Indian First Aid Manual 2016 PDF

INDIAN FIRST AID MANUAL 2016 (7th edition) AUTHORIZED MANUAL – ENGLISH VERSION St. John Ambulance Association (India) – Indian Red Cross Society National Headquaters 1, RED CROSS ROAD, NEW DELHI - 11001 TABLE OF CONTENT TABLE OF CONTENT................................................................................................................................ 1 PREFACE.................................................................................................................................................. 9 ACKNOWLEDGEMENTS........................................................................................................................ 10 USING THIS MANUAL............................................................................................................................ 12 A. BASIC FIRST AID TECHNIQUES...................................................................................................... 14 A.1 AIMS OF FIRST AID............................................................................................................................. 15 A.1.1 Aims of first aid..................................................................................................................... 15 A.1.2 The first aider........................................................................................................................ 15 A.2 FIRST AID AND THE LAW...................................................................................................................... 16 A.2.1 Indian Good Samaritan Protection Guidelines............................................................. 16 A.2.2 Duty of giving care............................................................................................................. 16 A.2.3 Consent of the person in need........................................................................................ 17 A.2.4 Privacy................................................................................................................................... 17 A.2.5 Negligence.......................................................................................................................... 17 A.3 DEALING WITH AN EMERGENCY......................................................................................................... 18 A.3.1 Step 1: Make the area safe............................................................................................... 18 A.3.2 Step 2: Evaluate the condition of the sick or injured person.............................. 19 A.3.3 Step 3: Seek help............................................................................................................... 19 A.3.4 Step 4: Provide first aid.................................................................................................... 20 A.3.5 When can I stop providing first aid?................................................................................ 21 A.4 STRESS WHEN GIVING FIRST AID........................................................................................................ 22 A.5 RESUSCITATION (BASIC CPR).............................................................................................................. 23 A.5.1 What do I see and enquire?............................................................................................. 23 A.5.2 Resuscitation of a person who is not breathing or not breathing normally............ 27 A.5.3 Resuscitation of baby/child (less than one year old) who is not breathing or not breathing normally............................................................................................................................ 30 A.5.4 When to refer to a healthcare facility?.......................................................................... 32 A.6 RECOVERY POSITION......................................................................................................................... 33 A.6.1 How to put a person into the recovery position?......................................................... 33 A.7 TOP TO TOE ASSESSMENT.................................................................................................................... 37 A.7.1 The initial top to toe assessment...................................................................................... 38 A.8 HYGIENE AND HAND WASHING.......................................................................................................... 42 A.8.1 General hygiene notes...................................................................................................... 42 A.8.2 Technique of hand washing............................................................................................. 43 A.9 FIRST AID OVERVIEW FLOW CHART...................................................................................................... 45 B. RESPIRATORY SYSTEM AND BREATHING...................................................................................... 46 B.1 RESPIRATION..................................................................................................................................... 47 B.1.1 The respiratory system........................................................................................................ 47 B.1.2 The respiratory muscles...................................................................................................... 48 B.1.3 Mechanism of respiration.................................................................................................. 48 B.2 NO BREATHING OR DIFFICULT BREATHING............................................................................................ 49 B.2.1 Causes of no breathing..................................................................................................... 49 B.2.2 What do I see and enquire?............................................................................................. 50 B.2.3 What do I do when the casualty is not breathing or not breathing normally?...... 51 B.2.4 When to refer the casualty to a healthcare facility?.................................................. 52 B.3 DROWNING...................................................................................................................................... 53 B.3.1 What do I see and enquire?............................................................................................. 53 B.3.2 What do I do?...................................................................................................................... 54 B.3.3 Remove the victim out of the water............................................................................... 54 B.3.4 When to refer a drowning victim to a healthcare facility?.............................. 55 B.4 STRANGULATION AND HANGING........................................................................................................ 56 B.4.1 What do I do?...................................................................................................................... 56 B.4.2 When to refer a victim of strangulation or hanging to a healthcare facility?................................................................................................................................................ 57 B.5 CHOKING........................................................................................................................................ 58 B.5.1 What do I see and enquire?............................................................................................. 58 B.5.2 What do I do in case a person is choking?................................................................... 59 B.5.3 What do I do if the choking person is a baby under the age of one year?........... 61 B.5.4 When to refer a choking person a healthcare facility?.............................................. 62 B.6 SWELLING WITHIN THE THROAT............................................................................................................ 63 B.6.1 What do I do in case of a victim with a suspected swelling within the throat?..... 63 B.6.2 When to refer person with a swelling throat a healthcare facility?.......................... 63 B.7 SUFFOCATION BY SMOKE OR GASES................................................................................................... 64 B.7.1 What do I do in case of a victim suffering suffocation by smoke?........................... 64 B.7.2 What do I do in case of a victim suffering suffocation by carbon monoxide (CO) or gases lighter than air?.................................................................................................................. 65 B.7.3 What do I do in case of a victim suffering suffocation by carbon dioxide (CO2) or gases heavier than air?.................................................................................................................... 66 B.7.4 When to refer person exposed to smoke or gasses to a healthcare facility?........ 66 B.8 ASTHMA........................................................................................................................................... 67 B.8.1 What do I see and enquire?............................................................................................. 67 B.8.2 What do I do?...................................................................................................................... 67 B.8.3 When to refer person with asthma to a healthcare facility?..................................... 68 C. HEART, BLOOD CIRCULATION, SHOCK....................................................................................... 69 C.1 THE HEART AND THE BLOOD CIRCULATION........................................................................................... 70 C.1.1 Heart and blood circulation............................................................................................. 70 C.1.2 Blood pressure..................................................................................................................... 71 C.1.3 Pulse....................................................................................................................................... 71 C.1.4 The blood.............................................................................................................................. 72 C.1.5 How blood clots.................................................................................................................. 73 C.2 CHEST DISCOMFORT.......................................................................................................................... 74 C.2.1 What do I see and enquire?............................................................................................. 74 C.2.2 What do I do?...................................................................................................................... 75 C.2.3 When to refer the person to a healthcare facility?..................................................... 76 C.3 BLEEDING........................................................................................................................................ 77 C.3.1 Types of bleeding................................................................................................................ 77 C.4 FIRST AID FOR BLEEDING (IN GENERAL)................................................................................................ 79 C.4.1 What do I see and enquire?............................................................................................. 79 C.4.2 What do I do?...................................................................................................................... 80 C.4.3 What do I do if an object is stuck in the wound?......................................................... 83 C.4.4 What do I do when I suspect an internal bleeding?................................................... 85 C.4.5 When to refer to a healthcare facility?.......................................................................... 86 D. WOUNDS AND INJURIES............................................................................................................... 87 D.1 TYPES OF WOUNDS............................................................................................................................ 87 D.1.1 Complications of wounds................................................................................................. 89 D.2 SMALL CUTS AND ABRASIONS............................................................................................................. 90 D.2.1 What do I see and enquire?............................................................................................. 90 TITLE OF CHAPTER 2 D.2.2 What do I do?...................................................................................................................... 90 D.3 HEAD INJURIES.................................................................................................................................. 93 D.3.1 Nose bleed........................................................................................................................... 93 D.3.2 Bleeding of the gums......................................................................................................... 94 D.4 CHEST INJURIES................................................................................................................................. 95 D.5 ABDOMINAL INJURIES........................................................................................................................ 96 D.6 BLEEDING FROM VARICOSE VEINS...................................................................................................... 97 D.7 AMPUTATION.................................................................................................................................... 98 D.8 CRUSH INJURIES..............................................................................................................................100 D.9 SHOCK...........................................................................................................................................101 D.9.1 Causes of shock................................................................................................................101 D.9.2 What do I see and enquire?...........................................................................................101 D.9.3 What do I do?....................................................................................................................102 D.9.4 When to refer to a healthcare facility?........................................................................103 E. BONES, JOINTS AND MUSCLES.................................................................................................. 104 E.1 THE SKELETON..................................................................................................................................105 E.1.1 The skull...............................................................................................................................105 E.1.2 The backbone or spine (Vertebral column)................................................................106 E.1.3 The ribs and breast bone (Sternum)..............................................................................107 E.1.4 The shoulders and upper limbs (arm, elbow, wrist and hand).................................107 E.1.5 The pelvis and lower limbs (leg, knee, ankle and foot).............................................108 E.2 JOINTS...........................................................................................................................................110 E.3 MUSCLES........................................................................................................................................111 E.4 FRACTURES (INJURIES TO BONES)......................................................................................................112 E.4.1 Causes of fractures...........................................................................................................112 E.4.2 Types of fractures..............................................................................................................113 E.4.3 What do I see and enquire?...........................................................................................113 E.4.4 What do I do?....................................................................................................................114 E.4.5 When to refer to a healthcare facility?........................................................................115 E.5 INJURIES AND FRACTURES TO THE HEAD, NECK AND SPINE...................................................................116 E.5.1 Causes of head, neck and spinal injuries and fractures...........................................116 E.5.2 What do I see and enquire?...........................................................................................116 E.5.3 What do I do?....................................................................................................................117 E.5.4 When to refer to a healthcare facility?........................................................................119 E.6 INJURIES AND FRACTURES TO THE CHEEKBONE, NOSE AND LOWER JAW...............................................120 E.6.1 Fracture of the cheekbone or nose..............................................................................120 E.6.2 Fractures of the lower jaw...............................................................................................121 E.7 INJURIES TO THE SHOULDER, RIBS OR BREASTBONE..............................................................................124 E.7.1 Injuries or fractures of the shoulder................................................................................124 E.7.2 Injuries and fractures of the collar bone......................................................................125 E.7.2.2 W..............................................................................................................................................125 E.7.3 Rib injuries and fractures..................................................................................................126 E.7.4 Fractures of the breast bone (sternum)........................................................................128 E.8 INJURIES TO THE ARM, ELBOW, WRIST, HAND OR FINGERS....................................................................129 E.8.1 Injuries and fractures of the arm (upper arm, fore arm, wrist).................................129 E.8.2 Injuries and fractures of hand or fingers.......................................................................132 E.9 INJURIES TO THE PELVIS, LOWER LIMBS, KNEE, ANKLE OR FEET...............................................................134 E.9.1 Injuries and fractures of the pelvis.................................................................................134 E.9.2 Injuries and fractures of the leg (thigh or lower leg) or ankle..................................135 E.9.3 Fracture of the knee cap (patella)...............................................................................138 E.9.4 Injuries and fractures of foot or toes..............................................................................139 E.10 DISLOCATIONS (INJURIES TO JOINTS)................................................................................................141 TITLE OF CHAPTER 3 E.10.1 Causes of dislocations.....................................................................................................141 E.10.2 What do I see and enquire?...........................................................................................141 E.10.3 What do I do?....................................................................................................................141 E.10.4 When to refer to a healthcare facility?........................................................................141 E.11 STRAINS AND SPRAINS (INJURIES TO LIGAMENTS, MUSCLES AND TENDONS)...........................................142 E.11.1 Causes of strains and sprains..........................................................................................142 E.11.2 What do I see and enquire?...........................................................................................142 E.11.3 What do I do?....................................................................................................................142 E.11.4 When to refer to a healthcare facility?........................................................................143 F. NERVOUS SYSTEM AND UNCONSCIOUSNESS........................................................................... 144 F.1 THE NERVOUS SYSTEM......................................................................................................................145 F.1.1 The central nervous system.............................................................................................145 F.1.2 The peripheral nervous system (PNS)............................................................................146 F.2 UNCONSCIOUSNESS........................................................................................................................148 F.2.1 Causes of unconsciousness............................................................................................149 F.2.2 What do I do?....................................................................................................................149 F.2.3 When to refer to a healthcare facility?........................................................................152 F.3 HEAD INJURIES................................................................................................................................153 F.3.1 Concussion.........................................................................................................................153 F.3.2 Cerebral compression......................................................................................................153 F.3.3 Skull fractures.....................................................................................................................153 F.3.4 What do I do?....................................................................................................................154 F.3.5 When to refer to a healthcare facility?........................................................................154 F.4 STROKE..........................................................................................................................................155 F.4.1 What do I see and enquire?...........................................................................................155 F.4.2 What do I do?....................................................................................................................155 F.4.3 What do I do when the person stops breathing?......................................................157 F.4.4 When to refer to a healthcare facility?........................................................................158 F.5 FITS – CONVULSIONS - SEIZURES.......................................................................................................159 F.5.1 What do I see and enquire?...........................................................................................159 F.5.2 What do I do?....................................................................................................................159 F.5.3 When to refer to a healthcare facility?........................................................................162 G. GASTROINTESTINAL TRACT, DIARRHOEA, FOOD POISONING AND DIABETES.................... 163 G.1 GASTROINTESTINAL TRACT................................................................................................................164 G.2 DIARRHOEA....................................................................................................................................168 G.2.1 What do I see and enquire?...........................................................................................168 G.2.2 What do I do?....................................................................................................................168 G.2.3 Prevent dehydration........................................................................................................169 G.2.4 When to refer to a healthcare facility?........................................................................171 G.3 FOOD POISONING.........................................................................................................................173 G.3.1 What do I see and enquire?...........................................................................................173 G.3.2 What do I do?....................................................................................................................173 G.3.3 When to refer to a healthcare facility?........................................................................174 G.4 DIABETES.......................................................................................................................................176 G.4.1 Type 1 diabetes.................................................................................................................176 G.4.2 Type 2 diabetes.................................................................................................................176 G.4.3 Gestational diabetes (diabetes during pregnancy).................................................176 G.4.4 Diagnosis.............................................................................................................................177 G.5 HYPERGLYCAEMIA..........................................................................................................................178 G.5.1 Symptoms of hyperglycaemic coma or diabetic coma..........................................178 G.5.2 What do I do?....................................................................................................................178 TITLE OF CHAPTER 4 G.5.3 When to refer to a healthcare facility?........................................................................179 G.6 HYPOGLYCAEMIA...........................................................................................................................180 G.6.1 Symptoms of hypoglycaemia........................................................................................180 G.6.2 What do I do?....................................................................................................................180 G.6.3 When to refer to a healthcare facility?........................................................................181 H. SKIN, BURNS, HEAT EXHAUSTION, FEVER AND HYPOTHERMIA............................................. 182 H.1 THE SKIN.........................................................................................................................................183 H.1.1 The outer layer: Epidermis...............................................................................................183 H.1.2 The middle layer: Dermis.................................................................................................183 H.1.3 The fatty layer: Hypodermis............................................................................................183 H.2 SKIN FUNCTIONS..............................................................................................................................184 H.2.1 Protection...........................................................................................................................184 H.2.2 Sensation............................................................................................................................184 H.2.3 Temperature regulation...................................................................................................184 H.2.4 Immunity.............................................................................................................................184 H.2.5 Allows growth and movement.......................................................................................184 H.2.6 Excretion.............................................................................................................................184 H.2.7 Synthesis of vitamins.........................................................................................................184 H.3 BURN WOUNDS...............................................................................................................................185 H.3.1 First, second and third degree burns............................................................................185 H.3.2 Type of burns by origin.....................................................................................................186 H.3.3 Danger of burns................................................................................................................187 H.3.4 Dry burns and scalds (burns from flames, hot surfaces, steam, …)........................188 H.3.5 Care of minor burns (small first and second degree burns).....................................193 H.3.6 Specific burn locations....................................................................................................195 H.3.7 Electrical burns and electrocution by electricity or lightning..................................196 H.3.8 Chemical burns.................................................................................................................201 H.3.9 Sunburns, snow/welders eyes, heat exhaustion and heat stroke...........................204 H.4 HEAT EXHAUSTION...........................................................................................................................208 H.4.1 What do I see and enquire?...........................................................................................208 H.4.2 What do I do?....................................................................................................................208 H.4.3 When to refer to a healthcare facility?........................................................................209 H.5 HEATSTROKE...................................................................................................................................210 H.5.1 What do I see and enquire?...........................................................................................210 H.5.2 What do I do?....................................................................................................................210 H.5.3 When to refer to a healthcare facility?........................................................................212 H.6 FROSTBITES......................................................................................................................................212 H.6.1 What do I see and enquire?...........................................................................................212 H.6.2 What do I do?....................................................................................................................213 H.6.3 When to refer to a healthcare facility?........................................................................215 H.7 PREVENTION OF BURNS....................................................................................................................216 H.8 FEVER............................................................................................................................................219 H.8.1 How to measure the body temperature?...................................................................219 H.8.2 What do I see and enquire when a person has fever?.............................................222 H.8.3 What do I do?....................................................................................................................223 H.8.4 When to refer to a healthcare facility?........................................................................225 H.9 HYPOTHERMIA................................................................................................................................226 H.9.1 What do I see and enquire?...........................................................................................226 H.9.2 What do I do?....................................................................................................................226 H.9.3 When to refer to a healthcare facility?........................................................................228 I. POISONING................................................................................................................................. 229 TITLE OF CHAPTER 5 I.1 POISONING....................................................................................................................................230 I.1.1 Poisoning by swallowing......................................................................................................230 I.1.2 Poisoning by gases...............................................................................................................230 I.1.3 Poisoning by injection..........................................................................................................230 I.1.4 Poisoning by skin absorption..............................................................................................230 I.1.5 What do you see and enquire?.........................................................................................231 I.1.6 What do I do?.......................................................................................................................231 I.1.7 When to refer to a healthcare facility?............................................................................233 J. BITES AND STINGS....................................................................................................................... 234 J.1 ANIMAL BITES (DOG, CAT, MONKEY, MONGOOSE, HORSE, COW OR OTHER ANIMAL BITES)..................235 J.1.1 What do I see and enquire?...............................................................................................235 J.1.2 What do I do?.......................................................................................................................235 J.1.3 When to refer to a healthcare facility?............................................................................237 J.2 SNAKE BITES....................................................................................................................................238 J.2.1 What do I see and enquire?...............................................................................................238 J.2.2 What do I do?.......................................................................................................................238 J.2.3 When to refer to a healthcare facility?............................................................................242 J.3 INSECT STINGS AND BITES..................................................................................................................243 J.3.1 What do I see and enquire?...............................................................................................243 J.3.2 What do I do?.......................................................................................................................244 J.3.3 When to refer to a healthcare facility?............................................................................246 K. SENSES, FOREIGN BODIES IN EYE, EAR, NOSE OR SKIN AND SWALLOWED FOREIGN OBJECTS.............................................................................................................................................. 247 K.1 THE SENSES.....................................................................................................................................248 K.1.1 Eye.......................................................................................................................................248 K.1.2 Ear........................................................................................................................................249 K.1.3 Tongue................................................................................................................................250 K.1.4 Nose.....................................................................................................................................250 K.1.5 Skin.......................................................................................................................................250 K.2 FOREIGN OBJECTS IN THE EYE, EAR, NOSE OR SKIN.............................................................................251 K.2.1 Foreign Body in the Eye...................................................................................................251 K.2.2 What do I do?....................................................................................................................251 K.2.3 When to refer to a healthcare facility?........................................................................252 K.3 FOREIGN BODY IN THE EAR..............................................................................................................253 K.3.1 What do I see and enquire?...........................................................................................253 K.3.2 What do I do?....................................................................................................................253 K.3.3 When to refer to a healthcare facility?........................................................................253 K.4 FOREIGN BODY IN THE NOSE...........................................................................................................254 K.4.1 What do I see and enquire?...........................................................................................254 K.4.2 What do I do?....................................................................................................................254 K.4.3 When to refer to a healthcare facility?........................................................................254 K.5 FOREIGN BODY IN THE SKIN..............................................................................................................255 K.6 SWALLOWED FOREIGN OBJECTS.......................................................................................................256 K.6.1 What do I see and enquire?...........................................................................................256 K.6.2 What do I do?....................................................................................................................256 K.6.3 When to refer to a healthcare facility?........................................................................256 L. URINARY SYSTEM, REPRODUCTIVE SYSTEM AND EMERGENCY CHILDBIRTH........................... 257 L.1 URINARY SYSTEM.............................................................................................................................258 L.2 REPRODUCTIVE SYSTEM....................................................................................................................260 L.2.1 Male reproductive system...............................................................................................260 TITLE OF CHAPTER 6 L.2.2 Female reproductive system..........................................................................................261 L.3 PREGNANCY..................................................................................................................................263 L.3.1 Stages of labour and giving birth..................................................................................264 L.4 AFTERCARE OF THE MOTHER............................................................................................................266 L.5 MEDICAL CONDITIONS AND PREGNANCY.........................................................................................268 L.5.1 Diabetes..............................................................................................................................268 L.5.2 High blood pressure..........................................................................................................268 L.5.3 Infections............................................................................................................................268 L.6 PREVENTION OF SEXUALLY TRANSMITTED DISEASES (STD)....................................................................272 L.6.1 Sexual transmitted infections..........................................................................................272 L.6.2 When to refer to a healthcare facility?........................................................................275 L.6.3 Reducing the risk of STDs/STIs..........................................................................................275 L.7 EMERGENCY CHILDBIRTH.................................................................................................................277 L.7.1 What do I see and enquire?...........................................................................................277 L.7.2 What do I do?....................................................................................................................277 M. PSYCHOLOGICAL FIRST AID................................................................................................... 282 M.1 DEFINITION OF PSYCHOLOGICAL FIRST AID........................................................................................283 M.2 TRAUMATIC CRISIS...........................................................................................................................284 M.2.1 (Psychological) Shock phase.........................................................................................284 M.2.2 Reaction phase.................................................................................................................285 M.2.3 Processing phase..............................................................................................................285 M.2.4 Reorientation phase.........................................................................................................285 M.3 HOW DO I PROVIDE (PSYCHOLOGICAL) FIRST AID?...........................................................................286 M.3.1 Behave calmly...................................................................................................................286 M.3.2 Listen to the affected person.........................................................................................286 M.3.3 General consideration when giving help....................................................................287 M.3.4 Physical Contact...............................................................................................................287 M.3.5 Allow people to have “Have a good cry”..................................................................288 M.3.6 Protect against inquisitive onlookers.............................................................................288 M.3.7 Do not let the affected person be alone....................................................................288 M.3.8 Providing psychological First Aid to all..........................................................................288 M.3.9 Don’t forget to take care of yourself............................................................................288 N. SPECIFIC EMERGENCY SITUATIONS AND DISASTER MANAGEMENT................................... 289 N.1 EMERGENCIES AT SCHOOL...............................................................................................................290 N.2 EMERGENCIES AT WORK..................................................................................................................291 N.3 ROAD AND TRAFFIC ACCIDENTS.......................................................................................................292 N.4 EMERGENCIES IN RURAL AREA..........................................................................................................294 N.5 DISASTERS AND MULTIPLE CASUALTY ACCIDENTS................................................................................296 N.6 EMERGENCY TRIAGE.......................................................................................................................298 O. FIRST AID TECHNIQUES: DRESSINGS, BANDAGES AND TRANSPORT TECHNIQUES............ 301 O.1 DRESSINGS.....................................................................................................................................302 O.1.1 Types of dressings..............................................................................................................302 O.1.2 How do I apply a dressing?............................................................................................303 O.2 BANDAGES.....................................................................................................................................304 O.2.1 Types of bandages...........................................................................................................304 O.2.2 Roller Bandages................................................................................................................313 O.2.3 Crepe bandages..............................................................................................................315 O.3 FAST EVACUATION TECHNIQUES (SINGLE RESCUER)............................................................................316 O.3.1 Shoulder pull.......................................................................................................................316 O.3.2 Ankle pull............................................................................................................................316 TITLE OF CHAPTER 7 O.4 TRANSPORT TECHNIQUES..................................................................................................................317 O.4.1 Single helper transport.....................................................................................................317 O.4.2 Multiple helper transport.................................................................................................320 O.5 STRETCHERS....................................................................................................................................325 O.5.1 Loading a stretcher..........................................................................................................325 O.5.2 Lifting and lowering a stretcher.....................................................................................327 O.5.3 Carrying a loaded stretcher...........................................................................................327 O.5.4 Loading a stretcher into an ambulance......................................................................327 O.6 MOVING AND TRANSPORTING A CASUALTY SUSPECTED OF A HEAD, NECK OR SPINAL INJURY...............329 CONTENT OF A FIRST AID KIT............................................................................................................. 332 SMALL FIRST AID BOX..................................................................................................................................332 MEDIUM FIRST AID BOX...............................................................................................................................332 LARGE FIRST AID BOX..................................................................................................................................333 FIRST MEDICAL RESPONDER FIRST AID KIT......................................................................................................334 REFERENCES........................................................................................................................................ 336 LIST OF RED CROSS INDIA STATE BRANCHES.................................................................................... 338 LIST OF ST JOHN AMBULANCE INDIA STATE BRANCHES.................................................................. 341 TITLE OF CHAPTER 8 PREFACE First aid training is a low cost, but highly effective strategy to reduce morbidity and mortality. With the help of Belgian Red Cross Centre for Evidence Practice (CEBaP), Belgian Red Cross- Flanders and a multi-disciplinary expert panel, Indian Red Cross Society prepared the evidence-based Indian First Aid Guidelines (IFAG) in 2014 which were used to update the sixth edition of first aid Manual prepared for the general public by the St. John Ambulance (India) and the Indian Red Cross Society. First aid has been practised in the world since antiquity. There is enough evidence that it was used to give relief to the injured and sick persons in wars and calamities in India since the times of Mahabarata. The use of first aid techniques expanded and improved with time, but it got the real fillip when the Red Cross Movement started in the world about 150 years ago. Consequently, The Indian Red Cross Society was established in 1920 through an Act of the Parliament. Until then, the St. John Ambulance carried out Red Cross work in addition to its normal activities. To provide the right and effective help before a trained health worker is available or the victim reaches a health facility, it needs to be given by the laypersons who happen to be present wherever a person suffers from an injury or illness. This will only be possible when a large number of laypeople are trained in evidence-based first aid techniques. Presently, about 6 lakh persons are trained in India every year in the basic first aid. The number looks impressive, but is not adequate considering the huge population and vast area not having good communication facilities. This seventh edition of the Indian First Aid Manual (IFAM) has several new and updated features. A brief on anatomy and physiology has been provided on each system. The chapter on cardio pulmonary resuscitation (CPR) has been completely revised. More emphasis has been put on chest compression to ensure improvement in the blood supply to heart and brain, and use of direct pressure to the site of bleeding to control further bleeding. A chapter on handwashing has been added to prevent the transmission of infections between the victim and first aiders. Guidelines related to snake bites have been totally revised considering the after effects of tourniquet binding. Useful guidelines have been added for important public health problems such as diarrhoea, fever, diabetes, emergency childbirth etc. which still claim many lives. I hope, the new Manual will be immensely useful for the laypersons as well as healthcare workers to understand the evidence-based techniques of first aid which are becoming more and more crucial in saving life in this era when the country is facing an epidemic of roadside accidents. Dr. S.P.Agarwal Secretary General Indian Red Cross Society & St. John Ambulance (India) TITLE OF CHAPTER 9 ACKNOWLEDGEMENTS We are very thankful to the many experts in the medical and first aid training profession who contributed their knowledge and experience to this manual. EXECUTIVE SPONSOR: Dr S.P. Agarwal General Secretary, Indian Red Cross Society General Secretary, St John Ambulance Association India Professor Neurosurgery EDITORIAL COMMITTEE (in alphabetical order): Dr V. Bhushan Joint Secretary, Indian Red Cross Society Joint Secretary, St John Ambulance Association India Chairman Editorial Board General Surgeon Mr S.C. Goyal Additional Commissioner, St John Ambulance Association India First Aid training specialist Mr M.M. Gupta Deputy Commissioner, St John Ambulance Association India First aid training specialist Dr T.S. Jayalakshmi Advisor, Indian Red Cross Society Professor Anaesthesiology AIIMS Dr K. Raizada Advisor, IFRC India General Medicine Dr J. Singh Consultant First Aid – Emergency Care, BRC-Fl India Epidemiologist EDITORIAL ADVISORS AND REVIEWERS (in alphabetical order): Dr G.M.A. Beckers Paediatric Urologist, VUMC Amsterdam, The Netherlands Dr T. Dada Professor Ophthalmology AIIMS Dr S. Gulati Professor Department of Paediatrics AIIMS Dr R.L. Icchpujani Public Health Surveillance and Laboratory advisor Global Disease Detection Regional Center (India), Center for Global Health Dr M.C. Misra Professor, Director AIIMS, New Delhi Dr N. Naik Professor Cardiology AIIMS Dr M. Singhal Additional professor Plastic and reconstructive surgery AIIMS Dr S. Singhal Assistant Professor Department G&O AIIMS Dr A. Singla Orthopaedic surgeon University of Virginia, USA PROJECT MANAGEMENT: H. Geuvens Belgian Red Cross-Flanders India delegation TITLE OF CHAPTER 10 FIELD TESTED BY: The development and publication of the Indian First Aid Guidelines (IFAG) and Indian First Aid Manual (IFAM) project was funded by Belgian Red Cross-Flanders and the Belgian Directorate-General for Development Cooperation (DGD) TITLE OF CHAPTER 11 USING THIS MANUAL This manual is offered by the Indian Red Cross Society and the St John Ambulance Association India for use by their members and the general public. Being laymen in the field of medicine, it is expected that they will practice the basic principles of first aid and render such aid needed by the casualty (casualties) till medical aid arrives or the person(s) has (have) been transported to the hospital. The basic characteristic of this manual is to make the layman fully competent practically in the subject. The first aid guidelines in this manual have been based on the latest available and accessible scientific and medical knowledge. In 2014, a team of Indian medical and first aid specialists publicised the Indian First Aid Guidelines (IFAG). These guidelines are developed using a rigorous and transparent methodology to overcome potential biases; are based on extensive research, data analysis and reviews; and are specifically adapted to be implemented within the Indian context. These guidelines are further complemented by the 2015 guidelines on resuscitation and first aid as published by International Liaison Committee on Resuscitation (ILCOR) and the American Heart Association (AHA). The editorial board reviewed the applicability of available first aid guidelines into the specific Indian context and rephrased or adapted them accordingly. For interventions were neither IFAG nor international first aid guidelines existed, or in case sufficient or scientifically evidence was not available, the editorial board decided to include the commonly applied first aid practices. In the first chapter, this manual specifies in detail what “first aid” is about and how to deal with an emergency. It further includes basic first aid techniques the first aider should master, i.e. observing vital signs and consciousness; cardiopulmonary resuscitation (CPR); recovery position, the first assessment of a casualty; and handwashing. The subsequent chapters describe a more in-depth first aid approach and techniques. The structure of these chapters is: Each chapter begins with a short overview of the anatomy and physiology. For specific situation or condition, a list of signs and symptoms a lay person may observe and recognize are included in the section ‘What do I see and enquire?’ This section is immediately followed by ‘What do I do?’ listing a sequence of first aid guidelines and techniques appropriate for that situation or condition. Drawings support the student/reader in understanding specific positions, techniques or signs. The list of guidelines and techniques is completed with a section on ‘When to refer the casualty to a healthcare facility?’ Please note all casualties should best consult a medical caregiver in all cases. If (urgent) patient transport is required, this is indicated by. If the casualty normally does not require organized (ambulance) transport for further treatment, it is marked with the sign. However, depending on the specific situation, condition of the person and severity of the injury or sickness, (ambulance) transport or even urgent transport might be required: the first aider needs to consider all elements on when and how a casualty needs to seek further medical help. In case of doubt, it is always better to arrange (urgent) transport to the healthcare facility for further medical treatment. Important remarks are highlighted in grey text box and preceded with a sign. Supplemental information is marked with and printed in a smaller font. TITLE OF CHAPTER 12 The contents of a first aid box are listed at the last few pages of the manual. Throughout the manual we opted to use the terms ‘injured person’, ‘casualty’ or simply ‘the person’ as a person who got injured or even killed by some event. If the reason is a disease or illness, the term ‘sick person’ is used. The guidelines and instructions are intended to be applied on both male and female casualties. To make the reading easier, and instead of writing ‘he/she’, we opted to use the pronoun ‘he’ meaning that the guideline or instruction is applicable both for male and female victims. Only if the intervention is specifically applicable to females, we use ‘she’ in the instructions. This manual is limited in describing the guidelines, interventions and techniques in words and pictures only. To acquire a practical knowledge, it is important to practice the specific techniques, i.e. basic first aid techniques e.g. cardiopulmonary resuscitation (CPR), how to put a person into recovery position, etc. First aid course organized by the Indian Red Cross Society and the St John Ambulance Association India are ideal opportunities in achieving a clear insight in the techniques and allows to exercise the theory into practice via simulation and on dummies. It is advised the trained first aider to refresh their first aid knowledge by reviewing the guidelines and techniques regularly in this manual and to practice them very frequently. The medical science is constantly in evolution. Newer scientific insights might have an influence on the approach of casualties by lay people and on the first aid guidelines and techniques. This manual is scheduled to be reviewed and updated every five years; the next review is scheduled in 2021. TITLE OF CHAPTER 13 A. BASIC FIRST AID TECHNIQUES In this chapter you will learn about: Aims of first aid. First aid and the law. Dealing with an emergency. Resuscitation (basic CPR). Recovery position. Initial top to toe assessment. Hygiene and hand washing. First aid overview flow chart. TITLE OF CHAPTER 14 A.1 AIMS OF FIRST AID First aid is the first assistance or treatment given to a casualty or a sick person for any injury or sudden illness before the arrival of an ambulance, the arrival of a qualified paramedical or medical person or before arriving at a facility that can provide professional medical care. As a consequence of disaster or civil strife people suffer injuries which requires urgent care and transportation to the nearest healthcare facility. A.1.1 AIMS OF FIRST AID The aims of first aid are: to preserve life, to prevent the worsening of one’s medical condition, to promote recovery, and to help to ensure safe transportation to the nearest healthcare facility. A.1.2 THE FIRST AIDER A first aider is the term describing any person who has received a certificate from an authorised training body indicating that he or she is qualified to render first aid. First aid certifications issued by St. John Ambulance Association and the Indian Red Cross Society are awarded to candidates who have attended a course of theoretical and practical work and who have passed a professionally supervised examination. TITLE OF CHAPTER 15 A.2 FIRST AID AND THE LAW A.2.1 INDIAN GOOD SAMARITAN PROTECTION GUIDELINES A Good Samaritan in legal terms refers to “someone who renders aid in an emergency to an injured person on a voluntary basis”. The Ministry of Road Transport and Highways has published the Indian Good Samaritan and Bystanders Protection Guidelines in The Gazette of India in May 2015 (Notification No 25035/101/2014-RS dated 12 May 2015). The guidelines are to be followed by hospitals, police and other authorities for the protection of Good Samaritans. Following guidelines are included (sub-selection of the guidelines): 1. A bystander or Good Samaritan, including an eyewitness of a road accident may take an injured to the nearest hospital and should be allowed to leave immediately. The eyewitness has to provide his address. No questions are to be asked. 2. The bystander or Good Samaritan shall not be liable for any civil and criminal liability. 3. A bystander or Good Samaritan who makes a phone call to inform the police or emergency services for the person lying injured on the road cannot be compelled to give his name or personal details on the phone or in person. The disclosure of contact details of the Good Samaritan is to be voluntary. 4. The lack of response by a (medical) doctor in an emergency pertaining to road accidents (where he is expected to provide care) shall constitute ‘Professional Misconduct’. A.2.2 DUTY OF GIVING CARE Usually, if a volunteer comes to the aid of an injured or sick person who is a stranger, the person giving the aid owes the stranger a duty of being reasonably careful. In relation to the “duty of giving care”, there is currently (2015) no legal obligation for first aiders to provide first aid in a general public context, not unless it's part of a job description. First aid officers in workplaces and school teachers have a duty of care. Once a first aider begins to provide first aid, a duty of care is established and the first aider then has an obligation to fulfil the duty of care. If a road user is involved in an accident, there is a legal requirement to stay at the scene, assist the injured and report the incident to the police. Not fulfilling a duty of giving care leaves the first aider open to questions of negligence. Whilst there is no law that forces anyone to treat a casualty this does not mean that one can simply leave a casualty who you know is in danger. To do so may make you liable through your omission to act. If you are not happy to provide first aid there are several things you can and should do including (but not limited to): inform someone else, such as the police or the emergency services; make the area around the casualty safe for yourself, others and the casualty; monitor the casualty and/or find out what happened; and comfort the casualty. TITLE OF CHAPTER 16 A.2.3 CONSENT OF THE PERSON IN NEED A conscious person has the right to either refuse or accept care. If the person is conscious, you must ask for his consent before commencing any first aid. If he refuses your help, stay nearby and call the police and emergency services, who can then deal with the situation. If the person is under 18, it is best to obtain consent from his parent or guardian if they are present. If they refuse your help, stay nearby and call the police and the emergency services, who can then deal with the situation. If the person is unconscious or unable to formally consent, his consent is inferred and you can then give the necessary first aid. A.2.4 PRIVACY In any first aid situation, the first aider must take steps to assist the person to maintain personal privacy. This means things like, keeping crowds away, putting up a screen if necessary, and covering any exposed body parts with blankets, or sheets, if available. The first aider also needs to take steps to maintain confidentiality. This means not talking about the incident to other people, or answering questions from the media, unless you have permission from the person involved in the accident. A.2.5 NEGLIGENCE If a volunteer comes to the aid of an injured or sick person who is a stranger, the person giving the aid owes the stranger a duty of being reasonably careful. Not fulfilling, or breaking a duty of care leaves the first aider open to questions of negligence. It is unlikely that a first aider would be sued as long as not practiced outside the parameters of the techniques taught at the first aid training. TITLE OF CHAPTER 17 A.3 DEALING WITH AN EMERGENCY Emergency situations vary greatly but there are four main steps that always apply: 1. Make the area safe. 2. Evaluate the injured person’s condition. 3. Seek help. 4. Give first aid. A.3.1 STEP 1: MAKE THE AREA SAFE Your own safety should always come first. As a first aider, you should: try to find out what has just happened; check for any danger: is there a threat from traffic, fire, electricity cables, etc.; never approach the scene of an accident if you are putting yourself in danger; do your best to protect both the injured person(s) and other people on the scene; be aware that the property of the injured person is at risk. Theft can occur. So mind your safety, and seek police or emergency help if an accident scene is unsafe and you cannot offer help without putting yourself in danger. An important part of safety also includes washing your hands and wearing gloves or a protection when coming in contact with the injured or sick person’s blood or body fluids. In case of road accidents, as a first aider, you should: always follow the traffic rules; ask other people to warn traffic about the event; if possible, place a warning sign at a good distance, at least 30 meters to either side of the accident, to warn traffic. Do not forget to remove the warning signs afterwards; seek help from the police or emergency services; not allow anybody to smoke near an accident site; switch off the engine of every car involved in the accident; and TITLE OF CHAPTER 18 try to apply the handbrake of vehicles involved in the accident to prevent them from moving. You can also put something against the tyres to prevent rolling. As a general rule, the injured person should not be moved from the scene of an accident. Any movement may make the injury worse if there has been a head, neck, back, and leg or arm injury. Only move injured people if: the injured person is in more danger if he is left there, the situation cannot be made safe, medical help will not arrive soon, and you can do so without putting yourself in danger. A.3.2 STEP 2: EVALUATE THE CONDITION OF THE SICK OR INJURED PERSON If it is safe, you can evaluate the sick or injured person’s condition. Always check that he is conscious and breathing normally. Situations in which consciousness or breathing are impaired are often life threatening. Bleeding can also happen inside the body and can be life-threatening although the loss of blood is not seen. Techniques of resuscitation (CPR), the recovery position, etc. are explained in this manual. A.3.3 STEP 3: SEEK HELP Once you have evaluated the sick or injured person’s condition you can decide if help is needed urgently. If help is needed, ask a bystander to call for help. Ask him to come back and confirm that help is underway. If you call for help, be prepared to have the following information available: TITLE OF CHAPTER 19 the location where the help is required (address, street, specific reference points, location; if in a building: floor, room); the telephone or mobile number you are calling from; the nature of the problem; what happened (car accident, fall, sudden illness, explosion, …); how many injured; nature of the injuries (if you know); what type of help is needed: ambulance, police, fire brigade, or other services; and any other information that might help. You might be asked to give your name. Always stay calm and answer their questions calmly. The call takers are professionals and will give you further guidance. If an ambulance can be obtained in a short time, it is best to call for one and use it to transport the injured or sick person to the healthcare facility. An ambulance is the best way to transport ill or injured persons, but they are not always and everywhere quickly available. You can always ask the police for help. If no help is available, you will have to arrange transport yourself (in a van, a truck, a car, an auto-rickshaw, a motorbike, a scooter, a bike-rickshaw, a bike...). Always move the sick or injured person with great care. A.3.4 STEP 4: PROVIDE FIRST AID Give first aid in accordance with the instructions given in the following chapters in this manual. When providing first aid, try to protect an ill or injured person from cold and heat. Do not give anything to eat or drink to a person who is: severely injured, feeling nausea, becoming sleepy, or falling unconscious. In fact, as a general principle, the rule is not to give a casualty anything to drink or eat. Important exceptions include hypothermia (low body temperature), hypoglycaemic shock (low blood sugar in a diabetes patient), diarrhoea and fever leading to dehydration and in case of heat exhaustion or heatstroke. The details can be reviewed in the specific chapters on these conditions. Be aware that experiencing an emergency situation is a very stressful experience for the injured or sick person. TITLE OF CHAPTER 20 To support him through the ordeal, follow these simple tips: tell the sick or injured person your name, explain how you are going to help him and reassure him. This will help to relax him; listen to the person and show concern and kindness; make him as comfortable as possible; if he is worried, tell him that it is normal to be afraid; if it is safe to do so, encourage family and loved ones to stay with him; and explain to the sick or injured person what has happened and what is going to happen. A.3.5 WHEN CAN I STOP PROVIDING FIRST AID? The question arises when your first aid ‘duty’ comes to an end? Within first aid, CPR is a lifesaving activity. But when you can stop giving CPR? There are four reasons allowing you to stop CPR: you see a sign of life, such as breathing; someone trained in first aid or a medical professional takes over; you are too exhausted to continue; or the scene becomes unsafe for you to continue. TITLE OF CHAPTER 21 A.4 STRESS WHEN GIVING FIRST AID It is only normal to feel stress if you are suddenly faced with the need to give first aid in a real emergency. Try to bring your emotions under control before you proceed. You may take some time to stand back from the situation and regain your calm. Do not set about the task too hastily and do not under any circumstances place your own safety at risk. It is not always easy to process a traumatic event emotionally. It is not unusual for first aiders to experience difficulty when working through their emotions afterwards. Talk to your friends, family, fellow first aiders or someone else. If you are still worried, talk to a professional and seek counselling. TITLE OF CHAPTER 22 A.5 RESUSCITATION (BASIC CPR) Reviving someone who is unconscious and/or not breathing or not breathing normally is called resuscitation. If the victim is not breathing or is not breathing normally, any source of suffocation should be removed and resuscitation is to be started. Chest compressions with or without rescue breathings are performed by an individual during cardio pulmonary resuscitation (CPR) in an attempt to restore spontaneous circulation. For untrained or minimally trained first aid providers treating an adult victim, compression-only CPR is recommended. These chest compressions ensure a small but crucial supply of blood to the heart and brain. For formally trained first aid providers (and professionals) treating an adult victim, compression with breaths is recommended. If the trained first aid provider is unable or unwilling, or in any other circumstance, compression-only CPR may be substituted for compression with breaths. For babies and children under one year, compressions with breaths are always recommended. A.5.1 WHAT DO I SEE AND ENQUIRE? In case of a cardiac arrest (heart stops functioning) you might notice the following signs: sudden collapse, loss of consciousness, no breathing, no pulse (however this is not always easy for laypeople to confirm). A.5.1.1 HOW TO OBSERVE RESPONSIVENESS AND CONSCIOUSNESS? Unconsciousness occurs when a person is suddenly unable to respond to stimuli like sound or pain, and appears to be asleep. A person may be unconscious for a few seconds (as is the case with fainting) or for longer periods of time. People who become unconscious do not respond to loud sounds or shaking. They may even stop breathing or their pulse may become faint. This calls for immediate emergency attention. The sooner the person receives emergency first aid, the better it is. The AVPU scale (an acronym from "alert, voice, pain, unresponsiveness") is a system by which a first aider can measure and record a patient's responsiveness, indicating the level of consciousness. It is based on the casualty’s eye opening, verbal and movement (motor) responses. The AVPU scale has only four possible outcomes: A – Alert. The person is fully awake (although not necessarily oriented). The person will spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function. TITLE OF CHAPTER 23 V – Responding to voice. The person makes some kind of response when you talk to him. It could be opening his eyes, responding to your questions or initiating a move. These responses could be as little as a grunt, moan, or slight movement of a limb when prompted by the voice of the rescuer. P – Responding to pain. The patient makes a response of any kind on the application of pain stimulus, such as a central pain stimulus like a rub on his breastbone or a peripheral stimulus such as squeezing his fingers. Patients with some level of consciousness (a fully conscious patient would not require any pain stimulus) may respond by using their voice, moving their eyes, or moving part of their body (including abnormal posturing). U - Unresponsiveness also noted as 'Unconsciousness'. This outcome is recorded if the patient does not give any eye, voice or motor response to voice or pain. To check a person’s responsiveness/consciousness state check the following: 1. A person who looks around, speaks, responds clearly to questions, feels touch and moves or walks around, is considered alert (A). 2. The person opens his eyes and responds to simple questions: “What is your name?” “Where do you live?” “How old are you?” The person responds to simple commands: “Squeeze my hand.” “Move your arm/leg/foot/hand.” If the person responds, he is responsive to voice (V). 3. If there is still no response, pinch the person and see if he opens his eyes or moves. If the person responds to pain, he is responsive to pain (P) If the person does not react to any of these stimuli, he is in an unconscious state (U). Note that a person might only partially respond to the stimuli you provide (sound, touch, pain) and might be in an in-between (groggy) state. TITLE OF CHAPTER 24 Checking if a casualty is conscious or unconscious should only take a few seconds and should not delay checking for the breathing. More information on unconsciousness is given in the respective chapter. A.5.1.2 HOW TO OBSERVE THE BREATHING? The airway may be narrowed or blocked making breathing noisy or impossible. Reasons for blockage may be: Loss of muscular control in the throat may allow the tongue to sag back and block the air passage. When the reflexes are impaired, saliva may lie in the back of the throat, blocking the airway. Any foreign body in the throat may block the air passage e.g. vomit, blood, dentures etc. It is essential to establish a clear airway immediately. Unless you can clearly see that the person is breathing normally, an unconscious person must be turned onto his back to unblock the breathing passage and to check for breathing. Unblocking the breathing passage takes priority over concerns about a potential spinal injury. To observe the breathing do following: 1. If the person is unconscious and is not on his back, turn him on to his back. 2. Kneel beside the casualty. 3. Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead backwards with the palm of the other hand. This manoeuvre will lift the tongue forward and clear the airways. 4. Observe breathing by listening, feeling and looking 5. After opening the victim's airway, check to see if the victim is breathing. To do this, place your cheek in front of the victim's mouth (about 3-5 cm away) while looking down his chest (towards his feet). If desired, you can also gently place a hand on the center of the victim's chest. This allows you to observe whether the victim is breathing in the following ways: a. look for chest/abdominal movement, b. listen to breathing sounds, c. feel the air coming out of the nose or mouth. TITLE OF CHAPTER 25 In the first minutes after cardiac arrest it often appears as if the person is trying to breathe. It can appear as if the person is barely breathing or is taking infrequent noisy gasps. It is important not to confuse this with normal breathing and you should start resuscitation immediately. 6. If the casualty’s chest still fails to rise, first assume that the airway is not fully open. Once the airway is cleared the casualty may begin breathing spontaneously. Else, clear the airway by removing any visible item that is blocking the airway: a. Hook your first two fingers covered with clean cloth/gloves. b. Sweep round inside the mouth/ throat. c. Check again the breathing. One should not spend time searching for hidden obstructions. Care should be taken not to push any object further down the throat. Be careful: do not put your fingers in somebody’s closed mouth. More information on the breathing can be found in the respective chapter. A.5.1.3 HOW TO OBSERVE THE PULSE? Feeling the pulse is not always easy. Feeling the pulse during an emergency at the wrist is often unreliable. The pulse can be felt by placing the finger tips gently on the voice box and sliding them down into the hollow between the voice box and the adjoining muscle. TITLE OF CHAPTER 26 Do not loose time trying to locate and feel the pulse. The current resuscitation guidelines for laypeople direct that resuscitation (CPR) is to be started when the person is not breathing or not breathing normally and does not require to check the pulse. More information on the pulse can be found in the respective chapter. A.5.2 RESUSCITATION OF A PERSON WHO IS NOT BREATHING OR NOT BREATHING NORMALLY A.5.2.1 SAFETY FIRST AND CALL FOR HELP 1. Make sure there is no danger to you, the person who needs help and bystanders before giving help. 2. The person urgently needs help. Shout or call for help if you are alone but do not leave the person unattended. Ask a bystander to seek help or to arrange urgent transport to the nearest healthcare facility. Tell him to come back to you to confirm if help has been secured. A.5.2.2 SECURE AN OPEN AIRWAY The airway may be narrowed or blocked making breathing noisy or impossible. It is essential to establish a clear airway immediately. Unblocking the breathing passage takes priority over concerns about a potential spinal injury. 3. If the person is not on his back, turn him on to his back. 4. Kneel beside the casualty. 5. Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead backwards with the palm of the other hand. This manoeuvre will lift the tongue forward and clear the airways. chin lift pic 6. Check for breathing. a. Look for chest/abdominal movement. b. Listen to breathing sounds. c. Feel the air coming out of the nose or mouth. 7. If the casualty’s chest still fails to rise, first assume that the airway is not fully open. Once the airway is cleared the casualty may begin breathing spontaneously. 8. Else, clear the airway by removing any visible item that is blocking the airway: Hook your first two fingers covered with clean cloth/gloves and sweep round inside the mouth/ throat. TITLE OF CHAPTER 27 One should not spend time searching for hidden obstructions. Care should be taken not to push any object further down the throat. Be careful: do not put your fingers in somebody’s closed mouth. 9. If the breathing restarts, place the patient in the recovery position (see recovery position). If the casualty still does not breathe, start CPR immediately. A.5.2.3 CPR: HOW TO GIVE CHEST COMPRESSIONS? 1. Turn the casualty on his back on a hard surface, if not already. 2. Kneel next to the casualty, beside his upper arm. 3. Place the heel of one hand in the center of the person’s chest. 4. Place the heel of the other hand on top of your first hand. If the person’s age is below puberty, only use one hand. If the victim is a baby, do not use this technique but apply the technique of CPR for babies and children under the age of one year. 5. Lock your fingers of both hands together. Do not apply pressure to the person’s ribs. Nor should you press the upper part of the stomach or the bottom end of the breast bone. 6. Make sure your shoulders are directly above the person’s chest. 7. With outstretched arms, push five to maximum six centimetres downwards. 8. Release the pressure and avoid leaning on the chest between compressions to allow full chest recoil. The compression and release should be of equal duration. Each time you press down allow the chest to rise fully again. This will let blood flow back to the heart. 9. Do not allow your hands to shift or come away from the breastbone. 10. Give 30 chest compressions in this way at a rate of 100 compressions a minute (you may go faster, but not more than 120 compressions a minute). This equates to just fewer than two compressions a second. TITLE OF CHAPTER 28 A.5.2.4 CPR: HOW TO GIVE RESCUE BREATHS? If for some reason you cannot or do not want to give rescue breaths, you can just continue giving chest compressions (five to maximum six centimetre deep at a rate of 100 compressions a minute). 1. Put one hand on the person’s forehead and tilt back his head. 2. Put your other hand on the bony part of the chin and lift the chin. 3. Then pinch the person’s nose with one hand that is on his forehead. 5. Take a normal breath and then put your mouth completely over the person’s mouth and seal with your lips. Calmly blow your air into the mouth of the person’s for one second. Check if the person’s chest rises. 6. If the chest does not rise, take the following steps: a. Check if anything is in the person’s mouth. If so, remove any visible items that may block the airway. b. Check that the head is well tilted and the chin is lifted properly. In any case, make no more than two attempts to blow air into the person. 7. Start another series of 30 chest compressions prior to trying to blow air into the person’s mouth again. Chest compressions and rescue breaths are tiring to administer. If there are a few trained rescuers present, it is best to alternate with each other. To ensure that the quality of the chest compressions remains optimal, the rescuers should switch every two minutes: The first rescuer gives 30 chest compressions followed by two ventilations and another set of 30 chest compressions and two ventilations. Then another rescuer takes over and repeats the above steps and switch again. The switches should happen with minimal interruption and as quickly and smoothly as possible. 8. Do not interrupt the resuscitation until: TITLE OF CHAPTER 29 the victim starts to wake up, moves, opens his eyes and breathes normally; help (trained in CPR) arrives and takes over; you become too exhausted to continue; or the area becomes unsafe for you to continue. A.5.2.5 HYGIENE Wash your hands after taking care of the person. Use soap and water to wash your hands. If no soap is available, you can use ash to wash your hands. Alcohol-based sanitizers can also be used, if available. A.5.3 RESUSCITATION OF BABY/CHILD (LESS THAN ONE YEAR OLD) WHO IS NOT BREATHING OR NOT BREATHING NORMALLY A.5.3.1 SAFETY FIRST AND CALL FOR HELP 1. Make sure there is no danger to you before giving help. 2. The child needs urgent help. Shout or call for help if you are alone but do not leave the person unattended. Ask a bystander to seek help or to arrange urgent transport to the nearest healthcare facility. Tell him to come back to you to confirm that help has been secured. A.5.3.2 HOW TO SECURE AN OPEN AIRWAY OF A BABY/CHILD LESS THAN ONE YEAR OLD? The airway may be narrowed or blocked making breathing noisy or impossible. It is essential to establish a clear airway immediately. Unblocking the breathing passage takes priority over concerns about a potential spinal injury. 3. Lay the baby/child down on the floor or hard and safe surface. 4. Move the baby’s/child head backwards and lift its chin slightly. This manoeuvre will lift the tongue forward and clear the airways. 5. Check for breathing. a. Look for chest/abdominal movement. b. Listen to breathing sounds. c. Feel the air coming out of the nose or mouth. If the baby still does not breathe, begin CPR immediately. TITLE OF CHAPTER 30 A.5.3.3 CPR: HOW TO GIVE CHEST COMPRESSIONS ON A BABY/CHILD LESS THAN ONE YEAR OLD? 1. Place three fingers of your hand on the center of the baby’s/child’s chest on its breastbone (sternum). 2. Remove the bottom finger of the three fingers and compress the chest with the two remaining fingers (middle and index finger) up to one third of the depth from the chest of the baby/child. Do not use the base or palm of your hand. Only use one hand. 3. Repeat these compressions 30 times at a rate of 1 0 0 - 120 per minute. Release the pressure completely between compressions without removing your fingers from the chest. Always make sure the chest rises before pressing down again. A.5.3.4 CPR: HOW TO GIVE RESCUE BREATHS ON A BABY/CHILD LESS THAN ONE YEAR OLD? 1. Move the baby’s/child head backwards and lift its chin slightly. 2. Cover the baby’s/child’s nose and mouth with your mouth and gently puff into his lungs only until you see his chest rise, pausing between rescue breaths to let the air flow back out. Remember that a baby’s lungs are much smaller than yours, so it takes much less than a full breath to fill them. TITLE OF CHAPTER 31 3. Check if the baby’s/child’s chest rises. If the chest does not rise, take following steps: a. Check if anything is in the baby’s/child’s mouth. If so, remove any visible items that may block the airway. b. Check that the head is well tilted and the chin is lifted properly. In any case: make no more than two attempts to blow air into the baby/child. 4. Start another series of 30 chest compressions prior trying to puff air into the baby’s/child’s mouth again. 5. Do not interrupt the resuscitation until: the child starts to wake up, moves, opens his eyes and breathes normally; help (trained in CPR) arrives and takes over; or the area becomes unsafe for you to continue. A.5.3.5 HYGIENE Always wash your hands after taking care of a person. Use soap and water to wash your hands. If no soap is available, you can use ash to wash your hands. Alcohol-based sanitizers can also be used, if available. A.5.4 WHEN TO REFER TO A HEALTHCARE FACILITY? Always – urgently: Any person that has stopped breathing or needed CPR should always be transported to the nearest healthcare facility as quickly as possible continuing CPR. TITLE OF CHAPTER 32 A.6 RECOVERY POSITION The recovery position refers to a lateral prone position of the body, in to which an unconscious but breathing normally casualty can be placed as part of the first aid treatment. In an unconscious person, the muscles are relaxed. This causes the tongue to obstruct the airway. This risk can be eliminated by carefully tilting the head back and lifting the chin. The recovery position should be used for unconscious casualties who are breathing. The position of the casualty’s arms and legs provide the necessary stability to keep the body in a safe and comfortable position. Unblocking the breathing passage takes priority over concerns about a potential spinal injury. Unless you can clearly see that the person is breathing normally, an unconscious person must be turned onto his back to unblock the breathing passage and to check breathing. A.6.1 HOW TO PUT A PERSON INTO THE RECOVERY POSITION? A.6.1.1 SAFETY FIRST AND CALL FOR HELP 1. Make sure there is no danger to you, the person who needs help and bystanders before giving help. 2. The victim needs urgent help. If not yet done, shout or call for help if you are alone but do not leave the person unattended. Ask a bystander to seek help or to arrange urgent transport to the nearest healthcare facility. Tell him to come back to you to confirm that help has been secured. A.6.1.2 HOW TO PUT A PERSON INTO THE RECOVERY POSITION 3. Put the person on the floor if he is not there already. 4. Remove the person’s spectacles if necessary. 5. Kneel down by the side of the casualty. 6. Make sure both of his legs are outstretched. 7. Place the nearest arm (the one on the side you are kneeling next to) at right angles to his body. 8. Bend the forearm upwards with palm facing up. 9. Lay the person’s other arm across his chest. TITLE OF CHAPTER 33 10. Hold the back of this hand against his cheek on the side at which you are kneeling. 11. Keep that hand in that position. 12. With your other free hand, grasp the leg on the other side of the person’s body under the knee. 13. Raise that leg, but leave the person’s foot on the ground. 14. Pull the raised leg towards you. 15. In the meantime, keep the back of the person’s hand held against his cheek. Roll the person towards you so he turns on his side. TITLE OF CHAPTER

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