PCN/M13/G/7

FIRST AID AND EMERGENCY CARE

Learning Objectives

i. To define emergency care

ii. Understand the process of First Aid

iii. Recognize a First Aid patient

iv. Understand various First Aid techniques and procedures

Course Outline

• Definition
• Aims and Objectives
• Scope of first aid
• Rules Guiding first aid
• Trends in emergency care
Definition

First aid is the skilled emergency care given to an injured or sick person before the arrival of a

doctor, medical personnel or before taking the victim to the hospital, using available materials at

the scene.

First aid is an important branch of medical science and safety in which the pharmacist has a

recognized role to play. It is an integral part of Emergency Care.

Emergency care provides initial intervention by the first responder in serious medical conditions

prior to the arrival of the emergency medical technicians (EMTs). It includes activities such as

performing cardio-pulmonary resuscitation (CPR) while awaiting an ambulance, as well as

caring for minor conditions, such as applying a gauze bandage to the cut.

Emergency care is concerned with both illnesses and injuries. Emergency care provides

emotional support to the casualties who are frightened because of an accident. Basic life support

measures are required in life threatening situations. The care provided keeps the casualty from

going into shock and perhaps dying. In an emergency, you may have to breathe for a patient and

keep his blood circulating (cardiopulmonary resuscitation- CPR). Emergency care is caring for

bruises, cuts, burns, fractures and internal injuries. Emergency care can be simple and at other

times very complicated but it saves the lives of the casualty. Emergency care also recognizes the

management of heart attacks, strokes, respiratory illnesses, diabetes emergencies, childbirth,

poisonings and drug abuse.

Good Samaritan Law:

The Good Samaritan law offers legal protection to someone who offers first aid in an emergency

to an injured person on a voluntary basis and if unconscious and the victim cannot respond or

speak, a Good Samaritan can help them on the grounds of implied consent.

Implied Consent:

This involves the implied consent when first aid is given to an unresponsive victim in a life-

threatening condition. It is assumed or “implied” that an unresponsive victim would consent to

lifesaving help.

CAB Concept:

DR CAB of First Aid. Check for Danger (D), respond (R), Check for the circulation (C),

thereafter the Airways (A) and then check that the victim is breathing (B).

Recovery Position:

If a victim is breathing, put him or her in the Recovery Position, which means turning the victim

to their side with lower arm in front.

Cardio Pulmonary Resuscitation (CPR):

If a victim is not breathing i.e. if the victim is unconscious, commence CPR (Cardio Pulmonary

Resuscitation); 30 compressions and 2 puffs until help comes or until the patient coughs or is

resuscitated.

Cardio Cerebral Resuscitation (CCR): The CCR is an alternative to the traditional CPR, for out

of hospital cardiac arrest. In contrast to CPR, CCR eliminate the mouth to mouth ventilation and

emphasizes continuous chest compression.

Aims and Objectives

This is usually referred to 3 P’s of First Aid

• Preserve life: the foremost objective of all medical care which includes first aid, is to

save lives and minimize the threat of death.

• Prevent further deterioration: also referred to as preventing the condition from

worsening, this covers both external factors, such as moving a patient away from any

cause of harm and applying first aid techniques like the immobilization of Fractures to

forestall a downward spiral in the casualty’s state of health.

• Promote recovery: first aid also involves trying to start the recovery process from the

illness or injury, and in some cases might involve completing a treatment, such as in the

case of applying a plaster to a small wound.

• More recently, with displacement of people in the population, etc. the issue of

psychosocial First Aid has come up, the aim being To provide reassurance and comfort

and alleviate suffering

Scope of first aid

1. In 10 seconds, survey or assess the scene

2. Assess victim(s); check for response and breathing

3. Diagnosis: The first aider should be able to identify and say in simple terms what the

problem is with the victim. eg broken bone, unconsciousness etc

4. Treatment: Treatment here implies all measures taken to preserve the life of the victim.
 5. Evacuation: The first aider should institute evacuation procedure according to standard

procedures or as laid down by his organization, and. make arrangement to transport

victim to the nearest hospital or clinic as quickly as possible.

Rules Guiding First Aid

1. Keep calm: Do not panic. Take charge

2. Use your own initiative. Rules may be broken depending on the prevailing situations

especially where first aider and the victim may be exposed to further danger, as in a fire

accident.

3. Do not attempt to do too much if you are unsure of what to do. Note that it may be better

not to do anything at all than to do something that will endanger the life of the victim.

4. Reassure victim all the time. This can be demonstrated by words of mouth or by action.

5. Do not move victim unless absolutely necessary, that is when the victim is exposed to

further danger as in the case of fire, drowning etc.

6. Do not allow people to crowd around you. Use others to keep the crowd away.

7. Do not have the victim unattended until the doctor takes charge

8. Loosen any tight or restrictive clothing around the neck and waist to allow easy breathing

and blood circulation.

Trends in Emergency Care

Current trends in emergency care involve the rapid movement of patients using specially

kitted air ambulances and helicopters. The insertion of self - contained EMERGENCY
 CARE PODS in regular aircraft is also popular. The pharmacist in the 21st Century will need

to be aware of universal precautions, able to stock emergency drugs and identify appropriate

medical consumables which are essential for keeping the patient alive.

Practical Techniques in First Aid

The human body is composed of a number of systems, each with a specific role in the function of

the body as a whole. There are some essential anatomical systems as far as first aid is concerned.

This section will address some of those systems.

Cardiovascular:

Cardiovascular emergencies are usually very serious and may be due to a stroke or heart attack.

If the person does not get help in 5 minutes he or she may have brain damage; and if help does

not come in 10 minutes the person may die. Thus, the best way to handle a cardiovascular

emergency is by applying DR CAB. If the person is unconscious, apply CCR, CPR or where

available, use the AED (Automated Electro Defibrillator). A person with cardiac arrest does not

respond when they are called; however they can be helped and the earlier they are helped the

better so as to avoid brain damage or permanent disability.

Respiratory

There are many respiratory / airway emergencies; however the most severe is due to inhaled or

ingested hydrocarbons. In such cases, Loosen tight clothing, ensure that the person is moved to a

well ventilated area, and stabilize the airways by administering oxygen as quickly as hospital,
thus the need to evacuate to a hospital in the shortest time possible. The risk of the patient

vomiting must be minimized to avoid aspiration which will further worsen the condition. If the

hydrocarbon is ingested by mouth do not induce vomiting as this can lead to aspiration.

Activated charcoal is not recommended as it hardly adsorbs the hydrocarbon and may cause

distention of the stomach leading to vomiting and an increased risk of aspiration.

Among other airway emergencies are, status asthmaticus; a severe acute asthmatic attack which

is life threatening and is severely worsened by the application of metred dose inhalers. The

condition is severely life threatening and should be treated with intravenous administration of

corticosteroids, usually by a medical practitioner. Status asthmaticus is best treated in a hospital.

MUSCULOSKELETAL

(Dislocations, Sprains & Strains): For most, the RICE procedure of Rest, Ice (apply an ice pack

after resting the limb), Compression (apply pressure) and Elevation (elevate the limb). This is

the RICE principle for sprains and strains. Always treat these as if they were fractures; get

medical attention, unless it is a minor injury.

Common emergency conditions

Bites and Stings

Bites and stings are common in a third world countries such as ours. There are different types of

bites and stings but a cold compress is usually a first response. This could be due to animal

bites, human bites, insect stings, or marine life. Some could be life threatening like the sting

fish; however most bites and stings can be treated by applying ice pack to constrict the blood

vessels and restrict absorption of the venom, and get the victim to the hospital as quickly as

possible. Whether the bite is by an insect, spider, dog or snake, it is necessary to apply the right

first aid procedures and seek proper medical assistance

First Aid Care

Sting and bites

• If the stinger is visible on the skin, try to remove it by gentle dislodgement with a clean flat

edged item like a cardboard.

• Wash the area with soap and water.

• Place a cold compress or an ice pack (wrapped in a cloth to protect the skin) on the sting or

bite for about 10 minutes to reduce pain and swelling.

• Apply calamine lotion, an antihistamine cream, or a paste of baking soda and water to the

area several times a day until itching and pain are resolved.
Advanced First Aid care for Severe Allergic Reaction

• Ask the casualty whether he or she carries an epinephrine injector, and if so, assist him or

her to use it according to label directions, apply as shown in diagram. Call 112

• Help the person to remain calm and lie quietly with the legs elevated. If vomiting occurs,

turn the casualty onto his or her side to prevent choking.

• If the casualty becomes unconscious and stops breathing, commence CPR, and continue

until medical help arrives. Some patients who react to food ingredients, certain chemicals

such as perfumes etc carry around an auto-injector device loaded with epinephrine.

Spiders

Most spider bites are harmless. Several hours to a day after the bite, you may notice symptoms

similar to an insect sting or bite, such as redness, swelling, pain, or itching. However, two kinds

of spiders can cause a more serious reaction: the black widow and the brown recluse. Both can

be easily identified. The black widow spider is about a half-inch long. It has a black body with a

red hourglass marking on the underside of its abdomen. Some black widows have red spots on

the upper surface of the abdomen with crosswise red bars on the underside. Black widow spider

venom causes problems with the nervous system. Within a few hours of a bite, you may notice

intense pain at the site of the bite, along with chills or fever, abdominal pain, nausea, and

vomiting.

Snake bites

Most snake bites are innocuous and are delivered by nonpoisonous species. Venomous snake

bites can produce an array of symptoms, including localized pain and swelling, convulsions,
nausea and even paralysis. First aid steps in snake bite include cleaning the wound, remaining

calm and still, remove constricting clothing or jewelry and immobilizing the affected area. To

identify a snake bite, considered the following general symptom: two puncture wounds, swelling

and redness around the wounds, pain at the bite site, difficulty breathing, vomiting and nausea,

blurred vision, sweating and salivating and numbness in the face and limbs. Always treat a snake

bite as if it’s venomous.

Dog bites

The risk of being bitten by a dog increases if there is a dog in the home. The dog bite victim

needs to be taken to a safe place away from the assailant dog to prevent further attack and injury.

Wound should be kept elevated and, if possible, washing the wound with tap water may be

attempted. Information should be obtained from the dog’s owner about the dog’s rabies

immunization status, but if this is not possible the animal control (veterinary clinics) centres

should be consulted. If the victim elect not to seek medical care the rabies immunization status of

the dog must be determined immediately. Rabies therapy if necessary must begin immediately.

The victim’s tetanus status also need to be current.

Scorpion bites

Scorpion is an Arachnida. The stinger of the scorpion transmit a toxin to the victim. Often a

scorpion sting causes discomfort which gradually abate, moderate to severe discomfort/pain.

The home remedy includes washing of scorpion sting site with soap and water, remove any

jewelry, application of ice or cool compress should be done for at least 10 minutes, keep the
affected part above the level of the heart, in case the patient is having difficulty swallowing,

avoid consuming any food or drink, to relieve pain give paracetamol every 4 hr. do not make a

cut in the wound and avoid applying sunction to it. The commonest ones are turmeric powder

Accidents

An accident is an undesirable, unplanned event that could have been prevented, had

circumstances leading up to the accident been recognized, and acted upon, prior to its

occurrence. Most scientists who study unintentional injury avoid using the term "accident" and

focus on factors that increase risk of severe injury and that reduce injury incidence and severity

(Robertson, 2015).

Assessment: As previously stated the first step is to assess the scene of the accident and ensure it

can be approached safely.

Act Fast: To treat bleeding, press firmly over site of wound with a clean dressing until it stops,

anywhere from three to 15 minutes. Clean under running water and gently pat dry. When a

wound is dirty or was caused by an animal scratch, rinse it with water and gently lather with

soap. If you can't control the bleeding after several attempts with direct pressure, call 112, or

head to an E.R (Emergency room). If a large piece of skin has been removed, wrap it in a clean,

moist cloth and place it in a bag over ice a doctor may be able to reattach it. Any animal bite that

has caused a deep cut should be seen by a doctor.

BURNS AND SCALDS

Burns and scalds are damage to the skin caused by heat. Both are treated in the same way. A

burn is caused by dry heat like pressing iron or fire, for example. A scald is caused by something

wet, such as hot water, hot oil or steam. Burns can be very painful and may cause:

• red or peeling skin

• blisters

• swelling

• white or charred skin

The amount of pain felt isn't always related to how serious the burn is. Even a very serious burn

may be relatively painless.

Paraffin (Kerosene) poisoning

This is a common problem among young children. Kerosene is poorly absorbed by the

gastrointestinal tract but there is often aspiration into the respiratory tract. This may lead to

pneumonitis or pulmonary oedema. The treatment involve removing the child from the source of

the poisoning and ensuring the airways is open. Remove the contaminating clothing and wash

the skin with soap and water. The patient should be taken to the hospital.

First aid for burns and scalds

• Immediately get the person away from the heat source to stop the burning

• Hold affected part under running clean water for up to 20 minutes (Room-temperature, not

iced water)

• Avoid applying any creams or greasy substances such as butter

 • Carefully remove watches, jewelry etc., provided they are not stuck to the skin

• Keep casualty warm by using a foil blanket or ordinary one.

• Cover the burn by placing a layer of cling film over it – a clean plastic bag could also be

used for burns on your hand

• Give painkillers such as paracetamol or ibuprofen to treat any pain

NB: Don't puncture any blisters. If the skin breaks, apply an anti-biotic cream and cover the area

with a bandage or gauze and tape until it's healed. Watch for any redness, swelling, tenderness,

or discharge all signs of infection.

Did You Know? Scalds, from hot foods or liquids, are the most common burn injury in children

ages 6months to 2 years.

Injuries

An injury is a term used in describing damage to the human body such as cuts, bruises, laceration

grave avulsions

An injury is damage to the body. Injuries are frequently caused by accidents, falls, weapons etc.

In the U.S., millions of people injure themselves every year. These injuries range from minor to

life threatening. Injuries anywhere can happen at work or play, indoors or outdoors, driving a

car, or walking across the street. Even in the office, paper cuts have been recorded.

Surgery, sutures, and stitches also cause wounds. Minor wounds usually aren't serious, but it is

important to clean them. Serious wounds may require first aid followed by a visit to your doctor.

Attention must be sought if the wound is deep, and if bleeding cannot be stopped.
1. First Aid for Sprains, Finger Dislocations or Fractures

The R-I-C-E Technique

R- Rest the injured limb

I- Ice, use an ice pack to reduce swelling

C- Compress, using good crepe bandages

E-Elevate, raise injured limb to reduce swelling as much as possible

First Aid Certification

Pharmacists who are passionate about offering First Aid Care should sign-up for the Basic Life

Support (BLS) Advanced Life support (ALS) or certificate of competence in First Aid which is

delivered by international humanitarian agencies as well as private organizations.

Key Learning Points

• First Aid is the immediate or emergency assistance given on the scene to sick or injured

person before professional medical care.

• The purposes of First Aid is to save life, provide reassurance and comfort to the ill or

injured, to prevent further injury or illness becoming worse (cause no harm), to minimize

or prevent infection and promote rapid recovery.

• First Aid measures are not meant to replace proper medical diagnosis and treatment.
References

Department of Occupational Health and Safety, University of Aston, Birmingham Great Britain

Received 9, September 1980.

Dorling Kindersley, First aid manual: 9th edition, 2009.

"Accidents and first aid". NHS Direct. Archived from the original on 2008-05-03. Retrieved

12-07-2016.

Longphre, John M.; Petar J. De Noble; Richard E. Moon; Richard D. Vann; John J. Freiberger

(2007). "First aid normobaric oxygen for the treatment of recreational diving injuries." Undersea

and Hyperbaric Medicine 34 (1): 43–49.

Jones and Barlett By 1993The National Safety Council, First Aid Institute Copyright 1993,

Publishers, ext. 2009.