Initial Steps in Managing Common Emergencies
The first step in managing any emergency is to verify scene safety, check for responsiveness, and activate the emergency response system immediately upon finding an unresponsive person. 1 This systematic approach ensures both rescuer safety and prompt access to advanced care.
General Approach to Emergencies
Assessment Phase
- Verify scene safety before approaching any victim 2, 1
- Check for responsiveness by tapping and shouting 2
- Shout for nearby help 2
- Activate emergency response system via mobile device if appropriate 2
- Check for breathing and pulse simultaneously (healthcare providers) 2
- Look for no breathing or only gasping
- Check pulse for no more than 10 seconds
Decision Points Based on Assessment
- If normal breathing and pulse present: Monitor until emergency responders arrive 2
- If no normal breathing but pulse present: Provide rescue breathing (1 breath every 2-3 seconds) 2
- If no breathing/only gasping and no pulse: Start CPR immediately 2
CPR Protocol for Different Rescuers
Untrained Lay Rescuer
- Provide Hands-Only CPR (chest compressions only) 2
- Push hard and fast on center of chest 2
- Continue until AED arrives or healthcare providers take over 2
Trained Lay Rescuer
Healthcare Provider
- Perform cycles of 30 compressions to 2 breaths until advanced airway placed 2
- After advanced airway: continuous compressions with ventilations (1 breath every 6-8 seconds) 2
- Compression rate: 100-120/minute 1
- Compression depth: 2-2.4 inches (5-6 cm) for adults 1
- Allow complete chest recoil between compressions 2, 1
- Minimize interruptions in chest compressions (<10 seconds) 2, 1
AED/Defibrillation Protocol
- Turn on the AED 2
- Follow the AED prompts 2
- If shockable rhythm: Give 1 shock, resume CPR immediately for 2 minutes 2, 1
- If non-shockable rhythm: Resume CPR immediately for 2 minutes 2, 1
- Continue until advanced life support providers take over 2
Emergency Response Planning for Specific Settings
School Emergency Response Plan
Schools should develop comprehensive emergency response plans including:
- Effective communication system throughout campus 2
- Coordinated response plan developed with school nurse, physicians, and local EMS 2
- Risk reduction strategies 2
- Training in first aid and CPR for staff 2
- AED program if needed 2
Medical Office Emergency Preparedness
Pediatric and primary care offices should:
- Perform self-assessment of office readiness 2
- Develop organizational plan for emergency response 2
- Maintain recommended emergency equipment and check regularly 2
- Maintain emergency medications with precalculated doses 2
- Practice mock codes regularly 2
- Educate families about emergency procedures 2
First Aid Emergencies
The American Heart Association and Red Cross recommend first aid providers be prepared to handle these common emergencies 2:
- Severe breathing problems (asthma, choking, anaphylaxis)
- Chest pain and heart attack
- Diabetes and low blood sugar
- Stroke
- Seizure
- Shock
- Bleeding
- Head and spine injury
- Broken bones
- Burns
- Sudden cardiac arrest
- Temperature-related emergencies (heatstroke, hypothermia)
- Poisoning
Positioning of Ill or Injured Persons
- For decreased alertness (non-traumatic): Recovery position (side-lying) 2
- For suspected neck/back/hip/pelvic injury: Leave in position found unless area is unsafe 2
- For breathing difficulty: Allow to assume position most comfortable for breathing (usually sitting up) 2
Common Pitfalls to Avoid
- Delaying CPR to check for pulse beyond 10 seconds 1
- Inadequate compression depth or rate 2, 1
- Excessive interruptions in chest compressions 2
- Delaying AED application 2, 1
- Excessive ventilation 2
- Failing to protect from environmental extremes 2
- Dismissing student reports of emergencies as pranks 2
- Delaying activation of EMS due to concern they might not be needed 2
By following these systematic approaches to emergency management, you can maximize the chances of survival and minimize morbidity in common emergency situations.