First Aid Basics

Definition of First Aid

• First aid is the initial assistance or treatment given to a casualty for any injury or sudden illness.
• It is administered before the arrival of an ambulance, doctor, or other qualified personnel.

Aims of First Aid

• Preserve life.
• Prevent the casualty's condition from worsening.
• Promote recovery.

Recovery Position in First Aid

• The recovery position is for people who are unconscious or semiconscious, but still breathing.
• Do not attempt to place a casualty in the recovery position if there are spinal or neck injuries.
• Leaving a victim in the recovery position for long periods may cause nerve compression.

Hyperventilation

• Hyperventilation, also known as excessive breathing, causes a reduction of carbon dioxide concentration (below normal) in the blood.

Symptoms of Hyperventilation

• Unnaturally fast, deep breathing.
• Attention-seeking behaviors.
• Dizziness, faintness, trembling, or marked tingling in hands, feet and lips.
• Headache.
• Chest pain.
• Slurred speech.
• Carpal spasm (cramps in hands and feet).

Causes of Hyperventilation

• Stress or anxiety.
• Consequence of lung diseases, head injuries, or stroke.

Treatment for Hyperventilation

• When speaking to the casualty, be firm but kind.
• If possible, lead the casualty to a quiet place to regain control of breathing.
• Have the casualty re-breathe their own exhaled air from a paper bag.
• A paper bag is preferred over a plastic bag, as a plastic bag may cause suffocation.

Fainting

• Fainting is a brief loss of consciousness caused by a temporary reduction of blood flow to the brain.

Symptoms of Fainting

• A brief loss of consciousness causing the casualty to fall to the floor.
• A slow pulse.
• Pale, cold, and sweaty skin.

Causes of Fainting

• Taking in too little food and fluids (dehydration).
• Low blood pressure.
• Lack of sleep.
• Over exhaustion.

Treatment for Fainting

• Lay the casualty down and slightly elevate their legs.
• Make sure the casualty has plenty of fresh air.
• As the casualty recovers, reassure them and help them sit up gradually.
• Look for and treat any injuries sustained during the fall.

Shock

• Shock occurs when the circulatory system fails, and insufficient oxygen reaches the tissues.
• Untreated shock can cause vital organs to fail, ultimately leading to death.
• Shock is made worse by fear and pain.

Symptoms of Shock

• Clammy, cool, pale, and damp skin.
• Restlessness and nervousness.
• Thirst.
• Loss of blood.
• Confusion.
• Fast breathing.
• Nausea or vomiting.
• Blotched or bluish skin, especially around the mouth and lips.
• Profuse perspiration.
• May pass out.

Causes of Shock

• Hypovolemic shock: Loss of blood volume (bleeding) or dehydration.
• Cardiogenic shock: Weakened heart unable to pump blood efficiently, often after a massive heart attack.
• Distributive shock: Lack of blood distribution to organs.
• Obstructive shock: Obstruction to blood flow at a site other than the heart.

Treatment for Shock

• Follow "P.E.L.C.R.N." and pronounce it as "Pell-Crin".
• Position the casualty on their back.
• Elevate the legs.
• Loosen clothing at the neck, waist, or wherever it is binding.
• Climatize to prevent casualty from getting too hot or too cold.
• Reassure the casualty and keep them calm.
• Notify medical personnel and call for a medic

Bee/Hornet Stings

• Symptoms include redness and swelling in the injured area.
• Treatment involves removing the stinger as fast as possible and reducing pain and swelling with a cold compress.

Cramps

• Cramps are painful sensations caused by contraction or over shortening of muscles.

Causes of Cramps

• Cold or overexertion.

Treatment for Cramps

• Stretch the muscle and apply heat or cold, preferably heat.
• For cramps from lack of salt and water, stretch the muscle and increase water and salt intake.

Choking

• Choking is the mechanical obstruction of the flow of air from the environment into the lungs.

Causes of Choking

• Introduction of a foreign object into the airway.
• Respiratory diseases.
• Compression of the airway, such as strangling.

Symptoms of Choking

• Unable to speak or cry out.
• Face turns blue from lack of oxygen.
• Victim grabbing at their throat.
• Weak coughing with labored breathing producing high-pitched noise.
• Unconsciousness.

Treatment for Choking

• Encourage the victim to cough.
• Perform the Heimlich maneuver.
• Administer back slaps using the heel of the hand on the upper back of the victim.
• Use abdominal thrusts by standing behind the victim and exerting pressure on the bottom of the diaphragm. This may result in injuries like bruises or fracture of ribs.

Types of Burns

• Dry burn: Caused by flame, contact with hot objects, friction.
• Scalds: Contact with steam and hot fluids.
• Electrical burn: Low-voltage current, lightning strike.
• Cold injury: Contact with freezing metals, dry ice, freezing vapors, liquid oxygen, and liquid nitrogen.
• Chemical burn: Contact with industrial or household chemicals.
• Radiation burn: Sunburn or over-exposure to UV lamp or radioactive source.

Degree of Burn

• First degree burn: Involves only the outermost layer of skin, characterized by redness, swelling, and tenderness.
• Second degree burn: Any 1% burn affecting layers of the epidermis, giving rise to rawness, blisters, and clear fluid can be fatal if it affects over 60% of the body.
• Third degree burn: All layers of the skin are burned, possible damage to nerves, fat tissue, and muscles. Skin may look waxy, pale, or charred. Purple fluid is observed and no pain is felt. Urgent medical attention is required.

Treatment for Minor Burns (First Degree Burns)

• Rinse the injured part with cold water for at least 10 minutes to stop burning and relieve pain.
• Gently remove jewelry, watches, belts, or constricting clothing from the injured area before it begins to swell.
• Cover area with sterile dressing or any clean, non-fluffy material and bandage loosely in place.
• Cold burns should not be rinsed with cold water, and cold water should never be applied to anyone with extensive burns.

Treatment for Severe Burns (Second and Third Degree Burns)

• Lay the casualty down, and protect the burn area from contact with the ground if possible.
• Rinse burn with plenty of cold water for at least 10 minutes or use burn-cooling gel.
• Arrange for the casualty to be sent to the hospital.
• While cooling the burn, watch for signs of difficulty in breathing and be ready to resuscitate if necessary.
• Remove rings, watches, belts, shoes, or burning clothing from the injured before it begins to swell.
• Remove burnt clothing, unless it is sticking to the burn.
• Cover dressing with a sterile dressing or some other suitable material to prevent infection and germs (this is not necessary if the burn is on the face).
• Do NOT burst any blisters, touch the infected area, or apply any lotions to the injury as this will retain heat within the burn

Electric Shock (Low-Voltage Currents)

• Treatment: Break contact of electric source with casualty by switching off mains or meter point, only if safe.
• Stand on an insulating material if unable to reach the cable.
• Push casualty's limbs away from the source with a broom or stick.
• Do not touch the person until the power supply is turned off.
• Be careful in areas that are wet.
• Dial 161 to summon an ambulance.

Fractures

• A fracture is a break or crack in the continuity of the bone

Symptoms of Fractures

• Pain at or near the fractured site.
• Tenderness on gentle pressure.
• Swelling over the fracture site.
• Deformity, e.g., irregularity of bone, angulation, or rotation of limb, depression of bone etc.
• Loss of power.
• Signs and symptoms of shock.
• Grating sound (crepitus).

Dislocations

• A dislocation is the displacement of one or more bones at a joint.
• It usually occurs in the shoulders, elbow, thumb, fingers, and the lower jaw

Symptoms of Dislocations

• Pain at the site of injury.
• Limited movement at the joint.
• Deformity.
• Swelling.
• Tenderness.

Strains

• A strain is an injury to a muscle in which the muscle fibers tear as a result of overstretching (Sprain - to a ligament).

Symptoms of Strains

• Localized pain.
• Stiffness.
• Inflammation.
• Bruising.

Sprains

• A sprain occurs at a joint where there is tearing or over-stretching of the ligaments and tissues.

Symptoms of Sprains

• Pain at the site of injury.
• Swelling and later bruising.
• Pain on movement.
• Loss of function.

Treatment for Sprains

• Support the joint in the most comfortable position.
• Use P.R.I.C.E. (Protect, Rest, Ice, Compression, Elevation) treatment.
• When a sprained ankle occurs outdoors, do not remove the shoe.
• If unsure whether there is a fracture, always assume it is one.

Foreign Bodies in Minor Wounds Treatment

• Control bleeding by applying firm pressure on either side of the object and by raising the wounded part.
• Cover the wound with gauze to minimize the risk of infection.
• Pad around the object until you can bandage over it without pressing down.
• Hold the padding in place while finishing the bandaging.
• If you cannot pad high enough, bandage around the object.

Bandaging

• Applying pressure to bleeding wounds and covering wounds.
• Applying to burns.
• Providing support and immobilization for broken bones, sprains, and strains.
• Three main types are triangular, Ace, and tubular.

General Principles Of Bandaging

• Work with the injured person and explain what you are doing.
• Work in front of the injured person where possible and from the injured side if you can.
• Bandage firmly over bleeding and securely over broken bones, but not so tight as to compromise circulation below the site of the injury.
• Use the body's natural hollows such as the knees, ankles, neck, and small of the back to slide the bandages gently into place when wrapping bandages around an injured person.
• Be aware that injuries swell – check regularly to ensure the bandage is still comfortable.
• Ensure the bandage remains firmly secured, particularly if the injured person moves; movement can loosen the bandage.
• Secure bandages with tape, clips, a bow, or a square knot.
• Make sure that bandages, especially knots, do not press into the skin.
• Place padding between the bandaging and the skin as necessary.

Triangular Bandages

• Triangular bandages are among the most versatile items of first aid equipment.
• They are usually made of washable cotton and are also available in disposable paper form.
• In its open form, a triangular bandage can be used as a sling or as a cover bandage.
• Making a broad fold to support broken bones or hold dressings loosely in place, fold the point to the base of the bandage, and fold the bandage in half again for a broad fold.
• To make a narrow fold to control bleeding, fold a broad fold in half again.

Ace Bandages

• Ace bandages are used for securing dressings or providing support, particularly to sprains and strains.
• They are made of cotton, gauze, or linen and secured in place with pins or tape.
• Variety of sizes recommended widths for different body parts. Finger: ½ inch; Hand: 1 inch; Arm: 1 ½-2 inches; Leg: 2-3 inches

Tubular Gauze

• Come in several sizes.
• The smallest size is used to hold dressings on fingers and toes.
• Comes with its own applicator and is best secured with tape.

Applying Tubular Gauze

• Cut two and half times the length of the finger or toe to be bandaged and push all of this on to the applicator.
• Place the dressing over the wound.
• Slide the applicator over the finger or toe.
• Hold the gauze at the base of the finger or toe and pull the applicator upward, covering the finger or toe.
• Above the finger or toe, twist the applicator twice and then push it back down, covering the finger or toe with another layer of gauze.
• Tape the gauze in place.

Signs and Symptoms of Reduced Circulation

• Pale skin, becoming blue.
• Skin feeling cold to the touch.
• Injured person complains of tingling or loss of feeling.
• Weak or slow pulse in an injured limb.
• Slow capillary refill below the site of the bandage.
• Ask the injured person to report any tingling or loss of feeling.
• Check capillary refill by gently squeezing the skin or the nail bed below the site of injury until the color disappears from the skin.
• If the color does not return quickly, circulation may be restricted.
• If there are signs that circulation is restricted, gently loosen the bandage(s).
• Do not remove dressings if the bandage covers a wound or burn.
• Support the injury if loosened a bandage is supporting a broken bone.

Checking Circulation

• Bandages can cut off circulation, particularly as the injury swells.
• Check circulation below the site of the bandaging immediately after treatment and every 10 minutes thereafter.

Responsibilities as a First Aider in Casualty

• Assess the situation quickly and safely and summon appropriate help.
• Protect casualties and others at the scene from possible danger.
• Identify the nature of the illness or injury affecting the casualty.
• Give each casualty early and appropriate treatment, treating the most serious condition first.
• Arrange for the casualty's removal to a hospital or into the care of a doctor.
• Remain with the casualty until appropriate care is available.
• Report observations to those taking care of the casualty and give further assistance if required.

Transportation of Casualty With Stretcher

• Keep the stretcher level to the ground.
• Carry the casualty with their feet facing the direction of movement.
• Bring the stretcher to the casualty and not the casualty to the stretcher.

Types of Stretcher

• Wooden stretcher.
• Collapsible stretcher with telescopic handle.
• Improvised stretcher.

Improvised Stretchers

• Rolled blanket.
• Blanket with two poles.
• Chair method.
• Shirts/Gunnysacks with two poles.

Priority of Casualties

• Save the conscious casualties before the unconscious ones as they have a higher chance of recovery.
• Save the young before the old.
• Do not jeopardize your own life while rendering first aid.
• In the event of immediate danger, get out of site immediately.
• Your aim is to preserve life, and not endanger your own in the process of rendering first aid.

Moving Casualties During Emergencies

• One Man Human Crutch: Conscious, Able to walk with some assistance
• Pick-a-back: Conscious, Lightweight, Able to hold on using arms
• Cradle method: Light weight, A child

The Drag

• Used in extreme emergencies over short distances.
• Crouch behind the victim, carefully pull them toward you, stop, take a step back, and pull again until you reach your destination.

Pulling or Dragging the victim

• Pull the victim in the direction of the long axis of their body, preferably from the shoulders.
• Make effort to avoid bending or twisting the neck or trunk.
• Less danger if you pull the victim with a blanket.

Emergency Methods of Moving Casualties - Seats

• Two-handed Seat: Unable to walk with assistance, Able to use their arms to support
• Three-handed Seat: Unable to walk with assistance, Usually with injury on one leg, Able to use arms to support
• Four-handed Seat: Unable to walk with assistance, Able to use arms to support

Immediate Rescue with Assistance

• Take action when hazards are so great that it is necessary to move an injured person a short distance without first immobilizing the affected parts.
• Chair Carry: Method satisfactory for going up and down stairs, through narrow corridors and around corners. Not suitable for neck, back or leg injuries.
• Fore and Aft Method. Used on unconscious patients without serious injuries of the trunk or fractures

Three-Four Man Hammock Carry

• One positioned at the victim's calves, one at the hips, and the third person at the shoulders.
• This technique is used in cases the victim suffered or suspected from spinal injury.

Aims of Triage

• Triage ensures patients are treated in order of clinical urgency.
• It ensures timely and appropriate treatment.
• Triage allocates patients to suitable assessments and treatment, avoiding congestion.
• It provides ongoing patient assessment.

Goal of Disaster Triage

• To do the greatest good for the greatest number of patients.

History of Triage

• The term "triage" originates from the French word "tier," meaning "to sort."
• Triage was developed by Baron Dominique Jean Larrey in the 1800s.
• Baron Larrey prioritized assessment and surgical management for battlefield injuries.

Definition of Triage

• Triage is prioritizing or sorting sick or injured people for treatment based on the condition's seriousness.
• It involves making quick decisions (30 seconds or less per patient).
• Triage provides limited treatment and focuses on the most urgent needs.
• Manually open airways.
• Clear airway with finger sweep.
• Control major bleeding

Primary and Secondary Triage

• Primary Triage: 1st contact, Assign triage category
• Secondary triage is a the process that takes place in a treatment or holding area.

Triage Categories

• Emergency or emergent.
• Urgent.
• Non-urgent.
• Dying or deceased.
• Categories are often defined visually by color; RED often indicates the most emergent category.

Triage Category Descriptions

• Urgent (yellow): Severely injured, but recoverable, requiring immediate assessment, simple resuscitation techniques, and transportation to a referral institution.
• Non-Urgent (green): An ambulant casualty in which hospital admission is unlikely and is titled "walking wounded."
• Deceased (black): Diseased or non-recoverable injuries

Emergency or Emergent (Red)

• Is the highest priority level assignable to patients and includes those casualties that are severely injured but are considered to be recoverable from their injuries, if treated immediately.
• Generally, these patients are experiencing threats to their AIRWAY, BREATHING or CIRCULATION.
• Includes exampes such as: patients with extensive haemorrhage, respiratory complications and patients who are choking.

Urgent (Yellow)

• Those who have sustained significant injuries and will require transportation to a referral institution for a time-critical intervention.
• Includes examples such as: Patients with internal injuries, major fractures

Non-urgent (Green)

• Traditionally referred to as the "WALKING WOUNDED", they have sustained minor injuries, but are stable and not likely to require hospital admission.
• Their injuries are easily treated by first-aid providers at the scene of the incident or at an established on-site-medical facility.
• Includes examples such as: Soft-tissue injuries, stable fractures and minor bleeding

Deceased (Black)

• With substantial injuries that the expenditure of a great amount of human and physical resources would not affect their likely poor outcome.

Disaster Triage

• Disaster triage categorizes and sorts patients by injury severity, medical and transportation resource availability.

Disaster Triage Competencies

• Clinically experienced.
• Good judgment and leadership.
• Calm and cool under stress.
• Decisive.
• Knowledgeable of available resources.
• Sense of humor.
• Creative problem solver.
• Available.
• Experienced and knowledgeable regarding anticipated casualties

Simple Triage and Rapid Treatment (START) System

• Used to quickly classify victims during a mass casualty incident (MCI).
• Developed in 1983 bystaff members of the Newport Beach Fire Department in Newport Beach, CA.
• It is easy to use, and focus signs and symptoms and is fast.

START considerations

• Ability to follow directions and walk.
• Respiratory effort.
• Pulses/perfusion.
• Mental status.

START Categories

• Walking wounded/ minor (green).
• Delayed (yellow).
• Deceased / expectant (black).

START Triage decision-making flow

• Begin by checking respirations. If present and under 30/min, check perfusion.
• If capillary refill is greater than 2 seconds, control bleeding.
• Next check menta status. If the patient can follow simple commands they are the “Delayed” category.
• Follow steps to tag

START Triage - ADULT Procedure

• To clarify a simple, quick and effective way to triage numerous patient in a short period of time.
• First, start where you stand and walk either clockwise or counterclockwise until the entire area has been triage.
• Then, as you approach, identify the uninjured or "walking wounded."
• Move them out of danger or use them (until additional help has arrived).
• Move them out of danger to control bleeding and to maintain an airway

START Triage- Proceed to non-ambulatory victims

• If none, open airway and tag DECEASED.
• Respirations greater than 30/min or less than 10/min, tag IMMEDIATE.
• Respirations between 10-30/min, go to Step 2.

START TRIAGE-ADULT Step II:

• If color regains in greater than 2 seconds or no radial pulse, tag IMMEDIATE.
• If the color returns in less than 2 seconds or has a radial pulse, tag DELAYED.
• If severe bleeding, apply a quick bandage, and “walking wounded” assists.
• Raise legs to return blood to the heart if time permits
• START Triage- Proceed to non-ambulatory victims.

START TRIAGE-ADULT Step III

• Altered mental status is in the ability to followimple commands, tag IMMEDIATE.
• Able to follow commands, tag DELAYED.
• If victims is unconscious, tag IMMEDIATE.

Focus On Tagging The Patients

• Clear out all ambulatory patients - tag GREEN.
• Rest of the patients require MORE triage- 3 steps, They will be either red, yellow or black.
• Check the respiratory effort,
• Pulses, and the menta status

“The greens”

• Once they walk towards you- designate a place for them
• Someone needs to tag them green
• Someone needs to stay with them and keep them informed

START- Step 1 RESPIRATORY EFFORT

• Not breathing, manually open their airway
• If they start breathing- tag RED
• If they don't start breathing- tag BLACK
• Breathing >30 or <10 = tag RED
• Breathing normal 10 - 30 = go to next step