CONTENTS

PRIORITIES OF CARE
PATIENT ASSESSMENT

Vital Signs Survey

Secondary Survey

Triage (multiple casualties)

SHOCK & FAINTING

Management of Fainting

Management of Shock
ANAPHYLAXIS

Management of Anaphylaxis & Auto Injector Use

NEEDLE STICK INJURIES

Management of Needle Stick Injuries

BREATHING EMERGENCIES ASTHMA & HYPERVENTILATION

Asthma

Hyperventilation
CARDIAC EMERGENCIES ANGINA & HEART ATTACK

Angina

Heart Attack
TRAUMATIC INJURY

Bleeding

Management of Minor Wounds

Nose Bleeds

Management of Major Wounds

Embedded Objects

Amputations

Crush injury

Internal bleeding
BANDAGING

Donut

Head Bandage (pirate hat)

Hand Bandage (glove)

Pressure Immobilisation Technique (P.I.T.)

SLINGS

Collar and Cuff Sling

Elevation Sling (shoulder sling)
Lower Arm Sling

FRACTURES
DISLOCATIONS
SOFT TISSUE INJURIES
HEAD, FACIAL AND SPINAL INJURIES

Concussion and fractured skull/Cerebral compression

Eye injuries

Teeth

Spinal injuries
ILLNESS AFFECTING THE CONSCIOUS STATE

Diabetes

Hypoglycaemia

Hyperglycaemia

Stroke

Epilepsy
OVER EXPOSURE TO HEAT AND COLD

Burns

Hypothermia

Heat exhaustion

Heat stroke
POISONING, BITES AND STINGS

Poisoning

Bites and stings

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DEFINITION: Emergency care provided for injury or sudden illness before medical care is
available
THE 5 Ps
Preserve life
Prevent further injury
Protect the unconscious
Promote recovery
Procure medical aid (access medical aid)

Signs:
can see
Symptoms:
patient can feel

things you
things the

PRIORITIES OF CARE Approach to an incident

Primary survey DRSABCD
Vital signs survey
Secondary survey - DOLOR
Vital Signs Survey monitoring trends in condition at regular intervals HSBC
Heart Rate
Average adult resting 60-90 bpm
Average child resting 70-110 bpm
Infants resting up to 150 bpm

o
o
o

Skin colour and skin temperature

Breathing Rate and Depth
Average adult 10-20 breaths per minute
Average infant 30-50 breaths per minute

o
o

Conscious state
Hearing, movement in the eyes
Able to answer questions, movement from limbs

o
o

Secondary Survey (conscious casualty) DOLOR

Assessment of Responsive patient
Description

Onset and Duration

Location
Other signs and symptoms

Ask the patient to describe the problem

Ask the patient when the problem arose and how it progressed
Ask the patient where on the body the problem is

- Do you notice any other signs?

- Is the patient aware of any other symptoms?

Relief

Has anything provided relief? Eg: rest, position, medication

Head to Toe Examination

Head
o
o
o

Look and feel for bleeding and bumps

Check for fluid discharge from ears and nose
Check the eyes for any signs of injuries

Neck
o

Look at and feel the back of the neck gently for tenderness & irregularities.

Back/Chest/Abdomen
o
o

Ask a responsive victim to inhale deeply and see if it causes discomfort

Look at & feel the chest, back and abdomen for irregularities & tenderness

Limbs
o
o

Look for an injury &/or deformity

Check from the extremities moving toward the trunk, feeling for irregularities

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Check for altered strength and sensation

*check gloves after each section for bodily fluids may need to change gloves
TRIAGE (MULTIPLE CASUALTIES)
Unconscious casualties take priority because they cannot protect their airway or protect
themselves from external dangers.
Triage: prioritise casualties in order of urgency of management.
The general priority for managing a casualty: BBFO
1) Check for breathing
2) Control any severe bleeding
3) Shock
4) Treat burns
5) Treat fractures
6) Attend to any other injuries

Useful Acronyms
Ambulance call 5 Ps
People
Problem
Position
Progress
Phone number

Ambulance handover EPIC

Event
Problem
Interventions
Current condition

Patient history SAMPLE

Signs and symptoms
Allergies
Medication
Previous medical history
Last oral intake
Event

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SHOCK & FAINTING

Signs & Symptoms
Tingling (poor circulation)
Light-headedness, dizziness
Nausea
Pale, cold clammy skin
Brief period of unresponsiveness (1 to 2 minutes)
Rapid, weak pulse & Rapid, shallow breathing
Altered responsiveness
Thirst
Weakness
Collapse
Causes of Fainting
Prolonged periods of standing
Emotional distress
Low fluids or food
Causes of Shock
Heart failure
Inadequate blood volume/blood loss
External or internal bleeding

Management of Fainting and Shock

Primary survey (DRSABCD)

Lay patient down with legs elevated
Treat cause if possible (i.e. bleeding)
Reassurance
Monitor and record vital signs
Provide oxygen, if available and qualified
Maintain body temperature
Seek urgent medical assistance

If the face is pale raise the tail,

If the face is red raise the head,
If the face is blue theyre almost through

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ANAPHYLAXIS

Management of Anaphylaxis & Auto Injector Use

Management:
Call 000 urgently
Primary survey (DRSABCD)
Position of comfort
Assist with medication:
Confirm correctness with casualty
Prepare the Epipen for use
Remove from protective case
Remove end cap
Grip in fist, thumb away from needle
Quickly press into casualtys upper thigh
Listen for click
Hold in for 10 seconds
Loosen clothing, remove jewellery
Provide oxygen, if available and qualified
Be prepared for resuscitation

NEEDLE STICK INJURIES

Management of Needle Stick Injuries

Management:
Wash the area thoroughly in warm soapy water
Report the incident and record it in a log book
Refer patient to see a doctor for treatment and counselling
Dispose of needles in sharps container

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BREATHING EMERGENCIES ASTHMA & HYPERVENTILATION

Asthma
Asthma is an allergic reaction resulting in the narrowing of the smaller airways. This narrowing is
brought about by three mechanisms:
Acute narrowing and spasm of small air passages
Swelling of the airway lining
Secretion of mucus in the airway
Preventer medications, taken daily, act to prevent the swelling and mucus secretion.
Reliever medications are taken to open the small airways in the event of an asthma attack.
All blue reliever puffers are safe, when used as directed. The student may experience harmless side
effects such as shakiness, headache, a tremor or a racing heart.
Mild Cases

More Severe

Very Severe

Cough
Rapid breathing
Wheeze
Rapid pulse
Chest tightness

Pale
Distressed, anxious
Fighting for breath
Aspiratory / Expiratory wheeze
Severe chest tightness

Exhaustion
Altered responsiveness
Cyanosis (blueness)
Difficulty / unable to speak
No wheeze at all

Management if responsive:
If a severe attack call 000 immediately
Reassure patient and assist them into a comfortable position
Administer oxygen therapy
Prepare the inhaler
Check with casualty for correctness of inhaler
Shake the blue reliever puffer and remove the cap
Insert the puffer into the spacer, ensuring that the casualty places their mouth over
the mouthpiece and gets a good seal
Demonstrate 4 x 4 x 4 technique
Give 4 separate puffs, breathing each puff 4 times
Wait 4 minutes before repeating if ineffective.
CPR may be required if the casualty becomes unconscious.

In a severe attack, 6-8 puffs may be given to an adult every 5 minutes

Even if medication appears to be effective, medical advice should be sought

Management if unresponsive:
Call 000 urgently
Conduct Primary Survey and act accordingly
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Hyperventilation
Management:
Conduct primary survey (DRSABCD)
Reassure a conscious patient and help them into a comfortable position
Remove casualty from the environment contributing to over breathing
Encourage them to breath normally
Seek medical aid as appropriate
CARDIAC EMERGENCIES ANGINA & HEART ATTACK
Recognition:
Chest pain or tightness
May be gradual or sudden onset
Often described as heavy, dull or crushing
May radiate to neck, jaw, shoulders and arms
Nausea or vomiting
Shortness of breath
Pale, cold & sweaty
May appear distressed

Angina occurs when the blood flow through a narrowed coronary artery is insufficient to meet
the oxygen requirement of the heart.
Management:
Rest and reassure the patient
If this is the first episode the patient has experienced, call 000 immediately
If the patient has their own medication, assist them to take it
Provide supplementary oxygen
Do not leave patient unattended
If no relief from medication and rest, call 000 urgently
Common medications used for the treatment of angina are inserted under the tongue or between the
gum and the lip, or sprayed into the mouth.

Heart Attack
Management if responsive:
Send for an ambulance urgently
Assist the person into a comfortable position
Rest and reassure
Loosen any tight clothing
If the patient has their own medication, assist them to take it
Provide supplementary oxygen
Do not leave patient unattended
Be prepared for sudden unresponsiveness
Management if unresponsive:
Call 000 urgently
Conduct primary survey (DRSABCD) and act accordingly
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Provide supplementary oxygen

TRAUMATIC INJURY
Wound Types

Abrasions

Scrapes on the surface of the skin with damage to small capillaries

Lacerations

Cuts caused by sharp objects that have ragged edges

Incisions

Cuts caused by sharp objects that have smooth edges

Avulsions

Where a flap of skin/or flesh has been totally or partially removed

Puncture wound
Embedded object

Occurs when a sharp, pointy object has penetrated the flesh

Wound with an embedded object still in place

Amputation

Occurs when a body part has been severed

Management of Minor Wounds

Superficial, small surface area (<2.5cm), bleeding ceases quickly

Wash in clean, running water or saline solution
Dry using sterile gauze
Cover with a clean dressing
Avulsions

Flaps of skin should not be removed unless it is very small

Large flaps of skin or appendages should be returned to normal position before applying the
sterile dressing/bandage

Seek medical attention if

o There is any doubt about the severity of the wound
o The wound cannot be easily cleaned
o Infection is a concern
o Stiches may be required
o Tetanus immunization may be necessary
Nose Bleeds

Management:
Ask patient to firmly squeeze the fleshy part of the nose, below the bone
Position the patient sitting upright, with their head slightly forward
Ask the patient to breathe through their mouth and avoid swallowing any blood
Seek medical aid if the bleeding exceeds 10mins
It is best not to apply pressure to a suspected broken nose
-Apply cold compress to the top of the nose and forehead
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Management of Major Wounds PER

Pressure / Elevation / Rest

Management:
Conduct Primary survey (DRSABCD) and act accordingly
Apply direct pressure to the wound site
Apply a sterile dressing, followed by a pad and bandage where possible
Elevate injured site if possible
Call ambulance (if required)
Keep patient still and reassure them
Monitor vital signs and treat for shock if required
If bleeding continues through the pad:
Apply another pad and bandage over the original pad and bandage
Remove pad and bandage and re-apply if bleeding continues
Apply pressure near the atery
Embedded Objects

Sometimes objects are embedded at the wound site. Where possible, these objects should be left in
place. Attempting to remove the object can cause further damage can exacerbate the bleeding.
Management:
Apply pressure around to the wound site
Elevate the affected area
Apply a ring bandage around the object
Dress around the wound without applying pressure to the embedded object
Amputations

Management of the stump:

Refer to management of major wounds
Management of the severed part:
Wrap the body part in a clean, sterile, non-adhesive dressing if possible
Place the body part in a sealed plastic bag or container
Place the sealed body part in a container of icy water
Do not allow part to come into direct contact with ice or water
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Seek urgent medical assistance

Crush injury

Management:
All crushing forces should be removed as soon as possible and an emergency medical team
be called immediately
Call 000
Keep the patient comfortable
Do not use a tourniquet
Monitor vital signs

Internal bleeding

WHEN TO SUSPECT IT
Internal bleeding may be suspected, depending on:
Type of trauma the victim has undergone
Victims past medical history (e.g., stomach ulcers)
Victim has signs and symptoms of shock
Pain and swelling in the affected area
Coughing up blood, dark brown blood in vomit or excretion of blood from urinary or
digestive system
Management:
Call 000 urgently
Conduct Primary survey (DRSABCD) and act accordingly
Lay patient down, if possible, and raise legs slightly
Keep still and reassure
Thermoregulation
Provide supplementary oxygen, if available and qualified
Maintain body temperature
Conduct a Secondary Survey (DOLOR)
Give nothing my mouth

Level 2 Senior First Aid

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BANDAGING
Donut Bandage

Head bandage (pirate hat)

place bandage over head
tying off at the back
tucking in loose bit over the tie off
criss-cross over loose bit and bring ends over to front
criss-cross over to back and tie off ends at the back
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Hand bandage (glove)

fold over the end of the bandage and place over knee
place fist on top of the bandage
bring loose apex end over the fist
criss-cross the two sides over the fist, bringing the loose end over the fist
tie off the criss-cross again

Pressure Immobilisation Technique (P.I.T.)

commencing at the bite site work your way down to the fingers
leave fingernails exposed
work back up the arm covering two-thirds of the bandage at each turn of the bandage
continue bandaging all the way up to the nearest lymph node.
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Splint the limb

Check for circulation beyond the bandage
Make the casualty comfortable, instructing them not to move

Note: it is a good idea to mark the bite site on the bandage with a cross to assist medical personnel
to locate where the bite is.
SLINGS
Collar and Cuff Sling

Elevation Sling (shoulder sling)

place bandage with apex pointing to elbow
over the arm
tuck in under the arm
twist both ends then tie off the two ends on the uninjured side

Level 2 Senior First Aid

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Lower Arm Sling

place bandage with apex to elbow over patients chest
bring opposite end over patients arm
tie off on injured side
twist remaining bandage at elbow and tuck in.

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FRACTURES
Management:
Conduct a Primary Survey and act accordingly
The main aim is to prevent any movement at the site of the fracture
o If unsure, keep the patient still and comfortable and call the ambulance
Immobilise the joint above or below the fracture site
Splint in a position of comfort for the patient
Check for a pulse beyond the fracture.
o If not, call for urgent medical aid. Refer the patient to the nearest medical care.
Do not attempt to realign a badly deformed limb
Where possible, an immobilized fractured limb should be elevated
Treat for shock
Support a fractured jaw with hands
DISLOCATIONS
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Management:
Conduct a Primary Survey and act accordingly
Immobilise the dislocated joint in the position found
Patient needs to be comforted and reassured
Check for a pulse below the dislocation
o if not present move the limb while monitoring any return of the pulse
Ambulance transport should be arranged if required
If possible apply ice
*Be aware that there is a strong possibility that a fracture could also have occurred.

SOFT TISSUE INJURIES

Sprains:
Occur at the joint
Usually occurs as a result of stretching and possibly tearing of the ligaments or other tissues at
the joint
Swelling at the site quickly follows the injury to the joint
This acts as a protective mechanism to stop further movement at the site

Strains:
Usually associated with muscles & tendons which attach the muscle to the bone.
Can be caused by overuse or putting excessive load on a muscle or muscle group.
It can also occur if muscles are not warmed up properly prior to strenuous use.
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Varied severity
Mild discomfort with minor muscle damage
Complete tearing of the muscle resulting in loss of use
Management: RICER + NOHARM
REST
ICE
o Apply 10-20 minutes every 1-2 hours
COMPRESSION
ELEVATION
REFERRAL
Advise the casualty to avoid the following for the first 48-72 hours following injury.
No:
Heat
Alcohol
Running
Massage

HEAD, FACIAL AND SPINAL INJURIES

Concussion and fractured skull/Cerebral compression

Management:
Consider the possibility of a spinal injury
Keep patient still and reassure them
Continually monitor vital signs
Seek medical advice

Eye injuries
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Management:
Keep patient still and comfortable
Place a sterile pad over the affected eye
Avoid putting any pressure on the affected eye
Encourage the patient not to blink or move either eye
Seek medical advice
Embedded Object

Do not remove the object

Try to place a protective cover around and over the injured eye (eg: polystyrene cup), but
avoid putting any pressure on eye or object
Seek urgent medical aid

Small Foreign Body

Encourage patient to blink several times

Flush the affected eye with clean water or saline
Seek medical aid if problem persists

Chemical Injury

Rinse the affected eye for at least 15 minutes with copious fresh, clean, flowing water
Seek urgent medical aid

Teeth
Management:
Gently clean dirt from tooth using milk, saline, water, or patients saliva
Place tooth back in the open socket, if possible
o Otherwise store in milk, saline, patients saliva, or water (in that order)
Keep tongue away from hole where tooth was
Refer patient to dentist

Spinal injuries
Management:
Conduct Primary Survey, Vital signs and Secondary Surveys accordingly
Call 000 urgently
Keep the patient still and reassure them
Maintain normal body temperature
Minimise any movement of the head and spinal column
Manage any other injuries
Provide oxygen
Continually monitor vital signs
ILLNESS AFFECTING THE CONSCIOUS STATE

Diabetes
Type 1 diabetes: insulin dependant
Type 2 diabetes: usually regulated by diet, exercise and lifestyle.
Hypoglycaemia (low blood sugar levels)
Management:
Level 2 Senior First Aid
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Give sweet drinks, sweets or sugar

Do not give diabetic drinks
Seek medical assistance

Hyperglycaemia (high blood sugar levels)

Management:
Seek medical advice
If unresponsive:
Conduct Primary Survey
Call 000 urgently
Provide oxygen

Stroke FAST
Management:
Call 000 urgently
Reassure patient
Help patient into comfortable position
Loosen any tight clothing
Provide oxygen

Epilepsy
Management:
Protect patient from external dangers
Do not restrain
Do not place objects in patients mouth
When fitting stops, conduct a Primary Survey and act accordingly
If appropriate, conduct Secondary Survey to check for injuries caused by seizure
Call an ambulance if:
Seizure last for more than 5 minutes
Patient does no become responsive between seizures
There is no history of seizures
Pregnancy or other medical conditions are involved
The patient is an infant
There are significant injuries caused by the seizure
The seizure occurs in water
Recovery appears to be slow

OVER EXPOSURE TO HEAT AND COLD

Burns
Ambulance is recommended for:
A flame burn the size of the casualtys palm
Any flame or scald burn involving the hands, face, perineum or genitals
Any chemical burns
Any electrical burns
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Any burns with suspected respiratory tract involvement

Any infant or child with any type of burn

Types of burns:
Superficial Burn
o

Only the top layer of skin is involved (eg: sunburn)

Partial Thickness Burn

o

The top layer and part of the next layer have been burnt

Full Thickness Burn

o
o
o

Both outer layers have been damaged, and possibly the subcutaneous tissue being affected
This can result in damage to fat, muscles, blood vessels and nerve endings
Tends to have little pain

Superficial
Redness
Pain

Partial
Severe pain
Redness
Weeping from the burn
Blistering

Full
Painless
Cracked and dry appearance
White or charred appearance

Management:
Conduct primary survey and act accordingly
Immediately cool the affected area with running/flowing water for 20 minutes
Remove all jewellery
Elevate burn limbs (where feasible)
Cover burn area with a clean, sterile, lint-free dressing burns dressing or wet cloth
Provide oxygen
Continue to cool burned area after covering/dressing
Do not
Peel off adherent clothing
Burst blisters
Apply ointments or lotions
Use ice or ice water
Apply pressure

Hypothermia
Management:
Mild
Conduct primary survey and act accordingly
Change into dry clothes if possible
Protect from elements
Warm, sweet drinks (no alcohol or caffeine)
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Seek medical advice

Moderate to Severe
If responsive:
Call 000 urgently
Handle patient gently
Lay patient down flat
Insulate from cold environment
Wrap with blankets, clothing
Monitor patients vital signs
Provide warm, sweet drinks if patient is responsive, stable and can swallow
Do not rub or massage
Do not expose to excessive heat (eg: fire, heater, hot shower)
If unresponsive:
Call 000 urgently
Handle patient gently
Lay patient down flat
Conduct Primary Survey
Commence CPR if indicated and continue until relieved by medical aid
Insulate from cold environment
Provide oxygen

Heat exhaustion
Management:
Conduct primary survey and act accordingly
Lay patient down and protect from the warm environment
Provide sips of cool fluids
Cool patients body
Seek medical advice

Heat stroke
Management:
Call 000 urgently
Lay patient down
Conduct primary survey and act accordingly
Cool patients body rapidly

o
o

Wetting the person with cold water and fanning them will increase evaporation heat loss
Ice/cold packs can be placed under the armpits, in the groin and around the neck

Monitor vital signs

Provide sips of cool fluids if conscious and can swallow
Provide oxygen

POISONING, BITES AND STINGS

Poisoning
Ingested Poisons
Management if responsive:
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Conduct Primary Survey and act accordingly

Comfort and reassure the patient
Continuously monitor vital signs
Try to identify type and quantity of poison taken
Call Poisons Information Centre on 13 11 26
Seek medical assistance
Do not induce vomiting unless instructed by P.I.C.

Management if unresponsive:
Call 000 urgently
Conduct Primary Survey
Continuously monitor vital signs
Provide supplementary oxygen
Try to identify type and quantity of poison taken, and when it was taken

Absorbed Poisons
Consider potential dangers when conducting Primary Survey
Ensure that you are not also affected
Call 000 urgently
Irrigate the affected area with large amounts of water
Inhaled Poisons
Consider potential dangers to ensure you are not also affected

Dont attempt a rescue if the patient is in a confined space

Call 000 urgently

Patient should be removed from contaminated areas prior to conducting Primary Survey
Provide oxygen

Bites and Stings

There are 3 ways to treat envenomation;
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Heat
[spines and spikes]
Ice
[stings]
Pressure and Immobilisation [bites]
o Pressure delays the reaction of venoms or renders it inactive
o Tourniquet is not used in first aid anymore because of risk of losing a limb

Do not wash bite site helps identify type of venom and appropriate anti-venom.
Types of venom:
Cardio-toxins (affect the heart)
Myo-toxins (affect the muscles)
Neuro-toxins (affect the brain)
Management:
Conduct Primary Survey and act accordingly
Apply Ice
Bee
Wasp
Red back spider / white tail
Bull ant
Centipede
Scorpions
Non tropical jelly fish (if hot water is not avaibale)

Immense in Hot Water

Stonefish
Stingray barb
Other spiny fish
Blue bottle
Box jelly fish

Pressure and Immobilisation Technique PIT

Blue ringed octopus
Snakes
Funnel web spiders
Cone shells
Allergic reaction

Poisonous Snake
Red Back Spider
Funnel Web Spider
Bee
Wasp
Bull ant
Scorpion
Centipede
Non-tropical Jellyfish
Bluebottle
Box Jellyfish (Irukandji)
Blue Ring Octopus
Cone Shell
Bullrout/Stone Fish
Stingray

Pressure
Immobilisation

Heat

Vinegar

Cold (Ice)

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