the following first aid information
is not to be trusted for accuracy
i include it as an interest item only
BASIC FIRST-AID
FAI.1. BASIC FIRST AID
INTRODUCTION
WHAT IS FIRST AID?
The initial care of the ill or injured.
THE AIMS OF FIRST AID
First aid aims to:
a. Promote a safe environment;
b. Preserve life;
c. Prevent injury or illness from becoming worse;
d. Help promote recovery;
e. Protect the unconscious; and
f. Reassure the ill or injured.
The first aider aims to prevent:
a. Further danger to himself, others or the casualty;
b. The casualty dying;
c. The casualty’s condition becoming worse;
d. Delay in the casualty’s recovery; and
e. Any harmful intervention.
WHAT IS MEDICAL AID?
Treatment by a doctor, registered nurse or ambulance officer.
First aid begins when the first aider arrives at the scene of an
incident, and continues until the casualty recovers, or medical aid
arrives. The first aider may be required to remain and assist.
HOW TO SEEK MEDICAL AID
If possible, send someone else to seek medical aid immediately.
Do not leave the casualty. However, if you are alone at the scene
of an incident, and it is unlikely that anyone will arrive for some
time, you will need to leave the casualty and seek help as soon as possible.
Messages should be brief. You should confirm that they are understood.
State your telephone number, the exact place with directions,
the time and nature of the incident. Give the number of casualties
with an indication of their condition. Ask the likely time of arrival
of aid.
Describe location
Name of district, suburb, etc:
Name of street, road, highway, etc:
Nearest cross street (suburban):
Distance from town or major landmark (country):
North South East West
of
(describe town or landmark)
Give accident details
Number of people hurt:
Time of accident (if known):
Time this message written:
Notes:
TURNING A CASUALTY TO A SAFE SIDE POSITION (COMA POSITION)
COMMUNICABLE DISEASES
Communicable diseases are those diseases which can be spread from one
person to another. They are caused by germs such as bacteria and viruses.
Medical studies have indicated that a first aider is unlikely to develop
any of these diseases as a result of attending to a casualty.
Because the risk to the first aider is so low, it is advised that
first aid should not be withheld.
Many communicable diseases can be present in the body before
symptoms and signs become evident. Therefore the first aider should
assume that any casualty may provide an element of risk, and should
always observe hygiene procedures, as described in this chapter.
SOME DISEASES THAT CAN BE TRANSFERRED FROM/TO CASUALTIES
* Colds
* Influenza
* Measles and Mumps
* Glandular fever
* Hepatitis A or B
* AIDS (Acquired Immune Deficiency Syndrome)
* Herpes
* Tuberculosis
* Some forms of Meningitis
* Some skin infections, eg Impetigo
HOW THESE DISEASES CAN BE PASSED ON TO THE FIRST AIDER
* By blood and body fluids, eg saliva, vomit, pus, urine and faeces.
These may enter the first aider’s bloodstream through cuts,
grazes or the mucous membranes.
* By infected hypodermic needles or sharp objects that break the
first aider’s skin.
OTHER WAYS IN WHICH THESE DISEASES ARE PASSED ON
* Through sexual intercourse where one partner is infected.
* By sharing hypodermic needles that have been used by/on an infected
person.
* Through transfusions of contaminated blood or injections of
contaminated blood products.
* Through droplet infection
* An infected mother can pass diseases to her child before and during
birth, or possibly through breast milk.
STEPS TO TAKE BEFORE MANAGEMENT OF A CASUALTY
Use the following checklist of hygiene procedures before managing a
casualty:
* Wash your hands thoroughly with soap and water if available.
* Cover exposed cuts and grazes with waterproof dressings.
* Put on disposable plastic or rubber gloves, if available.
These should be long enough to cover the
lower forearms and/or to be tucked under the sleeves.
* Put on a plastic apron to protect clothes, if available.
HYGIENE AFTER MANAGEMENT
Use the following checklist of hygiene procedures after managing a casualty:
* If clothing has been splashed with blood or body fluids, it is advisable
to soak it in the strongest recommended solution of a name-brand
household bleach for 30 minutes. Usually this solution will be one
part of bleach to nine parts of water, but you should follow the
instructions on the container. Always use a freshly prepared solution
of bleach. Wash clothing following disinfection. If bleaching
is not appropriate, machine wash clothing in the normal way,
using the hottest possible water temperature.
* Clean contaminated surfaces by covering for 30 minutes with
paper towels which have been soaked in the strongest recommended
solution of a name-brand household bleach. Wash the wet areas with
water and household detergent, and dry them thoroughly.
* Burn combustible waste materials.
* Waste materials that cannot be burned should be placed in a plastic
bag inside another plastic bag. Tie the bags securely and dispose of
them safely. Seek advice about safe disposal from your local hospital
or doctor.
* If a mask is used for resuscitation, wash it thoroughly in cold
running tap water, making sure that no splashing of nearby areas occurs.
Soak the mask for 30 minutes in the strongest recommended
solution of name-brand household bleach. Wash it thoroughly in
water and household detergent and dry well.
* Finally, wash your hands thoroughly with soap and water.
Remember:
* If splashed by blood or other body fluids, skin should be washed
thoroughly with soap and running tap water.
* If lips, mouth, tongue, eyes or broken skin come into contact with
blood or other body fluids, wash thoroughly with clean, cold running
tap water.
* If skin is punctured by a sharp object that may be contaminated,
wash the area thoroughly with soap and running tap water, and seek
medical advice as soon as possible.
* Use household bleach only in well ventilated areas.
* Do not put plastic bags of non-combustible waste material in the
rubbish tin.
THE DRABC ACTION PLAN
DRABC
- DANGER
- RESPONSE
- AIRWAY
- BREATHING
- CIRCULATION
D - Check for DANGER:
* to you
* to others
* to the casualty
* Make sure that no one else gets hurt. You will not be able to help
if you are also a casualty.
* Only proceed if it is safe to do so.
R - Check RESPONSE
* Is the casualty conscious?
* Gently shake the casualty and ask ‘can you hear me?’, ‘what is
your name?’
* If the casualty is conscious, check for and manage bleeding
and other injuries.
* If the casualty is unconscious, he/she should be turned on
the side.
A - Clear and open the AIRWAY
* With the casualty supported on the side, tilt the head backwards
and slightly down.
* Open the mouth and clear any foreign objects. Only remove
dentures if loose or broken.
* Place one hand high on the casualty’s forehead.
* Support the chin with the other hand.
* Gently tilt the head backwards.
* Lift the jaw forward and open the casualty’s mouth slightly.
B - Check for BREATHING
* Look for the chest rising and falling
* Listen for the sound of breathing
* Feel with your cheek
* If the casualty is breathing, ensure that he/she is in a stable
side position. Check for and manage bleeding and other injuries.
* If the casualty is not breathing, turn onto the back and commence
EAR (expired air resuscitation), giving 5 full breaths in 10 seconds.
C - Check for CIRCULATION
* Feel the pulse at the neck (carotid pulse)
* If pulse is present, continue EAR at the rate of 15 breaths per
minute. Check breathing and the pulse after 1 minute, then after
every 2 minutes.
* If pulse is not present, commence CPR (cardiopulmonary resuscitation).
* Check breathing and the pulse after 1 minute, then after every
2 minutes. If the pulse returns, continue EAR. If breathing returns,
turn the casualty to a stable side position. Check for and manage
shock, bleeding and other injuries.
* Seek medical aid.
DRABC SUMMARY
DANGER - to self, others and the casualty.
RESPONSE - (shake and shout)
YES - Manage bleeding and other injuries
NO - Turn casualty on side.
AIRWAY - clear and open.
BREATHING
- Stable side position manage shock, control bleeding and
her injuries.
no- Turn casualty on back start EAR. 5 full breaths in 10
seconds.
CIRCULATION - Check pulse.
YES - Continue EAR 15 breaths/minute check pulse and breathing
after 1 minute, then after every 2 minutes.
NO - Commence CPR 60 compressions, 8breaths/minute check
pulse and breathing after 1 minute then every 2 minutes.
RESUSCITATION
EAR - MOUTH TO MOUTH METHOD
1. Kneel beside the casualty.
2. Keep the casualty’s head tilted back.
3. Pinch the casualty’s nostrils with your fingers or seal with your
cheek.
4. Lift the jaw forward with your other hand.
5. Take a deep breath and open your mouth wide.
6. Place your mouth firmly over the casualty’s mouth making an airtight
seal.
7. Breathe into the casualty’s mouth.
8. Remove your mouth and turn your head to observe the chest fall and
listen or feel for exhaled air.
9. If the chest does not rise and fall, check head tilt position first,
then check for and clear foreign objects in the airway.
10. Give 5 full breaths in 10 seconds, then check the carotid
(neck) pulse. If pulse is present, continue EAR at the rate of 15
breaths per minute.
EAR - MOUTH TO NOSE METHOD
The mouth to nose method is used when:
* the jaw and/or teeth are broken
* the jaws are tightly clenched
* resuscitating in deep water
* resuscitating and infant or child when your mouth can cover the
casualty’s nose and mouth
1. Kneel beside the casualty.
2. Keep the casualty’s head tilted back.
3. Close the casualty’s mouth and place your thumb on the lower
lip to keep the mouth closed. Support the jaw.
4. Take a deep breath and open your mouth wide.
5. Seal your mouth around the casualty’s nose without compressing
the soft part.
6. Breathe into the casualty’s nose.
7. Remove your mouth after breathing in. Open the casualty’s mouth
with your thumb to allow exhalation.
EAR - MOUTH TO MASK METHOD
The mouth to mask method avoids mouth to mouth contact between the
first aider and the casualty by the use of a resuscitation mask.
However, resuscitation should not be delayed by attempts to obtain a mask.
An appropriate face mask is provided in the St John Ambulance Australia
Communicable Diseases Protection Pack.
1. Position yourself either beside the casualty’s head or at the
casualty’s head facing the feet. Use both hands to hold the jaw
forward, maintain an open airway and to hold the mask in place.
2. Place the narrow end of the mask on the bridge of the nose.
Apply the mask firmly to achieve an effective seal.
3. Take a deep breath and blow through the mouthpiece of the mask.
Remove your mouth to allow exhalation. Turn your head to listen and
feel for the escape of air.
4. If the chest does not rise, recheck head tilt, jaw support and
mask seal.
CARDIOPULMONARY RESUSCITATION
1. After finding that there is no pulse, kneel beside the casualty
with one knee level with the casualty’s chest and the other level
with the head.
2. Your hands must be positioned correctly:
- locate the lower end of the breastbone by running your fingers
along the lowest rib on each side from the outside inwards
- locate the upper end of the breastbone by placing a finger in
the groove between the collarbones
- extend the thumbs of each hand equal distances to meet in the
middle
- keep the thumb of the upper hand in position and place the
heel of the lower hand below it
3. Your fingers should be relaxed, pointing across the chest, and
slightly raised.
4. Place your other hand securely on top of the fist.
Lock the top thumb around the lower wrist, or interlock the fingers.
5. Exert pressure through the heel of your lower hand. your shoulders
should be above the breastbone and your compressing arm should be
straight. Pivoting from the hips, perform the compressions
rhythmically with equal time for compression and relaxation.
6. The breastbone should be depressed about 5 centimetres. Release
the pressure.
7. Give 15 compressions in 10-12 seconds.
Then give 2 breaths in 3-5 seconds. Continue 4 cycles per minute.
SUCCESSFUL CPR
If a casualty is not breathing and has no pulse, you should try to
give cardiopulmonary resuscitation. However, even if performed expertly
, you may not be successful in saving the casualty’s life.
Success depends on the cause of the injury or illness, how quickly you
are able to respond, and how quickly expert medical aid arrives.
Call medical aid as soon as possible.
WHAT NEXT?
After managing life-threatening problems, turn the casualty to a
stable side position. Remember that you must call medical aid as soon
as possible. You should then undertake an orderly assessment of the
casualty, looking for any bleeding, then other injuries such as burns and
fractures. Note any tenderness, swelling, wounds or deformity.
Examine the casualty in the following order:
* Head and neck
* Chest (including shoulders)
* Abdomen (including hip bone)
* Upper limbs
* Lower limbs
* Back
CPR - TWO FIRST AIDERS
The most experienced first aider should perform EAR. Kneeling on
opposite sides of the body give 5 compressions and 1 breath in 5 seconds.
Continue at 12 cycles per minute without pausing between cycles.
SHOCK
Shock is the term used to describe a life-threatening condition that
can occur as a result of serious injury or illness, particularly when
there is pain, severe bleeding, or fluid loss from burns. It is a
progressive condition that may lead to the collapse of the circulatory
system and death. The circulatory system consists of the heart and blood
vessels. It circulates blood to all parts of the body, supplying food
and oxygen, and removing waste products.
CAUSES
* If blood is lost, as a result of external or internal bleeding,
the volume of blood in the blood vessels becomes insufficient.
* Fluid lost from the tissues as a result of severe burns, diarrhoea
or vomiting, is replaced by fluid from the blood, thus reducing the
volume of blood.
* Damage to the heart, eg. as a result of heart attack.
* Decreased blood pressure, eg. as a result of spinal cord injury,
severe pain, infection or poisoning.
A combination of these factors may result in more severe shock.
SYMPTOMS & SIGNS
Immediately after injury, there may be little evidence of shock.
The symptoms and signs will develop progressively, depending on:
- the severity of the injury
- continuation of fluid loss
- effectiveness of management
Initial symptoms and signs are:
- pale face, fingernails and lips
- cold, clammy skin
- usually a weak, rapid pulse
- rapid breathing
- faintness or dizziness
- nausea
Symptoms and signs of severe shock are:
- restlessness
- thirst
- extremities become bluish in colour
- the casualty may become drowsy, confused or unconscious
- rapid breathing
- usually an extremely weak, rapid pulse
MANAGEMENT
* DRABC and control severe bleeding.
* Reassure the casualty.
* Seek medical aid urgently.
* Unless fractured, raise the casualty’s legs above the level of the
heart.
* Dress any wounds or burns.
* Immobilise and fractures.
* Loosen any tight clothing
* Keep the casualty comfortable by maintaining body warmth but do
not heat.
* If the casualty complains of thirst, moisten lips, but do not
give anything to eat or drink.
* Monitor and record breathing and pulse at regular intervals.
Maintain a clear and open airway.
* Place casualty in a stable side position if there is breathing
difficulty, if vomiting is likely, or if the casualty becomes
unconscious.
BLEEDING
Bleeding is a loss of blood from the blood vessels. Severe or continued
bleeding may lead to collapse and death. Thus, the first aider must aim
to control severe bleeding.
The total quantity of blood in the human body varies according to size.
An adult can lose 500ml of blood without any harm, but the loss of 300ml
might cause death in an infant.
Remember: severe bleeding is serious. The extent of bleeding may be
hidden. Act quickly!!
EXTERNAL BLEEDING
SYMPTOMS & SIGNS
* Obvious bleeding.
MANAGEMENT
* DRABC.
* Lay casualty down.
* Apply direct pressure to the site of bleeding.
* Raise and rest the injured part when possible.
* Loosen tight clothing.
* Give nothing by mouth.
* Seek medical aid urgently.
1. Apply direct pressure to the wound with your fingers or hand.
2. As soon as possible, place a clean dressing over the wound.
Apply a bulky pad extending beyond the edges of the wound, and firmly
bandage. If bleeding continues, leave the dressing in place and
relocate the pad.
3. Do not disturb pads or bandages once bleeding is controlled.
UNCONTROLLED BLEEDING
If severe bleeding cannot be controlled by direct pressure,
it may be necessary to apply pressure to the pressure points.
These are found on the main artery above the wound.
when bleeding has been controlled, remove pressure to the point
and reapply direct pressure to the wound.
Occasionally, in major limb injuries such as partial amputations
and shark attack, severe bleeding cannot be controlled by direct pressure.
Only then, it may be necessary to resort to the application of a
constrictive bandage above the elbow or knee.
APPLYING A CONSTRICTIVE BANDAGE
1. Select a strip of firm cloth, at least 7.5 centimetres wide and about 75 centimetres
long. This may be improvised from clothing or a narrow folded triangular bandage.
2. Bind the cloth strip firmly around the injured limb above the bleeding point until
a pulse can no longer be felt beyond the constrictive bandage and bleeding is controlled.
Tie firmly.
3. Note the time of application. After 30 minutes, release the bandage and check for
bleeding. If there is no bleeding, remove it. If bleeding recommences,
apply direct pressure. If this is unsuccessful, reapply the constrictive bandage
and recheck every 30 minutes.
4. Ensure that the bandage is clearly visible and inform medical aid of the location
and time of its application.
INTERNAL BLEEDING
SYMPTOMS & SIGNS
Evidence of internal bleeding from some organs may be seen by the first aider. For example:
- coughing up red frothy blood
- vomiting blood the colour of coffee grounds or bright red. The blood may be
mixed with food
- passing of faeces with a black, tarry appearance
- passing of faeces which are red in colour
- passing urine which has a red or smoky appearance
Concealed bleeding within the abdomen may be suspected when there is:
- pain
- tenderness
- rigidity of abdominal muscles
Internal bleeding will be accompanied by any of the following symptoms and signs:
- faintness or dizziness
- restlessness
- nausea
- thirst
- weak, rapid pulse
- cold, clammy skin
- rapid, gasping breathing
- pallor
- sweating
MANAGEMENT
* Lay the casualty down.
* Raise the legs or bend the knees.
* Loosen tight clothing.
* Seek medical aid urgently.
* Give nothing by mouth.
* Reassure the casualty.
ABRASIONS
Abrasions, eg. gravel rash, occur as a result of falls on hard, rough surfaces.
Dirt may be embedded in the wound and infection may follow.
MANAGEMENT
* Cleanse the wound thoroughly with sterile gauze soaked in sterile or cool
boiled water. An antiseptic may be used according to directions on the label
to help wound cleaning.
* If this is not possible, wash the wound under running tap water.
* Gently apply a non-stick dressing.
OPEN WOUNDS
MANAGEMENT
* DRABC.
* Control bleeding
* Clean the wound as well as possible.
* Apply a sterile or clean dressing.
* Seek medical aid.
Minimise infection by:
* Washing your hands well before and after management.
* Avoiding coughing, sneezing or talking while managing a wound.
* Handling the wound only when it is necessary to control severe bleeding.
* Using sterile or clean dressings.
Dirty and penetrating wounds should be examined by a doctor, as tetanus or other serious
and fatal infections may result.
PENETRATING WOUNDS
Penetrating wounds are serious and may occur when an object, eg. a bullet, nail
or needle, penetrates the skin. The penetration may be deep and infection may occur.
MANAGEMENT
* Control bleeding by applying direct pressure around the wound.
* Keep the wound as clean as possible.
* Cut away or remove clothing covering the wound.
* If not bleeding, carefully clean out loose dirt.
* Do not try to pick out foreign material embedded in the wound.
* Apply a sterile or clean dressing.
* Rest the injured part in a comfortable position.
* Always seek medical aid.
CRATER WOUNDS
These occur when large amounts of tissue are suddenly torn from the body.
Severe bleeding and shock may result.
MANAGEMENT
* Pack wound with sterile or clean material.
* Apply direct pressure and firmly bandage.
* Raise and rest the affected part.
* Seek medical aid urgently.
FOREIGN OBJECTS IN WOUNDS
MANAGEMENT
Foreign objects, eg. gravel, lying on the surface of a wound may be lightly brushed from
the wound. If the foreign object penetrates into tissue:
* Do not attempt to remove it as this may result in severe bleeding or may damage
deep structures.
* Control bleeding by applying pressure to the surrounding areas but not on the foreign
body.
* Place padding around the object or place a ring pad over the object and a bandage
over the ring pad.
* If the length of the object is such that it is protruding outside the ring pad,
take care to bandage only each side of the pad.
* Seek medical aid.
DO NOT:
* Exert any pressure over the object.
* Try to shorten the object unless its size makes it unmanageable.
MANAGING A FOREIGN OBJECT IN A WOUND
BURNS
CAUSES
Burns may be caused by:
* Excessive heat, eg, fire, steam, hot objects or liquids.
* Friction, eg, rope burn.
* Chemicals, eg, acids.
* Electricity, eg, domestic, high voltage.
* Radiation, eg, sun, microwaves, sun lamps.
EFFECTS
Burns may result in:
* Death of the superficial layers of the skin or, in severe cases, the whole skin and
deeper tissues.
* Damage to the superficial blood vessels with outpouring of fluid, seen as blisters
if the skin is intact.
* A raw area, which may lead to infection.
* Severe pain.
* The injured area becoming red, swollen and blistered.
* Shock.
WHEN TO SEEK MEDICAL AID
Extensive burns are dangerous and may be fatal. Seek medical aid if:
* The burn is deep (full thickness) - the skin may look white, or it may be black and
charred. The casualty may not feel pain.
* A superficial burn (a red, painful area which may blister) is larger than a
20 cent piece.
* The burn involves the airway, hands, face or genitals.
* Your are unsure about how serious the burn is.
RESCUE OF THE BURNT CASUALTY
Rescue can be dangerous - leave to expert help, if available.
If entering a burning building:
* Feel the temperature of the door. If very hot do not enter. If cold or slightly
warm, crouch low and open slowly.
* Cover mouth and nose with damp cloth.
If domestic voltage electricity is involved:
* Switch off the current of jerk the cable free.
* If this is not possible, remove the casualty from the current using non-conducting,
dry materials, eg, dry clothing or a dry wooden stick.
* Do not cut the cable.
If high voltage electricity is involved:
* Wait until the current is disconnected by the appropriate electricity authority.
* Ensure you and any bystanders are safe.
* Do not touch the casualty or any conducting material which is also in contact
until he current is disconnected.
MANAGEMENT
* DRABC.
* Remove the casualty from danger. Do not become another casualty yourself.
* Put out burning clothing. Smother with a blanket or jacket, or use water.
* Hold the burnt area under cold, gently running water until the part has returned
to normal body temperature (upto 10 minutes).
* Remove jewellery and clothing, but leave any that is stuck.
* Cover the burn with a sterile, non-stick dressing.
* Seek medical aid urgently.
* If the casualty is conscious and thirsty, give frequent small amounts of water.
Do not give alcohol.
* Alleviate extreme pain by gently pouring cold water over the dressing.
Warning:
* Do not apply any lotions, ointments or oily dressings
* Do not prick or break blisters
* Do not give alcohol to drink
* Do not overcool the casualty, particularly if very young, or if the burnt area
is extensive. Overcooling may be indicated by shivering
* Do not use towels, cotton wool, blankets or adhesive dressings directly on the wound
FIRES
In a fire, check for and manage:
* Asphyxia (lack of oxygen)
* Carbon monoxide poisoning
* Poisoning from the inhalation of gases given off by plastics and synthetic
building materials
* Burns to the airway
* Irritation to the respiratory tract and eyes from smoke and chemical fumes
SUNBURN
Take care to prevent sunburn.
MANAGEMENT
* Cold showers
* Apply cool moist compresses to the burnt area
* Rest in a cool place
* Cool drinks
* Young babies and casualties with blisters need medical aid
CHEMICAL BURNS
MANAGEMENT
* DRABC
* Wash off immediately with a large volume of flowing water for 20 minutes
* Remove contaminated clothing and footwear but avoid contaminating yourself
* Do not attempt to pick off contaminants that stick to the skin
* Cover the area with a sterile or clean non-stick dressing
* Seek medical aid urgently
ELECTRICAL BURNS
While the surface skin may show little or no evidence of burning, deep tissues may be
seriously burnt.
MANAGEMENT
* DRABC
* Remove the casualty from danger
* Wash and cool burnt area under gently running water well away from live wire
* Apply a clean, non-stick dressing
* Seek medical aid urgently for all electrical burns
BITUMEN BURNS
MANAGEMENT
* Do not attempt to remove bitumen from the skin or from the eyes
* Drench the burnt area immediately with cold, running water. Use iced water if available
* Apply cold wet towels frequently to maintain the cooling effect
* Continue the cooling for 30 minutes, but no longer
* If the burn is to the eye, flush the eye with water for 20 minutes and cover both eyes
* Seek medical aid urgently
LIMB INJURIES
Limb injury can involve damage to bones, joints, ligaments, muscles, the major blood
vessels and nerves of the limb. Depending on the severity, limb injuries may be
life-threatening, or cause considerable pain and long term disability. Blood loss
and shock may result, particularly in cases of multiple injury.
BRUISES
These may be caused by falls, blows or crushing. Bleeding into the deep tissues occurs,
causing bruising.
SYMPTOMS & SIGNS
* Pain
* Swelling
* Bruising
* Tenderness
MANAGEMENT
* RICE
RICE MANAGEMENT
R - REST the casualty and the injured part.
I - ICE packs wrapped in cloth may be applied to the injury - 20 minutes on
and reapplied every 2 hours for the first 24 hours, then every 4 hours for
a further 24 hours.
C - COMPRESSION bandages, eg, elastic bandages, should be applied to extend
well beyond the injury.
E - ELEVATE the injured part.
SPRAINS
A sprain occurs when a joint is forced beyond its normal range of movement,
stretching or tearing the ligaments that hold it together.
SYMPTOMS & SIGNS
* Pain, which may be quite intense which will also cause restriction
of movement and loss of function
* Swelling
* Bruising, which may develop quickly
MANAGEMENT
If in doubt, manage as a fracture.
* DRABC
* RICE
* Seek medical aid
STRAINS
A strain is the result of overstretching of a muscle or tendon.
SYMPTOMS & SIGNS
* Pain in the region, usually sharp and with sudden onset
* Additional pain on movement, or if the muscle is stretched
* Loss of power
* Tenderness over the muscle
* Sometimes a gap in the muscle
MANAGEMENT
* DRABC
* Apply a cold pack over the injured area
* Advise the casualty not to further overstretch the muscle
* Support the injured muscle with a compression bandage
* Encourage gentle exercise to reduce painful spasm and/or shortening of the muscle
* Avoid all rubbing or massage
DISLOCATIONS
A dislocation occurs when force stretches the ligaments so far that the bones in
the joint are pushed out of normal contact with each other.
SYMPTOMS & SIGNS
* Pain
* Inability to move the joint
* Deformity
* Tenderness over the joint
* Rapidly developing swelling and discolouration about the joint
MANAGEMENT
If in doubt, manage as a fracture.
* DRABC
* Do not attempt to reduce the dislocation
* If a limb:
- check the pulse and if absent, gently move the limb to try to restore
circulation. Seek medical aid urgently
- rest the joint in the most comfortable position
- elevate if possible
- expose the joint and apply cold packs
- use soft padding and bandages to support the joint in the position
in which it was found
* For shoulder dislocations, support the shoulder and arm in the
position of least discomfort and apply ice packs
FAI.9. BASIC FIRST AID Page 3 of 5
FRACTURES
A fracture is a broken or cracked bone. The break is usually
complete, but in the young the bone can be bent without breaking
completely. This is called a greenstick fracture. Correct first
aid management of fractures, in both conscious and unconscious
casualties, is essential, in order to reduce the amount of tissue
damage, bleeding, pain and shock.
CAUSES
* Direct force - a blow that breaks the bone at the point of
impact
* Indirect force - when the bone breaks at some distance
from the point of impact, eg, where a fall on an outstretched
hand results in a fracture of the collarbone
* Abnormal muscular contraction - a sudden contraction
of a muscle may result in a fracture, eg, an elderly person
snapping the kneecap after tripping and trying to prevent a fall
EFFECTS
* Bleeding - fractures of large bones may result in
considerable loss of blood, eg, a fractured thigh results in
the loss of 1 or 2 litres
* Damage to surrounding tissues and blood vessels
* Possible shock
TYPES
* Closed - skin is unbroken and blood is lost into tissues
* Open - a wound leads to the fracture, or bone protrudes
through the skin. blood loss may be severe, and infection can
result
* Complicated - Vital organs may be damaged, eg, rib fracture
with an injury to the lung
SYMPTOMS & SIGNS
* The break may have been felt or heard
* Pain at or near the site of the injury
* Difficult or impossible normal movement of the limb
* Loss of power
* Deformity, abnormal twist or shortening of limb
* Tenderness when gentle pressure is applied
* Swelling over the fracture, and possibly around it
* Bruising
* A coarse grating sound if one end of the bone moves
against the other. Never actively seek this sign as further
injury may result
MANAGEMENT - GENERAL RULES
* DRABC
* Control bleeding and cover all wounds
* Check for fractures - open, closed or complicated
* Ask the casualty not to move the injured part
* Immobilise fractures with slings, bandages or splints to
prevent movement oat the joints above and below the fracture
* Watch for signs of loss of circulation to the foot or hand
* Move the casualty only if there is danger to you or the
casualty
* Handle gently
* Observe casualty carefully and manage shock if necessary
* Seek medical aid
DISORDERS OF BREATHING
ASTHMA
Asthma is a breathing problem resulting from sudden or
progressive narrowing of the airways. Attacks can be caused by:
* Exercise
* Allergies, eg, pollens
* Cold air
* Some drinks
* Preservatives
* Respiratory infections
* Anxiety or emotional stress
* House dust
* Food additives
* Stress
* Smoke
SYMPTOMS & SIGNS
* Casualty may be sitting up
* Moderate to severe breathing difficulty
* Sometimes wheezing
* Sometimes coughing
* Possible paleness, sweating, blueness of lips, ear lobes
and fingertips
* May be very quiet or subdued
* Possible unconsciousness
MANAGEMENT
* DRABC
* If the casualty is conscious, assist him/her into
the most comfortable position, usually sitting upright
* Reassure the casualty
* Provide assistance in administering any medications
that have been prescribed for the casualty’s asthma attacks
* Ensure adequate fresh air
* Seek medical aid
* If the casualty is unconscious, follow the DRABC Action Plan
and seek medical aid urgently
CHOKING
Choking is common to all age groups and is preventable.
CAUSES
* Laughing or crying while eating or drinking
* Running and stumbling while eating or drinking
* Inadequate chewing of food
* Swallowing splinters of bone
* Inhaling while eating or drinking
SYMPTOMS & SIGNS
* Coughing
* Violent attempts to breathe
* Clutching the throat
* Increasing blueness of the face, neck, lips, ears and
fingernails
* Sometimes unconsciousness and absent breathing
MANAGEMENT
If the casualty is conscious:
* Encourage him/her to relax and breathe deeply
* Ask the casualty to cough to remove the object
* If breathing is laboured, seek urgent medical aid
If the casualty is not breathing:
* Lay the casualty with the head low
* Give 3 or 4 sharp blows between the shoulder blades
* Follow the DRABC Action Plan
SWOLLEN THROAT TISSUES
CAUSES
* Injury
* Allergy
* Infection
* Stings and bites
* Burns
* Inhalation of hot gases
SYMPTOMS & SIGNS
* Swelling in the neck
* Breathing difficulty
MANAGEMENT
* DRABC
* Depending on the cause, remove from smoke or allergic
atmosphere
BITES & STINGS
Bites and stings of some animals are potentially dangerous as
a result of the venom which is injected or because the casualty
is allergic to some insects.
ALLERGIC REACTIONS TO INSECT BITES
If the casualty has an allergic history or any signs of allergy,
eg, a rash, raised lumps on the skin, swelling of the throat,
wheezing, manage as follows:
* DRABC
* Apply pressure immobilisation
* Seek medical aid urgently
* Periodically observe and record the pulse and breathing
* If the casualty is carrying any medication for the allergy,
it should be taken at once. If the medication is not identified
for this purpose (by the casualty, a relative or the label), it
should not be taken.
* Carry out EAR or CPR if necessary
PRESSURE IMMOBILISATION
Pressure immobilisation is used in the case of an allergic reaction,
or for management of bites and stings of the following:
* Blue-ringed octopus
* Box jellyfish
* Cone shell
* Funnel web spider
* Snakes
Apply pressure immobilisation over the bitten area and around the
limb, using a crepe or conforming bandage about 15cm wide.
If unavailable, use pantyhose or other material.
1. Apply the bandage firmly enough to compress tissue, but not
so firmly as to restrict the flow of blood to the limb below
the bandage.
2. Bandage from the bite to the fingers or toes, then up to the
armpit or groin. When bandaging the arm, first bend the elbow
to 90 degrees.
3. Bandage as much of the limb as possible.
4. Apply a splint to the bandaged limb with a second bandage.
5. Do not remove the splint or bandage, once applied.
As a general rule, non-lethal bites and stings of land dwelling
insects are managed by application of ice compresses, eg:
* Bee
* Centipede
* European wasp
* Red back spider
* Scorpion
BITES & STINGS OF VARIOUS ANIMALS
Detailed management of bites and stings of various animals and
insects is described in the following alphabetical listing:
BEE
Bee stings are usually left behind in the skin with the venom sac
attached.
MANAGEMENT
* Remove sting by scraping it sideways with a fingernail or
the side of a knife blade
* Wipe the area clean
* Apply cold compresses
* If there are signs of allergy, or if the casualty has an
allergic history, see the section on allergic reactions at the
beginning of this chapter
FUNNEL WEB SPIDER
The funnel web spider is found around Sydney, on the New South
Wales coast and in south-east Queensland. It is a large black or
reddish-brown spider, 2 or 3 cm in length. It is found:
* in rock crevices
* in burrows
* in post holes
* underneath houses
* in trees and shrubs
PREVENTION
* Show children pictures of the spider and tell them to leave
such spiders alone
* If living in areas known to be infested, clean out obvious
habitats
SYMPTOMS & SIGNS
* Initially, intense pain at the site of the bite
* Nausea and abdominal pain
* Breathing may be difficult and noisy
* Numbness
* Muscular weakness
* Profuse sweating
* Saliva from the mouth
* Coughing up of secretions
* Weeping from the eyes
* Cold skin and shivering
MANAGEMENT
* DRABC
* Rest and reassure casualty
* Apply a pressure immobilisation bandage over the bitten
area and around the limb
* Seek medical aid urgently
LIZARDS
Lizards may bite if handled. The bite is not venomous but may
become infected.
* If the lizard will not let go, apply a lighted match to
its mouth
* Manage the wound
* Seek medical aid
RED BACK SPIDER
The red back spider is small, normally black with a red stripe
on the back. It is found:
* Throughout most parts of Australia
* In dark, unattended spots, eg, under eaves, in old tyres,
in garden sheds
PREVENTION
* Clean out habitats and treat the area with a suitable
pesticide
* Use gloves when handling old tyres, cleaning out sheds, or
carrying out other tasks likely to involve contact with the red
back spider.
SYMPTOMS & SIGNS
* A sharp sting may be felt
* Pain at the site of the bite, which then becomes general
* Nausea
* Dizziness and sometimes faintness
* Muscle weakness or spasm
* Sweating, sometimes profuse
* Swelling and localised sweating around the bite
* Rapid pulse
MANAGEMENT
* DRABC
* Reassure the casualty
* Apply a cold pack or compress over the area
* Seek medical aid
SCORPION
SYMPTOMS & SIGNS
* Immediate intense burning pain
* Throbbing and later, numbness
MANAGEMENT
* Apply a cold pack or compress over the affected area
* Seek medical aid
SNAKES
Snakes are not normally aggressive and tend only to bite when
they are threatened or mishandled. Some snakes, eg, the carpet
snake, are not venomous. Others, eg, the brown snake, tiger snake
and taipan, are very poisonous.
PREVENTION
* Leave snakes alone and do not collect snakes
* In snake infested country, wear stout shoes, walk socks
and jeans or similar clothing
* Do not wear sandals or thongs or walk in bare feet in places
where snakes could be present
* Do not put your hands in hollow logs, under piles of wood or
in rubbish
* Be noisy when walking in the bush
* Look carefully when walking through thick grass
* Use a torch around camps or farm houses at night
* Keep sheds free of mice
* Cut grass short around houses and in school playgrounds
SYMPTOMS & SIGNS
These do not appear immediately, but from about 15 minutes to 2
hours after the casualty is bitten. There are often no visible
symptoms and signs. Take seriously any information that a casualty
has been bitten by a snake:
* Strong emotional reaction
* Headache
* Double vision
* Drowsiness
* Nausea and/or vomiting and diarrhoea
* Pain or tightness in the chest or abdomen
* Giddiness or faintness
* Puncture marks about 1 centimetre apart at the site of
the bite, although sometimes there may only be fang scratches
on the skin. Bites are usually on the limbs, especially the legs
* Swelling of the bitten area
* Reddening
* Bruising
* Sweating
* Breathing difficulties
MANAGEMENT
* DRABC
* Rest and reassure the casualty
* Apply a pressure immobilisation bandage over the bitten area
and around the limb (see section on pressure immobilisation at the
beginning of this chapter)
* Seek medical aid urgently
Warning:
* Never wash the venom off the skin as this will help in later
identification
* Never cut or excise the bitten area
* Never try to suck the venom out of the wound
* Never use a constrictive bandage
* Do not try to catch the snake. However, a description of the
snake may assist medical aid
TICKS
Ticks occur in most parts of Australia. However, paralysis ticks
occur mainly along coastal eastern Australia, from Queensland to
northern Tasmania. Usually drab in colour, ticks are oval and flat.
Engorged, they may become globular and about 0.5 centimetres in
diameter. They may hide in body crevices. The venom may cause
paralysis, especially in small children. Many ticks do not cause
paralysis, but may cause local irritation or a skin nodule.
SYMPTOMS & SIGNS
* Weakness of the face and upper eyelids, progressing to arms
and breathing muscles
MANAGEMENT
* If in the ear, seek medical aid
* Remove the tick by sliding the open blades of a pair of small
sharp scissors or tweezers, one each side of the tick, and lever
the tick outwards, being careful not to leave the mouth parts in the
skin
* Search carefully for other ticks, particularly in the hair,
behind the ears and other body crevices
* If the casualty does not recover after a few hours or if the
casualty is a child, seek medical aid
OVEREXPOSURE TO HEAT & COLD
OVEREXPOSURE TO HEAT
The temperature of the healthy human body is maintained at about 37C.
In hot or humid conditions, eg, in a boiler room, or travelling
in hot climates, people are at risk of a heat illness.
There are three stages of heat illness;
* Heat cramps
* Heat exhaustion
* Heat stroke
PREVENTION
* Protect yourself from strong direct sunlight
* Wear loose fitting porous clothing and a broad brimmed hat
* Do not do heavy physical tasks in hot humid weather unless
conditioned to the task and the environmental conditions
* Drink enough water to satisfy your thirst
* Avoid alcohol, as this increases urine output, and hence
fluid loss
* Do not spend prolonged periods in saunas
* Do not leave infants or children in closed cars during hot
weather
* Cease working when affected by heat cramps or heat exhaustion
and seek medical aid if the symptoms persist
* Do not take part in ‘fun runs’ and similar activities during
the hot summer months
HEAT CRAMPS
SYMPTOMS & SIGNS
* Painful muscle cramps of the limbs and abdomen, either while
resting or exercising
* Nausea and/or vomiting
* Tiredness, dizziness or weakness
* Moist cool skin
MANAGEMENT
* Remove the casualty to a cool place, if possible
* Have the casualty lie down
* Replace lost fluid by giving plenty of water to which may be
added glucose or sugar in small amounts, and half a teaspoon
of salt per litre. If commercial preparations are used, they
should be diluted as recommended by the manufacturer. If the
casualty is nauseated, encourage slow drinking
* Apply ice packs to the cramped muscles
* Gently stretch the muscles, but do not massage
* Warn the casualty that further exertion and exposure in the
hot environment may lead to heat exhaustion and that he should
rest or work in a cooler area and/or at a less physically demanding
task
HEAT EXHAUSTION
Heat exhaustion occurs mostly in hot, humid climates. The young and
the elderly are more at risk, as are dehydrated casualties and those
wearing unsuitable clothing when working or exercising
SYMPTOMS & SIGNS
* Feeling hot, exhausted and weak, with a headache which may
have persisted for some hours or days
* Thirst
* Fatigue
* Nausea
* Loss of appetite
* Giddiness and faintness
* Stomach and muscle cramps
* Shortness of breath
* Muscular weakness
* Lack of coordination
* Pale, cool and clammy skin
* Profuse sweating
* Rapid breathing and pulse
* Possible, confusion or irritability
MANAGEMENT
* Move the casualty to a cool place with circulating air, and
lay him/her down
* Loosen any tight clothing and remove any unnecessary garments
* Sponge the body down with cold water, but do not overcool
* Replace lost fluid and body salt (as for management of heat
cramps)
* Seek medical aid if the casualty vomits and connot keep fluid
down, or does not recover promptly
* Manage cramps as previously outlined
HEATSTROKE
Heatstroke is a potentially lethal condition. Early recognition
of heat stroke is essential. Those at risk of heat stroke include:
* Infants left in closed cars on a hot day
* Athletes attempting to run long distances in hot weather,
particularly fun runners
* Unfit workers and overweight alcoholics in hot climates
* The elderly or ill
SYMPTOMS & SIGNS
* Headache
* Nausea and/or vomiting
* Dizziness
* Visual disturbances
* Often, irritability or mental confusion, and possible
aggression
* Altered mental state, which may progress to seizures and
unconsciousness
* A rise in body temperature to 40C or more
* A strong pounding and rapid pulse
* Skin flushed, and usually dry
MANAGEMENT
* DRABC
* Remove the casualty to a cool place
* Loosen any tight clothing and remove any unnecessary
garments
* Apply cold packs or ice to the areas of large blood vessels,
such as the neck, groin and armpits, to accelerate cooling
* If possible, cover the casualty’s body with a wet sheet and
fan to increase air circulation
* Continue until the body feels cold to the touch, then stop
cooling
* Seek medical aid urgently
* When the casualty is fully conscious give fluids, eg, water
to which is added glucose and salt (as for management of heat
cramps)
OVEREXPOSURE TO COLD
Overexposure to cold can occur:
* Following immersion
* As a result of wind chill
* When in the snow without protective clothing
* In lightly clad runners and motorcyclists exposed to wind
* In divers
* In unconscious, immobile or drugged persons in a cold
environment
* In young children, babies and the elderly in a cold
environment
The severity of overexposure depends on:
* Age and physical condition
* Clothing
* Temperature
* Wind speed
* Period of exposure
The following will accelerate the condition:
* Low atmospheric temperature
* Wind, snow, rain
* Fatigue
* Anxiety
* Hunger
PREVENTION
* Wear warm inner clothing made from natural fibres such as
pure wool, or material specially designed for extremely cold
environments
* Wear wind and waterproof outer clothing
* Ensure adequate protection of the ears and nose
* Have a minimum of four persons in your party
* Ask locals about usual weather conditions if boating, skiing
or mountain climbing in an unfamiliar area
* Listen to broadcast weather reports
* Be sure that boats or other equipment are in good condition
* Have adequate sleeping bags and covers
* Eat adequate food before departure
* Take adequate food and drink (not alcohol) with you
* Inform people of your departure and expected time of return
* If caught in bad weather take shelter early and watch for
signs of cold exposure
* Take steps to avoid more physical activity than is necessary
when conditions are extremely cold
MILD TO MODERATE OVEREXPOSURE TO COLD
SYMPTOMS & SIGNS
* A cold feeling and shivering
* Excessive fatigue
* Problems with vision
* Faintness
* Cramps
* Increasing slowness of physical and mental responses
* Uncoordinated movement, eg, stumbling
* Confusion
* Slurred speech
MANAGEMENT
* DRABC
* Protect the casualty and yourself from wind, rain and sleet
and from cold, wet ground
* If possible, remove wet clothing and wrap the casualty in
warm, dry clothing or a spare blanket
* If possible, put the casualty in a warmed sleeping bag
* If the casualty is conscious give warm fluids to drink
* Do not give alcohol
* Place the casualty in a bath of water heated to about 37C
and raise the temperature of the bathwater slowly to about 40C
* If a warm bath is not available, a companion stripped to
underclothing and sharing the casualty’s sleeping bag can
help to warm the body
* Do not try to warm the casualty in front of a fire
* Seek medical aid if recovery is not prompt
* Remain with the casualty until medical aid arrives
SEVERE ACCIDENTAL COOLING (HYPOTHERMIA)
Hypothermia is a dangerous condition, commonly caused by prolonged
immersion in cold water. Infants, the infirm and the elderly are
especially at risk. Alcohol, drugs and injury may aggravate the
condition.
SYMPTOMS & SIGNS
* Coldness
* Slow pulse
* Slow, shallow breathing
* Quietness and refusal of food in infants
* Unconsciousness, especially in the elderly or the ill
MANAGEMENT
* DRABC
* Remove to a warm dry place if possible
* Place the casualty between blankets so that the temperature
can rise gradually
* If conscious, give warm drinks (not alcohol)
* A companion stripped to underclothing and sharing the
casualty’s sleeping bag can help to warm the body
* Seek medical aid urgently
* Remain with the casualty until medical aid arrives
Warning - do not attempt to speed up the warming process by placing
the casualty in a hot bath, or by using hot water bottles or
electric blankets.
FROSTBITE
Frostbite results in local freezing of body tissue, eg, toes, fingers
and other extremities. Deep frostbite may affect the blood supply
so badly that amputation may be necessary.
SUPERFICIAL FROSTBITE
SYMPTOMS & SIGNS
* Numbness and tingling in exposed areas
* Sudden whiteness of the skin
* Waxy appearance
* Firmness to touch
* Area is painless until rewarmed
* Possible blistering
MANAGEMENT
* Remove the casualty to a warm dry place
* Remove anything constricting the affected limb
* Rewarm the area by body heat
* Never rub or massage the frostbitten area
* Never apply snow or cold water
* Never rewarm with direct heat
* Cover any blisters with dry sterile dressings
* Give no alcohol
* Seek medical aid
DEEP FROSTBITE
SYMPTOMS & SIGNS
In addition to those for superficial frostbite:
* The area is white, hard to the touch and painless
MANAGEMENT
* Do not attempt to thaw
* Keep the casualty dry and warm
* Protect the injured area from further injury