Emergency First Aid

Aims:

• To attain knowledge and practical competences required to

deal with a range of first aid situations

• To attain skills and knowledge to deal with emergencies

appropriately and safely, to prevent exacerbation of injury,

preserve life and prevent lasting harm.

First Aid and Role and Responsibilities

of First AiderFirst Aid is the immediate assistance given to someone who is ill or injured before professional help arrives.

3 AIMS of the First Aider to:

- Preserve life

- Prevent the worsening of any injuries or illness

- Promote recovery

Responsibilities include:

First do no harm and apply calculated risk in all situations

Provide first aid that is: EFFECTIVE, SAFE AND PROMPT

Consider the casualty’s response to First Aid and respect individual choice

Ensure no danger to self

Move danger away from casualty

Do not remove casualty unless they are in further danger.

Communication

Between yourself, casualty and other people around you

• Casualty should feel secure

• Explain and gain consent to provide first aid

• Be confident with positive body language

• Do not overplay your knowledge

• Keep and look calm

• Stay in control of the situation

OTHER PEOPLE can:

• Tell you what has happened

• Summon help

• Assist you, stay with casualty

• Make area safe.

Getting Help

Call 999 or 112, free to dial

Ask for ambulance

Assistance from operator

What information will you need to provide?

Exact address or location

Caller’s name and phone number

What happened

Condition and number casualties

Any other information asked for.

Stay on the phone or operator may

phone you back for updates

Use the hands-free facility if you need to attend to the

casualty at the same time

Average call out is between 8 and 19 minutes

If someone else is making the call you should give them as

much information as possible to pass onto operator and

they should return to you for updates

Non emergency NHS number 111

For advice on how to manage a casualty or

whether ambulance required.

Getting Help

First Aid Hygiene/PPE

Consider risk of infection

No vaccinations against Hep C or HIV

Wash hands with soap and water

Use alcohol gel before and after treatment

Cover up any open wounds or cuts you have

Use disposable gloves or improvise

Be careful not to cut yourself on sharp objects

Do not touch any dressings or blood without protection

If performing rescue breaths use a face shield

Dispose of waste properly.

Loss of Consciousness

This can happen as a result of a serious injury, illness, or

merely by fainting

An unawareness or vagueness

There is a reduced level of response

There is no response at all

Actions:

Check for breathing

Keep the airway open and clear

Try to establish the cause

How do we establish whether the casualty is

breathing?

Primary Survey - DRABC

Quickly assess condition and act promptly

Danger -Check for any danger to you, perform scene survey

Response - Check response “Can you hear me?”

Give command “Open your eyes”

Tap shoulders or pinch ear lobe

Airway - Open airway

Breathing - Check for breathing

Circulation – If breathing - Are they bleeding?

If not breathing – Commence CPR

Primary Survey – if there is a response

If casualty responds to voice commands or touch and if they

are in no further danger:

Leave and summon help, or ask someone to dial 999 or 112

Continue to monitor until help arrives

Be prepared to perform primary survey again if casualty

becomes unresponsive.

Primary Survey – if there is no response

If there is no response to voice commands or touch:

Shout for help

Open the airway by lifting the chin and tilting the head

backwards

Check for breathing by looking, listening and feeling for

breath for 10 seconds

Relay your findings to someone and ask them to call 999/112

and to return to you

If breathing normally check for other life threatening

conditions and treat

Place in recovery position and do not leave them at any time

unless you have to summon help.

The Unresponsive Breathing Casualty and the

Recovery Position

An unresponsive casualty is at risk of dying from a blocked

airway by their tongue, vomit or saliva

Placing them in the recovery position ensures the airway is

patent and clear – recheck breathing after positioning

Continue to assess normal breathing, if in doubt start CPR.

Video demonstration – Recovery Position

The video clip shows how to move an unresponsive but

breathing casualty into the recovery position

Verbal instructions and explanations are included

Remember - the reason you are putting the casualty on

their side in this position is to maintain a clear airway in

order to stop the casualty from choking

Watch the video clip of Recovery Position

Non Breathing Casualty

Cardiopulmonary Resuscitation - CPR

The heart and circulatory system pumps blood around the body

When the heart stops within minutes the brain will be starved of oxygen and brain cells will die, such as following cardiac arrest

You can artificially breathe for and pump oxygen around the body by using chest compressions and rescue breaths

You or someone must call 999 telling the operator the

casualty is NOT breathing or NOT breathing NORMALLY

Collect available AED as quickly as possible.

Adult Basic Life Support Algorithm

CPR

Give 30 chest compressions:

This will manually allow blood to still get around body by

compressing the stopped heart

• Compress the chest by 5-6cm at a rate of 100-120

compressions per minute, too fast and the heart can not

refill with blood.

Give 2 rescue breaths:

This will put oxygen into lungs

• Open airway, create good seal around the mouth

• Pinch the soft tissue of the nostrils closed

• Remove your mouth and allow chest to deflate

after each breath.

CPR

Carry on at the ratio 30:2 until:

• help arrives/AED is ready for use

• the casualty is revived

• you become exhausted

If not able or not happy to do rescue breaths perform 100 –

120 compressions per minute continuously.

Untrained bystanders can perform chest compression only

CPR.

Video demonstration – Primary Survey

and CPR

The video clip shows the primary survey being carried out

in real time, establishing that the casualty is not breathing

or not breathing normally

The first aider then passes the necessary information to her

helper before immediately commencing uninterrupted CPR

Watch the video clip of Primary Survey and CPR

Precautions during the Coronavirus

Pandemic

Please note the advice for looking, listening and feeling for

breath during primary survey has been temporarily changed to

looking for breath only, in order to minimise transmission risk

during the Coronavirus pandemic

It is also advised that rescue breaths

ideally be carried out with the use of a

resuscitation face shield at all times and that

during the Coronavirus pandemic continuous

compression-only CPR should be considered

AED

Automated External Defibrillation

shocks the heart back into a normal

rhythm

Correct position of pads allows for effective shock

Chances of survival falls by around

10% with every min that defibrillation

is delayed

Automatic and semi automatic AEDs.

AED for Sudden Cardiac Arrest

Risks to be aware of: water, metal, implants, patches,

explosives

Pads must be in direct contact with skin so skin must be dry

and hairless – AEDs come with razor and scissors

Cut open clothing and underwired bras

Remove necklaces

Remove any medication patches on chest

Follow verbal and visual instructions

AED will not shock unless required.

Video demonstration - AED

This video demonstrates the correct use of an AED

There are many different makes of AED but remember

once switched on, the AED will tell you what to do

Follow the instructions

ANYONE can use an AED

Watch the video clip of AED

Do not attempt cardio pulmonary

resuscitation - DNACPR

This is decided by the individual and their family alongside

the medical team - taking into account the individuals’ best

interests and whether it would be inappropriate or

ineffective to attempt CPR

In the event of a cardiac or respiratory arrest – no attempts

at CPR are made

All other treatments and care must be provided

During handover, you should be made aware if your client

has a DNR

The form must be immediately available if it is needed in an

emergency. Keeping it in a prominent place in the home is

important.

Recommended Summary Plan for

Emergency Care and Treatment -

ReSPECT

The ReSPECT process records patient preferences

and clinical recommendations forming a personalised plan for

types of emergency care and treatment choices including

whether CPR should be attempted

It is suitable for, but not exclusive to those with complex health needs,

those coming to the end of their lives and those with a risk of sudden

health deterioration or cardiac arrest

The form remains with the individual and should be immediately

available if it is needed in an emergency

The recorded recommendations are not legally binding.

Choking

Death can occur due to choking

Caused by partial or complete blockage

of the airways

Most incidences are minor, can be

cleared by coughing

Confirm with casualty ‘Are you choking?’

Ask casualty to cough.

Choking – Aim and SymptomsRemove the obstruction as quickly as possible

If not possible, call the emergency services

Symptoms of mild choking include:

• Difficulty speaking

• Difficulty coughing

• Difficulty breathing

• Red face

Symptoms of severe choking include:

• Unable to speak

• Unable to cough

• Unable to breathe

• Red face, later turning to grey

• Indicate their neck or throat is the problem

• Collapse.

Choking – Back Blows

Perform 5 back slaps:

- Stand to the side and slightly behind

- Support their chest, lean them forward

- Give 5 sharp blows between the

shoulder blades with the heel of your hand

- Check mouth

- If choking persists proceed to abdominal thrusts.

Choking – Abdominal Thrusts

Perform 5 abdominal thrusts:

- Stand behind, place arms around their

waist and bend them well forward

- Clench your fist and place it above their belly button

- Place other hand on top and thrust both hands

backwards with a hard upward movement

- Check if the blockage has cleared, if not after 1 cycle

- Call 999/112 and start cycle of back blows and abdominal

thrusts until blockage cleared or medical help arrives

- If casualty becomes unresponsive commence CPR.

Video demonstration - Choking

The video demonstrates how to assist a casualty who is

choking and can not cough

Look at how and where the first aider positions her hands

when performing the successful abdominal thrust

Remember – the obstruction may not clear first time. You

do a maximum of 5 abdominal thrusts before resuming

back blows

Watch the video clip of Choking

Choking – Aftercare

After successful back slaps casualty must seek

medical attention. Casualty may have a persistent

cough, difficulty with swallowing or feel there is still

something stuck in their throat

After successful abdominal thrusts casualty must be

assessed by the emergency services as this life saving

procedure can cause serious internal injury.

Seizures

Caused by something that interrupts the normal electrical

activity of the brain

Casualty becomes unresponsive but with involuntary

contractions of the muscles occurring

Most common cause is epilepsy.

Seizures

Symptoms:

• Sudden loss of consciousness, crying out

• Rigid body, arched back, breathing may cease, blueness of

lips. If casualty turns blue airway is compromised. Try to

get casualty on their side and open airway

• Involuntary movements, jerking, clenched jaw

• May lose control of bladder and bowel

• Relaxes after a minute or two, may be sleepy once

regained consciousness

• Confusion.

Seizures

Make surrounding area safe and protect the head

Note time of start and finish of seizure

Loosen tight clothing

When over, ensure clear airway, place in recovery position

Reassure and make comfortable, casualty remains vulnerable

Allow to compose themselves and offer any help needed

Call 999 if casualty has been in convulsive (Clonic) state for 5 minutes, if seizures are repeated or if unresponsive for more than 10 minutes after seizure has stopped, have injured themselves or if first seizure

Do not attempt to hold casualty down

Do not put anything in the mouth during seizure

Do not move casualty until fully conscious (unless turns blue)

Do not give casualty anything by mouth until fully conscious

Do not leave casualty at anytime unless it is unavoidable.

Wounds and Minor External

Bleeding - Cuts, Grazes, Splinters

A wound is a break in the surface of the skin or body

OPEN wound = everyday cuts, grazes, splinters, deep cuts

Consider risk of infection (Tetanus) and risk of

contamination

Wash hands and wear disposable gloves

Check casualty not allergic to plasters or adhesive tape

Clean area around wound with soap and water wiping away

from wound using clean swab for each stroke

Wash, dry and dress open wound with plaster or dressing

without touching sterile side of dressing

Dispose of soiled waste safely.

Minor External Bleeding

Cuts and Grazes

If wound is dirty such as a graze rinse particles

out with running water

If bleeding does not stop, elevate and add more

padding and secure. If bleeding becomes more severe or does

not stop after 10 minutes, seek medical assistance

Small Splinter

Aim to remove splinter and minimise infection

Using tweezers remove in the direction splinter went in

A little bleeding can remove remaining dirt in the wound

Wash, dry and cover with dressing

If embedded or difficult to dislodge do not probe

deeply

Pad around it, cover and get medical help.

Minor BruiseCLOSED wound = a bruise or internal bleeding

Aim of first aid treatment is to reduce blood

flow to the area and minimise swelling

Raise and support the injured area comfortably

Hold a cold compress such as a flannel soaked in cold water

on bruise for 20 mins. Re-soak flannel regularly to keep it

cool

Or using an ice pack (plastic bag with ice cubes/pack of

frozen peas wrapped in a dry cloth) hold on bruise for 20

mins.

Severe External Bleeding

Evidence of blood loss: spurt, trickle, pooling, open fracture

Severe blood loss may result in medical shock (average adult will go into

shock after 2 pints of blood lost)

Evidence of shock: sweaty, cold, clammy, pale skin, rapid pulse and

breathing, nausea, vomiting, thirst, restlessness, becoming less

responsive

Must try to prevent or treat shock

Casualty could lose consciousness

Get medical help urgently call 999

Wash hands, put on gloves

Apply direct PRESSURE to the wound

If embedded object put pressure either side

Dress the wound. If blood soaks through the dressing, remove and start

again

Dispose of used dressings carefully and wash hands.

Bleeding – Do nots

Do not remove embedded objects from wound

Do not use a tourniquet unless instructed to by 999 operator

Do not expose yourself to contact with the casualty’s blood

Do not allow the casualty to eat or drink

Do not leave the casualty alone unless unavoidable.

Watch the video clip of Bandaging

ShockMedical or hypovolaemic shock is a lack of blood supply to

vital organs (heart, lungs, brain)

Not enough blood being pumped around the body

Most common causes:

• Severe blood loss (external and/or internal)

• Burns

• Broken bones

• Severe vomiting and diarrhoea

Medical shock is a life threatening condition.

Shock - Symptoms

What are the symptoms of medical shock?

Pale, cold, clammy skin

Sweating

May have blue tinge around lips

May complain of feeling thirsty

Feel sick, or vomit

Rapid weak pulse

Rapid, shallow breathing

Restless, decreased level of consciousness.

Shock – TreatmentCall 999 to get medical help urgently

Lay casualty flat, raise and support feet to

improve blood supply to brain, heart and lungs

Keep casualty warm, insulate from the ground up

Loosen tight clothing

Treat cause if known such as halt bleeding

Check response and breathing

If UNRESPONSIVE but breathing – place in recovery position

Monitor and be prepared to resuscitate

Do not allow any food or drink

Do not allow casualty to smoke

Do not lie casualty down with raised legs if cause of shock is a head injury – Lay flat with head raised and supported

Do not raise either leg if there is a break above the knee. If break is below knee raise uninjured leg

Do not leave casualty alone unless it is unavoidable.

Minor Burns and Scalds

BURNS are caused by DRY HEAT:

• heat, flames, friction, chemicals, intense cold, radiation, sun

SCALDS are burns caused by WET HEAT:

• moist heat, steam, hot liquids

SYMPTOMS for minor burns/scalds

Skin could be:

• Red

• Swollen

• Blistered

• Painful.

Minor Burns and Scalds

Remove source of heat

Put on disposable gloves

Cool the burn – flood with cool running water for at least 20 minutes

Remove clothing or jewellery in case of swelling

Minimise risk of infection – cover with a burns dressing, non fluffy

sterile dressing or cling film

For burns to hands and feet – plastic bag useful.

Burns and Scalds – Do nots

Do not apply lotions or creams

Do not use fluffy materials or adhesive dressings

Do not bandage tightly

Do not allow casualty to eat or drink

Do not remove clothing or jewellery if it is stuck to the skin

Do not break blisters

Do not overcool

Do not apply a dressing to a facial burn

Remember airway is priority. If someone has burnt their airway they

can have sips of water to cool it.

Fractures

A break or crack in the bone (open, closed, stable, unstable)

Can be difficult to determine whether they have done

damage

Due to accident or injury such as falling

Suspect if:

History of recent fall

Snapping sound heard

Difficulty moving limb

Severe pain, tenderness, bruising, discolouration,

distortion, swelling

Bones protruding through the skin

Limbs out of position.

Fractures

Call for medical assistance 999/112

Protect and support injured limb using padding

If necessary immobilise limb, sling for arm, secure injured leg to uninjured one with bandage

Make casualty as comfortable as possible

Keep casualty calm

Observe for shock and treat if necessary

For open fracture, apply clean padding

around the bone until you can bandage over

it without pressing on the injury

Do not allow the casualty to have anything to eat or drink

Do not move your casualty unless it is necessary

Do not leave the casualty unless it is unavoidable.

Dislocation

A joint injury caused by strong force or muscle contraction

Bone partially or completely pulled out of normal position:

Shoulder, hip, knee, jaw, thumbs, fingers, vertebrae

Can tear tendons, damage nerves and cause fractures

Severe pain, inability to move joint, swelling,

bruising, deformity, shortening, bending of joint

Difficult to distinguish closed fracture from

a dislocation – any doubt treat as fracture.

DislocationDo not attempt to replace dislocation into socket

Do not move casualty until injury supported or immobilised

Remove jewellery and watches in case of swelling

Do not allow casualty to eat or drink

For shoulder dislocation:

Advise casualty to remain still

Support injured arm in comfortable position

Immobilise arm with a sling, if casualty allows

Casualty needs hospital treatment

Treat for shock if necessary but do not raise an injured leg,

elevate uninjured leg only

Monitor casualty.

Watch video clip of Applying a Sling

Sprains and Strains

A sprain affects ligament tissue, a stretch and/or tear to a

ligament (ligaments connect bone to bone)

Caused by a fall, a sudden twist or a blow

May be popping or tearing sound when

injury happened

Pain, swelling, bruising with instability,

and loss of ability to move or use the

joint

A strain is an injury to a muscle or tendon (tendons connect

bone to muscle)

Caused by twisting or pulling after recent trauma or overuse

Pain, limited movement, muscle spasms,

localised swelling, inflammation.

Sprains and Strains – Treatment

Sprains and strains usually treated similarly

Aim is to

• Reduce swelling

• Relieve pain

• Make casualty as comfortable as possible

Treatment can be remembered by RICE

• Rest

• Ice (indirectly) for 20 mins

• Comfortable support

• Elevation.

The casualty should recover within a few days.

Head Injury

Following a head injury symptoms can include:

Open or closed wound

Headache

Nausea and vomiting

Pale, clammy skin

Feeling dizzy or sleepy

Impaired vision

Being unsteady

Memory loss

Could be due to concussion (injury jolts the brain), skull

fracture (break in the skull) or compression injury (causing

bleeding or swelling inside skull pressing

on brain).

Head Injury - Treatment

Sit or lay the casualty down with head raised

If closed wound – apply cold compress

If open wound – apply dressing or bandage

Monitor carefully as condition may change

Consider possible spinal injury

Get medical help if necessary

When should a casualty with a head injury go to

hospital?

Head Injury - 999

Hospitalisation required if:

Previous symptoms worsen

Persistent headache

Vomiting episodes

**The casualty is aged 65 or over**

Seizures

Confusion, dizziness, loss of balance/memory

Difficulty speaking or walking

Casualty is taking anti-clotting medication

Dilated or fixed pupils or double vision

Straw coloured fluid/blood from ears or nose

Casualty under influence of alcohol or drugs

Casualty loses consciousness

If no responsible person to monitor them.

Spinal Injury

Possible causes:

Violent forward or backward bending or

twisting of the spine

Falling from height, horse, motorbike

Falling awkwardly

Diving into shallow water and hitting the bottom

Collapsed rugby scrum

Sudden impact in motor vehicle

Heavy object falling on the back

Injury to the head or face.

Spinal Injury

Symptoms:

Pain in back and/or neck

Deformity or twist in the spine

Bruising/pain in skin over spine

Consider damage to spinal cord – pinched, partly or

completely severed could cause weakness, burning,

tingling, stiffness or loss of limb control

Loss of bladder/bowel control

Breathing difficulties.

Spinal InjuryIf casualty is conscious:

Advise casualty not to move

Call 999/112

Kneel behind casualty’s head, steady and support the head

with spread fingers keeping head, neck and spine in

alignment

Ask helper to place rolled towels/blankets/clothing either side

of the head

Continue to hold head in neutral position until medical help

arrives

Helper should monitor casualty’s vital signs.

The Unresponsive Breathing Casualty with Suspected

Neck or Spinal Injury

Must not be moved unless breathing is compromised

• Do not tilt neck, keep it steady and still

• Steady and support the head and use jaw thrust to open

airway by: Placing hands either side of the face

• With fingertips at the jaw angle gently lift the jaw open

The Unresponsive Breathing Casualty with

Suspected Neck or Spinal Injury

If you hear or suspect fluid build up in the throat whilst

performing jaw thrust technique, airway may be compromised.

Place casualty on their side keeping spine as straight as

possible – ideally you will need helper assistance to do this

If you are alone and need to leave the casualty to get help

and the casualty is unable to maintain an open airway, place

them in the recovery position.

Angina

Pain or discomfort in chest, caused by narrowing

of one or more arteries in the heart muscle

Usually after exertion, in cold weather, emotional upset

Lasts a few minutes

Often confused with indigestion

TREATMENT:

Sit casualty in ‘W’ position with back supported

Nitrates (GTN) given as a mouth spray or dissolvable

tablets/ melts to relieve symptoms

Can cause headaches

If no relief after 2 x meds 5 mins apart, call 999

Remember someone who has angina is much more likely to have a heart

attack.

Angina

Heart Attack

Heart Attack

Caused by blood supply to the heart muscle suddenly being

completely blocked

Crushing vice like pain in the chest, jaw and down left arm

No response after nitrate spray

Breathless, clammy skin, ashen face, pale

Feel sick

Feel faint

Sense of doom

Sudden collapse.

Heart Attack – Treatment

Keep casualty calm

Sit them down in ‘W’ position

Loosen tight clothing

Summon help as soon as possible, call 999

If casualty has GTN spray, encourage and repeat if

necessary

300mg Aspirin can be chewed if sure casualty not allergic

Ask 999 if you are unsure whether to give Aspirin

Observe closely

If becomes unresponsive, conduct primary survey and if

breathing place in recovery position

Monitor and be prepared to perform CPR.

Stroke

Stroke is caused by part of the brain’s blood supply being cut off

and preventing enough oxygen and nutrients getting to the

brain cells causing their death

Due to a blood clot or a bleed

Stroke

Every year 150,000 people in the UK have a stroke

Every 5 minutes someone has a stroke

Most are over 65 years of age

1000 people under 30 each year have a stroke

4th most common cause of death in the UK

More than 900,000 people in the UK live with disabilities

following a stroke

Transient Ischaemic Attacks (TIA) or mini strokes – similar to

a full stroke, lasts for a few minutes and could lead to a full

stroke

Watch the FAST clip

Stroke Awareness - FAST Test

Facial weakness: cheek, smile, mouth or eye drooped?

Arm weakness: can they raise both arms?

Speech problems: clear speech, understand what you are

saying?

Time: call 999 A medical emergency

Keep casualty comfortable and monitor until help arrives. If in

a chair – leave them in sitting position

If on floor – raise head slightly and support it

Do not allow eating or drinking.