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PaediatricDavid OlleyEmergencyFirst Aid

Safety Publishing Ltd483 Green LanesLondonN13 4BSinfo@safetypublishing.co.ukwww.safetypublishing.co.uk©2017 Safety Publishing Ltd. All rights reserved. No part of this publication may be reproduced in anyform or by any means without the written permission of Safety Publishing LtdFirst AidContentsAirway 7Assessment 6BLS Child 9BLS Infant 13Bites and Stings 30Bleeding 27Calling Emergency Services 5Choking 21C.P.R. 12Cross Infection 4Defibrillation 16Febrile convulsions 20First Aid Kit 4Minor injury 29P.P.E. 4Recovery Position 17Scene Safety 6Seizure 19Shock 26Wound Dressing 28PaediatricEmergency

2E.P.F.A.Emergency Paediatric first aidEmergency Paediatric first aid training is designed for people who work with orspend time with children and who may be called upon to offer first aid in theevent of injury or sudden illness. This could include parents, babysitters or thoseemployed in professional childcare situations.1. Understand the role and responsibilities the emergency Paediatric first aider.▪ Explain the role and responsibilities of the Paediatric first aider.▪ Explain how to minimise the risk of infection to self and others.▪ Identify criteria for using personal protective equipment.▪ Understand contents of Paediatric first aid kit.▪ Understand the importance of reporting and record keeping.▪ Define an infant or child with regard to first aid.2. Assessment▪ Conduct a scene survey▪ Conduct a primary survey on an infant and child▪ Know when and how to call for help.3. Providefirstaidtoaninfant/childwhoisunresponsiveandbreathingnor‐mally▪ Use of the recovery position▪ Monitoring and infant/child whilst in the recovery position.▪ Treat an infant or child suffering a seizure.4. Beabletoprovidefirst‐aidforaninfant/childwhoisunresponsiveandnotbreathing normally.▪ Basic life support for infant/child▪ Administer CPR using an infant and child mannequin.5. Recognise foreign body airway obstruction▪ Give first aid for an infant or a child whose choking▪ Identify severity of choking event6. Give first aid to infant or child with external bleeding.▪ Explain the effect of severe blood loss on an infant or a child.▪ Demonstrate control of external bleeding.7. Provide first aid to an infant or child suffering from shock.▪ Recognise the signs and symptoms of blood loss shock.▪ Treat a child or infant suffering from blood loss shock.8. Givefirst‐aidtoaninfantorchildwithbites,stingsandminorinjuriesLearning outcomes○ Bites○ Stings○ Minor wounds○ Grazes○ Bruises○ Minor splinters○ Nosebleeds

3Role and ResponsibilitiesFirst AidPaediatric First aid is, quite simply, the initial treatment given to a baby or childwho suffers injury or sudden illness.If the injury or illness is minor then it may be the only help that the child receivesor needs.If the condition is more serious then first aid may be given until the child is handedover to a better qualified person or medical practitioner, who could be aparamedic or doctor.The basic principle of first aid is to keep the child alive, to prevent their conditionfrom deteriorating and to hand them over in the best possible condition in thecircumstances.The Paediatric First Aider should possess the following skills, and be able to:▪ deal with conditions which are immediately or potentially life-threatening.▪ provide first aid for conditions which may not be life-threatening but will requiretreatment to prevent further harm, before the emergency medical services arrive▪ provide first aid response in cases where injuries are minor and thetreatment may be all the child requires▪ provide reassurance to the patient as well as other children in the vicinity▪ record all actions and interventions and pass this information on whenhanding over to better qualified persons▪ be aware of the location and contents of emergency first aid kits▪ be aware of the need for and competent in, raising the alarm or callingemergency services in a timely manner▪ Make themselves aware of any pre-existing conditions suffered by children intheir care▪ display the personal skills needed, including composure, competence and self-confidence, while understanding their limitations▪ be prepared to do what is necessary to maintain their knowledge and skills to therequired level▪ work only within the scope of their training and competence.

4Role and responsibilitiesCross infection and personal protectionWhen dealing with an adult casualty the first aider has to be very aware of the risk ofinfectionwithblood‐bornevirusessuchasHIVorhepatitis.Thisriskismuchlesswhendealing with infants and children.Iftheinfantorchildisamemberofthefirst‐aider’sfamilythenan y riskwouldbeknown and probably immaterial.If dealing with blood or other body fluids it is still considered best practice to wearglovesorotherformofbarrierdeviceandtheseshouldbeavailableinfirst‐a idk its .Whether a Paediatric first aider would feel justified in withholding treatment due tothe absence of these barrier devices is a judgement for themselves.First Aid KitsArey ouaware ofthelocationandcontentsoffirst‐aid kits?If not, the best time to familiarise yourself with themwill be before you need one.First‐aid kits should be clearly mark ed with thesymbol of first‐aid, a white  cr oss o n a greenbackg round. They should contain only first‐aidequipment.Contents of first aid boxes would depend upon the assessment of risk and any specificproblems that might be anticipated. The contents of a box in the home is likely to bevery different to a box in a professional child care setting.Suggested minimum contentsGeneral Guidance Leaflet 1Disposable gloves, nitrile preferred 2 pairsSterile wrapped plasters 20 assortedSterile eye pad, with bandage 2Triangular bandages 4Wound dressings with bandage 6 medium - 2 largeIndividually wrapped wound wipes (Non alcohol) 6Safety Pins 6 assortedSome of this equipment may date expire so needs to be checked regularly.Any equipment used should be replaced as soon as possible.These are suggestions only and are minimum quantities. Your kit may be different,to meet your requirements.

112or999arethefree24‐hournumberstocallforemergencyhelpWhen you get through the operator will ask you which service you require. If you askfor an ambulance the ambulance controller will then take details of why you needhelp.The initial questions are to prioritise just how urgent the problem is. In particular theywill ask you if the person you’re calling about is unconscious, has breathing difficultiesorisbleedingastheseconditionsmaybeimmediately life‐threateningandneedthefastest response.▪ Try to stay calm and to pass on to ambulance control as much informationabout the casualty’s condition as you can.▪ Only pass on information you know to be true, guesses or assumptions maymean you are given inaccurate advice.▪ Give as much information about your location as possible to help theambulance crew find you.▪ Don’t hang up until the ambulance controller tells you to.▪ In an emergency the controller is trained to talk you through procedures or toremind you to do checks that you may not have thought of. This can bereassuring at a very tense time.▪ If you are calling from the street then stay with the casualty.▪ If you are calling from home then make sure doors are open and pets shutaway.▪ At night leave all your lights on to make it easier for the ambulance to findyou.If the event takes place within a professional childcare environment then there willalmostcertainlybebetterqualifiedfirst‐aidersinattendanceandtheywilltakeontherole of producing records and reports. However, they will still need to know what yousaw and what you did. In a public environment or at home then healthcareprofessionals such as paramedics or doctors will need to know what you saw and whatyou did. It is a very good idea to write down these details as soon as possible after theevent whilst your memory is still clear.Record KeepingInfant or child?▪ A neonate is birth to one month▪ An infant is one month to one year▪ A child is one year to puberty.If you are unsure whether a child may have reached puberty, treat them as an adult.5Role and ResponsibilitiesMaking an Emergency Call

Scene safetyAt the scene of any incident that might involve injury it is very important that the firstperson at the scene carefully assesses the risk of injury to themselves, the victim oranyoneelseinthevicinity.Thisreducestheriskofthefirst‐aiderbecomingavictimand therefore unable to assist their patient.As you approach the scene look carefully for anything that is or may become a risk toyour own health and safety. Look particularly for things like electricity, escaping gas,fire or smoke, traffic or immersion in water.Remember that circumstances can change quickly, so remain alert and be preparedto respond appropriately.Primary surveyWhen faced with an infant or child who has been injured or suffered sudden illness youneedtorapidlygather asmuchinformationaspossibleandalsounder tak e first‐aidtreatments based on that information.This gathering of information is known as the primary survey.The first stage of the primary survey is to assess the situation and if possible try todecide what may have happened and how. If you know what has happened or how ithas happened then that may indicate what is wrong with the child. As an example, ifa child has fallen from a height of more than a metre we might assume that they havesuffered a head injury or possibly a spinal injury, based purely on what happened.If a child was seen eating small sweets and suddenly appeared to have a problembreathing we might assume that they have suffered an obstruction to their windpipedue to the sweet “going down the wrong way”The next stage would be to assess the condition of the child at that moment.There are certain things that we need to know immediately:▪ Are they safe where they are? (Danger)▪ Are they conscious or responsive? (Response)▪ Are they able to breathe normally? (Airway)▪ Are they breathing normally? (Breathing)▪ Are they bleeding or in shock? (Circulation)Remember – D.R.A.B.C.DangerIn the vast majority of cases casualties should be moved as little as possible, prior tothe arrival of the emergency services. The best position to treat them in is the positionthat you find them in. However, if there is an imminent threat to the casualty fromtheir environment or surroundings then it may be essential to move them to a saferenvironment.If electric shock is suspected, ensure that the electrical supply is isolated, ideally at themain switch, so if you can remove the danger from the casualty then do so, or failingthat, remove the casualty from the danger.6Assessment

AirwayResponseAs you approach your casualty start to get an impression of their level of consciousness.If they are sitting up, looking around and crying then you can be certain that they arefully conscious and therefore they are breathing and their heart is beating.(Crying is a wonderful sound to a Paediatric first aider in an emergency)On the other hand, if they are lying still and not making any noise you might beconcerned that they are unconscious. Now your greatest priority is to find out if theyare able to breathe, if they are breathing normally and what other serious injury theymay have suffered. Now your priorities are A.B.C.Can they breathe?If they are unconscious open the airway with head tilt /chin lift. If they are conscious treat conditions such aschoking.AairwayAre they breathing normally?If they are unconscious and not breathing normally give 5rescue breaths and perform CPR for one minute beforeraising the alarm.If they are unconscious and breathing normally examinethem for other injuries and place them carefully into therecovery positionIf they are conscious but have breathing problems such asAsthma treat this condition before moving to the nextstep.BbreathingAre they bleeding or in shock?Control any serious bleeding and look for and treat theeffect of blood loss or shockCall 999 / 112 for an ambulance.CcirculationAs food enters the back of the throat it sets off a series of reflexes which cause theopening to the windpipe to be temporarily closed off, preventing the food from‘going down the wrong way’. This is the swallow reflex.If this mechanism fails, the food may enter the top of the windpipe. This causesanother set of reflexes to trigger which results in a forceful cough that blows theobject clear. This is called the cough reflex.These reflexes are lost in the unconscious child. This means that the airway isunprotected and that anything in the child’s mouth could drop into their windpipeand block it. This could include food, blood, saliva and most commonly, the tongue.7Assessment

Airway (continued)As we become unconscious our muscles start torelax. The tongue is a muscle and as it relaxes ittends to fall to the back of the throat, blocking it.If the airway is blocked no oxygen can reach thelungs to be transferred to the blood stream.With no oxygen in the blood, tissues will begin todie.BreathingThe air that we breathe in contains around 21% oxygen. We keep enough for our ownneeds but still breathe out a mixture that contains about 17% oxygen. This is morethan enough to sustain life and it means that we can use our expired air to keepsomeone else alive.When we blow our expired air into a child’s lungs, oxygen will be absorbed into theirblood stream automatically, ready to be circulated.CirculationAre there any visible signs of severe bleeding?If they are bleeding severely then your priority would be to control bleeding with theapplication of direct pressure using your hands, pad or wound dressing.Once the serious bleeding is controlled down 999/112 for an ambulanceBe alert for and be ready to treat shock.Blocked airway8Assessment

Approach with CAREIf they RESPOND▪ If the child responds by opening their eyes, speaking or trying to move:▪ keep them in the position that you find them.▪ Check for other injuries and treat any conditions that are immediately lifethreatening.▪ Send for help or raise the alarm.▪ Continue to monitor their condition until the arrival of trained help.Make sure that there is no danger to yourself, the child or bystanders.Check for RESPONSE▪ Speak loudly to the child, ask them to open theireyes.▪ Gently stimulate them by tapping them on the shoulder.▪ Never forcefully shake the child.▪ Watch their face for signs of eye opening ormovement.If there is NO RESPONSE▪ Shout loudly for helpShout for HELP▪ If someone is nearby ask them to wait as you may need their assistance.▪ If you are alone, shout for help loudly to try to attract attention, but do notleave the child.Open the AIRWAY▪ Place one hand on their forehead and pressgently downward.▪ Place the tips of your fingers under thebony part of their jaw to lift and supporttheir chin.▪ Rotate their head gently backward.9BasicLifeSupport‐Child

Check for NORMAL BREATHINGKneel next to them with your cheek over theirnose and mouth looking down their chesttowards their toes.▪ Look – for chest movement.▪ Listen – for breath sounds.▪ Feel – for breath on your cheek.▪ Take no more than 10 seconds to check.If they are BREATHING NORMALLY▪ Treatanyimmediatelylife‐threateninginjury.▪ Turn them into the recovery position as soon as itis practical to do so.▪ Continue to monitor their breathing until the arrivalof help.If they are NOT BREATHING NORMALLY▪ Give five rescue breathsGive RESCUE BREATHSEnsure that the airway is open (headtilt – chin lift)Pinch the soft part of their nosebetween the index finger andthumb of the hand which ispressing on the forehead.10BasicLifeSupport‐Child

Take a breath and place your lipsaround their mouth, ensuring that youhave a good seal.Blow steadily into their mouth forabout one second until you see theirchest rise.Lift your head away whilstmaintaining head tilt – chin lift andallow the air to come out of theirmouth.Airway obstructionIf you have difficulty achieving an effective breath it probably means that theairway is obstructed.▪ Re‐checktheirmouthandremoveanyobviousobstruction(donotuseablindfinger sweep).▪ Make sure the head is tilted and the jaw is lifted properly.▪ Make sure you are making a good seal around the mouth.▪ Repeat up to five attempts to give effective inflations.▪ If unsuccessful move on to chest compressions.Give CHEST COMPRESSIONS▪ The objective of chest compression is to use the child’s own heart as amechanical pump.▪ The heart is like a rubber ball, as you compress it blood is forced out and due tothesystemofone‐wayvalvesthebloodisforcedintothecorrectdeliverypipesor arteries.▪ When pressure is released the elastic nature of the heart means that blood isdrawn back into it. Again, valves positioned at the entry and exit of thechambers keeps the blood flowing in the correct direction.▪ The child should be on a firm flat surface for chest compressions to be fullyeffective.11BasicLifeSupport‐ChildGive RESCUE BREATHS (Cont.)

Place the heel of one hand overthe lower third of the child’sbreastbone.Lift the fingers to ensure that youdo not press on the ribs.▪ In larger children or with small rescuers this may be done with both hands, asin adult chest compression.▪ Repeat at a rate of 120 compressions a minute.▪ Give 30 effective chest compressions.Give CHEST COMPRESSIONSPosition yourself with yourshoulder over the chest andwith your arm straight.Push vertically downward withenough force to compress thechest by one third of its depth.Combine CHEST COMPRESSION and RESCUE BREATHING▪ After 30 chest compressions stop and give two more rescue breaths.▪ Alternate 30 compressions with two rescue breaths.▪ If there is no response after one minute, and nobody has called for help,stop and dial 999 for an ambulance.▪ When you know that help is coming, continue with rescue breathing/chestcompressions at a ratio of 30 to 2 until help arrives and someone takes over.▪ If there is more than one rescuer present, change over every two minutes.▪ Try to keep the chest compressions at a regular speed and depth.▪ Keep pauses or stoppages as short as possible12BasicLifeSupport‐Child