FIRST AID

BY MR. WEBBER
First aid is the science of handling problems
related to the human body.
• It refers to the action taken in response to
someone who is injured or taken ill.
• A first aider is a person who takes this action
while taking care to keep everyone involved,
safe and to cause no further harm while doing
so.
• A casualty is a person under a problem which
has not been investigated by a doctor.
• A patient is a diagnosed person.
• First aid deals only with illness or injuries i.e.
wounds, bleeding, breakages/fractures.
• One of the primary rules of first aid is to
ensure that an area is safe for you before you
approach a casualty.

First aid priorities.

I. Assess a situation quickly and calmly.
II. Protect yourself and any casualties from
danger-never put yourself at risk.
III. Prevent cross infection between yourself and
the casualty as far as possible.
IV. Comfort and reassure casualties at all times.
V. Assess the casualties; identify the injury or
nature of illness affecting a casualty.
VI. Give early treatment and treat the casualties
with the most serious (life-threatening)
conditions.
VIII. Arrange for appropriate help; if you suspect
serious injury or illness, take or send the
casualty to hospital; seek medical advice, or take
him home.
 How to prepare yourself.
• Be calm in your approach.
• Be aware of risks to yourself and others.
• Build and maintain trust from the casualty and
bystanders.
• Give early treatment, treating the most
serious (life threatening )conditions first.
• Call for appropriate help
• Remember your own needs
 Tools.
• Common sense.
• Improvisation/Innovativeness.

Aims of first aid.

• To sustain life- life is sustained by maintaining
ABC.
• To prevent a condition from becoming worse.
• To promote recovery .
 Emergency service scene organization.
• First, the area immediately around the incident
will be cordoned off-called the inner cordon.
• Around this is an outer cordon, the minimum safe
area for emergency personnel (fire, ambulance
and police), will be established. No one without
the correct identification and safety equipment
will be allowed inside this area.
• A casualty clearing station where treatment takes
place, a survivor reception center, where the
uninjured assemble and ambulance parking and
loading areas will be established inside the
cordons.
 Triage.
• Triage is used to sort patients into groups based
on the severity of their health problems and the
immediacy with which these problems must be
treated.
• All casualties undergo a primary
survey/assessment at the scene to establish
treatment priorities.
• This will be followed by a secondary
survey/assessment in the casualty clearing
station.
• This will be repeated and any change monitored
until a casualty recovers or is transferred into the
care of a medical team.
• Casualties who cannot walk will undergo
further assessment. Depending on the
findings, casualties will be assigned to Red
Priority One (immediate) or Yellow Priority
Two (urgent) areas for further treatment and
will be transferred to hospital by ambulance
as soon as possible.
• Walking casualties with minor injuries will be
assigned to the Green Priority Three area for
treatment and will be transferred to hospital if
necessary.
• Uninjured people will be taken to the survivor
reception center.
 1. Primary survey.
• This is an initial rapid assessment of a casualty
to establish and treat conditions that are an
immediate threat to life.
• If a casualty is unconscious, suffering from
minor injuries and is talking to you, then this
survey will be completed quickly.
• If a casualty is more seriously injured(e.g.
unconscious) this assessment may take longer.
• Follow the ABC principle: Airway, Breathing
and Circulation.
 Assessing the sick or injured.
• When assessing a casualty you first need to
identify and deal with any life-threatening
conditions or injuries-primary survey.
• Deal with each life-threatening condition as
you find it, working in the order of ABC before
you progress to the next stage.
• Depending on your findings you may not
move to the next stage of the assessment.
• If the life threatening injuries are managed or
there are none ,you continue the assessment
and perform a secondary survey.
• You will initially have noted whether or not a
casualty is conscious. This is important since
some illnesses and injuries cause a
deterioration in the casualty’s level of
response, so it is vital to assess the level, then
monitor him for changes.
 Action in emergency.
A mnemonic DRS.ABCDE is normally used.
• D-DANGER. Make sure the area is safe before
you approach. Is anyone in danger? If it is not
safe do not approach.
• R-RESPONSE. Is the casualty conscious? Try to
get a response by asking questions and gently
shaking his shoulders. If the casualty is
conscious or unconscious, proceed to ABC
according to their state of consciousness.
 Level of response.
• You need to monitor a casualty’s level of
response to assess her level of consciousness
and any change in his/her condition.
• Any injury or illness that affects the brain may
affect consciousness and any deterioration is
potentially serious.
• Assess the level of response using the AVPU
scale and make a note of any deterioration or
improvement.
 AVPU Scale.
• A-ALERT. Is the casualty alert? Are her eyes
open and does she respond to questions?
• V-VOICE. Does the casualty respond to voice?
Can she open her eyes, answer simple
questions and obey commands?
• P-PAIN. Does the casualty respond to pain?
Does she open her eyes or move if pinched?
• U-UNRESPONSIVE. Is the casualty
unresponsive to any stimulus (unconscious)?
The human body exists in 3 stages;
1. Conscious – one is supposed to be awake,
alert and awake by sense.
2. Subconscious – asleep state. When one is
asleep is at 0 gravity hence lies on a flat
surface so that the position of the heart to be
the same with the brain.
• Conscious and sub-conscious states of the
body are normal and they are inseparable.
3. Unconscious
• It’s an abnormal state of the brain.
• It assimilates sub-consciousness.
• One is neither awake, alert or asleep.
• The soft tissues of the body relaxes.
• The tongue is the most dangerous organ of
the body when one is unconscious.
• When one lies facing upwards, the tongue
becomes subject to the force of gravity.
• When the tongue is under the influence of
gravity, it blocks the airway.
 a) Airway.
• The first step is to check that a casualty’s airway is
open and clear.
• If a casualty is alert and talking to you, it follows
that the airway is open and clear.
• If a casualty is unconscious, the airway may be
obstructed. An obstructed airway will prevent
breathing causing hypoxia and ultimately death.
• You need to open and clear the airway. Do not
move to the next stage until it is open and clear.
 How to open the airway.
1. Place one hand on the forehead. Gently tilt
the head back. As you do this, the mouth will
fall open slightly.
2. Place the fingertips of your other hand(one
finger tip in an infant) on the point of the
casualty’s chin and lift the chin. Do not push
on the soft tissues under the chin since this
may block the airway.
 b) Breathing.
• Is the casualty breathing normally? Look ,listen
and feel for breath sounds.
• If he is alert and/or talking to you, he will be
breathing. However ,it is important to note the
rate, depth and ease with which he is breathing
e.g. conditions such as asthma that cause
breathing difficulty require urgent treatment.
• If an unconscious casualty is not breathing, the
heart will stop. Chest compression and rescue
breaths (cardiopulmonary
resuscitation/CPR)must be stated immediately.
 How to check breathing.
• Keeping the airway open, look, listen and feel for
normal breathing: look for chest movement;
listen for sounds of breathing; and feel for
breaths on your cheek.
• Do this for no more than 10 seconds before
deciding whether or not the casualty is breathing
normally .
• Breathing may be agonal (short irregular gasps
for breath) this should not be mistaken for
normal breathing. If present, CPR should be
started without hesitation.
• If there is any doubt, act as if it is not normal.
If the casualty is breathing:
• Use primary survey to identify the most serious
injury and treat conditions in order of priority.
• Place the casualty in the recovery position and
call for emergency help.
• Monitor and record vital signs-breathing, pulse
and level of response while waiting for help to
arrive.
If the casualty is not breathing:
• As a helper to call for emergency help. If you are
alone, make the call yourself.
• Then begin CPR with chest compressions for
adults and CPR with 5 initial rescue breaths for
children and infants.
 i. How to give CPR to an adult.
1. Kneel beside the casualty level with his chest.
Place the heel of one hand on the centre of
the casualty’s chest. You can identify the
correct hand position for chest compressions
through a casualty’s clothing.
NOTE: Place your hand on the casualty’s
breastbone, making sure that you do not press
on the casualty’s ribs the lower tip of the
breastbone or the upper abdomen.
2. Place the heel of your other hand on top of
the first and interlock your fingers, making
sure the fingers are kept of the ribs.
3. Leaning over the casualty, with your arms
straight, press down vertically on the breast
bone and depress the chest by 5-6 cm.
Release the pressure without removing your
hands from his chest. Allow the chest to
come back up fully(recoil) before giving the
next compression.
4. Compress the chest 30 times at a rate of 100-
120 compressions per minute. The time
taken for compression and release should be
about the same.
5. Move to the casualty’s head and make sure
that the airway is still open. Put one hand on
his forehead and two fingers of the other
hand under the tip of his chin. Move the
hand that was on the forehead down to
pinch the soft part of the nose with the
finger and thumb. Allow the casualty’s mouth
to fall open.
NB: If there is more than one rescuer, change
over every 1-2 minutes, with minimal
interruption to chest compressions.
6. Take a breath and place your lips around the
casualty’s mouth, making sure you have a
good seal. Blow into the casualty’s mouth
until the chest rises. A complete rescue
breath should take one second. If the chest
does not rise ,you may need to adjust the
head position.
7. Maintaining head tilt and chin lift, take your
mouth off the casualty’s mouth and look to
see the chest fall. If the chest rises visibly as
you blow and falls fully when you lift your
mouth away, you have given one rescue
breath- one rescue breath should take one
second. Give a second rescue breath.
8. Continue the cycle of 30 chest compressions
followed by 2 rescue breaths until either:
• Emergency help arrives and takes over;
• The casualty shows signs of regaining
consciousness, such as coughing, opening his
eyes, speaking or moving purposefully AND
starts to breath normally or;
• You are too exhausted to continue.
 ii. How to give CPR to a child.
1. Ensure the airway is still open by keeping one
hand on the child’s forehead and two fingers
of the other hand on the point of her chin.
2. Pick out any visible obstructions from the
mouth. Do not sweep the mouth with your
finger to look for obstructions.
3. Pinch the soft part of the child’s nose with
the finger and thumb of the hand that was
on the forehead. Make sure that her nostrils
are closed to prevent air from escaping.
Allow her mouth to fall open.
4. Take a deep breath in before placing your lips
around the child’s mouth, making sure that you
form an airtight seal. Blow steadily into the
child’s mouth; the chest should rise.
5. Maintain head tilt and chin lift, take your mouth
off the child’s mouth and look to see the chest
fall. If the chest rises visibly as you blow and falls
fully when you lift your mouth, you have given a
rescue breath. Each complete rescue breath
should take one second. If the chest does not
rise you may need to adjust the head. Give a
child 5 initial rescue breaths.
6. Kneel level with the child’s chest. Once one hand
at the centre of her chest. This is the point at
which you will apply pressure.
7. Lean over the child, with your straight, and
then press down vertically on the breastbone
with the heel of your hand. Depress the chest
by at least one-third of its depth. Release the
pressure without removing your hand from
the chest. Allow the chest to come back up
completely (recoil) before you give the next
compression. Compress the chest 30 times,
at a rate of 100-120 compressions per
minute. The time taken for compression and
release should be about the same.
8. Turn the child’s head, open the airway and
give 2 further rescue breaths.
9. If you are on your own, alternate 30 chest
compressions with 2 rescue breaths for one
minute, then stop to call for emergency help.
Continue CPR until either;
• Emergency help arrives or;
• The child shows signs of regaining
consciousness, such as coughing, opening her
eyes, speaking, or moving purposefully AND
start to breath normally or;
• You become too exhausted to continue.
 iii. How to give CPR to an infant.
1. Place the infant on his back on a firm surface,
at about waist height in front of you, or on
the floor. Make sure that the airway is still
open by keeping one hand on the infant’s
forehead and one fingertip of the other hand
under the tip of his chin.
2. Pick out any visible obstructions from mouth
and nose. Do not sweep the mouth with your
finger looking for obstructions.
3. Take a breath. Place your lips around the
infant’s mouth and nose to form an airtight
seal. If you cannot make a seal around the
mouth and nose, close the infant’s mouth
and make a seal around the nose only. Blow
steadily into the infant’s mouth for one
second; the chest should rise.
4. Maintaining head tilt and chin lift, take your
mouth off the infant’s mouth and see if his
chest falls. If the chest rises visibly as you
blow and falls fully when you lift your mouth,
you have given a breath. Each complete
rescue breath should take one second. Give 5
rescue breaths.
5. Place two fingertips of your lower hand on
the centre of the infant’s chest. Press down
vertically on the infant’s breastbone and
depress his chest by at least one-third of its
depth. Release the pressure without moving
your fingers from the breastbone. Allow the
chest to come back up fully (recoil) before
giving the next compression. The time taken
for compression and release should be about
the same. Repeat to give 30 compressions at
a rate of about 100-120 times per minute.
6. Return to the infant’s head, open the airway
and give 2 further rescue breaths.
7. If you are on your own, alternate 30 chest
compressions with 2 rescue breaths for one
minute then stop to call for emergency help.
Continue CPR until either;
• Emergency help arrives and takes over or;
• The infant shows signs of regaining
consciousness, such as coughing, opening his
eyes, speaking or moving AND starts to
breathe normally or;
• You become too exhausted to continue.
 Problems with rescue breathing.
• If a casualty’s chest does not rise when giving
rescue breaths:
Re-check the head tilt and chin lift.
Re-check the casualty’s mouth and remove
any obvious obstructions, but do not do a
finger sweep of the mouth.
Check that you have a firm seal around the
mouth.
• Make no more than two attempts to achieve
rescue breaths before repeating
compressions.
 Special consideration for CPR.
• If you have not been trained in CPR or are
unwilling or unable to give rescue breaths you
can give chest compressions only CPR.
• If there is more than one rescuer, change over
every 1-2 minutes, with minimal interruption
to chest compressions.
• If the casualty vomits during CPR, roll him
away from you onto his side, ensuring that his
head is turned towards the floor to allow
vomit to drain away. Clear any residual debris
from his mouth, then immediately roll him
onto his back again and recommence CPR.
• If a woman is in the late stage of pregnancy
requires CPR, raise her right hip off the ground
by tilting it upwards before you begin
compressions.
• Modified rescue breathing may be necessary
in some cases such as; if a casualty has a
chemical around the mouth, you can give
rescue breaths through the nose the nose.
 Variations for rescue breathing.
1. Mouth-to-nose rescue breathing.
2. Mouth-to-stoma rescue breathing.
3. Face shields.
4. Pocket masks.
5. Ambubag.
 c) Circulation.
• Conditions that affect the circulation of blood
can be life threatening.
• Injuries that result in severe bleeding can
cause blood loss from the circulatory system,
so must be treated immediately to minimize
the risk of a life-threatening condition known
as shock.
• Only when life-threatening conditions have
been stabilized, or there are none present,
should you begin to carry out a detailed
secondary survey of the casualty.
 2. Secondary survey.
• Once you have completed the primary survey and
dealt with any life-threatening conditions, start
the methodical process of checking for other
injuries or illnesses by performing a head-to-toe
examination. This is called the secondary survey.
• Ideally the casualty should remain in the position
found, at least until you are satisfied that it is safe
to move him to a more comfortable position
appropriate for his injury or illness.
• The survey includes two further checks beyond
the ABC, that is D and E.
• D-DISABILITY – this is the casualty’s level of
response.
• E-EXAMINE the casualty – you may need to
remove or cut away clothing to examine and/or
treat the injuries.
• By conducting this survey you are aiming to
discover the following:
• History – what happened leading to the sudden
injury or illness and any relevant medical history.
• Symptoms – information that the casualty gives
you about his condition.
• Signs – these are what you find on examination
of the casualty.
History.
• There are two important aspects to the history:
what happened and any medical history.
Event history.
The first consideration is to find out what
happened. Your initial questions should help you
discover the immediate events leading up to the
incident.
Previous medical history.
While this may have nothing to do with the present
condition, it could be a clue to the cause. Clues to
the existence of such a condition may include a
medical bracelet or medication in the casualty’s
possessions.
• When taking a history:
 Ask what happened to establish whether the
incident is due to illness or an accident.
 Ask about medication the casualty is taking
currently.
 Ask about medical history. Find out if there are
ongoing and previous conditions.
 Find out if a person has any allergies.
 Check when the person last had something to eat
or drink.
 Note the presence of a medical warning bracelet.
This may indicate an ongoing medical condition
such as epilepsy, diabetes or anaphylaxis.
• Use the mnemonic AMPLE as a reminder
when assessing a casualty to ensure that you
have covered all aspects of the examination.
• A –allergy,
• M –medications,
• P – previous medical history,
• L – last meal,
• E – event history.
Symptoms.
• These are the sensations that the casualty feels
and describes to you.
Signs.
• These are features such as swelling, bleeding,
discoloration, deformity and smells that you can
detect by observing and feeling the casualty.
• Use all of your senses-look, listen feel and smell.
• Always compare the injured and uninjured sides
of the body.
• You may also notice that the person is unable to
perform normal functions such as moving his
limbs or standing.
Head-to-toe examination.
• Once you have taken the casualty’s history
and asked about any symptoms she has, you
should carry out a detailed physical
examination.
Vital signs.
• When treating a casualty, you may need to
assess and monitor his breathing(rate, depth,
ease and noise), pulse(rate, strength and
rhythm) ,temperature and level of
consciousness.