FIRST AID AND CPR COURSE

DEMP

By the Divers Alert Network (DAN) and the National Association of Underwater Instructors (NAUI)

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Call or email (Click HERE to Send E-mail to Deep-Six) Deep-Six to express your interest in taking the DAN-NAUI First Aid DEMP , Oxygen Administration, and the AED course. The cost is $85 and the textbook, materials, and certification are $40. The benefit is great! 845-255-7446 is the number. The minimum class size is 4.

THE NEXT COURSE IS SCHEDULED FOR CALL FROM 0930 TO 1730

     DAN-NAUI First Aid DEMP can be conducted as a comprehensive course including all the segments (First Aid (BLS), CPR, AED, Blood-borne Pathogens, Diving Accidents, Hazardous Marine Life Injuries, Neurological Issues, and Emergency Oxygen Administration) in a single schedule or each of the segments may be delivered separately to meet specific needs of the students who may only need training in one discipline or another. Some course and recognition materials are delivered via email the week before the course at Deep-Six with the textbook to add to the hours required. In any case the certification is valid for a two-year period after which the student must complete refresher training, and a practical and theoretical exam.

     DIVING EMERGENCY PROVIDER COURSES are quite comprehensive. It makes the certified DEMP person a valuable part of life-saving procedure. The course, part of which is on-line with Deep-Six, is 17 hours long. Seven of those hours are conducted at Deep-Six form 0930 to 1730. The other hours are done over a week on-line. If you plan on attending the next DEMP course you MUST AGREE to the following:

     One week before the attendance at Deep-Six there will be daily emails sent to each student. You must agree to read each that day, learn what in each, and email requested information back to Deep-Six within 12 hours. It will amount to about 10 hours of on-line learning, dialog, and emailing.

Academic Sessions (Overview)

a. Scene Safety Assessment
b. Donning and Doffing Gloves
c. Initial Assessment
d. Recovery Position
e. Chest Compressions
f.  Ventilations
g. Full Cardiopulmonary Resuscitation
h. Automated External Defibrillator
i.  Foreign-Body Airway Obstruction
j.  Shock Management
k. Control of External Bleeding
l.  Applying a Tourniquet
m. F-A-S-T Assessment
n. Secondary Assessment
o. Splinting
p. History
q. Severe Allergic Reaction or Opioid Overdose
r. Oxygen Administration

The treatment of diving accidents, neurological examinations, and marine hazards are included.

Bleeding

• Bleeding
– Human body can tolerate losing a pint (1/2 liter)
– Loss of a quart/liter causes shock
– Loss of 2.5 quarts/liters usually results in death

• Types of bleeding: internal vs. external, capillary, arterial, and venous.
• Bleeding control: direct pressure, elevation, and pressure points.
• Bandaging principles and practice.
• Caring for other severe bleeding emergencies: penetrating objects, amputations, internal bleeding.

Universal Precautions
• In a bleeding emergency you must:
– Place a barrier between you and someone else’s blood, examples: latex gloves, protective eye wear, plastic bags, or plastic wrap.
– Cover any open sores, cuts, or scrapes you might have on your hands or exposed skin.
– Minimize the splashing of blood.
– Handle any sharp objects with great care.
– Not handle any food or drinks when providing first aid.
– Clean and disinfect any area where blood has been spilled.
– Wash your hands and any exposed areas thoroughly, immediately after you have provided first aid or cleaned up a spill.

Types of Bleeding
• Can be internal or external.
• Capillary – blood oozes slowly from the wound. The body usually can control the bleeding through clotting.
• Venous – dark red or maroon and blood flows in a steady stream.
• Arterial Bleeding – bright red and spurts from the wound; can be life threatening and difficult to control.

Bleeding Control
• Apply direct pressure to the wound. Use a barrier.
• Elevate the injured area.
• If pressure directly on the wound does not stop the bleeding, apply pressure to the pressure point above the wound.
– Arm – brachial artery
– Leg – femoral artery

Pressure Bandage
A dressing and pressure bandage can help control bleeding.
• Place a sterile dressing on the wound.
• Apply pressure to the dressing and elevate the extremity higher than the victim’s heart.
• If you see blood soaking through, add more dressings on top of the original.
• When bleeding is controlled, bandage the dressing in place and maintain pressure on the wound.
• Hold the end of the roller bandage on one side of the dressing and wrap the bandage around the wound, using overlapping turns to cover the dressing completely.
• Tie or tape the bandage in place.
• Check the fingers or toes beyond the bandage for evidence of circulation, by pressing gently on the nail observing rapid color return.
• Blue or gray digits indicate too tight a bandage.

Other Bleeding Emergencies
• Penetrating Objects:
Do Not Remove. Bandage around it, and stabilize in place.
• Amputations
– Follow the steps for bleeding control.
– Find the missing body part (if possible) and wrap it in a sterile or clean cloth.
– Place the body part in a plastic bag and seal it.
– Place the bag on a bed of ice. Do not cover the bag in ice.
– Be sure the body part is transported to the hospital with the victim.

• Internal Bleeding – signs and symptoms
– Blood loss from the mouth, nose, ear, rectum, vagina, or urinary tract.
– A painful, tender, or hard area on the chest or abdomen.
– Rapid and weak pulse.
– Cool or moist skin.
– Purplish bruising and swelling of the damaged area.
– Person has feeling of dread or something being wrong.

Causes of Shock
• Hypovolemic: caused by severely decreased bodily fluids
• Neurogenic: abnormal enlargement of blood vessels causing “pooling” of blood and compromised circulation
• Septic: toxins produced by certain bacteria lower effective perfusion
• Psychogenic: shock-like condition caused by excessive emotion
• Anaphylactic: systemic reaction to an allergen that can result in a maldistribution of intravascular fluid

Signs and Symptoms
• Weakness
• Fainting, faintness
• Pale, cool, and moist skin
• Rapid pulse rate
• Thirst
• Anxiety, restlessness, or irritability
• Nausea
• Altered consciousness
• Dazed expression and a blank look on the face

Burns
• Learning goals:
– Categories of Burns
– Burn Care by Cause and Severity

– First degree
• Superficial burn to the upper layers of skin
• Painful, but usually heal within a week
– Second degree
• Partial-thickness burns to the skin
• Blistered, swollen skin that is very painful, but heals within a month
– Third degree
• Full thickness burns that include underlying tissue (muscle, fat, nerves)

• Cause – Heat, Radiation, Chemical, Electrical

• First aid (first and second degree)
– Immerse the burn in cold water or run cold water over
– Cover the burn with a clean, dry dressing
– Elevate the burn above the level of the victim’s heart
– Treat for shock
• First aid (third degree)
– Call for help immediately
– Loosely cover the burn with a clean, dry dressing
– Elevate the burn above the level of the heart
– Treat for shock


Causes of Burns and Their First Aid continued
• Chemical Burns-
– Laboratory and industrial chemicals; household cleaners, paint remover, bleach, and others
– The stronger the chemical and the longer the chemical stays on the skin, the more severe the burn
• First Aid
– Call for help
– Remove as quickly as possible by flushing with water
– Treat for shock
Note: In or around the eye, flush the eye from the nose outward to avoid getting chemical into the other eye.

Airway Obstruction

Conscious Victims
• Generally will clutch at their throat
– Universal sign for choking
• Partially blocked
– Breathe with difficulty, perhaps speak
– Wheezing, coughing
– May cough out the object: LET THEM
• Completely blocked
– cannot breathe, speak, or cough (will shortly lose consciousness)
• Inform victim you are trained; ask for consent to assist

Conscious Adult – First Aid for Completely Obstructed Airway
1. Stand to the side and slightly behind the victim.
2. Have the victim bend forward at the waist to ensure object is dispelled if dislodged.
3. Support the victim with one hand under their chest.
4. With the heel of the other hand deliver up to five sharp back blows between the shoulder blades: any blow may dislodge the obstruction.
5. If the back blows are not successful and the victim is still conscious move on to abdominal thrusts.

Abdominal Thrusts
1. Stand behind the victim.
2. Wrap your arms around the victim’s waist.
3. Feel for the victim’s navel, and place two fingers of one hand above the navel.
4. Place the fist from your other hand above the two fingers with your thumb facing in.
5. Grasp the fist with the other hand.
6. Perform up to five quick inward and upward thrusts using your arms. With each thrust you are attempting to dislodge the object.
7. If the object is not expelled and the person is still conscious, perform five back blows and continue to alternate methods until the object is expelled or the person loses consciousness.
8. Lower the person to the ground if they lose consciousness. Immediately activate the emergency response system and begin CPR.

Chest Thrusts for Pregnant or Obese Victims
Same as above except:
Place a fist from one hand against the center of the victim’s breastbone.

Injuries and Wounds

Head Injuries
• Types of head injuries
– Open head injuries may include a lot of bleeding
– Closed head injuries may have no initial external signs
• Signs and symptoms:
– Unconsciousness
– Confusion
– Drowsiness
– Black eyes/bruising
– Clear fluid draining from the ears or nose
– Visual disturbances
– Unequal pupils
– Nausea or vomiting
– Skull depressions
• Call for help.
• If the person is leaking clear fluid from ear or nose, pad the affected ear, and gently turn the victim to the affected side.
• If the person has a bleeding wound, place a dressing on the wound and gently apply direct pressure.

Head Injuries: Unconscious Victim
1. Call for help.
2. Check for airway, breathing, and circulation, and start CPR if necessary.
3. If the person is leaking clear fluid from ear, pad the affected ear, and gently turn the victim to the affected side.
4. If the person has a bleeding wound, place a dressing on the wound and gently apply direct pressure.

Head Injuries: Concussion
• Cause: significant blow to the head
• Treatment:
– Help the person lie down, with their shoulders and head slightly elevated.
– Control any bleeding.
– Check for signs of a serious head injury.
– Transport the victim to medical attention.

Spinal (Neck) Injuries
Suspect a spinal injury in the following:
– Automobile accident
– Ejection from an automobile
– Diving into a body of water
• First aid:
– Call for help
– Minimize movement of the victim’s head and spine by placing your hands on both sides of the victim’s head and holding their head in line with their body until help arrives.
– Monitor the victim for breathing (using the jaw lift method if necessary) and circulation.
– Control any external bleeding
– Treat for shock

Dental Injuries
• Tooth knocked out:
– Have the victim sit with their head tilted slightly forward to allow blood to drain from the mouth.
– Roll a sterile dressing and place it in the space left by the missing tooth. Have the victim bite down to keep the dressing in place.
• Treat the tooth in one of the following ways:
– Pick up the tooth by the crown, rinse it in cool water, and place it back in the socket.
– Place the tooth in a small container of milk.
– Take the victim and the tooth to the dentist or an emergency room as soon as possible. The tooth must be replaced within 30 minutes and receive care from a dentist as soon as possible.

Chest Wounds
• Open or closed
– Open wounds may penetrate the lungs, and will have a “sucking” sound with each breath
– Closed wounds may include rib or other organ damage
• First aid: open chest wound with impalement
– Call for help
– Do not remove the object that caused the wound.
– Put padding around the object to stabilize it and prevent any movement
– Treat for shock
– Keep the victim from moving until medical help arrives.
– Monitor for breathing and circulation

• First aid: Open Chest Wound without Impalement
– Call for help
– Cover the wound to prevent outside air from entering chest cavity. Use plastic wrap, a plastic bag, a latex glove, or aluminum foil.
– Tape the covering down; leave one corner open so air can escape the chest cavity.
– Treat for shock
– Keep the victim from moving until medical help arrives
– Monitor for breathing and circulation

• First aid closed chest wound (blow to the chest)
– Call for help
– Have the victim rest comfortably
– Have the victim hold a pillow against the injured area
– Monitor for internal bleeding
– Treat for shock

Fractures and Dislocations
• General first aid
– Immobilize the injured area
– Apply an ice pack to control swelling and help reduce pain.
– Call for help or transport the victim to a medical center.
– Treat for shock.
– Treat any secondary injuries.
– Check the pulse at the distal (far) end of a limb, for example, the wrist or foot of an arm or leg injury.

Splinting Principles
• Splinting helps immobilize the injury, relieve pain and prevent further injury.
– Only splint an injured limb if you need to move or transport the victim.
– Only splint an injured limb if you can do it without causing further pain and discomfort to the victim.
– Splint the injured limb in the same position in which you found it.
– Splint the injured area as well as the joints above and below the injury. For a dislocation, immobilize the affected joint.
– Check for adequate circulation below the injured area after you have finished the splint.
– If a broken bone is exposed, cover the area with a sterile dressing. Do not attempt to reinsert the bone ends.

• Splint types
– Rigid: Boards, folded newspapers or magazines
– Soft: Folded blankets or towels, pillows, wetsuits
– Anatomic: splinting to an adjacent finger, or splinting an injured leg to the other leg
• Bandages types
– Triangular
– Kerlix®
– ACE™ bandage (elastic bandage)
– Medical tape (2 to 4 inches wide/5 to 8 centimeters wide)

Rigid Splint
• Support the injured area and the area above and below the injury. Ask the victim to assist with support if they are able.
• Check for pulse, feeling, warmth, and color below the site of the injury.
• Select a rigid splint long enough to immobilize the injured area as well as the joints above and below the injury.
• Place the rigid splint under the injured area.
• Space and tie bandages along the length of the splint to hold it and the broken bones in position.
• If appropriate, apply a sling or sling and swath for an arm injury to further immobilize the injury.
• Recheck for feeling, warmth, and color below the site of the injury.

Special Considerations for Crushing Injuries continued
• First Aid for Crush Injury
– Call for help
– If the muscle mass has been compressed for less then 60 minutes, remove the crushing force as quickly and gently as possible, if it is safe to do so. If it has been more than 60 minutes, wait for help to arrive.
– Treat any other injuries
– Treat for shock
– Reassure the victim

 

Water Hazards

• Drowning (or near-drowning)
• Pressure related injuries while skin or scuba diving
• Contact with hazardous aquatic life

Drowning (Death)

Near Drowning

– Cyanotic (bluish lips and fingernail beds)
– Confusion
– Coughing or spitting up fluid that is pink or frothy
– Abdominal swelling
– Vomiting

Cold Water Drowning

• Submersion in cold water can also induce the rapid onset of hypothermia, which has been observed to extend the time after clinical death during which a victim may be successfully revived and survive to return to normal life activities.
• Younger victims have been revived after an hour of submersion.
• Not fully understood, but victims should receive advanced care and clinical re-warming.

Skin and Scuba Diving Maladies

• Barotraumas (pressure injuries)
– Pulmonary – Arterial Gas Embolism (AGE), Emphysemas, Pneumothorax
• Decompression Sickness (DCS, The Bends)
• Squeezes

Seasickness
• Cause
– Motion – varies among individuals
• Signs and symptoms
– Unease and edginess
– Pale, clammy skin
– Headache
– Weakness
• Prevention
– Get adequate rest before your trip.
– Eat light easily digestible foods. Avoid grease.
– Avoid engine exhaust fumes.
– Avoid watching or smelling others who are sick.
– If possible, get to land.
– Remain on deck with fresh air and as little movement as possible.
– Watch the horizon.
– Stay warm and hydrated.
– Lie down and fall asleep, if possible.

Aquatic Life Injuries
• Cause:
– Careless divers bumping into or handling aquatic animals
– Animals defending themselves or their territory has been invaded

• Treating by Heat
– Injected toxins from urchins, fish spines, etc. are heat labile (break down from heat).
– Immerse the wounded area in hot water - not scalding (110°–113° F or 43°–45°C).
– Soak for 30 to 90 minutes; be sure the water stays as hot as can be tolerated.
– Repeat above step until the pain diminishes.
– For retained spines, use vinegar soaks.
– Transport the victim to medical attention as the wound may need exploration.

• Treating by white vinegar
– Toxin from stinging cells of jelly fish, fire coral, etc.
• Rinse with seawater
– Apply white vinegar to neutralize
• If unavailable use:
– A paste of baking soda
– Ice packs initially then hot water
• Scrape the stinging cells off
• Reapply more vinegar for 15 minutes
• Wash the area with soap and water
• Apply a thin layer of hydrocortisone cream
• Monitor for signs of an allergic reaction
• Seek medical attention, if necessary

• Treating by Pressure Immobilization
– Blue-ringed octopus or sea snake bites, or cone shell punctures can be life threatening.
– Call for help.
– Place a four inch by four inch (10 cm by 10 cm) by an inch (3 cm) thick cloth or gauze pad over the wound.
– Wrap with an elastic bandage at least an inch (2.5 cm) above and below the pad, tight enough to press the pad into the skin, but not cut off circulation.
– Apply a splint to immobilize the limb.
– Monitor for breathing, circulation, and signs of an allergic reaction.
– Transport the victim to medical attention.

Aquatic Life Injuries continued
• Bites
– Morays, sharks, barracuda, and other fish will bite if threatened, or when fed
• First aid
– It may be necessary to unhook by pushing inward first before withdrawing
– Assist the diver to the surface
– Clean the wound and remove any tooth fragments
– Control the bleeding and bandage as necessary
– Transport the victim to medical attention for possible stitches and antibiotics, if necessary

• Envenomation
– Jellyfish
– Sea urchins
– Stingrays
– Stonefish, scorpion fish, lionfish, or catfish.
– Blue-ringed octopus
– Cone snails (family Conidae)
– Sea snakes
– Bristle worms or fire worms
– Sea cucumbers
– Crown of Thorns seastar
– Sea sponges
• Cnidarian (Coelenterate)
– Portuguese man-of-war, fire coral, jellyfish, box jellyfish, sea nettles, hydroids, sea wasps, and anemones
– Nematocysts (stinging cells) inject venom on contact with living tissue.
• First Aid
– Use “Treating by white vinegar” as described

Fish Spine Envenomations
– Stonefish, scorpionfish, lionfish and catfish have spines and venom
– Excellent natural camouflage make these animals dangerous to divers, especially if handled or molested
• Treatment
– Use “Treating by Heat” as described
– Medical attention may be necessary
• Blue-Ringed Octopus Bite
– Small, tidal pool creature found in Australia and Indo-Pacific
– Bite may go unnoticed, but is deadly
– Small bruise or blood blister may be only sign
• Treatment
– Pressure immobilization as described
– Immediate medical care is required

Aquatic Life Injuries continued
• Cone Snail Sting
– Proboscis at the narrow end of the shell has a harpoon that can penetrate skin and light clothing
• Treatment
– Pressure immobilization as described
– Immediate medical care is required
• Sea snake bite
– Inhabit tropical/temperate waters of the Indo-Pacific
– May see puncture mark, but little or no pain
– If venom has been injected, can be deadly
• Treatment
– Pressure immobilization as described
– Immediate medical care is required

• Ingested Fish Poisoning
– Some fish and shellfish are poisonous to eat
– Fish toxins are unaffected by cooking, soaking
– May not be an obvious “off” taste or smell
• Ciguatera Poisoning
– 400 species implicated – but sporadic and unpredictable
– Some species are:
• Barracuda
• Grouper
• Snapper
• Sea bass
• Surgeonfish
• Mackerel

• Ciguatera Poisoning (continued)
• Signs and Symptoms
– Reversal of hot and cold perception
– Chills
– Weakness
– Numbness
– Paresthesias
• First Aid
– Induce vomiting if eaten within the last three hours.
– Mannitol given by medical personnel.
– Freeze a piece of the fish for analysis.
– Transport the victim to medical attention.

 

     The entire course is taught from 0930 to 1730 with a short break for a self-provided lunch.

To be Removed after class: To Page 28 (FE)

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