**COMMUNITY EMERGENCY RESPONSE TEAM**

**SESSION III:**

** DISASTER MEDICAL OPERATIONS --- PART 1**

**EMERGENCY MANAGEMENT INSTITUTE**

**NATIONAL EMERGENCY TRAINING CENTER**

** SESSION III**

** DISASTER MEDICAL OPERATIONS---PART 1**

** TIME: 2 hours 30 minutes**

**OBJECTIVES** At the conclusion of this session, the participants will
be able to:

1\. Identify the "killers."

2\. Apply techniques for opening airways, controlling bleeding, and
treating for shock.

3\. Conduct triage under simulated disaster conditions.

**SCOPE** § Introduction And Session Overview

§ Treatment Of Life-Threatening Conditions

§ Triage

§ Session Summary

+--------------+------------------------------------------------------+
| **TRAINING** | The lead instructor will begin this session by       |
|              | welcoming the participants to Session III: Disaster  |
| **METHODS**  | Medical Operations---Part 1, and will introduce the  |
|              | instructors for the session. The instructor will     |
|              | then overview the topics of the session: treatment   |
|              | of life-threatening conditions that may be           |
|              | encountered (airway obstruction, bleeding, and       |
|              | shock), and conducting triage.                       |
+--------------+------------------------------------------------------+

Next, the instructor will discuss and demonstrate the immediate
procedures required for opening the airway, controlling bleeding, and
treating for shock. The participants will have the opportunity to
practice techniques for treating each of these conditions. During this
period, some discussion will take place about the differences between
disaster medical operations and the participants' image of everyday
first aid. (For example, mouth-to-mouth resuscitation and
cardiopulmonary resuscitation (CPR) lose some of their importance in
disaster situations.)

+-------------------------+-------------------------------------------+
| **TRAINING**            | The next topic of this session will deal  |
|                         | with triage. The instructor will open     |
| **METHODS** (Continued) | with a discussion of the meaning and goal |
|                         | of triage and provide background from the |
|                         | military's experience using triage for    |
|                         | prioritizing treatment in multicasualty   |
|                         | situations. This background will lead to  |
|                         | comparisons of triage in disaster         |
|                         | circumstances and the steps that CERT     |
|                         | members will follow when conducting       |
|                         | triage.                                   |
+-------------------------+-------------------------------------------+

Finally, the participants will practice triage evaluation and immediate
treatment in a simulated multicasualty exercise. This exercise will
illustrate the need to conduct triage effectively and expeditiously
under pressure and to focus on rescuer safety.

**REFERENCES*** Community Emergency Response Team *Instructor Guide

* Community Emergency Response Team* Participant Handbook

Visuals 3.1 through 3.6

**EQUIPMENT** In addition to the equipment listed at the front of this
Instructor Guide, you will need the following equipment for this
session:

• 1 mannequin.

• 1 box of latex examination gloves.

• 1 box of 4 ´ 4 bandages.

• 1 triangular bandage.

• 1 roll of roller gauze.

• Notecards, markers, and masking tape.

**PREPARATION** The triage exercise near the end of this session
requires materials prepared in advance of the activity. Prepare note
cards listing the injuries of six "victims." The class will be divided
into groups of six, and each group will need a copy of the set of cards.
See page IG III-26 for details.

**NOTES** A suggested time plan for this unit is as follows:

Introduction And Session Overview 10 minutes

Treatment Of Life-Threatening Conditions 90 minutes

Opening The Airway

Exercise: Opening The Airway

Controlling Bleeding

Exercise: Controlling Bleeding

Recognizing And Treating For Shock

Exercise: Treating For Shock

Triage 45 minutes

Exercise: Conducting Triage

Session Summary 5 minutes

** Total Time: 2 hours 30 minutes**

+---------------+---------------+---------------+---------------+---+
|               |               | *Total Unit:* | **SESSION     |   |
|               |               |               | III: DISASTER |   |
|               |               | *2 hours 30   | MEDICAL       |   |
|               |               | minutes*      | OPER          |   |
|               |               |               | ATIONS---PART |   |
|               |               |               | 1**           |   |
+---------------+---------------+---------------+---------------+---+
|               | *Total        | *             |               |   |
|               | Topic:*       | *INTRODUCTION |               |   |
|               |               | AND SESSION   |               |   |
|               | *10 minutes*  | OVERVIEW**    |               |   |
|               |               |               |               |   |
|               |               | § Welcome the |               |   |
|               |               | participants  |               |   |
|               |               | to Session    |               |   |
|               |               | III of the    |               |   |
|               |               | CERT training |               |   |
|               |               | program.      |               |   |
|               |               |               |               |   |
|               |               | ·             |               |   |
|               |               |               |               |   |
|               |               | § Introduce   |               |   |
|               |               | the new       |               |   |
|               |               | instructors   |               |   |
|               |               | for this      |               |   |
|               |               | session and   |               |   |
|               |               | asks each to  |               |   |
|               |               | briefly       |               |   |
|               |               | describe his  |               |   |
|               |               | or her        |               |   |
|               |               | experience in |               |   |
|               |               | medical       |               |   |
|               |               | operations.   |               |   |
|               |               |               |               |   |
|               |               | ·             |               |   |
|               |               |               |               |   |
|               |               | -   Introduce |               |   |
|               |               |     this      |               |   |
|               |               |     session   |               |   |
|               |               |     by        |               |   |
|               |               |               |               |   |
|               |               |    explaining |               |   |
|               |               |     that the  |               |   |
|               |               |     need for  |               |   |
|               |               |     disaster  |               |   |
|               |               |     medical   |               |   |
|               |               |     operation |               |   |
|               |               |     is based  |               |   |
|               |               |     on two    |               |   |
|               |               |               |               |   |
|               |               |  assumptions: |               |   |
|               |               |               |               |   |
|               |               | • The number  |               |   |
|               |               | of victims    |               |   |
|               |               | will exceed   |               |   |
|               |               | local         |               |   |
|               |               | capacity for  |               |   |
|               |               | treatment.    |               |   |
|               |               |               |               |   |
|               |               | • Survivors   |               |   |
|               |               | will assist   |               |   |
|               |               | others. They  |               |   |
|               |               | will do       |               |   |
|               |               | whatever they |               |   |
|               |               | know how to   |               |   |
|               |               | do but it     |               |   |
|               |               | cannot be     |               |   |
|               |               | assumed that  |               |   |
|               |               | most will     |               |   |
|               |               | know          |               |   |
|               |               | lifesaving    |               |   |
|               |               | first aid or  |               |   |
|               |               | post-disaster |               |   |
|               |               | survival      |               |   |
|               |               | techniques.   |               |   |
+---------------+---------------+---------------+---------------+---+
|               |               |               |               |   |
+---------------+---------------+---------------+---------------+---+
|               | *Participant  | § Add         |               |   |
|               | Hand-book,    | emphasis to   |               |   |
|               | page PH       | the need for  |               |   |
|               | III-3.*       | neigh         |               |   |
|               |               | borhood-level |               |   |
|               |               | medical       |               |   |
|               |               | operations by |               |   |
|               |               | describing    |               |   |
|               |               | the three     |               |   |
|               |               | phases of     |               |   |
|               |               | death due to  |               |   |
|               |               | trauma:       |               |   |
|               |               |               |               |   |
|               |               | •* Phase 1:*  |               |   |
|               |               | Death within  |               |   |
|               |               | minutes due   |               |   |
|               |               | to            |               |   |
|               |               | over-whelming |               |   |
|               |               | and           |               |   |
|               |               | irreversible  |               |   |
|               |               | damage to     |               |   |
|               |               | vital organs. |               |   |
|               |               |               |               |   |
|               |               | •* Phase 2:*  |               |   |
|               |               | Death within  |               |   |
|               |               | several hours |               |   |
|               |               | due to        |               |   |
|               |               | excessive     |               |   |
|               |               | bleeding.     |               |   |
|               |               |               |               |   |
|               |               | •* Phase 3:*  |               |   |
|               |               | Death in      |               |   |
|               |               | several days  |               |   |
|               |               | or weeks due  |               |   |
|               |               | to infection  |               |   |
|               |               | or            |               |   |
|               |               | mu            |               |   |
|               |               | ltiple-system |               |   |
|               |               | failure       |               |   |
|               |               | (i.e., not    |               |   |
|               |               | from the      |               |   |
|               |               | injury per    |               |   |
|               |               | se).          |               |   |
+---------------+---------------+---------------+---------------+---+
| *Explain that |               |               |               |   |
| these phases  |               |               |               |   |
| represent the |               |               |               |   |
| reason        |               |               |               |   |
| [why          |               |               |               |   |
| ]{.underline} |               |               |               |   |
| disaster      |               |               |               |   |
| medical       |               |               |               |   |
| operations    |               |               |               |   |
| are conducted |               |               |               |   |
| as they are*  |               |               |               |   |
+---------------+---------------+---------------+---------------+---+
|               | *             |               |               |   |
|               | *INTRODUCTION |               |               |   |
|               | AND SESSION   |               |               |   |
|               | OVERVIEW**    |               |               |   |
|               | (Continued)   |               |               |   |
|               |               |               |               |   |
|               | § Point out   |               |               |   |
|               | that experts  |               |               |   |
|               | agree that    |               |               |   |
|               | over 40       |               |               |   |
|               | percent of    |               |               |   |
|               | disaster      |               |               |   |
|               | victims in    |               |               |   |
|               | the second    |               |               |   |
|               | and third     |               |               |   |
|               | phases of     |               |               |   |
|               | death could   |               |               |   |
|               | be saved by   |               |               |   |
|               | providing     |               |               |   |
|               | simple        |               |               |   |
|               | medical care. |               |               |   |
|               |               |               |               |   |
|               | § Add that    |               |               |   |
|               | CERT disaster |               |               |   |
|               | operations    |               |               |   |
|               | personnel are |               |               |   |
|               | trained to    |               |               |   |
|               | provide:      |               |               |   |
|               |               |               |               |   |
|               | • First aid   |               |               |   |
|               | treatment for |               |               |   |
|               | lif           |               |               |   |
|               | e-threatening |               |               |   |
|               | condit        |               |               |   |
|               | ions---airway |               |               |   |
|               | obstruction,  |               |               |   |
|               | bleeding, and |               |               |   |
|               | shock---and   |               |               |   |
|               | for other     |               |               |   |
|               | less urgent   |               |               |   |
|               | conditions.   |               |               |   |
|               |               |               |               |   |
|               | • The         |               |               |   |
|               | greatest good |               |               |   |
|               | for the       |               |               |   |
|               | greatest      |               |               |   |
|               | number of     |               |               |   |
|               | victims by    |               |               |   |
|               | conducting    |               |               |   |
|               | triage        |               |               |   |
|               | evaluations.  |               |               |   |
|               |               |               |               |   |
|               | § Introduce   |               |               |   |
|               | the concept   |               |               |   |
|               | of Simple     |               |               |   |
|               | Triage And    |               |               |   |
|               | Rapid         |               |               |   |
|               | Treatment     |               |               |   |
|               | (START) when  |               |               |   |
|               | initially     |               |               |   |
|               | dealing with  |               |               |   |
|               | casualties in |               |               |   |
|               | a disaster.   |               |               |   |
+---------------+---------------+---------------+---------------+---+
| *Note that    | § Poll the    |               |               |   |
| those who     | group to see  |               |               |   |
| have taken    | how many have |               |               |   |
| first aid     | taken first   |               |               |   |
| courses       | aid courses.  |               |               |   |
| typically     |               |               |               |   |
| have the most |               |               |               |   |
| difficulty    |               |               |               |   |
| adjusting to  |               |               |               |   |
| disaster      |               |               |               |   |
| medical       |               |               |               |   |
| operations.*  |               |               |               |   |
+---------------+---------------+---------------+---------------+---+
|               | **SESSION     |               |               |   |
|               | OBJECTIVES**  |               |               |   |
+---------------+---------------+---------------+---------------+---+
| *Visual 3.1*  | § Tell the    |               |               |   |
|               | group that at |               |               |   |
|               | the end of    |               |               |   |
|               | this unit,    |               |               |   |
|               | they will be  |               |               |   |
|               | able to:      |               |               |   |
|               |               |               |               |   |
|               | • Identify    |               |               |   |
|               | the           |               |               |   |
|               | "killers."    |               |               |   |
|               |               |               |               |   |
|               | • Apply       |               |               |   |
|               | techniques    |               |               |   |
|               | for opening   |               |               |   |
|               | the airway,   |               |               |   |
|               | controlling   |               |               |   |
|               | bleeding, and |               |               |   |
|               | treating for  |               |               |   |
|               | shock.        |               |               |   |
|               |               |               |               |   |
|               | • Conduct     |               |               |   |
|               | triage under  |               |               |   |
|               | simulated     |               |               |   |
|               | disaster      |               |               |   |
|               | conditions.   |               |               |   |
+---------------+---------------+---------------+---------------+---+
|               | **SESSION     |               |               |   |
|               | OBJECTIVES**  |               |               |   |
|               | (Continued)   |               |               |   |
|               |               |               |               |   |
|               | § Stress once |               |               |   |
|               | more that the |               |               |   |
|               | goal of       |               |               |   |
|               | disaster      |               |               |   |
|               | medical       |               |               |   |
|               | operations is |               |               |   |
|               | to do the     |               |               |   |
|               | greatest good |               |               |   |
|               | for the       |               |               |   |
|               | greatest      |               |               |   |
|               | number.       |               |               |   |
+---------------+---------------+---------------+---------------+---+
|               | **SUMMARY AND |               |               |   |
|               | TRANSITION**  |               |               |   |
|               |               |               |               |   |
|               | § Explain     |               |               |   |
|               | that this     |               |               |   |
|               | session will  |               |               |   |
|               | introduce the |               |               |   |
|               | participants  |               |               |   |
|               | to disaster   |               |               |   |
|               | first aid     |               |               |   |
|               | treatment and |               |               |   |
|               | the           |               |               |   |
|               | principles of |               |               |   |
|               | triage. Tell  |               |               |   |
|               | the group     |               |               |   |
|               | that,         |               |               |   |
|               | through-out   |               |               |   |
|               | the session,  |               |               |   |
|               | they will     |               |               |   |
|               | have          |               |               |   |
|               | opportunities |               |               |   |
|               | to practice   |               |               |   |
|               | the first aid |               |               |   |
|               | techniques    |               |               |   |
|               | and, at the   |               |               |   |
|               | end of the    |               |               |   |
|               | session, they |               |               |   |
|               | will have the |               |               |   |
|               | opportunity   |               |               |   |
|               | to conduct    |               |               |   |
|               | triage        |               |               |   |
|               | evaluations   |               |               |   |
|               | in a          |               |               |   |
|               | simulated     |               |               |   |
|               | disaster.     |               |               |   |
+---------------+---------------+---------------+---------------+---+
| ** ?**        | § Ask the     |               |               |   |
| *Discussion   | participants  |               |               |   |
| question.*    | if anyone has |               |               |   |
|               | any           |               |               |   |
|               | questions.    |               |               |   |
|               |               |               |               |   |
|               | § Explain     |               |               |   |
|               | that the      |               |               |   |
|               | first section |               |               |   |
|               | will deal     |               |               |   |
|               | with          |               |               |   |
|               | treatment for |               |               |   |
|               | lif           |               |               |   |
|               | e-threatening |               |               |   |
|               | conditions:   |               |               |   |
|               | airway        |               |               |   |
|               | obstruction,  |               |               |   |
|               | excessive     |               |               |   |
|               | bleeding, and |               |               |   |
|               | shock.        |               |               |   |
+---------------+---------------+---------------+---------------+---+

**YOUR NOTES:**

+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *     | **R   |       |       |       |       |       |
|       | Total | ECOGN |       |       |       |       |       |
|       | To    | IZING |       |       |       |       |       |
|       | pic:* | AND   |       |       |       |       |       |
|       |       | TRE   |       |       |       |       |       |
|       | *1    | ATING |       |       |       |       |       |
|       | hour  | L     |       |       |       |       |       |
|       | 30    | IFE-T |       |       |       |       |       |
|       | min   | HREAT |       |       |       |       |       |
|       | utes* | ENING |       |       |       |       |       |
|       |       | CO    |       |       |       |       |       |
|       |       | NDITI |       |       |       |       |       |
|       |       | ONS** |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *V    | §     |       |       |       |       |       |       |
| isual | Intr  |       |       |       |       |       |       |
| 3.2*  | oduce |       |       |       |       |       |       |
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|       | se    |       |       |       |       |       |       |
|       | ction |       |       |       |       |       |       |
|       | by    |       |       |       |       |       |       |
|       | te    |       |       |       |       |       |       |
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|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | that, |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | emer  |       |       |       |       |       |       |
|       | gency |       |       |       |       |       |       |
|       | medi  |       |       |       |       |       |       |
|       | cine, |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
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|       | struc |       |       |       |       |       |       |
|       | tion, |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding, |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | shock |       |       |       |       |       |       |
|       | are   |       |       |       |       |       |       |
|       | "kill |       |       |       |       |       |       |
|       | ers." |       |       |       |       |       |       |
|       | The   |       |       |       |       |       |       |
|       | first |       |       |       |       |       |       |
|       | pri   |       |       |       |       |       |       |
|       | ority |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | me    |       |       |       |       |       |       |
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|       | a     |       |       |       |       |       |       |
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|       | to    |       |       |       |       |       |       |
|       | those |       |       |       |       |       |       |
|       | pote  |       |       |       |       |       |       |
|       | ntial |       |       |       |       |       |       |
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|       | by:   |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Op    |       |       |       |       |       |       |
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|       | the   |       |       |       |       |       |       |
|       | ai    |       |       |       |       |       |       |
|       | rway. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | C     |       |       |       |       |       |       |
|       | ontro |       |       |       |       |       |       |
|       | lling |       |       |       |       |       |       |
|       | exce  |       |       |       |       |       |       |
|       | ssive |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Tre   |       |       |       |       |       |       |
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|       | for   |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hock. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Ex    |       |       |       |       |       |       |
|       | plain |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | this  |       |       |       |       |       |       |
|       | se    |       |       |       |       |       |       |
|       | ction |       |       |       |       |       |       |
|       | will  |       |       |       |       |       |       |
|       | train |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | reco  |       |       |       |       |       |       |
|       | gnize |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | "kil  |       |       |       |       |       |       |
|       | lers" |       |       |       |       |       |       |
|       | by    |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | ecogn |       |       |       |       |       |       |
|       | izing |       |       |       |       |       |       |
|       | their |       |       |       |       |       |       |
|       | sym   |       |       |       |       |       |       |
|       | ptoms |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | their |       |       |       |       |       |       |
|       | ef    |       |       |       |       |       |       |
|       | fects |       |       |       |       |       |       |
|       | on    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | body. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | emind |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | wear  |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | afety |       |       |       |       |       |       |
|       | equip |       |       |       |       |       |       |
|       | ment: |       |       |       |       |       |       |
|       | he    |       |       |       |       |       |       |
|       | lmet, |       |       |       |       |       |       |
|       | gog   |       |       |       |       |       |       |
|       | gles, |       |       |       |       |       |       |
|       | gl    |       |       |       |       |       |       |
|       | oves, |       |       |       |       |       |       |
|       | mask, |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | b     |       |       |       |       |       |       |
|       | oots. |       |       |       |       |       |       |
|       | Also, |       |       |       |       |       |       |
|       | since |       |       |       |       |       |       |
|       | speed |       |       |       |       |       |       |
|       | is    |       |       |       |       |       |       |
|       | impor |       |       |       |       |       |       |
|       | tant, |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | could |       |       |       |       |       |       |
|       | wear  |       |       |       |       |       |       |
|       | latex |       |       |       |       |       |       |
|       | g     |       |       |       |       |       |       |
|       | loves |       |       |       |       |       |       |
|       | under |       |       |       |       |       |       |
|       | their |       |       |       |       |       |       |
|       | work  |       |       |       |       |       |       |
|       | gl    |       |       |       |       |       |       |
|       | oves. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *P    | **OP  |       |       |       |       |       |
|       | artic | ENING |       |       |       |       |       |
|       | ipant | THE   |       |       |       |       |       |
|       | Hand- | A     |       |       |       |       |       |
|       | book, | IRWAY |       |       |       |       |       |
|       | page  | **    |       |       |       |       |       |
|       | PH    |       |       |       |       |       |       |
|       | II    |       |       |       |       |       |       |
|       | I-5.* |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *V    | §     |       |       |       |       |       |       |
| isual |       |       |       |       |       |       |       |
| 3.3*  | 0     |       |       |       |       |       |       |
|       | .  Di |       |       |       |       |       |       |
|       | splay |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | compo |       |       |       |       |       |       |
|       | nents |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    of |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |     r |       |       |       |       |       |       |
|       | espir |       |       |       |       |       |       |
|       | atory |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    sy |       |       |       |       |       |       |
|       | stem. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | Point |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   out |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |     r |       |       |       |       |       |       |
|       | espir |       |       |       |       |       |       |
|       | atory |       |       |       |       |       |       |
|       |     s |       |       |       |       |       |       |
|       | ystem |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   inc |       |       |       |       |       |       |
|       | ludes |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| -     |       |       |       |       |       |       |       |
| Point |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|    to |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   the |       |       |       |       |       |       |       |
|     a |       |       |       |       |       |       |       |
| irway |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|    on |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   the |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|    vi |       |       |       |       |       |       |       |
| sual. |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|  Then |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   ask |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   the |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|    pa |       |       |       |       |       |       |       |
| rtici |       |       |       |       |       |       |       |
| pants |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|    if |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|  they |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|  know |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|  what |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   the |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|  most |       |       |       |       |       |       |       |
|     c |       |       |       |       |       |       |       |
| ommon |       |       |       |       |       |       |       |
|     a |       |       |       |       |       |       |       |
| irway |       |       |       |       |       |       |       |
|     o |       |       |       |       |       |       |       |
| bstru |       |       |       |       |       |       |       |
| ction |       |       |       |       |       |       |       |
|     i |       |       |       |       |       |       |       |
| s.air |       |       |       |       |       |       |       |
| ways, |       |       |       |       |       |       |       |
|     l |       |       |       |       |       |       |       |
| ungs, |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   and |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|   mus |       |       |       |       |       |       |       |
| cles. |       |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
| **    |       |       |       |       |       |       |       |
| ?**   |       |       |       |       |       |       |       |
| *     |       |       |       |       |       |       |       |
| Discu |       |       |       |       |       |       |       |
| ssion |       |       |       |       |       |       |       |
| quest |       |       |       |       |       |       |       |
| ion.* |       |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       |       |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **OP  |       |       |       |       |       |       |
|       | ENING |       |       |       |       |       |       |
|       | THE   |       |       |       |       |       |       |
|       | AIR   |       |       |       |       |       |       |
|       | WAY** |       |       |       |       |       |       |
|       | (     |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *P    | If    |       | *P    | §     |       |       |
|       | artic | not   |       | artic | Ex    |       |       |
|       | ipant | menti |       | ipant | plain |       |       |
|       | Hand- | oned, |       | Hand- | that  |       |       |
|       | book, | tell  |       | book, | when  |       |       |
|       | page  | the   |       | page  | an    |       |       |
|       | PH    | group |       | PH    | a     |       |       |
|       | II    | that  |       | II    | irway |       |       |
|       | I-7.* | the   |       | I-8.* | o     |       |       |
|       |       | most  |       |       | bstru |       |       |
|       |       | c     |       |       | ction |       |       |
|       |       | ommon |       |       | is    |       |       |
|       |       | a     |       |       | suspe |       |       |
|       |       | irway |       |       | cted, |       |       |
|       |       | o     |       |       | CERT  |       |       |
|       |       | bstru |       |       | me    |       |       |
|       |       | ction |       |       | mbers |       |       |
|       |       | is    |       |       | s     |       |       |
|       |       | the   |       |       | hould |       |       |
|       |       | to    |       |       | clear |       |       |
|       |       | ngue. |       |       | the   |       |       |
|       |       | (     |       |       | a     |       |       |
|       |       | Refer |       |       | irway |       |       |
|       |       | the   |       |       | using |       |       |
|       |       | pa    |       |       | the   |       |       |
|       |       | rtici |       |       | Head  |       |       |
|       |       | pants |       |       | -Tilt |       |       |
|       |       | to    |       |       | /Chin |       |       |
|       |       | the   |       |       | -Lift |       |       |
|       |       | il    |       |       | me    |       |       |
|       |       | lustr |       |       | thod. |       |       |
|       |       | ation |       |       | (     |       |       |
|       |       | in    |       |       | Refer |       |       |
|       |       | their |       |       | the   |       |       |
|       |       | P     |       |       | pa    |       |       |
|       |       | artic |       |       | rtici |       |       |
|       |       | ipant |       |       | pants |       |       |
|       |       | H     |       |       | to    |       |       |
|       |       | andbo |       |       | their |       |       |
|       |       | oks.) |       |       | P     |       |       |
|       |       | Ex    |       |       | artic |       |       |
|       |       | plain |       |       | ipant |       |       |
|       |       | that, |       |       | H     |       |       |
|       |       | in an |       |       | andbo |       |       |
|       |       | u     |       |       | oks.) |       |       |
|       |       | ncons |       |       | This  |       |       |
|       |       | cious |       |       | m     |       |       |
|       |       | or    |       |       | ethod |       |       |
|       |       | sem   |       |       | inv   |       |       |
|       |       | icons |       |       | olves |       |       |
|       |       | cious |       |       | the   |       |       |
|       |       | vi    |       |       | foll  |       |       |
|       |       | ctim, |       |       | owing |       |       |
|       |       | espec |       |       | six   |       |       |
|       |       | ially |       |       | s     |       |       |
|       |       | one   |       |       | teps: |       |       |
|       |       | posit |       |       |       |       |       |
|       |       | ioned |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | his   |       |       |       |       |       |
|       |       | or    |       |       |       |       |       |
|       |       | her   |       |       |       |       |       |
|       |       | back, |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | tong  |       |       |       |       |       |
|       |       | ue--- |       |       |       |       |       |
|       |       | which |       |       |       |       |       |
|       |       | is a  |       |       |       |       |       |
|       |       | mu    |       |       |       |       |       |
|       |       | scle- |       |       |       |       |       |
|       |       | --may |       |       |       |       |       |
|       |       | relax |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | block |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | ai    |       |       |       |       |       |
|       |       | rway. |       |       |       |       |       |
|       |       | A     |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |       | ictim |       |       |       |       |       |
|       |       | with  |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | susp  |       |       |       |       |       |
|       |       | ected |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | irway |       |       |       |       |       |
|       |       | o     |       |       |       |       |       |
|       |       | bstru |       |       |       |       |       |
|       |       | ction |       |       |       |       |       |
|       |       | must  |       |       |       |       |       |
|       |       | be    |       |       |       |       |       |
|       |       | ch    |       |       |       |       |       |
|       |       | ecked |       |       |       |       |       |
|       |       | i     |       |       |       |       |       |
|       |       | mmedi |       |       |       |       |       |
|       |       | ately |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | brea  |       |       |       |       |       |
|       |       | thing |       |       |       |       |       |
|       |       | and,  |       |       |       |       |       |
|       |       | if    |       |       |       |       |       |
|       |       | neces |       |       |       |       |       |
|       |       | sary, |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | irway |       |       |       |       |       |
|       |       | must  |       |       |       |       |       |
|       |       | be    |       |       |       |       |       |
|       |       | op    |       |       |       |       |       |
|       |       | ened. |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *D    | •     | *Ex   | •     |       |       |       |       |
| emons | [Step | plain | [Step |       |       |       |       |
| trate | 1]{.u | that  | 3]{.u |       |       |       |       |
| each  | nderl | this  | nderl |       |       |       |       |
| step  | ine}: | m     | ine}: |       |       |       |       |
| s     | At an | ethod | Place |       |       |       |       |
| lowly | arm's | c     | two   |       |       |       |       |
| using | dist  | auses | fi    |       |       |       |       |
| the   | ance, | l     | ngers |       |       |       |       |
| manne | shake | ittle | of    |       |       |       |       |
| quin. | the   | or no | the   |       |       |       |       |
| Ex    | v     | cerv  | other |       |       |       |       |
| plain | ictim | ical- | hand  |       |       |       |       |
| that  | and   | spine | under |       |       |       |       |
| p     | s     | mani  | the   |       |       |       |       |
| roper | hout, | pulat | chin  |       |       |       |       |
| tech  | "Can  | ion.* | and   |       |       |       |       |
| nique | you   |       | tilt  |       |       |       |       |
| is    | hear  |       | the   |       |       |       |       |
| impor | me?"  |       | jaw   |       |       |       |       |
| tant, |       |       | u     |       |       |       |       |
| but   | •     |       | pward |       |       |       |       |
| so is | [Step |       | while |       |       |       |       |
| speed | 2]{.u |       | ti    |       |       |       |       |
| if    | nderl |       | lting |       |       |       |       |
| there | ine}: |       | the   |       |       |       |       |
| are   | If    |       | head  |       |       |       |       |
| mul   | the   |       | bac   |       |       |       |       |
| tiple | v     |       | kward |       |       |       |       |
| vict  | ictim |       | slig  |       |       |       |       |
| ims.* | does  |       | htly. |       |       |       |       |
|       | not   |       |       |       |       |       |       |
|       | or    |       | •     |       |       |       |       |
|       | c     |       | [Step |       |       |       |       |
|       | annot |       | 4]{.u |       |       |       |       |
|       | res   |       | nderl |       |       |       |       |
|       | pond, |       | ine}: |       |       |       |       |
|       | place |       | Look  |       |       |       |       |
|       | one   |       | for   |       |       |       |       |
|       | hand  |       | chest |       |       |       |       |
|       | on    |       | rise. |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | vic   |       | •     |       |       |       |       |
|       | tim's |       | [Step |       |       |       |       |
|       | fore  |       | 5]{.u |       |       |       |       |
|       | head. |       | nderl |       |       |       |       |
|       |       |       | ine}: |       |       |       |       |
|       |       |       | L     |       |       |       |       |
|       |       |       | isten |       |       |       |       |
|       |       |       | for   |       |       |       |       |
|       |       |       | air   |       |       |       |       |
|       |       |       | exch  |       |       |       |       |
|       |       |       | ange. |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       |       | •     |       |       |       |       |
|       |       |       | [Step |       |       |       |       |
|       |       |       | 6]{.u |       |       |       |       |
|       |       |       | nderl |       |       |       |       |
|       |       |       | ine}: |       |       |       |       |
|       |       |       | Feel  |       |       |       |       |
|       |       |       | for   |       |       |       |       |
|       |       |       | abdo  |       |       |       |       |
|       |       |       | minal |       |       |       |       |
|       |       |       | move  |       |       |       |       |
|       |       |       | ment. |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *     | *     |       |       |       |       |       |
|       | Total | *EXER |       |       |       |       |       |
|       | Exerc | CISE: |       |       |       |       |       |
|       | ise:* | OP    |       |       |       |       |       |
|       |       | ENING |       |       |       |       |       |
|       | *15   | THE   |       |       |       |       |       |
|       | min   | AIR   |       |       |       |       |       |
|       | utes* | WAY** |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | [     |       |       |       |       |       |
|       |       | Instr |       |       |       |       |       |
|       |       | uctor |       |       |       |       |       |
|       |       | Not   |       |       |       |       |       |
|       |       | e]{.u |       |       |       |       |       |
|       |       | nderl |       |       |       |       |       |
|       |       | ine}: |       |       |       |       |       |
|       |       | This  |       |       |       |       |       |
|       |       | exe   |       |       |       |       |       |
|       |       | rcise |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | llows |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | pa    |       |       |       |       |       |
|       |       | rtici |       |       |       |       |       |
|       |       | pants |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | pra   |       |       |       |       |       |
|       |       | ctice |       |       |       |       |       |
|       |       | using |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | Head  |       |       |       |       |       |
|       |       | -Tilt |       |       |       |       |       |
|       |       | /Chin |       |       |       |       |       |
|       |       | -Lift |       |       |       |       |       |
|       |       | m     |       |       |       |       |       |
|       |       | ethod |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | each  |       |       |       |       |       |
|       |       | o     |       |       |       |       |       |
|       |       | ther. |       |       |       |       |       |
|       |       | It is |       |       |       |       |       |
|       |       | impo  |       |       |       |       |       |
|       |       | rtant |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | have  |       |       |       |       |       |
|       |       | other |       |       |       |       |       |
|       |       | i     |       |       |       |       |       |
|       |       | nstru |       |       |       |       |       |
|       |       | ctors |       |       |       |       |       |
|       |       | who   |       |       |       |       |       |
|       |       | can   |       |       |       |       |       |
|       |       | help  |       |       |       |       |       |
|       |       | obs   |       |       |       |       |       |
|       |       | erve. |       |       |       |       |       |
|       |       | How   |       |       |       |       |       |
|       |       | ever, |       |       |       |       |       |
|       |       | make  |       |       |       |       |       |
|       |       | sure  |       |       |       |       |       |
|       |       | you   |       |       |       |       |       |
|       |       | all   |       |       |       |       |       |
|       |       | agree |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | roper |       |       |       |       |       |
|       |       | proce |       |       |       |       |       |
|       |       | dure. |       |       |       |       |       |
|       |       | F     |       |       |       |       |       |
|       |       | ollow |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | steps |       |       |       |       |       |
|       |       | below |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | facil |       |       |       |       |       |
|       |       | itate |       |       |       |       |       |
|       |       | this  |       |       |       |       |       |
|       |       | exer  |       |       |       |       |       |
|       |       | cise: |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *Pair | 1\.   |       |       |       |       |       |
|       | off   | D     |       |       |       |       |       |
|       | the   | ivide |       |       |       |       |       |
|       | part  | the   |       |       |       |       |       |
|       | icipa | pa    |       |       |       |       |       |
|       | nts.* | rtici |       |       |       |       |       |
|       |       | pants |       |       |       |       |       |
|       |       | into  |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | airs. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | 2\.   |       |       |       |       |       |
|       |       | Ask   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | erson |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | right |       |       |       |       |       |
|       |       | to be |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |       | ictim |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | erson |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | left  |       |       |       |       |       |
|       |       | to be |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | res   |       |       |       |       |       |
|       |       | cuer. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | 3\.   |       |       |       |       |       |
|       |       | Ask   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | vi    |       |       |       |       |       |
|       |       | ctims |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | lie   |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | floor |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |       | backs |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | close |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |       | eyes. |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *Ob   | 4\.   |       | §     |       | **OP  | *Ex   | §     |
| serve | Ask   |       | After |       | ENING | plain | R     |
| each  | the   |       | all   |       | THE   | that  | emind |
| group | re    |       | pa    |       | A     | head  | the   |
| and   | scuer |       | rtici |       | IRWAY | i     | pa    |
| co    | to    |       | pants |       | **(   | njury | rtici |
| rrect | use   |       | have  |       | Conti | r     | pants |
| imp   | the   |       | had   |       | nued) | efers | that, |
| roper | Head  |       | the   |       |       | to    | if    |
| t     | -Tilt |       | o     |       |       | c     | they  |
| echni | /Chin |       | pport |       |       | oncus | su    |
| que.* | -Lift |       | unity |       |       | sion, | spect |
|       | m     |       | to be |       |       | not   | that  |
|       | ethod |       | the   |       |       | head  | the   |
|       | on    |       | res   |       |       | or    | v     |
|       | the   |       | cuer, |       |       | f     | ictim |
|       | v     |       | di    |       |       | acial | has a |
|       | ictim |       | scuss |       |       | cuts, | head, |
|       | to    |       | any   |       |       | alt   | neck, |
|       | open  |       | pro   |       |       | hough | or    |
|       | the   |       | blems |       |       | these | s     |
|       | ai    |       | or    |       |       | may   | pinal |
|       | rway. |       | inco  |       |       | be    | i     |
|       |       |       | rrect |       |       | indic | njury |
|       | 5\.   |       | techn |       |       | ators | (all  |
|       | After |       | iques |       |       | of    | of    |
|       | the   |       | that  |       |       | head  | which |
|       | re    |       | were  |       |       | inj   | are   |
|       | scuer |       | obse  |       |       | ury.* | most  |
|       | has   |       | rved. |       |       |       | c     |
|       | made  |       | Ex    |       |       |       | ommon |
|       | two   |       | plain |       |       |       | in    |
|       | or    |       | how   |       |       |       | struc |
|       | three |       | to    |       |       |       | tural |
|       | att   |       | avoid |       |       |       | c     |
|       | empts |       | the   |       |       |       | ollap |
|       | at    |       | pro   |       |       |       | ses), |
|       | using |       | blems |       |       |       | they  |
|       | the   |       | in    |       |       |       | s     |
|       | Head  |       | the   |       |       |       | hould |
|       | -Tilt |       | fu    |       |       |       | try   |
|       | /Chin |       | ture. |       |       |       | li    |
|       | -Lift |       |       |       |       |       | fting |
|       | me    |       |       |       |       |       | the   |
|       | thod, |       |       |       |       |       | vic   |
|       | ask   |       |       |       |       |       | tim's |
|       | the   |       |       |       |       |       | chin  |
|       | v     |       |       |       |       |       | wi    |
|       | ictim |       |       |       |       |       | thout |
|       | and   |       |       |       |       |       | ti    |
|       | the   |       |       |       |       |       | lting |
|       | re    |       |       |       |       |       | the   |
|       | scuer |       |       |       |       |       | head. |
|       | to    |       |       |       |       |       |       |
|       | c     |       |       |       |       |       | §     |
|       | hange |       |       |       |       |       | Also  |
|       | r     |       |       |       |       |       | r     |
|       | oles. |       |       |       |       |       | emind |
|       |       |       |       |       |       |       | the   |
|       | 6\.   |       |       |       |       |       | pa    |
|       | Allow |       |       |       |       |       | rtici |
|       | each  |       |       |       |       |       | pants |
|       | re    |       |       |       |       |       | that  |
|       | scuer |       |       |       |       |       | part  |
|       | two   |       |       |       |       |       | of    |
|       | or    |       |       |       |       |       | their |
|       | three |       |       |       |       |       | mi    |
|       | obs   |       |       |       |       |       | ssion |
|       | erved |       |       |       |       |       | is to |
|       | att   |       |       |       |       |       | do    |
|       | empts |       |       |       |       |       | the   |
|       | to    |       |       |       |       |       | gre   |
|       | use   |       |       |       |       |       | atest |
|       | the   |       |       |       |       |       | good  |
|       | Head  |       |       |       |       |       | for   |
|       | -Tilt |       |       |       |       |       | the   |
|       | /Chin |       |       |       |       |       | gre   |
|       | -Lift |       |       |       |       |       | atest |
|       | me    |       |       |       |       |       | n     |
|       | thod. |       |       |       |       |       | umber |
|       |       |       |       |       |       |       | of    |
|       |       |       |       |       |       |       | pe    |
|       |       |       |       |       |       |       | ople. |
|       |       |       |       |       |       |       | For   |
|       |       |       |       |       |       |       | that  |
|       |       |       |       |       |       |       | re    |
|       |       |       |       |       |       |       | ason, |
|       |       |       |       |       |       |       | if    |
|       |       |       |       |       |       |       | brea  |
|       |       |       |       |       |       |       | thing |
|       |       |       |       |       |       |       | is    |
|       |       |       |       |       |       |       | not   |
|       |       |       |       |       |       |       | res   |
|       |       |       |       |       |       |       | tored |
|       |       |       |       |       |       |       | on    |
|       |       |       |       |       |       |       | the   |
|       |       |       |       |       |       |       | first |
|       |       |       |       |       |       |       | try   |
|       |       |       |       |       |       |       | using |
|       |       |       |       |       |       |       | the   |
|       |       |       |       |       |       |       | Head  |
|       |       |       |       |       |       |       | -Tilt |
|       |       |       |       |       |       |       | /Chin |
|       |       |       |       |       |       |       | -Lift |
|       |       |       |       |       |       |       | me    |
|       |       |       |       |       |       |       | thod, |
|       |       |       |       |       |       |       | CERT  |
|       |       |       |       |       |       |       | me    |
|       |       |       |       |       |       |       | mbers |
|       |       |       |       |       |       |       | s     |
|       |       |       |       |       |       |       | hould |
|       |       |       |       |       |       |       | try   |
|       |       |       |       |       |       |       | again |
|       |       |       |       |       |       |       | using |
|       |       |       |       |       |       |       | the   |
|       |       |       |       |       |       |       | same  |
|       |       |       |       |       |       |       | me    |
|       |       |       |       |       |       |       | thod. |
|       |       |       |       |       |       |       | If    |
|       |       |       |       |       |       |       | brea  |
|       |       |       |       |       |       |       | thing |
|       |       |       |       |       |       |       | c     |
|       |       |       |       |       |       |       | annot |
|       |       |       |       |       |       |       | be    |
|       |       |       |       |       |       |       | res   |
|       |       |       |       |       |       |       | tored |
|       |       |       |       |       |       |       | on    |
|       |       |       |       |       |       |       | the   |
|       |       |       |       |       |       |       | s     |
|       |       |       |       |       |       |       | econd |
|       |       |       |       |       |       |       | try,  |
|       |       |       |       |       |       |       | CERT  |
|       |       |       |       |       |       |       | me    |
|       |       |       |       |       |       |       | mbers |
|       |       |       |       |       |       |       | must  |
|       |       |       |       |       |       |       | move  |
|       |       |       |       |       |       |       | on to |
|       |       |       |       |       |       |       | the   |
|       |       |       |       |       |       |       | next  |
|       |       |       |       |       |       |       | vi    |
|       |       |       |       |       |       |       | ctim. |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *D    | §     |       |       |       |       |       |       |
| emons | Tell  |       |       |       |       |       |       |
| trate | the   |       |       |       |       |       |       |
| both  | group |       |       |       |       |       |       |
| te    | that, |       |       |       |       |       |       |
| chniq | if    |       |       |       |       |       |       |
| ues.* | brea  |       |       |       |       |       |       |
|       | thing |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | been  |       |       |       |       |       |       |
|       | rest  |       |       |       |       |       |       |
|       | ored, |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
|       | must  |       |       |       |       |       |       |
|       | still |       |       |       |       |       |       |
|       | be    |       |       |       |       |       |       |
|       | m     |       |       |       |       |       |       |
|       | ainta |       |       |       |       |       |       |
|       | ined. |       |       |       |       |       |       |
|       | One   |       |       |       |       |       |       |
|       | o     |       |       |       |       |       |       |
|       | ption |       |       |       |       |       |       |
|       | is to |       |       |       |       |       |       |
|       | use a |       |       |       |       |       |       |
|       | volu  |       |       |       |       |       |       |
|       | nteer |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | wa    |       |       |       |       |       |       |
|       | lking |       |       |       |       |       |       |
|       | wo    |       |       |       |       |       |       |
|       | unded |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | hold  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | head  |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | p     |       |       |       |       |       |       |
|       | lace. |       |       |       |       |       |       |
|       | The   |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
|       | can   |       |       |       |       |       |       |
|       | also  |       |       |       |       |       |       |
|       | be    |       |       |       |       |       |       |
|       | maint |       |       |       |       |       |       |
|       | ained |       |       |       |       |       |       |
|       | by    |       |       |       |       |       |       |
|       | pl    |       |       |       |       |       |       |
|       | acing |       |       |       |       |       |       |
|       | soft  |       |       |       |       |       |       |
|       | ob    |       |       |       |       |       |       |
|       | jects |       |       |       |       |       |       |
|       | under |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | vic   |       |       |       |       |       |       |
|       | tim's |       |       |       |       |       |       |
|       | shou  |       |       |       |       |       |       |
|       | lders |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | sli   |       |       |       |       |       |       |
|       | ghtly |       |       |       |       |       |       |
|       | el    |       |       |       |       |       |       |
|       | evate |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | shou  |       |       |       |       |       |       |
|       | lders |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | keep  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
|       | open. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **SU  |       |       |       |       |       |       |
|       | MMARY |       |       |       |       |       |       |
|       | AND   |       |       |       |       |       |       |
|       | TR    |       |       |       |       |       |       |
|       | ANSIT |       |       |       |       |       |       |
|       | ION** |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | § Ask |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | if    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | nyone |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | any   |       |       |       |       |       |       |
|       | ques  |       |       |       |       |       |       |
|       | tions |       |       |       |       |       |       |
|       | about |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | ecogn |       |       |       |       |       |       |
|       | izing |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | cle   |       |       |       |       |       |       |
|       | aring |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
|       | obst  |       |       |       |       |       |       |
|       | ruc-t |       |       |       |       |       |       |
|       | ions. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | emind |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | impor |       |       |       |       |       |       |
|       | tance |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | op    |       |       |       |       |       |       |
|       | ening |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | irway |       |       |       |       |       |       |
|       | as    |       |       |       |       |       |       |
|       | qu    |       |       |       |       |       |       |
|       | ickly |       |       |       |       |       |       |
|       | as    |       |       |       |       |       |       |
|       | poss  |       |       |       |       |       |       |
|       | ible. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Tell  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | next  |       |       |       |       |       |       |
|       | sec   |       |       |       |       |       |       |
|       | tion, |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | will  |       |       |       |       |       |       |
|       | learn |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | reco  |       |       |       |       |       |       |
|       | gnize |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | treat |       |       |       |       |       |       |
|       | un    |       |       |       |       |       |       |
|       | contr |       |       |       |       |       |       |
|       | olled |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *P    | **C   |       |       |       |       |       |
|       | artic | ONTRO |       |       |       |       |       |
|       | ipant | LLING |       |       |       |       |       |
|       | Hand- | BLEED |       |       |       |       |       |
|       | book, | ING** |       |       |       |       |       |
|       | page  |       |       |       |       |       |       |
|       | PH    | §     |       |       |       |       |       |
|       | II    | Intr  |       |       |       |       |       |
|       | I-9.* | oduce |       |       |       |       |       |
|       |       | this  |       |       |       |       |       |
|       |       | se    |       |       |       |       |       |
|       |       | ction |       |       |       |       |       |
|       |       | by    |       |       |       |       |       |
|       |       | te    |       |       |       |       |       |
|       |       | lling |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | group |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | un    |       |       |       |       |       |
|       |       | contr |       |       |       |       |       |
|       |       | olled |       |       |       |       |       |
|       |       | ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | init  |       |       |       |       |       |
|       |       | ially |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | auses |       |       |       |       |       |
|       |       | weak  |       |       |       |       |       |
|       |       | ness. |       |       |       |       |       |
|       |       | If    |       |       |       |       |       |
|       |       | ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | not   |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ontro |       |       |       |       |       |
|       |       | lled, |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |       | ictim |       |       |       |       |       |
|       |       | will  |       |       |       |       |       |
|       |       | go    |       |       |       |       |       |
|       |       | into  |       |       |       |       |       |
|       |       | shock |       |       |       |       |       |
|       |       | w     |       |       |       |       |       |
|       |       | ithin |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | short |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | eriod |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | time, |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | fi    |       |       |       |       |       |
|       |       | nally |       |       |       |       |       |
|       |       | will  |       |       |       |       |       |
|       |       | die.  |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | Ex    |       |       |       |       |       |
|       |       | plain |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | group |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | there |       |       |       |       |       |
|       |       | are   |       |       |       |       |       |
|       |       | three |       |       |       |       |       |
|       |       | types |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | type  |       |       |       |       |       |
|       |       | can   |       |       |       |       |       |
|       |       | us    |       |       |       |       |       |
|       |       | ually |       |       |       |       |       |
|       |       | be    |       |       |       |       |       |
|       |       | ident |       |       |       |       |       |
|       |       | ified |       |       |       |       |       |
|       |       | by    |       |       |       |       |       |
|       |       | how   |       |       |       |       |       |
|       |       | fast  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | blood |       |       |       |       |       |
|       |       | f     |       |       |       |       |       |
|       |       | lows: |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | •*    |       |       |       |       |       |
|       |       | Art   |       |       |       |       |       |
|       |       | erial |       |       |       |       |       |
|       |       | bleed |       |       |       |       |       |
|       |       | ing.* |       |       |       |       |       |
|       |       | Art   |       |       |       |       |       |
|       |       | eries |       |       |       |       |       |
|       |       | tran  |       |       |       |       |       |
|       |       | sport |       |       |       |       |       |
|       |       | blood |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | high  |       |       |       |       |       |
|       |       | pres  |       |       |       |       |       |
|       |       | sure. |       |       |       |       |       |
|       |       | Ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | from  |       |       |       |       |       |
|       |       | an    |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | rtery |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | [s    |       |       |       |       |       |
|       |       | purti |       |       |       |       |       |
|       |       | ng]{. |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | line} |       |       |       |       |       |
|       |       | blee  |       |       |       |       |       |
|       |       | ding. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | •*    |       |       |       |       |       |
|       |       | V     |       |       |       |       |       |
|       |       | enous |       |       |       |       |       |
|       |       | bleed |       |       |       |       |       |
|       |       | ing.* |       |       |       |       |       |
|       |       | Veins |       |       |       |       |       |
|       |       | tran  |       |       |       |       |       |
|       |       | sport |       |       |       |       |       |
|       |       | blood |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | low   |       |       |       |       |       |
|       |       | pres  |       |       |       |       |       |
|       |       | sure. |       |       |       |       |       |
|       |       | Ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | from  |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | vein  |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | [     |       |       |       |       |       |
|       |       | flowi |       |       |       |       |       |
|       |       | ng]{. |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | line} |       |       |       |       |       |
|       |       | blee  |       |       |       |       |       |
|       |       | ding. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | •*    |       |       |       |       |       |
|       |       | Capi  |       |       |       |       |       |
|       |       | llary |       |       |       |       |       |
|       |       | bleed |       |       |       |       |       |
|       |       | ing.* |       |       |       |       |       |
|       |       | C     |       |       |       |       |       |
|       |       | apill |       |       |       |       |       |
|       |       | aries |       |       |       |       |       |
|       |       | also  |       |       |       |       |       |
|       |       | carry |       |       |       |       |       |
|       |       | blood |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | low   |       |       |       |       |       |
|       |       | pres  |       |       |       |       |       |
|       |       | sure. |       |       |       |       |       |
|       |       | Ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | from  |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | apill |       |       |       |       |       |
|       |       | aries |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | [oozi |       |       |       |       |       |
|       |       | ng]{. |       |       |       |       |       |
|       |       | under |       |       |       |       |       |
|       |       | line} |       |       |       |       |       |
|       |       | blee  |       |       |       |       |       |
|       |       | ding. |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *D    | §     |       |       |       |       |       |       |
| emons | Tell  |       |       |       |       |       |       |
| trate | the   |       |       |       |       |       |       |
| each  | group |       |       |       |       |       |       |
| proc  | that  |       |       |       |       |       |       |
| edure | there |       |       |       |       |       |       |
| on    | are   |       |       |       |       |       |       |
| the   | three |       |       |       |       |       |       |
| mann  | main  |       |       |       |       |       |       |
| equin | me    |       |       |       |       |       |       |
| or    | thods |       |       |       |       |       |       |
| one   | for   |       |       |       |       |       |       |
| instr | c     |       |       |       |       |       |       |
| uctor | ontro |       |       |       |       |       |       |
| on    | lling |       |       |       |       |       |       |
| anot  | blee  |       |       |       |       |       |       |
| her.* | ding: |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | D     |       |       |       |       |       |       |
|       | irect |       |       |       |       |       |       |
|       | local |       |       |       |       |       |       |
|       | pres  |       |       |       |       |       |       |
|       | sure. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Eleva |       |       |       |       |       |       |
|       | tion. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Pre   |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       | po    |       |       |       |       |       |       |
|       | ints. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **C   |       | §     | *Ex   | §     |       |       |
|       | ONTRO |       | Ex    | plain | Ex    |       |       |
|       | LLING |       | plain | that  | plain |       |       |
|       | BLEED |       | to    | the   | that  |       |       |
|       | ING** |       | the   | ba    | a     |       |       |
|       | (     |       | group | ndage | pre   |       |       |
|       | Conti |       | that  | main  | ssure |       |       |
|       | nued) |       | local | tains | ba    |       |       |
|       |       |       | pre   | the   | ndage |       |       |
|       |       |       | ssure | d     | s     |       |       |
|       |       |       | com   | irect | hould |       |       |
|       |       |       | bined | pre   | be    |       |       |
|       |       |       | with  | ssure | tied  |       |       |
|       |       |       | elev  | n     | with  |       |       |
|       |       |       | ation | eeded | a     |       |       |
|       |       |       | is    | to    | bow,  |       |       |
|       |       |       | used  | stop  | so it |       |       |
|       |       |       | to    | the   | can   |       |       |
|       |       |       | ad    | blee  | be    |       |       |
|       |       |       | dress | ding. | loo   |       |       |
|       |       |       | 95%   | CERT  | sened |       |       |
|       |       |       | of    | me    | if    |       |       |
|       |       |       | blee  | mbers | neces |       |       |
|       |       |       | ding. | con   | sary. |       |       |
|       |       |       | D     | tinue |       |       |       |
|       |       |       | emons | to    | § Ask |       |       |
|       |       |       | trate | a     | if    |       |       |
|       |       |       | the   | ssess | a     |       |       |
|       |       |       | proc  | the   | nyone |       |       |
|       |       |       | edure | vic   | has   |       |       |
|       |       |       | for   | tim's | any   |       |       |
|       |       |       | c     | st    | ques  |       |       |
|       |       |       | ontro | atus. | tions |       |       |
|       |       |       | lling | If    | about |       |       |
|       |       |       | ble   | the   | app   |       |       |
|       |       |       | eding | vic   | lying |       |       |
|       |       |       | th    | tim's | a     |       |       |
|       |       |       | rough | limb  | pre   |       |       |
|       |       |       | d     | is    | ssure |       |       |
|       |       |       | irect | tu    | ban   |       |       |
|       |       |       | local | rning | dage. |       |       |
|       |       |       | pres  | blue  |       |       |       |
|       |       |       | sure: | or    | §     |       |       |
|       |       |       |       | bec   | D     |       |       |
|       |       |       | •     | oming | emons |       |       |
|       |       |       | [Step | numb  | trate |       |       |
|       |       |       | 1]{.u | below | the   |       |       |
|       |       |       | nderl | the   | proc  |       |       |
|       |       |       | ine}: | ban   | edure |       |       |
|       |       |       | Place | dage, | for   |       |       |
|       |       |       | d     | then  | c     |       |       |
|       |       |       | irect | it    | ontro |       |       |
|       |       |       | pre   | s     | lling |       |       |
|       |       |       | ssure | hould | ble   |       |       |
|       |       |       | over  | be    | eding |       |       |
|       |       |       | the   | loose | th    |       |       |
|       |       |       | wound | ned.* | rough |       |       |
|       |       |       | by    |       | eleva |       |       |
|       |       |       | pu    |       | tion: |       |       |
|       |       |       | tting |       | elev  |       |       |
|       |       |       | a     |       | ating |       |       |
|       |       |       | clean |       | the   |       |       |
|       |       |       | pad   |       | wound |       |       |
|       |       |       | over  |       | above |       |       |
|       |       |       | the   |       | the   |       |       |
|       |       |       | wound |       | level |       |       |
|       |       |       | and   |       | of    |       |       |
|       |       |       | pre   |       | the   |       |       |
|       |       |       | ssing |       | h     |       |       |
|       |       |       | fi    |       | eart. |       |       |
|       |       |       | rmly. |       | This  |       |       |
|       |       |       |       |       | can   |       |       |
|       |       |       | •     |       | be    |       |       |
|       |       |       | [Step |       | used  |       |       |
|       |       |       | 2]{.u |       | in    |       |       |
|       |       |       | nderl |       | c     |       |       |
|       |       |       | ine}: |       | ombin |       |       |
|       |       |       | Mai   |       | ation |       |       |
|       |       |       | ntain |       | with  |       |       |
|       |       |       | c     |       | d     |       |       |
|       |       |       | ompre |       | irect |       |       |
|       |       |       | ssion |       | pres  |       |       |
|       |       |       | by    |       | sure. |       |       |
|       |       |       | wra   |       |       |       |       |
|       |       |       | pping |       |       |       |       |
|       |       |       | the   |       |       |       |       |
|       |       |       | wound |       |       |       |       |
|       |       |       | [firm |       |       |       |       |
|       |       |       | ly]{. |       |       |       |       |
|       |       |       | under |       |       |       |       |
|       |       |       | line} |       |       |       |       |
|       |       |       | with  |       |       |       |       |
|       |       |       | a     |       |       |       |       |
|       |       |       | pre   |       |       |       |       |
|       |       |       | ssure |       |       |       |       |
|       |       |       | ban   |       |       |       |       |
|       |       |       | dage. |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       |       | [     |       |       |       |       |
|       |       |       | Instr |       |       |       |       |
|       |       |       | uctor |       |       |       |       |
|       |       |       | Not   |       |       |       |       |
|       |       |       | e]{.u |       |       |       |       |
|       |       |       | nderl |       |       |       |       |
|       |       |       | ine}: |       |       |       |       |
|       |       |       | D     |       |       |       |       |
|       |       |       | irect |       |       |       |       |
|       |       |       | pre   |       |       |       |       |
|       |       |       | ssure |       |       |       |       |
|       |       |       | and   |       |       |       |       |
|       |       |       | elev  |       |       |       |       |
|       |       |       | ation |       |       |       |       |
|       |       |       | can   |       |       |       |       |
|       |       |       | take  |       |       |       |       |
|       |       |       | 5 to  |       |       |       |       |
|       |       |       | 7     |       |       |       |       |
|       |       |       | mi    |       |       |       |       |
|       |       |       | nutes |       |       |       |       |
|       |       |       | to    |       |       |       |       |
|       |       |       | work. |       |       |       |       |
|       |       |       | Time  |       |       |       |       |
|       |       |       | is    |       |       |       |       |
|       |       |       | crit  |       |       |       |       |
|       |       |       | ical. |       |       |       |       |
|       |       |       | There |       |       |       |       |
|       |       |       | fore, |       |       |       |       |
|       |       |       | the   |       |       |       |       |
|       |       |       | use   |       |       |       |       |
|       |       |       | of a  |       |       |       |       |
|       |       |       | pre   |       |       |       |       |
|       |       |       | ssure |       |       |       |       |
|       |       |       | ba    |       |       |       |       |
|       |       |       | ndage |       |       |       |       |
|       |       |       | is    |       |       |       |       |
|       |       |       | nece  |       |       |       |       |
|       |       |       | ssary |       |       |       |       |
|       |       |       | so    |       |       |       |       |
|       |       |       | that  |       |       |       |       |
|       |       |       | the   |       |       |       |       |
|       |       |       | re    |       |       |       |       |
|       |       |       | scuer |       |       |       |       |
|       |       |       | can   |       |       |       |       |
|       |       |       | move  |       |       |       |       |
|       |       |       | on to |       |       |       |       |
|       |       |       | the   |       |       |       |       |
|       |       |       | next  |       |       |       |       |
|       |       |       | vi    |       |       |       |       |
|       |       |       | ctim. |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *     | §     |       |       |       |       |       |       |
| Point |       |       |       |       |       |       |       |
| out   | 0.    |       |       |       |       |       |       |
| major |  Tell |       |       |       |       |       |       |
| pre   |       |       |       |       |       |       |       |
| ssure |   the |       |       |       |       |       |       |
| p     |       |       |       |       |       |       |       |
| oints |    pa |       |       |       |       |       |       |
| on    | rtici |       |       |       |       |       |       |
| the   | pants |       |       |       |       |       |       |
| m     |       |       |       |       |       |       |       |
| anneq |  that |       |       |       |       |       |       |
| uin.* |       |       |       |       |       |       |       |
|       | there |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   are |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  also |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   pre |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       |     p |       |       |       |       |       |       |
|       | oints |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   can |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    be |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  used |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    to |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  stem |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  flow |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    of |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  blee |       |       |       |       |       |       |
|       | ding. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    Ex |       |       |       |       |       |       |
|       | plain |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   pre |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | point |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    is |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | pulse |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | point |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   for |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | major |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       | rtery |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   and |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   pre |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       |     p |       |       |       |       |       |       |
|       | oints |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   can |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    be |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    lo |       |       |       |       |       |       |
|       | cated |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    by |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    fi |       |       |       |       |       |       |
|       | nding |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       |     p |       |       |       |       |       |       |
|       | ulse. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   The |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   pre |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       |     p |       |       |       |       |       |       |
|       | oints |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  most |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | often |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  used |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   are |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  the: |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | **C   |       |       |       |       |       |       |
|       | C     |       |       |       |       |       |       |
|       | ONTRO |       |       |       |       |       |       |
|       | LLING |       |       |       |       |       |       |
|       | BLEED |       |       |       |       |       |       |
|       | ING** |       |       |       |       |       |       |
|       | (     |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Bra   |       |       |       |       |       |       |
|       | chial |       |       |       |       |       |       |
|       | point |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | arm.  |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Fe    |       |       |       |       |       |       |
|       | moral |       |       |       |       |       |       |
|       | point |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | leg.  |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Mot   |       |       |       |       |       |       |
|       | ivate |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | get   |       |       |       |       |       |       |
|       | vi    |       |       |       |       |       |       |
|       | ctims |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | help  |       |       |       |       |       |       |
|       | thems |       |       |       |       |       |       |
|       | elves |       |       |       |       |       |       |
|       | whe   |       |       |       |       |       |       |
|       | never |       |       |       |       |       |       |
|       | poss  |       |       |       |       |       |       |
|       | ible. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | § Ask |       |       |       |       |       |       |
|       | if    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | nyone |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | any   |       |       |       |       |       |       |
|       | ques  |       |       |       |       |       |       |
|       | tions |       |       |       |       |       |       |
|       | about |       |       |       |       |       |       |
|       | pre   |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       | po    |       |       |       |       |       |       |
|       | ints. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *     | *     |       |       |       |       |       |
|       | Total | *EXER |       |       |       |       |       |
|       | Exerc | CISE: |       |       |       |       |       |
|       | ise:* | C     |       |       |       |       |       |
|       |       | ONTRO |       |       |       |       |       |
|       | *15   | LLING |       |       |       |       |       |
|       | min   | BLEED |       |       |       |       |       |
|       | utes* | ING** |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | [     |       |       |       |       |       |
|       |       | Instr |       |       |       |       |       |
|       |       | uctor |       |       |       |       |       |
|       |       | Not   |       |       |       |       |       |
|       |       | e]{.u |       |       |       |       |       |
|       |       | nderl |       |       |       |       |       |
|       |       | ine}: |       |       |       |       |       |
|       |       | This  |       |       |       |       |       |
|       |       | exe   |       |       |       |       |       |
|       |       | rcise |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | llows |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | pa    |       |       |       |       |       |
|       |       | rtici |       |       |       |       |       |
|       |       | pants |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | pra   |       |       |       |       |       |
|       |       | ctice |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | techn |       |       |       |       |       |
|       |       | iques |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ontro |       |       |       |       |       |
|       |       | lling |       |       |       |       |       |
|       |       | ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | each  |       |       |       |       |       |
|       |       | o     |       |       |       |       |       |
|       |       | ther. |       |       |       |       |       |
|       |       | F     |       |       |       |       |       |
|       |       | ollow |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | steps |       |       |       |       |       |
|       |       | below |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | facil |       |       |       |       |       |
|       |       | itate |       |       |       |       |       |
|       |       | this  |       |       |       |       |       |
|       |       | exer  |       |       |       |       |       |
|       |       | cise: |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *Pair | 1\.   |       |       |       |       |       |
|       | off   | D     |       |       |       |       |       |
|       | the   | ivide |       |       |       |       |       |
|       | part  | the   |       |       |       |       |       |
|       | icipa | pa    |       |       |       |       |       |
|       | nts.* | rtici |       |       |       |       |       |
|       |       | pants |       |       |       |       |       |
|       |       | into  |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | airs. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | 2\.   |       |       |       |       |       |
|       |       | Ask   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | older |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | erson |       |       |       |       |       |
|       |       | to be |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |       | ictim |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | yo    |       |       |       |       |       |
|       |       | unger |       |       |       |       |       |
|       |       | p     |       |       |       |       |       |
|       |       | erson |       |       |       |       |       |
|       |       | to be |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | res   |       |       |       |       |       |
|       |       | cuer. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | 3\.   |       |       |       |       |       |
|       |       | Ask   |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | vi    |       |       |       |       |       |
|       |       | ctims |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | lie   |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | floor |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |       | backs |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | close |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |       | eyes. |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *Ob   | 4\.   |       |       |       |       |       |       |
| serve | Ask   |       |       |       |       |       |       |
| each  | the   |       |       |       |       |       |       |
| group | re    |       |       |       |       |       |       |
| and   | scuer |       |       |       |       |       |       |
| co    | to    |       |       |       |       |       |       |
| rrect | use   |       |       |       |       |       |       |
| any   | d     |       |       |       |       |       |       |
| imp   | irect |       |       |       |       |       |       |
| roper | local |       |       |       |       |       |       |
| te    | pre   |       |       |       |       |       |       |
| chniq | ssure |       |       |       |       |       |       |
| ues.* | to    |       |       |       |       |       |       |
|       | co    |       |       |       |       |       |       |
|       | ntrol |       |       |       |       |       |       |
|       | ble   |       |       |       |       |       |       |
|       | eding |       |       |       |       |       |       |
|       | from  |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | simu  |       |       |       |       |       |       |
|       | lated |       |       |       |       |       |       |
|       | wound |       |       |       |       |       |       |
|       | on    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | right |       |       |       |       |       |       |
|       | fo    |       |       |       |       |       |       |
|       | rearm |       |       |       |       |       |       |
|       | just  |       |       |       |       |       |       |
|       | below |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | e     |       |       |       |       |       |       |
|       | lbow. |       |       |       |       |       |       |
|       | Have  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | res   |       |       |       |       |       |       |
|       | cuer: |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Apply |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | pre   |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       | ban   |       |       |       |       |       |       |
|       | dage. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | El    |       |       |       |       |       |       |
|       | evate |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | arm.  |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | epeat |       |       |       |       |       |       |
|       | these |       |       |       |       |       |       |
|       | two   |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | teps. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | epeat |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | two   |       |       |       |       |       |       |
|       | steps |       |       |       |       |       |       |
|       | for   |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | peed. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | 5\.   |       |       |       |       |       |       |
|       | After |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | re    |       |       |       |       |       |       |
|       | scuer |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | made  |       |       |       |       |       |       |
|       | at    |       |       |       |       |       |       |
|       | least |       |       |       |       |       |       |
|       | three |       |       |       |       |       |       |
|       | att   |       |       |       |       |       |       |
|       | empts |       |       |       |       |       |       |
|       | at    |       |       |       |       |       |       |
|       | using |       |       |       |       |       |       |
|       | each  |       |       |       |       |       |       |
|       | techn |       |       |       |       |       |       |
|       | ique, |       |       |       |       |       |       |
|       | ask   |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | v     |       |       |       |       |       |       |
|       | ictim |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | re    |       |       |       |       |       |       |
|       | scuer |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | c     |       |       |       |       |       |       |
|       | hange |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | oles. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *     |       |       |       |       |       |       |
|       | *EXER |       |       |       |       |       |       |
|       | CISE: |       |       |       |       |       |       |
|       | C     |       |       |       |       |       |       |
|       | ONTRO |       |       |       |       |       |       |
|       | LLING |       |       |       |       |       |       |
|       | BLEED |       |       |       |       |       |       |
|       | ING** |       |       |       |       |       |       |
|       | (     |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | 6\.   |       |       |       |       |       |       |
|       | Allow |       |       |       |       |       |       |
|       | each  |       |       |       |       |       |       |
|       | re    |       |       |       |       |       |       |
|       | scuer |       |       |       |       |       |       |
|       | at    |       |       |       |       |       |       |
|       | least |       |       |       |       |       |       |
|       | one   |       |       |       |       |       |       |
|       | obs   |       |       |       |       |       |       |
|       | erved |       |       |       |       |       |       |
|       | at    |       |       |       |       |       |       |
|       | tempt |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | use   |       |       |       |       |       |       |
|       | each  |       |       |       |       |       |       |
|       | techn |       |       |       |       |       |       |
|       | ique. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | After |       |       |       |       |       |       |
|       | all   |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | have  |       |       |       |       |       |       |
|       | had   |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | o     |       |       |       |       |       |       |
|       | pport |       |       |       |       |       |       |
|       | unity |       |       |       |       |       |       |
|       | to be |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | res   |       |       |       |       |       |       |
|       | cuer, |       |       |       |       |       |       |
|       | di    |       |       |       |       |       |       |
|       | scuss |       |       |       |       |       |       |
|       | any   |       |       |       |       |       |       |
|       | pro   |       |       |       |       |       |       |
|       | blems |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | inco  |       |       |       |       |       |       |
|       | rrect |       |       |       |       |       |       |
|       | techn |       |       |       |       |       |       |
|       | iques |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | were  |       |       |       |       |       |       |
|       | obse  |       |       |       |       |       |       |
|       | rved. |       |       |       |       |       |       |
|       | Ex    |       |       |       |       |       |       |
|       | plain |       |       |       |       |       |       |
|       | how   |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | avoid |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | pro   |       |       |       |       |       |       |
|       | blems |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | fu    |       |       |       |       |       |       |
|       | ture. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *D    | §     |       |       |       |       |       |       |
| emons | D     |       |       |       |       |       |       |
| trate | uring |       |       |       |       |       |       |
| use   | the   |       |       |       |       |       |       |
| of    | d     |       |       |       |       |       |       |
| the   | iscus |       |       |       |       |       |       |
| bra   | sion, |       |       |       |       |       |       |
| chial | ask   |       |       |       |       |       |       |
| pre   | the   |       |       |       |       |       |       |
| ssure | pa    |       |       |       |       |       |       |
| point | rtici |       |       |       |       |       |       |
| by    | pants |       |       |       |       |       |       |
| app   | to    |       |       |       |       |       |       |
| lying | apply |       |       |       |       |       |       |
| pre   | pre   |       |       |       |       |       |       |
| ssure | ssure |       |       |       |       |       |       |
| to    | to    |       |       |       |       |       |       |
| your  | the   |       |       |       |       |       |       |
| own   | bra   |       |       |       |       |       |       |
| arm.  | chial |       |       |       |       |       |       |
| Then  | pre   |       |       |       |       |       |       |
| have  | ssure |       |       |       |       |       |       |
| the   | point |       |       |       |       |       |       |
| pa    | on    |       |       |       |       |       |       |
| rtici | their |       |       |       |       |       |       |
| pants | own   |       |       |       |       |       |       |
| apply | arms. |       |       |       |       |       |       |
| pre   |       |       |       |       |       |       |       |
| ssure |       |       |       |       |       |       |       |
| to    |       |       |       |       |       |       |       |
| their |       |       |       |       |       |       |       |
| own   |       |       |       |       |       |       |       |
| arms  |       |       |       |       |       |       |       |
| so    |       |       |       |       |       |       |       |
| that  |       |       |       |       |       |       |       |
| they  |       |       |       |       |       |       |       |
| can   |       |       |       |       |       |       |       |
| feel  |       |       |       |       |       |       |       |
| the   |       |       |       |       |       |       |       |
| e     |       |       |       |       |       |       |       |
| ffect |       |       |       |       |       |       |       |
| of    |       |       |       |       |       |       |       |
| this  |       |       |       |       |       |       |       |
| met   |       |       |       |       |       |       |       |
| hod.* |       |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *P    | **C   |       |       |       |       |       |
|       | artic | ONTRO |       |       |       |       |       |
|       | ipant | LLING |       |       |       |       |       |
|       | Hand- | BLEED |       |       |       |       |       |
|       | book, | ING** |       |       |       |       |       |
|       | page  | (     |       |       |       |       |       |
|       | PH    | Conti |       |       |       |       |       |
|       | III   | nued) |       |       |       |       |       |
|       | -13.* |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | Tell  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | pa    |       |       |       |       |       |
|       |       | rtici |       |       |       |       |       |
|       |       | pants |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | if    |       |       |       |       |       |
|       |       | none  |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | other |       |       |       |       |       |
|       |       | me    |       |       |       |       |       |
|       |       | thods |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ontro |       |       |       |       |       |
|       |       | lling |       |       |       |       |       |
|       |       | ble   |       |       |       |       |       |
|       |       | eding |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | s     |       |       |       |       |       |
|       |       | ucces |       |       |       |       |       |
|       |       | sful, |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | tourn |       |       |       |       |       |
|       |       | iquet |       |       |       |       |       |
|       |       | may   |       |       |       |       |       |
|       |       | be    |       |       |       |       |       |
|       |       | neces |       |       |       |       |       |
|       |       | sary. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | S     |       |       |       |       |       |
|       |       | tress |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | tourn |       |       |       |       |       |
|       |       | iquet |       |       |       |       |       |
|       |       | is    |       |       |       |       |       |
|       |       | *ra   |       |       |       |       |       |
|       |       | rely* |       |       |       |       |       |
|       |       | nece  |       |       |       |       |       |
|       |       | ssary |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | s     |       |       |       |       |       |
|       |       | hould |       |       |       |       |       |
|       |       | be    |       |       |       |       |       |
|       |       | used  |       |       |       |       |       |
|       |       | only  |       |       |       |       |       |
|       |       | as a  |       |       |       |       |       |
|       |       | *last |       |       |       |       |       |
|       |       | re    |       |       |       |       |       |
|       |       | sort* |       |       |       |       |       |
|       |       | ---in |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | "life |       |       |       |       |       |
|       |       | or    |       |       |       |       |       |
|       |       | limb" |       |       |       |       |       |
|       |       | situa |       |       |       |       |       |
|       |       | tion. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | Tell  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | group |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | two   |       |       |       |       |       |
|       |       | types |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | inj   |       |       |       |       |       |
|       |       | uries |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | which |       |       |       |       |       |
|       |       | t     |       |       |       |       |       |
|       |       | ourni |       |       |       |       |       |
|       |       | quets |       |       |       |       |       |
|       |       | are   |       |       |       |       |       |
|       |       | consi |       |       |       |       |       |
|       |       | dered |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |       | pprop |       |       |       |       |       |
|       |       | riate |       |       |       |       |       |
|       |       | are:  |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | •     |       |       |       |       |       |
|       |       | Cru   |       |       |       |       |       |
|       |       | shing |       |       |       |       |       |
|       |       | -type |       |       |       |       |       |
|       |       | inju  |       |       |       |       |       |
|       |       | ries. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | •     |       |       |       |       |       |
|       |       | Pa    |       |       |       |       |       |
|       |       | rtial |       |       |       |       |       |
|       |       | am    |       |       |       |       |       |
|       |       | putat |       |       |       |       |       |
|       |       | ions. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | -     |       |       |       |       |       |       |
|       |    Ex |       |       |       |       |       |       |
|       | plain |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | using |       |       |       |       |       |       |
|       |     a |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   can |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  pose |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    se |       |       |       |       |       |       |
|       | rious |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | risks |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    to |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   aff |       |       |       |       |       |       |
|       | ected |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | limb, |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    so |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   one |       |       |       |       |       |       |
|       |     s |       |       |       |       |       |       |
|       | hould |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   not |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    be |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  used |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    un |       |       |       |       |       |       |
|       | less, |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    wi |       |       |       |       |       |       |
|       | thout |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  one, |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |     v |       |       |       |       |       |       |
|       | ictim |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  will |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   die |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  from |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  exce |       |       |       |       |       |       |
|       | ssive |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | blood |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | loss. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | **C   |       |       |       |       |       |       |
|       | ONTRO |       |       |       |       |       |       |
|       | LLING |       |       |       |       |       |       |
|       | BLEED |       |       |       |       |       |       |
|       | ING** |       |       |       |       |       |       |
|       | (     |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *D    | §     |       |       |       |       |       |       |
| emons | Point |       |       |       |       |       |       |
| trate | out   |       |       |       |       |       |       |
| the   | that  |       |       |       |       |       |       |
| p     | the   |       |       |       |       |       |       |
| roper | most  |       |       |       |       |       |       |
| use   | se    |       |       |       |       |       |       |
| of a  | rious |       |       |       |       |       |       |
| tourn | da    |       |       |       |       |       |       |
| iquet | ngers |       |       |       |       |       |       |
| on    | from  |       |       |       |       |       |       |
| the   | a     |       |       |       |       |       |       |
| m     | tourn |       |       |       |       |       |       |
| anneq | iquet |       |       |       |       |       |       |
| uin.* | are:  |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •*    |       |       |       |       |       |       |
|       | Inco  |       |       |       |       |       |       |
|       | rrect |       |       |       |       |       |       |
|       | mate  |       |       |       |       |       |       |
|       | rials |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | app   |       |       |       |       |       |       |
|       | licat |       |       |       |       |       |       |
|       | ion,* |       |       |       |       |       |       |
|       | which |       |       |       |       |       |       |
|       | incr  |       |       |       |       |       |       |
|       | eases |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | d     |       |       |       |       |       |       |
|       | amage |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •*    |       |       |       |       |       |       |
|       | D     |       |       |       |       |       |       |
|       | amage |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | limb  |       |       |       |       |       |       |
|       | from  |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | t     |       |       |       |       |       |       |
|       | ourni |       |       |       |       |       |       |
|       | quet. |       |       |       |       |       |       |
|       | *Sur  |       |       |       |       |       |       |
|       | vival |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | limb  |       |       |       |       |       |       |
|       | is    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | lmost |       |       |       |       |       |       |
|       | never |       |       |       |       |       |       |
|       | pos   |       |       |       |       |       |       |
|       | sible |       |       |       |       |       |       |
|       | if a  |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       | is    |       |       |       |       |       |       |
|       | left  |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | place |       |       |       |       |       |       |
|       | too   |       |       |       |       |       |       |
|       | long. |       |       |       |       |       |       |
|       | Only  |       |       |       |       |       |       |
|       | do    |       |       |       |       |       |       |
|       | ctors |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hould |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | emove |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | urniq |       |       |       |       |       |       |
|       | uets. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Tell  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | if    |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | must  |       |       |       |       |       |       |
|       | apply |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | t     |       |       |       |       |       |       |
|       | ourni |       |       |       |       |       |       |
|       | quet, |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | sh    |       |       |       |       |       |       |
|       | ould: |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •*    |       |       |       |       |       |       |
|       | Leave |       |       |       |       |       |       |
|       | it in |       |       |       |       |       |       |
|       | plain |       |       |       |       |       |       |
|       | si    |       |       |       |       |       |       |
|       | ght.* |       |       |       |       |       |       |
|       | Do    |       |       |       |       |       |       |
|       | not   |       |       |       |       |       |       |
|       | ba    |       |       |       |       |       |       |
|       | ndage |       |       |       |       |       |       |
|       | over  |       |       |       |       |       |       |
|       | it or |       |       |       |       |       |       |
|       | cover |       |       |       |       |       |       |
|       | it.   |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •*    |       |       |       |       |       |       |
|       | A     |       |       |       |       |       |       |
|       | ttach |       |       |       |       |       |       |
|       | an    |       |       |       |       |       |       |
|       | adh   |       |       |       |       |       |       |
|       | esive |       |       |       |       |       |       |
|       | label |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | vic   |       |       |       |       |       |       |
|       | tim's |       |       |       |       |       |       |
|       | fore  |       |       |       |       |       |       |
|       | head* |       |       |       |       |       |       |
|       | st    |       |       |       |       |       |       |
|       | ating |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | time  |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       | was   |       |       |       |       |       |       |
|       | app   |       |       |       |       |       |       |
|       | lied. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Point |       |       |       |       |       |       |
|       | out   |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | time  |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       | was   |       |       |       |       |       |       |
|       | ap    |       |       |       |       |       |       |
|       | plied |       |       |       |       |       |       |
|       | can   |       |       |       |       |       |       |
|       | also  |       |       |       |       |       |       |
|       | be    |       |       |       |       |       |       |
|       | wr    |       |       |       |       |       |       |
|       | itten |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | blood |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | with  |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | magic |       |       |       |       |       |       |
|       | m     |       |       |       |       |       |       |
|       | arker |       |       |       |       |       |       |
|       | dir   |       |       |       |       |       |       |
|       | ectly |       |       |       |       |       |       |
|       | on    |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | vic   |       |       |       |       |       |       |
|       | tim's |       |       |       |       |       |       |
|       | fore  |       |       |       |       |       |       |
|       | head. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | [     |       |       |       |       |       |       |
|       | Instr |       |       |       |       |       |       |
|       | uctor |       |       |       |       |       |       |
|       | Not   |       |       |       |       |       |       |
|       | e]{.u |       |       |       |       |       |       |
|       | nderl |       |       |       |       |       |       |
|       | ine}: |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | emind |       |       |       |       |       |       |
|       | pa    |       |       |       |       |       |       |
|       | rtici |       |       |       |       |       |       |
|       | pants |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | one   |       |       |       |       |       |       |
|       | of a  |       |       |       |       |       |       |
|       | CERT  |       |       |       |       |       |       |
|       | t     |       |       |       |       |       |       |
|       | eam's |       |       |       |       |       |       |
|       | func  |       |       |       |       |       |       |
|       | tions |       |       |       |       |       |       |
|       | is to |       |       |       |       |       |       |
|       | co    |       |       |       |       |       |       |
|       | llect |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | ecord |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | forma |       |       |       |       |       |       |
|       | tion. |       |       |       |       |       |       |
|       | Pen   |       |       |       |       |       |       |
|       | cils, |       |       |       |       |       |       |
|       | mar   |       |       |       |       |       |       |
|       | kers, |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | tape  |       |       |       |       |       |       |
|       | are   |       |       |       |       |       |       |
|       | impo  |       |       |       |       |       |       |
|       | rtant |       |       |       |       |       |       |
|       | items |       |       |       |       |       |       |
|       | for   |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | dis   |       |       |       |       |       |       |
|       | aster |       |       |       |       |       |       |
|       | pr    |       |       |       |       |       |       |
|       | epare |       |       |       |       |       |       |
|       | dness |       |       |       |       |       |       |
|       | kit.  |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | S     |       |       |       |       |       |       |
|       | tress |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | impor |       |       |       |       |       |       |
|       | tance |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | pprop |       |       |       |       |       |       |
|       | riate |       |       |       |       |       |       |
|       | me    |       |       |       |       |       |       |
|       | dical |       |       |       |       |       |       |
|       | pers  |       |       |       |       |       |       |
|       | onnel |       |       |       |       |       |       |
|       | kn    |       |       |       |       |       |       |
|       | owing |       |       |       |       |       |       |
|       | how   |       |       |       |       |       |       |
|       | long  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | been  |       |       |       |       |       |       |
|       | on so |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | can   |       |       |       |       |       |       |
|       | make  |       |       |       |       |       |       |
|       | an    |       |       |       |       |       |       |
|       | inf   |       |       |       |       |       |       |
|       | ormed |       |       |       |       |       |       |
|       | dec   |       |       |       |       |       |       |
|       | ision |       |       |       |       |       |       |
|       | about |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | c     |       |       |       |       |       |       |
|       | ourse |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | treat |       |       |       |       |       |       |
|       | ment. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **SU  |       |       |       |       |       |       |
|       | MMARY |       |       |       |       |       |       |
|       | AND   |       |       |       |       |       |       |
|       | TR    |       |       |       |       |       |       |
|       | ANSIT |       |       |       |       |       |       |
|       | ION** |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Summ  |       |       |       |       |       |       |
|       | arize |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | three |       |       |       |       |       |       |
|       | main  |       |       |       |       |       |       |
|       | ways  |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | co    |       |       |       |       |       |       |
|       | ntrol |       |       |       |       |       |       |
|       | exce  |       |       |       |       |       |       |
|       | ssive |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding: |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | D     |       |       |       |       |       |       |
|       | irect |       |       |       |       |       |       |
|       | local |       |       |       |       |       |       |
|       | pre   |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Elev  |       |       |       |       |       |       |
|       | ation |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Pre   |       |       |       |       |       |       |
|       | ssure |       |       |       |       |       |       |
|       | p     |       |       |       |       |       |       |
|       | oints |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | S     |       |       |       |       |       |       |
|       | tress |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | ble   |       |       |       |       |       |       |
|       | eding |       |       |       |       |       |       |
|       | must  |       |       |       |       |       |       |
|       | be    |       |       |       |       |       |       |
|       | contr |       |       |       |       |       |       |
|       | olled |       |       |       |       |       |       |
|       | as    |       |       |       |       |       |       |
|       | qu    |       |       |       |       |       |       |
|       | ickly |       |       |       |       |       |       |
|       | as    |       |       |       |       |       |       |
|       | pos   |       |       |       |       |       |       |
|       | sible |       |       |       |       |       |       |
|       | so as |       |       |       |       |       |       |
|       | not   |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | end   |       |       |       |       |       |       |
|       | anger |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | vic   |       |       |       |       |       |       |
|       | tim's |       |       |       |       |       |       |
|       | life  |       |       |       |       |       |       |
|       | from  |       |       |       |       |       |       |
|       | blood |       |       |       |       |       |       |
|       | loss. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | emind |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | not   |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | use a |       |       |       |       |       |       |
|       | tourn |       |       |       |       |       |       |
|       | iquet |       |       |       |       |       |       |
|       | u     |       |       |       |       |       |       |
|       | nless |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | v     |       |       |       |       |       |       |
|       | ictim |       |       |       |       |       |       |
|       | would |       |       |       |       |       |       |
|       | othe  |       |       |       |       |       |       |
|       | rwise |       |       |       |       |       |       |
|       | die   |       |       |       |       |       |       |
|       | from  |       |       |       |       |       |       |
|       | exce  |       |       |       |       |       |       |
|       | ssive |       |       |       |       |       |       |
|       | blood |       |       |       |       |       |       |
|       | loss. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | R     |       |       |       |       |       |       |
|       | emind |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | they  |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hould |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | lways |       |       |       |       |       |       |
|       | wear  |       |       |       |       |       |       |
|       | their |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | ubber |       |       |       |       |       |       |
|       | g     |       |       |       |       |       |       |
|       | loves |       |       |       |       |       |       |
|       | and a |       |       |       |       |       |       |
|       | mask  |       |       |       |       |       |       |
|       | as a  |       |       |       |       |       |       |
|       | prote |       |       |       |       |       |       |
|       | ction |       |       |       |       |       |       |
|       | ag    |       |       |       |       |       |       |
|       | ainst |       |       |       |       |       |       |
|       | HIV,  |       |       |       |       |       |       |
|       | tub   |       |       |       |       |       |       |
|       | ercul |       |       |       |       |       |       |
|       | osis, |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | hepat |       |       |       |       |       |       |
|       | itis. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | § Ask |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | if    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | nyone |       |       |       |       |       |       |
|       | has   |       |       |       |       |       |       |
|       | any   |       |       |       |       |       |       |
|       | ques  |       |       |       |       |       |       |
|       | tions |       |       |       |       |       |       |
|       | about |       |       |       |       |       |       |
|       | c     |       |       |       |       |       |       |
|       | ontro |       |       |       |       |       |       |
|       | lling |       |       |       |       |       |       |
|       | exce  |       |       |       |       |       |       |
|       | ssive |       |       |       |       |       |       |
|       | blee  |       |       |       |       |       |       |
|       | ding. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Tell  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | next  |       |       |       |       |       |       |
|       | se    |       |       |       |       |       |       |
|       | ction |       |       |       |       |       |       |
|       | will  |       |       |       |       |       |       |
|       | deal  |       |       |       |       |       |       |
|       | with  |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | ecogn |       |       |       |       |       |       |
|       | izing |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | tre   |       |       |       |       |       |       |
|       | ating |       |       |       |       |       |       |
|       | for   |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hock. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | *P    | **R   |       |       |       |       |       |
|       | artic | ECOGN |       |       |       |       |       |
|       | ipant | IZING |       |       |       |       |       |
|       | Hand- | AND   |       |       |       |       |       |
|       | book, | TRE   |       |       |       |       |       |
|       | page  | ATING |       |       |       |       |       |
|       | PH    | FOR   |       |       |       |       |       |
|       | III   | SH    |       |       |       |       |       |
|       | -15.* | OCK** |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | Ex    |       |       |       |       |       |
|       |       | plain |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | group |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | shock |       |       |       |       |       |
|       |       | is a  |       |       |       |       |       |
|       |       | dis   |       |       |       |       |       |
|       |       | order |       |       |       |       |       |
|       |       | resu  |       |       |       |       |       |
|       |       | lting |       |       |       |       |       |
|       |       | from  |       |       |       |       |       |
|       |       | i     |       |       |       |       |       |
|       |       | neffe |       |       |       |       |       |
|       |       | ctive |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ircul |       |       |       |       |       |
|       |       | ation |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | b     |       |       |       |       |       |
|       |       | lood. |       |       |       |       |       |
|       |       | Rema  |       |       |       |       |       |
|       |       | ining |       |       |       |       |       |
|       |       | in    |       |       |       |       |       |
|       |       | shock |       |       |       |       |       |
|       |       | will  |       |       |       |       |       |
|       |       | lead  |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | death |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ells, |       |       |       |       |       |
|       |       | tis   |       |       |       |       |       |
|       |       | sues, |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | e     |       |       |       |       |       |
|       |       | ntire |       |       |       |       |       |
|       |       | or    |       |       |       |       |       |
|       |       | gans. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |       | §     |       |       |       |       |       |
|       |       | S     |       |       |       |       |       |
|       |       | tress |       |       |       |       |       |
|       |       | that  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | body  |       |       |       |       |       |
|       |       | will  |       |       |       |       |       |
|       |       | init  |       |       |       |       |       |
|       |       | ially |       |       |       |       |       |
|       |       | compe |       |       |       |       |       |
|       |       | nsate |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | blood |       |       |       |       |       |
|       |       | loss  |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | mask  |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | sym   |       |       |       |       |       |
|       |       | ptoms |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | s     |       |       |       |       |       |
|       |       | hock. |       |       |       |       |       |
|       |       | S     |       |       |       |       |       |
|       |       | tress |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |       | impor |       |       |       |       |       |
|       |       | tance |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |       | ontin |       |       |       |       |       |
|       |       | ually |       |       |       |       |       |
|       |       | evalu |       |       |       |       |       |
|       |       | ating |       |       |       |       |       |
|       |       | pat   |       |       |       |       |       |
|       |       | ients |       |       |       |       |       |
|       |       | for   |       |       |       |       |       |
|       |       | shock |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |       | monit |       |       |       |       |       |
|       |       | oring |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |       | condi |       |       |       |       |       |
|       |       | tion. |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **R   |       |       |       |       |       |       |
|       | ECOGN |       |       |       |       |       |       |
|       | IZING |       |       |       |       |       |       |
|       | AND   |       |       |       |       |       |       |
|       | TRE   |       |       |       |       |       |       |
|       | ATING |       |       |       |       |       |       |
|       | FOR   |       |       |       |       |       |       |
|       | SH    |       |       |       |       |       |       |
|       | OCK** |       |       |       |       |       |       |
|       | (     |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Tell  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | group |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | main  |       |       |       |       |       |       |
|       | signs |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | shock |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | CERT  |       |       |       |       |       |       |
|       | me    |       |       |       |       |       |       |
|       | mbers |       |       |       |       |       |       |
|       | look  |       |       |       |       |       |       |
|       | for   |       |       |       |       |       |       |
|       | are:  |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
| *V    | §     |       |       |       |       |       |       |
| isual |       |       |       |       |       |       |       |
| 3.4*  | -     |       |       |       |       |       |       |
|       | Rapid |       |       |       |       |       |       |
| \\*D  |       |       |       |       |       |       |       |
| emons |   and |       |       |       |       |       |       |
| trate |       |       |       |       |       |       |       |
| each  |    sh |       |       |       |       |       |       |
| step  | allow |       |       |       |       |       |       |
| using |       |       |       |       |       |       |       |
| the   | breat |       |       |       |       |       |       |
| m     | hing. |       |       |       |       |       |       |
| anneq |       |       |       |       |       |       |       |
| uin.* | •     |       |       |       |       |       |       |
|       | Capi  |       |       |       |       |       |       |
|       | llary |       |       |       |       |       |       |
|       | r     |       |       |       |       |       |       |
|       | efill |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | gr    |       |       |       |       |       |       |
|       | eater |       |       |       |       |       |       |
|       | than  |       |       |       |       |       |       |
|       | 2     |       |       |       |       |       |       |
|       | sec   |       |       |       |       |       |       |
|       | onds. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | •     |       |       |       |       |       |       |
|       | Fa    |       |       |       |       |       |       |
|       | ilure |       |       |       |       |       |       |
|       | to    |       |       |       |       |       |       |
|       | f     |       |       |       |       |       |       |
|       | ollow |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | imple |       |       |       |       |       |       |
|       | comm  |       |       |       |       |       |       |
|       | ands, |       |       |       |       |       |       |
|       | such  |       |       |       |       |       |       |
|       | as    |       |       |       |       |       |       |
|       | "Sq   |       |       |       |       |       |       |
|       | ueeze |       |       |       |       |       |       |
|       | my    |       |       |       |       |       |       |
|       | h     |       |       |       |       |       |       |
|       | and." |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | -     | §     |       |       |       |       |       |
|       |   Ask | D     |       |       |       |       |       |
|       |       | emons |       |       |       |       |       |
|       |   the | trate |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |    pa | proc  |       |       |       |       |       |
|       | rtici | edure |       |       |       |       |       |
|       | pants | for   |       |       |       |       |       |
|       |       | tre   |       |       |       |       |       |
|       |    to | ating |       |       |       |       |       |
|       |       | vi    |       |       |       |       |       |
|       | check | ctims |       |       |       |       |       |
|       |       | of    |       |       |       |       |       |
|       | their | shock |       |       |       |       |       |
|       |       | (     |       |       |       |       |       |
|       |   own | refer |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |  capi | pa    |       |       |       |       |       |
|       | llary | rtici |       |       |       |       |       |
|       |     r | pants |       |       |       |       |       |
|       | efill | to    |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |    by | chart |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       |    pu | il    |       |       |       |       |       |
|       | shing | lustr |       |       |       |       |       |
|       |       | ation |       |       |       |       |       |
|       |  down | in    |       |       |       |       |       |
|       |       | their |       |       |       |       |       |
|       |    on | P     |       |       |       |       |       |
|       |     a | artic |       |       |       |       |       |
|       |       | ipant |       |       |       |       |       |
|       | finge | H     |       |       |       |       |       |
|       | rnail | andbo |       |       |       |       |       |
|       |       | oks): |       |       |       |       |       |
|       |   and |       |       |       |       |       |       |
|       |       | •     |       |       |       |       |       |
|       |  then | [Step |       |       |       |       |       |
|       |       | 1]{.u |       |       |       |       |       |
|       | relea | nderl |       |       |       |       |       |
|       | sing. | ine}: |       |       |       |       |       |
|       |       | Lay   |       |       |       |       |       |
|       |  Tell | the   |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |  them | ictim |       |       |       |       |       |
|       |       | on    |       |       |       |       |       |
|       |    to | his   |       |       |       |       |       |
|       |       | or    |       |       |       |       |       |
|       | watch | her   |       |       |       |       |       |
|       |       | back. |       |       |       |       |       |
|       |  what | El    |       |       |       |       |       |
|       |       | evate |       |       |       |       |       |
|       |   hap | the   |       |       |       |       |       |
|       | pens. | feet  |       |       |       |       |       |
|       |       | 6-10  |       |       |       |       |       |
|       |   Ask | in    |       |       |       |       |       |
|       |       | ches. |       |       |       |       |       |
|       |   one | Mai   |       |       |       |       |       |
|       |       | ntain |       |       |       |       |       |
|       |    of | an    |       |       |       |       |       |
|       |       | open  |       |       |       |       |       |
|       |   the | ai    |       |       |       |       |       |
|       |       | rway. |       |       |       |       |       |
|       |    pa |       |       |       |       |       |       |
|       | rtici | •     |       |       |       |       |       |
|       | pants | [Step |       |       |       |       |       |
|       |       | 2]{.u |       |       |       |       |       |
|       |    to | nderl |       |       |       |       |       |
|       |       | ine}: |       |       |       |       |       |
|       |   exp | Co    |       |       |       |       |       |
|       | lain. | ntrol |       |       |       |       |       |
|       |       | ob    |       |       |       |       |       |
|       |  Then | vious |       |       |       |       |       |
|       |       | blee  |       |       |       |       |       |
|       |  have | ding. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the | •     |       |       |       |       |       |
|       |       | [Step |       |       |       |       |       |
|       |    pa | 3]{.u |       |       |       |       |       |
|       | rtici | nderl |       |       |       |       |       |
|       | pants | ine}: |       |       |       |       |       |
|       |       | Mai   |       |       |       |       |       |
|       | apply | ntain |       |       |       |       |       |
|       |       | body  |       |       |       |       |       |
|       |   and | te    |       |       |       |       |       |
|       |       | mpera |       |       |       |       |       |
|       |    re | ture. |       |       |       |       |       |
|       | lease | Cover |       |       |       |       |       |
|       |       | the   |       |       |       |       |       |
|       |   pre | v     |       |       |       |       |       |
|       | ssure | ictim |       |       |       |       |       |
|       |       | with  |       |       |       |       |       |
|       |    on | a     |       |       |       |       |       |
|       |       | bla   |       |       |       |       |       |
|       |   the | nket, |       |       |       |       |       |
|       |       | and   |       |       |       |       |       |
|       | palms | place |       |       |       |       |       |
|       |       | a     |       |       |       |       |       |
|       |    of | bl    |       |       |       |       |       |
|       |       | anket |       |       |       |       |       |
|       | their | or    |       |       |       |       |       |
|       |     h | other |       |       |       |       |       |
|       | ands. | mat   |       |       |       |       |       |
|       |       | erial |       |       |       |       |       |
|       |    Ex | under |       |       |       |       |       |
|       | plain | the   |       |       |       |       |       |
|       |       | v     |       |       |       |       |       |
|       |  that | ictim |       |       |       |       |       |
|       |       | to    |       |       |       |       |       |
|       |  capi | pr    |       |       |       |       |       |
|       | llary | ovide |       |       |       |       |       |
|       |     r | prote |       |       |       |       |       |
|       | efill | ction |       |       |       |       |       |
|       |       | from  |       |       |       |       |       |
|       |    is | ex    |       |       |       |       |       |
|       |       | treme |       |       |       |       |       |
|       |   how | g     |       |       |       |       |       |
|       |       | round |       |       |       |       |       |
|       |    it | te    |       |       |       |       |       |
|       |       | mpera |       |       |       |       |       |
|       | takes | tures |       |       |       |       |       |
|       |       | (hot  |       |       |       |       |       |
|       |   for | or    |       |       |       |       |       |
|       |       | c     |       |       |       |       |       |
|       |   the | old). |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | color | •     |       |       |       |       |       |
|       |       | [Step |       |       |       |       |       |
|       |    to | 4]{.u |       |       |       |       |       |
|       |       | nderl |       |       |       |       |       |
|       |    re | ine}: |       |       |       |       |       |
|       | turn. | Avoid |       |       |       |       |       |
|       |       | rough |       |       |       |       |       |
|       |  Tell | or    |       |       |       |       |       |
|       |       | exce  |       |       |       |       |       |
|       |   the | ssive |       |       |       |       |       |
|       |       | hand  |       |       |       |       |       |
|       | group | ling. |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  that |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |  this |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    is |       |       |       |       |       |       |
|       |     c |       |       |       |       |       |       |
|       | alled |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |   the |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       |    "b |       |       |       |       |       |       |
|       | lanch |       |       |       |       |       |       |
|       |     t |       |       |       |       |       |       |
|       | est." |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | *P    |       |       |       |       |       |       |
|       | artic |       |       |       |       |       |       |
|       | ipant |       |       |       |       |       |       |
|       | Hand- |       |       |       |       |       |       |
|       | book, |       |       |       |       |       |       |
|       | page  |       |       |       |       |       |       |
|       | PH    |       |       |       |       |       |       |
|       | III   |       |       |       |       |       |       |
|       | -15.* |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+
|       | **R   |       |       |       |       |       |       |
|       | ECOGN |       |       |       |       |       |       |
|       | IZING |       |       |       |       |       |       |
|       | AND   |       |       |       |       |       |       |
|       | TRE   |       |       |       |       |       |       |
|       | ATING |       |       |       |       |       |       |
|       | FOR   |       |       |       |       |       |       |
|       | SHOCK |       |       |       |       |       |       |
|       | **(   |       |       |       |       |       |       |
|       | Conti |       |       |       |       |       |       |
|       | nued) |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | § Ask |       |       |       |       |       |       |
|       | if    |       |       |       |       |       |       |
|       | a     |       |       |       |       |       |       |
|       | nyone |       |       |       |       |       |       |
|       | has a |       |       |       |       |       |       |
|       | que   |       |       |       |       |       |       |
|       | stion |       |       |       |       |       |       |
|       | about |       |       |       |       |       |       |
|       | the   |       |       |       |       |       |       |
|       | signs |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | trea  |       |       |       |       |       |       |
|       | tment |       |       |       |       |       |       |
|       | of    |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hock. |       |       |       |       |       |       |
|       |       |       |       |       |       |       |       |
|       | §     |       |       |       |       |       |       |
|       | Emph  |       |       |       |       |       |       |
|       | asize |       |       |       |       |       |       |
|       | that  |       |       |       |       |       |       |
|       | vi    |       |       |       |       |       |       |
|       | ctims |       |       |       |       |       |       |
|       | who   |       |       |       |       |       |       |
|       | are   |       |       |       |       |       |       |
|       | suff  |       |       |       |       |       |       |
|       | ering |       |       |       |       |       |       |
|       | from  |       |       |       |       |       |       |
|       | shock |       |       |       |       |       |       |
|       | s     |       |       |       |       |       |       |
|       | hould |       |       |       |       |       |       |
|       | *not* |       |       |       |       |       |       |
|       | eat   |       |       |       |       |       |       |
|       | or    |       |       |       |       |       |       |
|       | drink |       |       |       |       |       |       |
|       | anyt  |       |       |       |       |       |       |
|       | hing. |       |       |       |       |       |       |
|       | P     |       |       |       |       |       |       |
|       | eople |       |       |       |       |       |       |
|       | in    |       |       |       |       |       |       |
|       | shock |       |       |       |       |       |       |
|       | may   |       |       |       |       |       |       |
|       | be    |       |       |       |       |       |       |
|       | nau   |       |       |       |       |       |       |
|       | seous |       |       |       |       |       |       |
|       | and   |       |       |       |       |       |       |
|       | thi   |       |       |       |       |       |       |
|       | rsty. |       |       |       |       |       |       |
+-------+-------+-------+-------+-------+-------+-------+-------+

**YOUR NOTES:**

+----------+----------+----------+----------+----------+----------+
|          | *Total   | **E      |          |          |          |
|          | Ex       | XERCISE: |          |          |          |
|          | ercise:* | TREATING |          |          |          |
|          |          | FOR      |          |          |          |
|          | *15      | SHOCK**  |          |          |          |
|          | minutes* |          |          |          |          |
|          |          | §        |          |          |          |
|          |          | [In      |          |          |          |
|          |          | structor |          |          |          |
|          |          | No       |          |          |          |
|          |          | te]{.und |          |          |          |
|          |          | erline}: |          |          |          |
|          |          | This     |          |          |          |
|          |          | exercise |          |          |          |
|          |          | allows   |          |          |          |
|          |          | the      |          |          |          |
|          |          | part     |          |          |          |
|          |          | icipants |          |          |          |
|          |          | to       |          |          |          |
|          |          | practice |          |          |          |
|          |          | the      |          |          |          |
|          |          | steps    |          |          |          |
|          |          | for      |          |          |          |
|          |          | treating |          |          |          |
|          |          | for      |          |          |          |
|          |          | shock on |          |          |          |
|          |          | each     |          |          |          |
|          |          | other.   |          |          |          |
|          |          | Follow   |          |          |          |
|          |          | the      |          |          |          |
|          |          | steps    |          |          |          |
|          |          | below to |          |          |          |
|          |          | fa       |          |          |          |
|          |          | cilitate |          |          |          |
|          |          | this     |          |          |          |
|          |          | e        |          |          |          |
|          |          | xercise: |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | *Pair    | 1\.      |          |          |          |
|          | off the  | Divide   |          |          |          |
|          | partic   | the      |          |          |          |
|          | ipants.* | part     |          |          |          |
|          |          | icipants |          |          |          |
|          |          | into     |          |          |          |
|          |          | pairs    |          |          |          |
|          |          | (the     |          |          |          |
|          |          | same     |          |          |          |
|          |          | pairs as |          |          |          |
|          |          | in the   |          |          |          |
|          |          | previous |          |          |          |
|          |          | exe      |          |          |          |
|          |          | rcises). |          |          |          |
|          |          |          |          |          |          |
|          |          | 2\. Ask  |          |          |          |
|          |          | the      |          |          |          |
|          |          | person   |          |          |          |
|          |          | who was  |          |          |          |
|          |          | the      |          |          |          |
|          |          | rescuer  |          |          |          |
|          |          | first in |          |          |          |
|          |          | the last |          |          |          |
|          |          | exercise |          |          |          |
|          |          | to be    |          |          |          |
|          |          | the      |          |          |          |
|          |          | victim   |          |          |          |
|          |          | first.   |          |          |          |
|          |          |          |          |          |          |
|          |          | 3\. Ask  |          |          |          |
|          |          | the      |          |          |          |
|          |          | victims  |          |          |          |
|          |          | to lie   |          |          |          |
|          |          | on the   |          |          |          |
|          |          | floor on |          |          |          |
|          |          | their    |          |          |          |
|          |          | backs    |          |          |          |
|          |          | and      |          |          |          |
|          |          | close    |          |          |          |
|          |          | their    |          |          |          |
|          |          | eyes.    |          |          |          |
|          |          |          |          |          |          |
|          |          | 4\.      |          |          |          |
|          |          | Explain  |          |          |          |
|          |          | the      |          |          |          |
|          |          | f        |          |          |          |
|          |          | ollowing |          |          |          |
|          |          | scenario |          |          |          |
|          |          | to the   |          |          |          |
|          |          | r        |          |          |          |
|          |          | escuers: |          |          |          |
|          |          |          |          |          |          |
|          |          | • You    |          |          |          |
|          |          | have     |          |          |          |
|          |          | come     |          |          |          |
|          |          | upon     |          |          |          |
|          |          | this     |          |          |          |
|          |          | victim   |          |          |          |
|          |          | who has  |          |          |          |
|          |          | been     |          |          |          |
|          |          | bleeding |          |          |          |
|          |          | p        |          |          |          |
|          |          | rofusely |          |          |          |
|          |          | from a   |          |          |          |
|          |          | wound of |          |          |          |
|          |          | the      |          |          |          |
|          |          | upper    |          |          |          |
|          |          | arm for  |          |          |          |
|          |          | an       |          |          |          |
|          |          | unde     |          |          |          |
|          |          | termined |          |          |          |
|          |          | period   |          |          |          |
|          |          | of time. |          |          |          |
|          |          |          |          |          |          |
|          |          | • The    |          |          |          |
|          |          | victim   |          |          |          |
|          |          | is now   |          |          |          |
|          |          | unco     |          |          |          |
|          |          | nscious. |          |          |          |
+----------+----------+----------+----------+----------+----------+
| *Observe | 5\. Ask  |          | *        | ** ?**   | § Ask if |
| each     | the      |          | *SUMMARY | *Di      | anyone   |
| rescuer  | rescuer  |          | AND      | scussion | has any  |
| as he or | to treat |          | TRAN     | qu       | q        |
| she      | the      |          | SITION** | estion.* | uestions |
| treats   | victim.  |          |          |          | about    |
| for      |          |          | §        |          | the      |
| shock.*  | 6\. When |          | S        |          | signs of |
|          | each     |          | ummarize |          | shock or |
|          | rescuer  |          | the key  |          | its      |
|          | has been |          | points   |          | tr       |
|          | observed |          | about    |          | eatment. |
|          | treating |          | rec      |          |          |
|          | for      |          | ognizing |          | § Tell   |
|          | shock,   |          | and      |          | the      |
|          | ask the  |          | treating |          | group    |
|          | victim   |          | for      |          | that, in |
|          | and the  |          | shock:   |          | a        |
|          | rescuer  |          |          |          | disaster |
|          | to       |          | • A      |          | s        |
|          | switch   |          | victim   |          | cenario, |
|          | roles.   |          | may      |          | they may |
|          |          |          | display  |          | have     |
|          | § When   |          | one or   |          | many     |
|          | all      |          | more     |          | victims  |
|          | rescuers |          | signs of |          | r        |
|          | have had |          | shock.   |          | equiring |
|          | the      |          |          |          | a        |
|          | opp      |          | • If     |          | ttention |
|          | ortunity |          | there is |          | and few  |
|          | to treat |          | any      |          | r        |
|          | their    |          | reason   |          | esources |
|          | victims, |          | to       |          | to use.  |
|          | lead a   |          | suspect  |          | The next |
|          | di       |          | shock,   |          | section  |
|          | scussion |          | apply    |          | will     |
|          | about    |          | i        |          | deal     |
|          | any      |          | mmediate |          | with a   |
|          | i        |          | tr       |          | system   |
|          | ncorrect |          | eatment. |          | for      |
|          | te       |          |          |          | prio     |
|          | chniques |          |          |          | ritizing |
|          | observed |          |          |          | victim   |
|          | and how  |          |          |          | t        |
|          | to       |          |          |          | reatment |
|          | correct  |          |          |          | called   |
|          | them in  |          |          |          | triage.  |
|          | the      |          |          |          |          |
|          | future.  |          |          |          |          |
+----------+----------+----------+----------+----------+----------+

**YOUR NOTES:**

+----------+----------+----------+----------+----------+----------+
|          | *Total   | **       |          | *Par     | **WHAT   |
|          | Topic:*  | TRIAGE** |          | ticipant | IS       |
|          |          |          |          | Ha       | T        |
|          | *45      |          |          | nd-book, | RIAGE?** |
|          | minutes* |          |          | page PH  |          |
|          |          |          |          | *        |          |
|          |          |          |          |          |          |
|          |          |          |          | *        |          |
|          |          |          |          | III-17.* |          |
+----------+----------+----------+----------+----------+----------+
| ** ?**   | § Ask    |          | **WHAT   |          |          |
| *Di      | the      |          | IS       |          |          |
| scussion | group    |          | T        |          |          |
| qu       | how many |          | RIAGE?** |          |          |
| estion.* | remember |          | (Co      |          |          |
|          | the      |          | ntinued) |          |          |
| *The     | scenes   |          |          |          |          |
| point of | from the |          | §        |          |          |
| this     | te       |          | Explain  |          |          |
| di       | levision |          | further  |          |          |
| scussion | series   |          | that     |          |          |
| is to    | *M\*     |          | triage   |          |          |
| get the  | A\*S\*H* |          | was, in  |          |          |
| part     | where    |          | fact,    |          |          |
| icipants | the      |          | i        |          |          |
| thinking | hel      |          | nitiated |          |          |
| about    | icopters |          | by the   |          |          |
| multiple | arrived  |          | military |          |          |
| casu     | and the  |          | and that |          |          |
| alties.* | doctors  |          | military |          |          |
|          | and      |          | ex       |          |          |
|          | nurses   |          | perience |          |          |
|          | quickly  |          | has      |          |          |
|          | examined |          | shown    |          |          |
|          | each     |          | that     |          |          |
|          | patient  |          | triage   |          |          |
|          | to       |          | is an    |          |          |
|          | d        |          | e        |          |          |
|          | etermine |          | ffective |          |          |
|          | the      |          | strategy |          |          |
|          | priority |          | in       |          |          |
|          | for      |          | si       |          |          |
|          | tr       |          | tuations |          |          |
|          | eatment. |          | where:   |          |          |
|          | During   |          |          |          |          |
|          | these    |          | •        |          |          |
|          | scenes,  |          | Rescuers |          |          |
|          | the      |          | are      |          |          |
|          | medical  |          | over     |          |          |
|          | pe       |          | whelmed. |          |          |
|          | rsonnel: |          |          |          |          |
|          |          |          | • There  |          |          |
|          | •        |          | are      |          |          |
|          | Id       |          | limited  |          |          |
|          | entified |          | re       |          |          |
|          | the dead |          | sources. |          |          |
|          | and      |          |          |          |          |
|          | those    |          | • Time   |          |          |
|          | who were |          | is       |          |          |
|          | too      |          | c        |          |          |
|          | severely |          | ritical. |          |          |
|          | injured  |          |          |          |          |
|          | to be    |          |          |          |          |
|          | saved.   |          |          |          |          |
|          |          |          |          |          |          |
|          | • Sent   |          |          |          |          |
|          | those    |          |          |          |          |
|          | with     |          |          |          |          |
|          | re       |          |          |          |          |
|          | latively |          |          |          |          |
|          | minor    |          |          |          |          |
|          | injuries |          |          |          |          |
|          | and      |          |          |          |          |
|          | wounds   |          |          |          |          |
|          | to a     |          |          |          |          |
|          | holding  |          |          |          |          |
|          | area to  |          |          |          |          |
|          | await    |          |          |          |          |
|          | tr       |          |          |          |          |
|          | eatment. |          |          |          |          |
|          |          |          |          |          |          |
|          | •        |          |          |          |          |
|          | Id       |          |          |          |          |
|          | entified |          |          |          |          |
|          | those    |          |          |          |          |
|          | who      |          |          |          |          |
|          | would    |          |          |          |          |
|          | die      |          |          |          |          |
|          | without  |          |          |          |          |
|          | i        |          |          |          |          |
|          | mmediate |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | and sent |          |          |          |          |
|          | them to  |          |          |          |          |
|          | the      |          |          |          |          |
|          | o        |          |          |          |          |
|          | perating |          |          |          |          |
|          | room.    |          |          |          |          |
|          |          |          |          |          |          |
|          | § Tell   |          |          |          |          |
|          | the      |          |          |          |          |
|          | part     |          |          |          |          |
|          | icipants |          |          |          |          |
|          | that     |          |          |          |          |
|          | these    |          |          |          |          |
|          | scenes   |          |          |          |          |
|          | showed   |          |          |          |          |
|          | medical  |          |          |          |          |
|          | p        |          |          |          |          |
|          | ersonnel |          |          |          |          |
|          | co       |          |          |          |          |
|          | nducting |          |          |          |          |
|          | *tri     |          |          |          |          |
|          | age*---a |          |          |          |          |
|          | French   |          |          |          |          |
|          | term     |          |          |          |          |
|          | meaning  |          |          |          |          |
|          | "to      |          |          |          |          |
|          | sort."   |          |          |          |          |
|          |          |          |          |          |          |
|          | §        |          |          |          |          |
|          | Explain  |          |          |          |          |
|          | that in  |          |          |          |          |
|          | triage,  |          |          |          |          |
|          | victims  |          |          |          |          |
|          | are      |          |          |          |          |
|          | ev       |          |          |          |          |
|          | aluated, |          |          |          |          |
|          | sorted   |          |          |          |          |
|          | by the   |          |          |          |          |
|          | i        |          |          |          |          |
|          | mmediacy |          |          |          |          |
|          | of the   |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | needed,  |          |          |          |          |
|          | and set  |          |          |          |          |
|          | up for   |          |          |          |          |
|          | i        |          |          |          |          |
|          | mmediate |          |          |          |          |
|          | or       |          |          |          |          |
|          | delayed  |          |          |          |          |
|          | tr       |          |          |          |          |
|          | eatment. |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
| *E       | § Point  |          |          |          |          |
| mphasize | out that |          |          |          |          |
| that the | triage   |          |          |          |          |
| victim's | occurs   |          |          |          |          |
| location | as       |          |          |          |          |
| comes    | quickly  |          |          |          |          |
| into     | as       |          |          |          |          |
| play     | possible |          |          |          |          |
| when     | after a  |          |          |          |          |
| pe       | victim   |          |          |          |          |
| rforming | is       |          |          |          |          |
| hea      | located  |          |          |          |          |
| d-to-toe | or       |          |          |          |          |
| asses    | rescued. |          |          |          |          |
| s-ments. | During   |          |          |          |          |
| Triage   | triage,  |          |          |          |          |
| needs to | victims' |          |          |          |          |
| be done  | co       |          |          |          |          |
| imm      | nditions |          |          |          |          |
| ediately | are      |          |          |          |          |
| to       | e        |          |          |          |          |
| d        | valuated |          |          |          |          |
| etermine | and the  |          |          |          |          |
| if the   | victims  |          |          |          |          |
| person   | are      |          |          |          |          |
| is       | pri      |          |          |          |          |
| alive.   | oritized |          |          |          |          |
| Then the | into     |          |          |          |          |
| rescuer  | three    |          |          |          |          |
| must     | cat      |          |          |          |          |
| decide   | egories: |          |          |          |          |
| what to  |          |          |          |          |          |
| do based | •*       |          |          |          |          |
| on the   | I        |          |          |          |          |
| c        | mmediate |          |          |          |          |
| ondition | (I).*    |          |          |          |          |
| of the   | The      |          |          |          |          |
| bu       | victim   |          |          |          |          |
| ilding.* | has      |          |          |          |          |
|          | life-thr |          |          |          |          |
|          | eatening |          |          |          |          |
|          | (airway, |          |          |          |          |
|          | b        |          |          |          |          |
|          | leeding, |          |          |          |          |
|          | or       |          |          |          |          |
|          | shock)   |          |          |          |          |
|          | injuries |          |          |          |          |
|          | that     |          |          |          |          |
|          | demand   |          |          |          |          |
|          | i        |          |          |          |          |
|          | mmediate |          |          |          |          |
|          | a        |          |          |          |          |
|          | ttention |          |          |          |          |
|          | to save  |          |          |          |          |
|          | his or   |          |          |          |          |
|          | her      |          |          |          |          |
|          | life;    |          |          |          |          |
|          | rapid    |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | is       |          |          |          |          |
|          | imp      |          |          |          |          |
|          | erative. |          |          |          |          |
|          |          |          |          |          |          |
|          | •*       |          |          |          |          |
|          | Delayed  |          |          |          |          |
|          | (D).*    |          |          |          |          |
|          | Injuries |          |          |          |          |
|          | do not   |          |          |          |          |
|          | je       |          |          |          |          |
|          | opardize |          |          |          |          |
|          | the      |          |          |          |          |
|          | victim's |          |          |          |          |
|          | life if  |          |          |          |          |
|          | de       |          |          |          |          |
|          | finitive |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | is       |          |          |          |          |
|          | delayed. |          |          |          |          |
|          | The      |          |          |          |          |
|          | victim   |          |          |          |          |
|          | may      |          |          |          |          |
|          | require  |          |          |          |          |
|          | prof     |          |          |          |          |
|          | essional |          |          |          |          |
|          | care,    |          |          |          |          |
|          | but      |          |          |          |          |
|          | i        |          |          |          |          |
|          | mmediate |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | is not   |          |          |          |          |
|          | imp      |          |          |          |          |
|          | erative. |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
| *Some    | •* Dead  |          |          |          |          |
| part     | (DEAD).* |          |          |          |          |
| icipants | No       |          |          |          |          |
| may      | res      |          |          |          |          |
| respond  | piration |          |          |          |          |
| ne       | after    |          |          |          |          |
| gatively | two      |          |          |          |          |
| to not   | attempts |          |          |          |          |
| pe       | to open  |          |          |          |          |
| rforming | the      |          |          |          |          |
| CPR.     | airway.  |          |          |          |          |
| Explain  | CPR is   |          |          |          |          |
| that CPR | not      |          |          |          |          |
| is a     | p        |          |          |          |          |
| mai      | erformed |          |          |          |          |
| ntenance | in the   |          |          |          |          |
| therapy  | disaster |          |          |          |          |
| that     | envi     |          |          |          |          |
| requires | ronment. |          |          |          |          |
| time     |          |          |          |          |          |
| that may |          |          |          |          |          |
| not be   |          |          |          |          |          |
| a        |          |          |          |          |          |
| vailable |          |          |          |          |          |
| when     |          |          |          |          |          |
| dealing  |          |          |          |          |          |
| with     |          |          |          |          |          |
| multiple |          |          |          |          |          |
| ca       |          |          |          |          |          |
| sualties |          |          |          |          |          |
| after a  |          |          |          |          |          |
| d        |          |          |          |          |          |
| isaster. |          |          |          |          |          |
| In the   |          |          |          |          |          |
| event    |          |          |          |          |          |
| that     |          |          |          |          |          |
| multiple |          |          |          |          |          |
| ca       |          |          |          |          |          |
| sualties |          |          |          |          |          |
| are      |          |          |          |          |          |
| [        |          |          |          |          |          |
| not]{.un |          |          |          |          |          |
| derline} |          |          |          |          |          |
| enco     |          |          |          |          |          |
| untered, |          |          |          |          |          |
| CPR may  |          |          |          |          |          |
| be       |          |          |          |          |          |
| admi     |          |          |          |          |          |
| nistered |          |          |          |          |          |
| by       |          |          |          |          |          |
| a        |          |          |          |          |          |
| vailable |          |          |          |          |          |
| per      |          |          |          |          |          |
| sonnel.* |          |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | **WHAT   |          |          |          |          |
|          | IS       |          |          |          |          |
|          | T        |          |          |          |          |
|          | RIAGE?** |          |          |          |          |
|          | (Co      |          |          |          |          |
|          | ntinued) |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
| *Visual  | §        |          |          |          |          |
| 3.5*     | Explain  |          |          |          |          |
|          | that,    |          |          |          |          |
|          | from     |          |          |          |          |
|          | triage,  |          |          |          |          |
|          | victims  |          |          |          |          |
|          | are      |          |          |          |          |
|          | taken to |          |          |          |          |
|          | the      |          |          |          |          |
|          | de       |          |          |          |          |
|          | signated |          |          |          |          |
|          | medical  |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | area     |          |          |          |          |
|          | (i       |          |          |          |          |
|          | mmediate |          |          |          |          |
|          | care,    |          |          |          |          |
|          | delayed  |          |          |          |          |
|          | care, or |          |          |          |          |
|          | morgue)  |          |          |          |          |
|          | and from |          |          |          |          |
|          | there    |          |          |          |          |
|          | are      |          |          |          |          |
|          | tra      |          |          |          |          |
|          | nsported |          |          |          |          |
|          | out of   |          |          |          |          |
|          | the      |          |          |          |          |
|          | disaster |          |          |          |          |
|          | area.    |          |          |          |          |
|          |          |          |          |          |          |
|          | [In      |          |          |          |          |
|          | structor |          |          |          |          |
|          | No       |          |          |          |          |
|          | te]{.und |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | E        |          |          |          |          |
|          | mphasize |          |          |          |          |
|          | the need |          |          |          |          |
|          | for      |          |          |          |          |
|          | rescuer  |          |          |          |          |
|          | safety   |          |          |          |          |
|          | during   |          |          |          |          |
|          | triage.  |          |          |          |          |
|          | Rescuers |          |          |          |          |
|          | must     |          |          |          |          |
|          | wear all |          |          |          |          |
|          | safety   |          |          |          |          |
|          | eq       |          |          |          |          |
|          | uipment, |          |          |          |          |
|          | i        |          |          |          |          |
|          | ncluding |          |          |          |          |
|          | latex    |          |          |          |          |
|          | gloves,  |          |          |          |          |
|          | goggles, |          |          |          |          |
|          | a        |          |          |          |          |
|          | helmet,  |          |          |          |          |
|          | and a    |          |          |          |          |
|          | dust     |          |          |          |          |
|          | mask     |          |          |          |          |
|          | when     |          |          |          |          |
|          | e        |          |          |          |          |
|          | xamining |          |          |          |          |
|          | victims  |          |          |          |          |
|          | and must |          |          |          |          |
|          | change   |          |          |          |          |
|          | gloves   |          |          |          |          |
|          | between  |          |          |          |          |
|          | victims. |          |          |          |          |
|          | Th       |          |          |          |          |
|          | erefore, |          |          |          |          |
|          | tell the |          |          |          |          |
|          | group    |          |          |          |          |
|          | that     |          |          |          |          |
|          | their    |          |          |          |          |
|          | disaster |          |          |          |          |
|          | kits     |          |          |          |          |
|          | should   |          |          |          |          |
|          | have a   |          |          |          |          |
|          | box of   |          |          |          |          |
|          | latex    |          |          |          |          |
|          | gloves.  |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | *Par     |          |          |          |          |
|          | ticipant |          |          |          |          |
|          | Ha       |          |          |          |          |
|          | nd-book, |          |          |          |          |
|          | page PH  |          |          |          |          |
|          | III-18.* |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | **TRIAGE |          |          |          |          |
|          | IN A     |          |          |          |          |
|          | DISASTER |          |          |          |          |
|          | ENVIR    |          |          |          |          |
|          | ONMENT** |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | *Par     | § Refer  |          |          |          |
|          | ticipant | the      |          |          |          |
|          | H        | part     |          |          |          |
|          | andbook, | icipants |          |          |          |
|          | page *   | to their |          |          |          |
|          |          | Par      |          |          |          |
|          | *PH      | ticipant |          |          |          |
|          | III-19.* | Ha       |          |          |          |
|          |          | ndbooks. |          |          |          |
|          |          | Explain  |          |          |          |
|          |          | the      |          |          |          |
|          |          | general  |          |          |          |
|          |          | p        |          |          |          |
|          |          | rocedure |          |          |          |
|          |          | for      |          |          |          |
|          |          | co       |          |          |          |
|          |          | nducting |          |          |          |
|          |          | triage:  |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | • [Step  |          |          |          |          |
|          | 1]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Stop,    |          |          |          |          |
|          | Look,    |          |          |          |          |
|          | Listen,  |          |          |          |          |
|          | and      |          |          |          |          |
|          | Think.   |          |          |          |          |
|          | Before   |          |          |          |          |
|          | you      |          |          |          |          |
|          | start,   |          |          |          |          |
|          | stop and |          |          |          |          |
|          | size up  |          |          |          |          |
|          | the      |          |          |          |          |
|          | s        |          |          |          |          |
|          | ituation |          |          |          |          |
|          | by       |          |          |          |          |
|          | looking  |          |          |          |          |
|          | around   |          |          |          |          |
|          | and      |          |          |          |          |
|          | li       |          |          |          |          |
|          | stening. |          |          |          |          |
|          | THINK    |          |          |          |          |
|          | about    |          |          |          |          |
|          | how to   |          |          |          |          |
|          | approach |          |          |          |          |
|          | the      |          |          |          |          |
|          | si       |          |          |          |          |
|          | tuation. |          |          |          |          |
|          |          |          |          |          |          |
|          | • [Step  |          |          |          |          |
|          | 2]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Conduct  |          |          |          |          |
|          | voice    |          |          |          |          |
|          | triage.  |          |          |          |          |
|          | Begin by |          |          |          |          |
|          | calling  |          |          |          |          |
|          | out      |          |          |          |          |
|          | s        |          |          |          |          |
|          | omething |          |          |          |          |
|          | like,    |          |          |          |          |
|          | "E       |          |          |          |          |
|          | mergency |          |          |          |          |
|          | Response |          |          |          |          |
|          | Team. If |          |          |          |          |
|          | you can  |          |          |          |          |
|          | walk,    |          |          |          |          |
|          | come to  |          |          |          |          |
|          | the      |          |          |          |          |
|          | sound of |          |          |          |          |
|          | my       |          |          |          |          |
|          | voice."  |          |          |          |          |
|          | If there |          |          |          |          |
|          | are      |          |          |          |          |
|          | s        |          |          |          |          |
|          | urvivors |          |          |          |          |
|          | who are  |          |          |          |          |
|          | amb      |          |          |          |          |
|          | ulatory, |          |          |          |          |
|          | instruct |          |          |          |          |
|          | them to  |          |          |          |          |
|          | remain   |          |          |          |          |
|          | at a     |          |          |          |          |
|          | de       |          |          |          |          |
|          | signated |          |          |          |          |
|          | l        |          |          |          |          |
|          | ocation, |          |          |          |          |
|          | and      |          |          |          |          |
|          | continue |          |          |          |          |
|          | with the |          |          |          |          |
|          | triage   |          |          |          |          |
|          | op       |          |          |          |          |
|          | eration. |          |          |          |          |
|          | (If      |          |          |          |          |
|          | rescuers |          |          |          |          |
|          | need     |          |          |          |          |
|          | as       |          |          |          |          |
|          | sistance |          |          |          |          |
|          | and      |          |          |          |          |
|          | there    |          |          |          |          |
|          | are      |          |          |          |          |
|          | am       |          |          |          |          |
|          | bulatory |          |          |          |          |
|          | su       |          |          |          |          |
|          | rvivors, |          |          |          |          |
|          | then     |          |          |          |          |
|          | these    |          |          |          |          |
|          | s        |          |          |          |          |
|          | urvivors |          |          |          |          |
|          | should   |          |          |          |          |
|          | be asked |          |          |          |          |
|          | to       |          |          |          |          |
|          | provide  |          |          |          |          |
|          | assi     |          |          |          |          |
|          | stance.) |          |          |          |          |
|          | These    |          |          |          |          |
|          | persons  |          |          |          |          |
|          | may also |          |          |          |          |
|          | provide  |          |          |          |          |
|          | useful   |          |          |          |          |
|          | inf      |          |          |          |          |
|          | ormation |          |          |          |          |
|          | about    |          |          |          |          |
|          | the      |          |          |          |          |
|          | location |          |          |          |          |
|          | of the   |          |          |          |          |
|          | victims. |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | **TRIAGE |          |          |          |          |
|          | IN A     |          |          |          |          |
|          | DISASTER |          |          |          |          |
|          | ENVIR    |          |          |          |          |
|          | ONMENT** |          |          |          |          |
|          | (Co      |          |          |          |          |
|          | ntinued) |          |          |          |          |
|          |          |          |          |          |          |
|          | • [Step  |          |          |          |          |
|          | 3]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Follow a |          |          |          |          |
|          | sy       |          |          |          |          |
|          | stematic |          |          |          |          |
|          | route.   |          |          |          |          |
|          | Start    |          |          |          |          |
|          | with the |          |          |          |          |
|          | closest  |          |          |          |          |
|          | victims  |          |          |          |          |
|          | and work |          |          |          |          |
|          | outward  |          |          |          |          |
|          | in a     |          |          |          |          |
|          | sy       |          |          |          |          |
|          | stematic |          |          |          |          |
|          | fashion. |          |          |          |          |
|          |          |          |          |          |          |
|          | • [Step  |          |          |          |          |
|          | 4]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Evaluate |          |          |          |          |
|          | each     |          |          |          |          |
|          | victim   |          |          |          |          |
|          | and tag  |          |          |          |          |
|          | them     |          |          |          |          |
|          | **I**    |          |          |          |          |
|          | (imm     |          |          |          |          |
|          | ediate), |          |          |          |          |
|          | **D**    |          |          |          |          |
|          | (d       |          |          |          |          |
|          | elayed), |          |          |          |          |
|          | or       |          |          |          |          |
|          | *        |          |          |          |          |
|          | *DEAD.** |          |          |          |          |
|          | Remember |          |          |          |          |
|          | to       |          |          |          |          |
|          | evaluate |          |          |          |          |
|          | the      |          |          |          |          |
|          | walking  |          |          |          |          |
|          | wounded. |          |          |          |          |
|          |          |          |          |          |          |
|          | • [Step  |          |          |          |          |
|          | 5]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Treat    |          |          |          |          |
|          | **I**    |          |          |          |          |
|          | victims  |          |          |          |          |
|          | imme     |          |          |          |          |
|          | diately. |          |          |          |          |
|          | Initiate |          |          |          |          |
|          | airway   |          |          |          |          |
|          | man      |          |          |          |          |
|          | agement, |          |          |          |          |
|          | bleeding |          |          |          |          |
|          | control, |          |          |          |          |
|          | and/or   |          |          |          |          |
|          | t        |          |          |          |          |
|          | reatment |          |          |          |          |
|          | for      |          |          |          |          |
|          | shock    |          |          |          |          |
|          | for      |          |          |          |          |
|          | Category |          |          |          |          |
|          | **I**    |          |          |          |          |
|          | victims. |          |          |          |          |
|          |          |          |          |          |          |
|          | • [Step  |          |          |          |          |
|          | 6]{.und  |          |          |          |          |
|          | erline}: |          |          |          |          |
|          | Document |          |          |          |          |
|          | triage   |          |          |          |          |
|          | results  |          |          |          |          |
|          | for:     |          |          |          |          |
|          |          |          |          |          |          |
|          | \-       |          |          |          |          |
|          | E        |          |          |          |          |
|          | ffective |          |          |          |          |
|          | de       |          |          |          |          |
|          | ployment |          |          |          |          |
|          | of       |          |          |          |          |
|          | re       |          |          |          |          |
|          | sources. |          |          |          |          |
|          |          |          |          |          |          |
|          | \-       |          |          |          |          |
|          | Inf      |          |          |          |          |
|          | ormation |          |          |          |          |
|          | on the   |          |          |          |          |
|          | victims' |          |          |          |          |
|          | lo       |          |          |          |          |
|          | cations. |          |          |          |          |
|          |          |          |          |          |          |
|          | \- A     |          |          |          |          |
|          | quick    |          |          |          |          |
|          | record   |          |          |          |          |
|          | of the   |          |          |          |          |
|          | number   |          |          |          |          |
|          | of       |          |          |          |          |
|          | ca       |          |          |          |          |
|          | sualties |          |          |          |          |
|          | by       |          |          |          |          |
|          | degree   |          |          |          |          |
|          | of       |          |          |          |          |
|          | s        |          |          |          |          |
|          | everity. |          |          |          |          |
|          |          |          |          |          |          |
|          | §        |          |          |          |          |
|          | E        |          |          |          |          |
|          | mphasize |          |          |          |          |
|          | that the |          |          |          |          |
|          | r        |          |          |          |          |
|          | escuer's |          |          |          |          |
|          | safety   |          |          |          |          |
|          | is       |          |          |          |          |
|          | p        |          |          |          |          |
|          | aramount |          |          |          |          |
|          | during   |          |          |          |          |
|          | triage.  |          |          |          |          |
|          | Tell the |          |          |          |          |
|          | part     |          |          |          |          |
|          | icipants |          |          |          |          |
|          | to wear  |          |          |          |          |
|          | proper   |          |          |          |          |
|          | pr       |          |          |          |          |
|          | otective |          |          |          |          |
|          | e        |          |          |          |          |
|          | quipment |          |          |          |          |
|          | so as    |          |          |          |          |
|          | not to   |          |          |          |          |
|          | endanger |          |          |          |          |
|          | their    |          |          |          |          |
|          | own      |          |          |          |          |
|          | health.  |          |          |          |          |
+----------+----------+----------+----------+----------+----------+
|          | **PE     |          |          |          |          |
|          | RFORMING |          |          |          |          |
|          | A TRIAGE |          |          |          |          |
|          | EVAL     |          |          |          |          |
|          | UATION** |          |          |          |          |
+----------+----------+----------+----------+----------+----------+

+----------------------+----------------------+----------------------+
|                      | *Participant         | § Refer the          |
|                      | Hand-book, page PH * | participants to the  |
|                      |                      | table in their       |
|                      | *III-20.*            | Participant          |
|                      |                      | Handbooks. Explain   |
|                      |                      | that when conducting |
|                      |                      | a triage evaluation, |
|                      |                      | they should:         |
|                      |                      |                      |
|                      |                      | • Start with the     |
|                      |                      | airway. At an arm's  |
|                      |                      | distance, shake the  |
|                      |                      | victim and shout. If |
|                      |                      | the victim does not  |
|                      |                      | respond, then:       |
|                      |                      |                      |
|                      |                      | \- Position the      |
|                      |                      | airway.              |
|                      |                      |                      |
|                      |                      | \- Look, listen, and |
|                      |                      | feel.                |
|                      |                      |                      |
|                      |                      | \- Check breathing   |
|                      |                      | (greater than 30 =   |
|                      |                      | **I**).              |
|                      |                      |                      |
|                      |                      | \-                   |
|                      |                      |                      |
|                      |                      | -   If the victim is |
|                      |                      |     not breathing    |
|                      |                      |     after two        |
|                      |                      |                      |
|                      |                      | attempts to open     |
|                      |                      | airway, then =       |
|                      |                      | **DEAD**.            |
+----------------------+----------------------+----------------------+
| *Explain that the    | **TRIAGE IN A        |                      |
| blanch test is not   | DISASTER             |                      |
| valid in children,   | ENVIRONMENT**        |                      |
| and that mental      | (Continued)          |                      |
| status should be     |                      |                      |
| used instead as the  | • Go to bleeding.    |                      |
| main indicator.*     |                      |                      |
|                      | \- Stop uncontrolled |                      |
|                      | bleeding.            |                      |
|                      |                      |                      |
|                      | \- Perform blanch    |                      |
|                      | test (greater than 2 |                      |
|                      | seconds = **I**).    |                      |
|                      |                      |                      |
|                      | • Go to mental       |                      |
|                      | status.              |                      |
|                      |                      |                      |
|                      | \- Ask the victim to |                      |
|                      | follow a simple      |                      |
|                      | command (such as     |                      |
|                      | squeezing your       |                      |
|                      | hand). If no         |                      |
|                      | response, status =   |                      |
|                      | **I**.               |                      |
|                      |                      |                      |
|                      | If the victim passes |                      |
|                      | all tests, status =  |                      |
|                      | **D**. If the victim |                      |
|                      | fails one test,      |                      |
|                      | status = **I**.      |                      |
|                      | Remember that        |                      |
|                      | everyone gets a tag. |                      |
+----------------------+----------------------+----------------------+
|                      | *Participant         | § Refer the          |
|                      | Hand-book, page PH*  | participants to the  |
|                      |                      | flowchart in their   |
|                      | *III-21.*            | Participant          |
|                      |                      | Handbooks and        |
|                      |                      | recommend that they  |
|                      |                      | study the flowchart  |
|                      |                      | outside of this      |
|                      |                      | session until they   |
|                      |                      | are very familiar    |
|                      |                      | with triage          |
|                      |                      | procedures. (Point   |
|                      |                      | out that "2 seconds" |
|                      |                      | refers to the        |
|                      |                      | results of the       |
|                      |                      | capillary refill     |
|                      |                      | test.)               |
|                      |                      |                      |
|                      |                      | § Stress that time   |
|                      |                      | will be critical in  |
|                      |                      | a disaster. The      |
|                      |                      | participants will    |
|                      |                      | not be able to spend |
|                      |                      | very much time with  |
|                      |                      | any single victim.   |
+----------------------+----------------------+----------------------+

+----------------+----------------+----------------+----------------+
| *Visual 3.6*   | § Stress also  |                |                |
|                | that the       |                |                |
|                | participants   |                |                |
|                | should take    |                |                |
|                | advantage of   |                |                |
|                | local          |                |                |
|                | exercises as a |                |                |
|                | means of       |                |                |
|                | main-taining   |                |                |
|                | their triage   |                |                |
|                | skills and to  |                |                |
|                | help them      |                |                |
|                | avoid the      |                |                |
|                | triage         |                |                |
|                | pitfalls:      |                |                |
|                |                |                |                |
|                | • Inadequate   |                |                |
|                | medical        |                |                |
|                | size-up.       |                |                |
|                |                |                |                |
|                | • No team      |                |                |
|                | plan,          |                |                |
|                | organization,  |                |                |
|                | or goal.       |                |                |
|                |                |                |                |
|                | • Indecisive   |                |                |
|                | leadership.    |                |                |
|                |                |                |                |
|                | • Too much     |                |                |
|                | focus on one   |                |                |
|                | injury.        |                |                |
|                |                |                |                |
|                | • Treatment    |                |                |
|                | (rather than   |                |                |
|                | triage)        |                |                |
|                | performed.     |                |                |
+----------------+----------------+----------------+----------------+
|                | **PERFORMING A |                |                |
|                | TRIAGE         |                |                |
|                | EVALUATION**   |                |                |
|                | (Continued)    |                |                |
+----------------+----------------+----------------+----------------+
| ** ?**         | § Ask the      |                |                |
| *Discussion    | group if       |                |                |
| question.*     | anyone has any |                |                |
|                | questions on   |                |                |
|                | how to perform |                |                |
|                | triage.        |                |                |
+----------------+----------------+----------------+----------------+
|                | *Total         | **EXERCISE:    |                |
|                | Exercise:*     | CONDUCTING     |                |
|                |                | TRIAGE**       |                |
|                | *30 minutes*   |                |                |
|                |                | [Instructor    |                |
|                |                | Note           |                |
|                |                | ]{.underline}: |                |
|                |                | This exercise  |                |
|                |                | is intended to |                |
|                |                | allow the      |                |
|                |                | participants   |                |
|                |                | to practice    |                |
|                |                | conducting     |                |
|                |                | triage in a    |                |
|                |                | high-pressure  |                |
|                |                | situation. To  |                |
|                |                | conduct this   |                |
|                |                | exercise:      |                |
|                |                |                |                |
|                |                | 1\. Before the |                |
|                |                | session,       |                |
|                |                | prepare 6      |                |
|                |                | cards, each    |                |
|                |                | documenting    |                |
|                |                | the status of  |                |
|                |                | one disaster   |                |
|                |                | victim, as     |                |
|                |                | follows:       |                |
|                |                |                |                |
|                |                | • Victim #1:   |                |
|                |                | Ambulat        |                |
|                |                | ory---responds |                |
|                |                | to voice       |                |
|                |                | triage         |                |
|                |                |                |                |
|                |                | Minor bleeding |                |
|                |                |                |                |
|                |                | Normal blanch  |                |
|                |                |                |                |
|                |                | • Victim #2:   |                |
|                |                | Bleeding       |                |
|                |                | extremity      |                |
|                |                |                |                |
|                |                | Unconscious    |                |
|                |                |                |                |
|                |                | After 2        |                |
|                |                | attempts to    |                |
|                |                | open airway,   |                |
|                |                | still not      |                |
|                |                | breathing      |                |
|                |                |                |                |
|                |                | • Victim #3:   |                |
|                |                | Standing, but  |                |
|                |                | does not       |                |
|                |                | respond to     |                |
|                |                | voice commands |                |
|                |                |                |                |
|                |                | • Victim #4:   |                |
|                |                | No signs of    |                |
|                |                | bleeding       |                |
|                |                |                |                |
|                |                | Unconscious    |                |
|                |                |                |                |
|                |                | Blanch takes 5 |                |
|                |                | seconds        |                |
|                |                |                |                |
|                |                | • Victim #5:   |                |
|                |                | No bleeding    |                |
|                |                |                |                |
|                |                | Conscious      |                |
|                |                |                |                |
|                |                | Doesn't        |                |
|                |                | squeeze hand   |                |
|                |                | when asked     |                |
|                |                |                |                |
|                |                | • Victim #6:   |                |
|                |                | Minor bleeding |                |
|                |                |                |                |
|                |                | Conscious but  |                |
|                |                | disoriented    |                |
|                |                |                |                |
|                |                | Breathing rate |                |
|                |                | = 40 per       |                |
|                |                | minute         |                |
+----------------+----------------+----------------+----------------+
|                | **EXERCISE:    |                |                |
|                | CONDUCTING     |                |                |
|                | TRIAGE**       |                |                |
|                | (Continued)    |                |                |
|                |                |                |                |
|                | 2\. Break the  |                |                |
|                | class into     |                |                |
|                | 6-person       |                |                |
|                | groups. Have   |                |                |
|                | enough sets of |                |                |
|                | cards so that  |                |                |
|                | there will be  |                |                |
|                | one set for    |                |                |
|                | each group. In |                |                |
|                | each group, 3  |                |                |
|                | participants   |                |                |
|                | will act as    |                |                |
|                | victims, and 3 |                |                |
|                | will act as    |                |                |
|                | search and     |                |                |
|                | rescue team    |                |                |
|                | members (2     |                |                |
|                | rescuers and 1 |                |                |
|                | runner).       |                |                |
|                |                |                |                |
|                | 3\. Have the   |                |                |
|                | "victims"      |                |                |
|                | select a card  |                |                |
|                | from their set |                |                |
|                | and tape it to |                |                |
|                | their shirts.  |                |                |
|                |                |                |                |
|                | 4\. Designate  |                |                |
|                | a "disaster"   |                |                |
|                | area for each  |                |                |
|                | group and ask  |                |                |
|                | the victims to |                |                |
|                | arrange        |                |                |
|                | themselves     |                |                |
|                | within the     |                |                |
|                | designated     |                |                |
|                | area.          |                |                |
+----------------+----------------+----------------+----------------+
| *Remind the    | 5\. Explain to |                |                |
| participants   | the            |                |                |
| to bring their | participants   |                |                |
| blankets to    | that the 3     |                |                |
| the disaster   | "rescuers"     |                |                |
| area.*         | will have 5    |                |                |
|                | minutes to:    |                |                |
|                |                |                |                |
|                | • Conduct      |                |                |
|                | triage on each |                |                |
|                | of the victims |                |                |
|                | and determine  |                |                |
|                | how each       |                |                |
|                | should be      |                |                |
|                | tagged and     |                |                |
|                | treated.       |                |                |
+----------------+----------------+----------------+----------------+
|                | *Refer the     | • Document the |                |
|                | partici-pants  | number of      |                |
|                | to their       | victims in     |                |
|                | Participant    | each category  |                |
|                | Handbooks,     | of triage      |                |
|                | page PH IV-8,  | (immediate,    |                |
|                | for an example | delayed,       |                |
|                | of a triage    | dead).         |                |
|                | documenting    |                |                |
|                | system.*       |                |                |
+----------------+----------------+----------------+----------------+
|                | **EXERCISE:    | *Observe the   | 6\. Begin the  |
|                | CONDUCTING     | rescuers as    | activity. At   |
|                | TRIAGE**       | they plan for  | the end of the |
|                | (Continued)    | and conduct    | time period,   |
|                |                | triage.*       | call the       |
|                |                |                | groups         |
|                |                | *Take 3-5      | together to    |
|                |                | minutes for    | discuss the    |
|                |                | each           | results of the |
|                |                | discussion.*   | triage         |
|                |                |                | exercise.      |
|                |                |                | Discuss:       |
|                |                |                |                |
|                |                |                | • Problems     |
|                |                |                | that the       |
|                |                |                | rescuers       |
|                |                |                | encountered    |
|                |                |                | during triage. |
|                |                |                |                |
|                |                |                | • How it felt  |
|                |                |                | to be under    |
|                |                |                | pressure to    |
|                |                |                | conduct triage |
|                |                |                | within such a  |
|                |                |                | short period   |
|                |                |                | of time.       |
|                |                |                |                |
|                |                |                | Relate the     |
|                |                |                | rescuers'      |
|                |                |                | feelings about |
|                |                |                | their time     |
|                |                |                | constraints to |
|                |                |                | the pressure   |
|                |                |                | they will feel |
|                |                |                | under actual   |
|                |                |                | conditions.    |
|                |                |                | Explain that   |
|                |                |                | they will      |
|                |                |                | learn ways to  |
|                |                |                | control some   |
|                |                |                | of their       |
|                |                |                | stresses in a  |
|                |                |                | later session. |
|                |                |                |                |
|                |                |                | 7\. Have the   |
|                |                |                | group members  |
|                |                |                | switch roles   |
|                |                |                | and repeat the |
|                |                |                | activity, with |
|                |                |                | the 3 new      |
|                |                |                | victims using  |
|                |                |                | the 3 unused   |
|                |                |                | cards, so that |
|                |                |                | each           |
|                |                |                | participant    |
|                |                |                | has a chance   |
|                |                |                | to be a        |
|                |                |                | rescuer once.  |
+----------------+----------------+----------------+----------------+
|                | **SUMMARY AND  | ** ?**         | § Ask the      |
|                | TRANSITION**   | *Discussion    | participants   |
|                |                | question.*     | if they have   |
|                |                |                | any questions  |
|                |                |                | about triage.  |
|                |                |                |                |
|                |                |                | [Instructor    |
|                |                |                | Note           |
|                |                |                | ]{.underline}: |
|                |                |                | Be sensitive   |
|                |                |                | to the         |
|                |                |                | participants   |
|                |                |                | and the        |
|                |                |                | difficulty of  |
|                |                |                | these          |
|                |                |                | decisions      |
|                |                |                | during a       |
|                |                |                | catastrophic   |
|                |                |                | event.         |
|                |                |                | Emphasize that |
|                |                |                | planning and   |
|                |                |                | organization   |
|                |                |                | are necessary  |
|                |                |                | to do the      |
|                |                |                | "greatest good |
|                |                |                | for the        |
|                |                |                | greatest       |
|                |                |                | number."       |
+----------------+----------------+----------------+----------------+

**YOUR NOTES:**

+---+-------------------------------+-------------------------------+
|   | *Total Topic:*                | **SESSION SUMMARY**           |
|   |                               |                               |
|   | *5 minutes*                   | § Summarize the key points    |
|   |                               | from this session:            |
|   | *Participant Hand-book, page  |                               |
|   | PH *                          | • CERT members' ability to    |
|   |                               | open airways, control         |
|   | *III-23. *                    | bleeding, and treat for shock |
|   |                               | are critical to saving lives. |
|   | *Present key points.*         |                               |
|   |                               | \- Use the                    |
|   |                               | Head-Tilt/Chin-Lift method    |
|   |                               | for opening airways.          |
|   |                               |                               |
|   |                               | \- Control bleeding using     |
|   |                               | direct pressure, elevation,   |
|   |                               | and/or pressure points.       |
|   |                               |                               |
|   |                               | \- If there is a question     |
|   |                               | about whether a victim is in  |
|   |                               | shock, treat for shock.       |
|   |                               |                               |
|   |                               | • Triage is a system for      |
|   |                               | rapidly evaluating victims'   |
|   |                               | injuries and prioritizing     |
|   |                               | them for treatment. The       |
|   |                               | procedure for conducting      |
|   |                               | triage evaluations involves   |
|   |                               | checking:                     |
|   |                               |                               |
|   |                               | \- The airway and breathing   |
|   |                               | rate.                         |
|   |                               |                               |
|   |                               | \- Circulation and bleeding.  |
|   |                               |                               |
|   |                               | \- Mental status.             |
|   |                               |                               |
|   |                               | § Remind the participants     |
|   |                               | that disaster medical         |
|   |                               | operations require careful    |
|   |                               | planning, teamwork, and       |
|   |                               | practice. Urge them to take   |
|   |                               | advantage of participating in |
|   |                               | community-wide disaster       |
|   |                               | exercises whenever they are   |
|   |                               | scheduled.                    |
+---+-------------------------------+-------------------------------+
|   | **SESSION SUMMARY**           |                               |
|   | (Continued)                   |                               |
|   |                               |                               |
|   | § Ask the participants to     |                               |
|   | read and become familiar with |                               |
|   | Session IV: Disaster Medical  |                               |
|   | Operations--- Part 2 before   |                               |
|   | the next session.             |                               |
|   |                               |                               |
|   | § Remind the participants to  |                               |
|   | bring a blanket, roller       |                               |
|   | gauze, adhesive tape, and     |                               |
|   | cardboard to the next         |                               |
|   | session.                      |                               |
|   |                               |                               |
|   | § Thank everyone for          |                               |
|   | attending this session.       |                               |
+---+-------------------------------+-------------------------------+

**YOUR NOTES:**