Professional Documents
Culture Documents
First Aid in Emergency: Theme - 4
First Aid in Emergency: Theme - 4
First Aid in Emergency: Theme - 4
InWEnt -
International Weiterbildung und Entwicklung gGmbH
Capacity Building International, Germany
Friedrich-Ebert-Allee 40
53113 Bonn
Fon +49 228 4460-0
Fax +49 228 4460-1766
www.inwent.org
Environment and Forests (MoEF). The German Federal Ministry for Economic
Phone +49 30 25487-116 Cooperation and Development (BMZ) supports several environment related projects
steffi.mallinger@inwent.org in India through GTZ. ASEM focuses on seven major thrust areas -Sustainable
Industrial Development, Sustainable Urban Development, Sustainable Consumption
and Consumer Protection, Sustainable Environmental Governance and the cross
Disaster Management Institute cutting areas. Climate Change and Human Resource Development. Public Private
Paryavaran Parisar, E-5, Arera Colony, PB No. 563 Partnership (PPP) project with Indian and German companies contribute towards
Bhopal-462 016 MP (India), identified project activities. Detailed Information can be explored using our WEB sites:
Fon +91-755-2466715, 2461538, 2461348,
Fax +91-755-2466653 www.asemindia.com
www.hrdp-net.in
www.hrdp-iDRM.in
1 2
-Instructs all workers about the first-aid programme, including what workers see some accident, there are a few basic principles you should follow to protect yourself
should do if a co-worker is injured or ill. Putting the policies and programme in and the victim. The following steps are required immediately:
writing is recommended to implement this and other programme elements. 1. Survey the Scene. Before you help the victim, determine if the scene is safe. If
-Provides for scheduled evaluation and changing of the first-aid programme to anything dangerous is present, don't put your own life at risk to try and help the victim;
keep the programme current and applicable to emerging risks in the workplace, you will be of no aid if you become a victim too. Summon help and wait for trained
including regular assessment of the adequacy of the first-aid training course. people to resolve the situation. If the scene is safe, try and determine what happened
and how many victims there may be. Never move the victim unless an immediate, life
2. What is First-aid threatening danger exists, such as a fire or the threat of a building collapse.
2. Primary Victim Survey. After ensuring the scene is safe, you can turn your
attention to the victim. Begin by performing a primary survey to determine if the
First aid is the immediate care given to a person who is injured or ill. Sudden illness or victim:
injury can often cause irreversible damage or death to the victim unless proper care is
initiated as soon as possible. First aid includes identifying a life-threatening condition, A) is conscious
taking action to prevent further injury or death, reducing pain, and counteracting the B) has an open, unobstructed airway
effects of shock. Because life-threatening situations do occur, everyone should know C) is breathing
how to provide emergency care until a victim can be treated or transported to a D) has a heartbeat
medical facility. First aid is not intended to replace care by a physician or surgeon. Its E) is not bleeding severely
intent is to protect the victim until medical assistance can be obtained.
To check for consciousness, gently tap the person and ask if they are okay. If there is no
The primary purpose of first aid is to: response, this in an indication that a possible life-threatening situation may exist. If
Care for life-threatening situations the person is responsive and can talk or
Protect the victim from further injury and complications cry, this indicates they are conscious,
Arrange transportation for the victim to a medical facility breathing, have an unobstructed airway,
Make the victim as comfortable as possible to conserve strength and a pulse. If the victim is unconscious,
Provide reassurance to the victim kneel down next to the head and check
An accident can occur at any time or any place where hazardous chemicals are being for the ABC's:
used and the working conditions are not safe. If you are the first person to arrive and Airway,
Breathing, and
Circulation.
To check the Airway (clear and maintain
an open airway), Breathing (restore
breathing), and Circulation (restore
circulation), place your ear next to
the victim's mouth and
listen/feel for breath sounds while
looking for a rise and fall of the chest.
While doing this, check for a pulse by
placing your fingers on the neck, just
below the angle of the jaw, and feel
for the pulse from the carotid artery.
These three steps will determine if
cardiopulmonary resuscitation (CPR)is needed.
3 4
3. Principles of First aid breathing, they may need their head repositioned. If they are still not breathing
they need rescue breathing, do not give unless you are trained, instead, find an
adult.
The Gurumantra (thumbrule) of First aid is RAPABCH. To make it convenient we are C is for circulation
opting the point wise followings: If there is not a pulse, then this person needs CPR. The best place to check for a
R is for Responsiveness which means that we have to check the following: pulse is the carotid artery along the side of the neck along the windpipe.
If you are not trained in CPR, then find someone who is.
Is the victim conscious?
H is for hemorrhaging
Touch their shoulder, ask if they are alright.
If the victim is bleeding, then provide the necessary care. If not, then begin a
Ask if they need help.
secondary assessment.
If they say no, then proceed no further.
If yes, or no response, then proceed to A
A summary of the first aid can be briefed in Fig-1:
A is for Activate Emergency Management Services (EMS), in India recently the 108 has
started in jointly with health and police department. Please see what emergency
management services number is available in your area.
What are the four things you need to remember when making an EMS call? And YES
therefore the following points are suggested: IS THE CASUALTY TREAT ANY INJURIES
CONSCIOUS? GET HELP IF NECESSARY
Your name and contact number
The emergency NO
The location of the emergency condition of the victim YES
Check the victim for responsiveness. If he do not respond or if he tells you that he IS THE CASUALTY
IS THE CASUALTY BREATHING NOISILY?
need help, ask what need, to be contacted, when and where? Some very basic
question and stay till EMS arrives to take care of victim BREATHING?
YES
P is for Position OPEN AND CLEAR AIRWAY
NO NO
Only re-position the victim if the victim is in further danger in their present location.
And / or there does not seem to be spinal injury and additional care requires moving TREAT ANY LIFE
them. THREATENING INJURIES.
IS THERE PULSE?
PLACE CASUALTY IN
Explain when an injured person should and should not be moved? If there are suspected RECOVERY POSITION
spinal injuries, do not move the victim (except when the victim is in a life threatening NO AND CALL FOR HELP.
situation). YES
5 6
4. Emergency situations -Lungs being elastic and spongy, it comes back to the original state.
-Volume of lungs decreases and pressure in lungs increases. So air is pushed out.
Now in the following paragraphs some of the emergency situations are being Exchange of gases:
discussed from first aid angle: This occurs in capillaries surrounding the alveoli. Oxygen is absorbed by red blood
corpuscles (RBC) and water vapour and carbon-dioxide is let out from the blood plasma
4.1 Respiration into the alveoli, which is expelled during expiration.
Respiration means breathing in and breathing out of air. It helps in supply of oxygen Respiratory centre:
(of the air) to all parts of the body. Lungs are supplied with nerves, which are connected to the respiratory centre in brain.
This controls respiration. It determines the rate and depth of respiration.
Breathing contains three phases: -
Breathing in (inspiration). Respiratory rate:
Breathing out (expiration). Average adult- 16 to 18 times (per minute).
Pause. Children - 20 to 30 times (per minute).
Respiratory system: This varies during stress, exercise, injury, illness, etc.
Air passage.
Lungs. Heart rate will accordingly increase to carry the extra oxygen around the body.
Air passage:
Air passage consists of nose, mouth, throat (pharynx), the windpipe (trachea), and the CLINICAL DEATH - O MINUTES.
air tubes (bronchi). The bronchi divide in to minute branches (bronchioles), which end in
BREATHING AND CIRCULATION STOPS.
the lung substance (alveoli).
LETHAL BRAIN DAMAGE - 4 TO 6 MINUTES.
Lungs:
Two in number. BIOLOGICAL DEATH - 10 MINUTES.
Situated on right & left sides of chest cavity.
Made up of small sacs (alveoli). BRAIN CELLS DIE.
Covered by a membrane called pleura, which lines the inner wall of the chest cavity.
Mechanism of respiration:
Inspiration: 4.2 Asphyxia
-Diaphragm contracts and flattens.
(this increases chest cavity, above downwards) Asphyxia is a condition where lungs do not get sufficient supply of air for breathing.
-Ribs move upward and forward due to contraction of intercostals muscles.
(this increases the chest cavity from and to back). Causes:
-Due to this lungs expansion, volume of the lungs increases and pressure inside the Affecting air passages.
lungs decreases. At a point when the pressure in lungs is less than the atmospheric
pressure, air enters from atmosphere in to the lungs. Spasm:
Expiration: Food, water, irritant gases (coal gas, exhaust fumes, smoke, etc.), sewage gas, gas in
-Diaphragm relaxes and comes back to its original state. unused wells, etc., entering air passage, bronchial asthma.
=Intercostal muscle relaxes and ribs also come back to the original state.
7 8
Obstruction: Continue till normal breathing sets.
Due to foreign body, falling back of tongue in case of unconscious patient, swelling of Prevent damage to brain and other vital organs.
tissues of throat (scalding, burns, corrosives, etc.). Artificial respiration.
External cardiac compression.
Compression: Keep body warm by light blanket.
Strangulation, smothering, throttling. Provide shelter.
9 10
Management: Grasp your fist with the other hand.
Cut and remove the band contracting the throat, supporting the weight of the body Pull both hands towards you with quick inward and upward thrust so that upper
in case of hanging (cut below the knot). abdomen is compressed.
'ABC' of resuscitation. Repeat 4 times if needed.
Put in recovery position after recovery. In case of unconscious patient:
Shift to hospital. -Lay the patient back with head in open airway position.
-Kneel astride the patient's thigh.
Choking: -Place heel of one hand in the centre of patient's upper abdomen and cover with
It is due to obstruction of windpipe. other hand, with fingers clear of abdomen.
Common in children. -Press with both arms straight into the abdomen with quick inward and upward
Signs and symptoms: thrust.
-General signs of asphyxia. -Repeat if needed, for 4 times.
-Unable to speak or breathe.
-Gripping of throat. In children:
-Congestion of face and neck, etc. With prominent veins. Make the child sit on your lap.
Give abdominal thrust with one hand, with less pressure.
Management: Infant:
Remove the obstruction. -Place on firm surface.
Shift to hospital. -Press the upper abdomen with two fingers, with less pressure.
11 12
In coal-mines, deep unused wells, sewages, other gases emitted from leaking Continue artificial respiration till normal breathing resumes.
refrigerators, LPG, etc. Note:
Artificial respiration can be given even if breathing is there, but not normal.
Management:
Same as above except enter in upright position. If heart also not working:
Signs:
Bronchial asthma: Face will be pale or blue.
Due to sudden contraction of air way, due to allergy, infection, anxiety. Dilated pupils.
Heart beat and pulse will be absent.
Management:
Reassure the patient to sit up and lean forward with a table or pillows to lean. Management:
Open windows for fresh air. Lay casualty on back on a hard surface (bench, table, etc).
Shift to hospital. Give a hit, with edge of your hand on the lower and left angle of the sternum. This
usually stimulates the heart.
Artificial respiration: If heart does not work, persist striking for 10-15 times, at the rate of 1 strike/second.
Best method - mouth to mouth or If hear beat starts, then stop striking.
-Mouth to nose breathing. Continue artificial respiration side by side.
Other methods are: If heart does not function, start ECC.
-Sylvester's method.
-Holger nelson method. External Cardiac Compression (ECC):
-Schafer's method.
Note: - thumping the heart or ECC should not be done until the heart has stopped
Mouth to mouth method: beating.
Place the casualty on his back.
Hold the head tilted back. Feel and mark the lower part of sternum.
Take deep breath with your mouth wide open. Place heel of hand, two fingerbreadth above the joint of rib margin and breastbone.
Keep the casualty's nose pinched. Place heel of other hand over it.
Cover the mouth of casualty with your mouth smugly. (cover mouth with clean cloth With arms straight, press sternum backward (about 4 to 5 cms. In adults) and release.
if possible). Compression must be regular, smooth, not jerky or jabbing.
Blow on to the lungs and watch chest raise.
Withdraw your mouth and watch chest falling back. Rate: -
Repeat at the rate of 15 to 20 times per minute. Adults - above 60 per minute.
Note: Children (2 to 10 years) - above 80 to 90 but with one hand.
In case of small children, the open mouth should cover the mouth and nose and blow
gently. Rate 18-22 per minute. Children (0 to 2 years) - 100 per minute only with finger.
13 14
Signs of effective treatment: -Unusual odours of breath, on clothing or at the scene. (garlic smell rat poison)
Colour will become normal. -Abnormal breathing.
Pupils will contract. -Abnormal pulse.
Carotid pulse is felt. -Sweating.
-Dilated or contracted pupils.
If only one trained person is available: -Excess salivation or foaming from the mouth.
Artificial respiration and ECC is done alternatively by shifting position. -Painful swallowing.
15 compressions at the rate of 80 per minute, followed by two breaths of mouth-to- -Distension, pain & tenderness of abdomen.
mouth method. -Nausea & vomiting.
Check pulse after first minute and then every three minutes, till pulse is felt. -Diarrhoea.
Stop ECC, as soon as pulse is felt. -Convulsions.
Continue, mouth-to-mouth respiration till breathing becomes normal. -Altered state of consciousness.
Put in recovery position after the recovery.
Treatment:
4.3 Poisoning -Open airway.
-Dilute poison with water or milk.
Poison: -Induce vomiting with syrup ipecac, soap & water, etc. (except if patient is
A poison is a substance that, if taken into the body in sufficient quantity, can cause unconscious, ingested corrosives, gasoline products, etc.)
temporary or permanent damage. -Ensure patient does not aspirate vomitus.
-Give one tablespoon of powdered charcoal or white of egg.
Types of poisons: -Antidote, if known & available, can be given.
1. Ingested poison: eating or drinking poisonous substances. (Rat poison, poisonous -Transport to hospital in lateral recumbent position.
plants, etc.)
2. Absorbed poison: Absorbed through skin. (Insecticides) Inhaled poison:
3. Inhaled poison: Chemical vapours. (Sprays, cleaning fluids, etc.) Fumes from fire,
stoves, exhausts, sewer gases, etc. Signs and symptoms:
4. Injected poison: Insect bites. (Spiders, wasps, etc.), Snake bite, etc. -Unconsciousness or altered behaviour.
5. Drugs. -Shortness of breath.
-Cough.
Effects: -Abnormal pulse.
Depends on the nature, concentration and how it enters the body. -Burning eyes, mouth, nose, throat, chest, etc.
-Severe headache.
Acts as -Nausea & vomiting.
Corrosive or irritant. -Reddening of lips. (in carbon monoxide poisoning)
Suffocating agent displacing oxygen.
Treatment:
Signs, symptoms and management: -Remove the patient from the spot.
-Open airway.
Ingested poison: -CPR if needed.
-Remove contaminated clothing, carefully.
-Provide intensive First aid, if possible.
Signs and symptoms
-Shift to hospital.
-Burns and stains around the mouth.
15 16
Injected poison: Absorbed poison:
17 18
4.Chemical Burns:
Caused by strong acids like Sulphuric Acid, Nitric Acid, etc., strong Alkalis like Caustic
Soda, Potash, Quick Lime, etc.
5.Electrical Burns:
Caused by high tension electric current.
6.Radiation Burns:
Caused by exposure to Sun, X-Rays, and radiation after Nuclear explosion, etc.
Severity of Burns:
This is judged by the area of burns than the degree of burns. Superficial burns affecting
larger area is more dangerous than third degree burns affecting a smaller area. Area of
burns is judged by “rule of nines”. Third Degree Burn
19 20
How to rescue a person from fire? Burns in the mouth and throat:
Clean air will be at ground level. So crawl along the floor to pull out the person. (Usually Chemical Burns or Scalds)
Tie a wet kerchief round your face, to prevent inhalation of smoke. Swelling of mouth, tongue, throat, etc. Can cause airway obstruction. So treat
Act quickly. accordingly.
Don't open the windows.
Sun burns:
Management: Remove to shady cool place & bathe with cool water.
In minor cases: Cover with sterile dressing.
Pour cold water. If water is not available, use any cold harmless liquid like milk, etc. Treat for general effects of over heating.
Remove any material of constrictive in nature, like rings, watches, belts, shoes, etc. Shift to hospital.
Apply clean dressing.
Don't break blisters or remove any loose skins. Prevention of burns:
Don't apply any ointments. Stoves should be kept at a higher level.
Don't apply adhesive dressings. Avoid free hanging clothes.
Avoid using clothes made of nylon or similar fibres, which can catch fire quickly.
In Severe Cases: Better use cotton.
Lay casualty down. Never open Fire unattended in hazardous area.
Pour water. Restrict entry of local ignition sources in hazardous area.
Protect the burnt area from contact with the ground. Never keep combustible material near to open or direct flame or sources of heat.
Gently remove any rings, watches, etc. Keep Inflammable materials safe.
Carefully remove any clothing soaked in boiling liquid.
Cover the injured area with sterile dressing and secure. 5. First aid kit
Don't remove anything that is sticking to the burnt area.
Don't break blisters.
Don't apply ointments, Tips for making First aid kit
Immobilise badly burnt limbs.
Give oral rehydration fluids, if person is conscious. Container To keep all first aid items in one common container.
If unconscious, open airway & check breathing. Complete “ABC” of resuscitation and Gauze Pads -To cover wounds and prevent infection.
then put in recovery position. Roll Bandage -To stabilize strains and sprains and cover wounds.
Shift to hospital. Triangular Bandage -To cover wounds and prevent infection .
Bandages -To stop minor bleeding and prevent infection.
Chemical burns: Adhesive Tape -To secure bandages to wounds.
Wash the chemical with large quantities of water. Antibacterial Ointment -To prevent infection on small cuts.
Ensure that the washings does not flow over normal areas. Calamine Lotion -To prevent itching.
Cut out contaminated clothing. Soap -To clean minor wounds and cuts and to prevent infection.
Treat as for burns. Latex Gloves -To protect the rescuer from infection and blood pathogens.
Bandage Scissors -To cut gauze and bandages.
Burns of eye: Tweezers -To pull splinters.
Wash immediately with cold water. Moleskin -To protect blisters and prevent infection.
Ensure washing do not flow over other eye. Antiseptic lotion - To prevent infections.
Caution the patient against rubbing the eye. Analgesic - Pain killer
Treat as for burns. Anti-inflamatory - pyretic/ painkiller
21 22
Establish where extra items are kept to restock the kit.
Make up an inventory list. One copy with the kit, one copy with the troop.
Show everyone the kit, what is in it, and how to find/use the contents.
23 24
Thermometer - Good to know just how high the fever is. The training programme should include instruction on the following:
Aspirin - You can carry this in the kits for cardiac issues. Assessing the scene for safety, number of injured, and nature of the event;
Ibuprofen - Used for ailments such as joint and muscle Assessing the toxic potential of the environment and the need for respiratory
pain, etc. protection;
Chap stick - Dehydration can lead to cracked lips. Establishing the presence of a confined space and the need for respiratory
Throat Lozenges - Helpful for a sore throat. protection and specialised training to perform a rescue;
Antacid - Helps with some of that camp cooking or for Prioritising care when there are several injured;
stomach illness or disorder. Assessing each victim for responsiveness, airway patency (blockage), breathing,
Sanitiser - In the field a quick way to wash up before and circulation, and medical alert tags;
after treatment. Taking a victim's history at the scene, including determining the mechanism of
Soap - J and J shampoo mixed with water works well to clean injury;
cuts. Small soap bars are available in the travel section. Performing a logical head-to-toe check for injuries;
Stressing the need to continuously monitor the victim;
Emphasising early activation of EMS;
Indications for and methods of safely moving and rescuing victims;
Repositioning ill/injured victims to prevent further injury.
The training program should be designed or adapted for the specific worksite and may
include first-aid instruction on the following:
Establishing responsiveness;
Establishing and maintaining an open and clear airway;
Performing rescue breathing;
Treating airway obstruction in a conscious victim;
Performing CPR;
Using an AED;
Recognising the signs and symptoms of shock and providing first aid for shock due
6. Elements of Training in first aid to illness or injury;
Assessing and treating a victim who has an unexplained change in level of
6.1 Teaching methods consciousness or sudden illness;
Controlling bleeding with direct pressure;
Poisoning;
Training programmes should incorporate the following principles:
Recognising asphyxiation and the danger of entering a confined space without
Having appropriate first-aid supplies and equipment available;
appropriate respiratory protection. Additional training is required if first-aid
Exposing trainees to acute injury and illness settings as well as to the appropriate
personnel will assist in the rescue from the confined space.
response through the use of visual aids;
Responding to Medical Emergencies
Including a course information resource for reference both during and after training;
Allowing enough time for emphasis on commonly occurring situations; -Chest pain;
Emphasising skills training and confidence-building over classroom lectures; -Stroke;
Emphasising quick response to first-aid situations. -Breathing problems;
-Anaphylactic reaction;
6.2 Assessing the scene and the victim(s)
25 26
-Hypoglycemia in diabetics taking insulin; 7. Conclusion
-Seizures;
-Pregnancy complications;
Many deaths and impact of injuries can be prevented with First Aid if causalities are
-Abdominal injury;
treated immediately. First aid is the initial care given to an injured person. Mostly, this
-Reduced level of consciousness;
timely care prior to the arrival of the medical help means the difference between life
-Impaled object.
and death.
It must start immediately when the injury or illness occurs and continue until medical
6.4 Responding to Non-Life-Threatening Emergencies
help arrives or the casualty recovers.
The training programme should be designed for the specific worksite and include first- The basic aims of first aid are:
aid instruction for the management of the following:
To save life
Wounds
To protect the casualty from getting more harm
-Assessment and first aid for wounds including abrasions, cuts, lacerations,
To reduce pain and
punctures, avulsions, amputations and crush injuries;
Priorities of Casualty Treatment
-Principles of wound care, including infection precautions;
-Principles of body substance isolation, universal precautions and use of personal
Priorities of Casualty Treatment
protective equipment.
Asphyxia
Burns
Cardiac Arrest
-Assessing the severity of a burn;
Severe Haemorrhage (Bleeding)
-Recognising whether a burn is thermal, electrical, or chemical and the appropriate
Other Injuries/Illnesses
first aid;
Shock
-Reviewing corrosive chemicals at a specific worksite, along with appropriate first
aid.
Temperature Extremes Immediate Requirement
-Exposure to cold, including frostbite and hypothermia;
-Exposure to heat, including heat cramps, heat exhaustion and heat stroke. Critical four minutes
Musculoskeletal Injuries One of the most common causes of an accidental death is due to loss of oxygen supply.
-Fractures; This is mostly caused by a blocked airway. Normally it takes less than four minutes for a
-Sprains, strains, contusions and cramps; blocked airway to cause death.
-Head, neck, back and spinal injuries;
-Appropriate handling of amputated body parts. The 'golden hour'
Eye injuries In emergency medicine, the golden hour is the first 60 minutes after the occurrence of
-First aid for eye injuries; a major multisystem trauma. It is widely believed that the victim's chances of survival
-First aid for chemical burns. are greatest if he or she receives definitive care within the first hour. First aid is the
Mouth and Teeth Injuries first step to save a victim.
-Oral injuries; lip and tongue injuries; broken and missing teeth;
-The importance of preventing aspiration of blood and/or teeth. The first aid steps can be summarised again as in next Fig-2.
Bites and Stings
-Human and animal bites;
-Bites and stings from insects; instruction in first-aid treatment of anaphylactic
shock.
27 28
DANGER 8. Glossary
BREATHING Health Risk: The chance of something happening that will have an impact upon the
Looks, listen and Feel huma health.
CIRCULATION
Do
Yes No
they have a
pulse?
Commence Ear
Commence CPR
(not breathing, pulse
(not breathing, no pulse)
present)
Fig-2
29 30
9. References Notes
3. www.hrdp-idrm.in
31 32