First Aid

Introduction

In an emergency situation it is likely that you and the people around you will be stressed and under pressure. It is normal to feel worried and anxious but it is how you react to these pressures that will affect how well you manage these situations. Keeping calm is an important first step. Being calm will also help others, remember psychological support is important. Knowing you have the equipment and skills will help enormously with your level of confidence. You may be faced with injuries or illness either for yourself or your family. You have already taken one step towards ensuring you can manage by selecting a Survive-it Survival Kit. This will provide you with a good level of first aid equipment and with additional medical items included as recommended in Appendix 10, you can start to take control of a situation. This medical section provides you with standard advice for most basic medical emergencies. The advice in this booklet is based on internationally recommended practices. The information in this booklet, however, is no substitute for experience and we recommend that you or at least one member of your family acquire basic first aid skills from a reputable training organisation. It is also recommended that wherever possible trained medical advice is sought. This chapter will help you manage a medical situation until qualified advice can be obtained. The following section cannot cover medical advice for all injuries and illnesses; however, it covers information on the main situations you may have to deal with in an emergency. You should always seek professional medical advice.

Prioritise and assess the situation

In an emergency situation it is important that you look after yourself and make sure you are safe. It is important to minimise the number of people injured. Think first, putting yourself in danger may prevent you from being able to provide valuable help to others. You may be faced with the need to assess the injuries around you. It is important that you prioritise these calmly and rationally. A calm and systematic approach should be adopted. Move only if there is further danger

DO NOT move injured persons unless the situation is life threatening. However, you may need to move to make sure that you and they are safe so that you can proceed with further first aid measures. Make sure there are no fire or gas hazards or further danger of falling objects etc. People with broken bones should not be moved until a splint has been properly applied. Handle the person as little and as gently as possible to prevent further damage to the affected part and to prevent further shock.
Prioritise your treatment: Make an assessment of the person to assess the extent of injury, check breathing, heart and check for serious bleeding. If a person is suffering several injuries you should prioritise your treatment.

• Restore and maintain breathing.
• Maintain heartbeat.
• Stop further bleeding.
• Protect wounds.
• Immobilise fractures.
• Treat for shock.
• Check for emergency medical identification on the person.
• Get professional medical help quickly.
• Loosen any clothing that may restrict breathing or interfere with circulation.

NOTE: it may be necessary to stop serious bleeding first if the patient is in imminent danger of bleeding to death.

Emergency and Trauma situations

Breathing Problems: Breathing problems may have a number of causes such as blockage of the upper air passages, choking, inhalation of smoke, heart attack, electrocution. The symptoms may be a shortage of breath, dizziness, chest pain, rapid pulse, bluish-purple skin colour, dilated pupils and unconsciousness. How to check for breathing

1. Listen for breathing with your ear over the mouth and nose.
2. Normal breathing is quiet and easy. Noisy breathing indicates potential problems.
3. Watch for movement of the chest or abdomen.
4. Check colour of lips for an unnatural blue/grey tinge.

Treatment if the person has stopped breathing – Artificial Respiration

1. Lay victim flat on back. Tilt the head back with one hand to open airway, while placing two fingers of the other hand under the chin.
2. Clear airway, using your fingers in a hooked fashion to remove any solid or liquid obstructions. This may be sufficient to relieve any obstruction and enable breathing. The person may start to breath naturally.
3. Look, listen, and feel for breathing movement for 5 seconds. Begin artificial respiration at once. To be able to carry this out effectively it is best to be trained in the method. Artificial respiration training is available with most recognised first aid courses.
4. If breathing is absent, pinch person’s nostrils closed, take a deep breath, seal your lips completely cover the person’s mouth to make a good seal and give two slow, full breaths.
5. Check to see that the chest is rising as it fills with each of your breaths. If it does not fill then tilt the head back a little further to open the airway.
6. Check for pulse in neck and for signs of breathing.
7. If pulse is present: For adults – continue rescue breathing at a rate of one strong breath every five seconds. Re-check for pulse and breathing every twelve breaths. For infants and small children – breathe shallow breaths at a rate of one every three seconds or 20 per minute.
8. Don’t Give Up: – The first few minutes of resuscitation are the most critical and recovery is often rapid. However should the problem be more serious you should keep up artificial respiration for at least an hour. This can be tiring so you should try to take turns with another person where possible. Always remember to keep checking the heartbeat.

Treatment if a person has stopped breathing and there is no pulse – Cardio Pulmonary Resuscitation

1. If there is no improvement and the pulse is not present, begin Cardiopulmonary Resuscitation (CPR). This should be undertaken by a trained first aider. For adults put hands over each other and press firmly and rapidly on the middle part of the lower breastbone. Exert enough pressure to press down the breastplate 1 1/2 to 2 inches. Continue compressions at a rate of half a second duration, 60 times a minute (that is “one and two and…”). Artificial respiration should be continued whilst giving CPR. Every fifteen compressions should be followed with a pause by two resuscitation breaths. If two people are available then one can give CPR and the other artificial respiration at the normal rates recommended above.
2. When heart beat returns then face and lips will improve in colour. Check again for sound of a heartbeat. If heartbeats are heard then stop CPR but continue artificial respiration until normal breathing is restored. Continue to monitor the patient.

Note it is possible to carry out CPR for children however they should be treated carefully. Professional help should always be sought wherever possible.

1. For children Use only the heel of one hand to apply pressure to the breastplate 1 to 1 1/2 inches. Children require a higher rate of CPR than adults. Continue compressions at a rate of 100 per minute “one, two, three…” Every five compressions should be followed without a pause by one rescue breath.
2. For infants… Use only fingertips. Apply moderate pressure to depress breastplate 1/2 to 3/4 inches. Continue compressions at a rate of at least 100 per minute. Every five compressions (3 seconds) should be allowed without a pause by one rescue breath.

Choking or blocked/obstructed airway

Indications of choking may be a forceful cough, wheezing, inability of the person to speak or breathe and they may turn blue and lose consciousness. The person may be able to indicate their distress by grasping their neck. If a person has only a mild or partial blockage with a good airway, encourage them to cough to expel blockage so long as ability to breathe is maintained. Do not interfere with them, check that they are ok. If there is partial or complete blockage of the airway and person is unable to breathe or having difficulty breathing or requests assistance perform the Heimlich manoeuvre:

1. Stand slightly behind the person with your arms around there waist.
2. Put the thumb side of your fist above the person’s navel and below the lower end of the breastbone.
3. Take hold of your fist with your free hand and pull your fist upwards and in with a quick and firm movement.
4. Continue with this process until the object is freed or the airway is clear.

Infants should be treated differently.

1. Place infant face down on your forearm supporting the head and neck with your hand. Rest your hand on your knee with the infant’s head lower than its body. With the heel of your hand give four blows between the infant’s shoulder blades. Turn infant over, place two fingers on the centre of the infant’s chest (just below the nipples) and perform up to five chest thrusts. Repeat until obstruction is clear.
2. Seek medical attention after choking since complications may arise.

Treating Major Wounds

Three things need to be considered when treating major wounds.

Firstly quickly control major bleeding. Follow instructions for severe bleeding in Section 7.3.1 above.

Prevention of shock. Follow instructions for shock in Section 7.3.6.

Prevent infection.

1. Open wounds are at risk of infection. It is wise to ensure that you have tetanus immunisation, seek advice on this from your medical practitioner. Before treating an open wound you should wash your hands thoroughly.
2. If there are any foreign materials in the wound these should be left for professionals to deal with.
3. If there are large penetrating objects do not remove these. The object should be immobilised with clean dressings and bandages to prevent further damage occurring.
4. Clean the area around the wound and then clean the wound from the inside out to prevent contamination from around the wound. Use mild soap and water with a sterile pad. Do not use antiseptics on deep wounds.
5. Cover the wound with a clean sterile, dry dressing slightly bigger than the wound and immobilise in a position that is comfortable.
6. Severed body parts should be stored in a something clean and sent to a hospital with the injured person. Keep severed parts cool by placing in a container and then in ice if available. Keep ice out of direct contact with the body part.

Broken Bones – Fractures

Fractures can be breaks with the separation of pieces or may be cracks in a bone with no separation. In addition fractures may be open to infection or closed with no contact with the surface of the body. Open fractures are at risk of serious infection. How to determine if a fracture is present.

The following signs and symptoms may help indicate a fracture is present:

• Following a heavy blow the person may have heard the bone break.
• Severe pain which is normally aggravated by the limb or person being moved.
• Loss of use, the person may be unable or unwilling to move the affected area.
• Abnormal position or unusual movement.
• Deformity of the limb, irregular shape or swelling.
• Sensitivity particularly in one area.
• Swelling particularly in or around the site of the suspected fracture.
• A grating noise may be heard on movement – you should never move a limb to check for this noise if a fracture is suspected.

If medical help is expected then you should immobilise closed fractures and leave for medical professionals to deal with. Attempts to straighten limbs can cause further injury and risk later healing.

Do not move a person with a fracture until a splint has been applied to prevent further injury or damage. If there is a suspected fracture to the neck or spine Pain in back of neck and loss of feeling in lower limbs do not move the person. Immobilise with soft, firm objects to prevent movement of the head and body. Seek urgent medical attention. Treatment of a closed fracture

1. Keep person still and warm and treat for shock.
2. Treat bleeding.
3. Rest the affected area and immobilise to prevent further damage, reduce pain and stop further bleeding. mobilise the limb above and below the fracture site and if possible immobilise in the position it is found until help can arrive. Many materials can be used to form a splint, sticks, rolls of newspaper, broomsticks, using another part of the body, e.g. in the case of legs lash one to the other. Make sure that any hard materials used are padded to prevent further damage.
4. Check circulation regularly. Poor circulation can be identified by person complaining of numbness or loss of feeling, blue or white tinge to fingers and toes, coldness of parts below a fracture. Loosen bandages if necessary.

Treatment of an open fracture

1. Keep person still and warm and treat for shock.
2. Apply pressure to appropriate pressure point to control bleeding.
3. Do not move straighten or return limb to normal position. Do not touch or clean wound.
4. Cover wound with sterile cloth or dressing to prevent further risk of infection. Call for urgent medical assistance.
5. If it is urgent to move the person then immobilise in the position it is found until help can arrive. Many materials can be used to form a splint, sticks, rolls of newspaper, broomsticks, using another part of the body, e.g. in the case of legs lash one to the other. Make sure that any hard materials used are padded to prevent further damage and chafe.
6. Check circulation regularly. Poor circulation can be identified by person complaining of numbness or loss of feeling, blue or white tinge to fingers and toes, coldness of parts below a fracture. Loosen bandages if necessary.

Bleeding

If possible prior to any first aid situation make sure that you wear protective healthcare gloves to avoid contact with the patient’s blood.

1. Act quickly and lay the person down. Elevate the limb above the heart unless you suspect a broken limb. This will help to stop the bleeding.
2. Press where the blood comes from with a clean handkerchief. Sterile pad or clean cloth. Apply direct pressure to the wound firmly and quickly. If nothing else is available press with your hand or fist on the wound. There is a danger of infection from non sterile material however prevention of severe bleeding may be more important.
3. If pressure controls the bleeding then tie a dressing firmly around the wound to maintain the pressure and to protect the wound. Apply pressure for 5 – 10 minutes and resist the temptation to release the pressure to look. Minimise movement of the person and keep the injured part as still as possible because movement disturbs the process of the blood clotting.
4. If blood penetrates the bandage then place another one on top rather than remove the first bandage. Bandage more firmly.
5. Where possible call for professional medical help as soon as possible.
6. If you are bleeding and there is no immediate help then lie down and use your own body weight to apply pressure and call for immediate help.
7. Once bleeding has been stopped keep the person warm and cover with a blanket and monitor for shock.
8. Clean hands thoroughly when finished.

Shock

Shock can be extremely dangerous and treatment should be given a high priority. It is the body’s reaction to injury. In its mildest form it can be a feeling of faintness and in its extreme form can lead to unconsciousness. Shock can be fatal. Fear, pain and exposure can increase shock. Appearing calm and in charge of a situation will help the person. Do not leave a shock victim on their own, stay with them and hold there hand where possible to provide comfort. Shock can occur minutes or hours after an injury, you should keep a careful watch on injured persons to ensure shock does not become a problem. Shock can take a long time to pass. It is important that the person rests and does not move around unnecessarily. People may not realise that they are suffering from shock. How to identify shock.

A person may:

• Display little interest in their surroundings.
• May feel faint or shivery.
• Have skin that feels cold and clammy.
• Have a weak or rapid pulse.
• Have breathing that is rapid and shallow or may give frequent sighs.
• Lapse into unconsciousness.
• Show signs of excitement and apprehension.
• Be nauseous.

Treat causes of shock immediately with first aid i.e. bleeding

1. Maintain airway
2. Lay flat, if injuries permit
3. Loosen tight or restrictive clothing
4. Keep warm but do not overheat
5. Do not give anything by mouth, do not give fluids
6. Get professional medical help immediately

Treating Burns and Scalds

Burns are not an uncommon injury in disasters. Burns victims are susceptible to shock and infection. Extinguish any burning clothing by rolling over on the ground, covering with a blanket or item of clothing to put the flames out. Do not fan the flames. First Degree Burns

1. For first degree burns which affect the outer layer of skin (these are identified by redness or discoloration of the skin surface, some swelling and pain).
2. Immerse in cold water or apply cool wet cloths. Do not use ice. Preferably leave in cold slow running water for at least 10 minutes. This should be continued until it produces no further relief and removal does not cause an increase in pain.
3. Blot gently and apply dry sterile dressing.
4. These types of burns are not normally serious and do not require urgent medical attention but you should watch out for shock and call for assistance if necessary.

Second Degree Burns

1. Second degree burns extend to the second deeper layer of skin. Superficial second degree burns cause deep reddening, formation of blisters, considerable swelling and weeping of fluid. Deep burns are hard to tell from third degree burns and pain may be severe.
2. If possible elevate legs above heart level
3. Immerse in cold water or apply cool wet cloths. Do not use ice. Preferably leave in cold slow running water for at least 10 minutes and should be continued until it produces no further relief and removal does not cause increase in pain.
4. Under no circumstances apply any oils, ointment, grease, antiseptic or calamine lotion.
5. Blot gently and apply dry sterile dressing.
6. Give fluids to reduce those lost. Give small cold drinks frequently.
7. These types of burns may require medical treatment depending on extent and location on the body. You should watch out for shock and infection and call for assistance if necessary.

Third Degree Burns

1. Third degree burns extend to all layers of skin and can go below this and cause deep tissue damage. Third degree burns may be white, black and give the skin a charred or leathery look. Do not burst blisters. In third degree burns pain may be absent as nerve endings have been destroyed.
2. If possible elevate legs above heart level
3. Under no circumstances apply any oils, ointment, grease, antiseptic or calamine lotion.
4. Give fluids to reduce those lost. Small cold drinks given frequently are best. You should watch out for shock and call for urgent medical assistance.

Note: sunburn should be treated as for first and second degree burns.

Moving an Injured Person

As stated earlier, do not move a casualty unless absolutely necessary. If injury affects the neck or back do not move the casualty without professional medical help. The method used to move someone will depend on their injuries, state of consciousness and ability to help themselves. Before moving an injured person ensure any fractures are immobilised and severe bleeding has been stopped. If you must move a person then move the body lengthwise rather than sideways and use a blanket or coat to slide under the person so that the pull is on that rather than any of the limbs. Roll the person towards you, place the blanket under their back and roll person back onto the blanket carefully. Drag the person out headfirst rather than feet first using your improvised stretcher. If you need to lift an injured person, support each part of the body, particularly the head. Slide the person onto a firm surface if possible before lifting. Keep the body as level as possible.

Eye Injuries

If an object is impaled in the eye do not remove, call for medical help immediately.

1. Cover both eyes with sterile dressings to immobilise the eyes, (covering both eyes minimises movement of the eyes).
2. Do not rub or allow person to touch the eyes
3. Do not apply ice or other items to the eye.

To flush an eye – due to chemical or irritation but not caused by an impaled item.

1. Place person so eye is facing down.
2. Avoid flushing chemical substance from one eye to another.
3. Flush with cool or room temperature water for 15 minutes.
4. Remove contact lenses after flushing.

Chemical Burns

1. Flush affected area with cool running water for at least 15 minutes.
2. Remove any contaminated clothes or jewelry.
3. Monitor for shock and treat accordingly, Call for medical assistance.

Minor ailments and injuries

Sprains and strains

You should be cautious with identifying a sprain as there may be a fracture present. If in doubt be cautious and follow the advice for fractures. Seek medical advice wherever possible. The symptoms of a sprain will be swelling, discolouration, tenderness and painful movement. Pain is usually felt immediately although swelling may occur later. If an ankle or knee is affected the injured person should not be allowed to walk.

1. Elevate the limb.
2. Apply cold water compresses, never pack directly in ice or immerse in icy water.
3. The treatment should be given for 3 to 4 hours.
4. Allow gentle movement rather than leave for too long a period of rest, however too much stress should not be placed on the sprained limb or joint.

Cold exposure

Cold exposure can be serious.

1. If possible to move a person, move to a warm location.
2. Be on the alert for breathing difficulties and treat as necessary.
3. Remove wet or damp clothing and re-warm immediately by wrapping in blankets. You may re-warm in a tub of warm, not hot water. You should dry the person thoroughly after a bath.
4. Treat for shock as necessary.

Heat exhaustion: The person may show fatigue, irritability, headaches, significant perspiration or a weak and rapid pulse.

1. Ensure person is in shade and make sure they lie down.
2. Raise feet.
3. If person is conscious and not suffering other injuries then give cool water until they recover.
4. On recovery sit patient up slowly and carefully.