Begin your treatment and primary assessment by talking to the victim. If there is more than one victim, use the Triage sections below for assessment and assisting. Evaluate for confusion or unresponsiveness.  If the victim has been unconscious for any length of time, immobilize the head and neck, and activate EMS immediately.  Perform a head-to-toe evaluation.  Look for signs of trauma, bleeding, deformity, embedded or impaling objects, discoloration, or anything that might be of concern.  Be sure to locate any concealed injuries that may be more life threatening than the obvious injuries that you located at first.  To determine if an individual may have a potential fracture, simply ask them if they can move the area without causing pain.  If they are unable to move the area, or if it causes them significant pain, do not allow them to move it, and treat it as if known to be a fracture.

In order to prioritize your treatment, you should be constantly aware of the most life threatening situations.  This becomes even more important when you are dealing with an unconscious patient who cannot relate information to you. It may be necessary to ask yourself several important questions:

Life Threatening Priorities

1. Is there breathing?

2. Is there a pulse?

3. Is there severe bleeding?

4. Is there severe shock?

These items must be dealt with in order of their severity.  For example, although any of these situations could cause a fatality, severe bleeding should not be addressed until steps 1 and 2, breathing and heartbeat, have been remedied, as these are a more immediate threat to life.

A diabetic emergency may occur suddenly, or with little warning, and result in unconsciousness, seizures, or coma.  Diabetes is caused by improper regulation of insulin or sugar (glucose) in the bloodstream.  The cells of the body need oxygen and glucose to function, and insulin is the key that allows glucose to enter the cell.  Without glucose, the body feeds on muscles and fats, which reduce to acids, creating a fruity odor characteristic of acidosis.

Hypoglycemia (or insulin shock) occurs when the level of glucose in the blood drops too low. There is a rapid onset of symptoms including pale, cool, moist skin, a decreased level of consciousness, headache, hunger, and anxiety.  Often, victims of hypoglycemia are mistaken for victims of head injury or alcoholism due to the similar symptoms.

Hyperglycemia (or diabetic coma) occurs when the insulin levels drop and too much glucose is left in the blood.  Symptoms include fruity breath, deep and rapid breathing (known as Kussmaul respirations), and warm, dry skin.  Too much sugar in the bloodstream may also cause frequent urination, dehydration, thirst, nausea, and vomiting.

Treatment for diabetic emergencies includes the following: Administer food, preferably a hard, sugar candy to the victim.  Hypoglycemics require blood sugar, and this oral intake should cause a rapid recovery.  Hyperglycemics require insulin, but if you are not sure which treatment to give, treat the same, as a small amount of sugar will not cause the condition to become worse.  Never attempt to give anything by mouth to an unconscious individual.  Treat for shock and activate the EMS.

Another type of sudden illness or emergency is a seizure.  A seizure may be caused by a number of medical conditions, or by trauma.  It is characterized as a disorderly discharge of cerebral neurons causing the individual to lose consciousness, or muscle control momentarily. 

A petite mal seizure is a brief 10 to 30 second seizure that is characterized by a blank stare, and no memory of the lapsed time.  No damage is done to the victim.

A febrile seizure is caused by fever, and usually affects children and infants.  The recommended treatment is to quickly cool the victim in tepid water.

A grand mal seizure can be terrifying to witness and dangerous to the victim as well.  There are three stages to a seizure of this type.

1. The aura is a sensation felt moments before the seizure begins. It may be a light, a smell, or simply a premonition of some sort.  Individuals who suffer frequent seizures often learn to recognize the aura and get onto the floor or other safe area quickly.
2. The tonic-clonic phase is the rapid and often violent rigidity and relaxation that many people picture when they imagine a seizure.  It is during this phase that much of the danger exists from the victim striking hard or sharp objects. Move furniture out of their way and wait for the seizure to end. Do not attempt to restrain a person who is actively seizing. Do not force objects into their mouth.
3. The postictal stage is a period of profound exhaustion and relaxation following the seizure. If the victim becomes unconscious at this point, ensure that there is breathing and activate the EMS.  If there is breathing, roll the victim on his or her side to allow fluids to drain from the mouth.

A status seizure (or status elepticus) is usually a grand mal seizure that lasts longer than a few minutes or repeated seizures on short interval.  A person who is actively seizing often cannot breathe.  If the seizure lasts longer than 4-6 minutes, permanent brain damage may occur.  Activate the EMS and move heavy or sharp objects out of the victim’s way.

Problems with pregnancy constitute another form of sudden illness.  In general, there are situations that may arise at any stage of pregnancy that should be treated with caution or medical help.  Any unusual bleeding or pain should be reported to a physician immediately.  If serious symptoms develop, treat the victim for shock and activate the EMS

Poisoning can occur by ingestion, absorption, contact, injection, or inhalation.  Ingested poisons occur most frequently with young children exploring cupboards underneath the sink, and with elderly people who accidentally take too much of a prescribed medicine.  If you encounter an unconscious individual in the kitchen or bathroom, or if you notice any discoloration or burning around the mouth, suspect poisoning. If victim is unconscious, call 911 and maintain an open airway.  Follow the procedures for CPR if necessary.  Observe the environment for clues, and keep any open containers you find nearby.

Download and print this Handy Poison Control Center Number!

If victim is conscious, you may call the Poison Control Center directly or notify the EMS for assistance. The New National phone number is 1-800-222-1222. Do Not induce vomiting unless instructed to do so by a medical professional.  Do Not give anything by mouth, including water or milk, unless instructed to do so by a medical professional, and Do Not rely solely on label information which may be incorrect or outdated.  An item that the Poison Control Center may ask you to use, and which you may purchase at local drugstores is Activated Charcoal. (Syrup of Ipecac sis no longer recommended.)

Animal Bites and Stings can include venom or toxin from bees, spiders, dogs, snakes, jellyfish, and stingrays among others.  A major concern of any toxin introduced into the human body is anaphylaxis, or severe allergic reaction.  If a bee stings an allergic individual, for example, the swelling may be so rapid and severe as to block off the airway and cause suffocation.  Some treatments that may be prescribed for the individual include antihistamines to reduce swelling, or a shot of epinephrine (or adrenaline).  If you know severely allergic individuals, you should become familiar with their treatment and how to assist them in an emergency.

For bee stings, remove the stinger and poison sac by scraping it with a credit card.  Do not try to remove it with your fingers or tweezers, as you are likely to empty the poison sac into the body.  Wash the sting area / wound site with soap and warm water, keep the site at, or below heart level, and apply a cold pack to reduce swelling, and to slow the spread of the poison.  If serious symptoms develop, contact a physician or the EMS.

The treatment for spider bites is similar to bee stings, although the symptoms can be much different.  A black widow spider emits a neurotoxin that affects the nervous system of the victim.  Although rarely fatal, it can cause nausea, vomiting, difficulty breathing or swallowing, sweating, salivating, as well as pain, swelling and redness near the bite area.   The brown recluse’s poison causes more localized damage, and does not affect other parts of the body.  It will cause pain, scarring, and often large areas of necrosis, or tissue death.

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Snakes exist in almost every part of the world.  Of the approximately 8000 snake bites each year, however, fewer than 12 result in fatality.  This is due in part to the fact that about two thirds of all poisonous snake bites involve little or no venom; these are called “dry bites.”  Baby snakes are more dangerous in this regard as they have not yet learned to save their venom for prey.  If venom is injected, symptoms will begin rapidly and include pain, swelling, weakness, dizziness, fever, or chills.  In the event of snakebite, immediately remove all constricting clothing and jewelry from the extremity.  Wash the bite area with soap and warm water.  Keep wound site at or below heart level, and seek immediate medical attention.  Sometimes a constricting band may be used on snakebite, but it must not significantly affect circulation and it should be loose enough for you to slip your fingers underneath.

Do Not apply ice to snakebites, as it may crystallize the venom and compound the reaction.

Do Not attempt to “cut and suck” the venom, even using kits.  In order to be effective, the suction must be applied almost immediately, and the danger of severing an artery can outweigh the danger from the venom.

Although dogs do not inject venom, their bites can be damaging to tissue and often infectious as well.  If a dog has rabies, it can transmit the disease to a human by a single bite.  If a bitten individual suspects rabies, control the victim’s bleeding, treat for shock, and contact a physician for treatment. It may then be necessary to locate the dog in order to determine whether it is infected.  An infected individual must receive a series of shots to control the disease, which can be fatal if untreated.

Jellyfish can cause red, painful, rash-like symptoms, which may spread, to the hands and face of the victim if contacted.  Rinse thoroughly with water and apply vinegar or baking soda to stop the pain.

Stingrays are flat, round sea creatures that will inject a venomous barb into the leg or foot of an individual unlucky enough to step on them.  The barb releases a protein into the body which may cause the victim to go into shock.  Additionally, bits of the barb may remain in the wound and pose an infection risk.  Initial treatment includes immersing the wound in hot, non-scalding water.  Keep the wound below heart level, and see a physician for any potential infection.  Be alert for shock, and treat as necessary.  Shuffling your feet can often alert the stingray of your presence and allow it the opportunity to leave.

Eye Injuries – Eyes move together, so always immobilize both eyes.

Eyes are our portal to the world. and are especially sensitive to injury and contaminants. With any eye injury, treat as well as possible, always erring on the side of caution, while striving to minimize further damage, and with any eye injury - Seek medical attention.

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Heat cramps develop because of excessive perspiration and loss of salt from the body.  Symptoms of Heat Cramps include muscle cramps, usually in the abdomen & legs, heavy perspiration, lightheadedness, weakness, and exhaustion. Gently rub the affected areas, and increase fluid intake.

Heat exhaustion is caused by the accumulation of blood in the skin in the body's attempt to increase its cooling efficiency. Usually this is due to temperature or conditions that the individual is not accustomed to. The resulting loss of circulating blood volume decreases oxygen supply to the brain and can cause fainting.  Individuals suffering from heat exhaustion should be closely monitored to avoid escalation into heat stroke.

Symptoms of Heat Exhaustion can include nausea, dizziness, weakness, and headache. The skin is pale & moist, with possible heavy perspiration.  Temperature may be low or normal with weak pulse, dilated pupils, disorientation or fainting spells.

First Aid for Heat Exhaustion:

Remove victim to cooler location, out of the sun. Loosen or remove clothing and cool victim with water, fanning for quick evaporation. Use cold compresses-especially to head & neck area, also to armpits and groin.

• Do NOT use an alcohol rub
• Do NOT give any medication to lower fever

Give victim electrolyte beverages to sip, or slightly salted water (1 tsp. per quart), 1/2 cup every 15 minutes

Do NOT give any liquids containing alcohol or caffeine as these may interfere with the body's ability to regulate its internal temperature.  If the victim's condition does not improve or worsens seek medical attention immediately.

Heat stroke is caused by an inability to adequately dissipate body heat through perspiration, especially after strenuous physical activity. It is characterized by an excessive rise in body temperature, and a high fever that can cause permanent damage or death. Recovery depends on heat duration and intensity. The goal of emergency treatment is to maintain circulation and lower body temperature as quickly as possible.

Symptoms of Heatstroke include headache, nausea, dizziness, and hot, red, dry skin. The victim’s pulse may become strong & rapid, pupils may constrict, disorientation, unconsciousness and possible convulsions may occur.

First Aid for Heatstroke

Remember that HEATSROKE IS LIFE THREATENING!

Remove victim to a cooler location, out of the sun. Loosen or remove clothing and immerse victim in cool water.  If immersion isn't possible, cool victim with water, or wrap in wet sheets and fan for quick evaporation.  Use cold compresses, especially to the head & neck area, also to armpits and groin.  Seek medical attention immediately—continue first aid to lower body temperature.

Do NOT give any medication to lower fever—it will not be effective and may cause further harm.

Do NOT use an alcohol rub

It is not advisable to give the victim anything by mouth (even water) until the condition has been stabilized.

Hypothermia and Frostbite

Generalized hypothermia results from heat loss, or a decrease in the body’s heat production.  It is a potentially life-threatening condition.

• An individual in the first stage of hypothermia will respond by shivering. Shivering is a response by the body to generate heat.  It does not occur below a body temperature of 90 degrees Fahrenheit.
• Stage 2 is characterized by apathy and decreased muscle function.
• With stage 3, the victim may show signs of decreased responsiveness, a glassy stare, and possible freezing of extremities.
• Stage 4 indicates decreased vital signs, including slow pulse and slow respiration.
• Stage 5 is death.

Treatment:  The top priority is to remove the victim from the cold environment and to prevent further heat loss.  Remove wet clothing, and wrap the victim in thick blankets.  Heat packs may be placed on the chest, underarms, and groin.  Reheat gradually, do not massage roughly or immerse in hot water.

Localized cold injury, or frostbite, results from the freezing of body tissue.  It tends to occur on the hands, feet, ears, nose and cheeks, where ice crystals in the skin expand and block circulation. Frostbitten tissue may appear pale and waxy, or mottled and cyanotic.  Other signs and symptoms may include loss of feeling, swelling, and blisters.

Treatment:  Remove the victim from the cold environment.  Never initiate thawing procedures if there is any danger of refreezing.  Cover the affected area with dry dressings or clothing.  Do not rub or massage the affected skin.  Do not allow the victim to smoke, as this will further constrict the blood vessels.  Contact EMS as quickly as possible.

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Prior to providing care for a Conscious Adult, you must first obtain consent. This is a very simple procedure and requires only a few seconds. The steps are as follows:

1. Tell the victim your name.
2. Tell them you have been trained to assist in First Aid and/or CPR
3. Ask the person if he/she wants help.
4. Once they indicate that they want your help, begin care.

*If the victim is a minor, you may obtain consent from the minor’s legal guardian or parent if they are present on the scene. If the minor’s legal guardian or parent is not present, consider it a situation of Implied Consent.

What is Implied Consent?

If the victim is seriously ill, extremely confused, or unconscious, he or she may not be able to give consent. The law then assumes that the victims would most likely give consent if they could, so assistance may be given without verbal permission.

Valuable Information

Good Samaritan Laws and Legal Considerations

The “Good Samaritan Act” refers to a set of laws designed to protect bystanders who choose to provide care during an emergency situation. Lawsuits brought against those who provide care in an emergency are very unlikely and are seldom successful. Most states have instituted Good Samaritan Laws designed to protect you, as long you as follow some simple guidelines:

1. You must act in good faith.
2. You are neither reckless nor negligent.
3. Act as a prudent person would.
4. Only provide care that is within the scope of your training.
5. You must not abandon the victim once you have begun care.
6. You must not accept anything in return for your services.

* These laws may vary by state, so it is a good idea to check with your local library to establish the extent to which the law protects you.

Duty to Act

Depending on the specific State Law, most licensed and/or certified professionals, medical personnel, public safety officers and medically trained government employees have a “duty to act” while they are working or on assignment. If responding to an emergency while not on duty, the same person would be protected as a bystander choosing to provide care under the Good Samaritan Laws. Again, these laws may vary, so it is always a good idea to find out the extent to which the law protects you.

As a bystander, you must decide if you choose to provide voluntary assistance. If you choose to do so, first make sure the scene is safe for you as a rescuer, then you must follow these guidelines:

Once care has been initiated, you are obligated to continue care until one of the following occurs:

1. A qualified professional pronounces the victim dead.
2. Observable signs of circulation return ~ Victim begins breathing on his or her own.
3. Qualified personnel arrive who can render the same level of care or better.
4. You become too exhausted to continue.

Being prepared helps families alleviate fears and reduce potential losses related to disasters. In the event of emergencies or disasters, injured people need to receive help within the first hour of the incident. Often family members and co-workers are the initial first responders. First-aid kits are a necessity for attending to victims and should be kept in homes, vehicles, schools and workplaces.

You may purchase first-aid kits or customize your own kits for families, schools and businesses. Some kits are designed for specific activities, such as hiking, camping or boating.

Get your Gear on - Prepare for Disaster!

Make sure your kits have all the supplies you may need. Include personal items, such as medications and emergency phone numbers, or other items your health-care provider may suggest.

Check kits regularly.

Make sure the flashlight batteries work.

Check expiration dates and replace any used or out-of-date contents.

Basic First-Aid Kits may include these supplies, though variations can easily be made to meet the specific needs of families, schools and workplaces:

• Adhesive tape
• Aluminum finger splints
• Antibiotic ointment
• Antiseptic solution or towelettes
• Bandages, including a roll of elastic wrap and assorted bandage strips
• Instant cold packs
• Cotton balls and cotton-tipped swabs
• A box of disposable latex or synthetic gloves
• Gauze pads and roller gauze in assorted sizes
• Eye goggles
• First-aid manual
• Petroleum jelly or other lubricant
• Plastic bags for the disposal of contaminated materials
• Safety pins in assorted sizes
• Emergency Dental First Aid
• Scissors, tweezers and a needle
• Soap or instant hand sanitizer
• Sterile eyewash, such as a saline solution
• Thermometer
• Triangular bandage
• Turkey baster or other bulb suction device for flushing out wounds
• Activated charcoal (use only if instructed by Poison Control Center)
• Anti-diarrhea medication
• Over-the-counter oral antihistamine (i.e., Benadryl, others)
• Aspirin and nonaspirin pain relievers (never give aspirin to children)
• Calamine lotion
• Over-the-counter hydrocortisone cream
• Personal medications
• Syringe, medicine cup or spoon
• Sunscreen
• Mylar emergency blanket
• Disposable diapers
• Personal hygiene items
• Towels, sheets, linens, pillows
• Scarf (sling)
• Blankets

For more information, go to http://www.eden.lsu.edu republished from the Daily Press