Each emergency is different. The rules in Box 31-1 apply to any emergency. Hospitals and other agencies have procedures for emergencies. Rapid Response Teams (RRTs) are called when a person shows warning signs of a life-threatening condition. An RRT may include a doctor, a nurse, and a respiratory therapist. The RRT’s goal is to prevent death.

Box 31-1 Rules of Emergency Care

• Know your limits. Do not do more than you are able. Do not perform an unfamiliar procedure. Do what you can under the circumstances.

• Stay calm. This helps the person feel more secure.

• Know where to find emergency supplies.

• Follow Standard Precautions and the Bloodborne Pathogen Standard to the extent possible.

• Check for life-threatening problems. Check for breathing, a pulse, and bleeding.

• Keep the person lying down or as you found him or her. Moving the person could make an injury worse.

• Move the person only if the setting is unsafe. Examples include:

• A burning car or building

• A building that might collapse

• Stormy conditions with lightning

• In water

• Near electrical wires

• Wait for help to arrive if the scene is not safe enough for you to approach.

• Perform necessary emergency measures.

• Call for help. Or have someone activate the EMS system. Do not hang up until the operator has hung up. Give the following information.

• Your location: street address and city, cross streets or roads, and landmarks

• Phone number you are calling from

• What seems to have happened (for example, heart attack, crash, fire)—police, fire equipment, and ambulances may be needed

• How many people need help

• Conditions of victims, obvious injuries, and life-threatening situations

• What aid is being given

• Do not remove clothes unless you have to. If you must remove clothing, tear or cut garments along the seams.

• Keep the person warm. Cover the person with a blanket, coats, or sweaters.

• Reassure the person. Explain what is happening and that help was called.

• Do not give the person fluids.

• Keep on-lookers away. They invade privacy and tend to stare, give advice, and comment about the person’s condition. The person may think the situation is worse than it is.

See Focus on Communication: Emergency Care.

See Promoting Safety and Comfort: Emergency Care.

Focus on Communication

Emergency Care

Some illnesses and injuries are life-threatening. To find out what happened and the person’s condition, you can say:

• “Are you okay?”

• “Tell me what’s wrong.”

• “Where does it hurt?”

• “If you can, please point to where it hurts.”

• “Can you move your arms and legs?”

Promoting Safety and Comfort

Emergency Care

Safety

During emergencies, contact with blood, body fluids, secretions, and excretions is likely. Follow Standard Precautions and the Bloodborne Pathogen Standard to the extent possible.

When an emergency occurs in an agency, call for the nurse at once. You may need to activate the EMS system or the RRT. Or you take the person’s vital signs (Chapter 21). Assist as instructed by the nurse.

Comfort

Mental comfort is important during emergencies. Help the person feel safe and secure. Give reassurance. Explain the care you provide. Use a calm approach.

BLS for Adults

When the heart and breathing stop, the person is clinically dead. Blood is not circulated through the body. Heart, brain, and other organ damage occurs within minutes. The American Heart Association’s (AHA) BLS procedures support circulation and breathing.

Chain of Survival for Adults

The AHA’s BLS courses teach the adult Chain of Survival. These actions are taken for heart attack (Chapter 28), sudden cardiac arrest, respiratory arrest, stroke (Chapter 28 and p. 493), and choking (p. 491). They also apply to other life-threatening problems. They are done as soon as possible. Any delay reduces the person’s chance of surviving.

Chain of Survival actions for adults are:

• Recognizing cardiac arrest and activating the EMS system at once.

• Early cardiopulmonary resuscitation (CPR).

• Early defibrillation. See p. 487.

• Early advanced care. This is given by EMS staff, doctors, and nurses. They give drugs and perform life-saving measures.

• Organized post–cardiac arrest care. This is care given to improve survival following cardiac arrest.

See Focus on Communication: Chain of Survival for Adults.

Focus on Communication

Chain of Survival for Adults

Calling for help is a critical step in the Chain of Survival. If others are around, tell a certain person to activate the EMS system. You may not know the person’s name. Point to the person. Make eye contact. You can say: “Call 911 and get an AED.” (AED stands for automated external defibrillator. See p. 487.) Begin care. Follow up soon. Make sure the person was able to call for help.

Promoting Safety and Comfort

CPR for Adults

Safety

The discussion and procedures that follow assume that the person does not have injuries from trauma (Chapter 24). If injuries are present, special measures are needed to position the person and open the airway. Such measures are learned during a BLS certification course.

BLS guidelines for infants and children differ from adult guidelines. The procedures also differ. The discussion and procedures in this chapter apply to adults. BLS for infants and children is learned during a BLS certification course.

Chest Compressions.

The heart, brain, and other organs must receive blood. Otherwise, permanent damage results. In cardiac arrest, the heart has stopped beating. Blood must be pumped through the body in some other way. Chest compressions force blood through the circulatory system.

Before starting chest compressions, check for a pulse. Use the carotid artery on the side near you. To find the carotid pulse, place 2 or 3 fingertips on the trachea (windpipe). Then slide your fingers down off the trachea to the groove of the neck (Fig. 31-1). Check for a pulse for at least 5 seconds but no more than 10 seconds. While checking for a pulse, look for signs of circulation. See if the person has started breathing or is coughing or moving.

FIGURE 31-1 Locating the carotid pulse.
A, Two fingers are placed on the trachea. B, The fingertips are moved down into the groove of the neck to the carotid artery.

The heart lies between the sternum (breastbone) and the spinal column. When pressure is applied to the sternum, the sternum is depressed. This compresses the heart between the sternum and spinal column (Fig. 31-2). For effective chest compressions, the person must be supine on a hard, flat surface—floor or back-board. You are positioned at the person’s side.

FIGURE 31-2 The heart lies between the sternum and the spinal column. The heart is compressed when pressure is applied to the sternum.

Hand position is important for effective chest compressions (Fig. 31-3, p. 486). You use the heels of your hands—1 on top of the other—for chest compressions. For proper placement:

FIGURE 31-3 Proper hand position for CPR.
A, The heel of the dominant hand is placed in the center of the chest between the nipples. B, The heel of the non-dominant hand is placed on top of the dominant hand.

• Expose the person’s chest. Remove clothing or move it out of the way. You need to see the person’s bare skin for proper hand position.

• Place the heel of 1 hand (usually your dominant hand) in the center of the bare chest. The heel of this hand is placed on the sternum between the nipples.

• Place the heel of your other hand on top of the heel of the first hand.

To give chest compressions, your arms are straight. Your shoulders are directly over your hands. And your fingers are interlocked (Fig. 31-4). Exert firm downward pressure to depress the adult sternum at least 2 inches. Then release pressure without removing your hands from the chest. Releasing pressure allows the chest to recoil—to return to its normal position. Recoil lets the heart fill with blood.