Microsoft Word - Synerquest Standard First Aid With BLS Training Manual - Final R4

Synerquest Management Consultancy Services Inc.
DOLE Accreditation No. 235-220920-0002

Occupational Safety & Health Center, Department of Labor and Employment
FIRST AID TRAINING MANUAL

For
Standard First Aid and Basic Life Support Training
(32 HOURS)
Name of Participant: ______________________

Date of Training: _________________________
1 | Page
UNIT 5-IJK CRISSANT PLAZA BLDG., 272 COMMONWEALTH AVE., QUEZON CITY, PHILIPPINES
TEL: 77454995 Cel: 09173178343 E-mail: synerquest@yahoo.com
Table of Contents
No. of Module Topics Page Number
Hours
0.5 Module 1: 1.1 Course Requirements Pages 6-9
Course 1.2 International Humanitarian Law (IHL)
Orientation 1.3 Other Legal Concerns
1.5 Module 2: 2.1 Definition and Terms Pages 10 - 18
Introduction to 2.2 Objectives of First Aid
First Aid 2.3 Concept and Principles of First Aid
2.4 Dangerous situations that may affect
individuals, groups of workers, and
workplace on a daily basis
2.5 Self-protection of first aiders before,
during and after an emergency
3.0 Module 3: 3.1 Assessment Pages 19 - 30
Emergency 3.2 Scene survey
Action Principles 3.3 Primary assessment of the victim
3.4 Activating medical help
3.5 Secondary survey:
● Head-to-toe assessment of the
victim
● Short history taking
3.6 Log-roll technique
3.7 Breathing assessment
3.8 Techniques in the opening of airways:
● Tilt–chin-lift maneuver
● Jaw thrust maneuver
● H.A.I.N.E.S recovery position
● Head-to-toe body assessment of
the victim
2.0 Module 4: 4.1 Signs and symptoms of foreign body Pages 31 – 40
Airway and obstruction, asthma attack and
Breathing hyperventilation
Emergencies 4.2 First aid management of foreign body
obstruction for adults, children older
than 1 year and infants up to 1 year of
age
4.3 Positioning of a patient with breathing
difficulties
4.4 First aid management of hyperventilation
4.5 Techniques in clearing foreign body
airway obstruction
● Finger sweep
● Back blow or slap
● Chest thrust
● Abdominal thrust
2 | Page
2.0 Module 5: 5.1 Definition of bleeding and shock Pages 41 - 47

Bleeding and 5.2 Classifying and comparing type of
Shock bleeding according to blood vessel
affected
5.3 Common causes of bleeding
5.4 Signs and symptoms of shock
5.5 Causes of shock
5.6 Body’s response to shock
5.7 Types of shock
5.8 General principles of management of
shock
5.9 Techniques in applying direct pressure
on bleeding external wounds
5.10 Proper body position of victims with
bleeding wounds and in shock
2.0 Module 6: 6.1 Definition of heart attack and cardiac Pages 48 - 57
Cardiac arrest
Emergencies 6.2 Signs and symptoms of heart attack and
cardiac arrest
6.3 Positioning victims of heart attack
6.4 CPR
● One rescuer
● Group rescuer
6.5 Operation of AED including proper
application of electrode pads
2.0 Module 7: 7.1 Definition of poison Pages 58 - 64
Poisoning 7.2 Route of entry of poisons into the body
7.3 General mechanism of injury of poisons
7.4 Priority action approach for poisoning
7.5 Management of poisoning by route of
entry into the body:
● Ingestion
● Inhalation
● Carbon monoxide vs carbon
dioxide
● Injection
● Absorption
● Snakebites
2.0 Module 8: 8.1 Definition, causes , symptoms and Pages 65 - 72
Head & Spine prevention of head injury, concussion
Injuries and spinal injury
8.2 Assessment of victims with head and /
or spinal injuries
8.3 Manual stabilization of head and spine
8.4 Removal of helmet
8.5 Loading and securing victim to a
backboard
3 | Page
2.0 Module 9: 9.1 Definition of burn Pages 73 - 77

Soft Tissue 9.2 Types of burn
9.3 Burn management
2.0 Module 10: 10.2 Mechanism of injury Pages 78 - 85
Bone, Joints, and 10.3 Definition, causes, signs and symptoms
Muscle Injuries of the different injury to the bones, joints
and muscles
10.4 Priority action approach to limb injuries
10.5 Principles of limb injury assessment
10.6 Types of splints for upper and lower
limbs
10.7 Principles of splinting
10.8 Principles of immobilization
10.9 Different types of slings to immobilize
upper limb injuries
2.0 Module 11: 11.1 Common medical emergencies 101: Pages 86 - 90
Medical definition, types, signs and symptoms
Emergencies 11.2 Priority action approach for each medical
condition and their respective first aid
management
2.0 Module 12: 12.1 Health-related problems caused by heat Pages 91 - 95

Environmental and their signs and symptoms, and first-
Emergencies aid management
12.2 Health-related problems caused by cold
and their signs and symptoms, and first-
aid management
2.0 Module 13: 13.1 Role of first aid providers in emergency Pages 96 - 97
Special Situations preparedness and evacuation
13.2 The role of first aid providers in
emergency childbirth
13.3 Mechanism and process of drowning
13.4 Signs and symptoms of near drowning
13.5 First aid management of near drowning
3.0 Module 14: 14.1 Lifting and carrying guidelines Pages 98 - 102
Lifting and 14.2 Preparing the victim for routine
Moving transport
14.3 Emergency moves
14.3. 1 One-man assist)
● Fireman’s lift
● Pack strap carry
● Cradle carry
● One-person walking assist
● Leg drag
● Shoulder drag
● Clothing drag
14.3.2 With assist (Two-man)
4 | Page
● Two-person walking assist

● Two-handed seat carry
● Four-handed seat
● Two-Person Fore-and-aft lift
● Two-Person Lift, Patient Supine
● Multi-Person Direct Lift
14.4 Non-emergency moves
14.5 Securing victim to the carrying or lifting
device
4.0 Module 15: 15.1 Knowledge and skills assessment of Page 103
Knowledge and participants
Skills Assessment 15.1.1 Post Test
15.1.2 Evaluation
APPENDIX 16.1 References Page 104
5 | Page
Module 1: Course Orientation

(0.5 hr.)
Objectives:
Upon completion of this module the participants will be able to:
● Discuss the requirements of the course
● Explain the importance of dissemination of IHL and its appropriate chapters
1.1 Course Requirements

Legal Basis Requirement
DO198 series of Section 3: Definition of Terms
2018 is the IRR of
RA 11058 or an act Certified First Aider - refers to any person trained and duly certified to
strengthening the administer first aid by Philippine Red Cross, Department of Health, Bureau
compliance to of Fire Protection, TESDA and other DOLE accredited First Aid Training
Occupational Safety Provider (FATPro)
& Health Standards
and providing
penalties for every Section 15: Occupational Health Personnel and Facilities
violation thereof
First Aider Ratio Requirement:
Number of Workers LOW, MEDIUM, HIGH
RISK
1 – 99 1
100 – 199 2
200-500 3-5
501 - 2000 6-20
>2000 >20
Every 100 workers or a fraction 1
thereof
Section 29: Prohibited Acts and its Corresponding Penalties

Description of Violation Administrative Fine
Non-provision of workers’ training Php 20,000.00
(First Aid)
Non-provision of OH Personnel Php 40,000.00
(First Aiders)
6 | Page
DO235 series of Rule 1 General Provision: Section 2: Definition of Terms

2022 rules on the
certification of the Type of First Aid Training Description
first aider and the 1. Emergency First Aid refers to one-day training course
accreditation of first Training where participants are provided
aid training providers with knowledge on day-to-day
emergencies that ordinary people
may encounter until full medical
treatment is available
2. Occupational First Aid and refers to a two-day training course
Basic Life Support Training where participants are provided
with knowledge and skills to
establish, maintain and facilitate
the provision of effective life
support in a workplace
environment until full medical
3. Standard First Aid and Basic refers to a four-day training course
Life Support Training covering all aspects of first aid and
cardiopulmonary resuscitation for
infants, children, and adults in
various situations until full medical
Rule 2 Certification of First Aider: Section 2: Types of First Aid

Certification Training Courses
● That the designated first aider shall take the minimum certification
training course based on the establishment employment size and
risk level.
Training Courses Employment Size Risk Level
Emergency First Aid Nine (9) and below Low, Medium &
Training High
Occupational First Ten (10) to Fifty (50) Low
Aid and Basic Life
Support Training
Standard First Aid Ten (10) to Fifty (50) Medium & High
and Basic Life Fifty-One (51) and Low Medium &
Support Training above High
Rule 2 Certification of First Aider: Section 3: Validity of First Aid

Certification
● That all first aid certificates shall be valid for 3 years from the date
of issuance
7 | Page
Rule 1960 of OSH 1961.02: Definitions

Standards (as ● First Aid Treatment means adequate, immediate, and necessary
amended) - medical/and or dental attendance or remedy given in case of injury
Occupational or sudden illness suffered by the workers, irrespective of whether or
Health Services not such illness/injury is occupational in nature, before more
extensive medical and or/dental treatment can be secured
1964.03: Refresher Training

The occupational health personnel and the first-aiders of every
establishment shall undergo a minimum of eight (8) hours refresher training
course in their respective fields at least once a year.
1965:05: Duties of the First Aider

The duties of the First Aider are to:
1) Give immediate temporary treatment in case of injury or illness,
before the services of the physician become available. If the case
needs a physician, the first aider shall immediately call or refer the
injured to one;
2) Participate in the maintenance of occupational safety and health
programs, if a member of the OSH Committee; and
3) Maintain medical services and facilities.
1.2 International Humanitarian Law (IHL)

What is IHL?
Refers to International Humanitarian Law (IHL) which regulates relations between States, international
organizations and other subjects of international law. It is a branch of public international law that consists
of rules that, in times of armed conflict, seek – humanitarian reasons – to protect persons who are not or
are no longer directly participating in the hostilities, and to restrict means and methods of warfare.
In other words, IHL consists of international treaty or customary rules (i.e. rules emerging from State
practice and followed out of a sense of obligation) that are specifically meant to resolve humanitarian issues
arising directly from armed conflict, whether of an international or a non-international character.
Branches of IHL:
1. the 'law of Geneva', which is the body of rules that protects victims of armed conflict, such as military
personnel who are hors de combat (out of action due to injury or damage) and civilians who are not
or are no longer directly participating in hostilities.
8 | Page
2. the 'law of The Hague', which is the body of rules establishing the rights and obligations of
belligerents (hostile and aggressive) in the conduct of hostilities, and which limits means and methods
of warfare.
Essential IHL Rules:

The parties to a conflict must at all times distinguish between civilians and combatants in order to spare
the civilian population and civilian property. Neither the civilian population as a whole nor individual
civilians may be attacked. Attacks may be made solely against military objectives. Parties to a conflict do
not have an unrestricted right to choose methods or means of warfare. Using weapons or methods of
warfare that are indiscriminate is forbidden, as is using those that are likely to cause superfluous injury or
unnecessary suffering.
It is forbidden to wound or kill an adversary who is surrendering or who can no longer take part in the
fighting. People who do not or can no longer take part in the hostilities are thus entitled to respect for
their lives and for their physical and mental integrity. Such people must in all circumstances be protected
and treated with humanity, without any unfavorable distinction whatsoever. The wounded and the sick
must be searched for, collected and cared for as soon as circumstances permit. Medical personnel and
medical facilities, transport and equipment must be spared. The red cross, red crescent or red crystal on a
white background is the distinctive sign indicating that such persons and objects must be respected.
Captured combatants and civilians who find themselves under the authority of an adverse party are entitled
to respect for their lives, their dignity, their personal rights, and their political, religious and other
convictions. They must be protected against all acts of violence or reprisal. They are entitled to exchange
news with their families and receive aid. Their basic judicial guarantees must be respected in any criminal
proceedings against them.
1.3 Other Legal Concerns
Article 12 No. 4 of ACT No. 3815 or An Act Revising the Penal Code and Other Penal Laws
(Revised Penal Code) – “Any person who, while performing a lawful act with due care, causes an injury by mere
accident without fault or intention of causing it” is exempt from criminal liability.
Article 275 No. 1 and 2 of ACT No. 3815. Abandonment of person in danger and abandonment of
one's own victim. - The penalty of arresto mayor (one month and one day to six months) shall be
imposed upon:
1. Any one who shall fail to render assistance to any person whom he shall find in an uninhabited place wounded or in danger
of dying, when he can render such assistance without detriment to himself, unless such omission shall constitute a more serious
offense.
2. Anyone who shall fail to help or render assistance to another whom he has accidentally wounded or injured.
Clear Points:
✔ The Standard First Aid and Basic Life Support Training Course is one of requirements to achieving the
standards of health, safety and welfare required under the Republic Act No. 11058 and DOLE Department
Order No. 198-18
✔ Fulfilling the requirements of the course is essential for one to be a certified first aider
9 | Page
Module 2. Introduction to First Aid

(1.5 hrs.)
Objectives:
● Define and site the objectives of first aid
● Explain the different concepts and principles of first aid
● Assess the scene for anything that may threaten one’s safety, the victim, and bystanders.
2.1 Definition and Terms

First Aid – is the immediate care given to a person who has been injured or suddenly taken ill. It
includes self-help and home care if medical assistance is not available or
delayed.
Basic Life Support - Are an emergency procedure that consists of recognizing respiratory or cardiac
arrest or both and the proper application of CPR to maintain life.
First Aider – refers to any person trained and duly certified to administer first aid by the Philippine
Red Cross or any organization authorized by the secretary of the department of labor and
employment (DOLE)
2.2 Objectives of First Aid

Objectives of First Aid
1) Preserve life
2) To prevent added/further injury or danger
3) Seek immediate medical help
4) Provide reassurance
Roles of First Aid

1) It is the bridge that fills the gap between the victim and the physician
2) It is not intended to compete with, nor take the place of the services of the physician
3) It ends when the services of a physician begin
Need and Value of First Aid

1) To minimize if not totally prevent accident
2) To prevent added injury or danger
3) To train people to do the right thing at the right time
4) Accidents happen and sudden illnesses are common and often serious
5) People very often harm rather than help
6) Proper and immediate care is necessary to save life or limb
2.3 Concept and Principles of First Aid Management

1) Stay calm. Do not take risks for yourself, the injured person or any witnesses.
2) Manage the situation to give safe access to the person.
3) Manage the patient in line with current first aid guidance
4) Do things step by step
10 | Page
The Four Steps of First Aid:

1) Assess
● Assess the situation and check for any potential dangers to yourself, bystanders, or the
patient
● Check for safety before rushing to the injured patient
● Make sure the situation is safe for you, the casualty, and other people or bystanders
● If the situation is too dangerous, stay back and await professional assistance
● Assess the person’s condition:
o is the victim suffocating or bleeding heavily? In these cases, act immediately and
appropriately
o is the person conscious?
o is the person breathing normally?
● Assess for injuries, signs of shock or psychological trauma.
2) Plan for intervention

● Get help:
o call for help or ask someone to call for medical or professional help
● Plan first aid interventions:
o plan what action to take until professional help arrives, based on the initial or
primary assessment
o determine how much help you can give based on what you know and what skills
you have
o ensure your own ongoing safety as a rescuer
3) Implement First Aid

● Give first aid for life-threatening emergencies and specific injuries based on the initial
assessment
● If emergency services are arriving very soon, do not splint injuries
● Maintain safety and wait for assistance
● Give psychological first aid:
o talk to person and family
o inform them what is happening and what you are doing. If it is necessary, prepare
the person for transportation
4) Evaluate first aid actions

● check that medical or professional assistance will arrive soon
● check that the scene remains safe. If not, consider moving the person as carefully as
possible with help from bystanders or other rescuers
● re-check the actions after the initial assessment
● check that bandages are still in place and bleeding has stopped. If not, do NOT remove
existing dressings, but simply add more dressings and apply pressure
● if the person becomes unconscious, follow actions for basic life support (BLS)
● hand over the person to medical or professional personnel when they arrive
● find out which hospital, clinic, or health center will provide care
● inform family and relative
11 | Page
2.4 Dangerous situations that may affect individuals, groups of workers

and workplaces on a daily basis
Disease Transmission
1. Direct Contact Transmission
2. Indirect Contact Transmission
3. Airborne/Droplet Transmission
4. Vector Transmission
Mode of Transmission Definition Example

1. Direct Contact Occurs when bodily fluids A cut on your hand comes into
from an infected contact with an infected person’s
person enter another blood.
person’s body
Examples: HIV/AIDS, Hepatitis,
Herpes
2. Indirect Contact Occurs when germs from an You are not wearing gloves and you
infected object pick up a tissue that has been used by
or surface enter another an infected person, and then you rub
person’s body your eye.
Examples: Meningitis, Influenza
3. Airborne Transmission Occurs when a person You are not wearing a face mask while
breathes in germs from providing first aid to an infected
the air person.
The infected person sneezes, sending

germs into the air, and then you
breathe them in.
Examples: Measles, Tuberculosis
4. Vector-Borne Occurs when germs are An infected mosquito bites you,

Transmission introduced directly into the injecting pathogens into your blood.
body
Examples: Lyme Disease, Malaria,
Dengue
12 | Page
2.5 Self-protection of first aider before, during and after an emergency

First aider may be exposed to biological substances such as blood-borne pathogens and communicable
diseases, whilst dealing with a victim. Giving first aid care is a hands-on activity that can put you in close
contact with another person’s bodily fluids (such as saliva, mucus, vomit, and blood), which may contain
harmful pathogens microorganisms that can cause disease or infection). Some pathogens pose a
particular risk because of their long-term effects on the health of the infected person.
Pathogens spread from person to person through four modes of disease transmission. Some pathogens
spread through only one of these routes, while others spread through several.
These may result from dealing with:

1) Trauma-related injuries
2) Resuscitation
There are many different blood-borne pathogens that can be transmitted from a penetrating injury or
mucous exposure, in particular, Hepatitis B virus, Hepatitis C Virus and Human Immune-deficiency
Virus (HIV).
Exposure sources:
The following are common sources of exposure:
1) All human body fluids and secretions, especially any fluid with visible blood
2) Any other human material
Exposure Routes:
The following are typically means of exposure:
1) Punctures or cuts from sharp objects contaminated with blood/fluid
2) A spill of blood/fluid onto mucous membranes of the eyes, mouth, and/or nose
3) A spill of blood/fluid onto skin that may or may not be intact
4) A laceration and contaminated with blood/fluid from a bite
How to Prevent Diseases from Spreading During Conduct of First Aid?

1) Personal Precautions
Personal precautions are the actions that individuals can take to reduce the risk of disease
transmission
Examples includes:
● washing your hands frequently
● treating all blood and other bodily fluids as infectious materials
● covering your mouth and nose when sneezing
● eating well
● getting enough exercise and sleep
One way to significantly reduce your risk of infection is to inspect your hands regularly and cover
even small cuts with adhesive bandages.
13 | Page
Handwashing
Proper handwashing is an important precaution for preventing the spread of germs that cause many
infectious diseases. Frequent handwashing is important as part of a daily routine, for example, before
eating or drinking and after using the washroom.
Guidelines in proper handwashing:

Steps Action to be done Illustration
1 Always use warm running water
and a mild soap.
2 Create a lather by rubbing your hands together with the

soap—friction with the soap suds is what actually removes
the germs from hands.
Rub your hands together vigorously for at least 30

seconds.
3 Wash all parts of each hand. Be sure to scrub your palms

and wrists, between your fingers, under your
fingernails, and around the backs your hands.
4 Dry your hands with a clean paper towel.
5 Turn the faucet off using the towel as a barrier between

your hands and the faucet handle.
Use the towel as a barrier for the door handle as well.
In a first aid emergency, remember to wash your hands:

• Before and after contact with an ill or injured person.
• After handling dirty articles, instruments, or dressings.
• Before or after treating wounds.
• After removing gloves.
14 | Page
2) Equipment Precautions
Personal protective equipment (PPE) is the general term for items that
protect you from contact with pathogens and contaminated objects.
Examples include barrier devices such as:

Kind of PPE’s Usage
safety glasses For eye protection.
can prevent foreign objects or debris from damaging your vision.
Goggles For eye protection.

can prevent foreign objects or debris from damaging your vision.
Face Masks For airborne diseases protection
CPR breathing barriers CPR breathing barriers are used to reduce the risk of infection
when giving rescue breaths by eliminating the need for mouth-to-
mouth contact, protecting you from bodily fluids such as saliva
and blood.
Rama, CeCILL, via Wikimedia Commons
Gloves Wearing gloves is an important way to protect yourself while

giving first aid. Most gloves found in first aid kits
are disposable and latex-free, as some people are allergic to latex.
Wear gloves when:

• You are providing care, especially if there is a possibility
that you will come into contact with another person’s
blood or other potentially infectious material.
• You must handle items or surfaces soiled with blood or
other potentially infectious materials.
15 | Page
Proper technique for removing gloves without contaminating skin

Steps Description Illustration
1 With one hand, pinch the glove at the wrist of
your second hand, being careful to touch only
the glove’s outer surface.
2 Pull the glove down and off your hand.

Form the glove into a ball and hold it in the palm
of your gloved hand.
3 Insert your gloveless thumb under the glove of

your other hand at the inner wrist.
4 Pull the glove downward off the hand, turning it

inside out and trapping the other balled glove
inside.
5 Discard gloves appropriately.
6 Wash your hands thoroughly with soap and

water for at least 30 seconds, using the proper
handwashing technique.
3) Environmental Precaution
Environmental precautions refer to the systems that are implemented in an area to reduce exposure
to germs.
Examples include making sure there is proper ventilation in the workplace, and that any
contaminated materials are immediately disposed of in dedicated biohazard garbage.
Cleaning and Disinfecting Surfaces and Equipment

Reusable equipment and surfaces that have been contaminated by blood or other potentially
infectious materials need to be properly cleaned and disinfected before the equipment is put back
into service or the area is reopened. Clean and disinfect surfaces and equipment as soon as possible
after the incident occurs. Remember to wear appropriate personal protective equipment (PPE).
16 | Page
Immediate action at the scene following exposure:

For an open wound:
Steps Action to be taken Illustration
1 Encourage the wound to bleed, thoroughly wash with
water for 15 minutes and dress
2 Thoroughly wash with water for 15 minutes
3 Dress the wound with clean gauze
4 Do not attempt to use a caustic solution to clean the

wound
5 Seek medical advice as soon as possible
For a splash to a mucous membrane

steps Action to be done Illustration
1 Flush splashes to nose, mouth or eyes thoroughly
with water for 15 minutes
2 If the splash is in the mouth, spit out and thoroughly

rinse out with water for 15 minutes
17 | Page
3 If the splash is in the eyes, irrigate with the eyes open

for 15 minutes
4 Seek medical advice as soon as possible
For a splash to the skin

1 At the scene, wash thoroughly with soap and water
2 Seek medical advice as soon as possible if the

exposure is medium/high risk.
Clear Points:
✔ First aiders should conduct themselves according to first aid protocol and workplace guidelines
✔ Industrial accidents and medical emergencies have consequences that affect not only the victims but
also their families, work colleagues, friends, etc. physically and psychologically.
✔ The two most important areas of personal safety are overall and scene safety and the prevention of
disease transmission during care.
Notes:
18 | Page
Module 3. Emergency Action Principles

(3.0 hrs.)
Objectives:
● Discuss the steps to be followed when approaching a victim
● Assess the victim’s responsiveness, airway, breathing and pulse
● Determine when to activate medical help
● Perform secondary survey
● Demonstrate the following:
o Moving victims with suspected spinal injury by Log-roll technique
o Breathing assessment using the L.L.F (Look, Listen, and Feel)
o Techniques in the opening airway
o H.A.I.N.E.S recovery position
o Head-to-toe assessment of the victim
3.1 Assessment
First aid may be given in a dangerous place. The ill or injured person may be in a room
with poisonous fumes, on a busy street, or in a parking lot.
Before doing anything else, make sure the scene is safe for you and the injured person.
Keep looking around to make sure that the scene stays safe.
First Aider cannot help everyone if he/she injured herself/himself.
3.2 Scene Survey

Once you recognized that an emergency has occurred and decide to act, you must make
sure the scene of the emergency is safe for you, the victim/s, and any bystander/s.
In surveying the scene consider the following:

1. Is the scene safe?
2. What happened?
3. How many people are injured?
4. Are there bystanders who can help?
5. Identify yourself as a trained First Aider
Element of the Survey of the Scene
1. Scene safety
2. Mechanism of injury or nature of the illness
3. Determine the number of patients and additional resources.
3.3 Primary Assessment of the Victim

In every emergency situation, you must first find out:
1) If there are conditions that are an immediate threat to the victim’s life.
2) Do a primary survey of the victim.
19 | Page
In doing a primary survey follow this step:
C
CONSCIOUSNESS
A B C
AIRWAYS BREATHING CIRCULATION
1) Check for Consciousness

Assessing Responsiveness.
A patient’s response level can be summarized in the AVPU mnemonic as follows:
AVPU is a quick and easy way to assess a person’s level of consciousness.
MNEMONIC Condition of Patient
A - Alert If the person is fully awake and talking to you, they
are ‘A’
V – Responsive to Voice If the person is not fully awake, check if they

respond to your voice. If they can respond they
are a ‘V’
P - Responsive to Pain If they don’t respond to your voice, check if they

respond to a painful stimulus, this can include
sternum (breastbone) rubs or earlobe pinching. If
there is a response, they are a ‘P’
U– Unresponsive, Should the casualty not respond to any of the

Unconscious above they are a ‘U‘
2) Check for Airways

The airway is the pathway that connects the mouth and nose to the lungs. If it is closed or blocked,
air cannot get in. The airway is most commonly blocked by the tongue. If the person is speaking,
moaning, or crying, the person’s airway is open.
In checking victim’s airways, must follow these steps:

Steps Action Illustration
1 Position the victim.
Before you can check the airway, the victim needs
to be in the right position. If there is any exudate
(vomit, blood, etc.) in or around the person's
mouth, put on a glove and remove it to clear the
airway before you roll her.
20 | Page
Roll the person onto her back. This should be on a

surface as flat as possible so her body can be
straight and easy to work with. Make sure his
hands are down by his sides and his back and legs
are straight. Take a moment to push her shoulders
down gently. This expands the width of the
trachea and helps to keep the jaw lifted.
2 Move the head.
To open the airway when he is laying on the
ground, his head and breathing passages need to
be aligned correctly. Place one hand behind his
head and one hand under his chin. Tilt his head
back toward the sky. The chin should end in a
slightly lifted position as if he were sniffing the air
BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons
3 Remove foreign objects from the airway.

There may be situations where the airway is
obstructed. This may be from a foreign object, by
the victim's tongue, or by vomit or other bodily
fluids. If the airway is obviously obstructed by
vomit or any removable matter, get it out of the
mouth with a quick swipe with two or three
fingers in her mouth. You can quickly turn the
victim’s head to one side to assist in the removal.
If the person is unresponsive, perform a head-tilt/chin-lift. The head-tilt moves the back of the
tongue away from the airway, and the chin-lift opens the epiglottis (a flap of cartilage at the root of
the tongue, which is depressed during swallowing to cover the opening of the windpipe)
Performing the Head-Tilt/Chin-Lift
To perform a head-tilt/chin-lift, place
one hand on the person’s forehead and
2 or 3 fingers under the chin. Gently tilt
the head back until the chin is pointing
upward.
3) Check for Breathing

1 Look for obvious signs of breathing.
There are a few obvious signs that the victim is
breathing. Look for the rise and fall of the chest as
he takes oxygen into his lungs. Also, look for nose
fluctuations as he breathes in through his nose and
any opening and closing of his mouth as he
breathes in and out.
If there is not a rise of the chest, try to re-position

the airway a little in either direction. You may have
gone too far or not far enough to open the airway.
21 | Page
If the patient is gasping for breath or breathing

poorly, treat this as not breathing and check for
circulation
2 Do a breath check.
You can check for breath through feel and sound if
you can't see any obvious signs of breathing. Place
your hand near her nose and mouth to see if you
feel any breath. If you don't, lean your head down
close to the patient’s mouth and feel for breath on
your cheek and listen for any inhales or exhales.
If you hear normal breathing, there is no need for
CPR.
3 Turn the victim over if breathing starts. Opening
the airway may be enough to start the victim
breathing again. If this happens, roll the victim onto
his side so there is less pressure on his/her chest.
This will help him/her breathe better.
4) Check for Circulation
1 Feel for circulation.

Once you find that the victim is not
breathing, you need to check to see if blood
is still circulating.
On the lifted area of the chin, place your
index and middle fingers to the groove in the
neck, just beneath the jaw and to the right or
left of the voice box.
Slip your fingers into the groove there. This is
the carotid artery and should provide a strong
pulse if his blood is circulating well.
3.4 Activating Medical Help
1) If the victim does not wake up activate medical help.

2) If the pulse is weak or if there is no pulse, the person is in trouble and you need to
seek medical help.
Both trained and untrained bystanders should be instructed to Activate Medical Assistance as soon as
they have determined that an adult victim requires Emergency care “Phone First”. While for infants and
children a “Phone fast” approach is recommended.
22 | Page
3.5 Secondary Survey:

It is a systematic method of gathering additional information about injuries or conditions that may need
care.
1) Interview the victim
Ask the person questions. A series of questions will immediately give you a lot of information regarding
the person’s state. The questions should be easy while still requiring a level of basic cognition. Begin by
asking the person if he’s all right to see if he’s responsive at all. If the person answers clearly and
coherently, then he is displaying a high level of consciousness. If the person responds but answers
incorrectly to several of the first questions, then he’s conscious but showing signs of what is called an
altered or changed mental state, which includes confusion and disorientation.
Pertinent Data SAMPLE history
● Name ● Signs and symptoms
● Age ● Allergies
● Contact No. ● Medication
● Person to contact ● Pertinent Past Medical History
● Chief Complaint ● Last oral intake and output
● Event leading to the episode
2) Check vital signs

Vital signs are measurements of the body's most basic functions.
The four main vital signs

Vital Signs Vital Sign Description Standards
Checking
1)Body The normal body temperature of a Normal body temperature can range
temperature person varies depending on gender, from 36.5 degrees C, or Celsius) to 37.2
recent activity, food and fluid degrees C for a healthy adult.
© Freepik.com consumption, time of day, and, in
women, the stage of the menstrual
cycle.
2. Pulse Rate The pulse rate is a measurement of The normal pulse for healthy adults
the heart rate or the number of times ranges from 60 to 100 beats per minute.
the heart beats per minute. As the
heart pushes
blood through the arteries, the

arteries expand and contract with the
flow of the blood. Taking a pulse not
only measures the heart rate, but also
can indicate the following:
1) Heart rhythm
2) Strength of the pulse
23 | Page
3. Respiration rate The respiration rate is the number of Normal respiration rates for an adult
(rate of breathing) breaths a person takes per minute. person at rest range from 12 to 20
The rate is usually measured when a breaths per minute.
person is at rest and simply involves
counting the number of breaths for
one minute by counting how many
times the chest rises. Respiration rates
may increase with fever, illness, and
other medical conditions. When
checking respiration, it is important
to also note whether a person has any
difficulty breathing.
Blood pressure is the force of the
Blood pressure blood pushing against the artery walls
(Blood pressure is during the contraction and relaxation
not considered a of the heart. Each time the heart
vital sign, but is beats, it pumps blood into the
often measured arteries, resulting in the highest blood
along with the vital pressure as the heart contracts. When
signs.) the heart relaxes, the blood pressure
falls.
Two numbers are recorded when
measuring blood pressure. The higher
number, or systolic pressure, refers to
the pressure inside the artery when
the heart contracts and pumps blood
through the body. The lower https://www.adrenal.com/adrenal-tumors/high-blood-pressure
number, or diastolic pressure, refers

to the pressure inside the artery when
the heart is at rest and is filling with
blood.
3) Perform head-to-toe assessment.

In head -to -toe assessment consider the following:
D -O-T-S D-C-A-P B-T-L-S
Deformities Deformities Burn
Open Wound Contusion Tenderness
Tenderness Abrasion Laceration
Swelling Puncture Swelling
24 | Page
Steps in performing head to toe assessment

1 Put on a pair of gloves before performing your
head-to-toe assessment.
This will prevent the spread of disease through
contact with body fluids such as blood, urine, or
vomit.
2 Observe the injured person’s head for proper

shape and symmetry
3 Look at the condition of the person’s skin.

Check for cuts, scrapes, redness, bruising and
irritation, as these can be signs of physical trauma.
4 Examine the person’s chest. Look for any obvious

cuts or bruises. Then, watch the person breathing
to see if any part of the chest looks out of line or is
moving differently than the rest of the chest.
Divide the chest into four quadrants, and place
your hand lightly on each section of the chest to
watch for pain and unusual movement.
5 Palpate the 4 quadrants of the person’s abdomen:
upper left and upper right (including the shoulders
and ribs, down to their waist) and lower left and
lower right (including the lower ribs and stomach).
6 Assess the person’s capillary refill by pressing on

their fingernail. The fingernail will turn white when
pressed and will immediately turn pink again if
proper circulation is present. If the fingernail takes
longer to regain its pink color, the individual may
have a problem with their circulation.
7 Examine the bones of the arms and legs to check
for breakage. Place a hand on each side of the limb
and press inward, checking for flexing of the bone.
25 | Page
3.6 Log-roll technique

A log roll is a technique used to safely move a person (conscious or unconscious) who is suspected
to have a spinal injury. Normally a spinal injury casualty is NOT to be moved as you do not want
to cause further damage to their injury.
The first rule in first aid is to do no harm. This seems like an obvious rule of thumb, but it is one
that often goes against what every fiber in your body is telling you to do. In the event of severe
trauma to the head, neck or spine, your instinct is to move the person into a more comfortable
position or get them to a safer area, but moving them can injure them to a greater extent.
However, it may be absolutely necessary to move them when:

1) Assessing their injury
2) Dealing with a bleed
3) They have an airway blockage and needs to be cleared
4) Placing onto a spinal board
5) Move them away from immediate danger
First Aid Priority list to decide whether you should conduct a log roll or not.
Priority list:
1) Breathing
2) Bleeding
3) Bones/Burns
4) All others
The log roll immobilizes the casualty to prevent further damage to the spine or neck
area, preventing movement.
3.6 Log-roll technique steps:

1 Immobilize the head
The most important roll when conducting this In this first picture
maneuver is to ensure the spine and neck are in shows the head, neck
alignment (straight). The person in control of the and spine in perfect
head has the control over everyone else and gives alignment.
the instructions.
In this picture
shows what happens
to the alignment when
head is tilted
26 | Page
2 From the top of the casualty’s head use both

hands on either side of the head to keep it still
● Do not touch the neck
● Do not cover the ears, a conscious casualty
may need to listen to and respond to
questions
● Do not allow movement
● Avoid yes or no questions as they will nod
in response
3 Line up your help

Just think, top, middle and bottom
Top: Shoulders and abdomen
Middle: Waist and thigh
Bottom: Knees and feet
As per the picture line your help up and instruct

them what they are to do. (see the red dots)
1st person: Reach over and grab the shoulder (1)
and abdomen area (2)
2nd person: Reach over and grab the top (3) and
bottom (4) of the waist
3rd person: Reach over and grab the knee (5) and
ankle (6)
4 Begin the roll .
Once your helpers are in the right position the

person who controls the head has control of
everyone.
Timing is everything and everyone needs to work
together and at the same time, this is crucial.
State to everyone "on the count of three start to
roll the person towards you"
Everyone must go at the same time and at the
same speed.
The body is to stay in line when rolling.
5 Log roll completed

Once in the completed log roll position you can
now examine their injury, remove airway
blockages, etc.
You will not be able to hold this position for a

prolonged period of time so you will need to place
.
them back down again. Complete the roll in
reverse order.
27 | Page
State to everyone "On my count of three we will

roll them back again."
Roll them back onto their back.
Again all at the same time keeping the head, neck
and back in line through out.
6 Reverse the log roll
Complete the roll in reverse order.
State to everyone "On my count of three we will
roll them back again."
Roll them back onto their back.
Again all at the same time keeping the head, neck
and back in line throughout.
3.7 Breathing Assessment

Normal breathing is essential to maintaining life. A person who is gasping or breathing abnormally
and is unresponsive requires resuscitation.
Causes of Ineffective Breathing

Breathing may be absent or ineffective as a result of:
1) Direct depression of, or damage to, the breathing control center of the brain
2) Upper airway obstruction
3) Paralysis or impairment of the nerves and/or muscles of breathing
4) Problems affecting the lungs
5) Drowning
6) Suffocation
Assessment of Breathing
There is a high incidence of abnormal gasping (agonal gasps) after cardiac arrest. All rescuers
should use a combination of unresponsiveness and absent or abnormal breathing to identify the
need for resuscitation.
The rescuer should maintain an airway and assess for normal breathing:
LOOK for movement of the upper abdomen or lower chest.
LISTEN for the escape of air from nose and mouth.
FEEL for movement of air at the mouth and nose.
Movement of the lower chest and upper abdomen does not necessarily mean the person has a clear
airway. Impairment or complete absence of breathing may develop before the person loses
consciousness.
3.8 Techniques in opening of airways

Airway management is required to provide an open airway when the person:
1) Is unconscious
2) Has an obstructed airway
3) Needs rescue breathing
4) For unresponsive adults and children, it is reasonable to open the airway using the head tilt,
chin lift maneuver
28 | Page
Techniques in the opening of airways:

Techniques Description Illustration
1)Tilt-chin-lift The head-tilt/chin-lift is a procedure used
maneuver to prevent the tongue obstructing the
upper airways. The maneuver is
performed by tilting the head backwards
in unconscious patients, often by applying
pressure to the forehead and the chin.
The maneuver is used in any patient in
whom cervical spine injury is not a
concern and is taught on most first aid
courses as the standard way of clearing an
airway.
2. Jaw thrust The jaw-thrust maneuver is a first aid and
maneuver medical procedure used to prevent the
tongue from obstructing the upper
airways.
3. H.A.IN.E.S The HAINES (High Arm IN

recovery position Endangered Spine) recovery position is
definitely a skill everyone should have in
their first aid arsenal. It not only makes a
victims situation better, but it can save
lives. When concerned about the neck or
spinal injuries always place the left or
right arm under the head for support.
4. Head to Toe body Check the patient head to toe during the
assessment of the hands-on physical exam, going by the
victim following order: head, face, ears, neck,
chest, abdomen, pelvis, genitals, each
arm, each leg and back.
Look for:
Deformities
Open wound
Tenderness
Swelling
29 | Page
Clear Points:
✔ All victims should be thoroughly assessed to assure that all first aid needs are identified
✔ If the first aider is alone with a victim having circulatory arrest, the call first principle should be
followed.
✔ Continuous monitoring of the victim’s condition is important and find any non-life-threatening
conditions requiring treatment
✔ There are proper ways to maneuver and position victims to prevent inflicting further injury
Notes:
30 | Page
Module 4. Airways and Breathing Emergencies

(2.0 hrs.)
Objectives:
1) Recognize the signs and symptoms of the different airway and breathing emergencies:
● Foreign body obstruction
● Asthma attack
● Hyperventilation
● Provide first aid for airway obstruction to adults, children, and infants
2) Demonstrate the following:
● Back slaps
● Chest thrust
● Abdominal thrust
4.1 Signs and symptoms of foreign body obstruction, asthma attack, and
hyperventilation
Choking is a common breathing emergency. It occurs when the person’s airway is partially or
completely blocked. If a conscious person is choking, his /her airway has been blocked by a foreign
object, such as a piece of food or a small toy; by smelling in the mouth or throat; or by fluids; such
as vomiting.
Two Types of Obstruction

1. Anatomical Obstruction.
When the tongue drops back and obstructs the throat. Other causes are acute asthma, croup,
diphtheria, swelling and whooping cough.
2. Mechanical Obstruction.
When foreign objects are lodged in the pharynx or airways; solid or liquid accumulate in the
back of the throat.
What Is an Asthma Attack?

During an asthma attack, your airways swell, become inflamed, and produce extra mucus.
As the muscles around your airways contract, your bronchial tubes narrow. You may cough or
wheeze and find it hard to breathe. Asthma attacks can be minor or severe. Most improve with use
of your rescue inhaler. Those that don’t can become life-threatening and should be treated as an
emergency.
The best way to stop an asthma attack is to recognize the symptoms and treat it as
soon as possible.
Symptoms:
Asthma attack signs and symptoms vary from person to person.
31 | Page
Mild symptoms before an asthma attack.

These include:
● feeling tired
● tiring easily, especially with exertion
● signs of allergies or a cold, such as a runny nose, tickle in your throat, or nasal congestion
Common asthma attack symptoms include:

● shortness of breath
● chest tightening
● coughing or wheezing
● difficulty talking
Minor asthma attack can quickly become severe if not treated promptly.
The following signs and symptoms indicate your asthma attack is worsening:
● bluish lips
● silent chest, which means the attack is so severe that you don’t have enough airflow to
wheeze
● low blood pressure
● slow heart rate
● confusion
Severe asthma attack can be life-threatening and requires emergency medical treatment.
Triggers
An asthma attack can be triggered by a number of things, from allergies to illnesses.
Triggers can vary from person to person.
Common triggers include:

● exposure to an allergen, such as pollen, dust mites, or animal dander
● airborne irritants, such as smoke, chemical fumes, and strong odors
● respiratory infections
● strenuous exercise, which can lead to exercise-induced asthma
● cold weather
● dry air
● humidity
● gastroesophageal reflux (GERD)
● intense emotions or stress
First Aid Management of Asthma Attack:

▪ Remain calm
▪ Have patient sit comfortably
▪ Loosen any tight clothing
▪ Assist the person with prescribed quick-relief medication
▪ Patient having an asthma attack and has prescribed medications
▪ The victim identifies the medication and is unable to administer
32 | Page
What Is Hyperventilation?
Hyperventilation occurs when you breathe faster and deeper than normal.
This type of breathing prevents adequate gas exchange from taking place in lungs, and blood loses
carbon dioxide because of taking in oxygen at an unusually fast rate.
It can also be referred to as over breathing.
Causes of Hyperventilation:
The most common causes of sudden hyperventilation include:
● stress
● anxiety
● physical exertion
● fever
● and some medications.
Certain panic disorders and asthma may also cause hyperventilation.
Women tend to experience it more than men, and it can occur at almost any age.
Symptoms of Hyperventilation
1) primary symptom
● breathing quickly
2) In addition, may also experience

● feelings of anxiety
● lightheadedness
● tingling or numbness in the feet, hands, or mouth
● irregular heart rate
Symptoms tend to last between 20-30 minutes and can cause further anxiety
during an attack.
3) Other symptoms include

● Sighing
● Yawning
● and what is called air hunger - needing to breathe and feeling like you can't get
enough air in your lungs.
4.2 First Aid Management of foreign body obstruction for adults, children older than
1 year and infants up to I year of age
33 | Page
Table for First Aid Management of Foreign Body Obstruction

DEGREE OF RESPONSIVENESS RESCUERS ACTIONS
OBSTRUCTION
Mild Airway Blockage ● Good air exchange ● Do not interfere with the
● Breathing but may also victims owns attempt to relieve
be wheezing the obstruction instead, stay
● Coughing and making with the person and try to keep
noise them calm
● Encourage them to cough
● Call local emergency alerts if
the person does not clear the
obstruction or similarly seems
to be getting worse
Severe Airway Blockage ● Grasping the neck (the ● If the victim is an adult or child
universal sign of ask if he is choking. If the
choking) victim nods “yes” and cannot
● Weak or no cough talk, severe airway blockage is
● Unable to make noise present. (Certainly, an infant
or talk; may make a cannot respond to questions)
high-pitched noise ● Use abdominal trust (adults and
● Little or no breathing child) to attempt to remove the
Appears cyanotic (blue obstruction. However, five
around lips and back slap (infant) to remove the
fingertips obstruction
● Begin CPR if a person becomes
unresponsive
If you are not alone, send
someone to activate the
emergency response system
indeed.
If you are alone, provide about 2
minutes of CPR before leaving
to activate the emergency
response system.
Choking Relief in a Responsive Adult or Child

1 Stand behind the victim with one leg
forward between the victim’s legs.
But for a child, move down to their
level and keep your head to one side
2 Reach around the abdomen then
locate the navel
3 Place the thumb side of your fist
against the abdomen just above the
navel and well below the breastbone
34 | Page
4 Grasp your fist with your other hand.

After that thrust inward and upward
into the victim’s abdomen with a
quick, forceful upward thrust
5 For a responsive pregnant victim or
obese victim, perform chest thrusts
instead of abdominal thrusts; avoid
squeezing the ribs with your arms
6 Continue thrusts until the victim
throw out the object or the victim https://homspital.com/first-aid-for-foreign-bod
becomes unresponsive
Unresponsive Victim
1 Shout for help. If someone else is available, send that
person to activate the emergency response system.
2 Gently lower the victim to the ground if you see that

he is becoming unresponsive.
3 Begin CPR, starting with chest compression.

However, do not check for the pulse.
4 Each time you open the airway to give breaths, in the

same way, open the victim’s mouth wide and look for
the object.
5 After about 5 cycles or 2 minutes of CPR, activate the

emergency response system, if someone not already
done so.
35 | Page
Choking Relief in Infant

1 Kneel or sit with the infant in your lap.
It is easy to do, remove clothing from the infant’s chest.
http://www.mamaexpert.com/posts/content-625
2 Hold the infant face down with the head slightly lower than
the chest, resting on your forearm. Support the infant’s
head and jaw with your hand. Take care to avoid
compressing the soft tissues of the infant’s throat so, you
must rest your forearm on your lap or thigh to support the
infant. https://www.mirror.co.uk/news/uk-news/mum-saves-choking-baby-boys-12343204
3 Deliver up to 5 back slaps forcefully between the infant’s 5 back slaps

shoulder blades, using the heel of your hand. Afterward,
deliver each slap with sufficient force to attempt to dislodge
the foreign body.
4 After delivering 5 back slaps, place your free hand on the

infant’s back, supporting the back of the infant’s head with
one hand with the palm of your hand. The infant will be
appropriately held between your 2 forearms, with the palm https://laerdal.force.com/HelpCenter/
of one hand supporting the face and jaw while the palm of s/article/Relief-of-Foreign-Body-
Airway-Obstruction-for-Little-Baby-
QCPR
the other hand supports the back of the infant’s head.
5 Provide downward chest thrusts in the middle of the chest
over the lower half of the breastbone. Deliver chest thrust
at a rate of about 1 per second, with the intention of
creating enough force to dislodge the foreign body. https://laerdal.force.com/HelpCenter/
s/article/Relief-of-Foreign-Body-
Airway-Obstruction-for-Little-Baby-
QCPR
6 Repeat the sequence of up to 5 back slaps and up to 5 chest

thrusts until the object is removed or the infant becomes
unresponsive.
First aid procedures that is performed on a person who is choking

Action to be taken Illustration
1 Abdominal Thrust
The manual thrust with the hands
centered between the waist and
the rib cage
36 | Page
2 Backslaps
3 Chest Thrust
4.3 Positioning of patient with breathing difficulties

Shortness of breath can occur during activity, emotional excitement, exposure to adverse weather conditions, or
when you feel tense and need to relax. In conjunction with pursed lip breathing and diaphragmatic breathing, use
these breathing positions to help you reduce shortness of breath. These positions are helpful when you have
shortness of breath during activity, emotional excitement, exposure to adverse weather conditions or when you
feel tense and need to relax.
Type of Position Action to be taken Illustration

1. Sitting ● Rest your feet flat on the floor.
● Lean your chest forward slightly.
● Rest your elbows on your knees or
rest your chin on your hands.
● Relax your neck and shoulder
muscles.
2. Sitting -other ● Rest your feet flat on the floor.
way ● Lean your chest forward slightly.
● Rest your arms on a table.
● Rest your head on your forearms or
on some pillows.
37 | Page
3. Standing ● Stand with your feet shoulder width

apart.
● Lean your hips against a wall.
● Rest your hands on your thighs.
● Relax your shoulders, leaning
forward slightly and dangling your
arms in front of you.
4. Standing - ● Rest your elbows or hands on a
other way piece of furniture, just below
shoulder height.
● Relax your neck, resting your head
on your forearms.
● Relax your shoulders.
5. Sleeping ● Lie on your side with a pillow

between your legs and your head
elevated with pillows.
● Keep your back straight.
6. Sleeping - ● Lie on your back with your head
other way elevated and your knees bent, with a
pillow under your knees.
Respiratory Arrest:
Respiratory arrest is a type of breathing emergencies which occurs when breathing has stopped.
Rescue Breathing
Is a technique of breathing air into a person to supply him or her with the oxygen needed to survive. Rescue
breathing is given to victims who are not breathing or inadequate but still have pulse.
Ways to ventilate the lungs
Mouth-to-Mouth Mouth-to-Nose
Mouth-to-Mouth-and-Nose Mouth-to-Face Shield
38 | Page
Mouth-to-Mask Mouth-to-Stoma
Rescue Breathing for Adult

ACTION ADULT
(13 years old and above)
OPENING OF AIRWAY Maximum head tilt-chin-lift
METHOD Mouth-to-Mouth
BREATHS Normal breath (1 second per breath) enough to
make the patient’s chest rise
RATE 24 breaths for 2 minutes
(1 breath every 5 seconds)
RESCUE BREATHING CHILD AND INFANTS

ACTION CHILD (1-age of puberty) INFANT (under 1 year
old)
OPENING OF AIRWAY Neutral plus Neutral position
position
METHOD Mouth-to-Mouth or Mouth-to- Mouth-to-Mouth and
nose Nose
BREATHS Normal breath (1 second per breath) enough to make the
patient’s chest rise
RATE 40 breaths for 2 minutes (1 breath every 3 seconds)
RESCUE BREATHING CHILD AND INFANTS

ACTION CHILD (1-age of puberty) INFANT (under 1 year
old)
COUNTING FOR Breathe Breathe
STANDARDIZATION 1,1002, 1003, 1, 1001, breathe
PURPOSES 1 BREATH IN 1001 breathe 1, 1002, breathe
EVERY 3 OR 5 SECONDS 1,1002,1003, 1, 1003, breathe
1002 breathe 1, up to 1040
1, 1002, 1003, breathe
1003 breathe
1, 1002, 1003,
1004 up to 1024,
breathe
39 | Page
4.4 First Aid Management of Hyperventilation

Hyperventilation occurs when an individual overly breathes – exhaling and inhaling very rapid and shallow.
Usually, an individual who rapidly breathes causes panic attacks or anxiety but there are some serious medical
conditions that can result to hyperventilation.
First Aid Management of Hyperventilation

● If the person is hyperventilating and you are unsure whether it is caused by emotion, such as
excitement or fear, tell the person to relax and breathe slowly.
● If the person’s breathing still does not slow down, seek medical help immediately.
● A person who is hyperventilating from emotion may resume normal breathing if he or she is
reassured and calmed down.
Healthy Tips:
1) Breathe through the nose to prevent hyperventilation
2) Loosen clothing, tight belts, girdles, bras, and skin-tight jeans to prevent restricted breathing that can
result in shallow chest breathing.
3) Eat a healthy variety of foods such as fresh fruits and vegetables. Minimize drinking coffee, tea, and
soda.
4) Perform regular aerobic exercises that require taking in full breathes and lessening anxiety that results in
hyperventilation.
5) Encourage the individual to get plenty of sleep to prevent daytime anxiety.
6) Practice healthy thinking and avoid negative thoughts.
Clear Points:
✔ Difficulties in breathing can be a subjective complaint or can be accompanied by a very high or very
low breathing rate, and/or visible efforts and/or noisy breathing.
✔ Administration of bronchodilators or use of inhalers by first aid providers requires training and
specific competencies.
✔ Reassuring a person who is hyperventilating may be enough to alleviate the condition.
✔ While the first aider may be able to recognize the signs and symptoms of choking, the provider
should not interfere unless the airway is completely obstructed.
Notes:
40 | Page
Module 5. Bleeding & Shock Injuries

(2.0 hrs.)
Objectives:
● Define and differentiate bleeding and shock
● Classify bleeding according to type of blood vessel affected
● Discuss the common causes of bleeding
● Describe the signs and symptoms of shock
● Explain the causes of shock
● Discuss the body’s response to shock
● Compare the different types of shock
● Discuss the general principles of management of shock
● Demonstrate proper application of direct pressure on bleeding external wounds
● Discuss the general principles of management of shock
5.1 Definition of bleeding and shock

What is Bleeding?
● Bleeding is the loss of red blood cells
● Bleeding, also called hemorrhage, is the name used to describe blood loss.
Two Types of Bleeding:

1) internal bleeding - refer to blood loss inside the body
2) external bleeding – refer to blood loss outside of the body
What is Shock?
An acute medical condition associated with a fall in blood pressure, caused by such events as loss of
blood, severe burns, bacterial infection, allergic reaction, or sudden emotional stress, and marked by
cold, pallid skin, irregular breathing, rapid pulse, and dilated pupils.
● The most common recognition of shock is when blood loss is present.

● Even without blood loss, shock can still be present.
● Shock is not in itself a diagnosis of disease but a sign of something else.
5.2 Classifying and comparing type of bleeding according to blood vessel

affected
Bleeding can be divided into three categories depending on the blood vessels that have been
damaged.
Categories of Bleeding Illustration
1 Arterial bleeding
Typically bleeding from an open artery is bright
red in color due to the high oxygen content and
spurts (pulsates) in time with the contractions
of the heart.
http://biology-igcse.weebly.com/arteries-veins-and-capillaries---
structure-and-functions.html
41 | Page
The pressure causing the spurt also makes this

type of bleeding difficult to control.
As blood volume drops so will the patient’s

blood pressure and eventually, the arterial
spurting will decrease due to the low blood © medicalsupplieshub
volume.
2 Venous bleeding
© medicalsupplieshub
Bleeding from an open vein is much darker red
color due to the low oxygen content and flows
more steadily.
http://biology-igcse.weebly.com/arteries-veins-and-capillaries---structure-
As venous blood is under less pressure it does and-functions.html
not spurt and is easier to manage. However,

major venous bleeding (for example, a burst
varicose vein), can still be life-threatening as © medicalsupplieshub
large veins carry significant volumes of blood.
3 Capillary bleeding
Bleeding from damaged capillary vessels is dark
red and will ooze from the wound slowly but
steadily.
http://biology-igcse.weebly.com/arteries-veins-and-capillaries---structure-
and-functions.html
This type of bleeding often stops with no
medical intervention as the body forms a clot.
© medicalsupplieshub
Hemorrhage or Bleeding is broken down into 4 classes:

Class Description
I Involves up to 15% of blood volume. There is typically no change in vital signs
and fluid resuscitation is not usually necessary.
II Involves 15-30% of total blood volume. A patient is often tachycardic (rapid
heartbeat) with a narrowing of the difference between the systolic and diastolic
blood pressures. The body attempts to compensate with peripheral
vasoconstriction. Skin may start to look pale and be cool to the touch. The patient
might start acting differently. Volume resuscitation with crystaloids (Saline
solution or Lactated Ringer's solution) is all that is typically required. Blood
transfusion is not typically required.
III Involves loss of 30-40% of circulating blood volume. The patient's blood
pressure drops, the heart rate increases, peripheral perfusion, such as capillary
refill worsens, and the mental status worsens. Fluid resuscitation with crystaloid
and blood transfusion are usually necessary.
IV Involves loss of >40% of circulating blood volume. The limit of the body's
compensation is reached and aggressive resuscitation is required to prevent death.
42 | Page
The World Health Organization (WHO) standardized grading scale to

measure the severity of bleeding is as follows:
Grade 0: no bleeding
Grade 1: petechial bleeding
Grade 2: mild blood loss (clinically significant)
Grade 3: gross blood loss, requires transfusion (severe)
Grade 4: debilitating blood loss, retinal or cerebral associated with fatality
5.3 Common causes of bleeding
Bleeding is a common symptom. A variety of incidents or conditions can cause bleeding.
Possible causes include:

1) Traumatic bleeding
An injury can cause traumatic bleeding. Traumatic injuries vary in their severity.
Common types of traumatic injury include:

● abrasions (scrapes) that don’t penetrate too far below the skin
● hematoma or bruises
● lacerations (cuts)
● puncture wounds from items like needles, nails, or knives
● crushing injuries
● gunshot wounds
2) Medical conditions
There are also some medical conditions that can cause bleeding. Bleeding due to a
medical condition is less common than traumatic bleeding.
Conditions that can cause bleeding include:

● Hemophilia
● Leukemia
● Liver disease
● Menorrhagia, heavy or prolonged menstrual bleeding, like what’s sometimes seen in
endometriosis
● Thrombocytopenia, low blood platelet count
● Von Willebrand disease
● Vitamin K deficiency
● Brain trauma
● Colon diverticulosis
● Lung cancer
● Acute bronchitis
43 | Page
3) Medicines
Some medicines and certain treatments can increase your chances of bleeding, or
even cause bleeding.
Medications that may be responsible for bleeding include:

● Blood thinners
● Antibiotics, when used on a long term basis
● Radiation therapy
● Aspirin and other NSAIDs
5.4 Signs and symptoms of shock

A person who is going into shock may show any of the following signs and
symptoms:
● Restlessness or irritability
● Altered level of consciousness
● Nausea or vomiting
● Pale, ashen (grayish), cool, moist skin
● Rapid breathing
● Rapid, weak heartbeat
● Excessive thirst
5.5 Causes of shock

● Severe or sudden blood loss
● Large drop in body fluids
● Myocardial infarction
● Major infections
● High spinal injuries
● Anaphylaxis
● Extreme heat or cold
5.6 Body’s response to shock

Shock is a reaction by the body to a general lack of oxygen in the body's tissues, due to a lack of blood
circulating around the body. A decrease in blood pressure reduces the flow of oxygen to the vital
organs. If the blood flow is not restored, the person may die from complications due to lack of oxygen
supply to major organs.
5.7 Types of shock

There are four main categories of shock:
Categories of Shock Description
1 Hypovolemic Shock Not having enough fluid or blood volume
(hypovolemia), is the most common type of shock.
It can come from bleeding (also known as

hemorrhagic shock) or from some other sort of
fluid loss and dehydration.
44 | Page
As the body tries to compensate for the loss of

blood or fluid and attempts to keep the blood
pressure up, these signs occur:
● Rapid breathing
● Dilated pupils
● Pale, cool skin
● Sweating (diaphoresis)
As hypovolemic shock gets worse, the patient
becomes lethargic, confused, and eventually
unconscious.
If external bleeding is the cause, there will be blood.
If bleeding into the gastric system is the cause, the

© Alila Medical Media – www.AlilaMedicalMedia.com patient might vomit blood or have bloody diarrhea.
If it's hot or the patient has been exerting herself,

consider dehydration.
2 Cardiogenic Shock When the heart has difficulty pumping blood
adequately, it is known as cardiogenic shock.
It can occur after a myocardial infarction (heart

attack), malfunction of a heart valve, cardiac
arrhythmias, infections of the heart, and trauma to
the heart.
Symptoms of cardiogenic shock include:

• Weak and often irregular pulse
• Sometimes a very slow pulse
• Difficulty breathing
• Cough producing frothy sputum, white or
sometimes pink in color
• Swelling in the feet and ankles
Cardiogenic shock can be accompanied by the

signs and symptoms of a heart attack.
© Alila Medical Media – www.AlilaMedicalMedia.com
3 Distributive Shock This is the hardest category of shock to
understand, but it is very common.
When arteries in the body become flaccid and no
longer can constrict properly, the blood pressure is
very hard to control and will fall.
The two most common causes for this type of

shock are:
1) severe allergies (anaphylaxis)
© Alila Medical Media – www.AlilaMedicalMedia.com 2) severe infections (sepsis)
45 | Page
© Alila Medical Media – www.AlilaMedicalMedia.com
4 Obstructive Shock Obstructive shock comes from something pressing

on the blood vessels inside the body.
Common cause of obstructive shock is
1) from a tension pneumothorax (collapsed
lung)
2) cardiac tamponade, a rare condition caused
by blood trapped in the sack around the
heart, pressing on it and keeping it from
© Alila Medical Media – www.AlilaMedicalMedia.com adequately pumping blood
5.8 General principles of management of shock

● Recognize the signs of Shock early.
● Control any obvious bleeding
● Have the patient lie down
● Keep them warm
● If there is no suspected spinal or extremity injury, elevate the feet
REMEMBER:
V- I - P F-A-S-T-H-U-G
V - Ventilation, including airway, Feeding (prevent malnutrition, promote adequate caloric intake)
added oxygen and ventilation Analgesia (reduce pain, improve physical and psychological
I - Infusion of appropriate volume wellbeing)
expanders Sedation (titrate to the 3Cs – calm, cooperative, comfortable)
Thromboembolic prophylaxis (prevent Deep Vein Thrombosis)
P - improved heart Pumping with
Head of bed elevated (up to 45° to reduce reflux and Ventilator
drug therapy such as antiarrhythmics, Associated Pneumonia)
inotropes, diuretics and vasodilators Ulcer prophylaxis (to prevent stress ulceration)
Glycemic control (to maintain normal blood glucose levels)
5.9 Techniques in applying direct pressure on bleeding external wounds
Direct Pressure for Bleeding

1 ● Elevate the wound above the heart and apply firm
pressure with a clean compress (such as a clean,
heavy gauze pad, washcloth, T-shirt, or sock)
directly on the wound.
● Call out for someone to get help, or call emergency
hotline yourself.
● Do not remove a pad that is soaked through with
blood; you will disturb any blood clots that have
started to form to help stop the bleeding.
● If blood soaks through, place another pad on top
of the soaked one and continue applying direct
pressure.
46 | Page
2 ● When the bleeding slows or stops, tie the pad

firmly in place with gauze strips, a necktie, strips of
sheet, or a shoelace.
● Do not tie so tightly that blood flow to the rest of
the limb is cut off.
● Stay with the person and keep the wound elevated
until medical help arrives.
5.10 Proper body position of victims with bleeding wounds and in shock
S-E-E-P Illustration
Sit or lie the person down – to manage
shock and prevent them from feeling dizzy
and faint
Examine the area to see if there is anything

stuck in the wound – if there is do not
remove it
Elevate the bleeding area above the level of

the heart to slow down the bleeding
Pressure – apply direct pressure on the

wound to stop the blood coming out
Clear Points:
✔ First aid providers must prevent direct contact with blood when controlling bleeding.
✔ Tourniquets have limited benefits in the use by layperson first aid providers
✔ Items that have punctured the body's soft tissue and are still embedded such as knife can lead to a quick
deterioration and even death of the victim
47 | Page
Module 6. Cardiac Emergencies

(2.0 hrs.)
Objectives:
● Recognize the signs and symptoms of:
o Heart attack
o Cardiac Arrest
● Demonstrate the following:
o CPR
o Operation of AED
6.1 Definition of heart attack and cardiac arrest

What is a heart attack?
A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition caused
by a lack of blood flow to your heart muscle. The lack of blood flow can occur because of many
different factors but is usually related to a blockage in one or more of your heart’s arteries.
Without blood flow, the affected heart muscle will begin to die. If blood flow isn’t restored quickly,
a heart attack can cause permanent heart damage and death.
Heart Attack
Lack of blood flow
Plaque
Coronary artery
Blood clot
Dying heart muscle © Macrovector – Freepik.com
How a blocked artery can cause a heart attack
What is cardiac arrest?

Cardiac arrest happens when your heart stops beating or beats so fast that it stops pumping blood.
During cardiac arrest, people typically collapse and become unresponsive.
Symptoms start without warning. This is why it’s also known as sudden cardiac arrest. The condition can
become fatal if you don’t get immediate treatment.
48 | Page
Cardiac arrest vs. Heart attack:

Cardiac arrest happens when rapid, abnormal impulses
override your heart’s natural rhythm. It’s an electrical
issue.
Heart attack occurs when a clogged artery disrupts

blood flow to your heart.
A heart attack is a common cause of cardiac arrest.
© VectorMine | Dreamstime.com
HEART ATTACK CARDIAC ARREST
© Blausen Medical Communications, Inc. - commons.wikimedia.org © Freepik.com
Damage heart muscle Collapse of blood circulation
6.2 Signs and symptoms of heart attack and cardiac arrest

Chain of Survival
Survival from cardiac arrest depends on a series of critical interventions. If one of these critical
actions is neglected or©delayed,
VectorMine | Dreamstime.com
survival is unlikely.
© Freepik.com
© American Heart Association

49 | Page
Heart attack symptoms are different for men and women

Heart Attack Symptoms for Men Heart Attack Symptoms for Women
Men most often will experience the classic sign While some women may also experience
of: ▪ chest pain during a heart attack,
▪ chest pain, which may spread to the ▪ they are more likely to feel other
neck, jaw, or back. symptoms, including jaw pain, shortness
of breath, or nausea and vomiting.
Tiredness, sudden dizziness and a cold sweat are other heart attack signs to watch in both men
and women.
6.3 Positioning victims of heart attack
1 Put the person in a seated position, with knees
raised.
Medical authorities recommend sitting a suspected heart
attack sufferer down in the "W position" — semi-
recumbent (sitting up at about 75 degrees to the ground)
with knees bent.
Once the person is in the W position, then loosen any
loose clothing around his neck and chest (such as his
necktie, scarf, or top buttons of his shirt) and try to keep
him still and calm. You may not know what's causing his
discomfort, but you can reassure him that medical help is
on its way and that you'll stay with him at least until that
point.
The person should not be allowed to walk around.
Keeping a person calm while having a heart attack is
certainly a challenge, but avoid being too chatty and
asking lots of irrelevant personal questions. The effort
required to answer your questions may be too taxing to
the person.
While waiting for emergency help, keep the patient warm
by covering him with a blanket or jacket.
2 Ask the person if she carries nitroglycerine.
People with a history of heart problems and angina (chest
and arm pain from heart disease) are often prescribed
nitroglycerine, which is a powerful vasodilator that causes
large blood vessels to relax (dilate) so more oxygenated
blood can reach the heart.
Nitroglycerine also reduces the painful symptoms of a
heart attack. People often carry their nitroglycerin with
them, so ask if that's the case and then assist the person
in taking it while waiting for emergency personnel to
arrive. Nitroglycerin is available as little pills or a pump
spray, both of which are administered under the tongue
(sublingually). The spray (Nitrolingual) reportedly is faster
acting because it's absorbed quicker than the pills.
50 | Page
3 Administer some aspirin

If you or the heart attack sufferer has any aspirin, then
administer it if there's no indication of allergy. Aspirin
Ask the person if he has an allergy and look for any
medical bracelets on his wrists if he has trouble talking.
Provided he is not younger than 18 years old, give him a
300 mg aspirin tablet to chew slowly.
Aspirin is a type of non-steroidal anti-inflammatory drug
(NSAID) that can reduce heart damage by "thinning" the
blood, which means preventing it from clotting. Aspirin
also reduces associated inflammation and helps reduce
the pain of a heart attack.
Chewing the aspirin allows the body to absorb it faster.
Aspirin can be taken concurrently with nitroglycerine
4 Initiate CPR if the person stops breathing.
Cardiopulmonary resuscitation (CPR) involves chest
compressions in order to help push some blood through
the arteries (especially to the brain) combined with rescue
breathing (mouth to mouth), which provides some
oxygen to the lungs.
Keep in mind that CPR has its limitations and doesn't
usually trigger a heart to start beating again, but it can
provide some precious oxygen to the brain and buy some
time before emergency services arrive with their electrical
defibrillators.
6.4 CPR (Cardio-Pulmonary Resuscitation)
Cardio-Pulmonary Resuscitation
CPR is a combination of chest compressions and rescue breaths. When the heart is not beating,
chest compressions are needed to circulate blood containing oxygen.
51 | Page
Components of High Quality CPR

1) Correct Depth of Compression
2) Maintain Compression Rate of
100–120/minute
3) Allow full chest recoil after each
compression
4) Minimize interruptions
5) Avoid over ventilation
CPR Table of comparison:
CPR COMPARISONS FOR ADULT, CHILD AND INFANTS

COMPONENT ADULT CHILD (1- INFANT
(13 years old and age of puberty) (under 1 year old)
above)
Recognition of Cardiac Unresponsive (for all ages)
Arrest No breathing or no normal breathing (i.e. only gasping)
No definite pulse felt within 10 seconds

(13 years old and above) age of puberty) (under 1 year old)
CHECKING OF Carotid pulse Brachial pulse
BREATHING AND Breathing could be check by the rise and fall of the chest. For Lay
CIRCULATION Rescuer if no breathing start CPR

above)
CPR SEQUENCE Compression-Airway-Breathing
COMPRESSION At least 100-120/min
RATE
COMPRESSION 2 inches (5cm) not At least 1/3 AP At least 1/3 AP
DEPTH more than diameter diameter
2.4 inches About 2 inches About 1½ inches
(6cm) (5cm) (4cm)

above)
AIRWAY Head-tilt-chin lift (HCP& PR: suspected trauma: jaw thrust)
COMPRESSION- 30:2 1 or 2 rescuers 30:2 Single rescuers
TO-VENTILATION 15:2 2 HCP rescuers
RATIO (until advanced
airway placed)
52 | Page

above)
VENTILATIONS 1 breath every 6 seconds (10 breaths/min)
WITH ADVANCE Asynchronous with chest compressions
AIRWAY (HCP&PR) About 1 second/breath
Visible chest rise
When to Stop CPR

Once you begin CPR, do not stop except in one of these situations:
Spontaneous signs of circulation is restored
Turn over to more advance medical help
Operator is exhausted and cannot continue CPR
Physician assumes responsibilities
Scene becomes unsafe
When not to Start CPR

It is recommended that all patients in cardiac arrest receive resuscitation unless:
● The patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.
● The patient has signs of irreversible death: rigor mortis, decapitation, or dependent lividity.
● No physiological benefit can be expected because the vital functions have deteriorated despite
maximal therapy for such conditions as progressive septic or cardiogenic shock.
One Rescuer
1 The carotid pulse should be checked on the
side of the neck .
Don’t waste time feeling for a pulse longer
than 10 seconds.
Even if you do not feel the pulse, start a
cycle of CPR with two breaths and 30 chest
compressions.
2 The heel of one hand should rest on the
lower half of the sternum
3 The other hand should be above the first
53 | Page
4 Straighten your arms and press down

Each compression should reach 2 to 2.4″ (5
to 6 cm) into the patient’s chest, with a rate
of 100 to 120 compressions per minute.
5 Tilt the head and lift the chin to open the

airways after 30 compressions
● Tilt the head back after putting your
hand on the patient’s forehead.
● Lift the jaw with your index and
middle fingers on the lower jaw.
● If the patient has a neck injury, do
not tilt the head; simply use the jaw-
thrust.
● In applying the jaw-thrust maneuver,
hold the lower jaw’s angles and lift
with both hands, moving the jaw
forward from either side. Open the
lower lip with your thumb if the
patient’s lips are sealed
7 Watch the chest rise and give a breath. Do

this again while administering a second
breath.
8 Chest compressions should then be

resumed. Switch between compressions and
rescue breaths while minimizing
interruptions in the compressions.
Two Rescuer CPR

1 Have the second rescuer retrieve the AED
Note: AED will be discussed in detail in 6.5
54 | Page
2 Deliver chest compression counting out loud
3 The second rescuer applies the AED pads
4 Switch roles after every five cycles of

compression and breaths. One cycle consist
of 30 compression and two breaths
5 Be sure that between each compression you

complete stop pressing on the chest and
allow the chest wall to return to its natural
position
Leaning or resting on the chest between
compressions can keep the heart from
refilling in between each compression and
make CPR less effective.
6.5 Operation of AED including proper application of electrode pads
What is AED?
AED Stands for Automated External Defibrillator.
An AED is a portable device that is used to diagnose and treat ventricular fibrillation (VF) and
pulseless ventricular tachycardia (VT).
AEDs are devices that are attached to a victim with adhesive pads.
It recommend shock delivery only if the victim’s heart rhythm is one that a shock can treat.
AEDs give rescuers visual and voice prompts to guide rescuer actions.
AED can help save lives during sudden cardiac arrest.
Ⓒ metamorworks - shutterstock.com
55 | Page
Benefits of AED:
1) Restore heart signal
2) User friendly
3) Automatic Shock
Use of AED Pads

ADULT (Victims 9 Years of Age and Older)
Use only adult pads (do NOT use child pads or a child key or switch for victims 8 years of age and
older).
CHILD (Victims Years of Age 1 to 8 )

Use child pads if available. If not use Adult pads.
If the AED has a key or switch that will deliver a child shock dose, turn the key or switch.
For unwitnessed, out-of-hospital cardiac arrest perform 5 cycles before using and attaching the
AED.
Lone Rescuer with an AED

The lone rescuer should quickly activate the emergency response system and
get the AED.
The rescuer should then return to the victim and begin the steps of CPR.
The AED should be used only if the victim does not respond, has no
breathing, and has no pulse.
There are 2 exceptions to this rule:

1) If the victim is an adult and a likely victim of asphyxia arrest, the rescuer should give 5 cycles of
CPR before activating the emergency response system and getting AED.
2) If the victim is a child and the rescuer did not witness the arrest, the rescuer should give 5
cycles of CPR before activating the emergency response system and getting the AED.
How to Use an AED ?

1 Confirm that the patient is experiencing
cardiac arrest (no breathing, unconscious)
56 | Page
2 Turn on the AED. This is achieved by lifting

the lid and/or pressing an “On” button.
3 Expose the patient’s chest and apply the pads

to their bare skin. Use the diagram on each pad
as a guide.
4 Connect the pads to the defibrillator if they are

not yet connected.
5 Stand clear of the patient while the AED

searches for a shockable rhythm.
6 Follow the AED’s audible instructions. Press

the “Shock” button only if instructed, or allow
the AED to shock automatically for automatic
AED models.
7 When shock is complete (or if shock is not

recommended), perform CPR until emergency
services arrive or the patient regains
consciousness.
8 After 2 minutes of CPR, the AED may again

prompt you to stop CPR to analyze, potentially
resulting in additional shocks. Continue to
follow the AED prompts, with 2 minutes of
CPR between each analysis, until emergency
services arrive.
Clear Points:
✔ Prompt recognition of heart attack and cardiac arrest is the key to successful outcome.
✔ If the first aider is not willing or unable to give rescue breaths give chest compressions only
✔ Compression rate should be 100 to 120 per minute
✔ Compression and ventilation ratio stand at 30:2
✔ When an AED is available the first aid provider must always do CPR while waiting for the AED to be
available and made ready for use
57 | Page
Module 7. Poisoning
(2 hrs.)
Objectives:
• Define poison
• Discuss the route of entry of poisons into the body
• Explain the general mechanism of injury of poisons
• Describe the priority action approach for poisoning
• Reiterate the management of poisoning by route of entry into the body
7.1 Definition of poison
What is Poison?
© Freepik.com
Poison is any substance that can cause injury, illness or death when introduced into the body.
Poisons include solids, liquids, gases and vapors.
Poison can enter the body through four ways – ingestion, inhalation, injection and absorption.
7.2 Route of entry of poisons into the body

Routes of poison entry to the body:
Description Illustration
1 Poisoning by Injection
Enters the body through bites or stings or Injection
as drugs injected with a needle.
2 Ingestion
Ingestion is the most common route of exposure to
toxic chemicals. Ingestion
Enters the body through the mouth, lips,
esophagus, or stomach.
© sentavio – freepik.com
Drinking bleach is an example of swallowed
poisoning.
58 | Page
3 Topical (skin absorption)

Enters the body through the skin. Plants
(such as poison ivy) and chemicals can Absorption
cause absorbed poisoning.
© Jakob Vogel – thenounproject.com
4 Inhalation
Is breathed into the body. Breathing in
carbon monoxide from a car’s exhaust is
an example of inhaled poisoning. Inhalation
© Jakob Vogel – thenounproject.com
7.3 General mechanism of injury of poisons

Poisoning is the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in
contact with the skin, eyes, or mucous membranes, such as those of the mouth or nose.
Possible poisonous substances include:

1. prescription and over-the-counter drugs 6. food
2. illicit drugs 7. mushrooms
3. gases 8. plants
4. chemicals 9. animal venom
5. vitamins
Poisoning have been classified into two types:

1) Based on effect
a. Acute Poisoning
Acute Poisoning is produced by the adverse effects of a substance that occurs either
from a single exposure or from multiple exposures in a short period. It usually takes less
than 24 hours. Symptoms are pain, dizziness, swelling, increase heart rate, etc.
b. Chronic Poisoning
Chronic Poisoning is long-term exposure to a poison. It can be repeated or continuous
exposure to a poison where symptoms do not produce immediately or after each
exposure. Instead, the person gradually becomes ill and produces signs and symptoms
after a long period.
c. Sub-acute Poisoning
Subacute Poisoning describes the adverse effects occurring as a result of a single dose
or multiple doses of a test sample per day given during a period of from 14 to 28 days.
It is a repeat dose of poison.
d. Fulminant Poisoning
Fulminant means come suddenly with great severity. It is the type of Poisoning that
occurs due to immense exposure to poisonous substances or poison. Sometimes the
adverse effects produce such as death without any signs and symptoms. It is a sudden
reaction without being exposed for a more extended period.
59 | Page
2) Based on the way or process

a. Suicidal
Suicidal Poisoning is also known as Self-Poisoning. Suicidal Poisoning is the most common
means used by individuals to attempt suicide and is the common method among females.
A large portion of suicides and suicide attempts involves Poisoning, and most poisoning
includes prescription medication. It is intentional self-harm by using poisons.
b. Accidental
Childhood poisoning comes under accidental poisonings. It is an unintentional act. It is a type
of Poisoning that mainly happens in children under the age of 5. Accidental Poisoning includes
a person unintentionally poisoning themselves, which also involves an accidental drug
overdose. Sometimes these poisonings can result in acute Poisoning, which causes vomiting
and diarrhea. Exposure to any poisonous substances or poison at the occupational site and
which cause Poisoning is included in accidental Poisoning.
c. Homicidal
Homicidal Poisoning describes the murder of human beings by poison. Examples of the
poisons used in homicide are mainly arsenic, organophosphates, aluminum phosphide, and
paraquat.
d. Abuse
The abuse included Poisoning as an additional offense and was reported as the intentional
act of an overdose of a drug or the exposure of a toxic substance. Substances used for abuse
poisoning include alcohol, nicotine, opioids, cannabinoids, sedatives, volatile solvents,
hallucinogens, and stimulants. It is reported that most cases of intentional and accidental
Poisoning are due to drugs of abuse.
7.4 Priority action approach for poisoning

1) Excretion
An organism can minimize the potential damage of absorbed toxins by excreting the chemical
or by changing the chemical into a different chemical (biotransformation), or by both methods.
The body can excrete exogenous chemicals in the urine, bile, sweat, or milk; the lungs can
excrete gases such as carbon monoxide.
2) Swallowed poison.
Remove anything remaining in the person's mouth. If the suspected poison is a household
cleaner or other chemical, read the container's label and follow instructions for accidental
poisoning.
3) Poison on the skin.
Remove any contaminated clothing using gloves. Rinse the skin for 15 to 20 minutes in a shower
or with a hose.
4) Poison in the eye.
Gently flush the eye with cool or lukewarm water for 20 minutes or until help arrives.
5) Inhaled poison.
Get the person into fresh air as soon as possible.
If the person vomits, turn his or her head to the side to prevent choking.
Begin CPR if the person shows no signs of life, such as moving, breathing or coughing.
60 | Page
7.5 Management of poisoning by route of entry into the body:

1. Ingestion
People who have ingested poison may have burns or stains around the mouth, excessive
salivation, sweating, nausea and tear formation
Breath may smell like chemicals and they may have difficulty breathing; Vomiting, diarrhea,
convulsions, drowsiness and unconsciousness may occur
STOP - Assess and observe the scene; Is there a poisonous substance nearby?
THINK - Consider your safety and form an action plan; Can the substance harm me?
ACT - Check responsiveness
First Aid Management for Ingested Poison

Steps Action to be taken
1 Perform a primary and secondary assessment
2 For a responsive patient, conduct an illness assessment and gather information
about what, when and how much poison was ingested
3 If available, read the label on the substance for poisoning instructions
4 If instructed to induce vomiting, use a recommended substance
Save the vomitus and gather the poison container for laboratory analysis
2. Inhalation
If you inhale carbon monoxide or other harmful substances, you may experience headache,
dizziness, nausea and chest tightness
You may cough, wheeze and have difficulty breathing. The skin may become pale, then bluish
with cherry-red appearance on nail beds and lips
Steps for First Aid

1 If necessary, move the patient to an area with fresh air; Perform a primary and
secondary assessment and monitor the patient's
2 For a responsive patient, help to loosen clothing around the neck and chest for
easier breathing; Conduct an illness assessment and gather information about what,
when and how much poison was inhaled
3 If available, read the label on the substance for poisoning instructions
4 If available and permitted to do so, administer emergency oxygen and continue to
support the patient
3. Carbon monoxide vs carbon dioxide

Carbon monoxide poisoning is often called “the silent killer” because it is odorless,
colorless, tasteless, and non-irritating so early signs of poisoning are harder to detect.
Symptoms of carbon monoxide (CO) poisoning include:
● Headache ● Upset stomach ● “Flu-like” symptoms without fever
● Dizziness ● Vomiting ● Fainting
● Weakness ● Chest pain ● Seizures
● Tiredness ● Confusion ● Death
61 | Page
Excess CO2 takes up space in the air instead of oxygen, which creates an environment in
which a person can suffocate (asphyxiate) and causes a condition called hypercapnia
(or hypercarbia).
CO2 poisoning is rare.
Symptoms of carbon dioxide (CO2) poisoning include:
● Headache ● Rapid breathing and heart rate
● Dizziness ● Flushing
● Nausea ● Confusion, convulsions, and loss of
● Vomiting consciousness (in severe cases)
What Is the Treatment for Carbon Monoxide and Carbon Dioxide Poisoning?
Carbon monoxide (CO) poisoning is treated in the hospital with oxygen, usually administered for 4
to 5 hours.
Carbon dioxide (CO2) poisoning can sometimes be treated just by having patients
breathe in normal air. In more severe cases, oxygen may need to be administered and
hyperbaric oxygen therapy may be used.
How Do You Prevent Carbon Monoxide and Carbon Dioxide Poisoning?

To reduce the chances of carbon monoxide (CO) poisoning:
● Install a CO detector in your home

● Ensure all fuel-burning appliances (such as gas water heaters, gas stoves, gas
clothes dryers) in the home are working correctly
● Make sure all vents in the heating system are working correctly
● Never use a charcoal grill or portable propane grill indoors, or in poorly
ventilated spaces
4. Injected Poison
First Aid Management
1 Follow First Aid Action Plan - avoid needle stick injuries to yourself and casualty.
2 Treat any other signs and symptoms. Send any empty syringes, bottles, and vials
with the casualty to the hospital..
5. Absorption
1 Protect yourself (if possible) use protective clothing such as gloves, goggles, and
so on.
2 Wash the substance off immediately.
3 Ask the casualty to remove any contaminated clothing.
4 Flush the casualty’s skin with running water.
5 Wash gently with soap and water and rinse well.
62 | Page
6. Snakebites
How to treat a snake bite?
Snake bites should be treated as life threatening. Snakes force venom out under pressure
through fangs in the upper jaw. The spread of snake venom depends on its absorption
through the lymphatic system.
Signs and symptoms

● Visible in an hour or more after the person has been bitten.
● In children, signs and symptoms may appear within minutes.
● Paired fang marks, but often only a single mark or a scratch mark may be present.
Marks or scratches may bleed.
● Nausea, vomiting and diarrhea.
● Headache, drowsiness, giddiness or faintness.
● Double or blurred vision, drooping eyelids.
● Voice changes, trouble speaking or swallowing.
● Pain or tightness in the throat, chest or abdomen.
● Breathing difficulties, respiratory weakness or arrest.
First Aid Management for Snakebites:

• Reassure the patient .
• Avoid any interference with the bitten wound (incising,
rubbing, vigorous cleaning, massaging or applying herbs).
• Immobilize the patient, laying down in a comfortable and
safe position.
• Use a broad elastic roller bandage to cover bitten area.
• Avoid movement, doing so will assist the venom into
entering the blood stream.
First Aid Management for Bee Stings:

• Remove any visible stinger.
• Wash the site with soap and water.
• Cover the site with a dressing.
• Apply a cold pack to the area to reduce pain and swelling.
• Call the local emergency number if the person has any
trouble breathing or shows any other signals of anaphylaxis.
First Aid Management for Marine Life with poisonous spines

● Immerse the wound in 45ºC water, for 30 to 90 minutes.
● Soak the affected area in vinegar.
● Leave an inaccessible spine.
● Cleanse the wound with an antiseptic solution.
● Washing out remaining venom and pieces of spine
minimizes damage, speed healing and prevent infection.
63 | Page
First Aid Management for Jellyfish Stings

• Limit further discharge by minimizing patient movement.
• Wash out wounds or injury with vinegar.
• Remove any remnant of allergen such as jellyfish tentacles
and other foreign materials by scraping them off.
• Keep the patient warm.
Clear Points:
✔ The preferred action is to call and follow the instructions of the poison control center or the
EMS for life-threatening situation
✔ Limit further effect of poison by stopping exposure
✔ Dry chemicals or powders should be removed before the victim is rinsed
✔ Body surface should be rinsed
✔ Caustic toxin should be diluted
Notes:
64 | Page
Module 8. Head & Spine Injuries

(2.0 hrs.)
Objectives:
▪ Discuss the definition, causes, symptoms and prevention of:
o Head injury
o Concussion
o Spinal injury
o Assess head and spinal injuries
▪ Demonstrate:
o Manual stabilization of head and spine
o Removal of helmet
o Loading and securing victim to a backboard
8.1 Definition, causes, symptoms and prevention of head injury, concussion

and spinal injury
Head Injury:
What is Head Injury?
A head injury is any sort of injury to your brain, skull, or scalp. This can range from a mild bump or
bruise to a traumatic brain injury.
What causes a head injury?

1.Head injuries due to blows to the head
Head injuries caused by a blow to the head are usually associated with:
• motor vehicle accidents
• falls
• physical assaults
• sports-related accidents
2.Head injuries due to shaking

Head injuries caused by shaking are most common in infants and small children, but they can occur any
time you experience violent shaking.
Two types of head injury:
Head injuries can be classified as:
1) Open – with bleeding wounds to the face or head
2) Closed – no visible signs of injury to the face or head.
Symptoms of a head injury

Symptoms of serious head injury can include:
o Altered consciousness
- the person may lose consciousness for short or longer periods or may be conscious again,
but confused or drowsy. They may even have a brief seizure. They may also change by
improving for a while and deteriorating again later.
65 | Page
o Skull deformities
- compressions or deformities are signs of fractures.
o Clear fluid from the ears or nose
- a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid
to leak from the ears or nose.
o Black eyes and bruised skin behind the ears
- this indicates that the force of the blow was sufficient to rupture blood vessels around
the eyes and ears.
o Vision changes
- the pupils of the eyes may be dilated (enlarged) and be different sizes in a person with a
serious head injury. The person may complain of double or blurred vision.
o Nausea and vomiting
- these are common side effects of serious head injury and should always be considered
important if they persist.
First aid for head injury:

1) First aid when the injured person is conscious
o Encourage the injured person to minimize any movement of their head or neck.
o Scalp injuries can bleed profusely, so control any significant blood loss from head wounds
with direct pressure and a dressing.
o While examining the wound, avoid disturbing blood clots forming in the hair.
o Reassure the person and try to keep them calm.
2) First aid when the injured person is unconscious

o The person should not be moved unless they are in immediate danger. Any unnecessary
movement may cause greater complications to the head injury itself, the spine or other
associated injuries.
o A good rule is that if the head is injured, the neck may be injured too.
o Your role is to protect the injured person from any potential dangers at the scene.
o You should also monitor their airway and breathing until the arrival of an ambulance.
o If the person’s breathing becomes impaired due to a problem with their airway, you may
need to very carefully tilt their head back (and support it) until normal breathing returns.
o If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be
required.
Concussion:
What is concussion?
Concussion is a mild traumatic brain injury that follows some trauma to the head. It is a diagnosis made
by a doctor when it is certain a more serious head injury has not occurred.
CONCUSSION
A concussion is a traumatic brain injury
that affects your brain function
66 | Page
Direct impact Acceleration-deceleration Blast

brain injury brain injury brain injury
Brain
Skull
© Patrick J. Lynch - Wikimedia Commons
Signs and Symptoms of Concussion

Thinking and Physical Emotional Behavioral
Remembering
■Difficulty thinking ■ Headache ■ Irritability ■ Changes in
clearly ■ Blurry vision ■ Sadness sleeping
■ Difficulty ■Nausea or ■ Heightened habits (sleeping
remembering vomiting emotions more or less than
events that occurred ■Dizziness ■ Nervousness usual, difficulty
just prior to the ■Sensitivity to or anxiety falling asleep)
incident and just noise or light ■ Changes in
after the incident ■Balance playing
■Difficulty problems and eating habits
remembering ■Feeling sluggish (in
new information (lack of energy) children)
■Difficulty
concentrating
■Feeling mentally
“foggy”
■Difficulty
processing
information
▪ If you think that a person has sustained a concussion, advise the person to stop the activity
he or she was engaged in when the incident occurred.
▪ The person should follow up with a healthcare provider for a full evaluation.
▪ A healthcare provider is best able to evaluate the severity of the injury and make
recommendations about when the person can return to normal activities.
▪ And, while rare, permanent brain injury and death are potential consequences of failing to
identify and respond to a concussion in a timely manner.
67 | Page
Spinal injuries
Anatomy of Spine:
Photo Source: Shutterstock

What is the spine?
Your spine, or backbone, is your body's central support structure. It connects different parts of your
musculoskeletal system. Your spine helps you sit, stand, walk, twist and bend. Back injuries, spinal
cord conditions and other problems can damage the spine and cause back pain.
First Aid Treatment for Spinal injuries

● It is important to keep the injured person’s head in line with their neck.
● Avoid twisting their head or allowing their head to roll to the side.
● If you can, roll a t-shirt, towel or similar soft item and place it around their neck to keep their
head straight.
● Don’t try to move them unless there is an urgent need to.
8.2 Manual stabilization of head and spine

1) Head Grip for applying a Cervical Collar
1 Choose correct size
© herraez - 123rf.com © belchonock - 123rf.com
2 First rescuer holds their head

in line. Second rescuer slips
back section of open collar
under patient’s neck
© akacin - 123rf.com
3 Correctly position the collar to

fit the chin and neck
© lopolo - 123rf.com
68 | Page
2) Trapezius Squeeze
The trapezius squeeze is also used when you need to roll the patient from the supine to the lateral position
(modified trapezius squeeze). This is necessary if the patient is vomiting or is in pain in the supine position.
1 Maintain alignment with the patient’s body as
you kneel behind their head.
2 With your elbows on the ground or your knees,
slide your arms on the trapezius muscles of the
patient on either side of their head.
3 Your thumbs must be pointed downwards on
the front of the patient’s trapezius muscles, and
your fingers must be parallel to the spine on the
back. Don’t cradle the patient’s neck with your
hands.
4 Without lifting the patient’s head, move your
forearms inwards to support their head.
5 Without lifting the patient’s head, move your
forearms inwards to support their head.
3) Modified Trapezius Squeeze

If you need to roll a patient from the supine or prone position to a lateral position, you need to perform
a modified trapezius squeeze. However, you may also use it for a patient in the supine position.

1 Once again you kneel behind the patient’s head
in alignment with their body.
2 Support the elbow of your one arm on the

ground or against your knee and grip the
patient’s trapezius muscle with it.
Simultaneously, place your other hand against
the side of the patient’s head.
3 Use firm pressure to stabilize their head
between your palm and forearm of the hand on
the trapezius muscle.
69 | Page
4) Sternal Forehead Grip

If the time has come for you as a first responder to transfer the manual spinal restriction of the patient
to another responder or to release the patient, you will need to use the sternal forehead grip to stabilize
a patient’s head.

1 Kneel by the patient’s head with one knee beside their chest
or shoulder and the other by their head
2 With your elbow and forearm placed along their sternum,

place your hands on the patient’s face with:
● Your thumb on one cheekbone
● Your index and middle finger on the other cheekbone
ensure not to block their nose and mouth.
3 At the same time, with the other elbow on your knee, place
your other hand on the patient’s forehead.
4 Hold the head and neck into position without rotating them
or compressing them. 5. You can then arch your hands to
raise your forearm for sandbags to be placed or removed.
This maneuver also allows your partner to adjust their grip.
5) Sternal/Spinal Grip
When the patient is seated, you can perform a sternal/spinal grip when you stabilize a patient’s head.

1 Kneeling at a right angle at the patient’s side, place the elbow
and forearm along their sternum.
2 The hand of that arm is placed as follows:

● Thumb on one cheekbone or mandible
● Index and middle fingers on the other cheekbone or
mandible
3 At the same time, your other arm is positioned along the
patient’s spine, and you support their head by gripping it with
your hand.
70 | Page
8.3 Removal of Helmet

Steps Description Illustration
1 1 hand stabilize the helmet (fingers splay open the
helmet)
2 2 hands stabilize the head (helmet chin strap undone)
3 Helmet is gently “rocked” off the head
4 1 hand remove the helmet while the 2nd hand maintains

head stability
5 Gently lowered the head to the floor (where the helmet

is)
Continue to support the head until paramedics arrive
8.4 Loading and securing victim to a backboard
What is backboard?
The backboard (also referred to as the spine board or full board) is only used for lifting and is not
designed to carry people across long distances. It is constructed of either plywood or plastic. Backboards
are either rectangular in shape or tapered at one end. The board has holes cut along the sides through
which straps may be placed to secure the person’s body to the board. Most boards are approximately 1.8
meters (6 feet) long. If a backboard is used with a basket stretcher, the board must fit inside the stretcher.
71 | Page
Loading victim to a backboard:

1 Determine need for immobilization
2 Apply cervical collar and maintain in-line
stabilization
3 Place hands in appropriate position, then roll patient

onto backboard as one unit.
4 Position patient in center of backboard. Secure body

to backboard using
appropriate strapping devices in correct sequence
(chest, hips, feet).
5 Pad any natural hollows, then secure patient’s head

to backboard using appropriate equipment.
6 If necessary, reapply/adjust cervical collar. Secure

arms and hands in front of body and confirm
patient is secure before moving.
Clear Points:
✔ All victims with a soft tissue injury of the scalp must be assessed for
possible cervical spine injury and immobilized accordingly
✔ The level of consciousness of victims must be monitored from time to time for
any changes
✔ Once spinal injury is suspected, correct techniques for spinal realignment and
immobilization must be followed
72 | Page
Module 9. Soft Tissue Injuries

(2 hrs.)
Objectives:
● Define burn
● Discuss the different types of burns and their possible causes
● Explain the first aid management of burn
9.1 Definition of burn

What is burn?
A burn is a traumatic injury to the skin (and sometimes the underlying tissues as well)
caused by contact with caused by heat, chemicals, electricity, or radiation.
1. Extreme Heat Ex: Flames, Hot Liquid
2. Chemicals Ex. Corrosive chemicals
© thenounproject.com
3. Radiation (including Ex:

sunburn)
© freepik.com
© rawpixel.com - freepik.com
4. Electricity
ID 8006972 © Stefan Hermans | Dreamstime.com
73 | Page
9.2 Types of burns
Types of Burns:
a. Thermal Burns
b. Chemical Burns
c. Electrical Burns
d. Radiation
Degree stages of burn injury:

Degree Description
These burns only affect the outer layer of
your skin. Skin may be red and painful, but
you won’t have any blisters
First Degree
© buoyhealth.com
Skin reddened
The outer layer of skin as well the dermis –

the layer underneath – has been damaged.
Skin will be bright red, swollen, and may
look shiny and wet
Second Degree © buoyhealth.com
Blisters
Sometimes called a “full thickness burn,”

this type of injury destroys two full layers of
your skin
Third Degree
© buoyhealth.com
charring
74 | Page
9.3 Burn management

Basic First Aid after Burn
1 Step away from the source of the burn
© Image by Freepik
2 Gently flush the area with cool water to

reduce the temperature .Never use ice
3 Remove clothing from the wound unless it's © Macrovector - Freepik

sticking; in that case, leave it for medical
professionals to remove. Take off any
jewelry before the area can swell
4 Cover the burn with a clean cloth or a gauze
pad if you have it.
© designer_things - Freepik
5 Do not use any greases, sprays, butter, or

ointments on a burn, as they keep the heat in
© freepik.com
First Aid Managements For Thermal Burns
Image courtesy of Wikimedia Commons.
● Check the scene for safety.

● Stop the burning remove the victim from the source of the burn.
● Check for life-threatening conditions.
● Cool the burn with large amounts of cold running water.
● Cover the burn loosely with a sterile dressing.
● Prevent infection. Do not break blisters.
● Apply a triple antibiotic ointment if the person has no known allergies or sensitivities to the
medication.
● Take steps to minimize shock.
● Comfort and reassure the victim.
75 | Page
First Aid Management for Chemical

Chemical Burns- A chemical burn may be felt immediately or it may take time to develop, depending
on the cause
1 Wear protective gloves and brush off any
dry chemical. Then flush the area with cool
water for at least 10 minutes.
2 Remove any clothing or jewelry that may

have touched the chemical.
3 Cover the area loosely with gauze or a

nonstick material or cloth.
4 If the area begins to hurt again, repeat

flushing with cool water.
First Aid Management for Electrical Burns:

● Never go near the person in contact with the power source.
● Turn off the power at its source
● Call the local emergency number.
● Electrocution can cause cardiac and respiratory emergencies.
● Care for shock and thermal burns.
● Look for entry and exit wounds and give appropriate care.
● Remember that anyone suffering from electric shock requires advanced medical attention.
Electrical burns can be worse than they look on the surface. If you have an electrical burn from lightning,
electrical wires, or household objects, see a healthcare provider promptly. If you are assisting someone,
do not touch them if they are still in contact with the source of the electrical shock or burn.
Call or bring the patient to nearest medical care if observe the following:
● Severe burns
● Confusion or loss of consciousness
● Difficulty breathing
● Muscle spasms or seizures
When it is safe to touch the person, administer CPR if trained and the person is not moving or breathing.
Try to keep them warm and drape a clean cloth over the affected area. Do not use materials with fibers
that may become stuck to the wound.
76 | Page
First Aid Management for Radiation Burns:

● Care for a radiation burn, i.e. sunburn, as you would for any thermal burn.
● Always cool the burn and protect the area from further damage by keeping the person away
from the burn source.
Home Remedies for Burns

First-degree or mild second-degree burns can be treated at home.
Take the following steps at home:

● Flush the burn with cool water and gently clean it. Don't apply any ointment, grease, or spray.
● If develop blisters, don't break them. If they pop on their own, clean the area gently and apply
antibiotic ointment. Keep the area clean to prevent infection.
● Aloe vera or a mild moisturizer may soothe burn as it heals.
● Keep the burn lightly covered with a clean bandage that won't stick.
● If the burn continues to hurt, try an OTC pain reliever. Only take it as directed.
● Watch for signs of infection. If redness or feel weak, contact healthcare provider.
● Immediate medical assistance for electrical burns is essential.
Things not to do
o Don’t contaminate the burn with potential germs by breathing or coughing on it.
o Don’t apply any medical or home remedy, including ointment, butter, ice, spray, or cream.
o Don’t give the burned person anything to ingest.
o Don’t put a pillow under their head if you think they have an airway burn.
Clear Points:
✔ Immediate cooling of burns should be done to relieve pain and to stop the burning process.
✔ Blisters should not be burst.
✔ Ice and ice water should not be applied to burns
✔ Burns should be dressed with a sterile dressing after cooling
77 | Page
Module 10. Bone, Joints, and Muscle Injuries

(2 hrs.)
Objectives:
● Discuss the mechanism of injury
● Differentiate between sprain, strain, dislocation and fracture including their signs and symptoms
● Explain the priority action approach to limb injuries
● Discuss the principles of examination of limb injuries and immobilization
● Demonstrate the different techniques to immobilize upper and lower limb injuries
10.1 Mechanism of injury
Mechanism of injury, or MOI, refers to the method by which damage (trauma) to

● skin,
● muscles,
● organs, and
● bones occurs.
Chief Complaints associated with mechanism of injury include:

1) Animal Bites/Attacks
2) Assault/Sexual Assault/Stun Gun
3) Burns (Scalds)/Explosion (Blast)
4) Eye Problems/Injuries
5) Falls
6) Hemorrhage/Lacerations
7) Inaccessible Incident/Other Entrapments (Non-Traffic)
8) Stab/Gunshot/Penetrating Trauma
9) Traffic/Transportation Incidents
10) Traumatic Injuries (Specific)
10.2 Definition, causes, signs and symptoms of the different injury to the bones, joints and
muscles
Bones are strong, hard, dense, tissues that come in many different sizes and shapes.
More than 200 bones make up the skeleton, creating the framework for the body.
Muscles are soft tissues that can contract and relax. Most muscles are skeletal
muscles, which are attached to bones by tendons and move the body when they receive signals from the
brain.
A joint is formed where two or more bones are held together by ligaments that allow movement.
78 | Page
Bones, muscles, and joints have many jobs:

• Supporting the body
• Protecting internal organs
• Allowing movement
• Storing minerals
• Producing blood cells
• Producing heat through movement
Basic types of bone, muscle, and joint injuries:

Basic types of bone, muscle, and joint injuries: Illustration
1 Sprain:
Ankle Sprain
Occurs when a ligament is stretched, torn, or
damaged. Ligaments connect bones together at the
joints. Sprains most commonly affect the ankle, knee,
wrist, and finger joints.
2 Strain:
Occurs when a tendon or muscle is stretched, torn, or
damaged. Tendons connect muscles to bones. Strains
are often caused by overworking a muscle
(e.g., by lifting an overly heavy object or by
repetitively performing the same action). They usually
involve the muscles in the neck, back, thigh, or the
back of the lower leg.
https://is.muni.cz/el/med/jaro2018/aVLMT021/um/w11_12/Injuries.pdf
3 Dislocation:
Occurs when the bones that meet at a joint move out
of their normal position. This type of injury is usually
caused by a violent force that tears the ligaments
allowing the bones to move out of place. © forum.splav.ru
4 Fracture: © https://monib-health.com/en/post/67-bone-fractures
A complete break, chip, or crack in a bone.

Fractures can be:
1) open (if the end of the broken bone breaks
through the skin)
2) or closed (the broken bone does not break
through the skin). Open fractures are also
called "compound fractures." © https://monib-health.com/en/post/67-bone-fractures
5 Muscle cramp
is a painful condition that can be caused by heavy
exercise or staying in the same position for too long.
You can usually stop the pain by stretching and
massaging the area with the cramp, resting, or
changing position.
79 | Page
Common Causes
Bone, muscle, and joint injuries can occur in many ways. The causes include the following:
• Falls
• Awkward or sudden movements
• Direct blows to the body
• Repetitive actions or forces, such as jogging
Prevention
The following tips help prevent bone, muscle, and joint injuries:
• Always wear seat belts and shoulder restraints when in a vehicle, and ensure that all passengers do the
same.
• Secure younger children in approved and properly installed child restraint systems (e.g., car seats and
booster seats).
• Wear all safety equipment that is required or recommended (e.g., helmets, goggles, and pads).
• Put non-slip adhesive strips or a mat in the bathtub and shower stall.
• Stretch before exercising.
• Avoid over-exertion and take breaks often. Children should learn their limits and rest when they are
too tired or frustrated to continue safely.
The signs and symptoms of bone, muscle, and joint injuries may include the following:
• Pain, deformity, swelling, or bruising
• Limited or no use of the injured body part
• A broken bone or bone fragments sticking out of the skin
• A sensation or sound of bones grating
• Possible muscle cramps
• The sound of a snap or a pop when the injury happened
10.3 Priority action approach to limb injuries
What to Do if there is sign of bone, muscle and joint injuries?

• The person may be anxious and in a lot of pain. In most cases, the best thing that you can do is
keep the person comfortable and prevent further injury until the person receives medical attention.
• To avoid damaging nerves, blood vessels, and tissues, do not perform traction or any other
manipulation.
• When caring for an open fracture, your first priority is to stop any bleeding.
• Provide care as you would for any other open wound.
Steps in managing open fracture injury:

1 SEEK MEDICAL ATTENTION IMMEDIATELY.
Call and transport the victim to the emergency room after immobilizing the
affected area. DO NOT attempt to transport the victim if you suspect a head,
back, or neck injury; if there's a visible deformity of bone; or if the victim cannot
be splinted or transported without causing more pain.
80 | Page
2 Suspect back or neck injury if the victim is unconscious or has a head injury, neck
pain, or tingling in arms or legs.
If neck or back injury is suspected, DO NOT move the victim unless necessary to
save the victim's life.
3 Immobilize and support affected bone in the position found.
DO NOT try to push the protruding bone back into the body or let victim move
or use affected area.
4 Control any bleeding through direct pressure, but DO NOT elevate affected area.
5 If bone is protruding, cover with clean cloth once bleeding is controlled.
6 Observe for shock. DO NOT give the victim anything to eat or drink.
7 Immobilize the injured area, and, if no open wound is present, apply an ice pack
wrapped in a clean cloth.
10.4 Principles of Limb Injury Assessment

1 Jewelry (rings/watches etc.) must be removed from the affected limb (cut jewelry if
required)
2 Commence R.I.C.E treatment
Rest: Patient to rest injured limb
Immobilize: Apply a firm and supportive crepe bandage to the injury
Cold compress: Apply cold pack for 20 minutes / 2nd hourly if the injury to a limb is ≤
48 hours for analgesia and reduction in swelling
Elevate limb where possible
● Apply sling where appropriate
● Apply splint where appropriate
3 Avoid H.A.R.M.
Heat (hot packs, heat rubs, etc.)
Alcohol
Running (or excessive movement of an injured limb)
Massage
4 Provide analgesia as required according to a pain scale
5 Provide crutches with appropriate instructions where indicated
Instruct the patient on R.I.C.E. and H.A.R.M. principles for proceeding 72 hours
10.5 Types of splints for upper and lower limbs

Splinting involves securing an injured bone or joint to keep it from moving, which reduces the risk of
further injury and helps reduce pain.
The objective of splinting is to prevent motion in broken bone ends. Splinting is an effective first aid
treatment for fractures.
Splinting not only decreases pain, but also eliminates further damage to muscles, nerves, and blood vessels
by preventing further movement of the broken bone ends.
81 | Page
There are four types of splint:

Type of Splint Illustration
1 Soft splints are soft, bulky objects
(e.g., a folded blanket, towel, pillow, or bandage).
2 Rigid splints are hard, fixed objects

(e.g., a board, a rolled newspaper, a tree branch).
3 Anatomical splints use another body

part for support (e.g., immobilize an injured leg by
securing it to the uninjured leg).
4 Slings use cloth looped around the neck

to support an upper extremity (e.g., the
arm or wrist).
Bandaging Techniques:
Is a process of covering wound or injured part
Phases of Triangular Bandage:

1. Open Phase
2. Cravat or Broad Cravat
3. Semi-Broad Cravat
4. Narrow Cravat
Function of Bandage:
1. Control Bleeding
2. The splint in place
3. Immobilize body parts
4. Support Body Parts
Uses of Triangular Bandage:

1. Open Phase
Head (topside) Face/Back of the head
Chest/back of the chest Hand/Foot Arm Sling
82 | Page
2. Semi Broad
Elbow Knee Straight Elbow/knee bent Shoulder/Hip
10.6 Principles of splinting
A splint is a supportive device that protects a broken bone or injury. A splint keeps the injured part
of your body still to help with pain and promote healing. Some splints are flexible and some are rigid.
The type of splint you need will depend on the type of injury you have and the part of your body that
is injured.
What Are Splints Used For?

Splints are used to treat different types of injuries. Sometimes a splint is used before a cast, and
sometimes a splint is used alone.
Injuries that are treated with splints include:
o Broken bones o Dislocated bones
o Sprains o Strains
o Carpal tunnel syndrome o Tendon ruptures
How To Take Care of a Splint

1) Place your arm or leg on a pillow above the level of your heart as often as you can over the next 3 days
to help reduce swelling.
2) Ice the limb for 10 to 20 minutes every 1 to 2 hours for the next 3 days or until the swelling goes down.
3) Don't get your splint wet.
4) Wiggle your fingers or toes if they aren't injured to help move the blood in your injured limb.
5) Talk to your doctor about how to maintain your muscle strength and tone while you're in a splint.
6) Don't stick anything under your splint to scratch.
7) If you're itching and can't remove your splint, try blowing cool air under your splint from a blow dryer
or fan.
8) Don't use oils or lotions near your splint.
9) If your splint is irritating your skin, pad the edges with moleskin or tape.
10) If you can't take off your splint, cover it with plastic sheeting while you take a shower.
11) If you can remove your splint to take a shower, dry your skin well before you put it back on.
Complications from splints can range from minor to severe, and may include:
1) Bone movement
If you have a fracture that's been set, your bones may move out of place.
2) Skin irritation
You may develop pressure sores or other types of skin redness or irritation.
3) Stiffness in your joint
Your joint may become stiff after being held still in a splint.
83 | Page
4) Burns
Fiberglass and plaster splints can cause heat burns.
5) Neurovascular injury
Some types of dislocations and fractures can cause damage to your nerves or arteries when they are
repaired.
6) Compartment syndrome
This is a rare but serious complication that occurs more often with casts than splints. It happens
when the pressure in your muscles builds up to a dangerous level.
10.7 Principles of immobilization

Types of immobilization:
a) Transport immobilization (temporary)
Transport immobilization is placed on the injured at the injured site and saves him during transport
time.
b) Therapeutic immobilization (definitive).
Therapeutic or definitive immobilization is placed on the injured person after surgical treatment of the
wound and placing the designated bone in a normal position and staying until definitive healing.
Basic principles of immobilization

1. The injured part before each immobilization should be placed in that position to prevent any
movement. Sterile gauze should be applied to the open wound first.
2. The stick with which the immobilization is done should be placed on a cotton pad. Pulled parts
of the body that were immobilized (trochanter, femoral condyle, malleolus, etc.) should be
protected with compresses of cotton wool or flannel.
3. Always immobilize the two nearest adjacent joints. The joint above and at the site of injury
and the injured joint itself.
4. The injured part of the body should be placed in a physiological position.
5. Fingers should be left out of the gas in order to control circulation, motility and sensitivity.
Stabilization and anatomical positioning of the lower limb
10.8 Different types of slings to immobilize upper limb injuries

Support and protection of the shoulder are important after injuries and surgery. Slings and immobilizers
hold and safeguard the shoulder during healing.
Type of slings Illustration

1 The arm slings
The arm sling is used in cases of fractured ribs, injuries of upper limbs
and in cases of fracture in the fore arm, wrist and hands after the
application of splints or plaster casts and bandaging.
Applying the Sling:

1) Put one end of the spread triangular bandage over the uninjured
shoulder with the point on the injured side.
2) Pass the end around the neck and bring it over the injured
shoulder. The other end will, now, be hanging down over the
chest.
3) Place the forearm horizontally across the chest and bring the
hanging end up. The forearm is now covered by the bandage.
4) Tie the two ends in such a way that the forearm is horizontally
84 | Page
or slightly tilted upwards and the knot is placed in the pit, above
the collar bone.
5) Tuck the part of sling which is loose at the elbow, behind the
elbow and bring the fold to the front and pin it up to the front
the bandage.
6) Place the free base of the bandage in such a way that its margin
is just at the base of the nail of the little finger. The nails of all
the finger should be exposed.
7) Inspect the nails to see, if there is any bluish color. A bluish
color shows that there is a dangerous tightening of splint or
plasters and therefore, free flow of blood is not possible.
If the casualty is not wearing a coat, place a soft pad under the
neck portion of the sling to prevent rubbing of the skin in that
place.
2 Collar and cuff sling
This sling is used to support the wrist only.
Applying the sling:
1) The elbow is bent and the forearm is placed across the chest in
such a way that the fingers touch the opposite shoulder. In this
position, the sling is applied
2) A clove hitch is passed round the wrist and the ends tied in the
hollow above the collar bone on the injured side.
3 Triangular sling
A triangular sling is used in treating a fracture of the collar bone.
It helps to keep the hand raised high up, giving relief from pain
due to the fracture.
Applying the sling:
1) Place the forearm across the chest with the fingers pointing
towards the opposite shoulder and the palm over the breast
bone.
2) Place an open bandage over the chest, with one end over the
hand and the point beyond the elbow.
3) Tuck the base of the bandage comfortably, under the forearm
and hand.
4) Fold the lower end, also round the elbow and take it up and
cross the back over the uninjured shoulder and tie it with the
other free hand into the hollow, above the collar bone.
5) Tuck the point between forearm and bandage.
6) Tuck the fold, so formed, backwards over the lower half of the
arm and fix it with a safety pin.
Clear Points:
✔ Always manage life-threatening conditions before attempting to manage any fractures, dislocations or
amputations
✔ All fractures and dislocations must be immobilized before the patient Is transported
85 | Page
Module 11. Medical Emergencies

(2.0 hrs.)
Objectives:
● Describe the different common medical emergencies by definition, types, and signs and
symptoms of:
o Stroke
o Diabetic emergencies
o Seizures
o Anaphylaxis
o Fainting
11.1 Common medical emergencies 101: definition, types, signs and symptoms
What is Medical Emergency? A serious and unexpected situation involving illness or injury and
requiring immediate action.
Common Medical Emergencies

1) Stroke
© inspiring - Freepik
a disruption of blood flow to a part of the brain which may cause permanent damage to the
brain tissue. This is also called a cerebrovascular accident (CVA).
Signs and Symptoms:

The possibility/probability of stroke can be recognized easily via the following warning signs:
● Sudden numbness or weakness in the face, arm or leg, especially on one
side of the body.
● Sudden confusion, trouble speaking or understanding.
● Sudden trouble seeing in one or both eyes.
● Sudden trouble walking, dizziness, loss of balance or coordination.
● Sudden, severe headache with no known cause.
86 | Page
2) Diabetic Emergencies
Diabetes is a chronic condition characterized by the body’s inability to process glucose

(sugar) in the bloodstream
Diabetic Emergency:
1) Hyperglycemia – too much sugar in the blood
2) Hypoglycemia – too little sugar in the blood
Signs and Symptoms:

Although hyperglycemia and hypoglycemia are different conditions, their major signals are
similar.
The following are signs and symptoms of a diabetic emergency:
• Changes in the level of responsiveness
• Changes in behavior, such as confusion, irritability, or aggression
• Rapid breathing
• Cool, sweaty skin
• Skin that is paler than normal
• Appearance of intoxication (e.g., slurred speech, difficulty walking)
• Feeling and looking ill
3) Seizures
© Freepik.com
is when the normal functions of the brain are disrupted by injury, disease, fever, poisoning or
infection, the electrical activity of the brain becomes irregular.
Common types of seizures include:

1) Tonic-Clonic or Convulsive Seizures: During the tonic phase, muscles will stiffen. Then,
during the clonic phase, the extremities will jerk and twitch rhythmically.
2) Absence Seizures: The person experiences a brief, sudden lapse in responsiveness. He or
she may momentarily become very quiet and have a blank stare, or appear to be daydreaming.
3) Focal or Partial Seizures: These seizures begin in one specific part of the brain. The signs
and symptoms of the seizure vary depending on which region of the brain is affected
Common Causes
Seizures can have many different causes. One common cause is epilepsy, a chronic seizure
disorder that can often be controlled with medication.
87 | Page
Other causes of seizures include the following:

• Fevers or infections • Drug or alcohol withdrawal
• Head injuries • Diabetic emergencies
• Heat stroke • Audio-visual stimulation (e.g., flashing
• Poisons (including drugs) lights)
The following are common signs and symptoms of seizures:

• Hallucinations
• Uncontrollable muscle movement
• Eyes rolling upward into the head
• Drool or foaming at the mouth
• Uncontrolled repetitive motions (partial seizures)
4) Anaphylaxis
© macrovector – freepik.com
An allergy is caused by the over-activity of the immune system against specific antigens.
Sign and Symptoms

● Difficulty in breathing, wheezing or shortness of breath
● Tight feeling in the chest and throat
● Swelling of the face, throat or tongue
● Weakness, dizziness, or confusion
● Rashes or hives
● Low blood pressure
● Shock
5) Fainting
Fainting is a partial or complete loss of consciousness resulting from a temporary reduction of

blood flow to the brain.
Signs and Symptoms

● Light-headedness or dizziness.
● Signs of shock, such as pale, cool or moist skin.
● Nausea and numbness or tingling in the fingers and toes.
● Sweating
● Vomiting
88 | Page
● Distortion or dimming of vision

● Head or abdominal pain
● The feeling that everything is going dark.
11.3 Priority action approach for each medical condition and their respective first aid
management
Top priorities for a first aider at any emergency situation

A. Stroke
Assessment Mnemonic (F.A.S.T)
F – Face
Does one side of the face droop or is it numb?
Ask the person to smile. Is the person's smile uneven?
A – Arm
Is one arm weak or numb?
Ask the person to raise both arms. Does one arm drift downward?
S – Speech
Is speech slurred?
T – Time
Time to call

• Recognize the “signals” and take action:
• Call the local emergency number immediately.
• Minutes count!
• Have the person stop what he or she is doing and have them rest comfortably by sitting or
lying down.
• Give the victim supportive care and reassurance.
• Be prepared to perform CPR if the victim becomes unresponsive.
B. Diabetic Emergencies
• First, check and determine if there are any life-threatening conditions.
• A person with diabetes who is experiencing a diabetic emergency must be instructed to test
his or her blood glucose level.
• A victim experiencing a diabetic emergency due to hypoglycemia must be encouraged to treat
himself/herself with food or drink that contains sugar.
• The same action is advised if the condition still is to be determined or still remains unknown
(Are they hypoglycaemic or hyperglycaemic?).
• If the diabetic person is conscious and is able to swallow and then states that they need sugar.
• If the person is unconscious or is about to lose consciousness, call the local emergency
number.
• Maintain an open airway and do not give anything by mouth.
89 | Page
C. Seizures
• Reassure the victim that you are going to help.
• Remove nearby objects that might cause injury.
• Protect the victim’s head by placing a thinly folded towel or piece of clothing beneath it.
• Do not hold or restrain the patient when a seizure is in progress.
• Do not place anything between the victim’s teeth or put anything in the victim’s mouth.
• Loosen clothing and fan the victim if the seizure was caused by a sudden rise in body
temperature.
• Ensure that the victim’s airway is open and check for breathing and other injuries once the
seizure is over.
• Stay and watch over the victim until the victim is fully conscious.
D. Anaphlaxis
● Call the local emergency number.
● Calm and reassure the person.
● Help the person to rest in the most comfortable position for breathing.
● Monitor the person’s breathing. Look for any changes in their condition.
● Assist the person with the use of a prescribed epinephrine auto-injector, if available.
● Give care for life-threatening emergencies.
● Document any changes in the person’s condition over time.
E. Fainting
• Position the victim on his or her back.
• Keep the victim in a lying position.
• Loosen any restrictive clothing, such as a tie or a buttoned-up collar.
• Check for any other life-threatening and non-life- threatening conditions.
• Do not give the victim anything to eat or drink.
Clear Points:
✔ In terms of stroke, recognition of early signs, notation of time of onset, and immediate notification of
EMS are of primary importance.
✔ Early recognition of low blood sugar is important because rapid treatment is needed.
✔ Forcing a bite stick or oral airway into the mouth of a convulsing person should not be done.
✔ After a seizure, make sure that the person’s airway is open and check for injuries.
✔ The use of epinephrine auto-injector for anaphylaxis requires proper training.
✔ There are many causes of fainting and determining them is important for appropriate management.
90 | Page
Module 12. Environmental Emergencies

(2.0 hrs.)
Objectives:
describe the health problems cause by:
▪ Cold
▪ Heat
12.1 Health-related problems caused by heat and their signs and symptoms, and first-aid
management
Heat-Related Illnesses:
1) Heat Stroke is a form of hyperthermia. Prolonged exposure to high temperatures can
contribute to failure of the body’s temperature control system.
What to look for? What to do?

● High body temperature (38 oC or ● Call or have someone call the local emergency
higher) number.
● Hot, red, dry, or damp skin ● Move the person into a cool place, a shaded area, or
● Fast, strong pulse an air- conditioned room.
● Headache ● Cool the patient immediately by immersing him/her
● Dizziness in water.
● Nausea ● If water immersion is not possible or is delayed, the
● Confusion following actions can be performed: Douse the
● Losing consciousness (passing patient with copious amounts of cold water, spray
out) the patient with water, fan the patient, or cover the
patient with ice towels or surround the patient with
ice bags.
● Respond to any life-threatening conditions that may
come about.
2) Heat Exhaustion -a condition of fatigue and weakness, usually with normal body temperature,
resulting from prolonged exposure to heat:

● Heavy sweating ● Move to a cool place
● Cold, pale, and clammy skin ● Loosen your clothes
● Fast, weak pulse ● Put cool, wet clothes on your body or take a
● Nausea or vomiting cool bath
● Muscle cramps ● Sip water
● Tiredness or weakness Get medical help right away if:
● Dizziness • You are throwing up
● Headache • Your symptoms get worse
91 | Page
● Fainting (passing out) • Your symptoms last longer than 1 hour
3) Sunburn -reddening, inflammation, and, in severe cases, blistering and peeling of the skin caused by
overexposure to the ultraviolet rays of the sun

● Painful, red, and warm skin ● Stay out of the sun until your sunburn heals
● Blisters on the skin ● Put cool cloths on sunburned areas or take a
cool bath
● Put moisturizing lotion on sunburned areas
● Do not break blisters
4) Heat Cramps - a condition that is marked by sudden development of cramps in skeletal muscles and
that results from prolonged work or exercise in high temperatures
● Heavy sweating during intense ● Stop physical activity and move to a cool place
exercise ● Drink water or a sports drink
● Muscle pain or spasms ● Wait for cramps to go away before you do any
more physical activity
● Get medical help right away if:
● Cramps last longer than 1 hour
● You’re on a low-sodium diet
● You have heart problems
5) Heat Rash -is a common rash on the skin that can show up when you’re hot or you sweat a lot. It can
make parts of your skin feel prickly or sting due to overheating
● Red clusters of small blisters that ● Stay in a cool, dry place
look like pimples on the skin ● Keep the rash dry
(usually on the neck, chest, groin, ● Use powder (like baby powder) to soothe the
or in elbow creases) rash
12.3 Health related problems caused by cold and their signs and symptoms, and first aid
management
Hypothermia - is the general cooling of the entire body. In hypothermia, body

temperature drops below 35º C.
Sign & Symptoms First Aid management
● Shivering (may be absent in later ● Gently move the person to a warm place.
stages of hypothermia) ● Care for any life-threatening conditions.
● Numbness ● Call the local emergency number.
● Glassy stare or a blank expression ● Remove any wet clothing and dry the person.
● Apathy or decreasing level of ● Warm the person by wrapping him/her in
consciousness blankets or by replacing the person’s clothes
● Weakness with dry clothing (passive re-warming)
● Impaired judgment.
92 | Page
FREEZING INJURIES:
1) Frostnip is a common injury caused by exposure to cold or by contact with
cold objects (especially those made of metal)
● skin of the affected area turns paler ● Gentle rewarming (e.g., holding the affected
than the area around it and it may feel tissue next to unaffected skin of the victim
pain or stinging, followed by or of another person
numbness ● Never rub the affected parts - ice crystals in
● Skin may also appear shiny and rosy, the tissue could cause damage if the skin is
as well as hardened. The top layer of rubbed
skin feels hard but the deeper tissue ● Do not use very hot objects such as hot
still feels normal water bottles to rewarm the area or person
2) Frostbite is the mildest form of a freezing cold injury. It occurs when ear
lobes, noses, cheeks, fingers, or toes are exposed to the cold and the top
layers of a skin freeze
● Skin may look waxy and feel colder ● Steps to warm the area immediately. (e.g.,
than the area around it put your hands under your armpits, or pull
● Blood vessels may be severely and your arms into the inside of your jacket for
permanently damaged, and blood more direct contact with the body)
circulation may stop in the affected ● Move the victim to a warm area
tissue ● Remove wet clothing, and gently loosen or
● In mild cases, the symptoms include remove constricting clothing or jewelry that
inflammation of the skin in patches may restrict circulation
accompanied by pain ● Warm the person by wrapping them in
● In severe cases, there could be tissue blankets or by them putting on dry clothing.
damage without pain, or there could Cover the head and neck. Warm the person
be burning or prickling sensations slowly. Avoid direct heat which can burn the
resulting in blisters skin.
● Loosely cover the affected area with a sterile
dressing. Place some gauze between fingers
and toes to absorb moisture and prevent
them from sticking together.
If the person is alert, give them
liquids to drink.
● Check for signs of hypothermia and seek
medical attention. If necessary quickly
transport the victim to an emergency care
facility.
● Treat the person gently and monitor
breathing
93 | Page
NON-FREEZING INJURIES:
1) Chilblain are a mild cold injury caused by prolonged and repeated exposure for
several hours to air temperatures that are cold.
Signs and Symptoms First Aid Management
Affected skin area there will be redness, • Same with Frostbite
swelling, tingling, blisters, and pain.
2) Immersion foot occurs in individuals whose feet have been wet, but not freezing
cold, for days or weeks. It can occur at temperatures up to 10°C
Symptoms include tingling and numbness; • Move the victim to a warm area
itching, pain, swelling of the legs, feet, or • Remove wet clothing, and gently loosen
hands; or blisters may develop or remove constricting clothing or jewelry
that may restrict circulation
• Loosely cover the affected area with a
sterile dressing
3) Trench foot. is "wet cold disease" resulting from prolonged exposure in a damp
or wet environment from above the freezing point to about 10°C
Symptoms include tingling and numbness; • Move the victim to a warm area
itching, pain, swelling of the legs, feet, or • Remove wet clothing, and gently loosen
hands; or blisters may develop or remove constricting clothing or jewelry
that may restrict circulation
• Loosely cover the affected area with a
sterile dressing
What first aid can do for hypothermia?

Supplies for first aid: Applying hypothermia wrap:
● a tarp or plastic sheet to act as a vapor
barrier 1. apply as much insulation as possible.
● an insulated ground pad Add extra clothing and wrap the
● a hooded sleeping bag (or equivalent) person in blankets or sleeping bags
● another plastic or foil sheet (2x3 2. cover the person's head and neck
meters) to act as a vapor barrier inside with a toque, heavy hat, or hood
the sleeping bag 3. place a vapor barrier (plastic or foil)
● source of heat (e.g., warm water in outside the insulation wrap if the
bottle or hydration bladder, chemical person is dry. If the person is still
heating pads) wet, place the vapor barrier inside
the insulation wrap. If you have two
vapor barriers, place one inside and
one outside the insulation wrap.
94 | Page
NOTE (from https://onlinefirstaid.com/hypothermia-frostbite-chilblains-help/):

If they are very cold, avoid moving them if at all possible, as the extreme cold can cause abnormal heart rhythms
and any swift movement could cause a cardiac arrest.
If you do need to move them, to get them somewhere warmer, do this extremely carefully and phone an ambulance
for additional advice and help.
Do not use hot water bottles or put the person in a bath to warm them. This concentrates on warming their
extremities and can conversely dilate their blood vessels making it harder to warm their core. Hot water bottles
can also cause burns.
Clear Points:
✔ Heat stroke is a life-threatening medical emergency
✔ The mainstay in the management of frostbite is to rewarm the affected part but this is only if there is no
risk of refreezing.
✔ Hypothermia may occur in warm temperatures due to activity, wet clothing, etc.
Notes:
95 | Page
Module 13. Special Situations

(2.0 hrs.)
Objectives:
o Describe the role of first aid providers in emergency preparedness and evacuation
o Discuss emergency childbirth
o Demonstrate first aid management in aquatic emergencies
13.1 Role of first aid providers in emergency preparedness and evacuation
Emergency Evacuation Drill

A physical or mental exercise aimed at perfecting facility or skill especially by regular
practice.
Three Types of Drill

1.) Scheduled Drill
2) Unannounced Drill
3) In-Services Drill
Emergency Childbirth:
Emergency Childbirth occurs when delivery is unexpectedly and you cannot get medical help in time.
Causes of Emergency Childbirth

● Rupture tubal pregnancy with concealed hemorrhage into the abdominal cavity.
● Unusual bleeding from the vagina at any stage.
● Convulsions associated with pregnancy.
● Miscalculations in the anticipated delivery.
● Premature onset of labor after an accident.
● Delay in transportation.
● Other factors which may abbreviate delivery.
Signs and Symptoms

● If labor contractions are approximately 2 minutes apart.
● If the woman is straining or pushing down with contractions.
● If the woman is crying out constantly.
● Warning from the woman that the baby is coming.
Aquatic Emergencies
Emergency Actions
an emergency can happen to anyone in, on or around water. Regardless of how good a person is at
swimming, anyone can get into trouble because of a sudden illness or injury.
96 | Page
Emergency Actions -Near Drowning

● Make sure that the scene is safe.
● Always check first to see whether a lifeguard or other trained professional is present before helping
someone who may be having trouble in the water.
● DO NOT swim out to a victim unless you have the proper training, skills and equipment.
● If the appropriate safety equipment is not available and there is a chance that you cannot safely
help a person in trouble, call for help immediately.
● If you must assist someone who is having trouble in the water, you must have the appropriate
equipment both for your own safety and the victim’s.
● Send someone else to call the local emergency number while you start the rescue.
Submerged Victim
If a victim is at or near the bottom of the pool in deep water, call for trained help
immediately.
Emergency Actions -Submerged Victim

● If the victim is in shallow water that is less than chest deep, carefully wade into the
water with some kind of flotation equipment.
● Reach down and grasp the victim. Pull the victim to the surface.
● Turn the victim face-up and bring him or her to safety. Remove the victim from
the water.
● Provide emergency care.
Clear Points:
✔ Labor and delivery of the baby will happen without extraneous involvement on the part of the
first aid provider.
✔ The main role of the first aid provider in emergency childbirth is to make sure the mother is as
comfortable as possible, and to help her with such needs as getting water, a blanket, a cushion,
etc.
✔ Special training in life-saving of drowning victims is needed for one to rescue a victim
97 | Page
Module 14. Lifting and Moving

(3.0 hrs.)
Objectives:
Upon completion of the module, participants will be able to:
● Define body mechanics and considerations when lifting and moving victims
● Discuss the guidelines and safety precautions that need to be followed when lifting
and carrying a patient
● Explain the rationale for properly lifting and moving victims.
● Discuss the general considerations of moving victims
● Demonstrate proper lifting and moving
14.1 Lifting and carrying guidelines

The use of proper lifting techniques in first aid is essential to avoid back and knee injuries.
Utilizing the general principles in lifting also helps maintain your balance and prevent falls
that could further cause injury to the victim and rescuer.
Lifting and Moving Guidelines:

● Only attempt to move persons who you are sure you can comfortably handle.
● Bend your body at the knees and hips.
● Lift with your legs, not with your back.
● Walk carefully using short steps.
● When possible, move forward rather than backward.
● Always look where you are going.
● Support the victim’s head, neck and back, if necessary.
● If supine, lift and carry the patient’s entire body as one unit.
● Avoid bending or twisting a victim with a possible head, neck or back injury.
● Use the log-roll technique when placing a blanket or a spine board under the patient in
preparation for a carry.
Criteria for Selection of Method of Transfer:

1) Nature and Severity of the Injury
2) Size of the victim
3) Physical capabilities of Rescuer
4) Availability of Equipment
5) Evacuation Route
6) Distance of the place where the victim will be transferred
14.2 Preparing the victim for routine transport
Some things to remember when lifting a patient.

1) Think through the move before initiating it. Know what you will do and how to avoid possible
difficulties.
98 | Page
2) Do not attempt to move or lift someone if you think you cannot physically handle and control the
weight.
3) Always keep your balance and start the move from a balanced position. The loss of balance can lead
to serious injuries to both the patient and the victim.
4) Make sure to establish a good, firm footing that you can maintain throughout the move or lift.
5) Carry the weight with your leg muscles, not your back. Bend to your knees while keeping the other
foot slightly in front. Make certain your back is straight as you lift your legs.
6) Be aware of your breathing. Make sure you do not hold your breath while lifting or carrying.
7) If possible, always keep your back straight when lifting or carrying the victim.
14.3 Emergency moves

Is the movement of a patient to a safe place before initial assessment and care is
provided, typically because there is some potential danger.
Type of Lifting Moves

1) One Man assist
1 Fireman’s lift
Condition: victim is conscious, with or without facture of
extremities
1) Hook your elbows under the victim's armpits. (A)
2) Raise the victim to their feet. (B)
3) Place your right leg between the victim's legs.
4) Grab the victim's right hand with your left. (C)
5) Squat down.
6) Wrap your right arm around the back of the victim's
right knee. (D)
7) Rise up and lift the victim's right thigh over your right
shoulder. (E)
8) Move the victim.
2 Pack strap carry
Condition: victim is conscious and without fracture of
extremities
How?
1) Position yourself with your back to the person with
knees bent, so that your shoulders fit into the persons
armpits.
2) Cross the person’s arms in front of you and move
forward while lifting the person on your back.
3 Cradle carry
Condition: victim is either conscious or unconscious
1) Start from position zero and place one of your feet
between casualty’s feet, with your other foot at the
side of the casualty.
2) Place casualty’s hand that is nearer to you over your
shoulder.
3) And hold on to casualty’s hand and provide support
for the casualty by pulling him / her close to you.
4) Your free hand will go around the casualty’s waist and
99 | Page
grab some clothing.

5) Let go casualty’s hand and move into position.
6) Bend both your knees to lift the casualty and make
sure to keep your back straight.
7) Attempt to lift the casualty in one swift movement
8) Ensure that your hand which is under the casualty’s
legs goes right around BOTH legs.
9) Your other hand should still be grabbing some
clothing at the waist.
4 Leg drag moves:
1)Firmly grasp the patients ankles and move backward
2) Pull the patient in a straight line and be careful not to
bump his/her head
5 One-person walking assist

1) Place victim's arm around your neck and hold their
wrist
2) Place your arm nearest to them around their waist and
walk with them to safety
Note: Although the one-person walk assist is one of the

easiest methods of helping to carry an injured person,
never attempt to move anyone you think may have neck
or spinal injuries without proper training.
6 Shoulder drag
1) Place victim in a seated position
2) Squat behind the victim and reach under their arms
grasping your own wrist
3) Stand, lean back, and walk backward dragging the
victim to safety
7 Clothing/Blanket drag
Clothing:
1)Gather the patients clothing behind his or her neck. While
moving the patient cradle the head with his/her clothes
and your hands
2) Pull the patient to safe place
Blanket Drag:
1) Keep the patient between you and the blanket
2) Gather half the blanket and place it beside the patient
3) Roll the patient toward you as a unit
4) Reach over the patient and place the blanket under the
patient
5) Roll the patient onto the blanket
6) Gather the blanket at the head and move the patient to
safe place
100 | Page
2) Two Man Assist

1 Two-person walking assist
2 Two-handed seat carry steps:

1) Position the casualty on his back.
2) Position the casualty on his back.
3) Bearers position themselves on opposite sides of the
casualty's hips and kneel.
4) Each bearer passes one arm under the casualty's back
and the other arm under the casualty's thigh.
5) Bearers grasp each other's wrists securely.
6) Both bearers rise in unison, lifting the casualty.
7) Bearers move forward, carrying the casualty.
8) Each bearer passes one arm under the casualty's back
and the other arm under the casualty's thigh.
9) Bearers grasp each other's wrists securely.
10) Both bearers rise in unison, lifting the casualty.
11) Bearers move forward, carrying the casualty.
3 Four-handed seat carry steps:

1) Both bearers position themselves behind the casualty.
2) Bearers face each other. Each bearer grasps his own
left wrist with his right hand, and grasps the other
bearer's right wrist with his left hand. This forms the
seat for the casualty.
3) Casualty stands on his own or another soldier helps
the casualty to a standing position.
4) Both bearers lower their bodies so that the seat is
about even with the casualty's knees.
5) Casualty sits on the bearers' forearms and places his
arms around the bearers' shoulders for balance and
support.
6) Bearers stand erect in unison, lifting the casualty.
7) Bearers move forward.
4 Two-Person Fore-and-aft lift
101 | Page
3) Three-Rescuer Moves
1 Three-Rescuer Carry
Condition: victim is either conscious or unconscious without
any fractures.
14.4 Non-emergency moves

Is the movement of a patient when both the scene and the patient are stable.
1) Used to move patients when no emergency to life
2) Performed by multiple rescuer
3) Not used if patient has suspected spinal injury, internal bleeding or uncontrolled
external bleeding
4) Generally used to prepare to patient for transport
5) Stabilize patient before moving
6) Minimize any chance of aggravating illness or injury
14.5 Securing victim to the carrying or lifting device
Best practices that can help mitigate the risks associated with patient lifts.
1) Receive training and understand how to operate the lift.
2) Match the sling to the specific lift and the weight of the patient. A sling must be
approved for use by the patient lift manufacturer. No sling is suitable for use with
all patient lifts.
3) Inspect the sling fabric and straps to make sure they are not frayed or stressed at
the seams or otherwise damaged. If there are signs of wear, do not use it.
4) Keep all clips, latches, and hanger bars securely fastened during operation.
5) Keep the base (legs) of the patient lift in the maximum open position and situate
the lift to provide stability.
6) Position the patient’s arms inside the sling straps.
7) Make sure that the patient is not restless or agitated.
8) Lock the wheels on any device that will receive the patient such as a wheelchair,
stretcher, bed, or chair.
9) Make sure that the weight limitations for the lift and sling are not exceeded.
10) Follow the instructions for washing and maintaining the sling.
11) Create and follow a maintenance safety inspection checklist to detect worn or
damaged parts that need immediate replacement.
Clear Points:
✔ Lifting and carrying victims are skills learned and perfected through training and practice
✔ There is never an excuse for a victim falling off a carrying or lifting device
102 | Page
Module 15. Knowledge and Skills Assessment

(4.0 hrs.)
Objectives:
● To assess the level of knowledge and skills learned by participants by paper examination and return
demonstration of necessary first aid procedures, techniques, and equipment as part of management
of injuries and medical emergencies prior to hospital care.
● To provide instructors and management with knowledge of the learning outcomes of the elements
of the course, in order to continuously improve the modules and provide trainees the best possible
conditions for learning and for completing their studies.
15.1 Knowledge and skills assessment of participants

1) Post Test is being conducted after all modules has been discussed and presented.
The questionnaires are being prepared by assigned trainer.
2) Course Evaluation are likewise conducted after the end of all module has been discussed and
presented
Clear Points:
✔ First aiders should know how to properly apply the different procedures, techniques, and medical
equipment for the care of injured or sick workers as it is valuable in saving lives prior to the arrival
of emergency services personnel.
103 | Page
References:
1. Philippine Red Cross First Aid Manual
2. Comprehensive Guide for First Aid & CPR. The Canadian Red Cross Societies:
redcross.ca/firstaid. 2017
3. American College of Emergency Physicians First Aid Manual. Washington, DC,

USA. 2002
4. The Everything First Aid Book. United States of America: F+W Publications, Inc.
2008
5. American Red Cross First Aid/CPR/AED Instructor’s Manual. United States of

America: StayWell Health & Safety Solutions. 2014
104 | Page

Microsoft Word - Synerquest Standard First Aid With BLS Training Manual - Final R4

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Microsoft Word - Synerquest Standard First Aid With BLS Training Manual - Final R4

Uploaded by

Copyright:

Available Formats

Synerquest Management Consultancy Services Inc.

DOLE Accreditation No. 235-220920-0002

FIRST AID TRAINING MANUAL

Name of Participant: ______________________

2.0 Module 5: 5.1 Definition of bleeding and shock Pages 41 - 47

2.0 Module 9: 9.1 Definition of burn Pages 73 - 77

2.0 Module 12: 12.1 Health-related problems caused by heat Pages 91 - 95

● Two-person walking assist

Module 1: Course Orientation

1.1 Course Requirements

Section 29: Prohibited Acts and its Corresponding Penalties

DO235 series of Rule 1 General Provision: Section 2: Definition of Terms

Rule 2 Certification of First Aider: Section 2: Types of First Aid

Rule 2 Certification of First Aider: Section 3: Validity of First Aid

Rule 1960 of OSH 1961.02: Definitions

1964.03: Refresher Training

1965:05: Duties of the First Aider

1.2 International Humanitarian Law (IHL)

Essential IHL Rules:

1.3 Other Legal Concerns

Module 2. Introduction to First Aid

2.1 Definition and Terms

2.2 Objectives of First Aid

Roles of First Aid

Need and Value of First Aid

2.3 Concept and Principles of First Aid Management

The Four Steps of First Aid:

2) Plan for intervention

3) Implement First Aid

4) Evaluate first aid actions

2.4 Dangerous situations that may affect individuals, groups of workers

Mode of Transmission Definition Example

Examples: Meningitis, Influenza

The infected person sneezes, sending

Examples: Measles, Tuberculosis

4. Vector-Borne Occurs when germs are An infected mosquito bites you,

2.5 Self-protection of first aider before, during and after an emergency

These may result from dealing with:

How to Prevent Diseases from Spreading During Conduct of First Aid?

Guidelines in proper handwashing:

2 Create a lather by rubbing your hands together with the

Rub your hands together vigorously for at least 30

3 Wash all parts of each hand. Be sure to scrub your palms

4 Dry your hands with a clean paper towel.

5 Turn the faucet off using the towel as a barrier between

Use the towel as a barrier for the door handle as well.

In a first aid emergency, remember to wash your hands:

Examples include barrier devices such as:

Goggles For eye protection.

Face Masks For airborne diseases protection

Rama, CeCILL, via Wikimedia Commons

Gloves Wearing gloves is an important way to protect yourself while

Wear gloves when:

Proper technique for removing gloves without contaminating skin

2 Pull the glove down and off your hand.

3 Insert your gloveless thumb under the glove of

4 Pull the glove downward off the hand, turning it

5 Discard gloves appropriately.

6 Wash your hands thoroughly with soap and

Cleaning and Disinfecting Surfaces and Equipment

Immediate action at the scene following exposure:

2 Thoroughly wash with water for 15 minutes