First Aid Guidelines – Pre Hospital Care

BASIC LIFE SUPPORT – CPR (Cardio pulmonary resuscitation)

Check response

Shake shoulders gently and ask

“Are you alright?”

If no response

Call for help

Get an AED*

*AED – Automated External Defibrillator

Maintain the head tilt with one hand while locating the trachea with 2-3 fingers of other hand and slide it into the groove and feel the carotid pulse for 5-10 secs

If no pulse

Call for help

Get an AED*

*AED – Automated External Defibrillator

Maintain the head tilt with one hand while locating the trachea with 2-3 fingers of other hand and slide it into the groove and feel the carotid pulse for 5-10 secs

RECOVERY POSITION

If the person is breathing but unconscious, it is usually best not to move them, particularly following an incident (such as a road accident) where there is a likelihood of broken limbs, a back or neck injury. Otherwise, place the casualty in recovery position to keep the airway clear and allow fluid to drain from mouth:

  • Roll the casualty onto one side, keeping the legs straight.
  • Place the hand of the casualty’s upper arm under the chin to support the head.
  • Flex the leg to prevent rolling onto the back.

BITES AND STINGS

  • Remove the bee stinger (if present) from the wound.
  • Wash the sting site thoroughly with soap and water to minimize the possibility of infection.
  • Apply ice packs intermittently to reduce swelling and delay the absorption of venom while limiting oedema.
  • Oral antihistamines and analgesics may limit discomfort and pruritus. If oedema is significant, elevate and rest the affected limb, to reduce the swelling.

Remember “CARRY NO R.I.G.H.T”

CARRY: Do not allow victim to walk even for a short distance; just carry him in any form, especially when bite is in the leg.

NO Tourniquet, NO Electrotherapy, NO Cutting, NO Pressure immobilization.

R: Reassure the patient (70% of all snakebites are by non-venomous species).

I: Immobilize the patient. Use bandages or cloth to hold the splints, without blocking the blood supply or applying pressure. Do not apply any compression in the form of tight ligatures, they don’t work and can be dangerous!

GH: Get to Hospital Immediately.

T:  Tell the Doctor of any systemic symptoms that manifest on the way to the hospital.

CHOKING

  • Perform abdominal thrusts – stand behind the patient and while maintaining your balance, make a fist with one hand and place it thumb-side against the patient’s abdomen, just above the navel. Cover the fist with your other hand and give quick upward thrusts.
  • Continue delivering abdominal thrusts until the object is forced out and the person coughs and starts breathing or speaking.

If the patient becomes unconscious, start basic life support

BURNS

The following principles are the basis of pre-hospital care for burn patients:
  • S.A.F.E
    • Shout/call for help I Assess the scene I Free from danger I Evaluate the casualty.
  • Stop the burning process.
    • For example: Stop, Drop and Roll.
  • Remove all burnt/burning clothing (unless it is stuck to the patient) and jewellery.
    • Don’t forget to carry the burnt clothing to the hospital for examination.
  • Cool the burn area for up to 10 minutes. Water should not be ice cold. Be aware of the risk of hypothermia
  • Establish the airway (Diligent attention to the airway is essential, because rapid swelling may occur even when the initial assessment judges the airway to be acceptable).
  • Initiate fluid resuscitation.
  • Relieve pain.
  • Protect the burn wound:
    • If less than 10 % of the patient’s TBSA (Total Body Surface Area) is affected, saline-moistened sterile dressings may be applied.
    • If more than 10 %, (but under 20%) of the patient’s TBSA is affected, cover with a clean, dry sheet or dressings.
    • If more than 20 % of the patient’s TBSA is injured, cover with a clean dry sheet or dressings, and remember to keep the patient warm with blankets or by increasing the room temperature to 90 degrees.
  • Avoid hypothermia but cool the wounds to reduce the burn from extending.
  • Transport the patient to the nearest equipped hospital.

WOUNDS AND BLEEDING

The first aid that needs to be administered depends upon the intensity of the bleeding – minor such as small cuts, grazes, or severe / life-threatening such as injury to arteries / veins / organs etc.

Signs / Symptoms to look for? (not all of them may manifest visibly)
  • A wound with, or without, an embedded foreign object.
  • Pain from skin surface wounds.
  • Bruising or discolouration of the skin.
  • Loss of normal function in the injured area.
  • Pale, cold, sweaty skin.
What should be done?
  • Apply firm pressure over the wound. Use a sterile or clean bulky pad and apply it firmly with hand pressure. Apply a bandage to keep the dressing in place.
  • If bleeding is severe, do not waste time looking for suitable padding, but be prepared to use the patient’s hand or your hand to hold the wound together if the patient is unable to do this unaided.
  • If the wound is on a limb, raise it in a supported position to reduce blood flow to the injured area.
  • If an arm is injured, you could apply an arm sling or elevation sling.
  • If there has been any contact with blood/ any other body fluids or if the blood has splashed on your skin – wash the area thoroughly with soap and water as soon as possible.
  • If you are concerned about a possible risk of infection, take advice from your doctor.
  • Do not remove it – instead, apply padding on either side of the object and build it up to avoid pressure on the foreign body.
  • Hold the padding firmly in place with a roller bandage or folded triangular bandage applied in a criss-cross method to avoid pressure on the object.

Even if the injury involves the arm or upper part of the body, the patient should rest in a position of greatest comfort for at least 10 minutes to help control the bleeding.

  • If the wound appears to be minor and the patient is able to travel by car, arrange an urgent appointment with a local doctor to assess and treat the injury.
  • If the injury is severe or the patient is very unwell – call for an ambulance as soon as possible.
  • While waiting for an ambulance to arrive, observe the patient closely for any change in condition.
  • Apply a second pad over the first. Use a tea towel or similar bulky fabric and apply maximum pressure to the area.
  • For major uncontrolled bleeding quickly remove the blood-soaked pad and bandage and replace with a fresh bulky pad and bandage. The continuing bleeding may be due to the pad slipping out of position when the first bandage was applied

WOUNDS THAT NEED SPECIAL CARE

Control any bleeding

  • Use a bulky pad and apply it firmly to the bleeding area. Raise if possible.

Recover the severed part

  • If possible, gently place it in a plastic bag. Seal the bag with a little air inside to protect the severed part with a ‘cushion’ of air.
  • Place the inflated bag into a container or bucket with cold water to which several ice cubes have been added.
  • Ensure the severed part is transferred to the hospital with the patient.

A crush injury occurs from compression of large muscle groups and soft tissues by a heavyweight. The most serious sites for a crush injury to occur are the head, neck, chest, abdomen and thigh.

Remove the crushing force

  • Remove the crushing force if possible because permanent tissue damage may occur with severe crushing force.
  • If the crushing force has been in place for some time, be prepared to give prompt first aid, because removal of the crushing force may cause a sudden collapse or deterioration in the patient’s condition.

Treat the patient’s injuries

  • Assess and treat any injuries in order of their importance.
  • Control any bleeding with a sterile pad applied firmly to the injured area.
  • Assist the patient into a position of greatest comfort and use soft padding to provide support for the injured part.
  • If a limb is involved, support and immobilise the injured area.
  • While waiting for the ambulance to arrive, observe the patient closely for any change in condition.

A blow to the nose, flying at high altitude, or scuba diving may cause a bleeding nose.

For a child, always check whether there is a foreign body present – e.g. a bead or coin. If this is so, seek prompt medical help. Do not try to remove the object yourself because this may cause further damage.

If bleeding is due to a head injury (example – fractured skull), call for an ambulance urgently.

Apply firm pressure, elevation and rest

  • The patient needs to hold the head well forward and breathe through the mouth while pinching the entire soft part of the nose for 10 to 20 minutes.
  • The patient must be sitting down and at total rest until the bleeding stops.
  • If bleeding continues after 20 minutes of pressure, continue the pressure and call for an ambulance. Use a cold compress if required.
  • Once the bleeding has stopped, tell the patient not to blow their nose for a few hours because this may restart the bleeding.

OTHER WOUNDS

  • Gently clean with soapy or saline water. If there are pieces of gravel embedded in the wound, try and remove them while the area is soaking in soapy water.
  • Dry the area well by blotting with gauze swabs or a pad of tissues.
  • If a protective dressing is necessary, apply a non-adherent sterile dressing and fix it in place with a light roller bandage or tape.
  • Clean the wound with warm soapy water and allow it to penetrate the puncture track because tetanus spores may be trapped deep in the wound.
  • Allow the wound to dry thoroughly in the air before covering it.
  • If a protective dressing is needed, use a porous adhesive dressing and change it daily to keep the wound healthy and dry.
  • Contact a local doctor for advice about tetanus immunisation.

FRACTURES AND DISLOCATIONS

Signs and symptoms

  • Pain at or near the site of the injury.
  • Difficult or impossible to move normally.
  • Loss of power.
  • Deformity or abnormal mobility.
  • Discolouration and bruising.
  • Exclude life-threatening emergencies
  • Control any bleeding and cover any wounds.
  • Check for fractures – open, closed or complicated.
  • Ask patient to remain as still as possible.
  • Immobilise fracture:
    • Use broad bandages (where possible) to prevent movement at joints above and below the fracture.
    • Support the limb, carefully passing bandages under the natural hollows of the body.
    • Place a padded splint along the injured limb.
    • Place padding between the splint and the natural contours of the body and secure firmly, for leg fracture immobilise foot and ankle.
    • Check that bandages are not too tight (or too loose) every 15 minutes.
  • Watch for signs of loss of blood circulation to hands and feet
  • Ensure an ambulance has been called.
  • Do not attempt to force a fracture or dislocation back into place – this could cause further injuries.
  • It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always treat the injury as a fracture.
  • If collarbone is fractured, support arm on injured side in a sling.
  • If you suspect the joint is dislocated, rest, elevate and apply ice to the joint.
References:
  • Tintinalli’s Emergency Medicine 8th Edition.
  • American Burn Association.
  • St. Johns First Aid.