First Aid and Safety: Skills

Removing Gloves

1. Takes, or verbalizes, standard precautions.

2. Pinches one glove on the outside near the wrist.

3. Gently pulls the glove off, turning it inside out while pulling.

4. Holds the removed glove in gloved hand.

5. Slides two fingers of the bare hand inside the remaining glove at the wrist.

6. Gently stretches the glove away from the hand and gently pulls the glove off, keeping the glove inside out. The first glove remains inside the glove just removed.

7. Disposes of the gloves in a biohazard container or a sealed plastic bag.

8. Washes hands with soap and running water or, if not available, uses an alcohol-based hand sanitizer.

Adult CPR and Unresponsive Choking

1. Takes, or verbalizes, standard precautions.

2. R = Responsive? Taps the person on the shoulder and shouts, “Are you okay?”

   1. If the person responds, asks SAMPLE history questions and looks for and asks about DOTS.

   2. If the person does not respond, continue to next step.

3. A = Activate EMS and get an AED. Shouts for nearby help.

   1. If someone responds, Candidate has them call 9-1-1 and get an AED while Candidate provides care.

   2. If no one responds and a phone is available, Candidate calls 9-1-1 and puts the phone on speaker mode.

   3. If no one responds and a phone is not available, Candidate leaves the person to locate a phone and get an AED.

4. B = Breathing? Places the person faceup on a flat, firm surface. Observes the person’s chest for movement for 5 to 10 seconds.

5. C = Compressions.

   1. Removes enough clothing to locate correct hand position.

   2. Places the heel of one hand on the center of the person’s chest and on the lower half

   3. Places the other hand on top of the first one with fingers interlocked and off the person’s chest.

   4. Keeps arms straight and elbows locked, with shoulders positioned directly over hands.

   5. Pushes hard (at least 2 inches [5cm]) and pushes fast (100 to 120 compressions per minute).

   6. Allows the chest to fully recoil after each compression.

6. A = Airway. Opens the person’s airway using the head tilt–chin lift maneuver.

   1. Places one hand on person’s forehead and applies pressure to tilt the head backwards.

   2. Places two fingers of other hand under bony part of person’s jaw.

7. B = Breaths. Gives two breaths.

   1. Pinches the person’s nose shut (utilizing face shield) or places CPR mouth-to-barrier device over nose and mouth

   2. Makes tight seal with mouth over the person’s mouth over a mouth-to-barrier device.

   3. Gives two breaths, each lasting 1 second.

   4. Takes a normal breath after each breath.

   5. If first breath does not make the chest rise, then go to STEP 8

   6. If breaths go in, go to STEP 10

8. Candidate re-tilts the person’s head and gives a second breath. If second breath does not make the chest rise, then begin unresponsive choking procedure (STEP 9)

9. Candidate does the following:

   1. Begins CPR: 30 chest compressions

   2. Opens the mouth and looks for an object; if seen, removes it.

   3. Gives 2 breaths

   4. Continues 30 chest compressions, object check and 2 breaths until AED or EMS arrives

10. Continues sets of 30 chest compressions and 2 breaths until an AED or EMS arrives.

Child CPR and Unresponsive Choking

1. Takes, or verbalizes, standard precautions.

2. R = Responsive? Taps the child on the shoulder and shouts, “Are you okay?”

   1. If the child responds, asks SAMPLE history questions and looks for and asks about DOTS

   2. If the child does not respond, continue to next step.

3. A = Activate EMS and get an AED. Shouts for nearby help.

   1. If someone responds, Candidate has them call 9-1-1 and get an AED while Candidate provides care.

   2. If no one responds and a phone is available, Candidate calls 9-1-1 and puts the phone on speaker mode.

   3. If no one responds and a phone is not available, Candidate gives 5 sets of 30 chest compressions and 2 breaths before leaving to locate a phone and get an AED.

4. B = Breathing? Places the child faceup on a flat, firm surface. Observes the child’s chest for movement for 5 to 10 seconds.

5. C = Compressions.

   1. Removes enough clothing to locate correct hand position.

   2. Places the heel of one hand on the center of the child’s chest and on the lower half of their breastbone.

   3. Places the other hand on top of the first one with fingers interlocked and off the child’s chest.

   4. Keeps arms straight and elbows locked, with shoulders positioned directly over hands.

   5. Pushes hard (about one-third the depth of the chest) and pushes fast (100 to 120 compressions per minute).

   6. Allows the chest to fully recoil after each compression.

6. A = Airway. Opens the child’s airway using the head tilt–chin lift maneuver.

   1. Places one hand on child’s forehead and applies pressure to tilt the head backwards.

   2. Places two fingers of other hand under bony part of person’s jaw.

   3. Tilts the head backwards.

7. B = Breaths. Gives two breaths.

   1. Pinches the child’s nose shut (utilizing face shield) or places CPR mouth-to-barrier device over nose and mouth

   2. Makes tight seal with mouth over the child’s mouth or over a mouth-to-barrier device.

   3. Gives two breaths, each lasting 1 second.

   4. Takes a normal breath after each breath.

   5. If first breath does not make the chest rise, then go to STEP 8

   6. If breaths go in, go to STEP 10

8. Candidate re-tilts the person’s head and gives a second breath. If second breath does not make the chest rise, then begin unresponsive choking procedure (STEP 9)

9. Candidate does the following:

   1. Begins CPR: 30 chest compressions

   2. Opens the mouth and looks for an object; if seen, removes it.

   3. Gives 2 breaths

   4. Continues 30 chest compressions, object check and 2 breaths until AED or EMS arrives

10. Continues sets of 30 chest compressions and 2 breaths until an AED or EMS arrives.

Infant CPR

1. Takes, or verbalizes, standard precautions.

2. R = Responsive? Taps the infant’s foot and shouts their name.

   1. If the infant is unresponsive, continues to next step.

3. A = Activate EMS and get an AED. Shouts for nearby help.

   1. If someone responds, Candidate has them call 9-1-1 and get an AED while Candidate begins CPR.

   2. If no one responds and a phone is available, Candidate calls 9-1-1, puts the phone on speaker mode, and begins CPR.

   3. If no one responds and a phone is not available, Candidate performs 5 cycles of CPR and then leaves to find a phone.

4. B = Breathing? Places the infant faceup on a flat, firm surface. Observes the infant’s chest for movement for 5 to 10 seconds.

5. C = Compressions.

   1. Encircling thumbs technique: Places both thumbs on the lower third of the breastbone, both touching the imaginary nipple line and the fingers encircling around the infant’s back and chest or Two-finger technique: Places the pads of two fingers on the breastbone, with one touching just below the imaginary nipple line.

   2. Gives 30 chest compressions.

   3. Pushes hard (about 1.5inches [4cm] straight down, or at least one-third of the chest’s diameter) and pushes fast (100-120 compressions per minute).

   4. Allows the chest to fully recoil after each compression.

6. A = Airway. Opens the infant’s airway using the head tilt–chin lift maneuver.

   1. Places one hand on infant’s forehead and applies pressure to tilt head slightly into neutral position.

   2. Places two fingers of other hand under bony part of infant’s jaw.

7. B = Breaths. Gives two breaths.

   1. Covers the infant’s mouth and nose with mouth or mouth-to-barrier device and makes an airtight seal.

   2. Gives two breaths, each lasting 1 second, to make the infant’s chest rise. Takes a normal breath after each breath.

8. Continues CPR until one of the following occurs:

   1. The infant begins breathing.

   2. EMS arrives and takes over.

   3. Candidate become physically exhausted and unable to continue.

Adult or Child Responsive Choking (Back Blows & Abdominal Thrusts)

1. Takes, or verbalizes, standard precautions.

2. Ask patient “Are you choking?” If patient responds (nods) “YES” then ask for consent to help and calls EMS.

3. Back Blows: Stands behind the person and slightly to one side. Reaches across the person’s chest by wrapping one arm either over the person’s arm or under their armpit. Places the palm of that hand on the person’s upper chest, shoulder, or navel. Leaves the other hand free.

4. Has the person bend over at the waist to a 90° angle.

5. With fingertips up, uses the heel of their free hand to firmly strike the person between the shoulder blades five times.

6. (Instructor asks, “What do you do if five back blows do not dislodge the object?” Candidate answers, “Give up to five abdominal thrusts.”) Abdominal Thrusts: Stands behind an adult; stands or kneels behind a child. Wraps arms around the person’s waist.

   1. Locates the person’s navel with a finger. Makes a fist with the other hand and places the thumb side of the hand just above the person’s navel and below the tip of the breastbone. Grasps the fist with the other hand.

7. Provides abdominal thrusts:

   1. Thrusts the fist into the person’s abdomen with a quick upward motion. (Uses chest thrusts on a person who is choking and obese or pregnant.) Each thrust is a separate and distinct effort to dislodge the object.

   2. Continues without interruption until the person coughs up the object; speaks, moves, or breathes; or EMS or a person who is trained takes over.

8. If the person becomes unresponsive Candidate does the following:

   1. Gives 30 chest compressions.

   2. Each time before giving the first of two breaths, looks into the mouth for an object. If seen, removes it.

   3. Gives two breaths.

   4. Continues sets of 30 chest compressions and 2 breaths.

Infant Choking (Responsive & Unresponsive)

1. Takes, or verbalizes, standard precautions.

2. Ask the parent/guardian “If the infant choking?” If guardian responds “YES” and/or the infant is unable to cry/make sounds, then asks for consent to help and calls EMS. Gives up to five separate and distinct back blows:

   1. Supports the infant’s head with hand.

   2. Lays the infant face down over forearm, with the head lower than their chest.

   3. Braces forearm and the infant against thigh.

   4. Gives the back blows between the infant’s shoulder blades with the heel of the other hand

3. If object is not dislodged, turns the infant onto their back while supporting the head. Gives up to five separate and distinct chest thrusts:

   1. Supports the infant’s head with hand.

   2. Lays the infant face up over forearm, with the head lower than their chest.

   3. Braces forearm and the infant against thigh.

   4. Places two fingers of other hand in same location as giving CPR compressions.

   5. Gives thrusts 1 second apart (slower than CPR compressions).

4. Continues alternating the five back blows and five chest thrusts without interruption until the infant stops responding or can breathe, cough, or cry, or until EMS or a person with equal or higher training takes over.

5. Instructor asks, “What do you do if the infant is becomes unresponsive?” Candidate does the following:

   1. Gives 30 chest compressions.

   2. Looks into the infant’s mouth for an object. If seen, removes it.

   3. Gives two breaths.

Using an Epinephrine Auto-Injector

1. Takes, or verbalizes, standard precautions. Puts on gloves

2. Call EMS

3. Obtains consent to provide care.

4. Finds the injection site on the side of the person’s thigh, halfway between the knee and the hip. Checks for coins, keys, and pant seams at the injection site.

5. Takes epinephrine auto-injector out of its package and removes the safety cap by pulling it straight out, with the tip pointing down, without touching either end of the pen.

6. Administers epinephrine:

   1. Without touching either end of the pen, pushes the auto-injector firmly against the thigh until a click is heard.

   2. Holds in place for about 3 seconds.

7. Pulls the auto-injector straight out from the leg.

8. Rubs the injection site for about 10 seconds.

9. Puts auto-injector back into its safety case/ returns safety cap

10. Says they would provide used epinephrine auto-injector to EMS

Bleeding Control

1. Takes, or verbalizes, standard precautions. Put on gloves. Obtains consent to provide care.

2. Exposes the wound.

3. Covers the wound with a clean dressing.

4. Applies firm, continuous direct pressure using the flat part of their fingers or palm of their hand to press on the wound firmly until the bleeding stops.

5. If the bleeding IMMEDIATELY DOES NOT stop,

   1. removes blood soaked dressings

   2. applied new dressing

   3. presses more firmly over a wider area

      1. OR If the bleeding still DOES NOT stop within ten minutes

   4. Apply additional Gauze before applying a pressure bandage

   5. Apply a pressure bandage over the dressing. Cover the entire dressing and secure.

   6. Consider calling 911, if it hasn’t done so already

   7. Check distal circulation in an arm to leg to make certain the bandage is not too tight.

6. If applying direct pressure fails to control bleeding or appears to be life threatening

   1. Calls EMS

   2. Applies a hemostatic dressing or tourniquet, if available

7. When care is completed, Properly removes and disposes gloves and washes hands with soap and running water.

Checking CSM in an Upper Extremity

1. Takes, or verbalizes, standard precautions.

2. C = Circulation. Checks an upper extremity for circulation using the radial pulse (located on the thumb side of the wrist).

3. S = Sensation. Checks an upper extremity for sensation by having the person close their eyes and then squeezing one of the person’s fingers and asking which finger they feel being squeezed.

4. M= Movement. Checks an upper extremity for movement by asking the person to wiggle their fingers.

Checking CSM in a Lower Extremity

1. Takes, or verbalizes, standard precautions.

2. C = Circulation. Checks a lower extremity for circulation using the posterior tibial pulse (located between the inside ankle bone and the Achilles tendon).

3. S = Sensation. Checks a lower extremity for sensation by having the person close their eyes and then squeezing one of the person’s toes and asking which toe they feel being squeezed.

4. M= Movement. Checks a lower extremity for movement by asking the person to wiggle their toes.

RICE Procedure for Bone, Joint, and Muscle Injuries

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. R = Rest. Informs an injured person to not use or move the body part.

3. I = Ice pack.

   1. Applies cold pack or ice bag over the injured area. States would place a paper towel or thin cloth between the ice pack and skin for protection, or wrap ice in a damp towel.

   2. Uses an elastic bandage to hold the ice pack in place, if available. For extremity injuries, applies the elastic bandage starting distally and working proximally (toes toward hip or fingers towards shoulder).

   3. States they would apply cold for 20 minutes (or 10 minutes if uncomfortable) and reapply every 3 to 4 hours during the first 24 to 48 hours.

   4. Removes ice after no more than 20 minutes

4. C = Compression. Applies an elastic bandage when not applying ice. For extremity injuries, applies the elastic bandage starting distally and working proximally (toes toward hip or fingers towards shoulder).

5. E = Elevation. Keeps the injured part raised higher than the heart as much as possible.

Splinting the Upper Arm (Humerus)

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM.

3. Gently places the injured arm across the person’s chest. If available, ties a rigid splint to the outside of the arm. If a rigid splint is not available, moves on to next step.

4. Applies a sling, if available, or loops a cravat or strap around the person’s neck and wrist to allow the arm to hang in the sling position.

5. Secures the arm to the chest with a swathe (folded triangular bandage).

6. Assesses CSM.

Splinting an Elbow in the Bent Position

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. If the injured elbow is bent, places a rigid splint or SAM splint from the upper arm to the wrist.

4. Ties a rigid splint onto the arm with cravat bandages.

5. Places the arm in a sling.

6. Assesses CSM

Applying a Rigid Splint on a Forearm

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. Places a rigid object (eg, cardboard, wood board, folded newspaper or magazine) under the forearm. Places padding (eg, towel, T-shirt) between the rigid object and the skin. Places padding in the palm (eg, roller bandage, wad of cloth).

4. Secures the splint onto the arm with a roller bandage or folded triangular bandages (cravat bandages).

5. Places the arm in a sling with a binder.

6. Assesses CSM

Applying a Soft Splint on a Forearm

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. Wraps a pillow or folded blanket around the forearm.

4. Secures the soft splint (eg, pillow) by using folded triangular bandages (cravat bandages) or cloth bands.

5. Places the arm in a sling with a binder.

6. Assesses CSM

Splinting a Knee in the Straight Position

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM.

3. Lifts the injured leg and places a rigid splint (long board) under the leg. The splint extends from the buttocks to beyond the foot.

4. Places cravat bandages under the rigid splint.

5. Places soft padding under the knee and ankle.

6. Ties the cravat bandages against the splinting material. Does not tie the knots over the injured area or skin.

7. Assesses CSM.

Splinting a Knee in the Bent Position

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. Places a rigid splint (long board) against the injured leg. Does not place the splint against the knee.

4. Ties a cravat bandage around the splint and lower leg.

5. Ties a cravat bandage around the splint and thigh.

6. Ties knots over the splint, not over the leg.

7. Assesses CSM

Splinting the Lower Leg (Self-Splint)

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. Places padding (folded blanket) between the legs.

4. Pushes the cravat bandages under the leg with a thin board.

5. Ties the legs together.

6. Ties the knots between the legs and over the padding (folded blanket).

7. Assesses CSM.

Splinting the Lower Leg (Rigid Splint)

1. Takes, or verbalizes, standard precautions. Obtains consent to provide care.

2. Assesses CSM

3. Places one rigid splint (board) on the outside (lateral) and another on the inside (medial) of the injured leg.

4. Pushes the cravat bandages under the leg with a thin board.

5. Ties both splints and leg together with cravat bandages.

6. Ties the knots on top of the splint (board).

7. Assesses CSM