CWS 1: NATIONAL SERVICE TRAINING PROGRAM 1

HEALTH PROGRAM, FIRST AID AND BASIC LIFE compression to try to restart the heart. Place your hand flat
just above the point where the ribs meet the breastbone.
SUPPORT
• Bring the other hand on top of it and lock your fingers
together. With your arms straight, press down firmly on the
• First aid refers to the immediate, direct treatment of an injured breastbone, pushing it down by 4-5 cm. Release the pressure
person. Anyone with a basic understanding of medical and repeat the compressions at a rate of about 80 per minute.
treatment can administer aid at the first signs of trouble. If the person is also not breathing, alternate 15 compressions
• Simple procedures may include stopping blood loss by with two breaths until help arrives.
applying pressure, dressing a wound, treating a burn with • Stop bleeding by applying firm pressure to the wound for
ointment, or setting a bone with a splint. about 15 minutes. Never use a tourniquet.
• Some types of first aid, such as performing cardiopulmonary
resuscitation (CPR), require an individual to receive
The Recovery Position
specialized training from an accredited first aid program.
Many minor injuries can be overcome with simple, immediate • This is the best position for an unconscious person or
medical attention. someone having a fit. It allows them to breathe easily and
• A small cut, burn, or blister, for instance, can be attended to prevents them from choking.
by thoroughly cleaning the injury, applying a topical antibiotic • After checking the ABC, bend the nearest arm to you, putting
cream, and covering it with breathable bandage or wrap. the hand by the head. Then bring the far arm across the chest
• Treating bruises, muscle strains, swelling, and animal bites and hold both hands in one of yours. With your other hand
usually involves icing and compressing the injuries, as well as pull the furthest legs up at the knee and roll the person
taking over-the-counter anti-inflammatory or pain medication. towards you to lie in this position.
• Try out the positions for all these first aid procedures now with
Victim Assessment a friend. Better still, join a first aid class if any are available.
St. John’s Ambulance has many groups around the world on
• In first aid, usually we like to call the person getting hurt a a day your knowledge of first aid may save a life!
casualty instead of a victim. The first part of the assessment
of the casualty is the Primary Survey.
✓ A Check the AIRWAYS First Thing First
✓ B BREATHING • In an emergency any number of things may need your
✓ C and CIRCULATION (and BLEEDING) attention at the same time. If you try to do everything at once
• Before assessing the casualty, you will want to do an you may easily get distracted from the essential matters. On
Emergency Scene survey, and call for help. arriving at the scene…
1) Assess the situation
2) Take in quickly what has happened
Airway
3) Look for dangers to yourself and to the casualty
• The airway of an unconscious person may be narrowed or 4) Make the area safe
blocked, making breathing difficult and noisy or impossible. 5) An unconscious person always takes priority and needs
This happens when the tongue drops back and blocks the immediate help to make sure he or she can breathe.
throat. Lifting the chin and tilting the head back lifts the tongue Only then should you begin to assess any injuries
away from the entrance to the air passage.
• Place two fingers under the person’s chin and lift the jaw, Bleeding and Wounds
while placing your other hand on the forehead and tilting the
head well back. If you think the neck may be injured, tilt the External Bleeding
head very carefully, just enough to open the airway.
• External bleeding from a cut or scratch may be so minor that
treatment is unnecessary. In contrast, a more extensive
Breathing wound or cut may produce so much bleeding that stitches are
• Check for breathing by placing your head near the person’s required.
nose and mouth. Feel the breath on your cheek or moisture • Once the bleeding has stopped, however, this type of
on the back of your head. hemorrhage does not pose a threat to health. Still, there are
• If a person has just stop breathing use mouth to mouth some types of external bleeding that indicate a serious
ventilation, make sure the airway is open and head tilt back. medical problem that requires prompt attention.
Pinch the nostrils together, take a deep breath and blow into
the mouth, firmly sealing your lips around the mouth so air is First Aid
not lost. You should see the chest rise. • The three main principles of the treatment of external bleeding
• Remove your lips and let the chest fall. Continue this, giving are:
about ten breaths every minute until help arrives or breathing 1. Look
begins. 2. Apply
3. Elevate
1) Look at the wound to check how large it is. Check that the
Circulation wound has nothing in it (such as debris or a foreign body).
• Check for circulation (to see ifthe heart is still beating) by 2) Apply direct pressure to the wound. If the victim is able to
feeling for the Adam’s apple (lump on the windpipe) with two press on the wound, encourage him or her to do so. If not,
fingers. Slide the fingers to the side of the windpipe and feel then apply direct pressure yourself, initially with your fingers
for the pulse. If the heart has stopped beating use chest and, if you have it handy, with a sterile dressing or a piece of
clean cloth.
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3) Applying direct pressure to the wound enables the blood to • The most common accidents resulting in open wounds are
clot and therefore stems the blood flow from the cut. Once falls, mishandling of sharp objects, accidents with tools or
applied, a sterile dressing (or whatever you have handy) machinery, and car accidents
should ideally be held in place with a firm bandage or
improvised bandage such as a scarf or tie. First Aid Management
4) Elevate the part with the wound. If the injury is an arm or leg, • Control Bleeding
raise the wound above the level of the heart. It is harder for • Cover the wound
the blood to pump upward and this therefore reduces the • Care for the shock
blood flow and thus the fluid loss from the body. • Consult or refer to physician
5) Treat for shock. Keep the victim warm and continually at rest.
Reassure the victim. Home Care (Wounds With Bleeding Not Severe)
• Clean the wound with soup and water
Internal Bleeding • Apply mild antiseptics
• Is bleeding occurring inside the body. It can be a serious • Cover wounds with dressing the bandage
medical emergency depending on where it occurs (e.g. brain,
stomach, lungs), and can potentially cause death and cardiac Causes
arrest if proper medical treatment is not received quickly. • Blunt object that may result in contusion or bruises
• Once the bleeding has stopped, however, this type of • Application of external forces
hemorrhage does not pose a threat to health. Still, there are
some types of external bleeding that indicate a serious Close Wounds
medical problem that requires prompt attention.
• A wound is an injury that causes either an internal or external
Signs and Symptoms break in body tissue. An open wound (as in a knife cut) is a
• The person is known to have had an accident (not necessary break in the skin or mucous membrane.
in the immediate past) • The most common accidents resulting in open wounds are
• Signs and symptoms of shock falls, mishandling of sharp objects, accidents with tools or
machinery, and car accidents
• Bruising
• Boarding – this most commonly occurs where there is
Signs and Symptoms
bleeding into the stomach area; the quantity of blood
• Pain and tenderness
combined with the tissues swelling result in rigidity to the
tissues. • Swelling
• Swelling • Discoloration
• Bleeding from the body orifices • Hematoma
• Uncontrolled restlessness
First Aid • Thirst
1) Call or get someone to call emergency services. Don’t wait to • Symptoms of shock
see if the person improves or deteriorates. • Vomiting or cough-up blood
2) If available put synthetic gloves on as bleeding may become • Passage of blood in the urine or feces
apparent. • Sign of blood along mouth, nose and ear canal
3) Check airway, breathing and circulation. Begin
cardiopulmonary resuscitation (CPR) if necessary. If you want First Aid Management
to understand CPR in more depth then go to CPR – Q’s & • Iced application
A’s. • Compression
4) If unconscious and breathing – place the person in the • Elevation
recovery position and with legs higher than the heart if • Splinting
possible. Injuries permitting.
5) If conscious – lie the casualty down and raise or bend legs if 1) Calm the person, lay him/her, and cover with blanket.
injuries permit. 2) Stop the bleeding, see bleeding (severe) and shock
6) Keep casualty warm. This may help delay the onset of shock 3) Wrap amputated part in a clean and dry cloth then put it into a
by minimizing the bodies‟ heat loss. waterproof plastic bag.
7) Reassure and stay calm. This helps provide security for the 4) Close this bag and put it into another bag that contains cool
injured person. water/ice.
8) Continue to check pulse and breathing. 5) Do not give alcohol, cigarettes or food to casualty (in case of
9) Treat other injuries as appropriate. a surgery in hospital).
10) Do not give anything to eat or drink as they may require 6) Do not freeze the amputated part (just keep it cool).
surgery to stop bleeding.
Animal Bites
Open Wounds
• Any animal bite requires medical attention. Deep bites can
• A wound is an injury that causes either an internal or external cause serious wounds, severe bleeding, and tissue damage,
break in body tissue. An open wound (as in a knife cut) is a while all animal bites can cause infection.
break in the skin or mucous membrane. • Puncture wounds from teeth carry infection deep into the
tissue, while scratches are also an infection risk. The human
bite is among the most infectious.
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3) Save any empty container, spoiled food analysis.

Treatment 4) Save any vomits and keep it with the victim if the person is
• The priority is to ensure the safety of yourself and bystanders. taken to an emergency facility.
If the animal is still a risk, do not approach it but call the local
Animal Control Service through your police department. Carbon Monoxide
• Carbon monoxide (sometimes referred to as CO) is a
Nose Bleeding colorless, odorless gas produced by burning material
• Nose bleeds are often the result of common events, usually containing carbon. Carbon monoxide poisoning can cause
trauma, but nose bleeds can be a warning of other problems. brain damage and death. You can’t see it, smell it, or taste it;
• Nose bleeds are caused by a small blood vessel rupturing. but carbon monoxide can kill you.
There are two main types of nose bleed: upper and lower
nose bleeds. Symptoms
• Headache
First Aid • Dizziness
1) If your nose bleeds • Nausea
2) Sit down and lean forward • Flu-like symptoms, fatigue
3) Using your thumb & index finger, squeeze soft part of nose • Shortness of breath on exertion
4) This part is between end of nose and the bridge of nose • Impaired judgment
5) Continue holding till bleeding stops • Chest pain
6) Do not stop in-between
• Confusion
7) If bleeding continues, hold for another 10 minutes
• Depression
8) If the patient is a child, divert attention by TV/Stories
9) Avoid picking, blowing or rubbing nose for 2 days • Hallucinations
10) Place an ice pack on the bridge of nose • Agitation
• Vomiting
• Abdominal pain
Burns
• Drowsiness
• Burn is an injury involving the skin, including muscles, bones, • Visual changes
nerves and blood vessels. This results from heat, chemicals, • Fainting
electricity or solar or other forma of radiation. • Seizure
• Memory and walking problems
First Aid
For Minor Burns First Aid
1) Cool the burn. Hold the burned area under cool (not cold) 1) Firstly, stay calm and act quickly.
running water for 10 or 15 minutes or until the pain subsides. 2) Immediately, leave the area and get fresh air.
2) Cover the burn with a sterile gauze bandage. Don’t use fluffy 3) Turn off the source of carbon monoxide if it can be done
cotton, or other material that may get lint in the wound. safely.
3) Take an over-the-counter pain reliever. These include aspirin, 4) Call your local emergency medical services.
ibuprofen (Advil, Mortin, others), naproxen (Aleve) or 5) If severely affected, administer oxygen with a tight mask once
acetaminophen (Tylenol, others). the ambulance arrives.
6) Watch for the symptoms and give symptomatic treatment.
Caution 7) If the victim is unconscious, check for the ABC’s of life and
• Don’t use ice. Putting ice directly on a burn can cause a burn get him to an open area for fresh air.
victim’s body to become too cold and cause further damage 8) Call for medical help immediately.
to wound. 9) Hospitalization is necessary.
• Don’t apply butter or ointments to the burn. This could cause 10) Usually the victim is placed in a compressed, pressurized
infection. chamber with oxygen.
• Don’t break blisters. Broken blisters are more vulnerable to 11) This helps in replacing the carboxyhemoglobin with oxygen.
infection. 12) This proceeded is called hyperbaric oxygen therapy.

Poisoning Basic Life Support

Swallowed Poison CPR (or Cardiopulmonary Resuscitation)
• Poison is any substance: solid, liquid or gas that tends to • Combination of rescue breathing (mouth-to-mouth
impair health or cause death when introduced into the body or resuscitation) and chest compression. If someone isn’t
onto the skin surface. A poisoning emergency can be life breathing or circulating blood adequately, CPR can restore
threatening. circulation of oxygen-rich blood to the brain.
Causes: • Without oxygen, permanent brain damage or death can occur
• Common in suicide attempts in less than 8 minutes.
• Occasional accident poisoning • CPR may be necessary during many different emergencies,
including accidents, near-drowning, suffocation, poisoning,
First Aid smoke inhalation, electrocution injuries, and suspected
1) Try to identify the poison. sudden infant death syndrome (SIDS).
2) Place the victim on its left side.

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• Tips: Use CPR any time a victim’s breathing and heart beat food may go down the wrong way (go into the windpipe
have stopped. Use rescue breathing whenever there is pulse instead of food pipe) and cause choking.
but no breathing. • The danger of choking increases if the person has been
drinking alcohol and becomes careless about chewing food
Sign of Successful COR well.
1) Trying to swallow large pieces of food
• Chest rise and fall with each recue breath 2) Drunkenness
• Checking pulse after the 1st minute of CPR and every few 3) Wearing dentures
minutes to determine if the pulse has return 4) Eating too fast
• Having a rescue feel for carotid pulse while giving chest 5) Eating while laughing and talking
compression 6) Walking, running or playing with objects in the mouth

When To Stop CPR Types of Upper Airway Obstruction

• When a doctor – or some other appropriate emergency • Tongue: Relaxed tongue muscle of an unconscious victim
medical provider – tells you to stop. may slip or fall to the airway then cause obstruction. This is
• When you become exhausted and cannot continue (this gets the most common causes of obstruction.
messy, as we’ll see below). • Vomit: When at or near death, most people vomit.
• When the victim begins yelling at you to stop hitting him in the • Foreign Body: The shape of consistent nuts, candy hotdogs
chest (this really happens). In other words, when the victim and grapes have been become the primary reason why
gets better. children accidentally inhale this objects.
• Swelling: Victims who suffer allergic reactions (anaphylaxis)
When Not To Stop CPR and irritants tend to experience swelling of the throat leading
to obstruction of airway
• Situations where attempts to perform CPR would place the • Spasm: If a person accidentally inhaled water, the throat
rescuer at risk of serious injury or mortal peril starts to spasm. This usually happens when someone is
• Obvious clinical signs of irreversible death (e.g. Rigor mortis, drowning.
dependent lividity, decapitation, transaction, or
decomposition)
• A valid, signed, and dated advance directive indicating that Infant CPR
resuscitation is not desired, or a valid, signed, and dated STEP 1: CIRCULATION
DNAR order. 1) Place the baby gently on a flat surface, like a table or the
floor. CPR should always be done placing the victim on a flat
Recovery Position surface.
2) Gently place two of your fingers in the middle of the chest of
• Roll the victim onto side (if no evidence of head and neck the baby. To understand the exact point, imagine seeing a
injury) horizontal line going through the chest of the baby, dividing
• Place lower arm behind back his/her nipples! You need to pace your fingers (2 fingers of
• Place hand on upper arm under the chin one hard) in the center of the chest just below this horizontal
• Flexor bend the top leg line!
3) With the help of two fingers, gently compress the chest of the
Dangerous Complication of CPR baby. Dig your fingers about 1.5 inches deep into the chest
and pump about 100 compressions within a minute that is
• Vomiting about 16 compressions per 10 seconds. You can also count
• Stomach distension aloud to keep a track.
• Inhalation of foreign substances (aspiration)
• Chest compression related injuries STEP 2: AIRWAY
• Dentures, loose or broken teeth or dental appliances. 1) After the compressions to restore blood circulation in the
infant, the next step would be to clear the airways of the infant
allowing him/her to breath. You can do this after 30
Foreign Body Obstruction (Chocking)
compressions by gently tilting the head of the infant back by
• Choking is the physiological response to sudden airways lifting his/her chin with one hand and pushing the forehead
obstruction. Foreign Body Airway Obstruction (FBAO) causes down the other hand.
asphyxia and is terrifying condition, occurring very accurately, 2) Make sure that you don’t tilt the head way too much. It may
with the patient often unable to explain what is happening to prove to be harmful for the infant.
them. 3) Within 10 seconds of lifting the chin of the infant, check for
• If severe, it can result in rapid loss of consciousness and movements in the chest and breathing. Do this by placing
death if first aid is not undertaken quickly and successfully. your ears and cheeks in front of the baby’s mouth and nose.
Immediate recognition and response are of the utmost
importance. STEP 3: BREATHING
1) If there are still no signs of breathing, then the next step would
Causes of Chocking be to cover the infant’s nose and mouth with your mouth and
provide the infant with the rescue breathing!
• Choking is most common in children. A marble, button or food
may get in the air passage and cause blockage. In adults too,

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2) Slowly breathe into the infant and blow gentle puffs of air by • Jerky or jobbing compression rather than smooth ones
taking a second for a single breath! While you do this, also
check for the rise in the infant’s chest.
3) If you see the bay’s chest rising, then give the second rescue
breath. If the chest is not rising, then you will have to repeat
Step #2 and then again go for the rescue breathing!
4) It is advisable to give the infant two rescue breaths within a
period of every 30 compressions. Continue to do this until
help arrives!

Adult CPR
1) Attempt to wake victim. If the victim is not breathing (or is just
gasping for breath), call 911 immediately and go to step 2. If
someone else is there to help, one of you calls 911 while the
other moves on to step
2) Begin chest compressions. If the victim is not breathing, place
the heel of your hand in the middle of his chest. Put your other
hand on top of the first with your fingers interlaced. Compress
the chest at least 2 inches (4-5 cm). Allow the chest to
completely recoil before the next compression. Compress the
chest at a rate of at least 100 pushes per minute. Perform 30
compressions at this rate (should take you about 18 seconds).
3) Begin chest compressions. If the victim is not breathing, place
the heel of your hand in the middle of his chest. Put your other
hand on top of the first with your fingers interlaced. Compress
the chest at least 2 inches (4-5 cm). Allow the chest to
completely recoil before the next compression. Compress the
chest at a rate of at least 100 pushes per minute. Perform 30
compressions at this rate (should take you about 18 seconds).
4) If you don’t feel comfortable with this step, just continue to do
chest compressions at a rate of at least 100/minute.
5) Repeat chest compressions. Do 30 more chest compressions
just like you did the first time.
6) Repeat rescue breaths. Give 2 more breaths just like you did
in step 3 (unless you’re skipping the rescue breaths).
7) After 2 minutes of chest compressions and rescue breaths,
stop compressions and recheck victim for breathing. If the
victim is still not breathing, continue CPR starting with chest
compressions.
8) Repeat the process, checking for breathing every 2 minutes
(5 cycles or so), until help arrives. If the victim wakes up, you
can stop CPR.

Common CPR Mistakes

Rescue breathing (mouth to mouth) mistakes:
• In adequate head tilt
• Failing to pinch the nose shut
• Not giving slow breaths
• Failing to watch chest and listen for chest exhalation
• Failing to maintain tight seal around victim’s mouth and or
nose

Chest compression mistakes:

• Pivoting at knees instead of hips
• Wrong compression site
• Bending elbows
• Shoulders not above sternum
• Fingers touching chest
• Heel of bottom hand not in line with the sternum
• Placing palm rather than the heel of the hand on sternum
• Lifting hands off chest between compression (bouncing
movement)
• Incorrect compression rate
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