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David OlleyAt WorkA practical guide to rst aid in the workplace9thEdition
First AidAt WorkThis handbook is ideal for use insupport of a properly structuredrst aid course. It will also proveinvaluable as ongoing referencefor someone who has completedthe course.9thEditionContentsIntroductionDenitions 2Roles & Responsibilities 2Personal & Scene Safety 2Infection Control 3First Aid Kits 6Summoning Help 5Record Keeping 4AssessmentPrimary Survey 7Secondary Survey 8Top to Toe Examination 9The Unconscious Patient 10The Recovery Position 11Basic Life SupportThe Chain of Survival 12CPR- Adult 13AED 17CPR - Child & Infant 20Sudden Cardiac Arrest 12Circulatory EmergenciesHeart Attack 21Stroke 22Circulatory Shock 23Fainting 54Bleeding & Blood LossRecognition & Control 29Wounds 30Internal Bleeding 30Foreign Bodies 31Minor Injury 32Life-threatning Bleeding 33Crush Injury 35Scalp WoundHead Injury 36Eye Injury 39Nosebleed 32Amputation 32Abdominal injury 35Respiratory EmergenciesThe Obstructed Airway 24Penetrating Chest Injury 27Closed Chest Injury 28Asthma 5538Musculoskeletal InjuryBones 39Fractures 40Fractured Skull 41Spinal Injury 42Pelvic Fracture 43Rib Fracture 43Collarbone Fracture 44Arm Fracture 44Leg Fracture 45Dislocations 45Soft Tissue Injuries 46Back Pain 47Burn InjuryBurns by Type 48Estimating Severity 48Corrosive Burns 50Electrical Burns 50Burns to the Airway 50Hyperthermia 51Hypothermia 51Related problems 49General burn treatment49Acute IllnessDiabetes 52Seizure 53Anaphylaxis 54Meningitis 56Poisons 57
First Aid is quite simply the initial treatment given to someone who suers injury or sudden illness.If the injury or illness is minor then it may be the only help that the casualty receives or needs. If the condition ismore serious then rst aid may be given until the casualty is handed over to the appropriate medical practitionerwho could be a paramedic, Doctor or hospital emergency department.The basic principles of rst aid are:▪ Keep the casualty alive.▪ Prevent their condition from deteriorating.▪ Hand them over in the best possible condition in the circumstances.Often referred to as the three “P”s▪ Preserve Life▪ Prevent further harm▪ Promote a good recoveryFIRST AID AT WORKIntroduction2Roles and ResponsibilitiesThe rst aider needs to have a great deal of common sense and to be calm in an emergency, as well as having acaring personality. Not everybody will be suitable.The ability to remain calm in an emergency comes from condence and condence starts with training and practice.You will need:▪ To deliver rst aid in the workplace competently and within the scope of their training.▪ To protect yourself, the casualty and others at the scene from potential danger.▪ To arrange for appropriate assistance▪ To identify where appropriate, the injury or illness aecting the casualty.▪ To decide on priorities and to oer the casualty the appropriate treatment for their condition.▪ To allow your casualties to retain their dignity and modesty and to respect their privacy.▪ To arrange for the transfer of the casualty to the appropriate medical authority or to their home.▪ To remain with them until they are handed over to the care of others.▪ To inform subsequent carers of your observations and any treatment.▪ To maintain records of the treatment given and the outcome.▪ To complete entries into an accident record book as appropriate.▪ To undertake the maintenance and restocking of rst aid boxes as supplied in the workplace.Personal and Scene SafetyAs you approach the scene, look for threats to your own safety. These may be obvious threats, such as movingtrac, re or unstable structures or they may be much less obvious such as escaping gas or electricity.It is essential that you use all of your senses to alert you to danger and remember that although it may be safe toapproach now, things can change quickly so remain alert and continue to monitor the situation.There may be occasions, particularly when dealingwith poison gas or electricity, where it will be unsafe to approachthe victim although you may wish to do so. If there are specialist personnel who can deal with this type of threatthen they should be summoned as a matter of urgency and you should not approach the casualty until you havebeen told by the specialists that it is safe to do so.You should identify yourself to the casualty and to others at the scene, as a rst aider and if you feel that you arethe best qualied person at the scene, attempt to take control of the situation. Delegate tasks such as controllingtrac or keeping people back from the casualty to others at the scene where appropriate.Injuries in the workplace may result from dangerous occurrences. The problems that caused the accident maypersist and oer a threat to rst aiders and subsequent rescuers.It is vital that the rst aider is aware of this when attending an accident scene.The rst aider should take control of the safety of the casualty and if necessary, protect them from the inexpertattention of untrained people who may be trying to help but could cause further damage.In general terms, the seriously injured casualty should only be moved if it is to save their life, at leastinitially.Where there are multiple casualties then bystanders might be used to help in rst aid duties or just to reassurecasualties with minor injuries, although you must bear in mind the bystanders may have witnessed the eventsthemselves and may also be in need of reassurance.
Blood-Borne Pathogens Personal Protective Equipment▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Safe Working Practice▪ ▪ ▪ If you think you have been exposed:3FIRST AID AT WORKInfection Control
The records and the way they are kept should comply with the EU General DataProtection Regulation (GDPR) ▪ ▪ ▪ ▪ ▪ Note takingWhen you are examining or treating a casualty it can be very helpful tokeep records of what you see and what you do. Wherever possible, tryto keep records as you go along. This is likely to be much more accuratethan your memory after the event.When keeping records of events it is also very useful to note the timethat certain things happened when certain observations were made. Bylooking at the timescale it becomes easier to not only see how thecasualty’s condition is changing but also how quickly or slowly thecondition is changing.These records should be made available to the practitioner who takes over the care of your casualty. They canbe in the form of your written records along with a verbal explanation of what you have seen and what you havedone. Sometimes, a single observation that may not mean very much to you could be very important to a bettertrained and more experienced practitioner.RIDDORReporting of Injuries, Diseases or Dangerous Occurrences Regulations 2013RIDDOR is the law that requires employers and other people in charge of work premises report and keep recordsof:▪ Work-related accidents that cause death.▪ Work-related accidents that cause certain serious injury (reportable injuries)▪ Diagnosed cases of certain industrial diseases.▪ Certain “dangerous occurrences” (incidents with the potential to cause harm)▪ If you are an employer, self-employed or in control of premises, then it is a legal obligation to report any seriousincident or near miss, as well as injuries and some illnesses other than minor particularly if they result in morethan seven days o work.A full schedule of reportable incidents can be found here:www.hse.gov.uk/riddor/reportable-incidents.tmAll reporting can now be done online here:www.hse.gov.uk/riddor/report.html#onlineFIRST AID AT WORK4Accident Records
999 and 112 are the free 24-hour numbers to call foremergency helpWhen you call 999 you will be connected directly to an operator in anemergency control centre. The operator will need to ask some questionsthis point. This will not delay the ambulance, but is designed to helpprovide a more appropriate response. There is some information thatthe operator will require.Your location▪ Try to identify your location as accurately as possible, with address including postcode.▪ If away from home, look for obvious landmarks, street names or, if possible, ask someone from the area.The phone number you are calling from▪ In case the connection is lost and the operator needs to contact you.What has happened?This information will be enough to start the process. You may then be asked questions about the casualty, youranswers to these questions will help the operator to oer appropriate and important rst aid advice while youare waiting for the arrival of the ambulance.The casualty▪ Their approximate age, sex and known medical history▪ Are they conscious, breathing normally? The operator can provide advice on what to do if they are notbreathing normally.▪ Are there any signs of bleeding? The operator can provide information on how best to control the 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?▪ Which 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?▪ If you are outside, stay with the patient.▪ Call ambulance control immediately if the patient’s conditionchanges.▪ If possible, send someone to meet the ambulance and guide themto your location.▪ If you are at home, ensure doors are unlocked and pets put awaysafely.Try to stay calm, the operator is there to help you and to help the patient.Listen and act on the advice they give until the emergency respondersarrive.Phone for an ambulanceWhile waiting for the ambulance5FIRST AID AT WORKSummoning Help
The rst aid kit is a collection of equipment and material that can be used in treating the victim of accident, injuryor sudden illness. It may be a kit individual to the user, or maybe made available for others to use.First aid kits in the workplaceThe provision of rst aid kits in the workplace is the responsibility of the employerand is governed by the Health and Safety (rst aid) regulations 1981First aid equipment should be contained in a closed, dustproof box of suitable size,clearly marked with the symbol for rst aid, a white cross on a green background.First aid boxes should contain nothing but rst aid equipment. There is no place inrst aid boxes in the workplace drugs or medicines.There is a British standard BS 8599 for rst-aid kits. It is not a legal requirement for employers to purchasekits that comply with this standard. The contents of the box is dependent on an employer’s rst-aid needsassessment.This means the employer may have a rst-aid kit that complies with BS 8599 and that matches or exceeds thendings from the needs assessment or they may have access to a rst-aid kit whose contents matches the ndingsfrom the needs assessment but does not necessarily comply with the requirements of BS 8599.Contents of a workplace rst-aid kit – BS 8599 1 2019Component Small Medium Large TravelPersonalissueCriticalinjuryGuidance leaet 1 1 1 1 1 1Contents list 1 1 1 1 1 1Medium sterile dressing 12cm X12cm 2 4 6 1 0 0Large sterile dressing 18cm X 18cm 2 3 4 0 1 0Triangular bandage 90cm X 90cm X 127cm 2 3 4 1 1 0Sterile adhesive dressings Individually wrappedassorted sizes40 60 100 10 10 0Alcohol free moist cleansing wipes Min 80 cm² 20 30 40 10 4 0Adhesive tape roll 2.5cm X 5m 1 2 3 0 0 0Nitrile disposable gloves pairs (large) 6 9 12 2 2 2Sterile nger dressing 3.5 cm x 30 cm 2 3 4 0 0 0Resuscitation face shield with one-way valve 1 1 2 1 1 0Foil blanket 130 cm X 210 cm 1 2 3 1 1 1Burn dressing gel soaked, minimum 100 cm² 1 2 2 2 0 0Shears / Tu Cut 1 1 1 1 1 1Performing bandage 7.5 cm x 4 m 1 2 2 0 0 0Adhesive dressing 7.5 cm x 7.5 cm 0 0 0 1 0 0Trauma dressing large 15 cm x 400 cm bandage with15 cm 18 cm pad0 0 0 0 0 2Trauma dressing medium 10 cm x 400 cm bandagewith 10 cm X 18 cm pad0 0 0 1 0 0Haemostatic dressing 0 0 0 0 0 2Tourniquet 0 0 0 0 0 1Employers are required to make a risk assessment to decide what their hazard levels are and how manyemployees are involved in the area to be covered. Where there are special circumstances, such as remotenessthrough emergency medical services, shiftwork or sites with several separate buildings, they might need to bemore rst aid kits available.FIRST AID AT WORK6First Aid Kits
Primary and Secondary SurveyThe primary survey is conducted to nd and simultaneously treat conditions that are potentially life-threatening.The secondary survey should take place only after the primary survey and when you are sure that any life-threateningconditions have been treated eectively.Approach with careBe aware of potential danger to yourself, bystanders or thecasualty. Think about infection control procedures, particularlygloves.Assess responseDo they open their eyes to speech?Do they open the eyes to gentle movement?If unresponsive, shout for help in requesting AED if one isavailable.Open the airwayCheck that their airway is clear and open.If necessary, open the airway with head tilt/chin liftConsider possible cervical spine injuryIf the airway is obstructed Take steps to clear the airway.Check for normal breathingIf unresponsive and not breathing normally, start CPRIf unresponsive and breathing normally, place them carefully intothe recovery position and continue to monitor the condition.Conduct secondary survey and treat serious injury if appropriate.Check for serious bleeding orblood lossControl serious bleeding with direct pressure.Use elevation if injuries permit.Apply a wound dressing if available.Look for and be prepared to treat blood loss shockMaintain careEnsure professional help has been called.Continue to monitor their condition.Reassure them continuously.Perform rst aid procedures as necessary.Hand over to an appropriate practitioner.Primary Survey - TraumaBe alert for danger to yourself, the casualty or others at the sceneDDangerCan you wake them up?Do they open their eyes to sound or movement?RResponseMaintain airway with cervical spine controlAAirwayAssess breathing. Are they breathing normally?BBreathingAssess circulation with application of bleeding control. Anticipate shock.CCirculation7FIRST AID AT WORKPrimary Survey
Approach with careBe aware of potential danger to yourself, bystanders or thecasualty. Think about infection control procedures, particularlygloves.Assess response If unresponsive, shout for help in requesting AED if one isavailable.Open the airwayCheck that their airway is clear and open.If necessary, open the airway with head tilt/chin liftIf the airway is obstructed Take steps to clear the airway.Check for normal breathingIf unresponsive and not breathing normally, start CPRIf unresponsive and breathing normally, place them carefully intothe recovery position and continue to monitor the condition.Maintain careEnsure professional help has been called.Continue to monitor their condition.Reassure them continuously.Perform rst aid procedures as necessary.Hand over to an appropriate practitioner.Primary Survey - Sudden CollapseSecondary SurveyDuring the secondary survey, the patient will be checked athletically for any clues as to the current condition.Ideally, these checks should take place with a casualty in the position that you found them, at least until you haveascertained that it is safe to move them.The secondary survey may be carried out on an unconscious breathing casualty, but remember that care of theairway is the priority so if you have any doubts or problems with the airway place the patient carefully into therecovery position rst and then carry out the secondary survey in this position.Where possible,make a note of your ndings. This may be important to subsequent carers.There are three elements to the secondary survey:▪ History/mechanism of injury (MOI)▪ Signs▪ SymptomsTaking a historyThe history refers to what happened, how it happened and how it has aected the patient. It will give importantinformation or clues as to what may be wrong with them. Sometimes, the history is all we need to know, for example:If a casualty has fallen more than 3 m we can assume a spinal injury from the history alone and we should treat itappropriately.The history may be obtained from the patient, from friends or family, or from bystanders and witnesses.When taking a history, remember S.A.M.P.L.E.S = Signs / SymptomsA = AllergiesM = MedicationsP = Past medical historyL = Last oral intakeE = EventFIRST AID AT WORK8Primary and Secondary Survey
Signs and SymptomsSigns - how do they look?These are things that you can observe yourself, such as skin colour.Symptoms - how do they feel?These are things that the patient tells you. It often starts with pain but mightinclude feeling such as dizziness, sickness,etc.Allergies Ask if they have any allergies. This could include to medication, food orother environmental factors. Check for medical tags or bracelets.Medications Ask if they are taking any medications. Have they taken any recently?This could include over-the-counter medicines and recreational drugs.Past medical history Have they ever suered from any illness? Have they ever been admitted tohospital? Have they ever had surgery?Last oral intake When did they last had anything to eat or drink?Events What happened? How did it happen?S.A.M.P.L.E.Check their armsAsk them if they have any pain in their arms.Ask them if they can move their arms normally.Do they have full movement in their elbows andwrists?Look for signs of obvious injury such as blood,swelling or deformity.Ask them if they have any strange sensations, suchas pins and needles or burning sensations in thearms and hands.Check their grip by getting them to squeeze yourngers.Check their Face and HeadLook for blood or watery liquid, or possibly a mixture of both, leaking from the nose or ears.Look for bruising around the eyes, particularly where there is no damage to the face.Look for damage inside and around the mouth, which may later lead to airway problems.Look at the colour of the skin, in particular look for blue or grey appearance of the lips orearlobes (cyanosis) which may indicate low levels of oxygen.Look for obvious signs of blood or swelling around the head or in their hair.Check the pupils of the eyes to see if they are of equal size and reacting normally to light.Check the neckAsk them to keep their head and neck still.Loosen any tight clothing around the neck.Look for and remove any ligature.Look for bruises or abrasions that might suggeststrangulation.Ask them if they have any pain in their neck.Ask them if they have any strange sensations intheir arms and legs.Look at the chestLook for signs of obvious injury such as blood onthe clothing.Ask them to take a deep breath and watch theirface for signs of discomfort.Does the chest move equally on both sides?Listen for coughing or noisy breathing.Listen for any unusual sounds.Check the abdomenAsk them if they have any abdominal pain.Is the pain in any particular area of the ab-domen?Has the pain stayed in one place onmoved?Do they feel sick or have they vomited?Palpate the abdomen only if you havebeen trained to do so.Check their legsAsk them if they have any pain in the legs.Ask them if they can move their legs normally.Contrast and compare one leg with the other.Do they look the same size and shape?Are they pointing in the correct direction?Do they have any odd sensations, such as pins andneedles, in the legs and feet?If possible, feel and look at the skin of the feet.Is it cold to the touch or grey blue in appearance? Thiscould indicate injury or circulatory problem.Top to Toe Assessment9FIRST AID AT WORKTop to Toe Examination
Unconsciousness can be dened as a reduction in activity in thenervous system that leads to changes in the casualty’s responsesto the world around them.The management of the unconscious casualty may be the mostimportant thing that a rst aider will learn.Anyone who is unconscious is in grave danger due to the absence ofthe cough and swallow reexes which guard the airway. Anything in theirmouth could block the airway. This might include food, blood, saliva andvomit, but very commonly it is their own tongue.Assess level of responseAt some point you will have to establish the casualty's level of response so that you can tell if it is changing.Once you have established the level then you need to monitor the changes and pass this information on tosubsequent carers. To do this you can use the AVPU scale.Anyone who scores P or U on this scale requires urgent medical attentionFully conscious and aware, their eyes open spontaneously. They react normally to events and theirreexes are normal.May appear sleepy with their eyes closed, but their eyes open to speech or sound. Their ownspeech may be slurred and they may make uncoordinated movements.Appear asleep, with eyes closed and do not open their eyes to speech. There is little or no muscularcoordination but they still have functioning reexesAppeared to be asleep with their eyes closed and do not open their eyes to any stimulus. They donot react in any way and their reexes are absentAAlertVVerbalPPainUUnconsciousThe AirwayAs they lose consciousness their muscles lose their stiness or tone and relax. As the muscles of the tongue relaxthe tongue becomes oppy and may fall across the back of the throat. If it does not form a complete blockagethe casualties breathing may become noisy, with loud snoring. If the blockage is complete they will stop breathingaltogether. The base of the tongue is attached to the jaw, so by tilting the head gently backward and lifting thejaw (head tilt/chin lift) the tongue can easily be lifted from the back of the throat.Treatment of Unconsciousness▪ Perform a primary survey to establish airway and breathing.▪ Perform a secondary survey to nd and treat (if required) other injuries.▪ Place the casualty carefully into the recovery position to maintain the airway.▪ Send for medical help.▪ Continue to observe and monitor.FIRST AID AT WORK10The Unconscious Casualty
The aim of the recovery position is to maintain and protect the airway by placing the casualty in a position on theirside with the head lower than the chest. This allows allows for drainage of blood, saliva or stomach contents fromthe mouth. This, in turn, reduces the risk of the corrosive stomach contents entering and damaging the airway andlungs due to the absence of the swallow and cough reex.Before moving them▪ Check the area oer dangerous objects▪ Remove their glasses if they are wearing any▪ Remove sharp or bulky items from their pockets▪ Undo or remove any potential constriction from around the neckPlace the hand closest to you up and out of the way.Bring the furthest arm across and hold the hand alongside the face.Keep holding the hand against their face, to support their head as theyroll.Recovery position (Step 1)Reach down to the further knee and pull it up, keeping the foot at onthe oor.Keep your hand on the knee.Recovery position (Step 2)Pull gently on the knee to roll them toward you, supporting them onyour legs.Pull up on the need to prevent them from rolling back.Knee and hip should be at 90°Recovery position (Step 3)Adjust the head to keep the airway open.Do not cover themMonitor their breathing closely and be prepared to roll them onto theirback and start CPR in necessaryEnsure that an ambulance is on the wayRecovery position (Step 4)11FIRST AID AT WORKThe Recovery Position
Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating.Although more common in people with a history of heart disease it can aect anyone at any time.Unless SC A is treated within very few minutes it will usually result in death of the patient.The heart has an electrical system which controls the rate and rhythm of the heartbeat. Problems with thiselectrical system can cause irregular heartbeats, called arrhythmia.There are many dierent types of arrhythmia, some can make the heart beat too fast, some too slow and somewith an irregular rhythm. Some may cause the heart to stop pumping blood to the body.These are the arrhythmia's that cause sudden cardiac arrest.A sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest involves a disturbance in theelectrical system, whereas a heart attack is a problem with blood supply to the heart muscle. Sudden cardiacarrest however, may happen during or after recovery from a heart attack.People who have had a heart attack are at higher risk for sudden cardiac arrest, although it may aect anyone.Most people who suer SCA will die from it, often within minutes. The only treatment that is likely to reversethe condition is debrillation. A debrillator is a device that sends an electric shock to the heart to restore itsnormal rhythm.DebrillationThe machine used to deliver the shock is a debrillator and the type of machine most commonlyused outside of a specialist hospital unit would be an Automated External Debrillatoror AED.Debrillators have been in use for many years, but their use in the past has beenrestricted to individuals with specialist knowledge.The problem has never been in knowing how to shock but in knowing when toshock and the danger was in giving a shock to someone who didn’t need one. TheAED has solved this problem by using a computer to recognise whether or not acasualty needs a shock, and by not charging up or delivering a shock to someonewho would not benet from one.This means that AEDs can be used safely by non-medical people to save lives in suddencardiac arrest.Seizure and Sudden Cardiac ArrestBe suspicious of cardiac arrest in any patient presenting with seizureand carefully assess whether the victims breathing normally.If they are not breathing normally, or you are unsure, start CPRThe Chain of SurvivalThe chain of survival demonstrates the steps that are necessary to increase the casualties chance of survivingsudden cardiac arrest. Their chances will be greatly improved when all of the links are in place.FIRST AID AT WORK12Sudden Cardiac ArrestEarly Access Early CPR Early Deb Advanced Care Post Arrest Care
Early recognition and emergency callSudden cardiac arrest can happen to anyone at any time. If anyone is unresponsive, not breathing, normally(occasional gasping breaths) or if you are unsure, call 999 immediately. If there is an AED close by send somebodyto fetch it if possible. Sudden cardiac arrest may be associated with seizure, so in the event of treating seizurecheck very carefully for normal breathing and start CPR if necessaryEarly CPRThe sooner chest compressions are started, the better the chance of survival for the casualty. The emphasis shouldbe on immediate and good quality chest compressions. If you are trained, provide 30 chest compressions followedby 2 rescue breaths and repeat the cycle until the AED is ready for use or emergency medical responders take overthe care of the casualty. If a rescue is untrained, they should concentrate on chest compression only resuscitation.Early debrillationThe chance of survival decreases by around 10% a minute so early debrillation is critical. As soon as an AED(automated external debrillator) becomes available it should be attached to the patient’s chest following thediagram on the back of the pads. AEDs are safe and eective and designed for use by untrained persons, so willnot harm the patient. There is no reason to delay debrillation.Early advanced careStarts with the arrival of the emergency medical services and may include debrillation or the use of somemedications as well as high-quality CPR and careful monitoring. Urgent transport to hospital then takes place.Eective post-cardiac arrest careAt rst aider level this will involve placing them into the recovery position and monitoring their breathing closelyuntil the arrival of Emergency Medical Services. Be prepared to re-start CPR if necessary.Basic Life Support - Adult SequenceApproach with CARE▪ Be aware of any potential danger or threat your own health and safety, as well as that of the casualty andother bystanders in the vicinity.▪ If it is safe to deal with the threat, then do so.▪ If you cannot deal with the threat immediately, but it is safe to move the casualty away from the threat, thendo this rst.▪ If it is unsafe to approach the casualty in any way then stay back until the arrival of trained or specialist helpthat can make the area safe▪ Check for response, initially in a position that you nd them.▪ Speak loudly to them.▪ Use the name or ask them to open their eyes.▪ If there is no response to speech, shake them gently by the shoulder.Assess ResponseIf they respond▪ Leave them in the position that you found them.▪ Check to nd out what might be wrong.▪ Get help if required.▪ Observe and reassess regularly.If they do not respond.▪ Open the airway and check for normal breathing.13FIRST AID AT WORKThe Chain of Survival & Basic Life Support
▪ Turn them onto their back.▪ Remove anything tight around their neck and remove their glasses,if worn.▪ Place one hand on the forehead and two ngers of the other handunder the bony part of the jaw.▪ Gently rotate the head backward and lift the jaw. This lifts the tongueand straightens the airway.Open Airway▪ With the airway open with head tilt and chin lift, position your earclosely over the patient’s nose and mouth, facing towards their toes.▪ Look for movement of the chest and abdomen.▪ Listen for the sound of breath from the nose or mouth.▪ Feel for breath on your cheek.▪ Check for no more than 10 seconds.▪ If they are not breathing normally, call for an ambulanceCheck for Normal BreathingAgonal BreathingThe emphasis should be on listening for normal breathing.It is not uncommon for victims of sudden cardiac arrest to appear to continuebreathing, sometimes for severalminutes. The breaths will often be noisy, slow and infrequent, as if gasping for breath.This is called agonal breathing and should not be confused with normal breathing.If you are unsure or you have any doubt whether they breathing is normal, then you should act as if they arenot breathing normally and proceed with CPR.▪ If possible, use a mobile phone and stay with the patient whenmaking the call.▪ Activate the speaker function on the phone.▪ The ambulance control operator will be able to reassure andsupport you as they talk you through the procedure for performingCPR.▪ They will also ensure that the nearest available AED is sent to yourlocation as quickly as possible.Call an Ambulance▪ If there is someone else available, send them for an AED.▪ Tell them to look for the AED sign.▪ If you are alone, do not leave the casualty, but start CPR with chestcompressions immediately.Send for an AEDFIRST AID AT WORK14CPR - Adult
Kneel by their side,level with their chest.Place the heel of one hand in the centreof the chest, on top of the lower half ofthe breastboneRescue Breaths (Step 1)Position yourself so that yourshoulders are directly above the chest,the arms are straight and the elbowsare locked.Do not apply pressure over the upperabdomen or the bottom end of thebreastbonePlace the heel of the other hand on topof the rst.Interlock your ngers to stop thempressing on the chest wall and cominginto contact with the ribs.Push straight down on their chest to a depth of 5 to 6 cm.Release the pressure completely between compressions allowing the chest to re-expand but keeping your handin contact with the surface of the chest.Ensure your movements are smooth and not jerky.Compress the chest at a rate of 100 to 120 compressions per minute.Your performance is liable to deteriorate as you get tired, so for this reason it is recommended that if anotherrescuer is available and can perform chest compressions you should change over every two minutesChest Compression (Step 4)Deliver RESCUE BREATHSAir in the atmosphere contains about 21% oxygen. When we breathe we only use what we need, about 4%, sothe air that we breathe out still contains around 17% oxygen. This is more than enough to maintain life in ourcasualty.Take no more than 10 seconds to deliver two rescue breathsUse the ngers of the handperforming the head tilt to pinchthe nose closed. Take a normalbreath.Seal your lips around their mouth andblow steadily until the chest rises.Each breath should be sucient tocause the chest to rise as in normalbreathingRelease the nose and keeping theairway open let them breathe out.Re-seal your lips and give anotherrescue breath.Give two breaths in total.▪ Each breath should take about one second to deliver.▪ Watch the chest as the breath is delivered to ensure that it rises.▪ Do not interrupt compressions by more than 10 seconds to deliver the two breaths.▪ Following the second breath, immediately replace your hands on the chest and continue CPR with a further30 chest compressions.▪ Continue with chest compressions and rescue breathing in a ratio of 30:2.Do not stop unless:▪ You are sure the casualty has recovered, they open their eyes, move, are breathing normally.▪ You are directed to stop by a qualied practitioner▪ You become too exhausted to continue.Rescue Breaths (Step 2) Rescue Breaths (Step 3)Rescue breaths (Step 4)Chest Compressions (Step 1) Chest compressions (Step 2) Chest Compressions (Step 3)15FIRST AID AT WORKCPR - Adult