Presented byDr.Vivek GopalakrishnanBHMS,NDH(NZ),PGDHA&MT (http://in.linkedin.com/in/Vivekgopal1)Clinician-Healthcare Quality & Accreditation Consultant-Strategy & Operations Specialist-Policy Maker & Analyst

Definitions of ‘first aid’

“Help given to a sick or injured person until full medical treatment is available”

So what does this mean?

First aid can be anything from putting on a plaster to saving someone’s life

You don’t need formal first aid training to help someone in need

The aims of first aid

Broadly, there are three main aims when administering first aid:

●Preserve life●Prevent worsening of the condition (if possible)●Promote recovery

For example, applying a plaster is preventing the condition (a cut) from worsening by stopping infection!

These aims are known as the ‘three Ps’

Roles of a first aider● Manage the incident and ensure the continuing safety of themselves,

bystanders and the casualty

● Assess casualties and find out the nature & cause of their injuries

● Arrange for further medical help or other emergency services to attend

(e.g: the fire service)

● If trained, prioritize casualties based upon medical need

● Provide appropriate first aid treatment as trained

● If able, make notes/observations of casualties

● Fill out any paperwork as required

● Provide a handover when further medical help arrives

Calling for emergency helpEnsure you know which number to call!

Give clear, precise information about●The location of the incident●The number of casualties / people involved●The nature of their injuries●In some cases, their age●Any hazards at the incident (e.g: spilt fuel, fire, electricity)

If the area is remote/difficult to access, consider sending someone to meet the emergency services

Managing an incident

Always be aware of potential dangers at an incident (e.g: traffic, fire, electricity). Never put yourself or other bystanders in danger

YOU are the most important person

If the incident is too dangerous to approach, stay back and call for emergency help

ASSESSMENT & EVALUATION

Initial Assessment of the scene• Goal of the initial assessment:

– Visually determine whether there are life-threatening or other serious problems that require quick care.

– Determine if victim is conscious - by tap and shout. Check for ABC as indicated:

• A = Airway Open? – Head-tilt/Chin-lift.• B = Breathing? – Look, listen, and feel.• C = Circulation? – Check for signs of circulation.

Note: These step-by-step initial assessment should not be changed. It takes less than a minute to complete, unless first aid is required at any point.

• Breathing• Bleeding• Shock

• Burn• Choking

• Heart Attack• Fractures

Victim Assessment Sequence– If victim is responsive

• Ask them what injuries or difficulties they are experiencing.

• Check and provide first aid for these complaints as well as others that may be involved.

– If victim is not responsive (Unconscious or incoherent).

• Observe for obvious signs of injury or illness:– Check from head to toe

• Provide first aid/CPR for injuries or illness observed.

HYPERTHERMIA & HYPOTHERMIA

Hyperthermia: Body temperature above 38 degreesAbove 42 degrees=FATAL

Hypothermia: Body temperature below 36 degreesBelow 26 degrees=FATAL

Normal body Temperature=37 degree Celsius

HYPERTHERMIA

Due to loss of fluid(by sweating) & salt3 problems:

1.Heat Cramps

2. Heat Exhaustion

3.Heat Stroke/Sun Stroke

Heat Cramps:Signs & symptoms:1. Muscle pain: in legs & lower abdomen2. Skin: pale and moist3. Breathing: Rapid & shallow

Treatment:4. Move the casualty to a cool place5. Give a cold salty drink6. Stretch the muscle: when it is relaxed7. Monitor the temperature

NB:DO NOT massage or rub the cramping muscle-it worsens the pain

Heat Exhaustion

Signs & symptoms:1. Light headedness & faintness2. There may be vomiting and diarrhea3. Pulse: rapid and weakTreatment:4. Remove as much clothing as possible5. Treat for shock: lay down and raise legs6. Wet the skin & fan with a towel

NB:DO NOT over cool

Heat StrokeSigns & symptoms:1. Headache and dizziness2. Level of consciousness decreases rapidly3. Skin hot, flushed & dry4. Deep breathing5. Convulsions may occur

Treatment:6. Urgent medical attention

HYPOTHERMIA36

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26

Shivering, cold hands & feet------------------------numbness in limbs

Changes in mood-------------------slower to understand and respond

Confusion, abnormal behavior---------------------------shivering stops

Clumsy, stumbling, falling--------------slurred speech, blurred vision

Decreased level of consciousness---------------muscles become rigid

Unconscious--------------------------------shallow breathing, weak pulse

Cold, bluish color----------------------------------------------enlarged pupils

Death from heart failure-------------------------------------(((ONE HOUR)))

Hypothermia-Treatment1. Prevent Heat Loss & Improve body temperature2. Warming must be done slowly3. Ignore pleas of “Leave me alone----I am OK”-

This is very common4. Get casualty to dry shelter5. Dry the skin6. Use blankets: warm head and trunk first—limbs

later7. Treat for shock and watch casualty all the time

NB:DO NOT use artificial heat---can stop heart

FIRST AID IN WOUNDS

First aid for minor wounds> Wear gloves if available> Clean the wound thoroughly with antiseptic wipes or saline> Do not remove any embedded objects (e.g: glass) – seek medical advice> Cover the wound using a clean dressing (plaster, non-adherent pad etc.)> Seek medical advice if there are any signs of infection – redness, swelling or the area is warm to the touch

Basic First Aid for Wounds

A break in the skin’s surface that results in external bleeding and may allow bacteria to enter the body that can cause infection

• Abrasion• Laceration• Incisions• Punctures• Avulsion• Amputation

Basic First Aid for Wounds Cont.• What to Do???????????:

– Wear gloves (if possible) and expose wound– Control bleeding– Clean wounds

• To prevent infection• Wash shallow wound gently with soap and water• Wash from the center out / Irrigate with water

– Severe wound? • Clean only after bleeding has stopped

Basic First Aid for Wounds Cont.• Wounds Care

– Remove small objects that do not flush out by irrigation with sterile tweezers.

– If bleeding restarts, apply direct pressure.– Use roller bandages (or tape dressing to the body)– Keep dressings dry and clean– Change the dressing daily, or more often if it gets

wet or dirty.

Basic First Aid for Wounds Cont.• Signs of Wound Infection:

– Swelling, and redness around the wound– A sensation of warmth– Throbbing pain– Fever / chills– Swollen lymph nodes– Red streaks

• Tetanus (lock jaw), should receive injection in first 72 hours.

REMEMBER: PEEPPEEP is a way of remembering what to do if someone is bleeding.

P: Position the casualty in a position of restE: Elevate above the level of the heartE: Expose & examine the woundP: Pressure. Apply direct pressure.

What not to doDo not apply a tourniquet unless specifically trained to do so

Do not attempt to wash out a major wound – your aim is to control the bleeding

Dressings and Bandages

• The purpose of a dressing is to:– Control bleeding– Prevent infection and contamination– Absorb blood and fluid drainage– Protect the wound from further injury

• What to Do:– Always wear gloves (if possible)– Use a dressing large enough to extend beyond the

wound’s edges.– Cover the dressing with bandages.

FIRST AID IN BLEEDING

Bleeding Control• Control Methods For External Bleeding:

– Direct pressure stops most bleeding.• Wear gloves (if possible)• Place a gauze pad or a clean cloth over wound

– Elevating injured part to help reduce blood flow.• Combine with direct pressure over the wound (this will

allow you to attend to other injuries or victims).– If bleeding continues, apply pressure

at a pressure point to slow blood flow.• Pressure point locations:

– Brachial (Top of elbow)– Femoral (Inside upper thigh)

Bleeding Control Cont.

• Control Methods For Internal Bleeding:– Signs of internal bleeding:

• Bruises or contusions of the skin• Painful, tender, rigid, bruised abdomen• Vomiting or coughing up blood• Stools that are black or contain bright red blood

– What to Do:For severe internal bleeding, follow these steps:• Monitor ABC’s (Airway Breathing Circulation)• Keep the victim lying on his/her left side. (This will help prevent

expulsion of vomit from stomach, or allow the vomit to drain and also prevent the victim from inhaling vomit).

• Seek immediate medical attention

FIRST AID FOR SHOCK

Shock (1)Shock is a medical emergency which can be caused by severe blood lossThe casualty does not receive enough oxygen due to the loss of bloodSigns & symptoms include:

●Pale clammy skin●Drowsiness ●Thirst●Confusion●Nausea & vomiting

Shock Cont.

• What to Look For– Altered mental status

• Anxiety and restlessness– Pale, cold, and clammy skin, lips, and nail beds– Nausea and vomiting– Rapid breathing and pulse– Unresponsiveness when shock is severe

Shock Cont.

• What to Do– After first treating life-threatening injuries such

as breathing or bleeding, the following procedures shall be performed:

• Lay the victim on his or her back• Raise the victim’s legs 8” – 12” to

allow the blood to drain from the legs back to the heart.

• Prevent body heat loss by putting blankets and coats under and over the victim-Cover them with a blanket

• Call for emergency help if you haven’t already done so.

FIRST AID IN SPINAL INJURIES

Checking for Spinal Injuries– What to Look For

• General signs & symptoms–Painful movement of the arms or legs–Numbness, tingling, weakness, or

burning sensation in the arms or legs–Loss of bowel or bladder control–Paralysis of the arms or legs–Deformity (odd-looking angle of the

victim’s head & neck

Checking for Spinal Injuries Cont.• What to Do:

– Stabilize the victim against any movement.– Check ABCs. (Airway Breathing Circulation)

• Unresponsive Victim:– Look for cuts, bruise, and deformities.– Test response by pinching the victim’s hand, and

bare foot.• If no reaction, assume the victim may have spinal

damage.

Checking for Spinal Injuries Cont.

• Responsive Victim– Upper Extremity Checks:

• Victim wiggles fingers.• Victim feels rescuer squeeze fingers.• Victim squeeze rescuer’s hand.

– Lower Extremity Checks:• Victim wiggles toes.• Victim feels rescuer squeezes toes.• Victim pushes foot against rescuer’s hand.

FIRST AID FOR BURNS

Burns• Burns have been described

as:– First-degree burns

(Superficial)• What to Do:

– Immerse in cold water 10 to 45 minutes or use cold, wet cloths.

» Cold stops burn progression» May use other liquids

– Moisturizer lotion

Burns Cont.

• Second-degree burns (Partial Thickness)– What to Do:

• Immerse in cold water / wet pack• Do not break blisters• May seek medical attention

Burns Cont.• Third-degree burns (Full Thickness)

– What to Do:• Usually not necessary to apply cold to areas of third

degree• Do not apply ointments• Apply sterile, non-stick dressings (do not use

plastic)• Check ABC’s• Treat for shock• Get medical help

Burns Cont.– Thermal (heat) burns caused by:

• Flames• Hot objects• Flammable vapor that ignites• Steam or hot liquid

– What to Do:• Stop the burning

– Remove victim from burn source– If open flame, smother with blanket, coat or similar item, or

have the victim roll on ground.• Determine the depth (degree) of the burn

Burns Cont.• Chemical burns

– The result of a caustic or corrosive substance touching the skin caused by:

• Acids (batteries)• Alkalis (drain cleaners- often more extensive)• Organic compounds (oil products)

Burns Cont.• What to Do:

– Remove the chemical by flushing the area with water

• Brush dry powder chemicals from the skin before flushing

• Take precautions to protect yourself from exposure to the chemical

– Remove the victim’s contaminated clothing and jewelry while flushing with water

– Flush for 20 minutes all chemical burns (skin, eyes)

– Cover the burned area with a dry, sterile dressing

– Seek medical attention

Burns Cont.

• Electrical Burns– There are three types of electrical injuries:

• Thermal burn (flame) – Objects in direct contact with the skin are ignited by an electrical current.

– Mostly caused by the flames produced by the electrical current and not by the passage of the electrical current or arc.

• Arc burn (Flash) – Occurs when electricity jumps, or arcs, from one spot to another.

– Mostly cause extensive superficial injuries.• True Electrical Injury (contact) – Occurs when an electric

current truly passes through the body.

Burns Cont.

• What to Do:– Make sure the scene is safe

• Unplug, disconnect, or turn off the power.• If that is impossible, call the power company or EMS for

help.– Do not contact high voltage wires– Consider all wires live– Do not handle downed lines– Do not come in contact with person if the electrical source is live

– Check ABCs. (Airway Breathing Circulation)– If the victim fell, check for a spinal injury.– Treat the victim for shock by elevating the legs 8” –

12” if no spinal injury is suspected.– Seek medical attention immediately.

What not do to> Do not try to remove clothing sticking to a burn, instead cool through the clothingDo not apply toothpaste / butter / creams to a burn. Running water is the most effective cooling method.> Do not burst any blisters> Do not stop cooling before 10 minutes is up!

FIRST AID IN CHOKING

Choking

• What is it?– Obstruction in the airway.

• General Precaution– If someone is coughing, leave the person alone.

• Do not perform the Heimlich Maneuver. – Keep eyes on that person.– Ask the person if he/she needs help.

• Signs and Symptoms– Person is not able to breath or talk due to obstruction,

choking sign given, distressed, and panic.– Hands wrapped around the neck is universal sign for

choking.

Choking Cont.• What to Do:

– Perform Heimlich Maneuver if you are properly trained

• Conscious Victim:– Approach from behind and wrap arms around

the victim’s waist.– Place one fist just above the victim’s navel with the

thumb side against the abdomen.– Second hand over the fist.– Press into the victim’s abdomen with one upward thrust– Repeat thrust if necessary.– Try to pop the obstruction out with swift thrusts in and up.– Continue until the obstruction is relieved or victim collapses.– Have someone call for help.

Note: Always stay calm.

FIRST AID IN FRACTURES

Fractures• There are two categories of fractures:

– Closed (Simple) fracture• The skin is intact and no wound exists anywhere near the

fracture site.– Open (Compound) fracture

• The skin over the fracture has been damaged or broken.• The wound may result from bone protruding through the

skin.• The bone may not always be visible in the wound.

Fractures Cont.• What to Look for:

– General signs and Symptoms:• Tenderness to touch. • Swelling.• Deformities may occur when bones are broken, causing

an abnormal shape.• Open wounds break the skin.• A grating sensation caused by broken bones rubbing

together – can be felt and sometimes even heard.– Do not move the injured limb in an attempt to detect it.

• Loss of use.

Managing a fracture or dislocation• Control any bleeding and cover any wounds.• Ask patient to remain as still as possible.• Immobilize fracture:

– use broad bandages (where possible) to prevent movement at joints above and below the fracture

– support the limb, carefully passing bandages under the natural hollows of the body

– place a padded splint along the injured limb– place padding between the splint and the natural contours of the body

and secure firmly– for leg fracture, immobilize foot and ankle– check that bandages are not too tight (or too loose) every 15 minutes.

• Watch for signs of circulation loss to hands and feet• Ensure an ambulance has been called

Notes on first aid in Fracture

• Do not attempt to force a fracture or dislocation back into place – this could cause further injuries.

• It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always treat the injury as a fracture.

• If collarbone is fractured, support arm on injured side in a St John sling.

• If you suspect the joint is dislocated, rest, elevate and apply ice to the joint.

• DO NOT MOVE THE AREA UNWANTEDLY

FIRST AID IN BITES AND STINGS

Bites and Stings• Insect stings and bites

– What to Look For:• Check the sting site to see if a stinger and venom

sac are embedded in the skin.– Bees are the only stinging insects that leave their

stingers and venom sacs behind.– Scrape the stinger and venom sac away with a hard

object such as a long fingernail, credit card, scissor edge, or knife blade.

• Reactions generally localized pain, itching, and swelling.

• Allergic reaction (anaphylaxis) occurs will be a life threatening.

Bites and Stings Cont.• Insect stings and bites Cont.

– What to Do:• Ask the victim if he/she has had a reaction

before.• Wash the sting site with soap and water to

prevent infection.• Apply an ice pack over the sting site to slow

absorption of the venom and relieve pain. – Because bee venom is acidic, a paste made of baking

soda and water can help.• Seek medical attention if necessary.

FIRST AID IN HEART ATTACK

Heart Attack

• Heart Attack – Usually that happens when one of the coronary arteries is blocked by an obstruction or a spasm.– Signs and symptoms of a heart attack include:

• Pressure in chest, fullness, squeezing, or pain that lasts more than a few minutes or that goes away and comes back.

• Pain spreading to the shoulders, neck, or arms.

• Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath.

Heart Attack• What to Do:

– Call Amulance or get to the nearest hospital emergency department

– Monitor victim’s condition.– Help the victim to the least painful position, usually

sitting with legs up and bent at the knees.• Loosen clothing around the neck and midriff.

– Determine if the victim is known to have coronary heart disease

– If the victim is unresponsive, check ABCs and start CPR, if needed.

– CPR VIDEO-

CPR-HOW TO DO• Untrained. If you're not trained in CPR, then provide

hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive. You don't need to try rescue breathing.

• Trained and ready to go. If you're well-trained and confident in your ability, begin with chest compressions instead of first checking the airway and doing rescue breathing. Start CPR with 30 chest compressions before checking the airway and giving rescue breaths.

• Trained but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of about 100 a minute.

Before you begin• Before starting CPR, check:• Check =Is the person conscious or unconscious?• If the person appears unconscious, tap or shake his or her

shoulder and ask loudly, "Are you OK?"• If the person doesn't respond and two people are available,

one should call the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call emergency number before beginning CPR — unless you think the person has become unresponsive because of suffocation

• If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

• Remember to spell C-A-B

Compressions: to Restore blood circulation

• Put the person on his or her back on a firm surface.• Kneel next to the person's neck and shoulders.• Place the heel of one hand over the center of the person's chest,

between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

• Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.

• If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway

• If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

• Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth breathing and continue chest compressions.

Breathing: Breathe for the person

• Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

• With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

• Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.

• Resume chest compressions to restore circulation.• If the person has not begun moving after five cycles (about two minutes) and an

automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock.

• Continue CPR until there are signs of movement or emergency medical personnel take over.

CPR VIDEO-

THE RECOVERY POSITION

Unconsciousness vs

sleepingThe difference between being asleep and being unconsciousness is that an unconscious person will not wake up.

Unconsciousness is a medical emergency which requires immediate first aid intervention

Why the fuss?

When someone goes unconscious, they lose muscle tone. This means they go all ‘floppy’ – like a rag doll

The tongue (a muscle) can block their airway when it loses muscle tone. This is known colloquially as “swallowing your own tongue”

In addition, loss of control over their stomach muscles can cause stomach contents (vomit) to travel back up to the throat which can block the airway

Photo: blocked airway

Helping someone who is unconscious

You can use the mnemonic “DR ABC” to remember what to do!

DR ABC provides a structured way to think about how to assess the situation

D: DangerCheck to see if there are any dangers (actual or potential) to yourself or the casualty

For example electrical cables, moving traffic, other people etc.

Try and make the scene as safe as possible

If the area is too dangerous then stay back and call the emergency services

R: ResponseAttempt to wake the person up by shouting loudly in both ears and tapping them on the shoulders

If you do not get a response, then the person is unconscious

This is now a medical emergency. If possible, try to attract the attention of others by shouting for help

A: AirwayOpen the airway by tilting the head backwards and lifting the chin with two fingers.

B: Breathing (1)Keep your hands on the person’s head & chinPlace your cheek above their mouth and look at their chestLook, listen and feel for regular breathing for up to 10 seconds.

B: Breathing (2)If the person is not breathing, commence cardiopulmonary resuscitation (CPR)

If they are breathing, then place them in the recovery position in order to protect their airway

The recovery position involves rolling the casualty onto their side with their head tilted back.

Photo: the recovery position

The recovery position - steps

1.Kneel by the casualty’s waist2.Place the hand nearest you at right angles3.Grasp the hand furthest to you, place the back of their

hand against their cheek closest to you4.Lift the leg furthest away from you at the knee and

place their foot on the floor5.Using their knee as a lever, pull the person onto their

side6.Ensure their head is still tilted back and they are on

their side

C: Call an ambulanceOnce the person is in the recovery position call an ambulance if this has not been done already!

Recheck the casualty’s airway and breathing every few minutes until the ambulance arrives

Keep the casualty warm and dry if you can

INFECTION CONTROL

Basic infection controlVarious diseases can be transmitted via blood and body fluids (for example HIV and Hepatitis B & C)

If possible, always wear disposable latex/nitrile gloves when dealing with bodily fluids

HOWEVER: This is not always practical! You can improvise and use anything to create a barrier. e.g: a plastic carrier bag

Ensure any cuts/open injuries to your hands are covered with waterproof plasters or dressings.

Wash your hands with soap and warm water whenever possible

Infection control> Try and keep the wound as clean as possible> Try to avoid contact with the casualty’s blood

●Wear disposable latex / nitrile gloves if available●If not, use any available items to create a barrier (e.g: a plastic bag)

> Wash your hands thoroughly with soap and water afterwards> Seek medical advice if you are concerned

Handwashing

Alcohol handrub / handgel can be used if running water is not immediately available

Your basic first aid kit

• A basic first aid kit may contain:• plasters in a variety of different sizes and shapes• small, medium and large sterile gauze dressings• at least two sterile eye dressings• triangular bandages • crêpe rolled bandages• safety pins• disposable sterile gloves• tweezers• scissors• alcohol-free cleansing wipes• sticky tape• thermometer (preferably digital)• skin rash cream, such as hydrocortisone or calendula• cream or spray to relieve insect bites and stings• antiseptic cream• painkillers such as paracetamol (or infant paracetamol for children), aspirin (not to be given to children

under 16), or ibuprofen• cough medicine• antihistamine tablets• distilled water for cleaning wounds• eye wash and eye bath

Basic First Aid-Summary

– The following information from this presentation have been covered:

• What is First Aid?• Scene Survey• Initial Assessment• Victim Assessment

Sequence• Bleeding Control• Shock• Burns

• Choking• Fractures• Heart Attack• Basic First Aid for Wounds• Dressing and Bandages• Checking for Spinal Injuries• Bites and Stings

Basic First Aid-Summary cont.–Assess the situation–Call for help when necessary–Stabilize the situation before help

arrives–Try to remain calm and do not

panic

Exercise: incident management

Think about the photo on the next slide (either individually or in groups)

Take a few minutes to discuss:1) How would you manage this incident?2) What dangers are present or could be present?3) What should your first action be?

Exercise: incident management

REMEMBER!!!!!!!!!!!!!!!!!!

QUESTIONS IF ANY????????

THANK YOU FOR YOUR PATIENT LISTENING