Stcw 95 basic first aid june 13

STCW 95Basic First Aid

STCW 95Basic First Aid: References

• STCW95: Section A-VI, Table A-VI/1-3

• American Heart Association, Heartsaver AED

• Ship Captain’s Medical Guide, 1999, MCA

STCW 95STCW-95

• Elementary First Aid: Table A-VI/1-3

– Immediate Care. Required training for all seafarers

• Medical First Aid: Table A-VI/4-1

– “The first responder” required after 8/98• Person in Charge:Table A-VI/4-2

– At least one per ship• Medical Care Onboard:Table A-II/2

– Master Chief Mate.

STCW 95Course Objectives• Define potential scene hazards, biohazards

and methods to protect rescuers.• Demonstrate adult, single rescuer CPR and

airway management.• Introduction to the use of the AED.• Response to bleeding, shock and burn

emergencies.• Introduction to moving a patient.

STCW 95What are you required to do?

Take immediate action upon encountering an accident or medical emergency.

• Keep yourself safe!

• Assess for injury or illness

• Treat appropriately

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What are you required to do?– Proper patient positioning – Control the airway – Protect the spine – Maintain vital functions– CPR and AED– Control of hemorrhage and application of bandages – Immobilize when you suspect a bone injury– Treat burns, both thermal and electrical– Define, recognize and provide basic treatment for

shock from any cause

STCW 95How will we be tested?• Written, CPR/First Aid

• Skills, evaluations after through instruction

STCW 95Basic First Aid• The first responder

makes a tremendous difference in patient outcome

• What you do in the first 5 minutes can either help or doom a patient

STCW 95Onboard Resources

Call for help early!

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You are Responsible for Protecting:• Self

• Bystanders

• Patient

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Protect Yourself First: Scene Hazards• HAZMATS

• Confined spaces

• Electrical hazards

• Bloodborne pathogens

• Airborne pathogens

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First: Know what chemicals you are carrying!Do not enter a possibly contaminated / confined area unprotected!

Protect Yourself First: Scene Hazards

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Fire Hazard– Most combustibles will emit toxic smoke– Protect yourself and others from exposure to

inhaled toxins

Protect Yourself First: Scene Hazards

STCW 95Biohazards / Infectious Diseases


1. Wash your hands

2. Wash your hands

3. Wash, Wash, Wash your hands


• Use barrier devices such as: gloves, gowns, masks.

• Wash hands after contact with a patient.

• Have current vaccinations including Hepatitis B vaccine.

Personal Protection: Bloodborne Pathogens

STCW 95Personal Protection-Gloves

• Required for all patent contact.• If its wet and its not yours you don’t want it!• Gloves have small holes in them that we

cannot see but they are there.• Change bloody gloves immediately!

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Biohazards / Infectious DiseasesAirborne Pathogens; what can

you catch ?

• TB (HEPA Mask)

• Measles/Chicken Pox

• Meningitis

• Mono

• Upper respiratory infections including pneumonia

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Personal Protection: Airborne Pathogens• Use masks/ BVM for

CPR/Rescue breathing.• Wear face mask in

presence of person with cough.

• Keep patients with productive cough in well-ventilated area.

Biohazards / Infectious Diseases

STCW 95Biohazards / Infectious DiseasesStock a Broad range

of Antibiotics

STCW 95Proper Waste Disposal

STCW 95Duty-to-Act• Legal obligation of certain

persons either by statute, treaty or function to provide care

• Shipboard: Duty as officer to care for crew

• Shoreside: Protection through Good Samaritan Act

STCW 95Good Samaritan Act• Provides protection from law suit in non-

employment situation

• Must meet three criteria:• Acted within scope of practice or training.• No compensation received.• Patient turned over to competent provider.

STCW 95Consent• Expressed Consent: Knowingly consents to

being treated.

• Implied Consent: Cannot consent but a reasonable person would assume that they would wish to be treated. (i.e.; unconscious or minor unable to legally consent.

• Abandonment: Termination of care without patient’s consent.

STCW 95"חוק "לא תעמוד על דם רעך. 28/9/98, נכנס לתוקף ב-1998חוק לא תעמוד על דם רעך, התשנ"ח–

א( חובה על אדם להושיט עזרה לאדם הנמצא לנגד עיניו, עקב אירוע (פתאומי, בסכנה חמורה ומיידית לחייו, לשלמות גופו או לבריאותו, כאשר

לאל-ידו להושיט את העזרה, מבלי להסתכן או לסכן את זולתו.)ב( המודיע לרשויות או המזעיק אדם אחר היכול להושיט את העזרה

הנדרשת, יראוהו כמי שהושיט עזרה לעניין חוק זה; בסעיף זה, "רשויות" - חוק זה הופך את החובה .משטרת ישראל, מגן דוד אדום ושירות הכבאות

המוסרית של עזרה לזולת לחובה הנובעת מחוק. העובר על הוראת החוק .קנסעונשו

תקף במקרה שמתקיימים:"לאדם הנמצא לנגד עיניו".•"עקב אירוע פתאומי".•"בסכנה חמורה ומיידית לחייו, לשלמות גופו או לבריאותו".•

*הזעקת עזרה חיצונית )מד"א, משטרה וכיו"ב( נחשבת כעזרה מספקת.

STCW 95

Heartsaver AEDHeartsaver AEDfor the Lay Rescuer andfor the Lay Rescuer and

First ResponderFirst Responder

©1998 American Heart Association1998 American Heart Association

STCW 95Extent of the Problem• 1.1 million heart attacks

• 480,000 deaths due tocoronary heart disease

• 250,000 prehospital cardiac arrests

In Israel:

• 25,000 heart attacks a year

• 7,000 deaths a year due to coronary heart disease

STCW 95Heart Attack• Heart Attack

(Myocardial Infarction)– Blockage of blood flow.– Results in death of

heart muscle.

• Presentations:– Sudden death.– Massive chest pain.– Mild chest discomfort.

STCW 95Stroke: CVABlockage of a cerebral artery

Symptoms:• Dizziness, headache• One sided paralysis• Slurred speech• Unconsciousness, coma• Seizures

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“The first symptom of a heart attack is denial”!

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Heart Attack & Stroke: Risk Factors• Hypertension (high BP)• Smoking• Obesity

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• Excessive alcohol intake

• Diabetes

Heart Attack & Stroke: Risk Factors

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• Lack of exercise• High fat diet


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• Age

• Gender

• Family history

• Race


STCW 95Heart RhythmSinus Rhythm is normal electrical conduction in the

heart

VF is a frequent initial rhythm in sudden

cardiac arrest

VF is a quivering of the heart with no blood

flowDefibrillation is the only effective treatment for VF

STCW 95Other Heart Arrhythmias

Ventricular tachycardia

)shockable(

Asystole

)not shockable(

STCW 95Time and AEDs• Approximately 50%

survival after 5 minutes

• Survival reduced by 7% to 10% each minute

• Rapid defibrillation is the key

• CPR helps extend survival time

minutes

0

20

40

60

80

100

1 3 6 10

Survival

STCW 95Basic Life Support: CPR• If neck injury suspected:

– jaw thrust

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CPR IN THREE SIMPLE STEPS • CALL Check the victim for unresponsiveness. If

there is no response, Call 911 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions.

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CPR IN THREE SIMPLE STEPS cont.

• BLOW Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second.

STCW 95CPR IN THREE SIMPLE STEPS

cont.• •PUMP If the victim is still not breathing normally,

coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 30 times right between the nipples. Pump at the rate of 100/minute, faster than once per second.

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CPR IN THREE SIMPLE STEPS cont.

• CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES NOTE: This ratio is the same for one-person & two-person CPR. In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.

STCW 95Basic Life Support: CPRIf pulse & breathing are

restored– but patient remains

unresponsive

Place in the recovery position.

STCW 95Basic Life Support: CPRWhen can CPR be

discontinued?– Physically exhausted – Patient revived– Relieved by trained rescuers– Unsafe to continue

STCW 95When Can CPR be Discontinued?

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Basic Life Support: Obstructed Airway

STCW 95Assessing the Patient

Chief Complaint• Nature of the illness

• A statement in the patients own words as to “what's wrong.”

• Ask the patient what they think is wrong they may know.

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Medical Alert Tags Patients Medications

STCW 95Adult Assessment• Form a general impression

– does the patient look sick?

• What is the mental status?– are they awake? Do they respond when you call their

name? shake them or pinch them?

• Can they speak?• are they breathing well or labored?

– Can they complete a sentence without stopping or are they gasping?

• What is their general color– is the skin warm and pink or pale, cold, wet?– Look around the face and mouth.

STCW 95Assess the Pulse

STCW 95Assess the Respirations

STCW 95Bleeding• Types of bleeding:

– Arterial: bright red, spurting: usually most serious– Venous: dark red, steady flow– Capillary: oozing

• Signs of internal bleeding– bruising– fractured ribs or bruises on the chest or abdomen– vomiting or coughing up blood

STCW 95

Usually looks worse than what it actually is.

Methods to control bleeding:– direct pressure– elevation– pressure dressing– pressure point– Tourniquet

Do not remove a dressing - reinforce

Bleeding

STCW 95Bleeding : Direct Pressure

STCW 95Bleeding: Elevation and Direct

Pressure

STCW 95Bleeding: Pressure Points

Pressure Points - Compress the artery over the bone to stop bleeding.

STCW 95TourniquetApply pad over

artery - proximal to injury

Wrap with wide material, apply

leverage: “windlass”

Tie down lever & secure tails

STCW 95PuncturesHarbor bacteria & are prone

to infection• Soap and water• Use irrigation and soaking• Peroxide is useful

– Careful monitoring after injury for signs of infection

STCW 95

Lacerations: Rough Jagged Edges

STCW 95Abrasion: Scraping the top layers of skin

STCW 95Shock

Loss of circulating blood volume– present in all injuries– inadequate tissue perfusion

STCW 95ShockSymptoms: • Rapid pulse • Pulse may be weak ("thready") • Rapid breathing • Anxiety, nervousness • Cool skin • Weakness, excessive tiredness • Pale skin, bluish skin ( cyanosis) • Sweating, moist skin • Low blood pressure

STCW 95Shock

Treatment• Give Oxygen• Reduce body’s workload• Keep patient warm & calm• Treat or manage

underlying cause

STCW 95Burns: Thermal

First degree: reddened skin (e.g, sunburn), painful– Cool with water

STCW 95Burns: Thermal Second degree; blistering of

deeper layers of skin- painful– Cool with water, dry sterile

dressing– Do not break blisters

STCW 95Burns: Thermal Third degree: black charred,

or hard white skin– Cool with water, dry

sterile dressing – All layers of skin &

underlying tissue are burned

– May not be painful

STCW 95BurnsBurns

– Often a very serious injury

– Any significant burn requires evacuation

STCW 95Burns: treatmentStop the burning process- cool the area with tepid

water

Assess the burn

May give pain relief immediately

Apply sterile dry non adherent dressing

Always treat for shock

Monitor for infection

Don’t:•Use ice•Break blisters•Use butter or other home remedies

STCW 95Patients palm is equal to 1% of

their Body Surface

STCW 95Burns: Thermal Other considerations:

– Burns to face & neck: airway & vision compromise

– Circumferential burns: impaired circulation

– Patients are prone to Infection– Patients lose fluids - Hypovolemia– Patients lose heat - Hypothermia

STCW 95Burns: Electrical • Turn off power

• Check ABC’s– anticipate cardiac arrest– access AED

• Consider spinal protection when moving patient

STCW 95Burns: Chemical

Liquid chemical - flush with water

Dry chemicals (lime)- brush away before flushing

Chemical burns to the eyes– flush for at least 20 minutes after

burning stops– avoid contaminating non-

affected eye

STCW 95SplintingNever restrict blood flow

Check for color, motion and sensitivity to affected limb )CMS( – before/after

Immobilization prevents further damage

Combine with elevation and application of ice

Maintain position of function

STCW 95Splinting

• When splinting a broken bone- the splint should extend to immobilize also the joint above and below

• When splinting a joint- the splint should extend to immobilize also the bone above and below

STCW 95Splinting

STCW 95Sling and Swathe

• Useful for upper arm, shoulder or collarbone

• May also help in elbow fx. / dislocation

• Not required for ALL upper extremity injuries!!

STCW 95Open bone injuries1. Apply a sterile dressing over the bone ends2. Try to splint in a neutral position3. Do not bring ends of the bone back under the

skin unless advised to do so by the doctor

STCW 95Proper Splinting?

STCW 95Moving a Patient

General Rule: Do not move patient until skilled help arrives

• Exceptions:– Area unsafe to patient– Area unsafe to rescuer

STCW 95Moving a Patient: Blanket Roll

Place a half-rolled blanket alongside the casualty


Roll the casualty gently onto his side: The attendant closest to the head, or a 3rd attendant,

must support the casualty’s head


Roll the casualty gently over


Prepare the blanket for lifting the casualty by rolling the edges tightly


Lifting the casualty: Tension to all side of the blanket & traction applied to the head

STCW 95Moving a Patient: Backboard

STCW 95Moving a Patient: Two-Man Carry

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2-man drag through narrow space

Moving a Patient: Two-Man Carry

STCW 95Moving a Patient: One-Man Carry

One-man drag through narrow space

STCW 95Moving a Patient: One Man Drag

STCW 95Summary• Be safe: don’t become another victim• Remember to call for help• ABC’s of first aid

Stcw 95 basic first aid june 13

Health & Medicine

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