First Aid

RescueRanger · Jul 21, 2022

This thread is my public service for all PDF members, I have been teaching First Aid and Trauma Management for 18 years now and I will try to keep this as easy and informative as possible for you all. This is a real life skill and I hope you never have to use it, but it's one skill that you should rather have and NOT use it, then NOT have when you need to USE it!

Why is First Aid so Important?
Every day in Pakistan thousands of people get injured on roads, in their homes, in schools and workplaces. According to International Journal of Medicine Trauma is the leading cause of death for adults under 44 years age.

Road traffic accidents are the second highest cause of deaths in Pakistan.

Statistics published reports by the WHO 30,000 people in Pakistan die every year due to road traffic accidents, fires claim 16,500 deaths annually whilst sudden cardiac arrest accounted for more than 80,000 deaths per year – that’s more than 200 deaths every day.

Ambulances are in short supply in large and densely populated cities. For example, Rawalpindi a city with a population of 2.1 Million has only 14 fully equipped emergency ambulances (note: this number doesn't include motorcycle fast response service).

The professional pre-hospital care provided by Rescue1122 is testament to the hard work of its staff, however it is worth considering that the volume of emergency calls has risen from 90 calls a day in 2007, to over 230 a day, in a country with a population of over 212 million those few well equipped Ambulances staffed with professional EMTs will not be able to answer every call.

Hoax calls make up the bulk of incoming calls to the emergency helpline, in 2019 Rescue 1122 received 1.18 million calls deemed to be hoax, fake, nuicense or malicious.

Therefore, teaching communities first aid is vital, especially considering in a study into pre-hospital care by five major hospitals in Karachi showed that out of 187 patients admitted during a study, none received bystander CPR or first aid. The report concluded that “Patients who received life-support interventions survived for longer time, though not clinically significant, as compared to those who did not”.

This behaviour of “bystander effect” - the more people there are at the scene of an accident, the less likely anyone is to help as they all expect someone else to take charge and it is driven in part by the shared psychology of communities.

In an article published by the Association for Psychological Science in 2015 it was stated that “children as young as 5 years old are less likely to help a person in need when other children are present and available to help”.

First Aid: What is First Aid?

A brief history:

St. John Ambulance was the first to use the concept of first aid in the United Kingdom in 1879. Princess Christian – the daughter of Queen Victoria translated from German into English five ambulance lectures given by Prof. Esmarch in 1882, which were published under the title “First Aid to the Injured” by Smith Elder and his partners.

In 1882, St. Andrew established the First Aid Organization in Scotland in order “to alleviate the pains of the injured and patients in wartime and peacetime and to take measures required for their care”. The regulation of this organization, written by Sir George Beatson, was issued in 1891. In1908, St. John's and St. Andrew's organizations reached an agreement on merging their activities carried out in various regions of Scotland and the United Kingdom in order to manage them under a single roof (1). Esmarch (1823-1908) laid the foundations of civil first aid institutions. He became a physician in 1848, and then received education on surgery. In 1854, he specialized in surgery and ophthalmology. His main fields of interest were military surgery and first aid. He was one of the most important emergency surgeons of the 19th century. [1]

Simply put: First aid means Initial help given to a person who is sick or injured.

The Basics: Anatomy & Physiology

To be able to give basic first aid, it is not necessary to know how the body works, but if you read the information, you will understand the reasons for the first aid which should be given. The basic functions of the human body can be simply described as follows. It processes food, water and oxygen to produce the energy necessary for living and disposes of the waste that arises. We should think of the body as a series of separate systems for doing these things.

Examples of these systems are the integumentary system (Our skin, hair, nails, external glands), skeletal system (our bones), digestive system, the respiratory or breathing system, the circulatory system and the nervous system. If any of these are badly damaged, it will affect the others.

The principal parts of theses systems are the lungs, the heart and the brain. Theses organs are protected by the skeleton. The body also has an envelope of skin to act as a barrier against infection.

If the skeleton is damaged, as it is when a bone is broken, then the part of the body that is being protected and supported may also become damaged by the broken bone ends of the bone. If the skin is pierced , or cut - infection may be admitted and this can be more dangerous than the actual injury.

In this brief explanation, we will consider only three of the body's systems - Breathing, Circulation and the Nervous system. In emergency aid you are mainly concerned with these when a life is in danger.

Respiratory System

Its purpose is to extract oxygen from the air, the oxygen is then absorbed by the blood. The lungs act as bellows, drawing air in, extracting some of the oxygen and then pusing out air which contains the waste product - a gas called carbon dioxide.

Circulatory System

Comprises of the heart, blood and blood vessels. It works with the respiratory system to provide oxygen to those parts of the body which need it. The blood absorbs oxygen from the lungs and circulates it around the body.

The heart expands and receives blood, then contracts and forces it out, in fact, one side of the heart circulates blood through the lungs, where it absorbs oxygen, and the other side supplies the oxygenated blood to the rest of the body.

The average body contains about 10 units or about 1.2/1.5 gallons of blood or about 1 litre of blood per 13kg of body weight. The heart pumps out the oxygenated blood through arteries and the used blood is returned to the heart through the veins. If too much of these 10 units is lost or if the lungs are not providing enough oxygen, or if the heart is not pumping properly, the blood cannot do its work efficiently and the body may eventually cease to function.

If the skin is broken, blood will escape, and infection may enter the body. However as soon as a blood vessel is cut, the blood coming from the cut will start to clot. This is the body's mechanism for sealing off a wound and preventing further blood loss.

Nervous System

Part of which controls functions such as the heartbeat. Another, very important part of the nervous system affects body movements and sensations under control of the brain. Nerves run down the spinal column in the spinal cord, rather like wires in an insulated sheath. If the spinal cord is damaged the nerves may also be damaged and paralysis may result.

A person becomes "unconscious" as a result of the brain not working properly. In accident cases this is usually due to damage to the brain or excessive bleeding.

As the various parts of the body work, they make unwanted chemicals which must be carried away in the blood. One example of this is urea, a substance like ammonia, which is extracted from the blood by the kidneys and is eventually passed out of the body as urine.

What is the aim of First Aid:

To act quickly, calmly and correctly to:

Preserve life
Prevent the condition from worsening
Promoting recovery

What are the priorities of first aid:

Assess a situation quickly and calmly
Protect yourself and any casualties from danger - never put yourself at risk.
Prevent cross infection between yourself and the casualty as far as possible (wear gloves and use barriers)
Comfort and reassure the causalities at all times
Assess the casualty; identify, as far as you can, the injury or nature of illness affecting the casualty
Give early treatment, and treat the casualties with the most serious(life threatening) conditions first.
Arrange for appropriate help; call 911/1122 for emergency help if you suspect serious injury or illness; ask for AED (if you suspect a heart problem; take or send the casualty to hospital; transfer them into the care of a healthcare professional or to his home. Stay with a casualty until care is available.

Key Steps:

Be calm in your approach
Be aware of risks (to yourself and others) remove the danger from the casualty (only if in further danger)
Build and maintain trust (from the casualty and bystanders)
Give early treatment, treating the most serious (life threatening) conditions first
Call appropriate help
Remember your own needs too.

Infection prevention and hygiene:
It is important that as a first aider you do not transmit infections to your casualty or indeed contract infections from your casualty. To assist in minimising the risk of infection and cross contamination there are various precautions that can be taken such as:

Having good personal hygiene
Ensuring that barrier devices are used
Covering any open cuts or sores
Minimising contact with blood or bodily fluids
Changing gloves between casualties
Washing hands thoroughly after removing gloves

Resuscitation barrier devices

Resuscitation barrier devices are essential equipment and help to reduce the spreading of infection and cross-contamination. Barrier devices as their name suggests, place a barrier between the first aider and the casualty. Barrier devices include:
Nitrile or powder-free gloves
Face shields
Pocket masks

Emergency Response:
At any incident involving casualties, it is essential you appear and remain claim and let your common-sense, allied with your training and skills take over. Upon arrival at an incident a scene survey must be completed to ensure the safety of the casualty, any bystanders and the first aider. The scene survey should be conducted by remembering the mnemonic CLAP:

C: Control the situation: Stop, take a deep breath and take charge of people and vehicular traffic
L: Look for potential hazards: Look for anything that could cause further harm to the casualty, bystanders or more importantly yourself within the immediate area.
A: Assess the situation: Gather as much information about what has occurred from the casualty and from bystanders, and try to make a diagnosis (history of the casualty(do they have diabetes/asthma etc), any signs (things you can see i.e. blood), symptoms (anything the casualty complains about i.e. headache).
P: Protect and Priorities: Ensure PPE is worn and that casualties are prioritised (breathing, bleeding, bones/burns and other conditions). Try to gain assistance from a bystander and contact the emergency services.

This is a good video that explains a scene assessment:

Primary Survey:

Having contacted a scene survey and established that the immediate area is safe from any dangers, you can now approach the casualty. When approaching the casualty an initial casualty assessment should be completed - this initial assessment is called a primary survey. The primary survey is a systematic process of approaching, identifying and dealing with immediate and or life-threatening conditions.

The Primary survey can be remembered by the mnemonic DRSBACD:

Contacting the emergency services:

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First aiders will either contact the emergency services themselves or instruct a bystanders to do so. Contacting the emergency services at the earliest opportunity is paramount. When contacting the emergency services on either 1122/911/15, it is important that the information given is clear, concise and sufficient. This can be achieved by remembering the mnemonic LINE:

Location (Where are you, where is the incident, any landmark, be specific).
Incident What has happened
Number, provide your number for call-back
Exact number of injured, level of injuries.

Basic First aid for Bleeding and wounds

Clean the wound or abrasion with clean running tap water for at least 5 minutes or until the wound is totally clean (no dirt or other matter on the wound).If tap water is not available use bottled (non-carbonated) drinking water.
To stop the bleeding, apply firm steady pressure directly on the wound until bleeding stops.
If gauze, cloth or sanitary pads are available, place one directly over the bleeding area and apply steady pressure. Continue until bleeding stops.
If bleeding continues, do not remove the gauze; add more gauze on top and apply more pressure.
As the gauze, cloth or sanitary pads become soaked replace with dry ones if available.
Once the bleeding has stopped, apply an elastic bandage over the dry gauze, cloth or sanitary pad
Apply triple antibiotic ointment on abrasions (scrapes) to prevent infections.

First Aid

Have you ever encountered situations where first aid was necessary?

Yes

No

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