FIRST AID

I.
FIRST AID - is the initial assistance or treatment given to a person who is injured or suddenly becomes ill. The
person who provides this help may be a first aider, a first responder, a policeman or fireman, or a paramedic.
This chapter prepares you for being a first aider, psychologically and emotionally, as well as giving practical
advice on what you should and should not do in an emergency situation. The information given throughout this
book will help you give effective first aid to any casualty in any situation. However, to become a fully competent
first aider, you should complete a recognized first aid course and receive certification. This will also strengthen
your skills and increase your confidence. The American Red Cross and the American Heart Association teach a
variety of first aid courses, at different educational levels.
AIMS AND OBJECTIVES
 To understand your own abilities and limitations.
 To stay safe and calm at all times.
 To assess a situation quickly and calmly and summon the appropriate help if necessary.
 To assist the casualty and provide the necessary treatment, with the help of others if possible.
 To pass on relevant information to the emergency services, or to the person who takes responsibility for
the casualty.
 To be aware of your own needs.
BECOMING A FIRST AIDER
WHAT IS A FIRST AIDER?
First aid refers to the actions taken in response to someone who is injured or has suddenly become ill. A first
aider is a person who takes action while taking care to keep everyone involved safe and to cause no further
harm while doing so. Follow the actions that most benefit the casualty, taking into account your own skills,
knowledge, and experience, using the guidelines set out in this lecture.
Do not attempt heroic rescues in hazardous circumstances. If you put yourself at risk, you are unlikely to be able
to help casualties and could become one yourself and cause harm to others. If it is not safe, do not approach.
FIRST AID PRIORITIES
 Assess a situation quickly and calmly.
 Protect yourself and any casualties from danger—never put yourself at risk.
 Prevent cross-contamination between yourself and the casualty as best as possible
 Comfort and reassure casualties.
 Assess the casualty: identify, as best as you can, the injury or nature of illness affecting a casualty.
 Give early treatment, and treat the casualties with the most serious (life-threatening) conditions first.
 Arrange for appropriate help: call 911 for emergency help if you suspect serious injury or illness; take or
send the casualty to the hospital; transfer him into the care of a healthcare professional, or to a higher
level of medical care. Stay with a casualty until care is available.

HOW TO PREPARE YOURSELF

When responding to an emergency you should recognize the emotional and physical needs of all involved,
including your own. You should look after your own psychological health and be able to recognize stress if it
develops. A calm, considerate response from you that engenders trust and respect from those around you is
fundamental to your being able to give or receive information from a casualty or witnesses effectively. This
includes being aware of, and managing, your reactions, so that you can focus on the casualty and make an
assessment. By talking to a casualty in a kind, considerate, gentle but firm manner, you will inspire confidence
in your actions and this will generate trust between you and the casualty. Without this confidence he may not
tell you about an important event, injury, or symptom, and may remain in a highly distressed state. The actions
described in this chapter aim to help you facilitate this trust, minimize distress, and provide support to promote
the casualty’s ability to cope and recover.

The key steps to being an effective first aider are:

 Be calm in your approach

 Be aware of risks (to yourself and others)
 Build and maintain trust (from the casualty and the bystanders)
 Give early treatment, treating the most serious (life-threatening) conditions first
 Call appropriate help
 Remember your own needs

PROTECTION FROM INFECTION

When you give first aid, it is important to protect yourself (and the casualty) from infection as well as injury.
Take steps to avoid cross-contamination—transmitting germs or infection to a casualty or contracting infection
from a casualty. Remember, infection is a risk even with relatively minor injuries. It is a particular concern if you
are treating a wound, because blood-borne viruses, such as hepatitis B or C and Human Immunodeficiency Virus
(HIV), may be transmitted by contact with blood. In practice, the risk is low and should not deter you from
carrying out first aid. The risk increases if an infected person’s blood makes contact with yours through a cut or
scrape. Usually, taking measures such as washing your hands and wearing disposable gloves will provide
sufficient protection for you and the casualty. There is no known evidence of these blood-borne viruses being
transmitted during resuscitation. If a face shield or pocket mask is available, it should be used when you give
rescue breaths (pp.68–69 and pp.78–79).

CAUTION
To help protect yourself from infection you can carry protective equipment such as:
 Pocket mask or face shield
 Latex-free disposable gloves
 Alcohol gel to clean your hands

MINIMIZING THE RISK OF CROSSCONTAMINATION

Do wash your hands and wear latex-free disposable gloves (in case you or the casualty are allergic to latex). If
gloves are not available, ask the casualty to dress his or her own wound, or enclose your hands in clean plastic
bags.
 Do cover cuts and scrapes on your hands with waterproof dressings.
 Do wear a plastic apron if dealing with large quantities of body fluids, and wear glasses or goggles to
protect your eyes.
  Do dispose of all waste safely.
 Do not touch a wound or any part of a dressing that will come into contact with a wound with your bare
hands.
 Do not breathe, cough, or sneeze over a wound while you are treating a casualty.
DEALING WITH A CASUALTY
LISTEN CAREFULLY
Use your eyes and ears to be aware of how a casualty responds. Listen by showing verbal and nonverbal listening
skills.
 Make eye contact, but look away now and then so as not to stare.
 Use a calm, confident voice that is loud enough to be heard but do not shout.
 Do not speak too quickly.
 Keep instructions simple: use short sentences and simple words.
 Use affirming nods and “mmms” to show you are listening when the casualty speaks.
 Check that the casualty understands what you mean—ask to make sure.
 Use simple hand gestures and movements.
 Do not interrupt the casualty, but always acknowledge what you are told; for example, summarize what
a casualty has told you to show that you understand.
WHEN A CASUALTY RESISTS HELP
If someone is ill or injured he may be upset, confused, tearful, angry, and/or anxious to get away. Be sensitive
to a casualty’s feelings; let him know that his reactions are understandable. Also accept that you may not be
able to help, or might even be seen as a threat. Stay at a safe distance until you have gained the person’s consent
to move closer, so that he does not feel crowded. Do not argue or disagree. A casualty may refuse help, for
example because he is suffering from a head injury or hypothermia. If you think a person needs something other
than what he asks for, explain why. For example, you could say, “I think someone should look at where you’re
hurt before you move, in case moving makes it worse.” If someone still refuses your help and you think he needs
urgent medical attention, call 911 for emergency help. A casualty has the right to refuse help, even if it causes
further harm. Tell the dispatcher that you have offered first aid and have been refused. If you are worried that
a person’s condition is deteriorating, observe from a distance until help arrives.
TREATING THE CASUALTY
When treating a casualty, always relate to him calmly and thoughtfully to maintain trust. Think about how he
might be feeling. Check that you have understood what the casualty said and consider the impact of your
actions, for example, is the casualty becoming more (or less) upset, angry, and tense? A change in emotional
state can indicate that a condition is worsening. Be prepared to change your manner, depending on what a
person feels comfortable with; for example, ask fewer questions or talk about something else. Keep a casualty
updated and give him options rather than telling him what to do. Ask the casualty about his next-of kin or friends
who can help, and help him make contact with them. Ask if you can help make arrangements so that any
responsibilities the casualty may have can be taken care of. Stay with the casualty. Do not leave someone who
may be dying, seriously ill, or badly injured alone except to go to call for emergency help. Talk to the casualty
while touching his shoulder or arm, or holding a hand. Never allow a casualty to feel alone.
II.
The scene of any incident can present many potential dangers, whether someone has become ill or has been
injured, whether in the home or outside at the scene of an incident. Before any first aid is provided you must
make sure that approaching the scene of the incident does not present unacceptable danger to the casualty, or
to you or anyone else who is helping. This chapter provides advice for first aiders on how to ensure safety in an
emergency situation. There are specific guidelines for emergencies that pose a particular risk. These include
fires, traffic accidents, and incidents involving electricity and drowning. The procedures that are used by the
emergency services for major incidents, where particular precautions are necessary and where first aiders may
be called on to help, are also described here.
 To protect yourself from danger and make the area safe.
 To assess the situation quickly and calmly and summon help if necessary.
 To assist any casualties and provide necessary treatment with the help of bystanders.
 To call 911 for emergency help if you suspect serious injury or illness.
 To be aware of your own needs.
MANAGING AN INCIDENT
In any emergency it is important that you follow a clear plan of action. This will enable you to prioritize the
demands that may be made upon you, and help you decide on your best response. The principle steps are: to
assess the situation, to make the area safe (if possible), and to give first aid. Use the primary survey to identify
the most seriously injured casualties and treat them in the order of priority.
ASSESSING THE SITUATION
Evaluating the scene accurately is one of the most important factors in the management of an incident. You
should stay calm. State that you have first aid training and, if there are no medical personnel in attendance,
calmly take charge. Identify any safety risks and assess the resources available. Action for key dangers you may
face, such as fire, are dealt with in this chapter, but be aware, too, of tripping hazards, sharp objects, chemical
spills, and falling debris.
All incidents should be managed in a similar manner. Consider the following:
 Safety What are the dangers and do they still exist? Are you wearing protective equipment? Is it safe for
you to approach?
 Scene What factors are involved at the incident? What are the mechanisms of the injuries? How many
casualties are there? What are the potential injuries?
 Situation What happened? How many people are involved and what ages are they? Are any of them
children or elderly?
MAKING AN AREA SAFE
The conditions that give rise to an incident may still present a danger and must be eliminated if possible. It may
be that a simple measure, such as turning off the ignition of a car to reduce the risk of fire, is sufficient. As a last
resort, move the casualty to safety. Usually specialist help and equipment is required for this. When approaching
a casualty, make sure you protect yourself: wear high-visibility clothing, gloves, and head protection if you have
them. Remember, too, that a casualty faces the risk of injury from the same hazards that you face. If extrication
from the scene is delayed, try to protect the casualty from any additional hazards. If you cannot make an area
safe, call 911 for emergency help before performing first aid. Stand clear until the emergency services have
secured the scene.
GIVING EMERGENCY HELP
Once an area has been made safe, use the primary survey (pp.44–45) to quickly carry out an initial assessment
of the casualty or casualties to establish treatment priorities. If there is more than one casualty, attend to those
with life-threatening conditions first. If possible, treat casualties in the position in which you find them; move
them only if they are in immediate danger or if it is necessary in order to provide life-saving treatment. Enlist
help from others if possible. Ask bystanders to call for the emergency services (p.23). They can also help protect
a casualty’s privacy, put out flares or warning triangles in the event of a vehicle accident (p.30), or retrieve
equipment while you begin first aid.
MAKING THE ACCIDENT AREA SAFE
Do not put yourself or others in further danger. Take the following precautions:
 Park safely, well away from the site of the accident, set your hazard lights flashing, and put on a high-
visibility jacket/vest if you have one.
 Set up warning triangles or flares (or position another vehicle that has hazard lights) at least 50 yards (45
meters) from the accident in each direction; bystanders can do this while you attend to the casualty. If
possible, send helpers to warn oncoming drivers to slow down.
 Make vehicles safe. For example, switch off the ignition of any damaged vehicle. Stabilize vehicles. If a
vehicle is upright, and you can get in without risk to yourself, apply the emergency brake, put it in park,
or place blocks in front of the wheels. If it is on its side, do not attempt to right it.
 Watch out for physical dangers, such as traffic. Make sure that no one smokes anywhere near the
accident.
 Alert the emergency services to damaged power lines, fuel spills, or any vehicles with HAZMAT signs
(opposite)
FIRES
Fire spreads very quickly, so your first priority is to warn any people at risk. If in a building, activate the nearest
fire alarm, call 911 for emergency help, then leave the building. However, if doing this delays your escape, make
the call when you are out of the building. As a first aider, try to keep everyone calm. Encourage and assist people
to evacuate the area. When arriving at an incident involving fire, stop, observe, think: do not enter the area. A
minor fire can escalate in minutes to a serious blaze. Call 911 for emergency help and wait for it to arrive.
THE ELEMENTS OF FIRE
A fire needs three components to start and maintain it: ignition (a spark or flame); a source of fuel (gasoline,
wood, or fabric); and oxygen (air). Removing one of these elements can break this “triangle of fire.”
 Remove combustible materials, such as paper or cardboard, from the path of a fire, because they can
fuel the flames.
 Cut off a fire’s oxygen supply by shutting a door on a fire or smothering the flames with a fire blanket.
This will cause the fire to suffocate and go out.
 Turn off a car’s ignition, or switch off the gasoline supply.
LEAVING A BURNING BUILDING
If you see or suspect a fire in a building, activate the first fire alarm you see. Try to help people out of the building
without putting yourself at risk. Close doors behind you to help prevent the fire from spreading. If you are in a
public building, use the fire exits and look for assembly points outside. You should already know the evacuation
procedure at your workplace. If, however, you are visiting other premises you are not familiar with, follow the
signs for escape routes and obey any instructions given by the fire marshals.
CAUTION
When escaping from a fire:
 Do not reenter a burning building to collect personal possessions
 Do not use elevators
 Do not go back to a building unless cleared to do so by a fire officer
Fire precautions:
 Do not move anything that is on fire
 Do not smother flames with flammable materials
 Do not fight a fire if it could endanger your own safety
 If your clothes catch fire and help is not available, you can extinguish the flames yourself by stopping,
dropping to the ground, and rolling
 Do not put water on an electrical fire: pull the plug out or switch the power off
 Smother a grease fire with a fire blanket or pot lid; never use water

CLOTHING ON FIRE
Always follow this procedure: Stop, Drop, and Roll.
 Stop the casualty from panicking, running around, or going outside; any movement or breeze will fan
the flames.
 Drop the casualty to the ground. If possible, wrap him tightly in a fire blanket, or heavy fabric such as a
coat, curtain, blanket (not a nylon blanket or an open weave type of any material—acrylic, wool, cotton,
or other), or rug.
 Roll the casualty along the ground until the flames have been smothered. Treat any burns: help the
casualty lie down with the burned side uppermost, and cool the burn by applying cool water or fanning
the area gently.
SMOKE AND FUMES
Any fire in a confined space creates a highly dangerous atmosphere that is low in oxygen and may also be
polluted by carbon monoxide and other toxic fumes. Never enter a smoke- or fume-filled building or open a
door leading to a fire. Let the emergency services do this.
 If you are trapped in a burning building, if possible go into a room at the front of the building with a
window and shut the door. Block gaps under the door by placing a rug or similar heavy fabric across the
bottom of the door to minimize smoke. Open the window and shout for help.
 Stay low if you have to cross a smoke-filled room: air is clearest at floor level.
  If escaping through a high window, climb out backward feet first and lower yourself to the full length of
your arms before dropping down.
WATER INCIDENTS
Incidents around water may involve people of any age. However, drowning is one of the most common causes
of accidental death among young people under the age of 16. Young children can drown in fish ponds, paddling
pools, bathtubs, and even in buckets or the toilet if they fall in head first, as well as in swimming pools, in the
sea, and in open water. Many cases of drowning involve people who have been swimming in strong currents or
very cold water, or who have been swimming or boating after drinking alcohol. There are particular dangers
connected with incidents involving swimmers in cold water. The sudden immersion in cold water can result in
an overstimulation of nerves, causing the heart to stop (cardiac arrest). Cold water may cause hypothermia and
exacerbate shock. Spasm in the throat and inhalation of water can block the airway Inhaled or swallowed water
may be absorbed into the circulatory system, causing water overload to the brain, heart, or lungs. The exertion
of swimming can also strain the heart. Such incidents may happen in the winter, if someone falls through the
ice when skating on a pond or pursuing a pet.
CAUTION
 If the casualty is unconscious, lift him out of the water, support his head and neck, and carry him, his
head lower than his chest to keep him from inhaling water and protect the airway if he vomits.
 If removal from the water cannot be immediate, begin rescue breaths while still in the water.
 When you reach land, check for normal breathing and, if not, begin CPR with compressions.

WATER RESCUE
1. Your first priority is to get the casualty onto dry land with the minimum of danger to yourself. Stay on dry
land, hold out a stick, a branch or a rope for him to grab, then pull him from the water. Alternatively, throw him
a float.
2. If you are a trained lifesaver, there is no danger to yourself, and the casualty is unconscious, wade or swim to
the casualty and tow him ashore. If you cannot do this safely, call 911 for emergency help.
3. Once the casualty is out of the water, shield him from the wind, if possible. Treat him for drowning and the
effects of severe cold. If possible, replace any wet clothing with dry clothing.
4. Arrange to take or send the casualty to the hospital, even if he seems to have recovered completely. If you
are at all concerned, call 911 for emergency help.