Asha - EFA Handout 2016

ASHA INTERNATIONAL INSTITUTE OF MARINE TECHNOLOGY
Course Handout
[ELEMENTARY FIRST AID]
ELEMENTARY FIRST AID

ASHA INTERNATIONAL INSTITUTE
OF MARINE TECHNOLOGY
Citi Tower, C wing 3RD Floor, Plot No.55 Sec 15 CBD Belapur, Navi Mumbai,
Maharashtra 400614 .Phone: 022 -65771777 | Phone: 022-41271093
Email: info@aiimtvns.com | Website: www.aiimtvns.com
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ISBN: 978-81-88863-54-9
EAN: 9788188863549
Edition: 2016
© All rights reserved Asha International Institute of Marine Technology

Controlled Copy
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BASIC DETAILS OF COURSE
Aims
This model course aims to provide the training for candidates to provide elementary first aid
on board ship, in accordance with Section A – VI/1 of the STCW Code.
Objective
This syllabus covers the requirements of the 2010 STCW Convention Chapter VI, Section
A-VI/1, Table A-VI/3. On meeting the minimum standard of competence in elementary first
aid, a trainee will be competent to take immediate action upon encountering an accident or
medical emergency until the arrival of a person with medical first aid skills or the person in
charge of medical care on board.
Entry standards
The course is open to all seafarers who are to serve on board sea-going merchant ships.
There are no particular educational requirements.
Required attendance:
100% attendance is required for successful completion of the course.
However, in exceptional circumstances, a student is allowed absence of up to one day
subject to his attending the lectures missed out during the next course at the same institute.
The institute shall keep proper records of such cases.
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Time Table
PE RI O D DAY 1 DAY 2
09001100 GENERAL PRINCIPLES, BODY BLEEDING . MANAGEMENT OF SHOCK
STRUCTURE AN D FUNCTIONS
1100-1115 TEA BREAK

BODY STRUCTURE AN D FUNCTIONS BURNS AND SCALDS
1115-1215
121 5-1315 POSITIONING OF CASUALTY. BURNS AND SCALDS

THE UNCONSCIOUS CASUALTY
1315-1345 LUNCH BREAK

RESUSCITATION RESCUE A ND TRANSPORT OF CASUALTY
1345-1500
1500-1515 TEA BREAK

1515-1615 RESUSCITATION RESCUE A ND TRANSPORT OF CASUALTY
( PR ATICAL )
1615-1730 BLEEDING COURSE DISCUSSIONAND ASSESSMENT

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Index
Subject Page
1 Principal of First Aid 6
2 Body Structure and Functions 8
3 Positioning of Casualty 14
4 The Unconscious Casualty 17
5 Resuscitation 20
6 Bleeding 25
7 Management of Shock 31
8 Burns, Scalds and Accidents caused by Electricity 34
9 Rescue and Transport of Casualty 36
10 Other Topics 41
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CHAPTER-1
GENERAL PRINCIPLES
DEFINITION
First Aid is the immediately assistance given to the injured or ill with available resources before medical
help is available.
AIM :. The aims of First Aid are:

To save life by removing any danger, immediately threatening life. To
prevent further injury and deterioration of the patient's condition. To
relieve pain.
To make medical care available at the earliest.
QUALITIES OF FIRST AIDER:

A good First Aider should be :
A good observer.
Able to act quickly.
Calm and collected.
Able to lead and control the crowd and take help from on lookers. Self
confident and able to judge which injuries need to be tackled first, Able to
reassure the apprehensive victim and his/her anxious or nervous relatives by
Demonstrating competence, expressing sympathy and providing reassurance.
PRINCIPLES OF FIRST AID:
Remove the patient to a place of safety.
Loosen clothing around the neck and waist to aid breathing.

Remove the patient.
Look for the following:
a) Is there any failure of breathing? If yes start Artificial Respiration.

EFA 6 Asha International Institute of Marine Technology
Course Handout
b) Is there any failure of circulation? If yes, start External Cardiac Message.
c) Is there severe bleeding? If yes, stop bleeding by pressing firmly the bleeding area with a pad
For few minutes or apply pressure on the pressure point.
Treat for shock.
Relive pain.
Avoid handling the casualty unnecessarily.
Arrange for the safe removal of the casualty to hospital

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CHAPTER- 2
BODY STRUCTURE AND FUNCTIONS
Treatment of illness on board ship requires some understanding of the anatomy and physiology of the
human body. The human body can be compared with a factory which required to perform various
departmental functions in coordination. Functioning of all the departments is essential as no particular
department can be said to be more important than other.
Every First Aider should be familiar with the various systems of the body and their functioning so that he
can understand and treat any abnormalities in an emergency.
Some of the systems are as follows:

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THE SKELETON SYSTEM:
The human body consists of the head, the trunk and the limbs. The framework of the body a: the follows:
SKULL:
The seven bones of the skull and the fourteen bones of the face are firmly united and incapable of
movement. The bone of the lower jaw the mandible however, can be moved UI and down as well as from
side to side.
BACKBONE OR THE VERTEBRAL COLUMN:
It is composed of 33 small bones called vertebrae. There are 7 vertebrate in the neck (cervical vertebrae),
12 in the back (thoracic vertebrae), 5 in the join together with the rumj (sacrum) and 4 fused together in the
vestigial tail (coccyx).
RIBS:
There are 12 ribs on each side, attached to the thoracic vertebrae at the back except lowest four. The ribs
are attached to the breast bone in front.
BREASTBONE OR STERNUM:
It is flat bone forming the front of the thoracic cage.

COLLARBONE OR CLAVICLE:
It extends from the sternum or breast bone to the shoulder.

SHOULDER BLADE OR SCAPULA:
A thin flat bone forming a part of the shoulder girdle.

UPPER LIMB BONES:
There is one long bone in the ann-the humerus and tow long bones in the fore ann-the radius and the ulna.
The wrist has 8 small bones and the hand has 19 bones.
HIPBONE OR INNOMINATE BONE:

There are two hip bones attached to the sacrum. Each hip bone is made of 3 bones-ilium, ischium and
pubic bone.
LOWER LIMB BONES:

There is one long bone is the thigh-the femur, two long bones in the leg-tibia and fibula, 7 small bones in
the ankle and 19 bones in the foot.
THE JOINTS:

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The various bones in the human body are joined to one another by ligaments. The joints may be movable
or immovable. Movements between bones may be only in one plane as in the hinge joints at knee and
elbow, in all planes as in the ball and socket joint at the shoulder or there may be just a small degree of
movement as in the wrist joint.

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THE MUSCLES:
The bones are covered with muscles. The muscles are attached to two bones and cross over joints so that
when the muscles contract, movement is produced at the joints by bringing the bones together. Since the
muscles can be contracted at will they are called voluntary muscles. They are also called striated muscles
because they reveal striations under a microscope. There is another type of muscle called involuntary
muscle which cannot be contracted at will e.g. muscle in the wall of the bowel, air passages and blood
vessels. These are also called smooth muscles because they do not show striations under a microscope.
The muscle of the heart is a special type of involuntary muscle known as cardiac muscle.
SKIN:
The body is covered by skin under which lies a layer of fat which acts as insulations. The skin protects
the underlying tissue from mechanical injury as well as from in citations. It maintains body temperature
and also functions as an excretory organ by the process of sweating.
SYSTEMS OF THE BODY:
The brain is the master organ. It receives information from organs of special senses such as eyes? ears,
nose, tongue and skin. It controls movement, interprets sensation, regulates body activities and generates
memory and thoughts.
CARDIO VASCULAR SYSTEM:
Figure : 3 The Heart and its circulation

The cardio vascular system is made up of the h e , aorta, superior and inferior venecava, the
pulmonary artery, pulmonary veins and the peripheral blood vessels. The heart is of the size and shape
one's closed first and weighs about 300-350 gms in adults. It has 3 layers, the covering layer is called
pericardium, middle layer is called myocardium and the innermost layer is called endocardium.
The heart has 4 chambers. The upper two are called atria and the lower two called ventricles.
There is a valve with three cusp called tricuspid valve between the right atrium and the right ventricle.
The valve between the left ventricle has two cusps and is called bicuspid valve or mitral valve.
The right atrium receives impure blood from the lower part of the body through inferior venecava
and upper part of the body through the superior venecava. This blood passes into the right ventricle
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during the relaxation of the ventricle. From the right ventricle blood is pumped into the, lungs through the
pulmonary artery. The blood purified by the lungs returns to the left atrium through
pulmonary veins and drains in to the left ventricle through the mitral valve during ventricular relaxation.
During ventricular contraction the mitral valve closes and blood is pumped into the aorta to be circulated to
the body through various arteries.
The blood flow in the arteries is pulsatile due to rhythmic contractions of the heart. This is felt as
pulse at deferent sites. The side of the neck-the carotid, on the front of wrist-the radial, at the root of the leg
the femoral, on the back of the knee - the popliteal etc. The normal pulse rate is 70-80 per minute.
The pressure generated by the pumping of the blood by the heart and the resistance offered by the
blood vessels is called blood pressure. It is different during contraction or systole of the heart and
relaxation or diastole of the heart and is called systolic. and diastolic blood pressure respectively. It is
measured by using in instrument called B.P. apparatus.
Normal blood pressure is between.
110/170 and 130/90 mm ofHg.
THE RESPIRATORY SYSTEM
The respiratory system is composed for lungs and the respiratory tract consists of the nose, nose-
pharynx the larynx, the trachea or the wind pipe, the bronchi and bronchioles. The bronchioles finally
break into small sac called alveoli which are surrounded by pulmonary capillaries. Gaseous exchange
between the inspired air in the alveoli and impure blood in the capillaries occur at this level. The lungs
are covered by a sac called pleura. The inside of the sac is smooth and filled with a thin layer of fluid to
allow expansion of lungs without friction. When thorax expands, the lungs expand and a t is drawn into the
alveoli which is known as inspiration. With collapsing of the thorax to the original size the air is thrown
out which is called expiration. The normal respiratory rate is 16-20 per minute in adult. It is more rapid in
children being 40 per minute in a new born baby and 30-32 per minute at the age of5. The ratio of
respiratory rate to pulse rate is 1 :4.
DIGESTIVE SYSTEM:
It is composed of the stomach, the small intestine, the large intestine, the rectum and the glands,
which secrete digestive enzyme into the gastrointestinal tract-the salivary glands, liver, pancreas etc.
URINARY SYSTEM:
It consists of the kidneys, ureters, urinary bladder & urethra. It is involved in the removal of chemical
waste from the blood and helps to balance water and salt levels of the blood by excreting urine.
ENDOCRINE SYSTEM:
It consists of number of glands which secrete various hormo-nes into the blood stream which
help to regulate body activities & functions. The pituitary gland is the master gland which controls the
activity of other glands, such as thyroid, adrenal and sex glands or gonads- testis and ovary.

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REPRODUCTIVE SYSTEM:
It consists of the gonads and the reproductive tract and the hormones needed for sexual reproduction.
IMMUNE SYSTEM
It protects the body from disease causing organism.
SPECIAL SENSE ORGANS:

It consists of various organs that link with the nervous system to
• Sight.
• Hearing.
• Taste.
• Smell.
• Sensations.

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CHAP'I'ER-3
POSITIONING OF CASUALTY
The patient is nursed in different positions in different situations. The commonly used positions are:
RECOVERY POSITION:
The patient who is unconscious but breathing and has got heart beat should be nursed in recovery position
Figure ; 4 Recovery Position
Advantages of recovery position:
It maintains open airway.
Tongue cannot fall to the back for the throat.
Head and neck will remain in the extended position so that the air passage is widened so that any
vomit or other fluid in the casualties mouth will drain freely.
Recovery position cannot be used:
When there are fractures to the upper or lower body.
When the casualty is lying in a confined space or if it is not possible to bend the limbs.
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2. PRONE POSITION:
A patient is placed on his abdomen with head turned to one side. A pillow is placed under the head and the
heads are kept on the sides. This position is used for
- Bums of the back.
Figure : 5 Prone Position
3. POSITIONING IN SHOCK:
Lay the casualty on the back and turn head to one side. Raise the legs with 2 pillows to improve blood
supply to the heart. If the victim has fracture on the lower limbs it should not be elevated unless they are
well splinted.
Figure : 6 Positioning in Shock
4. FOWLERS POSITION:
When a patient is having difficulty in breathing this position is used. The patient is kept in a sitting
position with the help of3 to 4 pillows.

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5. DORSAL RECUMBENT POSITION:
The patient is kept o- his back. A pillow is placed under the head and hands are kept on both the sides. It is
used for examination of the patient. This position without pillow is used in case of fracture of the spine and
also to give CPR (Cardio Pulmonary Respiration).
Figure: 8 Dorsal Recumbent Position

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CHAPTER-4
THE UNCONSCIOUS CASUALTY
DEFINITION: Unconsciousness is a state of complete loss of consciousness and the casualty is totally
unresponsive to many painful stimulus. He is unaware of surroundings and his body muscles are in a
complete state of relaxation.
CAUSES OFUNCONCSIOUSNESS:-
Brain injuries.
Fits or Convulsion.
Syncope or lack of cerebral circulation.

Infection of the coverings of the brain-or tissues ofbrain.
Brain tumors.
Exposure to extreme cold.

Severe infections.
Severe injuries.
Severe burns. Drugs
reaction. Electric
Shock.
Failure of Liver or Kidney.

Poisoning with chemical gas or alcohol.
Severe heart attack.
Drowning.
Diabetes.
Diabetes or overdose of insulin.
Severe bleeding or fluid loss.

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LEVE OF RESPONSIVENESS:
There are the stages through which a person may pass during progression from consciousness or Vlce
versa. Stage I
Stage II-Stage III -

Stag IV Stag V Stag
VI
He may respond normally to questions and conversations.

He answers direct questions.
He responds vaguely to questions.
He obeys commands.
He responds to pain only.
He does not respond at all.
FIRST AID MANAGEMENT:
First Aid Management of Unconsciousness:
1. Maintain the airway open and keep it clear.

2. See that there is a free supply of fresh air and that the air passage is free.
3. Take the casualty away from harmful gases if any or if inside a room open doors and windows.
4. Remove any loose dentures or detached teeth and clear the casualty's mouth of any vomit or blood.
5. Correct the tongue, which might have fallen back.
6. Loosen any tight clothing around neck, chest and waist.
7. Keep the casualty warm but do not over heat him.
8. Keep back the crowds. They only obstruct fresh air.
9. If breathing has stopped or about to stop. Put the person on hard surface or in Supine position or
flat position and start artificial respiration immediately.
10. Listen to the heart sound an feel pulse at wrist and neck by placing the tips of the two fingers of
one hand into the groove between the windpipe and the large muscles at the side of the neck.
11. Check the pupils of the eyes to see if they are dilated or constricted. When the heart stops beating the
pupils will stay dilated an will not react to light.

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12. Start heart compression at once without wasting time if the heart has stopped, as delay in
restoring blood flow will damage the brain and the person may die within 4-5 minutes.
13. Watch continuously for any changes in the condition of pulse respiration and level of
responsiveness.
14. If pulse and respiration is restored place the person in recovery position.
15. Turn casualty's face down, head to one side and no pillow under the head should be placed.
16. Do not leave the casualty until he is handed over to the medical hands on a stretcher.
17. Nothing should be gives orally when the patient remains unconsciousness.
18. Remove the underlying cause of unconsciousness.
19. restore breathing and heart beat.

20. Control bleeding if any.
21. Remove poisons.
22. Prevent any further injuries to the patients.
23. Never underestimate and do you not treat it as minor case of unconscious casualty.

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CHAPTER - 5
RESUSCITATION
BASIC LIFE SUPPORT :
Basic life support is an emergency life saving procedure that consists of recognizing and correcting
failure of the respiratory or cardiovascular systems Any profound disturbance of the breathing or the
circulation can promptly produce brain death.
Basic life support comprises-the ABC steps which concern the airway, breathing and circulation
respectively. Its prompt application-is indicated as:
a) Airway obstruction.
b) Breathing or respiratory arrest.
c) Circulatory or cardiac (Heart) arrest.

Basic life support requires 40 instruments or supplies and the correct application of the steps for dealing
with the above three problems can maintain life until the patient recovers sufficiently to be transported to a
hospital where he can be provided advanced life support system and must be taken with the maximum
sense of urgency in case of any inadequacy or absence of breathing or circulation.
If breathing alone is inadequate or absent all that is needed - to open the AIRWAY or to apply
ARTIFICIAL RESPIRATION.
If circulation is also absent artificial circulation must be started through "HEART

COMPRESSION" in combination with artificial respiration.
If breathing stops before the heart stops enough oxygen will be available in the lungs to maintain
life for several minutes. However, if the heart arrest occurs first, delivery of oxygen to the brain
ceases immediately.
Brain damage is possible if the brain is deprived of oxygen for 4-6 minutes. Beyond 6 mins brain
damage is very likely without oxygen.
Once you have started basic life support do not interrupt it for more than 5 sees. for any reason
except when it is necessary to move the patient. Even in that case interruption should not exceed 15
each.
ABC of CPR (Cardio Pulmonary Respiration) (Steps)

A for airway clearance.
B for breathing (assist in breathing).

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C for circulation (establish circulation).C for circulation (establish circulation).
STEP-A(Airway)
Establish an open airway.
Place the person in a face-up position on a hard surface.
Put one hand under the patient's neck and the other hand on the forehead.
Lift the neck with one hand and apply pressure on the forehead with the other keeping the head
backward.
This extends the neck and moves the base of the tongue away from the back ofthe throat. The
head should be maintained in the position during the entire artificial respiration and heart
compression procedure. If the airway is still obstructed with any foreign material in the mouth or
throat it should be removed immediately with the' fingers.
Once the airway has been opened the patient may or may not start breathing again.
To assess whether breathing is restored the person providing the basic life support must place his
ear about 2 to 3 cms above the nose and mouth of the patient.
If rescuer can feel and hear the movement of air and can see the patient's chest and abdomen
move breathing has returned ..
With airway obstruction it is possible that there will be no air movement even through the chest and
abdomen rise and fall with the patient's attempt to breath. Also observation ofthe chest and
abdominal movements is difficult when the patient is fully clothed
If the patient does not resume adequate spontaneous breathing promptly after his head has been tilted

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backward than artificial respiration should be given by the mouth" to mouth or mouth to nose method or
with other techniques. Regardless" of the method used he preservation of an open airway is essential.
MOUTH TO MOUTH RESPIRATION

Keep the patient's head to a maximum backward tilt with one head under neck.
Place the heel of the other hand or the forehead with the thumb and index finger towards the nose.
Pinch together the patient's nostrils with the thumb and index finger to prevent air from escaping
through the nose.
Continue to exert pressure on the forehead with the palm of the hand to maintain the backward tilt
of the head.
Take deep breath and them form a tight seal with your mouth over and around the patient's mouth.
Blow four quick full breaths at first without allowing the lungs to deflate fully.
Watch the patient's chest while inflating the lungs. If adequate respiration is taking place the
chest should rise and fall.
Remove your mouth and allow the patient to exhale passively. If you are in right position the
patients exhalation will be felt on your cheek.
Take another deep breath forma tight seal around the patient's mouth and blow into the mouth
again.
Repeat this procedure 10-12 times a minute (one every five seconds) for adults and children over
four years of age.
If there is no air exchange and an airway obstruction exists that is to remove withe forgers and
then resumes artificial respiration.
STEP-C (Heart Compression):

In attempting to bring back to life a non breathing person whose heart has stopped beating heart
compression (external heart compression) should be applied along with artificial respiration.
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TECHNIQUES FOR HEART COMPRESSION:
Compression of the sternum produces some artificial ventilation bit not enough for adequate
oxygenation of the blood .For this reason artificial respiration is always required whenever heart
compression is used.
Effective heart compression requires sufficient pressure to depress the patient's lower sternum
about 4-5 ems (in adult).
For chest compression to be effective the patient must be in a firm surface. If he is in a bed a
board or improvised support should be placed under his back. However chest compression must
not be delayed by a search for a firm support.
Kneel close to the side of the patient and place the heel of one hand over the lower half of the
sternum. Avoid placing the hand over the tip of the breast bone which extends down over the
upper abdomen as pressure on the lower end may tear the liver and lead to severe internal
bleeding.
Feel the tip of the sternum and place the heel of the hand about 4cm nearer to the head of the
patient.
Your fingers must never rest on the patient's ribs during compression since this increase the
possibility of rib fractures.
Place the heel of the other hand on top of the first one.
Rock forward so that your shoulders are directly above the patient's chest.
Keep your arms straight and exert adequate pressure almost directly downwards to depress an
adult's chest for 4-5 cms,
Compress the chest 60 items per minter for an about, if helper is available as this is enough to
maintain blood flow and slow enough to allow heart to fill with blood.
The compression should. be regular, smooth and interrupted- compression and relaxation being of
equal duration.
under no circumstances should compression be interrupted for more than five seconds. It is
preferable to have to rescuers because artificial circulation must be combined with artificial
respiration
The most effective artificial respiration and heart compression are achieves by giving one lung
inflation quickly after each five heart compressions. The compression rate should be 60 per
minute if two rescuers are operating.
One rescuer performs heart compression while the other remains at the patient's head keeping it
tilted back and continues artificial respiration.

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Figure : 11 (a)
A single rescuer has to perform both artificial respiration and artificial circulation using 15:2 ratio. Two
very quick lung inflations should be delivered after each 15 chest compressions without waiting for full
exhalation of the patient's breath.
Figure : 11 (b)
A rate of 80 chest compression per minute bust be maintained by a single 'rescuer in order to achieve 50 -
60 actual compression per minute because of interruption for the lung inflation.

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CHAPTER-6
BLEEDING
INTRODUCTION:
The human body contains approximately 5 liters of blood. A healthily adult can loose up tl half a liter of
blood without harmful effects but the loss of more than this can be threatening to life.
DEFINITION:
Bleeding (Hemorrhage) is an escape of blood from the vessels and hemorrhage of bleeding i a flow of
blood from an artery, vein or capillary.
EFFECTS OF BLEEDING (HAEMORRHAGE):

Hemorrhage from major blood vessels of the arms, neck and thigh may occur so rapidly am extensively
that death occurs in few minutes. So hemorrhage must be controlled immediately to prevent excessive
loss of bloods.
The loss of red blood cells causes a lack of oxygen to the body systems.
A decrease in blood volume causes a decrease in blood pressure.
The heart's pumping rate increases to compensate for reduces blood pressure
The force of the heart beat is reduces since there is less blood to pump.
TYPES OF BLEEDING:
There are three different types of hemorrhage or bleeding.
1. ARTERIAL BLEEDING
Blood is bright red in color.
It supurts at each contraction of h e .

Flow is Pulse type.
2. VENOUS BLEEDING
Blood is dark red in color.

It does not spurt.
Steady flow of blood.

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3. CAPILLARY BLEEDING
Blood is red in color.
It does not spurt.
Slow but even flow.

CHECKING EFFECTIVENESS OF HEART COMPRESSION
Check the reaction of the pupils. If the pupils contract when exposed to light this is a sign that the
brain is receiving adequate oxygen and blood.
Carotid (neck pulse) should be felt after first minute of heart compression & artificial respiration
and every five minutes thereafter. The pulse will indicate the effective ness of the heart
compression.
Return of color of the skin.
Figure: 12 Checking Effectiveness of Heart Compression
4. EXTERNAL & INTERNAL BLEEDING
Bleeding may occur externally following an injury to outside of the body or internally from an injury in
which blood escapes through tissue spaces or through the body cavity.
(A) EXTERNAL BLEEDING
If the bleeding is from the surface of the body it is called external bleeding.
Evidence of major external blood loss.
Symptoms and sign of shock.
Casualty complains of thirst.
Blurring of vision.

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Fainting and giddiness.

Face and lips becomes pale.
Skin feels cold.
Pulse becomes faster but weaker.
Restlessness and sweating.
Breathing becomes shallow.
Unconsciousness.
(B) INTERNAL BLEEDING
If the bleeding is within the chest, skull or abdomen it is called internal bleeding because this cannot be
seen immediately but later the blood may ooze out through the nose or ear or coughed up from the lungs
or vomited from stomach.
History of sufficient injury to cause internal bleeding. I

Wounds that have penetrated the skull.
− Wounds that have penetrate the chest wall or abdomen.
History or medical condition which may cause internal bleeding like ulcer etc. Pain and
swelling around the affected area.
Signs of shock.
− Blood may appear from one of the body orifices as nose, ear, mouth, rectum, urethra, vagina
etc. FIRST AID MANAGEMENT:
AIM:
1. Control of bleeding as soon as possible.
2. Keep the wound clean and dress it to minimize blood loss and to prevent infection.
GENERAL MANAGEMENT:
1. Place the person in such a position that he/she will be least affected by the loss of blood.
2. Lie the person down and raise his legs in semi flexed position.
3. Control the bleeding.
4. Maintain the airway.

5. Prevent the loss of body heat by putting blankets under and over the person.
6. Keep him/her at rest as movement will increase heart action which causes the blood to flow
faster and perhaps interfere with clot formation.

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SPECIFIC MANAGEMENT:
(A) MINOR BLEEDING-
1. Wash your hands before dealing with wound.
2. If the wound if dirty lightly rinse it with running water if available.
3. Protect the wound with clean cloth and clean the surrounding skin with soap and water, if
available, and make it dry.
4. Dress a small wound with a band aid.
5. Raise and support the injured part unless you suspect and underlying fracture.
6. If the wound is larger apply medicated dressing or gauze or clean pad and bandage firmly in
position.
7. If in doubt seek medical help.
(A) MAJOR EXTERNAL BLEEDING:

THERE ARE FOUR METHODS TO CONTROL EXTERNAL BLEEDING (i)
DIRECT PRESSURE•
Do not waste your time hunting for dressing. Place your hand directly over to the wound and apply
pressure. Keep applying firm and steady pressure. If the wound is large squeeze the edge together.
If dressing or clean cloth is available use it and apply pressure until bleeding has stopped. This
may take 10-30 minutes or longer.
Tie the bandage firmly enough to control bleeding but not so tight to cut off circulation.
Never replace any dressing once it is in place.
If dressing is soaked with blood place another dressing directly over the blood soaked
dressing and hold it in place with firm pressure.
Immobilize and support the injured part.
(2) ELEVATION
Raise the bleeding part of the body above the level of the heart so that the flow of blood will slow
down in that part and clotting will speed up.
(3) . PRESSURE POINTS
Arterial bleeding can be controlled by thumb or finger pressure applied at the pres sure points
(Figure 13).
Pressure points are the places where arteries are close to the skin.
Pressing the artery against the underlying bone can control flow of blood to the injured part.

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(4) . APPLYING AT OUR NIQUET

A tourniquet is a strip of rubber or cloth used to control severe bleeding.
It should be used only for severe life threatening bleeding that cannot be controlled by other
means.
It can be used only in upper and lower limbs.
INTERNAL BLEEDING - FIRST AID PROCEDURE

Keep the person down with the head low and to one side to ensure good blood supply to brain.
Advise the person not to move.
If condition allows raise his legs to aid the return of blood low to important body organs.
Loosen any tight clothing around the neck, chest and waist.
Minimize shock.
Check breathing rate, pulse and level of responsiveness or consciousness.

Place the person in recovery position, if unconscious but breathing.
If breathing is stopped begin mouth to mouth resuscitation with chest massage and continue it.
Remove to hospital immediately and transport in a stretcher.
Do not apply hot water bottle or ice bag on to the chest or abdomen.
Do not hive anything to eat or drink because he may have to undergo surgery.

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CHAPTER-7
MANAGEMENT OF SHOCK
WHAT IS SHOCK?
Shock is a state of inadequate tissue perfusion. In other words it is a state of not enough oxygen and
nutrients are being delivered to the cells to keep them alive. Shock is the result of a decrease in the vital
functions of various organs of the body that results from a decrease in effective circulating oxygenated
blood or fluid in the body as a result of injury or illness.
EFFECTS OF SHOCK
It can vary from faintness to complete collapse.
Early loss of consciousness that mainly involves the nervous system and that may be fatal.
Progressive loss of blood from active circulation which may lead to failure of heart output and
insufficient oxygen to cells that are vital for survival.
Continuous lowering of blood pressure which may lead to kidney and liver failure.
CAUSES OF SHOCK
Severe or extensive injury.
Severe pain.
Heart attack.
Loss of blood that in internal or external bleeding.
Severe bum which leads to loss of body fluids.
Electric shock or electric shock or electrocution.

Exposure to extreme heat and Cole.
Drugs or allergic reactions.
Poisoning from drugs, gases and other chemicals and also from alcohol intoxication stress and
fright.
Bites or stings of poisonous snarled or insects.

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TYPES OF SHOCK
1. NERVOUS SHOCK.
Nervous shock is due to strong emotional upset that is fear, pain good or bad nose.
It may also result from spinal or head injury result in loss of control ofnervous system.
2. HAEMORRAGIC SHOCK
Owing to loss of blood from external bleeding or loss of body fluid due to wounds multiple injures or
severe bums, severe vomiting and loose motions.
3. CARDIOGENIC SHOCK
Cardiac muscles not pumping effectively due to injury or previous heart attack and the damaged heart
muscles no longer impart sufficient pressure to circulate the blood.
4. BACTERIAL OR SEPTIC SHOCK

Severe infection caused by bacteria, discharge of toxins into the blood causes pulling of blood in
capillaries with dislocation of vessels and not enough blood remains available for tissues.
5. ANAPHYLACTIC SHOCK,
It is a severe allergic reaction of the body with some drugs or foreign proteins to which the person is
sensitive. It causes dilatation of blood in the surrounding area,
6. ELECTRIC SHOCK
Owing to electrocution or high voltage electric current if any part of the body comes in content with a
live wire which is exposed and not covered by insulator or with a cable or a rail in which current is
passing through a person, gets .an electric shock.
SIGNS AND SYMPTOMS
Casualty is anxious and restlessness.

Weakness, fainting or giddiness and disorientation.
The skin is pale, cold and often moist but later it may develop a bluish \ash colour. Shallow,
rapid or gasping breathing.
Nausea, vomiting and extreme thirst.

Unconsciousness.
Blood pressure falls.

Pupils are dilated.
Evidence of associated external and internal injury.
FIRST AID TREATMENT
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Reassure and comfort the casualty when conscious.

Remove the causes of shock, this includes controlling of breathing, restoring breathing and
relieving severe pain.
Loosen any tight clothing to help the circulation ad assist breathing.

Keep the patient warm but do not cover heat.
Check breathing rage, pulse rate and level of consciousness.

Keep the person in recovery position.
If breathing and heart beat stops then clear and establish an airway.
Begin mouth to mouth resuscitation with chest message...
Administer fluids but liquids should not be given by mouth to the patient in conscious and
having any injuries to chest and abdomen.
Remove to hospital immediately.
Transport in stretcher case maintaining the treatment position.

DONOT
Apply hot water bottle as this will increase the blood who to the vessels of the skin and take it away from
the vital organs.
Move the casualty unnecessarily as this will increase shock.
Give the casualty any thing by mouth as it will present or dealy the surgery. Give alcohol.
Let the casualty smoke.

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CHAPTER -8
BURNS, SCALDS AND ACCIDENTS CAUSED BY

ELECTRICITY
Bums and Scalds are dangerous because not only they can cause death but delayed effects like Scarring
and deformity can be quite distressing. Hence prompt and correct treatment of burns and scalds are
essential.
Burns are the injuries that result from dry heat like
Fire .
− Contact with hot metals.
− Chemicals e.g. Nitric acid, Sulphuric acid, Ammonia Castic soda etc.
Electricity.
− Radiation.
− Scalds are injurious caused by moist heat like boiling water, steam oil hot tar and hot liquid. The
result of the bums and scalds are same.
DANGERS OF BURNS:
Shock - Shock developed because plasma leaks out of circulatory system in to burnt area. Infection -
There is a great risk of infection with bums because skin is damaged and there is no protection against
micro organisms.
CLASSIFICATION OF BURNS:
(A) Area - Burns are classified on the basis of area. Any burn over 30% should be hospitalized as
priority.
(B) Severity of burn:
Superficial burn involves the skin and blister formation takes place. All other burns are deep burns.
FIRST AID MANAGEMENT:
Put out the fire by pouring water or wrapping in blanket. Do not allow the person or fire to run
about especially in fresh air. Immerse the burnt part in cold water using a bucket. A bowl, a kitchen sink or
hold the affected ayes under running cold water. Keep the part in cold water for 15-20 minutes or until the
pain disappears. If that is not possible soak clean cloth in cold water and put it over the burnt area. It needs
Course Handout
to be changed frequently. Application of cold water removes residual heat from tissue and prevents
further damage.Cover burnt area with sterile dressing or freshly laundered lines. Avoid exposure in air. In
case of bums over face, make the dressing in the shape of a mask, with holes at the level of the nose for
breathing. Remove rings, bracelets, shoes and any other light fitting article as swelling may develop later
on making it difficult to remove them. Arrange for immediate transfer to hospital.
Give plenty of fluids to drink, inpatient can tolerate.When large areas are damaged pack ice in a clean towel
and apply it to the burnt area during transfer to a hospital. Do not put oil, lotions or ointments on the burnt
area. Do not pull away burnt clothing stuck to the body.
Do not handle or touch the patient unless it is absolutely necessary.
In chemical bums the damage continues as long as the chemical remains in contact with skin. Remove
the contaminated clothing carefully after soaking in water. Take care not to contaminate yourself. Flood the
affected area with water thoroughly and systematically for 10-15 minutes. One may use soda bi carbonate
solution to wash acid burns and vinegar to wash alkali bums before washing with water.Render general
care.
ELECTRIC BURNS:
Electrical injuries are due to the effect of high tension electric current or atmospheric electricity
as in lightening. The heat generated during passage of current through the body causes deep bums at the
exit and entrance of the current.
In case of DC source the patient remains stuck to the source of the electricity until the current is
discontinued. Hence the damage is extensive. In case of AC source the damage is less. There may be
physical injury when the patient falls down. The electrical current can disturb the respiratory centre and the
cardiovascular centre causing respiratory arrest and cardiac arrest respectively Damp clothing, damp foot
wear and damp ground increase electrical conductivity and make the damage worse. The patient may be
in shock.
The measures should be taken are :-
Switch off the current and remove the plug from the socket.
If the patient is lying in water keep out of it yourself as water is an excellent conductor of
electricity. For the same reason do not hold the patient under the arm pits.
If the patient is in contact with a live wire, the current in which cannot be switched off, separate the
wire from the patient using a long dry wooden stick and while standing on a nonconductor of
electricity like a wooden board or a pile of newspaper. Wear rubber gloves if available.
Render artificial respiration and external cardiac massage if necessary.

Treat for shock if present,
Treat for burns.
Give fluids to drink.
Arrange for medical aid.
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CHAPTER- 9
RESCUE AND TRANSPORTATION OF CASUALTY
The removal of a sick or injured person either from the site of an accident or ashore is a matter of
importance, since his life may depend on the arrangements made.
GENERAL PRINCIPLE TO BE OBSERVED WHILE TRANSPORTING A PAITENT:

− Arrest severe hemorrhage, treat for shock, splint fracture securely and cover wounds before
moving the patient.
− Support the injured part well while moving the patient.
Do not allow the patient with SOCK, hemorrhage, or head injury to walk even if the patient
is conscious.
− During transportation constantly observe the casualty's condition.
− Transportation must be safe, steady and speedy.
Method
− Method of transportation depends upon various factors.
− Number of helpers available.
Modes of transportation.
− Type of injury.
− Distance to be covered.
Nature of the route to be covered.

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Figure : Neck Drag
Figure :Human Crutch Figure : Pick a Back

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CHAPTER-10
Other Topics
Bandaging
A bandage is a piece of material used either to support a medical device such as a dressing or
splint, or on its own to provide support to or to restrict the movement of a part of the body. When
used with a dressing, the dressing is applied directly on a wound, and a bandage used to hold the
dressing in place. Other bandages are used without dressings, such as elastic bandages that are
used to reduce swelling or provide support to a sprained ankle. Tight bandages can be used to
slow blood flow to an extremity, such as when a leg or arm is bleeding heavily.
Bandages are available in a wide range of types, from generic cloth strips to specialized shaped
bandages designed for a specific limb or part of the body. Bandages can often be improvised as
the situation demands, using clothing, blankets or other material. In American English, the word
bandage is often used to indicate a small gauze dressing attached to an adhesive bandage.
List of Baddage in First aid kits
• Adhesive bandages (various sizes)

• Ace bandages
Enclose Space
A ship is a complex structure from inside with several small and enclosed spaces. Many of these
enclosed spaces are used for installing some machinery or for storing machine parts or workshop
equipments. Because of zero ventilation, these enclosed places generate and store toxic gases
which are either produced from chemicals stored in the place or leakage from pipelines. If a
person enters such place without taking precaution, he or she may suffer unconsciousness and
sometimes even death.
In order to prevent such unfortunate circumstances there is a proper procedure that needs to be
followed for safety and wellness of the person entering the enclosed space.
Procedure for Entering an Enclosed Space
The following are the points that need to be followed before entering an enclosed space:
• Ÿ Risk assessment to be carried out by a competent officer as enclosed or confined space

entry is deficient in oxygen, making it a potential life hazard.

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• Ÿ A list of work to be done should be made for the ease of assessment for e.g. if welding
to be carried out or some pipe replacement etc. This helps in carrying out the work
quickly and easily.
• Ÿ Risk assessment also needs to be carried out. Risk assessment includes what work to
be done, rescue operation etc.
• Ÿ Potential hazards are to be identified such as presence of toxic gases.
• Ÿ Opening and securing has to be done and precaution should be taken to check if the
opening of enclosed space is pressurized or not.
• Ÿ All fire hazard possibilities should be minimized if hot work is to be carried out. This
can be done by emptying the fuel tank or chemical tanknearby the hot work place.
• Ÿ The confined space has to be well ventilated before entering.
• Ÿ The space has to be checked for oxygen content and other gas content with the help of
oxygen analyzer and gas detector.
• Ÿ The oxygen content should read 20% by volume. Percentage less than that is not
acceptable and more time for ventilation should be given in such circumstances.
• Ÿ Enough lighting and illumination should be present in the enclosed space before
entering.
• Ÿ A proper permit to work has to be filled out and checklist to be checked so as to
prevent any accident which can endanger life.
• Ÿ Permit to work is to be valid only for a certain time period. If time period expires then
again new permit is to be issued and checklist is to be filled out.
• Ÿ Permit to work has to be checked and permitted by the Master of the ship in order to
work in confined space.
• Ÿ Proper signs and Men at work sign boards should be provided at required places so
that person should not start any equipment, machinery or any operation in the confined
space endangering life of the people working.
• Ÿ Duty officer has to be informed before entering the enclosed space.
• Ÿ The checklist has to be signed by the person involved in entry and also by a competent
officer.
• Ÿ One person always has to be kept standby to communicate with the person inside the
space.
• Ÿ The person may also carry a life line with him inside.
• Ÿ The person should carry oxygen analyzer with him inside the enclosed space and it
should be on all the time to monitor the oxygen content. As soon as level drops, the
analyzer should sound alarm and the space should be evacuated quickly without any
delay.
• Ÿ No source of ignition has to be taken inside unless the Master or competent officer is
satisfied.
• Ÿ The number of persons entering should be constrained to the adequate number of
persons who are actually needed inside for work.
• Ÿ The rescue and resuscitation equipment are to be present outside the confined space.
Rescue equipment includes breathing air apparatus and spare charge bottles.
• Ÿ Means of hoisting an incapacitated person should be available.
• Ÿ After finishing the work and when the person is out of the enclosed space, the after
work checklist has to be filled.
• Ÿ The permit to work has to be closed after this

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Infectious diseases
Exposures to blood and other body fluids occur across a wide variety of occupations. Health care
workers, emergency response and public safety personnel, and other workers can be exposed to
blood through needlestick and other sharps injuries, mucous membrane, and skin exposures. The
pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus
(HBV), and hepatitis C virus (HCV). Workers and employers are urged to take advantage of
available engineering controls and work practices to prevent exposure to blood and other body
fluids.
Standard Precautions
Standard precautions are a set of infection control practices used to prevent transmission of
diseases that can be acquired by contact with blood, body fluids, non-intact skin (including
rashes), and mucous membranes. These measures are to be used when providing care to all
individuals, whether or not they appear infectious or symptomatic.
Hand Hygiene
Personal Protective Equipment (PPE)
Needlestick and Sharps Injury Prevention
Cleaning and Disinfection
Respiratory Hygiene (Cough Etiquette)
Waste Disposal
Safe Injection Practices
Personal Health and Hygiene
It seems that every day we are bombarded with new beauty products and health fads that are
supposed to keep us fit, healthy and beautiful. All of this information coming at us at once, half
of it which contradicts the rest, can be very overwhelming (and not to mention expensive). As a
result, the importance of basic hygiene and healthy living can get lost along the way.
Thankfully, taking good care of your health and practicing proper hygiene doesn’t have to be
complicated. The health and beauty industry want to make you believe that you must rely on a
wide array of products in order to stay healthy and beautiful; but the truth is, in the end they are
just looking for your money. This is not to say that there are not some useful products out there;
and I have to admit, I fall under the spell of effective advertising from time to time myself.
However, the truth is that you don’t need to spend a lot of money, sacrifice a lot of your time or
endure a great deal of pain in order to look and feel your best.

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When it comes to personal health and hygiene, it’s about time that we went back to the basics.
Following these simple rules will ensure that you won’t need a lot of products or services to keep
you looking great and feeling even better.
1. Eat right. I know, you’ve heard it a million times before, but that is because it is truly one of
the most important keys to healthy living. What you put in your body has a major effect on
nearly all of your bodily functions. From preventing disease, maintaining a healthy weight,
sleeping well and staying regular, the benefits of eating a healthy, varied diet cannot be stressed
enough.
2. Exercise. Many people think of exercise as just a way to lose weight and stay fit; but exercise
has many important benefits that we often forget. For example, exercise regulates your sleep
cycles, improved digestion and releases endorphins that increase the feeling of mental and
emotional well-being. When you visit the doctor complaining of nearly any health issue, the first
things that they are going to recommend is a proper diet and regular exercise.
3. Bathe. While this one may seem obvious, many people do not bathe as regularly as they
should. Even if your don’t wash your hair everyday due to dryness, slap on a shower cap and
make sure the rest of you is getting clean on a daily basis. After all, you don’t want to be the
funky-smelling girl or guy at the office.
4. Oral care. We all know that oral hygiene is extremely important for healthy teeth and gums.
We know that we should brush at least twice a day, floss regularly and visit the dentist at least
once a year. We try to avoid snacks that are high in sugar, like soda and candy, and eat healthy
fare that is good for our dental health. However, even if we think that we are doing everything
right, chances are that we could be doing better. Most people need to revisit the basics. For
instance, you should brush your teeth for a minimum of two minutes at a time to ensure that you
thoroughly clean every surface of your mouth, including your tongue. Also, most people
underestimate the importance of flossing daily, which helps remove the bacteria-ridden food
from between your teeth that your toothbrush can’t reach.
5. Skin care. Your skin is your body’s largest organ and one that is often neglected and taken for
granted. Taking care of your skin from within includes eating right and exercising. As far as the
outside goes, make sure to cleanse and exfoliate regularly, wear sunscreen every day and avoid
excessive sun exposure.
That’s it folks. While this all may seem overly simplistic, I think that getting back to the basics is
exactly what we need to do. Instead of focusing on little details, like how to get rid of cellulite or
crow’s feet, focus on your health and well-being as a whole. Either those little things will come
later, or you will start to feel so go about yourself that they won’t bother you anymore.

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ASHA INTERNATIONAL INSTITUTE OF MARINE TECHNOLOGY

ELEMENTARY FIRST AID

© All rights reserved Asha International Institute of Marine Technology

BASIC DETAILS OF COURSE

1100-1115 TEA BREAK

121 5-1315 POSITIONING OF CASUALTY. BURNS AND SCALDS

1315-1345 LUNCH BREAK

1500-1515 TEA BREAK

1615-1730 BLEEDING COURSE DISCUSSIONAND ASSESSMENT

1 Principal of First Aid 6

2 Body Structure and Functions 8

4 The Unconscious Casualty 17

8 Burns, Scalds and Accidents caused by Electricity 34

9 Rescue and Transport of Casualty 36

AIM :. The aims of First Aid are:

QUALITIES OF FIRST AIDER:

PRINCIPLES OF FIRST AID:

Remove the patient to a place of safety.

Loosen clothing around the neck and waist to aid breathing.

Look for the following:

a) Is there any failure of breathing? If yes start Artificial Respiration.

b) Is there any failure of circulation? If yes, start External Cardiac Message.

For few minutes or apply pressure on the pressure point.

Treat for shock.

Avoid handling the casualty unnecessarily.

Arrange for the safe removal of the casualty to hospital

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BODY STRUCTURE AND FUNCTIONS

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THE SKELETON SYSTEM:

BACKBONE OR THE VERTEBRAL COLUMN:

It is flat bone forming the front of the thoracic cage.

It extends from the sternum or breast bone to the shoulder.

A thin flat bone forming a part of the shoulder girdle.

HIPBONE OR INNOMINATE BONE:

LOWER LIMB BONES:

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SYSTEMS OF THE BODY:

Figure : 3 The Heart and its circulation

110/170 and 130/90 mm ofHg.

THE RESPIRATORY SYSTEM

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It protects the body from disease causing organism.

SPECIAL SENSE ORGANS:

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Figure ; 4 Recovery Position

Advantages of recovery position:

It maintains open airway.

Tongue cannot fall to the back for the throat.

Recovery position cannot be used:

When there are fractures to the upper or lower body.

- Bums of the back.

Figure : 5 Prone Position

Figure : 6 Positioning in Shock

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5. DORSAL RECUMBENT POSITION:

Figure: 8 Dorsal Recumbent Position

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