ACEP First Aid Manual by American College of Emergency Physicians, Margaret Austin,

By American College of Emergency Physicians, Margaret Austin, Rudy Crawford, Vivien J. Armstrong, Gina M. Piazza

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Chain of survival Four elements increase the chances of a collapsed casualty surviving. If any one of the elements in this chain is missing, the chances of survival are reduced. » 57 THE UNCONSCIOUS CASUALTY « LIFE-SAVING PRIORITIES IMPORTANCE OF MAINTAINING CIRCULATION If the heart stops beating, blood does not circulate through the body. As a result, vital organs—most importantly the brain—become starved of oxygen. Brain cells are unable to survive for more than three to four minutes without a supply of oxygen.

As a result, the casualty will eventually lose consciousness, breathing will cease, the heart will stop, and death results. The airway must be kept open so that breathing can occur, allowing oxygen to enter the lungs and be circulated in the body. The priority of a first aider when treating any unconscious casualty is to assess for breathing and immediately begin CPR with chest compressions if breathing is absent. An automated external defibrillator (AED) may be required to “shock” the heart back into a normal rhythm.

If removal from the water cannot be immediate, begin rescue breaths while still in the water. 54–87). WATER RESCUE Your first priority is to get the casualty onto 1 dry land with the minimum of danger to yourself. Stay on dry land, hold out a stick, a branch or a rope for him to grab, then pull him from the water. Alternatively, throw him a float. If you are a trained lifesaver, there is no 2 danger to yourself, and the casualty is unconscious, wade or swim to the casualty and tow him ashore. If you cannot do this safely, call 911 for emergency help.

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