FIRST AID

First aid is the immediate and temporary proper aid provided to a sick or injured person or animal until medical treatment can be provided. It generally consists of series of simple, life-saving medical techniques that a non-doctor or lay person can be trained to perform with minimal equipment.

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History

The Knights Hospitaller were probably the first to specialize in battlefield care for the wounded St. John Ambulance was formed in 1877 to teach first aid (a term devised by the order) in large railway centres and mining districts. The order and its training began to spread throughout the British Empire and Europe. As well, in 1859 Henry Dunant helped organize villagers in Switzerland to help victims of the Battle of Solferino. Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross. Developments in first aid and many other medical techniques have been fueled in large by wars: the American Civil War prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote first aid, such as the military and scouting movement. New techniques and equipment have helped make today's first aid simple and effective.

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Training

It is best to obtain training in first aid before a medical emergency occurs. One needs hands-on training by experts to perform first aid safely, and recommendations change, so that training should be repeated every three years. CPR recertification is recommended annually. Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance. In many countries in the Commonwealth of Nations, St. John Ambulance provides first aid training and in some countries operates ambulance services. In Scotland, St. Andrew's Ambulance Association provides first aid training. In the United States, the American Heart Association and American CPR Training also offer first aid training.

In the United Kingdom, there are two main types of first aid courses offered. An "Emergency Aid for Appointed Persons" course typically lasts one day, and covers the basics, focusing on critical interventions for conditions such as cardiac arrest and severe bleeding, and is usually not formally assessed. A "First Aid at Work" course is a four-day course (two days for a requalification) that covers the full spectrum of first aid, and is formally assessed. Certificates for the "First Aid at Work" course are issued by the training organisation and are valid for a period of three years from the date the delegate passes the course. Other courses offered by training organisations such as St John Ambulance, St. Andrew's Ambulance Association< or the British Red Cross include Baby & Child Courses, manual handling, people moving, and courses geared towards more advanced life support, such as defibrillation and administration of medical gases (oxygen & entonox).

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Basic First Aid

This is intended as a quick guide only. Effective CPR and first aid require hands-on training that is best accomplished by attending a class in person. (See list above for organizations).

This section summarizes one common formula for performing first aid.

  1. Survey the scene What's going on? Is it safe for me to approach?
  2. Do a primary patient survey, checking Airway, Breathing, Circulation
  3. Call for emergency services
  4. Do a secondary patient survey, and provide appropriate emergency first aid

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Survey the Scene

Survey the scene and approach the victim. Determine whether the scene is safe. Look for dangers, such as downed powerlines, traffic, unstable structures or fast-moving water. Determine what may have happened, how many victims are involved, and if any bystanders can help.

If several persons appear to be injured, perform triage.

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Survey the Patient

Perform an initial assessment. Get consent from a conscious victim (parent/guardian if the victim is a minor) before providing care. If the victim is unconscious, consent is implied. Use infection control precautions and check for signs and symptoms of any life-threatening conditions and care for them. To perform an initial assessment:

Provide brief care for the conditions. If the patient lacks air or circulation, they may begin to suffer brain damage after approximately four minutes. After ten minutes, they most likely will have some permanent brain damage. (Although unusual, some severely hypothermic drowning victims have been successfully revived with no brain damage after an extremely long period without oxygen.) To care for breathing and circulation means first clearing the airway, and briefly attempting to restart their breathing or circulation with rescue breathing or CPR, (and use of a portable defibrillator (AED), where available). This step is crucial, because an unconscious person's airway can be blocked by a normal, comfortable-looking head position (e.g., on their back with a pillowed head). Often, simply tilting the head back will open the airway and restart their breathing. Likewise, many people recovering from a blocked airway vomit, and if they are unconscious, they can drown in the vomit. The standard prevention for both these issues is to turn a breathing, unconscious patient on their side, turning their head and spine in the same movement to avoid spinal injury, pillowing their head on one of their arms.

Do not move casualties unless it is necessary to remove them from danger, or to make treatment possible (such as onto a hard surface for CPR).

Calling for emergency medical services must take priority over extended care such as long term rescue breathing or extended CPR, since these techniques are intended to gain time for emergency services to arrive as part of the chain of survival. However, if bystanders are available, both can be pursued at the same time.

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Call for Emergency Services

The next step is to activate emergency medical services by calling for help using a local emergency telephone number, such as 911 in Canada or the United States, 999 in the UK, 112 in most of continential Europe, 000 in Australia , 111 in New Zealand and 120 in the mainland of the Peoples' Republic of China. Operators will generally require the caller's name and location and some information on person that is being called about (level of consciousness, injuries, name if known, chronic medical illnessess if known). The easiest way to convey all the essential information is to use the mnemonic 'Lionel' - Location Incident Other services required Number of casualties Extent of injuries Location (repeated)

If you ask bystanders to call an ambulance for you, make sure they report back to you once released by the emergency operator to confirm that the call has been made

Also note that in some circumstances, such as in remote areas or on the battlefield, outside help may be unavailable. The skill of wilderness first aid covers other measures including evacuation, but is no substitute for a medical professional if one can be located.

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Do a secondary survey and begin extended care

The secondary survey is to gather information about conditions or injuries that may not be life threatening, but may become so if not cared for.

A properly trained and certified first aider performs three stages in the secondary survey:

  1. Interview
  2. Vitals
  3. Head-to-toe examination

Perform a secondary survey only if you are sure that the victim has no life-threatening (ABC) conditions.

It is also essential that stages be performed in order, with the interview first, so that in case the patient loses consciousness all verbal medical and related information has been obtained. Additionally, any information obtained should be recorded, with some organizations employing standard forms that have multiple copies for emergency medical personnel.

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1) Interview the victim

  • Signs and Symptoms - Visible indications of injury and patient reported sensations (e.g. pain)
  • Allergies - especially those relevant to injury (i.e. allergy to latex, pencillin, etc.)
  • Medications - what current or recent medications the patient is taking
  • Past Medical History - any related history, or medical conditions that could complicate treatment (e.g. heart condition)
  • Last meal - last food and/or drink
  • Events - confirm how injury most likely occurred
(Note - interview should include bystanders as well, to supplement info from the patient)

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Vitals

(Most certifications at the first-aid level include only the following four vitals)
  • LOC - Level of Consciousness description (e.g. - alert, aware, disoriented, confused, unresponsive)or AVPU (Alert, Voice, Pain, Unresponsive)
  • Breathing Rate - Number of breaths per minute. Calculate by counting breaths for ten seconds and multiplying by six, or 15 seconds and multiplying by four.
  • Pulse Rate - Number of heartbeats per minute. Calculate by counting pulse for ten seconds and multiplying by six, or 15 seconds and multiplying by four. Pulse for an unconscious person is taken on the neck (carotid pulse) and on the wrist (radial pulse) for a conscious person.
  • Skin Condition - Pale vs. normal, cool/cold vs. hot, clammy/sweaty vs. dry

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3) Head-to-toe examination

  • Perform a head-to-toe examination (for a child, toe-to-head)
    • Look for medical alert bracelets or medallions.
    • Compare one side of the patient against the other
    • Look for pain, or deformity

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Wilderness and mass emergency first aid

Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.

In the United States, Wilderness First Aid (WFA) is the name of a certification in wilderness medicine that covers wilderness first aid; depending on the laws applicable where it is practiced, it may impose specific responsibilities and confer specific immunities on duly-diligent practitioners. For instance, the practicing of certain rules of WFA, by someone certified in the usual "street" First Aid discipline but not in WFA (or a higher Wilderness Medicine qualification), could result in civil liability or perhaps even criminal prosecution.

A classic problem is whether to leave an injured person or stay, if only one person is ambulatory. Barring special circumstances, the injured one should be stabilized, placed in shelter, and marked in a way visible from the air (usually a single long line of cut brush or trampled snow). Then the injured one should be left alone, while the other goes for help.

If there are three or more, the healthy group should be split into halves by speed, with the fastest going for help, and the others remaining to make the preparations. (In a party of four, it would be a rare hiker who would be better sent for help alone, rather than sent in a sub-party of two.)

Ensuring the rescuers can find the injured person is crucial. If a Personal Locator Beacon is available, it should be triggered and placed with the injured person. If enough help is available, air-visible markings may be worthwhile. Where surveyor's tape is available within the party (and assuming clear trails are available), it should be used by the sub-party going for help to back up memory and notes with tape-flagging of the toward-the-injury-location choices of trail at intersections. (When an injury location is off clear trails, or distances that make it impractical to keep blazes of tape within sight of each other, forks in watercourses should be used as substitutes for trail intersections.)

Training in wilderness first aid is available. Any group of persons traveling in wilderness should have at least one person trained in wilderness first aid and carry a first aid kit designed for the area they are traveling in.

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Conditions that often require first aid

  • Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain o lungs
  • Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens, such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine
  • Battlefield First aid - After the 9-11 terrorist attack, this protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the battlefield or in the affected area resulting from a terrorist attack.
  • Bone fracture a break in a bone initially treated by stabilizing the fracture with a splint./font>
  • Burns, which can result in damage to tissues and loss of body fluids through the burn site
  • Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient's trachea is not cleared, for example by the Heimlich maneuver
  • Childbirth
  • Cramps in muscles due to lactic acid buildup caused either by inadequate oxygenation of muscle or lack of water or salt.
  • Diving disorders resulting from too much pressure.
  • Gastrointestinal bleeding
  • Gender specific conditions, such as Dysmenorrhea and Testicular torsion
  • Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
  • Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
  • Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
  • Hemorrhage, or heavy bleeding, treated by applying pressure (manually and later with a pressure bandage to the wound site and elevating the limb if possible.
  • Hyperglycemia, or diabetic coma
  • Hypoglycemia, or insulin shock
  • Hypothermia, or exposure, occurs when a person's core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.
  • Insect and animal bites and stings.
  • Muscle strain.
  • Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
  • Sprain, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage
  • Stroke a temporary loss of blood supply to the brain.
  • Sucking chest wound, a life threatening hole in the chest which can cause the chest cavity to fill with air and prevent the lung from filling, treated by covering with an occlusive dressing to let air out but not in.
  • Toothache, which can result in severe pain and loss of the tooth but is rarely life threatening.
  • Wounds and bleeding, including laceration, and abrasion, and avulsion, which present risk of infection and should be irrigated with sterile normal saline and may require antibiotic medication.

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Providing first aid

  • Emergency Action Principles
  • Wilderness first aid
  • Emergency medical service
  • Good Samaritan law
  • First aid kit

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Techniques and procedures of first aid

  • Artificial respiration
  • Cardiopulmonary resuscitation (CPR)
  • Occlusive dressing
  • Oxygen first aid
  • Triage
  • Tourniquet
  • Sub-abdominal thrusts

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Red Cross symbol

Although commonly associated with first aid, the symbol of a red cross is an official symbol of the Red Cross. According to the Geneva Conventions and other international law, it should only be used by official agencies of the International Red Cross and Red Crescent, and as a protective emblem for medical personnel and facilities in combat situations. They recommend the use of other symbols or colors as indicators for "first aid", such as the Star of Life

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