First aid is the care and assistance of a suddenly sick or injured person. Everyone should learn how to give first aid as accidents tend to occur when least expected, whether this be at home, work or play. Sometimes the proper administration of first aid can mean the difference between life and death, or between full or partial recovery. Prompt affective first aid gives the casualty a much better chance of a good recovery. Note however that this article’s aim is to teach only the most elementary level of giving first aid, keeping your safety as top priority in doing so.
Each emergency is different, so it is impossible to provide a precise list of things you will need. Everyone should have a first aid kit at least in their home. All workplaces in developed countries will have a first aid kit as well as a designated first aid officer.
If you follow the principles of first aid you should deliver reasonable care even if you are unsure of what the problem is. When a situation requiring first aid arises, it is important to act promptly and not to panic. Form a plan of action, remain calm and think your actions through. Careful deliberate action taken without much delay is most beneficial to the casualty. A calm controlled individual who knows how to administer first aid will give everyone at the scene confidence that the event is being handled efficiently and effectively.
Examining a Casualty: Upon encountering an incident, take the time to look at the scene for anything that may threaten your safety or the safety of those on or around the scene. Look for bystanders who may be able to supply information on what happened and the number of casualties. As the goal of this article is to provide you with a very basic level of first aid knowledge, all you must remember is to move the casualty as little as possible, especially if he/she is unconscious. If you suspect back or neck injuries then ensure you do not move the casualty. This is an especially common injury in road accidents. If a high level of danger is present to either you or the casualty you might need to move him/her. However, this is likely to leave them paralyzed and significantly lower their chances of survival. The situation will dictate your action.
Triage – Priority of Treatment: This term refers to the sorting and classification of casualties, and the establishment of treatment priorities when multiple casualties are present. To effectively provide the best first aid treatment for the most needy, some seriously injured casualties may have to be temporarily ignored. Basically the requirement is for your limited first aid resources (including the time you spend giving treatment) to be allocated to the casualties who will survive because of it, and not those who are likely to die. The top priority is to ensure the greatest number of casualties’ survival. Ask yourself three questions:
1. Who needs immediate first aid treatment to save their life?
2. Who will really benefit, and who won’t?
3. If I treat one person, will other suffer seriously from lack of attention?
Safety, airway, breathing, circulation, control of severe bleeding, shock and burns are still the priorities when attending multiple casualties with little or no assistance. Casualties in cardiac arrest are only given CPR if there are no other seriously injured casualties requiring life-saving treatment. If you become distracted with a casualty in cardiac arrest, you will be fully committed to performing CPR with little chance of success and at the expense of another who may be saved by your active intervention. The most knowledgeable or experienced person present should undertake triage.
Emergency Action Plan: This is the most important piece of doctrine to learn if you aim to give first aid effectively. If there is one thing you should take from this article, it is everything under this heading. The emergency action plan consists of six steps: Danger (Safety), Response, Airway, Breathing, Circulation and Defibrillation (DRABCD). An easy way to remember this is DR-ABCD.
Danger – Ensure the safety of all those on the scene by checking for hazards. Check for hazards and risks to yourself, bystanders and the casualty. Take the time to take a good look and leave dangerous situations to the emergency personnel who have the training and equipment to manage the situation. Risking your own safety in a dangerous situation may increase the number of casualties to manage.
Response – Check the casualty for a response by touching the casualty’s shoulders and asking loudly ‘are you alright?’. Do not shake children or infants, and there is no need to aggressively shake a casualty to gain a response, just touching the casualty on the shoulders and talking loudly is an effective method and will awaken a sleeping person. An unresponsive casualty should be considered unconscious. If the casualty responds and appears conscious, leave them in the position you find them, check their condition and send or call for help if required. Reassess and observe the casualty for help. If the casualty does not respond, call for help and continue to the next step: Airway.
Airway – Ensure the casualty has an open airway. Place your hand on the forehead and fingertips of the other hand under the casualty’s chin. Gently tilt the head back and lift the chin to open the airway. Remove any visible objects inside the mouth or throat and check for signs of life – unconscious, unresponsive, not breathing normally, not moving. Avoid excessive force especially if you suspect an injury to the neck. If suspected lift the chin to open the airway. Do not press on the soft tissues under the chin for children and infants as this may block the airway.
Breathing – Keep the airway open and check for normal breathing. Look to see if the chest rises, listen for the sound of normal breathing, and feel for air coming out of the nose or mouth against your cheek. Do this for no more than 10 seconds. In the first few minutes of a casualty’s cardiac arrest, sounds of gurgling, sighing or coughing may be present, as well as movements of the chest and stomach. This type of breathing is ineffective as it does not move air into or out of the lungs. In this case treat the casualty as not breathing. If you are in any doubt whether the casualty is breathing or not, treat them as if they are not breathing. If breathing is present roll the casualty into the recovery position. Check the casualty’s condition and get help if needed. Make sure to observe and reassess the casualty for continued breathing regularly. If the casualty is not breathing send or call for help. Using the emergency number listed later in the article it should not be overly difficult getting an ambulance on the way. Give the casualty two breaths by opening the airway with head tilt and chin lift. Close the casualty’s nose and blow into the casualty’s mouth for about one second. Watch for chest rise with each breath and keep. Should the chest not rise there is most likely an obstruction to the airway. This will be covered later. Give the second breath and start chest compressions.
Compressions – If the casualty has no signs of life – unconscious, unresponsive, not breathing normally, not moving – commence compressions. Kneel by the side of the casualty, place your hands (or two fingers with an infant) in the centre of the casualty’s chest interlocking your fingers. Press straight down on the sternum (flat bone in the middle of the chest) 100 times per minute (a little less than 2 compressions a second). Give 30 compressions compressing 1/3 depth of the casualty’s chest. Give 2 breaths and return hands or fingers quickly to the centre of the casualty’s chest and give 30 compressions. Continue 30 compressions and 2 breath cycles. Make sure there is help on the way. CPR should only be stopped if the scene becomes unsafe, qualified help arrives to take over, signs of life return or an authorized person pronounces the casualty deceased.
Note: If rescue breaths do not make the chest rise with each attempt, proceed to give 30 compressions. Before your next attempt at rescue breaths check the casualty’s mouth and remove any visible obstructions to the airway. Ensure that there is adequate head tilt and chin lift. Do not attempt more than two rescue breaths before returning to compressions. If for some reason rescue breaths cannot be given, proceed with chest compressions as some oxygen will still be circulated. Do not interrupt resuscitation to re-check the casualty unless he/she starts breathing normally again. If there are multiple rescuers ensure that an ambulance has been called, change over the role of performing CPR approximately every 2 minutes to reduce fatigue. Do this with minimal delay between compressions.
Defibrillation: This area will not be covered as this is a basic first aid article. If someone at the scene is trained in using this equipment, they are likely the more senior first aider and you should allow them to take control of the situation and execute the directions they give you. Make sure they are trained however, as in high-pressure incidents individuals may want to help to the point of lying about their qualifications.
Emergency Contact Number: The GSM international standard emergency number is ‘112’, however it can only be dialed on mobile/cell phones. When dialing 112 anywhere in the world, the number is automatically translated to that country’s emergency number. In some countries, such as Australia, it will work without the presence of a SIM card or having the PIN number in the phone. When calling make sure you give as much information as possible about the location of the emergency so that an ambulance can reach you in as little time as possible. In addition to this tell the emergency operator your name, phone number from which the call is being made, what happened i.e. road accident, number and condition of casualties, including level of consciousness, breathing and circulation.
If you are giving first aid to a casualty, have a bystander telephone for help. If you are alone you have no other option that to call yourself. The circumstances surrounding the incident will dictate you action. If a bystander makes the call, tell them what information to pass on and make sure they relay you what the emergency operator is saying. Unless you know the bystander is trained in giving first aid, contain the whole situation yourself. You must know exactly what is going on at any time.
Medical Identification Tags: Look out for medical identification tags i.e. medical bracelets. These devices have the person’s identity, relevant medical condition, allergies, drugs required and specialized medical contact information. Medical conditions that may be shown vary from specific heart diseases, diabetes, epilepsy, asthma, and serious allergies.
Reassurance: Many people who assisted you in delivering care often need reassurance themselves. Relatives of the casualty may be concerned they let the casualty down and workmates or onlookers may feel guilty they provided little practical assistance. Once the incident is over, spend some time telling everyone how important their contribution was, and that caring for a casualty is a team effort where every job counts. This is especially important if the outcome of the emergency is unsuccessful.
Your Response to an Emergency: Everyone is affected differently to an emergency. You may be affected directly or indirectly, no matter the size of the emergency or its outcome. Emotional responses to disasters can appear immediately or months later. Some common responses to emergencies and disasters are: crying for no apparent reason, difficulty making decisions, difficulty sleeping, sadness and depression, emotional numbing, irritability and anger, apathy, excessive drinking or drug use, feeling powerless, flashbacks, headaches and stomach problems. If you are troubled for longer that four weeks you may want to seek professional help.
Clean Up: Once the incident is over, it is important to set some time aside for yourself. When you think about how you handled the incident, keep in mind that by stepping forward and administering first aid you have done more for the casualty than anyone. Talk to family members, friends or colleagues. When you go over how you handled the incident be realistic about your expectations. Once the incident is over, take a break and try to relax as much as possible. Talk about the incident with peers, clean up the scene and any equipment you used, restock your first aid kid and complete any documentation.
Legal Issues Concerning First Aiders: This varies significantly from country to country. You should know the laws well before you try to give first aid to a stranger. However, if your aim is to give first aid to a family member or close friend it is highly unlikely you have any legal issues afterward even if treatment is unsuccessful.
Hygiene: Cleanliness must be ensured in all first aid situations. Take precautions to ensure the risk of infection is minimized by practicing good first aid hygiene procedures. Prior to treatment wash hands with soap and water, or rinse with antiseptic. Ensure that hands are washed thoroughly between fingers and under nails.
Ensure you place a barrier between you and the casualty’s body fluids. Use a face shield or mask with a one-way valve or filter when performing resuscitation. Always wear nitrile or latex gloves if available, taking care not to touch any unclean objects when wearing gloves or once hands are washed. Cover any adjacent areas likely to produce infection and only use clean bandages and dressings. Avoid coughing, breathing or speaking over the wound, contact with body fluids and treating more than one casualty without washing hands or changing gloves. Once you finish give treatment clean up the casualty, yourself and the immediate vicinity where it took place. Dispose of dressings, bandages, sharps, gloves and soiled clothing safely and correctly. Waste materials can be placed inside a plastic bag, which is placed inside another plastic bag and tied security. Use a biohazard bag if possible and seek advice from the local health department on disposal options. Wash hands with soap and water even if gloves were used.
By reading and memorizing this article you have learned how to provide basic but potentially life-saving immediate first aid treatment to a casualty. You are now equipped with the knowledge that may one day save someone’s life or save them from disability. I would encourage everyone to take a short professional first aid course as it is only through practice that you can really become an effective first aider. Short courses for giving basic first aid are available in most countries, and are not expensive considering the knowledge you will gain from them. I strongly recommend you briefly recap on this information from time to time as you will find that you will forget it very quickly if you do not use it. Accidents occur when you least expect them, so be prepared! Good Luck.