09-Chapter14 Extremity Injury_ISC

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关于创伤的英文作文

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文档下载后可定制随意修改，请根据实际需要进行相应的调整和使用，谢谢!并且，本店铺为大家提供各种各样类型的实用资料，如教育随笔、日记赏析、句子摘抄、古诗大全、经典美文、话题作文、工作总结、词语解析、文案摘录、其他资料等等，如想了解不同资料格式和写法，敬请关注!Download tips: This document is carefully compiled by theeditor. I hope that after you download them,they can help yousolve practical problems. The document can be customized andmodified after downloading,please adjust and use it according toactual needs, thank you!In addition, our shop provides you with various types ofpractical materials,such as educational essays, diaryappreciation,sentence excerpts,ancient poems,classic articles,topic composition,work summary,word parsing,copyexcerpts,other materials and so on,want to know different data formats andwriting methods,please pay attention!Trauma can be a life-altering experience. It can leave a lasting impact on a person's mental and emotional well-being. The pain and suffering caused by trauma can be overwhelming, making it difficult to cope with everyday life.When a person experiences trauma, their world is turned upside down. Their sense of safety and security is shattered, leaving them feeling vulnerable and exposed.It's as if a storm has swept through their life, leaving behind a trail of destruction. The aftermath of trauma can be chaotic and confusing, with emotions running high and thoughts racing through the mind.One of the most challenging aspects of trauma is the way it can haunt a person. Memories of the traumatic event can resurface unexpectedly, triggering intense emotions and physical sensations. It's like a never-ending loop, replaying the trauma over and over again. The mind becomesa battlefield, with the person constantly fighting against the memories and the pain they bring.The aftermath of trauma can also manifest in physical symptoms. The body can become tense and on edge, always on high alert for any potential danger. Sleep disturbances, such as nightmares and insomnia, are common among trauma survivors. The body becomes a vessel for the pain and suffering, a constant reminder of the trauma that has been endured.In addition to the immediate impact, trauma can also have long-term effects on a person's mental health. Post-traumatic stress disorder (PTSD) is a common condition that can develop after experiencing trauma. It can cause flashbacks, intrusive thoughts, and intense anxiety. The person may become hypervigilant, constantly scanning their surroundings for potential threats. Everyday activities can become overwhelming, as the person tries to navigate through a world that feels unsafe.Recovery from trauma is a journey that takes time andpatience. It requires the person to confront their pain and work through it, often with the help of therapy and support from loved ones. Healing is possible, but it is a process that cannot be rushed. It's important to acknowledge the impact of trauma and give oneself permission to heal.In conclusion, trauma is a deeply distressing experience that can have a profound impact on a person's life. It can leave them feeling broken and lost, struggling to find their way back to a sense of normalcy. However, with time and support, healing is possible. It's important to remember that trauma does not define a person, but rather, it is a part of their story.。

受伤自救英文作文

受伤自救英文作文英文：Injuries can happen at any time, and knowing how to take care of yourself in these situations can be crucial. Here are some tips on how to self-rescue in case of injury.1. Assess the situation: The first thing you need to do is assess the severity of your injury and the environment around you. This will help you determine what actions you need to take next.2. Stop the bleeding: If you are bleeding, try to stop the bleeding as quickly as possible. Apply pressure to the wound with a clean cloth or bandage.3. Treat for shock: If you are in shock, lie down and elevate your feet. Cover yourself with a blanket or jacket to keep warm.4. Stay hydrated: If you are able to, drink water to stay hydrated. This will help your body heal faster.5. Seek medical attention: If your injury is severe, seek medical attention immediately. Do not hesitate to call for help.中文：受伤是随时可能发生的，知道如何在这种情况下自救可能非常重要。

如何救助断肢的人英语作文

如何救助断肢的人英语作文Title: Providing Aid to an Individual with an Amputation。

In emergency situations where individuals experience traumatic incidents leading to limb loss, it's crucial to provide immediate assistance to mitigate further harm and offer necessary medical care. Offering aid to someone with an amputation requires a combination of swift action, empathy, and knowledge. Here's a comprehensive guide on how to assist someone who has suffered an amputation:1. Assess the Situation: Upon encountering someone with an amputation, quickly assess the scene to ensure safetyfor both the victim and yourself. Check for any ongoing dangers such as fire, traffic, or further risks of injury.2. Call for Help: Dial emergency services immediately to summon professional medical assistance. Provide clear and concise information about the situation, including thelocation and the nature of the injury.3. Control Bleeding: Apply direct pressure to the wound using a clean cloth or bandage to control bleeding. Elevate the injured limb if possible to help reduce blood flow. Avoid using a tourniquet unless absolutely necessary and if you have been trained in its application.4. Comfort and Reassure: Stay calm and offer reassurance to the individual. Assure them that help is on the way and that they are not alone. Keep them warm by covering them with a blanket or jacket if needed.5. Address Shock: Traumatic incidents can induce shock, which may manifest as pale skin, rapid heartbeat, or altered mental state. Lay the person down, elevate their legs slightly, and cover them with a blanket to help maintain body temperature and alleviate shock symptoms.6. Handle the Amputated Limb: If the amputated limb is present, handle it with care. Wrap it in a clean, damp cloth, place it in a sealed plastic bag, and keep it coolby placing it in a container surrounded by ice or cold water. Do not directly apply ice to the severed limb.7. Provide Emotional Support: Coping with the immediate aftermath of an amputation can be emotionally overwhelming. Offer words of encouragement and support while respecting the individual's privacy and dignity.8. Stay with the Person: Until professional help arrives, remain with the individual to offer continuous support and monitor their condition for any changes. Reassure them that they are in good hands and that help is on its way.9. Communicate with Emergency Responders: When emergency medical services arrive, provide them with a clear account of the events leading up to the injury, any first aid measures you've administered, and any pertinent medical history if known.10. Follow-up Care: After the immediate crisis has been addressed, encourage the individual to seek follow-upmedical care and counseling to aid in their recovery process. Offer to assist them in making arrangements for ongoing support and rehabilitation services.In conclusion, providing aid to someone who has suffered an amputation requires a coordinated effort of prompt action, compassion, and knowledge. By following these steps, you can make a significant difference in the well-being and recovery of the individual in need.。

在森林里被蛇咬了的英语作文

在森林里被蛇咬了的英语作文In the Depths of the ForestThe sun had just begun to peek through the thick canopy of trees, casting a warm glow over the lush, verdant landscape. I had set out on a hike, eager to immerse myself in the tranquility of the forest, far from the bustling city. Little did I know that my peaceful journey would take an unexpected and harrowing turn.As I navigated the winding trails, I couldn't help but marvel at the towering oaks and the delicate wildflowers that dotted the forest floor. The air was crisp and clean, filled with the soothing sounds of rustling leaves and the distant calls of birds. I felt a sense of serenity wash over me, and I couldn't wait to explore deeper into the heart of this natural sanctuary.However, my reverie was shattered when I suddenly felt a sharp pain in my leg. I looked down to see a slender, coiled snake slithering away, its fangs still embedded in my skin. My heart raced as I realized the gravity of the situation – I had been bitten by a venomous snake, and I was miles away from any help.Panic gripped me as I tried to remain calm and assess the situation. I knew I had to act quickly to minimize the spread of the venom and prevent further complications. With trembling hands, I tore a piece of fabric from my shirt and fashioned a makeshift tourniquet, applying it above the bite to slow the circulation of the venom.As the pain intensified, I struggled to maintain my composure. I knew that time was of the essence, and I had to find a way to get to safety. Summoning my remaining strength, I began to slowly retrace my steps, fighting against the dizziness and nausea that threatened to overwhelm me.Each step was a battle, and the forest seemed to stretch on endlessly. The once-serene trails now felt like a labyrinth, and the weight of my own fear made every movement a challenge. I could feel the venom coursing through my veins, and the thought of succumbing to its effects terrified me.Just when I thought I couldn't go on any longer, I heard the faint sound of voices in the distance. Mustering every ounce of energy I had left, I called out for help, my voice weak and desperate. To my immense relief, a group of hikers emerged from the undergrowth, their faces etched with concern.They quickly sprang into action, providing first aid and calling foremergency services. As the paramedics arrived and tended to my wound, I felt a sense of overwhelming gratitude for the kindness and quick-thinking of these strangers who had come to my aid.The journey to the hospital was a blur, and I drifted in and out of consciousness, my body fighting the venom's effects. But through it all, I clung to the hope of survival, determined to overcome this ordeal and emerge stronger than before.In the days that followed, I underwent intensive treatment and monitoring, as the medical staff worked tirelessly to neutralize the venom and address the complications that had arisen. It was a long and arduous process, but with each passing day, I could feel my strength slowly returning, and the fear that had once consumed me began to subside.As I reflect on this harrowing experience, I am filled with a newfound appreciation for the power and unpredictability of nature. The forest, which had once seemed like a serene and welcoming sanctuary, had revealed its hidden dangers, reminding me that even in the most tranquil of settings, one must always remain vigilant and prepared.This encounter has forever changed the way I approach my outdoor adventures. I have learned the importance of proper preparation, the necessity of first-aid training, and the value of having a survival planin place. Most importantly, I have gained a deeper respect for the delicate balance that exists within the natural world, and I am committed to being a more responsible and aware steward of our shared environment.As I continue to heal, both physically and emotionally, I know that this experience has left an indelible mark on my life. It has taught me the true meaning of resilience, the power of human connection, and the vital importance of appreciating the beauty and wonder of the natural world, even in the face of its most formidable challenges.。

恐怖主义是残酷的英语作文

恐怖主义是残酷的英语作文Terrorism is a cruel and inhumane act that brings fear and destruction to innocent people.It is a cowardly way for individuals or groups to impose their beliefs or ideologies on others through violence and intimidation.The impact of terrorism goes far beyond the immediate physical damage. It creates a climate of fear and suspicion that can tear communities apart and disrupt the normal functioning of society.Terrorism preys on the vulnerability of people, exploiting their fears and insecurities for the sake of achieving political, religious, or ideological goals.The use of terror tactics, such as bombings, shootings, and hostage-taking, is a blatant violation of human rights and a threat to the fundamental values of freedom anddemocracy.The victims of terrorism are not only those directly affected by the attacks, but also the countless individuals who live in constant fear of the next strike.The global fight against terrorism requires a united front and a commitment to addressing the root causes of extremism, such as poverty, inequality, and social injustice.Terrorism is a complex and multifaceted problem that demands a comprehensive approach, including intelligence cooperation, law enforcement efforts, and diplomatic initiatives.The fight against terrorism is an ongoing struggle that requires vigilance, resilience, and a firm commitment to upholding the principles of peace and justice.。

小蚁被枯枝砸伤了腰读后感

小蚁被枯枝砸伤了腰读后感The incident of the ant being injured by a dry branch hitting its waist is indeed a distressing and thought-provoking event. It is a stark reminder of thevulnerability and fragility of life, and it prompts us to reflect on the value of compassion and empathy towards all living beings, regardless of their size or stature.From a human perspective, the injury suffered by the ant serves as a poignant reminder of the interconnectedness of all living beings. It prompts us to consider the impact of our actions on the environment and the creatures that inhabit it. The ant's injury serves as a wake-up call, urging us to be more mindful of our surroundings and to take greater care in our interactions with the natural world.On a more personal level, the incident of the injured ant evokes feelings of empathy and compassion. It is a stark reminder of the pain and suffering that can beexperienced by even the smallest of creatures. It prompts us to consider the ways in which we can alleviate the suffering of others, whether they are human or non-human. The sight of the injured ant tugs at our heartstrings, compelling us to take action and offer assistance in any way we can.From a philosophical standpoint, the injury suffered by the ant raises profound questions about the nature of suffering and the moral obligations we have towards other beings. It challenges us to consider the ethical implications of our actions and to reflect on the ways in which we can minimize harm and promote the well-being ofall living creatures. The incident serves as a powerful reminder of the inherent value of all life, and the importance of treating every being with kindness and respect.The injury suffered by the ant also serves as a reminder of the fragility of life and the inevitability of suffering. It prompts us to confront the harsh realities of the natural world, and to consider the ways in which we canrespond with compassion and empathy. The sight of the injured ant reminds us of our own mortality and vulnerability, and encourages us to approach life with a greater sense of humility and understanding.In conclusion, the incident of the ant being injured by a dry branch is a powerful and evocative event that prompts us to consider our relationship with the natural world, our moral obligations towards other beings, and the ways in which we can respond with empathy and compassion. It serves as a poignant reminder of the interconnectedness of all living beings, and challenges us to approach life with a greater sense of mindfulness and care.。

OSHA现场作业手册说明书

DIRECTIVE NUMBER: CPL 02-00-150 EFFECTIVE DATE: April 22, 2011 SUBJECT: Field Operations Manual (FOM)ABSTRACTPurpose: This instruction cancels and replaces OSHA Instruction CPL 02-00-148,Field Operations Manual (FOM), issued November 9, 2009, whichreplaced the September 26, 1994 Instruction that implemented the FieldInspection Reference Manual (FIRM). The FOM is a revision of OSHA’senforcement policies and procedures manual that provides the field officesa reference document for identifying the responsibilities associated withthe majority of their inspection duties. This Instruction also cancels OSHAInstruction FAP 01-00-003 Federal Agency Safety and Health Programs,May 17, 1996 and Chapter 13 of OSHA Instruction CPL 02-00-045,Revised Field Operations Manual, June 15, 1989.Scope: OSHA-wide.References: Title 29 Code of Federal Regulations §1903.6, Advance Notice ofInspections; 29 Code of Federal Regulations §1903.14, Policy RegardingEmployee Rescue Activities; 29 Code of Federal Regulations §1903.19,Abatement Verification; 29 Code of Federal Regulations §1904.39,Reporting Fatalities and Multiple Hospitalizations to OSHA; and Housingfor Agricultural Workers: Final Rule, Federal Register, March 4, 1980 (45FR 14180).Cancellations: OSHA Instruction CPL 02-00-148, Field Operations Manual, November9, 2009.OSHA Instruction FAP 01-00-003, Federal Agency Safety and HealthPrograms, May 17, 1996.Chapter 13 of OSHA Instruction CPL 02-00-045, Revised FieldOperations Manual, June 15, 1989.State Impact: Notice of Intent and Adoption required. See paragraph VI.Action Offices: National, Regional, and Area OfficesOriginating Office: Directorate of Enforcement Programs Contact: Directorate of Enforcement ProgramsOffice of General Industry Enforcement200 Constitution Avenue, NW, N3 119Washington, DC 20210202-693-1850By and Under the Authority ofDavid Michaels, PhD, MPHAssistant SecretaryExecutive SummaryThis instruction cancels and replaces OSHA Instruction CPL 02-00-148, Field Operations Manual (FOM), issued November 9, 2009. The one remaining part of the prior Field Operations Manual, the chapter on Disclosure, will be added at a later date. This Instruction also cancels OSHA Instruction FAP 01-00-003 Federal Agency Safety and Health Programs, May 17, 1996 and Chapter 13 of OSHA Instruction CPL 02-00-045, Revised Field Operations Manual, June 15, 1989. This Instruction constitutes OSHA’s general enforcement policies and procedures manual for use by the field offices in conducting inspections, issuing citations and proposing penalties.Significant Changes∙A new Table of Contents for the entire FOM is added.∙ A new References section for the entire FOM is added∙ A new Cancellations section for the entire FOM is added.∙Adds a Maritime Industry Sector to Section III of Chapter 10, Industry Sectors.∙Revises sections referring to the Enhanced Enforcement Program (EEP) replacing the information with the Severe Violator Enforcement Program (SVEP).∙Adds Chapter 13, Federal Agency Field Activities.∙Cancels OSHA Instruction FAP 01-00-003, Federal Agency Safety and Health Programs, May 17, 1996.DisclaimerThis manual is intended to provide instruction regarding some of the internal operations of the Occupational Safety and Health Administration (OSHA), and is solely for the benefit of the Government. No duties, rights, or benefits, substantive or procedural, are created or implied by this manual. The contents of this manual are not enforceable by any person or entity against the Department of Labor or the United States. Statements which reflect current Occupational Safety and Health Review Commission or court precedents do not necessarily indicate acquiescence with those precedents.Table of ContentsCHAPTER 1INTRODUCTIONI.PURPOSE. ........................................................................................................... 1-1 II.SCOPE. ................................................................................................................ 1-1 III.REFERENCES .................................................................................................... 1-1 IV.CANCELLATIONS............................................................................................. 1-8 V. ACTION INFORMATION ................................................................................. 1-8A.R ESPONSIBLE O FFICE.......................................................................................................................................... 1-8B.A CTION O FFICES. .................................................................................................................... 1-8C. I NFORMATION O FFICES............................................................................................................ 1-8 VI. STATE IMPACT. ................................................................................................ 1-8 VII.SIGNIFICANT CHANGES. ............................................................................... 1-9 VIII.BACKGROUND. ................................................................................................. 1-9 IX. DEFINITIONS AND TERMINOLOGY. ........................................................ 1-10A.T HE A CT................................................................................................................................................................. 1-10B. C OMPLIANCE S AFETY AND H EALTH O FFICER (CSHO). ...........................................................1-10B.H E/S HE AND H IS/H ERS ..................................................................................................................................... 1-10C.P ROFESSIONAL J UDGMENT............................................................................................................................... 1-10E. W ORKPLACE AND W ORKSITE ......................................................................................................................... 1-10CHAPTER 2PROGRAM PLANNINGI.INTRODUCTION ............................................................................................... 2-1 II.AREA OFFICE RESPONSIBILITIES. .............................................................. 2-1A.P ROVIDING A SSISTANCE TO S MALL E MPLOYERS. ...................................................................................... 2-1B.A REA O FFICE O UTREACH P ROGRAM. ............................................................................................................. 2-1C. R ESPONDING TO R EQUESTS FOR A SSISTANCE. ............................................................................................ 2-2 III. OSHA COOPERATIVE PROGRAMS OVERVIEW. ...................................... 2-2A.V OLUNTARY P ROTECTION P ROGRAM (VPP). ........................................................................... 2-2B.O NSITE C ONSULTATION P ROGRAM. ................................................................................................................ 2-2C.S TRATEGIC P ARTNERSHIPS................................................................................................................................. 2-3D.A LLIANCE P ROGRAM ........................................................................................................................................... 2-3 IV. ENFORCEMENT PROGRAM SCHEDULING. ................................................ 2-4A.G ENERAL ................................................................................................................................................................. 2-4B.I NSPECTION P RIORITY C RITERIA. ..................................................................................................................... 2-4C.E FFECT OF C ONTEST ............................................................................................................................................ 2-5D.E NFORCEMENT E XEMPTIONS AND L IMITATIONS. ....................................................................................... 2-6E.P REEMPTION BY A NOTHER F EDERAL A GENCY ........................................................................................... 2-6F.U NITED S TATES P OSTAL S ERVICE. .................................................................................................................. 2-7G.H OME-B ASED W ORKSITES. ................................................................................................................................ 2-8H.I NSPECTION/I NVESTIGATION T YPES. ............................................................................................................... 2-8 V.UNPROGRAMMED ACTIVITY – HAZARD EVALUATION AND INSPECTION SCHEDULING ............................................................................ 2-9 VI.PROGRAMMED INSPECTIONS. ................................................................... 2-10A.S ITE-S PECIFIC T ARGETING (SST) P ROGRAM. ............................................................................................. 2-10B.S CHEDULING FOR C ONSTRUCTION I NSPECTIONS. ..................................................................................... 2-10C.S CHEDULING FOR M ARITIME I NSPECTIONS. ............................................................................. 2-11D.S PECIAL E MPHASIS P ROGRAMS (SEP S). ................................................................................... 2-12E.N ATIONAL E MPHASIS P ROGRAMS (NEP S) ............................................................................... 2-13F.L OCAL E MPHASIS P ROGRAMS (LEP S) AND R EGIONAL E MPHASIS P ROGRAMS (REP S) ............ 2-13G.O THER S PECIAL P ROGRAMS. ............................................................................................................................ 2-13H.I NSPECTION S CHEDULING AND I NTERFACE WITH C OOPERATIVE P ROGRAM P ARTICIPANTS ....... 2-13CHAPTER 3INSPECTION PROCEDURESI.INSPECTION PREPARATION. .......................................................................... 3-1 II.INSPECTION PLANNING. .................................................................................. 3-1A.R EVIEW OF I NSPECTION H ISTORY .................................................................................................................... 3-1B.R EVIEW OF C OOPERATIVE P ROGRAM P ARTICIPATION .............................................................................. 3-1C.OSHA D ATA I NITIATIVE (ODI) D ATA R EVIEW .......................................................................................... 3-2D.S AFETY AND H EALTH I SSUES R ELATING TO CSHO S.................................................................. 3-2E.A DVANCE N OTICE. ................................................................................................................................................ 3-3F.P RE-I NSPECTION C OMPULSORY P ROCESS ...................................................................................................... 3-5G.P ERSONAL S ECURITY C LEARANCE. ................................................................................................................. 3-5H.E XPERT A SSISTANCE. ........................................................................................................................................... 3-5 III. INSPECTION SCOPE. ......................................................................................... 3-6A.C OMPREHENSIVE ................................................................................................................................................... 3-6B.P ARTIAL. ................................................................................................................................................................... 3-6 IV. CONDUCT OF INSPECTION .............................................................................. 3-6A.T IME OF I NSPECTION............................................................................................................................................. 3-6B.P RESENTING C REDENTIALS. ............................................................................................................................... 3-6C.R EFUSAL TO P ERMIT I NSPECTION AND I NTERFERENCE ............................................................................. 3-7D.E MPLOYEE P ARTICIPATION. ............................................................................................................................... 3-9E.R ELEASE FOR E NTRY ............................................................................................................................................ 3-9F.B ANKRUPT OR O UT OF B USINESS. .................................................................................................................... 3-9G.E MPLOYEE R ESPONSIBILITIES. ................................................................................................. 3-10H.S TRIKE OR L ABOR D ISPUTE ............................................................................................................................. 3-10I. V ARIANCES. .......................................................................................................................................................... 3-11 V. OPENING CONFERENCE. ................................................................................ 3-11A.G ENERAL ................................................................................................................................................................ 3-11B.R EVIEW OF A PPROPRIATION A CT E XEMPTIONS AND L IMITATION. ..................................................... 3-13C.R EVIEW S CREENING FOR P ROCESS S AFETY M ANAGEMENT (PSM) C OVERAGE............................. 3-13D.R EVIEW OF V OLUNTARY C OMPLIANCE P ROGRAMS. ................................................................................ 3-14E.D ISRUPTIVE C ONDUCT. ...................................................................................................................................... 3-15F.C LASSIFIED A REAS ............................................................................................................................................. 3-16VI. REVIEW OF RECORDS. ................................................................................... 3-16A.I NJURY AND I LLNESS R ECORDS...................................................................................................................... 3-16B.R ECORDING C RITERIA. ...................................................................................................................................... 3-18C. R ECORDKEEPING D EFICIENCIES. .................................................................................................................. 3-18 VII. WALKAROUND INSPECTION. ....................................................................... 3-19A.W ALKAROUND R EPRESENTATIVES ............................................................................................................... 3-19B.E VALUATION OF S AFETY AND H EALTH M ANAGEMENT S YSTEM. ....................................................... 3-20C.R ECORD A LL F ACTS P ERTINENT TO A V IOLATION. ................................................................................. 3-20D.T ESTIFYING IN H EARINGS ................................................................................................................................ 3-21E.T RADE S ECRETS. ................................................................................................................................................. 3-21F.C OLLECTING S AMPLES. ..................................................................................................................................... 3-22G.P HOTOGRAPHS AND V IDEOTAPES.................................................................................................................. 3-22H.V IOLATIONS OF O THER L AWS. ....................................................................................................................... 3-23I.I NTERVIEWS OF N ON-M ANAGERIAL E MPLOYEES .................................................................................... 3-23J.M ULTI-E MPLOYER W ORKSITES ..................................................................................................................... 3-27 K.A DMINISTRATIVE S UBPOENA.......................................................................................................................... 3-27 L.E MPLOYER A BATEMENT A SSISTANCE. ........................................................................................................ 3-27 VIII. CLOSING CONFERENCE. .............................................................................. 3-28A.P ARTICIPANTS. ..................................................................................................................................................... 3-28B.D ISCUSSION I TEMS. ............................................................................................................................................ 3-28C.A DVICE TO A TTENDEES .................................................................................................................................... 3-29D.P ENALTIES............................................................................................................................................................. 3-30E.F EASIBLE A DMINISTRATIVE, W ORK P RACTICE AND E NGINEERING C ONTROLS. ............................ 3-30F.R EDUCING E MPLOYEE E XPOSURE. ................................................................................................................ 3-32G.A BATEMENT V ERIFICATION. ........................................................................................................................... 3-32H.E MPLOYEE D ISCRIMINATION .......................................................................................................................... 3-33 IX. SPECIAL INSPECTION PROCEDURES. ...................................................... 3-33A.F OLLOW-UP AND M ONITORING I NSPECTIONS............................................................................................ 3-33B.C ONSTRUCTION I NSPECTIONS ......................................................................................................................... 3-34C. F EDERAL A GENCY I NSPECTIONS. ................................................................................................................. 3-35CHAPTER 4VIOLATIONSI. BASIS OF VIOLATIONS ..................................................................................... 4-1A.S TANDARDS AND R EGULATIONS. .................................................................................................................... 4-1B.E MPLOYEE E XPOSURE. ........................................................................................................................................ 4-3C.R EGULATORY R EQUIREMENTS. ........................................................................................................................ 4-6D.H AZARD C OMMUNICATION. .............................................................................................................................. 4-6E. E MPLOYER/E MPLOYEE R ESPONSIBILITIES ................................................................................................... 4-6 II. SERIOUS VIOLATIONS. .................................................................................... 4-8A.S ECTION 17(K). ......................................................................................................................... 4-8B.E STABLISHING S ERIOUS V IOLATIONS ............................................................................................................ 4-8C. F OUR S TEPS TO BE D OCUMENTED. ................................................................................................................... 4-8 III. GENERAL DUTY REQUIREMENTS ............................................................. 4-14A.E VALUATION OF G ENERAL D UTY R EQUIREMENTS ................................................................................. 4-14B.E LEMENTS OF A G ENERAL D UTY R EQUIREMENT V IOLATION.............................................................. 4-14C. U SE OF THE G ENERAL D UTY C LAUSE ........................................................................................................ 4-23D.L IMITATIONS OF U SE OF THE G ENERAL D UTY C LAUSE. ..............................................................E.C LASSIFICATION OF V IOLATIONS C ITED U NDER THE G ENERAL D UTY C LAUSE. ..................F. P ROCEDURES FOR I MPLEMENTATION OF S ECTION 5(A)(1) E NFORCEMENT ............................ 4-25 4-27 4-27IV.OTHER-THAN-SERIOUS VIOLATIONS ............................................... 4-28 V.WILLFUL VIOLATIONS. ......................................................................... 4-28A.I NTENTIONAL D ISREGARD V IOLATIONS. ..........................................................................................4-28B.P LAIN I NDIFFERENCE V IOLATIONS. ...................................................................................................4-29 VI. CRIMINAL/WILLFUL VIOLATIONS. ................................................... 4-30A.A REA D IRECTOR C OORDINATION ....................................................................................................... 4-31B.C RITERIA FOR I NVESTIGATING P OSSIBLE C RIMINAL/W ILLFUL V IOLATIONS ........................ 4-31C. W ILLFUL V IOLATIONS R ELATED TO A F ATALITY .......................................................................... 4-32 VII. REPEATED VIOLATIONS. ...................................................................... 4-32A.F EDERAL AND S TATE P LAN V IOLATIONS. ........................................................................................4-32B.I DENTICAL S TANDARDS. .......................................................................................................................4-32C.D IFFERENT S TANDARDS. .......................................................................................................................4-33D.O BTAINING I NSPECTION H ISTORY. .....................................................................................................4-33E.T IME L IMITATIONS..................................................................................................................................4-34F.R EPEATED V. F AILURE TO A BATE....................................................................................................... 4-34G. A REA D IRECTOR R ESPONSIBILITIES. .............................................................................. 4-35 VIII. DE MINIMIS CONDITIONS. ................................................................... 4-36A.C RITERIA ................................................................................................................................................... 4-36B.P ROFESSIONAL J UDGMENT. ..................................................................................................................4-37C. A REA D IRECTOR R ESPONSIBILITIES. .............................................................................. 4-37 IX. CITING IN THE ALTERNATIVE ............................................................ 4-37 X. COMBINING AND GROUPING VIOLATIONS. ................................... 4-37A.C OMBINING. ..............................................................................................................................................4-37B.G ROUPING. ................................................................................................................................................4-38C. W HEN N OT TO G ROUP OR C OMBINE. ................................................................................................4-38 XI. HEALTH STANDARD VIOLATIONS ....................................................... 4-39A.C ITATION OF V ENTILATION S TANDARDS ......................................................................................... 4-39B.V IOLATIONS OF THE N OISE S TANDARD. ...........................................................................................4-40 XII. VIOLATIONS OF THE RESPIRATORY PROTECTION STANDARD(§1910.134). ....................................................................................................... XIII. VIOLATIONS OF AIR CONTAMINANT STANDARDS (§1910.1000) ... 4-43 4-43A.R EQUIREMENTS UNDER THE STANDARD: .................................................................................................. 4-43B.C LASSIFICATION OF V IOLATIONS OF A IR C ONTAMINANT S TANDARDS. ......................................... 4-43 XIV. CITING IMPROPER PERSONAL HYGIENE PRACTICES. ................... 4-45A.I NGESTION H AZARDS. .................................................................................................................................... 4-45B.A BSORPTION H AZARDS. ................................................................................................................................ 4-46C.W IPE S AMPLING. ............................................................................................................................................. 4-46D.C ITATION P OLICY ............................................................................................................................................ 4-46 XV. BIOLOGICAL MONITORING. ...................................................................... 4-47CHAPTER 5CASE FILE PREPARATION AND DOCUMENTATIONI.INTRODUCTION ............................................................................................... 5-1 II.INSPECTION CONDUCTED, CITATIONS BEING ISSUED. .................... 5-1A.OSHA-1 ................................................................................................................................... 5-1B.OSHA-1A. ............................................................................................................................... 5-1C. OSHA-1B. ................................................................................................................................ 5-2 III.INSPECTION CONDUCTED BUT NO CITATIONS ISSUED .................... 5-5 IV.NO INSPECTION ............................................................................................... 5-5 V. HEALTH INSPECTIONS. ................................................................................. 5-6A.D OCUMENT P OTENTIAL E XPOSURE. ............................................................................................................... 5-6B.E MPLOYER’S O CCUPATIONAL S AFETY AND H EALTH S YSTEM. ............................................................. 5-6 VI. AFFIRMATIVE DEFENSES............................................................................. 5-8A.B URDEN OF P ROOF. .............................................................................................................................................. 5-8B.E XPLANATIONS. ..................................................................................................................................................... 5-8 VII. INTERVIEW STATEMENTS. ........................................................................ 5-10A.G ENERALLY. ......................................................................................................................................................... 5-10B.CSHO S SHALL OBTAIN WRITTEN STATEMENTS WHEN: .......................................................................... 5-10C.L ANGUAGE AND W ORDING OF S TATEMENT. ............................................................................................. 5-11D.R EFUSAL TO S IGN S TATEMENT ...................................................................................................................... 5-11E.V IDEO AND A UDIOTAPED S TATEMENTS. ..................................................................................................... 5-11F.A DMINISTRATIVE D EPOSITIONS. .............................................................................................5-11 VIII. PAPERWORK AND WRITTEN PROGRAM REQUIREMENTS. .......... 5-12 IX.GUIDELINES FOR CASE FILE DOCUMENTATION FOR USE WITH VIDEOTAPES AND AUDIOTAPES .............................................................. 5-12 X.CASE FILE ACTIVITY DIARY SHEET. ..................................................... 5-12 XI. CITATIONS. ..................................................................................................... 5-12A.S TATUTE OF L IMITATIONS. .............................................................................................................................. 5-13B.I SSUING C ITATIONS. ........................................................................................................................................... 5-13C.A MENDING/W ITHDRAWING C ITATIONS AND N OTIFICATION OF P ENALTIES. .................................. 5-13D.P ROCEDURES FOR A MENDING OR W ITHDRAWING C ITATIONS ............................................................ 5-14 XII. INSPECTION RECORDS. ............................................................................... 5-15A.G ENERALLY. ......................................................................................................................................................... 5-15B.R ELEASE OF I NSPECTION I NFORMATION ..................................................................................................... 5-15C. C LASSIFIED AND T RADE S ECRET I NFORMATION ...................................................................................... 5-16。

bury my heart at wounded knee叙事结构

《Bury My Heart at Wounded Knee》是美国作家迪坎普（Dee Brown）于1970年出版的一本纪实历史书籍，讲述了美国西部开拓时期对美洲原住民的侵略和压迫。

这本书的叙事结构主要分为三个部分：种族清洗、土地掠夺和部落迫害。

第一部分，种族清洗，描述了美国政府在19世纪通过逼迫、欺骗和武力手段，试图清洗或消灭美洲原住民的情况。

故事从西班牙人的殖民开始，继而是英国殖民者和美国政府的行动。

这一部分详细记录了原住民与欧洲殖民者之间的各种冲突和战斗，包括印第安纳波利斯什人的屠杀、小角恩河大屠杀和威尼布战争等。

第二部分，土地掠夺，聚焦于美国政府的土地政策和原住民土地被掠夺的过程。

通过签署不平等条约、强制流散和划定保留地等手段，原住民的土地被大量剥夺。

在这一部分中，书中详细描述了美国政府与局部政府、土地抢劫者和铁路公司之间的勾结，以及印第安人暴乱的动机。

第三部分，部落迫害，讲述了美洲原住民部落与美国政府之间的日常斗争与迫害。

书中揭示了美国政府通过取消政策、战争和流散等手段，对部落进行了长期的打压和迫害，这对原住民社区和文化造成了毁灭性的影响。

这一部分描述了大
量的历史事件和背景，包括布法罗兵团的屠杀、大领地行动和瓦拉肯战争等。

《Bury My Heart at Wounded Knee》以纪实的方式揭示了美洲原住民在西部拓荒时期所受到的不公正对待和种族灭绝的历史。

书中以各个个案及历史事件来展示这一过程，通过叙述这些故事，揭示了对原住民的侵略和不公的本质。

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Extremity Injuries
Fractures骨折
• Open (compound)开放性
• Communication to outside骨端外露 • Danger of contamination伤口污染 • Blood loss outside body外出血
• Closed (simple)闭合性
Extremity Trauma - 13 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Injuries
Open wounds开放性伤口
Chapter 14 Extremity Trauma
Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Trauma 肢体创伤
• No communication to outside • Danger of contamination • Blood loss inside body内出血
Extremity Trauma - 6 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Trauma
Extremity injuries肢体创伤
• Fractures骨折 • Dislocations关骨脱位 • Amputations断肢 • Open wounds开放性伤口
• Neurovascular injuries神经血管之损伤
• Impaled objects插有异物 • Compartment syndrome骨筋膜室综合症
• Remove contamination污染物
• Gross: remove 大量︰除去 • Smaller: irrigate with normal saline 小量︰用生理盐水冲洗
Amputations断肢
• Tourniquet if bleeding absolutely not controlled 如不能止血可使用止血带 • Rarely needed极少需要
• Retrieve amputated part运送断肢 • In plastic bag, inside ice water 放入胶袋中，再放于冰水内
• Neurovascular injuries 神经血管之损伤 • Impaled object 插有异物 • Compartment syndrome 骨筋膜室综合症
Estimated blood loss评估出血量
• Pelvic and extremity fractures盆骨及肢体骨折
Extremity Trauma - 2 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Injuries
• Potential for massive hemorrhage 潜在大量出血之危险
• Most often, bleeding controlled with ordinary pressure 通常直接压力已可止血
Extremity Trauma - 11 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
• Disabling and sometimes life-threatening 造戊残障有时可危害生命
Extremity Trauma - 10 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
• Neurovascular compromise神经血管受阻
• True emergency though not life-threatening紧急伤势 • Check PMS distal to major joint dislocations检查关节远程之PMS
Courtesy of Roy Alson, MD
Fractures
Hemorrhage with fracture骨折导致之出血 • Closed femur fracture闭合性股骨骨折 • Loss of 1 liter of blood出血可达一公升 • Two closed femur fractures life-threatening双股骨骨折可危害生命
Potential danger:潜在危险 • Hemorrhagic shock (very few)出血性休克(极少发生) • Neurovascular compromise神经血管受阻 • Distal PMS远程脉搏、运动、感觉
Extremity Trauma - 4 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Courtesy of Roy Alson, MD
Extremity Trauma - 5 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Courtesy of Bonnie Meneely, EMT-P Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Overview
Priority of extremity trauma处理肢体创伤的优先次序 Major complications and treatment :主要损伤及治理
• • • • • Fractures骨折 Dislocations关骨脱位 Amputations断肢 Open wounds开放性伤口 Sprains and strains 扭伤及拉伤
• No neurovascular compromise无神经血管受阻
• Splint in position found固定于受伤时位置
• Neurovascular compromise 神经血管受阻
• Apply only gentle traction in effort to straighten用轻力牵引拉直伤员处 • No more than 10 pounds of force拉力少于10磅 • Often best: pad and splint in most comfortable position and rapid safe transport 垫好及固定伤员处于伤者最舒适位置及速送医院
Amputations断肢
Management处理
• Cover with damp sterile dressing, elastic wrap
用消毒敷料遮盖，放于胶袋中
• Uniform reasonable pressure across stump
用均衡的压力包扎截肢
Extremity Trauma - 12 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddlajor mechanisms, associated trauma, potential complications, management 主要受伤基理,有关伤势,潜在并发症及处理:
• Pelvis盆骨
• • • • Femur大腿骨 Hip髋 Knee膝盖 Tibia/fibula胫/腓骨 • • • • Clavicle/shoulder锁骨/肩膊 Elbow手肘 Forearm and wrist前臂及手腕 Hand or foot手或足
Extremity Trauma - 3 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Trauma
Distorted or wounded extremities must not distract from life-threatening injuries.先处理其他危害生命之伤势. • Easy to identify容易分辨 • Disabling but rarely immediately life-threatening 絶少有实时生命危险
Extremity Trauma - 9 Campbell,International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ