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Chapter 6. Providing first aid

Types of medical aid

There are three types of medical aid provided to the wounded and patients by
the medical service of civil defence:
emergency medical aid,
first aid measures (First medical assistance),
specialized medical aid.

Emergency medical aid includes performance of the simplest measures to

facilitate the condition of a wounded or ill person. First aid is to be provided as
soon as possible directly on the site of damage or nearby. Such aid is provided by
ambulance teams, medical aid posts and the Civil Defence personnel. People
themselves should also be able to provide medical aid in accordance with the self-
and mutual aid regulations. In this view, the emergency medical aid regulations are
taught to all the people on the basis of special programmes prior to any accident
occurrence.

Emergency medical aid consists of the following:

temporary arrest of haemorrhage;
application of a sterile dressing to wounds or burns;
immobilization by splinting or use of handy facilities upon fractures, sprains
and hurts (fixing the injured part of the body);
to prevent radiation and chemical injuries by the use of individual protection
facilities in the sites damaged by chemical and radioactive matters, to clean
the open parts of the body, to dress respirators to the injured men and to take
them from the dangerous sites.

Providing emergency medical aid as soon as possible is critical for the last
result of injury, that is for saving the life of an injured person. Upon electric
shocks, strong bleeding, asphyxia, cardiac and respiratory arrests emergency
medical is to be provided at once. If emergency medical aid is required to a lot of
injured persons, then such aid is to be initially provided to children and badly
injured persons. In such cases, slightly injured persons should also provide self-
and mutual aid.
All emergency medical aid methods should be provided in strict and very
careful manner. Careless, crude emergency aid may cause additional troubles to the
wounded persons and make worse their condition.
Organic means given under the supply schedule, drugs and items from the
first-aid box and secondary handy means are also used when providing emergency
medical aid.
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Emergency medical aid upon haemorrhages

Temporary haemorrhage arrest methods. Depending on haemorrhage

types (arterial, venous, capillary) and handy means used upon emergency medial
aid, haemorrhage may be temporary or completely arrested.

Temporary external artery haemorrhage arrest methods include pressing the

damaged blood vessel to the bone by a finger, applying the turning stick
constrictor, full bending or opening the arm or leg joint and fixing in such position.

External venous and capillary haemorrhage is to be temporary arrested by

applying the pressing sterile bandage to the wound and keeping the wounded part
high against the trunk. In most cases, temporary venous and capillary haemorrhage
arrest may result in complete arrest of such haemorrhage. Arterial haemorrhage
and, in most cases, venous haemorrhage is completely arrested through surgical
operation performed in the wound.
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As soon as arterial haemorrhage is arrested by squeezing the vein with the

finger, the turning stick or twist is to be placed and the sterile bandage is to be
applied immediately.

Arterial Bleeding From Arm: Control it by squeezing the artery with the flat
of your fingers against the upper arm bone at a pressure point.

Arterial Bleeding from Leg: Control it by pressing the artery with the heel of
your hand against the pelvic bone.
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The date, time and minute of placing the turning stick are to be noted on a
piece of paper, and such paper is to be put under the turning stick in the visible
place. The surroundings of the turn, especially in winter, are to be covered with
warm items. An analgetic is to be administered into the wound through a unit-dose
syringe. In the case of a weak area of the surroundings below the place of the
turning stick application, 2 hours later the artery is to be squeezed with a finger, the
turning stick is to be loosened little by little for 5-10 minutes and be re-applied just
above. Prior to surgical aid to the wounded person the run is to be temporary
loosened every hour, and it is to be noted in the paper every time.

In the case of absence of the turn, haemorrhage may be arrested by applying

the bandage or bending the extremity in the joint down and strong fixing in such
position.
To arrest haemorrhage by use of the bandage, a rope, a spiral shawl, or tissue
is to be used. The turned belt folded like a double buttonhole and passed through
the arm (leg) may be also used as a handy turn.
Upon venous or capillary haemorrhage, a tight bandage is to be applied to the
wound. The bleeding place is to be covered with a sterile napkin or 3-4 layered
bandage and cotton from above. The bandage is to be applied by strongly
squeezing the bandage roll. If the blood soaks through the bandage, more bandage
roll is to be applied.

Emergency medical aid upon soft tissue, muscle injures

Emergency medical aid upon close injures

Close injuries mainly include hurts to subdermal tissues and internals of the
body without solution of continuity of the skin cover, brain commotion, general
body contusion, dislocation of the joint bones, sprains and etc.
Upon hurting, the body surface tissues and internals may be injured. In the
case of hurts to the soft tissues of the body, oedema and bruise occurs. In such
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cases emergency medical aid is to be provided through applying a tight bandage,
using ice, keeping the injured part of the body in a comfortable position.

In case of severe hurts to the chest and abdominal zone, the internals such as
lungs, liver, spleen, kidneys may be injured. Upon injuring such organs pains and
mostly internal haemorrhage take place. It is necessary to put ice on the injured
part of the body and to take such people to a medical institution immediately.

Fig. Bandage to be applied in case of injuries of the soft tissues of the chest
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Emergency medical aid upon dislocations and sprains

Sprains may occur in the joint bands when falling, jumping incorrectly and
lifting heavy things. In such case pains and oedema appear in the injured joint, and
movement at joints is restricted. To provide emergency medical aid in such case, a
tight bandage roll and ice are applied to the joint, and convenience of the injured
joint is to be ensured.

Sprains occur in the case of dislocation (separation) of the joint bones in the
joint cavity. In such cases the integrity of the joint zone is damaged, and some joint
bands are broken. The sprain signs of the extremity joints are pains in the joints,
difficulties in movement, changes in the joint shape, shortening the extremity (arm,
leg) and fixing in unusual position.
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In the case of dislocation in the joints, the extremities are to be immobilized
(put into rest position) and the joint is to be comfortably bandaged. In the case of a
dislocation in large joints - pelvis, thigh, knee, upper arm, as well as intervertebral
joints it is recommended to administer an analgetic to the injured person.

The person with the intervertebral joint sprain may be taken only in the
position laid back upwards on the hard board. In the case of the submandibular
joint sprain, a bandage keeping the lower jaw firmly is to be applied.

Emergency medical aid upon fractures

As a result of an abrupt movement, stroke, falling from the height, car and
other accidents, as well as due to earthquake the body bones may be fractured.
Fractures may be closed and open. Upon a closed fracture, the skin integrity is not
broken, and upon open fractures the skin in the fracture site is broken. Open
fractures are more dangerous.

Types of fractures: a) closed, b) open, c) complicated

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Fractures are not always diagnosed easily, so, in the doubtful cases
emergency medical aid is provided as in the case of fracture.
Upon fractures, basic rules for emergency medical aid are the following: first,
to perform emergency medical aid measures saving the life of the injured person,
to prevent the closed fracture modification to the open one, to fix the bones in the
fracture site by immobilizing the extremities or other body parts.

a) b)

c) d)

Fig. a) Haemorrhage arrest; b) the injured extremity immobilization;

c) the ice package is applied to reduce swelling and pains;
d) the fractured joint is fixed in the elevated position.
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Upon open fractures with bleeding, at first, haemorrhage is to be arrested,
further the injured part of the body is covered with a sterile bandage, an analgetic
is injected into the wound, and after that organic resources or handy facilities are
used to fix the bones immovably. Upon ensuring the immobility of the fracture
site, a special splint or handy means are to be put in such manner to cover two
joints close to the fracture site (above and below the fracture site). Such
immobilization is called transport immobilization.

Emergency medical aid upon burns

Causes of burns. Burns occur as a result of high temperature, as well as

different chemical matters affecting the body. Especially, the number of injured
persons exposed to the burns in the radioactive damage sites may be higher. In
such places, burns mainly occur along with traumas and radioactive injures.
Burns occurred due to light illumination, flame, hot water and steam effects
are called thermal burns.
As a result of effects to the skin surface and mucous membranes by dense
acids and alkali maters, chemical burns occur. Acids and alkali matters damage
not only the part of the body they come in contact with, but also cause the total
injury of the body. Burns caused by napalm and other burning matters are more
dangerous. Napalm sticks to the skin surface and clothes and continues to burn,
and, as a result, both the skin surface and subdermal and connective tissues and
muscles burn, and deep burns appear.
Radioactive burns occur If radioactive matters come in contact with the skin
surface and mucous membranes and remain there for a long time. Severity degree
of thermal, chemical and radioactive burns depends both on the depth of tissue
damage and the area of the surface exposed to the burn.
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Emergency medical aid rules. Upon providing medical aid, at first, the burnt
clothes are to be suppressed, so, a coat, blanket is to be put onto the person and fire
is to be slackened. Further, clothes are to be taken off the burnt part of the body:
for such purpose, clothes are to be cut around the burn site without touching it. It is
prohibited to tear off the blister from the burn site, to touch the burn site with
hands, and to spread oil, ointment and other matters on the burn. The burn site is to
be covered with a sterile bandage. Contour bandages may be used against the burn.
Such bandages to be applied to the face, chest, back, stomach, thigh are to be
primarily prepared in accordance with the same body parts, sterilized and absorbed
with a special solution.

Fig. Contour bandages: a to the back; b to the thigh;

c to the low foot of the leg
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Emergency medical aid upon burn in the eyes includes application of a sterile
bandage and provision of comfort of the person injured.

Put a sterile dressing and immediately tell your doctor

Chemical burns caused by acids and alkali matters are mainly deep ones. The
death of tissues (necrosis) covers not the skin only, but also the subdermal tissues.
Emergency medical aid provided upon chemical burns deals with a range of
features: the burn site is to be immediately washed with the running cold water for
15-20 minutes. Thereafter, if the burn is caused by acids, the baking soda is to be
poured onto the burn site, and if it is caused by acid, the burn is to be poured with
slight vinegar solution and dressed with a sterile bandage roll.

It is prohibited to wash with water the burn site caused by sulphate acid as
sulphate acid together with water results in strong heat. In such cases, to remove
infections the burn site is to be lubricated with the boiled (sterilized and cooled)
vegetable oil.
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Injury (traumatic) shock and anti-shock measures

Injury (traumatic) shock is a potentially lethal complication of severe injuries,

as well as different fractures. Such condition is characterized by various disorders
of the central nervous system activity, blood circulation, metabolism and other
processes essential for the life.
The reason of the shock may be single or repeated severe injuries of the body.
Shock mainly occurs upon large blood loss, and upon chill after injury in winter.
Core measures to prevent shock is to prevent or reduce pains caused by
injury, to arrest haemorrhage, to prevent chill of the injured person, to provide
emergency medical aid in most careful manner and to be careful upon
transportation of the injured person.
If there is no a unit-dose syringe, the injured person in a state of shock may be
given some vodka, hot tea, coffee, provided that he/she had no punctured wound in
the abdominal zone. Further, the injured person is to be covered with a blanket and
carefully taken with a stretcher to a medical institution.

Emergency medical aid upon cardiac and respiratory arrest

Upon electrical shock, drowning in water, compression in breathing passages,

as well as a range of other injuries the respiratory and cardiac activities arrest
suddenly and clinical death may take place.
The cardiac activity arrest may be evidenced by respiratory standstill, absence
of pulse, heart beats, reflexes and pupillary dilatations.
If such people are immediately provided with artificial respiration and
exterior heart massage, such people, in most cases, may be saved.
If the jaw of the injured person is closed, the lower jaw is to be pushed
forward, the chin is to be pressed and the mouth of the injured persons is to be
opened, further the mouth cavity is to be cleaned from spit or mucus by a napkin,
and artificial ventilation is to be provided; for such purpose, one-layer napkin (a
pocket) is to be spread into the opened mouth of the injured person, and the nose is
to be squeezed. A deep breath is to be taken, the lips are to be pressed down to the
lips of the injured person, and the air is to be loudly blown into his/her mouth. The
air is to be blown for a long time to make his/her lungs as much as possible every
time (it will be seen by the chest movement). If the air is blown by little, the
artificial ventilation will not be efficient. The air is to be blown 16-18 times per a
minute in rhythmic manner until natural breathing is restored or the death signs are
clearly seen.
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Heart massage. In the case of a sudden cardiac arrest, the heart massage is to
be performed at once. For such purpose, the injured person is to be laid back down,
someone has to be on the left of the injured person, then to put his/her hands
together and to place on the one third below the chest of the injured person.
Thereafter, the breast is to be pressed at the rate 30 quick rhythmic pushes per a
minute and the hands are to be raised after every push to let the chest to rise and
become straight. Upon pushing the chest is to be pressed 3-4 cm down at least.

If the cardiac arrest occurs along with the respiratory arrest, artificial
ventilation and heart massage are to be performed at the same time.

Emergency medical aid upon frostbiting, electrical damage, drowning,

sun stroke, venomous insect bites

Frostbiting. Frostbiting is the damage of the body tissues due to strong cold.
Legs and hands expose to frostbiting more often. Frostbiting may take place
even with temperature above 0C, in often changing mild climate conditions.
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Long-time immovable stay in cold climate, snow, rain, narrow boots, as well as
physical and psychological tiredness, constitutional weakness, blood losses and
previous frostbiting events may also result in quick frostbiting conditions. Upon
frostbiting, the tissues are not damaged at once. At first, the skin turns pale and
losses its sensitiveness due to exposure to cold. The actual intensity and area of the
injury may be determined only when the cold effects are removed, and in some
cases - some days later.

Upon providing emergency medical aid the injured person is to be placed in a

warm room, but if it is not possible, he/she is to be protected from cold in the field.
If there are still no changes in the tissues, the frostbitten areas are to be wiped with
spirit or fragrance, after that the frostbitten site is to be carefully chafed with clean
dry hands until reddening. To make the injured person warmed, he/she is to be
given hot tea or coffee. If it is possible, the person exposed to strong cold is to be
put into hot water bath.
If changes have occurred in the tissues of the injured person (it occurs upon
the 2nd, 3rd, 4th frostbiting degree) the damage area of the skin is to be wiped with
spirit and covered with a sterile bandage. It is not recommended to chafe the
damaged skin area with snow.

Electrical injuries. Such injuries occur when the central nervous system is
affected by electrical current. Slight injury characterizes with short-time syncope.
In the case of severe injury a man loses his/her memory, and his/her respiratory
and cardiac activity become worse. Sometimes the man in such state looks like a
dead man. The surface of the body tissue that comes in contact with the electric
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wire may have a yellowish spot slightly smashed in the middle. In the case of
short-circuit failure a man may be also exposed to thermal burns.
Upon providing medical aid the first measure is to stop the electrical current
exposure to the man. The person providing aid has to cut off the electrical current
from the source. If it is not possible, he/she has to remove the current wire from the
injured person. At the same time it should be kept in mind that a man exposed to
the electrical current becomes a current conductor, so, it is prohibited to touch
him/her with naked hands.
The person exposed to the electrical current may be wrapped round in dry
cloth with resin gloves or dry hands only, the dry part of his/her cloth is to be
taken, or a dry stick piece is to be used to be put under the injured person and to
remove the current wire. It is not allowed to use metal items. Further, the collapsed
victim is to be laid back down, the neckband and the hand strap are to be opened,
and the liquid ammonia is to be given to be smelt. In the case of respiratory and
cardiac activity failure, the artificial ventilation and the external heart massage are
to be done. The site exposed to the electrical current is to be covered with a sterile
bandage.
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Drowning it occurs in the case of filling the breathing passages with liquid,
such as like water as usual.
Upon drowning the lungs of the man are filled with water, his/her breath is
arrested, acute oxygen deficit takes place and the cardiac activity becomes failure.
The drowned person is to be taken from water as soon as possible.
Upon providing emergency aid such person is to be undressed till the waist,
his/her mouth is to be cleaned from silt, mucus, the injured person is to be laid
stomach down on the high mutakka or the knee, further the water is to be removed
from the lungs by pressing the breast. After that, artificial ventilation and the heart
massage are to be done. In such case, the most effective method is to do artificial
ventilation by mouth-to-mouth method as such artificial ventilation is to be
continued until restoration of breath of the injured person.

If breath is not restored and the injured person doesn't regain consciousness,
then artificial ventilation and heart massage are to be continued until the objective
death signs are found. Such signs include the eye staring, nor light reaction, long-
term heart biting absence, the corpse spot evidences.
In the case of the respiratory and cardiac activity restoration, the injured
person is to be given hot tea and taken to a medical institution.
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Sun stroke. In the case of overheating of the body, sun or heat stroke takes
place. Basic signs of such diseases are the body temperature increase till 40-410C,
cardiac acceleration till 150-170 beats per a minute or respiratory acceleration till
30 times per a minute, rapid face reddening and, sometimes, paling, strong
sweating, dizziness, and headaches.
Upon providing emergency medical aid the injured person is to be laid in the
shady place, the neckband and other sites tightening the body are to be opened, a
wet towel is to be put on the head and breast, and water is to be given. If the man
has lost his/her consciousness, the liquid ammonia is to be rubbed on the temples,
if the respiratory activity is failure the artificial ventilation is to be provided, and if
the cardiac activity is failure the heart massage is to be done.

Emergency aid upon bites of snake and venomous insects

If a venomous snake bites a man, its venom penetrates into the body through
the wound site. The venom of a range of venomous snakes is dangerous for the
human life, and if aid is not provided in time, it may result in death.
The snake bite characteristics are the wound consisting of 1-2 bleeding points
and strong pains.
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As venom penetrates deeper into the body the venom signs develop gradually:
strong pains, reddening, blueing and swelling at the site of the snake bite;
dizziness, headaches;
cardiac acceleration;
breathlessness;
general weakness, sleepiness;
nausea, vomiting;
fever, cold sweat.

Prior to arrival of Emergency ambulance: the injured person is to be

urgently laid down with legs to be raised a little and the absolute silence is to be
provided to reduce the venom distribution rate. The injured person shouldn't move
in any case. He/she is to be taken to emergency ambulance with stretchers.

Wound treatment:
The venom absorption procedure may be performed by applying a cupping
glass to the wound:
at the first seconds, the wound site is to be squeezed in the form of the thick
fold so strong that the first venom drop is to be extracted;
a match is to be burnt inside the glass and pressed to the wound to make the
bite site at the centre of the glass. Such procedure results in sucking out and
extracting a part of venom. The glass is to be kept for 15 minutes;
when venom is sucked out, the wound is to be cleaned with a napkin and
covered with a bandage.
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Venom sucking out by a cupping glass

If no cupping glass is available:

the wound site is to be squeezed like a thick fold to remove the first venom
drop;
the wound site is to be cleaned with the napkin soaked in iodine or brilliant
green solution;
further, a new sterile napkin is to be fixed around with adhesive plaster;
the injured person is to be given a lot of liquid (tea, water);
the tightening items above the bite site (a watch, a ring and etc.) are to be
removed, and the tightening clothes are to be loosened.

The injured extremity (a leg or an arm) is to be fixed immovably. The same as

in the case of fractures, a splint is to be applied on the extremity, or the injured
extremity is to be attached to the healthy one. The venom distribution rate is
reduced in such manner.

The most effective prevention and treatment measure is to inject the snake
bite serum.
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The following is prohibited:

Prior to injection of the serum the following is prohibited:
to use the turning stick;
to move;
to take food, alcohol drinks, coffee, coloured cool drinks;
to burn, cut and make a hole in the wound;
to use hot facilities;
to take drugs;
to remove bandages.

If the snake tooth signs are seen on the injured person, but there is no specific
sign of toxication, the injured person is to be hospitalized in any case.

Venomous spiders when a scorpion or black helminth bites, they sting with
neurotoxic venom (affecting the nervous system), and such venom paralyzes the
respiratory centre, and causes convulsions. If the appropriate aid is not provided to
the injured person in proper time, he/she can die. The phalanx bite is comparatively
less dangerous; although it causes strong pain, it doesn't result in death. Upon
providing emergency aid the insect stinger is to be removed from the body, and ice
is to be put on the site.

In the case of the spider bite, the same site is to be immediately treated with
soapy water. It is strictly prohibited to use solutions such as alcohol, cologne.
In the case of the scorpion bite the site is to be also treated with soapy water,
squeezed with a light bandage, the injured person is to be taken to a physician.