First Responder EMS Curriculum for Training Centers in Eurasia

transmission of disease to yourself or others. Always remember that the ABCs (airway,breathing, and circulation) are your first priority. You must support and maintain thepatient’s airway and provide artificial ventilation, if necessary.Use the following guidelines whenever attempting to control external bleeding:1. Apply fingertip pressure directly on the point of bleeding, using the flat part of thefingers.2. If no injury to the muscle or bone exists, elevate the bleeding extremity, whilemaintaining direct pressure.3. Large gaping wounds may require sterile gauze and direct hand pressure if fingertippressure is ineffective.4. If bleeding does not stop, remove the dressing and assess for the bleeding point toapply direct pressure. If more than one bleeding site is identified, apply additionalpressure.5. Pressure points, superficial arteries proximal to the injured area, may be used in theupper and lower extremities if direct pressure fails to control the bleeding.b. Internal BleedingInternal bleeding is often not as visually startling to the First Responder. Injured ordamaged internal organs, however, commonly lead to extensive bleeding that isconcealed. Deformed, swollen extremities resulting from long bone fractures may alsolead to serious internal blood loss. Pelvic bone fractures can also result in seriousinternal bleeding.Signs and SymptomsThe signs and symptoms of internal blood loss are much more subtle than those ofexternal blood loss. Pay special attention to the patient’s vital signs and associated signsand symptoms as well as the condition of the injured body part. These signs andsymptoms include:1. Discolored, tender, swollen, or hard tissue2. Increased respiratory and pulse rates3. Pale, cool skin4. Nausea and vomiting5. Thirst6. Altered mental statusRole of the First ResponderComplete the First Responder assessment. Complete a scene size-up before initiatingemergency medical care. Complete an initial assessment on all patients. Complete aphysical exam as needed. Complete ongoing assessments. Comfort, calm, and reassurethe patient until additional EMS personnel arrive.Management1. Complete the First Responder assessment.2. Maintain body substance isolation.3. Check ABCs: airway, breathing, circulation4. Maintain airway/artificial ventilation.5. Manage any external bleeding.6. Reassure the patient.158 First Responder EMS Curriculum/AIHA, July 2002