11.5 Basic First Aid, CPR Principles, and Emergency Response Protocols

1. Survey Vehicle Safety Equipment & ANSI/ISEA Z308.1 First Aid Kits

Survey crews frequently operate in isolated, rural, or wilderness environments where professional emergency medical services (EMS) response times may exceed 30 to 45 minutes. Establishing comprehensive emergency preparedness inside field survey vehicles is essential for life safety.

First Aid Kit Performance Standards (ANSI/ISEA Z308.1)

OSHA requires all construction and survey field vehicles to maintain compliant first aid supplies. ANSI/ISEA Z308.1 (Required Requirements for Workplace First Aid Kits and Supplies) classifies kits into two performance categories:

• Class A First Aid Kits: Designed to treat common workplace injuries (such as minor cuts, scrapes, abrasions, and mild burns). Intended for small, low-risk field crews.
• Class B First Aid Kits: Designed to treat a broader range and higher severity of injuries encountered in complex, high-risk, or remote environments (e.g., heavy construction sites, remote timber surveys). Class B kits feature expanded quantities of burn dressings, trauma pressure dressings, padded splints, CPR face shields, and commercial tourniquets.

Essential Vehicle Emergency Gear

Every survey field vehicle must be equipped with the following mandatory safety items:

1. ANSI Class B First Aid Kit (inspected monthly and restocked after any use).
2. Fire Extinguisher: Rated at least 2A:10B:C (multipurpose dry chemical), mounted securely in an accessible bracket.
3. Emergency Eye Wash Station: Portable eyewash bottles (minimum 16 oz of sterile saline) for flushing chemical splashes or airborne debris from the eyes.
4. Trauma Emergency Blanket & Thermal Wraps: To treat shock and prevent hypothermia.
5. Roadway Warning Equipment: Three collapsible bidirectional reflective triangles or high-intensity LED flare pucks.

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2. Severe Hemorrhage Control & Commercial Tourniquet Protocols

Uncontrolled arterial bleeding is the leading cause of preventable trauma death on remote job sites. A victim suffering a severed femoral or brachial artery can bleed to death in less than 3 minutes.

Classifying Types of Bleeding

• Arterial Bleeding: Characterized by bright red blood spurting in rhythm with the heartbeat under high pressure. Arterial bleeding is a catastrophic medical emergency requiring immediate aggressive control.
• Venous Bleeding: Characterized by dark red blood flowing steadily without pulsation.
• Capillary Bleeding: Characterized by slow, oozing blood from superficial wounds.

Progressive Hemorrhage Control Steps

1. Direct Pressure: Apply immediate firm, continuous manual pressure directly over the wound using a sterile gauze pad or clean trauma dressing.
2. Pressure Dressing: Wrap a heavy elastic bandage firmly over the dressing to maintain pressure.
3. Commercial Tourniquet Application: If severe arterial bleeding on an arm or leg cannot be controlled immediately with direct pressure, a commercial windlass tourniquet—such as the CAT (Combat Application Tourniquet) or SOFTT-W (Special Operations Forces Tactical Tourniquet)—must be applied without delay.

+-------------------------------------------------------------------------------+
|                    COMMERCIAL WINDLASS TOURNIQUET PROTOCOL                    |
+-------------------------------------------------------------------------------+
| 1. POSITION TOURNIQUET: Place strap 2 TO 3 INCHES ABOVE (PROXIMAL TO) WOUND. |
|    - Avoid joints! Never place over an elbow or knee joint.                   |
|    - If wound location is unclear, place HIGH AND TIGHT on the limb.          |
|                                                                               |
| 2. TIGHTEN STRAP & WINDLASS: Pull main strap tight; rotate windlass rod until  |
|    bright red arterial bleeding STOPS and distal pulse is eliminated.        |
|                                                                               |
| 3. LOCK WINDLASS: Secure the windlass rod inside the locking clip/cleat.      |
|                                                                               |
| 4. RECORD APPLICATION TIME (CRITICAL): Write exact time (e.g., "T 14:15")     |
|    directly on the tourniquet time strap or on the victim's forehead!         |
|                                                                               |
| 5. NEVER LOOSEN IN THE FIELD: Tourniquets must remain locked until surgical    |
|    care is reached. Never loosen a tourniquet in the field.                   |
+-------------------------------------------------------------------------------+

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3. Adult CPR & Automated External Defibrillator (AED) Operations

Sudden Cardiac Arrest (SCA) occurs when an electrical disruption causes the heart to beat chaotically (Ventricular Fibrillation), halting blood circulation to the brain and vital organs. Brain death begins within 4 to 6 minutes without CPR.

Recognizing Cardiac Arrest

A victim is in cardiac arrest if they are unresponsive, not breathing (or exhibiting only irregular, gasping "agonal" breaths), and have no pulse detected within 10 seconds of assessment.

High-Quality Adult CPR Guidelines (AHA Standards)

High-quality Cardiopulmonary Resuscitation (CPR) manually circulates oxygenated blood to the brain:

Automated External Defibrillator (AED) Protocols

An AED delivers an electric shock to stun a fibrillating heart, allowing its natural pacemaker to restore a normal rhythm.

1. Power On AED: Open lid or press power button immediately upon AED arrival.
2. Apply Electrode Pads: Apply self-adhesive pads to bare chest as indicated on pad diagrams (Right Upper Chest below collarbone; Left Lower Ribcage below armpit).
3. Clear Victim for Analysis: Stand clear and ensure no one touches the victim while the AED analyzes heart rhythm.
4. Deliver Shock if Advised: Announce loudly "CLEAR!", visually confirm no one is touching the victim, and press the flashing shock button.
5. IMMEDIATE POST-SHOCK ACTION (CRITICAL): Immediately resume high-quality chest compressions starting with 30 compressions right after the shock is delivered. Do not check pulse or delay compressions. Perform 2 minutes (approx. 5 cycles of 30:2 CPR) before allowing the AED to re-analyze.

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4. Fracture Immobilization, Burn Care & Shock Management

Musculoskeletal Injury Management (RICE Protocol)

For suspected sprains, dislocations, or fractures:

• RICE: Rest, Ice (apply cold packs wrapped in cloth for 20 min), Compression (elastic wrap), Elevation (elevate above heart if no fracture suspected).
• Fracture Splinting: Immobilize fractures in the exact position found. Splints must extend to immobilize the joint above and the joint below the fracture site. Recheck distal circulation (capillary refill and sensation) after applying splints.

Burn Injury Classification & First Aid

• Thermal Burns: Cool immediately with cool, running water (not ice water) for at least 10 minutes. Cover loosely with sterile, non-adherent dry dressings. Never apply butter, grease, or ointments to burn wounds.
• Chemical Burns: Flush skin continuously with clean water for at least 15 to 20 minutes while removing contaminated clothing.
• Electrical Burns: Contact with high-voltage lines causes severe internal tissue destruction with distinct entry and exit wounds. Immediately call 911; prepare for CPR; treat for traumatic shock.

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5. Emergency Action Plans (EAP) & Remote Emergency Dispatching

Formulating Site-Specific Emergency Action Plans

Before deploying to remote survey locations, the crew chief must establish a site Emergency Action Plan (EAP):

• Identify the exact name, address, and drive-route to the nearest hospital with emergency services.
• Verify primary and secondary communication channels (cellular, satellite messenger, or two-way VHF radio).
• Designate crew roles (Primary First Aider, 911 Caller, Gate Guide to meet EMS).

Communicating Location to 911 Dispatchers

When calling 911 from a remote survey site (such as a forested boundary line, pipeline easement, or rural highway), physical street addresses do not exist.

CRITICAL DISPATCH PROTOCOL: Survey technicians must read the precise Latitude and Longitude coordinates directly from their GNSS/GPS data collector or handheld receiver to 911 dispatchers. Geographic coordinates allow emergency dispatchers and airborne medical evacuation (Medevac helicopter) flight crews to pinpoint the exact location and land without delay.

Example 911 Remote Location Transmission:
"Emergency Dispatch, we have a remote medical emergency.
Location: Latitude 38° 53' 42.1" N, Longitude 77° 02' 11.5" W.
Topographic Landmark: 1.2 miles West of Highway 15 on Timber Access Road 4.
Standby for helicopter landing zone setup."