Emergency Lifesaver Course

Objectives of First Aid

Preserve Life ・ Prevent Worsening ・ Pain Relief

Necessity of First Aid

Importance of the first 5 minutes

Necessity of independent aiders - the courage to help

In saving others, society saves us

Casualty (person injured or taken ill)

Responder （ passer-by)

91366

87650

39220

10185 27306

350968

Sudden Illness

RTA

General

Hosp. Transfer

Assaults

Others

Tokyo Ambulance Call-outs in 2001

606,695 calls (up 5.4％ ) One every 52 seconds. 204 teams responding to 3,018 calls each.

1 in 20 citizens used service. Average response time at scene 5-6min.

The Chain of Survival

Early Access

Calmly and quickly call 119 and explain

the situation

Early CPR

Perform CPR or other first aid as necessary until

ambulance arrives

Quick Emergency Measures

Ambulance team provides further

expert care

Early Medical Care

Professional care at medical institution

１ ２ ３

１min １ hour３２ ５ １０ １５ ３０30s

１００

２５

５０

７５

０

① 50% die within 3min after circulatory arrest② 50% die within 10min after pulmonary arrest③ 50% die within 30min of major bleeding

Is Resuscitation Possible?

Death rate

time

* Average ambulance arrival time is 6min from call

Make comfortable.

Treat fractures, wounds, injuries,

burns, drowning. Transportation.

OtherAid

If no heartbeat

If unconscious

Em

ergency A

id

First A

id

Preserve airway

Artificially ventilate

Chest compressions

Remove obstruction

Stop bleedingIf bleeding heavily

If not breathing

If airway blocked

Age Divisions for First Aid Treatment

• Life Saving• CPR（ observation, airway, breathing,

circulation)• Bleeding

• Age Divisions　　 Adult　　 8 years or over　　 Child　　 Between 1 and 8 years　　 Infant　　 Between 1 month and 1

year　　Newborn Less than 1 month old　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　

Observation and First Aid

• Heavy bleeding? 　 Stop bleeding

• Impaired consciousness? 　 Preserve airway

• Breathing absent or impaired? 　 Ventilate

• No signs of circulation? 　 CPR

Is casualty breathing?

Any coughing?

Any movement?

Signs of

circulation

Watch response

Give two breaths

Whenventilating

Signs of Circulation: Checking the Pulse

Adults, children

　（ carotid artery）

Infants, newborns　（ brachial or

femoral artery）

⑧ Continue CPR

(15 compressions: 2 breaths)

If breathing still insufficientcontinue ventilating (one breath

every 5 seconds)

Put in recovery position and observe

⑦⑧ CPR (15 compressions: 2 breaths) for 4 cycles

⑤Ventilate (2 times)

③Open airway

②Get help

If breathing recovers orcasualty protests, stop

ventilating

①Conscious?

⑥Circulation signs?

④Breathing?

⑥Circulation signs?(breathing, coughing, movement)

④Breathing?

YesNo

Insufficient

Yes

Yes

Sufficient

Sufficient

Observation: Consciousness

Call “Are you alright? Can you hear me?” into casualty’s ear while tapping their shoulder. See if they can talk or respond. If no response, get progressively louder/harder (no more than 3 times!) 　　　　　　　　　　　　　　　　　　　　　　　

Can you

hear me?

Judge whether casualty is conscious or unconscious

Do not move or slide the casualty

For infant/newborn casualty, scrape the sole of the foot

Choose someone and request their help.

Get Help

Please call

119 for an

ambulance

The airway is the path taken by air through the mouth and nose to the lungs.

　（ Consciousness problems/ not breathing/ airway obstruction ）

The Airway

Opening the Airway

　 Lift the chin forwards with the index and middle fingers of one hand while pressing the forehead backwards with the heel of the other hand.

Do not put pressure on the soft parts of the chin or throat.

Do not do this if there is a risk of a neck injury.

Opening the Airway (2): neck injuries

Grasp the jawbone with both hands and gently ease upwards, applying pressure with all 4 fingers on both sides.

Place your ear above the casualty’s mouth and nose. Look along the chest and abdomen. If she is breathing you will hear and feel the breath on your face and see movement.

Observe Breathing

Count “1 2 3 4 5 6”“No breathing”

“Ventilate”

Observe for no more than 10 seconds to judge whether or not casualty is breathing.

The Recovery Position

For the casualty who is breathing sufficiently but is not fully conscious. Use the casualty’s own hand under their jaw to keep the airway open.

Keeping the airway open, pinch the nostrils so that air cannot escape through the nose but is forced into the lungs.

Artificial Ventilation

Mouth-to--Mouth-Nose-Mouth & nose-Mask-Tracheostomy

etc.

Breathe for the Casualty　　　　　　Open your mouth wide, take a deep breath, and seal your lips around the casualty’s mouth. Blow into the lungs, looking along the chest until you see the chest rise slightly.

Blow about 10cc per kg of casualty’s weight. (e.g. 500-800cc)

Problems:

Open airway?

Nostrils?

Seal?

Airway obstructions?

Remove your mouth and watch the chest fall

　　　　　　　　　　　　　　　　　

Pros and cons of Mouth-to-Mouth VentilationRequires no special toolsCan be done by one person, even a childEasy to see if it’s working

Risk of infectionRisk of secondary poisoningMay feel unpleasant

Preventing Infection

A non-return valve resuscitation mask can be used.

If you’re worried about infection you can perform chest compressions only.

Ventilating when circulation signs are present

１ ２ ５ ７１ ９１ ２ ４ ６ ８ １０２ ３ １

“No b

reathin

g”

Ven

tilate

Breath

e gently for tw

o second

s

“Circu

lation S

igns p

resent”

Ven

tilate

Breath

e gently for tw

o second

s

Check signs for no more than ten seconds.

Look for autonomous breathing, coughing or

movement.

Breathing may still be insufficient.

Ven

tilate

Breath

e gently for tw

o second

s

Breathing: Age groups

Mouth-to-nose

Mouth-to-mouth-and-nose

Infant

1 sec.Every 1 - 2 sec.Newborn

1 - 1.5 sec.

Until chest

rises gently.

Every 3 sec.

Child

　

Mouth-to-mouth

2 sec.500-800cc

（ 10cc/kg）Every 5 sec.Adult

MethodDurationAmountFrequency

The heart is located within the ribcage, slightly to left of centre.

An incorrect hand position will make compressions less effective, and break the casualty’s ribs.

Chest Compressions: Correct Hand Position

Heart

Hand position

Hand position: lower half of the sternum (breastbone)　　　　　　　　　　　　　　

For adults and children, the first hand should be placed on the sternum one finger-space from the lower end.

Sternum

One finger-space

Xiphoidprocess

Handposition

Lower limit for compression

Finding the correct hand position

Trace the underside of the ribs with your index and middle fingers.

ribs

Place the middle finger in the sternal notch, and the index finger on the sternum

Using two fingers, trace the underside of the ribs to the notch where the sides join in the middle.Leaving your middle finger in the notch, rest the index finger next to it on top of the sternum.

Middle finger in the notch

Index finger on the sternum

Now rest the heel of the other hand on the sternum next to the extended index finger. This is the correct hand position for compressions.

Cardiac Compressions - Essential Points

①　 Sit level with the casualty’s chest②　 Correct hand position, with the heel of the hand③　 Lock your elbows④　 Position your shoulders over the chest⑤　 Using your body weight, compress straight down

towards the ground

Adult casualty:Compress 3.5 〜 5cmRhythm of 100 per min.

Compression technique

Avoiding pressure on the casualty’s ribs, compress only the narrow sternum. This maximises the safety and effectiveness of the compressions.

Use this part (the heel of the hand) to compress the chest

Compress Vertically

With elbows straight, push straight down. Release pressure promptly. Take care not to lose your position.

Cardiac Compressions

Compressing the heart between the sternum and spine causes blood to circulate.

Compress 15 times at a rate of 100 compressions/minute.

sternumheart

spine

upstrokedownstroke

How NOT to do it!

Don’t push at an angle Don’t bend your elbows

Repeat cycles of 15 compressions to two breaths (ratio 15:2)After the first four cycles, check again for signs of circulation - for no more than 10 seconds

Cardio-pulmonary Resuscitation(CPR)

15 chest compressions

2 breath

s

10 second check for

signs of life

One cycle15 compressions : 2 breaths

“No b

reathin

g. Ven

tilate.”

2 breath

s

“Ch

eckin

g signs”

“No sign

s of life”

“Startin

g CP

R”

Removing Obstructions (1)

Open the casualty’s mouth with the “crossed finger” technique.Cross the thumb and index finger. Place the thumb on the upper teeth, the index finger on the lower teeth, and twist to open the mouth.

Don’t move the head when inspecting the mouth.

Do you need to remove dentures?

Removing Obstructions (2)

Turn casualty’s head to one side.

Wrap your finger with a handkerchief or cloth, and wipe out any obstructions.

Make sure to clean away all blood or body fluids.

Back Slaps

　 Slap sharply and strongly 4 or 5 times between the casualty’s shoulder blades using the heel of your hand.

Heimlich Maneuver (Sitting)

Only on conscious casualties aged > 8 yearsPut the ball of the thumb against the upper stomach area

Put your chest against the casualty’s back.

Put both arms under the casualty’s armpits.

Squeeze inward and upward.

Heimlich Maneuver (Astride)

With the heel of one hand on the upper stomach area, support with the other hand and push sharply upwards and inwards.

Compression from Behind

With one knee raised, put open hands on the lower trunk beneath the ribs on either side of the spine. Squeeze strongly, inwards and upwards.

⑧ Perform CPR (15:2)

If breathing sufficient, continue ventilations (1 every 2 to 3 sec.)

Recovery position(continue to monitor)

⑦⑧ Perform CPR (15:2) 　

⑤ Two breaths

③ Open airway

② Call for help

If breathing recovers or casualty objects, stop

ventilations

① Conscious?

⑥ Check signs of life

④ Breathing?

⑥ Check signs of life　　　　　　　Breathing? Coughing? Moving?

④ Breathing?

YesNo

Not enough

Yes

Yes

Enough

Enough

CPR for Children, Babies and Newborns

Mouth-to-MouthTwo breaths.1～ 1.5 seconds apart.Chest should rise gently.

Child Baby &

Newborn

Mouth-to-Nose & Mouth

Two breaths.

Breathe for 1 sec.

Child

Casualty Hand Position Technique Extent Rate

Child

(1-8 yrs)

Lower half of sternum

Heel of one hand

About 1/3 depth of chest

100/minute

Baby

(1-12 month) One finger width below line joining the nipples

Middle & ring fingers only

At least 100/minute

Newborn (less than 28 days) About 120/minute

Baby & Newborn

Removing Obstructions: Baby & Child

Thoracic Compressions

Face upward.

Compress lower sternum as for CPR, 5 times.

Back Slaps

　 Turn over, facing downwards

Support chin with fingers

Slap 5 times with heel of hand

Cycle both techniques. If becomes unconscious start CPR!

Bleeding Control: Direct Pressure

Consider the cleanliness, thickness and position.

Apply direct pressure to the wound.

Use a plastic bag or rubber gloves to avoid infection.

Gauze pad

bone

wound

Bleeding Control: Tourniquet

Position between the wound and the heart.

Centered a few cm from the wound.

Using a wide (at least 3cm) triangular bandage or scarf.

Tighten using a stick. 　　　　　　　　　　　Release pressure every 30 mins.

1. Prepare the tourniquet.

2. Tie loosely. Insert a pad.

3. Insert the stick. Steady the pad.

4. Turn the stick until bleeding stops.

5. Secure the stick so it won’t move.

6. Record the time.

Legal Protection for First Aiders

　 USA: Good Samaritan Law. If emergency aid is given with sincere spirit there will be no retribution even in the event of a mistake.

JAPAN: “Regarding actions made in good faith, in the absence of malice or negligence, there shall be no civil or legal liability.”

　( 総務庁長官官房交通安全対策室・交通事故現場における市民による応急手当促進方策委員会報告書・平６．３ )