Essential First Aid Skills

First aid is the immediate care of a person who has been injured or suddenly taken ill. The treatments are simple and can be learned by anyone, young or old.

The main aim of first aid is to keep a casualty alive until more experienced and better equipped help – ambulanceman, nurse or doctor – is available.

Often the first aider is the most important person in the passage from injury to recovery. Someone who has suffered serious injury can die within four minutes -far less time than it takes for an ambulance to arrive. So prompt and effective first aid is a lite saver in serious injury or illness.

Here we concentrate on life-saving techniques and measures to prevent injuries becoming worse and to reduce the time taken for a casualty to recover. Throughout we have specifically referred to the casualty as either ‘him’ or ‘her’ – but of course, all the techniques and treatments described apply equally to both sexes.

First aid is not the elaborate and precise bandaging of wounds, nor should it be thought of as being entirely the province of voluntary organizations such as St John Ambulance or the Red Cross. These bodies provide an excellent service, but they are not immediately available when your child is accidentally burnt or an elderly relative suffers a heart attack.

Ideally, everyone should know how to perform life-saving first aid. Every day thousands of people are injured or taken ill suddenly, many of them while they are at home. There are one million home accidents in Britain each year where the casualty needs hospital treatment. More than s,ooo people in England and Wales die each year as a result of home accidents.

The elderly and the very young are particularly vulnerable.

The need for all adults and older children to know how to cope with serious injury and illness is obvious, but there is a second less obvious reason why everyone should know first aid. Research has shown that people trained in first aid, even through emergency first aid courses lasting only tour hours, are less likely to be involved in accidents.

The reasons for this are not yet fully understood, but it seems probable that trainees become more aware of potential danger and are also more determined to avoid injury.

It the whole family becomes more aware of potential danger in the home it is likely to become a safer place.

GENERAL POINTS TO REMEMBER

At all times consider first the safety of the casualty and of yourself. You cannot help an injured person if you become the second casualty. This is particularly important when dealing with electric shock, smoke filled rooms and road accidents.

A first aider should aim to do as little as possible but all that is essential to maintain life.

Elaborate bandaging should be avoided because time will be wasted at hospital removing it again. Wherever possible the first aider should do no more than summon help, reassure the casualty and, by careful vigilance, try to prevent more serious conditions developing.

Moving someone with a damaged limb will cause pain, increase shock and possibly cause further damage. Wherever possible wait for experts to move the casualty.

Summon expert help as quickly as possible. Ask another responsible person to ring for the doctor or an ambulance so that you can remain with the injured person. Rescue services are called by dialling 999 and asking the operator to send an ambulance. Remember to give the full address of the place where help is needed. This must include the village or part of town as well as the street and house number. State the nature of the injury and the number of casualties who need help.

Keep the number of your doctor near your telephone for quick reference. If help is required urgently, always ring for an ambulance first it should arrive more quickly.

See also General Aspects of First Aid and Summary of Life-saving First Aid.

FIRST PRIORITY OXYGEN

The most important system of the body is that which provides oxygen to the brain and other vital organs. Anything which prevents oxygen reaching the brain will lead to death in a very short time.

When we breathe, oxygen enters the lungs where it passes into the bloodstream. The blood is pumped round the body by the heart and so delivers oxygen to all the organs, the most important of which is the brain. The heart is very efficient, pumping about 4.75 litres of blood a minute.

The brain can be deprived of oxygen in four main ways:

– The path from the mouth to the lungs is blocked.

– Breathing stops.

– The heart stops beating.

– There is not enough blood to take the oxygen to the brain.

Life-saving first aid concentrates on preventing or correcting these problems when they occur.

LIFE-SAVING

TECHNIQUES

– Keeping an open, clear airway from the mouth to the lungs.

– Restarting breathing or breathing for the casualty.

– Preventing further loss of blood or other body fluids.

– Placing casualty in recovery position.

A further life-saving technique is restarting the heart or using external pressure on the heart to pump blood round the body. Unfortunately, this last technique cannot be taught by a manual, it requires good personal instruction and practice on dummies.

SHOCK

Shock follows every serious injury or illness and, without proper treatment, can lead to death. The treatment of injuries discussed later is largely concerned with preventing further shock.

Cause

Shock is caused by the loss of body fluid in the form of whole blood, blood plasma, vomit or sweat. Here, we are primarily concerned with the loss of whole blood or blood plasma.

Red blood cells carry oxygen round the body. Plasma is the liquid part of the blood

FIRST All and is usually lost following burns or crush injuries. Loss of plasma isjust as serious as loss of whole blood.

Once blood has been lost from the circulation, the body changes in an attempt to make up for the blood loss.. If the body fluid loss continues, the body becomes unable to compensate and death may occur.

Treatment

The treatment of blood or plasma loss can only be carried out in hospital, because lost blood has to be replaced with a transfusion. The first aider must deal with the cause of the blood loss, reassure the casualty and arrange for transport to hospital as quickly as possible.

Unconscious

If the casualty has lost consciousness, is semi-conscious or is vomiting, place him in the recovery-position..

Conscious

If the casualty is conscious he should be kept warm with a light blanket, reassured that he will be all right and made comfortable by loosening tight clothing at the neck, chest and waist.

Fainting is a less serious form of shock. It can be caused by the sight of blood, bad news, pain, heat or infection. While blood is not actually lost from the body, it stagnates in the muscles and gut, temporarily reducing the volume of blood available for transporting oxygen to the brain. As a result the patient will look I and may appear to be having a fit..

Because shock means that the brain is being deprived of oxygen, the blood supply to the brain should be increased by lying the conscious casualty on his back with the head low and the legs raised.

The casualty usually recovers very quickly because falling down automatically increases the flow of blood to the brain. This recovery can be aided by placing the casualty in the feet high position shown and by loosening all tight clothing.

If the faint is the result of an infection the patient may not make a quick recovery. In such cases a doctor should be called.

DIARRHOEA AND VOMITING

These conditions are usually the result of infection and lead to a large amount of fluid loss from the body and hence to shock. The condition of patients, particularly children, may deteriorate rapidly.

Treatment is mainly by controlling diet. Solid foods should be avoided, as should fruit juices. The patient should be given plenty of fluids to minimise shock – milk and water are most suitable. The patient should be kept at rest and warm.

If symptoms continue for several hours a doctor should be called – particularly in the case of a young child.

UNCONSCIOUSNESS

Unconsciousness is the result of injury to, or interference with, the function of the brain. States of unconsciousness can vary trom drowsiness to coma, where the casualty cannot be roused at al

POINTS TO REMEMBER ABOUT SHOCK

Shock will follow every serious illness or injury.

– The only treatment for shock caused by blood loss is a transfusion.

– Summon an ambulance as quickly as possible.

– Treat external bleeding and make sure the casualty is breathing.

– If the casualty is unconscious, put him in the recovery position.

– If the casualty is conscious, make him comfortable, loosen any tight clothing, keep him warm but not too hot, and he him down with his legs raised higher than his head. Remember to talk to the patient and to give lots of reassurance.

In general, if a casualty cannot answer your questions coherently she should be treated as unconscious.

The immediate cause of unconsciousness mav not always be obvious, but the treatment is always the same. Many people who become unconscious die unnecessarily because they do not receive the correct first aid.

When someone loses consciousness, her brain loses its ability to control many of the body’s muscles – including those which position the tongue. If the casualty falls to the ground on her back, the tongue will tend to move to the back of the throat, cutting off the supply of air to the lungs. If this happens the brain, deprived of oxygen, will be damaged within four minutes and death will quickly follow.

The aims of first aid treatment for the unconscious casualty are to ensure that she can breathe and will continue to breathe and to get her to hospital as quickly as possible. Trivial injuries must not be treated before you have dealt with unconsciousness.

The first priority is to open the airway, which is done by tipping the head back. This has the effect of pulling the tongue away from the back of the throat, allowing air into the lungs. This process is helped it the lower jaw is also pulled forward.

It this procedure does not lead to the casualty’s breathing restarting then artificial respiration will be necessary.

A second threat to the lite of the unconscious casualty is the possibility that she mav vomit, so reblocking her airway. Breathing may also be cut off by broken false teeth, or blood or saliva at the back of the throat. These blockages must be cleared, if necessary with your fingers, in order to allow the casualty to continue breathing.

If the casualty is breathing she should be turned into the recovery position, which is also called the unconscious, coma, or semi-prone position.

This position keeps the tongue away from the back of the throat, because the head is tilted back, and at the same time allows anything in the mouth or throat – such as vomit, blood or saliva – to drain out through the mouth. If possible, the lower body should be raised to increase blood flow to the brain. Make sure that the casualty’s mouth and nose are not covered by whatever she is lying on. Also, remember to loosen all tight clothing.

Recovery position

It does not matter how you put someone into the recovery position, but the following method is the easiest – with practice even children can use it to turn an adult over. The casualty should be turned onto a blanket it one is available.

Kneel by the side of the casualty, who has collapsed onto her back, and position yourself level with her hips. Place her arms alongside her body, the nearer arm tucked slightly under the body, and cross the tar leg over the near one. By grabbing the clothing at the far hip pull towards you until the casualty is lying across your knees. If you are able to pull the casualty over using only one hand, use your other hand to protect her head as she is pulled over.

When the casualty is lying across your knees, slide out allowing her to come to rest on the ground. Bring the casualty’s nearest knee up towards her chest. The arm on the same side should be positioned at right angles to the body, and the forearm should then be bent up parallel with the casualty’s head. The far leg can be slightly bent and the far arm pushed a little way from the body. Tip the casualty’s head slightly back.

In the recovery position it is impossible for the unconscious casualty to roll over on her own. But never leave an unconscious person alone. She may recover slightly and move back into a dangerous position or she may stop breathing. Send a responsible person to call for an ambulance.

Things to check

Check that the casualty continues to breathe and take her pulse regularly, making a note of its speed and strength. Check for bleeding and. if necessary, treat it – but do not leave the casualty in order to look for dressings.

Never try to revive the casualty by slapping or shaking her. Nothing should be given by mouth to an unconscious casualty: she is incapable of swallowing.

Any person who has been unconscious, even for a short time, must always be seen by a doctor. The only exceptions to this rule are people who have fainted; and known epileptics who have suffered a fit but recovered normally with no injury to the person.

No head injury should ever be ignored. The damage caused may not become apparent until some time after the injury, and then it may be too late to help. Anyone who has suffered a head injury should go to hospital or see his doctor.

POINTS TO REMEMBER

ABOUT

UNCONSCIOUSNESS

– Make sure the airway is open and clear of obstruction.

– If the casualty is not breathing, start artificial respiration immediately.

– If the casualty is breathing turn her into the recovery position.

– Never leave an unconscious casualty alone. Send another responsible person to call tor an ambulance.

– Never give an unconscious person anything to drink.

– Get the casualty to hospital as quickly as possible. Practice turning people into the recovery position. It is the easiest way in which you can save a life.

BLEEDING

The importance of blood in carrying oxygen to the organs of the body -particularly the heart – has already been explained. The average adult has between 10 and 12 pints of blood. Children have less – about 1 litre per 13 kg of bodyweight.

Blood is kept circulating by the pumping of the heart, which beats at a rate which can vary considerably from person to person. However, the heart of an adult who is relaxing will normally beat between 60 and 80 times a minute. Children tend to have a faster heart rate.

The heart rate will increase at times when the body requires extra oxygen — for instance, following physical exercise or when lifting heavy weights. However, an increased heart rate can also be a sign that something is wrong.

Blood loss

Blood passes through the body in a vast system of pipes or blood vessels. If any of these is cut. blood will escape and be lost. Shock will develop, its severity depending upon the amount of blood lost. Blood loss can be external and internal.

External bleeding will follow cuts in the skin. Deep cuts can be caused by glass or knives, or the skin can be torn by catching on sharp objects such as barbed wire. Bruises are another form of blood loss. Extensive bruising can indicate a large loss of blood from the circulation.

Internal bleeding is less obvious simply because the blood is not immediately visible. It can follow injury to the internal organs of the body — as a result of a tall or head injury, for example. Fractures where the skin is not broken are also likely to cause internal bleeding. The sharp ends of the broken bones may cut through blood vessels, allowing blood to leak into the muscles and hollow parts of the body. Certain medical conditions can also lead to internal bleeding, one example being a burst ulcer.

Effects. The effects of internal and external bleeding are the same. If a person loses 20 per cent of his blood, that is, 1 litre in an adult, he is ill and will look it. Changes in the body make it relatively easy to identify a victim of blood loss.

Symptoms

Because the brain, heart and lungs must be kept supplied with blood, other organs may be starved of their normal supply when blood loss is heavy. The skin normally contains a large amount of blood which gives the body a normal healthy colour. When the volume of blood is reduced, the supply to the skin is withdrawn to keep the brain, heart and lungs functioning. So the first sign of blood loss is pallor of the skin.

Blood circulating through the skin keeps it warm and evaporates the large amount of fluid which passes through the skin as sweat. When blood is withdrawn from the skin, it becomes cold and clammy to the touch.

When the body is losing blood, it is less efficient at taking in and circulating oxygen. In order to compensate for this, it will try to grab more oxygen from the air. The casualty starts to breathe more quickly and each breath is shallower than the last. So breathing becomes fast, shallow and may sound laboured.

The victim of blood loss will become anxious, particularly when suffering from internal bleeding where there may be no obvious sign of injury. The lack of oxygen to the brain will lead to irritation and restlessness.

Finally, in order to move oxygen around the body as quickly as possible, the heart will beat faster but each beat will be weaker.

SUMMARY OF SYMPTOMS OF BLOOD LOSS

– The skin becomes pallid, cold and clammy.

– Breathing becomes fast and shallow.

– The casualty becomes anxious and restless.

– The heart beats faster but less strongly.

With serious blood loss, unconsciousness and death may follow if condition remains untreated.

Taking the pulse

When a casualty has no obvious injuries and the signs of blood loss or shock are detected it is reasonable to assume that there is internal bleeding. The surest sign is the pulse rate which continues to get faster and weaker as blood is lost. Because the pulse is such an important indication of blood loss it is essential that all first aiders are capable of measuring and recording it accurately. With practice the technique is quite simple.

Al the wrist. The illustration of a hand will help you to find the pulse. Place your middle three fingers on the bone, which can be felt quite easily. The fingers should be placed in a straight line, directly below the base of the thumb. The fingers should then be pulled over the skin in the direction of the arrow. By pressing the fingers in between the bone and the next ridge of the wrist, the pulse should be telt.

Practise finding the pulse on yourself or on other people until you can find it with ease. If the pulse is too weak to detect at the wrist, it may be possible to feel it at the neck. This point is nearer the heart, so the pulse should be stronger.

Place two or three fingers in line from above to below the Adam’s apple. Slide the fingers sideways into the hollow on either side. Press the fingers in and you should be able to feel the pulse. Again, practise finding this pulse on yourself

Whenever you are taking a pulse remember never to use your thumb. This is because the thumb has quite a strong pulse of its own and you might find yourself measuring your own pulse instead of that of the casualty.

Recording the heart beat

Each beat felt is one beat of the heart. Using a watch with a second hand, count the number of beats in 30 seconds and multiply by 2 to find out how many times the heart is beating in a minute. The strength of the heartbeat can be judged by how difficult it is to feel the pulse.

When treating a casualty, keep a note of the pulse each time you take it. This will show how the heart rate has changed over a period of time – useful information for doctors estimating the extent of blood loss. Even without the help of a watch, you should be able to judge whether the heart rate is increasing or not and whether the beats are getting weaker.

First aid for internal bleeding

Internal bleeding leads directly to shock. There is no treatment a first aider can give. The patient must be sent to hospital as soon as possible for a blood transfusion.

If the patient is unconscious he should be placed in the recovery position.

If the patient is conscious he should be made comfortable, placed in the legs higher than head position described under SHOCK, reassured and kept warm. His pulse should be taken and recorded regu-larlv, and you should check that he remains conscious and continues to breathe.

There is no excuse for a casualty to be allowed to die from internal bleeding just because the symptoms go unrecognized. Always assume that a casualty is suffering from internal bleeding until you are satisfied that he is not. Watch for the signs of blood loss to develop for at least 20 minutes and monitor the pulse carefully.

First aid for external bleeding

External bleeding is generally easy to detect. But sometimes blood can collect in the hollows under the body or be soaked up by the casualty’s clothes, so be sure to check carefully for such signs of bleeding. The signs of serious blood loss are the same as those for internal bleeding – pallid, cold and clammy skin; fast, shallow breathing; casualty becomes anxious and restless; the heart beats faster but less strongly. The casualty may become unconscious and death may follow.

Most cases of bleeding from wounds are minor and the blood flow will stop naturally with the help of the clotting process. This seals up the hole in the blood vessel. When bleeding is severe, clots may not be able to form and help is needed for the natural process to work.

Control of external bleeding is achieved in three ways; rest, elevation and pressure.

Rest is essential for a casualty who is bleeding. Make him lie down before you do anything else and try to keep him from mining. Movement will disturb blood clots which are forming and will also increase the amount of blood flow, leading to even more bleeding.

The pulse rate is an important indicator of blood loss. All first aiders should be able to measure it, particularly so that they can recognize internal bleeding. The pulse at the neck can be found in the hollow on either side of the Adam’s apple. It may be possible to detect the heart beat here if the pulse is too weak to be felt at the wrist. The wrist pulse is found below the base of the thumb by pressing into the hollow between the bone and the next ridge of the wrist. Practise finding both pulses until you are confident -and remember not to use your thumb.

Elevation

When the casualty is lying down raise the part of the body which is bleeding above the level of the heart. This will reduce the flow of blood to the wound because it is harder for the heart to pump ‘uphill’.

Pressure

Remove clothing from around the wound and press with your fingers or hand directly onto the bleeding point. If you can, press over a sterile dressing or any clean, absorbent material – but do not waste time. If nothing is quickly available just press with your hand. This pressure must be maintained for at least 10 minutes, to reduce or stop the blood flow and allow clotting to take place.

A dressing should be placed on the wound as soon as possible — pressure can be applied more effectively with a dressing than with the hand.

Any pad may be bandaged onto the wound, but sterile dressings are best. These consist of a thick pad of cotton wool topped with a layer of lint stitched to an open weave bandage. The pad should be placed directly onto the wound and the longer end of the bandage should be wound firmly over the pad. The knot should be tied directly over the wound to provide extra pressure.

If the wound continues to bleed do not remove the dressing as this would only disturb any clotting which has occurred. Instead, a second dressing should be applied firmly over the first.

It is important to check that the blood flow to the injured limb below the wound has not been cut offby too tight a dressing. Compare the injured limb with the good one, checking that the colour is the same and that the blood vessels do not appear more pronounced. If the blood flow has been cut off, the dressing must be loosened and re-tied.

Serious bleeding

When dealing with serious bleeding, speed is essential: stopping the blood loss reduces the level of shock which will develop. Do not waste time washing your hands, cleaning the wound, or searching for sterile dressings. Do not bother how neatly the bandage is tied as long as it stays in place and provides sufficient pressure on the wound without causing too much distress to the circulation of the lower limb.

After bandaging the wound take the pulse and look for the signs of shock. A casualty who looks ill, feels weak and has a pulse which is fast and weak must be taken to hospital.

Tourniquets must NEVER be used to stop bleeding

They can lead to the loss of a limb.

Bleeding can always be stopped by simply applying direct pressure to the wound area.

Foreign bodies such as glass or sharp blades should be left in a wound, to he removed at hospital. Often if left in place they will reduce or prevent bleeding. Moving them might well cause damage. Dressings can be built up round the foreign body. For example, a rolled bandage on each side of the object can be used to apply pressure. A further bandage can then be used to cover the wound, the foreign body and the rolled bandages. The outside bandage should be tight enough to apply pressure to the sides of the wound but care must be taken not to press down on the foreign body as you bandage.

Nose bleeds

Nose bleeds are quite common but they can be alarming, nevertheless. As in all cases of bleeding, a small amount of spilt blood can cover a large area. However, nose bleeds are generally quite easy to stop.

The casualty should sit over a basin or bowl with his head inclined slightly forward. This will allow any blood which runs down the back of the nose to escape from the mouth and not be swallowed.

The casualty should breathe through the mouth, and the fleshy part of the nose should be pinched closed between finger and thumb. The pressure must be maintained for at least 10 minutes and the casualty should not blow his nose for several hours afterwards.

If the bleeding continues or recurs, the casualty should see a doctor or be taken to hospital. Never attempt to plug the casualty’s nose.

Minor cuts and bruises

Unlike cases of serious bleeding, speed is not essential when dealing with minor wounds. Blood loss is minimal and shock will not be a problem. The main aim of this first aid treatment is to prevent infection and to protect the injury.

Before starting treatment wash your hands carefully, preferably in hot running water. Stop the bleeding by putting a sterile dressing over the wound and applying firm pressure. At the same time elevate the injured limb.

It the wound area is dirty, wash it under running water and use cotton wool 181 swabs to clean the wound. Use each swab once only and work in towards the wound, but wiping away from the injury. When the wound is clean and tree from grit or other dirt, dry the skin with more cotton wool.

Puncture wounds can be caused by animal bites, stabbing or by treading on a nail. Such wounds may not appear very serious as bleeding may be slight and easily controlled. However, there is a danger that nerves or muscles may have been damaged and that dirt may have been introduced deep into the body. Similar problems may also occur with jagged cuts such as those caused by the sharp edges of opened tins. Bleeding from deep wounds should be controlled as described under Serious bleeding and a dressing applied. Such casualties should see a doctor and hospital treatment may be required to ensure the wound is properly cleansed. Often, the casualty will be given an injection to prevent the possibility of tetanus developing.

Widespread cuts or grazes can be covered with a sterile dressing to keep them clean. For small wounds a porous fabric plaster should be used to cover and protect. This type of plaster allows air to circulate around the wound and promotes healing. Waterproof plasters should be used only when the wound is likely to be exposed to dirty water. Afterwards the waterproof plaster should be replaced with a fabric one.

Generally it is better not to apply any ointments or lotions. A diluted antiseptic lotion may, however, be used to clean the wound. Remember that with minor wounds the main concern is to prevent infection.

Slings

In cases of minor bleeding from arm or hand it is useful to keep the limb elevated in a sling when it has been dressed. With other injuries, too, the comfort of the casualty can be improved by supporting the arm across the chest with a sling.

SLINGS CAN BE IMPROVIZED IN THE FOLLOWING WAYS:

– By supporting the arm inside a buttoned jacket or waistcoat.

– By pinning the sleeve of a dress or shirt to the clothing.

– By turning the lower edge of a jacket up over the arm and pinning it to the clothing.

– By using scarves, belts or ties. However, the best sling is made from a triangular bandage.

Triangular bandage sling

Ask the casualty to support his injured arm across his chest as high above his heart as possible with the fingers pointing towards the shoulder on the uninjured side.

Place the triangular bandage across the forearm with the long edge hanging straight down and one short end parallel with the injured arm and with the point well below the elbow. Ease the base of the bandage under the arm and around the casualty’s back onto the front of the sound shoulder. Tie the ends of the bandage in the hollow in front of the neck on the uninjured side. Fold the point across the front of the elbow and secure it with a safety pin. It you have no safety pin, simply tuck the point inside the sling. A pad can be placed under the knot to prevent it digging into the casualty’s neck. As long as the sling is comfortable and is capable of holding the arm securely in place, it does not matter how well it is 182 applied. Remember to feel for the casualty’s pulse and look at the colour of his fingers to check that blood is still circulating in the injured arm. It is a good idea to practise tying triangular slings if you can find a co-operative friend.

POINTS TO REMEMBER ABOUT BLEEDING

– Blood loss is serious because it leads to shock.

– After any injury always suspect, and check for, internal bleeding.

– With internal bleeding treat for shock and send to hospital.

– With external bleeding lie the casualty down and keep him at rest. Elevate the area which is bleeding and apply direct pressure to the wound for at least 10 minutes.

– Maintain pressure by applying one or more dressings.

– If signs of shock develop, send the casualty to hospital.

BURNS AND SCALDS

Burns are injuries caused by heat, cold, friction, electricity or chemicals. Scalds are caused by hot liquids. Burns and scalds have a similar effect on the body and the first aid treatment for both is similar.

Most burns happen in the home and children are most at risk. The seriousness of a burn depends more on the extent of the body area injured than on the depth of the injury.

But for young children even small burns should be regarded as very serious and hospital help should be sought.

When the skin is damaged by burns, plasma – the liquid part of the blood — seeps from the nearby blood vessels and can form blisters.

It is important to be able to estimate what proportion of the body is affected in cases of burns. Anyone with bums over 10 per cent of his or Iter body needs hospital treatment urgently. Burns covering 10 per cent or more of the body can prone fatal, but hospitals can noil’ save the lines of people who have up to jo per cent of the body area burnt. In assessing the area of bums, it is useful to remember that the palm of the casualty’s baud represents one per cent of his oilier body area

Losing plasma is equivalent to losing a similar volume of blood, so. as with bleeding, a major problem with burns is shock. Extensive burns can be fatal because of the shock produced.

A burn which affects 10 per cent of the body area produces a loss equivalent to 1 litre of blood. Someone who loses that much blood is quite ill and will need hospital treatment.

Estimating area of burns

It is important to estimate what proportion of the body has been burnt. For instance, a burn to the whole arm or both forearms will cover about 10 per cent of the body area.

A good way of estimating the extent of a burn is to remember that the palm of the casualty’s hand is one per cent of her body area.

With scalds it is possible for several separate areas of the body to be affected. Remember that it is the total area injured that matters – whether one, two or more areas are burnt.

Burns are unlike bleeding in that the loss of fluid from the body is slow and insidious. Shock may not become apparent until one or two hours after the injury and because of this it may be difficult to convince a burn victim that he is seriously ill – especially where serious burns have destroyed the pain-sensitive cells.

But first aid measures should not be sacrificed in an attempt to rush the patient to hospital. Prompt first aid treatment for burns can dramatically reduce shock.

Although burns covering more than ro per cent of the body area can prove fatal, hospitals can now save the lives of people who have up to 70 per cent of their body area burnt.

Anyone who receives a burn larger than a five pence piece should be seen by a doctor. Similarly, anyone with burns on the hands or face should be sent to hospital for expert attention, as scarring or other damage can occur.

THE AIMS OF TREATMENT FOR BURNS:

– To prevent further damage.

– To prevent infection.

– To minimize the effects of pain and fluid loss from the burnt area.

– To reassure the casualty.

– To transport the casualty to hospital.

Cooling the injury

The first priority in the treatment of burns is to cool the injured area as quickly as possible. This reduces the pain and lessens the severity of the burn. Often a major part of the burn damage occurs after the actual contact with heat. Quick cooling can reduce the amount of tissue damage.

The burnt area should immediately be held under the nearest cold running water and the treatment continued for at least 10 minutes. If after this time no further pain relief is achieved by cooling or the pain does not return when cooling stops, the next stage of the treatment can begin. Otherwise cooling under running water should continue.

Extensive burns

It there are extensive burns, or if the burns are on parts of the body which are awkward to place under running water, cooling of the injuries by immersion in a cold bath should be used.

If burnt clothing is attached to the skin leave it there

It will have been made sterile by the heat and pulling it away may tear the skin. However, if the area has been scalded, the wet clothing should be stripped off because it will retain the heat. Scalding will cause the injured area to swell, and so it is important that anything constrictive such as tight clothing, rings or bracelets should be removed as quickly as possible.

If they are left in place they may have to be cut off in hospital – a sometimes difficult and possibly painful procedure.

Preventing infection

After cooling, the next priority is to prevent infection. The burnt or scalded areas should be covered with loose, clean, dry dressings. For example, a clean pillow case will make an excellent covering for a burnt arm. Never apply pressure to burnt areas, simply cover them entirely.

When burns require hospital treatment, on no account should any creams or ointments be applied to the injuries. This will only delay treatment while the wounds are cleaned – a painful process.

Never prick or burst blisters. If this is done a closed wound becomes open to infection. The blisters may well be removed at hospital but sterile instruments will be used in sterile conditions.

Relieving shock

Once the burns have been covered, the casualty should be treated for shock. She should be kept calm and be reassured that she is going to be all right. An ambulance should be called for transport to hospital.

Burns are one type of injury where the conscious casualty may be given drinks. In fact, seriously burnt patients should be given water which they may sip slowly. They should be discouraged from drinking too much too quickly as this may cause them to vomit. But a sensible amount of drinking will help replace some of the lost body fluid.

Treatment of minor burns

Virtually all burns should be seen by a doctor- even if hospital treatment is not necessary. // the skin is broken, no ointment or cream should be applied but the burn should be covered with a non-adherent dressing. // the skin is not broken, cream can be applied to the burnt area. This should then be covered with lint and a layer of cotton wool over the top. The burn will produce a discharge which the cotton wool will absorb. The discharge forms a crust over the burnt area and protects the wound while healing occurs.

Do not change the dressing frequently. Often it will have stuck to the wound and removing it may pull away the protective crust, causing bleeding and retarding healing. It the dressing must be removed, it should be soaked otf.

Even with small wounds infection is a danger. But there is no need to remove the dressing to check the wound for infection. Simply trim the dressing so that it covers the burnt area but leaves the skin immediately around the burn uncovered. If infection occurs the area round the wound will become red, swollen and painful. If this happens consult a doctor.

Sunburn can destroy skin tissue in the same way as any other type of burn, so the same treatment – cooling and covering -should be given. If blistering occurs, medical help should be sought. If the skin is red but not blistered, calamine lotion will give some pain relief.

Cold burns

If the skin is kept in contact with the frost in a deep freezer for too long it may stick to the frost and the casualty may tear the skin while trying to free herself. A burn of this type should not be treated by cooling. The injured area should be cleaned and covered with a nonadherent dressing.

Electrical burns

Electrical burns are caused by contact with live current and anyone who suffers such a burn should see a doctor. Although only a small area of the skin may appear burnt, the electricity passing through the body travels along the blood vessels and will damage structures under the skin, such as muscles, nerves and tendons.

All electrical burns are deep, and often surgery is necessary to repair the damage caused. Electrical burns should be covered with clean, dry dressings and the casualty should be sent to hospital.

Chemical burns should be treated in the same way as scalds. The affected areas should be showered with cold water for 10 to 20 minutes. All contaminated clothing should be removed while the water is being applied, but take care not to burn yourself in the process.

The treatment should be immediate and continue until you are sure that all the chemical has been washed off and the injury cooled. This time will be well spent – the initial first aid measures being more effective than quick removal to the hospital.

After washing and cooling the burn, cover it with a clean, dry dressing and send the casualty to hospital with a sample of the offending chemical. Chemical bums to the eye. Turn the affected eye towards a basin or bowl , and wash or, preferably, shower the injured eye with plenty of water for at least 20 minutes – check the time on a watch or clock. Then cover the eye with a clean, dry dressing and send the casualty to hospital.

Summary of types of burn likely to be received in the home or during leisure activities.

Dry heat bums may be caused by contact with fires, irons, hot plates or hot water bottles.

Dry cold bums may be caused by contact with the frost in deep freezes. Sunburn can follow over-exposure to natural sunlight or sunray lamps. Friction bums can be caused by grabbing fast moving ropes or through the skin coming into contact with surfaces at high speed – for example, when sliding on gravel after falling from a bicycle. Electrical bums can be caused by poor wiring or do-it-yourself accidents. Scalds can be caused by hot water from kettles or saucepans, or by hot fat. Chemical burns can result from contact with bleaches, cleaning agents and caustic soda.

Precautions against burns

All parents are aware of the risks to children of hot objects or liquids and yet thousands of youngsters suffer burns each year. Do 184 remember to take care when cooking -never leave children unattended in the kitchen. Guard all fires and put matches and cleaning agents well out of the reach of young children, preferably in kicked cupboards.

POINTS TO REMEMBER ABOUT BURNS

– Burns should be cooled with running water as quickly as possible after the injury.

– Cooling should be continued for at least 10 minutes or until no further pain relief is being achieved.

– The cooling process should not be rushed – it is the most important part of the treatment tor burns.

– The injured area should be covered with a loose, clean, dry-dressing.

– The casualty should be treated tor shock and sent to hospital.

ARTIFICIAL RESPIRATION

Artificial respiration, or artificial breathing, is necessary when a casualty is unable to breathe for himself. A person who has stopped breathing will be unconscious because the brain is deprived of oxygen.

If a casualty is not breathing, start artificial respiration immediately. Make sure that the mouth is clear of obstructions, then tilt site head back to lift the tongue from the back of the throat. Support the jaw with one hand and pinch the casualty’s nose with the other. Then cover the victim’s mouth with your own and blow into it, watching for the chest to rise – indicating that air is reaching the lungs. , and overdoses of drugs often found in the home, such as aspirin or prescribed medicines, can prevent the body from using oxygen efficiently and so cause breathing to fail.

Signs of breathing failure

It is usually easy to tell if someone has stopped breathing. He will appear pale and the face, lips and finger nails will be tinged blue-grey, indicating a lack of oxygen in the blood.

Watch for the chest rising and tailing. Listen for breathing, with your cheek close to the casualty’s nose and mouth where you should be able to feel exhaled breath on your skin.

If it is clear that the casualty is not breathing, mouth-to-mouth or mouth-to-nose resuscitation should be started immediately.

Applying artificial respiration

The aims of artificial respiration are to get the casualty to begin breathing again on his own or, if this is not possible, to provide 185 recovery position and then watched carefully to ensure that breathing continues. If he stops breathing, turn him onto his back and start mouth-to-mouth resuscitation again. Do not move the casualty unnecessarily. Make sure that someone has called for an ambulance.

If there is no improvement in the colour of the casualty’s skin and no pulse can be felt at the neck, it is likely that the heart has stopped beating. But continue with artificial respiration because the heart may still be working, though less efficiently than normal.

Heart failure

The heart may stop beating following a heart attack, an electric shock or simply through lack of oxygen because the casualty has stopped breathing. him with oxygen until more expert and better equipped help arrives.

Giving artificial respiration means breathing air into the lungs of the casualty who cannot do this for himself. We use only about one quarter of the oxygen that we breathe, so when we breathe out we expclabout 15 per cent oxygen-more than is needed by a casualty to survive.

– In order to receive artificial respiration the casualty should be placed on his back.

– Check that nothing is blocking the mouth or throat. If there is any obstruction it must be removed or allowed to drain out by turning the head to one side.

– When obstructions have been cleared, the head should be tilted back in order to open the airway as wide as possible. Sometimes these actions alone may be enough for the casualty to start breathing again. If he does start to breathe, he should be turned into the recovery position.

Mouth to mouth. If the casualty does not begin to breathe, keep his head tilted back by pushing up on the lower jaw and use your other hand to pinch his nostrils closed, thus preventing air from escaping through the nose. Then completely cover the casualty’s mouth with your own and blow into him, watching all the time for his chest to rise.

If the chest rises oxygen is successfully reaching his lungs. If the chest does not rise check that the head is tilted far enough backwards and that the seals at the nose and mouth are not allowing air to escape.

Start by giving four quick, full ‘blows’ without allowing the casualty’s chest to fall completely between each one. This will quickly saturate the lungs with oxygen. After the first four inflations, respiration should continue at the normal breathing rate- about 12 times a minute. After each ‘blow’ remove your mouth and watch the chest deflate.

Mouth to nose. The mouth-to-nose method should be used when there is difficulty or danger in using the casualty’s mouth, for example when the mouth is injured, when corrosive chemicals are present or when the mouth is too big. The technique is the same except that the lips should be sealed and the nose left open.

When performing artificial respiration on a very young child or a baby, cover both his mouth and nose with your mouth. More gentle blowing will be needed to fill Ins lungs, but the rate of breathing should be faster than that for an adult.

Continue with artificial respiration until the casualty begins to breathe on his own or until someone else takes over for you -it is a very tiring procedure. When carrying out mouth-to-mouth resuscitation, do not stop immediately when an ambulance or doctor arrives. Wait until the expert tells you he/she is ready to take over. It may he necessary for him/her to obtain equipment or oxygen supplies before actually taking over treatment. Any interruption in the treatment could have serious results. If the technique is working, the colour of the casualty’s skin will change from blue-grey to pink.

If the casualty does not begin to breathe on his own DO NOT GIVE UP; you should try to continue giving artificial respiration for at least an hour or until you are told to stop by a doctor.

Normally, expert help will have arrived long before the hour is up.

When the casualty is breathing on his own, he should be turned into the

POINTS TO REMEMBER ABOUT ARTIFICIAL RESPIRATION

– Check whether or not the casualty is breathing.

– If the casualty is not breathing turn him on to his back.

– Check that nothing is blocking the airway. If there is a blockage, remove it.

– Tilt the head backwards to open the airway as wide as possible.

– Seal the nose and cover the casualty’s mouth with your own.

– Give tour quick ‘blows’ without waiting for the chest to deflate completely.

– Continue to ‘blow’ at a normal rate, removing your mouth between each one and watching the chest fall before blowing into the casualty again.

– Continue artificial respiration until the casualty begins to breathe on his own, or until expert help can take over, or until you are told to stop by a doctor.

– If the casualty begins to breathe on his own, turn him into the recovery position.

– Transport the casualty to hospital as soon as possible by ambulance.

Left, above: mouth to mouth and nose respiration

Right: treatment lor a choking baby

Right, above: the Heimlich Manoeuvre

Artificial respiration will not work if the heart has stopped completely because oxygen in the lungs will not be circulated via the blood stream to the vital organs.

There is a technique for ‘massaging’ the heart back into action, and maintaining artificial circulation of the blood, which trained first aiders can perform. But the technique cannot be taught through the printed word. Good tuition and extensive practice on life-like dummies are essential because damage can be caused if heart massage is carried out incorrectly.

Almost anyone can learn the technique with practice and we strongly recommend that you seek out a local centre where tuition is available. Imagine the distress of being the only person available to help a dying casualty and not having the necessary skills to provide that help.

A second reason for attending such a course is the need to practice the techniques of mouth-to-mouth and mouth-to-nose resuscitation.

These must never be practised on people who are breathing normally, only on lite-like dummies. As with all first aid techniques, practice will give you greater confidence to use the techniques it a real emergency arises.

RESPIRATORY EMERGENCIES

The title ‘respiratory emergencies’ sounds very daunting. It refers to conditions which can cause difficulty in breathing -the most urgent of which is choking.

Choking on food is the sixth most common cause of accidental death m the U.S.A., and in 1978 about 560 people in Britain choked to death.

If a sweet or a piece of food lodges in the airway, stopping breathing, the victim will die in a short time unless the obstruction is removed. Fortunately, most people who start to choke manage to clear the obstruction by coughing it out.

Recognising choking. Foreign body obstruction of the airway usually occurs while the victim is eating. However, in the case of young children choking may also happen during play when a small object or toy becomes lodged in the airway.

A choking victim may well bring his hand to his throat. Ask anyone who gives this sign whether they are choking and look for a nod of the head in response.

There are three stages of choking: inability to speak or breathe; pallor of the skin and a blue tinge to the lips ; loss of consciousness and collapse. By the time a victim becomes unconscious he is very close to brain damage and death.

There is a danger that choking could be confused with a heart attack. The setting provides a clue – sudden death in restaurants is nearly always caused by choking. Age may also be an indicator – heart attacks are relatively rare occurrences below the age of 30.

The conventional treatment for choking is a series of sharp slaps on the back and an attempt to remove any firmly lodged obstruction with the fingers. In the ease of babies it is better if they can be held upside down, and a young child can be bent facedown over your knee. Giving the casualty a drink is dangerous.

If the methods described do not remove the obstruction, a new technique known as the Heimlich Manoeuvre may be tried. There is still some question over how effective the technique is and further damage to the victim may result from its use. For this reason the technique should be used only as a last resort.

The Heiniiicli Manoeuvre. The object of the Heimlich Manoeuvre is to produce a pressure of air from the victim’s lungs, forcing the obstruction out of the airway.

If the victim is standing or sitting, you should stand behind him and wrap your arms round his waist. Place your fist slightly above his navel and below the rib cage, with your thumb against the victim. Grasp your fist with your other hand and press into the victim with a quick upward thrust. The action should consist of a sharp flexion of the elbows rather than a ‘hug’ -with the emphasis on your hands. This may be repeated several times if necessary.

If the victim has collapsed to the floor and you cannot lift him, place him on his back, kneel astride him and place the heel of one hand just above the navel and below the rib cage. Place your other hand on top of the first and again give a quick upwards thrust, repeating it several times if necessary.

The Heimlich Manoeuvre for infants. Most choking incidents in young children can be dealt with by a slap on the back. But the Heimlich Manoeuvre may prove necessary and the rescuer should use the same method as for adults but apply less pressure. With very young children sufficient pressure can be applied using only the middle and index fingers of both hands.

Remember that the Heimlich Manoeuvre should only be used when survival depends on clearing the airway quickly.

The victim should see a doctor immediately after a rescue.

FITS OR CONVULSIONS

Fits and convulsions can often appear more dangerous than they really are. Generally a person having a fit or convulsion should not be restrained unless in danger of injuring himself. If restraint is necessary, gentle force only should be used because the victim may be aware of what is happening and could become more violent in his actions.

Move any objects which could cause injury out of the victim’s way. When the fit has finished lie the victim in the recovery position and send for medical help.

If a baby ‘has convulsions, he is often easier to handle if wrapped in a blanket.

Convulsions in young children often result from high temperatures caused by infection. It is therefore important that the child should see a doctor.

EPILEPSY

There are many different kinds of epilepsy and they vary considerably in severity. About 2,000 new cases are diagnosed each year, many of them the result of head injuries.

Anyone witnessing a major epileptic fit is likely to be alarmed because death may appear imminent. The patient will lose consciousness and become intensely rigid, with teeth and fists clenched. The breathing muscles may be affected causing the face colour to become livid. The eyes will stay open and fixed and appear to roll upward. ‘I’he convulsion stage follows, during which muscle contractions can become extreme with violent jerkings of the body and limbs. As this stage passes, jerky breathing is restored preventing any danger of death. The convulsions eventually cease and breathing returns to normal.

Return to consciousness may or may not be quick. A patient who regains consciousness quickly will look exhausted and will have a pale, sweating skin. He may not be aware of his surroundings and should be encouraged to sleep if he wants to. A patient who does not recover consciousness quickly may enter a coma which gradually changes into natural sleep.

Treatment is restricted to preventing injuries occurring during the attack. If there is time before the convulsions start, loosen tight clothing and use something soft to support and protect the head.

Try to keep onlookers out of the way and reassure them that the patient is not seriously ill. Do not put anything into the victim’s mouth – it could cause damage and epileptics rarely bite their tongues. Do not restrict the patient’s movements during the convulsion stage, but move furniture or other hard objects out of the way if possible.

When the fit has finished and the patient is sleeping, treat him as though you had found him unconscious: clear the mouth of any excessive saliva and mucus and turn him into the recovery position.

When he wakes, stay with him and offer him a drink. Do not leave him alone until he is totally aware of his surroundings.

As long as the patient is known to be epileptic there is no need for him to go to hospital and he may return to work as soon as he has completely recovered from the attack. But make sure that the patient is fully recovered and capable of answering questions.

On recovery the patient will be aware of any injuries which may have occurred and some minor first aid may be necessary.

There are rare cases where fits recur without recovery between attacks. If attacks continue for longer than is minutes, either a doctor or an ambulance should be called urgently.

DIABETES

Diabetes is a disease affecting one per cent of the population and it is estimated that a 188 further 60,000 people in the UK are undiagnosed sufferers. Although the disease cannot be cured, it can be controlled -allowing sufferers to lead full and active lives.

Diabetes is caused by the inability of the body to produce sufficient insulin. The action of insulin is not fully understood, but it is known to reduce the amount of glucose in the blood and make it available as a source of energy to the body.

It is important that the amount of glucose and insulin in the blood are balanced. The patient must maintain this balance by careful diet and often by injecting himself with extra insulin. Emergencies arise when an imbalance occurs.

Too much insulin

The most common inbalance is one in which the patient has too much insulin. This may result from an overdose of insulin which the patient has given himself by mistake, or following excessive physical exercise, worry or when a meal has been missed – all of which will reduce the amount of glucose available to the body.

The condition is relatively easy to diagnose, particularly if the patient is a known diabetic. However, it is quite common for a diabetic going into a coma to be mistaken for a drunk. The patient becomes aggressive, with a pale sweating skin. He will appear confused, mentally agitated and may start shouting. Speech can be affected and the patient becomes unsteady on his feet before eventually losing consciousness and entering a coma. Changes will occur in the breathing and the pulse will become weak and fast.

A diabetic coma is a life threatening condition so correct diagnosis and first aid are essential.

First priority is to prevent the patient losing consciousness. The immediate treatment is to give five teaspoonfuls of sugar in a warm drink to the patient. He may be unco-operative, but persist and make sure it is swallowed.

It there is any doubt about the onset of an insulin reaction do not hesitate to give sugar – it is better to err on the safe side as no harm will result.

Recovery is usually quite rapid. When the patient has recovered, tell him how much sugar he has taken so that he can make adjustments to his diet.

If the patient is not given sugar before he lapses into a coma, no treatment by the first aider is possible. The patient should be treated as unconscious and urgent medical aid should be sought. It the patient is sent unconscious to hospital, it is important to inform staff that he is a diabetic and that you believe he is in a diabetic coma.

Too little insulin

In cases where a patient has insufficient insulin for the body’s needs, the onset of symptoms will be much slower and hospital treatment should be sought – particularly in the case of undiagnosed diabetics. Giving sugar to a diabetic in this state, while not improving the condition, will not cause serious damage.

Many diabetics carry a ‘medic alert’ card to warn of their condition. They may also carry sugar for use in case of emergency.

POISONING

A poison is any substance which when taken into the body in sufficient quantity is capable of causing damage or death. About 3,000 people in Britain die of poisoning every year. Children under five are most at risk – about 40,000 of them are treated for poisoning in hospital each year. Poisons may be solid, liquid or in gas form.

Common solid poisons include aspirin, paracetamol, prescribed tablets and poisonous foods such as some fungi, berries and plants- particularly laburnum and belladonna.

Liquid poisons include household cleaning materials, which may be corrosive; petrol and oil-based liquids; weedkillers, and alcohol if taken in excess.

Common poisonous gases are fumes from fires or stoves and motor exhaust fumes.

Different poisons can affect a victim in different ways. The following signs may be noticed: excitability, loss of coordination of movements, changes in breathing-this may become faster or slower- or convulsions. The combination of the effects that occur will depend on the poisons involved.

Treatment

The first priority is to ensure that the victim’s airway is kept open and that breathing is maintained. If the victim loses consciousness, turn her into the recovery position. If breathing fails, start artificial respiration immediately. If the victim remains conscious, keep her still and reassure her that she will be all right.

Avoid causing extra stress to the victim as this will cause the poison to be absorbed more quickly. You may have seen films in which someone who has taken a drug overdose is kept awake and made to walk about. This method must not be used. Nor should poison casualties ever be given any form of stimulant such as black coffee.

The second priority is to get the victim to hospital as quickly as possible. Although 3,000 people die from poisoning each year, of the 120,000 poisoned casualties who reach hospital only about 600 die – that is one death for every 200 casualties. These figures emphasize the vital importance of prompt hospital treatment. [

If the victim is conscious and unlikely to vomit, and it you have your own transport, take her to hospital yourself. If there is a danger of unconsciousness, vomiting or breathing failure ring for an ambulance.

Apart from coping with the emergencies which may follow poisoning, the best course is to do nothing. If the casualty is conscious, ask her what the poison was and how much she has taken. This should be done quickly in case the victim loses consciousness. For the same reason the casualty should never be left alone.

In almost every case the casualty should not be made to vomit. This might cause turther damage. On no account should salt water drinks or any other emetic be given.

The only occasion on which you should try to make the conscious casualty vomit is following a drug overdose when you know there will be a delay before the victim can reach hospital. Induce vomiting by pushing fingers down the victim’s throat.

The only time when a drink may be given is when the casualty complains of lips, mouth or throat burning – an indication that she has swallowed something caustic. Even in this situation, if quick access to hospital is possible, it is better not to give a drink. But if there is some delay and you are sure that the casualty is fully conscious and unlikely to vomit, she maybe given milk or water to sip. This should dilute the poison and reduce further damage.

Take a sample of the poison to hospital with you if possible. This could be in the form of tablets, empty or part-filled bottles, or berries you suspect of being poisonous.

When a victim has vomited, a sample of this vomit should also be taken to hospital. In order to pick up a sample, put your hand into a plastic bag, grab a handful of vomit and turn the bag inside out. Then seal the top of the bag. If possible, let the hospital know when the poison was taken and how much was consumed.

Precautions. Awareness of the dangers of poisoning in the home is very important. Children love to put things in their mouths – particularly if they are colourful, as so many drugs are these days. The only safe way is to keep anything poisonous out of the reach of children. Medicines and household cleaners should be locked up. Always keep poisons and medicines in properly labelled containers and preferably the ones they were bought in. Never take medicines in the dark and always dispose of old tablets and other medicines by flushing them down the lavatory.

THE FOLLOWING CAN BE POISONOUS:

Acids

Ammonia

Bleach

Carbolic Soap

Carpet Cleaner

Caustic Soda

Detergents

Floor or Furniture Polish

Grease Spot Remover

Lavatory Cleaner

Metal Polish

Oven Cleaner

Paintbrush Cleaner

Paint Thinner

Paraffin

Petrol or Kerosene

Rust Remover

Shoe Polish iyo

POINTS TO REMEMBER ABOUT POISONS

– Make sure the casualty’s airway is not blocked and that she is breathing.

– Arrange tor transport to hospital as quickly as possible.

– Keep the conscious casualty still and reassure her.

– Never leave the casualty alone.

– Do not make the casualty vomit. Never use salt water drinks – they are dangerous.

– Drinks of milk or water should only be given to conscious casualties who have swallowed an acid or caustic substance – burning round the mouth is a tell-tale sign. But do not give drinks even in this situation if the casualty can be transported to hospital quickly.

STROKES

Strokes are caused by a bursting artery or a blood clot in the brain. They occur most commonly in elderly people and can vary considerably in severity.

Symptoms

At the onset of a stroke the patient becomes confused and dizzy and may have a headache. He may have trouble controlling his limbs and muscles, find talking difficult and will usually dribble saliva from one side of his mouth. The patient will look extremely ill, his skin will appear blue and breathing will be loud and harsh.

Treatment

If the patient is conscious he should be placed at rest in a comfortable position and given a lot of reassurance. A doctor should be called straight away. It the patient is unconscious he should be placed in the recovery position and treated as an unconscious casualty.

HEART ATTACKS

The role of the heart in pumping blood containing oxygen round the body to the brain and other organs is discussed earlier. We have also recorded that the heart may fail soon after breathing fails or following an electric shock. However, it is more common for the heart to tail as a result of disease.

Heart disease is a major cause of death. The term ‘heart attack’ is used to describe many different types of sudden illness involving the heart, but it is not important for the first aider to know exactly what has gone wrong. As in all emergency first aid the priority is to maintain life until expert medical aid can take over.

A person who has suffered a heart attack will be in a state of shock. He will look ill, his skin will be pale, cold and clammy, and he may teel giddy. He will be very anxious and restless, his breathing will be laboured and his pulse will be weak and irregular.

Treatment

It the victim is conscious, he will probably complain of severe pain around the chest, down his left arm and in his neck and jaw. Do not move him unnecessarily but put him into the sitting position. This will give him maximum relict and comfort and will allow him to breathe more easily.

Loosen any tight clothing at the neck, chest and waist. Reassure the casualty that he is going to be all right and arrange for an ambulance to come as quickly as possible.

If the casualty loses consciousness, he should be turned into the recovery position and his breathing and pulse should be checked frequently.

Following a serious heart attack, the heart may fail. If this happens heart massage and artificial respiration will be necessary to maintain life until help arrives.

Again we must encourage you to attend a course where you can learn to perform external heart massage and have the opportunity to practise mouth-to-mouth resuscitation. These skills are particularly important if you have elderly relations living with you.

POINTS TO REMEMBER ABOUT HEART ATTACKS

– Summon an ambulance as quickly as possible.

– It the victim is conscious place him in the sitting position and give him reassurance.

It the victim is unconscious place him in the recovery position and check frequently that his airway is clear and that he is still breathing.

– If the heart fails, external heart massage and mouth-to- mouth resuscitation are required to maintain life.

EYE INJURIES

All serious injuries to the eye and the skin immediately around it require urgent medical attention. When a casualty has an eye wound, she should be made to lie down and be kept still. The eye should be closed and covered with a sterile dressing, and she should be sent to hospital as soon as possible.

Black eye. A black eye is a bruise of the eye socket and lids, and the colour and swelling are due to bleeding underneath the skin. Swelling can be reduced with ice packs if they are used quickly after the injury.

Beef steaks are not recommended — they provide no relief and are rather expensive! A black eye may be associated with eye damage and even a fractured skull, so it is essential that the casualty be sent to hospital for assessment.

Foreign bodies

Small foreign bodies such as grit, loose eyelashes and fragments of metal or glass can float on the surface of the eyeball, causing considerable pain and distress to the casualty. The casualty should be discouraged from rubbing her eye as this will only cause more discomfort.

Such floating foreign bodies can be removed with the corner of a paper tissue or a clean handkerchief.

Seat the casualty facing a good light and stand behind her. Ask her to lean her head back until it is against you. Search the eye systematically for the foreign body. The casualty should be asked to look up, to the right, to the left and then down so that you can see the different parts of the eye.

If you still cannot find the object, grasp the lashes on the upper eyelid and pull it down. This may loosen the foreign body. but if not the upper lid can be turned back on itself to expose more of the eye. To do this, ask the patient to look down, pull the upper lid down, place a cotton bud across the lid and gently pull the lid out and up to fold it over. Ifyou have friends who are not squeamish, practise this technique on them.

Once the offending object has been found, it should be removed with one gentle wipe of a paper tissue. If the object does not move or come out with the wipe, then it is probably stuck to the eye and no further attempt should be made to remove it.

Cover the eye with a pad and semi the casualty to hospital.

An alternative method of removing a foreign body from the eye is to blink her eye under water. However, this method is less likely to be effective.

If no foreign body is found but the casualty continues to suffer discomfort, she should be sent to hospital for closer examination of the eye.

FOREIGN BODIES IN NOSE OR EAR

It is quite common for children to stick beads, food such as beans or peas, or other small objects into their ears or nostrils. Do not attempt to remove objects which are stuck , nor pour water or oil into the ear. The child should be taken to hospital where the object will be removed. There is generally no immediate danger of injury by a foreign body – unless it is sharp.

FRACTURES

A fracture is a broken or cracked bone, and can be either closed or open.

A closed fracture is one where there is no break in the surface of the skin.

An open fracture is one where there is a wound leading down to the break or where the broken end of a bone protrudes through the skin.

Fractures usually occur in accidents involving force, such as car crashes or falls. Falling is the most common cause of death in the home – more than 3,000 people die in the home each year because of a fall. A common home accident is caused by people standing on chairs and stretching to reach high cupboards or to hang curtains. Always use a pair of steps for such jobs.

INDICATIONS OF A POSSIBLE FRACTURE ARE:

– Pain in or near the injured part.

– Tenderness on gentle pressure.

– Swelling around the injured part.

– Loss of control over the injured part and loss of power – for example, an inability to put weight on a leg.

– Deformities such as: irregularity of the bones; shortening of the injured limb; depression of a fiat bone such as the skull; the ability of the limb to move in abnormal ways; the sound of grating when the limb is moved.

Dangers

Fractures themselves are not generally life-threatening injuries – even though they can be extremely painful and incapacitating. The immediate danger for the casualty is blood loss and the resulting shock.

The ends of broken bones are very sharp anil can cause considerable damage to the soft tissues around them. They can also cut through blood vessels. Such internal bleeding may be seen as swelling around the site of the fracture.

It is not unusual for certain fractures to cause the loss of as much as I litre of blood. Multiple fractures may cause an even greater loss. As we have already seen, the loss of two or more pints of blood means that a casualty will be seriously ill.

Fractures to the skull and spine are particularly dangerous.

Skull, or base of skull fractures

A casualty who sutlers such an injury is likely to be drowsy or unconscious. Such an injury can sometimes be identified because of bleeding from the nose or ear. If a skull

Elderly people are particularly prone to Never test for and as this will cause fractures. This is because their bones unnecessary pain and probably further become brittle with age and they may be damage as wel unsteady on their feet and more likely to tall in consequence.

Diagnosing a fracture

A casualty often knows when she has suffered a fracture because she hears the bone snap. However, the way to be sure that a fracture has occurred is by an X-ray. It there is any uncertainty about whether a casualty has a fracture or not, always assume she has broken a bone and send her to hospital for an X-ray and expert medical treatment.

Not all these indications will be present with a fracture. In fact, sometimes the victim of a fracture will continue as normal without realizing that her injury is so serious. A good way of checking for a fracture is to compare the injured limb with the uninjured limb. Differences may well make the fracture obvious. 193 fracture is suspected, the casualty’s head should be kept absolutely rigid. The bleeding should be allowed to continue, the blood being soaked up by cotton wool or any available absorbant material. Fracture of the spine.

When such an injury has occurred, a conscious casualty may complain that she is unable to feel or move her legs. An unconscious casualty may be discovered in a grotesque twisted position. If a fracture of the spine is suspected, the casualty must not be moved because of the danger of causing further damage.

The only times when a casualty with a fractured skull or spine should be moved are when the casualty is in danger of further injury – for example, when a fire is threatening her life – or if her breathing fails. In this latter ease, artificial respiration becomes the first priority.

Chest and rib injuries

Ribs are commonly fractured in falls, through being crushed against the steering wheel in a car crash, or when playing sports. They can even be broken by a severe coughing fit. The casualty will complain of a sharp pain in the region of the fracture on breathing or coughing. She will take shallow breaths in order to reduce the pain. If a lung has been damaged by the broken rib, she may cough up blood and her breathing will be very distressed.

Muscles attached to the ribs provide adequate immobilization, and first aid treatment is limited to dealing with any complications and making the casualty comfortable.

A conscious casualty should be placed in a half-sitting position inclined towards her injured side. This allows the uninjured lung to continue working normally and ensures that any blood flow will be restricted to the already damaged lung.

Arrangements should be made to send the casualty to hospital as quickly as possible, preferably by ambulance.

A chest wound caused by a fractured rib coming through the skin is a serious complication as it may allow air to be sucked into the chest cavity. Other puncture wounds caused by a knife or bullet create a similar problem.

The wound should be covered at once with a sterile dressing covered by an adhesive dressing. A polythene bag can also be used to prevent air being sucked in. Again the patient should be inclined towards the injured side. If the patient is conscious, she can be transported to hospital in a sitting position or a half sitting position inclined towards the injured side.

Arm and leg fractures

Although it is generally best to do as little first aid as possible when dealing with fractures, there are occasions when some treatment may be helpful.

A conscious casualty who has suffered a fractured arm can be transported to hospital by car: it is not necessary to call an ambulance. It will aid the comfort of the casualty if the damaged limb is put into a sling; use a folded newspaper to provide a rigid support.

A casualty with a broken leg must be taken to hospital by ambulance and in most cases it is best simply to ensure that she is as comfortable as possible until the ambulancemen arrive. Support the injured leg in the most comfortable position with pillows or cushions, and try to prevent movement of the injured limb. Do not attempt to straighten or splint a broken limb – leave this to the ambulancemen.

They will have special inflatable splints and anaesthetic gas to relieve the pain.

Sometimes, however, it may be necessary to move the casualty; for example, when she may be in further danger. Before you move the casualty, immobilize the 194 injured leg by securing it to the sound leg. Remember, this technique should be used only when the injured leg is not severely deformed.

Always bring the uninjured leg towards the injured one, moving carefully and slowly – there is usually no need to rush. Watch the casualty to make sure you are not causing too much pain. Use some padding – towelling or sweaters for example – between the knees and ankles to prevent these bony projections rubbing against each other and secure with triangular bandages, folded into broad bandages. Do not remove the casualty’s shoes they will make the bandaging more effective and comfortable.

The first bandage, which should be applied in a figure of eight around the ankles and feet, is best tied on the edge of one of the shoes. Unless the knee is fractured, the second bandage should be placed around the knees and tied at the side of the uninjured leg. Two more bandages may be used, one above and one below the site of the fracture – again tied on the uninjured side.

The bandages should be tied firmly enough to prevent one leg moving without the other. But watch for swelling around the fracture. If this occurs it will be necessary to loosen one or more of the bandages.

Once the fractured leg is immobilized in this way the casualty will be more comfortable while being moved. However, this form of immobilization is likely to cause pain to the casualty and should only be used when it is really necessary to move her.

General treatment

The best treatment for fractures is to do as little as possible. Unnecessary movement will only cause further distress and damage. Usually a conscious casualty will adopt the most comfortable position automatically. Once she has done this there is no point in moving her.

Open Fracture. If the fracture is open there may be external bleeding. There is also the danger that infection will enter the wound or even the bone. The wound should be covered carefully with a sterile dressing but pressure should not be applied as bleeding will probably be minor. It pressure is required to stop the bleeding, the method of dressing wounds containing foreign bodies should be used.

Arrange for an ambulance to come as quickly as possible. While waiting for it to arrive, treat the casualty for SHOCK. Reassure her that help is on the way and that she will be all right. Loosen all tight clothing and cover with a blanket. Do not leave the casualty alone, and check her breathing and consciousness. Keep a record of her pulse rate as this will help doctors to estimate the amount of blood lost and to decide whether a transfusion is necessary.

If the casualty loses consciousness, she should be moved gently into the recovery position.

If breathing fails, mouth-to-mouth resuscitation must be started at once. Never give the casualty anything to eat or drink as she will probably need an anaesthetic when she reaches hospital.

Sprains and dislocations

Sprains anil dislocations are both injuries which affect joints such as the shoulder or ankle. In a sprain the soft tissue around the joint is stretched or torn. A dislocation is the displacement of one or more bones at a joint.

Both types of injury appear similar to fractures and often occur at the same time. Usually an X-ray is required before an accurate diagnosis of the injury can be made. It is not necessary for the first aider to be able to tell the difference between fractures, sprains and dislocations. The casualty should be treated in the same way for all three conditions.

POINTS TO REMEMBER ABOUT FRACTURES

Move the casualty as little as possible, just help to make her comfortable.

– Quick transport to hospital should be arranged.

– The casualty should be treated for shock as internal bleeding will occur. Reassure the casualty.

– Open fractures should be covered with a sterile dressing to reduce the risk of infection.

– Check carefully for possible fractures ot the skull or spine. It such fractures are suspected, the casualty must not be moved unless it is absolutely essential in order to preserve life.

HEAT EXHAUSTION/STROKE

Heat exhaustion or heat stroke may occur when a person is exposed to too much sun and high temperatures – most likely to be encountered when on holiday abroad -but it can effect you in your own garden if you don’t time sun-bathing sessions sensibly, or if you fall asleep in full sun.

In lical exhaustion the casualty will suffer dizziness, nausea, headache and muscle cramps. He will also have the symptoms of shock – pale colour, cold clammy skin and a weak pulse.

The casualty should be moved to a cool place and /’/ conscious given cool drinks to sip. Large amounts of salt should not be given as this may increase nausea.

Heat stroke is a very serious condition; 195 the casualty may lose consciousness, his face will be flushed, his skin will feel hot and dry, his pulse will be strong and fast and his temperature may be very high. He-should be treated as an unconscious patient and the doctor called as soon as possible.

HYPOTHERMIA

This is a serious condition in which the body temperature falls dangerously low. This can occur because of exposure to severe weather and is also likely to affect elderly people because of insufficient heating at home o.g and ask for an ambulance. Be as precise as you can about the nature of the illness /accident and always give the lull address clearly.

Treatment

If conscious, the casualty should be placed in bed and covered with warm clothing so that he warms gradually. Direct heat – such as a hot water bottle -should not be used, but the casualty can be given warm drinks. Call a doctor.

If the casualty is unconscious he should again be put in bed – in the recovery position – and covered with warm clothing. An ambulance should be called without delay and a careful check should be kept on the patient’s breathing.

GENERAL ASPECTS OF FIRST AID

Approaching a casualty

Your approach to a casualty should be calm, reassured and unhurried, as this will help to allay the anxiety that any casualty will have. It will also help you to overcome your own anxiety. Announce that you are a first aider and reassure the casualty and others present that the situation is under control and that further help will arrive soon. Never rush into treatment. Check first whether there is danger of further injury and whether it is necessary to move the casualty.

Be careful not to waste time treating obvious injuries such as minor bleeding when more serious, life-threatening problems may exist.

The priorities

Make sure the casualty is breathing, that there is no serious bleeding and that the casualty is conscious before doing anything else.

If there is more than one casualty, deal with the one who is in the most serious condition first. Responsible onlookers can be told how to care for the casualties who are less seriously hurt. The first aider must assume leadership unless a doctor or more qualified first-aider is present.

Sending for help

Send a responsible person for help as soon as possible. Generally it is best to send for an ambulance. The person requesting it should give the exact location of the emergency, the cause, the number of casualties involved, and brief details of extent of injuries, it known. As far as possible never leave a casualty unattended. Always send someone else to phone for help.

One point to remember when calling for help is that if the injury was caused more than 24 hours earlier, a hospital may refuse treatment without referral from a doctor. Therefore, if the effects of the injury do not appear until 24 hours after the accident which caused it, a general practitioner should be summoned in the first instance.

When to give drinks

The general rule is that no food or drink should be given to a casualty, for the following reasons: 1. Unconscious patients are unable to [96 swallow and will choke on anything given by mouth.

– Many casualties will require an anaesthetic on arrival at hospital. An anaesthetic can only be given to a patient whose stomach is empty, again because of the danger of his choking or vomiting while unconscious. If a casualty has been given something to drink, treatment may be delayed for several hours until the stomach empties.

Only conscious casualties suffering from burns, or who have swallowed acids or caustic substances, may be given drinks.

However, there is always the danger that these drinks may cause the casualty to vomit; so, it the casualty can be transported to hospital quickly, avoid giving him a drink. If you know that there will be some delay in getting the casualty to hospital, then a drink should be given.

Offer the casualty water and allow him to take sips rather than forcing him to take the whole drink quickly – which could cause the patient to vomit.

A person who is recovering from a faint may be given a drink – but on no account must this ever be alcohol.

Keeping the casualty warm

Following injury or sudden illness, the casualty should be kept warm but not overheated. One blanket will generally be enough cover, and as most heat is likely to be lost if his body is in contact with a cold surface, the blanket should be placed under the casualty if possible.

Never use a lot of blankets or any form of artificial heating, such as a hot water bottle. If the skin is overheated, blood will. return to the skin to help cool the area and this will only increase the casualty’s shock.

How to handle a casualty

Casualties should always be handled gently and carefully. Rough handling will increase pain and anxiety, and can make injuries worse or increase bleeding. It it is not essential to move a casualty, do not do so. A conscious casualty will generally put himself into the position which he finds most comfortable, so nothing will be gained by moving him. Casualties with fractures or dislocations should not be moved unless they are in danger or have more serious complications such as bleeding or unconsciousness. Wait for the ambulance to arrive and let the ambulancemen take responsibility for moving the casualty – they are experts.

Distance from emergency services.

The advice in this article has been to give as little first aid as is necessary at all times. This is because we are dealing with accidents in the home and most people live near enough to ambulance services and hospitals for expert help and treatment to be given reasonably quickly.

However, a large number of people live in more isolated places where help may not arrive for some time. More elaborate first aid treatment may be appropriate in such cases, and people living in isolated areas are advised to attend a full 16-hour first aid course. These are offered by the St John and St Andrew’s Ambulance Associations, the British Red Cross and other organizations. It may also be worthwhile to attend a home nursing course.

Also, in isolated areas it may be better to call a doctor to the scene of an accident before sending for the ambulance. If you know the ambulance will take a long while to arrive, a doctor will probably be able to ease the casualty’s pain and certainly offer more advanced first aid.

Transporting casualties

After receiving first aid, many casualties need to be quickly transported to hospital where more expert attention and equipment is available. In most cases where urgent medical attention is required, it is best to dial 999, give relevant in formation, and ask for an ambulance.

But there are times when transport by ambulance is inappropriate or even antisocial. Sometimes it may be quicker to take a casualty to hospital by car – either your own or a neighbour’s – and at other times treatment may not be required or a doctor’s visit may be sufficient ‘second aid’.

Naturally, it is better to err on the side of safety and obtain hospital treatment as quickly as possible if serious injury or illness is suspected.

An ambulance must he called to any casualty whose life is threatened: for example, casualties who are unconscious, have uncontrolled internal or external bleeding, are not breathing or are in severe shock. An ambulance will also be needed for a casualty who can be moved only by stretcher.

Casualties may be taken to hospital by car in certain instances: for example, following a fracture of the arm or shoulder, where a poisoned casualty is conscious, following a blow to the head where the casualty is conscious and co-operative, when bleeding is controlled but stitching is required, or following burns.

When driving a casualty to hospital try to have a third person in the car who can ensure that the injured person does not deteriorate and that he remains conscious.

Where life is not threatened and hospital treatment does not appear necessary, the best course is to ask the casualty’s GP to call as soon as possible. However, always bear in mind that anyone who has been injured or has suffered an acute illness could develop symptoms over a period of time: for example, where there is internal bleeding. So it is important not to leave the casualty alone and to check his condition -particularly his pulse – for some time after the injury.

SAFETY AND THE FIRST AIDER

A casualty is usually found at the place where she was injured, so the possibility of a second accident is very real. Before attending to a victim’s injuries stop to consider what has caused those injuries. If the hazard still exists it must be removed before treatment begins.

Above everything else the first aider must ensure that he or she does not become a second victim. This will not help the original casualty and may make rescue even more difficult.

The second consideration is the danger of further injury to the casualty. Where such danger exists the first aider must decide whether to move the casualty to a safer place.

Car accidents

There is great danger in treating a casualty at the site of a road accident and this applies even if the site happens to be outside your own front door, in a normally peaceful street. People should be sent in both directions to warn approaching traffic if the casualty is not to be moved.

If two or more vehicles have collided, there is a danger that petrol may ignite. Engines should be turned off and keys removed from the ignitions before starting any first aid treatment.

Do not allow smoking near a road traffic accident.

Electricity is another potential danger. It the victim of an electric shock is still in contact with live current she must not be touched by anyone. If you can locate it quickly, switch off the electricity supply at the main, otherwise switch off at the plug, then remove the plug before attempting any treatment.

Fire or poisonous gases

Even when you are sure there is a casualty in a room filled with smoke or poisonous fumes, do not enter alone unless you are wearing some form of breathing apparatus. It you have an assistant, tie a rope round your waist and cover your mouth with a damp cloth. Keep close to the ground because smoke and poisonous gases will rise, leaving more oxygen near the floor.

The assistant should be instructed to pull you out by the rope if you do not return within a couple of minutes.

When giving first aid to someone who has been in contact with poisonous substances or gases, take care not to be affected yourself while removing contaminated clothing from the casualty. If artificial respiration is required, start it only after the casualty has been moved into the fresh air and move your head well away from the casualty as she exhales. Where there are signs of burns around the mouth do not use mouth-to-mouth resuscitation use mouth-to-nose instead, if safe to do so.

Before treating a casualty who is bleeding:

– Remove any source of further potential injury, such as broken glass, and switch off any unattended machinery.

– If the casualty has been injured by falling stones or bricks, move her to safety before starting treatment.

Commonsense

Such matters may seem simple commonsense when considered at leisure. But when confronted with an injured person, your first reaction is likely to be a mixture of shock, confusion and a desire to help as quickly.is possible.

Do not rush in without thinking. Stop to consider what has happened and whether there are still potential dangers. This few seconds delay will also give you a chance to overcome your initial nervousness.

Too many cases are reported of one or more rescuers dying while the first casualty survives. However good the intention, this is not good first aid. Remember: the first priority is safety -your own safety and the safety of the casualty.

THE HOME FIRST AID BOX

Every home should have a First Aid Box, because accidents can happen – even in the most highly organized of households. Yoti can either buy one already equipped, from main chemist shops and stores, or you can improvize one and stock it up as recommended below. All members of the family should know where the box is kept – and how to use the contents. But it must, of course, be kept well out of reach of young children.

Any box in which first aid materials are to be kept should be clearly labelled ‘First Aid’. A biscuit tin or an empty ice cream container will serve the purpose as long as it is properly cleaned and labelled.

The following contents are recommended for home treatment: Standard wound dressings – numbers 8 and 9. 1 crepe bandage Triangular bandages Cotton wool

Lint, gauze or melolin squares Plaster strip

A selection of porous fabric plasters Antiseptic cleanser Antiseptic cream Calamine cream Wasp-eze spray Burn spray Soluble aspirin BP Paracetamol Milk of magnesia Safety pins

Scissors, 13 cm stainless steel with blunt points Tweezers – spade ended

Wound dressings

The standard wound dressings are the type with a pad stitched to the bandage. They are sold in various sizes, but Numbers 8 and 9 are the most handy for home use.

Crepe bandages can be used to give additional pressure over a dressing it bleeding is hart! to control. The bandage should 198 not be stretched to more than two-thirds of its capacity when applied. This will allow for the limb swelling, but remember to check that blood circulation is not affected.

Triangular bandages are particularly useful because besides making slings they can be folded and used as ordinary bandages. You can make your own triangular bandages by cutting a 90 cm square of cotton diagonally from corner to corner.

Cotton wool is useful for cleaning wounds and for absorbing discharges when used over a non-adhesive dressing.

Lint, gauze and melolin squares are used to cover small wounds. Melolin squares are small, sterile, non-adherent wound dressings. They are reasonably inexpensive and particularly useful for covering grazes and small burns.

Plaster strip, cut into short lengths, is useful for fixing small dressings to the skin. Porous fabric plasters are recommended because they promote better healing than waterproof plasters, which do not allow air to circulate. When the injured parts are likely to be exposed to dirty water, waterproof plasters may be used, but afterwards they should be replaced with the fabric variety.

Antiseptic creams and lotions

Generally it is best to leave a clean, dry dressing. However, if the wound is likely to weep, an antiseptic cream can be used to provide a greasy surface which will prevent a dressing from sticking to the wound. Liquid antiseptic can also be used to clean small wounds, and antiseptic cream to treat gravel grazes or very small burns. When using an antiseptic cleanser be sure to follow the manufacturer’s directions, otherwise healthy skin tissue may be damaged or skin reactions may occur.

Cold compresses

In the case of a twisted ankle or bruising in which the skin is not broken, swelling can be reduced and comfort provided by the application of a cold compress or ice pack. However, it is important first to check that no serious injury, for example a fracture, is present. A cold compress can be made by soaking a clean, folded handkerchief or a folded triangular bandage in cold water. Place the compress over the injury without wringing it out. This dressing can then be secured with a firm bandage. Alternatively, a No 8 or 9 bandage can be soaked and applied directly over the injury. The bandage should be kept wet with more cold water.

Always check that the bandage is not tied too tightly, preventing blood flow.

Alt ice pack can be made by wrapping ice cubes in a towel and crushing them with a hammer. The pack can then be placed on the injury.

Calamine cream is useful for the relief of sunburn, itchy bites, heat spots and other minor skin irritations. It has the benefit of cooling the affected skin area.

Wasp-cze spray reduces the swelling and pain associated with wasp or bee stings.

Burn sprays are also very effective in reducing pain but they must be used with caution – only on minor burns and never on burns where the skin is broken.

Any wound or burn which requires hospital attention should have nothing other than a sterile dressing applied.

Soluble aspirin BP is effective in relieving pain and cold symptoms. It also tends to lower temperatures. Aspirin should not be given to people with upset stomachs or with a history of stomach trouble.

Paracetamol is also effective in relieving pain and is less likely to cause upset stomachs. 199.

Milk of magnesia should be used for minor stomach upsets.

Other items such as tablets for indigestion may be added it considered necessary.

Remember that minor problems such as headaches, stomach upsets and indigestion should be referred to a doctor if they recur frequently or last lor more than 24 hours.

Scissors

It is worth investing in a good pair of scissors for cutting dressings, but make sure they stay 111 the first aid kit.

Safety pins are particularly useful for fixing dressings, especially where triangular bandages are used as slings.

Tweezers are useful for removing splinters and stings.

SUMMARY OF LIFE-SAVING FIRST AID

Good first aid should help to prevent the casualty reaching the next stage in the chain. In fact, the casualty can be helped to progress back up the chain: for example, if breathing is restored or consciousness regained.

A casualty need not pass through every stage. Heart attacks, electric shocks and head injuries can lead directly to unconsciousness or to heart failure.

Very occasionally, following serious injury, death may be almost immediate.

Bleeding

Prevent further blood loss by lying the casualty down, using direct pressure, elevation and rest.

Burns

Reduce plasma loss by cooling the affected area and cover with a loose, clean, dry dressing.

Fractures

Do little more than reassure the casualty. Cheek for fractures of the skull and spine.

Shock

Reassure the casualty, make him comfortable, lie him down and raise the lower part of the body, loosen tight clothing. Check the pulse frequently and keep a written note of the rates, for the information of the doctor/ambulancemen.

Unconsciousness

Ensure that the airway is clear. Turn the casualty into the recovery position. Check frequently that breathing continues. Note the pulse frequently, and keep a written record as above.

Breathing failure

Turn the casualty onto his back. Check that his airway is clear and tilt his head back. Start mouth-to-mouth or mouth-to-nose resuscitation immediately.

Heart failure

Lie the casualty 011 his back. Make sure the airway is clear. Start heart massage and mouth-to-mouth resuscitation at once. Heart massage can be learnt only by attending a first aid course. Remember: Sever leave a carnally 1111-attended. Arrange lor transport to hospital as quickly as possible – but do not delay first aid treatment.

FIRST AID PRIORITIES

The first priority is to maintain a clear airway at all times and to keep the casualty breathing. The second priority is to stop serious bleeding. The third priority is to turn the casualty into the recovery position. Remember the priorities as follows: A-Airway B-Bleeding C—Consciousness

If the casualty is breathing normally, serious bleeding has been checked, he is in the recovery position and an ambulance has been called, attention can be given to treating less serious injuries. But always remember to check breathing and pulse rates regularly until the ambulance arrives and you are relieved of responsibility for the casualty.

Reading about first aid techniques cannot take the place of practical experience. This can only be obtained bv attending a first aid course. Most people enjoy learning first aid, and facilities will probably be available for practising the techniques of mouth-to-mouth resuscitation and heart massage, which cannot be practised at home.

First aid is the simple appliance of common sense, but many casualties still die unnecessarily every day and a widespread knowledge of life-saving techniques would prevent many of these deaths.

However advanced your knowledge of first aid the simple priorities must never be ignored – that way you should always deliver a live casualty to hospital.

Essential First Aid Skills

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