First Aid Level 1 Learner Guide 2024 PDF

**FIRST AID MANUAL**  **FIRST AID TRAINING - BEGINNER** **UNIT STANDARD: 119567** **Contents** {#contents.TOCHeading} ============ [Overview of the Modules 3](#overview-of-the-modules) [Introduction 4](#introduction) [Definition of key terms 4](#definition-of-key-terms)...

**FIRST AID MANUAL**  **FIRST AID TRAINING - BEGINNER** **UNIT STANDARD: 119567** **Contents** {#contents.TOCHeading} ============ [Overview of the Modules 3](#overview-of-the-modules) [Introduction 4](#introduction) [Definition of key terms 4](#definition-of-key-terms) [The Basic Principles of First Aid- Emergency 6](#_Toc177877392) [Emergency Scene Management 8](#_Toc177877393) [Good Samaritan Clause 11](#good-samaritan-clause) [Module 2: Anatomy & Physiology 14](#module-2-anatomy-physiology) [Systems of the Human Body 15](#_Toc177877396) [Module 3: Emergency Situations and Common Injuries 26](#module-3-emergency-situations-and-common-injuries) [Emergency Procedure 27](#emergency-procedure) [Common Injuries and their treatment 33](#common-injuries-and-their-treatment) [Circulatory Problems 40](#circulatory-problems) [Environmental Injuries 43](#environmental-injuries) [Stroke 52](#stroke) [Respiratory Problems 54](#respiratory-problems) [Wounds and Bleeding 55](#wounds-and-bleeding) [Wounds 60](#wounds) [Appendicitis 63](#appendicitis) [Fever 67](#fever) [Module 4: First Aid/Life Saving Procedures 74](#module-4-first-aidlife-saving-procedures) [Lifesaving Procedure 75](#lifesaving-procedure) [Cardiopulmonary Resuscitation (CPR) 77](#cardiopulmonary-resuscitation-cpr) [First Aid Kit 90](#first-aid-kit) [Incident Investigation Form (5 Why's) 93](#incident-investigation-form-5-whys) Overview of the Modules ======================= Introduction ============ Definition of key terms ======================= I. **Emergency**: is a sudden, unexpected, or approaching circumstance that may result in injury, loss of life, and/or interference with a person\'s routine activities and so necessitates immediate attention and corrective action. II. **Management**: is the management and coordination of an enterprise\'s activities in line with specific policies and in pursuit of stated goals. III. **Legislation**: is the process through which statutes are enacted by a legislative body that is established and empowered to do so. IV. **Emergency management: is the managerial role in charge of developing the framework that allows communities to reduce their vulnerability to hazards and cope with disaster.** - Containers should be placed at the point of use. - The person who generates the sharp should be accountable for its safe disposal. - Sharps should not be transmitted between workers by hand. Use disposable sharps whenever possible. Employees should be instructed not to: - Bend, break, recap or otherwise Manipulate needles. - Place hands in hidden regions, such as garbage bags and crevices. - Compress garbage bags and hold them near to the body. - Hold garbage bags by the base. The Basic Principles of First Aid- Emergency ============================================ If the person is unconscious, search for a medical ID card, bracelet, or necklace. Try not to move the victim. However, if you do move the sufferer, do it as little as possible, especially if there is a risk of breaking bones. If they are vomiting, simply move their head to allow the vomit to readily exit their mouth and avoid breathing in the vomit. Hopefully, the victim is now stable enough to wait for professional help. Not every occurrence needing first aid is a life-threatening condition, and most first aid expertise is utilized to treat minor injuries at home or at work. This immediate care and attention before the arrival of an ambulance can sometimes mean the difference between life and death, or a full or partial recovery.\ \ **The Main Aims of First Aid Are To:** - Preserve life - Protect the casualty from further harm - Provide pain relief - Prevent the injury or illness from becoming worse - Provide reassurance - Promote a speedy recovery Emergency Scene Management ========================== - Explain the maintenance of personal safety in terms of preventing injuries to self and infectious diseases. - Explain the methods of safeguarding the emergency scene in accordance with relevant practices and legislation. - Explain the methods of safeguarding the injured person in accordance with relevant practices and legislation. - Explain the medico-legal implications of rendering First Aid in terms of the relevant legislation. Good Samaritan Clause ===================== - You identify yourself as a First Aider and ask permission to help before you touch the person. - You use reasonable skill and care that is in accordance with your level of knowledge and skill. - You are not negligent in what you do. - You don't abandon the person.  1. **Assess hazards and make the area safe** -- Your safety comes first! If you cannot enter the area without risking your safety, don't do it, call Emergency Services immediately and wait for them. If you think you can safely enter the area, look around the emergency scene for anything that can be dangerous or hazardous to you, the casualty or anyone else at the scene. Do whatever you can to make the area safe if the result will not be more hazardous or more of a risk to people at the scene. Bystanders can help with making the area safe. 2. **Take charge of the situation** -- If you are the first aider on the scene act fast. If someone is already in charge, briefly introduce yourself and see if that person needs any help. If there is any chance the casualty could have a head or spinal injury, tell them not to move! 3. **Get Consent** -- Always identify yourself as a first aider and offer to help. Always ask for consent before touching a conscious adult casualty and always ask for consent from a parent or guardian before touching an unconscious child or infant. With an unconscious adult casualty consent is implied as it is generally accepted that most people want to live. 4. **Assess Responsiveness** -- Is the casualty conscious or unconscious? Note their response while you are asking them for their consent. If they respond continue with the primary survey, and if they don't respond, be aware that an unconscious casualty is or has the potential of being a breathing emergency. 5. **Call out for help** -- this will attract bystanders. Help is always useful in an emergency. Anytime you need help just call out. Someone can be called over to phone for medical help. Others can bring blankets if needed, get water etc. A bystander can help with any of the following: - **Make the area safe** - **Find all the casualties** - **Find a first aid kit or any useful medical supplies** - **Control the crowd call for medical help** - **Help give first aid under your direction.** - **Gather and protect the casualty's belongings** - **Take notes, gather information, be a witness** - **Reassure the casualty's relatives** Module 2: Anatomy & Physiology ============================== - Describe the different systems of the human body in terms of their structure and function. - Explain the way the systems relate to each other in accordance with basic medical science. - Explain the way in which each system operates in accordance with basic medical science. Systems of the Human Body ========================= Module 3: Emergency Situations and Common Injuries ================================================== - - Assess the emergency in terms of priority treatments. - Identify the cause of the emergency in terms of the main contributing factors. - Identify the type of injury in terms of broad classification. - Assess the situation in terms of the type of assistance required. - Identify and describe the different types of injuries and conditions in terms of their severity, cause and possible treatment. - Taking the appropriate universal precautions in terms of preventing infections. - Improvise equipment that is not readily available in terms of the First Aid procedure required. - Provide follow-up care in accordance with the specific needs of the casualty. Emergency Procedure =================== - providing information about the casualty or the accident, - calling Emergency Services, or - giving treatment to the casualty. 1. Take charge of the situation. 2. Call to attract the attention of bystanders. 3. Assess hazards, establish cause of the accident and secondary causes as a result thereof. 4. Identify yourself as a first aider and offer help. 5. Before attending to the casualty, you must first survey the scene to ensure your safety. 6. Then, do a primary survey of the casualty. 7. After checking the casualty, call the Emergency Medical Services (EMS), giving them a description of the emergency as well as the location of the scene. 8. After calling EMS, provide appropriate care based on your primary survey of the casualty until EMS or other advanced medical personnel arrives and takes over. -- -- -- -- -- -- -- -- - Airway -- Open the airway - Breathing -- Apply artificial respiration (rescue breathing) - Circulation -- Check pulse. Stop bleeding. Start CPR. - The casualty has sustained injuries to the head, neck or back. - The casualty is having trouble breathing. - The casualty is unable to move or use the injured body part without experiencing pain. - **History** -- events leading up to the emergency situation/s, accidents/violence can be obtained from the surroundings, the casualty or bystanders. - **Signs** -- conditions you can see, feel, smell or hear that indicate disease or injury e.g. body temperature, pulse, and breathing patterns. Commonly named as the vital signs. - Safety of emergency area - Accurate assessment of the casualty - Assistance for backup of emergency services - Providing information about the casualty or the accident, - Calling the Emergency Medical Services, or - Giving treatment to the casualty.  - - - - - - - - - Common Injuries and their treatment =================================== - Injuries to the head neck or back, Breathing problems - Excruciating pain to injured body part - Severely broken bone/s - Severe bleeding - Heart attack - Shock - Stomach ailments - Asthma - Allergic reactions - Feelings of light-headedness, dizziness, confusion, or weakness - The casualty may become pale or flushed, and may start sweating - Nausea and vomiting are causes for concern, as is diarrhoea - Changes in consciousness - Seizure - Paralysis, Slurred speech - Difficulty seeing - Severe headache - Breathing difficulty - Persistent pressure or pain 1. First, call EMS immediately and care for any life-threatening conditions the casualty may have. 2. Check CAB and start CPR is necessary. 3. Help the casualty rest comfortably and prevent him/her from getting chilled or overheated. 4. Reassure the casualty. Monitor him/her for changes in consciousness, and do not give the casualty anything to eat or drink. 5. If the casualty vomits, place the casualty on his/her side to prevent choking. 6. If the casualty faints, position him/her on the back and elevate the legs about 30cm if you do not suspect a head, neck or back injury. A person about to faint becomes pale, begins to perspire, and then loses consciousness and collapse. Remember the adage: "if the head is pale, raise the tail," which refers to returning blood and circulation to normal after fainting. 7. If the casualty has a diabetic emergency, give him/her some form of sugary drink or sweets. - **Fractures**, which may be open or closed, and - **Dislocations**, which involve muscles and joints as well.  Closed fracture Open fracture - Pain/tenderness at place of fracture - Inability to use limb (or a lack of will -- any movement will be painful) - Irregular line of the bone under the skin - Shock - Crepitus (grating noise as the broken end of the bone rubbing against each other) 1. Do not try to move a patient with a severely broken bone unless it is absolutely necessary. 2. Calling EMS is the best course of action in this case. 3. However, if you must move the patient, you must immobilize the injured body part. One way is to splint it but do this only if it can be done without hurting the casualty, and always attempt to splint the part in the position you find it. 4. Splint the injured area & the joints above and below the injured area. You may use another body part, like splinting an injured leg to an uninjured one, or an injured arm to a chest - this is called an ***anatomic splint***. Make a ***soft splint*** from folded blankets or towels, or use a triangular bandage to make a sling, another type of soft splint, which is used to support an injured arm, wrist or hand. Use folded magazines or newspapers, cardboard or metal strips to support the injured body part with a ***rigid splint***. Use several folded triangular bandages to secure the injured body part to the splinting material, tying them securely but not too tight. 5. Maintain body temperature. 6. Remember to be reassuring. - Changes in consciousness - Vision and breathing problems - Nausea and vomiting - Inability to move a body part - Steady headache - Tingling or loss of sensation in hands, fingers, feet or toes - Blood in the ears or nose - Seizures - Severe pain, pressure or bleeding in the head, neck or back - Bruising of the head - Loss of balance 1. Call Emergency Services immediately, and **DO NOT** attempt to move the casualty or you may injure him or her further. 2. Minimize movement of the head and spine, maintain an open airway (lift the chin slightly but 3. Check consciousness and breathing. 4. Control any bleeding. 5. Prevent the casualty from getting chilled or overheated. - Kneeling at the top of the casualty's head, at a 45˚ angle, reach forward and place one hand on each side of the lower jaw; do your best to immobilize the head using your forearms. - Use your index fingers to push forward on the angles of the lower jaw to open the mouth; use your thumbs to open the mouth and maintain an open airway. - Begin rescue breathing if the casualty is in respiratory arrest. This applies whether you perform mouth to mouth or mouth to mask resuscitation. 1. Ask for at least 4 volunteers to assist with the log roll. 2. You, as first aider, should take the position at the head. You will be in charge of giving the commands, it is imperative that all others do exactly what is ordered. 3. Lie down on your stomach; place your hands on each side of the casualty's face, being 4. Direct 3 volunteers to the side of the casualty you will be rolling them to. One at the shoulder, the second at the hips, the last at the knees. 5. Move the casualty's arms slowly to the sides of the body. 6. Volunteer one should place his/her one hand on the opposite shoulder and the other hand on the opposite hip. 7. Volunteer two should place one hand over volunteer one's arm and grab hold of the opposite 8. Volunteer three should place one hand over volunteer two's arm and grab hold of the opposite thigh. The other hand must be used to keep the feet together (the feet can also be tied together). 9. Volunteer four should sit on the side of the casualty that is to be lifted, placing his/her hands between the other volunteers' hands. Volunteer four should also be the person to handle the backboard if one is to be used and must be kept ready and close at hand. 10. Following the first aider's (person at the head) instructions all volunteers will react on his/her count. Make sure to tell the volunteers to move slowly and precisely. On the final count, all the volunteers will lift the body up and towards themselves, so that the casualty is rotating on the side of the body close to them. 11. You, the first aider, should roll with the body, keeping the head steady and the neck and spine in one line. You should be on your side along with the casualty, by doing this you will ensure 12. Once the casualty is straight up on his/her side, have the fourth volunteer slide the backboard all the way against the body so when he/she is rolled back down, he/she will be rolled back onto the board. 13. Countdown again, and in one move roll the casualty back onto the backboard. You must continue to hold the head until EMS arrives and takes over from you.  - **Dislocations** -- (abnormal bump, ridge or hollow due to displaced bone) - **Sprains** -- (swelling at the joint) - **Strains** -- (stretching and tearing of muscles or tendons) 1. The formula for proper care is rest, ice, compression and elevation (RICE). 2. Make the casualty as comfortable as possible and apply ice (not directly onto the skin) to reduce pain and swelling. 3. Minimize movement of the injured part by supporting it with something like a pillow. Circulatory Problems ==================== - Dizziness - Drowsiness - Confusion - Rapid breathing - Rapid pulse - Sweating yet with skin that is cold to the touch 1. If you know that a person is diabetic and he or she is experiencing these symptoms, treat the person as though he or she has hypoglycemia, or low blood sugar. 2. If the casualty is conscious, give him or her something to eat or drink that contains plenty of sugar, such as sweets, fruit juice, cola, etc. If the person is suffering from low blood sugar, or hypoglycemia, the sugar will help within minutes. If the person is feeling ill because of high blood sugar, or hyperglycemia, he or she will not be harmed by the extra sugar. 3. If the casualty does not feel any better after five minutes, call Emergency Medical Services. - Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone. - Discomfort radiating to the back, jaw, throat, or arm. - Fullness, indigestion, or choking feeling (may feel like heartburn). - Sweating, nausea, vomiting, or dizziness. - Extreme weakness, anxiety, or shortness of breath. - Rapid or irregular heartbeats. 1. If you think you or anyone else is having a heart attack call for emergency help. Immediate treatment of a heart attack is very important to lessen the amount of damage to your heart. 2. Don\'t tough out the symptoms of a heart attack for more than five minutes. 3. Chew and swallow an aspirin, unless you\'re allergic to aspirin or have been told by your doctor never to take aspirin. But seek emergency help first, such as calling EMS. 4. Place casualty in a comfortable position, sitting up. Use pillows for support. 5. Loosen any tight or restrictive clothing, especially around the neck. 6. Begin CPR if the person is unconscious. If you\'re with a person who might be having a heart attack and he or she is unconscious, call EMS. You may be advised to begin cardiopulmonary resuscitation (CPR). - the heart must be working well, - an adequate amount of blood must be circulating, and - the blood vessels must be intact and able to adjust blood flow. - brain, - heart and - lungs, among others. - Restlessness or irritability - Altered consciousness - Pale, moist, cool and eventually blue skin - Rapid breathing - Rapid pulse - Thirst - Weakness and dizziness - Nausea and possible vomiting 1. Call Emergency Medical Services immediately. 2. Have the casualty lie down in order to rest comfortably, minimizing pain. 3. Control any bleeding. 4. Prevent the casualty from becoming chilled or overheated. 5. Reassure the casualty. 6. Elevate the legs about 30cm unless you suspect head, neck or back injuries or broken bones in the hips or legs, in which case you must leave the casualty lying flat. 7. Do not give the casualty anything to eat or drink. Environmental Injuries ====================== - Heat (flames, hot grease, or boiling water), - The sun (solar radiation), - Chemicals or, - Electricity. 1st degree 2nd degree 3rd degree 1. Stop the burning. Put out flames or remove the casualty from the source of the burn. 2. Cool the burn. Use large amounts of water to cool the burn. Never use ice, it causes body heat loss. If the area cannot be immersed, like the face, you can soak a clean cloth and apply it to the burn, being sure to continue adding water to keep the cloth cool. 3. Cover the burn. Use dry, sterile dressings or a clean cloth to help prevent infection and reduce pain. Bandage loosely. 4. Call EMS if the burn covers a large part of the body. Always advise a casualty to seek medical attention even if they only sustained a minor burn wound. 1. Call Emergency Services in any case of a chemical burn. 2. Remove the chemical from the skin or eyes immediately by flushing the area with large amounts of cool running water until EMS arrives. 3. Remove any clothes with chemicals on them, and be careful not to spread the chemical to other body parts or to yourself. 1. Call Emergency Services in case of an electrical burn. 2. Do not go near the person unless you are sure the power source has been turned off. 3. If the casualty is unconscious, check breathing and pulse. 4. The burn itself will not be the major problem. Check for other injuries, and do not move the casualty because he/she may have spinal injuries. 5. Cover an electrical burn with a dry, sterile dressing. Do not cool the burn unless you are sure it is safe to use water at the scene. 6. There may be two wounds, one where the current entered the body and one where it left, make sure to check for and treat both. 7. Maintain body temperature. 8. Reassure the casualty. - DO NOT apply ointment, butter, ice, medications, fluffy cotton dressing, adhesive bandages, cream, oil spray, or any household remedy to a burn. This can interfere with proper healing. - DO NOT allow the burn to become contaminated. Avoid breathing or coughing on the burned area. - DO NOT disturb blisters or dead skin. - DO NOT immerse a severe burn that covers a large part of the body in cold water. This can cause shock. - DO NOT place a pillow under the casualty's head if there is an airway burn and they are lying down. This can close the airway. - Makes you fall - Muscle contraction - Seizures - Dehydration - Burns - Fractures - Clotting of blood - Tissue death (narcosis) - Respiratory/heart/kidney failure - Changes in alertness (consciousness) - Broken bones - Heart attack - Headache - Problems with swallowing, vision, or hearing - Irregular heartbeat - Muscle spasms and pain - Numbness or tingling - Breathing problems or lung failure - Seizures - Cold, clammy skin (when going into shock) - Skin burns #### 1. Do not attempt to move the casualty from the current source 2. The first step is to switch off the current source, otherwise, move the source using a wooden stick (non-conductive). 3. Call EMS 4. Attend to the casualty 5. Check for breathing, no breathing, do CPR 6. Re-establish vital functions 7. If breathing, do a physical secondary examination 8. Treat for minor burns and other injuries (look out for shock) 9. Excessive burns may require hospitalization/ surgery 10. Supportive care must be provided - Swallowed - Inhaled - Absorbed - Injected - Nausea & vomiting - Abdominal cramps - Diarrhoea - Difficulty breathing - Coughing blood - May or may not turn blue - Lethargy - Convulsion - There may be burn marks in or around the mouth 1. Call emergency services if the person is unconscious or there are signs of poisoning. 2. Provide information about the poisoning: what poison was taken; the amount; how it entered the body; when it was taken; the person\'s age 3. Perform CPR if the person is unconscious and not breathing, but first check for poisonous material around the mouth. 4. Wash the area around the person\'s mouth and if necessary, use a barrier device. 5. Keep a sample of what the person has taken, even if it is an empty container. 6. Never try to induce vomiting as this could cause further damage. Some poisons, especially corrosive substances, can cause further damage during vomiting. 7. DO NOT give anything to eat or drink. - Irritated eyes, nose, throat or lungs. - Coughing - Headache - Shortness of breath or dizziness. 1. Call EMS if the casualty is unconscious or there are signs of poisoning. 2. Remove the casualty from the area to a well-ventilated room or move them outside. 3. Perform CPR if the casualty is unconscious and not breathing. 4. Place them in the recovery position once vital signs have been re-established. - Reddening of the skin, blisters, swelling or burns. 1. If the person is unconscious, call emergency services immediately. 2. Flush the affected area thoroughly with cool water. 3. Remove clothing that has been in contact with the poison - be careful not to touch it. 4. Wash the area carefully with soap and water. 5. If there is poison in the eye, rinse the eye with cool water for 20 minutes. 6. Keep a sample of the poisonous substance, even if it is an empty container. - Irritation around the point of entry. 1. Call emergency services if the person is unconscious, 2. Keep the casualty as calm as possible. The faster the heart beats, the faster the poison will spread. 3. Delay the spread of the poison to the rest of the body by keeping the affected limb below the heart. - Antifreeze - Drain cleaners - Toilet bowl cleaners - Insecticides - Artificial nail removers - Topical anesthetics (i.e. products that may be used for sunburn pain) - Medicines (even vitamins) - Detergents - Furniture polish - Perfume & aftershave - Mouthwash - Gasoline, kerosene, and lamp oil - Paint and paint thinner - Mothballs - Alcoholic beverages - Rat and mouse poison - Beauty products - Plants - Tonic phase. Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall. This phase tends to last about 10 to 20 seconds. - Clonic phase. The muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes. - A sense of unexplained dread, a strange smell or a feeling of numbness - Some people may cry out at the beginning of a seizure - Loss of bowel and bladder control - Unresponsiveness after convulsions - Confusion. - Fatigue - Severe headache 1. Keep calm and reassure other people who may be nearby. 2. Prevent injury by clearing the area around the person of anything hard or sharp. 3. Time the seizure with your watch. If the seizure continues for longer than five minutes without signs of slowing down or if a person has trouble breathing afterwards, appears to be injured, in pain, or recovery is unusual in some way, call EMS. 4. Do not hold the casualty down or try to stop his/her movements. 5. Do not put anything in the casualty's mouth. Efforts to hold the tongue down can injure the 6. Stay with the person until the seizure ends naturally and he is fully awake. 7. Once the seizure has ended and the casualty is breathing, place them in the recovery position. 8. Do not give them anything to eat or drink. 9. Be friendly and reassuring as consciousness returns. - The seizure lasts longer than five minutes without signs of slowing down or if a person has trouble breathing afterwards, appears to be in pain or recovery is unusual in some way. - The person has another seizure soon after the first one. - The person cannot be awakened after the seizure activity has stopped. - The person became injured during the seizure. - The person becomes aggressive. - The seizure occurs in water. - The person has a health condition like diabetes or heart disease or is pregnant. Stroke ====== - **Face**. Does the face droop on one side trying to smile? - **Arms**. Is one arm lower when trying to raise both arms? - **Speech**. Can a simple sentence be repeated? Is speech slurred or strange?  - **Time**. During a stroke every minute counts. If you observe any of these signs, call EMS immediately - Weakness or numbness on one side of the body including either leg - Dimness, blurring or loss of vision, particularly in one eye - Severe headache --- a bolt out of the blue --- with no apparent cause - Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other signs or symptoms - Call EMS - Check CABs - Lay the patient down with head and shoulders slightly elevated - Reassure the casualty - Never give a suspected stroke casualty anything to eat/drink - The casualty is unaware of his/her surroundings and does not respond to sound. - They make no purposeful movements. - The do not respond to questions or to touch. - May or may not be breathing or has no signs of circulation. 1. Check for responsiveness 2. Loosen any restrictive clothing and or jewelry. 3. Look for any medical alert information. This could be on a neck chain, bracelet or in a wallet. This information could help to identify the casualty's condition. 4. Check CAB 5. Call EMS if the patient is unconscious for more than a few seconds, if you suspect a neck or head injury or if there is no breathing or circulation. 6. Check the patient for any other injuries for example, bleeding, burns, broken limb. Give first aid accordingly. 7. If there is no neck or head injury place the casualty into the recovery position. 8. Manage casualty's core body temperature. 9. Do not give the casualty anything to eat or drink when they regain consciousness. Respiratory Problems ==================== 1. Call EMS immediately. 2. Open the airway by tilting the head, checking the mouth, and lifting the chin. Check for breathing for up to 10 seconds. 3. If the casualty is breathing, place them into the recovery position. 4. If the casualty is not breathing, provide rescue breathing and full CPR if necessary. 5. When the water starts coming out, turn the casualty's head to the side and allow the water to 6. When vital functions are re-established cover the casualty and bring their body temperature back up to a normal temperature. - Coughing, difficulty breathing - Decreased level of activity, lethargic - Fast, shallow breathing - Chest pains - May appear pale, blue, grayish in colour 1. Call EMS immediately. 2. If patient becomes unconscious check CAB and start CPR. 3. Place them in the recovery position when vital functions have been re-established. Wounds and Bleeding ===================  1. Apply firm direct pressure to the wound; 2. Instruct the casualty to place pressure directly on their wound, if they are able; 3. If the casualty is unable to assist, apply pressure using gloved hands or a pad; 4. Elevate the bleeding part (if no fracture or spinal injuries are suspected), restrict movement; 5. Apply a pad over the wound and secure with a bandage. ##### Brachial Pressure Point Femoral Pressure Point 1. Apply pressure over the arterial pressure point to facilitate blood coagulation. 2. Apply for 3 -- 5 minutes, check if bleeding has slowed or stopped. 3. Reapply pressure if necessary. 4. If bleeding has stopped, dress the wound. 1. Apply a wide bandage (at least 5cm) high above the bleeding point. The bandage should be tight enough to stop all circulation to the injured limb and control the bleeding. 2. Note the time of application and relay this information direct to EMS by phone (if possible). 3. Leave the tourniquet uncovered. 4. The bandage/tourniquet can only be removed by a medical specialist. - Evidence of major external blood loss (clothes soaked with blood, pooling of blood) - Restlessness and anxiety - Progress of shock - Pale, cold and clammy skin - Rapid pulse becoming weaker - Faintness and dizziness - Shallow breathing, yawning, and gasping for air - Possible unconsciousness 1. Wear disposable gloves. 2. Expose the wound and check for foreign objects that might be present. 3. Apply direct pressure with your fingers or the palm of your hand to control the bleeding. 4. Squeeze the edges together if the wound is very large. 5. Lay the casualty down. If the wound is on a limb and there is no fracture you should raise and support the limb. 6. If the wound is on a limb you can apply indirect pressure to the main artery that supplies the limb should direct pressure be ineffective. 7. **Indirect pressure should not be applied for longer** than 3-- 5. 8. Place an un-medicated and sterile dressing over the wound. Make sure that the dressing is bigger that the wound so that it covers the whole wound. 9. Press down firmly and secure with a bandage. Tie firm enough to control the bleeding but not cut off the circulation. Also immobilise the injured part of the body. 10. Should the bleeding continue, apply more dressing on top of the original ones and bandage firmly. 11. Treat for shock. 12. Take to the hospital immediately. - After a violent injury - If there are signs and symptoms of shock but no visible blood loss - If there is patterned bruising corresponding to the seams or texture of a person's clothing - Pain and tenderness around the affected area, feel swelling and tension - Bruising - Blood in vomit, bleeding from the rectum or vagina - Signs and symptoms of shock - Shallow breathing sometimes accompanied by yawning and sighing - Restlessness - Thirst - Blood appearing from one of the body's openings - History of a medical illness that may cause internal bleeding - History of a violet injury that could cause internal bleeding 1. Call EMS immediately. 2. Lay the casualty down -- head low and to one side to ensure good blood flow to the brain. 3. Advise the casualty not to move. 4. Raise his/her legs to help with the return of blood flow to the vital organs if the injuries allow you to do so. 5. Loosen any tight clothing around the neck, chest and waist. 6. Reassure the casualty. 7. Treat for shock. 8. Monitor breathing, pulse and levels of consciousness at 5 - 10min intervals and record the information for the doctor. 9. Examine the person for other injuries and treat them. 10. If the casualty loses consciousness but is still breathing normally put him/her in the recovery position. 11. Should the casualty stop breathing and the heartbeat stop, start with CPR. 12. Keep the casualty covered and if possible, also put a blanket underneath them. 13. Record any specimens passed or vomited by the casualty and if possible, send a sample with the casualty to the hospital. 14. Don't give the casualty anything to drink or eat. 15. Remove to the hospital immediately. Wounds ======   ##### Graze Wounds: - Damaged skin - Bleeding 1. Wash your hands or wear disposable gloves. 2. Press the wound with thumb and fingers (holding cut edges together if necessary) until bleeding stops. 3. Rinse wound under a tap if it's dirty. 4. Carefully remove any small pieces of glass or gravel from the wound with a clean pair of tweezers. 5. Then, using gauze, gently clean with soap and water. Work from the centre of the wound outwards, using a clean swab for each wipe. 6. Finish with some diluted antiseptic. 7. Pat skin thoroughly dry. 8. For small cuts and grazes, a plaster is enough. 9. Larger injuries need a non-adhesive dressing secured with a gauze bandage, which you tie firmly, but not so tightly that the circulation is restricted. 10. **Never** put fluffy dressings like cotton wool on the wound -- it'll stick to the wound and may cause infection. Only handle the very edges of a dressing. - Swelling of the face, especially around the mouth, throat and eyes - Swelling of the affected area if there has been contact with a chemical or venom (e.g. insect sting) - Redness of the skin or an itchy rash over the chest and back - Nausea and/or vomiting - Breathing difficulty similar to an asthma attack - Dizziness, weakness or collapse - Diarrhoea 1. Call for EMS at the first sign of allergic reaction 2. Monitor CABs 3. Help a responsive casualty use their medications/emergency epinephrine kit (EpiPen) 4. Have casualty lie down, and cover them lightly with a blanket. If shortness of breath occurs, have casualty sit up. Appendicitis ============ - Significant abdominal pain, especially around the belly button or in the lower right part of the abdomen (perhaps coming and going and then becoming consistent and sharp) - Low-Grade Fever - Loss Of Appetite - Nausea And Vomiting - Diarrhoea - Swollen Or Bloated Abdomen, Especially In Infants 1. Call your doctor/EMS immediately 2. Don\'t give your child/casualty any pain medication or anything to eat or drink unless instructed to by the doctor 3. Ice pack may reduce discomfort 4. Reassure your child or the casualty Appendicitis is treated surgically. - Difficulty in breathing, with a very prolonged breathing-out phase There may also be: - Wheezing as the casualty breathes out - Difficulty speaking and whispering - Distress and anxiety - Coughing - Cyanosis (lips or fingernails turning blue). 1. You need to keep the casualty calm and reassure them 2. If they have an inhaler encourage them to use it 3. Encourage the casualty to breathe slowly and deeply 4. Encourage the casualty to sit in a position that they find most comfortable, often leaning forward with arms resting on a table or the back of a chair 5. Do not lie the casualty down 6. A mild asthma attack should ease within three minutes but if it doesn't encourage the casualty to use their inhaler again 1. The inhaler has no effect after five minutes 2. The casualty is becoming worse 3. Breathlessness makes talking difficult 4. The casualty becomes exhausted 5. Dial EMS immediately 6. Encourage the casualty to use their inhaler every five to 10 minutes 7. Monitor and record the breathing and pulse rate every 10 minutes until EMS arrives at the scene. - Wheezing or difficulty with breathing - Tightness in the throat or chest - Swelling of the lips, tongue, or face - Dizziness or fainting - Nausea or vomiting 1. Make a quick get away from the bees or more stings may occur 2. Remove the stinger - speed matters not the method 1. If a person knows they are allergic to bee stings they will usually carry an epinephrine auto- injector (EpiPen). This needs to be given straight away DO NOT WAIT FOR ALLERGIC SYMPTOMS TO APPEAR. 2. If the person has an **anaphylactic reaction call EMS immediately.** 3. Monitor CABs. Give CPR if needed. 3. If the person experiences a **local allergic reaction or inflammation** at the site of the sting consider giving them an antihistamine tablet and pain relief. It is common to develop some itchiness at the sting site. 4. Apply a **cold compress** to the stung area. - Bleeding from nose Causes of nosebleeds: - Infection - Trauma, including self-induced by nose picking, especially in children - Allergic and non-allergic rhinitis - Hypertension (high blood pressure) - Use of blood thinning medications - Alcohol abuse - Less common causes include tumors and inherited bleeding problems - Hormonal changes during pregnancy may increase the risk of nosebleeds 1. Sit down and lean forward 2. Using your thumb & index finger, squeeze soft part of nose between end of nose and the bridge of nose 3. Breathe through your mouth 4. Continue holding till bleeding stops -- approx. 10min 5. If bleeding continues, hold for another 10 minutes 6. If the patient is a child, divert attention by TV/Stories 7. Avoid picking, blowing or rubbing nose for several hours afterwards 8. Place an ice pack on the bridge of nose Consult a Doctor If: - The bleeding continues for more than 15 minutes - The bleeding is caused by an injury - You get nosebleeds often - Noisy, difficult breathing which usually worsens at night - Hoarse, barking cough Other symptoms: - Stuffy or runny nose - Fever 1. Call your doctor 2. Expose immediately to moist air; use a humidifier in a small room or put patient in the bathroom and turn on the shower to fill the room with steam(keep door and windows closed) 3. Make sure the child rests and takes in plenty of fluids 4. If the symptoms worsen, take your child to the emergency room - Your child will have large, runny, frequent or watery stools - The colour might vary from brown to green - Diarrhoea might also be associated with tummy cramps or pain - The most serious problem associated with diarrhoea is the possibility of it leading to dehydration - Blood in the faeces - Pus in the faeces - Painful passage of faeces - Repeated vomiting - Inability to increase fluid intake - Reduced or absent urination - Fever (temperature greater than 38ºC) 1. It's always a good idea to see your doctor if your child has diarrhoea, especially with young children and infants 2. Plenty of fluids to prevent dehydration 3. Oral rehydration drinks to replace lost salts and minerals. These drinks are available from pharmacies. An alternative is one part unsweetened pure fruit juice diluted with four parts of water 4. Intravenous replacement of fluids in severe cases 5. Medications such as antibiotics and anti-nausea drugs - Skin may be punctured or torn - May show teeth/fang marks - Bruising - Bleeding 1. Control any bleeding. 2. Using a clean washcloth or towel, apply gentle pressure to the wound until it stops. 3. If there's a lot of blood, elevate the injured area. 4. Wash with mild soap and water, cover with sterile dressing and bandage 5. Do not try to capture or calm the dog down, as this may result in further injury to yourself or others - You don't know the dog that bit your child (in which case, a rabies shot may be in order) - The wound looks very deep or is on your child's face or neck - You can't stop the bleeding after ten minutes of direct pressure Fever ===== - Fever is higher-than-normal body temperature (Normal temperature is 37˚C) - Hot flushed face - Lack of interest in food - Nausea - Vomiting - Head and body ache - Constipation - Diarrhea - Delirium - Convulsion 1. Monitor temperature using a thermometer 2. Keep the person at a comfortable body temperature 3. Give a sponge bath in lukewarm water 4. Dry the casualty, and dress them in comfortably warm clothing 5. Continue to take casualty's temperature, and repeat these steps if necessary until fever is reduced or the doctor is contacted 6. Give plenty of cool water and other cold or frozen fluids to drink 7. Give prescribed doses of acetaminophen /paracetamol. Don't give aspirin to a person with fever 8. Do not wrap the person in blankets / warm clothing Consult a doctor in case of: - Irregular breathing - Stiff neck - Confusion - Rashes - Persistent sore throat - Vomiting - Diarrhoea - Painful urination - Convulsions - Feeling faint or dizzy - Nausea - Heavy sweating - Rapid, weak heartbeat - Low blood pressure - Cool, moist, pale skin - Low-grade fever (37.1˚C -- 38.2˚C) - Heat cramps - Headache - Fatigue - Dark-coloured urine 1. Get the person out of the sun and into a shady or air-conditioned location. 2. Lay the person down and elevate the legs and feet slightly. 3. Loosen or remove tight clothing. 4. Have the person drink cool water or other non-alcoholic beverage without caffeine. 5. Cool the person by spraying or sponging with cool water and fanning. 6. Monitor the person carefully. Heat exhaustion can quickly become heatstroke. 7. Call EMS if the person\'s condition deteriorates, especially if fainting, confusion or seizures occur, or if fever of 40˚C or greater occurs with other symptoms. **Heat Rash** - Symptoms range from superficial blisters to deep, red lumps - Clear, fluid-filled blisters and bumps (papules) that break easily - Red bumps - Itchy or prickly feeling in the affected area - Little or no sweating in the affected areas - Firm, flesh-coloured lesions that resemble goose bumps - You or your child has symptoms that last longer than a few days - The rash seems to be getting worse, or there are signs of infection - There is increased pain, swelling, redness or warmth around the affected area - These is pus draining from the lesions - Your lymph nodes in the armpit, neck or groin are swollen - You have fever or chills 1. The best treatment for any form of heat rash is to reduce sweating by staying in air- conditioned buildings or, when that\'s not possible, using fans to circulate the air 2. Wearing lightweight clothing made of fabrics that \"breathe" 3. Limiting physical activity 4. Once skin is cool, heat rash tends to clear quickly. Mild heat rash doesn\'t require any other treatment. - Calamine lotion to soothe itching - Anhydrous lanolin, which may help prevent duct blockage and stop new lesions from forming - Topical steroids in the most serious cases - Avoid using creams and ointments, which can block pores further **Heat Stroke** - Markedly elevated body temperature, generally greater than 40˚C - Changes in mental status ranging from personality changes to confusion and coma - Skin may be hot and dry although if heatstroke is caused by exertion, the skin may be moist - Rapid heartbeat - Rapid and shallow breathing - Elevated or lowered blood pressure - Cessation of sweating - Irritability, confusion or unconsciousness - Feeling dizzy or lightheaded - Headache - Nausea - Fainting, which may be the first sign in older adults 1. Move the person out of the sun and into a shady or air-conditioned space 2. Call EMS 3. Cool the person by covering with damp sheets or by spraying with cool water 4. Direct air onto the person with a fan or newspaper 5. Have the person drink cool water or other non-alcoholic beverage without caffeine, if he or she is able - Intense pain/burning at the sting site - Mild swelling around sting site - Numbness/tingling in area of sting - Sensitivity to touch - Nausea or vomiting - Excessive salivation Severe symptoms include: - Widespread numbness - Difficulty swallowing - Difficulty breathing/hyperventilation - A thick tongue - Blurred vision / Roving eye movements - Disorientation - Muscle spasms / Seizures - Racing pulse or heartbeat - Anaphylactic shock 1. Wash the affected area: If possible, get the site of the sting under cold water immediately 2. Medicate topically: Apply a layer of ointment containing an antihistamine, a corticosteroid, and an analgesic 3. Apply ice: Hold a bag of ice over the ointment on the area. The ice will reduce the pain and inflammation 4. Medicate orally: Take one dose of Benadryl (antihistamine) and one dose of a pain killer (acetaminophen) 5. Go to the hospital: Because some scorpion stings can be fatal, if possible, get someone else to drive you 6. Ice as needed: Keep applying ice until pain is tolerable. You may experience pain for any length of time between a few hours to a couple days  - Fang marks in the skin - Swelling at the site of the bite - Bleeding from wound - Blurred vision - Burning of the skin - Convulsions - Dizziness - Excessive sweating - Fainting - Fever - Increased thirst - Loss of muscle coordination - Nausea and vomiting - Numbness and tingling - Rapid pulse - Tissue death - Severe pain - Skin discoloration - - Weakness **Treatment For a Snake Bite** 1. Remain calm and keep the casualty calm 2. Phone EMS 3. Remove jewelry or tight clothing at the site of the bite before it starts to swell 4. Position the affected area, if possible, so that the bite is at or below the level of your heart. 5. Wipe away any excess venom and cover it with a clean, dry dressing 6. Immobilize the bitten arm or leg, and stay as still as possible to keep the poison from spreading through the body 7. Monitor the person\'s vital signs - temperature, pulse, rate of breathing, and blood pressure. If there are signs of shock, lay the person flat, raise the feet and maintain body temperature - Don\'t use a tourniquet or apply ice - Don\'t cut the wound or attempt to suck out the venom - Don\'t drink caffeine or alcohol - Don\'t try to capture the snake, but try to remember its colour and shape so you can describe it, which will help in your treatment - Do NOT allow the person to become over-exerted. If necessary, carry the person to safety - Do NOT give the person stimulants or pain medications unless a doctor tells you to do so - Do NOT give the person anything by mouth - Do NOT raise the site of the bite above the level of the casualty\'s heart - Uneasiness of the stomach - Spit up - Vomiting - Can\'t keep down liquids or foods for more than 24 hours - Fever with abdominal pain - Signs of dehydration (dizziness, decreased urination, fatigue) - Unable to take medication the person normally takes - Nausea or vomiting is due to surgery, anticancer drugs, motion sickness, pregnancy, or vertigo 1. Have the person drink small amounts of water, sports drinks, or clear liquids 2. If the person can keep it down, give the person light, bland foods like bread and crackers. 1. Have the person drink small amounts of water, sports drinks, or clear liquids 2. Don\'t give the person solid food until vomiting has stopped 3. When the person can tolerate food, try small amounts of the BRAT diet: bananas, rice, applesauce, and toast  Module 4: First Aid/Life Saving Procedures ========================================== - Apply First Aid treatment appropriate to the situation and the prevention of complications. - Improvise equipment that is not readily available in terms of First Aid procedure required. - Taking the appropriate universal precautions in terms of preventing infections. - Apply First Aid in accordance with current practice. - Perform CPR and AR in accordance with accepted procedures. - Assist a person that is choking. - Referral to medical assistance in accordance with the specific needs of the casualty. Lifesaving Procedure ==================== - The casualty begins to breathe on his or her own; - The casualty has no pulse-begin CPR immediately; - More advanced medical personnel takes over; - You are too exhausted to continue. 1. Use a head tilt and a chin lift to keep the casualty\'s airway open. 2. Pinch the casualty\'s nose closed gently, using your thumb and index finger. 3. Then place your mouth over the casualty\'s mouth, making a seal.  4. Breathe slowly, giving full forceful breaths, watching to see the chest rise. Pause in between each breath to let the airflow out. 5. If the casualty's chest does not rise and fall, re-tilt the head and try again. If the air still does not go in, the casualty may have an obstructed airway, and you must perform **"abdominal thrusts"**. 6. After giving 2 breaths, check for a pulse. If the casualty has a pulse but still is not breathing, continue rescue breathing. 7. Check for a pulse after about **1** minute of rescue breathing (about **12 breaths**). If the casualty has a pulse but still is not breathing, continue rescue breathing and checking the pulse every minute. If the casualty\'s pulse stops, begin "CPR". 8. If the casualty's vital functions are re-established (breathing & pulse) place him/her in the recovery position. 1. Use a head tilt and a chin lift to keep the casualty\'s airway open. 2. Pinch the casualty\'s nose closed gently, using your thumb and index finger. 3. Then place your mouth over the casualty\'s mouth, making a seal. 4. Breathe slowly, giving full (not forceful) breaths, watching to see the chest rise. Pause in between each breath to let the airflow out. 5. If the casualty's chest does not rise and fall, re-tilt the head and try again. If the air still does not go in, the casualty may have an obstructed airway, and you must perform **"abdominal thrusts"**. 6. After giving 2 breaths, check for a pulse. If the casualty has a pulse but still is not breathing, continue rescue breathing. 7. Check for a pulse after about **1** minute of rescue breathing (about **12 breaths**). If the casualty has a pulse but still is not breathing, continue rescue breathing and checking the pulse every minute. If the casualty\'s pulse stops, begin "CPR". 8. If the casualty's vital functions are re-established (breathing & pulse) place him/her in the recovery position. 1. To open the airway of an infant, you do not need to tilt the head as far back as an adult\'s. A very slight tilt should allow air to go in. 2. Give the infant **1** slow breath (no full forceful breaths) every **3** seconds. 3. On an infant, you must make a seal over both the infant\'s mouth and nose. 4. After **1** minute of rescue breathing (about 20 breaths), check for a pulse. 5. If the infant has a pulse but is still not breathing, continue rescue breathing and checking the pulse each minute. If breaths do not go in, re-tilt and try again. If breaths still do not go in, you must go immediately to "abdominal thrusts - infant". 6. If the infant\'s pulse stops, begin **"CPR -- Infant"**. 7. If the infant's vital functions are re-established (pulse & breathing) place him/her in a comfortable position. Cardiopulmonary Resuscitation (CPR) =================================== - Adults -- 8 years and older - Children -- 1 to 8 years old - Infants -- less than 1 year old 1. Shout for help. Leave the casualty in the position in which s/he was found and open the airway. 2. If you are unable to open the airway in the position in which the patient was found, roll him/her on to his/her back and open the airway.  **How To Open The Airway** 1. Place one hand on the forehead. Gently tilt the head back. 2. Place the fingertips of your other hand on the point of the casualty's chin and lift the chin. Check the breathing. 1. Ask a bystander to call emergency services for help. If you are alone, make the call yourself. 2. Begin CPR 1. Feel for a pulse, if no pulse is present kneel beside the casualty level with his/her chest. Place the heel of one hand on the centre of the chest. 2. Place the heel of your other hand on top of the first hand and interlock your fingers. 3. Leaning over the casualty, with your arms straight and elbows locked, press down vertically on the breastbone and depress the chest 5/6 cm. Allow the chest to come back up before giving the next compression. 4. Compress the chest 30 times at a rate of 2 per second. Count 1 and 2 and 3 and 4 to keep time. Recheck for a pulse, if no pulse is present...  5. Move to the casualty's head and make sure that the airway is still open. Put one hand on his/her forehead and two fingers of the other hand under the tip of the chin. Move the hand that was on the forehead down to pinch the soft part of the nose closed with forefinger and thumb. 6. Take a breath and place your lips around the casualty's mouth (or on the mouthpiece of the respiratory valve / face shield), making sure you have a tight seal. Blow into the mouth until the chest rises. If the chest does not rise, open the airway again. 7. Maintaining head tilt and chin lift, take your mouth off the person's mouth and look to see if 8. Continue the cycle of 30 chest compressions followed by TWO rescue breaths until either: emergency help arrives and takes over; the casualty shows signs of regaining consciousness, such as coughing, opening the eyes, speaking or moving purposefully, AND starts to breathe normally; or you are too exhausted to continue. 1. Shout for help. Leave the child in the position in which he/she was found and open the airway. 2. If you are unable to open the airway in the position in which the child was found, roll him/her on to his/her back and open the airway. 1. Place one hand on the forehead. Gently tilt the head back. 2. Place the fingertips of your other hand on the point of the child's chin and lift the chin. Do not push on the soft tissues under the chin since this may close the airway. Check the breathing. #### How To Give CPR 1. Feel for a pulse, if no pulse is present kneel level with the child's chest. Place ONE HAND on the centre of the chest. This is the point at which you will apply pressure. 2. Lean over the child, with your arm straight, and then press down vertically on the breastbone with the heel of your hand. Depress the chest by at least one-third of its depth. Release the pressure without removing your hand from the chest. Allow the chest to come back up completely before you give the next compression. Compress the chest 30 times and count 1 and 2 and 3 and 4 to keep the correct rhythm. Recheck for a pulse, if no pulse is present... 3. Ensure the airway is still open by keeping one hand on the child's forehead and two fingers of the other hand on the point of the chin. 4. Pick out any visible obstructions from the mouth. Do not sweep the mouth with your finger to look for obstructions. 5. Pinch the soft part of the child's nose with the finger and thumb of the hand that was on the forehead. Make sure that his/her nostrils are closed to prevent air from escaping. Allow the mouth to fall open. 6. Take a deep breath in before placing your lips around the child's mouth, making sure that you form an airtight seal. Blow steadily into the child's mouth (do not give full forceful breaths); the chest should rise. 7. Maintaining head tilt and chin lift, take your mouth off the child's mouth and look to see the chest fall. If the chest rises visibly as you lift your mouth, you have given a rescue breath. Each complete rescue breath should take one second. If the chest does not rise you may need to adjust the head.  8. Continue the cycle of 30 chest compressions followed by TWO rescue breaths until either: emergency help arrives and takes over; the casualty shows signs of regaining consciousness, such as coughing, opening the eyes, speaking or moving purposefully, and starts to breathe normally; or you are too exhausted to continue. ###### **CPR For Infants** 1. Place one hand on the infant's forehead. Gently tilt the head back. 2. Place one finger of your other hand on the point of the infant's chin and gently lift the chin. Do not push on the soft tissues under the chin since this may close the airway. Check the breathing, by keeping the airway open and look, listen and feel for normal breathing. 1. Feel for a pulse, if no pulse is present place TWO FINGERTIPS of your lower hand on the centre of the infant's chest. Press down vertically on the infant's breastbone and depress the chest by at least one-third of its depth. Release the pressure without removing your fingers from the breastbone. Repeat to give 30 compressions at a rate of two compressions per second. Count 1 and 2 and 3 and 4 to keep rhythm. Recheck for a pulse, if no pulse is present... 2. Make sure that the airway is still open by keeping one hand on the infant's forehead and one 3. Pick out any visible obstructions from the mouth. Do not sweep the mouth with your finger to look for obstructions. 4. Take a breath. Place your lips around the infant's MOUTH AND NOSE to form an airtight seal. If you cannot make a seal around the mouth and nose, close the infant's mouth and make a seal around the nose only. Take a breath and blow steadily into the infant's mouth for one second; the chest should rise. Do not give full forceful breaths. 5. Maintaining head tilt and chin lift, take your mouth off the infant's mouth and look to see the chest fall. If the chest rises visibly as you lift your mouth, you have given a rescue breath. Each complete rescue breath should take one second. If the chest does not rise you may need to adjust the head. Give 5 rescue breaths.  6. Continue the cycle of 30 chest compressions followed by TWO rescue breaths until either: emergency help arrives and takes over; the casualty shows signs of regaining consciousness, such as coughing, opening the eyes, crying or moving purposefully, and starts to breathe normally; or you are too exhausted to continue. 1. Stand behind the conscious choking adult, wrapping your arms around his or her waist. 2. With one hand, make a fist. 3. Place the thumb side of the fist against the person\'s abdomen just above the bellybutton. 4. Be sure your hand is far below the tip of the breastbone. 5. Put your other hand over the fist and give quick inward & upward thrusts into the casualty\'s abdomen. 6. Give 5 abdominal thrusts, if the object is still obstructing the airway give 5 back slaps, repeat until the object blocking the airway is dislodged and the casualty begins to breathe, or until the casualty becomes unconscious. 1. If, during the primary survey, your breathing is ineffective in an unconscious adult, despite having re-tilted the head and tried again, you must assume the casualty\'s airway is obstructed. If the casualty is a conscious choking adult who becomes unconscious, you must lower him/her to the floor on his/her back. 2. Perform a head tilt and chin lift to try to open the airway, and attempt to remove the obstruction by sweeping it out of the casualty\'s mouth with 3. Perform a head tilt and chin lift and give 2 slow breaths. If the breaths still do not go in, go to abdominal thrusts. 4. Sit to the side of the casualty's thighs. Place the heel of one hand on the casualty\'s abdomen, just above the bellybutton yet far below the tip of the breastbone. Place your other hand on top of the first, interlacing your fingers, and give 5 quick upward thrusts. 5. Then do a finger sweep and give 2 slow breaths. 6. If air still will not go in, continue giving 5 abdominal thrusts, a finger sweep and 2 slow breaths. 7. Continue giving thrusts until the object is dislodged, air goes into the casualty's lungs, or trained medical personnel takes over. 8. If the casualty is not breathing but has a pulse, you must perform "Rescue Breathing". 9. If the casualty is not breathing and does not have a pulse, go to "CPR". 1. If the child can cough or talk, encourage him/her to continue coughing. 2. If the child cannot cough/talk, ask if he/she is choking. 3. Perform abdominal thrusts. Stand behind the child, wrap your arms around his/her waist, and make a fist with one hand. Place the thumb side of the fist against the child\'s abdomen, above the bellybutton yet far below the tip of the breastbone. Put your other hand over the fist and give quick upward thrusts into the child\'s abdomen.  4. Give 5 abdominal thrusts, if the object is still obstructing the airway give 5 back slaps, repeat until the object blocking the airway is dislodged and the casualty begins to breathe, or until the casualty becomes unconscious. 1. If the child was a conscious choking casualty who became unconscious, lower the child down onto his/her back. Or, you may have determined during the primary survey that air would not go in, even after you re-tilted and tried again. 2. You must give the child 5 abdominal thrusts, do a finger sweep if you see the object, and open the airway with a head tilt and a chin lift and give 2 slow breaths. 3. If the breaths still will not go in, continue giving abdominal thrusts, a finger sweep and 2 slow breaths until the object is expelled, the child starts to breathe or cough, or EMS takes over. 4. If the child is not breathing but has a pulse, you must perform "Rescue Breathing". If the child is not breathing and does not have a pulse, go to "CPR - child". 1. Give 5 back blows and 5 chest thrusts. 2. Place the infant face-up on your forearm. Put your other arm on top of the infant. Use your thumb and fingers to hold the infant\'s jaw, sandwiching the infant between your forearms. Turn the infant over, face-down on your forearm. Place your arm down on your thigh, being sure that the infant\'s head is lower than his/her chest. Using the heel of your hand, give 5 back blows between the infant\'s shoulder blades. Be sure to hold the infant\'s jaw with your thumb and fingers to stabilize the head. 3. You must turn the infant back over to give 5 chest thrusts. Place your free hand and forearm across the infant, sandwiching it between your forearms and supporting the head. Turn the infant over onto his/her back and place your arm down on your thigh, making sure the infant\'s head is lower than his/her chest. Imagine a line across the infant\'s chest between the nipples. Place your ring finger on the infant\'s breastbone just below the imaginary line. Place the pads of the next two fingers just under the line. Raise your ring finger, and if you can feel the notch at the tip of the infant\'s breastbone, move your fingers up a little bit. Compress the infant\'s breastbone 1.5 -- 2.5 cm with the pads of your fingers and then let the breastbone return to its normal position. Give 5 compressions. 4. Continue giving back blows and chest thrusts until the infant can breathe or cough. 1. If the infant was a conscious choking casualty who became unconscious, place the infant down on its back. You may have determined during the primary survey, even after re-tilting the head and trying again, that air would not go in. 2. Do a foreign body check: open the infant\'s mouth, holding the tongue and lower jaw and lifting them upward, and look for an object; if you do see an object, do a finger sweep to remove it with your little finger. 3. Then give 2 slow breaths. If air still will not go in, continue doing back blows, chest thrusts, foreign body check and 2 slow breaths until the infant starts to breathe or cough or air goes in. 4. If the infant is not breathing but has a pulse, you must perform "Rescue Breathing". If the infant is not breathing and does not have a pulse, go to "CPR - infant".  1. Kneel on the floor to one side of the person. 2. Place the person's arm that is nearest you at a right angle to their body, so it is bent at the elbow with the hand pointing upwards. This will keep it out of the way when you roll them over. 3. Gently pick up their other hand with your palm against theirs (palm to palm). Now place the back of their hand onto their opposite cheek (for example, against their left cheek if it is their right hand). Keep your hand there to guide and support their head as you roll them. 4. Now use your other arm to reach across to the person's knee that is furthest from you, and pull it up so that their leg is bent and their foot is flat on the floor. Gently pull their knee towards you so they roll over onto their side, facing you. Their body weight should help them to roll over quite easily. 5. Move the bent leg that is nearest to you, in front of their body so that it is resting on the floor. 6. Bend their knee so that it is at a right angle to their body. This position will help to balance them. 7. Gently raise their chin to tilt their head back slightly, as this will open their airway and help them to breathe. Check that nothing is blocking their airway. If there is an obstruction, such as food in their mouth, remove this if you can do so safely. Stay with them, giving reassurance, until they have fully recovered. First Aid Kit ============= - Wound cleaner / antiseptic (100ml) - Swabs for cleaning wounds - Cotton wool for padding (100g) - Sterile gauze (minimum quantity 10) - 1 pair of forceps (for splinters) - 1 pair of scissors (minimum size 100mm) - 1 set of safety pins - 4 triangular bandages - 4 roller bandages (75mm x 5m) - 4 roller bandages (100mm x 5m) - 1 roll of elastic adhesive (25mm x 3m) - 1 Non-allergenic adhesive strip (25mm x 3m) - 1 Packet of adhesive dressing strips (minimum quantity 10 assorted sizes) - 4 First aid dressing (75mm x 100mm) - 4 First aid dressings (150mm x 200mm) - 2 Straight splints - 2 Pairs large and 2 pairs medium disposable latex gloves - 2 CPR mouth pieces or similar devices - First Aid and Emergency booklet - List of emergency phone numbers - Adhesive tape - Antibiotic ointment - Antiseptic solution - CPR breathing mask - Disposable gloves - Elastic and adhesive bandages - Gauze pads - Ice packs - Roller bandages - Rubbing/cleaning wipes - Safety pins - Small, sharp scissors - Splints - Sterile dressings - Thermometer - Triangular bandages - Tweezers - An accurate measuring device - Antihistamine cream & tablets - Calamine Lotion - Paracetamol or ibuprofen - Prescription medications - Triple-antibiotic ointment - Relevant medical history on all family members   Incident Investigation Form (5 Why's) ===================================== **Root Cause Analysis Date: \_\_\_\_\_\_\_\_\_\_\_\_ Prepared by: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **Problem** **1^st^ Why** **2^nd^ Why** **3^rd^ Why** **4^th^ Why** **Root Cause** --------------------- --------------- --------------- --------------- --------------- ---------------- List Event Direct Factor Direct Factor Contributing Factor Contributing Factor