First Aid: Introduction DEFRTiON it aid is the immediate and temporary care given to the victim of an accident or sudden illness/Its purpose is e life, assist recovery and prevent aggravation o of the condition until the services fa doctor can be obtained or during transportation to hospital or to the casualty’s home. J “The term ‘first aid’ was adopted officially in England for the first time in 1879 by the St John Ambulance Association. The expression ‘first aid’ had not come till 1894 and intended to designate any person who has received a certificate from an authorized association that he/she is qualified to render first aid. OUTLINE OF FIRST AID The principles and practice of first aid are based on the principles of practical medicine and surgery, knowledge of which, in case of accident or sudden illness, enables trained persons to give such skilled assistance as will preserve life. Promote recovery and prevent the injury or illness becoming worse until medical aid has been obtained. ‘The term ‘medical aid’ is used to indicate treatment by a doctor either on the spot, in the home or in hospital. ‘The first aider’s responsibilities ends as soon as medical aid is available, but he/she should standby after making his/her report to the doctor in case he/ ‘she can be of further assistance. _ First aid is definitely limited to the assistance rendered at the time of emergency with such material as may be available. It is not n ed that the first aider should take the place of the doctor and it e clearly understood that the redressing of injuries and other er treatment are outside the scope of first aid.4 Section |: Introduction Throughout the manual standard methods of treatment are given for a number of defined conditions, which may occur in different circumstances, but the first aider will find that these conditions seldom conform to an exact pattern and that even in the same circumstances individuals may react in different ways. He/She must | be prepared to sum up any situation with which he/she may be faced and adapt himself/herself to wide variation from the average or typical, ~~ PE OF FIRST AID 1 To determine the nature of the case requiring attention so far is necessary for intelligent and efficient treatment—diagnosis. To decide on the character and extent of the ‘treatment’ to be given and to apply the treatment most suited to the circumstances until medical aid is available. ZA To arrange for the ‘disposal’ of the casualty by removal either to his/her home or other suitable shelter, or to hospital. DIAGNOSIS In deciding nature of the case, first aider must consider its ‘history, symptoms and signs: AMistory History is thestory ofhowan accidentor sudden illness occurred. This may be obtained from the casualty (if conscious) or from witnesses. It may be information that a person is subject to a particular disease or the surroundings may suggest the cause, e.g, a broken bicycle. Symptoms are the sensations of the casualty such as feeling cold " shivery, faintness, neysea, thirst pain, which can be obtained, if ne ae is a very helpful diagnostic point jeeoasieaee /her attention to the part, which is and es a great deal of time during his/Chapter 1:First Aid: Introduction 5 “Signs Signs are any variations from the normal conditions of the casualty such as pallor, congestion, swelling and deformity, which can be observed by the first aider. Signs are the most reliable indications on which to base diagnosis, but the circumstances of each particular case will determine the relative importance of history, symptoms and signs. TREATMENT Ifthe cause of the condition is still active, remove the cause if possible (e.g, a log of wood on leg), or remove the casualty from the cause of the conditions (e.g. gas-filled room). Give treatment to preserve life, promote recovery and prevent the condition becoming worse. Pay special attention to the treatment of failure of breathing, severe bleeding and shock. When there is the slightest doubt as to whether a casualty is dead or alive, continue treatment until medical aid has been obtained. DISPOSAL ‘The speed with which a casualty is brought under medical care is of tremendous importance in his/her recovery. Unless the casualty is examined by a doctor on the spot, it is the responsibility of the first aider to see thathe/she is conveyed to his/her home (or other suitable temporary shelter) or to hospital as soon as possible in the manner most suitable in the circumstances. A tactful message should be sent to the casualty’s home or relatives indicating in a general way, ‘what has happened and the casualty’s destination’ WANAGEMENT OF THE CASE ‘The first aider must always: 1, Respond quickly to calls for assistance, the saving of a life may depend on promptness of action. 2, Adopt a calm and methodical approach to the casualty, quick and confident examination, and treatment, which will relieve pain and distress, lessen the effect of the injury and may save life. Time spent on long and elaborate examination of a casualty maybe time lost in his/her ultimate recovery.| | 6 Section brotecr r 3. Treat obvious injuries and conditions endangering life such « failure i Rething and severe shock, before making a complet, | diagnosis. | 4, Take rst aid materia, ifthisis immediately available. Ifstandars equipment is not available, the first aider must depend on material to hand, which will have to be improvised as required 5. Study the surroundings carefully. These may influence the action to be taken and therefore require careful consideration for example: 2 a. Danger: From falling building, moving machinery, electric current, fire, poisonous gases and similar hazards. b. Weather: If the accident occurs out-of-doors, the casualty may be treated in the open air if the weather is fine; if the weather is bad, he/she must be removed to shelter as soon as is reasonably possible. c. Shelter: Houses and buildings near at hand, whether occupied orunoccupied, andwhetherlikely tobe particularly useful (e.g. a chemist’s shop), otherwise, temporary shelter may be provided by means of umbrellas, rugs, etc. 4. Light: Itis impossible to treat a patient satisfactorily without sufficient light, and the first aider must provide for this. Po Assistance: Crowds must be tactfully controlled. If a doctor 4s present, work under his/her direction. If not, ask if anyone with knowledge of first aid is present. If neither is available ‘ make Beets bystanders to the best advantage. Keassure the casualty: By speaking encouragingly, warn ___ him/her to be still and tell that he/she is in Seas DEN RULES OF FIRST AID L Do ‘first things first’ quickly and with y y ‘out fuss or panic. “Give artificial respiration; if breathing has stopped—every8 Sectiontitodation Whether you and the casualty are not in any danger Ifthe casualty has any life-threatening conditions Ifany bystanders can help you Whether you need to call for assistance. Safety ‘You must minimize the risk of danger to yourself, the cas bystanders, and guard against any further casualties a example, in the case of road accidents). Road accidents Instruct a bystander to control traffic, keeping it well a yourself and the casualty. Watch out for life risks, especi: petrol spillage and switch off the ignition of the vehicles conc (refer Chapter 5 for more details of ‘procedure at major inci DETERMINING PRIORITIES + In order to determine the condition of a casualty, ask “What happened?” * Areply will help you to know what to look for + It also tells you that he/she is conscious; his/her clear; he/she is able to breathe, if he/she does not to questioning or touch, perform the following immediately. Airway, Breathing and Circulation 1. Following the airway, breathing and circulation (ABC) quickly check that the airway is open and that the casuz breathing. If not, commence artificial ventilation im: (Figs 1.1A and B). 2, Check pulse for circulation (Fig, 1.2). If absent, comme ‘external chest compression’ Check for any severe bleeding a control it, Unconsciousness Place an unconscious casualty or one whose breathing is noisy, in the recover position (refer Chapter 4, topic on ‘recovery position’ and assess the level of responsiveness (refer the topic ‘levels of responsiveness’),Chapter 1; First Ald: Introduction 11 a single injury, ot treatment xt. In such Figures 1.1A and B: Artificial respiration. A. Head-tilt, chin-lift; B. Patency of airway. If there is any possibility of spinal injury, do not turn the casualty and keep in spinal recovery position (refer the topic ‘examining the spine’) unless difficulty in breathing makes it essential, or vomiting is likely to occur: Gas and poisonous fumes: If possible cut off the source and ensure adequate ventilation « Electrical contact: Break the contact, if possible, and take the necessary precautions against further contact « Fire and collapsing buildings: Move the casualty to safety immediately, ifyou can do so without endangering your own life. Getting Others to Help You Some bystanders can be extremely useful and may be able to assist with treatment. For example: 1, Controlling severe bleeding or supporting a badly injured limb. 2, Other bystanders may become nuisances so you must keep them occupied to prevent their interfering h yo "work, They can to control traffic Figure 1.2: Radial pulse checking (three fingers method)10 Section Introduction << make sure that they understand the message that is to be sent, ;; possible, ask them to write it down, but in any case, ask them 1 repeat the to you before actually sending it Always make sure ey report back to you afterwards. Keep the casualty warm, quiet and lying down until skilled help arrives. Other Needs Unless there is immediate danger to life from the surroundings, treat all fractures and large wounds before moving a casualty. If the casualty is in danger, support the injured part whilst moving (refer Chapter 9) or you suspect that the casualty has a fractured spine. CALLING FOR ASSISTANCE ‘Once you decide that assistance is required, and this may include ambulance, police, fire brigade, gas or electricity boards, send for it immediately. Go to the nearest telephone booth for ambulance service required. Do not leave the casualty unattended. Whether you are giving the message yourself or instructing someone to doso ‘make sure that the following information is passed on: “1. Your telephone number. _ 2. The exact location of the incident; if you can point out nearby road junctions for other landmarks. indication of the type and seriousness of the incident, ¢8 d traffic accident, two cars involved, three people trapped. umber, sex and approximate age of the casualties involved ‘possible, the nature of their injuries, for special help and if you suspect a heart attack oF hea { ‘ d Injuries casualty, you must decide by rapi¢ ority of treatment. Remember tha most severely injured. In first aid, tant as the actual knowledge of theChapter 1: First Aid: Introduction 11 In real life, serious accidents rarely produce only a single injury, frequently two or more injuries occur so that the correct treatment of one may interfere with the correct treatment of the other. In such circumstances you must decide, which injury is the more serious one and treat that in the correct way. You should then deal with the other injuries correctly as possible under the conflicting circumstances. Examination and Diagnosis Examination and diagnosis means taking account of the casualty’s history and that of the incident, the symptoms, signs and levels of responsiveness. History History is the full story of how the incident occurred or the illness began, and should be taken directly from the casualty and a responsible bystander wherever possible. Never hurry the casualty and remember to pass on all the information you have obtained when skilled help arrives. Symptoms Symptoms are sensations that the casualty feels and describes to you—the most useful of these is pain. If the casualty is unconscious or unreliable because dazed or in shock, their diagnosis cannot be based on symptoms, but has to be based on information obtained from bystanders and signs. Signs Signs are the details ascertained by you using your senses—sight, touch, hearing and smell. These may be signs of injury such as bleeding, swelling, deformity or signs of illness such as raised temperature and/or a rapid or one irregular pulse. _-~ BOW TO CARRY OUT AN EXAMINATION? A general examination should be carried out quickly to discern ent threats to life whether the casualty is conscious or when examining a casualty. There are certain rules to follow:12 Sectoalomemicion aim | * Move him/her as little as possible to avoid aggravating any | * Begin examination at the head and work methodically towards | n . Pea to Reel gbturberist- 1006 feel, listen and sme] Always compare one side of the casualty’s body with the other ,. this makes it easier to detect any nes or irregularities tha, require first aid. ; Noe re rat any Pears ane the examination, the casualty’s breathing becomes noisy and difficult, place the casualty in the recovery Sees Chapter 4, topic on ‘recovery positions’). iat § noting the rate, depth and nature (whether easy or quiet); note also any odor. Check inside of the -it contains no foreign matter, such as vomit, blood, that might cause choking. ML eta ay oy} Y Wp 5 of bani or discoloration that might ; Lookinside the lips for blueness, which Sure that dentures they are not, remove he black circular eck the whiteChapter 1: First Aid: Introduction 13 Nose Check for signs of blood, clear fluid or a mixture of both, which might come from inside the skull. Face Look at the color—it may be pale, flushed or even bluish if breathing is affected. At the same time, feel the temperature of the face to check whether it is particularly hot or cold and note the state of the skin whether it is dry or clammy or even sweating profusely. Ears Check the ears for foreign bodies and traces of blood and/or clear cerebrospinal fluid that might indicate skull fracture. Speak into the casualty’s ears to test hearing. Skull Gently run the hands over the scalp searching for bleeding, swelling or any indentation that might indicate a fracture. Examining the Spine Loosen clothing around the neck. Run your fingers over the spine from the base of the skull down to as far as you can reach between the shoulders, checking for any irregularity of the vertebrae that might indicate a fracture. Check round the neck, to see whether any ‘warning medallion is being worn. Check the carotid pulse (Fig, 1.3), e its rate, strength and pte the presence or Figure 1,3: Carotid pulse checking14, Section I: Introduction ee any clothing. Feel along the spine as high and as low as you can the;, by checking for irregularity of the vertebrae or swelling. Examining the Trunk = Check the chest for evenness of rib movement or breathing ang note any wounds that are ‘sucking air’ bei = Check the ribs for irregularity or depression that might indicate fracture and also feel along the line of the breast bone * Check both collarbones for irregularity and the shoulders for signs of deformity. Carefully feel either side of the pelvis looking for signs of fracture and note any indication of incontinence. Examining the Arms Examine the upper arm bones, then the bones in the forearm, wrists, hands and fingers. Check carefully for any deformity and ‘swelling, which might indicate fractures. Check the forearms to ‘see if the casualty is wearing a medical warning bracelet and for injection marks. Needle marks might indicate either drug abuse or diabetes. i the Legs thighs, knee caps, both bones of the lower legs, the in the same way as the arms, igh which a casualty may pass during to unconsciousness, If the casual! unconsciousness is only light (¢ Hin a potentially dangerous stat” consciousness is deeper a"!(try to arouse by shaking the shoulders gently) ai face, while you pinch the skin, or hand (ankle). should keep a similar check on the casualty's breat temperature. Your findings should be recorded. Aids to Diagnosis. Your diagnosis will be based on information from various sources. taking the history of the incident, asking the casualty for symptoms and examining him/her for signs, it should be possible to make an accurate diagnosis. The following chart is a summary of how to achieve this. Hi (Table 1.1) Btained from surroundings, casualty and bystanders. by the casualty and obtained by asking tactful questions: + Pain + Loss of normal movement his/her own senses: + Sight Respiration Bleeding (type and volume) Wounds Foreign bodies Color of face Swelling Deformity Bruising Reflexes Responses to touch and sound Incontinence Vomit Needle marks Containers Hearing Breathing Groans Crepitus + TouchChay inst Aid: Introduction 17 Continue treatment until skilled medical aid is available Control bleeding. To Prevent the Condition Worsening + Dress wounds «Provide comfortable support for any large wounds and fractures «Place the casualty in the most comfortable position consistent with the requirements of treatment. To Promote Recovery Relieve the casualty of anxiety and encourage confidence ‘Attempt to relieve the casualty of pain and discomfort Handle the casualty gently Protect the casualty from the cold and wet. picezoxe. After Treatment Once you have carried out your treatment the casualty should normally receive attention from a qualified person (doctor or nurse) without undue delay. Depending on the severity of the condition and the availability of skilled help you should: 1. Arrange transportation to hospital by ambulance (or by car for minor injuries and arm fractures). 2. Handover the casualty to the care of a doctor or nurse at the « _ scene. 3. Take the casualty to anearby house or shelter to await the arrival “ofthe ambulance or doctor. - Allow the casualty to go home and advise him/her to seek advice, if necessary. Never send anyone home who has been unconscious for a short time or who is in shock; seek medical aid. wuld always be accompanied by a brief written report es your care. If necessary, you should accompany ‘and prepare personal report. The need to supply tion cannot be emphasized enough and it should18 Section |: Introduction History of the accident or illness Brief description of the injury ‘The level of responsiveness and any changes Any other associate injuries ‘The pulse and any changes ‘The skin color and any changes Blood loss sustained Any unusual behavior by the casualty Any treatment is given and when? 0 ees & 6 628 Informing Relatives You should also send a tactful message to the casualty’s home stating what has happened and where he/she has been taken if this has no; already been done by the police or other authority attending the incident. If the casualty is unconscious or unable to tell you where io contact his/her relatives, look for a diary or donor card, which may give the relevant details (refer the topic ‘external clues’). Property “Take care of any property belonging to the casualty and hand it over an accurate diagnosis or conduct a prope! This should be done with the minimum of disturbance 5 you should only remove as much as is actual! should not be damaged unnecessarily. If ve!) as a girdle has to be cut, do this along n sufficient privacy. M over his/her shoulders. Bet! nd remove the coat from that se ut of its sleeve, keeping the ) the seam on the Baty 's eoonne m < 8d P Fec bpRemoving a Shirt or Vest Remove a coat, if necessary slit it down the front or side. Removing Trousers Pull them down from the waist to reveal the casualty's thigh or raise the trouser leg to expose the calf and knee; if necessary slit up the inside seam. Removing Boots or Shoes Support the ankle, undo or cut any laces and carefully remove the shoe. If the casualty is wearing long boots, that will not unfasten, carefully slit them down the back seam with a sharp knife. Removing Socks If these are difficult to remove insert first two fingers between the sock and the leg. Raise the socks and cut it between the fingers with scissors. i Removing Crash Helmets Whether or not you remove a protective helmet, such as motor cycle crash helmet, depends on the situation and condition of the casualty. Itis best left on and should only be removed, if the casualty’s condition warrants it. If possible, the helmet should be removed by the casualty. A full face helmet that encloses the head and face should only be removed, if it obstructs breathing, if the casualty is ‘vomiting or if there are severe head injuries. Removing an Open Face Helmet nfasten or cut through the chinstrap, if necessary. Take pressure off | by forcing the sides apart, then lift the helmet upwards and