PARTICIPANT WORKBOOK PARTICIPANT BASIC EMERGENCY CARE: Approach to the acutely ill and injured APPROACH TO THE ACUTELY ILL AND INJURED BASIC EMERGENCY CARE APPROACH TO THE ACUTELY ILL AND INJURED Basic emergency care: approach to the acutely ill and injured ISBN (WHO) 978–92–4-151308–1 ISBN (ICRC) 978–2-940396–58–0 © World Health Organization (WHO) and the International Committee of the Red Cross (ICRC), 2018. Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO or the International Committee of the Red Cross logo is not permitted. 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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization, the International Committee of the Red Cross or the International Federation for Emergency Medicine concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization, the International Committee of the Red Cross or the International Federation for Emergency Medicine in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization and the International Committee of the Red Cross and the International Federation for Emergency Medicine to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or the International Committee of the Red Cross or the International Federation for Emergency Medicine be liable for damages arising from its use. Design by Inís Communication – www.iniscommunication.com BEC | Contributors Editors Teri Reynolds, Nikki Roddie, Andi Tenner, Heike Geduld. Other contributors of written material Kalie Dove-Maguire, Vijay Kannan, Sean Kivlehan, Nelson Olim, Max Ritzenberg, Stas Salerno Amato, Morgan Broccoli, Farrah Kashfipour, Harald Veen, Lee Wallis Peer reviewers Annet Alenyo, John Brown, Emilie Calvello, Brendan Carr, Keegan Checkett, Matthew Cooke, Megan Cox, Anne Creaton, Rochelle Dicker, Shaheem De Vries, Stephen Dunlop, Rajith Ellawala, George Etoundi, Sabariah Faizah, Scott Fruhan, Nicolaus Glomb, Renee Hsia, Christina Huwer, Muhumpu Kafwamfwa, Joseph Kalanzi, Gamal Khalifa, Olive Kobusingye, Clifford Mann, Edgardo Menendez, Juma Mfinanga, Nee-Kofi Mould-Millman, Hani Mowafi, Andrew Muck, Brittany Murray, Marcos Musafir, Theresa Olasveengen, Gerard O’Reilly, Tom Potokar, Junaid Razzak, Anthony Redmond, Andres Rubiano, Kelly Schmiedeknecht, Chris Stein, Janis Tupesis, Vikas Kapil, and Benjamin Wachira. The following members of the International Liaison Committee on Resuscitation (ILCOR) Pediatric Task Force provided essential peer review on relevant sections: Ng Kee Chong, Allan de Caen, Ian Maconochie, and Remigio Véiz. The following members of the International Federation for Emergency Medicine executive committee provided essential peer review: Peter Cameron, James Ducharme, Jim Holliman, Bob Schafermeyer, and Andrew Singer. Focus groups and pilots We thank the nurses and doctors of Muhimbili National Hospital in Dar es Salaam, United Republic of Tanzania, for their invaluable input during early focus groups: Ally M. Akrabi, Prosper J. Bashaka, Avelina N. Ijumba, Jennifer Jamieson, Khadija H. Juma, Bernard Kepha, Said Kilindimo, Josephine Lazaro, Wendy Lukwambe, Peter S. Mabula, Deogratius Mally, Nyakanda Marwa, Juma Mbugi, Felix D. Mlay, Victoria Mlele, Brittany Murray, Kissa Mwampagama, Meera Nariadhara, Catherine R. Shari, Patrick J. Shao, Shahzmah Suleman, Renatus Tarimo, Tito William. We are grateful to the African Federation for Emergency Medicine for overall coordination of pilots conducted in 2015–2017. Uganda course pilots were led by Joseph Kalanzi, and course facilitators included Aliga Cliff Asher, Charmaine Cunningham, Heike Geduld, Nemganga Kizega, Namaganda Lukia, Grace Magambo, Alex Makupe, Juma Mbugi, Josephine Nabulime, Annet Alenyo Ngabirano, Muzaza Nthele. Participants: Halima Adam, Douglas Akibua, Muhwezi Amos, Beatrice Babirye, Andrew Balinda, Evans Bonabana, Kamara Francis, Alele Franco, Muduwa Grace, Jagwe Hakim, Henry Kagaba, Shadia Kaggwa, Andrew Kagwa, Peter Kavuma, Winnie Kibirige, Bazibu Musa Kireka, Brian Kisembo, Nakiyemba Margaret, Edward Mugisha, Linda Nalugya, Gertrude Namidembe, Joanita Namuddu, Denis Onyang, and Emma Tukehayo. United Republic of Tanzania course pilots were led by Hendry Sawe, and course facilitators included Charmaine Cunningham, Jimmy Ernest, Upendo George, Nemganga Kizega, Deogratius Mally, Juma Mbugi, Juma Mfinanga, Felix Mlay, Brittany L Murray, Suzanna Ngalla, and Nikki Roddie. Participants: Ntuli Abraham, Thomas Bwire, Hamza Haji, Agripina Hugho, Stella Ibrahim, Philomena Jumanne, Teonila Kamba, Neema Kayembe, Sikudhani Khamsini, Clemence Luambono, Raymond Makona, Rosemary Marishay, Rashidi Matitu, Vicent Mboya, Erick Mhaiki, Rashid Mhina, Asha Mkwachu, Frank Mlaguzi, Leonidas Mutakosa, Piensia Nanyimbula, Kiohombo Phim, Mary Shauritanga, and Ndamba Sigonda. Zambia course pilots were led by Muhumpu Kafwamfwa, and course facilitators included: Namasiku Chime, Chipoya Chipoya, Ngandu Hassan, Mwandameda Kabuku, Irene Lufunda, Alex Makupe, and Mzaza Nthele. Participants: Gloria Chambeshi, Maureen Chikwa, Azelina Chulu, Mwanza Jackson, Usaliwa Jere, Tina Malunga, Pidini Mary, Mable Nakazwe Mulenga, Joy Judy Mweshi, Chicco Siame, Ivan Sinaulieni, and Franko Zulu. We wish to thank Morgan Broccoli, Simon Charwey, Catherine Haeffele, Farrah Kashfipour for input on visual design and illustration, and Tein Jung for the original illustrations throughout. Contents INTRODUCTION. .1 The ABCDE and SAMPLE history approach . 9 Module 1: The ABCDE and SAMPLE history approach . 11 Module 2: Approach to trauma . .37 Module 3: Approach to difficulty in breathing . .75 Module 4: Approach to shock. .95 Module 5: Approach to altered mental status . 119 WHO BASIC EMERGENCY CARE [SKILLS]. .141 GLOSSARY . 203 WHO sources . 214 Basic Emergency Care Quick Cards . 215 vi PARTICIPANT WORKBOOK INTRO INTRODUCTION ABCDE Overview Health emergencies happen every day, everywhere. They affect adults and children and include injuries and infections, heart attacks and strokes, acute complications of pregnancy TRAUMA and of chronic disease. While specialised care may never be available at all times in all places, a systematic approach to emergency conditions saves lives. The Disease Control Priorities Project estimates that nearly half of deaths and a third of disabilities in low- and middle-income countries result from conditions that could be addressed by emergency care. The World Health Organization (WHO), in collaboration with the International Committee of the Red Cross (ICRC) and the International Federation for Emergency Medicine (IFEM), has BREATHING developed the Basic Emergency Care (BEC) course for frontline providers who manage acute life-threatening