First aid protocol

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This protocol is a protocol that needs training on- if you have not been trained in it and kept that training up to date, you're not doing it within queercare.

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

Please see #protocols on Slack to discuss this protocol further.

This protocol is part of first aid protocol and should not be used outside of the accident procedure

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

Please see #protocols on Slack to discuss this protocol further.

This is the protocol for doing first aid, as a high level overview: each section provides a broad coverage of what to do, any red flags and links to full protocol for carrying out a specific task.

Queercare works on the DR(mc)ABCDEFG accident procedure - when doing first aid, you must work down this page, following the instructions for each section in order.

  • If you aren't sure what to do, go to the top of the procedure and start again.
  • If you lose your place, go to the top of the procedure and start again.
  • If you get to the bottom of the procedure, go to the top of the procedure and start again.

Background

The procedure focuses on making sure that the brain is functioning, and especially ensuring oxygenated blood flow to the brain - every step in the first part of the procedure is directly related to this("DR(mc)ABC") while the latter part("DEFG") deals with longer term threats to this blood flow, and getting help to deal with other risks to health.

As you descend the algorithm, the issues you're dealing with become more complex and nuanced as well as less immediately threatening.

  • "Danger" is about making sure that the scene of the incident is not going to become more dangerous, and that you can intervene without becoming a casualty yourself, or hurting the casualty.
  • "Response" is a rapid check for brain function - this lets you flag issues with brain function which may not be immediately visible, and tell the difference between someone who's 'just asleep' and 'comatose'.
  • "Massive haemorrhage" deals with immediate blood loss, which will prevent blood getting to the brain within the seconds to a few minutes.
  • "C-spine" deals with threats to the nervous system which could disrupt the beating of the heart, and thus stop blood getting to the brain (or cause paralysis longer term)
  • "Airway" deals with things that are stopping oxygen getting from someones mouth to their lungs (and thus to their brain)
  • "Breathing" deals with lung function - whether someones lungs are transferring oxygen through the airway and into the bloodstream, and how well that's functioning.
  • "Circulation" determines whether someones heart, arteries and veins are getting the oxygen from their lungs to the brain(and other parts of their body).
  • "Damage" is the first indirect step - it focuses on issues that will cause harm in the longer term such as broken limbs, burns, or blood loss.
  • "Environment" deals with heat related injury- the capability of the body to cool or heat itself.
  • "Flip" refers to putting someone in the "recovery position", a reasonably safe common position to wait for help in.
  • "Get help" covers getting help (calling 999, or getting second line medical support) and handing off to them.


Danger

Red flagYou must call for backup, for example an ambulance if there is danger you cannot secure against when doing first aid

You must do a scene survey. This survey is to spot dangers, and gives you a second to prevent yourself from accidentally harming the patient, or injuring yourself, and making the situation worse. The scene survey should inform your choice of PPE, and you may decide not to engage.

Dangers you might pick up in a scene survey include:

  • Traffic
  • Cops, their dogs, and their horses
  • Bystanders
  • Terrain
  • Fascists
  • Environmental dangers such as live wires, broken glass and needles


You must put on appropriate PPE, and should wear gloves even if there are no bodily fluids in evidence(yet).

This has two reasons behind it: Obviously, you wish to be protected from whatever dangers are involved in the scene, but also taking a second to put on gloves gives you a physical reminder to pause, protect yourself, and calm yourself before acting.

In this time, you should consider your own mental health, and take a second to consider the situation around you. This can also involve calming your breathing quickly, which controls adrenaline and helps you make better decisions.

You should check with your buddy- This protocol is designed for use with a buddy, and all Queercare care work must be done with a buddy. Talking to your buddy about the scene survey, PPE, and your mental health helps make sure you've done the things required in this stage, and have the same understanding of your approach to the situation.

Response

Red flagYou must call for backup, for example an ambulance If a person is only responsive to pain or is completely unresponsive
Red flagYou must call for backup, for example an ambulance If a person has a GCS of below 9
Red flagYou must call for backup, for example an ambulance If a person has a response that is deteriorating rapidly

You must check how responsive the person is, using AVPU- Talk to the person and if they respond coherently, they're Aware.

If they don't respond, try speaking into their other ear, and then raising your voice until you're shouting- if they respond(even a groan or moving their body) then they are Verbally Responsive. If they are not responding now, it is a red flag, have someone(your buddy) call for backup.

Next, you must check for a pain response by pinching the trapezius muscle(the soft part) in the shoulder, or doing a [sternum rub]. If they respond to this, they are pain responsive, and if they do not respond, they are unresponsive. Make sure help is coming and move down the accident procedure.

If you're trained on it, you can use GCS instead.

If they're aware but are becoming(or have become) disoriented, irritable or combative- Keep an eye on them as you continue. If they rapidly slide from disoriented to irritable or irritable to combative, this is a red flag- Get backup now.

Keep moving down the accident procedure and bear in mind you're looking for things that may be effecting their cognition, like alcohol or other cognitive depressants (ie. benzos), severe bleeding, a lack of blood sugar or oxygen.

Massive Haemorrhage

Red flagYou must call for backup, for example an ambulance if you see spurting or pouring blood

If you see spurting or pouring blood, like from a a hosepipe or tapYou must push down hard directly over the location of the bleed, holding the pressure on until it stops.

You will already be wearing gloves when you do this, and you may use a dressing or soft, clean pad, between your hands and your injury. If you have an appropriate dressing which can apply sufficient pressure to stop the bleed, you can use it.

If the blood does not stop from direct pressure, or circumstances do not allow direct pressure, you should apply a tourniquet.

C-spine

Red flagYou must call for backup, for example an ambulance if a person has fallen from more than twice their own height, or been injured by similar force

As you survey and approach the scene, consider whether there's a possibility that the person has fallen from more than twice their own height(or had a similar impact upon them- hit by a car or police horse, for example). If this is the case do not move the persons neck or spine. Approach from their feet(or wherever is in their eye-line without them moving their head) and tell them not to move their head as you approach.

Airway

Red flagYou must call for backup, for example an ambulance if a person does not appear to be breathing

You must Look listen and feel for breathing.

If the person is not breathing and has no evidence of a c-spine injury, you should do a head tilt chin lift. If a person has evidence of a C-spine injury, you should do a jaw thrust instead.

Breathing

Red flagYou must call for backup, for example an ambulance if a person is not breathing
Red flagYou must call for backup, for example an ambulance if a person is breathing under 12 or over 30 breaths per minuite
Red flagYou must call for backup, for example an ambulance if a person has crackles, wheezes or whistles in their breathing

When you Looked, Listened and Felt, you should have been able to determine whether how quickly, deeply or easily the person was breathing. If a person was not breathing but has started breathing when you cleared their airway, look, listen and feel again.

  • If a person is not breathing, do Basic life support
  • If a person is breathing unusually quickly, check for asthma or panic attacks.
  • If a person is using muscles in their kneck when they breathe in(otherwise known as accessory muscles), red flag and check for pneumonia.
  • If a person has wheezes, chrackles or whistles, red flag and continue.

Circulation

Red flagYou must call for backup, for example an ambulance if a persons capillary refill time is more than 3 seconds
Red flagYou must call for backup, for example an ambulance if a persons skin shows symptoms of shock
Red flagYou must call for backup, for example an ambulance if a person has a burn larger than their own hand
Red flagYou must call for backup, for example an ambulance if a person has a third degree burn
Red flagYou must call for backup, for example an ambulance if a person has lost more than 20% of their blood volume
Red flagYou must call for backup, for example an ambulance if an injury exposes nerves or bone

You must check [Capilary refil protocol|capilary refil] or use a [[Pulse oximiter protocol|pulse oximiter] to check the persons circulation.

You must identify any bleeds which aren't massive haemorrhages with a [Chunk Check Protocol|Chunk check] and [Dressing wounds protocol|Dress them].

Damage

Red flagYou must call for backup, for example an ambulance if a person has straw or clear fluid coming from their eyes, ears or nose
Red flagYou must call for backup, for example an ambulance if there is unexplained bruising around their eyes or behind their ears
Red flagYou must call for backup, for example an ambulance if there are unexplained sensory, speech or balance problems
Red flagYou must call for backup, for example an ambulance if a person is experiencing unexplained seizures
Red flagYou must call for backup, for example an ambulance if a person is sliding down DICC
Red flagYou must call for backup, for example an ambulance if there are constrictions to blood flow for more than 10 minutes
Red flagYou must call for backup, for example an ambulance if there is a broken pelvis or leg
Red flagYou must call for backup, for example an ambulance if there is any sign of a dangerous drug overdose

If there are any signs of head trauma (for example, a potential fall or baton hit) you must [Head injury protocol|check for signs of a head injury].

You must check if there are any [DICC sliding protocol|signs the persons cognition is impaired].

You must check for [Disabling injury check protocol|circulation, sensation and motion] in all limbs.

If the person is conscious, you must ask them if they've taken any medications or substances which could cause an overdose. You should reassure them that this information will not be passed to the police (and, do not pass it to the police) and will not get them in trouble. If this is the case, for poisoning.

If the person is unconscious, you should look around for signs of an overdose or of medications effecting their consciousness - for example pill packets, syringes, needles, bottles or cans. If you suspect opioid overdoses, [Naloxone_protocol|treat these].

Environment

Red flagYou must call for backup, for example an ambulance if a person has hot but dry skin
Red flagYou must call for backup, for example an ambulance if a person has cold and pale or grey skin, combined with tiredness or sliding down DICC

Flip

If the person is unconscious, you must now move them into the recovery position, unless they have a suspected C-spine injury. You must not move someone with a suspected C-spine injury.

If the casualty is conscious you should not move them, and tell them instead to move to make themselves comfortable. When they do this you should advise:

- Raising minor veinous bleeds to reduce pressure to reduce blood pressure around the injury. When doing this, ensure that these do not lead to disruption of the airway via this blood- for example, do not tilt the head back to ease the pressure on a nosebleed, causing blood to flow down the airway as opposed to out of the nose.

Get help

If you have encountered any Red Flags, above, now is the time to [Red flag protocol|call an ambulance] or other medical backup, or to check in with this process if your buddy has already initiated it.

If you're not dealing with a case which has a red flag, you should consider whether to move the person to reduce risk, or to leave them in their current position(or to move on and say goodbye if there's no further risk)