Appendix

Appendix
Contents
Knowledge Reviews A-2

Knowledge Reviews Answer Keys A-9

Primary Care Final Exam A-11

Secondary Care Final Exam A-17

Primary Care Final Exam Answer Sheet A-23

Secondary Care Final Exam Answer Sheet A-24

Primary Care Final Exam Answer Key A-25

Secondary Care Final Exam Answer Key A-26

Course Enrolment Form A-27

Skills Completion Form A-28 A-1

Course Return Form A-29

Illness and Injury Assessment Record A-30

Responders in Action Report Form A-33

Emergency Contact Information Sheet A-34

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Emergency First Response

Primary Care Knowledge Review

Flexible Mode of Delivery  Yes*  No
(*If yes: Knowledge reviews must be completed and returned to your EFR First Aid at Work Instructor 1 week
prior to the commencement of the course.)

Name _______________________________________ Date ______________________

Note to student: Unless otherwise indicated, select only one response that best answers the questions.

1. From the introductory statements below, which one would you select when asking
permission to help a patient?
 a. Hello? My name is _______. I’m an Emergency Responder. May I help you?
 b. I’m a doctor. May I help you?
 c. Are you hurt? Where?

2. You should never fear harming a patient when performing CPR on an individual whose
heart has stopped because you cannot make a person worse:
 True  False

3. 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 originating
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.

4. What three systems of the human body are most involved in life-threatening
A-2 emergencies? (Select all that apply.)
 a. Lymphatic system  d. Muscular system
 b. Circulatory system  e. Respiratory system
 c. Nervous system  f. Digestive system

5. State what each letter stands for:

D= ______________________________ C = ____________________________
R= ______________________________ D = ____________________________
A= ______________________________ S = ____________________________
B= ______________________________

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 Appendix - EFR Knowledge Reviews

6. How do you activate the Emergency Medical Service in your area?

Phone number: ___________________

7. 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.
8. Match the type of bleeding listed below with the description of how each
is identified.
A Arterial Bleeding _____ Dark red blood, steadily flowing from a wound
without rhythmic spurts.
B Venous Bleeding _____ Blood slowly oozing from the wound.
C Capillary Bleeding _____ Bright red blood that spurts from a wound in
rhythm with the heartbeat.
9. List the five signs of internal bleeding:
1 ________________________________
2 ________________________________
3 ________________________________
4 ________________________________
5 ________________________________
10. List the three symptoms of internal bleeding:
1 ________________________________
2 ________________________________
3 ________________________________
11. What are indications of shock? (Select all that apply.)
 a. Pale or bluish tissue color  g. Mental confusion, anxiety, restlessness or A-3
irritability
 b. Altered consciousness  h. Nausea and perhaps vomiting
 c. Lackluster eyes, dazed look  i. Moist, clammy skin with perhaps shivering
 d. Thirst  j. Shallow, but rapid and labored breathing
 e. Rapid, weak pulse  k. Ear-ache
 f. Elbow pain

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12. In what circumstances should you always suspect a spinal injury?

(Select all that apply.)
 a. Lightning strike
 b. Serious impact injury
 c. Falling from a height greater than victim’s own height
 d. Traffic or car accident
 e. Being thrown from a motorised vehicle
 f. Swimming pool, head-first dive accident

13. If you suspect a patient has a spinal fracture and is conscious you would tell the patient to
move into a comfortable position.
 True  False

14. What do these two 3-lettered abbreviations mean? Match the letters on the right with
the words on the left. There are only two correct responses in the right column. (Draw
lines to indicate your response.)
Expired Air Resuscitation (a) CPR
Expiry Air Revive (b) EAR
Cardio Pulmonary Resuscitation
Cardiac Pull Removal

15. What is digestion? _______________________________________________________

______________________________________________________________________
16. What is the best way to control bleeding? _____________________________________
______________________________________________________________________

A-4

Particpant signature ____________________________________________ Date __________

Instructor signature _____________________________________________ Date __________

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 Appendix - EFR Knowledge Reviews

Emergency First Response

Secondary Care Knowledge Review

Flexible Mode of Delivery  Yes*  No
(*If yes: Knowledge reviews must be completed and returned to your EFR First Aid at Work Instructor 1
week prior to the commencement of the course.)

Name _______________________________________ Date ______________________

Note to student: Unless otherwise indicated, select only one response that best answers the questions.

1. Regardless of a patient’s injury of illness, you initially perform a _________ assessment

and monitor the patient’s _________.
 a. secondary; line of life
 b. primary; lifeline

2. Once a patient is stabilised 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:
 a. something the patient tells you is wrong.
 b. something you can see, feel or hear.

6. Assessment first aid is the treatment of conditions that are not immediately
(Finish the sentence): _____________________________________________________ A-5
7. The most common heart attack symptom is chest pain accompanied by a pressure or
squeezing in the centre of the chest:
 True  False

8. For upper limb fractures it is most important to: (Select all that apply.)
 a. splint the injury in the position found.
 b. not try to straighten the fractured limb.
 c. move the fracture to fit splint.
 d. not splint upper limb fractures.

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9. In a severe asthma attack you may not be able to hear the ____________ sound.

10. Hypothermia is a condition where a patient has become excessively cold and they may
die if not treated immediately.
 True  False

11. A patient should be restrained during an epileptic seizure if they are in danger of
hurting someone or themselves.
 True  False

12. For an unconscious patient with a fractured jaw you must not move the jaw.
 True  False

13. During an injury assessment blood and fluid is found in the patient’s ears. Should the
Emergency Responder continue the assessment?
 a. Yes, as more life threatening injuries may be found.
 b. No, as this indicates a head injury and the patient should keep still until the
Emergency Medical Services arrives.
 c. No, as this indicates a spinal injury.
 d. Yes, a full examination must always be done and a report given to Emergency
Medical Services personnel.

14. State what each letter stands for when treating sprains and strains:
R= ______________________________
I= ______________________________
C= ______________________________
E= ______________________________
15. A patient has got chemicals splashed in their eye. What treatment would
you provide?
 a. Ask patient to roll the eye continuously until it feels better.
A-6
 b. Immediately flush eye with water for 15 minutes or until Emergency Medical
Services arrives.
 c. Don’t do anything except call Emergency Medical Services.
 d. Cover the affected eye with a moist bandage.

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16. If a patient has an open chest wound and is having difficulty breathing, what course of
action do you follow? (Select all that apply.)
 a. Walk the patient to the car, drive really quickly to the hospital.
 b. Call Emergency Medical Services, apply pressure bandage, place in comfortable
position.
 c. Call Emergency Medical Services, apply pressure bandage, lean patient to
injured side.
 d. Call Emergency Medical Services, carry on with what you were doing.

17. Signs of a stroke may include: (Select all that apply.)

 a. Numbness
 b. Paralysis
 c. Weakness in the face
 d. Having trouble speaking
 e. Severe headache
 f. Sore teeth
 g. Decreased vision in one or both eyes
 h. Hallucinations

18. Patients suffering from __________ blood sugar may appear pale, have moist skin and
sweat excessively. Patients may complain of a headache and dizziness and be irritable
and confused.
 Low  High

19. Fractured fingers and toes:

 a. should not be splinted as lower limb fractures heal by themselves.
 b. must only be treated by Emergency Medical Services personnel.
 c. may be taped to adjacent fingers/toes.
 d. Fingers and toes do not fracture. A-7

Particpant signature ____________________________________________ Date ________

Instructor signature _____________________________________________ Date ________

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Emergency First Response

Emergency Care in the Workplace

Knowledge Review
Flexible Mode of Delivery  Yes*  No
(*If yes: Knowledge reviews must be completed and returned to your EFR First Aid at Work Instructor 1
week prior to the commencement of the course.)

Name __________________________________________ Date ____________________

1. List four of the seven primary goals of occupational health and safety legislation:
1 __________________________________________________________________
2 __________________________________________________________________
3 __________________________________________________________________
4 __________________________________________________________________
2. Besides providing primary and secondary care to individuals, workplace Emergency
Responders may also be called upon to: (List two)
1 __________________________________________________________________
2 _________________________________________________________________________

3. Fill in the blanks with the appropriate words. Emergency care in the workplace can only
be provided to an individual upon ____________________________. If a patient is
non-responsive, then consent is ___________________________.

4. Name the two emergency care documents that can guide you in accurate workplace
recording and reporting:
1 __________________________________________________________________
A-8
2 _________________________________________________________________________

5. State two reasons for keeping your emergency care skills updated:
1 __________________________________________________________________
2 _________________________________________________________________________

Particpant signature ____________________________________________ Date _______

Instructor signature _____________________________________________ Date _______

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 Appendix - EFR Knowledge Review Answer Keys

Emergency First Response

Primary Care Knowledge Review

Answer Key
1. a. 9. 1. Anxiety and restlessness

2. True 2. Rapid breathing

3. Rapid and weak pulse
3. a.
4. Unconsciousness
4. b., c., e. 5. Bleeding from any body opening
5. D = Danger such as the ears, mouth and nose.

R = Responsive? 10. 1. Pain and tenderness around

A = Airway Open effected area.

B = Rescue Breathing 2. Thirst

C = Chest Compressions 3. Nausea

D = Defibrillation 11. a., b., c., d., e., g., h., i., j.
S = Serious Bleeding Management; 12. a., b., c., d., e., f.
Shock Management;
Spinal Injury Management 13. False

6. ______________ Appropriate 14. (a) CPR = Cardio Pulmonary

emergency number for local area or Resuscitation
country. (b) EAR = Expired Air
7. a. Resuscitation
8. A = Bright red blood that spurts 15. Breaking down food into
from a wound in rhythm with tiny molecules
the heartbeat.
B = Dark red blood, steadily flowing 16. Direct pressure A-9
from a wound without rhythmic
spurts.
C = Blood slowly oozing from
the wound.

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Emergency First Response

Secondary Care Knowledge Review

Answer Key
1. b. 12. False
2. b. 13. b.
3. Physical harm to the body 14. R = Rest
4. An unhealthy condition of the body I = Ice
5. a. C = Compression
6. Life threatening E = Elevation
7. True 15. b.
8. a., b. 16. b.
9. Wheezing 17. a., b., c., d., e., g.
10. True 18. Low
11. False 19. c.

Emergency First Response

Emergency Care in the Workplace

Knowledge Review Answer Key
1. Answer can be four of the following: 2. Answer can be any two of the
• To promote health, safety and welfare following:
of people at work • Responsibility for first aid kits
• To ensure safe work practices in the • Managing period care of
A-10 handling of equipment and materials. AED units
• To ensure the prevention of injury and • Maintenance of emergency
illness & any risks to health and safety care rooms
arising out of the activities at work. • Accurate recording and
• To identify and report any potential storage of reports
hazards from equipment, facilities and 3. Consent, a given/assumed
the environment
• To rectify where possible any potential 4. Illness & Injury Assessment Record
hazards. Sheet and Incident Report

• To report any accidents or incidents. 5. Skills degrade over time, new

• To complete any required occupational research and legislation requirements.
health and
safety training.

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 Appendix - EFR Final Exams

Emergency First Response

Primary Care Final Exam

Flexible Mode of Delivery  Yes  No

Name _________________________________________________ Date ____________

Location __________________________________________________________________

Instructor _________________________________________________________________

1. In Emergency First Response courses, you learn to provide emergency care based on
the same priorities used by medical professionals to assist injured or ill persons.
 True  False
2. When someone needs emergency care, time is critical because:
 a. when a person has no signs of life (unresponsive, not moving and not breathing
normally), irreversible brain damage can occur within minutes.
 b. it becomes more difficult to administer first aid.
 c. emergency Medical Services are typically far away.
3. State one reason why you might hesitate to provide emergency care to
an individual.
_____________________________________________________________________
_____________________________________________________________________
4. In general, to be protected by a Good Samaritan law, you should: (Select all
that apply.)
 a. act in good faith.
 b. never apply bandages to bleeding patients.
 c. help an individual in need of emergency care even if he says he does not wish
for you to assist him.
A-11
 d. act as a prudent person would.
 e. only provide care that is within the scope of your training.
 f. never be reckless or negligent.

5. State one reason why you should assist someone who needs emergency care.
_____________________________________________________________________
_____________________________________________________________________

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6. Using the Chain of Survival illustration below, write the appropriate letters in the
boxes to describe each of the links.
A Early CPR
B Early Professional Care and Follow up
C Early Recognition and Call for Help
D Early Defibrillation

7. In Call First, once you’ve established __________, you immediately call an ambulance
or activate your local Emergency Medical Service.
 a. a patient is in shock
 b. the unresponsiveness of an adult patient
 c. the temperature of a patient

8. Each time you perform CPR, the patient’s heart will restart and you will restore the
patient’s life.
 True  False

9. From the introductory statements below, which one would you select when asking
permission to help a patient?
 a. Hello? My name is ______, I’m an Emergency Responder. May I help you?
 b. I’m a doctor. May I help you?
A-12
 c. Are you hurt? Where?

10. You should never fear harming a patient when performing CPR on an individual whose
heart has stopped because you cannot make the person worse.
 True  False

11. As an Emergency Responder what general rule may help you avoid infection by
bloodborne pathogens?
 a. Always place a barrier between you and any moisture or fluid originating 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.

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 Appendix - EFR Final Exams

12. On the lifeline diagram below, list the meaning for each of the letters in the
DRABCD’S of emergency care.

13. In what two ways can you recognise cardiac arrest in a patient?
(Select two responses.)
 a. The patient does not respond when you speak to or touch him.
 b. Paralysis of the arm.
 c. Bleeding from the nose and mouth.
 d. The patient has no signs of life – no movement, breathing
or coughing.

14. How do you activate the Emergency Medical Service in your area?
Phone number:________________________________

15. Signs and symptoms of stroke include: (Select all that apply.)
 a. Unconsciousness
 b. Numbness, paralysis or weakness of face, arm or leg
 c. Facial droop
 d. Sweating
 e. Unexplained headaches A-13
 f. Sudden blurred or decreased vision in one or both eyes
 g. Difficulty speaking

16. The universal sign that someone is choking is: ________________________________

17. CPR’s primary function is to:

 a. extend the window of opportunity for patient revival by forcing oxygen-rich
blood from the heart to vital body organs.
 b. restore a patient’s breathing.
 c. defibrillate a patient’s heart.

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18. 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.

19. Rescue breathing can provide plenty of oxygen to a patient, enough to support a
nonbreathing patient during CPR.
 True  False

20. Match the type of bleeding listed below with the description of how each
is identified.
A Arterial Bleeding _____ Dark red blood, steadily flowing from a wound
without rhythmic spurts.
B Venous Bleeding _____ Blood slowly oozing from the wound.
C Capillary Bleeding _____ Bright red blood that spurts from a wound in
rhythm with the heartbeat.
21. What are indications of shock? (Select all that apply.)
 a. Pale or bluish tissue color  h. Nausea and perhaps vomiting
 b. Altered consciousness  i. Moist, clammy skin
 c. Lackluster eyes, dazed look  j. Shallow, but rapid and
 d. Thirst labored breathing

 e. Rapid, weak pulse perhaps shivering  k. Earache

 f. Elbow pain
 g. Mental confusion, anxiety, restlessness or irritability

22. Indications that someone might have a spinal injury include: (Select all that apply.)
 a. sweating
A-14  b. fast pulse
 c. vision problems
 d. headache
 e. nausea/vomiting
 f. when asked, a patient cannot move a body part
 g. loss of balance when walking or sitting
 h. difficulty breathing

23. How do you determine if a patient is not breathing during a primary assessment?

_____________________________________________________________________

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24. How can you practise and refresh your emergency care skills? (Provide two examples.)

_____________________________________________________________________

25. In what circumstances should you always suspect a spinal injury?

(Select all that apply.)
 a. Lightning strike
 b. Serious impact injury
 c. Falling from a height greater than victim’s own height
 d. Traffic or car accident
 e. Being thrown from a motorised vehicle
 f. Swimming pool, head-first dive accident

26. When opening an airway (spinal injury not suspected), the head tilt/chin lift method
should be used at all times.
 True  False

27. An unconscious, breathing patient without a suspected spinal injury should be:
 a. given CPR immediately.
 b. moved immediately to a hospital.
 c. placed in the recovery position.

28. On an adult patient, the best way to check for signs of life is:
 a. look for signs of breathing (look, listen and feel),
coughing and movement.
 b. a pulse check.
 c. to conduct an illness assessment.

29. During CPR the ratio of chest compressions to rescue breaths is:
 a. 10 compressions to 1 breath
 b. 15 compressions to 3 breaths
A-15
 c. 30 compressions to 2 breaths

30. During CPR the rate of chest compressions per minute is:
 a. 200
 b. 50
 c. 100

31. Rescuers should minimise interruptions of chest compressions and CPR should not be
interrupted to check for signs of life.
 True  False

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32. The first and most successful method of managing serious bleeding is:
 a. use of pressure points.
 b. direct pressure.
 c. elevate wound area.

33. While managing serious bleeding, if a pressure bandage or dressing becomes soaked
with blood, remove it and replace it with a new one.
 True  False

34. Shock management often includes elevating the patient’s legs

15-30 centimetres/6-12 inches and ________________.
 a. performing a pulse check
 b. providing water to drink
 c. protecting from the sun or covering the patient to maintain body temperature
based on local climate

35. A _____________ allows you to turn a patient on his back carefully when a spinal
injury is suspected.
 a. log roll
 b. fireman’s carry
 c. hand carry

36. (optional) When administering CPR to an infant you should use:

 a. both hands.
 b. heel of one hand.
 c. two fingers.

37. What is the general purpose of the respiratory system?: (select all that apply)
 a. To supply the body with oxygen

A-16  b. To remove oxygen from the body

 c. To supply the body with carbon dioxide
 d. To remove carbon dioxide from the body

Participant signature ____________________________________________ Date _______

Instructor signature _____________________________________________ Date _______

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 Appendix - EFR Final Exams

Emergency First Response

Secondary Care Final Exam

Flexible Mode of Delivery  Yes  No

Name _______________________________________________ Date ________________

Location __________________________________________________________________
Instructor__________________________________________________________________

1. If Emergency Medical Services are either delayed or unavailable

you may need to assist an injured patient using secondary care.
 True  False

2. A secondary assessment is your second evaluation of __________________.

 a. an injured or ill person
 b. first aid
 c. bleeding

3. Examples of an injury are: (Select all that apply.)

 a. Headache
 b. Dislocation and fractures
 c. Allergy
 d. Electrical wound
 e. Bruise
 f. Dental wound
 g. Poisoning

4. ________________ is an unhealthy condition of the body. A-17

 a. An illness
 b. A symptom
 c. A sign

5. Regarding a patient’s condition during an illness or injury assessment, a sign is

 a. something the patient tells you is wrong.
 b. something you can see, hear or feel.
 c. something a bystander tells you about an accident.

6. The most common heart attack symptom is chest pain accompanied by a pressure or
squeezing in the centre of the chest.
 True  False

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7. Assessment first aid is the treatment of conditions that ___________________.

 a. are not immediately life-threatening.
 b. are life-threatening.
 c. require the use of CPR.

8. If during an injury assessment the patient complains of head, neck or back pain you
should:
 a. attempt to determine exactly where the pain is coming from.
 b. perform an illness assessment.
 c. stop your assessment and stabilise the head and neck – wait for Emergency
Medical Services to arrive.

9. During an illness assessment you use the mnemonic “SAMPLE” to guide you.
SAMPLE stands for: (Write in the correct meaning of each letter.)
S = ______________________________________________________________
A = ______________________________________________________________
M = ______________________________________________________________
P = ______________________________________________________________
L = ______________________________________________________________
E = ______________________________________________________________

10. When bandaging a wound on a hand, arm, leg or foot, make the bandage as tight as
you possibly can.
 True  False

11. Regarding the splinting of an upper or lower limb: (Select all that apply.)
 a. Even when commercial splints are unavailable, avoid using make-shift items
such as magazines, blankets and boards as splinting material.
A-18  b. Splint an injury in the position found.
 c. Always straighten an injured site prior to splinting.
 d. When possible, place splint material on both sides of an injury site.
 e. Try to minimise movement of an injured extremity until you
complete splinting.
 f. Splint only if you can do so without causing more discomfort and pain to
the patient.

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12. Management of a patient with pelvic injury includes:

 a. place padding between the ankles and tie them together
 b. place padding between the legs from the knees to the ankles and tie
them together
 c. apply a cold compress to the area to reduce swelling

13. A conscious patient with a fractured jaw should be:

 a. left alone to hold their jaw
 b. told to lie down and wait for Emergency Medical Services to arrive
 c. be encouraged to assume a position they are most comfortable in

14. Major burns are best managed by:

 a. rubbing antiseptic lotion over the affected area
 b. flushing or soaking the area with cool water
 c. covering burns with a cool, moist sterile bandage or clean cloth

15. Penetrating objects in the eye should be treated by:

 a. medical professionals only
 b. covering both eyes
 c. covering the affected eye only

16. A patient who is most comfortable in a half sitting position, leaning towards the injured
side is likely to have suffered from:
 a. stroke
 b. shock
 c. chest injury

17. Management of a patient with diabetes where it is not known if they have low or high
blood sugar levels may include:
 a. give sugar or sweet drinks
 b. assist them with an insulin injection A-19
 c. give water

18. A patient who has pain in the chest lasting more than 10 minutes could be
suffering from:
 a. asthma
 b. indigestion
 c. heart attack

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19. A patient who is convulsing could be suffering from: (Select all that apply.)
 a. heat stroke
 b. epilepsy
 c. heart attack
 d. stroke
 e. hypoglycemia

20. To re-warm a patient with mild hypothermia, have them perform some physical
exercise to generate heat:
 True  False

21. Blue-Ring octopus bites are managed by:

 a. flushing the area with cold water.
 b. pouring vinegar over the bite area.
 c. applying pressure immobilisation.

22. Heat exhaustion is a life threatening medical emergency:

 True  False

23. It is important for a near drowned patient who appears to have fully recovered to:
 a. be admitted to hospital due to possible delayed complications.
 b. told to go home and rest.
 c. seek medical advice only if they notice any delayed symptoms.

24. A red back spider bite causes the following signs and symptoms:
 a. Pain, swelling, nausea vomiting, abdominal pain, swollen glands.
 b. Pain, swelling, difficulty breathing, and possible collapse.
 c. Local irritation, difficulty breathing and walking, double vision.

25. If a patient involved in a motorbike accident is breathing and conscious you should
A-20 leave the helmet on:
 True  False

26. The role of the Emergency Responder in the workplace might include:
(Select all that apply)
 a. maintenance of first aid kit and room.
 b. servicing the emergency oxygen equipment.
 c. avoiding back injury.
 d. recording and reporting incidents to local authorities.

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27. Fractured fingers and toes:

 a. should not be splinted as lower limb fractures heal by themselves.
 b. must only be treated by Emergency Medical Services personnel.
 c. may be taped to adjacent fingers/toes.
 d. Fingers and toes do not fracture.

28. During an Injury Assessment, blood and fluid is found in the patient’s ears. Should the
Emergency Responder continue the assessment?
 a. Yes, as more life threatening injuries could be found
 b. No, as this indicates a head injury and the patient should be kept still until
Emergency Medical Services arrives
 c. No, as this indicates a spinal injury
 d. Yes, a full examination must always be done and a report given to Emergency
Medical Services personnel

29. Asthma is a lung condition which is usually controlled by medication. Which

statements are correct in case of a severe asthma attack? (Select all that apply)
 a. In a severe asthma attack you may not be able to hear the wheezing sound.
 b. A patient may experience difficulty speaking, drowsiness,
or unconsciousness.
 c. A severe asthma attack is a medical emergency.
 d. Severe asthma attacks should not be treated by Emergency Responders.

30. When caring for a patient having an epilectic seizure: (Select all that apply)
 a. attempt to cushion the patient’s head.
 b. restrain the patient.
 c. move objects out of the way.
 d. protect the patient from hurting themselves further.

31. Reaction to venomous bites and stings depends on the location of the bite or sting and A-21
how much venom was injected. The patient’s reaction to the venom will also depend on
the patient’s____________: (Select all that apply)
 a. size
 b. current health
 c. body chemistry
 d. previous exposure

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32. Hypothermia is a condition where a patient has become excessively cold and they may
die if not treated immediately.
 True  False

33. What do the following letters stand for when treating sprains and strains?
R = ______________________________________________________________
I = ______________________________________________________________
C = ______________________________________________________________
E = ______________________________________________________________

34. A patient has got chemicals splashed in their eye. What treatment would
you provide?
 a. Ask patient to roll the eye continuously until it feels better.
 b. Immediately flush eye with water for 15 minutes or until Emergency Medical
Services arrives.
 c. Don’t do anything except call Emergency Medical Services.

A-22

Particpant signature ____________________________________________ Date ________

Instructor signature _____________________________________________ Date ________

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 Appendix - EFR Final Exam Answer Sheets

Emergency First Response

First Aid at Work Primary Care

Final Exam Answer Sheet
Flexible Mode of Delivery  Yes  No
Name __________________________________________ Date ___________________
Location _______________________________ Instructor ________________________

1.  True  False 16. ______________________________

2.  a.  b.  c. ______________________________
3. ______________________________ 17.  a.  b.  c.
______________________________ 18.  a.  b.  c.
______________________________ 19.  True  False
4.  a.  b.  c.  d.  e.  f. 20. ___Dark red blood, steadily flowing
5. ______________________________ from wound...
______________________________ ___Blood slowly oozing from wound...
______________________________
___Bright red blood that spurts from
6. a wound...
21.  a.  b.  c.  d.  e.  f.
 g.  h.  i.  j.  k.
22.  a.  b.  c.  d.  e.
 f.  g.  h.
7.  a.  b.  c. 23. ______________________________
8.  True  False 24. ______________________________
9.  a.  b.  c. ______________________________
10.  True  False 25.  a.  b.  c.  d.  e.  f.
11.  a.  b.  c. 26.  True  False A-23
12. D = __________________________ 27.  a.  b.  c.
R = __________________________ 28.  a.  b.  c.
A = __________________________
B = __________________________ 29.  a.  b.  c.
C = __________________________ 30.  a.  b.  c.
D = __________________________ 31.  True  False
S = __________________________
__________________________ 32.  a.  b.  c.
__________________________ 33.  True  False
13.  a.  b.  c.  d. 34.  a.  b.  c.
14. Phone No.: _____________________ 35.  a.  b.  c.
15.  a.  b.  c.  d.  e.  f. 36.  a.  b.  c.
 g. 37.  a.  b.  c.  d.
please sign on next page... Version 2.03 (12/07)
 First Aid at Work – Asia Pacific Edition

Emergency First Response

First Aid at Work Secondary Care

Final Exam Answer Sheet
Flexible Mode of Delivery  Yes  No

Name __________________________________________ Date ___________________

Location _______________________________ Instructor ________________________

1.  True  False 17.  a.  b.  c.

2.  a.  b.  c. 18.  a.  b.  c.
3.  a.  b.  c.  d.  e. 19.  a.  b.  c.  d.  e.
 f.  g. 20.  True  False
4.  a.  b.  c. 21.  a.  b.  c.
5.  a.  b.  c. 22.  True  False
6.  True  False 23.  a.  b.  c.
7.  a.  b.  c. 24.  a.  b.  c.
8.  a.  b.  c. 25.  True  False
9. S = __________________________ 26.  a.  b.  c.  d.
A = __________________________
M = __________________________ 27.  a.  b.  c.  d.
P = __________________________ 28.  a.  b.  c.  d.
L = __________________________ 29.  a.  b.  c.  d.
E = __________________________
30.  a.  b.  c.  d.
10.  True  False
31.  a.  b.  c.  d.
11.  a.  b.  c.  d.  e.  f.
32.  True  False
12.  a.  b.  c.
33. R = __________________________
A-24 13.  a.  b.  c. I = __________________________
14.  a.  b.  c. C = __________________________
15.  a.  b.  c. E = __________________________
16.  a.  b.  c. 34.  a.  b.  c.

Select the Final Exam(s) completed:

 Primary Care Final Exam only  Primary & Secondary Care Final Exams
Particpant signature ____________________________________________ Date ________________

Instructor signature _____________________________________________ Date ________________

Version 2.03 (12/07)

 Appendix - EFR Final Exam Answer Keys

Emergency First Response

Primary Care Final Exam Answer Key

1. True 17. a.
2. a. 18. a.
3. Choices include: 19. True
• Anxiety 20. B C A
• Guilt 21. a., b., c., d., e., g., h., i., j.
• Fear of imperfect performance 22. c., d., e., f., g., h.
• Might make person worse 23. Look, Listen and Feel
• Responsibility 24. Choices include:
• Fear of infection • Review EFR video
4. a., d., e., f. • Role-play with friends/family
5. Choices include: • Practise CPR using a pillow/bag
• Save/restore a patient’s life • Enrol in an EFR First Aid at
• Reduce a patient’s recovery time Work Revision programme
• Make the difference between a 25. a., b., c., d., e., f. (all apply)
patient having a temporary or 26. True
lifelong disability 27. c.
6. C A D B 28. a.
7. b. 29. c.
8. False 30. c.
9. a. 31. True
10. True 32. b.
11. a. 33. False
12. D = Danger 34. c.
R = Responsive? 35. a.
A = Airway Open 36. c. (optional)
A-25
B = Rescue Breathing 37. a., d.
C = Chest Compressions
D = Defibrillation
S = Serious Bleeding Management;
Shock Management;
Spinal Injury Management
13. a., d.
14. Response varies.
15. b., c., e., f., g.
16. • Grasping, clutching the neck
• Unable to speak or breathe

Version 2.03 (12/07)

 First Aid at Work – Asia Pacific Edition

Emergency First Response

Secondary Care Final Exam Answer Key

1. True 19. a., b. d., e.
2. a. 20. False
3. b., d., e., f. 21. c.
4. a. 22. False
5. b. 23. a.
6. True 24. a.
7. a 25. True
8. c. 26. a., c., d.
9. S = Signs and Symptoms 27. c.
A = Allergies 28. b.
M= Medications 29. a., b., c.
P = Preexisting Medical 30. a., c., d
Conditions 31. a., b., c., d.
L = Last Meal 32. True
E = Events 33. Rest, Ice, Compression, Elevation
10. False 34. b.
11. b., d., e., f.
12. b.
13. c.
14. c.
15. b.
16. c.
17. a.
A-26 18. c.

Version 2.03 (12/07)

 First Aid at Work Course Enrolment Form
Instructor Name __________________________________________ Instructor No. ________________
 AED Orientation Skill Completed  Emergency Oxygen Use Skill Completed  Revision
Certificate IV in Assessment and Workplace Training Holder (name) _____________________________
Copy of certificate held at Emergency First Response Pty Ltd? If not, please provide copy with this form.

PARTICIPANTS Flexible Mode of Delivery  Yes  No

1. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
2. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
3. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
4. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
5. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
6. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
7. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
8. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
9. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
10. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
11. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date ________________
12. Name ________________________________________________________ Phone __________________________
Address ______________________________________________________________________________________
___________________________________ email _______________________ Completion Date _______________
Product No. 10282AP Version 2.0 (4/07) © Emergency First Response, Corp. 2007

A-27
 _______________________________________________

© Emergency First Response, Corp. 2007

S4
_______________________________________________

INSTRUCTOR NAME___________________________________________________ INSTRUCTOR NO. _______________

Emergency First Response Skills Completion Form

R2. Recommended Skill - Emergency Oxygen Use

S3
R1. Automated External Defibrillator (AED) Use
_______________________________________________

S4. Splinting for Dislocations and Fractures

S2
_______________________________________________

S1
_______________________________________________

R2
_______________________________________________

R1
S2. Illness Assessment
_______________________________________________
S1. Injury Assessment
Secondary Care Skills
Recommended Skills

9
_______________________________________________
S3. Bandaging

8
_______________________________________________
7

_______________________________________________
6I*

_______________________________________________
6C*

_______________________________________________
7. Serious Bleeding Management

6A
6. Choking/FBAO Adult (Child*,

_______________________________________________
9. Spinal Injury Management

5A 5C* 5I*
5. CPR Part Two – Chest

_______________________________________________
Compressions Adult

8. Shock Management

_______________________________________________
(Child*, Infant*)

_______________________________________________
Infant*)

4A 4C* 4I*

_______________________________________________
_______________________________________________
_______________________________________________
* (optional skills)
4. CPR Part One – Rescue

_______________________________________________
3. Primary Assessment
1. Scene Assessment

_______________________________________________
Breathing Adult
(Child*, Infant*)
Primary Care Skills

1
2. Barrier Use

_______________________________________________
Product No. 10283AP Version 2.01 (12/07)
Participants
______________
Flexible Mode
Course Date

 Yes  No

10.

11.

12.
1.

2.

3.

4.

5.

6.

7.

8.

9.

A-28
 First Aid at Work
Course Return Form

To be filled in and forwarded upon completion of the First Aid at Work Course

Course Date ___________________________________ Flexible Mode  Yes  No

Day/Month/Year

Trainer Name _______________________________________________________________________

First Middle Last

EFR Instructor # _________________________________

* Assessor Name ___________________________________________________________________

First Middle Last

EFR Instructor # _________________________________

* If the course is conducted by an Assessor please provide name of supervising Certificate IV in

Assessment & Workplace Training holder and attach a copy of their qualification

Location (Suburb/State) _____________________________________________________________

No. of certificates awarded _____________________ Pass rate (%)_______________________

Return to: Emergency First Response Pty Ltd, PO Box 575 Brookvale, NSW 2100, Australia.
Phone: +61 2 9454 2980 Fax: +61 2 9454 2999 Email: info@[Link]

A-29
 Illness and
Illness Injury
and InjuryAssessment Record
Assessment Record Sheet
Sheet
KEY POINTS
✔ Stop, Think, then Act.
✔ Use barriers as appropriate.
✔ Use this record sheet in the event that Emergency Medical Services is either delayed or unavailable.
✔ As you record information on this sheet for Emergency Medical Services, provide measured rates per minute
and descriptive terminology.
✔ To help guide your assessment, remember that:
● The average pulse rate for adults is between 60 – 80 beats per minute.
● Average breathing rate for adults is between 12 and 20 breaths per minute. Patients who take less than
eight breaths per minute, or more than 24 breathes per minute probably need immediate medical care.
● Average skin temperature is warm and skin should feel dry to the touch.
● Noticeable skin colour changes may indicate heart, lung or circulation problems.

PATIENT INFORMATION

Surname ______________________________________ Given Name _______________________________________

□ Male □ Female Date of Birth ______________________________________________________

Address ________________________________________________________________________________________

Postcode ______________________________________ Telephone ________________________________________

□ English Speaking □ Non-English Speaking □ Medical Alert Tag? Type ________________________

Patient Condition at Beginning of Emergency Responder Care: □ Conscious □ Unconscious

Patient Position Prior to Care: □ Standing □ Sitting □ Lying

Patient Referred To: □ Emergency Medical Services Personnel □ Hospital □ Personal Physician □ None

Illness Assessment
SAMPLE – Signs and Symptoms
1. How do you feel now? ________________________________________________________________________
__________________________________________________________________________________________
2. What were you doing when you began to feel ill?___________________________________________________
__________________________________________________________________________________________
3. When did the first symptoms occur? _____________________________________________________________
__________________________________________________________________________________________
4. Where were you when the first symptoms occurred? ________________________________________________
__________________________________________________________________________________________
5. Patient’s pulse rate ________________ (use carotid or radial pulse; count beats for 30 seconds, multiply by two)

Version 2.0 (4/07) © Emergency First Response, Corp., 2007

A-30
 6. Describe patient’s pulse: □ Rapid □ Strong □ Weak
7. Patient’s breathing is: □ Rapid □ Slow □ Labored □ Wheezing □ Gasping
8. Patient complains of: □ Shortness of breath □ Dizziness/Lightheadedness □ Chest pain
□ Numbness □ Tingling in arms/legs
9. Patient’s respiration rate ____________________ (count respirations for 30 seconds, multiply by two;
avoid telling patient you are counting respirations.)

10. Has the patient been exercising? □ Yes □ No

11. Patient’s skin is: □ Warm □ Hot □ Cool □ Clammy □ Wet □ Very dry
12. Colour of patient’s skin is:
□ Pale □ Ashen (gray) □ Red □ Blue □ Yellowish □ Black and Blue Blotches
13. Dark-skinned patient, check for colour changes on the nailbeds, lips, gums, tongue, palms, whites of the eye, and
ear lobes: □ Pale □ Ashen (gray) □ Red □ Blue □ Yellowish □ Black and Blue Blotches

AMPLE – Allergies
S
1. Is the patient allergic to any foods, drugs, airborne matter, etc? □ Yes □ No
If so, what is he/patient allergic to? _____________________________________________________________
__________________________________________________________________________________________
2. Ask the patient if he has ingested or taken anything he may be allergic to: □ Yes □ No

SA MPLE – Medications
1. Ask the patient: Do you take medication? □ Yes □ No
If yes, what type and name: __________________________________________________________________
2. Ask the patient: Did you take your medication today? □ Yes □ No
How much did you take and when? ____________________________________________________________
3. If possible, collect all medication to give to Emergency Medical Services personnel and/or get name of the
doctor who prescribed the medication.

SAM PLE – Preexisting Medical Conditions

1. Ask the patient: Do you have a preexisting medical condition? □ Yes □ No
If yes, what type: ___________________________________________________________________________

SAMP E – L Last Meal

1. Ask the patient: Did you eat recently? □ Yes □ No
If yes, what did you eat? _____________________________________________________________________

SAMPL E – Events
1. Ask the patient: What events led to your not feeling well?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

A-31
 Injury Assessment
HISTORY
What happened? __________________________________________________________________________________
________________________________________________________________________________________________
How did the injury happen? __________________________________________________________________________
________________________________________________________________________________________________
When did the injury occur? ___________________________________________________________________________
________________________________________________________________________________________________

INJURY LOCATION (Follows Injury Assessment Order. Use Injury Key to denote condition.)
□ Head _____________ □ Patient’s Face _____________ Injury Condition Key
A = Abrasion
□ Ears/Nose _____________ □ Eyes _____________ B = Bleeding
□ Skull/Neck _____________ □ Shoulder Blades _____________ Bu = Burns
C = Contusion (injury
□ Shoulder _____________ □ Collarbones _____________ to tissues; no bone
□ Right Arm _____________ □ Left Arm _____________ or skin broken)
D = Deformity
□ Right Hand _____________ □ Left Hand _____________ F = Fracture
□ Chest _____________ □ Spinal Column _____________ L = Laceration
(deep/jagged cut)
□ Abdomen _____________ □ Hips _____________ P = Pain
□ Right Leg _____________ □ Left Leg _____________ S = Swelling
T = Tenderness
□ Right Foot _____________ □ Left Foot _____________

Emergency Responder Care Given:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Additional Responder Notes:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

A-32
 Emergency First Response

Responders in Action Report Form

Responders in Action
When you use your skills as an Emergency Responder to care for an injured or ill person, we’d like to hear
about it. The incident need not be dramatic, involve a life-threatening condition or necessarily have a favorable
outcome. Sharing your story motivates and encourages others to use their skills and provide assistance in
emergency situations. This information is also useful to monitor and gauge the effectiveness of Emergency First
Response training and assist in future program development.

Please Type or Print Clearly

Name _______________________________________________________________________________________________
Last Name First Name Middle Initial

Address _____________________________________________________________________________________________

City _______________________________ State/Province ___________ Country _______ Zip/Postal Code _________

Phone ( _________ ) _____________________ Email Address _______________________________________________

Date of your last Emergency First Response Certification/Recertification Course __________________________________

Day/Month/Year

Name of your Emergency First Response Instructor/Trainer ___________________________________________________

Instructor No. _______________________________

Description of Events
Location of Incident ___________________________________________________________________________________

Date of Incident _____________________________

Day/Month/Year

On the back of this sheet, or on a separate sheet of paper, please describe the incident, including the nature of the
injury or illness, the skills used to render aid, and if possible, information on the outcome. Please type or print
neatly and submit your report to your local Emergency First Response office.
 By marking this box I understand I am granting Emergency First Response Corp. permission to
reprint the details of this incident for the benefit of other Responders. I understand details that
may identify the patient will be omitted but my name as an Emergency Responder may be used.

Signature ____________________________________________________ Date _________________________

Day/Month/Year

Return to: Emergency First Response Pty Ltd, PO Box 575 Brookvale, NSW 2100, Australia.
Phone: +61 2 9454 2980 Fax: +61 2 9454 2999 Email: info@[Link]

© Emergency First Response, Corp. 2007

A-33
 Emergency Contact Information
Home
To Activate Emergency Services, call____________________________________________
Police, call _________________________________________________________________________

Fire, call __________________________________________________________________________

Poison Control Center, call____________________________________________________________

• Remain calm
• State the nature of your emergency Rescue
• Give your location ______________________________

_____________________________________________
Chest
_____________________________________________ Compressions

• Your phone number _____________________________

• Stay on the line until the operator hangs up
• Send someone to guide emergency services to your location, if possible.
© Emergency First Response, Corp. 2007

Emergency Contact Information

Workplace
To Activate Company Emergency Plan, call ____________________________________
Emergency Services, call ________________________________________________________
Police, call _________________________________________________________________________

Fire, call __________________________________________________________________________

Poison Control Center, call____________________________________________________________

• Remain calm
• State the nature of your emergency
Rescue
• Give your location ______________________________

_____________________________________________

_____________________________________________ Chest
Compressions

• Your phone number _____________________________

• Stay on the line until the operator hangs up
• Send someone to guide emergency services to your location, if possible.
A-34 © Emergency First Response, Corp. 2007