EFR Participant Manual Mobile

About this Manual EMERGENCY FIRST RESPONSE ®

Creating Confidence to Care®

Primary Secondary Care and

TM

®

EMERGENCY FIRST RESPONSE TM

Tis Participant Manual belongs to __________________________________________________________________________ Mailing Address _________________________________________________________________________________________ City __________________________________________________________________ State/Province ___________________ Zip/Postal Code _________________________________ Country ________________________________________________ Phone Number __________________________________________________________________________________________ Instructor Statement

I certify that this person has completed the following Emergency First Response course requirements and indicated recommended skills.

Primary Care (CPR) Instructor Signature _______________________________________________ Number ___________________________ Completion Date _____________________________________________________________________________________ Recommended Skill – Automated External Defibrillator (AED) Use Instructor Signature ____________________________________________ Number ___________________________ Completion Date _________________________________________________________________________________ Recommended Skill – Emergency Oxygen Use Instructor Signature ____________________________________________ Number ___________________________ Completion Date _________________________________________________________________________________

Secondary Care (First Aid) Instructor Signature _______________________________________________ Number ___________________________ Completion Date _____________________________________________________________________________________

Emergency First Response® Primary Care and Secondary Care Participant Manual Copyright © 2011 by Emergency First Response Corp. All rights reserved. Produced by Emergency First Response Corp. No reproduction of this book is allowed without the express written permission of the publisher Published and distributed by Emergency First Response Corp., 30151 omas Street, Rancho Santa Margarita, CA 92688-2125 Printed in the United States of America ISBN number 978-1-61381-991-3 Product No. 70370 (Rev. 06/11) Version 1.0

EFR

ACKNOWLEDGEMENTS

Y D U T S T N E D N E P E D N I

For More Information For more information about Emergency First Response, Corp., courses, products and emergency care go to www.emergencyfirstresponse.com.

Patient Care Standards Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses follow the emergency considerations and protocols as developed by the members of the International Liaison Committee on Resuscitation (ILCOR). Members include American Heart Association (AHA), European Resuscitation Council (ERC), Australian Resuscitation Council (ARC), New Zealand Resuscitation Council (NZRC), Heart and Stroke Foundation of Canada (HSFC), Resuscitation Council of Southern Africa (RCSA), Inter American Heart Foundation (IAHF), Resuscitation

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Council of Asia (RCA - current members include Japan, Korea, Singapore, aiwan). Source authority for the development of content material in Emergency First Response programs is based on the following: • Circulation, Journal of the American Heart Association. Volume 122, Number 18, Supplement 3.November 2010. http:// circ.ahaj ournals.orgl content/vo1122/18_suppL31 • Resuscitation, Journal of the European Resuscitation Council. Volume 81, Number 1. October 2010. http://www.resuscitationjournal.com/ • Australian Resuscitation Council Guidelines. December 2010. http://www.resus.org.au/policy/ guidelineslindex. asp. • New Zealand Resuscitation Council Policies and Guidelines. December 2010. http://www.nzrc.org.nz/policies-and-guidelines/.

Emergency First Response gratefully acknowledges the following contributors for their assistance with publishing this manual:

International Medical Review PhilBryson, MBChB, DCH, DRCOG. MRCGP Medical Director Diving Disease Research Centre, UK

DesGorman,

BSc, MBChB, FAFOM, PhD Head - Occupational Medicine School of Medicine, University of Auckland Auckland, New Zealand

Equipment LaerdalMedical Corporation CardiacScience Corporation Agilent /Phillips HeartSine®Technologies, Incorporated

JanRisberg, MD, PhD Begen, Norway

BrianSmith,

MD Mountain West Anesthesia Utah, USA

SECTION ONE

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About this Manual Te Emergency First Response Participant Manual has three sections s

Section One – Independent Study Workbook

s

Section wo – Skills Workbook

s

Section Tree – Emergency Reference

Section One provides you with foundational information specific to Emergency Responder care. By reading the background information in this section, you’ll better understand why your role as an Emergency First Responder is so important to those who need emergency care. Section wo applies to skill development portion of your EFR course. Under your Emergency First Response Instructor’s supervision, you’ll use this step-bystep workbook to guide you through a practice session for each of the course’s skills. Section Tree provides a quick emergency care reference to use after you complete your Emergency First Response course. Tis section includes emergency care reference for: u

Primary Care - CPR for Adults, Children and Infants

u

Assembling a First Aid Kit

u

Injury First Aid - Dislocations, fractures, cuts, scrapes, bruises, dental injuries, strains,

u

u

iv

sprains, eye injuries and electrical injuries emperature-Related Injuries - Burns, hypothermia, frostbite, heat stroke and heat exhaustion Illness First Aid - Heart attack, stroke, diabetic problems, seizures, allergic reactions, poisoning, venomous bites and stings

SECTION ONE

SectionONE

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IndependentSTUDY Contents Introduction ....................................................... ........................................................ ............. 1-3 Course Structure ................................................ ......................................................... ............ 1-5 Helping Others in Need . ........................................................ ................................................ 1-10 The Emotional Aspects of Being an Emergency Responder ....................... ............................. 1-15

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Keeping Your Skills Fresh ........ ........................................................ ...................................... 1-17 Leading a Healthy Lifestyle ................................................... ................................................ 1-18 Protecting Yourself Against Bloodborne Pathogens ...................................................... .......... 1-19 Recognizing Life-Threatening Problems .................................................. .............................. 1-20 Primary Care Definitions and Background Information ................................................. .......... 1-22 Using AB-CABS and the Cycle of Care ...................................................... ............................. 1-26 Primary Care Knowledge Review ................................................... ....................................... 1-36 Secondary Care (First Aid) ........................................... ........................................................ .. 1-38 Secondary Care (First Aid) Knowledge Review ................................ ....................................... 1-42

SECTION ONE

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Section ONE

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Independent Study SECTION ONE

Introduction


Someone cuts his finger in a kitchen. At a gym, an older gentleman collapses from a heart attack. During a sporting event, a young boy faints from standing too long. wo automobiles collide, seriously injuring the occupants. A youngster floats motionless, face down in a swimming pool. A diner at the next table chokes on food, unable to breathe. It happens every day. Some of these people just need a helping hand while others will die or suffer serious permanent injury if not immediately attended to. Many things separate those who live and escape serious disability from those who die or suffer long after their misfortune: the individual’s fitness and health, the severity of the initial incident, the distance from medical care and often, just plain luck. No one can control these variables.

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But there’s one variable youcan control when you’re on the scene of any medical emergency:You. Often, life versus death or complete recovery versus long-term disability lies with a layperson first responder providing care between the emergency’s onset and the arrival of professional medical personnel. If you are there, you can provide that care. You can be an Emergency Responder. As a layperson, you can’t guarantee that a patient will live or fully recover - there’s too much beyond anyone’s control- but you can feel confident that given the circumstances, everything that could be done will be done. If you’re not familiar with emergency care procedures, it can seem intimidating and complex. What do you do? For that matter, how do you know what to do first? Such questions may appear overwhelming, but actually, they’re not. If you can remember “ABCD’S,” you’ll know what to do. Tis is because no matter what the nature of a medical emergency, you follow the same steps in the same order, providing basic care based on what you find. In the Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses, you’ll learn that ABCD’S prompt you to follow the necessary steps in the right order, so you do the right things at the right time. You’ll learn to apply first responder care following the same priorities used by medical professionals.

Regional Resuscitation Councils and Organizations American Herat Association (AHA) guidelines are used in Americas, Unites States, Canada, Asia and the Pacific Island countries. European Resuscitation Council (ERC) guidelines are used in the UK, Europe, Africa, Middle East and Russia. Australia and New Zealand Resuscitation As a lay Emergency Responder, you’ll learn to apply care following the same priorities used by medical professionals.

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The Cycle of Care Emergency First Response Primary Care (CPR) teaches you the steps and techniques for handling life-threatening emergencies. Te Cycle of Care guides you.

Cycle of Care: AB-CABS

“

Te Cycle of Care illustrates the correct pathway and priorities for emergency care.

”

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til Help or AED Arrive s Continue Un

s

AB Airway Breathing Open? Normally?

s

s

s

C Chest Compressions

A

Airway Open

s

Breathing

B

Check Quickly

Unresponsive & Not Breathing Normally

for Pateint

S

Serious Bleeding Shock Spinal Injury

Responsive & Breathing Normally

Te Cycle of Care illustrates the memory word AB-CABS, providing you with the correct pathway and priorities for emergency care. Visualize the Cycle of Care illustration as you assist someone in need. You continue aCycle of Care for a patient until Emergency Medical Service personnel arrive and take over.

Primary Care Priorities: AB-CABS A= B=

Is the patient’s Airway Open? Is the patient’s Breathing Normally?

C = Chest Compressions A = Open Airway B = Breathing for the Patient S = Serious Bleeding, Shock, Spinal Injury

CABS

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SECTION ONE

A

B

CourseStructure


Tis manual and the Emergency First Response Video provide the study tools for two courses — Emergency First Response Primary Care (CPR) and Emergency First Response Secondary Care (First Aid). Your instructor may conduct these courses separately or together.

The Nine Skills Learned in Emergency First Response® Primary Care (CPR) s

Scene Assessment

s

Barrier Use

s

Primary Assessment

s

CPR – Chest Compression

s

CPR – Chest Compressions combined with Rescue Breathing

s

Conscious and Unconscious Choking Adult

s

Serious Bleeding Management

s

Shock Management

s

Spinal Injury Management

s s

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Recommended Skill – Automated External Defibrillator (AED) Use Recommended Skill – Emergency Oxygen Use Orientation

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Emergency First Response Primary Care (CPR) teaches you the steps and techniques for handling life-threatening emergencies. In it, you’ll learn nine skills for aiding patients who aren’t breathing normally, have no heartbeat, may have serious bleeding, may be in shock or who may have a spinal injury. You’ll learn how to apply the Cycle of Care, so that you provide the patient with every possible chance of survival in the face of the most serious emergencies.

The Four Skills Learned in Emergency First Response® Secondary Care (First Aid) s s Injury Assessment

Illness Assessment

s

Bandaging

s

Splinting for Dislocations and Fractures

Emergency First Response Secondary Care (First Aid) teaches you what to do when Emergency Medical Services (EMS) are either delayed or unavailable. Tis course also teaches you how to provide first aid for patients with conditions that aren’t life-threatening. You’ll learn to apply the Cycle of Care in such a way to reduce imminent threats to a patient’s life while providing care that reassures, eases pain and reduces the risk of further harm. For both courses, you’ll begin by reading the Independent Study section of this manual and watching the Emergency First Response Video. Tis gives you the basic information about why each skill is important and how to do it. Ten you’ll practice the skill with your instructor so that you become capable and comfortable with it. After you’ve learned all of the skills in each course, your instructor will stage mock emergencies for you and your classmates. During these scenanos, you’ll practice applying your skills and learn to adapt what you’ve learned to circumstances like you might find in real life. You’ll find that the emphasis is on learning the skills so that you’re comfortable using them.

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Emergency First Response Secondary Care (First Aid) teaches you what to do w hen Emergency Medical Services are either delayed or unavailable.


Course Flow – Begin Here

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Read the Independent Study portion of this Participant Manual.

Complete the Knowledge Review at the end of the Independent Study portion of your Participant Manual.

Watch your Emergency First Response Video.

Attend the Skill Development session organised by your Emergency First Response Instructor.

Complete the Scenario Practice with your Emergency First Response Instructor.

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Learning Tips Here are a few pointers to help you get the most out of the Emergency First Response Primary Care (CPR) and Secondary Care (First Aid) courses. 1.

Don’t focus on perfection. A common misconception with emergency care is that the smallest error will hurt or kill a patient. Tis is seldom true. Your instructor will make sure you understand what’s critical and what’s not. When someone focuses on perfection, there’s a tendency to do nothing in a real emergency because that person fears not doing everything “perfectly.” Don’t get caught in that trap — it’s not hard to provide adequate care. Always remember — Adequate care provided is better than perfect care withheld.

2.

Don’t be intimidated. You’re learning something new, so don’t be surprised if you’re not immediately comfortable with a skill or need some guidance. So what? If you already knew how to do it, you wouldn’t be there. Mistakes aren’t a problem — they’re an important part of learning.

3.

Have fun. Tat may sound odd given the seriousness of what you’re learning, but the truth is, you’ll learn more and learn faster if you and your classmates keep things light. Polite humor and light jests are normal in this kind of learning. But, be sensitive and aware that others taking the course with you may have been involved in a situation similar to what you’re practicing. You can have fun without seeming insensitive or uncaring about human suffering.

4.

Be decisive and then act. Tere’s more than one right answer. When you practice the scenarios, you’ll find that circumstances don’t always give you a clear direction in exactly how to best apply the ABCD’S. Don’t worry — this is exactly why you’re doing the mock emergencies. Decide how to apply your training and then do it. It may not be the only way, and later, you may think of a different way that you would have liked better. That’s fine for learning, but it doesn’t make the way you did it wrong. Never forget that Adequate care provided is better than

perfect care withheld.

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5.

It all comes back. When you’re practicing the scenarios, you may notice that as you follow the steps within the ABCD’S, things you “forgot” come back to you - not necessarily smoothly at first, but adequately so that you’re capable of providing emergency care. Remember that feeling. If you’re ever faced with a real emergency and have doubts about remembering what to do, recall this feeling. You can trust that the ABCD’S will bring back what you need to know. Adequate care provided is better than perfect care withheld.

6.

Complete all your independent study prior to class. In most situations, your EFR Instructor will expect you to come to the Skill Development and Scenario Practice session having read all of your Emergency First Response Participant Manual and watched the entire Emergency First Response Video. Doing so will streamline your learning by allowing you to focus on skill development with your instructor. Begin by scanning a section, read through its study questions, then read the section. At the end of the independent study material, you will find one Knowledge Review for each course. Complete the Knowledge Review and bring it to class along with your participant manual.

SECTION ONE


Who May Enroll In Each Course and What Are The Prerequisites? Anyone of any age may enroll in the Emergency First Response Primary Care (CPR) course. Te course is performancebased, meaning that as long as you can meet each of the stated objectives and complete the necessary skills to the satisfaction of your instructor, you can receive a course completion card. o enroll in the Emergency First Response Secondary Care (First Aid) course, you need only complete the Primary Care (CPR) course. Or, if you’re currently CPR trained from another qualified training organization, you can enroll directly in the Emergency First Response Secondary Care (First Aid) course with a quick review by your instructor. Examples of other qualified CPR training organizations include: American Heart Association, Red Cross, American Safety and Health Institute, Cruz Roja de Mexico, Deutsches Rotes Kreuz, Medic First Aid, Inc®., Queensland Ambulance Service, South African Red Cross Society and St. John’s Ambulance. Tere may be others that qualify; check with your instructor.

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Helping Others inNeed If you encounter someone who needs primary emergency care and you’ve assessed the scene for your own personal safety (more on this later), you should render assistance immediately – even seconds count. Te chances of successful resuscitation diminish with time. When a person has no heartbeat and is not breathing, irreversible brain damage can occur within minutes. Many medical emergencies, like sudden cardiac arrest, require the secondary assistance of Emergency Medical Service personnel. Get them on the scene fast – seconds count. It is typically best to alert the Emergency Medical Service first, before rendering emergency care (more on this later). Besides providing an act of kindness toward a fellow human being in need, there are three basic reasons for assisting someone who needs emergency care:

Study Questions • Why is time critical when someone needs emergency care? • Why should you assist someone who needs emergency care? • What are the five reasons people hesitate to provide emergency care to a patient – even if they are trained in CPR and first aid?

1.

You can save or restore a patient’s life.

2.

You can help reduce a patient’s recovery time; either in the hospital or at home.

3.

You can make the difference between a patient having a temporary or lifelong disability.

Some individuals, even when CPR and first aid trained, hesitate to provide emergency care to those in need. Tis is understandable and there are legitimate concerns on the part of Emergency Responders when helping those with injuries and illnesses. Te six most common reasons why people hesitate to provide emergency care are: 1.

Anxiety. People may hesitate due to general nervousness or anxiousness. Tis is a perfectly normal reaction when helping those in need. However, as it’s been emphasized, trust your training. When you follow the priorities of care as outlined in this course, you are giving your patient the best change of survival or revival.

2.

Guilt. People may hesitate when thinking about how they might feel if the patient doesn’t recover after delivering first aid. You can’t guarantee that a patient will live or fully recover – there’s too much beyond anyone’s control. Be confident that any help you offer is a contribution to another human being and has the potential to make a difference in the patient’s outcome. Even in the worst of outcomes. you can take comfort in the fact that you used your skills and gave the patient more of a chance than he had alone. When someone is in need of emergency care, you should render assistance immediately – even second counts.

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SECTION ONE

3.


Fear of imperfect performance. People may hesitate because they feel they cannot properly help an injured or ill person. It is seldom true that the smallest error will hurt or kill a patient. During this course, you will learn what’s critical and what’s not. If you focus on perfection, you’ll have a tendency to do nothing in a real emergency. Don’t get caught in that trap -it’s not hard to provide adequate care, andadequate care provided is always better than perfect care withheld .

4.

Fear of making a person worse. Te most serious medical emergency is when a patient isn’t breathing and has no heartbeat. Sometimes people hesitate to help such a patient, fearing they will make him worse. As an Emergency Responder, realize that you cannot make such a person worse. A person with no breathing and no heartbeat is already in the worst state of health. You can trust your training. ake a moment to relax, think of your training, then step forward and help.

5.

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Fear of infection. People may hesitate because they are af raid of being infected by the person they are assisting. Keep in mind that a large percentage of all CPR is performed in the home or for a loved one or friend. In these cases, risk of infection is low and fear of infection should not cause you to withhold CPR or emergency care. Infection is a concern, but your training includes learning to use protective barriers to minimize the risk of disease transmission. By using barriers, you’re highly unlikely to get any disease or infection from someone you help. Further, research has shown that the chance of disease transmission is very rare when providing CPR.

6.

Responsibility concerns. People may hesitate because they are af raid of being sued. In general, the fear of being sued should not stop Emergency Responders from providing emergency care. In many regions of the world, Good Samaritan laws have been put in place to encourage people to come to the aid of others.

Good Samaritan Laws Good Samaritan laws (or related, local laws) are enacted to encourage people to come to the aid of others. In general, they protect individuals who voluntarily offer assistance to those in need. Tey are created to provide immunity against liability. Often, a Good Samaritan law imposes no legal duty to help a stranger in need. However, local laws may vary on this point and in some areas people are required to provide aid. ere may not be Good Samaritan laws in your local area. It would be wise to determine the extent and use of Good Samaritan laws in your local area. Your Emergency First Response Instructor may be able to provide you with information about Good Samaritan laws in your local region. ere are six ways you should act to be protected by Good Samaritan laws. Tey are: 1.

Only provide care that is within the scope of your training as an Emergency Responder.

2.

Ask for permission to help

3.

Act in good faith.

4. 5.

Do not be reckless or negligent. Act as a prudent person would.

6.

Do not abandon the patient once you begin care.Te exception to this is if you must do so to protect yourself from imminent danger.

Good Samaritan laws are enacted to encourage people to come to the aid of others.

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The Chain of Survival and You – The Emergeny Responder Te Chain of Survival illustrates the four links of patient care. It emphasizes the teamwork needed in emergency situations between you and professional emergency care providers. When you recognize a potentially life-threatening emergency, you help with the first three links in the Chain • What are the Chain of Survival’s of Survival. Te fourth link involves only professional emergency care four linksand which three involve providers - EMs, Paramedics, nurses and doctors. Let’s look at each of the an Emergency Responder? four links in the Chain of Survival.

Study Question

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Early Recognition and Call for Help

Early CPR — Cardiopulmonary Resuscitation

Early Defibrillation

Early Professional Care and Followup

Early Recognition and Call for Help As an Emergency Responder, you must first recognize that an emergency exists. Once you’ve determined that an emergency exists, evaluate the scene to determine if it is safe for you to assist the patient. You’ll make sure a scene is safe by conducting a Scene Assessment, a skill you’ll learn in the Emergency First Response Primary Care (CPR) course. Further, for a patient with a life-threatening problem, you must rapidly activate the Emergency Medical Service (EMS) in your local area. Tis is the Call First concept. More on this to come.

Early CPR – Cardiopulmonary Resuscitation A person who is not breathing normally and has no heartbeat needs CPR immediately. Early CPR is the best treatment for cardiac arrest until a defibrillator and more advanced trained professionals arrive. Effective and immediate chest compressions prolong the window of time during which defibrillation can occur and provides a small amount of blood flow to the heart, brain, and other vital organs. Immediate CPR can double or triple a patient’s chance of survival from irregular heartbeats or sudden cardiac arrest. Tis link also involves you, the Emergency Responder. 1-12

SECTION ONE


Early Defibrillation Combined with CPR, early defibrillation by you, the Emergency Responder, or EMS personnel, can significantly increase the probability of survival of a patient in cardiac arrest. During your Primary Care course, you may learn how to use an Automated External Defibrillator (AED). If you witness a cardiac arrest and an AED is immediately available, you should begin chest compressions and use the AED as soon as possible (more on this later). When applied to a person in cardiac arrest, an AED automatically analyzes the patient’s heart rhythm and indicates if an electric shock is needed to help restore a normal heartbeat. If you learn how to use an AED in this course, this link involves you, the Emergency Responder. Most EMS personnel also use AED units.

Early Professional Care and Follow-Up EMS personnel can provide advanced patient care that you can not. Te advanced care EMS personnel can provide

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includes artificial airways, oxygen, cardiac drugs and defibrillation (when an AED is unavailable). Mter initial on-scene care, EMS personnel take the patient to the hospital for more advanced medical procedures. Te patient remains hospitalized until no longer needing constant, direct medical attention.

Asking a Patient for Permission to Help When an injured or ill responsive adult needs emergency care, ask permission before you assist the person. Asking for permission to help reassures the patient, noting that you are trained appropriately. You ask for permission to help with the Responder Statement. You simply say, Hello? My name is __________________. I’m an Emergency Responder. May I help you? It’s important to get the patient’s agreement if he is alert and responsive. If the patient agrees or doesn’t respond, you can proceed with emergency care. Tere is implied permission - meaning you can proceed with emergency care - if the patient is unresponsive. If an injured or ill responsive adult refuses emergency care, do not force it on the person. If possible, talk with the individual and monitor the patient’s condition by observation without providing actual care. You could, however, activate EMS at this time.

When an injured or ill responsive adult needs emergency care, ask permission before you assist the person. Asking for permission to help reassures the patient, noting that you are trained appropriately

“

Hello? My name is

_____________________ I’m an Emergency Responder. May I help you?

” SECTION ONE

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Activating the Emergency Medical Service – Call First and Care First In the Chain of Survival your role as the Emergency Responder is to summon emergency medical aid and to assist the patient until it arrives. Activating EMS is so important that in most circumstances, if you’re alone and there’s no one else to activate the EMS for you, you Call First, then assist the patient. After establishing patient unresponsiveness, and identifYing that he is not breathing normally, ask a bystander to call EMS and secure an AED if possible. If you are alone, use your mobile phone to call EMS. If you do not have a mobile phone, leave the patient to call EMS if no other option exists. Tis is theCall First approach to emergency care. You Call First to activate Emergency Medical Services, then you

Study Questions • When should you activate the Emergency Medical Service once you find an unresponsive aduly or child who needs emergency care? • How do you activate Emergency Medical Services (EMS) in your area?

provide assistance.


Early CPR — Cardiopulmonary Resuscitation



An exception to the Call First rule is if the patient is a child or an adult who has experienced submersion in water. In these cases, you provide CPR for a short time, and then call EMS. Tis is calledCare First.

NOTE - wo national guidelines define providingCare First for a short time differently. In North, South and Central America, Asia and the Pacic Island countries (AHA Guidelines), it’s dened as providing care for approximately 2 minutes; the European Resuscitation Council guidelines defines a short time as 1 minute. With EMS on the way, the care you provide increases the chance that advancec care will help the patient when it arrives. Your training in this course is based on handling emergencies where you have an EMS system in place. If you need to provide emergency aid in areas away from EMS support, you should continue your education with more advanced first aid training.

NOTE - You can dial 112 from any mobile cell phone anywhere in the world to reach EMS.

In my local area, EMS is activated by calling: __________________

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SECTION ONE

Call First means that if you’re alone and there’s no one else to activate the Emergency Medical Service for you, you Call First, then assist the patient.

Te Emotional Apects of Being anEmergency Responder Helping another person in need is satisfying and feels good. Depending on the circumstances, however, it may also produce a certain amount of stress and some fearfulness. In most cases, a little stress may actually assist you when helping others by preparing you physically and mentally.

CPR – Cardiopulmonary Resuscitation – Is No Guarantee of a Successful Outcome


Study Questions • Why should you never fear harming a patient when performing CPR on an individual whose heart has stopped?

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• Why is CPR no guarantee that the patient’s heart will restart? • How can you care for yourself as an Emergency Responder after you’ve provided emergency care in stressful situations?

CPR is a two-step process - pressing on a patient’s chest and breathing for the person. CPR is a temporary measure that can extend the window of opportunity for the patient to be revived. CPR - and some types of first aid - are inherently emotional activities. However, as an Emergency Responder you should never fear harming a patient, especially when performing CPR on an individual who is unresponsive and not breathing normally. Why? Simply put - you really cannot make the person worse. A person that is unresponsive and not breathing normally is already in the worse state of health possible since he probably does not have a heartbeat. If you perform CPR as outlined in this course, you really cannot make the patient worse than when you first found the individual. You don’t need to fear providing CPR. Perform CPR to the best of your ability. rust your training. If your efforts to revive a person in need do not succeed, focus on the fact that you tried your best to help. But, if you could have provided CPR and didn’t, you may spend the rest of your life wondering if it could have made a difference. Don’t let that happen - again, trust your training.Adequate care provided is better than perfect care withheld. CPR – and some types of first aid – are inherently emotional activities. However, as an Emergency Responder you should never fear harming a patient when performing CPR on an individual who is unresponsive and not breathing normally.

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Providing emergency care to those in need can be emotional. You may have elevated physical and emotional stress after providing emergency care. If you do, try the following: s

s s

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s

s

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ry to relax after the incident. Lower your heartbeat and blood pressure by resting or walking slowly. Relaxing will reduce elevated adrenaline produced by your body to help you through the stress of providing emergency care. Avoid stimuli such as caffeine, nicotine or alcohol. alk about the incident to others. Sharing your experience with others helps in processing thoughts and emotions, therefore reducing stress and anxiety. alk can be a healing medicine. If you experience physical or emotional problems such as prolonged depression, sleeping disorders, persistent anxiety or eating disorders, seek the help of a health care professional. Spend time with others. Reach out – people care.

SECTION ONE

About this Keeping Your Manual Skills Fresh When this course is completed, make it a point to practice your primary care skills from time to time. When not used or practiced, all skills deteriorate over time. CPR and first aid skills can begin to deteriorate as soon as six months after initial training. Hopefully, you won’t have to use your emergency skills in an actual situation. But if you don’t, you will then need to practice your skills to keep them fresh and properly sequenced. You can practice and refresh your skills on your own by:

YY D D UU TT SS TT N N EE D D N N EE PP EE D D N IN I

Study Questions • Why should you practice primary care skills after the course is over? • How can you practice and refresh your skills?

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s

Reviewing the Emergency First Response video.

s

Resding through this manual.

s

Role-playing scenarios with your family members or friends.

s

Walking through the CPR sequence using a pillow or appropriately sized stuffed bag.

An easy and effective way to practice and fine-tune your emergency care skills is by enrolling in an Emergency First Response refresher. During the refresher, you’ll practice by completing the Skill Development portion of an EFR course with an Emergency First Response Instructor. After completing the refresher, you’ll be issued a new Emergency First Response completion card. It’s a good idea to take a refresher program at least every 24 months to keep your skills and completion card current. Also, check with your Emergency First Response Instructor for any specific workplace, recertification requirements.

An easy and effective way to practice and finetune your emergency care skills is by enrolling in an Emergency First Response refresher.

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Leading a Healthy Lifestyle In many countries, more men and women die from coronary heart disease each year than from all other causes of death combined, including cancer and AIDS. It is fitting to discuss how you can reduce your own risk of coronary heart disease and lead a healthy lifestyle. Reducing your risk will also help you be a more fit Emergency Responder. Here are four ways you can reduce your risk of heart disease:

Study Questions • What four ways can you keep your own heart healthy and avoid coronary hear disease? • How can you lead a healthy lifestyle?

s

Avoid exposure to cigarette smoke.

s

Reduce and manage stress.

s

Eat a diet low in saturated fat, transfat, highly refined carbohydrates and cholesterol.

s

s

Exercise regularly. Exercise regularly with your physician’s guidance. o maintain a moderate level of fitness, health and fitness professionals recommend a minimum of 30 to 60 minutes of exercise, on most days of the week, at 50 to 80 percent of your maximum capacity. Your exercise should include resistance training and cardiovascular training for optimum health and fitness. If you have high blood pressure or diabetes, keep up with the treatment procedures agreed upon with your doctor. Both high blood pressure and diabetes are risk factors for heart disease. In general, get regular checkups by your physician.

Tere are other ways to lead an all-around healthy lifestyle. Consider the following: s s s

Learn to relax, but don’t be lethargic. Manage stress. Don’t merely focus on how to avoid it. ake care of yourself, so you are able to function effectively as an Emergency Responder.

“

Your exercise should include resistance training and

cardiovascular training.

”

1-18

SECTION ONE

Protecting Yourself Against


Bloodborne Pathogens Infections (viruses, bacteria or other microorganisms) carried by the blood are called bloodborne pathogens. Te three bloodborne pathogensof greatest concern to Emergency Responders are: s

Hepatitis C virus

s

Hepatitis B virus

s

Human immunodeficiency virus (HIV )

Study Questions • What three bloodborne pathogens are of greatest concern to Emergency Responders? • As an Emergency Responder, what four ways can you protect yourself against bloodborne pathogens? • As an Emergency Responder, what general rule may help you avoid infection by bloodborne pathogens?

As an Emergency Responder, there are four ways you can protect yourself against bloodborne pathogenswhen assisting those in need of emergency care: s

Use gloves.

s

Use ventilation masks or face shields when giving mouth-to-mouth rescue breathing.

s s

9 1 1

Use eye or face shields; including eye glasses or sunglasses, goggles and face masks. Always wash your hands or any other area with antibacterial soap and water after providing primary (CPR) and secondary (first aid) care. Scrub vigorously, creating lots of lather. If water is not available, use antibacterial wipes or soapless liquids.

As a general rule, always place a barrier between you and any moist or wet substance srcinating from a patient. All blood and body fluid should be considered potentially infectious. ake precautions to protect yourself against them. As an Emergency Responder you will want to avoid infections by bloodborne pathogens. Fear of disease transmission is a common reason why laypersons trained in CPR avoid action. However, it is important to note that research has shown that chance of disease transmission is very rare when providing CPR. Do not delay emergency patient care if barriers are not available. If gloves and ventilation barriers are immediately available, use them during CPR to protect yourself and the patient from possible disease transmission. When available, use eye shields and facemasks when patients have serious bleeding.

Use of barriers when providing emergency care can protect you against bloodborne pathogens. This photo shows a facemask with attached eye shield.

Face mask and eye shield.

Gloves are easy to keep in your vehicle and on your person.

SECTION ONE

1-19


Recognizing Life-Treatening Problems When you witness a serious car accident or watch someone take a bad fall, it’s reasonable to assume the patient will have life threatening injuries. Even if you don’t see it occur, many accident scenes clearly point to medical emergencies. Unfortunately, notall life-threatening emergencies are so obvious. Some serious conditions occur due to illness or

Study Questions • How can you recognise life-threatening emergencies like:

subtle the patient’s symptoms worse come on quicklyaccidents. and otherSometimes times the patient gets progressively over time. Because time is critical, as you’ve already learned, you need to be able to recognize all life threatening conditions and then provide appropriate emergency medical care.

u Heart

attack

u Cardiac

arrest

u Stroke u Complete

airway obstruction

Heart Attack A heart attack occurs when blood flow to part of the patient’s heart is stopped or greatly reduced. Heart attack patients commonly complain of chest pain and an uncomfortable pressure or squeezing. Tis usually lasts for more than a few minutes, or goes away and comes back. Te pain is sometimes described as an ache, or feeling similar to heartburn or indigestion. Pain may spread to the shoulders, neck or arms. Patients may also complain of nausea, shortness of breath and dizziness or lightheadedness. Tey may sweat or faint.

With restricted blood flow, part of the heart muscle begins to die.

Often, heart attack patients deny that anything is seriously wrong. Tis is especially true when symptoms are mild or go away temporarily. If you suspect a heart attack, do not delay in calling EMS or transporting the patient to a medical facility. Te longer the heart goes without adequate blood flow, the more permanent damage is likely to occur.

Cardiac Arrest When a heart artery becomes blocked and the heart stops receiving oxygen, it may begin to quiver – calledventricular fibrillation – or just stop beating. Tis is called cardiac arrest. Although cardiac arrest is most often caused by heart disease or heart defects, it can occur any time regular heart rhythms are disturbed.

Ventricular fibrillation

Tere are two ways to recognize cardiac arrest. First, the patient does not respond when you speak to or touch him. Second, the patient does not appear to have any signs of circulation - no breathing, coughing, and movement. Beginning CPR quickly and providing defibrillation as quickly as possible are critical to patient survival.

1-20

SECTION ONE

Stroke


A stroke occurs when a blood vessel is blocked or ruptures in the patient’s brain. Blockage or rupture deprives the brain of oxygen and causes cell death. Signs, symptoms and damage depend on which part of the brain is affected. Use the memory word FAS to help you identify if a patient is having a stroke.

F = Face

Ask the patient to smile. Does one side of their face droop?

A = Arms

Ask the patient to raise both arms. Does one arm drift downward?

S = Speech

Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T = Time

If you observe any of these signs, call EMS immediately.

1 2 1

Early recognition and treatment of stroke helps minimize damage to the patient’s brain.

Common signs and symptoms of a stroke include: 1. Sudden weakness or numbness of the face,arm, or leg, especially on one side of the body or on both sides 2. Sudden confusion or drowsiness 3. rouble speaking, understanding or swallowing 4. Sudden vision trouble from one or both eyes 5. Sudden trouble walking,dizziness, loss of balance or coordination 6. Sudden severe headache with no known cause Some strokes are mild and last for only a few minutes while others are serious and debilitating. If you suspect a stroke, do not delay in calling EMS or transporting the patient to a medical facility. Mild strokes often precede more serious strokes, making immediate medical care crucial.

Complete/Severe Airway Obstruction Complete/Severe airway obstruction usually results when a patient chokes on food, although any object placed in the mouth could end up blocking the patient’s airway. Recognizing airway obstruction is important because the patient can’t speak. Patients also tend to become embarrassed and try to leave the area. You may suspect choking if a patient grasps or clutches the neck or throat area. Tis is the universal distress signal for choking. By asking the patient what’s wrong, you can determine if the patient can speak, is breathing or is able to cough. A patient with a complete or severe airway obstruction may become unconscious if the airway is not cleared quickly.

The universal signal for “I am choking.”

During skill development, you will learn to help dislodge the obstruction and care for a choking patient.

SECTION ONE

1-21


Primary CareDefinitions and Background Information Te Emergency First Response courses, Primary Care (CPR) and Secondary Care (First Aid), are skill intensive. However, skills alone are not enough. Knowing how, why and when to apply your skills during an emergency is important as well. Te definitions and background information outlined here will give you the confidence to use your skills - knowing you are giving the correct care in the correct sequence.

Primary Assessment and Primary Care

Study Questions • What are Primary Assessment and Primary Care • What are the ABCD’S of the lifeline? • What is meant by continually monitor and treat a patient’s lifeline? • How do you activate the Emergency Medical Service in your area?

Primary means first in a series or sequence. It means most important. An assessment is an evaluation or an appraisal. Terefore, in terms of emergency care, aprimary assessment is an Emergency Responder’sfirst evaluation of an injured or ill person. Primary assessment is the first step of emergency care. Primary assessment also refers to the evaluation of a patient for any life-threatening conditions needing immediate attention – heart and breathing problems, choking, primary care to serious bleeding, shock and spinal injuries. You will be able to provide patients with these life-threatening injuries or illnesses. Injuries and illnesses that are life-threatening need to be treated first.

CPR CPR stands for Cardiopulmonary Resuscitation. Cardio means “heart” and Pulmonary means “concerning the lungs,and breathing.” Resuscitation means “to revive from unconsciousness.” If a patient is unresponsive and not breathing normally, you begin CPR immediately. We’ll discuss what we mean by “not breathing normally” in just a bit.

C P R

= CARDIO “heart”

Primary assessment also refers to the evaluation of a patient for any = PULMONARY life-threatening conditions needing “concerning the lungs – breathing” immediate attention.

= RESUSCITATION

“to revive from unconsciousness”

As discussed earlier, CPR is a two-step process. First, press on a patient’s chest and second, blow in the patient’s mouth providing him oxygen. Complete CPR combines manual chest compressions with rescue breathing.

CPR is a two-step process. First, press on a patient’s chest 1-22

SECTION ONE

Second, blow in the patient’s mouth.

How Does CPR Work


Te heart pumps oxygen-rich blood throughout the body. It also returns the oxygen-poor blood to the lungs for more oxygen. If the heart is beating erratically or not beating at all, rescue breathing alone is ineffective. If a patient’s heart has stopped, you substitute manual chest compressions for the heart’s pumping action to circulate blood through the body. Chest compressions force blood from the heart through the arteries and deliver oxygen-rich blood to vital organs. Tese manual chest compressions deliver no more than one third of normal blood flow to the body. Terefore, as an Emergency Responder you must begin compressions immediately and minimize interruptions during CPR. Delaying chest compressions for any reason is counterproductive. CPR used as anarrive. interim emergency procedure until an of AED and/or Chain Survival EMS ispersonnel However, it iscare a vital link in the .


Early CPR — Cardiopulmonary


3 2 1

Oxygen-rich blood from the lungs pumps through the heart and is delivered to cells throughout the body.


Resuscitation

“

As an Emergency Responder

you must begin compressions immediately and minimize interruptions during CPR.

” Chest compressions force blood from the heart through the arteries and deliver oxygen-rich blood to vital organs.

SECTION ONE

1-23


CPR extends the window of opportunity for resuscitation - greatly increasing the patient’s chance of revival. Tat said, CPR rescue efforts are difficult to sustain for long periods. From an Emergency Responder perspective, CPR is exhausting. Tis is another reason to call the EMS immediately. o reduce fatigue, change rescuers every few minutes. Switching rescuers will reduce deterioration of chest compression quality. Regarding CPR, if you are unable or feel uncomfortable giving a nonbreathing patient rescue breaths – RELAX! Simply give the patient continuous chest compressions. Chest compressions alone are very beneficial to a patient who is unresponsive and not breathing normally. Your efforts may still help circulate blood that contains some oxygen. Remember:Adequate care provided is better than perfect care withheld. You will learn adult CPR during your Primary Care Skill Development sessions.

Unresponsive Patients Who Are Not Breathing Normally Unresponsive patients who are not breathing normally may

be in cardiac arrest. Rapid recognition of cardiac arrest is very important. After you’ve determined that a patient is unresponsive and not breathing normally, activate EMS immediately. Next, you begin CPR.

To reduce fatigue, change rescurers every few minutes. Switching rescuers will reduce deterioration of chest compression quality/

What does unresponsive mean? A patient who is unresponsive shows no sign of movement and does not respond to stimulation, such as a tap on the collarbone or loud talking. Tis is also known as unconsciousness. What does not breathing normally mean? An unresponsive person taking gasping breaths is NO breathing normally. In the first few minutes after cardiac arrest, a patient may be barely breathing, or taking infrequent, slow and noisy gasps. Do not confuse this with normal breathing. A patient barely breathing, or taking infrequent, slow and noisy gasps needs CPR immediately. How do you determine if an unresponsive person is breathing normally? Most unresponsive individuals in cardiac arrest will not be breathing at all. During the Primary Care Skill Development sessions you will learn how to quickly check a patient for responsiveness and normal breathing.

During the Primary Care Skill Development sessions you will learn how to quickly check a patient for responsiveness and normal breathing.

NOTE – Do not take time to check for a pulse. Studies show

“

Regarding CPR, if you are unable or feel uncomfortable giving a non-breathing patient rescue breaths – RELAX! Simply give the patient continuous chest compressions.

” 1-24

SECTION ONE

that even healthcare providers have difficulty detecting a pulse on unresponsive patients. Checking for a pulse takes too much time. Instead, immediately begin CPR.

Reasons for a Person to Stop Breathing


A person may not be breathing for a number of reasons. Here are ten: 1. Heart attack or sudden cardiac arrest

6.

Drug overdose

2. Submersion and near drowning

7.

Electrocution, suffocation

3. Stroke

8.

Injuries

4. Foreign body airway obstruction - choking

9.

Lightning strike

5. Smoke inhalation

10. Coma

How Rescue Breathing Works 5 2 1

If after providing unresponsive patientpatient. you decide him rescue breaths, is plenty of We unused oxygen in chest your compressions expired breathtotoanhelp a nonbreathing Te to airgive we breathe contains 21 there percent oxygen. use about five percent for ourselves. Tis leaves a very high percentage of oxygen in the air we exhale after each breath. Te unused oxygen can be used for rescue breathing to support a nonbreathing patient. You will learn how to perform and will practice giving rescue breaths in your Skill Development session.

NOTE – If you are unable or feel uncomfortable giving an unresponsive patient rescue breaths - RELAX. Simply give the patient continuous chest compressions. Chest compressions alone are very beneficial to a patient without a heartbeat. Your efforts may still help circulate blood that contains some oxygen.

You will learn how to perform and will practice giving rescue breaths in your Skill Development session.

SECTION ONE

1-25


Using AB-CABS and the Cycle of Care to Prioritize Primary Care Remembering How to Help

Study Questions

If you are ever in a situation where you can help another • What does the AB-CABS memory word mean? in need, nervousness will be natural. Your nervousness can • What is meant by the Cycle of Care? make it difficult to remember what to do and how to do it. o help you remember what to do, the memory word • What do you do if you discover a patient is not (mnemonic) AB-CABS can be used to remind you of the breathing normally? pathway and priorities of emergency care. By learning this memory word, you’ll know what to do first, second, third and so on when a person with a life-threatening illness or injury needs you. Te meaning and prioritized Bow of AB-CABS is:

Cycle of Care: AB-CABS

A = Airway Open

til Help or AED Arrive s Continue Un

B = Breathing Normally

s

AB

C = Chest Compressions A = Airway Open

Airway Breathing Open? Normally?

s

s

s


A

Airway Open

B = Breathing for the Patient S S S S =

erious Bleeding,

hock,

pinal Injury

Also Helping You Remember ... Te first “A” in the memory word AB-CABS can mean more than simply asking the question is the patient’s “Airway Open?” It can also remind you, in priority order, toAssess the Scene for personal safety and Apply Barriers – gloves, ventilation shields, facemasks and eye shields. Tese are two of the first actions you complete before helping a person in need. You’ll learn how to assess a scene and apply barriers during the skills portion of this course.

1-26

SECTION ONE

B

s

Breathing for Pateint Serious Bleeding

S

Shock Spinal Injury

The AB-CABS Cycle of Care Graphic


When you first begin to assist a patient with a life-threatening illness or injury, reflect on the AB-CABS Cycle of Care graphic:

Cycle of Care: AB-CABS til Help or AED Arrive s Continue Un

s


s

s

s


A

Airway Open

B

Breathing for Pateint

S Check Quickly

Unresponsive & Not Breathing Normally

s

First begin with the “AB” portion of the memory word. This reminds you to quickly check to see if the patient’s Airway is open

7 2 1

and to note if he’sBreathing normally.


Responsive & Breathing Normally

Reading from left to right on the graphic you first begin with the ‘’AB’’ portion of the memory word. Tis reminds you to quickly check to see if the patient’s Airway is open and to check if he’s Breathing normally. If his airway is open and he’s not breathing normally, move to the “CAB” portion of the memory word (in the blue sphere). In this situation you must act immediately to provide Chest Compressions. AfterChest Compressions you open the patient’s Airway and then Breathe for the patient (CAB). As defined earlier, this is how CPR is administered. Once you are finished providing rescue breaths for the patient, you return to Chest Compressions and begin again. You continue CPR in a continuous cycle of chest compressions, re-opening the airway and breathe for the patient. We call this the Cycle of Care. If you find a patient who is breathing normally, then he does not need CPR. You SKIP all the steps in the blue sphere the CAB portion of the memory word. In this situation you move along theCycle of Care to the S portion of CABS and treat the patient for Serious bleeding,Shock and Spinal injury. Notice that if you are performing CPR on a patient who is not breathing normally you continue with Chest Compressions, opening theAirway and providing rescue Breaths — CAB. You do not attempt to treat the patient for serious bleeding, shock and spinal injury. CPR takes priority over all other concerns.

SECTION ONE

1-27


Continually Move Through T he Cycle of Care Regardless of a patient’s situation upon your arrival, you begin a primary assessment using the memory word AB-CABS to Cycle of Care help you remember how to begin and what steps to follow. Remember the word AB-CABS and think of the graphic. Te phrase, “Continually move through the Cycle of Care” helps you maintain appropriate primary care sequencing. In a continual Cycle of Care you deliver CPR, remembering the CAB portion of the memory word. You do this until professional help (ambulance or Emergency Medical Services) arrives or an Automated External Defibrillator (AED) is located and brought to the patient. More on AED’s in the next topic. Let’s apply the priorities indicated by the Cycle of Care to two different situations.

8 2 1


s


s

s

s


A

Airway Open

B

s


S


Situation One Choose the correct sequence of care by numbering the actions (1 to 8) below based on this scenario: You are alone and find a patient lying in his yard. He is unresponsive and not breathing normally. He has fallen on a sharp gardening tool and it has impaled his leg. His leg is bleeding. For this patient, what is the sequence of emergency care? You should: ___ Assess the scene for unknown dangers to yourself and the patient and apply barriers ___ Alert EMS’ ___ Breathe for the patient - give rescue breaths ___ Continue with CPR until help or an AED arrives ___ Provide patient with chest compressions ___ Apply direct pressure to the bleeding leg ___ Check for an open airway and normal breathing ___ Open the patient’s airway

Correct Sequence: 1) Assess the scene for unknown dangers to yourself and the patient and apply barriers, 2) Check for an open airway and normal breathing, 3) Alert EMS, 4) Provide patient with chest compressions, 5) Open the patient’s airway, 6) Breathe for the patient - give rescue breaths, 7) Continue CPR until help or an AED arrives, 8) Apply direct pressure to the bleeding leg.

NOTE – You would only attend to the bleeding leg if the patient became responsive and was breathing normally. Otherwise, you would continue CPR until relieved by EMS.

1-28

SECTION ONE


Situation Two Choose the correct sequence of care by numbering the actions (1-5) below based on this scenario: A painter falls from a tall ladder onto cement. When you find him he is moaning and talking, but obviously hurt. For this patient, what is the proper sequence of emergency care? ___ Look for and treat suspected bleeding, shock and/or spinal injury ___ Alert EMS ___ Continually move through the Cycle of Care until EMS arrives ___ Assess the scene for unknown dangers to yourself and the patient ___ Check for an open airway and normal breathing

9 2 1

Correct Sequence: 1) Assess the scene for unknown dangers to yourself and the patient, 2) Check for an

open airway and normal breathing, 3) Alert EMS, 4) Look for and treat suspected bleeding, shock and/or spinal injury, 5) Continually move through the Cycle of Care until EMS arrives. In this situation the patient is responsive and talking. If a patient talks and moans, then he has an open airway and is breathing. He does not need CPR, so you skip theCAB portion of the Cycle of Care. You would provide care for possible Serious bleeding,Shock and/or Spinal injury.

SECTION ONE

1-29


Importance of an AED and DefibriIlation A heartbeat is triggered by electrical impulses. When these natural electrical impulses malfunction, the heart begins to beat erratically. Tis is called ventricular fibrillation. Fibrillation means to twitch. Ventricular fibrillation causes sudden heart attacks. o stop the heart from twitching erratically, an Automated External Defibrillator (AED) is used to deliver an electrical shock, disrupting this abnormal twitching. Te momentary disruption can allow the heart’s normal heartbeat to return.

Study Questions • What is defibrillation and why is it important to a patient whose heart has stopped? • When a patient’s heart is beating erratically or quivering (ventricular fibrillation), what are two ways it can be restored to a normal heart rhythm (defibrillation)? • What is an Automated External Defibrillator (AED)?

Administering an electrical shock from an AED is called difibrillation. Since ventricular fibrillation is one of the most common life-threatening heart-related emergencies, prompt defibrillation is vital to the Chain of Survival.

How AEDs Work An AED is a portable machine that automatically delivers a shock to a patient who is not breathing normally and whose heart has stopped beating or is beating irregularly. AEDs connect to a patient via two chest pads. When the AED is turned on, its computer analyzes the patient’s need for a shock. If the AED detects a shockable heart rhythm, the machine will indicate that a shock is advised. Depending on the type of AED, either the Emergency Responder will activate the shock or the machine does so automatically. You may have an orientation to an AED as an optional skill in the Emergency First Response Primary Care (CPR) course.

An AED is an easy-to-use, portable machine that automatically delivers a shock to a patient who is not breathing and has no heartbeat.

AED’s vary by manufacturer. 1-30

SECTION ONE

Properly operating an AED is simple with a little training.

Serious Bleeding, Shock and Spinal Injury


If a patient’s Airway is open and he’s Breathing normally (AB), then there is no need to provide chest compressions, make Cycle sure his airway is open or breathe for the patient. In other words, there is no need to act on the “CAB” portion of the of Care. Since you can skip the CAB portion of the Cycle of Care, you next check the patient forSerious bleeding,Shock, and Spinal injuries. Tese comprise the “S” in the word “CAB S,” and each needs to be managed by Emergency Responders to effectively help a patient. Let’s look at each separately.

Cycle of Care: AB-CABS til Help Continue Un

s


AED Arrives

1 3 1

s

s

s

or


s

A

Airway Open

B s

Serious Bleeding

s

s


S Serious Bleeding Shock Spinal Injury

Study Questions

Experience you that when the skin andgoing underlying tissue is cut,tells scraped or punctured, there’s to be blood. How much blood flows from the wound and how quickly it leaves the body is what determines whether it’s a minor problem or serious bleeding. Te human body contains about six litres/quarts of blood. Rapid loss of just one litre/quart is dangerous and can lead to death. Because serious bleeding is life-threatening, you, as an Emergency Responder, need to be able to recognize and manage this during a primary assessment. Serious bleeding is the first S in AB-CABS Cycle of Care.

• What are the three types of bleeding and how are each identified?

In general, there are three types of bleeding. In an emergency, it’s not critical for you to diagnose the exact type of bleeding. However, by knowing the differences, you’ll be better able to judge how serious the wound is and how best to manage it. Dttring skill development, you’ll learn how to control bleeding.

• In what seven circumstances should you always suspect a spinal injury?

• What is shock, what can cause it, and what are the nine indications of shock? • What does the spinal cord do in the human body and why is it important to protect the spinal cord during primary care? • What eight indications might signal the need for spinal injury management?

• What are two situations where you must move an injured or ill persons?

SECTION ONE

1-31


Arterial Bleeding Arterial bleeding can be recognized when bright red blood spurts from a wound in rhythm with the heartbeat. Tis is the most serious type of bleeding since blood loss occurs very quickly. If a major artery is cut, death can occur within a minute.

Venous Bleeding Venous bleeding can be recognized when dark red blood steadily flows from the wound without rhythmic spurts. Tis bleeding can also be life threatening and must be controlled as quickly as possible.

Arterial Bleeding

Capillary Bleeding 2 3 1

Capillary bleeding can be recognized when blood slowly oozes from the wound. Tis slow bleeding may stop on its own or is typically easy to handle with direct pressure. Any time a patient has serious bleeding, use barriers and activate the Emergency Medical Service immediately and quickly render care to prevent excessive blood loss.

Venous Bleeding

Capillary Bleeding

Experience tells you that when the skin and underlying tissue is cut, scraped or punctured, there’s going to be blood.

1-32

SECTION ONE

Shock


Any injury or illness, serious or minor, which stresses the body, may result in shock. In reaction to a medical condition, the body pools blood into one or more vital organs. Tis reduces normal blood flow to other body tissues depriving cells of oxygen. During shock, the body begins to shut down. Shock is a life-threatening condition that is easier to prevent f rom getting worse than it is to treat after it becomes severe. Shock management is the second S in AB-CABS Cycle of Care. During primary assessment and care, you take the first steps to managing shock by dealing with other life-threatening conditions. Checking that a patient is breathing, has adequate circulation and is not bleeding profusely helps the patient’s body maintain normal blood flow. You render additional care by keeping the patient still and maintaining the patient’s body temperature. You may elevate the patient’s legs if it won’t aggravate another injury. Continuing to monitor theCycle of Care until EMS

3 3 1

arrives also contributes to shock management. Te nine indications of shock are: 1.

Rapid, weak pulse

2.

Pale or bluish tissue color

3.

Moist, clammy skin - possibly with shivering

4.

Mental confusion, anxiety, restlessness or irritability

5.

Altered consciousness

6.

Nausea and perhaps vomiting

7.

Tirst

8.

Lackluster eyes, dazed look

9.

Shallow, but rapid, labored breathing

Manage shock by keeping the patient still and maintaining the patient’s body temperature.

Even if you don’t recognize any of these signs and symptoms in a patient, continue for shock when you providetoemergency care to an injuredtoormanage ill patient. Remember, it’s better prevent shock than to let it complicate a patient’s condition. You may also elevate the patient’s legs to manage shock.

During the Skill Development session, you will learn how to manage shock and provide emergency care.


s


s

s

s


s

s

A

Airway Open

B s

s


S

Serious Bleeding

Shock Spinal Injury

SECTION ONE

1-33


Spinal Injury Te spinal cord connects the brain with the rest of the body and organs. Nerve impulses, or messages between the brain and the body, travel through the spinal cord. An intact, functioning spinal cord is essential for life. Vertebrae are a ring of bones surrounding the spinal cord and run from the neck to the lower back. Tese bones make up the backbone, or spinal column. A spinal cord injury may result in permanent paralysis or death. Te higher up in the spinal column the injury, the more likely it will cause a serious disability. Tis is why it’s so important to guard the head, neck and spine when attending to an injured patient. Important: Never move a patient unless absolutely necessary.

4 3 1

The spinal cord is surrounded by vertebrae that protect it. A serious blow, fall or jolt could cause a break and damage the cord.

A patient with a severe injury will likely be unable to move. However, a less severe spinal injury will not necessarily keep a patient down. Accident victims often try to get up and move away from the scene. Because an injured spinal cord is f ragile, allowing a patient to walk around could turn a minor injury into a permanent disability. If you suspect a neck or spinal cord injury, keep the patient still and support the head to minimize movement. If you must open the patient’s airway, use the chin lift method – do not tilt or move the patient’s head. If CPR is necessary and you must position the patient flat on the back, turn the patient as a unit – avoid twisting or jarring the spine. If you didn’t see the injury occur or the circumstances surrounding an injury are not clear, look for these indications that may signal the need for spinal injury management: 1. Change of consciousness - like fainting. 2. Difficulty breathing. 3. Vision problems. 4. Inability to move a body part. 5. Headache. 6. Vomiting. 7. Loss of balance. 8. ingling or numbness in hands, fingers and feet or toes. 9. Pain in the back of the neck.

Any time you suspect a head, neck or spine injury, minimize movement.


s


s

s

s


s

A s

1-34

SECTION ONE

Airway Open

s

B

s


S

Serious Bleeding Shock

Spinal Injury

Tese are common indications of a back or neck injury, however none may be present even though the patient has an injury. So, regardless of whether these indications are present or not, if you think a person has an injured neck or back, treat it as such.


Spinal injuries generally result from falls or other blows associated with accidents. Tere may be other incidents that injure the spine, but you should always suspect a spinal injury in these circumstances: 1.

raffic or car accident

2.

Being thrown from a motorized vehicle

3.

Falling from a height greater than victim’s own height

4.

Severe blow to the head, neck or back

5.

Swimming pool, head-first dive accident

6.

Lightning strike

7.

Serious impact injury

It’s always better to assume the patient has a neck or spine injur y and not move the patient unless absolutely necessary.

5 3 1

It’s always better to assume the patient has a neck or spine injury and not move the patient unless absolutely necessary. When you approach any patient, handle the patient’s head, neck and spine carefully.

If You Must Move a Patient As just discussed, you should move an injured or ill person only if it’s absolutely necessary. Tis includes circumstances of clear and direct danger to the patient’s life, or if emergency care is impossible due to a patient’s location or position. Situations in which you may need to move a patient to give emergency care include:

Only move a patient when the location is hazardous or prevents you from providing care.

• Patient is in water. • Patient is near a burning object or structure that may explode • Patient is under an unstable structure that may collapse. • Patient is on an unstable slope. • Patient is on a roadway and you can’t eectively direct traffic away from patient’s location. Many other situations may apply. You may discuss these with your instructor during skill development while you learn and practice the steps for scene assessment. By taking a moment to assess an accident scene, you help protect yourself from life threatening hazards and prevent the patient from suffering further harm. During skill development, you’ll also practice turning a patient while protecting the neck and spine. Tis technique for moving a patient is called the log roll. You’ll learn to roll a patient by yourself and with the assistance of another Emergency Responder.

During skill development, you’ll also practice turning a patient while protecting the neck and spine.

SECTION ONE

1-35


Primary CareKnowledge Review Name: _________________________________________________________

Date: __________________________

1. When someone needs emergency care,time is critical because: (Check all that apply.) ______ a. It becomes more difficult to administer first aid. ______ b. Te chances of successful resuscitation diminish with time. ______ c. When a person has no heartbeat and is not breathing, irreversible brain damage can occur within minutes. 2. Give three reasons why you should assist someone who needs emergency care: a. ___________________________________________________________________________________________ b. ___________________________________________________________________________________________ c. ___________________________________________________________________________________________ 3. Of the six reasons causing people to hesitate when providing emergency care to a patient, name three: a. ___________________________________________________________________________________________ b. ___________________________________________________________________________________________ c. ___________________________________________________________________________________________ 4. Good Samaritan laws are enacted to encourage people to come to the aid of others. Generally, they protect individuals who voluntarily offer assistance to those in need. ______ rue ______ False 5. To be protected by Good Samaritan laws you should: (Check all that apply.) ___ a. Only provide care that is within the scope of your training as an Emergency Responder. ___ b. Ask for permission to help ___ c. Act in good faith. ___ d. Do not be reckless or negligent. ___ e. Avoid helping an injured or ill person when others are around. ___ f. Act as a prudent person would. ___ g. Do not abandon the patient onceyou begin care. Te exception to this is if you must do so to protect yourself from imminent danger. 6. Name the Chain of Survival’s four links in the spaces below.

a. ______________

b. ______________ c. ______________ d. ______________

7. From the introductory statements below,which one would you select when asking permission to help a patient? (Place a check by your response.) __ a. I’m a doctor. May I help you? __ b Hello? My name is ________________________, I’m an Emergency Responder.May I help you? __ c. Are you hurt? Where? 8. After establishing patient unresponsiveness andidentifying that he is not breathing normally,you should: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 9. How do you activate the Emergency Medical Service in your area? Phone number: __________ 10. Why should you never fear harming a patient when performing CPR on an individual who is unresponsive and is not breathing normally? ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 1-36

SECTION ONE


11. When not used or practiced, your primary care skills will deteriorate over time. It’s a good idea to take a Refresher course at least every 12 to 24 months to keep your skills current. ______ rue ______ False 12. As an Emergency Responder what general rule may help you avoid infection by bloodborne pathogens? ___ a. Always place a barrier between you and any moist or wet substance srcinating from a patient. ___ b. Ask the patient not to cough when you are giving him emergency care. ___ c. Have the patient bandage his own bleeding wounds whenever possible. 13. List six common signs andsymptoms of a stroke: 1. ___________________________________ ___________________________________ 2. ___________________________________ 3.

4. ___________________________________ 5. ___________________________________ 6. ___________________________________

14. Primary Assessment means: ___ a. Checking a patient’s breathing. ___ b. Providing direct pressure on a bleeding wound. ___ c. An Emergency Responder’s first evaluation of an injured or ill person.

7 3 1

15. CPR stands for: ________________________________________________________________________________ 16. Fill in the missing meaning for each letter on theCycle of Care graphic. C = __________________________________ A= __________________________________ B= __________________________________ S = __________________________________ s 17. Why is defibrillation important to a patient with cardiac arrest? ___ a. Defibrillation disrupts the abnormal twitching of a heart, restoring a normal heartbeat. ___ b. Defibrillation causes the heart to beat erratically. ___ c. It keeps the patient from having to go to the hospital after CPR has been administered.


Cycle of Care: AB-CABS til Help Continue Un

s

or

AED Arrives

s

C

s

s

A B S

Shock Spinal Injury

18. Match the type of bleeding listed below with the description of how each is identified. (Draw a line from the description to the type of bleeding.) Arterial Bleeding Venous Bleeding Capillary Bleeding

Dark red blood, steadily flowing from a wound without rhythmic spurts. Blood slowly oozing from the wound. Bright red blood that spurts from a wound in rhythm with the heartbeat.

19. What are indications of shock.(Check all that apply.) ___ a. Pale or bluish tissue color ___ b. Altered consciousness ___ c. Lackluster eyes, dazed look ___ d. Tirst ___ e. Rapid, weak pulse ___ f. Elbow pain ___ g. Mental confusion, anxiety, restlessness or irritability ___ h. Nausea and perhaps vomiting ___ i Moist, clammy skin, perhaps with shivering ___ j. Shallow, but rapid and labored breathing ___ k. Earache 20. In what circumstances should you always suspect a spinal injury? (Check all that apply.) ___ ___ ___ ___ ___ ___

a. b. c. d. e. f.

Lightning strike A penetration wound, such as a gunshot Falling from a height greater than victim’s own height raffic or car accident Being thrown from a motorized vehicle Swimming pool, head-first dive accident

SECTION ONE

1-37


SecondaryCare First Aid Introduction Every day people have mishaps or get sick. Some may be involved in bad accidents or suffer from serious illness, yet remain conscious and responsive. Teir conditions may not be immediately life threatening, yet they still need medical care. Emergency First Response Secondary Care (First Aid) teaches you to assist injured or ill patients by offering first aid and support while waiting for Emergency Medical Service (EMS) personnel. Te course prepares you to render emergency care for common medical problems that are not immediately life threatening. As you learned in your Emergency First Response Primary Care (or other CPR course), any time you approach a patient to provide emergency care, regardless of the injury or illness, you perform a primary assessment and monitor the patient using the Cycle of Care. During this course, you’ll review the Cycle of Care – assuring there is no imminent threat to the patient’s life – then practice providing care that reassures, eases pain and reduces the risk of further harm. If EMS is nearby, you may never need to use the skills in this course. However, if EMS is unavailable or delayed or there is time and distance between the patient and professional medical care, you may need use your skills to render first to aid.

You provide secondary care to an ill or injured patient who is responsive.

Four Skills of Emergency First Response® Secondary Care s

Injury Assessment

s

Illness Assessment

s

Bandaging

s

Splinting for Dislocations and Fractures

Secondary Care Definitions and Background Information Secondary means second in a series or sequence. An assessment is an evaluation or appraisal. Secondary assessment is your second evaluation of an injured or ill person. Once a patient is stabilized during primary care, you attend to the next level of emergency care – Secondary Care. Tis is the care you provide to a patient with injuries or illnesses that are not immediately life threatening. During skill development, you’ll practice injury assessment that helps you determine the location and extent of all the patient’s injuries. You’ll also learn the steps for illness assessment that help you identify and report medical problems that affect a patient’s health and may aid in treatment. Bandaging wounds, sprains and strains along with splinting dislocations and fractures round out the skills you need to provide secondary care.

1-38

SECTION ONE

The Difference Between Injury and Illness

Study Questions

Troughout this manual, you’ve read the words injury and illness. When discussing secondary care, it’s important to understand exactly what these terms mean.

• What is the difference between injury and illness?

An injury is defined as physical harm to the body.


• What is a Secondary Assessment and Secondary Care?

• What is Assessment First Aid?

Examples include: s

Cuts, scrapes and bruises

s

Chest wounds

s

Head, eye and dental wounds

s s s s

9 3 1

Burns Dislocations and fractures emperature-related problems — hypothermia, frostbite, heat exhaustion and heat stroke Electrical wounds

An illness is an unhealthy condition of the body. Illnesses may be caused by preexisting conditions such as allergies, heart disease or diabetes. Tey may also occur due to external factors such as breathing toxic fumes or ingesting poison. Generally, illnesses are determined by

Injury Assessment

IllnessAssessment

Bandaging

SplintingforDislocationandFracture

SECTION ONE

1-39


Signs and Symptoms s s

s

s s

A sign is something you can see, hear or feel. For an injury assessment you look for signs such as wounds, bleeding, discolorations, or deformities. You also listen for unusual breathing sounds and feel for swelling or hardness, tissue softness or unusual masses. For an illness assessment you look for changes in skin color, breathing rate or patient awareness along with shivering or seizures. You listen for breathing difficulty and you feel the patient’s skin temperature and pulse. A symptom is something the patient tells you is wrong. For both injury and illness assessments, the patient may complain of nausea, thirst, dizziness, numbness or pain.

You look, listen and feel for signs.

A symptom is something the patient tells you is wrong.

Medical Alert ags In a medical emergency, information is critical. People with serious medical conditions or severe allergies may wear medical alert tags to provide instant information to Emergency Responders. Usually worn as necklaces, bracelets or other jewelry, these tags may list the patient’s medical problem, medications, allergies and physician, hospital or relative contact numbers. When a patient is unresponsive or is having difficulty communicating, check for a medical alert tag. It can provide you with the information you need to provide proper care.

1-40

SECTION ONE


What is Normal? It’s difficult to determine if an ill patient’s signs are abnormal if you don’t know what is “normal.”Te fact is that what is normal for one patient may be completely abnormal for another. Tere are “normal” ranges for breathing rate, pulse and skin temperature. However, a patient could be outside the average and still be within a personal “normal” range. Tis is why it’s important when giving information to EMS personnel to avoid using the word normal and simply provide measured rates per minute and use other descriptive terminology. Here are the average ranges that may help guide your assessment: s

Te average breathing rate for adults is between 12 and 20 breaths per minute. A patient who takes less than 8 breaths per minute, or more than 24 breaths per minute, probably needs immediate medical care.

s s

1 4 1

Te average pulse rate for adults is between 60-80 beats per minute. Average skin temperature is warm and skin should feel dry to the touch.

Assessment First Aid Assessment first aid is the treatment of conditions that are not immediately life threatening, uncovered during either an illness assessment or an injury assessment. For example, applying a bandage to a wound or wrapping a shivering patient in a warm blanket is assessment first aid. Although the emphasis of the Emergency First Response Secondary Care (First Aid) course is on rendering emergency care until EMS arrives, you’ll find that you may also use your skills to handle common minor medical problems. Cleaning and dressing a child’s scraped knee is assessment first aid. Placing a cool compress on a family member’s head to relieve flu symptoms is also assessment first aid.

Assessment first aid is the treatment of conditions that are not immediately life threatening.

In every situation that involves injury and illness, you’ll follow the sequence and steps that you learn and practice in this course. For emergency care and first aid information that is more specific, for example – what to do for snakebite, use the reference section of your Emergency First Response Participant Manual.

SECTION ONE

1-41


Secondary CareKnowledge Review Name: _________________________________________________________

Date: __________________________

1. Regardless of a patient’s injury or illness, you perform a ___________________assessment and monitor the patient’s ____________________ .(Place the correct letter in the blank.) ______

a. secondary; line of life

______

b. primary; Cycle of Care

2. Once a patient is stabilized during primary care, you attend to the next level of emergency care – ________________ . ______ ______

a. injury care b. secondary care

3. An injury is defined as ______________________________________________ . 4. An illness is defined as ______________________________________________ . 5. A symptom is: (Place a check by your response.) ______

a. something the patient tells you is wrong

______

b. something you can see, hear or feel

6. Assessment first aid is the treatment of conditions that are not immediately _______________________________ .

1-42

SECTION

SectionTWO SkillsWORKBOOK Contents Primary Care (CPR) Primary Care Skill 1 Scene Assessment ..................................................... ................................ 2-2 Primary Care Skill 2 Barrier Use....................................................... ......................................... 2-4 Primary Care Skill 3 Primary Assessment ................................................. ................................ 2-6 Primary Care Skill 4 CPR – Chest Compressions................................................ .................... 2-10

KK OO OO BB KK RR OO W W SS LL L IL I KK SS

Primary Care Skill 5 CPR – Chest Compressions Combined With Rescue Breathing............ 2-13 Optional Primary Care Skill Automated External Defibrillator Use.......................................... 2-17 Primary Care Skill 6 Serious Bleeding Management ................................................... ........... 2-20 Primary Care Skill 7 Shock Management.................................................. .............................. 2-22 Primary Care Skill 8 Spinal Injury Management ................................................. .................... 2-24 Primary Care Skill 5 Conscious/Unconscious Choking Adult............................................... .. 2-27 Optional Primary Care Skill Emergency Oxygen Use — Orientation....................................... 2-32

1 -1 22

Secondary Care (First Aid) Secondary Care Skill 1 Injury Assessment ................................................ .............................. 2-34 Secondary Care Skill 2 Illness Assessment ........................................................ .................... 2-38 Secondary Care Skill 3 Bandaging ................................................... ....................................... 2-43 Secondary Care Skill 4 Splinting for Dislocations and Fractures ........................................... 2-45

SECTION TWO

2-1

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SECTION TWO

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T I Y R T SECTION TWO

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SECTION TWO

2-7


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? oyu ya? pl ko hIe uo ya rye A M re. ,ks dn a op dn se ae cyR n bonr gre all e oc m E no na tn e ’m I. tiap __ e ___ htp __ at __ ne _ ht ___ t,n si e e m e m a ttas N y ru o ?loM yo e te H t:n onsp e em ta tS

se r on fI

.s se ne ivs no ps er fo elv le a ealv er lil w it gn ip pa t dn a ev iti sn es is en ob ra ll oc e T

st’ ne it ap eh tf i er us nu er uao yf I. gn ih ta er B la m ro n dn a ay rw i A ne po na ro f k ay?k hecc o y oyu lkci e u Ar Q

SECTION TWO

2

o w T pe tS

dn a pl eH ro f la C – ev is on sep rn U

ne O pe tS

ee hrT pe St a ne po ot ftli m ih cittl aed h het es

:y ll a rm on gn ih ta er b si eh s ifr ih o ne n p peo lyok si ci ya u Q rw ia s

s.d nu os gn ih ta ay reb rw ai ro de f kc ne lo t U b lisd na eu y tn a nog w e r t ai m eh he ev t t o t,n ks m iet ocl ts ap b eh ev nd is a cr no ck of a sep bs ko rn l a u f o na ne L .g nI fot ni tha da re r e tif e ytl eh e u .k oy ht l, th . bla c s n eh la ih e c h re in ne o m r t P. n gd ab ti d hc p w gn ft o n d W nu si o tp on o e r i i a a usy inlh andh ade hesi e.no ipsrt fho inth .Sty fok a c- r h h p e tn c a ce e w g w ira tlit uoy orf tilt etS nfi iop eht ira hC s

to n si tn eti ap eh tf I. cklyi uq de hs il p .y ml e.e occ tea rh a id t eb e pe t m tS su m i .k m R ee g P n C chr iht sd uo aer ee y bl ne no a h ,y ira rm o ll de nr am irp of or x k n refo ecch ingh le is tea eF T rb s

PRC m r for eP

er e t uo uc va sir y es h F ne dn to la ht, a no C se S d eh ic M ou ts vre E ll yf isi Sl ac I. ac id ot S .T s re M sti eM E d l x tans calo neio ncye by te tp ger a n or m ks oh e E ,ay pe tho et lla ilb o aiv n t m ro om if ca n ru S to gn oy M ts ih e E ir ta su lla Fl er ,e co al br n t C o loa ten uo ev er it Y is a a .e no u pe rac o spe yf the yc rt I. v ne on leb ale rg .e i , e c is sso en m nta entti fpi hop toe sia ap D lei ch e bo aor id eh E v tf A mp o I na a pa rp 3

ru Fo pe St

o w T pe tS

ee rh T etp S

en O pe St

fi er a cyn eg re m e ya le dt on o D .d na ht a yl et ai de m im fi rs riea b no tu P 4

O D .ll ik A xtse M R n Oe N ht G ni IN R HP T C A nr E ae R ll B li T w O uo NY dn (. a R vei P sn C g op ni se vig rn n u ig is eb t ient elyt ap ai eh de t m If im , Y L L

t.n es b reaa sr ei rr ab

5

yr o m L m A e M eh R t O fo Nn G oti N I rop H” T “S A e E th R B thi SI w T tn U e B m s vei ses sn s op A se yra rn m u ir is P t r ient you ap eu eh int t no If c , Y L

).  N PA I IC  R A P R E H  O N A N O R P C E C I  C A R P  O N

6

uo (Y .y jurni la ni pS dn a kc oh S, gn id ee lb su oi re Sr of kc eh c S B A C rdo w

ev Fi pe St

cea pl, ctede p )r. sus et r la od sn n re uo cn fs oc iy er rju ca ni yc la eng inp re sr o m e kc es o eh hs t ,g gea ni na ede m lb tow usoi oh rse rna on le fI 7

:n oti is op rye vo ce r eh t ni tn iet ap gn ih ta reb ,e vi s onps er un eh t

th gir at tau o uo yt esr ae n m ra eh t ec lap dn a ed is s’t ne it ap eh t atl ee n K s

.d ra w p ul m ap eh t dn at ne b w ob le eh t hti w yd ob ’st ne it ap eh to leg na

e.no pe tS

ti llu p dn d hae ane en ht k fo eh kc t ab . ve o eh w ob e. t tp at er ldo et suj th h S. g ept dn uo el S at yt raf .d se se e nu hc rae ht ro eh n spa ge t ke rg th sso eh ,d n rc cs n ot a ’t ah oo n m ra eit reh fe ra ap to ht f e r g theg ths you epine ni ina thi k, r g B a W pu

s

s

s

ish n ntoe tia p eh t gn tit up ,u oy sd ra w ot tn eit ap eh tl lu p lyt eng, w o N

ra en

eh t no

30 n andh ackb tha re ll reo u w m lo ply ro ’st tn f ne ge no iit tia ,e so p b eh de p t en .y yr ec f a ev lap I. w r o ,e oni ia cre ids atz nep eht si lii o in h ab na t no ts er pe ec rfo us ke n k sa b O .r cen to tos uo e ad a f ht eh ht tepS erd t’sn ient .e nu ie ap ids ro tap eh tf I 8

eh t e lievr to ed is eti so pp o eh t ot tn eti ap eh t gn in ru tr ed is onc, se tu ni m

. rm ar e w ol eh tno er sus rep

eiv sn op se rn u na no sol a dn at ne it ap ev is no ps er a n ntoe m ss ses A rya m ir P a m ro fr ep pu rog ceit ca rp ru oy

yc ne gr e m E eh ts at ca ot cen ah c eh t ev ah dl uo hs oney re v .E re dn op se R cyn eg re m E eh ts ir eh to eh t eil

yre vo ce r eh t ni tn eti ap eh t gn it tu p ec it ca rp ,t ne tia p ingh ta er bl a rm on ,e ivs no ps er nu na ro f, os l A r.e dn op s

t,n eti ap eh ts i en o; sp et s eh t ngi da er ,e di ug e sthi no sr ep en O y.ll a m ro n gn ih ta er bt on si oh w tn eit nI pa hw R e

T I Y R T

K O O B K R O W S L L I K S .r toc trus ni ru oy yb edt ce ri d sa se cn at s m uc ri cr etl A .n oit is po

SECTION TWO

9 2

2-9

s

S B A -C B A : e r a C f o e l c y C

e v

A A o

E

r r

i

s

0 -1 2

2-10

no it at ic su se R aryn 4l o sn li m oi l u kS p ss er oid erp a ra m CCo yr C air R m –P esth P CC SECTION TWO

tn ie atP ro f

S

S

B

A

A

r

p l

e

H

C est

l i

t

ns hC ios esr p m o

n

U e u

n i t

n o C

C

s


B

enp O ya rw i

s

D

g inh ta er

nte i atp e th pa t dn at ne etm at rSe dn op Res e th ev i G •

yr ngi uj ede nI lB al su kc nip iro hoS S e

s

ts eh c 00 t1sa el ta fo tea r at a sn oi ss er p om ct se hc – R P C tl ud

s l a a m o G rorf r eP us o Y

dir ht -e no lye atim xo rp apt se hc eh t gn is se rp ed dn a et un i m re ps no i esr p m oc

s

B A

s.e hc ni 2/ m c 5t sa el ta –t se chf o pthe d eh t

? lay m ro B N ay ?ne riw p A O gn ih ate r

s n o i s s re p m o C t s e h C

s t n i o P y e K

s.n oi ss er p m oc ts eh c ni sn oit pu rre tn i zeim in i M s

s

ste hc neo etp S s.s e oc pr et -os w t a is PCR •

e,v sin op s ren u ist ne tai p het fI .e n bo olarc e th no

la m ro n nda ay w ri a ne po na ro f k chec lyk icu q

eu sce r o w t pe st yb ed w lo fore a nso is se pr m co

.e no pe st ran lel ’u yo, li sk si thg nir u D g.n hit ae br

yl et ai de m m i, lay rm no gn hti ae rb to n si ientt pa e thf I •

. ngi tah er b

a nig v gi e bl tar of m o ncu le ef or e bla un er a uo y If •

nte tai p e th e ivG .x al re – sh ta er uebc se r eh tt n iet pa

dyr .s tus noi a ses on rp dn om a C k st ac e .s bs hC no hi gn sis no nin er e gi p bt be s o om C u t est ntm e prio Ch ita ec ni p af ge eh ru b T s • n ly. .s tao am r on la o t sis icfi gn ah er e in dt p ne ht oo ocm bry rae lb b e ste ve to lta hc ear n uc is ri uos en oh cp o l un a w le t h i cont isnso ienta still dn es p i a rp eiv sw tae om sn tro die ct ops ffe m se er ru im Ch un oY

a no nso is s rep m o tcs hec – RP C icetc ar p yl n O •

.n eg xyo sn ia tn co

. nta ipc i rta p erh otn a no re ve n in,u qe nna m ot d or w y or m e m BSA CAB dn a areC of e cyl C e th es U •

sn ios se rp m oC ts eh C rom fr ep ot ber m e em r uo y lpe h

ro f gn hit ae rB dn a ya rw iA st’ n iet apa g inn ep o er foe b

. nte tai p eh t


re dn op se R eh t gn iv ig y sbe ne vi sn op se r ro ft ne tia p eh t kc eh C .y te fa sr of en e sce ht ss es s A 1

en ob ra ll oc no tn iet pa eh t pa enth t, tn e em ta ts ru oy ot es no ps er on fI

le ve l al ae evr lli w ti gn ip apt and ev tii sn es si en ob ra llo c e T

yc eng er m E an ’m I. _ __ ___ ___ _ ___ _ ___ ___ __ __ ___ ?ya _ ok ies uo y m a ou? re A N y y lp ?y M e ka o?l hIy ou e a o H t:n .M r rey, e ed A ks n em ta sop ad e n tS R a

ya w irA ne p O

S M E rte lA

ss evn sin op se R kc eh C

g inh t ea Br al m or N ro f kc eh C


reo efb t

s.s en ivesn pos er fo s

.g inh ta er B la m ro n dn a ay rw i A ne po na ro f k hecc yl kc iu Q s 2

eb aym tn eit ap a, ts rer a ca id ra cr et fa se tu in m w ef ts rfi e thnI E T O N

de m. tern ingh tef tea os rb is la i m T .s ron ps h ag it y,s w io dse n, uf tn no ueq ce er bt fn o i nt gn su ik m at d ro na ,g g n ni thiae athe rb rb yl aln rea og b a

sr Fil a C . yll

aro m n gn ih ta er bt on dn a ev is no ps er nu si tn eit ap eh tf .e Si carg M ni E tr idv le or Ap

e.l ibs so pf i D E A na er uc es dn a S M E lla c ot re dn at bysa ks A

1 2

.S M E ll ac ot en oh p lei bo m ru oy es u, en ol a reau yof I

.s sti xe no it po re ht o on if S M E ll ac ot tn eit ap thee va e L

sss

3

SECTION TWO

2-11

eit S no is s roe oCm re p roP


2 -1 2

2-12

.) no iti so p si ht ni yd ae lra to nf i( kc ab ish no tn eit pan oit is oP

.e ti s no is se rp m oc ts eh c the tea co L

4

5

e.ti s no is se r po m c eh t dn fi to rya ss ec en if yl no ts eh c st’ ne tia p eh t seop x E s ss

SECTION TWO

s oniit is op si ht ,sl au di vi dn i e m os n O r.e tn ec ts eh c eh t nid anh en of ol ee h eh t gn it tu p yb eit s oni ss er p m oc e thd ni F

s.e lp pi n eh t enw te b

.s re gn fir uo y kc ol re tn i dn at s che eh t no yd ae rl a dn ah eh tf o po t no dn ah re ht or u eyoc la P

sn io ses rp om Ct esh C

.t se hc eh t ffo sr eg nfip ee K .e ti s no is se rp m oc eh t no dn ah ru oy fo m la p thee s U

.s no is se rp m oc ts cher ev il e s ss D 6

s.w ob le ru oy kc ol -t hg air st rea s rm ar uo y dn a sd na h oury re vo ylt ce ri d rea sr ed lu oh sr ouy ta ht os fl es ru oy oniit so P

.e n tbos ae rb eh tf o pti re w ol eh tr o eg ca ibr eh t no gn ih s pud io va n w od th gi ar ts sn oi ss rep m oc eh tf o cer fo e thpe e K ss

.s oni ss er p m ecoh tr ev lie d ot th gi e w yd ob ru oy w oll a, s w ob le de kc olth i W

lye ta xim or pp a en ob ts ae rb eh t gn is se rp ed ,t sa f hs up dn a d har shu p ldu oh s uo y sn oi ss er p om ct se hc ev it ce ffe ed i rovp o

.s eh cn i 2/ se tr eit m ne c 5t sa el ta -t se hc ’st ne it ap eh tf o thp ed eh t dr thien o

.n oti is op la rm on sit to rnu te tort se hc eh t gn i w oll a, sea el er ,n ios esr p m oc ts eh c hc eare ft A

sn o esir p m oc eh t m ro fr eP .s no is se rp om c 03 ro f) ts af gn i unto c( ,n o so dn a -r uo fee rh to tw -e no -f o ec ap at a atep e R

el po e

eh t gn

stpo m na ht re ts af to l as i et ar e T .e tu ni m re p sn ios s

diae r, ed iu g eh ts i no rse p en O .n iu qe nn a m a no sn oi s resp m oc ts eh c R P C m ro fr ep ,p uo rg ec it ca rp ru oy n I

rep m oc 00 1t sa el ta eb ldu oh s tea rr uo Y e.l bi ss op sa y idlu fls a

t.s aF hs u P, dr a H hs u P -kn ih t

ru oy e sure ak m ot yl w los sp et s eh t ec it ca rp ,t sir F. re dn op se

e. im tl ae r in ina ga sp et s eh t ec it c

cn yR eg er m E eh ts ir eh to eh t eli h w ,s eh ct a w en o, sp et s

rapt, xe N .e ta rip or pp a is no iit so p yd ob dn a m ra ,s dn a h

T I Y R T

gn ih ta er B eu esc no R it hti at ic W su de se ni Rb ryan C om 5l o sn li m oi l u kS p ss er oid erp a ra m CCo yr C air R m –P esth P CC

n e p O y a rw i A s S B A C B A : e r a C f o le c y C

e v

A E

r r

ne pO ay rw i

s

i

s

D

A

A

o p l

e

s l a o G r us o Y

S

ry jun Il nai p

S

t n e it a P r o F g in h t a e r B

H

C tes

l i

t

ns h osi se rp m o

n

U e u t

n o C

s.e hc ni 2/ m c 5t sa el ta –t se chf o pthe d eh t

s n o i s s e

C

n i

C

s

dir ht -e no lye atim xo rp apt se hc eh t gn is se rp ed dn a et un i m re p sn io esr p m oc

B

A

r

s

ts eh c 00 t1sa el ta fo tea r at as no is esr p om ct se ch – R P C tl ud ar m of re P

g tn in ei tah taP er r f B o

gn dei el B k su c o rioe hS S

s

gn ih ta er

B

?y al m ro N

A

O

rp m o C t s e h C

seo n eh t hc inp dn a ay w ira t’sn eit ap eh t en p O •

B A iwayr n?pe

s.n oi ss er p m oc ts eh c ni sn oit pu rre tn i zeim in i M s

s t o in P y e K

ot re b m e em r uo y lep h ot re Caf o lec ehCy t es U •

iftl ni chitlt da eh eh fto nig no itis op erp o pr Im d.e s clo

uec se r ons ae r en o erb m nu eh t is ya w ira an ne op to

a gn nei po er of eb sn oi sse rp m oC ts e

.t ne i apt e thr fo g inh ta er B nda ya w r ’sAit ne tai p

hC rm fro ep

, nod c se en reo v tos uj ts la sh t era b uec ers e tcvi Efe •

.e vti ce ff e in er a sh ta bre nte tai p eh t p ta dn at ne m et tSa re dn o sp

,e vi sn op se r un ist ne tai p e tfh I e.n ob r

eRe th ev i G •

cola eh t no

e.s rit se hc ’st n iet pa eh t kea m tor ia ghu on et usj h it w

al m ro n dn a ya rw ai ne po na ro f kc che lyk iuc q

ro leb an u er a ouy n ito uiat las ut ac na gn rui Ifd • , ly a m ro n gn hit ae brt on si tn taie p e thf I ig.nh ta er b

net it pa ngi tah reb -n on a g inv ig el ba tr fo m oc nu l

ste hc su ou in nto tcn eit ap het ev ig ,s ht ae rb uec fe res

.s n iso esr p m oC ts eh C n gie b ly itead e m m i

a dn a esv ol g e us, leb lai av a yl te iade m m if I •

y erv rea en o al sn ios se pr m cto se hC .s n iso esr p

ru Yo ta. eb rta eh at uo hit w tn iet pa a ot l iac fie com ben

sn i tan oc ta ht do lob tae lu ircc pl eh li ts ya m st ro ef

ya le d otn od ,r vee w o .Hn oi ss i m nsa rt se eais d m or f

et coa l to ngi y tr yb rea c cny eg er m idgen voi rp

nte tai p dn a lef sr uo y cte otr p tor ier ra b tonia lti ne v

de ivd o pr er ac tea uq ed a – re b m e m eR .n eg xoy e


d.l eh iht w re cta ce rfe p na th r tet e som isb

3 -1 2

s.r reri ab

SECTION TWO

2-13

ya w irA ne p O


4 -1 2

erd no ps e R eh t gn iv i ygb sse ne vis no ps rer of tn iet ap eh t kc eh C . e ytfe n asr o fo D en sce t’s I hts s w essA o

H1 2-14

ngi ht a

s nese v sin op esR kc eh C

?y a yIa ko ou M r.e yre nod A,k spe sa d R cny nae ger no e br m E lla

.s se ne ivs no ps er fo le ve an con ala m I’. otn ev __ eti erl __ ap il __ e w __ ht tig __ pta inp __ n pa __ eht td __ t, na __ ne e __ em ivit __ tta sn __ sr es si uo si e y en m a to obr N y sen allo M op c o?l esr e e T H :tn fnoI ay?k e ?u uo o o m tea ylp ye r tS eh A

SECTION TWO

.g ni ht ae r lB a m ro n dn a ay rw i A ne po na ro f k ecch yl kc iu Q

gn itrs ir t F b on l dn o a . e a du C S o eht cna y M f is tsi I E s lla .S si sa e c MT ot E s.t idv re lla six ro dn c e p o n u ystab etn tiop yon a hop oer eth ska le ht ,S ,ly bi o M la o on E m r fi et rm on uo S avti ca gn yse M ih u, E l o ta e lac tst er nlo ot ir bt a t F l on ear nie a t C a dn uo p u a yf eh oY vesi Ie. te e.r no lb vae ca ps ilaa l, cyn ren va eno eg us is hp er i e m entti foni bileo oet ap D m hc a aor eh E ev p tf A I na ah pa

2

3

sn o ssi er p m oC set hC re lvie D

S EM rte lA

Bre al rm o N ofr kc eh C

.) no iti so ps ih t ni yd earl at on f(i cka bs ih no tn

.e its no is se rp m oc ts e

tieap onit is oP

hceh t et ac o L

4

5

e.it s no is pres m oc eh t dn fi to rya ss ec en if yl no ste hc ’st enit ap eh t seop x E ss

e om s n O .r et ne ct esh c e nthi dn ah en of . ol sel ee pp h in eh e t ht gn n tit ee up w t yb eb eit si s noi no tsi is o esr psi p th m oc s,l a thed iduiv ni dn F i ss

s.r gen fir uo y kc lor et ni dn a esth c eh t no yd ae rl a dn ah eh tf o po t on dn ah re ht or u yoec la P

.t se hc eh t ffo sr ngefi epe K .e its no is se rp m oc eh t no dn ah ru oy fo lm ap the se U s

.s no is se rp m oc steh cr veli se D 6

er as m arr uo y dn as dn a rhu oy re vo ytl ce ri d rea sr ed lu oh sr uo . yt sw ah ob t le sof ru els oy ru kc yo loionit htig so ra P ts s

eh tr o eg s. ac n o ibr iss eh rep t m no oc gn eh i t ushp verli ido ed av ott - h n ige w od w th dy o iga br trs uo sn y ois ow l esr l.A p e n m oc ob eh sta tf er o be ec ht ro f f o e p thpe rtie e w K ol ss

/s ert e m tin ec 5t sa el ta -t se hc rdaa t’sn h eti hs ap up e h ldu tf oh oh s tp uo ed ys e no ht is dr esr ith p -e m oc on ts lye eh ta c im ev x it ro ce p p eff ae ed n i o . rovp tbas hesc o erb in2 eh t gn sis er pe d, ts af hs up dn

.n ioit so pl a m ro ns it to rn eturo tt esh c eh t gn i w lol a, sea lee r, onis se rp m oc ste hc hc reae tf A

ns s.n osis osi rep se m rp co .st m 0 aF co 01 sh 03 ts u ro ale P, f) ta dr sta eb aH f d h g l s tinn oush Puuo e k c( tar ni ,n r th o uo le os Y p dn .le oep b a si st -r so o uo ps m f- a na ee ly th rh di re -to ufl sta as ft tw -e sn lo no ois as -f ser iet o p ar cea m o e p ce T at th .te u a atep rm o inm f e re re RP p

ks a M te cok P r reir aB no tnilat eV no it so P

eu cs er ska -m ot -h tu o m ro ht

p.ir gl ot si pr ot fli inh ctil t da e

oum ot -h tu o m ro f ni uq en na m eh t no re ir ra b no it lati ne avn oti is oP

h-s do the m no m m oc o tw fo E N O es U .y a w ri as ’t ne it a epht ne p O

7

.s tha er b

8

cte to rp ot ht uo em ht es loc ytl ne g, w aj ro ec af eh t ot y:r uj ni na sa ht ne i patf I E T O N

re ir no ra it b lai eh tn t e vero nvai t thu er o .C e m ru son oy e ec th lap hg ,d our es ht ol s c th w aj are eh be t uc gn s id er lo ev h gi eil d h an e W . s sited enoh er tg uj ni ni re eh vo t c

a gn is U .s re othn ah t es on o-t -h tu o m ro fr tet eb er a) ks a m te cko p as hacu s( sr eri ra b

.k s am ot -h tu o m de lla c gn ih ta er b eu cs er fo m ro fr eh to na kiss a m te kc po

es o N h Pinc nad ya r iw A ne p O

.d seo lc seo n eh t hc ni p, ec al npi re ir ra b no tia lti ne v eh t dn a kc ab de tli t da eh ’st ne tia eph t hit W 9

03 of lec yC erh to nS ign eB

sh ate rB uec se R o w T ev i G

tn iet ap eh t ed iv or P. dn co sen ot uo ba ts al ldu oh s tha er b hc a .E sh ta er b eu cs re o w etiv g, w o N 0 1

.t se hc ’st ne tia p eh t ni eis r hist ro f oko L .e isr ts eh cs ’t ne it ap eh t ek a m tor ia hg uo tens uj thi w

ro ftil ni hc -lt it da eh eh tt ae p ,reht ae rb ts rfi eh t hti w eis rt se hc ’st ne it ap eh t ek a m tn’ a uco yf I s

a gn in ep o lyr ep or p m I. tha er b hert on a gn it p m ett a er of eb ya rw ia eh t ne po -e r tot ifl pi lgrot si p

.s gn ul ’st ne tia p a et afl ni etol ab gn ie bt on fo es ua c no m m oc sto m eh ts i ya w ira nt’sie ta p

.e isr ts eh c eh t kea m ta ths ht ear b eu cs er ev ig ot ec i tw anh t er o m yr tt no D E T O N

ek a m ye ht re het ,w sh ate rb o w tr .ni et ga f a A .s sn no osi sis sre rep p m o m oc ct ts se eh ch c in ne ge e b, tw eb ton y r elad eois ez rt i es m in hc i e M ht

sn o ssi er p om Ct se hC


de osl C

s.n osi se rp m oc ts eh c 03 fo le ycr eh to na ing eb yl et iad e m m i, sh ta reb eu cs er o w t gn ir

:il tn us tha er s.n b o osi w t se hit rp w m sn cot osi se se rp ch gn m id oc vio 03 rp gn ni it an sy re al e lt ivel zedi eau dr m nit i no tef in s s s AM s Cs 1 1

s.e ivr arS M E

).r toa lli fibre D la nr et x E de ta m ot u A ( D E A na hit w et lail rb fie d anc uo Y

. alym ro n eh ta er b tos ni ge b dn a ev is onp se rs e m coe bt ne i pat e T

.s tr off e R P C erv os ek at re dn op se R cyn eg re m E r theo n A

5 -1 2

.e un it no c to de ts ua hx e oo t are uo Y

2 1

SECTION TWO

2-15


6 -1 2

rse uc se R o w T n ee w eBt er aC tea nr elt A e– guti aF RP C iod Av

.e ra c gn tia nr elt eraid sn oc tn es er ps ir ed no ps e R yc ne rge m E en o na ht re om fI E T O N

2-16

.h cit sw ne h ndta se tu ni m o w tr of R P C re ivl ed na cr ed vio rp hc ea, e iguta f di ov a o

. onsit pu rr et in onis se rp m oc ste hc ez i im ni m ,s re di vo rp g hinct i w s lei h W

SECTION TWO

, m leb or p ryo t iraps er re ht or o gn in w rod a eb ldu oc m leb rop s’t ne it ap hetf I E T O N

dn a e im tt ro hs rao ft enti ap eh t ot R P C ed vio rp uo yt ah ts na e m si . TS rst.iF E M ll a rea c CN E vei H g 

nI y.tl ne re ffi ed m tit ro hs ar of ts irF er a C gn id iv or p en fie ds en il ed iu lgan oti an o w 

A He ht (A se s;e i t ntru inu oc m dn ow asl ty I let cfi a cia m i P xor eh p t ap dn ro a fe asi ar c A a,c ngi rie idv m or p A alr as nte dne C e dn d s hat ,it’)s uo e ,Sh nlie rto idu NG

.e tu ni m ones a e m tit ro hs as en fie ds en il ed iu gl ic nu o C no it ait cs esuR ane po ru E

gn id ae r, ed iu g e sthi no sr ep en .O ni uq en na m a no gn ih ta er b uec se r thi In w edn ib m oc sn o esir p m oc ste hc R P C m ro fr ep ,s pu rog ec tic rap ru oy

T I Y R T

.r ed no ps e R ncye rge m E eh ts ir eh to eh t eil h w ,s eh ct a w en o, sp et s e th

yd ob dn a rm ds,an ah ru oy reu s ek a m to yl w los sp et s eh t ec it acr p, ts ri F

e. im tl ae r inn ia ga sp tes eh t ec it acr p, tx e N .e ta ir po rp pa si no iti so p

e s U D E A S B A C B A : e r a C f o le c y C

e v

A A o

E

r r

s

s

tn eit Par fo

ryu jn I aln ip S

S

B

ot rea Cf o e cly . C sut eh a t st use cal dn ied tan m e ts’n eit sm ess ap sa a y or ar tin o im rp m a lya u m orf tni re on P c •

A

A

r

p l

e

H

C tes

l i

t

sn hC ios s rpe m oC

n

U e u

n i t

n o C

s

eS U ro ta lli llir k b reSa efiD C lan yr r a etx m ir E P la det n a tiop tom u OA

B

ne p O ya irw

s

i

D

g inh ta re

ngi de leB k uso co rei hS S

s

s

gn ?ly hit a a rm

B er No A ayirw np?e B

A

O

gn id ro cca in

s l a o G r u o Y

:o t w oh et ar nsto m e D

quen na m a no ) D E A (r toa lil rb fie D la nr ex E de ta m ot u A na es U s

s.e inl ed iu g ’sr er ut ca fu na m en ih cn ae m ht ot

.n iot al uc ri cf os ng is on hti w tn eit ap a no sd ap D E A ec al P s

. D E A anth i w edt all ir bfi ed lyl uf ss ec cu s ne eb sa h oh w tn iet a apt iss s A s

s t o in P y e K

dn a . edt elb ac la ol ia si va y D EA lte dn dai a e hile im w is de D AE rm o e ref th p if eb en v ysa e– we al us ldu ro oh fd s ei R da CP re •

kei or-s dan rsle s a u coe si cs rp syl re roc an yal i a ro m f ,d tm h d ree ryh nge w tr si p-o ae ed yr ha re tte s as ab et D ,d rao EA et pr .m a o e tcis cni tsy ih si s y ops hte or c is isa devi adv EAD ed c-k . nA asb ohs uoy •

si is D E .t ree Ae nie h ht at fti lei pe ,s h h no w tn sis RP od er eC ec p tinun plag com set o,c ine hc tn be ni ees ra r s nso pr da tip ue ep rur cse ht et r d in en na zie no no im ha de in te hct m ro i oT m sw • se lyza na tI . dsa pt se hc o w t iav tn eit ap het to tsc e nn coD EA eh T •

cok ash ne h w tcs tee d . dn m a ht yl yhr ac tr it a a eh ml tuo am a ro n m tyh ae hr ro tr ts eah ero nt’se edtd tai ee p ns a i

g inv a sh orr e at w f of g ipnw yb ts eh c het rea pe rp ,y ra ses ce fIn •

de. t rcit s re eb ya m sn sro ep ayl yb e us D EA ,s n igo ree m os In •

.d ec al p e ar dsa p ree h w ri ah

o w t em ht ec a pl – s kera ecm pra . y veo aw a dsa hc p ni EAD eno / cea rset lp e re m i ve tn N ec •

.S M nd rtEe igan la r b nda to en dna ec S s ss M E es la sa c o –t te ca no ne em ht os ,k k inh as, .el t p b po, leh iala ts g va to nnii is erb obta one m e ne fi, m eR hW D EA •

la m re snd ar t af poto no ytl ce ri d sd ap h. D EA tc a e p acl ino pt ta on ic d o e D m •

yb dlaye no tno ssi o i D m .e nsa lab rt ail es va ae if isd sr ier m o ra ftr b ne nio tia tail p t dn env af d els na r s you ovel cet gg to in rP su •

.e lb lai vaa to n rae sr ier ra b if er ac ncye gr e m e

ev er bs p .s .O ee ce cea .K afr fr D us E sut A iev e eh t w ft cud a ro n on e co ngti turac orp se fu m r n a st a d n mm taie teh rof p y ya no b w d d e as sue nlit da eb uo np ya esl oti u a m ry lir s te b f fi ED A as ed •


re d spone ne.o R br e a th olc g inv het ig yb not k ne ech tai c p ss pa en t, e e ivs sno no ps spe er rt on ne if tai nd p a a nte rm m fro aet eP tS •

SECTION TWO

7 -1 2

2-17


8 -1 2

eh t . ot D re E fe A r c es fii ae ec l ps P. a la rse gin vi su nu n dn eh a w ci sn nere ctiou g tr rea sin sp d et na s s gn en i lie w oll di of ug e err T ut - ca E fu T n O a N m .s ut at s cali de m ’st ne it ap eh tr toi no m yll au nti no c o et

e n r o Ca D of ycle t’s I Ceh t w esU o H1 2-18

re dn at ysb a ev ah ro S M E calt rsfi ,y ll . a R m ro PC n n gn ig ih eb ta yl er et bt ai on de dn m a im ev ,tx is e no N . spe D rn E u A n is a nteti ap eh tf I

ingrb dn al la c

2

SECTION TWO

fo el pu oc ar of R P C eu nit no,c yb es loc D E A na dn fi to ree h w w on k dn a en ol a areu yof I s

. D E A eh t er uc es lyk ci uq tot ne it ap eh t ev ae l ne h stte un i m

. R P C eu int no cr o ing eb uo ileyh w os od to m eh tt ce ird , D E A na te g og na cr ed stany b af I s

eh t no sd ap ts eh c eh t ec al p d anp ut it es m eh t ev ah , D E A eh t thi w se vi rra no sr ep het ec n O

.s no is se rp m oc ts eh c to nsoti pu rr et ni se zi m in i m si T . R P C eu int no c uo y eil h tw ne tia p

RP C ni ge B

tsp m o Pr w ol oF – D EA on n uTr

S M El aC

D E sAg inr B erd atn sy B

.r eu cs er e thsa ed is e m as eh t no ra e ’st ne it ap eh t to seo cl D E A het no iti osP

.y lt ca xe st p m or p ec iv ed w oll of N O re w o pD E A rnu 

.t en m ec al p da p ot ro ir pt esh hect gn iy rd re di sn oc ,t e w ist ne tia p eh tf I. ts eh cs ’t ne atip eh t rea B

3

4

5

ot yl kc iu qt i es u, leb ali a favI . D E A na thi w de du lc ni eb ot ro za r ar of no m m ncou to n si tI

.ir ah yd ob ev sice xe ev ah s

eh t m or f gn ik ca b cti sa lp ev i teco rp yn a ya w al ee p gn ig ak ca p m or f sd ap ro ta lli rb efid ev o m e R 6

eh t ni li slk nao it po na sa D EA n oat no it at ne i or an ev ha ya m uo Y

.s da p

tn tiea p a ot k och s sar e ilv ed D EA nA

on sa h dn a g in aeth rb to n si oh w

ta e tbr ae h

.e sr u co) PCR ( rea C yr a im Pr e nso ps eR ts irF y nce gr e m E

ed is ev is eh da ,t esh c er ab ’st ne pati no sd ap ro ta lli rb fie d ec al p, re ru tc af un a m eh t yb tedce ird s A 7

:y lla ci py s). da pr o gn ig ak ca p da p on sn oit ar stu lli tn e m ec al p e ot(n n w od

eh t ot tx en dn a en ob ra ll o echt w ol eb ,t se hc eh tf o ed is th gi rre pp u eh t no se og adp en O

.e onbt sa er b

.e inl lep pi n eh t w ol eb d ant fe l eh t ot ,t se hc eh tf o ed sit fe lre w ol eh t no se og adp en O

e m oS (. m ht yh rt ra eh ’st eni pat eh t ez yl an al li w D E A .d et p m or pr o de de en fi D E A ni gu l P 8

). no tt ub ez yl an A na hs up ot uo y eir u req s D E A

sr e nad ts yB dn a res uc se R ra el C

RP C e m sue R

sd aP altor ir fibe D ec al P

kc oh S ed voi Pr

t.n eti ap eh t gn ih cu ot si en o noe ru s gn ik a m tn eit ap eh t m or fs re dn at sy b dn a sr e

si e ony er e,v r elac er a ouy ,r ael c’I m ,

cusre ra el C

keam ,o ls A

9

ed vio rp ot st p m or p eh t w oll of ouldh sr ed no spe r eh t, de de en is kc oh s at ah ts es iv da

ya S. tn eti ap eh t gn ih cu ot si tn e m pi uq e on reu s

.r leac

E D A eh tf I 0 1

. R P C e m sue r yl et iad e m m i, kc hos a es iv da to ns eo d D E A eh tf I. R P C yb de w lol of ck,o hs en o

eh ,tt re ne of sb eb al s ilt etu ss n i im . gn o R ih w P ta tt C er ia e un lba w lli ti con orm nf sw D e, I. E im A tt m ht tso ath yh M g rt k. in ra co ru eh h D s ’st re .ni ne th ga it o a ap na tn eh rev eti t il ap zey de eh aln to tg a uo ni ina yt cko ga p hs or d lli m w p na D E aym ginz A D ly e E a T A na

se m us er tn iet ap eh tl it nu R Ph C it w de inb m oc sk co hs el gn is ev ig to eu nti no c, de ptm or ps A

1 1

2 1

e.u nti no c ot el abn u lyl ac si hyp er a uo yl it nu ro ,l en no rse p S M E yb de ve lie rl it nu g,in ht ae rb

lec y C

eh t es u ot eu nit no c dn a ya irw a enp o eh tt ro pp us ,y ll a m ro n gn ih ta reb sn ig eb tn atiep eh tf I 3 1

eh t hg uo rh t de ec or p dn a in

s.u ta ts la ci de m s’t ne it ap eh tr toi no m toe

ra C fo

quen na m a no sd ap D E A ec lap ,p uo rg ec it ca rp ru oy n I

,s eh ct a w en o, sp et s eh t gn id rea,e di ug eh t is ons re p en O .s pe ts kc oh S dn a ez yl an A

T I Y R T

:d ulo hs re dn op se R yc ne gr e E m hc a E .r ed no spe R yc eng re m E eh t si re tho eh t eil h w .

t.n e em ca lp da p D E A ec it ca r P •

a gn ik co hs dn a gn iz yl an a for sp et s eh t et al u im sr or en air  D E A na no ceti ca r • P

.) inu qe nn a m (t ne it a p

re tl A .r ed no ps e R yc ne g er m E eh ts at ca ot ec na hc eh t ash en yor ev e reu s ek a


9 -1 2

.r toc ur ts ni ru yo yb de tc rei d sa se cn at s m uc ri

Mc

SECTION TWO

2-19

g n i d e e l B s u o ir e S

t n e m e g a n a M

ry ju Inl a inp S

kc oh S

s

S B A C B A : e r

A A o

E

r r

e v i

enp O ya rw i

s

s

D

gn ih ta er

B

tn ie aPt ro f

yr ngi uj ede nI lB la su kc inp oir oh S e S S

S

B

A

A

r

p l

e

H


0 -2 2

2-20

C a f o e l c y C

C tseh

l i

t

n

U e u

C

n i t

n o C

C

s

s

tn e m e agn 6l a li M kS gn er ide a el CB yr s air iour m P eS SECTION TWO

l a o G r u o Y

seu to w hoe ta rt sn o m e D

a dn a reu ss rep ctre id de ni at su s

a eg an a m ot gead na b er us se rp

.d nu o w ngid ee lb su oi re s

nso ssi er p m o

s

B A

? lay m ro B N ya ?n riw ep A O gn ih ta re

s t in o P y e K

SM tEr el a d an nee cs ses s as –t ac n het k, inh t, po ts ot erb m e m Re •

ed ul nci s eri arb et iar opr pp a, ngi de el b su oi esr orF y.l tea ir p rpo pa irers arb e Us •

orm ft n iet a dpn af le sr ouy tc r.s e e ort airr P. b k d as an ecm vse a o lfa lg g osn nis re u p yb d n an soi lde is ih m s s eye, trane se sa olv sei g d

t en em ta St dern op s Re eh t gn iv gi .e yb on b cke arl ch oc ses not evn ient sin ap o p spe ta, r e nte sn it po a ap reso nf rm for id eP an •

’st ne tia p se traoi bt n o us m m ly ngi au de tni el no rbe oc b te m e arC erm fo –t lec en yC me sse the ss s a U. y g ar nin .s m ri et tu ap reaht stal rm e- ac for lif die eP eb m • to er ve

. ngi de el rbo ft erat uo y sa t enit pa e thre us sa Re •

gn. it ae tr eil h w t orf om c of onit is po a ton it n tiea pt iss As •

do h et m l sfu ecs c stu so m d atn sr fi eh t is t. e n usr em s rpe ega tc an ierd gm ta ni ht de d el in sbu m in orie epe sr K fo •

reu s esr .Ap ngi de el b ortl no c ot pe ts t exn eh t si e adg na b er su pres a ngi Us •

nd.u o w a on e usr se rp tn tas ocn se acl pt ah t gn ih ty an ise adg abn

yl a icd reio P reu sse Pr es ae le R

ytl hg iT r hte aR eg dna aB

er sus reP tc ire D ed ina sut S lyp pA

eg da aBn er u sse rP es U

rse ir aBr ont Pu


e r u s e r P t c e ri D

e,n ec s sse ss A t.n e em ta ts re dn op se R yc n ger m E ev i G 1

.n ep o si ya w ri a er us ek a m d anS M E tr el a

sa ska m ec fa dn a, sd le ih s ey e, se vo lg sr riea b no tu P 2

e.ta rip or pp a

dn a dn uo w re vo gn is se rd eil re ts ar o tho lc anel c a ec la P 3

es ,ue lb ail av at on is ht ol cr o gn is se rd af I. e sure rp yl pp a

d.na h edv ol g

.d ep po ts ro ed w ol ss ah gn id ee lb fi en i m ert ed ot yll ac id oi re p er u esrp sea lee R 4

.g ins se rd eil re ts eh tr ev o e dagn ab er us se rp a ec al p, dn uo w no er us se rp tc er id gn lyipp a eli h W

e g a d n a B e r u s s e r P 1

eg ad na b dn a po t no gn is se dr o ht ol c na el cr eh otn a ec al p, de ka os -d oo lb se m co beg ad na bf I 2

.e ca lp ni

.d nu o w to er us se rp tc eri d lyp pa toe un tin o C 3

olr tn oc lpe h gn is se r edh t in tso lc do lob es ua ce bs eg ad na b de ako sdo lob veom er t’ no D 4

y.r sas ec en ass eg ad na b d d. A gn id ee lb

ro sr eg nfi fo gn ir loo cs id o (nw ofl do lob fo no it icr ts rel at ot gn id io va lyt hg it re athr eg ad na B 5

sti w t ot eg ad na b eh t gn ill ow a di ov a dn uo w ts ina ga ta fl eg ad na b reu ss er p eh pte e K .) se ot

.g inr t lsa m s a ot ni

,d nu o w eh t no er us se rp cte ird es .U

na to dn et at dn at ne m ss es sa y arm ir p a gn i m ro fr ep yb ni ge b pu rog ceti ca rp ru oy nI

arm st’ ne tia p a no dn uo w gn id ee lb su ior es yr an ig a m i

as as tc a en o, sp et s eh t gn id ae ,re guid eh ts i no sr ep en O .e ga dn ab er us se rp a yl pp a dn a

r.e dn op es R yc n rgee m E eh t isr eh ot eh t lei h w ,d nu o w a hti w tn iet ap


r.e dn op se R yc ne gr e m E r.o eh tc ts ru at ts ca inr ot uo ec yy na b hc de eh tec t ri sa d h as en es oy cn re ta ve s m reu cur s ic ek re a lt MA

1 -2 2


2-21

t n e m e g a y n r a ju M In k la c n o i h p S S S

nig de el B uso ir e

s

S B A C B A : e r a fC o e l c y C


i r

A E

s

D

A o

B

ne p O ya w ir

s e v

nti tae roP f

ro yr jun i na ne h w st esulr k och S •

S

B

A

A

r

p l

e

H l

C shet

i

t

n

U e u

C

n i t

n o C

sn o sis e pr m o C

s

s

s

sse ss a

gn yl? ih a ta m r

B er No A iywar p?en B

A

2 2

7l tn li e kS m er ega a na C yr M air ock m P hS 2-22

r

gn ih ta re

gn y urj dei nI e Bl k nla uos oc piS rie hS S

SECTION TWO

l a o G r u o Y

gn tic et or p, tn e sm se ss a yr a im rp a gn it ucd no c yb cko hs eg an a m to w hoe ta rt sn o m e D

O

tn s i o P y e K

.d eah eh t gn iz ili ba t dsn at ne it ap eh t

’sy do b eh t orf tl u ficif dt i s ake m ss en li

et a que da ed vio rp ot m tes sry la scua vo dir ca

.s na gr loa itv to d olo b etd an gey xo ofs ntu o am

sea sie — d tc m a o rf ne tn th iet kn a hit .S p ,p M dn o E a ostt ertla relfs re d uo b na yt m e en tce m eR ecs orP • •

.s re rir ba nda se vo lg gn is u by oni ss i m nsa rt

kc o srh of nte tia lpi ro de ujr ni ant reat sy a w Al •

. nte sb a rea s m ot p ym s dn a s signf i env e

yb kc eh c sse ne vi nso spe trn tiea p a rm of re P •

tn taie p e tht el , nte tai p e ivs pons re a ro F •

e bla tr of m o tcs o m is no tii s pot ha ew in m ert ed

e th r toi no .t M . ne tn e em s ta m ts sse s re a dn ry a spoe im r rp eh a t gn rm iv orf ig eP •

. e n li e f li

ts’n eti ap

c.t ,en w od gn i ,lyg itnt si —

to n o D .d nu of no sito p eh t ni tn eit ap su oi cs no cn ur o ev is e nop n ser o nu D ,de r nju t’s I ina t w are o

H

1

e.v o m

gn ir ev oc na e m ya

03 -5 1 gse l

.g inv o m m or f kc en eh t pe ek ot da eh ’st ne i pate ht ldo H

i .n sm u .T et se a ht m il m cl o r cao fn l oi no tc de teo sa rp b er er u ut so ar px ep e ro m te te yd kn ob al ’st ba ne th i i patn tw ia neit tn a ia pe M ht

hete ta ve le ,d tec ep su ss er ut ca rf ge lr os ier uj ni la ni ps o enra ree ht fI

2

3

4

.t are h eh t ot nr ut er ot do ol b w oll a to se hc ni 21 es/6rt e im tn ec

da He ’s net tia P dl o H

sg eL et a evl E

d ounF onti sio P ni ta er T

reu ta per m eT y oBd ina tn a M

dn at ne m ss es sa y ari m rp a gn i m ro fr ep yb ni ge b, pu or g ec it ca rp ru oy nI

hit w re vo C .r oofl eh nto gn iy al tn iet ap su oi cs no cn u na ro f kc oh s eg an a m

tea ve l E .e ru ta re p m ltea m ro n a ed iv rop tot ne tia p eh t ed ah sr ot ek na bl a

eh ts i no sr ep e n. O se hc ni 21 -6 /s ret e m tin ec 03 -5 1 sg le st’ ne it ap eh t

erh to eh t lei h w ,k co shh ti w tn eit ap as as tc a en o, sp et s eh t gn id ae r, ed iu g

ot m oo r eh t ni s item seu ,l uf ec ru os er e .B re dn op se R cyn eg er m E eh t si

.s ge l et av el e dn at ne it ap re vo cr o ed ah s


r.e dn op es R yc ne gr e m E .ro eh tc t ur ast ts ca inr ot uo ec yy na b hc ed eh tce ts ri ah ds en aes yor cna ev st e m reu urc s ci ek re a lt MA

3 -2 2


2-23

gn id ee l B su oir e

t n e m e g a n a M

y r ju n I kc la oh nip S S S

s

S B A C B A : e r

A A o

E

r r

e v i

enp O ya rw i

s

s

D

ngi tah er

B

tn ie ta Pr of

g y ind urj ee nI Bl k lna su c ip oir ho S e S S

S

B

A

A

r

ad Hee iliz ba St

p l

e

H


4 -2 2

2-24

C a f o e l c y C

C seth

l i

t

n

U e u

C

n i t

n o C

C

s

s

tn ee m 8l ga li na kS er M yr a uj Cn yr I air nali m P pS SECTION TWO

nso ssi er p m o

l a o G r u o Y

s

B A

yr ai m rp a gn it cu dn oc yb la ni ps de tc ep su s eg an a m to w hoe ta rt sn o m e D

? lay m ro B N ya ?n riw ep A O gn ih ta re

.d eah eh t gn iz ili ba ts dn at ne it ap eh t gn it ce rotp ,t en m ss es sa

.S M E rlte a dn a nee cs ss e sas

s t in o P y e K

— tc a enh t nki t,h po st ot ber m e m eR •

no if dn a t.n e em ta str e ondp se r e th ngi ivg yb kc e ch sse ne v yl. nis et o ari ps po re rp nt pa tei a rriers ap ab rm o es fre U P • •

to n o D . ndu of si tn iet pae evr ht es no l, af tii so a p gn eh iv lo t ni vn it nte ne m di ses nci s sa yn ray roa f im yr rp jnu il rm o nai t. fre p c p as pa ble, is cte im ps gno so uS rts pfI • • erh ot or sha r ,c olw b

.e no br al oc no nt eti ap p e,ta nso ps er

yl a nuti no c to er Caf o le ycC het e Us. n ito se qu ni si y eft sa ss lne tu ienta p ev o m

su. att sl cai de m ’st n eit a apr toi no m


ly l a m r o n g in th a e r b s i o h w t n e it a p t n e ti a p e v i s n o p s re a r o F

ro s m ra ru oy ro hc na ot tp m et t A t. ene m vo m tn ev er p ot ed is hc ae no dn ah a gn ic lap yb d eah ez ili ba tS 1

t.n e m ev o m dn ah ru oy gn iz i m in i m ithw sti ss a ot onit is op el ba ts ra li im s a es ur o dn uo rg e thn os w ob le

e.v rir a ot S M E ro f gn tii a w el hi w kc en ro da eh si h ev o m to n dn al lti s ni a m re tot n atiep tc ur ts nI 2

nig ht ear B ses ss A – ya w ri A ne p O

it rnu t

.k ca bs ih no eb ts u m tn iet ap , R P C ors ht ae rb eu cs er re ts in i m da g,n ih ta er bs se ss a, ya irw a ne po o

y ll a rm o n g n i h t a e r b t o n s i o h w t n e it a p e v i s n o p s e r n u n a r o F 1

korc ab da eh ltit to n o D .y a w ira ’st ne it ap ne po ot do ethm tif l ni hc -tl it da eh eh t es u, kc ab si h no yd ae lra si entit ap fI s

e.d si to deis m rof s

.t n atiep no iit so pe r tol lo r go l eh t es u, cka b si h no to n si entit ap fI

:fl es ru oy byl lo r go l ar m of re p o s s

.p lar uo y ot ni ll or to nl il w entit ap ta ht os m oo r hg uo ne ev ae L .e di s s’t ne it pa eh atl ee n K

t.n iet ap f eod is ts ina ga s m ra ne th iga tr S .s egl ’st ne it ap ne th gi ar stly tn e G

s.d na urho yf o en o hti w dn ih eb m or f kc en dn a da eh ’st ne it pael da r C

.u oy m or f ay aw ts eh tr uf ist ah t as rm t’n eit ap eh t no w ob le st’ ne it ap no dn ah re ht or uoy ec al P

.k ca bs ih ot no enh t, ed is ish ot no ,u oy dr ao w tt in u a sa tn eit ap llo R .e lb is so p sa yll uf er ac sa tn atiep ll o R

nte em ov M kc e N dn a nei pS ez i m i in M l– oR go L m ofr re P


5 -2 2

s s s

2

SECTION TWO

2-25

l Ro g Lo on rse Po w T


6 -2 2

,d ae h :ll ’st or ne go ita l p no se rse zlii p- ba o ts w t re a dn o rm of pse erp R ,e cy lb ne ail gr avs m e i E e lpe nO hf I s

hit w de zli ib at ss i da eh ’st ne it aP .t enit a lspo r en o

.g inv o m om rf ti pe ek ot s andh tho b

hit w so se od ,t enit ap gn ill or re dn op se R yc enrg e m E s

3

2-26

SECTION TWO

. w ob le w ol eb dn a ev ob a rm a s’t ne it ap no s andh tho b

ton ot in u en os at ne it ap ll or rse . dn kc o a espr t’sbn ht eti o a B p s

no tn e m ss es sa y arm ir p a gn i rm of re p yb ing eb ,p our g ec tic rap ru oy nI

T I Y R T

go l a ec it ca rp ,t x ey .N ru jn lia ni ps de tc ep su s a thi w tn iet ap ev is no ps er a

tn iet ap ev is no spe rn dun a su oi cs no cn u na no tn e m ss es sa yr a im rp dn al lo r

.n w od

en O .ls lo r go l

la ni ps a hit w tn iet

ecfa edn oit is op si oh w yr uj ni la ni ps de tc ep su s a thi w

onsr ep -e no dn a no sr ep -o w t tho b ec tic rap ,l ac tic rap fI

ap sa tsc a en o, sp et s eh t gn id ae r, ed iu g eh ts i no sr ep

er.d no ps e R yc ne rge m E eh ts ir eh to eh t lei h w ,y ru jn i

.r ed no ps e R yc ne gr eE r. m eh oct ts ur at st n ac ir to uyo cen y ah bd c te eh ce t ir sa d h sa en se oy cn re at ve s er m u us cir ek cre a tl MA

s

dult A gn ik oh C su o scin 9l oc li n kS U er dna a s Cu yr oi air nsco m PC


v

r r

i

A A o

E

enp O ya rw i

s e

s

D

tn ie t Par fo

S

S

B

A

p l

e

H

C tse

l i

t

ns hC osi se rp

n

U e u

n i t

n o C

om C

s

s

B A

? llya m ro B N ya ?n w ri ep O ngi ht ae r

A

E T O N

B

gn ryu id e njI lBe la su ck inp oir oh S e S

A

r

s

.y lla no it an re tn ryia vt ne it ap gn ik oh c su ioc sn co a gn lid na hr of esr ud ocer P -

gn i tah er

sl ep x ten eit pa eh tl i ntu ev re sb ,ok a

sn m n / io C iot orf ai e ,a atit R (l icr cs A arv m se ocs em ues cin d er A R u on nclui educ ralt ane C lli or en pro iot ks pt C u ta ic si ne dn E re a ,s)e sus T h a.e ffdi tu nli eR ra e oS ed d ru T ,h iu nal yor .se tro G ae Z of urd N A w e et ec in H A ( iar or des se N po pe u ri dna rp in n tn n pa le iot uo ali sl diu aic cd rat coo gt sos nla su to ne A sI A rp re tr c su eh ffid ae ic l,p t Ha ) rna reh anc eP C R lel tn rie htd (E il o m na lic w de A a nu uo sa e is o Y b ht A C

? y ll a m r o N g n i h t a e r B

s t n i o P y e K

). C R Z N

gn ik o t hcsu n oic e sn m ocn e ri udn u asu q ocis e no R ca e tsis c sa n to a w m r hoetra o fr stno e me PD

eh lte px e ot g inh gu oc pe ke ot tn iet a

A g.n hit nay od uo y reo fe tbn es no spe hept viec na e cr ga tgs u o ru .t ign oc tm l ca ez ne dua ne he dn su ht ,w a oi kn gn ure cs ih ih s no s ,tp ug ea c ot co .R .l at s is n ia a ot t iot re ht re nei uc ta re b ta srt m b m e pe ob ing m e m eR hfIt hte ofer m Re • • •

. nt ice ffi su si odn da eh

pl he ya m nso is .h rse gu p oc m o ot sct leb he a .C e otbn CPRn li gi e w tn ,bs eit uo i pa sc eh no ,et cnu evr se es m is co eg eb t kac nei lob tap eh eh ftI ftI • •

.n oti c rut sb o eh tl ep xe

la ni m od ba na ht ehr t ra sl a diu idv ine ebs o ort na ng er p no st su r tth se hc rm for eP •

ly cai ed m y m d ulo hs gn koi hc su o

.s st rhu t

cisn co ro tfn e m ta e tr e th ev ie ecr oh w tsn iet aP •

. nso tai icl po m c gn in tae er th eif l yn at uo lue r to d tae ul av e


7 -2 2

.n iot cu rt sb o ya w ri a et lep m oc ro la it r pa hit w tn eti ap

SECTION TWO

2-27


8 -2 2

2-28

tss ur T la ni om bdA

l a tr n e C d n a h t u o S , h tr o N ( s e n li e id u G A H A tl u d A g in k o h C s u io c s n o C

no tt uB yl eB –l vae N et ac oL

tn tie Pa dn ih eB dn a St

tn e m et at Sr ed no ps e ) s e ir t n u o c d n a l s I c fi i c a P e h t d n a a iA s , a c ir e m A

”? gn kio ch ouy e Ar“ -

tn iet ap e e visn n osp o er D ag skin t’s I ayb wtrtaS o

H1

SECTION TWO

heR t ev ig ,y ll a m ro n gn ih ta er bt on si r-o ka ep st on na c entit ap eh tf I 2

?”u oy lp hIe ya M re. ndpo se R yc ne gr e m E na m ’ .I _ ___ __ _ ___ _ ___ si e m yna M ?o el ’ ‘H

to st p m et ta hti w de ec rop dn a SM E tr el a, )t ne ic ffi us si do n da eh a( de tn rag si t. no cje sis bo ier het m p eg ne d h olsi Wd

no tss ur tht se hc hit w n egiB .e vit ce ffe to n er as stu rh tl an i m od ba if st su rh tt s cher ed is no C

3

4

.e esb o lyd ek ra m ro tn an ge rp er a how st ne it ap

s t s u r h lT . a tis n i aw mdnu o roa ds b rma A ru g oye n i clap k dn o at h eni C tap s eh ut ind io c heb s dn n taS o C1

.ti ev ob a sh td i w re g fino w ts i tei st su rh t eh t -) no tt ub yll eb (l ev an s’t ne it a eph t et ac o L

.e ti st su rh t eh t no ed is b m uh t eh t cea pl dn stafi a ek a M

.t sfi eh tf o ed is tu o eh tr ev o dn ah re h rotu oy ec la P

.e g cabi r eh t gn zie eu sq ido va ot dr a w tu os w ob le dn a s m rau oy nde B

tn eti ap eh tr o de ra el c isn oit cu rt sb o eh tl it nu st su rh t dr a w pu dn a dr a w ni k uicq m ro fr eP

2 3 4 5 6

.t ne it ap eh tr oti no m dn

s.u oi cs no ncu se m oc eb

eaht ear b ot tn iet ap eh t eg ar uo cn ,ed er ae lc si no it cu rt obse ht ec n O 7

s.ti p m ra

ts Fi r ve O dn a reH ht O ec a Pl

tss ruh T ste hC gn kio Ch su oi scn Co

t isF a e ak M

s sut hTr rda w –p rda nIw m ro ref P

.r et ne c eh t ni te e m sb ir het ree h w tn io p eh t hc ae r uo yl it nu rda w pu ibr ts e w eloh t w oll oF

s tu dernu s r ,yd h ob Td t nuo s ra es h rma C ru g oye n i clap k dn o at h eni C tap s eh ut ind io c heb s dn n taS o C1 2

sd ra w tu O s w ob E/l s m Ar dn eB

, m un ert s, en ob sta reb eh tf of la hr e w ol eh t no h otcn eh tl eeF 3

eh t is si T .h ct on eh t no re gn . fi R xe PC dn ro i fs dn a a tni led o di pn o m r iss youe pre ca m lp co e dn m a as

eh tr o de lle px es it ce jb o eh tl tin us ts ur ht dr a w in k uicq m ro fr eP

ev ob a tei st su rh t eh t no ed is b m uh t . eh hc t to cea ne pl ht dn n stafi rsoe a gnfi ek r a uo My

.t sfi eh tf o dei st uo eh tr ev o dn ah re

4

5 6

thoe ht ec la P

.s uo ic sn oc nu se ce om bt ne it ap

.e ga c ibr eh t no er us se rp g tinu p di ov A

eh ate rb ot tn eit ap eh t eg ar uo cn e, rsa lec no it cu rt sb eoh tf i po tS

7 8

t.n eti ap eh t tori no m dn a

s w ol b cak b erv il ed ly m irF

stfi a e ak M

st s ruh t rad tuw o d ar w in m ro f ePr

on ubt yl be et ac oL

sd ar w uto so w bl e/ s m ar dn eB

tn iet pa dn ih eb nda tS

sfit erv o dn ah r hte o cea lP

nda ed si eh t lefto sr uo y no iit so P s e n il e id u G ) C R E ( li c n u o C n io t a ti c s u s e R n a e p o r u E tl u d A g in k o h C s u io c s n o C

o? el H “t

”? gn kio ch uo y rAe “-

tn iet ap e e visn n osp o er Dag skin t’s I ayb wtrtaS o

H1

ne m et at Sr ed no ps e eR th ev ig ,y ll a m ro n gn ih ta er bt on si ro ake ps to nn ac entit ap eh tf I 2

”? oyu ehpl yI aM .r dne op es R yc n ger e m E an ’m I. __ _ ___ _ ___ _ ___ __ s_ie m an y M

to st p m et ta hti w de ec rop dn a SM E tr el a, )t ne ic ffi us si do n da eh a( de tn rag si t. no cje sis bo ier het m p eg ne d h olsi Wd

la ni m od ba hit w s w lob kc ab atern elt .A st su rh lta ni m od ba ot ev o m ne ths w ol b kc a hbti w ni ge B

3

4

nte it pa ndi he b

.s uo ic sn o uncs e m oc eb tn eit ap eh tr o de ra el c is no it cu rt sb o eh t tiln us stu rh t

s yl wth o l glis B dn k aedi c se a th B to g niot n i isop ka o ek h a,t C sw . s olb tnei u kc ta ba ep io c ervli htd s ed ni n o heb o C1

.d ar rw of tn iet ap eh t na le dn a, dn ah en o hti w ts eh c het tr op upS 2

eh t hit w se da lb re ldu oh s eh t ne e tw eb no sr ep eh t keitr s yl m irF

.s e m ti ev fi dn ah re h eoth tf ol ee h

to hc ti w ,sn oit cu rt sb o eh tr eal ct on od s w ol kbc ab ev fif I 3

.s ts ur thla in m od ba

eh ate rb ot tn eit ap eh t eg ar uo cn e, rsa lec no it cu rt sb eoh tf i po tS 5


l a n i m o d b A g n i k o h C s u io c s n o C

erp pu eh t dn uo r s rm a ht ob ec lap dn at ne tia p eh t

ts indheb s d u r ntaS h T1

.n e m od eabh tf ot ra p

.d ra w ro ft ne i pate th ane L

)n tot ub yll eb (l ev an eh t ne e w te bt i ec al p dn at sfi uro y hc ne l C

2 3

e.g a bcri eh t dn a

sd ra w in lyp ra hs ll up dn a dn ah re ht o ru oy thi w dn a shi ht ps ar G 4

. rdsa w pu dn a

s.e im etv fit ae pe R

to chit sw ,n oti cu rt sb o eh tr ae lc otn od st su rh tl an i om db a ev fif I

5 6

.sw ol b kc ab


eh ate rb ot tn eit ap eh t eg ar uo cn e, rsa lec no it cu rt sb eoh tf i po tS

9 -2 2


7

SECTION TWO

2-29


0 -3 2

2-30

s e n il e d i u G ) C R Z N / C R A ( il c n u o C n io t a it c s u s e R d n a l a e Z w e N d n a ia l a rt s u A tl u d A g in k o h C s u io c s n o C

”? uo y ple hI ay M r.e d opn es R cyn eg re m E an ’m __.I _ ___ __ ies m an y M ol? e H “t

”? gn ik hco uo y rAe “

-t ne it ap e e ivsn n osp o er D ag skin t’s I ayb wtrtaS o

H1

ne m et at Sr ed no ps e eR th ev ig ,y ll a m ro n gn ih ta er bt on si ro ake ps to nn ac entit ap eh tf I

.s uo ic sn oc nu se m coe bt ne it ap eh tr o de r .t clea ecj isn bo oi eh tc t urt eg s do bo ls eh id t l to itn st u p st m et sur ta ht thi tse w hc de h ec it rop w s dn w ol a b SM ackb E tr eta lea rn ),t elt ne .A ic st s ffi us urh si tst do eh n c da ot eh ev a( om de n tn eh rag ts si w ol no b sis kca ier hbti m p w ne ni h ge WB

2 3 4

SECTION TWO

s w ol b cka br veil ed ly m r Fi dn a die s eh t lftoe s uro y no iti so P

.t ne it ap eh t dn s ehibyl wth o l glis B dn k aedi c se a th B to g niot n i isop ka o ek h at, C sw s olb u kc ba io c ervli s ed n o

o C1

.d ar rw of tn iet ap eh t na le dn a, dn ah en o hti w ts eh c het tr op upS

ev fi ot pu dn ah re ht o eh tf ol hee ht hit w se adl br ed lu oh s eh t ne e w te b no sr ep eh t keitr s yl m irF

2 3

.s w lob .nt ev eti fil ap la e ev ht ig ro ot itn o anh m t d erh ane ta h r at er ow lb b o hc tt ae nie hit at p w eh no t it eg cu ar rt u sb co o ne eh ,s t ra vee lec lie n r iot ot c is urst mb aie eoh t .T se fip m it toS

.s ts u thrt se ch to hc ti w s, no it cu rt sb o eh tr eal ct on od s w ol kbc ab ev fif I 4

s.ti p m ra

s tu dernu s r ,yd h ob Td t nuo s ra es h rma C ru g oye n i clap k dn o at h eni C tap s eh ut ind io c heb s dn n taS o C1

.r et ne c eh t ni te e m sb ir het ree h w tn io p eh t hc ae r uo yl it nu rda w pu ibr ts e w eloh t w oll oF

st s ruh Tt s heC ngki o Ch s oui cs no C

tn ie apt dn hei b

xe dn i dn a el dd i m ru oy ec al p nda ) m un re ts ( en ob ts ae rb eh tf of la hr e w ol eh t no h otcn eh tl eeF

2 3

.h ct on het no re gn fi

si is T .h tco n eh t on rse gn fi

.e agc ibr eh t

uroy ev ob a tei st su rh t eh t . no R ed PC is r b fos m uh at t ni eh op t n cea osi pl sre dn p stafi com a em ek as a e M ht

.t sfi eh tf o dei st uo eh tr ev o dn ah re

oner sus er p gn it utp di ov A .s ts ur ht dr a w ni kc iu q ev fi o ptu m ro fr eP

4

5 6 7

thoe ht ec la P

ste hc ev fil la vei g ot na ht erht rat su rh tt se hc hc ae hit w no it cu rt sb o eh t ev eil re

.t enit ap eh tr oit no m dn a eh at

rebo tt ne it ap eh t eg ar uo cn e, rsa lec no it cu rt sb o eh tf i tois optS .s im a tsu e r T ht

.d nu or g eh t ot t tiena ps uo ic sn oc nu eh t pl eh lyl s uf n er o i ac g ,p e l R eh ll ot A g iy in n d tr e e s uar U - oy t eil n hw e it suo a iscn P oc g nuse n i om k ceb o tn h iet C ap s gni u ko o i hc,e siv c s n onps o er c afI n

U1

.d llea c yd ae lra to nf i S M E et av tic A

.5 lil kS er a C yr a m ir Pr ep s aP R C ni ge B

eh t ev o m er dl uo hs uo y, ne es ist ce jb o anf I. no it cu rt sb o el bi si v yn a ev o m er ot tp m tet a dn a utho m s’t enit ap eh t ni ko ol lyk ci uq ,s no is se rp m oc ts e chg ni w oll oF

2 3 4

le ibs iV veo m eR – h uot n M tio ni cu ko trs b Lo O

s tha e Br eu c eRs

PCR ing Be – S EM te vait Ac

. r.e gn fir uo yhit w cte jb o

.s ht ae rb eu cs er o w thi w de ec or p, de vo m re ne eb sa ht ce jb o het ro ene ss ctiej bo on fI

s.e ivr ra S M E ro de ve il re si no it cu rt sb ol it nu R Pe C un it no C

6 6

gn ik oh cs uo ic sn acot si ss a ot sp tes eh t rm of re p, pu rog ec tic ar pr uo y n I

t,n iet ap eh t is e ,ons pe ts eh t gn id ae r, ed iu g eh t is no sr ep en O .t ne it a

eh t sa h en oy re ve er esuk a M .r ed r. no ed ps no e ps R e yc R ne yc gr en e gr me E m eh E t eh si t re sa tho tca eh ot t ec eil n h ah

p w c

T I Y R T

.e ict ca rp gn ir ud s low br o st su rh t m ro fr ep yll uat ca to n o D -r eb m e m e R

ash oh w tn eit ap gan tis is sa ro f sp et s eh t m ro fr ep ro /d na ss uc si d, tx e

la re ta lr o/ dn as w ol ckba b -t ne di cn i gn ik oh c a m or fs uo ic sn con u e m oc e


se cn at s m uc ri cr etl A ou.y tc eri dl li w ro tc ur ts ni ru oY . R P C ro tss ur tht se h

1 -3 2

r.o tc ur ts ni ru oy yb de tc eir d s Nb c a

SECTION TWO

2-31

s


r

i r

s

A E

D

2 -3 2

2-32

lli ks er a

t ine ta Pr of

S

B

A

A

r

p l

e

H

C set

l i

t

ns hC ois esr p m o

n

U e u

n i t

n o C

C

s


B

enp O ya rw i

s e v

A o

gn hi aet r

g ryu ind e njI lBe al su kc inp ori oh S eS S

no it at ne ir O

ra se–U yC m ir ne P gy de x dn O e ycn me com e ergm RE SECTION TWO

s

s

g inh ta

B re A ywair B

A

l a o G r u o Y

tn iet ap a ot ne gy ox yc ne gr e m er tes in i dm a ot w hoe ta rt sn o m e D

?y la m or N ?n ep O

.y ru jn ir os se nll i gn in et ae rh t feil rosu oi ers a thi w

y ? ll a m r o N g n i th a re B

fo es u ith w ts sis A

e n o D

gen.y x O y nce gr e m E

s t n i o P y e K

t.i nu ne gy xo pu te s tos no tic ur ts ni

tI stemys ’s w w loolF o H1

.k s a m to gn i w ofl si ne gy xo ath tt se t dn a ly w ols no ev la v rnu ts ya lw A

ecla p dn a ne gy xo ed iv or p ya m uo yf i ska ,t ne tia p ev i onsp se r ar oF

2

3

.S M Et r lea dn a nee cs ss es sa tac ne ht , nki ht p,o st ot re b m e em R •

dn a esv ol g gn is u yb oin sis sm anr t es ae dis m rof tn eit ap nda fl e rsu oy t etc roP •

.e lb ali av a otn rea res ir ra bf i er ac yc ne gr e

,t ne m te tSa re ndo ps eR eh t g inv gi by kc e ey chs m al se det vne i no nso o p D .e esr bla tn ila eit va ap fi a sr m eir rof arb erP •

e.n ob ra l con ton iet pa pa t, e nso ps re on fi dn a

seu to lya d un een tin ya oc m ot uo er yt ah Caf t o ts el i nu cy C eng eh t yx o se ndua us. ency tn tat reg e sl m m ss aci ee e de ht ssa m iht yr st’ w a ne rai i l m rip ta im p a a fa r e m ro toi om fr no c eP m eB • •

or e m afl fo e rcu os .c yn et, a lo m ro hco fy ,sk aw ro a a w re e, ad m hot litate a n - ev a em ht in seu gne ot xy de yo en nc e uo gr y em roe e efb esU •

.e urs se rp hg hi erd un er a s nte nto c es ua

t.a eh

bec ly uf er car ed in ycl ne g xoy el nda H •

ta. eh tot i ngi s pxo er o re nldi yc gn ppi or d di ov A

epl Ihya ale. h m ,n xet eg on yx s o e iss od i tu T , b, ya S. es on dn a ht uo m s’t ne it ap e thre vo ska m

? oyu

.d tec i stre r is es u ne gy x ,os n iog er e m os In •

.s kc tat at ra eh dn a tsn ed ic ni

tn eti aP no ks a M e acl P

ska m m or f ht ae rb ts rfi se ka tr e ndop se R

g inv di ab cus ,g inn w rdo aer n ro ft ne m ta tree ta rpi or pp a si ne gy xo yc ne gr e m E •

w ol tFs eT

n gye x O no rnu T

geu aG ne gy xO ro itn o M

edd dA ithw sh ta reB eu en cg esR yxO

ask M s lod Ht ni tea P

eh ta er b ot tn eti ap eh tl le t dn eac al p ni ks a m eh t ldo ht ne it ap eh t ev ah ,s ee rg at ne i pat eh tf I s

ly.a m ro n

e.c a plin ti pe ek ot pa rt s eh t es ,uk sa m eh t ldo ht ’n ac tn ei pat eh tf I s

hti w er uc es dn a thu o m dn a es no’s tn eit ap no ks a m ec lap ,t ne tia p gn ih ate rb ,e vi sn op resn u na orF 4

sh ate rb eu sce r lyp pu s ot uo y sl ow la ta ht ks a m a seu ,t ne tia p gn ih ate rb -n on ,s uo ic s .p rat s

oncn u an orF 5

.k sa m ot ins w ofl geny xo eil h w

t.n eti ap eh t no lil st si ks a m e ethli h w ti gn iy tp m e di ov a ot eg ua g er us se rp itn u ne g xyo ro ti no M

s.n oi ge r e m so in de ri uq erb ya m ne gy xo yc ne gr e m e gn ir et si ni m da ni gn in ia ltra no iti dd A

6

7

’sr toc ur ts ni ru oy g ino w llo ft in u eng yx o na pu te s, pu or g ec tic rap ru oy nI

en O .t ne it ap ev sin op se arn ot ne m ss es sa rya m ir p a m ro fr ep ,t xe N .s onit ce ird

si erh to eh t eil h w ,t n atiep eh ts i en o, sp et s eh t gn id ae r, ed iu g eh ts i no sr ep

ru oy gn i w lol of ne gy xo cyn eg re m et ne tia pr eff .O re dn op se R cyn eg re m E eh t

.s no it ecr id ’sr ot cu rt sn i


re lt A .r ed no ps e R yc ne gr eE m eh ts . at rot ac cru to tsn cen ir ah uo c yy eh b t d sa et h ec en ir oy ds re as ve ec er na us ts ek m a cuir Mc

3 2


2-33


4 -3 2

2-34

ni tn e m ss ses a eh t m orf re p e,l ib

d i A t s r i F

er ayr 1llik tn C ad Ser emss a es no Cyr sA air uryj m Sec P nI SECTION TWO

pos ne h W •

l a o G r u o Y

dn at ne .l ti e ap onsr no e tn p) e S m M sse E ss (ec a iv ryu re jn Sl i a eo ci t- de ot M -d y ae cn h eg at re ucd m no E o c ttr to op w e hoe tors ta ei rt r sn uj o in m e teo Dn

ts n i o P y e K

d.n uo f s tin taei p e th n itos op het

ida ts r tfia h w nie rm tee d ltoi ks ish t seU •

– y ujr ni y anf ton ev e het ni dee en eb ya m

veo em r otn od , cae lp in rae sg ins se r dn uo fw I • e ivc re S acl id e M yc n ger e Em n hew ly ai ecp se

ro nso it ar o olc isd ,g .t ind ne ee l m ss ,bs es dn sa u . o s the orw ite g f m inr ko orf ud oL ed •

el. abil vaa nu or d ayel dre eh ti e si

ss es sa –t ac ne t,h nki th, po t ost ebr m e em R •

.s ndu os g inh t ear bl uas nuu for ne ts iL •

,s se ntf os e sus t,i ss e dnr ah ro gn li e sw orf le eF •

by kc eh c .y ss ra ss nee cee y.l vis nf et no i ai sp S pr re ro t EM t p n lera aps atiep r nda reri a a rm nee be for s cs U eP • •

s ieti m ro fe d, sse nr den et nti jo, se ssa lm a suu nu

kae M e.r tua re p etm yd ob in se angh c dn a

tr poe r nda nte m sse ss a het fo se t lnoa nte m

sue dn t.n at e ne m et m s tas ses re sa ndo yra espr rim p e a th m gn ro i f ivg erP •

ro t ea ot g ihn ty ant .l n en ei n ta sor pd ep er S jnu i EM g to ivn gns dg dni iov fi A •

a ro itn o m ly au tnin oc to

.y re rug s de en ya m e sha k,n ir d

no tn e sm .s se tau ssa stl yr uj e r a a C d c i inm f e o m ro f e l s c t’ erp y n C e i eh at yln t p O •

st n iet ap ev sni o esp ,rs u ioc nso c

of no it an al px e efi br

e n o D

aev i G .t iss as to no is is rm ep gn ik sa ,t ne m et at s re dn op

.s ev ol g no tu P. tn e m sse ssa eh t gn ir ud gn io d be

tI resrev u’loy ’s il ta w eD hw o H1

tot ne it ap w lol at on o y.D ll ab re vr e w sn a ot tn eti ap tc ur ts ni dn a da he ’st ne ti paez lii abt S 2

.d ae h d noro ev o m

.n ia p kc ab ro eckn ,d ae hf os ni al p m oc tn eit ap ift ne m ss es sa po ts ly atei de m m I 3

ot S M E ro f gn iti a w dn at ne m ss es sa gn id ne kc en dn a da eh ez .e lii vo abt m s to o etu onD int .e no ivr C ra

da e H ez li bia tS

rsa E kc hCe

t is As to oni sis rm eP ks A

es iti m orf e rD of eel F


da eH t tna e m s ess Ats ra tS

to yd ob n w od ya w ru oy kr o w dn a da eh att ne m ess at ra tS 4

.s eo t

gn in nu r lyt ne g yb ec af s’t ne it ap no se iti m ro f der of le eF 5

.n ih c dn as ke eh c, da eh er of re vo s

tc ep su s, tn es er pf I. idu flr o do ol br of es on dn a

ergn fir uo y

rsae kc eh C

5 -3 2

t.n e m ss ses ar eh tr uf po ts dn a uryjn i da eh

6

SECTION TWO

2-35

s dea lB re dl ouh S cke hC

se Ey cek hC

dns a H ez ee uq S ot nte it aP skA

se iitl a


6 -3 2

se Ey kc eh C

r. w lol eht fot ge ne ote it v ap o ev m ah ldu ,d oh s heae esy ht E . gn gin iv kc o ra t m tu ht oh oo ti m sr W s.e fo ye es ’st ye ne kce it h paf C . ot sye no es rf ih ni ht re iw fing gern a fi ec r al uo P y 7

2-36

orm bnA ro f kc e N l eeF

.t hg il ot no it ca er dn a ez is ilp up kc eh c le,bi ss op fI

t.n e m ss ses a po ts ,n i paf os ni lap m oc tn eit ap fI s.e tili a rm on ba ro f kc en dn

ed al br ed lu oh s hc ae r ove dn ah en o ec al pr o ed lis ,s ed al br ed lu oh s eh t hc ae

.s rda w ni hs up

lau ks ele F

rnca uo yf I

lytn eg dn a

8

9

SECTION TWO

. m la p thiw rda w ni ylt ne gs se rp dn a sr ed lu oh s ot dr a w tu o s andh veo M

.rte ne c ot rse dl uo hs m or f esn ob ra ll oc eh tr ev o sr eg n fio tw nu R

0 1

1 1

erp pu eh t n w od dn ah erh to ed lis yl tn e G . m ra ez ili ba ts ot re dl uo hs no dn a hen o ec la P 2 1

sd na h ht ob no sr eg nfi le ig w ot tn eit ap sk .A m ra re ht o no ta ep e R .t isr w dn a ow bl e, rm a

s rm A cek hC

en ob ra l oC cke h C

res dl uo Sh k ech C

s.d na hr uo y e ezu qs dn a

dn a eg ac bi rs t’n eit ap fo desi hc ae no ,n i lm ap ,d na h a ec al P. yti m ro efd ro ft s chet ce ps nI 3 1

sa ae ra hc u m sa re vo

.d ra w in shup ytl ne g

n .C m ul oc la ni ps eh tl ee f to tn ei ta p re dn u sd na h ru oy put lyt ne G 4 1

ro f gn lie ef ,e ni ps ’st ient ap eh t gn loa hc uo t lyt ne G .t ne it ap gn iv o m tu oh t ie w lb is so p

.s ei alit rm on ba

dn at hg ir to er us se rp e ntle g lyp p .A ne m od abs t’n eit ap on hs up ylt ne g, dn ah neo gn is U 5 1

.l vea n w ol eb dn a ev ob a dn a, ne m od ba foe ids tf le

n m luo lCa ipn S cek hC

se no b ip H kc hCe

dn Hat sn aig At ooF sse rP

set hC cte p nsI

ne m dob A k ech C

gse L – st hg iT cek hC

.s iph n noi hs up lyt ne g dn a, rda w ni s lm ap ,s en ob pi hr ev o s andh veo M

ks A .e lk na dn a egl ero w l, ee nk ,g el re pp u eh t n w od dn ah ed lis ,h igh t eh t atg nit ra tS

6 1

7 1

.g ler eh to no ta ep e R .d hanr uo yt sn ia ga to of eh tf o el os ss er p dn as eo t el gg i tt ow ne tia p

ro itn o m ot eu nti no C el.n no sr ep S M E ot tr op er ro f yit la rm on e. ba lin ro fei l ina st’ pf nei o ta easr tpa a ert et o dn Na 8 1

.t ne it ap vei sn op se r a no ent sm se ss a yr a m ir p a m ro fr ep ,p uo rg ec tic rap ru oy nI

edy lae dr eh ite si S M E , iont au ti s ish t nI .t ne m ss es s A ryu jn Ir uo . y leb ni la ge ia b, va tx nu e r No

si re ht o eh t eli h w ,t ne it ap thes i en o, sp et s eh t gn id ae r, ed iu g eh t si no sr ep en O

.y ru jn i yr an ig a m i na fo

eh t s .A re dn op se R cy

y.r uj ni eh tt uo tc a, tn

nkith ldu oh st ne it ap hc a E .r ed no ps e R cyn eg re m E eh t

engr e m E eh t hti w yr jun i yr an ig a m i si ht er ah st on o D

em sse ss A yr jun I si h s m ro fr ep re dn op se R yc ne gr e m E


.r ed no ps e R yc ne gr eE r. m eh oct ts ur at st n ac ir to uyo cen y ah bd c te eh ce t ir sa d h sa en se oy cn re at ve s er m u us cir ek cre a tl MA

7 -3 2


2-37


8 -3 2

2-38

2l li kS tn er em a ss C es yr s ad A onc esnl eS lI SECTION TWO

l a o G r u o Y

:y bt ne m ss ses as se nll i dn at cu dn co to w hoe ta rt sn o m e D

y.r ot si hl ac id e m ’st ne it ap tau ob a no it a m ro fn i gn in ia tb o dn a lse ef tn eit ap a w hogn ik s A s

r.o lo c dn a er ut iso m inks ,e ru ta re p em t, tea r es lu p, sn oit air ps er st’ ne it ap a ingk ce h C s

rea s m top m yS . nte it ap a ith w ngo r w si se ouy g inh et om s er a sn iSg •

.l en no s per) S M E ( ec iv re Sl cai de M yc eng re m E to sg ni dn fi ingtr op e R s

s t in o P y e K

st firt haw en i m r tee d dn a no tai m ro f in re ht ag tlo kis si th seU •

hts ae br 02 dn a 21 :t ne hat etw r .g be be is no m e slt r m w e u si ,r ad u tn e yo sm e ratg s ll s ni e t e tn ss th iet ar are ap uo b y e het ed agr gn uig ev hit lp ea e he hT m  so oT u • ne h w lay i ecps e – ss en li nya otf ne ev eh t in de d een be ya m ida

.y .e rsa bla se ial ce n navu ifS ro M E edy etlr lea da dr na e thi een e si cs se ss c e vir ssa eS – t alc ca id n e e M th yc ,k ne nhi reg ,tp m E toS •

r pe tas re sd be p ee 08 hts ny ae bl dn rb a a b 60 hgt rop n ei te ee na un w ht im etb ss r si e le p stl se sh ud ka ta a t er r hw o 4b re. efo 2 t a net na lc ar it th iac es ap e d ul ro e p m e .Ae m tu ro et agr a in et ide ev a m re inu m eh m p m i T

u

g ins u by n sios i m s anr t sea sei d m or ft n iet pa dn fla se uor yt c te roP •

. res rri ba dn a se lovg

re dn pos er the gn i ivg yb kc hec ss en vei nso ps er tn eit ap a rm of erP •

yr lde ef d uol hs ni ks nda m ar w is er tu pera m et ni ks e ag .e erv t a niu eh m T

h.c uo t hte ot

u

.s tn teia ot p e e r a iv C f o o pnss e l er c y . ,s C s u eh ta uoi t ts cs es la n u ic oc nda de no st tn m n e t’sn e m m e s i sse ta se ss pa ss a r as rya oit se on ln im rp m im .t y r ne a la orf u e m em rfo nti yp tas erP onc nlO • •

ro g unl ,t r eah te cia d in ya m se g hanc ro olc ni ks leb eac it o N 

in no sr ep y thl ae h a no tn e m ss e ss .s em blo rp n iot al ciur c

u

dr o w eh t g usin ido va ,l en no rse p S M E ot no tai rm of in gn i ivg ne hW •

as e lni na gn i cut dn oc yB 

uo y ne h w re t la se nec erff id es in ogc e n. ort soer leb p a yht eb la li he w nu uo n y, at ss is al ss c a

u

ss e lni na ctu cond ot w o reh b m e m er to E PL M AS ci no m en m e th

s,e i ev rge tpi lA i scre s,m d top dn m a Sy e dn unt i a m ng re iS p ro se f ta sd r de ant s usr EL ae P m M AS dei :t vo y ne rP og .l lo m ss a in e m orn erm t esU sa •

s.t ne Ev dn ael m ts aL , roy ts ih la ci de m ntgi si xe -e rP , nso tai ic edM

sel Pu id otr aC gn i cek hC

sse nll I eh t es U .n iot a fn orm it ne m ss es sa ss en lil rdo ce r tol ic ne e p/ne n pa o d D nar e ap t’s I ad w niF

o H

1

.n oti ce es

cn rfee e R eh tf o dn e eh tt at ee hS rdo ce R t

nem ss es s A

.n oit a rm of ni dr oc er es le en oe m os ev ah le,bi sso pf I 2

ovlg no tu P

.s esn lli fo te sn o eh t e efor s m blye o t taid p em m mid y er S ruc d cot n ah a wd s na n gin g i elef S ist – neti a pw E L P ohk M sA

3

1

.d ed ee n ne h w es

A S

:e du lc in ya m nsoi ts eu Q

? w on le ef uo y odw o H

r?u cc os m ot p m ys ts rfi eh t d dine h W ~ l?li le ef to na ge b uo y ne h w gn io d uo y er e tw ah W

s s s

.d anh en of os re gn fi ledd

?d er ru cc os m top m ys ts rfi eh t ne h w uo y er e w re h W

.u oy ot ts es ol c e side ht no kc en eh tf o ev oo rg eh t ot ni n w od sr eg nfi e thed il S

:y im re dna tr xe a dn di ie to th ra th c iw eh el t ppa gn ’s is ma u dA et ’st ar en e t es tiap a lu e R e p ht ls u ndfi tecao P g o L n i s ss s s d n i F

.e ids eit so pp o eh t toe ov m ,u yo tot se so lc ed is eh t no sel up eh t dn fit ’n a uco yf I

e. im t em as eh tt as ed is ht ob no es lu p idt or ac eh tl ee f to yr rtve e N

.e tu ni m re ps ta eb tr ae h eh t en i m re te d to o tw yb lyp til u m dn as dn coe s 03 in st eab fo re b m un eh


9 -3 2

tnu o C

2

SECTION TWO

2-39

se ulP rey tr Al a dia R g ink ce hC


0 -4 2

:y .d re na tr hf al oe ai dsi da b r muh eh ,t t tisr gn w is st’ u neti et a ar pn es ory lu et ra dpn tecao fi L os 

.e di s b m uh t eh t no dn ah eh t w ol eb yl tea i edm m it si r w eh tf o ev oo rg eh t ot ni rse gn fi ee rh tr o o tw ed il S s

.e lsu pl iad ar a gn ik at enh w b m uh tr uo y es u otn o D s

3

2-40

SECTION TWO

.e tu ni m re ps ta eb tr ae h eh t en i m re te d to o tw yb lyp til u m dn a sd no ce s 03 ins ta eb fo re b m un eh tnu o C s

.k ae w ro ngo rt s, di pa rs a de bi rc se d eb ay m els up eh tr eh eth w ine rm et e D 4

sn iot rai spe R ngit uon C

n o ti ra i p s e R g n i k c e h C

:gin du cln i, ss ret si d yr ot ar ip se rf o s m ot p m ys dn as ng siro f ko o L 5

.s eh ta reb ientt ap eh t ne h w se si on edh cit phg ih ro gn il rgu g, gn ezi h W s

.d ed ae thh gi orl yz zi d gn lie fer o tha er bf os se nt ro hs fo sn ia lp m oc ntie ta P s

s.g el ro s m ra ni gn il ingt ro ss en b m un dn at se ch eh t in ina pf os ina lp m oc ntie ta P s

s:d oh te m o tw fo en o es u, se tha er bt ne it ap as e im tf or eb m un e thn uo c o  6

.s no it rai ps er eh tt nu oc andl la f dn a seir ste hc ’st ne it pa hc ta w lyp im S: odh te tsM ri F s

.n en e tfo m od ts ba nei ’st taP ne s. it n ap oti eh air t ps no re dn t’s .de ah nei tn ec tap uoc lap e g ,ll ht nei f fa ot be d n r anes ouc hsat rit an ear se ita br hc bo ei ’st ot hte ne st ra it r w ap off a eh er em t uo oc ee y e st ks b on a yeh t na m c to ife uo uo ta yf ys rg I: w in o odh lla hta te no erb M itsi ri nod pos ther ce i tel S Ta s

en i m re etd ot o w t yb yl iptl u m dn a s ndo ce s 03 ro fs no tia irp esr ’st ne it ap tn uo c, sd oh te m h otb ro F s

.e ta r ryo ratip se r

.g inp sa gr o gn iz ee h w ,d reo ba ,lo w sl, sta f sa de bi rc se d eb ay m sn oit ar ip esr re ht eh w ine rm et e D 7

e r u t is o m d n a e r u t a r e p m te g n i k c e h C

er tsu io M – rue ta epr m Te gn kic eh C

ru oy no dn a erhh to ru oy gn is u er ut ar ep m et n w or uo y hti w er ap m o. C dn ah ru oy fo kc ab eh t hti w eke hc ro da eh reo fs ’t

.e si cr ex alec is yh p gn io d ne eb sp ah re ps ah tn eit ap eh tf i yif re

enita lpe eF

.ad V eh er fo

8

.c t ,eym am lc ,t iso m l,o oc ,t oh , m ra w si ni ks eh tr eh te h w ine rm et e D 9

r lo o C

-d na -k c blar o hs i w oll ey ,e ul b, edr ,) ye rg ( enh sa e,l ap lye em rt x ase edb ir cs ed eb ya m ath ts eg na hc ro lo c ni ks tn rea pp raof ko o L

n g i n i m r e t e 0 D 1

.s e tchol b eu lb

e)n il nae rd (A e inr hp e inp E

.s beo lr ae

?

fo ed os i

ndas yee eh tf os eit h w ,s m la ,pe ug no t, s m ug ,s ipl s,d eb ailn eh t no se gn ah cr loo cr of kc eh c, ni ks kr ad sa ht n tieap eh tf I

low of dn a yc ne gr e em la icd e m as as no it ca er ci gr lel a e vere st ear 

epro ir p a de re ffu s ev ah oh w el po eP .) nil an er da ( en ir h epin pe yb de ta er t eb na c) isx al yh pa na ( no it ca er icg re l alre ev es A

3

4

1 1

E – L P M

tieap fi ks A

nism ag ro na yb gn ut sr o ne tit b ene bt ne tia p eh t sa H ? ctoi gr lel a eb ya m eh gn ih ty na ne ka tr o de ts eg ni tn iet pae ht sa H

S

1

2

s e i g r e ll A

A

.c et, re atm en ro rbi ,as gu rd ,d oo f gn ih ty na ot ci gr ell a ist n

s.e ru de co rp er ac yr a m ir p

ro ro tc jen utoia eh t es ut ne it ap eh t ev a H .) nil an er da ( en ir hp en i fepo ro tc ej ni ot ua na m eh tr of de bi rc se rp . ev se ah us ne tih fto it s w axily em h hp tst an iss a a

eb ay m lin)a enr da ( en ir hp en ip ef o es od dn oc es a, leb ail av at o isn ec na sti ss al ac id e m edc na vd a ne h w se cn at s m uc ri c uals un u nI 5

sUe ro t ecj ni ot Au

:e du lc ni ya m sn

.t si rse ps xia ly pha na fo s m ot p sym fi ne ivg

tiose u Q .n oit id no cl ac i s dem n a o it rof a noita c i cide d m e se M katt n

–

?n iot ac id e m ek at

E L P

uoy o D

tieap fi ks MA

A S

1

e?k at uo y od no it cai de m fo ep yt ta h s,w ey fI

ssss

y?a do t no it ac id e m ek at ouy id D

?n eh w dn a ek at uo y di d no it ac id e m hc u m w o H

.n iot a dice m eh t edb ric se rp oh w ro cto d eh tf o e m an te gr o/ nda le nn os re p S M E ot ev ig to no it cai de m ll at ce ll oc le,bi sso pf I


1 -4 2

2

SECTION TWO

2-41


2 -4 2

s ,ste n eb o it iad, i noi d tid n n o tcorae C l ,h a ..g c i e(n d otii e dn M col g aicd n it em g s i intis x xe e rep .) e r aas tce, P ht syp – ne eil E L

tiap fi P ks MA

A S 2-42

pea, m ht sa

1

SECTION TWO

de m us no c sa h e ifh sk A .e ta tn iet ap ta h w l dnal a ea e m M aad t hts s la a tn L eti – ap E enh L wk P s MA

A S

1

vei sn op se r a no

.s gu rd la no it ae rc er ro l ho cl a yn a

s.s en lli ot pu gn id ae l st ne v s t ete n on e ro v tu E ob – at ient E L ap P ks MA

A S

1

nte sm se ss a yr a m ir p a m ro fr ep ,p uo rg ec tic rap ru oy nI

is S M E ,n oit au ti ish t nI .t ne m ss es s A ss en . ll leb Ir a uo lia y av ing nu eb ro ,t de xe y al N .t ed ne re tia hit p e

T I Y R T

eil h w ,t ne it ap thes i en o, sp et s eh t gn id ae r, ed iu g eh t si no sr ep en O

ss en lli e thg nit cu dn oc re dn op se R yc ne gr e m E eh ts ir eh to eh t

no sr ep yh tl eah nao tn e m ss ses as se nll i na gn it cu dn oc y B .t en m ss es sa

ts is sa uo y ne h w teral se cn er eff id ez in go ce r ot el ab eb lli w uo y, ss al c in

.n os re p yh lta eh nu na

. yc rot ne cru gr st eE rinu m eh oy ts yb at d e ac tec to ird cen as ah se c cn eh ta t s sa m h ucr en ic oy re re lt ve A er .re us dn ek op a se MR

s t n i o P y e K

3l li kS er a Cg yr n ad ig noc ndaa eS B

nya fo tn ev e e th in de de en be ay m aid srt tafi h w en i m etr ed ot ilk s ihs t es U •

or edy lae dr eh ti e si cei vr Sle deica M yc eng re m fiE ly ica pes e – ryu j in

l a o G r u o Y

. ray ss ec en if S EM ret la nda en ec s ess sa –t ca ,k inh t, po st ot erb m e m eR •

.e lb lai av nua

re ll ro gn is u m ra ro dn ah ,g el ,t oo f a eg ad na b to w hoe ta rt sn o m e D

.s gea dn ab ra lu gn a trid na se ga dn ab

r iotn o m ly a ntiu no c ot

. nte m tae str ed no spe r eh t nig v gi yb k ech c sse ne . vi lye ns ta po ir s e opr rt pap neti sr pa eri a arb rm of sUe reP • •

ngi udl nci se ga re nda a C bf f o o le c esp y C tyt e ne th use fier d nda alr tn t.n ev e e m s e es sse uta sm d ss st ess luc s l a a a in rya uc ry ya d u m i e jin m itk pr m a ’st na id ne m a rm o it ro ts ref pa ref fir P a P A • • •

sr el or e uza g, se ga nad b gn i m ro nf ,co psir ts ev is e dha ,s eg dan bar a ulg na i tr

rs.e l ro itc asl e dn a) no tto c tics al en o (n

.s ve t’s I olgn o w tuP o

. ndu o w eh t gn ir ev oc gn is esr d eil re ts ar ev o ytl ce ri d eg dana b yl pp A

t.ra eh eh t rda w ot dr a w pu kr o w dn a dn uo w w loe b eg dana b yl pp A

eg a nda k b c gn eh ik c a ot m de di s voa opx - es lyt re ne gn ts fi is d no na c se dn to a e yl va m rfi eL . eg th ad gti na oo erbll orte or so pa ol r o W ot

1

2

3

4

e n o D

H

of e ust se b het ek a m ro y urj in the no de sa b gae dn ab ts eb eh t seo hCo •

eg ad anB rue ce S th g Ti oTo gea d anB gn i ak M d ovi A

. leb ilaa va is re v tae h w

.e ca lp ni ti gn ip at ro gn ik cu t, gn iy t yb gea dn ab f .no it al uc ri c

odn e er uc eS 5


gae d aBn elr Ro apr W

3 -4 2

dn uo W re v Co

rs rie Ba se olv G es U

SECTION TWO

2-43


4 2

2-44

se m it la re ve s el kn a eh t d unor at i gn ip pa r w yb gea dn t. ab oo er fe uc th es n ,t o oo eit f s eh yr t ju gn ni ig r ad ve anb koac ne b h ne W th

t.s ir w eh t dn uo ra dn a b m uh t het re vo ti gn ip pa r w yb eg ad na b er uc es ,d na h gn ig ad anb ne h W

e.ti s yr uj ni ez i abilt s ot tn io j eh t ev ob a dn a w ol eb eg ad na b, de vl ov ni isw ob le fI

.y ru jn i eh t ez lii b stao tt ni oj eh t veo ba dn a w ol eb eg ad na b, de vl ov ni si enk eh tf I

6

7

8

9

SECTION TWO

.e vo m ret on odd na ec lap int ce jb o eh t eg ad na b, tc ej bo de la p im n isae re ht fI 0 1

nd Ha gn ig a nda B

net m ec al rPe po Pr

bis R ne ko rB le isb so P gn itr pop Su

to Fo gn i agd n Ba

ra lu nag hiTrit w yr jun It ro pp Su

d En Tie– eg dna aB er uc eS

r.e dl uo hs ro s ,rib rm ar ep pu eh tf os ier jun it ro pp us ot se agd na br al nguai rt es U

s e g a d n a B r la u g n a ir T g n i s U 1

r.e ldu oh s eh tr ev o eg ad na br al ug na rit eh tf poo t ec al P

.e agd na b eh t erv o dn at se hc eh ts so rc a rm ae ro f gn ir b, w ob le eh tt ar m a dn e B

2

3

fo kc ab eh tt a off iet nda re ldu oh s eit so pp o eh tr ev o eg ad na b eh tf o dn er ew lo gn ir B 4

.g nli s eh t ni

.ck en eh t

ae rm ht gn ik co l, w ob le s’t ne it ap eh tt a eg ad na br lau gn riat ffo ei  5

stn ia ga m ra eh t ldo h to e dagn ab ra lu gn iar t dn oc es a seu ,d et ce ps us er a sb ri en

dn a lsi an re gn fi in eu ss ftio ro lo cr of ko o L .d es op xe rse gn fi eh t ev ae lt ub ,d n ahrt op pu S 6

eg ad n Ba

.sl ia ne to

t.s eh c eh t dn uo ra dn gani ls eh tr ev o eg ad na b iet yl p m iS .t se hc eh tf o ed is rokb redu ne jin h e W th 7

re ll ro a gn is u a rm o ge l a gn ig ad na b ec it acr p, pu or g ec tic rap ru oy nI

rya V .g nli s m arn a ek a m ot eg ad na br al ug na ir t a es u ne th, eg ad na b

T I Y R T

yl no uo y, re b m e em R .u oy tc eir dl li w ro tc ur stn ir uo y –s eit s dn uo w eh t

.e lb ailv an ur o de ya le dr eh ti e si S M E fi sd nu o w eg ad na b

eil h w ,t ne it ap thes i en o, sp et s eh t gn id ae r, ed iu g eh t si no sr ep en O

eh s t as sa e h cn en ta s yor m e u evre cirr us elt ek A a .re d M r.e no dn pse op R se cy R ne yc gr eng em re E m eht E s eh a ts tc ir ao eh te to c eh anh t c

r.o ctu rt sn ir uo y yb de tc eir d

se ru tc ar F dn as 4l iont li ac kS ol er siD a r C of yr g ad ni onc intl eS pS

,d et a ocl isd ,d e urt ca rf a ez ili bo m i nda tc et or p ot gn i ntli ps sUe •

l a o G r u o Y

.r e tu c a rf r o n io t a c lo is d a to t n il p s a ly p p a to o w h e n i m r e t e D

s t o in P y e K

fo nte ve e thni ed eed n eb ya m di at rfis ta h w nei m etr de ot li sski ht sUe •

rt.a p y odb de ina rt sr o de ni ar sp

edy al ed erhit e si cie vr Sle ac die M cyn eg er m fiE yl iac e spe el. b ury–j vaila in n nay ruo

la cri e m m co g ind lcu ni se c vie d di rig ofy t reia v a e udl nci ya m st iln Sp •

vay he, se ni azg a m ro rse pa ps w ne de l (rol s nitl sp de si v rop m rio tns il sp

tr ap de ujr ni het rue ecs sol a ya m uo Y tc.)e ,d aro b d dde ap , rda o dbr ca

if S M rtEe al dn a en cse ss es sa –t ca ne ht ,k ni ht ,p tso to ber em m eR •

asry. se ce n

;r eg nfi de ujr n niu an to erg fin de ru nj g.,i. e( tr ap y odb de ujr n niu an to

nig us y nboi ssi m nsa rt es ae isd m o ftr ne tai p uor y dn a lfe sr yout c toe rP •

to yr T n.e th iga trs ot yr tto n o D d.n uo ).. ionf ct ti ,et spo se e ch th eh in t ry to uj m ni ar eht de t r n jnu ilp i S • to n re rsa ier ra b if er ca yc ne rge m e ya eld to n o .D el b lai av ifa rse ir ra b

e.l b lai av a

.g itn ni pls tee lp m oc ouy lti nu yti m xtree het fo tn e m veo m e iz m i in m

re d onp se r het gn vii g yb cke hc ss en ev sni op se rt n iet a ap m orf re P •

si Th. eit s ryu j in eh tf o se di s ht ob no sl ria tae tnm lip s e acl p, leb ail av faI •

om fr se onb het st n vee rp dn a yit m er tx rued nji het of n iot toa r tsn ev er p

ni ap dn tra of m oc si d reo m de. gni lv su vno ac i t re uo sae ithw onb os er od o n ac m or uo o y w tf fi i yl ngi not chu inl ot pS •


tn. eti ap e th ot

yl au int no .e no br al oc no tn eti ap pa ,et sn op se r on fi dn a nte m tae ts

toc er aC of el yCc e th es u dn at ne ssm es as ray m ir ap rm of re P •

5 -4 2

.s tau slt a idc e m tsn’ eti a rapo int o m

.t ne m sse s as ruy nji an m orf re P •

SECTION TWO

2-45


6 -4 2

.y ru jn i eh t

y.r jun i eh t

elow b dn a ev ob as tn io j ez iil bo m m i ot hg e uon n eg o no D ltn i spl t’s I ase o w ohC o

ndat inl ps ne e w te b gn id da p lep m a lyp pa ,s tn lip s di igr

1

H 2-46

.ll e w sa s w lol oh yd ob la ru ta n eh t to

na ,e ga d ban arl ug na ir t a, eg ad na br ell or a gn is u yb ec al p ni tn

gnsi ingd u da ne p h dd WA

lips eg ad na B

2

3

SECTION TWO

.s la rie at m el ba ila va re ht or o ep at ev is eh da ,e g dana b cit sa le

ne so ol t,n e abs si els up fI .g int nil ps re tf a dn a er of eb no it lau cir c ckeh cs ay lw A 4

ntli pS da P

no tia lu rci C kc e Ch

lpint tSc e ror C es o hoC

e Plac ni tn lip S gea nad B

in e isut fo ro lo cr of ko ol ,s ih t od o  .s nr ut er es lu p eh tl ti unt nli ps eh t

.s ila ne ot d sanli an re gn fi

.g tini lp sr et fa gn lis in m ra ec al p, m arr ep pu eh t in si e turca rf eh tf I 5

fo yt ei arv a ry . arm ro ge l a gn it inl ps ec tic ar p, pu or g ec it ca rp ru oy nI

leb sis op es u dn a efulc ru os er e B l.a ir et a m gn tin lip s de lip pu sro tc ur ts ni

T I Y R T

eh t lei h w ,t enti ap

.u oy dn uo ra dn uo fl air tea m gn tin lip s

hets i en o, sp et s eh t gn id ae r, ed iu g eh t si no rse p en O

ec y anh bed c tc eh re t id sa s h as en e c eryov stan e m er urc su cir ek e a lt A M .r r.e ed d no no ps pse e R R y yc c ne ne g rge re mm E E eh eth t s isr at eh ca to ot

g linS ni m Ar e alc P

r.o tc ur ts ni ru oy


Tis Page Left Blank Intentionally

7 -4 2

SECTION TWO

2-47

SectionTHREE EmergencyREFERENCE Contents Alphabetical Order A Allergic Reactions ......................... ............ 3-15 Asthma ........................... .......................... 3-14 B Bruises ........................... ........................... . 3-6 Burns .......................... ........................... ..... 3-8

E C N E R E F E R Y C N E G R E M E

C Chemical Burn ........................................... 3-14 Choking, Adult ................ ........................... .. 3-3 Choking, Child ..................... ........................ 3-4 Choking, Infant .................... ........................ 3-4 Cone Shell Sting ......... ........................... .... 3-19 Convulsion, Febril ......................... ............. 3-14 Coral, Jellyfish and Hydroid Stings ......... .... 3-18 CPR, Adult ....................... ........................... .. 3-3 CPR, Child ........................ ........................... . 3-3 CPR, Infant ........................... ........................ 3-3 Cuts ........................ ........................... .......... 3-6 D Dental Injury ................................................ 3-6 Diabetic Problems ......................... ............. 3-13 Dislocations and Fractures .......................... . 3-5 E Electrical Injury ............................................3-7 Eye Injuries ..................................................3-6 F First Aid Kit, Assembling a ............................3-2 Fish Spine Injury ........................................3-19 Frostbite ......................................................3-9

1 3

3-1

SECTION THREE

H Heat Exhaustion ......................... ............... 3-10 Heat Stroke ............................................... 3-10 Heart Attack ........................... ................... 3-12 Hypothermia ................................................3-9 I Illness Assessment. ......................... .......... 3-10 Illness Assessment Record Sheet ..............3-21 Injury Assessment ........................... ............ 3-5 Injury Ass essment Record Sheet ............... 3-23 Insect Stings ......................... .................... 3-18 O Octopus Bite ......................... .................... 3-19 P Poisoning .......................... ........................ 3-15 Primary Care ...................................... ........ 3-3 S Scrapes ...................................................... 3-6 Seizures ........................... ........................ 3-14 Snake Bites .............................................. 3-18 Spider Bites .......................... .................... 3-18 Strains and Sprains ......................................3-6 Stroke .......................... ........................... .. 3-13 T Temperature-Related Injuries .......................3-8 V Venomous Bites and Stings ............ ............3-17

lf e s r u o Y t c e t o r P

e c n e r e f e R

yc ne y gr tit e n m e eid cfi o ic ts e ya nspo ,w is no yc it ne a g m ro re fn m it ela na cid tr e op m e im tht uo a ys hw ev – ig s n iont tioa ce uit ss s i er T ac

FR E

.t it ae rt ot w oh dn a, s m ot p m ys dn sang is iav ti

ti dK i A ts ri F a gn il b em ss A

s r e h t o d n a

,) no tci teo rp m u m xia m orf ( el bi s pos ree h W

:t n iet ap lli ro de ru jn i na ot nig nd tea ne h w

gn ir eb m e m er hit w ts sis a ot yc n .e rgee cn m er e fee an r in sa de dse su u – –d alu rac na en o M tn hp/ a s ipci ino tr c/ aP sr e se b onp m u es ne R ts noh yFirc ypcn ne eg gr re e mm EE

.s) eed n d ati sr fi anl : oi itk regno d d i sea a yb t ras s r sece fi ne d yab e m k sm c eti o t ezd e s -l aclii scae l ep ivs e –s or w s ro a emtid oncne l d li etse baur u ggu D B (Ss s s

ess sa gle ne ye h w gn sd le diu ih cnl sr i; o sk dsl ei sa h m . se no R c .s ita CP afr e lti g o glov ven idnv ey es es or es U U p U • • •

no tia rm of int ca t onct na rto p im

sn eg oh ta p en ro bd oo lb ts ina ga re uc se r tc et or opt – se vo l G

no is is g nsm ar edinel t b es p ae ot si s dt lpe sn h ia ot ga d re esu uc – se s rt ez ce iss otr uo p ira ot v de s;g su ni – sse sr rd ier t r n abn iot lait ne V

berso ba eg ra L

sd nu o w ss er dn a gn id ee lb po st lpe h ot de su – se izs su oi ra v; sd ap zeu ag eli ert S

enh w sk as m cea f nda se glg og ,s es s la ungs or

sd nu o w ss er d ot de su –s ez is su oi ra v; se ga dn ab d oler gn ig inl C

ear a re ht o y an or dsn ah ru yo hs a w ays w Al •

g.n die leb si ta h ttn eit pa a g tins sis a

sd nu o w ss red to eds u –s ez si su oi ra v; se ga d nab ev is eh d A

sd nu o w ss er d ot de su – apet ev is eh d A

sd nu o w nr ub ss er d ot de su – sd ap yr d, t rene hd ano N

l raie cta bit na iht w dis flu y odb ot sed pox e

se turc raf dn a sn oti ac ols id ez lii bo m im ot eds u –s eg ad n bar al ug na ir 

g itn ae rc ,y slu or o igv bu rc S. etr a w d paan so

sd nu o w ss red to eds u – tont oc lei re tS

es u, e bla ila va to n isr tae w f .rI het ofla tso l

sd nu o w na el c ot de su – sb a w s edppi t no tt o C

.s di qiul gn sin eal c or esp i w ailr e act tbin a

le arp pa tn iet ap dn as eg ad na bt uc ot de su –s ro ciss eg ad na B

gn it nli ps sa de su eb os la dl uo c nt;e m ss es ass se nll i gn ir ud sn gi sl ati v kc eh c to –s ro ss pree d eu gn o

se ru tc ar f dn a sn oit ac ols id re gn rfiof la ir et a m

la ir tea m ng ie ro f gn iv o em r ni ts is sa to– sr ez ee w 

ali ert a m ng ie ro f gn iv o m er ni ts sis oat – led ee N

esg ad na b er uc es dn a hc at ta ot –sn ip yt fea S

lo to no it an i am xe ans a seu ot dn at hg li orf– th gli ne P

gni sl ati v a sa reu ta re p em t er us ae m ot –r et e om m re ht la r O

hs a w dn uo w ro ey e, sn ru b; ek strot ae h thi w st ne it ap dn a no it ar dy hr of –r et a w fo e tlob ez ee uq S

E C N E R E F E R Y C N E G R E M E 9 2 --4 3 3

s sss sss sss ss ss ss ss s

SECTION THREE

3-49 3-2

E C N E R E F E R Y C N E G R E M E 9 -1 3

3-19

re thr fu nIca ow H

as I? tera w hte gn iln tiS sit lle etni hS tap en eth o Is C

– dn en a ecs et e i vr B su esb po od tc na O sses s– re– A

a C tn POT iet S aP 1

y? rab en reu ta screu o m on ev

– na lp no it ca m ro f dn a yt ef sar uo yr ed is no C – K IN H T

2

er. a C fo le yce e.t C

iar ht po g rp nsi pa u sa tne ,S ti a M pr E ot T i R n E o L m A d dn na as tn se e ne m s ivs sess no a ps yr er a ir kc m

tn? tiae p het dn af yselm ehC ap tec – m ro ort TC fer p A P

sn iot ce ird troln oc la icd e m la co l w oll fo dn a ni at bo ,d et ca tn oc is

l.a ivr ra ri eh t tor oir pt ne m ta SM tred E le ec fi n ro Of

3 4 5

SECTION THREE

reu ss er pt ce dire ca lp yl tea id e m m I. ts ret a dn al ilt st ne it ap pe ek d aner us sa e R 6

.d na h edv ol gr o da p, gn is se rd lei re ts a hti w dn ouw eh t on

.d nu o w eh tr ev o no tia zil ib o m m i er u resp lyp p A

r he rut f nIa c ow H

a Is? tera w eh t ni li ts tn ite ap e ths I

y.it ilc af la ci de m o rto ps na r 

7 8

– en ec s ev re sb o dn a ss es s– A

yr uj nI en ip S hs i F re–a C tn POT iet S aP 1

?y br ae ne ru ta screu o m on ev

– na lp no it ca m ro f dn a yt ef sar uo yr ed is no C – K IN H T

2

e.r a C fo le yce e.t C a

ir ht po g rp ni pa su sa tne ,S ti a M pr E ot T i R n E o L m A d dn na as tn se e ne m s ivs sess no a ps yr er a ir kc m

tn? tiae p het dn af yselm ehC ap tec – m ro otr TC fer p A P

sn iot ce ird troln oc la icd e m la co l w oll fo dn a ni at bo ,d et ca tn oc is

l.a ivr ra ri eh t tor oir pt ne m ta SM tred E le ec fi n ro Of

3 4 5

.d e edn if kc oh sr of ta er  t.s er ta dn al ilt st ne it ap pe ek d aner us sa e R

hs fi de d bedm e ev o m er ,e no d lyi sa ef I. gn id eel b su ior es eg an a de ,m de en If

6 7

.s en ip s

09 ot pu ro f eds re m m i ev ea .L re ta w gn id la cs to nt ub to h ni dn uo w ser e m m I 8

to ns eo dr et at w oh fI .t ne m ta ret ish tt ae pe r de de en fI fe lie r ni ap fors et un i m

.d nu o w eh t ot ss er p m oc ldo c lyp pa ,f eli er n pai ed iv rop

s.c tip es it na la co l lyp p A .r et a w dn a pa so thi w d ounw na el C

.e cn at iss sa la dice m ke eS

0 9 1


3-21

t n e m s s e s s A s s e n l Il

s m o t p m y

S d n a s n g i S – E

L P M A

S

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

? onw ele f uo yo d ow H . 1

SECTION THREE

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

) o tw y b ly ip lt u m , s d n o c e s 0 3 r fo ts a e b t n u o c ; e u ls p l ia d a r r o itd ro a c e s u ( _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ e t a r e s l u p s ’t n e ti a P . 2

k a e W □ g n ro t S □ d i p a R

□ :e s l u p s t’ n e it a p e b ri c s e D . 3

). s n o ti ra i p s e r g n it n u o c e r a u o y t n ie ta p g n lli te id o v a ; o w t y b ly p til u m ,s d n o c e s 0 3 r fo s n io tri a p s e r t n u o (c _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ e t ra n ito a ir p s e r ’s t n e ti a P . 4

s g e l/ s rm a in g n li g in T □

g n i p s a G □

s s e n b m u N □

e lu B d y r n d a k y r c e a l V B □ □

n ia p t s e h C □

h s i w o t e lle W Y □ □

s s e n d e d a e h t h g i L / s d s re e n o b a zii L D □ □ g in z e e h W □

th a re b f o s s e n t d i r p o a h R S □ □ w o l S □

: is g n i th a re b ’s t n e tia P . 5

:f o s n i la p m o c t n e tia P . 6

y m m a l C □

s e h c t o l B

e u l B □

lo d o e C R □ □

t o H □ rm a W □

: is in k s ’t n e ti a P . 7

n e h s A □

e l a P □ : s i in k s ’ts n e ti a fp o r o l o C . 8

) y a r g (

s e i rg e ll

A – E

L P M

A S

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ o _ N _ _ _ □ _ _ _ _ _ s _ e _ Y _ _ □ _ _ _ _ _ _ _ ? _ _ c te _ ,r _ _ tte _ _ a _ _ m _ e _ n r _ _ o _ b _ ir _ a _ , s _ g _ _ ru _ d ? , t s o d c o i r fo g y e ll n a a t n o t ite c i a g r /p e le l a h t is n t e a tip h a w , e s e th y s I If . 1

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

o N □ s e Y □ : to c i g r e l a e b y a m e h g n i th y n a n e k a t r o d e t s e g n i s a h e h fi t n e it a p e th k s A . 2

s n o it a ic d e

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ o _ _ N _ _ □ _ _ _ _ _ _ s _ e Y _ _ _ □ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ n?o __ tia __ ci __ ed __ m __ ke _

at uo y o D t: n

M ieat p e h – E tk L P

s A

M .1 A S

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ o _ _ N _ _ □ _ _ _ _ _ _ s _ e Y _ _ _ □ _ _ _ _ _ _ _ _ _ _ ?y __ ad __ _ to __ no _ i _ atc __

. n io ta c i d e m e h t d e ib r c s e r p o h w r o t c o d e h t f o e m a n t e g r /o d n a le n n o rs e p S M E die ?n to e m eh iv ru w g oy dn to ek ae ino t a ?e tu kat cai oy uo de m an di yd m ll nda D di at ep t: ch lcel u ty nie m oc ath at w e,l o p ,H ib s ,w e s th s s e k e o y s y p fI fI A fI . 2

. 3

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

) d e u n it n o c (

t n e m s s e s s A s s e n ll I

s n o ti d n o C l a c i d e M g in t is x e e r P – E L P

M A S

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ o _ _ N _ _ _ □ _ _ _ _ _ s _ e _ _ Y _ □ _ _ _ _ _ ? __ idtion ___ no __ c __ alc __ die __ m __ g _ itn __ si __ eex __ _ pr __ a ev ___ ha __ uo __ y __ o _ D __ ?e t: p n y ite tt a a p h

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ o _ _ N _ _ _ □ _ _ _ _ _ s _ e _ Y _ _ □ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ?y __ tln __ ec __ er _ _ ate __ _ ou _

l a e y d M iD t s t: a nite

L

w

e th k s A . 1

, s e y fI

E –

L

P M A S

a p

e th k s A . 1

t? ea ouy idd ta h w , s e y fI

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ? n te a e s a tw a h

W

. 2

ts n e v

E – E L

P M A S

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ l?l ___ e _ w _ g __ lien __ fe __ otn __ r __ ouy __ _ to __ de __ l _ tsn __ e __ ev __ t _ ha __ W __ _ _ _ t: n _ ite _ a _ _ p _ _ e _ th _ k _ s _ A . 1

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ l?il __ le _ ef __ ot __ na __ ge __ b __ _ ouy __ ne __ h __ w _ gn __ oid __ _ uo __ y __ e _ er __ tw _ ha __ W _ . 2

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ?r __ cuc __ o __ s __ m _ top __ _ m ys __ t __ rsif __ eh __ t __ id __ nde __ h _ W _ . 3

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ?d __ _ rer __ ccu __ o _ s ___ m _ top __ _ m ys __ ts __ rfi __ e __ th __ enh __ w __ _ ouy __ er __ e __ w _ ree __ h _ W _ . 4

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

o N □ s e Y □

? g in s i c re x e n e e b t n ite a p e th s a H . 5

E C N E R E F E R Y C N E G R E M E

t. e e h s e t a r a p e s n o s e t o n r e d n o p s e R l a n io it d d a h c a tt A

SECTION THREE

2 9 6 -2 3

3-22

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Emergency Contact Information Home To Activate Emergency Services, call 8-1-1 or ____________________

TM

Police, call __________________________________________________________________________ Fire, call ____________________________________________________________________________ Poison Control Center, call _______________________________________________________________ • Remain calm • State the nature of your emergency • Give your location ___________________________________ __________________________________________________

Monitor a Patient’s Lifeline — The ABCD’S B B = Breathing

__________________________________________________ • Your phone number __________________________________ • Stay on the line until the operator hangs up. • Send someone to guide emergency services to your location, if possible.

D = Defibrillation D

A = Airway A

S

S = Shock Management Spinal Injury Management Serious Bleeding Management C C = Circulation – Chest Compressions

Emergency Contact Information Workplace To Activate Company Emergency Plan, call _______________________

TM

Emergency Services, call 8-1-1 or _____________________________ Police, call __________________________________________________________________________ Fire, call ____________________________________________________________________________ Poison Control Center, call _______________________________________________________________ • Remain calm • State the nature of your emergency Monitor a Patient’s Lifeline — The ABCD’S

• Give your location ___________________________________ __________________________________________________ __________________________________________________ • Your phone ext. _____________________________________ • Stay on the line until the operator hangs up. • Send someone to guide emergency services to your location, if possible.

B B = Breathing

A = Airway A

D = Defibrillation D

S

S = Shock Management Spinal Injury Management Serious Bleeding Management C C = Circulation – Chest Compressions

SECTION THREE


ISBN 978-1-61381-991-3

Emergency First Response

®

emergencyfirstresponse.com Product Number 70370 (06/11) Version 1.0 © Emergency First Response Corp. 2011 TM

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