First Aid Reference Guide PDF

First aid reference guide How to respond to emergency situations Contents 4 First aid 4 The first aider 5 General information on COVID-19 or pandemics 6 Being a first aider 6 The role of a first aider 9 Equipment 11 Reporting 12 Keeping yourself informed 13 Personal protection equipment 14 Self-care 15 Assessing a casualty 15 Primary survey 18 Secondary survey 18 Head-to-toe survey 19 Monitoring a casualty 23 Unresponsive not breathing casualty 23 Cardiopulmonary resuscitation (CPR) 23 Chest compressions 24 Rescue breaths 28 Automated external defibrillation (AED) 32 CPR after drowning 33 Response problems 33 Seizures 35 Stroke 36 Head injuries 37 Diabetes 39 Airway and breathing problems 39 Choking 40 Asthma 42 Allergic reactions 43 Auto-injector 44 Hyperventilation First aid reference guide 3 45 Circulation problems 45 Chest pains 46 Shock 47 Fainting 48 Bleeding 55 Burns, poisons and foreign objects 55 Burns 57 Poisons 59 Foreign objects 61 Effects of heat and cold 64 Meningitis 64 Sepsis 65 Bites and stings 67 Bone, muscle and joint injuries 67 Sprains and strains 67 Dislocations 68 Fractures 69 Spinal injuries 70 Crush injuries 4 First aid reference guide First aid First aid is the immediate assistance given to someone who is ill or injured. In the vital few minutes before the emergency services arrive basic first aid can be the difference between life and death. The five most common causes of needless death from a lack of first aid are: h choking h the heart not beating h severe bleeding h heart attack h blocked airway. This reference guide provides information about how to respond to each of these emergency situations. It also contains guidance about how to deal with many other injuries and conditions that you may encounter in your daily life. As well as specific treatments, you will also learn how to manage a first aid incident as a whole. The essential advice and practical information contained here will help you to act in an effective, safe and prompt way, ensuring that, should an emergency occur, you can be the difference between a life lost and a life saved. The first aider Anyone can be a first aider. The skills are not difficult to learn, and their value cannot be overestimated. Whether you are busy shopping, looking after children, playing sport, out and about, or providing first aid as a volunteer or as part of your job, it is likely that at some point you will encounter someone who needs first aid. As a first aider, you may be: h working in a small organisation h a childminder h providing first aid in a public place h the first at the scene of a car crash h one of several first aiders in a large company h a teacher. If you are providing first aid at work or as a volunteer, it is important that you receive appropriate training so you have the knowledge and skills for your role. This reference guide aims to support your first aid training, giving you all the notes and guidance you need in one place. First aid training is not a one-off process. It requires ongoing practice and regular refresher training to ensure your knowledge and skills are kept up to date. First aid reference guide 5 As well as receiving first aid training, it is vital that your role is supported by clear policies and procedures. Whether you are a hotel receptionist or a graphic designer, it is important that you understand how the first aid role works in your setting. The information in this guide is set out so you can: h take an overview of the role of the first aider h deal with a first aid incident h treat specific injuries h manage common medical conditions h know what first aid equipment may be needed for your role h understand how the setting can affect first aid needs. General information on COVID-19 or pandemics During a pandemic (such as COVID-19) it is important that you keep yourself safe. The Resuscitation Council will have up to date advice on treating casualties during such a time there web site can be found here www.resus.org.uk St John Ambulance will also update any guidance in line with the Resuscitation Council our advice can be found on our website here sja.org.uk There is common advice that will help you keep safe during a pandemic or local epidemic they include h good hand hygiene h wearing a face mask or covering, in line with latest guidance h avoid touching your eyes, nose, mouth or face covering h good respiratory hygiene, cough or sneeze into a tissue and bin and wash your hands immediately, if you do not have a tissue use your elbow h keeping physical distance from those you do not live with h self-isolate, test and report in accordance with local government guidance. 6 First aid reference guide Being a first aider The role of a first aider There is much more to being a first aider than patching up wounds. It is a diverse role that requires the skills and knowledge to provide effective, safe and prompt first aid, as well as the ability to work and communicate effectively with a variety of people. An effective first aider As a first aider you should: h be calm in your approach h be aware of risks to yourself and others h build and maintain trust with all those involved in an incident h give early treatment h call for appropriate help h remember your own needs. All the skills you need to be an effective first aider are covered on your training course. Health and safety and first aid Much is made of the health and safety culture – most of it negative. However, health and safety is simply a common-sense approach to minimising the risk of harm or injury. It uses a methodical and logical procedure to do this which allows you to put in place appropriate measures to manage an incident, for instance, training first aiders and providing them with the appropriate equipment. Health and safety requirements come from: h legislation h best practice h the organisation’s policies h an assessment of the risks in the environment and the activities taking place there. As a first aider, you need to be aware of these requirements and how they affect you. Risk assessment A risk assessment is a systematic way of looking at the potential risks that may affect a place or activity. A risk assessment can be one of the following: h a process of identifying significant hazards and assessing risks at a specific workplace or event, such as a beauty salon or a school trip h a process of planning for any emergencies that might occur, for example on a First aid reference guide 7 sports field. A risk assessment can look at many aspects of a workplace or event, including: h previous accidents, injuries or emergencies h special requirements for people with specific needs. Both first aid cover and equipment must be determined from the risk assessment. St John Ambulance provides an online tool that allows you to develop a plan to ensure you have sufficient first aid cover. Visit sja.org.uk/FA-calculator for more information – you simply need to input details about your workplace. Ongoing process Risk should be regularly assessed to ensure that any changes in the environment are addressed. Health and safety policy A health and safety policy must meet the specific needs of an individual organisation. It sets out: h an organisation’s strategy for managing health and safety for its personnel and visitors to its premises h the arrangements the organisation has put in place to ensure this happens. The policy must be supported by clear arrangements or procedures that make it clear: h what actions are needed h who is responsible for them h the timescales that must be adhered to. A larger organisation, perhaps with multiple sites, may have a corporate policy outlining a general approach, with detailed arrangements varying at individual sites. Written policy A business with five or more employees must have a written policy that is freely available to all staff. Smaller companies might want to issue a printed copy of the policy to individuals, while larger organisations may prefer to include it on a staff intranet site. However it is distributed, it is important that all staff are aware of the content of the policy and have access to it. Content A written health and safety policy should be easy to understand and not open to misinterpretation. There are no rules about how long it needs to be or how the information is presented. It must simply communicate: h the management’s commitment to health and safety 8 First aid reference guide h how health and safety is implemented and monitored in the working environment. The policy must state whose role and responsibility it is to ensure that health and safety standards and identified requirements are both checked and maintained. The policy should include: h the job title of the senior person in the organisation who is responsible for health and safety policies h the names of the health and safety policy adviser and any safety representatives h commitment to the basic requirements of the Health and Safety at Work etc Act 1974 h commitment to the management’s additional requirements under the Health and Safety Regulations h duties towards the wider public and others h the principal hazards in the organisation h specific policies of the organisation h specific targets for the immediate and long-term future. The Health and Safety Executive (HSE) provides comprehensive advice and a range of resources to enable organisations to produce a health and safety policy. The role of risk assessment The policy’s objectives should address identified risks in an appropriate way, for instance by putting up a sign to highlight a trip hazard. The risk assessment determines the level of detail needed in the arrangements section. Don’t confuse a health and safety policy with a risk assessment. The HSE website states: h policy: general vision and arrangements for the whole business h risk assessment: a regular review of how you remove or control hazards, and whether you are doing enough, or require further controls. A policy will only be effective if management and staff act on it, follow it through and review it on a regular basis. Source: hse.gov.uk Risk assessment can be a useful approach, particularly for an organisation with a number of sites where different activities are carried out. It allows you to tailor the organisation section of the policy to the individual managers at each site. Monitor Monitoring the policy to ensure it is both effective and relevant is crucial. This can First aid reference guide 9 be done in a number of ways, such as carrying out spot checks or safety inspections. More formal monitoring can be achieved through audits and by reviewing management reports and accident investigations. Review Just as risk assessment is an ongoing process, so should the review of the health and safety policy. The policy and arrangements should be updated if: h a specific incident shows a weakness, failure or omission h a risk assessment identifies new risks that must be addressed. Health and safety good practice The acronym APR can help you remember health and safety good practise: h Assess: assess actions and the environment for risks h Perform: put measures in place based on the assessment h Review: routinely review the assessment. A lot of health and safety good practise information is available; visit hse.gov.uk to find out more. Equipment Specialist equipment can help you perform first aid more effectively. When providing first aid as part of an organisation, a risk assessment should be carried out to determine what equipment is needed. It is also a good idea to have the right equipment on hand outside your usual first aid environment, such as in your car or at home. You never know when you might need to be the difference. It is possible that you might have to perform first aid without any equipment at all. During your training course, ideas as to how you can improvise using items at the scene will be discussed. First aid kits There is a legal requirement for workplaces, schools and other publicly used buildings, such as libraries, shopping centres, leisure centres and stations, to have first aid kits. First aid kits must also be available for events and meetings, for example at Brownie camp, at Saturday morning football or at the village Christmas concert. Passenger-carrying vehicles are also required to carry a first aid kit. These first aid kits must: h be clearly marked h contain items appropriate to their environment. h contain suitable Personal Protective Equipment h non-latex gloves 10 First aid reference guide h a face shield h hand sanitiser h Type 2 fluid resistant surgical face mask (for the first aider) It is good practice for first aid kits to be available: h at home h in cars and on motorbikes h at any outdoor or sporting activity h on holiday. Again, these first aid kits should be clearly marked and contain appropriate items. What should a first aid kit contain? There are British Standards for workplace and motor vehicle first aid kits, to which the St John Ambulance workplace and motor vehicle first aid kits conform. They can be found at sja.org.uk/first-aid-supplies As a first aider, you must regularly check your first aid kits to ensure that the contents are all in date and that used items are replaced. A full range of first aid kits and replacement supplies can be found at sja.org.uk/first-aid-supplies Health and safety equipment As a first aider, you might need to use health and safety equipment in an emergency, for instance, firefighting equipment to make an area safe before treating a casualty. Also, to ensure that a casualty gets the most effective treatment, you should be able to locate a first aid kit (and health and safety equipment) in public places. Signs and directions In public places and the workplace, there have to be clear signs showing: h where the first aid kit is h who the first aider is h who the fire marshal is h where the AED machine is h escape routes and assembly points h the location of fire alarms h the location of firefighting equipment. Evacuation equipment In tall buildings or where people with specific mobility issues work, equipment like an evacuation chair should be provided. Emergency evacuation plans Every workplace or public building must have an emergency evacuation plan. Everybody working at that site should know how the plan affects them. This should First aid reference guide 11 include: h how the building or premises is evacuated h where to assemble h the procedure for calling the fire and rescue service. Firefighting equipment Public places and workplaces must have firefighting equipment available. In an emergency, you might need to use this equipment to be able to evacuate a casualty safely or to make an area safe. Only do this if you have received the necessary training and can do so without endangering yourself. Reporting Reporting is an important part of a first aider’s role. It is always useful to keep a record of what happened to a casualty, for example: h where the incident took place h what you did to help the casualty h who else was involved or helped you h what advice you gave the casualty h whose care the casualty was passed to. Sometimes records need to be formal, such as an accident report book at work. Or they can be simple notes that you jot down after stopping to help at an incident on holiday. It is useful to make the record as soon as possible after the incident while your memory of the event is fresh. Any notes or records should stick to the facts and not include speculation or personal opinion; these notes and records can be used as evidence in legal action. The information in these reports should be: h taken into account during the ongoing risk assessment process h used to review the organisation’s health and safety policy and arrangements so that measures can be introduced to prevent similar accidents from happening again. Accident report book An accident report book is a place to record accidents and what treatment was provided. The record of each incident should be kept for three years from the date of the incident. The casualty’s personal information must be protected. An accident report book is required for all organisations employing more than 10 people but is a useful document for: h volunteer groups h for specific events, such as school trips for recording injuries to employees or visitors of a smaller organisation. 12 First aid reference guide Anyone acting on behalf of the casualty can complete an accident report book. The first aider is normally the most appropriate person since they treated the casualty, though the injured person or someone acting on their behalf can also complete the accident report. RIDDOR reporting In the workplace, you must report certain incidents arising from accidents at work under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). This reporting must be done within specific times. Guidelines are set out on each page of the accident report book stating: h which injuries, diseases or incidents need to be reported h who to report them to and when. Notifiable diseases This guide gives details of when a disease must be reported to the local authority. This is done by a medical practitioner. Early years settings such as nurseries must inform Ofsted when there is an outbreak of any notifiable diseases in their setting. Keeping yourself informed Both first aid and health and safety are evolving subjects. All first aiders need to keep themselves informed about changes. The St John Ambulance website sja.org.uk provides useful first aid information. It also provides tools for you to use, such as a way to work out the first aid needs for your workplace. Regular training St John Ambulance recommends that you keep your skills and knowledge up to date by attending refresher and renewal training on a regular basis. This is because: h without regular use, skills and knowledge fade h first aid certificates must be kept in date for them to be valid (this is a legal requirement in some instances) h techniques, treatments, protocols and procedures change to keep up with medical developments and best practices. The HSE strongly recommends that a workplace first aider attends a skills refresher course annually. Online learning etraining.sja.org.uk First aid reference guide 13 First aid calculator We recommend regularly reviewing training needs so our free online requirements calculator can quickly and easily assess your workplace requirements and let you know what is the right option for you and your business. sja.org.uk/FA-calculator Personal protection equipment You should consider carrying these items with you at all times: h disposable non-latex gloves for first aid use: nitrile gloves (often purple or blue) are recommended h a face shield to cut the risk of infection when giving rescue breaths h alcohol gel for use before and after giving treatment. Gloves Putting on disposable gloves Only handle gloves by their cuff when putting them on. Avoid the outside of gloves coming in contact with your skin or any other surface. Taking off disposable gloves Pull the glove from the cuff over your fingers until it is inside out. Repeat with the other hand. Avoid contact with what was the outside surface at all times. Disposing of used gloves Used gloves should be treated as clinical waste and put in a yellow (biohazard) bag. Face shield A plastic face shield can be used when giving rescue breaths to a child or an adult. Once you have opened the airway, remove the shield from its packaging, being careful not to touch the side that will come in contact with the casualty. Place it over the casualty’s face so the filter is over their mouth: a printed guide on the plastic will help you position it correctly. Pinch the casualty’s nose through the plastic, and deliver rescue breaths through the filter with minimal interruption. Alcohol gel Use alcohol gel to wash your hands thoroughly the same way as using soap and water. Pay particular attention to: h the palms and backs of both hands – use the palm of one hand to rub the back of the other h between your fingers – interlock your fingers to work the gel between them h the backs of your fingers – form a loose fist and rub the backs of your fingers against the palm of the other hand h your thumbs – rub the entire thumb by encasing it with your other hand 14 First aid reference guide h your finger and thumb tips – rub them against the palm of the other hand. Hygiene Good hygiene reduces the risk of infections passing between a first aider and a casualty. Minimising the risk of cross infection h Wash your hands, before and after treating a casualty h Wear disposable non-latex gloves for first aid use: nitrile gloves are recommended. If gloves are not available, ask the casualty to dress their own wound, or enclose your hands in clean plastic bags h Cover cuts and grazes on your hands with waterproof dressings h If there are large quantities of body fluids, wear a plastic apron and plastic glasses to protect your eyes h Dispose of all waste safely. Soiled material should be placed in a yellow (biohazard) bag for incineration. Used needles should go in a sharps container. The emergency services may take the waste with them for proper disposal, and your local council should have facilities h Do not touch a wound with your bare hands h Do not touch any part of a dressing that will come in contact with a wound h Do not cough or sneeze over a casualty while you are treating them. In particular, avoid breathing, coughing or sneezing over an open wound. Hand washing Hand washing reduces the risk of infections passing between a first aider and a casualty Self-care Following a more serious first aid incident and depending on the outcome, some first aiders can experience a range of emotions. You may go through what happened again and again in your mind, so it may be useful to talk to someone else who may have been there at the incident or someone you know has been in a similar experience. This is especially important if the outcome was not what you hoped for. Even with the correct treatment and however hard you try on some occasions a casualty will not recover from the injuries or illness. If you are finding it hard to deal with what has happened you should seek support, if your workplace has a mental health first aider they may be able to help signpost you to appropriate support and maybe a good person to talk to, other options include your GP, a counsellor or any support mechanisms that your company may have in place. First aid reference guide 15 Assessing a casualty When you encounter a casualty, you have to assess them so you can deliver effective, safe and prompt first aid. There are two procedures you must follow to help you determine what your response should be: h The first process is called the primary survey which is an initial assessment to identify and deal with life threatening injuries or conditions h This can be followed by the secondary survey which is a detailed and methodical examination of the casualty to look for injuries that may not be apparent. Primary survey The primary survey is often referred to as DRABC. DRABC stands for the five main parts of the primary survey and is a good way to remember the procedure: h Danger h Response h Airway h Breathing h Circulation. You should apply DRABC to all first aid incidents, however small. Danger Before approaching any casualty, first, ensure that there is no danger to you. If possible, move any potential sources of danger so that you can carry out first aid without any risk of injury to you or the casualty. Only as a very last resort should you move the casualty. The emergency services are trained to do this and they usually arrive a few minutes after the emergency call is made. Response Check to see if your casualty is responsive: h Call their name if you know it. Alternatively, shout a command, such as ‘Open your eyes!’ or ask a question, like ‘Can you hear me?’ h Tap or flick the sole of a baby’s foot h Gently tap or shake the casualty’s shoulders. If the casualty is a child or baby gently tap. As you check the casualty, shout for help or ask bystanders to be ready to help. If help arrives, ask that person to wait until you have assessed breathing before dialling 999 or 112 for an ambulance. 16 First aid reference guide Airway When the airway is blocked, air cannot enter the lungs and breathing stops. When a casualty is unresponsive their tongue can block their airway. However, it is very easy to keep an airway open. Baby 1. Place one hand on the baby’s forehead. Gently tilt their head back 2. Place one finger from the other hand on the point of the baby’s chin, taking care not to press the soft tissues under the chin. Gently lift their chin. Child and adult 1. Kneel by the casualty. Place a hand on their forehead. Gently tilt their head back so their mouth opens (don’t put your other hand under their neck) 2. Place your index and middle fingertips under the point of their chin. Lift and hold the chin to keep the airway open. If you suspect the casualty has a spinal injury, use the jaw- thrust technique (see page 70). Breathing Once you have opened the airway, check whether the casualty is breathing normally through their nose. 1. Place your cheek just above the casualty’s mouth and nose 2. Listen, look and feel for breath (for no more than 10 seconds). At the same time look down the casualty’s chest for any movement. In the first few minutes after the heart has stopped it is common to see agonal breathing. This is short, infrequent gasps for breath and should not be mistaken for normal breathing. h If the casualty is not breathing normally, perform cardiopulmonary resuscitation (CPR) immediately (see pages 23-28) h If the casualty is breathing normally, treat any life threatening injuries and place them in the recovery position (see pages 21-22). If their breathing becomes noisy, stop treatment and turn them into the recovery position before continuing. Circulation Injuries or conditions that result in severe bleeding can be life threatening because of the risk of shock. However, only check for circulation once you are sure that the casualty is breathing normally: do not waste any time performing CPR. First aid reference guide 17 Oxygen flow chart Assess the situation. Are there Think safety first. Deal with any any dangers? Yes dangers. When dafe go to step 2. No Assess the casualty. Does the Treat the casualty and diall casualty repsond? Yes 999 or 112 for an ambulance if necessary. No Shout for help. Open the airway/ If possible, check for and treat Is the casualty breathing any serious injuries before normally? placing in the recovery position. Yes If their breathing becomes noisy, stop treatment and turn them into the recovery position before continuing. No Dial 999 or 112 for the emergency services yourself ideally using the mobile device on speaker phone. If you have a helper send them to call for emergency help and to get an AED. If you are alone with no mobile device, and are helping a child or baby, perform CPR for 1 minute before leaving to call for emergency help. Baby or child Adult Give five initial rescue breaths. Perform CPR. If they have drowned, start with five initial rescue breaths before beginning chest compressions. During a pandemic, compression- only-CPR may be recommended Perform CPR. by the UK Resuscitation Council www.resus.org.uk 18 First aid reference guide Secondary survey After providing any initial emergency treatment that the casualty needs, you should then find out what else is wrong with them. The procedure for this is called the secondary survey. It involves finding out the history, signs, symptoms and physically examining the casualty in a methodical way. History - what has happened. Signs - things you can see such as swelling, deformity, bleeding or any obvious injury. Symptoms - these are things the casualty will tell you such as they are feeling sick or their arm hurts. Some useful questions to ask are about A - Allergies (are they allergic to anything?) M - Medication (are they taking any drugs, prescribed or over the counter) P - Previous medical conditions (such as asthma, heart disease or diabetes) L - Last meal (what food or drink did they last have and when) E - Event history (what happened in the lead up to them needing help) Head-to-toe survey Tell the casualty what you are doing and why. Listen carefully to what they tell you. 1. Run your hands over the casualty’s scalp looking for bleeding, swelling or indentations. Try not to move their head or neck 2. Look into each ear for blood, fluid or objects 3. Open their eyes and check their pupils for size and reaction to light. The pupils should be an equal and normal size and react equally 4. Check their nose for blood, fluid or objects 5. Check the rate and depth of their breathing. Note any unusual odour on their breath 6. Check their mouth for anything that may block their airway. Do not remove dentures unless they are loose. Check for wounds 7. Look at their face for wounds or irregularities to the natural lines 8. Note the colour and temperature of their skin. 9. Loosen clothing around their neck. Look for wounds or swelling to their neck tissues 10. Check for a medic-alert talisman, which is usually worn around the neck or wrist 11. Move your hands down their chest to check for swellings, irregularities or wounds. If the casualty is responsive, ask them to take a breath to assess the chest for equal movements and to listen for unusual lung sounds 12. Check their collar bones for deformities 13. Check each arm in turn for wounds or irregularities. If the casualty is responsive, ask them to bend and straighten their fingers and elbows if it First aid reference guide 19 doesn’t cause pain 14. Check each hand and finger for injury 15. If there is a problem with movement or loss of feeling in their arms, do not examine their spine. If there is not, place your hands under the hollow of their back to check for swelling, tenderness or irregularity 16. Look at their abdomen for wounds or bruising, then place a hand on the casualty’s abdomen. Press down gently, looking for tenderness or rigidity 17. Note any signs of incontinence or bleeding from the genital or anal areas 18. Examine each leg in turn for wounds and swelling. If the casualty is responsive, ask them to move each joint in turn 19. Check each foot and ankle for swelling, irregularity and movement. When you have completed the survey treat any problems you have found. Note any abnormalities so that this information can be given to the emergency services. Hygiene Be aware of the risk of cross infection when carrying out the secondary survey. Follow hygiene guidance and in particular: h Always wash your hands before and after touching a casualty, if this is not possible use hand sanitiser h If possible, wear disposable non-latex gloves for first aid use: nitrile gloves are recommended h Make sure that any open wounds you have are covered with a dressing or plaster h Try not to touch a wound. Monitoring a casualty Once you have carried out any first aid emergency services, you may need to wait for emergency services to arrive. During this time you should monitor the casualties: h breathing h level of response using the AVPU scale. A - Alert (responding normally) V - Voice (responding to voice commands only) P - Pain (responds to pain only) U - Unresponsive (does not respond to anything) Monitoring must be done regularly. If possible, record the results so they can be handed over to the emergency services; in particular note any changes. Breathing Check the casualty’s breathing rate and listen for breathing difficulties or unusual noises: h Baby and child rate is 20–30 breaths per minute 20 First aid reference guide h Adult rate is 12–16 breaths per minute. As well as listening for each breath, watch or feel the casualty’s chest movements. Make a note of the factors below: h Rate: how many breaths is the casualty taking per minute? h Depth: are the breaths deep or shallow? h Ease: does the casualty find it easy, difficult or painful to breathe? h Noise: are there any usual sounds made while breathing? Please note if the casualty is unresponsive and not breathing normally start CPR (Cardiopulmonary resuscitation) First aid reference guide 21 Unresponsive breathing casualties Recovery position The recovery position is used to maintain an unresponsive casualty who is breathing normally in a safe position that allows them to breathe more easily. All casualties h Maintain an open airway throughout the procedure h Monitor the casualty’s level of response and breathing until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). h If you suspect a spinal injury keep the spine straight at all times. Child and adult 1. Kneel beside the casualty. Remove their spectacles. Straighten their legs 2. Place the arm nearest to you at right angles to the casualty’s body with their elbow bent and palm facing up 3. Take the casualty’s far arm and place it across their chest so their hand is under their cheek nearest to you 4. With your other hand, grasp the casualty’s far leg just above their knee. Pull it up until their foot is flat on the floor 5. Roll the casualty towards you, keeping their hand pressed against their cheek 6. Adjust the casualty’s upper leg so that both their hip and knee are bent at right angles 7. Tilt the casualty’s head back to keep their airway open and clear. 22 First aid reference guide Baby 1. Cradle the baby with their head pointing down to prevent them from choking on their tongue or vomit 2. Support and protect the baby’s head with your hand. First aid reference guide 23 Unresponsive not breathing casualty Cardiopulmonary resuscitation (CPR) Chest compressions and rescue breaths performed together are called cardiopulmonary resuscitation (CPR). CPR is an important part of the chain of survival for a casualty whose heart has stopped. The quality of CPR is dependent on the correct depth and rate. Chain of survival h Recognising cardiac arrest h Early request for help to the emergency services h Early basic life support – CPR h Early defibrillation h Early advanced life support. To provide the last two links in the chain you need to get help as soon as possible. Defibrillation is known to greatly improve the outcome for some casualties whose hearts have stopped. If a defibrillator is available, get it when calling the emergency services: a defibrillator should not be used on a baby. In the first few minutes after the heart has stopped, it is common to see agonal breathing – short, infrequent gasps for breath. If the casualty is not breathing normally, perform CPR immediately. Casualties might not recover while you are performing CPR but your actions will help to keep them alive until the emergency services take over. Chest compressions The heart pumps blood around the body. When it stops you can do this manually by performing chest compressions. There is no need to remove the casualty’s clothes to find the correct hand position when giving chest compressions. 24 First aid reference guide Rescue breaths Rescue breaths are given to an unresponsive casualty who is not breathing normally increasing oxygen in their lungs and bloodstream, increasing their chances of survival. Rescue breaths should always be performed with chest compressions, and never by themselves. During a pandemic, compression-only-CPR may be recommended by the UK Resuscitation Council www.resus.org.uk If the chest does not rise: 1. Check that the casualty’s head is in the correct position and that their airway is open 2. Check that you have a good seal around the casualty’s mouth (mouth and nose for a baby) 3. Check that you are pinching the nose properly if the casualty is a child or adult 4. Check that there is no obstruction in the casualty’s mouth. Do this visually – do not use your fingers to blindly sweep the mouth. If your attempts are unsuccessful carry on with the CPR sequence. Hygiene We recommend you use a face shield when performing rescue breaths. Adult CPR 1. Follow the DRABC protocol as far as step ‘B’ (see pages 15-16): h check for Danger h check for a Response. Shout for help h open the Airway h check for Breathing for no more than 10 seconds If they are unresponsive and not breathing normally, continue with the procedure below: 2. Dial 999 or 112 for an ambulance. Also, get a defibrillator if one is available h If there is someone to help you, ask them to call for the ambulance immediately and to get the defibrillator h If you are on your own, use the speakerphone function on your mobile device to call the emergency services. Do not leave the casualty to search for a defibrillator 3. Perform chest compressions using both hands; place the heel of one hand on the centre of the casualty’s chest. Place the heel of your other hand on top. Interlock your fingers and keep them up, off the casualty’s ribs First aid reference guide 25 4. Perform 30 chest compressions, to a depth of 5–6cm, at a rate of 100–120 compressions per minute 5. Give two rescue breaths: h Ensure the casualty’s airway is open h Carefully remove any visible obstruction from their mouth (do not do a blind sweep with your finger) h Keep supporting the casualty’s chin with the fingertips of one hand h With the thumb and two fingers of your other hand, pinch the soft part of the casualty’s nose h Take a breath and place your lips over the casualty’s lips, making sure there is a good seal h Breathe steadily into the casualty’s mouth for one second. Watch their chest rise h Keeping your hands in position, remove your mouth. Let their chest fall. 6. Continue giving 30 chest compressions followed by two rescue breaths until one of these things happens: h professional help takes over h the adult starts to wake up, move, open eyes and breathe normally h you become exhausted. If there is another trained first aider present, change over every two minutes with minimum disruption. If you are unable or reluctant to give rescue breaths, perform only chest compressions at the same rate of 100– 120 per minute. Do not perform rescue breaths without giving chest compressions. During a pandemic, compression-only-CPR may be recommended by the UK Resuscitation Make no moreCouncil www.resus.org.uk than two attempts to give rescue breaths. Child CPR 1. Follow the DRABC protocol as far as step ‘B’ (see pages 15-16): h check for Danger h check for a Response. Shout for help h open the Airway h check for Breathing for no more than 10 seconds If they are unresponsive and not breathing normally, continue with the procedure below: 2. Ask a helper to dial 999 or 112 for an ambulance. If you are alone, start the sequence of rescue breaths and chest compressions below. Do not leave the child alone at this time 3. Get a defibrillator if one is available 4. Give five initial rescue breaths: 26 First aid reference guide h Ensure the child’s airway is open h Carefully remove any visible obstruction from their mouth (do not do a blind sweep with your finger) h Keep supporting the child’s chin with two fingertips of one hand. Be careful not to damage the soft tissues under the chin h With your other hand, pinch the soft part of the child’s nose h Take a breath and place your lips around the child’s lips, making sure there is a good seal h Breathe steadily into the child’s mouth for one second. Watch their chest rise h Keeping your hands in position, remove your mouth and allow their chest to fall. 5. Start chest compressions using one hand; leaning over them, place the heel of one hand on the centre of the child’s chest, press straight down to at least a third of the depth of the child’s chest, keeping your elbow straight. Release the pressure fully, but do not take your hand off their chest at a rate of 100–120 compressions per minute 6. Give two rescue breaths 7. Continue alternating 30 chest compressions with two rescue breaths 8. After one minute, if you have no helper, dial 999 or 112 for an ambulance. If you have left the child, check their airway and breathing when you return 9. Continue giving 30 chest compressions followed by two rescue breaths until one of these things happens: h professional help takes over h the child starts to wake up, move, open eyes and breathe normally h you become exhausted. If there is another trained first aider present, change over every two minutes with minimum disruption. If you are unable or reluctant to give rescue breaths, perform only chest compressions at the same rate of 100– 120 per minute. Do not perform rescue breaths without giving chest compressions. Make no more than five attempts to give initial rescue breaths or two attempts to give the subsequent rescue breaths. Baby CPR 1. Follow the DRABC protocol as far as step ‘B’ (see pages 15-16): h check for Danger h check for a Response. Shout for help h open the Airway h check for Breathing for no more than 10 seconds First aid reference guide 27 If they are unresponsive and not breathing normally, continue with the procedure below: 2. Ask a helper to dial 999 or 112 for an ambulance. If you are alone, start the sequence of rescue breaths and chest compressions below for one minute before calling for help yourself. Use your mobile on speaker phone or take the baby with you to a phone. Do not leave the baby alone at this time 3. Give five initial rescue breaths: h Ensure the baby’s airway is open. Do not tilt their head too far back as their airway may close h Carefully remove any visible obstructions from their mouth and nose (do not do a blind sweep with your finger) h Keep supporting the baby’s chin with the fingertip of one hand. Take care not to press on the soft tissues under the chin h Take a breath and place your lips around the baby’s mouth and nose, making sure there is a good seal h Breathe steadily into the baby’s mouth and nose for one second and watch their chest rise h Keeping your hands in position, remove your mouth and allow their chest to fall. 4. Start chest compressions; place two fingertips on the centre of the baby’s chest. Make sure your fingertips are placed so you do not apply pressure to the: h ribs h bottom end of the breastbone h upper abdomen 5. Press straight down to at least a third of the depth of the baby’s chest. Release the pressure fully, but do not take your fingertips off their chest, perform 30 chest compressions, to at least a third of the depth of the baby’s chest, at a rate of 100–120 compressions per minute 6. Give two rescue breaths 7. Continue alternating 30 chest compressions with two rescue breaths 8. Continue giving 30 chest compressions followed by two rescue breaths until one of these things happens: h professional help takes over h the baby starts to wake up, move, open it’s eyes and breathe normally h you become exhausted. If there is another trained first aider present, change over every one to two minutes with minimum disruption. If you are unable or reluctant to give rescue breaths, perform only chest compressions at the same rate of 100– 120 per minute. 28 First aid reference guide Do not perform rescue breaths without giving chest compressions. Make no more than five attempts to give initial rescue breaths or two attempts to give the subsequent rescue breaths. Automated external defibrillation (AED) The heart is a muscular organ that pumps blood around the body. It is located behind the breastbone (sternum) and between the lungs. The heart’s muscles are stimulated by tiny electrical impulses generated by a network of specialised tissue. Cardiac arrest is when the heart stops beating. Not all causes of sudden cardiac arrest are known. One common cause is myocardial infarction (heart attack) which is when the heart’s own arteries become blocked. Apart from not supplying the body with oxygenated blood, the heart muscle itself is starved of oxygen and becomes damaged so does not respond properly to the natural electrical signals: h The electrical impulses may no longer cause rhythmical pumping and the muscle contractions become uncoordinated h The muscle may quiver or tremble, due to chaotic impulses h The heart stops pumping. The unrhythmical and chaotic attempts to beat are called arrhythmia. There are several forms of arrhythmia, and not all of them are shockable with an AED. However, the most common type, which occurs in about 80% of cardiac arrests, is shockable. This is called ventricular fibrillation (VF). If treated quickly, VF may be converted back to a working rhythm. An AED should be applied to a casualty with a suspected heart attack who is unresponsive and not breathing normally. It is a good idea to familiarise yourself with the AED you are likely to use as this can save vital seconds in an emergency. Procedure This procedure is for children and adults: an AED should not be used on a baby. A child can be defibrillated if paediatric pads are available for the AED. When you arrive at the scene, quickly establish: h where the casualty is in the chain of survival h what, if any, emergency first aid has been administered. Using an AED 1. If necessary, perform a primary survey. If a trained first aider has already done this there is no need to repeat the survey, though check the area for flammable liquids and gases, such as oxygen First aid reference guide 29 2. Ask a helper to dial 999/112 for emergency help. If you are alone make the call yourself using your mobile device on speakerphone 3. If the casualty is unresponsive and not breathing normally prepare to use the AED. If possible, ensure someone is performing CPR as you do this. They should continue to perform CPR even as you attach the pads to the casualty’s chest, only stopping when you reach step 8 4. Position the AED beside the casualty, ideally to their left as this makes the pad placement easier and means you don’t need to reach over the casualty. If you cannot position the AED on the casualty’s left do not worry as its position does not affect its operation 5. Remove medication patches and metal jewellery from the casualty but this should not delay the application of the AED 6. Turn on the AED and follow the voice prompts 7. Remove the electrode pads from their sealed packets. Place them on the casualty’s bare chest following the instructions given with the pads. Attach the pads without delay; do not wait to complete chest compressions. 8. Instruct everyone to stand clear. Any CPR being performed should stop. Check that no one is touching the casualty. The AED now analyses the casualty’s heart rhythm 9. If the casualty needs to have shocks, the AED will charge and issue a voice prompt. Perform CPR while this happens 10. Before giving the shock, double-check that everyone (including you) is clear of the casualty by giving a second command to stand clear. Look to make sure everyone is clear. Press the ‘Shock’ button on the AED 11. When the shock is delivered the casualty may twitch – this is normal 12. Keep following all voice prompts issued by the AED. Do not give up if the first shock seems ineffective. Make sure that the electrode pads remain securely in place and the casualty’s skin is still dry before each shock is administered (see below) Before each new shock is administered, make sure that everyone (including you) is clear of the casualty. Give the command to stand clear and check that this has been followed. There is no maximum number of shocks the AED will deliver. It may advise you to continue CPR, this is usually because the heart is in a nonshockable rhythm. It is vital that CPR is performed until emergency services arrive and tell you to stop. Leave the pads in place while waiting for the emergency services in case the casualty has another cardiac arrest. Safety h Containers with flammable liquids or gases should be removed to a safe distance before the AED is switched on h In a confined space with a high concentration of flammable gases in the air, 30 First aid reference guide sparks from the electrode pads can cause a fire. Placing the pads Placing the pads correctly is critical. The electric current needs to travel from one pad to the other directly through the heart to provide the maximum amount of energy. If the pads are not stuck firmly to the skin they may cause electrical sparks and skin burns. Attaching the AED pads 1. Remove or adjust the casualty’s clothing as necessary. Check the casualty’s skin 2. The casualty’s skin must be free from sweat and other moisture. Wet skin must be dried thoroughly: h where the pads will be placed to ensure there is good contact with the skin h between the two pads, to prevent the current from running over the surface of the skin, rather than through the chest Use a paper towel or anything else you have that is absorbent and free from grease 3. If the casualty has very hairy skin use the disposable razor or scissors in the AED pack to remove excess hair from the pad sites 4. Each pad has a clear visual instruction showing where to place it. One pad goes on the right side of the casualty’s upper chest, directly under their collar bone. The other one is placed on the left side of the casualty’s chest, about 10cm below their armpit. If the casualty has a pacemaker fitted, the pads must be placed 12–15cm from it. An implanted pacemaker appears as a bump under the skin. It is usually under the armpit and can be felt with your fingers 5. Apply the pads using a sweeping motion while smoothing the edges in place by running your fingers around them 6. If the AED tells you to check the pads, or if they become loose, smooth them in place with your fingers. If this does not help, apply a new set of pads 7. Before each shock, make sure that the pads remain firmly in place. Smooth the edges down, if necessary. Consider replacing the pads with fresh ones if they are not sticking properly. To use an AED requires that the casualty’s upper clothing is partly removed. It is important to respect the casualty’s right to dignity. Possible issues that can arise Both CPR and using an AED can be complicated by: h specific environments h the cause of the cardiac arrest h the casualty’s medical condition. First aid reference guide 31 Electrocution The casualty must be removed from the source of the electricity before you touch them. Electrocution can cause: h abnormal heart rhythms that may be either shockable or nonshockable h muscle paralysis, which can make CPR difficult to perform h other injuries including burns and bone fractures. Only treat these once the casualty has been successfully resuscitated. Oxygen If oxygen is being used in resuscitation, the mask should be removed while the AED is analysing or shocking. Make sure the area is well ventilated so that there is no risk of fire. Pregnancy Using an AED on a pregnant woman carries no extra risks. CPR is also performed as normal. If she is in the early stages of pregnancy, follow the normal procedures following cardiac arrest when performing CPR and using an AED. If she is in the later stages of pregnancy, there may be additional considerations: h The woman’s abdominal organs may be pushed upward due to the pregnancy h Her neck may appear shorter and obese, though this shouldn’t affect how you open and maintain her airway h During pregnancy a woman’s oxygen consumption increases, so her brain experiences oxygen starvation faster than usual. The unborn baby is also starved of oxygen. It is vital to provide effective rescue breaths h The unborn baby can press on the woman’s blood vessels reducing her circulation. Place a small cushion or other wedge under her right buttock to move her uterus and reduce the pressure. If you have been trained, manually move the uterus upwards and to the woman’s left. Maintain this throughout the resuscitation process, except when the casualty is receiving shocks h The casualty’s increased breast size may mean you need to move one or both of her breasts to place the electrode pad. This must be carried out with respect and dignity. Trauma Most resuscitation attempts following a trauma produce a non shockable heart rhythm. Follow the voice prompts given by the AED. Handover to emergency services Continue to resuscitate the casualty until the emergency services are ready to take over from you. Clearly and concisely, tell them: 32 First aid reference guide h the casualty’s present state h how many shocks were delivered: this may be displayed on the AED screen h the total time since the casualty collapsed h any relevant medical history that is known. Post-use procedure Dispose of any used materials as clinical waste and replace used items. Some AEDs, especially those that are part of the national defibrillator programme, have a memory log that needs to be downloaded and stored. The memory can then be cleared ready for the AED to be used again. You need to confirm how this is done in your organisation. An accident report and, if required, a defibrillation report need to be completed. Consider the emotions that you have experienced as a result of carrying out the procedure, whether or not the casualty has survived. Consider what support you need and ensure that you receive it. CPR after drowning Do not put yourself in danger when trying to rescue a casualty. When the casualty is rescued from the water, you should first perform a primary survey. If this establishes that they are unresponsive and not breathing h Give 5 initial rescue breaths h Give 30 compressions h Continue 30:2 until help arrives If they are breathing but unresponsive place them into the recovery position and monitor until help arrives. During a pandemic As with all adult resuscitation during a pandemic, rescue breaths may not be recommended, but compression-only-CPR, for the majority of first aiders. Rescue breaths would be given in the following circumstances during the COVID-19 pandemic; h In all paediatric CPR situations (by those employed to work with those under 18 years of age) h When someone has drowned (by those employed as lifeguards, lock-keepers or in an employed role where there is a significant risk of a drowning incident). First aid reference guide 33 Response problems Seizures Seizures (child and adult) Seizures happen when some of the body’s muscles contract involuntarily. They are caused by a disturbance in the brain’s activity and some seizures can be violent. The casualty may not be aware of what is happening or might be unresponsive. There are two main types: absence seizures and major seizures. Recognition (absence seizures) An absence seizure is when the casualty loses general awareness for a few seconds. This can go unnoticed by people around them. Sometimes unusual movements are apparent, such as repeated swallowing or other gestures. Children who are thought to be accident-prone might in fact be suffering from absence seizures. People who know that they experience seizures often wear a medic-alert talisman, usually around their neck or wrist. Treatment Aims - To protect and monitor the casualty until they are fully recovered. h There is no immediate treatment for this other than reassurance. Advise the casualty to get medical advice. h Be aware that an absence seizure may be followed by a major seizure. Recognition (seizures) h Sudden loss of response h Becoming rigid, arching their back h Breathing may become noisy and difficult h Convulsions begin (jerky movements) h Saliva from the mouth can be blood-stained if they have bitten their lips or tongue h Loss of bladder and bowel control. Treatment Aims - To protect and monitor the casualty and to get medical help. 1. Clear space around the casualty and protect them by padding sharp or dangerous objects with coats or cushions. If possible, protect the casualty’s head from the floor with a cushion or some other similar item 2. Loosen tight clothing around the neck, chest and waist. Do not put anything into the casualty’s mouth 3. When the seizure stops, check the casualty’s breathing: h If they are breathing normally, place them in the recovery position (see pages 21-22) 34 First aid reference guide h If they are not breathing normally, be prepared to perform CPR (see pages 23-28). Do not attempt to force or keep their jaw open 4. Stay with the casualty. Monitor their breathing and level of response 5. Dial 999 or 112 for an ambulance if the casualty: h has continuous seizures h sustains an injury that requires urgent medical attention h has never had a seizure before h has a seizure that lasts for more than five minutes h is unresponsive for more than 10 minutes. Following the seizure the casualty will relax, their breathing will return to normal and they become responsive within a few minutes. They may be unaware of their surroundings and feel very tired. They can fall into a deep sleep. Febrile convulsions Both babies and children can have convulsions (seizures) between the ages of six months and five years caused by high body temperature. It does not mean they will have seizures throughout their life. Recognition h Vigorous shaking with an arched back h Possible vomiting h Loss of bowel or bladder control h Red, puffy face and neck h High temperature with hot, flushed skin and, perhaps, sweating. A high temperature (fever) is normally a sign of illness. However, a baby’s temperature may also rise if they are teething. Treatment Aims - To protect and monitor the baby/child and to get medical help. 1. Let the convulsion happen naturally, but protect the baby/child from hurting themselves on hard or sharp objects: h If they are on the floor, try to protect their head with a cushion or similar item h Do not put anything into their mouth 2. Cool the baby/child by removing any bedding and clothes. You may only be able to do this once the seizure has stopped. Ensure a good supply of fresh air. Do not overcool 3. Dial 999 or 112 for an ambulance 4. Place the baby/child in the recovery position once the convulsion has ended (see pages 21-22). Do not give them anything to eat or drink until they are fully recovered 5. Reassure the baby/child and monitor vital signs. First aid reference guide 35 Hygiene We recommend you use a face shield when performing rescue breaths. Dispose of any waste, including body fluids, properly. Stroke A stroke is caused by a portion of the brain being starved of oxygen. This can be due to: h a bleed h a clot The lack of oxygen causes damage to the brain. The long-term effects of a stroke depend on what part of the brain and how much tissue is affected. Recognition There may be some or all of the following: h Sudden and severe headache that doesn’t go away h Confusion and emotional instability h Deterioration in the level of response (this may be sudden or progressive) h Signs of weakness or paralysis usually affecting one side of the body h Slurring or loss of speech h Unequal pupils h Possible loss of bladder control. To help with the recognition of a stroke, the FAST test can be used: h Facial weakness: look at the casualty’s face. Can they smile? Is the face uneven? h Arm weakness: can the casualty raise both of their arms? h Speech problems: can the casualty speak clearly? Do they understand what you say? h Time to dial 999 or 112 for an ambulance. Treatment Aims - To protect and monitor the casualty and to get medical help. Responsive casualty 1. Keep the casualty comfortable and supported 2. Dial 999 or 112 for the emergency services 3. Loosen any tight clothing and continue to reassure the casualty 4. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). Unresponsive casualty 1. Open their airway and check their breathing: 36 First aid reference guide h If they are breathing normally, place them in the recovery position (see pages 21-22) h If they are not breathing normally, perform CPR (see pages 23-28) 2. Dial 999 or 112 for an ambulance 3. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). Head injuries Any head injury must be treated seriously as it is potentially life threatening and can cause impaired responsiveness. A head injury can result in: h damage to brain tissue h a bleed inside the skull h a fracture of the skull Always assume that a casualty with a head injury also has a neck injury and treat accordingly. Recognition h Recent blow to the head h Wound to the head h Brief loss of responsiveness h Increased drowsiness h Worsening headache h Confusion, memory loss, strange behaviour and nausea h Weakness to a limb h Speech difficulties h Dizziness, seizures or balance problems h Sight problems, including double vision h Clear fluid or watery blood leaking from the nose or ear Treatment Responsive casualty 1. Help the casualty to sit down in a comfortable position 2. Apply a cold compress to their head injury 3. Monitor breathing and level of response regularly. Keep a close eye on the level of response in case it deteriorates 4. When they have recovered ask a responsible adult to look after them 5. If they were playing a sport when it happened do not let them return to play until they have been fully assessed by a medical practitioner 6. Seek medical help if any of the following apply: h worsening headache h difficulty in speaking or walking h vomiting First aid reference guide 37 h double vision h seizure h over 65 years old h previous brain surgery h they are taking anti clotting medication h they are intoxicated with drugs or alcohol h there is no responsible adult to look after them. Unresponsive casualty 1. If the casualty is breathing, maintain an open airway using the jaw-thrust technique (see page 70) 2. Dial 999 or 112 for an ambulance 3. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). A casualty who becomes unresponsive (however briefly) after a blow to the head must see an appropriate health care professional. Diabetes Diabetes mellitus affects up to one in ten of the population, and people from all age groups. It is caused by a deficiency of or a resistance to insulin. This impairs the body’s ability to store and use glucose so untreated the blood sugar levels are higher than normal. Hyperglycaemia (all casualties) Hyperglycaemia is caused by having too much sugar in the blood stream. Its onset is slow, over a period of hours or days. Its causes include poor management of medication, infection, illness or trauma. Recognition h Warm, dry, red skin h Deep and sighing breathing h Sweet smell on the breath h Restless, drowsy or lethargic behaviour. Treatment Aims - To monitor the casualty and to get medical help. 1. Dial 999 or 112 for an ambulance 2. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). 38 First aid reference guide Low blood sugar (all casualties) Low blood sugar levels (hypoglycaemia) are caused by having too little sugar in the bloodstream. It is due to poor intake, treatment or other medical conditions. Recognition h Weakness, faintness or hunger h Palpitations or muscle tremors h Strange actions or behaviour; confused, belligerent or even violent h Sweating h Pale, cold and clammy skin h Strong, bounding pulse h A medic-alert talisman which is usually worn around the neck or the wrist. Treatment Aims - To return blood sugar levels to normal and to get medical help, if necessary. Responsive casualty 1. If they have their own glucose gel, help them to take it. If not give them up to the equivalent of 15-20g of glucose, eg. a 150ml glass of non-diet fizzy drink or fruit juice, three teaspoons of sugar or sugary sweets 2. If they improve, let them rest and give them more sugary food or drink until they feel better. Encourage them to test their blood with their glucose testing kit and monitor them until they feel completely well 3. If they don’t improve look for other causes, dial 999 or 112 and monitor breathing and level of response Unresponsive casualty 1. Open their airway and check their breathing: h If the casualty is breathing normally, place them in the recovery position (see pages 21-22) h If the casualty is not breathing normally, perform CPR (see pages 23-28) 2. Dial 999 or 112 for an ambulance 3. Monitor the casualty’s breathing and level of response until the emergency services arrive. First aid reference guide 39 Airway and breathing problems Choking Food or other objects stuck in the mouth or throat can cause choking. If the object isn’t cleared, it can lead to death. Even though most choking incidents are minor, they can be frightening. Child and adult recognition h Unable to cough or speak h Difficulty or absence of breathing h Grasping at the neck or throat h Pointing to the mouth or throat Treatment Aims - To clear the obstruction and to get medical help. 1. Ask the casualty, ‘Are you choking?’ 2. Encourage the casualty to cough 3. If they cannot clear the object themselves, or they cannot cough or breathe, support them with one hand while leaning them forwards. Give up to five back blows between their shoulder blades. Visually check the casualty’s mouth and remove any obstruction with your fingertips (do not sweep blindly with your finger). If choking persists, go to step 4 4. Give up to five abdominal thrusts. Stand behind the casualty and link your hands below their rib cage. Pull sharply inwards and upwards. Check their mouth 5. If the obstruction still hasn’t cleared dial 999 or 112 for emergency help. 6. Continue the cycles of back blows and abdominal thrusts while waiting for help to arrive. If the casualty becomes unresponsive at any point during the procedure, open their airway and check their breathing: h If the casualty is breathing normally, place them in the recovery position (see pages 21-22) h If the casualty is not breathing normally, perform CPR (see pages 23-28). Baby recognition h Unable to cry or make any noise h Difficulty in coughing or breathing Treatment Aims - To clear the obstruction and to get medical help. 1. Lay the baby face down on your thigh while supporting their head. Give the baby up to five back blows 40 First aid reference guide 2. Turn the infant over so they are lying on your other thigh, along your arm with their head supported and check their mouth for obvious obstructions (do not sweep blindly with your finger). If choking persists go to step 3 3. Give up to five chest thrusts. Place two fingers on the breastbone, one finger’s breadth below the nipple line, and push with a downwards motion. If you have cleared the object stop before you reach five 4. Check the mouth 5. If the obstruction still hasn’t cleared dial 999 or 112 for emergency help. Take the baby with you if necessary 6. Continue the cycles of back blows and chest thrusts while waiting for help to arrive or the baby becomes unresponsive. If the baby becomes unresponsive at any point during the procedure, open their airway and check their breathing: If the baby is breathing normally, place them in the recovery position (see pages 21-22). If the baby is not breathing normally, perform CPR (see pages 23-28). Hygiene We recommend you use a face shield when performing rescue breaths. Asthma Asthma is a potentially life threatening condition. It affects the air passages, which are the tubes that carry air into and away from the lungs. The air passages in someone with asthma are sensitive to particular irritants. These irritants, commonly known as triggers, include pollen, animal fur, feathers, exercise, smoke and house dust mites. Infection can make asthma worse, people with asthma may have more difficulty breathing at night. Once diagnosed with asthma, the person is given support to help them through their illness. This can include medication, breathing exercises and details of support groups. Medication is usually delivered by inhaler. There are two main types of inhalers: h Reliever inhalers (usually blue or with a blue cap) are used immediately to relieve symptoms h Preventer inhalers (often brown or with a brown cap) are used each day to help prevent asthma attacks, not for relief when an attack starts. Anyone with asthma may use a spacer fitted to their inhaler so they can breathe in the medication more effectively. First aid reference guide 41 All casualties Recognition h Difficulty breathing and/or talking h Wheezing h Distress and anxiety h Coughing h Grey-blue skin (cyanosis) h May only be able to speak in one word or short sentences. h In a severe attack, the casualty may experience exhaustion, become unresponsive and stop breathing Treatment Aims - To ease breathing and to get medical help, if necessary. 1. Keep calm and reassure the casualty. Get them to take a dose of their reliever inhaler, using a spacer if they have one. This should relieve the asthma attack within a few minutes. Encourage the casualty to breathe slowly and deeply 2. Let the casualty find a position that they find comfortable. This is often sitting down. Do not make them lie down 3. A mild attack should ease within a few minutes of them using their inhaler. If it doesn’t the casualty may take 1-2 puffs of their inhaler every 30-60 seconds for up to 10 puffs. If they have a personal plan this should be followed and seek medical aid if necessary. 4. Dial 999 or 112 for an ambulance if any of these things happen: h the casualty’s condition gets worse or their inhaler has had no effect h the casualty becomes exhausted or finds talking difficult 5. Monitor and record the casualty’s vital signs until help arrives. If there is a delay of more than 15 minutes repeat taking 1-2 puffs every 30-60 seconds up to 10 puffs. 6. If the casualty becomes unresponsive, open their airway and check breathing: h If the casualty is breathing normally, place them in the recovery position (see pages 21-22) Monitor the casualty’s breathing and level of response until the emergency services arrive h If the casualty is not breathing normally, perform CPR (see pages 23-28). Hygiene We recommend you use a face shield when performing rescue breaths Salbutamol inhalers in schools From 1 October 2014 UK schools have been allowed to purchase a salbutamol inhaler without a prescription for use in emergencies when a child with asthma cannot access their own inhaler. The emergency salbutamol inhaler should only be used by children, for whom written parental consent for use of the emergency inhaler has been given, who have 42 First aid reference guide either been diagnosed with asthma and prescribed an inhaler, or who have been prescribed an inhaler as reliever medication. More information on the rules and regulations surrounding their storage, supply and use can be found at www.gov.uk Allergic reactions An allergic reaction is an abnormal sensitivity to a trigger. A trigger is a substance that is usually harmless to most people, such as food, chemicals, pollen and multiple other agents. Minor allergic reaction (all casualties) Recognition A casualty may experience one or more of the following depending on the nature of their allergy: h red, itchy rash or raised areas of skin h wheezing and difficulty in breathing h abdominal pain h vomiting and diarrhoea. Treatment Aims - To relieve symptoms and to get medical help, if necessary. 1. Assess the casualty’s signs and symptoms and ask if they know whether they suffer from an allergy 2. Treat any symptoms and help the casualty take any medication 3. Advise the casualty to get medical advice. Severe allergic reaction (all casualties) Anaphylactic shock is a severe allergic reaction that can develop within seconds of contact with a trigger. Possible triggers include: h skin or airborne contact with certain materials h injection of a specific drug h stings of certain insects h ingestion of food, such as nuts or milk products. Recognition The following may be present alongside minor allergic reaction symptoms (opposite) h Anxiety h Red, blotchy skin eruptions h Red and watery eyes h Swelling of the tongue and throat h Pale or flushed skin h Impaired breathing h Signs of shock leading to becoming unresponsive. First aid reference guide 43 Treatment Aims - To get medical help and to help administer emergency medication. 1. Dial 999 or 112 for an ambulance 2. Check whether the casualty has the necessary medication. If they do, help them to use it h If the casualty is responsive, sit them in a position that helps them breathe h If the casualty is unresponsive, open their airway and check their breathing. If they are breathing normally, place them in the recovery position (see pages 21-22). If they are not, perform CPR (see pages 23-28) 3. Be aware of the possibility of shock (see page 46). Auto-injector An auto-injector is a preloaded ‘syringe’ carried by people with known medical conditions. The auto-injectors you may need to use as a first aider are the ones prescribed to people who experience severe allergic reaction. These are used to deliver a single dose of adrenaline to the casualty when the casualty feels a reaction starting. The casualty should administer their own auto-injector unless their condition has deteriorated so far that they are unable to do so. If you have been trained, do not be afraid to administer their auto-injector. Auto-injectors come in adult and child doses. Auto-injectors in schools Following a lengthy campaign and public consultation, an amendment was passed in parliament to the Human Medicines Regulations. This amendment allows schools from 1 October 2017 to purchase adrenaline auto-injectors without a prescription and keep these for emergency purposes. These should be stored and delivered in line with the ‘Supporting pupils with medical conditions at school’ guidance which requires appropriate training to be provided to staff expected to administer the auto-injectors. Pre-use checks Before using an auto-injector: h Have you correctly identified the casualty’s condition as anaphylaxis? h Is the auto-injector in date? h Is it prescribed to the casualty? Basic rules h Never practise with a real auto-injector h Never remove the safety caps unless you are going to use the auto-injector h Never inject into veins, buttocks, hands or feet h Never put your fingers or hands near the needle end of the auto-injector h Never leave the casualty until the emergency services arrive h When an auto-injector is used, the casualty must always receive medical 44 First aid reference guide treatment even if they appear to have made a full recovery. Using an auto-injector 1. Arm the auto-injector by taking it from the hard case and removing the safety cap 2. Help the casualty to administer the auto-injector into the middle of their outer thigh. Firmly push the tip against their outer thigh until it clicks (it can be delivered through clothing) 3. Hold in place for 3 seconds or as instructed on the autoinjector 4. Repeated doses can be given at 5 minute intervals if there is no improvement, symptoms return and the casualty carries a second auto-injector 5. Give any used auto-injectors to the emergency services as proof of administration. 6. Advise the casualty to get a new auto-injector as soon as possible. Hyperventilation Hyperventilation is unnaturally fast or deep breathing; normally caused by anxiety or emotional upset. They may have a history of panic attacks Recognition h Abnormally fast or deep breathing h Anxiety h A fast pulse rate h Trembling/tingling in hands and feet h Sweaty and a dry mouth h Dizziness and faintness h Cramping in hands, feet and around the mouth Treatment 1. Be kind and reassure them 2. Take them somewhere quiet, if possible 3. Encourage them to seek medical advice Hyperventilation due to anxiety is rare in children, look for other possible causes. Be aware that serious illness can also cause rapid breathing and anxiety. First aid reference guide 45 Circulation problems Chest pains Heart attack A heart attack is often caused by the blood supply to the heart suddenly being blocked, usually by a clot. The main risk to the casualty is that they then experience cardiac arrest, which is when the heart stops beating. Recognition A casualty may experience one or more of the following: h persistent, dull and heavy, vice-like pain in the centre of their chest. This pain may spread down their left arm and up their neck and jaw. The pain does not go away with rest and may even occur while they are at rest h abdominal pain or discomfort, like indigestion h breathlessness h ashen skin with a blueness to the lips h rapid pulse that may have an irregular rhythm and become weaker h feeling faint or giddy h an overwhelming feeling of terror h possible sudden and unexpected collapse. Some people will have very few symptoms, especially those with diabetes mellitus. Treatment (responsive casualty) Aims - To keep the casualty at rest and to get medical help as quickly as possible. 1. Dial 999 or 112 for an ambulance and tell the emergency services that you suspect a heart attack 2. Make the casualty as comfortable as possible by putting them in a half sitting position. Make sure that their head and shoulders are supported. If possible, place a coat or a blanket under their knees for additional support. 3. Encourage the casualty to rest 4. If possible get the casualty to chew and swallow 300mg of aspirin (one full dose) 5. If the casualty has medication for angina, encourage them to take it 6. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to start CPR (see pages 23-38) Treatment (unresponsive casualty) Aims - To maintain an open airway, resuscitate and defibrillate, if necessary, and get urgent medical help. 1. Open the casualty’s airway and check their breathing 2. If they are breathing normally, place them in the recovery position (see pages 21-22) 3. Dial 999 or 112 for an ambulance and tell the emergency services that you 46 First aid reference guide suspect that the casualty is having a heart attack and they are unresponsive 4. Monitor the casualty’s breathing and level of response until the ambulance services arrive. If the casualty is not breathing normally, perform CPR (see pages 23-38). Angina This condition has similar recognition features to a heart attack. However, an angina attack often starts as a result of exercise or exertion and normally goes away with rest. 1. Help the casualty to sit down 2. If they have angina medication, such as tablets or spray, help them to take it 3. If the pain is not relieved in five minutes advise them to take a second dose 4. If they are still in pain five minutes after their second dose call 999/112 for an ambulance 5. If the pain subsides within 15 minutes after rest and/or medication, the casualty should be able to resume what they were doing. If they or you are concerned, seek medical advice Shock This life threatening condition occurs when the body cannot get blood to its vital organs, such as the brain and heart. It is usually caused by severe blood loss, but there are other causes. Shock requires immediate emergency treatment to prevent permanent organ damage and death. Shock can be made worse by fear and pain. If there is a risk of shock developing, reassure the casualty and make them comfortable; this may be enough to stop the casualty deteriorating. All casualties Recognition h Rapid pulse h Pale, cold, clammy skin Sweating. As shock develops: h grey-blue skin, especially inside the lips (cyanosis) h weakness and dizziness h nausea, and possibly vomiting h thirst h rapid, shallow breathing h weak pulse. Eventually, the casualty may become restless or aggressive and may yawn or gasp for air before becoming unresponsive. First aid reference guide 47 Treatment Aims - To treat any obvious causes of shock, to improve blood supply to the brain and to get medical help. 1. Treat any possible causes of shock first, like serious burns or bleeding (see pages 48-54) 2. Lay the casualty down on a blanket. Constantly reassure them 3. Raise and support their legs to improve blood supply. If the leg is bleeding and the casualty is comfortable you can raise both legs, if there is a suspected fracture to the pelvis, hip or either leg, both legs should stay down 4. Dial 999 or 112 for an ambulance 5. Loosen tight clothing at the neck, chest and waist 6. Keep the casualty warm and reassure them. Do not let them eat or drink. If the casualty is obviously pregnant lean her to her left side to prevent the baby restricting blood flow back to the heart 7. Monitor the casualty’s breathing and level of response until the emergency services arrive. Be prepared to perform CPR (see pages 23-28). Fainting Fainting is usually a short-lived condition with the casualty making a quick and full recovery. It is caused by the brain not receiving enough blood for a short time. There are a number of different reasons this can happen, such as standing for a long period, lack of food or emotional stress. Recognition (all casualties) h A brief period of unresponsiveness causing the casualty to fall to the floor h Pale, cold, clammy skin. Treatment for a casualty feeling faint Aims - To improve blood flow to the brain and to provide reassurance. 1. Ask the casualty to lie down. Raise their legs 2. If possible, open a door or window to provide fresh air 3. As the casualty recovers, reassure them 4. Allow them to sit up slowly. If they sit up too quickly, they may feel faint again. If they do feel faint, lay them down again and raise their legs. Treatment for a casualty who has fainted Aims - To improve blood flow to the brain and to get medical help, if necessary. 1. Raise the casualty’s legs 2. If they do not become responsive quickly: h reassess DRABC h place them in the recovery position if they are breathing h dial 999 or 112 for an ambulance. 48 First aid reference guide If they show signs of becoming responsive, follow steps 2 to 4 for a casualty feeling faint (see above). Bleeding A break in the surface of the skin or body is known as a wound. Wounds can be described as open or closed: h Open wounds are when the skin is broken; most commonly, they are cuts and grazes. Open wounds can be serious and involve severe bleeding h Closed wounds are when the skin is not broken and the most common one you will deal with is a bruise. There are some injuries, such as broken bones, where a bruise can be an indication of something more serious. Internal bleeding may happen as the result of an injury or because of a medical condition like a stomach ulcer bursting. You should always consider the risk of a casualty having internal bleeding, especially if they display the symptoms of shock without any obvious fluid loss. All bleeding must be taken seriously as uncontrolled severe bleeding can lead to shock, collapse and even death. Controlling the bleeding is always your priority. For details of the symptoms of shock and how to treat it, see page 46. Minor bleeding Treatment Aims - To clean the wound and reduce the risk of infection. 1. If it is dirty, clean the wound under running water or with an alcohol-free wipe. Pat the wound dry using sterile materials, like a gauze swab 2. Cover the wound completely with a sterile material, such as a gauze square or dressing 3. If possible, elevate and support the injured area above heart level 4. Clean the surrounding area, remove the wound covering and apply a sterile adhesive dressing to the wound 5. Advise the casualty to see their own doctor if there is a special risk of infection. Splinters Splinters from wood, glass, or metal can enter the skin and can carry a risk of infection. Splinters can be easily removed from the skin using tweezers. However, if the splinter is deep in the skin it can be difficult to remove and should be left in place. Advise the casualty to seek medical help. 1. Clean the area around the splinter carefully with warm water and soap. 2. Grasp the splinter with the tweezers as close to the skin as possible and draw it out in a straight line keeping it at the same angle as it goes into the skin. 3. Squeeze the wound carefully to encourage slight bleeding as this will help to remove any dirt. First aid reference guide 49 4. Clean and dry the wound and cover with a dressing. 5. If appropriate ask about tetanus immunisation Tetanus Tetanus is a dangerous infection, caused by bacterium that lives in soil. If it enters a wound it can multiply and release toxins. Tetanus can be prevented by immunization, normally given in childhood but may need to be repeated in adulthood. Ask the casualty about tetanus immunisation. Seek medical help if: h They have a dirty wound h They have not been immunised h They are unsure of the number or timing of immunisation. Bruising Bruising is the result of blood entering the skin or bleeding in the tissues under the skin. A bruise can appear moments or days after an injury and can be a sign of a deep injury. Elderly people or those taking some medications can bruise easily. All casualties Treatment 1. Raise the injured limb and support it in a comfortable position 2. Use a cold compress to cool the area. Apply it firmly and keep it in place for at least 20 minutes. Nosebleed Bleeding from the nose most commonly occurs when tiny blood vessels inside the nostrils are ruptured. A nosebleed can be serious if the casualty loses a lot of blood. It may indicate a more serious head injury. All casualties Treatment Aims - To control bleeding and maintain an open airway. 1. Sit the casualty down and tilt their head forward to allow the blood to drain from the nostrils 2. Ask the casualty to breathe through their mouth and to pinch the soft part of their nose 3. After 10 minutes, tell the casualty to release the pressure. If the bleeding has not stopped tell them to reapply the pressure for two further periods of 10 minutes 4. If the bleeding stops and then restarts, help the casualty to reapply pressure 5. If the nosebleed is severe, or if it lasts longer than 30 minutes, arrange medical advice such as 111. 50 First aid reference guide Hygiene There is a risk of cross infection when dealing with an open wound. Follow the hygiene guidance on page 14, and in particular: h Always wash your hands before and after treating any wound h If possible, wear disposable non-latex gloves for first aid use: nitrile gloves are recommended h Make sure that any open wounds you have are covered with a dressing or plaster h Try not to touch a wound or the surface of a dressing that will come in contact with a wound h Dispose of any waste properly. The casualty is at risk of tetanus if the wound has come into contact with the tetanus bacterium, which is carried in soil, dust and manure. If you suspect that this has happened, advise the casualty to check that their immunisation is up to date. Severe bleeding Treatment Aims - To control the bleeding, get medical help and treat for shock 1. Control the bleeding by applying direct pressure to the wound 2. Dial 999 or 112 for the emergency services 3. Apply an appropriate dressing firmly to control the bleeding and minimise the risk of infection. It should not be so tight that it restricts the casualty’s circulation 4. Treat for shock by lying the casualty down with their feet raised. If possible, lay the casualty on a blanket or some other item to insulate them from the cold ground. 5. If blood comes through the dressing, remove the dressing and reapply direct pressure over the wound with a new dressing or pad to control the bleeding. 6. Secure the dressing with the bandage once the bleeding is controlled, tie the knot over the pad to help maintain pressure 7. It may be that the call handler instructs you how to improvise a tourniquet to control life-threatening bleeding if you are not trained or do not have a tourniquet in your first aid kit, using items such as a triangular bandage, belt or tie 8. Monitor the casualty’s breathing and level of response while waiting for the emergency services to arrive. Foreign objects in a wound h Small pieces of debris in a wound should be carefully removed before it is treated. If they are left in place they can cause infection or prevent the wound from healing properly h Objects firmly embedded in a wound should be left in place to be removed First aid reference guide 51 by medical experts. Trying to remove them can cause further damage and bleeding. Treatment for embedded objects Aims - To control bleeding without causing further injury, to minimise the risk of infection and to get medical help. 1. Control the bleeding by applying pressure on either side of the object. Be careful not to push the object further into the wound. Do not try to remove the object 2. Cover both the injury and object with sterile gauze. Pad around the object, then bandage the wound. Make sure there is no pressure on the object. Check the casualty’s circulation beyond the bandage every ten minutes; loosen and reapply the bandage, if necessary 3. Dial 999 or 112 for the emergency services Penetrating chest wound Any object that penetrates the chest can damage the organs and major blood vessels that are protected by the ribcage and breastbone. These include the liver and spleen, as well as the heart and lungs. A lung can collapse (pneumothorax) even if the object does not fully penetrate the lung itself. Each lung is protected by two membranes and if air or blood gets between them the resulting pressure on the lung can make it collapse. A collapsed lung can put pressure on the other lung and the heart: h The heart may not manage to refill with blood properly (tension pneumothorax) which leads to reduced blood circulation and shock h Pressure on the other lung leads to breathing difficulties. All casualties Recognition h Breathing difficulties, often painful, rapid, shallow and uneven breaths h Acute sense of alarm h Lack of oxygen reaching tissues (hypoxia) h Grey-blue skin (cyanosis) h Coughing up blood h Skin around the wound crackles h Blood bubbling from the wound h Sound of air entering through wound as casualty breathes in h Neck veins become prominent. Treatment Aims - To maintain breathing, treat shock and get medical help. 1. Help the casualty to sit down and to lean toward the wound 2. If the wound is bleeding ask them to press on it using the palm of their hand or 52 First aid reference guide if necessary apply a dressing 3. Dial 999 or 112 for the emergency services 4. Maintain the

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