View source for First aid protocol

{{draft trained protocol}}
{{draft first aid protocol}}
This is the protocol for doing first aid, as a high level overview: each section provides a broad coverage of what to do, any [[red flag|red flags]] and links to full protocol for carrying out a specific task. 
Queercare works on the DR(mc)ABCDEFG accident procedure - when doing first aid, you must work down this page, following the instructions for each section in order. 
* If you aren't sure what to do, go to the top of the procedure and start again. 
* If you lose your place, go to the top of the procedure and start again.
* If you get to the bottom of the procedure, go to the top of the procedure and start again.
== Background ==
The procedure focuses on making sure that the brain is functioning, and especially ensuring oxygenated blood flow to the brain - every step in the first part of the procedure is directly related to this("DR(mc)ABC") while the latter part("DEFG") deals with longer term threats to this blood flow, and getting help to deal with other risks to health. 
As you descend the algorithm, the issues you're dealing with become more complex and nuanced as well as less immediately threatening. 
* "Danger" is about making sure that the scene of the incident is not going to become more dangerous, and that you can intervene without becoming a casualty yourself, or hurting the casualty.  
* "Response" is a rapid check for brain function - this lets you flag issues with brain function which may not be immediately visible, and tell the difference between someone who's 'just asleep' and 'comatose'. 
* "Massive haemorrhage" deals with immediate blood loss, which will prevent blood getting to the brain within the seconds to a few minutes.  
* "C-spine" deals with threats to the nervous system which could disrupt the beating of the heart, and thus stop blood getting to the brain (or cause paralysis longer term) 
* "Airway" deals with things that are stopping oxygen getting from someones mouth to their lungs (and thus to their brain) 
* "Breathing" deals with lung function - whether someones lungs are transferring oxygen through the airway and into the bloodstream, and how well that's functioning.  
* "Circulation" determines whether someones heart, arteries and veins are getting the oxygen from their lungs to the brain(and other parts of their body). 
* "Damage" is the first indirect step - it focuses on issues that will cause harm in the longer term such as broken limbs, burns, or blood loss.  
* "Environment" deals with heat related injury- the capability of the body to cool or heat itself.  
* "Flip" refers to putting someone in the "recovery position", a reasonably safe common position to wait for help in. 
* "Get help" covers getting help (calling 999, or getting second line medical support) and handing off to them. 
== Danger ==
{{redflag|if there is danger you cannot secure against when doing first aid}}
You must do a [[scene survey protocol|scene survey]]. This survey is to spot dangers, and gives you a second to prevent yourself from accidentally harming the patient, or injuring yourself, and making the situation worse. The scene survey should inform your choice of PPE, and you may decide not to engage. 
Dangers you might pick up in a scene survey include: 
* Traffic
* Cops, their dogs, and their horses
* Bystanders 
* Terrain
* Fascists 
* Environmental dangers such as live wires, broken glass and needles 
'''You must put on [[PPE protocol|appropriate PPE]]''', and '''should wear gloves''' even if there are no bodily fluids in evidence(yet).
This has two reasons behind it: Obviously, you wish to be protected from whatever dangers are involved in the scene, but also taking a second to put on gloves gives you a physical reminder to pause, protect yourself, and calm yourself before acting. 
In this time, '''you should consider your own mental health''', and take a second to consider the situation around you. This can also involve calming your breathing quickly, which controls adrenaline and helps you make better decisions.  
'''You should check with your [[buddy protocol|buddy]]'''- This protocol is designed for use with a buddy, and all Queercare care work must be done with a buddy. Talking to your buddy about the scene survey, PPE, and your mental health helps make sure you've done the things required in this stage, and have the same understanding of your approach to the situation.
==Response==
{{redflag| If a person is only responsive to pain or is completely unresponsive}}
{{redflag| If a person has a GCS of below 9}}
{{redflag| If a person has a response that is deteriorating rapidly}}
You must check how responsive the person is, using AVPU- '''Talk to the person and if they respond coherently, they're Aware'''. 
If they don't respond, '''try speaking into their other ear, and then raising your voice until you're shouting'''- if they respond(even a groan or moving their body) then they are '''Verbally Responsive'''. If they are not responding now, it is a [[red flag]], have someone(your buddy) call for backup. 
Next, '''you must check for a pain response''' by [[trapezius squeeze protocol|pinching the trapezius muscle(the soft part) in the shoulder]], or doing a [sternum rub]. '''If they respond to this, they are pain responsive''', and '''if they do not respond, they are unresponsive.''' Make sure help is coming and move down the accident procedure. 
If you're trained on it, you can use [[GCS protocol|GCS]] instead. 
If they're aware but are becoming(or have become) [[DICC protocol|disoriented, irritable or combative]]- Keep an eye on them as you continue. '''If they rapidly slide from disoriented to irritable or irritable to combative, this is a red flag'''- Get backup now. 
Keep moving down the accident procedure and bear in mind you're looking for things that may be effecting their cognition, like alcohol or other cognitive depressants (ie. benzos), severe bleeding, a lack of blood sugar or oxygen.
==Massive Haemorrhage ==
{{redflag|if you see spurting or pouring blood}}
'''If you see spurting or pouring blood, like from a a hosepipe or tap[[Direct Pressure Protocol|You must push down hard directly over the location of the bleed, holding the pressure on until it stops]].
You will already be wearing gloves when you do this, and you may use a dressing or soft, clean pad, between your hands and your injury. If you have an appropriate dressing which can apply sufficient pressure to stop the bleed, you can use it. 
If the blood does not stop from direct pressure, or circumstances do not allow direct pressure, you should [[Tourniquet protocol|apply a tourniquet]].
==C-spine==
{{redflag|if a person has fallen from more than twice their own height, or been injured by similar force}}
As you survey and approach the scene, '''consider whether there's a possibility that the person has fallen from more than twice their own height'''(or had a similar impact upon them- hit by a car or police horse, for example). If this is the case '''do not move the persons neck or spine'''. Approach from their feet(or wherever is in their eye-line without them moving their head) and tell them not to move their head as you approach.
==Airway==
{{redflag|if a person does not appear to be breathing}}
You must [[Accessing airway protocol|Look listen and feel]] for breathing. 
If the person is not breathing and has no evidence of a c-spine injury, you should do a [[Airway protocol|head tilt chin lift]]. If a person has evidence of a C-spine injury, you should do a [[Airway protocol|jaw thrust]] instead.
==Breathing==
{{redflag|if a person is not breathing}}
{{redflag|if a person is breathing under 12 or over 30 breaths per minuite}}
{{redflag|if a person has crackles, wheezes or whistles in their breathing}}
When you Looked, Listened and Felt, you should have been able to determine whether how quickly, deeply or easily the person was breathing. If a person was not breathing but has started breathing when you cleared their airway, look, listen and feel again. 
* If a person is not breathing, do [[BLS protocol|Basic life support]]
* If a person is breathing unusually quickly, check for [[asthma]] or [[panic attacks]].
* If a person is using muscles in their kneck when they breathe in(otherwise known as accessory muscles), red flag and check for pneumonia. 
* If a person has wheezes, chrackles or whistles, [[red flag]] and continue.
==Circulation==
{{redflag|if a persons capillary refill time is more than 3 seconds}}
{{redflag|if a persons skin shows symptoms of shock}}
{{redflag|if a person has a burn larger than their own hand}}
{{redflag|if a person has a third degree burn}}
{{redflag|if a person has lost more than 20% of their blood volume}}
{{redflag|if an injury exposes nerves or bone}}
You must check [Capilary refil protocol|capilary refil] or use a [[Pulse oximiter protocol|pulse oximiter] to check the persons circulation. 
You must identify any bleeds which aren't massive haemorrhages with a [Chunk Check Protocol|Chunk check] and [Dressing wounds protocol|Dress them].
==Damage==
{{redflag|if a person has straw or clear fluid coming from their eyes, ears or nose}}
{{redflag|if there is unexplained bruising around their eyes or behind their ears}}
{{redflag|if there are unexplained sensory, speech or balance problems}}
{{redflag|if a person is experiencing unexplained seizures}}
{{redflag|if a person is sliding down DICC}}
{{redflag|if there are constrictions to blood flow for more than 10 minutes}}
{{redflag|if there is a broken pelvis or leg}}
{{redflag|if there is any sign of a dangerous drug overdose}}
If there are any signs of head trauma (for example, a potential fall or baton hit) you must [Head injury protocol|check for signs of a head injury]. 
You must check if there are any [DICC sliding protocol|signs the persons cognition is impaired].
You must check for [Disabling injury check protocol|circulation, sensation and motion] in all limbs.
If the person is conscious, you must ask them if they've taken any medications or substances which could cause an overdose. You should reassure them that this information will not be passed to the police (and, do not pass it to the police) and will not get them in trouble. If this is the case, [https://wiki.queercare.network/Treating_poisoning_protocol|treat for poisoning].
If the person is unconscious, you should look around for signs of an overdose or of medications effecting their consciousness - for example pill packets, syringes, needles, bottles or cans. If you suspect opioid overdoses, [Naloxone_protocol|treat these].
==Environment==
{{redflag|if a person has hot but dry skin}}
{{redflag|if a person has cold and [[pale or grey]] skin, combined with tiredness or sliding down DICC}}
==Flip==
If the person is unconscious, you must now [[Recovery position protocol|move them into the recovery position]], unless they have a suspected C-spine injury. You must not move someone with a suspected C-spine injury.  
If the casualty is conscious you should not move them, and tell them instead to move to make themselves comfortable. When they do this you should advise:
- Raising minor veinous bleeds to reduce pressure to reduce blood pressure around the injury. When doing this, ensure that these do not lead to disruption of the airway via this blood- for example, do not tilt the head back to ease the pressure on a nosebleed, causing blood to flow down the airway as opposed to out of the nose.
==Get help ==
If you have encountered any Red Flags, above, now is the time to [Red flag protocol|call an ambulance] or other medical backup, or to check in with this process if your buddy has already initiated it.
If you're not dealing with a case which has a red flag, you should consider whether to move the person to reduce risk, or to leave them in their current position(or to move on and say goodbye if there's no further risk)