1.

Emergency nursing deals with human responses to any trauma or sudden illness
that requires immediate intervention to prevent imminent severe damage or death
2. Care is provided in any setting to persons of all ages with actual or perceived
alterations in physical or emotional health.
3. Initially, patients may not have a medical diagnosis.
4. Care is episodic when patients return frequently, primary when it is the initial
option for health or preventive care, or acute when patients need immediate and
additional interventions.
5. Emergency nursing is a specialty area of the nursing profession like no other.
6. Emergency nurses must be ready to treat a wide variety of illnesses or injury
situations, ranging from a sore throat to a heart attack.

Emergency Care Environment

1. Prehospital care by emergency medical services (EMS), emergency medical

technicians, and paramedics provides initial stabilizations and transport of
patients; personnel communicate with the emergency department during patient
transport
2. The national emergency telephone number 911 is the result of an effort to
improve access to EMS
3. The concept of the emergency room has expanded to that of the emergency
department, which provides various levels of care
4. Specialized electronic technology and techniques are used to monitor patient
status continuously; these may pose safety hazards to patients, such as possible
exposure to electric shock

D. Triage

1. Triage classifies emergency patients for assessment and treatment priorities

2. Triage decisions require gathering objective and subjective data rapidly and
effectively to determine the type of priority situation present
3. Emergent situations are potentially life-threatening; they include such conditions
as respiratory distress or arrest, cardiac arrest, severe chest pain, seizures,
hemorrhage, severe trauma resulting in open chest or abdominal wounds, shock,
poisonings, drug overdoses, temperatures over 105°F (40.5°C), emergency
childbirth, or delivery complications
4. Urgent situations are serious but not life-threatening if treatment is delayed
briefly; they include such conditions as chest pain without respiratory distress,
major fractures, burns, decreased level of consciousness, back injuries, nausea or
vomiting, severe abdominal pain, temperature between 102 and 105°F (38.9 and
40.5° C), bleeding from any orifice, acute panic, or anxiety
5. Nonemergency situations are not acute and are considered minor to moderately
severe; they include such conditions as chronic backache or other symptoms,
 moderate headache, minor burns, fractures, sprains, upper respiratory or urinary
infections, or instances in which a patient is dead on arrival

E. Roles of the Emergency Nurse

1. Care provider: provides comprehensive direct care to the patient and family.
2. Educator: provides patient and family with education based on their learning
needs and the severity of the situation and allows the patient to assume more
responsibility for meeting health care needs
3. Manager: coordinates activities of others in the multidisciplinary team to achieve
the specific goal of providing emergency care
4. Advocate: ensures protection of the patient’s rights

F. Functions of the Emergency Nurse

1. Uses triage to determine priorities based on assessment and anticipation of the

patient’s needs
2. Provides direct measures to resuscitate, if necessary
3. Provides preliminary care before the patient is transferred to the primary care area
4. Provides health education to the patient and family
5. Supervises patient care and ancillary personnel
6. Provides support and protection for the patient and family

G. Legal issues affecting the provision of emergency nursing

1. Negligence
2. Malpractice
3. Good Samaritan Laws (these statutes may protect private citizens but usually do
not apply to emergency personnel on duty or in normal emergency situations)
4. Informed consent
5. Implied consent
6. Duty to report suspected crimes to the police
7. Duty to gather evidence in criminal investigations; be aware of hospital policy
and state laws for evidence collection
8. Advanced directives, including durable power of attorney and living wills

H. Qualifications of an Emergency Nurse

1. An emergency nurse is a registered nurse with specialized education and

experience in caring for emergency patients.
2. Emergency nurses continually update their education to stay informed of the latest
trends, issues, and procedures in medicine today.
3. Many take a special examination that proves their level of knowledge. After
successful completion of this exam they are certified in emergency nursing.
 4. Some emergency nurses also acquire additional certifications in the areas of
trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury
prevention
5. Many emergency nurses acquire additional certifications in the areas of trauma
nursing, pediatric nursing, nurse practitioner, and various areas of injury
prevention

First aid is the immediate care given to a person who has been injured or has suddenly
taken ill. If includes self-help and home care if medical assistance is not available or is
delayed. It includes well-selected words of encouragement, evidence of willingness to
help, and promotion of confidence by demonstration of competence.

II. Reasons For First Aid

A. First aid knowledge and skill often mean—

1. The difference between life and death

2. The difference between temporary and permanent disability

3. The difference between rapid recovery and long hospitalization

B. First aid training is of value in—

1. Preventing and caring for accidental injury or sudden illness

2. Caring for persons caught in a natural disaster or other catastrophe

3. Equipping individuals to deal with the whole situation, the person, and
the injury

4. Distinguishing between what to do and what not to do

C. First aid training is needed because—

1. Statistics show that among persons from age 1 to age 38, accidents are
the leading cause of death, and thereafter they remain one of the
leading causes.

a. The death rate is twice as high among males as females.

b. The annual cost of medical attention, loss of earning ability due

to temporary or permanent impairment, and direct property
damage and insurance costs amount to many billions of dollars
each year.
 c. Accidents take their toll in pain and suffering, disability, and
personal tragedy.

d. Motor vehicle accidents account for approximately half of all

accidental deaths.

2. The concept of massive numbers of casualties has become a reality

with the advent of the nuclear age.

3. The pattern of medical care has changed.

4. The growing population and expanding health needs have not been
balanced by a proportional increase in numbers of doctors, nurses,
and allied health workers.

5. The limitation of time in case of an accident or sudden illness may be

so critical in terms of minutes or even seconds that only a person
with first aid knowledge and skills who is on hand has any
opportunity of preventing a fatal outcome.

D. First aid training promotes safety awareness in the home, at work, at play,
and on streets and highways. In the promotion of such awareness, it is
important to closely relate three terms: cause, effect, and prevention.

1. Cause

When in-depth study of an actual or hypothetical accident

situation identifies all the causative factors, it becomes possible
to determine what can be done to eliminate, control, or avoid the
hazards.

2. Effect

When analysis carefully considers both immediate and long-

range, or permanent, effects of injury or sudden illness, it
becomes obvious why every possible effort should be taken to
eliminate, control, or avoid a situation that is hazardous to
oneself or to others

3. Prevention

A better understanding of the overall accident problem is

developed if all the circumstances surrounding various types of
accidents are carefully studied. Preventive measures should
include consideration of how accident-causing conditions and
activities can be eliminated, controlled, or avoided.
III. Value of First Aid Training

A. Help for others

Through the study of first aid, a person is prepared to assist others wisely
if they are stricken, to give them instruction in first aid, and to promote
among them a reasonable safety attitude. On a humanitarian basis, there is
always an obligation to assist the stricken and the helpless. There is no
greater satisfaction than that of relieving suffering or saving the life of a
member of your family, a coworker, an acquaintance, or a stranger.

B. Self-help

In being prepared to help others, the first-aider is better able to care for
himself in case of injury or sudden illness. Even when his condition is so
bad that he is unable to care for himself, he can direct others in the correct
procedures to be taken in his behalf.

C. Preparation for disaster

First aid training is of particular importance in time of catastrophe, when

medical and hospital services are limited or delayed. Catastrophe may
taken the form of well-publicized disasters, such as hurricanes, floods,
earthquakes, tornadoes, and fires. It also may take the form of a single
accidental death, or life-threatening illness. Knowing what to do in an
emergency helps to avoid the panic and disorganized behavior
characteristic of unprepared persons at such times. Knowledge of first aid
is a civic responsibility: It not only helps to save lives and prevent
complications from injuries but also helps in setting up an orderly method
of handling emergency problems according to their priority for treatment
so that the greatest possible good may be accomplished for the greatest
number of people.

IV. General Directions For Giving First Aid

As a first-aider, you may encounter a variety of problem situations. Your decisions and
actions will vary according to the circumstances that produced the accident or sudden
illness, the number of persons involved, the immediate environment, the availability of
medical assistance, emergency dressings and equipment, and help from others. You will
need to adapt what you have learned to the situation at hand, or to improvise.

Sometimes prompt action is needed to save a life. At other times there is no need for
haste, and efforts will be directed toward preventing further injury, obtaining assistance,
and reassuring the victim, who may be emotionally upset and apprehensive, as well as in
pain.
First aid begins with action, which in itself has a calming effect. If there are multiple
injuries or if several persons are hurt, priorities must be set. Enlist the help of bystanders
to make telephone calls, to direct traffic, to keep others at a distance if necessary, to
position safety flares in case of highway accidents, and perform similar duties. Provide
life support to victims with life-threatening injuries, then care for those with less critical
injuries.

Telephone, or have someone else telephone, the appropriate authorities regarding an

accident. The police department or the highway patrol is a good first contact: but the
circumstances surrounding the accident should be a guide as to whom to call. Always
have a list of emergency numbers available; if the numbers are not readily available, ask
the telephone operator for assistance. Describe the problem, indicate what is being done,
and request the assistance needed, such as an ambulance, the fire department, the rescue
squad, or utility company personnel. Give your name, the location of the accident, the
number of persons involved, and the telephone number where you can be reached. Do not
hang up the receiver until after the other party hangs up because he may wish to clarify
some information.

A. Urgent care

In case of serious injury or sudden illness, while help is being summoned,

give immediate attention to the following first aid priorities:

1. Effect a prompt rescue. (For example, remove an accident victim from

water, from a fire, or from a garage or room containing carbon
monoxide, smoke, or noxious fumes.)

2. Ensure that the victim has an open airway and give mouth-to-mouth or
mouth-to-nose artificial respiration, if necessary.

3. Control severe bleeding.

4. Give first aid for poisoning, or ingestion of harmful chemicals.

B. Additional first aid directions

Once emergency measures have been taken to ensure the victim’s safety,
the following procedures should be carried out:

1. Do not move a victim unless it is necessary for safety reasons. Keep

the victim in the position best suited to his condition or injuries; do
not let him get up or walk about.

2. Protect the victim from unnecessary manipulation and disturbance.

3. Avoid or overcome chilling by using blankets or covers, if available.
If the victim is exposed to cold or dampness, place blankets or
additional clothing over and under him.

4. Determine the injuries or cause for sudden illness. After immediate

problems are under control—

a. Find out exactly what happened. Information may be obtained

from the victim or from persons who were present and saw the
accident, or saw the individual collapse in the case of sudden
illness.

b. Look for an emergency medical identification, such as a card or

bracelet, which may provide a clue to the victim’s condition.

c. If the victim is unconscious and has no sign of external injury,

and if the above methods fail to provide identity, try to obtain
proper identification either from papers carried in a billfold or
purse, or from bystanders, so that relatives may be notified. (It
is advisable to have a witness when searching for
identification.)

5. Examine the victim methodically but be guided by the kind of

accident or sudden illness and the needs of the situation. Have a
reason for what you do.

a. Loosen constricting clothing but do not pull on the victim’s belt

in case spinal injuries are present.

b. Open or remove clothing if necessary to expose a body part in

order to make a more accurate check for injuries. Clothing may
be cut away or ripped at the seams, but utmost caution must be
used or added injury may result. Do not expose the victim
unduly without protective cover, and use discretion if clothing
must be removed.

c. Note the victim’s general appearance, including skin

discoloration, and check all symptoms that may give a clue to
the injury or sudden illness.

In the case of a victim with dark skin, change in skin color

may be difficult to note. It may then be necessary to depend
upon change in the color of the mucous membrane, or inner
surface of the lips, mouth, and eyelids.
 d. Check the victim’s pulse. If you cannot feel it at the wrist, check
for a pulse of the carotid artery at the side of his neck.

e. Check to see if the victim is awake, stuporous, or unconscious.

Does he respond to questions?

f. If the victim is unconscious, look for evidence of head injury. In

a conscious person, look for paralysis of one side of the face or
body. See if the victim shows evidence of a recent convulsion.
(He may have bitten his tongue, producing a laceration.)

g. Check the expression of the victim’s eyes and the size of his
pupils.

h. Example the victim’s trunk and limbs for open and closed
wounds or for signs of fractures.

i. Check the front of the victim’s neck to determine whether he is a

laryngectomy. (Most laryngectomys carry a card or other
identification stating that they cannot breathe through the nose
or mouth.) Do not block the stoma (air inlet) of a laryngectomy
when carrying out other first aid, since blockage could cause
death from asphyxiation.

j. If poisoning is suspected, check for stains or burns about the

victim’s mouth and a source of poisoning nearby, such as pills,
medicine bottles, household chemicals, or pesticides.

6. Carry out the indication first aid:

a. Apply emergency dressing, bandages, and splints, as indicated.

b. Do not move the victim unless absolutely necessary.

c. Plan action according to the situation, and the availability of

human and material resources.

d. Utilize proper first aid measures and specific techniques that,

under the circumstances, appear to be reasonably necessary.

e. Remain in charge until the victim can be turned over to qualified

persons (for example, a physician, and ambulance crew, a
rescue squad, or a police officer), or until the victim can take
care of himself or can be placed in the care of relatives.
f. Do not attempt to make a diagnosis of any sort or to discuss a
victim’s condition with bystanders or reporters.

g. Above all, as a first aid worker, you should know the limits of
your capabilities and must make every effort to avoid further
injury to the victim in your attempt to provide the best possible
emergency first aid care.