A/V Geeks 16mm Films: Keep Them Alive - Emergency Medical Procedures

They're both dead. Oh, Lord. They can't be dead. There's broken bones and cuts and bumps. Those aren't fatal. Why then? What? What do you have to do? How do you keep them alive? You're going to be first at the scene of many accidents. And people are going to be hurt. And you're going to be alone. It's up to you to provide emergency medical treatment. It's up to you to keep them alive. And that's what this is all about. The natural impulse is to get busy. Stop the blood. Bandage the cuts. Straighten them out and make them comfortable. Splint the broken bones. Get busy on the obvious injuries, while hidden ones could be killing them. Wrong. Dead wrong. First, think about priorities. Think about conditions that could kill rapidly. Life-threatening conditions. He will die if he can't breathe. He will die if his heart stops beating. He may die from loss of blood. These are the killer conditions, and they are what you think about and what you look for. This is the primary survey. Is he breathing? Is his heart beating? Is he bleeding severely? Breathing. First, clear the airway. Clear out broken teeth, clots of blood, or anything else obstructing breathing. Then carefully tilt the head slightly back. In a situation like this, use a modified jaw thrust maneuver so the airway isn't cramped. Now look for chest movement, the rise and fall of the chest that indicates the person is breathing. Listen and feel for movement of air at nose and mouth. If there are no signs of breathing, begin mouth-to-mouth ventilation immediately. That's immediately, because even a few seconds' delay could be fatal. Don't even take time to get a resuscitator. If the victim doesn't start breathing for himself after four ventilations, it may be his heart isn't pumping. So check for pulse. Feel the carotid artery. It's right under the sharp bend of the jawbone. It's large, it's close to the surface, and if there is a pulse, you'll feel it. If there is, go back to mouth-to-mouth ventilation. If you can't feel a pulse, the heart has stopped, and you must supply the pump. Start cardiac chest massage. If the patient is breathing and has a heartbeat, go on with the primary survey. The next thing you look for is serious bleeding. Look for bright red, spurting blood. That means an artery has been cut, and unless the bleeding is stopped, shock and death will follow. Clamp your hand hard over the wound, your bare hand. Clamp it on and leave it on. Keep that pressure on. Don't worry about pressure points or tourniquets. Clamp that hand on and keep it there. On some wounds, you may be able to see the cut artery. Pinch it with your fingers. How long do you hold it? Until ambulance personnel or someone else can take over. You've checked the victim's breathing and got it going again if there was a problem. You've checked the pulse of the victim and made sure his heart was beating. You've examined him for serious bleeding, the rapid, bright red bleeding that could kill him. Breathing, heartbeat, serious bleeding. The primary survey, the search for life-threatening conditions. If there is more than one victim, each must have a primary survey before you go on to the secondary survey. The secondary survey is a head-to-toe search for additional injuries which could cause serious complications. Check first for possible spinal fracture. If the person is unconscious, suspect a neck injury. Again, if he's unconscious, always suspect a neck injury. Now, if he has pain in the neck area or if there's a deformation of the neck or if he's paralyzed, you naturally suspect a neck injury. But unconsciousness is a less obvious and equally strong indication of spinal fracture. Never move an accident victim unless absolutely necessary and then only with great care. If he has a spinal fracture, mishandling could kill him. If you suspect spinal cord injury, place rolled towels or blankets or sandbags on each side of the head or apply a cervical collar. If the victim is conscious, tell him not to move his head. The next thing to check are his eyes. Pupils of normal eyes are regular in outline, are of about the same size, and respond to light. If the eyes are dilated, as on the left, flash a light across them and watch for response. If the pupils are constricted, as in the center, or unequal with one larger than the other, or do not respond to light, there may be a brain injury present. It is important that pupil size and condition be noted and this information transmitted to hospital personnel. The head is the next area of survey. Look for blood in the hair. If you find any, separate the hair strands gently to see where it's coming from and how much bleeding is taking place. Don't move the head while you do this. Check the back of the head by placing your fingers behind his neck and sliding them upwards toward the top of his head. You're looking for depressions in the skull, bone fragments, and bumps. You'll tell the ambulance personnel about any you find. You may have time to bandage lacerations yourself, but don't do it now. Now check the ears and nose. You're looking for blood and a clear, water-like fluid. Either can indicate a possible skull fracture and damage to the brain. Blood from the nose alone may just be a bloody nose. Again, you're gathering information for the medical people. There isn't much you can do about brain damage at the scene of an accident. Now look at facial color and pay special attention to the color of the lips. If the lips are blue or gray, it can be an indication of oxygen deficiency. The person needs oxygen and needs it now. Keep an eye on skin color while applying oxygen, and it's a good idea to recheck the person's pulse periodically. Now you're going to take a look at the chest area, and if you're going to do it right, get his clothes off. The safest and fastest way is to cut them off. First, see if breathing is normal with full respirations at an even, regular pace, or if it's shallow or labored, and note the respiratory rate. Feel the ribs on both sides for depressions due to broken ribs. Feel for protrusions and a crackling as broken ribs rub together. A flail chest is easy to detect. Usually, several ribs in a row are broken, and the pieces separated so a depression is formed. Even if you can't feel evidence of broken ribs, you may be able to see it in chest movements. If one side moves up more than another in breathing, something's broken. Check the abdomen for spasms and tenderness. Press gently. A rock-like abdomen or spasms indicate internal bleeding or organs which have spilled into the abdominal cavity. Tenderness or flinching when you press down can indicate an injury, as does guarding, a tightening against the pressure. Now go on to the pelvic girdle. Feel for bony protrusions, grating and tenderness, any of which can indicate a fracture. Now look at and feel the legs for broken bones. Look for swellings and discolorations that are signs of closed fractures. A leg shorter than the other and with the foot off to one side may indicate a broken hip. Check out the arms the same way. A wrist and hand that take the shape of a silver fork can indicate a broken wrist. If the person says a particular area hurts, palpitate it to see if he can really feel the pain. One way to check the condition of the spinal cord is by examining his fingers and toes. What you're looking for is paralysis. If he can't wiggle his fingers or lift his hand or arm, it's a good indication of spinal injury, probably in the neck area. If he can't wiggle his toes, the injury to the spinal cord could be in the neck or the lower back area. If he's unconscious, pinch his toes or probe the sole of his foot with a sharp instrument and watch for reaction. You're hunting for paralysis, lack of feeling. A good test for pain is the sternal rub, rubbing your knuckles against the sternum. Rub hard and note the response. See what moves and how it moves. And remember to tell the medics. If you find any reason at all to suspect the spinal cord may be damaged, don't move him. Any movement may sever the spinal cord and cause permanent paralysis or death. And now you have completed the secondary survey. You've determined generally the extent of the person's injuries. You have gathered important information which should be passed along to others better equipped to act on it. Now you can go back and treat cuts and broken bones. First of all, you thought. Thought about the conditions that could threaten life. No breathing, no heartbeat, serious bleeding. You took care of these killer conditions. Then you proceeded with the secondary survey. The search for additional injuries which could cause serious complications. Any of these you couldn't deal with, you passed along to the medical people. Follow these procedures and you'll have a much greater chance to keep them alive. ♪