Training now being delivered in Corby at Rubix Northampton, England

1. ATLANTIAN BUSINESS SOLUTIONS
FIRST PERSON ON THE SCENE
F-POS
BASIC 10 Hours OF TRAINING
INTERMEDIATE 30 Hours OF TRAINING

2. Pre – Hospital Environment
Definition: Pre – Hospital Care
Any Medical Intervention or procedure given prior to arrival
of the casualty in Hospital
Definition: First Aid
The First intervention of any person providing care to a
person who has become ill through injury or illness
(Including Mental Health)
Definition: Paramedic
Authorised person trained to provide Advanced Medical
Intervention outside of a Hospital Environment (including the
administration of some authorised Drugs)
Definition: Hospital Care
Any Medical intervention given within a Hospital
environment (NHS Trust) which could be Out-Patients, In-
Patients, Doctors Surgery or Out Reach Clinics (Hospitals
provide Advanced Specialist Medical Treatment)

3. Role of the First Person On the Scene
• To Help reduce the amount of Unnecessary
deaths and complications by providing Medical
Assistance prior to the arrival of Paramedics,
Doctors or the Evacuation to Hospital facility
• Provision of the - CHAIN OF SURVIVAL
EARLY EMERGENCY SERVICE ACCESS
EARLY BASIC LIFE SUPPORT
EARLY DEFIBRILLATION
EARLY ADVANCED LIFE SUPPORT

4. Role of the First Person On the Scene
Scene Safety
Danger
Look
Listen
Think
Violence

5. DANGERS
• Before undertaking any Patient Assessment
• Consider your own SAFETY
• Consider Safety at the SCENE
• Consider SAFETY - PATIENT
• Consider the stability of the ENVIRONMENT
The first few seconds of an incident will be
confusing and dangerous for you or others
Don’t become a Casualty yourself
Or
Endanger Others Lives

6. LOOK
• Immediate dangers to yourself, patients and others
(Drivers, The Public & Bystanders)
• Hazards – Electricity, Water, Land Slides, Violence, Chemicals,
The Environment, Vehicles and Gases
• Incident – What has happened and what is about to happen
• Mechanism of Injury – Fall from Height, RTC, Sharps
Injury, Act of Violence, High/Low speed impact & Velocity
• Position of Patient - Trapped, Lying Awkwardly, In Water,
In Car, In between moving machines
• How Many Patients: Is anyone missing, What
are their Injuries
• Triage injured C - ABC
• What Assistance is already on the Scene
(Police, Fire or other Trained Medic’s)

7. Listen
• Use your ears – Traffic, Creaking
Buildings, Wind, even for the lack of noise, it all
tells a story
• Listen to what bystanders or Witnesses telling
you about How, when, where, who and any other
possible dangers or injuries
• Listen to Colleagues, Members of other Services

8. THINK
• Think and Consider all you have Seen
• All you have heard
• Your Priorities
• What can be done to help the Patients
• What Additional YOU need
• What was the cause of the initial injuries
DON’T RUSH IN
TAKE A MOMENT TO ASSESS THE SITUATION

9. VIOLENCE
• Unfortunately people can turn violent even when
being treated by Medical Staff
• Where always remain Calm yet Assertive
• Be Polite and Professional
• Maintain a clear exit route whenever possible
• If the Aggression becomes focused on you Leave
immediately Contact your Supervisor/Police if in
attendance
• Use Conflict Management Skills –
Rapport, Empathy and engagement to reduce the
chain of frustration (Frustration – Anger – Aggression –
Violence)

10. Minimising the Risk of Infection
Universal Precautions
• Keep Cuts & Grazes Covered at all times
• Good Personal Hygiene (Regular Hand Washing)
• Clean , Short finger nails
• Wash hands Before, After and in between medical interventions
or patient contacts
• Wear PPE – Gloves, Eye Protection & Overalls
• Dispose of Clinical Waste Appropriately (Such as bandages,
Sharps and used equipment)
• All re-usable Equipment must be sent for disinfecting and
cleaning
• Get Your immunisations up to date Tetanus & Hepatitis B
(Minimum)
• Wash all stained clothing at 60 degrees centigrade
and separate from normal washes

11. Blood & Body Fluids - Spillages
• These are a potential Hazard from Infection and
may contaminate other equipment
• Deal with caution – Gloves – Face Mask Etc.
• Ensure their Safe Removal
• Minimise the Risk of Infection to YOU & Others
• Small amounts of fluids may be wiped up with
paper towels or similar (Dispose in Clinical Waste
bags)
• If in Possession of Granules, absorbent
powder, Verucidal disinfectant spray - use as per
manufacturers instructions
ALWAYS WEAR GLOVES WHEN
DEALING WITH SPILLAGES

12. RESPONDING TO A CALL
PLANNING IS ESSENTIAL :
• Check: Mobiles, Pagers, Radios are Serviceable
(Check for areas with poor reception on with your provider. Charged?)
• Check all Medical Equipment (Spare Batteries,
Inspected/Calibrated, Straps not worn, In Date, Clinically Sealed etc.)
• Route Planning (Maps, Sat Nav, Weather, Accessibility &
timings to RV points/Other Services, Vehicles)
• Paper Trail (Medical Notes, Roma’s, Patient Forms, Incident
Reports) *If it’s not written down it didn’t happen or it’s your fault*
• Unless escorted you have NO EXEMPTION
under the Road Traffic Act – Road Safety,
Park Safely, light up the area – STAY ALIVE

13. EQUIPMENT – CHECKS (Demo)
• Personal Protective Equipment • Stiff Neck Collars (All Sizes)
• Identity Cards • Telford Extraction Device (TED)
• Gloves • Spinal Boards (Head immobilisation)
• Protective Overalls • OP Airways (Various Sizes)
• Jackets • Oxygen Cylinder & Regulator
• Torch • Bag Valve Mask
• Pager • Oxygen Masks
• Pocket Mask • Suction Equipment
• Scissors/Cutting Shears
• AED – (Charged) Incident Management Kit
• Glow Lights/Beacons
• Various Dressings
• Ropes & Straps
• Radio/Mobile Phones
• Blankets
• Maps • Police Cones
• Patient Report Forms • Incident Tape

14. COMMUNICATING WITH PATIENTS
Dealing with patients who may be distressed because
of their situation & who are suffering from Injuries, an
illness and or Pain may be difficult to deal with; they
may be frustrated, verbally abusive, angry or
violent, invariably this is not directed at the Medic but is
in fact a symptom of their situation.
• Remain Calm and Professional
• Speak Clearly in normal language (No Jargon)
• Use Empathy & Rapport
• Position yourself appropriately to the threat
• Reduce the Pain (Entonox/Position/GTN)
• Be truthful (Especially if a procedure hurts, Say so)

15. Behaviour – Medical Conditions
• Hypoglycaemia (Low Blood Sugar) Inappropriate
behaviour, violence appearance of being drunk
• Stroke – Their speech may be slurred or
garbled, or the person may not be able to talk at all
despite appearing to be awake and in mild cases
my be frustrated and or Aggressive
• Mental Health – Multiple conditions with multiple
degrees of emotion, frustration, Anger or Violence
• Heat Stroke (Hyperpyrexia) In severe heat
stroke, they may be confused, hostile, or
seemingly have intoxicated behaviour
• Drugs Overdose – Varying behaviour types
from passive to extreme violence and fear

16. PATIENT INTERACTION
• Consent must be obtained from the Patient prior to
delivering any medical intervention
• Approval/Consent can be given in several ways –
Verbal Consent, Non Verbal Consent and the
Consent of an Authorised Carer
• Where the Patient is Unconscious or in Cardiac
Arrest & No Relative or Carer is present – You may
commence treatment as delay could be fatal
• Relatives can express a view but can NOT give
LEGAL Consent
• Whilst relatives cannot stop a Medic delivering care
they may become aggressive if you do not stop
when asked – Don’t endanger your own safety.

17. Language Barriers
• Use Relatives or Bystanders (Avoid Breaking
Patient Confidentiality)
• Allow more time so the patient can understand
• Use Non – Verbal methods to reassure them,
hands, facial, Descriptive drawings
• Never raise you voice in anger/frustration
• Communicate information about what is
happening
• Make an effort to Pronounce the Patients name
correctly
• Find out if the Patients has any worries or
concerns
• Do Not maintain a Silence it may seem ignorant

18. HAND OVER TO AMBULANCE CREW
• Any Dangers – immediate or in the future
• Patients Name
• Patients Age (Date of Birth)
• Brief history of the event – Illness or Injury
• Past Medical History
• Allergies (Especially Anaphylaxis)
• The Mechanism of Injury (Known or Suspected)
• Injuries Found/Suspected
• Signs & Symptoms
• Any Treatment Given
• Any Medication used/taken by Patient

19. EXAMINATION & ASSESSMENT
• Not all injuries are Obvious
• History is as important as the application of
Immediate First Aid
• Listening to the History prevents (?) FATAL
mistakes in treatment
• HISTROY can be from the: Patient, Bystander,
Relative (if no one present – Visual)
• Visual observation of the Patient/Scene
• Listen carefully to How/When and What
Happened
• Always be calm, confident, Assertive and
Professional

20. HISTORY OF THE INCIDENT
• The Human body can be remarkably Resilient
• As a Medic we need to understand the
possibilities involved during impact, through the
Transference of Energy
• A severely damage Car is likely to have a
Severely damaged person inside or outside of the
Vehicle (Sometimes several metres away)
• Conversely people have died or have been
paralysed from falling/tripping a road kerb stone

21. HISTORY OF THE INCIDENT
Sudden illness
• What is the main problem? (C-ABC)
• What are the patients symptoms ?
• Has the patient had this before ?
• Do they have Medication ? (GTN, Glucose)
• When did the problem start ? (Original & New)
• What changes if any since the symptoms began?
• Monitor & Record – BP, B-sugars, Temperature
Pulse, Respirations, Pain (0 = none 10 = unbearable)
• Respond to monitored changes

22. HISTORY OF THE INCIDENT
• Fall from Height
• Indirect pressure (Blast wave)
• Imbalance of weight (Tendon Strain)
• Whiplash (Car Crash)
• Sudden Impact (Hit by Object)
• Gun Shot
• Violence
• Pressure (Crushing injury)
• Insect (Bites & Stings)
• Exposure (Gas, Poisons, Pathogens)
• Environmental (Heat & Cold)

23. MECHANISM OF INJURY
• The Energy of any impact is transmitted and shared
between the bodies involved
• The Energy of a Metal object strikes a human
body, that energy doesn’t stop but transfers into the
tissues, creating varying amounts of damage
depending on the velocity, size and resistance
Consider:
Type of Incident (A Fall down the Stairs)
Forces Produced and Applied
(Speed, Direction, Energy, Sudden Stop)
Area of the body involved (Head, Body, Limbs)
Nature of injuries likely to be produced (Dependent on
objects hit on the way down the stairs) , Wood, Concrete, Carpeted

24. MECHANISM OF INJURY
• RTC (Road Traffic Collision)
Whip Lash Facial Injuries Chest Compression
Fractures Lower Limp Injuries Seat Belt Injuries

25. MECHANISM OF INJURY
• Compression
• Acceleration
• Deceleration
• Low Energy
• Medium Energy
• High Energy
• Shearing (Change of Speed)
• Stretch
• Cutting
• Cavitation
• Thermal Injury

26. MECHANISM OF INJURY
• Body generating Opposing Directional forces

27. PRACTICAL ASSESSMENT
• DANGER
• PRIMARY SURVEY
• AIRWAY
• BREATHING
• CIRCULATION
• DISABILITY
A – ALERT
V - VERBAL STIMULUS
P – PAINFUL STIMULUS
U – UNRESPONSIVE
• MONITOR every 5 – 15 minutes

28. Trauma Triage
• Trauma triage is the prioritising of patients for
treatment or transport according to their severity of
injury.
• Primary triage is carried out at the scene of an
accident
• Secondary triage at the casualty clearing station at
the site of a major incident.
• Triage is repeated prior to transport away from the
scene and again at the receiving hospital.

29. Trauma Triage
• The primary survey aims to identify and
immediately treat life-threatening injuries and is
based on the 'ABCDE' resuscitation system.
• Airway control with stabilisation of the cervical
spine.
• Breathing.
• Circulation (including the control of external
haemorrhage)
• Disability or neurological status.
• Exposure or undressing of the patient while also
protecting the patient from hypothermia.

30. Trauma Triage
• Priority is given to patients most likely to
deteriorate clinically
• Triage takes account of vital signs,
• Is a dynamic process and patients should be
reassessed frequently.
• In the UK, the 'T system' is conventionally used at
a major incident:

31. T - System
• Immediate priority (T1): require immediate life-
saving intervention (Red).
• Urgent priority (T2): require significant
intervention within two to four hours (Yellow).
• Delayed priority (T3): require intervention, but not
within four hours (Green).
• Expectant priority (T4): treatment at an early
stage would divert resources from potentially
beneficial casualties, with no significant chance of
a successful outcome (Blue).

32. Trauma Triage
• Smart Incident Command System (MIMMS)
• Dead - patients who have a trauma score of 0 to 2
and are beyond help
• Immediate - patients who have a trauma score of 3
to 10 (RTS) and need immediate attention
• Urgent - patients who have a trauma score of 10 or
11 and can wait for a short time before transport to
definitive medical attention
• Delayed - patients who have a trauma score of 12
(maximum score) and can be delayed before
transport from the scene

33. Sieve - Triage
• Can the patient walk? (Yes): Is the patient
breathing? No/Minor Bleeding Priority 3 (Green)
• Not Breathing (After opening airway)/Major
Bleeding : Priority 1 (Red).
• Breathing without resuscitation - What is the
respiratory rate? Above 30/minute or less than
10/minute: Priority 1 (Red).
• 10-30/minute: What is the pulse rate (or capillary
refill time)? Less than 40 or more than 120 (or
capillary refill time greater than 2 seconds):
Priority 1 (Red).
• Between 40 and 120 (or capillary refill time less
than 2 seconds): Priority 2 (Yellow)

34. Fractures & Injuries
Radius
Ulna
Posterior dislocation
of the radius and the ulna

35. Cervical/Spinal Injuries

36. 24 Mobile vertebra in the spine & 5 Fused
7
12
5
5 Fused

37. INJURY TO SPINAL CORD
Protect the Patients Quality
of Life
IF IN DOUBT
Stiff Neck Collar
TED
Spinal Board
Immobilisation
HOSPITAL P1 (T1)

38. Incident Management
Scene Management Scene Visibility
Scene management is one of the most important aspects
of First Aid – Never forget the stupidity of Humanity

39. Incident Management
• Look Behind – Front – Left & Right
• LOOK ABOVE & BELOW
• WHAT HAZARDS HAVE YOU SEEN ?
• Light up the Scene – HAZARD LIGHTS ON
RED – BLUE - AMBER LIGHTS FLASHING
• Considerations:
• FIRE (Fuels, Fabric's, Toxic Gas/Materials)
• SOURCES OF COLLAPSE (Loads, Trees, Mud,
Water, Roofs, Vehicle Debris etc.)
• SAFE - Exit & Entry Routes
Patients have been thrown up to 20ft from impact
Wondering injured 50 Metres plus

40. IMPACT ZONE
5 - 10 METRES
IMMEDIATE
BLOCK OFF
100ft
Harbour Area
Diversion/Hazard
Warning
Min 500ft 100ft