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EMERGENCYApracticalguidetoemergencyrstaidFIRST AID10TH EDITION

3                              10thEditionThis 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 suers 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:-Recogniseandassessthecausesandeectsof sudden illness and/or injury in a pre-hospitalenvironment and call for emergency medicalservices.-Reactappropriatelytosuchpre-hospitalemergencies.-Recordandreportactionsandinterventionstaken during handover to emergency medicalservices.-Retainaprofessionalandcaringattitudeintheir 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.-Whereappropriate,attempttominimisethesehazards.Useothersatthesceneifappropriate.-Aretheremultiplecasualties?Istherehelpavailableatthesceneifrequired?-Isthereequipmentavailablethatyoumightneed(FirstAidKit/AED)andcanyousendsomebody to bring it?-Doyouneedtocallemergencyservicesimmediately?The Aftermath-Whenemergencymedicalserviceshavebeeninvolved,theyusuallytakeresponsibilityforcleaning and making the area safe afterwards.-Intheeventofmoreminorinjuryyoumayhavetoensurethatpotentialhazardssuchasbloodstained dressings are disposed of safely and appropriately and the area made safe.-IfaFirstAidKitorequipmenthasbeeninusethiswillneedtobecheckedandreplenishedandput back into service.-Iftheoutcomeoftheincidenthasbeenworsethanyouwouldhavehopedfor,rememberthatas 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-Whenemergencymedicalservicesarrive,introduceyourselfastheFirstAideronscene.-Tellthemwhatyouhaveseen,whatyouhavedoneandwhataect,ifany,youractionshavehad. Be brief but accurate.-Wherepossible,takewrittennotesandalwaystrytorecordthetimewheneventsoccurredorchanges took place.-MakesuretheEMSonscenehaveyourpersonalcontactdetailsincasetheyneedtobeintouchor require further information.3EMERGENCY FIRST AIDRoles and ResponsibilitiesAssess and Treat the Casualty or Casualties-QuicklyassesstheirconditionusingABC(PrimarySurvey).-Treatpotentiallylife-threateningconditionsrst.-Lookforandtreatotherproblemsinorderofpriority(SecondarySurvey).-Staywiththem,reassurethemcontinuously,makethemascomfortableaspossibleandcontinueto 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 oer 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 Immunodeciency Virus (HIV) and the Hepatitis BVirus (HBV).Safe Working Practice-Treatallbloodandbodyuidsasiftheywereinfectious.-Wearappropriatepersonalprotectiveequipment.-Whendeliveringrescuebreaths,useapocketmaskequippedwithaone-wayvalve.-Containspillsimmediately,thencleanupanddisinfectthearea.-Cleanupcontaminatedsharpsorbrokenglasswithtongs,forcepsorabrushanddustpan.-Handleallwasteasifitcontainsharpsorinfectiousmaterial.-AfterremovingPPE,washhandsandotheraectedareaswithsoapandwater.-Placeallpotentiallyinfectiousmaterialsandcontaminateditemsinclosedcontainersorbags,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.-PPEalwaysstartswithglovesbutcouldincludeapronsandpocket masks.-Glovesandapronsprotectyourclothingandhandsfromcoming into contact with blood. Vinyl or Nitrile gloves arepreferred to latex as there is a possibility of serious allergicreaction to latex.-PocketMasksrefertooneofseveraltypesofdevicesthatmay 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 Leaet 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.-ThephonenumberyouarecallingfromIn case the connection is lost and the operator needs to contact you.-Whathashappened999 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-Theirapproximateage,sexandknownmedicalhistory.-Aretheyareconscious,breathingnormally?Theoperatorcanprovideadviceonwhattodoifthey are not breathing normally.-Arethereanysignsofbleeding?Theoperatorcanprovideinformationonhowbesttocontrolthe bleeding.-Dotheyhavechestpains?Theoperatorcanadviseonappropriatetreatment.-Dotheyhavesignsofinjuryandareyouawareofhowitmayhavehappened?-Whatpartofthebodyisaected?Safety-Istheareathatyouareinsafe?-Arethereanyspecichazards,suchasviolentattackersinthearea?-Arepeopletrapped?While you are waiting for the ambulance-Ifoutside,staywiththepatient.-Callambulancecontrolifthepatient’sconditionchanges.-Ifpossible,sendsomeonetomeettheambulanceandguidethem to your location.-Ifathome,ensuredoorsareunlockedandpetsputawaysafely.-Trytostaycalm,theoperatoristheretohelpyoutohelpthepatient. 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 oer 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.Airway -Cantheybreathe?Breathing -Aretheybreathingnormally?Circulation -Aretheybleedingorinshock?Disability -AssesslevelofconciousnessExpose -ExposetheareaofinjuryorconcernAccident 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 oer guesses or opinions.The priorities for First Aid treatment can be remembered by the initials ABCDEEMERGENCY FIRST AID7Record Keeping & Initial Response

Are they awake?Assess the level of conciousness using the ACVPU scale (Page 10).Are they bleeding or in shock?Can you see the problem?Be prepared to expose the area of injury or concern, but preserve thecasualty’s dignity as much as possible.Can 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).Can you wake them up?Do they respond to your voice or a gentle shake?Are 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.AAirwayBBreathingCCirculationDDisabilityControl any serious bleeding (Page 23) and look for and treat the eectof blood loss or Shock (Page 22).Primary SurveyEMERGENCY FIRST AIDEExposureAre 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.DDangerRResponse

The Secondary Survey is undertaken to discover the extent of the casualty’s injuries or illness,or to assess the eectiveness 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-Haveagoodlookatthecasualtyfromtoptotoelookingforobvioussignsofbleeding.-Lookforsignsofhiddenbleedingsuchasbruisingorswelling.-Pale,coldskinorsignsofshock?-Havetheygotbloodontheirclothing?-Controlanyseriousbleedingasapriority.Head and Neck-Arethereanysignsofinjurytotheheadsuchaslumps,bruisingorbleeding?-Swellingorbruisingaroundtheeyes?-Blood,orpalecolouredliquidleakingfromearsornose?-Doestheaccidentsuggestaneckinjury? If so, assume it.Torso and Limbs-Arethereanyobvioussignsofinjury?-Doesthecasualtyseemtohavetroublebreathing?-Dotheyexperiencepainonbreathingorcoughing?-Doesthehistoryoftheincidentsuggestabloworcrushinginjurytothetorso?-Aretheirarmsandlegsthecorrectshapeandpointingintherightdirection?-Aretheyshowingsignsofbleedingorshockwithnoobviousexternalbleeding?Pockets and Clothing-Isthereanyinformationthatmightexplaintheirsituation?-Lookparticularlyformedicalinformationonlocketsorbracelets.-Aretheycarryingmedication?-Removeanysharporbulkyitemsfromtheirpocketsbeforemovingthemtoavoidpotentialinjury.EMERGENCY FIRST AID7Secondary Survey

-Fullyconsciousandaware-Eyesopenspontaneously-Reexesareintactandnormal-Appearssleepywitheyesclosed-Eyesopentospeechorsound-Speechmaybeslurred-Maymakeuncoordinatedmovements-Reexesareintact-Appearsdeeplyasleepwitheyesclosed-Doesnotopeneyestospeech-Functioningreexes-Appearsdeeplyasleepwitheyesclosed-Doesnotopeneyes-Doesnotrespondtoanystimulus-NofunctioningreexesApatientwitharesponseofanythingotherthan‘A’willrequireemergencymedical attention.-Mayappeardisorientated-MayexhibitincoherentspeechordicultyansweringquestionsThe 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 reexes 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 ACVPU scale:UUNRESPONSIVEAALERTPPAINCauses of UnconsciousnessApersonmaybecomeunresponsivedueto 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-PerformaPrimarySurveytoestablishairwayand breathing.-Dial999foranambulance.-PerformaSecondarySurveytondandtreat(if required) other injuries.-Placethecasualtycarefullyintotherecoveryposition to maintain the airway.-Continuetoobserveandmonitor.Whatever the initial cause the immediate First Aid treatment would be the same.The Unresponsive CasualtyEMERGENCY FIRST AIDVVERBALCCONFUSED

1Place the hand closest to you up and outof the way.Apersonwhohassueredsignicantinjuryshouldbetreatedinthepositionfound,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 Deb Advanced Care Post Arrest CareEarly Access-Earlyrecognitionandanimmediate999callarecritical. 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 DebAs soon as an AED (Automated External Debrillator) 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 specic training. There is no reasonto delay debrillation.Early ACLSEective advanced life support will be provided by the emergency medical responders andmay include high-quality CPR, debrillation, oxygen and use of medicines or appropriatedevices.Good Post Arrest CareComprehensive, multidisciplinary system of care which will include close monitoring, specic*Compression Only ResuscitationCardio Pulmonary Resuscitation means combining chest compressions with rescue breathing. Iffor any reason the rescuer does not feel condent 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

Check RESPONSE-Checkinitiallyinthepositionyoundthem.-Speakloudlytothem.-Usetheirnameoraskthemtoopentheireyes.-Ifnoresponse,shakethemgentlybytheshoulder.If they respond:-Leavetheminthepositionthatyoufoundthem-Checktondoutwhatmightbewrong.-Observeandreassessregularly.If they do not respond:Open the AIRWAY-Undoanythingtightaroundtheneckandremovetheirglasses if worn.-Placeonehandontheforeheadandtwongersoftheother hand under the bony part of the jaw.-Gentlyrotatetheheadbackwardsandliftthejaw.-Thisliftsthetongueandstraightenstheairway.Check for NORMAL BREATHING-Placeyourearoverthecasualty'snoseandmouth,lookingdownwards towards their feet.-Checkfornomorethan10seconds.LOOK -formovementLISTEN -forbreathingFEEL -forbreathonthecheekCall EMERGENCY SERVICESAsk someone to fetch an AED if one is available.-Ensurethatanambulanceiscalled. Trytocallyourselfwithoutleavingthe casualty.-Ifyouhaveaspeakerphoneswitchiton.-CallingambulancecontrolmeansthattheycanlocatethenearestAEDand arrange for it to be sent if necessary. They can also offer advice ondiagnosis and treatment and if necessary talk you through theprocedure.Assess breathing whilst making the callEMERGENCY FIRST AID3Basic Life Support (Adult)