NFN 108: TRAUMA AND EMERGENCY NURSING

COURSE CONTENT
INTRODUCTION TO FIRST AID
 Definition of Basic Terminologies
 Principles of First Aid
 Roles and Responsibilities of a First Aider
EMERGENCY SCENE MANAGEMENT(ESM)
 Steps of ESM
 Scene Survey
 Primary Survey
 Secondary survey
 Ongoing casualty care
 Multiple casualty management (triage)
 Lifting and moving
 Extrication
AIRWAY AND BREATHING EMERGENCIES
 Hypoxia
 Effective and ineffective breathing
 Breathing emergencies caused by illness
 Choking
CARDIOVASCULAR EMERGENCIES AND CPR
 Cardiovascular disease
 Angina and heart attack
 Chain of Survival®
 Stroke and transient ischemic attack (TIA)
 Cardiac arrest
 Cardiopulmonary Resuscitation (CPR)
 Automated External Defibrillation
WOUNDS AND BLEEDING
 Dressings, bandages, and slings
 Types of Wounds
 Bleeding
 Internal bleeding
 Amputations
BONE AND JOINT INJURIES
 Fractures
 Dislocations & Sprains
OTHER FIRST AID EMERGENCIES
 Poisoning
 shock

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INTRODUCTION TO FIRST AID
Definition of Basic Terminologies
First Aid
emergency help given to an injured or suddenly ill person using readily available
materials
First Aider
A person who takes charge of an emergency scene and gives first aid
Emergency
A situation that poses an immediate risk to health, life, property and environment
Golden hour
Th period lasting few minutes to several hours following a traumatic injury being
sustained by a casualty during which there is highest likelihood that prompt
medical treatment will prevent death
Casualty/victim
A person suffering from a sudden injury or trauma or illness and needs first aid
Roles and Responsibilities of a First Aider
The three priorities of first aid, in order of importance, are to:
 Preserve life
 Prevent the illness or injury from becoming worse
 Promote recovery
Besides giving first aid, it is important to:
 Protect the casualty’s belongings
 Keep unnecessary people away
 Reassure family or friends of the casualty
 Clean up the emergency scene and work to correct any unsafe conditions
that may have caused the injuries in the first place

Principles of First Aid

 1. You identify yourself as a first aider and get permission to help the injured
or ill person before you touch them—this is called consent
2. You use reasonable skill and care in accordance with the level of
knowledge and skill that you have
3. You are not negligent in what you do
4. You do not abandon the person

Consent
The law says everyone has the right not to be touched by others. As a first aider,
you must respect this right.
Always ask if you can help. If the casualty cannot answer, you have what is called
implied consent, and you can help.
If the casualty is an infant or a young child, you must get consent from the child’s
parent or guardian. If there is no parent or guardian at the scene, the law assumes
the casualty would give consent if they could, so you have implied consent to help.
A person has the right to refuse your offer of help. In this case, do not force first
aid on a conscious casualty. If you do not have consent to help, there may be other
actions you can take without touching the casualty, such as controlling the scene,
and calling for medical help.
Be aware of difficulties in communicating when a casualty:
 Is hard of hearing
 Speaks a different language
 Is visually impaired
 Is a child
 Is in pain
 Shows signs of mood disorder

Reasonable skill and care

As a Good Samaritan, when you give first aid you are expected to use reasonable
skill and care according to your level of knowledge and skills.

Negligence
Give only the care that you have been trained to provide, and always act in the best
interest of the casualty

Abandonment
Never abandon a casualty in your care. Stay until:
 You hand them over to medical help
 You hand them over to another first aider
 They no longer want your help—this is usually because the problem is no
longer an emergency, and further care is not needed

EMERGENCY SCENE MANAGEMENT(ESM)

Definition
Emergency scene management is the sequence of actions you should follow to
ensure safe and appropriate first aid is given.
Steps of ESM
1. Scene survey—during the scene survey you take control of the scene, find
out what happened and make sure the area is safe before assessing the casualty.
2. Primary survey—assess each casualty for life-threatening injuries and
illnesses, call or send someone to call 9-1-1, and give life-saving first aid.
3. Secondary survey—the secondary survey is a step-by-step way of gathering
information to form a complete picture of the casualty’s overall condition.
4. Ongoing casualty care—during ongoing casualty care you continue to
monitor the casualty’s condition until medical help takes over

1. Scene Survey
 Take charge of the situation
 Call out for help to attract bystanders
 Assess hazards and make the area safe
 Find out the history of the emergency, how many casualties there are
and the mechanism(s) of injury
 Identify yourself as a first aider and offer to help, get consent
 Assess responsiveness

2. Primary Survey
Check for life-threatening conditions, the ABCs:
A = Airway
B = Breathing
 C = Circulation
D= Disability
E= exposure
The sequential steps of the primary survey should be performed with the casualty
in the position found unless it is impossible to do so.
The primary survey should begin immediately after the scene survey.
 Check the airway
If the casualty is conscious, ask “what happened?” How well the casualty responds
will help you determine if the airway is clear. Use a head-tilt-chin-lift to open the
airway of an unresponsive casualty.
If you suspect a head or spinal injury, and have been trained, use a jaw-thrust
without head-tilt.
  Check for breathing
If the casualty is conscious, check by asking how their breathing is.
If the casualty is unconscious, check for breathing for at least five seconds,
and no more than 10 seconds. If breathing is effective, move on to check
circulation. If breathing is absent or ineffective (gasping and irregular, agonal),
begin CPR.

 Check circulation
Control obvious, severe bleeding
Check for shock by checking skin condition and temperature
Check with a rapid body survey for hidden, severe, external bleeding and
signs of internal bleeding
 Check for disability (abnormal neurological status)
Assess the casualty’s level of consciousness
Look for any seizures, altered mental status
Check for signs of opioid overdose

 Exposure
This involves a rapid whole-body inspection to avoid missing signs or injuries that
impact management
Remove jewelry, watches and constrictive clothing
Prevent hypothermia and protect modesty

Rapid body survey

The rapid body survey is a quick assessment of the casualty’s body which is
performed during the primary survey. By running your hands over the casualty’s
entire body from head to toe (and under heavy outwear), you are able to feel for
severe bleeding, internal bleeding and any obvious fractures.
When performing the rapid body survey:
Wear gloves when possible, and check gloves for blood every few seconds
Be careful not to cause any further injuries while performing the survey
Look at the casualty’s face to notice any responses to the rapid body survey
Provide first aid for life-threatening injuries or conditions.
Maintain an open airway with a head-tilt chin-lift or by placing the
unresponsive breathing casualty into the recovery position
Provide CPR if the unresponsive casualty is not breathing or not breathing
normally (gasping)
Control severe bleeding
Provide support for obvious fractures
Give first aid for shock by providing first aid for life-threatening injuries and
maintaining the casualty’s body temperature
Evaluate the situation and decide whether to do a secondary survey

Do a secondary survey if:

 The casualty has more than one injury
 Medical help will be delayed more than 20 minutes
 Medical help is not coming to the scene and you have to transport the
casualty

3. Secondary survey
A secondary survey follows the primary survey and any life-saving first aid. It is a
step-by-step way of gathering information to form a complete picture of the
casualty. In the secondary survey, the first aider is looking for injuries or illnesses
that may not have been revealed in the primary survey. You should complete a
secondary survey if:
The casualty has more than one injury
Medical help will be delayed for 20 minutes or more
You will transport the casualty to medical help

The secondary survey has four steps:

1. History
2. Vital signs
3. Head-to-toe exam
4. First aid for any injury or illness found
History
A SAMPLE history is used to gather a brief medical history of the casualty. This
information may be useful for health care professionals who will continue to assist
the casualty. If the casualty is unable to respond, some of the SAMPLE history
could be answered by a close family member.
S = symptoms – what the casualty is feeling (such as pain, nausea, weakness, etc.)
A = allergies – any allergies, specifically allergies to medications
M = medications – any medications or supplements they normally take, have
taken in the past 24 hours, or any doses they may have missed
P = past or present medical history – any medical history, especially if it is
related to what they are experiencing now. Ask if they have medical alert
information
L = last meal – last meal they ate and when, anything else taken by mouth
E = events leading to the incident – what was happening before the
injury/illness? How did the injury occur?
Vital signs
There are four vital signs to check on the casualty
1. Level of consciousness (LOC)
2. Breathing
3. Pulse
4. Skin condition and temperature

Level of consciousness (LOC)

A common method of obtaining a casualty’s LOC is using the acronym AVPU.
When using AVPU to indicate LOC, it is a scale which ranges from good (A), to
not as good (V), to bad (P), to worse (U)
A = Alert – An alert casualty will have their eyes open and will be able to answer
simple questions. An alert casualty is oriented to person, place and time.
V = Verbal – The casualty will respond when spoken to, but may not be able to
effectively communicate. They may not be oriented to person, place or time.
P = Pain – This casualty will only respond when a painful stimuli is delivered,
such as pinching them or rubbing your knuckles on their sternum. They may move
or make noise, but they will not communicate.
U = Unresponsive – the unresponsive casualty will not respond to any stimulus.
Please note that an alternative to quickly estimate a casualty’s LOC is to evaluate
their eye, verbal and motor skills. If their eyes are open, they can clearly speak, and
obey a command such as “squeeze my fingers,” they are alert
Breathing
To assess the breathing rate, watch the casualty closely for a total of 30 seconds. It
is OK to place your hand on their upper abdomen to feel the rise and fall. Check
the quality of the breathing. Carefully count each breath over the 30 seconds and
multiply that number by two for breaths per minute.
Pulse
The pulse rate is the number of beats your heart takes in one minute, and it is an
essential skill for assessing all casualties. The most common places to assess a
pulse is at the wrist or neck, and for infants, the inside of the upper arm.
To assess the pulse, use two fingers and gently place them on either the inside of
the wrist (just below the hand on the thumb side), or on the side of the neck
(carotid artery), or for infants, the inside of the upper arm, on the brachial artery.
Press just gently enough to feel the pulse. You may have to feel around the area
until you find it. Once you have found the pulse, count the number of beats over 30
seconds and multiply that number by two.
Skin condition and temperature
When assessing the skin we look for the temperature (warm or cold), the colour
(normal skin tones or pale) and whether the skin is dry or wet. Use the back of
your gloved hand to feel the casualty’s forehead and cheeks. If their skin normal,
they will have normal skin colour, and their skin will be warm and dry. If the skin
is pale, cold and wet (sweaty), this could be an indication of shock.
Head-to-toe exam
The head-to-toe exam is a complete and detailed check of the casualty for any
injuries that may have been missed during the rapid body survey.
Do not examine for unlikely injuries. You may need to expose an area to check
for injuries, but always respect the casualty’s modesty and ensure you protect them
from the cold. Only expose what you absolutely have to.
Ask the casualty if they feel any pain before you start. Note any responses.
Speak to the casualty throughout the process. Explain what you are checking
for as you proceed.
 Always watch the casualty’s face for any facial expressions that may
indicate pain.
Do not stop the exam. If you find an injury, note it and continue.
Do not step over the casualty. If you need to, walk around them.
During a detailed exam, you are looking for all bumps, bruises, scrapes, or
anything that is not normal.
If the casualty is unconscious, look for medic alert devices during your
survey, such as a tag, bracelet, necklace, watch, or other indicator.
Look, then feel
Document
Upon completion of the secondary survey, document your findings as accurately as
possible. This information may be valuable to medical professionals who will
continue to assist the casualty.
Documentation is also important in a workplace emergency as it may be used as
part of an investigation. Documentation of the incident and the first aid given
should be completed on pre-printed forms and maintained as required by provincial
regulations/ legislation for reference by investigators.
5. Ongoing casualty care
Once first aid for injuries and illnesses that are not life threatening has been given:
The first aider will hand over control of the scene to the casualty, or
someone else, and end their involvement in the emergency
The first aider will stay in control of the scene and wait for medical help to
take over, or
The first aider will stay in control of the scene and transport the casualty to
medical help

The first aid must maintain the casualty in the best possible condition until
handover to medical help by:
 Giving first aid for shock
 Position the casualty based upon their condition
 Monitoring the casualty’s condition
 Recording the events of the situation
 Reporting on what happened to whoever takes over
Instruct a bystander to maintain manual support of the head and neck (if
head/spinal injuries are suspected). Continue to steady and support manually, if
needed.
Recovery Position
This position protects the casualty and also reduces bending and twisting of the
spine. This position protects the airway if you must leave the casualty.

Multiple casualty management (triage)

The process of making decisions at an emergency scene where multiple people are
injured is called triage. In triage, first aiders quickly examine all casualties and
place them in order of greatest need for first aid and for transportation. The idea is
to do the most good for the greatest number of casualties.
Casualties are categorized into three levels of priority:
Highest priority—casualties who need immediate first aid and
transportation to medical help
Medium priority—casualties who probably can wait one hour for medical
help without risk to their lives
Lowest priority—casualties who can wait and receive first aid and
transportation last, or casualties who are obviously dead
Triage sequence of actions
Begin ESM
Determine how many casualties there are in the scene survey.

Start with the nearest casualty, and move outward

Do a primary survey
Give first aid for life-threatening injuries
If the person is obviously dead, go to the next nearest casualty

Repeat step 2 for each casualty

Always move to the next nearest casualty

Categorize
Decide which casualties have the highest priority, second priority, and
lowest priority.

Arrange transportation
Arrange for the highest priority casualties to be transported to medical help
as soon as possible

Perform secondary survey

Begin with the highest priority. Give appropriate first aid, and move on

Give ongoing care for each casualty until transported

In a multiple casualty situation, constantly assess the casualties and the situation
and make changes to priorities.

Lifting and moving

You may have to move a casualty when:
There are life-threatening hazards to yourself or the casualty e.g. danger
from fire, explosion, gas or water
Essential first aid for wounds or other conditions cannot be given in the
casualty’s present position or location
The casualty must be transported to a medical facility
 If life-threatening hazards make it necessary to move a casualty right away,
you may need to use a rescue carry.
In urgent and dangerous situations where casualties are moved with less than
ideal support for injuries, the casualty’s injuries may be made worse by improper
movement and handling. The chance of further injury can be reduced with proper
rescue carry techniques
Lifting techniques and proper body mechanics
Moving any casualty from an emergency scene poses dangers to the rescuer as well
as the casualty. If the casualty must be moved, select the method that will pose the
least risk to the casualty and to you. You can be of little help to a casualty if you
injure yourself in the rescue.
Using incorrect body mechanics in lifting or moving a casualty may leave the
rescuer suffering muscle strains. Use the following lifting guidelines:

 Stand close to the object to be lifted.

 Bend your knees, not your waist.
 Tilt the object so that you can put one hand under the edge or corner closest
to you.
 Place your other hand under the opposite side or corner, getting a good grip
on the object.
 Use your leg muscles to lift, and keep your back straight.
 When turning, turn your feet first; don’t twist your body
Rescue carries
A rescue carry is an emergency method of moving a casualty over a short distance
to safety, shelter or to transportation. Select the type of carry based on the
circumstances.
The size and weight of the casualty relative to the rescuer
The number of rescuers available to assist
The type of injury
The distance to move the casualty
Drag carry
This carry is used by the single rescuer to drag a casualty who is either lying on
their back or in a sitting position. The drag carry provides maximum protection to
the head and neck, and therefore should be used when you are moving a casualty
with this type of injury.
If time permits, tie the casualty’s wrists together across their chest before dragging.
To perform a drag carry:
1. Stand at the casualty’s head facing their feet.
2. Crouch down and ease your hands under the casualty’s shoulders. Grasp the
clothing on each side. Support the casualty’s head between your forearms to
stop movement.
3. Drag the casualty backward only as far as necessary for their safety.
Human crutch
If a leg or foot is injured, help the casualty to walk on their good leg while you
give support to the injured side

1. Take the weight of the casualty’s injured side on your shoulders by placing
the casualty’s arm (on the injured side) around your neck and grasping the wrist
firmly.
2. Reach around the casualty’s back with your free hand, and grasp the clothing
at the waist.
3. Tell the casualty to step off with you, each using the inside foot. This lets
you, the rescuer; take the casualty’s weight on the injured side
Chair carry
The chair carry enables two rescuers to carry a conscious or unconscious casualty
through narrow passages and up and down stairs. Do not use this carry for
casualties with suspected neck or back injuries. Specially designed rescue chairs
are available and should be used for this type of carry.
If the casualty is unconscious or helpless:
1. Place an unconscious casualty on a chair by sliding the back of the chair under
their legs and buttocks, and along the lower back.
2. Strap their upper body and arms to the back of the chair.
3. Two rescuers carry the chair, one at the front and one at the back. The rescuer at
the back crouches and grasps the back of the chair, while the rescuer at the front
crouches between the casualty’s knees and grasps the front chair legs near the
floor.
4. The rescuers walk out-of-step.
Going down stairs
. The casualty faces forward
. The front rescuer faces the casualty
. A third person should act as a guide and support the front rescuer in case
they lose their footing
Extremity carry
Use the extremity carry when you don’t have a chair and do not suspect fractures
of the trunk, head, or spine.

1. One rescuer passes their hands under the casualty’s armpits, and grasps the
casualty’s wrists, crossing them over their chest.
2. The second rescuer crouches with their back between the casualty’s knees
and grasps each leg just above the knee.
3. The rescuers step off on opposite feet—walking out-of-step is smoother for
the casualty
Blanket lift with four bearers
Roll the blanket or rug lengthwise for half its width. Position bearers at the head
and feet to keep the head, neck and body in line. Place the rolled edge along the
casualty’s injured side.

1. Kneel at the casualty’s shoulder and position another bearer at the waist to
help log-roll the casualty onto the uninjured side. Turn the casualty as a unit so
the casualty’s body is not twisted.
2. Roll the casualty back over the blanket roll to lay face up on the blanket.
Unroll the blanket and then roll the edges of the blanket to each side of the
casualty. Get ready to lift the casualty—have the bearers grip the rolls at the
head and shoulders, and at the hip and legs.
3. Keep the blanket tight as the casualty is lifted and placed on the stretcher

Extrication
Extrication is the process of freeing casualties who are trapped or entangled in a
vehicle or collapsed structure and cannot free themselves. Provide as much support
as possible to the casualty during extrication. Whenever possible, give essential
first aid and immobilize the injuries before the casualty is moved.
When there is an immediate danger and you are alone and must move a casualty
from a vehicle, proceed as follows:
 1. If necessary, disentangle the person’s feet from the vehicle and bring the feet
toward the exit. Ease your forearm under the person’s armpit on the exit side,
extending your hand to support the chin.
2. Ease the person’s head gently backward to rest on your shoulder while
keeping the neck as rigid as possible.
3. Ease your other forearm under the armpit on the opposite side and hold the
wrist of the casualty’s arm which is nearest the exit.
4. Establish a firm footing and swing around with the person, keeping as much
rigidity in the neck as possible. Drag the casualty from the vehicle to a safe
distance with as little twisting as possible

AIRWAY AND BREATHING EMERGENCIES

Hypoxia and ineffective breathing
Choking and breathing emergencies cause a lack of oxygen in the blood, a
condition called hypoxia. This can damage vital tissues and eventually cause death.
The causes of hypoxia are grouped under three headings:
Lack of oxygen —for example: The oxygen level is low, such as at a high altitude
The oxygen is displaced by other gases, such as a build-up of silo gas in a grain
silo
The oxygen in a small space is used up—for instance in a confined space
Blocked airway—for example: A casualty chokes on a foreign object, such as
food
An unconscious casualty’s airway is blocked by their tongue
A casualty’s airway becomes swollen due to an allergic reaction
Abnormal heart and lung function—where the heart and lungs are not working
properly due to:
An illness such as pneumonia or congestive heart failure
An injury preventing effective breathing
A drug overdose or poisoning
The normal breathing rate varies for infants, children and adults. A breathing rate
that is too slow or too fast is a sign of a breathing emergency

Signs of ineffective breathing include:

 The casualty is struggling for breath or gasping for air
 Breathing rate is too fast or too slow
 Breathing rhythm is irregular
 Breathing depth is too shallow or too deep
 Breathing is noisy or raspy
 The person is “getting tired” from trying to breathe
 The person is sweating
 Decreased level of consciousness
 The lips, ears and fingernail beds turn blue—called cyanosis
 Chest movement may be abnormal

First aid for hypoxia and ineffective breathing

Always send or go for medical help at the first sign of a breathing emergency.
The first aid for ineffective breathing has two parts:
1. Give first aid for the injury or condition and position the responsive casualty
in the semi-sitting position if possible
2. If breathing stops the casualty will become unresponsive, get medical help
immediately and begin CPR
Inhalation injuries
Inhalation injuries happen when the casualty inhales hot steam or hot (superheated)
air, smoke or poisonous chemicals
Signs and symptoms of inhalation injuries include signs of shock:
Dizziness, restlessness, confusion
Pallor or cyanosis
Abnormal breathing rate or depth

Together with a history of fire and:

 Noisy breathing
 Pain during breathing
 Burns on the face, especially the mouth and nose
 Singed hair on the face or head
 Sooty or smoky smell on breath
 Sore throat, hoarseness, barking cough, difficulty swallowing

First aid for an inhalation injury

1. Perform a scene survey and do a primary survey. Give first aid for the
ABCs.
2. Place a conscious casualty in the semi-sitting position and loosen tight
clothing at the neck, chest and waist.
3. If breathing stops, begin CPR starting with compressions.
4. Give ongoing casualty care until handover to medical help.

Breathing emergencies caused by illness

Illnesses that can lead to severe breathing difficulties include asthma, allergies,
chronic obstructive pulmonary disease (e.g. emphysema), congestive heart failure,
stroke and pneumonia.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease is a term used to describe a group of
respiratory conditions such as chronic bronchitis and emphysema. Casualties
present with on-going shortness of breath and appear to be struggling to breathe.
Some people may use supplemental oxygen delivered by nasal prongs from a small
canister they carry when they have a more serious case of COPD.
Asthma
Asthma is a reactive airway illness in which the person has repeated shortness of
breath, characterized by wheezing and coughing. A mild asthma attack is not a
health emergency and can be managed by the casualty. A severe asthma attack can
be fatal and requires immediate first aid. In response to a ‘trigger’ the person’s
airway can spasm, swell and secrete thick mucus, which narrows the airway
passage. Some common triggers that can cause asthma are:
 Colds, upper airway infections
 Pet dander
 Insect bites, stings
 Foods
 Pollen, paint and smoke

Signs and symptoms of a severe asthmatic attack:

 Shortness of breath with obvious trouble breathing
 Coughing or wheezing
 Fast, shallow breathing
 Casualty sitting upright trying to breathe
 Bluish colour in the face (cyanosis )
 Anxiety, tightness in the chest
 Fast pulse rate, shock
 Restlessness at first, and then fatigue

First aid for a severe asthma attack

1. Perform a scene survey and a primary survey; send for medical help.
2. Place the casualty in the most comfortable position for breathing. This is
usually sitting upright with arms resting on a table.
3. Help the casualty take prescribed medication.
4. Give ongoing casualty care.
5. If the unconscious casualty stops breathing, begin CPR.
A person with asthma may carry medication in the form of a Metered-dose inhaler
(MDI)
Usually the person can give themselves this medication without help. If the person
needs help, a first aider can assist.
An inhaler delivers a pre-measured amount of medication. Always read and follow
the manufacturer’s instructions. Check the prescription label to confirm the
casualty’s name and expiry date
To assist with a Metered Dose Inhaler
The metered dose inhaler (or “puffer”) is the more common method of delivering
medication for asthma.
1. Shake the container, then remove the cap.
2. Tell the casualty to breathe out completely
3. Tell the casualty to breathe in slowly and deeply—as the casualty does, the
MDI will be pressed to release the medication. The MDI can be in the mouth, or
just in front of the mouth
4. Tell the casualty to hold their breath for 10 seconds so the medication can
spread out in the lungs. Then tell them to breathe normally, so the medication
won’t be expelled. If more doses are needed, wait at least 30-60 seconds before
repeating these steps

Choking
A person chokes when the airway is partly or completely blocked and airflow to
the lungs is reduced or cut off. The choking casualty either has trouble breathing or
cannot breathe at all.
First aid for choking
First aid for a choking adult or child
 1. Perform a scene survey.
2. If the casualty can cough forcefully,
speak or breathe, tell them to try to cough up
the object. If a mild obstruction lasts for a
few minutes, get medical help.

If you think there might be a severe obstruction,

check by asking,“Are you choking?” If the
casualty cannot cough forcefully, speak or
breathe, use back blows followed by abdominal
thrusts to remove the blockage.
1. Give back blows and abdominal thrusts:
2. Support the casualty and give up to five
blows between the shoulder blades using the
heel of your hand.
3. If the obstruction is not cleared, step
behind the casualty ready to support them if
they become unconscious.
Make a fist, place it on the casualty’s abdomen
at the belly button, in line with the hip bones.
Grasp the fist with the other hand and give five
forceful inward and upward abdominal thrusts.
5. If the object is not removed, repeat back
blows and abdominal thrusts.
If the casualty becomes unconscious
1. Lower them to the ground. Call for
medical help and get an AED if available.
2. Begin chest compressions immediately.
After the first 30 compressions, check the
mouth. Remove any foreign object you can see.
Try to give 2 breaths. If air does not go in,
continue to give chest compressions and
inspecting the mouth before ventilations
4.

First aid for a choking casualty much larger

than the rescuer
If a choking casualty is very large or is in the
late stages of pregnancy, give back blows as
normal, followed by chest thrusts.
1. While supporting the casualty, give up to
five back blows between the shoulder
blades, using the heel of your hand.
2. If the obstruction is not cleared, stand
behind the casualty.
3. Keep your arms horizontal and snug up
under their armpits.
4. Place your fist against the lower half of
the breastbone, thumb-side in.
5. Hold your fist with your other hand. Pull
inward forcefully.
6. Continue giving back blows and chest
thrusts until either the object is removed or
the casualty becomes unconscious.

Choking adult – self-help

If you begin to choke on an object you may have to clear your own airway.
1. If there are people around, get their attention, do not isolate yourself from
others.
2. Try to cough up the object.
3. Give yourself abdominal thrusts until you can cough forcefully, breathe or
speak.

A second method is to use a solid object like the back of a chair, a table or the edge
of a counter.
. Position yourself so the object is just above your hips.
. Press forcefully to produce an abdominal thrust
First aid for a choking infant
An infant is choking when they suddenly have trouble breathing, coughing,
gagging, with high-pitched, noisy breathing.
1. Perform a scene survey and primary survey.
 2. If the baby can cough forcefully or breathe let the baby try to cough up the
object. If a mild obstruction lasts for more than a few minutes, send for medical
help.
3. If the baby cannot cough forcefully, cannot breathe, makes a high-pitched
noise when trying to breathe or starts to turn blue, begin back blows and chest
thrusts.
4. Secure the baby between your forearms and turn them face down.
5. With the baby’s head lower than the body, use the heel of your hand to give
five forceful back blows between the shoulder blades.
6. Turn the baby face-up and give five chest thrusts
7. Keep giving back blows and chest thrusts until either the airway is cleared or
the baby becomes unconscious.
8. . If the baby becomes unconscious, send for medical help. Begin chest
compressions immediately. After the first 30 compressions, check the mouth.
Remove any foreign object you can see. Try to give 2 breaths and continue to
give chest compressions and inspecting the mouth before ventilations

CARDIOVASCULAR EMERGENCIES AND CARDIOPULMONARY

RESUSCITATION (CPR)
Cardiovascular disease
Cardiovascular disease is one of the leading causes of death of adults in Canada.
Some of these deaths could be prevented if appropriate first aid was given. This
chapter describes the first aid for cardiovascular emergencies, including
First aid for angina/heart attack
First aid for stroke/TIA
First aid for cardiac arrest, which is CPR

Angina
Angina occurs when the blood supply feeding the heart muscle becomes limited
due to narrowed, damaged, or blocked arteries. When the heart works harder and
needs more blood (e.g. when you run for a bus or shovel snow), it cannot get
enough blood. This causes pain or discomfort in the chest, which may spread to the
neck, jaw, shoulders, and arms. Angina pain typically doesn’t last long, and goes
away if the person rests and takes their prescribed medication.
Heart attack
A heart attack happens when heart muscle tissue dies because its supply of blood
has been cut off. A heart attack can feel just like angina, except the pain doesn’t go
away with rest and medication. If the heart attack damages the heart’s electrical
system, or if a lot of the heart muscle is affected, the heart may stop beating
properly. This is cardiac arrest
Signs and symptoms of angina and a heart attack:
A heart attack will produce shock and may display some or all of the following:
 Pale, ashen skin
 Sweating, cold and clammy to the touch
 Shortness of breath
 Showing obvious pain or discomfort

The pain or discomfort will be in the upper body, from the upper abdomen to the
jaw and arms, and may feel like:
 Heaviness in chest
 Tightness or pressure in chest
 Squeezing or crushing chest
 Indigestion, nausea or vomiting
 Aching jaw
 Sore shoulder or arms

First aid for angina/heart attack

Perform a scene survey, then do a primary survey. Ask the casualty
questions : “Can you show me where it hurts?”
“Have you had this pain before?”
“Do you have medication for this pain?”

 Call for medical help and get a defibrillator.

 Place the casualty at rest, the semi-sitting position is usually the best option,
and reassure them.
 Assist the conscious casualty to take their prescribed medication, usually
nitroglycerin. If the casualty has no prescribed medication, or the first dose is
ineffective, ask the casualty if they have any allergies to ASA, or if a doctor has
ever told them not to take it. If the casualty believes they can take it, suggest
they chew one regular ASA tablet (or two low-dose tablets). ASA can reduce
the effects of a heart attack because of its anti-clotting properties.
  If the casualty loses consciousness and stops breathing, start CPR.


Nitroglycerin tablets or sprays are common medications for relief of chronic

angina pain. A casualty in serious distress may need your help to take their
medication
Have the casualty spray the medication under the tongue or place the tablets under
the tongue—they aren’t to be swallowed

Stroke and transient ischemic attack (TIA)

Stroke
A stroke happens when blood flow to a part of the brain is interrupted either by a
blocked artery or by a ruptured blood vessel in the brain. A stroke may cause brain
damage which impairs certain body functions, depending on the part of the brain
affected.
Transient ischemic attack (TIA)
A TIA is a temporary blockage of the blood flow to part of the brain. It’s typically
of short duration and leaves no permanent damage but looks exactly like a stroke

Remember FAST as a way to check for the signs and symptoms of a stroke and to
get immediate help.
Facial droop. Ask them to smile. One side of the face may not move as well
as the other side.
Arm drift. Ask the casualty to hold both arms out with the palms up, and
close their eyes. One arm may not move or drifts down compared to the other arm.
Speech. Ask them to repeat a phrase you say. The casualty may slur words,
use the incorrect words or is not able to speak.
Time. When was the onset of symptoms? Ask the casualty, or their family,
friends, or bystanders when the symptoms were first noticed. Get immediate
medical help; the earlier a stroke is treated the better the outcome
Other signs and symptoms of a stroke include
 Blurred vision
 Sudden confusion
 Dizziness
 Headache
 Loss of balance

First aid for stroke/TIA

1. Perform a scene survey, then do a primary survey; perform the FAST
assessment.
2. Call for medical help.
3. Place the casualty at rest in the semi-sitting position.
4. Give nothing by mouth, especially ASA.
5. Give ongoing care.
If the casualty becomes unconscious, place them in the recovery position. If there
is paralysis, position the casualty with the paralyzed side up. This will reduce the
chance of tissue or nerve damage to the affected side
Cardiac arrest
Cardiac arrest means the heart stops beating properly. With no blood flow going to
the brain the casualty becomes unresponsive and stops breathing. Cardiac arrest
means the casualty is clinically dead, but if CPR is started and a defibrillator is
applied quickly there is still an opportunity to restore a normal heartbeat.
Common causes of cardiac arrest include:
 Heart attack
 Severe injuries
 Electrical shock
 Drug overdose
 Drowning
 Suffocation

Cardiopulmonary Resuscitation (CPR)

CPR is artificial respiration and artificial circulation. Artificial respiration provides
oxygen to the lungs. Artificial circulation causes blood to flow through the body.
The purpose of CPR is to circulate enough oxygenated blood to the brain and other
organs to delay damage until either the heart starts beating again, or medical help
takes over from you. CPR is most effective when interruptions to chest
compressions are minimized
CPR – Adult casualty
1. Perform a scene survey.
2. Assess responsiveness.
 3. If there is no response, call for medical help on a mobile device
4. Perform a primary survey: Open the airway. Check for breathing for at least
5 and no more than 10 seconds.
5. If the casualty is not breathing, or not breathing effectively (agonal breaths)
position your hands in the centre of the upper chest and your shoulders directly
over your hands. Keep your elbows locked.
6. Give 30 compressions—Push hard—Push Fast!
 Press the heels of the hands straight down on the breastbone.
 The depth of each compression should be at 5-6 cm (2-2.4 inches).
 Release pressure and completely remove your weight at the top of each
compression to allow chest to return to the resting position.
 Give compressions at a rate of 100 to 120 per minute.
 Count compressions out loud to keep track of how many you have given,
and to help keep a steady rhythm.
7. Open the airway by tilting the head and lifting the chin.
8. Position a barrier device and breathe into the casualty twice. For an adult
casualty, each breath should take about for 1 second, with just enough air to make
the chest rise
This is one cycle of 30:2 (30 compressions to 2 ventilations).
9. Continue CPR until either an AED is applied, the casualty begins to respond,
another first aider or medical help takes over or you are too exhausted to continue.
The AED should be applied as soon as it arrives at the scene.

CPR – Infant casualty

1. Perform a scene survey.
2. Assess responsiveness. Gently tap the baby’s feet.
3. If there is no response, send or call for medical help and an AED if
available.

If you are alone with no phone perform 5 cycles of CPR (two minutes) then go
for medical help. Carry the infant with you if possible.
1. Perform a Primary Survey Open the airway.
2. Check for breathing for at least 5 and no more 10 seconds
If the baby is not breathing, or not breathing effectively (agonal breaths)
begin CPR
3. Place two fingers on the breastbone just below the nipple line. Push down on the
breastbone 1/3 the depth of the chest or about 4 cm (1 1/2 inches).
4. Release the pressure completely but keep your fingers in light contact with the
chest. Repeat the pressure and release phases rhythmically so that each phase takes
the same amount of time.
5. Give compressions at a rate of 100 to 120 per minute. Count compressions out
loud to keep track of how many you have given, and to help keep a steady rhythm.
6. Open the airway by tilting the head and lifting the chin.
7. Position a barrier device and breathe into the casualty twice, with just enough air
to make the chest rise

WOUNDS AND BLEEDING

Dressings, bandages, and slings
Dressings
A dressing is a protective covering put on a wound to help control bleeding, absorb
blood from the wound, and prevent further contamination. A dressing should be:
 Sterile, or as clean as possible
 Large enough to cover the wound
 Highly absorbent
 Compressible, thick and soft
 Non-stick and lint-free to reduce the possibility of sticking to the wound

Dressings are available in a variety of sizes and designs. The dressings used most
often in first aid are:
Adhesive dressings – prepared sterile gauze dressings with their own
adhesive strips
Wound closures – adhesive strips that bring the edges of the wound together to
assist healing
Gauze dressings – packaged gauze available as sterile single packs or in bulk
packaging
• Pressure dressings – large sterile dressings of gauze and other absorbent
material, usually with an attached roller bandage. They are used to apply pressure
to a wound with severe bleeding
• Improvised dressings – prepared from lint-free sterile or clean absorbent
material such as a sanitary pad
• Hemostatic dressings – pressure dressings impregnated with clot promoting
agents used to stop serious bleeding. These dressings are not designed for all
wound types. Check with your local protocols for more information
Follow the guidelines below for putting on dressings:
 Prevent further contamination
 Extend the dressing beyond the edges of the wound
 If blood soaks through a dressing, leave it in place and cover with more
dressings
 Secure a dressing with tape or bandages

Bandages
A bandage is any material that is used to hold a dressing in place, maintain
pressure over a wound, support a limb or joint, immobilize parts of the body or
secure a splint.
When using bandages, remember to:
Apply firmly to make sure bleeding is controlled or immobilization is
achieved
Check the circulation below the injury before and after applying a bandage,
you may have applied it too tightly or swelling may have made it too tight
The Triangular Bandage
A triangular bandage may be used:
As a whole cloth—opened to its fullest extent, as a sling or to hold a large
dressing in place
As a broad bandage—to hold splints in place or to apply pressure evenly
over a large area
As a narrow bandage—to secure dressings or splints or to immobilize ankles
and feet in a figure-8

Broad Bandage
To form a broad bandage, fold the point to the centre of the base with the point
slightly beyond the base
Fold in half again from the top to the base
Narrow Bandage
Fold a broad bandage in half again from the top to the base to form a narrow
bandage
Roller bandage
Roller bandages, usually made of gauze-like elastic material, are used to hold
dressings in place or to secure splints.

Slings
A sling can be easily improvised with a scarf, belt, necktie or other item that can
go around the casualty’s neck. You can also support the arm by placing the hand
inside a buttoned jacket or by pinning the sleeve of a shirt or jacket to the clothing
in the proper position
Arm sling
To put on an arm sling:
1. Support the forearm of the injured limb across the body. Place an open
triangular bandage between the forearm and the chest so the point extends
beyond the elbow and the base is straight up and down.
1. Bring the upper end around the back of the neck to the front of the injured
side. While still supporting the forearm, bring the lower end of the bandage over
the hand and forearm and tie off on the injured side in the hollow of the collarbone.
Place padding under the knot for comfort.
2. Twist the point into a “pigtail” at the elbow and tuck it inside the sling.
3. Adjust the sling so you can see the fingernails—this way you can watch
them to check on circulation

St. John tubular sling

This sling is used for injuries to the shoulder or collarbone. To put on a St. John
tubular sling:
1. Support the forearm of the injured side diagonally across the chest, the
fingers pointing toward the opposite shoulder.
2. Place a triangular bandage over the forearm and hand with the point
extending beyond the elbow and the upper end over the shoulder on the
uninjured side. The base is placed vertically in line with the body on the
uninjured side.
3. Ease the base of the bandage under the hand, forearm and elbow. Tuck the
base of the bandage under the injured arm to make a pocket that runs the full
length of the arm.
4. Gather the bandage at the elbow by twisting it and bring the lower end
across the back and over the shoulder on the uninjured side. This closes the
pocket at the elbow.
5. Gently adjust the height of the arm as you tie off the ends of the bandage so
the knot rests in the natural hollow above the collarbone. Place padding under
knot, if available. Tie the sling tightly enough to support the weight of the
injured arm.
6. above the collarbone. Place padding under knot, if available. Tie the sling
tightly enough to support the weight of the injured arm

Types of Wounds
A wound is any damage to the soft tissues of the body. It usually results in the
escape of blood from the blood vessels into surrounding tissues, body cavities or
out of the body.
A wound can be either open or closed:
 Open wound—a break in the outer layer of the skin
Closed wound—no break in the outer layer of skin but there is internal
bleeding
The aim in the care of wounds is to stop the bleeding and prevent infection.
Although some bleeding may help to wash contamination from the wound,
excessive blood flow must be stopped quickly to minimize shock.

Contusions or bruises
Contusions or bruises are closed wounds. The tissues under the skin are damaged
and bleed into surrounding tissues, causing discolouration. A bruise may be a sign
of a deeper, more serious injury or illness.
Abrasions or scrapes
Abrasions or scrapes are open wounds where the outer protective layer of skin and
the tiny underlying blood vessels are damaged. The deeper layer of the skin is still
intact
Incisions
Incisions are clean cuts caused by something sharp such as a knife
Lacerations
Lacerations are tears in the skin and underlying tissue with jagged and irregular
edges.
Puncture wounds
Puncture wounds are open wounds caused by blunt or pointed instruments that
may have a small opening, but often penetrate deep into the tissue
Avulsions and Amputations
Avulsions are injuries that leave a piece of skin or other tissue either partially or
completely torn away from the body.
Amputations involve partial or complete loss of a body part

Bleeding
Bleeding is the escape of blood from the blood vessels. In external bleeding, blood
escapes the body through a surface wound. In internal bleeding, blood escapes
from tissues inside the body.
In arterial bleeding, the blood is bright red and spurts with each heartbeat.
In venous bleeding, the blood is dark red and flows more steadily
Severe blood loss will result in the following signs and symptoms of shock:
 Pale, cold and clammy skin
 Rapid pulse, gradually becoming weaker
 Faintness, dizziness, thirst and nausea
 Restlessness and apprehension
 Shallow breathing, yawning, sighing and gasping for air
First aid for severe external bleeding
1. Perform a scene survey, then do a primary survey.
2. To control severe bleeding, apply direct pressure to the wound.
3. Place the casualty at rest.
4. Once bleeding is under control, continue the primary survey, looking for other
life-threatening injuries.
5. Before bandaging the wound, check circulation below the injury. Bandage the
dressing in place.
6. Check the circulation below the injury and compare it with the other side. If it is
worse than it was before the injury was bandaged, loosen the bandage just
enough to improve circulation if possible.
7. Give ongoing casualty care
If the dressings become blood-soaked, don’t remove them—add more dressings
and continue pressure. Removing the blood-soaked dressings may disturb blood
clots and expose the wound to further contamination
Internal bleeding
Suspect internal bleeding if:
The casualty received a severe blow or a penetrating injury to the chest,
neck, abdomen or groin
There are major limb fractures such as a fractured upper leg or pelvis

Signs of internal bleeding:

 Bleeding from the ear canal or the nose
 Bloodshot or black eye (bleeding inside the head)
 Coughing up blood that looks bright red and frothy (bleeding into the lungs)
 Vomiting bright red blood, or brown blood that looks like coffee grounds
 Blood in the stool that looks either red or black and tarry
 Red or smoky brown-looking blood in the urine
 Signs of shock with no signs of external injury
First aid for internal bleeding
1. Perform a scene survey. Have the casualty lie flat on their back and do a
primary survey.
 2. Send or go for medical help.
3. Give ongoing casualty care, including laying the casualty in the supine
position, and giving first aid for shock.

You can do very little to control internal bleeding. Give first aid to minimize shock
and get medical help as quickly as you can
Amputations
An amputation is when a part of the body has been partly or completely cut off.
You must control the bleeding from the wound, care for the amputated tissue and
get medical help.
First aid for amputations
1. Perform a scene survey, then do a primary survey.
2. Control bleeding—apply direct pressure to the wound. Reposition a partly
amputated part to its normal position and bandage.
3. Send for medical help and continue ongoing casualty care to the casualty.
4. Care for the amputated part by wrapping it in a clean, moist dressing (if
clean water is available).
5. Put the amputated part in a clean, watertight plastic bag and seal it. Put this
bag in a second plastic bag or container partly filled with crushed ice. Attach a
record of the date and time this was done and send this package with the
casualty to medical help
6. If direct pressure fails to control life-threatening external limb bleeding, a
tourniquet could be considered by a trained first aider (in special circumstances,
such as mass casualty management, a disaster, remote locations).

First aid for a nosebleed

A nosebleed may start for no obvious reason, or may be caused by blowing the
nose, an injury to the nose, or by an indirect injury, such as a fractured skull.
1. Perform a scene survey and assess the mechanism of injury. If you suspect a
head or spinal injury, tell the casualty not to move. Do a primary survey.
2. Assess the bleeding from the nose. If the blood from the nose is mixed with
straw-coloured fluid, suspect a skull fracture. Allow the nose to bleed and give
first aid for a skull fracture.
3. If a head or spinal injury is not suspected, place the casualty in a sitting
position with the head slightly forward. Leaning forward allows blood to drain
 from the nose and mouth instead of back into the throat and stomach where it
will cause vomiting.
4. Tell the casualty to compress the entire fleshy part below the bridge of the
nose firmly with the thumb and index finger for about 10 minutes or until
bleeding stops
5. Tell the casualty to breathe through the mouth and not blow their nose for a
few hours, so that blood clots will not be disturbed. If bleeding does not stop
with this first aid, or if it starts again, get medical help

BONE AND JOINT INJURIES

Injuries to bones, joints and muscles are common and, although they are usually
not life-threatening, they can be painful and debilitating. Appropriate first aid for
these injuries can reduce the pain and prevent further injury
Fractures
A break or crack in a bone is called a fracture. A fracture is either closed or open:
A closed fracture is where the skin over the fracture is not broken
An open fracture is where the skin over the fracture is broken—this could
cause serious infection, even if the wound is very small
A fracture can be caused by a;
direct force (e.g. a punch or kick)
indirect force (e.g. a fall)
twisting force
Certain bone diseases, such as osteoporosis, make bones very brittle and they can
break without much force.
One or more of the following signs and symptoms will be present when a bone is
fractured:
Pain and tenderness—worse when the injury is touched or moved
Loss of function—the casualty cannot use the injured part
A wound—the bone ends may be sticking out
Deformity—any unnatural shape or unnatural position of a bone or joint
Unnatural movement
Shock—these increases with the severity of the injury
 Crepitus—a grating sensation or sound that can often be felt or heard when
the broken ends of bone rub together
Swelling and bruising—fluid accumulates in the tissues around the fracture

Dislocations & Sprains

Ligaments connect bones to other bones to form joints, while tendons connect
muscles to bones. Ligaments limit the range of movement, support the joint in
motion or prevent certain movements altogether. Joints may be injured when the
bones and surrounding tissues are forced to move beyond their normal range.
When that happens:
The bones may break, resulting in a fracture
The ligaments may stretch or tear, resulting in a sprain
The bone ends may move out of proper position resulting in a dislocation
Sprains
A sprain is an injury to a ligament and can range from a stretched to a completely
torn ligament. Be cautious and give first aid as if the injury is serious to avoid
further damage and pain. Sprains of the wrist, ankle, knee and shoulder are most
common. The signs and symptoms of sprains may include:
Pain that may be severe and increase with movement of the joint
Loss of function
Swelling and discolouration
Dislocations
A dislocation is when the bones of a joint are not in proper contact. A force
stretches and tears the joint capsule, causing the dislocation. Once this occurs, the
bones can put pressure on blood vessels and nerves, causing circulation and
sensation impairments below the injury. The most commonly dislocated joints are
shoulder, elbow, thumb, fingers, jaw, and knee.
The signs and symptoms of a dislocation are similar to those of a fracture, and
may include:
Deformity or abnormal appearance, a dislocated shoulder may make the arm
look longer
Pain and tenderness aggravated by movement
Loss of normal function; the joint may be “locked” in one position
Swelling of the joint
General first aid for injuries to bones and joints
The aim of first aid for bone and joint injuries is to prevent further tissue damage
and to reduce pain.
1. Perform a scene survey and a primary survey.
2. Steady and support any obvious fractures or dislocations found in the
primary survey (during the rapid body survey).
3. Do a secondary survey to the extent needed, gently expose the injured area.
You may have to cut clothing to do this without moving the injured part. Examine
the entire injured area to determine the extent of the injury.
4. Check the circulation below the injury. If circulation is impaired, medical
help is needed urgently.
5. Steady and support the injured part and maintain support until medical help
takes over, or the injury is immobilized. Protect protruding bones. Do not push the
bone ends back in. Do not attempt to apply traction to a limb (pull on it) or
manipulate it in any way.
6. If medical help is on the way and will arrive soon, steady and support the
injury with your hands until they arrive.
7. If medical help will be delayed, or if the casualty needs to be transported,
immobilize the injury

Use RICE for injuries to bones, joints and muscles

Most injuries to bones, joints and muscles benefit from RICE, which stands for:
R – Rest
I – Immobilize
C – Cold
E – Elevate
Use RICE while waiting for medical help to arrive or while transporting a casualty
to medical help. Even the most minor injuries will benefit from RICE.
Rest means stopping the activity that caused the injury and staying off it until a
doctor tells the casualty it is OK to continue. For a minor injury, gentle use of the
injured part is okay provided the casualty can easily tolerate the pain.
Immobilize means suspecting a fracture whenever there is an injury to an arm or a
leg and taking steps to prevent movement of the injured limb. Immobilization may
mean using a sling for a shoulder joint injury or a splint to immobilize the joint
above and the joint below the injury.
Cold means applying cold to the injury as soon as you can once the injury has been
immobilized. The cold narrows the blood vessels, reducing pain, swelling and
bruising. Use a commercial cold pack, an improvised ice pack or a cold compress
for more about using cold. Apply cold over the entire injured area—15 minutes on,
15 minutes off.
Elevate means raising the injured part if possible. Only elevate if it will not cause
more pain or harm to the casualty. Elevation helps to reduce swelling and makes it
easier for fluids to drain away from the injury. This in turn, helps reduce swelling
(don’t elevate a “locked” joint).

First aid for specific bone & joint injuries

Collarbone/shoulder blade fracture
Signs and symptoms include:
Pain at injury site
Swelling and deformity
Loss of function of the arm on the side of the injury
Casualty holds and protects the arm if they can, and may tilt the head to the
injured side

First aid for a fractured collarbone or shoulder blade

1. Check circulation below the injury. If circulation is impaired, get medical
help quickly.
2. Immobilize the arm in the position of most comfort. A St. John tubular sling
may work.
3. Secure the arm to the chest with a broad bandage to prevent movement of
the arm. Pad under the elbow, if necessary, to keep the arm in the most
comfortable position. Tie the bandage on the uninjured side—don’t tie it so tightly
that the arm is pulled out of position. Pad under the knots for comfort.
4. Check circulation below the injury. If circulation is impaired, and it was not
before, loosen the sling and bandage.

Immobilizing a dislocated joint

Immobilize the limb in the position of most comfort—usually the position found.
To immobilize a dislocated shoulder, if the arm will bend:
Use a St. John tubular sling to transfer the weight of the arm to the other side
 Use broad bandages to prevent movement
Pad under the elbow for support

If the arm will not bend:

Support the weight of the arm with a bandage around the neck
Bandage the arm to the body to prevent movement
Pad under the elbow, if necessary, to keep the arm in the most comfortable
position
The casualty may want to hold the injured arm

Immobilizing the upper arm

To immobilize an open fracture of the upper arm (humerus):
1. Expose the injury site. Cover the wound with a sterile dressing and check
circulation.
2. Pad and bandage the dressings. Pad lengthwise on both sides of the fracture
site. Padding should be bulky enough to protect any protruding bone ends. Hold
the padding in place with tape then bandage dressings tightly enough to hold
padding and dressings in place.
3. An arm sling provides full support for the arm—broad bandages above and
below fracture site prevent arm movement. Pad under the elbow as needed to hold
the arm in the position of comfort.

Immobilizing an injured elbow

The elbow can be severely sprained, fractured or dislocated. Immobilize the injury
in the position found, if possible, or in the position of greatest comfort.
1. Expose the injury and look for any open wounds. Check circulation below
the injury and compare it with the other side. If circulation is impaired, get medical
help quickly.
2. If the elbow is bent so the arm is in front of the chest, immobilize the arm in
an arm sling. Leave the sling loose at the elbow. Pad under the elbow, if necessary,
to keep the arm in the most comfortable position and use a broad bandage to limit
movement.
3. If the elbow will not bend, support the arm at the wrist and use broad
bandages and padding to immobilize the arm. Check circulation below the injury
and compare it with the other side—if it is impaired, and it wasn’t before, adjust
the sling and/or bandages.
Immobilizing the forearm and wrist
1. Examine the injury and decide the best position for splinting—this is usually
in the position found. Have the casualty or a bystander steady and support the
injured arm.
2. Measure the splint against the uninjured arm to make sure it is the right size.
Pad the splint for comfort and to support the fracture. Position the arm on the splint
with as little movement as possible.
3. Once the splint is in position, have the casualty or bystander support it while
you secure the splint.
4. Start above the injury and bandage the splint and the arm snugly, but not too
tightly. Leave the fingertips visible so you can check circulation below the injury
and bandages.
5. Use an arm sling to support the arm and hand, and prevent movement of the
elbow with the fingertips exposed so you can check circulation.

Immobilizing an injured hand

When you suspect bones in the hand are fractured:
1. Examine the injured hand and decide the best position for splinting—this is
usually in the position of function. Have the casualty or a bystander steady and
support the injury. If there are open wounds, place non-stick sterile dressings
between the fingers to prevent the fingers sticking together.
2. Measure the splint against the uninjured hand and arm to make sure it is the
right size
3. Position the arm on the splint with as little movement as possible

Immobilizing an injured upper leg (femur)

A common fracture of the upper leg is a break at the neck of the femur. This is
often referred to as a broken hip, and most commonly happens to elderly
people. In a younger, healthy person, great force is needed to fracture the upper
leg—always assess for a head or spinal injury

1. Have a bystander steady and support the injured limb.

2. Gather the splinting materials. Measure the splint(s) against the uninjured leg.
Put bandages into position. Pad the splints and position them as shown.
3. Tie the bandages from chest to ankle—from the stable end to the unstable end.
4. Give ongoing casualty care. Get medical help.
5. If you are using a long and a short splint, place bandages at the ankles, calves,
knees, above and below the fracture, hips and chest
6. Push bandages under the natural hollows of the body and position as shown
above
7. Place splints just below the armpit and just below the groin
8. Extend both splints below the foot
9. Tie off all bandages on the splint