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David Olley9thEditionEmergencyA practical guide to emergency rst aid
3 9thEditionThis handbook is ideal for use insupport of a properly structured rstaid course. It will also prove invaluableas ongoing reference for someonewho has completed the course.EmergencyFirst AidContentsFirst Aid Objectives2Learning Outcomes 2AssessmentInfection Control Procedures 4First Aid Kits 5IntroductionRoles & Responsibilities3Record Keeping 7Priorities 7Primary Survey 8Secondary Survey 9Unresponsive Casualty 10Recovery Position 11Life Support & ResuscitationChain of Survival 12Basic Life Support (Adult) 13Basic Life Support (Child/Infant) 17AED 18Foreign Body Airway ObstructionAdult1920Child/Infant21SummaryInjuryBleeding & Wounds2322Circulatory ShockWound Dressing24Catastrophic Bleeding 25Internal Bleeding 27Minor Injuries 28Burns 31Fractures 32Acute IllnessSeizures33Asthma 35Stroke 36Anaphylaxis 37Diabetes 38Heart Attack 39Summoning Help 6
First Aid ObjectivesFirst Aid is, quite simply, the initial treatment given to someone who suers injury or suddenillness, usually at the scene and at the time.If the injury or illness is minor then it may be the only help that the casualty receives or needs.If the condition is more serious then First Aid may be given until the casualty is handed over tothe appropriate medical practitioner, who could be a paramedic or doctor, or to the care of ahospital emergency department.The basic principle of First Aid is to keep the casualty alive, to prevent their condition fromdeteriorating and to hand them over in the best possible condition in the circumstances.The objective of this training is to allow a First Aider to have the skills to manage apatient who has become suddenly ill or injured in the pre-hospital environment,until the arrival of emergency medical services.Learning OutcomesUpon completion of a rst aid training course,the student will be able to:- Recognise and assess the causes and eectsof sudden illness and/or injury in a pre-hospitalenvironment and call for emergency medicalservices.- React appropriately to such pre-hospitalemergencies.- Record and report actions and interventionstaken during handover to emergency medicalservices.- Retain a professional and caring attitude intheir performance as First Aiders.EMERGENCY FIRST AIDIntroduction
The First Aider should not be expected to deal with complex casualties or incidents,but to provide an initial response where rst aid is required.In some circumstances such as minor wounds or injuries the rst aid given may be the onlytreatment that the casualty receives. Where injuries or illnesses are more serious, rst aid may befollowed by treatment from ambulance paramedics, doctors or hospital sta.Assess the Situation- Identify potential hazards to the health and safety of yourself, the casualty and others.- Where appropriate, attempt to minimise these hazards. Use others at the scene if appropriate.- Are there multiple casualties? Is there help available at the scene if required?- Is there equipment available that you might need (First Aid Kit/AED) and can you sendsomebody to bring it?- Do you need to call emergency services immediately?The Aftermath- When emergency medical services have been involved, they usually take responsibility forcleaning and making the area safe afterwards.- In the event of more minor injury you may have to ensure that potential hazards such asbloodstained dressings are disposed of safely and appropriately and the area made safe.- If a First Aid Kit or equipment has been in use this will need to be checked and replenished andput back into service.- If the outcome of the incident has been worse than you would have hoped for, remember thatas long as you have done your best within the limits of your training you have no reason to blameyourself. If you nd this upsetting it is important to discuss the situation with colleagues, family orpossibly even your family doctor.Handover the Casualty to Medical Help- When emergency medical services arrive, introduce yourself as the First Aider on scene.- Tell them what you have seen, what you have done and what aect, if any, your actions havehad. Be brief but accurate.- Where possible, take written notes and always try to record the time when events occurred orchanges took place.- Make sure the EMS on scene have your personal contact details in case they need to be in touchor require further information.3EMERGENCY FIRST AIDRoles and ResponsibilitiesAssess and Treat the Casualty or Casualties- Quickly assess their condition using ABC (Primary Survey).- Treat potentially life-threatening conditions rst.- Look for and treat other problems in order of priority (Secondary Survey).- Stay with them, reassure them continuously, make them as comfortable as possible and continueto monitor their condition until the arrival of help.
Cross Infection occurs when bacteria or viruses that can cause infection arepassed from one person to another.In a rst aid situation this may be from the casualty to the First Aider or from the First Aiderto the casualty. It is a good idea to minimise any risk. Although the risk of catching diseasefrom a patient is low, it is something that anyone who is likely to oer rst aid should beaware of.Blood Born PathogensPathogens are microorganisms that cause disease. Blood-borne pathogens are viruses orbacteria that are present in human blood and body uids which can infect and cause disease inhumans.The two most important of these are Human Immunodeciency Virus (HIV) and the Hepatitis BVirus (HBV).Safe Working Practice- Treat all blood and body uids as if they were infectious.- Wear appropriate personal protective equipment.- When delivering rescue breaths, use a pocket mask equipped with a one-way valve.- Contain spills immediately, then clean up and disinfect the area.- Clean up contaminated sharps or broken glass with tongs, forceps or a brush and dust pan.- Handle all waste as if it contain sharps or infectious material.- After removing PPE, wash hands and other aected areas with soap and water.- Place all potentially infectious materials and contaminated items in closed containers or bags,clearly marked as infected waste or biohazard.Personal Protective EquipmentPersonal Protective Equipment (PPE) may include clothing andequipment worn by an individual when undertaking activitieswhich could result in exposure to blood-borne pathogens.- PPE always starts with gloves but could include aprons andpocket masks.- Gloves and aprons protect your clothing and hands fromcoming into contact with blood. Vinyl or Nitrile gloves arepreferred to latex as there is a possibility of serious allergicreaction to latex.- Pocket Masks refer to one of several types of devices thatmay be used whilst performing CPR or Rescue Breathing.Infection Control ProceduresEMERGENCY FIRST AID
The rst aid kit is a collection of equipment and material that can be used intreating the victim of accident, injury or sudden illness.The provision of First Aid Kits in the workplace is the responsibilityof the employer. First Aid equipment should be contained in aclosed, dustproof box of suitable size, clearly marked with thesymbol for rst aid, a white cross on a green background.First aid boxes should contain nothing but rst aid equipment.EMERGENCY FIRST AID3First Aid KitsSuggested ContentsThe suggested contents below comply with the latest standard BS 8599-1: 2019 forworkplace rst aid kits. It is not a legal requirement for employers to purchase kits thatcomply with this standard. The contents of the box is dependent on an employer’s rst aidneeds assessment.Contents Small Medium Large TravelPersonalissueCriticalinjuryGuidance Leaet 1 1 1 1 1 1Contents List 1 1 1 1 1 1Medium Sterile Dressing 2 4 6 1 0 0Large Sterile Dressing 2 3 4 0 1 0Triangular Bandage 2 3 4 1 1 0Sterile Adhesive Dressings 40 60 100 10 10 0Alcohol Free Cleansing Wipes 20 30 40 10 4 0Adhesive Tape Roll (2.5cm X 5m) 1 2 3 0 0 0Nitrile Disposable Gloves (pairs) 6 9 12 2 2 2Sterile Finger Dressing 2 3 4 0 0 0Resuscitation Face Shield 1 1 2 1 1 0Foil Blanket (130 cm X 210 cm) 1 2 3 1 1 1Burn Dressing (gel soaked) 1 2 2 2 0 0Shears / Tu Cut 1 1 1 1 1 1Conforming Bandage 1 2 2 0 0 0Adhesive Dressing 0 0 0 1 0 0Trauma Dressing Large 0 0 0 0 0 2Trauma Dressing Medium 0 0 0 1 0 0Haemostatic Dressing 0 0 0 0 0 2Tourniquet 0 0 0 0 0 1
There is some information that the operator will require:- Your LocationTry to identify your location as accurately as possible with an address, including postcode. If awayfrom home look for obvious landmarks, street names or if possible, ask someone from the area.- The phone number you are calling fromIn case the connection is lost and the operator needs to contact you.- What has happened999 or 112 are the free 24 hour numbers to call for emergency help.When you call 999 you will be connected directly to an operator in an emergency control centre.The operator will need to ask some questions at this point. This will not delay the ambulance butis designed to help provide a more appropriate response.The Casualty- Their approximate age, sex and known medical history.- Are they are conscious, breathing normally? The operator can provide advice on what to do ifthey are not breathing normally.- Are there any signs of bleeding? The operator can provide information on how best to controlthe bleeding.- Do they have chest pains? The operator can advise on appropriate treatment.- Do they have signs of injury and are you aware of how it may have happened?- What part of the body is aected?Safety- Is the area that you are in safe?- Are there any specic hazards, such as violent attackers in the area?- Are people trapped?While you are waiting for the ambulance- If outside, stay with the patient.- Call ambulance control if the patient’s condition changes.- If possible, send someone to meet the ambulance and guidethem to your location.- If at home, ensure doors are unlocked and pets put awaysafely.- Try to stay calm, the operator is there to help you to help thepatient. Listen and act on the advice they give until theemergency responders arrive.This information will be enough to start the process.. You may then be asked questions about thecasualty. Your answers to these questions will help the the operator to oer appropriate andimportant rst aid advice while you are waiting for the arrival of the ambulance.Summoning HelpEMERGENCY FIRST AID
Priorities for First Aid TreatmentYour priority will always be to deal with conditions that are the most potentiallylife-threatening rst. This is known as the primary or rst assessment.It means nding and immediately treating conditions that are, or may become life-threatening.Danger - Are you, the casualty or others in danger?Response - Is the casualty responsive?Airway - Can they breathe?Breathing - Are they breathing normally?Circulation - Are they bleeding or in shock?Accident RecordsIf resources are available it is always a good idea to try to keep a record of what you’ve seen andwhat you have done, either at the time or as soon as possible afterwards, while your memory isstill fresh. This can be very useful when you hand your patient over to the emergency medicalservices and also should there be any form of enquiry following the incident.Wherever possible, when you make the record try to record the time when events occurred asthis may assist the emergency responders to better understand the development or severity ofthe condition.For incidents in the workplace there may be otherrecords to be kept.The casualty may want to keep a record of whathappened in case of subsequent enquiries. An accidentreport book should be available at all workplaces and isthere for the use of the casualty. They may ask you toassist in lling it in.The records and the way they are kept should comply with the EU General DataProtection Regulation (GDPR).In addition, there may be investigation into the incident, what occurred and why it happened.You may be asked to assist in this investigation. In this case, report only what you saw and whatyou did. Do not be tempted to oer guesses or opinions.The priorities for First Aid treatment can be remembered by the initials DRABCEMERGENCY FIRST AID7Record Keeping & Initial Response
DDangerAre you, or anyone else in danger?Be aware of the threat to you or others as you approach the casualty. Can youdeal with it, can you move the casualty away from it or do you need to wait forassistance? Do not become a victim yourself.RCan you wake them up?ResponseDo they respond to your voice or a gentle shake?AAirwayCan they breathe?If the person is unconscious open the airway with head tilt / chin lift (Page 13).If they are conscious treat conditions such as choking (Page 19).BBreathingAre they breathing normally?If they are unconscious and not breathing normally rst call 999/112 for helpthen start CPR. If they are unconscious and breathing normally examine themfor other injuries and place them carefully into the Recovery Position (Page 11).If they are conscious but have breathing problems such as Asthma treat thiscondition before moving to the next step.CAre they bleeding or in shock?CirculationControl any serious bleeding (Page 23) and look for and treat the eectof blood loss or Shock (Page 22).Primary SurveyEMERGENCY FIRST AID
The Secondary Survey is undertaken to discover the extent of the casualty’s injuries or illness,or to assess the eectiveness of treatment given during the Primary Survey.There are three elements to the Secondary Survey:- History / Mechanism of Injury (MOI) - What and how it happened.- Signs - What you see.- Symptoms - What they tell you.Examining the casualty just means looking carefully at themIt is important that the casualty is examined for signs of obvious injury, and for their generalappearance and demeanour. The results of the examination put together with the history andthe symptoms described by the casualty are often enough to suggest what might be wrongwith them and also suggest an appropriate course of action.Bleeding- Have a good look at the casualty from top to toe looking for obvious signs of bleeding.- Look for signs of hidden bleeding such as bruising or swelling.- Pale, cold skin or signs of shock?- Have they got blood on their clothing?- Control any serious bleeding as a priority.Head and Neck- Are there any signs of injury to the head such as lumps, bruising or bleeding?- Swelling or bruising around the eyes?- Blood, or pale coloured liquid leaking from ears or nose?- Does the accident suggest a neck injury? If so, assume it.Torso and Limbs- Are there any obvious signs of injury?- Does the casualty seem to have trouble breathing?- Do they experience pain on breathing or coughing?- Does the history of the incident suggest a blow or crushing injury to the torso?- Are their arms and legs the correct shape and pointing in the right direction?- Are they showing signs of bleeding or shock with no obvious external bleeding?Pockets and Clothing- Is there any information that might explain their situation?- Look particularly for medical information on lockets or bracelets.- Are they carrying medication?- Remove any sharp or bulky items from their pockets before moving them to avoid potential injury.EMERGENCY FIRST AID7Secondary Survey
The management of the unresponsive casualty may be the most important thing that theFirst Aider will learn. Any casualty who is unconscious is in grave danger due to the absenceof the cough and swallow reexes which guard the airway. Anything in their mouth couldblock the airway. This may include food, blood, saliva and vomit but most commonly, theirown tongue.The level of consciousness my be estimated using the AVPU scale:VVERBALPPAINAALERTUUNRESPONSIVE- Fully conscious and aware- Eyes open spontaneously- Reexes are intact and normal- Appears sleepy with eyes closed- Eyes open to speech or sound- Speech may be slurred- May make uncoordinated movements- Reexes are intact- Appears deeply asleep with eyes closed- Does not open eyes to speech- Functioning reexes- Appears deeply asleep with eyes closed- Does not open eyes- Does not respond to any stimulus- No functioning reexesA patient with a response of anything other than ‘A’ will require emergencymedical attention.Causes of UnconsciousnessA person may become unresponsive dueto direct injury to the brain from suchconditions as concussion, haemorrhage orhead injury.They may also become unresponsive dueto indirect causes such as drugs, includingalcohol, heart attack, diabetes orinfections.Treatment of Unconsciousness- Perform a Primary Survey to establish airwayand breathing.- Dial 999 for an ambulance.- Perform a Secondary Survey to nd and treat(if required) other injuries.- Place the casualty carefully into the recoveryposition to maintain the airway.- Continue to observe and monitor.Whatever the initial cause the immediate First Aid treatment would be the same.The Unresponsive CasualtyEMERGENCY FIRST AID
1Place the hand closest to you up and outof the way.A person who has suered signicant injury should be treated in the position found, unlesstheir airway is threatened.23 4Reach down to the further knee and pull itup keeping the foot at on the oor.56Bring the furthest arm across and hold thehand alongside the face.Pull gently on the knee to roll themtowards you.Pull up on the knee to prevent them fromrolling back. Knee and hip should be at90°.Adjust the head to keep the airway open.EMERGENCY FIRST AID3The Recovery Position
The Chain of Survival demonstrates the steps that are necessary to increase thecasualty’s chance of surviving Sudden Cardiac Arrest. Their chances will begreatly improved when all of the links are in place.Early Access Early CPR Early Deb Advanced Care Post Arrest CareEarly Access- Early recognition and an immediate 999 call are critical. If there is an AED close by, sendsomebody to fetch it if possible.Early CPRThe emphasis is on immediate and good quality chest compressions. If you are trained,provide 30 chest compressions and two rescue breaths and repeat the cycle until the AED isready or emergency medical responders arrive and take over. If you are not trained thenconcentrate on chest compression only*.Early DebAs soon as an AED (Automated External Debrillator) becomes available it should beattached to the patient’s chest and you should follow the visual and voice prompts. AEDsare simple and safe to use, even if you have not received specic training. There is no reasonto delay debrillation.Early ACLSEective advanced life support will be provided by the emergency medical responders andmay include high-quality CPR, debrillation, oxygen and use of medicines or appropriatedevices.Good Post Arrest CareComprehensive, multidisciplinary system of care which will include close monitoring, specic*Compression Only ResuscitationCardio Pulmonary Resuscitation means combining chest compressions with rescue breathing. Iffor any reason the rescuer does not feel condent in performing full CPR then they should startcompression only resuscitation immediately.Press in the middle of the chest at least 100 times a minute until the arrival of the ambulance oruntil a trained person takes over and starts full CPR.The Chain of SurvivalEMERGENCY FIRST AID
Approach with CARE- Make sure there is no danger to yourself, the casualty or bystanders.- Deal with danger if appropriate but do not take any chances with your own safety.Check RESPONSE- Check initially in the position you nd them.- Speak loudly to them.- Use their name or ask them to open their eyes.- If no response, shake them gently by the shoulder.If they respond:- Leave them in the position that you found them- Check to nd out what might be wrong.- Observe and reassess regularly.If they do not respond:Open the AIRWAY- Undo anything tight around the neck and remove theirglasses if worn.- Place one hand on the forehead and two ngers of theother hand under the bony part of the jaw.- Gently rotate the head backwards and lift the jaw.- This lifts the tongue and straightens the airway.Check for NORMAL BREATHING- Place your ear over the casualty's nose and mouth, lookingdownwards towards their feet.- Check for no more than 10 seconds.LOOK - for movementLISTEN - for breathingFEEL - for breath on the cheekSeizure and Sudden Cardiac ArrestBe suspicious of Cardiac Arrest in any patient presenting with seizure and carefullyassess their breathing following the seizure. Be prepared to oer life support asappropriate.EMERGENCY FIRST AID3Basic Life Support (Adult)