FIRST AID

What is First Aid?

First Aid is the provision of emergency care for an injured or ill person(s) prior to the arrival of professional medical personnel on the scene.  It is important to remember you are not being trained as a paramedic, nurse or doctor.  Your role is to provide basic support for the casualty until you are relieved by professional assistance.

It is the initial care of the sick or injured prior to medical care; your ability to remain calm and in control is an important part of successfully managing a casualty situation. Gaining confidence in your own abilities to deal with the situations that may arise is the key focus of this course.

A major role in first aid treatment is reassuring the casualty, thereby gaining his or her trust through your ability to confidently manage an accident, illness or injury situation through effective and appropriate communication.

·   First aid ranges from applying an adhesive dressing to being able to assist in a life threatening emergency.

You will also be providing accident scene management to ensure the further safety of the casualty, yourself, other rescuers and outside observers and bystanders.  Part of accident scene management is the recording of details of the scene and the casualty’s condition.  This information is to be given to the professionals who arrive on scene.

First Aid can be split into to 2 segments, primary and secondary care.

Primary careteaches you to provide assistance in response to immediate life threatening situations.  This includes topics such as:

·   Safety assessment of the accident scene

·   Arranging immediate medical aid

·   Assessing who at the scene may be able to assist you

·   Use of personal barriers for protection from communicable disease

·   Cardiopulmonary Resuscitation (CPR) for adult and child and infants

·   Airway management for adults and children including obstructions

·   Managing both a conscious and unconscious casualty

o    Management of suspected head and spinal injury

o    Shock management

Secondary careteaches you to provide assistance in response to non-immediate life threatening situations.  This includes topics such as:

·   Injury and Illness assessments

·   Obtaining the history of the casualty’s condition

·   Monitoring the casualty’s condition and reassuring them

·   Effective bandaging. (This segment will be conducted interactively with First Aid International trainers)

·   Splint making, for stabilising dislocations and fractures

·   Immobilisation of the casualty

·   Bleeding

·   Burns

·   Breaks

Many other issues will also be addressed during this course including:

allergic reactions, burns both chemical and non-chemical, electrical injuries, eye injuries, assembling and maintaining a first aid kit, frostbite and hypothermia, heat exhaustion and heatstroke, heart attack, insect / rodent / snake bites and stings, poisoning and seizures.

REMEMBER, it is important for you to do something.  This training will provide you with the state of mental preparedness to ACT when faced with an emergency situation.  The quicker you respond, the better the chance the casualty will recover.

Easing of anxiety and discomfortis extremely important in provision of emergency aid.  You are treating aperson as well as an injury or situation.  By combining calming reassurance with good First Aid management you will, in most cases, immediately reduce the pain, stress and anxiety levels of the casualty. This is vital in controlling and minimising the escalation of shock.

Remember, if you stay calm, they stay calm; if you panic, they will panic!

A lot of people are concerned with legal issues pertaining to the provision of First Aid.  You will not incur any legal ramifications if you act to the best of your ability, following what you have learned in this First Aid course. The states have particular legislation and Acts to protect you as long as you stay within first aid guidelines, and within the training you have been given.

Legal Issues

The following guidelines should be utilized only as a reference point for rendering First Aid.  If you have any specific concerns or issues, please consult with a legal professional.  As a provider of First Aid you are not expected to perform as a medical professional.  First Aid providers should act in a responsible, prudent manner.  You are performing First Aid as a good faith act in the best interest of the casualty.  Remember, the quicker you act, the better the chance for the casualty to fully recover.

As a non-medical professional provider, you will provide First Aid to the best of your ability.  As a non-professional medical person, you are not expected to be perfect.  It is also an unfortunate fact that not every situation will turn out as we all would like.

There are 4 main legal considerations involved with rendering First Aid, they are:

Duty of Care

Within the realm of Australian law, an individual, whether a qualified first Aid provider or not, is not legally required to stop and render assistance to an injured or ill person except in specific situations.  Each individual provider’s personal moral code will play a decisive role in their personal decision as to whether they will render first aid.  Common law principles do not place a duty on you to provide first aid in every situation you may encounter. Once you decide to provide first aid, you then owe that person/s a duty of care to provide that aid in a manner appropriate to the circumstances, according to the needs and wishes of that person/s. Furthermore, you must ensure your actions in treating and assisting the casualty will not result in further risk to the casualty, and that care continues until the casualty no longer requires your assistance, or medical aid takes over from you.

Legislation can, however, impose a duty of care, determined by the terms of your employment, if you have voluntarily taken on the role of the first aid officer in the workplace.

There are specific situations, which may arise, that require you to provide assistance.  Some examples of these are:

If you are the driver of a vehicle involved in an accident, you must stop and render First Aid, to the best of your ability, to ANY injured person resulting from the accident.  This rule applies even if you are NOT trained to provide First Aid.

As an employee of a given company, you have been trained and designated as the First Aid provider and are being compensatedaccordingly.  If you function in this capacity within your workplace, you must render First Aid to the best of your abilities.

Within the work environment, your responsibility to provide First Aid is primary over any other duties.  The Duty of Care takes precedence over any authority the employer may have over the First Aid provider or the casualty.

If you have assumed responsibility for caretaking of another individual, i.e. a child, an invalid or a disabled person, and that person requires First Aid; you must render First Aid to the best of your ability.

Once you commence providing first aid, you must continue providing that aid until the casualty no longer requires your assistance, or medical aid relieves of that responsibility. You may NOT avoid your responsibilities by terminating First Aid provision in the middle of the situation.

Quite naturally, once professional medical personnel have arrived on the scene, you will relinquish control of the situation to these professionals.  You must however still maintain a presence to assist in providing First Aid in any manner which may be asked of you.  When turning the victim over to the medical professionals, the items you have noted in your record keeping will be of assistance.

If you have not had the chance to write down your observations, once relieved by the medical professionals, stay in the area and write them down.  We will go into this further in the Record Keeping segment.

Negligence

Negligence of care provision can only be proven if ALL of the following requirements have been established:

The First Aid provider failed to act within the guidelines of Duty of Care

The proper level of care, as outlined within the Duty of Care, was not rendered

Further injury was incurred due to the provision of First Aid

The First Aid provider gave care which exceeded their training level or the First Aid provider acted in a reckless or careless manner.

This brings up a question which is on all First Aid provider minds;

“What if the individual is in imminent further danger and must be moved at the risk of further injury, am I being negligent?”  The answer is simply, NO.  You have exercised your Duty of Care by prudently assessing the scene and determining that the casualty would be in more danger or possibly even under threat of loss of life, by leaving them in the situation.  You have met your Duty of Care obligation by taking a reasonable and prudent, good faith act, with the best interest of the casualty in mind.

If you are hesitantto provide First Aid, remember that they will have

A MUCH better chance for full recovery if you provide immediate assistance.  As you may recall from the first lesson; “IT IS IMPORTANT FOR YOU TO DO SOMETHING”.

Consent

Australian law provides that an individual retains control of their own personal being and as such, that individual may bring charges if touched without consent.

They further maintain the right to accept or reject medical and/or First Aid treatment, assistance or advice.  The casualty may do this with either professional medical personnel or a First Aid provider.  If rejected, DO NOT FORCE provision of First Aid on them. 

Make a note in your records for the proper authorities that the casualty refused aid.

The injured person also maintains his or her right to consult with the medical professional of their own choosing.

‘Implied Consent’ may come into play with emergency situations.  If the casualty is unconscious or seriously injured, i.e. bleeding profusely, the law allows for ‘Implied Consent’.  The application of ‘Implied Consent’ may only be allowed if the casualty is in a life threatening situation or their future health is in jeopardy.

In a situation that involves infants or small children, it is always best to obtain consent from a parent or guardian.  If none are available and it is an emergency situation, the law allows the provider to take ‘reasonable action’ without formal consent.

Record Keeping

As has been stated throughout, keeping written records of incidents is extremely important.  It will not only serve the provider when transferring responsibility to medical professionals but also mandatory within the work environment.  By law you are required to record all incidents in the work place, whether First Aid has been provided or not.  Another side benefit of recording all incidents and accidents in the workplace is that it provides the employer with a means to evaluate safety procedures and implement more effective controls, as may be required.

In the event the incident ended up in a court of law, you would have detailed notes which also help serve to protect you and others.  There would be no question of your recollection of the incident, services rendered or services rejected. By recording vital details as soon as possible, you are recording information that is still clear and fresh in your mind. In stressful or difficult situations, important facts and details are easily missed or forgotten. Notes taken at the time of the incident or accident are called contemporaneous notes. Ensure you keep the information detailed and accurate, focusing on facts only, not speculation. Do not include opinions of other people in your notes.

CARDIOPULMONARY RESUSCITATION - D.R.S.A.B.C.D

When approaching any accident scene, you must endeavour to follow all safety guidelines to minimise risks to yourself, bystanders and any casualties, as well as removing the possibility of further danger or injury to all concerned. Another primary reason to implement these procedures is to ensure no steps are omitted and to ensure the best possible outcome.

Wherever possible, ascertain the history of the incident. This will assist in determining the nature of any risks or dangers to anyone involved at the scene. Look at the casualty or casualties for indications as to what may have occurred.

By focusing on a simple acronym, the steps to assist you will follow a very clear process. That acronym isDRSABCD and is the action plan for any situation where the casualty may be unconscious, or where life-threatening circumstances are immediately apparent.

·   D– Danger (to, in order of priority, you, the bystanders, and the casualty)

·   R– Response (are they conscious / aware?)

·   S – Send for help (Call 000 – bystander calls ideally)

·   A – Airway (look for obstructions, make sure it is clear & then open)

·   B– Breathing (look, listen, feel for normal breathing)

·   C– Compressions (commence chest compressions)

·   D– Defibrillation (use Automated External Defibrillator,  if available, & follow the prompts)

LIFE THREATENING SITUATIONS ARE ALWAYS IDENTIFIED AND HANDLED FIRST

The steps involved in accomplishing the DRSABCD action plan are also referred to as the Primary Survey.

The Secondary Survey, discussed later, involves a complete physical head to toe examination of the casualty and further questioning to assess and manage injuries which are not immediately life threatening.

 

Primary Survey - DRSABCD

In all emergency situations, the first aider must;

·   Assess the situation quickly

·   Ensure safety for self, bystanders and the casualty

·   Call for help

·   Follow the Basic Life Support guidelines and commence first aid procedures.

Assess Danger

This procedure includes looking at the accident scene to ensure YOU, the casualty involved in the accident and bystanders are not in further danger.  If the casualty has experienced a snake bite, for example, you want to make sure the offending creature is not poised to hurt anyone else in the vicinity or harm the casualty further. 

Other potential dangers could include:

·   Live electrical wiring downed in the area from a storm or traffic accident

·   Fumes, chemicals, falling objects, gas leaks, storm debris or road traffic

·   Environmental dangers – the road or footpath on a very hot day, weather conditions, etc.

Whatever the danger presented, the first aider should take every precaution to remove or minimize the Danger, prior to beginning further steps of the DRSABCD procedure.

Be prepared to minimise the danger to yourself by following practical infection-control procedures. Implement the use of barriers such as face masks or gloves, etc. for personal protection.

Assess Responsiveness

An important point to remember when approaching the casualty to assess their responsiveness is to NEVER SHAKE them. This can cause further injury. If there are multiple casualties involved, any that appear to be unconscious are of primary concern for attention.  A casualty who may be shouting or screaming IS breathing, focus attention on the unconscious casualties, but don’t forget the quiet ones.

A simple method to remember for assessing responsiveness is the COWS method:

·   C– Can you hear me?

·   O– Can you open your eyes?

·   W– What is your name? Who are you? What happened?

·   S  – Squeeze my hands

If the individual is CONSCIOUS and able to respond, calmly inform him or her who you are and seek permission to help. If they tell you not to touch them, you can’t touch them. However, you do not need their consent to call an ambulance. If, in your assessment, an ambulance is needed, CALL 000.  If unsure, never be afraid to call an ambulance.  Wait with the casualty until medical assistance arrives.  By remaining in the area, should the casualty become unconscious, appropriate First Aid procedures may be implemented.

If the individual is UNCONSCIOUS, call 000 immediately.  Ideally, have a bystander make the call to free you up to continue to assess and manage the casualty as information is relayed.

Assess the Airway

The easiest position in which to assess an individual’s Airway and Breathing is with the individual lying on the back.  Look into the casualty’s mouth.  If you see any liquid or solid material, place him or her on their side in the recovery position and clear the airway.

Many versions of the recovery position exist; consider the following when rolling the person onto their side.

·   The casualty should be in as near a true lateral position as possible, with the face towards the ground to allow drainage of fluid.

·   The position needs to be stable

·   Any pressure to the chest that may impede breathing should be avoided

·   It should be possible to move the casualty to the side, and return to the back easily and safely to minimise risk of spinal damage.

·   Good observation of, and access to the airway should be possible

·   The position itself should not give rise to further injury

·   Women in late pregnancy should be rolled onto their LEFT side wherever possible, to minimiserestriction of circulation.

There are exceptions where the individual should be immediately placed into the recovery position to clear the airway:

·   If the individual has experienced a submersion injury (drowning / partial drowning)

·   The airway is obstructed with fluid such as vomit or blood

·   History shows they have an airway obstruction – e.g. choking.

To check the casualty’s airway, use one hand only to gently pull the lower jaw down. Stabilise the head with the other hand on the forehead to reduce movement. Look inside their mouth. DO NOT tilt their head back until you have made an initial check of the mouth, as this will lift the tongue and allow any fluid or objects in the mouth to enter the windpipe. If you see nothing in the mouth then tilt the head back gently to check further.

This is called the Head Tilt / Chin Lift technique:

·   Place one hand on the individual’s forehead

·   Place two fingers under the chin

·   Gently tilt the head back while gently lifting the weight of the head just slightly

·   Gently lift the chin with the two fingers opening the airway

Check for (Normal) Breathing

Look, Listen and Feelby kneeling down and with your cheek and ear next to the casualty’s mouth and nose area, looking down the body towards the abdomen:

·   Lookat the upper abdomen and chest to see if it is rising and falling

·   Listento hear if they are breathing, gasping or not breathing

·   Feelfor their breath on your cheek and / or rise and fall of the chest with your hand on the diaphragm

Take a FULL 10 seconds to perform the Look, Listen and Feel evaluation.  You need to be sure of what you are finding.

Normal breathing is rhythmic, in & out, not one way. Normal breathing is usually 12 – 20 breaths per minute.

Gasping is NOT considered normal breathing.  Breathing MUST be normal.  If you are not CERTAIN that breathing is normal, assume there is no breathing present.

If the casualty is unconscious and breathing NORMALLY, place him or her into the Recovery Position.  To do this:

·   Place the arm furthest from you straight out to the side

·   Place the other arm across their chest

·   Raise the knee nearest to you to its highest apex (foot as close to the buttocks as possible)

·   Using the shoulder and the knee nearest to you, gently roll them away from you, onto their side

·   Once on their side, continue to raise the knee so it is at right angles to their body to help stabilize them. Roll the uppermost shoulder forward slightly so that their face and mouth are directed to the floor for drainage.

Call 000 immediately, if not already done, or designate someone else to call 000.  If a phone is not readily available or you are alone, shout for help.  It may be necessary to momentarily leave the individual in the Recovery Position to seek help.

·   Continue to closely monitor the casualty’s breathing until medical assistance arrives. The unconscious, breathing casualty must remain in the recovery position to maintain a clear and open airway. Unconscious casualties should NEVER be left on the back.

·   Perform Secondary Survey, providing treatment as normally prescribed

·   Await arrival of professional medical assistance

The combination of rescue breathing and chest compressions is quite often referred to as CPR orCardiopulmonary Resuscitation.  Remember your ABCs, the central components of the DRSABCDprocedures.  This will allow you to easily and quickly move from Airway to Breathing to Compressions, thus ensuring circulation is restored to the body as quickly as possible.

If the casualty is NOT breathing normally:  Begin chest compressions immediately.

Providing Chest Compressions

If you are unwilling to perform rescue breathing, perform the chest compressions alone.  REMEMBER it is better to do something than do nothing. 

Kneel down beside the casualtywith one knee at approximately shoulder height and the other at approximately mid-stomach height on the casualty’s body.  This should place you on the central portion of the casualty’s chest area.

·   Place the heel of one of your hands in the centre of the casualty’s chest, on the lower half of their sternum.

·   Position your other hand on top of the first hand, interlocking your fingers

·   Pull your fingers backso only the heel of your first hand is in contact with the individual’s chest area

·   Raise up on your knees so your arms are straight and vertical to the individual with your chest and shoulders above the compression point to allow you to apply your weight

Compress the chest to approximately 1/3 of the original depth of the chest.  If unsure, press harder rather than softer.

Use your body weight, not your arm muscles to perform chest compressions.  Using your arm muscles will tire you much quicker.

Chest compressionsneed to be performed at a fairly rapid pace (about two compressions per second).  It helps to count aloud.  The cycle for performing chest compressions is:

·   30 chest compressions

·   2 rescue breaths

To perform Rescue Breathing

·   Open the casualty’s airway using the Head Tilt / Chin Lift procedure

·   In combination with the Head Tilt / Chin Lift, the nasal passage must be sealed by either pinching the nostrils or using your cheek to seal the nose

·   Perform 2 rescue breaths

·   With a tight seal around the individual’s mouth, using a pocket mask, lip guards or your lips,blow for approximately 1 second while keeping notice of the chest rising out of the corner of your eye

·   If the chest does not rise with the first breath

o    Repositionusing the Head Tilt / Chin Lift procedure

o    Ensure the nasal passages are sealed

o    Re-administerthe first rescue breath

·   If the chest rises with the first breath, prepare to perform the second rescue breath

·   Give the second rescue breath exactly as the first rescue breath was provided

·   Only breathe hard enough to see some movement of the chest.  Do not overinflate the chest as this is less effective over time and could result in unnecessary and dangerous regurgitation.

As a simple guide for pace, five of these cycles should be completed in approximately 2 minutes.  It is a rapid pace and must be continued until:

·   Professional medical assistance arrives and relieves you

·   The casualty begins to breath normally

·   It becomes too dangerous to continue

·   You become too exhausted to continue

·   Another First Aid Provider takes over for you

·   The individual begins to vomit or regurgitate, go back to the steps for clearing the Airway

·   A medical doctor pronounces the casualty to be deceased

If performing CPR on a woman in the latter stages of pregnancy, left lateral tilt must be implemented to ensure effective circulation. To achieve this, either;

·   Put something under the woman’s right hip, such as a pillow, folded blanket or towel, cushion, etc.

·   Make a fist with their right hand, and push this under the right buttock.

This ensures the baby is moved off the vein that returns blood to the heart.

If you can’t do the rescue breaths, or if you are uncomfortable with doing the rescue breaths, do the compressions only. ANYTHING is better than NOTHING!

Assess Defibrillation

Defibrillation through the use of an Automated External Defibrillator (AED) should be performed as early as possible for the best chance of a positive outcome.

A machineutilized to provide a small electric shock to the body to return the electrical rhythm of the heart to normal is called a Defibrillator.  While CPR has been proven to continue oxygen enriched blood circulation to the heart, brain and other vital organs, it is not a standalone remedy. The casualty will need to be ‘shocked’ so that the heart and breathing may have the opportunity to return to normal functions.

If an AED is available, turn it on, follow the prompts and attach the pads to the casualty’s bared chest. These machines have audio prompts which are designed to talk you through step by step instructions.  The use of a Defibrillator is also not a standalone remedy to treat Cardiac Arrest. Each step in the ‘Chain of Survival’ must be performed to increase the casualty’s chance of recovery.

The four “links” in the Chain of Survival are:

·   Early access

·   Early CPR                                                                                        

·   Early defibrillation

·   Early advanced care (by professionals) 

Infants and Children

Infants are classified as children up to 1 year of age.  Children are classified as 1 through 8 years of age. For the purpose of First Aid, casualties over the age of 8 are classified as Adults. 

Resuscitation for both infants and children is the largely the same process as for adults.  However, it differs in a few areas, based on where they are at in their development. 

To ensure a seal to be able to deliver breaths to an infant, you will need to cover both the open mouth and nose with your mouth.  You need only “puff” from the cheeks to be able to deliver enough air.

As an adult, the airway is fully formed and, therefore, supported by rings of cartilage.  That means when we give head tilt to an adult, because of those rings of cartilage, the airway stays in shape and does not narrow or collapse.

Infants do not have rings of cartilage yet. So applying head tilt as a method of opening their airway will actually have the effect of “kinking” it, and they will be unable to breathe.

If the infant or child is breathing, place them in the recovery position.

·   Infants - DO NOT perform a full head tilt,keep their head in a  ‘neutral’ position and assist the airway by gently maintaining a slight jaw lifting position

·   Children- perform a full, normal head tilt position

Monitor their Airway and Breathing, call 000 for Ambulance or designate someone else to call.

·   If the infant or child is NOT breathing

o    Call 000 for ambulance or designate someone else to call.

o    Commence chest compressions

§  For infants, use two fingers

§  For children, use two hands (if required to achieve depth)

§  Ensure compressions achieve 1/3 depth of the chest.  Do not be afraid to apply sufficient pressure.

·   Perform the Chest Compressions to Rescue Breaths cycle at:

o    30 compressions to 2 Rescue Breaths

o    5 cycles should be performed every 2 minutes

Special Considerations when performing Rescue Breathing

In specific circumstances it may become necessary to modify ‘normal’ Rescue Breathing techniques.  These can occur when:

·   An injury dictates an alternative method, such as a potential head or neck injury where the minimizing of movement of the areas is imperative,

·   Dealing with a pregnant woman

·   The individual has a STOMA in place

·   A pocket mask is being utilized

·   In water rescue situations

·   The First Aid provider decides an alternate method is more appropriate

One of the most common modifications associated with Rescue Breathing is Mouth to Nose.  This method may have to be performed if the individual has sustained serious injury to the mouth area. To accomplish this:

·   Close the casualty’s mouth with the hand supporting the jaw

·   Apply the Head Tilt and seal the mouth with the thumb

·   Blow into the casualty’s nose

·   Turn your head to Look, Listen and Feel

Performing Mouth to Mask provides both the rescuer and casualty the most hygienic means of performing Rescue Breathing.  To accomplish this method:

·   Position yourself at the head or side of the individual

·   Place the mask firmly sealed over the casualty’s mouth and nose

·   Maintain the Head Tilt / Jaw Lift position

·   Breathe into the mask

·   Turn your head to Look, Listen and Feel

DO NOT DELAY  performance of Resuscitation while waiting for a mask to arrive.

There are numerous people who have gone through surgery to remove the upper portion of their windpipe and must breathe through an apparatus implanted in their throat area.  This device is called aSTOMA.  Rescue Breathing can be performed for an individual with this apparatus if they cease breathing.

If you unsure about, or uncomfortable with, breathing through the stoma, simply commence the cardiac compressions and continue with just the compressions.

In some cases you may not notice the STOMA until you have performed the Head Tilt.  You may see a tube protruding from the STOMA enabling the hole to remain open so the individual can breathe.  MAKE SURE THE TUBE STAYS IN PLACE.  If you note a valve on the tube, the valve must be removed prior to Rescue Breathing so that the air may enter.

Rescue breathing in this instance is accomplished as follows:

·   Ensure the STOMA or tube is not blocked

·   Seal your mouth around the STOMA

·   Sealthe individual’s mouth and nasal passages to ensure air does not escape

As stated above, if you have any concerns with breathing through the stoma, simply commence the cardiac compressions and continue with just the compressions.

ANYTHINGis better than NOTHING!

Secondary Survey

Remember the secondary survey is NOT to be performed until all immediately life threatening situations have been addressed.  The steps involved in the Secondary Survey are designed to:

·   Provide a gentle, yet probing head to toe examination of the individual. This includes both visual observation and physical contact

As the First Aid Provider you are trying to find out if the casualty has:

·   Any other life threatening injuries

·   Signs or symptoms of shock

·   Injuries which may be treated using the methods taught throughout this course

The Secondary Survey is a head-to-toe physical and visual check. Start at the top of the head, gently palpate (feel with the full length of your fingers) the skull area, working down around the ears and to the back of the head and neck. Continue feeling down the casualty’s body, including areas not easily visible, looking for the following;

·   Fractures and dislocations

·   Bumps and bruising

·   Wet spots which could indicate a bleed or burn

·   Medi-alert bracelets which could provide a medical ‘history’ of what may have happened

·   Signs of envenomation – bites or scratches.

·   Most importantly – continually monitor the airway and breathing!