REVISED
10TH EDITION
FIRST AID MANUAL
WRITTEN AND AUTHORISED BY THE UK’S LEADING FIRST AID PROVIDERS
The Authorised Manual of St John Ambulance,
St Andrew’s First Aid and the British Red Cross
St John Ambulance
Dr Margaret Austin DStJ LRCPI LRCSI LM
Chief Medical Adviser
St Andrew’s First Aid
Mr Rudy Crawford MBE BSc (Hons) MB ChB FRCS (Glasg) FRCEM
Chairman of the Board
British Red Cross
Dr Barry Klaassen BSc (Hons) MB ChB FRCS (Edin) FRCEM
Chief Medical Adviser
REVISED
10TH EDITION
LONDON, NEW YORK, MUNICH, MELBOURNE, DELHI
Consultant editor
Jemima Dunne
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DORLING KINDERSLEY
Text revised in line with the latest guidelines from the Resuscitation Council (UK).
Note: The masculine pronoun “he” is used when referring to the first aider or casualty, unless the individual shown
in the photograph is female. This is for convenience and clarity and does not reflect a preference for either sex.
Revised 10th edition first published in Great Britain in 2016 by
Dorling Kindersley Limited, 80 Strand, London WC2R 0RL
A Penguin Random House Company
2 4 6 8 10 9 7 5 3 1
001 –289239–July/2016
Text copyright © 2016 St John Ambulance;
St Andrew’s First Aid; The British Red Cross Society
Illustration copyright © 2016 Dorling Kindersley Limited, except as listed in acknowledgments on p.288
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of the copyright owners.
All enquiries regarding any extracts or re-use of any material in this book should be addressed
to the publishers, Dorling Kindersley Limited. A CIP catalogue record for this book is available from the British Library
ISBN: 978-0-2412-4123-3
Printed and bound in Slovakia
Discover more at
www.dk.com
St John Ambulance is a registered charity (No. 1077265/1); St Andrew’s First Aid is the trading name of St Andrew’s Ambulance
Association, incorporated by Royal Charter 1899, is a charity registered in Scotland (No. SC006750); The British Red Cross Society,
incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949), Scotland (SC037738), and the Isle of Man
(0752). Each charity receives a royalty for every copy of the book sold by Dorling Kindersley. Details of the royalties payable can be
obtained by writing to the publishers, Dorling Kindersley Limited, at 80 Strand, London WC2R 0RL. For the purposes of the Charities
Acts no further seller of this book shall be deemed to be a commercial participator with these three Societies.
THE FIRST AID SOCIETIES
Drawing on hundreds of years of combined experience, the First Aid Societies are the
acknowledged experts in training and practising first aid. Each society offers distinct charitable,
voluntary and training services, but all work together to raise standards in first aid. Our medical
advisers have based the advice in this book on the most up-to-date research, and our training
experts have presented it in a way that is both easy to learn and easy to recall.
ST JOHN AMBULANCE
As the nation’s leading first aid charity, St John
Ambulance believes that no one should die
because they needed first aid and did not get it.
This is why we teach people first aid (in schools,
workplaces and the community), equipping
them with the skills to be the difference
between life and death. Some of the people we
teach go on to become one of our 40,000
volunteers, providing first aid at events, acting
as first responders to NHS emergency calls in
the community, or supporting their local
ambulance service.
You too can be the difference between a life
lost and a life saved. To find out how, visit
sja.org.uk, or call 08700 10 49 50
ST ANDREW’S FIRST AID
St Andrew’s First Aid is Scotland’s dedicated
first aid charity and provider of first aid training,
services and supplies. Our volunteers provide
essential first aid services in communities
across Scotland, including cover for events large
and small, and teach life-saving skills to others.
We also supply a full range of first aid products
and training materials to first aid professionals,
industry and the general public.
■■ Visit www.firstaid.org.uk
■■Email info@firstaid.org.uk
■■Call 0141 332 4031
BRITISH RED CROSS
As part of the world’s largest provider of first
aid, the British Red Cross trains tens of
thousands of people in the UK every year,
building resilience within communities and
preparing them to cope with all types of
emergencies. Our courses provide training for
every need, including treatment for adult, child
and baby and first aid at work. Through our
global network of volunteers we also provide
first aid cover at public events, respond to
natural disasters conflicts and individual
emergencies.
■■The British Red Cross – refusing to ignore
people in crisis
■■For more information and to learn about first
aid, visit:
redcross.co.uk/firstaid
or call us to book a course on 0344 412 2808
CONTENTS
What is a first aider? ________________________________________ 14
How to prepare yourself ___________________________________ 15
Protection from infection ________________________________ 16
Dealing with a casualty ____________________________________ 19
Requesting help ________________________________________________ 22
The use of medication ______________________________________ 24
Remember your own needs _____________________________ 24
26
Assessing the sick or injured __________________________ 40
Mechanisms of injury _____________________________________ 42
Primary survey ________________________________________________ 44
Secondary survey ___________________________________________ 46
Head-to-toe examination _______________________________ 49
Monitoring vital signs _____________________________________ 52
38
54
Breathing and circulation ________________________________ 56
Life-saving priorities ________________________________________ 57
Unresponsive adult _________________________________________ 62
Unresponsive child __________________________________________ 72
Unresponsive infant _______________________________________ 80
How to use an AED __________________________________________ 84
88
The respiratory system ___________________________________ 90
Hypoxia ____________________________________________________________ 92
Airway obstruction __________________________________________ 93
Choking adult __________________________________________________ 94
Choking child ___________________________________________________ 95
Choking infant ________________________________________________ 96
Hanging and strangulation _____________________________ 97
Inhalation of fumes _________________________________________ 98
10
Action at an emergency ___________________________________ 28
Traffic incidents _______________________________________________30
Fires __________________________________________________________________ 32
Electrical incidents ___________________________________________ 34
Water incidents _______________________________________________ 36
Major incidents ________________________________________________ 37 RESPIRATORY
PROBLEMS
MANAGING AN
INCIDENT
BECOMING A
FIRST AIDER
ASSESSING
A CASUALTY
INTRODUCTION
THE UNRESPONSIVE
CASUALTY
12
Drowning _______________________________________________________100
Hyperventilation ___________________________________________ 101
Asthma ___________________________________________________________ 102
Croup ______________________________________________________________ 103
Penetrating chest wound ______________________________ 104
106
The heart and blood vessels __________________________ 108
Bleeding and types of wound ________________________ 110
Shock _______________________________________________________________ 112
Severe external bleeding ________________________________ 114
Internal bleeding ____________________________________________ 116
Impalement _____________________________________________________ 117
Amputation _____________________________________________________ 117
Crush injury _____________________________________________________ 118
Cuts and grazes _______________________________________________ 119
Bruising ___________________________________________________________ 119
Blisters ___________________________________________________________ 120
Infected wound ______________________________________________ 120
Foreign object in a wound ______________________________ 121
Scalp and head wounds __________________________________122
Eye wound _______________________________________________________123
Bleeding from the ear _____________________________________123
Nosebleed _______________________________________________________124
Knocked-out adult tooth _______________________________ 125
Bleeding from the mouth _______________________________ 125
Finger wound __________________________________________________126
Wound to the palm ________________________________________ 127
Wound at a joint crease _________________________________ 127
Abdominal wound ___________________________________________128
Vaginal bleeding ______________________________________________128
Bleeding varicose vein ____________________________________129
130
The skeleton __________________________________________________ 132
Bones, muscles and joints _______________________________134
Fractures ________________________________________________________ 136
Dislocated joint _____________________________________________ 139
Strains and Sprains ________________________________________ 140
The brain and nerves ______________________________________142
Head injury ______________________________________________________144
Facial injury _____________________________________________________146
Lower jaw injury ______________________________________________147
Cheekbone and nose injury ____________________________147
Collar bone injury ____________________________________________148
Shoulder injury ________________________________________________149
Upper arm injury ____________________________________________150
Elbow injury ______________________________________________________151
Forearm and wrist injuries _____________________________ 152
Hand and finger injuries _________________________________ 153
Rib injury __________________________________________________________154
Pelvic injury______________________________________________________ 155
Back pain ________________________________________________________ 156
Spinal injury ____________________________________________________ 157
Hip and thigh injuries ____________________________________ 160
Lower leg injuries __________________________________________ 162
Knee injury ______________________________________________________ 164
BONE, JOINT
WOUNDS AND MUSCLE INJURIES
AND BLEEDING
MEDICAL
CONDITIONS 208
Foreign object in the eye ________________________________196
Foreign object in the ear _________________________________197
Foreign object in the nose ______________________________197
How poisons affect the body __________________________198
Types of poison _______________________________________________199
Swallowed poisons _______________________________________ 200
Drug poisoning ______________________________________________ 201
Alcohol poisoning _________________________________________ 202
Animal and human bites ______________________________ 203
Insect sting ____________________________________________________ 204
Tick bite _________________________________________________________ 205
Other bites and stings __________________________________ 205
Snake bite ______________________________________________________ 206
Stings from sea creatures _____________________________ 207
Marine puncture wound _______________________________ 207
Angina ____________________________________________________________ 210
Heart attack ____________________________________________________ 211
Stroke _____________________________________________________________ 212
Diabetes mellitus ___________________________________________ 214
Hyperglycaemia _____________________________________________ 214
Hypoglycaemia ______________________________________________ 215
Seizures in adults ___________________________________________ 216
Seizures in children ________________________________________ 218
Fever _______________________________________________________________ 219
Meningitis _____________________________________________________ 220
The skin __________________________________________________________ 170
Assessing a burn ____________________________________________ 172
Severe burns and scalds ________________________________ 174
Minor burns and scalds _________________________________ 176
Burns to the airway _________________________________________ 177
Electrical burn _________________________________________________ 178
Chemical burn _______________________________________________ 179
Chemical burn to the eye ______________________________ 180
Flash burn to the eye ______________________________________ 181
Incapacitant spray exposure __________________________ 181
Dehydration ___________________________________________________ 182
Sunburn __________________________________________________________ 183
Heat exhaustion _____________________________________________ 184
Heatstroke ______________________________________________________ 185
Hypothermia __________________________________________________ 186
Frostbite _________________________________________________________ 189
The sensory organs _________________________________________192
Splinter ____________________________________________________________194
Embedded fish-hook ______________________________________ 195
Swallowed foreign object ______________________________ 195
Ankle injury ____________________________________________________ 165
Foot and toe injuries ______________________________________166
Cramp ____________________________________________________________ 167
168
190
EFFECTS OF
HEAT AND COLD
FOREIGN OBJECTS,
POISONING, BITES & STINGS
Fainting __________________________________________________________ 221
Allergy ____________________________________________________________ 222
Anaphylactic shock ________________________________________ 223
Headache _______________________________________________________ 224
Migraine _________________________________________________________ 224
Sore throat _____________________________________________________ 225
Earache and toothache __________________________________ 225
Abdominal pain _____________________________________________ 226
Vomiting and diarrhoea _________________________________ 227
Childbirth _______________________________________________________ 228
Emergency childbirth _____________________________________ 229
Removing clothing _________________________________________ 232
Removing headgear _______________________________________ 233
Casualty handling __________________________________________ 234
First aid materials __________________________________________ 235
Dressings ________________________________________________________ 238
Cold compresses ____________________________________________ 241
Principles of bandaging _________________________________ 242
Roller bandages ____________________________________________ 244
Tubular gauze bandages ________________________________ 248
Triangular bandages _______________________________________249
Reef knots ______________________________________________________250
Hand and foot cover bandage _______________________250
Arm sling _________________________________________________________ 251
Elevation sling ________________________________________________ 252
Improvised slings ___________________________________________ 253
Action in an emergency ________________________________ 256
CPR for an adult _____________________________________________ 258
Chest-compression-only CPR ________________________ 258
CPR for a child ______________________________________________ 260
CPR for an infant ___________________________________________ 260
Heart attack __________________________________________________ 262
Stroke _____________________________________________________________ 262
Choking adult _______________________________________________ 264
Choking child ________________________________________________ 264
Choking infant ______________________________________________ 266
Meningitis _____________________________________________________ 266
Asthma ___________________________________________________________ 268
Anaphylactic shock ________________________________________ 268
Severe external bleeding ______________________________ 270
Shock _____________________________________________________________ 270
Head injury _____________________________________________________ 272
Spinal injury ____________________________________________________ 272
Broken bones _________________________________________________ 274
Burns and scalds ____________________________________________ 274
Seizures in adults ___________________________________________ 276
Seizures in children ________________________________________ 276
Swallowed poisons _________________________________________ 278
Hypoglycaemia ______________________________________________ 278
First aid regulations _________________________________ 280
Index ________________________________________________________ 282
Acknowledgments ____________________________________288
TECHNIQUES
AND EQUIPMENT
EMERGENCY
FIRST AID
230
254
10
INTRODUCTION
HOW TO USE THIS BOOK
This publication, now in its revised 10th
edition, is the authorised manual of the First
Aid Societies – St John Ambulance, St Andrew’s
First Aid and the British Red Cross. Together,
they have endeavoured to ensure that this
manual reflects the relevant guidance from
informed authoritative sources, current at the
time of publication. While the material
contained here provides guidance on initial care
and treatment, it must not be regarded as a
substitute for medical advice.
The First Aid Societies do not accept
responsibility for any claims arising from the
use of this manual when the guidelines have
not been followed. First aiders are advised to
keep up-to-date with developments, to
recognise the limits of their competence and to
obtain first-aid training from a qualified trainer.
The first three chapters provide background
information to help you examine your role as a
first aider, manage a situation safely and learn
how to assess a sick or injured person
effectively. Treatment for injuries and conditions
is given in specific chapters that follow. Lifesaving
treatment for an unresponsive casualty
has an entire chapter. In other chapters, injuries
and conditions are grouped either by body
system, for example Respiratory Problems or by
the type of injury, such as Wounds and Bleeding
and Effects of Heat and Cold.
The chapters are grouped by body system or
cause of injury. Within the chapters there are
easy-to-understand anatomy features that
explain the risks involved with particular
injuries or conditions and how and why first
aid can help.
ANATOMY
INTRODUCTION
Colour-coded chapters
help you find relevant
sections easily
Introduction gives an
overview of the anatomy
for the section
Clear computer-generated
artworks of body systems
illustrate essential anatomy
Additional artworks
provide extra information
108 109
the heart and blood vessels
key
key
The heart and the blood vessels make up the
circulatory system. These structures supply the
body with a constant flow of blood, which
brings oxygen and nutrients to the tissues and
carries waste products away.
Blood is pumped around the body by
rhythmic contractions (beats) of the heart
muscle. The blood runs through a network
of vessels, divided into three types: arteries,
veins and capillaries. The force that is exerted
by the blood flow through the main arteries
is called blood pressure. The pressure varies
with the strength and phase of the
heartbeat, the elasticity of the arterial
walls and the volume and thickness
of the blood.
The heart pumps blood by muscular
contractions called heartbeats, which are
controlled by electrical impulses generated
in the heart. Each beat has three phases:
diastole, when the blood enters the heart; atrial
systole, when it is squeezed out of the atria
(collecting chambers); and ventricular systole,
when blood leaves the heart.
In diastole, the heart relaxes. Oxygenated
blood from the lungs flows via the pulmonary
veins into the left atrium. Blood that has given
up its oxygen to body tissues (deoxygenated
blood) flows from the venae cavae (large veins
that enter the heart) into the right atrium.
In atrial systole, the two atria contract and the
valves between the atria and the ventricles
(pumping chambers) open so that blood flows
into the ventricles.
During ventricular systole, the ventricles
contract. The thick-walled left ventricle forces
blood into the aorta (main artery), which carries
it to the rest of the body. The right ventricle
pumps blood into the pulmonary arteries, which
carry it to he lungs to collect more oxygen.
how the heart functions
wounds and bleeding the heart and blood vessels
How blood circulates
Oxygenated blood passes
from the lungs to the heart,
then travels to body tissues via the
arteries. Blood that has given up its
oxygen (deoxygenated blood) returns
to the heart through the veins.
Capillary networks
A network of fine blood vessels
(capillaries) links arteries and veins within
body tissues. Oxygen and nutrients pass
from the blood into the tissues; waste
products pass from the tissues into the
blood, through capillaries. The heart
This muscular organ pumps blood
around the body and then to the
lungs to pick up oxygen. Coronary
blood vessels supply the heart
muscle with oxygen and nutrients.
Carotid artery
Brachial vein
Jugular vein
Aorta
Heart
muscle
Superior
vena cava
Coronary
artery
Inferior
vena cava
Capillary
Small artery
(arteriole)
Small vein
(venule)
Radial vein
Femoral vein
Pulmonary arteries carry
deoxygenated blood to
lungs
Pulmonary veins carry
oxygenated blood from
lungs to heart
Heart pumps blood
around body
Vena cava carries
deoxygenated blood from
body tissues to heart
Brachial artery
Radial artery
Femoral artery
Aorta carries oxygenated
blood to body tissues
Pulmonary
artery
Blood flow through the heart
The heart’s right side pumps deoxygenated blood from
the body to the lungs. The left side pumps oxygenated
blood to the body via the aorta.
The blood cells
Red blood cells contain haemoglobin,
a red pigment that enables the cells
to carry oxygen. White blood cells
play a role in defending the body
against infection. Platelets help
blood to clot.
Right atrium
Right ventricle
Valve
Left
ventricle
White blood cell
Platelet
Left atrium
Ascending aorta carries
blood to upper body
Superior vena
cava carries
blood from
upper body
Inferior vena
cava carries
blood from
lower body
Descending aorta carries
blood to lower body
Pulmonary arteries
carry deoxygenated
blood to lungs
Red blood cell
There are about 6 litres (6 pints), or 1 litre per
13kg of body weight (1 pint per stone), of blood
in the average adult body. Roughly 55 per cent
of the blood is clear yellow fluid (plasma). In this
fluid are suspended the red and white blood
cells and the platelets, all of which make up
the remaining 45 per cent.
composition of blood
Vessels carrying oxygenated blood
Vessels carrying oxygenated blood
Vessels carrying deoxygenated blood
Vessels carrying deoxygenated blood
11
176 177
EFFECTS OF HEAT AND COLD MINOR BURNS AND SCALDS | BURNS TO THE AIRWAY
MINOR BURNS AND SCALDS BURNS TO THE AIRWAY
SEE ALSO Hypoxia p.92 | Shock pp.112–13 | The unresponsive casualty pp.54–87
■■ Reddened skin
■■ Pain in the area of the burn
Later there may be:
■■ Blistering of the affected skin
There may be:
■■ Soot around the nose or mouth
■■ Singeing of the nasal hairs
■■ Redness, swelling or actual burning
of the tongue
■■ Damage to the skin around the
mouth
■■ Hoarseness of the voice
■■ Breathing difficulties
■■ To stop the burning
■■ To relieve pain and swelling
■■ To minimise the risk of infection
■■ To maintain an open airway
■■ To arrange urgent removal
to hospital
RECOGNITION
RECOGNITION
YOUR AIMS
YOUR AIMS
Small, superficial burns and scalds are often due to domestic
incidents, such as touching a hot iron or oven shelf. Most minor
burns can be treated successfully by first aid and will heal
naturally. However, you should advise the casualty to seek
medical advice if you are at all concerned about the severity
of the injury (Assessing a burn, pp.172–73).
After a burn, blisters may form. These thin “bubbles”
are caused by tissue fluid leaking into the burnt area just
beneath the skin’s surface. You should never break a blister
caused by a burn because you risk introducing infection
into the wound. WHAT TO DO
WHAT TO DO
Call 999/112 for emergency help. Tell ambulance control that
you suspect burns to the casualty’s airway.
Flood the injured part
with cold water for at least
ten minutes or until the pain is
relieved. If there is no water
available, any cold, harmless
liquid, such as milk or canned
drinks, can be used.
Reassure the casualty. Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while waiting for
emergency help to arrive.
Seek medical advice if the
casualty is a child, or if you
are in any doubt about the
casualty’s condition.
Take any steps possible to improve the casualty’s air supply, such
as loosening clothing around his neck.
Gently remove any
jewellery, watches, belts
or constricting clothing from
the injured area before it begins
to swell.
Offer the casualty ice or small sips of cold water to reduce
swelling and pain.
When the burn is cooled,
cover it with kitchen film or
place a clean plastic bag over a
foot or hand. Apply the kitchen
film lengthways over the burn,
not around the limb because the
tissues swell. If you do not have
kitchen film or a plastic bag, use a
sterile dressing or a non-fluffy pad,
and bandage loosely in place.
4
4
2
2
1
1
3
3
Any burn to the face, mouth or throat is very serious because
the air passages rapidly become swollen. Usually, signs of
burning will be evident. Always suspect damage to the airway if
a casualty sustains burns in a confined space since he is likely to
have inhaled hot air or gases.
There is no specific first aid treatment for an extreme case of
burns to the airway; the swelling will rapidly block the airway,
and there is a serious risk of hypoxia. Immediate and specialised
medical help is required.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
■■ Do not break blisters or
otherwise interfere with the
injured area.
■■ Do not apply adhesive dressings
or adhesive tape to the skin;
removing them may tear
damaged skin.
■■ Do not apply ointments or fats;
they may damage tissues and
increase the risk of infection.
■■ The use of specialised dressings,
sprays and gels to cool burns is
not recommended.
■■ Do not put blister plasters on
blisters caused by a burn.
CAUTION CAUTION
Never burst a blister; they
usually need no treatment.
However, if a blister breaks or
is likely to burst, cover it with
a non-adhesive sterile dressing
that extends well beyond the
edges of the blister. Leave
the dressing in place until
the blister subsides.
SPECIAL CASE BLISTERS
SEE ALSO Assessing a burn pp.172–73
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INTRODUCTION | HOW TO USE THIS BOOK
The main part of the book features seven
colour-coded chapters that outline first aid for
over 110 conditions or injuries. For each entry
there is an introduction that describes the risks
and the likely cause, then first aid treatment is
shown in clear step-by-step instructions.
At the back of the manual is a quick-reference
emergency section. This provides additional
at-a-glance action plans summarising treatment
for potentially life-threatening injuries and
conditions ranging from unresponsiveness and
bleeding to asthma and heart attack.
CONDITIONS AND INJURIES
EMERGENCY ADVICE
Special Case boxes highlight
instances where alternative
action may be required
Step-by-step instructions
explain each stage of treatment
Introductory text describes
background and effects of
each condition
Lists of recognition features
help you identify a condition
Your Aims boxes summarise
purpose of first aid
See also references direct
you to related conditions
Recognition lists repeated to
provide quick identification
of a condition
Cross references guide you
back to the main article in
the book
Every step described is
illustrated for instant advice
Caution boxes advise on
possible complications
274 275
EMERGENCY FIRST AID
BROKEN BONES
BURNS AND SCALDS
Help the casualty to support the
affected part at the joints above
and below the injury, in the most
comfortable position.
Immediately flood the injury
with cold water; cool for at least
ten minutes or until pain is
relieved. Make the casualty
comfortable by helping him to
sit or lie down and protect the
injured area from contact with
the ground.
Place padding, such as towels or
cushions, around the affected
part, and support it in a
comfortable position.
Call 999/112 for emergency help
if necessary. Tell ambulance
control that the injury is a burn
and explain what caused it, and
the estimated size and depth.
For extra support or if help is
delayed, secure the injured part to
an uninjured part of the body. For
upper body injuries, use a sling;
for lower limb injuries, use broadand
narrow-fold bandages. Tie
knots on the uninjured side.
While you are cooling the burn,
carefully remove any clothing or
jewellery from the area before it
starts to swell; a helper can do this
for you. Do not remove anything
that is sticking to the burn.
A casualty with an arm injury
could be taken by car if not in
shock; a leg injury should go by
ambulance, so call 999/112 for
emergency help. Treat for shock.
Monitor and record the casualty’s
breathing, pulse and level of
response while waiting for help.
When cooled cover the burn with
kitchen film placed lengthways
over the injury, or use a plastic
bag. Alternatively, use a sterile
dressing or clean, non-fluffy pad.
Monitor and record the casualty’s
vital signs while waiting for help
to arrive.
SUPPORT
INJURED PART
START TO COOL
BURN
PROTECT INJURY
WITH PADDING
CALL FOR
EMERGENCY
HELP
SUPPORT WITH
SLINGS OR
BANDAGES
REMOVE ANY
CONSTRICTIONS
TAKE OR SEND
CASUALTY TO
HOSPITAL
COVER BURN
FIND OUT MORE pp.136–38
FIND OUT MORE pp.174–75
4
4
3
3
2
2
1
1
BROKEN BONES | BURNS AND SCALDS
■■ Do not attempt to move an injured
limb unnecessarily, or if it causes
further pain.
■■ If there is an open wound, cover
it with a sterile dressing or a
clean, non-fluffy pad and bandage
it in place.
■■ Do not give the casualty anything
to eat or drink as an anaesthetic
may be needed.
■■ Do not raise a broken leg when
treating a casualty for shock.
■■ Do not apply lotions, ointment or
fat to a burn; specialised burn
dressings are also not
recommended.
■■ Do not use adhesive dressings.
■■ Do not touch the burn or burst
any blisters.
■■ If the burn is severe, treat the
casualty for shock (pp.270–71).
■■ If the burn is on the face, do not
cover it. Keep cooling with water
until help arrives.
■■ If the burn is caused by contact
with chemicals, wear protective
gloves and cool for at least
20 minutes.
■■Watch the casualty for signs of
smoke inhalation, such as difficulty
breathing.
CAUTION
CAUTION
■■ Deformity, swelling and bruising
at the injury site
■■ Pain and difficulty in moving the
injured part
There may be:
■■ Bending, twisting or shortening of
a limb
■■ A wound, possibly with bone ends
protruding
There may be:
■■ Possible areas of superficial, partialthickness
and/or full-thickness burns
■■ Pain in the area of the burn
■■ Breathing difficulties if the airway
is affected
■■ Swelling and blistering of the skin
■■ Signs of shock
RECOGNITION
RECOGNITION
274-275_Emergency_First_Aid.indd All Pages 09/03/2016 11:24
Caution boxes alert you to
potential risks or alternative
treatments
First aid is the initial assistance or
treatment given to a person who
is injured or taken ill. The person
who provides this help is a first aider.
This chapter prepares you for being a first
aider, psychologically and emotionally, as
well as giving practical advice on what you
should and should not do in an emergency.
The information provided throughout
this book will help you to provide effective
first aid to any casualty in any situation.
However, to become a fully competent first
aider, you should complete a recognised
first aid learning programme. Completing
this will strengthen your skills and increase
your confidence. St John Ambulance,
St Andrew’s First Aid and the British Red
Cross are all able to provide first aid
education tailored to your needs.
■■ To understand your own abilities and limitations
■■ To stay safe and calm at all times
■■ To assess a situation quickly and calmly and summon
help if necessary
■■ To assist the casualty and provide the necessary
treatment, with the help of others if possible
■■ To pass on relevant information to the emergency
services, or the person who takes responsibility for
the casualty
■■ To be aware of your own needs
AIMS AND OBJECTIVES
BECOMING A
FIRST AIDER
14
BECOMING A FIRST AIDER
WHAT IS A FIRST AIDER?
First aid refers to the actions taken in response
to someone who is injured or taken ill. A first
aider is a person who takes this action while
taking care to keep everyone involved safe
(p.28) and to cause no further harm while doing
so. Using the guidelines set out in this book, you
should take actions that most benefit the
casualty. Always take into account your own
skills, knowledge and experience.
This chapter prepares you for the role of first
aider by providing guidance on responding to
a first aid situation and assessing the priorities
for the casualty. There is advice on the
psychological aspect of giving first aid and
practical guidance on how to protect yourself
and a casualty. Chapter 2, Managing an Incident
(pp.26–37), provides guidelines on dealing with
events such as traffic or water incidents or
fires. Chapter 3, Assessing a Casualty
(pp.38–53), looks at the practical steps to
take when assessing a sick or injured person.
One of the primary rules of first aid is to
ensure that an area is safe for you before you
approach a casualty (p.28). Do not attempt
heroic rescues in hazardous circumstances.
If you put yourself at risk, you are unlikely
to be able to help others and you could
become a casualty. If it is not safe, do not
approach the casualty, but call 999/112 for
emergency help.
■ Assess a situation quickly and calmly.
■ Protect yourself and any casualties from
danger – never put yourself at risk (p.28).
■ Prevent cross infection between yourself and
the casualty as far as possible (p.16).
■ Comfort and reassure casualties at all times.
■ Assess the casualty: identify, as far as you
can, the injury or nature of illness affecting a
casualty (pp.38–53).
■ Give early treatment, and treat the casualties
with the most serious (life-threatening)
conditions first.
■ Arrange for appropriate help: call 999/112
for emergency help if you suspect serious
injury or illness; in England, call 111 for a less
serious condition; take or send the casualty to
hospital; seek medical advice, or take him
home. Stay with the casualty until the right
care is available.
FIRST AID PRIORITIES
Assessing an incident
When you come across an incident stay calm and
support the casualty. Ask him what has happened.
Try not to move the casualty; if possible, treat him
in the position you find him.
15
WHAT IS A FIRST AIDER? | HOW TO PREPARE YOURSELF
HOW TO PREPARE YOURSELF
When responding to an emergency it is
important to recognise both the emotional
and physical needs of all involved, including
your own. You should look after your own
psychological health and be able to identify
stress if it develops (pp.24–25).
A calm, considerate response from you that
facilitates trust and respect from those around
you is fundamental to you being able to give
or receive information from a casualty or
witnesses effectively. This includes being aware
of, and managing, your reactions, so that you
can focus on the casualty and make an
assessment. By talking to a casualty in a kind,
considerate, gentle but firm manner, you will
inspire confidence in your actions and this will
generate trust between you and the casualty.
Without this confidence he may not be able to
tell you about an important event, injury or
symptom, and he may remain in a highly
distressed state.
The actions described in this chapter aim to
help you facilitate this trust, minimise distress
and provide support to promote the casualty’s
ability to cope and recover. The key steps to
being an effective first aider are:
■ Be calm in your approach
■ Be aware of risks (to yourself and others)
■ Build and maintain trust (from the casualty
and the bystanders)
■ Give early treatment, treating the most
serious (life-threatening) conditions first
■ Call appropriate help
■ Remember your own needs
It is important to be calm in your approach.
Consider what situations might challenge you,
and how you would deal with them. In order
to convey confidence to others and encourage
them to trust you, you need to control your
emotions and reactions.
People often fear the unknown. Becoming
more familiar with first aid priorities and the
key techniques in this book can help you feel
more comfortable. By identifying your fears in
advance, you can take steps to overcome them.
Find out as much as you can, for example, by
completing a first aid learning programme with
one of the Societies. For additional reassurance,
talk to other people about how they dealt with
similar situations or talk through your fears with
a person you trust.
STAY IN CONTROL
In an emergency situation, the body responds by
releasing hormones that may cause a “fight,
flight or freeze” response. When this happens,
your heart beats faster, your breathing quickens
and you may sweat more. You may also feel
more alert, want to run away or feel frozen
to the spot.
If you feel overwhelmed and slightly panicky,
you may feel pressured to do something before
you are clear about what is needed. Pause and
take a few slow breaths. Consider who else
might help you feel calmer, and remind yourself
of the first aid priorities (opposite). If you still
feel overwhelmed, take another breath and say
to yourself “be calmer” as a cue. When you are
calm, you will be better able to think more
clearly and plan your response.
The thoughts you have are linked to the
way you behave and the way you feel. If you
think that you cannot cope, you will have more
trouble working out what to do and will feel
more anxious: more ready to fight, flee or
freeze. If you know how to calm yourself, you
will be better able to deal with your anxiety and
so help the casualty.
BE CALM
16
BECOMING A FIRST AIDER
PROTECTION FROM INFECTION
When you give first aid, it is important to
protect yourself (and the casualty) from
infection as well as injury. Take steps to avoid
cross infection (transmitting germs or infection
to a casualty or contracting infection yourself
from a casualty). Remember, infection is a risk
even with relatively minor injuries. It is a
particular concern if you are treating a wound,
because blood-borne viruses, such as hepatitis
B or C and Human Immunodeficiency Virus
(HIV), may be transmitted by contact with
blood. In practice the risk is low and should not
deter you from carrying out first aid. The risk
does increase if an infected person’s blood
makes contact with yours for example through
a cut or graze.
Usually, taking measures such as washing
your hands and wearing disposable gloves will
provide sufficient protection for you and the
casualty. There is no known evidence of these
blood-borne viruses being transmitted during
resuscitation. If a face shield or pocket mask
is available, it should be used when you give
rescue breaths (pp.68–69 and pp.78–79).
Take care not to prick yourself with any needle
found on or near a casualty, or cut yourself on
glass. If you accidentally prick or cut your skin,
or splash your eye, wash the area thoroughly
and seek medical help immediately. If you are
providing first aid on a regular basis, it is
advisable to seek guidance on additional
personal protection, such as immunisation. If
you think you have been exposed to an infection
while giving first aid, seek medical advice as
soon as possible.
■ Do wash your hands and wear latexfree
disposable gloves. If gloves are not
available, ask the casualty to dress his
or her own wound, or enclose your hands in
clean plastic bags.
■ Do cover cuts and grazes on your hands with
waterproof dressings.
■ Do wear a plastic apron if dealing with large
quantities of body fluids and wear plastic
glasses to protect your eyes.
■ Do dispose of all waste safely (p.18).
■ Do not touch a wound with your bare hands,
and do not touch any part of a dressing that
will come into contact with a wound.
■ Do not breathe, cough or sneeze over
a wound.
WHEN TO SEEK MEDICAL ADVICE
MINIMISING THE RISK OF CROSS
INFECTION
To help protect yourself from infection you can carry
protective equipment such as:
CAUTION
■ Pocket mask or face shield
■ Latex-free disposable gloves
■ Alcohol gel to clean your hands
17
PROTECTION FROM INFECTION
HOW TO WASH YOUR HANDS
Wet your hands under
running water. Put some
soap into the palm of a cupped
hand. Rub the palms of your
hands together.
Rub the back of the fingers
of your right hand against
the palm of your left hand, then
repeat with your left hand in
your right palm.
Rub the palm of your left
hand against the back of
your right hand, then rub the
right palm on the back of your
left hand.
Rub your right thumb in
the palm of your left hand,
then your left thumb in the
right palm.
Interlock the fingers of both
hands and work the soap
between them.
Rub the fingertips of your
left hand in the palm of your
right hand and vice versa. Rinse
thoroughly, then pat dry with a
disposable paper towel.
1
4
2
5
3
6
If you can, wash your hands before you touch
a casualty, but if this is not possible, you should
wash them as soon as possible afterwards. It is
important to wash your hands thoroughly. Pay
attention to all parts of your hands – palms,
wrists, fingers, thumbs and fingernails. Use soap
and water if available, or rub your hands with
alcohol gel.
THOROUGH HAND WASHING
»
18
BECOMING A FIRST AIDER
In addition to hand washing, disposable gloves
give added protection against infection in a
first aid situation. If possible, carry protective,
disposable, latex-free gloves with you at all
times. Wear them whenever there is a likelihood
of contact with blood or other body fluids. If in
doubt, put them on anyway.
Disposable gloves should only be used to
treat one casualty. Put them on just before you
approach the person and remove them as soon
as the treatment is completed and before you
do anything else. When taking off the gloves,
hold the top edge of one glove with your other
gloved hand and peel it off so that it is inside
out. Repeat with the other hand so that you do
not touch the outside of the gloves. Dispose
of them safely – in a clinical waste bag if
possible (see below).
Ideally, wash your
hands before
putting on the gloves.
Hold one glove by the
top and pull it on. Do
not touch the main
part of the glove with
your fingers.
Pick up the second
glove with the
gloved hand. With your
fingers under the top
edge, pull it on to your
hand. Your gloved
fingers should not
touch your skin.
CAUTION
Always use latex-free gloves. Some people have a
serious allergy to latex, and this may cause
anaphylactic shock (p.223). Nitrile gloves (often blue
or purple) are recommended.
USING PROTECTIVE GLOVES
DEALING WITH WASTE
Once you have treated a casualty, all soiled
material must be disposed of carefully to
prevent the spread of infection.
Place items such as dressings or gloves in
a clinical waste bag and ask the attending
emergency service how to deal with this type of
waste. Seal the bag tightly and label it to show
that it contains clinical waste. Put sharp objects,
such as needles, in a special plastic box called a
sharps container. If there is no sharps container
available, put used needles in a jar with a screw
top and dispose of it safely.
CLINICAL WASTE BAG SHARPS CONTAINER
1 2
PUTTING ON DISPOSABLE GLOVES
«PROTECTION FROM INFECTION
19
PROTECTION FROM INFECTION | DEALING WITH A CASUALTY
DEALING WITH A CASUALTY
Casualties are often frightened because of
what is happening to them, and what may
happen next. Your role is to stay calm and take
charge of the situation – be ready to stand back
if there is someone better qualified. If there is
more than one casualty, use the primary survey
(pp.44–45) to identify the most seriously injured
casualties and treat in the order of priority.
It is important to consider the age and
appearance of your casualty when you talk to
him, since different people need different
responses. Always respect people’s wishes;
accept that someone might want to be treated
in a particular way. Communication can be
difficult if a person speaks a different language
or cannot hear you. Use simple language or
signs or write questions down. Ask if anyone
nearby speaks the same language, knows the
person and/or saw the incident and can describe
what happened.
SPECIAL CASE TREATING CHILDREN
BUILDING TRUST
DIVERSITY AND COMMUNICATION
Establish trust with your casualty by
introducing yourself. Find out what the person
likes to be called, and use his name when you
talk to him. Crouch or kneel down so you are
at the same height as the casualty. Explain
what is happening and why. You will inspire
trust if you say what you are doing before you
do it. Treat the casualty with dignity and respect
at all times. If possible, give him choices, for
example, whether he would prefer to sit or lie
down and/or who he would like to have with
him. Also, if possible, gain his consent before
you treat him by asking if he agrees with
whatever you are going to do.
You will need to use simpler, shorter
words when talking to children. If
possible, make sure a child’s parents
or carers are with him, and keep
them involved at all times. It is
important to establish the carer’s
trust as well as the child’s. Talk first
to the parent/carer and get his or
her permission to continue. Once
the parent/carer trusts you, the child
will also feel more confident.
Reassure the casualty
When treating a casualty, remain calm and do not do
anything without explaining it first. Try to answer any
questions he may have honestly and clearly.
»
20
BECOMING A FIRST AIDER
DEALING WITH A CASUALTY
Use your eyes and ears to be aware of how a
casualty responds. Listen by showing verbal and
non-verbal listening skills.
■■Make eye contact, but look away now and
then so as not to stare.
■■Use a calm, confident voice that is loud
enough to be heard but do not shout.
■■Do not speak too quickly.
■■Keep instructions simple: use short
sentences and simple words.
■■Use affirming nods and “mmms” to show you
are listening when the casualty speaks.
■■Check that the casualty understands what
you mean – ask to make sure.
■■Use simple hand gestures and movements.
■■Do not interrupt the casualty, but always
acknowledge what you are told; for example,
by summarising what a casualty has told you
to show that you understand.
WHEN A CASUALTY RESISTS HELP
TREATING THE CASUALTY
LISTEN CAREFULLY
If someone is ill or injured he may be upset,
confused, tearful, angry and/or keen to get
away. Be sensitive to a casualty’s feelings; let
him know that his reactions are understandable.
Also accept that you may not be able to help, or
might even be seen as a threat. Stay at a safe
distance until you have gained the person’s
consent to move closer, so that he does not feel
crowded. Do not argue or disagree. A casualty
may refuse help for example because he is
suffering from a head injury or hypothermia. If
you think a person needs something other than
what he asks for, explain why. For example, you
could say, “I think someone should look at
where you’re hurt before you move, in case
moving makes it worse”. If someone still refuses
your help and you think they need urgent
medical attention, call 999/112 for emergency
help. A casualty has the right to refuse help,
even if it causes further harm. Tell the
emergency services that you have offered first
aid and been refused. If you are worried that a
person’s condition is deteriorating, observe
from a distance until help arrives.
When treating a casualty, always relate to him
calmly and thoughtfully to maintain trust. Think
about how he might be feeling. Check that you
have understood what the casualty said and
consider the impact of your actions, for
example, is the casualty becoming more (or
less) upset, angry and tense? A change in
emotional state can indicate that a casualty's
condition is worsening.
Be prepared to change your manner,
depending on what a person feels comfortable
with; for example, ask fewer questions or talk
about something else. Keep a casualty updated
and give him options rather than telling him
what to do. Ask the casualty about his
next-of-kin or friends who can assist, and
help him to make contact with them. Ask if
you can help to make arrangements so that
any responsibilities the casualty may have
can be taken care of.
Stay with the casualty. Do not leave someone
who may be dying, seriously ill or badly injured
alone except to go to call for emergency help. Talk
to the casualty while touching his shoulder or
arm, or holding a hand. Never allow a casualty
to feel alone.
«
21
DEALING WITH A CASUALTY
In an emergency situation you may be faced
with several tasks at once: to maintain safety, to
call for help and to start giving first aid. Some of
the people at the scene may be able to help you
do the following:
■■Make the area safe, for example, control
traffic and keep onlookers away
■■Call 999/112 for emergency help (p.23)
■■Fetch first aid equipment, for example
an AED (automated external defibrillator)
■■Control bleeding with direct pressure,
or support an injured limb
■■Help maintain the casualty’s privacy by
holding a blanket around the scene and
encouraging onlookers to move away
■■Transport the casualty to a safe place if his
life is in immediate danger, only if it is safer
to move him than to leave him where he is,
and you have the necessary help and
equipment (p.234)
The reactions of bystanders may cause you
concern or anger. They may have had no first
aid training and feel helpless or frightened
themselves. If they have seen or been involved
in the incident, they too may be injured and
distressed. Bear this in mind if you need to
ask a bystander to help you. Talk to people in
a firm but gentle manner. By staying calm
yourself, you will gain their trust and help
them remain calm too.
ENLISTING HELP FROM OTHERS
CARE OF PERSONAL BELONGINGS
KEEPING NOTES
Make sure the casualty’s belongings are with
them at all times. If you have to search
belongings for identification or clues to a
person’s condition (medication, for example), do
so in front of a reliable witness. If possible, ask
the casualty’s consent before you do this.
Afterwards, ensure that all of the clothing,
personal belongings and medication accompany
the casualty to hospital in the ambulance or are
handed over to the police.
As you gather information about a casualty,
write it down so that you can refer to it later.
A written record of the timing of events is
particularly valuable to medical personnel.
Note, for example, the length of time a casualty
is unresponsive, the duration of a seizure, the
time of any changes in the casualty’s condition
(improvement or deterioration), and the time of
any intervention or treatment. Hand your notes
to the emergency services when they arrive, or
give them to the casualty. Useful information to
provide includes:
■■Casualty’s details, including his name, age
and contact details
■■History of the incident or illness
■■Brief description of any injuries
■■Unusual behaviour, or a change in behaviour
■■Treatment – where given, and when
■■Vital signs – breathing, pulse and level of
response (pp.52–53)
■■Medical history
■■Medication the casualty has taken, with
details of the amounts taken and when
■■Next-of-kin contact details
■■Your contact details as well as the date, time
and place of your involvement
Remember that any information you gather is
confidential. Never share it with anyone not
involved in the casualty’s care without his
agreement. Let the casualty know why you are
recording information and who you will give it
to. When you are asking for such information,
be sensitive to who is around and of the
casualty’s privacy and dignity.
22
BECOMING A FIRST AIDER
REQUESTING HELP
Further help is available from a range of
sources. If help is needed, you must decide both
on the type of help and how to access it. First,
carry out a primary survey (pp.44–45) to
ascertain the severity of the casualty’s condition.
If it is not serious, explain the options and allow
him to choose where to go. If a casualty’s
condition is serious, call 999/112 for emergency
help. Throughout the book there are guidelines
for choosing appropriate level of help.
■■Call 999/112 for emergency help if the
casualty needs urgent medical attention; for
example, when you suspect a heart attack
or stroke.
■■Take or send the casualty to hospital. Choose
this option when a casualty needs hospital
treatment, but his condition is unlikely to
worsen; for example, with a finger injury.
You can take him yourself if you can arrange
transport – either in your own car or in a taxi.
■■Seek medical advice. Depending on
what is available in his area, the casualty
should be advised to call his own doctor’s
surgery, NHS walk-in centre or NHS advice
line, such as the 111 service available in
England. He should do this, for example,
when he has symptoms such as earache
or diarrhoea.
You can telephone for help from any of the
following sources.
■■Emergency services, including police, fire and
ambulance services; mine, mountain, cave
and fell rescue; and HM Coastguard by
calling 999 or 112.
■■Utilities, including gas, electricity or water.
The phone number will be in the local
telephone directory.
■■Health services, including doctor, dentist,
nurse, midwife or NHS helpline, such as the
111 service in England – this phone number
varies in different areas. The phone numbers
will be in the local telephone directory.
Calls to the emergency services are free from
any phone, including mobiles. On motorways,
emergency phones can be found every 1.6 km
(1 mile); arrows on marker posts indicate the
direction of (and distance to) the nearest phone.
To summon help using these telephones, pick
up the receiver and your call will be answered.
Keep time away from the casualty to a
minimum. Ideally, tell someone else to make the
call while you stay with the casualty. Ask the
person to confirm that the call has been made
and that help is on the way. If you have to leave
a casualty to make a call for help, first take any
necessary vital action (primary survey pp.44–45).
TELEPHONING FOR HELP
Calling for help
Use your mobile phone to call for help. Stay calm,
be clear and concise, and give as much detail as
possible – use the hands-free facility if you need to
attend to the casualty at the same time. Stay with
the casualty once the call has been made.
23
REQUESTING HELP
When you dial 999 or 112, you will be asked
which service you require. If there are
casualties, ask for the ambulance service. Stay
on the telephone until the emergency services
clear the line; you will be asked a number of
questions and be given information about what
to do for the casualty while you wait. If someone
else makes the call, ensure he is aware of the
importance of his call and that he reports back
to you. The call should be made by someone
who is with the casualty and from a phone that
can remain with the casualty until help arrives.
Put your device on speaker phone so that you
administer first aid instructions given by the
emergency services. Identify a point of contact
to receive information from the emergency
services and to direct the ambulance personnel
to where they are needed when they arrive.
TALKING TO THE EMERGENCY
SERVICES
State your name clearly and say that you are
helping at the scene of an incident. It is
essential to provide the following information:
■■Your telephone number and/or the number
you are calling from.
■■The exact location of the incident; give
a road name or number and postcode, if
possible – some street signs include the
postcode. Your call can be traced if you
are unsure of your exact location. It can
be helpful to mention any junctions or
other landmarks in the area. If you are
on a motorway, say which direction the
vehicles are travelling in.
■■The type and gravity of the emergency. For
example, “Traffic incident, two cars, road
blocked, three people trapped”.
■■Number, gender and age of casualties. For
example, “One man, early sixties, breathing
difficulties, suspected heart attack”.
■■Details of any hazards, such as gas, toxic
substances, power-line damage, or adverse
weather conditions, such as fog or ice.
■■Follow instructions such as first aid guidance
given by the emergency services.
When the emergency services arrive, they will
take over the care of the casualty. Tell them
what has happened and any treatment given.
Hand over any notes you made while attending
the casualty. You may be asked to continue
helping, for example, by assisting relatives or
friends of the casualty while the paramedics
provide emergency care.
You may be asked to contact a relative.
Explain as simply and honestly as you can what
has happenened and where the casualty has
been taken. Do not cause unnecessary alarm.
It is better to admit ignorance than to give
someone misleading information. However, the
information you give may cause distress; if so,
remain calm and be clear about what they need
to do next.
MAKING THE CALL
WHEN THE EMERGENCY SERVICES ARRIVE
Assisting at the scene
Once the emergency services arrive, tell the team
everything that you know. While they assess and treat
the casualty, you may be asked to look after or
reassure friends.
24
BECOMING A FIRST AIDER
THE USE OF MEDICATION
REMEMBER YOUR OWN NEEDS
In first aid, administering medication is
largely confined to relieving general aches and
pains. It usually involves helping a casualty to
take his own painkillers.
A variety of medications can be bought
without a doctor’s prescription. However,
you must not buy or borrow medication to
administer to a casualty yourself.
If you advise the casualty to take any
medication other than that stipulated in this
manual, he may be put at risk, and you could
face legal action as a consequence. Whenever
a casualty takes medication, it is essential to
make sure that:
■■It is for the condition
■■It is not out of date
■■It is taken as advised
■■Any precautions are strictly followed
■■The recommended dose is not exceeded
■■You keep a record of the name and dose
of the medication as well as the time and
method of administration
Most people who learn first aid gain
significantly from doing so. As well as learning
new skills and meeting new people, by learning
first aid you can make a real difference to
peoples’ lives. Being able to help people who
are ill or injured often results in a range of
positive feelings. However, you may also feel
stressed when you are called upon to administer
first aid, and feel emotional once you have
finished treating a casualty, whatever the
outcome. Occasionally, that stress can interfere
with your physical and mental well-being after
an incident. Everyone responds to stressful
situations in different ways, and some people
are more susceptible to stress than others. It
is important to learn how to deal with any
stress in order to maintain your own health
and effectiveness as a first aider. Gaining an
understanding of your needs can help you
be better prepared for future situations.
An emergency is an emotional experience.
Many first aiders experience satisfaction, or
even elation, and most cope well. However,
after you have treated a casualty, depending
on the type of incident and the outcome, you
might experience a mixture of the following:
■■Satisfaction
■■Confusion, worry, doubt
■■Anger, sadness, fear
You may go through what has happened again
and again in your mind, so it can be helpful to talk
to someone you trust about how you feel and
what you did. Consider talking to someone else
who was there, or who you know has had a similar
experience. Never reproach yourself or hide your
feelings. This is especially important if the
outcome was not as you had hoped. Even with the
correct treatment, and however hard you try, a
casualty may not recover.
IMMEDIATELY AFTER AN INCIDENT
Aspirin should never be given to anyone under the
age of 16 years as there is risk of a rare condition
called Reye’s syndrome.
CAUTION
25
THE USE OF MEDICATION | REMEMBER YOUR OWN NEEDS
Delivering first aid can lead to positive feelings
as you notice new things about yourself, such
as, for example, your ability to deal with a crisis.
However, occasionally, the effect of an incident
on you will depend on your first aid experience
as well as on the nature of the actual incident.
The majority of the incidents you will deal
with will be of a minor nature and they will
probably involve people you know. If you have
witnessed an incident that involved a threat to
life or you have experienced a feeling of
helplessness, you may find yourself suffering
from feelings of stress after the incident. In
most cases, these feelings should disappear
over time.
If, however, you experience persistent or
distressing symptoms associated with a
stressful incident, such as nightmares and
flashbacks, seek further help from someone
you trust and feel you can confide in.
See your doctor if you feel overwhelmed by
your symptoms. Your doctor will talk through
them with you and together you can decide
what is best for you. Seeking help is nothing
to be embarrassed about, and it is important to
be able to overcome these feelings. This will not
only help you deal with your current reactions,
but it will also help you learn how to respond to
situations in the future.
LATER REACTIONS
Talking things over
Confiding in a friend or relative is often useful. Ideally,
talk to someone who also attended the incident; she
may have the same feelings about it as you. If you are
unable to deal with the effects of the event you were
part of or witnessed, seek help from your doctor.
WHEN TO SEEK HELP
The scene of any incident can present
many potential dangers, whether
someone has become ill or has been
injured, whether in the home or outside at
the scene of an incident. Before any first aid
can be provided you must make sure that
approaching the scene of the incident does
not present unacceptable danger to you,
the casualty or anyone else who is helping.
This chapter provides advice for first
aiders on how to ensure safety in an
emergency situation. There are specific
guidelines for emergencies that pose a
particular risk. These include fires, traffic
incidents and incidents involving electricity
and drowning.
The procedures used by the emergency
services for major incidents, where
particular precautions are necessary and
where first aiders may be called on to help,
are also described here.
■■ To protect yourself from danger and make the
area safe
■■ To assess the situation quickly and calmly and
summon help if necessary
■■ To assist any casualties and provide necessary
treatment with the help of bystanders
■■ To call 999/112 for emergency help if you suspect
serious injury or illness
■■ To be aware of your own needs
AIMS AND OBJECTIVES
MANAGING
AN INCIDENT
28
MANAGING AN INCIDENT
ACTION AT AN EMERGENCY
In any emergency it is important that you
follow a clear plan of action. This will enable
you to prioritise the demands that may be made
upon you, as well as help you decide on your
best response.
The principle steps are: to assess the situation,
to make the area safe (if possible) and to give
first aid. Use the primary survey (pp.44–45) to
identify the most seriously injured casualties
and treat them in the order of priority.
Evaluating the scene accurately is one of the
most important factors in the management of
an incident. You should stay calm. State that
you have first aid training and, if there are no
medical personnel in attendance, calmly take
charge of the situation.
Identify any safety risks and assess the
resources available to you. Action for key
dangers you may face, such as fire, are dealt
with in this chapter, but be aware, too, of trip
hazards, sharp objects, chemical spills and
falling masonry.
All incidents should be managed in a similar
manner. Consider the following:
■■Safety What are the dangers and do they still
exist? Are you wearing protective equipment?
Is it safe for you to approach?
■■Scene What factors are involved at the
incident? What are the mechanisms of the
injuries (pp.42–43)? How many casualties are
there? What are the potential injuries?
■■Situation What happened? How many people
are involved and what age are they? Are any
of them children or elderly?
The conditions that give rise to an incident may
still present a danger and must be eliminated if
possible. It may be that a simple measure, such
as turning off the ignition of a car to reduce the
risk of fire, is sufficient. As a last resort, move
the casualty to safety. Usually specialist help
and equipment is required for this.
When approaching a casualty make sure you
protect yourself: wear high-visibility clothing,
gloves and head protection if you have them.
Remember, too, that a casualty faces the risk of
injury from the same hazards that you face. If
extrication from the scene is delayed, try to
protect the casualty from any additional hazards
– without endangering yourself.
If you cannot make an area safe, then call
999/112 for emergency help. Stand clear of the
incident until the emergency services have
secured the scene.
ASSESSING THE SITUATION
MAKING AN AREA SAFE
Making a vehicle safe
Wear a high-visibility jacket if you have one to alert
others of your presence. Switch off the ignition (even
if the engine is no longer running); this reduces the
risk of a spark causing a fire.
29
ACTION AT AN EMERGENCY
Once an area has been made safe, use the
primary survey (pp.44–45) to quickly carry out
an initial assessment of the casualty or
casualties to establish treatment priorities. If
there is more than one casualty, attend to those
with life-threatening conditions first. If possible,
treat casualties in the position in which you find
them; move them only if they are in immediate
danger or if it is necessary for you to be able to
provide life-saving treatment.
Enlist help from others if possible. Ask
bystanders to call for the emergency services
(p.23). They can also help to protect a casualty’s
privacy, put out warning triangles in the event
of a vehicle incident (p.30) or fetch equipment
while you begin first aid.
Hand over any notes you have made to the
emergency services when they arrive (p.21).
Answer any questions they may have and follow
any instructions. As a first aider you may be
asked to help, for example, to move a casualty
using specialist equipment. If so, you should
always follow their instructions.
HELICOPTER RESCUE
Occasionally, helicopter rescue is required. If a
casualty is being rescued in this way, there are a
number of safety rules to follow. The emergency
services may already be in attendance, in which
case you should keep clear unless they give you
specific instructions.
If the emergency services are not in
attendance, it is important to keep bystanders
clear. Make sure everyone is at least 50m (55yd)
away from the landing site, and that no-one is
smoking. Kneel down as the helicopter
approaches, keeping well away from the rotor
blades. Once the helicopter has landed do not
approach it. Keep bystanders back and wait for
a member of the crew to approach you.
GIVING EMERGENCY HELP
ASSISTING THE EMERGENCY SERVICES
Begin treatment
Start life-saving
first aid as soon as
possible. Ask others to
call for help and fetch
equipment such as an
AED (automated external
defibrillator).
30
MANAGING AN INCIDENT
TRAFFIC INCIDENTS
The severity of traffic incidents can range from
a fall from a bicycle to a major vehicle crash
involving many casualties. Often, the incident
site will present serious risks to safety, largely
because of passing traffic.
It is essential to make the incident area safe
before you attend any casualties (p.28); this not
only protects you, but also the casualties and
any other road users. Once the area is safe,
quickly assess the casualty or casualties and
prioritise treatment (pp.44–45). Give first aid to
those with life-threatening injuries before
treating anyone else. Call 999/112 for
emergency help, giving as much detail as you
can about the incident, indicating the number
and age of the casualties, and types of injury.
Do not put yourself or others in further danger.
Take the following precautions.
■■Park safely, well clear of the incident site, set
your hazard lights flashing and put on a highvisibility
jacket/vest if you have one.
■■Set up warning triangles (or another vehicle
with hazard lights) at least 45m (49yd) from
the incident in each direction; bystanders can
do this while you attend to the casualty. Send
helpers who are wearing high-visibility jackets
to warn other drivers to slow down.
■■Make vehicles safe. For example, switch off
the ignition of any damaged vehicle and, if
you can, disconnect the battery. Pull the
supply cut-off on large diesel vehicles; this is
normally found on the outside of the vehicle
and will be marked.
■■Stabilise vehicles. If a vehicle is upright, apply
the handbrake, put it in gear and/or place
blocks in front of the wheels. If it is on its side,
do not attempt to right it, but try to prevent it
from rolling over further.
■■Watch out for physical dangers, such as
traffic. Make sure that no-one smokes
anywhere near the incident.
■■Alert the emergency services to damaged
power lines, spilt fuel or any vehicles with
Hazchem signs (opposite).
MAKING THE INCIDENT AREA SAFE
Warn other road users
Ask a bystander to set up
warning triangles in both
directions. Advise the
person to watch for other
vehicles while she is
doing this.
31
TRAFFIC INCIDENTS
Quickly assess any casualties by carrying out a
primary survey (pp.44–45). Deal first with those
who have life-threatening injuries. Assume that
any casualty who has been involved in a roadtraffic
incident may have a neck or spinal injury
(pp.157–59). If possible, treat casualties in the
position in which you find them, supporting
the head and neck at all times, and wait for the
emergency services.
Search the area around the incident thoroughly
to make sure you do not overlook any casualty
who may have been thrown clear, or who has
wandered away from the site. Bystanders can
help. If a person is trapped inside or under a
vehicle, she will need to be released by the fire
service. Monitor and record the casualty’s vital
signs – breathing, pulse and level of response
(pp.52–53) – while you are waiting.
ASSESSING THE CASUALTIES
Casualty in a vehicle
Assume that any injured casualty in a vehicle has a
neck injury. Support the head while you await help.
Reassure her and keep her ears uncovered so that she
can hear you.
■■ Do not cross a motorway to attend to an incident
or casualty.
■■ At night, wear or carry something light or reflective,
such as a high-visibility jacket, and use a torch.
■■ Do not move the casualty unless it is absolutely
necessary. If you do have to move her, the method
will depend on the casualty’s condition and
available help.
■■ Be aware that road surfaces may be slippery because
of fuel, oil or even ice.
■■ Be aware that undeployed air bags and unactivated
seat-belt tensioners may be a hazard.
■■ Find out as much as you can about the incident and
relay this information to the emergency services
when they arrive.
Traffic incidents may be
complicated by spillages of
toxic substances or vapours.
Keep bystanders away from
the scene and stand upwind
of the vehicle. Hazchem signs on
the back of the vehicle indicate
that it may be carrying a
potentially dangerous substance.
Give the details to the emergency
services so they can assess the
risks involved. If in doubt about
your safety or the meaning of a
symbol, keep your distance. If the
top left panel of a sign contains
the letter “E”, the substance is a
public safety hazard.
CAUTION
SPECIAL CASE HAZARDOUS SUBSTANCES
Emergency action code
for emergency services
Symbol indicates
nature of chemical,
for example, poison
Company logo
UN number, specifying
exact chemical
Phone number for
specialist advice
OXIDISING
AGENT
FLAMMABLE
GAS
RADIOACTIVE TOXIC GAS
AGENT
COMPRESSED
GAS
CORROSIVE
AGENT
32
MANAGING AN INCIDENT
FIRES
Fire spreads very quickly, so your first priority
is to warn any people at risk. If you are in a
building, activate the nearest fire alarm, call
999/112 for emergency help, then leave the
building. However, if doing this delays your
escape, make the call when you are out of the
building. As a first aider, try to keep everyone
calm. Encourage and assist people to evacuate
the area as quickly and calmly as possible.
When arriving at an incident involving fire,
stop, observe, think: do not enter the area. A
minor fire can escalate in minutes to a serious
blaze. Call 999/112 for emergency help and
wait for it to arrive.
A fire needs three components to start
and maintain it: ignition (a spark or flame); a
source of fuel (petrol, wood or fabric); and
oxygen (air). Removing one of these elements
can break this “triangle of fire”.
■■Remove combustible materials, such as
paper or cardboard, from the path of a fire,
as they can fuel the flames.
■■Cut off a fire’s oxygen supply by shutting
a door on a fire or smothering the flames
with a fire blanket. This will cause the fire
to suffocate and go out.
■■Switch off a car’s ignition, or pull the fuel
cut-off on a large diesel vehicle (this is
normally marked on the outside of the
vehicle), or switch off the gas supply.
If you see or suspect a fire in a building,
activate the first fire alarm you see. Try
to help people out of the building without
putting yourself at risk. Close doors behind you
to help prevent the fire from spreading. If you
are in a public building, use the fire exits and
look for assembly points outside.
You should already know the evacuation
procedure at your workplace. If, however, you
are visiting other premises you are not familiar
with, follow the signs for escape routes and
obey any instructions you are given by their
fire marshals.
THE ELEMENTS OF FIRE
LEAVING A BURNING BUILDING
When escaping from a fire:
■■ Do not re-enter a burning building to collect personal
possessions
■■ Do not use lifts
■■ Do not go back to a building until cleared to do
so by a fire officer
Fire precautions:
■■ Do not move anything that is on fire
■■ Do not smother flames with flammable materials
■■ Do not fight a fire if it puts your own safety at risk
■■ If your clothes catch fire and help is not available,
extinguish the flames by wrapping yourself up tightly
in suitable material and rolling along the ground
■■ Do not put water on an electrical fire: pull the plug
out or switch the power off at the mains
■■ Smother a hot fat fire with a fire blanket; never
use water
CAUTION
Evacuating other
people
Encourage people to
leave the building calmly
but quickly by the nearest
exit. If they have to use
the stairs, make sure they
do not rush and risk
falling down.
33
FIRES
If a person's clothing is on fire always follow
this procedure: Stop, Drop and Roll.
■■Stop the casualty panicking, running around
or going outside; any movement or breeze
will fan the flames.
■■Drop the casualty to the ground. If possible,
wrap him tightly in a fire blanket, or heavy
fabric such as a coat, curtain, blanket (not
a nylon or cellular type) or rug.
■■Roll the casualty along the ground until the
flames have been smothered. Treat any burns
(pp.174–80): help the casualty to lie down
with the burned side uppermost and start
cooling the burn as soon as possible.
Any fire in a confined space creates a highly
dangerous atmosphere that is low in oxygen
and may also be polluted by carbon monoxide
and other toxic fumes. Never enter a smoke- or
fume-filled building or open a door leading to a
fire. Let the emergency services do this.
■■When you are trapped in a burning building,
if possible go into a room at the front of the
building with a window and shut the door.
Block gaps under the door by placing a rug or
similar heavy fabric across the bottom of the
door to minimise smoke. Open the window
and shout for help.
■■Stay low if you have to cross a smoke-filled
room: air is clearest at floor level.
■■If escaping through a high window, climb out
backwards feet first; lower yourself to the full
length of your arms before dropping down.
CLOTHING ON FIRE
SMOKE AND FUMES
Putting out flames
Help the casualty on to the ground to stop flames
rising to his face. Wrap him in a fire blanket to starve
flames of oxygen, and roll him on the ground until
the flames are extinguished.
Avoiding smoke and fumes
Shut the door of the room you are in and put a rug or
blanket against the door to keep smoke out. Open the
window and shout for help. Keep as low as possible to
avoid fumes in the room.
34
MANAGING AN INCIDENT
ELECTRICAL INCIDENTS
When a person is electrocuted, the passage
of electrical current through the body may stun
him, causing his breathing and heartbeat to
stop (cardiac arrest, p.57). The electrical current
can also cause burns both where it enters and
where it exits the body to go to “earth”. An
electrical burn may appear very small or may
not be visible on the skin, however, the damage
the burn causes can extend deep into the
tissues (p.178).
The factors that affect the severity of the
injury are: the voltage; the type of current;
and the path of the current. A low voltage of
240 volts is found in a home or workplace, a
high voltage of 440–1,000 volts is found in
industry and voltage of more than 1,000 volts
is found in power lines. The type of current will
either be alternating (AC) or direct (DC), and
the path of the current can be hand-to-hand,
hand-to-foot or foot-to-foot.
Most low-voltage and high-tension currents
are AC, which causes muscular spasms (known
as tetany) and the “locked-on” phenomenon –
the casualty’s grasp is “locked” on to the object,
which prevents him from letting go, so he may
remain electrically charged (“live”). In contrast,
DC tends to produce a single large muscular
contraction that often throws the person away
from the source of electricty. Be aware that the
jolt may cause the casualty to be thrown or to
fall, which can results in injuries such as spinal
injuries and fractures.
Contact with a high-voltage current found
in power lines and overhead cables, is usually
immediately fatal. Anyone who survives will
have severe burns, since the temperature of the
electricity may reach up to 5,000°C (9,032°F).
Furthermore, the shock produces a muscular
spasm that propels the casualty some distance,
causing additional injuries.
High-voltage electricity may jump (“arc”) up
to 18m (20yd) from its source. The power must
be cut off and isolated before anyone
approaches the casualty. A casualty who has
suffered this type of shock is likely to be
unresponsive. Once you have been officially
informed that it is safe to approach, assess the
casualty, open the airway and check breathing
(The unresponsive casualty, pp.54–87).
HIGH VOLTAGE CURRENT
Protect bystanders
Keep everyone away from the incident. Bystanders
should stay at least 18m (20yd) from the damaged
cable and/or casualty.
■■ Do not touch the casualty if he is in contact with the
electrical current.
■■ Do not use anything metallic to break the electrical
contact.
■■ Do not approach high-voltage wires until the power
is turned off.
■■ Do not move a person with an electrical injury unless
he is in immediate danger and is no longer in contact
with the electricity.
■■ If the casualty is unresponsive, and it is safe to touch
him, open the airway and check breathing (The
unresponsive casualty, pp.54–87).
CAUTION
35
ELECTRICAL INCIDENTS
Domestic current, as used in homes and
workplaces, can cause serious injury or even
death. Incidents are usually due to faulty or
loose switches, frayed flexes or defective
appliances. Young children are at risk since
they are naturally curious, and may put fingers
or other objects into electrical wall sockets.
Water is also a very efficient conductor of
electricity, so presents additional risks to
both you and the casualty. If you handle
an otherwise safe electrical appliance with
wet hands, or when you are standing on a wet
floor, you greatly increase the risk of an
electric shock.
A natural burst of electricity discharged from
the atmosphere, lightning forms an intense trail
of light and heat. Lightning seeks contact with
the ground through the nearest tall feature in
the landscape and, sometimes, through anyone
standing nearby. However, because the duration
of a lightning strike is short it usually precludes
serious thermal injury. It may, however, set
clothing on fire, knock the casualty down or
cause the heart and breathing to stop (cardiac
arrest, p.57). Cardiopulmonary resuscitation/
CPR (adult, pp.66–71; child, pp.76–79; infant,
pp.82–83) must be started promptly.
Always clear everyone from the site of a
lightning strike since, contrary to popular belief,
it can strike again in the same place.
LOW-VOLTAGE CURRENT
LIGHTNING
BREAKING CONTACT WITH ELECTRICITY
Before beginning any treatment, look first,
do not touch. If the casualty is still in contact
with the electrical source, she will be “live” and
you risk electrocution.
Once you are sure that the contact between
the casualty and the electricity has been
broken, perform a primary survey (pp.44–45) and
treat injuries in order of priority. Call 999/112 for
emergency help.
Turn off the source of electricity, if possible, to
break the contact between the casualty and
the electrical supply. Switch off the current at the
mains or meter point if possible. Otherwise remove
the plug or wrench the cable free.
Alternatively,
move the source
away from both you and
the casualty. Stand on
some dry insulating
material, such as a
wooden box, plastic mat
or telephone directory.
Using a wooden pole or
broom, push the
casualty’s limb away
from the electrical
source or push the
source away from her.
If it is not possible to break the contact using a
wooden object, loop a length of rope around
the casualty’s ankles or under the arms, taking
great care not to touch her, and pull her away from
the source of the electrical current.
2
3
5
1
4
36
MANAGING AN INCIDENT
WATER INCIDENTS
■■ If the casualty is unresponsive, lift him clear of the
water, supporting his head and neck; try to keep him
upright. When you reach land, lay him down and
open the airway and check breathing. Begin CPR if
necessary (The unresponsive casualty, pp.54–87).
Incidents around water may involve people
of any age. However, drowning is one of the
most common causes of accidental death
among young people under the age of 16.
Young children can drown in fish ponds,
paddling pools, baths and even in the toilet
if they fall in head first, as well as in swimming
pools, in the sea and in open water. Many cases
of drowning involve people who have been
swimming in strong currents or very cold water,
or who have been swimming or boating after
drinking alcohol.
There are particular dangers connected with
incidents involving swimmers in cold water.
Open water around Great Britain and Ireland
is cold, even in summer. Sea temperatures range
from 5°C (41°F) to 15°C (59°F); inland waters may
be colder. The sudden immersion in cold water
can result in an overstimulation of nerves,
causing the heart to stop (cardiac arrest).
Submersion in cold water may cause
hypothermia (p.186) and exacerbate shock
(pp.112–13). Spasm in the throat and inhalation
of water can block the airway (Hypoxia, p.92
and Drowning, p.100). Inhaled or swallowed
water may be absorbed into the circulatory
system, causing water overload to the brain,
heart or lungs. The exertion of swimming can
also strain the heart.
CAUTION
RESCUING A PERSON FROM WATER
Your first priority is to get the casualty on
to dry land with the minimum of danger to
yourself. Stay on dry land, hold out a stick, a branch
or a rope for him to grab, then pull him from the
water. Alternatively, throw him a float.
If you are a trained life-saver and the
casualty is unresponsive, wade or swim to
the casualty and tow him ashore – try to keep
him upright. If you cannot do this safely, call
999/112 for emergency help.
Once the casualty is out of the water, shield
him from the wind, if possible. Treat him for
drowning (p.100) and the effects of severe cold
(hypothermia, pp.186–88). If possible, replace any
wet clothing with dry clothing.
Arrange to take or send the casualty to
hospital, even if he seems to have recovered
completely. If you are at all concerned, call 999/112
for emergency help.
2
1
3
4
37
WATER INCIDENTS | MAJOR INCIDENTS
MAJOR INCIDENTS
A major incident is one that presents a serious
threat to the safety of a community, or may
cause so many casualties that it requires special
arrangements from the emergency services.
Events of this kind can overwhelm the resources
of the emergency services in the area because
there may be more casualties to treat than there
are personnel available.
It is the responsibility of the emergency
services to declare a situation to be a major
incident, and certain procedures will be
activated by them if necessary. The area around
the incident will be sealed off and hospitals and
specialist medical teams will be notified. It
is not a first aider’s responsibility to organise
this, but you may be asked to help the
emergency services.
If you are the first person on the scene
of what may be a major incident, do not
approach it. Call 999/112 for emergency help
immediately (pp.22–23). The ambulance control
will need to know the type of incident that has
occurred (for example, a fire, a traffic incident
or an explosion), the location, the access,
any particular hazards and the approximate
number of casualties.
First, the area immediately around the incident
will be cordoned off – called the inner cordon.
Around this an outer cordon, the minimum safe
area for emergency personnel (fire, ambulance
and police), will be established. No one without
the correct identification and safety equipment
will be allowed inside the area. A casualty
clearing station, where treatment takes place, a
survivor reception centre, where the uninjured
assemble, and ambulance parking and loading
areas will be established inside the cordons.
TRIAGE
The emergency services initially use a system
called a triage sieve to assess casualties. All
casualties undergo a primary survey (pp.44–45)
at the scene to establish treatment priorities.
This will be followed by a secondary survey
(pp.46–48) in the casualty clearing station.
This check will be repeated and any change
monitored until a casualty recovers or is
transferred into the care of a medical team.
■■Casualties who cannot walk will undergo
further assessment. Depending on the
findings, casualties will be assigned to Red
Priority One (immediate) or Yellow Priority
Two (urgent) areas for treatment and will be
transferred to hospital by ambulance as soon
as possible.
■■Walking casualties with minor injuries will
be assigned to the Green Priority Three area
for treatment and will be transferred to
hospital if necessary.
■■Uninjured people will be taken to the
survivor reception centre.
FIRST AIDER’S ROLE
You will not be allowed to enter the
cordoned area without adequate personal
safety equipment and correct identification.
Once inside you may be asked to assist the
emergency services at an incident by, for
example, helping casualties with minor injuries,
supporting injured limbs or making a note of
casualties’ names and/or helping to contact
their relatives. You may be asked to help at the
survivor reception centre.
EMERGENCY SERVICE SCENE ORGANISATION
When a person is suddenly taken ill
or has been injured, it is important
to find out what is wrong as quickly as
possible. However, your first priority is to
make sure that you are not endangering
yourself by approaching a casualty.
Once you are sure that an incident area
is safe, you need to begin your assessment
of the casualty or casualties. This chapter
explains how to approach each casualty
and plan your assessment using a
methodical two-stage system, first
to identify and treat life-threatening
conditions according to their priority
(primary survey), then to carry out a
detailed assessment looking for injuries
that are not immediately apparent
(secondary survey). There is advice on
deciding treatment priorities, managing
more than one casualty and arranging
aftercare. A casualty’s condition may
improve or deteriorate while in your care,
so there is guidance on how to monitor
changes in his condition.
■■ To assess a situation quickly and calmly, while first
protecting yourself and the casualty from any danger
■■ To assess each casualty and treat life-threatening
injuries first
■■ To carry out a more detailed assessment of
each casualty
■■ To seek appropriate help. Call 999/112 for
emergency help if you suspect serious injury
or illness
■■ To be aware of your own needs
AIMS AND OBJECTIVES
ASSESSING A
CASUALTY
40
ASSESSING A CASUALTY
ASSESSING THE SICK OR INJURED
From the previous chapters you will now know
that to ensure the best possible outcome for
anyone who is injured or suddenly becomes ill
you need to take responsibility for making
assessments. Tell those at the scene that you
are a trained first aider and calmly take control.
However, as indicated in Chapter 2 (pp.26–37),
resist the temptation to begin dealing with any
casualty until you have assessed the overall
situation, ensured that everyone involved is safe
and, if appropriate, have taken steps to organise
the necessary help.
As you read through this chapter, look
back at Chapter 1 (pp.12–25) as well and
remember the following:
■■Be calm
■■Be aware of risks
■■Build and maintain the casualty’s trust
■■Call appropriate help
■■Remember your own needs
There are three aspects to managing a sick or
injured person. It is important to work quickly
and systematically to avoid unnecessary delay.
■■First, find out what is wrong with the casualty.
■■Second, treat conditions found in order of
severity – life-threatening conditions first.
■■Third, arrange for the next step of a casualty’s
care. You will need to decide what type of
care a casualty needs. You may need to call
for emergency help, suggest the casualty
seeks medical advice or allow him to go home,
accompanied if necessary.
Other people at the incident can help you
with this. Ask one of them to call 999/112 for
emergency help while you attend a casualty.
Alternatively, they may be able to help support
injured limbs, look after less seriously injured
casualties, or fetch first aid equipment.
MANAGING THE INJURED OR SICK
First actions
Support the casualty;
a bystander may
be able to help. Ask the
casualty what happened,
and try to identify the
most serious injury.
41
ASSESSING THE SICK OR INJURED
If there is more than one casualty, you will need to
prioritise those that must be treated first according
to the severity of their injuries. Use the primary
survey ABC principles (above) to do this. Remember
that unresponsive casualties are at greatest risk.
METHODS OF ASSESSMENT
When you assess a casualty you first need to
identify and deal with any life-threatening
conditions or injuries as quickly as possible with
a primary survey. Deal with each life-threatening
condition as you find it, working in the following
order – airway, breathing, then circulation –
before you progress to the next stage.
Depending on your findings you may not
move on to the next stage of the assessment.
If the life-threatening injuries are successfully
managed, or there are none, you continue the
assessment and perform a secondary survey.
THE PRIMARY SURVEY
This is an initial rapid assessment of a casualty
to establish and treat conditions that are an
immediate threat to life (pp.44–45).
If a casualty is suffering from minor injuries
and responding to you, for example, talking,
then this survey will be completed very quickly.
If, however, a casualty is more seriously injured
and/or not responding to you (unresponsive),
the assessment may take longer.
Follow the ABC principle: Airway, Breathing
and Circulation.
■■Airway Is the airway open and clear?
The airway is not open and clear if the
casualty is unable to speak. An obstructed
airway will prevent breathing, causing hypoxia
(p.92) and ultimately death.
The airway is open and clear if the casualty is
talking to you.
■■Breathing Is the casualty breathing normally?
If the casualty is not breathing normally, call
999/112 for emergency help, then start
chest compressions with rescue breaths
(cardiopulmonary resuscitation/CPR). If this
happens, you are unlikely to move on to the
next stage.
If the casualty is breathing, check for and
treat any breathing difficulty such as asthma,
then move on to the next stage: circulation.
■■Circulation Is the casualty bleeding severely?
If he is bleeding this must be treated
immediately since it can lead to a lifethreatening
condition known as shock
(pp.112–13). Call 999/112 for emergency help.
If there is no bleeding, continue to the
secondary survey.
THE SECONDARY SURVEY
This is a detailed examination of a casualty to
look for other injuries or conditions that may
not be immediately apparent (pp.46–48). To
do this, carry out a head-to-toe examination
(pp.49–51). Your aim is to find out:
■■History What actually happened and any
relevant medical history.
■■Symptoms Injuries or abnormalities that
the casualty tells you about.
■■Signs Injuries or abnormalities that you
can see.
By checking the recognition features of the
different injuries and conditions explained
in the chapters of this book you can identify
what may be wrong. Record your findings
and pass on any relevant information to the
medical team.
LEVEL OF RESPONSE
You will initially have noted whether or not a
casualty is responding to you. He may have
spoken to you or made eye contact or some
other gesture (see p.44). Or perhaps there has
been no response to your questions such as “Are
you all right?” or “What happened?”. Now you
need to establish the level of response using the
AVPU scale (p.52). This is important since some
illnesses and injuries cause a deterioration in a
casualty’s level of response, so it is vital to
assess the level, then monitor him for changes.
SPECIAL CASE SEVERAL CASUALTIES
42
ASSESSING A CASUALTY
MECHANISMS OF INJURY
The injury that a person sustains is directly
related to how it is caused. In addition, whether
a casualty sustains a single or multiple injury is
also determined by the mechanisms that caused
it. This is the reason why a history of the
incident, and therefore the injury mechanism
is important. In many situations, this vital
information can only be obtained by those
people who deal with the casualty at the
scene – often first aiders. Look, too, at the
circumstances in which an injury was sustained
and the forces involved.
The information is useful because it also
helps the emergency services and medical team
predict the type and severity of injury, as well
as the treatment required. This therefore helps
the diagnosis, treatment and likely outcome
for the casualty.
CIRCUMSTANCES OF INJURY
The extent and type of injuries sustained due
to impact – for example, a fall from a height or
the impact of a car crash – can be predicted if
you know exactly how the incident happened.
For example, a car occupant is more likely to
sustain serious injuries in a side-impact collision
than in a frontal collision at the same speed.
This is because the side of the car provides less
protection and cannot absorb as much energy
as the front of the vehicle. For a driver wearing a
seatbelt whose vehicle is struck either head-on
or from behind, a specific pattern of injuries can
be suspected. The driver’s body will be suddenly
propelled one way, but the driver’s head will lag
behind briefly before moving. This results in a
“whiplashing” movement of the neck (below).
The casualty may also have injuries caused by
the seatbelt restraint; for example, fracture
of the breastbone and collarbone and possibly
bruising of the heart or lungs. There may also be
injuries to the face due to contact with the
steering wheel or an inflated airbag.
Whiplash injury
The head may be whipped
backwards and then rapidly
forwards, or vice versa, due to
sudden forces on the body,
such as in a car crash. This
produces a whiplash injury, with
strained muscles and stretched
ligaments in the neck.
43
MECHANISMS OF INJURY
Most serious injury
may be hidden
A first aider should keep the
casualty still, ask someone to
support her head and call 999/112
for emergency help.
FORCES EXERTED ON THE BODY
The energy forces exerted during an impact are
another important indicator of the type or
severity of any injury. For example, if a man falls
from a height of 1m (3ft 3in) or less on to hard
ground, he will probably suffer bruising but no
serious injury. A fall from a height of more than
2m (6ft 6in), however, is likely to produce more
serious injuries, such as a pelvic fracture and
internal bleeding. An apparently less serious fall
can mask a more dangerous injury. If a person
falls down the stairs, for example, she may tell
you that she injured her ankle. If she has fallen
awkwardly on to a hard surface, however, she
may have sustained a spine and/or head injury.
A fall down more than five stairs is associated
with a greater risk of injury, than a fall down
fewer than five stairs. Be aware too that the
elderly or those suffering from bone disorders
such as osteoporosis are at greater risk of
serious injury from minor knocks or falls.
QUESTIONS TO ASK AT THE SCENE
When you are attending a casualty, ask the
casualty, or any witnesses, questions to try
to find out the mechanism of the injury.
Witnesses are especially important if the
casualty is unable to talk to you. Possible
questions include:
■■Was the casualty ejected from a vehicle?
■■Was the casualty wearing a seat-belt?
■■Did the vehicle roll over?
■■Was the casualty wearing a helmet?
■■How far did the casualty fall?
■■What type of surface did he land on?
■■Is there evidence of body contact with a
solid object, such as the floor or a vehicle’s
windscreen or dashboard?
■■How did he fall? (For example, twisting
falls can stretch or tear the ligaments or
tissues around a joint such as the knee
or ankle.)
Pass on all the information that you have
gathered to the emergency services
(pp.21 and 23).
44
ASSESSING A CASUALTY
PRIMARY SURVEY
The primary survey is a quick, systematic
assessment of a person to establish if any
conditions or injuries sustained are life
threatening. By following a methodical
sequence using established techniques,
each life-threatening condition can be
identified in a priority order and dealt with
on a “find and treat” basis. The sequence
should be applied to every casualty you attend
quickly and systematically. You should not allow
yourself to be distracted from it by other events.
The chart opposite guides you through this
sequence. Depending on your findings you
may not move on to the next stage of the
assessment. Only when life-threatening
conditions are successfully managed, or there
are none, should you perform a secondary
survey (pp.46–48).
RESPONSE
At this point you need to make a quick
assessment to find out whether a casualty is
responding to you or is unresponsive. Observe
the casualty as you approach. Introduce yourself
even if he does not appear to be responding to
you. Ask the casualty some questions, such as,
“What happened?” or “Are you all right?” or give
a command, such as “Open your eyes!” If there
is no initial response, gently shake the casualty’s
shoulders. If the casualty is a child, tap his
shoulder; if he is an infant, tap his foot. If there
is still no response, he is described as
unresponsive. If the casualty makes eye contact
or some other gesture, he is responsive.
Unresponsive casualties take priority and
require urgent treatment (pp.54–87).
AIRWAY
The first step is to check that a casualty’s airway
is open and clear. If a casualty is alert and
talking to you, it follows that the airway is open
and clear. If, however, a casualty is unresponsive,
the airway may be obstructed (p.59). You need
to open and clear the airway (adult, p.63; child,
p.73; infant, p.80) – do not move on to the next
stage until it is open and clear.
BREATHING
Is the casualty breathing normally? Look, listen
and feel for breaths. If he is alert and/or talking
to you, he will be breathing. However, it is
important to note the rate, depth and ease with
which he is breathing. For example, conditions
such as asthma (p.102) that cause breathing
difficulty require urgent treatment.
If an unresponsive casualty is not breathing,
the heart will stop. Chest compressions and
rescue breaths (cardiopulmonary resuscitation/
CPR) must be started immediately (adult,
pp.66–71; child, pp.76–79; infant, 82–83).
CIRCULATION
Conditions that affect the circulation of blood
can be life threatening. Injuries that result in
severe bleeding (pp.114–15) can cause blood
loss from the circulatory system, so must be
treated immediately to minimise the risk
of a life-threatening condition known as
shock (pp.112–13).
Only when life-threatening conditions have
been stabilised, or there are none present,
should you begin to carry out a detailed
secondary survey of the casualty (pp.46–48).
PRIMARY SURVEY
45
THE ABC CHECK
If life-threatening
conditions are managed,
or there are none present,
move on to the secondary
survey (pp.46–48) to check
for other injury or illness.
CIRCULATION
Are there any signs of
severe bleeding?
UNRESPONSIVE RESPONSIVE UNRESPONSIVE RESPONSIVE
AIRWAY
Is the casualty’s airway
open and clear (adult,
pp.62–63; child, pp.72–73;
infant, p.80)?
BREATHING
Is the casualty breathing
normally?
Look, listen and feel for
breaths.
■■ If the casualty is responsive,
treat conditions such as
choking or suffocation that
cause the airway to be blocked.
Go to the next stage,
BREATHING, when the airway
is open and clear.
■■ If the casualty is unresponsive,
tilt the head and lift the chin to
open the airway (adult, p.63;
child, p.73; infant, p.80).
Go to the next stage,
BREATHING, when the airway
is open and clear.
■■ Treat any difficulty found;
for example, asthma.
Go to the next stage,
CIRCULATION.
■■ If the casualty is unresponsive
and not breathing, call 999/112
for emergency help. Begin
chest compressions and rescue
breaths (adult, pp.66–71; child,
pp.76–79; infant, pp.82–83). If
this happens, you are unlikely
to move on to the next stage.
■■ Control the bleeding
(pp.114–15). Call 999/112 for
emergency help. Treat the
casualty to minimise the risk
of shock (pp.112–13).
NO
YES
YES
YES
NO
NO
Work through these checks quickly
and systematically to establish
treatment priorities.
46
ASSESSING A CASUALTY
SECONDARY SURVEY
Once you have completed the primary survey
and dealt with any life-threatening conditions,
start the methodical process of checking for
other injuries or illnesses by performing a headto-
toe examination. This is called the secondary
survey. Question the casualty as well as the
people around him. Make a note of your
findings if you can, and make sure you pass
all the details to the emergency services or
hospital, or whoever takes responsibility for
the casualty (p.29).
Ideally, the casualty should remain in the
position found, at least until you are satisfied
that it is safe to move him into a more
comfortable position appropriate for his
injury or illness.
This survey includes two further checks beyond
the ABC (pp.44–45).
■■Disability This is the casualty’s level of
response (p.52).
■■Examine the casualty You may need to
remove or cut away clothing to examine and/
or treat the injuries.
By conducting this survey you are aiming to
discover the following:
■■History What happened leading up to the
injury or sudden illness and any relevant
medical history
■■Symptoms Information that the casualty
gives you about his condition
■■Signs These are what you find on examination
of the casualty
HISTORY
There are two important aspects to the history:
what happened and any medical history.
EVENT HISTORY
The first consideration is to find out what
happened. Your initial questions should help
you to discover the immediate events leading
up to the incident. The casualty can usually tell
you this, but sometimes you have to rely on
information from people nearby so it is
important to verify that they are telling you
facts and not just their opinions. There may also
be clues, such as the impact on a vehicle, which
can indicate the likely nature of the casualty’s
injury. This is often referred to as the
mechanism of injury (pp.42–43).
PREVIOUS MEDICAL HISTORY
The second aspect to consider is a person’s
medical history. While this may have nothing to
do with the present condition, it could be a clue
to the cause. Clues to the existence of such a
condition may include a medical bracelet or
medication in the casualty’s possessions (p.48).
TAKING A HISTORY
■■Ask what happened; for example, establish
whether the incident is due to illness or
an accident.
■■Ask about medication the casualty is
taking currently.
■■Ask about medical history. Find out if there
are ongoing and previous conditions.
■■Find out if a person has any allergies.
■■Check when the person last had something
to eat or drink.
■■ Note the presence of a medical warning
bracelet – this may indicate an ongoing
medical condition, such as epilepsy, diabetes
or anaphylaxis.
47
SECONDARY SURVEY
Listen to the casualty
Make eye contact with the casualty as you talk to him.
Keep your questions simple, and listen carefully to the
symptoms he describes.
SYMPTOMS
These are the sensations that the casualty
feels and describes to you. When you talk to the
casualty, ask him to give you as much detail as
possible. For example, if he complains of pain,
ask where it is. Ask him to describe the pain (is
it constant or intermittent, sharp or dull). Ask
him what makes the pain better or worse,
whether it is affected by movement or breathing
and, if it did not result from an injury, where and
how it began. The casualty may describe other
symptoms, too, such as nausea, giddiness, heat,
cold or thirst. Listen very carefully to his
answers (p.20) and do not interrupt him while
he is speaking.
SIGNS
These are features such as swelling, bleeding,
discoloration, deformity and smells that you can
detect by observing and feeling the casualty.
Use all of your senses – look, listen, feel and
smell. Always compare the injured and
uninjured sides of the body. You may also notice
that the person is unable to perform normal
functions, such as moving his limbs or standing.
Make a note of any obvious superficial injuries,
going back to treat them only when you have
completed your examination.
Compare both sides of the body
Always compare the injured part of the body with
the uninjured side. Check for swelling, deformity
and/or discoloration.
QUICK REMINDER
Use the mnemonic A M P L E as a reminder
when assessing a casualty to ensure that you have
covered all aspects of the examination. When the
emergency services arrive, they may ask:
A – Allergy – does the person have any allergies?
M – Medications – is the person on any medication?
P – Previous medical history – do you know of any
pre-existing conditions?
L – Last meal – when did the person last eat?
E – Event history – what happened?
»
48
ASSESSING A CASUALTY
«SECONDARY SURVEY
LOOK FOR EXTERNAL CLUES
As part of your assessment, look for external
clues to a casualty’s condition. If you suspect
drug abuse, take care as he may be carrying
needles and syringes. You may find an
appointment card for a hospital or clinic, or a
card indicating a history of allergy, diabetes or
epilepsy. Horse-riders or cyclists may carry such
a card inside their riding hat or helmet. Food or
medication may also give valuable clues about
the casualty’s condition; for example, people
with diabetes may carry sugar lumps or glucose
gel. A person with a known disorder may also
have medical warning information on a special
locket, bracelet, medallion or key ring (such as a
“MedicAlert” or “SOS Talisman”). Keep any such
item with the casualty or give it to the
emergency services.
If you need to search a casualty’s belongings,
always try to ask the casualty first and then
carry out the search in front of a reliable
witness (p.21).
MEDICAL CLUES
MEDICATION
A casualty may be carrying medication such as
anti-inflammatories for back pain or glyceryl
trinitrate for angina.
“PUFFER” INHALER
The presence of an inhaler usually indicates that the
casualty has asthma; reliever inhalers are generally blue
and preventive inhalers are usually brown or white.
MEDICAL WARNING BRACELET
This may be inscribed with information about a casualty’s
medical history (for example, epilepsy, diabetes or
anaphylaxis), or there may be a number to call.
AUTO-INJECTOR
This contains adrenaline for use by people at risk of
anaphylactic shock. The pens are colour-coded for
adult and child doses.
INSULIN PEN
This may indicate that a person has diabetes. The casualty
may also have a glucose testing kit.
49
SECONDARY SURVEY | HEAD-TO-TOE EXAMINATION
»
Once you have taken the casualty’s history
(p.46) and asked about any symptoms she
has (p.47), you should carry out a detailed
examination. Use all your senses when you
examine a casualty: look, listen, feel and smell.
Always start at the casualty’s head and work
down; this “head-to-toe” routine is both easily
remembered and thorough. You may have to
sensitively loosen, open, cut away or remove
clothing where necessary to examine the
casualty (p.232). Always be sensitive to a
casualty’s privacy and dignity, and ask her
permission before doing this.
Protect yourself and the casualty by putting
on your disposable gloves. Make sure that you
do not move the casualty more than is strictly
necessary. If possible, examine a casualty who is
responding to you in the position in which you
find her, or one that best suits her condition,
unless her life is in immediate danger. If an
unresponsive breathing casualty has been
placed in the recovery position, leave her in
this position while you carry out the head-totoe
examination.
Check the casualty’s breathing and pulse
rates (pp.52–53), then work from her head
downwards (see overleaf). Initially, note any
minor injuries found but continue your
examination to make sure that you do not miss
any concealed potentially serious conditions;
only return to the minor injuries when you have
completed your examination.
HEAD-TO-TOE EXAMINATION
■ Pain ■ Anxiety ■ Heat ■ Cold ■ Loss of sensation ■ Abnormal
sensation ■ Thirst ■ Nausea ■ Tingling ■ Pain on touch
or pressure ■ Faintness ■ Stiffness ■ Weakness ■ Memory loss
■ Dizziness ■ Sensation of broken bone ■ Sense of
impending doom
The casualty may tell you of these
symptoms
METHOD OF IDENTIFICATION
POSSIBLE FINDINGS ON CARRYING OUT AN EXAMINATION
SYMPTOMS OR SIGNS
You may see these signs
You may feel these signs
You may hear these signs
You may smell these signs
■ Temporary unresponsiveness ■ Anxiety and painful expression ■ Unusual chest
movement ■ Burns ■ Sweating ■ Wounds ■ Bleeding from orifices ■ Response
to touch ■ Response to speech ■ Bruising ■ Abnormal skin colour ■ Muscle
spasm ■ Swelling ■ Deformity ■ Foreign bodies ■ Needle marks ■ Vomit
■ Incontinence ■ Loss of normal movement ■ Containers and other
circumstantial evidence
■ Dampness ■ Abnormal body temperature ■ Swelling ■ Deformity
■ Irregularity ■ Grating bone ends
■ Noisy or distressed breathing ■ Groaning ■ Sucking sounds from a
penetrating chest injury ■ Response to touch ■ Response to speech
■ Grating bone (crepitus)
■ Acetone ■ Alcohol ■ Burning ■ Gas or fumes ■ Solvents or glue
■ Urine ■ Faeces ■ Cannabis
50
ASSESSING A CASUALTY
Look at the skin. Note the colour and
temperature: is it pale, flushed or grey-blue
(cyanosis); is it hot or cold, dry or damp? Pale, cold,
sweaty (clammy) skin suggests shock; a flushed,
hot face suggests fever or heatstroke. A blue tinge
indicates lack of oxygen; look for this in the lips,
ears and face.
Look in the mouth for anything that might
obstruct the airway. If the casualty has
dentures that are intact and fit firmly, leave them.
Look for mouth wounds or burns and check for
irregularity in the line of the teeth.
Check the nose for discharges as you did
for the ears. Look for bleeding, clear fluid
or watery blood coming from either nostril.
Any of these discharges might indicate serious
head injury.
6
7
5
HEAD-TO-TOE EXAMINATION
Loosen clothing around the neck, and
look for signs such as a medical warning
medallion (p.48) or a hole (stoma) in the windpipe.
Run your fingers gently along the spine from the
base of the skull down as far as possible without
moving the casualty; check for irregularity,
swelling, tenderness or deformity.
Assess breathing (p.52). Check the rate (fast or
slow), depth (shallow or deep) and nature (is it
easy or difficult, noisy or quiet). Check the pulse
(p.53). Assess the rate (fast or slow), rhythm
(regular or irregular) and strength (strong or weak).
Start the physical examination at the
casualty’s head. Run your hands carefully over
the scalp to feel for bleeding, swelling, tenderness
or depression of the bone, which may indicate a
fracture. Be careful not to move the casualty if you
suspect that she may have injured her neck.
Speak clearly to the casualty in both ears
to find out if she responds or if she can hear.
Look for bleeding, clear fluid or watery blood
coming from either ear. These discharges may be
signs of a serious head injury (pp.144–45).
Examine both eyes. Note whether they are
open. Check the size of the pupils (the black
area). If the pupils are not the same size it may
indicate head injury. Look for any foreign object,
blood or bruising in the whites of the eyes.
WHAT TO DO
1
2
3
4
8
«
51
HEAD-TO-TOE EXAMINATION
Gently feel the casualty’s abdomen to
detect any evidence of bleeding, and
to identify any rigidity or tenderness of the
abdomen’s muscular wall, which could be a sign
of internal bleeding. Compare one side of the
abdomen with the other.
Check that the casualty has no abnormal
sensations in the arms or fingers. If the
fingertips are pale or grey-blue there may be
a problem with blood circulation. Look out for
needle marks on the forearms, or a medical
warning bracelet (p.48).
If there is any impairment in movement or
loss of sensation in the limbs, do not move
the casualty to examine the spine, since these
signs suggest spinal injury. Otherwise, gently
pass your hand under the hollow of the back
and check for swelling and tenderness.
13
11
12
Check the legs. Look and feel for bleeding,
swelling, deformity or tenderness. Ask the
casualty to raise each leg in turn, and to move
her ankles and knees.
Feel both sides of the hips, and examine the
pelvis for signs of fracture. Check clothing
for any evidence of incontinence, which suggests
spinal or bladder injury, or bleeding from orifices,
which suggests pelvic fracture.
15
14
Check the movement and feeling in the
toes. Check that the casualty has no
abnormal sensations in her feet or toes.
Compare both feet. Look at the skin colour:
grey-blue skin may indicate a circulatory
disorder or an injury due to cold.
16
Look at the chest. Ask the casualty to breathe
deeply, and note whether the chest expands
evenly, easily and equally on both sides. Feel the
ribcage to check for deformity, irregularity or
tenderness. Ask the casualty if she is aware of
grating sensations when breathing, and listen for
unusual sounds. Note whether breathing causes
any pain. Look for any external injuries, such as
bleeding or stab wounds.
Feel along the collar bones, shoulders,
upper arms, elbows, hands and fingers for
any swelling, tenderness or deformity. Check
the movements of the elbows, wrists and fingers
by asking the casualty to bend and straighten
each joint.
10
9
52
ASSESSING A CASUALTY
MONITORING VITAL SIGNS
When treating a casualty, you may need to
assess and monitor his breathing, pulse and
level of response. This information can help you
to identify problems and indicate changes in a
casualty’s condition. Monitoring should be
repeated regularly, and your findings recorded
and handed over to the medical assistance
taking over (p.21).
In addition, if a casualty has a condition that
affects his body temperature, such as fever, heat
stroke or hypothermia, you will also need to
monitor his temperature.
You need to assess and monitor a casualty’s
level of response and make a note of any change
in her condition (deterioration or improvement)
while she is in your care. Any injury or illness
that affects the brain may alter a person's ability
to respond, and any deterioration is potentially
serious. Assess the level of response using the
AVPU scale (right) and repeat the assesment at
regular intervals.
■■A – Is the casualty Alert? Are her eyes open
and does she respond to questions?
■■V – Does the casualty respond to Voice? Can
she open her eyes, answer simple questions
and obey commands?
■■P – Does the casualty respond to Pain?
Does she open her eyes or move if you pinch
her ear lobe?
■■U – Is the casualty Unresponsive to any
stimulus (unconscious)?
LEVEL OF RESPONSE
When assessing a casualty’s breathing,
check the rate of breathing and listen for
any breathing difficulties or unusual noises.
An adult’s normal breathing rate is 12–16
breaths per minute; in babies and young
children, it is 20–30 breaths per minute. When
checking breathing, listen for breaths and watch
the casualty’s chest movements. For a baby or
young child, it might be easier to place your
hand on the chest and feel for movement of
breathing. Record the following information:
■■Rate – count the number of breaths per
minute
■■Depth – are the breaths deep or shallow
■■Ease – are the breaths easy, difficult
or painful
■■Noise – is the breathing quiet or noisy, and
if noisy, what are the types of noise
BREATHING
Checking a casualty’s breathing rate
Observe the chest movements and count the number
of breaths per minute. Use a watch to time breaths.
For a baby or young child, place your hand on the
chest and feel for movement.
53
MONITORING VITAL SIGNS
Brachial pulse
Place the pads of two fingers
on the inner side of an infant’s
upper arm.
Digital thermometer
Used to measure temperature
under the tongue or armpit. Leave
it in place until it makes a beeping
sound (about 30 seconds), then
read the display.
Radial pulse
Place the pads of three fingers just
below the wrist creases at the base
of the thumb.
Forehead thermometer
A heat-sensitive strip for use on a
young child. Hold it against the
child’s forehead for about 30
seconds. The colour on the strip
indicates temperature.
Carotid pulse
Place the pads of two fingers in the
hollow between the large neck
muscle and the windpipe.
Ear sensor
Place the probe inside the ear.
Press the measurement key and
wait for a beeping sound, then read
the display. This thermometer can
be used while a person is asleep.
PULSE
BODY TEMPERATURE
Each heartbeat creates a wave of pressure
as blood is pumped along the arteries
(pp.108–109). Where arteries lie close to the
skin surface, such as on the inside of the wrist
and at the neck, this pressure wave can be felt
as a pulse. The normal pulse rate for an adult is
60–80 beats per minute. The pulse rate is faster
in children and may be slower in very fit adults.
An abnormally fast or slow pulse rate may be a
sign of illness or injury.
The pulse may be felt at the wrist (radial pulse),
or if this is not possible, the neck (carotid pulse).
In babies, the pulse in the upper arm (brachial
pulse) is easier to find.
When checking a pulse, use your fingers (not
your thumb) and press lightly against the skin.
Record the following points.
■■Rate (number of beats per minute).
■■Strength (strong or weak).
■■Rhythm (regular or irregular).
Although not a vital sign, you may need to
record temperature to assess body temperature.
You can feel exposed skin on the forehead for
example, but use a thermometer to obtain an
accurate reading. Normal body temperature is
37°C (98.6°F). A temperature above this (fever)
is usually caused by infection, but can also be
the result of heat exhaustion or heatstroke
(pp.184–85). A lower body temperature may
result from exposure to cold and/or wet
conditions – hypothermia (pp.186–88) – or it
may be a sign of life-threatening infection or
shock (pp.112–13). There are different several
types of thermometer, see below.
To stay alive we need an adequate supply
of oxygen to enter the lungs and be
transferred to all cells in the body by the
circulating blood. If a person is deprived
of oxygen for any length of time, the brain
will begin to fail. As a result, the casualty
will eventually become unresponsive,
breathing will cease, the heart will stop
and death results.
The casualty’s airway must be kept
open so that breathing can occur, allowing
oxygen to enter the lungs and be circulated
in the body.
Therefore, the priority of a first aider
when treating any collapsed casualty is
to establish an open airway and maintain
breathing and circulation. An AED
(automated external defibrillator) may
be used to “shock” a fibrillating heart back
into a normal rhythm. This chapter outlines
the priorities to remember when dealing
with an unresponsive adult, child or infant.
There are important differences in
the treatment for unresponsive infants,
children and adults; this chapter gives
separate step-by-step instructions for
dealing with each of these groups.
■■ To maintain an open airway, to check breathing and
resuscitate if required
■■ To call 999/112 for emergency help
AIMS AND OBJECTIVES
THE UNRESPONSIVE
CASUALTY
56
THE UNRESPONSIVE CASUALTY
BREATHING AND CIRCULATION
Oxygen is essential to support life. Without it,
cells in the body die – those in the brain survive
only a few minutes without oxygen. Oxygen is
taken in when we breathe in (pp.90–91), and it
is then circulated to all the body tissues via the
circulatory system (p.108). It is vital to maintain
breathing and circulation in order to sustain life.
The process of breathing enables air, which
contains oxygen, to be taken into the air sacs
(alveoli) in the lungs. Here, the oxygen is
transferred across blood vessel walls into the
blood, where it combines with blood cells. At
the same time, the waste product of breathing,
carbon dioxide, is released and exhaled in the
breath. When oxygen has been transferred to
the blood cells it is carried from the lungs to the
heart through the pulmonary veins. The heart
then pumps the oxygenated blood to the rest
of the body via blood vessels called arteries.
After oxygen is given up to the body tissues,
deoxygenated blood is brought back to the
heart by blood vessels called veins (p.108).
The heart pumps this blood to the lungs via the
pulmonary arteries, where the carbon dioxide is
released and the blood is reoxygenated before
circulating around the body again.
SEE ALSO How breathing works p.91 | The heart and blood vessels pp.108–109 | The respiratory system p.90
How the heart and lungs
work together
Air containing oxygen is taken into the
lungs via the mouth and nose. Blood
is pumped from the heart to the lungs,
where it absorbs oxygen. Oxygenated
blood is returned to the heart before
being pumped around the body.
Exchange of gases in the air sacs
Carbon dioxide passes out of blood
cells into air sacs (alveoli). Oxygen
crosses the walls of alveoli into
blood cells.
Red blood cell
Air sac
(alveolus)
Lungs
Heart pumps
oxygenated blood
around the body
Direction of
carbon dioxide
flow
Direction of
oxygen flow
Oxygenated blood
returns from the lungs
to the heart
Fresh oxygen is drawn into the lungs via the
nose and mouth by the windpipe (trachea)
Oxygenated blood
leaves the heart to
be circulated around
the body via the aorta
Deoxygenated
blood returns
from body
tissue to
the heart
Deoxygenated
blood is pumped
to the lungs by the
heart through
the pulmonary
arteries
57
BREATHING AND CIRCULATION | LIFE-SAVING PRIORITIES
LIFE-SAVING PRIORITIES
The procedures set out in this chapter can
maintain a casualty’s circulation and breathing.
With an unresponsive casualty your priorities
are to maintain an open airway, to maintain
blood circulation (to get oxygenated blood to
the tissues), and to breathe for the casualty (to
get oxygen into the body). In an adult during
the first minutes after the heart stops (cardiac
arrest), the blood oxygen level remains
constant, so chest compressions are more
important than rescue breaths in the initial
phase of resuscitation. After about two to four
minutes, the blood oxygen level falls and rescue
breathing becomes more important. The
combination of chest compressions and rescue
breaths is known as cardiopulmonary
resuscitation, or CPR.
In addition to CPR, a machine called an AED
(automated external defibrillator) can be used
to deliver an electric shock that may restore a
normal heartbeat (pp.84–87). In children and
infants, a problem with breathing is the most
likely reason for the heart to stop. Because
of this they should therefore be given FIVE
initial rescue breaths before the chest
compressions are started.
CHEST-COMPRESSION-ONLY CPR
If you have not had any training in CPR, or you
are unwilling or unable to give rescue breaths, you
can give chest compressions only. The emergency
services will give instructions for chestcompression-
only CPR (pp.70–71).
KEY ELEMENTS FOR SURVIVAL
If all of the following elements are complete,
the casualty’s chances of survival are as good
as they can possibly be:
■■Emergency help is called quickly
■■CPR is used to provide circulation and oxygen
to the body tissues
■■AED is used promptly
■■Specialised treatment and advanced care
arrive quickly
Call 999/112 for
emergency help so
that an AED and
expert help can be
brought to the
casualty.
Chest compressions
and rescue breaths
are used to “buy
time” until expert
help arrives.
A controlled electric
shock from an AED
is given. This can
“shock” the heart into
a normal rhythm.
Specialised treatment
by paramedics and in
hospital stabilises the
casualty’s condition.
CHAIN OF SURVIVAL
EARLY ADVANCED
CARE
EARLY
DEFIBRILLATION
EARLY HELP EARLY CPR
»
58
THE UNRESPONSIVE CASUALTY
If the heart stops beating, blood does not
circulate through the body. As a result, vital
organs – most importantly the brain – become
starved of oxygen. Brain cells are unable to
survive for more than three to four minutes
without a supply of oxygen.
Some circulation can be maintained
artificially with chest compressions (pp.66–67).
These act as a mechanical aid to the heart in
order to get blood flowing around the body.
Pushing vertically down on the centre of the
chest increases the pressure in the chest cavity,
expelling blood from the heart and forcing it
into the tissues. As pressure on the chest is
released, the chest recoils, or comes back up,
and more blood is “sucked” into the heart; this
blood is then forced out of the heart by the next
compression. It is possible to find the hand
position for chest compressions without
removing clothing.
To ensure that the blood is supplied with
enough oxygen, chest compressions should be
combined with rescue breathing (opposite).
A machine called an AED (automated external
defibrillator) will be used to attempt to restart
the heart when it has stopped (pp.84–87). The
earlier the AED is used, the greater the chance
of the casualty surviving. With each minute’s
delay, the chances of survival fall – however, do
not leave a casualty to search for an AED; ask
a bystander to fetch one (p.60). AEDs can be
used safely and effectively without any prior
training in their use.
AEDs are found in many public places, such
as railway stations, shopping centres, airports,
coach stations and ferry ports. They are
generally housed in cabinets, often marked with
a recognised symbol (p.85), and placed where
they can be easily accessed – on station
platforms for example. The cabinets are not
locked, but most are fitted with an alarm that is
activated when the door is opened.
RESTORING HEART RHYTHM
IMPORTANCE OF MAINTAINING CIRCULATION
USING AN AED
GIVING CHEST COMPRESSIONS
«LIFE-SAVING PRIORITIES
59
LIFE-SAVING PRIORITIES
An unresponsive casualty’s airway can become
narrowed or blocked. This can be the result of
muscular control being lost, which allows the
tongue to fall back and block the airway. When
this happens, the casualty’s breathing becomes
difficult and noisy and may stop altogether.
Lifting the casualty's chin and tilting the
head back lifts the tongue away from the
entrance of the air passage, which allows
the casualty to breathe.
Exhaled air contains about 16 per cent oxygen
(only 5 per cent less than inhaled air) and a
small amount of carbon dioxide. Your exhaled
breath therefore contains enough oxygen to
supply another person with oxygen – and
potentially keep him alive – when it is forced
into his lungs during rescue breathing.
By giving a casualty rescue breaths (p.67),
you force air into his air passages. This reaches
the air sacs (alveoli) in the lungs, and oxygen
is then transferred to the blood vessels in
the lungs.
When you take your mouth away from the
casualty’s, his chest falls, and air containing
waste products is pushed out, or exhaled, from
his lungs. This process, performed together with
chest compressions (pp.66–67), can supply the
tissues with oxygen until help arrives.
AN OPEN AIRWAY
BREATHING FOR A CASUALTY
Blocked airway
In an unresponsive
casualty, the
muscle control in
the tongue is lost
so it falls back,
blocking the
throat and airway.
Open airway
In the head-tilt,
chin-lift position,
the tongue is
lifted from the
back of the
throat and the
trachea is open,
so the airway will
be clear.
Tongue
blocking
airway
Tongue free
of airway
Air cannot
enter airway
Air entering
airway
CAUTION
AGONAL BREATHING
This type of breathing usually takes the form
of short, irregular gasps for breath. It is common
in the first few minutes after a cardiac arrest. It
should not be mistaken for normal breathing and,
if it is present, chest compressions and rescue
breaths (cardiopulmonary resuscitation/CPR)
should be started without hesitation.
GIVING RESCUE BREATHS
»
60
THE UNRESPONSIVE CASUALTY
This action plan is a summary of the techniques
to use when attending a collapsed adult. There
are more detailed instructions given on the
following pages. Carry out the following
steps in rapid succession to minimise
interruption to CPR.
ADULT RESUSCITATION
Leave the casualty in the position
found. Use the primary survey
(pp.44–45) to identify the most
serious injury and treat in order
of priority.
■■ Try to get a response by asking
questions and gently shaking his
shoulders (p.62).
Is there a response?
If possible, leave the casualty in
the position found. Use the
primary survey (pp.44–45) to
identify the most serious injury
and treat in order of priority. Place
the casualty in the recovery
position (pp.64–65). Call 999/112
for emergency help.
■■ Tilt the head back and lift the chin
to open the airway (p.63).
■■ Check for breathing (p.63).
Is he breathing normally?
■■ Give 30 chest compressions
(pp.66–67).
■■ Give TWO rescue breaths (p.67).
■■ Alternate 30 chest compressions
with TWO rescue breaths (30:2)
until help arrives; the casualty
shows signs of becoming
responsive, for example, coughing,
opening his eyes, speaking, or
moving purposefully, and starts
to breathe normally; or you are
too exhausted to continue.
■■ If you are on your own, start CPR
straight away; do not leave the
casualty in search of an AED.
■■ If you have not had training in
CPR, or you are unwilling or unable
to give rescue breaths, you can
give chest compressions only
(pp.70–71). The emergency
services will give instructions for
chest-compression-only CPR.
■■ If the casualty starts breathing
normally, but remains
unresponsive, place him in the
recovery position (pp.64–65).
Ask a helper to call 999/112 for emergency help and fetch an AED
■■ If you are on your own, make the call yourself.
OPEN THE AIRWAY; CHECK FOR BREATHING
CHECK CASUALTY’S RESPONSE
BEGIN CPR
NO
NO
YES
YES
«LIFE-SAVING PRIORITIES
61
LIFE-SAVING PRIORITIES
This action plan shows the order for the
techniques to use when attending a child
between the ages of one and puberty or an
infant under one year.
CHILD/INFANT RESUSCITATION
Leave the child in the position
found. Use the primary survey
(pp.44–45) to identify the most
serious injury and treat in order
of priority.
If possible, leave the casualty in
the position found. Use the
primary survey (pp.44–45) to
identify the most serious injury
and treat in order of priority. Place
the child in the recovery position
(pp.74–75), or hold an infant (p.81).
Call 999/112 for emergency help.
■■ It is better to give a combination
of rescue breaths and chest
compressions with infants and
children. However, if you have not
had training in CPR, or you are
unwilling or unable to give rescue
breaths, you may give chest
compressions only (pp.70–71).
The emergency services will
give instructions for chestcompression-
only CPR.
■■ If you are alone, carry out CPR
for one minute before calling for
emergency help. Take the infant
or child with you to the phone
if necessary – never leave a child
to search for an AED.
■■ If the child starts breathing
normally, but remains
unresponsive, place her in the
recovery position (child, pp.74–75;
infant, p.81).
■■ Try to get a response by asking
questions and gently tapping
the child’s shoulder or an
infant’s foot.
Is there a response?
■■ Tilt the head back and lift the chin
to open the airway (child, p.73;
infant, p.80).
■■ Check for breathing (child, p.73;
infant, p.81).
Is she breathing normally?
Ask a helper to call 999/112 for emergency help and, for a child,
fetch an AED, ideally with paediatric pads.
■■ Do not use an AED on an infant.
■■ Carefully remove any visible
obstruction from the mouth.
■■ Give FIVE initial rescue breaths
(child, p.76; infant, p.80).
■■ Give 30 chest compressions
(child, p.77; infant, p.83).
■■ Follow with TWO rescue breaths.
■■ Alternate 30 chest compressions
with TWO rescue breaths (30:2)
until emergency help arrives; the
child shows signs of becoming
responsive, such as coughing,
opening her eyes, speaking, or
moving purposefully, and starts to
breathe normally; or you are too
exhausted to continue.
GIVE INITIAL RESCUE BREATHS
OPEN THE AIRWAY; CHECK FOR BREATHING
CHECK CHILD’S RESPONSE
BEGIN CPR
NO
NO
YES
YES
62
THE UNRESPONSIVE CASUALTY
The following pages describe techniques for
the management of an unresponsive adult who
may require resuscitation.
Always approach and treat the casualty from
the side, kneeling down next to his head or
chest. You will then be in the correct position to
perform all the stages of resuscitation: opening
the airway; checking breathing; and giving chest
compressions and rescue breaths (together
called cardiopulmonary resuscitation, or CPR).
At each stage you will have decisions to make –
for example, is the casualty breathing? The
steps given here tell you what to do next;
work through them in rapid succession with
minimal interruption.
The first priority is to open the casualty’s
airway so that he can breathe or you can give
rescue breaths. If normal breathing returns at
any stage, you should place the casualty in the
recovery position. If the casualty is not breathing,
the early use of an AED (automated external
defibrillator) may increase his chance of survival.
On discovering a collapsed casualty, you should first make sure
the scene is safe and then establish whether he is responsive or
unresponsive. Do this by gently shaking the casualty’s shoulders.
Ask “What has happened?” or give a command such as, “Open
your eyes”. Always speak loudly and clearly to the casualty.
HOW TO CHECK THE RESPONSE
If there is no further danger, leave the casualty
in the position in which he was found. Use the
primary survey (pp.44–45) to identify the most
serious injury and treat conditions in order of
priority. Summon help if needed.
Shout for help. Leave the casualty in the
position in which he was found and open
the airway.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – until
help arrives or the casualty recovers.
If you are unable to open the airway in
the position in which he was found, roll
him on to his back and open the airway. Go to
How to open the airway (opposite).
1
1
2
2
IF THERE IS NO RESPONSE
IF THERE IS A RESPONSE
■■ Always assume that there is a
neck injury and shake the
shoulders very gently.
CAUTION
UNRESPONSIVE ADULT
63
UNRESPONSIVE ADULT
Keeping the airway open, look, listen and feel
for normal breathing: look for chest movement;
listen for sounds of breathing; and feel for
breaths on your cheek. Do this for no more than
10 seconds before deciding whether or not the
casualty is breathing normally. Breathing may
be agonal (p.59). If there is any doubt, act as if
it is not normal.
HOW TO CHECK BREATHING
HOW TO OPEN THE AIRWAY
Place one hand on his forehead. Gently tilt his
head back. As you do this, the mouth will fall
open slightly.
Place the fingertips of your other hand on the
point of the casualty’s chin and lift the chin.
Check the casualty’s breathing. Go to How to check
breathing, below.
1 2
Use the primary survey (pp.44–45) to identify
the most serious injury and treat conditions in
order of priority.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while
waiting for help to arrive. Go to How to place
casualty in recovery position (pp.64–65).
Place the casualty in the recovery
position (pp.64–65) and call 999/112 for
emergency help.
Begin CPR with chest compressions – do not
leave a casualty in search of an AED. Go to
How to give CPR (pp.66–67).
1
3
1
2
2
IF THE CASUALTY IS BREATHING
IF THE CASUALTY IS NOT BREATHING
»
Ask a helper to call 999/112 for emergency
help. Ask the person to bring an AED if one
is available. If you are alone, make the call
yourself, ideally use your mobile device set to
speaker phone to make the call.
64
THE UNRESPONSIVE CASUALTY
If the casualty is found lying on his side or
front, rather than his back, not all the following
steps will be necessary to place him in the
recovery position. If the mechanism of injury
suggests a spinal injury, treat as described
opposite and on pp.157–59.
WHAT TO DO
Kneel beside the casualty. Remove his
spectacles and any bulky objects, such as
mobile phones or large bunches of keys, from his
pockets. Do not search his pockets for small items.
Make sure that both of the casualty’s legs are
straight. Place the arm that is nearest to you at
right angles to the casualty’s body, with the elbow
bent and the palm facing upwards.
Bring the arm that is farthest from you
across the casualty’s chest, and hold the
back of his hand against the cheek nearest to
you. With your other hand, grasp the far leg just
above the knee and pull it up, keeping the foot
2 flat on the ground.
1 3
4
HOW TO PLACE CASUALTY IN RECOVERY POSITION
Keeping the casualty’s hand pressed against
his cheek, pull on the far leg and roll the
casualty towards you and on to his side.
«UNRESPONSIVE ADULT
65
UNRESPONSIVE ADULT
If necessary, adjust the hand under the cheek
to keep the airway open.
Tilt the casualty’s head back and tilt his chin so
that the airway remains open (p.63).
If it has not already been done, call 999/112
for emergency help. Monitor and record vital
signs – breathing, pulse and level of response
(pp.52–53) – while waiting for help to arrive.
If the casualty is likely to remain in the
recovery position for a while, after 30 minutes
roll him on to his back, and then roll him on to the
opposite side – unless other injuries prevent you
from doing this.
Adjust the upper leg so that both the hip and
the knee are bent at right angles. 5 7
6
8
9
If you suspect a spinal injury (pp.157–59) and
need to place the casualty in the recovery
position because you cannot maintain an
open airway, try to keep the spine straight
using the following guidelines:
■■ If you are alone, use the technique shown
opposite and above.
■■ If you have one helper, one of you should
steady the head while the other turns the
casualty (right).
■■With three people, one person should steady
the head while another turns the casualty. The
third person should keep the casualty’s back
straight during the manoeuvre.
■■ If there are four or more people in total, use the
log-roll technique (p.159).
SPECIAL CASE RECOVERY POSITION FOR SUSPECTED SPINAL INJURY
»
66
THE UNRESPONSIVE CASUALTY
Place your hand on the casualty’s breastbone as
indicated here. Make sure that you do not press
on the casualty’s ribs, the lower tip of the breastbone
or the upper abdomen.
WHAT TO DO
Kneel beside the casualty level with his chest.
Place the heel of one hand on the centre of the
casualty’s chest. You can identify the correct hand
position for chest compressions through a
casualty’s clothing.
Place the heel of your other hand on top of the
first hand, and interlock your fingers, making
sure the fingers are kept off the ribs.
Leaning over the casualty, with your arms
straight, press down vertically on the
breastbone and depress the chest by 5–6cm
(2–2½in). Release the pressure without removing
your hands from his chest. Allow the chest to
come back up fully (recoil) before giving the
next compression.
2
1
3
HAND POSITION
Hand position
Ribs
Breastbone
Upper
abdomen
Lower tip of
breastbone
HOW TO GIVE CPR
«UNRESPONSIVE ADULT
67
UNRESPONSIVE ADULT
If there is more than one rescuer,
change over every 1–2 minutes,
with minimal interruption to
chest compressions.
Move to the casualty’s
head and make sure that
the airway is still open. Put one
hand on his forehead and two
fingers of the other hand under
the tip of his chin. Move the
hand that was on the forehead
down to pinch the soft part of
the nose with the finger and
thumb. Allow the casualty’s
mouth to fall open
Maintaining head tilt
and chin lift, take your
mouth off the casualty’s mouth
and look to see the chest fall.
If the chest rises visibly as
you blow and falls fully when
you lift your mouth away, you
have given a rescue breath –
one rescue breath should take
one second. Give a second
rescue breath.
Take a breath and place
your lips around the
casualty’s mouth, making
sure you have a good seal. Blow
into the casualty’s mouth until
the chest rises. A complete
rescue breath should take one
second. If the chest does not
rise, you may need to adjust
the head position (How to open
the airway, p.63).
Continue the cycle of 30
chest compressions followed
by TWO rescue breaths (30:2)
until: emergency help arrives
and takes over; the casualty
shows signs of becoming
responsive – such as coughing,
opening his eyes, speaking, or
moving purposefully – and starts
to breathe normally; or you are
too exhausted to continue.
Compress the chest 30
times at a rate of 100–120
compressions per minute.
The time taken for compression
and release should be about
the same.
4 5
6 7 8
CAUTION
»
68
THE UNRESPONSIVE CASUALTY
There are circumstances when it may be more
difficult to deliver CPR:
■■If you have not been trained in CPR or are
unwilling or unable to give rescue breaths you
can give chest compressions only (pp.70–71).
An ambulance dispatcher will give
instructions for chest-compression-only CPR.
■■If there is more than one rescuer, change over
every 1–2 minutes, with minimal interruption
to chest compressions.
■■If the casualty vomits during CPR, roll him
away from you onto his side, ensuring that his
head is turned towards the floor to allow
vomit to drain away. Clear any residual debris
from his mouth, then immediately roll him
onto his back again and recommence CPR.
■■If a woman in the late stage of pregnancy
requires CPR, raise her right hip off the
ground by tilting it upwards before you begin
compressions, see below.
■■Modified rescue breathing may be necessary
in some cases: for example, if a casualty has
a chemical around the mouth, you can give
rescue breaths through the nose (opposite).
A casualty may breathe through a hole in the
front of the neck – a stoma – opposite). You
can also use a pocket mask or face shield
when giving rescue breaths.
If a casualty's chest does not rise when giving
rescue breaths:
■■Re-check the head tilt and chin lift.
■■Re-check the casualty's mouth and remove
any obvious obstructions, but do not do a
finger sweep of the mouth.
Make no more than two attempts to achieve
rescue breaths before repeating compressions.
If a heavily pregnant woman is lying on her
back, the pregnant uterus will press against the
large blood vessels in the abdomen. This
restricts blood from the lower part of the body
returning to the heart, which reduces
the amount of blood circulation that can be
achieved with chest compressions. To prevent
this from happening, tilt her right hip upwards.
CPR IN LATE STAGES OF PREGNANCY
SPECIAL CONSIDERATIONS FOR CPR
Positioning the woman
Keep the woman's upper body
as flat on the floor as possible in
order to give good-quality
compressions. Raise her right hip
and ask a helper to kneel beside
the woman so that his knees are
underneath the raised hip. If you
are on your own, place tightly
rolled up clothing or towels under
the woman’s hip to lift it.
PROBLEMS WITH RESCUE BREATHING
«UNRESPONSIVE ADULT
69
UNRESPONSIVE ADULT
FACE SHIELDS AND POCKET MASKS
Face shields are plastic barriers with a filter that
is placed over the casualty’s mouth. A pocket
mask has a mouthpiece through which breaths
are given. If you have one of these barrier
devices, avoid unnecessary interruptions to
CPR when you use it.
There are some situations where mouth-tomouth
rescue breaths are not appropriate and
you need to use a mouth-to-nose or mouth-tostoma
technique.
The ambulance service may initially send a
sole responder in a fast-response vehicle or
a community first responder ahead of the
ambulance. If an AED is not already attached
to the casualty, the ambulance personnel will
do that. They will also use additional drugs and
equipment to provide advanced care (p.57). If
you are asked to help you should listen carefully
and follow the instructions given (p.23).
The ambulance personnel will make a decision
whether to transfer the casualty to hospital
immediately or to continue treatment at the
scene. Any decision to stop resuscitation can only
be made by a health care professional.
VARIATIONS FOR RESCUE BREATHING
WHEN THE AMBULANCE ARRIVES
Mouth-to-nose rescue breathing
If a casualty has injuries to the mouth that make it
impossible to achieve a good seal, you can use the
mouth-to-nose method for giving rescue breaths.
With the casualty’s mouth closed, form a tight seal
with your lips around the nose and blow steadily
into the casualty’s nose. Then allow the mouth
to fall open to let the air escape.
Mouth-to-stoma rescue breathing
A casualty who has had his voice-box surgically
removed breathes through an opening in the front
of the neck (a stoma), rather than through the mouth
and nose. Always check for a stoma before giving
rescue breaths. If you find a stoma, close off the
mouth and nose with one hand and then breathe
into the stoma.
Using a pocket mask
Kneel behind the casualty’s head. Open the airway
and place the mask, narrow end towards you, over
the casualty’s mouth and nose. Deliver rescue breaths
through the mouthpiece.
Using a face shield
Tilt the casualty’s head back to open the airway. Place
the shield over the casualty’s face so that the filter is
over the mouth and pinch the nostrils shut. Deliver
rescue breaths through the filter.
»
70
THE UNRESPONSIVE CASUALTY
Healthcare professionals and trained first aiders will deliver
CPR using chest compressions combined with rescue breaths
(pp.66–67). However, if you have not had training in CPR or you
are unwilling or unable to give rescue breaths, chestcompression-
only CPR has been shown to be of great benefit
certainly in the first minutes after the heart has stopped. The
emergency services will give instructions for chest-compressiononly
resuscitation for an unresponsive casualty when advising an
untrained person by telephone. Put your device on speakerphone
mode so that you can deliver first aid and talk to the
dispatcher. Start chest compressions as soon as possible and
continue them until: emergency help arrives and takes over; the
casualty shows signs of becoming responsive – such as coughing,
opening his eyes, speaking or moving purposefully – and starts
breathing normally; or you are too exhausted to continue.
WHAT TO DO
Check for a response.
Gently shake the casualty’s
shoulders, and talk to him or give
a command (p.62).
IF THERE IS A RESPONSE
Use the primary survey (pp.44–45)
to identify the most serious injury
and treat conditions in order
of priority.
IF THERE IS NO RESPONSE
Shout for help and open the
airway, step 2.
Open the casualty’s airway.
Place one hand on the
forehead and gently tilt the head
– the mouth should fall open.
Place the fingertips of your other
hand on the chin and lift it.
2
1
■■ If there is more than one rescuer
swap every 1–2 minutes to
prevent fatigue. Make sure there
is minimal interruption when
you change over to maintain the
quality of the compressions.
■■ For unresponsive children and
infants who are not breathing,
it is best to give CPR using
rescue breaths with chest
compressions (pp.76–77 and
pp.82–83).
■■ If a casualty has been rescued
from water and is not breathing,
it is best to give CPR using
rescue breaths and chest
compressions (Drowning, p.100).
CAUTION CHEST-COMPRESSION-ONLY CPR
«UNRESPONSIVE ADULT
71
UNRESPONSIVE ADULT
Check breathing: look,
listen and feel for signs
of breathing for no more
than 10 seconds.
IF HE IS BREATHING
Use the primary survey (pp.44–45)
to identify the most serious injury
and treat conditions in order of
priority. Place in the recovery
position (pp.66–65).
IF HE IS NOT BREATHING
Call 999/112 for emergency help
then begin chest compressions,
step 4.
Kneel beside the casualty,
level with his chest. Place
one hand on the centre of the
chest (p.66) – you can identify the
position through clothing. Put the
heel of your other hand on top of
the first and interlock your fingers.
Make sure your fingers are not in
contact with the ribs.
Begin chest compressions:
lean over the casualty, with
your arms straight and press down
vertically on his breastbone,
depressing the chest by about
5–6cm (2–2½in). Release the
pressure – but do not take your
hands off the chest – and let the
chest come back up. The time
taken for compression and release
should be about the same.
Continue with chest
compressions at a rate of
100–120 per minute until:
emergency help arrives; the
casualty shows signs of becoming
responsive – such as coughing,
opening his eyes, speaking or
moving purposefully – and starts
breathing normally; or you are
too exhausted to continue.
3
4
5
6
72
The following pages describe the techniques
that may be needed for the resuscitation of
an unresponsive child aged between one year
and puberty.
When treating a child, always approach and
treat her from the same side, kneeling down
next to the head or chest. You will then be in
the correct position to carry out all the different
stages of resuscitation: opening the airway,
checking breathing and giving rescue breaths
and chest compressions (together known as
cardiopulmonary resuscitation, or CPR). At each
stage you will have decisions to make; for
example, is the child breathing? The steps given
here tell you what to do next; work through all
of them in rapid succession with minimal
interruption. Your first priority is to open the
child’s airway, so that she can breathe, or so
that you can give rescue breaths. If normal
breathing resumes, place the child in the
recovery position (pp.74–75).
If a child with a known heart condition
collapses, call 999/112 for emergency help
immediately and ask for an AED to be brought
(pp.84–87). Early access to advanced care can
be life-saving.
On discovering a collapsed child, you should
first establish whether she is responsive or
unresponsive. Do this by speaking loudly and
clearly to the child. Ask “What has happened?”
or give a command such as, “Open your eyes”.
Place one hand on her shoulder, and gently tap
her to see if there is a response.
HOW TO CHECK RESPONSE
THE UNRESPONSIVE CASUALTY
If there is no further danger, leave the
child in the position in which she was found.
Use the primary survey (pp.44–45) to identify the
most serious injury and treat conditions in order
of priority.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – until
emergency help arrives or the child recovers.
Shout for help. Leave the child in the position
in which she was found, and open the airway.
If you are unable to open the airway in
the position in which she was found, roll the
child on to her back and open the airway. Go to
How to open the airway (opposite).
2
1
1
2
IF THERE IS A RESPONSE
IF THERE IS NO RESPONSE
UNRESPONSIVE CHILD ONE YEAR TO PUBERTY
73
Keep the airway open and look, listen and
feel for normal breathing – look for chest
movement, listen for sounds of normal
breathing and feel for breaths on your cheek.
Do this for no more than 10 seconds.
HOW TO CHECK BREATHING
HOW TO OPEN THE AIRWAY
UNRESPONSIVE CHILD
IF THE CASUALTY IS BREATHING
IF THE CASUALTY IS NOT BREATHING
Place one hand on the child’s forehead. Gently
tilt her head back. As you do this, the mouth
will fall open slightly.
Use the primary survey (pp.44–45) to identify
the most serious injury and treat conditions in
order of priority.
Ask a helper to call 999/112 for emergency
help. If you are on your own, perform CPR
for one minute and then make the emergency
call yourself. Use your mobile device set to speaker
phone to make the call or take the child with you to
the telephone if necessary.
Place the child in the recovery position and
call 999/112 for emergency help.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while
waiting for help to arrive. Go to How to place child
in recovery position (pp.74–75).
Begin CPR with FIVE initial rescue breaths.
Go to How to give CPR (pp.76–77).
Place the fingertips of your other hand on the
point of the chin and lift. Do not push on the
soft tissues under the chin since this may block the
airway. Now check to see if the child is breathing.
Go to How to check breathing (below).
2
1
1
2
3
2
1
»
74
THE UNRESPONSIVE CASUALTY
UNRESPONSIVE CHILD ONE YEAR TO PUBERTY
If the child is found lying on her side or front,
rather than her back, not all of these steps will
be necessary to place her in the recovery
position. If the mechanisms of injury suggest a
spinal injury, treat as described on pp.157–59.
HOW TO PLACE CHILD IN RECOVERY POSITION
Make sure that both of the child’s legs are
straight. Place the arm nearest to you at right
angles to the child’s body, with the elbow bent and
the palm facing upwards.
Bring the arm that is farthest from you across
the child’s chest, and hold the back of her hand
against the cheek nearest to you. With your other
hand, grasp the far leg just above the knee and pull
it up, keeping the foot flat on the ground.
Kneel beside the child. Remove her spectacles
and any bulky objects from her pockets, but do
not search them for small items.
1
2
3
WHAT TO DO
Keeping the child’s hand pressed against her
cheek, pull on the far leg and roll the child
towards you and on to her side.
4
«
75
UNRESPONSIVE CHILD
Adjust the upper leg so that both the hip and
the knee are bent at right angles. Tilt the child’s
head back and lift the chin so that the airway
remains open.
If necessary, adjust the hand under the cheek
to make sure that the head remains tilted and
the airway stays open. If it has not already been
done, call 999/112 for emergency help. Monitor
and record vital signs – breathing, pulse and level
of response (pp.52–53) – until help arrives.
If the child is likely to remain in the recovery
position for a while, after 30 minutes you
should roll her on to her back, then turn her on to
the opposite side – unless other injuries prevent
you from doing this.
6
7
If you suspect a spinal injury (pp.157–59) and need
to place the child in the recovery position because
you cannot maintain an open airway, try to keep
the spine straight using the following guidelines:
■■ If you are on your own, use the technique shown
opposite and left.
■■ If there are two of you, one person should steady the
head while the other turns the child, see below.
■■ If there are three of you, one person should steady the
head while one person turns the child. The third
person should keep the child’s back straight during the
manoeuvre.
■■ If there are four or more people in total, use the logroll
technique (p.159).
»
SPECIAL CASE RECOVERY POSITION
FOR SUSPECTED SPINAL INJURY
5
76
THE UNRESPONSIVE CASUALTY
WHAT TO DO
Ensure the airway is still open by keeping one
hand on the child’s forehead and two fingers of
the other hand on the point of her chin.
Pinch the soft part of the
child’s nose with the finger
and thumb of the hand that was
on the forehead. Make sure that
her nostrils are closed to prevent
air from escaping. Allow her
mouth to fall open.
Take a deep breath in
before placing your lips
around the child’s mouth,
making sure that you form an
airtight seal. Blow steadily into
the child’s mouth; the chest
should rise.
Maintaining head tilt and
chin lift, take your mouth
off the child’s mouth and look to
see the chest fall. If the chest
rises visibly as you blow and falls
fully when you lift your mouth,
you have given a rescue breath.
Each complete rescue breath
should take one second. If the
chest does not rise you may
need to adjust the head (p.73).
Give a child FIVE initial
rescue breaths.
Pick out any visible obstructions from the
mouth. Do not sweep the mouth with your
finger to look for obstructions.
1 2
3 4 5
«UNRESPONSIVE CHILD ONE YEAR TO PUBERTY
HOW TO GIVE CPR
77
UNRESPONSIVE CHILD
HAND POSITION
With more than one rescuer, change every 1–2
minutes with minimal interruption to compressions.
Return to the child’s head, open the airway
and give TWO further rescue breaths.
If you are on your own, alternate 30 chest
compressions with TWO rescue breaths (30:2)
for one minute, then stop to call 999/112 for
emergency help. Continue CPR until: emergency
help arrives and takes over; the child shows signs
of becoming responsive – such as coughing,
opening her eyes, speaking, or moving purposefully
– and starts to breathe normally; or you become
too exhausted to continue.
Kneel level with the child’s chest. Place one
hand on the centre of her chest. This is the
point at which you will apply pressure.
Lean over the child, with your arm straight,
and then press down vertically on the
breastbone with the heel of your hand. Depress
the chest by at least one-third of its depth. Release
the pressure without removing your hand from
the chest. Allow the chest to come back up
completely (recoil) before you give the next
compression. Compress the chest 30 times, at
a rate of 100–120 compressions per minute. The
time taken for compression and release should
be about the same.
8
9
6
7
CAUTION
Place one hand on the child’s breastbone as
indicated here. Make sure that you do not apply
pressure over the child’s ribs, the lower tip of the
breastbone or the upper abdomen.
Hand position
Ribs
Breastbone
Lower tip of
breastbone
Upper
abdomen
»
78
There are circumstances when it may be more
difficult to deliver CPR. While it is better to give
a combination of rescue breaths and chest
compressions, you may not have been formally
trained in CPR or you may be unwilling or
unable to give rescue breaths. In this situation
you can give chest compressions only. The
emergency services will give instructions for
chest-compression-only CPR when you call.
■■If there is more than one rescuer, change over
every 1–2 minutes, with minimal interruption
to compressions.
■■If the child vomits during CPR, roll her away
from you onto her side, ensuring that her head
is turned towards the floor to allow vomit to
drain away. Clear the mouth, then immediately
roll her onto her back again and recommence
CPR.
■■If the child is large, or the rescuer is small, you
can give chest compressions using both hands,
as for an adult casualty (pp.66–67). Place one
hand on the chest, cover it with your other
hand and interlock your fingers, keeping them
clear of the chest.
If a child’s chest does not rise when giving
rescue breaths:
■■Recheck the head tilt and chin lift;
■■Recheck the mouth. Remove any obvious
obstructions, but do not do a finger sweep of
the mouth.
Make no more than two attempts to achieve
rescue breaths before repeating the chest
compressions.
PROBLEMS WITH RESCUE BREATHING
SPECIAL CONSIDERATIONS FOR CPR
THE UNRESPONSIVE CASUALTY
GIVING CHEST-COMPRESSION-ONLY CPR
Kneel beside the child, level with her chest.
Place the heel of one hand on the centre of
her chest.
Lean over the child with your arm straight and
depress the chest by at least one third of the
depth, and release the pressure (but do not remove
your hand).
Repeat compressions at a rate of 100–120
per minute until: emergency help arrives and
takes over; the child shows signs of becoming
responsive – such as coughing, opening her eyes,
speaking, or moving purposefully – and starts to
breathe normally; or you become too exhausted
to continue.
2
3
1
«UNRESPONSIVE CHILD ONE YEAR TO PUBERTY
79
There are some cases where mouth-to-mouth
rescue breaths are not appropriate and you will
need to use a mouth-to-nose technique.
FACE SHIELDS AND POCKET MASKS
A face shield is a plastic barrier with a filter that
is placed over the casualty’s mouth. A pocket
mask is more substantial and has a valve
through which breaths are given. If you have
one of these barrier devices, avoid unnecessary
interruptions when giving CPR to the child.
The ambulance service may initially send
a sole responder in a fast response vehicle or
a community first responder ahead of the
ambulance. If an AED is not already attached
to the child the ambulance personnel will do
that. They will also use additional drugs and
equipment to provide advanced care (p.57). If
you are asked to help you should listen carefully
and follow the instructions given (p.23).
The ambulance personnel will make a
decision whether to transfer the child to
hospital immediately or to continue treatment
at the scene. Any decision to stop resuscitation
can only be made by a health care professional.
VARIATIONS FOR RESCUE BREATHING
WHEN THE AMBULANCE ARRIVES
Mouth-to-nose rescue breathing
If a child has been rescued from water, or injuries to
the mouth make it impossible to achieve a good seal,
you can use the mouth-to-nose method for giving
rescue breaths. With the child’s mouth closed, form a
tight seal with your lips around the nose and blow
steadily into the casualty’s nose. Then allow the
mouth to fall open to let the air escape.
Using a pocket mask
Kneel behind the child’s head. Open the airway and
place the mask, broad end towards you, over the
child’s mouth and nose. Deliver breaths through
the mouthpiece.
Using a face shield
Tilt the child’s head back to open the airway and lift
the chin. Place the plastic shield over the child’s face
so that the filter is over her mouth. Pinch the nose
and deliver breaths through the filter.
UNRESPONSIVE CHILD
80
UNRESPONSIVE INFANT UNDER ONE YEAR
The following pages describe techniques that
may be used for the resuscitation of an
unresponsive infant under one year. For a child
over the age of one year, use the child
resuscitation procedure (pp.72–79).
Always treat the infant from the side, the
correct position for doing all the stages of
resuscitation: opening the airway, checking
breathing and giving rescue breaths and
chest compressions (cardiopulmonary
resuscitation, or CPR). Work through all of them
in rapid succession with minimal interruption.
Your first priority is to ensure that the airway
is open and clear. If normal breathing resumes
at any stage, hold the infant in the recovery
position (opposite). Call 999/112 for
emergency help immediately if an infant with a
known heart condition becomes unresponsive.
Gently tap or flick the sole of the infant’s foot
and call his name to see if he responds. Never
shake an infant.
HOW TO CHECK THE RESPONSE
HOW TO OPEN THE AIRWAY
IF THERE IS NO RESPONSE
Shout for help, then lay her on her back on a firm
surface and open the airway. Go to How to open
the airway (below).
IF THERE IS A RESPONSE
THE UNRESPONSIVE CASUALTY
Place one fingertip of your
other hand on the point
of the infant's chin. Gently lift the
point of the chin. Do not push on
the soft tissues under the chin
since this may block the airway.
Place one hand on the
infant’s forehead and very
gently tilt the head back.
Now check to see if the
infant is breathing. Go
to How to check breathing
(opposite).
2
1 3
Use the primary survey (pp.44–45) to identify
the most serious injury and treat conditions in
order of priority.
Summon help if needed – take the infant with
you to make the call. Monitor and record vital
signs – breathing, pulse and level of response
(pp.52–53) – until help arrives.
2
1
81
Keep the airway open and look, listen and
feel for normal breathing – look for chest
movement, listen for sounds of breathing
and feel for breaths on your cheek. Do this for
no more than ten seconds.
HOW TO CHECK BREATHING
HOW TO HOLD IN AN INFANT IN THE RECOVERY POSITION
IF THE INFANT IS BREATHING
IF THE INFANT IS NOT BREATHING
UNRESPONSIVE INFANT
Use the primary survey (pp.44–45) to identify
the most serious injury and treat conditions in
order of priority.
Hold the infant in the recovery position.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – regularly
until help arrives. Go to How to hold an infant in
the recovery position (below).
Ask a helper to call 999/112 for emergency
help. If you are on your own, perform CPR for
one minute before making the call yourself. Use
your mobile device set to speaker phone to make
the call or take the infant with you to the telephone
if necessary.
Begin CPR with FIVE initial rescue breaths. Go
to How to give CPR (pp.82–83).
2
1
1
2
Cradle the infant in your arms with his head
tilted downwards. This position prevents him
from choking on his tongue or from inhaling vomit.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – until
help arrives.
2
1
»
82
If you cannot achieve rescue breaths:
■■ Recheck the head tilt and chin lift
■■ Recheck the infant’s mouth and nose and remove
obvious obstructions. Do not do a finger sweep
■■ Check that you have a firm seal around the mouth
and nose
■■Make up to five attempts to achieve rescue breaths,
then begin chest compressions
If the infant vomits during CPR, roll him away from
you onto his side to allow the vomit to drain. Resume
CPR as soon as possible.
WHAT TO DO
Place the infant on his back on a firm surface,
at about waist height in front of you, or on the
floor. Make sure that the airway is still open by
keeping one hand on the infant’s forehead and one
fingertip of the other hand under the tip of his chin.
Take a breath. Place your lips around the
infant’s mouth and nose to form an airtight
seal. If this is not possible, close the infant’s mouth
and make a seal around the nose only. Blow gently
and steadily into the infant’s nose for one second;
the chest should rise.
Pick out any visible obstructions from mouth
and nose. Do not sweep the mouth with your
finger looking for obstructions.
Maintaining head tilt and chin lift, take your
mouth off the infant’s mouth and see if his
chest falls. If the chest rises visibly as you blow and
falls fully when you lift your mouth, you have given
a breath. Each complete rescue breath should take
one second. Give FIVE rescue breaths.
3
2 4
1
CAUTION
THE UNRESPONSIVE CASUALTY
«UNRESPONSIVE INFANT UNDER ONE YEAR
HOW TO GIVE CPR
83
Place two fingertips of your lower hand on the
centre of the infant’s chest. Press down
vertically on the infant’s breastbone and depress
his chest by at least one-third of its depth. Release
the pressure without moving your fingers from the
breastbone. Allow the chest to come back up fully
(recoil) before giving the next compression. The
time taken for compression and release should be
about the same. Repeat to give 30 compressions at
a rate of 100–120 times per minute.
Return to the infant’s head, open the airway
and give TWO further rescue breaths.
If you are on your own, alternate 30 chest
compressions with TWO rescue breaths (30:2)
for one minute then stop to call 999/112 for
emergency help. Continue CPR until: emergency
help arrives and takes over; the infant shows signs
of becoming responsive – such as coughing,
opening his eyes, speaking or moving – and starts
to breathe normally; or you become too exhausted
to continue.
6
5
7
UNRESPONSIVE INFANT
Place your fingers on the breastbone as indicated
here. Make sure that you do not apply pressure
over the ribs, the lower tip of the infant’s
breastbone or the upper abdomen.
HAND POSITION
Finger position Breastbone
Lower tip of
Upper breastbone
abdomen
Ribs
While it is better to give a combination of rescue
breaths and chest compressions, if you have not had
formal training in CPR, or if you are unwilling or
unable to give rescue breaths, you can give chest
compressions only. The emergency services will give
instructions for chest-compression-only CPR; put
your mobile device on speaker phone so you can
deliver first aid and talk to the ambulance dispatcher.
CHEST-COMPRESSION-ONLY CPR
With more than one rescuer, change every 1–2
minutes with minimal interruption to compressions.
CAUTION
84
HOW TO USE AN AED
When the heart stops, a cardiac arrest has occurred. The most
common cause is an abnormal rhythm of the heart, known as
ventricular fibrillation. This abnormal rhythm can occur when
the heart muscle is damaged as a result of a heart attack or when
insufficient oxygen reaches the heart. A machine called an AED
(automated external defibrillator) can be used on adults and
children over the age of one year to correct the heart rhythm
by giving an electric shock. AEDs can be used safely and
effectively without prior training. They are available in many
public places, including shopping centres, railway stations and
airports – the logo opposite will be visible on the outside of the
case. The machine analyses the casualty’s heart rhythm and
visual prompts or voice prompts describe the action to take at
each stage. In most situations when an AED is called for, you will
have already started CPR. When the AED is brought, continue
with CPR while the pads are being attached to the casualty.
THE UNRESPONSIVE CASUALTY
■■Make sure that no-one is
touching the casualty because
this will interfere with the AED
readings and there is a risk of
electric shock.
■■ Do not turn off the AED or
remove the pads at any point,
even if the casualty appears to
have recovered.
■■ It does not matter if the AED
pads are reversed. If you put
them on the wrong way round,
do not try to move them; it
wastes time and the pads may
not stick to the chest properly
when they are reattached.
CAUTION
The AED will start analysing
the heart rhythm. Ensure
that no-one is touching the
casualty. Follow the voice and/or
visual prompts given by the
machine (opposite).
4
WHAT TO DO
1 Switch on the AED and take the pads out 2
of the sealed pack. Remove or cut through
clothing and wipe away sweat from the chest
if necessary.
Remove the backing paper and attach the
pads to the casualty’s chest in the positions
indicated. Place the first pad on the casualty’s
upper right side, just below his collarbone.
Place the second pad on the
casualty’s left side, just
below his armpit (inset above).
Make sure the pad has its long
axis along the head-to-toe axis of
the casualty’s body.
3
85
The AED will start to give you a series of visual
and verbal prompts as soon as it is switched on.
There are several different AED models
available, each of which has different voice
prompts. Do not stop chest compressions while
the pads are applied. You should follow the
prompts given by the machine that you have
until advanced care arrives.
SEQUENCE OF AED INSTRUCTIONS
HOW TO USE AN AED
■■ Switch on the AED.
■■ Attach pads to casualty’s chest.
The AED re-analyses heart rhythm.
The AED re-analyses heart rhythm.
■■ If the casualty shows signs of becoming
responsive, such as coughing, opening his
eyes, speaking or moving purposefully and
starts to breathe normally, place him in the
recovery position (pp.64–65). Leave the AED
attached to the casualty.
AED advises that a shock is needed; the
machine charges up.
AED instructs you to deliver the shock.
■■ Make sure everyone is clear of the casualty.
■■ Depending on the type of AED, it will either
deliver the shock automatically or instruct you
to push the shock button. The casualty may
appear to “jump” with each shock; this is
quite normal.
AED instructs you to continue CPR for two
minutes before it re-analyses.
AED instructs you to continue CPR for two
minutes before it re-analyses heart rhythm.
AED advises that no shock is needed.
AED gets ready to analyse the casualty’s heart rhythm. It may state
“Stand clear, analysing now” or “Analysing”. Make sure that no-one is
touching the casualty while it is analysing.
Is a shock advised?
»
YES NO
European AED symbol
All AED cabinets feature
a form of this symbol on
the front. The European
standard one is green,
as here, but some
companies use other
colours.
86
The use of an AED is occasionally complicated by underlying
medical conditions, external factors, clothing or the cause of
the cardiac arrest. Safety of all concerned should always be
your first consideration.
CLOTHING AND JEWELLERY
Any clothing or jewellery that could interfere
with pads should be removed or cut away.
Normal amounts of chest hair are not a
problem, but if hair prevents good contact
between the skin and the pads, it should be
shaved off. Ensure any metal is removed from
the area where the pads will be attached.
Remove clothing containing metal, such as an
underwired bra.
EXTERNAL FACTORS
Water or excessive sweat on the chest can
reduce the effectiveness of the shock so the
chest should be dry. If a casualty is rescued
from water (p.36), dry the chest before applying
the AED pads.
If the casualty is unresponsive following an
electric shock, start CPR immediately the
contact with electricity is broken. The electric
current may cause muscle paralysis, which can
make rescue breaths and chest compressions
more difficult to perform, however, it will not
affect the use of the AED.
MEDICAL CONDITIONS
Some casualties with heart conditions have a
pacemaker or an implantable cardioverter
defibrillator (ICD). This should not stop you
using an AED. However, if you can see or feel a
device under the chest skin, do not place the
pad directly over it. If a casualty has a patch
such as a glyceryl trinitrate (GTN) patch on the
chest, remove it before you apply the AED.
PREGNANT CASUALTIES
There are no contra-indications to using an
AED during pregnancy; however, the increased
breast size may present some problems.
Therefore, to place the AED pads correctly, you
may need to move one or both breasts. This
must be carried out with respect and dignity.
CONSIDERATIONS WHEN USING AN AED
THE UNRESPONSIVE CASUALTY
Never use an AED on an infant
under one year.
CAUTION
«HOW TO USE AN AED
87
Standard adult AEDs can be used on children over the age of
eight years. For children between the ages of one and eight, use a
paediatric AED or a standard machine and paediatric pads. If
neither is available, then a standard AED and pads can be used.
When the emergency services arrive continue
to resuscitate the child until they take over from
you. They need to know:
■■Casualty’s present status; for example,
unresponsive and not breathing
■■Number of shocks you have delivered
■■When the casualty collapsed and the length
of time he has been unresponsive
■■Any relevant history, if known
If the casualty recovers at any point, leave the
AED pads attached to his chest. Ensure that
any used materials from the AED cabinet are
disposed of as clinical waste (p.238). Inform
the relevant person what has been taken out
of the cabinet as it will need to be replaced.
POSITIONING AED PADS ON CHILDREN
HANDING OVER TO THE EMERGENCY SERVICES
Positioning paediatric AED pads
Place one pad in the centre of the child’s back. Then
place the second pad over the centre of the child’s
chest. Make sure both pads are vertical. Connect the
pads to the AED and proceed as described on p.85.
Using AED pads on a larger child
Place the pads on the child’s chest as for an adult –
one on the child’s upper right side, just below his
collarbone, and the second pad on the child’s left side,
just below the armpit. Make sure the pad has its long
axis along the head-to-toe axis of the child’s body.
HOW TO USE AED
Never use an AED on an infant
under one year.
CAUTION
Oxygen is essential to life. Every time
we breathe in, air containing oxygen
enters the lungs. This oxygen is then
transferred to the blood, to be transported
around the body. Breathing and the
exchange of oxygen and carbon dioxide
(a waste product from body tissues) are
described as respiration. The structures
within the body that enable us to breathe –
the air passages and the lungs – together
make up the respiratory system, and work
with the heart and circulatory system.
Respiration can be impaired in several
different ways. The airways may be blocked
causing choking or suffocation, the
exchange of oxygen and carbon dioxide in
the lungs may be affected by the inhalation
of smoke or fumes, lung function may be
impaired by chest injury, or the breathing
mechanism may be affected by conditions
such as asthma. Anxiety can also cause
breathing difficulties. Problems with
respiration can be life-threatening and
need urgent first aid.
■■ To assess the casualty’s condition
■■ To identify and remove the cause of the problem and
provide fresh air
■■ To comfort and reassure the casualty
■■ To maintain an open airway, check breathing and be
prepared to resuscitate if necessary
■■ To obtain medical help if necessary. Call 999/112
for emergency help if you suspect a serious illness
or injury
AIMS AND OBJECTIVES
RESPIRATORY
PROBLEMS
90
RESPIRATORY PROBLEMS
THE RESPIRATORY SYSTEM
This system comprises the mouth, nose,
windpipe (trachea), lungs and pulmonary
blood vessels (the blood vessels of the lungs).
Respiration involves the process of breathing
and the exchange of gases (oxygen and carbon
dioxide) both in the lungs and in cells
throughout the body.
We breathe in air to take oxygen into the
lungs, and we breathe out to expel the waste
gas, carbon dioxide, a by-product of respiration.
When we breathe, air is drawn through the nose
and mouth into the airway and the lungs. In the
lungs, oxygen is taken from air sacs (alveoli) into
the pulmonary capillaries. At the same time,
carbon dioxide is released from the capillaries
into the alveoli. The carbon dioxide is then
expelled as we breathe out. An average man’s
lungs can hold approximately 6 litres (10 pints)
of air; a woman’s lungs can hold about 4 litres
(7 pints) of air.
Structure of the
respiratory system
The lungs form the central
part of the respiratory system.
Together with the circulatory
system, they perform the vital
function of gas exchange in order to
distribute oxygen around the body
and remove carbon dioxide.
Gas exchange in air sacs
A network of tiny blood vessels
(capillaries) surrounds each air sac
(alveolus). The thin walls of both
structures allow oxygen to diffuse into
the blood and carbon dioxide to leave it.
Epiglottis
Pulmonary
capillary
Alveolus
Larynx
Ribs surround
and protect the
chest cavity
Windpipe (trachea)
extends from the larynx to
two main bronchi
Intercostal muscles
span spaces
between ribs
Lungs are two
spongy organs that
occupy a large part
of the chest cavity
Pleural membrane, which
has two layers separated
by a lubricating fluid,
surrounds and protects
each of the lungs
Diaphragm is a sheet of muscle
that separates chest and
abdominal cavities
Bronchioles are small
air passages that
branch from bronchi
and eventually open
into air sacs (alveoli)
within the lungs
Windpipe divides into
two main bronchi (sing.
bronchus), one to each
lung, further subdivide
into smaller bronchi,
then bronchioles
Bronchiole
91
THE RESPIRATORY SYSTEM
The breathing process consists of the actions
of breathing in (inspiration) and breathing out
(expiration), followed by a pause. Pressure
differences between the lungs and the air
outside the body determine whether air is
drawn in or expelled. When the air pressure
in the lungs is lower than outside, air is drawn
in; when pressure is higher, air is expelled. The
pressure within the lungs is altered by the
movements of the two main sets of muscles
involved in breathing: the intercostal muscles
and the diaphragm.
Breathing is regulated by a group of nerve cells
in the brain called the respiratory centre. This
centre responds to changes in the level of
carbon dioxide in the blood. When the carbon
dioxide level in the body rises, the respiratory
centre reacts by stimulating the intercostal
muscles and the diaphragm to contract, and a
breath occurs. Our breathing rate can be altered
consciously under normal conditions or in
response to abnormal levels of carbon dioxide,
low levels of oxygen, or with stress, exercise,
injury or illness.
HOW BREATHING WORKS
HOW BREATHING IS CONTROLLED
Breathing in
The intercostal muscles (the muscles between the ribs)
and the diaphragm contract, causing the ribs to move
up and out, the chest cavity to expand, and the lungs to
expand to fill the space. As a result, the pressure inside
the lungs is reduced, and air is drawn into the lungs.
Breathing out
The intercostal muscles relax, and the ribcage returns to
its resting position, while the diaphragm relaxes and
resumes its domed shape. As a result, the chest cavity
becomes smaller, and pressure inside the lungs
increases. Air flows out of the lungs to be exhaled.
Lung
inflates
Lung
deflates
Intercostal muscles
between ribs contract
Ribs rise and
swing outwards
Diaphragm returns to
domed position
Intercostal muscles
between ribs relax
Ribs move down
and inwards
Diaphragm contracts and
moves down
92
RESPIRATORY PROBLEMS
HYPOXIA
SEE ALSO Anaphylactic shock p.223 | Asthma p.102 | Burns to the airway p.177 | Croup p.103 | Drowning p.100 |
Hanging and strangulation p.97 | Inhalation of fumes pp.98–99 | Penetrating chest wound pp.104–05 | Stroke pp.212–13
In moderate and severe hypoxia,
there will be:
■■ Rapid breathing
■■ Breathing that is distressed or
gasping
■■ Difficulty speaking
■■ Grey-blue skin (cyanosis). At first,
this is more obvious in the
extremities, such as lips, nailbeds
and earlobes, but as the hypoxia
worsens cyanosis affects the rest
of the body
■■ Anxiety
■■ Restlessness
■■ Headache
■■ Nausea and possibly vomiting
■■ Cessation of breathing if the hypoxia
is not quickly reversed
RECOGNITION This condition arises when there is insufficient oxygen in the
body tissues. There are a number of causes of hypoxia, ranging
from suffocation, choking or poisoning to impaired lung or brain
function. The condition is accompanied by a variety of
symptoms, depending on the degree of hypoxia. If not treated
quickly, hypoxia is potentially fatal because a sufficient level of
oxygen is vital for the normal function of all the body organs and
tissues, especially the brain.
In a healthy person, the amount of oxygen in the air is more
than adequate for the body tissues to function normally.
However, in an injured or ill person, a reduction in oxygen
reaching the tissues results in deterioration of body function.
Mild hypoxia reduces a casualty’s ability to think clearly, but
the body normally responds to this by increasing the rate and
depth of breathing (p.91). However, if the oxygen supply to the
brain cells is cut off for as little as three to four minutes, the
brain cells will begin to die. All the conditions covered in this
chapter can result in hypoxia.
■■Suffocation by smoke or gas ■ Changes in atmospheric pressure, for
example, at high altitude or in a depressurised aircraft
Insufficient oxygen in inspired air
INJURY OR CONDITION
INJURIES OR CONDITIONS CAUSING LOW BLOOD OXYGEN (HYPOXIA)
CAUSES
Airway obstruction
Conditions affecting the chest wall
Impaired lung function
Damage to the brain or nerves
that control respiration
Impaired oxygen uptake by
the tissues
■ Blocking or swelling of the airway ■ Hanging or strangulation
■ Something covering the mouth or nose ■ Asthma ■ Choking
■ Anaphylaxis
■ Crushing, for example, by a fall of earth or sand or pressure from a crowd
■ Chest wall injury with multiple rib fractures or constricting burns
■ Lung injury ■ Collapsed lung ■ Lung infections, such as pneumonia
■ A head injury or stroke that damages the breathing centre in the brain
■ Some forms of poisioning ■ Paralysis of nerves controlling the
muscles of breathing, as in spinal cord injury
■■Carbon monoxide or cyanide poisioning ■ Shock
93
HYPOXIA | AIRWAY OBSTRCTION
AIRWAY OBSTRUCTION
SEE ALSO Asthma p.102 | Burns to the airway p.177 | Choking adult p.94 | Choking child p.95 |
Choking infant p.96 | Drowning p.100 | Hanging and strangulation p.97 | Inhalation of fumes pp.98–99
The airway may be obstructed externally or internally, for
example, by an object that is stuck at the back of the throat
(pp.94–96). The main causes of obstruction are:
■■Inhalation of an object, such as food
■■ Blockage by the tongue, blood or vomit while a casualty is
unresponsive (p.59)
■■Internal swelling of the throat occurring with burns, scalds,
stings or anaphylaxis
■■Injuries to the face or jaw
■■An asthma attack in which the small airways in the lungs
constrict (p.102)
■■External pressure on the neck, as in hanging or strangulation.
■■Peanuts, which can swell up when in contact with body fluids.
These pose a particular danger in young children because they
can completely block the airway
Airway obstruction requires prompt action; be prepared to give
chest compressions and rescue breaths if the casualty stops
breathing (The unresponsive casualty, pp.54–87).
The information on this page is appropriate for all causes of
airway obstruction, but if you need detailed instructions for
specific situations, refer to the relevant pages given below.
■■ Features of hypoxia (opposite), such
as grey-blue tinge to the lips,
earlobes and nailbeds (cyanosis)
■■ Difficulty speaking and breathing
■■ Noisy breathing
■■ Red, puffy face
■■ Signs of distress from the casualty,
who may point to the throat or grasp
the neck
■■ Flaring of the nostrils
■■ A persistent cough
■■ To remove the obstruction
■■ To restore normal breathing
■■ To arrange removal to hospital
■■ If the casualty is unresponsive,
open the airway and check
breathing (The unresponsive
casualty, pp.54–87).
CAUTION
WHAT TO DO
Remove the obstruction
if it is external or visible in
the mouth.
Even if the casualty appears
to have made a complete
recovery, call 999/112 for
emergency help. Monitor and
record his vital signs – breathing,
pulse and level of response
(pp.52–53) – until help arrives.
If the casualty is responsive
and breathing normally,
reassure him, but keep him
under observation.
3
2
1
RECOGNITION
YOUR AIMS
94
RESPIRATORY PROBLEMS
CHOKING ADULT
SEE ALSO Unresponsive adult pp.62–71
WHAT TO DO
If the casualty is breathing,
encourage her to continue
coughing. Remove any obvious
obstruction from the mouth.
Check her mouth. If
the obstruction has not
cleared, call 999/112 for
emergency help.
Repeat steps 2 and 3 –
rechecking the mouth
after each step – until help
arrives or the casualty
becomes unresponsive (see
CAUTION, above, left).
If back blows fail to clear the
obstruction, try abdominal
thrusts. Stand behind the
casualty and put both arms
around the upper part of her
abdomen. Make sure that she is
still bending well forwards.
Clench your fist and place it
between the navel and the
bottom of her breastbone. Grasp
your fist firmly with your other
hand. Pull sharply inwards and
upwards up to five times.
If the casualty cannot speak
or stops coughing or
breathing, carry out back blows.
Support her upper body with one
hand, and help her to lean well
forward. Give up to five sharp
blows between her shoulder
blades with the heel of your
hand. Stop if the obstruction
clears. Check her mouth.
3
4
5
2
1
A foreign object that is stuck in the throat may block it and
cause muscular spasm. If blockage of the airway is mild, the
casualty should be able to clear it; if it is severe, she will be
unable to speak, cough or breathe, and will eventually become
unresponsive. If she is unresponsive the throat muscles may
relax and the airway may open enough to do rescue breathing. Be
prepared to begin rescue breaths and chest compressions.
Ask the casualty: “Are you
choking?”
Mild obstruction:
■■ Casualty able to speak, cough and
breathe
Severe obstruction:
■■ Casualty unable to speak, cough or
breathe, and eventually becomes
unresponsive
■■ To remove the obstruction
■■ To arrange urgent removal to
hospital if necessary
RECOGNITION
YOUR AIMS
■■ If at any stage the casualty
becomes unresponsive, open
the airway and check breathing
(p.63). If she is not breathing,
begin CPR (pp.66–69) to try to
relieve the obstruction.
CAUTION
95
CHOKING ADULT | CHOKING CHILD
CHOKING CHILD ONE YEAR TO PUBERTY
■■ To remove the obstruction
■■ To arrange urgent removal
to hospital if necessary
Ask the child: “Are you choking?”
Mild obstruction:
■■ Child able to speak, cough and
breathe
Severe obstruction:
■■ Child unable to speak, cough or
breathe, and eventually becomes
unresponsive
■■ If at any stage the child
becomes unresponsive, open
the airway and check breathing
(p.73). If she is not breathing,
begin CPR to try to relieve the
obstruction (pp.76–79).
Young children especially are prone to choking. A child may
choke on food, or may put small objects into her mouth and
cause a blockage of the airway.
If a child is choking, you need to act quickly. If she becomes
unresponsive, the throat muscles may relax and the airway
may open enough to do rescue breathing. Be prepared to
begin rescue breaths and chest compressions.
CAUTION
WHAT TO DO
If the child is breathing,
encourage her to cough;
this may clear the obstruction.
Remove any obvious obstruction
from her mouth.
If the back blows fail, try
abdominal thrusts. Put your
arms around the child’s upper
abdomen. Make sure that she is
bending well forwards. Place
your fist between the navel and
the bottom of her breastbone,
and grasp it with your other
hand. Pull sharply inwards and
upwards up to five times. Stop
if the obstruction clears.
If the child cannot speak, or
stops coughing or breathing,
carry out back blows. Bend her
well forward and give up to five
blows between her shoulder
blades using the heel of your
hand. Check her mouth, but do
not sweep the mouth with
your finger.
Check the mouth. If
the obstruction has not
cleared, call 999/112 for
emergency help.
Repeat steps 2 and 3 –
rechecking the mouth after
each step – until help arrives or
the child becomes unresponsive
(see CAUTION, above, right).
3
2
1
4
5
YOUR AIMS
RECOGNITION
SEE ALSO Unresponsive child pp.72–79
96
RESPIRATORY PROBLEMS
CHOKING INFANT UNDER ONE YEAR
SEE ALSO Unresponsive infant pp.80–83
■■ To remove the obstruction
■■ To arrange urgent removal
to hospital if necessary
Mild obstruction:
■■ Infant able to cough, but has
difficulty crying or making any
other noise
Severe obstruction:
■■ Unable to make any noise or
breathe, and eventually becomes
unresponsive
■■ If at any stage the infant
becomes unresponsive, open
the airway and check breathing
(pp.80–81). If the infant is not
breathing, begin CPR (pp.82–83)
to try to relieve the obstruction.
An infant is more likely to choke on food or small objects than
an adult. The infant will rapidly become distressed, and you need
to act quickly to clear any obstruction. If the infant becomes
unresponsive, the throat muscles may relax and the airway may
open enough to do rescue breathing. Be prepared to begin
rescue breaths and chest compressions.
CAUTION
WHAT TO DO
If the infant is unable to cry,
cough or breathe, lay her
face down along your forearm
and thigh and support her head.
Give up to five back blows
between the shoulder blades,
with the heel of your hand.
If back blows fail to clear
the obstruction, try chest
thrusts. These are similar to
chest compressions, but sharper
in nature and delivered at a
slower rate. Lay the infant face
up on your leg, place two fingers
on the lower part of the
breastbone one finger’s breadth
below the nipple line and push
downwards. Give up to five
chest thrusts.
Check the mouth. If the
obstruction still has not
cleared, call 999/112 for
emergency help; take the infant
with you if necessary.
Repeat steps 1 to 3 –
rechecking the mouth after
each step – until help arrives or
the infant becomes unresponsive
(see CAUTION, above left).
3
2
1
4
5
YOUR AIMS
RECOGNITION
Turn the infant over so
that she is face up along
your other leg and check her
mouth. Remove any obvious
obstructions with your
fingertips. Do not sweep the
mouth with your finger as this
may push the object further
down the throat.
97
CHOKING INFANT | HANGING AND STRANGULATION
HANGING AND STRANGULATION
SEE ALSO Spinal injury pp.157–59 | The unresponsive casualty pp.54–87
If pressure is exerted on the outside of the neck, the airway is
squeezed and the flow of air to the lungs is cut off. The main
causes of such pressure are:
■■Hanging – suspension of the body by a noose around
the neck.
■■Strangulation – constriction or squeezing around the neck
or throat.
Sometimes, hanging or strangulation may occur accidentally –
for example, by ties or clothing becoming caught in machinery.
Hanging may cause a broken neck; for this reason, a casualty in
this situation must be handled extremely carefully.
■■ A constricting article around
the neck
■■Marks around the casualty’s neck
■■ Rapid, difficult breathing; impaired
consciousness; grey-blue skin
(cyanosis)
■■ Congestion of the face, with
prominent veins and, possibly, tiny
red spots on the face or on the
whites of the eyes
■■ To restore adequate breathing
■■ To arrange urgent removal
to hospital
■■ Do not move the casualty
unnecessarily, in case of spinal
injury.
■■ Do not destroy or interfere with
any material that has been
constricting the neck, such as
knotted rope as the police may
need it for evidence.
■■ If the casualty is unresponsive,
open the airway and check
breathing (The unresponsive
casualty, pp.54–87).
CAUTION
WHAT TO DO
If the casualty is hanging,
support the body while
you relieve the constriction. Be
aware that the body will be very
heavy if he is unresponsive.
Quickly remove any
constriction from around
the casualty’s neck.
Call 999/112 for emergency
help, even if he appears to
recover fully. Monitor and record
his vital signs – breathing, pulse
and level of response (pp.52–53)
– until help arrives.
If the casualty is responsive,
help him to lie down while
supporting his head and neck.
4
3
2
1
RECOGNITION
YOUR AIMS
98
RESPIRATORY PROBLEMS
INHALATION OF FUMES
The inhalation of smoke, gases (such as carbon
monoxide) or toxic vapours can be lethal. A
casualty who has inhaled fumes is likely to have
low levels of oxygen in his body tissues
(Hypoxia, p.92) and therefore needs urgent
medical attention.
Do not attempt to carry out a rescue if it is
likely to put your own life at risk; fumes that
have built up in a confined space will quickly
overcome anyone who is not wearing
protective equipment.
SMOKE INHALATION
Any person who has been enclosed in a
confined space during a fire should be assumed
to have inhaled smoke. Smoke from burning
plastics, foam padding and synthetic wall
coverings is likely to contain poisonous fumes.
Casualties who have suffered from fume
inhalation should also be examined for other
injuries due to the fire, such as external burns.
INHALATION OF CARBON
MONOXIDE
Carbon monoxide is a poisonous gas, but it is
hard to detect as it has no taste or smell. The
gas acts directly on red blood cells, preventing
them from carrying oxygen to the body tissues.
If carbon monoxide is inhaled in large
quantities – for example, from smoke or
vehicle exhaust fumes in a confined space –
it can very quickly prove fatal. However,
lengthy exposure to even a small amount of
carbon monoxide – for example, due to a
leakage of fumes from a defective heater or
flue – may also prove fatal.
■ Exhaust fumes of motor vehicles ■ Smoke
from most fires ■ Back-draughts from blocked
chimney flues ■ Emissions from defective gas
or paraffin heaters and poorly maintained
boilers ■ Disposable or portable barbeques
used in a confined space
Prolonged exposure to low levels:
■ Headache ■ Confusion ■ Aggression ■ Nausea
and vomiting ■ Diarrhoea
Brief exposure to high levels:
■ Grey-blue skin coloration ■ Rapid, difficult breathing
■ Impaired level of response, leading to
unresponsiveness
Carbon
monoxide
FUMES
EFFECTS OF FUME INHALATION
POSSIBLE SOURCE EFFECTS
Smoke
Carbon
dioxide
Solvents
and fuels
■ Tends to accumulate and become dangerously
concentrated in deep enclosed spaces, such as
coal pits, wells and underground tanks
■ Fires: smoke is a bigger killer than fire itself.
Smoke is low in oxygen (which is used up by the
burning of the fire) and may contain toxic fumes
from burning materials.
■ Breathlessnes ■ Headache ■ Confusion
■ Unresponsiveness
■ Rapid, noisy and difficult breathing ■ Coughing and
wheezing ■ Burning in the nose or mouth ■ Soot
around the mouth and nose ■ Unresponsiveness
■ Glues ■ Cleaning fluids ■ Lighter fuels
■ Camping gas and propane-fuelled stoves
(Solvent abusers may use a plastic bag to
concentrate the vapour, especially with glues)
■ Headache and vomiting ■ Impaired level of
response ■ Airway obstruction from using a plastic
bag or from choking on vomit may result in death ■
Solvent abuse is a potential cause of cardiac arrest
99
INHALATION OF FUMES
WHAT TO DO
Call 999/112 for emergency
help. Tell ambulance control
that you suspect fume
inhalation.
Stay with the casualty until
help arrives. Monitor and
record the casualty’s vital
signs – breathing, pulse and level
of response (pp.52–53) – until
help arrives.
If it is necessary to escape
from the source of the
fumes, help the casualty away
from the fumes into fresh air.
Do not enter the fume-filled
area yourself.
Support the casualty and
encourage him to breathe
normally. If the casualty’s
clothing is still burning, try to
extinguish the flames (p.33).
Treat any obvious burns
(pp.174–77) or other injuries.
2 4
1 3 ■■ If the casualty is in a garage
filled with vehicle exhaust
fumes, open the doors wide
and let the gas escape before
you enter.
■■ If the casualty is found
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
CAUTION
■■ To restore adequate breathing
■■ To call 999/112 for emergency help
and obtain urgent medical attention
YOUR AIMS
SEE ALSO Burns to the airway p.177 | Fires pp.32–33 | Hypoxia p.92 | The unresponsive casualty pp.54–87
100
RESPIRATORY PROBLEMS
DROWNING
SEE ALSO The unresponsive casualty pp.54–87 | Hypothermia pp.186–88 | Water incidents p.36
Drowning causes breathing impairment as a result of
submersion or immersion in a liquid. Drowning begins when a
casualty is unable to breathe because the nose, mouth and air
passages are submerged below the surface of a liquid. Any
incident involving immersion when there is no problem with
breathing is not defined as drowning but as a rescue (p.36).
A casualty rescued from a drowning incident must be assessed
using the primary survey (pp.44–45) to establish whether or not
CPR is required. If he is unresponsive and not breathing, give five
initial rescue breaths before you start chest compressions, then
continue with CPR at a rate of 30 chest compressions to two
rescue breaths. Always call 999/112 for the emergency services.
■■ To restore breathing
■■ To arrange urgent removal to hospital
■■ Take care to avoid putting yourself
in danger when rescuing a person
from water (p.36).
■■ If the liquid is a chemical or a
waste liquid such as in a slurry
tank be aware that there may be
toxic fumes in the atmosphere.
■■Many casualties who drown may
regurgitate stomach contents so
be prepared to roll him onto his
side to clear his airway (p.68).
■■ If you are a trained rescuer and it
is safe to do so, start rescue
breaths while removing the
casualty from the liquid.
■■ Call 999/112 for emergency help
even if a casualty appears to
recover immediately after rescue.
CAUTION
YOUR AIMS
WHAT TO DO
When the casualty is rescued from liquid
(p.36), start the primary survey. Check his level
of response, open his airway and check breathing.
Continue CPR at a rate of 30:2 until help
arrives; the casualty shows signs of becoming
responsive – coughing, opening his eyes, speaking,
or moving purposefully – and starts breathing
normally; or you are too exhausted to continue.
If he is unresponsive and not breathing
normally, shout for help and call 999/112 for
emergency help or ask someone to make the call
and request an AED.
2
1 4
If an AED is available attach while continuing
CPR (pp.84–86). 5
If the casualty starts to breathe normally,
treat him for hypothermia (pp.186–87) by
covering him with warm clothes and blankets.
If possible replace wet clothes with dry
ones. Monitor and record the casualty’s vital
signs – breathing, pulse and level of response
(pp.52–53) until help arrives.
Check that the airway is open and give FIVE 6
initial rescue breaths. Follow this with 30 chest
compressions, then TWO rescue breaths.
3
DROWNING CHAIN
OF SURVIVAL
Prevent drowning
Always be safe in
and around water.
Recognize distress
Ask someone to call
for help.
Provide flotation
This can prevent
submersion.
Remove from water
Do this only if it is
safe to do so.
Provide care as needed
Seek medical attention
and treat as necessary.
101
DROWNING | HYPERVENTILATION
HYPERVENTILATION
WHAT TO DO
When speaking to the casualty be kind and reassuring. If
possible, lead the casualty away to a quiet place where she may
be able to regain control of her breathing more easily and quickly. If
this is not possible, ask any bystanders to leave.
Encourage the casualty to seek medical advice on preventing and
controlling panic attacks in the future. 2
1
This is commonly a manifestation of acute anxiety and may
accompany a panic attack. It may occur in individuals who have
recently experienced an emotional upset or those with a history
of panic attacks.
The unnaturally fast or deep breathing of hyperventilation
causes an increased loss of carbon dioxide from the blood, which
leads to chemical changes within the blood. These changes result
in symptoms such as dizziness and trembling, as well as tingling
in the hands. As breathing returns to normal, these symptoms
will gradually subside.
■■ Unnaturally fast or deep breathing
■■ Fast pulse rate
■■ Apprehension
There may also be:
■■ Dizziness or faintness
■■ Trembling, sweating and dry mouth,
or marked tingling in the hands
■■ Tingling and cramps in the hands and
feet and around the mouth
■■ To remove the casualty from the
cause of distress
■■ To reassure the casualty and calm
her down
■■ Do not advise the casualty to
rebreathe her own air from a
paper bag as it may aggravate
a more serious illness.
■■ Hyperventilation due to acute
anxiety is rare in children. Look
for other causes.
■■ Be aware that serious illness
may also cause rapid breathing
and anxiety.
CAUTION
RECOGNITION
YOUR AIMS
102
RESPIRATORY PROBLEMS
ASTHMA
In an asthma attack, the muscles of the air passages in
the lungs go into spasm. As a result, the airways become
narrowed, which makes breathing difficult.
Sometimes, there is a recognised trigger for an attack, such
as an allergy, a cold, a particular drug or cigarette smoke. At
other times, there is no obvious trigger. Many sufferers have
sudden attacks.
People with asthma usually deal with their own attacks by
using a “reliever” inhaler at the first sign of an attack. Most
reliever inhalers have blue caps. Preventer inhalers have brown
or white caps and are used to help prevent attacks. They should
not be used during an asthma attack.
WHAT TO DO
Keep calm and reassure
the casualty. Get her to
take her usual dose of her reliever
inhaler; use a spacer if she has
one. Ask her to breathe slowly
and deeply.
Sit her down in the position
she finds most comfortable.
A mild attack should ease
within a few minutes. If it
does not, the casualty may take
one to two puffs from her
inhaler every two minutes until
she has had ten puffs.
Call 999/112 for emergency
help if the attack is severe
and one of the following occurs:
the inhaler has no effect; the
casualty is getting worse;
breathlessness makes talking
difficult; she is becoming
exhausted.
Help the casualty to
continue to use her inhaler
as required. Monitor her vital
signs – breathing, pulse and level
of response (pp.52–53) – until
help arrives.
2
1
3
4
5
■■ Difficulty breathing
■■Wheezing
■■ Difficulty speaking, leading to short
sentences and whispering
■■ Coughing
■■ Distress and anxiety
■■ Features of hypoxia (p.92), such as a
grey-blue tinge to the lips, earlobes
and nailbeds (cyanosis)
■■ Exhaustion in a severe attack. If the
attack worsens the casualty may
stop breathing and become
unresponsive
■■ To ease breathing
■■ To obtain medical help
if necessary
■■ If this is a first attack and the
casualty has no medication call
999/112 for emergency help
immediately.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty
pp.54–87).
CAUTION
RECOGNITION
YOUR AIMS
A spacer device can be fitted
to an asthma inhaler to help
a casualty breathe in the
medication more effectively.
They are especially useful
when giving medication to
young children.
SPECIAL CASE USING A SPACER DEVICE
103
ASTHMA | CROUP
CROUP
WHAT TO DO
Sit your child on your knee, supporting her back. Calmly reassure
the child. Try not to panic; this will only alarm her, which is likely
to make the attack worse.
Call medical help or, if
the croup is severe, call
999/112 for emergency help.
Keep monitoring her vital signs –
breathing, pulse and level of
response (pp.52–53) – until
help arrives.
1
2
An attack of breathing difficulty in young children is known
as croup. It is caused by inflammation in the windpipe and larynx.
Croup can be alarming but usually passes without lasting harm.
Attacks of croup usually occur at night and can be made worse
if the child is crying and distressed.
If an attack of croup persists, or is severe, and accompanied by
fever, call for emergency help. There is a small risk that the child
is suffering from a rare, croup-like condition called epiglottitis,
in which the epiglottis (p.90), a small, flap-like structure in the
throat, becomes infected and swollen and may block the airway
completely. The child then needs urgent medical attention.
■■ Distressed breathing in a young child
There may also be:
■■ A short, barking cough
■■ A rasping noise, especially on
breathing in (stridor)
■■ Croaky voice
■■ Blue-grey skin (cyanosis)
■■ In severe cases, the child uses
muscles around the nose, neck and
upper arms in trying to breathe
Suspect epiglottitis if:
■■ A child is in respiratory distress and
not improving
■■ The child has a high temperature
■■ To comfort and support the child
■■ To obtain medical help if necessary
■■ Do not put your fingers down
the child’s throat. This can cause
the throat muscles to go into
spasm and block the airway.
CAUTION
RECOGNITION
YOUR AIMS
104
RESPIRATORY PROBLEMS
PENETRATING CHEST WOUND
SEE ALSO Hypoxia p.92 | Shock pp.112–13 | The unresponsive casualty pp.54–87
The heart and lungs, and the major blood vessels around them,
lie in the chest, protected by the breastbone and the 12 pairs of
ribs that make up the ribcage. The ribcage extends far enough
downwards to protect organs such as the liver and spleen in the
upper part of the abdomen.
If a sharp object penetrates the chest wall, there may
be severe damage to the organs in the chest and the upper
abdomen and this will lead to shock. The lungs are particularly
susceptible to injury, either by being damaged themselves or
from wounds that perforate the two-layered membrane (pleura)
that surrounds and protects each lung. Air can then enter
between the membranes and exert pressure on the lung, and
the lung may collapse – a condition called pneumothorax.
Pressure around the affected lung may build up to such
an extent that it affects the uninjured lung. As a result, the
casualty becomes increasingly breathless. This build-up of
pressure may prevent the heart from refilling with blood
properly, impairing the circulation and causing shock – a
condition known as a tension pneumothorax. If the wound is
not actively bleeding, it is important to leave it exposed,
without a dressing.
■■ To seal the wound and maintain
breathing
■■ To minimise shock
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ Difficult and painful breathing,
possibly rapid, shallow and uneven
■■ Casualty feels an acute sense of
alarm
■■ Features of hypoxia (p.92), including
grey-blue skin coloration (cyanosis)
There may also be:
■■ Coughed-up frothy, red blood
■■ A crackling feeling of the skin around
the site of the wound, caused by air
collecting in the tissues
■■ Blood bubbling out of the wound
■■ Sound of air being sucked into the
chest as the casualty breathes in
■■ Veins in the neck becoming
prominent
RECOGNITION
Pleural
membranes
Pressure
balance
Lung
pulled
out
Pressure
balance
maintained
Chest wall
pulled out
Pooled blood in
pleural cavity
Normal breathing
The lungs inflate by being pulled out as they “suck”
onto the chest wall. Pressure is maintained within
the fluid-filled pleural space.
Collapsed (right) lung
Air from the right lung enters the surrounding pleural
space and changes the pressure balance. The lung
shrinks away from the chest wall.
Pleural space
Entry
of air
Rupture
site
Rib
Air enters
lung
Bronchus Lung collapses
inwards
105
PENETRATING CHEST WOUND
Help the casualty to sit down. Encourage him to lean towards the
injured side. Leave the wound exposed, without a dressing. 1
SPECIAL CASE IF THE CASUALTY IS UNRESPONSIVE
If the casualty is unresponsive,
open the airway and check breathing
(The unresponsive casualty,
pp.54–87). If you need to place a
breathing casualty in the recovery
position, roll him on to his injured
side to help the healthy lung to
work effectively (p.64).
If the wound is obviously bleeding, control with direct pressure
and, if necessary, apply a dressing. 2
Call 999/112 for emergency
help. While waiting for help,
continue to support the casualty
in the same position as long as
he continues to be responsive.
3 Monitor and record the
casualty’s vital signs –
breathing, pulse and level of
response (pp.52–53) – until
help arrives.
4
WHAT TO DO
The heart and blood vessels are
collectively known as the circulatory
(cardiovascular) system. This system keeps
the body supplied with blood, which carries
oxygen and nutrients to all body tissues.
The circulatory system may be disrupted by
severe internal or external bleeding or fluid
loss, for example from burns (pp.174–79).
The techniques described in this section
show how you can help to maintain an
adequate blood supply to the heart and
brain following injury that affects the
circulatory system.
A break in the skin or the internal body
surfaces is known as a wound. Wounds can
be daunting, particularly if there is a lot of
bleeding, but prompt action reduces the
amount of blood loss and minimises shock.
Treatments for all types of wound are
covered in this chapter.
■■ To assess the casualty’s condition quickly and calmly
■■ To control blood loss by applying pressure and
elevating the injured part
■■ To minimise the risk of shock
■■ To comfort and reassure the casualty
■■ To call 999/112 for emergency help if you suspect
a serious injury or illness
■■ To be aware of your own needs, including the need to
protect yourself against blood-borne infections
AIMS AND OBJECTIVES
WOUNDS AND
BLEEDING
108
THE HEART AND BLOOD VESSELS
KEY
The heart and the blood vessels make up the
circulatory system. These structures supply
the body with a constant flow of blood, which
brings oxygen and nutrients to the tissues and
carries waste products away.
Blood is pumped around the body by
rhythmic contractions (beats) of the heart
muscle. The blood runs through a network
of vessels, divided into three types: arteries,
veins and capillaries. The force that is exerted
by the blood flow through the main arteries
is called blood pressure. The pressure varies
with the strength and phase of the
heartbeat, the elasticity of the arterial
walls and the volume and thickness
of the blood.
WOUNDS AND BLEEDING
How blood circulates
Oxygenated blood passes
from the lungs to the heart,
then travels to body tissues via the
arteries. Blood that has given up its
oxygen (deoxygenated blood) returns
to the heart through the veins.
Capillary networks
A network of fine blood vessels
(capillaries) links arteries and veins within
body tissues. Oxygen and nutrients pass
from the blood into the tissues; waste
products pass from the tissues into the
blood, through capillaries. The heart
This muscular organ pumps blood
around the body and then to the
lungs to pick up oxygen. Coronary
blood vessels supply the heart
muscle with oxygen and nutrients.
Carotid artery
Brachial vein
Jugular vein
Aorta
Heart
muscle
Superior
vena cava
Coronary
artery
Inferior
vena cava
Capillary
Small artery
(arteriole)
Small vein
(venule)
Radial vein
Femoral vein
Pulmonary arteries carry
deoxygenated blood to
lungs
Pulmonary veins carry
oxygenated blood from
lungs to heart
Heart pumps blood
around body
Vena cava carries
deoxygenated blood from
body tissues to heart
Brachial artery
Radial artery
Femoral artery
Aorta carries oxygenated
blood to body tissues
Pulmonary
artery
Vessels carrying oxygenated blood
Vessels carrying deoxygenated blood
109
KEY
The heart pumps blood by muscular
contractions called heartbeats, which are
controlled by electrical impulses generated
in the heart. Each beat has three phases:
diastole, when the blood enters the heart; atrial
systole, when it is squeezed out of the atria
(collecting chambers); and ventricular systole,
when blood leaves the heart.
In diastole, the heart relaxes. Oxygenated
blood from the lungs flows via the pulmonary
veins into the left atrium. Blood that has given
up its oxygen to body tissues (deoxygenated
blood) flows from the venae cavae (large veins
that enter the heart) into the right atrium.
In atrial systole, the two atria contract and the
valves between the atria and the ventricles
(pumping chambers) open so that blood flows
into the ventricles.
During ventricular systole, the ventricles
contract. The thick-walled left ventricle forces
blood into the aorta (main artery), which carries
it to the rest of the body. The right ventricle
pumps blood into the pulmonary arteries, which
carry it to the lungs to collect more oxygen.
HOW THE HEART FUNCTIONS
THE HEART AND BLOOD VESSELS
Blood flow through the heart
The heart’s right side pumps deoxygenated blood from
the body to the lungs. The left side pumps oxygenated
blood to the body via the aorta.
The blood cells
Red blood cells contain haemoglobin,
a red pigment that enables the cells
to carry oxygen. White blood cells
play a role in defending the body
against infection. Platelets help the
blood to clot.
Right atrium
Right ventricle
Valve
Left
ventricle
White blood cell
Platelet
Left atrium
Ascending aorta carries
blood to upper body
Superior vena
cava carries
blood from
upper body
Inferior vena
cava carries
blood from
lower body
Descending aorta carries
blood to lower body
Pulmonary arteries
carry deoxygenated
blood to lungs
Red blood cell
There are about 6 litres (10 pints), or 1 litre per
13kg of body weight (1 pint per stone), of blood
in the average adult body. Roughly 55 per cent
of the blood is clear yellow fluid (plasma). In
this fluid are suspended the red and white
blood cells and the platelets, all of which
make up the remaining 45 per cent.
COMPOSITION OF BLOOD
Vessels carrying oxygenated blood
Vessels carrying deoxygenated blood
110
BLEEDING AND TYPES OF WOUND
When a blood vessel is damaged, the vessel
constricts, and a series of chemical reactions
occur to form a blood clot – a “plug” over the
damaged area (below). If large blood vessels are
torn or severed, uncontrolled blood loss may
occur before clotting can take place, and shock
(pp.112–13) may develop.
TYPES OF BLEEDING
Bleeding (haemorrhage) is classified by the type
of blood vessel that is damaged. Arteries carry
oxygenated blood under pressure from the
heart. If an artery is damaged, bleeding will
be profuse. Blood will spurt out with each
heartbeat. If a main artery is severed, the
volume of circulating blood will fall rapidly.
Blood from veins, having given up its oxygen
into the tissues, is darker red. It is under less
pressure than arterial blood, but vein walls can
widen greatly and the blood can “pool” inside
them (varicose vein). If a large or varicose vein
is damaged, blood will flow from the wound
profusely and blood volume can fall rapidly.
Bleeding from capillaries occurs with any
wound. At first, bleeding may be brisk, but
blood loss is usually slight. A blow may rupture
capillaries under the skin, causing bleeding into
the tissues (bruising).
When a blood vessel is severed or damaged,
it constricts (narrows) in order to prevent
excessive amounts of blood from escaping.
Injured tissue cells at the site of the wound,
together with specialised blood cells called
platelets, then trigger a series of chemical
reactions that result in the formation of a
substance that creates a mesh. This mesh traps
blood cells to make a blood clot. The clot
releases a fluid known as serum, which
contains antibodies and specialised cells.
This serum begins the process of repairing
the damaged area.
At first, the blood clot is a jelly-like mass.
Fibroblast cells form a plug within the clot.
Later, this dries into a crust (scab) that seals and
protects the site of the wound until the healing
process is complete.
HOW WOUNDS HEAL
WOUNDS AND BLEEDING
Injury
At the site of injury, platelets in the
blood arrive to begin formation of a
clot. Other cells are attracted to the
site to help with repair.
Clotting
A clot is formed by platelets in the
blood and blood-clotting protein.
Tissue-forming cells migrate to the
damaged area to start repair.
Plugging and scabbing
A plug of fibrous tissue forms within
the clot. The plug hardens and forms
a scab that eventually drops off
when the skin beneath it is healed.
Blood clot
New tissue
Site of injury
Epidermis Dermis
Plug of
fibrous tissue
Severed
blood vessel
Fibroblast
111
Wounds can be classified into a number of
different types, depending on the object that
produces the wound – such as a knife or a
bullet – and the manner in which the wound
has been inflicted.
Each of these types of wound carries
specific risks associated with surrounding
tissue damage and infection.
TYPES OF WOUND
Incised wound
This is caused by a clean
surface cut from a sharpedged
object such as a
razor. Blood vessels are cut
straight across, so bleeding
may be profuse. Structures
such as tendons or nerves
may be damaged.
Laceration
Blunt or ripping forces result in
tears or lacerations. These wounds
may bleed less profusely than
incised wounds, but there is likely to
be more tissue damage. Lacerations
are often contaminated with germs,
so the risk of infection is high.
Puncture wound
An injury such as standing on a nail
or being pricked by a needle will
result in a puncture wound. It has
a small entry site but a deep track
of internal damage. Since germs
and dirt can be carried far into
the body, the infection risk with
this kind of wound is high.
Abrasion (graze)
This is a superficial wound in which
the topmost layers of skin are
scraped off, leaving a raw, tender
area. Abrasions are often caused by
a sliding fall or a friction burn. They
can contain embedded foreign
particles that may cause infection.
Stab wound
This is a deep incision caused by
a sharp or bladed instrument,
usually a knife, penetrating the
body. Stab wounds to the trunk
must always be treated seriously
because of the danger of injury
to vital organs and life-threatening
internal bleeding.
Contusion (bruise)
A blunt blow can rupture capillaries
beneath the skin, causing blood to
leak into the tissues. This process
results in bruising. Extensive
contusion and swelling may
indicate deeper damage, such as
a fracture or an internal injury.
Gunshot wound
This type of wound is caused by
a bullet or missile being driven into
or through the body, resulting in
serious internal injury and sucking
in clothing and contaminants from
the air. The entry wound may be
small and neat; any exit wound
may be large and ragged.
BLEEDING AND TYPES OF WOUND
Entry wound
Exit wound
112
SHOCK
This is a life-threatening condition that occurs when the
circulatory system (which distributes oxygen to the body tissues
and removes waste products) fails and, as a result, vital organs
such as the heart and brain are deprived of oxygen. It requires
immediate emergency treatment. Shock can be made worse
by fear and pain. Minimise the risk of shock developing by
reassuring the casualty and making him comfortable.
The most common cause of shock is severe blood loss.
If blood loss exceeds 1.2 litres (2 pints), which is about one-fifth
of the normal blood volume, shock will develop. This degree of
blood loss may result from external bleeding. It may also be
caused by: hidden bleeding from internal organs (p.116), blood
escaping into a body cavity (p.116) or bleeding from damaged
blood vessels due to a closed fracture (p.136 and p.138). Loss of
other body fluids can also result in shock. Other conditions that
can cause severe fluid loss include diarrhoea, vomiting, bowel
obstruction and serious burns.
In addition, shock may occur when there is sufficient blood
volume but the heart is unable to pump the blood around the
body. This problem can be due to severe heart disease, heart
attack or acute heart failure (cardiogenic shock). Other causes
of shock include overwhelming infection (septic shock), severe
allergic reaction (anaphylactic shock) and spinal cord injury
(neurogenic shock).
SEE ALSO Anaphylactic shock p.223 | Internal bleeding p.116 | Severe burns and scalds pp.174–75 |
Severe external bleeding pp.114–15 | Spinal injury pp.157–59 | The unresponsive casualty pp.54–87
■■ Do not allow the casualty
to eat or drink because an
anaesthetic may be needed. If
he complains of thirst, moisten
his lips with a little water.
■■ Do not leave the casualty
unattended, unless you have to
call emergency help.
■■ Do not warm the casualty with
a hot-water bottle or any other
direct source of heat.
■■ If the casualty is in the later
stages of pregnancy, help her
to lie down leaning towards her
left side to prevent the pregnant
uterus restricting blood flow
back to the heart.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
■■Little or no effect; this is the quantity of blood normally taken in a
blood donor session
■■Hormones such as adrenaline are released, quickening the pulse and inducing
sweating ■■Small blood vessels in non-vital areas, such as the skin, shut down to
divert blood and oxygen to the vital organs ■ Shock becomes evident
0.5 litre (about 1 pint)
APPROXIMATE VOLUME
EFFECTS OF BLOOD OR FLUID LOSS
EFFECTS ON THE BODY
Up to 2 litres (3½ pints)
2 litres (3½ pints) or more
(over a third of the normal
volume in the average adult)
■ As blood or fluid loss approaches this level, the pulse at the wrist may become
undetectable ■■Casualty will gradually become unresponsive ■ Breathing will
cease and finally the heart will stop
WOUNDS AND BLEEDING
CAUTION
113
WHAT TO DO
Treat any possible cause of shock that you can detect, such
as severe bleeding (pp.114–15) or serious burns (pp.174–75).
Reassure the casualty.
Loosen tight clothing to
reduce constriction at
the neck, chest and waist.
Call 999/112 for emergency
help. Tell the ambulance
control that you suspect shock.
Keep the casualty warm by covering
his body and legs with coats or blankets.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while
waiting for help to arrive.
4
3
5 6
1
Help the casualty to lie down – on a rug or blanket if there is
one, as this will protect him from the cold. Raise and support
his legs above the level of his heart to improve blood supply to
the vital organs.
2
■■ To recognise shock
■■ To treat any obvious cause of shock
■■ To improve the blood supply to the
brain, heart and lungs
■■ To arrange urgent removal to
hospital
Initially there may be:
■■ A rapid pulse
■■ Pale, cold, clammy skin
■■ Sweating
As shock develops:
■■ Rapid, shallow breathing
■■ A weak, “thready” pulse. When the
pulse at the wrist disappears, about
half of the blood volume will have
been lost
■■ Grey-blue skin (cyanosis),
especially inside the lips. A
fingernail or earlobe, if pressed, will
not regain its colour immediately
■■Weakness and dizziness
■■ Nausea, and possibly vomiting
■■ Thirst
As the brain’s oxygen supply
weakens:
■■ Restlessness and aggressive
behaviour
■■ Yawning and gasping for air
■■ Casualty becomes unresponsive
■■ Finally, the heart will stop
SHOCK
YOUR AIMS
RECOGNITION
114 SEE ALSO Foreign object in a wound p.121 | Shock pp.112–13
When bleeding is severe, it can be dramatic and distressing. If
bleeding is not controlled shock will develop and the casualty
may no longer be responsive.
Bleeding from the mouth or nose may affect breathing. When
treating severe bleeding, check first whether there is an object
embedded in the wound; take care not to press directly on the
object. Do not let the casualty have anything to eat or drink as he
may need an anaesthetic later.
SEVERE EXTERNAL BLEEDING
WOUNDS AND BLEEDING
■■ To control bleeding
■■ To prevent and minimise the effects
of shock
■■ To minimise infection
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Remove or cut away clothing to
expose a wound if necessary
(p.232).
■■ If the casualty is unresponsive,
open the airway and check
breathing (The unresponsive
casualty, pp.54–87).
WHAT TO DO
2
1
CAUTION
Apply direct pressure over the wound with your fingers
using a sterile dressing or clean, non-fluffy pad. If you do not
have a dressing, ask the casualty to apply direct pressure himself. If
there is an object in the wound, apply pressure on either side of the
object (opposite).
Ask a helper to call 999/112 for emergency help. Tell him or her
to give ambulance control details of the site of the bleeding and
the extent of the bleeding.
115
Control bleeding by pressing firmly on either
side of the embedded object to push the
edges of the wound together. Do not press directly
on the object, or try to remove it.
To protect the wound, drape a piece of gauze
over the object. Build up padding on either
side, then carefully bandage over the object and
pads without pressing on the object (p.121). Check
the circulation beyond the bandage every ten
minutes (p.243). If the circulation is impaired,
loosen the bandage and reapply.
Call 999/112 for emergency help. Monitor
and record vital signs – breathing, pulse
and level of response (pp.52–53) – while waiting
for help to arrive. Treat for shock if necessary
(pp.112–13).
2
3
1
SEVERE EXTERNAL BLEEDING
If bleeding shows through
the dressing, apply a second
one on top of the first. If blood
seeps through the second
dressing, remove both and
apply a fresh one, ensuring that
pressure is applied accurately at
the point of bleeding.
Support the injured part in
with a sling and/or bandage.
Check the circulation beyond
the bandage every ten minutes
(p.243). If the circulation is
impaired, loosen the bandage
and reapply.
Monitor and record the
casualty’s vital signs –
breathing, pulse and level of
response (pp.52–53) – while
waiting for help to arrive.
Secure the dressing with a bandage that is firm
enough to maintain pressure, but not so tight
that it impairs circulation (p.243). Call 999/112 for
emergency help if this has not been done already.
As shock is likely to develop (pp.112–13), help
the casualty to lie down – on a rug or blanket if
there is one, as this will protect him from the cold.
Raise and support his legs so that they are above
the level of his heart.
6 7
3
4
5
SPECIAL CASE IF THERE IS AN OBJECT IN THE WOUND
116 SEE ALSO Crush injury p.118 | Head injury pp.144–45 | Shock pp.112–13
■■ Initially, pale, cold, clammy skin. If
bleeding continues, the skin may
turn blue-grey (cyanosis)
■■ Rapid, weak pulse
■■ Thirst
■■ Rapid, shallow breathing
■■ Confusion, restlessness and
irritability
■■ Possible collapse and casualty may
become unresponsive
■■ Bleeding from body openings
(orifices)
■■ In cases of violent injury, “pattern
bruising” – an area of discoloured
skin with a shape that matches the
pattern of clothes or crushing or
restraining objects
■■ Pain
■■ Information from casualty that
indicates recent injury, illness, or
operation
RECOGNITION Bleeding inside body cavities may follow an injury, such as a
fracture or a blow from a blunt object, but it can also occur
spontaneously – for example, bleeding from a stomach ulcer. The
main risk from internal bleeding is shock (pp.112–13). In addition,
blood can build up around organs such as the lungs or brain and
exert damaging pressure on them.
Suspect internal bleeding if a casualty develops signs of shock
without obvious blood loss. Check for any bleeding from body
openings (orifices) such as the ear, mouth and nose. There may
also be bleeding from the urethra or anus (below).
The signs of bleeding vary depending on the site of the blood
loss (below), but the most obvious is a discharge of blood from a
body opening. Blood loss from any orifice is significant and can
lead to shock. In addition, bleeding from some orifices can
indicate a serious underlying injury or illness. Follow treatment
for shock (pp.112–13).
INTERNAL BLEEDING
WOUNDS AND BLEEDING
■ Bright red, frothy, coughed-up blood ■■Bleeding in the lungs
■ Vomited blood, red or dark reddishbrown,
resembling coffee grounds
■ Bleeding within the digestive system
Mouth
SITE
POSSIBLE SIGNS OF INTERNAL BLEEDING
APPEARANCE OF BLOOD CAUSES OF BLOOD LOSS
Ear
Nose
Anus
Urethra
Vagina
■ Fresh, bright red blood ■ Injury to the inner or outer ear or perforated eardrum
■ Thin, watery blood ■ Leakage of fluid from around the brain due to head injury
■ Thin, watery blood ■ Leakage of fluid from around the brain due to head injury
■ Fresh, bright red blood ■ Ruptured blood vessel in the nostril
■ Fresh, bright red blood ■ Piles or injury to the anus or lower intestine
■ Black, tarry, offensive-smelling stool (melaena) ■ Disease or injury to the intestine
■ Red or smoky appearance to urine,
occasionally containing clots
■ Bleeding from the bladder, kidneys or urethra
■ Either fresh or dark blood ■ Menstruation ■ Miscarriage ■ Pregnancy
■■Recent childbirth ■ Assault
117
IMPALEMENT
INTERNAL BLEEDING | IMPALEMENT | AMPUTATION
SEE ALSO Severe external bleeding pp.114–15 | Shock pp.112–13
If someone has been impaled, for example by falling on to
railings, never attempt to lift the casualty off the object involved
since this may worsen internal injuries. Call 999/112 for
emergency help immediately, giving clear details about the
incident. They will bring special cutting equipment with them to
free the casualty.
A limb that has been partially or completely severed can,
in many cases, be reattached by microsurgery. The operation
will require a general anaesthetic, so do not allow the casualty
to eat or drink. It is vital to get the casualty and the amputated
part to hospital as soon as possible. Shock is likely, and needs
to be treated.
WHAT TO DO
WHAT TO DO
Control blood loss by applying direct pressure and raising
the injured part above the casualty’s heart (pp.114–15).
Call 999/112 for emergency
help. Send a helper to make
the call if possible. Explain the
situation clearly to ambulance
control, so that the right
equipment can be brought.
Support the casualty’s body
weight until the emergency
services arrive and take over.
Reassure the casualty while you
wait for emergency help.
Place a sterile dressing or a non-fluffy, clean pad on the
wound, and secure it with a bandage. Treat the casualty for
shock (pp.112–13).
Call 999/112 for emergency help. Tell ambulance control
that amputation is involved. Monitor and record vital signs –
breathing, pulse and level of response (pp.52–53) – while waiting
for help to arrive.
Wrap the severed part in kitchen film or a plastic bag. Wrap the
package in gauze or soft fabric and place it in a container full of
crushed ice. Mark the container with the time of injury and the
casualty’s name. Give it to the emergency service personnel.
1
1 2
2
3
4
AMPUTATION
■■ To prevent further injury
■■ To control bleeding
■■ To minimise the effects of shock
■■ To arrange urgent removal to
hospital
■■ To prevent deterioration of the
injured part
YOUR AIM
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Do not wash the severed part.
■■ Do not let the severed part
touch the crushed ice when
packing it.
■■ Do not allow the casualty
to eat or drink because an
anaesthetic may be needed.
CAUTION
CAUTION
118 SEE ALSO Fractures pp.136–38 | Severe external bleeding pp.114–15 | Shock pp.112–13
WHAT TO DO
If you know the casualty has been crushed for
less than 15 minutes and you can release him,
do this as quickly as possible. Control bleeding,
steady and support any suspected fracture
(pp.136–38) and treat him for shock (pp.112–13).
If the casualty has been crushed for more than
15 minutes, or you cannot move the cause of
injury, leave him in the position found and comfort
and reassure him.
Call 999/112 for emergency help, giving clear
details of the incident to ambulance control.
Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while
waiting for help to arrive.
2
3
1
4
Traffic and building site incidents are the most common causes
of crush injuries. Other possible causes include explosions,
earthquakes and train crashes.
A crush injury may include a fracture, swelling and internal
bleeding. The crushing force may also cause impaired circulation,
which results in numbness at or below the site of injury.
DANGERS OF PROLONGED CRUSHING
If the casualty is trapped for any length of time, two serious
complications may result. First, prolonged crushing may cause
extensive damage to body tissue, especially to muscles. Once the
pressure is removed, shock may develop rapidly as tissue fluid
leaks into the injured area.
Secondly, and more dangerously, toxic substances will build
up in damaged muscle tissue around a crush injury. If released
suddenly into the circulation, these toxins may cause kidney
failure. This process, called “crush syndrome”, is extremely
serious and can be fatal.
CRUSH INJURY
WOUNDS AND BLEEDING
■■ To obtain specialist medical aid
urgently, taking any steps possible
to treat the casualty
YOUR AIM
■■ Do not release a casualty who
has been crushed for more than
15 minutes.
■■ Do not lift heavy objects.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
CAUTION
119
CRUSH INJURY | CUTS AND GRAZES | BRUISING
CUTS AND GRAZES
SEE ALSO Foreign object in wound p.121 | Infected wound p.120 | Internal bleeding p.116
■■ To control bleeding
■■ To minimise the risk of infection
■■ To reduce blood flow to the injury,
and so minimise swelling
YOUR AIMS
YOUR AIM
Bleeding from small cuts and grazes is normally easily
controlled by pressure and elevation. A plaster is generally all
that is required, and the wound will heal by itself in a few days.
Medical help need only be sought if: bleeding does not stop;
there is a foreign object embedded in the cut (p.121); there is a
particular risk of infection, from a human or animal bite (p.203),
or a puncture by a dirty object; an old wound shows signs of
becoming infected (p.120).
Caused by bleeding into the skin or into tissues beneath the
skin, a bruise can develop rapidly or emerge a few days after
injury. Bruising can also indicate deep injury. Elderly people and
those taking anticoagulant (anti-clotting) drugs can bruise easily.
WHAT TO DO
WHAT TO DO
If the wound is dirty, clean
it by rinsing under running
water, or use alcohol-free wipes.
Pat the wound dry using a
gauze swab and cover it with
sterile gauze.
Raise and support the
injured part above the level
of the heart, if possible. Avoid
touching the wound.
Clean the area around the
wound with soap and water.
Wipe away from the wound and
use a clean swab for each stroke.
Pat dry. Remove the wound
covering and apply a sterile
dressing. If there is a particular
risk of infection, advise the
casualty to seek medical advice.
Place a cold compress
(p.241) over the bruise for at
least ten minutes.
Raise and support the
injured part in a comfortable
position for the casualty.
2
1
3
1 2
BRUISING
Ask the casualty about tetanus
immunisation. Seek medical
advice if:
■■ He has a dirty wound
■■ He has never been immunised
■■ He is uncertain about the
number or timings of injections
■■ He has not had at least five
injections previously
CAUTION
SPECIAL CASE TETANUS
This is a dangerous infection
caused by a bacterium which
lives in soil. If the bacterium
enters a wound, it may multiply
in the damaged tissues and
release a toxin that spreads
through the nervous system,
causing muscle spasms and
paralysis. Tetanus can be
prevented by immunisation,
which is normally given during
childhood. This may need to
be repeated in adulthood.
120
WOUNDS AND BLEEDING
SEE ALSO Bleeding and types of wound pp.110–11 | Cuts and grazes p.119
■■ Increasing pain and soreness at the
site of the wound
■■ Swelling, redness and a feeling of
heat around the injury
■■ Pus within, or oozing from, the
wound
■■ Swelling and tenderness of the
glands in the neck, armpit or groin
■■ Faint red trails on the skin that lead
to the glands in the neck, armpit or
groin
If infection is advanced:
■■ Signs of fever, such as sweating,
thirst, shivering and lethargy
■■ To prevent further infection
■■ To obtain medical advice if necessary
RECOGNITION
YOUR AIMS
■■ Do not burst a blister because it
increases the risk of infection.
Blisters occur when the skin is repeatedly rubbed against another
surface or when it is exposed to heat (p.173). The damaged area of
skin leaks tissue fluid that collects under the top layer of the skin,
forming a blister.
Any open wound can become contaminated with microorganisms
(germs). The germs may come from the source
of the injury, from the environment, from breath, from the
fingers handling the wound or from particles of clothing
embedded in it (as may occur in gunshot wounds). Bleeding
may flush some dirt away; remaining germs may be destroyed
by the white blood cells. However, if dirt or dead tissue remain
in a wound, infection may spread through the body. There is also
a risk of tetanus (p.119).
Any wound that does not begin to heal within 48 hours is
likely to be infected. A casualty with a wound that is at high
risk of infection may need treatment with antibiotics and/or
tetanus immunisation (p.119).
CAUTION
BLISTERS
INFECTED WOUND
WHAT TO DO
Cover the wound with a sterile dressing or large clean, non-fluffy
pad, and bandage it in place.
Raise and support the injured part with a sling and/or bandages.
This helps to reduce the swelling around the injury.
Advise the casualty to seek medical advice. If infection is
advanced (with signs of fever, such as sweating, shivering and
lethargy), take or send the casualty to hospital.
2
1
3
WHAT TO DO
Wash the area with clean water and rinse.
Gently pat the area and surrounding skin dry
thoroughly with a sterile gauze pad. If it is
not possible to wash the area, keep it as clean
as possible.
Cover a blister caused by friction with an
adhesive dressing; make sure the pad of the
plaster is larger than the blister. Ideally use a
special blister plaster since this has a cushioned
pad that provides extra protection and comfort.
1 2
121
FOREIGN OBJECT IN A WOUND
SEE ALSO Cuts and grazes p.119 | Embedded fish hook p.195 | Severe external bleeding pp.114–15 | Splinter p.194
■■ To control bleeding without pressing
the object further into the wound
■■ To minimise the risk of infection
■■ To arrange transport to hospital if
necessary
YOUR AIMS
Ask the casualty about tetanus
immunisation. Seek medical
advice if:
■■ He has a dirty wound
■■ He has never been immunised
■■ He is uncertain about the
number or timings of injections
■■ He has not had at least five
injections previously
WHAT TO DO
Control bleeding by
applying pressure on either
side of the object (see p.115) and
raising the area above the level
of the casualty’s heart. Drape a
piece of gauze over the wound
and object.
Build up padding on either
side of the object (rolled
bandages make good padding)
until it is high enough for you
to be able to bandage over the
top of object without pressing
it further into the wound. Hold
the padding in place until the
bandaging is complete.
Arrange to take or send the
casualty to hospital.
2
3
1
It is important to remove foreign objects, such as small pieces of
glass or grit, from a wound before beginning treatment. If left in a
wound, they may cause infection or delay healing. The best way to
remove superficial pieces of glass or grit from the skin is to pick
them out with tweezers. Alternatively, rinse loose pieces off with
cold water. Do not try to remove pieces that are firmly embedded
in the wound because you may damage the surrounding tissue and
aggravate bleeding. Instead, cover the object with a dressing and
bandage around it.
CAUTION
BLISTERS | INFECTED WOUND | FOREIGN OBJECT IN A WOUND
If you cannot build padding high
enough to bandage over the top
of an object, drape a clean piece
of gauze loosely over it. Place
padding on either side of the
object and bandage above and
below the object.
SPECIAL CASE BANDAGING AROUND A LARGER OBJECT
122
WOUNDS AND BLEEDING
SEE ALSO Head injury pp.144–45 | Shock pp.112–13 | Spinal injury pp.157–59
■■ To control bleeding
■■ To arrange transport to hospital
YOUR AIMS
■■ If at any stage the casualty
becomes unresponsive, open
the airway and check breathing
(The unresponsive casualty,
pp.54–87).
The scalp has many small blood vessels running close to the
skin surface, so any cut can result in profuse bleeding, which
often makes a scalp wound appear worse than it is.
In some cases, however, a scalp wound may form part of a
more serious underlying head injury, such as a skull fracture, or
may be associated with a neck injury. For these reasons, you
should examine a casualty with a scalp wound very carefully,
particularly if it is possible that signs of a serious head injury are
being masked by alcohol or drug intoxication. If you are in any
doubt, follow the treatment for head injury (pp.144–45). In
addition, bear in mind the possibility of a neck (spinal) injury.
WHAT TO DO
If there are any displaced flaps of skin at the
injury site, carefully replace them over the
wound. Reassure the casualty.
Keep the pad in place with a roller bandage to
secure the pad and maintain pressure.
Help the casualty to lie down with her head
and shoulders slightly raised. If she feels faint
or dizzy or shows any signs of shock, call 999/112
for emergency help. Monitor and record vital signs
– breathing, pulse and level of response (pp.52–53) –
while waiting for help to arrive.
Cover the wound with a sterile dressing or a
clean, non-fluffy pad. Apply firm, direct
pressure on the pad to help control bleeding to
reduce blood loss, and minimise the risk of shock.
3
4
2
1
CAUTION
SCALP AND HEAD WOUNDS
123
SCALP AND HEAD WOUNDS | EYE WOUND | BLEEDING FROM THE EAR
EYE WOUND
BLEEDING FROM THE EAR
■■ Pain in the eye or eyelids
■■ Visible wound and/or bloodshot
appearance
■■ Partial or total loss of vision
■■ Leakage of blood or clear fluid from
a wound
RECOGNITION
The eye can be bruised or cut by direct blows or by sharp,
chipped fragments of metal, grit and glass.
All eye injuries are potentially serious because of the risk to
the casualty’s vision. Even superficial grazes to the surface
(cornea) of the eye can lead to scarring or infection, with the
possibility of permanent deterioration of vision.
WHAT TO DO
WHAT TO DO
Help the casualty to lie on his back, and hold his head to keep it
as still as possible. Tell him to keep both eyes still; movement of
the “good” eye will cause movement of the injured one, which may
damage it further.
Give the casualty a sterile
dressing or a clean, nonfluffy
pad to hold over the affected
eye. If it will take some time to
obtain medical help, secure the
pad in place with a bandage.
2
1
2
This may be due to a burst (perforated) eardrum, an ear
infection, a blow to the side of the head or an explosion.
Symptoms include sharp pain, earache, deafness and possible
dizziness. The presence of blood or blood-stained watery fluid
may indicate a more serious, underlying head injury (pp.144–45).
■■ To arrange transport to hospital
YOUR AIM
■■ If you suspect a head injury
(pp.144–45), support the
casualty’s head in the position
you found him and call 999/112
for emergency help.
CAUTION
Hold a sterile dressing or a
clean, non-fluffy pad lightly
in place on the ear. Do not plug
the ear. Send or take the
casualty to hospital.
Help the casualty into a
half-sitting position, with
his head tilted to the injured
side to allow blood to drain
from the ear.
1
■■ To prevent further damage
■■ To arrange transport to hospital
YOUR AIMS
■■ Do not touch or attempt to
remove anything that is sticking
to, or embedded in, the eyeball
or on the coloured part (iris) of
the eye.
CAUTION
Arrange to take or send
the casualty to hospital. 3
SEE ALSO Foreign object in the ear p.197 | Head injury pp.144–45
124
WOUNDS AND BLEEDING
WHAT TO DO
Tell the casualty to sit down and tilt his head
forward to allow the blood to drain from the
nostrils. Ask him to breathe through his mouth (this
will also have a calming effect) and to pinch the soft
part of his nose for up to ten minutes. Reassure and
help him if necessary.
Advise the casualty not to speak, swallow,
cough, spit or sniff since this may disturb blood
clots that have formed in the nose. Give him a clean
cloth or tissue to mop up any dribbling.
After ten minutes, tell the casualty to release
the pressure. If the bleeding has not stopped,
tell him to reapply the pressure for two further
periods of ten minutes.
2
1
3
NOSEBLEED
■■ To maintain an open airway
■■ To control bleeding
YOUR AIMS
Bleeding from the nose most commonly occurs when tiny
blood vessels inside the nostrils are ruptured, either by a blow to
the nose, or as a result of sneezing, picking or blowing the nose.
Nosebleeds may also occur as a result of high blood pressure and
anti-coagulant (anti-clotting) medication.
A nosebleed can be serious if the casualty loses a lot of blood.
In addition, if bleeding follows a head injury, the blood may
appear thin and watery. The latter is a very serious sign because
it indicates that the skull is fractured and fluid is leaking from
around the brain.
■■ Do not let the casualty tip his
head back since blood may then
run down the throat and induce
vomiting.
CAUTION
Once the bleeding has stopped, and with
the casualty still leaning forwards, clean
around his nose with lukewarm water. Advise him
to rest quietly for a few hours. Tell him to avoid
exertion and, in particular, not to blow his nose,
because this could disturb any clots.
4
If bleeding stops and then restarts, help
the casualty to reapply pressure. 5
If the nosebleed is severe, or if it lasts
longer than 30 minutes, arrange to take
or send the casualty to hospital.
6
SEE ALSO Foreign object in the nose p.197 | Head injury pp.144–45
A child may be worried
by a nosebleed. Tell her
to lean forward, and
then pinch her nose for
her, reassure her and
give her a bowl to spit
or dribble into.
SPECIAL CASE FOR A YOUNG CHILD
125
NOSEBLEED | KNOCKED-OUT ADULT TOOTH | BLEEDING FROM THE MOUTH
KNOCKED-OUT ADULT TOOTH
CAUTION
CAUTION
If a secondary (adult) tooth is knocked out, it should be
replanted in its socket as soon as possible. If this is not possible,
ask the casualty to keep the tooth inside his cheek if he feels able
to do this. Alternatively, place it in a small container of milk or
saliva to prevent it from drying out.
Cuts to the tongue, lips or lining of the mouth range from
minor injuries to more serious wounds. The cause is often the
casualty’s own teeth or dental extraction. Bleeding from the
mouth may be profuse and can be alarming. There is a risk that
blood may be inhaled into the lungs, causing breathing problems.
WHAT TO DO
WHAT TO DO
If a tooth cannot be
replaced keep it moist by
placing it in milk, or if none is
available, in the casualty’s saliva
(in the mouth, a cup or even a
piece of saliva-soaked gauze).
Send the casualty to a dentist so
the tooth can be reimplanted.
Pick up the tooth by its
crown, and wash it under
cold running water for ten
seconds. Push the tooth gently
into the socket and cover it with a
piece of gauze. Ask the casualty to
gently close his mouth over it.
If bleeding persists, replace
the pad. Tell the casualty
to let the blood dribble out; if
she swallows it, it may induce
vomiting. Do not wash the
mouth out because this may
disturb a clot. Advise her to
avoid drinking anything hot
for 12 hours.
Ask the casualty to sit
down, with her head
forwards and tilted slightly to
the injured side, to allow blood
to drain from her mouth. Place
a sterile gauze pad over the
wound. Ask the casualty to
squeeze the pad between finger
and thumb and press on the
wound for ten minutes.
1
1 2
BLEEDING FROM THE MOUTH
SPECIAL CASE
BLEEDING TOOTH SOCKET
To control bleeding from a tooth
socket, roll a gauze pad thick
enough to prevent the casualty’s
teeth meeting, place it across
the empty socket, and tell him
to bite down on it.
■■ Do not touch the root of a
knocked out tooth or store it in
anything apart from milk or
saliva as you will damage the
surface, reducing the chance of
reimplantation and healing.
■■ Keep any tooth fragments.
■■ If the wound is large, or bleeding
lasts longer than 30 minutes
or restarts, seek medical or
dental advice.
YOUR AIMS
■■ To control bleeding
■■ To safeguard the airway by
preventing any inhalation of blood
2
126
WOUNDS AND BLEEDING
SEE ALSO Amputation p.117 | Foreign object in a wound p.121
■■ To control bleeding
■■ To assess whether or not the wound
needs a medical assessment
YOUR AIMS
Injuries to the fingers are common and can vary from small cuts
and grazes to wounds with underlying damage to bones, tendons
and ligaments. Injuries to the nails are the most common. All
finger wounds need good management as the hand is a finely
coordinated part of the body that must function correctly for
many everyday activities.
A cut to a finger may go through the skin only or it can cut
through blood vessels, nerves and tendons that lie just under
the skin. There will be bleeding, which can be profuse, and
possibly bruising, deformity or loss of movement or sensation
if the underlying structures are damaged.
FINGER WOUND
Seek urgent medical advice if
there is:
■■ Severe pain
■■ Severe bleeding
■■Missing tissue or nail, or
amputation of part of finger
■■Obvious deformity
■■ A gaping wound
■■ Numbness, weakness or loss of
movement in the finger or hand
■■ A foreign object in the wound WHAT TO DO
Press a sterile dressing or
clean non-fluffy pad on the
wound and apply direct pressure
to control bleeding.
When the bleeding has
stopped, cover the wound
to protect it. Use an adhesive
dressing or for a larger wound
apply a dressing pad, secured with
a tubular gauze bandage (p.248).
Seek medical help if
necessary. If you need to
take the casualty to hospital,
support the injured arm in an
elevation sling (p.252).
Raise and support the
injured hand and maintain
pressure on the wound until the
bleeding stops.
3
4
2
1
CAUTION
127
FINGER WOUND | WOUND TO THE PALM | WOUND AT A JOINT CREASE
WOUND TO THE PALM
WOUND AT A JOINT CREASE
SEE ALSO Foreign object in a wound p.121 | Shock pp.112–13
WHAT TO DO
WHAT TO DO
Press a sterile dressing or
clean pad firmly into the
palm, and ask the casualty to
clench his fist over it or to grasp
his fist with his other hand.
Check the circulation
(p.243) in the lower part of
the limb beyond the bandage
every ten minutes. If necessary,
remove the bandage, and apply
more loosely.
Secure the dressing with a
bandage tied firmly enough
to maintain pressure. If possible,
help the casualty to lie down
with his legs raised. Take or send
the casualty to hospital.
Raise and support the hand.
Bandage the casualty’s
fingers so that they are clenched
over the pad; leave the thumb free
so that you can check circulation.
Tie the ends of the bandage over
the top of the fingers to help
maintain pressure.
Support the arm in an
elevation sling (p.252).
Arrange to take or send him to
hospital. Check the circulation
(p.243) in the thumb every ten
minutes. If necessary, remove
the bandage, and reapply.
Press a sterile dressing or
clean, non-fluffy pad on the
injury and apply direct pressure
to control bleeding. Raise and
support the injured limb.
2
2 3
3
1
1
The palm of the hand has a good blood supply, which is why a
wound there may cause profuse bleeding. A deep wound to the
palm may sever tendons and nerves in the hand and result in loss
of feeling or movement in the fingers.
Bandaging the fist can be an effective way to control bleeding.
If, however, a casualty has a foreign object embedded in a palm
wound, it will be impossible to clench the fist. In such cases, treat
the injury using the method described on p.121.
Large blood vessels pass across the inside of the elbow and
back of the knee. If severed, these vessels will bleed profusely.
The steps given below help to control bleeding and shock. Take
care to ensure that there is adequate circulation to the part of
the limb beyond the bandage.
YOUR AIMS
YOUR AIMS
■■ To control bleeding
■■ To prevent and minimise the effects
of shock
■■ To arrange transport to hospital
■■ To control bleeding and the effects
of shock
■■ To minimise the risk of infection
■■ To arrange transport to hospital
128
WOUNDS AND BLEEDING
■■ To minimise shock
■■ To arrange urgent removal
to hospital
YOUR AIMS
A stab wound, gunshot or crush injury to the abdomen may
cause a serious wound. Organs and large blood vessels can
be punctured, lacerated or ruptured. There may be external
bleeding, protruding abdominal contents and internal injury
and bleeding, so this is an emergency.
ABDOMINAL WOUND
WHAT TO DO
Help the casualty to lie down on a firm surface, on a blanket if
available. Loosen any tight clothing, such as a belt or a shirt.
Cover wound with a sterile
dressing and hold it firmly;
the casualty may be able to help.
Raise and support the casualty’s
knees to ease strain on injury.
2
1
Be sensitive to the woman’s feelings. The bleeding is most
likely to be menstrual bleeding, but it can also indicate a more
serious condition such as miscarriage, pregnancy, recent
termination of pregnancy, childbirth or injury as a result of sexual
assault. If the bleeding is severe, shock may develop.
If a woman has been sexually assaulted, it is vital to preserve
the evidence if possible. Gently advise her to refrain from
washing or using the toilet until a forensic examination has been
performed. If she wishes to remove her clothing, keep it intact in
a clean plastic bag if possible. Be aware that she may feel
vulnerable and will prefer to be treated by a woman. ■■ To make the woman comfortable and
reassure her
■■ To arrange removal to hospital if
necessary
YOUR AIMS
■■ If bleeding is severe, call
999/112 for emergency help.
■■ Treat for shock (pp.112–13).
Monitor and record vital signs –
breathing, pulse and level of
response (pp.52–53) – while
waiting for help to arrive.
CAUTION
If she has period pains, she
may take the recommended
dose of paracetamol or her own
painkillers.
2 Allow the woman privacy
and give her a sanitary
towel. Make her as comfortable
as possible in whichever position
she prefers.
1
■■ Do not touch any protruding
intestine. Cover the area
with a clean plastic bag or
kitchen film to prevent the
intestine surface from
drying out.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty
pp.54–87). If he is breathing,
support the abdomen as you put
him in the recovery position. Do
not allow the casualty to eat or
drink because an anaesthetic
may be needed.
CAUTION
Call 999/112 for emergency
help. Treat the casualty for
shock (pp.112–13). Monitor and
record vital signs – breathing,
pulse and level of respomse
(pp.52–53) – while waiting for
help to arrive.
3
SEE ALSO Shock pp.112–13
VAGINAL BLEEDING
129
ABDOMINAL WOUND | VAGINAL BLEEDING | BLEEDING VARICOSE VEIN
BLEEDING VARICOSE VEIN
WHAT TO DO
Help the casualty to lie down on his back.
Raise and support the injured leg as high as
possible immediately; this reduces the amount
of bleeding.
Rest the injured leg on your shoulder or on
a chair. Apply firm, direct pressure on the
injury, using a sterile dressing or a clean, non-fluffy
pad, until the blood loss is under control. If
necessary, carefully cut away clothing to expose
the site of the bleeding.
Remove garments such as garters or elastictopped
stockings because these may cause the
bleeding to continue.
2
1
3
■■ To control bleeding
■■ To minimise shock
■■ To arrange urgent removal
to hospital
Veins contain one-way valves that keep the blood flowing YOUR AIMS
towards the heart. If these valves fail, blood collects (pools)
behind them and makes the veins swell. This problem, called
varicose veins, usually develops in the legs.
A varicose vein has taut, thin walls and is often raised,
typically producing knobbly skin over the affected area. The vein
can be burst by a gentle knock, and this may result in profuse
bleeding. Shock will quickly develop if bleeding is not controlled.
Keeping the leg raised, put another large, soft
pad over the dressing. Bandage it firmly
enough to exert even pressure, but not so tightly
that the circulation in the limb is impaired.
4
Call 999/112 for emergency help. Keep the
injured leg raised and supported until the
ambulance arrives. Monitor and record vital
signs – breathing, pulse and level of response,
(pp.52–53) – regularly until help arrives. In addition,
check the circulation in the limb beyond the
bandage (p.243) every ten minutes.
5
SEE ALSO Shock pp.112–113
The skeleton is the supporting framework
around which the body is constructed.
It is jointed in many places, and muscles
attached to the bones enable us to move.
Most of our movements are controlled at
will and coordinated by impulses that travel
from the brain via the nerves to every
muscle and joint in the body.
It is difficult for a first aider to distinguish
between different bone, joint and muscle
injuries, so this chapter begins with an
overview of how bones, muscles and
joints function and how injuries affect
them. First aid treatments for most
injuries, from serious fractures to sprains,
strains and dislocations, are included here
in this section.
First aid for head and spinal injuries
is also covered in this chapter. There is
anatomical information about the nervous
system that explains how these injuries can
be made worse by potential damage to the
brain and spinal cord.
■■ To assess the casualty’s condition quickly and calmly
■■ To support the injured part of the body
■■ To minimise shock
■■ To call 999/112 for emergency help if you suspect
a serious injury
■■ To comfort and reassure the casualty
■■ To be aware of your own needs
AIMS AND OBJECTIVES
BONE, JOINT AND
MUSCLE INJURIES
132
THE SKELETON
The body is built on a framework of bones
called the skeleton. This structure supports the
muscles, blood vessels and nerves of the body.
Many bones of the skeleton also protect
important organs such as the brain and
heart. At many points on the skeleton, bones
articulate with each other by means of joints.
These are supported by ligaments and moved
by muscles that are attached to the
bones by tendons.
BONE, JOINT AND MUSCLE INJURIES
The skeleton
There are 206 bones in the skeleton,
providing a protective framework for
the body. The skull, spine and ribcage
protect vital body structures; the
pelvis supports the abdominal
organs; and the bones and joints
of the arms and legs enable the
body to move.
Breastbone (sternum)
Ulna
Radius
Upper arm bone
(humerus)
Collar bone
(clavicle)
Hip joint is point at
which leg bones are
connected to pelvis
Forearm bones
Thigh bone (femur)
Kneecap (patella)
Splint bone (fibula)
BONES OF THE HAND
Wrist bones
(carpals)
Hand bone
(metacarpal)
Finger bone
(phalanx)
Shin bone (tibia)
Lower leg bones
Ankle bones (tarsals)
Foot bone (metatarsal)
Shoulder blade
(scapula)
Twelve pairs of ribs form
ribcage, which protects
vital organs in chest and
moves with lungs during
breathing Spine, which is
formed from bones
(vertebrae), protects
spinal cord and enables
back to move
Skull protects brain and
supports structures of face
Collar bones
and shoulder
blades form
shoulder girdle,
to which arms
are attached
Jawbone (mandible) is hinged and
enables mouth to open and close
Pelvis is attached to
lower part of spine
and protects lower
abdominal organs
Scaphoid
133
Also known as the backbone, the spine has a
number of functions. It supports the head,
makes the upper body flexible, helps to support
the body’s weight and protects the spinal cord
(p.171). The spine is a column made up of 33
bones called vertebrae, which are connected by
joints. Between individual vertebrae are discs of
fibrous tissue, called intervertebral discs, which
help to make the spine flexible and cushion it
from jolts. Muscles and ligaments attached to
the vertebrae help to stabilise the spine and
control the movements of the back.
THE SPINE
This bony structure protects
the brain and the top of the
spinal cord. It also supports the
eyes and other facial structures.
The skull is made up of several
bones, most of which are fused at
joints called sutures. Within the
bone are air spaces (sinuses),
which lighten the skull. The
bones covering the brain form
a dome called the cranium.
Several other bones form the eye
sockets, nose, cheeks and jaw.
THE SKULL
Spinal column
The vertebrae form five groups: the
cervical vertebrae support the head
and neck; the thoracic vertebrae form
an anchor for the ribs; the lumbar
vertebrae help to support the body’s
weight and give stability; the sacrum
supports the pelvis; and the coccyx
forms the end of the spine.
Structures that make the
spine flexible
The joints connecting the vertebrae,
and the discs between the vertebrae,
allow the spine to move. There is only
limited movement between adjacent
vertebrae, but together the vertebrae,
discs and ligaments allow a range of
movements in the spine as a whole.
THE SKELETON
Structures of the skull
This illustration shows the cranium and the main
bones of the face. The lower jawbone (mandible)
is the only bone in the skull that moves.
Cervical spine
(7 bones)
Thoracic spine
(12 bones)
Lumbar spine
(5 bones)
Sacrum
(5 fused bones)
Suture
Parietal bone
Vertebra
Gelatinous
core
PORTION OF SPINE
SECTION OF
INTERVERTEBRAL
DISC
Fibrous
covering
Intervertebral disc
Frontal bone
Eye socket
Nasal bone
Lower jawbone
(mandible)
Cheekbone
(zygomatic bone)
Ligaments between
vertebrae help to
control movement
of spine
Projection provides
an anchor for
ligaments and
muscles
Coccyx
(4 fused bones)
Occipital bone
Temporal bone
Upper jaw bone
(maxilla)
134
BONE, JOINT AND MUSCLE INJURIES
BONES, MUSCLES AND JOINTS
Bone is a living tissue containing calcium and
phosphorus; minerals that make it hard, rigid
and strong. From birth to early adulthood,
bones grow by laying down calcium on the
outside. They are also able to generate new
tissue after injury.
Age and certain diseases can weaken
bones, making them brittle and susceptible to
breaking or crumbling, either under stress or
spontaneously. Inherited problems, or bone
disorders such as rickets, cancer and infections,
can cause bones to become distorted and
weakened. Damage to the bones during
adolescence can also shorten a bone or
impair movement. In older people, a disorder
called osteoporosis can cause the bones to
lose density, making them brittle and prone
to breaking.
Muscles cause various parts of the body to
move. Skeletal (voluntary) muscles control
movement and posture. They are attached to
bones by bands of strong, fibrous tissue
(tendons), and many operate in groups. As one
group of muscles contracts, its paired group
relaxes. Involuntary muscles operate the
internal organs, such as the heart, and work
constantly, even while we are asleep. They are
controlled by the autonomic nerves (p.143).
THE MUSCLES
Parts of a bone
Each bone is covered by a
membrane (periosteum),
which contains nerves and blood
vessels. Under this membrane is
a layer of compact, dense bone;
at the core is spongy bone. In
some bones, there is a cavity at
the centre containing soft tissue
called bone marrow.
Straightening the arm
The triceps muscle, at
the back of the upper
arm, shortens
(contracts) to pull
down the bones of the
forearm. The biceps
muscle, at the front of
the arm, relaxes.
Bending the arm
The biceps muscle,
at the front of the
arm, shortens
(contracts), pulling
the bones of the
forearm upwards
to bend the arm.
At the same time,
the triceps muscle
relaxes and
lengthens.
Spongy bone
Compact bone
Bone marrow
Vein
Artery Nerve Periosteum
Triceps muscle
contracts
Biceps muscle
relaxes
Tendon
Triceps muscle
relaxes
Biceps muscle
contracts
135
BONES, MUSCLES AND JOINTS
THE JOINTS
A joint is where one bone meets another. In
a few joints (immovable joints), the bone edges
fit together or are fused. Immovable joints are
found in the skull and pelvis. Most joints are
movable, and the bone ends are joined by
fibrous tissue called ligaments, which form
a capsule around the joint. The capsule
lining (synovial membrane) produces fluid
to lubricate the joint; the ends of the bones
are also protected by smooth cartilage. Muscles
that move the joint are attached to the bones
by tendons. The degree and type of movement
depends on the way the ends of the bones fit
together, the strength of the ligaments and the
arrangement of muscles.
Structures of a movable joint
Cartilage covers the bone ends
and minimises friction. Bands of
tissue (ligaments) hold the ends
together. The joint is enclosed in
a lubricant-filled capsule.
Pivot joint
One bone
rotates within
a fixed collar
formed by
another,
as at the base
of the skull.
Saddle joint
Bone ends meet at
right angles in this
joint. The only
example is at the
base of the thumb.
Hinge joint
This joint allows bending
and straightening in only
one plane, as in the knees
and elbows.
Plane joint
Surfaces of this type
of joint are almost
flat and slide over
each other. This joint
is found in the wrist
and foot.
Ball-and-socket joint
This joint allows
movement in all
directions. Examples are
the hip and shoulder.
Ellipsoidal joint
In this type of joint, movement
can occur in most directions. The
wrist joint is an example.
Bone
Ligament
Cartilage
Synovial
membrane
Synovial fluid
136
BONE, JOINT AND MUSCLE INJURIES
■■ To prevent movement at the
injury site
■■ To arrange removal to hospital, with
comfortable support during
transport
YOUR AIMS
FRACTURES
There may be:
■■ Deformity, swelling and bruising at
the fracture site
■■ Pain and/or difficulty in moving
the area
■■ Shortening, bending or twisting of
a limb
■■ Coarse grating (crepitus) of the bone
ends that can be heard or felt (by
casualty) – do not try to seek this
■■ Signs of shock, especially if the thigh
bone or pelvis are fractured
■■ Difficulty in moving a limb normally
or at all (for example, inability to
walk)
■■ A wound, possibly with bone ends
protruding (What to do for an open
fracture, p.138)
RECOGNITION A break or crack in a bone is called a fracture. Considerable
force is needed to break a bone, unless it is diseased or old.
However, bones that are still growing are supple and may split,
bend or crack like a twig. A bone may break at the point where a
heavy blow is received. Fractures may also result from a twist or
a wrench (indirect force).
In an open fracture, one of the broken bone ends may pierce the
skin surface, or there may be a wound at the fracture site. An
open fracture carries a high risk of becoming infected.
In a closed fracture, the skin around the fracture is intact.
However, bones may be displaced (unstable) causing internal
bleeding and the casualty may develop shock (pp.112–13).
OPEN AND CLOSED FRACTURES
A stable fracture occurs when the broken bone ends do not
move because they are not completely broken or they are
impacted. Such injuries are common at the wrist, shoulder, ankle
and hip. Usually, these fractures can be gently handled without
further damage.
In an unstable fracture, the broken bone ends can easily move.
There is a risk that they may damage blood vessels, nerves and
organs around the injury. Unstable injuries can occur if the bone is
broken or the ligaments are torn (ruptured). They should be handled
carefully to prevent further damage.
STABLE AND UNSTABLE FRACTURES
Closed fracture
The skin is not
broken, although
the bone ends may
damage nearby
tissues and blood
vessels. Internal
bleeding is a risk.
Open fracture
Bone is exposed at
the surface where it
breaks the skin. The
casualty may suffer
bleeding and shock.
Infection is a risk.
Stable fracture
Although the bone
is fractured, the
ends of the injury
remain in place. The
risk of bleeding or
further damage is
minimal.
Unstable fracture
In this type of
fracture, the broken
bone ends can
easily be displaced
by movement or
muscle contraction.
Pelvis
Femur
137
FRACTURES
SEE ALSO Crush injury p.118 | Internal bleeding p.116 | Shock pp.112–13
WHAT TO DO FOR A CLOSED FRACTURE
Advise the casualty to keep still. Support the joints above and
below the injured area with your hands, or ask a helper to do this,
until it is immobilised with a sling or bandages.
Place padding around the injury for extra support. Take or send
the casualty to hospital; an arm injury may be transported by car;
call 999/112 for emergency help for a leg injury.
For firmer support and/or if removal to hospital is likely to be
delayed, secure the injured part to an unaffected part of the
body. For upper limb fractures, immobilise the arm with a sling
(pp.251–52). For lower limb fractures, move the uninjured leg to
the injured one and secure with broad-fold bandages (p.249).
Always tie the knots on the uninjured side.
Treat for shock if necessary (pp.112–13) . Do not raise the injured
leg; elevate the uninjured limb if shock is present. Monitor and
record vital signs (pp.52–53) while waiting for help. Check the
circulation beyond a sling or bandage (p.243) every ten minutes. If
the circulation is impaired, loosen the bandages.
1
2
3
4
■■ Do not move the casualty until
the injured part is secured and
supported, unless she is in
immediate danger.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
CAUTION
»
138
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Severe external bleeding pp.114–115 | Shock pp.112–13
■■ To prevent blood loss, movement
and infection at the site of injury
■■ To arrange removal to hospital,
with comfortable support during
transport
YOUR AIMS
WHAT TO DO FOR AN OPEN FRACTURE
Cover the wound with a sterile dressing or large, clean, non-fluffy
pad. Apply pressure around the injury to control bleeding
(pp.114–15); be careful not to press on a protruding bone.
1
Carefully place a sterile wound dressing or more clean padding
over and around the first dressing. 2
Secure the dressing and padding with a bandage. Bandage
firmly, but not so tightly that it impairs the circulation beyond
the bandage.
3
Treat the casualty for shock (pp.112–13) if necessary. Do not raise
the injured leg; elevate the uninjured limb if shock is present.
Monitor and record vital signs – breathing, pulse and level of response
(pp.52–53) – while waiting for help to arrive. Check the circulation
beyond the bandage (p.243) every ten minutes.
5
Immobilise the injured part as for a closed fracture (p.137), and
arrange to transport the casualty to hospital. 4
■■ Do not move the casualty until
the injured part is secured and
supported, unless he is in
immediate danger.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Do not press directly on a
protruding bone end.
CAUTION
«FRACTURES
If a bone end is protruding,
build up pads of clean, soft,
non-fluffy material around the
bone, until you can bandage
over it without pressing on
the injury.
SPECIAL CASE
PROTRUDING BONE
FRACTURES | DISLOCATED JOINT
139
DISLOCATED JOINT
■■ “Sickening”, severe pain
■■ Inability to move the joint
■■ Swelling and bruising around the
affected joint
■■ Shortening, bending or deformity
of the area
RECOGNITION
■■ To prevent movement at the
injury site
■■ To arrange removal to hospital, with
comfortable support during
transport
YOUR AIMS
SEE ALSO Fractures pp.136–38 | Strains and sprains pp.140–41
WHAT TO DO
Advise the casualty to keep
still. If, for example, he has a
dislocated shoulder, help him to
support the injured arm in the
position he finds most
comfortable.
1
Arrange to take or send the casualty to hospital. Treat for shock if
necessary – do not raise an injured leg; elevate the uninjured one.
Monitor and record vital signs (pp.52–53) while waiting for help.
■■ Do not try to replace a
dislocated bone into its socket
as this may cause further injury.
■■ Do not move the casualty until
the injured part is secured and
supported, unless she is in
immediate danger.
■■ For a hand or arm injury remove
bracelets, rings and watches in
case of swelling.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
This is a joint injury in which the bones are partially or CAUTION
completely pulled out of their normal position. Dislocation
can be caused by a strong force wrenching the bone into an
abnormal position, or by violent muscle contraction. This very
painful injury most often affects the shoulder, knee, jaw or joints
in the thumbs or fingers. Dislocations may be associated with
torn ligaments (pp.140–41), or with damage to the synovial
membrane that lines the joint capsule (p.135).
Joint dislocation can have serious consequences. If vertebrae are
dislocated, the spinal cord can be damaged. Dislocation of the
shoulder or hip may damage the large nerves that supply the
limbs and result in paralysis. A dislocation of any joint may
also fracture the bones involved. It is difficult to distinguish a
dislocation from a closed fracture (p.136). If you are in any doubt,
treat the injury as a fracture.
For extra support for an injured arm, secure the limb to the chest
by tying a broad-fold bandage (p.249) right around the chest and
the sling.
3
Check the circulation beyond the bandages (p.243) every
ten minutes. 5
Immobilise the injured
arm with a sling (p.251)
or use padding and/or broadfold
bandages (p.249) for a
leg injury, whichever is most
comfortable.
2
4
140
BONE, JOINT AND MUSCLE INJURIES
STRAINS AND SPRAINS
The softer structures around bones and joints
– the ligaments, muscles and tendons – can be
injured in several ways. Injuries to these soft
tissues are commonly called strains and sprains.
They occur when the tissues are overstretched
and partially or completely torn (ruptured) by
violent or sudden movements. For this reason,
strains and sprains are frequently associated
with sporting activities.
Strains and sprains should be treated initially by
the “RICE” procedure:
R – Rest the injured part
I – Apply Ice pack or a cold pad
C – Provide Comfortable support
E – Elevate the injured part
This procedure may be sufficient to relieve the
symptoms, but if you are in any doubt as to the
severity of the injury, treat it as a fracture
(pp.136–38).
Muscles and tendons may be strained, ruptured
or bruised. A strain occurs when the muscle is
overstretched; it may be partially torn, often at
the junction between the muscle and the tendon
that joins it to a bone. In a rupture, a muscle or
tendon is torn completely; this may occur in the
main bulk of the muscle or in the tendon. Deep
bruising can be extensive in parts of the body
where there is a large bulk of muscle. Injuries
in these areas are usually accompanied by
bleeding into the surrounding tissues, which
can lead to pain, swelling and bruising.
MUSCLE AND TENDON INJURY
Muscle tears
Vigorous movements may cause muscle fibres,
such as the hamstring in the leg, to tear. Muscle
tears can cause severe pain and swelling.
Ruptured tendon
The Achilles heel tendon attaches the calf muscle
to the heel bone. It can snap after sudden exertion
and may need surgery and immobilisation.
One common form of ligament injury is a
sprain. This is the tearing of a ligament at
or near a joint. It is often due to a sudden
or unexpected wrenching motion that
pulls the bones in the joint too far
apart and tears the
surrounding tissues.
LIGAMENT INJURY
Sprained ankle
This is due to overstretching
or tearing of a ligament –
the fibrous cords that
connect bones at a joint.
In this example, one of the
ligaments in the ankle is
partially torn.
Ruptured
Achilles
tendon
Normal
muscle fibres
Torn muscle
fibres produce
localised pain
and swelling
Tibialis anterior
tendon
Tibia Fibula
Sprained
ligament
Heel
bone
141
STRAINS AND SPRAINS
There may be:
■■ Pain and tenderness
■■ Difficulty in moving the injured part,
especially if it is a joint
■■ Swelling and bruising in the area
RECOGNITION
■■ To reduce swelling and pain
■■ To obtain medical help if necessary
YOUR AIMS
SEE ALSO Cold compresses p.241 | Fractures pp.136–38
WHAT TO DO
Help the casualty to sit or
lie down. Support the
injured part in a comfortable
position, preferably raised.
Cool the area by applying a
cold compress, such as an
ice pack or cold pad (p.241), to
the injury. This helps to reduce
swelling, bruising and pain.
1 2
Apply comfortable support to the injured part.
Leave the cold compress in place or wrap a
layer of soft padding, such as cotton wool, around
the area. Secure it with a conforming bandage that
extends to the next joint; for an ankle injury, the
bandage should extend from the base of the toes
to the knees; make sure it is not too tight.
3 Support the injured part in a raised position to
help minimise bruising and swelling in the area.
Check the circulation beyond the bandages (p.243)
every ten minutes. If the circulation is impaired,
undo the bandage and reapply more loosely.
4
If the pain is severe, or the casualty is unable
to use the injured part, arrange to take or send
him to hospital. Otherwise, advise the casualty
to rest the injury and to seek medical advice
if necessary.
5
142
BONE, JOINT AND MUSCLE INJURIES
THE BRAIN AND NERVES
The nervous system is the body’s
information-gathering, storage and control
system. It consists of a central processing
unit – the brain – and a network of nerve cells
and fibres.
There are two main parts to the nervous
system: the central nervous system,
consisting of the brain and spinal cord, and
the peripheral nervous system, which
consists of all the nerves that connect the
brain and the spinal cord to the rest of the
body. In addition, the autonomic (involuntary)
nervous system controls body functions such
as digestion, heart rate and breathing. The
central nervous system receives and analyses
information from all parts of the body. The
nerves carry messages, in the form of highspeed
electrical impulses, between the brain
and the rest of the nervous system.
Spinal cord protection
The spinal cord is
protected by the
vertebral column. Nerves
from the spinal cord
emerge between
vertebrae.
Brain
Structure of the
nervous system
The system consists
of the brain, spinal
cord and a network
of nerves that carry
electrical impulses
between the brain
and the body.
Cross-section
through a nerve
Each nerve is made up
of bundles of nerve fibres
(fascicles). A fatty substance
(myelin) surrounds and
insulates larger nerve fibres.
Cranial nerves (12 pairs)
extend directly from the
underside of the brain; most
serve the head, face, neck
and shoulders
Vagus nerve, longest of the
cranial nerves, serves organs
in chest and abdomen; it
controls the heart rate
Radial nerve
controls
muscles that
straighten
elbow and
fingers
Tibial nerve
serves calf
muscles
Sciatic nerve serves
hip and hamstring
muscles
Body of
vertebra
Spinal nerve
Spinal cord
Nerve fibre
Myelin sheath
Nerve
fascicle
143
THE BRAIN AND NERVES
Structure of the brain
The brain is enclosed within the skull. It has
three main parts: the cerebrum, which has an
outer layer called the cortex; the cerebellum;
and the brain stem.
THE BRAIN AND SPINAL CORD
Together the brain and spinal cord make up
the central nervous system (CNS). This system
contains billions of interconnected nerve cells
(neurons) and is enclosed by three
membranes called meninges. A clear fluid
called cerebrospinal fluid flows around the
brain and spinal cord. It functions as a shock
absorber, provides oxygen and nutrients and
removes waste products.
The brain has three main structures:
the cerebrum, which is concerned with
thought, sensation and conscious
movement; the cerebellum, which
coordinates movement, balance and
posture; and the brain stem, which
controls basic functions such as
breathing. The main function of the
spinal cord is to convey signals between
the brain and the peripheral nervous
system (below).
AUTONOMIC NERVES
Some of the cranial nerves, and several small
spinal nerves, work together as the autonomic
nervous system. This system is concerned with
vital body functions such as heart rate and
breathing. The system’s two parts – the
sympathetic and parasympathetic systems –
counterbalance each other. The sympathetic
nerves prepare the body for action by releasing
hormones that raise the heart rate and reduce
the blood flow to the skin and intestines. The
parasympathetic nerves release hormones with
a calming effect.
PERIPHERAL NERVES
The peripheral nervous system consists of two
sets of paired nerves – the cranial and spinal
nerves – connecting the CNS to the body.
The cranial nerves emerge in 12 pairs from the
underside of the brain. The 31 pairs of spinal
nerves branch off at intervals from the spinal
cord, passing into the rest of the body. Nerves
comprise bundles of nerve fibres that can
relay both incoming (sensory) and outgoing
(motor) signals.
Spinal cord extends
from brain stem to
lower end of spine
Vertebral column
protects delicate
spinal cord
Brain
stem
Cerebrum
Cerebellum
Skull
Cerebrospinal
fluid
Meninges (membranes)
surround brain and
spinal cord
144
BONE, JOINT AND MUSCLE INJURY
HEAD INJURY
Head injuries are common. They are potentially serious because
they can lead to damage to the brain. There may also be injuries
to the spine in the neck, scalp wounds and/or a skull fracture.
If a casualty has sustained a minor injury such as a bruise or
scalp wound, he is likely to be responding normally. If he has
suffered a more serious blow to the head, such as in a sporting
impact, responsiveness may be temporarily impaired.
The brain lies inside the skull, cushioned by fluid and can
therefore be shaken by a blow to the head. This is called
concussion and it may produce a temporary period of
unresponsiveness, but is not usually associated with any lasting
damage to the brain. The casualty may be confused, but this lasts
only a short time and is followed by a full recovery.
If a casualty has suffered a severe blow to his head, this may
cause bleeding or swelling inside the skull that can press on the
brain (compression). This is a serious condition. The pressure can
rise immediately after the impact or it may develop a few hours
or even days later. The severity of the head injury is related to
the mechanism of injury and its impact on the head. A serious
head injury is likely after a high speed motor collision or a fall
from a height.
Seek medical advice if you
notice signs of a worsening head
injury such as:
■■ Increasing drowsiness
■■ Persistent headache
■■ Confusion, dizziness, loss of
balance and/or loss of memory
■■ Difficulty speaking
■■ Difficulty walking
■■ Vomiting episodes after the
injury
■■ Double vision
■■ Seizure
CAUTION
Causes of head injury
The brain can be literally “shaken” inside
the skull with concussion (below). Injury that
results in bleeding can cause pressure to
build up inside the skull and damage the
tissues of the brain (below right).
Skull
Brain
Indirect force from
blow shakes brain
within skull
Skull
Accumulated blood
Brain presses on brain
Assess a casualty’s level of
response using the AVPU scale.
Check the casualty at regular
intervals. Make a note
of your findings at each
assessment, paying particular
attention to any change – the
casualty’s condition may improve
or deteriorate while you are
looking after him.
A – Is the casualty Alert? Are his
eyes open and does he respond
to questions?
V – Does the casualty respond to
Voice? Can he answer simple
questions and obey commands
P – Does the casualty respond to
Pain? Does he move or open his
eyes if you pinch his earlobe?
U – Is he Unresponsive to any
stimulus?
ASSESSING THE LEVEL OF
RESPONSE
CONCUSSION COMPRESSION
Direction of force
145
HEAD INJURY
There may be:
■■ Brief period of impaired response or
unresponsiveness
■■ Scalp wound
■■ Dizziness or nausea
■■ Loss of memory of events at the
time of, or immediately preceding
the injury
■■Mild generalised headache
■■ Confusion
For severe head injury there may
also be:
■■ History of a severe blow to the head
■■ Deteriorating level of response
■■ Loss of responsiveness
■■ Leakage of blood or blood-stained
watery fluid from the ear or nose
■■ Unequal pupil size
RECOGNITION
■■ To place the casualty in the care of a
responsible person
■■ To obtain medical help if necessary;
for serious head injury arrange
urgent removal to hospital
YOUR AIMS
SEE ALSO Facial injury p.146 | Scalp and head wounds p.122 | The unresponsive casualty pp.54–87
Regularly monitor and record vital signs – breathing, pulse and
level of response (pp.52–53). Watch especially for changes in his
level of response.
Sit the casualty down and give him a cold compress to hold
against the injury. Carry out an assessment of the casualty’s level
of response using the AVPU scale (opposite). Treat any scalp wounds
by applying direct pressure to the wound (p.122).
When the casualty has recovered, ask a responsible person to
look after him.
If a casualty’s injury is the result of a sporting incident, do not
allow him to return to the sport until he has been fully assessed
by a medical practitioner.
Advise the casualty to seek medical help if he develops signs and
symptoms of a worsening head injury (see CAUTION, opposite),
or if ANY of the following apply:
He is over 65 years of age
He has had previous brain surgery
He is taking anti-coagulant (anti-clotting) medication
The head injury is accompanied by drug or alcohol intoxication
There is no responsible person to look after him
Call 999/112 for emergency help – tell the operator that you suspect
head injury. Maintain an open and clear airway. Do this in the position
the casualty was found – try not to move him because of the additional
risk of spinal injury (pp.158–59). If this is not possible, use the jaw thrust
method to open the airway (p.159). Regularly monitor and record vital
signs – breathing, pulse and level of response (pp.52–53) – while waiting
for help to arrive. Watch especially for changes in his level of response.
SPECIAL CASE SEVERE HEAD INJURY
WHAT TO DO
2
3
4
5
1
146
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Head injury pp.144–45 | Knocked out adult tooth p.125 | Shock pp.112–13 | Spinal injury pp.157–59
| The unresponsive casualty pp.54–87
There may be:
■■ Pain around affected area; if the jaw
is affected, difficulty speaking,
chewing or swallowing
■■ Difficulty breathing
■■ Swelling and distortion of the face
■■ Bruising and/or a black eye
■■ Blood or bloodstained watery fluid
leaking from the nose or ear
RECOGNITION
■■ Never place a bandage around
the lower part of the face or
lower jaw in case the casualty
vomits or has difficulty
breathing.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
■■ If an unresponsive casualty is
breathing, place him in the
recovery position (pp.64–65)
with his injured side
downwards so that blood or
other body fluids can drain
away. Place soft padding
under his head. Be aware of
the risk of neck (spinal) injury.
Fractures of facial bones are usually due to hard impacts.
Serious facial fractures may appear frightening. There may be
distortion of the eye sockets, general swelling and bruising, as
well as bleeding from displaced tissues or from the nose and
mouth. The main danger with any facial fracture is that blood,
saliva or swollen tissue may obstruct the airway and cause
breathing difficulties.
When you are examining a casualty with a facial injury,
assume that there is damage to the skull, brain or neck. There is
also a danger that you may misinterpret the symptoms of a facial
fracture as a black eye.
CAUTION
FACIAL INJURY
■■ To keep the airway open
■■ To minimise pain and swelling
■■ To arrange urgent removal to
hospital
YOUR AIMS
WHAT TO DO
Call 999/112 for
emergency help.
Help the casualty to sit
down and make sure the
airway is open and clear.
Ask the casualty to spit out
any blood, displaced teeth
or dentures from his mouth.
Keep any teeth to send to
hospital with him.
1
4
2
Gently place a cold
compress (p.241) against the
casualty’s face to help reduce
pain and minimise swelling.
Treat for shock (pp.112–13)
if necessary.
3
Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
5
147
FACIAL INJURY | LOWER JAW INJURY | CHEEKBONE AND NOSE INJURY
CHEEKBONE AND NOSE INJURY
SEE ALSO Facial injury opposite | Head injury pp.144–45 | Knocked out adult tooth p.125 | Nosebleed p.124
WHAT TO DO
WHAT TO DO
There may be:
■■ Pain, swelling and bruising
■■ Obvious wound or bleeding from the
nose or mouth
RECOGNITION
■■ If there is blood or bloodstained
watery fluid leaking from the
casualty’s nose, treat the
casualty as for a head injury
(pp.144–45).
■■ Do not allow the casualty
to eat or drink because an
anaesthetic may be needed.
CAUTION
■■ To minimise pain and swelling
■■ To arrange transport to hospital
YOUR AIMS
Fractures of the cheekbone and nose are usually the result of
direct blows to the face. Swollen facial tissues are likely to cause
discomfort, and the air passages in the nose may become
blocked, making breathing difficult. These injuries should always
be examined in hospital.
Gently place a cold
compress, such as a cold pad
or ice pack (p.241), against the
injured area to help reduce pain
and minimise swelling.
1
If the casualty has a
nosebleed, try to pinch the
nose to stop the bleeding
(p.124). Arrange to take or send
the casualty to hospital.
2
LOWER JAW INJURY
There may be:
■■ Difficulty speaking, swallowing and
moving the jaw
■■ Pain and nausea when moving
the jaw
■■ Displaced or loose teeth and
dribbling from the mouth
■■ Swelling and bruising inside and
outside the mouth
RECOGNITION
■■ To protect the airway
■■ To arrange transport to hospital
YOUR AIMS
Jaw fractures are usually the result of direct force, such as a
heavy blow to the chin. In some situations, a blow to one side
of the jaw produces indirect force, which causes a fracture on
the other side of the face. A fall on to the point of the chin can
fracture the jaw on both sides. The lower jaw may also be
dislocated by a blow to the face, or is sometimes dislocated
by yawning.
If the face is seriously injured, with the jaw fractured in more
than one place, treat as for a facial injury (opposite).
If the casualty is not
seriously injured, help him
to sit with his head forward to
allow fluids to drain from his
mouth. Encourage the casualty
to spit out loose teeth, and
keep them to send to hospital
with him.
1 Give the casualty a soft pad
to hold firmly against his
jaw in order to support it.
2
Arrange to take or send the
casualty to hospital. Keep
his jaw supported throughout.
3
148
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Fractures pp.136–38 | Upper arm injury p.150
■■ To immobilise the injured shoulder
and arm
■■ To arrange transport to hospital
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
The collar bones (clavicles) form “struts” between the shoulder
blades and the top of the breastbone to help support the arms. It
is rare for a collar bone to be broken by a direct blow. Usually, a
fracture results from an indirect force transmitted from an
impact at the shoulder or passing along the arm, for example,
from a fall onto an outstretched arm.
Collar bone fractures often occur in young people as a result
of sports activities. The broken ends of the collar bone may be
displaced, causing swelling and bleeding in the surrounding
tissues as well as distortion of the shoulder.
WHAT TO DO
Help the casualty to sit down. Gently place the injured arm across
her body in the position that she finds most comfortable. Ask her
to support the elbow on the injured side with her other hand, or help
her to do it.
Support the arm on the
affected side with an arm
sling (p.251). Make sure the knot
is clear of the site of injury.
For extra support, secure
the arm to the chest by
tying a broad-fold bandage
(p.249) around the chest and
the sling. Once the arm is
supported the casualty will
be more comfortable.
2
1
3
CAUTION
COLLAR BONE INJURY
There may be:
■■ Pain and tenderness, increased by
movement
■■ Swelling and deformity of the
shoulder
■■ Attempts by the casualty to relax
muscles and relieve pain; she may
support her arm at the elbow, and
incline her head to her injured side
RECOGNITION
Arrange to take or send
the casualty to hospital
in the position she finds most
comfortable.
4
149
COLLAR BONE INJURY | SHOULDER INJURY
SHOULDER INJURY
■■ To support and immobilise the
injured limb
■■ To arrange transport to hospital
YOUR AIMS
■■ Do not attempt to replace a
dislocated bone into its socket.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
A fall on to the shoulder or an outstretched arm, or a wrenching
force may pull the head of the upper arm bone (humerus) out of
the joint socket – dislocation of the shoulder. At the same time,
ligaments around the shoulder joint may be torn. This injury
can be extremely painful. Some people experience repeated
dislocations and may need a strengthening operation on the
affected shoulder.
A fall onto the point of the shoulder may damage the ligaments
bracing the collar bone at the shoulder. Other shoulder injuries
include damage to the joint capsule and to the tendons around
the shoulder; these injuries tend to be common in older people.
To treat a shoulder sprain, follow the RICE procedure – Rest the
affected part, cool the injury with Ice, provide Comfortable
support with bandaging and Elevate the injury (pp.140–41).
WHAT TO DO
Help the casualty to sit
down. Gently place the arm
on the injured side across her
body in the position that is most
comfortable. Ask the casualty to
support her elbow on the injured
side, or help her to do it.
For extra support if
necessary, secure the arm to
the chest by tying a broad-fold
bandage (p.249) around the
chest and the sling.
Support the arm on the
injured side with an arm
sling (p.251).
Arrange to take or send
the casualty to hospital
in the position she finds most
comfortable.
3
1 2
4
CAUTION
There may be:
■■ Severe pain, increased by movement;
the pain may make the casualty
reluctant to move
■■ Attempts by the casualty to relieve
pain by supporting the arm and
inclining the head to the injured side
■■ A flat, angular look to the shoulder
RECOGNITION
SEE ALSO Fractures pp.136–38
150
There may be:
■■ Pain, increased by movement
■■ Tenderness and deformity over the
site of a fracture
■■ Rapid swelling
■■ Bruising, which may develop more
slowly
■■ To immobilise the arm
■■ To arrange transport to hospital
RECOGNITION
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
The most serious form of upper arm injury is a fracture of
the long bone in the upper arm (humerus). The bone may be
fractured across the centre by a direct blow. However, it is much
more common, especially in elderly people, for the arm bone
to break at the shoulder end, usually in a fall.
A fracture at the top of the bone is usually a stable injury
(p.136), as the broken bone ends stay in place. For this reason,
it may not be immediately apparent that the bone is broken,
although the arm is likely to be painful. There is a possibility
that the casualty will cope with the pain and leave the
fracture untreated for some time.
WHAT TO DO
Help the casualty to sit
down. Remove all jewellery
such as bracelets, rings and
watches. Gently place the
forearm horizontally across her
body in the position that is most
comfortable. Ask her to support
her elbow if possible.
Slide a triangular bandage
in position between the arm
and the chest, ready to make an
arm sling (p.251). Place soft
padding between the injured
arm and the body, then support
the arm and its padding in an
arm sling.
For extra support, or if
the journey to hospital is
prolonged, secure the arm by
tying a broad-fold bandage
(p.249) around the chest and
over the sling; make sure that
the broad-fold bandage is below
the fracture site.
Arrange to take or send the
casualty to hospital.
1 2 3
4
CAUTION
UPPER ARM INJURY
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Fractures pp.136–38
151
UPPER ARM INJURY | ELBOW INJURY
ELBOW INJURY
There may be:
■■ Pain, increased by movement
■■ Tenderness over the site of a fracture
■■ Swelling, bruising and deformity
■■ Fixed elbow
■■ To immobilise the arm without
further injury to the joint
■■ To arrange transport to hospital
RECOGNITION
YOUR AIMS
■■ If the casualty feels faint, help her
to lie down.
■■ Do not allow the casualty to eat or
drink because an anaesthetic may
be needed.
■■ Do not try to move the injured
arm.
WHAT TO DO
If the elbow can be bent, treat as for upper arm injury opposite.
Remove all jewellery such as bracelets, rings and watches.
If the casualty cannot bend her arm, help her to sit down.
Place padding, such as a towel, around the elbow for comfort
and support.
Secure the arm in the most comfortable position for the casualty
using broad-fold bandages. Keep the bandages clear of the
fracture site.
Arrange to take or send the
casualty to hospital.
Check the wrist pulse
(p.53) in the injured arm
every ten minutes until medical
help arrives. If you cannot feel a
pulse, gently undo the bandages
and straighten the arm until the
pulse returns. Support the arm
in this position.
2
1
3
4
5
Fractures or dislocations at the elbow usually result from
a fall on to the hand. Children often fracture the upper arm bone
just above the elbow. This is an unstable fracture (p.136), and the
bone ends may damage blood vessels. Circulation in the arm
needs to be checked regularly. In any elbow injury, the elbow
will be stiff and difficult to straighten. Never try to force a
casualty to bend it.
CAUTION
SEE ALSO Fractures pp.136–38
152 SEE ALSO Fractures pp.136–38 | Severe external bleeding pp.114–15
There may be:
■■ Pain, increased by movement
■■ Swelling, bruising and deformity
■■ Possible bleeding with an open
fracture
■■ To immobilise the arm
■■ To arrange transport to hospital
RECOGNITION
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
The bones of the forearm (radius and ulna) can be fractured by
an impact such as a heavy blow or a fall. As the bones have little
fleshy covering, the broken ends may pierce the skin, producing
an open fracture (p.136 and p.138).
A fall onto an outstretched hand can result in a fracture of the
wrist. This is called a Colles fracture and commonly occurs in
elderly people.
The wrist joint is rarely dislocated, but is often sprained.
It can be difficult to distinguish between a sprain and a fracture,
especially if the tiny scaphoid bone (at the base of the thumb)
is injured. If you are in any doubt about the injury always treat
as a fracture.
WHAT TO DO
Ask the casualty to sit
down. Steady and support
the injured forearm and place it
across his body; ask the casualty
to support it if he can. Expose
and treat any wound. For extra support, or if
the journey to hospital is
likely to be prolonged, secure
the arm to the body by tying a
broad-fold bandage (p.249) over
the sling and body. Position the
bandage as close to the elbow as
you can. Arrange to take or send
the casualty to hospital.
Slide a triangular bandage
in position between the
arm and the chest, ready to
make an arm sling (p.251).
Surround the forearm in
soft padding, such as a
small towel.
Support the arm and the
padding with an arm sling;
make sure the knot is tied on the
injured side.
4
2
1 3
CAUTION
FOREARM AND WRIST INJURIES
BONE, JOINT AND MUSCLE INJURIES
153
FOREARM AND WRIST INJURIES | HAND AND FINGER INJURIES
HAND AND FINGER INJURIES
SEE ALSO Crush injury p.118 | Dislocated joint p.139 | Fractures pp.136–38 | Wound to the palm p.127
There may be:
■■ Pain, increased by movement
■■ Swelling, bruising and deformity
■■ Possible bleeding with an open
fracture
■■ To elevate the hand and immobilise it
■■ To arrange transport to hospital
RECOGNITION
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
WHAT TO DO
Help the casualty to sit
down and ask her to raise
and support the affected wrist
and hand; help her if necessary.
Treat any bleeding and losely
cover the wound with a sterile
dressing or large clean, nonfluffy
pad.
For extra support, or if
the journey to hospital is
likely to be prolonged, secure
the arm by tying a broad-fold
bandage (p.249) around the
chest and over the sling; keep it
away from the injury. Arrange to
take or send the casualty
to hospital.
Remove any rings before
the hand begins to swell,
and keep the hand raised to
minimise swelling. Wrap the
hand in soft, non-fluffy padding
for extra protection.
Gently support the affected
arm across the casualty’s
body by placing it in an elevation
sling (p.252).
4
2
1 3
The bones and joints in the hand can suffer various types
of injury, such as fractures, cuts and bruising. Minor fractures are
usually caused by direct force. A fracture of the knuckle often
results from a punch.
Multiple fractures, affecting many or all of the bones in the
hand, are usually caused by crushing injuries. The fractures may
be open, with severe bleeding and swelling, needing immediate
first aid treatment.
The joints in the fingers or thumb are sometimes dislocated or
sprained as a result of a fall onto the hand (for example, while
someone is skiing or ice skating).
Always compare the suspected fractured hand with the
uninjured hand because finger fractures result in deformities that
may not be immediately obvious.
CAUTION
154
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Abdominal wound p.128 | Penetrating chest wound pp.104–05 | Shock pp.112–13
■■ To support the chest wall
■■ To arrange transport to hospital
YOUR AIMS
■■ Do not allow the casualty
to eat or drink because an
anaesthetic may be needed.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty
pp.54–87). If he needs to be
placed in the recovery position,
lay him on his injured side to
allow the lung on the uninjured
side to work to its full capacity.
One or more ribs can be fractured by direct force to the
chest from a blow or a fall, or by a crush injury (p.118). If there
is a wound over the fracture, or if a broken rib pierces a lung,
the casualty’s breathing may be seriously impaired.
An injury to the chest can cause an area of fractured ribs
to become detached from the rest of the chest wall, producing
what is called a “flail-chest” injury. The detached area moves
inwards when the casualty breathes in, and outwards as he
breathes out. This “paradoxical” breathing causes severe
breathing difficulties.
Fractures of the lower ribs may injure internal organs such as
the liver and spleen, and may cause internal bleeding.
CAUTION
RIB INJURY
■■ Pain at the site of injury
■■ Pain on taking a deep breath
■■ Bruising, swelling or a wound at the
fracture site
■■ Shallow breathing
■■ Paradoxical chest movement
■■ Signs of internal bleeding (p.116) and
shock (pp.112–13)
RECOGNITION WHAT TO DO
Help the casualty to sit
down and ask him to
support the arm on the injured
side. For extra support if
necessary, place the arm on the
injured side in a sling (pp.251–52).
1 Arrange to take or send the
casualty to hospital. 2
155
RIB INJURY | PELVIC INJURY
PELVIC INJURY
■■ To minimise the risk of shock
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Keep movements of the casualty
to a minimum to prevent
worsening the injury.
■■ Do not bandage the casualty's
legs together if this increases
the pain. In such cases,
surround the injured area
with soft padding, such as
clothing or towels.
CAUTION
SEE ALSO Fractures pp.136–38 | Internal bleeding p.116 | Shock pp.112–13
There may be:
■■ An inability to walk or even stand,
although the legs appear uninjured
■■ Pain and tenderness in the region of
the hip, groin or back, which increases
with movement
■■ Difficulty or pain passing urine, and
bloodstained clothing
■■ Signs of shock and internal bleeding
RECOGNITION
WHAT TO DO
Help the casualty to lie
down on her back with her
head flat/low to minimise shock.
Keep her legs straight and flat.
Call 999/112 for
emergency help. Treat the
casualty for shock (pp.112–13).
Do not raise her legs.
1 3
Place padding between the
bony points of her knees
and ankles. Immobilise her legs
by bandaging them together
with folded triangular bandages
(p.249); secure her feet and
ankles with a narrow-fold
bandage (1), and her knees with
a broad-fold bandage (2).
Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
2 4
Injuries to the pelvis are usually caused by forces such as a car
crash, a fall from a height or by crushing. These incidents can
result in a stable or unstable fracture of the pelvis. An unstable
fracture can be life-threatening.
A fracture of the pelvic bones may also be complicated by
injury to the tissues and organs in the pelvis, such as the bladder
and the urinary passages. The bleeding from large organs and
blood vessels in the pelvis may be severe and can lead to shock.
2
1
156
BONE, JOINT AND MUSCLE INJURIES
BACK PAIN
SEE ALSO Fractures pp.136–38 | Spinal injury pp.157–59
■■ To relieve pain
YOUR AIM
If any of the following symptoms
or signs are present, call 999/112
for emergency help:
■■ Acute back pain in a casualty
under 20 or over 55
■■ Recent history of injury, such as
a road traffic incident or fall from
a height
■■Other symptoms of illness, such
as fever, as well as back pain
■■ Numbness and tingling down
the back of both legs
■■ Swelling or deformity along the
spine
■■ Difficulty with bladder and/or
bowel function
Lower back pain is common and most adults may experience
it at some point in their lives. It may be acute (sudden onset)
or chronic (long term). It is usually caused by age-related
degenerative changes or results from minor injury affecting
muscles, ligaments, vertebrae, discs or nerves. It may be the
result of heavy manual work, a fall or a turning or twisting
movement. Serious conditions causing back pain are rare and
beyond the scope of first aid.
Most cases are simple backache, often in the lower back, in
people aged 20–55 who are otherwise well. In a small number
of casualties, the pain may extend down one leg. This is called
sciatica and is caused by pressure on the nerve root (a so-called
“trapped nerve”).
Spine injuries in those under 20 or over 55, or that result
from a more serious injury, require investigation and treatment
(Spinal injury, opposite and pp.157–59).
WHAT TO DO
Advise the casualty to stay active to mobilise the injured area.
Encourage him to return to normal activity as soon as possible.
An adult casualty may take the recommended dose of
paracetamol tablets, or his own painkillers. 2
1
CAUTION
■■ Pain in the lower back following
lifting or manual work
■■ Possible pain radiating down the
back of one leg with numbness or
tingling in the affected leg – sciatica
RECOGNITION
3 Advise the casualty to seek medical advice if necessary.
157
Injuries to the spine can involve one or more parts of the back
and/or neck: the bones (vertebrae), the discs of tissue that
separate the vertebrae, the surrounding muscles and ligaments,
or the spinal cord and the nerves that branch off from it.
The most serious risk associated with spinal injury is damage
to the spinal cord. Such damage can cause loss of power and/or
sensation below the injured area. The spinal cord or nerve roots
can suffer temporary damage if they are pinched by displaced or
dislocated discs, or by fragments of broken bone. If the cord is
partly or completely severed, damage may be permanent.
CAUSES OF SPINAL INJURY
The most important indicator is the mechanism of the injury.
Suspect spinal injury if abnormal forces have been exerted on the
back or neck, and particularly if a casualty complains of any
changes in sensation or difficulties with movement. If the
incident involved violent forward or backward bending, or
twisting of the spine, you must assume that the casualty has a
spinal injury. You must take particular care to avoid unnecessary
movement of the head, neck and spine at all times.
Although spinal cord injury may occur without any damage to
the vertebrae, spinal fracture greatly increases the risk. The areas
that are most vulnerable are the bones in the neck and those
in the lower back.
Any of the following incidents should alert you to the
possibility of a spinal injury:
■■Falling from a height, such as a ladder
■■Falling awkwardly, for instance, while doing
gymnastics or trampolining
■■Diving into a shallow pool and hitting
the bottom
■■Falling from a horse or motorbike
■■Collapsed rugby scrum
■■Sudden deceleration in a motor vehicle
■■A heavy object falling across the back
■■Injury to the head or the face
When the vertebrae are damaged,
there may be:
■■ Pain in the neck or back at the injury
site. This may be masked by other,
more painful, injuries
■■ Step, irregularity or twist in the
normal curve of the spine
■■ Tenderness and/or bruising in the
skin over the spine
■■When the spinal cord is damaged,
there may be:
■■ Loss of control over limbs –
movement may be weak or absent
■■ Loss of sensation, or abnormal
sensations such as burning or
tingling; a casualty may tell you that
his limbs feel stiff, heavy or clumsy
■■ Loss of bladder and/or bowel control
■■ Breathing difficulties
RECOGNITION
BACK PAIN | SPINAL INJURY
Spinal cord protection
The spinal cord is protected
by the bony vertebral (spinal) column.
Nerves branching from the cord emerge
between adjacent vertebrae.
Intervertebral
disc
Vertebra
Spinal cord
Nerve root
SPINAL INJURY
»
158
BONE, JOINT AND MUSCLE INJURY
■■ To prevent further spinal damage
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ Do not move the casualty from
the position in which you found
her unless she is in immediate
danger and it is safe for you to
move her.
■■ If the casualty has to be moved,
use the log-roll technique
(opposite).
Ask a helper to place rolledup
blankets, towels or items
of clothing on either side of the
casualty’s head while you keep
her head in the neutral position.
Continue to support the casualty’s
head until emergency services
take over, no matter how long
this may be.
Kneel or lie behind the casualty’s head. Rest your elbows on
the ground or on your knees to keep your arms steady. Grasp
the sides of the casualty’s head. Spread your fingers so that you do
not cover her ears – she needs to be able to hear you. Steady and
support her head in this neutral position, in which the head, neck
and spine are aligned.
3
2
CAUTION
SPINAL INJURY
Get your helper to monitor
and record vital signs –
breathing, pulse and level of
response (pp.52–53) – while
waiting for help to arrive.
4
«
WHAT TO DO FOR A RESPONSIVE CASUALTY
Reassure the casualty and advise her not to move. Call 999/112
for emergency help, or ask a helper to do this. 1
159
SPINAL INJURY
■■ To maintain an open airway
■■ To begin CPR if necessary
■■ To prevent further spinal damage
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ If the casualty has to be moved
and you have help, use the logroll
technique (below).
■■ If you are alone and you need
to leave the casualty to call
for emergency help, and the
casualty is unable to maintain
an open airway, you should
place her in the recovery
position (pp.64–65) before
you leave her.
WHAT TO DO FOR AN UNRESPONSIVE CASUALTY
Kneel or lie behind the casualty’s head. Rest your elbows on the
ground or on your knees to keep your arms steady. Grasp the
sides of her head. Support her head so that her head, trunk and legs
are in a straight line.
Check the casualty’s
breathing. If she is
breathing, continue to support
her head. Call 999/112 for
emergency help or ask a helper
to do this.
Open the casualty’s airway using the jaw-thrust technique. Place
your fingertips at the angles of her jaw. Gently lift the jaw to open
the airway. Take care not to tilt the casualty’s neck.
If the casualty is not
breathing, begin CPR
(pp.66–67). If you need to turn
the casualty, use the log-roll
technique (below).
3
2
1
4
CAUTION
Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
5
This technique should be used to turn a
casualty with a spinal injury. While you
support the casualty’s head and neck,
ask your helpers to straighten her
limbs gently. Position three people
along one side to pull the casualty
towards them, and two on the other
to guide her forwards. The person at
the legs should place her hands under
the furthest leg. The middle helper
supports the casualty’s leg and hip.
Direct your helpers to roll the
casualty. Keep the casualty’s head,
trunk and legs in a straight line at all
times; the upper leg should be
supported in a slightly raised position
to keep the spine straight.
SPECIAL CASE LOG-ROLL TECHNIQUE
SEE ALSO The unresponsive casualty pp.54–87
POSITIONING FIRST AIDERS TURNING CASUALTY
160
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Dislocated joint p.139 | Fractures pp.136–38 | Internal bleeding p.116 | Shock pp.112–13
There may be:
■■ Pain at the site of the injury
■■ An inability to walk
■■ Signs of shock
■■ Shortening of the leg and turning
outwards of the knee and foot
RECOGNITION
■■ Do not allow the casualty
to eat or drink because an
anaesthetic may be needed.
■■ Do not raise the casualty’s legs,
even if she shows signs of shock,
because you may cause further
internal damage.
The most severe injury of the thigh bone (femur) is a fracture.
It takes a considerable force, such as a car crash or a fall from a
height, to fracture the shaft of the femur. This is a serious injury
because the broken bone ends can pierce major blood vessels,
causing severe blood loss, and shock may result.
Fracture of the neck of the femur is common in elderly people,
particularly women, whose bones become less dense and more
brittle with age (osteoporosis). This fracture is usually a stable
injury in which the bone ends are impacted together. The
casualty may be able to walk with a fractured neck of the femur
for some time before the fracture is discovered.
In the hip joint, the most serious, though much less common,
type of injury is dislocation.
CAUTION
HIP AND THIGH INJURIES
■■ To immobilise the limb
■■ To arrange urgent removal to
hospital
YOUR AIMS
2 3
5
6
4
7 1
SPECIAL CASE PREPARING A CASUALTY FOR A LONG JOURNEY
If the journey to hospital is likely to be long and
rough, more sturdy support for the leg and feet will
be needed. Use a purpose-made malleable splint
or a long, solid object, such as a fence post or long
walking stick, which reaches from the armpit to the
foot. Place the splint against the injured side. Insert
padding between the casualty’s legs and between the
splint and her body. Tie the feet together with a
narrow-fold bandage (1). Secure the splint to the body
with broad-fold bandages in the following order: at
the chest (2), pelvis (3), knees (4), above and below
the fracture site (5 and 6), and at one extra point (7).
Do not bandage over the fracture site. Once the
casualty’s leg is fully immobilised, she should be
moved onto the stretcher using the log-roll
technique (p.159).
HIP AND THIGH INJURIES
161
WHAT TO DO
Help the casualty to lie
down and make her as
comfortable as possible.
If the ambulance is not expected to arrive
quickly, immobilise the leg by securing it
to the uninjured one. Gently bring the sound leg
alongside the injured one. Position a narrow-fold
bandage (p.249) at the ankles and feet (1), then a
broad-fold one at the knees (2). Add additional
bandages above (3) and below (4) the fracture site.
Place soft padding between the legs to prevent the
bony parts from rubbing. Secure the bandages on
the uninjured side.
Suport the injured leg
at the knee and ankle.
If possible, ask someone else
to help you.
Take any steps possible to treat the casualty
for shock (pp.112–13): insulate her from the cold
with blankets or clothing. Do not raise her legs.
Monitor and record her vital signs – breathing,
pulse and level of response – while waiting for
help to arrive.
4
2
1
5
2 1
3
4
Call 999/112 for emergency
help. If the ambulance is
expected to arrive quickly, keep
the leg supported in the same
position until it arrives.
3
162
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Fractures pp.136–38 | Severe external bleeding pp.114–15 | Strains and sprains pp.140–41
There may be:
■■ Localised pain
■■ Swelling, bruising and deformity of
the leg
■■ An open wound
■■ Inability to stand on the injured leg
RECOGNITION
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Do not raise the casualty’s legs,
even if he shows signs of shock,
because you may cause further
internal damage.
Injuries to the lower leg include fractures of the shin bone
(tibia) and the splint bone (fibula), as well as damage to the soft
tissues (muscles, ligaments and tendons).
Fractures of the tibia are usually due to a heavy blow (for
example, from the bumper of a moving vehicle). As there is little
flesh over the tibia, a fracture is more likely to produce a wound.
The fibula can also be broken by the twisting forces that sprain
an ankle.
WHAT TO DO
Help the casualty to lie down and make him comfortable. Steady
and support the injured leg by hand at the knee and ankle to
prevent any movement. If there is a wound, carefully expose it and
treat the bleeding. Place a dressing over the wound to protect it.
Call 999/112 for emergency help. Maintain support until the
ambulance arrives. Treat for shock if necessary (pp.112-13). Do not
raise the injured leg; elevate the uninjured leg if shock is present.
2
1
CAUTION
LOWER LEG INJURIES
■■ To immobilise the leg
■■ To arrange transport to hospital
YOUR AIMS
LOWER LEG INJURIES
163
Steady and support the injured leg by hand
at the knee and foot (not over the fracture
site) to prevent any movement. If there is a wound,
treat the bleeding and place a dressing over the
wound to protect it. Call 999/112 for emergency
help. Maintain support until the ambulance arrives.
Treat the casualty for shock if necessary (pp.112–13).
Do not raise the injured leg; elevate the uninjured
leg if shock is present.
If the ambulance is delayed, splint the injured
leg to the other leg – ask a helper to maintain
support while you secure bandages. Bring the
uninjured leg to the injured one. Position a narrowfold
bandage (p.249) at the feet. Slide two broadfold
bandages under both knees; leave one at the
knee (2) and slide the other down to just above the
fracture site (3). Insert padding between the lower
legs and tie the feet together (1). Then secure the
other two bandages (2 then 3). Tie all knots on the
uninjured side.
If the ambulance is delayed, support the injured
leg by splinting it to the other leg. Bring the
uninjured leg alongside the injured one and slide
bandages under both legs. Position a narrow-fold
bandage (p.249) at the feet and ankles (1), then
broad-fold bandages at the knees (2) and above and
below the fracture site (3 and 4). Insert padding
between the lower legs. Tie a figure-of-eight
bandage around the feet and ankles, then secure the
other bandages; tie knots on the uninjured side.
If the casualty’s journey to hospital is likely to
be long and uncomfortable, place additional
soft padding on the outside of the injured leg, from
the knee to the foot. Secure the legs with broad-fold
bandages as above. Treat the casualty for shock
(pp.112–13) if necessary, but do not raise his legs.
1 2
3
4
3 4 1 2
1
3 2
SPECIAL CASE IF THE FRACTURE IS NEAR THE ANKLE
164
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Strains and sprains pp.140–41
■■ To protect the knee in the most
comfortable position for the casualty
■■ To arrange urgent removal to
hospital
YOUR AIMS
■■ Do not attempt to straighten
the knee forcibly. Displaced
cartilage or internal bleeding
may make it impossible to
straighten the knee joint safely.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
■■ Do not allow the casualty
to walk.
The knee is the hinge joint between the thigh bone (femur) and
shin bone (tibia). It is capable of bending, straightening and, in
the bent position, slight rotation.
The knee joint is supported by strong muscles and ligaments
and is protected at the front by a disc of bone called the kneecap
(patella). Discs of cartilage protect the end surfaces of the major
bones. Direct blows, violent twists or sprains can damage these
structures. Possible knee injuries include fracture of the patella,
sprains and damage to the cartilage.
A knee injury may make it impossible for the casualty to bend
or straighten the joint, and you should ensure that the casualty
does not try to walk on the injured leg. Bleeding or fluid in the
knee joint may cause marked swelling around the knee.
WHAT TO DO
Help the casualty to lie down, preferably on a blanket to insulate
him from the floor or ground. Place soft padding, such as pillows,
blankets or coats, under his injured knee to support it in the most
comfortable position.
Wrap soft padding around the joint. Secure the padding with a
roller bandage that extends from the middle of the casualty's
lower leg to mid-thigh.
Call 999/112 for emergency help. The casualty needs to remain
in the position he finds most comfortable and should be
transported to hospital by ambulance.
2
1
3
CAUTION
KNEE INJURY
There may be:
■■ Pain on attempting to move the knee
■■ Swelling at the knee joint
RECOGNITION
165
KNEE INJURY | ANKLE INJURY
ANKLE INJURY
SEE ALSO Strains and sprains pp.140–41 | Lower leg injuries pp.162–63
■■ To relieve pain and swelling
■■ To obtain medical aid if necessary
YOUR AIMS
■■ If the casualty has pain and
swelling in the bony areas of the
ankle, suspect a break. Secure
and support the lower leg as
described for fracture near the
ankle (p.163), and arrange to
take or send him to hospital.
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
A sprain is the most common ankle injury. It is usually caused
by a twist to the ankle and can be treated using the RICE
procedure (pp.140–41):
■■Rest the affected part
■■Cool the injury with Ice
■■Provide Comfortable support with bandages
■■Elevate the injury
If the casualty cannot bear any weight on the injured leg or there
is severe pain swelling and/or deformity at the ankle, suspect a
break and treat it as a fracture of the lower leg near the ankle
(p.163). Be aware too, however, that a casualty may have a
fracture and still be able to walk and move his toes. If you are in
any doubt about an ankle injury, treat it as a fracture.
WHAT TO DO
Support the ankle in the most comfortable position for the
casualty, preferably raised.
Apply comfortable support to the ankle. Leave
the cold compress in place or wrap a layer of
soft padding around the area. Bandage the ankle
with a support bandage that extends from the base
of the foot to the knee; it should not be too tight.
Apply a cold compress, such as an ice pack or a cold pad (p.241),
to the site to reduce swelling and bruising.
Raise and support the injured limb. Check the
circulation beyond the bandage (p.243) every
ten minutes. If the circulation is impaired, loosen the
bandage. Advise the casualty to rest the ankle and
seek medical advice if necessary.
3
2
1
4
CAUTION
■■ Pain, increased either by movement
or by putting weight on the foot
■■ Swelling at the site of injury
RECOGNITION
166
BONE, JOINT AND MUSCLE INJURIES
SEE ALSO Crush injury p.118
■■ To minimise swelling
■■ To arrange transport to hospital
YOUR AIMS
■■ Do not allow the casualty to eat
or drink because an anaesthetic
may be needed.
The bones and joints in the foot can suffer various types of
injury, such as fractures, cuts and bruising. Minor fractures are
usually caused by direct force. Always compare the injured foot
with the uninjured foot, especially toes, because fractures can
result in deformities that may not be immediately obvious.
Multiple fractures, affecting many or all of the bones in the foot,
are usually caused by crushing injuries. These fractures may be
open, with severe bleeding and swelling, needing immediate first
aid treatment. Foot and toe injures must be treated in hospital.
CAUTION
FOOT AND TOE INJURIES
■■ Difficulty in walking
■■ Stiffness of movement
■■ Bruising and swelling
■■ Deformity
RECOGNITION
WHAT TO DO
Help the casualty to lie down, and carefully
steady and support the injured leg. If there is a
wound, carefully expose it and treat the bleeding.
Place a dressing over the wound to protect it.
Remove any foot jewellery before the area
begins to swell. 2
1
Apply a cold compress, such as an ice pack or a
cold pad (p.241). This will also help to relieve
swelling and reduce pain.
3
Arrange to take or send the casualty to
hospital. If he is not being taken by ambulance,
try to ensure that the injured foot remains elevated
during travel. Check the circulation beyond the
bandage (p.243) every ten minutes. If the
circulation is impaired, loosen the bandage.
5
Place padding around the casualty’s foot and
secure it with a bandage. 4
167
FOOT AND TOE INJURIES | CRAMP
CRAMP
SEE ALSO Dehydration p.182
■■ To relieve the spasm and pain
This condition is a sudden painful spasm in one or more muscles. YOUR AIM
Cramp commonly occurs during sleep. It can also develop after
strenuous exercise, due to a build-up of chemical waste products
in the muscles, or to excessive loss of salts and fluids from the
body through sweating or dehydration. Cramp can often be
relieved by stretching and massaging the affected muscles.
Cramp in the foot
Help the casualty stand with his weight on the
front of his foot (or rest the foot on your knee)
to stretch the affected muscles. Once the spasm
has passed, massage the affected part of the foot
with your fingers.
Cramp in the calf muscles
Help the casualty straighten his knee, and support
his foot. Flex his foot upwards towards his shin to
stretch the calf muscles, then massage the affected
area on the back of the calf.
Cramp in the front of the thigh
Help the casualty to lie down. Raise the leg and bend
the knee to stretch the muscles. Massage the affected
muscles once the spasm has passed.
Cramp in the back of the thigh
Help the casualty to lie down. Raise the leg and
straighten the knee to stretch the muscles. Massage
the area once the spasm has passed.
This chapter deals with the effects of
injuries and illnesses caused by
environmental factors such as extremes
of heat and cold.
The skin protects the body and helps to
maintain body temperature within a normal
range. It can be damaged by fire, hot liquids
or caustic substances. This chapter contains
advice on how to assess burns, whether
minor or severe.
The effects of temperature extremes can
also impair skin and other body functions.
Injuries may be localised – such as frostbite
or sunburn – or generalised, as in heat
exhaustion or hypothermia. Young children
and the elderly are most susceptible to
problems caused by extremes of
temperature.
■■ To assess the casualty’s condition quickly and calmly
■■ To comfort and reassure the casualty
■■ To call 999/112 for emergency help if you suspect a
serious illness or injury
■■ To be aware of your own needs
For burns:
■■ To protect yourself and the casualty
from danger
■■ To assess the burn, prevent further damage and
relieve symptoms
For extremes of temperature:
■■ To protect the casualty from heat or cold
■■ To restore normal body temperature
AIMS AND OBJECTIVES
EFFECTS OF
HEAT AND COLD
170
EFFECTS OF HEAT AND COLD
THE SKIN
One of the largest organs, the skin plays key
roles in protecting the body from injury and
infection and in maintaining the body at a
constant temperature.
The skin consists of two layers of tissue –
an outer layer (epidermis) and an inner layer
(dermis) – which lie on a layer of fatty tissue
(subcutaneous fat). The top part of the
epidermis is made up of dead, flattened skin
cells, which are constantly shed and replaced
by new cells made in the lower part of this layer.
The epidermis is protected by an oily substance
called sebum – secreted from glands called
sebaceous glands – which keeps the skin supple
and waterproof.
The lower layer of the skin, the dermis, contains
the blood vessels, nerves, muscles, sebaceous
glands, sweat glands and hair roots (follicles). The
ends of sensory nerves within the dermis register
sensations from the body’s surface, such as heat,
cold, pain and even the slightest touch. Blood
vessels supply the skin with nutrients and help
to regulate body temperature by preserving or
releasing heat (opposite).
Structure of the skin
The skin is made up of two layers: the thin, outer
epidermis and the thicker dermis beneath it. Most
of the structures of the skin, such as blood vessels,
nerves and hair roots, are contained within the dermis.
Hair follicle
Pore releases sweat
at the skin surface
Erector pili muscle
contracts to pull the
hair upright
Hair
Tiny structures called
papillae form the
junction between the
dermis and epidermis
Nerve
Epidermis
Dermis
Layer of
fatty tissue
Nerve ending
Sweat gland
secretes sweat onto
the skin surface
Sebaceous gland
produces oily
secretion (sebum)
Arteriole supplies
oxygenated blood
Venule carries
away waste
171
THE SKIN
One of the major functions of the skin is to
help maintain the body temperature within its
optimum range of 36–37°C (97–99°F). An organ
in the brain called the hypothalamus regulates
body temperature. If the temperature of blood
passing through this thermostat falls or rises
to a level outside the optimum range, various
mechanisms are activated to either warm or
cool the body as necessary.
HOW THE BODY KEEPS WARM
When the body becomes too cold, changes
take place to prevent heat from escaping. Blood
vessels at the body surface narrow (constrict)
to keep warm blood in the main part (core)
of the body. The activity of the sweat glands
is reduced, and hairs stand on end to “trap”
warm air close to the skin. In addition to the
mechanisms that prevent heat loss, other
body systems act to produce more warmth.
The rate of metabolism is increased. Heat is
also generated by muscle activity, which may
be either voluntary (for example, during
physical exercise) or, in cold conditions,
involuntary (shivering).
HOW THE BODY LOSES HEAT
In hot conditions, the body activates a number
of mechanisms to encourage heat loss and thus
prevent the body temperature from becoming
too high. Blood vessels that lie in or just under
the skin widen (dilate). As a result, blood flow
to the body surface increases and more heat is
lost. In addition, the sweat glands become more
active and secrete more sweat. This sweat then
cools the skin as it evaporates.
MAINTAINING BODY TEMPERATURE
How skin responds to low
body temperature
Blood vessels narrow (constrict) to reduce
blood flow to the skin. The erector pili
muscles contract, making the hairs stand
upright and trap warm air close to the skin.
How skin responds to high body
temperature
Blood vessels widen (dilate), making the
skin appear flushed, and heat is lost. Sweat
glands become active and produce sweat
droplets, which evaporate to cool the skin.
Constricted
blood vessel Contracted erector Dilated blood vessel
pili muscle Sweat
gland
“Goose pimple”
Sweat droplet
Erect hair
Hair
Relaxed erector
pili muscle
Dermis
Layer of
fatty tissue
Epidermis
172
EFFECTS OF HEAT AND COLD
ASSESSING A BURN
When skin is damaged by burning, it can
no longer function effectively as a natural
barrier against infection. In addition, body fluid
may be lost because tiny blood vessels in the
skin leak tissue fluid (serum). This fluid either
collects under the skin to form blisters or leaks
through the surface.
There may be related injuries, significant fluid
loss and infection may develop later.
WHAT TO ASSESS
It is particularly important to consider the
circumstances in which the burn has occurred;
whether or not the airway is likely to have been
affected; and the extent, location and depth
of the burn.
There are many possible causes of burns
(see below). By establishing the cause of the
burn, you may be able to identify any other
potential problems that could result. For
example, a fire in an enclosed space is likely to
have produced poisonous carbon monoxide gas,
or other toxic fumes may have been released if
burning material was involved. If the casualty’s
airway has been affected, he may have difficulty
breathing and will need urgent medical
attention and admission to hospital.
The extent of the burn will also indicate
whether or not shock is likely to develop. Shock is
a life-threatening condition that occurs whenever
there is a serious loss of body fluids (p.116). In a
burn that covers a large area of the body, fluid
loss will be significant and the risk of shock high.
If the burn is on a limb, fluid may collect in the
tissues around it, causing swelling and pain. This
build-up of fluid is particularly serious if the limb
is being constricted, for example by tight clothing
or footwear.
Burns allow germs to enter the skin and so
carry a serious risk of infection.
■ Flames ■ Contact with hot objects, such as domestic appliances or
cigarettes ■ Friction – for example, rope burns
Dry burn
TYPE OF BURN
TYPES OF BURN AND POSSIBLE CAUSES
CAUSES
Scald
Electrical burn
Cold injury
Chemical burn
Radiation burn
■ Steam ■ Hot liquids, such as tea and coffee, or hot fat
■ Low-voltage current, as used by domestic appliances
■ High-voltage currents, as carried in mains overhead cables
■ Lightning strikes
■ Frostbite ■ Contact with freezing metals ■ Contact with freezing
vapours, such as liquid oxygen or liquid nitrogen
■ Industrial chemicals, including inhaled fumes and corrosive gases
■ Domestic chemicals and agents, such as paint stripper, caustic soda, weed killers,
bleach, oven cleaner or any other strong acid or alkali chemical
■ Sunburn ■ Over-exposure to ultraviolet rays from a sunlamp
■ Exposure to a radioactive source, such as an X-ray
173
ASSESSING A BURN
Burns are classified according to the depth of
skin damage. There are three depths: superficial,
partial-thickness and full-thickness. A casualty
may suffer burns of more than one or more
depths of burn in a single incident.
A superficial burn involves only the
outermost layer of skin, the epidermis. It
usually heals well if first aid is given promptly
and if blisters do not form. Sunburn is one of
the most common types of superficial burn.
Other causes include minor domestic incidents.
Partial-thickness burns are very painful. They
destroy the epidermis and cause the skin to
become red and blistered. They usually heal
well, but if they affect more than 20 per cent of
the body in an adult or 10 per cent in a child
they can be life-threatening.
In full-thickness burns, pain sensation is lost,
which can mask the severity of the injury. The skin
may look waxy, pale or charred and needs urgent
medical attention. There are likely to be areas of
partial and superficial burns around them.
DEPTH OF BURNS
If the casualty is a child, seek medical advice or
take the child to hospital, however small the
burn appears. For adults, medical attention
should be sought for any serious burn. Such
burns include:
■■All full-thickness burns.
■■All burns involving the face, hands, feet or
genital area.
■■All burns that extend right around an
arm or a leg.
■■All partial-thickness burns larger than
one per cent of the body surface (an area
the size of the palm of the casualty’s hand).
■■All superficial burns larger than five per cent
of the casualty’s body surface (equivalent to
five palm areas).
■■Burns comprising a mixed pattern of varying
depths.
If you are unsure about the severity of any burn,
seek medical advice.
BURNS THAT NEED HOSPITAL TREATMENT
Superficial burn
This type of burn involves only
the outermost layer of skin.
Superficial burns are
characterised by redness,
swelling and tenderness.
Partial-thickness burn
This affects the epidermis, and
the skin becomes red and raw.
Blisters form over the skin due
to fluid released from the damaged
tissues beneath.
Full-thickness burn
With this type of burn, all the layers
of the skin are affected; there may
be some damage to nerves, fat
tissue, muscles and blood vessels.
Burn Tissue fluid Blister Damaged tissues
174
EFFECTS OF HEAT AND COLD
SEVERE BURNS AND SCALDS
SEE ALSO Burns to the airway p.177 | Fires pp.32–33 | Shock pp.112–13
There may be:
■■ Possible areas of superficial, partial
thickness and/or full-thickness burns
■■ Pain
■■ Difficulty breathing
■■ Features of shock (pp.112–13)
■■ To stop the burning as soon as
possible and relieve pain
■■ To maintain an open airway
■■ To treat associated injuries
■■ To minimise the risk of infection
■■ To minimise the risk of shock
■■ To arrange urgent removal to
hospital
■■ To gather information for the
emergency services
RECOGNITION
YOUR AIMS
■■ Do not remove anything
sticking to the burn; you may
cause further damage and
introduce infection into the
burnt area.
■■ Do not burst any blisters.
■■ Do not apply any type of lotion
or ointment to the burnt area;
it may damage tissues and
increase the risk of infection.
■■ The use of specialised dressings,
sprays and gels to cool burns is
not recommended.
■■ Do not use adhesive dressings
or apply adhesive tape to the
skin; a burn may be more
extensive than it first appears.
■■ If the casualty has a burn on his
face, do not cover the injury;
you could cause the casualty
distress and obstruct the airway.
■■ Do not allow the casualty to eat
or drink because he may need
an anaesthetic.
Take great care when treating burns. The longer the burning
continues, the more severe the injury will be, and the longer it
will take to heal. If the casualty has been injured in a fire, assume
that smoke or hot air has also affected his breathing.
Your priority is to cool the burn as soon as possible (which
stops the burning process and relieves the pain) and continue
cooling for at least 10 minutes, or until the pain is relieved. A
casualty with a severe burn or scald injury will almost certainly
be suffering from shock because of the fluid loss and will need
urgent hospital treatment.
The possibility of non-accidental injury must always be
considered, no matter what the age of the casualty. Keep an
accurate record of what has happened and any treatment you
have given. If you have to remove or cut away clothing, keep it
in case of future investigation.
WHAT TO DO
Start cooling the injury as soon as possible. Flood the burn with
plenty of cold water, but do not delay the casualty’s removal to
hospital. Help the casualty to sit or lie down. If possible, try to prevent
the burnt area from coming into contact with the ground to keep the
burn as clean as possible.
Call 999/112 for emergency help. If possible, get someone to do
this while you continue cooling the burn.
1
2
CAUTION
175
SEVERE BURNS AND SCALDS
Continue cooling the affected area for at least 10 minutes, or
until the pain is relieved. Watch for signs of breathing difficulty.
Do not over-cool the casualty because you may lower the body
temperature to a dangerous level, causing hypothermia. This is
a particular hazard for babies and elderly people.
Do not touch or otherwise interfere with the burn. Gently
remove any rings, watches, belts, shoes and burnt or smouldering
clothing before the tissues begin to swell. A helper can do this while
you are cooling the burn. Do not remove any clothing that is stuck
to the burn.
When the burn is cooled, cover the injured area with kitchen film
to protect it from infection. Discard the first two turns from the
roll and then apply it lengthways over the burn. A clean plastic bag
can be used to cover a hand or foot; secure it with a bandage or
adhesive tape applied over the plastic, not the damaged skin. If there
is no plastic film available, use a sterile dressing, or improvise with
non-fluffy material, such as a folded triangular bandage (p.249).
Reassure the casualty and treat him for shock (pp.112–13) if
necessary. Record details of the casualty’s injuries. Monitor
and record his vital signs – breathing, pulse and level of response
(pp.52–53) – while waiting for help to arrive.
4
3
5
6
176
EFFECTS OF HEAT AND COLD
MINOR BURNS AND SCALDS
■■ Reddened skin
■■ Pain in the area of the burn
Later there may be:
■■ Blistering of the affected skin
■■ To stop the burning
■■ To relieve pain and swelling
■■ To minimise the risk of infection
RECOGNITION
YOUR AIMS
Small, superficial burns and scalds are often due to domestic
incidents, such as touching a hot iron or oven shelf. Most minor
burns can be treated successfully by first aid and will heal
naturally. However, you should advise the casualty to seek
medical advice if you are at all concerned about the severity
of the injury (Assessing a burn, pp.172–73).
After a burn, blisters may form. These thin “bubbles”
are caused by tissue fluid leaking into the burnt area just
beneath the skin’s surface. You should never break a blister
caused by a burn because you risk introducing infection
into the wound.
WHAT TO DO
Flood the injured part
with cold water for at least
ten minutes or until the pain is
relieved. If there is no water
available, any cold, harmless
liquid, such as milk or canned
drinks, can be used.
Seek medical advice if the
casualty is a child, or if you
are in any doubt about the
casualty’s condition.
Gently remove any
jewellery, watches, belts
or constricting clothing from
the injured area before it begins
to swell.
When the burn is cooled,
cover it with kitchen film or
place a clean plastic bag over a
foot or hand. Apply the kitchen
film lengthways over the burn,
not around the limb because the
tissues swell. If you do not have
kitchen film or a plastic bag, use a
sterile dressing or a non-fluffy pad,
and bandage loosely in place.
4
2
1
3
■■ Do not break blisters or
otherwise interfere with the
injured area.
■■ Do not apply adhesive dressings
or adhesive tape to the skin;
removing them may tear
damaged skin.
■■ Do not apply ointments or fats;
they may damage tissues and
increase the risk of infection.
■■ The use of specialised dressings,
sprays and gels to cool burns is
not recommended.
■■ Do not put blister plasters on
blisters caused by a burn.
CAUTION
Never burst a blister; they
usually need no treatment.
However, if a blister breaks or
is likely to burst, cover it with
a non-adhesive sterile dressing
that extends well beyond the
edges of the blister. Leave
the dressing in place until
the blister subsides.
SPECIAL CASE BLISTERS
SEE ALSO Assessing a burn pp.172–73
177
MINOR BURNS AND SCALDS | BURNS TO THE AIRWAY
BURNS TO THE AIRWAY
SEE ALSO Hypoxia p.92 | Shock pp.112–13 | The unresponsive casualty pp.54–87
There may be:
■■ Soot around the nose or mouth
■■ Singeing of the nasal hairs
■■ Redness, swelling or actual burning
of the tongue
■■ Damage to the skin around the
mouth
■■ Hoarseness of the voice
■■ Breathing difficulties
■■ To maintain an open airway
■■ To arrange urgent removal
to hospital
RECOGNITION
YOUR AIMS
WHAT TO DO
Call 999/112 for emergency help. Tell ambulance control that
you suspect burns to the casualty’s airway.
Reassure the casualty. Monitor and record vital signs – breathing,
pulse and level of response (pp.52–53) – while waiting for
emergency help to arrive.
Take any steps possible to improve the casualty’s air supply, such
as loosening clothing around his neck.
Offer the casualty ice or small sips of cold water to reduce
swelling and pain.
4
2
1
3
Any burn to the face, mouth or throat is very serious because
the air passages rapidly become swollen. Usually, signs of
burning will be evident. Always suspect damage to the airway if
a casualty sustains burns in a confined space since he is likely to
have inhaled hot air or gases.
There is no specific first aid treatment for an extreme case of
burns to the airway; the swelling will rapidly block the airway,
and there is a serious risk of hypoxia. Immediate and specialised
medical help is required.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
CAUTION
178
EFFECTS OF HEAT AND COLD
ELECTRICAL BURN
SEE ALSO Electrical injury pp.34–35 | Severe burns and scalds pp.174–75 | Shock pp.112–13 |
The unresponsive casualty pp.54–87
There may be:
■■ No response from casualty
■■ Full-thickness burns, with swelling,
scorching and charring
■■ Burns at points of entry and exit of
electricity
■■ Signs of shock
■■ To treat the burns and shock
■■ To arrange urgent removal to
hospital
RECOGNITION
YOUR AIMS
■■ Do not approach a casualty of
high-voltage electricity until you
are officially told that the
current has been switched off
(pp.34–35).
■■ If the casualty is unresponsive,
open the airway and check his
breathing (The unresponsive
casualty, pp.54–87).
Burns may occur when electricity passes through the body.
There may be surface damage along the point of contact, or
at the points of entry and exit of the current. In addition, there
may also be internal damage between the entry and exit points;
the position and direction of wounds will alert you to the likely
site and extent of hidden injury, and to the degree of shock that
the casualty may suffer.
Burns may be caused by a lightning strike or by a low- or highvoltage
electric current. Electric shock can cause cardiac arrest. If
the casualty is unresponsive, your priority, once the area is safe, is
to open his airway and check his breathing.
WHAT TO DO
Gently remove any jewellery, watches, belts or constricting
clothing from the injured area before it begins to swell. Do not
touch the burn.
Make sure that contact with the electrical source is broken before
you touch the casualty (pp.34–35).
Flood the injury with cold
water (at the entry and exit
points if both are present) for at
least 10 minutes or until pain
is relieved. If water is not
available, any cold, harmless
liquid can be used.
When the burn is cooled,
place a clean plastic bag
over a burn on a foot or hand –
tape the bag loosely in place
(attach tape to the the bag, not the
skin). Or, cover it with kitchen film
– lay the film along the length of
the limb not around it. If neither is
available, cover the burn with a
sterile dressing or a clean, nonfluffy
pad, and bandage loosely.
Call 999/112 for emergency help. Reassure the casualty and
treat him for shock (pp.112–13). Monitor and record vital signs –
breathing, pulse and level of response (pp.52–53) – while waiting
for help to arrive.
3
1
CAUTION
2
4
5
179
ELECTRICAL BURN | CHEMICAL BURN
CHEMICAL BURN
SEE ALSO Chemical burn to the eyes p.180 | Inhalation of fumes pp.98–99
There may be:
■■ Evidence of chemicals in
the vicinity
■■ Intense, stinging pain
Later:
■■ Discoloration, blistering
and peeling
■■ Swelling of the affected area
■■ To make the area safe and inform the
relevant authority
■■ To disperse the harmful chemical
■■ To arrange transport to hospital
RECOGNITION
YOUR AIMS
■■ Never attempt to neutralise acid
or alkali burns unless trained to
do so.
■■ Do not delay starting treatment
by searching for an antidote.
■■ If the incident occurs in the
workplace, notify the safety
officer and/or emergency
services.
WHAT TO DO
Make sure that the area around the casualty is safe. Ventilate the
area to disperse fumes. Wear protective gloves to prevent you
from coming into contact with the chemical. If it is safe to do so, seal
the chemical container. Move the casualty if necessary. If the chemical
is in powder form, it can be brushed off the skin.
Arrange to take or send
the casualty to hospital.
Monitor vital signs – breathing,
pulse and level of response
(pp.52–53) – while waiting for
medical help. Pass on details of
the chemical to medical staff if
you can identify it.
Flood the burn with water for at least 20 minutes to disperse the
chemical and stop the burning. If treating a casualty lying on the
ground, ensure that the contaminated water does not collect
underneath her. Pour water away from yourself to avoid splashes.
Gently remove any
contaminated clothing while
flooding the injury.
4
1
3
Certain chemicals may irritate, burn or penetrate the skin,
causing widespread and sometimes fatal damage. Most strong,
corrosive chemicals are found in industry, but chemical burns can
also occur in the home; for instance from dishwasher products
(the most common cause of alkali burns in children), oven
cleaners, pesticides and paint stripper.
Chemical burns are always serious, and the casualty will
need hospital treatment. If possible, note the name or brand of
the burning substance. Before treating the casualty, ensure the
safety of yourself and others because some chemicals give off
poisonous fumes, which can cause breathing difficulties.
CAUTION
2
180
EFFECTS OF HEAT AND COLD
CHEMICAL BURN TO THE EYE
Splashes of chemicals in the eye can cause serious injury if not
treated quickly. Some chemicals damage the surface of the eye,
resulting in scarring and even blindness.
Your priority is to wash out (irrigate) the eye so that the
chemical is diluted and dispersed. When irrigating the eye, be
careful that the contaminated rinsing water does not splash you
or the casualty. Before beginning to treat the casualty, put on
protective gloves if available.
WHAT TO DO
Put on protective gloves. Hold the casualty’s affected eye under
gently running cold water for at least ten minutes. Irrigate the
eyelid thoroughly both inside and out; if the casualty’s eye is shut in
a spasm of pain, gently, but firmly, try to pull the eyelid open.
Arrange to take or send
the casualty to hospital.
Identify the chemical if possible
and pass on details to
medical staff.
Make sure that contaminated water does not splash the
uninjured eye. You may find it easier to pour the water over the
eye using an eye irrigator or a glass.
Ask the casualty to hold a
clean, non-fluffy pad over
the injured eye. If it will be
some time before the casualty
receives medical attention,
bandage the pad loosely
in position.
2 4
1
3
There may be:
■■ Intense pain in the eye
■■ Inability to open the injured eye
■■ Redness and swelling around the eye
■■ Copious watering of the eye
■■ Evidence of chemical substances or
containers in the immediate area
■■ To disperse the harmful chemical
■■ To arrange transport to hospital
■■ Do not allow the casualty to
touch the injured eye.
■■ Do not forcibly remove a
contact lens.
■■ If the incident occurs in the
workplace, notify the safety
officer and/or emergency
services.
CAUTION
RECOGNITION
YOUR AIMS
181
CHEMICAL BURN TO THE EYE | FLASH BURN TO THE EYE | INCAPACITANT SPRAY EXPOSURE
FLASH BURN TO THE EYE
SEE ALSO Allergy p.222 | Asthma p.102
WHAT TO DO
Move the casualty to a well-ventilated area with a free flow of air
to ensure rapid dispersal of the spray.
Put on gloves if you are handling contaminated items such as
clothing. Advise the casualty to remove contact lenses – he may
need help. Remove wet clothing and put it in a sealed plastic bag.
If necessary, the casualty may wash his skin with soap and
water paying particular attention to skin folds and ears.
Showering may release spray particles trapped in the hair and
cause transient irritation.
2
1
3
This condition occurs when the surface (cornea) of the eye is
damaged by exposure to ultraviolet light, such as prolonged
glare from sunlight reflected off snow. Symptoms usually develop
gradually, and recovery can take up to a week. Flash burns can
also be caused by glare from a welder’s torch.
■■ Intense pain in the affected eye(s)
There may also be:
■■ A “gritty” feeling in the eye(s)
■■ Sensitivity to light
■■ Redness and watering of the eye(s)
■■ To prevent further damage
■■ To arrange transport to hospital
■■ Do not remove the casualty's
contact lenses.
CAUTION
RECOGNITION
YOUR AIMS
Reassure the
casualty. Ask him
to hold an eye pad against
each injured eye. If it is
likely to take some time
to obtain medical
attention, lightly bandage
the pad(s) in place.
Arrange to take or
send the casualty
to hospital.
2
1
There are two types of incapacitant spray – CS spray and
pepper spray. Both sprays are used by police forces for riot
control and self-protection, and both have been used by
unauthorised people as weapons in assault situations. They are
both aerosols and have the same effects. The effects usually wear
off 15–20 minutes after a person has been exposed to the spray.
There may be:
■■ Burning sensation and watering of
the eyes
■■ Sneezing and runny nose
■■ Stinging sensation on the skin with
redness and possibly blistering
■■ Difficulty breathing
■■ To remove the casualty from the
spray area
■■ If the casualty suffers from
asthma the spray may trigger
an attack.
■■ If the casualty’s symptoms
persist seek medical advice.
CAUTION
RECOGNITION
YOUR AIM
INCAPACITANT SPRAY EXPOSURE
WHAT TO DO
182
EFFECTS OF HEAT AND COLD
DEHYDRATION
This condition occurs when the amount of fluids lost from the
body is not adequately replaced. Dehydration can begin to
develop when a person loses as little as one per cent of his
bodyweight through fluid loss. A two to six per cent loss can
occur during a typical period of exercise on a warm day; the
average daily intake of fluids is 2.5 litres (4 pints). This fluid loss
needs to be replaced. In addition to fluid, the body loses essential
body salts through sweating.
Dehydration is mainly the result of: excessive sweating during
sporting activities, especially in hot weather; prolonged exposure
to sun, or hot, humid conditions; sweating through raised body
temperature during a fever; and loss of fluid through severe
diarrhoea and vomiting. Young children, older people or those
involved in prolonged periods of activity are particularly at risk.
Severe dehydration can cause muscle cramps through the loss of
body salts. If untreated, dehydration can lead to heat exhaustion.
The aim of first aid is to replace the lost water and salts
through rehydration. Water is usually sufficient but oral
rehydration solutions can help to replace lost salt.
SEE ALSO Cramp p.167 | Heat exhaustion p.184
WHAT TO DO
Reassure the casualty. Help
him to sit down. Give him
plenty of fluids to drink. Water
is usually sufficient, but oral
rehydration solutions can help
with salt replacement.
If the casualty is suffering
from cramp, stretch and
massage the affected muscles
(p.167). Advise the casualty
to rest.
1
2
Monitor and record the
casualty’s condition. If he
continues to be unwell, seek
medical advice straightaway.
3
There may be:
■■ Dry mouth and dry eyes
■■ Dry and/or cracked lips
■■ Headaches (light- headedness)
■■ Dizziness and confusion
■■ Dark urine
■■ Reduction in the amount of urine
passed
■■ Cramp, with a feeling of tightness
in the most used muscles, such as
the calves
■■ In babies and young children, pale
skin with sunken eyes. In young
babies the soft spot on the head
(the fontanelle) may be sunken
■■ To replace the lost body fluids
and salts
RECOGNITION
YOUR AIM
183
DEHYDRATION | SUNBURN
Over-exposure to the sun or a sunlamp can result in sunburn.
At high altitudes, sunburn can occur even on an overcast
summer’s day, or in the snow. Some medicines can trigger
severe sensitivity to sunlight. Rarely, sunburn can be caused
by exposure to radioactivity.
Sunburn can be prevented by staying in the shade,
wearing protective clothing and by regularly applying a high
factor sunscreen.
Most sunburn is superficial; in severe cases, the skin is
lobster-red and blistered. In addition, the casualty may suffer
from heat exhaustion or heatstroke.
Cover the casualty’s skin
with light clothing or a
towel. Help her to move out
of the sun or, if at all possible,
indoors.
Encourage the casualty
to have frequent sips of
cold water. Cool the affected skin
by dabbing with cold water. If the
area is extensive, the casualty may
prefer to soak the affected skin in
a cold bath for ten minutes.
If the burns are mild,
calamine or an after-sun
lotion may soothe them. Advise
the casualty to stay inside or in
the shade. If sunburn is severe,
for example, if there is blistering
or other skin damage, seek
medical advice.
2
1
3
■■ Reddened skin
■■ Pain in the area of the burn
Later there may be:
■■ Blistering of the affected skin
■■ To move the casualty out of the sun
as soon as possible
■■ To relieve discomfort and pain
■■ If there is extensive blistering,
or other skin damage, seek
medical advice.
CAUTION
RECOGNITION
YOUR AIMS
SEE ALSO Dehydration opposite | Heat exhaustion p.184 | Heatstroke p.185 | Minor burns and scalds p.176
SUNBURN
WHAT TO DO
184
EFFECTS OF HEAT AND COLD
HEAT EXHAUSTION
This disorder is caused by loss of salt and water from the body
through excessive sweating. It usually develops gradually and
often affects people who are not acclimatised to hot, humid
conditions. People who are unwell, especially those with illnesses
that cause vomiting and diarrhoea, are more susceptible than
others to developing heat exhaustion.
A dangerous and common cause of heat exhaustion occurs
when the body produces more heat than it can cope with. Some
non-prescription drugs, such as ecstasy, can affect the body’s
temperature regulation system. This, combined with the exertion
of dancing in a warm environment, can result in a person
becoming overheated and dehydrated. These effects can lead to
heatstroke and even death.
As the condition develops, there
may be:
■■ Headache, dizziness and confusion
■■ Loss of appetite and nausea
■■ Sweating, with pale, clammy skin
■■ Cramps in the arms, legs or
abdomen
■■ Rapid, weakening pulse and
breathing
■■ To cool the casualty down
■■ To replace lost body fluids and salts
■■ To obtain medical help if necessary
RECOGNITION
YOUR AIMS
SEE ALSO Dehydration p.182 | Heatstroke opposite | The unresponsive casualty pp.54–87
WHAT TO DO
Help the casualty to a cool, shady place.
Encourage him to lie down and raise and
support his legs.
If the casualty’s vital signs worsen, call
999/112 for emergency help. Monitor and
record vital signs – breathing, pulse, level of
response and temperature (pp.52–53) – while
you are waiting for help to arrive.
Give him plenty of water to drink. Oral
rehydration salts or isotonic drinks will help
with salt replacement.
Monitor and record vital signs – level of
response, breathing and pulse (pp.52–53). Even
if the casualty recovers quickly, advise him to seek
medical help.
4
1 2
3
185
HEAT EXHAUSTION | HEATSTROKE
HEATSTROKE
SEE ALSO Drug poisoning p.201 | The unresponsive casualty pp.54–87
WHAT TO DO
Quickly move the casualty to a cool place. Remove as
much of his outer clothing as possible. Call 999/112 for
emergency help.
Monitor and record vital signs – breathing,
pulse, level of response and temperature
(pp.52–53) – while waiting for help to arrive. If the
casualty’s temperature rises again, repeat the
cooling process.
Help the casualty to sit down, supported with cushions.
Wrap him in a cold, wet sheet until his temperature falls to 38°C
(100.4°F) under the tongue, or 37.5°C (99.5°F) under the armpit. Keep
the sheet wet by continually pouring cold water over it. If there is no
sheet available, fan the casualty, or sponge him with cold water.
Once the casualty’s temperature appears to
have returned to normal, replace the wet sheet
with a dry one.
4
2
1
3
This condition is caused by a failure of the “thermostat” in the
brain, which regulates body temperature. The body becomes
dangerously overheated, usually due to a high fever or prolonged
exposure to heat. Heatstroke can also result from the use of
drugs such as ecstasy. In some cases, heatstroke follows heat
exhaustion when sweating ceases, and the body then cannot be
cooled by the evaporation of sweat.
Heatstroke can develop with little warning; the casualty may
become unresponsive within minutes of feeling unwell.
There may be:
■■ Headache, dizziness and discomfort
■■ Restlessness and confusion
■■ Hot, flushed and dry skin
■■ Rapid deterioration in the level of
response
■■ Full, bounding pulse
■■ Body temperature above 40°C
(104°F)
■■ To lower the casualty’s body
temperature as quickly as possible
■■ To arrange urgent removal to
hospital
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
CAUTION
RECOGNITION
YOUR AIMS
186
EFFECTS OF HEAT AND COLD
HYPOTHERMIA
This is a condition that develops when the body temperature
falls below 35°C (95°F). The effects vary depending on the speed
of onset and the level to which the body temperature falls. The
blood supply to the superficial blood vessels in the skin, for
example, shuts down to maintain the function of the vital organs
such as the heart and brain. Moderate hypothermia can usually
be reversed. Severe hypothermia – when the core body
temperature falls below 30°C (86°F) – is often, although not
always, fatal. No matter how low the body temperature becomes,
persist with life-saving procedures until emergency help arrives
because in cases of hypothermia, survival may be possible even
after prolonged periods of resuscitation.
WHAT CAUSES HYPOTHERMIA
Hypothermia can be caused by prolonged exposure to cold.
Moving air has a much greater cooling effect than still air, so a
high “wind-chill factor” in cold weather can substantially increase
the risk of a person developing hypothermia. Immersion in cold
water can cause death from hypothermia. When surrounded by
cold water, the body can cool up to 30 times faster than in dry
air, and body temperature falls rapidly.
Hypothermia may also develop indoors in poorly heated
houses. Elderly people, infants, homeless people and those who
are thin and frail are particularly vulnerable. Lack of activity,
chronic illness and fatigue all increase the risk; alcohol and drugs
can exacerbate the condition.
SEE ALSO Drowning p.100 | The unresponsive casualty pp.54–87 | Water rescue p.36
As hypothermia develops there
may be:
■■ Shivering, and cold, pale, dry skin
■■ Apathy, disorientation or irrational
behaviour
■■ Lethargy or impaired responsiveness
■■ Slow and shallow breathing
■■ Slow and weakening pulse. In
extreme cases, the heart may stop
■■ To prevent the casualty losing more
body heat
■■ To re-warm the casualty
■■ To obtain emergency help
if necessary
RECOGNITION
YOUR AIMS
■■ Do not give the casualty alcohol
because it dilates superficial
blood vessels and allows heat
to escape, making hypothermia
worse.
■■ Do not place any direct heat
sources, such as hot-water
bottles or fires, next to the
casualty because these may
cause burns.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty, pp.54–
87). Persist with CPR until
emergency help arrives to
assess the casualty’s condition.
■■ It is important that you stay
warm yourself.
CAUTION
187
HYPOTHERMIA
TREATING HYPOTHERMIA WHEN OUTDOORS
Take the casualty to a sheltered place as
quickly as possible. Shield the casualty
from the wind.
Call 999/112 or send for emergency help.
Ideally, two people should go for help and stay
together if you are in a remote area. It is important
that you do not leave the casualty by himself;
someone must remain with him at all times.
To help re-warm a casualty who is fully alert,
give him warm drinks and high-energy foods
such as chocolate, if available.
Monitor and record the casualty’s vital
signs – breathing, pulse, level of response
and temperature (pp.52–53) – while waiting for
help to arrive.
Remove and replace any wet clothing if
possible; do not give him your clothes. Make
sure his head is covered.
Protect the casualty from the ground.
Lay him on a thick layer of dry insulating
material, such as pine branches, heather or
bracken. Put him in a dry sleeping bag and/or cover
him with blankets or newspapers. Wrap him in a
plastic or foil survival bag, if available. You can
shelter and warm him with your body.
2
4
5
6
3
1
»
188
EFFECTS OF HEAT AND COLD
HYPOTHERMIA
TREATING HYPOTHERMIA WHEN INDOORS
The casualty must be re-warmed. Cover him
casualty with layers of blankets and warm the
room to about 25°C (77°F).
Monitor and record the casualty’s vital signs –
breathing, pulse, level of response and
temperature (pp.52–53) – as he is rewarmed.
Give the casualty a warm drink such as soup
and/or high-energy foods such as chocolate to
help re-warm him.
Seek medical advice. Be aware that
hypothermia may also be disguising the
symptoms of a serious underlying illness such as
a stroke (pp.212–13), heart attack (p.211) or
underactive thyroid gland (hypothyroidism).
4
1 2
SPECIAL CASE HYPOTHERMIA IN INFANTS
A baby’s mechanisms for regulating
body temperature are underdeveloped,
so she may develop
hypothermia in a cold room. The
baby’s skin may look healthy but feel
cold, and she may be limp, unusually
quiet and refusing to feed. Re-warm a
cold baby by wrapping her in blankets
and warming the room. You should
always seek medical advice if you
suspect a baby has hypothermia.
«
3
189
HYPOTHERMIA | FROSTBITE
FROSTBITE
SEE ALSO Hypothermia pp.186–88
WHAT TO DO
Advise the casualty to put his hands in his armpits. Move
the casualty into warmth before you thaw the affected
part further.
Raise the affected limb to
reduce swelling. An adult
may take the recommended
dose of paracetamol or her own
painkillers. A child may have the
recommended dose of
paracetamol syrup (not aspirin).
Take or send the casualty
to hospital.
Once inside, gently remove
gloves, rings and any other
constrictions, such as boots.
Warm the affected part with
your hands, in your lap or
continue to warm them in
the casualty’s armpits. Avoid
rubbing the affected area
because this can damage skin
and other tissues.
Place the affected parts in
warm water at around
40°C (104°F). Dry carefully, and
apply a light dressing of dry
gauze bandage.
4
2
1
3
With this condition, the tissues of the extremities – usually the
fingers and toes – freeze due to low temperatures. In severe
cases, this freezing can lead to permanent loss of sensation and,
eventually, tissue death and gangrene as the blood vessels and
soft tissues become permanently damaged.
Frostbite usually occurs in freezing or cold and windy
conditions. People who cannot move around to increase their
circulation are particularly susceptible.
In many cases, frostbite is accompanied by hypothermia
(pp.186–87), and this should be treated accordingly.
There may be:
■■ At first, “pins-and-needles”
■■ Paleness (pallor) followed by
numbness
■■ Hardening and stiffening of
the skin
■■ A colour change to the skin of the
affected area: first white, then
mottled and blue. On recovery, the
skin may be red, hot, painful and
blistered. Where gangrene occurs,
the tissue may become black due
to loss of blood supply
■■ To warm the affected area slowly to
prevent further tissue damage
■■ To arrange transport to hospital
■■ Do not put the affected part
near direct heat.
■■ Do not attempt to thaw the
affected part if there is danger
of it refreezing.
CAUTION
RECOGNITION
YOUR AIMS
Objects that find their way into the
body, either through a wound in the
skin or via an orifice, are known as “foreign
objects”. These range from grit in the eye to
small objects that young children may push
into their noses and ears. These injuries can
be distressing but do not usually cause
serious problems for the casualty.
Poisoning may result from exposure to
or ingestion of toxic substances, chemicals
and contaminated food. The effects of
poisons vary but medical advice will be
needed in most cases.
Insect stings and marine stings can often
be treated with first aid. However, multiple
stings can produce a reaction that requires
urgent medical help. Animal and human
bites always require medical attention due
to the risk of infection.
■■ To ensure the safety of yourself and the casualty
■■ To assess the casualty’s condition quickly and calmly
■■ To assess the potential danger of a foreign object
■■ To identify the poisonous substance
■■ To comfort and reassure the casualty
■■ To look for and treat any injuries associated with
the condition
■■ To obtain medical help if necessary. Call 999/112
for emergency help if you suspect a serious illness
or injury
■■ To be aware of your own needs AIMS AND OBJECTIVES
FOREIGN OBJECTS,
POISONING, BITES & STINGS
192
FOREIGN OBJECTS, POISONING, BITES & STINGS
THE SENSORY ORGANS
The body is covered and protected by the skin.
This is one of the body’s largest organs and is
made up of two layers: the outer layer called
the epidermis, and an inner layer, the dermis.
The skin forms a barrier against harmful
substances and germs. It is also an important
sense organ, containing nerves that ensure the
body is sensitive to heat, cold, pain and touch.
These complex organs enable us to see the
world around us. Each eye consists of a coloured
part (iris) with a small opening (pupil) that
allows rays of light to enter the eye. The size of
the pupil changes according to the amount of
light that is entering the eye.
Light rays are focused by the transparent lens
onto a “screen” (retina) at the back of the eye.
Special cells in the retina convert this
information into electrical impulses that then
travel, via the optic nerve that leads from the
eye, to the part of the brain where the impulses
are analysed.
Each eye is protected by a bony socket in the
skull (p.133). The eyelids and delicate
membranes called conjunctiva protect the front
of the eyes.
Tears form a protective film across the front
of the conjunctiva, lubricating the surface and
flushing away dust and dirt.
Structure of the eye
The eyes are fluid-filled, spherical structures about
2.5cm (1in) in diameter. They have focusing parts
(cornea and lens), and light- and colour-sensitive cells
in the retina.
Structure of the skin
The skin consists of the thin epidermis and the
thicker dermis, which sit on a layer of fatty tissue
(subcutaneous fat). Blood vessels, nerves, muscles,
sebaceous (oil) glands, sweat glands and hair roots
(follicles) lie in the dermis.
THE SKIN
THE EYES
Hair
Nerve
Epidermis
Dermis
Fatty tissue
Blood vessel
Muscle
Lens focuses light
onto retina
Cornea directs
light entering
eye onto lens
Sclera maintains
eyeball’s shape
Iris adjusts
size of pupil
Blood
vessel
Pupil allows
light to enter
eyeball
Conjunctiva
protects eye
surface
Muscle
Retina
Optic
nerve
193
THE SENSORY ORGANS
These cavities form the entrances to the
digestive and respiratory tracts respectively.
The nasal cavities connect with the throat.
They are lined with blood vessels and
membranes that secrete mucus to trap debris
as it enters the nose. Food enters the digestive
tract via the mouth, which leads into the gullet
(oesophagus). The epiglottis, a flap at the back
of the throat, prevents food from entering the
windpipe (trachea).
Structure of the mouth and nose
The nostrils lead into the two nasal cavities,
which are lined with mucous membranes and blood
vessels. The nasal cavities connect directly with the
top of the throat, which is at the back of the mouth.
Structure of the ear
The ear is divided into three main parts:
the outer, middle and inner ear. The
eardrum separates the outer and middle
ear. The inner ear contains the organs of
hearing and balance.
As well as being the organs of hearing, the ears
also play an important role in balance. The
visible part of each ear, the auricle, funnels
sounds into the ear canal to vibrate the
eardrum. Fine hairs in the ear canal filter out
dust, and glands secrete ear wax that traps any
other small particles.
The vibrations of the eardrum pass across the
middle ear to the hearing apparatus (cochlea) in
the inner ear. This structure converts the
vibrations into nerve impulses and transmits
them to the brain via the auditory nerve. The
vestibular apparatus within the inner ear is
involved in balance.
THE EARS
THE MOUTH AND NOSE
Vestibular apparatus
Auricular regulates balance
cartilage
Ear
canal
Eardrum vibrates in
response to sound
Eustachian tube connects
middle ear with back of
nose and throat
Cochlea contains
receptor for hearing
Outer ear Inner ear
Auditory nerve transmits
sound impulses to brain
Middle ear
Pinna
(ear flap)
Nasal cavity is lined
with blood vessels and
mucous membranes
Salivary gland
Tongue
Throat
Epiglottis
Larynx
Oesophagus
Trachea
Scalp muscle
194
FOREIGN OBJECTS, POISONING, BITES & STINGS
SPLINTER
■■ To remove the splinter
■■ To minimise the risk of infection
Ask the casualty about tetanus
immunisation. Seek medical
advice if:
■■ He has a dirty wound
■■ He has never been immunised
■■ He is uncertain about the
number or timings of injections
■■ He has not had at least five
injections previously
Small splinters of wood, metal or glass may enter the skin.
They carry a risk of infection because they are rarely clean. Often
a splinter can be successfully withdrawn from the skin using
tweezers. However, if the splinter is deeply embedded, lies over
a joint, or is difficult to remove, you should leave it in place and
advise the casualty to seek medical help.
CAUTION
If a splinter is embedded or
difficult to dislodge, do not probe
the area with a sharp object,
such as a needle, or you may
introduce infection. Pad around
the splinter until you can
bandage over it without pressing
on it, and seek medical help.
SPECIAL CASE EMBEDDED
SPLINTER
WHAT TO DO
Gently clean the area around the splinter with soap
and warm water.
Draw the splinter out in
a straight line at the same
angle that it went into the skin;
make sure it does not break.
Hold the tweezers close to
the end for a better grip.
Grasp the splinter with tweezers
as close to the skin as possible.
Carefully squeeze the
wound to encourage a little
bleeding. This will help to flush
out any remaining dirt. Clean and
dry the wound and cover with
a dressing.
2 3
1
4
YOUR AIMS
195
SPLINTER | EMBEDDED FISH-HOOK | SWALLOWED FOREIGN OBJECT
EMBEDDED FISH-HOOK
SWALLOWED FOREIGN OBJECT
■■ To obtain medical help
■■ To minimise the risk of infection
■■ If help is delayed, remove the fishhook
without causing the casualty
any further injury and pain
■■ To obtain medical advice as soon as
possible
■■ Do not try to pull out a fishhook
unless you can cut off the
barb. If you cannot, seek
medical help.
Ask the casualty about tetanus
immunisation. Seek medical
advice if:
■■ He has a dirty wound
■■ He has never been immunised
■■ He is uncertain about the
number or timings of injections
■■ He has not had at least five
injections previously
A fish-hook that is embedded in the skin is difficult to remove
because of the barb at the end of the hook. If possible, you
should ensure that the hook is removed by a healthcare
professional. Only attempt to remove a hook yourself if medical
help is not readily available. Embedded fish-hooks carry a risk of
infection, including tetanus.
Children may put small items in their mouths when playing. An
adult may swallow a bone by mistake or ingest unlikely objects
on purpose. Most objects will pass through the digestive system,
but some can cause a blockage or perforation.
CAUTION
CAUTION
WHAT TO DO
WHAT TO DO
Support the injured area.
If possible, cut off the
fishing line as close to the
hook as possible.
Reassure the casualty and
find out what he swallowed.
If medical help is not
available, you can try to
remove the hook if you can see
the barb. Cut off the barb with
wirecutters, then carefully
withdraw the hook back through
the skin by its eye.
Seek medical advice.
If medical help is readily
available, build up pads of
gauze around the hook until you
can bandage over the top
without pushing it in further.
Bandage over the padding and
the hook and arrange to take or
send the casualty to hospital.
Clean and dry the wound
and cover with a dressing.
3
2
2
1
1
4
■■ Do not let the casualty make
himself vomit as the object
could damage the gullet.
YOUR AIMS
YOUR AIM
196
FOREIGN BODIES, POISONING, BITES & STINGS
FOREIGN OBJECT IN THE EYE
There may be:
■■ Blurred vision
■■ Pain or discomfort
■■ Redness and watering of the eye
■■ Eyelids screwed up in spasm
■■ To prevent injury to the eye
RECOGNITION
YOUR AIM
■■ Do not touch anything that is
sticking to, or embedded in, the
eyeball. Cover the eye (p.123)
and arrange to take or send
casualty to hospital.
Foreign objects such as grit, a loose eyelash or a contact lens
that are floating on the surface of the eye can easily be rinsed
out. However, you must not attempt to remove anything that
sticks to the eye or penetrates the eyeball because this may
damage the eye. Instead, make sure that the casualty receives
urgent medical attention.
WHAT TO DO
Stand beside, or just behind,
the casualty. Gently
separate her eyelids with your
thumbs or finger and thumb. Ask
her to look right, left, up and
down. Examine every part of her
eye as she does this.
If you can see a foreign
object on the white of the
eye, wash it out by pouring clean
water from a glass or jug, or by
using a sterile eyewash if you have
one. Put a towel around the
casualty’s shoulders. Hold her eye
open and pour the water from the
inner corner so that it drains on to
the towel.
If this is unsuccessful, try lifting the object off with a moist swab
or the damp corner of a clean handkerchief or tissue. If you still
cannot remove the object, seek medical help.
Advise the casualty not to rub her eye. Ask her to sit down facing
a light.
3
4
1
2
CAUTION
Ask the casualty to grasp the
lashes on her upper eyelid and
pull the upper lid over the lower
lid; the lower lashes may brush
the particle clear. If this is
unsuccessful, ask her to try
blinking under water since this
may also make the object float
off. Do not attempt to do this if
the object is large or abrasive.
SPECIAL CASE IF OBJECT IS
IN UPPER EYELID
SEE ALSO Eye wound p.123
197
FOREIGN OBJECT IN THE EYE | FOREIGN OBJECT IN THE EAR | FOREIGN OBJECT IN THE NOSE
FOREIGN OBJECT IN THE EAR
FOREIGN OBJECT IN THE NOSE
There may be:
■■ Difficult or noisy breathing through
the nose
■■ Swelling of the nose
■■ Smelly or blood-stained discharge,
indicating that an object may have
been lodged for a while
■■ To arrange transport to hospital
RECOGNITION
YOUR AIM
■■ Do not attempt to remove any
object that is lodged in the ear.
You may cause serious injury
and push the foreign object
in further.
■■ Do not attempt to remove the
foreign object, even if you can
see it.
WHAT TO DO
WHAT TO DO
Arrange to take or send the
casualty to hospital as soon
as possible. Do not try to remove
a lodged foreign object yourself.
Try to keep the casualty
quiet and calm. Tell him to
breathe through his mouth at a
normal rate. Advise him not to
poke inside his nose to try to
remove the object himself.
Reassure the casualty
during the journey or until
medical help arrives.
Arrange to take or send the
casualty to hospital, so that
the object can be safely removed
by medical staff.
2
2
1
1
If a foreign object becomes lodged in the ear, it may cause
temporary deafness by blocking the ear canal. In some cases,
a foreign object may damage the eardrum. Young children
frequently push objects into their ears. The tips of cotton wool
buds are often left in the ear. Insects can fly or crawl into the ear
and may cause distress.
Young children may push small objects up their noses. Objects
can block the nose and cause infection. If the object is sharp it
can damage the tissues, and “button” batteries can cause burns
and bleeding. Do not try to remove a foreign object; you may
cause injury or push it further into the airway.
CAUTION
CAUTION
■■ To prevent injury to the ear
■■ To remove a trapped insect
■■ To arrange transport to hospital if a
foreign object is lodged in the ear
YOUR AIMS
Reassure the casualty and ask
him to sit down. Support his
head, with the affected ear
uppermost. Gently flood the
ear with tepid water; the insect
should float out. If this flooding
does not remove the insect, seek
medical help.
SPECIAL CASE INSECT INSIDE THE EAR
198
FOREIGN OBJECTS, POISONING, BITES & STINGS
HOW POISONS AFFECT THE BODY
A poison (toxin) is a substance that,
if taken into or absorbed into the body in
sufficient quantity, can cause either temporary
or permanent damage.
Poisons can be swallowed, absorbed
through the skin, inhaled, splashed into
the eyes or injected. Once in the body,
they may enter the bloodstream and
be carried swiftly to all organs and tissues.
Signs and symptoms of poisoning vary with
the poison. They may develop quickly or over
a number of days. Vomiting is common,
especially when the poison has been
ingested. Inhaled poisons often
cause breathing difficulties.
Effects of poisons on the body
Poisons can enter the body through
the skin, digestive system, lungs or
bloodstream. Once there, they can be
carried to all parts of the body and
cause multiple side effects.
Poisons reaching the brain may cause
confusion, delirium, seizures and
unresponsiveness
Swallowed corrosive chemicals can burn
the mouth, lips and food
passage (oesophagus)
Some poisons disturb the
action of the heart
by interrupting its normal
electrical activity
Poisons reaching the
kidneys (situated towards
the back of the body behind
the large intestine) from
the bloodstream can
cause serious damage
to these organs
Injected poisons and
drugs rapidly enter
the bloodstream;
some prevent blood
cells from carrying
oxygen to body tissues
Corrosive chemicals can
burn the skin. Pesticides
and plant toxins may be
absorbed through the
skin, causing local or
general reactions
Poisons in the digestive
system can cause
vomiting, abdominal pain
and diarrhoea
Poisons can seriously
damage the liver
Poisonous gases, solvents,
vapours or fumes can be inhaled
and affect the airways and lungs,
causing severe breathing
problems
199
HOW POISONS AFFECT THE BODY | TYPES OF POISON
TYPES OF POISON
Some poisons are man-made – for example,
chemicals and drugs – and these are found in
the home as well as in industry. Almost every
household contains substances that are
potentially poisonous, such as bleach and paint
stripper, as well as prescribed or over-thecounter
medicines, which may be dangerous
if taken in excessive amounts.
Other poisons occur in nature: for example,
plants produce poisons that may irritate the
skin or cause more serious symptoms if
ingested, and various insects and creatures
produce venom in their bites and stings.
Contamination of food by bacteria may result
in food poisoning – one of the most common
forms of poisoning.
■ Monitor casualty
■ Call emergency help
■ Commence CPR if
necessary (pp.54–87)
■ Use a face mask to protect
yourself if you need to give
rescue breaths
■ Remove contaminated
clothing
■ Wash with cold water for
20 minutes
■ Seek medical help
■ Commence CPR if
necessary (pp.54-87)
■ Help casualty into the
fresh air
■ Call emergency help
■ Commence CPR if
necessary (pp.54–87)
■ Irrigate the eye for ten
minutes (p.180)
■ Call emergency help
■ Commence CPR if
necessary (pp.54–87)
For sting/venom:
■ Remove sting, if possible
■ Call emergency help
■ Commence CPR if
necessary (pp.54–87)
For injected drugs:
■ Call emergency help
■ Commence CPR if
necessary (pp.54–87)
■ Nausea and vomiting
■ Abdominal pain
■ Seizures
■ Irregular, or fast or slow
heartbeat
■ Impaired level of response
■ Pain
■ Swelling
■ Rash
■ Redness
■ Itching
■ Difficulty breathing
■ Hypoxia
■ Grey-blue skin (cyanosis)
■ Pain and watering of
the eye
■ Blurred vision
■ Pain, redness and swelling
at injection site
■ Blurred vision
■ Nausea and vomiting
■ Difficulty breathing
■ Seizures
■ Impaired level of response
■ Anaphylactic shock
■ Drugs and alcohol
■ Cleaning products
■ DIY and gardening
products
■ Plant poisons
■ Bacterial food poisons
■ Viral food poisons
■ Cleaning products
■ DIY and gardening
products
■ Industrial poisons
■ Plant poisons
■ Fumes from cleaning
and DIY products
■ Industrial poisons
■ Fumes from fires
■ Cleaning products
■ DIY and gardening
products
■ Industrial poisons
■ Plant poisons
■ Venom from stings
and bites
■ Drugs
Swallowed
(injested)
Absorbed
through the
skin
Inhaled
Splashed in
the eye
Injected
through the
skin
RECOGNISING THE EFFECTS OF DRUG POISONING
ROUTE OF ENTRY
INTO BODY
POISON POSSIBLE EFFECTS ACTION
200
FOREIGN OBJECTS, POISONING, BITES & STINGS
SWALLOWED POISONS
SEE ALSO Alcohol poisoning p.202 | Chemical burn p.179 | Drug poisoning p.201 | Inhalation of fumes pp.98–99
| The unresponsive casualty pp.54–87
Chemicals that are swallowed may harm the digestive tract, or
cause more widespread damage if they enter the bloodstream and
are transported to other parts of the body. Hazardous chemicals
include some household substances such as bleach and paint
stripper, which are poisonous or corrosive if swallowed.
Drugs, both prescribed or those bought over the counter, can
also be harmful if an overdose is taken. Some plants and their
berries can also be poisonous.
■■ To maintain an open airway,
breathing and circulation
■■ To remove any contaminated
clothing
■■ To identify the poison
■■ To arrange urgent removal to
hospital
■■ History of ingestion/exposure
Depending on what has been
swallowed, there may be:
■■ Vomiting, sometimes bloodstained,
later diarrhoea
■■ Cramping abdominal pains
■■ Pain or a burning sensation
■■ Empty containers in the vicinity
■■ Impaired level of response
■■ Seizures
YOUR AIMS
RECOGNITION
■■ Never attempt to induce
vomiting.
■■ If a casualty is contaminated
with chemicals, wear
protective gloves, goggles
and/or a mask.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
■■ If there are any chemicals on the
casualty’s mouth, protect
yourself by using a face shield or
pocket mask (adult p.71, child
p.79) to give rescue breaths.
CAUTION
WHAT TO DO
If the casualty is responding, ask her what she has swallowed,
and if possible how much and when. Look for clues – for example,
poisonous plants, berries or empty containers. Try to reassure her.
Call 999/112 for emergency help. Give ambulance control as
much information as possible about the poison. This information
will assist the medical team to treat the casualty.
Monitor and record the casualty’s vital signs (pp.52–53) while
waiting for help. Keep samples of any vomited material. Give
these samples, containers and any other clues to the ambulance crew.
1
2
3
SPECIAL CASE IF LIPS ARE BURNT
If the casualty’s lips are burnt by
corrosive substances, give him
frequent sips of cold milk or water
while waiting for help to arrive.
201
SWALLOWED POISONS | DRUG POISONING
DRUG POISONING
SEE ALSO The unresponsive casualty pp.54–87
Poisoning can result from an overdose of prescribed drugs, or
drugs that are bought over the counter. It can also be caused by
drug abuse or drug interaction. The effects may vary depending
on the type of drug and how it is taken (below). When you call
the emergency services, give as much information as possible.
While waiting for help to arrive, look for containers that might
help you to identify the drug.
■■ To maintain breathing and circulation
■■ To arrange removal to hospital
YOUR AIMS
■■ Do not induce vomiting.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing, (The
unresponsive casualty,
pp.54–87).
CAUTION
WHAT TO DO
If the casualty
is responding,
help him into a
comfortable
position and ask him
what he has taken.
Reassure him while
you talk to him.
Call 999/112 for
emergency
help. Tell ambulance
control you suspect
drug poisoning.
Monitor and record
casualty’s vital signs
(pp.52–53) while
waiting for help to
arrive.
Keep samples
of any vomited
material. Look for
evidence that helps
identify the drug,
such as empty
containers. Give
evidence or samples
to the ambulance
personnel.
1 2 3
■ Lethargy and sleepiness, leading to
unresponsiveness ■ Shallow breathing ■ Weak,
irregular or abnormally slow or fast pulse
■ Excitable, hyperactive behaviour, agitation
■ Sweating ■ Tremor of the hands
■ Hallucinations in which the casualty may claim
to “hear voices” or “see things” ■ Dilated pupils
■■Small pupils ■ Sluggishness and confusion,
and casualty may become unresponsive ■ Slow,
shallow breathing, which may stop altogether
■ Needle marks which may be infected
■ Nausea and vomiting ■ Headaches
■ Hallucinations ■ Casualty may be unresponsive
■ Rarely, cardiac arrest
■ Drowsiness ■ Shallow breathing ■ Hallucinations
■ Upper abdominal pain, nausea and vomiting
■ Ringing in the ears ■ “Sighing” when breathing
■ Confusion and delerium ■ Dizziness
■ Barbiturates and
benzodiazepines (swallowed)
■ Amphetamines (including
ecstasy) and LSD (swallowed)
■ Cocaine (inhaled or injected)
■ “Legal highs”
■ Morphine, heroin (commonly
injected
■ Glue, lighter fuel (inhaled)
■ Ketamine
■ Paracetamol (swallowed)
Painkillers ■ Aspirin (swallowed)
Nervous system
depressants and
tranquillisers
Stimulants and
hallucinogens
Narcotics
Solvents
Anaesthetic
RECOGNISING THE EFFECTS OF DRUG POISONING
CATEGORY DRUG EFFECTS OF POISONING
■ Little effect at first, but abdominal pain, nausea
and vomiting may develop ■ Irreversible liver
damage may occur within three days (alcohol and
malnourishment increase the risk)
202
FOREIGN OBJECTS, POISONING, BITES & STINGS
ALCOHOL POISONING
Alcohol is a drug that depresses the activity of the
central nervous system – in particular, the brain (pp.142–43).
Prolonged or excessive intake of alcohol can severely impair
all physical and mental functions, and the person may
become unresponsive.
There are other risks to a casualty from alcohol poisoning,
for example: an unresponsive casualty may inhale and choke
on vomit; alcohol widens (dilates) the blood vessels so the
body loses heat, and hypothermia may develop.
An unresponsive casualty who smells of alcoholic drink may
be misdiagnosed and not receive appropriate treatment for the
underlying cause of his condition, such as a head injury, stroke,
heart attack or hypoglycaemia.
WHAT TO DO
Cover the casualty with a coat or blanket to protect him from the
cold and reassure him.
Assess the casualty for any injuries, especially head injuries, or
other medical conditions.
Monitor and record vital signs – level of response, pulse and
breathing (pp.52–53) – until the casualty recovers or is placed in
the care of a responsible person. If you are in any doubt about the
casualty’s condition, call 999/112 for emergency help.
2
1
3
■■ To maintain an open airway
■■ To assess for other conditions
■■ To seek medical help if necessary
There may be:
■■ A strong smell of alcoholic drink
■■ Empty bottles or cans
■■ Impaired level of response: the
casualty may respond if roused, but
will quickly relapse
■■ Flushed and moist face
■■ Deep, noisy breathing
■■ Full, bounding pulse
In the later stages:
■■ Shallow breathing
■■Weak, rapid pulse
■■ Dilated pupils that react poorly
to light
■■ No response
YOUR AIMS
RECOGNITION
■■ Do not induce vomiting.
■■ If the casualty becomes
unresponsive, open the airway
and check his breathing (The
unresponsive casualty,
pp.54–87).
CAUTION
SEE ALSO Head injury pp.144–45 | Heart attack p.211 | Hypoglycaemia p.215 | Hypothermia pp.186–88 |
Stroke pp.211–13 | The unresponsive casualty pp.54–87
203
ALCOHOL POISONING | ANIMAL AND HUMAN BITES
ANIMAL AND HUMAN BITES
WHAT TO DO
Wash the bite wound thoroughly with soap and warm water in
order to minimise the risk of infection.
Raise and support the wound and pat dry with clean gauze swabs.
Then cover with a sterile wound dressing.
Arrange to take or send the casualty to hospital if the wound is
large or deep.
2
1
3
Bites from sharp, pointed teeth cause deep puncture wounds
that can damage tissues and introduce germs. Bites also crush
the tissue. Any bite that breaks the skin needs prompt first aid
because there is a high risk of infection.
A serious infection risk is rabies, a potentially fatal viral
infection of the nervous system. The virus is carried in the saliva
of infected animals. If bitten in an area where there is a risk of
rabies, seek medical advice since the casualty must be given antirabies
injections. Try to identify the animal.
Tetanus is also a potential risk following any animal bite. There
is probably only a small risk of hepatitis viruses being
transmitted through a human bite – and an even smaller risk of
transmission of the HIV/AIDS virus. However, medical advice
should be sought straight away.
YOUR AIMS
■■ If you suspect rabies, arrange to
take or send the casualty to
hospital immediately.
Ask the casualty about tetanus
immunisation. Seek medical
advice if he:
■■ Has a dirty wound
■■ Has never been immunised
■■ Is uncertain about the number
and timing of injections
■■ Has not had at least five
injections previously
CAUTION
SPECIAL CASE
FOR A DEEP WOUND
If the wound is deep, control
bleeding by applying direct
pressure over a sterile pad and
raise the injured part. Cover the
wound and pad with a sterile
dressing or large, clean
non-fluffy pad and bandage
firmly in place. Treat the casualty
for shock and call 999/112 for
emergency help.
SEE ALSO Cuts and grazes p.119 | Infected wound p.120 | Severe external bleeding pp.114–15 | Shock pp.112–13
■■ To control bleeding
■■ To minimise the risk of infection
■■ To seek medical help if necessary
204
FOREIGN OBJECTS, POISONING, BITES & STINGS
INSECT STING
SEE ALSO Allergy p.222 | Anaphylactic shock p.223 | The unresponsive casualty pp.54–87
Usually, a sting from a bee, wasp or hornet is painful rather
than dangerous. An initial sharp pain is followed by mild swelling,
redness and soreness.
However, multiple insect stings can produce a serious
reaction. A sting in the mouth or throat is potentially dangerous
because swelling can obstruct the airway. With any bite or sting,
it is important to watch for signs of an allergic reaction, which
can lead to anaphylactic shock (p.223).
■■ Pain at the site of the sting
■■ Redness and swelling around the site
of the sting
■■ To relieve swelling and pain
■■ To arrange removal to hospital if
necessary
RECOGNITION
YOUR AIMS
■■ Call 999/112 for emergency
help if the casualty shows signs
of anaphylactic shock (p.223),
such as breathing difficulties
and/or swelling of the face and
neck. Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
WHAT TO DO
Reassure the casualty. If
the sting is visible, brush
or scrape it off sideways with
the edge of a credit card or your
fingernail. Do not use tweezers
because you could squeeze the
sting and inject more poison into
the casualty.
Raise the affected part and
apply a cold compress such
as an ice pack (p.241) to
minimise swelling. Advise the
casualty to keep the compress in
place for at least ten minutes.
Tell her to seek medical advice if
the pain and swelling persist.
Monitor vital signs –
breathing, pulse and level
of response (pp.52–53). Watch
for signs of an allergic reaction,
such as as wheezing and/or
reddened, swollen, itchy skin.
2
3
1
CAUTION
If a casualty has been stung in
the mouth, there is a risk that
swelling of tissues in the mouth
and/or throat may occur, causing
the airway to become blocked. To
help prevent this, give the
casualty an ice cube to suck or a
glass of cold water to sip. Call
999/112 for emergency help if
swelling starts to develop.
SPECIAL CASE
STINGS IN THE MOUTH
AND THROAT
205
INSECT STING | TICK BITE | OTHER BITES AND STINGS
TICK BITE
OTHER BITES AND STINGS
SEE ALSO Allergy p.222 | Anaphylactic shock p.223 | The unresponsive casualty pp.54–87
Scorpion stings as well as bites from some spiders and
mosquitoes can cause serious illness, and may be fatal.
Bites or stings in the mouth or throat are potentially
dangerous because swelling can obstruct the airway. Be alert
to an allergic reaction, which may lead the casualty to suffer
anaphylactic shock (p.223).
Ticks are tiny, spider-like creatures found in grass or
woodlands. They attach themselves to passing animals (including
humans) and bite into the skin to suck blood. When sucking
blood, a tick can swell to about the size of a pea, and it can then
be seen easily. Ticks can carry disease, so they should be
removed as soon as possible.
Depends on the species, but
generally:
■■ Pain, redness and swelling at site
of sting
■■ Nausea and vomiting
■■ Headache
■■ To relieve pain and swelling
■■ To arrange removal to hospital if
necessary
■■ To remove the tick
RECOGNITION
YOUR AIMS
YOUR AIM
■■ Call 999/112 for emergency
help if a scorpion or a red back
or funnel web spider has stung
the casualty, or if the casualty is
showing signs of anaphylactic
shock (p.223).
■■ Do not try to remove the tick
with butter or petroleum jelly or
burn or freeze it, since it may
regurgitate infective fluids into
the casualty.
WHAT TO DO
WHAT TO DO
Raise the affected part
if possible. Place a cold
compress such as an ice pack
(p.241) on the affected area for
at least ten minutes to minimise
the risk of swelling.
Reassure the casualty and
help him to sit or lie down.
Using tweezers, grasp
the tick’s head as close to
the casualty’s skin as you can.
Gently pull the head upwards
using steady even pressure. Do
not jerk the tick as this may leave
the mouth parts embedded, or
cause it to regurgitate infective
fluids into the skin.
Monitor vital signs –
breathing, pulse and level of
response (pp.52–53). Watch for
signs of an allergic reaction, such
as wheezing and/or reddened,
swollen, itchy skin.
Save the tick for
identification; place it in
a sealed plastic bag and give
it to the casualty. The casualty
should seek medical advice;
tell him to take the tick with
him since it may be required
for analysis.
3
2
2
1
1
CAUTION
CAUTION
206
FOREIGN OBJECTS, POISONING, BITES & STINGS
SNAKE BITE
SEE ALSO Anaphylactic shock p.223 | The unresponsive casualty pp.54–87
Snake bites are uncommon in the UK. The only poisonous
snake native to mainland Britain is the adder, and its bite is rarely
fatal. However, poisonous snakes are sometimes kept as pets and
people can be exposed to venomous snakes through travel.
While a snake bite is not usually serious, it is safer to assume
that a snake is venomous. Serious reactions similar to
anaphylaxis are rare but can occur within minutes or several
hours later. Immediate sharp pain is usually followed by a
sensation of tingling and local swelling that spreads up the limb.
Note the time of the bite, as well as the snake’s appearance to
help doctors identify the correct antivenom. If possible (and it is
safe), take a digital photograph that can be sent by email or
message. Take precautions to prevent others being bitten. Notify
the authorities who will deal with the snake.
Help the casualty to sit down and make her comfortable.
Reassure her and advise her not to move her limbs to prevent
venom spreading. Immobilise an upper limb in a sling and apply
broad-fold bandage around limb and body; secure a lower limb to the
other leg with broad- and narrow-fold bandages (p.249). Call 999/112
for emergency help. Keep the casualty immobilised throughout.
If the casualty sustains a
painless bite from an exotic
snake, place a pad on the site
and apply a pressure bandage on
top; extend the bandage as far
up the limb as possible. Do not
interfere with clothing at the site
as movement increases the
absorption of the venom into
the bloodstream.
Apply another pressure bandage to extend
from the bite as far up the limb as possible.
Check circulation after bandaging (p.243). If
possible, mark the site of the bite. Immobilise the
limb by securing it to the other leg with broad- and
narrow-fold bandages (p.249). If the bite is on the
trunk a pressure bandage should still be applied.
Monitor and record the casualty's vital signs
(pp.52–53) while waiting for help to arrive.
1
2
3
4
■■ To prevent venom spreading
■■ To arrange urgent removal to
hospital
There may be:
■■ A pair of puncture marks – the bite
may be painless
■■ Severe pain, redness and swelling at
the bite; the whole limb may become
swollen and bruised within 24 hours
■■ Nausea and vomiting
■■ Disturbed vision
■■ Increased salivation and sweating
■■ Laboured breathing; it may stop
altogether
YOUR AIMS
RECOGNITION
■■ Do not apply a tourniquet,
slash the wound with a knife
or try to suck out the venom.
■■ If the casualty becomes
unresponsive, open the
airway and check breathing
(The unresponsive casualty,
pp.54–87).
CAUTION
WHAT TO DO
207
SNAKE BITE | STINGS FROM SEA CREATURES | MARINE PUNCTURE WOUND
STINGS FROM SEA CREATURES
MARINE PUNCTURE WOUND
SEE ALSO Allergy p.222 | Anaphylactic shock p.223
■■ To relieve pain and discomfort
YOUR AIM
WHAT TO DO
Encourage the casualty
to sit or lie down. Immerse
the affected area in hot water
(40–41ºC/104–106ºF) for
ten minutes to relieve pain
and swelling. Alternatively, wash
the area in copious quantities of
cold water.
Help the casualty to sit
down. Immerse the injured
part in water as hot as he can
tolerate for about 30 minutes.
Take or send the casualty to
hospital so that the spines
can be safely removed.
Monitor vital signs –
breathing, pulse and level of
response (pp.52–53). Watch for
signs of an allergic reaction, such
as wheezing and itchy skin.
1
2
2
1
Jellyfish, Portuguese men-of-war, sea anemones and corals can
all cause stings. Their venom is contained in stinging cells that
stick to the skin. Most marine species found in temperate
regions of the world are not dangerous. However, some tropical
marine creatures can cause severe poisoning. Occasionally, death
results from paralysis of the chest muscles and, very rarely, from
anaphylactic shock (p.223).
Many marine creatures have spines that provide a mechanism
against attack from predators but that can also cause painful
wounds if trodden on. Sea urchins and weever fish have sharp
spines that can become embedded in the sole of the foot.
Wounds may become infected if the spines are not removed.
The hot water breaks down fish venom.
■■ To relieve pain and discomfort
■■ To seek medical help
if necessary
Depends on the species, but
generally:
■■ Pain, redness and swelling at site
of sting
■■ Nausea and vomiting
■■ Headache
YOUR AIMS
RECOGNITION
■■ If the injury is extensive or there
is a severe reaction, call 999/112
for emergency help. Monitor
and record vital signs –
breathing, pulse and level of
response (pp.52–53) – while
waiting for help to arrive.
■■ Do not bandage the wound.
■■ Do not scald the casualty.
CAUTION
CAUTION
SPECIAL CASE
JELLYFISH STING
Pour copious amounts of
vinegar or sea water over the
area of the injury to incapacitate
the stinging cells. Help the
casualty to sit down and treat as
for a snake bite (opposite). Call
999/112 for emergency help.
WHAT TO DO
Many everyday conditions, such as
fever and headache, need prompt
treatment and respond well to first aid.
However, a minor complaint can be the
start of a serious illness, so you should
always be alert to this and seek medical
advice if you are in doubt about the
casualty’s condition.
Other conditions such as heart attack,
stroke, diabetes-related hypoglycaemia
(lower than normal blood sugar levels),
severe allergic reaction (anaphylaxis) and
meningitis are potentially life-threatening
and require urgent medical attention.
Childbirth is a natural process and often
takes many hours. When a woman goes into
labour unexpectedly, while it is important
to call for emergency help as soon as
possible, there is usually plenty of time to
seek help and get her to hospital. In the
rare event of a baby arriving quickly, do not
try to deliver the baby – the birth will
happen naturally without intervention.
Miscarriage, however, is a potentially
serious problem due to the risk of severe
bleeding. A woman who is miscarrying
needs urgent medical help.
■■ To assess the casualty’s condition quietly and calmly
■■ To comfort and reassure the casualty
■■ To call 999/112 for emergency help if you suspect
a serious illness
AIMS AND OBJECTIVES
MEDICAL
CONDITIONS
210
■■ Vice-like central chest pain, which
may spread to the jaw and down one
or both arms
■■ Pain that eases with rest
■■ Shortness of breath
■■ Tiredness, which is often sudden and
extreme
■■ Feeling of anxiety
■■ To ease strain on the heart by
ensuring that the casualty rests
■■ To help the casualty with any
medication
■■ To obtain medical help if necessary
RECOGNITION
YOUR AIMS
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
WHAT TO DO
Help the casualty to stop what he is doing and sit down. Make
sure that he is comfortable and reassure him; this should
help the pain to ease.
If the casualty has angina medication, such as tablets or a pumpaction
or aerosol spray, let him administer it himself. If necessary,
help him to take it.
If the pain is not relieved five minutes after taking the angina
medication, advise him to take a second dose.
Encourage the casualty to rest, and keep any bystanders away.
If the casualty is still in pain five minutes after the second dose,
or it returns, suspect a heart attack (opposite). Call 999/112 for
emergency help.
If the pain subsides within 15 minutes after rest and/or
medication, the casualty will usually be able to resume what he
was doing. If he is concerned, tell him to seek medical advice.
2
1
3
4
5
6
The term angina literally means a constriction of the chest.
Angina occurs when coronary arteries that supply the heart
muscle with blood become narrowed and cannot carry sufficient
blood to meet increased demands during exertion or excitement.
An attack forces the casualty to rest; the pain should ease
soon afterwards.
CAUTION
ANGINA
MEDICAL CONDITIONS
SEE ALSO Heart attack opposite
211
ANGINA | HEART ATTACK
HEART ATTACK
■■ Persistent, vice-like central chest
pain, which may spread to the jaw
and down one or both arms. Unlike
angina (opposite), the pain does not
ease when the casualty rests
■■ Breathlessness
■■ Discomfort occurring high in the
abdomen, which may feel similar to
severe indigestion
■■ Collapse, often without any warning
■■ Sudden faintness or dizziness
■■ Casualty feels a sense of impending
doom
■■ “Ashen” skin and blueness at the lips
■■ A rapid, weak or irregular pulse
■■ Profuse sweating
■■ Extreme gasping for air (“air hunger”)
■■ To ease the strain on the heart by
ensuring that the casualty rests
■■ To call for urgent medical help
without delay
RECOGNITION
YOUR AIMS
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
■■ Do not give the casualty aspirin
if you know that he is allergic
to it or if he is under 16 years
of age.
A heart attack is most commonly caused by a sudden
obstruction of the blood supply to part of the heart muscle –
for example, because of a clot in a coronary artery (coronary
thrombosis). It can also be called a myocardial infarction. The
main risk is that the heart will stop beating.
The effects of a heart attack depend on how much of the heart
muscle is affected; many casualties recover completely. Aspirin
can be used to try to restrict the size of the clot.
WHAT TO DO
Call 999/112 for emergency help. Tell ambulance control that
you suspect a heart attack.
Make the casualty as comfortable as possible to ease the strain
on his heart. A half-sitting position, with his head and shoulders
supported and his knees bent, is often best. Place cushions behind
him and under his knees.
Assist the casualty to take
one full dose aspirin tablet
(300mg in total). Advise him to
chew it slowly.
If the casualty has angina
medication, such as tablets
or a pump-action or aerosol
spray, let him administer it; help
him if necessary. Encourage him
to rest.
Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
Stay calm to avoid undue stress.
1
2
3
4
5
CAUTION
SEE ALSO The unresponsive casualty pp.54–87
Coronary thrombosis
Coronary arteries supply
blood to the heart muscle.
When an artery is blocked, for
example by a blood clot, the
muscle beyond the blockage
is deprived of oxygen and
other nutrients carried by the
blood and begins to die.
Area deprived of oxygen
and nutrients
Coronary arteries
Site of
blockage in
coronary
artery
212
MEDICAL CONDITIONS
STROKE
■■ Facial weakness – the casualty is
unable to smile evenly and the mouth
or eye may be droopy
■■ Arm weakness – the casualty is only
able to raise one arm
■■ Speech problems – the casualty is
unable to speak clearly
There may also be:
■■ Sudden weakness or numbness of
the face, arm or leg on one or both
sides of the body
■■ Sudden loss or blurring of vision in
one or both eyes
■■ Sudden difficulty with speech or
understanding the spoken word
■■ Sudden confusion
■■ Sudden severe headache with no
apparent cause
■■ Dizziness, unsteadiness or sudden fall
RECOGNITION
A stroke, or brain attack, is a medical emergency that occurs
when the blood supply to the brain is disrupted. Strokes are the
third most common cause of death in the UK and many people
live with long-term disability as a result of a stroke. This
condition is more common later in life and is associated with
disorders of the circulatory system, such as high blood pressure.
The majority of strokes are caused by a clot in a blood vessel
that blocks the flow of blood to part of the brain. However, some
strokes are the result of a ruptured blood vessel that causes
bleeding into the brain. If a stroke is due to a blood clot, it may
be possible to give drugs to limit the extent of damage to the
brain and improve recovery. Call 999/112 for emergency help
immediately if you think a casualty has had a stroke.
Use the FAST (Face–Arm–Speech–Time) guide if you suspect a
casualty has had a stroke:
F – Facial weakness – the casualty is unable to smile evenly and
the mouth or eye may be droopy
A – Arm weakness – the casualty is only able to raise one of
his arms
S – Speech problems – the casualty is unable to speak clearly
or may not understand the spoken word
T – Time to call 999/112 for emergency help if you suspect
that the casualty has had a stroke
TRANSIENT ISCHAEMIC ATTACK (TIA)
A transient ischaemic attack, or TIA, is sometimes called
a mini-stroke. It is similar to a full stroke, but the symptoms may
only last a few minutes, will improve and eventually disappear. If
you suspect a TIA, it is important to seek medical advice to
confirm the casualty’s condition. If there is any doubt assume
that it is a stroke.
■■ To arrange urgent admission to
hospital
■■ To reassure and comfort the casualty
YOUR AIMS
■■ If the person becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty,
pp.54–87).
CAUTION
Bleeding into brain
Site of clot
BLOCKED BLOOD VESSEL BURST BLOOD VESSEL
Area deprived
of oxygen
Damaged
blood vessel
Causes of a stroke
Any disruption to the flow of blood
to the brain starves the affected
part of the brain of oxygen and
nutrients. This can cause temporary
or permanent loss of function in
that area of the brain. A stroke can
result from a blood clot that blocks
an artery supplying blood to the
brain (right), or from a burst blood
vessel that causes bleeding which
presses on the brain (far right).
SEE ALSO The unresponsive casualty pp.54–87
213
STROKE
WHAT TO DO
Look at the
casualty’s face. Ask
him to smile: if he has
had a stroke he may only
be able to smile on one
side – the other side of
his mouth may droop.
Ask the casualty to raise both his arms: if he
has had a stroke, he may only be able to lift
one arm.
2
1
Find out whether the person can speak clearly
and understand what you say. When you ask a
question does he respond appropriately?
3
Call 999/112 for emergency help and tell
ambulance control that you have used the
FAST guide and you suspect a stroke.
4
Keep the casualty comfortable and supported.
If the casualty is responding, you can help him
to lie down. Reassure him that help is on its way.
5
Regularly monitor and record vital signs
– breathing, pulse and level of response
(pp.52–53) – while waiting for help to arrive.
Do not give the casualty anything to eat or drink
because it may be difficult for him to swallow.
6
214
MEDICAL CONDITIONS
This is a long-term (chronic) condition in
which the body fails to produce sufficient
insulin. Insulin is a chemical produced by the
pancreas (a gland that lies behind the stomach),
which regulates the blood sugar (glucose) level
in the body. This condition can result in higher
than normal blood sugar (hyperglycaemia) or
lower than normal blood sugar
(hypoglycaemia). If a person with diabetes is
unwell, giving him sugar will rapidly correct
hypoglycaemia and is unlikely to do harm in
cases of hyperglycaemia.
TYPES OF DIABETES
There are two types: Type 1, or insulindependent
diabetes, and Type 2, also known
as non-insulin-dependent diabetes.
In Type 1 diabetes, the body produces little
or no insulin. People with Type 1 diabetes need
regular insulin injections throughout their lives.
Type 1 diabetes is sometimes referred to as
juvenile diabetes or early onset diabetes
because it usually develops in childhood or
teenage years. Insulin can be administered
via an injection pen (insulin pen) or a special
pump. The pump is a small device about the
size of a pack of cards that is strapped to
the person’s body. The insulin is delivered
via a piece of tubing that leads from the
pump to a needle that sits just under the
person’s skin.
In Type 2 diabetes, the body does not
make enough insulin or cannot use it properly.
This type is usually linked with obesity, and is
also known as maturity-onset diabetes, as it is
more common in people over the age of 40.
The risk of developing this type of diabetes
is increased if it runs in your family. Type 2
diabetes can normally be controlled with diet,
weight loss and regular exercise. However, oral
medication and, in some cases, insulin
injections may be needed.
WHAT TO DO
DIABETES MELLITUS
High blood sugar (hyperglycaemia) may develop slowly over a
period of hours or days. If it is not treated, hyperglycaemia will
result in the person becoming unresponsive (diabetic coma) and
so requires urgent treatment in hospital. Those who suffer from
hyperglycaemia may wear medical warning bracelets, cards or
medallions alerting a first aider to the condition.
■■Warm, dry skin
■■ Rapid pulse and breathing
■■ Fruity sweet breath and excessive
thirst
■■ Possible medical warning bracelet
■■ Drowsiness, leading to
unresponsiveness if untreated
RECOGNITION
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty, pp.54–87).
CAUTION
Monitor and record vital
signs – breathing, pulse and
level of response (pp.52–53) –
while waiting for help to arrive.
2 Call 999/112 for
emergency help; tell
ambulance control that you
suspect hyperglycaemia.
1
SEE ALSO The unresponsive casualty pp.54–87
■■ To arrange urgent removal to hospital
YOUR AIM
HYPERGLYCAEMIA
215
DIABETES MELLITUS | HYPERGLYCAEMIA | HYPOGLYCAEMIA
HYPOGLYCAEMIA
WHAT TO DO
Help the casualty to sit down. If he has an emergency sugar
supply such as glucose gel, help him to take it. If not give him the
equivalent of 15–20g of glucose – for example, a 150ml glass of nondiet
fizzy drink or fruit juice, three teaspoons of sugar (or sugar lumps)
or three sweets such as jelly babies.
If the casualty responds quickly, give him more sugary food
or drink and let him rest until he feels better. Help him find his
glucose testing kit so that he can check his glucose level. Monitor
him until he has completely recovered.
If casualty’s condition does not improve, look for other possible
causes. Call 999/112 for emergency help and monitor and record
vital signs – breathing, pulse and level of response (pp.52–53) – while
waiting for help to arrive.
2
1
There may be:
■■ A history of diabetes – the casualty
himself may recognise the onset of
a hypoglycaemic episode
■■Weakness, faintness or hunger
■■ Confusion and irrational behaviour
■■ Sweating with cold, clammy skin
■■ Rapid pulse
■■ Palpitations and muscle tremors
■■ Deteriorating level of response
■■Medical warning bracelet or necklace
and glucose gel or sweets
■■Medication such as an insulin pen
or tablets and a glucose testing kit
RECOGNITION
This condition occurs when the blood sugar level falls below
normal. It is characterised by a rapidly deteriorating level of
response. Hypoglycaemia develops if the insulin–sugar balance
is incorrect; for example, when a person with diabetes misses a
meal or takes too much exercise. It is common in a person with
newly diagnosed diabetes while he is learning to balance sugar
levels. More rarely, hypoglycaemia may develop following an
epileptic seizure (pp.216–17) or after an episode of binge drinking.
People with diabetes normally carry their own blood-testing
kits to check their blood sugar levels, as well as their insulin
medication and sugary food for use in an emergency. For
example, a person may have sugar lumps or a tube of glucose gel.
If the hypoglycaemic episode is at an advanced stage, his level
of response may be affected (p.52) and you must call 999/112
for emergency help.
SEE ALSO Alcohol poisoning p.202 | Head injury pp.144–45 | The unresponsive casualty pp.54–87
■■ To raise the sugar content of the
blood as quickly as possible
■■ To obtain appropriate medical help
YOUR AIMS
■■ If the person is not fully alert
(p.52), do not give him
anything to eat or drink.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty
pp.54–87).
CAUTION
3
216
MEDICAL CONDITIONS
SEIZURES IN ADULTS
■■ Do not move the casualty unless
he is in immediate danger.
■■ Do not put anything in his
mouth or attempt to restrain
him during a seizure.
Call 999/112 for emergency
help if:
■■ The casualty is having repeated
seizures or it is his first seizure
■■ The casualty is not aware of any
reason for the seizure
■■ The seizure continues for more
than five minutes
■■ The casualty is unresponsive for
more than ten minutes
■■ The casualty has sustained
an injury to another part of
the body
CAUTION A seizure – also called a convulsion or fit – consists of
involuntary contractions of many of the muscles in the body.
The condition is due to a disturbance in the electrical activity
of the brain. Seizures usually result in the person becoming
unresponsive or his response is impaired. The most common
cause is epilepsy. Other causes include head injury, some braindamaging
diseases, shortage of oxygen or glucose in the brain
and the intake of certain poisons, including alcohol or drugs.
Epileptic seizures result from recurrent, major disturbances
of brain activity and they can be sudden and dramatic. Just
before a seizure, a casualty may have a brief warning (aura)
with, for example, a strange feeling or a special smell or taste.
No matter what the cause of the seizure, care must always
include maintaining an open, clear airway and monitoring
of the casualty’s vital signs – breathing, pulse and level of
response. You will also need to protect the casualty from
further harm during a seizure and arrange appropriate
aftercare once he has recovered.
■■ Help him to sit down in a quiet
place
■■ Remove any potentially dangerous
items such as hot drinks or sharp
objects
■■ Talk to him in a calm and
reassuring way and stay with him
until he has fully recovered
■■ Advise him to seek medical advice
if he is unaware of his condition or
does not fully recover
Some people experience a mild
form of epilepsy known as
absence seizures, during which
they appear distant and unaware
of their surroundings. These
seizures tend to affect children
more than adults and a full one
may follow. A casualty may
suddenly “switch off” and stare
blankly ahead. You may notice
slight or localised twitching or
jerking of the lips, eyelids, head
or limbs and/or odd “automatic”
movements, such as lip-smacking
or making noises. If a casualty
has an absence seizure:
SPECIAL CASE ABSENCE SEIZURES
217
SEIZURES IN ADULTS
WHAT TO DO
Make space around the casualty; ask bystanders to move away.
Remove potentially dangerous items, such as hot drinks and sharp
objects. Note the time that the seizure started.
Protect the casualty’s head from objects nearby; place soft
padding such as rolled towels underneath or around his neck
if possible. Loosen tight clothing around his neck if necessary.
2
1
In epilepsy, the following sequence
is common:
■■ Sudden loss of responsiveness
■■ Casualty becomes rigid, arching his
back
■■ Breathing may be noisy and become
difficult – the lips may show a greyblue
tinge (cyanosis)
■■ Convulsive movements begin
■■ Saliva may appear at the mouth
and may be bloodstained if the
lips or tongue have been bitten
■■ Possible loss of bladder or bowel
control
■■Muscles relax and breathing
becomes normal; the casualty
recovers and is responsive again,
usually within a few minutes. He may
feel dazed or act strangely. He may
be unaware of his actions
■■ After a seizure, the casualty may feel
tired and fall into a deep sleep
RECOGNITION
■■ To protect the casualty from injury
during the seizure
■■ To care for the casualty when he is
responsive again and arrange
removal to hospital if necessary
YOUR AIMS
When the convulsive movements have ceased, open the
casualty’s airway and check breathing. If he is breathing, place
him in the recovery position.
Monitor and record vital signs – breathing, pulse and level of
response (pp.52–53) – until he recovers. Make a note of how long
the seizure lasted.
4
3
SEE ALSO Head injury pp.144–45 | The unresponsive casualty pp.54–87
218 SEE ALSO Unresponsive child pp.72–79 | Unresponsive infant pp.80–83
■■ Loss of or impaired response
■■ Vigorous shaking, with clenched fists
and an arched back
There may also be:
■■ Obvious signs of fever: hot, flushed
skin and perhaps sweating
■■ Twitching of the face and squinting,
fixed or upturned eyes
■■ Breath-holding, with red, “puffy” face
and neck and drooling at the mouth
■■ Possible vomiting
■■ Loss of bowel or bladder movement
■■ To protect the child from injury
during the seizure
■■ To cool the child
■■ To reassure the parents
■■ To arrange removal to hospital
RECOGNITION
YOUR AIMS
In young children, seizures – sometimes called fits or
convulsions – are most often the result of a raised body
temperature associated with a throat or ear infection or other
infections. This type of seizure, also known as a febrile seizure,
occurs because the electrical systems in the brain are not mature
enough to deal with the body’s high temperature.
Although seizures can be alarming, they are rarely dangerous
if properly dealt with. However, you should always seek medical
advice for the child to rule out any serious underlying condition.
WHAT TO DO
Place pillows or soft padding around the child so that even
violent movement will not result in injury. Do not restrain the
child in any way.
Reassure the child as well as the parents or
carer. Monitor and record vital signs –
breathing, pulse and level of response (pp.52–53) –
until emergency help arrives.
Once the seizure has stopped, place the child
in the recovery position to maintain an open
airway. Call 999/112 for emergency help.
Cool the child. Remove any bedding and
clothes, for example T-shirt or pyjama top; you
may have to wait until the seizure stops. Ensure a
good supply of fresh air, but be careful not to
overcool the child.
1
4
2 3
SEIZURES IN CHILDREN
MEDICAL CONDITIONS
■■ Do not over- or under-dress a
child with fever; do not sponge
a child to cool her as there is a
risk of overcooling.
CAUTION
219
FEVER
SEE ALSO Meningitis p.220 | Seizures in children opposite
■■ Raised body temperature above
37ºC (98.6ºF)
■■ Pallor – casualty may feel cold with
goose pimples, shivering and
chattering teeth
Later:
■■ Hot, flushed skin and sweating
■■ Headache
■■ Generalised aches and pains
■■ To bring down the fever
■■ To obtain medical aid if necessary
RECOGNITION
YOUR AIMS
■■ If you are concerned about the
casualty’s condition, seek
medical advice.
■■ Do not over- or underdress a
child with fever; do not sponge
a child to cool her as there is a
risk of overcooling.
■■ Do not give aspirin to any
person under 16 years of age.
WHAT TO DO
Keep casualty cool and comfortable – preferably in bed with a
light covering.
Monitor and record a casualty’s vital signs – breathing, pulse,
temperature and level of response (pp.52–53) – until she recovers.
Give her plenty of cool drinks to replace any body fluids lost
through sweating.
If the child appears distressed or unwell, she may have the
recommended dose of paracetamol syrup (not aspirin). An adult
may take the recommended dose of paracetamol tablets.
4
2
1
3
A sustained body temperature above the normal level of
37ºC (98.6ºF) is known as fever. It is usually caused by a bacterial
or viral infection, and may be associated with earache, sore
throat, measles, chickenpox, meningitis (p.220) or a local
infection, such as an abscess. The infection may have been
acquired during overseas travel.
In young children a temperature above 39ºC (102.2ºF) can be
dangerous and may trigger seizures (opposite). If you are in any
doubt about a casualty’s condition, seek medical advice.
CAUTION
SEIZURES IN CHILDREN | FEVER
220
MEDICAL CONDITIONS
The symptoms and signs are
usually not all present at the same
time. They include:
■■ Flu-like illness with a high
temperature
■■ Cold hands and feet
■■ Joint and limb pain
■■Mottled or very pale skin
As the infection develops:
■■ Severe headache
■■ Neck stiffness (the casualty will
not be able to touch her chest with
her chin)
■■ Vomiting
■■ Eyes become very sensitive to any
light – daylight, electric light or even
the television
■■ Drowsiness
■■ In infants, there may also be highpitched
moaning or a whimpering
cry, floppiness and a tense or bulging
fontanelle (soft part of the skull)
Later:
■■ A distinctive rash of red or purple
spots that do not fade when pressed
■■ To obtain urgent medical help
RECOGNITION
YOUR AIM
This is a condition in which the linings that surround the brain
and the spinal cord become inflamed. It can be caused by
bacteria or a virus and can affect any age group.
Meningitis is potentially a very serious illness and the casualty
may deteriorate very quickly. If you suspect meningitis, you must
seek urgent medical assistance as prompt treatment in hospital
is vital. For this reason it is important that you are able to
recognise the symptoms of meningitis, which may include a
high temperature, headache and a distinctive rash. With early
diagnosis and treatment most people make a full recovery.
WHAT TO DO
Seek urgent medical advice
if you notice any of the signs
of meningitis; for example,
shielding eyes from the light. Do
not wait for all the symptoms
and signs to appear because
they may not all develop. Treat
the fever (p.219).
Check the casualty for signs
of a rash. On dark skin,
check on lighter parts of the
body; for example, the inner
eyelids or fingertips. If you see
any signs, call 999/112 for
emergency help.
1 2
MENINGITIS
■■ If a casualty’s condition is
deteriorating, and you suspect
meningitis, call 999/112 for
emergency help even if she has
already seen a doctor.
While waiting for help
to arrive, reassure the
casualty and keep her cool.
Monitor and record vital signs –
breathing, pulse and level of
response (pp.52–53).
3
Accompanying the later stage of
meningitis is a distinctive red or
purple rash that does not fade if
you press it. If you press the side
of a glass firmly against most
rashes they will fade; if a rash
does not fade, call 999/112 for
emergency help immediately.
IMPORTANT MENINGITIS RASH
SEE ALSO Fever p.219
CAUTION
221
MENINGITIS | FAINTING
SEE ALSO The unresponsive casualty pp.54–87
■■ Brief period of unresponsiveness
that causes the casualty to fall to
the ground
■■ A slow pulse
■■ Pale, cold skin and sweating
■■ To improve blood flow to the brain
■■ To reassure the casualty and make
him comfortable
A faint is a brief loss of responsiveness caused by a temporary
reduction of the blood flow to the brain. It may be a reaction to
pain, exhaustion, lack of food or emotional stress. Fainting is also
common after long periods of physical inactivity, such as
standing or sitting still, especially in a warm atmosphere. This
inactivity causes blood to pool in the legs, reducing the amount
of blood reaching the brain.
When a person faints, the pulse rate becomes very slow.
However, the rate soon picks up and returns to normal. A
casualty who has fainted usually makes a rapid and complete
recovery. Do not advise a person who feels faint to sit on a chair
with his head between his knees because if he faints he may
fall and injure himself. If the casualty is a woman in the late stage
of pregnancy, help her to lie down so that she is leaning towards
her left side to prevent the pregnant uterus restricting blood
flow back to her heart.
WHAT TO DO
When a casualty feels
faint, advise him to lie
down. Kneel down, raise his legs,
supporting his ankles on your
shoulders to improve blood flow
to the brain. Watch his face for
signs of recovery.
Make sure that the casualty
has plenty of fresh air; ask
someone to open a window if
you are indoors. In addition, ask
any bystanders to stand clear.
As the casualty recovers,
reassure him and help him
to sit up gradually. If he starts to
feel faint again, advise him to lie
down once again, and raise
and support his legs until he
recovers fully.
1 2 3
FAINTING
■■ If the casualty does not regain
responsiveness quickly, open
the airway and check breathing
(The unresponsive casualty,
pp.54–87).
CAUTION
RECOGNITION
YOUR AIMS
222
MEDICAL CONDITIONS
An allergy is an abnormal reaction of the body’s defence
system (immune response) to a normally harmless “trigger”
substance (or allergen). An allergy can present itself as a
mild itching, swelling, wheezing or digestive condition,
or can progress to full-blown anaphylaxis, or anaphylactic
shock (opposite), which can occur within seconds or
minutes of exposure to an offending allergen.
Common allergy triggers include pollen, dust, nuts,
shellfish, eggs, wasp and bee stings, latex and certain
medications. Skin changes can be subtle, absent or
variable in some cases.
ALLERGY
WHAT TO DO
Assess the casualty’s signs and symptoms. Ask if she has any
known allergy.
Remove the trigger if possible, or move the casualty from
the trigger. 2
1
SEE ALSO Anaphylactic shock opposite | Asthma p.102
Features of mild allergy vary
depending on the trigger. There
may be:
■■ Red, itchy rash or raised areas of skin
(weals)
■■ Red, itchy eyes
■■Wheezing and/or difficulty breathing
■■ Swelling of hands, feet and/or face
■■ Abdominal pain, vomiting and
diarrhoea
RECOGNITION
■■ Call 999/112 for emergency
help if the casualty does not
improve, she has difficulty in
breathing or is becoming
distressed. Monitor and record
vital signs (pp.52–53) while
waiting for help.
CAUTION
■■ To assess the severity of the allergic
reaction
■■ To seek medical advice if necessary
YOUR AIMS
Treat any symptoms. Allow the casualty to take her own
medication for a known allergy. 3
If you are at all concerned about the casualty’s condition, seek
medical advice. 4
223
ALLERGY | ANAPHYLACTIC SHOCK
ANAPHYLACTIC SHOCK
SEE ALSO Hypoxia p.92 | Shock pp.112–13 | The unresponsive casualty pp.54–87
WHAT TO DO
Call 999/112 for emergency
help. Tell ambulance control
that you suspect anaphylaxis.
If the casualty has an autoinjector
of adrenaline, help
her to use it. If she is unable to
administer it, and you have been
trained, give it to her. Pull off the
safety cap and, holding the autoinjector
with your fist, push the
tip firmly against the casualty’s
thigh until it clicks, releasing the
medication (it can be delivered
through clothing). Hold for
ten seconds, remove the
autoinjector, then massage the
injection site for ten seconds.
Help the casualty to sit up
in the position that best
relieves any breathing difficulty.
If she becomes pale with a weak
pulse, help her to lie down with
legs raised and treat for shock
(pp.112–13).
2
1 3
Features of allergy (opposite) may
be present:
■■ Red, itchy rash or raised areas of skin
(weals)
■■ Red itchy, watery eyes
■■ Swelling of hands, feet and/or face
■■ Abdominal pain, vomiting and
diarrhoea
There may also be:
■■ Difficulty breathing, ranging from
a tight chest to severe difficulty,
causing the casualty to wheeze
and gasp for air
■■ Pale or flushed skin
■■ Visible swelling of tongue and throat
with puffiness around the eyes
■■ Feeling of terror
■■ Confusion and agitation
■■ Signs of shock, leading to collapse
and unresponsiveness
RECOGNITION
This is a severe allergic reaction affecting the whole body. It
may develop within seconds or minutes of contact with a trigger
and is potentially fatal. In an anaphylactic reaction, chemicals
are released into the blood that widen (dilate) blood vessels.
This causes blood pressure to fall and air passages to narrow
(constrict), resulting in breathing difficulties. In addition, the
tongue and throat can swell, obstructing the airway. The amount
of oxygen reaching the vital organs can be severely reduced,
causing hypoxia (p.92). Common triggers include: nuts, shellfish,
eggs, wasp and bee stings, latex and certain medications.
A casualty with anaphylactic shock needs emergency
treatment with an injection of adrenaline.
■■ If a pregnant casualty needs to
lie down, lean her towards her
left side to prevent the pregnant
uterus restricting blood flow
back to the heart.
■■ If the person becomes
unresponsive, open the airway
and check breathing (The
unresponsive casualty
pp.54–87).
CAUTION
■■ To ease breathing
■■ Treat shock
■■ To arrange urgent removal to
hospital
YOUR AIMS
Monitor and record vital
signs – breathing, pulse
level of response (pp.52–53) –
while waiting for help to arrive.
Repeated doses of adrenaline
can be given at five-minute
intervals if there is no
improvement or the
symptoms return.
4
224
MEDICAL CONDITIONS
■■ To relieve the pain
■■ To obtain medical advice if necessary
YOUR AIMS
A headache may accompany any illness, particularly a feverish
ailment such as flu. It may develop for no reason, but can often
be traced to tiredness, tension, stress or undue heat or cold.
Mild “poisoning” caused by a stuffy or fume-filled atmosphere,
or by excess alcohol or any other drug, can also induce a
headache. However, a headache may also be the most
prominent symptom of meningitis or a stroke.
WHAT TO DO
HEADACHE
■■ Do not give aspirin to anyone
under 16 years of age or who
you know is allergic to it.
Seek urgent medical advice if:
■■ Pain develops very suddenly
■■ Pain is severe and incapacitating
■■ Pain is accompanied by fever or
vomiting
■■ Pain is recurrent or persistent
■■ Pain is accompanied by loss of
strength or sensation, or by
impaired level of response
■■ Pain is accompanied by a stiff
neck and sensitivity to light
■■ Pain follows a head injury
CAUTION
WHAT TO DO
Help the casualty to sit or
lie down in a quiet place.
Give him a cold compress to
hold against his head (p.241).
An adult may take the
recommended dose of
paracetamol tablets or his own
painkillers. A child may have
the recommended dose of
paracetamol syrup (not aspirin).
2
1
Migraine attacks are severe, “sickening” headaches and can
be triggered by a variety of causes, such as allergy, stress or
tiredness. Other triggers include lack of sleep, missed meals,
alcohol and some foods – for example, cheese or chocolate.
Migraine sufferers usually know how to recognise and deal with
attacks and may carry their own medication.
■■ Before the attack there may be
disturbance of vision in the form of
flickering lights and/or a “blind patch”
■■ Intense throbbing headache, which
may be on just one side of the head
■■ Abdominal pain, nausea and vomiting
■■ Inability to tolerate bright light or
loud noise
RECOGNITION
■■ Do not give aspirin to anyone
under 16 years of age or who
you know is allergic to it.
CAUTION
Advise the casualty to lie
down or sleep for a few
hours in a quiet, dark room.
Provide him with some towels
and a container in case he
vomits.
Help the casualty to take 2
any medication that he may
have for migraine attacks.
1
If this is the first attack,
advise the casualty to seek
medical advice.
3
SEE ALSO Head injury pp.144–45 | Meningitis p.220 | Stroke pp.212–13
MIGRAINE
■■ To relieve the pain
■■ To obtain medical advice if necessary
YOUR AIMS
225
HEADACHE | MIGRAINE | SORE THROAT | EARACHE AND TOOTHACHE
EARACHE AND TOOTHACHE
WHAT TO DO
WHAT TO DO
An adult may take the
recommended dose of
paracetamol tablets or her own
painkillers. A child may have
the recommended dose of
paracetamol syrup (not aspirin).
Give her a source of heat,
such as a hot-water bottle
wrapped in a towel, to hold
against the affected side.
In addition for toothache,
you can soak a plug of
cotton wool in oil of cloves to
hold against the affected tooth.
2
1 3
■■ To relieve the pain
■■ To obtain medical or dental advice
if necessary
YOUR AIMS
Earache can result from inflammation of the outer, middle or
inner ear, and is often caused by an infection associated with a
cold, tonsillitis or flu. It can also be caused by a boil, an object
stuck in the ear canal or transmitted pain from a tooth abscess.
There may also be temporary hearing loss. Earache often occurs
when flying as a result of the changes in air pressure during
ascent and descent. Infection can cause pus to collect in the
middle ear and the eardrum may rupture, allowing the pus to
drain, which temporarily eases the pain.
Toothache can develop when pulp inside a tooth becomes
inflamed due to dental decay. If untreated, the pulp becomes
infected, leading to an abscess, which causes a throbbing pain.
Infection may cause swelling around the tooth or jaw.
■■ Do not give aspirin to anyone
under 16 years of age or who
you know is allergic to it.
■■ If there is a discharge from an
ear, fever or hearing loss, obtain
medical help.
CAUTION
Advise a casualty to seek
medical advice if you are
concerned, particularly if the
casualty is a child. If a casualty
has toothache, advise her to see
her dentist.
4
The most common sore throat is a “raw” feeling caused by
inflammation, which is often the first sign of a cough or cold.
Tonsillitis occurs when the tonsils at the back of the throat are
infected. The tonsils become red and swollen and white spots of
pus may be seen. Swallowing may be difficult and the glands at
the angle of the jaw may be enlarged and sore.
■■ To relieve the pain
■■ To obtain medical advice if necessary
YOUR AIMS
■■ Do not give aspirin to anyone
under 16 years of age or who
you know is allergic to it.
■■ If you suspect tonsillitis or
glandular fever, tell the casualty
to seek medical advice.
CAUTION
An adult may take the
recommended dose of paracetamol
tablets or his own painkillers. A child may
have the recommended dose of
paracetamol syrup (not aspirin).
2 Give the casualty
plenty of fluids to
help ease the pain and
stop the throat from
becoming dry.
1
SEE ALSO Foreign object in the ear p.197
SORE THROAT
226
MEDICAL CONDITIONS
■■ To relieve pain and discomfort
■■ To obtain medical help if necessary
YOUR AIMS
Pain in the abdomen often has a relatively minor cause, such as
food poisoning. The pain of a stitch usually occurs during
exercise and is sharp. Distension (widening) or obstruction of the
intestine causes colic – pain that comes and goes in waves –
which often makes the casualty double up in agony and may be
accompanied by vomiting.
Occasionally abdominal pain is a sign of a serious disorder
affecting the organs and other structures in the abdomen. If the
appendix bursts, or the intestine is damaged, the contents of
the intestine can leak into the abdominal cavity, causing
inflammation of the cavity lining. This life-threatening condition,
called peritonitis, causes intense pain, which is made worse
by movement or pressure on the abdomen, and will lead to
shock (pp.112–13).
An inflamed appendix (appendicitis) is especially common in
children. Symptoms include pain (often starting in the centre of
the abdomen and moving to the lower right-hand side), loss of
appetite, nausea, vomiting, bad breath and fever. If the appendix
bursts, peritonitis will develop. The treatment is urgent surgical
removal of the appendix.
ABDOMINAL PAIN
■■ If the pain is severe, or occurs
with fever and vomiting, call
999/112 for emergency help.
Treat the casualty for shock
(pp.112–13). Do not give her
medicine or allow her to
eat or drink, because an
anaesthetic may be needed.
CAUTION
WHAT TO DO
Reassure the casualty and make her comfortable. Prop her
up if she finds breathing difficult. Give her a container to use
if she is vomiting.
Give the casualty a hot-water bottle wrapped in a towel to hold
against her abdomen. If in doubt about her condition, seek
medical advice.
2
1
SEE ALSO Shock pp.112–13
This common condition is a form of
cramp, usually associated with
exercise, which occurs in the trunk
or the sides of the chest. The most
likely cause is a build-up in the
muscles of chemical waste
products, such as lactic acid, during
physical exertion. Help the casualty
to sit down and reassure him. The
pain will usually ease quickly. If it
does not disappear within a few
minutes, or if you are concerned
about the casualty’s condition, seek
medical advice.
SPECIAL CASE STITCH
227
ABDOMINAL PAIN | VOMITING AND DIARRHOEA
VOMITING AND DIARRHOEA
SEE ALSO Drug poisoning p.201 | Swallowed poisons p.200
WHAT TO DO
Reassure the casualty if she is vomiting and
give her a warm damp cloth to wipe her face.
Help her to sit down and, when the vomiting
stops, give her water or unsweetened fruit
juice to sip slowly and often.
When the casualty is hungry again, advise
her to eat easily digested foods such as pasta,
bread or potatoes for the first 24 hours.
2
1
3
There may be:
■■ Nausea
■■ Vomiting and later diarrhoea
■■ Stomach pains
■■ Fever
RECOGNITION
These problems are usually due to irritation of the digestive
system. Diarrhoea and vomiting can be caused by a number of
different organisms, including viruses, bacteria and parasites.
They usually result from eating contaminated food or drinking
contaminated water, but infection can be passed directly from
person to person. Cleanliness and good hand hygiene (p.17) help
prevent the spread of infectious diarrhoea.
Vomiting and diarrhoea may occur either separately or together.
Both conditions can cause the body to lose vital fluids and salts,
resulting in dehydration. When they occur together, the risk of
dehydration is increased and can be serious, especially in infants,
young children and elderly people.
The aim of treatment is to prevent dehydration by giving
frequent sips of water or unsweetened fruit juice, even if the
casualty is vomiting. Rehydration powder, which is added to
water, provides the correct balance of water and salt to replace
those lost through the vomiting and diarrhoea.
■■ Do not give anti-diarrhoea
medicines.
■■ If you are concerned about a
casualty’s condition, particularly
if the vomiting or diarrhoea is
persistent, or the casualty is a
young child or an older person,
seek medical advice.
CAUTION
■■ To reassure the casualty
■■ To restore lost fluids and salts
YOUR AIMS
228
MEDICAL CONDITIONS
■■ To obtain medical help or arrange for
the woman to be taken to hospital
■■ To ensure privacy, reassure the
woman and make her comfortable
■■ To prevent infection in the mother,
baby and yourself
■■ To care for the baby during and
after delivery
YOUR AIMS Childbirth is a natural and often lengthy process that normally
occurs at about the 40th week of pregnancy. There is usually
plenty of time to get a woman to hospital, or get help to her,
before the baby arrives. Most pregnant women are aware of
what happens during childbirth, but a woman who goes into
labour unexpectedly or early may be very anxious. You will need
to reassure her and make her comfortable. Miscarriage, however,
is potentially serious because there is a risk of severe bleeding.
A woman who is miscarrying needs urgent medical help (p.128).
There are three distinct stages to childbirth. In the first stage,
the baby gets into position for the birth. The baby is born in the
second stage, and in the third stage, the afterbirth (placenta and
umbilical cord) is delivered.
First stage
In this stage, a woman’s body begins
to experience contractions, which,
together with the pressure of the
baby’s head, cause the cervix (neck
of the uterus/womb) to open. The
contractions become stronger and
more frequent until the cervix is
fully dilated (open) – about 10cm
(4in) – and ready for the baby to be
born. During this first stage, the
mucus plug that protects the uterus
from infection is expelled and the
amniotic fluid surrounding the baby
leaks out from the vagina. This stage
can take several hours for a first
baby, but is normally shorter in any
subsequent pregnancies.
Second stage
Once the cervix is fully dilated, the
baby’s head will press down on the
mother’s pelvic floor, triggering a
strong urge to push. The birth canal
(vagina) stretches as the baby
travels through it. The baby’s head
normally emerges first, and the
body is delivered soon afterwards.
This stage of labour normally lasts
about an hour.
Third stage
About 10–30 minutes after the baby
is born, the placenta (the organ that
nourishes the unborn baby) and the
umbilical cord will be expelled from
the uterus. The uterus begins to
contract again, pushing the placenta
out, then it closes down the area
where it was attached; this reduces
the bleeding.
CHILDBIRTH
Placenta detaches from
wall of uterus
Baby’s head
presses against
cervix
Baby
emerges
Uterus contracts
to push baby
down
Birth canal
fully dilated
Umbilical cord
229
CHILDBIRTH | EMERGENCY CHILDBIRTH
EMERGENCY CHILDBIRTH
SEE ALSO Shock pp.112–13 | Vaginal bleeding p.128
■■ Do not give the mother anything to eat because there is a risk
that she may vomit. If she is thirsty give her sips of water.
■■ Do not pull on the baby’s head or shoulders during delivery.
■■ If the umbilical cord is wrapped around the baby’s neck as he is
born, check that it is loose, and then very carefully ease it over
the head to protect the baby from strangulation.
■■ If a newborn baby does not cry, open the airway and check
breathing (Unresponsive infant, pp.80–83). Do not smack a baby.
■■ Do not pull or cut the umbilical cord, even when the placenta
has been delivered.
WHAT TO DO
Call 999/112 for emergency help. Give the
ambulance control details of the stage that the
mother has reached, the length of each contraction
and the intervals between them. Call the mother’s
midwife too if she requests it.
As the baby is born, handle him carefully, as
newborn babies are very slippery. Give him to
the mother; lay him on her stomach or wrap him in
a clean cloth, towel or blanket.
As the third stage begins, reassure the
mother. Support her as she delivers the
afterbirth; do not cut the cord. Keep the placenta
and the umbilical cord intact as the midwife,
doctor or ambulance crew need to check that it
is complete. If bleeding or pain is severe, treat for
shock (pp.112–13). Help the mother to lie down
and raise her legs.
When the second stage starts, the mother
will want to push. Make sure the surroundings
are as clean as possible to reduce the risk of
infection. The mother should remove any items
of clothing that could interfere with the birth. Put
clean sheets or towels under the woman; she may
also want to be covered. Encourage her to stay as
upright as possible.
During the first stage, help her sit or kneel
on the floor in a comfortable position. Support
her with cushions or let her move around. Stay
calm, and encourage her to breathe deeply during
her contractions.
Massage her lower back gently using the heel
of your hand. She may find having her face and
hands wiped soothing, or you can spray her face
with cool water and give her ice cubes to suck.
4
5
6
2
1
3
In the rare event of a baby arriving
quickly, you should not try to “deliver”
the baby; the birth will happen
naturally without intervention. Your
role is to comfort and listen to the
wishes of the mother and care for her
and her baby.
CAUTION
This chapter outlines the techniques
and procedures that underpin first aid,
including moving a casualty and applying
dressings and bandages. Usually, a first
aider is not expected to move an injured
person, but in some circumstances – such
as when a casualty is in immediate danger –
it may be necessary. The key principles for
moving casualties are described here.
Information is also given on making an
assessment of the risks involved in moving
a casualty or assisting a casualty to safety.
A guide to the equipment and materials
commonly found in a first aid kit is given,
with information on how and when to use
them. Applying dressings and bandages
effectively is an essential part of first aid:
wounds usually require a dressing, and
almost all injuries benefit from the support
that bandages can give.
■■ To assess the casualty’s condition
■■ To comfort and reassure the casualty
■■ To maintain a casualty’s privacy and dignity
■■ To use a first aid technique relevant to the injury
■■ To use dressings and bandages as needed
■■ To apply good handling techniques if moving
a casualty
■■ To obtain appropriate help: call 999/112 for
emergency help if you suspect serious injury
or illness
AIMS AND OBJECTIVES
TECHNIQUES
AND EQUIPMENT
232
REMOVING CLOTHING
To make a thorough examination of a casualty,
obtain an accurate diagnosis or give treatment,
you may have to remove some of his clothing.
This should be done with the minimum of
disturbance to the casualty and with his
agreement if possible. Remove as little clothing
as possible and do not damage clothing unless it
is necessary. If you need to cut a garment, try to
cut along the seams, keeping the clothing clear
of the casualty’s injury. Maintain the casualty’s
privacy and prevent exposure to cold. Stop if
removing clothing increases the casualty’s
discomfort or pain.
REMOVING CLOTHING IN LOWER BODY INJURIES
REMOVING CLOTHING IN UPPER BODY INJURIES
Shoes
Untie any laces, support the ankle
and carefully pull the shoe off by
the heel. To remove long boots,
you may need to cut them down
the back seam.
Socks
Remove socks by pulling them
off gently. If this is not possible,
lift each sock away from the leg
and cut the fabric with a pair
of scissors.
Trousers
Gently pull up the trouser leg
to expose the calf and knee or pull
down from the waist. If you need
to cut clothing, lift it clear of the
casualty’s injury.
Jackets
Support the injured arm. Undo any fastenings on the
jacket and gently pull the garment off the casualty’s
shoulders. Remove the arm on the uninjured side from
its sleeve. Pull the garment round to the injured side
of the body and ease it off the injured arm.
Sweaters and sweatshirts
With clothing that cannot be unfastened, begin by
easing the arm on the uninjured side out of its sleeve.
Next, roll up the garment and stretch it over the
casualty’s head. Finally, slip off the other sleeve of the
garment, taking care not to disturb her arm on the
injured side.
TECHNIQUES AND EQUIPMENT
233
Protective headgear, such as a riding hat or a motorcyclist’s
crash helmet, is best left on; it should be removed only if
absolutely necessary, for example, if you cannot maintain an
open airway. If the item does need to be removed, the casualty
should do this herself if possible; otherwise, you and a helper
should remove it. Take care to support the head and neck at all
times and keep the head aligned with the spine.
REMOVING CLOTHING | REMOVING HEADGEAR
SEE ALSO Spinal injury pp.157–59
Ask a helper to grip the
sides of the helmet and pull
them apart to take pressure off
the head, then lift the helmet
upwards and backwards.
Undo or cut the straps. Working from the base
of the helmet, ease your fingers underneath
the rim. Support the back of the neck with one
hand and hold the lower jaw firmly. Ask a helper to
hold the helmet with both hands.
Maintain support on the head and neck. Ask your helper to tilt
the helmet forwards slightly so that it will pass over the base of
the skull, and then to lift it straight off the casualty’s head.
Continue to support the casualty’s neck and
lower jaw. Ask your helper, working from
above, to tilt the helmet backwards (without
moving the head) and gently lift the front of the
helmet clear of the casualty’s chin.
2
1
3
2
Do not remove a helmet unless
absolutely necessary.
CAUTION
REMOVING AN OPEN-FACE OR RIDING HELMET
REMOVING A FULL-FACE HELMET
Undo or cut through the
chinstrap. Support the
casualty’s head and neck,
keeping them aligned with the
spine. Hold the lower jaw with
one hand and support the neck
with the other hand.
1
REMOVING HEADGEAR
234
CASUALTY HANDLING
■■ Do not approach a casualty
if doing so puts your own life in
danger.
■■ Do not move a casualty unless
there is an emergency situation
that demands you take
immediate action.
When giving first aid you should leave a casualty in the position
in which you find him until medical help arrives. Only move him
if he is in imminent danger, and even then only if it is safe for you
to approach and you have the training and equipment to carry
out the move. A casualty should be moved quickly if he is in
imminent danger from:
■■Drowning (p.100)
■■Fire or he is in an area that is filling with smoke (pp.32–33)
■■Explosion or gunfire
■■A collapsing building or other structure
CAUTION
If it is necessary to move a casualty, consider
the following before you start.
■■Is the task necessary? Usually, the casualty
can be assessed and treated in the position in
which you find him.
■■What are his injuries or conditions, and will a
move make them worse?
■■Can the casualty move himself? Ask the
casualty if he feels able to move.
■■The weight and size of the casualty.
■■Can anyone help? If so, are you and any
helpers trained and physically fit?
■■Will you need protective equipment to enter
the area, and do you have it?
■■Is there any equipment available to assist
with moving the casualty and are you trained
to use it?
■■Is there enough space around the casualty
to move him safely?
■■What sort of ground will you be crossing?
If you need to move a casualty, take the
following steps to ensure safety.
■■Select a method relevant to the situation,
the casualty’s condition and the help and
equipment that is available.
■■Use a team. Appoint one person to
coordinate the move and make sure that the
team understands exactly what to do.
■■Plan your move carefully and make sure that
everyone is prepared.
■■Prepare any equipment and make sure that
the team and equipment are in position.
■■Use the correct technique to avoid injuring
the casualty, yourself or any helpers.
■■Ensure the safety and comfort of the casualty,
yourself and any helpers.
■■Always explain to the casualty what is
happening, and encourage him to cooperate
as much as possible.
■■Position yourself as close as possible
to the casualty’s body.
■■Adopt a stable base, with your feet shoulderwidth
apart, so that you remain well balanced
and maintain good posture at all times during
the procedure.
■■Use the strongest muscles in your legs and
arms to power the move. Bend your knees.
ASSESSING THE RISK OF MOVING A CASUALTY
ASSISTING A CASUALTY SAFELY
TECHNIQUES AND EQUIPMENT
235
FIRST AID MATERIALS
All workplaces, leisure centres, homes and cars
should have first aid kits. The kits for workplaces
or public places must conform to legal
requirements and be clearly marked in a green
box with a white cross and easily accessible. For
home or the car, you can either buy a kit or put
together first aid items yourself and keep them
in a clean, waterproof container. Any first aid kit
must be kept in a dry place, and checked and
replenished regularly.
The items on these pages form the basis of a
first aid kit for the home. You may wish to add
pain-relief tablets such as paracetamol.
STERILE DRESSINGS
CASUALTY HANDLING | FIRST AID MATERIALS
Wound dressings
The most useful dressings
consist of a dressing pad
attached to a roller
bandage, and are sealed in
protective wrapping. They
are easy to apply, so are
ideal in an emergency.
Various sizes are available.
Individual sterile dressing
pads are also available that
can be secured with tape
or bandages. Dressings
with a non-stick surface
are useful.
Adhesive dressings or plasters
These are applied to small cuts
and grazes and are made of fabric
or waterproof plastic. Use
hypoallergenic plasters for anyone
who is allergic to the adhesive in
regular ones. People who work
with food are required to use blue
plasters. Special gel plasters can
protect blisters.
STERILE EYE PAD
STERILE WOUND DRESSING STERILE PAD
FABRIC PLASTERS WATERPROOF PLASTERS
CLEAR PLASTERS BLUE CATERING PLASTERS
NOVELTY PLASTERS FOR CHILDREN
GEL BLISTER PLASTER »
236
FIRST AID MATERIALS
PROTECTIVE ITEMS
BANDAGES
Roller bandages
These items are used to give
support to injured joints, secure
dressings in place, maintain
pressure on wounds and
limit swelling.
Triangular bandages
Made of cloth, these items can be used folded
as bandages or slings. If they are sterile and
individually wrapped, they may also be used
as dressings for large wounds and burns.
Disposable gloves
Wear gloves, if available, whenever you dress
wounds or when you handle body fluids or other
waste materials. Use latex-free gloves because
some people are allergic to latex.
Tubular bandages
Gauze tubular bandage is used to secure dressings
on fingers and toes and is put over the injury using
a special applicator. Elasticated tubular bandages
are sometimes used to support injured joints such
as the knee or elbow.
Protection from infection
You can use a plastic face shield or a pocket mask
to protect you and the casualty from cross infection
when giving rescue breaths.
TECHNIQUES AND EQUIPMENT
FACE SHIELD POCKET MASK
GAUZE TUBULAR BANDAGE AND APPLICATOR
SUPPPORT
ROLLER BANDAGE
CONFORMING
ROLLER BANDAGE
OPEN-WEAVE
ROLLER BANDAGE
SELF-ADHESIVE
BANDAGE
FOLDED TRIANGULAR BANDAGE
«
237
BASIC MATERIALS FOR A FIRST AID KIT
ADDITIONAL ITEMS
FIRST AID MATERIALS
Cleansing wipes
Alcohol-free wipes can be used
to clean skin around wounds.
Useful extras
Kitchen film or clean plastic bags can be used to dress
burns and scalds. Keep a bottle of alcohol gel to clean
your hands when no water is available.
Scissors, shears and tweezers
Choose items that ideally are blunt-ended so that they
will not cause injuries. Use shears to cut clothing.
Pins and clips
Use these to secure the ends of bandages.
Gauze pads
Use these pads as dressings, as
padding, or as swabs to clean
around wounds.
Adhesive tape
Use tape to secure dressings
or the loose ends of bandages.
If the casualty is allergic to the
adhesive on the tape, use a
hypoallergenic tape.
For use outdoors
A blanket can protect a casualty from cold. Survival
bags are very compact and will keep a person warm
and dry in an emergency. A torch helps visibility, and
a whistle can be used to summon help.
■■ Easily identifiable watertight box
■■ 20 adhesive dressings (plasters) in
assorted sizes
■■ Six medium sterile dressings
■■ Two large sterile dressings
■■ One sterile eye pad
■■ Six triangular bandages
■■ Six safety pins
■■ Disposable gloves
■■ Two roller bandages
■■ Scissors
■■ Tweezers
■■ Alcohol-free wound cleansing wipes
■■ Adhesive tape
■■ Plastic face shield or pocket mask
■■ Notepad and pencil
■■ Alcohol gel
Other useful items:
■■ Blanket, survival bag, torch, whistle
■■Warning triangle and high visibility
jacket to keep in the car
238
DRESSINGS
You should always cover a wound with a
dressing because this helps to prevent infection.
With severe bleeding, dressings are used to help
the blood-clotting process by exerting pressure
on the wound. Use a pre-packed sterile wound
dressing with a bandage attached (opposite)
whenever possible. If no such dressing is
available, use a sterile pad. Alternatively,
any clean, non-fluffy material can be used
to improvise a dressing (p.240). Protect small
cuts with an adhesive dressing (p.241).
When handling or applying a dressing, there
are a number of rules to follow. These enable
you to apply dressings correctly; they also
protect the casualty and yourself from
cross infection.
■■Always put on disposable gloves, if these are
available, before handling any dressing.
■■Cover the wound with a dressing that extends
beyond the wound’s edges.
■■Hold the edge of the dressing, keeping your
fingers well away from the area that will be in
contact with the wound.
■■Place the dressing directly on top of the
wound; do not slide it on from the side.
■■Remove and replace any dressing that slips
out of position.
■■If you only have one sterile dressing, use it
to cover the wound, and put other clean
materials on top of it.
■■If blood seeps through the dressing, do not
remove it; instead, place another dressing
over the top. If blood seeps through the
second dressing, remove both dressings
completely and then apply a fresh dressing,
making sure that you put pressure on the
bleeding point.
■■After treating a wound, dispose of gloves,
used dressings and soiled items in a suitable
plastic bag, ideally a clinical waste bag
(below). Keep disposable gloves on until you
have finished handling any materials that may
be contaminated, then put them in the waste
bag as well.
RULES FOR USING DRESSINGS
TECHNIQUES AND EQUIPMENT
WEAR DISPOSABLE GLOVES USE DRESSING LARGER THAN WOUND DISPOSE OF WASTE
SEE ALSO Cuts and grazes p.119 | First aid materials pp.235–37 | Severe external bleeding pp.114–15
239
HOW TO APPLY A STERILE WOUND DRESSING
DRESSINGS
■■ If the dressing slips out of place,
remove it and apply a new
dressing.
■■ Take care not to impair the
circulation beyond the
bandage (p.243).
WHAT TO DO
Break the seal and remove the wrapping.
Unwind some of the bandage, taking care not
to drop the roll or touch the dressing pad.
Wind the other end (head) of the bandage
around the limb to cover the whole pad. Leave
the short end of the bandage hanging free.
To secure the bandage, tie the ends in a reef
knot (p.250). Tie the knot directly over the pad
to maintain firm pressure on the wound.
Once you have secured the bandage, check
the circulation in the limb beyond it (p.243).
Loosen the bandage if it is too tight, then reapply.
Recheck every ten minutes.
Unfold the dressing pad, and lay it directly on
the wound. Hold the bandage on each side of
the pad as you place it over the wound.
Wind the short end of the bandage once
around the limb and the pad to secure
the dressing.
4
5
6
2
1
3
This type of dressing consists of a dressing pad attached to
a roller bandage. The pad is a piece of gauze backed with a layer
of cotton wool or padding.
Sterile dressings are available individually wrapped in various
sizes. They are sealed in protective wrappings to keep them
sterile. Once the seal on this type of dressing has been broken,
the dressing is no longer sterile.
CAUTION
»
240
DRESSINGS
If there is no sterile wound dressing with bandage available,
use a sterile pad or make a pad out of pieces of gauze. Make sure
the pad is large enough to extend well beyond the edges of the
wound. Hold the dressing face down; never touch the part of
the dressing that will be in contact with a wound. Secure the
dressing with tape. If you need to maintain pressure to control
bleeding, use a bandage.
If you have no suitable dressings, any clean
non-fluffy material can be used in an emergency.
If using a piece of folded cloth, hold it by its
edges, unfold it, then refold it so that the clean
inner side can be placed against the wound.
IMPROVISED DRESSINGS
STERILE PAD AND GAUZE DRESSINGS
TECHNIQUES AND EQUIPMENT
WHAT TO DO
WHAT TO DO
■■ Never apply adhesive tape all
the way around a limb or digit
since this can impair circulation.
■■ Check that the casualty is not
allergic to the adhesive before
using adhesive tape; if there is
any allergy, use a pad and
bandage instead.
CAUTION
Secure the pad with a
bandage or a clean strip
of cloth, such as a scarf. Tie
the ends in a reef knot (p.250).
Place the cloth pad
directly on to the wound. If
necessary, cover the pad with
more material.
Secure the pad with adhesive tape or a roller
bandage.
Hold the material by the
edges. Open it out and
refold it so that the inner surface
faces outwards.
Holding the dressing or pad by the edges,
place it directly on to the wound.
2 3
2
1
1
«
241
DRESSINGS | COLD COMPRESSES
Plasters, or adhesive dressings, are useful for covering small
cuts and grazes. They consist of a gauze or cellulose pad with an
adhesive backing, and are wrapped singly in sterile packs. There
are several sizes available, as well as special shapes for use on
fingertips, heels and elbows; some types are waterproof. Blister
plasters have an oval cushioned pad. People who work with food
must cover any wounds with visible, blue, waterproof plasters.
Cooling an injury such as a bruise or sprain can reduce swelling
and pain. There are two types of compress: cold pads, which are
made from material dampened with cold water, and ice packs. An
ice pack can be made using ice cubes (or packs of frozen peas or
other small vegetables) wrapped in a dry cloth.
ADHESIVE DRESSINGS
WHAT TO DO
Clean and dry the skin around the wound. Unwrap the plaster
and hold it by the protective strips over the backing, with the pad
side facing downwards.
Peel back the strips to
expose the pad, but do not
remove them. Without touching
the surface of the pad, place the
pad on the wound.
Soak a clean flannel or
towel in cold water. Wring it
out lightly and fold it into a pad.
Hold it firmly against the injured
area (right).
Partly fill a plastic bag with
small ice cubes or crushed
ice, or use a pack of frozen
vegetables. Wrap the bag in a
dry cloth.
Carefully pull away the
protective strips, then press
the edges of the plaster down.
Re-soak the pad in cold
water every few minutes to
keep it cold. Cool the injury for
no more than ten minutes.
Hold the pack firmly on the
area (left). Cool the injury
for no more than ten minutes,
topping up the ice as needed.
1
3
2
2
1
2
1
■■ Check that the casualty
is not allergic to the adhesive
dressings. If he is, use
hypoallergenic tape or
a pad and bandage.
■■ To prevent cold injuries, always
wrap an ice pack in a cloth. Do
not leave it on the skin for more
than ten minutes at a time.
CAUTION
CAUTION
COLD PAD ICE PACK
USING A COLD COMPRESS
COLD COMPRESSES
242
PRINCIPLES OF BANDAGING
There are a number of different first aid uses
for bandages: they can be used to secure
dressings, control bleeding, support and
immobilise limbs and reduce swelling in an
injured limb. There are three main types of
bandage. Roller bandages secure dressings and
support injured limbs. Tubular bandages hold
dressings on fingers or toes, or support injured
joints. Triangular bandages can be used as large
dressings, as slings to secure dressings or folded
to immobilise limbs. If you have no bandage
available, you can improvise from everyday
items; for example, you can fold a square of
fabric, such as a headscarf, diagonally to make
a triangular bandage (p.249).
■■Reassure the casualty before applying a
bandage and explain clearly what you are
going to do.
■■Help the casualty to sit or lie down in a
comfortable position.
■■Support the injured part of the body while
you are working on it. Ask the casualty or a
helper to assist.
■■Work from the front of the casualty, and from
the injured side where possible.
■■Pass the bandages through the body’s natural
hollows at the ankles, knees, waist and neck,
then slide them into position by easing them
back and forth under the body.
■■Apply bandages firmly, but not so tightly that
they interfere with circulation to the area
beyond the bandage (opposite).
■■Fingers or toes should be left exposed, if
possible, so that you can check the circulation
afterwards.
■■Use reef knots to tie bandages (p.250).
Ensure that the knots do not cause
discomfort, and do not tie the knot over a
bony area. Tuck loose ends under a knot if
possible, to provide additional padding.
■■Check the circulation in the area beyond the
bandage (opposite) every ten minutes once
it is secure. If necessary, unroll the bandage
until the blood supply returns, and reapply
it more loosely.
RULES FOR APPLYING A BANDAGE
TECHNIQUES AND EQUIPMENT
SEE ALSO Roller bandages pp.244–47 | Triangular bandages p.249 | Tubular gauze bandages p.248
243
If circulation is impaired there
may be:
■■ A swollen and congested limb
■■ Blue skin with prominent veins
■■ A feeling that the skin is painfully
distended
Later there may be:
■■ Pale skin
■■ Skin cold to touch
■■ Numbness and tingling followed
by severe pain
■■ Inability to move affected fingers
or toes
RECOGNITION
When applying bandages to immobilise
a limb you also need to use soft, bulky material,
such as towels or clothing, as padding. Place the
padding between the legs, or between an arm
and the body, so that the bandaging does not
displace broken bones or press bony areas
against each other. Use folded triangular
bandages and tie them at intervals along the
limb, avoiding the injury site. Secure with reef
knots (p.250) tied on the uninjured side. If both
sides of the body are injured, tie knots in the
middle or where there is least chance of causing
further damage.
When bandaging a limb or applying a sling, you must check the
circulation in the hand or foot immediately after you have
finished bandaging, and every ten minutes thereafter. These
checks are essential because limbs can swell after an injury,
and a bandage can rapidly become too tight and restrict blood
circulation to the area beyond it. If this occurs, you need to undo
the bandage and reapply it more loosely.
IMMOBILISING A LIMB
CHECKING CIRCULATION AFTER BANDAGING
TIE KNOTS ON THE UNINJURED SIDE
PRINCIPLES OF BANDAGING
Press one of the nails or the
skin beyond the bandage,
for five seconds until it turns
pale, then release the pressure.
If the colour does not return
within two seconds, the bandage
is too tight.
Loosen a tight bandage by
unrolling enough turns for
warmth and colour to return to
the skin. The casualty may feel
a tingling sensation. If necessary
loosen and reapply the bandage.
Recheck every ten minutes.
1 2
WHAT TO DO
244
ROLLER BANDAGES
This type of bandage can be made of cotton,
gauze, elasticated fabric or linen and is
wrapped around the injured part of the body
in spiral turns. There are three main types of
roller bandage.
■■Open-weave bandages are used to hold
dressings in place. Because of their loose
weave they allow good ventilation, but they
cannot be used to exert direct pressure on
the wound to control bleeding or to provide
support to joints.
■■ Self-adhesive support bandages are used to
support muscle (and joint) injuries and do not
need pins or clips.
■■Crêpe bandages are used to give firm, even
support to injured joints.
There are several ways to fasten the end
of a roller bandage. Safety pins or adhesive tape
are usually included in first aid kits. Some
bandage packs may contain bandage clips. If you
do not have any of these, a simple tuck should
keep the bandage end in place.
Before applying a roller bandage, check that it
is tightly rolled and of a suitable width for the
injured area. Small areas such as fingers require
narrow bandages of approximately 2.5cm (1in)
wide, while wider bandages of 10–15cm (4–6in)
are more suitable for large areas such as legs.
It is better for a roller bandage to be too wide
than too narrow. Smaller sizes may be needed
for a child.
SECURING ROLLER BANDAGES
CHOOSING THE CORRECT SIZE OF BANDAGE
TECHNIQUES AND EQUIPMENT
Adhesive tape
The ends of bandages can be
folded under and then stuck down
with small strips of adhesive tape.
Safety pin
These pins can secure all types of
roller bandage. Fold the end of the
bandage under, then put your
finger under the previous layer of
bandage to prevent injury as you
insert the pin (right). Make sure
that, once fastened, the pin lies flat
(far right).
Bandage clip
Metal clips are sometimes supplied
with crêpe roller bandages for
securing the ends.
Tucking in the end
If you have no fastening, secure the
bandage by passing the end around
the limb once and tucking it in.
245
Follow the general rules below when applying a roller bandage
to an injury.
■■Keep the rolled part of the bandage (the “head”) uppermost
as you work. (The unrolled short end is called the “tail”.)
■■Position yourself in front of the casualty, on the injured side.
■■Support the injured part while you apply the bandage.
APPLYING A ROLLER BANDAGE
ROLLER BANDAGES
WHAT TO DO
Place the tail of the bandage below the injury.
Working from the inside of the limb outwards,
make two straight turns with the bandage to
anchor the tail in place.
Finish with one straight turn. If the bandage is
too short, apply another one in the same way
so that the injured area is covered.
Secure the end of the bandage, then check
the circulation beyond the bandage (p.243).
If necessary, unroll the bandage until the blood
supply returns, and reapply it more loosely.
Recheck every ten minutes.
Wind the bandage in spiralling turns working
from the inner to the outer side of the limb,
and work up the limb. Cover one half to twothirds
of the previous layer of bandage with
each new turn.
3
2 4
1
■■Once you have applied the
bandage, check the circulation
in the limb beyond it (p.243).
This is especially important if
you are applying an elasticated
or crêpe bandage since these
mould to the shape of the limb
and may become tighter if the
limb swells.
CAUTION
»
246
ROLLER BANDAGES
ELBOW AND KNEE BANDAGES
TECHNIQUES AND EQUIPMENT
WHAT TO DO
Pass the bandage to the
inner side of the limb, just
above the joint. Make a turn
around the limb, covering the
upper half of the bandage from
the first turn.
To finish bandaging the
joint, make two straight
turns around the limb, then
secure the end of the bandage
(p.244). Check the circulation
beyond the bandage as soon as
you have finished, then recheck
every ten minutes (p.243). If
necessary unroll the bandage
and reapply more loosely.
Support the injured limb in
a comfortable position for
the casualty, with the joint
partially flexed. Place the tail of
the bandage on the inner side of
the joint. Pass the bandage over
and around to the outside of the
joint. Make one-and-a-half turns,
so that the tail end of the bandage
is fixed and the joint is covered.
Continue to bandage
diagonally above and below
the joint in a figure-of-eight.
Increase the bandaged area by
covering about two-thirds of the
previous turn with each new
layer of bandage.
Pass the bandage from the
inner side of the upper limb
to just below the joint. Make one
diagonal turn below the elbow
joint to cover the lower half of
the bandaging from the first
straight turn.
2
5
1
3 4
■■ If the dressing slips out of place,
remove it and apply a new one.
■■ Take care not to impair the
circulation beyond the
bandage (p.243).
CAUTION
Roller bandages can be used on elbows and knees to support soft
tissue injuries such as strains or sprains. To ensure that there is
effective support, flex the joint slightly, then apply the bandage
in figure-of-eight turns rather than the standard spiralling turns
(p.245). Work from the inside to the outside of the upper surface
of the joint. Extend the bandaging far enough on either side of the
joint to exert an even pressure.
«
247
A roller bandage may be applied to hold
dressings in place on a hand, or to support a
wrist in soft tissue injuries. A support bandage
should extend well beyond the injury site
to provide pressure over the whole of the
injured area.
HAND BANDAGES
ROLLER BANDAGES
WHAT TO DO
Repeat the sequence of figure-of-eight turns.
Extend the bandaging by covering about twothirds
of the bandage from the previous turn with
each new layer. When the hand is completely
covered, finish with two straight turns around the
casualty’s wrist.
Secure the end (p.244). As soon as you have
finished, check the circulation beyond the
bandage (p.243), then recheck every ten minutes.
If necessary, unroll the bandage until the blood
supply returns and reapply it more loosely.
Pass the bandage diagonally
across the back of the hand
to the outer side of the wrist.
Take the bandage under the
wrist. Then repeat the diagonal
over the back of the hand.
Working from the inner side
of the wrist, pass the
bandage diagonally across the
back of the hand to the nail of
the little finger, and across the
front of the casualty’s fingers.
Place the tail of the bandage
on the inner side of the
wrist, below the base of the
thumb. Make two straight turns
around the wrist.
1 2 3
4
5
248
TUBULAR GAUZE BANDAGES
These bandages are rolls of seamless, tubular fabric. The tubular
gauze bandage is used with an applicator that is supplied with the
bandage. It is suitable for holding dressings in place on a finger or
toe, but not to control bleeding. Use hypoallergenic tape to secure
the bandage if the casualty has an allergy to adhesive tape.
TECHNIQUES AND EQUIPMENT
4
1 3
2
Cut a piece of tubular gauze about two-and-ahalf
times the length of the casualty’s injured
finger. Push the whole length of the tubular gauze
on to the applicator, then gently slide the
applicator over the finger and dressing.
While still holding the gauze at the base of
the finger, gently push the applicator back
over the finger to apply a second layer of gauze.
Once the gauze has been applied, remove the
applicator from the finger.
Holding the end of the gauze on the finger,
pull the applicator slightly beyond the
fingertip, leaving a layer of gauze bandage on
the finger. Twist the applicator twice to seal the
bandage over the end of the finger.
Secure the gauze at the base of the finger with
adhesive tape, that does not encircle the
finger. Check the circulation to the finger (p.243),
then again every ten minutes. Ask the casualty
if the finger feels cold or tingly. If necessary,
remove the gauze and apply it more loosely.
■■ Do not encircle the finger
completely with tape because
this may impair circulation.
APPLYING A TUBULAR GAUZE BANDAGE
CAUTION
249
This type of bandage may be supplied in a
sterile pack as part of a first aid kit. You can also
make one by cutting or folding a square metre
of sturdy fabric (such as linen or calico)
diagonally in half. The bandage can be used in
the following three ways.
■■Folded as a broad-fold bandage or narrowfold
bandage (below) to immobilise and
support a limb or to secure a splint or
bulky dressing.
■■Opened to form a sling, or to hold a hand,
foot or scalp dressing in place.
■■If from a sterile pack, folded into a pad and
used as a sterile dressing.
Keep triangular bandages in
their packs so that they remain
sterile until you need them.
Alternatively, fold them as
shown (right) so that they are
ready-folded for use as a pad
or bandage, or can be shaken
open for use as a sling.
STORING A TRIANGULAR BANDAGE
MAKING A BROAD-FOLD
BANDAGE
MAKING A NARROW-FOLD
BANDAGE
TUBULAR GAUZE BANDAGES | TRIANGULAR BANDAGES
Open out a triangular bandage and lay it
flat on a clean surface. Fold the bandage
in half horizontally, so that the point of the triangle
touches the centre of the base.
Start by folding the triangle
into a narrow-fold bandage
(above right). Bring the two ends
of the bandage into the centre.
Fold a triangular bandage to make a broad-fold
bandage (above).
Continue folding the ends
into the centre until the
bandage is a convenient size for
storing. Keep the bandage in a
dry place.
Fold the bandage in half again in the
same direction, so that the first folded
edge touches the base. The bandage should now
form a broad strip of fabric.
Fold the bandage horizontally in half again.
It should form a long, narrow, thick strip
of material.
2
2
1
1
1
2
Point
End
OPEN TRIANGULAR BANDAGE Base
TRIANGULAR BANDAGES
250
REEF KNOTS
HAND AND FOOT COVER BANDAGE
When securing a triangular bandage, always
use a reef knot. It is secure and will not slip, it is
easy to untie and it lies flat, so it is more
comfortable for the casualty. Avoid tying the
knot around or directly over the injury, since
this may cause discomfort.
Pass the left end of
the bandage (dark)
over and under the
right end (light).
Lift both ends
of the bandage
above the rest of
the material.
Lay the bandage
flat. Place the
casualty’s hand on the
bandage, fingers
towards the point. Fold
the point down over
the hand.
Pass the end in
your right hand
(dark) over and under
the left end (light).
Cross the ends
over the hand,
then pass the ends
around the wrist in
opposite directions. Tie
the ends in a reef knot
(above) at the wrist.
Pull the ends to
tighten the knot,
then tuck them under
the bandage.
Pull the point
gently to tighten
the bandage. Fold the
point up over the knot
and tuck it in.
1 2
1
3
2
4
3
TYING AND UNTYING A REEF KNOT
Untying a reef knot
Pull one end and one piece of bandage
from the same side of the knot firmly so
that the piece of bandage straightens.
Hold the knot and pull the straightened
end through it.
An open triangular
bandage can be used
to hold a dressing in
place on a hand or
foot, but it will not
provide enough
pressure to control
bleeding. The method
for covering a hand
(right) can also be
used for a foot, with
the bandage ends tied
at the ankle.
TECHNIQUES AND EQUIPMENT
251
ARM SLING
WHAT TO DO
Ensure that the injured arm
is supported with the hand
slightly higher than the elbow.
Fold the base of the bandage
under to form a hem. Place the
bandage with the base parallel
to the casualty’s body and level
with his little finger nail. Slide
the upper end under the injured
arm and pull it around the neck
to the opposite shoulder.
Tie a reef knot (opposite)
on the injured side, at the
hollow above the casualty’s
collar bone. Tuck both free ends
of the bandage under the knot
to pad it. Adjust the sling so that
the front edge supports the
hand – it should extend to the
top of the casualty’s little finger.
Fold the lower end of
the bandage up over the
forearm and bring it to meet
the upper end at the shoulder.
Hold the point of the
bandage beyond the elbow
and twist it until the fabric fits
the elbow snugly, then tuck it in
(inset). Alternatively, if you have
a safety pin, fold the fabric and
fasten it to the front.
As soon as you have
finished, check the
circulation in the fingers (p.243).
Recheck every ten minutes. If
necessary, loosen and reapply
the bandages and sling.
1
3
2
4 5
An arm sling holds the forearm in a slightly
raised or horizontal position. It provides support
for an injured upper arm, wrist or forearm, on a
casualty whose elbow can be bent, or to
immobilise the arm for a rib fracture (p.154).
An elevation sling (p.252) is used to keep the
forearm and hand raised in a higher position.
REEF KNOTS | HAND AND FOOT COVER BANDAGE | ARM SLING
252
ELEVATION SLING
This form of sling supports the forearm and
hand in a raised position, with the fingertips
touching the casualty’s shoulder. In this way, an
elevation sling helps to control bleeding from
wounds in the forearm or hand, to minimise
swelling. An elevation sling is also used to
support the arm in the case of an injured hand.
WHAT TO DO
TECHNIQUES AND EQUIPMENT
Ask the casualty to support
his injured arm across his
chest, with his fingers resting on
the opposite shoulder.
Bring the lower end of the
bandage up diagonally
across his back, to meet the
other end at his shoulder.
Place the bandage over his
body, with one end over the
shoulder on the uninjured side.
Hold the point of the bandage
just beyond his elbow.
Tie the ends in a reef knot
(p.250) at the hollow above
the bone. Tuck the ends under
the knot to pad it.
Ask the casualty to let go
of his injured arm while
you tuck the base of the
bandage under his hand,
forearm and elbow.
Twist the point until the
bandage fits closely around
the casualty’s elbow (inset). Tuck
the point in just above his elbow
to secure it. If you have a safety
pin, fold the fabric over the
elbow and fasten the point at
the corner. Check the circulation
in the thumb every ten minutes
(p.243); loosen and reapply
if necessary.
1
4
2
5
3
6
253
ELEVATION SLING | IMPROVISED SLINGS
IMPROVISED SLINGS
If you suspect that the forearm
is broken, use a cloth sling or
a jacket corner to provide
support. Do not use any other
improvised sling: it will not
provide enough support.
If you need to support a casualty’s injured arm but do not have
a triangular bandage available, you can make a sling by using a
square metre (just over one square yard) of any strong cloth
(p.249). You can also improvise by using an item of the casualty’s
clothing (below). Check circulation after applying support (p.243)
and recheck every ten minutes.
CAUTION
Jacket corner
Undo the casualty’s
jacket. Fold the lower
edge on the injured side
up over his arm. Secure
the corner of the hem to
the jacket breast with a
large safety pin. Tuck and
pin the excess material
closely around the elbow.
Button-up jacket
Undo one button of
a jacket or coat (or
waistcoat). Place the
hand of the injured arm
inside the garment at
the gap formed by the
unfastened button.
Advise the casualty to rest
his wrist on the button
just beneath the gap.
Belt or thin garment
Use a belt, a tie or a pair
of braces or tights to
make a “collar-and-cuff”
support. Fasten the item
to form a loop. Place it
over the casualty’s head,
then twist it once to form
a smaller loop at the
front. Place the casualty’s
hand into the loop.
Long-sleeved shirt
Place the injured arm
across the casualty’s
chest. Pin the cuff of the
sleeve to the breast of
the shirt. To improvise an
elevation sling (opposite),
pin the sleeve at the
casualty’s opposite
shoulder, to keep her
arm raised.
This chapter is designed as a userfriendly
quick-reference guide to
first aid treatment for casualties with
serious illnesses or injuries. It begins
with an action plan to help you assess a
casualty and identify first aid priorities,
using the primary survey (pp.44–45)
followed by the secondary survey
(pp.46–48) where appropriate.
The chapter goes on to show how to
treat unresponsive casualties, whose care
always takes priority over that of less
seriously injured casualties. In addition,
there is step-by-step essential first aid for
potentially life-threatening illnesses and
injuries that benefit from immediate first
aid. These include asthma, stroke, severe
bleeding, shock, heart attack, burns, broken
bones and spinal injuries. Each condition is
described in more detail in the main part of
the book and cross-referenced here so that
the entry can easily be found if you need
further advice and background information.
■■ To protect yourself from danger and make the
area safe
■■ To assess the situation quickly and calmly and
summon appropriate help
■■ To assist casualties and provide necessary treatment
with the help of bystanders
■■ To call 999/112 for emergency help if you suspect
a serious illness or injury
■■ To be aware of your own needs
AIMS AND OBJECTIVES
EMERGENCY
FIRST AID
256
EMERGENCY FIRST AID
ACTION IN AN EMERGENCY
UNRESPONSIVE
CASUALTY
Use the primary survey (pp.44–45) to identify
the most serious injury, and treat injuries in
order of priority. Once these are managed
carry out a secondary survey (pp.46–48).
AIRWAY
Is the casualty’s airway open
and clear?
Open the airway
Tilt the head and lift the chin
to open the airway.
BREATHING
Is the casualty
breathing normally?
Check breathing
Look along the chest,
and listen and feel
for breaths.
CIRCULATION
Check for and treat life-threatening conditions, such
as severe bleeding.
Call 999/112 for emergency help.
Maintain an open airway. Place the casualty on
his side in the recovery position.
DANGER
Make sure the area is safe before you
approach. Is anyone in danger?
RESPONSE
Is the casualty responding?
Try to initiate a response by asking
questions and gently shaking his
shoulders.
Is there a response?
CPR/CIRCULATION
Ask someone to call 999/112 for
emergency help and bring an AED
if possible. Begin cardiopulmonary
resuscitation/CPR (adult p.258,
child p.260, infant p.260).
Are you on your own?
CPR/CIRCULATION
If the casualty is a child or infant, give
FIVE initial rescue breaths and
cardiopulmonary resuscitation/CPR for
one minute (child p.260, infant p.260).
Call 999/112 for emergency help, then
continue CPR. Take a child or infant to
the phone if necessary.
If the casualty is an adult, call 999/112
for emergency help first, then begin
CPR (p.258).
Do not leave any casualty (adult or child)
alone to search for an AED.
START
CHEST-COMPRESSION-ONLY CPR
If you have not had training in CPR or
you are unwilling or unable to give
rescue breaths you can give chest
compressions only. The emergency
services will give instructions for
chest-compression-only CPR.
NO
NO
NO
NO
YES
YES
YES
YES
257
ACTION IN AN EMERGENCY
Anaphylactic shock p.268
Asthma p.268
Broken bones p.274
Burns and scalds p.274
Choking adult p.264
Choking child p.264
Choking infant p.266
Head injury p.272
Heart attack p.262
Hypoglycaemia p.278
Meningitis p.266
Seizures in adults p.276
Seizures in children p.276
Severe external bleeding p.270
Shock p.270
Spinal injury p.272
Stroke p.262
Swallowed poisons p.278
RESPONSIVE
CASUALTY
If it is not safe, do not approach.
Call 999/112 for emergency help.
AIRWAY AND
BREATHING
If a person is alert and
talking to you, it follows
that her airway is open
and clear and she is
breathing. Her breathing
may be fast, slow, easy
or difficult. Assess and
treat any problem found.
CIRCULATION
Are there life-threatening conditions, such as
severe bleeding or heart attack?
CARRY OUT A SECONDARY SURVEY
Assess the level of response using the AVPU scale (p.52) and
carry out a head-to-toe survey to check for signs of illness or injury.
Call for appropriate help. Call 999/112 for emergency help if you suspect
serious injury or illness. Monitor and record a casualty's vital signs – breathing,
pulse and level of response (pp.52–53) – while waiting for help to arrive.
TREAT LIFE-THREATENING
INJURIES OR ILLNESSES
Call 999/112 for emergency help.
Monitor and record a casualty's vital
signs – breathing, pulse and level of
response (pp.52–53) – while waiting for
help to arrive.
A–Z OF EMERGENCIES
NO
YES
258
EMERGENCY FIRST AID
CPR FOR AN ADULT
CHEST-COMPRESSION-ONLY CPR
Place one hand on the centre
of the casualty’s chest. Place the
heel of your other hand on top of
the first and interlock your fingers,
but keep your fingers off the
casualty’s ribs.
Check for a response. Gently
shake the casualty’s shoulders,
and talk to him. If there is no
response, go to the next step.
Lean directly over the casualty’s
chest and press down vertically
about 5–6cm (2–2½in). Release
the pressure, but do not remove
your hands. Give 30 compressions
at a rate of 100–120 per minute.
Open the casualty’s airway. Place
one hand on the forehead and
gently tilt the head – the mouth
should fall open. Place the
fingertips of your other hand on
the chin and lift it.
Tilt the casualty’s head with one
hand and lift the chin with two
fingers of your other hand. Pinch
the nostrils closed, and allow his
mouth to fall open. Take a breath,
seal your lips over the casualty’s
mouth, and blow steadily until the
chest rises.
Check breathing: put your ear as
near to the casualty’s mouth and
nose as you can and look along his
chest. Look, listen and feel for
breathing for no more than
10 seconds. If he is not breathing
call 999/112 for emergency help,
then begin chest compressions.
POSITION HANDS
ON CHEST
CHECK FOR
RESPONSE
GIVE 30 CHEST
COMPRESSIONS
OPEN THE
AIRWAY
OPEN AIRWAY,
BEGIN RESCUE
BREATHS
CHECK
BREATHING
3
3
2
2
1
1
259
■■ If you have not had training in
CPR, or you are unwilling or
unable to give rescue breaths
you can give chest compressions
only, see below. The emergency
services will give instructions for
chest-compression-only CPR.
■■ If the casualty vomits during
CPR, roll him away from you
onto his side, with his head
turned towards the floor to
allow vomit to drain. Clear his
mouth, then immediately roll
him onto his back again and
restart CPR.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.
■■ Ask a helper to fetch an AED.
■■ Chest-compression-only CPR is
given only if you have not had
training in CPR, or you are
unwilling or unable to give
rescue breaths. The emergency
services will give instructions for
chest-compression-only CPR.
■■ If the casualty vomits during
CPR, roll him away from you
onto his side, ensuring that his
head is turned towards the floor
to allow vomit to drain. Clear his
mouth, then immediately roll
him onto his back again and
restart chest compressions.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to chest
compressions.
■■ Ask a helper to fetch an AED.
Maintaining the open airway,
take your mouth away from the
casualty’s. Look along the chest
and watch it fall. Repeat to give
TWO rescue breaths; each full
breath should take one second.
Repeat 30 chest compressions
followed by TWO rescue breaths.
Kneel level with the casualty's
chest. Place one hand on the
centre of the chest. Put the heel
of your other hand on top of the
first and interlock your fingers.
Press down on his breastbone, to
depress the chest 5–6cm (2–2½in),
then release the pressure.
Continue CPR (30:2) until:
emergency help arrives; the
casualty shows signs of becoming
responsive – such as coughing,
opening his eyes, speaking or
moving purposefully – and starts
breathing normally; or you are too
exhausted to continue.
Give compressions at a rate of
100–120 per minute until: help
arrives; the casualty shows signs of
becoming responsive (coughing,
opening his eyes, speaking or
moving purposefully) and starts
breathing normally; or you are too
exhausted to continue.
WATCH CHEST
FALL
BEGIN CHEST
COMPRESSIONS
CONTINUE CPR
CONTINUE CHEST
COMPRESSIONS
FIND OUT MORE pp.66–69
FIND OUT MORE pp.70–71
5
5
4
4
CAUTION
CAUTION
CPR FOR AN ADULT | CHEST-COMPRESSION-ONLY CPR
260
EMERGENCY FIRST AID
CPR FOR A CHILD ONE YEAR TO PUBERTY
CPR FOR AN INFANT UNDER ONE YEAR
Tilt the child’s head with one hand
and lift the chin with two fingers
of the other hand to ensure the
airway is open.
Place the infant on a firm surface
or on the floor. Gently tilt the
head with one hand and lift the
chin with one finger of the other
hand to ensure the airway is open.
Pinch the nose to close the
nostrils. Allow the mouth to fall
open. Take a breath and seal your
lips over the child’s mouth. Blow
steadily until the chest rises, then
watch it fall; a rescue breath
should take one second. Give
FIVE rescue breaths.
Take a breath and place your lips
over the infant’s mouth and nose.
Blow gently and steadily into the
mouth and nose until the chest
rises, then watch it fall. Each full
breath should take about one
second. Give FIVE rescue breaths.
Place the heel of one hand on the
centre of the chest. Lean directly
over the child’s chest and press
down to at least one third of its
depth, then release the pressure,
but do not remove your hand.
Give 30 compressions at a rate
of 100–120 per minute.
Place the tips of your index and
middle finger on the centre of
the chest. Lean over the infant’s
chest and press down vertically
to at least one third of its depth.
Release the pressure but not your
fingers. Give 30 compressions at a
rate of 100–120 per minute.
CHECK THAT
AIRWAY IS OPEN
CHECK THAT
AIRWAY IS OPEN
GIVE FIVE INITIAL
RESCUE BREATHS
GIVE FIVE INITIAL
RESCUE BREATHS
GIVE 30 CHEST
COMPRESSIONS
GIVE 30 CHEST
COMPRESSIONS
3
3
2
2
1
1
261
■■ If you have not had training in
CPR, or you are unwilling or
unable to give rescue breaths
you can give chest compressions
only. The emergency services
will give instructions for chestcompression-
only CPR.
■■ If the child vomits, roll her away
from you onto her side, with her
head turned towards the floor
to allow vomit to drain. Clear
her mouth, then immediately
roll her onto her back again and
restart CPR.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.
■■ Ask a helper to fetch an AED,
ideally with paediatric pads.
■■ If you have not had training in
CPR or you are unwilling or
unable to give rescue breaths
you can give chest compressions
only. The emergency services
will give instructions for chestcompression-
only CPR.
■■ If the infant vomits during CPR,
roll her away from you onto her
side, with her head turned
towards the floor to allow vomit
to drain. Clear her mouth, roll
her onto her back again
immediately and restart CPR.
■■ If there is more than one
rescuer, change over every
1–2 minutes, with minimal
interruption to CPR.
■■ Do not use AED on an infant.
Return to the head and give TWO
rescue breaths. Repeat 30 chest
compressions followed by TWO
rescue breaths (30:2) for one
minute. Call 999/112 for
emergency help if this has not
already been done. Take the child
to the phone with you if necessary.
Return to the head and give
TWO more rescue breaths. Repeat
30 chest compressions followed
by TWO rescue breaths (30:2) for
one minute. Call 999/112 for
emergency help if this has not
already been done. Take the infant
to the phone if necessary.
Continue CPR (30:2) until:
emergency help arrives; the child
shows signs of becoming
responsive – such as coughing,
opening her eyes, speaking or
moving purposefully – and starts
breathing normally; or you are too
exhausted to continue.
Continue CPR (30:2) until:
emergency help arrives; the infant
shows signs of becoming
responsive – such as coughing,
opening her eyes, speaking or
moving purposefully – and starts
breathing normally; or you are
too exhausted to continue.
GIVE TWO
RESCUE BREATHS
GIVE TWO
RESCUE BREATHS
CONTINUE CPR
CONTINUE CPR
FIND OUT MORE pp.76–79
FIND OUT MORE pp.82–83
5
5
4
4
CAUTION
CAUTION
CPR FOR A CHILD | CPR FOR AN INFANT
262
EMERGENCY FIRST AID
HEART ATTACK
STROKE
Call 999/112 for emergency help.
Tell ambulance control that you
suspect a heart attack.
Keep the casualty comfortable.
Ask him to smile. If he has had a
stroke, he may only be able to
smile on one side – the other side
of his face may droop.
Help the casualty into a
comfortable position; a half-sitting
position is often best. Support his
head and shoulders and place
cushions under his knees.
Reassure the casualty.
Ask the casualty to raise his arms.
If he has had a stroke, he may only
be able to lift one arm.
CALL FOR
EMERGENCY HELP
CHECK
CASUALTY'S
FACE
MAKE CASUALTY
COMFORTABLE
CHECK
CASUALTY'S
ARMS
2
2
1
1
There may be:
■■ Vice-like chest pain, spreading to one
or both arms or jaw that does not
ease with rest
■■ Breathlessness
■■ Discomfort, like indigestion, in upper
abdomen
■■ Collapse, with no warning
■■ Sudden dizziness or faintness
■■ Casualty may have sense of
impending doom
■■ “Ashen” skin and blueness of lips
■■ Rapid, weak or irregular pulse
■■ Profuse sweating
■■ Extreme gasping for air (air hunger)
Use the FAST (Face – Arms –
Speech – Time) guide (p.212) to
assess the casualty.
■■ Facial weakness – casualty is unable
to smile evenly
■■ Arm weakness – casualty may only
be able to move his arm on one side
of his body
■■ Speech problems
There may also be:
■■ Sudden weakness or numbness
along one side or both sides of body
■■ Sudden blurring or loss of vision
■■ Sudden difficulty understanding the
spoken word
■■ Sudden confusion
■■ Sudden severe headache with no
apparent cause
■■ Dizziness, unsteadiness or a
sudden fall
RECOGNITION
RECOGNITION
263
■■ Be aware of the possibility of
collapse without warning.
■■ Do not give the casualty aspirin
if you know that he is allergic
to it, or if he is under 16 years
of age.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–59).
■■ Do not give the casualty
anything to eat or drink; he
will probably find it difficult
to swallow.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–59).
Assist the casualty to take one
full dose aspirin tablet (300mg
in total); advise him to chew it
slowly. If the casualty has tablets
or a spray for angina, allow him to
take it. Help him if necessary.
Ask the casualty some questions.
Can he speak and/or understand
what you are saying?
Encourage the casualty to rest.
Keep any bystanders away.
Monitor and record the casualty’s
vital signs – breathing, pulse and
level of response – while waiting
for help to arrive.
Call 999/112 for emergency help.
Tell ambulance control that you
suspect a stroke. Reassure the
casualty and monitor and record
his vital signs – breathing, pulse
and level of response – while
waiting for help to arrive.
GIVE CASUALTY
MEDICATION
CHECK
CASUALTY'S
SPEECH
MONITOR
CASUALTY
CALL FOR
EMERGENCY
HELP
FIND OUT MORE p.211
FIND OUT MORE pp.212–13
4
4
3
3
CAUTION
CAUTION
HEART ATTACK | STROKE
264
EMERGENCY FIRST AID
CHOKING ADULT
CHOKING CHILD ONE YEAR TO PUBERTY
If the casualty is breathing,
encourage her to cough to try to
remove the obstruction herself.
If this fails, go to step 2.
If the child is breathing,
encourage her to cough to try to
remove the obstruction herself. If
this fails, go to step 2.
If the casualty cannot speak,
cough or breathe, bend her
forward. Give up to five sharp
blows between the shoulder
blades with the heel of your hand.
Check her mouth. If choking
persists, proceed to step 3.
If the child cannot speak, cough
or breathe, bend her forward.
Give up to five sharp blows
between the shoulder blades with
the heel of your hand. Check her
mouth. If choking persists,
proceed to step 3.
ENCOURAGE
CASUALTY TO
COUGH
ENCOURAGE
CHILD TO COUGH
GIVE UP TO FIVE
BACK BLOWS
GIVE UP TO FIVE
BACK BLOWS
2
2
1
1
Ask the casualty: “Are you
choking?”
For mild obstruction:
■■ Difficulty in speaking, coughing and
breathing
For severe obstruction:
■■ Inability to speak, cough or breathe
■■ Eventually casualty will become
unresponsive
Ask the child: “Are you choking?”
For mild obstruction:
■■ Difficulty in speaking, coughing and
breathing
For severe obstruction:
■■ Inability to speak, cough or breathe
■■ Eventually child will become
unresponsive
RECOGNITION
RECOGNITION
265
Stand behind the casualty. Put
both arms around her, and put one
fist between her navel and the
bottom of her breastbone. Grasp
your fist with your other hand, and
pull sharply inwards and upwards
up to five times. Recheck the
casualty’s mouth.
Stand behind the child. Put both
your arms around her, and put
one fist between her navel and
the bottom of her breastbone.
Grasp your fist with your other
hand, and pull sharply inwards and
upwards up to five times. Recheck
the child’s mouth.
If the obstruction has not cleared,
call 999/112 for emergency help.
Repeat steps 2 and 3 – rechecking
the mouth after each step – until
emergency help arrives, the
obstruction is cleared or the
casualty becomes unresponsive.
If the obstruction has not cleared,
call 999/112 for emergency help.
Repeat steps 2 and 3 – rechecking
the mouth after each step – until
emergency help arrives, the
obstruction is cleared or the child
becomes unresponsive.
GIVE UP TO FIVE
ABDOMINAL
THRUSTS
GIVE UP TO FIVE
ABDOMINAL
THRUSTS
CALL FOR
EMERGENCY HELP
THEN CONTINUE
CALL FOR
EMERGENCY HELP
THEN CONTINUE
FIND OUT MORE p.94
FIND OUT MORE p.95
4
4
3
3
CHOKING ADULT | CHOKING CHILD
■■ Do not do a finger sweep when
checking the mouth.
■■ If the child becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.260–61).
■■ Do not do a finger sweep when
checking the mouth.
■■ If the casualty becomes
unresponsive, open the
airway and check breathing
(p.256). Be prepared to give
CPR (pp.258–59).
CAUTION
CAUTION
266
EMERGENCY FIRST AID
CHOKING INFANT UNDER ONE YEAR
MENINGITIS
If the infant is unable to cough or
breathe, lay her face down along
your forearm and thigh, and
support her head. Give up to five
back blows between the shoulder
blades with the heel of your hand.
If you notice any signs of
meningitis, such as the casualty
shielding her eyes from light or
a stiff neck, seek urgent medical
advice.
Turn the infant over so that she is
face up along your other leg and
check her mouth. Check the
mouth – do not sweep the mouth
with your finger. Pick out any
obvious obstructions. If choking
persists, proceed to step 3.
Keep the casualty cool and give
plenty of water to replace fluids
lost through sweating. An adult
may take the recommended dose
of paracetamol tablets; a child
may have the recommended dose
of paracetamol syrup.
GIVE UP TO FIVE
BACK BLOWS
SEEK MEDICAL
ADVICE
CHECK INFANT’S
MOUTH
TREAT FEVER
2
2
1
1
Mild obstruction:
■■ Able to cough but difficulty in
breathing or making any noise
Severe obstruction:
■■ Inability to cough, make any noise
or breathe
■■ Eventually infant will become
unresponsive
Some, but not all, of these signs
and symptoms may be present:
■■ Flu-like illness with a high
temperature
■■ Cold hands and feet
■■ Joint and/or limb pain
■■Mottled or very pale skin
As infection develops:
■■ Severe headache
■■ Neck stiffness
■■ Eyes become sensitive to light
■■ Drowsiness
■■ A distinctive rash of red or purple
spots that look like bruises and do
not fade when pressed
■■ In infants, a high-pitched moaning or
whimpering cry, floppiness and a
tense or bulging fontanelle (soft part
of the skull)
RECOGNITION
RECOGNITION
267
With the infant lying on your leg,
place two fingertips on the lower
half of her breastbone, a finger’s
breadth below the nipples. Give
up to five sharp downward thrusts,
similar to chest compressions
(p.260), but sharper and slower.
Recheck the infant’s mouth.
If the obstruction is still not clear,
call 999/112 for emergency help.
Take the infant with you to make
the call if necessary. Repeat steps
1 to 3 until emergency help arrives,
the obstruction is cleared or the
infant becomes unresponsive (see
caution, above right).
Call 999/112 for emergency help
if you see signs of the rash, or if
medical help is delayed. Reassure
the casualty. Keep her cool and
monitor her vital signs –
breathing, pulse and level of
response – until help arrives.
Check the casualty for signs
of the meningitis rash: press
against the rash with the side of a
glass. Most rashes will fade when
pressed; if you can still see the
rash through the glass, it is
possibly meningitis.
GIVE UP TO FIVE
CHEST THRUSTS
CHECK FOR SIGNS
OF A RASH
CALL FOR
EMERGENCY HELP
THEN CONTINUE
CALL FOR
EMERGENCY
HELP
FIND OUT MORE p.96
FIND OUT MORE p.220
4
4
3
3
CHOKING INFANT | MENINGITIS
■■ Do not do a finger sweep when
checking the mouth.
■■ Do not use abdominal thrusts on
an infant.
■■ If the infant becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.260–61).
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
CAUTION
CAUTION
268
EMERGENCY FIRST AID
ASTHMA
ANAPHYLACTIC SHOCK
Keep calm and reassure the
casualty. Help her to find her
reliever inhaler (it is usually blue)
and take her usual dose; use a
spacer device if she has one. The
reliever inhaler should take effect
within minutes.
Call 999/112 for emergency help.
Ideally, ask someone to make the
call while you treat the casualty.
Tell ambulance control that you
suspect anaphylaxis.
Help the casualty into a
comfortable position. Tell her to
breathe slowly and deeply. A mild
attack should ease within a few
minutes. If it does not ease, the
casualty may take one to two
puffs from her inhaler every two
minutes, up to ten puffs.
If she has an adrenaline autoinjector,
help her to use it. If you
are trained, give it to her. Hold the
injector in your fist, pull off the
safety cap and push the tip against
her thigh until it clicks. Hold it
for ten seconds, remove it and
massage the site for ten seconds.
HELP CASUALTY
USE INHALER
CALL FOR
EMERGENCY
HELP
ENCOURAGE
SLOW BREATHS
HELP CASUALTY
WITH
MEDICATION
2
2
1
1
■■ Difficulty in breathing
■■Wheezing
■■ Coughing
■■ Distress and anxiety
■■ Difficulty in speaking
■■ Grey-blue colouring in skin, lips,
earlobes and nailbeds
In a severe attack:
■■ Exhaustion and casualty may
become unresponsive
■■ Anxiety
■■ Red, blotchy skin, itchy rash and red,
itchy, watery eyes
■■ Swelling of hands, feet and face
■■ Puffiness around the eyes;
■■ Abdominal pain, vomiting and
diarrhoea
■■ Difficulty breathing, ranging from
tight chest to severe difficulty, which
causes wheezing and gasping for air
■■ Swelling of tongue and throat
■■ A feeling of terror
■■ Confusion and agitation
■■ Signs of shock (p.270) leading to
casualty becoming unresponsive
RECOGNITION
RECOGNITION
269
Call 999/112 for emergency help
if the attack is severe and one of
the following occurs: the inhaler
has no effect; breathlessness
makes talking difficult; the
casualty is becoming exhausted.
Reassure the casualty and help
her to sit in a position that eases
any breathing difficulties. If she
becomes very pale with a weak
pulse, lay her down with legs
raised as for shock (pp.270–71).
Monitor and record the casualty’s
vital signs – breathing, pulse and
level of response – until she
recovers or help arrives. Help her
to reuse her inhaler as required.
Advise the casualty to seek
medical advice if she is concerned
about the attack.
Monitor and record vital signs –
breathing, pulse and level of
response – while waiting for help
to arrive. Repeat the adrenaline
dose every five minutes if there is
no improvement or the casualty’s
symptoms return.
CALL FOR
EMERGENCY HELP
MAKE CASUALTY
COMFORTABLE
MONITOR
CASUALTY
MONITOR
CASUALTY
FIND OUT MORE p.102
FIND OUT MORE p.223
4
4
3
3
ASTHMA | ANAPHYLACTIC SHOCK
■■ Do not leave the casualty alone
since the attack may quickly
worsen.
■■ If this is a first attack and she
has no medication, call 999/112
for emergency help
immediately.
■■ If the attack worsens, the
casualty may become
unresponsive. If this happens
open the airway and check
breathing (p.256). Be prepared
to begin CPR (pp.258–61).
■■ An adrenaline autoinjector can
be delivered through clothing.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
■■ If a pregnant casualty needs to
lie down, lean her towards her
left side to prevent the pregnant
uterus restricting blood flow
back to the heart.
CAUTION
CAUTION
270
EMERGENCY FIRST AID
SEVERE EXTERNAL BLEEDING
SHOCK
Apply direct pressure over the
wound with your fingers or the
palm of your hand using a sterile
dressing or clean, non-fluffy pad. If
you do not have a dressing, ask
the casualty to apply direct
pressure himself. Remove or cut
any clothing if necessary.
Press either side of the embedded
object to control bleeding. Do
not press directly on the object
and do not make any attempt to
remove it.
Treat any cause of shock, such as
bleeding (above) or burns
(pp.274–75). Help the casualty to
lie down, ideally on a blanket.
Raise and support his legs above
the level of his heart.
Call 999/112 for emergency help
– ideally ask a helper to to do this.
Give the ambulance control
details of the injury and extent
of the bleeding.
Call 999/112 for emergency help
– ideally ask a helper to do this.
Tell ambulance control that you
suspect shock.
APPLY DIRECT
PRESSURE TO
WOUND
IF THERE IS AN
OBJECT IN THE
WOUND
HELP CASUALTY
TO LIE DOWN
CALL FOR
EMERGENCY
HELP
CALL FOR
EMERGENCY
HELP
3
2
2
1
1
■■ Rapid pulse
■■ Pale, cold, clammy skin
■■ Sweating
As shock develops:
■■ Rapid, shallow breathing
■■Weak, “thready” pulse
■■ Grey-blue skin, especially inside lips
■■Weakness and giddiness
■■ Nausea and vomiting
■■ Thirst
As the brain’s oxygen supply
weakens:
■■ Restlessness and aggressive
behaviour
■■ Gasping for air
■■ Casualty will become unresponsive
RECOGNITION
271
Monitor and record vital signs –
breathing, pulse and level of
response – while waiting for
emergency help to arrive.
Loosen any tight clothing to
reduce constriction at the neck,
chest and waist.
Secure a pad over the wound with
a bandage. Check the circulation
beyond the bandage every ten
minutes. Loosen and reapply the
bandage if necessary. Treat
casualty for shock, see below.
Cover the casualty with a blanket
to keep him warm. Advise the
casualty not to move. Monitor
and record vital signs – breathing,
pulse and level of response – while
waiting for help to arrive.
MONITOR
CASUALTY
LOOSEN TIGHT
CLOTHING
APPLY BANDAGE
AND TREAT
FOR SHOCK
KEEP CASUALTY
WARM
FIND OUT MORE pp.114–115
FIND OUT MORE pp.112–13
4
4
5
3
SEVERE EXTERNAL BLEEDING | SHOCK
■■ Do not apply a tourniquet.
■■ If there is an object in the
wound, apply pressure on either
side of the wound to control
bleeding.
■■ If blood seeps through the
bandage, place another pad on
top. If blood seeps through the
second pad, remove all dressings
and apply a fresh one, ensuring
that it exerts pressure on the
bleeding area.
■■ Do not give the casualty
anything to eat or drink as an
anaesthetic may be needed.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
■■ Do not give the casualty
anything to eat or drink because
an anaesthetic may be needed.
■■ Do not leave the casualty
unattended, unless you have to
call for emergency help.
■■ Do not let the casualty move.
■■ Do not try to warm the casualty
with a hot-water bottle or any
other form of direct heat.
■■ If the casualty is in the late
stages of pregnancy, lean her
towards her left side so the
pregnant uterus does not
restrict blood flow to the heart.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
CAUTION
CAUTION
272
EMERGENCY FIRST AID
HEAD INJURY
SPINAL INJURY
Replace any displaced skin flaps
over the wound. Put a sterile
dressing or a clean, non-fluffy pad
over the wound. Apply firm, direct
pressure with your hand to control
the bleeding.
Sit or kneel behind the casualty’s
head and, resting your arms on
the ground. Grasp either side of
the casualty’s head and hold it
still. Do not cover her ears.
Secure the dressing over the
wound with a roller bandage to
help maintain direct pressure on
the injury.
Tell the casualty not to move. Call
999/112 for emergency help. If
possible, ask a helper to make the
call while you support the head
and neck. Tell ambulance control
that a spinal injury is suspected.
APPLY DIRECT
PRESSURE TO ANY
WOUND
STEADY AND
SUPPORT HEAD
SECURE
DRESSING WITH
BANDAGE
CALL FOR
EMERGENCY
HELP 1
1 2
2
■■ Can occur after a fall from a height
onto the back, head or feet
There may be:
■■ Pain in neck or back
■■ Step, irregularity or twist in the
normal curve of the spine
■■ Tenderness in the skin over the spine
■■Weakness or loss of movement in the
limbs
■■ Loss of sensation, or abnormal
sensation
■■ Loss of bladder and/or bowel control
■■ Difficulty breathing
There may be:
■■ Level of response may be impaired
for a brief period
■■ Possible scalp wound
■■ Dizziness and/or nausea
■■ Loss of memory of events at the time
of, or immediately before, the injury
■■Mild headache
■■ Confusion
For severe injury:
■■ History of severe blow to the head
■■ Deteriorating level of response
■■ Casualty may become unresponsive
■■ Leakage of blood or bloodstained
watery fluid from the ear or nose
■■ Unequal pupil size
RECOGNITION
RECOGNITION
273
Continue to hold her head. Ask
a helper to place rolled towels,
or other padding, on either side
of the casualty’s head for extra
support.
Help the casualty to lie down,
ideally on a blanket. Ensure that
his head and shoulders are slightly
raised. Make him as comfortable
as possible.
Monitor and record the casualty’s
vital signs – breathing, pulse and
level of response. Call 999/112 for
emergency help if there are any
signs of severe head injury.
Monitor and record the casualty’s
vital signs – breathing, pulse and
level of response – while waiting
for help to arrive.
PLACE EXTRA
SUPPORT
AROUND HEAD
HELP CASUALTY
TO LIE DOWN
MONITOR
CASUALTY
MONITOR
CASUALTY
FIND OUT MORE pp.144–45
FIND OUT MORE pp.157–59
4
4
3
3
HEAD INJURY | SPINAL INJURY
Seek medical advice if after the
injury you notice signs of
worsening head injury such as:
■■ Increasing drowsiness
■■ Persistent headache
■■ Confusion, dizziness, loss of
balance and/or loss of memory
■■ Difficulty speaking
■■ Difficulty walking
■■ Vomiting episodes
■■ Double vision
■■ Seizure
■■ Do not move the casualty unless
she is in danger.
■■ If the casualty is unresponsive,
open the airway by gently lifting
the jaw, but do not tilt the head,
then check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
■■ If you need to place the casualty
into the recovery position use
the log-roll technique (p.159).
CAUTION
CAUTION
274
EMERGENCY FIRST AID
BROKEN BONES
BURNS AND SCALDS
Help the casualty to support the
affected part at the joints above
and below the injury, in the most
comfortable position.
Immediately flood the injury
with cold water; cool for at least
ten minutes or until pain is
relieved. Make the casualty
comfortable by helping him to
sit or lie down and protect the
injured area from contact with
the ground.
Place padding, such as towels or
cushions, around the affected
part, and support it in a
comfortable position.
Call 999/112 for emergency help
if necessary. Tell ambulance
control that the injury is a burn
and explain what caused it, and
the estimated size and depth.
SUPPORT
INJURED PART
START TO COOL
BURN
PROTECT INJURY
WITH PADDING
CALL FOR
EMERGENCY
HELP
2
2
1
1
■■ Deformity, swelling and bruising
at the injury site
■■ Pain and difficulty in moving the
injured part
There may be:
■■ Bending, twisting or shortening of
a limb
■■ A wound, possibly with bone ends
protruding
There may be:
■■ Possible areas of superficial, partialthickness
and/or full-thickness burns
■■ Pain in the area of the burn
■■ Breathing difficulties if the airway
is affected
■■ Swelling and blistering of the skin
■■ Signs of shock
RECOGNITION
RECOGNITION
275
For extra support or if help is
delayed, secure the injured part to
an uninjured part of the body. For
upper body injuries, use a sling;
for lower limb injuries, use broadand
narrow-fold bandages. Tie
knots on the uninjured side.
While you are cooling the burn,
carefully remove any clothing or
jewellery from the area before it
starts to swell; a helper can do this
for you. Do not remove anything
that is sticking to the burn.
A casualty with an arm injury
could be taken by car if not in
shock; a leg injury should go by
ambulance, so call 999/112 for
emergency help. Treat for shock.
Monitor and record the casualty’s
breathing, pulse and level of
response while waiting for help.
When cooled cover the burn with
kitchen film placed lengthways
over the injury, or use a plastic
bag. Alternatively, use a sterile
dressing or clean, non-fluffy pad.
Monitor and record the casualty’s
vital signs while waiting for help
to arrive.
SUPPORT WITH
SLINGS OR
BANDAGES
REMOVE ANY
CONSTRICTIONS
TAKE OR SEND
CASUALTY TO
HOSPITAL
COVER BURN
FIND OUT MORE pp.136–38
FIND OUT MORE pp.174–75
4
4
3
3
BROKEN BONES | BURNS AND SCALDS
■■ Do not attempt to move an injured
limb unnecessarily, or if it causes
further pain.
■■ If there is an open wound, cover
it with a sterile dressing or a
clean, non-fluffy pad and bandage
it in place.
■■ Do not give the casualty anything
to eat or drink as an anaesthetic
may be needed.
■■ Do not raise a broken leg when
treating a casualty for shock.
■■ Do not apply lotions, ointment or
fat to a burn; specialised burn
dressings are also not
recommended.
■■ Do not use adhesive dressings.
■■ Do not touch the burn or burst
any blisters.
■■ If the burn is severe, treat the
casualty for shock (pp.270–71).
■■ If the burn is on the face, do not
cover it. Keep cooling with water
until help arrives.
■■ If the burn is caused by contact
with chemicals, wear protective
gloves and cool for at least
20 minutes.
■■Watch the casualty for signs of
smoke inhalation, such as difficulty
breathing.
CAUTION
CAUTION
276
EMERGENCY FIRST AID
SEIZURES IN ADULTS
SEIZURES IN CHILDREN
Try to ease the casualty’s fall. Talk
to him calmly and reassuringly.
Clear away any potentially
dangerous objects to prevent
injury to the casualty. Ask
bystanders to keep clear. Make a
note of when the seizure began.
Clear away any nearby objects
and surround the child with soft
padding, such as pillows or rolled
towels, so that even violent
movement will not result in injury.
If possible, cushion the casualty’s
head with soft material until the
seizure ceases. Place padding
around him to protect him from
objects that cannot be moved.
Loosen any tight clothing around
the casualty’s neck.
Remove bedding and clothing,
such as a vest or pyjama top; you
may have to wait until the seizure
stops to do this. Ensure a good
supply of cool air, but do not let
the child become too cold.
PROTECT
CASUALTY
PROTECT CHILD
FROM INJURY
PROTECT HEAD
AND LOOSEN
TIGHT CLOTHING
HELP THE CHILD
COOL DOWN
2
2
1
1
Seizures often follow a pattern:
■■ Sudden loss of responsiveness
■■ Rigidity and arching of the back
■■ Breathing may be noisy and become
become difficult. The lips may show
a grey-blue tinge (cyanosis)
■■ Convulsive movements begin
■■ Saliva (bloodstained if he has bitten
his lip or tongue) may appear at
the mouth
■■ Possible loss of bladder or bowel
control
■■Muscles relax and breathing
becomes normal again
■■ After the seizure the casualty
may be dazed and unaware of
what has happened
■■ Casualty may fall into a deep sleep
■■ Loss of or impaired response
■■ Vigorous shaking with clenched fists
and arched back
There may also be:
■■ Signs of fever, such as hot, flushed
skin
■■ A twitching face and squinting, fixed
or upturned eyes
■■ Breath-holding, with red, puffy face
and neck
■■ Drooling at the mouth
■■ Possible vomiting
■■ Loss of bladder or bowel control
RECOGNITION
RECOGNITION
277
Once the seizure has stopped the
casualty may fall into a deep sleep.
Open the casualty's airway and
check breathing (p.256). If he is
breathing, place him in the
recovery position.
Once the seizure has stopped,
open the airway and check
breathing (p.256). If the child
is breathing, place him in the
recovery position.
Monitor and record vital signs –
breathing, pulse and level of
response – until he recovers. Note
the duration of the seizure.
Call 999/112 for emergency help.
Reassure the parents or carer, if
necessary. Monitor and record
the child’s vital signs – breathing,
pulse, level of response and
temperature – while waiting for
help to arrive.
PLACE CASUALTY
IN RECOVERY
POSITION
PLACE CHILD IN
RECOVERY
POSITION
MONITOR
CASUALTY'S
RECOVERY
CALL FOR
EMERGENCY
HELP
FIND OUT MORE pp.216–17
FIND OUT MORE p.218
4
4
3
3
SEIZURES IN ADULTS | SEIZURES IN CHILDREN
■■ Do not attempt to restrain the
casualty.
■■ Do not put anything in the
casualty's mouth during a
seizure.
Call 999/112 for emergency
help if the casualty:
■■ Is having repeated seizures
■■ Has a seizure that lasts more
than five minutes
■■ Is having his first seizure
■■ Remains unresponsive for more
than ten minutes after the
seizure has stopped
■■ Has sustained an injury
■■ Do not let the child get too cold.
■■ Do not sponge a child to cool
him as there is a risk of over
cooling.
■■ If the child becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.260–61).
CAUTION
CAUTION
278
EMERGENCY FIRST AID
SWALLOWED POISONS
HYPOGLYCAEMIA
Reassure the casualty. If she
is responsive, ask her what she has
swallowed and if possible how
much and when. Look for clues
such as poisonous leaves or
berries, containers or pill bottles.
Help the casualty to sit down. If
he has his own emergency sugar
remedy, help him to take it. If not
give him the equivalent of 15–20g
of glucose – a 150ml glass of fruit
juice or non-diet fizzy drink, three
teaspoons (or lumps) of sugar or
three sweets such as jelly babies.
Call 999/112 for emergency help.
Give ambulance control as much
information as possible. This will
help the medical team to give the
casualty the correct treatment.
If the casualty responds quickly,
give him more food or drink and
let him rest until he feels better.
Help him to find his glucose
testing kit so that he can check
his glucose levels.
IDENTIFY THE
POISON
GIVE CASUALTY
SUGAR
CALL FOR
EMERGENCY HELP
GIVE MORE
SUGARY FOOD
2
2
1
1
■■ A history of ingestion/exposure to
poison; evidence of poison nearby
Depending on what the casualty
has taken, there may be:
■■ Vomit that may be bloodstained, and
later diarrhoea
■■ Cramping abdominal pains
■■ Pain or burning sensation
■■ Empty containers near the casualty
■■ Impaired level of response
■■ Seizures
There may be:
■■ A history of diabetes – the casualty
may recognise the onset of a
hypoglycaemic (low blood sugar)
episode
■■Weakness, faintness or hunger
■■ Confusion and irrational behaviour
■■ Sweating with cold, clammy skin
■■ Rapid pulse
■■ Palpitations and muscle tremors
■■ Deteriorating level of response
■■ Diabetes medical warning bracelet
or necklace
■■ Emergency sugar remedy such as
glucose gel or sweets with the
person
■■ Glucose testing kit and medication
such as insulin pen or tablets
RECOGNITION
RECOGNITION
279
Monitor and record the casualty's
vital signs – breathing, pulse and
level of response – while waiting
for help to arrive. Keep samples of
vomited material and any other
clues and give them to the
ambulance crew.
Monitor and record the casualty’s
vital signs – breathing, pulse and
level of response – until he is fully
recovered.
If the casualty has swallowed a
substance that has burnt her lips,
give her frequent sips of cool milk
or water.
If the casualty’s condition
does not improve, look for other
causes of his condition. Call
999/112 for emergency help.
Continue to monitor his vital
signs – breathing, pulse and level
of response – while waiting for
help to arrive.
MONITOR
CASUALTY
MONITOR
CASUALTY
IF CASUALTY'S
LIPS ARE BURNT
CALL FOR
EMERGENCY HELP
FIND OUT MORE p.200
FIND OUT MORE p.215
4
4
3
3
SWALLOWED POISONS | HYPOGLYCAEMIA
■■ Do not attempt to induce
vomiting.
■■ If the casualty is contaminated
with chemicals, wear protective
equipment such as disposable
gloves, a mask and goggles.
■■ If the casualty becomes
unresponsive, make sure that
there is no vomit or other matter
in the mouth. Open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–60).
■■ If there are chemicals on the
casualty’s mouth, protect
yourself by using a face shield
or pocket mask when giving
rescue breaths.
■■ If the operson is not fully
responsive do not give him
anything to eat or drink.
■■ If the casualty becomes
unresponsive, open the airway
and check breathing (p.256).
Be prepared to begin CPR
(pp.258–61).
CAUTION
CAUTION
280
APPENDIX
FIRST AID REGULATIONS
First aid may be practised in any situation
where injuries or illnesses occur. In many
cases, the first person on the scene is a
volunteer who wants to help, rather than
someone who is medically trained. However,
in certain circumstances the provision of first
aid, and first aid responsibilities, is defined by
statutes. In the UK, these regulations apply to
incidents occurring in the workplace and at
mass gatherings.
FIRST AID AT WORK
The Health and Safety (First Aid) Regulations
1981 (as amended) place a duty on employers
to make first aid provision for employees. The
practical aspects of this statutory duty for
employers and for the self-employed are set
out in the Guidance on Regulations, which was
amended on 1 October 2013. In order to meet
their regulatory requirements, employers have
a responsibility to carry out an assessment of
their first aid needs based on hazards and risks
involved in their work, select a suitable training
provider and undertake due diligence on that
provider.
The Voluntary Aid Societies are cited in the
Guidance on Regulations as the standard setters
for currently accepted first aid at work. The
training provided by the Voluntary Aid Societies
meets the requirements of employers identified
in the needs assessment.
The Guidance on Regulations encourages all
employers to assess their organisation’s ability
to meet certain first aid standards. The number
of first aiders required in a specific workplace is
dependent on your needs assessment, which
should be carried out by your Health and Safety
Representative. The checklist opposite will
assist in determining the number and type of
first aid personnel required in a workplace.
Comprehensive advice can also be found at
www.hse.gov.uk/firstaid/
ACCIDENT BOOK
An employer has the overall responsibility for
an accident book, but it is the responsibility of
the first aider or appointed person to look after
and note details of incidents in the book.
If an employee is involved in an incident
in the workplace, the following details should
be recorded in the accident book:
■■ Date, time and place of incident
■■ Name and job of the injured or ill person
■■ Details of the injury/illness and what first aid
was given
■■ What happened to the person immediately
afterwards (for example, went home or taken
to hospital)
■■ Name and signature of the first aider
or person dealing with the incident
REPORTING OF INJURIES, DISEASES
AND DANGEROUS OCCURRENCES
In the event of injury or ill health at work, an
employer has a legal obligation to report the
incident. The Reporting of Injuries, Diseases
and Dangerous Occurrences Regulations
1995 (RIDDOR) requires an employer to
report the following:
■■Deaths
■■Major injuries
■■Injuries lasting more than seven days –
where an employee or self-employed person
is away from work or unable to perform their
normal work duties for more than seven
consecutive days
■■ Injuries to members of the public or people
not at work, where they are taken from the
scene of an accident to hospital
■■ Some work-related diseases
■■ Some dangerous occurrences such as a
near miss, where something happened that
although no injury occurred could have
resulted in an injury
281
FIRST AID REGULATIONS
FACTORS TO CONSIDER
Is your workplace low risk (for
example, shops, offices and
libraries)?
Is your workplace higher risk (for
example, light engineering and
assembly work, food processing,
warehousing, extensive work with
dangerous machinery or sharp
instruments, construction or
chemical manufacture). Do your
work activities involve special
hazards, such as hydrofluoric acid
or confined spaces?
Are there inexperienced workers on
site, or employees with disabilities
or special health problems?
What is your record of accidents
and ill health? What injuries and
illness have occurred and where?
Do you have employees who travel
a lot, work remotely or work alone?
Do any of your employees work
shifts or work out of hours?
Are the premises spread out; for
example, are there several buildings
on the site or multi-floor buildings?
Is your workplace remote from
emergency medical services?
Do any of your employees work at
sites occupied by other employers?
Do you have sufficient provision
to cover absences of first aiders
or appointed persons?
Do members of the public visit
your premises (for example,
schools, places of entertainment,
fairgrounds, shops)?
The minimum provision is: An appointed person to take charge of first aid
arrangements ■ A suitably stocked first aid box. As there is a possibility of an
accident or sudden illness consider providing a qualified first aider
First aider requirements: For fewer than 25 employees, one appointed
person ■ For 25–50 employees, at least one first aider trained in Emergency
First Aid at Work (EFAW) ■ For over 50 employees, one First Aid at Work
(FAW) trained first aider for every 100 employees (or part thereof)
Where there are large numbers of employees consider: Additional first aid
equipment ■ A first aid room
The minimum provision is: An appointed person to take charge of first aid
arrangements ■ A suitably stocked first aid box
First aider requirements: For fewer than five employees, one appointed
person; for 5–50 employees, at least one first aider trained in Emergency First
Aid at Work (EFAW) or First Aid at Work (FAW) dependng on the type of
injuries that could occur; for over 50 employees, at least one First Aid at Work
(FAW) trained first aider for every 50 employees (or part thereof)
Consider: Additional training for first aiders to deal with injuries resulting from
special hazards ■ Additional first aid equipment ■ Precise siting of first aid
equipment ■ Providing a first aid room ■ Informing the emergency services
if there are chemicals on site.
Consider: Additional training for first aiders ■ Additional first aid equipment
■ Local siting of first-aid equipment
Your first aid provision should cover any work-experience trainees
Ensure your first aid provision caters for the type of injury and illness that
might occur in your workplace. Monitor accidents and ill health and review
your first aid provision as appropriate
Consider: Personal first aid kits ■ Personal communicators or mobile phones
for remote or lone workers
Ensure there is adequate first aid provision at all times while people
are at work
Consider: First aid provision in each building or on each floor
Consider: Special arrangements with the emergency services ■ Informing the
emergency services of your location
Make arrangements with other site occupiers to ensure adequate provision of
first aid. A written agreement between employers is strongly recommended
Consider what cover is needed for: Annual leave and other planned absences
■ Unplanned and exceptional absences
Under the regulations, there is no legal obligation to provide first aid for
non-employees, but the Health and Safety Executive (HSE), strongly
recommends that you consider the members of the public when planning
your first aid provision
CHECKLIST FOR ASSESSMENT OF FIRST AID NEEDS
282
INDEX
INDEX
ABC check 45
Abdomen
examining for injury 51
pain 226
stitch 226
wound 128
Abrasions 20, 111
Absence seizures 216
Aches
abdominal pain 226
earache 225
headache 224
toothache 225
Adhesive dressings 235
applying 241
Adhesive tape 237
securing roller bandages 244
Adrenaline autoinjector 48
anaphylactic shock 223, 268–69
Afterbirth, delivery of 228, 229
Agonal breathing 59
Aids
HIV infection 16
human bites 203
Air travel, earache 225
Airway
breathing difficulties 88–105
burns 177
checking 44
croup 103
hanging and strangulation 97
inhalation of fumes 98–99
obstruction 92–95
opening 59
adults 63
children 73
infants 80
jaw thrust method 159
respiratory system 90–91
unresponsive casualty 93
Alcohol poisoning 202
Allergy 222
anaphylactic shock 223
asthma 102
Alveoli 56, 90
Ambulances, telephoning for
help 21–22
Amphetamines, overdose 201
Amputation 117
Anaesthetic, poisoning 201
Anaphylactic shock 223
emergency first aid 268–69
Angina pectoris 210
drugs 48
Animal bites 203
Ankles
bandaging 160
fractures 163
sprains 140–41
Anus, bleeding from 116
Approved Code of Practice
(ACOP) 280
Arms
bandaging 245
slings 251
examining for injury 50
immobilising 243
injuries 149–55
elbow 151
forearm and wrist 152
hand and fingers 153
upper arm 150
muscles 134
wounds
amputation 117
bleeding at elbow crease 127
fingers 126
Arteries
bleeding from 110
circulatory system 108
pulse 53
severe bleeding 114–15
Artificial ventilation
see Rescue breathing
Aspirin
heart attack and 211, 263
overdose 201
Assessing casualties 39–53, 256–57
examining casualty 49–51
primary survey 41, 44–45
secondary survey 41, 46–48
symptoms and signs 50–51
unresponsive casualties:
adults 62
children 72
infants 80
Assessing a situation 28
Asthma 102
emergency first aid 268–69
inhalers 48
Auto-injectors 48
using, 223, 268
Automated external defibrillators
(AED) 54, 57, 84–87
for children 87
Autonomic nerves 143
AVPU code, checking level of response
52, 144
B
Babies see Infants
Back injuries 157–59
emergency first aid 272–73
examining for 51
pain 156
recovery position 65, 75
treatment 158–59
Bacteria, food poisoning 199
Bandages 236, 242–49
checking circulation 243
choosing correct size 244
elbow and knee 246
first aid kit 236–37
general rules 242–43
hand and wrist 247
Bandages continued
immobilising limb 243
roller bandages 236, 244–47
triangular bandages 236, 249–52
tubular bandages 236, 248
Barbiturates, overdose 201
Bee stings 204
allergy to 222
Benzodiazepines, overdose 201
Biohazard bags 18
Birth 228–29
Bites and stings 190, 203–07
anaphylactic shock 223
animal bites 190, 203
human bites 190, 203
insect stings 190, 204–05
marine creatures 190, 207
rabies 203
snake bites 206
tetanus 203
ticks 205
Bleeding
bruising 119
checking for 49–51
childbirth 229
emergency first aid 270–71
from ear 123
from mouth 125
internal bleeding 116
miscarriage 228
nosebleeds 124
severe bleeding 114–15
shock 112–13
types of 110
types of wound 111
vaginal 128
varicose veins 129
see also Wounds
Blisters 120
burns 183
Blood
circulatory system 56, 88, 108–09
clotting 110
composition 109
see also Bleeding
Blood pressure 108
Body temperature 171
fever 219
frostbite 189
heat exhaustion 184
heatstroke 185
hypothermia 186–88
taking 53
Bones
joints 135
skeleton 132–33
structure 134
see also Fractures
Bracelets, medical warning 48
Brachial pulse 53
Brain
absence seizures 216
cerebral compression 144
concussion 144
A
283
INDEX
Brain continued
head injury 144–45
heatstroke 185
meningitis 220, 266–67
nervous system 142–43
oxygen deprivation 54, 59
seizures 216–17
skull fracture 144
stroke 212–13
see also Unresponsive casualty
Breathing
agonal 59
airway obstruction 93
asthma 102, 268–69
checking 44, 52
unresponsive adult 63
unresponsive child 73
unresponsive infant 81
circulatory system 56
croup 103
examining for injury 49, 50
fume inhalation 98–99
hyperventilation 101
opening airway 59
adults 63
children 73
infants 80
rescue breathing 59
adults 68–69
children 76–77
infants 82–83
respiratory system 91
Broad-fold bandages 249
Bruises 111
cold compresses 241
treatment 119
Bullet wounds 111
Burns 172–81
airway 177
assessing 172–73
chemical 179–80
depth 173
dressing 176
electrical 172, 178
emergency first aid 274–75
flash burns to eye 181
minor burns and scalds 176
severe burns and scalds 174–75
sunburn 183
swallowed poisons 200
Bystanders 29–31
C
Capillaries
bleeding 110
circulatory system 90, 108
Car accidents
see Traffic accidents
Carbon dioxide
hyperventilation 101
inhalation of 98
respiratory system 90
Carbon monoxide 33
inhalation of 98
Cardiac arrest 84
in water 36
Cardiopulmonary resuscitation
see CPR
Carotid pulse 53
Cartilage 135
Casualties
assessing 31, 39–53, 256–57
unresponsive 62, 70, 78
dealing with 19–21
examining 49–51
handling 234
monitoring vital signs 52–53
moving 234
multiple 31
passing on information 23
removing clothing 232
resisting help 20
unresponsive 54–87
see also Emergencies
Central nervous system 143
Cerebral compression 144
Cerebrospinal fluid 143
Cheekbone fractures 147
Chemicals
burns 172, 179–80
CS spray 181
Hazchem symbols 31
in eye 180, 199
inhaled gases 199
pepper spray 181
on skin 199
swallowed poisons 200
Chest, “flail-chest” injury 154
Chest compressions 57
adults 66–67, 70–71, 258–59
chest-compression-only CPR 70–71,
children 78
children 77–78, 261
infants 83, 261
pregnant casualties 68
Chest injuries
penetrating wounds 104–05
ribcage fractures 154
Chest pain 104, 210, 211
Childbirth 228–29
miscarriage 208, 228
stages 228
Children
chest compressions 77–78, 259
choking 95, 264–65
croup 103
dealing with 19
dehydration 182
nosebleeds 124
recovery positions 74–75
rescue breathing 76–77, 260–61
resuscitation 61, 72–79, 260–61
seizures 218, 276–77
see also Infants
Choking 94–96
adults 94
children 95
emergency first aid 264–67
infants 96
Circulatory system 56, 90, 108–09
checking circulation after bandaging
243
CPR, adults 66–71, 258–59
Circulatory system continued
children 76–79, 260–61,
infants 82–83, 260–61
problems 112–13, 212
anaphylactic shock 223
fainting 221
heart disorders 210–11
internal bleeding 116
shock 112–13
pulse 53
Cleansing wipes 237
Clips 237
securing roller bandages 244
Closed fractures 136
treatment 137
Clothing
on fire 33
improvised slings 253
removing 233
Clotting, blood 110
Cocaine, overdose 201
Cold
burns 172
frostbite 189
hypothermia 186–88
temperature control 171
Cold compresses 241
Collar bone, fractures 148
Colles’ fracture 152
Coma see Unresponsive casualty
Compresses, cold 241
Concussion 144
Consciousness see Response, levels of,
and Unresponsive casualty
Contusions 111
Convulsions
see Seizures
Coral stings 207
Cornea, flash burns 181
Coronary arteries 210–11
CPR 57
adults 66–71, 258–9
chest-compression-only 70–71,
258–59
in children 78
children 76–79, 260–61
infants 82–83, 260–61
Cramp 167
stitch 226
Crash helmets, removing 233
Cross infection, preventing 16–18
Croup 103
Crush injuries 118
CS spray injury 181
Cuts 119
D
Defibrillators 54, 84–87
Dehydration 182
vomiting and diarrhoea 227
Delayed reactions 25
Delivery, childbirth 228–29
Diabetes, insulin pen for 48
Diabetes mellitus 214, 214–15
hyperglycaemia 214
hypoglycaemia 208, 215, 278–79
284
INDEX
Diarrhoea 227
Digestive system
diarrhoea 227
food poisoning 199
vomiting 227
Dislocated joints 139
shoulder 149
Dressings 235, 238–41
adhesive 241
applying 239–41
burns 175
first aid kit 235
gauze 240
improvised 240
non-sterile 240
sterile 235
applying 239–40
Drowning 100
Drugs
administering 24
assessing a casualty 48
poisoning 199
Drunkenness 202
E Ears 193
bleeding from 124
earache 225
examining for injury 49
foreign objects 197
internal bleeding 116
Ecstasy
heat exhaustion 184
heatstroke 201
overdose 199
Elbows
bandaging 246
bleeding from joint crease 127
injuries 151
Elderly people
hypothermia 188
Electrical injuries 34–35
burns 168, 178
high voltage 34
lightning 35
low-voltage 35
Elevation slings 252
Emergencies, action at 19–37
assessing casualty 39–53, 256–57
assessing situation 28
controlling bystanders 29
electrical injuries 34–35
emergency first aid 254–79
fires 32–33
major incidents 37
moving casualties 234
multiple casualties 31
telephoning for help 22
traffic incidents 30–31
triage 37
water rescue 36
Emotions, after an incident 24–25
Epiglottitis 90
Epilepsy 216–17
drugs 48
Epinephrine see Adrenaline
Eyes 192
chemical burn 179–80
examining for injury 49
flash burns 181
foreign objects 196
incapacitant spray injury 181
sterile eye pads 235
wounds 123
F Face
burns 175, 177
examining for injury 50
fractures 146–47
FAST test 212, 262
Face shields and masks 236
for rescue breathing 69, 79
Fainting 221
Febrile convulsions 218
Feet
bandaging: triangular bandages 250
checking circulation 243
cramp 167
examining for injury 51
fractures 166
frostbite 189
Femur 132
fractures 160–61
Fever 219
febrile convulsions 218
Fibroblast cells 110
Fibula 132
fractures 162–63
“Fight or flight response” 15
Fingers
fractures 153
frostbite 189
wounds 126
tubular bandages 248
see also Hands
Fires 32–33
burns 172
smoke inhalation 98–99
First aid 11–37
being a first aider 14–15
emergency first aid 254–79
giving care with confidence 15
looking after yourself 16–18
materials 235–53
priorities 14
regulations and legislation 280
First aid courses 11
First aid kit 235–37
Fish-hooks, embedded 195
Fits 216–18
“Flail-chest” injury 154
Food poisoning 199
Foot see Feet
Forearm, injuries 152
Foreign objects 190–97
in ear 197
in eye 196
in nose 197
Foreign objects continued
swallowed 195
in wounds 115, 121
Fractures 136–38
closed fractures 136
treatment 137
emergency first aid 274–75
open fractures 136
treatment 138
protruding bone 138
stable fractures 136
type of
ankle 162–63
arm 150–52
collar bone 148
facial 146–47
foot 166
hand 153
hip 160–61
leg 160–63
pelvis 155
ribcage 154
skull 144
spine 157–59
unstable fractures 136
Frostbite 189
Fuels, inhalation of 98
Fumes 33
inhalation of 98–99
G
Gases, inhaled 199
Gauze pads 237
Germs, cross infection 16–18
Gloves, disposable 236
Glue, poisoning 199
Grazes 111
treatment 119
Gunshot wounds 111
H
Haemorrhage see Bleeding
Hallucinogens, overdose 199
Handling and moving casualties 234
Hands
bandaging
roller bandages 247
slings 252
triangular bandages 250
bones 132
checking circulation 243
injuries 153
palm wounds 127
see also Fingers
Hanging 97
Hazchem symbols 31
Head injuries 144
cerebral compression 144
concussion 144
emergency first aid 272–73
examining for 49
scalp wounds 122
skull fracture 144
wounds 122
Headache 224
Headgear, removing 233
Health and Safety (First Aid)
Regulations (1981) 280
285
INDEX
Heart
cardiac arrest 84
circulatory system 56, 90–91, 108–09
disorders 210–11
angina 210
heart attack 211
emergency first aid 262–63
heartbeat 108
restoring rhythm 59
defibrillators 59, 84–85
see also Resuscitation
Heat
body temperature 171
heat exhaustion 184
heatstroke 185
sunburn 183
Helicopter rescue 29
Helmets, removing 233
Help, requesting 22–23
Hepatitis
B 16
C 16
human bites 203
Heroin, overdose 201
High-voltage electricity 35
Hip fractures 160–61
HIV 16
human bites 203
Hooks, fish 195
Hormones, “fight or flight response” 15
Hornet stings 204
Human bites 190, 203
Humerus 132
Hygiene
childbirth 229
preventing cross infection 16–18
Hyperglycaemia 214
Hyperventilation 101
Hypoglycaemia 208, 215
emergency first aid 278–79
Hypothermia 186–88
Hypoxia 92
I Ice packs 241
Immunisation 16
Impalement 117
Improvised dressings 240
Improvised slings 253
Incapacitant spray exposure 181
Incised wounds 111
Industrial chemicals 199
Infants
assessing casualties 80
childbirth 228–29
choking 96, 266–67
dehydration 182
hypothermia 188
pulse 53
recovery position 81
rescue breaths 82, 260–61
resuscitation 61, 82–83,
260–61
Infection
childbirth 229
cross infection 16–18
Infection continued
in wounds 120
Information, passing on 23
Inhalation
fumes 98–99
gases 199
respiratory system 91
Inhalers, asthma 48, 102
Injuries, mechanisms of 42–43
Insects
in ears 197
stings 190, 204–05
Insulin
diabetes mellitus 214
pen for diabetes 48
Internal bleeding 116
Intervertebral discs 133, 155
J Jaw thrust 159
Jaws
dislocation 147
fractures 147
Jellyfish stings 207
Joints 135
injuries
dislocation 139
elbows 151
fingers 153
knees 164
shoulders 149
sprains 140–41
wrists 152
wounds in creases 127
K Ketamine, overdose 201
Kidney failure, “crush syndrome” 118
Knees
bandaging 246
injuries 164
Knots, bandages 250
L
Labour, childbirth 228–29
Lacerations 111
Legislation 280
Legs
bandaging 243
cramp 167
examining for injury 51
hip and thigh 160–61
knee 164
lower leg 162–63
varicose veins 129
immobilising 243
injuries
amputation 117
ankle sprain 140–41, 165
Level of response
impaired 144
monitoring 52
Ligaments 135
shoulder injuries 149
Ligaments continued
sprains 140–41
Lighter fuel, poisoning 201
Lightning 35
Limbs see Arms; Legs
Lips, burned 200
“Log-roll”, moving casualties 159
Low-voltage electricity 35
LSD, overdose 201
Lungs 90
airway obstruction 93
asthma 102
penetrating wounds 104–05
respiratory system 90–91
M
Major incidents 37
Marine stings 190, 207
Masks, in rescue breathing 69, 79
Mass gatherings 280
Mechanisms of injuries 43
Medical warning jewellery 48
Medication see Drugs
Meningitis 220, 266–67
Menstrual bleeding 128
Migraine 224
Miscarriage 128, 208, 228
Monitoring vital signs 52–53
Morphine, overdose 201
Mosquitoes 205
Mouth 198
bleeding from 125
burned lips 200
examining for injury 50
insect stings 204, 205
internal bleeding 116
knocked-out tooth 125
sore throat 225
toothache 225
Mouth-to-mouth breathing
see Rescue breathing
Mouth-to-nose rescue breathing 69, 79
Mouth-to-stoma rescue breathing 69
Moving casualties 234
hip and thigh injuries 160–61
lower leg injuries 162–63
“log-roll” 159
splints 160
Multiple casualties 31
Muscles 134
ruptures 140
stitch 226
strains 140–41
tears 140
N
Nails, checking circulation 243
Narcotics, overdose 201
Narrow-fold bandages 249
Neck
back pain 156
examining for injury 50–51
spinal injury 157–59
whiplash injury 42
Needles, sharps containers 18
286
INDEX
Nervous system 142–43
seizures 216–17
children 218
spinal injury 157–59
stroke 212–13
structure 142–43, 155
see also Brain; Unresponsive casualty
Nose 193
examining for injury 50
foreign object in 197
fractures 147
internal bleeding 116
mouth-to-nose rescue breaths
69, 79
Nosebleed 124, 147
O
Open fractures 136
treatment 138
Orifices, bleeding from
ear 123
mouth 125
nose 124
vagina 128
Over-breathing,
hyperventilation 101
Overdose, drug 201
Oxygen
breathing 56
circulatory system 56, 90
hypoxia 92
respiratory system 90–91
P Painkillers, overdose 201
Palm wounds 127
Panic attacks, hyperventilation 101
Paracetamol, overdose 201
Pelvis
examining for injury 51
fractures 155
Pepper spray injury 181
Peripheral nerves 143
Personal belongings 21
Pins 237
Placenta, delivery of 228, 229
Plants, poisonous 199
Plasters 235
applying 241
Platelets 109–10
Pneumothorax 104
Poisoning 190, 198–202
alcohol 202
chemicals on skin 199
drugs 201
emergency first aid 278–79
food 199
in eye 199
inhaled gases 199
injected poisons 199
plants 199
swallowed poisons 199, 200,
278–79
types of poison 199
Portuguese man-of-war
stings 207
Pregnancy
childbirth 208, 228–29
miscarriage 228
Pulse, checking 53
Puncture wounds 111
animal bites 203
marine stings 207
snake bites 206
R Rabies 203
Radial pulse 53
Radiation burns 172
Radius 132
fractures 152
Reactions, delayed 25
Recovery position
adults 64–65
children 74–75
infants 81
spinal injuries 65, 75
Red blood cells 109
Reef knots 250
Regulations, first aid 280
Rescue breathing 59
adults 66–69
with chest compressions 66–69
children 76–79
with chest compressions 76–77
face shields 69, 79
infants 82–83
with chest compressions 83
mouth-to-nose 69, 79
mouth-to-stoma 69
pocket masks 69, 79
Respiratory system 88–105
airway obstruction 93
asthma 102, 268–69
breathing 91
choking 94–96
croup 103
disorders 92–105
drowning 100
hanging and strangulation 97
hyperventilation 101
hypoxia 92
inhalation of fumes 98–99
inhaled gases 199
penetrating chest wounds 104–05
Response, levels of 52
AVPU 52, 144
checking level of response 52
impaired response 144
See also Unresponsive casualty
Resuscitation
adults 62–71
chest compressions 66–71, 258–59
chest-compression-only CPR 70–71
CPR 66–71, 258–59
rescue breathing 68–69, 259
sequence chart 60
children 72–79
chest compressions 77–79, 261
CPR 76–77, 260–61
rescue breathing 76–77, 79,
260–61
sequence chart 61
Resuscitation continued
choking 94–96
defibrillators 84–86
infants 61, 80–83
chest compressions 83, 261
CPR 80–81, 260–61
rescue breathing 80–81, 260–61
sequence chart 61
priorities 57–8
recovery position 64–65, 74–75, 81
Ribcage, fractures 154
“RICE” procedure, strains and sprains
140, 141
Road accidents
see Traffic incidents
Roller bandages 236
applying 245–47
choosing correct size 244
elbow and knee 246
securing 244
Ruptured muscles 140
S
Safety
emergencies 28, 30
fires 32
moving casualties 234
personal 14
traffic incidents 30
Safety pins
securing roller bandages 244
Scalds 172
minor burns and scalds 176
severe burns and scalds 174–75
Scalp
examining for injury 50
wounds 122
Sciatica 156
Scissors 237
Scorpion sting 205
Sea anemone stings 207
Sea creatures, stings 207
Sea urchin spines 207
Seizures
absence seizures 216
in adults 216–17
in children 218
emergency first aid 276–77
Sensory organs 192–93
Serum 110
Sexual assault 128
Sharps containers 18
Shock 112–13
anaphylactic shock 223, 268–69
burns and 172
emergency first aid 274–75
Shoulders
dislocation 139
injuries 149
Signs, assessing a casualty 51
Skeleton 132–33 see also Bones
Skin
allergies 222
bites and stings 203–07
burns and scalds 172–81
chemical burns 179, 199
embedded fish-hooks 195
287
INDEX
examining for injury 50
splinters 194
structure 170
sunburn 183
temperature control 171
Skull 133
examining for injury 50
fractures 144
see also Head injuries
Slings 251–53
elevation 252
improvised 253
Smoke 33
inhalation of 98–99
Snake bites 206
Soft tissue injuries 140–41
Solvents
inhalation of 98
poisoning 201
Sore throat 225
Spider bites 205
Spinal cord
injuries 157
nervous system 142–43
protection 142, 155
Spine 142
back pain 156
examining for injury 50–51
spinal injury 157–59
emergency first aid 272–73
moving casualty 159
recovery position 65
Splinters 194
Splints 160
Sprains 140–41
ankle 140–41, 165
cold compresses 141, 241
finger 153
shoulder 149
Stab wounds 111
Sterile dressings 235
applying 239–40
Stimulants, overdose 201
Stings
allergy to 222
anaphylactic shock 223
insects 204–05
marine creatures 190, 207
Stitch 226
Stoma, mouth-to-stoma rescue breaths 69
Strains, muscles 140–41
Strangulation 97
Stress, looking after yourself 24
Stroke 212–13
emergency first aid 262–63
Sunburn 183
Surveying casualties
primary 44–45
secondary 46–48
Survival bags 237
Swallowed poisons 200, 201
emergency first aid 278–79
Symptoms, assess a casualty 51
T Teeth
knocked out 125
Teeth continued
sockets, bleeding 125
toothache 225
Telephoning for help 22–23
Temperature, body 171
fever 219
frostbite 189
heat exhaustion 184
Temperature continued
heatstroke 185
hypothermia 186–88
taking 53
Tendons 135
shoulder injuries 149
Tetanus 119, 203
Thermometers 53
Thighs, fractures 160–61
Throat
insect stings 204, 205
sore 225
see also Airways
Tibia 132
fractures 162–63
Tick bites 205
Toes see Feet
Tooth sockets, bleeding 125
Toothache 225
Traffic incidents 30–31
safety 28, 30
Tranquillisers
overdose 201
Transient ischaemic attack
(TIA) 212
Transporting casualties see Moving
casualties
Travel, air travel 225
Triangular bandages 236, 249–53
folding 249
hand and foot cover 250
reef knots 250
slings 251–52
storing 249
Tubular bandages 236
applying 248
Tweezers 237
U Ulna 132
fractures 152
Ultraviolet light, flash burns
to eye 181
Umbilical cord, childbirth 229
Unconsciousness see Unresponsive
casualty
Unresponsive casualty
cerebral compression 144
checking response 44, 62, 72, 80
choking 94–96
concussion 144
diabetes mellitus 214, 215
emergency first aid 256, 258–61
examining 49–51
impaired level of response 144
penetrating chest wound 105
recovery position
adult 64–65
child 74–75
Unresponsive casualty continued
infant 81
seizures in adults 216–17
seizures in children 218
skull fracture 144
spinal injury 157–59
stroke 212–13
see also Resuscitation
Urethra, internal bleeding 116
V Vaginal bleeding 116, 128
childbirth 229
miscarriage 228
Varicose veins, bleeding 129
Veins 104
bleeding 110
varicose veins 129
Vertebrae 133
injuries 157
Vital signs, monitoring 52–53
Vomiting 227
W Wasp stings 204
allergy to 222
Waste material 18
Water
drowning 100
electrical injuries 35
hypothermia 186
rescue from 36
Weever fish spines 207
Whiplash injury 42
White blood cells 109
“Wind chill factor” 186
Windpipe see Airway
Work, first aid at 280–81
Wounds
abdominal 128
amputation 117
animal bites 203
at joint creases 127
blood clotting 110
chest 104–05
cross infection 16–18
crush injuries 118
cuts and grazes 119
dressing and bandaging 238–50
emergency first aid 270–71
eyes 123
fingers 126
foreign objects 115, 121
head injury 144–45
healing 110
impalement 117
infection 120
palm 127
scalp and head 122
severe bleeding 114–15
types of 111
Wrist
bandages 247
injuries 152
ACKNOWLEDGMENTS
288
AUTHORS OF REVISED 10TH EDITION
St John Ambulance
Dr Margaret Austin dstj lrcpi lrsci lm
Chief Medical Adviser
St Andrew’s First Aid
Mr Rudy Crawford mbe bsc (hons) mb chb frcs
(glasg) frcem
Chairman of the Board
British Red Cross
Dr Barry Klaassen bsc (hons) mb chb frcs (edin)
frcem
Chief Medical Adviser
Dr Vivien J. Armstrong mbbs drcog frca pgce (fe)
CONTRIBUTORS TO THE REVISED 10TH EDITION
Dr Meng Aw-Yong bsc mbbs dfms dfmb
Medical Adviser, St John Ambulance
Jim Dorman
Operations and Policy Director, St Andrew's First Aid
Joe Mulligan
Head of First Aid Education, British Red Cross
TRIPARTITE COMMERCIAL COMMITTEE
St John Ambulance
Andrew New
Head of Training
Richard Fernandez
Head of of Public Affairs
Deji Soetan
Marketing Manager
St Andrew’s First Aid
Grant MacKintosh
National Sales Manager
Laura Dennett
Marketing and Fundraising Executive
Jim Dorman
Operations and Policy Director
British Red Cross
Patrick Gollop
Head of Training
Paul Stoddart
Marketing Manager
AUTHORS’ ACKNOWLEDGMENTS
The authors would like to extend special thanks to: St John Ambulance Clinical Directorate – Sarah Flynn Project Assistance;
St Andrew's First Aid – Stewart Simpson Training Manager; British Red Cross – Christine Boase Product Development Manager, Marenka
Vossen Project Assistance First Aid Education, Tracey Taylor First Aid Education Development Manager.
PUBLISHERS’ ACKNOWLEDGMENTS
Dorling Kindersley would like to thank: Alex Lloyd for design assistance; Daniel Stewart for organising locations for photography; Bev
Speight and Nigel Wright of XAB Design for art direction of the original photography shoots.
Dorling Kindersley would also like to thank the following people who appear as models:
Lyndon Allen, Gillian Andrews, Kayko Andrieux, Mags Ashcroft, Nicholas Austin, Neil Bamford, Jay Benedict, Dunstan Bentley, Joseph
Bevan, Bob Bridle, Gerard Brown, Helen Brown, Jennifer Brown, Val Brown, Michelle Burke, Tamlyn Calitz, Tyler Chambers, Evie Clark, Tim
Clark, Junior Cole, Sue Cooper, Linda Dare, Julia Davies, Simon Davis, Tom Defrates, Louise Dick, Jemima Dunne, Maria Elia, Phil Fitzgerald,
Alex Gayer, John Goldsmid, Nicholas Hayne, Stephen Hines, Nicola Hodgson, Spencer Holbrook, Jennifer Irving, Dan James, Megan Jones,
Dallas Kidman, Carol King, Ashwin Khurana, Andrea Kofi-Opata, Andrews Kofi-Opata, Edna Kofi-Opata, Joslyn Kofi-Opata, Tim Lane, Libby
Lawson, Wren Lawson-Foley, Daniel Lee, Crispin Lord, Danny Lord, Harriet Lord, Phil Lord, Gareth Lowe, Mulkina Mackay, Ethan Mackay-
Wardle, Ben Marcus, Catherine McCormick, Fiona McDonald, Alfie McMeeking, Cath McMeeking, Archie Midgley, David Midgley, Eve Mills,
Erica Mills, Gary Moore, Sandra Newman, Matt Robbins, Dean Morris, Eva Mulligan, Priscilla Nelson-Cole, Rachel NG, Emma Noppers, Phil
Ormerod, Julie Oughton, Rebekah Parsons-King, Stefan Podohorodecki, Tom Raettig, Andrew Roff, Ian Rowland, Phil Sergeant, Vicky Short,
Lucy Sims, Gregory Small, Andrew Smith, Emily Smith, Sophie Smith, Bev Speight, Silke Spingies, Michael Stanfield, Alex Stewart, Adam
Stoneham, David Swinson, Hannah Swinson, Laura Swinson, Becky Tennant, Laura Tester, Pip Tinsley, Daniel Toorie, Helen Thewlis, Fiona
Vance, Adam Walker, Jonathan Ward, David Wardle, Dion Wardle, Francesca Wardell, Angela Wilkes, Liz Wheeler, Jenny Woodcock, Nigel
Wright, Nan Zhang.
Picture credits Dorling Kindersley would like to thank the following for their kind permission to reproduce their photographs: Getty
Images: Andrew Boyd 168–69.
All other images © Dorling Kindersley. For further information see www.dkimages.com
ACKNOWLEDGMENTS
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