PSAR 2023-24 Competition Season Only - Part 8 (PDF)

Public Safety and Aquatic Rescue training manual - 35th Edition_en Module 7 – Emergency Care Safety First Best Practice Guidelines First Aid Kits Secondary Assessment Advanced Medical Assistance Cardiovascular Emergencies ly Respiratory Emergencies on Circulation Emergencies 4 Allergic Reactions /2 Brain-related Emergencies 20 23 Temperature-related Emergencies Musculoskeletal Injuries Venomous Bites and Stings -s ea so n Module 7 – Reflective Questions C om pe tit io n us e Safety First Several diseases may be transmitted during the provision of emergency care and first aid. Remember to protect yourself and others against diseases by taking infection control precautions such as: maintaining a clean work environment practising good cough etiquette (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 302 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en safely disposing of contaminated materials safely disposing of sharps washing your hands in warm soapy water wearing personal protective equipment (PPE). Refer to the safety first training in the resuscitation module of this manual for more detailed information on safety precautions to take when providing emergency care. ly Best Practice Guidelines 20 23 /2 4 on The emergency information contained within this manual is based on the Australian Resuscitation Council (ARC) guidelines available at the time of publication. The ARC recommends that all those trained in basic emergency care should refresh their training at least every 3 years. Aims of First Aid preserve life us e First aid aims to minimise pain and -s ea so n Information is also based on Safe Work Australia’s model code of practice for first aid in the workplace. This model code of practice includes information on first aid kits and offers guidance on how to provide adequate first aid facilities in Australian workplaces, such as surf lifesaving clubs. prevent an injury or illness from becoming worse io n promote recovery protect people from danger pe tit provide reassurance and comfort to the ill or injured. om Legal Considerations C As a lifesaver on patrol, you have a duty of care to provide emergency care within the limits of your training so far as is reasonably practicable. When a person is conscious and requires first aid, you must first obtain their consent to provide treatment before commencing. For people under the age of 18, you will need their parent’s or guardian’s consent where possible. After you begin providing emergency care for someone, continue to treat them until: another person trained in the provision of first aid or advanced medical assistance takes over the incident scene becomes unsafe (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 303 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en the person, their parent or guardian withdraws their consent you are physically unable to continue. While providing first aid it is important to remember to: accurately complete incident documentation. act within the limits of your training follow the guidelines as set down in this manual and recognised peak bodies such as the ARC ly maintain a person’s right to privacy on obtain consent to provide treatment where appropriate seek appropriate advanced medical assistance if required /2 4 treat people with respect and dignity n 20 23 During any legal proceedings that may follow an incident, such as a worker’s compensation or insurance claim, you will be judged against the standard of emergency care to which you have been trained. For any claim to be successful, it must be proved that damage was caused by your negligence. Negligence can be established if: -s ea so a duty of care was owed the standard of care required was breached C om pe tit io n us e injury occurred to the person receiving treatment (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 304 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en -s ea so n 20 23 /2 4 on ly First Aid Kits io n us e First aid kits are identifiable by a white cross on a green background displayed on the outside. They should be kept in a visible and accessible location so anyone can retrieve them promptly. All lifesavers should know exactly where the nearest first aid kit is located for retrieval in an emergency. C om pe tit Note : The equipment referenced within this Emergency care module relates to the contents of SLS club first aid kits that meet Australian standards. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 305 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en -s ea so n 20 23 /2 4 on ly Contents io n us e Under state and territory legislation, first aid kits must be kept in the workplace. Various state and territory regulations may stipulate appropriate contents of a first aid kit because codes of practice or guidelines on first aid issues are part of Workplace Health and Safety (WHS) requirements. C om pe tit A decision on the exact type and contents of a first aid kit takes into consideration the likelihood of situations that could occur and require the provision of first aid. For example: trauma kits at surf lifesaving clubs for shark or crocodile attacks, special event kits for sports carnivals, occupational first aid kits for the office and basic first aid kits in lifesaver bum bags for roving patrols. Other factors to consider include the distance from medical or hospital services, time taken to reach that service, number of people normally at the location and the number of first aid qualified personnel usually available. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 306 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en Taking guidance from Safe Work Australia’s model code of practice for first aid in the workplace notes, first aid kits in SLS clubs should include: a list of the contents for that kit notebook and pen io n bandages us e first aid manual including a resuscitation chart pe tit ◦ roller bandages in a range of sizes that may be made from cotton or elasticised crepe ◦ triangular bandages om dressings C ◦ adhesive dressings in a range of sizes—plastic or fabric (those with a dressing patch and adhesive cover) ◦ combine pad ◦ non-adherent dressings instruments ◦ scissors ◦ shears ◦ tweezers/forceps other ◦ adhesive dressing tape (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 307 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en ◦ antiseptic liquid/spray ◦ disposable gloves ◦ disposable vomit bags ◦ emergency thermal blanket ◦ eye pad ◦ face shield ◦ gauze squares ◦ hand sanitiser ly ◦ instant heat packs on ◦ instant ice packs ◦ safety pins /2 4 ◦ saline solution 20 23 ◦ sealable plastic bags ◦ sharps container ◦ single-use pocket resuscitation mask with oxygen inlet ◦ wound cleaning wipes. -s ea so ◦ vinegar (tropical areas) n ◦ splinter probe us e Note: A first aid kit at your SLS club may also contain some medications allowed as per your local state/territory legislation, e.g., asthma inhaler, EpiPen®, aspirin. io n Bandages and Dressings Bandages pe tit Bandages and dressings are one of the most frequently used pieces of first aid equipment as they are used to treat a range of emergencies. om Bandaging is an extremely useful first aid skill and can help to: C control bleeding keep dressings in place protect and keep a wound clean provide support prevent swelling restrict movement. Bandages that are frequently used by first responders include: roller bandages—long, thin bandages rolled up that are used to support joint injuries (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 308 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en and hold dressings in place triangular bandages—large, triangular-shaped pieces of cloth that you can fold to use as either a bandage or sling, or as a pad for large wounds and burns pressure immobilisation bandages—often elasticised, these help put pressure on wounds to stop bleeding and reduce swelling. Dressings ly Dressings are used to soak up blood and other fluids, to assist the body in forming a clot, to help reduce pain and to protect wounds from infection. /2 4 on Dressings come in many shapes and sizes to cover different wounds and their margins. They are made from a range of materials. There are medicated and non-medicated dressings, sterile or non-sterile dressings, combined dressings, non-adhesive and adhesive dressings, gauzes and hydrogels, all of which help in the administering of first aid. 20 23 Sterile dressings should be removed from their packet with gloved hands only when the wound is ready to be covered. -s ea so n Non-adhesive dressings need to be held in place by bandages or medical tape. ✖ DO NOT use a sterile dressing that is past its expiry date use cottonwool or other materials with loose fibres that might stick to a wound during healing. io n us e pe tit Maintaining First Aid Kits C om It is essential that first aid equipment be replaced immediately after it has been used. This will ensure that your first aid kit is fully stocked and ready to use again. A first aid kit is maintained by: cleaning equipment after use as per manufacturer instructions developing and implementing protocols to ensure that first aid equipment is ready for use at all times making sure that first aid kits and equipment are checked regularly recording any discrepancies, using established club and organisation protocols removing sterile products that are no longer sealed or have been tampered with restocking first aid supplies after use or prior to expiry. As an SLS member, you should help stock and maintain the contents of any first aid kit (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 309 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en according to the manufacturer guidelines and your organisational SOPs. If your SLS club has a first aid officer assigned to maintaining the club’s first aid kits and first aid room, you still need to inform your patrol captain of any first aid equipment that needs cleaning or replacing. Secondary Assessment /2 4 on ly After completing a primary assessment that includes checking for danger and putting on personal protective equipment, e.g., gloves and protective glasses, a secondary assessment should be carried out to identify and assess other injuries a person may have and to prioritise their treatment. It may include a physical assessment when consent has been obtained from the person. During a secondary assessment is also when you should assess the person’s pain levels, monitor their condition for improvement or deterioration, provide reassurance and complete incident documentation. om pe tit io n us e -s ea so n 20 23 Secondary Assessment Procedure C The following steps outline how to complete a secondary assessment. It is important to note that you should recommence a primary assessment any time during this procedure if the person becomes unresponsive to questioning or unconscious. Secondary assessment steps include: 1. make introductions—introduce yourself and ask the person their name 2. gain consent to provide (and document) treatment 3. ask and record how the person feels: are they experiencing any pain or discomfort (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 310 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en where do they feel pain or discomfort how they would rate it from ‘none’ (0) to ‘worst pain or discomfort possible’ (10) are they feeling anxious, nauseous, dizzy, distressed, cold, short of breath or generally unwell 4. ask the person questions while collecting information from them to inform treatment. Record details in an incident report form. You may use the mnemonic SAMPLE as a guide: S —signs (record what you see, smell and hear) and symptoms (ask and record how they feel) ly A —allergies on M —medications 4 P —past medical history 20 23 E —events leading up to the illness or injury /2 L —last oral intake 5. Gain consent to touch—ask the person if you can gently perform a basic body check -s ea so n 6. Complete a secondary survey (basic body check) with the person’s consent: Remain calm while continually informing the person what you are doing and ask their permission to do it before acting—ensure you still have their consent to proceed Use your senses: look—for bleeding, deformity, penetrating objects, spontaneous movements, abnormal skin colour, abnormal breathing. Also, look for the person’s ability to open their eyes and wriggle their fingers and toes us e listen—for the person’s responses to questions and pain stimuli, and any signs of abnormal breathing io n feel—gently pat areas to feel for deformity, swelling, skin temperature and texture, and wetness that may suggest bleeding pe tit smell—to note any odours that may indicate other issues Sequentially examine the following body areas to check for signs of any additional injuries or illnesses: om head, face and neck C shoulders and front of chest, ribs, abdomen and pelvis front and back of limbs—upper then lower back (if possible) 7. Prioritise the treatment of any additional injuries identified using the four Bs to help you: i. breathing ii. bleeding iii. burns iv. breaks 8. Provide treatment according to best practice guidelines (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 311 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 9. Manage the person’s pain levels (see Pain management) 10. Monitor and reassure the person (see Monitoring and reassuring a person) 11. Document the details of the secondary and primary assessments in an incident report form as well as the treatment provided. Note: Another member of your patrol team may ask the person questions and document details in an incident report while you complete a secondary survey. 4 on ly As a general rule in a multiple person situation, an unconscious person takes priority over other persons. However, you may need to make a decision in some extreme situations, such as mass rescues, about which person will most benefit from your assistance. 20 23 /2 Ask open questions, e.g., ‘How are you feeling?’. Do NOT pose leading questions, e.g., ‘Do you feel nauseous?’ Be mindful of the person’s age, gender and culture and maintain their dignity when asking questions and providing treatment. -s ea so n Look to see if the person has a medical alert bracelet or necklace, or if there is any medication near the person. Move the person if they are in immediate danger, require extraction, need to be in a different position to maintain their airway or control severe bleeding, or to protect them from extreme weather conditions. This often takes teamwork and planning as moving a victim is a hazardous manual task. us e Pay careful attention to areas such as the groin and armpit where blood may be hidden. io n Record any time the person’s level of consciousness changes. pe tit Pain Management C om A person suffering pain will be very focused on the pain and how they feel, so they can be overwhelmed. They often find it difficult to express how they are feeling and to listen to any assistance being provided. It is very important that a calm and professional approach is adopted to help them manage the pain until paramedics arrive. It is important to assess the person’s level of pain prior to administering treatment. This will assist you and paramedics to decide whether simple pain management methods such as rest, ice and immobilisation will manage the pain or if more formal pain management techniques are required. It is best practice to also assess the pain levels at regular intervals during the provision of first aid to gauge and document the effectiveness of treatment. In addition to having a person indicate their pain on a level of ‘none’ (0) to ‘the worst pain possible’ (10), the Wong–Baker FACES® pain rating scale may be used. It is often useful with young children aged 3 years and older and may also be useful for adults with a disability or people from non-English speaking backgrounds. Point to each face using the words provided (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 312 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en on ly to describe the pain intensity, then ask the person to choose the face that best describes their own pain and record the appropriate number. pe tit io n us e -s ea so n 20 23 /2 4 Monitoring and reassuring the person C om Monitoring a person’s condition begins as you approach them for a primary assessment and continues throughout the secondary assessment procedure. You or a member of your lifesaving team should regularly record the person’s breathing, pulse and state of consciousness every few minutes to help determine if the person’s condition is worsening, stable or improving over time. Refer to the Management of the person after CPR section of this manual for a summary of normal and abnormal vital signs for adults and children. A period of observation is recommended following the provision of emergency care. If the person’s condition has not deteriorated and their vital signs are normal after an appropriate period of observation, it is reasonable to discharge the person from your care. For emergencies requiring an ambulance, you should continue to monitor the person’s condition, record their vital signs, provide reassurance and follow the advice of the ambulance service until the paramedics accept responsibility for the person. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 313 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Providing the person with reassurance while respecting their dignity can help reduce any anxiety as well as encourage the sharing of details that can help inform treatment and determine the person’s condition over time. You can help reassure a person receiving emergency care by: acting confidently to instil trust advising the person what you intend to do and seek permission before you do it advising the person if an ambulance has been called or help is on its way asking open questions ly being as honest as possible on making the person comfortable with minimal movement providing appropriate pain relief /2 4 responding to the person in a culturally aware, sensitive and respectful manner 20 23 staying with the person using their name when addressing them. C om pe tit io n us e -s ea so n Documentation The details of both a primary assessment (DRSABCD) and a secondary assessment need to be accurately recorded in an incident report. It is important to remember that written documentation is mandatory under state and territory regulations for work health and safety in addition to: being used to support insurance, compensation or workers compensation claims providing protection for the injured person, SLS and yourself (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 314 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en providing information for SLS data collection such as data on hazards for club safety officers and first aid responses for SLS annual reports supporting accurate sharing of information during person handovers to paramedics. Refer to the Resuscitation module this manual for more information about documentation and person handovers. -s ea so n 20 23 /2 4 on ly Advanced Medical Assistance us e The management of some emergencies requires you to request an ambulance while others may require you to refer the person to a medical practitioner. io n Requesting an ambulance C om pe tit You should send for help, additional resources and request an ambulance when a person experiences any of the emergencies outlined in the below table. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 315 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en pe tit io n us e After you have confirmed an ambulance has been requested, continue to monitor and reassure the person until the paramedics accept responsibility for them. You should also provide pain management where appropriate. At the same time, you should maintain safety at the scene. As per your resuscitation training, you should use an incident report form and the mnemonic IMIST AMBO to assist you to provide a clear, concise and structured handover to paramedics. om Referring to a Medical Practitioner C You should send for help and additional resources to provide first aid treatment then refer the person to a medical practitioner when they experience any of the emergencies outlined in the below table. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 316 of 479 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en n Note: There are also medical information services you may wish to refer to for further information. -s ea so For example, the Poisons Information Centre—call 13 11 26 at anytime from anywhere in Australia if you suspect someone has been poisoned, bitten by something poisonous or has made a medication error. us e Cardiovascular Emergencies io n Cardiovascular emergencies relate to the circulatory system (heart and blood vessels). pe tit Remember to gain a person’s consent before providing emergency care for cardiovascular emergencies and provide treatment within the limits of your training. om Note: An ambulance should be requested for anyone showing signs and symptoms of a cardiovascular emergency. C The Heart Circulation of the oxygenated blood around the body is caused by the mechanical action of the heart. Should the heart stop beating, the delivery of oxygenated blood required by all parts of the body would cease and organ failure may result. Refer to the Resuscitation module of this manual for more information on the heart and how it forms part of the circulatory system. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 317 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Cardiac Arrest -s ea so n Cardiac arrest is when the heart stops pumping oxygen-rich blood around the body due to an electrical problem in the heart. Signs and symptoms us e A person is often unconscious and breathing abnormally or not breathing at all until a normal heart rhythm can be restored. No normal vital signs (signs of life) pe tit Unconscious io n Not breathing normally Management om Primary assessment (follow DRSABCD): C send for help, additional resources (AED) and request an ambulance provide CPR apply an AED and follow its prompts if the person is unconscious and not breathing normally. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 318 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Heart Attack -s ea so n A heart attack is a sudden and complete blockage of a coronary artery that supplies oxygenrich blood to the heart. A person is often conscious and breathing with chest pain. arms may feel heavy chest pain or discomfort us e Signs and symptoms io n this can often feel like a heaviness, tightness or pressure in the centre of the chest pe tit it may feel it’s spreading from the chest to different parts of the upper body—arm(s), shoulder(s), neck, jaw and/or back feeling nauseous om feeling generally unwell or ‘not quite right’ feeling dizzy or light-headed C feelings of indigestion pale skin shortness of breath sweating vomiting Note Some people may present signs and symptoms of a heart attack as a warning sign before cardiac arrest occurs. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 319 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Signs and symptoms can come on suddenly or develop over minutes and get progressively worse. The person may have just one symptom, or a combination of several. The person may suffer from a condition known as angina, which presents the same signs and symptoms as someone experiencing a heart attack. First responders should manage people with angina as a suspected heart attack. Management 1. Send for help, additional resources (AED) and request an ambulance. ly 2. Reassure and advise the person to sit comfortably and rest. on 3. Loosen any tight clothing. 4 4. Assist the person to take aspirin (300 mg) where available. 20 23 /2 5. Monitor and reassure the person while waiting for paramedics to arrive. Note n Place the person in the recovery (lateral) position if they become unconscious and are breathing normally. -s ea so Commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. Dissolvable aspirin is preferred when available. us e First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of angina. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. pe tit io n Refer to the latest ARC Guideline for the Recognition and First Aid Management of Heart Attack to learn more. om Respiratory Emergencies Respiratory emergencies relate to the respiratory system (upper and lower airways). C When assessing respiratory emergencies, it is important to assess not only the breathing rate, but also the effort it takes to breathe. Remember to gain a person’s consent before providing emergency care for respiratory emergencies and provide treatment within the limits of your training. Respiratory system The respiratory system supplies the body with a constant supply of oxygen. It consists of the upper and lower airways. Refer to the Resuscitation module of this manual for more (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 320 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en information on the respiratory system. Asthma Asthma is a condition in which the air passages of the respiratory system become narrowed due to muscle spasm, swollen mucous membranes and/or increased mucus production. This makes it difficult for the person to breathe, especially to exhale. Common triggers for asthma include: ly allergens such as pollens or smoke on cold air 4 chest infections /2 emotional factors 20 23 exercise. Signs and symptoms n A dry, irritating, persistent cough -s ea so Chest tightness Shortness of breath Wheezing us e Sever Severe, e, life-thr life-threatening eatening asthma attack Blue discolouration around the lips Difficulty to speak a few words at a time or unable to speak io n Gasping for breath pe tit Feeling distressed and anxious Loud wheeze or no wheeze heard om Pale and sweaty skin Reduced consciousness C Severe chest tightness Sucking in of the throat and rib muscles Unable to move around Note: Wheezing may or may not be audible depending on the severity of an asthma attack. In severe asthma attacks, the audible wheezing may subside as the condition worsens with very little air moving in and out of the lungs. This is an emergency situation. Never assume that a decreased audible wheeze is a sign of improvement unless the breathing also improves. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 321 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Management 1. Seat the person comfortably upright while providing reassurance. 2. Obtain and shake a blue/grey reliever inhaler (puffer), e.g., Ventolin. 3. Give four separate puffs (one round) of the inhaler (through a spacer if available) shake the inhaler before delivering each puff one at a time ask the person to take four breaths after each puff (through a spacer if available) repeat until all four puffs have been taken. 4. Send for help and request an ambulance. on ly 5. Keep giving four puffs every four minutes until the person’s condition improves or the paramedics arrive. /2 4 Note 20 23 An easy way to remember the use of the inhaler is the 4×4×4 round rule—4 puffs, with 4 breaths after each puff, and waiting 4 minutes after the fourth puff before commencing another round. -s ea so n Send for help and request an ambulance immediately if the person is showing any signs of a severe asthma attack, no inhaler is available or their condition suddenly becomes worse. Use the person’s own inhaler if possible. If not, use the inhaler in the first aid kit or borrow one from someone else. Ask them if they have an individual asthma management plan you can follow. io n us e First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of asthma. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. C om pe tit Refer to the latest ARC Guideline for Asthma to learn more. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 322 of 479 C om pe tit io n us e -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 323 of 479 C om pe tit io n us e -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 324 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Choking An airway obstruction may be partial or complete for a conscious or unconscious person. A partial airway obstruction may progress to a complete airway obstruction within seconds. A complete obstruction is commonly referred to as choking. Signs and symptoms 20 23 /2 4 on ly Lifesavers need to be able to assess the signs of partial or complete airway obstructions for both conscious and unconscious persons. -s ea so n After asking the person if they are choking, look for non-verbal responses from a person indicating that a partial airway obstruction has progressed to a complete one. For example: nodding their head in response to your question pointing to their throat C om pe tit io n us e showing the universal choking sign — namely clutching their throat. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 325 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Management Partial airway obstruction 1. Reassure the person. 2. Encourage them to keep coughing to expel any foreign material. 3. Reassure and monitor the person until they recover, or the partial airway obstruction progresses to a complete one. on 1. Send for help, additional resources (AED) and request an ambulance. ly Complete airway obstruction 2. Place the person in the appropriate position to begin treatment: /2 4 adult or child — bent forward while in a sitting or standing position 20 23 infant — head downward position and on their front across your thigh. 3. Perform up to five sharp back blows: n In an upward motion using the heel of your dominant hand in the middle of the person’s back between their shoulder blades. C om pe tit io n us e -s ea so Quickly assess the person’s airway after each back blow for signs of the foreign material’s removal and normal breathing. 4\. Place the person in the appropriate position to progress the treatment: (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 326 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en adult or child — lying down on their back infant — head downward position and on their back across your thigh. 5\. Perform up to five sharp chest thrusts (compressions): At the centre of the person’s chest. Quickly assess the person’s airway after each chest thrust for signs of the foreign material’s removal and normal breathing. io n us e -s ea so n 20 23 /2 4 on ly 6\. Continue to perform five back blows followed by five chest thrusts in a rapid sequence until the foreign body is removed, or the person becomes unresponsive. pe tit Note om The aim of the back blows and chest thrusts is to gradually relieve the airway obstruction. You may not need to perform all five of them. C Chest thrusts are the same as chest compressions for CPR, but they are performed more forcefully and at a slower rate. Do NOT thrust the person’s abdominal area (the Heimlich manoeuvre) as this can cause internal injury or vomiting. If the person becomes unconscious, make sure that help has been sent for before you clear any visible foreign material from their airway with a finger sweep and start CPR. There may be some resistance from an airway obstruction when providing rescue breaths. If you blow the obstruction into the lower airways in your efforts to resuscitate the person, hospital staff can later remove the obstruction. Refer to the latest ARC Guideline for Breathing to learn more. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 327 of 479 C om pe tit io n us e -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 328 of 479 om pe tit io n us e -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en C Circulation Emergencies (Bleeding) Bleeding is the loss of blood from the circulatory system. It can occur inside the body (internal bleeding) or blood can be lost outside of the body (external bleeding). External bleeding is primarily managed by applying direct pressure on the wound or around a protruding object. Internal bleeding must be treated by a medical practitioner. Remember to gain a person’s consent before providing treatment for bleeding emergencies and provide treatment within the limits of your training. At all times, you must avoid direct contact with the blood, or any of the body fluids of the person, by wearing gloves and other PPE such as protective glasses. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 329 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Circulatory system The circulatory system moves blood around the body. The main components of this system are the heart, arteries, veins and capillaries. Refer to the Resuscitation module of this manual for more information on the circulatory system. Signs and symptoms on The signs of external bleeding depend on the type of damaged blood vessel: ly External bleeding /2 4 oxygenated blood from an artery appears bright red and will spurt out in time with the person’s heartbeat 20 23 deoxygenated blood from a vein appears dark red and will flow steadily out of the body bleeding from a capillary will appear bright red and flows steadily out of the body. altered state of consciousness -s ea so The signs of internal bleeding include: n Internal bleeding bleeding from orifices in the body, e.g., ears, nose, mouth blood in urine or stool us e bruising feeling weak or lightheaded io n nausea pain pe tit pale skin—all over or localised shortness of breath om signs of shock that are unresponsive to treatment (see Shock). C Severity Unlike minor bleeding from small cuts and abrasions, severe bleeding can lead to a significant drop in blood pressure, shock and death. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 330 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en on ly Minor cuts and abrasions /2 4 An abrasion occurs when the superficial skin layer is scraped off, causing damage to capillaries and minor external bleeding. 20 23 A cut occurs when the superficial and deeper layers of skin and tissue are sliced or torn, causing damage to capillaries, arteries and/or veins and minor external bleeding. Management -s ea so n 1. Gain consent to provide (and document) treatment. 2. Clean dirty areas with antiseptic, washing away from the wound. us e 3. Clean the wound with water, sterile saline or a moistened gauze square. 4. Control bleeding—apply firm direct pressure and rest until bleeding stops. pe tit io n 5. Completely cover the wound with a sterile, absorbent, non-stick dressing (this may be self-adhesive). om 6. Obtain a roller bandage or tape to secure the dressing in place if it is not self-adhesive: C roller bandage—with the roll facing upward, anchor the bandage over the dressing with two rotations around the limb. Then continue rotations on a slight angle along the limb towards the body until the affected area is suitably covered. Each rotation should cover approximately two-thirds of the previous rotation. medical tape—apply the tape over the dressing (not the wound) and ensure it is secured to clean dry skin. Do NOT stretch the tape as you secure the dressing and use enough for it to extend about 1 cm beyond the dressing. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 331 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en Note us e A sterile, absorbent, non-stick and self-adhesive dressing that does not require to be secured in place with a bandage or tape may also be used to completely cover wounds. Ensure that the self-adhesive part of the dressing does not touch the wound. io n Abrasions that contain ground-in dirt, road material or other foreign material may leave serious and unattractive scars unless promptly treated by thorough cleaning in hospital. This applies particularly to abrasions or cuts on the face. pe tit Cleaning of a wound before any dressing is applied to it reduces the risk of infection and diseases such as tetanus. Advise the person to see a medical practitioner if they notice any signs of infection. om Minor cuts and abrasions resulting from scrapes with rocks in the aquatic environment and coral are prone to infection. C Refer to the latest ARC Guideline for the management of bleeding to learn more. Nosebleeds A nose injury, changes in altitude and high blood pressure may cause minor internal bleeding from the nose. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 332 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en Management us e 1. Reassure the person. 2. Ask the person to apply equal pressure over the soft part of their nostrils, below the bridge of the nose. io n 3. Have the person sit up and lean forward to avoid blood flowing down the throat. pe tit 4. Have the person rest and remain seated for at least 10 minutes. om 5. Inform the person you can help them seek advanced medical assistance if bleeding continues for more than 20 minutes. C Note On a hot day or after exercise, it might be necessary to maintain pressure for at least 20 minutes. Refer to the latest ARC Guideline for the management of bleeding to learn more. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 333 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en -s ea so n 20 23 /2 4 on ly Major external bleeding 1. Reassure the person us e In order to stop major external bleeding as soon as possible: io n 2. Ask the person to lie down, remain still and apply pressure to their wound if they can pe tit 3. Send for help and additional resources (first aid kit and AED) 4. Gain consent to provide (and document) treatment om 5. Apply firm direct pressure over the wound or on each side of a protruding object: using the heel of your hands C using a sterile dressing held in place by a bandage 6. Check that the pressure is applied directly over the wound or on each side of a protruding object—move your point of pressure if necessary 7. Apply a second bandage over the first one and increase pressure if bleeding continues. 8. Treat for severe, life-threatening bleeding if uncontrollable. Note Do NOT remove a protruding object, e.g., stingray barb. You may immobilise a bleeding limb to restrict movement, e.g., by using a sling (see (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 334 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Slings). Refer to the latest ARC Guideline for the management of bleeding to learn more. Severe, life-threatening external bleeding ly Severe, life-threatening external bleeding (uncontrolled bleeding) cannot be controlled by smaller, regularly used combine dressings and roller bandages. Unlike minor bleeding from small cuts and abrasions or nosebleeds, severe bleeding can lead to a significant drop in blood pressure, hock and death. Common causes around the water include propeller cuts and shark bites. on Signs and symptoms 20 23 Decreased level of consciousness or unconsciousness /2 Bleeding that cannot be controlled by local pressure 4 Amputated or partially amputated limb above wrist or ankle Major trauma to any part of the body n Management -s ea so Manage severe, life-threatening external bleeding (uncontrolled bleeding) before checking the airway and breathing when performing a primary assessment (DRSABCD). Severe, life-threatening bleeding from a limb us e 1. Send for help, additional resources (trauma kit with an arterial tourniquet, first aid kit, AED) and request an ambulance. io n 2. Expose the skin above the bleeding point where possible—you may use shears to cut clothing or wetsuits. pe tit 3. Stop uncontrolled bleeding from a limb as soon as possible by applying an arterial tourniquet high and tight as per the manufacturer’s instructions, or by using a windlass tourniquet as follows: om position the tourniquet: C ◦ horizontally ◦ at least 5 cm above the bleeding point ◦ over an intact part of the injured limb ◦ over exposed skin where possible ◦ not over a joint or wound ◦ with the strap on the lateral (‘outer’) side of the limb pull the tourniquet strap tightly through the buckle so there is no space between the strap and the limb turn the windlass as tightly as is physically possible or until the bleeding stops secure the windlass through the locking loop. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 335 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 4. Record the time the tourniquet was applied on the tab of its strap (or on the person’s head) as well as in an incident report for the paramedics to note. C om pe tit io n us e -s ea so n 20 23 /2 4 on ly 5. Monitor and reassure the person while waiting for the paramedics. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 336 of 479 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en cover a tourniquet with any bandages or clothing 20 23 apply a tourniquet over a joint or a wound remove a tourniquet once it has been applied in the pre-hospital environment. -s ea so n /2 4 ✖ DO NOT Note A second tourniquet (if available) should be applied to the limb, preferably above the first, if bleeding continues. io n us e After applying a tourniquet to control the severe, life-threatening bleeding, commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. Place the person in the recovery (lateral) position if they become unconscious and are breathing normally. pe tit First responders must not ease the tension or remove a tourniquet after it has been applied. C om First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of severe, life-threatening bleeding. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. Keep the person warm to avoid hypothermia and treat for shock (see Shock). Tightening tourniquets on people causes them pain and discomfort. Improvised tourniquets of a similar broad width to commercial ones that do not stop all circulation can increase bleeding and risk tissue damage. However, an improvised one is better than none. If you have no tourniquet, you may improvise one from bandages, clothing, a surfboard leg rope or other available items of a similar nature. Any improvised tourniquet should be tightened by twisting a rod or stick under its band, similar to the windlass in commercial tourniquets. Refer to the latest ARC Guideline for the management of bleeding to learn more. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 337 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en https://www.youtube.com/embed/NfJIkjbFeeg?rel=0 us e Severe, life-threatening bleeding from a wound site not suitable for a tourniquet Note pe tit io n When severe, life-threatening bleeding is not from a limb, treat the injury as major external bleeding with direct pressure. om Do not wrap bandages tightly around the chest or abdomen. C First responders qualified in advanced first aid may apply a haemostatic dressing if one is available. First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of severe, life-threatening bleeding. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. Shock Shock is the term used to describe the loss of effective circulation resulting in impaired oxygen delivery to vital organs and tissues. You should always seek urgent advanced (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 338 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en medical assistance for any person suffering from shock. Signs and symptoms Anxiety and restlessness Breathlessness Collapse Confusion or agitation Extreme discomfort or pain Faintness and dizziness on ly Feeling cold, shivering or chills Nausea 4 Pale, cold, clammy skin /2 Rapid or shallow breathing 20 23 Reduced level of consciousness Signs of bleeding Thirst -s ea so n Vomiting Weakening pulse Management us e Ask the person to lie down or place the unconscious person in the recovery (lateral) position. Control any bleeding promptly. Send for help, additional resources (first aid kit and AED) and request an ambulance. io n Administer treatments relevant to the cause of the shock. pe tit Maintain the person’s body temperature. Monitor and reassure the person while waiting for the paramedics. om Note C Commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. Place the person in the recovery (lateral) position if they become unconscious and are breathing normally. Do NOT give the person anything by mouth (no food or drink). First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of shock after bleeding. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. Shock may be caused by a loss of circulating blood volume, cardiac emergencies, abnormal dilatation of blood vessels or a blockage of blood flow in or out of the heart. Each of these causes will require a different treatment. For example, treatment of (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 339 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en anaphylaxis is different to the treatment of fractures. There are many causes of shock aside from bleeding. Refer to the latest ARC Guideline for Shock to learn more. Allergic Reactions Allergy occurs when a person’s immune system reacts to substances in the environment that are harmless for most people. These substances are known as allergens and they often trigger airway inflammation and breathing issues. on ly Remember to gain a person’s consent before providing emergency care for allergic reactions and provide treatment within the limits of your training. 20 23 /2 4 The immune system -s ea so n The immune system consists of a complex network of cells, tissues and organs within the human body that protects the body against infection. Some people have immune system disorders that are caused by an overactive or underactive immune system. For example, an overactive immune system may overreact by producing antibodies that attack allergens and cause an allergic reaction. Allergies us e The most common causes of allergic reactions in Australia are: dust mites io n foods such as eggs, milk, peanuts, sesame, seafood, soy and wheat. furry or hairy animals such as cats, dogs, horses, rabbits and guinea pigs pe tit insect stings from bees, wasps, ticks and ants medications om moulds C pollen. Signs and symptoms Abnormal breathing—coughing, wheezing, shallow breathing Itchy or running nose Rash Red skin or hives located to one area of the body Tingling in the mouth Watery eyes (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 340 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Management 1. Ask the person if they have any allergies or if they are anaphylactic. 2. If they are anaphylactic—manage as per treatment for anaphylaxis. 3. If they have allergies—remove any exposure to potential allergens: for food allergy—ask the person to spit the food out and rinse out their mouth if the allergen is still in their mouth for bee allergy—flick out any identified bee sting as quickly as possible by any means. ly 4. Ask the person if they have any allergy medications that they can take themselves. 4 on 5. Reassure the person and advise them to see a medical practitioner if their condition becomes worse or they have been stung on the face. 20 23 /2 Note Remember to ask a conscious person if they have a history of allergies and to reassure them. A cold compress can help reduce pain and swelling. -s ea so n Refer to the latest ARC Guideline for the management of Anaphylaxis or allergyfacts.org.au to learn more. Anaphylaxis io n us e Anaphylaxis is a severe allergic reaction that requires immediate management with an adrenaline auto-injector prior to calling an ambulance. It is potentially life threatening as a common symptom is upper airway obstruction, hypotension or bronchospasm. pe tit Anaphylaxis usually occurs within 20 minutes to 2 hours of exposure to an allergen to which a person is already extremely sensitive. You should always treat it as a medical emergency. Signs and symptoms om Abdominal pain and vomiting C Becoming pale and floppy (in young children) Difficult/noisy breathing or persistent cough Difficulty talking Dizziness, loss of consciousness or collapse Hives, welts and body redness Itchy or running nose Swelling of face, eyes, lips and tongue Swelling/tightness in throat Watery eyes (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 341 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Management 1. Remove any exposure to potential allergens. 2. Lay the person flat or allow them to sit still if breathing is difficult lying down. 3. Administer an adrenaline auto-injector into the person’s outer mid-thigh as per the instructions label on the device. 4. Hold the device in place for the time stated on the instructions label of the device. 6. Monitor and reassure the person while waiting for paramedics to arrive. ly 5. Send for help, additional resources (another adrenaline auto-injector, asthma medication if possible and an AED) and request an ambulance. C om pe tit io n us e -s ea so n 20 23 /2 4 on 7. Administer a second adrenaline auto-injector if there is no response/improvement of the person after 5 minutes and if one is available. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 342 of 479 ly Public Safety and Aquatic Rescue training manual - 35th Edition_en 4 on ✓ DO Ask them if they have an individual anaphylaxis action plan. Commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. 20 23 Follow the instructions of the ambulance service. /2 Always administer an adrenaline auto-injector as per the manufacturer’s instructions. -s ea so n If possible, assist the person to administer their own adrenaline auto-injector before sending for help. us e ✖ DO NOT Use an adrenaline auto-injector on infants under 7.5kg unless indicated on their individual anaphylaxis action plan. Rub the injection site. pe tit om Note io n C When administering a second adrenaline auto-injector (if required), administer to the person’s other outer mid-thigh if possible. This will help reduce any pain at the first injection site. If the person has asthma and is also at risk of anaphylaxis, the adrenaline auto-injector should be used first, followed by the asthma reliever medication. If an adrenaline auto-injector is not available for an anaphylactic person, give asthma reliever medication if the person is conscious. An adrenaline auto-injector containing 300 micrograms can be used on a young child (7.5 – 20kg) if an injector with a lower dose is not available. An adrenaline auto-injector containing 500 micrograms can be used on a child over 20kg if an injector with a lower dose is not available. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 343 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Expired adrenaline auto-injectors or ones with discoloured adrenaline are not as effective when used for treating anaphylaxis. However, they should be used in preference to not using one at all. Advise the person of any potential issue with an adrenaline auto-injector and gain their consent to use it. First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of anaphylaxis. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced resuscitation training. on ly Adrenaline auto-injectors contain a synthetic version of adrenaline – epinephrine. Further information regarding these auto-injectors can be accessed via the ASCIA (Australian Society of Clinical Immunology and Allergy) webpage and Allergy & Anaphylaxis Australia (A&AA). 20 23 Brain-related Emergencies /2 4 Refer to the latest ARC Guideline for the management of Anaphylaxis or allergyfacts.org.au to learn more. -s ea so n Brain emergencies relate to illnesses and injuries that occur within the brain. All brain emergencies require urgent advanced medical assistance. Remember to gain a person’s consent before providing emergency care for brain emergencies and provide treatment within the limits of your training. us e Nervous system pe tit io n The brain, through the spinal cord and the nerves, controls every part of the body. In particular, the brain sends messages that control the heartbeat, the movement of the muscles of breathing and all other body functions. The brain cells require a continuous supply of oxygen in order to function. om Refer to the Resuscitation of this manual for more information on the brain, which forms part of the nervous system. C Stroke A stroke occurs when the supply of oxygen-rich blood to a part of the brain is blocked or when bleeding from a blood vessel within the skull occurs. A stroke should always be treated as a time-critical medical emergency. Signs and symptoms During your secondary assessment, use the FAST acronym to identify a stroke. F —facial weakness—can the person smile without one side of their face drooping (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 344 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en somewhere? A —arm weakness—can the person raise both arms? S —speech difficulties—can the person speak clearly or understand what you say? T —time to act—it’s time to send for help and request an ambulance if the person cannot perform these actions. Other signs and symptoms may include: ly difficulty swallowing on dizziness, loss of balance 4 drowsiness and/or confusion /2 nausea or vomiting 20 23 paralysis, numbness, weakness or loss of limb coordination, sometimes on only one side of the body severe headache unequal pupils urinary incontinence warm, flushed, clammy skin. us e Management -s ea so sudden loss of, decrease of or blurred vision n slurred speech 1. Send for help, additional resources (AED) and request an ambulance. pe tit io n 2. Reassure and advise the person to sit or lie down comfortably and rest, taking care that the airway does not become blocked or obstructed. 3. Maintain the person’s body temperature. C Note om 4. Monitor and reassure the person while waiting for paramedics to arrive. A person may not present all the signs or experience all the symptoms of a stroke. Seek advanced medical assistance if one or more of the signs or symptoms are present. Commence CPR and apply an AED if the person becomes unconscious and is not breathing normally. Do NOT give the person anything to eat or drink. First responders qualified in advanced resuscitation may safely administer oxygen to persons showing the signs and symptoms of stroke. Refer to the SLS Pathways website or the appropriate person at your SLS club for more information on advanced (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 345 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en resuscitation training. Place the person in the recovery (lateral) position if they become unconscious and are breathing normally. Refer to the latest ARC Guideline for Stroke to learn more. io n us e -s ea so n 20 23 /2 4 on ly Head Injury om pe tit Both members of the public and SLS members on patrol, or competing in surf sports, have the potential to suffer a knock to the head and possible concussion – a form of traumatic brain injury. C A head injury should be suspected with any witnessed or reported knock to the head, as well as when signs and symptoms of a head injury are present. Signs and symptoms Signs and symptoms of a head injury may show immediately or may evolve over the hours or days following an incident. They may be obvious or more subtle. They include: altered state of consciousness appearing in a daze, blank/vacant stare bleeding from the head or face, or into the eyes bruises on the head or face (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 346 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en confusion disorientation fluid discharge from ears, nose or mouth headache impaired vision, hearing or speech memory impairment nausea or vomiting neck pain ly notable changes in behaviour on numbness or tingling in arms or legs 4 seizure. /2 Management 20 23 1. Ask the person to lie down with their head and shoulders slightly raised. 2. Identify and control any bleeding with direct pressure if possible. -s ea so n 3. Provide spinal care using a trapezius grip to protect the person’s neck while maintaining the person’s clear airway for an appropriate period of observation. 4. Determine what advanced medical assistance is required: send for help and request and ambulance if any of the following red flags are identified: ◦ a deteriorating state of consciousness at any time, no matter how brief us e ◦ an unusual behavioural change ◦ disturbed hearing or vision io n ◦ increasing levels of headache, confusion or agitation pe tit ◦ neck pain ◦ repeated vomiting ◦ seizure om ◦ weakness, tingling or burning feeling in the arms or legs. C Refer the person to a medical practitioner as soon as possible for further assessment in all other cases. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 347 of 479 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en /2 4 Note 20 23 A period of observation is recommended following the provision of emergency care. If, after an appropriate period of observation, the person has not shown any of the red flags noted above, it is reasonable to discharge the person from your care. -s ea so n Anyone with suspected head injuries should not resume any activity until cleared for participation by a medical practitioner. Any athlete participating in SLS surf sports with a suspected head injury is not allowed to return to sport that day and the sport’s referee needs to be informed of this decision. Refer to the Safety and Wellbeing module of this manual for more information on personal injury reporting. us e Any blood or fluid coming from the ear should be treated by securing a sterile dressing lightly over the ear and laying the person on their injured side where possible. This helps the fluid to drain out. io n Do NOT prevent fluid discharge from ears or nose. pe tit Refer to the Spinal Management module of this manual for more detail on spinal care and how to perform a trapezius grip. om The possibility of spinal injury must be considered with any head injury (e.g., concussion, structural head injury). C Refer to the latest ARC Guideline for Head Injury to learn more. Temperature-related Emergencies Prolonged exposure to hot and cold environments can lead to a range of temperaturerelated illnesses that can progress into temperature-related emergencies. Remember to gain a person’s consent before providing first aid for temperature-related emergencies and provide treatment within the limits of your training. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 348 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Integumentary system The integumentary system consists of the skin, nerves, hair, nails and sweat glands, which work together to protect the body from the outside world and maintain the right balance of internal body conditions for healthy functioning. One of the system’s key functions is to maintain and regulate body temperature. It may do this by changing the pattern of blood supply to the skin or by sweating. Body systems and organs progressively fail as the body’s temperature rises above or falls below the normal body temperature of about 37° C. on ly Sunburn /2 4 Sunburn is damage to the skin caused by ultraviolet radiation. Sunburns can range from mild to blistering. 20 23 Signs and symptoms Blistering Dehydration n Headache -s ea so Fever Pain Redness us e Vomiting Management 1. Rest the person in a cool place. io n 2. Cool the sunburn with running water for up to 20 minutes. pe tit 3. Give the person fluids by mouth. om Note Do NOT prick or pop blisters. C Seek a medical practitioner if sunburn is extensive, especially if the person is has blisters, is vomiting, is dehydrated, has severe headache or is a child. There are many other types of burns aside from radiation burns. Refer to the latest ARC Guideline for Burns to learn more. Note for lifesavers on patrol SLS members should refer to the SLSA Environmental Factors Guidelines in the SLS Members Area Document Library for guidance on how to avoid sunburn while on patrol. More information on sun safety can also be found within the Safety and wellbeing platform. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 349 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Hypothermia Hypothermia occurs when the deep body (core) temperature falls below 35° C. The body can pass through various stages when suffering from hypothermia, ranging from mild to lifethreatening. Infants and the elderly are at a greater risk of hypothermia. Signs and symptoms -s ea so n 20 23 /2 4 on ly The following table outlines the signs of hypothermia. Management 1. Send for help and additional resources (warm blankets and drinks, AED). us e 2. Monitor their condition while warming the person: place the person in a warm, wind-protected environment—on an insulating blanket or towel if available io n remove wet clothing when the warm blanket arrives and dry the person pe tit wrap the person’s body, head and neck (not the face) in a dry emergency thermal blanket or dry towel om encourage the person to curl up into a ball to maintain heat and prevent heat loss C give them sips of warm sweet drinks when conscious—not alcohol, caffeine or energy drinks apply external heat source—body-to-body warmth or heat packs to the sides of the neck, the armpits and the groin, where large arteries are close to the surface if their condition deteriorates, request an ambulance for severe and lifethreatening hypothermia. ✖ DO NOT rub or massage the person’s limbs (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 350 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en remove wet clothing if there is no dry blanket or other suitable cover permit a conscious person showing signs of severe and life-threatening hypothermia to have sips of warm drinks or take a warm bath or shower. Note You may permit a conscious person with mild hypothermia (‘feeling cold’) to have a warm shower under supervision and advise them to inform you if they begin to feel dizzy. Showers have the added risk of ‘re-warming collapse’ because of low blood pressure. on ly Refer to the latest ARC Guideline for Hypothermia to learn more. 4 Note for lifesavers on patr patrol ol 20 23 /2 Lifesavers are often required to spend extended periods of time in cold-weather conditions. Plan ahead for the cold and avoid experiencing hypothermia by: wearing a wetsuit when in cold water n wearing warm protective clothing when on patrol -s ea so leaving the water when you feel cold or start to shiver curling into a ball to help prevent heat loss if unable to leave the water (remember the mnemonic ‘HELP’ (Heat Escape Lessening Posture). us e Heat exhaustion pe tit io n Heat exhaustion is a heat-induced illness that occurs when a person’s body temperature elevates after experiencing prolonged exposure to excessive or unaccustomed heat. It is a moderate form of hyperthermia. Signs and symptoms om Cramps or muscle weakness Dehydration C Dizziness Elevated body temperature Fatigue Headaches Heavy sweating Nausea or vomiting Pale skin Potential collapse Thirst (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 351 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Management 1. Lay the person down in a cool, shaded and protected environment. 2. Loosen and remove excess clothing. 3. Cool the person quickly with a combination of the following cooling methods: apply wrapped cold packs or ice to the groin, armpits, facial cheeks, palms and soles gently fan them give a sip of cool water or a commercial sports drink slowly when conscious ly moisten the skin with a cool damp cloth or gently spray the person with water. on 4. Monitor the person’s condition and reassure them. /2 4 Note 20 23 Send for help and request an ambulance if the person’s condition does not improve quickly or deteriorates. Do NOT give fluids by mouth if the person is unconscious and breathing normally. n Do NOT give the person any paracetamol used to reduce fever. -s ea so Refer to the latest ARC Guideline for Heat Induced Illness to learn more. Heat stroke us e Heat stroke is a life-threatening heat-induced illness that occurs when the core body temperature rises above 40° C after prolonged exposure to excessive or unaccustomed heat. It is a severe form of hyperthermia. io n Signs and symptoms pe tit Collapse Dehydration om Elevated body temperature above 40° C Hot dry skin C Intense thirst Lack of sweating Altered state of consciousness Management 1. Primary assessment (follow DRSABCD): send for help, additional resources (cold packs, AED) and request an ambulance provide CPR if required apply an AED and follow its prompts if the person is unconscious and not breathing normally. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 352 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 2. While waiting for the ambulance to arrive for individuals over 5 years of age: Immerse (i.e., whole-body from the neck down) in cold water (a bath if possible, as cold as possible) for 15 minutes. This is the most effective method of cooling. If this is not available, a combination of the following methods should be used: Wet the person with cold or cool water, under a shower if safe, or with a hose or other water source Apply ice packs (groin, armpits, facial cheeks, palms and soles). Repeatedly moisten the skin with a moist cloth or atomizer spray. Fan continuously. on ly While waiting for the ambulance to arrive for childr children en 5 years of age and under a combination of the following methods should be used: /2 4 Cool in a tepid (lukewarm) bath sponging frequently for 10 minutes. If bath available: 20 23 Repeatedly moisten the skin with a moist cloth or atomizer spray Fan continuously -s ea so n 3. Monitor the person’s condition and reassure them while waiting for paramedics to arrive. Note Rapidly cool the person as per heat exhaustion treatment if cold water immersion not possible. us e Do NOT give fluids by mouth if the person is unconscious and breathing normally. Do NOT give the person any paracetamol used to reduce fever. io n Refer to the latest ARC Guideline for Heat Induced Illness to learn more. pe tit Note for lifesavers on patr patrol ol Lifesavers are often required to spend extended periods of time in hot-weather conditions. om Plan ahead for the heat and avoid experiencing heat exhaustion or hyperthermia by: C following the sun safety guidelines within the SLSA Environmental Factors Guidelines regularly drinking water to stay hydrated staying in well-ventilated areas wearing a hat while outdoors wearing light coloured and loose-fitting clothing, e.g., your patrol uniform staying in the shade where possible. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 353 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Musculoskeletal Injuries Musculoskeletal injuries relate to the bones, muscles, tendons, ligaments and joints. The most common musculoskeletal system injuries seen on the beach are fractures (bones), sprains (ligaments), strains (muscles and tendons) and dislocations (joints). Remember to gain a person’s consent before providing first aid for musculoskeletal injures and provide treatment within the limits of your training. on ly Musculoskeletal system 20 23 /2 4 The musculoskeletal system consists of a rigid framework of bones, called the skeleton, which supports the rest of the body and provides protection for important organs. The bones are connected by a series of joints where movement occurs, for example the shoulder, hip, knee and elbow joints. Joints are held in place by fibrous bands called ligaments. Muscles are attached to the bones at various points by tendons. Contraction and relaxation of the muscles allows movement of the bones so that the body can move and breathe. -s ea so n The skeleton consists of: the skull, to which the lower jaw is attached—the skull encloses and protects the brain the spine or vertebral column—encloses and protects the spinal cord the rib cage, which protects the lungs and heart us e the upper limb bones Fractures io n the pelvis and lower limb bones. pe tit A fracture is a break or a crack in a bone that has the potential to cause shock and serious injury to internal body structures. om Fractures can be classified as either: C open—the bone pierces the skin and soft tissue when it breaks and can be seen through the skin. Alternatively, an open fracture may be caused by an object penetrating the skin and fracturing a bone closed*—*the bone does not pierce the skin and cannot be seen. Signs and symptoms Bone/s protruding from an open, bleeding wound Deformity—the affected part has changed in shape Feeling/sound of bone ends grating or the sound of a snap or pop at the time of injury Loss of function (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 354 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Pain and tenderness at the site Signs and symptoms of shock (see Shock) Swelling at the site, resulting from internal bleeding Tingling or numbness Unnatural movement—the affected part can be moved too freely Management ly The precise treatment of a fracture depends on the location of the injury. However, these steps for an injured limb apply to most fractures. on 1. Reassure the person. 4 2. Advise the person not to move and to support their injury in a position of least pain. 20 23 4. Gain consent to provide (and document) treatment. /2 3. Send for help, additional resources (first aid kit) and request an ambulance. 5. Immobilise the injured limb in the position you found it in. -s ea so n 6. Check for circulation to their limb—press on the nearest fingernail/toenail to see if the blood circulation returns after applying pressure. 7. Monitor and reassure the person where they fell or injured themselves if possible and safe to do so while waiting for the paramedics to arrive. Note us e A lifesaver qualified in providing pain management may also administer methoxyflurane for pain relief. io n If the fracture is open, apply a clean dressing to the wound where appropriate and treat for shock (see Shock). pe tit Treat for shock (see Shock). om When moving the person is required, first immobilise the area above and below the fracture. C Sprains and strains Sprains Sprains are caused when the ligaments that hold bones together are forced beyond their normal range, leading to stretching or tearing. Sprains are more significant injuries than strains and may result in permanent damage if not managed properly. Strains A strain is a simple soft tissue injury affecting muscle, usually caused by overstretching. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 355 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Strains will usually heal by themselves, although there may be complications if tendons (which attach muscle to bone) are involved. Signs and symptoms Loss of power or ability to bear weight Pain and tenderness at the site Possible discoloration Swelling ly Management /2 4 on The RICER and no HARM approach to soft tissue injuries aims to minimise bleeding, swelling and further tissue damage. Remember to provide reassurance and gain the person’s consent to provide emergency care before taking the RICER and no HARM approach. 20 23 R-I-C-E-R R – rrest est -s ea so n Reassure the person and advise them to sit or lie down, then not to move while supporting their injury in a position of least pain. I – ice Apply cold packs or ice wrapped in a damp cloth to the site of the injury. us e A cold compress may be used at irregular intervals for periods of 5–15 minutes to reduce pain and swelling. io n C – compr compression ession pe tit Wrap a compression bandage around the injured area to reduce movement and swelling at the site of injury. om Check that circulation is present beyond the bandage to ensure it is not too tight – press on the nearest fingernail/toenail to see if the blood circulation returns after applying pressure. C Also check the colour, warmth, movement and sensation in the area above and below the compression bandage. E – elevation Elevate the limb to reduce swelling, bleeding and blood flow to the area. This will also help relieve pain. R – rrefer eferral ral Refer the person to a medical practitioner for definitive diagnosis and continuing management. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 356 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en H-A-R-M In the first 2–3 days, it is important that the person does not do any HARM to their injury. H – heat Avoid any type of heat that will increase blood supply to the area and, consequently, will increase bleeding. Avoid hot showers and baths, saunas. Avoid using hot water bottles or heat rubs. on ly A – alcohol 4 Avoid consuming alcohol as this may increase swelling. 20 23 /2 R – running Avoid exercising the area too soon as this may aggravate and worsen the injury. n M – massage -s ea so Avoid any form of massage, as this will increase swelling and bleeding. Dislocations io n us e A dislocation is an injury in which a bone is moved out of its normal position in a joint. The most common examples of this are in the finger and the shoulder joints. Dislocations may also be associated with fractures of nearby bones. Signs and symptoms pe tit Bruising or discoloration of the skin Deformity om Loss of joint function—abnormal or no mobility Pain and tenderness C Swelling Management 1. Reassure the person. 2. Advise the person not to move and to support their injury in a position of least pain. 3. Send for help and additional resources (first aid kit). 4. Gain consent to provide (and document) treatment. 5. Immobilise the injured limb in the position you found it in. 6. Determine if an ambulance is required: (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 357 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en press on the nearest fingernail/toenail to see if the blood circulation returns after applying pressure. Request an ambulance if there are signs of decreased circulation request an ambulance if the dislocation involves a major joint, e.g., shoulder or kneecap. 7. Monitor and reassure the person where they fell or injured themselves if possible and safe to do so. on ly 8. Refer the person to a medical practitioner or continue to reassure the person while waiting for an ambulance to arrive. 20 23 give the person anything to eat or drink (nil by mouth) /2 attempt to reposition the dislocated joint or put a bone back in place move the person until the joint has been immobilised, if safe to do so test the function of a suspected dislocation. -s ea so n 4 ✖ DO NOT Note Absence of circulation constitutes a medical emergency. You should send for help and request an ambulance immediately. us e If possible, apply ice packs (covered by a towel or clothing) or cold compresses at irregular intervals over the site of injury for periods of 5–15 minutes to reduce pain and swelling. io n Treat for shock where appropriate (see Shock). pe tit A first responder qualified in providing pain management may also administer methoxyflurane for pain relief. om Immobilisation—slings C The following information explains how to apply slings using a triangular bandage. There are several types of slings. Note (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 358 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Do NOT continue to use a sling when the person feels that their arm is better supported and less painful in another position. Elevated sling The aim of elevated slings (upper arm slings) is to immobilise and support injured upper limbs and shoulders. They are best used for arm injuries above the elbow, e.g., a fractured collarbone, a suspected shoulder dislocation, or a fractured upper arm. Follow these steps to apply an elevated sling: ly 1. point an open triangle bandage’s apex towards the injured arm 4 on 2. drape the triangle bandage over the injured arm. Have its apex beyond the elbow and its upper end over the person’s non-injured shoulder /2 3. ease the bandage under the person’s hand, then forearm and elbow 20 23 4. take the lower end of the bandage diagonally up across the person’s back 5. twist the bandage’s apex until it supports the elbow before securing it in place -s ea so n 6. tie the ends of the bandage with a reef knot, close to the hollow of the person’s neck on their non-injured side C om pe tit io n us e 7. check the sling is applied firmly for support yet not too tight to restrict circulation. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 359 of 479 ly Public Safety and Aquatic Rescue training manual - 35th Edition_en on Large arm sling /2 4 The aim of large arm slings (lower arm slings) is to immobilise and support an injured upper limb. They are best used for arm injuries below the elbow, e.g., a broken forearm. 20 23 Follow these steps to apply a large arm sling: 1. point an open triangle bandage’s apex towards the injured arm -s ea so n 2. place the triangle bandage between the injured arm and the person’s chest. Have its apex level with the elbow and its upper end on the person’s non-injured shoulder 3. bring the lower end of the bandage over the injured arm and place it on the injured arm’s shoulder us e 4. tie the ends of the bandage using a reef knot into the hollow of the person’s neck on their non-injured side 5. fold and secure the triangle bandage’s apex while making sure the hand is fully supported C om pe tit io n 6. check the sling is applied firmly for support yet not too tight to restrict circulation. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 360 of 479 -s ea so n 20 23 /2 4 on ly Public Safety and Aquatic Rescue training manual - 35th Edition_en us e Venomous Bites and Stings pe tit io n Venomous bites and stings affect the lymphatic system, which is closely connected to the circulatory system. Venom is known to cause blood clotting and may cause damage to the nervous system. Bites and stings are also known to cause infection and bites may spread diseases. C om Remember to gain a person’s consent before providing first aid for venomous bites stings, and to provide treatment within the limits of your training. Lymphatic system The lymphatic system returns water and proteins from various tissues back to the bloodstream and produces lymphocytes, which make antibodies to defend the body against invasion by agents such as viruses, bacteria, or fungi. It also collects some venoms and toxins that it will return over time to the circulation system. Lymph nodes are usually found in groups in different places throughout the body, including the neck, armpit, chest, abdomen, pelvis and groin. They often swell when the lymphatic system is protecting the body. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 361 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en The lymphatic system mainly relies on body movement and contraction of nearby muscles to move its contents (including some venoms and toxins) along, as it does not have a pump like the circulatory system. Lymph vessels, like veins, have one-way valves so that lymph can flow in only one direction. Bites and stings Signs and symptoms 4 on ly Some bites, stings and penetrating injuries from various creatures may show signs of bleeding or result in irritation or pain at the site of injection. Refer to the Venomous sea creatures section of this module for a list of signs and symptoms specific to the most commonly encountered venomous sea creatures at Australian beaches. /2 Management 20 23 There are four main treatments for venomous bites and stings by either sea- or land-based creatures which are outlined below. -s ea so n Refer to the Venomous sea creatures section of this module to note which treatment is used for which marine creature. Heat Cold Vinegar us e Pressure immobilisation technique C om Heat pe tit io n For all venomous bites and stings, you should monitor the person for signs of an allergic reaction as well as refer them to a hospital if the bite or sting is to their face or tongue, or if they present the signs and symptoms of anaphylaxis. Heat reduces pain in the majority of injuries by penetrating spines as well as non-tropical jellyfish stings. It does not destroy any venom already injected. 1. Ask the person to rest while providing reassurance. 2. Gain consent to provide (and document) treatment. 3. Manage any signs the venomous creature: non-tropical jellyfish—pick off any tentacles with gloved fingertips and rinse the sting area well with seawater to remove invisible nematocysts (stinging capsules) stingray barb—control any bleeding (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 362 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en protruding sea urchin spine—remove the spine with tweezers. 4. Turn on a hot water shower or tap and make the temperature as hot as the person can comfortably tolerate. 5. Place the person’s stung area in the hot water for 20 minutes and ask the person to rate their pain level from ‘no pain’ (0) to ‘worst pain possible’ (10). 6. Reassess the person’s level of pain by asking them to rate it again. ly 7. Send for help if heat fails to relieve the person’s pain, or if unable to manage other symptoms. on Note 20 23 /2 4 1. Do NOT remove any embedded objects, e.g., stingray barbs, sea urchin spines or stonefish spines. These need to be removed by a medical practitioner in a hospital setting to reduce further injury and prevent infection. 2. Do NOT allow rubbing of the stung area. n 3. If local pain is unrelieved by heat, or if hot water is not available, apply a wrapped cold pack or ice. -s ea so 4. If possible, top up with more hot water as necessary, testing the temperature each time. 5. Send for help and request an ambulance if: pain persists or is generalised (felt over a wide area) us e the sting area is large (half of a limb or more) C om pe tit io n the sting involves sensitive areas, e.g., the eye. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 363 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Cold -s ea so n Cold is a basic pain management technique for local skin pain. 1. Ask the person to rest while providing reassurance. 2. Gain consent to provide (and document) treatment. 3. Manage any signs of the venomous creature: io n us e non-tropical jellyfish—pick off any jellyfish tentacles with your gloved fingertips then rinse the sting area well with seawater to remove invisible nematocysts (stinging capsules) bees—remove any bee stings. pe tit 4. Apply a wrapped cold pack or ice to the sting site for 10–20 minutes and ask the person to rate their pain level from ‘no pain’ (0) to ‘worst pain possible’ (10). om 5. Reassess the person’s level of pain by asking them to rate it again. C 6. Reapply wrapped ice or cold pack if necessary. 7. Send for help if cold fails to relieve the person’s pain, or if unable to manage other symptoms. Note A cold compress may be used at irregular intervals for periods of 5–15 minutes to reduce pain. Remember the Wong–Baker FACES® pain rating scale may be used with young children, adults with a disability or adults from non-English speaking backgrounds to help communicate changing pain levels over time. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 364 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Cold treatment may also be used to relieve pain from most spider and insect bites. When heat and cold is not available If hot water is not available, or if there are not enough cold packs or ice stores available, do NOT use any other unauthorised treatments—they may cause further stinging or harm the person. 1. Make the person comfortable and provide reassurance. 2. Spray seawater on the area of the sting, using a fine spray. on ly 3. Repeat this as often as necessary, constantly monitoring and reassuring the person. om pe tit io n us e -s ea so n 20 23 /2 4 Vinegar C Vinegar is included in the treatment for all unknown jellyfish stings that occur in tropical Australia. This is to prevent further stinging from tentacles that may remain on the skin after a box jellyfish sting and to prevent further discharge of stinging cells after an Irukandji sting. 1. Send for help, additional resources (vinegar, cold packs or ice and an AED) and request an ambulance. 2. Ask the person to rest while providing reassurance. 3. Gain consent to provide (and document) treatment. 4. Manage any signs of the venomous creature. For tropical jellyfish—apply vinegar over the jellyfish tentacles then pick off any remaining tentacles with your gloved fingertips. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 365 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 5. Monitor and reassure the person while waiting for paramedics to arrive. 6. Manage the person’s pain levels (see Pain management). Note If vinegar is not available, pick off any jellyfish tentacles with your gloved fingertips then rinse the sting well with seawater. Do NOT apply fresh water onto the sting as this may cause the discharge of undischarged nematocysts—pay close attention to any water from ice or cold packs. ly Vinegar does not provide pain relief from venom already injected. 4 on Vinegar may cause nematocyst discharge of some other jellyfish, including bluebottles, so it is recommended only for tropical areas where box jellyfish and Irukandji stings occur. 20 23 /2 Vinegar needs to be kept only in tropical Australian surf lifesaving clubs for use on box jellyfish stings, Irukandji stings and unknown tropical jellyfish stings. Pressure immobilisation technique -s ea so n The pressure immobilization technique (PIT) is used to slow the movement of poisonous venom from animal bites and stings through the lymphatic system. us e In PIT, bandaging compresses veins and lymphatic vessels in the area of a bite, reducing absorption of venom from the area and thus delaying the onset of symptoms. It does not stop arterial blood flow (i.e., delivery of oxygen) to the area. Animals io n PIT is recommended for application to bites/stings by the following four creatures only: pe tit 1. blue-ringed octopus 2. cone shell om 3. funnel-web spider C 4. venomous snakes, including sea snakes. Application 1. Send for help, additional resources (first aid kit and AED) and request an ambulance. 2. Ask the person to rest while providing reassurance. 3. Gain consent to provide (and document) treatment. 4. Firmly apply a broad pressure bandage directly over the bite site as soon as possible. 5. Apply a second bandage that starts at the fingers or toes of the limb and continues towards the body while covering as much of the limb as possible. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 366 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 6. Check the bandages are applied firmly yet not so tight as to restrict circulation. 7. Mark the outer bandage with an X over the bite site. 8. Immobilise the limb. 9. Advise the person to rest and keep still. C om pe tit io n us e -s ea so n 20 23 /2 4 on ly 10. Monitor the person’s condition and reassure them while waiting for paramedics to arrive Note Bring transport to the person if possible. Do NOT wash the bitten area or remove the bandage. Do NOT apply a tourniquet to apply pressure. (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 367 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en Venomous sea creatures The venomous sea creatures in this section are listed in alphabetical order. Refer to the Bites and stings section of this module for more detailed information about their treatment (heat, cold, vinegar and PIT). You may also refer to the latest ARC Guidelines for Envenomation to learn more. us e -s ea so n 20 23 /2 4 on ly Bluebottle (Physalia physalis) io n Distribution Seasonal note pe tit Australia-wide and in most warm oceans worldwide C om Frequently present in the summer months on the eastern coast of Australia, and during autumn and winter in southern Western Australia. Signs and symptoms Pain and burning sensation Single raised white welt with a prominent ‘beading’ effect Occasionally, pain on breathing, back pain, sweating, anxiety and nausea may develop Management Heat (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 368 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Blue-ringed octopus (genus Hapalochlaena) Widespread around Australia Signs and symptoms Numbness of lips and tongue -s ea so n Distribution us e Conscious and able to hear although fully paralysed and unable to breathe without assistance io n Progressive weakness of the muscles leading to breathing difficulties and potentially respiratory failure as a result Management pe tit Visible but painless bite om 1. Primary assessment (follow DRSABCD): C 2. send for help, additional resources (first aid kit and AED) and request an ambulance 3. provide CPR 4. apply an AED and follow its prompts if the person is unconscious and not breathing normally. 5. Pressure immobilisation technique (PIT) Note An adult’s body is around 5 cm long with arms up to 10 cm. Blue-ringed octopuses present their iridescent blue markings when they are agitated (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 369 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en or hunting. Collectively there are around 10 species known as blue-ringed octopuses. They are commonly found in shallow reefs and tide pools. Spontaneous breathing can return after 2–13 hours of external ventilation support. -s ea so n 20 23 /2 4 on ly Box jellyfish (Chironex fleckeri) Tropical Australian waters io n Seasonal note us e Distribution pe tit Stinger peak season is October to May om Signs and symptoms Adherent tentacles often still present, especially if severely stung C Instant and severe burning skin pain, with what look like whip or burn marks on the skin Person may rapidly lose consciousness and stop breathing Management 1. Primary assessment (follow DRSABCD): 2. send for help, additional resources (vinegar and AED) and request an ambulance 3. provide CPR 4. apply an AED and follow its prompts if the person is unconscious and not breathing (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 370 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en normally. 5. Vinegar us e -s ea so n 20 23 /2 4 on ly Cone shell (genus Conus) io n Distribution pe tit Tropical Australian waters Signs and symptoms om Disturbed vision, speech and hearing C Numbness of lips and tongue Pain, swelling or a spot of blood at the bite Progressive weakness of the muscles leading to breathing difficulties and potentially respiratory failure as a result Management 1. Primary assessment (follow DRSABCD): 2. send for help, additional resources (first aid kit and AED) and request an ambulance 3. provide CPR (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 371 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 4. apply an AED and follow its prompts if the person is unconscious and not breathing normally. 5. Pressure immobilisation technique (PIT) Note Signs and symptoms may begin within minutes or take days to appear. Cone shells are usually found within tropical coral reefs and associated with sandy bottoms and inter-tidal environments. io n us e -s ea so n 20 23 /2 4 on ly Fire jelly (Morbakka fenneri) Distribution pe tit Northern Australian waters; reaches as far south as Sydney at times om Signs and symptoms C Burning, itchy pain at sting site Wide, raised pink welts surrounded by red skin flare Occasionally Irukandji-type symptoms may arise Management Vinegar (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 372 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Hair jellyfish (Cyanea barkeri) n Distribution -s ea so Worldwide Signs and symptoms Minor skin pain, although may sometimes be more severe us e Red zigzagged lines or irregular raised white welts surrounded by red flare io n Management C om pe tit Cold (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 373 of 479 Public Safety and Aquatic Rescue training manual - 35th Edition_en 20 23 /2 4 on ly Irukandji (Carukia barnesi) Distribution -s ea so n Tropical Australian waters Seasonal note Stinger peak season is October to May us e Signs and symptoms Initial minor sting that may show goose pimples, localised sweating or itching feeling ◦ anxiety pe tit ◦ backache io n After a delay of 5–40 minutes (usually 25–30 minutes), the person may experience ◦ headache om ◦ muscle cramps ◦ nausea C ◦ sometimes a red rash around the affected area Management 1. Primary assessment (follow DRSABCD): 2. send for help, additional resources (vinegar and AED) and request an ambulance 3. provide CPR 4. apply an AED and follow its prompts if the person is unconscious and not breathing normally (c) 2023 Surf Life Saving Australia - this version of the PSAR35 manual is for competition use only. Page 374 of 479 Public S

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