MODULE 7

FIRST AID
Overview
Some self-limiting illnesses or minor injuries may only require first aid intervention,
and no further treatment. First aid generally consists of some simple, often life-saving
techniques that most people can be trained to perform with minimal equipment. First aid
usually refers to administration of care to a human, although it can also be done on
animals. The aim of first aid is to prevent a deterioration of the patient's situation, to aid
recovery, and to preserve life. Technically, it is not classed as medical treatment and
should not be compared to what a trained medical professional might do. First aid is a
combination of some simple procedures, plus the application of common sense.

Objectives
At the end of the lesson, you are expected to be able to:

1. distinguish the different aims of first aid;

2. recognize and evaluate the significance of vital first aid skills; and
3. devise and apply an effective and efficient first aid survey.

What are the aims of first aid?

• To preserve life: this is the main aim of first aid; to save lives. This includes the
life of the first aider, the casualty (the victim, the injured/sick person), and
bystanders.

• To prevent further harm: the patient must be kept stable and his/her condition
must not worsen before medical services arrive. This may include moving the
patient out of harm's way, applying first aid techniques, keeping him/her warm
and dry, applying pressure to wounds to stop bleeding, etc.

• Promote recovery: this may include applying a plaster (bandage) to a small

wound; anything that may help in the recovery process.
What are the vital first aid skills?

ABC (and sometimes D) The most common term referred to in first aid is ABC,
which stands for Airway, Breathing, and Circulation. In fact, the term also is
commonly used among emergency health professionals. The D stands
for Deadly bleeding or Defibrillation.

• Airway - the first aider needs to make sure the casualty's airway is clear.
Chocking, which results from the obstruction of airways, can be fatal.

• Breathing - when the first aider has determined that the airways are not
obstructed, he/she must determine the casualty's adequacy of breathing, and
if necessary provide rescue breathing.

• Circulation - if the casualty is not breathing the first aider should go straight
for chest compressions and rescue breathing. The chest compressions will
provide circulation. The reason is, time - checking circulation to a non-
breathing casualty consumes time that could be used with chest compressions
and rescue breathing. With less serious casualties (those that are breathing),
the first aider needs to check the casualty's pulse.

• Deadly bleeding or Defibrillation - some organizations have this fourth step,

while others include this as part of circulation

How to evaluate and maintain the ABCs of a patient depends on how well trained the first
aider is. As soon as ABC has been secured the first aider can then focus on any additional
treatments.

Some organizations use the 3Bs system, which stands for Breathing, Bleeding, and Bones,
while others used 4Bs, which stands for Breathing, Bleeding, Brain, and Bones.

ABCs and 3Bs are taught to be carried out in order of sequence. However, there are times
when the first aider may be performing two steps at the same time, as might be the case
when providing rescue breathing and chest compressions to a casualty who is not
breathing and has no pulse.

Many organizations have other acronyms (similar to abbreviations) that remind people of
their sequence of steps. For example, First Aid Works, an organization that trains people
in the UK uses DRAB to remind first aiders what to do during their Primary Survey:

Primary Survey - DRAB (danger, response, airway, breathing)

 • Danger- check for dangers to the casualty and to you as a first aider. If there is
danger present, can you get rid of the danger, or move the casualty out from
the danger? If there is nothing you can do, stay away and get professional help.
The worst thing a rescuer can do is to become another victim.

• Response- if safe to approach. Is the casualty conscious? See if the patient is

alert, ask questions and see if you get a response, find out whether he/she
responds to your touch. Very well trained first aiders will know how to find out
whether the casualty responds to pain.

• Airway- is the casualty's airway open and clear? If not, try to clear it. Trainers
advice first aiders to have the casualty lying on their back, and then to place
one hand on his/her forehead and place two finger from the other hand on the
casualty's chin and gently tilt the head back while slightly raising the chin
further upwards. Any obstructions need to be removed from the casualty's
mouth, including dentures. First aiders are trained only to put their fingers in
the casualty's mouth if they can see an obstruction there.

• Breathing- is the casualty breathing effectively? The first aider should look at
the chest for movement, his/her mouth for signs of breathing (e.g. sounds),
and get close to the casualty and see if air exhalation can be felt on the first
aider's cheek.

The Secondary Survey - DOMS (deformities, open wounds, medic alert tags,
swellings) If the casualty is breathing adequately, then it is possible to carry out
a Secondary Survey. This is a rapid whole body check. As soon as this has been done, the
casualty should be placed in a recovery position. At this point the first aider should call for
an ambulance.

What is the recovery position?

Even if the casualty is breathing, but is unconscious, there is still a significant risk of
airway obstruction. The recovery position minimizes the risk to the patient. A first aider
should do the following:

• Remove glasses if the casualty is wearing them

• Make sure his/her legs are
straight

• Place the arm that is nearest to

you at right angles to the
casualty's body (you are kneeling
next to him/her)

• Bring the other arm across their

chest; hold the back of his/her
hand against his/her nearest
cheek

• With you other hand, hold the casualty's thigh that is furthest from you and pull up the
knee. Make sure his/her foot is flat on the
Fig. 1 The recovery position can be a vital part of first aid.
ground

• Slowly pull down on the casualty's raised knee and roll him/her over towards you

• Move the upper leg slightly so that the casualty's hip and knee are bent at right-angles.
This makes sure they do not roll back onto their face

• Gently tilt the head back so that the airway is kept open.

First Aid for Animal Bites

Worldwide, up to five million people are bitten by snakes every year. Of these,
poisonous (envenoming) snakes cause considerable morbidity and mortality. There are
an estimated 2.4 million envenomation (poisonings from snake bites) and 94,000–125,
000 deaths annually, with an additional 400,000 amputations and other severe health
consequences, such as infection, tetanus, scarring, contractures, and psychological
sequelae. Poor access to health care and scarcity of antivenom increases the severity of
the injuries and their outcomes.

Who is most at risk?

The majority of snake bites occur in Africa and South-East Asia. Snake bites are
most common among people living in rural, resource-poor settings, who subsist on low-
cost, non-mechanical farming and other field occupations. Agricultural workers, women
and children are the groups most frequently bitten by snakes. Adding to the burden of
these injuries is their socio-economic impact on families and communities. Adult victims
are often the wage earners or care providers of the family unit and child victims can suffer
lifelong disability intensifying demands on families and communities.

First Aid For Snakebites

1. Call medical help immediately if possible.

2. Remain calm, remember most snake bites are not fatal.
3. Minimize movement if possible. If you are hiking alone you may have to hike out
for help.
4. If you are bitten on the arm or finger remove any rings, bracelets or watches.
Loosen any tight clothing in case swelling occurs.
5. Apply a pressure bandage to the bitten limb. If the bite is to the trunk, head or
neck, apply firm pressure to the bitten area. Do not restrict chest movement as
breathing will be affected by this.
6. Splint or use a sling on the bitten limb to restrict movement.
7. If there is no bandage or equivalent to apply a pressure bandage make note of any
inflammation by tracing the edge of the swelling with a pen or the like near/around
the bite and mark the time clearly next to it. If it progresses make a new tracing
noting the time of each new mark beside that new tracing. This will give valuable
information to medical help as to the development of the swelling.
8. If possible, lie down and keep the bitten extremity at body level. Raising it can
cause venom to travel through the body quicker. Holding it down, can increase
swelling.
9. When possible arrange for transport to the nearest hospital emergency room,
where anti-venom for snakes are common to the area and will often be available
and given if required.

Some definite No No's for Snake Bite First Aid

1. NO aspirin or other pain relievers.

2. NO tourniquets. This cuts blood flow completely and may result in loss of the
affected limb.
3. DO NOT try to suck the venom out of the wound or cut into the bite with a knife.
Such measures have not been proven useful and may cause further injury.
4. DO NOT apply a cold compress or ice on the bite. Research has shown this to be
potentially harmful.
 5. DO NOT raise the wound above the heart. Raising it can cause venom to travel into
the body. Holding it down, can increase swelling.
6. DO NOT use electric shock or a stun gun on the bite area. This method is under
study and has yet to be proven effective. It could harm the victim.
7. DO NOT wash the snake bite area - Australian recommendations for snake bite
treatment strongly recommend against cleaning the wound. Traces of venom left
on the skin/bandages from the strike can be used in combination with a snake bite
identification kit to identify the species of snake.
8. This speeds determination of which anti-venom to administer in the emergency
room.
9. DO NOT try and capture the snake. If it's safe you can try to take a photo with a
camera or with your phone. This is the best way in aiding snake identification.

Dog bites

There are no global estimates of dog bite incidence, however studies suggest that
dog bites account for tens of millions of injuries annually. In the United States of America
for example, approximately 4.5 million people are bitten by dogs every year. Of these,
nearly 885,000 seek medical care; 30,000 have reconstructive procedures; 3–18% develop
infections and between 10 and 20 fatalities occur. Other high-income countries such as
Australia, Canada and France have comparable incidence and fatality rates.

Who is most at risk?

Children make up the largest percentage of people bitten by dogs, with the highest
incidence in mid-to-late childhood. The risk of injury to the head and neck is greater in
children than in adults, adding to increased severity, necessity for medical treatment and
death rates. In some countries, males have a higher frequency of dog bites than females.
Dog bites account for over 50% of animal-related injuries in people who are travelling.

Steps to First Aid for a Dog Bite

1. Wash the bite thoroughly for several minutes with soap and warm water. If you
have antibacterial soap on hand, use it.
2. If the wound is still bleeding after being cleaned, apply pressure with a clean
gauze pad for a few minutes while keeping the bite elevated. With minor
wounds, the bleeding should stop fairly quickly.
3. Apply an antibiotic cream to help ward off infection.
 4. Wrapped bandage with enough pressure to help seal the wound, but not so
tight that it will affect circulation.
5. Change the bandage daily, wash the bite, and apply antibiotic ointment prior
to reapplying the dressing. If the bandage becomes soiled, by dirt, blood, or
water, change it as needed.
6. Watch the wound closely for any signs of infection: increased pain, swelling,
pus-like ooze, fever, etc. In case of infection, seek medical attention as soon as
possible. An antibiotic will be needed to clear the infection. Do not wait!
Infection changes the situation from a painful annoyance to a dangerous and
potentially life-threatening crisis.

Cat bites

Worldwide, cat bites account for 2–50% of injuries related to animal-bites. They are
commonly second to dog bites in terms of incidence. In Italy for example, the incidence
of cat-related injuries is 18 per 100,000 population, while in the United States of America,
there are an estimated 400,000 cat bites and 66,000 visits to hospital emergency
departments every year.

Who is most at risk?

Female adults have the highest rate of cat bites.

Cleaning Minor Cat Bites at Home

1. Assess the severity of the bite. Sometimes cats just give warning nips without
breaking the skin, other times the bites can result in deep punctures from their
canines.

2. Wash a minor bite. If the cat’s teeth did not break the skin or broke the skin
but did not go deep, you can wash and clean the bite at home.

• Thoroughly wash the bite with soap and clean tap water, allowing the water to
flow over the bite and remove dirt and bacteria from the wound. Hold the bite
under running water for several minutes.
• Gently squeeze the bite to help the blood flow. This will help remove dirt and
bacteria from the inside of the wound.
 3. Disinfect the wound to prevent bacteria or other pathogens from
growing. Put the disinfectant on a sterile cotton ball and then gently wipe it over
the bite. It will probably sting, but only briefly. The following chemicals have
excellent germicidal properties:

• Rubbing alcohol
• Iodine scrub
• Hydrogen peroxide

4. Prevent infection in a minor bite by applying an over-the-counter antibiotic

cream. Smear a pea-sized amount of topical antibiotic cream over all areas where
the skin was broken.

• Triple antibiotic creams are widely available and effective. Always read and follow
the manufacturer’s instructions.
• Talk to a doctor before using these medications on infants or if you are pregnant.

5. Protect the wound with a band aid. This will help keep dirt and bacteria out as
it heals. Cover all areas where the skin was broken with a clean band aid.

• Because cat bites usually cover a small area, you will probably be able to cover it
with an over-the-counter adhesive Band Aid.
• Dry the bite first, to help the Band Aid stick.

Monkey bites

Monkey bites account for 2–21% of animal bite injuries. In India for example, two
studies found monkeys to be second to dogs as the most common source of animal bite
injuries.

Who is most at risk?

Monkey bites are an important risk among travelers, being the second most
common animal bite risk to travelers after dog bites.

First Aid

If you are exposed to a macaque monkey, begin first aid immediately.

 • First, thoroughly wash and gently scrub the wound or area on your body that had
contact with the monkey with soap, detergent, or iodine for 15 minutes.
• Afterwards, run water over the wound or area for 15 to 20 minutes more.
Then immediately seek medical attention. Tell the healthcare provider that you
have been exposed to a macaque monkey that may be infected with B virus.

Rat Bite

Among all the rodent species all over the world, rats are the most troublesome to
humans. Not only do they contaminate food, but they also transmit parasites that cause
diseases, and can also cause damage to properties. They thrive in any type of conditions,
but especially in areas populated by humans because it means they are near food
sources.

To further understand how dangerous rats are, here is a list of some of the diseases
they can spread:

Leptospirosis – This is a bacterial disease that can infect humans and animals and is
caused by the bacteria Leptospira. Considered as a very dangerous disease, it can lead to
kidney damage, liver failure, and could even be fatal. Signs and symptoms include
headache, vomiting, nausea, high fever, jaundice, red eyes, rashes, and abdominal
pains. This disease is treated with antibiotics.

Tetanus – This is also a bacterial disease caused by the bacterium Clostridium

tetani. These bacteria enter our bodies through breaks in the skin; so a rat bite by a rat
carrying this bacteria in its saliva is one of the ways humans contract this disease. Most
people call it by the name lockjaw, since its main characterization is muscle spasms that
begins with the jaw, and moves on to the rest of the body. Other symptoms may include
fever, headache, trouble with swallowing, sweating, fast heart rate, and high blood
pressure.

The Hantavirus Pulmonary Syndrome (HPS) – The HPS is a severe respiratory disease
caused by the hantavirus infection and can be fatal. This disease is transmitted via direct
contact with rats, especially if bitten. Aside from being bitten by a rat, humans can become
infected through exposure or inhalation of rodent urine, droppings, or saliva. Eating food
that is contaminated by rodent droppings, urine, or saliva can also transfer the virus. Early
symptoms of HPS include fever, dizziness, nausea, vomiting, diarrhea, chills, headache,
fatigue, and muscle pains. According to the Center for Disease Control, the mortality rate
for this disease is 38%.
Rat bite fever – The rat bite fever is a disease contracted by humans after getting bitten
by rats infected with the bacteria Streptobacillus moniliformis and Spirillum minus. Signs
and symptoms are fever, headache, vomiting, muscle pains, and joint pains. Symptoms
usually begin from 3 to 10 days after the rat bite.

If confrontation is unavoidable, and a rat bit you, here are some first aid treatments you
can perform:

1. Clean your wound with soap and water. Water should be warm. Wash the
wound thoroughly with water, making sure that all the soap would be rinsed
away to avoid irritation,
2. If there is bleeding, make sure to control it until it stops.
3. After washing, put an antibiotic ointment then cover with a clean and dry
dressing. Rat bites often lead to infection, and this step can help prevent it.
4. Try to capture the rodent that bit you if possible. This can help determine if
the rodent is infected with a disease.
5. After performing first aid treatment, seek immediate care from a
doctor. Remember that these steps are only for first aid, and not the treatment
itself.