Elementary First Aid – Module 1: Introduction and General Principles

1. What is First Aid?

First Aid is the immediate, temporary care given to an ill or injured person until professional
medical help is available. The goal is to:
• Preserve life
• Prevent the condition from worsening
• Promote recovery
It is not a full medical treatment but a crucial life-saving skill, especially onboard ships where access
to doctors can be delayed.

2. Importance of First Aid at Sea

Onboard ships:
• Medical help may be hours or days away
• The crew must be able to act immediately and effectively
• Every seafarer must know basic first aid to respond during emergencies
STCW 1978 Convention, as amended, mandates all seafarers to receive EFA training.

3. Objectives of First Aid

The main aims of first aid can be remembered by the 3 Ps:
1. Preserve Life
o Ensure the casualty is breathing
o Administer CPR if necessary
o Stop severe bleeding
2. Prevent the Condition from Worsening
o Immobilize fractures
o Remove the casualty from dangerous environments (e.g. smoke, fire)
o Treat for shock and monitor vitals
3. Promote Recovery
o Reassure the casualty
o Keep the person warm and comfortable
o Hand over to medical professionals as soon as possible

4. General Principles of First Aid

a. Assess the Situation
• Ensure the scene is safe (no fire, gas leak, electric hazard)
• Do not become a second casualty
• Check for multiple casualties, call for help
b. Assess the Casualty
• Use DRABC:
o D – Danger: Check for hazards
o R – Response: Check if casualty is conscious
o A – Airway: Ensure it's open and clear
o B – Breathing: Check if they are breathing
o C – Circulation: Check for pulse and severe bleeding
c. Call for Help
• Alert the ship's medical officer or master
• Contact telemedical services if necessary (e.g. via INMARSAT)
• Prepare to give information: casualty’s age, symptoms, known medical history
d. Apply Appropriate First Aid
• Administer care based on the casualty’s condition
• Monitor closely for any change in symptoms
 5. First Aid Kit and Equipment
A ship's first aid kit includes:
• Bandages and dressings
• Scissors and tweezers
• Disposable gloves
• Antiseptics and disinfectants
• Burn creams
• CPR face shields
• Emergency blankets

7. Responsibilities of a First Aider

• Stay calm and act quickly
• Maintain hygiene and wear gloves to prevent infection
• Reassure the casualty
• Do not give food or drink to an unconscious or semi-conscious person
• Ensure continuous observation until help arrives

BODY STRUCTURE & FUNCTION for Elementary First Aid (EFA)

1. Introduction to Human Anatomy and Physiology
• Anatomy: Study of the body's structure.
• Physiology: Study of the body's functions.
• Importance: Understanding these concepts is crucial for effective first aid, as it helps in
assessing injuries and administering appropriate care.
• 2. Body Structure and Functions
• Levels of Organization: Cells → Tissues → Organs → Systems → Organism.
• Homeostasis: The body's ability to maintain a stable internal environment.
3. Major Body Systems and Their Relevance to First Aid
a. Skeletal System
• Functions: Provides structure, protects organs, anchors muscles, and stores calcium.
• First Aid Relevance: Understanding bone structure aids in identifying fractures and
administering immobilization techniques.
b. Muscular System
• Functions: Facilitates movement, maintains posture, and generates heat.
• First Aid Relevance: Knowledge of muscle groups assists in recognizing strains, sprains,
and performing CPR.
c. Cardiovascular System
• Components: Heart, blood vessels, and blood.
• Functions: Transports nutrients, gases, and wastes; regulates body temperature.
• First Aid Relevance: Critical for assessing circulatory issues like shock, bleeding, and
performing CPR.
• d. Respiratory System
• Components: Lungs, trachea, bronchi.
• Functions: Facilitates gas exchange (oxygen and carbon dioxide).
• First Aid Relevance: Essential for managing choking, respiratory distress, and
performing rescue breathing.
e. Nervous System
• Components: Brain, spinal cord, nerves.
• Functions: Controls body activities, interprets sensory information.
• First Aid Relevance: Important for assessing consciousness levels, seizures, and
neurological responses.
f. Digestive System
• Components: Mouth, esophagus, stomach, intestines.
• Functions: Breaks down food, absorbs nutrients, eliminates waste.
• First Aid Relevance: Knowledge aids in managing abdominal pain, vomiting, and
poisoning cases.
g. Endocrine System
• Components: Glands like thyroid, pancreas, adrenal.
• Functions: Regulates metabolism, growth, and mood.
• First Aid Relevance: Understanding hormonal imbalances helps in managing diabetic
emergencies and stress responses.
h. Urinary System
• Components: Kidneys, ureters, bladder, urethra.
• Functions: Removes waste and excess substances from the blood.
• First Aid Relevance: Useful for recognizing dehydration, urinary retention, and kidney-
related issues.
i. Lymphatic System
• Components: Lymph nodes, spleen, lymph vessels.
• Functions: Defends against infection, maintains fluid balance.
• First Aid Relevance: Important for recognizing signs of infection and swelling.

Positioning of Casualty – EFA Course Overview

Learning Objectives
This module equips candidates with the knowledge and skills to:
• Assess the condition of an unconscious casualty.
• Safely position the casualty to maintain an open airway and prevent aspiration.
 • Ensure the casualty's safety and comfort until medical help arrives.
• Understand the importance of correct positioning in preventing further injury.

Techniques for Positioning a Casualty

1. Recovery Position (Lateral Recumbent Position)
This is the standard position for an unconscious casualty who is breathing and has no suspected
spinal injuries:
• Kneel beside the casualty.
• Place the arm nearest to you at a right angle to their body.
• Bring the far arm across their chest and hold the back of their hand against the cheek
nearest to you.
• With your other hand, grasp the far leg just above the knee and pull it up so the foot is flat
on the floor.
• Keeping the casualty's hand pressed against their cheek, pull on the far leg to roll them
towards you onto their side.
• Adjust the upper leg so that both the hip and knee are bent at right angles.
• Tilt the head back to ensure the airway remains open.
• Monitor the casualty's condition and breathing regularly.
2. Unconscious Position (Face Down)
If the casualty is unconscious but breathing, and you are unable to place them in the recovery
position:
• Turn the casualty onto their side, facing downward.
• Ensure the head is turned to one side to allow drainage of fluids.
• Keep the airway open and monitor breathing.
• Avoid using pillows under the head.
• Loosen any tight clothing around the neck and waist.
• Remove any artificial dentures if present.

Special Considerations
• Spinal Injury Suspected: If spinal injury is suspected, avoid moving the casualty unless
absolutely necessary. Immobilize the head, neck, and spine.
• Breathing and Pulse Check: Always check for breathing and pulse before positioning. If
the casualty is not breathing, commence CPR immediately.
• Continuous Monitoring: Regularly monitor the casualty's condition, especially if they
remain unconscious.
 Practical Application
The positioning techniques are taught through a combination of theoretical lectures and practical
demonstrations. Trainees are encouraged to practice these techniques to ensure proficiency.

Resuscitation in Elementary First Aid

1. Understanding Resuscitation
Resuscitation refers to the process of reviving someone from unconsciousness or apparent death.
It encompasses techniques like Cardiopulmonary Resuscitation (CPR), rescue breathing, and the
use of resuscitation equipment.

2. Key Components of Resuscitation

a. Cardiopulmonary Resuscitation (CPR)
• Purpose: To restore circulation and breathing in cases of cardiac arrest.
• Techniques:
o Chest Compressions: Performed at the center of the chest, compressing the
sternum to a depth of about 5–6 cm at a rate of 100–120 compressions per minute.
o Rescue Breathing: Delivering breaths to the victim by sealing their mouth with
your own and blowing air into their lungs.
• Considerations:
o Ensure the airway is open.
 o Check for normal breathing.
o Use an Automated External Defibrillator (AED) if available.
b. Rescue Breathing
• Indications: For victims who are not breathing but have a pulse.
• Procedure:
o Open the airway using the head-tilt, chin-lift method.
o Pinch the nose shut, take a normal breath, and make a complete seal over the
victim's mouth.
o Give 2 breaths,
o each lasting about 1 second, watching for chest rise.
o Continue with 1 breath every 5–6 seconds.

Bleeding in Elementary First Aid (EFA)

1. Understanding Bleeding
Bleeding, or hemorrhage, refers to the loss of blood from the circulatory system. It can be
classified into two main types:
• External Bleeding: Blood loss visible outside the body.
• Internal Bleeding: Blood loss within the body, not visible externally.
2. Types of External Bleeding
External bleeding is categorized based on the type of blood vessel involved:
• Arterial Bleeding:
o Characteristics: Bright red blood spurting in rhythm with the heartbeat.
o Cause: Injury to an artery.
o Risk: Rapid blood loss; requires immediate intervention.
• Venous Bleeding:
o Characteristics: Dark red blood flowing steadily.
o Cause: Injury to a vein.
o Risk: Continuous blood loss; needs prompt attention.
• Capillary Bleeding:
o Characteristics: Oozing of blood from small vessels.
o Cause: Minor cuts or abrasions.
o Risk: Usually minimal; can be controlled easily.

3. Signs and Symptoms of Severe Bleeding

In cases of significant blood loss, the casualty may exhibit:
• Pale, cold, and clammy skin
• Rapid, weak pulse.
• Shallow, irregular breathing.
• Profuse sweating.
 • Thirst and dizziness.
• Loss of consciousness in severe cases.

4. First Aid Management of External Bleeding

a. Minor Bleeding (Capillary or Small Venous)
1. Clean the Wound: Rinse with clean water or antiseptic solution.
2. Apply Pressure: Use a sterile dressing or clean cloth to apply direct pressure to the
wound.
3. Elevate the Limb: Raise the injured part above the level of the heart to reduce blood flow.
4. Secure the Dressing: Bandage the dressing in place without cutting off circulation.
5. Monitor the Casualty: Check for signs of shock and seek medical attention if necessary.
b. Severe Bleeding (Arterial or Large Venous)
1. Apply Direct Pressure: Use a clean cloth or dressing to apply firm pressure to the wound.
2. Use Pressure Points: If bleeding persists, apply pressure to the nearest pressure point
(e.g., brachial artery for arm injuries).
3. Apply a Tourniquet: If bleeding cannot be controlled with pressure, apply a tourniquet
above the wound site. Ensure it is tight enough to stop bleeding but not so tight as to cause
further injury.
4. Monitor Vital Signs: Keep the casualty warm and monitor for signs of shock.
5. Seek Immediate Medical Help: Transport the casualty to a medical facility as soon as
possible.

5. Management of Internal Bleeding

Internal bleeding may not be immediately visible. Signs include:Pain or tenderness in the affected
area.
• Swelling or bruising.
• Signs of shock.
First Aid Measures:
1. Lay the Casualty Down: Position the casualty flat on their back with legs elevated to
improve circulation.
2. Keep the Casualty Warm: Cover with a blanket to prevent hypothermia.
3. Monitor Vital Signs: Watch for changes in pulse, breathing, and consciousness.
4. Seek Immediate Medical Help: Transport the casualty to a medical facility without delay.
Management of Shock
What is Shock?
Shock is a life-threatening condition where the circulatory system fails to deliver enough
oxygenated blood to the body’s vital organs. If not treated promptly, it can lead to organ failure
and death.

Types of Shock

Type Cause

Hypovolemic Loss of blood or fluids (e.g. bleeding, burns,

Shock dehydration)

Cardiogenic Shock Heart failure (e.g. heart attack)

Anaphylactic
Severe allergic reaction
Shock

Septic Shock Severe infection leading to low blood pressure

Neurogenic Shock Damage to the nervous system (e.g. spinal injury)

Electric Shock Due to electrical current passing through the body

Signs and Symptoms of Shock

• Cold, clammy, pale skin
• Rapid, weak pulse
• Shallow, rapid breathing
• Nausea or vomiting
• Thirst
• Dizziness or fainting
• Confusion, anxiety, restlessness
• Cyanosis (bluish lips or fingertips)
• Loss of consciousness (in severe cases)

Objectives of Shock Management

• Restore oxygen and blood flow to vital organs
• Prevent worsening of the casualty’s condition
• Keep the casualty calm, warm, and conscious
 • Arrange for immediate medical assistance

First Aid – Management of Shock

Step-by-Step Procedure:
1. Ensure Safety
o Remove the casualty from danger (e.g. fire, electric source).
o Wear gloves if available to protect against blood exposure.
2. Lay the Casualty Down
o Position them on their back.
o If there’s no head, neck, or spine injury suspected, elevate the legs ~12 inches to
improve blood flow to the heart.
3. Loosen Tight Clothing
o Around the neck, chest, and waist for comfort and easier breathing.
4. Keep Warm
o Cover the casualty with a blanket or jacket to prevent heat loss.
o Avoid overheating (e.g. do not apply direct heat).
5. Reassure the Casualty
o Keep them calm to avoid worsening the shock due to stress or panic.
6. Treat Underlying Cause
o Control bleeding (apply pressure).
o Treat burns, fractures, or allergic reactions (if trained).
7. Do Not Give Food or Drink
 o In case surgery is needed or if they become unconscious.
8. Monitor Vital Signs
o Check pulse, breathing, level of consciousness regularly.
9. Call for Medical Help Immediately
o Inform ship’s medical officer or arrange for emergency evacuation if on a vessel.

DO NOT:
• Raise legs if there’s chest injury, suspected spinal injury, or leg fractures.
• Give fluids by mouth.
• Leave the casualty unattended.

Emergency Shock Management Kit (onboard ships)

As per STCW and DG Shipping Guidelines, the first aid kit on ships must include:
• Sterile gauze and bandages
• Blankets
• Gloves
• CPR mask
• Splints
• Tourniquets
• Oxygen (if available)

Ongoing Care
• Continue to monitor the casualty until professional medical help arrives.
• Be prepared to perform CPR if breathing or heartbeat stops.

Burns, Scalds & Electrical Accidents –

Elementary First Aid (EFA)

PART 1: BURNS AND SCALDS

 What are Burns and Scalds?
• Burns are injuries caused by dry heat (fire, hot objects, chemicals, radiation).
• Scalds are caused by moist heat (steam, boiling liquids).

Classification of Burns (By Depth)

Degree Description Appearance Pain

1st
Superficial (epidermis) Red, dry, no blisters Painful
Degree

2nd
Partial thickness Blisters, red, moist Very painful
Degree

3rd Full thickness (epidermis + White, charred, Painless (nerve

Degree dermis) leathery damage)

Signs & Symptoms

• Pain, redness, blistering (early)
• Swelling and fluid loss
• Pale, cold skin in severe burns (shock)
• Breathing difficulty (if inhaled smoke)
• Possible unconsciousness in severe cases
 First Aid Management
General Rules:
1. Ensure Safety – Remove casualty from source of burn.
2. Cool the Burn – Use cool running water for at least 10 minutes.
3. Remove Clothing/Jewelry – Only if not stuck to burn area.
4. Cover the Burn – Use sterile, non-fluffy dressing (cling film is ideal).
5. Do NOT:
o Use ice directly.
o Break blisters.
o Apply butter, oil, or creams.
6. Treat for Shock – Lay the person down, elevate legs, cover with blanket.
7. Refer to Hospital – Especially if:
o Burn is deep or larger than the casualty’s palm.
o Burn is on face, hands, feet, groin, or joints.
o Electrical or chemical burn.

Special Cases
• Chemical Burns: Wash thoroughly with water for at least 20 minutes. Avoid
contaminating yourself.
• Inhalation Burns: Remove to fresh air, monitor breathing. Administer oxygen if trained.
 PART 2: ACCIDENTS CAUSED BY ELECTRICITY

Causes of Electrical Injuries

• Direct contact with live wires or terminals
• Faulty or wet electrical equipment
• Lightning strikes
• Damaged cables or poor insulation on vessels

Dangers of Electric Shock

• Cardiac arrest (ventricular fibrillation)
• Burns at entry and exit points
• Muscle contractions causing fractures
• Respiratory failure
• Unconsciousness or death

First Aid Management of Electric Shock

Step-by-Step:
1. Ensure Safety
o Do NOT touch casualty until power source is disconnected.
o Switch off the power or use non-conductive object (wood, plastic) to separate
casualty from source.
2. Check Response
o Check consciousness, breathing, and pulse.
3. CPR if Needed
o If casualty is not breathing or has no pulse, begin CPR immediately.
4. Treat Burns
o Check for entry and exit wounds.
o Cool burns with water, cover with sterile dressing.
5. Treat for Shock
o Keep the casualty warm and still. Elevate legs unless spinal injury is suspected.
6. Monitor
o Check vital signs and stay with the casualty until help arrives.
7. Hospital Referral
o All electrical injuries should be referred for medical attention, even if casualty
appears normal.

Possible Outcomes of Electrical Injury

• Cardiac arrhythmias
• Neurological damage
• Deep tissue burns
• Respiratory complications
• Unconsciousness

First Aid Kit Essentials (Relevant for Burns & Electrical Injuries)
• Sterile non-adhesive dressings
• Burn gel (if available)
• Cling film (plastic wrap)
• Scissors
• Disposable gloves
• CPR mask or face shield
• Blanket
 Rescue and Transport of a Casualty

Objective
The goal of rescue and transport is to safely move an injured or ill person from a dangerous
or inaccessible location to a safer area or medical facility, without causing further injury.

Key Principles
• Safety First: Ensure the safety of the rescuer and the casualty.
• Minimize Movement: Only move the casualty if necessary (e.g., fire, water, toxic gas).
• Spinal Precautions: Always assume spinal injury unless proven otherwise.
• Use Proper Techniques and Equipment: Prevent further harm to both rescuer and
casualty.

Situations Requiring Immediate Rescue

• Fire on board
• Explosion
• Flooding
• Toxic gas release
• Electrical hazard
• Confined space accident

General Procedure for Rescue

1. Assess the Scene
 o Ensure the area is safe.
o Wear protective equipment (gloves, helmet, mask if needed).
2. Assess the Casualty
o Check for consciousness, breathing, bleeding, and pulse.
o Look for spinal, head, or limb injuries.
3. Stabilize Before Moving
o Provide essential first aid (control bleeding, CPR if needed).
o Immobilize fractures or suspected spinal injuries before moving.
4. Select Appropriate Method of Transport
o Based on casualty’s condition and availability of equipment.

Equipment Used (Onboard Ships)

• Stretcher (standard or scoop)
• Spinal board
• Neck collar
• Blanket, straps, belts
• Improvised tools (e.g., plank, door, rope sling)

Methods of Rescue & Transport

1. One-Person Techniques
• Shoulder Drag: Used in confined spaces or when casualty is unconscious.
• Blanket Drag: Place casualty on a blanket and drag from danger zone.
• Fireman’s Carry: Effective for short distance; only if no spine injury.
• Cradle Carry: For conscious child or light adult.

2. Two-Person Methods
• Four-Handed Seat: Conscious casualty, no injuries to arms or spine.
• Two-Handed Seat: Better support for unconscious or heavier casualty.
• Chair Carry: For moving casualty downstairs or narrow passages.

3. Stretcher Carry
• Best for spinal injury or unconscious casualties.
• Requires minimum 2 people, preferably 4.
• Secure head and body before lifting.
 • Maintain horizontal alignment for spinal injuries.

Transport Considerations (on Ships)

• Use ramps/ladders carefully
• Coordinate movement with proper communication
• Keep casualty flat unless breathing difficulty demands propped position
• Avoid sudden jerks or drops

Special Situations

Situation Action

Use spinal board, collar, log-roll

Spinal Injury
technique

Fractures Immobilize limb before moving

Unconscious, but
Recovery position before transport
breathing

Cardiac Arrest CPR on-site before any movement

Priorities During Transport

1. Maintain airway, breathing, circulation
2. Prevent further injury
3. Avoid unnecessary delays
4. Constant monitoring of vital signs
5. Communicate condition to medical team or officer