Nursing Level – III

Based on January, 2022curriculum

version I

Module Title: First Aid and Emergency Response

Module code: HLT NUR3 M03 0122

Nominal duration: 180 Hours

Prepared By: Ministry of Lobar and Skill

August 2022
Addis Ababa Ethiopia

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Acknowledgment

Ministry of Labor and Skills and Ministry of Health wish to extend thanks and
appreciation to Hosanna, Hawassa, Gondar, Shashemene ,Metu, and Mizan Aman Health
Science College for sending experienced instructors who sacrificed their time and knowledge
to the development of this Teaching, Training and Learning Materials (TTLM).

Final we would like to acknowledge Jimma University.

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Table of Contents
Acknowledgment........................................................................................................... ii

List of tables...................................................................................................................v

List of figures................................................................................................................ vi

Acronyms......................................................................................................................vii

Introduction to the module.........................................................................................viii

Module Contents:.....................................................................................................viii

Unit One: Assess and identify client’s condition.......................................................1

Learning Instructions:...................................................................................................... 1

Introduction to first aid..................................................................................................2

1.1. Basic principle of first aid................................................................................2
1.2. Minimizing hazards.........................................................................................6
1.3. Identifying causality........................................................................................7
1.4. Recognizing emergency situation.....................................................................8
Information............................................................................................................... 8
1.5. Monitoring vital signs and state of consciousness.............................................10
1.6. Obtaining history of the event........................................................................14
1.7. Safety equipment and aids required for emergencies.........................................15
Self-check 1............................................................................................................ 17
LG-1 Operation Sheet -1...........................................................................................18
LG-1- LAP TEST-1................................................................................................. 19

Unit two: First aid service........................................................................................ 20

Learning Instructions:.................................................................................................... 20
2.2. First aid resources and equipment’s...............................................................22
2.2. Basic ABCDE rules........................................................................................... 24
Self-check 2............................................................................................................ 58
Operation Sheet -2................................................................................................... 60
LAP TEST-2........................................................................................................... 61

UNIT THREE: Prepare, evaluate and act in an emergency.......................................62

3.1. Options for action and group control strategies in cases of emergency.....................63
3.2. Occupational health / safety policies, procedures and safe working practices.....63

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 Self-check 3............................................................................................................ 68

UNIT FOUR: Communicate Details of the incident...................................................69

4.1. Soughing first aid assistance.........................................................................70
4.4. Details of casualty’s physical condition, management............................................72
Self-check 4............................................................................................................ 73

UNIT FIVE: Refer Client Requiring Further Care.......................................................75

5.1. Documenting relevant client history.....................................................................76
5.2. Documentation for Referral procedure.................................................................76
5.3. Conveying appropriate information to individuals involved in referral....................77
5.4. Maintaining client care confidentiality during referral............................................78
Self-check 5............................................................................................................ 80

UNIT SIX- Evaluate own performance........................................................................82

6.1. Clinical expert feedback.....................................................................................83
6.2. The possible psychological impacts on rescuers....................................................83
6.3. Participation in debriefing and evaluation.............................................................83
Self-check 6............................................................................................................ 85

Reference......................................................................................................................86

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List of tables

Table 1. First aid Management................................................................................................44

Table 2 First aid Management:................................................................................................46
Table 3 General first aid treatment for major wounds involves..............................................49

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List of figures

Figure 1 Pulse oximeteri sensor..............................................................................................21

Figure 2 Mouth to mouth respiration......................................................................................38
Figure 3 Infant mouth to mouth respiration...........................................................................39
Figure 4 Cardio pulmonary resuscitation...............................................................................41
Figure 5Figure 2.4:-chain of survival.....................................................................................42
Figure 6 Techniques of Obstructed Airway management/Conscious Victim.........................42
Figure 7 Techniques of Obstructed Airway management/unconscious Victim.....................43
Figure 8: choking................................................................................................................... 44
Figure 9 Elevated extremity Pressure point brachial and Pressure point Femoral................48
Figure 10 seizures.................................................................................................................. 50
Figure 11 superficial burn.......................................................................................................51
Figure 12 2nd degree burn (Intermediate burn)......................................................................51

Airway, Breathing, Circulation, Disability and Exposure

Acronyms
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ABCDE
AED Automatic External Defibrillator
AVPU Alert, Voice, Pain, Unresponsive
BP Blood Pressure
CPR Cardiopulmonary Resuscitation
CRT Capillary Refill Time
DOTS Deformity, Open Wound, Tenderness and Swelling
EMS Emergency Medical Staff)
EMT Emergency Medical Technician
GCS Glasgow Coma Scale
HIV Human Immunodeficiency Virus
LOC Level Of Consciousness
MAP Mean Arterial Pressure
PPE Personal Protective Equipment
PPT Place, People and Time
PTSD Post-Traumatic Stress Disorder
SCA Sudden Cardiac Arrest
VF Ventricular Defibrillation
VT Ventricular Tachycardia

Introduction to the module

This module has been developed to guide the trainees with the knowledge, skills and right
attitudes required to recognize and respond to life threatening emergencies using basic life

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support, provide first aid response, management of casualty(s), the incident and other first
aiders, until the arrival of medical or other assistance

Module Contents:
 Assess and identify client’s condition
 Provide first aid service
 Prepare, evaluate and act in an emergency
 Communicate details of the incident
 Refer client requiring further care
 Evaluate own performance

Learning Objective of the Module

 Assessing scene safety and patient condition
 Address basic principles of first aid
 Determine immediate risk to self and casualty`s health and safety
 Identify hazards in the situation that may pose a risk of injury or illness
 Select, use, maintain and store safety equipment in emergency
 Take vital signs and state of consciousness
 Obtain history of the event
 Practice occupation health and safety procedures and safe working practices
Module Instruction
For effective use this modules trainees are expected to follow the following module
instruction:
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described below.
3. Read the information written in the information Sheets
4. Accomplish the Self-checks
5. Perform Operation Sheets
6. Do the “LAP test”

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7.

Unit One: Assess and identify client’s condition

Instruction Sheet

This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Definition of terms
 Basic principles of first aid
 Identifying, assessing and minimizing hazards
 Minimizing risks
 Identifying causality
 Recognizing emergency situation
 Monitoring vital signs and state of consciousness
 Obtaining history of the event
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Define of terminologies
 Apply principles of first aid
 Perform basic emergency assessment
Learning Instructions:
 Read the specific objectives of this Learning Guide
 Read the information written in the information Sheet1
 Accomplish the ―Self-check 1

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Introduction to first aid

First Aid is the first assistance or aid or treatment given to a patient in an emergency situation
before formal and appropriate medical help is available. Any trained person or emergency
medical technician (EMT) at any point of time can render First Aid services.

The purpose of giving first aid is to prevent further deterioration of the patient’s health. The
responsibility of a First Aider is to help the patient by winning her/his confidence. At the
same time, the First Aider must not endanger her/his own life while providing treatment.
She/he must always keep in the mind that the casualty may have more than one injury. When
a person suffers an injury or sudden illness, immediate medical attention or treatment may be
provided to her/him in order to reduce the discomfort, pain and deterioration of her/his
condition. Therefore, the ‘first care’, which is provided before professional medical help is
available, is called ‘First Aid’.

1.1. Basic principle of first aid

First aid is all about providing initial lifesaving care before the arrival of professional help. It
is the first assistance or aid or treatment given to a patient in an emergency situation before
formal and appropriate medical help is available. Its main aim is to preserve the life of the
victim until she/he can be treated by medical professional.
Any trained person or Emergency technician (EMT) at any point of time can render First Aid
services. At the same time, the First Aider must not endanger her/his own life while
providing treatment. S/he must always keep in the mind that the casualty may have more
than one injury.
When a person suffers an injury or sudden illness, immediate medical attention or treatment
may be provided to her/him in order to reduce the discomfort, pain and deterioration of
her/his condition. Therefore, the ‘first care’, which is provided before professional medical
help is available, is called ‘First Aid’. The overall aims in first aid are keeping the three Ps.
These are: Preserve the life of the victim, Prevent worsening of the situation, Promote
recovery from the injury or illness

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First aid involves timely response to emergencies and immediate care of sick and injured
people. Trained first aiders apply a range of procedures and techniques that offer care when
accidents and injuries occur, often making the difference between life and death during high-
risk, low-frequency emergencies. More than ever, first aid intervention is a valuable link in
the life saving chain, where casualties are addressed and monitored prior to the arrival of
emergency services personnel.
Basic principles of first aid include:
 Preserve life: This includes preserving the life of the casualty and the rescuer.
 Ensure protection of the casualty from further harm: the treatment area needs to be
safe and must not have excess people.
 Provide pain relief: This includes the use of ice packs or applying a sling.
 Prevent the condition from worsening: Ensure that the First Aid procedures do not
worsen the patient’s condition.
General principles

When administering first aid, you have to take these 6 principles into consideration.

1. Keep calm during an emergency situation.

Try to bring your emotions under control before you act. Only proceed when you have
regained your calm.

2. Avoid infection.

If possible, wash your hands with water and soap before and after administering first aid.

3. Act as a first aider.

Make sure you do not make the situation worse.

4. Ensure the comfort of the ill or injured person.

Protect the ill or injured person against cold and heat, but do not give food or drinks.

5. Give psychosocial first aid.

Try to make the ill or injured person feel better. Listen to him, talk quietly, explain what you
are doing and touch him gently.

6. Emotional reactions afterwards might occur.

Talk to family, friends, fellow first aiders or a religious leader. If you are still worried, talk to
a professional and seek counseling

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 1.1. Assesses and minimize hazards

A common way to classify hazards is by category:

 Biological – bacteria, viruses, insects, plants, birds, animals, and humans, etc.,
 Chemical – depends on the physical, chemical and toxic properties of the chemical,
 Ergonomic – repetitive movements, improper set up of workstation, etc.,
 Physical – radiation, magnetic fields, temperature extremes, pressure extremes (high
pressure or vacuum), noise, etc.,
 psychosocial – stress, violence, etc.,
 Safety – slipping/tripping hazards, inappropriate machine guarding, equipment
malfunctions or breakdowns.

1.1.1. Assessment of the situation/scene size up/

Assessment of the situation /Scene size up/ – An assessment of the scene (current situation of
an event) and the surroundings, if it is safe, will provide valuable information to the first
responder and will ensure the well-being of the first responder. Example, Unstable Situation,
violent, Hazmat Situation (industry hazardous material) etc. Scene safety in relation to
personal protection, casualty and bystander protection is important.

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Assessment of the situation /Scene size-up/ is a multifaceted process that occurs before and
immediately upon arrival at the scene, prior to executing any other activities. The subject to
the unique environmental dangers associated with patient care in the field that often
contributed to, or are a result of, the patient’s injury or illness.

A successful first aider in active field operations

 Assesses the scene,

 Acts on the assessment finding
 Mitigates danger prior to the provision of any patient care or evaluation
[Link]. Purpose of Assessment of the situation /scene size-up
The purpose of scene size-up is to expeditiously ensure that there is a safe scene on which to
provide care, and that the proper resources are summoned to the scene according to the
number of patients and their specific care needs. Many scenes evolve even after the first unit
has arrived, and various specialty units have different perspectives on the size-up of the same
scene. The hazardous materials team will have a different focus and perspective during size-
up than the first arriving advanced life support unit. Just as a scene is dynamic, aspects of the
size-up should be reevaluated over the course of an incident.

If the scene is unsafe, make it safe, Otherwise, DO NOT ENTER

[Link]. The components of assessment/scene size-up/

These components of size-up can initially be assessed from the relatively safety of the
emergency response vehicle. The components of scene size-up require simultaneous
assessment and include the review of

 identification of the scene and the number of patients,

 identification of mechanism of injury or nature of illness,
 resource determination,
 standard precautions determination,
 Assessment of scene safety.

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 1.2. Minimizing hazards
Managing health and safety hazards is key to operational excellence in the work place
regardless of its size. Where possible, Always try to remove or eliminate hazards from the
workplace, for example by using a different process, or changing the way a job is done. If it
is not possible to eliminate the hazard. Below are 6 steps to determine the most effective
measures to control workplace hazards and to minimize risk.
Step 1: Design or re-organize to eliminate hazards

It is often cheaper and more practical to eliminate hazards at the design or planning stage of a
product, process or place used for work. In these early phases, there is greater scope to design
out hazards or incorporate risk control measures that are compatible with the original design
and functional requirements. For example, remove trip hazards on the floor or dispose of
unwanted chemicals.
Step 2: Substitute the hazard with something safer
If it is not reasonably practical to eliminate the hazards and associated risks, you should
minimise the risk. For example, today the dangers associated with asbestos are well known
and there are numerous alternatives to asbestos products currently on the market including
cellulose fibre, thermoset plastic flour or polyurethane foams. Replacing solvent- based
paints with water-based ones is also a better alternative.
Step 3: Isolate the hazard from people

This involves physically separating the source of harm from people by distance or using
barriers. For example, introducing a strict work area, using guard rails around exposed edges
and holes in the floors, using remote control systems to operate machinery, enclosing a noisy
process from a person and storing chemicals in a fume cabinet.
Step 4: Use engineering controls

An engineering control is a control measure that is physical in nature, including a mechanical

device or process. For example this can be done through the use of machine guards, effective
ventilation systems and setting work rates on a roster to reduce fatigue.

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Step 5: Use administrative controls

Administrative controls are work methods or procedures that are designed to minimise
exposure to a hazard. Establish appropriate procedures and safe work practices such as; limit
exposure time to a hazardous task so that fewer employees are exposed, routine maintenance
and housekeeping procedures, training on hazards and correct work methods and use signs to
warn people of a hazard.
Step 6: Use Personal Protective Equipment (PPE)

Provide suitable and properly maintained PPE and ensure employees are trained in its proper
use. Examples include gloves, earplugs, face masks, hard hats, gloves, aprons and protective
eyewear. PPE limits exposure to harmful effects of a hazard but only if workers wear and use
the PPE correctly

1.3. Identifying causality

The first things to do in first aid procedure in order of importance are:
A. Remove the casualty from the danger or remove the danger from the casualty
B. Assess the victim and treat the most urgent casualties at an accident scene.
There are four categories of casualties:

1. Casualties with life threatening conditions such as cessation of breath, or circulation

of blood and the unconscious.
2. Casualties with serious injuries, head and spinal cord injuries and casualties with
impelled objects
3. Casualties with fractures, minor injuries, bruises and scald

C. Casualties with life threatening conditions are mostly the unconscious, move them with
great care. Before moving them, watch out for spinal cord injuries. Put the unconscious in a
comfortable position (prone or recovery position) to ease respiration.
D. Give artificial respiration ( mouth to mouth, or mouth to nose respiration) for casualties
with breathing problems.
E. Restore the functioning of the heart by instituting the principle of external cardiac massage
(chest compression) if heart has stopped working.
F. Guard against shock by stopping severe bleeding and pains.
G. Reassure the victim to give him confidence of recovery from whatever condition he/she

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may be in
H. Control the crowd, keep them away to ensure adequate supply of fresh air and prevent
them from inciting causalities
I. Do not give the casualty anything to eat or drink
J Handle casualty properly in a case of suspected fracture of the spinal cord. DO NOT LIFT
casualty alone until there are enough helpers (four to six persons)
K. Transport the casualty to the hospital or any nearby medical center without delay

The DRSABCD or Basic First Aid Action Plan is the start of all treatment. This plan will
identify any life threatening injuries the casualty may be suffering from that will need urgent
attention.
D – Danger – Is the Area Safe?
R – Response – Check for a Response. Is the casualty conscious?
S – Send for Help – Call for an Ambulance.
A – Airway – Is the airway open and clear?
B – Breathing – Look, Feel and Listen for breathing.

1.4. Recognizing emergency situation

Getting medical help right away for someone who is having a medical emergency can save
their life. This article describes the warning signs of a medical emergency and how to be
prepared.

Information
According to the American College of Emergency Physicians, the following are warning
signs of a medical emergency:

 Bleeding that will not stop

 Breathing problems (difficulty breathing, shortness of breath)
 Change in mental status (such as unusual behavior, confusion, difficulty
arousing)
 Chest pain
 Choking
 Coughing up or vomiting blood
 Fainting or loss of consciousness
 Feeling of committing suicide or murder
 Head or spine injury
 Severe or persistent vomiting

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  Sudden injury due to a motor vehicle accident, burns or smoke
inhalation, near drowning, deep or large wound, or other injuries
 Sudden, severe pain anywhere in the body
 Sudden dizziness, weakness, or change in vision
 Swallowing a poisonous substance
 Severe abdominal pain or pressure
Be prepared:

Determine the location and quickest route to the nearest emergency department before an
emergency happens. Keep emergency phone numbers posted in your home where you can
easily access them. Also enter the numbers into your cell phone. Everyone in your household,
including children, should know when and how to call these numbers. These numbers
include: fire department, police department, poison control center, ambulance center, your
doctors' phone numbers, and contact numbers of neighbors or nearby friends or relatives, and
work phone numbers.

Know at which hospital(s) your doctor practices and, if practical, go there in an emergency.

Wear a medical identification tag if you have a chronic condition or look for one on a person
who has any of the symptoms mentioned.

Get a personal emergency response system if you're an older adult, especially if you live
alone.

WHAT TO DO IF SOMEONE NEEDS HELP:

Stay calm, and call your local emergency number (such as 911).

Start CPR (cardiopulmonary resuscitation) or rescue breathing, if necessary and if you know
the proper technique.
Place a semiconscious or unconscious person in the recovery position until the ambulance
arrives. DO NOT move the person, however, if there has been or may have been a neck
injury.

Upon arriving at an emergency room, the person will be evaluated right away. Life- or limb-
threatening conditions will be treated first. People with conditions that are not life- or limb-
threatening may have to wait.

CALL YOUR LOCAL EMERGENCY NUMBER (SUCH AS 911) IF:

The person's condition is life threatening (for example, the person is having a heart
attack or severe allergic reaction).The person's condition could become life threatening on the
way to the hospital

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Moving the person could cause further injury (for example, in case of a neck injury or motor
vehicle accident) the person needs the skills or equipment of paramedics Traffic conditions or
distance might cause a delay in getting the person to the hospital

1.5. Monitoring vital signs and state of consciousness

Vital signs
Temperature, pulse, respiration, blood pressure (BP), and oxygen saturation, are
measurements that indicate a person’s hemodynamic status. These are the five vital signs
most frequently obtained by health care practitioners Vital signs will potentially reveal
sudden changes in a patient’s condition and will also measure changes that occur
progressively over time. A difference between patients’ normal baseline vital signs and their
present vital signs may indicate the need for intervention.

1. Temperature

Normal (oral) = 35.8ºC to 37.3ºC

Oral temperature: Place the thermometer in the mouth under the tongue and instruct patient to
keep mouth closed. Leave the thermometer in place for as long as is indicated by the device
manufacturer.

Axillary temperature: Usually 1ºC lower than oral temperature. Place the thermometer in
patient’s armpit and leave it in place for as long as is indicated by the device manufacturer.

Tympanic membrane (ear) temperature: Usually 0.3°C to 0.6°C higher than an oral
temperature. The tympanic membrane shares the same vascular artery that peruses the
hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal.

Rectal temperature: Usually 1ºC higher than oral temperature. Use only when other routes are
not available.
2. Pulse:

Normal resting heart rate = 60 to 100 beats per minute

Radial pulse: Use the pads of your first three fingers to gently palpate the radial pulse at the
inner lateral wrist.

Apical pulse: Taken as part of a focused cardiovascular assessment and when the pulse rate is
irregular. Apical heart rate should be used as the parameter indicated in certain cardiac

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medications (e.g., digoxin). Apical pulse rate should be taken for a full minute for accuracy,
and is located at the fifth intercostal space in line with the middle of the clavicle in adults.

Carotid pulse: May be taken when radial pulse is not present or is difficult to palpate.

3. Respiration rate

Normal resting respiratory rate = 10 to 20 breaths per minute

Count respiratory rate unobtrusively while you are taking the pulse rate so that the patient is
not aware that you are taking the respiration rate. Count for 30 seconds or for a full minute if
irregular.

4. Blood pressure (BP):

The average BP for an adult is 120/80 mmHg, but variations are normal for various reasons.

The systolic pressure is the maximum pressure on the arteries during left ventricular
contraction.

The diastolic pressure is the resting pressure on the arteries between each cardiac contraction.

The patient may be sitting or lying down with the bare arm at heart level. Palpate the brachial
artery just above the antecubital fossa medially. Wrap the BP cuff around the upper arm
about 2.5 cm above the brachial artery.

Palpate the radial or brachial artery, and inflate the BP cuff until the pulse rate is no longer
felt. Then inflate 20 to 30 mmHg more.

Place the bell of the stethoscope over the brachial artery, and deflate the cuff slowly and
evenly, noting the points at which you hear the first appearance of sound (systolic BP), and
the disappearance of sound (diastolic BP).

5. Oxygen saturation (SpO2):

A healthy patient will have an SpO2 of ≥ 97%.

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A pulse oximeter sensor attached to the patient’s finger or earlobe measures light absorption
of hemoglobin and represents arterial SpO2.

Figure 1 Pulse oximeteri sensor

State of consciousness
The more aware we are of our thoughts, feelings, perceptions and surroundings, the higher
the level of consciousness. Our level of awareness of internal events and external
surroundings is known as a state of consciousness
The AVPU scale (Alert, Voice, Pain, and Unresponsive) is a system, which is taught to
healthcare professionals and first aiders on how to measure and record the patient's level of
consciousness. It is a simplification of the GCS Scale (Glasgow Coma) which assesses a
patient's response using Eyes, Voice and Motor skills as measures.

The AVPU has only one of four possible outcomes:

A. Alert

Patient is fully awake (though not necessarily orientated), will have spontaneously open eyes,
and will respond to voice (thought may be confused). They will have bodily motor function.

B. Voice

The patient makes some sort of response when you talk to them. This could be through the
eyes, which open when you speak to them, or by voice which may only be as little as a grunt.
Or, it could be by moving a limb when prompted to do so by the rescuer.

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C. Pain

A patient may respond by using any of the three components when pain stimulus is used on
them (Eyes, Voice, Movement). Recognised methods for causing pain are pinching the ear or
pressing into the bed of a fingernail. A fully conscious patient will locate the pain and push it
away, whereas a patient who is not alert and not responded to voice may only manifest
involuntary flexion or extension of a limb. Performing pain stimulus should be used with
caution as in extreme circumstances this could be considered assault.

D. Unresponsive

This outcome is noted if the patient does not give any Eye, Voice or Motor response to voice
or pain.

 Recognition of any change of level of consciousness is important.

 Full consciousness- the casualty is able to speak and answer questions normally

 Drowsiness- the casualty is easily aroused but lapses in to unconscious state

 Stupor –the casualty can be roused with difficulty, aware of painful stimuli.

 E.g. pin prick, but not of other external elements like being spoken to.

 Coma - cannot be roused by any stimuli.

 In general make full use of your senses to obtain maximum information (Look, smell,
listen and touch)

In first aid, an AVPU score less than A is a good indication of the need to get further help.

Treatment:

If patient conscious level is below 'A' seek medical help.

 Monitor patient's level of response until medical help arrives.

 An unconscious patient is serious and the priority here is the patient's airway.

 Place in recovery position.

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 Dial to Emergency Medical service

 Treat any bleeding or cover open fractures.

1.6. Obtaining history of the event

Organization should be aware of the various types of emergencies that can happen and the
procedures for dealing with them. Of the possible kinds of emergencies, fire, medical
emergencies, hazardous materials incidents and bomb threats are the most likely. The lack of
an organization emergency policy could lead to severe losses such as multiple casualties and
possible financial collapse of the organization.
Emergency plan specifies procedures for handling sudden or unexpected situations.
Development of the policy and procedure begins with a vulnerability assessment include;
How likely a situation is to occur?
What means are available to stop or prevent the situation?
What is necessary for a given situation?
The objective is to:
 Prevent fatalities and injuries.
 Reduce damage to buildings, stock, and equipment.
 Protect the environment and the community.
 Accelerate the resumption of normal operations.

History of the incident must be taken into consideration. An examination made to determine
the signs, symptoms and level of consciousness. Signs are variations from normal ascertained
by the first aider and symptoms are sensations and feelings that are described by the casualty.
Obtain appropriate history of how the accident happened or the illness began include its
casualty
Emergency situations are often confusing and frightening. To take appropriate actions in any
emergency, follow the three basic emergency action steps:
 CHECK the scene and the person,
 CALL for help or the local emergency number
 CARE first for the person until advanced medical support

The history of the incident must be taken in to consideration and an examination made to
determine the signs and symptoms and level of consciousness.

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History:-The story of how the accident happened or the illness began can be obtained from:-
 The causality (e.g. I slipped and fall down)
 A witness or a bystander(s) whether he/she saw the happenings Points to be
considered during history taking:
 Any history of illness: E.g. Epilepsy, Diabetes mellitus,
 For history of ingested material E.g. Drug, Alcohol, type of food or fluid

1.7. Safety equipment and aids required for emergencies

An occupational Health & Safety policy is defined as laws and guidelines keep helping
your workplace safe. It is important that you are familiar with the occupational Health &
Safety policies that exist in your state or territory.
The purpose of the Health and Safety policies and procedures is to guide and direct all
employees to work safely and prevent injury, to themselves and others. All employees are
encouraged to participate in developing, implementing, and enforcing Health and Safety
policies and procedures. All employees must take all reasonable steps to prevent accidents
and never sacrifice safety for expedience. Our goal is to eliminate or minimize hazards that
can cause accidents. Health, safety, the environment and loss control in the workplace are
everyone’s responsibility. Everyone join put efforts to provide a healthy and safe working
environment on a continuous day to day basis. The legislation places duties on owners,
employers, workers, suppliers, the self-employed and contractors, to establish and maintain
safe and healthy working conditions.
It outlines the responsibilities of employers to provide first aid facilities and first aid
trained personnel/workers. The regulations may also detail the requirements of first aid
kits and facilities based on the size of the organization and the type of work environment.
One of your most important responsibilities is to protect your Health and Safety as well as
that of your co-workers.
Occupational health & safety policies guidelines for preventing accidents in the workplace
should be found in the organizational polices and standard operating procedures. It should
have procedures on how to deal with a workplace accident. It may include instructions on
how to use Personal Protective Equipment (PPE), which can prevent infection spreading.
Similarly you can read the detail of Ethiopian Occupational Health & Safety policies for
more detail.
The legislation outlines requirements for:

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 The reporting requirements for notifiable incidents.
 Licenses, permits and registrations (e.g. for persons engaged in high risk work or
users of certain plant or substances).
 Provision for worker consultation, participation and representation at the workplace
 Provision for the resolution of health and safety issues.
 Protection against discrimination and others

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Self-check 1

Directions: Answer all the questions listed below.

I. Short Answer Questions
1. What is the purpose of First
Aid?-----------------------------------------------------------------------------------------------
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2. State the principles of First Aid. ?-
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3. Describe state of consensuses. ?-
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4. The key signs that are used to evaluate the patient’s condition are called? ?-
-----------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------
----------------------
5. The site for taking pulse in unresponsive patient who are older than 1 year,
is_____________

17
LG-1 Operation Sheet -1

Measuring Vital signs and state of consciousness

a) Tools and equipment’s
I. Vital sign measurement equipment; like thermometer ,BP apparatus
b) Procedures/Steps/Techniques
I. Calibrate and ready each of vital sign measuring tool before measurement.
II. Calm yourself and select appropriate place
III. Sit the patents comfortable in appropriate place and position
IV. Calm the patients appropriately
V. Control condition that affect patents Temperature, respiration, pulse and heart
beat Differentiate the normal and abnormal range of each vital sign.
VI. Measure each of vital sign correctly
VII. Register the findings.

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 LG-1- LAP TEST-1

Name……………………………….
ID……………………………..

Time started: ________________________ Time finished: ________________

Instructions: Given necessary templates, tools and materials you are required to perform the
following tasks within 1 hour. The project is expected from each student to do it.

Task-1: Count respiratory rate of individuals in all age groups accordingly.

Task-2: Count Pulse rate of individuals.
Task-3: Measure human body temperature of individuals.
Task-4: Perform measuring of blood pressure of individuals
Task-5: Records and interpret each findings of measurement.

19
Unit two: First aid service
Instruction Sheet

This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Communication style
 First aid resources and equipment’s
 Basic ABCDE rules
 Responding the casualty in a culturally aware and sensitive manner
 First aid procedures
 Informed consent
 Established first aid principles and procedures
 Client care techniques
 Casualty's condition and management
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Define First aid service
 Apply principles of first aid
 Basic ABCDEE rules
 Performing emergency assessment
Learning Instructions:
 Read the specific objectives of this Learning Guide
 Read the information written in the information Sheet2
 Accomplish the ―Self-check 2

20
1. First aid service
Introduction
First aid is the first and immediate assistance given to any person with either a minor or
serious illness or injury, with care provided to preserve life, prevent the condition from
worsening, or to promote recovery. It includes initial intervention in a serious condition prior
to professional medical help being available, such as performing cardiopulmonary
resuscitation (CPR) while waiting for an ambulance, as well as the complete treatment of
minor conditions, such as applying a plaster to a cut. First aid is generally performed by
someone with basic medical training. Mental health first aid is an extension of the concept of
first aid to cover mental health, while psychological first aid is used as early treatment of
people who are at risk for developing PTSD. Conflict First Aid, focused on preservation and
recovery of an individual's social or relationship well-being
2.1. Communication style

Communication is so important in a first aid emergency because it helps the first aider get a
good mental picture of what has happened and how to respond to the first aid emergency.

First aiders learn a lot about communication skills during their first aid training course and
this is because it is a valuable part of the course.

Communicating with a child is not much different from communicating with a senior citizen
if tackled in a calm compassionate way. Both the child and the senior citizen may be
confused and upset so showing compassion and calmness first aiders usually get a good
picture of what has happened. Adults do get upset and sometimes confrontational but good
communication skills usually calm things down with them too.

Communication is key between the casualty and the first aider and by asking open questions
we can usually get a good picture of what has happened. So communication is key, and
during the roleplay part of the course so the first aid learners can hone their communication
skills we get casualties to be difficult if the first aider doesn’t ask the right questions and in
the right manner.

The learners get to convey their findings during the feedback session and usually, they get it
mostly right if the right questions have been asked.

21
When someone has been involved in an accident or incident they can get quite
understandably become emotional and upset and if someone is not compassionate about how
they communicate with the person then important information can be lost

2.2. First aid resources and equipment’s

This part of the unit has various equipment and materials used for First Aid. First Aid
facilities and ambulance service must be available at a workplace to meet emergency
situations. Institution should have First Aid facilities, such as a First Aid room, First Aid kit, ,
First Aiders and First Aid equipment in the premises to meet emergency situations.
First Aid room:-It is the place where equipment and materials are arranged systematically for
providing First Aid services. First Aid room could accommodate the following:
 A nameplate with the symbol of First Aid
 Adequate lighting and ventilation facility
 Toilets, which should be friendly for differently abled persons
 Facilities for the easy movement of a person on a stretcher or wheelchair
 Table and chairs
 A telephone
First Aid room should; it also include not limited;
 Examination lamp
 Medical examination couch with blankets and pillows
 a portable screen
 A container for storing sharp equipment, like surgical knives, etc.
 Sink and washbasin with hot and cold running water
 Sterilizer
 Stretcher
 Work bench or dressing trolley
 Oxygen cylinder
 Sphygmomanometer — blood pressure measuring
 Instrument
 Resuscitation equipment
 Cupboards for storing medicines, dressings and linen

22
  Electric power points
 Seating arrangements
 Container for soiled dressings
 medical waste containers etc

 First Aid kit

A First Aid kit consists of items for providing First Aid in case of emergency. A basic First
Aid kit includes the following:
 Bandages of all sizes for cleaning and dressing wounds
 Medical tape, Cotton balls, Safety pins, Alcohol pads , Anti-microbial hand wipes
 hydrogen peroxide for cleaning skin wounds, Sterile water bottle
 Eye flushing solution bottle with an eye cup
 arm sling, chemical ice pack, Chemical hot pack
 Thermometer oral and rectal (for children)
 Tweezers, Scissors, torch, Nail clippers
 Sterile gloves and etc
 Important medications and other relief materials.
This to be kept in a First Aid kit (check for their expiry and replace them immediately with a
fresh batch) include the following:
• Antibiotic ointment for cuts and scrapes on the skin
• medicated sunburn spray or cream
• Calamine lotion
• Insect sting relief pads
• Advil (ibuprophen), an anti-inflammatory tablet used for pain, swelling and fever
• Benadryl (diphenhydramine) syrup, an anti-histamine for allergic reactions,
itching and running nose
• Cough suppressant
• Oral rehydration salts (ors)
• Defibrillator,
• Sling, a bandage used to rest an injured forearm; it is a wide triangular piece of
cloth used to support the hand from around the neck

23
 • Splint, orthopedic mechanical device used to restrain and protect a part of the
body in case of a fracture (such as a broken leg or hand)

2.2. Basic ABCDE rules

The mnemonic “ABCDE” stands for Airway, Breathing, Circulation, Disability, and
Exposure. First, life-threatening airway problems are assessed and treated; second, life-
threatening breathing problems are assessed and treated; and so on
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is applicable in
all clinical emergencies for immediate assessment and treatment. The approach is widely
accepted by experts in emergency medicine and likely improves outcomes by helping health
care professionals focusing on the most life-threatening clinical problems. In an acute setting,
high-quality ABCDE skills among all treating team members can save valuable time and
improve team performance. Dissemination of knowledge and skills related to the ABCDE
approach are therefore needed. This paper offers a practical “how-to” description of the
ABCDE approach.
1.2.1. Respiratory Emergencies
Respiratory emergency is one in which normal breathing stops or in which breathing is
reduced so that oxygen intake is insufficient to support life.
Artificial respiration is a procedure for making air to flow into and out of a person’s lungs
when his natural breathing is inadequate or ceases.
Causes of Respiratory Failure
A. Anatomical Obstruction
The most common cause of respiratory emergency is interference with breathing caused by
the drooping of the tongue back and obstructing the throat.
Other causes of obstruction that constrict the air passages are:
 Asthma
 Croup
 Diphtheria
 Laryngeal spasm
 Swelling after burns of the face
 Swallowing of corrosive poisons
 Direct injury caused by a blow

24
B. Mechanical Obstruction
 Solid foreign objects lodging in the respiratory passage e.g.
choking of food
 Accumulation of fluids in the back of the throat (mucous ,blood or
saliva)
 Aspiration (Inhalation of any solid or liquid substance)

C. Air Depleted of Oxygen or Containing Toxic Gases

 Asphyxia – is a condition in which there is a lack of oxygen in the blood and the
tissue do not receive an adequate supply of oxygen.
 It may occur due to decreased oxygen in the air or increased carbon monoxide (CO)
or other toxic gases e.g., mining area, sewer etc.
 Explosion hazard -Combustible gases that accumulate in confined spaces where
natural or manufactured gases are free in the air, and are explosive in certain
concentrations.
 The explosion may result if a flame is introduced, if static electricity is discharged or
if an electric switch doorbell, telephone or other device is used.
D. Additional Causes of Respiratory Failure are:-
 Drowning
 Circulatory collapse (shock)
 Heart disease
 Strangulation
 Lung disease e.g. pneumonia
 Poisoning by alcohol, barbiturate, codeine etc.
 Electrical shock
 Compression of the chest e.g. accident
In case of respiratory failure the vital steps to carry out is applying basic rule of "DRS
ABCDE"
Danger (D):- Check the surrounding area and make sure it’s safe for you, the injured person
and others in the area. Do this by looking, listening and smelling If the casualty is in
immediate danger you should move them, but only if it is safe to do so. Try to lift or move
the person in a way that will not incur further injury, and remember to protect yourself from
back strain or other injuries.

25
 Response (R): Check the patient’s responses by talking and touching them (squeezing
their shoulders). This is referred to as the “Talk and Touch Method”. You may say: Can
you hear me, what is your name and Open your eye.

If the patient responds they are conscious, breathing and have a pulse – make them
comfortable and check them for any injuries using the secondary survey technique, call for
help if required and continue to monitor them for at least 10-15 minutes before letting them
move
A person who does not respond is unconscious and this is potentially life-threatening as they
are at risk of choking, their breathing may stop or uncontrolled bleeding may result in death.
 Send for help(S):- Call and Seek for an ambulance or medical assistance as soon as
possible.
When speaking on the phone, try your best to maintain your composure, speak clearly to the
telephone operator and try to answer all the questions as best you can.

There are situations where it may be necessary to request the use of a bystander’s mobile
phone to make the emergency call. If possible you should ask a bystander to make the call for
you so that you are able to remain with the casualty and continue with the required treatment.
If you are alone you should shout for help. However if no one comes you should immediately
proceed with CPR.

As well as seeking help for calling emergency services you may also ask bystanders for help
in the treatment of casualties. This may be particularly helpful when conducting CPR as it
can be physically tiring.
Elements of ABCDE approach:
It is very important approach in case of assessing Respiratory Emergencies.
 Approach every patient in a systematic way
 Recognize life-threatening conditions early
 DO most critical interventions first - fix problems before moving on
 The ABCDE approach is very quick in a stable patient

a. Airway (A): Open airway to allow air to reach the lungs. Check that the individual’s
airway is clear so that their breathing is not obstructed. To check their airway use the
head tilt/chin lift technique as this helps lift the tongue from the back of the throat. One

26
 hand is placed on the casualty’s forehead to tilt the head back while the fingers of the
other hand are positioned on the bony part of the chin to lift it up and outward. The mouth
should then be gently opened by pulling down on the jaw to check for any obstruction. If
there is any foreign material present you should move the casualty into the recovery
position and allow gravity to aid in draining material from the mouth. Ensuring and
providing an open airway always takes precedence over the possibility of a spinal injury.
b. Breathing (B): While keeping the airways open, look, listen and feel for normal
breathing signs. Restore breathing to reverse respiratory arrest, allow sufficient oxygen to
enter the lungs and pass in to the blood. This is often easier to do when the injured person
is on their back but can also be done while they are in the recovery position. For a full 3-5
seconds you should position yourself so that you can hear and feel if air is escaping from
the nose and mouth, while also watching the chest and abdomen to see if they rise and fall
with air movement. If the casualty is breathing normally, position them in the recovery
position and again check their airway and head position. Check their airway after one
minute and thereafter every two minutes.
c. Circulation(C): Determine if there is adequate perfusion and Check for life-threatening
bleeding. Look, listen and feel for signs of poor perfusion, Cool, moist extremities,
Delayed capillary refill, Diaphoresis, Low blood pressure, Tachypnea, Tachycardia and
Absent pulses
d. Disability(D):
 Assess and protect brain and spinal functions.
 Assess level of consciousness (AVPU or GCS) in trauma
 Check for low blood glucose (hypoglycemia), pupils (size, reactivity to light and if
equal), movement and sensation in all four limbs
 Look for abnormal repetitive movements or shaking and Seizures/convulsions
E. Exposure (E):
 Examine the entire body for hidden injuries, rashes, bites or
 Other lesions Rashes, such as hives, can indicate an allergic reaction
 Other rashes can indicate infection
First Aid management of air way and breathing problem
Emergency medical care begins with ensuring an open airway and breathing status. The
patient’s airway and breathing status are the first step in your initial assessment for a very
good reason: unless you can immediately open and maintain a patent airway.

27
The following activities are helpful to position the patient for airway and breathing status
management:
 Shout for help (depend on the condition)
 Determine the consciousness of the causality by taping the victim on the shoulder and
asking loudly
 Are you okay!?
 Assess and ensure that patient air way is clear
 Place the patient flat on his back with the head turned to one side
 Remove any thing which is preventing the taking in of air (Remove constraints from the
neck)
 Kneel beside the patient’s head place one hand under his neck and the other hand under
his lower Jaw extend his head and neck gently back ward.
 This prevents the tongue from falling back in to the throat.
 Place your cheek and ear close to the victim’s mouth and Nose.
 Look at the victim’s chest to see if it rises, falls, and listen and fell for air to be exhaled
for about 5 seconds.
 If there is no breathing pinch the victim’s nostrils shut with thumb and index finger of
your hand that is pressing on the victim’s forehead.
 This action prevents leakage of air when the lungs are inflated through the mouth.
 Take very deep breath and hold it.
 Fit your mouth tightly over the patients open mouth and forcibly in to the lungs
 While carrying out respiration, check the patient’s pulse every 2 or 3 minutes to ensure
the heart has not stopped.
 Continue the breathing procedure at the rate 12 to 18 breaths per minute until the chest is
seen to rise and the patient is breathing for himself or until is certain.
 If a patient is child, our mouth should cover both his nose and mouth. Very gentle
breathing should be used and the younger the child, the gentler this should continue at a
rate of 25 breaths per minute.
 Once the patient can breathe by him/herself/ place him/her in what is called the recovery
position.

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 Figure 2 Mouth to mouth respiration

For infants and children mouth- to- mouth and -nose resuscitation are administered as
described above except that the
 Backward head tilt should not be as extensive as that of adult.

 Both the mouth and nose of the infant or child should be sealed off by your mouth.

 Blow in to the infant’s mouth and nose once every 3 seconds (about 20 times per
minutes)

 But in the case of children blow once every 4 seconds (about 15 times per minute).

 The amount of air is determined by the size of the victim.

If mouth to mouth is failed and no pulse cardiopulmonary resuscitation is followed.

29
Figure 3 Infant mouth to mouth respiration

Compressions/CPR
Cardiopulmonary Resuscitation (CPR) is the name given to the technique of combining
rescue breaths with external cardiac compressions. It restore circulation to keep blood
circulating and carrying oxygen to the heart, lungs, brain, and body. When CPR is applied to
the casualty, multiple body systems such as the brain and the heart are affected by the
procedure as oxygen is being pumped into the blood through the circulatory system.
CPR can save lives or increase the chance of survival for the casualty until qualified medical
help takes over. The job of the first aider who is considering CPR as a lifesaving option is to
determine whether the casualty has a need for it. This can be assessed by looking for signs of
collapse or indications of a life-threatening situation such as stopped breathing, no pulse and
unconsciousness. If there is a lack of response from the victim and vital signs are missing,
then it is cause to proceed with CPR immediately.
The importance of the initial assessment cannot be overstated. If the casualty has been
assessed to be in a life and death situation, there is a high priority to implement appropriate
life saving strategies.
For example,. If the casualty was found unconscious and not breathing properly, then CPR
could be performed.
Failure to initiate CPR promptly can lead to brain damage and subsequent death of the
injured person. The more immediate the response time to perform CPR, the better the chances
of survival and less injury to the casualty. Timing is crucial when dealing with life-
threatening injuries and illnesses as brain damage can occur within four minutes of oxygen
being deprived.
When you perform CPR apply the following steps:
 Ensure the person is lying on their back, if possible and ideally on a flat, hard surface,
and with their head at the same level as their heart.

30
 Kneel beside the person midway between the head and chest for ease of movement
between giving breaths and compressions.
 Find the correct hand position – this is in the center of the chest.
 Apply pressure to the sternum with the heel of your hand, keeping your fingers up.
 With the other hand either grip the wrist of the hand on the chest, or place it over the top
of the first hand. You can interlace your fingers so that the top ones pull the bottom ones
off the chest during compressions.
 Use two hands for an adult, one for a child and the pads of two fingers for an infant.
 Keep your shoulders directly over your hands when making compressions – this will help
you to push straight down on the chest giving the best blood flow.
 Keep elbows locked – this applies to the elbow of the hand on the chest if holding the
wrist and both if interlacing the fingers. This will help reduce fatigue as you will be able
to use the weight of your upper body, rather that the strength of your arms when doing the
compressions.
 Compress the lower part of the sternum by up to a third of the chest depth – this will vary
depending on the size of the person.
 After each compression, allow the chest to return to the normal position as you rise up,
but keep contact with it.
 Keep the up and downward movements smooth, with a steady rhythm.
 Compress faster than 1 per second.
 After every 30 compressions, give two rescue breaths.
After every 30 compressions you will need to deliver 2 rescue breaths. To do this:
 Position the head using the head tilt/chin lift method. The ‘pistol grip’ is often the best
and easiest way to hold and position the jaw.
 Take a breath and place your mouth over the person’s mouth.
 Pinch their nose or seal it with your cheek.
 Blow into their mouth and then turn your head to see if their chest rises and falls with
the breath, indicating an effective breath and that air has reached their lungs. This also
prevents you from inhaling their exhaled breath and allows you to hear air escaping
from their mouth.
 If the chest does not rise and fall, adjust the position of the person’s head, being careful
not to lift, twist or turn their neck.
 Repeat with a second breath.

31
Remember to give smaller breaths to infants and children as they have smaller lung
capacities. Whenever possible use a resuscitation mask. If signs of life return consciousness,
normal breathing, moving place the person in the recovery position. It is more important that
CPR is not interrupted too often to check for signs of life as regular checking has been shown
to reduce survival rates.

If you are unwilling to give mouth-to-mouth you should at least continue to administer
chest compressions. Any resuscitation is better than none. Do not stop until emergency
help arrives.

Figure 4 Cardio pulmonary resuscitation

The chain of survival:

The chain of survival is the rapid administration of CPR in sudden cardiac arrest
situations to maximize its life saving potential. Understanding the links in the chain of
survival will improve the probability of survival from a cardiac arrest.
Four links in the chain of survival:
1. Early Access:- Recognize the signs of an impending cardiac arrest and call for help
2. Early CPR: - As soon as the first aider observes the victim collapse to the ground,
Commence CPR immediately.
3. Early Defibrillation:- Request an AED (Automatic External Defibrillator) from a by
stander, they are easy to use and applied the moment the heart is in ventricular
defibrillation (VF). For every minute defibrillation is delayed, there is approximately
10% reduction in survival. CPR should not be stopped until ambulance personnel or an
AED (Automated External Defibrillator) arrive. An AED is an electronic device that is
portable, easy to operate, and used when the casualty is having a Sudden Cardiac Arrest
(SCA). When the machine detects an abnormal heart rhythm, such as Ventricular
Fibrillation (VF) or Ventricular Tachycardia (VT), an electrical shock is sent to the heart,
which can restore normal heart rhythm. People requiring CPR has abnormal heart
rhythms.

32
4. Early Advanced Care Procedures:- The sooner professional emergency medical
personnel/workers can attend the casualty, the better the chance of survival. Seek
assistance from paramedics as soon as possible.

Figure 5Figure 2.4:-chain of survival

OBSTRUCTED AIRWAY: Conscious Victim

If the victim has good air exchange with only partial obstruction and is still able to speak or
cough effectively, do not interfere with his attempts to expel a foreign body. If the victim
cannot speak or cough, shows a distress signal, appears cyanotic or reveals an exaggerated
effort to breathe, you must intervene appropriately.

Figure 6 Techniques of Obstructed Airway management/Conscious Victim

OBSTRUCTED AIRWAY - unconscious victim

 If you are not getting air exchange, reposition the head and again attempt to ventilate.

33
 If you still do not get an air exchange immediately turn the victim on his side towards
you, resting his chest against your knees and administer four sharp blows between the
shoulder blades

 Place the victim on his back (supine) and spread legs wide apart, straddle his hips or one
thigh. This position gives comfort for the first -aider.

 Open the victim’s airway and sweep with the fingers.

 If the procedures are ineffective, you must repeat the sequence.

 Attempt to ventilate and Perform five rapid back blows

 Perform five thrusts (push on the chest ) and Do finger sweep

 If the stomach is building gastric distention, turn the adult victim to one side and clear the
mouth after pressing your hand briefly and firmly over the upper abdomen between the
rib margin and the navel. This procedure will force air out of the stomach. But it may also
cause regurgitation.

Figure 7 Techniques of Obstructed Airway management/unconscious Victim

CHOKING:
Choking is difficulty of breathing or stopping of breathing a totally or partially obstructed
airway – caused by swollen tissues or a foreign body. E.g. Food or other material entering the
windpipe instead of the gullet.
Common signs and symptoms include:
 Inability to cough breathes, speak or cry out.
 Clutching/gripping of throat.
34
  Cyanosis – blue skin, tongue, mouth lining.
 Anxiety/restlessness and Noisy breathing/wheezing.
 Red/congested face with bulging neck veins and Collapse/unconsciousness.

Table 1. First aid Management

Can the patient breathe, speak or cough?

If Yes: If No and Conscious: If No and Unconscious:
1. Give the patient  Call for help and ambulance.  Call for help and
Reassurance  Have person stand if able and lean on the back ambulance.
and encourage of a chair.
coughing until  Give five sharp, upward back blows between  Lie on person on side
cleared. Do the shoulder blades, using the heel of the
 and try to clear the airway
nothing else. hand.
– check mouth for visible
 After each blow – check if the object has been
foreign material.
2. If the patient expelled.
continues/starts  If not successful – give up to 5 chest thrusts  Use head tilt and jaw
wheezing or (similar but slower and sharper than CPR support to open airway –
breathing compressions).
look, listen and feel for
noisily  Check to see if object has been expelled.
breath signs.
if person becomes unconscious:
 Lie on person on side and try to clear the  If person still not breathing
 airway – check mouth for visible foreign commence ABC Basic
material. Life Support process.
 Use head tilt and jaw support to open airway
 look, listen and feel for breath signs.
 If person still not breathing commence ABC
Basic Life Support process

Figure 8: choking

For infant /child:

Follow procedures for an adult, with these differences:
 Position child face down over your lap to take advantage of gravity.

35
  Position head lower than chest, at a 45 degree angle.
 Give 5 back blows between the shoulder blades.
 While giving back blows support the child’s head by placing hand around jaw.
 If unsuccessful give up to 5 chest thrusts.
 If child becomes unconscious and stops breathing commence CPR.

Figure 2.7: Child choking

SHOCK:
It is potentially life-threatening. Shock can occur when the body is unable to cope with
serious injuries, illnesses or stressful situations e.g. bleeding, burns, severe allergic reactions,
witnessing an accident.
A person who goes in to shock the body prioritizes the supply of oxygen/blood to the vital
organs first, restricting blood to the limbs, resulting in pale, cold, sweaty skin. Blood will
then be restricted to the digestive system, resulting in nausea. After a time the tissues of the
arms and legs will begin to die, at this stage the brain will return blood flow to these parts,
causing vital organs to loose blood flow. If this continues the person will become drowsy,
and the heart and lungs will begin to shut down, resulting in death.
Recognizing shock:
 Cold, pale, sweaty skin.
 Rapid, weak pulse.
 Rapid breathing.
 They may feel anxious, restless and very thirsty.
 They may develop nausea/vomiting and Altered conscious state

36
 Table 2 First aid Management:

If the patient is conscious: If the patient is unconscious :

 Prevent further injury. 1. Commence ABCDE Basic Life
 Assess patient and provide first aid for major injury/illness. Support.
 Manage any other injuries e.g. fractures, bleeding. 2. Call for help and an ambulance.
 Make person comfortable and cover with a blanket to
maintain body temperature.
 Do not give the patient any food or drink. If needed moisten
lips to make more comfortable.
 Call for an ambulance and for help.
 Continue to monitor ABC (Airway Breathing Circulation)
and consciousness/responses.

STROKE
Most commonly caused by a bleeding or a blood clot in the brain, a stroke occurs when the
brains blood flow is disrupted, leading to brain tissue damage.
The most common method for checking for a stroke is using the FAST method.
F – Facial weakness – Can the person smile? Does the mouth or eye droop?
A – Arm weakness – Can the person raise both arms?
S – Speech – Is the speech slurred? Can the person understand what you say?
T – Time to act fast – Call an ambulance
Other common signs and symptoms include:
 Sudden weakness/numbness/paralysis of one side of the face, arm or leg.

 Sudden difficulty swallowing and Blurred/decreased vision

 Severe sudden headache and May develop nausea, vomiting and drowsiness.

 May develop dizziness, fatigue or become and unconscious.

37
Time is critical so calling an ambulance quickly is vital.
If the patient is conscious:
 call an ambulance
 Carry out any required first aid.
 Help the person rest comfortably
 Reassure person to help relieve anxiety.
 Do not give the casualty anything to eat or drink.
 If the person is drooling or has difficulty swallowing move them in to the recovery
position on the side with the facial droop facing down/closest to the ground.
If the patient is unconscious;
 Commence DRS ABCDE Basic Life Support.
 Call an ambulance
 Move them in to the recovery position on the side with the facial droop facing
down/closest to the ground.
 Care for any life-threatening illnesses/injuries.
 Continue to monitor vital signs until ambulance arrives.
BLEEDING:
Bleeding is defusing or oozing of blood from blood vessels(Hemorrhage)
Any bleeding, wounds and injuries will need to be located and treated accordingly. It may
be life-threatening if there is blood spurting from the wound. Bleeding can be classed and
checked as internal or external .
Methods of controlling bleeding externally
 Direct pressure- using compresses
 Pressure bandage can be placed to hold pads of cloth.
 Put a thick pad of cloth held between the hand and wound

Fig. 2.8: Fingertip and direct pressure

38
  Elevation:- The injured part of the body should be raised about the victim’s heart
 Applying pressure on the supplying artery specially on brachial artery in severe
bleeding,

 Apply tourniquet in severe bleeding

Figure 9 Elevated extremity Pressure point brachial and Pressure point Femoral

WOUNDS:
A wound is a break in the continuity of the body tissue either internal or external.
Wounds are categorized as either closed or open.
 Closed Wounds – damage occurs beneath the surface of the skin e.g. a bruise.
 Open Wounds – damage breaks the outer layer of the skin e.g. scrape, cut. Usually
involves bleeding.
Types of Wounds: Abrasions, Incisions, Lacerated, Punctures, Avulsions
The main aims when dealing with wound:
 To control the wound stop bleeding
 To treat and prevent shock
 To protect the wound from contamination and infection
 To prevent complication

39
If the patient is conscious: If the patient is unconscious:
 Put a dressing on the wound and control bleeding  Follow ABC Basic Life
 (as for external bleeding). Support process.
 Call for help or get the person to medical
 Call for help and follow
attention.
emergency personnel
 Do not remove bandage once bleeding has been
instructions.
controlled.
 Do not try to clean the wound – medical staff will
do this.
 Continue to monitor person closely.
 Be prepared to treat for shock.
 I f person becomes unconscious follow ABCDE
basic life support process.
Table 3 General first aid treatment for major wounds involves

SEIZURES:
Seizures occur when the electrical activity of the brain is interrupted or becomes irregular.
This may be caused by a number of conditions and injuries including: Stroke, Poisoning.
Head injury, Meningitis, Brain tumour. Epilepsy etc.

Figure 10 seizures

40
First aid management may include;
During the seizure:
 Do not try to stop the seizure.
 Do not try to restrain/hold the person – this could result in other injuries.
 Make the area around the person safe – remove objects, furniture etc. Away form the
person.
 Protect the person’s head – use a low pillow or folded clothing etc. Under their head.
 Do not place anything in the person’s mouth/between their teeth – they will not swallow
their tongue. While they may bite their tongue or cheek this is not usually done with
enough force to cause significant damage/bleeding.
Immediately after the seizure:
 Place the person in the recovery position to manage the airway and allow any
fluids to drain out of the mouth. This may include blood and vomit.
 Keep on side until fully conscious – they may be drowsy or disoriented after the
seizure.
 Carry out any required first aid.
 Reassure the person.
 Ask bystanders not to crowd around.
 If the person became incontinent during/after the seizure provide some covering
for the person’s clothing ifpossible.
 Remain with the person until they are fully conscious and aware of their
surroundings.
 Contact for medical help.
BURNS:
A burn is an injury that results from heat, chemical agents, or radiation. It may vary in depth,
size, and severity causing injury to the cells in the affected area.
Burns are usually classified in three levels based on the depth or degree of skin damage.
These are:-i
1. First degree burn
2. Second degree burn, and

41
 3. Third degree burn.
 1st degree burn (Superficial burn): may have Redness or discoloration, Mild swelling
and pain and rapid healing.

Figure 11 superficial burn

 2nd degree burn (Intermediate burn): Greater depth than first degree burns; Redness
and mottled appearance, Blisters, Severe pain, Swelling and Prone to infection.

Figure 12 2nd degree burn (Intermediate burn)

 3rd degree burn(Deep burn): Deep tissue distraction, White appearance, No pain and
blisters; and Complete loss of all layers of skin. This type of burn results in severe
disability and/or death

Fig.2.13: 3rd degree burn (Deep burn)

First-aid measures: If the victim is burned with fire apply cold applications, immerse the
burned area in cold water role the burned person on the ground, or cover with water socked
thick cloth or blanket and put out the fire. If the accident is of electric source, quickly
disconnect at the electric meter or check point, or use rope wooden stick, dried cloth etc. to
disconnect it.

42
  Move the victim from the accident place to avoid further injury;
 Loosen and/or remove burned dresses and lay down the victim on his/her back and let
him/her breathe fresh air and ensure that no foreign objects have entered and blocked
the passage of the respiratory system;
 If the victim is not breathing properly, initiate mouth to mouth artificial respiration;
 Cool the burned area under cool water for 20 minutes.
 Gently remove any clothing and jewellery from the burned area.
 Thoroughly check the wound to determine the size, and the degree of burn;
 Do not try to remove any clothing that is sticking to it.
 If the area cannot be immersed – such as the face – towel, sheets or wet clothes that
have been soaked in water can be applied. Change/rewet these regularly as they will
absorb heat from the burn.
 Cover the burn with a sterile, non-stick dressing and loosely bandage in place. If this is
not available or the burn covers a large area use a dry, clean sheet or other material that
is not fluffy.
 Minimize shock.
 Do not use ointments, lotions, creams or powders on a burn – these will seal in heat and
may contaminate the burn
 Seek for medical care
Measure to prevent burns:
 Keep away from children items such as matches, burning lamp and candles;
 Prepare and place stoves and other cooking installations in a safe way. E.g. locally made
standing stove
 Keep away from fire inflammable materials and don’t' come with materials such as
nylon close to fire-place;
 Educate smokers not to smoke inside a house and if they smoke give them strict advice
to put off the burning left over cigarette
FRACTURES:
Fractures are breaks in bones tissues and can be classed as either open or closed fractures.
Open fractures: involve an open wound – both sides of the fracture do not need to be
visible. Limb may be severely bent or an object may have penetrated the skin, breaking the
bone.
Closed fractures: no unbroken skin, more common than open fractures.

43
Compound fractures: involve both feature
Fractures can become life-threatening if there is severe internal or external bleeding and
due to the risk of shock. If organs or major nerves or other structures/systems are also
injured, the fracture, whether open or closed, is classed as ‘complicated’.
Common signs and symptoms include;
 Pain/tenderness – at or near injury site.
 Deformity or abnormal position/twist of limb.
 Swelling and Loss of function.
 Discoloration, Bruising of skin and Shock.

Figure 2.14: Fracture

44
General first aid measure include:
If the patient is conscious:
 Control any bleeding and cover any wounds.
 Check for signs of fractures.
 Ask casualty not to move injured body part.
 Immobilize and/or support the fracture.
 Handle gently – move the limb/body part as little as possible to prevent making the
fracture worse (e.g. a closed fracture may become an open fracture) and to lessen the
person’s pain.
 Seek medical aid.
If the patient is unconscious:
 Give ABC Basic Life Support.
 Seek medical aid.
DISLOCATIONS:
Dislocations occur when a bone is separated or displaced from its normal anatomical
position. If left untreated dislocations may lead to a permanent loss of function in the affected
area. Joints which are most frequently dislocated are shoulder, elbow, thumb, finger, Jaw and
etc.
Signs and symptoms:-Pain, near the joint, victim cannot move it, deformity abnormal
Appearance, swelling and busy is usually present.
First aid and management :-
 Support and secure the part in most comfortable position
 Obtain medical aid at once
 Do not attempt to replace the bones to normal position
 Seek professional medical help

45
UNCONSCIOUSNESS:
Victim is said to be unconscious when the patient is asleep, he/she cannot speak and has no
control over his movement. Victim cannot respond to place, people and time (PPT)
Cause of unconsciousness
 Head injury (bleeding),Fainting, Heart attacks, Poisoning, Shock, Epilepsy, Diabetes
etc
Level of unconsciousness
 Alertness: the patient can speak, answers, questions and feels pain
 Lethargy: the patient is awoke but answers questions slowly- he may be confused about
what is happening and where he is.
 Drowsiness: the patient is sleep of he is unable to concentrate on what we are saying
 Semi-consciousness: the patient is very sleep of and has great difficulty in speaking and
in answering your questions
 Unconsciousness: the patient is sleepy we cannot speak and has no control his
movements
First aid management for unconscious Patient
During treatment of unconscious patient follow principles of ABCDE and
 Check for any bleeding and attempt to stop bleeding
 If the victim is improving place in recovery position
 Do not give to an unconscious victim anything by mouth
 Establish level of responsiveness, check pulse,
 Breathing rate and record any observations
 Give priority to respiratory problems and heartbeat.
 Seek for medical help

Figure 2.15: Recovery position of unconscious patient.

46
STRAINS AND SPRAINS
A strain is over stretching of muscles due to over pulling of Muscles. Occurs when muscle
or tendon fibers are stretched and torn.
Sprain is an injury which occurs at a joints when the ligaments and tissue around particular
joints are suddenly twisting or torn. Sprain is more severe than strain. It usually happens or
occurs at joint especially at ankle joint. It might involve bone ( broken). Sprain is also
tearing of ligaments Signs and symptoms. Pain specially on movement. Swelling. Loss of
movement
Common signs and symptoms of strains include:
 Signs and symptoms of strain
 Pain (sudden sharp pain at the site of the injury)
 Stiffness of muscles
 Difficulty in moving the affected parts
First aid treatment for sprains and strains uses the RICER acronym:
 R – Rest: Avoid movement/activities that cause pain. Assist person to most comfortable
position – if head/neck/spinal injuries are suspected leave person lying flat.
 I – Ice: Control bleeding if applicable then apply a wrapped ice pack/cold compress.
Reapply every 2 hours for first 48-72 hours. This helps to reduce swelling and relieve
pain/discomfort.
 C –Compression: Apply a firm, supporting bandage over the area, giving even pressure
over the area. Light padding may be used if pain is severe.
 E – Elevation: If possible, raise the injured area above the level of the heart. This slows
the blood flow to the area and reduces swelling. Do not elevate if fracture is suspected.
 R – Referral: refer the person for further advice and treatment. May be their doctor or
emergency department

Figure 2.16: sprain and strain

47
POISONS:-
A poison is a substance that can cause injury, sickness and possibly lead to death.. Many
poisons may only be harmful if exposed to larger quantities. Poisons enter the body either
accidentally or intentionally. As with any medical emergency it is important to try and
identify the source of the injury and illness so that it may be treated appropriately.
Poisons can enter the body by contact with the skin, ingested, injected or inhaled and they
can be solid, liquid or gas (including fumes and vapours)
Inhaled Poisons include;
 Gases:- carbon monoxide from an engine, carbon dioxide occurring naturally from
decomposition, nitrous oxide used in medicine, chlorine used in pools and cleaning.
 Fumes from sources such as: glues, paints, petrol, drugs, including cocaine, as well as
other odour less fumes.
Ingested Poisons include:
 Medications – both prescribed and over-the-counter.
 Contaminated foods including mushrooms and shellfish.
 Alcohol and Cleaning products.
 Pesticides and Plants.
Injected Poisons include: Those obtained through the bite or sting of insects, spiders,
snakes, marine animals, etc. Those from drugs or medications injected through a needle or
other sharp object.
Common signs/symptoms of poisoning include: Chest and/or abdominal pain, Nausea,
Vomiting, Diarrhea, Difficulty breathing/irregular breathing, Presence of drug
paraphernalia., Sweating, Seizures, Altered conscious state, Burns around the lips and tongue
in inhaled/ingested.
General steps for dealing with a poisons situation are
 Remove the poison from the body
 Give the patient the antidote
 Treat symptoms
 Give comfort and confidence
How to remove the poison from the body
 Make the victim vomit it
 Give plenty of tape water.
 If it is a child give them syrup or water

48
  Repeat the procedure
 Refer the victim if it is not improving
NB. Do not make patient vomit if the poison e.g. paraffin or kerosene. Do not make the
patient vomit if unconscious. For poisoning by acid, give alkali, anti-acids.

SUBSTANCE MISUSE (alcohol & other drugs)

Substance misuse occurs when a person takes an overdose of a drug and it becomes toxic to
the cells and organs in the body. There are accidental and intentional overdoses. As a result, a
drug overdose can be life threatening and require first aid management.
Any drug, can be misused when it is taken outside approved medical uses. With over the
counter drugs or commonly used drugs, there are strict instructions on the package of the
drug that specifies the daily dosage. Examples of commonly used over the counter drugs are
aspirin, ibuprofen, paracetamol, acetaminophen (Tylenol) and products that contain codeine.
With all prescription drugs, there is a sticker label with the name of the patient, the daily
amount to be taken and when to take the medication (morning/afternoon or before/after
meals).
Illicit drugs or street drugs are those obtained without a prescription and are illegal to
possess. Alcohol overdose, can be harmful and in extreme cases cause death.
In medical literature, it is known that excessive alcohol consumption can cause drunkenness,
impair judgment and make the person more prone to accidents in the workplace when
operating machinery or driving.
Binge drinking can slow respiration and lead to unconsciousness. Too much alcohol can
cause death. First aid management of substance misuse is similar to treating casualties who
have been affected by poisonous substances because the body sees a drug overdose as being a
poison. First aid treatments can include:

Figure 2.17: Substance abuse

BITES:
49
There are different types of bite occur. The following are commonly happen bite.
I. Snake Bite
Signs and symptoms
 Disturbed vision
 Feel nauseated or vomiting
 One or two small puncture wounds with sharp pain and local swelling
 Symptoms and sign of shock
 Sweating and salivation in advanced stages of venom reaction
First aid management;
 Lay the victim down and advise not to move
 Calm the victim
 Immobilized the affected part and keep it below the level of the heart
 Wipe the wound of venom
 Apply firm cord just above the bite
 This must be removed if you are sure that anti venoum has been injected and you
cannot get the victim to hospital in time.
 Seek for medical help
If there is no anti venoum do the following:
 Tie a cord tightly around the limb just above the bite
 Using a razor blade or a clean knife make a cut 1 cm deep
 Suck the liquid which is coming out of the wound
 Continue to suck and dispose for 5-10 minutes
 Loosen the cord around the patients limb
 Disinfect the wound
 Refer to hospital for anti- venom injection.

Figure 2.19: Snake bite

II. Dog Bite;

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Rabies is a sickness due to an infection from an animal usually a rabid dog, cat, fox, wolf,
and bats. The infection grows in the animal’s nerves, may develop the disease, if the saliva
enters a wound or scratch on a human being.
Signs and symptoms of a rabid dog
 Has difficulty in swallowing
 Is lethargic /lazy/
 Hides it self
 Does not want food, but swallows, pieces of wood stone etc.
 Barks in unusual way and never stop barking
 Saliva runs out of its mouth
First aid management:
 Clean the wound with soap and water
 Cover the wound with dressing ointment/powders
 Find out if anyone knows the dog that bit the patient
 If the dog known, ask its owner to watch the dog carefully for lodges and to let you
know it shows any of the above sign and symptoms in that time. See, during that time,
it begins to show any of the above signs and symptoms. Get the dog Killed. Send the
person to hospital or Health center immediately for anti-rabies vaccination.
EYE INJURY
Eye injuries may be serious, even if minor, as the eye is very sensitive and easily damaged.
Eye injuries may involve either or both the bones and soft tissues surrounding the eye, as
well as the eyeball itself.
Since the eyes are delicate, they can be affected easily therefore; immediate help should be
given.
Signs and symptoms
 Pain inside the eye
 A high volume of tears in the eye.
 Wound or cut around the eye ball
 Different between the size of eye ball
 Sight decreases
 Inflammation and infection

Management of the eye injury

 Avery light covering be applied to an injured eyes
51
  Do not apply pressure
 Reassure the patient
 If no improvement in few days, Refer the victim to the nearest health facility
If foreign bodies in the eye (such as dirt, sand, slivers of wood etc.):
 Tell the person the try to remove the foreign body by blinking several times – this will
produce more tears, which may flush it out.

 If this does not work, try flushing the eye with water – keep the affected eye lower so
the unaffected eye does not become contaminated.

 If this does not remove the object, cover the eye with a pad, taped in place, then seek
professional medical attention

If object is embedded in the eye:

 Do not attempt to remove the object.
 Place a sterile dressing around the object.
 Stabilize the object in place as best as possible: a paper cup could be used, placing it over
the object before applying the bandage.
 Bandage it in place.
 Ask the person to keep unaffected eye closed – this will prevent blood/dirt/fluid from
entering it.
 Advise person to try not to move the unaffected eye – this will prevent movement in the
affected eye also.
 Seek for medical help

Figure 2.20: Eye injures

EAR INJURIES
Bleeding and fluids in or draining from the ear may be from an injury to the ear itself or as a
result of a serious head or spinal injury.

52
Signs and symptoms of ear injuries may include:
 Pain and Impaired hearing or deafness in affected ear.
 Bleeding from the ear.
 If related to an injury within the skull: watery fluid mixed with blood coming from
the ear, headache and/or altered conscious state.
If Bleeding from the ear:
 Cover the ear with a clean material (sterile if available) dressing.
 Do not plug the ear with wool
 Do not put in drops
 Refer the victim to the nearest health facility
Foreign body in the ear:
 Turn the patient’s head to the affected part of the ear so that the foreign body may
drop out.
 If it is an insect which is inside the ear, direct torch- light to the ear- the insect may
follow the light and come out of the ear. If this does not succeed, Pour in taped
boiled water, the insect may float out
 If neither these treatment is successful refer the client to the next health facility.

Figure 2.21:Ear injures

NOSE INJURES
Bleeding from the Nose: If the foreign body is either beans, peas, avoid putting

53
Water or any fluid
 Get the patient to pinch the lower part of his nose firmly for 10 minutes, while
breathing through his mouth
 Loose tight clothing around his neck
 Tell the patient not to blow his nose for several hours
 If bleeding persists, refer the client to the next health facility.
Foreign body in the nose: In an adult, a foreign body may enter the nose by accident, but
mostly common in children who insert a pea or a bean in to their noses.
NB. - Do not attempt to remove it, refer to the next health facility.

Figure 2.22: Noise injures

NEEDLE STICK INJURIES

A needle stick injury occurs when a used needle punctures a person’s skin. This puts the
person at risk of infection of blood-borne diseases such as HIV, hepatitis B and hepatitis C.
General first aid treatment for a needle stick injury involves:
If the patient is conscious:
 Reassure the patient and get them to rest and stay calm.
 Let the wound bleed freely for a few seconds.
 Flush/wash the injury site with soap and running water – if not available an alcohol-
based hand rub/wash may be used.
 If necessary a sterile, waterproof dressing may be applied.
 Urge the person to go straight advanced treatment. If possible the needle should be
retained in a rigid, puncture resistant container with lid for later testing.

54
If the patient is unconscious
 Follow DRS ABCDE Basic Life Support process.
 Call for ambulance and help.

Figure 2.23:-Needle stick injures

DIARRHEA
If someone has over three frequent/subsequent loose stool in a day, it is called diarrhea.
When an individual loses much fluid from the body due to diarrhea and vomiting, it is likely
that he/she becomes unconscious and /or dies.
Causes of diarrhea and/or vomiting: Food poisoning and Intestinal parasites. Excessive
diarrhea may lead to loss of body fluids and called dehydration
Signs of dehydration;- Body debilitation or loss of weight
 Dryness of the mouth or tongue, sunken eye balls, eye drops, and sunken fontanel, in
children
 Dry and wrinkled skin,
 Restless and unconscious and others
First-aid measures:
 First, ensure that there are no adverse signs that are usually precipitated by diarrhea and
vomiting such as:- Sunken eye balls, wrinkled skin, restlessness; and unconsciousness;
and in children, continuous vomiting after taking fluids, shivering etc.
 Prepare ORS in one litter of boiled and cold water. If ORS is not available prepare
homemade solution as follows. Mix eight spoon of sugar, with half a spoon salt in one
litre (three normal beer bottles) of boiled cold water. If available, add half a glass of
orange or banana juice into the solution; The ORS or home-made solution is prepared
for an adult. Therefore, he/she must take the fluid in small amount every five minutes.

55
 If the one liter solution is not finished in 24 hours, prepare and give a new/fresh solution
in the following day. In addition frequently provide the victim soup, rice water,
gruel/oatmeal (an adult can take daily up to three liters of fluid)
 For children give ORS or a solution mix of eight spoon of sugar and half spoon of salt
in one liter of boiled cold water or mix of 2 times rice flour or corn or wheat or smashed
potato in one liter of water and boiled for 5-7 minutes. Feed children after it is properly
cooled in the following manner.
 Children 2 months to 2 years old must get 50-100 milliliters (1 or 2 cups), a maximum
of 500 milliliters in one day (one spoon every 2 minutes)
 Children 2-10 years old must get 100-200 milliliters or 2-4 cups of ORS or home-made
solution after every diarrhea episode the child can take up to one liter of the solution).
 If the victim is over 10 years old, give the fluid until satisfied
 If the victim vomits the fluid, wait for about 10 minutes, and give one spoon of the
solution every three minutes
 Frequently breast feed the victim and add in small amount other supplementary foods
such as gruel/oat meals every 10 minutes; and
 Continue the supplementary feeding for about two weeks after the diarrhea ceased.
 Consult care takers for further medical help.
Rationale for referral;
 Persistent vomiting after taking fluids
 If the diarrhea is stained/mixed with blood and the victim has high fever
 If the vomiting is accompanied with sign such as tenderness and sever cramp of the
stomach
 If the diarrhea continues for 3 days in children and 4 days in adults without
improvement.
Measures to be taken after first-aid assistance:
 Explain the causes of diarrhea and vomiting'
 Observe on the presence of precipitating factors in the household, such as the
maintenance of house cleanliness and personal hygiene, water source usage, the
handling of food and feeding practices. Based on the findings educate the household or
the community with demonstrations.
Preventive Measures:
 Educate and demonstrate to the household on the importance of washing hands with
soap and water, or with endod or sand and water etc. before eating
56
  Feed children supplementary food and milk with cup and spoon or breast-feed instead
of bottle feeding
 Keep children in clean areas and keep them always away from dirty area
 Don’t feed on unclean and unprotected food stuff
 Use always latrines/toilets
 Maintain personal hygiene and clean environment.
DISEASES CHARACTERIZED BY FEVER
When an individual’s body temperature is too hot than normal (above 37.5 oc) he/she has a
fever. Fever itself is not an illness, but a sign of many different illnesses.
Common diseases that precipitate fever:-Yellow fever, Typhus, relapsing fever , Typhoid,
Meningitis’, Influenza, Malaria and etc
Adverse consequences of febrile diseases
 Mental confusion, unconsciousness;
 Reduction of body fluid;
 Convulsion; and
 High fever precipitates brine damage, paralysis, low blood pressure, dysfunction of
kidneys, inability to hear, speak, and liver damage.
First-aid Measures for febrile cases in general
 Cover with or put light dress on the victim. If the victim is a child, cover it with light
cloth and carry it in your arms;
 Replace fluids lost by profuse sweating give frequently the victim, soup, gruel
oatmeal, if the victim is a child, give frequently breast-milk;
 Put cloth soaked in lukewarm water on the chest, face and abdomen to bring down
the fever;
 Ask or ensure perhaps the presence of convulsion, chillness, vomiting, diarrhea,
meningitis etc;
 Consult or refer for the professional staff in the health facility to find out whether the
cause of the fever is or not an infectious disease

57
Self-check 2

Directions: Answer all the questions listed below.

Test I: Short Answer Questions
1. What mean by ABCDE?
_____________________________________________________________________
_____________________________________________________________________
________________________________________________
2. Discuss the following emergency term and how it manage Bleeding, wound, Shock,
fracture, Burn, choking, Eye, ear, noise injures and Obstructed air way.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
___________________________
Test II: Choose the best answer
1. Which of the following is a signal of respiratory distress?
A. Gasping for air
B. Breathing that is slower than normal
C. Wheezing
D. All of the above

58
2. Before beginning a check for life-threatening conditions, you should first;
A. Move the person to a convenient location for care.
B. Check the scene.
C. Call for help
D. a and b
3. After checking for consciousness, you determine that the person is unconscious. What
should you do next?
A. Have Call for help
B. Give 2 rescue breaths.
C. Check for breathing and severe bleeding.
D. Begin a check for non-life-threatening conditions.
4. When you give rescue breaths, how much air should you breathe into the person?
A. Enough to make the stomach clearly rise
B. Enough to make the chest clearly rise
C. Enough to fill the person’s cheeks
D. As much as you can breathe in 2 seconds
5. Which is the purpose of CPR?
A. To keep a person’s airway open
B. To identify any immediate threats to life
C. To supply the vital organs with blood containing oxygen
D. All of the above
6. When is CPR needed for an adult?
A. When the person is conscious
B. For every person having a heart attack
C. When the person is unconscious and is not breathing
D. When the person who is having a heart attack loses consciousness

59
Operation Sheet -2

Operation Title: Apply Basic rules of ABCDE life

Instruction: Perform the ABCDE rules correctly.
Purpose: to help patient suffered for emergency
Required tools and equipment: Vital sign measurement equipment; like thermometer, BP
apparatus, Basic first aid kit, ambulance.
Precautions: use personal protective equipment (PPE)
Procedures:
 Find all important first aid equipment to provide first aid service for patients in
emergency condition.
 Identify the client status ,
 Place the client comfortable in appropriate place
 Apply basic rules of ABC
 Provide first aide service to patients with the following emergency accordingly.

60
 LAP TEST-2

Name __________________ID ______________________Date _______________

Time started: ________________________ Time finished: ________________

Instructions: Given necessary templates, tools and materials you are required to perform the
following tasks within short time. The project is expected from each student to do it.
Task-1. Perform ABC rule of life
Task-2. Give first aid for the patents with bleeding
Task-3. Give first aid for the patents with shock
Task-4. Give first aid for the patents with obstructed air way
Task-5. Give first aid for the patents with wound
Task-6. Give first aid for the patents with choking
Task-7. Give first aid for the patents with burn
Task-8. Give first aid for the patents with drowning
Task-9. Give first aid for the patents with poison
Task-10. Give first aid for the patents with bite
Task-11. Give first aid for the patents with fracture
Task-12. Give first aid for the patents with eye, ear, noise injury
Task-13. Give first aid for the patents with diarrhea

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UNIT THREE: Prepare, evaluate and act in an emergency
Instruction sheet

This learning guide is developed to provide you the necessary information regarding the following
content coverage and topics:
o Options for action in emergency and control strategies
o Occupational health and safety procedures and policies.
o Removing clients and others from dangers.
o Assessing, evaluating, reporting and documenting potential hazards.
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Follow Options for action in cases of emergency and group control strategies for
evaluation
 Identify Occupational health and safety policies, procedures and safe working practices
 Remove clients and other individuals from danger
 Assess, evaluate, report and document potential hazards
Learning Instructions:
 Read the specific objectives of this Learning Guide.
 Follow the instructions described below.
 Read the information written in the information Sheets
 Accomplish the Self-checks

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 3.1. Options for action and group control strategies in cases of emergency
 In Event of the emergency alarm sounding (a continuous ringing) evacuation should be
immediate. Any one should urge individuals to leave quickly. Emergency situations are
often confusing and frightening. To take appropriate actions in any emergency, follow the
three basic emergency action steps:

 CHECK the scene and the person

 CALL for help or the local emergency number

 CARE first for the person until advanced medical support.

All evacuees should muster at the designated assembly point. Refer more on unit one.

3.2. Occupational health / safety policies, procedures and safe working practices
Occupational Health & Safety policies are defined as laws and guidelines keep helping your
workplace safe. It is important that you are familiar with the occupational Health & Safety
policies that exist in your state or territory.

The purpose of the Health and Safety policies and procedures is to guide and direct all
employees to work safely and prevent injury, to themselves and others. All employees are
encouraged to participate in developing, implementing, and enforcing Health and Safety
policies and procedures. All employees must take all reasonable steps to prevent accidents
and never sacrifice safety for expedience. Our goal is to eliminate or minimize hazards that
can cause accidents. Health, safety, the environment and loss control in the workplace are
everyone’s responsibility. Everyone join put efforts to provide a healthy and safe working
environment on a continuous day to day basis. The legislation places duties on owners,
employers, workers, suppliers, the self-employed and contractors, to establish and maintain
safe and healthy working conditions.
It outlines the responsibilities of employers to provide first aid facilities and first aid trained
personnel/workers. The regulations may also detail the requirements of first aid kits and
facilities based on the size of the organization and the type of work environment. One of your
most important responsibilities is to protect your Health and Safety as well as that of your co-
workers.

63
Occupational health & safety policies guidelines for preventing accidents in the workplace
should be found in the organizational polices and standard operating procedures. It should
have procedures on how to deal with a workplace accident. It may include instructions on
how to use Personal Protective Equipment (PPE), which can prevent infection spreading.
Similarly you can read the detail of Ethiopian Occupational Health & Safety policies for
more detail.

The legislation outlines requirements for:

 The reporting requirements for modifiable incidents.
 Licenses, permits and registrations (e.g. for persons engaged in high risk work or
users of certain plant or substances).
 Provision for worker consultation, participation and representation at the workplace
 Provision for the resolution of health and safety issues.
 Protection against discrimination and others
The purpose of the Occupational Health and Safety policies and procedures is to guide and
direct all employees to work safely and prevent injury, to themselves and others.
Its goal is to eliminate or minimize hazards that can cause accidents.

3.3. Removing clients and other individuals from danger

Emergency rescue is the act of removing some one from danger is technical term for rescue
taking place under hazardous circumstances with high risk to rescue personnel but must be
done immediately to save person’s life.

It is essential to know how to properly package a victim in a safe, effective, and efficient
manner.

It is our responsibility to be able to prepare a victim for removal from danger atmosphere as
quickly as possible, through the use of many different lifts, assists, carries, and drags, while
also striving to minimize any further damage to the victim.

At times, drastic and unconventional lifting techniques may be needed to remove a victim
from severe conditions.

64
The only limiting factors when removing a victim in an expedient manner are safety, the
environment, and the imagination of the rescuers. Raw strength is helpful, but not necessary
with the proper technique and form.

There are some indications for immediate rescue

1 The victim has stopped breathing

2 The victim has severe bleeding

3 The victim has heart attack

4 The victim is electrically shocked

5 The victim is on fire

6 The victim is drowning

Victim removal precautions:

 Victims who are injured should only be moved if a life‐threatening emergency exists.
 Spinal injury from trauma is one the greatest threats to an injured victim.
 In most situations, it is safer to move the victim along the long axis of their body
leading with the head or feet.
 For the safety of the victim and the rescuers, two or more rescuers should be used when
conditions allow.
 Victims who are unconscious tend to be much more difficult to move than conscious
victims.
 Using improper lifting techniques causes many back injuries to rescuers.

Victim removal techniques

The following are the basic skills of victim removal techniques that we should be proficient
at performing.

 One rescuer emergency drag

 Two rescuer emergency Drag (Under Arm)
 Two Person Drag (Football)
 Two Person Drag (Over The Shoulder)

65
  Window Rescues
 Movement up and down stairs
 Use of Webbing
One Rescuer Emergency Drag
 Locate and asses the downed victim. Utilize the appropriate victim positioning
technique.
 Cross the victim’s arms.
 The firefighter positions their arms under the victim’s arm and grasps the victim’s
wrists. This will lock the arms in place
 Slightly lift the victim off of the ground.
 Push off of the posted leg.
 The firefighter’s chest must remain in close contact with the victim’s back to avoid
unnecessary strain on the lower back
 Move in short, quick “steps”.

Fig 3.1 Arm drag

Two Rescuer Emergency Drags (Under Arm)
 Locate and assess the downed victim. Utilize the appropriate victim positioning
technique.
 The firefighters will position themselves on opposite sides of the victim’s head facing
the same direction
 Each rescuer will place their inside arm underneath the armpit of the victim, keeping it
locked in the natural pinch point of the forearm and the bicep.
 Both firefighters post the rear leg and Push off the post.

3.4. Assessing, evaluating, reporting and documenting potential hazards

Potential Hazard means a danger to health or safety which may occur if corrective action is
not taken.
66
Potential hazard assessments are very important as they help to:
 Create awareness of hazards and risk.
 Identify who may be at risk (e.g., employees, cleaners, visitors, contractors, the public,
etc.)
 Determine whether a control program is required for a particular hazard.
 Determine if existing control measures are adequate or if more should be done.
 Prevent injuries or illnesses, especially when done at the design or planning stage.
 Prioritize hazards and control measures.
 Meet legal requirements where applicable.
The aim of Potential hazard risk assessments process is to evaluate hazards, then remove that
hazard or minimize the level of its risk by adding control measures, as necessary. By doing
so, you have created a safer and healthier workplace.
Once you have established the priorities, the organization can decide on ways to control each

67
Self-check 3

Name:_____________________ ID:_________________ Date:_______________

Directions: Answer all the questions listed below.
Test I: short Answer questions
1. Explain how assess the potential hazard
2. What is entanglement?
3. What are the types of emergency drags
4. Discuss briefly on types of emergency carry
5. Demonstrate log rolling
Test II: Short Answer Questions
1. Define occupational health / safety policy and its importance?
___________________________________________________________________________
_____________________________________________________________
2. Visit a nearby hospital and observe the various hazards. List the common hazards that
you notice?
___________________________________________________________________________
_____________________________________________________________
3. Describe control strategies of hazard ?
___________________________________________________________________________
_____________________________________________________________
4. Asses and evaluate potential hazard in your environment that cause emergency.
___________________________________________________________________________
_____________________________________________________________

68
UNIT FOUR: Communicate Details of the incident
Instruction sheet
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Soughing first aid assistance
 Requesting ambulance support and medical assistance
 Conveying the observed casualty's condition and management activities
 Assessing, managing and reporting the causality
 Maintain confidentiality
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Identify causality level of consciousness and communication style
 Sough first aid assistance from others in a timely manner
 Request ambulance support and/or appropriate medical assistance
 Observe casualty's condition and management activities
 Describe details of casualty’s physical condition, changes in condition, management
 Keep Confidentiality of records and information
Learning Instructions:
 Read the specific objectives of this Learning Guide.
 Follow the instructions described below.
 Read the information written in the information Sheets
 Accomplish the Self-checks

69
4.1. Soughing first aid assistance
4.1.1. Seeking first aid assistance in a timely manner.

In all first aid situations there can be a need to call on others who are not professional medical
people to help/ provide the basic first aid in an emergency situation.
Wherever possible you should always seek assistance from others to help someone. Seek
assistance from work colleagues, supervisors, Friends and family members of casualty and
anybody else close by. You may also ask by standers for help in the treatment of casualties.
Call for help if possible. When asking for help:
Never be afraid to ask for help – from anyone;
Most people are prepared to help even if they do not know what to do. They will do what you
tell them or ask them to do.
A vital thing they can do is to confirm professional medical help is on the way. If one person
refuses to help, ask someone else. Never assume just because one person has refused,
everyone will refuse
People may be asked to:
 Give information about causes of injury
 Provide directions to emergency services and Contact friends or relatives of the casualty
 Help carry or move the casualty and Protect casualty
 Communicate with emergency services and Record verbal information you give them
 Obtain first aid requisites for you.

70
4.2. Requesting ambulance support and medical assistance

Ambulance is a vehicle that transports critically sick or injured people to a medical facility.
 Ambulance is a standardized vehicle for emergency management or move from the
scene to health facilities for definitive care.
 It is designed in such a way to deliver emergency (particularly life threatening
injuries or acute illness) care
 The size of the ambulance and the interior content (medical and non-medical
equipment) may vary from country to country.
 In Ethiopia, the types of vehicle used for ambulance and its speed, warning light,
siren, right-of-way etc are determined by federal road and transport authority.

It accommodate one or more patients and emergency medical personnel, supplies and
equipment to stabilize a patient’s condition en-route a hospital. Requesting of ambulance
support and/or appropriate medical assistance according to relevant circumstance using
relevant communication media and equipment is live saving.
Accurately convey assessment of casualty's condition and management activities to
ambulance services /other emergency services/relieving personnel.
Obtained professional medical help as much as possible. Ask someone else to call for help
such as a colleague, management, a bystander or member of the public while you go to the
casualty or while you are rendering first aid. Yelling out for help. Yell out for someone to
ring an ambulance. Flagging down a passing vehicle and asking them for help or to ring an
ambulance.
The importance of obtaining professional medical help:
 It increases the likelihood of survival of the casualty
 It allows necessary drugs and medications to be administered to the casualty at the
earliest opportunity
 It enables professional care to be provided as soon as possible
 It reduces the possibility of the casualty suing the venue for breach of ‘duty of care’.
Facilitate the arrival of emergency services or other help by:
 Opening gates, or arranging for them to be opened
 Moving vehicles which may impede access

71
  Asking others to position themselves in locations to signpost the location of the casualty
as emergency service workers arrive on scene.
4.3. Observation of casualty's condition and management activities
Once you have started treating the casualty for their injuries you should continue to monitor
their condition and document any changes, or treatments that you administer. Continue to
monitor the vital signs of the casualty including: Body temperature, Pulse (or heart rate),
Blood pressure, Respiratory rate.
It is important to monitor these vital signs as they can change rapidly causing the
casualty to descend into unconsciousness or regain consciousness. The casualty’s
condition can deteriorate or improve according to the treatment being administered.
All information form the assessment must be carefully collected, ready to be passed
onto ambulance/paramedic personnel.
4.4. Details of casualty’s physical condition, management
When relaying information to the emergency care, stick to facts about the incident not
opinions. Answer questions and convey information in a calm, clear and concise manner.
Convey information:
 Where the incident occurred
 What has happened
 When the incident occurred
 Who you are and the identity of the casualty
 What action taken to casualty
4.5. Confidentiality of records and information
Accurately record details of casualty's physical condition, changes in conditions,
management and response to management in line with established procedures. Maintain
confidentiality of records and information in line with privacy principles. Explain to the
person involved, where possible, that a record of the incident will be made and the reasons
for doing so and that they may access the record if desired. File the record appropriately.
First aiders also need to be aware of privacy legislation that protects medical data from being
circulated to the general public and to be handled by authorized workers on a need to know
basis. You should safeguard sensitive medical information. Remember, there are
consequences and legal implications should patient information be leaked.

72
Self-check 4

Name: _____________________ ID:________________ Date:__________________

Directions: Answer all the questions listed below.
Test I: Choose the best answer
1. When a person is not aware of what is going on and is not able to respond normally to
things that happen to and around him or her is;
A. Consciousness C. Decreased Consciousness
B. Unconsciousness D. All
2. One of the following is important communication held during first aid.
A. Communicating with other health care professional;
B. Communicating with children and geriatric patients
C. Communicating with hearing/ visually impaired patients
D. Communicating with patients of other languages
E. All
3. All of the following are importance of obtaining professional medical help during
emergency except;
A. It increases the likelihood of survival of the casualty
B. It allows necessary drugs and medications to be administered to the casualty at the
earliest opportunity
C. It enables professional care to be provided as soon as possible
D. None
4. Safeguarding of medical information from being circulated to the general public and to be
handled by authorized workers .
A. Confidentiality
A. Communication
B. Causality
C. No

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Test II: Short Answer Questions
1. Describe level of Consciousness
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________
2. Define communication style during first aid
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________
3. How do you handle medical data?
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________

74
UNIT FIVE: Refer Client Requiring Further Care

Instruction sheet
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Relevant client history
 Documentation
 Conveying appropriate information in referral
 Maintaining client care
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Document relevant client history according to Health care service standard guidelines
 Ensure documentation for referral procedures
 Convey appropriate information to individuals involved in referral to facilitate
understanding and optimal care
 Maintain client care until responsibility is taken over by staff of the receiving health
institutions during referral.
Maintain client confidentiality at all times and levels.
Learning Instructions:
 Read the specific objectives of this Learning Guide.
 Follow the instructions described below.
 Read the information written in the information Sheets
 Accomplish the Self-checks

75
5.1. Documenting relevant client history
You will begin gathering the patient information as soon as you reach the patient. Continue
collecting information as you provide care until you arrive at the hospital. This information
describes the nature of the patient’s injuries or illness at the scene and the initial treatment
you provide. Although this report might not be read immediately at the hospital, it may be
referred to later for important information.
It’s vital to keep track of this information throughout the treatment. Once documented it will
provide an overall and comprehensive account of how the casualty is going.
Documentation may include: Patient information and Administrative information
 Patient information: Chief complaint, Level of consciousness, Systolic blood pressure for
patients older than age 3 years, Skin color and temperature, Pulse, Respirations and effort
and Casualty details and others
 Administrative information collected;
 Time that the incident was reported
 Time that the first aider arrived at the scene
 Time that patient care was transferred and others.
 Documenting date of patents refusal
5.2. Documentation for Referral procedure
Referral is a process in which a health worker at one level seeks the assistance for advanced
management of the client’s.
Key reasons for deciding to refer either an emergency or routine case include:
 To seek expert opinion regarding the client.
 To seek additional or different services for the client.
 To seek admission and management of the client.
 To seek use of diagnostic and therapeutic tools.
 To meet the client’s expectation to be seen by specialist.
Providing high-quality referrals involves assessing individual clients’ circumstances,
identifying potential barriers, and helping them to problem-solve and reduce all barriers, there
in increasing their ability to access referral services.
Without support, clients may receive referral information, but still not access services. Some
of the many barriers clients face in accessing services during referral are related to: Finances,

76
Language, transportation, Age-based consent issues, Legal and policy, Fear of a lack of
privacy, Fear of disclosing status etc.
Ensure staff to have adequate support to help clients with ways to overcome these barriers so
they can access the services they need.
5.2.1. Referral &Patient Rights
 The patient has the right to know (why, where, when) to be referred.
 The patient has the right to discuss referral options and alternatives.
 The patient has the right to refuse referral unless it will be of a threat to his/her life.
5.2.2. Receiving Facility:
The receiving facility must be prepared for the arrival and to receive the client with their
referral form. They will use the information sent on the referral form to begin a thorough
assessment of the client and begin management of the case. They will use its particular
resources to provide the client high quality care and maintain documentation according to
agreed standards. When the client's care has finished at the higher level facility, back referral
to the original facility is important.
The receiving facility completes the lower part of the referral form. This communication
contains information on special investigations, findings, diagnosis and treatment given by the
higher level facility as well as follow up expected from the lower level facility. The back
referral can be delivered by the client to the initiating facility, but may also be sent by fax or
post or E-mail. This communication not only assures proper patient care and follow up, but
also provides continuing education to the initiating facility and their staff. The receiving
facility can also give feedback to the initiating facility on the appropriateness of referral. If
there are any issues regarding the need for referral, timing, speed or information sent. The
higher level facility provides specific feedback to the initiating facility, if there is any issue
related to referring technical issue. This will assist the lower level facility to be surer of
referral processes in the future. The receiving facility completes its own register of referrals
in and out, from their perspective.
5.3. Conveying appropriate information to individuals involved in referral

Documentation should greatly assist the transferal of information from the first aider to the
team providing the casualty with ongoing care and treatment.
It should be performed at the time of treating the casualty (if possible) or right after treatment
has concluded while the information is fresh in your mind.

77
When recording details of the casualty’s physical condition, stick to facts about the incident
and not an opinions. Casualty details should include: Name of casualty, Age, Address, Time
of incident, History of incident/injury, Description of any injuries and/or illness, Changes in
level of consciousness, Changes in vital signs such as temperature, Changes in pulse and
respiratory rate, Changes in the color of the skin, Treatments administered, Changes in
mental status, Response to each treatment and others
To allow for a smooth transition from the first aid management to the care by paramedics, the
first aider should record details, at the earliest convenience.
If applying first aid outside of the workplace the first aider should make a record of the
event, at a minimum a note about the first aid given.
Records should be clear and concise as they may be used as a legal document. You should
take care to ensure that any first aid records are accurate, factual and reflect only your
observations and actions and do not include opinions.
When recording a first aid incident, do not use correction. Try to record original information
and record date and Sign.
5.4. Maintaining client care confidentiality during referral
Appropriate Client care could be maintained up on referral. Unless care not provided during
referral, the client may suffer for more complication. Client vital sign were registered and
maintained by first aider and trained EMT.

Simply don’t talk about specific patient private issue at all with others not involved in the
patients care. you will have an ethical responsibility to respect patients right to privacy. You
may get such an information through history taking, physical examination or observation. In
this case patient right of privacy is legally protected. Information contained in incident
reports, notes taken, conversations held between medical staff (paramedics, nurse and
doctors) are to remain confidential.
Violation of confidentiality can damage public trust up on your profession and liable you for
legal elements. The first aider is privy to medical information about the casualty and this is
not be divulged to anybody outside of the emergency medical personnel.
It doesn’t matter how long ago the incident occurred. You are obliged by law to maintain
confidentiality about the medical details such as the medical history (allergies) and illnesses
the casualty suffered from.
If it is a workplace incident, there are may have polices and standard operating procedures in
place, protecting incident reports.

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Duty to act and standard of care

 Duty to act is individual’s responsibility to provide patient care and is a legal task given
for you that originate from your professional role.
So that you must proceed promptly to scene and render emergency medical care within the
limits of your training and available equipment.
 Standard of care is level of care you are expected to give for your patient. It is the
manner in which you must act or behave.

79
Self-check 5
Name:_____________________ ID: _________________ Date:_______________
Directions: Answer all the questions listed below.
Test I: Choose the best answer
1. All of the following is major client history Documented during first aid except ?
A. Nature of the patient’s injuries
B. Level of consciousness
C. Chief complaint
D. Casualty details
E. None

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 2. Key reasons for deciding to refer during first aid is:
A. To seek expert opinion regarding the client.
B. To seek additional or different services for the client.
C. To seek admission and management of the client.
D. To seek use of diagnostic and therapeutic tools.
E. All
Test II: Short Answer Questions
1. Describe Referral procedure in emergency?
_______________________________________________________________________
_____________________________________________________
2. State how you convey appropriate information to individuals involved in referral?
_______________________________________________________________________
_____________________________________________________
3. Explain role of receiving facility during referral?
_______________________________________________________________________
_____________________________________________________
4. How you maintain client confidentiality during first aid?
_______________________________________________________________________
_______________________________________________________________________
____________________________________________

81
UNIT SIX- Evaluate own performance

Instruction sheet
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Appropriate clinical expert feedback
 Recognizing psychological impacts on rescuer.
 Debriefing and evaluation
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Seek feedback from appropriate clinical expert
 Address possible psychological impacts on rescuers
 Participate in debriefing/evaluation to improve future response
Learning Instructions:
 Read the specific objectives of this Learning Guide.
 Follow the instructions described below.
 Read the information written in the information Sheets
 Accomplish the Self-checks

82
6.1. Clinical expert feedback
Once you have handed over care of the casualty to professional medical personnel and
completed the required reports and forms you should look back and evaluate how well you
performed. Clinical experts involved in the first aid management are a good source of feedback
Clinical experts may include: Your supervisor/manager, Ambulance officer/paramedic and Other
medical or health workers.
6.2. The possible psychological impacts on rescuers.
Not everyone who is involved in critical incidents will experience psychological trauma but it
has been widely documented that paramedics and medical and rescue workers involved in
emergency incidents can have a higher risk of suffering from mental health issues such as Post-
Traumatic Stress Disorder (PTSD).
Indications of psychological trauma include: Irritability, Disturbed sleep, Flashbacks, Feeling
numb, Emotional outbursts and Anxiety.
Dealing with Post-Traumatic Stress disorder: strategies that may help with stress can be
supported with talking to a friend or co- worker who can offer support, talking to a counselor,
engaging in hobbies that have helped in the past such as walking or listening , relaxing with
music. Eating well and getting sufficient sleep can also help.
Bringing to psychologist can provide a medical evaluation in mental health issues and refer you
to a qualified psychologist to provide counseling support. Community mental health services
also provide counseling. Other than counseling, meditation and relaxation classes can help with
stress which has been shown. These can be taken in general community health centers can be
located through local councils.

6.3. Participation in debriefing and evaluation

6.3.1 Debriefing: as a first aider that has been personally involved in an emergency incident,
there is an opportunity to participate in debriefing by talking to your supervisor, work colleague
or counselor. This enables you to raise any issues or concerns you have had about the emergency
process.

83
In participating in a debriefing or evaluation session, you may learn more about your abilities
such as your successes and failures in a crisis situation to improve the response in future
emergency situations. Debriefing may also provide closure on the incident for you.
6.3.2. Evaluate your own performance
Go back over the situation in your mind. Were there things you could have done better?
Was there anything you couldn’t do because you had forgotten or never learned something?
Be honest with yourself. If you think you could have done better, you can gain objective
feedback from an outsider who may place your efforts in proper perspective.
Always be on the lookout to improve your skills. Evaluating your performance may be the only
way you can identify how to provide better first aid before.
Your organization can also learn from your experience and develop methods to improve
emergency response techniques.
If the incident occurred outside of the workplace, you may gain feedback from a health care
professional. A discussion with the treating doctor may also bring closure to the incident

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Self-check 6

Name: _________________ ID: __________________Date:____________________

Directions: Answer all the questions listed below.
Test I: Short Answer Questions
1. Define feedback in emergency?
________________________________________________________________________
____________________________________________________
2. Describe post-traumatic stress disorder and how they managed?
________________________________________________________________________
____________________________________________________
3. What is debriefing and its importance in first aid?
________________________________________________________________________
____________________________________________________
4. How you evaluate your own performance during first aid?
________________________________________________________________________
____________________________________________________

85
Reference

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12. WHO 2018 , Basic emergency care approach to the acutely ill and injured , April 2022.
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14. American Red Cross (2012), Responding to Emergencies Comprehensive First
Aid/CPR/AED program. April 2022.
15. Goniewicz K, Goniewicz M, Pawłowski W, Fiedor P, La - sota D. Risk of road traffic
accidents in children. Medical Studies/Studia Medyczne 2017; 33: 155-160. April 2022.
16. Goniewicz M, Chemperek E, Nowicki G, Wac-Górczyń - ska M, Zielonka K, Goniewicz
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19. [Link] April 2022.
20. [Link] April 2022.
21. [Link]
temperature-pulse-rate-respiration-rate-blood-pressure, April 2022.

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Participate Profile

[Link] Name Qualification Educational College Email

background
1. Abraham Samuel MSc EMCCN Hosanna health science Abrahamsamuel 133@gmail
2. Amanuel Melaku HO Public Mizan health science amanuelmelaku28@[Link]
3. Desalew Tesema MPH/RH HO Mettu mayadesalew@[Link]
4. Melaku Nokola BSc Nurse Hawasa -
5. Samson Sisay Woldie MPH/RH BSC TEDA Samsonwoldie92@[Link]
6. Tadele Arfassa MPH [Link] Shashemene health science tadeharar61@[Link]

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