First Aid Responder Level 3 (VTQ)
Course Content
- Introduction Level 3 First Responder
- Initial Patient Care
- Introduction to Initial Patient Care
- Consent to help
- Asking permission and consent to help
- Fears of First Aid
- Scene Safety
- Calling the Emergency Services
- What3Words - location app
- Waiting for the E.M.S to arrive
- DRCA(c)BCDE
- Chain of Survival
- How to use face shields
- Hand Washing
- Waterless hand gels
- Medications and First Aid
- The Airway
- Breathing
- Circulation
- Heart Attack
- Heart Attack Position
- Aspirin and the Aspod
- Stable angina
- Pulse Oximetry
- 3 Lead ECG
- The Pulse
- Capillary Refill
- Types of Bleed
- Serious Bleeding
- Ambulance Dressings
- Excessive Blood Loss
- Excessive Bleeding Control
- Embedded Objects
- Knife Wounds
- Using trauma dressings
- Amputation Treatment
- Blast Injuries
- Fox chest seals
- Hemostatic Dressing or Tourniquet?
- Air Wrap Dressings
- RapidStop Tourniquet
- CAT Tourniquets
- Improvised Tourniquets
- Tourniquets and Where to Use Them
- What Damage can be Done with Tourniquets
- When Tourniquets Don't Work - Applying a Second
- Hemostatic Dressings
- Packing a Wound with Celox Z Fold Hemostatic Dressing
- Celox A
- Celox Granules
- Disability
- Exposure/Environment
- Basic Life Support and Defibillation
- Adult CPR Introduction
- When to call for assistance
- Cardiac Arrest and CPR Overview
- Adult CPR
- CPR Hand Over
- Compressions Only CPR
- Mouth to Stoma Ventilations
- Cardiac Arrest and Pregnancy
- Paediatric Airway
- Child CPR
- Child CPR Breakdown
- Infant CPR
- Infant Recovery Position
- Cardiac Arrest and the Drowned Patient
- Drowning
- SADS
- Effective CPR
- Improving compressions
- Improving breaths
- AED Introduction
- Types of AED Units
- AED Setup
- How to Use an AED
- Child AED
- AED Maintenance
- AED Pads
- AED Batteries
- AED Troubleshooting
- AED Locations
- Community AED Units
- AED Post Resuscitation Procedures
- CPR Risks
- Advanced Decision and DNR CPR in Basic Life Support
- Recognition and Management of Life Extinct
- Post Resusitation Care
- Real time CPR scenario
- Medical Gasses
- What are Medical Gasses
- Oxygen
- When Oxygen is Used
- Contra Indications Of Oxygen
- Hazards of using oxygen
- Hypoxia
- BOC Oxygen Kit
- The BOC Cylinder
- Storage Of Oxygen
- PIN INDEX cylinder
- Oxygen Regulators
- Standard oxygen cylinder
- Transport of Cylinders
- How long does an Oxygen cylinder last?
- Demand Valves and MTV's
- Non Rebreather Mask
- Nasal Cannula
- Medical gas storage
- Medical Emergencies - Injuries and accidents
- Spinal Injury
- Stabilising the spine
- Spinal Recovery Position
- Introduction to Spinal Boards
- The spinal board
- Using the Spinal Board
- The Scoop Stretcher
- Using the scoop stretcher
- Cervical collars
- Vertical C-Spine Immobilisation
- Joint examination
- Adult fractures
- Types of fracture
- Elevated Slings
- Horizontal Slings
- Lower limb immobilisation
- Shock
- Elevation Techniques
- Helmet Removal
- Different Types of Helmets
- The Carry Chair
- Applying Plasters
- Strains and Sprains and the RICE procedure
- Eye Injuries
- Electrical Injuries
- Burns and burn kits
- Treating a burn
- Foreign objects in the eye, ears or nose
- Nose bleeds
- Bites and stings
- Chest Injuries
- Foxseal chest seals
- Abdominal Injuries
- Treating Snake Bites
- Types of head injury and consciousness
- Dislocated Shoulders and Joints
- Other Types of Injury
- Dental Injuries
- Medical Emergencies - Illness
- Illness assessment and SAMPLE
- Blood Pressure Cuffs
- Stethoscopes and Auscultation
- What is Anaphylaxis
- Allergic reactions and Anaphylaxis treatment
- Medical ID tags for allergies
- Common causes of allergic reactions
- Minor allergic reactions
- Signs and Symptoms of Anaphylaxis
- What is an Auto-Injector?
- Who prescribes auto injectors?
- Storage and disposal
- EpiPen®
- Emerade®
- Jext®
- Giving a second dose
- Biphasic Anaphylactic Response
- Hyperventilation
- Dealing with Fainting
- Febrile convulsions
- Meningitis
- Sickle Cell
- Poisons and Food Poisoning
- Epilepsy
- Epilepsy treatment
- Asthma
- Asthma Spacers
- When an Asthma inhaler is not available
- Accuhaler®
- Diabetes
- Blood Sugar Testing
- Stroke
- Alcohol Poisoning
- Sepsis
- Trauma
- Summary and Practical Module
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Now we are going to have a look at the primary survey protocol. This is a protocol used in our initial approach to a patient to keep us safe and the patient safe. And the easy way to remember it is by using the mnemonic DRCA [c] BCDE. D, D stands for danger. Danger is to yourself and others. So basically, before we approach a patient, whether that be an RTC or whether that be to somebody's house, or a pub, or a club, or anywhere, we are going to look at the dangers to ourselves. Are we safe to approach that incident? Are we safe to approach that patient? If we are safe to approach that patient and we have done our dynamic risk assessment, which is a very, very quick mental assessment to decide on the safety aspects of the approach, we then proceed to approach the patient. Also, we are looking at, is the patient safe? Is there anything else going on? Is somebody wandering around with a knife or a gun? Is there a fight taking place? And until those things are combated, or sorted, or corrected, then it is dangerous, too dangerous for us to start treatment. Because once you start concentrating on your patient, if there is a fight going on in the room, the next thing that happens is you will be in the middle of it yourself and getting potentially injured and your patient gets worst injured. So, danger comes first. Next, we look at response. It is response from the patient. How is the patient responding to me? We do that by voice, by talking, by communicating. And what is the response back to our communication? Are they responding back compos mentis? Are they responding back to us appropriately with the appropriate words? Is there any slurring? Anything that can be interpreted as being not correct? So the response should come back nice, clear answer, just by talking and communicating with a patient. Next thing we are looking at, which is incredibly important these days, is catastrophic haemorrhage. This has to be looked at immediately, because with a catastrophic haemorrhage with an arterial bleed, we can lose up to a liter of blood per minute. And if we do not correct that immediately, no matter what else we do, the patient dies whilst we are doing it, so Airway always used to come number one. It still is number one, but we have to take into consideration catastrophic haemorrhage, because the patient will lose an awful lot of blood whilst we are doing other things. So, we are looking for it, we are sensing for it. And it is normally pretty obvious when somebody has a catastrophic bleed. There is normally an awful lot of blood being lost from the patient, from wherever the haemorrhage is taking place. Then, we move on to the airway itself, including C-spine. So we have to remember that if there has been a situation where C-spine may have been affected, I.e. An RTC, fall from a height twice the patient's height, or onto something that may have created a C-spine injury, like falling back onto a curb, where the patient may have actually damaged the base of skull or the back of the neck, we have to take C-spine into consideration. Because if we do the normal head tilt/chin lift to open the airway to check it and there has been any catastrophic damage to the spine, we can make this much, much worse. So, we have to take into consideration airway management with the position of the head, and instead of using a head tilt/chin lift, we then would use C-spine or jaw-thrust maneuvers to open the airway without occluding or damaging the spine itself. We then move on to breathing. We look, listen and feel for no more than 10 seconds with breathing. And look at how they are breathing, look at the position they are standing in, are they tripoding? In other words, are they making a stance with their body to assist the way they breathe? You imagine you have just ran around the block and you are short of breath, you will always lean over, you will always hold on to something and actually create a tripod, as you would get with a camera stand, to allow your lungs to fall, using gravity to assist the breathing, rather than lying flat on your back and having to push against gravity. Also, what is the rate and rhythm like of their breathing? 12 to 20 breaths would be a normal breathing rhythm, roughly every three seconds. Is that taking place? Are they overbreathing, breathing too fast, hyperventilating? Or, are they breathing too slow, or agonal gasping from cardiac arrest? So, assess the breathing. What is it telling you? And it will tell you an awful lot. Circulation, we move on to next. Radial pulses, capillary refill of the fingers, radial pulses of the wrist, or carotid pulses in the neck, the two main pulses we use. The first pulse to disappear when blood pressure falls will always be the radial pulse, normally indicates a blood pressure above 90. Normal blood pressure roughly around 120 over 80, and if 120 stays around 90 or drops to 90, your radial pulse will still be in situ. And that means that your internal organs will be functioning adequately and without any major worries about internal organ failure. But if that radial pulse disappears, it is a very quick and very accurate indicator that blood pressure is falling, and somewhere on that body, we have a blood problem, a bleed, a leak of some description, whether it is internal or external, that will come later. But we need to find that pulse to give us some indications. Capillary refill also on the tips of the fingers, on the tips of the toes, tells us that circulation is getting past the injury site. It is getting to the point where we do the capillary refilling or the capillary tests. So if we have put a bandage on, if we have got a fracture, if we have got a limb that is trapped but we have capillary perfusion below two seconds past that site, then we must have good blood flow, which means that the limb is not at risk, blood flow is still arriving to the fingertips or the toes. And consequently, circulation is not occluded. Capillary refill, we squeeze the finger, we squeeze blood from the finger so the finger goes white and then release. And within two seconds, that should come back to a nice pink color. If it is over two seconds, capillary perfusion is low, which means that the circulation and the heart is not pumping adequately to push blood to the tip of the finger or the tip of the toe, but it also might mean that there is something stopping it getting there, I.e. Pressure, tourniquets, that type of stuff. We then move on to disability. Disability, basically, has the patient got all their limb movement? Can they move their fingers? Can they sense, have they got sensations in all limbs? Have they got any strange sensations, pins and needles and this type of thing? We then move on to E for exposure and examine. Basically, exposure, we need to have a look at the patient's body. We need to have a look at the areas. We can never assume, we can never actually guess what is going on. We need to actually be able to have a look at the situation and have a look at where on that patient the injuries have occurred. If we have blood in the footwell of the car, we cannot assume that it has come from the foot. It may have come from the lower part of the leg or the upper part of the leg, and run down past the trousers. Motorcyclist leathers actually keep the blood inside the leathers, and it comes out, again, at the wrist or at the bottom of the ankle, into the boots, and sometimes can be hidden from sight. So, we need to expose, have a look at what we are dealing with. Stab wounds, bullet wounds, these sort of things do not leave a massive amount of damage to the external clothing, however, can do an awful lot of damage to internal organs and internal structure, so we need to actually have a look at and eradicate or sort any problems that we find during the exposure phase of the assessment. The rationale behind the protocol that we have just been looking at is because we need to prioritise. There is no point beautifully dressing a person's cut toe if their airway is occluded and they are dying in front of you. There is no point working on a person's airway if, while we are working on their airway, they are bleeding to death in front of you. So, we have to have a protocol in place, in order, to look after the patient from top to bottom, examining the most crucial parts first and making sure those parts are working effectively before we move to the next stage. And when we move to the next stage, if something we do may change the original point... So, if we move on to breathing and what we do may change the airway itself, the position of the patient, we have to go back to check airway again. The process should take no more than 90 seconds, because if we actually talk to our patient, they talk back, then they must have an airway, they must be breathing, they must have a pulse. The only thing we need to check now, really, is that there is no catastrophic bleeds. So, the 90-second check can be done in two or three seconds just by talking and communicating with your patient. And it is the one thing we must never forget. The patient is a person, they are frightened, they are concerned, and they don not know what is going on and what is happening. They want you to reassure them, to actually bring them under some sort of control, to manage their expectations, and to make them feel comfortable. If we do this correctly, the patient's heart rate will slow down, their breathing rate will come back to a normal level, and the patient starts to feel better, and we have not yet actually treated anything. We have just bought them a little bit more self-control, a little bit more understanding of what is going on so they are not frightened as they were before.
Primary Survey Protocol: Introduction to DRCA(C)BCDE Protocol
Overview
The DRCA(C)BCDE protocol is a structured approach to conducting a primary survey, ensuring thorough assessment and prioritization of critical interventions.
DRCA(C)BCDE Protocol
The protocol involves the following steps:
- Danger: Assess dangers to self, others, and the casualty.
- Response: Check the casualty's level of consciousness and responsiveness.
- Catastrophic Haemorrhage: Identify and address severe bleeding immediately.
- Airway: Ensure the casualty's airway is clear and unobstructed.
- C-spine: Assess and stabilize the cervical spine if necessary.
- Breathing: Check for breathing and address any respiratory issues.
- Circulation: Assess circulation, including pulse and bleeding control.
- Disability: Evaluate neurological status and signs of neurological impairment.
- Expose and Examine: Expose the casualty, conduct a thorough examination, and provide appropriate treatment based on findings.
Rationale
The hierarchical order of the protocol is designed to prioritize interventions based on the severity of potential threats to life and limb.
- FPOS level 3 unit one LO1.1 and level 4 unit two LO1.1
- IPOSi Unit one LO1.2
- IPOSi Unit one LO4.3
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