Basic First Aid

The four scenarios covered will include:

The unresponsive patient with a pulse

The unresponsive patient without a pulse - CPR

Choking

Acute bleeding

First Aid Facts:

A blocked airway can kill someone in three to four minutes, but it can take more than eight
minutes for an ambulance to arrive. So a simple procedure such as opening someones airway can
save their life whilst waiting for emergency help to arrive.

Thousands of people are dying each year in situations where first aid could have made the
difference; this includes nearly 900 people who choke to death, 2,500 who asphyxiate from a
blocked airway and 29,000 who die from heart attacks.

A recent statistic, released by St Johns Ambulance, has revealed that 140,000 people die each
year in the UK from incidents where first aid could of possibly saved their lives.

Nearly two-thirds of people (59%) within the UK wouldnt feel confident enough to even try and
save a life, and a further quarter of these people (24%) would do nothing and wait for an
ambulance to arrive or even hope that a passerby would know the correct first aid required.

The use of CPR dates all the way back to 1740, yet even today, many individuals dont know how
to perform it. Given properly and immediately to sudden cardiac arrest victims, CPR can save
lives.

In 2009, Mother and Baby Magazine fulfilled a Save A Life Survey; after this survey was
conducted it showed that a massive 82% out of 2,000 questioned parents with young children
would not know what to do if their child started choking, was burned or even stopped breathing,
etc.

A survey found that in the event of a child choking 53% of parents would try to get the object out
using their fingers; however placing fingers into the throat could cause damage!

Nearly 9 in 10 teenagers have been confronted with some kind of medical emergency, 4 out of 5
of them say that they would feel safer if they had some basic first aid knowledge to apply to the
situation and its circumstances.
Contents of a basic first aid kit:

plasters in a variety of different sizes and shapes

small, medium and large sterile gauze dressings
at least two sterile eye dressings
triangular bandages
crpe 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
first aid manual

Primary survey

When you find a casualty it is important to perform a primary survey- this is a rapid assessment to
safely assess whether someone has life-threatening injuries.

The order of the primary survey is intentional; it allows you to consider each body system in order of
priority, assessing first those injuries that will cause fatality the quickest i.e. Airway and Breathing.
The contents and order of the primary survey can be easily remembered by using the mnemonic
DR.ABC:

Danger:

Before you approach the casualty you MUST check for danger

YOUR safety is the number one priority

Examples of danger to be aware of:

1. Moving vehicles

2. Broken glass
3. Live electricity - Do not touch patient. Switch off source or disconnect using wood/plastic

4. Fire and smoke

Is the area safe?

YES: Proceed to help casualty

NO: Can you make the area safe?

YES: Make it safe and help casualty

NO: Stay back and call for help!

Response:

Ask the patient simple questions in BOTH ears- Can you hear me? and Can you open your eyes?

YES: If there is any response then proceed to check airway

NO: Gently hold shoulders and shake - Still no response? Proceed to check airway

Airway:

Is the airway open and clear of blockages?

YES: If patient can talk then the airway is open and clear. Proceed to assess breathing

NO:

o Responsive: Do not put your fingers in a conscious casualtys mouth, encourage them to try and
remove an obvious blockage with their hands or by coughing

o Unresponsive: Finger sweep to remove obvious blockages and open airway by tilting head back
whilst lifting chin (N.B. Head tilt chin lift manoeuvre will be covered in a later video)

Proceed to assess breathing

Breathing:

Place your ear to the casualtys mouth and look towards their chest, is the casualty breathing
normally?

YES: You can hear normal breath sounds, feel breath on your cheek and see chest rising and falling
- Proceed to assess circulation

NO: Shout for help and get them to call 999 for emergency services (if alone call yourself) and
immediately begin cardiopulmonary resuscitation (N.B. CPR will be covered in a later video)

Proceed to circulation ONLY if the casualty starts to breathe independently.

Circulation:

Is the casualty bleeding severely from anywhere?

YES: Control excessive bleeding and call 999 for emergency help (N.B. Treating bleeding will be
addressed in a later article)

NO: If A-C have been successfully dealt with then reassure the patient and wait with them for
emergency services to arrive.

Automated external defibrillators

What is an AED?

An electrical device that aims to restart a stopped heart

It works by delivering a shock to the casualty

Where can I find an AED?

Certain shops e.g. pharmacies

Shopping centres

Train stations

Airports

If you need an AED, make sure to ask!

How do I use an AED?

You do not need any prior experience to operate an AED

AEDs guide the user through each step via visual and/or audible prompts

Each AED has two shock pads: these must be placed on the chest at the areas shown on them

Make sure to STAND WELL AWAY from the casualty when shocking them
Performing CPR

Here is a flow chart overview of the rationale behind CPR

What causes bleeding?

Bleeding occurs when an injury causes a break in the skin and damage to blood vessels.

Most of the time when we cut ourselves, we bleed and the body forms a clot to stop it. In severe
bleeds when a large vessel is damaged, the bleeding can flow too quickly for a clot to form. If the
bleeding is not controlled then the casualty may lose too much blood and go into shock - a state in
which there is not enough blood in the body to supply all of your organs with enough oxygen, shock
can quickly prove fatal.

The three sources of bleeding are:

Arterial: Arterial blood is oxygenated and carried away from the heart. A bleeding artery tends to
produce profuse bright red blood that spurts out in time with the casualtys heartbeat.

Venous: Venous blood is deoxygenated and is carried back towards the heart. A bleeding vein tends
to produce dark red blood that pours out of the wound and doesnt pulsate.

Capillary: Capillaries are small blood vessels just under the skin. They are damaged in even the
least severe wounds and do not tend to produce enough bleeding to be of concern. When capillaries
burst underneath the skin, bruising develops.

Types of wound

Wounds can be caused in a number of different ways by a variety of different objects, be it blunt,
sharp or projectile. They are classified into several categories dependent on the cause and resulting
injury:

Incised wound - A clean, straight cut caused by a sharp edge (i.e. a knife). Tends to bleed heavily
as multiple vessels may be cut directly across. Connecting structures such as ligaments and tendons
may also be involved.

Laceration - A messy looking wound caused by a tearing or crushing force. Doesnt tend to bleed as
much as incised wounds but often causes more damage to surrounding tissues.

Abrasion - A wound caused by a scraping force or friction. Tends not to be very deep but can often
contain many foreign bodies such as dirt (i.e. after a fall on loose ground).

Puncture - A deep wound caused by a sharp, stabbing object (i.e. a nail). May appear small from
the outside but may damage deep tissues. Particularly dangerous on the chest, abdomen or head
where major organs are at risk.

Avulsion - A wound caused by a tearing force in which tissue is torn away from its normal position.
May bleed profusely depending on the size and location. The tissue is often completely detached.

Amputation - The loss of a distinct body part such as a limb, finger, toe or ear. Often very severe
with profuse bleeding. In the cases of limb loss this is a medical emergency.
Controlling a severe bleed

Controlling a severe bleed is vital to prevent shock and save lives!

Step 1 - EXPOSE:

If the wound is covered by clothing expose it to assess the type and severity

Step 2 - PRESSURE:

Is there a foreign body in the wound? (i.e. a piece of glass)

YES

DO NOT APPLY DIRECT PRESSURE ON WOUND - this could push object deeper

DO NOT REMOVE THE OBJECT - this may cause more damage inside the wound

APPLY PRESSURE EITHER SIDE OF FOREIGN BODY - pushing the wound edges together

NO

Apply direct pressure over wound, preferably with a clean dressing. If not then ask the patient to
apply the pressure themselves with their hand

Step 3 - RAISE:

Maintain pressure on the wound and raise it above the level of the heart - reduced blood flow to
wound

Injured arm: raise over casualtys head

Injured leg: lie the casualty down and gently raise and hold the leg up

Severe bleed/suspected shock: lie casualty down and raise both legs above the level of the heart

Step 4 - WARM:

Blood loss puts the casualty at risk of hypothermia (dangerously low body temperature) so keep
them warm using a blanket or rug if one is available. If not then use a jumper or jacket.

Step 5 - BANDAGE:

DO NOT tourniquet the limb

If a sterile bandage available then use it to dress the wound

Wrap tight enough to maintain pressure but dont cut off the circulation - this may threaten the limb

If blood seeps through then apply another one on top or change the bandage if saturated

Secure limb in a raised position and check occasionally to ensure circulation is not cut off
Step 6 - HELP:

Call 999 for emergency help if the bleeding continues. Continue to apply pressure and pay attention
to the casualtys breathing and consciousness level until help arrives

What is shock?

The commonest type of shock is called hypovolemic shock - this occurs due to loss of fluids, usually
blood. The body begins to go into shock when more than 2 pints of blood has been lost. It is life-
threatening and requires immediate management! Here are some of the features which suggest
shock is present in order to help you to recognize it.

Immediate:

Quick heart rate (feel at wrist)

Pale skin and cold, sweaty hands

Worsening:

Quick and shallow breathing

Weakening of pulse at wrist

Blue/grey skin - check lips and fingertips

Weakness and drowsiness

Nausea and vomiting

Extreme thirst

Critical:

Change in behaviour e.g. aggressive

Gasping for a breath

Complete loss of consciousness

Death!
Managing shock

In dealing with shock there are some key things that is important to remember.

DO

1. TREAT - Check for any obvious cause (bleeding) and aim to treat it. Call 999 for emergency help!

2. FLOOR - Lie casualty down on back, preferably on a soft and warm surface (e.g. a blanket)

3. RAISE - Lift casualtys legs up and hold in position to improve blood supply to vital organs

4. WARM - Undo tight clothing but cover the casualty in warm jumpers or blankets

5. MONITOR - Keep an eye on casualtys consciousness, breathing and heart rate until help arrives

DO NOT:

Give the casualty food or drink - they may need an anaesthetic at a later stage

Leave casualty unattended

Attempt to warm casualty with a direct heat source

Dealing with a choking patient

Firstly, confirm if the casualty is choking by asking them if they are choking. Check for signs of
choking:

Partial obstruction:

Able to speak, cough and breathe

Encourage coughing

No need for physical intervention unless casualty worsens

Complete obstruction:

Unable to speak, cough and breathe: MEDICAL EMERGENCY

Managing the Choking Casualty

Step 1: Encourage casualty to keep coughing if possible and check their mouth for obstruction
Remove any obstruction if possible

Step 2: If casualty worsens (i.e. is turning blue or stops breathing or coughing) then perform 5 back
blows. Whilst supporting casualty lean them forward and use the heel of your hand to give five firm
blows directly between the two shoulder blades. If this works and the obstruction clears, stop
immediately.

Step 3: If back blows fail then perform the Heimlich manoeuvre (chest thrust). To perform this, stand
directly behind the casualty. Place both arms around the casualty, to get the correct position place
your little finger at the belly button and clench your fist with one hand, place the other hand over the
fist to create a tight grip. In one firm and quick motion, pull your fist inwards and upwards. Repeat
this up to five times.

Step 4:

Recheck the mouth to see if obstruction has cleared. If not, call 999 for emergency help and repeat
Steps 2 and 3

Continue until casualty stops choking, loses consciousness or help arrives

The role of a first aider

First aid is the help given to someone who is injured or ill, to keep them safe until they can get more
advanced medical treatment by seeing a doctor, health professional or go to hospital.

The role of a first aider is to give someone this help, while making sure that they and anyone else
involved are safe and that they dont make the situation worse.

If you think someone needs your help, these are the seven things you need to do as a first aider:

1. Assess the situation quickly and calmly:

Safety: Are you or they in any danger? Is it safe for you to go up to them?

Scene: What caused the accident or situation? How many casualties are there?

Situation: Whats happened? How many people are involved and how old are they? What do you
think the main injuries could be?

2. Protect yourself and them from any danger:

Always protect yourself first - never put yourself at risk

Only move them to safety if leaving them would cause them more harm

If you cant make an area safe, call 999/112 for emergency help

3. Prevent infection between you and them:

Wash your hands or use alcohol gel

Wear disposable gloves

Dont touch an open wound without gloves on

 Dont breathe, cough or sneeze over a wound or a casualty

4. Comfort and reassure:

Stay calm and take charge of the situation

Introduce yourself to them to help gain their trust

Explain whats happening and why

Say what youre going to do before you do it

5. Assess the casualty:

If theres more than one casualty, help those with life-threatening conditions first

Start with the Primary Survey and deal with any life-threatening conditions

Then, if youve dealt with these successfully, move on to the Secondary Survey

6. Give first aid treatment:

Prioritise the most life-threatening conditions

Then move on to less serious ones

Get help from others if possible

7. Arrange for the right kind of help:

Call 999/112 for an ambulance if you think its serious

Take or send them to hospital if its a serious condition but is unlikely to get worse

For a less serious condition call 111 for medical advice (in England)

Suggest they see their doctor if theyre concerned about a less serious condition

Advise them to go home to rest, but to seek help if they feel worse

Stay with them until you can leave them in the right care.