Standard First Aid Guide

Training Provider:
https://sera.sg/
CONTENTS
Chapter 1 – Essentials of First Aid 01
1) Definition and Aims of First Aid 02

2) Roles and Limitations of a First Aider 03
3) Universal Precautions 04
4) First Aid Kit Content and Maintenance 05
5) Primary Survey 07
6) Secondary Survey 10
7) Record and Report 13
8) SCDF’s myResponder Mobile Application 14
Chapter 2 – Unconscious Casualty (Non-Cardiac Arrest) 16
1) Head and Spinal Injuries 19

2) Heat Disorders 22
3) Fits 24
4) Fainting 25
5) Low Blood Sugar 26
6) Stroke 27
7) The Recovery Position 28
Chapter 3 – Respiratory Problems 30
1) Adult Foreign Body Airway Obstruction (FBAO) 36

2) Asthma 41
3) Hyperventilation 44
4) Fumes Inhalation 45
5) Allergic Reaction 47
Chapter 4 – Shock, Bleeding and Wounds 49
1) Shock 52
2) Types of Bleeding 55
3) Types of Wounds 57
4) Bandaging Techniques 63
Chapter 5 – Musculoskeletal Injuries 74
1) Fracture and Dislocation 76

2) Soft Tissue Injuries 90
3) Immobilisation techniques 94
Chapter 6 – Burn Injuries 97
1) Burns Depth and Severity of Burns 99

2) Classification and Treatment of Burns 101
Chapter 7 – Other First Aid Knowledge 105
1) Eye Injuries 107

2) Epistaxis (Nose Bleeding) 110
3) Poisoning 111
4) Transportation of Casualty 113
Chapter 8 – CPR(Hands-Only)+AED Refer to SRFAC’s CPR(Hands-Only)+AED Manual
I
The Singapore Resuscitation and First Aid Council (SRFAC) would like
to thank the following members of the First Aid Sub-Committee for
contributing to the creation of this manual:
College of Emergency Physicians
College of Paediatrics and Child Heath
Ministry of Manpower
Singapore Armed Forces
Singapore Civil Defence Force
Singapore First Aid Training Centre
Singapore Heart Foundation
Singapore Red Cross Society
St. John Association Singapore
II
This Standard First Aid manual is referenced from the following:
➢ Ministry of Manpower (MOM) – National First Aid Council (NFAC) Occupational First
Aid (OFA) Manual (2005 Edition)
➢ Part 15: First Aid - 2015 American Heart Association and American Red Cross
Guidelines - Update for First Aid
➢ European Resuscitation Council Guidelines for Resuscitation 2015 – Section 9. First
Aid
➢ 10th Edition First Aid Manual (jointly produced by St John Ambulance UK, St Andrew’s
First Aid and British Red Cross)
➢ International First Aid and Resuscitation Guidelines 2016 (by International Federation
of Red Cross and Red Crescent Societies)
Majority of the pictures used in this manual were derived from the MOM-NFAC
Occupational First Aid Manual (2005 Edition) with the exception of the
following:
➢ Fig. 2: https://www.healthhub.sg/live-healthy/471/keepyourhandsclean
➢ Fig. 3: https://thescoutshop.co.uk/?attachment_id=6800;
https://www.firstaid4sport.co.uk/first-aid-equipment-c48/dressings-and-bandages-
c102/crepe-bandage-p3; https://www.amconlabs.com/product/6298/305/Gauze-
Pads-Sponges-Non-Sterile-2-x-2/; https://www.firstaid4sport.co.uk/strapping-and-
taping-c3/surgical-tape-c33/hypoallergenic-silk-tape-p127;
http://www.trackexports.net/products/dressing-&-bandage-products/triangular-
bandage; https://www.blueridgeoutdoors.com/go-outside/climb-higher-a-guide-
selects-his-go-to-climbing-gear/; https://www.blackwoods.com.au/safety-site-
environmental/first-aid/sharps-clean-up-kit/pins-safety-assorted-856944-
12/p/00845911; https://forextribune.com/tag/disposable-gloves-insights/;
http://www.ophthalmicsolution.in/eye-shield-1908265.html;
https://www.a1firstaid.co.nz/product/eye-pads/; https://mywellsafety.en.made-in-
china.com/product/YjMQEBoUZcVs/China-M-P01-Medical-Grade-PVC-Pocket-
Mask.html; https://www.ebay.co.uk/itm/10pcs-CPR-Face-Shield-Mask-Mouth-to-
Mouth-Guard-CPR-Mask-Keychain-One-Way-Valve-/302898509649;
https://www.superiorhealthcare.com.au/PSBX661_dash_1/Sodium-Chloride-
0.9%25-for-Irrigation-100mL/pd.php; https://nextthing.co/p/1657232/opoway-
penlight-medical-diagnostic-batteries
➢ Fig. 6: https://hasshe.com/plain-body-graph-5c148c278719620724a38b15/
➢ Fig. 7: https://www.scienceabc.com/humans/medulla-oblongata-definition-
structure-and-functions.html
➢ Fig. 8: http://www.theindependentbd.com/magazine/details/55861/Head-injury
➢ Fig. 9: https://forensic-analysis.com/forensic-services/environmental;
https://www.necksolutions.com/whiplash-neck-injury/;
http://poolaccidents.blogspot.com/2011/03/diving-accidents-fast-facts.html
➢ Fig. 13: https://www.mountsinai.org/health-library/diseases-conditions/spinal-cord-
trauma
➢ Fig. 14: https://health.howstuffworks.com/medicine/first-aid/first-aid5.htm
➢ Fig. 15 to Fig. 19: SRFAC BCLS+AED manual
➢ Fig. 20: https://www.thinglink.com/scene/466274591791120384
➢ Fig. 21: https://www.sharewhy.com/why-does-fluid-build-up-in-lungs/
➢ Fig. 22: http://www.bikes.org.uk/how-to-breathe-correctly-while-cycling/
➢ Fig. 24: SRFAC BCLS+AED manual
➢ Fig. 30: https://learn.allergyandair.com/asthma-and-cold-weather/
➢ Fig. 31: https://physiology.kitware.com/_inhaler_methodology.html
➢ Fig. 32: Courtesy of KK Women’s and Children’s Hospital
III
➢ Fig. 34: http://content.myteamsafe.com/epipen-safety/
➢ Fig. 38: https://www.healthline.pw/tag/hemorrhage-symptoms/
➢ Fig. 41: https://www.texaschildrens.org/health/when-your-athlete-has-strain-sprain-
or-contusion
➢ Fig. 51: https://thescoutshop.co.uk/?attachment_id=6800
➢ Fig. 52: https://www.amconlabs.com/product/6298/305/Gauze-Pads-Sponges-Non-
Sterile-2-x-2/
➢ Fig. 53: https://www.firstaid4sport.co.uk/first-aid-equipment-c48/dressings-and-
bandages-c102/crepe-bandage-p3
➢ Fig. 54: http://www.trackexports.net/products/dressing-&-bandage-
products/triangular-bandage
➢ Fig. 68: Courtesy of Singapore First Aid Training Centre
➢ Fig. 69: http://www.tommilance.com/ortho.htm;
https://www.pinterest.es/pin/505599495665248935/?autologin=true&nic=1a
➢ Fig. 71: https://www.stjohn.org.nz/First-Aid/First-Aid-Library/Fractures-and-
Dislocations/
➢ Fig. 72: https://www.physiotherapyroom.com/Shoulder
➢ Fig. 73: https://produto.mercadolivre.com.br/MLB-1074838673-tala-moldavel-
modelo-splint-imobilizaco-resgate-sos-_JM
➢ Fig. 79: https://quizlet.com/47008855/flexor-forearm-flash-cards/
➢ Fig. 83: https://www.texaschildrens.org/health/when-your-athlete-has-strain-sprain-
or-contusion
➢ Fig. 88: Courtesy of Mr Loke Jun Hao
➢ Fig. 90: http://dxline.info/diseases/subcutaneous/
➢ Fig. 91 to Fig. 93: https://burnsurvivor.com/burn_types_third/
➢ Fig. 94: http://piculig.pw/adult-burn-chart.html;
https://www.surgery.wisc.edu/2017/10/05/assessment-and-referral-of-burn-
patients/
➢ Fig.95: https://studylib.net/doc/18397213/safety-data-sheet
The term “casualty” may be used interchangeably between “victim” or “patient” in this
manual. Similarly, the terms “he, she or they” refers to the casualty, with no intended
discrimination.
IV
Chapter 1
Essentials of First Aid
1) Definition and Aims of First Aid

2) Role and Limitations of a First Aider
3) Universal Precautions
4) First Aid Kit Content and Maintenance
5) Primary Survey
6) Secondary Survey
7) Record and Report
8) SCDF’s myResponder Mobile Application
Singapore Resuscitation and First Aid Council

All rights reserved.
No part of this book may be modified without the prior written permission
from Singapore Resuscitation and First Aid Council.
Rev 1 / 2020
1
1.1 – Definition and Aims of First Aid
WHAT IS FIRST AID?

First Aid is the immediate management of a person who is injured or has
suddenly taken ill.
AIMS OF FIRST AID

The four aims of First Aid are:
1. To preserve life.
a. Provide chest compressions/CPR if casualty is not breathing
normally.
b. Control any serious bleeding.
2. To prevent condition from worsening.
a. Cover wounds.
b. Immobilise open wounds and fractures.
c. Place casualty in a comfortable position.
3. To promote recovery.
4. To provide comfort and relief.
a. Relieve pain and discomfort.
b. Reassure and comfort.
c. Protect casualty from extreme heat or cold.
2
1.2 – Roles and Limitations of a First Aider
The roles of a First Aider:

1. Provide First Aid to the casualty until medical help arrives.
2. As a First Aider, you should:
o Be familiar with the layout of places frequented, eg. workplace,
home, school, shopping malls, etc.
o Understand the processes and associated hazards before
embarking on any work/activity to anticipate possible types of
incidents and be prepared to render appropriate First Aid.
o Take note of the casualty’s condition, type and time of treatment
provided and basic details of the casualty. A more detailed report
may be required in workplaces or schools; therefore, it is
important for the First Aider (employed/contracted) to be familiar
with the documentation and reporting procedure of the
organisation.
o Periodically check that the First Aid kit and contents are in order
and are replenished regularly.
3. However, for appointed First Aiders with duty of care within the
organisation/workplace:
o You may be required to administer prescribed medication, based
on the organisation/workplace Standard Operation Procedures
(SOPs) to the casualty with the diagnosed condition.
o You may refer to the Workplace Safety and Health Act to
understand the details of the specific roles and responsibilities.
(https://www.mom.gov.sg/workplace-safety-and-
health/workplace-safety-and-health-act and
https://sso.agc.gov.sg/Act/WSHA2006)
The limitations of a First Aider:

1. A First Aider should not be prescribing any medication to the casualty.
2. Please seek consent before administering First Aid treatment. Deemed
consent will apply to casualties who are unconscious.
3
1.3 – Universal Precautions
Infections by blood-borne
pathogens may be transmitted
during life saving activities.
Use Personal Protective
Equipment (PPE) (see figure 1)
whenever possible while Fig. 1 – Personal Protective Equipment (PPE)
providing First Aid. Examples
are:
1. Keep open wounds covered with dressings to prevent contact with
blood.
2. Use disposable latex/nitrile gloves in every situation involving blood or
other body fluids. If disposable latex/nitrile gloves are not available, use
the most waterproof material or extra gauze dressing to form an
impervious barrier.
3. Whenever possible, use a mouth-to-barrier device with a one-way valve
for protection when performing ventilations (if trained) as there may be
blood, vomit, body fluids or unknown contaminants in the casualty’s
mouth.
4. Wash the area immediately with soap and running water when exposed
to blood or other body fluids and dispose of soiled items appropriately.
5. Wash hands with soap and water thoroughly (see figure 2) after the
incident, as soon as possible.
Fig. 2 – Hand Washing Technique
4
1.4 – First Aid Kit Content and Maintenance
Appointed First Aiders must be familiar with the First Aid kit’s location, content
and usage.
First Aid kit should not contain materials other than those required for First Aid
treatment (see figure 3). It is essential that First Aid kit be checked frequently
to make sure they are fully equipped, and all items are usable. Used or expired
items should be replaced as soon as possible.
Medication should not be stored in the First Aid Kit. Co-workers/staff or
residents with diagnosed conditions may carry life-saving medication with
them. The First Aider will need to know how to assist the casualty when their
condition is triggered.
No. Content Sample Image Quantity
Individually wrapped
1 sterile adhesive 20 – 40
dressings
Crepe bandage (5
2 1-4
cm)
Crepe bandage (10

3 1-6
cm)
Absorbent gauze
4 5 - 15
(sealed packets)
5 Hypoallergenic tape 1-2
5
6 Triangular bandages 4-6
7 Scissors 1
8 Safety pins 4-6
Disposable gloves
9 2-4
(pairs)
10 Eye shield 2-6
11 Eye pad 2-6
6
Resuscitation mask
with one-way valve
12 1–2
or Disposable face-
shield
Sterile water or
saline in 100 ml
13 1-3
disposable
containers
14 Penlight 1
Fig. 3 – The above table serves as a reference and is not intended as an endorsement of the respective
products’ brand/model.
The number of First Aid kit required depends on the physical layout of the
premises and the number of people within the premises.
The First Aid kit should be adequately equipped, properly maintained, checked
regularly, identifiable and placed in a well-lit and accessible location, under the
charge of a person appointed by the workplace or organisation.
7
1.5 – Primary Survey
As an emergency is a sudden unexpected event that creates a risk to life and

limb. Rapid action is necessary to rescue the casualty. This would require an
immediate but systematic plan to ensure the safety of the casualty and self, as
well as to perform triage of the casualty to determine the priority required to
save a life. Thus, an Emergency Action Plan is needed, which comprises of two
main portions – Primary and Secondary Surveys.
Factors to consider when carrying out Primary Survey

1. Environmental conditions
Assess dangers and difficulties in removing the casualty:
a. Moving vehicles
b. Fumes and poisonous gases
c. Unsafe structures
d. Trapped casualty
2. Hazards
a. Look out for fire, smoke, faulty electrical wires, spilled water, etc.
b. Unseen dangers such as toxic gases, risk of falling objects, etc.
3. Mechanisms of injury
Try to find out the mechanism of injury. This helps to identify the extent of injuries:
a. Fall from height – look for multiple fractures.
b. Ejection from a vehicle – look for multiple injuries.
c. Sudden deceleration – look for blunt abdominal or chest injury due to these
areas hitting the steering wheel.
The Primary Survey

The Primary Survey (see figure 4) comprises of the following 6 steps:
➢ Danger – Ensure personal safety
➢ Response – Check for casualty’s responsiveness
➢ Shout for Help – Get help and call 995 for Singapore Civil Defence Force
(SCDF), which will dispatch the appropriate resources for the incident
➢ AED – Have a nearby AED brought to the casualty
➢ Breathing – Look for normal breathing
➢ Chest Compressions – Start Chest Compressions if breathing is absent or
unsure
8
Fig. 4 – The Primary Survey (DRSABC)
The purpose of the Primary Survey is to ensure that the casualty receives
immediate priority and treatment for life-threatening conditions:
➢ If casualty is unresponsive but breathing normally, check and manage
any external injuries found. Monitor the casualty regularly (see Chapter
2).
➢ If casualty is bleeding severely, apply direct pressure on the wound.
Apply a tourniquet if a limb is amputated and record the time of
application (see Chapter 4).
➢ If casualty is unresponsive and not breathing, start chest compressions
and apply an AED (see Chapter 8).
Rapid Body Survey

Do a head-to-toe examination of the body to look for injuries, bleeding and
wounds:
1. Check for external bleeding/deformities at:
a. Head and neck.
b. Chest and abdomen.
c. Back and lower extremities.
d. Upper extremities.
2. Expose and examine the injury site.
3. Provide appropriate emergency care accordingly: Arrest bleeding, cover
wounds and immobilise fractures.
9
1.6 – Secondary Survey
The Secondary Survey should be performed after the Primary Survey has been
conducted and when casualty’s life is not in any immediate danger. The
information collected should be passed on to the paramedics who are taking
over the care of the casualty. The Secondary Survey covers the following:
1. History.
2. Vital Signs.
3. Head-to-toe examination.
History
1. Chief complaint
➢ What did the casualty say?
2. Details of chief complaint
➢ Note the following:
o Location and description of injury.
o Nature of pain.
3. Medical History
➢ Previous health and/or history of illness.
➢ Previous/current treatment given by a doctor.
➢ Allergies – any sensitivity to drugs, food or environment.
➢ Check for Medic Alert Tag or Medic AWAS Card.
Vital Signs
Assess the following four vital signs after
Primary Survey and Secondary Survey at
regular intervals. Record the time and
information collected. Additional
information may be collected if the
supporting
1. Check the level of consciousness
(AVPU) (see figure 5)
➢ The casualty is alert and Fig. 5 – AVPU Scale
conscious.
10
➢ The casualty responds to verbal stimulation.
➢ The casualty responds to painful stimulus.
➢ The casualty is completely unresponsive.
2. Pulse rate
➢ Assess the rate, rhythm and strength.
3. Breathing rate
➢ Look for normal breathing which is regular and not laboured.
➢ Assess the rate, rhythm and depth.
4. Skin colour
➢ Normal skin is pink, warm and dry.
➢ When in shock, the skin may appear pale/bluish grey, cold and
sweaty.
Head-to-toe Examination
Examine the body in the same order as Rapid Body Survey except more time is
taken to confirm any abnormalities – injury, wounds and deformities.
This includes sorting of casualty (Triage) by:
1. Priority of attention.
2. Urgency for evacuation.
3. Evacuation and transport.
1. Priority of attention
a. Unconscious casualties – Check that there is normal breathing. Place
casualty in recovery position (see Chapter 2) if spinal/head injuries
are not suspected.
b. Serious casualties – Chest Injury (Injury to the respiratory or
cardiovascular system); head injuries but conscious; fractures and
wounds.
c. Minor injuries: minor wounds.
2. Urgency for evacuation

a. Urgent evacuation — All unconscious casualties, all casualties with
chest or abdominal wounds, all casualties with head injuries.
b. Less urgent evacuation — Other wounds and fractures.
c. Non-urgent evacuation — Walking injured, minor injuries.
11
3. Evacuation and transportation plan
a. Stretcher for spinal injury, multiple injuries, chest and abdominal
wounds.
b. One rescuer assisted evacuation, two or three rescuers assisted
evacuation for casualties who are unable to walk unsupported but
are conscious; an alternative is to use a chair to evacuate the
casualty.
12
1.7 – Record and Report
When Singapore Civil Defence Force (SCDF) officers arrive, you will be required
to provide some basic information regarding the incident and the treatment
provided. If in doubt, take que from the SCDF Officer’s instructions.
Additionally, your workplace may require you to provide a written report –
follow your workplace’s reporting process.
The following pointers can be used as a reference:
1. Scene of incident – Hazards, site location, etc.
2. Mechanism of injury if known – Look at circumstances in which injury
was sustained, extent and type of injuries sustained due to impact.
3. History: chief complaint and the details – Symptoms of illness or trauma;
any past allergies; any past medical conditions.
4. Provide a written report (if required by your workplace) covering the
following:
a. Casualty’s name, department and staff ID (if any).
b. History of the incident or
illness.
c. Vital signs - Note level of
consciousness, pulse,
breathing and skin colour.
d. Any unusual behaviour.
e. Any treatment given and
when – List all first aid
treatment given. Record
injuries from head to toe.
Use a diagram (see figure
6).
f. Response – Note
Fig. 6 – Diagram used for marking out injuries
response to treatment (eg.
Reduction of pain, improved level of consciousness, etc).
g. Progress – Note the change of vital signs if any.
13
1.8 – SCDF’s myResponder Mobile Application
In Singapore, many of the emergency cases SCDF responds to could be quickly

attended to by members of the public even before SCDF’s arrival. For example,
more than 2,500 people suffer from Out-of-Hospital Cardiac Arrest (OHCA),
with a survival rate of just 5%, which could be improved by simple medical
intervention within the first few critical minutes. At the same time, there are
more than 1,000 minor fires (such as rubbish chute/bin fire) that could easily
be extinguished using publicly-available means.
myResponder is an application by SCDF to alert members of the public to

nearby fire and medical cases, and thereby save lives and increase the survival
rate for OHCA, as well as mitigate minor fires in the first few critical minutes.
14
myResponder is also a means by which members of the public may be asked to
provide onsite information (via submission of photos and videos) for SCDF to
gain an understanding of the situation. Through the ‘Call 995’ button in the
app, users can also send their geolocation to SCDF’s 995 Operations Centre,
enabling SCDF to dispatch the emergency resources to the scene sooner.
myResponder works by notifying members of the public – also known as
Community First Responders (CFRs) – of cardiac arrest and fire cases within
400m of their location. myResponder will also highlight nearby AEDs that may
be available to responders, and provide guided advisories in the mitigation of
minor fires. CFRs can then proceed to the stated location and assist by
performing CPR or applying an AED to revive the patient, mitigating minor fires
using available extinguishing means, or providing further information to SCDF’s
995 Operations Centre.
Response is entirely voluntary, and we only encourage volunteers to respond
when they are available within safe and reasonable means.
The above QR code works for both Apple iOS and Google Android OS and will
direct to the App Store or Google Play respectively. The myResponder function
is also available within the SGSecure application.
15
Chapter 2
Unconscious Casualty
1) Head/Spinal Injuries
2) Heat Disorders
3) Fits
4) Fainting
5) Low Blood Sugar
6) Stroke
7) The Recovery Position

Rev 1 / 2020
16
Definition of Unconsciousness
Unconsciousness is defined as impairment of awareness. It can range from

drowsiness and confusion to total lack of response.
Fig. 7 – The basic structure of the brain
Frontal lobe – The frontal lobes are involved in motor function, problem solving,
spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual
behaviour.
Parietal lobe – The parietal lobe receives and processes sensory information from all over
the body and are also important for understanding spatial orientation and for proper
navigation.
Temporal lobe – The temporal lobe is involved in primary auditory perception, such as
hearing, and holds the primary auditory cortex.
Occipital lobe – The occipital lobe is responsible for processing visual information from the
eyes.
Pons – The pons helps to regulate the respiratory system by assisting the medulla oblongata
in controlling breathing rate and is also involved in the control of sleep cycles and the
regulation of deep sleep. It also inhibits movement during sleep.
Cerebellum – The cerebellum coordinates voluntary movements such as posture, balance,
coordination, and speech, resulting in smooth and balanced muscular activity.
Medulla Oblongata – The medulla oblongata helps regulate breathing, heart and blood
vessel function, digestion, sneezing, and swallowing.
Spinal Cord – Its three major roles are to relay messages from the brain to different parts of
the body, to perform an action, to pass along messages from sensory receptors to the brain,
and to coordinate reflexes that are managed by the spinal cord alone.
17
Causes
Unconsciousness can be due to:
➢ Cardiac Arrest
➢ Head injury
➢ Electrocution
➢ Poisoning
➢ Drowning
➢ Fainting
➢ Fits
➢ Stroke
➢ Low blood sugar
➢ Alcohol/drug related causes
Important Notes
➢ Ensure the scene is safe to enter.
➢ Call 995 for SCDF.
➢ Do not give the casualty anything by mouth.
➢ Do not move the casualty unnecessarily.
➢ Treat any obvious injuries.
➢ Perform the Primary Survey. If casualty is unresponsive and not
breathing, start chest compressions and apply an AED (see Chapter 8).
➢ If the casualty is breathing normally on his/her own, place in the
recovery position to keep the airway clear. However, do not turn or
move the casualty if neck or spinal injury is suspected (see chapter 2.1
on page 19) – based on the how the injury was sustained, and the force
or height involved.
➢ Do not leave the casualty unattended at any time. Monitor the casualty
and record the vital signs at regular intervals.
18
2.1 – Head/Spinal Injuries
Head and spinal injuries may occur in a variety of sporting activities where
impact is great or in accidents involving sudden deceleration or heights.
Causes
Caused by a direct or indirect
force resulting in the
following:
➢ Concussion: brain is
shaken resulting in
partial loss of
consciousness
Head ➢ Compression: pressure
Injury exerted on the brain by
swelling/bleeding or a
blood clot
➢ Skull Fracture: a partial
or complete break of
the skull bone, large Fig. 8 – Common Signs of Head Injury
force is involved to
cause such injury
➢ Fall from height
➢ Diving into shallow
waters
➢ Being thrown off a
Spinal motor vehicle
➢ Hit across the back by a
Injury
heavy object or force
➢ Injury to the head or
face
Fig. 9 – Causes of Spinal injury
Recognition
Concussion
➢ Brief or partial loss of consciousness.
➢ Dizziness on recovery.
➢ Loss of memory of events at the time
of, or immediately preceding the injury.
➢ A mild, generalised headache. Fig. 10 – Concussion
19
Compression
➢ A headache which grows with intensity.
➢ Breathing becomes slow and noisy. Pulse is
slow and strong.
➢ Pupils are unequal or dilated.
➢ Weakness or paralysis down one side of the
face or body.
➢ Flushed face. Fig. 11 – Compression
➢ Irritability.
Skull Fracture
➢ A wound or bruise on the head.
➢ Progressive deterioration in the level
of consciousness.
➢ Clear fluid (cerebro-spinal fluid) or
watery blood coming out from the
nose or ear.
➢ Bleeding into the whites of the eyes.
Fig. 12 – Skull Fracture
Spinal Injury
When spinal column (vertebrae) is
damaged:
➢ Severe pain at the fracture site.
➢ A deformity in the normal curve of
the spine.
➢ Tenderness on gently feeling the
spine.
When spinal cord is also damaged:
➢ Inability to move the lower limbs.
➢ Abnormal/loss of sensation.
➢ Limb weakness/paralysis of all four
limbs if the cord is damaged at the
neck.
➢ Difficulty in breathing if the injury Fig. 13 – Spinal column and Spinal Cord
is high up the neck.
20
Actions to Take
Head Injury (Concussion, Compression and Skull Fracture):

✓ Call for 995 for SCDF.
✓ Perform the Primary Survey. If casualty is unresponsive and not
✓ If the casualty is breathing normally on his/her own, place in the
move the casualty if neck or spinal injury is suspected.
✓ If the casualty is conscious, place in a comfortable position.
✓ Stop any external bleeding if found.
✓ If there is discharge (blood or fluid) from the ear or nose, position the
casualty such that the affected ear or nose is lower than the unaffected
one.
✓ Monitor and record vital signs and level of consciousness every 5
minutes.
Spinal Injury:
✓ Call for 995 for SCDF.
✓ Do not move the casualty.
✓ If the casualty is conscious,
reassure the him/her and advise
not to move.
✓ Immobilise and support the head
in the position found with a head
grip or with objects (eg. waist
pouch, books, rolled-up jacket, etc)
Fig. 14 – Immobilise the head with objects
to prevent further movement (see
figure 14).
21
2.2 – Heat Disorders
Heat disorders are a group of physically related illnesses caused by prolonged

exposure to hot temperatures, insufficient fluid intake, or failure of
temperature regulating mechanisms of the body. Disorders of heat exposure
include heat cramps, heat exhaustion, and heat stroke. Proper rest, hydration,
warm-up and acclimatisation before any strenuous activity is crucial in helping
to prevent heat disorders.
Recognition
Heat Cramps:
➢ Over-exertion of a particular muscle group
➢ Lack of warm-up activity
➢ Insufficient water intake
Heat Exhaustion:
➢ Severe tiredness due to loss of body fluid through excessive sweating
from strenuous activity
➢ Muscle cramps in legs, arms or abdomen
➢ Weakness, dizziness or headache
➢ Pale, clammy skin
➢ Rapid pulse and breathing
➢ Nausea or vomiting
Heat Stroke:
➢ The body temperature rises while the sweating mechanism fails, and the
body is unable to cool down. Body temperature may rise above 40c due
to:
o Prolonged heat exposure
o Insufficient water intake
➢ Throbbing headache, dizziness and acute discomfort
➢ Restlessness and confusion
➢ Hot, flushed and dry skin
➢ Rapid and weak pulse
➢ May lead to unconsciousness
22
Actions to Take
Heat cramps:
✓ Stop all activity and sit in a cool place.
✓ Drink enough water.
✓ Seek medical attention if the cramps do not subside in 1 hour.
✓ Do not return to strenuous activity for 2 hours after the cramps subside.
Heat Exhaustion:
✓ Help to move casualty to a cool place and lay him/her down.
✓ Remove clothing if possible.
✓ Monitor and record vital signs and level of consciousness regularly.
✓ Give frequent small sips of isotonic drink or water to hydrate the
casualty.
✓ Even if the casualty recovers quickly, ensure that he/she consults a
doctor.
Heat Stroke:
✓ Heat Stroke is a life-threatening emergency. Call 995 for SCDF.
✓ Quickly move casualty to a cool place and lay him/her down.
✓ Remove clothing if possible.
✓ Cool the casualty rapidly with whatever methods available.
✓ Wrap the victim in a cool wet sheet and keep it wet until body
temperature falls to 38c. If no sheet is available, constantly fan the
victim or sponge him/her with cool water.
✓ Slow down the cooling measures when the casualty starts shivering.
✓ Casualty may not be fully conscious, do not feed the casualty anything.
23
2.3 – Fits
Fits is the uncontrolled shaking of limbs and disturbance of consciousness.

Anyone having two or more unprovoked fits or seizures can be said to have
Epilepsy and it may vary widely in its forms, causation and severity.
Recognition
➢ Involuntary contractions of many of the muscles, caused by a

disturbance in the function of the brain.
Actions to Take

✓ Support or ease their fall and lay the casualty down in a quiet place.
✓ Call 995 for SCDF.
✓ Remove any possible sources of harm.
✓ Do not attempt to insert anything into the casualty’s mouth.
✓ Turn the casualty to the side to allow drainage of fluids from the mouth.
✓ Stay with the casualty.
✓ After the fits has stopped, ensure casualty is breathing normally and has
no severe injuries before placing in the recovery position.
24
2.4 – Fainting
Fainting is the temporary loss of consciousness in response to sever pain,

unpleasant sights, prolonged standing or hunger.
Recognition
➢ Sudden loss of consciousness.

➢ May have warning symptoms of dizziness.
Actions to Take
✓ Lay the casualty on a flat surface with legs elevated if there is no

evidence of trauma.
✓ Loosen tight clothing.
✓ Check breathing and pulse.
✓ Advise the casualty to seek medical attention.
25
2.5 – Low Blood Sugar
Loss of consciousness can be due to a lack of blood sugar. While it can occur to
casualties who are diabetic, it may also affect any person who had insufficient
food intake.
Recognition
➢ Rapid loss of consciousness.

➢ The casualty has not taken any food after their diabetes medication or
injection.
Action to Take
✓ Give a sweet beverage if the casualty can drink.

✓ Call 995 for SCDF and stay with the casualty.
✓ Do not feed anything by mouth if the casualty turns unconscious.
26
2.6 – Stroke
A stroke is a condition in which the blood supply to the brain is suddenly

impaired by a blood clot or a ruptured blood vessel.
Recognition
➢ Altered level of consciousness

➢ Slurred or garbled speech
➢ Loss of movement and sensation, usually on one side of the body
➢ Severe headache
➢ Identify signs of Stroke with the acronym “FAST”:
o Facial weakness – Can the person smile? Is his/her eye or mouth drooping?
Does one side of the face droop?
o Arm weakness – Can the person raise both arms? Does one arm drift
downwards?
o Speech difficulty – Can the person speak clearly and understand what you say?
Does the speech sound slurred or strange?
o Time to act fast – Call 995 for SCDF.
Actions to take

✓ Reassure the casualty. He/she may be able to understand you even if
they are unable to communicate.
✓ Support the casualty’s head and shoulders if he/she is conscious.
27
2.7 – The Recovery Position
The recovery position is used in the management of a casualty who is

unresponsive but is breathing normally.
When an unresponsive casualty is lying supine (facing up) and breathing
normally, his/her airway may be obstructed by the tongue, mucus and/or
vomit.
These problems may be prevented when the casualty is placed in the recovery
position. This position keeps the airway open as fluid can drain easily from the
mouth.
If there is no evidence of trauma, place the casualty on his/her side in the
recovery position. The recovery position keeps the airway open. The following
steps are recommended:
Step 1: Position the casualty
Fig. 15 – Tuck the hand Fig. 16 – Place the back of hand

under the casualty’s hip against the casualty’s cheek
➢ Tuck the hand nearer to you, arm straight and palm upward under the
casualty’s hip (see figure 15).
➢ Bring the other arm (further from you) across the casualty’s chest and place
the back of his/her hand against his/her cheek (see figure 16).
➢ Put your palm against the casualty’s palm that is on the cheek and maintain
this position.
➢ Using your other hand, bend the casualty’s far knee to a 90-degree angle,
hold the casualty’s far hip and roll him/her towards you (see figure 17).
28
Fig. 17 – Bend the casualty’s far knee to a 90-degree angle
Step 2: Roll the casualty towards the rescuer

➢ Use your knees/thighs to support the casualty’s body as you
turn him/her towards you to prevent him/her from rolling
too far forward (see figure 18).
Fig. 18 – Turn casualty towards you
Step 3: Final Recovery Position
➢ Ensure that the casualty’s cheek is resting on the back of
his/her palm.
➢ Check that the casualty’s other hand is positioned alongside his/her body
with palm facing upwards.
➢ The former far leg should preferably be bent
at the knee to a 90-degree angle (see figure
19).
➢ Stay with the casualty and monitor his/her
breathing continuously. Fig. 19 – The Recovery Position
29
Chapter 3
Respiratory Emergencies
1) Adult Foreign Body Airway Obstruction

2) Asthma
3) Hyperventilation
4) Fumes Inhalation
5) Allergic Reaction

Rev 1 / 2020
30
The Respiratory System
Fig. 20 – The structure of the respiratory system
Structure
The respiratory system comprises of:
➢ Nasal cavity
➢ Pharynx
➢ Larynx
➢ Trachea
➢ Lungs
➢ Bronchi
➢ Bronchioles
➢ Alveoli
➢ Diaphragm
31
Function
The functions of the respiratory system are:
➢ To provide oxygen for use in the body
➢ To excrete carbon dioxide
Respiration involved the process of breathing and the exchange of gases,

oxygen and carbon dioxide in the lungs, and in cells throughout the body.
We breathe in air in order to take oxygen into the lungs and breathe out to
expel the waste gas carbon dioxide, a by-product of respiration. When we
breathe, air is drawn in through the nose and mouth into the airway and the
lungs.
In the lungs, oxygen
is taken from air
sacs (alveoli) into
blood vessels
(pulmonary [lung]
capillaries). At the
same time, carbon
dioxide is released
from the capillaries
into the alveoli and
expelled as we
breathe out (see
Fig. 21 – Gas exchange process
figure 21).
Mechanism of Breathing
During inspiration (breathing in) the chest cavity is enlarged. The lungs which
are elastic, expand to fill up the increased space, and air is sucked in. Two main
factors enlarge the chest cavity:
➢ Upward and outward movement of the ribs caused by the action of the
inter-costal muscle.
➢ Flattening downward movement of the diaphragm.
32
➢ During expiration (breathing out) the lungs contract, the cavity returns
to normal size and air is forced out.
Fig. 22 – Mechanism of breathing
Requirements for Normal Breathing

For breathing to proceed normally, the following are required:
➢ Oxygen, which is present in the air (about 21%).
➢ The respiratory tract consists of:
o The airway, a passage leading from the nose to the lungs. This passage allows
a free flow of air in and out of the lungs during respiration.
o Muscles of the chest wall and diaphragm, to draw air into the lungs.
o The respiratory centre in the brain and connective nerves to the respiratory
muscles, to control and maintain autonomic regular breathing movements.
o The lungs, where oxygen is taken from the air into the blood, in exchange for
carbon dioxide which is then breathed out.
Blood which carries oxygen absorbs from the lungs to the tissues throughout
the body. The oxygen is carried and attached to the haemoglobin, a pigment in
the red blood cells of the blood.
The heart pumps the blood and keeps it flowing to all parts of the body where
oxygen is needed.
33
Breathing Rates for Normal Persons at Rest
Adult: 12 – 16 breaths per min
Babies and young children: 20 – 30 breaths per min.
Respiratory Emergencies
Respiratory emergencies occur when the casualty is having laboured breathing
or breathing is in distress.
Recognition:
➢ Difficulty in breathing and gasping for breath
➢ Use of accessory (neck) muscles to breathe
➢ Casualty appears anxious, restless and panicky
➢ Casualty cannot speak a few words between breaths
➢ Casualty’s skin is bluish in colour (cyanosis)
➢ Confusion, disorientation leading to unconsciousness
➢ Breathing or heart may stop
Causes
Common causes of respiratory problems are:
➢ Choking
➢ Fumes inhalation
➢ Drowning
➢ Hanging, Strangulation and Throttling
➢ Hyperventilation
➢ Bronchial Asthma/Chronic Obstructive Pulmonary Disease
➢ Heart Failure
Important Notes
➢ Ensure the scene is safe to enter. In cases of poisoning by gases, fumes
or lack of oxygen in and enclosed space, the casualty should be moved
to a well-ventilated place.
➢ Reassure the casualty to allay his anxiety and panic.
34
➢ Find out from the casualty what happened to him to determine the
cause for his breathing difficulty, if he is conscious.
➢ Perform the Primary Survey and commence CPR and use the AED if the
casualty is not breathing.
➢ If the casualty does not respond, call 995 for SCDF.
➢ Check to see whether there are any obstructions in the mouth, e.g.
foreign bodies, food, dentures, vomitus etc.
➢ If the casualty is unconscious but breathing normally, place him/her in
the recovery position (see Chapter 2). However, do not turn or move the
casualty if neck or spinal injury is suspected.
➢ Do not leave the casualty unattended at any time. Monitor the casualty
35
3.1 – Foreign Body Airway Obstruction
Complete airway obstruction is an emergency that will result in death within

minutes, if not treated immediately. A casualty can develop airway obstruction
from either intrinsic (tongue and epiglottis) or extrinsic (foreign body) causes.
Causes
Intrinsic Causes
➢ The tongue can fall backward into the pharynx in an unconscious
casualty in the supine position.
➢ Blood from head and facial injuries can flow into the airway.
➢ Regurgitated stomach contents can enter the airway.
Extrinsic Causes
Foreign bodies, e.g. food, dentures etc.
Contributing Factors
➢ Large, poorly chewed pieces of meat/food.
➢ Elevated blood alcohol levels.
➢ Dentures.
➢ Playing, crying, laughing and talking with food in the mouth.
Precautions
➢ Cut food into small pieces. Chew slowly and thoroughly, especially if
wearing dentures.
➢ Avoid excessive intake of alcohol.
➢ Avoid laughing and talking when the mouth is full.
36
Recognition
Foreign Body Airway Obstruction (FBAO) can be

either partial or complete. Coughing is the
body’s natural defence against airway
obstruction.
A casualty with partial (mild) airway obstruction
will cough to expel the foreign body. If the
Fig. 23 – The universal sign of
casualty is wheezing (breathing noisily with a choking
wheezing sound) or coughing, this means that
the airway is partially obstructed. Do not interfere. Allow the casualty to
cough to expel the object himself/herself.
In complete (severe) airway obstruction, the casualty is unable to speak,
breathe or cough and may become cyanotic (blue). The casualty will clutch the
neck with thumb and fingers, the universal distress signal for choking (see
figure 23) that requires immediate action (see figure 24).
Fig. 24 – Summary of adult FBAO relief
37
Actions to Take
Techniques used to relieve FBAO include the Heimlich Manoeuvre (abdominal

thrusts) and chest thrusts for pregnant and obese casualties.
The Heimlich Maneuver, also known as the sub-diaphragmatic abdominal
thrusts or abdominal thrusts is recommended for the relief of FBAO in
responsive adults (more than 8 years of age) and children (1 to 8 years of age).
The Heimlich Maneuver elevates the diaphragm and increase airway pressure,
which forces air out from the lungs. This creates an artificial cough which can
expel the foreign body from the airway.
In obese or pregnant casualties, chest thrusts should be used instead of
abdominal thrusts.
Abdominal Thrust
✓ Ask if the casualty is choking. A choking casualty will not be able to speak,
breathe or cough but may nod his/her head. Tell the casualty that you can
help.
✓ If the casualty can cough, instruct the casualty to cough as hard as possible.
If casualty is unable to cough, perform the Heimlich Maneuver.
✓ If the casualty is standing, the First Aider should stand behind the casualty.
If the casualty is seated, the First Aider should be kneeling behind the
seated casualty. Wrap the arms around the casualty’s abdomen.
✓ Locate the navel and place 2 fingers above the
navel and well below the tip of xiphoid process.
✓ Make a fist with the other hand with the thumb
in the palm (see figure 25).
✓ Place the thumb side of the fist against the
casualty’s abdomen in the midline and just Fig. 25 – Make a fist with
thumb in the palm
above the 2 fingers’ spacing.
✓ Lean the casualty forward with one hand, while maintaining the fist against
the abdomen.
✓ Grasp the fist with the other hand and
provide quick inward and upward abdominal
thrusts in one motion into the casualty’s
abdomen (see figure 26).
✓ Deliver each abdominal thrust firmly and
distinctly with the intent of relieving the
obstruction until the foreign body is expelled
or the casualty becomes unconscious. Fig. 26 – Provide quick inward and
upward abdominal thrusts
38
Chest Thrusts
This technique is used as an alternative for obese or pregnant casualties.
✓ Ask If the casualty is choking, the casualty will not be able to speak,
breathe or cough but may nod his/her head. Tell the casualty that you
can help.
✓ If the casualty can cough, instruct the casualty to cough as hard as
possible. If casualty is unable to cough, perform the Chest Thrust.
✓ If the casualty is standing, the First Aider should stand behind the
casualty. If the casualty is seated, the First Aider should be kneeling
behind the seated casualty. Wrap the arms around the casualty’s
abdomen.
✓ Place your arms under the casualty’s
armpits encircling the chest.
✓ Make a fist with one hand with the thumb
in the palm (see figure 27).
✓ Place thumb-side of fist on the middle of Fig. 27 – Make a fist with
thumb in the palm
the casualty’s sternum (breastbone).
✓ Grasp your fist with your other hand
and bring yourself close to the
casualty before giving quick
backward thrusts (see figure 28).
✓ Deliver each backward thrust firmly
and distinctly with the intent of
relieving the obstruction until the
foreign body is expelled or the Fig. 28 – Deliver quick backward thrusts
casualty becomes unconscious.
Unconscious Choking Casualty

If the casualty becomes unconscious, proceed with
the following steps:
✓ Support and position the casualty lying on
his/her back on a firm flat surface.
✓ Call 995 for SCDF and get an AED if visible and
nearby.
✓ Locate the landmark and perform 30 chest
compressions using the same location (see Fig. 29 – Provide chest
figure 29) and techniques as Cardio Pulmonary compressions
Resuscitation (see Chapter 8).
39
✓ After 30 chest compressions, check the mouth and remove any foreign
body if seen.
✓ DO NOT perform blind finger sweep as it may push the object back or
further into the airway.
✓ Continue with 30 chest compressions and check the mouth after every
30 chest compressions until help arrives and takes over or the casualty
starts breathing, coughing, talking or moving.
40
3.2 – Asthma
Asthma is a condition where there is difficulty in breathing due to the muscles

of the air passages (bronchi and bronchioles) going into spasm (see figure 30).
Sometimes there is a recognized trigger for an asthmatic attack, such as an
allergy, cold weather, a particular drug, dust or pollen. At other times, no
obvious trigger can be identified.
Asthmatics can usually deal with their own attacks. They carry inhalers that
they use regularly to prevent attacks. The drugs in the inhalers dilate the air
passages, easing the difficulty in breathing.
Fig. 30 – Changes in the Bronchioles during an asthma attack
Causes
➢ Environmental triggers like cold air, pollen, cigarette smoke and

perfumes.
➢ Occupational exposures such as dust, fumes and industrial smoke.
Recognition
➢ Difficulty in breathing.
➢ Wheezing during expiration.
41
➢ Blueness of the skin (cyanosis).
➢ Distress and anxiety.
➢ In severe attacks, the effort of breathing will tire out the casualty.
Actions to Take
✓ Place the casualty in a position that he/she finds most comfortable,

which is often sitting down. Do not lay the casualty down.
✓ Ask him/her to breathe slowly and deeply.
✓ Ensure a good supply of fresh air – open windows etc.
✓ Ask casualty about any asthma
medication and assist to use
the Metered Dose Inhaler
(MDI). Some casualties may
require a spacer (see figure 31)
to administer the medication.
✓ If the casualty has an Asthma
Action Plan, follow the plan
closely (see figure 32).
✓ If the attack is prolonged or Fig. 31 – Metered Dose Inhaler with Spacer
does not respond to medication,
or severe respiratory distress occurs, call 995 for SCDF.
✓ Commence chest compressions and use the AED if the casualty is not
breathing.
Direct MDI use
✓ Remove the cap from the MDI and shake well.
✓ The casualty should seal their mouth over the MDI’s mouthpiece.
✓ Casualty should inhale and exhale deeply before use. Each puff should
be coordinated with a deep breath and held for about 10 seconds.
MDI with Spacer
✓ Insert the MDI into the spacer before the casualty should seal their
mouth over the spacer’s mouthpiece (a face mask may be required for
children under 6 years of age).
✓ Each puff into the spacer should be followed by normal 6 breaths
through the spacer.
42
✓ If more than 1 puff is needed (as prescribed by their doctor – not more
than 8 sprays), rest for 1 minute before commencing the above steps
until the required number of puffs have been completed.
Fig. 32 – Example of a Written Asthma Action Plan (Courtesy of KK Women’s and Children’s Hospital)
43
3.3 – Hyperventilation
Hyperventilation is a condition of over-breathing. This is commonly seen in

cases of acute anxiety and may accompany hysteria or a panic attack. It may
also be seen in a casualty who has received an emotional shock.
Over-breathing causes and excessive loss of carbon dioxide from the blood,
leading to a tingling sensation and numbness of the hands and legs. As
breathing returns to normal, the casualty gradually recovers.
Causes
➢ Anxiety
➢ Hysteria
➢ Panic attack
➢ Fright
Recognition
➢ Unnaturally fast, deep breathing

➢ Dizziness, faintness, trembling or marked tingling in the hands
➢ Cramps in the hands and feet
Actions to take
✓ Reassure the casualty.

✓ Lead the casualty to a quiet place, where he/she may be better able to
regain control of his/her breathing.
✓ Advise casualty to see a doctor.
44
3.4 – Fumes Inhalation
Fumes or smoke that have accumulated in a confined space can quickly

overcome anyone who is not wearing protective equipment. A burning
building presents not only the fire itself, but also falling structures as well as
dangers from fumes and smoke.
Any person who has been enclosed in a confined space during a fire should be
assumed to have inhaled smoke. Smoke from burning plastics, foam padding
and synthetic wall coverings will probably contain poisonous fumes. Casualties
should also be examined for other injuries sustained as a result of the fire.
Recognition
Fumes Inhalation:
➢ Difficulty in breathing from spasm and swelling of the air passages.
➢ Burns in or around the nose or mouth.
➢ Unconsciousness.
➢ The heart may stop.
Carbon Monoxide Inhalation:
This highly dangerous gas prevents the blood from carrying oxygen. It is
tasteless and odourless. A large amount of carbon monoxide in the air, such as
in a confined space, can kill a person very quickly. Lengthy exposure to a slow
leak from a faulty gas heater may also cause severe, possibly fatal poisoning.
➢ Difficulty in breathing
➢ Headache/Dizziness
➢ Nausea and vomiting
➢ Confusion
➢ Unconsciousness
➢ May lead to respiratory and cardiac arrest
45
Actions to Take
✓ DO NOT enter a gas or

smoke-filled room
without proper safety
equipment. Look after
yourself and do not end
up being a casualty.
✓ Call for help. Call 995 for
SCDF.
✓ If you are sure that it is
safe to do so, remove Fig. 33 – Remove casualty to safety
the casualty from danger.

✓ Perform the Primary Survey and commence CPR and use the AED if the
✓ If the casualty is unconscious but breathing normally, place him/her in
the recovery position (see Chapter 2). However, do not turn or move the
casualty if neck or spinal injury is suspected – based on the how the
injury was sustained, and the force or height involved.
✓ Treat other injuries e.g. burns, open wounds, etc.
✓ Do not leave the casualty unattended at any time. Monitor the casualty
46
3.5 – Allergic Reaction
Allergies are an overreaction of the body's natural defence system that helps
fight infections (immune system). The immune system normally protects the
body from viruses and bacteria by producing antibodies to fight them. In
an allergic reaction, the immune system starts fighting substances that are
usually harmless (such as dust mites, pollen, or a medicine) as though these
substances were trying to attack the body.
An allergic reaction may not occur during the first exposure to an allergy-
producing substance (allergen). For example, the first time you are stung by a
bee, you may have only pain and redness from the sting. If you are stung again,
you may have hives or trouble breathing. This is caused by the response of the
immune system.
Many people will have some problem with allergies or allergic reactions at
some point in their lives. Allergic reactions can range from mild and annoying
to sudden and life-threatening.
Anaphylactic shock is failure of the circulation due to a severe allergic reaction
within the body in response to something either taken by mouth, or comes
into contact with the body, or was injected.
Recognition
Mild to Moderate Allergic Reaction

➢ Widespread or localised (over one area only) red, blotchy skin rashes
➢ Swelling of the face and neck
➢ Puffiness around the eyes
Life-threatening Allergic Reaction (Anaphylaxis)
➢ Impaired breathing, ranging from a tight chest to severe difficulty; the
casualty may wheeze and gasp for air.
➢ Persistent cough, hoarse voice, difficulty in swallowing or swollen
tongue.
➢ Pale or dizziness/sleepy, may become unconscious.
Action to Take
47
✓ Place a conscious casualty in a sitting position to relieve any breathing
difficulty.
✓ In mild to moderate cases, advise the casualty to seek treatment at a
clinic. If unsure or in severe cases, call 995 for SCDF.
✓ Ask if the casualty is carrying their prescribed medication (eg.
Antihistamines or Epinephrine auto injector) to treat their known allergic
reaction.
✓ If the casualty indicates the need to use an auto injector, ask whether
you should help inject the medication. This is usually done by pressing
the auto injector against the person's thigh (see figure 34) for 3 to 10
seconds and massaging the area for 10 seconds (or follow the specific
instructions indicated on the
auto-injector).
✓ Loosen tight clothing and
cover the person with a
blanket. Do not give the
casualty anything to drink.
✓ If there's vomiting or bleeding
from the mouth, turn the
casualty to the side to prevent
choking.
✓ Commence chest
compressions and use the AED
if the casualty is unconscious
and not breathing.
✓ Call 995 for SCDF even if
symptoms start to improve as
it is possible for symptoms to
recur. Monitoring in a hospital
is usually necessary.
Fig. 34 – Use of Epinephrine auto injector
48
Chapter 4
Shock, Bleeding and Wounds
1) Shock
2) Bleeding
3) Wounds
4) Bandaging

Rev 1 / 2020
49
The Circulatory System
The circulatory system is made up of the

heart and blood vessels (see figure 35).
Four to six litres of blood circulate around
the body to distribute oxygen and
nutrients to the tissues and carry waste
products away.
Blood Vessels
There are three types of blood vessels:
arteries, veins and capillaries.
Fig. 35 – The circulatory system
Arteries – Strong, muscular, elastic-walled
vessels which carry blood away from the heart towards the tissues.
Veins – Thin-walled vessels which carry blood back to the heart. Blood is
squeezed through the veins by action of the surrounding muscles and is kept
flowing towards the heart through one-way valves.
Capillaries – Arteries subdivide to form a dense network of fine, thin-walled
vessels called capillaries within the body tissues. The thin capillary walls allow
for the exchange of gases and other materials between cells of the body and
the blood. The capillaries then rejoin to become veins.
Blood Pressure
The force with which the heart pumps blood through the vessels and around
the body is known as “blood pressure”.
➢ Systolic pressure in adults = 100 – 140 mm Hg
➢ Diastolic pressure in adults = 60 – 90 mm Hg
The Pulse
This is the pressure wave along arteries, generated by the contraction of the
heart. It can be felt where the artery is close to the surface of the body. The
50
pulse rate may increase with exertion, fear, fever, blood loss and certain
illness. On the other hand, fainting, severe head injuries and heart disorders
may slow it down.
Where the pulse may be felt

The pulse can be felt at the wrist (radial pulse). It
can also be felt at the neck (carotid pulse) (see
figure 36).
Pulse rate for a normal person at rest

• Adult = 60 – 80 beats per min
• Child = 80 – 120 beats per min
• Infant = 100 – 160 beats per min
Fig. 36 – Sites to check pulse rate
Abnormal pulse
Rate
➢ Tachycardia > 100/min – fast heart rate
➢ Bradycardia < 60/min – slow heart rate.
Rhythm
➢ Irregular heartbeat or abnormal beats in heart disease
Strength
➢ Weak e.g. in shock or low pressure.
51
4.1 – Shock
Shock is defined as a life-threatening condition which may be progressive and

may lead to the collapse of the circulatory system.
Recognition
Types of Shock
Hypovolemic Shock
Hypovolemic shock is failure of the circulation due to more than 20 percent
(one-fifth) of the body’s blood or fluid supply being lost either internally or
externally. This severe fluid loss makes it difficult for the heart to pump enough
blood to the rest of the body. The signs and symptoms vary with the degree of
severity of shock.
Cardiogenic Shock
Cardiogenic shock is failure of circulation due to a heart attack or any condition
that damages the heart muscle.
Septic Shock (A form of distributive shock)

Septic shock is a potentially fatal medical condition that occurs when organ
injury or damage in response to infection, leads to dangerously low blood
pressure and abnormalities in cellular metabolism.
Anaphylactic Shock (A form of distributive shock)

Anaphylactic shock is failure of the circulation due to a severe allergic reaction
within the body in response to something either taken by mouth, or comes
into contact with the body, or was injected. Visible signs include widespread or
localised (over one area only) red, blotchy skin rashes, swelling of the face and
neck, puffiness around the eyes as well as Impaired breathing, ranging from a
tight chest to severe difficulty; the casualty may wheeze and gasp for air.
52
Neurogenic Shock (A form of distributive shock)
Neurogenic shock results in low blood pressure, occasionally with a slowed
heart rate, due to the disruption of the autonomic pathways within the spinal
cord. It can occur after damage to the central nervous system, such as spinal
cord injury and traumatic brain injury. Low blood pressure occurs due to
decreased systemic vascular resistance as a result of lacking sympathetic
tone which in turn causes pools of blood staying within the extremities and not
being redirected to the core body.
Signs associated with types of Shock

Hypo- Cardio- Neuro-
Vital Sign Septic Anaphylactic
volemic genic genic
Skin Temp. Cool, Clammy Warm, Dry
Pale,
Pale, Cyanosed (light
Skin Colour blue)
Mottled Pink
(blotchy)
Blood
Drops
Pressure
Level of Lucid
Altered
Consciousness (Normal)
Capillary Refill
Delayed Normal
Time
Response to blood loss
Volume Signs & Symptoms

300 – 500 ml ➢ Little or no effect
➢ Increased blood pressure (diastolic)
500 – 1500 ml ➢ Slightly increased pulse rate
➢ Pale, cool and clammy skin
➢ Increased pulse rate
➢ Shallow and rapid breathing
1500 – 2000 ml ➢ Pale, cool and clammy skin
➢ Nausea
➢ Drowsiness
➢ Pulse becomes undetectable
More than 2000 ml ➢ Loss of consciousness
➢ Breathing may cease and heart may stop
53
Actions to Take

✓ Raise the casualty’s legs
above the level of the heart Fig. 37 – Raise the legs above the level of the heart
(see figure 37), unless there
is a fracture of the lower limb, pelvis, head or spinal injury.
✓ Control severe bleeding and bandage any wounds or burns.
✓ Immobilize any fractures.
✓ Loosen any tight clothing and keep the casualty comfortable.
✓ Moisten the lips if the casualty complains of thirst.
✓ Do not leave the casualty unattended at any time. Monitor the casualty
✓ Perform the Primary Survey and commence CPR and use the AED if the
54
4.2 – Bleeding
TYPES OF BLEEDING
There are three types of bleeding: arterial bleeding; venous bleeding and
capillary bleeding (see figure 38).
Recognition
Fig. 38 – Types of external bleeding
Arterial Bleeding
Arterial blood is bright red in colour and spurts from wounds in time with each
heartbeat. Bleeding from a big artery can quickly lead to shock.
Venous Bleeding
Venous blood is dark red. If flows steadily rather than spurts from a wound.
Bleeding from a large vein can quickly lead to shock.
Capillary Bleeding
If capillaries are cut, blood will ooze from the wound.
Internal bleeding
➢ Bleeding in the lungs may result in blood streaked sputum being
coughed out.
➢ Bleeding in the stomach or intestines may result in coffee ground
vomitus, passing of black, tarry stools or even fresh blood.
55
➢ Bleeding in the urinary tract may result in passing of urine which is
smoky in appearance.
➢ Pain, tenderness and rigidity of abdominal muscles.
➢ Signs and symptoms of shock may be present if bleeding is severe.
Actions to Take
External Bleeding
✓ Apply direct pressure to the wound using a gloved hand and place a
clean dressing over the wound as soon as possible (see figure 39).
✓ Direct Pressure can help control minor to moderate bleeding.
✓ Apply a bulky pad extending beyond the edges of the wound, and
bandage firmly. If bleeding continues, leave the dressing in place and
bandage another one on top (see figure 40).
✓ Do not disturb the pads or bandages once bleeding is controlled.
Fig. 39 – Apply direct pressure over Fig. 40 – Apply bulky pad over and
to wound with a clean dressing beyond the wound
Internal Bleeding
✓ Perform the Primary Survey.
✓ Lay the casualty down and raise the casualty’s legs above the level of the
heart, unless there is a fracture of the lower limb, pelvis, head or spinal
injury.
✓ Loosen tight clothing.
✓ DO NOT leave the casualty unattended at any time. Monitor the casualty
✓ Commence chest compressions and use the AED if the casualty is not
breathing.
✓ Give nothing by mouth and reassure the casualty.
56
4.3 – Wounds
A wound is an injury to body tissues which can be closed or open.

➢ An open wound is a break in the skin
➢ A closed wound is a wound where the skin is intact. Blood escapes into
the surrounding tissues.
Types of Wounds
➢ Contusion
➢ Abrasion
➢ Incision
➢ Laceration
➢ Avulsion
➢ Amputation
➢ Bites and Stings
Recognition
Contusion
➢ Most commonly caused by a fall or bump
➢ Skin is not broken but appears swollen and
discoloured
➢ Pain and tenderness upon touch
Fig. 41 – Contusion
Abrasion
➢ Most commonly caused by a sliding fall or a
friction burn
➢ The top layers of the skin are scraped off,
leaving a raw tender area.
➢ Abrasions often contain embedded foreign
Fig. 42 – Abrasion wound
particles that may cause infection
57
Incision
➢ A cut by a sharp edge, such as a blade or
broken glass
➢ There may be profuse bleeding because the
blood vessels have been cut
➢ Tendons and other structures may have also Fig. 43 – Incision wound
been cut
Laceration
➢ A rough tear caused by a crushing or ripping
force such as from machinery, barbed wire and
animal claws
➢ Wound edges are irregular (jagged)
➢ Bleeding may be less profuse than from clean-
Fig. 44 – Laceration wound
cut wounds, but there is more bruising and
tissue damage
➢ The risk of infection is high as contamination from germs often occur
Avulsion
➢ Torn tissues from the body are left
hanging as a flap
➢ It may involve ears, fingers, hands or a
muscle tissue Fig. 45 – Avulsion wound
Penetrating Object
➢ A deep wound caused by a nail, needle or a
sharp pointed object.
➢ Object may be left
embedded in the wound. Fig. 46 – Puncture wound
Amputation
➢ A body part has been completely cut or torn off
➢ Examples are fingers, toes, hands, feet, arms or
legs Fig. 47 – Amputation
58
Bites and Stings
➢ Bite/puncture marks or stinger left behind on the skin
➢ Swelling and discolouration on the affected area
➢ Pain and tenderness at the affected area, may spread to other parts
➢ Allergic reaction may affect the casualty’s breathing
Actions to Take
Contusion
✓ Apply cold pack to the wound.
✓ Casualty should seek medical help if:
o Sharp pain or numbness is experienced
o Swelling does not subside
Abrasion
✓ Cleanse the wound thoroughly with normal saline.
✓ You may also wash the wound under a running tap.
✓ Gently apply a clean non-stick dressing.
Incision and Laceration

✓ Control the bleeding by applying direct pressure.
✓ Apply a sterile dressing.
✓ Casualty should seek medical help if:
o Bleeding does not stop
o The wound was caused by dirty/rusty objects
o The wound is deep/wide as stitching may be required
Avulsion
✓ Cover the wound with sterile or clean material.
✓ Apply direct pressure and bandage firmly.
✓ Raise and rest the affected part. Take any detached tissue to the
hospital.
59
Penetrating Object
✓ Control bleeding by applying direct pressure
with clean dressing around the bleeding edges
of the wound.
✓ Keep the wound as clean as possible.
✓ DO NOT remove embedded object in the Fig. 48 – Stabilise the
wound. Stabilise the embedded object if its embedded object
movement cause more pain or bleeding (see

figure 48).
✓ Apply paddings that would stabilise the
protruding object while controlling the
bleeding around the edges.
✓ Bandage over the pads around or over the
embedded object without pushing the object
Fig. 49 – Bandage around
deeper (see figure 49). or over the object
✓ Rest the injured part in a comfortable position.
Amputation
✓ Control bleeding with direct pressure.
✓ Apply a tourniquet (see figure 68 on page 73) – Record the time of the
application and inform the SCDF officer taking over the casualty.
✓ Treat the casualty for shock.
✓ Find the amputated part and preserve it as (see figure 50):
o Step A - Wrap the amputated part in dry clean gauze or cloth
o Step B - Place it in a small plastic bag
o Step C - Place the plastic bag in a container of ice
A
B
C
Fig. 50 – How to preserve the amputated part
60
✓ The amputated part must travel with the casualty when the ambulance
arrives.
Bites and Stings

Bee Sting:
✓ If the bee’s stinger is in the wound, remove it with a pair of tweezers or
with the edge of a card.
✓ Apply a cold compress to relieve pain.
✓ Advise the casualty to see a doctor if the pain and swelling persist.
✓ For a sting in the mouth, give the casualty some ice to suck on or cold
water to sip and get medical attention.
✓ Monitor for allergic reaction.
Scorpion Sting:
✓ Apply a cold compress to relieve pain.
✓ Immobilize the injured area.
✓ Monitor for allergic reaction.
Snake Bite:
✓ Calm the casualty.
✓ DO NOT suck the bite wound or apply tourniquet for snake bites.
✓ Immobilize the bitten area and keep it lower than the heart position.
✓ Cover the wound with a sterile dressing.
✓ Apply a pressure bandage at the site of the bite wound and apply
another pressure bandage further up the limb (from the bite wound) to
slow the spread of the venom.
✓ Call 995 for SCDF, tell them it is a snake bite and, if possible, give them a
detailed description of the snake.
Jellyfish Sting:
✓ Sit the casualty down. Pour large amounts of vinegar or sea water to
stop the stinging cells from releasing venom for at least 30 seconds.
✓ Immersion of the wounded part into warm water (about 40 Degrees
Celsius) may help to relieve the pain. Cold compress (a less effective
alternative) may be used if warm pack or water is not available.
✓ Monitor the casualty for difficulty in breathing.
61
Animal Bite:
✓ Wash the wound with running water, if bleeding is mild.
✓ Control bleeding by applying direct pressure and cover wound with
sterile dressing or a clean pad and bandage.
✓ Treat for signs of shock if condition worsens.
62
4.4 – Bandaging
Dressings
Dressings are used to control bleeding, absorb any fluids
from the wound and prevent infection of the wound.
Common dressings: Individually wrapped sterile adhesive
dressing (also known as plasters) and absorbent gauze.
Individually wrapped sterile adhesive dressing (plaster):

Fig. 51 – Individually
➢ These are adhesive strips plasters of various shapes wrapped sterile
and sizes used to cover small wounds. adhesive dressing
(plaster)
➢ Ensure skin is dry before applying the plaster.
Absorbent Gauze:
➢ Absorbent gauze are non-adhesive layers of
weaved cotton which may be available in sterilised
and non-sterilised versions.
➢ They can be used to stop bleeding when pressure is
applied, allowing blood to clot on a bleeding wound
or used as a light dressing to cover over a burn to
prevent infection. Fig. 52 – Absorbent
➢ Bandages or adhesive tape are used to secure the gauze
dressings in place.
Bandages
Bandages found in the First Aid kit are used to maintain direct pressure to
control bleeding, to keep dressings in place, to prevent undesirable movement
of an injured limb, to support an injured limb or joint and to limit swelling.
There are two types of bandages: Crepe and Triangular
63
Crepe Bandages:
➢ They are made of cotton, gauze or linen materials.
➢ Available in varying lengths and width to suit different
parts of the body.
➢ Elastic crepe bandages are preferred as they conform
to the body part’s contours and can provide even
pressure over the injury.
Fig. 53 – Crepe
bandage
Triangular Bandages:
➢ Triangular Bandages are usually used as arm
slings or to immobilise limbs.
➢ They may also be used as paddings between
splints and the limb to provide more comfort.
➢ It can also be used as additional paddings to
increase pressure to control severe bleeding.
➢ Triangular bandage can be improvised as a
tourniquet when needed. Fig. 54 – Triangular
bandage
Important Notes:
Pain, tingling and numbness are indications of a bandage that is too tight. If
any of these symptoms appear, remove the bandage immediately and re-apply
the bandage to the area less tightly. If bleeding is already controlled, the
bandage need not be so tight since its main purpose is to hold the dressing in
place.
64
Different Folds of a Triangular Bandage
Fig. 54 – Different folds of a triangular bandage
65
Tying a Reef Knot
A Reef Knot (see figure 55), or also known as a Square Knot, is widely practiced
in First Aid training courses as a simple way to secure the ends of bandages
while ensuring a comfortable flat knot when resting on the body.
An additional advantage of this knot is the ability to be quickly undone,
allowing adjustments to be made.
However, it should be noted that a Reef Knot is not the only knot that must be
used. In an emergency, the ability to apply a secure knot to provide suitable
support for the various slings and immobilisation should be the focus.
Fig. 55 – Steps in tying a Reef Knot
Making a Ring Pad
A ring pad (see figure 56)

is an ideal padding when
immobilising
embedded/impaled
object. Sizing of the
embedded/impaled object
Fig. 56 – Making a Ring Pad
must be done before
creation of the ring pad.
66
Despite the advantages of the ring pad, the first aider will need to consider the
time required to create a ring pad for the embedded object. Alternatively,
improvisation can come in the form of pads from folded triangular bandages or
folded gauze.
Applying a Crepe Bandage
Application of a crepe bandage is a relatively simple process (see figure 57).

This is usually done to secure dressings in place and should be done in a
manner that does not restrict blood flow. It is ideal to ensure bleeding has
been controlled with direct pressure before application of the crepe bandage.
Fig. 57 – Applying a Crepe Bandage
The above method can be used on

straight limbs such as arms and legs.
However, if a crepe bandage is
required at the joints such as the
elbow, palm/wrist, knee or
ankle/foot, it can be applied as
shown below (see figure 58).
Fig. 58 – Applying a Crepe Bandage at other parts
67
Applying a Large Arm Sling
A large arm sling (see figure 59) is supposed to provide comfort,

immobilisation or support to an injured arm. Do note that the palm should not
be dangling out of the sling and should not be lower than the elbow level.
Common uses for a large arm sling may include:
✓ Fracture of lower or upper arm
Fig. 59 – Applying a Large Arm Sling
68
Applying an Elevation Sling
Due to the angulation of this

sling, it would be useful when
some form of elevation is
required at the lower arm, wrist
or palm to reduce swelling or to
control blood flow to those
areas. Common uses include:
✓ Fracture or dislocation of
the shoulder or collarbone
✓ Bleeding wounds to the
lower arm, wrist or palm Fig. 60 – Applying an Elevation Sling
✓ Fracture of the ribs
Bandaging the Scalp
Bleeding from a scalp wound can be profuse and may appear to be more
serious than it is.
✓ Control bleeding by applying direct pressure (see figure 61).
✓ Apply pressure around edges of the wound with a ring pad (see figure 56
on page 66) if a skull fracture is suspected.
✓ Secure the dressing with a
triangular bandage (see figure
62). Tie the knot at the
forehead, just above the
eyebrows (see figure 63).
✓ Lay the casualty down with the
head and shoulders raised to
control bleeding.
✓ Monitor and record the vital
Fig. 61 – Control bleeding with direct pressure
signs every 5 minutes.
✓ DO NOT leave the casualty unattended.
69
Fig. 63 – The Scalp Bandage
Fig. 62 – Applying a Scalp Bandage
Applying an Eye Bandage
✓ Apply an eye pad over the cut

eyelid to control the bleeding.
✓ Apply an eye shield if small
foreign bodies are present in the
eye.
✓ DO NOT remove any impaled
object from the eye. Stabilise the
object using ring pads.
✓ Apply the eye bandage as shown
(see figure 64). Fig. 64 – Applying an Eye Bandage
70
Applying a Hand Bandage
For minor cuts, burns or abrasions

to the hand, a hand bandage (see
figure 65) can be applied over the
initial dressing using an open
triangular bandage.
Alternatively, a crepe bandage may
be applied over the initial dressing.
It can be supported with an
elevation sling (see figure 60 on
Fig. 65 – Applying a Hand Bandage using
page 69).
Triangular Bandage
Applying an Elbow, Knee or Foot Bandage
Fig. 66 – Applying Elbow, Knee and Foot Bandage
The above bandages (see figure 66) can be applied to the respective parts of
the body to secure dressing for minor cuts, burns or abrasions.
71
Applying a Torso Bandage
This method can be used when a bandage is required to be covered over the
wound (see figure 67).
Fig. 67 – Applying a Torso Bandage
Applying a Tourniquet
Tourniquets are an effective means of arresting life‐threatening external

haemorrhage from limb injury. It is recommended to use tourniquets for the
following situations:
✓ Severe external limb bleeding that could not be controlled by direct
pressure
✓ Multiple casualties with extremity haemorrhage and lack of resources to
maintain simple methods of haemorrhage control
✓ Extreme life‐threatening limb haemorrhage, or limb
amputation/mangled limb with multiple bleeding points
72
Important notes when applying a tourniquet:
✓ The version of tourniquet below is an improvised type (see figure 68).
✓ Direct pressure must still be applied on the wound when applying a
tourniquet (see step 1 of figure 68).
✓ Use a broad-fold triangular bandage from the First Aid kit. Other suitable
materials such as a belt, scarf or strips of clothes may also be used.
✓ When applying the tourniquet, place it about 5cm from the bleeding site
(see step 2 of figure 68) and rotate the stick (see step 3 of figure 68) until
the bleeding it completely stopped.
✓ DO NOT apply over a joint as it will be ineffective.
✓ Secure the stick
such that it does
not undo the
tightening effect
(see step 4 of figure
68).
✓ Once applied, the
tourniquet can be
left in place for up
to 2 hours.
✓ Record the time of
the application and
inform the SCDF
officer taking over
the casualty.
✓ If the First Aid kit
Fig. 68 – Applying a Tourniquet
within your premise
is equipped with
more specialized tourniquets, do be familiar with its application.
73
Chapter 5
Musculoskeletal Injuries
1) Fracture and Dislocation

2) Soft Tissue Injuries
3) Immobilisation/Bandaging

Rev 1 / 2020
74
The Musculoskeletal System
Fig. 69 – The Musculoskeletal System
The musculoskeletal system (see figure 69) provides structure, support,

stability, and movement to the body. It comprises of the bones of the skeleton,
muscles, tendons, cartilage, ligaments, joints, and other connective tissue that
supports and binds tissues and organs together.
Infants are born with about 300 bones, almost a third of which eventually fuse
to form the adult skeleton with 206 bones.
➢ The skull, spine and ribcage protect the vital body organs
➢ The pelvis supports the abdominal organs
➢ The bones and joints of the arms and legs enable the body to move
75
5.1 – Fracture and Dislocation
Fractures are breaks or disruptions in bone tissue. These can be complete or

partial breaks in the bone.
Dislocation is the displacement of a bone at a joint, caused by a strong force
wrenching the bone out of its joint, or by a violent muscle contraction. There
may be associated tearing of the ligaments. The joints most commonly
dislocated are the shoulder, fingers and jaw.
In many cases, it can be difficult to distinguish a dislocation from a closed
fracture. If in any doubt, treat the injury as a fracture. A severe dislocation of
any joint may also fracture the bones involved.
Types of Fracture
➢ Closed fracture – a bone is broken but the skin is intact. Bruising and
swelling often occur around the fracture side.
➢ Open fracture – a wound accompanies the fracture and the overlying
skin is broken. The bone may be exposed through the wound.
➢ Complicated fracture – a fracture is complicated by injury to adjoining
muscles, blood vessels, nerves and organs. E.g. a fractured rib damaging
the lung causing bleeding.
Causes
Direct force – a bone may break at a point
where a heavy blow is received (see figure 70).
For example, the forearm bone may be broken
by the impact of a piece of wood falling on it.
Indirect force – a force my travel from the point
of impact through the body to break bones
elsewhere (see figure 70). A common example is
falling on an outstretched hand which in an
adult, results in a fracture of the collar bone; a
fracture of the wrist in the elderly; and an
elbow fracture in a child. Fig. 70 – Direct and Indirect Forces
76
Recognition
Fracture
➢ Deformity or shortening
of the affected limb
➢ Open injuries or internal
bleeding, (manifested as
shock if severe)
➢ Pain and tenderness at
the injury site
➢ Swelling and bruising –
from internal bleeding Fig. 71 – Closed and open fractures
➢ Loss of function of the
limb
Dislocation
➢ Intense pain
➢ Joint instability
➢ Deformity of the joint area
➢ Reduced muscle strength
➢ Bruising or redness of joint area
➢ Difficulty moving joint
➢ Stiffness Fig. 72 – Dislocation
Actions to Take
Open Fracture:
✓ Cover the wound with a clean pad and apply pressure around it to
control bleeding with a bandage.
✓ Move the uninjured part of the body and secure to the injured part of
the body.
✓ Check the circulation beyond the bandaging every 10 minutes.
77
✓ DO NOT press down directly on a protruding bone. Use ring pads around
the protruding bone to hold it in place.
✓ DO NOT move the casualty until the injured part is secured and
supported.
✓ DO NOT let the casualty eat or drink anything.
Closed Fracture:
✓ Lay the casualty down and minimize movement.
✓ Support the injured part until it is immobilized.
✓ Move the uninjured part of the body and secure to the injured part of
the body.
✓ Check the circulation beyond the bandaging every 10 minutes.
supported.
Dislocation:
✓ Support the injured part until it is immobilized.
✓ Secure the injured part to an uninjured part of the body.
✓ Elevate the injured limb if possible.
✓ Check the circulation beyond the bandaging every 10 minutes
supported.
✓ DO NOT force the dislocated joint back into its “original” position.
Use of Splints
A splint is a device used for support or
immobilization of a limb or the spine and can be
made from many different materials. Splinting of
the injured part should be applied in the position it
was found without straightening or causing more
pain/discomfort. Fig. 73 – SAM splint
78
Some examples of splints are:
➢ Improvised splint: folded newspaper, magazines, cardboard, or wooden
sticks
➢ Commercial splint: SAM splint (mouldable splint) (see figure 73 on page
78), air splint
➢ Body splint: the injured part is tied to an uninjured body part (e.g. an
injured finger to an adjacent finger; an injured arm tied to the chest).
Important Notes:
✓ Find a splint of suitable material and length.
✓ Pad the splint if needed.
✓ Pad the natural spaces between the splint and limb.
✓ Secure the splint at the joints above and below the fractured site for the
limb fracture.
✓ Secure the splint above and below the fractured joint for a joint fracture.
Specific Bone Injuries
Skull Fracture
A skull fracture is any break in the
cranial bone, also known as the
skull (see chapter 2). There are
many types of skull fractures, but
only one major cause: an impact
or a blow to the head that’s strong
enough to break the bone. An
injury to the brain can also
accompany the fracture, but that
may not always be the case.
Fig. 74 – Skull Fracture
79
Recognition
➢ A wound or bruise on the head.

➢ Progressive deterioration in the level of consciousness.
➢ Clear fluid (cerebro-spinal fluid) or watery blood coming out from the
nose or ear.
➢ Bleeding into the whites of the eyes.
Actions to Take

✓ Immobilise the head & neck.
✓ Perform CPR if casualty is not breathing.
✓ Casualty may not be fully conscious, do not feed the casualty anything.
✓ If there is discharge (blood or fluid) from the ear or nose, position the
casualty such that the affected ear or nose is lower than the unaffected
one.
✓ Stay with the casualty.
Jaw Fracture/Dislocation
A broken jaw is a break (fracture) in the jaw bone. A dislocated jaw means the
lower part of the jaw has moved out of its normal position at one or both joints
where the jaw bone connects to the skull (temporomandibular joints).
Recognition
➢ Pain when moving the jaw and swallowing

➢ Distortion of the teeth and dribbling
➢ Swelling, tenderness and bruising
➢ A wound or bruising within the mouth
80
Actions to Take

✓ Sit the casualty up with his/her head well forward, to allow any fluid to
drain away.
✓ Ask the casualty to hold a soft pad firmly in place to support the jaw.
Collar Bone Fracture
The collar bone (clavicle) forms a strut between the breastbone and the
shoulder blade, giving support to the arm. It is usually broken by indirect force,
transmitted from a fall onto the outstretched hand.
Recognition
➢ The casualty supports the arm and inclines

the head to the injured side
➢ Inability to raise the arm
➢ Sharp pain and deformity at the injury site
➢ Casualty’s head may be tilted towards the
injured side to minimise movement
Fig. 75 – Collar Bone Fracture
Action to Take

✓ Ask the casualty to sit down and gently place the affected arm across the
chest at a comfortable angle.
✓ Apply an elevation sling to the affected arm (see figure 60 on page 69).
✓ Insert soft padding between the arm and the chest on the affected side
if needed.
✓ A broad bandage can be applied across the arm and chest to stabilise the
injury (see figure 84 on page 93).
81
Shoulder Dislocation
A fall onto the shoulder or a wrenching force may

cause the head of the arm bone (humerus) to
come out of the shoulder joint socket. This form
of dislocation caused acute pain and any
movement of the shoulder would be intolerable.
Fig. 76 – Shoulder Dislocation

Recognition
➢ Pain, swelling and loss of rounded contour of the shoulder

➢ The casualty supports the arm and inclines the head to the injured side
➢ Inability to raise the arm
Actions to take

✓ DO NOT attempt to replace the bone into its socket.
✓ DO NOT allow the casualty to eat or drink.
✓ Ask the casualty to sit down and gently place the affected arm across the
chest at a comfortable angle.
✓ Apply an elevation sling or large arm sling to the affected arm (see figure
60 on page 69 and figure 59 on page 68 respectively).
✓ Insert soft padding between the arm and the chest on the affected side.
✓ A broad bandage can be applied across the arm and chest to stabilise the
injury (see figure 85 and 86 on page 94).
Rib Fracture
Rib fractures may be caused by a direct or indirect force. If the fracture is

complicated by a penetrating wound or a fracture at two or more locations of
the ribcage (also known as flail chest), breathing may be severely impaired.
82
Recognition
➢ Pain at the fracture site

➢ Pain on taking deep breaths or
coughing
➢ Shallow breathing
➢ An open wound over the fracture
through which you might hear air
being “sucked” into the chest cavity
➢ Presence of shock in the casualty
Fig. 77 – Rib Fracture
Actions to Take
For a fractured rib:

✓ Place soft padding between the injured side of the chest and arm.
✓ Support the limb on the injured side in an elevated arm sling (see figure
60 on page 69).
✓ Tie a broad-fold bandage across the chest (see figure 85 on page 94).
For open (puncture) chest wound or multiple rib fractures:

✓ If there is puncture wound to the chest and lung, leave the entry wound
open and apply direct pressure over the exit wound (if any) with sterile
dressings.
✓ DO NOT seal up or cover the entry wound.
✓ Lay the casualty down in a half sitting position.
✓ Apply an elevation sling to the limb on the injured side (see figure 60 on
page 69).
✓ Tie a broad bandage across the sling (see figure 85 on page 94).
✓ If the casualty is unconscious with no suspected spinal injury, place
him/her in the recovery position with the injured side down. This allows
the lung on the uninjured side to work at its full capacity while
immobilising the injured side.
83
Upper Arm Fracture
The long bone of the upper arm (humerus) may be fractured across its shaft by
a direct blow, but it is more common for the neck of the humerus at the
shoulder to break following a fall.
Recognition
➢ Pain and tenderness at the fracture site
➢ Swelling and bruising
➢ Difficulty in raising the arm
Actions to Take
✓ Sit the casualty down. Place the injured arm across his/her chest in a
position that is most comfortable. Get him/her to support the arm if
possible.
✓ Support the injured arm in a large arm sling (see figure 60 on page 68);
place soft padding between the arm and chest.
✓ Tie a broad-fold bandage around the chest over the sling (see figure 86
on page 94). Tie the knot on the uninjured side.
Elbow Fracture
Fractures around the elbow are rather common, often resulting from a fall.
Recognition

84
Actions to Take
For an elbow that can be bent:

✓ Treat as for a fracture of the upper arm (see page 84).
For an elbow that cannot be bent:

✓ DO NOT attempt to forcibly bend or straighten the elbow.
✓ Lay the casualty down and place the injured limb on the trunk.
✓ Place soft padding between the injured limb and the body to ensure that
bandaging will not displace the broken bones.
✓ Bandage the injured limb to the trunk, first at the wrist and hips, then
above the elbow (see figure 87 on page 95).
Forearm and Wrist Fracture
The bones of the forearm (the radius and

ulna) may be fractured across their
shafts by a violent blow.
In the elderly, the bones at the wrist may
be broken in a fall. This is called the
Colles’ fracture.
Fig. 78 – Forearm or Wrist Fracture
Recognition
➢ History of a fall onto an outstretched hand

or history of a direct blow on the arm
➢ Pain, bruising and swelling
➢ “Dinner fork” deformity (see figure 79)
Fig. 79 – “Dinner fork” deformity
85
Actions to take

✓ Have the casualty seated. Gently steady and support the injured forearm
across his chest.
✓ Expose and treat any open wounds.
✓ Gently place soft padding around the forearm.
✓ Support the arm in an arm sling (see figure 59 on page 68).
✓ Secure the arm to the chest with a broad-fold bandage tied over the
sling, close to the elbow (see figure 86 on page 94). Tie the knot of the
broad bandage in front on the uninjured side.
Hand and Fingers Fracture
The hand consists of many small bones, any of which may be injured by direct
or indirect force. Multiple fractures of these bones are frequently caused by
crushing injuries, severe bleeding and swelling may occur.
Recognition

➢ Deformity
Actions to Take

✓ Protect the injured hand by placing soft padding around the hand.
✓ Gently support the injured arm in an elevation sling (see figure 60 on
page 69).
✓ Secure the arm to the chest by applying a broad-fold bandage over the
sling (see figure 85 on page 94). Tie the knot in front on the uninjured
side.
86
Thigh Fracture
A fracture of the shaft of the thigh bone may be caused by a direct blow. It
may result in severe blood loss into the tissues. Shock may develop.
Recognition
➢ Severe pain, pallor and sweatiness

➢ Bruising and swelling of fracture area
➢ An outward turning of the knee and
foot
➢ Shortening of the leg
➢ Inability to stand
➢ Signs of shock
Fig. 80 – Thigh Bone Fracture

Actions to Take

✓ Lay the casualty down.
✓ Bring the sound leg alongside the injured leg and immobilise with the
injured leg.
✓ Slide one bandage under the knee and another under the ankle.
✓ Slide two more bandages under the knees, one above and one below the
fracture.
✓ Place soft padding between the thighs, knees and ankles to cushion the
bony parts.
✓ Tie a narrow-fold figure-of-eight around the ankles first (see figure 88 on
page 95).
✓ Tie a broad-fold bandage around the knees (see figure 89 on page 96).
✓ Then tie one broad-fold bandage above and one broad-fold bandage
below the fracture (see figure 89 on page 96).
✓ Tie the knots on the uninjured side (see figure 89 on page 96).
87
Lower Leg and Ankle Fracture
The shin bone (tibia) of the lower leg

usually requires a direct force to break
it, e.g. a hit by a vehicle or heavy
objects. The thinner splint bone (fibula)
may be broken by a twisting force or a
direct force.
Recognition Fig. 81 – Parts of the Lower leg and Ankle
➢ Deformity and shortening of the limb

➢ Possibility of an open injury
Actions to Take

✓ Lay the casualty down. Carefully steady and support the injured leg
✓ Gently expose and treat any open wounds.
✓ Bring the sound leg alongside the injured leg and immobilise with the
injured leg.
✓ Maintain support at the ankles.
✓ Slide one bandage under the knees and another bandage under the
ankles.
✓ Slide two more bandages under the knees, one above and one below the
fracture site.
✓ Place soft padding between the calves, knees and ankles.
✓ Tie a narrow-fold figure-of-eight around the ankles first (see figure 88 on
page 95).
✓ Tie a broad-fold bandage around the knees (see figure 89 on page 96).
✓ Then tie one broad-fold bandage above and one broad-fold bandage
below the fracture (see figure 89 on page 96).
✓ Tie the knot on the uninjured side (see figure 89 on page 96).
88
Foot Fracture
Fractures affecting the numerous

small bones of the foot are
typically caused by crushing
injuries. Hospital treatment is
required for these fractures
Fig. 82 – Parts of the Foot
Recognition
➢ Deformity of the foot

➢ An open injury may be present
➢ Bruising and swelling
Actions to Take

✓ Sit the casualty down.
✓ Elevate and support the foot to minimize swelling.
✓ Cold compress may be used to reduce the pain and swelling.
89
5.2 – Soft Tissue Injuries
Fig. 83 – Strain, Sprain and Contusion
Strain
A strain is the result of overstretching a muscle resulting in a partial tear e.g. in
the calf muscle.
Muscle Contusion
Muscle contusion (bruise) result from a blow to the muscles.
Muscle Cramp
Overuse of a muscle, dehydration, muscle strain or simply holding a position
for a prolonged period can cause a muscle cramp.
Sprain
A sprain is the partial or complete stretching or tearing of the ligaments
connected with a joint. The ankle is the most commonly sprained joint.
90
Recognition
Strain
➢ A sudden sharp or severe pain
➢ Tenderness when the area is touched
Muscle Contusion
➢ Swelling of the affected muscle
➢ Pain and tenderness
➢ A bruise may appear
Muscle Cramp
➢ Pain and uncontrollable spasm
➢ Restricted movement
Sprain
➢ Acute pain and tenderness at the joint
➢ Swelling around the joint
➢ Limited movement
Actions to take
Strain and Muscle Contusion

✓ Apply the RICE treatment (see below).
Muscle Cramp
✓ Get the casualty to gently stretch the affected muscles;
or
✓ Relax the muscles by applying steady pressure to them.
91
Sprain
✓ Remove the footwear gently to check and treat the injury.
✓ Apply the RICE procedure (see below).
✓ If a fracture cannot be excluded, immobilize the joint and call 995 for
SCDF.
RICE Treatment
The acronym RICE is used for contusions (bruises), strains, sprains, dislocations
and fractures (see figure 84 on page 93).
R- Rest:
✓ Rest, steady and support the injured part in the most comfortable
position for the casualty.
I – Ice:
✓ Using cold compress will reduce swelling, bruising and pain.

✓ Apply a cold compress for 10-15 minutes or stop when the casualty
starts to shiver or feels numb at the site.
✓ DO NOT apply a cold compress longer than 20 minutes at a time as
frostbite and/or nerve damage can result.
C – Compression:
✓ Apply gentle, even pressure to the injured part by surrounding the area
with a thick layer of soft padding, such as cotton wool or plastic foam,
and secure with a crepe bandage.
✓ DO NOT apply the bandage too tightly as this would restrict circulation.
Expose the fingers and toes to observe for possible colour change.
E – Elevation:
✓ Raise and support the injured limb to reduce swelling.

✓ DO NOT elevate a suspected fracture until it has been stabilized with a
splint. Note that some fractures should not be elevated e.g. a spinal
fracture.
92
Fig. 84 – RICE Treatment.
93
5.3 – Immobilisation/Bandaging
Immobilisation
Immobilisation requires movement of the injured part to be minimised in
order to reduce pain and prevent further injury. This can be done with the use
of splints (see page 78) along with bandaging techniques covered in chapter 4.
Immobilisation should consider the casualty’s level of comfort (and
cooperation). Straightening of the angulated fracture should not be performed
by the First Aider and should be referred to professionals with specific training.
Immobilisation of the Upper Body
Apply an elevation sling with a broad-fold

bandage across the sling and chest (see figure
85):
✓ Dislocated shoulder
✓ Fractured collar bone
✓ Fracture of the ribs (soft padding to be
Fig. 85 – Elevation Sling with
placed between chest and arm) Broad-Fold Bandage across
Apply a large arm sling with a broad-fold

bandage across the sling and chest (see figure
86):
✓ Lower arm fracture (with splint along the
lower arm)
✓ Upper arm fracture (with splint along the
upper arm)
✓ Wrist or hand fracture (with splint along
Fig. 86 – Large Arm Sling with
the wrist and hand)
Broad-Fold Bandage across
✓ Elbow fracture (if the arm can be kept at
an angle suited for a large arm sling)
94
For elbow fracture where the elbow cannot be bent (see figure 87):
Fig. 87 – Immobilisation
for elbow fracture that
cannot be bent
Immobilisation of the Lower Body

When immobilising parts of the lower body, it is important to start with the
feet or ankles as they are the most distant point from the torso and any
movement will cause pain or discomfort. This should include splinting of the
lower limb with available splints or using the uninjured side as a splint.
The following picture shows a figure-of-eight bandage (see figure 88) used to
secure the feet to prevent outward rotation of the legs, leading to further
aggravation of the leg or pelvic fracture. Other alternatives include tying the
laces of both shoes together and using crepe or triangular bandage to secure
the feet together. After the immobilizing the feet, other bandages can be
applied to deal with the specific lower body fractures.
Fig. 88 – Figure-of-Eight
bandage at the feet for
immobilisation
✓ Triangular bandages can be prepared into broad of narrow folds and

inserted under the natural spaces under the knees, ankles or the lower
back.
✓ Gently slide the folded bandages under the body into place to be tied.
95
✓ Padding should be placed between both legs to provide some comfort.
✓ Knots are usually tied on the uninjured side.
Immobilisation for Thigh (Femur) or Lower Leg (Tibia/Fibula) Fractures

✓ Find appropriate splint and pad between the legs.
✓ Figure-of-eight bandage at the ankles.
✓ 1 broad-fold triangular bandage at the knees.
✓ 1 narrow-fold bandage above the fracture site.
✓ 1 narrow-fold bandage below the fracture site.
✓ All knots to end off on the uninjured side.
Fig. 89 – Immobilisation of the lower legs. Example shown here is for Lower Leg fracture.
96
Chapter 6
Burn Injuries
1) Burns Depth and Severity of Burns

2) Classification and Treatment of Burns

Rev 1 / 2020
97
The Skin Structure
Fig. 90 – The Skin Structure
Epidermis – The outer layer

Dermis – The layer with sebaceous glands, blood vessels and nerve endings
Subcutaneous tissue – The layer with sweat glands, hair follicles, blood vessels
and fat
Function
➢ Protects from injury
➢ Protects from infections
➢ Regulates body temperature
Important Notes
➢ Establish own safety before attempting to treat the casualty.
➢ Stop the burning, by means of rapid cooling using water for 5 – 10
minutes, in order to prevent further damage to the tissues, to reduce
swelling, minimize shock, and alleviate pain.
➢ Cover the injury to protect it from infection.
➢ Except in cases of very minor burns, obtain appropriate medical aid.
98
6.1 – Burns Depth and Severity of Burns
Burns and scalds are damage to the skin usually caused by heat. Both are
treated in the same way.
A burn is caused by dry heat – by an iron or fire, for example. A scald is caused
by something wet, such as hot water or steam.
The amount of pain experienced by the casualty is not always related to the
severity of the burn. Even a very serious burn may be relatively painless.
Recognition
Burns Depth
Superficial Burn (1st Degree)

➢ Injury involves only the outer
layer of the skin
➢ Redness, swelling, tenderness
and pain are present
Fig. 91 –
Partial Thickness Burn (2nd Degree)

➢ Injury affects the deeper layers
of the epidermis
➢ Formation of blisters
➢ Pain is present
Fig. 92 –
Full Thickness Burn (3rd Degree)

➢ Injury involves all layers of the
skin; damage may extend to
nerve, muscle and fat
➢ The skin appears pale, waxy or
charred Fig. 93 –
➢ Relatively pain free
99
Severity of Burns
The extent of a burn is expressed in terms of a percentage of the Body Surface
Area (BSA).
The “Rule-of-Nines”,
which divides the surface
area of the body into
areas of approximately
9%, is used to calculate
extent and to decide
what level of medical
attention should be
sought.
The Palmar Method is
used for estimating the
percentage of body
surface area on a casualty
by using the casualty’s
palm to estimate 1% of
their Body Surface Area
(BSA). This method may
be useful in estimating
burn areas smaller than a Fig. 94 – “Rule-of-Nines” and Palmar Method
full extremity.
For a normal adult:
✓ Any partial-thickness burn (2nd degree) of 1% or more (covering an area
approximating to that of the casualty’s palm) must be seen by a doctor.
✓ A partial-thickness burn (2nd degree) of 9% or more may lead to shock;
the casualty needs hospital treatment.
✓ A full-thickness burn (3rd degree) of any size requires immediate hospital
treatment.
100
6.2 – Classification and Treatment of Burns
Classification of Burns Injuries

➢ Thermal burns – caused by hot surfaces and fires
➢ Scalding – caused by steam, hot liquids, hot oil
➢ Chemical burns – caused by acids and alkalis
➢ Electrical burns – caused by electricity and lightning strikes
➢ Radiation burns – caused by exposure to the sun or radioactive
substances
Actions to Take
Superficial Burn (1st Degree) and Partial Thickness Burn (2nd Degree)
✓ Remove jewellery, belts and other restrictive items, especially from
burned areas around the neck as burned areas may swell rapidly.
✓ Flush the burnt area with tap water for at least 10 minutes, blot dry and
cover with a sterile dressing or any clean cloth.
✓ Treat the casualty for shock if present.
✓ Seek medical attention.
✓ DO NOT break blisters.
✓ DO NOT use adhesive dressings.
✓ DO NOT apply ice.
✓ DO NOT remove anything stuck to the burn as further damage and
infection may result.
✓ DO NOT use antiseptic preparation, ointment sprays, lotions or creams
to the injury.
Full Thickness Burn (3rd Degree)

✓ Cover the area with a sterile dressing or any clean cloth.
✓ Treat the casualty for shock if present.
✓ Watch for breathing difficulty involving burns on the face and neck.
101
✓ DO NOT immerse large burnt areas into water as it can cause loss of
body heat.
to the injury.
Burns in Special Areas

Burns to the face and within the mouth or throat by inhalation or heated
fumes are extremely dangerous as they cause rapid swelling and inflammation
of the air passages. Signs of burning will usually be evident. There may also be
hoarseness of voice in the casualty.
For extreme cases, there is no specific first aid treatment. As swelling quickly
blocks the airway, suffocation may result. Urgent and highly specialized
medical aid is required.
✓ Call 995 for an SCDF. Inform dispatch that the casualty may have airway
burns.
✓ Take any steps possible to facilitate the casualty’s breathing; e.g. loosen
clothing around the neck.
✓ If the casualty becomes unconscious, be prepared to provide chest
compressions and use the AED.
Thermal Burns and Scalding

Thermal burns are caused by an external heat source that raises the
temperature of the skin and tissues beneath the skin, destroying cells. Scalding
is also considered a form of thermal burns and occurs when hot liquid or steam
comes into contact with the skin. Superficial or Partial thickness burns may
result.
✓ Remove the source of heat. Remove hot clothing if possible.
✓ Cool the injured area with water for at least 10 minutes or until the pain
is relieved.
✓ Remove any constricting objects (jewellery, watches, belts or clothing)
from the injured area before the swelling begins.
✓ Use a sterile dressing or a clean, non-fluffy pad to bandage loosely and
consult a doctor for further treatment.
102
✓ DO NOT break blisters.
✓ DO NOT use adhesive dressings.
to the injury.
Chemical Burn
This occurs when caustic or corrosive substances come into contact with the
skin.
✓ Flush the area immediately
with large amounts of water
for 15 – 20 minutes or longer.
Some chemicals require
specific treatment, always
refer to the chemical’s Safety
Data Sheet (SDS) for more
information (see figure 95).
✓ Wear gloves, apron and eye
protection if available.
Remove the casualty’s
contaminated clothing whilst
flushing.
✓ Cover the burned area with a
dry clean dressing.
✓ Call 995 for SCDF. Inform the
dispatch that chemicals are
involved. Fig. 95 – Example of a Safety Data Sheet
Electrical Burn
An electrical burn is caused by electricity entering the body at the point of
contact. Most of the damage occurs inside the body although the burn appears
small and is seen only on the outside. The electricity normally exits where the
body is in contact with a surface or the ground.
103
✓ Ensure that the area is safe. Unplug, disconnect, or turn off the power.
✓ Check for fractures and spinal injury.
✓ Treat the casualty for shock by raising the legs and prevent heat loss by
covering him with a cot or blanket.
✓ Cover entry and exit burns.
✓ Sudden Cardiac Arrest may occur. Perform Chest Compressions and use
the AED if casualty’s breathing stops.
Radiation Burn
The most common type of radiation burn is sun burn caused by Ultra Violet
(UV) radiation.
✓ Remove the casualty from the sun or source of heat. Move to a cool and
sheltered area or cover the affected parts with light clothing.
✓ Encourage the casualty to stay hydrated in small amounts at a time and
cool the affected skin by dabbing with water.
✓ If signs of heat disorders are also present, treat the casualty accordingly
(refer to Chapter 2) and call 995 for SCDF.
104
Chapter 7
Other First Aid Knowledge
1) Eye Injuries
2) Epistaxis (Nose Bleeding)
3) Poisoning
4) Transportation of Casualty

Rev 1 / 2020
105
The Eye
Structure of the Eye

The eyeball is situated in the
eye socket and its
movement is controlled by
six eye muscles. The front of
the eye is covered by the
cornea, which is
transparent. Beneath the
cornea is the iris and the
central opening in the iris is
called the pupil. The eye is
protected by the upper and
Fig. 96 – Structure of the Eye lower eyelids.
Function
The eye is protected from injury by the quick movement of the eyelids.
Secretions from the eye in response to irritation and chemicals help to wash
the eye.
Important Notes
➢ Whenever possible, cover both the casualty’s eyes with cold, wet pads.
➢ Always seek medical attention – call 995 for SCDF.
106
7.1 – Eye Injuries
Eye injuries occur due to damage caused by a direct blow to the eye. The
trauma may affect not only the eye, but the surrounding area, including
adjacent tissue and bone structure.
Other forms of eye injuries can be caused by foreign bodies or chemicals and
may have a high risk of long-term damage to the eyes.
Common causes of eye injuries:

➢ Penetration by a foreign body
➢ Chemicals
➢ Foreign bodies
➢ Blunt force trauma
➢ Cuts to the eye and eyelid
Recognition
Penetrating Eye Injury

➢ Eyeball may be collapsed due to leakage of vitreous fluid
➢ Penetrating object might be visible in the eye
➢ Movement of uninjured eye will cause pain in the injured eye
Chemicals
Chemical burns to the eye can occur at the workplace, at home or in schools
and may not even involve industrial chemicals. Common soap, detergent, hand
sanitiser or shampoo may get into the eye and cause varying levels of
discomfort.
➢ Redness and swelling
➢ Sharp or burning pain
➢ Unable to open eyes
➢ Tearing
107
Foreign Bodies
➢ Pain or discomfort
➢ Blurred vision
➢ Redness and tearing
➢ Eyelid may be tightly closed
➢ Sand, wood, dust or fragments of an object may be visible
Blunt Force Trauma

➢ Being hit by a blunt instrument or a fist
➢ “Black eye” – caused by bleeding into the eyelid and surrounding tissues
Cuts to the Eye and Eyelid

➢ Being hit by a sharp or blunt instrument
➢ Laceration of the eyelid or conjunctiva
Actions to Take
Penetrating Eye Injury

✓ Protect the injured eye with an eye
pad or eye shield.
✓ Cover the uninjured eye with a patch
to stop movement of the uninjured
eye.
✓ If object is too large to be covered by
an eye pad or eye shield, apply
techniques for dealing with Fig. 97 – Eye Bandage
penetrating objects (see page 59).

➢ DO NOT remove any object stuck in the eye.
➢ DO NOT apply too much pressure to the injured eye (vitreous fluid might
be lost).
108
Chemicals
✓ Place the casualty’s head under a tap and rinse the eye with clean water
for at least 15 to 20 minutes.
✓ Irrigate from the nose side of the eye outwards to avoid flushing the
chemical into the other eye.
✓ Encourage the casualty to roll his or her eyeball so that the water can
flush out the chemical from all parts of the eye.
✓ Place and eye pad to the affected eyes and bandage both eyes.
Foreign Bodies
✓ Protect the injured eye with an eye pad or eye shield to prevent object
from being driven deeper into the eye.
✓ Cover the uninjured eye with a patch to stop movement of the uninjured
eye.
✓ DO NOT allow the casualty to rub the eye.
✓ DO NOT attempt to remove any embedded object.
✓ DO NOT use dry cotton (cotton balls or cotton-tipped swabs) or
instruments such as tweezers on the eye.
Blunt Force Trauma

✓ Apply a cold compress for about 15 minutes to reduce pain and swelling.
✓ Consult a doctor immediately in case of pain, reduced vision or
discolouration (black eye).
Cuts to the Eye and Eyelid

➢ Loosely bandage both eyes.
➢ Call 995 for SCDF.
➢ DO NOT flush the eye with water.
➢ DO NOT apply too much pressure to the injured eye (vitreous fluid might
be lost).
109
7.2 – Epistaxis (Nose Bleeding)
Nosebleeds are common in children but may occur in adults as well. Other
causes may also be due to injury to the nose, picking of nose dry climate,
frequent nose blowing. The bleeding is usually minor in most cases. A
nosebleed after a head injury should be taken seriously and medical attention
should be sought, as it may suggest a possible skull fracture.
Actions to Take
✓ Sit the casualty down with his/her head slightly forward. Allow a small
bowl for the child to spit in if necessary.
✓ Help the casualty pinch the fleshy part of the nose for 10 minutes, asking
him/her to breathe through his open mouth.
✓ If the bleeding continues, reapply the pressure for another 10 minutes.
Most nosebleeds should stop within 20 to 30 minutes. If it persists for
more than half an hour, you should seek medical attention.
✓ After the bleeding has stopped, advise the casualty to rest for a few
hours.
110
7.3 – Poisoning
Poisoning is a process or
condition when a casualty
becomes harmed (poisoned) by
a toxic substance. Poisoning can
be acute (sudden or over a very
short period of time) or chronic
(over a prolonged period of
time). Depending on the length
of exposure and dose, effects
Fig. 98 – Routes of Poisoning
may range from temporary to
irreversible damage or death.
Poison may enter the body through breathing (inhalation), skin contact
(absorption/injection) or by mouth (ingestion) (see figure 98).
Recognition
Depending on the substance, dose and exposure, the signs and symptoms may
vary and may include the following (but not limited to):
➢ Altered levels of consciousness and may lead to unconsciousness
➢ Breathing difficulty
➢ Corrosive burns around the mouth if substance was ingested
➢ Vomiting and/or diarrhoea
➢ Presence of poisonous substances nearby
➢ Corrosive burn marks if the substance was absorbed through the skin
➢ History of substance abuse (eg. puncture marks on skin)
➢ Headache, nausea or giddiness
Actions to Take

111
✓ For poisoning cases in a workplace involving substances used during the
work process, refer to the instructions on the Safety Data Sheet (SDS)
and follow the emergency procedures established for such incidents. If
such procedures are not in place or you are unsure, call 995 for SCDF
and inform them that chemicals (type and amount if known) are
involved. Keep the casualty calm and minimise the casualty’s
movements.
✓ For poisoning cases in a domestic or household setting, keep the
casualty calm and minimise the casualty’s movements. Call 995 for SCDF.
✓ DO NOT leave the casualty unattended at any time. Monitor the casualty
and record the vital signs at regular intervals. If casualty is conscious and
alert, get a detailed history.
✓ Ensure personal safety when handling the substance (eg. chemical,
pesticide, detergent, syringe with needles, bottles, etc). Inform SCDF of
the suspected substance and bring the substance’s container along to
the hospital.
✓ DO NOT force the casualty to vomit unless it is a natural body reaction.
✓ DO NOT force the casualty to drink more water unless advised by SCDF
or a Doctor.
112
7.4 – Transportation of Casualty
Important factors when considering BEFORE moving the casualty:

➢ It is always ideal to wait for the arrival of the Ambulance crew and take
instructions from them.
➢ DO NOT move the casualty unnecessarily unless there is immediate
danger or casualty is exposed to harsh weather elements.
➢ DO NOT leave the casualty alone. Send someone else to get help.
➢ If the casualty is seriously injured or has multiple injuries, it may be
better to attend to him where he is, because movement may cause
further injuries.
➢ Consider the terrain or environment when moving the casualty.
➢ Communicate with other First Aiders of the transport/evacuation plan.
➢ Always ensure the safety of both the casualty and other First Aiders or
assistants during the transportation process.
➢ Plan for a short stop every few minutes to check on the casualty and
allow a change of hands if needed.
To move the casualty, the following methods may be used:
➢ Support by a single rescuer
➢ Handseats and the “kitchen chair” carry
➢ Blanket lift
➢ Stretcher
➢ Wheeled transport (e.g. wheelchair)
Principles of Lifting
➢ Know your capabilities. Do not try to handle too heavy a load – seek
help.
➢ Keep your back straight. Tighten the muscles of the buttocks and
abdomen.
➢ Apply a safe grip. Use as much of the palms as possible.
➢ Position your feet shoulder width apart for balance, with one foot in
front of the other.
➢ When lifting, do not twist your back; pivot with your feet.
➢ While lifting and carrying, do so in a slow motion and smooth motion, in
unison with other rescuers.
113
➢ Before moving a casualty, inform him/her about what you are going to
do.
One Rescuer Methods
The following methods should only be used by a First Aider when a casualty
cannot be lifted, or is incapable of standing up, but needs to be moved from
danger promptly. Avoid using any of these methods if you suspect that the
casualty has sustained neck or head injuries.
Shoulder Drag
✓ Used for short distances over a rough
surface
✓ Stabilize the casualty’s head with your
forearms
✓ Crouch behind the casualty, help
him/her to sit up, and cross his/her
arms over his/her chest
✓ Pass your arms under the casualty’s
armpits and grasp his/her wrists
✓ Carefully pull casualty backwards. Fig. 99 – Shoulder Drag
✓ DO NOT use this method if there are
shoulder, head or neck injuries.
Human Crutch
✓ If one of the casualty’s legs is injured, help
him/her to walk on the good leg while you
support the injured side.
✓ Stand at his/her injured side, except when
there is an injury to an upper limb.
✓ Assist the casualty by putting your arm
round his/her waist, grasp the clothing at
the hip, and place his/her arm round your
neck, holding his/her hand with your free
hand. Fig. 100 – Human Crutch
114
✓ Move off with your inside foot. Take small steps and walk at the
casualty’s pace.
✓ Reassure the casualty as you move.
✓ If his/her upper limbs are uninjured and the other hand is free, the
casualty may obtain additional help from a second supporter, or by using
a walking stick.
Cradle Carry
• Used when lightweight casualties are
unable to walk.
• Lift the casualty by passing one of your
arms beneath both the knees, with the
casualty’s neck resting on the bend of the
elbow of your other arm.
Fig. 101 – Cradle Carry
Fireman’s Carry
✓ If the casualty’s injuries permit, longer distances can be travelled with
the casualty carried over your shoulder.
✓ Help the casualty to stand.
✓ Grasp casualty’s right/left wrist with
your left/right hand.
✓ Squat down with your head under
his/her extended right/left arm so
that your right/left shoulder is level
with the lower part of casualty’s
abdomen; and place your right/left
arm between or around his/her legs.
✓ Taking the weight on your right/left
shoulder, rise to a standing position.
✓ Pull the casualty across both Fig. 102 – Fireman’s Carry
shoulders and transfer his/her
right/left wrist to your right/left hand, leaving your other hand free.
✓ DO NOT use this method if the casualty is heavier/bigger than you.
115
Pick-a-Back Carry
✓ When injuries make the fireman’s
carry unsafe, this method is used
✓ Crouch in front of the conscious
casualty, with your back to him
✓ Ask the casualty to put his arms over
your shoulders and clasp his hands in
front of you
✓ Grasp the casualty’s thighs and rise
slowly, keeping your back straight.
Fig. 103 – Pick-a-Back Carry
Two Rescuers Methods
Two-handed Seat Carry

✓ This method is mostly used to carry a casualty who is unable to assist
first aiders with his/her arms.
✓ Two first aiders face each other and stoop at each side of the casualty
✓ Each first aider passes his forearm nearest the casualty’s body behind his
back just below the shoulders, taking hold of his clothing
✓ They slightly raise the casualty’s back and pass their other forearm
under the middle of his thighs, clasping their hands together with the
hook-grip.
Fig. 104 – Two-Handed Seat Carry
116
✓ To clasp their hands together, the first aider on the left of the casualty
faces his palm upwards whilst the first aider on the right faces his palm
downwards
✓ To prevent their fingernails from hurting each other’s hand, a folded
handkerchief can be used as a buffer
✓ The first aiders then rise together and step off, the one on the right side
with his right foot and the one on the left side with his/her left foot.
Four-handed Seat Carry

✓ This is the easiest method for two
persons to carry a casualty when no
equipment is available.
✓ The casualty cannot walk but is able
to assist by using one or both arms
to hang onto the first aiders.
✓ With two First Aiders facing each
other positioned behind the
casualty, their left hands grasp each
other’s right wrists, and their right
hands grasp their own left wrists. Fig. 105 – Four-Handed Seat Carry
✓ With both First Aiders stooping

down, the casualty is then instructed to place one arm around the neck
of each first aider, so as to raise him/her to sit on their hands and steady
himself/herself during transportation.
✓ The First Aiders then rise together and step off with their outer feet,
walking at an ordinary pace.
Fore-and-Aft Carry
✓ One First Aider carries the casualty
below the armpits, holding onto the
linked forearms of the casualty.
✓ The second First Aider carries the
casualty at the knees.
Fig. 106 – Fore-and-Aft Carry
117
Improvised Methods
Chair Carry
✓ A useful method when a conscious casualty without any serious injuries,
is to be transported along narrow passageways or up/down the stairs.
✓ A kitchen/dinning chair that is strong enough to take the casualty’s
weight should be used.
✓ The casualty should be seated on the
chair and supported by First Aiders at
the front and rear.
✓ The casualty and the chair are then
slowly tilted backwards at a slight
angle (about 30 degrees) and lifted.
✓ One First Aider should support the
back of the chair with the casualty on
it; the other should hold the chair by
the front legs and move carefully down
the stairs.
✓ If the staircase or passageway is wide
Fig. 107 – Chair Carry
enough, the First Aiders can stand at
the sides of the chair, each supporting a
back and front leg.
Blanket/Sheet Pull
✓ Roll the casualty onto a blanket/sheet
and pull it from behind casualty’s head.
✓ DO NOT use this method over rough or
bumpy surfaces.
Fig. 108 – Blanket/Sheet Pull
Other materials or methods can be considered for use if time, resources and
casualty’s condition allow for it.
➢ Wheeled chair
➢ Make-shift stretcher
➢ Wheel barrow/Trolley cart
➢ Three rescuers carry
118
Cardio-Pulmonary
Resuscitation
and
Automated External
Defibrillation
(CPR+AED)
Provider Course Manual

No part of this book may be reproduced, in any form or by
any means, without prior written permission of SRFAC.
REV 1 / 2022
CONTENTS
1: CARDIAC ARREST AND YOU
1.1: Introduction 02
1.2: The Heart, the Lungs and the Circulation 03
1.3: Risk Factors for Heart Attack 06
1.4: What Happens in a Heart Attack 07
1.5: What Happens in a Cardiac Arrest 08
1.6: Other Common Causes of Cardiac Arrest 10
1.7: The Chain of Survival 11
1.8: SCDF myResponder Mobile Application 13
2: CARDIO PULMONARY RESUSCITATION (CPR)

2.1: The Importance of Early CPR 16
2.2: Adult One-Rescuer CPR 17
2.3: CPR in Special Circumstances 27
3: AUTOMATED EXTERNAL DEFIBRILLATION (AED)

3.1: The Importance of Early Defibrillation 30
3.2: Automated External Defibrillators (AEDs) 32
3.3: Preparation for AED use 32
3.4: Placement of AED Electrode Pads 34
3.5: Defibrillation Procedures 36
3.6: Post-Incident Procedures 39
3.7: Retrieval of Automated External Defibrillator 41
3.8: Sample Practical Scenarios (For Adults) 43
3.9: Child/Infant Defibrillation 44
The Singapore Resuscitation and First Aid Council (SRFAC) would like to thank
the members of the Basic Cardiac Life Support and Automated External
Defibrillation Sub-Committee for contributing to the creation of this manual.
CHAPTER 1
Cardiac Arrest and You
1.1: INTRODUCTION
1.2: THE HEART, LUNGS AND CIRCULATION
1.3: RISK FACTORS FOR HEART ATTACK
1.4: WHAT HAPPENS IN A HEART ATTACK
1.5: WHAT HAPPENS IN A CARDIAC ARREST
1.6: OTHER COMMON CAUSES OF CARDIAC ARREST
1.7: THE CHAIN OF SURVIVAL
1.8: SCDF MYRESPONDER MOBILE APPLICATION

No part of this book may be reproduced, in any form or by any means,
without prior written permission of the copyright owner.
Rev 1 / 2022
1
1.1: INTRODUCTION
Based on national health statistics from the Ministry of Health

in 2019, Singapore, ischemic heart disease (lack of blood
circulation to heart muscles) is the third most common
cause of death, contributing to 18.8% of total mortality.
A person with heart disease is prone to a heart attack, which

could result in cardiac arrest and sudden death. According to
a study conducted in Singapore*, the crude incidence rate of
Out-of-Hospital Cardiac Arrest (OHCA) in 2019 was 56.7 per
100,000 population in 2019 (3233 casualties), of which,
2239 cases (74%) of cardiac arrests occur in the home.
Bystander CPR was performed on 1937 casualties (60%)
and bystander defibrillation was performed on 340 (10.5%)
of them. Out of 200 survivors (6.2%), 156 (4.8%) of them
survived to be discharged with good-to-moderate neurological
functions.
Survival from sudden death can be maximized with the prompt

application of basic life-saving skills of cardio-pulmonary
resuscitation (CPR) and use of automated external
defibrillators (AEDs). These can be performed by anyone,
anywhere and anytime. All that is needed is the rescuer’s two
hands.
* White AE, Shaidah N, Asyikin N et al. Singapore Out-of-Hospital Cardiac Arrest Registry Report
2011-2019. July 2021. Republic of Singapore. Unit for Pre-hospital Emergency Care.
2
1.2: THE HEART, LUNGS AND CIRCULATION
The heart is a muscular pump

located in the center of the
chest and slightly towards the
left. (See figure 1-1)
The heart has two halves. The

right side receives low oxygen
blood from all parts of the body
through veins and pumps it to
the lungs via the pulmonary
arteries to pick up oxygen. (See
figure 1-2)
Figure 1-1 - The heart and lungs
The left side receives oxygen-rich blood from the lungs

through the pulmonary veins and delivers it to all parts of the
body, including the vital organs such as the heart, lungs,
kidneys and brain.
Figure 1-2 - The circulatory system
3
The heart muscles receive oxygen rich blood via a set
of coronary arteries.
The pumping action of the heart is initiated by electrical signals

from a pacemaker (sinoatrial or SA node), these signals travel
to other parts of the heart in an orderly manner through a
conductive network. The electrical signals from the heart can
be picked up by an electrocardiogram (ECG). (See figure 1-3)
Figure 1-3 - The heart’s electrical conduction
The pumping action gives rise to an organized heart-beat at

regular rate of 60-100 beats per minute in a normal person.
4
On an ECG, normal heart rhythm, also known as the Normal
1 small square = 0.04 s 1 large square = 0.2 s
Sinus Rhythm, appears as below (see figure 1-4):
Figure 1-4 - Normal Sinus Rhythm Count the number of large

5 large squares =1second
squares between 2 RR
1 QRS per second
intervals and divide into 300
The human body Heart has
rate =two lungs
60 per min which absorb oxygen from the
air that is breathed in. 21% of air consists of oxygen, of which

5% is extracted by the lungs. The extracted oxygen is passed
to the blood within the capillaries of the lungs. The capillaries
confluence into the pulmonary vein, which transports the
oxygenated blood into the left side of the heart. (See figure 1-
5)
Trachea
Alveoli
Figure 1-5 - Exchange of Oxygen and Carbon Dioxide in the lungs
The remaining 16% of unabsorbed oxygen is breathed out.

This is extremely important in the context of mouth-to-mouth
ventilation; the air that the rescuer ventilate into a cardiac
arrest casualty can deliver sufficient oxygen to save and
sustain life.
5
1.3: RISK FACTORS FOR HEART ATTACK
Survival rates of Sudden Cardiac Arrest is dismal even in the

best cities. Prevention is of paramount importance to prevent
heart attack from occurring. Several key risk factors contribute
to the development of a heart attack. Human Beings can
minimize the chance of getting a heart attack by controlling
the risk factors. These are:
Smoking – Smoking promotes the

development of plaques within the coronary
arteries and increases the risk of heart
attack by two-fold. This habit should be
avoided altogether. (See figure 1-6) Figure 1-6 - Avoid smoking
Blood Pressure – If the blood pressure is

high, there will be tremendous stress on the
heart. Frequent blood pressure checks and
reduction of salt in the diet is important.
Those with high blood pressure should take
their medicines and check their blood Figure 1-7 - Check your
pressure regularly as instructed. (See blood pressure regularly
figure 1-7)
Blood Sugars – Avoid a diet high in

carbohydrates or refined sugars and control
body weight through diet and exercise. (See
figures 1-8 and 1-9) If you have diabetes,
take your medications regularly as
instructed.
Figure 1-8 - Eat healthily
Blood Lipids - Manage blood lipids
(fats) by avoiding foods high in fats. Doing
regular exercise could improve your blood
lipid profile and take your medications
regularly as instructed. (See figure 1-9)
Adopting healthy lifestyles by not smoking,

eating foods in moderate amounts and
regular exercise will decrease the risk of
heart disease and other illnesses. Figure 1-9 -
Exercise regularly
6
1.4: WHAT HAPPENS IN A HEART ATTACK?
A heart attack occurs when

cholesterol deposits and /
or blood clots block one of
the coronary arteries
supplying the heart
muscle. (See figure 1-10)
The heart muscles beyond
the blocked vessel dies due
to lack of oxygenated
blood. This is heart attack.
Figure 1-10 - Blocked coronary artery
Symptoms of a Heart Attack
A person who has a heart attack may experience any of these:
Pain – described as tightness or discomfort either over the

chest or upper part of the abdomen. (See figure 1-11) This
pain may also spread to the left shoulder, left arm, neck or
lower jaw. Some may mistake this for indigestion or fatigue.
Shortness of breath – A sudden

difficulty in breathing may be a warning
sign of a heart attack.
Other Symptoms - Sweating, nausea,

vomiting or dizziness
If a heart attack is not treated Figure 1-11 - Pain

promptly, deterioration of heart or discomfort over
function will occur and the casualty the chest or upper
may develop a sudden cardiac arrest. abdomen
Learn to recognize the symptoms of a heart attack. When

someone experiences these, it is best to call for an ambulance
(telephone: 995) and be taken to the nearest Emergency
Department for immediate evaluation.
7
1.5: WHAT HAPPENS IN A CARDIAC ARREST?
When a portion of the heart muscles dies, it affects the
electrical impulses within the heart. The orderly flow of
electrical signals within the heart is disrupted. This is a
dangerous situation and an irregular, chaotic electrical rhythm
called Ventricular Fibrillation (VF) develops in many cases (see
figure 1.12).
Figure 1-12 - Normal Sinus Rhythm to Ventricular

Fibrillation
When VF occurs, the heart does not pump the blood to the rest
of the body. This is a state of cardiac arrest and the casualty
will be unconscious and stops breathing normally.
Biological death and Clinical death
Figure 1-13 - Irreversible brain damage after 10 minutes
When cardiac arrest occurs, the heart stops pumping and

circulation stops. The oxygen level in the blood decreases,
causing brain damage. If this situation is reversed immediately,
survival chance could be as high as 90%. With a 6 minutes
delay, this drops to 40–50% and at 9 minutes, it is a dismal
10%. (See figure 1-13) This is known as clinical death. Unless
the circulation is restarted quickly, organ death will start to
occur. The most sensitive organ is the brain and if the
8
circulation to the brain is not started within about 4 minutes,
permanent and irreversible brain damage will start to occur.
This is known as biological death. It is therefore important to
start CPR as quickly as possible
Air contains approximately 21% oxygen at sea level. During

its passage through the body, only about ¼ of oxygen is
utilised and hence exhaled air contains approximately 16%
oxygen. When mouth-to-mouth ventilation is done during CPR,
there is sufficient oxygen in the exhaled air to keep the
casualty alive. Chest compression squeezes the heart between
the breastbone and the spine, thereby helping to circulate the
blood and deliver oxygen to the vital organs, especially the
brain.
Immediate CPR and defibrillation are key components for

increased chances of survival.
9
1.6: OTHER COMMON CAUSES OF CARDIAC
ARREST
A heart attack is the most common cause of cardiac arrest.
There are other causes, which include:
Figure 1-14 - Other common causes of cardiac arrest
Death in these situations can be prevented if someone trained

in CPR and first-aid skills provides prompt help.
10
1.7: THE CHAIN OF SURVIVAL
The essential steps for helping a cardiac arrest victim are
illustrated in a system called the “Chain of Survival”. The
seven rings in this chain are: Prevention, Early Recognition
and Access, Early CPR, Early Defibrillation, Emergency Medical
Services (Ambulance), Advanced Cardiac Life Support and
Recovery. (See figure 1-15)
Figure 1-15 - The chain of survival
First Ring: Prevention

Prevention is better than intervention. A healthy diet and
lifestyle can reduce the risk of heart diseases. Going for
regular medical check-ups can help detect problems early and
prompt the individuals to seek treatment early and adjust their
diet and lifestyles.
Second Ring: Early Activation and AED Access

Call for ambulance (dial 995) and get an AED if visible and
near-by. Follow the SCDF dispatcher’s instructions.
Third Ring: Early CPR

The brain cells start dying within 4-6 minutes of cardiac arrest.
CPR must be initiated as soon as possible to provide blood and
oxygen flow to the brain and heart.
Fourth Ring: Early Defibrillation

Automated external defibrillators (AEDs) are increasingly
available in the community, at lift lobbies, void decks,
gymnasium, shopping malls, hotels, airports and schools etc.
Apply onto the casualty and be ready to defibrillate.
Fifth Ring: Emergency Medical Services (Ambulance)

Quick access to the scene and transport to the hospital makes
a difference to the casualty’s chances of survival.
11
Sixth Ring: Advanced Cardiac Life Support
Medical teams will provide advanced cardiac life support at the
hospital with the use of Intravenous/Intraosseous (IV/IO)
medication and delivery of oxygen via mechanical systems (ie.
Bag-Valve Masks and ventilators).
Seventh Ring: Recovery

To ensure a good survival outcome after OHCA requires
continued community and medical support (ie. social services,
physio/occupational therapy, nutritional guidance, etc) and
therapy to re-habilitate the individual back to normalcy.
12
1.8: SCDF MYRESPONDER MOBILE
APPLICATION
In Singapore, many of the emergency cases SCDF responds to could be
quickly attended to by members of the public even before SCDF’s arrival. For
example, more than 3000 people suffer from Out-of-Hospital Cardiac Arrest
(OHCA), with a survival rate of just 5%, which could be improved by simple
medical intervention within the first few critical minutes. At the same time,
there are more than 1,000 minor fires (such as rubbish chute/bin fire) that
could easily be extinguished using publicly-available means. (See figure 1-16)
Figure 1-16 – Incidents that will trigger myResponder notifications
Figure 1-17 – The myResponder mobile application is available on Apple

and Android stores.
13
myResponder is an application by SCDF to alert members of the public to
nearby fire and medical cases, and thereby save lives and increase the
survival rate for OHCA, as well as mitigate minor fires in the first few critical
minutes. myResponder is also a means by which members of the public may
be asked to provide onsite information (via submission of photos and
videos) for SCDF to gain an understanding of the situation. Through the ‘Call
995’ button in the app, users can also send their geolocation to SCDF’s 995
Operations Centre, enabling SCDF to dispatch the emergency resources to
the scene sooner.
myResponder works by notifying members of the public – also known as

Community First Responders (CFRs) – of cardiac arrest and fire cases within
400m of their location. myResponder will also highlight nearby AEDs that
may be available to responders, and provide guided advisories in the
mitigation of minor fires. CFRs can then proceed to the stated location and
assist by performing CPR or applying an AED to revive the patient, mitigating
minor fires using available extinguishing means, or providing further
information to SCDF’s 995 Operations Centre.
Response is entirely voluntary, however, volunteers are encouraged to

respond, when they are available and within safe and reasonable means.
Fig 1-18 – The above QR code works for both Apple iOS and Google Android
OS and will direct to the App Store or Google Play respectively. The
myResponder function is also available within the SGSecure application.
14
CHAPTER 2
Cardio-Pulmonary
Resuscitation (CPR)
2.1: THE IMPORTANCE OF EARLY CPR
2.2: ADULT ONE-RESCUER CPR
2.3: CPR IN SPECIAL CIRCUMSTANCES

Rev 1 / 2022
15
2.1: THE IMPORTANCE OF EARLY CPR
When the heart stops beating, blood stops flowing through the
body. Unless the flow is restarted quickly, other organs in the
body will stop functioning. For example, if the blood does not
flow to the brain for 4 to 6 minutes, it could result in brain
death. CPR is a series of actions required to restart the heart
and get the blood flowing once again as soon as possible.
CPR includes mouth-to-mouth ventilation and chest

compressions. When mouth-to-mouth ventilation is done
during CPR, oxygen is introduced into the body. However, in
view of COVID-19 pandemic, healthcare providers were taught
on the use of bag-valve-mask (BVM) instead of mouth-to-
mouth (MTM) ventilation. Chest compression squeezes the
heart between the breastbone and the spine and thereby helps
to circulate the blood and deliver the oxygen to the vital organs,
especially the brain, heart, and kidneys.
If CPR is performed promptly and correctly:
 Heart function may be restored, and
 Circulation may be maintained until institution of other

life support measures.
In many cases, rescuers in the community are unwilling and/or

unable to provide ventilations. Hands only (chest
compressions only) CPR can be initiated. This only requires
continuous chest compressions without mouth-to-mouth
ventilation, is easier to learn and is as effective as standard
CPR.
The next section takes you step-by-step through the

procedures needed to perform CPR – the basic skill needed to
save lives in the event of cardiac arrest.
16
2.2: ADULT ONE-RESCUER CPR
MNEMONIC: DRSABC
D Check for Danger

R Check Responsiveness
S Shout to get help and call 995 for Singapore Civil
Defence Force (SCDF) Emergency Medical Services
(EMS)
A Ask someone to get an AED
B Check for Normal Breathing and Pulse (for trained
Healthcare Providers)
C Provide continuous Chest Compressions
Notes:
1. If you are a single rescuer and feeling tired, you may take a rest of not more than 10
seconds (preferably after 100 continuous chest compressions).
2. For Healthcare Provider only: If no BVM is available and you are unable or unwilling
to do mouth-to-mouth ventilations, perform continuous chest compressions.
Figure 2-1 – One rescuer CPR steps

*BVM: Bag Valve Mask
17
(D) Check for Danger
Ensure that the rescuer operates in a safe environment.

Resuscitation should start where the casualty is found, unless
the site is unsafe or unconducive (eg. roads which are still
open to traffic, burning building, etc), then the casualty should
be removed to a safe, flat and open space as soon as possible.
(R) Check for Responsiveness
 The rescuer should tap the

casualty’s shoulders firmly and
ask loudly: ‘Hello! Hello! Are you
okay?’ (See figure 2-2)
 Avoid violent shaking of the

casualty as this may result in
injury.
Figure 2-2 – Tap shoulder
 Avoid unnecessary movements for response
of the neck in the event of
injuries to the head and neck.
For CPR to be effective, the casualty must be lying on his/her back on a firm,
flat surface. If the casualty is lying face down (prone position), or on his/her
side, rescuer will need to roll the casualty over onto his/her back.
(S) Shout to get help
 If the adult is unresponsive, shout to get

help from bystanders to call ‘995’ for SCDF
EMS or activate the emergency response
system (for in-facility/in-hospital cardiac
arrest). If alone, use a handphone to call
995 for SCDF EMS and put on speaker
phone mode. An SCDF emergency medical
dispatcher can help a lay rescuer Figure 2-3 –
recognise cardiac arrest, and once this is Call 995 for
established, the dispatcher will guide the an ambulance
rescuer to begin CPR by providing
18
instructions on how to perform Chest Compressions via a
handphone. (See figure 2-3)
 In a situation where a lone rescuer found an unresponsive

casualty in a remote area with no accessibility to activate
emergency medical service, it is necessary for the lone
rescuer to assess the casualty’s responsiveness and
breathing. If normal breathing is absent, chest
compressions should commence immediately and
continued for at least two minutes before leaving the
casualty to seek help.
Note:
 However, if there is another person around, ask him/her to call 995 for
SCDF EMS and get an AED.
(A) Ask someone to get an AED
 Ask someone to get an AED if

there is one within a 60-second
walking distance. The SCDF
emergency medical dispatcher
may be able to locate the
nearest AED and summon help
Figure 2-4 – Ask someone to
from CPR-trained rescuers in
get an AED
the vicinity. However, if you
are the lone rescuer, do not
leave the casualty. (See figure 2-4)
(B) Check for normal Breathing
 Look for the rise and fall of the

chest. (See figure 2-5)
 Checking for normal breathing

should not take more than ten
seconds.
Figure 2-5 - Look for normal
 It is important to recognize breathing
that gasping is NOT normal
breathing but a sign of cardiac
arrest (gasping can also happen in severe asthmatic
19
attack). Start chest compressions immediately if you are
unsure whether the casualty has abnormal breathing or
gasping. (See https://youtu.be/T85vd3CBs04 for video of
contrast between gasping and normal breathing)
For trained healthcare providers
 Checking of carotid pulse and breathing should not take

more than 10 seconds.
 Check for carotid pulse when checking for normal

breathing. Slide your fingers down to the groove at the side
of the neck near you (this is the location of the carotid
pulse).
 If unsure about the presence of carotid pulse and no

normal breathing, assume cardiac arrest and commence
chest compressions.
(C) Chest Compressions
 Site of chest compression should be at the centre of the

chest at the lower half of the sternum (breastbone). (See
figures 2-6 and 2-7)
o Ensure adequate exposure of the chest.
o Kneel by the side of the casualty.
o Place the heel of one hand on the lower half of the
sternum (breastbone) and avoid the Xiphoid Process.
o Place the heel of the second hand on top of the first.
o Interlace the fingers of both hands and lift the fingers
off the chest wall. (See figure 2-8)
o Straighten both the elbows and lock them into position.
o Position the shoulders directly over the casualty’s chest.
Use the body weight to compress the casualty’s
sternum (breastbone).
o Depth of chest compression for adults must be at least
4 cm but not more than 6 cm.
o The compression rate is 100–120 per minute.
o Ensure complete recoil of the chest wall after each
compression. (See figure 2-9)
o Loud counting of the chest compressions should be
encouraged: 1&2&3&4&5&, 1&2&3&4&10&,
20
1&2&3&4&15, 1&2&3&4&20, 1&2&3&4&25,
1&2&3&4&30… up to 100. Chest compressions consist
of a series of rhythmic applications of pressure over the
lower half of the sternum (breastbone). These
compressions create blood flow to the vital organs
(heart, lungs and brain).
o If tired after 100 compressions, rescuer can take up to
10 seconds of rest and then resume chest
compressions.
Figure 2-6 - Xiphoid Process Figure 2-7 - Xiphoid Process

(Female casualty) – to be avoided (Male casualty) – to be avoided
Figure 2-8 – Lift fingers off the chest wall and interlock hands
Figure 2-9 - Compression and release

during CPR
21
For trained healthcare providers
 Perform 30 chest compressions and provide 2 ventilations

via a BVM.
 Complete 5 cycles of 30 compressions and 2 ventilations
before re-assessing breathing and circulation.
Perform BVM ventilations:
 Perform a Head-Tilt, Chin-Lift manoeuvre. An open airway

will ensure BVM ventilations are effective. In the
unresponsive casualty, muscle tone is impaired resulting
in the tongue falling backward and obstructing the
airway. (See figure 2-10) As the tongue is attached to the
lower jaw, moving the lower jaw forward will lift the
tongue away from the back of the throat and open the
airway.
 Head-tilt - Place your palm on the forehead and push it

backwards.
 Chin-lift – Use the index and middle fingers of your

other hand to lift the bony part of the chin upwards. (See
figure 2-11)
Figure 2-10 - The

Figure 2-11 - The Head-
airway blocked by the
Tilt, Chin-Lift Manoeuvre
tongue
 When using a Bag Valve Mask

(BVM), select a mask that fits over
the mouth and nose of the casualty
– The nasal portion of the mask
over casualty’s nose high enough to
Figure 2-12 -
cover the bridge without air leaks appropriate mask
size
22
and the lower portion of the mask over the chin, allowing
it to seal along the two cheekbones. (See figure 2-12)
 E – C hand placement – ‘E’: Using one hand, hold the

mask with
your middle and index finger wrapped
around the connector stem of the mask.
‘C’: Extend your thumb underneath the
casualty’s jaw, and pull it upward into
the mask. (See figure 2-13)
 While maintaining the upward traction Figure 2-13 – ‘E-C’

on casualty’s jaw, press the mask hand placement
downward onto the face to attain a tight
mask seal. (See figure 2-14)
Figure 2-14 – Maintaining the upward traction

of the jaw and downward traction of the mask
 Perform ventilation by squeezing the bag steadily and

smoothly using your other hand over 1 second. Then,
release the bag to allow it to reinflate fully before
providing second ventilation.
 Each ventilation should be enough to make the chest rise.

This is approximately 400 – 600 ml of air.
 Do not interrupt chest compressions for more than 10

seconds to perform 2 ventilations.
23
Note:
 Do not press deeply into the soft tissues under the chin.
 Do not place your hands or the mask on the casualty’s eyes as doing so
may damage the eyes or cause a vagal reaction.
 Excessive force and rapid insufflation increase gastric distension.
 If BVM is not available, you may provide mouth-to-mouth ventilations if
you are trained and willing to perform.
 If you are unable or unwilling to perform ventilations for any reasons,
please perform continuous chest compressions at the rate of 100 – 120
per minute. If you are a single rescuer and feeling tired, you may take a
rest of not more than 10 seconds (preferably after 100 compressions).
The cycles of 30 chest compressions to 2 ventilations

(see figure 2-15) should be continued until one of the
following occurs:
Figure 2-15 – 30 chest compressions followed by 2 ventilations via bag-

valve-mask (BVM)
 An AED is connected to the casualty and prompts you to

stop CPR.
 The ambulance crew arrives and takes over further care of

the casualty.
 The casualty regains normal breathing or consciousness.

___________________________________________
Continue to perform CPR until:

 Paramedic takes over from the rescuer; or
 AED prompts to analyse the casualty’s heart rhythm, is
charging or when shock is to be delivered; or
 Casualty wakes up or regains normal breathing.
 Healthcare providers who are trained and confident in
pulse check should check the pulse after at least five cycles
24
of 30 compressions to two ventilations (done via a bag-
valve mask). Checking of pulse should not take more than
ten seconds. If unsure of the presence of a pulse by the
end of ten seconds, the rescuer should resume CPR.
Summary on selection of appropriate mask & ventilation

bag size for bag-valve-mask (BVM) ventilation
Adult Child Infant

(>12 yrs old) (1–12 yrs old) (<1 yr old)
Mask size Face mask should extend from the bridge of

the nose to the cleft of the chin, covering the
nose and the mouth but avoiding compression
of the eyes.
Ventilation
bag size
1500-2000 mls 500-1500 mls 500 mls
Note:
 The tidal volume delivered should be sufficient to

produce a normal chest rise.
For Trained-Healthcare Providers
 Check for normal breathing and pulse after every 5 cycles

of CPR 30:2.
 If normal breathing and pulse are absent or you are unsure,

continue CPR 30:2.
25
 If pulse is present and normal breathing is absent, perform
rescue breathing at a rate of 12 breaths per minute (one
breath every 5 seconds) by giving one breath and counting
2-a-thousand, 3-a-thousand, 4-a-thousand, 5-a-
thousand.
 Repeat the sequence until you have completed a total of

12 breaths. Re-assess for normal breathing and pulse.
 If both the breathing and pulse are present, maintain the

casualty in a supine position and continuously monitor the
casualty until help arrives.
_________________________________________________
26
2.3: CPR IN SPECIAL CIRCUMSTANCES
Resuscitation training should simulate the environment that
rescuers may find themselves in. For example, healthcare
providers should practice resuscitation skills on manikins on a
trolley bed (see figure 2-16) or stand on a step stool at the
side of the trolley bed. This is to ensure the elbows can be
straightened to facilitate chest compressions.
Figure 2-16 – CPR on a trolley bed
For resuscitation involving two or more rescuers, one rescuer

can focus on chest compressions with the other handling the
ventilations. Additional rescuers can be delegated with other
tasks such as calling 995 for SCDF or retrieving and using the
AED.
Although chest compressions are

commonly performed by kneeling at the
side of the casualty, there may be
specific circumstances involving narrow
alleys, walkways or corridors where the
rescuer may have to perform chest
compressions by positioning over the
head instead of the usual lateral side.
(See figure 2-17)
In the case of a passenger aircraft, a

Figure 2-17 –
rescuer should kneel in the leg-space in
Overhead CPR
front of the aisle seats to perform chest
compressions if the casualty cannot be transferred within a
few seconds to an area with adequate floor space such as the
galley.
27
For transferring a collapsed person from a chair to the floor,
the following link provides some guidance (see item 10iv
within the document in the link) –
http://lgnbe.org.uk/resources/g26.pdf.
The above-mentioned are not definitive guidelines to

resuscitation in tight spaces but can be taken as a reference
should anyone be caught in similar situations.
28
CHAPTER 3
AUTOMATED EXTERNAL
DEFIBRILLATION (AED)
3.1: THE IMPORTANCE OF EARLY DEFIBRILLATION
3.2: AUTOMATED EXTERNAL DEFIBRILLATION (AED)
3.3: PREPARATION FOR AED USE
3.4: PLACEMENT OF AED ELECTRODE PADS
3.5: DEFIBRILLATION PROCEDURES
3.6: POST-INCIDENT PROCEDURES
3.7: RETRIEVAL OF AUTOMATED EXTERNAL DEFIBRILLATOR
3.8: SAMPLE PRACTICAL SCENARIOS (FOR ADULTS)
3.9: CHILD/INFANT DEFIBRILLATION

Rev 1 / 2022
29
3.1: The Importance of Early Defibrillation
At the time of a sudden cardiac arrest, the most common
underlying cardiac rhythm is an irregular and chaotic electrical
rhythm (shockable rhythms) called Ventricular Fibrillation
(VF) or Ventricular Tachycardia (VT) without pulse. (See
figure 3-1) However, not all cardiac arrests present as VF and
may appear as other electrical rhythms (eg. asystole which is
non-shockable).
Figure 3-1 - Ventricular Fibrillation & Ventricular Tachycardia without pulse
During VF, the heart muscles do not contract effectively and

delivery of blood to the rest of the body ceases. The treatment
for VF is a shock administered using an AED. This shock,
together with chest compressions, will reinstate normal heart
rhythm and contractility if administered as soon as possible
(within 4 minutes). The survival rate decreases by 7-10% for
every minute of delay in treating VF. If delayed or untreated,
VF eventually degenerates into a fatal rhythm known as
asystole where the heart has no electrical activity as reflected
by a flat line tracing. (See figure 3-2) At this juncture, the only
treatment possible is to administer CPR.
In the past, only trained doctors, nurses and paramedics,

could perform manual defibrillation as it requires the operator
to recognize the cardiac rhythm of the casualty, whether it is
shockable or non-shockable. Since the invention of AEDs,
which are able to analyse the casualty’s cardiac rhythm
through the electrode pads and advise if a shock is needed, a
lay rescuer can now perform the defibrillation, thus improving
survival rates.
30
Figure 3-2 - Asystole
The AED should be brought to every person in cardiac arrest.

Therefore, when calling 995 for SCDF ambulance, also call for
an AED by instructing others nearby “Get AED”. However, if
you are the lone rescuer, do not leave the casualty.
Research has shown that cardiac arrest casualties with VF who

are treated promptly have the best chances of survival. Similar
experiences from around the world has also demonstrated that
more lives are saved if early CPR is combined with early
defibrillation. (See figure 3-3)
Chain of survival factors in cardiac arrest and their

impact on outcomes
Figure 3-3 - Importance of the chain of survival
Richard O. Cummings ACLS – Principles and Practice. American Heart

Association; 2003. Chapter 6: Defibrillation: Principles and Practice; p93
31
3.2: AUTOMATED EXTERNAL DEFIBRILLATORS
(AEDs)
Automated External Defibrillators (AED) are devices that
deliver electrical shocks to shockable rhythms like VF &
Pulseless VT, allowing the heart to restore its function. AEDs
are defibrillators designed to be small in size, lightweight and
portable. They generally work on similar basic principles and
do the following:
 Analyze the electrical rhythm of the heart.

 Determine whether the heart needs to be shocked.
 If a shock is required, it automatically charges to a
pre-set energy level. If no shock is required, the
device will not charge-up.
 Deliver electric shocks via attached AED pads.
 Advise the rescuer through voice prompts on key
actions to deliver the shock, check the casualty or
continue CPR.
 Some AEDs provide counting tempo to assist rescuers
in chest compressions.
3.3: PREPARATION FOR AED USE

The rescuer must first ascertain that the scene is safe for use
of an AED. Avoid the following:
 Metallic surface - Remove casualty from contact with

metal surfaces. These can conduct electric currents to the
rescuer.
 Water - Sweat and moisture are good conductors of

electricity and pose danger to the rescuer. It also reduces
the adhesion of pads to the chest wall. If the chest is wet,
wipe dry quickly with a towel.
 Gas - Flammable gases and oxygen sources are fire

hazards. Move the casualty away from these before
applying AED.
32
Steps in chest preparation and applying the AED
electrode pads (see figure 3-4):
 Expose the chest of the casualty to facilitate application of

AED electrode pads. If needed, cut away the clothing.
 If chest hair prevents proper electrode pad placement,

shave the hair from these sites promptly. AEDs come with
a shaver blade to expedite this.
 Metallic objects such as necklace and chains should be

moved away from the pads. These may result in sparks and
potential burns to the chest wall.
 For casualties with a pacemaker or implanted cardiac

defibrillator on the right, apply the pads at least four fingers’
breadth away from these devices.
 Medication patches or monitoring electrodes on the chest

wall should be removed as they may interfere with
electrode pads placement.
 Wipe dry a wet or sweaty chest to ensure proper adhesion

of the electrode pads to the chest. Application of AED
electrode pads to the chest wall must be done quickly with
minimal interruptions to chest compressions.
Figure 3-4 - Things to take note of during chest preparation
33
3.4: PLACEMENT OF AED ELECTRODE PADS
1. Switch on the AED. Some AEDs would automatically turn

ON when the AED cover is lifted.
Figure 3-5 – Application and use of AED
2. Apply the AED pads on the chest according to the

instructions on the AED. (See figure 3-5)
Figure 3-6 - How AED

shocks the heart
3. The right pad is placed on the casualty’s right chest just

below the collar bone. The left pad is placed on the left
34
chest just below and to the left of the left nipple. (See
figure 3-6)
4. Plug the connector end of the cable into the AED. Some
AEDs already have pre-connected electrode pads cable and
may start analysis once the pads are in place.
Minimize CPR interruption when preparing the

chest and placing of AED pads
35
3.5: DEFIBRILLATION PROCEDURES
1. The AED will initially analyse the heart’s electrical rhythm.
It will give a voice prompt, such as
“ANALYSING HEART RHYTHM. DO NOT TOUCH THE

CASUALTY.”
If you hear this, stop chest compressions. Do not touch the

casualty and do not allow others to touch the casualty
while the AED is analysing.
2. Spread your arms apart and say clearly “Stay Clear”.

(See figure 3-7)
Figure 3-7 – “Stay clear!”
3. If the casualty has a shockable rhythm, AED machine will

charge automatically. Charging takes a few seconds and
may be indicated by a warning tone from AED. No one
should touch the casualty during this brief charging phase.
4. Once the AED is fully charged, it will prompt “PRESS THE

SHOCK BUTTON NOW”. The rescuer then states clearly
“Stay Clear”, ensures quickly that no one is touching the
36
casualty, and then presses the shock button on the AED
firmly before releasing it.
5. Once the shock is delivered, restart chest compressions.

Continue the chest compressions until the AED repeats the
voice prompt (every 2 minutes): “ANALYSING HEART
RHYTHM. DO NOT TOUCH THE CASUALTY.”
6. If the AED prompts: “NO SHOCK ADVISED”, the lay rescuer

should resume continuous chest compressions until the
emergency medical team arrives to take over, or the AED
prompts the rescuer not to touch the casualty, or the
casualty starts breathing normally.
Healthcare providers who are trained and confident in

pulse check should check the pulse when the AED prompts
to analyse the casualty’s heart rhythm every two minutes,
or when breathing or movement is detected. Checking of
pulse should not take more than ten seconds. If unsure of
the presence of a pulse by the end of ten seconds, the
rescuer should resume CPR. If the pulse is present but not
breathing, start rescue breathing.
7. Only stop CPR when:

a. Paramedic takes over from rescuer; or
b. AED prompts to analyse the casualty’s heart rhythm,
is charging or when shock is to be delivered; or
c. Casualty wakes up or regains normal breathing.
8. Keep casualty in the same (supine) position and continue

to monitor the casualty until help arrives.
9. Throughout this period, the AED should remain connected

to the casualty.
37
Algorithm for One-Rescuer CPR and Use of AED
Figure 3-8 – Flowchart of CPR and AED algorithm.
38
3.6: POST-INCIDENT PROCEDURES
Hand-over to emergency services
When paramedics takes over the casualty, they may require a

summary of the events that has occurred:
 Time of collapse (best estimate)

 Whether the AED was used
 How many shocks were given?
 Any previous medical history and medications, if known.
 If available, provide a document that lists these events.
Assist the paramedics:
 Until casualty is loaded into the ambulance.

 The AED electrode pads should remain on the casualty
while transporting to hospital.
What are the duties for the person in charge of the AED
after AED has been used?
The facility or safety manager must be informed on the usage

of AED.
The person in charge of the AED has the following

responsibilities:
For commercial establishments or work places, or the

local community centre or management office for
residential areas
1. For AEDs located in places other than HDB blocks, they
should be returned to the AED owner (building
management or security staff) after use.
2. Replace the AED consumables such as the electrode
pads, shaver kit, towel and gloves if used (replacement
done by AED owner or AED vendor).
3. The AED battery must be checked. Contact the vendor
of the AED device for advice on battery replacement.
4. If the AED was removed from a box with a key in a thin
glass window, the glass may have been broken to
retrieve the key. This glass piece would need to be
39
replaced and the key placed back onto the holder
(replaced by the AED vendor).
5. Most AEDs have a chip that records the resuscitation
sequence. Get the AED vendor to print the record from
this chip. It is useful for audit and quality assurance
purposes.
6. AEDs are almost maintenance-free.
7. The battery indicator on the AED needs to be checked
annually (or as advised by the AED vendor) to ensure
that it is still functional. Once it gives a low-battery
display, steps to replace the battery promptly should be
undertaken.
For Public Access AEDs from Housing Development

Board (HDB)
1. SCDF Ambulance crew will convey the casualty to the
hospital along with the public access AED. The used
AED will be collected by the contracted vendor at the
respective fire stations. The vendor will restock and
replace the AED back to its original location.
2. AEDs are almost maintenance-free.
3. The battery indicator on the AED needs to be checked
periodically to ensure that it is still functional. Once it
gives a low-battery display, steps to replace the battery
promptly should be undertaken (facilitated by
SCDF/HDB).
40
3.7: RETRIEVAL OF AUTOMATED EXTERNAL
DEFIBRILLATOR
Public access Automated External Defibrillators (AEDs) in

Singapore are typically secured in a locked box with a break
glass mechanism. The glass must be broken to retrieve the
key and to unlock the box.
During emergencies, members of the public responding to

potential cardiac arrests case have been reported to have
suffered injuries while retrieving AEDs, such as by being cut
by glass while breaking the pane of glass or while trying to
retrieve the key. (See figure 3-9)
Figure 3-9 – Examples of injuries sustained when retrieving key
41
A recent survey of cardiac arrest responders who
retrieved AEDs conducted locally highlighted that a
pattern of injuries exists.
Jonathan SY Ng, Reuben JS Ho, JY Yu, YY Ng. Factors influencing

success and safety of AED retrieval in out of hospital cardiac arrests in
Singapore. Korean J Emerg Med Ser. 2022 Aug; 26(2), 97-111.
The following are recommendations for retrieval of AEDs:
1. Download the SCDF myResponder application!

(See Chapter 1.8) Responders with the app have
a much better chance to find the nearest
defibrillator with the help of the AED map.
2. To safely retrieve the AED:
a. Do not use your bare hands/elbows to
break the glass – most injuries from
retrieving occur with breaking the glass.
Use personal items instead e.g. mobile
phone, shoes, keys etc. to reduce the risk
of injuries sustained.
b. Clear all glass fragments around the edges
with the object used to break the glass
before retrieving the key. Another common
mechanism of injury is due to lacerations
when reaching for the key inside.
42
3.8: SAMPLE PRACTICAL SCENARIOS (FOR
ADULTS)
The following scenarios may be used by the instructor to depict
possible situations which you may encounter due to the varied
nature of an emergency. By practicing these scenarios, you
can be more confident to assist a casualty in emergencies.
1) Shock – No Shock – No Shock

2) No Shock – Shock – No Shock
3) Shock – Shock – No Shock
4) No Shock – No Shock – Shock
5) No Shock – No Shock – No Shock
43
3.9: CHILD/INFANT DEFIBRILLATION
Use of AED in Children
Out-of-hospital cardiac arrest in children are usually from non-

cardiac causes with majority of the casualties presenting with
non-shockable cardiac rhythms (asystole or pulseless
electrical activity).
Thus, proper ventilation and oxygenation are critical in

paediatric resuscitation.
However, ventricular fibrillation in out-of-hospital paediatric

arrest also occurs. Reviews of out-of-hospital paediatric
cardiac arrest have reported incidence of shockable rhythms
(ventricular fibrillation or pulseless ventricular
tachycardia) as the initial cardiac rhythm to be from 5-19%.1
School-going children and adolescents were reported to have
higher incidence of shockable rhythms compared to infants,
toddlers and preschoolers.2
1. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM,

Berg RA, Hiraide A. Conventional and chest-compression-only
cardiopulmonary resuscitation by bystanders for children who have
out-of-hospital cardiac arrests: a prospective, nationwide,
population-based cohort study. Lancet. 2010 Apr
17;375(9723):1347-54. doi: 10.1016/S0140-6736(10)60064-5.
2. Akahane M, Tanabe S, Ogawa T, Koike S, Horiguchi H, Yasunaga H,
Imamura T. Characteristics and outcomes of pediatric out-of-hospital
cardiac arrest by scholastic age category. Pediatr Crit Care Med. 2013
Feb;14(2):130-6.
Recommendation for AED Use in Children
The International Liaison Committee on Resuscitation (ILCOR)

advocates early use of AEDs on children to analyse rhythms
and provide defibrillation in cases of cardiac arrest with
shockable rhythms. When recognised early and rapidly
treated, paediatric patients with ventricular fibrillation or
pulseless ventricular tachycardia have a higher survival rate
than those with other rhythms.
It is recommended that a paediatric dose-attenuating system

be used in children aged 1-12 years to reduce the energy dose
44
delivered by the AED. This may be done either via a paediatric-
specific pad-cable system or an AED with a key or switch to
select a smaller dose. If a paediatric dose-attenuating system
is unavailable, then a standard AED should be used.
Use of AED for Child/Infant
 If an AED with paediatric pads or mode is not available, an

AED with adult pads may be used.
 In these cases, the risk/benefit ratio may be favourable,
and the use of an AED (preferably with paediatric pads or
mode) should be considered.
 For AEDs with paediatric pads or mode:
o When the AED arrives, switch it on.
o Switch to the paediatric electrode pads or mode.
o Attach the electrode pads according to the
illustrations on the placement of electrode pads
(see figure 3-9).
o Follow the AED’s instructions and continue chest
compressions and ventilations until medical help
arrives.
 For AEDs without paediatric pads or mode:
o When the AED arrives, switch it on.
o If only adult pads are available, ensure that the
pads do not touch or overlap each other. Attach the
defibrillation pads on front (right pad on central
sternum) and back (left pad on the upper back
between the shoulder blades) in an anterior-
posterior electrode pads placement as shown (see
figure 3-9).
o Follow the AED’s instructions and continue chest
compressions and ventilations until medical help
arrives.
Placement of Defibrillation Pads for Children/Infant
1. For AEDs recommending anterior-anterior electrode

pads placement, ensure that the electrode pads are
not touching or overlapping each other, and are at
least 2cm apart (see figure 3-10).
45
Figure 3-9 - Anterior-posterior Figure 3-10 -
AED electrode pads placement Anterior-anterior
for children AED electrode pads
placement
46

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Training Provider:

1) Definition and Aims of First Aid 02

Chapter 2 – Unconscious Casualty (Non-Cardiac Arrest) 16

1) Head and Spinal Injuries 19

Chapter 3 – Respiratory Problems 30

1) Adult Foreign Body Airway Obstruction (FBAO) 36

Chapter 4 – Shock, Bleeding and Wounds 49

Chapter 5 – Musculoskeletal Injuries 74

1) Fracture and Dislocation 76

Chapter 6 – Burn Injuries 97

1) Burns Depth and Severity of Burns 99

Chapter 7 – Other First Aid Knowledge 105

1) Eye Injuries 107

Chapter 8 – CPR(Hands-Only)+AED Refer to SRFAC’s CPR(Hands-Only)+AED Manual

College of Emergency Physicians

College of Paediatrics and Child Heath

Singapore Armed Forces

Singapore Civil Defence Force

Singapore First Aid Training Centre

Singapore Heart Foundation

Singapore Red Cross Society

St. John Association Singapore

1) Definition and Aims of First Aid

Singapore Resuscitation and First Aid Council

WHAT IS FIRST AID?

AIMS OF FIRST AID

The roles of a First Aider:

The limitations of a First Aider:

Fig. 2 – Hand Washing Technique

No. Content Sample Image Quantity

Crepe bandage (10

5 Hypoallergenic tape 1-2

8 Safety pins 4-6

10 Eye shield 2-6

11 Eye pad 2-6

As an emergency is a sudden unexpected event that creates a risk to life and

Factors to consider when carrying out Primary Survey

The Primary Survey

Rapid Body Survey

2. Urgency for evacuation

In Singapore, many of the emergency cases SCDF responds to could be quickly

myResponder is an application by SCDF to alert members of the public to

Singapore Resuscitation and First Aid Council

Unconsciousness is defined as impairment of awareness. It can range from

Fig. 7 – The basic structure of the brain

Fig. 9 – Causes of Spinal injury

Head Injury (Concussion, Compression and Skull Fracture):

Heat disorders are a group of physically related illnesses caused by prolonged

Fits is the uncontrolled shaking of limbs and disturbance of consciousness.

➢ Involuntary contractions of many of the muscles, caused by a

✓ Perform the Primary Survey. If casualty is unresponsive and not

Fainting is the temporary loss of consciousness in response to sever pain,

➢ Sudden loss of consciousness.

✓ Lay the casualty on a flat surface with legs elevated if there is no

➢ Rapid loss of consciousness.

✓ Give a sweet beverage if the casualty can drink.

A stroke is a condition in which the blood supply to the brain is suddenly

➢ Altered level of consciousness

✓ Perform the Primary Survey. If casualty is unresponsive and not

The recovery position is used in the management of a casualty who is

Step 1: Position the casualty

Fig. 15 – Tuck the hand Fig. 16 – Place the back of hand