First Aid

Training, Teaching and Learning Materials (TTLM)
The Ethiopian TVET-System
Human Resource Operation Level III
Learning Guide
Unit of Competence: Apply First Aid
Module Title: Applying First Aid
LG Code: EIS HRO3120812

TTLM Code: EIS RRO3M12 0812
Date: September, 2018

TLM Development Manual Compiled by: Business Study Department
Gide line
The key guiding principles and purpose of first aid, is often given in themnemonic"3 Ps".
These three points govern all the actions undertaken by a firstaider.
•Prevent further injury
• Preserve life
•Promoter cove
North America
•LifesavingSociety:TheLSS,Canada'slifeguardingexpert,providesfirstaidtraining geared
toward both life guards and public
•RedCross:TheRChasbeenaleadingfirstaidtrainingorganizationthroughoutNorth
America
•St.JohnAmbulance:providesfirstaidcoursestothepublic,aswellasmoreadvanced training
•Canadian Ski Patrol: provides first aid training for their ski patrollers as well as the
public
•Heart and Stroke Foundation of Canada
•Corporate training programs: there are various corporations which provide their own
programs
•Many ambulance and fire services offer basic first aid courses to those who are
interested, contact your local Emergency Services Station for more information.
ETHIOPIA
•EthiopianRedCross:TheEthiopianRedCrossispartofthenationalorganization, and
provides personal and commercial first aid training
•TebettaAmbulance:istheothermainvoluntaryprovideroffirstaidtrainingin the
Ethiopia
Professional Levels beyond First Aid

Professional pre-hospital care is provided by local or regional Emergency Medical Services.
It is feasible for interested personstoundertakefurthertraining.Higherlevelsoftraining include:
•FirstResponder-Thefirstresponderlevelisoftenaimedatprofessionals,suchaspolice officers,
al though in some areas, lay persons can become first responders, designated to reach
emergencies before an ambulance
•EmergencyMedicalTechnician-Mostambulanceservicesworldwidequalifytheirstaff
asEMTsoranequivalent.Theadditionalskillstheyhavevarybetweenservices,however
mostcoverareassuchasmoreadvancedspinalcare,resuscitationandpatienthandling. In
manycountries,firstaiderscanattainthisleveloftrainingthroughvoluntary organizations or
through private training.
•Paramedic -Paramedics are often the most highly qualified of the ambulance personnel,
usuallywitharangeofintravenousdrugsanditemssuchasintubationkits.Itisunlikely that any
non-professional could achieve paramedic level. In many countries, the title is
Protected, meaning that a nun qualified person calling them selves a paramedic could
face prosecution.
Date: September, 2018

TLM Development Manual Compiled by: Business Study Department
LO 1 Assess the situation
First Aid/Consent
Importance
First aid is the provision of immediate care to a victim with an injury of illness, usually
effected by a lay person, and performed with in a limited skill range. First aid is normally
performed until the injury or illness is satisfactorily dealt with(such as in the case of small
cuts, minor bruises, and blisters)or until the next level of care, such as an ambulance or
doctor, arrives.
Best Practice
Firstaidersshouldalwayserrtowardstreatingavictim.Youractionsmaybecoveredby a Good
Samaritan Law, andwherethisdoesnotapply,mostcountriesgivemuchleewaytothoseactingin
good faith.
Most people and cultures involve a certain amount of respect for a person's personal space.
This varies withculturalandpersonalattitude,buttouchinganotherpersonisgenerally
consideredtoberude,offensiveorthreateningunlesstheirpermissionisgained.
As most first aid treatment does involve touching the victim, it is very important that the
first aider gains t heir permission, so as to avoid causing often se or di stress. In most
jurisdictions, it may be considered battery if a first aider touches the victim without
permission.
Gaining consent
The simplest way to gain consent is to ask the victim if they will allow you to treat them.
Talk to the victim, and build up a rapport with them. During this conversation, itis
important to identify the following key points:
•Who you are-Start with your name, and explain that you area trained first aider
•Why you are with t hem-They are likely to know they have an injury or illness
(although you can't al ways assume this in the case of patients in emotional shock,
children or those with learning difficulties),but explain to them that you would like to
help with their injury or illness
•What you are going to do-Some first aid procedures can be uncomfortable(such as
thesting which accompanies cleaning a wound with saline),so it is important to be
honest with the patient about what you are doing, and if necessary, why it is important.
Implied consent
There are some cases where you can assume that the victim gives their consent to you
treating them. The key, un equivocalre as on for assuming consent is if the patient:
•Is unconscious
•Has a very reduced level of consciousness
In these cases, you can per form any reasonable treatment within your level of training, and
your position is protected in most jurisdictions.
Judgment of consent
There are also so me cases where the first aider may have to exercise a level of judgment in
treatingavictimwhomayinitiallyrefuse.Caseslikethisincludewhenthevictimis:
•Intoxicated
•Irrational(i.e. delusional, in sane or confused due to the injuries)
•Aminor (parent or guardian must give consent if present and able; otherwise consent is
implied)
• Suffering from learning difficulties
In thesejudgmentcases,thefirstaidermustmakeadecision,evenifthevictimisrefusing
treatment.Ifthisoccursitisveryimportanttomakeanoteofthedecision,whyitwas
taken,andwhyitwasbelievedthatthepersonwasunfittorefusetreatment.Itisadvisable to
summon professional medical assistance if you believe the victim should be treated and
Is refusing, as medical professionals are experienced in dealing with people reluctant to
accept treatment.
Other influences of consent
Wishes of relatives
In somecases,relativesmayobjecttothetreatmentoftheirrelative.Thiscanbea problem
ati care a for the first aider, with several important factors to be considered.
In thefirstinstance,itmaynotbeanydecisionoftherelativetochoosetoconsenttofirst aid
treatment. In most countries, the only timeth is decision can be definitively taken is if the
person requiring treatment is a child.
In other cases, the presumption for the first aider must be to wards treating the victim,
especially if they are unconscious.
The other main consideration is if the person claiming to ref use consent on behalf of the
victim is in fact a relative, or if they have the victim's best interests at heart. In some cases,
the person may have caused h arm to the victim. If in this case, you fear for your safety, or
the person becomes aggressive, you should look after your own safety as a priority, and call
for assistance from the police.
Advance directive
Somevictimsmayhaveastatementrecorded,calledanadvanceddirectiveorlivingwill, that
they do not wish to be treated in the case of life threatening illness. This can be recorded
on a piece of paper, or on wearable items such as a bracelet.
Thelegalforceoftheseitemsmayvarywidelybetweencountries.However,in the majority of cases
they should follow a certain format, and be countersigned by a solicitor or notary public.
In anycase,assuggestedabove,thefirstaidershouldalwayspresumetowardstreatinga
victim,allowinghealthcareprofessionalstomakethefinaldecision.Almosteveryfirstaid treatment
will only extend life, rather than definitive ely save it, meaning you are usually not
breakingtheadvancedirective.ThisincludesactionssuchasCPR,whichsimplyextendthe time
until which definitive treatment will work-usually delivered by a healthcare professional, who
can make their own clinical decision on any advance directive.
First Aid/Protective Precautions
Awareness of Danger
Thefirstthingthatanyfirstaidershouldbeawareofwhenenteringasituationisthe potential for
danger to them selves. This is especially important in first aid, as situations
whicharedangerousarethemostlikelytoproducecasualtieswhorequirefirstaid.
Danger can consist of:
•Environmental danger-A danger in the surroundings, such as falling masonry, broken
glass, fast vehicles or chemicals.
•Humandanger-Dangerfrompeopleatthescene(includingthevictim)whichcanbe
intentional or accidental.
Barrier Devices
Keepingyourselfprotectedisthefirstpriorityofanyfirstaider.Thekeyskillfor this is
awareness of your surroundings and the changing situation.
Once you are a ware of the hazards, you can then take steps to minimize the risk to oneself.
Oneofthekeydangerstoafirstaiderisbodilyfluids,suchasblood,vomit,urineandfeces, which
pose ariskofcrosscontamination.Bodyfluidscancarryinfectionsanddiseases, including, but not
limited to, HIV and hepatitis.
Gloves
The main tool of the first aider to
avoid this risk is a pair of
impermeable gloves. Gloves protect
the key contact point with the victim
(i.e. the hands)and allow you to work
in increased safety. They protect not
only from bodily fluids, but from any
dermatological infections or
Parasites that the victim may have.
The first thing a first aider
should do when approaching, or
on their way to, a victim is to put
on their gloves.
Remember GO to the victim(Gloves
On) The yare generally of three
types:
• Nitrile-These gloves can come in
any color(of ten purple or blue)
And are completely impermeable
to bodily fluids. These are the
gloves most recommended for use
APurpleNitrileGlove
During victim contact. This
Material is also rated for dealing with chemical spills. If you ever need to deal with
chemicalburns,thesearetheglovestouse(youcanbrushoffdrychemicalswithgloved hands if
you usenitrile).Nitrilegloves,how ever, a real so the most expensive.
•Latex-Usually white gloves, often treated with powder to make the messier to get on or off.
These are not used as widely as they once were due to a prevalence of allergies to latex.
Latex all ergiesarera rely life-threatening; if you must use latex gloves, ask the victim if
they haveasevereallergytolatex.
•Vinyl-Vinyl glovesarefoundin somekits, although they should not be used for contact
withbodyfluids,thoughtheyarefarbetterthannothing. Theyshouldprimarilybeused for
touchingvictimswhodo nothaveexternalbodyfluidsduetotheglove'shighbreak
rate.Forthisreason,someorganizationsrecommendtheyarenotkeptin firstaid kits
duetotheriskofconfusion.
CPR Adjunct
The other key piece of protective
equipment that should be in every
first aid kit is an adjunct for helping
to perform safe mouth-to-mouth
resuscitation.
With mouth-to-mouth resuscitation,
there is a high probability of bodily
fluid contact, especially with re
gurgitateds to mach contents and
mouth borne infections. A suitable
mask will protect the rescuer from
infections the victim may carry(and
to some extent, protect the victim ACPRpocketmask,withcarryingcase
from the rescuer).Ital so makes the
performanceofCPRlessonerous(notwishingtoperformmouthtomouthisakeyreason citedf or
by standers not attempting CPR).
CPR a adjuncts come in a variety of forms, from small key rings with a nitrile plastic shield,
up to a fitted rescue 'pocket mask' such as the one pictured.
Other equipment
Larger first aid kits, or those in high risk are as could contain additional equipment such
as:
• Safety glasses-Preventsspurtingorpooledfluidwhichcouldsplayfromcomingin contact
with the eyes.
•Apron or gown-Disposable a pronsare common items in larger kits, and help protect
there scuers clothing from contamination.
• Filter breathing mask-Some large kits, especially in high risk are as such as chemical
plants,maycontainbreathingmaskswhichfilteroutharmfulchemicalsorpathogens. These
can be useful in normal first aid kits for dealing with victim who are suffering from
communicable respiratory infections such as tuberculosis .
Improvisation
Many first aid situations take place
without a first aid kit readily toh and
anditmaybethecasethata first aider
has to improvise materials and
equipment. As ageneral rule, some
help is better than no help, especially
in critical situations, so a key first aid
skill is the ability to adapt to the
situation, and use available materials
until more help arrives.
Some common improvisations
include:
•Gloves→plasticbags,dish gloves,
leatherworkgloves(washyour
handswithsoapandwater
especiallywellafterusingthese)
•Gauze→cleanclothing(butnot
paperproducts)
•Splints→straightsectionsof
wood,plastic, cardboardormetal
•Slings→thevictim'sshirt'sbottom
hempinnedtothecenteroftheir
chestwill immobilizeaforearm
nicely
Improvisedcarefor bl e e di ng
FirstAid/LegalLiability
GoodSamaritanLaws
BestPractice
Allrescuersshouldnotbeafraidofliabilityaffectingthemwhilstperforming theirduties.In manycases,itis
oftenbesttoprovidecareandtodo so tothebestofyourabilitywithoutworryoflegalimplications.
GoodSamaritanlawsin theUnitedStatesandCanadaarelawsthatreducetheliabilityto
thosewhochoosetoaidotherswhoareinjured orill, thoughitdoesnotprotectyou from
[1]
beingsued,itjustsignificantlyreducesyourliability.Ontario'sGoodSamaritanAct is
oneexampleofsuchlegislation.Theyareintendedtoreducebystanders'hesitationto assist,for
fearofbeingprosecutedfor unintentionalinjuryorwrongfuldeath.In other countries(as
wellastheCanadianprovinceofQuebec),GoodSamaritanlawsdescribea legalrequirementfor
citizenstoassistpeoplein distress,unlessdoingso wouldput themselves in
harm'sway.Citizensareoften requiredto,atminimum,callthelocal emergencynumber.
Checkwithyourgovernmentfor applicablelegislationin yourarea.Typically,theGood
Samaritanlegislationdoesnotcoveranindividualwhoexceedstheirtraininglevelorscope
ofpractice;norwouldyou beprotectedagainstgrossnegligence.
Generalguidelines
1.Unlessacaretakerrelationship(suchasaparent-childordoctor-patientrelationship)
existspriortotheillnessorinjury,orthe"GoodSamaritan"isresponsible for the existence
oftheillnessorinjury,no personisrequiredtogiveaid ofanysorttoavictim.
2.Any firstaidprovidedmustnotbein exchange for anyrewardorfinancialcompensation.
Asaresult,medicalprofessionalsaretypicallynotprotectedby GoodSamaritanlaws
whenperforming firstaid in connection withtheiremployment.
3.Ifaidbegins,therespondermustnotleavethesceneuntil:
•Itisnecessaryin ordertocallfor neededmedicalassistance.
•Somebodyofequalorhigherabilitycantakeover.
•Continuingtogiveaidisunsafe(thiscanbeassimpleasalackofadequateprotection
againstpotentialdiseases,suchasvinyl,latex,ornitrileglovestoprotectagainst
blood-bornepathogens)—arespondercanneverbeforcedtoputhimselforherselfin
dangertoaidanotherperson.
4.Theresponderisnotlegallyliablefor thedeath,disfigurement ordisabilityofthevictim
aslongastheresponderactedrationally,in goodfaith, andin accordancewiththeirlevel
oftraining.
Negligence
Negligencerequiresthreeelementstobeproven:
Dutyofcare
Youhadadutytocarefor thevictim
Often,ifyou beginfirstaid,thenadutyofcareexists
Standardofcarewasnot met
FirstAid/LegalLiability 15
Youdidn'tperformfirstaidproperly,orwentbeyondyourleveloftraining
Thestandardofcareiswhat areasonablepersonwithsimilartrainingwoulddo
insimilarcircumstances
Causation
Thedamagescausedwereyourfault
Causation requiresproofthatyouractoromissioncausedthedamages
Assistingwith Medications
Assistingwithmedications canbeavitalcomponentduringamedicalemergency. Assisting
withmedicationsincludeshelpingthevictimlocate themedication,taking thecapoffofa
bottleofpills,andreadingthelabeltoensurethatthevictimisgoingtotaketheright
medication.Assisting,however,doesnotimplyactuallyadministeringthemedication--this
isanadvancedlevelskill,which,ifdone,mayopenyou uptoliabilityfromgoingbeyond
yourleveloftraining.However,by assisting,you maybeabletohelpthevictimfindtheir
medicationsmorequickly,resultingin animprovedoutcome.
FirstAid/CriticalIncidentStress
&VictimDeath
WhatisCriticalIncidentStress?
Any emergencythatinvolvesasevereinjuryordeathisacritical incident. Thisincident
couldbeamplifiedshouldtheemergencyinvolveafamilymemberorfriend.Thestressthat
theseincidentscausemayoverwhelmafirstaiderandshutdowntheirabilitytocope.This iswhat
isknownascriticalincidentstress(CIS).Thisconditionmayhaveagreatimpacton
thefirstaidersufferingfromit,andifleftun-treated,thisstressmayleadtoamoreserious
conditionknownaspost-traumatic stresssyndrome.
SignsofCIS
•Maynotperform wellattheirjob.
•Mayseempre-occupied.
•Confusion
•Poorconcentration
•Denial
•Guilt
FirstAid/CriticalIncidentStress&VictimDeath 16
•Anger
•Change in appetite
•Unusualbehavior
Treatment
CIS requiresprofessionalhelp toavoidPost-TraumaticStressSyndrome.However,there
aresupplementstoprofessionaltreatmentthatwill helpsuchas:
•Relaxationtechniques
•Avoidingdrugsandalcohol
•Eatingabalanceddiet
•Gettingenoughrest
•Talkingwithpeers
FirstAid/Abuse&Neglect
Neverconfront anysuspectedabusers. Don'tdothis!
Neverjudgewhetherornotacomplaintistrueornot.Alwaystreatanycomplaintin aseriousmanner.
Abuse:iswhenaperson'swell-beingisdeliberatelyandintentionallythreatened.In
somejurisdictions,ifyou area healthcareproviderthenyou maybeobligatedtoreportabuseor
neglectthatyou observe. In particular,ifyou arein anypositionofauthority in relationtoa child,you
arelikelyrequiredby lawtoreportchildabuse.
Ifyou arenotunderaprofessionaldutyofcare,itisstronglyrecommendedthatyou report
anyinstancesofsuspectedabuse.Sticktoreportingthefacts,andlettheauthorities determinethe
truthofanysuspicion.Neverconfrontthepotentialabuser yourself- consideryourownsafety.
Themostvulnerablegroupsaretheyoungandelderly,butbeawareofthepotentialfor abusein
allpeople(suchasabuseofaspouseofeithergender).
Physicalabuse
abuseinvolvingcontactintendedtocausepain,injury,orotherphysicalsufferingor harm
Emotionalabuse
along-termsituationin whichonepersonuseshisorherpowerorinfluenceto
adverselyaffectthementalwell-beingofanother.Emotionalabusecanappearin
avarietyofforms,includingrejection,isolation,exploitation,andterror.
Sexualabus
isdefinedby theforcingofundesiredsexualactsby onepersontoanother.

Neglect
acategoryofmaltreatment,whenthereisafailuretoprovidefor theproperphysical
careneedsofa dependent.
Someformsofabusemaybemore obvioussuchasphysicalabusebuttherestmaybe concealed
dependingon thevictim.Ifyou noticeanywhipmarks,burns,bruiseswithan
unexplainedorigin,slap marks, bitemarks, etc.,you maysuspectabuse.
Iftheperson'slife isin immediatedangerthenyou shouldcontactemergencymedical services.
Asafirstaideryou arein agoodpositiontodo thiswithoutsuspicion-if questionedyou
shouldstatethatyou believethevictimrequiresfurthertreatment.If possible,you
shouldrequestpoliceassistance,although notifyou arein thepresenceof
thesuspectedabuser.Tohelpwiththis,someambulances operateasafewordsystem (usuallyfor
theircrews)whichcanbeenteredin tothecalltoflaganabusequery. These
arenotwidelypublished (to protecttheirusage),butifyou workfor arecognized
organization,theymaybewillingtosharethiswordwithyou oryourgroup.
Iftheperson'ssafetyisnotin immediatedanger,you shouldcontactyourlocalgovernment
departmentwhichdealswithaccusationsofabuse,whichmayvarywithinlocationsby the
demographics ofthepersonbeing abused(child,elder,learningdifficultiesetc.).Ifin
doubt,contactyourlocalpolice,whoshouldbeabletosignpostyou tothemostappropriate service.
LO-2 Apply first aid procedures

FirstAid/EmergencyFirstAid & InitialActionSteps
PrimaryAssessment
Protectingyourself
Firstaidersareneverrequiredtoplacethemselvesin asituationwhichmightputthemin
danger.Remember,you cannothelpavictimifyou becomeavictimyourself.
Whenafirstaideriscalled upontodealwithavictim,theymustalwaysrememberto
safeguardthemselvesin thefirstinstanceandthenassessthesituation.Onlyafterthese
stepsarecompletedcantreatmentofthevictimbegin.
Whencalledtoascene,rememberthatpersonalsafetyisparamount.Beforeyou entera
scene,puton personalprotectiveequipment,especiallyimpermeable gloves.
Asyou approachascene,you needtobeawareofthedangerswhichmightbeposedtoyou
asafirstaider,ortothevictim.Thesecanincludeobviouslydangerousfactorssuchas
traffic,gasorchemicalleaks, live electricalitems,buildingson fireorfallingobjects.While
manycoursesmayfocuson obviousdangerssuchasthese,itisimportantnottoneglect
everydayfactorswhichcouldbeadanger.(ex.Gas fires,wherein gettingclosetoavictim
couldresultin burns fromtheheatedvapor.)
Therearealsohumanfactors,suchasbystandersin theway,victimnotbeingco-operative,
oranaggressorin thevicinitywhomayhaveinflictedtheinjurieson thevictim.Ifthese
factorsarepresent,havethepolicecalledtocontrolthesituation.
AlwaysrememberthebigDfor Danger.
Onceyou have madeyourfirstassessmentfor danger,you shouldcontinuetobeawareof
changestothesituationorenvironmentthroughoutyourtimewiththevictim.
Iftherearedangerswhichyou cannotmitigateby youractions(suchasfallingmasonry),
thenSTAYCLEARandcalltheemergency services. Remembertoneverputyourselfin
harmsway.
Whathashappened?
Asyou a p p r o a c h ,trytogainasmuchinformationaspossibleabouttheincident. Try
andbuildamentalpicturetotryandhelpyou treatthevictim.
AssesstheScene-Whereareyou?Whatstores,clubs,publicbuildings,etc.arenearby?
Hasanythingherecausedtheinjury?Whattimeofdayisit?
GetsomeHistory-Iftherearewitnesses,askthemwhat'shappened"Didyou seewhat
happenedhere?"andgaininformationabouthowlongagoithappened"Howlonghave
theybeenlikethis?",butstartyourassessmentandtreatmentofthevictimwhileyou are
doingthis.
Be suretoListen-Whileworkingon avictimyou mayoverhearinformationfromwitnesses in
thecrowd.Anexampleofthiswouldbeanold manfallingon thesidewalk,asyou
approachthesceneyou canhearsomeonesay"Hewasjustwalkingandhislegswentout
fromunderhim."Butyou maynotseethepersonsayingthis.Everythingshouldbetaken
intoaccountshouldno witnesseswanttobecomeinvolvedoryou cannotask questions.
Note whatissaid andcontinue treatment.
Responsiveness
Onceyou areconfidentthatthereisminimaldangertoyourselfin thesituation,thenext
keyfactoristoassesshowresponsive thevictimis.
Thiscanbestartedwithaninitialresponsiveness checkasyou approachthevictim.Thisis
bestasaformofgreetingandquestion,suchas:
"Hello,areyou alright?"
Thebestresponsetothiswouldbeavictimlookingatyou andreplying.Thismeansthatthe
victimisAlert.
Victimscanbequicklyassessedandprioritizedon theAVPUscale,andthiswill helpmake
decisionsabouttheircare.Thescalestandsfor Alert,Voice,Pain,andUnresponsive.
Ifthevictimlooksatyou spontaneously,cancommunicate(evenifitdoesn'tmakesense)
andseemstohavecontroloftheirbody,they canbetermedAlert. Key
indicatorson thevictimaretheir:
• Eyes-Are theyopen spontaneously?Are theylookingaround?Dotheyappeartobeable
toseeyou?
• Responsetovoice-Dotheyreply?Dotheyseemtounderstand?Cantheyobey
commands,suchas"Openyoureyes!"?
Ifthevictimisnotalert,butyou cangetthemtoopentheireyes,orobeyacommandby
talkingtothem,thenyou cansaythattheyareresponsivetoVoice
Ifavictimdoes notrespondtoyourinitialgreetingandquestion, you willneedtotryand
getaresponsetopainfromthem.
Theword"pain"isabitmisleading-itreferstoanyphysicalstimulus.Thefirststimulusto useisa
tap/shakeoftheshoulder.Thereareother,morepainfulstimulithatcanbe
employedshouldthisbeunsuccessful,butall ofthesehavetheirdownsides,especiallyif overused.
Ofthese,thethreemostcommonlyusedonesare:
• Sternalrub-Thisinvolvesdiggingyourknucklein tothesternum,orbreastbone,ofthe
victim(betweenthenipples).
•Nailbedsqueeze-Usingtheflatedgeofapenorsimilarobject,squeezein tothe bottom
ofthevictim'sfingernail(hard).
•Earlobesqueeze-usingthumb andforefinger,squeezethevictim'searhard.
Ifanyoftheseprovokeareaction(groaning,amovement,flutteringoftheeyes),thenthey
areresponsivetopain.Itisimportanttonotethatdifferenttrainershavedifferentopinions on
these,so askyourtrainerbeforeemployinganyoftheseon afirstaidcourse.
Any oftheresponsesA,VorP,mean thatthevictimhassomelevelofconsciousness. If
theyarenotalert,you shouldalwayssummonprofessionalhelp-callanambulance.
IftheyareonlyresponsivetoVoiceorPain,thenconsiderusingtheRecoverypositionto
helpsafeguardthem.
Ifthey do notrespondtovoiceorpain,thenthey areUnresponsiveandyou musturgently
performfurthercheckson theirkeylife criticalsystems ofbreathingandcirculation (ABCs).
Summary
Tothisstagethefirstaider,on approachingavictimshouldhave:
•GO -Puttheirgloveson
•D-Checkedfor danger
•R-Checkedfor responsiveness
•S-Lookedatthescenefor cluesaboutwhathashappened
•H -Gainedhistoryon theincident
•AVPU-Assessedtoseehowresponsive thevictimis.
Thiscanberememberedasthemnemonic"Go DRSHAVPU"(Go DoctorShavpu)
NextSteps
Ifthevictimisunconscious,thefirstaidershouldimmediatelycallanambulance-you
willneedprofessionalhelpregardlessofwhethertheyarebreathingornot.Waitingwould
endangerthevictim'slife unnecessarily. Ifyou arealone withanadultvictim,call
immediately,evenifyou mustleavethevictim.Placingthemintotherecoverypositionwill
safeguardtheirairwayagainstaspirationiftheyshouldvomitwhileyou arecallingthe ambulance.
Ifyou arealonewithachild,continue yourprimaryassessment;you will call once you
haveconfirmedthatthevictimisbreathing,orafter2minutesofCPR.Ifyou arenotalone, have
yourbystandercalltheambulanceimmediatelywhileyou continueyour
assessmentandcareofthevictim.
Ifthereismorethanonepersoninjuredtherescuermustdeterminetheorderin
whichvictimsneedcare.In general,rescuersshouldfocuson thevictimwiththeinjurythatisthe
greatestthreattolife.Simpletriagetechniquesshouldbeappliedtomakesurethatthose
in greatestneedofcarereceive supportquickly.
Treatment
Thelaststepistoactuallyprovidecaretothelimitsofthefirstaider'straining--butnever beyond. In
somejurisdictions,you openyourselftoliabilityifyou attempttreatmentbeyond
yourleveloftraining.
Treatmentshouldalwaysbeguided by the3Ps:
Preservelife
Preventfurtherinjury
Promoterecovery
Treatmentobviouslydependson thespecificsituation,butall victimsmustreceivesome
leveloftreatmentfor shock.Thelevelofinjurydeterminestheleveloftreatmentfor
shockwhichisrequired,butall victimswill requireit.
Theprinciplesfirst,donoharmandlifeoverlimbareessentialpartsofthepracticeof
firstaid.Donothingthatcausesunnecessarypainorfurtherinjuryunlesstodo
otherwisewouldresultin death.
FirstAid/AforAirway
AforAirway
Theairwayofthehuman bodyisone
ofthemoreimportantpartstobe
checkedwhenprovidingfirstaid.
Theairwayistheentrancepointof
oxygenandtheexitpointofcarbon
dioxidefor thebody.Shouldthis
becomeblocked,respiratoryarrest
orcardiacarrest(ifleftun-treated)
mayoccur.
Anunconsciousperson'sairwaymay Thehead-tiltchin-liftopenstheairwaysafelyandeffectively.
beblockedwhentheirtonguerelaxes
andfallsacrosstheairway.Thetechniqueusedtoopentheairwayiscalledthe"head-tilt chin-
lift"technique.Thevictimmustbesupine(lyingon theirback).Withonehandon
theforeheadandtheotherhandunderthechin,thevictim'sheadistiltedback,andtheirchin
lifted.Thevictim'sjawlineshouldbeperpendiculartotheground.
Consciousvictimscannormallymaintainanopenairway;ifthevictimistalking orhasno
respiratorydistress,theirairwayisadequate.
Youmayalsochecktheairwayfor visible,removableobstructionsin themouth,whichyou
couldremovewithafinger. Youcanremoveanyitemin themouthwhichisremovable,but
shouldnotwastetime trying toremovelodgeditemssuchas dentures.
FirstAid/A forAirway 22
Ifaconsciousvictim'sairwayisobstructedby aforeignobject,theobjectmustberemoved.
Abdominalthrustsarethestandardmethodfor consciousvictims.RefertoObstructed
Airwayforunconsciousprocedures.
FirstAid/BforBreathing
Principles
Humanrespirationworksby inspiringfreshair,absorbingpart(butnotall) oftheoxygenin
it,whichisthendistributedtothecellsby theblood,andexchangingcarbondioxide.Lungs
haveacapacityofadozenofliters.
Whenavictimstopsbreathing,spontaneousrespirationcanrestartifstimulatedby
insufflations.However,avictimin respiratoryarrestislikelytofall intocardio-respiratory arrest.
Checkingtherespiration
RegionalNote
In someareas,trainersadvocate callingemergency medicalservices assoonasyou findapatientunconscious ("call
first"),buttheILCORprotocolistocallEMSonceyou determinewhetherthevictimisbreathingornot
("callfast").Thisensuresthatthecorrectpriorityisgiventoyourcall.Youshouldsummonanambulancein eithercaseifthe
patientisunconscious.
Afteropeningthevictim'sairway,checkfor breathing.Todo this,placeyourcheekin front

ofthevictim'smouth(about 3-5 cm away)whilelookingattheirchest.Youcanalsogently
placeahandon thecentreofthevictim'schestifyou wish.Youmaybeabletodetectthe
followingsignsifthevictimisbreathing:
1.Feel theairflowon yourcheek
2.Heartheairflow
3.Seethechestriseandfall
4.Smellthebreathofthevictim
5.Feelthechestriseandfall underyourhand(ifyou haveplaced iton thechest) Searchfor
thesesignsfor 10 seconds.Ifthereisno breathing,you muststartCPR.
CallingFor Help
Ifabystanderhasnotalreadysummonedassistance,thenyou mustatthispointcallthe
EmergencyMedicalServiceorAmbulanceService.
Ifanambulanceisrequired,getsomeoneelsetocallifpossible.Ifyou'realone, makethe
callyourself:
•Europe: 112
•USA &Canada: 911
FirstAid/B forBreathing 23
•Australia:000
•UnitedKingdom:999
Youwill needtogivetheemergency services:
•Yourexactlocation
• Natureoftheincident
•Services you require
•Atelephonenumberyou canbecontactedbackon (forinstance,iftheyhavedifficulty
findingyou)
In somecases,they will runthroughalistofquestionswithyou,in
ordertohelpprioritiseyourcallproperly.Theymayalsoaskthenameanddetailsofthecaller.Someti
mes,the victimmustbeleftalone whilethefirstaiderleaves toseekhelp for them.Ifthevictimis
unconscioustheyshouldbeleftin therecoverypositionso thattheydo notchoketodeath
iftheyshouldvomitwhileleftunattended.Whilstordinarily,ifaspinalinjuryissuspected,
itisadvisednottomovethecasualty,ifthey areunconsciousandneedleavingalone,itis
essentialthattherecoverypositionisemployedanyway.There arealternativemethodsfor
saferpositioningavailabletothosewithmore advancedtraining.
(SeeSuspectedSpinalInjuryformoreinformation.)
RescueBreaths
In Europe,give5rescuebreathsfor victimsof: RegionalNote
• Drowning
• Trauma
• Drugoverdose
For othervictims,begin withcompressions insteadofrescuebreaths.
Rescuebreathsmustbeprovidedtovictimsin astate ofrespiratoryarrest;do notprovide

themtoaweaklybreathingvictim.Ifyou cannotdetectthebreathofthevictim,beginCPR.
Ifyou haveaCPRmask,useittoprotectyourselfandthevictimfromexchangeofbody
fluids.Cheap,keyring-sizedCPRmasksareavailablein mostpharmacies.Makesureyou
readtheinstructionsfor howtouseanyequipmentyou buy.However,chancesarethatyou will
findyourselfunequipped;do yourbestwithwhatyou have,butdo notplaceyourselfin dangerby
directcontactwithbodyfluids,suchasblood-proceedtocompressionsonly.
Startby givingtworescuebreaths.
•Maintainanopen airwayusing thehead-tilt chin-lift
•Plugthenose ofthevictimwithyourfreehand
•Putyourmouthon themouthofthevictimin anairtightmanner,andblowintothe
mouthofthevictim,do notblowforcefullyasthismaycausetheairtoenterthestomach, whichwill
causevomiting,thebestwaytoavoidthisistoblowairintothemouthjust
enoughtomakethechestrise
•Lettheairexit,andgiveanotherbreath
ContinuewithCPRcompressions.
FirstAid/B forBreathing 24
FirstAid/CforCompressions
Principles
Thepurposeofdoingchest
compressions istoeffectively
squeezetheheartinsidethevictim's
chest,causingbloodtoflow.This
allowsthenormalgaseousexchange
betweenthelungs,bloodstreamand
tissuestooccur. Compressionsare
nowusuallyperformedbeforeany
rescuebreathsduetothefactthat
whennormalbreathingand
circulationstop,thereisstillagood
amount ofresidualoxygenleftin the
bloodstream(asithasno wayto
exchange outofthebody).
Technique
Theaimisalwaystocompressin
thecenterofthechest,regardlessof Schematic ofthehumanheart.
thevictim.Thismeansthat
compressionsareperformedon thesternumorbreastboneofthevictim,approximatelyin
linewiththenipples on malesandchildren.
•Foradults(>8)-placethepalm
ofonehandin thecentreofthe
chest,approximatelybetweenthe
nippleline(on adultmales-for
females,you mayneedto
approximatetheidealpositionof
thislineduetovariationsin breast
sizeandshape).Bringyourother
handtoreston topofthefirst
hand,andinterlockyourfingers.
Bringyourshouldersdirectly
aboveyourhands,keepingyour
armsstraight.Youshouldthen
Compressionsfor infantCPRaredonewithtwofingers.
pushdownfirmly,depressingthe
chesttoaboutonethird(1/3)ofits
depth.
•Forchildren(1-8)-placethepalmofonehandin thecentreofthechest,approximately
betweenthenippleline.Bringyourshoulderdirectlyaboveyourhand,withyourarm
FirstAid/Cfor Compressions25
straight,andperformcompressionstoonethird(1/3)thedepthofthechestwithonearm only.
•Forinfants(<1yr)-Useyourforefinger andmiddlefinger only.Placeyourforefinger on the
centreofthechild'schestbetweenthenipples,withyourmiddlefinger immediatelybelowiton
thechest,andpushdownwardsusingthestrengthin yourarm,
compressingthechestaboutonethird(1/3)ofit'sdepth.
Give30compressionsinarow,andthentwo(2)rescuebreaths.
Thenrestartyournext cycleof compressions
Makingcompressionseffective
YouMUSTallowtheribstocomeallthewaybackoutaftereachcompression, followedby
abriefpause.Thisallowstheheart'schamberstorefill.Spacingcompressions
tooclosetogetherwill leadtothembeing ineffective.
Youareaimingfor arateof100compressionsperminute,whichincludesthetimeto
giverescuebreaths.In practice,you shouldgetjustover2 cyclesof30compressionsin
alongwithbreathsperminute.
Almosteveryonecompressesthechesttoofast-Experience showsthatevenwell
trainedfirstaiderstendtocompressthehearttoofast.Therateyou areaimingfor isonlya
littleoverone persecond. Thebestequippedfirstaid kits shouldincludeaMetronomewith
anaudible 'beep'tomatchyourspeedto.Manypublicaccessdefibrillators have these includedin
theirpack.Ifone isnotavailable,countthenumberofcompressionswiththe
word'and'betweenthem.Whenyou pressdownon thechest,saythenumber,whenthe
chestrisessay'and'.thisway,you will besaying'one-and-two-and-three...'
Keepyourarmsstraight-Alot oftelevisionandfilmsshowactors'performingCPR'
bendingtheirelbows.Thisisnotcorrect-you shouldalwayskeepyourarmsstraight,with
yourelbowslockedanddirectlyaboveyourhands.
Itoftenhelpstocountoutloud-Youneedtotryandget30compressionspercycle,and ithelps
tocount thisoutloudorunderyourbreath.Performingcompressionsistiring,and you
maynotbeabletocountoutloudfor theduration,butensureyou keepcounting.
If youlosecount,don'tstop,justestimate-Itisimportanttocarryon onceyou've started,so
ifyou losecount,don'tpanic, andsimplyestimatewhen30 compressions is over,anddo
2breaths,thenstartovercountingagain.
Youarelikelytobreakribs-Whenperformedcorrectly,especiallyon olderpeople,
compressionsaremorelikelythannottobreakribsorthesternumitself.Youshouldcarry on
regardlessofthisoccurring.Itisa signthatyou areperforminggood,strong
compressions.Oftentimesthecracking soundyou willhearisjustthecartilageoftheribs
andsternumbreaking,andnotthebonesthemselves.Ifbystandersareconcernedabout
injurytothevictim,you maywanttoremind themofthelifeoverlimbprinciple andassure
themthatitisnormaltohearthesesounds.
FirstAid/Cfor Compressions26
LO-3 Communicate details of the incident

WhentoStop
YoushouldcontinuegivingthevictimCPRuntil:
• Thevictimstartsbreathingspontaneously-Thisdoesnotincludegasping,called
agonalbreathing.Victimsarealsolikelytomakesighingnoisesorgroansasyou
performchestcompressions-thisshouldnotbemistaken for breathing.
• Thevictimvomits-ThisisanACTIVEmechanism,meaningthevictimmovesand
activelyvomits.Nottobeconfusedwithregurgitation,wherestomachcontentsmake
theirwaypassivelyin tothemouth.Ifthevictimvomits,rollthemtotheirside,clearthe
airwayoncethey'redonevomitingandreassessABCs.
•Qualifiedhelparrivesandtakesover.Thiscouldbearesponderwithadefibrillator,
theambulance serviceoradoctor. HoweverDONOT STOPuntiltoldtodo so. Theyare
likelytorequiretimetosetuptheirequipment,andyou shouldcontinuewithCPRuntil
instructedtostop.Theyarelikelytoworkaroundyou,placingdefibrillationpadson
thevictim'schestwhileyou continuecompressions.Continueworkingasnormal,andlet
themworkaroundyou.
•Youareunabletocontinue-CPRisphysicallyverydemanding,andcontinued periods
canbeexhausting.Try tochangeplacesfrequentlywithanothertrainedrescuertolessen
thechanceofexhaustion.
•Youputyourselfindangerby continuing-Hazardsmaychange,andifyourlife is
endangeredby anewhazard,you shouldstopCPR.Ifpossible,removethevictimfrom
thehazardoussituationaswell.
ObstructedAirway
Ifyourventilations don'tgo in, tryadjustingtheangleofthehead(usuallytiltingitfurther
back)andre-attemptventilation.Ifthebreathstilldoesn'tgo in, thendo your
compressions,andchecktheairwayfor obviousforeignobstructionsafterthe compressions.
Ifyou seeaforeignobstruction,removeitwithyourfingers ifpossible.Do
notdiscontinueCPRbecausetheairwayisoccluded.
FirstAid/DforDeadlyBleeding
DeadlyBleeding
BestPractice
Ifthegauzeordressingbecomessaturated,DONOT takethegauzeaway.Applymore gauzeasneccessary,only
professionalmedicalpersonnelshouldremovedressings.
CPRwithoutenoughbloodisuseless,so acheckfor deadlybleedingshouldbeincludedin

yourprimarysurveywheneverpossible.
FirstAid/D forDeadlyBleeding 27
If yourvictimisbreathing,thenyou shouldcontinueyourprimaryassessmentwitha check

for deadlybleeding.
If yourvictimisn'tbreathing,thenyou'llbedoingCPR;a bystanderorsecondtrained
firstaidermaybeabletoperform thischeck whileyou continueresuscitation.
Assessment
Withglovedhandscheck thevictim'sentirebodyfor bleeding,startingwiththehead.Run
yourhandsasfarunderthevictimaspossibleon eithersides,checkingyourglovesoften.If
yourhandsarebloody,thenyou'vefoundbleeding.Makesureyou checktheheadcarefully; ifyou
findaninjuryon theheadorneck,itmayindicate aspinalinjury,in whichcase,the
spineshouldbeimmobilized.Aswell,hairconcealsbloodsurprisinglywell-makesureyou
checkthescalp thoroughly.
Caution
Rememberthatabout80%oflife-threatening bleedingcanbecontrolledadequatelyusingdirectpressurealone
andtheapplicationofatourniquetmayresultin thelossofthelimb.
Treatment
Thekeyelementin treatingseverebleedingistheapplicationoffirm,directpressuretothe
wound,using sterilegauzeorotherdressing.Thewoundmaybeelevatedabovetheheart
toreducebloodpressure,though thisshouldnotbedoneifthereisariskofdisturbing
fractures,orifitcausesmuchpaintothevictim.
Considerusing pressurepoints tocontrol majorbleeding: pressdownon anarterythatis
betweentheheartandthewoundtokeepbloodfromflowingtothewound.Tourniquets
mayalsobeusefulin controllingmassivebleeding; thisisnotastandardprocedureand
shouldonlybeusedasalastresortwhenthevictimwilldiewithoutit.
FirstAid/CPRsummary
ThisisasummaryofCPRprocedure,intendedasareminderforthosewithpreviousCPRtraining.
Itisnotintendedasa"teachyourselfCPR" guide.ItdoesnotincludethefulldetailsofCPR,which are
includedinthewikibookproper.
Area-checkthearea
Lookfor hazards.Iftherearehazards,removethem,orremovethevictimfromthemif
possible.Ifnot,thenretreattoasafedistance,callEMSandwaitfor theirarrival. Make
surethatyou donotputyourselfin danger.Ifyou areneararoad,ensurethatyou are
clearlyvisibletotraffic.
Putonglovesifyou havethem.
Awake-checklevel ofconsciousness
Doesthevictim respond tovoiceor
painfulstimulus?
If YES,checkthevictimfor other conditionsandcallfor help ifnecessary.
If NO, callEMS.
Ambulance-callEMS
CallEMSusingabystanderifpossible.Ifyou're alone,andthevictimisanadult(>8years
old),thenleavethevictimtocallEMSyourself.Ifyou're alonebutthevictimisachild(1-8
yearsold)oraninfant(<1yearold),thencontinue;you'llcallEMSlater.
ObtainanAED andAED-trainedresponderifpossible.
Airway-opentheairway
Quicklyremoveanylooseandobviousobstructionsfromthemouth.Thentilttheheadback andlift
thechinso thevictim'sjawlineisperpendiculartotheground
Breathing-checkforbreathing
Is thevictimbreathing?
If YES,placethevictimin the
Recoverypositionandcallfor help
unlessaspinalinjuryissuspectedin
whichitiscrucialtonotmovethe
patient.Ifthepatientvomits,
however,itismore importanttoroll
themovertotheirsidewhileholding
theback,neck,andheadstable.
If NO,give2rescuebreathsand
begin compressions.
Compressions-begin
compressions
CPRTable
Correctpositionfor CPR.Thearmsarefullyextendedandthe
thrustsaregivenfromthehips.
Age Group Adult Child Infant
Single-Person 30-2 30-2 30-2
Two-Person 30-2 15-2 15-2
Technique Bothhands Onehand Two fingers

•Adulttechnique:tophandpullsbottomhand'sfingersbackwhilealsoapplyingpressure.
•RescueBreathsaregivenatarateof2-3 secondsbetweenbreaths.
•Compressionsareatarateof100perminute.
•Hand/fingerplacementisjustbelowthenipplelineandabovethebottomofthebreast bone,
justslightlytothe(victim's)left.
•After5cycles(approx.2minutes)callEMSifyou haven'tdoneso already (in thecaseof children
orinfants).
After5cycles(approx.2minutes)callEMSifyou haven'tdoneso already (in thecaseof children
orinfants).Ifa bystanderisavailable,getthemtocallimmediatelyuponarrival.
ContinueCPRuntilemergencyhelptakesover,thevictimmovesortakesabreath,oryou
aretooexhaustedtocontinue.IfanAED andAED-trainedresponderarriveson thescene,it will
havepriorityon theoverCPR.ContinueCPRuntiltheAED operatorasksyou tostop.
Secondaryassessment
FirstAid/Head-to-toe
Thepurposeofasecondary assessment(composedofahead-to-toe,historyandvitals)isto
continuallymonitorthevictim’sconditionandfindanynon-life-threateningconditions
requiringtreatment.Asecondary assessmentshouldbedonefor anyvictimrequiring ambulance
intervention, orifthereisaconcernthatthe victim’sconditionmaydeteriorate. In somecases,you
maywanttodo anshortenedsecondary survey-useyourbest
judgment.
Whoisthisfor?
TheHead-to-toeassessmentisatechniqueusedby layrescuers,firstresponders,and ambulance
personneltoidentifyaninjuryorillnessordeterminetheextentofaninjuryor illness.
Itisusedon victimswhomeetthefollowingcriteria:
•Victimoftraumainjuries (except minorinjuries affectingperipheralareas)
•Unconsciousvictims
•Victimswithveryreducedlevelofconsciousness
Ifavictimisfoundunconscious,andno historyisavailable,you shouldinitiallyassumethat
theunconsciousnessiscausedby trauma,andwherepossibleimmobilizethespine,until
youcanestablishanalternativecause.
Thesecondaryassessmentshouldbeperformedon allthevictimmeeting the criteria
(especiallytrauma)regardlessofgenderofrescuerorvictim.However,you shouldbe
sensitivetogenderissueshere(aswithall aspectsoffirstaid),andifperformingafull body check on
amemberoftheoppositesex,itisadvisabletoensurethereisanobserver present,for
yourownprotection.In anemergencyhowever,victimcarealwaystakes priority.
PriorityofABCs
Thehead-to-toeshouldbecompleted aftertheprimary survey,so youarealreadyconfident in
thevictimhavingapatentairway,breathingsatisfactorilyandwithacirculation.
YoushouldalwaysmakeABCs aprioritywhendealing withvictimswhoareappropriatefor
asecondarysurvey.In thecaseoftraumavictims,wherethevictimisconsciousandableto
talk,keeptalkingtothemthroughout.Thisnotonlyactstoreassurethemandinformthem what
you're doing,butwill assureyou thattheyhaveapatentairwayandarebreathing.
Forunconsciousvictims,ifyou areon yourown,checktheABCs betweencheckingevery
bodyarea,orifyou arewithanothercompetentperson,makesuretheycheck ABCs
continuouslywhilstyou performthesurvey.
Rememberthatifthepersonisunconsciousandifyou knoworsuspectittobea trauma
injury(evidenceofblood,fall etc.)thanyou MUSTtreatitasapotentialspinalinjuryin the
firstinstance.Thisisbecausein trauma,anyblowtotheheadsufficienttocause
unconsciousnessisalsosufficienttocausespinalinjury.In thiscaseimmobilizationof the
head,neckandspine takespriorityoverthesecondarysurvey. Ifyou haveasecondrescuer
orbystander,thenhavethemimmobilizewhileyou performthehead-to-toe.
Whatisbeinglookedfor?
Thehead-to-toeisadetailedexaminationwhereyou shouldlookfor abnormality.Thiscan
taketheformofasymmetry;deformity;bruising; pointtenderness(wincingorguarding-
don'tnecessarilyexpectthemtotellyou);minorbleeding; andmedicalertbracelets,
anklets,ornecklaces.
Itisimportanttorememberthatsomepeople naturallyhave unusualbodyconformation,so
besensitiveaboutthis,butdon'tbeafraid toask theconsciousvictimorrelativesifthisis normalfor
them.Itisalwaysworthlookingfor symmetry-ifitisthesamebothsides,the chancesare,it'snormal.
Thesixareas
Dividethebodyinto6areas;afteryou examineeacharea,you reassessABCs.
• Headandneck-Theheadandneckareimportantareastoassess,andyou shouldtake time
andcaretolookfor anypotentialproblems.
• Head-Usingbothhands(withgloveson),gentlyrunyourhandsacrosstheskull, pressingin
gentlybutfirmly,startingattheforeheadandworkingaroundtotheback ofthehead.Feelfor
indentations,lookfor bloodorfluidandwatchthevictimfor signs
ofdiscomfort.Ifitisatraumainjury,checkbothearsfor signsofbloodorfluid.
• Neck-Theneckisanimportantarea.Startatthesidesoftheneckandgentlypress
in.Watchcarefullyfor signsofpain.Movearounduntilyou reachthespine,movingas
fardowntheneckaspossiblewithoutmovingthem,iftheyareon theirback.Ifthere
ispain,tendernessordeformityhere,thenyou shouldstopthesurveyandimmediately
immobilizetheneck,placingonehandon eachsideofthehead,withthethumb
aroundtheear.Thisismostcomfortabledonefrom'above'withthevictimlyingsupine on
theirback,althoughyou shouldsupportthevictimin thepositionyou findthem.If
thereisroom,you canalsolie on yourfront,withyourelbowson thefloortosupport
thehead.Iftherearetwopeople,oneshouldimmobilizethehead,whilstthe other
continuesthesurvey.Ifthereisonlyoneperson,immobilizetheheadandwaitfor
help.
• Shoulders,chestandback-Thisareaofthebodycontainsmanyofthevitalorgans,so
itisimportanttolookfor damagewhichcouldindicateinternalinjury
• Shoulders-Youshouldtryandexposetheshouldersifpossible,lookingfor
obviousdeformity,especiallyaroundthecollarbones.Youcantrypressingalongthelineofthe
collarbone,watchingfor deformityorpain.Youshouldthenplaceahandon
eachshoulder,andgentlypushdown,lookingtoensurethatone sidedoesnotmovemore
thantheother.
• Chest-Thechestisideallydoneexposed,althoughyou shouldbeawareofthe
sensitivityoffemalestothis,andifyou areabletokeepbreastscovered,itisadvisable todo so.
Youshouldbelookingfor sectionsofthechestwhichareoutoflinewiththe
restofit,orwhicharemovingdifferentlytotherestofthechestwhilstbreathing.You
shouldalsolookfor obviouswounds.Youcanthengentlypresson thechest.Thebest
waytodo thisistoimaginethechestdividedin tofourquartersrunningneckto stomach.
Youshouldplaceonehand(balledasafistworkswellhere,toavoidconcerns overexcess
touching)andpressdownone on theleftandoneon therightin each
quarter(avoidingbreastsifapplicable).Youarewatchingfor onesidemoving
differentlytotheother,orfor painbeingcaused.
• Back-Ifthevictimislyingon theirside,orfront,you canalsofeeldowntheirspine.If they
arelyingon theirback,thenskipthispartofthecheck,andleaveitfor the ambulancecrew.
•Armsandhands-Runbothyourhandsdownone armatatime, lookingfor deformityor pain.
•Abdomen-Theabdomencontains theremainderofthebody'scriticalorgans,so
itshouldbechecked for potentialdamage.Theabdomenismostlydoneby gentlepushing,
usingtheflatofyourhands.Again,usesymmetry,andpushbothsidessimultaneously.
Checkiftheabdomenfeelshard(called'boarded')orfor paincausedby thepalpation.
• Pelvis-Thepelvis(hips)isalargebone,withpotentialfor afairamountofdamage.The
maindiagnostictesttotoplaceahandon eachhipandfirstgentlycompress thehips
togetherwithboth hands(thereshouldbeverylittle movement,andlittle tono pain).If
thepatienthasmoderatetoseverepainwhenthehipsarecompressed,orthehipsmove
whencompressed, donotrockthehipsfromside toside. Ifthereisno painor
movement,gentlypushdownon thehipsin a"rocking"motiontoseeifthereisany movement.
• Legsandfeet-Aswitharms,usebothhandsatthesametime,runningthemdownthe
insideandoutside ofeachleg simultaneously(avoidingthegroin areaon theinside).You
shouldalsolookfor anyshorteningorrotationofonelegcompared totheother.Finally, you
taketakeeachfoot,check thatithasnormalmotility(can bemovednormally)and hasno
obviousinjuries
FirstAid/History
History
Takingavictimhistoryisacrucialstep.Ifanambulanceneedstobecalledandthevictim
isconscious,taking ahistorybefore thevictim'sconditionworsens will assistthe responding
paramedicsandtheemergency departmenttobetterhelpthevictimandbe
awareofmedicalconditionsthevictimissufferingfrom.
Somecommonthingstoaskfor inahistoryarecanberememberedusingtheacronym
CHAMPION:
BestPractice
Ifpossible,writethesedownfor qui c k referencelater!
Chiefcomplaint
Whatistheproblem?
Historyofchiefcomplaint
Howdidthishappen?
Hasiteverhappenedbefore?
Allergies
Are youallergic toanything?
Medicalhistoryandmedications
Doyou haveanymedicalconditions(angina,highBP, diabetes…)? Doyou
takeanymedications?
Doyourmedicationshelpwhenthishappens?
Whatisthenameofyournormaldoctor?
Painassessment
Painlocation
Qualityofpain (sharp/dull, squeezing…)
Radiatingpain?
Severityofpain (on ascalefrom1 to10)
Timing(Constant?Forhowlong?)
Also trytofindoutwhatmakesitfeelbetter/worse
ImportantInformation
Name,dateofbirth,age,sex,address…
Onset
Whendidthesymptomsstart?
Whatwereyou doing?
NextofKin
Is thereanyoneyou wouldlikecontacted?
FirstAid/Vitals
Purpose
Aspartofyourongoingassessmentofthevictim,andin preparationfor thearrivalofany
assistanceyou havecalled,itisimportanttokeepacheckon avictim'svitalsigns.
Ifpossible,theserecordingsshouldbewrittendownso thatyou cankeeparecordofany
changes,andhandthisovertotheambulancecrewwhotakethevictimfromyou.Ideally,it
shouldberecordedon areport,whichshouldformpartofeveryfirstaidkit.Alternatively, you
canwriteiton anypieceofpaper,oroftenfirstaidersendupwritingon their
Assessments
Thevitalsignsyou arelookingtorecordrelatetothebody'sessentialfunctions.Itstarts
withtheairwayandbreathingalready coveredin basiclife support(althoughyou should lookfor
additionaldetail)andcontinueswithcirculation,lookoftheskin,levelof
consciousnessandpupilreaction.
Breathing
Whilemaintaininganopenairway,ensurethatthevictimisbreathingandcounttherateof
breathing.Theeasiestwaytodo thisistocountthenumberofbreathstakenin agiven
time period(15or30 secondsarecommontime frames), andthenmultiplyuptomakea
minute.Thelongerthetimeperiod,themoreaccurateitis, howeveryou arelikelytowant
thepatientnottoconverse(asthisdisruptstheirbreathingpattern),anditisimportantnot
totellthemthatyou arewatchingtheirbreathing,asthisislikelytomakethemalterthe pattern,so
ashorterperiodislikelytobemoreusefulandreduceworryfor thepatient.
In additiontorate,you shouldnoteifthebreathingisheavyorshallow,andimportantlyifit
isregular.Ifitisirregular,seeifthereisapatterntoit(suchasbreathingslowly,getting
faster,thensuddenlysloweragain).Notewhetherbreathingisnoisy(wheezingcouldbea sign
ofasthma,rattling(alsocalled'striddor')asignoffluidin thethroatorlungs)
Circulation
Whereas in theprimarysurvey,we didnotcheckthecirculationofthevictimtoseeifthe
heartwasbeating(weassumedthatifthevictimwasbreathing,theirheartwasworking
andiftheywerenotbreathing,theirheartwasalsostopped),itisimportantin monitoring
thebreathingvictimtochecktheircirculation.
Thetwomainchecksare:
•CapillaryRefill-Thecapillariesarethesmallesttypeofbloodvessel,andare responsible for
gettingbloodin toall thebodytissues.Ifthebloodpressureisnothigh enough, thennotenough
bloodwill begettingtothecapillaries.Itisespeciallyimportant
tocheckcapillaryrefillifthevictimhassuffered aninjurytooneoftheirlimbs.You
checkcapillaryrefillby
takingthevictim'shand,liftingitabovetheleveloftheheart,andsqueezingreasonablyhardfor
aboutasecondon thenailbed.Thisshouldmovethebloodout,andthenailbedwill
appearwhite.Ifthepinkcolourreturnsquickly(andin ahealthyvictim,itmayreturnbeforeyou
evenmoveyourfingersawaytolook!),thenthisisnormal.Victimswhohavepoorperipheralcircula
tion,especiallytheelderlyand
hypothermiavictims,maynotdemonstrateadequatecapillaryrefillduetogenerallackof
bloodflow,makingthistestlessvaluableon thesepatients.Anormaltimefor thepink
colourtoreturnislessthantwoseconds. Ifittakeslongerthantwosecondsfor colourto
return,thenthiscouldindicateaproblemandyou shouldseekmedicaladvice.
•Pulsecheck-Asafirstaider,you canalsocheckavictim'sheartrateby feelingfor their
pulse.Therearethreemainplacesyou mightwishtocheckfor apulse:
•Radialpulse-Thisisthebestpulse tolookfor afirstaider,on aconsciousvictim,as itisnon-
invasiveandrelativelyeasytofind.Itislocated on thewrist(overtheradial
bone).Tofindit,place thevictim'shandpalmup andtakethefirsttwofingers ofyour
hand(NEVERuseyourthumb,asitcontainsapulseofitsown)andon thethumbside
ofthevictim'swristyou will feelaroundedpieceofbone,movein fromhere1-2cmin
toashallowdipattheside ofthebone,andpressyourfingersin (gently),whereyou
shouldbeabletofeelapulse. Takingapulse herecanbeaskillthattakespractice,so
itisworthfrequentlytestingthisskill.Shouldtherebeno pulsein avictimwhoispale
andunwell,you areadvisedtoseekmedicalassistanceurgently.
•CarotidPulse-Thisisin themainarterywhichsuppliestheheadandbrain,andis located in
theneck. Thisisbestusedon unconsciousvictims,orthosevictimwhere you
areunabletofindaradialpulse.Tolocateit,placeyourtwofingersin tothe
indentationtothesideofthewindpipe,in linewiththeAdam'sApple(on men),or
approximatelythelocationaAdam'sApplewouldbeon women.
• PedalPulse-Thepedalpulsecanbefoundin severallocationson thefoot,andthisis
usedwhenyou suspectabrokenleg,in ordertoascertainifthereisbloodflowingto thefoot.
Whenmeasuringapulse you shouldmeasurethepulserate.Thisisbestachievedby
countingthenumberofbeatsin 15seconds,andthenmultiplyingtheresultby four.You
shouldalsocheckifthepulseisregularorirregular.
Skin
Related tocirculation, isthecolouroftheskin.Changesin circulationwill causetheskinto
bedifferent colours,andyou shouldnoteifthevictimisflushed,pale,ashen,orbluetinged.
Itshouldalsobenotedifthevictim'sskinisclammy,sweatyorverydry,andthis
informationshouldbepassedon totheambulancecrew.
LevelofConsciousness
YoucancontinuetousetheacronymAVPUtoassessifthevictim'slevelofconsciousness
changeswhileyou arewiththem.Torecap,thelevelsare:
Alert
Voiceinducesresponse
Paininducesresponse
Unresponsivetostimuli
Pupils
Valuableinformationcanbegainedfromlookingavictim'spupils.Forthispurpose,first
aidkitsshouldhaveapenlight orsmalltorchin them.
Ideally,thepupilsoftheeyeshouldbeequalandreactivetolight,usuallywrittendownas
PEARL.
Pupils
Equal
And
Reactiveto
Light
Tocheckthis,ask thevictimtolookstraightatyou withbotheyes.Looktoseeifboth
pupilsarethesamesizeandshape(besensitivetothosewhomaybeblindin oneeye,or
mayevenhave aglasseye,althoughtheywill usuallytellyou).
Tocheck ifthey arereactive,takethepenlight, andask thevictimtolookatyournose. Briefly(5
seconds orso) shieldtheireyewithyourhandfromthelight sourcewherethey
are(sunlight,roomlightingetc.),andthenturnon thepenlight, positioningitofftotheside
oftheirhead.Movethepenlightin overtheireyequickly,andwatchtoseethesizechange.
Anormalreactionwouldbethepupilgettingsmallerquicklyasthelightisshone in toit. Repeat on
theothereye.
Ifbothpupilsarethesame,andbothreact,notethison yourformasPEARL,orelsenote
downwhatyou did,ordidnotsee.
Circulatoryemergencies
FirstAid/ExternalBleeding
Introduction
Bleedingisacommonreasonfor
theapplication
offirstaidmeasuresand
canbeinternalorexternal.The
principle difference iswhetherthe
bloodleavesthebody-external
bleedingcanbeseen,whereasin
internalbleeding,no bloodcanbe
seen.
Therearemanycausesofexternal
bleeding,whichfall intosix main
categories,whichare:
•Abrasion-Also calledagraze,
thisiscausedby Roadrashcanvaryin severity;hereitcausedsomeminor
transverseactionofaforeignobjectag bleedingandfluiddischarge.
ainsttheskin,andusuallydoesnotpen
etratebelowtheepidermis
•Excoriation-In commonwithAbrasion,thisiscausedby mechanicaldestructionofthe
skin,althoughitusuallyhasanunderlyingmedicalcause
•Laceration-Irregularwoundcausedby bluntimpact tosofttissueoverlyinghardtissue
ortearingsuchasin childbirth
• Incision-Aclean 'surgical'wound,causedby asharpobject,suchasaknife
•PunctureWound-Caused by anobjectpenetratedtheskinandunderlyinglayers,such
asanail,needleorknife
•Contusion-Also knownasabruise,thisisablunttraumadamagingtissueunderthe
surfaceoftheskin
•Gunshotwounds-Caused by aprojectile weapon,thismayincludetwoexternalwounds
(entry andexit)andacontiguouswoundbetweenthetwo
FirstAid/ExternalBleeding 38
Recognition
Recognizingexternalbleedingis
usuallyeasy, asthepresenceof
bloodshouldalertyou toit.Itshould
howeverberememberedthatblood
maybeunderneathorbehinda
victim.Itmaybedifficulttofindthe
sourceofbleeding,especiallywith
largewoundsor(evenquitesmall)
woundswithlargeamountsof bleeding.
Ifthereismorethan5cups
ofbleeding,thenthesituationis
life-threatening.
Minorbleedingfroman abrasion.
Treatment
Bleedingfromathumbwound.
Caution
Putgloveson beforecomingintocontactwithanybloodorbodyfluids.
Aswithall firstaidsituations,thepriorityistoprotectyourself,so puton protectivegloves before

approaching thevictim.
Allexternalbleedingistreatedusingthreekeytechniques,whichallowthebody'snatural
repairprocesstostart.Thesecanberememberedusingtheacronymmnemonic'RED':
Rest
Elevation
Directpressure
Rest
In allcases,thelessmovementthewoundundergoes,theeasierthehealingprocesswill be,so
restisadvised.
Elevation
Directpressureisusuallyenoughto
stopmostminorbleeds,butfor
largerbleeds,itmaybenecessaryto
elevatethewoundabovethelevelof
theheart(whilstmaintainingdirect
pressurethewholetime).This
decreasesthebloodflowtothe
affectedarea,slowingthebloodflow,
andassistingclotting.
Elevationonlyworkson
theperipheriesofthebody(limbsand
head)andisnotappropriatefor body
wounds.Youshouldaskthevictimto
holdtheirwoundashighaspossible.
Youshouldassistthemtodo thisif
necessary,andusefurnitureor
surroundingitemstohelpsupport
Arescuerapplyingdirectpressureandelevatingthearmfor an themin thisposition.Ifitisthelegs
armlaceration. affected, you shouldlie themon their
back(supine),andraisetheirlegs.
DirectPressure
Themostimportantofthesethreeisdirectpressure.Thisissimplyplacingpressureon thewoundin
ordertostemtheflowofblood.This isbestdoneusingadressing,suchasa
sterilegauzepad(althoughin anemergency,anymaterialissuitable).
Ifthebloodstartstocomethroughthedressingyou areusing,addadditionaldressingsto
thetop,toamaximumofthree.Ifyou reachthreedressings,you shouldremoveall butthe one in
contactwiththewounditself(asthismaycauseittoreopen)andcontinuetoadd padson top.
Repeat thisagainwhenyou reachthreedressings.Thereasonfor notsimply
addingmoredressingsisthatitbecomeshardertoapplythedirectpressurewhichis
clearlyneededifthismuchbloodisproduced.
Whereanarticulateareaofthebodyiswounded(suchasthearmsorhands),itis
importanttoconsiderthepositionofthearea in keepingpressureon thewound.For
example,ifahandiscut'across'fromthethumbtohalfwayacrossthepalm,thewouldcan
beclosedwithdirectpressureby simplyclasping thevictim'shandshut.However,ifthe
handwaswoundedfrombetweenthetwomiddlefingersdowntothewrist,closingthe
handwouldhave theeffect ofopeningthewound,andso thevictimshouldhave theirhand
keptflat.
In mostcases,duringtheinitialtreatmentofthebleed,you will applypressureby handin
ordertostemtheflowofblood.In somecases,adressingmayhelpyou do thisasitcan
keeppressureconsistentlyon thewound.Ifyou stoptheflowby hand,you shouldthen consider
dressingthewoundproperly,asbelow.
Dressing
Oncethebleedingisslowedorstopped,orin somecases,toassisttheslowingoftheblood flowyou
shouldconsider dressingthewoundproperly.
Todressawound,useasterilelow-adherentpad,whichwill notstick tothewound,butwill
absorbthebloodcomingfromit.Oncethisisin place,wrapacrepeorconformingbandage
aroundfirmly.Itshouldbetightenoughtoapplysomedirectpressure,butshouldnotbeso
tightastocutbloodflowoffbelowthebandage.Asimplecheckfor thebandagebeingtoo tighton
alimbwoundisacapillaryrefillcheck;todo this,holdthehandorfoot(dependent on
whatlimbisinjured) abovetheleveloftheheartandfirmlypinchthenail.Ifittakes
morethan2seconds for thepinkcolortoreturnunderthenail,thenthebandageislikely
tobetootight.
Ifthebloodstartstocomethroughthedressingyou haveapplied,addanotheron top,toa
maximumofthree.Iftheseareall saturated,removethetoptwo,leavingtheclosest
dressingtothewoundin place.Thisensuresthatanybloodclotsthathaveformedarenot
disturbed;otherwise,thewoundwouldbeopenedanew.
Specialcases
Nosebleeds(epistaxis)
Ifapersonhasnosebleed,havethempinchthesoftpartofthenosefirmlybetweenthumb
andforefinger,justbelowtheendofthebone.Ifnecessary,do thisyourself,butitis
preferabletohavethemdo itthemselvesiftheyareabletodo iteffectively.
Thevictimshouldleantheirheadslightlyforwardandbreathethroughtheirmouth.You
canalsoleavetheheadin aneutralposition,butnevertilttheheadback.Tiltingthe
headforwardensuresthatbloodisn'tingested(asitcancausevomiting)orinhaled
(chokinghazard).
Ifyou areunsuccessfulatstoppingthebleedingafter10minutesofdirectpressure,you
shouldassessthebloodflow.Ifthebloodflowisminor,you couldconsiderusing anice pack on
thebridgeofthenose tohelpstemtheflow.
Ifthenosecontinuestobleedwithafastflow,you shouldseekmedicalassistance,probably
fromtheambulance.
EmbeddedObjects
If thereissomethingembeddedinthewound,donotremoveit.Instead,apply
pressurearoundtheobject using sterilegauzeasdescribedabove.Rolledbandagesare
perfectfor this.Be carefulnottodisturbtheobject,asmovingitmayexacerbatethe
bleeding.Thisdoesn'tapplytosuperficialsplintersandsuch.
Stab,punctureor gunshotwoundstothebody
Thesewoundsarelife threatening,andafterassessingtheABCs ofthevictim,you should
immediatelysummonanambulance.Asalways,you shouldcheckthatyou arenotin danger
whenapproachingthesevictims(fromsomeonewithaknifeorgun,for instance).Aswith
all embeddedobjects,ensureyou do notremovetheitem fromthebody.
Ifpossible,you shouldsitthevictimup(asbloodin thebodywill go tothelowestpoint,
allowingtheheartandlungstoworkasefficientlyaspossible).Youshouldalsoleanthem
totheinjured side, keepingthehealthyside freefromincursionby blood.
Assessthevictimfor openchestwoundsorabdominalinjuries,andtreataccordingly.
Amputations
Ifabodyparthasbeenamputated,immediatelysummonambulance assistance,andtreat
thebleedingasabove.Covertheamputatedpartwithamoistdressingandgetitintoa
cleanplasticbag,andplacethisbagintoabagoficeandwater,sending itwiththevictim
tothehospital.(labeldate&time,what bodypartitisie:Rightfinger)Youshouldavoid puttingthe
partin directcontactwithice,asthiscancauseirreparabledamage,meaning
thatsurgeonsareunabletoreattachit.
Ifthebodypartispartiallyamputated,do notdetach.
FirstAid/InternalBleeding
Introduction
Internalbleedingisbleeding whichoccursinsidethebody.Sometimesthebloodwill leak
frominsidethebodythroughnaturalopenings. Othertimesthebloodstaysinsidethebody,
causingpain andshock,eventhoughyou cannotseethebloodloss.
Causes
Internalbleedingcanbecausednumerous ways.Any timesomeonecouldhaveinternal
bleeding, you will do no harmby treatingthemfor internalbleeding,butnottreatingthe
victimcouldleadtodeath.
Somecausesinclude:
•Falls
• CarAccidents
FirstAid/HeartAttack&Angina 43
•MotorcycleAccidents
•PedestriansStruckby aVehicle
•GunShotWounds
•InjuresfromExplosions
•ImpaledObjects
• StabWounds
•Surgery
Recognition
Apersonmaybebleeding internally ifone ofthesethingshappens:
•Bloodcomesoutofthenoseormouth(occursfromsevereheadtrauma)
•Bloodorclearfluidcomesoutoftheear(occursfromsevereheadtrauma)
•Bloodisin thestool
•Bloodisin theurine
•Brightredblood,orbloodlike'coffee-grounds',isin thevomit
•Bloodcomesfromawoman'sbirthcanalafteraninjuryorduringpregnancy
•Bruisingovertheabdominalorchestarea
•Painovervitalorgans
• Fracturedfemur
Butremember,apersonmaybebleeding insidethebody,eventhoughyou cannotseethe
bleeding. Ifyou seethesignsofshockandno apparentinjuries,alwayssuspectinternal bleeding.
Checktheskincolorchanges.In casesofinternalbleeding theskinmaybecome
paleandcold,andcyanosismaybepresent.
Treatment
BestPractice
Any timethereisthepossibilityofinternalbleeding,it iscrucialtotreatas ifthereisinternalbleeding. Not
treatingmayresultin death,buttreatingwhenthereisno injurywill notresultin harm.
Aswithanyvictim,beforetreating,puton disposableglovesandtakeothernecessarybody
substanceisolationprecautions.
•Checkthevictim'sABCs.
•IfthevictimhasABCcomplications,treatthosefirst-ABCs alwaystakepriority.
• Callanambulance
• Treatfor shock
•Assistthevictimintothemostcomfortableposition
•MonitorABCs andvitalsuntiltheambulancearrives
FirstAid/HeartAttack&Angina
Introduction
Heartattack(myocardialinfarction)
iswhenbloodsupplytotheheartor
partoftheheartiscutoffpartiallyor
completely,whichleadstodeathof
theheartmuscleduetooxygen
deprivation.Heartattacksusually
occurafterperiodsofrestorbeing
recumbent,andonlyrarelyoccur
afterexercise(despitepopular
portrayal).
Angina(angina pectoris)isa
'miniatureheartattack'causedby a
shorttermblockage.Anginaalmost
Heartattackcanbecausedby blockagein arteriessupplying
alwaysoccursafterstrenuous exercise bloodtotheheart.
orperiods ofhighstressfor thevictim.
Thekeydifferentiationbetweenaheartattackandanginaisthat,in linewiththeirtypical
onsetmodes,anginashouldstarttorelieveveryshortlyafterresting(afewminutes), whereasa
heartattackwill notrelieve withrest.
Recognition
• Chestpain:tightnessin thechestorbetweentheshoulderblades,oftenradiatinginto
theleftarm,andthejaw
•Nauseaorindigestion(especiallyin women)
•Pale,clammyskin
•Ashengreyskin
•Impendingsenseofdoom
•Denial
Treatment
Assistthevictimwithmedication,iftheyhaveany.Peoplewithanginawill often have
medicationtocontrol it; eitheraspillsoraspray.Thepillsshouldneverbetouchedwith bareskinby
therescuer,astheymaycauseamigraineheadache,andtheyareplaced underthetonguefor
absorption.Thesprayshouldbetakenon thebottomofthetongue.
Onlythevictimshouldadministerhismedication.Ifheisunabletodo so, thenthe rescuer
shouldnotdo itfor him.Helpingtotakethelid offorhanding thebottletothevictimis
fine,thisshouldbedocumentedifpatientistransferredtootherrescuers.
• Callforanambulanceifthey don'thavemedication,orifthemedicationdoesn'thelp
•Loosentightclothing,especiallyaroundtheneck
•Assistthevictimintoarecumbentposition,withthebodyleantbackatabout45
degrees,withfeeton thefloor,butkneesraised-thisputsthepatientin a'W' position.
•Ifthe patientisnoton anyanti-coagulantmedicinesuchas heparinorwarfarin,then

assistthemin takingone doseofaspirinifthey decide todo so.
•Continuemonitoringvitals
•BepreparedtodoCPRshouldthevictimgo intocardiacarrest.
FirstAid/Stroke&TIA
AStrokeisasmallblockagein abloodvesselofthebrain,whichcausesoxygenstarvation
tothatpart.Thisoxygenstarvationcancausealossoffunction,relatedtotheareaofthe
brainaffected. Dependanton thelengthoftimetheareaisblocked,thedamagemay
becomeirreparable.Theblockageisusuallycausedby asmallbloodclot,although
incursionssuchasairbubblescanhavethesameeffect.
Therearetwomaintypes ofstroke-aCVA (CardiovascularAttack-sometimes called justa
strokeormajorstroke)andaTIA (TransientIschaemicAttack-sometimes called a
mini-stroke).
ThedifferencebetweenaCVAanda TIAissimplythedurationofthesymptoms.Ifthe
symptomspass
Recognition
BestPractice
Totestfor theaffectedsideofastroke,havethevictimsqueezeyourhandsatthesametime.Youwill noticea difference in
pressurethattheymaynot.
Thekeyrecognitionsignsfor astrokecanberememberedwiththeacronymFAST,which
standsfor:
•FacialWeakness-Canthepersonsmile?hastheireyeormouthdrooped?
•ArmWeakness-Canthepersonraiseboth armsandholdthemparallel?Iftheysqueeze
yourhandscanthey exertequalforce?
• Speechproblems-Canthepersonspeakclearlyandunderstandwhatyou say
• Testallthreesymptoms
Thepatientmayalsoexperienceadditionalsymptoms,whichon theirowndo notindicate a
stroke.Theseinclude:
•Suddenblurred,dimorpatchyvision
•Suddendizziness
•Sudden,severe,unusualheadache
FirstAid/Stroke&TIA 45
Treatment
Consciousvictim
•Callfor anambulance
•Reassurethevictim
•Encourageandfacilitatethevictimtomovein toapositionofcomfortifpossible.Ifthey
havesignificantparalysis,theymaybeunabletomovethemselves,so youshouldmake
themascomfortableaspossiblewheretheyare.Ifpossible,inclinethemtothe unaffected side
(ifthereisone),asthiswill helpyou relievesomesymptomssuchasa feelingoffloating.
•Takevitals,historyandregularobservations
Unconsciousvictim
•Assessthevictim'sABCs (attemptCPRifnotbreathing)
•Assistthevictimintotherecoverypositionon theirunaffectedside wheregravitymay
assistbloodtoreachtheinjuredsideofthebrain,whichisbelowtheunaffectedsideof
thebrain.Additionally,bleeding(ifany)maydrainouttheear.
FirstAid/Shock
Introduction
Shockisarangeofrelatedmedicalconditionswherethedeliveryofoxygenandnutrients
isinsufficienttomeetthebody'sneeds.Themaincarrierofoxygenandnutrientsin
thebodyistheblood,so mostcausesarerelatedtotheblood,withthemostcommonfirstaid
considerationbeinglossofblood.Shockisalife-threateningemergency,itshouldnotbe
confusedwithafeelingofextremesurprise-onedoesnotleadtotheother.
Keytypesofshock
•Hypovolaemicshock-Thisiscausedby thelossofbloodfromthecirculatory system
(notnecessarily fromthebody,asitmaybetheresultofinternalbleeding)
•Cardiogenicshock-Thisiswherethebloodisnotpumpingeffectivelythroughthebody
-usuallycausedby heartproblems,suchasaheartattack
•Anaphylacticshock-Caused by anallergicreactionthatcausesairpassagestoswell,
blockingtheflowofoxygen,andcausingalackofoxygenin theblood
FirstAid/Shock 46
Recognition
Signsofshockcanrangegreatly,somecommonsigns are:
EarlyPhases
•Arapidpulse
•Pale,cold,clammyskin
•Sweating
Developingphase
•Cyanosis-Grey/blueskin,especiallyin areassuchasthelips.Sometimesknownas
'bluing'
•Weaknessanddizziness
•Nauseaandpossiblyvomiting
•Thirst
•Rapid,shallowbreathing
•Weak,'thready'pulse
Advancedphases
•Absenceofpulsefromthewrist(radial)
•Restlessnessandaggressiveness
•Yawningandgaspingfor air
•Unconsciousness
Finalphase
•Cardiac arrest
FirstAid/Shock 47
Treatment
Themostimportanttreatmentfor
shockofanyvarietyistotryand
maintainthebloodflowtothebody's
core(thoraxandhead). Todo this,lie
thepatientflaton thefloorandraise
theirlegsabout6-12inches
(15-30cm)offtheground.
Otherimportantfactorsin the
treatmentofshockcanbe
rememberedby thesimplemnemonic
WART:
Warmth
ABCs(Airway,Breathing,
Circulation.)
Rest&Reassurance
Treatmentofunderlyingcause A''healthcareprovider''checksthecarotidpulseofavictimin
the'''recoveryposition'''.
Unconsciouspatients
Shouldapatientbecomeunconscious,callfor anambulanceandtakethefollowingsteps:
•AssessABCs.Shouldanychangeoccur,compensatewithrequiredtreatment.(ex.Patient
goesintocardiacarrest,beginCPR.)
•Asairwaytakespriorityoverothertreatment,you shouldplacethemin therecovery positionin
ordertoensureapatentairway.
FirstAid/Shock 48
Respiratoryemergencies
FirstAid/AnaphylacticShock
Introduction
Anaphylaxisisalife-threateningmedicalemergencybecauseofrapidconstrictionofthe
airway,oftenwithinminutesofexposuretotheallergen.Itiscommonlytriggeredby
insectstingsandfoodssuchasshellfishorpeanuts.Callfor helpimmediately.Firstaidfor
anaphylaxisconsistsofobtainingadvancedmedicalcareatonce.Looktoseeifadevice suchasanEpi-
penisavailable-mostpeoplewhoknowtheyhaveanaphylacticreactions willcarryanEpi-
penwiththem.Firstaidersin manyjurisdictionsarenowpermittedto administerepinephrinein
theformofanEpi-penifthevictimisunabletodo so themselves. Checkwhatthelawsays in yourarea.
Recognition
•Hivesorrashall overaccompaniedby itchiness
•Swellingorpuffinessofthelymphnodes, especiallyaroundtheneckandmouth
•Swellingoftheairwayandtongue
•Difficultybreathing,wheezingorgasping
Treatment
•CallEMSimmediately
•HavethevictimadministertheirEpi-penifpossible
•Encouragethevictimtobreatheslowly;calmthem
•ThevictimshouldrestuntilEMSarrives
•MonitorABCs andbeginCPRifrequired
•IfthevictimisunabletoadministertheirEpi-penanditislegaltodo so, administerthe
Epi-penfor them
AdministeringanEpiPen
RegionalNote
AdministeringanEpiPenisnotlegalin alljurisdictionswithoutpropertrainingandcertification.
EpiPensarethemostcommonformofepinephrineauto-injectors,andaredesignedfor
easeofuse.Thereareinstructionsin thetubewiththeauto-injector,butyou shouldknowhow
touseoneaheadoftime. They'redesignedtoinject throughclothes,so youdon'thaveto
removethevictim'spants-evenifthey'rewearingaheavymateriallikedenim.Whenever
possible,thevictimshouldinject themselves, butifthey'reunabletodo so, you maybe
legallypermittedtoinject thevictim.
Removetheauto-injectorfromthetube.Oneendhasablacktip-thisiswheretheneedle will
comeout.Donottouchthistip!Theotherendhasagreycap.Removethegreycap,
FirstAid/AnaphylacticShock 49
holdtheEpiPenin yourfist,andpressitfirmlyagainsttheoutsideofthevictim'souter thigh.There

shouldbeanaudible click.Ifthereisnot,tryagainbutpressingharder.Hold theauto-
injectorinplacefor10seconds.Whenyou removeit,massagetheareafor 10 seconds,
thenreplacetheEpiPenintothetubeneedleendfirsttoavoidanydanger.When
EMSarrives,theycandisposeofitfor you.
FirstAid/Asthma&Hyperventilation
Introduction
Asthmaisamedicalconditionwhich
causesswellingoftheairway,
constrictingairflow.
Hyperventilationissimplybreathing
ataninappropriatelyhighrate.
Recognition
Asthmaattacksarecharacterizedby inflammationofthe
Asthmaischaracterizedby airway,whichconstrictsairexchange.
difficultybreathing,wheezing,increas
ed
secretionsin theairway,andahistoryofasthma.Hyperventilationcanberecognized by
fastbreathingwhichisinappropriatefor thecircumstances,afeelingofnotbeingableto
catchone'sbreath,andlightheadedness.
FirstAid/Asthma&Hyperventilation 50
Treatment
ForAsthma
•If thevictimhasafast-acting
inhalerforasthmaattacks,
encouragethemtouseit.You
mayassistwithfindingtheinhaler.
•Havethevictimmatchyour
breathingpatterns-calmthe
victimwhileslowingtheir
breathingrate
•Assistthecasualty tositin
apositionwhichrelievespressureon
thechest.Thetripodpositionis ideal -
sittingup,leaning slightly
forward,supportingtheirweight Asthmainhalerscomein severalstyles.Theoneon theleftis
withtheirarmseitheron notafast-actinginhaler,andshouldnotbeadministeredin an
asthmaattack
theirkneesoron atableorthelikein
frontofthem.
•CallEMS ifthevictim'sconditiondoesnotimproveorifthevictim'slevelof
consciousness islowered
ForHyperventilation Theaimistocalmthecasualty down,toreducetheirrateof
breathing,andifpossibletoincreasetheconcentrationofcarbondioxidein theairthey
breathe,perhapsby gettingthemtobreatheintoapaperbag.
Source: http://en.wikibooks.org/w/index.php?title=First_Aid/Asthma_&_
Hyperventilation&oldid=1164309
PrincipalAuthors:Mike.lifeguard,Mike6271,Chris.rigby.69,Nugger
FirstAid/ObstructedAirway
ConsciousVictims
Abdominalthrustsareusedtocleartheobstructedairwayofaconsciousvictim.Itisan
effectivelife-savingmeasurein casesofsevereairwayobstruction.
Apersonperformingabdominalthrustsusestheirhandstoexertpressureon thebottomof
thediaphragm.Thiscompressesthelungsandexertspressureon anyobjectlodgedin the
trachea,hopefullyexpellingit.Thisamountstoanartificialcough.(Thevictimofan
obstructedairway,havinglosttheabilitytodrawairintothelungs,haslosttheabilityto coughon
theirown.)
Evenwhenperformed correctly, abdominalthrustscaninjure thepersonthey are
performedon.Abdominalthrustsshouldneverbeperformedon someonewhocanstill
cough,breathe,orspeak-encouragethemtocoughinstead.
FirstAid/ObstructedAirway 51
Signsofasevereairwayobstruction
• Thepersondesperatelygrabsattheirneck
•Thepersoncannotspeakorcryout
•Theperson'sface turnsblue fromlackofoxygen
ObstructedAirwayforAdults&Children
Abdominalthrustsareonlyusedon consciousadult
orchildvictimswithsevereairwayobstructions.
Beforeattemptingabdominalthrusts,ask thevictim
"Areyou choking?"Ifthevictimcanreplyverbally,
youshouldnotinterfere,butencouragethevictimto
cough.
Ifthevictim'sairwayobstructionissevere,then
performabdominalthrusts:
•Therescuerstandsbehindandtothesideofthe
victimandwrapstheirarmsaroundthevictim's
sides,underneaththevictim'sarms
•Onehandismade intoafistandplaced, thumb side in,
flatagainstthevictim'supperabdomen,below
theribsbutabovethenavel
•Theotherhandgrabsthefistanddirectsitin
aseriesofupwardthrustsuntiltheobjectobstructing
theairwayisexpelled
•Thethrustsshouldnotcompress orrestrictthe Abdominalthrustsareperformedonly on
ribcagein anyway. consciousadultorchildvictimswith
asevereairwayobstruction
•Ifyou're notabletocompress thevictim's
diaphragmduetotheirsizeorpregnancy,thenperformthethrustsatthechest.
If thevictimlosesconsciousness,callforanambulance.Theyfall-youcall
ObstructedAirwayforInfants
Forinfants, asevereobstructionmaybeaccompaniedby ahigh-pitched,crow-likesound
whichisnotpresentin adultsorchildren.Thisisduetotheincompleteformationofthe
infant'sairway.Insteadof abdominalthrusts,alternate5 chestthrustswith5 back blows:
•Holdtheinfantwiththeheadin yourhand,andthespine alongyourforearm andthe
headbelowtherestofthebody
•Compressthechest5timesasyou wouldfor infantCPR
•Switchtheinfanttoyourotherforearm, so theirchestisnowagainstthearm
•Perform5backblows,keepingtheinfant'sheadbelowtherestofthebody
•Continueuntiltheobstructioniscleared,ortheinfantgoesunconscious
UnconsciousVictims
Ifavictimhasbecomeunconsciousasaresultofanoccludedairway,you
shouldimmediatelycallfor assistancefromtheemergency medicalservices,
andcommencea
primaryassessment,startingwithAirwayandifrequired,commenceCPRtokeepthe
victimalive.
Softtissueinjuries
FirstAid/Burns
Burnsarespecialtypesofsoft-tissueinjuriesthatcandamageoneormorelayers ofthe
skinandunderlyingtissues.
Recognition
Thereare3degreesofburns:
1.SuperficialBurn-First-degree
Skinwill bedry,red,mayswell
andwill usuallybepainful.
2.Partialthickness-Second-degree
Skinwill beredandmayswell,
usuallyispainful,hasblistersthat
mayopenandreleaseaclearfluid.
Thiswill makethe skinappear
wet.
3.Full Thickness-Third-degreeMay
destroy underlyingtissuessuch as
Asecond-degreethermalburn-noticetheblistercentreof
fat,bones, nerves,andmuscles.
theburn,andthesurroundingredness.
Skinmaybebrownorblackand
will lookcharred.Tissueunderneathmayappearwhite.Maybeverypainfulorpainless
duetonerveendingsbeingdestroyed.
Burnsmaybecausedby heat(thermalburns),chemicals(wetordry),by electricity,orby

radiation.
Treatment
Thermalburns
Youmuststoptheburningby removingthepersonfromthesourceoftheburn.Checkfor anylife-
threateningconditionsby checkingtheAirway,Breathing,andCirculation.Cool
theburnwithcopiousamounts ofwateruntilthepainisrelieved.
Covertheburnlooselywithasterile(preferablynon-adhesive)dressing.Donotuse
butter,oils,creams,etc.;theycantrapheatandincreaseriskofinfection.Theywill
alsoneedtobecleanedoutby thehospital later,whichonlyincreasesthepainthepatientmust
endure.Also donotuseantisepticsthatmayaggravatesensitiveskin.Treatforshock.
Burnscripplethebody'sabilitytoregulateheat.Ensurethepersondoesnotbecome
over-heatedorchilled.
Aloe veraextract,silverdene(SilverSulfazdiazine),topicalanalgaesics,andNSAIDs(such
asibuprofenoraspirin)arecommonlyusedmedications.Consultadoctorbeforeuse.
FirstAid/Burns 54
Chemicalburns
Don'tdothis!
• Applyiceoricedwaterexcepton smallfirstdegreeburns.
• Touchaburnwithanythingotherthanasterilecovering.
• Removeadheredclothing.
• Trytocleanasevereburn.
• Breakblisters.
• Useanykindofointment on asevereburn.
Ifthereisadrychemical,brushitofftheskinusing paper,cloth,orwithaglovedhand.Be
surenottogetanyon yourselformoreon thepatient.Oncethebulkofthedrychemicalis
gone,flushwithrunningwaterasabove.CallEMSimmediately.Iftheburniscausedby
awetchemical,flushwithplentyofwaterfor 15minutesandwhileflushing,callEMS immediately.
Electricalburns
Electricalburnslooklikethird-degreeburns,butarenotsurroundedby first-and
second-degreeburns.Theyalwayscomein pairs:anentrywound(smallest)andexitwound
(larger).CallEMSimmediatelyifapersonhasbeenshockedaselectrocutioncancause
cardiacandrespiratoryproblems.Be preparedtogiveCPRordefibrillation.Careisthe samefor
thermalburns.
Radiationburns
Radiationburns,thoughtypicallycausedfromanuclearsource,couldalsoinclude
ultravioletradiationin theformofsunburnwhichshouldbetreatedas a thermalburn.
Burnscausedby
anuclearsource,thoughrare,arestillpossible.Radiationburnscannotbetreatedby alay
rescuer.Individualsworkingin high-riskenvironmentsfor possible
radiationexposurearetrainedin thetreatmentofradiationburns.Therescuermay
unknowinglyputhimself/herselfatriskofradiationexposure by treatingsomeonewitha
radiationburn.Forall nuclearradiationburns,callyourlocalemergencynumber immediately.
Radiationburnsalsocomein theformofsnowblindness(orotherintenselightburnstothe
retina).Covertheeyeswithsterilegauze,andcontactEMSimmediately.Dowhateveryou
cantokeepthevictimcomfortable,monitorABCs,treatfor shock,andkeepthevictim
calm.
CriticalBurns
Thefollowingburnsrequiremedicalattentionassoonaspossible.Theymaybe life-
threatening,disabling,anddisfiguring.Callthelocalemergencynumberif:
•Burnstoachildyoungerthanfive yearsold orburnstoanelderlyperson.
•Thepatientishavingdifficultybreathing.
•Theburnsareon more thanone bodypart.
•Thereareburnstothehead,neck,hands,feet,orgenitals.
•Burnstothemouthornosemaybesigns ofburnstotheairway.
•Any burnsresultingfromchemicalsorelectricity.
FirstAid/Burns 55
FirstAid/Electrocution
Electrocution isarelatedsetofinjuriescausedby directcontactwithlive electrical
connections.Theeffectscanvaryfromminortocausingcardiacarrest.
ActionsandTreatment
Caution
Beforeattemptingtotreatanelectrocution victim,ensurethey arenotstillin contactwithlive electricity.Turn
offthepoweratthemainorremovethevictimfromcontactusing anon-conductingmaterial,suchasawooden pole.
•BeawareofDanger-Thecleardangerin thissituationistheelectricalsupply.
•Ifthevictimisstilltouchingalive electricalsource,eitherturnoffthepowertothe
source,orbreakthevictim'scontactwithit.Findanon-conductiveobject(wooden
broomhandlesarecommonlyused)andbreakthecontactbetweenthevictimandthe
source.Shouldthevictimbein contactwithdownedpowerlines,do notattempta
rescue.Instead,call911andwaitfor professionalrescuerstocomeandensurethe
powerlinesareno longerlive.
•Callanambulanceimmediately-all victimsofelectrocution,whetherconsciousor
unconsciousrequireassessmentin hospital.
•Afterensuringtheareaissafe,beginaprimaryassessment-checkABCs&beginCPR
ifrequired.
•Conductasecondaryassessmentlookingspecificallyfor 2electricalburns.
•Electricalburnslooklikethird-degreeburns,butarenotsurroundedby first-and second-
degreeburns.Theyalwayscomein pairs:anentrywound(smaller)andexit
wound(larger).Youshouldcoverthewoundswithnonstick,steriledressings.
Rememberthatthemostseriousproblemisrarelytheburn,andcardiacarrestisvery possible.
Electrocutioncausingunconsciousness
Seriouselectrocutionmaycauseunconsciousness,atleastfor abriefperiod.Ifthisisthe
case,conduct yourprimaryassessmentby checkingABCs.Iftheyarenotbreathing,begin
CPR.Airwayswellingcanoccurfrombeing electrocuted.Frequentlycheck thevictim's
breathing.
Ifthevictimreceived aseriouselectricshock,do notputthevictimin
therecoveryposition.Head/neck/back injuries
alongwithmultiplefracturescanoccurfromstrongmusclecontractionsfrombeingelectrocuted.Be
ginasecondaryassessment,lookingspecificallyfor2ormoreelectricalburns-
oneentrancewoundandoneexitwound.ContinuallyevaluatetheABCs.Cardiacrhythmdisturbance
scanquicklycausethevictimtogo intocardiacarrest.
FirstAid/Electrocution 56
Electrocutionnotcausingunconsciousness
Thosevictimswhoarenotrenderedunconsciousarelikelytofeelunwellafterthe
experience,andmaywellcomplainofnumbness orpins&needlesin the areawhere
throughtheelectricity haspassed.Thesevictimsmuststillbetransportedtoahospitalfor
evaluation,asheartrhythmdisturbancescanleadtocardiacarrest.
FirstAid/Chest&AbdominalInjuries
ClosedChestWounds
Chestwoundscanbeinherentlyseriousasthisareaofthebodyprotectsthemajorityofthe
vitalorgans.Mostchesttraumashouldreceiveprofessionalmedicalattention,so considercallingfor
anambulancefor anyseriouschestinjury.
Themostlikelyinjuriesthatcanbecausedwithachestinjuryincludebrokenribs.Asingle
brokenribcanbeverypainfulfor thepatient,andaribfracturecarrieswithittheriskof causing
internalinjury,such aspuncturingthelung,whichcanleadin turntothelung collapsing.
There arealsosomespecific,more complicated,ribfracturepatterns,whichinclude:
• Flailchest–2ormoreribfracturesalongthesamerib(s)
•Cancausea'floating'segmentofthechestwallwhichmakes breathingdifficult
• Stovechest–all ribsfractured
•Cancausetheentireribcagetoloseitsrigidity,causinggreatdifficultybreathing
Recognition
•Troublebreathing
•Shallowbreathing
•Tendernessatsiteofinjury
•Deformity&bruising ofchest
•Unevenexpansionofchest
•Painuponmovement/deepbreathing/coughing
•Cyanosis
•Maycoughupblood
•Cracklingsensationin skiniflungispunctured
Treatment
•AssessABCs andinterveneasnecessary
•Assistthevictimintoapositionofcomfort
•Conductasecondary survey
•Monitorvitalscarefully
FirstAid/Immobilization 59
OpenChestWounds
Anopenpneumothoraxorsuckingchestwound-thechestwallhasbeenpenetrated
(by knife,bullet,fallingontoasharpobject...)
Recognition
•Anopen chestwound–escapingair
•Entranceandpossibleexitwound(exitwoundsaremoresevere)
•Troublebreathing
•Suckingsoundasairpassesthroughopeningin chestwall
•Bloodorblood-stainedbubblesmaybeexpelledwitheachexhalation
•Coughingupblood
Treatment
•AssessABCs andinterveneasnecessary
• Donotremoveanyembeddedobjects
•Fluttervalveoverwound,asdescribedbelow
•Lateralpositioning:victim'sinjuredsidedown
• Treatfor shock
•Conductasecondary survey
•Monitorvitalscarefully
Makingafluttervalve
Getsomesortofplasticthatisbiggerthanthewound.Ideas: creditcardorsimilar,Ziploc
bag,somefirstaid kits will haveaready-to-usevalve.Tapetheplastic patchoverthe woundon
only3sides.The4thsideisleftopen,allowingbloodtodrainandairtoescape.
Thisopeningshouldbeatthebottom(as determinedby thevictim’sposition).
AbdominalInjuries
Ifatraumainjuryhascausedthevictim'sinternalorganstoprotrudeoutsidetheabdominal
wall,donotpushthembackin.Instead,havethepersonlie flatwiththeirkneesbent
andcovertheorganswithamoist,steriledressing(notpaperproducts -usegauze).Donot
allowthevictimtoeatordrink, thoughtheymaycomplainofextremethirst.Callan
ambulancetreatfor shockandmonitorABCs untiltheemergencymedicalteamarrives.
Iftheabdominalinjurydoes notcauseanopenwound,havethepersonlie flatwiththeir
kneesbentandtreatfor shockuntilEMSarrives.
Bone&jointinjuries
FirstAid/MusculoskeletalInjuries
Sprainor Fracture?
Sprains,strains,dislocations,andfracturescanall presentwiththesamesymptoms.Itis
verydifficulttodeterminewhattheinjurymaybe.Itisnotnecessarytoknowwhichinjury
thevictimhasasthetreatmentwill bethesamefor all ofthem.
Ifthepatienthasanyofthefollowingsymptoms,you shouldtreatfor apossiblemuscleor
skeletalinjury.
•Deformityattheinjurysite
•Crepitus -Agrindingorcrackingsoundwhentheaffectedareaismoved(usually
accompanied by extremepain).(Donottestforthis!Itshouldbereportedby thepatient.)
•Bruisingandswelling
•No pulsebelowinjurysite
•Inabilitytousetheaffected bodypartnormally
Iftheinjuryappearstobesevere,EMSshouldbeactivatedas soonas possible.
Treatment
Thetreatmentfor anymuscle,boneorjointinjuryfollowsthesimpleacronym"RICE".
Rest-Rest isveryimportantfor softtissueinjuries, bothin theshorttermandfor
longertermcare.
Immobilize-Sprains,strainsanddislocationscanslinged;fracturesshouldbesplinted
andslinged.
Cold-Iceshouldbeappliedperiodically,for around10-20minutesatatime. You
shouldthentaketheiceofffor aroundthesametimeitwason for.In ordertoavoid
problems,alwaysplace somefabricbetweentheiceandtheskin.
Elevation-Whereappropriate,theinjuryshouldbeelevated,asthismayhelpreduce
thelocalizedswellingwhichoccurs.Donotelevateifthiscausesmorepaintothe victim.
FirstAid/Immobilization
Immobilization
Thepropermethodofslingingdependson wheretheinjuryoccurredon thearm.After
applyingasling,ensurecirculationtothearmhasnotbeencompromisedby doingadistal
circulationcheck.Rememberalsothatmovinganarmintoapositionwhereyou canputa slingon
itmaybepainfulfor thevictim.Ifthatisthecase,simplyimmobilizein theposition found.Youwill have
toimprovisesomething basedon thevictim’spositionofcomfort.
Thearmsling–forinjuriestotheforearm
•Supporttheinjuredforearm
approximatelyparalleltothegroundwith
thewristslightlyhigherthantheelbow.
•Placeanopentriangularbandage
betweenthebodyandthearm,withits
apextowardstheelbow.
•Extendtheupperpointofthebandage
overtheshoulderon theuninjuredside.
•Bringthelowerpointupoverthearm,
acrosstheshoulderon theinjuredsideto
jointheupperpointandtiefirmlywitha
reefknot.
•Ensuretheelbowissecureby foldingthe
excessbandageovertheelbow,securing
itwithasafetypin.
Thiscanbeaccomplishedby usingthe
victim’sshirtorsweaterasasling.Simply
pinthebottomhemtotheirchestusing
multiplesafetypins,goingoverthearm.
Thisworkssurprisinglywell!
Elevatedsling–forinjuriesto
theshoulder
Asplintandslingappliedtotheforearm. Notethe
•Supportthevictim’sarmwiththeelbow secondtriangularbandageimmobilizingthearmby
besidethebodyandthehandextended holdingit againstthetorso.
towardstheuninjuredshoulder.
•Placeanopenedtriangularbandageovertheforearmandhand,withtheapextowards
theelbow.
•Extendtheupperpointofthebandageovertheuninjuredshoulder.
•Tuckthelowerpartofthebandageundertheinjuredarm,bringitundertheelbowand
aroundthebackandextendthelowerpointuptomeettheupperpointattheshoulder.
•Tie firmlywithareefknot.
•Securetheelbowby foldingtheexcess materialandapplyinga safetypin,andthen
ensurethattheslingistuckedunderthearmgivingfirmsupport.
Collarandcuff–forupperarm or ribinjuries
•Allow theelbowtohangnaturallyatthesideandplacethehandextendedtowardsthe shoulder
on theuninjuredside.
•Formaclovehitchby formingtwoloops–one towardsyou,theotheraway.
•Puttheloopstogetherby slidingyourhandsundertheloopsandclosingwitha
“clapping”motion.Ifyou cantieaclovehitch,simplytieiton thewrist.
•Slidetheclovehitchoverthehandandgentlypullitfirmlytosecurethewrist.Extend
thepointsofthebandagetoeithersideoftheneck,andtiefirmlywithareefknow.
•Allow thearmtohandnaturally.
•Itisespeciallyimportantfor thisslingthatyouensurethatcirculationtothehandisnot
compromised –do distalcirculationchecksoften
Femoralfractures
Thefemuristhelargestbonein thebody,andhasalargeartery,thefemoralartery,
directlybesideit.Becauseamechanismofinjurywhichcanfracturethefemurislikelyto
alsodisplacethefracture,itispossiblethatthefemoralarterywill bedamagedinternally.
Damagetothefemoralarteryislikelytocausemassiveinternalbleeding,so itisamajor
emergency;CallEMSimmediately.Be suretomaintainasmuchimmobilizationaspossible
andmonitorABCs untilEMSarrives.
FirstAid/Head&FacialInjuries
HeadInjuries
Headwoundsmustbetreatedwithparticularcare,sincethereisalwaysthepossibilityof
braindamage.Thegeneraltreatmentfor headwoundsisthe sameasthatfor otherflesh
wounds.However,certainspecialprecautionsmustbeobserved ifyou aregivingfirstaidto
apersonwhohassufferedaheadwound.Victimswithaheadinjurycausingdecreased
levelofconsciousness (no matterhowbrief)requireassessmentby aphysician.Victims
withaheadinjuryalsorequireassessmentfor apotentialspinalinjury.Any mechanismof
injurythatcancauseaheadinjurycanalsocauseaspinalinjury.
Concussion
•Mildheadinjurythatcausesabrief"short-circuit"ofthebrain
•Essentially,thebrainhasbeenrattledwithintheskull
•No damageorinjurytobraintissue
Recognition
•Possiblyunconsciousfor ashortperiodoftime
•Dazedandconfusedfor severalminutes
•Vomiting
FirstAid/Head&FacialInjuries 61
•Visualdisturbances(seeingstars)
•Amnesia(memoryloss)
•Pupilsunequalin sizeorunreactivetolight
• Headpain
•Anxiety&agitation
Compression
• Pressureon thebraincausedby abuild-upoffluidsoradepressedskullfracture
•Thebrainhasbeenbruised
•Damagetobraintissueislikely
•Symptomsareprogressive,andwill usuallygetworse overtime
Recognition
•Possiblyunconsciousfor ashortperiodoftime
•Dazedandconfusedfor severalminutes
•Vomiting
•Visualdisturbances(seeingstars)
•Amnesia(memoryloss)
•Pupilsunequalin sizeoruncreativetolight
• Headpain
•Anxiety&agitation
•Symptomsusuallyworsen overtime
Treatment
•EMS
•Immobilizespineifrequired
• Treatfor anybleeding,bruisingorswelling(ifyou suspectaskullfracture,do notapply
pressure–instead,useathickdressingwithaslittlepressureaspossible)
Notesforheadinjuries
•Ifthelevelofconsciousness isaltered,callEMS
•Donotusedirectpressuretocontrolbleedingiftheskullisdepressedorobviously
fractured,asthiswouldcausefurtherinjuryby compressingthebrain
Injuriesinvolvingtheeye
Woundsthatinvolvetheeyelidsorthesofttissuearoundtheeyemustbehandledcarefully
toavoidfurtherdamage.Iftheinjurydoesnotinvolvetheeyeball,applyasterilecompress
andholditin place withafirmbandage.Iftheeyeballappearstobeinjured,usealoose bandage.
(Rememberthatyou mustNEVERattempttoremoveanyobjectthatisembedded in
theeyeballorthathaspenetratedit;justapplyadry,sterilecompresstocoverboth
eyes,andholdthecompress in place withaloosebandage).Any personwhohassuffereda
facialwoundthatinvolvestheeye,theeyelids,orthetissuesaroundtheeyemustreceive
medicalattentionassoonaspossible.Be suretokeepthevictimlyingdown.Usea stretcherfor
transport.
Manyeyewoundscontainforeignobjects.Dirt,coal,cinders,eyelashes,bitsofmetal,anda
varietyofotherobjectsmaybecomelodgedin theeye.Sinceevenasmallpiece ofdirtis
FirstAid/SuspectedSpinalInjury 63
intenselyirritatingtotheeye,theremovalofsuchobjects isimportant.However,theeyeis
easilydamaged.Impairmentofvision(oreventotallossofvision)canresultfromfumbling,
inexpertattemptstoremoveforeignobjectsfromtheeye.Thefollowingprecautionsmust
beobserved:
•DONOT allowthevictimtorubtheeye.
•DONOT pressagainsttheeyeormanipulateitin anywaythatmightcausetheobjectto
becomeembeddedin thetissuesoftheeye.Be verygentle;roughnessisalmostsureto
causeinjurytotheeye.
•DONOT usesuch thingsasknives,toothpicks,matchsticks, orwirestoremovethe object.
•DONOT UNDERANYCIRCUMSTANCESATTEMPTTOREMOVEANOBJECTTHAT IS
EMBEDDEDIN THEEYEBALLOR THAT HAS PENETRATEDTHEEYE! Ifyou seea
splinterorotherobjectstickingoutfromtheeyeball,leaveitalone!Onlyspecially
trainedmedicalpersonnelcanhopetosavethevictim’ssightifanobjecthasactually
penetratedtheeyeball.
Smallobjectsthatarelodgedon thesurfaceoftheeyeoron themembrane liningthe
eyelidscanusuallyberemovedby thefollowingprocedures:
1.Try towashtheeyegentlywithlukewarm,sterilewater.Asterilemedicinedropperora
sterilesyringecanbeusedfor thispurpose.Havethevictimlie down,withthehead
turnedslightlytooneside.Holdtheeyelidsapart.Directtheflowofwatertotheinside
corneroftheeye,andletitrundowntotheoutsidecorner.Donotletthewaterfall
directlyontotheeyeball.
2.Gentlypullthelowerlid down,andinstructthevictimtolookup.Ifyou canseethe
object,trytoremoveitwiththecornerofaclean handkerchief orwithasmallmoist
cottonswab.Youcanmaketheswabby twistingcottonaroundawoodenapplicator,not
tootightly,andmoisteningitwithsterilewater.
CAUTION:Neverusedrycottonanywhereneartheeye.Itwill sticktotheeyeball
ortotheinsideofthelids,andyou will havetheproblemofremovingitaswellas
theoriginalobject.
1.Ifyou cannotseetheobjectwhenthelowerlid ispulleddown,turntheupperlid back
overasmoothwoodenapplicator.Tell thevictimtolookdown.Placetheapplicator
lengthwiseacrossthecenteroftheupperlid. Graspthelashesoftheupperlid gentlybut
firmly.Pressgentlywiththeapplicator.Pullupon theeyelashes,turningthelid back
overtheapplicator.Ifyou canseetheobject,trytoremoveitwithamoistcottonswabor
withthecornerofacleanhandkerchief.
2.Iftheforeignobjectcannotberemovedby anyoftheabovemethods,DONOT MAKE
ANYFURTHERATTEMPTSTOREMOVEIT.Instead,placeasmall,thickgauzedressing
overbotheyes andholditin placewithaloosebandage.Thislimitsmovementofthe injuredeye.
3.Getmedicalhelpfor thevictimattheearliestopportunity.
LO-4 Evaluate own performance

FirstAid/SuspectedSpinalInjury
Introduction
Thespinalcordisathicknervethatrunsdowntheneckandback;itisprotectedby
bonescalledvertebrae.Ifthespinalcordisinjured, thiscanleadtoparalysis.Sincethe vertebrae
protectthespinalcord,itisgenerally difficulttocausesuchaninjury.Note thatonlyan
x-raycanconclusivelydetermineifaspinalinjuryexists.Ifaspinalinjuryissuspected,the
victimmustbetreatedasthough onedoes exist.
Recognition
•Mentalconfusion(suchasparanoiaoreuphoria)
•Dizziness
•Head, neck orback pain
•Paralysis
•Any fallwheretheheadorneckhasfallenmorethantwometres(justoverheadheight on
anaveragemale)
•Cerebrospinalfluidin thenoseorears
•Resistancetomovingthehead
•Pupilswhicharenotequalandreactivetolight
• Headorbackinjury
•Priapism
Treatment
BestPractice
Lifeoverlimb:Immobilizethespineasbestasyou can,butAirway,Breathing andCirculationtakepriority.
Thevictimshouldnotbemovedunlessabsolutelynecessary.Withoutmovingthevictim, check
ifthevictimisbreathing.Iftheyarenot,CPRmustbeinitiated;thevictimmustbe
rolledwhileattemptingtominimizemovementofthespine.Ifthevictimisbreathing,
immobilizetheirspinein thepositionfound.Theeasiestwaytoimmobilizethespinein
thepositionfoundissandbagging. Despitethename, itdoesn'tnecessarily requirebagsof
sand.Simplypacktowels,clothing,bagsofsandetc.aroundthevictim'sheadsuchthatitis
immobilized.Be suretoleavetheirfaceaccessible, since you'llneedtomonitortheir breathing.
Ifyou mustrollthevictimovertobeginCPR,takegreatcaretokeeptheirspine
immobilized.Youmaywanttorecruitbystanderstohelp you.Hands-ontrainingistheonly
waytolearnthevarioustechniqueswhichareappropriatefor usein thissituation.
AquaticSpinalInjuryManagement
Manyspinalinjuriesaretheresultofadiveintoshallowwater.Lifeguardsandlifesavers receive
specializedtrainingtomanagespinalinjuriesin thewater.Suchhands-ontraining
istheonlywaytolearnthevarioustechniqueswhichareappropriatefor usein such situations.
Environmentalillness&injury
FirstAid/Heat-Related Illness&Injury
Burns
Forburns,seeThermalBurns
HeatCramps
Heatcrampsusuallyoccur whenapersonhasbeenactivein hotweatherandis
dehydrated.
Treatingheatcrampsisverysimple,do thefollowing:
•Removethevictimfromthehotenvironment,ashadyareawill suffice.
•Stretchthecalfandthighmusclesgentlythroughthecramp. Thisusuallyresultsin
immediaterelief.
•Hydrate thevictim,useasmallconcentrationofsaltfor bestresults.(ex.Givingthe person
asaltine crackertoeatwhiledrinking.)
•Havethevictimrest.
Shouldthecrampingcontinue, seekfurthermedicaladvice.
HeatExhaustion
Heatexhaustionisamilderformofheat-relatedillnessthatcandevelopafterseveraldays
ofexposuretohightemperaturesandinadequateorunbalancedreplacementoffluids.
Thosemostpronetoheatexhaustion areelderlypeople, people withhighbloodpressure,
andpeople workingorexercising in ahotenvironment.
SymptomsofHeat Exhaustion
•Heavysweating
•Paleness
•Musclecramps
•Tiredness
•Weakness
•Dizziness
•Headache
•Nauseaorvomiting
•Fainting
FirstAid/Heat-RelatedIllness&Injury 66
TreatmentofHeat Exhaustion
•Loosentheclothing.
•Applycoolwetcloths.
•Movethevictimtoeitheracooloranair-conditionedarea,andfanthevictim.
Thetreatmentpriorityfor heatexhaustionistocoolthevictim.Heatexhaustion isnot life-
threatening (unlikeheatstroke), so EMSisnotneededunlessthevictim'scondition
worsenstothepointofenteringheatstroke.Ifthevictim'slevelofconsciousnessis
affected,thatisheatstroke.
HeatStroke
Heatstrokeoccurs whenthecorebodytemperaturerisestoofarfor thebody'snatural
coolingmechanismstofunction.Itisaserious,life-threateningproblemthatcancause deathin
minutes. ThetreatmentprioritywithheatstrokeistocallEMSandcoolthevictim down.
Whenyou providefirstaid for heatstroke,rememberthatthisisatruelife-and-death
emergency. Thelongerthevictimremainsoverheated,thehigherthechancesof
irreversiblebodydamageorevendeathoccurring.
SymptomsofHeatStroke
•Unconsciousorhasamarkedlyabnormal mentalstatus
•Flushed,hot,anddryskin(althoughitmaybemoistinitiallyfromprevioussweatingor
fromattemptstocoolthepersonwithwater)
•Mayexperiencedizziness,confusion,ordelirium
•Mayhaveslightlyelevatedbloodpressureatfirstthatfallslater
•Maybehyperventilating
•Rectal(core)temperatureof105°Formore
TreatmentofHeatstroke
•NotifyEMS.
•Coolthevictim'sbodyimmediatelyby dousingthebodywithcoldwater.
•Applywet,coldtowelstothewholebody.
•Packiceintothevictim'sheat-lossareas(underarms,groin,neck).Donotleticecontact
thevictim'sbareskinasthismaycausefrostbite!
•WettingandEvaporatingmeasuresworkbest.(Think,artificialsweating.)
•Movethevictimtothecoolestpossibleplaceandremoveasmuchclothingaspossible
(ensureprivacy).
•Maintainanopen airway.
•Exposethevictimtoafanorair-conditionersince draftswill promotecooling.
•Immersingthevictimin acoldwaterbathisalsoeffective.
•Givethevictim(ifconscious)coolwatertodrink.
•Donotgiveanyhotdrinksorstimulants.
•Nevergiveanunconsciousvictimsomethingtodrinkasitmayobstructtheairwayor
causevomiting.
FirstAid/Heat-RelatedIllness&Injury 67
•Getthevictimtoamedicalfacilityassoonaspossible.Coolingmeasuresmustbe
continuedwhilethevictimisbeingtransported.
Monitorthevictim'svitalsignsfrequently.Be preparedtobeginCPRshouldthevictim
becomeunconsciousandnotbebreathing.
FirstAid/Cold-RelatedIllness &Injury
Frostbite
Frostbiteiswhentissuesfreeze.If
thefrozentissueismorethanskin
deep,thisisconsidereddeep
frostbite.
Treatmentfor frostbiteisasfollows:
•NotifyEMS assoonaspossibleor
bepreparedtotransportvictimto
amedicalfacility,evenafter
treatmentoffrostbite.
•Makesurethereisno riskof
re-freezing.Skinthatre-freezes
afterthawingwill have more
damage.
•Removevictimfromcold
environment,ensurethereisno
possibilityofhypothermia.(If
thereis, seebelow.)
•Fill ashallowcontainerwith
enoughwatertocoverthe Three typesoffrostbite
frostbittenbodypart.Makesure
thewaterisatroomtemperature.Thewaterdoes nothavetobecool,butitcannotbe
toowarm.Thewarmerthewater,theworsethepain.
•Immersetheinjuredarea,ensurethattheskindoesnotcomeintocontactwithanything!
•Repeattheabovestepby refreshingthewaterasitcoolsuntiltheskinisbacktoa
normalcolorandtexture.Thismaytakeseveralhoursdependingon theseverityofthe injury.
Remembertotransportthevictimtoamedicalassistancefor furtherassessmentafterthe
abovesteps.
FirstAid/Cold-RelatedIllness&Injury 68
Hypothermia
Hypothermiaiswhenthebody'scoretemperaturedropsso lowthebodycanno longer
warmitselfback up.Severehypothermia isclassifiedaswhenthebodydropsbelow95
degreesFahrenheit.
Treatmentfor victimsofhypothermia isasfollows:
Don'tdothis!
Neverjostleavictimofextremehypothermiaasthismaycausecardiacarrest!
•Removethevictimfromthecoldenvironment.
• Forcasesofextremehypothermia,wherethepatientisshowingsignsofconfusion,
slurredspeech,fumblinghands,orgo unconscious,notifyEMS.
•Removewetclothingfromthevictimandreplacewithdryclothing.(Adryhatis
recommended tobeworn.)
•Wrapvictimin blankets.
•Useheatpackstowarmthepatient.Donotallowthepackstotouchnakedskin.
•VictimswhoareAlertmaydrinkwarmliquids,however,do notgiveanydrinks
containingalcohol,caffeine,orgiveadrinkthatistoohot.
Warning:Victimsofhypothermia maybecomeworse astheywarm,thisisduetocoldblood
movingtowardsthecoreofthebody.Ifapatientgoesunconscious,checktheirABCs andnotifyEMS.
"Nobody'sdeaduntilthey'rewarmanddead"Firstaidproceduresmustthereforecontinue
untilprofessionalhelpisavailable.
FirstAid/Pressure-RelatedIllness&Injury
Pressure-RelatedIllness&Injury
Diversandswimmersalikemustavoidinjuriescausedby changesin airpressure.The weight
ofthewatercolumnabovethedivercausesanincreasein airpressurein any compressible
material(wetsuit, lungs, sinus)in proportiontodepth,in thesamewaythat
atmosphericaircausesapressureof14.7lbspersquareinchatsealevel.Thesepressure injuries
&illnesses aremostcommonin divers, butsomecanaffect skindivers (snorkellers) orswimmers
Treatment
•CallEMS
•MonitorABCs andvitals
•Raisethevictim'slegs andfeetifpossible
Iftherearebubblespresentin thebloodstream,thiswill helpkeepthemfromthe
internalorgans.Bubblestendtotravelup-awayfromthebrain(preventing
stroke)andheart(preventingheartattack).
•Recompressionmayberequired;tellEMSthatthesituationinvolvesa pressure-related
injuryorillness
•Ifyou aretrainedin oxygenadministrationandhavetheappropriateequipment,
administerhigh-flow O 2
DecompressionSickness(theBends)
Asdiversascend,thepressurethewatercolumnexertson themdecreases,which
decreasesthesolubilityofgasses.Thosegaseswill nolongerstaydissolvedin the
bloodstream,andescapeatamaximumrate.Ifthe ascentisfasterthantheratethatthe
gasescanescapefromthebloodstreamis, thenthegasesformbubbles.Thelocationof
thesebubblesdetermineswhattypeofdecompressionsicknessdevelops;ifthebubbles formin
thelungs, thenairembolismdevelops.
Recognition
Bubblescanformanywherein thebody,butsymptomaticsensationismostfrequently
observed in theshoulders, elbows,knees,andankles.
Thistablegivessymptomsfor thedifferentDCS types.
•The"bends"(jointpain)accountsfor about60to70percentofall altitudeDCS cases,
withtheshoulderbeing themostcommonsite.Thesetypesareclassifedmedicallyas DCS I.
•Neurologicalsymptomsarepresentin 10to15percentofall DCS caseswithheadache
andvisualdisturbancesthemostcommon.DCS caseswithneurologicalsymptomsare
generallyclassifiedasDCS II.
•The"chokes"arerareandoccurin lessthantwo-percentofall DCS cases.
•Skinmanifestationsarepresentin about10to15percentofall DCS cases.
Signsandsymptomsofdecompression sickness.
DCS Type Bubble Signs&Symptoms

Location
BENDS Mostly • Localizeddeeppain,rangingfrommild(a"niggle")toexcruciating.Sometimes

largejoints adullache,butrarelyasharppain.
ofthebody • Activeandpassivemotionofthejointaggravatesthepain.
(elbows, • Thepainmaybereducedby bending thejointtofindamore comfortable
shoulders, position.
hip, • Ifcausedby altitude,pain canoccurimmediatelyoruptomanyhourslater.
wrists,
knees,
ankles)
NEUROLOGIC Brain • Confusionormemoryloss
• Headache
• Spots in visualfield,tunnelvision,doublevision,orblurryvision
• Unexplainedextremefatigueorbehaviourchanges
• Seizures,dizziness,vertigo,nausea,vomitingandunconsciousnessmayoccur
SpinalCord • Abnormalsensationssuchasburning,stinging,andtinglingaroundthelower
chestandback
• Symptomsmayspreadfromthefeetupandmaybeaccompanied by ascending
weakness orparalysis
• Girdlingabdominalorchestpain
Peripheral • Urinaryandrectalincontinence
Nerves • Abnormalsensations,suchasnumbness,burning,stingingandtingling
• Muscleweaknessortwitching
CHOKES Lungs • Burningdeepchestpain(underthesternum)

• Painisaggravatedby breathing
• Shortnessofbreath
• Dry constantcough
SKINBENDS Skin • Itchingusuallyaroundtheears,face,neckarms,anduppertorso

• Sensation oftinyinsectscrawlingovertheskin
• Mottledormarbledskinusuallyaroundtheshoulders,upperchestand
abdomen, withitching
• Swellingoftheskin,accompaniedby tinyscar-likeskindepressions
OxygenToxicity
Oxygentoxicityoccurswhenoxygenin thebodyexceeds asafe level.
Recognition
•Dizziness
•Nauseaandtwitching,especiallyon theface
•Seizures
•Unconsciousness
Air Embolism
Asdiversascend,thepressurethewatercolumnexertson themdecreases,which
decreasesthesolubilityofgasses.Thosegaseswill nolongerstaydissolvedin the
bloodstream,andescapeatamaximumrate.Ifthe ascentisfasterthantheratethatthe
gasescanescapefromthebloodstreamis, thenthegasesformbubbles.Thelocationof
thesebubblesdetermineswhattypeofdecompressionsicknessdevelops;ifthebubbles formin
thelungs, thenairembolismdevelops.
Air embolismcanalsodevelopwhenadiverreceivespressuredamagetotheirlungs
followingarapidascentwherethebreathisinappropriatelyheldagainstaclosedglottis,
allowingpressuretobuildupinsidethelungs,relativetotheblood.Thegasbubblescan
impedetheflowofoxygen-richbloodtothebrainandvitalorgans.Theycanalsocause
clotstoformin bloodvessels.
Gasembolismanddecompression sickness(DCS)maybedifficulttodistinguish,asthey
mayhavesimilarsymptoms,especiallyin thecentralnervoussystem.Thetreatmentfor both
isthesame,becausetheyareboththeresultofgasbubblesin thebod

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Training, Teaching and Learning Materials (TTLM)

The Ethiopian TVET-System

Human Resource Operation Level III

LG Code: EIS HRO3120812

Date: September, 2018

Professional Levels beyond First Aid

Date: September, 2018

Other influences of consent

isdefinedby theforcingofundesiredsexualactsby onepersontoanother.

LO-2 Apply first aid procedures

Afteropeningthevictim'sairway,checkfor breathing.Todo this,placeyourcheekin front

Rescuebreathsmustbeprovidedtovictimsin astate ofrespiratoryarrest;do notprovide

LO-3 Communicate details of the incident

CPRwithoutenoughbloodisuseless,so acheckfor deadlybleedingshouldbeincludedin

If yourvictimisbreathing,thenyou shouldcontinueyourprimaryassessmentwitha check

Age Group Adult Child Infant

Single-Person 30-2 30-2 30-2

Two-Person 30-2 15-2 15-2

Technique Bothhands Onehand Two fingers

Aswithall firstaidsituations,thepriorityistoprotectyourself,so puton protectivegloves before

•Ifthe patientisnoton anyanti-coagulantmedicinesuchas heparinorwarfarin,then

holdtheEpiPenin yourfist,andpressitfirmlyagainsttheoutsideofthevictim'souter thigh.There

Burnsmaybecausedby heat(thermalburns),chemicals(wetordry),by electricity,orby

LO-4 Evaluate own performance

DCS Type Bubble Signs&Symptoms

BENDS Mostly • Localizeddeeppain,rangingfrommild(a"niggle")toexcruciating.Sometimes

CHOKES Lungs • Burningdeepchestpain(underthesternum)

SKINBENDS Skin • Itchingusuallyaroundtheears,face,neckarms,anduppertorso

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