Back injuries, 255 Body temperature, 352-55
unhealthy consequences of using, 338-39 See also Head, neck and back injuries control of, 352-55
See also Substance misuse and abuse Bacteria, 28 factors affecting, 352, 354-55
Allergens, 90 Bandage compress, 186 head, neck and back injuries, 259
Alveoli, 47 Bandages, 180, 184, 185 people at increased risk, 355
Alzheimer’s disease, 388, 394-95 Barbiturates, 338 See also Cold-related emergencies; Heat-related
Web site for, 394 Barriers to action, 4, 8-10 emergencies
American Academy of Dermatology, 357 Basic, 9-1-1, 11 Bones, 44, 51-52, 206, 209-10
American Cancer Society, 357 Beach drag, 378 Brachial pulse, 67
American National Standards Institute (ANSI), 449 Behavior, unusual, 7-8 Brain, 44, 45, 49
American Red Cross, Certificate of Merit, 14 Benzodiazepines, 338 after stroke, 296-97
Amniotic sac, 404 Binging and purging, 342 Brain attack. see Stroke
Amphetamines, 337 Biofeedback, 458 Brain damage time table, 89, 118
Amputations, 183, 184, 188 Biohazard container, 31 Brain injuries, 254-55
Anabolic steroids, 342, 344-45 Birth canal, 404-05 See also Head, neck and back injuries
See also Substance misuse and abuse Birth process, 404-06 Breathing, checking, 66-67
Anaphylactic shock, 90, 171 See also Childbirth See also Breathing emergencies; Rescue
Anaphylaxis, 304, 310-11, 314 Bites and stings, 318-31 breathing
Anaphylaxis kit, 90, 314 care for, 320-28 Breathing barriers, 98-99
Anatomical airway obstruction, 88 domestic and wild animals, 326-28 Breathing emergencies, 86-113
Anatomic splints, 244-45 human bites, 328 breathing process, 88
Aneurysms, 265, 294 insects, 320 conscious choking adult, 108
Index 493
conscious choking child, 109 Cardiopulmonary resuscitation (CPR), 13, 49, 66, communicating with an ill or injured child,
conscious choking infant, 110-11 67, 117-18 388, 389
head, neck and back injuries, 259 for adults, 121-25, 140-41 conscious respiratory distress and, 94
respiratory arrest, 88, 97-99, 101-02 chest compressions, 121 CPR and, 124-25, 144-45
air in the stomach, 99 for children, 124-25, 144-45 farming injuries and, 418-19
breathing barriers, 98-99 compression/breathing cycles, 123 injury and illness, 390
dentures and, 102 compression technique, 122-23 rescue breathing for, 98, 112
head, neck, or back injuries and, 102 defined, 116 respiratory distress and, 92, 96, 109
mouth-to-nose breathing, 101 hand position, 121-22 shock in, 172
mouth-to-stoma breathing, 101-02 for infants, 124-26, 148-49 unconscious choking and, 126-27, 146-47
rescue breathing, 97-102 multiple responders, 123-24 Chlorine, 304
rescue breathing for a child, 112 rescuer position, 122 Choking. See Breathing emergencies; Unconscious
rescue breathing for an infant, 113 stopping, 124 choking
stopping, 99 See also Cardiac emergencies Cholesterol, 116, 451
vomiting and, 101 Cardiorespiratory endurance, 440, 456 Chronic illness, 286
respiratory distress, 88-97 Cardiovascular disease, 116-17 Cincinnati pre-hospital stroke scale (FAST), 395
airway obstruction-conscious victim, 92-97, Care First, 24, 65 Circulation, checking, 67
108-11 CARE for the victim, 24, 32 Circulatory system, 46, 48-49
anaphylactic shock, 90 Carotid arteries, 67 Cirrhosis, 338
asthma, 89 Carotid endarterectomy, 297 Citizen responders, 4, 6, 10
bronchitis, 90 Carpals, 229 Clavicle, 229-30
care for, 91-92 Carpal tunnel syndrome, 234-35 Clinical death, 117-18
chest thrusts, 95-96 Cells, 44, 45 Closed fractures, 212
children and, 92 Centers for Disease Control and Prevention Closed wounds, 180-82
conscious choking adult who becomes (CDC), 89, 308, 328 Clostridium tetani, 197
unconscious, 96 Cerebral palsy, 396 Clot busters (t-PA), 296
conscious choking infant who becomes Cerebrovascular accident (CVA), 286, 294 Clothes drag, 34-35
unconscious, 96-97 See also Stroke Clothing, for cold weather, 360
emphysema, 89-90 Certificate of Merit, American Red Cross, 14 Clotting, 158
hyperventilation, 90-91 Cervix, 404-05 Cocaine, 337
signals of, 88-89, 90 CHECK the scene, 20-22, 32 Coils (endovascular procedure), 297
time and, 88-89 Checking the victim, 21-22, 32, 62-83 Cold, for strains and sprains, 216
See also Airway obstruction conscious victims, 68-72, 80-83 Cold-related emergencies, 358-64
Breech birth, 410-11 checking the victim from head to toe, clothing, 360
Bronchioles, 46-47 68-70, 72 frostbite, 352, 358-59, 361
Bronchitis, 90, 458 giving care, 70, 72 hypothermia, 352, 359, 361
Brown recluse, 323-24 interviewing the victim and bystanders, 68 icy water rescue, 362
Bruises, 181 moving a victim, 72 preventing, 363-64
Bulimia, 342 CPR and, 121 Collarbone, 229
Burns, 55, 180, 188, 190-96, 424-26 for external bleeding, 160 Commercial splints, 226-27
Bystanders, 8-9 for heart attacks, 119 Compass, 431
interviewing, 68 infants and children, 72, 78-79 Concussion, 254, 260
life-threatening conditions, 64-65 Confusion, older adults and, 395
C consciousness, 64-65 Consciousness, 22, 50
Caffeine, 337 recovery position, 65 checking the conscious victim, 64-65, 68-70,
Calcium, 213, 452 shock, 64 72, 80-83
Call First, 23, 64-65 signs of life, 64 giving care to the conscious victim, 72
Calling 9-1-1, 22-23, 32 older adults, 73 head, neck and back injuries, 259
CPR and, 121 for respiratory distress, 91 interviewing the victim and bystanders, 68
for external bleeding, 160 for shock, 172 respiratory distress and, 92-97, 108-11
for heart attack, 119 unconscious victims, 65-68 transporting, 72
for respiratory distress, 91 adults, 76-77 Consent, 20, 22, 28, 31-32
for shock, 172 airway, 66 implied, 28, 31-32
Calories, 440, 451 breathing, 66 Contractions, 404, 405, 409
Camping, kit for, 430 children, 78 Contusions, 181
Cancer, of the larynx, 100 circulation, 67 Copperhead, 325-26
Cannabis products, 334, 341 head-tilt/chin-lift technique, 66 Coral snake, 325-26
See also Substance misuse and abuse infants, 79 Coronary arteries, 116-17
Capillaries, 47, 158 severe bleeding, 67-68 Coronary artery disease. See Coronary heart disease
Carbohydrates, 440, 452 Cheek injury, 260, 261 Coronary heart disease, 116-17
Carbon dioxide, 46, 304 Chemical burns, 193 See also Cardiac emergencies
Carbon monoxide, 304, 307-08 Chest, 272-73 Corticosteroids, 309
Car collisions, 71, 273 checking, 69, 70 CPR. See Cardiopulmonary resuscitation
alcohol and, 340 Chest compressions, 121 Crack cocaine, 337
Cardiac arrest, 48-49, 116, 120-21 Chest injuries, 272-76 Cranial cavity, 44-45
Cardiac chain of survival, 117-18 puncture wounds, 275-76 Cravats, 226-27, 231, 233-34, 238, 240
Cardiac emergencies, 115-26 rib fractures, 274 Crime scenes, 398
angina pectoris, 120 Chest thrusts, 95-96 Critical burns, 180
aspirin and, 119 Child abuse, 388, 392 identifying, 190-91, 192
automated external defibrillators (AED), Child safety, 448 Croup, 92
127-29, 132-35 Childbirth, 402-13 Crowning, 404, 405, 407-08
cardiac arrest, 120-24 assisting with delivery, 406-08 CVA. See Cerebrovascular accident
cardiac chain of survival, 117-18 birth process, 404-06 Cyanosis, 48, 88, 89, 97
cardiopulmonary resuscitation (CPR), 117-18 caring for the newborn and mother, 408-10
for an adult, 121-25 complications during childbirth, 410-11 D
for children, 124-25 complications during pregnancy, 410 DAWN. See Drug Abuse Warning Network
for infants, 124-26, 148-49 pregnancy, 404 Deep burns, 180
cardiovascular disease, 116-17 preparing for delivery, 406 DEET. See Diethyltolumide
clinical death, 117-18 Children Defibrillation, 116, 117-18, 127, 129
defibrillators, 116, 117-18 AEDs and, 134-35, 154-55 See also Automated external defibrillators (AED)
heart attack, 118-20 aspirin and, 390 Delayed-help situations, 414-35
See also Automated external defibrillators characteristics of, 389-90 bleeding, 424, 425
(AED); Cardiopulmonary resuscitation checking, 72, 388-90 burns, 424-26
(CPR) checking pulse, 65, 67 calling for help, 421
Cardiogenic shock, 171 checking unconscious, 78 checking for resources, 419
494 Index
checking the scene, 417 Electrocardiograph, 128 shoulder injuries, 229-30
checking the victim, 417-18 Electrolytes, 56 upper arm injuries, 230-31
constructing shelters, 428-29 Embedded objects, 183, 185, 189 Eye injury, 262
defined, 416 Embolus, 294
disaster situations, 416-17 Embryo, 404 F
farming emergencies and, 418-19 Emergency care, history of, 71 Facial injuries, 255
fractures and dislocations, 424 Emergencies Fainting (syncope), 286, 287-88
head, neck and back injuries, 426-27 barriers to action, 8-10 Falls, older adults and, 393
heat- or cold-related emergencies, 428 fear of disease transmission, 10 FARMEDIC Training, Inc., 419
improvised distress signals, 421, 422 fear of doing something wrong, 10 Farming, injuries and, 418-19
leaving a victim alone, 423 nature of injury or illness, 9 Farm safety, Web sites, 419
making a plan, 420-21 presence of bystanders, 8-9 FAST recognition of stroke (face, arm, speech,
monitoring the victim, 423-24 uncertainty about victim, 9 time), 295
overnight camping kit, 430 before giving care, 26-39 Fat, 440, 451
preparing for emergencies, 428-32 citizen responder’s role in, 4, 6, 28 FCC. See Federal Communications Commission
protection for weather, 427-28 deciding to act, 8-10 Febrile seizure, 293
rural areas, 416 defined, 4 Federal Communications Commission (FCC), 11
sending for help, 421-22 life-threatening, 4 Femoral arteries, 236
shock, 426 non-life-threatening, 4 Femurs, 236
sudden illness, 426 preparing for, 12-13, 429-32 Fentanyl, 342
transporting a victim to help, 423 first aid kits, 12-13 Fetus, 404
vehicle survival kit, 428 medical alert tags or bracelets, 13 Fiber, 452
wilderness areas, 416 recognizing, 6-8 Fibula, 236
Dentures, breathing emergencies and, 93, 102 unusual appearance or behavior, 8 Fingers, 229
Dependency, 334 unusual noises, 6, 7 Fire safety, 442-44
defined, 335 unusual odors, 7 First aid, 4, 13, 22
See also Substance misuse and abuse unusual sights, 6-7 First-aid kits, 12-13, 431
Depressants, 334, 337-40 sudden illness, 4 First Care, 419
See also Substance misuse and abuse taking action, 10-12 First degree burns, 190
Dermis, 180 calling 9-1-1 or local emergency number, 8, First responders, 4-5
Designer drugs, 342 10-12 Fitness, 455-57
See also Substance misuse and abuse until help arrives, 12 “Flying ambulances”, 71
Dextroamphetamines, 337 wireless 9-1-1 technology, 11 Food and Drug Administration, 357
Diabetes mellitus, 55, 286, 288 Emergency action steps Food labels, 451-52
innovations in the treatment of, 290-91 step 1: CHECK the scene and the victim, Food poisoning, 308-09
stroke and, 295 20-22, 32 Foot, 236
Diabetic coma, 289 step 2: CALL 9-1-1 or the local emergency Foot injuries, 239-40
Diabetic emergencies, 286, 288-92 numbers, 20, 22-24, 32 Forearms, 226, 229
Diabetic ketoacidosis, 289 step 3: CARE for the victim, 20, 24, 32 Forearm, wrist and hand injuries, 232-36
Diet Emergency blanket, 431 Fractures, 53-54, 206, 212-14, 424
healthy, 452-55 Emergency care, history of, 71 Frostbite, 352, 358-59, 361
stroke and, 395 Emergency medical services (EMS) personnel, 4 Full-thickness burns, 190, 191
Dietary fiber, 452 Emergency medical services (EMS) system, 4-6, 10 Fumes, poisonous, 304
Diethyltolumide (DEET), 329 background of, 71
Digestive system, 56 Emergency medical technicians (EMTs), 4-6 G
Direct contact transmission, 28, 29, 30 Basic level, 5 Gases, poisonous, 304
Direct pressure, 158 Intermediate level, 5 Gastric distention, 99
Disability, defined, 388, 395 Paramedics, 5 Genitals, 57, 272
Dislocations, 214 Emergency moves, 33-35 Genitourinary system, 56-57
Disease transmission, 28-31 Emergency scenes, 20 Glands, 55
bloodborne pathogens, 29 Emergency telephone numbers, 12 Gloves, removing, 38-39
disease-causing agents, 28 Emphysema, 89-90, 458 Glucose, 286, 288
disease infection process, 28-29 EMS. See Emergency medical services Glucose monitors, 290
exposure in, 31 EMTs. See Emergency medical technician Good Samaritan laws, 4, 10, 32
fear of, 10 Endocrine system, 55
standard precautions, 28, 29-31 Endovascular procedures, 297 H
cleaning up a blood spill, 31 Enhanced 9-1-1 system, 11 H.A.IN.E.S. See High Arm In Endangered
personal hygiene and hand washing, 30 Epidermis, 180 Spine, 65
personal protective equipment, 30-31 Epiglottis, 46 Hair, 54
removing disposable gloves, 38-39 Epiglottitis, 92 Hallucinogens, 334, 337
Dislocations, 206, 214, 424 Epilepsy, 286, 292 Hand injuries, 232-36
Disposable gloves, 30-31 Epinephrine administration, 311, 314 Hand washing, 30
removing, 38-39 EpiPen, 90, 314 Hands, 229
Distressed swimmer, 372, 373, 374 Esophagus, 46 HBV. See Hepatitis B virus
Distress signals, 421, 422 Exercise, 455-56 Head injuries, 254-55
Dressing, 180 preventing stroke and, 295 older adults and, 393
occlusive, 275-76 Exhalation, 46, 47 See also Head, neck and back injuries
Dressings, 184-87 Exposure in disease transmission, 31 Head, neck and back injuries, 252-69,
Drowning victims, 372-74 External bleeding, 158, 160-61, 166 426-27
See also Water emergencies head, neck and back injuries, 259 breathing emergencies and, 102
Drug Abuse Warning Network (DAWN), 335 External insulin pumps, 290 care of, 257-59
Drugs, defined, 334, 335 Extremities, 224-51 body temperature, 259
See also Substance misuse and abuse defined, 226 consciousness and breathing, 259
DTaP, 197 immobilizing injuries external bleeding, 259
Durable powers of attorney for health care, 130-31 arm sling and binder, 250-51 life-threatening conditions, 258-59
splints, 226-28, 231, 244-49 manual stabilization, 258
E lower extremity injuries, 236-40 checking the scene, 257
Ear injury, 262-63 ankle and foot injuries, 239-40 preventing injuries, 265-66
Eating disorders, 342 knee injuries, 238-39 recognizing
ECG. See Electrocardiogram lower leg injuries, 236-38 back, 255-57
Elapid snakes, 325-26 thigh injuries, 236 face, 255
Elastic bandages, 187 signals of serious extremity injuries, 229 head, 254-55
Elbow injuries, 231-32 upper extremity injuries, 229-36 neck, 255
Electrical burns, 193-96 elbow injuries, 231-32 spine, 255-57
Electrocardiogram (ECG), 128 forearm, wrist and hand injuries, 232-36 signals of, 257
Index 495
specific injuries, 259-65 Ice, 337 unconscious choking, 142-43
cheek injury, 260 Icy rescue, 362, 382-83 See also Heading under each life-threatening
concussion, 260 Imagery, 458 emergency
ear injury, 262-63 Immobilizing injuries, 206, 226-28 Ligaments, 51, 206, 208
eye injury, 262 Impairment, 388 Lightning strikes, 193, 194-95
lower back injury, 265 defined, 395 Limbs, loss of, 396
mouth, jaw and neck injuries, 263-65 mental, 397-98 Liver, 56
nose injury, 260-62 motor, 396-97 Living wills, 130-31
scalp injury, 260 Implantable cardioverter-defibrillator (ICD), 133 Lockjaw, 198
water emergencies and, 379-82 Implied consent, 28, 31-32 Lower back injury, 265
Head splint, 381-82 Indirect contact transmission, 28, 29, 30 Lower extremity, 226, 237
Head-tilt/chin-lift technique, 64, 66 Infants Lower extremity injuries, 236-40
Head to toe check, 68-70, 72 characteristics of, 389 Lower leg, 226
Healthy lifestyles, 437-63 checking, 72, 388-90 Lower leg injuries, 236-38
injuries, 440-50 checking pulse, 65, 67 LSD. See Lysergic acid diethylamide
child safety, 448 checking unconscious, 79 Lung cancer, 458
factors affecting risk of, 440 conscious respiratory distress and, 94-95, Lung diseases, 393
fire safety, 442-44 110-11 Lungs, 44, 46-47
home safety, 444-48 CPR and, 124-26, 148-49 Lyme borreliosis, 322
leading causes of injury-related deaths rescue breathing for, 97-98, 113 Lyme disease, 320, 322-23
(2003), 441 unconscious choking and, 127-28, 150-51 Lysergic acid diethylamide (LSD), 337
recreational safety, 449-50 unconscious respiratory distress and,
reducing risk of, 441 96-97 M
vehicle safety, 441-42 See also Childbirth Manual stabilization, 254, 258
work safety, 448-49 Infection process, 28-29 Marine life, 326, 327
reducing illnesses, 450-60 Infections, 28, 54, 196-98 Matches, 431
alcohol, 459-60 burns and, 425-26 MDMA. See Ecstasy;
fitness, 455-57 Ingested poison, 304 Methylenedioxymethamphetamine
nutrition, 451-55 Inhalants, 334 Mechanical airway obstruction, 88
smoking, 458-59 Inhalation, 46, 47 Medical alert tags or bracelets, 13, 68-69,
stress, 457-58 Inhaled poison, 304 73, 90
weight, 455 Injected poison, 304 Medication patches, AEDs and, 133
Hearing loss, 388, 396, 397 Injuries Medications, 334
Heart, 44, 48-49 causes of injury-related deaths (2003), 441 defined, 335
electrical system of, 128 defined, 4 See also Substance misuse and abuse
facts about, 129 reducing risk of, 441 Mental (cognitive) function, 388
Heart attack, 116, 118-20 See also Healthy lifestyles Mental impairment, 397-98
aspirin and, 119 Insect bites and stings, 310-11, 320-22 Mescaline, 337
care for, 119-20 See also Bites and stings; Poisoning Metabolism, 55
signals of, 118-19, 120 Insulin, 286, 288 Metacarpals, 229
Heat, for strains and sprains, 216 Insulin pumps, external, 290 Metatarsals, 236, 239
Heat cramps, 352, 355-56, 361 Insulin replacement therapy, 290 Methamphetamines, 337
Heat exhaustion, 352, 356 Insulin shock, 289 Methylenedioxymethamphetamine (MDMA), 342
Heat-related emergencies, 355-58, 361 Integumentary system, 54-55 Microorganisms, 54
care for, 356, 358 Internal bleeding, 158, 161-62 Minnesota Farm Bureau Federation
early stages of, 356 International Association of Laryngectomees Web site, 419
heat cramps, 352, 355-56, 361 (IAL), 100 Miscarriage (spontaneous abortion), 410
heat exhaustion, 352, 356 Interviewing victim and bystanders, 68 Moderation, 454
heat stroke, 352, 356 In-water assists, 377-78 Motor function, 388, 395
last stages of, 356 Iron, 452 Motor impairment, 388, 396-97
preventing, 363-64 Mouth, jaw and neck injuries, 263-65
sun damage, 357 J Mouth-to-nose breathing, 101
Heat stroke, 352, 356 Jaw injuries, 255, 263-65 Mouth-to-stoma breathing, 101-02
Heaving jug, 376 Joints, 206, 210-11 Moving the victim, 32-35, 72, 423
Heaving line, 376 clothes drag, 34-35
Helmets, 266, 449 K gaining access, 33
Hemorrhagic stroke, 297 Kidneys, 56-57 musculoskeletal injuries and, 219-20
Hepatitis B virus (HBV), 29 Knee, 211 pack-strap carry, 33-34
Hepatitis C virus (HBV), 29 Knee injuries, 238-39 two-person seat carry, 34-35
High Arm In Endangered Spine (H.A.IN.E.S.), Kneecaps, 236 walking assist, 33-34
65, 102 Knives, 431 Multiple births, 411
High blood pressure (hypertension), 294 Multiple responders, CPR and, 123-24
High energy food, 431 L Multiple sclerosis, 396
HIV. See Human immunodeficiency virus Labor (during childbirth), 404-06 Muscles, 44, 52-53, 206
Home safety, 444-48 Lacerations, 182, 183 Muscular dystrophy, 396
Hormones, 55 Language barriers, 398 Musculoskeletal injuries, 211-23
Hostile victims, 398 Larrey, Dominique Jean, 71 care for, 218-19
Human bites, 328 Laryngectomies, 100 cold, 219
Human immunodeficiency virus (HIV), 28, 29, 328 Larynx, 46 elevation, 219
Humerus, 230-31 Laxatives, 342 immobilization, 218-19
Humidity, 352, 354 Legal considerations, 31-32 rest, 218
Hygiene, 30 Good Samaritan laws, 32 splints, 206, 219
Hyperglycemia, 286, 289 obtaining consent, 31-32 checking for, 217-18
Hypertension (high blood pressure), 294 Leg injuries. See Lower extremity injuries dislocations, 206, 214
Hyperventilation, 90-91 Legs, 226, 236 fractures, 206, 212-14
Hypodermis, 180 checking, 70 moving victims, 219-20
Hypoglycemia, 286, 289 Life expectancy, 392 sprains, 206, 214-15, 216
Hypothalamus, 352 Life-threatening emergencies, 4 strains, 206, 215-17
Hypothermia, 352, 359, 361 bleeding emergencies, 156-67 Musculoskeletal system, 51-54, 206-11
AEDs and, 133 breathing emergencies, 86-113 bones, 206, 209-10
Hypovolemic shock, 171 cardiac emergencies, 115-26 joints, 206, 210-11
checking for, 64-65 muscles, 206-08
I conditions for, 21-22 skeleton, 206, 208-09
IAL. See International Association of Laryngectomees head, neck and back injuries, 258-59 MyPyramid (USDA), 452-55
ICD. See Implantable cardioverter-defibrillator shock, 168-75 Web site, 453
496 Index
N Pharynx, 46 Respiratory distress
Nails, 54 Phencyclidine (PCP), 337 defined, 47, 88
Narcotics, 334, 338 Pit vipers, 325-26 See also Breathing emergencies
Nasal sprays, 342-43 Placenta, 404, 405, 409 Respiratory system, 46-48
National Institute on Drug Abuse, 340 Plants, poisonous, 304-05 Reye’s syndrome, 390
National Vital Statistics Reports, 335 Plasma, 158 Rib cage, 272, 273
Neck, checking, 69, 70 Platelets, 158, 159 Rib fractures, 274
Neck injuries, 255, 263-65 Poisoning, 302-17 Ribs, 52
See also Head, neck and back injuries absorbed poison, 304-05 Rigid splints, 226
Nerves, 44, 49-50 American Association of Poison Control Ring buoy, 376
Nervous system, 49-51 Centers Web site (www.aapcc.org), 307 Risk factors, 116
Neurogenic shock, 171 anaphylaxis, 310-11, 314 Rocky Mountain spotted fever, 320, 322
Neurological disorders, organizations and Web care for, 310-11, 314 Roller bandages, 186
sites for, 297 epinephrine administration, 311
Neuroprotectants, 297 signals of, 310 S
Nicotine, 337 causes of by age group, 306 Safety, 266
9-1-1 children and, 392 child, 448
background of, 71 general care guidelines, 307 fire, 442-44
Basic, 11 ingestion, 304 at home, 444-48
calling, 22-23 care for, 308-09 recreational, 449-50
Enhanced, 11 food poisoning, 308-09 safe food handling tips, 309
procedure, 10-12 safe food handling tips, 309 vehicular, 441-42
wireless technology and, 11 inhalation, 304 at work, 448-49
Nitroglycerin patches, AEDs and, 133 care for, 307-08 Safety belts, 266
Nitrous oxide, 304 injection, 305 Salmonella, 308
Noises, unusual, 6-7 care for, 310 Saturated fat, 440, 451
Non-life-threatening emergency, 4, 72 National Poison Control Center phone number Scalp injury, 260, 261
Nose injury, 260-62 (800-222-1222), 307 Scapula, 229
Nutrition, 440, 451-55 Poison Control Centers, 307 School-age children, 389
poisonous gases and fumes, 304 Scorpions, 324-25
O poisonous plants, 312-13 Second degree burns, 190, 191
Obesity, 440 preventing, 314-15 Seizures, 22, 286, 292-94
Occlusive dressing, 184, 185, 275-76 signals of, 306 Septic shock, 171
Odors, unusual, 7 Pregnancy, 404 Severe bleeding, 64, 65, 67-68
Older adults, 392-93 See also Childbirth Sexual assault, 57
Alzheimer’s disease, 394 Preparing, for emergencies, 12-13, 429-32 Shelters, constructing, 428-29
checking, 393 Preschoolers, 389 Shepherd’s crook, 374, 375
confusion and, 395 Pressure bandage, 158 Shock, 64, 168-75, 426
as emergency victims, 73 Pressure bandages, 184, 185 blood volume, 170
falls, 393 Prevention body’s responses, 170-71, 173
head injuries, 393 of bites and stings, 328-29 burns and, 426
heat and cold and, 395 of disease transmission, 28, 29-31 care for, 172
Open fractures, 212 of head, neck and back injuries, 265-66 in children, 172
Open wounds, 180, 182-88 of head, neck and back injuries in water, 380 common types and causes of, 171
Oral medications, for diabetes, 290 of heat-and cold-related emergencies, 363-64 defined, 170
Organs, 44, 45-46 of infection, 196-98 domino effects, 173
Osteoporosis, 210, 213 of poisoning, 314-15 signals of, 171-72
Out-of-water assists, 374-77 of stroke, 295 vital organs, 170
Over-the-counter substances, 342-43 of substance misuse and abuse, 344-46 Shoulder blades, 229
See also Substance misuse and abuse Prolapsed umbilical cord, 410, 411 Shoulder injuries, 229-30
Overdose, 334, 336 Proteins, 440, 452 SIDS. See Sudden infant death syndrome
See also Substance misuse and abuse Psilocybin, 337 Sights, unusual, 6-7
Overnight camping kit, 430 Public Service Answering Point, 11 Signs of life, 20, 22, 64
Oxygen, 46 Pulse, 44, 48 in children and infants, 67
needed before brain damage or death occurs, 88-89 checking infants and children, 65, 67 Skeleton, 208-09
Puncture wounds, 183, 184, 275-76 Skill sheets
P AED for adults, 152-53
Pack-strap carry, 33-34 R AED for children, 154-55
Pancreatic islet cell transplantation, 290-91 Rabies, 320, 327 arm sling and binder, 250-51
Paralysis, 50-51, 256, 396 Radiation burns, 196 checking a conscious victim, 80-83
Paramedics, 5 Radius, 229, 231 checking an unconscious adult,
Partial thickness burns, 190, 191 Rain gear, 431 76-77
Passive drowning victim, 372, 373, 374 Rape, 57 checking an unconscious child, 78
Patella, 236 Rattlesnake, 325-26 checking an unconscious infant, 79
Pathogens, 54 Reaching and moving victims in the water. See conscious choking-adult, 108
Patient Self-Determination Act (1990), 130 Water emergencies conscious choking-child, 109
PCP. See Phencyclidine Reaching assists, 372, 374-75 conscious choking-infant, 110-11
Pelvic bones, 236 Recognizing emergencies, 6-8 controlling external bleeding, 166
Pelvic cavity, 45, 272, 278 unusual appearance or behavior, 7-8 CPR-adult, 140-41
Pelvic injuries, 278-79 unusual noises, 6-7 CPR-child, 144-45
Pelvis, 278 unusual odors, 7 CPR-infant, 148-49
People with special needs, 386-401 unusual sights, 6-7 removing disposable gloves, 38-39
crime scenes, hostile victims, suicide situations, 398 Recovery position, 65 rescue breathing for a child, 112
hearing loss, 396, 397 Recreational safety, 449-50 rescue breathing for an infant, 113
infants and children, 388-92 Red blood cells, 158 splints-anatomic, 244-45
language barriers, 398 Replanting a tooth, 264 splints-rigid, 248-49
mental impairment, 397-98 Reproductive system, 57 splints-soft, 246-47
motor impairment, 396-97 Rescue breathing, 48, 66-67, 72, 88, 97-99, unconscious choking-adult, 142-43
older adults, 392-95 101-02, 112-13 unconscious choking-child, 146-47
vision loss, 396, 397 See also Breathing emergencies unconscious choking-infant, 150-51
Personal hygiene, 30 Respiratory arrest Skin, 44, 54-55
Personal protective equipment, 28, 30-31 defined, 48, 88 checking, 69
Phalanges, 229, 236, 239 See also Breathing emergencies See also Soft tissue injuries
Index 497
Skull, 211 Sudden illness, 4, 284-301, 426 checking an unconscious infant, 79
Smoking, 458-59 diabetic emergencies, 288-92 checking for (ABC, airway, breathing,
quitting sources, 458 care for, 292 circulation), 65-68
stroke and, 295 innovations in treating, 290-91 infant and respiratory distress, 96-97
Snakes, 325-26 signals of, 292 See also Unconscious choking
Snell Memorial Foundation, 449 fainting (syncope), 287-88 Upper arm injuries. See Upper extremity injuries
Sodium, 440, 451-52 seizures, 292-94 Upper arms, 226
Soft splints, 226 stroke, 294-98 Upper extremities, 226, 228
Soft tissue, 180 care for, 297-98 See also Extremities
Soft tissue injuries, 178-203 hemorrhagic stroke, 297 Upper extremity injuries, 229-36
burns, 180, 188, 190-96 organization Web sites, 297 Urinary system, 56-57
care for, 191-93 preventing, 295, 296-97 Uterus, 404, 409
chemical burns, 193 recognizing, 295
electrical burns, 193-96 risk factors for, 294-95 V
full-thickness burns, 190, 191 transient ischemic attack (TIA), 286, 294, Vagina, 404-05
partial-thickness burns, 190, 191 296-97 Vaginal bleeding, 409-10
radiation burns, 196 treatment for, 296-98 Van Beek, Allen L., 419
superficial burns, 190 Sudden infant death syndrome (SIDS), 388, Vehicle safety, 441-42
defined, 180 391, 392 Vehicle survival kit, 428
infections, 196-98 Sugars, 452 Veins, 44, 48, 158, 159
care for, 198 Suicide, 398 Ventricular fibrillation (V-fib), 116, 129
preventing, 196-98 by overdose, 336 Ventricular tachycardia (V-tach), 116, 129
signals of, 198 Sun exposure, 357 Vertebrae, 52, 254, 255-56
wounds, 180-88 Sun protection, 431 Vertebral column, 255-56
closed wounds, 180-82 Sun protection factor (SPF), 357 V-fib. See Ventricular fibrillation
open wounds, 180, 182-88 Superficial burns, 180, 190 Victims
Solar burns, 196 Swimmer behavior, 374 caring for, 24
Special needs. See People with special needs Syncope (fainting), 286, 287-88 checking, 21-22
SPF. See Sun protection factor Synergistic effect, 334, 337 interviewing, 68
Spiders, 323-25 See also Substance misuse and abuse reaching and moving, 32-35
Spinal cavity, 44-45 See also Checking the victim; Consciousness;
Spinal column, 255-56 T Moving the victim; Unconsciousness
Spinal cord, 44, 49, 154 Target heart rate (THR), 456-57 Viruses, 28-29
Spinal cord injuries, 255-57 Tarsals, 236, 239 Vision loss, 388, 396, 397
Spine, 49, 254, 255-57 Teeth injuries, 263-64 Vital organs, 45-46, 170, 273
Splints, 226-28, 231-36, 238-39 Tendons, 52-53, 206 Vitamin A, 452
applying anatomic splint, 244-45 Tetanus, 28, 197, 327-28 Vitamin C, 452
applying rigid splint, 248-49 Thigh bones, 236 Vitamin D, 213
applying soft splint, 246-47 Thigh injuries, 236 Vomiting, 65, 101
Spontaneous abortion (miscarriage), 410 Thighs, 226 V-tach. See Ventricular tachycardia
Sprains, 54, 206, 214-15, 216 Third degree burns, 191, 192
Standard precautions, 28, 29 Thoracic cavity, 44-45 W
Stents, 297 THR. See Target heart rate Wading assist, with equipment, 377-78
Sternum, 48, 272 Thrombolytics, 296 Walking assist, 33-34, 378
Steroids, 342, 344-45 Thrombus, 294 Water
See also Substance misuse and abuse Throw bag, 376-77 AEDs and, 133
Stimulants, 334, 337 Throwing assist, 372, 375-77 drinking, 431, 452
See also Substance misuse and abuse TIA. See Transient ischemic attack Water emergencies, 370-85
Stitches, 189 Tibia, 236 beach drag, 378
Stomach, air in, 99 Ticks, 322-23 behaviors of distressed swimmers and drowning
Stomas, 88, 101-02 Tissues, 44, 45, 209 victims compared with swimmers, 374
Strains, 54, 206, 215-17 Tobacco products, 337 CHECK-CALL-CARE, 374
Stress, 440, 457-58 Toddlers, 389 head, neck or back injury, 379-82
Stress management, 458 Toes, 236 icy rescue, 362, 382-83
Stressor, 440, 457 Tolerance, 334, 336 preventing, 372
Stroke, 286, 294-98, 396 See also Substance misuse and abuse reaching assists, 374-75
FAST recognition of (face, arm, speech, time), 295 Topographic map, 431 recognizing, 372-74
prevention of, 295 Total fat, 451 risk of drowning, 372
risk factors for, 294-95 Tourniquets, 416, 424, 425 submerged victim, 378
sudden signals of, 296 Trans fat, 451 throwing assists, 375-77
treatments for, 296-98 Transient ischemic attack (TIA), 286, 294, 295, 296 two-person lift, 378-79
Submerged water victim, 378 See also Stroke wading assist with equipment, 377-78
Substance misuse and abuse, 332-49 Transporting the victim. See Moving the victim walking assist, 378
care for, 343 Trauma, AEDs and, 133 Water moccasins, 325-26
defined, 334 Two-person lift, 378-79 Weather, protection from, 427-28
effects of, 335 Two-person seat carry, 34-35 Weight, 455
forms of, 335-37 nutrition and, 454
help sources for victims of, 346 U Weight-loss strategies, 454
preventing, 344-46 Ulna, 229, 231 Wheezing, 89
signals of, 343 Ultraviolet (UV) light rays, 357 Whistles, 431
summary of substances and effects, 338-39 Umbilical cord, 404, 409 Wilderness areas, 416
types of substances, 337-43 prolapsed, 410, 411 Wind, 352, 354
alcohol, 338-41 Unconscious choking Wind-chill factor, 354
anabolic steroids, 342, 344-45 adult, 126-27, 142-43 Wireless technology, 9-1-1 calls and, 11
cannabis products, 341 children, 126-27, 146-47 Withdrawal, 334, 336
depressants, 337-40 infants, 127-28, 150-51 See also Substance misuse and abuse
designer drugs, 342 Unconsciousness, 21-23, 64 Workplace safety, 448-49
hallucinogens, 337 adult or child and respiratory distress, 96 Wounds, 180-88
inhalants, 340-41 checking an unconscious adult, 76-77 Wrist injuries, 232-36
narcotics, 340 checking an unconscious child, 78 Wrists, 229
over-the-counter substances, 342-43
stimulants, 337
See also Alcohol
MISSION OF THE AMERICAN RED CROSS
The American Red Cross, a humanitarian organization led by volunteers and
guided by its Congressional Charter and the Fundamental Principles of the
International Red Cross Movement, will provide relief to victims of disaster and
help people prevent, prepare for, and respond to emergencies.
ABOUT THE AMERICAN RED CROSS

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The Red Cross is not a government agency; it relies on donations of time, money,
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FUNDAMENTAL PRINCIPLES OF THE INTERNATIONAL

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FIRST AID—Responding to Emergencies, Fourth

Edition is the definitive text from which many schools
teach first aid, CPR and AED skills. Through an
integrated teaching approach using classroom The training YOU need to save a life.
lecture, simulated emergency situations, discussion
and hands-on skill practice, the American Red Cross
offers instructors and students the vital skills needed This revised printing was necessary
to save a life. The revised fourth edition of this to provide consistent treatment of the
textbook includes the following enhancements for
students and instructors: latest science for first aid, CPR and
For students: emergency cardiovascular care.
• Updated information with the latest science for first
aid, CPR and emergency cardiovascular care
CERTIFICATION AVAILABLE IN:
• Chapter-opening scenarios, objectives, sidebars,
skill sheets and study questions that can help you • CPR—Adult • AED—Adult
retain vital information • CPR—Child • AED—Child
• Important lifesaving skills needed to face our • CPR—Infant • First Aid
challenging world
For instructors:
• An Instructor CD-ROM with a PowerPoint
presentation and testing resource questions
• Video segments that are now on DVD for ease of
moving between skill sessions
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PARTICIPANT’S MANUAL

First Aid—Responding to Emergencies

learned to program a computer,

Become an American Red Cross Instructor…

It doesn’t take much. A little time. A little caring. A BIG reward.

Your time. Your knowledge. Your experience.

Do You Have What It Takes?

For more information, contact your local American Red Cross

This participant’s textbook is an integral part of the American Red Cross

All rights reserved. No part of this publication may be reproduced, stored in

Printed in the United States of America

Composition by Graphic World

Library of Congress cataloged the 4th edition as follows:

Donald J. Gordon, PH.D., M.D. James A. Judge II, EMT-P, CEM

Stuart A. Balter, ATC, EMT-D Lisa Anne Johnson, EMT-P

Dayna S. Brown Constance S. LaBarbera, B.S., M.S., Ed.S., Ed.D.

Kathleen C. Brown, MPH, BSN, CHES Louise Feasel Lindenmeyer

Les Chatelain Nancy S. Maylath, HSD

Verallyn M. Cline Carol G. McKenzie, PhD

Raymond A. Cranston Tim McQuade, NYS EMT-P

Susan T. Dempf, PhD Marshall J. Meyer

Dean W. Dimke Anthony Museulino

Ann E. Graziadei Sean E. Page, MSN, CRNP, APRN-BC, CSN

Arthur L. Grist, Sr. Deborah Radi

American College of Emergency Medicine Girl Scouts of the USA

American College of Emergency Physicians National Association of Emergency Medical

Emergency Trauma Services Children’s National Shenandoah Mountain Rescue Group

Health Precautions and Guidelines During First Aid Training, xxix

PART ONE INTRODUCTION, 1

PART TWO ASSESSMENT, 41

PART THREE LIFE-THREATENING EMERGENCIES, 85

PART FOUR INJURIES, 177

PART FIVE MEDICAL EMERGENCIES, 283

PART SIX SPECIAL SITUATIONS, 369

PART SEVEN HEALTHY LIFESTYLES, 437

Appendix A, Answers to Study Questions, 464

Chapter 2: Responding To An Emergency, 18

Chapter 3: Before Giving Care, 26

Chapter 5: Checking the Victim, 62

CPR for an Adult, 121 Chapter 8: Bleeding, 156

Chapter 23: Delayed-Help Situations, 414 PART SEVEN: HEALTHY

REQUIREMENTS FOR COURSE If this course is taught at a college or university,

■ Descri ant acti

Shock: The D CHAPTER 9

all items that

108 PART THREE

Skill Sheets Step 1

HOW TO USE THIS TEXTBOOK

Nationally recognized course completion certificate. American Red Cross

Courses developed by experts. American Red Cross materials are developed

DURING FIRST AID TRAINING to the recommended end-of-class decontamination procedures.

*A person with hepatitis B infection will test positive for

3 Before Giving Care

The EMS System

a citizen responder, your primary role in an emer-

A spilled medicine container.

Table 1-1 Recognizing Emergencies

Unusual noises Screams, yells, moans or calls for

Unusual Appearance or Behavior These and other appearances and behaviors

Figure 1-5 You may need to respond to an emergency