Ministry of Health & Family Welfare

Government of India

Training Manual on Management of Common

Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres
Ministry of Health & Family Welfare
Government of India

Training Manual on Management of Common

Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres

2021
Table of Contents

Chapter 1: Introduction 1

Chapter 2: Role of ANM/MPW (F/M) in emergency and trauma care 3

Chapter 3: Management and Prevention of Common Emergency Conditions 4

Annexures  42

Annexure I: Cardiopulmonary Resuscitation (CPR) 42

Annexure II: When and where to refer 45

List of Contributors 46

Abbreviations 47

Table of Contents iii

Chapter 1

Introduction

In the last fifteen years primary health care has focused on health of mothers, children
and adolescents, communicable diseases, non-communicable diseases and other chronic
communicable diseases like tuberculosis, leprosy and HIV infection. The primary health care
system primarily focused on delivery of care related to reproductive, maternal, new-born, child
health, infectious diseases and nutrition and the newly added Non-Communicable Diseases.

With the launch of the Ayushman Bharat Health and Wellness program, a wider range of services
are being rolled out with the aim of providing Comprehensive Primary Health Care to the
communities. Emergency and trauma care services is one of the expanded package of services
being provided through the Ayushman Bharat-Health and Wellness Centres (AB-HWCs).

As you already know, there are some health conditions which require immediate medical care
and need to reach an appropriate health facility for treatment as soon as possible, usually within
an hour. These conditions are life-threatening and therefore it is extremely important that they
receive the right care at the right time. A common example is an accident leading to severe
bleeding or a person suffering a heart attack. These emergency situations may arise at any time
and can affect anyone. The broad goal of emergency care is to intervene as quickly as possible to
avoid life-threatening morbidity and death in emergency and trauma cases. You might encounter
such cases in the community during field visits or they may directly present to the SHC-HWC. This
module will train you on your role in management and referral of emergency conditions.

What is an emergency?
An emergency is any condition that threatens the life or well-being of a person. A health emergency
comprises a range of conditions which may pose a threat to life and require immediate medical
care. Emergencies that are commonly encountered in the community may span from accidents
and trauma to emergencies arising out of chronic diseases of the heart or lung. Trauma is one of
the most common emergencies that occur in the community and a major reason for morbidity and
mortality in India. The challenge with respect to most emergency and trauma cases is that they
are non-discriminatory in the sense that they can happen to anyone irrespective of age, gender,
economic status etc.

Introduction 1
What is emergency care?
Emergency care refers to the care provided to the victim in the ‘Golden Hour’ (usually the hour
following an accident ) of an emergency condition before/while reaching the appropriate health
facility, in order to prevent death or serious disabilities due to medical conditions or due to trauma.
In the first few hour, early recognition and stabilization before transfer of a critically ill person
significantly reduces morbidity and mortality.

Emergency Care, in principle is based on three Ps:

!! Preserve Life
!! Promote Healing
!! Prevent Complications

ANM/MPW (F/M) can play a crucial role in identifying and seeking help for emergency and
trauma cases in the community, which include carrying out initial assessment, identifying life-
threatening conditions, initial management and arrangement of referral transport as needed and
be competent in identifying emergency conditions that require priority management and referral.
ANM/MPW (F/M) shall also support the ASHA in raising awareness regarding health emergencies
and their prevention in the community. ANM shall assist the CHO in basic care management of
emergency cases at the SHC-HWC.

This module will help you understand your role in emergency and trauma care. You will also find
simple to use protocols in managing such cases as well.

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Chapter 2

Role of ANM in Emergency and

Trauma Care

Emergencies can present in various forms and have various causes. Most cases of emergency
are avoidable by creating awareness regarding their prevention. Even when the emergency
has occurred, prompt stabilization and safe referral significantly reduces death and disability.
As an ANM/MPW (F/M), you would be assisting and supervising ASHA at the community level in
undertaking preventive activities and CHO at the SHC-HWC in basic care management as and
when required in relation to Emergency and Trauma care, ensuring scene safety in emergency
situations and also in providing basic first aid for the victims whenever need be.

In the next few chapters, you will learn how to:

A. Create awareness among the members of the community regarding prevention of
common emergency conditions
B. Recognize life threatening critical illness requiring immediate medical care in the
community
C. Promptly stabilize such cases at the scene of emergency
D. Seek immediate help and ensure safe transport of such cases to the nearest appropriate
Public Health Facility.
E. Provide follow up care to victims of emergencies who are referred back from higher
centres.

Role of ANM in Emergency and Trauma Care 3

CHAPTER 3

Management and Prevention of

Common Emergency Conditions

Trauma and emergency situations, in many cases, are avoidable. The emergency situations which
can largely be prevented are listed below.
1. Accidents and trauma: Accidents leading to trauma commonly occur in the home, at the
workplace, on the roads and in playgrounds. Most of these accidents are avoidable if
proper precautions are taken.

2. Burns including lightening injuries and electrocution: Burns occurring from flames, hot
liquids and steam, electric shocks and certain chemicals like acids or alkali burns caused
by lime, or some alkali based toilet cleaners etc. are all preventable. Alkali burns are more
serious than acid burns as the damage is ongoing.

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3. Bites: The three common cases of bites which are preventable are animal bites, snake
bites and scorpion bites. Educate about dos.

4. Poisoning: Causes of unintentional ingestion of poisonous substances commonly available

domestically can be prevented.

5. Near-Drowning: Drowning is most commonly seen among small children and infants in
the community.

6. Choking: Choking can occur in adults but are more commonly seen in children who
accidentally ingest objects like coins/toys, seeds, button, batteries etc.

Management and Prevention of Common Emergency Conditions 5

 7. Exposure Illnesses:
!! Heat Exhaustion and Heat Stroke: These occur on prolonged exposure to heat and can
sometimes be fatal.
!! Hypothermia and Frostbites: These occur on prolonged exposure to cold leading to a
decrease in body temperature which if left untreated, could be fatal.

8. Emergencies like heart attacks, stroke and diabetic coma caused by uncontrolled
hypertension and diabetes.
9. Emergencies arising out of allergic reactions are preventable if the allergen is known.
Proper history taking and identification of the allergen can help prevent the emergency
situation in subsequent times.

All of these are emergency conditions that can be prevented by being aware and taking specific
precautions against them. You will play an important role in raising awareness among community
members about these emergencies and educating them regarding their prevention

In any case of emergency, the first step is to call for help.

!! Immediately call the ambulance (102) or any other state specific ambulance services in place
!! Inform the CHO and MO about the situation

Stabilization of sick or injured persons is required to prevent their condition from deteriorating
further too quickly before they can reach a medical facility for treatment. As you have learnt in
the previous section, you must inform the CHO and MO and call for an ambulance as soon as you
suspect an emergency. After calling for help, the person needs to be stabilized till the time he/
she is being transferred to the health facility. In this section you will learn how about general and
specific measures of stabilization.

Caution: It is important to note that stabilization of any case of emergency requires close
contact. Due precautions must be taken, owing to the COVID-19 pandemic, while carrying out all
stabilization procedures.

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Stabilization of any case of emergency involves two approaches:
1. Removing any imminent danger to the person
2. Specific measures for stabilization

1. Removing imminent danger

Scene safety
This is done to ensure safety of self, patient as well as the bystanders
and removing the patient from the emergency situation wherever
required, eg., dangerous traffic, sharp objects, slope of ground,
electric live circuit, etc.

Safe Transport
Once scene safety has been secured, with great care, lift the injured victim without bending him/her
anywhere. Take special care that the head and neck do not bend. The victim should be transported
in a flat condition as far as possible. However, if there is any suspected injury to the spine, the victim
should be immobilized in that position only, and no attempt should be made to lay him/her flat.

If you have help, have another person put the stretcher in place

!! In cases of trauma, the approach is (H)ABCDE instead of ABCDE. Because trauma

cases need management of life-threatening hemorrhage (bleeding) as the first step
before ABCDE.

This approach should be performed within 1-2 minutes and repeated whenever the victim’s
condition worsens.
H: Haemorrhage (bleeding) control (only during trauma cases)
A: Airway
B: Breathing
C: Circulation
D: Disability
E: Exposure

2. Specific measures for stabilization

Haemorrhage/bleeding control
Haemorrhage or bleeding control needs to be addressed first only in the cases of trauma where
there obvious visible bleeding from any part of the victim’s body. Profuse or uncontrolled bleeding

Management and Prevention of Common Emergency Conditions 7

should be given maximum priority. Remember that you can only manage the bleeding when the
bleeding is from the extremities like the hands and the legs and not internal. Internal bleeding
can only be managed by a doctor, however you can attempt to control bleeding. The procedure
for hemorrhage control will be discussed in detail in the following sections.

Note: Whenever and wherever the concerned victim is a pregnant woman, there could be
vaginal bleeding which is heavy (Heavy bleeding is defined as a clean pad or cloth becoming
soaked within less than 5 minutes), but is not yet shocked (they are able to stand or sit up and
speak normally). Any problem that might be hindering the circulation of the woman, unless rapidly
treated, could lead to shock or heart failure.

Note: In all non-trauma cases, you shall make use of the ABCDE approach.

Airway
Check whether the passage from nose to throat and lung is clear of obstruction. Obstruction to
the airway can be caused by food, swollen tongue falling back to the throat, thick mucus or blood
in the airway, or any foreign body stuck in the airway. If the airway is blocked then tilt back the
head of the person and lift the chin. If any visible obstruction is seen then try to remove it from
the mouth with a clean cloth wrapped around your finger.

(Caution: If there is neck or head injury then only chin lift should be done without turning the head
of the person.)

Breathing
Check whether the person is breathing properly. A person can only survive a few minutes without
oxygen. Normal breathing rate for adults is 17-20 breaths per minute, for children between 1-5
years is 40 breaths per minute and for infants is 50 breaths per minute. In case of irregular
breathing rates, arrange for oxygen for the patient. If the breathing has stopped, mouth to mouth
breathing should be given. (Caution: In times of COVID-19 pandemic, care must be taken since
mouth to mouth breathing might increase risk of spread of infection.)

Circulation
Check for pulse (in the wrist- radial pulse, or neck- carotid pulse) to assess circulation i.e., pumping
of blood by the heart. Normal pulse in adults ranges between 60-90 per minute.

In unconscious patients, you should always check for carotid pulse.

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How to feel for the carotid pulse?
!! The pulse from the carotids may be felt on either side of the front of the neck just below
the angle of the jaw.
!! To check for pulse, place your index and middle fingers on your neck to the side of your
windpipe.
!! Count the pulses you feel for 15 seconds.
!! Multiply this number by 4 to obtain the heart rate.

Disability
Check the person’s level of consciousness using the AVPU method.

A: Alert: The person is aware and is responding to the surrounding on their own. The person will
also be able to follow your instructions, open eyes spontaneously, and track objects.

V: Verbally Responsive: The person’s eyes do not open spontaneously. The victim’s eyes will
open only in response to voice/calling out his/her name.

P: Responsive to Pain: The person’s eyes do not open on their own and will only respond if a
painful stimulus is given, eg. pressure to the chest. The victim may move, moan, or cry out directly
in response to the painful stimuli.

U: Unresponsive/unconscious: The victim does not respond spontaneously and does not respond
to verbal or painful stimuli.

Note: whenever and wherever the concerned victim is a pregnant woman, sometimes you may
find on AVPU assessment that the woman is Unresponsive. (Do not panic in such case and
remember that it is not rare to find that women experiencing obstetric emergency could be
unresponsive or unconscious from the intensity of pain)

Exposure
Minimize heat loss by covering the person’s body.

If the victim is unresponsive but breathing, turn them into a recovery position and wait for help
to arrive.

Recovery position
The recovery position is when a person is lying down on their side.

Management and Prevention of Common Emergency Conditions 9

Below is a step-by-step depiction of placing the victim in the recovery position.

Step 1 Kneel beside the person, open his/

her airway by tilting the head and
lifting the chin.
Caution: Do not attempt to head-
tilt, chin-lift if the person presents
with any suspected spinal injury
Straighten his/her legs.
Place the arm nearer to you at right
angles to his/her body, elbow bent
and move the hand palm to the
upper side.

Step 2 Bring the arm further from you

across the chest and hold the
hand, palm outwards, against the
person’s cheek.

Step 3 With your other hand, grasp the

thigh further from you and pull the
knee up, keeping the foot flat on
ground.

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Step 4 Keeping his/her hand pressed
against his/her cheek, pull at the
thigh to roll the person towards
and on to her side.

Step 5 Tilt the head back to make sure the airway remains open. Adjust the hand under the cheek if
necessary, so that the head stays in this tilted position.
Step 6 Adjust the upper leg, if necessary, so that both the hip and knee are bent at the right angles.

Infant Recovery Position: Cradle the infant in your arms, with the head tilted downwards to
prevent the child from choking on its tongue or by inhaling vomit. Maintain this position until you
get medical help.

The recovery position will help in keeping their airway clear and they will be able to breathe
properly. If the victim happens to vomit, this position will ensure that he/she doesn’t choke. This
position prevents the tongue from falling back and blocking the throat. Since the head is slightly
lower than the rest of the body, it allows liquids to drain from the mouth, reducing the risk of
choking on fluids or vomit. This position should also be used in fits or seizure after the shaking
movements have stopped.

(Caution: If you suspect that the person has suffered injury to the neck or spine, do not attempt
the recovery position.)

While the ABCDE and scene safety approach is almost universal and should be carried out for
every emergency situation, some other approaches could be used for particular emergency
situations which are the specific measures which you shall learn in the following sections.

3.1. Trauma and Accidents

3.1.1. Recognising life threatening situations

The most common warning signs of a case that is life threatening or requires immediate care,
involve:
!! Bleeding that will not stop
!! Breathing problems (difficulty breathing, shortness of breath)
!! Change in mental status (such as unusual behavior, confusion, difficulty waking up/gaining
consciousness)
!! Chest pain
!! Choking
!! Coughing up or vomiting blood
!! Fainting or loss of consciousness

Management and Prevention of Common Emergency Conditions 11

 !! Trauma or severe injury to any part of the body especially head or spine injury, injury to
abdomen or other vital organs like eyes, any major or severe wound
!! Sudden, severe pain anywhere in the body
!! Sudden dizziness, weakness, or change in vision
!! Sudden weakness in any limb or of face
!! Severe abdominal pain or pressure
!! Seizures/fits

If the situation is found to be life-threatening, the only focus should be on keeping the patient
alive till help arrives. In all cases of emergency your role is to ensure prompt stabilization and safe
transport to the nearest public health facility. The stabilization process should be continued till
the arrival of ambulance.

3.1.2. Management protocol

Specific Measures

Trauma or accident is the most common type of emergency. Though it can fatal, major disability
or even death can be prevented by providing stabilization using two modes:
!! Immobilization
!! Control of bleeding

You learnt in the previous section that you should always look for signs of bleeding and swelling.
You might be able to see swelling and redness around a bone which could indicate fracture. In
this sub section, we shall learn about how to suspect a fracture, immobilize an injured body part
of the victim and control excessive bleeding.

Immobilization is required whenever a fracture of bone is suspected. A patient with fracture may
present with following possible signs and symptoms:
!! The break may have been felt or heard
!! Pain at or near the area of the injury
!! Pain when gentle pressure is applied over the area
!! Difficult or impossible normal movement of the limb
!! Deformity, abnormal twist or shortening of limb
!! Swelling over and around the area
!! A coarse grating sound if one end of the bone moves against the other

In case of fracture, use the RICER approach.

1. R: Rest the affected body part, ie., immobilization. Use splints/strips of bark/sleeve of
cardboard to immobilize the bone. The pictures below show how fractures in different
body parts can be immobilized.
2. I: Ice can be applied over the suspected fractured area (only if there is no external
bleeding).
3. C: Compression of the area using a bandage but make sure it is not too tight.

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 4. E: Elevate the affected body part to prevent further swelling.
5. R: Refer the person to a Medical Officer immediately.

Caution
!! Never rub or massage a broken body part or the skin above a bone that you suspect to
be broken.
!! Wherever a severe injury is seen especially to the neck, immobilize using heavy
towels or rolled sheets on both sides of the neck or hold the head and neck to prevent
movement.
!! If the person has suffered a two-wheeler/motorcycle accident, and is wearing a helmet,
then do not attempt to remove the helmet. You can open the wind shield of the helmet
without disturbing the placement. This would help prevent movement of the neck and
head and will protect against any injury.

Management and Prevention of Common Emergency Conditions 13

Bleeding could range from minor, major to even life threatening and hence it is important to try
everything to stop the bleeding. If the bleeding is at the site of the neck, it is possible that it could
cause blocking in the airway.
!! Wash your hands before you attempt to stop bleeding in a person.
!! Apply pressure on the site of bleeding using a clean cloth. Use the material that you
already have and not waste time in searching for proper dressing material. Make sure that
the cloth you use is clean.
!! Press on the wound for at least 10 minutes to give
the blood time to clot.
!! Once you are holding pressure on the bleeding
site, do not remove the pressure to check if the
bleeding has stopped.
!! It may be useful to make the person lie down
on their back and raising the injured part above
the level of the victim’s chest. This will help in
reducing the flow of blood.
!! If the bleeding does not stop with pressure then
bandage the injured part with a cloth firmly (but
not very tightly as it might restrict the circulation
and make the arm/leg turn blue). If bleeding strikes
through the dressing, bandage another firmly over the top.
!! If bleeding or injury is severe, raise the feet and lower the head to prevent shock.
!! Do not use a tourniquet. It can make the bleeding worse, and may result in tissue damage
and even gangrene.
!! Remember to also protect yourself from infection. If you have any open wound on your
skin, first cover the wound before helping the victim.

Control of excessive bleeding

1. Raise the injured part
2. Apply pressure on the wound directly by tying a clean cloth/bandage
3. Hold the pressure
4. Tie the bleeding site with a bandage firmly but not very tightly.
5. Hold this pressure until help arrives.

3.1.3. Safe Referral/Transport

As you have been taught before, you should call for help as soon as you identify a life-threatening
situation. You need to know the public health facilities nearest to you which provide care for
trauma and accident related emergencies. Mapping of all the nearest referral centres should be
done and information should be kept handy regarding facilities:
i. Which can provide primary care for emergencies like superficial bleeding wounds etc.
ii. Which provide secondary care (where a Medical Officer is present) for emergencies like
minor head injury, unconsciousness, seizures etc.
iii. Where specialist doctors are available who can manage emergencies like severe head
injury etc.

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 1. You need to keep the phone numbers for all available ambulance services handy with you
at all times.
2. You need to keep the contact numbers of the CHO and MO handy with you at all times.
3. You need to stay informed about the facility where the patient has been referred and
follow up once he/she is discharged.

Table in Annexure II may be used to understand what cases can be treated at which level so that
time is not wasted in referring to facility that is not equipped to address the case.

3.1.4. Follow-up Care

Most cases of emergency and trauma require care even after discharge from the health facility,
for complete recovery. The ASHA will be involved in identifying those persons who have received
treatment for emergency or trauma but require follow-up care. The follow up care could either
be for a short duration (till complete recovery) or for a longer period of time. Your role will be to
provide supportive supervision to ASHA in follow-up care and providing hand-holding support to
ASHA whenever your intervention is required.

In cases where the patient is a victim of trauma/accident, you could provide the following care:

Educate the person on wound care: Major wounds usually take a few weeks to heal completely.
You can ensure that he/she visits the health facility regularly for change in dressing, takes
prescribed medicines regularly and follows good hygiene practices.

Check for any complication in healing: In case the wound gets infected or healing is delayed,
the person will develop redness, swelling, fever, foul smell, pain around the wound, pus/
discharge etc. If any of these is present, inform the person and refer him/her to the nearest
SHC-HWC.

Assistive devices: If the person has been provided with any assistive devices like wheelchair,
walking crutches, immobilization devices etc., then on your follow-up visits, check for the status
and maintenance of these devices and also note the difficulties the patient is facing if any. In case
the person requires any assistive device after discharge for any disability that develops later,
inform the CHO and facilitate arrangement of such devices from the PHC-HWC.

If any person has been prescribed physiotherapy, facilitate by mobilizing them to the SHC-HWC
for the same on designated days.

In case a person develops permanent disability, ensure that he/she receives appropriate palliative
care. Link him/her with the palliative care services provided through the AB-HWCs.

Provide psycho-social support to help the person overcome the crisis.

3.1.5. Prevention and Awareness Generation at the Community Level

Some of the key messages you need to make use of, to educate the community regarding
prevention of emergency situations like accidents etc. leading to trauma are:
1. Make sure there are no accident-prone areas in the house (eg. do not let water accumulate
on the floor, clean up spills immediately, keep sharp objects like knives and scissors out
of reach of children, do not store heavy objects at the edge of shelves, remove any sharp
protruding edge of furniture,
2. Make sure all areas of the house are well lit.

Management and Prevention of Common Emergency Conditions 15

 3. Get eyesight checked regularly, especially for older people in the house.
4. Take proper precautions if any occupational hazards are present at workplace (eg. caution
while working with heavy machinery, use of safety guards to prevent injury from thresher
and cutter while farming, handling of chemicals, live wires etc.)
5. Always stay alert and look in all directions while walking on/crossing roads and streets.
6. Always wear seat belt or helmet when traveling in vehicles.
7. Avoid the use of mobile phones while crossing/walking on the roads, driving or riding.
8. When driving vehicles, always follow safety and traffic rules.
9. Teach children to be safe while playing outdoors.

3.2. Burns

3.2.1. Recognizing life threatening situation

3.2.2. Management Protocol

Specific Measures

In cases of burns, use the STOP approach:

1. S: Strip burnt clothes/jewelry.
2. T: Turn on COOL tap and let the burn wash under cool water for at least 10 minutes.
3. O: Organize safe referral.
4. P: Protect burn with a clean cloth.

Caution
!! Do not apply ice directly over the burn.
!! Do not apply any lotions/creams over the burn.
!! Do not attempt to remove cloth stuck to the skin that is burnt.
!! Do not peel away burnt skin or blisters.

3.2.3. Safe Referral/Transport

As you have been taught before, you should call for help as soon as you identify a life-threatening
situation. You need to know the public health facilities nearest to you which provide care for
trauma and accident related emergencies. Mapping of all the nearest referral centres should be
done and information should be kept handy regarding facilities –
i. Which can provide primary care for emergencies like superficial burns etc.
ii. Which provide secondary care (where a Medical Officer is present) for burn
emergencies
iii. Where specialist doctors are available who can manage emergencies like severe burns
etc.

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 1. You need to keep the phone numbers for all available ambulance services handy with you
at all times.
2. You need to keep the contact numbers of the CHO and MO handy with you at all times.
3. You need to stay informed about the facility where the patient has been referred and
follow up once he/she is discharged.

Table in Annexure II may be used to understand what cases can be treated at which level so that
time is not wasted in referring to facility that is not equipped to address the case.

Remember:
While transporting the victim of lightening injuries, you should follow the protocol mentioned
above while maintaining immobilization by supporting the head and neck of the victim. A
pregnant victim of lightening needs to be referred to a facility where an obstetric surgeon is
available irrespective of the severity of the injury.

3.2.4. Follow-up Care

Most cases of extensive burns require care even after discharge from the health facility, for
complete recovery. The ASHA will be involved in identifying those persons who have received
treatment for burns but require follow-up care either for a short duration until complete recovery
or for a longer period of time which is called palliative care. Your role will be to provide supportive
supervision to ASHA in follow-up care and providing hand-holding support to ASHA whenever
your intervention is required.

In cases where the patient is a victim of burns, you could provide the following care:

Educate the person on wound care: Major burn wounds usually take a few weeks to heal
completely. You can ensure that he/she visits the health facility regularly for change in dressing,
takes prescribed medicines regularly and follows good hygiene practices.

Check for any complication in healing: In case the wound gets infected or healing is delayed, the
person will develop redness, swelling, fever, foul smell, pain around the wound, pus/discharge
etc. If any of these is present, inform the person and refer him/her to the nearest SHC-HWC.

If any person has been prescribed physiotherapy, facilitate by mobilizing them to the SHC-HWC
for the same on designated days.

In case a person develops permanent disability, ensure that he/she receives appropriate palliative
care. Link him/her with the palliative care services provided through the AB-HWCs.

Provide psycho-social support to help the person overcome the crisis.

3.2.5. Prevention and Awareness Generation at the Community Level

Some of the key messages you need to make use of, to educate the community regarding
prevention of emergency situations like burns are:
1. Never leave children unattended in the kitchen.
2. Always switch off stove/oven when not in use.
3. Do not handle/be careful while handling very hot liquids.

Management and Prevention of Common Emergency Conditions 17

 4. If any chemical like cleaning acid, lime or alkaline based toilet cleaners etc is there in the
house, keep it away safely.
5. Burns can also be caused by steam, eg. Steam from pressure cookers, etc.

Electrocution:
1. Stay alert while using any electrical appliance inside or outside the house
2. Use of rubber slippers while dealing with live electric wires, sockets etc.
3. Do not leave any electrical appliance near water eg. Iron box, heater, etc.
4. Keep small children away from electric appliances, plug points, etc.
5. Do not go near electric grids or live wires.

Lightening Injuries
As you may have seen, lightening is the electric discharge that happens during thunderstorms. In
some cases, this can be very dangerous when the lightening comes in contact with the body. In
most situations, lightning often travels over the skin rather than
through the body and hence, most victims of lightening injuries
survive. The most common immediate effect of lightening
injuries is on the respiratory system of the body which can
cause cardiac arrest leading to death.

How to recognise life threatening situations pertaining to

lightening injuries?

You should treat every case of lightening injury as immediate

and refer to the nearest appropriate facility as soon as possible.
However, there are some signs that you can look for in the
victim to understand the severity and provide stabilization.
!! Loss of consciousness ‘
!! Loss of memory
!! Confusion
!! A feathering or fern shaped burn on the skin (This is not very common, but whenever
present, is a classical sign of lightening injury).

All of the above signs you will be able to see in the victim, when you check for AVPU and follow
ABCDE protocol.

Preventing lightening injuries:

Even though lightening injuries are dangerous, it is largely possible to prevent getting struck by
lightning. The following key messages can be used for awareness generation in the community
to avoid injuries related to lightening:

1. Prevention of indoor lightening casualties:

!! Even though houses provide safe shelter during a lightning storm, you may still be at risk.
It is a myth that lightening injuries cannot be caused indoors.

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 !! Avoid water Do NOT bathe, shower, wash dishes, or have any other contact with
water during a thunderstorm because lightning can travel through a housing plumbing
vent.
!! Avoid electronic equipment Do NOT use your computers, laptops, game systems,
washers, dryers, stoves, or anything connected to an electrical outlet. Lightning can travel
through electrical systems, radio and television reception systems, and any metal wires
or bars in concrete walls or flooring.
!! Avoid windows, doors, porches, and concrete Do NOT lie on concrete floors during a
thunderstorm. Also, avoid leaning on concrete walls. Lightning can travel through any
metal wires or bars in concrete walls or flooring.

2. Prevention of outdoor lightening casualties:

!! Be aware If aware about thunderstorms predictions, postpone outdoor activities, or make
sure adequate safe shelter is readily available.
!! Go indoors Remember the phrase, “When thunder roars, go indoors.” Find a safe,
enclosed shelter when you hear thunder. Safe shelters include homes, offices, shopping
centres, and hard-top vehicles with the windows rolled up.
!! Seek shelter immediately even if caught out in the open If you are caught in an open
area, act quickly to find adequate shelter. The most important action is to remove yourself
from danger.

Remember: Crouching or getting low to the ground can reduce your chances of being struck,
but does not remove you from danger.

If one is caught outside with no safe shelter nearby, the following actions may reduce their
risk:
!! Immediately get off elevated areas such as hills, mountain ridges, or peaks.
!! Never lie flat on the ground. Crouch down in a ball-like position with your head
tucked and hands over the ears so that they are down low with minimal contact with
the ground.
!! Never shelter under an isolated tree.
!! Never use a cliff or rocky overhang for shelter.
!! Immediately get out of and away from ponds, lakes, and other bodies of water.
!! Stay away from objects that conduct electricity (barbed wire fences, power lines, windmills,
etc.).

Separate If one is in a group during a thunderstorm, separate from each other. This will reduce
the number of injuries if lightning strikes the ground.

DO NOT do the following:

!! Do not stay in open vehicles, structures, and spaces During a thunderstorm,
avoid open vehicles such as motorcycles. Be sure to avoid open structures such as
playgrounds.
!! Do not stay near tall structures Do NOT lie on concrete floors during a thunderstorm.
Also, avoid leaning on concrete walls. Lightning can travel through any metal wires or
bars in concrete walls or flooring.

Management and Prevention of Common Emergency Conditions 19

3.3. Bites (Animal bite/snake bite/scorpion sting/other insect bites)

3.3.1. Recognizing life threatening situations

Irrespective of the nature of the bite, i.e. even if you feel that the victim’s condition does not
appear serious, you should refer the case to the nearest health facility since symptoms could
have delayed occurrence and shall need observation to understand the fatality of the situation.

However, sometimes an animal bite or sting could present with obvious signs as follows which
require immediate care:
!! Symptoms that are not just at the site of the bite or sting
!! If the bite appears infected (redness with or without pus, warmth, fever, or a red streak
that spreads toward the body)
!! An open or ulcerated bite wound could be suggestive of a scorpion bite
!! Wheezing
!! Shortness of breath
!! Chest pain or tightness
!! Sensation of the throat closing or difficulty speaking or swallowing
!! Faintness or weakness

3.3.2. Management Protocol

Specific Measures

Animal bites and scratches are commonly seen in both adults and children. Animal bites (dog,
cat, monkey, and domestic animals like cow or horse, wild animals) may cause a deadly disease
called rabies, if bitten by an infected animal. Rabies is caused by a virus which is present in the
saliva of infected animals which can spread through bites or licks on broken skin. In case of
animal bites, the following steps must be followed:
1. Wash the wound immediately with soap and running water for at least 10 minutes.
2. Reassure the person.
3. Control any bleeding from the site of bite. Apply pressure but not too tightly since it can
speed up the spread of virus.
4. Refer the person immediately to a health facility for proper management and
vaccination.

Caution
!! Do not apply turmeric powder, chili powder, limestone, paste of leaves or plants on the
bite wound.
!! Do not place coins, bark of trees or any other object on the bite wound.
!! Do not cut the wound open.
!! You should ask the victim or his relatives/family to observe the dog for 10 days to see if
there are any behavioral changes in the dog.

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Snake bite:

In case of snake bite, use the RIGHT approach.

R: Reassure the person (70% of snakebites: from non- poisonous snakes only 50% poisonous
snakes inject poison).
I: Immobilize the affected body part of the person.
GH: Get to the Hospital immediately.
T: Tell the doctor at the referred facility about presence of any symptoms (Pain, weakness,
bleeding, etc.).

Caution
!! Do not tie a tourniquet in cases of snake bite.
!! Snake venom does not spread through blood.
!! Do not try to suck out poison from snake bite, or cut the wound open.
!! Do not make the patient move too much.
!! In most cases, if the snake has been killed, it should be taken to the hospital along with
the patient to make sure the treatment is right BUT DO NOT waste time in searching for
the snake. It could lead to more casualty if the snake is not dead and only injured.

Scorpion sting/other insect bites:

In case of scorpion sting or other suspected poisonous insect bite, wash the wound immediately
with soap and water and refer the person to the nearest health facility.

3.3.3. Safe Referral/Transport

As you have been taught before, you should call for help as soon as you identify a life-threatening
situation. You need to know the public health facilities nearest to you which provide care for
emergencies related to bites. Mapping of all the nearest referral centres should be done and
information should be kept handy regarding facilities –
i. Which can provide primary care for emergencies like superficial bites etc.
ii. Which provide secondary care for emergencies from bites
iii. Where specialist doctors are available who can manage emergencies

You need to keep the phone numbers for all available ambulance services handy with you at all
times along with numbers of the CHO and MO.

You need to stay informed about the facility where the patient has been referred and follow up
once he/she is discharged.

Table in Annexure II may be used to understand what cases can be treated at which level so that
time is not wasted in referring to facility that is not equipped to address the case.

3.3.4. Follow-up Care

Most cases of bites do not require extensive care after discharge from the health facility, for
complete recovery. The ASHA will be involved in identifying those persons who have received

Management and Prevention of Common Emergency Conditions 21

treatment for bites but require follow-up care either for a short duration until complete recovery
or for a longer period of time which is called palliative care. Your role will be to provide supportive
supervision to ASHA in follow-up care and providing hand-holding support to ASHA whenever
your intervention is required.

In cases where the patient is a victim of bites, you could provide the following care:
!! Educate the person on wound care: Major bite wounds usually take a few weeks to heal
completely. You can ensure that he/she visits the health facility regularly for change in
dressing, takes prescribed medicines regularly and follows good hygiene practices.
!! Check for any complication in healing: In case the wound gets infected or healing is
delayed, the person will develop redness, swelling, fever, foul smell, pain around the
wound, pus/discharge etc. If any of these is present, inform the person and refer him/her
to the nearest SHC-HWC.
!! Assistive devices: If the person has been provided with any assistive devices like
wheelchair, walking crutches, immobilization devices etc., then on your follow-up visits,
check for the status and maintenance of these devices and also note the difficulties the
patient is facing if any. In case the person requires any assistive device after discharge
for any disability that develops later, inform the CHO and facilitate arrangement of such
devices from the PHC-HWC.
!! If any person has been prescribed physiotherapy, facilitate by mobilizing them to the
SHC-HWC for the same on designated days.
!! In case a person develops permanent disability, ensure that he/she receives appropriate
palliative care. Link him/her with the palliative care services provided through
the AB-HWCs.
!! Provide psycho-social support to help the person overcome the crisis.

3.3.5. Prevention and Awareness Generation at the Community Level

As you know, cases of bites are very much preventable for which you could use the following
messages to educate the community.
1. Do not unnecessarily go near animals. Teach children to not harm animals and be careful
if they play with animals. Do not leave small children unattended outside the house.
2. Stay alert and wear adequate protective clothes, shoes, etc. to prevent snake and scorpion
bites while going to the field or other areas.
3. For farmers and people working in forests or fields – Always wear protective gear while
going for work.
4. Make adequate safety provisions to prevent snakes, scorpions, other insects and animals
from entering the house.

3.4. Obstetric Emergencies

3.4.1. Recognizing life threatening situations

It is important to understand that pregnant women are not only vulnerable to obstetric emergencies
but could also be a victim of trauma/accident or any of the other emergency conditions. Hence,
when you are attending to a distressed pregnant woman, always consider it an emergency. The
following are signs of emergency:

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 !! Any bleeding from the vagina
ƒƒ Heavy bleeding with severe stomach pain in the first three months of pregnancy
ƒƒ Heavy bleeding with cramping in the first three to four months of pregnancy
ƒƒ Bleeding with abdominal pain in the
last three months of pregnancy
ƒƒ Severe bleeding within the first few
days after delivery
!! Headache and blurred vision
!! Dizziness, loss of consciousness or fits
!! Severe vomiting
!! Severe pain in the abdomen
!! Sudden and significant swelling of hands,
face and feet
!! Regular, increasingly intense contractions
before 37 weeks of pregnancy

3.4.2. Management Protocol

Specific Measures

The first principles of dealing with obstetric emergencies are the same as for any emergency
(see to the airway, breathing, and circulation). Eclampsia (headache, blurred vision, fits),
Antepartum Hemorrhage (vaginal bleeding during pregnancy) and Postpartum Hemorrhage
(vaginal bleeding few days after delivery), Ruptured Ectopic Pregnancy should be treated as
emergencies and help should be called for as soon as possible. However, until help arrives, there
are certain measures that you can take to stabilize the woman.

Eclampsia
If a pregnant woman presents with sudden headache, blurred vision and fits, provide basic first aid
as you would in other cases of fits. Remember that the focus should be on keeping the airway clear
of any obstructions, and seeing to it that the woman is able to breathe properly. The measures to
take during fits include:
!! Do not leave the woman unattended and keeping surrounding safe to avoid any maternal
injuries due to fits (eg. keeping pillows to avoid injury from surrounding objects, remove
any objects in the way that can injure the woman further).
!! Placing a clean cloth between the teeth of the woman so that she does not bite the
tongue. If the biting or jittering of the teeth is vigorous, do not attempt this since it could
hurt your fingers.
!! Placing her in recovery position after the fits stop.

Caution
!! Do not attempt to hold the woman’s mouth open.
!! Do not hold the woman down or try to stop her movements or restrain her arms/legs tightly.
!! Do not offer the woman water or food until she is fully alert.

Management and Prevention of Common Emergency Conditions 23

Antepartum haemorrhage:

If a pregnant woman presents with vaginal bleeding, immediately call the ambulance and refer
her to the nearest health facility where a gynaecologist is available.

Post-Partum Hemorrhage:
1. Uterine massage can help control the bleeding and should be done until bleeding is visibly
less. Rub the uterus gently from outside immediately to keep the uterus well-contracted.
2. Encouraging the woman to empty her bladder. If she
cannot urinate on her own, help her by trickling warm
water over her abdomen.
3. Maintain the woman’s body warmth by covering with
blanket.
4. Position the woman by making her lay flat, rising her legs
to maintain blood pressure.
5. Keep the woman emotionally supported, and keep her
calm.

Ruptured Ectopic Pregnancy

An ectopic pregnancy is a condition in which a fertilized egg implants itself outside the uterus,
most commonly the fallopian tube. Ectopic pregnancies usually do not reach term, and rupture
around 10-12 weeks causing severe internal bleeding which may lead to shock and present as
an emergency.

In many cases of ectopic pregnancy, the first presentation may be after it has ruptured and the
woman might not even know she was pregnant. A ruptured ectopic pregnancy always requires
surgical intervention. Any of the following symptoms and signs warrant an emergency situation
and immediate stabilization and referral to a specialist should be sought.
!! Sudden, severe abdominal or pelvic pain
!! Dizziness or fainting
!! Pain in the lower back
!! Pain in the shoulders (due to leakage of blood into the abdomen affecting the
diaphragm)
!! Cold clammy skin, rapid thready pulse indicating hypovolemic shock

In every case involving the above symptoms in a pregnant woman, you should suspect ruptured
ectopic pregnancy and refer to the Community Health Centre (CHC) or District Hospital (DH),
whichever is nearer, by first informing the Community Health Officer (CHO).

3.4.3. Safe Transport and Referral

Refer section 3.1.3 as well as annexure II.

3.4.4. Follow-up Care

Most cases of obstetric emergencies do not require extensive care after discharge from the health
facility, for complete recovery. However, they do require follow-up care to check for any post-
discharge complications like bleeding, loose stitches, infections etc. The ASHA will be involved in

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checking for such complications during HBNC visits and inform you or the CHO for any suspected/
reported complication. Your role will be to provide supportive supervision to ASHA in follow-up
care and providing hand-holding support to ASHA whenever your intervention is required.

3.5. Neonatal Emergencies

3.5.1 Recognising life threatening situations
In a new-born or infant, the following are the signs of emergency:
!! Abnormally high or low body temperature
!! Drowsy, lethargic or unconscious
!! Not being able to feed or vomiting everything
!! Convulsions
!! Grunting and severe chest in-drawing
!! Fast breathing

3.5.2. Management Protocol

Specific Measures

In any type of neonatal emergencies, you should carry out ABCDE protocol, provide first-aid
wherever possible and then the child should be referred to a facility where the presenting
condition can be treated (Refer annexure II)

The most common neonatal emergencies are collectively called “THE MISFITS”

T: Toxicity
H: Heart disease
E: Endocrine
M: Metabolic (electrolyte imbalance)
I: Inborn errors of Metabolism
S: Sepsis
F: Formula Mishaps
I: Intestinal problems
T: Trauma
S: Seizures

3.5.3. Safe Transport and Referral

Apart from the referral protocol mentioned in section 3.1.3, in cases where you suspect
a neonatal emergency, you should co-ordinate with the CHO and refer the case to the
appropriate nearest facility.

3.5.4. Follow up care

Like you have already learnt in previous sections on follow up care, even infants who have
suffered emergency situations could need follow-up care in order to make sure there is
no complications. In such cases, you should educate the parents or guardians of the infant
regarding wound care and report any complication to the CHO.

Management and Prevention of Common Emergency Conditions 25

3.5.5. Prevention at community level
Neonatal emergencies could be any of the emergency conditions ranging from poisoning, burns,
choking, drowning, acute abdomen, trauma, bites etc. that can be prevented by being aware and
taking specific precautions against them. You will play an important role in raising awareness among
community members about these emergencies and educating them regarding their prevention by
targeting parents during immunization days, Village Health and Nutrition Days (VHNDs) etc.

3.6. Emergency conditions arising out of NCDs

3.6.1. Recognising life threatening situations

Some of the general signs that can be considered life threatening in relation to emergencies
arising out of NCDs are:
!! Sudden weakness in arms or legs (usually affects one side of the body)
!! Sudden drooping or weakness in one side of face
!! Sudden loss of balance, headache, dizziness or loss of consciousness
!! Sudden blurring of vision
!! Sudden difficulty in speech/inability to speak
!! Sudden pain in the chest
!! Diabetic emergencies

Low Blood Sugar Level High Blood Sugar Level

1. Tiredness 1. Dry mouth
2. Sweating 2. Increased thirst
3. Mental confusion 3. Weakness
4. Dizziness or unconsciousness 4. Headache
5. Headache 5. Severe dehydration
6. Nausea and abdominal discomfort
7. Severely high blood sugar levels can cause coma

You shall learn more about specific emergency conditions in the section on management
protocol.

3.6.2. Management Protocol

(a) General Measures

The general measures for management and prompt stabilization of emergency conditions arising
out of NCDs is similar to the one you have learnt in the beginning of the chapter with the following
exception.

The sequence of ABCDE protocol is different for cases suggestive of cardiac emergencies. When
you are attending to a victim of cardiac emergency like cardiac arrest, the most important step
is to allow blood to be pumped by the heart and hence, the suggested protocol for cardiac
emergencies is CAB instead of (H)ABCDE/ABCDE.

In addition to this, you should follow the rest of the protocols under general measures that you
have learnt.

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(b) Specific Measures

As you have learnt earlier, the two most common NCDs – hypertension and diabetes – can lead
to emergencies if not controlled. You have been trained about these complications in the module
on non-communicable diseases. The following emergency conditions can arise as complications
of uncontrolled hypertension and diabetes.

In NCD related emergency conditions, the most important step you must take is planning a proper
referral. Apart from that, sometimes when you find no pulse, you will be needed to perform CPR
(annexure I).

Stroke

It is characterized by:
!! Sudden weakness in arms or legs (usually affects one side of the body)
!! Sudden drooping or weakness in one side of face
!! Sudden loss of balance, headache, dizziness or loss of consciousness
!! Sudden blurring of vision
!! Sudden difficulty in speech/inability to speak

A case of stroke must be immediately transferred to a tertiary care hospital.

Heart attack/cardiac arrest

It is characterized by sudden pain in the chest which may spread to left arm, difficulty in breathing
and loss of consciousness. Sometimes a heart attack may present only as sweating, nausea,
tiredness, tingling and numbness in the extremities.
A case of heart attack must immediately be taken to the nearest health facility. The person may
require Cardio-Pulmonary Resuscitation (CPR) (Remember to follow CAB and not ABC). See
Annexure I for procedure of CPR.

Diabetic emergencies: High and low sugar in the body

Patients with diabetes have high blood sugar

levels because of the body’s inability to
utilize the glucose. Diabetic patients follow
a low sugar diet and take medicines which
help the glucose to get utilized and thus
keeps the blood sugar levels in check.

Diabetic emergencies arise in two situations:

1. When the disease is uncontrolled
(the patient does not follow
low sugar diet or does not take
medicines) it leads to very high
blood sugar level.
2. When the patient on diabetes
medicine does not eat for a long
time, it leads to very low blood
sugar level.

Management and Prevention of Common Emergency Conditions 27

The symptoms of high and low blood sugar levels have been given in the table in section 3.6.1.
If a person who has a known history of diabetes shows any of these symptoms, refer him/her
immediately to the nearest health facility.

3.6.3. Safe transport and Referral

(Refer to section 3.1.3)

3.6.4. Follow-up Care

In cases of NCD related emergencies, the follow-up care would consist of ensuring regular check-
ups of the patient as well as educating him/her regarding strict adherence to dietary and lifestyle
modification advice and medications, which you along with the CHO have already been doing.

3.6.5. Prevention and Awareness Generation at the Community Level

You have already been involved in generating community level awareness regarding NCDs like
diabetes, hypertension, cancer etc. In addition to the work you have already been doing, you
could also consider the following key messages in order to prevent emergencies related to NCDs
(hypertension and diabetes):
1. All hypertensive and diabetic patients should get their blood pressure and blood sugar
checked regularly, take medicines as prescribed, follow dietary advice, maintain healthy
lifestyle and visit the doctor regularly.
2. Pregnant women with hypertension and other co-morbidities should undergo periodic
monitoring of their vitals and keep family/ASHA informed.

3.7. Heat Exhaustion and Heat Stroke

As you are aware, India is a country of high humidity (especially in the southern coastal area)
and extreme temperatures (summers in the northern states). In such conditions, heat illnesses
are common considering long hours spent in harsh sun. Prolonged time in the sun could lead
to dehydration (loss of water from the body) which could further cause or trigger heat illnesses.
In the following section, you shall learn about the two most common heat illnesses namely heat
exhaustion and heat stroke and how to help the victims of these illnesses.

What is Heat Exhaustion?

Heat Exhaustion is basically a warning that the body is getting too hot. The body on touch will
feel cold and clammy because the temperature of body as well as the pulse is normal in such
cases. Exhaustion in simple terms mean “getting tired”. Similarly, in heat exhaustion, the body is
tired because of loss of water and salt from the body due to excessive sweating. Although heat
illnesses can happen with anyone, it is more seen in elderly people.

What is Heat Stroke?

If Heat Exhaustion is left untreated, it could lead to more severe symptoms causing a ‘Heat Stroke’.
This is the most serious heat illness and is caused by body temperature rising to 104 F (40 C) or
higher. A heat stroke would need immediate medical attention and without any delay you should
transport the victim to the nearest appropriate facility since untreated heatstroke can quickly
damage your brain, heart, kidneys and muscles. The degree of damage that a heat stroke can
cause will depend on the height of body temperature and the amount of time spent in the sun.

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3.7.1. Recognising life threatening situations
Emergency conditions due to heat illnesses are common especially in extreme climatic regions.
These are illnesses that occur due to prolonged exposure to high heat conditions. The symptoms
of heat exhaustion and heat stroke are given in the table below:

Heat exhaustion Heat stroke

1. Dizziness or fainting 1. Headache
2. Excessive sweating 2. No sweating
3. Cool, pale and clammy skin 3. Red, hot and dry skin (feels like fever)
4. Rapid and weak pulse 4. Rapid but strong pulse
5. Nausea or vomiting 5. Nausea or vomiting
6. Muscle cramps 6. May lose consciousness

3.7.2. Management Protocol

Specific Measures

In a case of heat exhaustion, assure the following:

1. Get the person to lie down in a cool place in the shade.
2. Loosen his/her clothing.
3. Apply cool, wet cloth on the forehead, neck, arms and other exposed areas of the body.
4. Fan the person with cool air.
5. Give sips of water slowly.
6. If vomiting occurs, refer immediately to the nearest health facility.

In a case of heat stroke, assure the following:

1. Start cool bath or sponging to reduce body temperature. Use extreme caution.
2. Start rapid cooling until body temperature reaches 38°C (100.4°F). External cooling is
most effective. Place patient on a cooling surface, wet the victim’s skin and dry with
fan to optimize evaporative cooling, and
place ice packs to the neck, cold water
immersion is effective, but not practical.
(Commonly used cooling techniques are
given below).
3. Do not give fluids orally if the person is
not conscious.
4. If the victim starts having fits (seizures),
follow the stabilization protocol as learnt
in section 3.9.2.

External cooling

What is external cooling?

Management and Prevention of Common Emergency Conditions 29

It is a method that involves application of a cooling media (like cold water, ice, fanning etc.) to
the skin, which causes removal of heat, usually resulting in a lower temperature. This type of
cooling is important in extreme cases of heat illnesses. Some of the most commonly used cooling
techniques are as follows:

1. Evaporative cooling: In very simple words, this means using air to cause cooling to the victim.
This is very similar to how we use a hand fan in summers. You can use any object that is available
at the site to cause this. Most commonly used objects could be a magazine, papers, cloth like
dupatta etc. this is one of the most acceptable and readily available techniques for cooling and
is also well tolerated by victims. (Remember, in case of a heat stroke, the victim shall not be seen
sweating. In this case, you should first wet the victim’s skin by splashing some water on the
victim’s face and body and then using a hand held fan etc. to cause evaporative cooling)

2. Immersive cooling: This is also a simple technique, however, it might not always be
possible because you will need a water source, a bucket like vessel to hold the cold water
etc. In cases where you have access to these materials, you can use this technique as
it is also proven to be effective. The following steps are to be followed for conducting
immersive technique:
!! Fill a vessel (a bucket preferably) with ice-cold water.
!! Dip the victim’s hands/ feet in the bucket
!! You can also dip a cloth in this water and put it on the forehead of the victim like is
traditionally done during fever. More frequent ice pack/cloth change and reapplication of
cold water will allow for more rapid cooling.

Caution:
DO NOT use immersive cooling in cases of classic heat exertion like in elderly, where evaporative
cooling would be enough. You should use immersive cooling only in EXTREME situations.
While conducting immersive cooling, you should take care to monitor for ‘shivering’. In case the victim
shivers, you should stop the cooling immediately.

3.7.2. Cold exposure related illnesses (Hypothermia and Frostbite)

Similar to heat related illnesses, some parts of the Indian terrain are also prone to cold
exposure related illnesses especially in the Himalayan regions, Ladakh, Siachen, Leh, owing
to extreme cold weather. You might have come across cases where a thumb or a toe goes
numb after a long exposure to extreme cold. Any such cases should always be treated as a
medical emergency.

What is hypothermia?

Hypothermia is a sharp fall in the body temperature, caused by prolonged exposures to very
cold temperatures. The body’s temperature drops below 95° F (35° C) against a normal body
temperature of 98.6° F (37° C). When the body temperature is dangerously low, the brain and
body cannot function properly and hence it should always be treated as an emergency.

What is frostbite?
Frostbite is different from hypothermia in the sense that it is more localised. It affects the body
parts that are far from the heart or those with large exposed areas to cold weather. Hypothermia
affects the whole body. A person with frostbite on the arms or legs may also have hypothermia.
Frostbite can occur when skin is exposed to a temperature of 0 °C (32 °F) or lower, resulting in

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vasoconstriction. The resultant decrease in blood flow does not deliver sufficient heat to the
tissue to prevent the formation of ice crystals. The anatomic sites most susceptible to frostbite
include hands, feet, and exposed tissues (eg, ears, nose, and lips).

How is hypothermia different from frostbite?

Frostbite affects the body parts that are far from the heart or those with large exposed areas to
cold weather while hypothermia affects the whole body. A person with frostbite on the arms or legs
may also have hypothermia due to loss of body heat, causing lowering of body temperature.

[Link]. Recognising life threatening situations

Hypothermia Frostbite
Adults: ƒƒ Redness or pain in any skin area may be the
ƒƒ Shivering first sign of frostbite
ƒƒ A white or grayish-yellow skin area
ƒƒ Exhaustion
ƒƒ Skin that feels unusually firm or waxy
ƒƒ Confusion
ƒƒ Numbness- victim unable to feel the affected
ƒƒ Fumbling hands
area
ƒƒ Memory loss
ƒƒ Slurred speech
ƒƒ Drowsiness
Infants:
ƒƒ Bright red, cold skin
ƒƒ Very low energy

[Link]. Management protocol

Specific Measures

In a case of cold exposure related illnesses,

1. Move the victim away from the cold exposure to a warm room or shelter.
2. You could use hot water bags/ bottles to help warm the affected area.
3. Do not use electric warmers or other dry heating sources as these could cause burns.
4. Do not rub or make the victim walk or use the affected body part.
5. If there are blisters, be careful to not break them or let the victim break them.
6. Remove any wet clothing the victim is wearing.

Management and Prevention of Common Emergency Conditions 31

 7. If the victim is conscious and alert, you could offer warm fluids like tea, warm milk or high
energy food like chocolate etc.
8. Keep the body dried and wrapped, including their head and neck, in a warm blanket.
9. If the victim is unresponsive, on assessment, he/she may be in need of CPR or assisted
breathing.

Note: If you are comfortable and willing, you could use skin-to-skin contact where your own body
heat can be used to warm the victim, in cases where you are not able to find a hot water bottle/bag or
blankets,

Caution: A victim of frostbite could often be unaware due to numbness in the skin of the affected
body part. In such situations, the victim could be prone to self-harm. While stabilizing, you should
be careful not to allow the victim to rub, scratch or massage the affected area

3.7.3. Safe transport and referral

Referral and transport is especially of prime importance if it is a case of heat stroke or the person
presents with vomiting. In such cases, you should plan a referral to the nearest health facility by
keeping CHO informed.

3.7.4. Follow-up Care

Heat related illnesses are mostly controlled with general measures or once treatment is
completed and do not require follow up care for recovery. However, each case is different
and if the MO or the CHO who treated the patient prescribes follow-up care (either due to
any injuries or underlying disorder), you along with the ASHA should help the patient maintain
treatment compliance and aid in the patient’s recovery.

3.7.5. Prevention and Awareness Generation at Community Level

Generally heat illnesses are self-limiting and are largely preventable. The following precautionary
measures can be used by you to create awareness in the community regarding the same.
1. Wear loose fitting, light colored clothes in summer. Always keep head covered when
going out in the sun.
2. Avoid direct sun heat (especially during afternoon).
3. Rest in shaded places. For occupations which require working outdoors, take frequent
breaks.
4. Avoid vigorous physical activities in hot and humid weather.
5. Drink plenty of fluids and water to stay hydrated during hot weather.

For cold exposure illnesses:

1. Wear woolen/warm multilayer clothing in winters or in areas with cold climate, adequately
covering the extremities like feet, hands, chin, and ears.

2. Avoid long and direct exposure to extreme cold like snow, waterbodies etc

3. Consumption of locally available foods that help in warming up the body like peanuts,
ghee etc.

4. Exercising or regular physical activity help warm up the body

32 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
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3.8. Severe Allergic Reactions
3.8.1. Recognizing life threatening situations
Even though allergies are common, sometimes, allergic
reactions may be life-threatening. Severe allergic reactions
can be of two types. The warning signs are as follows:
!! In the first type, there is swelling of the lips, tongue,
face and throat which can lead to wheezing and
difficulty in breathing. Sometimes swelling may also
appear in the genitals, hands, and feet.
!! In the second type, the blood pressure falls drastically
leading to shock with symptoms like dizziness and
fainting, mental confusion, weak and rapid pulse,
cold and clammy skin, nausea and vomiting.

Sometimes mild allergic reactions may progress to severe

allergy. Therefore it is also important to be cautious of mild
allergic symptoms such as:
!! Sneezing, itching of the nose, eyes or roof of the
mouth, stuffy nose, watery, red or swollen eyes
!! Tingling sensation in the mouth particularly due to food allergens

!! Severe itching or hives (red, very itchy, smoothly elevated areas of skin) all over the body

3.8.2. Management Protocol

Specific Measures
The treatment for allergies is divided into two parts: History taking and Symptomatic treatment

History taking:
If the person is able to speak, a history of what caused the allergy should be taken so that it can
be avoided in future. If the person is not able to speak, ask anyone who was there with him/her at
the time the allergy began. You could ask if the cause of the allergy is any of the above-mentioned
allergens that the patient might have come in contact with. If not, you should ask about any other
substance that the patient could have been exposed to for the first time. If the person has had
allergic reactions before, ask the person about what had caused it the previous time.

Symptomatic treatment:
Most of the times, you will see that the person suffering from such an allergic reaction will
have symptoms as we learnt in the previous chapter. Proper and timely first aid can help the
patient from progressing into a dangerous anaphylaxis shock. Sometimes, minor redness or
itching can turn into a severe reaction within minutes and hence should not be ignored.
In such situations, first call for help and inform the nearest public health facility as well as the
CHO about their readiness to take the case. To stabilize the patient till help arrives:
1. Lay the person flat with legs raised
2. Reassure the person
3. Loosen any tight clothing

Management and Prevention of Common Emergency Conditions 33

 4. Apply a cool, damp cloth on the hives, if present, to soothe the itching
5. Move the person to the shade since heat could worsen the symptoms

Caution:
!! Do not allow the patient to stand or walk

!! Do not place them in seated, standing, or upright position

!! Do not give any other medicine

!! Do not give any food or water to the person if he/she is breathless or unconscious

3.8.3. Safe transport and Referral

If you recognise the situation of the patient to be life-threatening based on the presenting
symptoms, you should first call for help and inform the nearest public health facility as well as the
CHO about their readiness to take the case.

Refer section 3.1.4.

3.8.4. Follow up Care

Follow up care is of importance when it comes to patients who have had an allergic reaction
earlier. The care that the patient will need post treatment is not related to treatment, but it is
actually to prevent further incidences as this one.
In case of Anaphylaxis/Severe Allergic Reactions, you could help the person identify the
allergen (substance that caused the allergy) through a thorough history taking, and educate
him/her to avoid the identified allergen from then onwards. This information can also come
handy in case the situation repeats.

3.8.5. Prevention and Awareness Generation at the Community Level

An Allergy is a condition where our body reacts to a foreign substance in the body which could
either be inhaled or ingested. This reaction usually causes symptoms in the nose, throat, ears,
skin and stomach. An allergic reaction usually starts within a few minutes. Some of these foreign
substances include but is not limited to the following:

!! Airborne allergens such as pollen, animal

dander, dust mites and mould

!! Certain food particularly peanuts, wheat,

fish, shellfish, eggs and milk

!! Insect stings such as from a bee or wasp

!! Medications particularly penicillin or

penicillin-based antibiotics

!! Latex or other substances you touch which

can cause allergic skin reactions

What could cause allergy in one person may not cause allergy in another, in the sense that
allergens could be unique to individuals and hence it is difficult to identify the allergen unless the
individual is exposed to it. This is why history taking is extremely important.

34 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
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3.9. Seizures/Fits

3.9.1. Recognising life threatening situations

Fits (convulsions/seizures) can occur due to many underlying medical causes, in both adults and
children. In case of a person suffering from fits, assure the following:

Identify whether the fits are affecting the entire body (Generalized) or some parts (Focal)
a. Generalized fits involves shaking of the whole body (the person is on the floor and
vigorously shaking, he/she may appear confused or may lose consciousness).
b. Focal fits involves only some parts of the body (the person may have repetitive movements
like chewing/blinking or rhythmic twitching of any body part.

3.9.2. Management Protocol

If the victim before you is having fits, you should not do anything that restricts the person’s
movements. However, you should make sure that the person does not hurt him/herself during
the fits episode due to any obstacles in the way. You can follow the below mentioned steps to
ensure the same:
1. Keep surrounding safe (eg. keep pillows to avoid injury from surrounding objects, remove
any objects in the way that can injure the patient further).
2. Place a clean cloth between the teeth of the patient so that he/she does not bite the tongue.
3. Place patient in recovery position after the fits stop.

Caution
!! Do not attempt to hold the person’s mouth open.
!! Do not hold the person down or try to stop his/her movements or restrain his/her arms/
legs tightly
!! Do not offer the person water or food until he/she is fully alert.

3.9.3. Safe transport and Referral

As you learnt in the management protocol, you should never restrict the movements of the
person who is having fits. Hence, you should also not move or transport the person while the
person is having seizures. Call for help as soon as you attend the patient and keep CHO informed
about the referral. A person experiencing a seizures, needs to be referred to a facility that has
availability of a CT scan.

Management and Prevention of Common Emergency Conditions 35

Remember that you should move or transport the patient only when the person has stopped
seizures and movements are stable.

3.9.4. Follow up Care

Patients of epilepsy or fits generally require long-term follow-up care especially if the root cause
of the epilepsy has not yet been diagnosed. For this, a thorough history taking is extremely
important followed by investigations. Hence, when you attend to a patient who is having fits, you
should be very observant as it will help in a proper history and diagnosis.

Once the diagnosis has been established, the patient might require help in terms of treatment
compliance, side effects of the treatment medications etc which you could help with during home
visits with ASHA. You could also undertake educating the family regarding the condition so that
the patient receives the necessary support. You should also make sure that the patient as well as
the family is aware of the specifications of the disorder, the medications, the possible side-effects
with the medication, recurrence etc.

Any recurring episode needs to be reported to the CHO so that appropriate treatment can be
done. In case the person develops permanent disability, ensure that he/she receives appropriate
palliative care. Link him/her with the palliative care services provided through the AB-HWC and
provide psycho-social support to help the person overcome the crisis.

5.9.5. Prevention and Awareness Generation at the Community Level

Lack of awareness regarding epilepsy or seizures at the community level acts as a barrier in
providing treatment and care in the community. Not all seizures are preventable but seizures
that occur as a result of trauma from accidents, stroke or other heart diseases, infections, and
maternity related events can be prevented to certain extent. You as an ANM, could make the
community aware regarding the causes of epilepsy that are preventable as well as treatment
options available.

Some key messages that you can make use of in the community are
!! Encouraging immunization for every individual in the community (so as to protect the
community from preventable infections)
!! Ensuring pregnant women receive proper ANC
!! Generating awareness regarding safety measures to avoid head injuries
!! Promoting healthy lifestyle in order to avoid stroke and other heart diseases.

5.10. Choking
Even though choking is more common in children, it can also happen in adults. The object on
which the victim has choked, might block the throat. In such cases, the victim might have difficulty
in breathing or talking and sometimes the skin might turn blue.

5.10.1. Recognizing life threatening situations

In some cases, choking can be life-threatening since the object the victim is choking on could
cut off airway giving the brain limited oxygen. The brain can only function without oxygen for few
minutes and this is why it is important to attend to the victim of choking as soon as possible. A
person who’s choking may cough continuously until they expel the food or liquid from their throat

36 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
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or airway. However, in some cases, the object, food, or liquid gets stuck in the throat and cuts off
the air supply. Some of the signs to identify if the case is life-threatening and needs emergency
care are following:
!! The victim is unable to speak, cough, make noise or breathe
!! Bluish tint to the lips, skin, or nails from a lack of oxygen.

5.10.2. Management Protocol

Specific Measures:

The object on which the victim has choked, might block the throat. In such cases, the victim might
have difficulty in breathing or talking and sometimes the skin might turn blue.

The tables given below shows how to manage a case of choking. Either technique can be
used.

For an adult:
Step 1 Reassure the person.
Step 2 Bend him/her forwards so that the head is lower than the chest.
Step 3 Encourage him/her to cough if possible.
Step 4 Give up to five sharp blows on the back between
shoulder blades with the flat of your hands. When
to slap back when to compress the bell?

OR
Step 1 Stand behind the victim and put both arms
round the upper part of his/her abdomen. If
the choking patient is a child, position yourself
to the correct height. If the choking patient is
a pregnant woman, place your arms below the
chest and above the level of the abdomen.

Step 2 Lean the victim forward.

Step 3 Clench your fist and place it between the umbilicus (navel) and the bottom of sternum (breast
bone).
Step 4 Grasp this hand with your other hand and pull sharply inwards and upwards.
Step 5 Repeat up to five times.

Management and Prevention of Common Emergency Conditions 37

For a small child:
Step 1 Place the child over your knee

Step 2 Slap him on the back between shoulder blades using less force than for an adult. Use the
heel of one hand to give up to 5 back slaps between the baby’s shoulder blades.

For a baby:

Step 1 Lay the baby along your forearm

Step 2 Slap him on the back between shoulder blades using less force than for a child. Use the
heel of one hand to give up to 5 back slaps between the baby’s shoulder blades.

Note: If the choking patient is unconscious, do not attempt these techniques. Look for and remove
the foreign body ONLY if it is visible. Refer to the hospital immediately.

3.10.3. Safe transport and Referral

Refer section 3.1.3

3.10.4. Follow up Care

Generally the hazards from choking are short-lived and do not require post-treatment. However,
as the ANM you could visit the victim post-treatment along with the ASHA to track any
complications.

3.10.5. Prevention and Awareness Generation at Community Level

Children or even adults usually choke from objects that they have accidentally ingested. However,
they may also choke when eating too quickly or when talking/laughing with food in their mouths,
inhaling smoke (choking on the soot of the smoke) etc. As an ANM, you can help create awareness
in the community regarding prevention of choking accidents using the following messages:

38 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
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 1. Do not leave infants and small children unattended around toys or other small objects like
coins, bottle caps, batteries etc.
2. Stay alert while eating or drinking. Supervise small children while they eat or drink. Educate
parents to discourage their children talking/laughing while eating or eating too fast etc.
3. Making it a habit to always keep water next to oneself while eating.
4. Educate community on how to relive obstruction due to choking. Can be taught to
volunteers, school kids, etc

3.11. Poisoning
3.11.1. Recognizing life-threatening situations
Poisoning can be caused by substances that are easily available both inside and outside the
house. Cases of poisoning can be both accidental and intentional. However, irrespective of the
cause and intention, you as an ANM, should always report cases of poisoning to the CHO and
provide prompt stabilization and facilitate referral of the victim to appropriate nearest facility.
Some of the signs of poisoning that are life-threatening are:
The effects of poisoning depend on the substance, amount, and type of contact as well as the
age, weight, and state of health of the victim.
Possible symptoms of poisoning include:
!! Nausea and/or vomiting
!! Diarrhoea
!! Rash
!! Redness or sores around the mouth
!! Dry mouth
!! Drooling or foaming at the mouth
!! Trouble breathing
!! Dilated pupils (bigger than normal) or constricted pupils (smaller than normal)
!! Confusion
!! Fainting
!! Shaking or seizures

3.11.2. Management Protocol

Specific Measures

A person who has ingested or inhaled poisonous substance should be immediately stabilized
and referred to the nearest health facility as soon as possible. Reassure the person. Rinse mouth
of the person with water in case of ingested poison and move him/her to a place with adequate
ventilation so that he/she gets fresh air to breathe, in case of inhaled poison.

Caution
!! Do not make the person vomit.
!! Do not make the person eat or drink anything.

Management and Prevention of Common Emergency Conditions 39

3.11.3. Safe Transport and Referral
Refer 3.1.3.

3.11.4. Follow-up Care

Refer 3.1.4.

3.11.5. Prevention and Awareness Generation at the Community Level

Cases of poisoning are largely preventable and the best way to do that is to avoid contact with
harmful substances.
You can use the following messages to create awareness in the community regarding the
prevention of poisoning:
1. Keep all household substances out of the reach of children. You should put them in high
or locked cabinets.
2. Wear protective clothing, like gloves, when you use cleaners and chemicals.
3. If you use chemicals inside the house, keep the area well aired.
4. Do not mix chemicals as mixed chemicals could become poisonous.
5. Keep medicines and chemicals in their original containers and label every such container.
6. Get rid of old or expired medicines and household products.
7. Do not drink spurious liquor.

3.12. Near-Drowning
3.12.1. Recognizing life-threatening situations
Even though we use the word “drowning” commonly to refer to suffocation from water entering
the nose and mouth of a person, the correct word to be used is “near-drowning” which means
almost dying from suffocating under water. This is the stage where emergency care is needed to
save the victim’s life.
A victim of near-drowning could most probably be unresponsive which you will learn when you
conduct AVPU. The other signs that are life-threatening are:
!! Cold or bluish skin
!! Abdominal swelling
!! Chest pain
!! Cough
!! Vomiting
!! No breathing
!! Erratic breathing
!! No pulse
!! Nail beds, slow or no circulation
!! Mouth, nose or skin turning blue

3.12.2. Management Protocol

AVPU and ABCDE are extremely important in cases of near-drowning as the victim might be
unresponsive on assessment and may be in need of CPR or assisted breathing.

40 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres
When you Check for ABCDE in a victim of near-drowning, you could follow the below mention
approach:

Check for the victim’s breathing If no spinal injury,

(Use look, listen, feel) Put the victim in recovery position
Look for visible movement of chest Breathing Cover the victim in warm
Listen for breathing sound blanket- keep victim warm
Feel the victim’s pulse Observe

Not Breathing No Pulse

DO CPR

Specific Measures

In a case of drowning or near drowning, you could undertake the following measures:
!! Remove the victim from water immediately

!! Assess for breathing. If the victim is breathing then place him/her in recovery position.
If the victim is not breathing or moving then he/she might require Cardio-Pulmonary
Resuscitation (CPR) (As shown in the previous section)
!! Be very careful when handling the person and performing CPR, as the individual could
have a neck or spinal injury. Do not move or turn their neck or head. Stabilize the neck by
manually holding the head and neck in place or placing towels or other objects around
the neck to support it.
!! Remove wet clothes and cover the victim with a blanket to prevent hypothermia (support
the neck while removing the victim’s clothes)
!! Remove any visible foreign body, weed, sand or mud from the mouth

!! Transfer the victim to the appropriate nearest health facility immediately.

3.12.3. Safe transport and Referral

Refer section 3.1.3.

3.12.4. Follow up Care

Refer section 3.1.4.

3.12.5. Prevention and Awareness Generation at the Community Level

1. Do not leave infants and small children unattended around water bodies.
2. Do not leave vessels filled with water uncovered around small infants and children, eg.
Buckets, drums, gamla, etc.
3. Avoiding alcohol consumption while driving or boating or playing near water bodies

References
1. Williams N, O’Connell PR, McCaskie AW. Bailey and Love’s Short Practice of Surgery. 27th
ed. Boca Raton, Florida: CRC Press, Taylor & Francis Group; 2018. 326 p.

Management and Prevention of Common Emergency Conditions 41

Annexures

Annexure I: Cardio-Pulmonary Resuscitation (CPR)

CPR in adults

Step 1 Kneel by the side of the victim

Step 2 Place the heel of one

hand in the centre of
victim’s chest.

Step 3 Place the heel of your

other hand on top of
the first hand.

Step 4 Interlock the fingers

of your hands and
ensure that pressure
is not applied over the
victim’s ribs.

42 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
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Step 5 Position yourself
vertically above the
victim’s chest and with
your arms straight,
press down on the
sternum 4-5 cm

Step 6 After each compression release all the pressure on the chest without losing contact
between your hands and sternum.

Step 7 Repeat at the rate of minimum 100-120 compressions per minute (a little less than 2
compression a second).

Step 8 Compression and Release should take equal amount of time.

Combine chest compressions with rescue breaths

After 30 compressions give mouth to mouth breathing to the victim.

Give a total of two rescue breaths and the return your hands without delay to the correct position
on the sternum and give a further 30 chest compressions.

Continue with chest compression and recue breaths in a ratio of 30:2.

Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt
resuscitation.

Only CPR
If you are unable or not willing to give rescue breaths, give hands only CPR.

If chest compressions only are given these should be continuous at the rate of 100 per minute.

Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt
resuscitation.

Two-person CPR
If there are two trained personnel (rescuers) present at the scene, CPR is conducted by both
persons in turns. They should coordinate to perform chest compressions. If the rescuers performing
CPR are unable or not willing to give rescue breaths, hands only CPR should be done.

In the two-person CPR, rescuers switch positions after about every two minutes. One of the
rescuers is positioned near the chest area and gives chest compressions while the other one
is positioned near the head of the victim and gives after every 30 compressions. This position
allows quick position changing.

Switching regularly and quickly ensures that the depth and the rate of compressions are
adequate. The two-person CPR method allows rescuers to continue performing CPR for hours
until medical help arrives.

Annexures 43
Indications to start chest compressions in infants (or children)
!! When no define pulse is palpable in 5-10 seconds.
!! When pulse rate is less than 60 beats/minute.

CPR in Children
The adult sequence may also be used for children but following minor modifications in the
sequence will make it more suitable for use in children:
1. Give initial rescue breaths before starting chest compressions.
2. If you are on your own perform CPR for approximately one minute before going for help.
3. Use one or two hands as needed for a child over one year to achieve adequate depth of
compression (about 2 inches) at the rate of at least 100 per minute, at the centre of the
chest.
4. Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover
the mouth with yours and blow until you see the chest rise. Each breath should take 1
second.

Caution: Breaths can be omitted during pandemic times and hands-only CPR may be
performed.

CPR in Infants
For checking the pulse in infant, brachial pulse is preferred –it can be felt in the middle of upper
arm on the medial side. CPR even if HR is <60.
1. Identify inter-mammary line
2. Press with two fingers just below the
centre of the inter-mammary line.
3. Compress chest by 1/3 to 1/2 of the
depth of the chest (about one and
a half inches). Give 15 gentle chest
compressions at the rate of at least
100 per minute.
4. Open the airway using a head tilt lifting
of chin. Do not tilt the head too far
back.
5. If the baby is not breathing or not
breathing normally, cover the baby’s
mouth and nose with your mouth and
give 2 gentle breaths. Each breath
should be 1 second long. You should
see the baby’s chest rise with each
breath.

Caution: Breaths can be omitted during pandemic times and hands-only CPR may be
performed.

44 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres
Annexure II: When and where to refer
Referral plan for the commonly presenting emergency conditions

Village level SHC-HWC PHC-HWC

SHC-HWC PHC-HWC FRU/DH/Tertiary Care Centre

(CHO) (MO) (Specialist/MO)
ƒƒSimple Burns ƒƒFever with altered mental status ƒƒChest Pain
ƒƒfresh scratches / ƒƒFever with Headache/ chest Pain/ ƒƒCardiac problems (e.g. : Heart block,
superficial Jaundice CHF, rhythm disturbances)
ƒƒwounds ƒƒChest Pain ƒƒBreathing problems (difficult breathing,
shortness of breath), Choking
ƒƒAnimal/insect ƒƒChoking ƒƒUnconsciousness/ Fainting,
bites Disorientation/ Stroke
ƒƒChest Pain (only ƒƒSimple Burn injuries including ƒƒShock (including due to blood loss,
for first aid) chemical and acid burn dehydration etc.)
ƒƒUncomplicated ƒƒConvulsions, Epileptic seizures ƒƒUncontrollable bleeding, e.g.: nose
choking Headache bleed, hematuria
ƒƒUnconsciousness/ Fainting, ƒƒPainful Bleeding P/R
Disorientation
ƒƒBreathing Problems (difficult ƒƒCyanosed infant/ child, (e.g.: Foreign
breathing, shortness of breath), Body inhalation)
hanging / Drowning / Electrocution
/ Stroke
ƒƒAbnormal bleeding Per Vegina ƒƒConvulsions, Epileptic Seizures, Diabetic
emergencies
ƒƒOngoing bleeding (Blood in ƒƒAnimal bites, snake bites/ Scorpion bite
vomitus, Blood in cough, Blood in
urine, Nose bleeding etc)
ƒƒAcute abdominal pain, Drug ƒƒDrowning
overdose, Poisoning - with stable
vital signs
ƒƒSevere allergic reactions ƒƒPoisoning -unstable vitals
ƒƒMinor head Injury and other ƒƒAcute abdominal pain (severe), Burns
Musculo skeletal injuries and inhalational injuries (including steam,
acid attack and smoke inhalation)
ƒƒSuspected spine Injury (any) Injury ƒƒMusculo skeletal injuries (e.g.: Road
to a pregnant Woman Traffic Injuries, fall from height etc.)
ƒƒInjuries due to weapons (e.g.: gunshot
wound, Stab wounds etc.)
ƒƒInjuries due to violence (e.g.: Suspected
sexual assault,domestic violence)
ƒƒAny other life threatening condition

Annexures 45
List of Contributors

List of contributors from Ministry of Health and Family Welfare (MoHFW)

Dr Tanu Jain, DDG, DGHS

List of contributors from National Health Systems Resource Centre (NHSRC)

Maj Gen (Prof) Atul Kotwal, Executive Director

Dr (Flt Lt) M A Balasubramanya, Advisor, Community Process and Comprehensive

Primary Health Care

Dr Anantha Kumar S R, Senior Consultant, Community Process and Comprehensive Primary

Health Care

Dr Rupsa Banerjee, Former Senior Consultant , Community Process and Comprehensive

Primary Health care

Dr Sushma Adappa, Consultant, Community Process and Comprehensive Primary Health Care

Dr Vijaya Shekhar Salkar, Junior Consultant, Community Process and Comprehensive

Primary Health Care

List of contributors from Rajiv Gandhi University of Health

Sciences-JeevRaksha
Dr S Sacchidanand, Vice Chancellor, Rajiv Gandhi University of Health Sciences

Dr Vijaybhaskar Reddy, Associate Professor University of Utah, USA & Senior instructor
JeevaRaksha, Bengaluru

Dr Ram Krishnan Nair, Sr Consultant in Emergency Medicine, CEO, JeevaRaksha, Bengaluru

46 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres
Abbreviations

AB Ayushman Bharat
ABC Airway Breathing Circulation
ABCDE Airway, Breathing, Circulation, Disability, Exposure
ACLS Advanced Cardiovascular Life Support
ACS Acute Coronary Syndrome
AED Automated External Defibrillator
AF ASHA Facilitator
ALS Advanced Life support
AMBU Artificial Manual Breathing Unit
AMIs Acute myocardial infarctions
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activists
ASV Anti-Snake Venom
AVPU Alert, Voice, Pain, Unresponsive
AWW Anganwadi Worker
BGL Blood Glucose Levels
BLS Basic Life Support
BP Blood Pressure
BSA Burns of Special Areas
BVM Bag Mask Ventillation
CAB Circulation, airway, breathing
CCF Congestive Cardiac Failure
CHC Community Health Centre

Abbreviations 47
CHO Community Health Officers
COPD Chronic Obstructive Pulmonary Disease
CHW Community Health workers
CMO Chief Medical Officer
COVID-19 Corona Virus Disease-19
CPR Cardio-Pulmonary Resuscitation
CRT Capillary Refill Time
CVAs Cerebrovascular accidents
DALYs Disability-adjusted life-years
DBP Diastolic Blood Pressure
DH District Hospital
DNA Deoxyribonucleic Acid
DPR Detailed Project Report
ECG Electrocardiogram
EMT Emergency Medical Technician
FAST Focused Assessment with Sonography in Trauma
FGD Focussed Group Discussion
FLWs Front line workers
FRU First Referral Unit
GBD Global Burden of Disease
GCS Glasgow Coma Scale
GDP Gross Domestic Product
GoI Government of India
GRS Grievance Readressal System
HR Human Resource
HWC Health & Wellness Centre
IDSP Integrated Disease Surveillance Programme
IEC Information Education Communication
ISBAR Identity, Situation, Background, Assessment, Recommendation
IV Intravenous
IV/IO Intra-venous/ Intra-osseous line
JAS Jan Arogya Samithi
LMA Laryngeal Mask airway
MAS Mahila Arogya Samithi
MOANS Mask Seal, Obesity, Age, No Teeth, Stiff
MD NHM Mission Director- National Health Mission

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MLC Medico legal cases
MLP Mid-Level Providers
MLR Medico legal report
MO Medical Officer
MoHFW Ministry of Health & Family Welfare
MPW Multi-Purpose Workers
MPW-M Multipurpose Worker-Male
NCC National Cadet Corps
NHSRC National Health Systems Resource Centre
NREGA National Rural Employment Guarantee Act
NRP Neonatal Resuscitation Protocol
NS Normal Saline
OPD Out Patient Department
ORS Oral Rehydration Therapy
PAT Paediatric Assessment Triangle
PHC Primary Health Centre
PHC-HWC Primary Health Centre - Health and Wellness Centre
PIP Program Implementation Plan
PPE Personal Protective Equipment
PPH Post- Partum Haemorrhage
PR Per-Rectally
PRI Panchayati Raj Institutions
RDT Rapid Diagnostic Test
RICER Rest, Ice/Immobilisation, Compression, Elevation , Referral
RIGHT Reassure, Immobilise, Get to Hospital, Tell
RR Respiratory Rate
RTI Road traffic injuries
RL Ringers Lactate
SAMPLE Signs & Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake,
Events surrounding the injury or illness
SBCC Social Behaviour Change Communication
SBP Systolic Blood Pressure
SC Sub Centre
SHC Sub- Health Centre
SHC-HWC Sub Health Centre - Health and Wellness Centre
SN Staff Nurse
SOP Standard Operating Procedure

Abbreviations 49
SOPs Standard operating protocols
SpO2 Partial Pressure of Oxygen
TABC Temperature, Airway, Breathing, Circulation
TBSA Total Body Surface Area
TOR Terms of Reference
ULB Urban Local Bodies
UHC Universal Health Coverage
UPHC Urban Primary Health Centre
VHSNC Village Health Sanitation and Nutrition Committee
VHSND Village Health Sanitation & Nutrition Days

50 Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres
Note
Note
Namaste!
You are a valuable member of the Ayushman Bharat – Health and Wellness Centre
(AB-HWC) team committed to delivering quality comprehensive primary healthcare
services to the people of the country.
To reach out to community members about the services at AB-HWCs, do connect to the
following social media handles:

[Link]
[Link]
[Link]
[Link]

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54 National Health Systems Resource Centre

Training Manual on Management of Common Emergencies, Burns and Trauma for Multipurpose Worker
at Ayushman Bharat- Health and Wellness Centres