Providing first aid to the injured. Algorithm for using an automatic external defibrillator (AND) Stages of giving the victim a stable lateral position

There are various options for a lateral stable position, each of which should ensure the victim's body position on the side, free outflow of vomit and secrets from the oral cavity, and no pressure on the chest (Fig. 19):

A b

V G


Rice. 19. Stages of giving the victim a stable lateral position

  • 1. remove glasses from the victim and put them in a safe place;
  • 2. kneel down next to the casualty and make sure both legs are straight;
  • 3. Take the victim’s hand closest to the rescuer to the side to a right angle to the body and bend it in elbow joint so that her palm turned up (Fig. 19a);
  • 4. move the second hand of the victim through the chest, and hold the back surface of the palm of this hand against the cheek closest to the rescuer (Fig. 19 b);
  • 5. With the other hand, grab the victim's leg farthest from the rescuer just above the knee and pull it up so that the foot does not come off the surface (Fig. 19c);
  • 6. holding the victim's hand pressed to the cheek, pull the victim by the leg and turn him to face the rescuer in a position on his side;
  • 7. bend the victim's thigh to a right angle at the knee and hip joints to keep the airway open and provide the flask with secretions, tilt the casualty's head back. If it is necessary to maintain the achieved position of the head, place the hand of the victim under the cheek (Fig. 19d);

If you suspect spinal injury but must leave the patient, place the patient in a modified stable lateral position.

Straighten his arm above his head, and turn his body so that his head rests on a straightened arm. This position is HAINES (English high arm in endangered spine) (Fig.20)


Rice. 20. Position HAINES

Check for normal breathing every 5 minutes; Move the victim to a lateral stable position on the other side every 30 minutes to avoid positional compression syndrome.

The “restorative”, or stable lateral, position is used in unconscious victims with spontaneous breathing in order to prevent retraction of the tongue and the occurrence of asphyxia. There are several modifications of the "restorative position", none of them is preferable. The position should be stable, close to natural lateral, without chest compression.

Sequencing

1) remove glasses from the victim and straighten his legs;
2) sit on the side of the victim, bend his arm, which is closer to you, at a right angle to the body;
3) take the palm of the second hand of the victim in your palm and put his hand under his head;
4) with your other hand, grab the knee of the victim farthest from you and, without lifting your legs from the surface, bend as much as possible at the knee joint;
5) using the knee as a lever, turn the victim on his side;
6) check the stability of the position of the victim and the presence of breathing.

Obstruction (blockage) of the upper respiratory tract by a foreign body is most often associated with food intake.


With partial blockage of the upper respiratory tract, there is a cough, sharply shortness of breath, noisy breathing, cyanosis (blue) of the skin, while the victim often wraps himself around his neck (“universal symptom of respiratory stress”). The victim, as a rule, is able to independently achieve coughing up a foreign body.


With complete blockage upper respiratory tract (asphyxia) breaths and coughing shocks of the victim are ineffective, fast loss voices and consciousness. The victim needs immediate help.

First aid

If the casualty is breathing on his own, observe the efficiency of his breathing and encourage him to cough. If the victim is conscious, but his weakness progresses, breathing and coughing weaken and stop, apply a series of 5 shocks between the shoulder blades:

  1. stand to the side and slightly behind the victim;
  2. grasp the casualty under the upper shoulder girdle with one hand and tilt it forward;
  3. with the edge of the second palm, apply 5 pushes between the victim's shoulder blades.

Don't try to land all 5 thrusts at once! Control the removal of the foreign body from the victim's mouth after each push!


If the application of pushes between the shoulder blades was not effective, perform the "Heimlich maneuver" - the application of abdominal pushes:

  1. stand behind the victim and wrap your arms around the body under the upper shoulder girdle at the level of the upper abdomen;
  2. supporting the torso, tilt the victim forward;
  3. fold one of your hands into a fist and place it with your thumb towards the body along the midline of the body in the middle of the distance between the navel and the xiphoid process of the sternum (costal angle), with your other hand fix the fist on top;
  4. apply a series of 5 sharp intense shocks in the direction from the bottom - up and from the outside - inward to the diaphragm, achieving the removal of the foreign body.

If abdominal thrusts were ineffective for the victim in consciousness, combine the application of 5 shocks between the shoulder blades.


If the victim has lost consciousness, it is necessary to start basic life support measures according to the rules described above (paragraphs 4-7):

  1. gently lay the victim on a flat surface;
  2. immediately organize an ambulance call (03,112);
  3. in the absence of spontaneous breathing in the victim, immediately begin chest compressions in a ratio with artificial breaths (30:2);
  4. before artificial breaths, check the victim's oral cavity and remove possible foreign bodies under visual control.

Obstruction of the upper respiratory tract by a foreign body in an obese victim or a pregnant woman


Technique of jerky pressure on the chest in a standing or sitting position:

  1. stand behind the victim, place your foot between his feet, grab his chest at the level of the armpits; place the hand of one hand, clenched into a fist, with your thumb in the middle of the sternum, clasp it with the brush of the second hand; perform jerky movements along the sternum towards yourself until the foreign body comes out;
  2. if the casualty is unconscious, begin basic resuscitation immediately.

The drawings show the technique of pushing the sternum in the supine position for obese victims and pregnant women.

What to do if a person is unconscious, BUT breathing?
In this case, it is necessary to provide prophylaxis possible complications(for example, in a victim lying on his back the root of the tongue may sink, which can lead to respiratory arrest; also, if vomiting begins, then the vomit may enter the respiratory tract). To avoid such complications, place an unconscious (or confused) person in a recovery position:

restorative position- This is a position on the side in a stable posture. In this position, the airways are open.
In this position, you can easily put a person of any build and weight, if you know how to do it correctly. So, you need:
1. Remove from the victim and put away everything hanging on his belt: mobile phones, waist bags, knives, etc. It is advisable to do this in front of witnesses so that later you cannot be accused of stealing.
2. Remove and set aside glasses (if the victim is wearing glasses).
3. Remove your mobile phone, glasses, and anything else from your pants pockets that could be crushed or hurt when turned over to the side position. It is advisable to do this in front of witnesses.
4. Sit on your knees on the side of the victim. Place one of your hands under the victim's knee (with outside), bend his leg at the knee as much as possible. With the other hand, take the hand of the victim (farthest from you):

Place the palm of the victim's hand behind his cheek (when you turn the victim to the side position, his cheek will lie in the palm of your hand).
Next, you simply use bent knee the victim and the elbow wound on the cheek of the hand like a lever, turning the person over:

Here is a video of how this happens (a video from the same first aid school that I went to):

Despite the fact that for some reason this was not taken into account in the video, in the classroom we were told that we needed make sure that:
- lower hand straightened and lies with the palm on the ground;
- the cheek lies on the second hand;
- the nose and mouth are not closed by anything;
- elbow upper hand lies on the ground;
- should not be "foot on foot".
That is, a person should lie as in the picture below, and not as in the video (I don’t even know why there are such discrepancies in the same first aid school):


IMPORTANT: every 20 minutes you need to turn the victim, changing the side on which he lies.

There are various options for a lateral stable position, each of which should ensure the victim's body position on the side, free outflow of vomit and secrets from the oral cavity, and no pressure on the chest (Fig. 19):

1. remove glasses from the victim and put them in a safe place;

2. kneel down next to the casualty and make sure both legs are straight;

3. Take the hand of the victim closest to the rescuer to the side to a right angle to the body and bend at the elbow joint so that her palm is turned up;

4. move the other hand of the victim through the chest, and hold the back surface of the palm of this hand against the cheek closest to the rescuer;

5. With the other hand, grab the victim's leg farthest from the rescuer just above the knee and pull it up so that the foot does not come off the surface;

6. holding the victim's hand pressed to the cheek, pull the victim by the leg and turn him to face the rescuer in a position on his side;

7. bend the victim's thigh to a right angle in the knee and hip joints;

9. check for normal breathing every 5 minutes;

10. shift the victim to a lateral stable position on the other side every 30 minutes to avoid positional compression syndrome.

Rice. 19.

Common Mistakes during basic and advanced resuscitation

Delaying the start of CPR and defibrillation, loss of time for secondary diagnostic, organizational and therapeutic procedures.

The absence of a single leader, the presence of outsiders.

Incorrect chest compression technique (rare or too frequent, superficial compressions, incomplete chest relaxation, interruptions in compressions when applying electrodes, before and after applying a shock, when changing rescuers).



Incorrect artificial respiration technique (airway patency not secured, tightness when air is blown in, hyperventilation).

Waste of time looking for intravenous access.

Multiple unsuccessful attempts at tracheal intubation.

Lack of accounting and control of ongoing therapeutic measures.

Premature termination of resuscitation.

Weakening of control over the patient after the restoration of blood circulation and respiration

FEATURES OF REANIMATION IN CHILDREN


Scheme 2.

The BRM algorithm for children has the following differences from the algorithm for adults:

BRM start with 5 artificial breaths. Only if the child has passed out in front of bystanders and no one else is around, should BRM be started with 1 min of chest compressions and then go for help;

When performing artificial respiration, an infant (a child under 1 year old) should not unbend its head; lips should be wrapped around the mouth and nose of the baby at the same time (Fig. 28);


Rice. 28.

After 5 initial artificial breaths, check for signs of restoration of spontaneous circulation (movement, cough, normal breathing), pulse (in infants - on brachial artery, in older children - on the carotid; pulse on the femoral artery - in both groups), spending no more than 10 seconds on this. If signs of restoration of spontaneous circulation are detected, artificial respiration should be continued if necessary. In the absence of signs of spontaneous circulation, start chest compressions;

Perform chest compressions on the lower part of the sternum (find the xiphoid process and step back one finger thickness higher), 1/3 of the depth of the child's chest. In infants - with two fingers if there is one rescuer and by the circular method if there are two rescuers. In children older than one year - with one or two hands (Fig. 29-30);

Rice. 29.

Rice. thirty.

Continue CPR at a ratio of 15:2;

Abdominal thrusts are not used in the management of foreign body airway obstruction due to the high risk of injury. internal organs in infants and children;

Technique for performing blows on the back in infants: hold the child in a position with his back up, while his head should be pointing down; the rescuer sitting on a chair must hold the baby, placing him on his lap; support the baby's head thumb hands on the angle of the lower jaw and one or two fingers of the same hand on the other side of the jaw; do not squeeze the soft tissues under the lower jaw; apply up to five jerky blows between the shoulder blades with the base of the palm, directing the force of the blows cranially;

Technique for performing blows on the back in children over 1 year old: blows will be more effective if the child is given a position in which the head is located below the body; a small child can be placed above the knee bent leg across, just like baby; if this is not possible, bend the child's torso forward and perform back blows from behind; with the ineffectiveness of blows to the back, one should proceed to performing pushes in the chest.

Chest thrusts in infants: Lay the child on his back so that the head is lower than the torso. This is easily achieved by placing the free hand along the child's back, while the fingers cover the back of the head. Lower the hand holding the child below your knee (or pass over your knee). Determine the area to be pressured (lower sternum, approximately one finger above the xiphoid process). Perform five chest thrusts; the reception resembles an indirect heart massage, but is performed more abruptly, abruptly and at a slower pace. Tremors in the chest in children older than 1 year - according to the usual method.

There are the following differences in the algorithm for advanced resuscitation for children from the algorithm for adults:

Any air ducts should be used with great care, since the child's soft palate can be easily injured;

Tracheal intubation should be performed by an experienced specialist, since children have anatomical features of the structure of the larynx. Uncuffed endotracheal tubes are usually used in children under 8 years of age;

If it is impossible to provide intravenous or intraosseous routes of drug administration, the intratracheal route should be used (adrenaline 100 μg / kg, lidocaine 2-3 mg / kg, atropine 30 μg / kg, diluted in 5 ml of saline);

Adrenaline in children is administered intravenously or intraosseously at a dose of 10 mcg / kg (maximum single dose 1 mg); amiodarone - 5 mg / kg;

Defibrillation:

Electrode size: 4.5 cm in diameter for infants and children weighing less than 10 kg; 8-12 cm in diameter - for children weighing more than 10 kg (over 1 year old);

If, with the standard arrangement of the electrodes, they overlap each other, the electrodes should be placed in the anteroposterior position;

Discharge power - 3-4 J / kg;

The allowance of the Ministry of Emergency Situations of Russia will help not to get lost in a difficult situation for participants in an accident, eyewitnesses of a heart attack in a sick person. The book also lists algorithms for providing first aid for traumatic injuries and emergency conditions. Such as external bleeding from injuries, abdominal wounds, penetrating chest wounds, bone fractures and thermal burns, as well as hypothermia and frostbite. Readers will learn how to behave properly in order to actually help the one who is afflicted. electric shock or swallowed water in the river, or maybe became a victim of serious poisoning. The manual also contains recommendations for assistance in case of injuries and chemical burns to the eyes, bites poisonous snakes, insects, as well as heat and sunstroke.

1. Priority actions in the provision of first aid to the sick and injured

First of all, help is given to those who are suffocating, who have profuse external bleeding, penetrating wounds of the chest or abdomen, who are in an unconscious or serious condition.

Make sure you and the victim are safe. Use medical gloves to protect from the body fluids of the victim. Remove (bring) the victim to a safe area.
Determine the presence of a pulse, spontaneous breathing, pupillary reaction to light.
Ensure patency of the upper airway.
Restore breathing and heart activity by applying artificial respiration and chest compressions.
Stop external bleeding.
Apply a sealing bandage to the chest for a penetrating wound.

Only after stopping external bleeding, restoring spontaneous breathing and heartbeat, do the following:

2. The order of cardiopulmonary resuscitation

2.1. Rules for determining the presence of a pulse, spontaneous breathing and pupillary response to light (signs of "life and death")

Start resuscitation only if there are no signs of life (points 1-2-3).

2.2. Sequence of artificial lung ventilation

Ensure patency of the upper airway. With the help of gauze (scarf) remove roundabout fingers from the oral cavity mucus, blood, other foreign objects.
Tilt the victim's head back. (Lift the chin while holding the cervical spine.) Do not perform if a fracture is suspected cervical spine!
Pinch the victim's nose with a large one and index fingers. Using a device for artificial ventilation of the lungs of the "mouth-device-mouth" type, seal the oral cavity, make two maximum, smooth exhalations into his mouth. Allow two to three seconds for each passive exhalation of the victim. Check whether the victim's chest rises when inhaling and falls when exhaling.

2.3. Rules for conducting a closed (indirect) heart massage

The depth of pushing through the chest should be at least 3-4 cm, 100-110 pressures in 1 minute.

- for infants, massage is performed with the palmar surfaces of the second and third fingers;
- for teenagers - with the palm of one hand;
- in adults, the emphasis is on the base of the palms, the thumb is directed to the head (legs) of the victim. The fingers are raised and do not touch the chest.
Alternate two "breaths" of artificial lung ventilation (ALV) with 15 pressures, regardless of the number of people conducting resuscitation.
Control your heart rate carotid artery, reaction of pupils to light (determination of the effectiveness of resuscitation).

It is necessary to carry out a closed heart massage only on a hard surface!

2.4. Removal of a foreign body from the respiratory tract using the Heimlich maneuver

Signs: The victim is suffocating (convulsive respiratory movements), unable to speak, suddenly becomes bluish, may lose consciousness.

Children often inhale parts of toys, nuts, candies.

Place the baby on the forearm of the left hand, palm right hand slap 2-3 times between the shoulder blades. Turn the baby upside down and lift him by the legs.
Grab the victim from behind with your hands and clasp them into a “lock” just above his navel, under the costal arch. With force, sharply press - with brushes folded into a "castle" - into the epigastric region. Repeat the series of pressures 3 times. Pregnant women squeeze the lower chest.
If the victim is unconscious, sit on top of the thighs, with both palms, sharply press on the costal arches. Repeat the series of pressures 3 times.
Remove the foreign object with fingers wrapped in a napkin, bandage. Before removing a foreign body from the mouth of the victim lying on his back, you must turn your head to one side.

IF DURING THE REANIMATION DURING THE REANIMATION THE INDEPENDENT BREATHING, THE HEART RATE DO NOT RECOVER, AND THE PUPILS REMAIN DIFFERENT FOR 30-40 MINUTES AND THERE IS NO HELP, THERE SHOULD BE CONSIDERED THAT THE VICIOUS BIOLOGICAL DEATH HAS COME.

3. Algorithms for providing first aid to victims of traumatic injuries and emergency conditions

3.1. First aid for external bleeding

Make sure that nothing threatens either you or the victim, put on protective (rubber) gloves, take out (bring) the victim out of the affected area.
Determine the presence of a pulse on the carotid arteries, the presence of independent breathing, the presence of a reaction of the pupils to light.
With significant blood loss, lay the victim with raised legs.
Stop the bleeding!
Apply a (clean) aseptic dressing.
Ensure the immobility of the injured part of the body. Put a cold (ice pack) on the bandage over the wound (on the sore spot).
Place the victim in a stable lateral position.
Protect the victim from hypothermia, give plenty of warm sweet drinks.

Pressure points for arteries

3.2. Ways to temporarily stop external bleeding

Clamp the bleeding vessel (wound)

Finger pressure on the artery is painful for the victim and requires great endurance and strength from the caregiver. Before applying a tourniquet, do not release the pressed artery so that bleeding does not resume. If you start to get tired, ask someone from those present to press your fingers from above.

Apply a pressure bandage or tamponade the wound

Apply a hemostatic tourniquet

A tourniquet is an extreme measure to temporarily stop arterial bleeding.

Apply a tourniquet to a soft lining (items of the victim's clothing) above the wound as close to it as possible. Bring the tourniquet under the limb and stretch.
Tighten the first turn of the tourniquet and check the pulsation of the vessels below the tourniquet or make sure that the bleeding from the wound has stopped and the skin below the tourniquet has turned pale.
Apply subsequent turns of the tourniquet with less force, applying them in an ascending spiral and grabbing the previous turn.
Put a note with the date and exact time under the tourniquet. Do not cover the tourniquet with a bandage or splint. In a conspicuous place - on the forehead - make the inscription "Tourniquet" (with a marker).

The duration of the tourniquet on the limb is 1 hour, after which the tourniquet should be loosened for 10-15 minutes, after clamping the vessel, and tightened again, but not more than 20-30 minutes.

Stopping external bleeding with a twist tourniquet (a more traumatic way to temporarily stop bleeding!)

Apply a tourniquet-twist (turnstile) from narrowly folded improvised material (fabric, scarves, ropes) around the limb above the wound over clothing or by placing the fabric on the skin and tie the ends with a knot so that a loop forms. Insert a stick (or other similar object) into the loop so that it is under the knot.
Rotating the stick, tighten the twist tourniquet (tourniquet) until the bleeding stops.
Secure the stick with a bandage to prevent it from unwinding. Loosen the tourniquet every 15 minutes to prevent tissue death in the limb. If the bleeding does not come back, leave the tourniquet open, but keep it on in case of rebleeding.

3.3. First aid for abdominal wounds

It is impossible to set the fallen organs into the abdominal cavity. It is forbidden to drink and eat! Wet your lips to quench your thirst.
Place a roll of gauze bandages around the fallen organs (protect the fallen internal organs).
Apply an aseptic dressing over the rollers. Without pressing the fallen organs, bandage the bandage to the stomach.
Apply cold to the bandage.
Protect the victim from hypothermia. Wrap yourself in warm blankets and clothes.

3.4. First aid for penetrating chest injury

Symptoms: bleeding from a wound on chest with the formation of bubbles, suction of air through the wound.

If there is no foreign object in the wound, press your palm to the wound and close the air in it. If the wound is through, close the inlet and outlet wound openings.
Cover the wound with an airtight material (seal the wound), fix this material with a bandage or plaster.
Give the victim a semi-sitting position. Apply cold to the wound with a cloth pad.
If there is a foreign object in the wound, fix it with bandage rollers, plaster or bandage. It is forbidden to remove foreign objects from the wound at the scene of the incident!

Call (on your own or with the help of others) an ambulance,

3.5. First aid for nosebleeds

Causes: trauma to the nose (blow, scratch); disease (high arterial pressure, decreased blood clotting); physical stress; overheating.

Sit the victim down, slightly tilt his head forward and let the blood drain. Squeeze the nose just above the nostrils for 5-10 minutes. In this case, the victim must breathe through his mouth!
Invite the victim to spit out blood. (If blood enters the stomach, vomiting may occur.)
Apply cold to the bridge of your nose (wet handkerchief, snow, ice).
If the bleeding from the nose does not stop within 15 minutes, insert rolled-up gauze swabs into the nasal passages.

If the bleeding does not stop within 15-20 minutes, send the victim to a medical facility.

3.6. First aid for broken bones

Call (on your own or with the help of others) an ambulance.

3.7. Rules of immobilization (immobilization)

Immobilization is a mandatory event. Only in case of a threat to the injured rescuer is it permissible to first move the injured to a safe place.

Immobilization is performed with immobilization of two adjacent joints located above and below the fracture site.
Flat narrow objects can be used as an immobilizing agent (tire): sticks, boards, rulers, rods, plywood, cardboard, etc. Sharp edges and corners of improvised tires should be smoothed. The tire after application must be fixed with bandages or plaster. A splint for closed fractures (without skin damage) is applied over clothing.
In case of open fractures, it is impossible to apply a splint to places where bone fragments protrude.
Attach the tire along its entire length (excluding the level of the fracture) to the limb with a bandage, tightly, but not very tight, so that blood circulation is not disturbed. At a fracture lower limb put tires on both sides.
In the absence of splints or improvised means, the injured leg can be immobilized by bandaging it to a healthy leg, and the arm to the body.

3.8. First aid for thermal burns

Call (on your own or with the help of others) an ambulance. Ensure the transfer of the victim to the burn department of the hospital.

3.9. First aid for general hypothermia

Call (on your own or with the help of others) an ambulance.

With signs of your own hypothermia, fight sleep, move; use paper, plastic bags and other means to insulate your shoes and clothes; seek or build shelter from the cold.

3.10. First aid for frostbite

In case of frostbite, use oil or petroleum jelly; it is forbidden to rub frostbitten parts of the body with snow.

Call (on your own or with the help of others) an ambulance, ensure the delivery of the victim to a medical facility.

3.11. First aid for electric shock

Call (on your own or with the help of others) an ambulance.

Determine the presence of a pulse on the carotid artery, the reaction of the pupils to light, spontaneous breathing.
If there are no signs of life, perform cardiopulmonary resuscitation.
When restoring spontaneous breathing and heartbeat, give the victim a stable lateral position.
If the victim has regained consciousness, cover and warm him. Monitor his condition until the arrival of medical personnel, there may be a second cardiac arrest.

3.12. First aid for drowning

Call (on your own or with the help of others) an ambulance.

3.13. First aid for traumatic brain injury

Call (on your own or with the help of others) an ambulance.

3.14. First aid for poisoning

3.14.1. First aid for oral poisoning (when a toxic substance enters through the mouth)

Call an ambulance immediately. Find out the circumstances of the incident (in case of drug poisoning, present the medicine wrappers to the arriving medical worker).

If the victim is conscious

If the victim is unconscious

Call (on your own or with the help of others) an ambulance, ensure the delivery of the victim to a medical facility.

3.14.2. First aid for inhalation poisoning (when a toxic substance enters through the respiratory tract)

Signs of carbon monoxide poisoning: pain in the eyes, ringing in the ears, headache, nausea, vomiting, loss of consciousness, redness of the skin.

Signs of household gas poisoning: heaviness in the head, dizziness, tinnitus, vomiting; sharp muscle weakness, increased heart rate; drowsiness, loss of consciousness, involuntary urination, blanching (blue) of the skin, shallow breathing, convulsions.

Call an ambulance.

4. First aid algorithms for acute diseases and emergency conditions

4.1. First aid for a heart attack

Signs: acute pain behind the sternum, radiating to the left upper limb, accompanied by "fear of death", palpitations, shortness of breath.

Call, instruct others to call an ambulance. Ensure receipt fresh air, unfasten tight clothing, give a semi-sitting position.

4.2. First aid for eye injuries

4.2.1. When hit by foreign bodies

Ensure the transfer of the victim to a medical facility.

4.2.2. For chemical eye burns

The victim should only move by the hand with the accompanying person!

When exposed to acid you can wash your eyes with a 2% solution baking soda(add baking soda to a glass of boiled water on the tip of a table knife).

When exposed to alkali you can wash your eyes with a 0.1% solution of citric acid (add 2-3 drops of lemon juice to a glass of boiled water).

4.2.3. In case of eye and eyelid injuries

The victim must be in the "lying" position.

Ensure the transfer of the victim to a medical facility.

4.3. First aid for poisonous snake bites

Limit the movement of the affected limb.

If consciousness is not restored for more than 3-5 minutes, call (on your own or with the help of others) an ambulance.

4.6. First aid for heat (sun) stroke

Signs: weakness, drowsiness, thirst, nausea, headache; increased breathing and fever, loss of consciousness are possible.

Call (on your own or with the help of others) an ambulance.