BFA Africa UGANDA Anatomy Physiology en WEB

Basic
Basic first
first aid
aid
for
in Uganda
X
INCLUDING
ANATOMY
AND
PHYSIOLOGY
Basic first aid
in Uganda
INCLUDING
ANATOMY
AND
PHYSIOLOGY
3
Contents
Contents ........................................................................................................................................... 4
Introduction..................................................................................................................................... 7
1 General principles................................................................................................................... 9
1.1 Six principles of first aid................................................................................................ 9
1.2 Four steps in first aid...................................................................................................19
2 Emergencies...........................................................................................................................35
2.1 Unconsciousness........................................................................................................... 36
2.2 Chest discomfort.......................................................................................................... 47
2.3 Choking........................................................................................................................... 49
2.4 Stroke.............................................................................................................................. 55
2.5 Poisoning........................................................................................................................ 57
2.6 Severe bleeding and shock.........................................................................................67
2.7 (Near-)drowning............................................................................................................ 74
2.8 Temperature-related emergencies........................................................................... 79
2.9 Electrocution................................................................................................................. 84
2.10 Emergency child birth.................................................................................................. 88
3 Injuries......................................................................................................................................99
3.1 Skin wounds.................................................................................................................100
3.2 Burns.............................................................................................................................110
3.3 Injuries to muscles, joints and limbs.......................................................................116
3.4 Injuries to the head, neck and back........................................................................129
3.5 Eye injuries...................................................................................................................141
3.6 Nosebleed....................................................................................................................149
3.7 Stings and bites...........................................................................................................151
4 Illnesses.................................................................................................................................163
4.1 Fainting.........................................................................................................................164
4.2 Fever..............................................................................................................................168
4.3 Fits.................................................................................................................................173
4.4 Diarrhoea.....................................................................................................................177
4.5 Rash...............................................................................................................................187
4.6 Low blood sugar.........................................................................................................192
5 The first aid kit....................................................................................................................195
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6 The human body, an introduction to anatomy and physiology..............................201
6.1 How does it work?......................................................................................................202
6.2 What can go wrong?...................................................................................................226
Methodology................................................................................................................................267
Index ........................................................................................................................................271
References....................................................................................................................................277
Notes ........................................................................................................................................279
Colophon.......................................................................................................................................282
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Introduction
Either directly or indirectly, each and every one of us is affected by injury or sudden
illness at some point. It is therefore important that citizens possess the right knowledge
and skills to be able to recognize emergency situations, and provide basic life-saving care
to those injured and suddenly ill persons until professional medical services are available.
In doing so, the most valuable lives are sustained, and much of the injury-related costs
and burden to the family and healthcare systems are reduced.
The Uganda Red Cross Society (URCS) commits to further her auxiliary mandate by
supporting the provision of high-quality emergency care system throughout the country
through the provision of community and workplace First Aid Education for all; equipping
households, by-standers, workers and community lay-responders with evidence-based
life-saving procedures. To fulfil this commitment further, we are glad to present this first
Edition of Basic First Aid Manual; which is a joint effort of the URCS and the Belgium
Red Cross’ Centre for Evidence-Based Practice (CEBaP), the International Federation
of the Red Cross and Red crescent Societies’ (IFRC) Global First Aid Reference Centre
(GFARC) and Cochrane Collaboration Centre. This manual provides life-saving guidance
for common, mild, serious, and life-threatening situations that you may face, in a step-by-
step-process, using illustrations and photographs to help promote better understanding
of the problem at hand. This manual is in line with the African First Aid Materials (AFAM)
guidelines; suiting local low-resourced environments in Uganda and other developing
countries. The manual also complies with the International Federation of Red Cross
and Red Crescent Societies’ (IFRC) 2021 Edition of the International First Aid and
Resuscitation Guidelines. Although the manual is designed to provide you with a good
knowledge base, it is strongly encouraged that readers; in addition take a formal first aid
course from any of the Red Cross Branches near you. It is also recommended that you
refresh your skills on a regular basis.
We hope that you will enjoy learning how to help those in need of emergency care and
that you will gain confidence in your knowledge and practice as you proceed through
this manual.
Robert Kwesiga
Secretary General
7
1. General principles
8
1 General
principles
1.1 Six principles of first aid

When administering first aid, the first aider’s safety is the first priority, but there are
several other principles to consider. In addition to the specific techniques the first aider
needs to apply, there are six guiding principles. These principles are essential to provide
first aid in a proper way and will help the first aider to adopt the right attitude to respond
correctly and safely during a first aid situation.
Principle 1: Keep calm in a first aid situation

Most first aid situations occur suddenly and unexpectedly. Therefore, it is normal for the
first aider and the ill or injured person to experience stress. As a first aider, you should
avoid acting impulsively. Regain your calm, before providing first aid.
Technique - Calming down in a first aid situation
Use the following tips to calm down in first aid situations:

■ Take a couple of deep breaths.
■ Stop negative thoughts, encourage yourself.
■ Talk to the ill or injured person. This will give you a chance to control your own
emotions.
■ Stick to the techniques and first aid actions you know.
■ If you do not know what to do, call for help.
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Principle 2: Avoid infection

When providing first aid, you should be aware of the risk of infection. As a first aider you
can infect the ill or injured person, but they can also infect you.
Follow the following instructions to avoid infection:
■ Frequent handwashing reduces the risk of infection for the first aider and the ill or
injured person. Wash your hands before and after providing first aid.
■ Cover your own wounds with a waterproof plaster or other suitable dressing.
■ Avoid direct contact with blood or body fluids:

■ Wear clean disposable gloves. When disposable gloves are not available, use any
available local alternative (e.g. clean plastic bags).
■ If no disposable gloves or local alternatives are available, instruct the ill or injured
person on how to provide first aid to themselves if possible.
■ Handle sharp objects (e.g. broken glass, needles and first aid equipment) carefully.
■ Do not touch any part of the dressing that will cover the wound.
■ If your wounds come into contact with another person’s blood or body fluids, wash
them thoroughly with clean water (e.g. drinking water, boiled and cooled water … )
and soap as soon as possible. Other person’s blood or body fluids in your eyes, nose or
mouth should be rinsed out with clean water immediately.
■ After providing first aid, place bloody or soiled dressings and your disposable gloves
or locally available alternative in a plastic bag. Arrange for the bag to be collected,
burned or buried.
■ If you accidentally come into contact with blood or other body fluids, or you have
pricked or cut yourself on a used object, seek medical attention as soon as possible.
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Technique - Handwashing
Wash your hands before and after providing first aid (after removing disposable
gloves, if applicable). Washing your hands should take between 40 and 60 seconds.
Are you wearing long-sleeved clothes? Then roll up your sleeves so that your
forearms are free. Take off any jewellery (bracelet, watch, rings, etc.).
When clean running water is available:

1. Wet your hands under clean running water.
2. Use soap. If soap is unavailable, use ash from a clean wood fire that is no longer
hot.
3. Rub your hands firmly together and wash thoroughly. Make sure the soap (or ash)
touches all parts of your hands including the palm, back of the hand, fingertips,
thumb, skin between fingers and wrists of both hands.
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4. Rinse your hands well, using plenty of water.
5. Dry your hands with a clean towel or cloth.
When no clean running water is available:

■ Wash your hands using clean water (e.g. drinking water, boiled and cooled water)
which you pour out of a clean bottle, jug or can.
■ Disinfect your hands using an alcohol-based hand sanitiser.
Principle 3: Act as a first aider

When you are in a first aid situation, act as a first aider. You followed a first aid course,
so your contribution is of great value to the ill or injured person. When you are in doubt
about what you can do, limit yourself to those actions that you are sure can help. Know
your limits; do not perform actions that you have not learned. Make sure you do not
make the situation worse.
Principle 4: Ensure the comfort of the person

In a first aid situation, a person has an injury or condition that requires attention.
Nevertheless, it is also important to pay attention to the comfort of the person.
■ The general rule is to never move an ill or injured person. You should try to adapt the
environment safely to the situation. The person should only be moved when danger is
imminent (see: STEP 1: Ensure safety, p. 19).
■ Protect the ill or injured person from cold and heat. Put a coat or a blanket over them
to protect them from the cold. This also provides a certain degree of privacy for the
person.
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■ Allow the ill or injured person to adopt a comfortable position when you do not
suspect a spinal injury (see: p. 134). Do not impose a specific position on them, but let
them determine the most comfortable position for themselves.
■ Do not allow the ill or injured person to eat, drink or smoke. Also, do not allow
any bystanders to smoke. Only allow the ill or injured person to eat or drink when
requested by a medical professional, or in some specific cases (e.g. low blood sugar or
hypothermia), which are discussed in this manual. Use drinking water if an ill or injured
person needs to drink.
Principle 5: Provide psychosocial first aid

A first aid situation happens unexpectedly and is often shocking. Try to take the emotions
and reactions of the ill or injured person, family members, friends and bystanders into
consideration when providing first aid.
Providing psychosocial support is an essential part of providing first aid, but could be
challenging. Psychological first aid comforts the person, assesses the needs and concerns
of the person and helps them to connect to information. It is not something that only
professionals do and it is not therapy or treatment.
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When people are faced with a strong or sudden emotional and physical strain, such as a
first aid situation, most will experience stress. Stress is a state of pressure that affects
body and mind. It is a part of everyday life and is not necessarily negative. It can be
positive when it makes a person perform optimally (e.g. in an exam).
Reactions to stress help people cope with adverse situations. Be aware that signals can
differ strongly between people. Stress may manifest as follows:
Physical reactions Emotional reactions

■ Shaking ■ Anger
■ Nausea/vomiting ■ Anxiety
■ Tiredness ■ Grief
■ Crying ■ Guilt
■ Clammy skin ■ Desperation
■ Blushing ■ Shame
■ Diarrhoea ■ Hopelessness
■ Fast heartbeat ■ Sadness
■ Pacing the floor ■ Feeling numb
■ Tapping feet and/or fingers
■ Physical tension and headache
Cognitive reactions Behavioural reactions

■ Loss of concentration ■ Aggression
■ Confusion ■ Irritability
■ Losing sense of place and time ■ Withdrawal
■ Becoming disoriented ■ Isolation
■ Indecision ■ Apathy
■ Excessive use of cigarettes, alcohol or
substance abuse
Source: eCBHFA Volunteer manual (1)
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Technique - Psychological first aid
These recommendations can help a first aider to approach someone in distress and
provide psychological first aid.
Approaching the person:
■ Approach the person in a respectful, friendly way without any preconceptions.

■ Try to see the situation from the other person’s point of view.
■ Introduce yourself, give your name and say that you have completed training in
first aid (if this is the case). Ask the person’s name, listen to what they say and
show empathy. Ask what has happened.
■ Display appropriate attentive behaviour (e.g. sit at the same eye level as the
person, maintaining some eye contact while talking to the person, display facial
expressions that express interest and concern). This shows that you are paying
attention to and are interested in the ill or injured person’s message.
■ Keep your voice calm and soft. Be patient and often repeat what you say.
■ Stay calm, do not make any abrupt movements and do not touch the person
without asking their consent.
While providing first aid:
■ Ask permission to touch the person and provide first aid.

■ When the ill or injured person does not know what happened, explain to them
what happened (e.g. ‘You have been hit by a car’ or ‘You fainted’).
■ Explain what you are doing, what you can and will do and why you are doing it.
It will help the person to calm down and feel safe. Even if they do not appear to
hear (e.g. an unconscious person), they may hear more than you think, so always
be careful what you say.
■ Provide honest and correct information, do not make statements about things
you are not sure about. If the person asks you a question you cannot answer, tell
them that you do not know.
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■ Provide first aid in an organised way and try not to forget anything.
■ Remind the person that you are there to help them and that they are safe, if it is
true.
■ Explain what kind of help is on its way.
■ Stay with the person, do not leave them alone if possible.
What to do if the person is nervous:
■ Be attentive for symptoms of stress. Be aware that these signals can differ
strongly between people.
■ Encourage the person to carry out small actions (e.g. supporting a painful arm
themselves). This way you show respect and give the person a sense of control.
Assist the person practically:
■ Look after their possessions. If the ill or injured person needs to go to the hospital,
make sure their possessions and clothing accompany them. If necessary, give the
belongings to the police.
■ Motivate the person to contact a loved one. Help them to reach this person (e.g.
by offering a phone).
What to do if the ill or injured person is a child:
■ Talk to a trusted adult of the child who is present first (e.g. parent, companion,
grandparent). If they accept you as a first aider, you will also gain the child’s trust
more easily.
■ Distract the child if possible.
■ Explain what you are going to do and why, using simple words. Answer the child’s
questions honestly. Their imagination is often far worse than the reality.
■ Do not be patronising. Make sure that the child feels involved.
■ Never leave a child alone. Do not take a child away from their parents or other
trusted people unless necessary. Reunite them as soon as possible with a trusted
person.
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Principle 6: Pay attention to emotional reactions
after the event
After providing first aid, it can be pleasant for the ill or injured person, their family
members or friends, other parties involved and for yourself to continue to chat for a
while. You can explain what you saw or did, but remain discrete and talk only to those
who were directly involved.
After providing first aid, most people feel confident and they rightly feel useful. But
what if you feel like you did not do it right? Talk to family, friends, fellow first aiders or
a community leader. If you are still worried, talk to a professional and seek counselling.
Family members or friends of the ill or injured person can also be casualties of the
situation. During the days and weeks after the event, they may experience different
feelings: insecurity, distress and anger, all of which are normal reactions to the stressful
event. Family members or friends of the casualties can help them by offering practical
help and listening. Contact them now and then and briefly repeat the offer to help.
Sometimes people will not have heard or did not dare to accept the first offer.
First aiders can, if they are trained in Psychological First Aid, help casualties and their
family members or friends by helping them access services and by providing information
on stress and coping. A first aider could also help by providing factual information about
the event and by connecting casualties with loved ones and social support. However, the
first aider must ensure that they do not take on more responsibility than necessary.
As a first aider, you should be attentive for emotional reactions after a shocking event.
Be aware that emotions and signals of stress can differ strongly between people. The
following recommendations can help you deal with emotional reactions after the event:
Start the conversation

■ Acknowledge the event and express your concern. Let the person know you are willing
to talk, about anything, including the event. Allow them to share what they think and
feel, but do not force them to talk about the event.
■ Provide time and space to talk. Find a quiet place where you both feel comfortable. If
the person does not wish to talk, respect this. Tell them that you are willing to listen
and talk at a later time as well.
■ Listen without judging. Avoid discussion, criticism, accusation or minimisation.
■ Stay calm. Intense reactions could give the person the idea they cannot share their
concerns with you.
■ Limit giving advice, but look for solutions together. Respect how the person copes
with the event and do not encourage substance abuse to cope with the situation.
■ Offer support and show compassion. Try to understand what happened and how the
person feels. Let them know you are there for them. Confirm that everybody reacts
differently to a shocking event and that their reactions are normal.
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Assist and support the person

■ Offer practical help, but only do things the person wishes you to do. Do not take over
everything.
■ Encourage them to talk about their thoughts and feelings to relatives or friends. Do
this after offering a listening ear yourself.
■ Stay present. The thoughts and feelings related to the event should become less
intense, but there could still be difficult moments. Maintain contact and support in
the long term.
■ Maintain your role as a family member, friend, colleague. Take sufficient time to talk
about other subjects and things that are going well.
Guide the person to professional or other help
■ Respect the person’s privacy, but do not promise confidentiality.
■ If you think the person needs professional help but does not want to be helped, be
patient, but do not give up. Discuss the pros and cons of professional help and focus
on the opportunities.
■ Let the person know you are willing to assist when they are ready to seek help.
Encourage them to seek professional help if their daily life remains disrupted after
several weeks. Offer assistance to find help and discuss the possibilities, but do not
take control, let them decide.
■ Ensure safety by contacting professional help (emergency services) if there is
imminent threat to the person or others if the person loses touch with reality. Try to
act as much as possible in dialogue with the person.
Guard your personal boundaries and take care of yourself
■ Acknowledge and accept your own thoughts and feelings (e.g. related to a similar
event you experienced). Being aware of these thoughts will help you not to let them
influence your assistance in a negative way.
■ Limit your own responsibility. You offer support, but are not responsible for the
person you want to help.
■ Let yourself be supported by family, friends or acquaintances.
■ Maintain a healthy lifestyle. Take time to relax and to do things that give you energy.
Source: International First Aid Resuscitation and Education Guidelines 2020 (2)
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1.2 Four steps in first aid
Although every first aid situation can be different, you should always follow the following
four steps while providing first aid. These steps will help you to correctly assess the
situation and provide appropriate first aid.
STEP 1: Ensure safety

Before you start helping, check the situation thoroughly. Only when it is safe can you
approach the ill or injured person. Try to eliminate the danger if possible. It may be a
simple measure, such as turning off a car’s ignition, scaring away a dog, unplugging an
electrical device or extinguishing a fire.
Your safety
Never put yourself at risk. Only approach the ill or injured person if it is safe for you.
The safety of the ill or injured person

As a rule of thumb, never move an ill or injured person, because any movement may
worsen their condition. Nevertheless, some situations require the ill or injured person
to be moved, for example in the event of (near-)drowning, fire, explosion or collapse of
a building.
■ Only move an ill or injured person if:

■ you can do so without endangering yourself;
■ the person is in more danger if left there;
■ the situation cannot be made safe;
■ medical help will not arrive soon.
■ If you have to move the injured person, consider:
■ explaining what you are going to do. Ask them to follow your instructions.
■ supporting their neck. Keep their head in line with their body. In case of a spinal
injury (see: p. 134), movement may cause further damage.
■ moving them to the nearest safe place.
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Bystander safety
Alert bystanders to the dangers and risks of the situation. Sometimes bystanders panic
and get in the way. Give directions to bystanders who want to help (e.g. ask them to place
a warning triangle, warn oncoming traffic or arrange urgent transport).
Technique - Moving an ill or injured person in danger
There are different techniques for moving an ill or injured person. If possible, move
them with at least two people. The most appropriate technique depends on the
situation.
You are alone
■ If the person is able to stand on one leg and hold onto

you, consider supporting them like a ‘human crutch’.
1. Stand on the appropriate side of the person:

■ If the person is injured, it is best to stand on the
uninjured side of the person.
■ If the person is paralysed (e.g. due to a stroke
(see: p. 55), you should support them on their
paralysed side.
2. Place one hand around their waist, so that it rests
on their hip.
3. Put their arm over your shoulder and take hold of
their wrist.
4. Support the person while letting them walk slowly.
5. Draw the person’s attention to possible obstacles
(e.g. uneven ground, stairs).
■ If the person is able to hold onto you, consider carrying

them on your back.
1. Stand in front of the person, facing the same

direction. Bend through both of your knees, keeping
your back straight.
2. Have the person put their arms around your neck.
3. Help them onto your back, with their legs above
your waist.
4. Support the person’s legs.
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■ If the person is heavier but able to hold on to you, move them using the
Fore-technique.
1. Sit behind the person with your legs either side of them.
2. Put your arm under one of the person’s armpits and place your hand under
their other armpit. Have the person hold on to your forearm with both hands.
3. Have them rest their head on your shoulder.
4. Put your free hand behind you as support. Pull the person backwards by
pushing your legs.
■ If the person is unconscious, or unable to

stand or hang on:
■ If the person is very lightweight, move
them using the cradle technique.
1. Bend through both of your knees, while

keeping your back straight.
2. Scoop up the person, who is lying on the
ground, with one hand around their back
and the other hand under their knees.
3. Lift the person in one swift movement,
while keeping your back straight.
4. Ensure that your forearm, which is under
the person’s legs, goes around both of
their legs.
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■ If the person is lighter than the first aider, move them using the Rautek-
technique.
1. Place the person’s arms against their body

and put their feet side by side.
2. Kneel behind the person’s head. Slide one
hand under their neck and the other hand
between their shoulder blades. Gently raise
the head and shoulders and slide yourself
closer.
3. Lift the person’s back up to a seated

position. Support the person by the
shoulders.
4. Put both of your arms under the person’s

armpits and grab one forearm with your
hands. Grasp it with one hand at the wrist
and with the other at the elbow.
5. Squat, without letting go of the arm. Press
the person’s arm firmly against the chest.
Hold the person close to you.
6. With your back stretched out, pull the
person up until they rest on your thigh.
Step back and drag them with you.
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There is 1 person to help you
■ Move the person, using the

two-handed lift:
1. Stand on one side of the injured

person, facing your helper on
the other side.
2. Put one arm around the
person’s back for support (one
person can support the lower
back, while the other supports
the upper back).
3. Put your other arm under the
person’s thighs and grasp your
helper’s wrist.
4. Have the person put their arms
around your necks.
5. Lift the person.
■ Move the person, using the

four-handed lift:
1. Stand to one side of the injured

person, facing your helper on
the other side.
2. Grasp your own left wrist with
your right hand. Have your
helper do the same.
3. Grasp your helper’s right wrist
with your free (left) hand,
thereby creating a ‘seat’. Have
your helper do the same.
4. Bend down and ask the person
to sit on this ‘seat’. Have them
put their arms around your
necks.
5. Lift the person.
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There are more than 4 people to help you
1. Position yourself at the head

end. Have the helpers kneel on
one knee on each side of the
person.
2. Support the head and neck of
the person.
3. Have each helper place their
hands carefully underneath the
person, supporting the back as
much as possible.
4. On your command, everyone
lift the person as evenly as
possible.
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STEP 2: Assess the ill or injured person’s condition
When the situation is safe, assess the ill or injured person’s condition. Briefly find out
what is wrong; try to find out what happened and if there are any injuries. Listen to what
the ill or injured person says and listen to the bystanders who witnessed the accident.
If the person is unable to cooperate, for example because they are unconscious, try to
find an explanation by looking closely at the ill or injured person and their environment.
1. Check the person’s consciousness.

2. Open the person’s airway and check for breathing.
3. Find out what is wrong with the person.
ACTION 1: CHECK FOR CONSCIOUSNESS

Checking if the ill or injured person is conscious is the first action you should take when
assessing their condition. Ask the person loudly: “Are you all right?” and shake both of
their shoulders gently.
Does the person react?

■ Yes, the person reacts (e.g. by answering or opening their eyes). The person is conscious.
■ If the person is conscious and talking, they are able to keep their own airway open
and it is safe to assume that they are breathing adequately.
■ Proceed to ACTION 3: Find out what is wrong with the ill or injured person.
■ No, the person does not react. The person is unconscious.
■ Proceed to ACTION 2: Open the airway and check for breathing.
If the ill or injured person is lying on their stomach, it is hard to assess their condition. If this
is the case, turn them from their stomach onto their back using the following technique. Do
not turn the person when you suspect that they have a spinal injury (see: p. 134).
If, when checking for consciousness, you clearly see that the person is breathing normally,
there is no need to turn them on their back. Put them straight into recovery position.
However, if you suspect that the person has a spinal injury, leave them in position, on
condition that they are clearly breathing normally.
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Technique – Turning a person from their stomach to their back
Use this technique to turn an ill or injured person lying on their stomach to their back
when you are alone. If possible, you turn the injured person over their non-injured
side.
1. Kneel beside the person’s waist.
2. Place their arm, from the side on which you are going to turn the person, against
their torso, or all the way up.
3. Support the person’s neck and head with one hand and grasp the hip with the
other.
4. Turn the person towards you in a smooth movement and continue to support the
head and neck. Turn the person in such a way that the head, shoulders and torso
move as a whole.
26
5. Carefully lay the person down.
ACTION 2: OPEN THE AIRWAY AND CHECK FOR BREATHING

An unconscious person’s tongue could slacken. As a result, there is a risk of the tongue
sinking into the throat and closing off the airway, making it impossible to breathe
normally. By opening the airway, the first aiders can eliminate this risk (see further).
When you have opened the airway of the unconscious person, you should check whether
they are breathing normally (see further).
How is the person’s breathing?

■ The person is breathing normally. Provide first aid as in unconsciousness with normal
breathing (see: p. 36).
■ The person is not breathing normally. Provide first aid as in unconsciousness without
normal breathing (see: p. 40).
Technique – Opening the airway
1. Kneel beside the person’s chest.

2. Put one hand on the forehead of the person. Gently press it down and tilt their
head back.
3. Put two fingertips of your other hand beneath the person’s chin, but do not push
into the soft part of the chin. Lift the chin to open the airway.
When you suspect a spinal injury (see: p. 134), do not tilt the person’s head back. In
this case you only perform the chin lift.
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Technique – Check for breathing
While keeping the person’s airway open, bring your ear close to their mouth.
■ Look to see if the chest goes up and down.

■ Listen at the mouth and nose for breathing sounds.
■ Feel with your cheek if there is air flow.
Looking, listening and feeling are done simultaneously and should not take longer
than 10 seconds. However, it should be done long enough, because an unconscious
person may breathe slowly. If you do not check the breathing for long enough, you
may incorrectly assume that the person is no longer breathing.
! Attention! - Gasping
In the first few minutes after a cardiac arrest, it often looks like the person is still
trying to breathe. The person could make (sometimes noisy) breathing movements,
but there is no detectable air flow at the nose and mouth. The person may make
involuntary movements with the arms and legs. This is called ‘gasping’ and should
be categorised as ‘not breathing normally’. CPR must be started immediately (see:
p. 40).
ACTION 3: FIND OUT WHAT IS WRONG WITH THE ILL OR

INJURED PERSON
Based on various signs and symptoms, you will determine which actions to take in order
to provide appropriate first aid to the ill or injured person.
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STEP 3: Seek help
As a first aider you can take care of a lot of small injuries yourself. It is not always necessary
to call in further help (e.g. a simple skin wound or a nosebleed). However, in other cases
you will have to decide if urgent help is needed (e.g. serious injuries or unconsciousness).
Which type of help should you seek?

In the following chapters, ‘STEP 3: Seek help’ will be mentioned multiple times. Below,
you will read what you need to do when the following actions are referred to:
■ “Alert the emergency services“: When the situation is unsafe or a person has to be
rescued from an unsafe situation, alert the emergency services.
■ Seek the help of the fire department in case of fire, poisoning by inhalation,
(near-)drowning or high voltage electrocution.
■ Seek the help of the police in case of road accidents or violence.
■ “Call for help and arrange urgent transport to medical care”: In this case, the ill or injured
person should be transported to the closest medical facility as soon as possible. An
ambulance is the best and safest way to transport an ill or injured person to a medical
centre. Call for an ambulance if one can be obtained quickly.
■ If no ambulance can be obtained quickly, transport the ill or injured person to a
medical facility yourself. This can be done with the help of bystanders, with or
without motorised transport (see further).
■ While waiting for transport or during the transport to a medical facility, provide
first aid as described in STEP 4. This way, the person reaches medical care in the
best possible condition.
■ “Often, there is no need for urgent medical care in this situation. Arrange medical attention
if the person shows the signs described in STEP 4”. Normally, urgent medical care will
not be needed in this situation. However, arrange professional medical attention for
the ill or injured person if they show signs and symptoms described in STEP 4.
■ Providing first aid is easier when there is assistance. Do not hesitate to ask bystanders
for help and to give them instructions.
How to seek help?

■ Ask a bystander to call for help or to arrange
transport for the ill or injured person. If the
bystander has to leave the scene to find help,
command them to return to confirm when help has
been secured.
■ If you are alone with the ill or injured person, shout
or call for help. Only leave the person to find help
or to arrange urgent transport if you have no other
choice, and come back as soon as possible.
■ If you have to leave an ill or injured person, put
them in recovery position if they are unconscious
or if their condition might deteriorate.
29
What information?
When you need to call the emergency (medical) services, you are usually in a stressful
situation. However, it is important that you pass on precise and correct information to
the operator of the emergency services and that you can answer their questions. Before
you call the emergency services, try to find out the following:
■ Where is the exact location of the emergency?

■ What is the type of emergency?
■ Who is injured and what is wrong with them?
Technique – Transporting an ill or injured person to medical help
Do you need a stretcher to move the person?

■ Improvise one by using a blanket, shirts, sacks or other cloth, and two strong
sticks.
Do you transport the person by car?

■ Urgent transport of an ill or injured person should preferably be done by
ambulance.
■ If no ambulance is available, the ill or injured person can be transported by a
normal car.
■ Besides the driver, the person should be accompanied by a first aider. The driver
should focus on driving, while the first aider can check the ill or injured person.
■ An ill or injured person who is able to sit upright should preferably be seated in
the back seat, together with the first aider.
■ When the ill or injured person is unable to sit upright:
- slide them carefully into the backseat of the car;
- put them in recovery position (see: p. 37).
■ When the ill or injured person has to be placed in the front seat, recline the
seat as far as possible.
■ Ensure safety during the transport. Have the driver drive carefully.
30
STEP 4: Provide further first aid
Are you sure the situation is safe? Have you checked consciousness and breathing? Did
you find out what is wrong with the ill or injured person? Have you arranged urgent
transport, if necessary? Then provide further first aid!
Set priorities in first aid provision

As a first aider, you cannot do everything at the same time. It is necessary to determine
which injury needs your care first. For example, opening an airway is more urgent than
rinsing a skin wound. This also applies when there are several casualties, in which case
you need to determine which one you care for first.
If a person has suffered multiple injuries, you have to make choices. Prioritise as follows:
1. Suppress catastrophic bleeding (see further).
2. Take care of unconsciousness, with or without normal breathing (see: p. 36).
3. Cool burns (see: p. 110).
4. Take care of large wounds (see: p. 100).
5. Apply first aid for injuries to muscles, joints and limbs (see: p. 116).
6. Take care of minor injuries.
Good to know! - What is catastrophic bleeding?
Catastrophic bleeding is when a person is rapidly losing a very large amount of blood.
It could happen when:
■ blood is spurting or gushing from the wound;

■ there is an amputation of a limb(s);
■ there is a wound to the thigh.
Bloodloss from a catastrophic bleed must be stopped instantly, even before checking
for consciousness and breathing. You may not stop all the bleeding immediately, but
if you can stop most of it, you could be saving a life. Putting direct pressure on the
bleed and using pressure dressings are options for controlling a catastrophic bleed.
It can be difficult to estimate the volume of blood that is being lost. Even a small
amount of blood can look very dramatic and serious. Therefore, look for active blood
loss rather than just the presence of blood on the injured person.
31
Provide first aid

Further on, this manual describes in detail what to do in case of certain injuries and
illnesses. While providing first aid, continue to check the person’s consciousness and
breathing regularly. Changes in consciousness and breathing can indicate a change in
their condition.
When possible, write down your findings so that you can pass them on to the medical
care providers.
Arrange medical attention for the person

Many first aid situations can be dealt with by the first aider themselves, but in some
situations, medical attention is necessary. In these cases, the situation requires the
advanced medical skills of a formal health worker (e.g. community health worker) or a
medical professional (e.g. nurse, midwife or doctor). This medical follow-up should not
be delayed, but urgent transport is not needed in this case.
32
33
34
2 Emergencies
Emergencies are serious, unexpected and often dangerous situations. These situations
pose an imminent risk to the health or even the life of the affected person. Most of
these emergencies require immediate action to prevent the situation from worsening.
Common types of emergencies mentioned in this manual are:
■ unconsciousness;
■ chest discomfort;
■ choking;
■ stroke;
■ poisoning;
■ severe bleeding and shock;
■ (near-)drowning;
■ temperature-related emergencies;
■ electrocution;
■ emergency child birth.
35
2. Emergencies
2.1 Unconsciousness
Unconsciousness is a state of loss of consciousness in which a person no longer responds
to stimuli from their surroundings, like being asked loudly: “Are you all right?”, or being
shaken. The person appears to be asleep. Unconsciousness may be caused, for example,
by a head injury, heart failure, stroke or poisoning.
2.1.1 Unconsciousness with normal breathing

■ Check the person’s consciousness and breathing.
■ Find out what is wrong with the person. The person:
■ is unconscious;
■ is breathing normally.
STEP 3: Seek help

■ Call for help and arrange urgent transport to medical care.

■ Is a spinal injury (see: p. 134) suspected in the ill or injured person?
■ No, there is no spinal injury suspected.
- Put the person in recovery position (see further).
■ Yes, a spinal injury is suspected.
- Keep the person in the position you found them in. Do not move an unconscious
person with a suspected spinal injury.
- If they are breathing normally, lift their chin up to keep their airway open, but do
not tilt their head (see: p. 27).
- Provide first aid as in injuries to the neck and back (see: p. 134).
■ Stay with the person until they receive medical care.
■ Check their consciousness and breathing every minute.
■ Act according to your observations. Start CPR if the person stops breathing
normally (see: p. 40).
■ Arrange medical attention for the person, even if they recover quickly.
■ Wash your hands after providing first aid.
36
Technique - Recovery position
The recovery position is a safe position that will keep the airway of an unconscious
person open, while preventing vomit or blood entering the lungs.
1. Kneel beside the person’s chest.

2. If the person is wearing glasses, remove them first.
3. Make sure that the person’s legs are stretched out.
4. Place the person’s arm that is closest to you at a right angle to the body. Bend
the forearm upwards and place the palm upwards. Do not force.
5. Grab their furthest arm by the hand. Bring the arm over the chest. Press the back
of their hand against their cheek on your side.
37
2. Emergencies
6. With your free hand, grasp the person’s furthest knee. Raise and bend their leg,
keeping their foot flat on the ground.
7. Pull their bent leg towards you, while holding the back of their hand against their
cheek. The person will roll towards you and stay on that side.
8. Place their upper leg in such a way that the hip and knee are both at right angles.
38
9. Carefully tilt their head back to ensure an opened airway. Make sure their mouth
is angled to the ground; if necessary, adjust the hand under the cheek to keep the
head tilted.
10. Monitor the person’s consciousness and breathing every minute.
When you put a poisoned person or pregnant woman in recovery position, it is best
to place them on their left side. If this is not possible (because of their injuries or the
location), it is okay to put them on their right side.
This technique can also be used with children and babies. If necessary, place a small
pillow or a rolled-up blanket behind the child’s back to ensure stability.
39
2. Emergencies
2.1.2 Unconsciousness without normal breathing

■ is unconscious;
■ is not breathing normally.
STEP 3: Seek help


■ Put the person on their back, on a hard surface.
■ Start cardiopulmonary resuscitation (CPR) as soon as possible:
■ Give 30 chest compressions (see further).
■ Give 2 rescue breaths. This can be done by mouth-to-mouth rescue breaths (see
further) or by rescue breaths with a pocket mask (see further).
- When you are not willing or able to give rescue breaths, continuously give chest
compressions.
■ Continue CPR: repeat the cycle of 30 compressions and 2 rescue breaths until:
■ professional help arrives and takes over the CPR;
■ the person breaths normally again;
■ you are too tired to carry on.
40
Good to know! – Alternating first aiders
When several first aiders are present, the administration of chest compressions
should be alternated between first aiders in order to maintain quality chest
compressions.
Switch every two minutes, preferably after giving rescue breaths. The switch should
be made with only minimal interruption to the chest compressions.
Good to know! – AED
An automatic external defibrillator (AED) is a device that can be used during CPR.
The AED is a computer-controlled device that tells the first aider with spoken (and
sometimes visual) instructions what to do.
When the heart stops beating, it is called a cardiac arrest. But often the heart still
contracts irregularly and chaotically, which is called an arrhythmia. An AED can
correct some arrhythmias by administering an electric shock. The device evaluates
the heart rhythm and decides for itself whether an electric shock is appropriate.
However, chest compressions and rescue breaths remain highly necessary, even
when using an AED!
AED’s can be found, for example, in airports, malls, emergency vehicles, beaches,
hotels, companies, schools, mines and Red Cross Headquarters.
41
2. Emergencies
Technique - Chest compressions
1. Kneel on both knees beside the person’s chest.

2. If possible, make sure the person is lying on their back on a hard surface.
3. Place the heel of one of your hands in the middle of the person’s chest. This
corresponds to the lower half of the breastbone.
4. Place the heel of your other hand on top of your first hand.
5. Hook the fingers of both hands together. Raise the fingers of your first hand
upwards. Do not apply pressure to the ribs or the upper part of the stomach or
the bottom end of the breastbone.
6. Make sure your shoulders are directly above the person’s chest.
7. Push the breastbone at least 5 centimetres deep (maximum 6 centimetres), with
your arms outstretched and your elbows locked.
8. Allow the chest to fully rise again after each chest compression. Do not lose
contact between your hands and the breastbone. Do not allow your hands to
shift.
9. Give 30 chest compressions at a frequency of 100 to 120 times per minute.
Interrupt the chest compressions as little as possible.
42
Technique - Rescue breaths
1. Open the person’s airway (see: p. 27).

2. Squeeze the soft part of their nose closed with the thumb and index finger of the
hand lying on their forehead.
3. Allow the mouth to spontaneously open, but maintain the chin lift.
4. Breathe in normally and place your mouth completely over the person’s mouth.
Ensure an airtight seal.
5. Blow in gently for 1 second. Avoid rapid or forceful ventilation.
6. Check if their chest comes up during the rescue breath. If the chest comes up, it
is an effective ventilation. If it does not:
■ Check whether there is an object in the person’s mouth. Remove any visible
items that may be blocking the airway, but do not probe blindly with your
finger in their mouth.
■ Check that the head is well tilted and the chin is lifted properly.
7. Move your mouth away from the person’s mouth, but keep their head in the same
position. Check if their chest descends again.
8. Repeat this technique. Breathe in again and give a second rescue breath.
Do not interrupt chest compressions for more than 10 seconds to deliver the two
rescue breaths, even if one or both are not effective.
43
2. Emergencies
Technique - Rescue breaths with a pocket mask
With the use of a pocket mask, the first aider avoids direct mouth-to-mouth contact
with the person. This protects the person and the first aider to a limited extent
from infection. However, the pocket mask does not offer complete protection from
infectious diseases.
1. Remove the pocket mask from the packaging. Push the pocket mask open, with
the attachment outward. If there is a filter in the package, place it on the pocket
mask.
2. Place the pocket mask on the person’s face, with the narrow part over the nose
and the wide part between the lower lip and the chin.
3. Place a hand on the forehead and press the pocket mask on the face with your
index finger and thumb. Gently tilt the head back.
4. Lift the chin up with the other hand. Press the pocket mask onto the chin with
your thumb.
5. Breathe in normally and place your mouth completely over the valve of the
pocket mask. Ensure an airtight seal.
6. Blow in gently for 1 second. Avoid rapid or forceful ventilation.
7. Check if their chest comes up, during the rescue breath. If the chest comes up, it
is an effective ventilation.
8. Move your mouth away from the pocket mask, but keep the head in the same
position. Check if their chest descends again
9. Repeat this technique. Breathe in again, and give a second rescue breath.
44
Technique - Cardiopulmonary resuscitation (CPR) in children
(1 year - beginning of puberty)
1. Start with 5 initial rescue breaths (see: p. 43).

2. Give 30 chest compressions (see: p. 42).
■ Compress about one third of the depth of the chest (no more than 6 cm).
Depending on what is needed to reach the right compression depth, use one or
two hands. For larger children or small rescuers, it is easiest to use both hands
with the fingers of both hands hooked together.
3. Give 2 rescue breaths. Make up to 5 attempts to achieve 2 effective rescue

breaths. If unsuccessful, proceed with chest compressions.
4. Repeat the cycle of 30 compressions and 2 rescue breaths.
45
2. Emergencies
Technique - Cardiopulmonary resuscitation (CPR) in babies

(under 1 year old)
1. Start with 5 initial rescue breaths.

■ Ensure the head is in a neutral position and lift the chin up. If necessary, use a
rolled-up towel under the upper body to maintain the neutral position.
■ Do not pinch the nose of the baby.

■ Breathe in normally and place your mouth completely over the mouth and nose
of the baby. Ensure an airtight seal.
■ Blow in gently for 1 second. Avoid rapid or forceful ventilation.
■ Check if their chest comes up, during the rescue breath. If the chest comes up,
it is an effective ventilation. If it does not:
- Check whether there is an object in the baby’s mouth. Remove any visible
items that may be blocking the airway, but do not probe blindly with your
finger in their mouth.
- Check whether the head of the baby is in a neutral position.
■ Move your mouth away from the baby’s mouth, but keep their head in the same
position. Check if their chest descends again.
■ Repeat this technique. Breathe in again, and give 4 more initial rescue breaths.
2. Give 30 chest compressions:
■ Place two fingers (your middle and index fingers) in the centre of the baby’s
chest and lift your other fingers up. Put the other hand on their forehead.
■ Compress the chest with the two fingers.
■ Compress about one third of the depth of the chest.
■ Give 30 compressions at a rate of 100 to 120 per minute.
3. Give 2 rescue breaths. Make up to 5 attempts to achieve 2 effective rescue

breaths. If unsuccessful, proceed with chest compressions.
4. Repeat the cycle of 30 compressions and 2 rescue breaths.
46
2.2 Chest discomfort
If someone complains of chest discomfort, it might be a sign that not enough oxygen-rich
blood is going to the heart. This most commonly occurs when there is a blockage in the
arteries that carry blood rich in oxygen to the heart. The muscle cells of the heart start to
die as soon as they stop receiving oxygen. This can cause a heart attack, which is a serious
problem that requires immediate medical attention.
However, chest discomfort can also occur with various other conditions, such as stomach
and oesophageal problems, panic attacks, lung problems and rib fractures. Because the
symptoms are similar, first responders should always assume it is a heart attack until
proven otherwise.
STEP 2: Assess the ill person’s condition

■ experiences discomfort, pain or tightness in the chest. This pain might spread to
the jaw, neck, back, arms, shoulders and stomach;
■ may sweat and feel anxious;
■ may have bluish lips, finger- and toenails and/or greyish skin;
■ In addition, the person may experience:
- shortness of breath;
- abdominal pain, nausea or vomiting;
- sudden fainting (see: p. 164) or dizziness.
47
2. Emergencies
STEP 3: Seek help


■ Have the ill person keep still and rest. Put the person in a comfortable position (e.g. a
sitting or half-sitting position). Try to calm them down.
■ Make sure that the person can breathe freely. Loosen tight clothing.
■ Do not prevent the person from taking prescribed medication. Ask them to respect
the prescribed dose.
■ Act according to your observations. Start CPR if the person loses consciousness and
stops breathing normally (see: p. 40).
! Attention! - Heart attack
Heart attacks may start with non-specific symptoms, such as pain in the upper
abdomen, nausea, shortness of breath, pain radiating to the teeth or jaws, pain
between the shoulder blades or a feeling of flu. Women, more often than men, can
sometimes have only limited and possibly isolated symptoms in the event of a heart
attack. The symptoms may vary from person to person and can occur suddenly or
slowly.
It is even possible for a heart attack to occur without any symptoms.
48
2.3 Choking
In the case of choking, there is an airway obstruction caused by a foreign object. This
can be an object, food or drink. The obstruction is in many cases cleared by coughing.
Sometimes, however, the condition is serious and the object can block the airway. This
makes breathing difficult or impossible, which is a life-threatening situation. Infants and
children often choke on foreign objects such as coins and small toys. Most adult cases of
choking occur while eating.
A foreign object can cause mild or severe airway obstruction. A person who can speak,
cough or breathe has a mild obstruction. A person who can speak, cough or breathe has
a mild airway obstruction.
2.3.1 Mild airway obstruction
STEP 2: Assess the person’s condition

■ Ask the person: “Are you choking?”
■ Find out what is wrong with the person. The
person:
■ confirms they are choking;
■ can speak, cough or breathe.
STEP 3: Seek help
■ Often, there is no need for urgent medical care in this situation. Arrange medical
attention if the person shows the signs described in STEP 4.
49
2. Emergencies
■ Encourage the person to cough.

■ Continue to monitor the person until they resume breathing normally. Act according
to your observations.
■ Arrange medical attention for the person if the person:
■ continues to cough;
■ has difficulty swallowing;
■ feels that there is something in their throat.
50
2.3.2 Severe airway obstruction

■ Ask the person: “Are you choking?”
■ confirms they are choking;
■ is unable to talk, cough or breathe;
■ makes coughing movements without sound;
■ may have blue lips and finger- and toenails;
■ may gradually lose consciousness (see: p. 36).
STEP 3: Seek help
■ If the person is conscious but can no longer cough firmly, give 5 blows to the back (see
further).
■ If the person still cannot breathe, give 5 abdominal thrusts (see further).
■ If the problem is still not solved, keep alternating the 5 blows to the back and the
5 abdominal thrusts until the problem is solved.
■ If the person becomes unconscious and no longer reacts, put them carefully on the
ground, start CPR and provide first aid as in unconsciousness without normal breathing
(see: p. 40). Call for help and arrange urgent transport to medical care.
■ Continue to monitor the person until they resume breathing normally.
■ A person who has received abdominal thrusts (or chest thrusts in pregnant women)
needs to see a medical professional. Arrange medical attention for the person, even
if they recover quickly.
■ Act according to your observations.
51
2. Emergencies
Technique - Blows to the back
A person over 1 year of age

1. Stand to the side and a little behind
the person.
2. Put one arm under their armpit
and support their chest with your
hand. Bend the person well forward.
This way, the object will come out
through the mouth and will not
go deeper into the airway when it
comes loose.
3. With the heel of your free hand,
give 5 firm blows in quick succession
between their shoulder blades.
A child under 1 year of age

1. Stand up or sit on a chair.
2. Place the baby on their belly on your
forearm. Their head should be lower
than their trunk.
3. Support the baby’s lower jaw with
your hand. Do not put pressure on
their throat.
4. With the heel of your free hand,
give 5 firm blows in quick succession
between their shoulder blades.
52
Technique - Abdominal thrusts
A person over 1 year of age

1. Stand behind the person.
2. Bring your arms under their armpits and have them lean forward.
3. Make a fist with one hand and place it between their belly button and their
breastbone. Grasp your fist firmly with your other hand.
4. Pull your fist firmly towards yourself and upwards with a quick movement.
5. Repeat this up to 5 times.
A child under 1 year of age (chest thrusts)

1. Stand up or sit on a chair.
2. Place the baby on their back on your
forearm. Support their head with your hand.
Their head should be lower than their trunk.
3. Place two fingers of your free hand in the
centre of the baby’s chest and lift your
other fingers up. Compress the chest with
the two fingers, as you would do in chest
compressions (see: p. 46).
4. Give up to 5 quick chest compressions.
53
2. Emergencies
A pregnant woman (chest thrusts)

1. Stand behind the pregnant woman.
2. Bring your arms up under their armpits and have them lean forward.
3. Make a fist with one hand and place it on the lower half of their breastbone.
Grasp your fist firmly with your other hand.
4. Encourage the pregnant woman to cough.
5. Pull your fist firmly towards yourself with a quick movement. Direct your strength
backwards, toward the spine.
6. Repeat this up to 5 times.
Prevention of choking
■ Take small bites and chew food thoroughly.

■ Teach children not to talk, laugh or cry with food in their mouths.
■ Do not lie down, walk, run or jump while eating.
■ Watch children and prevent them from putting small objects into their mouths
(e.g. small toys).
■ Do not let children eat unsupervised.
■ Do not let a child drink when lying down.
54
2.4 Stroke
A stroke is caused by insufficient oxygen-rich blood reaching the brain. This can be the
result of bleeding or a blockage of an artery in the brain. As a consequence, oxygen supply
to the brain is interrupted, leading to the death of the affected brain tissue. A stroke
is often the result of several risk factors. People with high blood pressure, diabetes or
obesity run a higher risk of developing this condition.
■ If you need to move the person, support them on their paralysed side (see: p. 20).

■ may have disturbances in consciousness, such as loss of consciousness (see: p. 36),
sleepiness, confusion, agitation, arousal;
■ may experience a headache;
■ may experience loss of vision or hearing;
■ may experience nausea, dizziness or an unsteady gait. As a result, it may appear
that the person is drunk;
■ may have numbness, weakness or loss of mobility in an arm, hand, leg or facial
muscles on one side of the body;
■ may have slow or slurred speech;
■ may have drooping on one side of the mouth.
■ Check for signs of a stroke using the FAST test (see further).
STEP 3: Seek help
■ Have the ill person keep still and rest. Put them in a comfortable position (e.g. a sitting
or half-sitting position). Try to calm them down.
■ Do not give food or drink to a person that is having a stroke. They are at risk of choking
and vomiting.
55
2. Emergencies
Technique - FAST test
You can check if the person is having a stroke by using the FAST test:
Face: Ask the person to smile or show

their teeth. Is their mouth skewed or is
there a mouth corner hanging down?
Arm: Ask the person to extend both

arms horizontally in front of them at
the same time and turn the palms of the
hands upward. Are they able to keep
their posture, or is one arm sinking or
swaying?
Speech: Ask the person or bystanders .....sv..mmho
who know them if there are any changes k...kk...isj....
in speaking. Do they have problems

speaking or finding words?
Time: Time to seek immediate medical assistance! Also, try to find out when the
symptoms started.
If the person has difficulties with any of the first three actions, a stroke is very likely
and immediate medical help is needed.
56
2.5 Poisoning
There are many potentially toxic products to be found in our surroundings. These are
often products that we use almost daily. These toxic products can occur in solid form
(medication, plants, rat poison, etc.), in liquid form (cleaning products, disinfectants, etc.)
or in gaseous form (exhaust gases, chlorine vapours, butane gas, etc.). From the scene of
the accident, you can often conclude that the person has been poisoned. For example,
you see empty medicine packaging, discover traces of the product in the person’s mouth,
you see an opened bottle of a chemical product or you see a syringe lying on the floor.
Often, a conscious person can indicate what happened.
Someone can be poisoned by:

■ swallowing a toxic substance (e.g. pesticides, cleaning products, toxic plants,
medication or drugs);
■ inhaling a toxic substance (e.g. carbon monoxide, smoke from a fire, chemical irritants);
■ injecting a toxic product (e.g. intravenous drugs, medication);
■ coming into contact with the toxic substance (e.g. pesticides, chemicals) through the
skin or mucous membranes (e.g. the eyes, inside the nose, mouth, vagina and anus).
Not every poisoning is equal. Depending on the type of toxic product, the poisoned
person may develop signs and symptoms immediately or after some time. The degree
of toxicity of a product plays an important role in the severity of the poisoning, as do
multiple other factors, such as the person’s body weight, the route of administration and
the duration of exposure.
2.5.1 Poisoning by swallowing
■ Wash your hands. When you touch clothing or body parts covered in the toxic
substance, put on gloves or a locally available alternative resistant to the product. Do
the same when you remove residues of the toxic product.
■ Seal the packaging of the toxic product. Put the remains of the toxic substance in a
safe place, if you can do this safely.
57
2. Emergencies
STEP 2: Assess the poisoned person’s condition

■ Find out what is wrong with the person. The following symptoms may occur
immediately or over time:
■ stomach cramps, nausea and vomiting;
■ burns in mouth or throat (see: p. 110);
■ a tingling sensation in the eyes, nose or mouth;
■ very large or very small pupils;
■ headache, dizziness, faintness (see: p. 164) or loss of consciousness (see: p. 36);
■ muscle twitching or fits (see: p. 173);
■ discoloration of the skin;
■ strong sweating and clammy skin;
■ breathing difficulties;
■ fast or irregular heartbeat;
■ signs of shock (see: p. 72).
■ You may be able to deduct from the circumstances that the person swallowed a toxic
substance (e.g. empty medicine packaging, open bottle of cleaning product). Find out
what and how much toxic product was swallowed and, if possible, when it happened.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the person shows serious
symptoms (e.g. breathing difficulties or unconsciousness) or when their condition
deteriorates.
58
■ If the poisoned person is conscious but has breathing difficulties, put them in a
comfortable position (e.g. a sitting or half-sitting position) and make sure that they
can breathe freely. Loosen tight clothing.
■ If the person is unconscious, put them in recovery position. Preferably, put a poisoned
person in recovery position (see: p. 37) on their left side. This delays the contents
of the stomach going into the small intestine, and therefore slows the poison’s
absorption.
■ Stay with the person until they receive medical care, when urgent transport to medical
care is needed (see STEP 3).
■ Take off your gloves and wash your hands after providing first aid.
59
2. Emergencies
2.5.2 Poisoning by inhalation
■ Open windows and doors from the outside and ventilate the room before you enter.
■ Do not switch electrical devices (including lights) on or off, as some gases are explosive.
Avoid fire (also cigarettes) in the surroundings.
■ Never enter a closed space (basement, pit or tank) to save an unconscious person.
Only evacuate the person if you can do so without endangering yourself.
■ Put on clean disposable gloves or a locally available alternative.

■ nausea and vomiting;
■ burns in mouth or throat (see: p. 110);
■ strong sweating, clammy skin or a burning sensation on the skin;
■ You may be able to deduct from the circumstances that the person inhaled a toxic
substance (e.g. a weird smell, an opened chemical container). Find out what and how
much toxic substance was inhaled and, if possible, when it happened.
STEP 3: Seek help
deteriorates.
■ Alert the emergency services if the poisoned person cannot be reached without
endangering yourself.
60
■ Take off your disposable gloves and wash your hands after providing first aid.
61
2. Emergencies
2.5.3 Poisoning by injection
■ Wash your hands and put on clean disposable gloves or a locally available alternative.
■ Store needles safely so that no one can hurt themselves. Put the remains of the toxic
substance in a safe place, if you can do this safely.

■ stomach cramps, nausea and vomiting;
■ strong sweating and clammy skin;
■ You may be able to deduct from the circumstances that the person injected a toxic
substance (e.g. a syringe, skin lesions). Find out what and how much toxic substance
was injected and, if possible, when it happened.
STEP 3: Seek help
deteriorates.
62
63
2. Emergencies
2.5.4 Poisoning through contact
■ Wash your hands. When you touch clothing or body parts covered in the product, put
on gloves or a locally available alternative resistant to the product. Do the same when
you remove residues of the toxic substance.
■ Seal the packaging of the toxic product. Put the remains of the toxic substance in a
safe place, if you can do this safely.
■ Ventilate the room if the toxic product is volatile.

■ burns (see: p. 110) or irritated skin or eyes;
■ nausea and vomiting;
■ dizziness, faintness (see: p. 164) or loss of consciousness (see: p. 36);
■ clammy skin, strong sweating and a burning sensation on the skin;
■ You may be able to deduct from the circumstances that the person had contact with
a toxic substance (e.g. a puddle of chemical product on the ground). Find out what
and how much toxic substance the person was in contact with and, if possible, when
it happened.
STEP 3: Seek help
deteriorates.
64
■ Rinse the skin thoroughly with clean water (e.g. drinking water, boiled and cooled
water) for 10 to (preferably) 20 minutes.
■ Remove clothing and jewellery that do not stick to the skin. Put the clothing in a
plastic bag and seal it.
■ Take care of burns (see: p. 110).
■ Take off your gloves and wash your hands after providing first aid.
! Attention! - Poisoning
■ Do not give the person anything to eat or drink (not even charcoal or milk) and do
not induce vomiting, unless a medical professional advises you to do so.
■ If you have to perform CPR on a person who has been poisoned by swallowing,
inhalation or through contact to the face, do not give mouth-to-mouth rescue
breaths. Use a pocket mask (see: p. 44) or give chest compressions only.
65
2. Emergencies
Prevention of poisoning
Most accidental poisonings occur at home when parents and caregivers are not
paying attention to children.
■ Teach children about the dangers of toxic

substances.
■ Store all medicines in their original packaging in
a safe place, out of sight and reach of children.
Bring old, expired medicines to a healthcare
facility, so that nobody is tempted to use them
again.
■ Avoid taking medicine in front of children because
they often copy adults. Never tell children that
medicines are ‘sweets’.
■ Take or give medicines in a well-lit environment.
This way, you know you are using the correct
amount of the right medicine.
■ Store household cleaning products, pesticides,
fertilisers and paraffin out of reach of children,
preferably in child-proof containers.
■ Check containers of toxic products and make
sure they are correctly and clearly labelled and
locked away.
■ Never use food containers or old soda bottles to
store toxic substances.
■ Do not reuse containers of toxic substances.
■ Never put insecticide powders or rat poison on the floors of your home; choose a
place out of reach of children.
■ Identify toxic plants in and around your house and put them out of reach of
children or remove them. Never eat fruits, berries, mushrooms or plants in the
wild unless you are sure that they are not poisonous.
■ Do not handle chemicals used on the farm with your bare hands.
66
2.6 Severe bleeding and shock
Bleeding is the loss of blood after a blood vessel has been damaged. This can happen to
any blood vessel in the body. Bleeding can be external or internal.
■ In case of external bleeding, (a lot of) blood is visible from the outside.
■ In the case of internal bleeding, the blood does not leave the body (e.g. bruising or
bleeding in the abdomen).
Any bleeding (internal or external) involving massive blood loss is serious, since the
consequences of bleeding can be enormous and even life-threatening. An injured person
who loses too much blood may go into shock and lose consciousness.
2.6.1 Severe external bleeding
■ Ask the injured person to press on the wound themselves.
■ Help them to lie down while pressing on the wound.
67
2. Emergencies
STEP 2: Assess the injured person’s condition

■ Find out what is wrong with the person. The person has a severely bleeding wound.
Blood gushes or squirts out of the wound.
STEP 3: Seek help
symptoms (e.g. unconsciousness or shock) or when their condition deteriorates.
■ Do not encourage the person to move. Keep them calm.

■ Do not clean or rinse the wound. The priority is to control the bleeding.
■ Look if there is a foreign object embedded in the wound. If there is an object in the
wound, do not remove it, keep it motionless (see: p. 106).
■ Press on the wound with both hands using a clean cloth. If the wound continues to
bleed, press harder. Apply direct, manual pressure on the wound for 10 minutes.
■ Raise the injured limb if possible.
68
■ Apply a pressure dressing around the wound (see further).
■ Bandage the wound firmly but not tightly. If the skin area below the bandage starts
to turn grey or swell, or if the person experiences numbness in that area, loosen the
bandage a little. Do not remove the bandage, as the wound will start bleeding again.
■ If the wound bleeds through the bandage, do not remove the bandage. Add another
bandage on top and continue to apply pressure.
■ Keep the injured person warm. Remove wet clothing, cover them with a blanket and
keep them sheltered from the cold and wind.
■ Arrange medical attention for the person, even if they recover quickly. The bandage
should only be removed by a medical professional.
69
2. Emergencies
Technique - Applying a pressure dressing
1. Apply pads to the wound. Bandages specifically designed as pressure dressings

may already have a pad.
2. Roll the bandage firmly around the limb, on the wound site, several times,
ensuring that it applies pressure to the wound. Dedicated pressure bandages are
usually stretchy, so you need to pull quite tight.
3. Tie the ends of the bandage together. Try to do this on top of the wound, this will
increase the pressure on the wound.
If blood seeps through the bandage, apply a cloth (e.g. a few gauze pads, another
bandage, a piece of cloth) on top of the wound site. This increases the pressure on
the bleeding. Roll the bandage further around the limb.
Do not apply pressure dressings in neck wounds. Severely bleeding neck wounds
must be stopped by applying manual pressure to the wound.
70
2.6.2 Severe internal bleeding
■ Help the person to lie down, to prevent them from falling.


■ may have had an impact with a blunt object (e.g. a steering wheel after car accident,
a fall, a kick from a horse);
■ may have blood loss from body openings (e.g. mouth, nose, ears, anus, penis,
vagina);
■ may show signs of shock (see: p. 72).
STEP 3: Seek help

■ Keep the person warm. Remove wet clothing, cover them with a blanket and keep
them sheltered from the cold and wind.
71
2. Emergencies
2.6.3 Shock
When a person with severe bleeding loses too much blood, this could lead to shock.
Shock is a general term used to describe a lack of blood reaching major organs, causing
these organs to run out of oxygen. There are many causes of shock, including:
■ severe blood loss trough external and internal bleeding;

■ significant loss of fluids due to diarrhoea, vomiting or extensive burns;
■ heart failure;
■ obstruction of major blood vessels;
■ poisoning and allergic reactions.
■ Help the person to lie down, to prevent them from falling.


■ may show signs of severe external or internal bleeding;
■ may feel drowsy, confused, unwell and dizzy when standing
up;
■ may have greyish skin, start sweating and shivering;
■ may complain of cold, have cold hands and feet;
■ may feel nauseous and have vomiting tendencies;
■ may breathe rapidly and superficially;
■ may eventually lose consciousness (see: p. 36).
STEP 3: Seek help
72
■ Stop severe external bleeding, if that is the case (see: p. 67).

■ Keep the person warm. Remove wet clothing, cover them with a blanket and keep
them sheltered from the cold and wind.
■ Do not give the person anything to eat or drink. Although, you can wet their lips if they
ask for water.
73
2. Emergencies
2.7 (Near-)drowning
If someone who is in the water can no longer remain above water, water will enter their
lungs. People can suffocate when their breathing is hindered by a liquid. Because of the
lack of oxygen in the person’s body, the person will eventually lose consciousness. When
this suffocation causes the death of the person, it is called drowning. Near-drowning is
defined as survival after a person’s breathing was hindered due to submersion in a liquid.
(Near-)drowning can occur in deep waters (lakes, rivers and the sea) and in shallow
waters (baths, ponds, streams). This happens when a person accidentally enters the
water without adequate swimming skills or strength. But even people who are able to
swim can get into difficulties when they overestimate themselves, become exhausted,
or suffer from muscle cramps or an injury. It is also possible that the person first
loses consciousness and then ends up in the water. Any condition that causes a loss of
consciousness can cause drowning (e.g. stroke). Thirdly, the person may no longer be
able to swim due to external factors (e.g. strong currents).
In addition to suffocation, other problems may also arise as a result of near-drowning,

such as hypothermia (see: p. 79), lung problems, or a spinal injury (see: p. 134). These
factors make the person’s condition worse.

■ Ensure your own safety.
■ Rescue the person without
entering the water yourself.
This can be done with aids
available in the area (e.g. a
lifebuoy). Ideally, this aid
should be attached to a rope
to pull the person to the side.
Make sure that you do not pull
yourself into the water in the
event of a dry rescue.
■ In some cases, there may be
other people nearby who can
reach the person safely (e.g.
with a boat).
■ Only enter the water if you have been properly trained to do so. A rescue in which
the rescuer goes into the water, is the last resort. Bear in mind that a drowning
person may react in panic and grab the rescuer.
■ If you cannot rescue the drowning person safely, alert the emergency services.
Mention that help is needed to get the person out of the water.
■ Move the person as horizontally as possible. This can be done by using a plank (or
surfboard) to evacuate the person.
74
STEP 2: Assess the nearly drowned person’s condition

■ may be in the water, have managed to bring themselves to safety or been taken out
of the water;
■ may have obstructed breathing because of water, mud or seaweed in the airways;
■ may vomit;
■ may have an injury to the head (see: p. 129) or a spinal injury (see: p. 134) after a
dive or fall in shallow water;
■ may be hypothermic (see: p. 79).
STEP 3: Seek help

deteriorates.
■ If the person is still in the water, alert the emergency services. Mention that help is
needed to get the person out of the water.

■ If the person is unconscious and is not breathing normally, immediately start CPR (see:
p. 40).
■ Bear in mind that the person may have a spinal injury (see: p. 134).
■ Put a nearly drowned person who is unconscious, but still breathing, in recovery
position (see: p. 37), if you do not suspect a spinal injury. If you suspect a spinal
injury, leave the person lying on their back if they are breathing normally.
■ If possible, move the person to a warmer environment. If this is not possible, shield
them from cold and wind. Take off their wet clothing completely, dry them and cover
them warmly, but do not rub them warm (see: p. 79).
■ Have the person make as few movements as possible.
75
2. Emergencies
Prevention of (near-)drowning
■ Be careful near a river, pond, lake, sea or swimming pool.

■ Keep a close watch on children around water.
■ Do not enter the water while you are under the influence of sedative medication,
alcohol or drugs.
■ Do not leave small children alone near water. They can also drown in small
amounts of water, such as washing tubs, water wells, irrigation ditches or animal
drinking troughs.
■ Fill in unused ditches and water holes near your home.

■ Make a fence around water reservoirs.
76
■ If available, use a flotation device for children and anyone who cannot swim.
However, keep paying attention, as accidents can still occur. Those able to swim
should also use a flotation device when going into deep or fast-flowing water,
even when they are on a boat.
■ Only enter the water to rescue a drowning person if you have been properly
trained to do so.
77
2. Emergencies
2.7.1 Car in the water

In the event of a car accident, someone may end up in the water in their car. If this
happens, they should leave the car as soon as possible, without waiting until it has
submerged completely. Usually a car remains afloat for about a minute before it sinks.
When you are the first aider

■ Ensure your own safety (see: p. 19).
■ Check whether there is one or more people in the car.
■ Call for help!
■ Alert the emergency services. If the person is still in the water, mention that help is
needed to get the person out of the water.
■ A relatively undamaged car that has ended up in the water can remain afloat for about
a minute. If there are multiple bystanders, you can try using a rope or a human chain
to pull the car closer to the side.
■ If you choose to go into the water, smash a side window with a heavy object, or open a
door if the trapped person has not opened a window or door. Do this by resting both
feet on the bodywork and pulling the handle very powerfully.
■ When the person has been evacuated from the water, provide first aid as in
(near-)drowning (see: p. 74).
■ If the car has sunk, look for traces on the water’s edge (tyre print, damage to
vegetation). Make sure nobody erases these traces before specialist aid workers have
arrived.
When you are in the car

■ Stay calm.
■ Turn on all vehicle lights.
■ Undo your and your passengers’ safety belts.
■ Open a side window immediately. If this does not work in the normal way, break the
side window with a heavy object (e.g. the bottom of a fire extinguisher).
■ Help children to leave the car. Leave them on the roof of the car until all occupants
have escaped.
■ Take hold of the car roof and leave the car horizontally, head first, facing upwards.
! Attention! - Car in the water
A car windscreen is made of strong, layered glass and is not suitable as an escape
route. Choose to break a side window to create an escape route.
78
2.8 Temperature-related emergencies
The human body, regardless of the ambient temperature, tries to keep the internal
temperature constant around 37°C. At this temperature, the vital functions of the body
perform optimally. When the body temperature rises too high or drops too low, the
normal functioning of the human body is at risk.
2.8.1 Hypothermia
A person whose body temperature falls too low, is said to be ‘hypothermic’. The following
factors contribute to the development of hypothermia:
■ inadequate clothing;
■ lack of protection;
■ wind;
■ wet clothing;
■ cold water;
■ one of the above in combination with drugs or alcohol.
■ Avoid unnecessary, sudden or harsh movements. If possible, move the hypothermic

person horizontally.

■ is or was in a cold environment;
■ may tremble uncontrollably and has chattering teeth (in case of prolonged
hypothermia, this might stop over time);
■ may have cold, greyish, dry skin that evolves into bluish lips and finger- and toenails;
■ may breathe rapidly, which evolves to slow and superficial breathing;
■ may experience stiff muscles and reduced coordination of movements;
■ may experience difficulty speaking;
■ may have consciousness issues such as drowsiness, memory loss, confusion and
fatigue. Eventually the person loses consciousness (see: p. 36).
79
2. Emergencies
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the person:
■ shows serious symptoms (e.g. breathing difficulties or unconsciousness) or when
their condition deteriorates;
■ stops shivering;
■ has stiff muscles.
■ If possible, put the person in a warmer environment and protect them from further
cooling.
■ Take off the person’s wet clothes. Do this gently if the person is unconscious or does
not shiver. Wipe the person dry and cover them warmly.
■ Do not rub the person warm.
■ If the person shivers and is conscious:
■ Roll the person in a warm, dry blanket. Also cover their head.
■ Have the person put on warm, dry clothing.

■ Give them a warm, non-alcoholic drink (only if the person is fully conscious). This is
an exception to the fourth principle of first aid (see: p. 12).
■ If the person does not shiver and/or is not conscious.
■ Use warm objects such as blankets, clothes and hot water bottles to cover the
person. Put a cloth between the skin and the hot water bottle, to make sure the
person does not get burned.
■ Make a fire close to the person, if safely possible.
80
Good to know! - Frostbite
Extreme cold makes it more difficult for warm blood to flow to extremities (such as
ears, nose, fingers and toes) that are exposed to the cold. This restriction of blood
flow can be so severe that cells are damaged.
When the temperature in these body parts drops below 0 degrees, fluid in the cells
of the body parts can freeze, causing these cells and body parts to die off. This is
called frostbite.
Prevention of hypothermia
■ Hypothermia can be prevented by wearing appropriate clothing. When you go

to a cold area, wear layers of clothing, put on a hat and gloves. Wear waterproof
clothing on cold, wet days.
■ Do not ignore shivering; it is the first signal that your body temperature is
dropping. Move to a warmer environment if possible.
■ It is said that you get warmer by drinking alcohol. However, alcohol does not work
as a ‘warmer’, despite the fact that the person may feel this way. There is a chance
that you will no longer feel the cold, while your body temperature drops further.
81
2. Emergencies
2.8.2 Heatstroke / sunstroke

If the body produces more heat than it releases, problems such as dehydration,
exhaustion, faintness and muscle cramps may occur. Disturbed heat regulation can
cause the body temperature to rise abnormally. If a person with heat problems is not
helped quickly, they may get heatstroke, which is an emergency. If the person’s body
temperature is disrupted by direct sunlight on the head, this is known as sunstroke.
■ Remove the person from the sun or from the warm environment; take them to a
cooler environment.

■ Find out what is wrong with the person. The person may:
■ be in a hot and humid environment or have been exposed to the sun for a long
period of time;
■ have carried out extreme physical effort;
■ experience a headache and faintness (see: p. 164);
■ be nauseous and vomit;
■ have abdominal and muscle cramps;
■ have a sunburn (sensitive, painful, itchy skin, which could look red, swollen and have
blisters*);
■ sweat, which may diminish over time due to dehydration;
■ have fits (see: p. 173);
■ have consciousness issues such as confusion and drowsiness. Eventually, the person
may lose consciousness (see: p. 36).
*Not all of these symptoms will be noticeable in a person with dark skin.
STEP 3: Seek help
■ shows serious symptoms (breathing difficulties or unconsciousness);
■ stops sweating;
■ has fits.
82
■ Have the ill person keep still and rest.

■ Remove clothing that is too warm.
■ Cool the person immediately.
■ Aim a fan at the person.
■ Place ice cubes in a bag of water, cooling bags or cold and wet cloths on their body
(e.g. in the groin, under the armpits or on the neck).
■ Sprinkle the person with cold water.

■ Immerse the person’s hands and feet in cold water.
■ Are the symptoms the result of extreme physical effort and is the person fully
conscious? Then give the person a cool, non-alcoholic drink (sports drink, water, cold
tea). This is an exception to the fourth principle of first aid (see: p. 12).
Prevention of heatstroke and sunstroke
■ Avoid extreme physical effort in a hot environment if you are not specifically
prepared for this.
■ Drink enough when the weather is hot. Drink regularly, preferably in small
volumes.
■ Never leave anyone in a car parked in the sun.
83
2. Emergencies
2.9 Electrocution
When the human body comes into contact with electricity, electrocution can occur.
The body then acts as a conductor for the electricity. An electrical accident can occur
during work on the power supply, when manipulating a broken electrical device, or
when touching unsafe electrical connections. It can involve low-voltage or high-voltage
electricity.
■ Low-voltage accident: when the voltage is less than 1000 volts. These accidents
often occur at home, e.g. when manipulating a broken electrical socket.
■ High-voltage accident: at a voltage of more than 1000 volts, such as a high voltage
pylon or the overhead wires of electric trains. When such a cable breaks, a very
dangerous situation can arise. A high-voltage accident is always serious. The person
can even be thrown by the force.
Usually you can tell from the scene whether it is a low- or high-voltage accident.
2.9.1 Low-voltage electrocution
■ Turn off the power as soon as possible and make sure it cannot be turned back on
accidentally. Do not touch a person connected to a power source before you have
turned off the power.
■ Remove the person from the electrical source.
■ When you cannot turn off the power:
■ Isolate yourself from the ground by
wearing rubber shoes or standing on
isolating material (e.g. wooden surfaces,
boxes or books).
■ Then use an object that does not
conduct electricity (e.g. a wooden stick)
to remove the person from the power
source.
84
■ When the person is no longer connected to the power source, make the first contact
with them by touching them with the back of your hand.
■ may be unconscious (see: p. 36);
■ may have difficulty breathing or have chest discomfort (see: p. 47);
■ may have burns (see: p. 110). Look especially at the place where they had contact
with the power source (e.g. the hands) and the place where the power left their
body (e.g. the feet);
■ may have muscle cramps.
STEP 3: Seek help
deteriorates.
■ First aid can only be safely provided when the power source is removed or turned off.
■ Provide first aid according to the person’s injuries.
85
2. Emergencies
2.9.2 High-voltage electrocution
■ Do not come near the power source. Stay at least 10 meters from any high-voltage
installation. A high-voltage cable lying on the ground may still be live. The soil, within
a radius of a few meters of the area will also be energised.
■ Do not remove the power source from the person as described in low-voltage
electrocution. The voltage is too high.
■ Find out what is wrong with the person, without approaching or touching them. The
person:
■ may have symptoms similar to a low-voltage accident;
■ may have been thrown from the power source, have torn clothing, and their gloves
or safety-helmet may have been thrown by the air displacement.
STEP 3: Seek help
■ Call for help!

■ Alert emergency services, if possible.
86
■ Leave the rescue of the person to the emergency services.
Prevention of electrocution
■ Have the installation of the electrical wiring in your home installed by an expert.
Make sure you have a good grounding.
■ Avoid using faulty electrical devices.
■ Do not use an electrical device in the vicinity of water. Avoid using devices with
wet hands.
■ Roll a cable reel all the way down, even if you do not need the full length of the
cable.
■ Never work on electrical devices when they are under power. Leave repairs to
electrical devices to an expert.
■ When unplugging an electrical cable, do not pull the wire.
87
2. Emergencies
2.10 Emergency child birth

In the last phase of pregnancy, an expectant mother can go into labour at any time. As a
first aider you may be required to assist with the delivery of a baby during an emergency
childbirth.
2.10.1 First stage: When labour starts
STEP 2: Assess the expectant mother’s condition
■ Check the expectant mother’s consciousness and breathing.

■ The following signs indicate that labour has started and the baby is coming:
■ painful labour pains occurring at increasingly shorter intervals, which turn into
uncontrollable contractions;
■ the amniotic membranes can break, causing the woman to lose amniotic fluid (also
known as ‘water’);
■ sticky discharge;
■ abdominal discomfort;
■ local back pains.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if:
■ the unborn baby is known to be positioned head-up (the feet are pointed toward
the birth canal) in the woman’s uterus (womb);
■ there are no contractions six hours after the water broke;
■ the contractions continue for more than 12 hours;
■ the expectant mother is bleeding or has a fever (see: p. 168).
■ If there is a Health Facility in the area, transport must be arranged immediately. If not,
report to the Village Health Teams or work with Local Council authorities to call for
medical help urgently.
88
■ If available, take a delivery kit, containing:

■ soap;
■ disposable gloves;
■ two clamps or ties;
■ disinfected scissors, knife or razor blade;
- Disinfecting can be done by boiling the equipment in water for at least 10 minutes
or running it through a flame of a clean fire a few times. Allow the object to cool
down before using it.
■ clean towels;
■ locally available antiseptics.
■ Encourage the expectant mother’s companions or relatives to be involved, but protect
and respect her privacy. Praise and encourage her.
■ Massage the woman´s back to help relieve the pain and reduce anxiety, if she consents.
■ Encourage her to move around and find the most comfortable position (preferably in
an upright position).
■ Encourage her to drink water during labour. She can have a light meal to keep up her
strength.
■ The woman in labour should be encouraged to empty her bladder whenever she feels
the need to do so.
■ Encourage her to breathe out slowly and loudly, and to relax with each breath. Suggest
breathing slower if she feels dizzy, unwell or has tingling in her face, hands or feet.
■ If the expectant mother desires to listen to music to relax, let her do so.
■ Do not use any remedies or medications to speed up labour or to clear out the bowel,
unless a mid-wife or doctor tells you to do so.
■ Do not leave a woman in labour alone.
■ Take off your disposable gloves and wash your hands when a medical professional
takes charge of the delivery.
89
2. Emergencies
2.10.2 Second stage: The pushing stage

When the contractions become more intense and regular, the woman in labour will feel
an uncontrollable urge to push. Every time she pushes, the baby travels further along the
birth canal until it is finally born.
■ Wash your hands and put on clean disposable gloves or a locally available alternative,
if you did not already do so when the labour started.
STEP 2: Assess the expectant mother’s condition
■ Check the expectant mother’s consciousness and breathing.

■ The following signs indicate that the woman is in the pushing stage:
■ the expectant mother feels an uncontrollable urge to push;
■ the head of the baby can be seen.
STEP 3: Seek help
■ the baby presents with buttocks, feet or anything other than the head (other body
parts or the umbilical cord) first;
■ the expectant mother is bleeding or has a fever (see: p. 168).
■ If there is a Health Facility in the area, transport must be arranged immediately. If not,
report to the Village Health Teams or work with Local Council authorities to call for
medical help urgently.
90
■ Help the woman into the most comfortable position.

■ An upright/squatting position is best for the woman giving birth. A lying position is
less challenging to assist with delivery.
■ If she prefers to lie on her back, it is best to put a small pillow under the right hip.
This way, you prevent the unborn baby from pressing on important blood vessels.
■ Naturally, at this stage the mother feels the urge to push. If the pushing is not
working, tell her to change position and empty her bladder. Tell her not to push when
the baby’s head is being delivered.
■ Watch the baby come out while supporting the baby´s head and shoulders. Do not pull
the baby out!
■ Do not push on the woman’s belly during labour or after the delivery.
■ Do not leave a woman alone during the pushing stage.
■ Take off your disposable gloves and wash your hands when a medical professional
takes charge of the delivery.
91
2. Emergencies
2.10.3 Third stage: When the baby is born
■ Wash your hands and put on clean disposable gloves or a locally available alternative,
if you did not already do so in the pushing stage.
STEP 2: Assess the mother’s condition
■ Check the mother’s consciousness and breathing.

■ The woman is in the third stage of childbirth when the baby is born but still connected
to the placenta by the umbilical cord.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care for the mother, if she:
■ has a fever (see: p. 168);
■ has pain in her belly;
■ releases a bad smelling substance from the vagina;
■ has sudden bleeding or increasing loss of blood;
■ has fits (see: p. 173);
■ experiences difficulty breathing or fast breathing;
■ has an irregular heart beat or chest pain;
■ experiences weakness and is unable to get out of bed;
■ experiences faintness (see: p. 164), dizziness, terrible headaches and blurry vision;
■ experiences nausea, vomiting.
Or when the afterbirth is incomplete or has not been delivered one hour after the birth
of the baby.
■ Arrange urgent transport to medical care for the baby if the baby:
■ is very small;
■ has difficulty breathing;
■ feels cold;
■ is bleeding from the cord stump;
■ is not able to breastfeed.
92
■ Immediately place the baby on the mother’s bare chest or belly so that they have skin-
to-skin contact.
■ Cut the baby´s umbilical cord:

- Use two long ties and a disinfected knife, scissors or razor blade.
- Tie the first knot on the umbilical cord, 2 cm (two fingers) away from the baby´s
belly. Tie the second knot 5 cm (five fingers) away from the baby’s belly.
- Cut the cord between the two knots.
- Add another tie on the side of the baby, if the cord continues to bleed after it has
been cut.
- If possible, disinfect the cord with antiseptic. Keep the cord dry and clean. Do
not put any substance on the baby’s cord or stump. This could lead to infection!
■ Use a clean cloth to dry off the baby. Wrap the baby in a clean cloth and cover the
baby’s head to keep it warm.
■ The mother and baby must be kept warm and close together.
93
2. Emergencies
■ The afterbirth will come out on its own. When it is delivered, put it somewhere safe
until it can be disposed of properly. Do not try to pull out the afterbirth by pulling the
cord. Avoid tearing the afterbirth.
■ Encourage breastfeeding immediately after birth. Although there is no breast milk,

the baby’s sucking will stimulate the production of the milk. Breastfeeding helps the
placenta to come out and reduces blood loss in the mother after childbirth. Early
breastfeeding reduces the risk of health problems and mortality in the new born baby.
■ When the mother is bleeding heavily after delivery, seek immediate help. Massaging
the belly firmly below the belly button, or letting the mother urinate, might help stop
the bleeding.
■ The mother should always seek medical attention after delivery. A new born baby
should always get medical attention.
■ The mother should not be left alone during the first 24 hours after child birth.
■ Encourage the mother to move around as soon as she feels able and ready.
■ Take off your disposable gloves and wash your hands.
94
2.10.4 When the new born baby is not breathing
normally
STEP 2: Assess the new born baby’s condition
■ Check the new born baby’s consciousness and breathing.

■ Find out what is wrong with the new born baby. The baby:
■ is unconscious;
■ does not breathe normally.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care for the baby.
■ Move the baby to a clean, dry and warm surface.

■ Tell the mother that the baby is having problems breathing and that you will help
them to breathe.
■ Keep the baby wrapped up warm.
■ Start CPR immediately (see: p. 40).
■ Stop CPR after 20 minutes if the baby is not breathing or is gasping for air. Explain to
the mother what has happened and provide psychological first aid (see: p. 13).
95
2. Emergencies
2.10.5 Promotion of safe pregnancy

To prevent complications during pregnancy or harmful situations for either the mother
or baby:
■ Encourage pregnant women to go to the health centre at least 8 times during their
pregnancy and to ask a health worker about vaccinations, healthy diet and measures
to take to prevent diseases that can endanger their health and the health of their
unborn child. Pregnant women should visit the health centre even if there are no
problems during their pregnancy.
■ Pregnant women should always follow the advice of the health care worker carefully.
■ If at any time the mother feels sick or has concerns about her health and/or the health
of her baby in between the 8 visits, she should visit a health centre immediately. Early
detection of a medical problem makes it possible to control the problem better.
■ Pregnant women should seek medical advice before taking medication. Pregnancy
can be a contraindication for some ‘over the counter’-medication.
■ Pregnant women should have a safe delivery kit close to hand, if available. They need
to make sure that they have the kit with them when delivering. Even when the woman
has the kit available, it is recommended that she goes to the health centre for regular
check-ups and delivery.
■ Pregnant women should avoid sleeping on their back. Preferably, they should sleep
on their side.
96
■ Pregnant women should always sleep under a (preferably insecticide-treated) bed
net, as a malaria infection (see: p. 171) during pregnancy can be a serious threat to
the unborn baby´s health.
■ Good hygiene is very important for the mother and her baby. Therefore, the mother
should wash her hands before breastfeeding and after changing a baby’s diaper.
97
98
3 Injuries
An injury is physical damage to the body caused by accidents, falls, blows, stings, bites,
weapons and more. Injuries range from minor to life-threatening and can happen at work
or at home, indoors or outdoors, when driving a car or walking down the street.
Common types of injuries, mentioned in this manual, are:
■ skin wounds;
■ burns;
■ injuries to muscles, joints and limbs;
■ injuries to the head, neck and back;
■ eye injuries;
■ nosebleeds;
■ stings and bites.
99
3. Injuries
3.1 Skin wounds

A skin wound occurs when the skin gets damaged, and is frequently accompanied by
bleeding. The damage is commonly the result of an accident and can be caused by
different mechanisms. Skin wounds come in different shapes and sizes, such as cuts,
grazes, tears, scratches or pierced skin. To avoid further suffering, skin wounds must be
properly taken care of.
3.1.1 Skin wound


■ has damaged skin and possibly underlying tissue;
■ is bleeding from the damaged skin;
■ may have discoloration of the skin;
■ may feel pain.
■ If there is a lot of blood loss (the blood gushes or squirts out of the wound), provide
first aid as in severe external bleeding (see: p. 67).
STEP 3: Seek help


■ Clean the wound by rinsing it with plenty of clean water (e.g. drinking water, boiled
and cooled water). Even small, superficial wounds need to be rinsed thoroughly.
100
■ Use a wet gauze pad or clean cloth to carefully remove any remaining dirt from the wound.
■ Pat the wound and surrounding skin dry with a clean cloth.
■ Cover the wound with a wound dressing by bandaging a compress to the wound (see
further), an adhesive plaster (see further) or a clean cloth to protect it from germs and dirt.
■ Arrange medical attention for the person when:

■ the wound was caused by a bite (see: p. 160) or by a dirty or rusty object;
■ the wound is on the face or in the genital area;
■ the wound is large, deep or has jagged edges;
■ the edges of the wound do not stay together;
■ it is not feasible to properly clean the wound;
■ the wound has faeces or urine in it;
■ they lose sensation in or have problems moving the body part;
■ they have diabetes, an immune disease or are 60 years old or older;
■ it has been more than 10 years since the person had a tetanus vaccination, or there
is any doubt about if or when they had a tetanus vaccination.
■ In these cases, wounds need to be managed within 6 hours. Do not delay seeking
medical help.
Technique – Applying an adhesive plaster
1. Cut off an adhesive plaster from a roll or open the individual packaging. Make
sure the wound pad is slightly bigger than the wound.
2. Pull the protective strips partially open.
3. Carefully pull off one of the two protective strips and stick that side of the plaster
to the skin. Then do the same with the second protective strip. Do this without
touching the wound pad or the wound.
4. Gently press the edges of the plaster onto the skin.
101
3. Injuries
Technique - Bandaging
Before bandaging the wound, place a clean gauze pad on the wound, covering the
entire wound.
Bandaging an arm or leg

1. Start under the wound and wind the bandage
towards the heart. Apply the beginning of the
first turn at a slight angle.
2. After the first turn, fold back the tip of the

bandage and apply the second turn over the tip.
3. Make spiralling turns around the limb, ensuring

that each turn covers half to two thirds of the
previous turn.
4. Finish with a straight turn around the limb. Fasten

the bandage with adhesive tape or hooks.
102
Bandaging an elbow or knee
1. Ask the injured person to keep the injured limb
slightly bent, in a comfortable position.
2. Apply the first turn on the joint itself. After the

first turn, fold back the tip of the bandage and
apply the second turn also on the joint.
3. Apply the following turns above and then below

the joint. Turns should cross and overlap on the
inside of the joint.
4. Finish with two circular turns above the joint.

Fasten the bandage with adhesive tape or hooks.
103
3. Injuries
Prevention of skin wounds
■ Do not clean up broken glass or pottery with your bare hands. Use hard gloves or
cleaning tools.
■ Wear protective clothing when working with heavy objects or sharp materials.
■ Handle sharp objects carefully and safely.
■ Do not leave sharp objects lying around. Store unused sharp objects safely, out of
reach of children
■ Pass scissors or knives to other people handle-end first.
■ Do not scratch insect bites or itchy skin.
Good to know! - Tetanus
Tetanus is a bacterial infection in which the bacteria enter the body through a
contaminated wound. Any wound that has not been thoroughly cleansed increases
the risk of infection with the tetanus bacteria.
A tetanus infection is severe and treatment requires hospitalisation and intense

care. Therefore, prevention is very important. Prevention can be done by getting a
tetanus vaccination at least every 10 years.
104
3.1.2 Skin wound with a large embedded object

■ Find out what is wrong with the person. The person has a skin wound in which a foreign
object is embedded (e.g. glass, nail).
■ When there is no visible object in the wound, an object might be stuck in the wound
if the person:
■ feels pain in a specific area;
■ has a painful lump;
■ has the feeling that something is stuck in the wound;
■ has a discoloured area of skin.
STEP 3: Seek help
■ has severe external bleeding;
■ or if their condition deteriorates.
■ Do not remove the object as the bleeding will increase if you do so.
■ Try to stop or slow down the bleeding. Be careful not to push the object deeper.
■ Prevent the object from moving (see further).
105
3. Injuries
■ Remove jewellery or other objects on the limb (see further) where the wound is
located, which could disrupt blood flow in case of swelling.
■ Arrange medical attention for the injured person, even when the situation does not
look dangerous. The embedded object needs to be removed by a medical professional.
■ Stay with the person until they receive medical care. When the person needs urgent
transport to medical care:
Technique - Keeping an embedded object motionless
1. Put a gauze pad or clean cloth on both sides

of the embedded object. 130
2. Fill in the difference in height between the

skin and the object on both sides, e.g. with
rolled up bandages or gauze pads, until you
can bandage it without pressing the object
down.
3. Apply the bandage without pressing on or

moving the object
106
Technique - Removing a ring from a finger
1. Apply soap, oil or other lubricant to the finger. Make sure the finger is slippery.
2. Ask the person to relax the finger.
3. Grasp the ring with your fingers and make circular movements while gently
pulling the ring.
4. If you are unable to remove the ring, arrange medical attention.
107
3. Injuries
3.1.3 Wound aftercare and wound infection

Wound aftercare
A wound heals faster when covered, preferably in a moist wound environment (provided
it has been properly cleaned first). If a wound is not covered, it dries out into a scab, which
leads to slower healing. Use the following tips for the aftercare of a simple skin wound:
■ Check the outside of the dressing every day.
■ If the dressing is clean, leave it in place.
■ Change the dressing when you see obvious stains on it.
■ If a dressing needs to be changed, do not tear the old dressing off, as this can
damage the healing wound. Instead, soak the bandage with clean water (e.g.
drinking water, boiled and cooled water) to take it off easily.
■ Clean the wound at every dressing change.
■ It is normal for the skin around a wound to be slightly red and for clear fluid to seep
out initially.
■ Refer the person to medical attention if signs of infection appear (see below).
More complex wound care (e.g. after discharge from hospital following surgery, trauma
or burns) requires professional medical attention.
Wound infection
Wound infection occurs when a microorganism (such as bacteria, virus or fungus) comes
into contact with a wound. As a result, local and/or general signs of disease can develop.
A skin wound might be infected when
■ the person:
■ experiences worsening pain;
■ has a fever (see: p. 168) or a general feeling of sickness.
■ the wound site:
■ shows swelling;
■ is encircled by red skin;
■ feels warm to the touch;
■ drains pus;
■ develops an abscess (a collection of pus under the skin);
■ emits an abnormal odour.
Always arrange medical attention when you suspect a wound to be infected.
108
Prevention of wound infection
■ Even small wounds need attention to prevent infection.

■ Closing an open, dirty wound will infect the wound underneath the skin. Wounds
should only be closed by medical professionals.
■ Do not allow animals to touch your skin wounds. Keep flies and other insects away
from the wound to prevent infection. Keeping the wound clean will help, as a bad
smell attracts flies.
109
3. Injuries
3.2 Burns
Burns occur when the skin (and tissue) are damaged by heat, chemicals, electricity,
radiation or extreme cold. There are 3 types of burns, classified by their depth:
■ superficial burns, a burn that has only affected the surface of the skin;
■ partial-depth burns, a burn that has gone deeply into the skin;
■ full-depth burns, a burn where the heat has gone through the skin and into the tissue
layers below.
■ Remove the cause of the burn safely, if possible.

■ When a person (or their clothes) is on fire, do not let them run around. Make them
drop down and let them roll over the ground.
■ If it is possible to do so safely, help to smother the fire with a blanket or towel.

■ has superficial burns when:
- the skin is dry, darkened and swollen;
- the burnt area feels painful.
110
■ has partial-depth burns when:
- the skin appears to be wet and red;
- blisters, filled with fluid, appear on the burnt skin;
- the burnt area is very painful.
■ has full-depth burns when:

- the skin is charred;
- they feel no pain directly over the full-depth burn. However, burns with a full-
depth burn are usually a mixture of the above types of burns. Full-depth burns
are often accompanied by painful superficial and partial-depth burns.
STEP 3: Seek help
■ the burn is on the eyes or in the mouth or throat;
■ the burn encircles the entire limb or body;
■ the burn is equal or larger than the injured person’s hand size;
■ the burn is a full-depth burn;
■ the person has no feeling in the burn area;
■ the person has inhaled flames, heat or a smoke.
111
3. Injuries
■ Cool the burn with clean, running water when available. Otherwise use any (preferably
clean) water (e.g. drinking water, boiled and cooled water). The water should be cool
to lukewarm.
■ If limited amounts of water are available, recycle the water by catching it in a clean
bucket and scooping it out again.
■ Do not use ice on a burn, this will cause further damage.

■ Target the water stream a few centimetres above the burn and allow the water to
flow over the burn.
■ Cool the burn for 10 to (preferably) 20 minutes. Even if it hurts less after a while, cool
the burn for at least 10 minutes. Cooling reduces the pain and prevents a burn from
going deeper by removing heat from the skin.
■ Remove jewellery (see: p. 107), clothing or other objects in the vicinity of the burnt
area if they do not stick to the skin. Do not remove any material that is stuck to the
burn. Scissors may be needed to cut around material that is stuck to the skin.
■ When no urgent transport to medical care or medical attention is needed:
■ Put liquid honey, aloe vera or vaseline on the burn. This will improve the healing
process, ease the pain and prevent infection.
■ Cover the burn with a dressing that will not stick to the burn, or with clean banana
leaves. Apply a bandage (see: p. 102), but avoid doing this too tightly. Be aware of
swelling of the injured limb.
112
■ When urgent transport to medical care or medical attention is needed:
■ cover the burn temporarily with a clean wet cloth or wrap it in clean plastic food
wrap. Apply it loosely over the burnt area, awaiting medical help.
■ Protect the injured person from hypothermia (see: p. 79):

■ avoid cooling the burn with very cold water;
■ protect them from the wind, and wrap them in blankets.
■ the burn is on the face, hands, feet, joints or genitals;
■ they are under 5 or over 60 years old;
is any doubt about if or when they had a tetanus vaccination;
■ there is clothing or jewellery stuck to the burnt skin;
■ the burns were caused by electricity, chemicals or high-pressure steam;
■ a wound infection (see: p. 108) develops in the following days.
Wound aftercare for burns

■ Do not use toothpaste, creams, oil, butter or soap on burns. They can worsen the burn
and might cause wound infection.
■ Never puncture blisters caused by burns. This creates an open wound, which is
vulnerable to infection.
■ Rinse the burn with clean water (e.g. drinking water, boiled and cooled water) and
change the dressing daily. If the wound is infected (see: p. 108), arrange medical
attention.
113
3. Injuries
Prevention of fire and burns

Prevention of accidental fires
■ Never leave candles unattended. Keep candles in a fireproof, sturdy holder and
keep them away from flammable materials.
■ Handle paraffin stoves and lamps carefully as they can easily be knocked over
and ignite. Maintain a good pressure on a paraffin stove, preventing the paraffin
leaking outside the stove.
■ Never smoke in bed or leave burning cigarettes unattended. Do not throw
smouldering ashes in a trash can.
■ Pour water or sand on smouldering ashes. In case of an open fire, use fire
extinguishers, a fire blanket or sand buckets to extinguish the fire quickly and
safely.
■ Be aware of danger when burning bushes. Bush fires can easily spread beyond
your control. Therefore, do not start several bush fires at the same time or when
you are alone, as the fire might overwhelm you.
■ Do not pour petrol or paraffin on wood when making a fire.
■ Remove electrical cords from floors and keep them out of reach of children.
■ Be careful with exposed electrical wires and electrical appliances near water.
Exposed wires or bad connections can cause fire.
Prevention of burns
■ Teach children about the dangers of fire and about household objects that can
cause burns.
■ Store matches, lighters and flammable material safely and out of reach of children.
■ Never leave children alone near heat sources, hot water and open fires.
■ Keep hot drinks away from young children.

■ Install guards around open fires and electric, gas or coal heaters to discourage
children from standing too close. If you cook outside, raise the level of the stove
and build mud barriers.
114
■ Never leave food unattended on a stove. Turn pot and pan handles toward the
back of the stove, so that they cannot be accidentally knocked over. Do not leave
spoons or other utensils in pots while cooking.
■ Avoid wearing loose clothing that could catch fire during cooking.
■ Keep cooking areas free of flammable objects.
■ When bathing, avoid using too hot water. Check the temperature with your elbow.
■ Handle chemical products carefully. Always read the instructions and wear
protective clothing, such as gloves and safety glasses.
115
3. Injuries
3.3 Injuries to muscles, joints and limbs

Injuries to muscles, joints and limbs are often the result of a wrong movement, an impact
or accident, violence or overuse causing the muscles, joints and/or bones to be forced.
3.3.1 Bruise
Soft tissue in the limbs (such as blood vessels, muscles, tendons, nerves and fatty tissue)
can be damaged by a fall, impact or crushing. This is called a bruise. In bruises, the
damage is limited to ruptured blood vessels under the skin and possibly nerves, and may
be accompanied by swelling, darkening of the skin, and local pain.

■ feels pain on the bruised limb;
■ may have swelling or discoloration on the skin at the site of the bruise;
■ may experience difficulty in moving the injured limb.
■ If you have doubts about the severity of the injury, assume the worst case scenario.
Provide first aid as in broken or dislocated limbs (see: p. 121).
STEP 3: Seek help
■ Remove jewellery (see: p. 107) or other objects on the injured limb, which could
disrupt blood flow in case of swelling.
116
■ Wrap ice in a cloth or towel and apply it to the injury to reduce swelling and pain. If
you do not have ice, use cold water. Cool the injured area as long as the person can
tolerate, but no longer than 20 minutes.

■ the pain does not fade after cooling;
■ the person cannot use the injured limb.
117
3. Injuries
3.3.2 Sprain
A sprain often occurs during sports, for example, due to a wrong movement or a bad
landing after a jump. With a sprain, the range of movement of a joint is exceeded; causing
ligaments to stretch. The joint, surrounding blood vessels, nerves and other soft tissues
may be bruised, but the bones remain unaffected.

■ feels pain in the injured joint;
■ may have swelling or discoloration on the skin at the site of the sprain;
■ experiences difficulty in moving the injured joint.
■ If you have doubts about the severity of the injury, assume the worst case scenario.
Provide first aid as in broken or dislocated limbs (see: p. 121).
STEP 3: Seek help
■ Advise the injured person not to move the

injured joint.
■ Remove jewellery (see: p. 107) or other
objects on the injured limb, which could
■ If the injury is on the foot or in the ankle
region, have the person take off their shoe
themselves.
■ Wrap ice in a cloth or towel and apply it to
the injury to reduce swelling and pain. If
you do not have ice, use cold water. Cool
the injured area as long as the person can
118
■ Do not massage the injury.
■ If you suspect a sprained ankle, you can apply a bandage to the ankle (see below).
■ the pain does not fade after cooling;
■ the person cannot use the injured joint.
Technique - Bandaging an ankle
1. Ask the injured person to keep their foot in a neutral position.

2. Apply the first turn just above the ankle. Apply the beginning of the first turn at
a slight angle.
3. After the first turn, fold back a tip of the bandage and apply the second turn over
the tip.
4. Apply the bandage diagonally across the top of the foot towards the toes.
119
3. Injuries
5. Make a complete turn around the toes, but do not cover the toes completely. This
way, the injured person can still move them and the first aider can observe the
toenails.
6. Return crosswise over the top of the foot to the place where you started
bandaging, just above the ankle. Turn behind the ankle and return to the toes.
7. Repeat this series of cross-shaped turns around the foot, going back towards the
ankle each time.
8. Place the turns a little further away from the end of the foot. Work towards the
ankle.
9. Finish with two circular turns around the ankle. Fasten the bandage with adhesive
tape or hooks.
10. Make sure the bandage is not too tight. If the toes become cold and greyish,
loosen the bandage.
120
3.3.3 Broken or dislocated limb
A dislocation occurs when two bones that come together in a joint (e.g. the shoulder, hip
or knee) have moved in an abnormal way relative to one another.
A broken bone or bone fracture refers to a bone that may be completely fractured or
cracked partially.
■ Wash your hands and put on clean disposable gloves or a locally available alternative
if it concerns an open fracture or dislocation.

■ feels pain in the injured limb or joint;
■ may show an abnormal position of the injured limb or joint;
■ may have swelling or discoloration at the site of the dislocation or broken bone;
■ experiences difficulty in moving the injured limb or joint.
■ When a skin wound occurs, possibly showing bone fragments, at the site of the
fracture or dislocation, it is called an open fracture or open dislocation.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care when:
■ it concerns an open fracture or dislocation;
■ it concerns a fracture or dislocation of the lower limbs.
■ Advise the injured person not to move the injured limb.

■ If it is an open fracture or dislocation:
■ Stop the bleeding by gently pressing directly on the wound.
■ Cover the wound with a wound dressing or clean cloth to protect it from germs and
dirt.
■ Remove jewellery (see: p. 107) or other objects on the injured limb, which could
121
3. Injuries
■ If you suspect a broken leg:

■ Tell the person not to stand on it.
■ Splint the leg. Splinting provides pain relief, supports the bone ends of the potential
fracture and facilitates safe and seamless transport. Splints must immobilise joints
above and below the injury (see further).
■ If you suspect a broken arm:
■ Immobilise the arm. Immobilising the injured arm provides pain relief, supports
the bone ends of the potential fracture and facilitates safe and seamless transport
(see further).
■ Do not apply these splints or immobilisation techniques when an ambulance will
arrive shortly.
■ Wrap ice in a cloth or towel and apply it to the injury to reduce swelling and pain. If
you do not have ice, use cold water. Cool the injured area as long as the person can
■ Exception! Do not cool an open fracture or open dislocation.
■ Always arrange medical attention for a person when you suspect a broken bone or a
dislocation.
■ Take off your disposable gloves (if applicable) and wash your hands after providing
first aid.
122
Technique - Immobilising legs
■ If just one leg is injured, the injured leg must be splinted to the uninjured leg using
bandages or strips of cloth.
1. Carefully move the uninjured leg close to the injured leg.
2. Put 4 bandages or strips of cloth under the knees of the injured person.
3. Slide the 1st bandage carefully to the thighs.
4. Slide the 2nd bandage carefully to the ankles.
5. Slide the 3rd bandage carefully to just above the knees.
6. Slide the 4th bandage carefully to just below the knees.
7. Put padding (e.g. a rolled-up blanket) between the legs to fill in hollow areas
in between the legs. Attach the legs together using the bandages or strips of
cloth.
■ When both legs are injured, both legs must be immobilised separately by using a
splint (e.g. a straight branch, pole or stick).
1. Put 4 bandages or strips of cloth under the knee of one of the injured legs.
2. Slide the 1st bandage carefully to the thigh.
3. Slide the 2nd bandage carefully to the ankle.
4. Slide the 3rd bandage carefully to just above the knee.
5. Slide the 4th bandage carefully to just below the knee.
6. Tie the splint (e.g. straight branch, pole or stick) to the outer side of the 1st
injured leg using the bandages or strips of cloth.
7. Repeat this procedure for the 2nd injured leg.
Make sure the bandages are not tied too tight. If the toes become cold and greyish,
loosen the splint.
123
3. Injuries
Technique - Immobilising an arm
■ The injured person can immobilise their arm by holding their arm close to the
body.
■ If the person cannot support their own arm:
■ If a triangular bandage is available:
1. Stand in front of the person. Have them support their injured arm at a right
angle, across the front of their body.
2. Place the triangular bandage under the injured arm, with the tip facing the
elbow of the injured arm. Hold the long side vertically.
3. Slide the top of the bandage just past the elbow. Make sure the fingertips
extend over the vertical side of the bandage. The top end of the bandage rests
on the shoulder of the uninjured side.
4. Fold the lower end of the bandage over the arm to be supported. This end
should now rest on the shoulder of the injured arm.
5. Tie both ends of the bandage together at the side of the neck.
6. Fold the protruding part of the top, at the elbow of the injured arm, of the
bandage forward. Fasten with a safety pin or tie a knot.
124
■ If no triangular bandage is available:
1. Turn up the lower end of their clothing.
2. Pin it above the arm, using a safety pin, forming a sling.
125
3. Injuries
Good to know! - Broken or dislocated limb
■ When applying a splint to immobilise a leg, remember that you are trying to
provide support and comfort. Therefore:
■ Take your time.
■ Use plenty of padding and make sure the splint or the triangular bandage is
properly secured.
■ If possible, ask a bystander to carefully hold the injured limb while you
immobilise it.
■ Do not splint or immobilise if an ambulance is on its way (and will arrive soon).
Ambulances are equipped with professional equipment to effectively splint the
limb.
■ If a limb looks crooked or dislocated, do not try to reset it. This can make the injury
worse.
126
3.3.4 Muscle cramp
Muscle cramps are abrupt, involuntary contractions that occur in different muscles and
are often painful. The calves, the back of the thigh and the front of the thigh are muscles
that are often affected.

■ has suddenly hard and painful muscles;
■ experiences difficulty in moving the injured limb;
■ does not have swelling or discoloration of the injured area.
STEP 3: Seek help
■ Advise the injured person to stop the activity and rest, this will reduce the pain.
■ Stretch the muscle gradually and carefully.
■ In case of a calf cramp, pull the toes up.
■ In case of a cramp in the thigh, stretch the leg.
127
3. Injuries
■ It can help to massage the muscle lightly.

■ Apply heat to the muscle (warm clothing or a heat bag). Put a cloth between the skin
and the warm object, to make sure the person does not get burned.
■ Arrange medical attention for the person when they regularly have muscles cramp
without a clear cause (e.g. sports).
Prevention of injuries to muscles, joints and limbs
■ Do not leave objects lying on the floor and clean up spilled liquids or food on the
ground. Remove electrical cords from the ground and avoid loose carpets. Repair
damaged carpets and uneven or cracked floors immediately.
■ Pay attention when walking on wet floors or on slippery ground.
■ Store things you need frequently within easy reach.
■ Use non-slip mats and arm grips in your shower or bathtub.
■ Ensure good lighting.
■ Ensure safe stairs, remove loose objects or carpets and use the handrail.
■ Use a stair gate or something to block entry at the
top or bottom of the stairs to prevent children from
falling down the stairs. Do not let young children go
up and down the stairs alone.
■ Do not let young children climb in trees.
■ Ensure that children cannot fall from an open window
or balcony. If possible, use window guards and
balcony railings.
■ Wear shoes that fit properly. Slippers, smooth soles
and high heels can cause you to slip and fall.
Prevention of sports-related injuries
■ Avoid sporting activities or exercises when you are tired. Take a break when you
feel exhausted.
■ Warm up properly (about 20 minutes) before engaging in sports by stretching
your muscles and starting your activity gently. Cool down by doing some light
exercise and stretch your muscles after engaging in sports.
■ Drink enough before and during physical activity. If you have been sweating
excessively during sport, drink (carbohydrate-electrolyte) sports drinks, skimmed
milk or water. Avoid drinking alcoholic beverages.
■ Respect the rules of the game.
■ Wear shoes that support and protect your feet when doing sports or outdoor
activities. Be careful when running or walking on uneven surfaces.
128
3.4 Injuries to the head, neck and back
3.4.1 Injury to the head

A head injury is often the result of direct contact between the head and an object, or of a
sudden and violent acceleration or deceleration of the body (e.g. a traffic accident, a fall
from height). There may be damage to the skin (e.g. skin wound), to the skull (e.g. skull
fracture) and to the brain (e.g. concussion or brain haemorrhage).
3.4.1.1 Minor head injury

■ may have a bleeding wound on the head or a deep cut on the scalp, revealing the
skull;
■ may have a bump on the head;
■ may have a headache, feel drowsy or be confused.
STEP 3: Seek help
symptoms (e.g. unconsciousness) or when their condition deteriorates.
129
3. Injuries
■ If the injured person has a minor head wound, provide first aid as in skin wounds (see:
p. 100).
■ If the person has a bump, wrap ice in a cloth or towel and apply it to the injured area to
reduce swelling and pain. If you do not have ice, use cold water. Put this cold compress
loosely on the bump as long as the person can tolerate, but no longer than 20 minutes.
■ Exception! Do not cool a bleeding wound. Once the bleeding has stopped and you
have dressed the wound, you can cool the head wound.
■ the wound was caused by a bite (see: p. 160) or by a dirty, rusty or contaminated
object;
■ the wound is on the face;
■ the wound is large, has jagged edges or the edges of the wound do not stay
together;
■ it is not feasible to properly clean the wound;
■ the person has diabetes, an immune disease or is 60 years old or older;
is any doubt about if or when they had a tetanus vaccination.
■ the person feels unwell;
■ you have doubts about the severity of the injury.
130
Technique - Bandaging a wound on the head
■ Once you have cleaned the wound put a clean gauze pad on the wound, covering
the entire wound:
1. Ask the person to keep their head still. Bring the first wrap around the head.
Apply the beginning of the first wrap at a slight angle.
2. Try to keep ears and eyes uncovered.
3. After the first wrap, fold over a tip of the bandage and apply a second wrap
over the tip. This prevents the bandage from slipping.
4. Roll the bandage around the head a few times.
5. To ensure a better grip, roll the bandage a few times a bit lower on the back of
the head. That way the bandage stays on better.
6. Fasten the bandage with adhesive tape or hooks.
131
3. Injuries
3.4.1.2 Severe head injury

■ has had a hard blow on the head through a road accident or from falling from a
height greater than standing height;
■ may feel nauseous or is vomiting;
■ may have a terrible headache that does not go away;
■ may be sensitive to light and/or sound;
■ may suffer a partial loss of sight, smell, hearing or balance;
■ may have minor head injuries (see: p. 129);
■ may lose blood or clear liquid from the nose, mouth and/or ear;
■ may show signs of an injury to the neck and back (see: p. 134);
■ may not remember what just happened, or feel drowsy or confused;
■ may behave in an irritated or unusual way;
■ may have fits (see: p. 173);
■ may have problems with consciousness or lose consciousness (see: p. 36).
STEP 3: Seek help
132
■ The injured person is conscious and breathing normally:

■ Calm the person and let them rest. Convince them not to move.
■ Immobilise their head and neck if you suspect a spinal injury (see: p. 134). Only do
this if the person wants to cooperate, not when they are agitated or restless.
■ The injured person is unconscious and breathing normally:
■ In this case you have to suspect a spinal injury (see: p. 134). Let the person lie the
way you found them. If they are breathing normally, lift their chin up to keep their
airway open, but do not tilt their head (see: p. 27).
■ Do not put an unconscious person with a suspected spinal injury in recovery
position.
- Exception! Only put a person with a suspected spinal injury in recovery position
if you have to leave them on their own (e.g. to seek help) or when they vomit.
Support their neck while turning them into recovery position.
■ When there is a minor head wound:
■ Provide first aid as in minor head injuries (see: p. 129).
■ When there is a serious head wound:
■ Do not clean or rinse a serious head wound.
■ Leave the loose flap of skin on the head, if present.
■ When the wound is bleeding heavily, stop the bleeding by pressing on the wound
for 10 minutes. Apply a pressure bandage after 10 minutes.
Good to know! - Injuries to the head
■ A person with an injury to the head, may be confused and behave in an unusual, or
even aggressive way. It is possible that the person refuses your help or does not
cooperate. Use psychological first aid techniques to convince the person to allow
themselves to be helped (see: p. 13).
■ Never straighten a crooked nose yourself.
■ If the injured person cannot close their lower jaw, never try to put it back in place
yourself.
133
3. Injuries
3.4.2 Injury to the neck or back
Neck and back injuries are injuries to one or more neck and back bones. They are also
referred to as spinal injuries. These types of injuries can be very serious and should
always be managed with great caution, because they could cause partial or complete
paralysis of the body.
■ Check the person’s consciousness and breathing. If you suspect a spinal injury, perform
the chin lift to open the airway (see: p. 27), but do not tilt their head backwards.
■ Find out what is wrong with the person. Suspect a spinal injury if the person:
■ has had a hard blow through a road accident or from falling from a height;
■ has had an accident involving a forward or backward movement of the neck or
trunk (e.g. a rear-end collision);
■ is unconscious after a road traffic incident;
■ has injuries to the head (see: p. 129), neck or above the collarbone;
■ has pain in the neck, back or rear of the pelvis, both spontaneous and during
movement;
■ complains about numbness or tingling sensations. The person may;
- have sensory disturbances and signs of paralysis. Sometimes they may have a
diminished or tingling sensation in the limbs or around the anus (which could be
accompanied by involuntary loss of urine or faeces);
- have serious leg injuries but does not complain about pain.
Even when the person has no symptoms, a spinal injury may be present.
134
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care. An ambulance is the best
way to transport a person with a spinal injury. Call an ambulance if it can be obtained
in a short time.
■ The injured person is conscious and breathing normally:

■ Calm the person and have them rest; convince them not to move.
■ Immobilise their head and neck (see further). Only do this if the person wants to
cooperate, not when they are agitated or restless.
■ The person is unconscious and breathing normally:
■ Let the person lie the way you found them. If they are breathing normally, lift their
chin up to keep their airway open, but do not tilt their head.
■ Do not put an unconscious person with a suspected spinal injury in recovery
position.
- Exception! Only put a person with a suspected spinal injury in recovery position
if you have to leave them on their own (e.g. to seek help) or when they vomit.
Support their neck while turning them into recovery position.
135
3. Injuries
Technique - Immobilising the head and neck

With your hands
1. Kneel behind the head of the person.
2. Gently grasp the person’s head with both your hands on both sides of the head.
Do this without moving their head. Try not to cover their ears.
3. Support your forearms on your knees or thighs.
With folded cloths
Place tightly folded cloths on each side of the person’s head and neck. Reinforce
these cloths so that they support the head well. Try not to cover their ears.
136
Prevention of road traffic injuries
For car drivers and passengers
■ Always wear your seat belt while driving. Use a child’s seat for children younger
than 10 years or as specified by local regulations and make sure it is used properly.
■ Whenever possible, place children in the back seats of the car.

■ Do not drive a car after drinking alcohol or taking drugs and do not ride with a
driver who has done so. Discourage people who are under the influence of alcohol
or drugs from driving.
■ Do not drive the car when you are feeling tired or sleepy. The following methods
can stop you from dozing off while driving:
■ take a break every 2 hours;
■ switch drivers when driving long distances (> 2 hours).
■ Always pay attention to the road; do not reach for things or use your cell phone
while driving.
■ Do not speed. Leave enough space between vehicles and always check for
oncoming traffic when leaving a parking space or overtaking other vehicles.
■ Pay attention to cyclists and motorcyclists.
■ Regularly maintain your car.
■ Avoid using unsafe public transport, such as overcrowded buses, vehicles in bad
condition or a vehicle driven by somebody who is tired or under the influence of
alcohol or drugs.
137
3. Injuries
For motorcyclists and cyclists
■ Wear a helmet when riding a bicycle or motorcycle. Wear protective clothing

(e.g. solid shoes, trousers, a jacket with body armour and gloves) when riding a
motorcycle.
■ When you cycle or drive a motorcycle at night:
■ use lights so that you can see where you are going;
■ use reflective materials to make sure that you are seen, if available.
For pedestrians
■ If the road has no sidewalk, walk on the side of the oncoming traffic.
■ Carry a flashlight to light the road when walking at night.
■ Do not let children play on the road. Do not allow children to cross the road
unsupervised.
138
Removing a motorcyclist’s helmet
When a motorcyclist is unconscious after a road traffic accident, remove their helmet to
check the injured person’s breathing.
Technique - Removing a helmet from a motorcyclist
The following technique can only be performed safely by 2 people.
1. Kneel at the side of the injured person, near their head. Ask a bystander to kneel
at the top of the injured person’s head.
2. Instruct the bystander to gently grasp the helmet with both of their hands, on
both sides of the helmet.
3. Undo or cut the chin straps.
4. Without moving the head, ease your fingers of one hand under the back edge of
the helmet and support the back of the person’s neck. Use your other hand to
hold on to the person’s jaw, at the front. Do not move the neck.
5. While keeping hold of the person’s neck and jaw, instruct the bystander to:
■ Grip the helmet under the rim/edges at the sides, and pull them apart. Gently
tilt the helmet back without moving the head.
139
3. Injuries
■ Lift the front of the helmet clear of the chin/lower jaw.
■ Tilt the helmet slightly forwards, so the back of the helmet passes over the
rear of the skull.
6. The bystander should now be able to slide the helmet off the person’s head,
while you support the person’s head. Do not let the head drop to the ground.
7. Be careful not to hurt the person’s ears when removing a tightly fitted helmet.
140
3.5 Eye injuries
Injuries in the vicinity of the eye are serious because the eyes themselves can be damaged.
Dirt, a dangerous substance or an object can get into the eye, or someone can get a blow
to the eye. Since the eye is a person’s window to the world, eye injuries should always be
managed with great care.
3.5.1 Speck in the eye

■ Put them in a place where there is enough light to examine the eye. The person may
not see well; guide the person when you move them.
■ Do not touch the eyeball.
■ has a scratching sensation when the eyes blink or move;
■ has a red, weeping eye, which they keep tightly closed.
STEP 3: Seek help
141
3. Injuries
■ Ask the injured person not to rub their eyes.

■ Try to rinse away the dirt with plenty of clean water (e.g. drinking water, boiled and
cooled water) (see further).
■ the speck cannot be removed by rinsing the eye;
■ they have impaired vision;
■ the pain is getting worse;
■ they still experience discomfort in the eye after 3 days.
Technique - Rinsing the eye
1. Tilt the injured person’s head backwards. Stand behind them and carefully open
their eye with your thumb and forefinger.
2. Let clean water flow. Rinse the eye from the nose to the side of the face. Be
aware that this is not comfortable for the person.
3. Have them alternately look up, down, left and right while rinsing the eye.
142
3.5.2 Object stuck in the eye

■ has a foreign body stuck in the eye; this object may be visible or invisible;
■ may have pain in the eye;
■ may have weeping or red eyes;
■ may lose blood or a clear fluid from the eye;
■ may have impaired vision.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care, even when the object is small.
143
3. Injuries
■ Do not remove the embedded object yourself, unless it is a speck in the eye (see: p. 141).
■ Put them in a comfortable position and keep their head still.
■ Advise them to make as few eye movements as possible. Both eyes move together;
therefore, it is easier if both of their eyes are covered.
■ If possible, have the person put gauze pads or a clean, dry cloth over both eyes. Make
sure that no pressure is put on the eye nor on the embedded object. If necessary,
attach the gauze pads or cloth with an adhesive plaster.

144
3.5.3 Blow to the eye

■ Find out what is wrong with the injured person. The person:
■ has swelling and discoloration to the area around the eye;
■ may have problems with their vision;
■ cannot keep their eye open;
■ may experience pain in the eyeball itself;
■ may have an injury to the head (see: p. 129).
STEP 3: Seek help
145
3. Injuries
■ Wrap ice in a cloth or towel and apply it to the area around the injured eye to reduce
swelling and pain. If you do not have ice, use cold water. Put this cold compress loosely
on the eye as long as the person can tolerate, but no longer than 20 minutes. Do this
without putting pressure on the eye itself.
■ Try to open the eyelids carefully. Test whether the person has normal sight with the
injured eye.
■ they have impaired vision;
■ the pain is getting worse;
■ the discomfort in the eye does not subside after 3 days.
146
3.5.4 Harmful liquids in the eye
■ Seal the packaging of the corrosive product and put the remains of the harmful
substance in a safe place, if you can do this safely.

■ may have burned skin around the eye;
■ may experience pain or a burning sensation in the eyeball itself;
■ may have scorched eyebrows or eyelashes;
■ may have red eyes;
■ may have a film on their eyeball.
STEP 3: Seek help

■ Rinse away the liquid for 10 to (preferably) 20 minutes with plenty of clean water (e.g.
drinking water, boiled and cooled water) (see: p. 142). Prevent the rinsing water from
leaking into the person’s other eye or onto your hands.
147
3. Injuries
Prevention of eye injuries
■ Wear safety glasses, goggles or a face shield when hammering nails or metal and
working with power tools to protect against flying fragments, dust particles and
sparks.
■ Use chemical goggles when you are exposed to splashing fertilisers, pesticides
and chemicals.
■ Wear a mask or goggles designed for welding, when you are welding or are near
someone else who is welding.
■ Be careful when handling and throwing a fishing line. Avoid that the fish hook
gets in your eye.
■ Do not let children throw stones and tell them to be careful of their eyes when
playing with sticks.
■ If you have lost one eye, always wear protection for the other eye, since you are at
greater risk of eye injury due to a loss of vision.
148
3.6 Nosebleed
The nose contains small blood vessels that can easily burst and start bleeding. Therefore,
nosebleeds are common as a result of a blow to the nose or head, but also of sneezing,
blowing or picking the nose. However, a nosebleed can also occur spontaneously as a
result of increased blood pressure or sudden exposure to a hot environment.

■ has blood dripping or running from the nose. It can also run in their throat;
■ may be nauseous, if they swallowed blood;
If the nosebleed is the result of direct contact with an object, or of a sudden and violent
acceleration or deceleration of the body (e.g. a traffic accident, a fall from height) provide
first aid as in injuries to the head, neck and back (see: p. 129).
STEP 3: Seek help
symptoms (e.g. unconsciousness or shock) or when their condition deteriorates.
■ Ask the injured person to lean forwards,

pinch their nose with their index finger
and thumb and breathe through their
mouth. If necessary, pinch their nose
yourself.
■ Pinch the nose for at least 10 minutes. If
the bleeding continues after 10 minutes,
pinch the nose for 10 more minutes. If
needed, repeat this until the bleeding
stops, while arranging medical attention.
149
3. Injuries
■ When the bleeding has stopped, carefully clean the outside of their nose and face.
■ Advise the person to take it easy, and to not blow their nose, pick their nose or move
abruptly during the first few hours after the nosebleed.
■ the bleeding does not stop after 20 minutes;
■ the nosebleed is the result of direct contact between the head and an object, or
of a sudden and violent acceleration or deceleration of the body (e.g. a traffic
accident, a fall from height);
■ the bleeding gets worse or is accompanied by other symptoms (e.g. headache,
bruising around the eyes);
■ blood spurts from the nose.
Prevention of nosebleed
■ Do not pick your nose or blow your nose hard.

■ Prevent children from putting small objects in their nose. Children under 3 years
of age are at the highest risk because they explore their environment by putting
objects in their mouth or nose.
150
3.7 Stings and bites
Different types of animals (and even humans) can sting or bite people. Often the
consequences of these stings and bites are rather mild. However, bee and wasp stings
can be life-threatening because of allergic reactions and some types of snake, spider or
scorpion venom can cause human death.
3.7.1 Bee or wasp

■ has been stung by a bee or wasp;
■ may have local swelling and redness of the skin;
■ experiences itching and pain where the insect has stung.
STEP 3: Seek help
■ was stung in the mouth or throat;
■ is known to be allergic to bee or wasp stings;
■ has generalised signs of an allergic reaction. The person can experience breathing
difficulties, difficulty swallowing, hoarseness, feeling unwell, stomach aches,
itching all over the body, or even lose consciousness.
151
3. Injuries
■ When the injured person is stung by a bee, remove the stinger as soon as possible.
Scrape it off with a fingernail, laminated card or a clean blunt knife.
■ Wash the stung area with clean water (e.g. drinking water, boiled and cooled water).
■ Remove jewellery (see: p. 107) or other objects on the limb where the person was
stung, which could disrupt blood flow in case of swelling.
■ Wrap ice in a cloth or towel and apply it to the stung area to reduce swelling and
pain. If you do not have ice, use cold water. Cool the injury as long as the person can
152
■ Advise the person not to scratch the stung skin. This can cause infections, especially
when fingernails are dirty.
■ you cannot remove the stinger;
■ they start to feel bad after the sting (up to 24 hours afterwards);
■ they have been stung a lot;
■ the sting is very painful.
Good to know! - Stinger
Bees have hooks on their stinger, so that it remains in the person’s skin when it
stings. When the bee pulls away, the stinger (and the venom sac) tear off from their
abdomen, causing the bee to die after stinging. Wasps have a smooth stinger and
retract it. Therefore, they can sting several times in a row.
Prevention of bee and wasp stings
■ Keep away from flowering plants, ripe fruit bushes and trees, rotten fruit, compost
and food waste. If you do need to come near these areas, wear long trousers and
long-sleeved clothes and cover your hands and face as much as possible.
■ Cover drinks and check food and drinks for
bees and wasps before eating or drinking.
■ Do not leave food waste uncovered
outside.
■ Wipe off food remains on children’s
clothes, hands and faces. These may
attract bees or wasps.
■ Shake out shoes, socks and clothing before
wearing them, as they might contain
insects.
■ Do not touch or disturb beehives or wasp nests. If you want to harvest honey,
protect yourself by wearing long trousers and long-sleeved clothes and cover
your hands and face as much as possible.
■ Remain calm when bees or wasps come close. Do not wave your hands in an
attempt to brush them away, since they react to movement.
■ Run and find shelter if attacked by a swarm.
153
3. Injuries
3.7.2 Snake
■ Make sure you do not get bitten yourself. Do not try to catch the snake.

■ Find out what is wrong with the person. Depending on the kind of snake, the person:
■ has two rows of teeth marks or small pointed wounds;
■ may bleed, experience pain and have swelling or bruising near the bite;
■ may experience numbness, weakness or confusion;
■ may experience nausea and vomiting;
■ may start to sweat and produce excessive amounts of saliva;
■ may have impaired vision;
■ may have fits (see: p. 173);
■ may experience difficulty breathing or chest discomfort (see: p. 47).
■ Check what type of snake has bitten the person, if it is safe to do so. If possible, take a
picture or write down a description of the snake (its shape, colours and distinguishing
features).
STEP 3: Seek help
■ Help the injured person to lie down and tell them not to
move. This slows down the spread of the venom. Offer
comfort and keep them calm.
154
■ Remove jewellery (see: p. 107) or other objects on the limb where the person was
bitten, which could disrupt blood flow in case of swelling.
■ Always assume that the person has been bitten by a poisonous snake.
■ Have they been bitten on the arm?
- Immobilise the arm (see: p. 124).
■ Have they been bitten on the leg?
- Immobilise the leg (see: p. 123).
■ Did venom squirt in their eye(s)?
- Rinse their eye(s) for 10 to (preferably) 20 minutes with clean water (e.g. drinking
water, boiled and cooled water) (see: p. 142). Prevent the rinsing water from
leaking into the person’s other eye or onto your hands.
! Attention! - Snake bites
■ Do not tie off the part of the body where the bite wound is.
■ Do not try to suck or cut the venom out.
■ Do not rub herbs or black stones/snake stones on the bite.
These actions will not help and could possibly harm the person even more.
155
3. Injuries
3.7.3 Scorpion or spider
■ Make sure you do not get bitten yourself. Do not try to catch the spider or scorpion.

■ Find out what is wrong with the person. Depending on the type of scorpion or spider,
the person:
■ may have pain, swelling, discoloration or itching near the bite;
■ may experience nausea and vomiting;
■ may have a headache;
■ may experience difficulty breathing or chest discomfort (see: p. 47).
STEP 3: Seek help
symptoms (e.g. breathing difficulties, chest discomfort or unconsciousness) or when
their condition deteriorates.
■ Wrap ice in a cloth or towel and apply it to the stung or bitten area to reduce swelling
and pain. If you do not have ice, use cold water. Cool the injury as long as the person
can tolerate, but no longer than 20 minutes.
156
■ Arrange medical attention for the person when they experience extreme pain or
itching.
Prevention of snake and spiders bites and scorpion stings
■ Check all clothing, towels and bed sheets for scorpions and spiders. Shake shoes
out before putting them on.
■ Sleep under a bed net that is properly hung and tucked under the mattress.
Wherever possible, sleep above ground level.
■ Maintain a clean domestic environment and seal holes and cracks in walls. This
way, you reduce the number of hiding places for snakes, scorpions and spiders.
■ Store food in sealed containers to keep small animals away.
■ Keep the environment of your house clean. Keep the grass short around your
house.
■ Avoid places where snakes may live (e.g. tall grass, rocky areas, fallen logs, swamps,
marshes and deep holes in the ground). Watch where you sit when outdoors, do
not put your hands into areas where snakes, spiders or scorpions may be hiding.
■ When walking through tall grass or weeds,
wear loose, long trousers and high, thick
boots. Poke at the ground in front of you
with a long stick to scare away snakes.
■ When walking outside at night, shine a light
on your path.
■ Wear work gloves when selecting firewood,
gardening, harvesting or working in an area
where snakes, spiders or scorpions are
likely to live.
■ If a spider lands on you, flick the spider
off with a finger rather than squishing it
against the skin.
■ Do not agitate a snake if it comes nearby.
Keep calm and move away slowly.
■ Do not touch a snake, even when it seems
dead. Recently killed snakes may still bite
as a reflex.
■ Do not drive your car over a snake
intentionally. It may become agitated and
attack pedestrians or wrap itself around
the undercarriage of your car and come
home with you.
157
3. Injuries
3.7.4 Jellyfish
■ Avoid direct contact with the injured skin.

■ Find out what is wrong with the person. Depending on the type of jellyfish, the person:
■ may have pain, itching or a burning sensation on the injured skin;
■ may have discoloration and small bumps on the skin;
■ may have generalised symptoms such as:
- nausea and vomiting;
- cramps;
- difficulty breathing or chest discomfort (see: p. 47);
- signs of shock (see: p. 72);
- loss of consciousness (see: p. 36).
STEP 3: Seek help
deteriorates.
■ Rinse the stung skin with seawater, if

available.
■ After rinsing, immerse the stung
body part in warm clean water (e.g.
drinking water, boiled and cooled
water) (as warm as possible, without
burning the skin) until the pain is
relieved (20 to 30 minutes).
■ Remove visible tentacles with
tweezers.
158
■ Arrange medical attention for the person when the symptoms do not subside despite
your actions.
! Attention! - Jellyfish stings
■ Do not use vinegar or urine to rinse the injured skin.

■ Do not apply pressure on the injured skin.
159
3. Injuries
3.7.5 Mammal or human
■ Make sure you do not get bitten yourself. Do not try to catch the animal or restrain
the person.

■ Find out what is wrong with the person. Depending on the animal, the person:
■ has bite marks caused by animal or human teeth;
■ may have laceration wounds on the skin;
■ may have bruising on the skin, resulting in discoloration;
■ may experience pain;
■ may have bleeding from the bite wound.
STEP 3: Seek help
■ If the wound is bleeding severely, act accordingly (see: p. 67).

■ Clean the wound by rinsing it with plenty of clean water (e.g. drinking water, boiled
and cooled water). Even small, superficial wounds need to be rinsed thoroughly.
160
■ Cover the wound with a wound dressing, adhesive plaster or clean cloth to protect it
from germs and dirt.
■ Arrange medical attention for the person, even if they recover quickly. Bite wounds by
mammals or humans need to be managed within 6 hours. Do not delay seeking medical
help. A person who has been bitten, might need medication to prevent infection. It is
also important to be vaccinated against tetanus.
Prevention of bite wounds
■ Teach children not to threaten or scare animals.

■ Never leave children alone in the presence of animals.
■ Do not touch (domestic) animals that you do not know. Do not touch animals
while they are eating, sleeping or playing. Avoid unusual behaving animals.
■ Do not enter a compound where there is a guard dog that is not supervised.
■ Avoid running in the presence of animals.
■ Stand still if you are attacked by a dog. Do not try to run away, but walk away
slowly when the dog loses interest.
■ Do not allow your dog to approach strangers without your supervision.
161
162
4 Illnesses
Illness is what causes someone to be ill or sick. It is the absence of good health, a
malfunction of one or more bodily functions. There are many types of illnesses, ranging
from harmless conditions (e.g. colds) to serious and life-threatening conditions (e.g.
pneumonia, heart attack and cancer). An illness can occur suddenly, as is often the case
with epidemics (e.g. flu, cholera or COVID-19), but can also be inherited or chronic (e.g.
diabetes). Common symptoms of illnesses mentioned in this manual, are:
■ fainting;
■ fever;
■ fits;
■ diarrhoea;
■ rash;
■ low blood sugar.
163
4. Illnesses
4.1 Fainting
Fainting, or ‘passing out’, is a brief and sudden loss of consciousness. This happens when
there is a temporary shortage of oxygen in the brain, due to a decreased supply of blood
to the brain. Frequently, the person does not become completely unresponsive, and
becomes fully responsive immediately after. Fainting may be caused by many reasons,
such as:
■ emotional distress;
■ tiredness;
■ hunger;
■ standing for a long period of time;
■ a sudden change in body position;
■ spending a long time in a hot environment (see: p. 82);
■ specific medical conditions (e.g. chest discomfort, dehydration, low blood sugar).
Usually, a person will experience a brief period of feeling faint before fainting. When
someone feels faint, they can perform some physical countermeasures (see further)
which might prevent them from fainting.
■ Help the person to lie down on the ground, in order to prevent them from falling.
■ When the person faints in a hot environment, move them to a cool area if possible
(see: p. 82).

■ feels dizzy and may see black spots or stars;
■ experiences weakness and sometimes nausea;
■ could yawn;
■ may hear a murmur;
■ may have clammy, greyish skin;
■ may experience tingling sensations in the fingers;
■ may lose consciousness (see: p. 36) and fall down.
164
STEP 3: Seek help
■ does not regain consciousness within 2 minutes;
■ might have heart problems.
■ Make sure that the ill person can breathe freely and gets enough fresh air. Loosen
tight clothing and have bystanders keep a distance.
■ If the person does not regain consciousness within 2 minutes, put them in recovery
position (see: p. 37) and provide first aid for unconsciousness (see: p. 36).
■ Once the person regains consciousness, have them lie down for a couple of minutes.
Gradually have them sit upright and stand up. If they feel weak again, have them lie
down again until they are fully recovered.
■ Put cold compresses or a wet cloth onto the forehead of the person, if they agree.
■ Find out if the person has injured themselves if they fell down. Provide first aid
according to your findings.
■ Stay with the person until they are fully recovered.
■ they faint without a noticeable cause (e.g. emotion, heat or severe pain);
■ they faint often.
165
4. Illnesses
Technique - Physical countermeasures to prevent fainting
■ Sit on the edge of a chair or bed with your head bent forward between your knees.
Hold this position as long as possible or until your symptoms disappear.
■ Squat. Hold this position as long as possible or until your symptoms disappear.
■ Hold your hands by hooking your fingers and pull them without letting go. Hold
this grip as long as you can or until your symptoms disappear.
166
■ Cross one leg over the other and squeeze the muscles in your legs, abdomen and
buttocks. Hold this position as long as possible or until your symptoms disappear.
■ If you feel you cannot prevent fainting, lie down to avoid falling down.
Prevention of feeling faint
■ Avoid stress, tiredness, hunger and standing for long periods.

■ Do not stand up quickly from a lying or sitting position.
■ Drink enough water and avoid physical exertion when you are in a hot environment
for a long period of time.
167
4. Illnesses
4.2 Fever
Fever can be caused by various medical conditions ranging from non-serious to life-
threatening, including infections and non-infectious causes (e.g. severe injuries and side
effects of medication). Any person with a fever needs medical attention to determine
the cause.


■ may have a warm forehead;
- If you have a thermometer and know how to use it, put a thermometer under the
person’s armpit. The person has a fever if their temperature is higher than 37.5°C.
■ experiences coldness, but feels warm to the touch. They may sweat, but shiver,
have goose bumps and chattering teeth;
■ feels unwell and may have a headache;
■ may experience muscle pains;
■ may show signs of dehydration (see: p. 179).
■ In children under 5 years of age, febrile fits can occur as a result of a rapidly developing
fever (see: p. 176).
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STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the ill person:
■ cannot drink or take medication;
■ vomits a lot or has diarrhoea (see: p. 177);
■ shows signs of dehydration (see: p. 179);
■ has a headache;
■ is sleepy, difficult to wake up or confused;
■ cannot stand or sit up, or is a baby who is too weak to keep itself straight when
carried;
■ has difficult, rapid, wheezy or crackly breathing;
■ is bleeding spontaneously.
■ Pay attention to how the ill person is dressed. Dressing too warm can increase the
fever, dressing too lightly can cause shivering. Remove excess clothing from a person
with a fever, but pay attention to their comfort.
■ A person with a fever needs to rest and drink lots of fluids to prevent dehydration (see:
p. 179). This is an exception to the fourth principle of first aid (see: p. 12).
■ Give the person more to drink if the colour of their urine is dark or if they do not
urinate often.
■ Breastfed babies should breastfeed more frequently than usual. Bottle-fed babies
should be given extra rehydration drinks in addition to their normal feeds.
■ If the person must travel for help, keep giving them sips of drinks on the way there.
169
4. Illnesses
■ Sponge the person with lukewarm clean water (e.g. drinking water, boiled and cooled
water), unless it upsets them or causes shivering. Do not use cold water.
■ Have the person take anti-fever medication, like paracetamol, if they want. Have them
follow the instructions and doses on the package leaflet.
■ If a child with a fever has a fit, provide first aid as in febrile fits (see: p. 176).
■ Arrange medical attention for the person. Every person with a fever needs medical
attention to determine the cause. Medical care is especially important for babies,
children and pregnant women with a fever.
■ Have a relative of the person keep an eye on the person, day and night. Advise them to
get up two or three times in the night to check on the ill person’s condition.
Prevention of fever
■ Adhere to your local government’s vaccination programme. Get a vaccine against

several infectious diseases such as measles, tetanus, polio, meningitis, tuberculosis,
diphtheria, hepatitis B, haemophilus influenzae B and whooping cough.
■ Wash your hands after taking care of or having contact with an ill person.
■ Children and pregnant women should have as little contact as possible with
someone with a fever.
■ If you have a fever, cough into a tissue and always wash your hands carefully
afterwards. If no tissues are available, cough into your elbow rather than into your
hand, because illnesses are spread easily by hands.
170
4.2.1 Malaria
Malaria is an infectious disease caused by parasites, entering a person’s body through a
mosquito bite. Fever caused by malaria can be very dangerous when left untreated.

■ has been in a region where malaria occurs;
■ may have fever (see: p. 168);
■ may have abdominal pain, nausea and loss of appetite;
■ may have a headache;
■ may cough;
■ may be dizzy or tired;
■ may have muscle pains.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care when a person who has
been in a malaria risk area complains of severe headaches.
■ If the person has a fever, provide first aid as in fever (see: p. 168).
■ Arrange medical attention for the person. Every ill person with suspected malaria
needs medical attention.
171
4. Illnesses
Prevention of malaria
The prevention of malaria consists in avoiding mosquito bites:
■ Avoid or drain stagnant water in unused ditches and water holes. Dispose of waste
that can hold water. Maintain a clean environment around your home.
■ Wear long-sleeved clothes and especially cover your feet, as mosquitos normally
bite closer to the ground.
■ Stay inside the house after sunset, because the mosquito that causes malaria is
most active between sunset and sunrise. Close windows and doors before sunset.
■ Sleep under a (preferably insecticide-treated) bed net. This is especially important
for pregnant women and children under 5 years of age. Use the bed net as
instructed by the provider.
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4.3 Fits
During a fit, the ill person suddenly starts to shake uncontrollably. It is different to normal
shivering and trembling. It may manifest in all limbs or in just a single limb.
Fits may be caused by:
■ epilepsy;
■ a rapidly developing fever (see: p. 168);
■ malaria (see: p. 171);
■ a severe head injury (see: p. 132) or brain damage;
■ alcohol or drug abuse;
■ heart problems.
■ During the fit:

■ Remove objects that could hurt the person, or move the person to a safe place.
■ If possible, put something soft under the person’s head if they are lying on the
ground.
■ Do not try to restrict the person’s movements.

■ Do not put anything in their mouth.
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4. Illnesses

■ may experience strange sensations before the actual fit occurs:
- seeing flashes of light;
- hearing a murmur;
- having a strange taste in the mouth.
■ may suddenly shake uncontrollably;
■ may urinate or defecate without control;

■ may lose consciousness (see: p. 36);
■ may have blue lips and finger- and toenails;
■ may roll their eyes.
■ When the fit stops:
■ Remove the soft object from under the person’s head.
STEP 3: Seek help
■ it is the person’s first fit;
■ there is more than one fit and the person does not wake up between the fits;
■ the fit lasts longer than 5 minutes;
■ no bystander is aware of the person suffering from epilepsy;
■ they have a fever (see: p. 168);
■ the have hurt themselves during the fit;
■ they are under the influence of alcohol or drugs;
■ the person is a child, is pregnant or has diabetes;
■ you are in doubt.
174
■ Make sure that the ill person can breathe freely. Loosen tight clothing.
■ Put the person into recovery position (see: p. 37).
■ If the fit was caused by fever, provide first aid as in fever (see: p. 168).
■ Make sure the person can recover in a quiet environment. Provide assistance to make
them comfortable (freshen up, change clothes, etc.). Stay with the person and talk
calmly, until they have recovered.
■ The person may feel sleepy after the fits. Have them rest, put them preferably in
recovery position (see: p. 37).
■ A fit can be a sign of a serious illness. Anyone who has a fit and is not known to have
epilepsy, needs medical attention.
Good to know! - Fits
■ The person cannot swallow their tongue during the fit. They might bite their
tongue, but this normally heals in a few days.
■ Putting an object or your finger in the mouth of someone having a fit is dangerous
for the ill person and yourself. Do not force anything between the person’s teeth.
175
4. Illnesses
Good to know! - Febrile fits
In children under the age of 5, febrile fits can occur as a result of a rapidly developing
fever (see: p. 168).
■ Follow STEP 1 in Fits.
STEP 2: Assess the child’s condition
■ Follow STEP 2 in Fits.
STEP 3: Seek help
■ In addition to STEP 3 in Fits, call for help and arrange urgent transport to
medical care when the child has more than one fit.
■ In addition to STEP 4 in Fits, remove the child’s clothes and any warm
bedding.
176
4.4 Diarrhoea
Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or
more frequent passage than is normal for the individual). Frequent passing of formed
stools is not diarrhoea, nor is the passage of loose ‘pasty’ tools by breastfed babies.
Diarrhoea is usually caused by an infection, possibly caught by the ill person by:
■ not washing their hands;
■ contact with stools;
■ drinking contaminated water;
■ eating unsafe food, such as fish that was caught in polluted waters, food that has not
been kept cold or has gone bad, or food prepared with contaminated water.
Diarrhoea can cause dehydration (see further), as too many fluids and nourishing
substances leave the body too fast. If diarrhoea is not treated in time, bodily functions
can be seriously disrupted, causing serious harm to the body of the ill person. Babies and
children are most at risk.

■ passes loose, thin or watery stools;
■ experiences a frequent urge to pass stools and could have trouble keeping it under
control;
■ may have abdominal cramps and a swollen stomach;
■ may have a fever (see: p. 168);
■ may show symptoms of dehydration (see further).
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the ill person:
■ is extremely sleepy, or has difficulty waking up or confusion;
■ shows signs of cholera (see: p. 186);
■ shows signs of dehydration (see: p. 179);
■ shows signs of shock (see: p. 72).
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4. Illnesses
■ Help the ill person to move to the sanitary facilities.

■ Prevent dehydration (see further). This is an exception to the fourth principle of first
aid (see: p. 12).
■ At the first sign of diarrhoea, give the person plenty to drink. Avoid the use of
alcohol and dairy milk.
■ Buy rehydration drinks in sachets from the pharmacy. Use these oral rehydration
solutions (ORS) according to the instructions mentioned on the package or by the
seller.
■ If an ORS is not available in the pharmacy, prepare a rehydration drink yourself (see
further).
■ If making an ORS is unfeasible, give the person apple juice, coconut water or water.
■ Each time the person passes diarrhoea, they must drink to replenish the fluid they
lost:
- Children under 2 years old: between a quarter and half a large cup of fluid (50-
100 ml).
- Children from 2 to 10 years old: between half
and a full large cup of fluid (100-200 ml).
- Older children and adults: at least 1 large cup
of fluid (200 ml).
■ If they vomit, wait for 5-10 minutes before
giving another drink. Use a spoon to give the
drink more slowly.
■ A person with diarrhoea should continue to
eat, if possible:
- Breastfed babies: administer an ORS in
addition to more frequent breastfeeding.
- Bottle-fed babies: administer an ORS in
addition to continuing with normal feeds. The
ORS should not be mixed with the formula.
- Older children and adults: eat as soon as they
feel like it, but spicy food, alcohol and strong
coffee should be avoided.
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■ If the person also has a fever, provide first aid for fever (see: p. 168).
■ their stools do not improve after 2 days;
■ the have blood or pus in their diarrhoea;
■ they vomit or cannot drink;
■ they take important medication;
■ the person is a child, a pregnant woman or an elderly person.
Good to know! - Dehydration
Dehydration is a shortage of fluids in the body. It occurs when the loss of bodily
fluids exceeds the uptake of fluids. Dehydration occurs when an ill person loses a lot
of fluids through sweating, vomiting or diarrhoea. Also, in warm or humid weather,
or during prolonged physical effort, fluid loss through sweating could cause
dehydration when the person does not drink enough water.
Suspect dehydration when a person:

■ is thirsty and has a dry mouth;
■ urinates less, or the colour of the urine darkens;
■ feels weak and ill;
■ has a headache;
■ their skin is not very elastic;
■ You can check this by pinching the skin on the person’s arm. In well-hydrated
people, the skin should spring back into place within a second or two. When it
takes longer for the skin to return to its usual position, this could be a symptom
of dehydration.
■ is a baby crying without tears and with dry nappies for a longer period of time
than normal.
179
4. Illnesses
Technique - Homemade ORS

Wash your hands before preparing the ORS.
Maize ORS
1. Mix 60 grams of maize flour (2 fistfuls) with 1 litre of clean water (e.g. drinking
water, boiled and cooled water).
2. Add 2 pinches of salt and mix well.
3. Cook the solution on a fire. Stir the solution continuously until it boils.
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Rice ORS
1. Mix 60 grams of rice powder (2 fistfuls) with 1 litre of clean water (e.g. drinking
water, boiled and cooled water).
2. Add 2 pinches of salt and mix well.
3. Cook the solution on a fire. Stir the solution continuously until it boils.
181
4. Illnesses
Prevention of diarrhoea
General hygiene
■ Wash your hands:
■ before and after providing first aid or taking care of an ill person;
■ before preparing food, after touching raw meat and before eating;
■ before breastfeeding;
■ after blowing your nose, coughing or sneezing;
182
■ after using the toilet, changing a baby or having contact with others’ faeces;
■ after touching garbage;

■ after touching an animal, animal feed or animal waste.
■ Throw away stools in the toilet or latrine. Also throw away the water used for
washing children after defecation.
■ Keep toilet areas away from water sources and water storage places.
183
4. Illnesses
Kitchen hygiene
■ Clean cooking and eating materials immediately after eating and let them dry on
a rack. Wash kitchen utensils immediately after they have been in contact with
raw meat.
■ Ensure that your food is completely cooked, especially when you prepare meat
or eggs.
■ Keep your household clean at all times.
■ Eating fruits and vegetables regularly reduces the risk of diarrhoea. Peel or wash
fruit and vegetables with clean water (e.g. drinking water, boiled and cooled
water) before eating.
■ Do not eat fruit or vegetables that have been partially eaten by animals.
■ Store food (including leftovers) carefully. Cover it and keep it in a cool, clean and
dry place (preferably in a fridge).
■ Do not eat spoiled or foul-smelling food.
■ Avoid eating food if you are not sure whether it has been safely prepared.
Water
■ Use fresh, not stored, clean water (e.g. drinking water, boiled and cooled water)
to prepare baby food or food for young children. If no fresh water is available, use
clean water stored in clean pots with a narrow mouth and lid at the top or a clean
jerrycan. Always close the lid after filling the water storage container.
■ Jerrycans that once contained petrol, paraffin or a chemical should not be used
for water storage.
■ Always drink water from a clean glass or container.
■ Do not use water from shallow wells or other open sources that are open to
contamination by animals, humans or waste. Use water from a protected source,
like a piped supply, borehole, protected well or spring, or rain water collection. Be
aware that this can still be unsafe. If there are rumours that these sources are not
safe, disinfect the water using the following techniques.
184
■ Unsafe or cloudy water should first be filtered with a clean cloth.
■ Then, disinfect the water using one of the following methods:

- Let the water boil (and bubble) for at least 1 minute. Let the water cool down
before consumption.
- Ceramic and biosand filtration. Carefully read and follow the manufacturer’s
instructions for the water filter you intend to use.
- Using a product like chlorine or a flocculent/disinfectant powder. Follow the

manufacturer’s instructions on the label or in the package.
- Solar disinfection.
185
4. Illnesses
4.4.1 Cholera
Cholera is a severe intestinal infection that is caused by consumption of food or water
that contains cholera bacteria. These bacteria are found when sanitation is poor or
water is dirty. Regions where basic infrastructure is disrupted, and water and sanitation
provisions have been destroyed, are particularly vulnerable to cholera outbreaks.
In the case of a cholera outbreak, always follow the authorities’ public health advice to
reduce the spread of the disease!
■ Severe cholera is characterised by a sudden onset of acute rice-water diarrhoea

(watery diarrhoea containing whitish flecks) and can lead to severe dehydration.
STEP 3: Seek help

■ Present any person you suspect to have cholera to a health facility, or notify the
Ministry of Health’s toll-free line 0800100066.
■ Provide first aid as in diarrhoea (see: p. 177).

186
4.5 Rash
Many medical conditions present with a rash. These conditions can range from mild and
harmless skin irritation to serious illnesses. Rashes can be caused by:
■ allergies, for example to food, medicines, insect stings, metals;

■ skin diseases, irritation or poor personal hygiene;
■ potentially life-threatening infectious diseases:
■ Measles is a highly contagious viral disease, which affects mostly children. It is
transmitted via droplets from the nose, mouth or throat of an infected person. This
rash is usually red, starts on the forehead and face and spreads downward. The rash
is accompanied by a fever or sore throat. Measles is a vaccine-preventable disease.
■ Meningitis is a highly contagious bacterial disease with high mortality. It can be
transmitted through saliva and occasionally through close, prolonged general
contact with an infected person. Rashes caused by meningitis show as red or purple
discoloured spots on the skin. The spots are caused by bleeding underneath the
skin. Meningitis is a vaccine-preventable disease.
4.5.1 Measles
■ Keep the ill person away from other people, especially unvaccinated pregnant women,
children and babies.
187
4. Illnesses

■ has reddish-brown, slightly swollen spots on their forehead, which spread
downwards over the body. The rash can be difficult to see on dark skin; look for
roughness on the skin;
■ has red spots with small white dots on the inside of the mouth;
■ has a high fever that lasts 4 to 7 days (see: p. 168);
■ has a runny nose, may have a cough and red, watery eyes.
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the ill person shows
serious symptoms (e.g. breathing difficulties or unconsciousness) or when their
condition deteriorates.
■ Isolate the ill person from others.

■ When they have irritated eyes:
■ have them rest in a semi-dark room;
■ dab their eyes with lukewarm, clean water (e.g. drinking water, boiled and cooled
water).
188
■ Always arrange medical attention for the person when you suspect measles.
Prevention of measles
■ Measles is a vaccine-preventable disease. Contact a health worker to ask about

the measles vaccination. Like people who have already had measles, vaccinated
children are extremely unlikely to get measles.
■ People who had contact with the ill person should avoid contact with vulnerable
people. Unvaccinated young children are at highest risk of measles and its
complications, but unvaccinated pregnant women are also at risk.
■ Keep children with measles away from other unvaccinated babies, children and
pregnant women for at least 5 days after the rash has disappeared, to prevent
them from getting ill too.
189
4. Illnesses
4.5.2 Meningitis
■ Keep the ill person away from other people.

■ may have a rash of red or purple spots. These spots do not disappear when you
press on them with a glass. The rash can be difficult to see on dark skin; look for
roughness on the skin;
■ may suddenly develop:
- an intense headache;
- a fever (see: p. 168);
- nausea and vomiting;
- neck stiffness;
- sensitivity to bright light;
■ may have diarrhoea (see: p. 177);
■ may experience muscle pains;
■ may have stomach cramps;
■ may be sleepy and difficult to wake;
■ may have fits (see: p. 173).
190
STEP 3: Seek help
■ Call for help and arrange urgent transport to medical care if the ill person shows
serious symptoms (e.g. breathing difficulties or unconsciousness) or when their
condition deteriorates.
■ Isolate the ill person from others.

■ If the person has fits, provide first aid as in fits (see: p. 173).
■ Always arrange medical attention for an ill person when you suspect meningitis.
Prevention of meningitis
■ Meningitis is a vaccine-preventable disease. Contact a health worker to ask about

the meningitis vaccination.
■ If there is an outbreak of meningitis in your region, stay away from crowded

places.
191
4. Illnesses
4.6 Low blood sugar

Diabetes mellitus, or diabetes, is a disease in which the processing of sugars in the body
is disturbed. People with diabetes can keep it under control with a low-sugar diet and, if
necessary, medication. But many people are unaware they have the condition.
A possible consequence of diabetes is low blood sugar (hypoglycaemia). In hypoglycaemia,

the person’s body does not have enough sugar to function normally. But hypoglycaemia
can also occur in people who are not known to have diabetes.

■ experiences dizziness, faintness (see: p. 164) or hunger;
■ may know they are diabetic;
■ may be sweaty;
■ may show nervous or abnormal behaviour (changing mood, aggression, confusion,
loss of concentration);
■ may show signs similar to a stroke (headache, impaired vision, etc.) (see: p. 55).
STEP 3: Seek help
■ the ill person shows serious symptoms (e.g. unconsciousness) or when their
condition deteriorates;
■ your actions are not helping sufficiently.
192
■ Try to find out whether the ill person suffers from diabetes. If possible, have the
person take their blood glucose readings.
■ If the person is fully conscious and able to swallow:
■ Give them a glucose tablet or powder, a sugary drink or sugary food. Provide more
sugary food after 15 minutes, until they start to recover.
■ When they start to recover, give them more substantial food with sugar (e.g. bread
with jam or honey, banana, pineapple, cooked sweet potatoes or porridge).
■ This is an exception to the fourth principle of first aid (see: p. 12).
■ Arrange medical attention when the person:

■ is more frequently hypoglycaemic than usual;
■ does not feel the hypoglycaemia coming (anymore).
■ Stay with the person until they are fully recovered or until they receive medical care,
when urgent transport to medical care is needed (see STEP 3).
193
194
5 The first aid kit
When deciding on the contents of a first aid kit (e.g. for at home), always follow the
advice of your national Red Cross/Red Crescent society. Try to include items that can
serve multiple purposes (e.g. gauzes and bandages have more purposes than an eye
bandage). We recommend including these useful items (and their alternatives) in your
home first aid kit:
■ Disposable gloves
■ Suitable alternative: clean plastic bags
195
5. The first aid kit
■ Surgical mouth mask

■ Suitable alternative: cloth mask
■ Adhesive plaster and tape
■ Sterile wound dressing
■ Splints
■ Suitable alternative: sticks and towels
196
■ Roller bandages
■ Suitable alternative: strips of clean cloth or a necktie
■ Triangular bandage
■ Suitable alternative: bandana
■ Eye pads
■ Cold pack
■ Burn cream (e.g. aloe vera cream or vaseline).

■ Safety pins
197
5. The first aid kit
■ Scissors (scissors with rounded ends are safest)
■ Tweezers
■ Note pad and a pen
198
■ Face shield or pocket mask for CPR
■ Flashlight
Keep these items in a secure container to keep them clean and dry.
199
200
6 The human body,
an introduction
to anatomy
and physiology
The human body consists of a number of systems, which work well together in normal
circumstances. But when one of those systems fails, the whole body can be at risk.
Therefore, it is useful to know how the body works and how diseases and disorders occur.
In this chapter the anatomy and physiology of the human body will be briefly explained
in ‘How does it work?’.
All the mentioned first aid situations will be elaborated in the chapter ‘What can
go wrong?’. For each first aid topic, this chapter will provide you with background
information.
201
6. The human body, an introduction to anatomy and physiology
6.1 How does it work?
6.1.1 The vital functions

The vital functions are a number of the body’s functions that are essential to keep the
person alive. There are three basic vital functions: consciousness, breathing and circulation.
All three functions are closely related to each other. Impairments in consciousness can
have a negative impact on the proper functioning of both breathing and circulation.
Circulatory disorders, in turn, have unfavourable effects on consciousness and breathing.
Breathing disorders can lead to loss of consciousness and inadequate circulation.
The life-sustaining processes within body cells are called metabolism. All the cells in the
body need a constant supply of oxygen (O2), present in inhaled air, to convert the ‘fuel’
in our food into energy. The functioning of the body is seriously compromised if there
is an inadequate supply of oxygen or when not enough carbon-dioxide (CO2), the waste
product of the metabolism within the cells, is removed. All of the three vital functions
-consciousness, breathing and circulation- play an essential role in delivering oxygen to
the bodily cells. Each of these functions are managed by a specific system, called the
nervous system, the respiratory system and the circulatory system.
The nervous system controls all the processes in the body (e.g. consciousness and the
functioning of the heart, lungs, digestive system and muscles). The respiratory system is
responsible for the uptake of oxygen by the body and the removal of carbon dioxide. The
circulatory system is responsible for transporting blood containing oxygen and nutrients
to the cells and for removing waste materials. If any of these systems are not working
properly, a life-threatening situation can occur.
202
6.1.1.1 The nervous system
The nervous system controls all the processes in the body (e.g. body movements and organ
functions) and enables the body to perceive stimuli through the senses (see: p. 218), and
process them. The nervous system consists of the brain, spinal cord and nerves.
The brain
The brain, safely nestled in the skull, is responsible for managing the body. In order to
carry out its task, the brain receives the necessary information collected and transmitted
by the nerves. Based on this information, the brain regulates the functioning of the
body and adjusts it if necessary. Certain tasks are associated with specific locations in
the brain. The brain consists of three major parts: the cerebrum, the cerebellum and the
brain stem.
■ The cerebrum is the largest part of the brain.
It controls conscious movements and creates
thoughts and emotions.
■ The cerebellum is involved in the coordination
of movements by processing sensory stimuli
and information from the balance organ (see:
p. 218).
■ The brain stem is a part below the brain that
connects the rest of the brain to the spinal
cord. The brain stem regulates important
but involuntary functions, such as heart rate,
breathing, blood pressure, swallowing and the
cycle of sleeping and waking up.
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The spinal cord

The spinal cord hangs down like a tail from the
brain stem and is located in the spinal column,
a hollow tube consisting of a sequence of
vertebrae united by intervertebral discs. The
spinal cord sends information to and from the
brain and coordinates some of the unconscious
movements, called reflexes.
A reflex is the body’s immediate reaction to a

stimulus, without any instruction being issued
by the brain. The information about the stimulus
is still sent to the brain and processed there,
but before the information reaches the brain,
the reflex has already occurred ‘automatically’.
Most reflexes have a protective function, such
as the automatic contraction of the hand and
arm muscles when there is a pain stimulus in the
hand.
The nerves
Nerves can be found everywhere in the body.
All the nerves make up an extensive network
throughout the body, terminating in the
muscles, the skin and all the organs. Nerves
send information from the whole body, through
the spinal cord to the brain, and transmit orders
from the spinal cord and brain to the rest of the
body.
Some nerve cells have specialised nerve endings (receptors). These are able to register
information from the sensory organs (see: p. 218). They register perceptions of
vision, hearing and smell, but also general perceptions such as temperature, pain and
information about the functioning of the body (e.g. blood pressure and oxygen levels in
the blood).
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6.1.1.2 The respiratory system
The cells of the human body need oxygen (O2) to function. The respiratory system inhales
atmospheric air and withdraws oxygen from it, to fulfil the oxygen needs of the body.
The respiratory system consists of the respiratory centre, the airways, the lungs and
the respiratory muscles.
The respiratory centre

Breathing is controlled by the respiratory centre, which is located in the brain stem (see:
p. 203). This part of the brain allows the human body to breathe automatically. This is why,
under normal circumstances, we do not have to think about breathing in order to breathe.
The airways
The main function of the airways is to carry air from outside the body to the lungs. The
airway consists of upper and lower airways.
The upper airway includes the nasal and oral cavities, the pharynx, the larynx (voice
box) and the beginning of the windpipe (trachea), and is above the chest.
The nasal and oral cavities can be closed off from the throat cavity by the uvula, the
visible valve in someone’s mouth. The uvula is important for swallowing and articulating
many speech sounds. At the top of the larynx is the epiglottis, a valve which closes off
the larynx when swallowing. The vocal cords are located within the larynx. As well as
conveying air, the upper airways have other functions.
■ In the nasal cavity, dust particles are caught and the air is warmed and moistened. The
top of the nasal cavity enables odours to be perceived.
■ The vocal cords are situated within the larynx. By making the vocal cords vibrate when
exhaling, sounds are produced.
■ The oral and throat cavities serve as a route for the digestive system. As the beginning
of the airway and the oesophagus are located close to each other, food can end up in
the trachea accidentally. The epiglottis closes off the airway when food is passing into
the oesophagus, preventing the aspiration of food.
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The lower airways are mostly located inside the chest cavity. They consist of the rest of
the trachea, two large airway branches (bronchi) and numerous small airway branches
(bronchioles). Inhaled air flows through the two bronchi, which go to the left and right
lung respectively, and then flows into progressively smaller bronchioles.
The lungs
The lungs are two large organs occupying half of the chest cavity on either side of
the heart. The lungs mostly consist of hollow cup-shaped cavities at the end of the
bronchioles, called alveoli. Alveoli are made of a very thin membrane and surrounded by
a network of thousands of tiny blood vessels, called capillaries (see: p. 210). The alveoli
fill with air when the person inhales.
The ribs and the respiratory muscles

The main muscles that are responsible for breathing are the diaphragm and the muscles
between the ribs (intercostal muscles).
■ The diaphragm is a dome-shaped muscle. The diaphragm contracts when inhaling,
causing the chest cavity to enlarge. When exhaling the diaphragm relaxes and the
chest cavity becomes smaller.
■ The ribs surround the lungs and are joined together at the front by the breastbone
and at the back by the spinal column. Intercostal muscles connect the different ribs
together. When these muscles tense, the chest cavity enlarges. When these muscles
relax, the rib cage returns to its original position causing the chest cavity to return to
its normal size.
■ There are also accessory muscles of respiration in the chest, neck and back. These
muscles start tensing when the person experiences breathing difficulties (e.g. when
the airways are obstructed or in shortness of breath).
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How the respiratory system works
When the respiratory centre initiates an inhalation, the diaphragm and intercostal
muscles contract. This causes the rib cage, and thus the chest cavity, to expand. Since
the lungs stick to the inside of the ribcage, the lungs will expand as well. This will create
negative pressure inside the lungs. This negative pressure draws the atmospheric air
through the airways into the lungs. This process is called inhalation.
The inhaled, oxygen-rich, atmospheric air will fill the alveoli. In the alveoli and their
surrounding capillaries, gas exchange occurs.
The oxygen in the inhaled air can pass, through the alveoli’s very thin membrane, from
the alveoli into the blood through the capillaries. This way, oxygen is absorbed into
the blood while, at the same time, carbon dioxide (CO2) passes from the blood into the
alveoli. Afterwards, the freshly oxygenated blood travels through the circulatory system
(see further) to the rest of the body. Oxygen-deficient and carbon dioxide-rich blood
returns after its journey through the body to the lungs, where it picks up oxygen and
releases carbon-dioxide again.
When this gas exchange has taken place, the respiratory centre loosens the respiratory
muscles. The chest cavity will return to its normal, smaller state, pushing the carbon
dioxide-rich air out of the lungs. This process is called exhalation.
6.1.1.3 The circulatory system

Blood transports oxygen and nutrients to the body cells, and carries waste substances
(e.g. carbon dioxide) away from the cells, through the blood vessels. When the circulatory
system functions poorly, a possibly life-threatening situation develops. The circulatory
system consists of the heart, the blood vessels and the blood.
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The heart
The heart is a muscle that continuously pumps blood around the body. When the heart
contracts, blood is pushed along the blood vessels. The heart is the size of a fist and is
located centrally between the breastbone and the spinal column, slightly towards the
left side of the body.
The heart has a left and a right side, each consisting of an atrium (small chamber) and
a ventricle (large chamber). The right atrium receives oxygen-deficient blood from
the whole body. The blood passes from the right atrium into the right ventricle, from
where it is pumped through the arteries and capillaries to the lungs. There, the blood is
replenished with oxygen (see: p. 211). From the lungs, the oxygen-rich blood goes to the
left atrium of the heart. From this atrium, the blood passes into the left ventricle, from
where it is pumped to the rest of the body.
Heart valves lie between the atrium and the ventricles and also between the ventricles
and the exiting blood vessels. They ensure that the blood can only flow in one direction.
The heart needs oxygen to function. The heart muscle is supplied with oxygen through
the coronary arteries.
The heartbeat (each time the heart contracts) is mostly determined by a sinus node.
This node emits electrical signals causing the heart muscle to contract. The sinus node is
influenced by the nervous system (see: p. 203). Generally, an adult has a heartbeat of 60
to 80 beats per minute. In a child, this is 80 to 120 per minute. During physical effort the
heart beats faster.
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When the heart contracts, blood is pushed from the heart into the arteries.
When the heart relaxes, blood is drawn into the heart from the veins.
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Blood vessels
Blood vessels connect the heart to the rest of the body. They carry blood from the heart
through the whole body before returning it to the heart again. Blood vessels can be
subdivided into arteries, capillaries and veins.
Arteries are the blood vessels that take blood from the heart to the rest of the body.
They have a thick, elastic wall, enabling them to expand and contract. Each time the heart
muscle contracts, blood is forced away from the heart through the arteries. This is called
the pulse, which can be felt in the arteries. From the large arteries, the blood flows into
smaller and smaller arteries and ultimately ends up in the capillaries.
Capillaries are very tiny blood vessels forming a network linking the arteries and veins
to the organs. In the capillaries, the blood releases oxygen and nutrients into the bodily
cells through the very thin capillary walls. At the same moment, the blood absorbs carbon
dioxide and other waste substances from the bodily cells through the capillary walls.
After passing the organs, capillaries merge back into larger blood vessels, the veins.
Veins are the blood vessels through which blood (containing carbon dioxide and other
waste substances) from the various parts of the body is brought back to the heart. They
have thinner and less tough walls compared to arteries. In veins, no pulse can be felt.
Blood
Blood transports all kinds of substances (e.g. oxygen, carbon dioxide, nutrients, but also
waste materials) in the body, through the blood vessels. Blood consists of plasma and
blood cells.
■ Plasma is a fluid in which, among other things, nutrients and waste substances are
dissolved.
■ Blood cells are subdivided into red blood cells, white blood cells and platelets. Red
blood cells are responsible for carrying oxygen, white blood cells provide defence
against infections, and platelets are involved in blood clotting.
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How the circulatory system works
1. Oxygen-deficient and carbon dioxide-rich blood is pumped from the right side of
the heart to the lungs, where it is replenished with oxygen, and carbon dioxide is
removed.
2. The blood, replenished with oxygen, flows from the lungs to the left side of the heart.
3. The oxygen-rich blood is pumped from the heart through the body.
4. Bodily cells absorb the oxygen from the blood and emit carbon dioxide into the blood.
5. Oxygen-deficient and carbon dioxide-rich blood flows back to the heart.
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6.1.2 The musculoskeletal system

The musculoskeletal system is the system that gives humans the ability to move, using
their skeleton and muscular system. It provides form, stability, support and movement
to the body. The musculoskeletal system consists of the skeleton, subdivided into bones
and joints, and the muscular system, consisting of muscles and tendons.
Bones
The skeleton is the internal framework of the human body, composed of over 200 bones.
The skeleton has several functions:
■ Protecting organs (e.g. the skull bones protect the brain, ribs protect the heart and
lungs, and the pelvis protects the organs of the lower abdomen).
■ Shaping the body (e.g. bones in the arms and legs ensure that the limbs remain
straight, the vertebral column allows the body to sit or stand up straight).
■ Helping body movements. Movement occurs as a result of muscle contraction. The
skeleton and joints form the passive motor system which the muscles depend on to
exert their force.
The skeleton is made up of different kinds of bones:
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■ Long bones, consisting of a shaft and two
ends. Examples of long bones are the
upper arm bone and the shin bone.
■ Short bones, which are smaller bones
without a clear shaft and ends. Examples
of short bones are the small bones of the
fingers and the spine.
■ Flat bones, which are plate-shaped.
Examples of flat bones are the skull and
the shoulder blade.
Every bone is covered in a bone membrane

which provides its blood supply, needed for
bone growth and recovery after an injury.
Bones often contain gaps or spaces in which
the bone marrow is found. Bone marrow has
an important role in the formation of blood
cells.
Joints
A joint is a place where two or more bones are joined together. In a joint, both ends of the
bone are coated in a layer of cartilage. Cartilage is softer and more elastic compared to
bones. Cartilage reduces friction and works as a buffer against impacts. Cartilage is also
a structural component of the ears, nose, and many other body components.
Examples of highly mobile joints are the elbow, knee and shoulder. Joints are only mobile
in certain directions and within a certain range. Ligaments run across the joint capsule,
strengthening the joint and providing stability.
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The muscles and tendons

A muscle consists of a large number of elastic muscle cells, woven together into bundles.
Muscles are attached to the bones by less elastic tendons.
Movement occurs as a result of muscles being stimulated. When a muscle is stimulated

by the nervous system (see: p. 203), it contracts. When the stimulus stops, the muscle
relaxes. The strength and speed of muscle contractions are controlled by the nervous
system. Every movement requires muscles that contract and other muscles which have
an opposing effect.
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6.1.3 The skin
The skin covers the entire body and consists of three layers. The upper layer of the skin
is called the epidermis. This is a thin layer of skin of which the surface is constantly being
worn away. Underneath the epidermis, the dermis can be found. The dermis contains
sensitive nerve endings, hairs and hair muscles, sweat glands and capillaries (see: p. 210).
The hypodermis is the deepest layer of the skin. It forms the transition to the underlying
tissues such as muscle tissue or the membrane covering a bone. The hypodermis contains
a large number of blood vessels, nerve fibres and fatty tissue.
The skin has various functions:

■ The epidermis protects the body against germs, sun rays, injuries and drying out.
■ Sensory nerve endings in the dermis are responsible for perception such as the sense
of touch and for perception of pain, cold and heat.
■ Different components in the dermis regulate the body temperature.
■ Fat in the hypodermis provides a backup store of fuel, for when there is a shortage of
new nutrients, forms a cushioning layer to protect deeper-lying tissues from blows or
knocks, and plays an important role in thermal insulation of the body.
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6.1.4 The digestive system

The digestive system is a series of organs responsible for the intake, digestion and
excretion of food. A human being can easily survive for a few days without food, because
stores are created of the ‘fuel’ that is needed by cells, for example in the form of fatty
tissue. However, it will certainly be necessary to consume nutrients in order to survive in
the longer term. The digestive system consists of organs through which food passes, but
also a number of organs that are involved in the process of digestion, but which never
contain food.
Oral cavity
Throat cavity
Oesophagus
Liver
Gallbladder Stomach
Pancreas
Small intestines
Large intestines
Anus
■ Food enters the digestive system through the mouth. In the mouth, food passes the
first step of digestion, chewing. Food is crushed and ground by the teeth and mixed
with saliva to enable more efficient breakdown further in the digestive system. After
chewing, food passes through the throat cavity to the oesophagus. The oesophagus
is about 25 cm long and runs through the middle of the chest, connecting the throat to
the stomach. Continuous movement in the oesophagus (peristalsis) pushes the food
towards the stomach.
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■ In the mouth and throat cavity, the airway and the route taken by food run in parallel.
To prevent food entering the airway, the airway can be closed off by the epiglottis
when swallowing. If food enters the airway anyway, this could cause an airway
obstruction (choking).
■ The stomach, a bag-shaped organ, is located beneath the diaphragm (see: p. 206).
The stomach is involved in the second phase of digestion. It breaks down the food by
means of enzymes and gastric acid. From the stomach, food passes into the intestines.
■ The small intestine is about 6 meters and folds many times. Most of the absorption
of nutrients and minerals from food takes place in this organ. Along the way, the liver,
gallbladder and pancreas add bile and pancreatic juice to help with the digestion of
food, but these organs never contain food. The pancreas also produces hormones,
having an important role in the sugar balance of the human body. In the small intestine,
nutrients are absorbed into the blood via the walls of the small intestine, through
thousands of capillaries (see: p. 210). These nutrients are transported in the blood
to the various cells in the body, where they are used as fuel or building materials for
cells. Through the small intestine, the processed food passes, by means of peristalsis,
to the large intestine.
■ The large intestine is the last part of the digestive system. Inside the colon, water is
absorbed from the remains of what once was food, and the remaining indigestible
material is then stored as faeces. The indigestible food residues are pushed along
through the colon to the rectum and then excreted through the anus by defecation.
Good to know! - The appendix
At the beginning of the large intestine, the worm-shaped appendix can be found.
For a long time it was thought that the appendix was a rudimentary organ that no
longer had any function. Recently scientists have found more and more evidence
that the appendix is actually a very important organ. For example, it could play a role
in maintaining intestinal flora.
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6.1.5 The senses

Humans are able to interact with their environment through their senses. The sensory
organs receive stimuli and send them to the nervous system (see: p. 203), which results
in perceptions. There are five senses: sight (the eye), hearing (the ear), smell (the nose),
taste (the tongue and the nose) and touch (the skin).
The eyes
Sight is provided through the eyes. The eyes detect light and convert it into impulses for
the nerves, which the brain processes into visual perceptions.
The eyes are located in the eye socket, a bony cavity of the skull, and are surrounded by
protective fatty tissue. The eye is also protected by eyebrows and eyelashes, to keep
dust out. Tear glands secrete a clear fluid that continually bathes the eyeball, while the
eyelids distribute the tears evenly over the eye. This fluid is drained through the tear
duct into the nasal cavity.
The eye itself has a tough outer layer, the sclera, known as the white of the eye. At the
front, the sclera is transparent and is known as the cornea. Behind the cornea, the iris
can be found. The iris separates the anterior and posterior chambers of the eye. The iris
can have different colours: blue, brown, red, grey or green. The pupil is a round opening
in the iris which can adapt to the intensity of light (like the diaphragm in a camera).
Behind the pupil, in the posterior chamber of the eye, the lens can be found. Behind the
lens, the inside of the eye consists of a gelatine-like mass, known as the vitreous body. At
the back of the eye is the retina, a nerve layer connected to the optic nerve.
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Light enters the eye through the pupil. It then passes through the lens and vitreous body
and arrives at the retina. The light-sensitive nerve endings on the retina detect light and
colour. The optic nerve sends these stimuli to the brain, which converts them into a visual
perception.
The ears
The ear consists of three parts: the outer, the middle and the inner ear.
Auditory Semicircular
bones canals
Inner ear
Cochlea
Ear
Ear canal
Ear drum
Eustachian tube
Outer ear Middle ear
■ The outer ear is formed of the pinna, made of cartilage, and the ear canal, which is
closed on the interior side by the eardrum.
■ The middle ear is connected to the nasal cavity by the Eustachian tube, which keeps
the air pressure on both sides of the eardrum equal. Three tiny ear bones (the
hammer, anvil and stirrups) transmit sound stimuli from the eardrum to the inner ear.
■ The inner ear consists of a rolled-up tube, the cochlea, which transmits sounds to
the brain via the auditory nerve. Adjacent to it are three semi-circular canals, which
control our sense of balance.
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Stapes Semicircular
canals
Incus
Malleus
Cochlea
Ear drum
A source of sound causes vibrations. These vibrations are transmitted through the air and
make the eardrum vibrate. This vibration of the eardrum passes through the middle ear
and the inner ear to stimulate the auditory nerve, which transmits the electrical signals
to the brain. The brain processes these signals into an auditory perception.
The tongue
The tongue has taste buds, containing nerve endings, on its surface; which can detect
sour, salty, bitter, sweet and umami tastes. The remainder of the tastes are detected at
the back of the palate and in the nose.
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The nose
The nose is the organ of smell. It consists of a right and a left nasal cavity, separated
by a nasal septum. In the side walls of the nasal cavity, there are three nasal turbinates
coated with a mucous membrane, located one above the other. The two nasal cavities
both open at the back into the throat cavity.
High up in the inner part of the nasal cavity is the olfactory membrane, enabling the
sense of smell. All substances that have a smell give off fine smell particles, which are
distributed in the air. The olfactory membrane receives these stimuli and sends them to
the brain, which converts them into the impression of smells.
The skin
The sense of feeling is located in the skin, but the skin has many functions besides being
a sensory organ (see: p. 215).
The term ‘feeling’ is very broad and includes feeling pain, cold and heat, hardness or
pressure and shapes. The skin is full of sensors, specialised nerve cells. There are various
types of sensors in the skin. Pain receptors (nociceptors) respond to damage or the
threat of damage to the skin. Thermoreceptors respond to changes in temperature.
Mechanoreceptors respond to mechanical stimuli; for touch sensors the stimulus is
contact, while for pressure sensors it is a change in pressure in the skin tissue. A stimulus,
sensed in these nerve cells, is transmitted to the brain, converting the stimuli into a
perception of feeling.
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6.1.6 The reproductive system

Reproduction is a process that allows the continuation of all forms of life. A new individual
is formed by the merging of two different cells: a male sex cell (sperm cell) and a female
sex cell (egg). The reproductive system comprises all the organs that are responsible for
the development and fertilisation of sex cells.
Male sex organs

Male sex organs are largely situated outside the body.
■ The penis contains the urethra, the erectile tissue, the glans and the foreskin. The
foreskin fully or partly covers the glans. The erectile bodies fill with blood at times
of sexual excitement, and as a result the penis becomes larger and stiffer (erection).
■ The scrotum contains the testes. On each testis there is a smaller structure known as
the epididymis, which is linked to the urethra by an ejaculatory duct.
The male sex cells, called sperm cells, are developed within the testis. From each testis,
the sperm cells move to the epididymis, where they can be stored for some time. During
ejaculation, fluid from the prostate and seminal vesicles is added to the sperm cells.
This mixture of sperm cells and fluid is called semen. The ejaculatory duct carries the
sperm cells to the urethra, which continues within the penis. The muscles in the bladder
ensure that urine and semen are never expelled at the same time. The semen passes
through the urethra and then leaves the body.
A sperm cell has a head (containing the man’s

genetic material), neck, body and tail. At the
time of fertilisation, the sperm cell uses its tail to
move along through the female sex organs.
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Female sex organs
Female sex organs are largely situated inside the body. The internal sex organs consist of
the ovaries, the fallopian tubes, the uterus and the vagina, all located in the pelvis.
Female sex cells, also called egg cells, are amongst the largest of all human cells. These
egg cells develop within the ovaries. The fallopian tube carries the egg cells to the
uterus (womb), a muscular organ in the woman’s pelvis. An empty uterus is approximately
the same size and shape as a pear. The cervix connects the uterus with the vagina. The
vagina creates a connection between the uterus and the outside world. Its walls are very
flexible; during childbirth its diameter can easily increase to 15 centimetres.
The external female sex organs consist of the labia, surrounding the openings to the
vagina, the urethra and the clitoris. The external female sex organs are collectively
referred to as the vulva.
Primary and secondary sexual characteristics

Primary sexual characteristics are the features that allow a male and female body to
display differences even from birth (e.g. male and female sex organs). Secondary sexual
characteristics develop under the influence of sex hormones. In a man, these include
the growth of the larynx (giving a ‘deep voice’), the development of facial hair and more
developed bones and muscles. In a woman, they include the development of breasts and
the widening of the pelvis.
How the reproductive system works

The development of sex cells begins even before birth. From puberty onwards, this
development accelerates and the sex cells mature into their active form. They initiate
the process of sexual development.
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In women, puberty begins with the onset of ovarian cycles. Several egg cells mature each
month and one egg cell is released from the ovaries under the influence of hormones.
This process is called ovulation. The egg cell is carried to the uterus along the fallopian
tube. When the egg cell stays unfertilised, it will be released together with some of the
mucous membrane from the uterus, which is the monthly bleeding (menstruation) from
the vagina.
Fertilisation of the egg cell usually takes place in the fallopian tube. The egg cell is
fertile for approximately two days. Sperm cells live for a maximum of four to six days and
travel on average 12 to 24 hours to the egg cell. During sexual intercourse, the male sex
organs release semen into the woman’s vagina, through ejaculation. Many sperm cells
die along the way, but ultimately a number of sperm cells reach the egg cell. A single
sperm cell will succeed in breaking through the wall of the egg cell. As soon as that has
happened, the wall changes its structure so that other sperm cells can no longer break
in. The egg cell has now been fertilised. A new life can now start to grow in the uterus of
the expectant mother.
In about 40 weeks (counting from the first day of the woman’s last menstruation) a
fertilised egg grows into a baby. This gestation period is divided into three trimesters:
■ The first trimester comprises the first 13 weeks of the pregnancy. In the first trimester,
the fertilised egg is pushed through the fallopian tube to the uterus (womb) where it
develops and grows by cell division. Once in the uterus, the cells continue to divide
and nestle in the thick wall of the uterus. From this moment on, two weeks after the
last menstruation, a pregnancy test can be positive. However, most pregnancy tests
are considered reliable from the first day of the missed period.
After nestling in, each cell has its own destination. The placenta and the embryo
develop, the cells of the embryo grow into the nervous system, the skeleton, the
organs, etc. In the sixth week of pregnancy, the embryo’s heart starts beating. Around
the eighth week, various body parts start to form. From this moment on, the unborn
baby is called a foetus instead of an embryo. It then has all the characteristics of a
baby, but needs to grow.
At the end of the first trimester, the foetus is about 7.5 cm tall, is recognisable as a
human being and is able to move inside the placenta. Movements of the foetus are
noticeable for the mother from about 20 weeks.
■ The second trimester covers week 14 to week 27 of the pregnancy. During this
time, the foetus continues to develop. The foetus’s body becomes larger and their
movements become more powerful. The foetus makes large movements with
their arms, legs and trunk, small movements with their hands and also breathing
movements. Furthermore, the foetus is able to perceive sounds and can distinguish
light from dark. The foetus’s genitals are clearly developed and their other organs
start to work as well.
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■ The third trimester starts in week 28 of pregnancy and ends with the delivery. During
this trimester, the foetus grows, its weight increases and a subcutaneous layer of fat
forms. Various organ functions continue to develop, such as the lungs, so that the
baby can breathe independently after birth. The skull of the foetus remains soft and
the skull bones are not yet fused, making it easier for the head to pass through the
birth canal.
At the end of the third trimester, the foetus is about 50cm tall and weighs on average
a little over 3 kilograms.
Good to know! - Female genital mutilation
Female genital mutilation (FGM) comprises all procedures involving partial or total
removal of the external female genitalia or injuring female genital organs for non-
medical reasons. FGM is internationally considered to be a violation of several human
rights of girls and women.
FGM harms girls and women in numerous ways without any health benefits. It
damages healthy and normal female genital tissue, disrupts the natural functioning
of female bodies and causes immediate and long-term complications.
Immediate complications Long-term complications

■ Severe pain ■ Urinary problems (painful urination,
■ Excessive bleeding urinary tract infections)
■ Genital tissue swelling ■ Vaginal problems (discharge, itching
and infections)
■ Fever
■ Menstrual problems (painful
■ Infections
menstruations, difficulty in passing
■ Urinary problems menstrual blood, etc.)
■ Wound healing problems ■ Scar tissue
■ Injury to surrounding genital tissue ■ Sexual problems (pain during
■ Shock intercourse, decreased satisfaction,
■ Death etc.)
■ Increased risk of childbirth
complications and new-born deaths
■ Need for later surgeries
■ Psychological problems (depression,
anxiety, post-traumatic stress
disorder, low self-esteem, etc.)
Source: Female genital mutilation (3)
If a first-aider identifies any of the mentioned complications, they should arrange

medical attention for the injured person.
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6.2 What can go wrong?
Emergencies
6.2.1 Unconsciousness
Consciousness can be defined as ‘the state of alertness or awareness, characterised by
response to external stimuli’. So, unconsciousness is a reduced alertness and ability to be
aroused, which can manifest in a variety of states. Some unconscious persons will regain
full consciousness without intervention, while others will require intensive medical
management.
A changed level of consciousness can indicate a (temporary) problem within the brain.
The level of consciousness can be lowered when the brain does not get enough oxygen
(O2). This could be the case when, e.g.:
■ someone becomes unconscious after choking;
■ a casualty loses consciousness during severe bleeding, because their brain does not
get enough (oxygen-rich) blood;
■ someone has increased pressure in the skull, e.g. caused by a head injury. This will
cause a shortage of oxygen-rich blood reaching the brain.
Besides reduced blood supply to the brain, infections of the nervous system (see: The
nervous system, p. 203), low blood sugar, too high or too low body temperature and
poisoning are, among others, causes of a change in consciousness.
While unconscious, a person loses their protective reflexes, does not respond adequately
to sensations, and their muscles slacken. When the tongue slackens, there is a risk of
the tongue sinking into the pharynx and closing off the airway (see: p. 205), making it
impossible to breathe normally. This is why opening the airway of an unconscious person
is vital.
A first aider will need to look, listen and feel up to 10 seconds to determine whether the
unconscious person is breathing normally. Looking, listening and feeling should be done
long enough because an unconscious person can breathe slowly. A first aider who does
not check the person’s breathing long enough, could wrongly assume the unconscious
person is no longer breathing. If the unconscious person’s breathing cannot be detected
within 10 seconds, it is by definition not normal.
Bodily cells need oxygen to survive. Brain cells, in particular, are very sensitive to a
prolonged lack of oxygen. Some brain cells start dying less than 5 minutes after their
oxygen-supply disappears. As a result, unconscious persons who are not breathing
normally can quickly suffer severe brain damage or death. In order to restore the
circulation of oxygen-rich blood through the body, CPR must be started immediately
when a person is unconscious and not breathing normally.
226
6.2.2 Chest discomfort
Chest discomfort can be felt in many different ways, for example, between the ribs,
behind or at the bottom of the breastbone, on one side, on both sides or in the middle
of the chest. The pain may appear suddenly or gradually. The pain can occur without a
cause or occur occasionally when exercising, coughing, moving or when pressing on the
sensitive area. With chest pain, people are always worried that it may be caused by the
heart, but there are also many other causes:
■ Chest pain caused by muscles and ribs can be felt when pressing or lying on the
sensitive area, moving and coughing. This pain is usually caused by overexertion of
the muscles between the ribs, for example, because you have to cough for days at
a time or because you have worked hard for a long time. You may also feel stabbing
pain where the ribs are attached to the breastbone. There are muscles, tendons and
cartilage, which can be irritated.
■ Chest discomfort can also occur in case of lung problems, like pneumonia, flu or
a severe cold. Breathing and coughing can hurt, and inflammation of the lung
membranes can cause sharp pain.
■ Pain behind the breastbone can also be caused by the stomach and oesophagus,
through gastric acid in your oesophagus. You will feel the pain a few hours after
eating. Especially if you lie down or bend over.
■ A feeling of tightness in the chest can be caused by stress, a panic attack or anxiety.
Chest discomfort due to the heart

If the heart is not supplied with enough oxygen-rich blood, this often causes chest
discomfort. Because the symptoms are often similar to the above forms of chest
discomfort, first aiders need to assume that a person with chest discomfort has an
urgent heart problem.
Chest discomfort due to a heart problem is caused by lack of blood supply to the heart
muscle (see: p. 208). Often, there will be a narrowing or obstruction of the coronary
arteries providing oxygen-rich blood to the heart muscle. The narrowing makes it more
difficult to supply blood, and therefore oxygen, to the heart muscle cells behind the
narrowing. This deficiency of oxygen causes chest discomfort.
Healthy
coronary artery
Heart Coronary
artery
227
Narrowing of
coronary artery
Obstruction of
coronary artery
■ During exercise, the heart muscle requires more oxygen than can be supplied by the
constricted coronary arteries, resulting in discomfort that diminishes at rest. This is
called ‘angor’. Angor does not necessarily cause permanent harm to the heart muscle.
■ A heart attack can occur both during activity and at rest, but does not pass at rest. As
a result, a part of the heart muscle receives insufficient oxygen and the functioning
of the heart is disturbed. Depending on the severity and duration of the oxygen
deficiency, (a part of) the heart muscle may die.
A heart problem often occurs unexpectedly, but is more likely to occur when risk factors
are present. Some factors are beyond the person’s control, such as increasing age,
heredity and gender (men are more at risk). Other risk factors can be influenced. Poor
lifestyle choices such as smoking, an unhealthy diet or a lack of exercise increase the risk
of having a heart problem.
228
6.2.3 Choking
Choking occurs when a person is unable to breathe, due to a constricted or obstructed
airway (see: p. 205). Choking usually occurs while the person eats or drinks, when the
food or drink accidently enters the respiratory tract. Older people as well as people with
neurological disorders choke more easily. Young children and babies, who are curious
and put lots of things in their mouths, could choke by swallowing objects such as coins
and small toys. Often, this happens in the presence of an adult taking care of the child. If
the adult knows how to react, there is a good chance that the choking will be resolved.
Coughing is a defence mechanism of the human body to solve this problem quickly and,
in many cases, it removes the obstruction. But when an object completely blocks the
airway, coughing can be insufficient. This is a life-threatening situation that requires
immediate action from a first aider.
In a mild airway obstruction, a limited amount of air can pass to the lungs. In a severe
airway obstruction, the airway is completely blocked. Due to the obstruction, the lungs
cannot deliver sufficient oxygen to the body. This oxygen deprivation will cause bodily
cells to die. In healthy persons, enough oxygen is stored in the lungs and blood to keep
the affected person alive for several minutes after breathing stops. However, when
someone is unable to take up sufficient oxygen for a longer time, it will lead inevitably
to death.
229
6.2.4 Stroke
Another word for ‘stroke’ is CVA (cerebrovascular accident). It is a collective noun for
multiple conditions in which a part of the brain receives insufficient blood and therefore
too little oxygen. This causes brain tissue (see: p. 203) to die. A stroke can happen
because of a brain haemorrhage or a blockage in the blood flow to or in the brain.
■ A brain haemorrhage is bleeding in the brain. This can occur spontaneously, or

be caused by clotting problems, high blood pressure or an injury to the head (see:
p. 252), or when a deformed blood vessel bursts open.
Brain haemorrhage
■ A blood vessel in the brain can get blocked, preventing blood (containing oxygen) to
flow through the brain. This blockage can be caused by a clot, formed in the brain or
originating somewhere else in the body. The blockage can also be caused by a drop of
fat (from the bone marrow (see: p. 213) in the event of a bone fracture) or by an air
bubble (e.g. by a medical error).
Blocked blood vessel
A stroke often occurs unexpectedly, but is more likely to occur when risk factors are
present. Some factors are beyond the person’s control, such as increasing age, heredity
and gender (men are more at risk). Other risk factors can be influenced. Poor lifestyle
choices such as smoking, an unhealthy diet or a lack of exercise increase the risk of having
a stroke.
230
Brain cells are particularly sensitive to oxygen deficiency. If there is a problem in the
blood supply to the brain, the oxygen supply and the functioning of a part of the brain is
compromised. Some brain cells start dying less than 5 minutes after their oxygen supply
disappears. To limit brain damage by resolving the cause of the stroke, it is important to
urgently transport the ill person to a medical facility. To adequately help the person, it is
important for the medical staff to have an indication of when the stroke started.
Brain damage due to a stroke
Sometimes the symptoms of a stroke occur temporarily, which is called a transient

ischemic attack (TIA). The symptoms can last from a few minutes to a few hours (most
TIAs last less than a quarter of an hour). It is impossible to distinguish a TIA from a stroke
at the time of symptoms. First aid is the same in both situations. Although a TIA in itself
has few serious consequences, it is an important alarm signal.
231
6.2.5 Poisoning
Poisoning occurs when someone comes into contact with a toxic substance. These
products can cause negative health effects when a person is exposed to a certain
quantity. Many potentially toxic products can be found in our environment; these are
often products we use on a daily basis. Toxic substances can be solid (e.g. pills or plants),
liquid (e.g. household products) or gaseous (e.g. chlorine vapours and exhaust gases).
Someone can have contact with a toxic substance by swallowing it, inhaling it, injecting
it, or touching it.
Not every toxic product is equal. The degree of toxicity plays an important role in the
severity of the poisoning: the more toxic a product is, the more serious the person’s
reaction to it. Additionally, the person’s reaction depends on multiple other factors,
such as their body weight, their metabolism, the route of administration, quantity of
the product and the duration of exposure. Toxic products can affect the nervous system,
heart, lungs, stomach, intestines, liver and skin, causing the affected person to show
many different symptoms.
When faced with a poisoned person, first aiders cannot always be sure that it is a
poisoning based on the person’s symptoms alone. Poisoning can often be assumed from
the circumstances in which the person is found (e.g. a running engine in a closed room,
empty medicine packaging, an open bottle of cleaning product or a syringe). A distinction
can be made between accidental and intentional poisoning.
■ In the case of accidental poisoning, the person is accidentally exposed to a toxic

substance.
■ In the case of intentional poisoning, the person deliberately takes certain toxic
products, often alcohol or drugs, with or without the aim of getting drunk or ‘high’.
Even in the case of intentional poisoning, first aiders should provide help when there
is a request for help or an acute health risk. However, caution is advised. A person
who does not want help may react aggressively when you insist on giving help.
Use psychological first aid techniques (see: p. 13) to convince the person to allow
themselves to be helped.
A further distinction must be made regarding the manner in which the toxic product was
taken.
■ Poisoning by ingestion occurs when swallowing a toxic product (e.g. a child accidentally
drinking household products, or when eating toxic plants). It can also occur when
ingesting an excessive quantity of a consumable product (even water).
■ Poisoning may occur by inhalation of gases (e.g. exhaust gases, chlorine vapours,
butane gas or putrefaction gases). After inhalation, the toxic gas can have an immediate
harmful effect on the respiratory tract. Because the lungs have many blood vessels,
the toxins are quickly absorbed into the blood.
■ Liquids can be injected into the body. Injections are often used by medical professionals
to administer various medications. Giving an injection is a medical act, uniquely
carried out by medical professionals or patients suffering from certain conditions
(e.g. diabetics). But injections are also used for the administration of certain forms of
drugs. This means that poisoning by injection can be a deliberate act, but can also be
an accident (e.g. in the case of an overdose of medication or drugs).
232
■ Contact (through touch or splashes) with certain poisonous products on the skin,
mucous membranes (inside the nose, mouth, vagina or anus) or in the eyes can cause
poisoning. Certain products may irritate the skin, mucous membranes and eyes, or
cause burns. Other products can cause allergic reactions (e.g. redness and itching).
Certain substances cause poisoning when they are absorbed through the skin into the
blood.
Good to know! - Carbon monoxide poisoning
■ Carbon monoxide (CO) is a colourless and odourless gas produced during

incomplete burning of organic matter (e.g. exhaust from motor vehicles, heaters,
or kerosene stoves). When CO is created and spaces are not well ventilated,
people inside the space are prone to CO poisoning. CO poisoning typically occurs
from inhaling excessive levels of CO.
■ Common symptoms include headache, dizziness, vomiting, chest discomfort and
confusion. High exposures can result in loss of consciousness, fits, cardiac arrest,
or even death.
233
6.2.6 Severe bleeding
External bleeding
In case of external bleeding, the skin, one or more blood vessels and the underlying
tissues are damaged. If an artery (see: p. 210) is damaged, blood will spurt out of the
wound, which can quickly lead to major blood loss. A person with external bleeding can
lose a lot of blood if the bleeding is not stopped in time.
Internal bleeding
In case of internal bleeding, one or more blood vessels inside the body are damaged,
but blood does not leave the body. Even if there is no external wound, there can be an
internal injury.
It is very difficult to estimate the severity of an internal bleed because there is no blood
to be seen. Some organs (e.g. the heart, liver, spleen or kidneys) contain a lot of blood
vessels and can lose a lot of blood if they are damaged. Examples of causes of internal
bleeding are crushing and severe abdominal injuries.
■ Crushing injuries happen when a body part is crushed between or under a heavy object.
It mainly occurs in traffic accidents, shipyard accidents, explosions, train accidents and
earthquakes. The force or the weight of the object can compress the blood vessels,
disrupting or stopping the blood supply to (part of) the body.
■ A heavy blow or impact to the abdomen (e.g. a trauma by a blunt object or a car crash)
can cause serious injuries to the intestines.
■ In the case of a broken hip, the loss of blood can be considerable, as sharp bone ends
can damage large blood vessels.
Shock
When someone has seen or experienced an accident and is emotionally affected by it,
the term ‘shock’ is often used in the sense of an emotional state of shock. However, in
this chapter, physical shock is described. In shock, the body’s circulatory system is not
capable of providing the body with a sufficient flow of oxygenated blood, which is a life-
threatening condition that requires urgent medical care.
Shock can have various causes:

■ low circulating blood volume, for example due to:
■ blood loss (due to internal or external bleeding);
■ loss of fluid (due to burns, excessive diarrhoea or vomiting).
■ a heart problem;
■ a generalised allergic reaction.
The total blood volume of an adult with a normal physique is about 1 litre per 13 kilograms
of body weight. If a person loses too much blood (25-30% of their total blood volume),
they may go into shock. Since shock is a life-threatening situation, it is important to act
quickly and correctly in order to limit blood loss.
234
External blood loss is quickly noticeable, causing us to think of and prevent shock more
quickly. In an injured person who is losing a lot of blood as a result of internal bleeding,
signs of shock are often the only signs of the bleeding. A first aider does not always think
of a shock because there is no blood to be seen. Nevertheless, the risk of shock in the
event of internal bleeding is as high as in the event of external bleeding.
When too much blood is lost, the oxygen supply of all tissues is compromised. As a result,
the vital functions of the body (see: p. 202) are seriously threatened. When there is too
little circulating fluid, the body will set in motion various compensatory mechanisms to
limit the consequences.
■ Blood vessels will constrict in less vital parts of the body, such as the skin (becomes
pale, cold and clammy) and the digestive system (making the person nauseous). This
allows the blood volume to flow to the organs that are necessary for survival: heart,
lungs and brain.
■ Furthermore, the body will try to retain as much fluid as possible, reducing urine
production.
■ The heartbeat will increase in order to circulate the remaining blood adequately. The
breathing rate will also speed up.
In order to treat shock, rapid intervention by medical professionals is required. The loss
of fluid and/or blood must be replenished via an infusion. If the person with shock is
not treated quickly, the situation will worsen: the blood pressure will eventually drop,
the pulse accelerates even more and becomes difficult to feel, and the person becomes
confused, drowsy and unconscious. Eventually, the person could die.
Good to know! - Cardiogenic shock
Cardiogenic shock occurs when the heart cannot pump enough blood to meet the
body’s needs. This could be caused by a severe heart attack.
Good to know! - Anaphylactic shock
A lot of people suffer allergies. But in some people, certain substances (allergens)
can cause a reaction in the blood vessels, called anaphylaxis.
As the result of exposure to allergens, capillaries dilate in various body parts. As a

consequence, the current blood volume is not sufficient to fill all blood vessels. The
person still has the same amount of blood, but it can no longer be distributed evenly,
causing vital organs to receive insufficient oxygen-rich blood.
235
6.2.7 (Near-)drowning
Drowning occurs when someone spends too much time with their mouth and nose
submerged in a liquid, usually water. The liquid closing over the person’s mouth and nose
cuts off the body’s supply of oxygen. If the person is not rescued in time, their bodily cells
become deprived of oxygen, they will lose consciousness, and their heartbeat eventually
ceases. Drowning is commonly associated with a fatal outcome, but when a drowning
person is rescued in time it is called ‘near-drowning’. In these near-drowning events, the
actions of first aiders play an important role.
In addition to the obstruction of breathing, a casualty of near-drowning could also

experience other health problems as the result of being submerged in liquid, such as
hypothermia (see: p. 237), a lung infection after inhaling polluted water, or a spinal injury
(see: p. 253) in the event of a diving accident. These factors make the condition of a
nearly drowned person more serious.
Drowning could happen when a person accidentally enters the water without sufficient
swimming skills or strength. But even people who are able to swim can get into
difficulties when they overestimate themselves, become exhausted, suffer muscle
cramps or an injury, or when strong currents arise. It is also possible that the person first
loses consciousness and then ends up in the water. Any condition that causes a loss of
consciousness can be the cause of drowning (e.g. stroke).
236
6.2.8 Temperature-related emergencies
The human body tries to maintain the internal temperature, which is the temperature of
the brain, heart, lungs and intestines, constant. This constant temperature is necessary
for the proper functioning of the body. In a healthy person, the body temperature
varies between 35°C and 37.5°C. At lower temperatures, many bodily processes slow
down, while at higher temperatures important cells can become damaged, disrupting
body processes. Thermoregulation is a mechanism by which humans maintain their body
temperature regardless of the temperature of their environment.
Hypothermia
When the body loses more heat than it produces, the body temperature drops. At a
body temperature below 35°C, called hypothermia, many processes and bodily functions
are compromised. If untreated, hypothermia could cause failure of the circulatory,
respiratory and nervous systems and eventually death.
The person’s body temperature is a parameter for the severity of hypothermia, but
is difficult to measure correctly in first aid practice. The symptoms associated with
hypothermia can also be used to determine the severity. The table below shows the
symptoms in relation to the person’s temperature.
Mild hypothermia Moderate Severe

(35°C -32°C) hypothermia hypothermia
(32°C-28°C) (<28°C)
Shivers Shivers and Reduced shivers No shivers

chattering teeth
Skin Greyish skin* Bluish skin* Bluish skin*
Breathing Fast breathing Slowed breathing Slow breathing
Circulation - Fast heart rate - Slowed heart rate - Slow, irregular

- Increased blood - Lowered blood heart rate
pressure pressure - Low blood
pressure
- Cardiac arrest
Consciousness - Exhaustion - Reduced mental Coma resembling

- Memory loss function death to effective
- Confusion - Lethargy death
- Poor judgement - Unclear speech
- Wide pupils
- Loss of
consciousness
Motor skills - Clumsiness - Muscle stiffness Absence of reflexes

- Slow movements - Reduced reflexes
and reactions
- Disturbed balance
Other Sometimes vague

symptoms such as
hunger or nausea
* Not all of these symptoms will be noticeable in a person with dark skin. 237
The distinction between degrees of hypothermia is irrelevant in the provision of first aid.
Therefore, we present two criteria that are clearer to see:
■ Is the person still shivering?
■ Is the person conscious?
Depending on the answer, the first aider will perform other actions.
■ If the answer to both questions is ‘yes’, the person can still warm themselves. The first
aider should make sure the person does not lose any more heat (passive warming).
■ If the answer to any of the questions is ‘no’, the person is no longer able to warm
themselves. In this case, the first aider will have to help them to warm up with warm
objects (active warming).
Shivering is a noticeable sign of a dropping body temperature. It is the body’s automatic

defence against cold temperatures - an attempt to warm itself. But someone with
hypothermia is often unaware of their condition because the symptoms often start
gradually. Furthermore, confusion caused by hypothermia prevents self-awareness
and can lead to risky behaviour. An initially mild hypothermia can develop into a severe
hypothermia.
Some factors can influence the development of hypothermia, such as inadequate or wet
clothing, lack of shelter, wind, medication, certain illnesses, etc. A near-drowned person
(see: p. 236) has an increased risk of hypothermia, as cold water cools the body faster
than air. Also, people under the influence of alcohol or drugs cool down fast, as their
blood vessels expand and they feel their bodies cool down less quickly. Furthermore,
they often do not take any steps to reheat themselves.
But it is mainly babies, the elderly and people with health issues who are prone to
hypothermia. Children, especially new born babies, have a large skin surface area
compared to their body volume. This makes it more difficult for them to maintain their
body temperature, because there are more places from which they can lose heat. The
elderly are more prone to cold because they have less subcutaneous fat tissue and they
are often less capable of increasing their body’s heat production.
Heatstroke/sunstroke
In order to maintain a constant body temperature of 37°C, heat must also be dissipated.
In hot environments, body heat can be released by:
■ increasing the blood circulation in the skin, which causes the skin to become flushed
and warm. This makes it possible for the body heat to be released into the environment.
■ increasing the production of sweat. Through the evaporation of sweat, heat is
extracted from the body.
If the body produces more heat than it releases, problems such as dehydration,
exhaustion, faintness and heat cramps occur. This occurs, for example, in people who
carry out extreme physical effort in a hot and humid environment, people whose heat
output does not function properly (e.g. the elderly and babies), or in the case of certain
poisonings (e.g. intoxication by drugs). These people may get a heatstroke if they are not
helped quickly. A heatstroke can be a life-threatening situation. If the heat management
is disrupted by direct sunlight on the head, this is known as a sunstroke.
238
6.2.9 Electrocution
When the human body comes into direct contact with electricity, electrocution can occur.
The body could act as a conductor of the electricity between two points (e.g. two power
cables, a power cable and its grounding, or a power cable and the earth).
■ Low voltage is referred to when there is an alternating current of less than 1000 volts,
as is the case for household appliances. In the event of an accident with low voltage,
the current passes through the body. These kinds of accidents can occur at home, for
example, when manipulating a defective and unsafe electrical device, or by pulling a
plug out of a socket with wet hands.
■ High voltage is referred to when there is an alternating current of 1000 volts or more,
as in the case of a high-voltage pylon or the overhead catenary of an electric train.
In the event of a high-voltage electrocution, the current does not pass through but
over the body. Due to the displacement of air as a result of the heat around the body,
the person can even be thrown by the high force. A high-voltage accident is always
serious. High-voltage accidents can occur when working on an electrical cabin or when
a high-voltage cable is damaged.
■ A specific form of electrocution could occur when a person is in the vicinity of a
lightning strike.
Electricity does not take the shortest route between two points but the route with the
least resistance. In the human body, this route is through the nerves, blood vessels,
muscles and skin. While some electrical injuries may look minor, there still may be serious
internal damage. Electric current causes harm in different ways:
■ Burns: When an electrical current travels through the body, it leaves a burn (see: p.
246) at the points of contact. Some electrical burns are easy to recognise, since they
look like heat burns, but the internal damage may be worse than the external injuries
suggest. Electrical burns often damage the inside of the body, which could have
serious consequences like scarring, amputation, loss of function, loss of sensation and
even death.
■ Cardiac arrest: An electrical current passing through the heart can cause cardiac
problems, since it could interfere with the nerves regulating the heartbeat (see: p.
208). This could cause the heart to start beating irregularly or possibly a cardiac
arrest (see: p. 227) at the time of the electric shock or in the hours following the
electric shock.
■ Muscle spasms: A strong electrical current going through the muscles could induce
a prolonged contraction of the muscle. The casualty may be unable to let go of the
source of the current, making the duration of the contact longer, which increases the
severity of the electrical shock. But an electrical current travelling through muscles
could cause muscles, ligaments and tendons (see: p. 214) to tear as a result of the
sudden contraction.
■ Nervous system: When nerves are affected by an electric shock, it could cause
pain, tingling, numbness, weakness, or difficulty moving a limb. These effects may
be temporary or permanent. An electrocution could also affect the spine and brain,
causing the person to be dazed or experience memory loss, seizures or respiratory
arrest.
239
6.2.10 Pregnancy – emergency child birth

Pregnancy in itself is not an emergency, but when childbirth happens in another place
or situation than planned, when no trained medical personnel are present, emergency
measures for delivery are indicated when childbirth is imminent.
After about 40 weeks of pregnancy, the foetus (see: p. 224) is ready to be born. The time
between the first signs and the actual delivery is called labour. The period of labour is
often longest for the birth of the first child. In the case of subsequent births, the labour
is usually shorter. Childbirth takes place in different stages.
■ When labour starts (dilatation phase): Labour can start in different ways. There are
contractions of the uterus (see: p. 223) which cause a painful, pressing feeling in the
lower abdomen and back of the pregnant woman. In the beginning, these contractions
feel like menstrual pains. Over time, contractions become more frequent, regular and
painful, and it becomes difficult to relax in between them.
The amniotic sac can break unexpectedly, which is not painful. Amniotic fluid (which is
clear with white flakes) can flow out in drops or gushes and cannot be stopped. These
membranes can also break at a later stage of delivery.
Regular contractions shorten the cervix. The cervix also opens until there is an opening
of 10 cm. Only then can the baby be born. In a first childbirth, this phase takes an
average of 8 to 12 hours. During this phase, the woman is allowed to walk and move
around. If the woman wants to lie down, she does this preferably on her left side.
■ The pushing stage (foetal expulsion or the birth): The contractions become more
intense. The woman in labour will feel an uncontrollable urge to push. Every time she
pushes, the foetus travels further along the birth canal until it is finally born. This
phase takes, on average, 45 minutes for a first delivery. After the head is born, the
baby’s shoulders and trunk usually follow smoothly. Sometimes childbirth does not
happen smoothly, which means that extra aids are needed for the birth (e.g. forceps,
suction cups or Caesarean section).
240
■ When the baby is born (placenta delivery or the afterbirth): Immediately after
birth, the baby is still connected to the placenta, which is still located in the uterus
immediately after birth, by the umbilical cord. The person assisting during birth will
need to cut this connection between the new born baby and the placenta. Usually
within an hour after birth, the uterus starts to contract again in order to expel the
placenta. It is important that no residue is left in the uterus, as this could cause
infection or bleeding. Therefore, the expelled placenta must always be examined
thoroughly for tears.
After birth, direct skin-to-skin contact between the mother and the new born baby
calms and relaxes both mother and baby. Furthermore, it regulates the baby’s heart
rate, breathing and stimulates digestion and interest in feeding. Skin-to-skin contact
stimulates the release of hormones in the mother that induce breastfeeding and enables
colonisation of the new born baby’s skin with the mother’s friendly bacteria, providing
protection against infection for the baby.
241
Injuries
6.2.11 Skin wounds

In skin wounds, the normal cohesion of the different skin layers (see: p. 215) is broken.
In deep skin wounds even deeper lying tissues (e.g. muscles, bones and organs) can be
damaged. Different kinds of skin wounds exist depending on the injuring mechanism,
causing skin wounds to look different, be more or less painful, and involve a lot or little
blood loss.
■ A graze is a superficial wound, where only the

epidermis is scraped off. As a result, loose skin
can be seen. A graze does not bleed profusely,
is red in colour, pointy bleeding can be seen and
there is often dirt in the wound (e.g. sand or small
stones). Grazes can be quite painful because
many nerve endings may have been injured.
■ In cuts, the skin is damaged by a sharp object

(e.g. a knife or shard of glass). In superficial cuts,
a small incision and slight bleeding can be seen,
but deep cuts often bleed heavily. In cuts, wound
edges are sharply defined. A cut is less painful
compared to a graze, because fewer nerve
endings are harmed.
242
■ A stab wound is caused by a pointy object (e.g.
a nail, screwdriver or knife). It has a small but
visible wound, but internal damage is difficult
to assess. Stab wounds usually bleed only
moderately (depending on the location) and
are not very painful. When an object is still
inside the wound, the wound is called a splinter
wound or a wound with an embedded object,
depending on the size of the object.
■ A tear wound can be seen, for example, after an

accident involving barbed wire or on an earlobe
after an earring has been torn out. The wound
edges are frayed, making healing more difficult
and increasing the risk of developing scar tissue.
Tear wounds usually do not bleed profusely, but
can hurt a lot. In older people, the skin can tear
more easily.
■ Bite wounds are caused by the bite of animals

or human beings. The bleeding and pain are
dependent on the location of the wound and the
intensity of the bite. Because a mouth contains
a lot of bacteria, bite wounds carry a high risk of
infection.
243
Wound healing
Wound healing usually occurs spontaneously. The healing of a wound takes place in four
stages, which overlap to some extent.
1. Inflammatory stage: The body’s first reaction to a skin wound is to narrow the blood
vessels to limit blood loss. Then the body clears the dead tissue and kills bacteria
that have entered the wound through wound exudate or pus. During this phase the
wound is swollen and appears red, is warm to the touch and painful.
2. Granulation stage: New bodily cells arrive in the wound. Nodes of new skin tissue
appear at the ends of the damaged blood vessels. These spread throughout a network
of fibres, and new blood vessels are formed. These blood vessels supply the new skin
tissue with oxygen and nutrients. During this stage the wound appears red and has a
granular appearance.
3. Reparation stage: The strength of the new skin tissue increases through reorganisation
of the fibres. Small bundles of muscle are formed which pull the wound edges
together. New skin cells are formed, growing towards each other from the edges of
the wound. Islands of skin cells also appear around hairs, and sweat and sebaceous
glands. These expand until they come into contact with other skin cells.
4. Scar formation: During this last phase, a scar forms. Deeper lying tissues connect
again, through connective tissue that is red, hard, thick and strong at first. As time
goes by, this tissue becomes more flexible and soft. This process can take more than
a year.
When wounds heal spontaneously, they pass through all the stages of wound healing.
At the beginning of the healing process the wound is rather moist and its edges become
softer. As time passes, the wound dries out and a scab is formed to protect the fragile
new skin tissue. Disinfecting wounds with antiseptics delays this wound process, which is
why cleaning wounds with clean water is preferred over disinfecting.
Ideally, a healing wound is neither too moist nor too dry. By providing appropriate wound
care and using the correct dressing materials, it is possible to provide an almost ideal
environment for wound healing. This causes the wound to heal faster and limits the risk
of wound infection and the formation of scars.
To allow deep wounds to heal more quickly and cleanly, a doctor may decide to close the
wound using wound closure strips, sutures or staples. A wound must be closed within a
few hours to ensure that the wound edges heal against each other. Wounds which are
contaminated with a large quantity of bacteria (such as dog bites) are usually not closed.
This is in order to be able to clean the wound often, lowering the risk of wound infection
(see further). Sutures and staples need to be removed by a medical professional.
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Infected wounds
Microorganisms, such as bacteria, viruses or fungi, can be found in every wound. These
microorganisms originate from the injured person’s skin, materials that caused the wound
or even the hands of the first aider. When these microorganisms have not yet multiplied,
or when they are recognised and removed in time, it is defined as a contamination of the
wound. The human immune system usually ensures that a contamination does not have
any negative effects on the body, but this is not always the case.
When microorganisms multiply in or on the body and cause signs of disease in the body,
it is called an infection. This can cause both local and general signs of disease. These signs
of infection can often be treated by doctors, by applying an appropriate dressing and
antibiotics. However, if the infection is minor, antibiotics are often not necessary.
Tetanus
Tetanus is a disease caused by the tetanus bacteria, which can be found everywhere (e.g.
in soil, on objects or in dirt). The tetanus bacterium multiplies in the wound and produces
a highly toxic substance, which attacks the nervous system, causing muscle stiffness and
cramps. Wounds with an increased risk of tetanus are:
■ stab wounds;
■ wounds in contact with soil or animal faeces;
■ wounds caused by rusted objects;
■ wounds with a lot of bruised tissue;
■ bite wounds.
The very first sign of tetanus is a stiffening of the jaw muscles, which is why the disease
is popularly referred to as ‘lockjaw’. Afterwards, other facial muscles contract and neck
muscles, back muscles and limbs cramp. The cramps become more severe, last longer
and longer and can be provoked by a sound or light stimulus. In further stages, the ill
person will suffer from swallowing disorders. Eventually their respiratory muscles will
cramp, causing the person to die from suffocation. When the first typical signs of tetanus
appear, about half of affected people do not survive the disease.
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6.2.12 Burns
Burns are damage to the skin (and possibly underlying tissue) caused by heat, electricity,
chemicals, radiation or steam. Even extreme cold can cause some form of burn, called a
frostbite. Burns are categorised based on an estimation of their depth:
■ Superficial burns are often the result of an accident

at home or of radiation from the sun. This type of
burn causes the skin to look dry, darkened and
slightly swollen, and is painful. Only the top layer of
skin, the epidermis, is damaged. As a result, the pain-
sensitive nerve endings in the skin are continuously
stimulated.
■ In partial-depth burns, blisters form. When these

blisters open, a red or white wound can be seen.
This type of burn is usually very painful because
both the epidermis and the dermis are damaged.
Partial-depth wounds are often surrounded by
superficial burns.
■ Full-depth burns look black, white or parchment-

like, and the skin may be charred. All the nerves
responsible for the sense of touch and the perception
of pain have been destroyed, causing a full-depth
burn to be numb and not painful. Full-depth burns
are always surrounded by less deep burns, which are
very painful.
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Besides its depth, there are multiple factors influencing the severity of a burn. Since it is
not always easy to determine the depth of the burn, a first aider should be able to make a
distinction between mild and severe burns. Severe burns always require specialised help,
while first aiders can take care of mild burns themselves. The following factors play a role
in estimating the severity of the burn:
■ The deeper the burn, the more serious it is. Superficial burns are less severe than a
full-depth burns. Every full-depth burn is serious.
■ The burnt surface also plays a role: the bigger the burn, the more serious it is. Large
burns have a bigger chance of infection and fluid loss. Burns exceeding 10% (5% in
children) of the total body surface are considered life-threatening. To estimate the
size of the burn, compare it with the burnt person’s open hand with fingers together.
The size of the person’s closed hand corresponds to about 1% of their total skin
surface.
■ The location of the burn also determines whether or not the burn is serious. Burns in
the mouth and throat are always life-threatening, since there is a risk of suffocation
due to swelling of the tissues. Burns to the face, ears, hands, feet, joints or genitals are
also serious because of the risk of loss of function by scarring. In addition, burns that
completely surround the neck, torso or limbs are serious, since swelling of the tissue
can obstruct the blood supply.
■ The cause of the burn is a determining factor for its severity. Burns caused by chemicals
are always serious because there may be additional injuries due to the absorption of
the chemicals through blood circulation (see: p. 211). In addition, a chemical wound
will continue to burn as long as the chemical is not completely removed. In burns
caused by electricity, the severity of the injury is not easy to estimate because a large
part of the injury is internal. Burns caused by open flames are often deep burns.
■ The age of the burnt person is important to determine whether the person needs
medical attention. For children younger than 5 or adults older than 60 years of age, it
is recommended to see a medical professional after being burnt.
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Burns to the respiratory tract

Someone who has been in a fire could have inhaled hot, harmful gases. These gases could
cause internal burns to the throat and respiratory tract, which can be life-threatening.
Swelling can cause breathing problems even hours after the person has been rescued
from the fire. That is why it is important not to think too quickly that the person is out
of danger.
Burns to the eye

Burns to the eye can be caused by direct contact with a flame, hot liquids, steam, corrosive
products or by radiation. A burn to or around the eye is always a serious injury. Burning of
the eyeball itself is rare, as the blinking reflex ensures that the eye closes quickly when
feeling heat.
Chemical burns
The symptoms of a chemical burn can occur immediately or after a delay. There are many
chemical products, each with a different effect. Corrosive chemicals can irritate the
skin as well as burn it, but symptoms may also occur elsewhere in the body because the
product was absorbed into the bloodstream.
Always use plenty of water for rinsing. Never try to neutralise the effect of a chemical
product by using other chemicals, unless it is instructed by a medical professional.
Electricity burns
When an electric current passes through the body, it causes injuries (see: p. 239).
Burns may be visible where the current entered the body and where it left the body,
but first aiders should prioritise the consciousness and breathing of the injured person.
Afterwards they can take care of the burns.
Sunburn
The sun emits visible light and invisible, ultraviolet light (UV light, also called UV
radiation). Exposure to a high dose of UV rays burns the skin. The more often the skin
burns, the greater the risk of developing skin cancer.
Not everyone reacts in the same way to the sun’s UV rays. The speed at which a person
tans or burns depends on the skin type, and the intensity and duration of contact.
Shock due to burns

When someone has severe burns, body fluid can leave the body through the burn. If too
much fluid is lost, there is less fluid in the blood vessels and shock could occur (see: p.
234). It takes some time for a burnt person to go into shock due to fluid loss trough
burns, and this will rarely happen in a first aid setting. Someone going into shock quickly
after being burned, may have other important injuries, such as internal bleeding (see: p.
234).
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6.2.13 Injuries to muscles, joints and limbs
Bruises
When muscles and tendons (see: p. 214) are damaged in a fall, a knock, or a compression,
it is called a bruise. In bruises, the damage is mainly limited to small, subcutaneous blood
vessels and nerves. The limited bleeding under the skin, allowing a small amount of
blood to leak into the tissues under the skin, can be visible as a discoloration of the skin.
When a bruise is serious, it is often difficult to determine whether there is also a sprain,
broken bone or dislocation. Sprains, broken bones and dislocations are also often
accompanied by bruises. That is why, when in doubt, it is best to assume the worst
situation.
Sprains
When the range of movement of a joint is exceeded, a sprain occurs. The ends of the
bones remain in their position, but surrounding ligaments are stretched or torn, the joint
capsule is damaged, and sometimes a blood vessel and nerves are damaged. A sprain
often occurs during sports, for example, due to a wrong movement or a poor landing
after a jump.
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Broken bones
When a bone breaks, it is called a bone fracture or a broken bone. A bone fracture is
caused by a strong force acting at the level of a bone (e.g. a blow, bump or fall), by
prolonged overburdening of the bone (e.g. overexertion of the foot bones after a long
walk), or as the result of a bone marrow disease (e.g. osteoporosis). Bone fractures come
in different forms:
■ A bone can be broken partially or completely.
■ A fracture can be either open or closed. A bone fracture is called ‘open’ when the
injured limb shows a skin wound at the level of the bone fracture. The broken bone
can, but does not have to, be visible in the wound. A bone fracture is ‘closed’ when
there is no wound visible at the site of the bone fracture.
■ Broken bones can, in open as well as closed fractures, move. If the position of the
bones moves because of a fracture, the parts of the fracture may shift relatively to
each other. This is called a bone fracture with displacement. Displaced bone fractures
can be dangerous because blood vessels and nerves can be damaged by displaced
bone fragments.
250
Dislocation
If two bone ends, which normally join together in a joint, are abnormally displaced from
each other, it is called a dislocation. Dislocations are often caused by a direct external
force (e.g. a blow, bump or fall) or a rotating force acting on the joint.
In dislocations, the joint capsule could be severely damaged and the surrounding
soft tissue can be torn or damaged. The joint often shows an abnormal position. If a
dislocation results in a wound, it is called an open dislocation.
Muscle cramps
Normal muscle contractions are not painful. But muscles can suddenly, involuntarily and
for a long time remain in a contracted state. This is a (painful) muscle cramp, which can
occur as a result of sudden, abrupt movements, incorrect posture or prolonged exertion.
A lack of oxygen or a shortage of fluid and minerals in the muscle, excessive cooling
of the muscle, or overstimulation of the muscle (e.g. in epilepsy, tetanus, spasticity or
electrocution) can also cause muscle cramps.
Muscle cramps can occur in many parts of the body. They often occur in the calf muscle,
but can also occur in the feet, thighs, hands or arms.
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6.2.14 Injury to the head

Head injuries are the result of direct contact between the head and an object or of a
sudden and severe acceleration or deceleration (e.g. fall from height, traffic accident).
There can be damage to the skin (a head wound), to the skull (a fracture of the face or
skull) or to the brain (brain injury or concussion).
Head wound
The scalp is well supplied with blood vessels. This causes head wounds to often bleed
heavily. Usually, this heavy bleeding makes the injury look worse than it actually is.
When the wound is located in the hairy scalp, the blood spreads between the hairs and
starts to clot. As a result, it can be difficult to determine exactly where the wound is
located.
Skull and facial fractures

A skull fracture is a break in the skull, usually occurring as the result of an impact with
a blunt force. In case of a forceful impact, the skull may fracture at or near the site of
the impact and cause damage to the brain. While some skull fractures occur without
associated serious symptoms, any significant blow to the head results in a concussion,
with or without loss of consciousness.
The face consists of several bones (e.g. nasal bones, cheekbones, upper and lower jaw)
which are fused with each other and with the skull. A facial fracture is usually the result
of a blow to the face. Some facial fractures can be recognised:
■ Fractures of facial bones can be accompanied with pain, bruises and swelling of the
surrounding tissues, just like other fractures (see: p. 250).
■ Fractures of the nose, but also to the base of the skull, can be associated with
nosebleeds (see: p. 254). A nose fracture may also be associated with a crooked nose.
■ Deformity and asymmetry of the face (e.g. sunken cheekbones or teeth which do not
align properly) could also suggest the presence of a facial fracture.
■ A person with a jaw fracture often has difficulty opening their mouth and may
experience numbness in the lip and chin.
Concussion and brain damage

In the event of a serious head injury, there is always a risk of brain damage. This damage
can disrupt the functioning of the brain temporarily or permanently. The symptoms of a
serious head injury depend on the seriousness of the impact and the size and location of
the brain damage.
■ A concussion is considered to be a temporary disturbance of the functioning of the
brain, without serious permanent damage. A concussion is caused by a bump, blow,
or jolt to the head that causes the head and brain to move rapidly back and forth.
This sudden movement causes the brain to bounce around within the skull, causing
stretching of or damage to the brain cells.
Symptoms of a concussion include a headache, dizziness, feeling dazed and confused,

memory loss, feeling sick, trouble with balance, unusual behaviour, changes in vision
(blurred or double vision, seeing stars) and struggling to stay awake.
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■ Brain damage is a more permanent disturbance of the brain caused by a blow or jolt
to the head. The damage to the brain can involve a specific location in the brain or the
entire brain. In some cases, but not all, the skull is fractured.
During the accident, the brain crashes inside the skull causing bruising, bleeding, and
tearing of nerves. In the first moments after the incident, the casualty can be confused,
dizzy, have memory loss, have blurry vision or lose consciousness. The person may
appear fine at first, but their condition can deteriorate quickly since the damaged
brain could swell and push itself against the skull, causing a disruption in supply
of oxygen-rich blood. This shortage of oxygen in the brain could cause permanent
damage or even death.
As a first aider you can only suspect brain damage. Therefore, a first aider always needs
to arrange urgent transport for a casualty with a severe head injury.
6.2.15 Injury to the neck or back

Injuries to the neck and back are also called spinal or vertebral injuries. A spinal injury
includes all injuries to the spine and surrounding structures that cause a temporary or
permanent change in its function. It may involve a compression, fracture or dislocation
of one or more vertebrae, as well as damage to the ligaments between the vertebrae.
These kinds of injuries occur when there is a severe impact to the neck and back. The way
the impact happens determines the severity and the location of the fracture in the spine.
Compression, a fracture or a dislocation of one or more vertebrae may cause a disruption
of the cohesion and firmness of the vertebral column. Since this vertebral column protects
the spinal cord (see: p. 204), there is a risk of damage to the spinal cord and nerves when
the vertebral column is damaged. Serious damage to the spinal cord, whereby the nerves
are interrupted, is called a spinal cord lesion.
Depending on the severity of the injury and the location of the damage, the symptoms of
a spinal injury could vary. Symptoms range from numbness to paralysis of, for example,
the fingers or the pelvis (which could cause, amongst other things, bladder incontinence).
Symptoms of paralysis and sensory dysfunction occur below the site of the spinal cord
injury. If the spinal cord is damaged near the neck, a large part of the body can become
paralysed or the injured person can even die due to a respiratory arrest. Injuries to the
chest or lower back can cause paralysis of the lower part of the body.
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6.2.16 Injury to the eye

The eye is embedded in the eye socket, protecting the eye from most injuries. Reflexes to
close the eye-lids also protect the eye from possible damage. But despite this protection,
the eye can still be damaged. In addition, injuries in the area of the eyes can also be
serious.
Speck and object in the eye

A speck in the eye can be annoying. Usually this is sand or dust, but it can also be a piece of
stone, an insect or even a displaced contact lens. Sometimes a person has the impression
that there is dirt in the eye, but there is not. This could be caused by an infection or a
small injury to the eye or the eyelids.
Objects stuck in the eye, (e.g. a splinter of metal or a shard of glass) cannot be rinsed out
and should be removed by a medical professional.
Blow to the eye

If an injury occurs near the eye, limited internal bleeding can easily occur. This limited
internal bleeding causes swelling and discoloration of the skin and is often called a bruise
or a ‘black eye’. In the beginning, this bruise turns blue-red, then blue-black. Gradually it
turns brownish-yellow-green, after which the discoloration disappears*. Swelling of the
eyelids can hinder the injured person from opening their eyes.
When someone has suffered a blow to the eye, the first aider must also be vigilant for
other injuries. Other injuries, such as an injury to the head (see: p. 252), may also be
present if the eye injury was caused by a blow to the eye.
* Not all of these symptoms will be noticeable in a person with dark skin.
6.2.17 Nosebleed
If one or a few blood vessels in the nose tear, a person may bleed from the nose.
A nosebleed can occur after a blow to the nose, but people can get a nosebleed
spontaneously after fiercely nose-blowing or sneezing, if they have increased blood
pressure, when switching from a cold to a warm environment, or after nose-picking.
When someone has a nosebleed after suffering a blow to the nose, first aiders must be
vigilant for other injuries such as a facial fracture. When a person loses watery blood
through the nose and simultaneously shows signs of a concussion, this may indicate a
fracture of the skull (see: p. 252).
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6.2.18 Stings and bites
Animals can cause injuries by biting or stinging. In many cases these bites or stings
cause limited harm. However, sometimes stings and bites are accompanied by general
reactions, bruises, skin wounds, pain and bleeding. Sometimes, stings and bites caused
by animals carry a serious risk for humans. Some animals (e.g. snakes and scorpions)
produce poisonous venom, the saliva of some mammals can carry harmful pathogens,
and the stings of wasps could cause allergic reactions.
Bee or wasp
The sting from a bee or wasp causes a small skin wound and, usually, some slight
discomfort. In some cases, a bee or wasp sting can also be serious:
■ When someone is stung several times, the amount of venom injected may be sufficient
to cause a serious, generalised reaction.
■ A sting in the throat can be life-threatening, since the swelling of the skin can obstruct
the airway.
■ Some people are allergic to bee or wasp stings. In these persons, even a single sting
can cause a serious, generalised allergic reaction (see: p. 234).
Snake
Snake-bites could be life-threatening because of the toxins in the bite of a venomous
snake. Certain species of snakes can also envenom humans by spraying venom into the
eyes.
As a first aider, you do not always know whether a snake is poisonous. It is therefore best
to always assume the worst-case scenario.
Scorpion and spider

Spider bites and scorpion stings can cause serious reactions and even death because
of the toxins they contain. Children, weakened people and the elderly are particularly
susceptible to the venom of scorpions or spiders.
Jellyfish
Jellyfish have tentacles with nettle cells, which secrete a substance to paralyse their
prey. In humans, the reaction to these nettle cells are mostly local. Just a few species of
jellyfish can kill humans with their tentacles. People come into contact with jellyfish by
walking on the beach or by swimming in the sea. In certain circumstances, jellyfish can be
found on the coastline when they are washed ashore. The stinging cells of dead, washed-
ashore jellyfish are still a risk.
Stings from sea anemones or coral can show similar reactions to those from jellyfish.
Mammals and humans

The cause of a bite by a mammal is often related to human behaviour towards the
animal. It is therefore very important to teach adults and children how to handle animals
properly. But it is not just animals that bite humans, humans can bite other humans too.
The consequences of bite injuries are diverse. The consequences range from a bruise to
255
a tear/bite wound. Bite wounds are prone to infection. There are many microorganisms
in the mouth and on the teeth, which can enter the bite wound and cause an infection
if the wound is not cared for properly. An example of serious infection by bites is rabies
or tetanus (see: p. 245). Besides bodily harm, bites can often have psychological effects
(such as fear of the animal).
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Illnesses
6.2.19 Fainting
Fainting is a short and sudden loss of consciousness, occurring due to a reduced blood
supply to the brain. As a result, the brain suffers from a temporary lack of oxygen.
Fainting may be a reaction to pain, fever, fatigue, exhaustion or emotions. It also occurs
in people who stand up for a long time, especially in a busy or warm environment.
Fainting is a relatively common condition and is usually harmless, but someone can
also lose consciousness due to more serious problems, mentioned in the chapter on
Unconsciousness (see: p. 226).
6.2.20 Fever
If the body detects an infection, the brain will raise the body temperature. This
phenomenon is called fever. The raised temperature stimulates the body’s immune
system, which helps the body fight the infection. But fever can also be caused by other
causes, such as poisoning or a heatstroke.
Fever is said to occur when the body temperature exceeds 37.5°C. When the body
temperature rises to 40°C or more, it could cause permanent damage. In small children, a
rapid rise in body temperature can cause febrile fits (see: p. 259).
When caring for a person with a fever, it is always important to pay sufficient attention
to good hand hygiene. This should be done in order not to get infected by the ill person’s
infection or transmit it to other people.
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6.2.21 Fits
Sudden, jerky movements of (a part of) the body are called fits. Fits can have a number of
causes. The person having fits may be known to have epilepsy, but fits can also be caused
by fever, brain damage, poisoning or drug abuse. At the moment of the fits, it is often
difficult to determine what the cause may be, but the first aid approach to a person with
fits is always the same.
Epilepsy
Epilepsy is a brain disorder that causes seizures. An epileptic seizure, also called an insult
or convulsion, is a temporary change in a person’s perception, behaviour or consciousness.
Epileptic seizures are caused by a sudden, temporary disturbance in the brain. Symptoms
of a seizure depend on where in the brain the disturbance takes place. Some seizures
occur in a small area of the brain (partial attacks) while other seizures spread throughout
the brain (generalised attacks). As a result, the symptoms of a seizure differ from person
to person (e.g. one person is unresponsive for a while, another loses consciousness,
another falls and has fits). Epileptic seizures are classified according to where the seizure
starts and the extent of the seizure:
■ When there is local disturbance in the brain, an arm, leg or head can suddenly start
shaking uncontrollably. The person may make certain aimless movements (smacking,
running around, rubbing the abdomen, etc.) or have abnormal perceptions (seeing
flashes of light, hearing noise, tasting a strange taste in the mouth, etc.). Sometimes a
person is aware of the uncontrollable movements they make, but sometimes they do
not remember anything after the seizure.
■ A generalised disturbance of the brain can result in a minor or major generalised
seizure:
■ In a minor generalised seizure (also known as ‘petit mal’ or ‘absence’), the person
suddenly appears to be absent for a moment, without falling. It seems as if the
person is daydreaming. This is most common in children.
■ In the case of a major generalised seizure (a ‘grand mal’), the person suddenly loses
consciousness and unintentionally flexes their muscles. The person makes jerky
movements called fits. During a major seizure, performing life-saving actions such
as opening the airway is nearly impossible. Therefore, the first aider should not put
anything between the person’s teeth (not even their fingers) in an attempt to open
the airway. A jaw clamp may occur due to cramping of the jaw and chewing muscles.
During a major attack, the person’s breathing may be disturbed and they may run
out of oxygen. If the attack starts over and over again or continues for a long time,
a life-threatening situation can arise. This is called a status epilepticus.
In 40% of people with diagnosed epilepsy, the epilepsy has a genetic cause. 60% of
epilepsy patients have acquired epilepsy through an abnormality in the brain tissue such
as a scar, tumour, bleeding, diseases, disruption of the immune system, or infection in the
brain (see: p. 261). Often, there is no clear cause of the seizure.
For some epilepsy patients, there is a clear link between a situation and the occurrence
of a seizure, called ‘triggers’. Triggers could be alcohol, drugs, stress, shortage of sleep,
hormonal changes, light flashes or fever (see: p. 257).
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Febrile fits
Febrile fits usually occur in children under 5 years of age. These fits precede or succeed a
rapid rise in body temperature. It is not so much the height of the fever that is important
for the occurrence of fits, but rather the speed at which the temperature rises. Febrile
fits could be the first sign that the child is sick.
Not all children develop febrile fits; the predisposition can be hereditary. It often occurs
only once. A child who has had a febrile fit does not necessarily have an increased risk of
epilepsy.
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6.2.22 Diarrhoea
When someone has a passage of three or more loose or liquid stools per day (or a more
frequent passage than normal for the individual), it is called diarrhoea. The frequent
passing of formed stools, or the passing of loose, pasty stools by breastfed babies cannot
be defined as diarrhoea.
Diarrhoea is often a symptom of an infection in the intestines (see: p. 216), caused by

bacteria, viruses or parasites. These microorganisms can spread through the consumption
of contaminated food or drinking water, or between people due to poor hygiene.
Infections with these organisms are more common when adequate sanitation, hygiene
and safe water for drinking, cooking and cleaning is lacking. Water contaminated with
human and/or animal stools (e.g. from sewage, septic tanks and latrines) is of particular
concern, but unsafe handling and storing of domestic water is an important risk factor
too. Furthermore, unhygienically stored and prepared food, eating fish and seafood from
polluted water, and poor personal hygiene could also cause diarrhoea.
Diarrhoea is a leading cause of child mortality in the world. Every episode of diarrhoea
takes away necessary nutrition essential for the child’s growth. Therefore, diarrhoea
causes malnutrition in many children. In addition, malnourished children are particularly
susceptible to new intestinal infections, causing more diarrhoea.
Dehydration
Fluids make up over two-thirds of the healthy human body, lubricating the joints and eyes,
aiding digestion, flushing out waste and toxins, and keeping the skin elastic and healthy.
When the body lacks fluids, it is called dehydration. When having diarrhoea, the human
body loses water and electrolytes (e.g. sodium, chloride, potassium and bicarbonate)
through liquid stools, vomit, sweat and urine. Dehydration is the most important threat
posed by diarrhoea.
Dehydration occurs when the ill person’s body loses more fluids than it takes in, causing the
body not to have enough fluid to fulfil normal bodily functions. A healthy person can tolerate
a slight reduction in total body fluids without suffering from adverse health effects. But
even moderate loss of bodily fluids causes fatigue and dizziness. A major decrease of bodily
fluids can cause physical and mental deterioration accompanied by severe thirst.
Mild dehydration can usually be reversed by drinking more fluids, but severe dehydration
needs immediate medical treatment since it leads inevitably to death. Dehydration is
especially dangerous for young children and the elderly.
Cholera
Cholera is caused by ingestion of food or water contaminated with the cholera bacteria.
Cholera can cause severe acute watery diarrhoea, showing 12 hours to 5 days after
ingesting contaminated food or water.
Most infected people do not develop any symptoms, but the bacteria are present in
their stools for 1 to 10 days after the infection, potentially infecting other people. Most
people who develop symptoms, have mild or moderate symptoms. A minority develop
acute watery diarrhoea with severe dehydration.
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6.2.23 Rash
A rash is an area of irritated or swollen skin affecting the appearance or texture of the
skin. Often, skin with a rash is red, bumpy, warm, painful, itchy and irritated. Often, a rash
can lead to blisters or patches of raw skin. It may appear all over the body or localised in
one part of the body.
There are numerous causes of rashes (illnesses, exposure to irritating substances and
allergies), making the assessment of a person with a rash rather complicated.
When defining the cause of the rash, the following factors need to be considered: the
appearance of the rash, associated symptoms, what the person has been exposed to,
occupation of the ill person, and occurrence in family members. The treatment of a rash
depends on its cause. But the presence of a rash can also aid the diagnosis of a disease,
since it could have a distinct appearance.
Measles
A measles rash has a particular appearance and starts to show a few days after the onset
of fever. The rash classically starts at the head and spreads downwards.
Measles is a highly contagious infection caused by a virus. Symptoms usually develop 10

to 12 days after exposure to an infected person. Infection occurs by direct contact with
a sick person or by inhaling small droplets released by sneezing or coughing. It can be
transmitted by an infected person from 4 days prior to the onset of the rash to 4 days
after the rash erupts.
Initial symptoms of measles are fever (see: p. 257), cough, a runny nose, and inflamed
eyes. Small white spots can form inside the mouth. The rash, which is a red, flat rash
typically begins three to five days after the start of symptoms. But also more serious
complications can occur, such as an ear or lung infection. Sometimes, acute infection of
the brain may occur, which can be fatal.
Measles outbreaks can result in epidemics that cause many deaths, especially among
young, malnourished children. But children can be vaccinated against measles. The
measles vaccine is often incorporated with rubella and/or mumps vaccines. It is equally
safe and effective in the single or combined form. Unvaccinated young children and
unvaccinated pregnant women are at highest risk of measles and its complications.
Meningitis
A meningitis rash spreads rapidly over the body and precedes other symptoms. The rash
consists of numerous small, purple or red spots on the torso, legs, mucous membranes
(e.g. mouth, nose, eyes) and sometimes on the palms of the hands or soles of the feet.
Typically, the rash does not disappear when pressed with a finger or a glass. Although
the rash is not necessarily present in someone with meningitis, it is quite specific for the
disease.
The meninges are brain membranes located just below the skull, around the brain, to
protect the brain. In the case of meningitis, the meninges are inflamed, caused by a
bacterium or a virus. This inflammatory reaction can have negative consequences on the
261
brain membranes. Because inflammation of the meninges increases the pressure in the
space between the meninges, some brain cells can die. As a result, major complications
such as blindness, hearing and speech problems, memory loss or epilepsy can occur.
Some forms of meningitis are highly contagious and develop rapidly. The disease is
transmitted by the spread of droplets (by coughing and sneezing) or by direct contact
with an infected person. Children, young people and people with reduced resistance are
particularly prone to meningitis.
Meningitis caused by bacteria is serious and can be life-threatening if it not treated

quickly with antibiotics. Children can be vaccinated against some bacteria that cause
meningitis, with a single injection at the age of 1 year. A viral meningitis, which shows no
rash, is less severe compared to a bacterial meningitis: it requires no treatment and heals
spontaneously.
262
6.2.24 Diabetes
Diabetes is a disease in which the processing of sugars in the body is disturbed. It is one
of the most common and fastest growing chronic diseases in the world.
The body converts sugars from food into blood sugar (glucose). Glucose is transported
to all body cells, which need it as a source of energy. In order to absorb glucose into
the cells, insulin is needed, which is a hormone produced and secreted by the pancreas.
After a meal, when there is a lot of sugar in the blood, insulin will be produced to enable
the bodily cells to absorb the glucose. In people with diabetes, there is a problem with
this mechanism. Depending on the cause, different types of diabetes mellitus can be
distinguished:
■ In type 1 diabetes mellitus, the pancreas cannot produce enough insulin. When too
little insulin is produced, glucose cannot be absorbed into the cells and blood sugar
levels in the blood increase. This type of diabetes usually develops at a young age.
Patients with type 1 diabetes have to inject themselves with insulin as a treatment.
■ In type 2 diabetes mellitus, the pancreas produces a normal amount of insulin, but
the body cells are less sensitive to insulin. This type of diabetes is more common in
older and/or overweight people. Type 2 diabetes is usually treated first with a healthy
diet and physical exercise. Sometimes patients also have to take medication that
lowers blood sugar levels.
■ With gestational diabetes, high blood sugar levels are measured during pregnancy.
Some pregnancy hormones, needed for the development of the baby, counteract the
action of insulin. Therefore, the pregnant woman’s body has to produce a lot more
insulin in order to control blood sugar levels. When the body of the pregnant woman
fails to do this, she develops gestational diabetes. If gestational diabetes remains
untreated, it can pose both short- and long-term risks to the mother and child.
As a result of diabetes, the blood sugar level of people with diabetes does not remain
constant. By living a healthy life in combination with adequate medication, someone with
diabetes can balance their blood sugar level more or less. Some diabetic patients can
determine their blood sugar level themselves by means of a blood sugar meter. Its use is
reserved for trained patients, their family members and medical professionals.
However, sometimes things do not go as planned:

■ When blood sugar levels drop too low (too little glucose in the blood), it is called
hypoglycaemia (low blood sugar). Often, this occurs when someone with diabetes
injects too much insulin, eats too little or does not eat in time, or after physical
exertion or drinking alcohol.
Symptoms of hypoglycaemia occur within a couple of minutes to hours. The person
may become dizzy, faint, restless, confused or aggressive and move uncontrollably.
The person may develop a headache, become pale, sweat a lot, start to shiver and
be hungry. In extreme cases, the affected person may become less conscious or lose
consciousness altogether.
■ The blood sugar level could rise too high (too much glucose in the blood), which is
called hyperglycaemia (high blood sugar). This occurs when a diabetic does not take
their medication (appropriately), eats too much or suffers from fluid loss (vomiting
and diarrhoea) and infections.
263
Hyperglycaemia usually occurs in the course of several hours to days. In the short term,
a person with hyperglycaemia urinates more often, causing them to become increasingly
thirsty. They may feel nauseous, drowsy and lose consciousness. In the longer term,
fatigue and weight loss are common symptoms. When the hyperglycaemia persists
for a long time, the person’s body becomes acidic and urgent hospital-admission is
necessary. Moderately increased blood sugar levels over a longer period can have serious
consequences. It can cause blindness, kidney failure and cardio-vascular diseases.
Good to know! - Diabetes for First Aiders
This manual focusses on ‘low blood sugar’, since it is the most important complication
of diabetes for first aiders. In contrast, hyperglycaemia occurs more gradually, is
more difficult to recognise and there is less the first aider can do about it.
Many people do not (yet) realise that they have diabetes. When you, as a first aider,
recognise the signs and symptoms of a complication of diabetes in a person who is
not known to have diabetes, encourage them to see a medical professional.
264
265
266
Methodology
When making a first aid manual with practical recommendations, it is important to

be clear about what those recommendations are based on. After all, recommending
ineffective or harmful practices may cause more harm than good. This section describes
the methods used to develop “Basic First Aid in Africa”, with the aim of making the best
and most appropriate recommendations for practice.
The manual you are reading is developed according to the principles of ‘Evidence-Based
Practice’. This means that the recommendations made in this manual are in accordance
with the latest scientific findings, but taking into account the practical experience of
experts in the field, and considering the resources, values and preferences of our target
audience, the general population of sub-Saharan Africa. A practical recommendation
that is developed according to these principles is what we call an evidence-based
recommendation.
The expert panel

We have developed this manual in collaboration with a panel of African experts with
extensive experience in first aid education and emergency medicine. As several of
the experts involved are actual first aid trainers from Red Cross National Societies in
sub-Saharan Africa, they are well-placed to represent our end users. The expert panel
267
Methodology
has been consulted throughout the development of “Basic First Aid in Africa”, from
defining the table of contents, revising the collected evidence and making practical
recommendations, to ensuring the usefulness and clarity of the illustrations.
The composition of the expert panel is as follows:
Name Affiliation Country

Prof. Dr. Jimmy Volmink Stellenbosch University South Africa
(chair)
Mr. Kheri Issa Tanzania Red Cross Society Tanzania
Prof. Dr. Walter Jaoko University of Nairobi Kenya
Ms. Simphiwe Kubeka South African Red Cross South Africa
Society
Ms. Jeanne Mukeshimana Rwanda Red Cross Society Rwanda
Mr. Alick Msusa Malawi Red Cross Society Malawi
Mr. Admire Mugambiwa Zimbabwe Red Cross Zimbabwe
Society
Mr. Mabvuto Ng’ambi Zambia Red Cross Society Zambia
Dr. Navindhra Naidoo Western Sydney University Australia
Mr. Paul Okot Uganda Red Cross Society Uganda
Dr. Patrick Shao Muhimbili University Tanzania
Mr. Fabian Van Hoyweghen Belgian Red Cross Society Belgium
Dr. Benjamin Wachira Aga Khan University Kenya
Scope and content of the manual

During an online kick-off meeting in June 2020, the expert panel defined the scope and
content of the manual. They defined key questions for which evidence needed to be
collected.
Collection of the best available evidence

The Centre for Evidence-Based Practice (CEBaP) of the Belgian Red Cross (www.cebap.
org) addressed the key questions defined by the panel of experts via systematic searches
for scientific literature. The process is described briefly below. More information about
how scientific literature was searched and collected can be found on www.cebap.org/
methodology.
Key questions were defined according to the PICO (population-intervention-comparison-

outcome) format, and relevant scientific publications addressing these PICO questions
were searched in three databases of scientific literature: Medline, Embase and the
Cochrane Library, between July 2020 and September 2020.
Where PICO questions were already addressed in systematic reviews by the International
Liaison Committee on Resuscitation (ILCOR, www.costr.ilcor.org), we did not address
these with a new systematic literature search. Conclusions by ILCOR were then presented
to our expert panel. Recommendations for basic first aid interventions are in accordance
with the “First Aid for First Responders” manual of the Belgian Red Cross, and the IFRC
268
International First Aid and Resuscitation Guidelines, as these are also based on CEBaP
evidence. However, where necessary, these recommendations were adapted to the
target group of African basic first aiders.
We composed a total of 266 PICO questions, of which 198 were PICO questions for
which CEBaP or ILCOR already had up-to-date evidence summaries or systematic
reviews available, while for 68, no up-to-date evidence summary or systematic review
was available. Of these, 58 were updates of questions addressed in previous first aid
guidelines, while 10 were newly composed for this manual. For each of these PICO
questions, we developed specific search strategies. To identify scientific studies with
relevance to a PICO question, we developed formal criteria for eligibility.
Data collection
Scientific evidence was collected for each of the 68 PICO questions in an evidence
summary by CEBaP. You can consult the evidence summaries developed for “Basic First
Aid in Africa” in the evidence summary database of CEBaP (http://www.cebap.org/
knowledge-dissemination/first-aid-evidence-summaries/).
We judged the certainty of the identified evidence for each PICO question according to
the methods developed by the GRADE working group (4). For each PICO question, a level
of certainty of the evidence was applied, ranging from high to very low:
■ High certainty: We are very confident that the true effect lies close to that of the
estimate of the effect.
■ Moderate certainty: We are moderately confident in the effect estimate. The true
effect is likely to be close to the estimate of the effect, but there is a possibility that
it is substantially different.
■ Low certainty: Our confidence in the effect estimate is limited. The true effect may be
substantially different from the estimate of the effect.
■ Very low certainty: We have very little confidence in the effect estimate. The true
effect is likely to be substantially different from the estimate of effect.
From scientific evidence to practical recommendations

A dedicated content writer from the Belgian Red Cross’ First Aid service wrote a draft
version of this manual, where possible based on scientific findings collected in the
evidence summaries. Alternatively, when evidence was too scarce, conflicting or lacking,
Good Practice Points were formulated, which are important points for practice on which
consensus is reached and that nobody is likely to question. The collected evidence and
the draft manual, with illustrations, were revised by the expert panel, who provided
written feedback.
The expert panel then further discussed their feedback during online meetings in
February-March 2021, taking into account the concepts of the GRADE Evidence-to-
Decision framework (5): the balance between the benefits and harms, certainty of the
evidence, patient values, cost, acceptability and feasibility of a proposed action. Where
needed, the expert panel formulated additional Good Practice Points.
A revised version of the manual was prepared and sent out for revision. During a third
online meeting in May 2021, the experts validated the content of the manual, after which
the manual went in layout.
269
Methodology
Internal validation
The final version of this manual, with illustrations, was circulated electronically and
approved by the expert panel. The chair of the expert panel revised and addressed any
remaining comments.
Update
This manual will be updated every five years. The next update is scheduled for 2026.
270
Index
abdominal thrusts.................................................53 a bandage on the head..................................131

airway....................................................................205 a bandage to an ankle....................................119
obstruction, mild.......................................49, 229 an adhesive plaster.........................................101
obstruction, severe...................................51, 229 a pressure dressing...........................................70
open the..............................................................27 arrange medical attention...................................32
appendix...............................................................217 assess the person’s condition.............................25
applying automatic external defibrillator (AED).............41
a bandage.........................................................102
bites brain.......................................................................203
human....................................................... 160, 255 damage.............................................................253
mammal................................................... 160, 255 breathing, check for..............................................28
snake......................................................... 154, 255 bruise............................................................ 116, 249
spider........................................................ 156, 255 burns............................................................. 110, 246
bleeding..........................................................67, 234 aftercare for.....................................................113
catastrophic.......................................................31 chemical............................................................248
severe external..........................................67, 234 electricity..........................................................248
severe internal...........................................71, 234 shock due to.....................................................248
blood......................................................................210 sun .....................................................................248
vessels...............................................................210 to the eye..........................................................248
blows to the back..................................................52 to the respiratory tract..................................248
bones.....................................................................212
broken...................................................... 121, 250
calming down........................................................... 9 chest

cardiopulmonary resuscitation (CPR)...............40 compressions.....................................................42
in babies..............................................................46 discomfort..................................................47, 227
in children...........................................................45 choking............................................................49, 229
car in the water......................................................78 cholera.......................................................... 186, 260
cerebrovascular accident (CVA)............ see stroke concussion............................................................252
consciousness, check for......................................25
271
Index
dehydration................................................. 179, 260 dislocated limb............................................ 121, 251

diabetes........................................................ 192, 263 drowning..................................see (near-)drowning
diarrhoea...................................................... 177, 260
ear...........................................................................219 temperature-related................................79, 237

electrocution..................................................84, 239 ensure safety..........................................................19
high-voltage...............................................86, 239 epilepsy.................................................................258
low-voltage................................................84, 239 eye..........................................................................218
emergency..................................................... 35, 226 blow to the.............................................. 145, 254
child birth....................................................88, 240 harmful liquids in the.....................................147
pushing stage........................................90, 240 object stuck in the................................. 143, 254
when labour starts...............................88, 240 rinsing the.........................................................142
when the baby is born.........................92, 241 speck in the............................................. 141, 254
when the baby is not breathing
normally..........................................................95
fainting......................................................... 164, 257 fits................................................................. 173, 258

physical countermeasures.............................166 epilepsy.............................................................258
FAST test.................................................................56 febrile....................................................... 176, 259
female genital mutilation..................................225 fracture ........................................ see broken bones
fever.............................................................. 168, 257 facial..................................................................252
find out what is wrong.........................................28 skull....................................................................252
first aid frostbite..................................................................81
four steps in.......................................................19
priorities in.........................................................31
provide further..................................................31
psychological...............................................13, 15
gasping....................................................................28
handwashing..........................................................11 hyperglycaemia....................................................263
heart.......................................................................208 hypoglycaemia............................................ 192, 263
attack...........................................................48, 228 hypothermia...................................................79, 237
human body
how does it work?...........................................202
what can go wrong?........................................226
272
I
illnesses........................................................ 163, 257 injuries.............................................................99, 242

immobilising eye............................................................. 141, 254
a leg...................................................................123 spinal.................see injuries to the neck or back
an arm................................................................124 to muscles, joints and limbs................. 116, 249
the head and neck...........................................136 to the head......................................129, 132, 252
to the neck or back................................ 134, 253
joint............................................................... 118, 213
keeping an embedded object motionless......106
low blood sugar........................ see hypoglycaemia lung........................................................................206
malaria...................................................................171 muscle....................................................................214
measles......................................................... 187, 261 cramp........................................................ 127, 251
meningitis.................................................... 190, 261
moving a person in danger..................................20
(near-)drowning.............................................74, 236 nose........................................................................221

nerves....................................................................204 bleed......................................................... 149, 254
oral rehydration solution (ORS).......................180
poisoning........................................................57, 232 of bite wounds.................................................161

by inhalation......................................................60 of choking...........................................................54
by injection.........................................................62 of diarrhoea.....................................................182
by swallowing....................................................57 of electrocution.................................................87
through contact................................................64 of eye injuries..................................................148
prevention of feeling faint.................................................167
of bee and wasp stings..................................153 of fever..............................................................170
273
Index
of fire and burns..............................................114 of nosebleed....................................................150

of heatstroke and sunstroke..........................83 of poisoning.......................................................66
of hypothermia..................................................81 of road traffic injuries....................................137
of injuries to muscles, joints and limbs.......128 of skin wounds.................................................104
of malaria..........................................................172 of snake and spiders bites and scorpion
of measles........................................................189 stings.............................................................157
of meningitis....................................................191 of wound infection.........................................109
of (near-)drowning............................................76 promotion of safe pregnancy.............................96
rash................................................................ 187, 261 respiratory

recovery position...................................................37 centre................................................................205
removing muscles.............................................................206
a helmet............................................................139 ribs..........................................................................206
a ring from a finger.........................................107
rescue breaths.......................................................43
with a pocket mask...........................................44
seek help.................................................................29 stings and bites........................................... 151, 255

senses....................................................................218 stroke...............................................................55, 230
sex organs heat..............................................................82, 238
female...............................................................223 sun................................................................82, 238
male...................................................................222 system
sexual characteristics.........................................223 circulatory.........................................................207
shock................................................................72, 234 how it works................................................211
anaphylactic.....................................................235 digestive...........................................................216
cardiogenic.......................................................235 musculoskeletal..............................................212
due to burns.....................................................248 nervous.............................................................203
skin.........................................................................215 reproductive....................................................222
wound................................................... see wound how it works................................................223
spinal respiratory........................................................205
cord....................................................................204 how it works................................................207
injury .................see injuries to the neck or back
sprain............................................................ 118, 249
stinger...................................................................153
stings
bee............................................................ 151, 255
jellyfish..................................................... 158, 255
scorpion................................................... 156, 255
wasp.......................................................... 151, 255
tendon...................................................................214 transporting an ill or injured person.................30

tetanus......................................................... 104, 245 turning a person from their stomach to
tongue...................................................................220 their back................................................................26
transient ischemic attack (TIA)..............see stroke
274
U
unconsciousness............................................36, 226
with normal breathing.....................................36
without normal breathing...............................40
vital functions......................................................202
wound infection............................................................108
aftercare...........................................................108 skin............................................................ 100, 242
head...................................................................252 with a large embedded object.....................105
healing...............................................................244
275
276
References
1. The IFRC Psychosocial Centre. eCBHFA Volunteer manual. Copenhagen, Denmark:

Danish Red Cross; 2020 [cited 2021 April 29th]. Available from: https://pscentre.org/
wp-content/uploads/2018/10/NC_MHPSS_VOLMANUAL.pdf
2. International Federation of Red Cross/Red Crescent Societies. International First
Aid Resuscitation and Education Guidelines 2020. Montrouge, France: Global First
Aid Reference Centre; 2020 [cited 2021 April 26th]. Available from: https://www.
globalfirstaidcentre.org/first-aid-guidelines-2020/.
3. Meklit Mersha. Female genital mutilation. World Health Organisation; 2020 [cited
2021 May 27th]. Available from: https://www.who.int/news-room/fact-sheets/detail/
female-genital-mutilation
4. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of
evidence and strength of recommendations. BMJ. 2004;328(7454):1490.
5. Alonso-Coello P, Schunemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli
M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent
approach to making well-informed healthcare choices. 1: Introduction. BMJ.
2016;353:i2016.
277
278
Notes
279
Notes
280
Notes
281
Colophon
Basic First Aid in Uganda
Illustrations
Medical Visuals - Maartje Kunen
Mixed Art – Myrthe Boymans
Design and layout
Zeppoz
Copyright
Copyright ©2021 by Belgian Red Cross
All rights reserved. No part of this publication may be reproduced, distributed, or
transmitted in any form or by any means, including photocopying, recording, or other
electronic or mechanical methods, without the prior written permission of the publisher
Belgian Red Cross. For permission requests, write to the publisher at the address below.
The illustrations used in this book are the property of Belgian Red Cross and may not be
reproduced without their prior permission.
Disclaimer
The information presented in this manual has been produced for information and
educational purposes only. Whilst all efforts have been taken to provide the latest up-to-
date First Aid information available, the Uganda Red Cross Society does not accept any
liability to any person, group or organization for the information, advice or techniques
presented in this manual.
Address
Belgian Red Cross-Flanders Uganda Red Cross Society
Motstraat 40 Plot 551/555 Rubaga Road.
2800 Mechelen P. O. Box 494, Kampala
Belgium Uganda
[email protected] Tel: (256)414 258701/2

www.rodekruis.be Email: [email protected]
www.rodekruis.be/afam Website: https://www.redcrossug.org
Responsible publisher
Philippe Vandekerckhove
Motstraat 40
2800 Mechelen
Belgium
Depot nr: D/2021/0665/13

September 2021
282
If something happens to a relative, colleague or
stranger, do you know how to react? Can you provide
first aid in case of a sprain, burn or fever? This manual
seeks to equip the layperson with the basic skills and
principles needed to provide effective first aid in
cases of injuries, illnesses or emergency situations,
until professional medical assistance can be provided.
First Aid training is an important part of increasing

communities’ resilience to disasters and emergencies,
as well as to provide very useful knowledge for
everyday life. Since the first evidence-based African First
Aid guidelines of 2010, many Red Cross/Red Crescent
volunteers and the general public in 15 sub-Saharan
African countries have been trained in basic first aid,
using this manual.
The topics, covered in this manual, include:

■ General principles in first aid
■ Emergencies such as unconsciousness,
choking, stroke and severe bleeding
■ Injuries such as burns, and broken and
dislocated limbs
■ Symptoms of illnesses such as fever,
diarrhoea and rash
■ An introduction to anatomy and physiology
Edition 2021 NOT FOR SALE

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Basic

1.1 Six principles of first aid

Principle 1: Keep calm in a first aid situation

Technique - Calming down in a first aid situation

Use the following tips to calm down in first aid situations:

Principle 2: Avoid infection

■ Avoid direct contact with blood or body fluids:

When clean running water is available:

4. Rinse your hands well, using plenty of water.

5. Dry your hands with a clean towel or cloth.

When no clean running water is available:

Principle 3: Act as a first aider

Principle 4: Ensure the comfort of the person

Principle 5: Provide psychosocial first aid

Physical reactions Emotional reactions

Cognitive reactions Behavioural reactions

Approaching the person:

■ Approach the person in a respectful, friendly way without any preconceptions.

While providing first aid:

■ Ask permission to touch the person and provide first aid.

What to do if the person is nervous:

Assist the person practically:

What to do if the ill or injured person is a child:

Start the conversation

Assist and support the person

STEP 1: Ensure safety

The safety of the ill or injured person

■ Only move an ill or injured person if:

Technique - Moving an ill or injured person in danger

You are alone

■ If the person is able to stand on one leg and hold onto

1. Stand on the appropriate side of the person:

■ If the person is able to hold onto you, consider carrying

1. Stand in front of the person, facing the same

■ If the person is unconscious, or unable to

1. Bend through both of your knees, while

1. Place the person’s arms against their body

3. Lift the person’s back up to a seated

4. Put both of your arms under the person’s

■ Move the person, using the

1. Stand on one side of the injured

■ Move the person, using the

1. Stand to one side of the injured

There are more than 4 people to help you

1. Position yourself at the head

1. Check the person’s consciousness.

ACTION 1: CHECK FOR CONSCIOUSNESS

Does the person react?

Technique – Turning a person from their stomach to their back

1. Kneel beside the person’s waist.

ACTION 2: OPEN THE AIRWAY AND CHECK FOR BREATHING

How is the person’s breathing?

Technique – Opening the airway

1. Kneel beside the person’s chest.

Technique – Check for breathing

■ Look to see if the chest goes up and down.

ACTION 3: FIND OUT WHAT IS WRONG WITH THE ILL OR

Which type of help should you seek?

How to seek help?

■ Where is the exact location of the emergency?

ACTION 2: OPEN THE AIRWAY AND CHECK FOR BREATHING

ACTION 3: FIND OUT WHAT IS WRONG WITH THE ILL OR