First Responder EMS Curriculum for Training Centers in Eurasia

equire assistance with opening and maintaining their airway. The tongue can fallbackwards and obstruct the airway in the unresponsive patient. The jaw-thrust maneuverwithout head tilt is used to open the airway for patients with suspicion for trauma to thehead or neck. For non-trauma patients, the jaw-thrust or head –tilt-chin lift maneuvermay be used to open the airway. Once you have opened the airway, inspect the airwayvisually and reassess for persistent obstruction. Foreign bodies, secretions, blood, andvomit can all cause airway obstruction and should be cleared as best as possible whenthey are detected in the setting of airway obstruction.d. BreathingOnce you have assessed, opened, and cleared the airway, assess the patient’s breathing.Look, listen, and feel for the presence of ventilations. If the patient is not breathingspontaneously after the airway has been opened and cleared, then you need to ventilatethe patient. Techniques for ventilation include bag-valve mask, mouth to mask, andmouth to mouth. If the patient is breathing spontaneously, observe the work ofbreathing. Does the patient appear to be breathing comfortably? Or does the patientappear to be having difficulty breathing? A patient who continues to have difficultybreathing after the airway is opened and cleared most likely has an underlying problemrequiring urgent medical attention. These patients should receive oxygen as quickly aspossible. They may require artificial ventilation.e. CirculationAfter you have assessed the airway and breathing and dealt with any problems in theseareas, assess the patient’s circulatory status. Check for the radial pulse in adults who areresponsive. Check for the carotid pulse in adults who are unresponsive. For infants,assess the brachial pulse. In unresponsive children, check the carotid or femoral pulse.In responsive children, check the brachial or radial pulse.Determine if major external bleeding is present. If bleeding is present, control bleedingas described in Skill Algorithms: Illness and Injury.Assess the patient’s skin color and temperature for signs of shock, or decreased bloodflow to important anatomic structures and organs. Patients with shock may have skinthat is moist or clammy and cool to the touch. Their skin or mucous membranes mayhave a pale or cyanotic (bluish) appearance. Normally, the skin should be warm and dry,with a normal color.f. Brief EMS ReportAfter completing the initial assessment and addressing any life-threatening problemsnoted in the ABCs, the First Responder can update the responding EMS unit with a briefradio report describing the findings. This step will give the responding EMS unit a senseof the urgency of the needs of the patient and what they are likely to expect upon arrivalat the scene. This brief report should include the following elements in the followingorder:1. Age and sex2. Chief complaint3. Responsiveness4. Airway and breathing status5. Circulation statusFirst Responder EMS Curriculum/AIHA, July 2002 83