First Aid

First Aid

First aid: refers to initial or immediate assistance given to someone who has sustained an injury or got a sudden illness before the arrival of an ambulance, a doctor or any other qualified person.

Or: Is immediate care given to the injured or suddenly ill person. First aid does not take place in presence of proper medical treatment.

It consists only of giving temporary assistance until competent medical care, if needed, is obtained, or until the chance of recovery without medical care is ensured. Most injuries and illnesses require only first aid care. 

First aid includes assessing the victim for life-threatening conditions, performing appropriate intervention to sustain life and mental conditions until he/she can enter the emergency or casualty unit in the hospital.

F-Fast arrival

I-Intelligent

R-Recording and reporting

S-Safety precautions

T-Timely action

A-Alertness

I-Initiation and implementation

D-Decision making

 

• First aider: Is a person who is capable of providing first aid to a casualty.
• A casualty: This is any person who has sustained an injury or a sudden illness.
• By- standers or on- lookers: These are people around the accident or the emergency scene.

AIMS OF FIRST AID

• Save life 
• Promote life
• Prevent worsening of the casualty’s condition
• Relive pain and anxiety
• Make the casualty as comfortable as possible
• Ensure that proper and immediate medical care is available.
• Transport the casualty to the nearest hospital at the earliest.

SCOPE OF FIRST AID

• • Diagnosis: Determine the nature of the case requiring attention so far, as is necessary for intelligent and efficient treatment or diagnosis. I.e. Diagnosis: – Taking proper history, checking signs (bleeding pile) and symptoms (pain).

• Treatment: To decide the character and extent of the treatment to be given and to apply the treatment, which is most suited to the circumstances until medical aid is available. I.e. Treatment: Remove the cause. Make the casualty comfortable and continue assistance till doctors arrives.

Apply treatment which is most suited to the circumstances until medical aid is available.

• Disposal: Arrange for disposal of the casualty by shifting him either to his home or other suitable shelter or to hospital. I.e. Disposal: To nearest shelter, by the quickest means and to send a word to relatives.

PRIORITIES OF TREATMENT IN CASE OF AN ACCIDENT

The first aider should;

• Observe carefully
• Think carefully
• Act quickly

OTHER FIRST AID PRIORITIES:

• Assess the situation quickly and calmly. 
• Protect yourself and the casualty from danger. Never put yourself at risk.
• Prevent cross infection between yourself and casualty as possible.
•  Comfort and reassure casualties at all times.
• Assess the casualty by identifying the injuries or nature of illness affecting him or her.
• Give early treatment and treat the casualties with the most serious or life threatening conditions first. 
• Arrange for appropriate help. I.e. call for emergence help if you suspect a serious injury or illness or arrange for transportation of the casualty hospital or his home.

QUALITIES OF A GOOD FIRST AIDER

• Observant: First aider should use all his senses and closely observe the cause of accident and its effect on the casualty.
• Tactful: First aider should be tactful in dealing with casualty, crowd, doctor and relatives. He should be sensitive to the needs of the casualty and take prompt action. 
• Self–control: On seeing the accident, the first aider should have self-control and not get panic or excited.
• Resourceful: First aider should be resourceful and make use of anything available at site of rescue to save life.
• Knowledgeable: One should have good knowledge of accidents, emergencies, rescue measure, disease conditions, disasters, etc.
• Skillful: One should have skill in taking vital signs, control of bleeding, cardio pulmonary resuscitation, bandaging, caring for sick, etc.
• Empathy: A good first aider must have empathy and be understanding. (This is known as a good Samaritan principle).
• He/she must be able to act quickly.
• He must have common sense.
• Discriminating: First aider may decide which of the several injuries should be given attention.
• Explicit: Giving clear instructions to the patient and advice to the assistants.
• A good first aider must be updated with knowledge and skills.
• He/she must have the ability to make decisions quickly.

OBJECTIVES OF FIRST AID

The objectives of first aid are:

• To preserve life.
• To prevent further injury and deterioration of the condition.
• To prevent complications related to injury or illness conditions.
• To make the victim as comfortable as possible to conserve the strength.
• To put the injured person under professional medical care at the earliest.

BASIC OBJECTIVES OF PSYCHOLOGICAL FIRST AID

• To establish a human connection in anon intrusive compassionate manner.
• To enhance immediate and ongoing safety, and provide physical and emotional comfort. Calm and orient emotionally overwhelmed or distraught survivors.
• To help survivors to articulate immediate needs and concerns, and gather additional information as appropriate. 
• To offer practical assistance and information to help survivors address their immediate needs and concerns.
• To connect survivors as soon as possible to social support networks, including family, neighbors and community helping resources.
• To support adaptive coping, acknowledge coping efforts and strengths, and empower survivors, encourage adults, children and families to take an active role in their recovery. 
• To provide information that may help survivors to cope effectively with the psychological impact of disasters. 
• Facilitate continuity in disaster response efforts by clarifying how long the psychological first aid provider will be available and (when appropriate) linking the survivor to another member of a disaster response team or to indigenous recovery systems, mental health services, public sector services and organizations. 

GOLDEN RULES OF FIRST AID

• Do first things quickly and without fuss or panic.
• Give artificial respiration, if breathing has stopped every second.
• Stop any bleeding. 
• Guard against or treat for shock by moving the casualty as little as possible and handling him gently.  
• Do not attempt too much do the minimum that is essential to save life and prevent the condition from worsening. 
• Reassure the casualty and those around and so help to lessen anxiety. 
• Do not allow people to crowd round as fresh air is essential. 
• Do not remove clothes unnecessarily. 
• Arrange for the removal of the casualty to the care of a doctor or hospital as soon as possible.

PRINCIPLES OF FIRST AID (ACTION AT AN EMERGENCY)

1. Remove the casualty to a place of safety
2. Loosen clothing around the neck and waist, to help breathing
3. Reassure the patient
4. Look for the following:

• Is there any failure of breathing? If yes, start artificial respiration.
• Is there any failure of circulation? If yes, start external cardiac massage.
• Is there severe bleeding? If yes, stop bleeding by pressing firm on pressure areas with a clean pad for few minutes.
• Are there any signs and symptoms of shock? If yes, treat shock

• 5. Relieve pain
• 6. Avoid handling the casualty unnecessarily. 
• 7. Arrange for safe removal of the casualty to the hospital. 

GENERAL RULES OF FIRST AID

• Reach accident spot quickly. This will help to save life of the casualty.
• Shout for help. Organize labour or onlookers or bystanders to help in any possible way. Make sure there are enough people to help you.  
• Be calm, methodical and quick. By doing so, you can minimize the pain and the effect of the injuries, which may save life. Handling casualty clumsily will make the final recovery difficult.
• Remove the casualty from danger or danger from casualty.
• Look for the following:

• Is there failure of breathing?
• Is there severe bleeding?
• Is the shock high or severe? Is there any signs/ symptoms of shock?
• Attend to these and then treat easily observable injuries.
• Start artificial respiration, if the casualty is not breathing, it must begin at once, as every second gained is helpful.
• Stop bleeding by pressing on the pressure point, press firmly on the bleeding area for at least a few minutes (minimum 3 minutes) by watch – take help if available.
• Treat shock
• Avoid handling casualty unnecessarily.

Note: Never give anything by mouth to the patient who is unconscious.

• Use the first aid articles if available (All trains, railway stations, Lorries and buses keep first aid box). Make use of material so obtained. In case, first aid box is not available, improvise and make use of available resources.
• Assess the situation sensibly in regard to medical aid treatment which may be needed.
• Make a written note on the general condition and your findings about the casualty.
• Inspect the area: Take the casualty away from live wire, fallen walls, beams, fire, broken gas chamber, moving machinery, etc. to safer place.
• Clear the crowd with polite words. Do not allow people to crowd around the casualty as the casualty needs fresh air. If a doctor is present, he will guide you. Any other first aider should be asked to help, otherwise take the assistance of by standers by giving them correct instructions.
• Note the weather: If it is not raining, too hot or cold, treat in open, otherwise move the casualty into an airy room. If no suitable house or shelter is available nearby, it’s best to protect the casualty with an umbrella or a sheet of cloth or even a newspaper.
• Reassure the casualty by soft words and encourage talking. This will help the casualty to take things lightly and lie quietly. This will help in recovery.
• Arrange for dispatch of the casualty to the care of a doctor or to a nearby hospital. At the same time inform relatives as to where the casualty is being taken to. 
• Do not attempt too much. You are only a first aider, give minimum assistance so that condition does not become worse and life can be saved.

DO’S AND DON’T’S 

• Do not forget that you are not a doctor hence, do not attempt to overdo things.
• Do not handle the victim unnecessarily as that condition may worsen.
• Do not expose the casualty unnecessarily
• Do not open any wounds / dressing, if bandaged previously by anybody.
• Do not move any fracture case without putting proper splints.
• Do not tie tourniquet at bleeding site and forget about it.
• Attend to casualty as per priority.
• Attend to children and women first.
• Ensure self – safety and security before jumping into heroic attempts to save casualty
• Follow precautions in handling communicable / infectious cases.
• Never declare any casualty dead, it is that doctor’s job.

THE MANAGEMENT OF THE CASE

The first aider must always:

• Respond quickly to calls for assistance, the saving of a life may depend on promptness of action.
• Adopt a calm and methodical approach to the casualty, quick and confident examination and treatment will relieve pain and distress, lessen the effect of injury and may save life. Time spent on long and elaborate examination of a casualty may be time lost in his ultimate recovery.
• Treat obvious injuries and conditions endangering life such as failure of breathing, severe shock, before making a complete diagnosis.
• Take first aid material. If this is immediately available. If standard equipment is not available the first aider must depend on material to hand which will have to be provided as required.
• Study the surroundings carefully. These may influence the action to be taken and therefore require careful consideration for example:
• Danger: From falling building, moving machinery, electric current, fire, poisonous gases and similar hazards.
• Weather: If the accident occurs out of doors, the casualty may be treated in the open if the weather is fine, if the weather is bad, he must be removed to shelter as soon as is reasonably possible.
• Shelter: Note houses and buildings near at hand, whether occupied or unoccupied and whether likely to be particularly useful, such as a chemist’s shop, otherwise, temporary shelter may be provided by means of umbrellas, rugs and the like.
• Assistance: Crowds must be tactfully controlled. If a doctor is present, work under his direction. If not, ask if anyone with knowledge of first aid is present. If neither is available make use of bystanders to the best advantage.
• Reassure the casualty by speaking encouragingly to him. Warm him to be still and tell him that he is in trained hands.  

STEP BY STEP ACTION TO BE TAKEN BY THE FIRST AIDER

1. Examination and Diagnosis: This is taking account of the casualty‘s history and that of incident, symptoms, signs and level of responsiveness.
2. History: This is the full story of how the incident occurred or the illness began, and should be taken directly from the casualty and a responsible bystander wherever possible.
3. Never hurry the casualty and remember to pass on all information you have obtained when skilled help arrives.
4. Symptoms: These are sensations that the casualty feels and describes to you the most useful of these is pain. If the casualty is unconscious or unreliable because dazed (confused) or in shock, their diagnosis cannot be based on symptoms but has to be based on information obtained from bystanders and signs.
5. Sign:  These are details ascertained by you using your senses – sight, touch, hearing and smell. These may be signs of injury such as: bleeding, swelling, deformity, or signs of illness such as raised temperature and rapid or regular pulse.

• Cardiopulmonary resuscitation (every second).
• Control bleeding.
• Treat shock and special care of unconscious cases. 
• Fracture immobilization 
• Burn cover, with clean washed or dressing and treat shock.
• Eye, nose and ear injuries.
• Multiple superficial injuries.
• Transportation

RESPONSIBILITIES OF A FIRST AIDER IN THE MANAGEMENT OF CASUALTIES:

• Gain access to the patient in easiest and safest way.
• Observe the accidents scene and assess the situation.
• If necessary, direct others to direct traffic keep bystanders at a safe distance and make essential telephone calls. Turn off all engines that may be still running.
• To find out whether is unconscious, conscious alive dead. 
• Identify the disease or condition from which the casualty is suffering.
• Give immediate, appropriate and treatment considering priority of the first aid measures. Such as first priority will be of restoration of breathing and circulation, while second will be stopping the bleeding.
• Should bear in mind that a casualty may have more than one injury and that some casualties will require more urgent attention than others. 
• Arranging without delay for shifting of the casualty to a doctor, hospital or home according to the condition in such a manner that injury is not complicated or the victim is not subjected to unnecessary discomfort.
• Keeping the record of the patient and of the patient and of incidence, addresses and witness.
• Once a first aider has voluntarily started care, he should not leave the scene, or stop the care until a qualified and responsible person relieves him.
• To report your observations to those taking over care of the casualty and to give further assistance if required.
•  To prevent cross infection between yourself and casualty as much as possible.

LIMITATIONS OF THE FIRST AIDER

1. The first aider should be observant with the rules or objectives of first aid and act quickly and vigilantly.
2. He should inspire confidence in the patient and others closely related to the patient.
3. To save lives, there are three conditions that call for first aid: – stoppage of breathing, severe bleeding and shock.
4. If breathing movements are not proper, the lips, tongue and finger nails become blue, in such a situation, artificial respiration should be started immediately.
5. If there is heavy bleeding: It may be from wounds through one or more large vessels. In this condition, pressure should be applied directly over the wound. For this, a clean handkerchief or a pad may be kept on the wound and pressed firmly with one or both hands, then apply affirm bandage.
6. The important factor to be attended immediately is shock. Shock accompanies severe injury or emotional disturbance. Cold and clammy skin, beads of perspiration on the fore head and palms. Pale face, nausea and vomiting are the common symptoms of shock.

SKILLS REQUIRED FOR THE FIRST AIDER:

• Control the scene of accident.
• Gain access to the patient.
• Evaluate the scene in terms of safety and possible cause of accident.
• Gather information from patient and bystanders.
• Determine vital signs (pulse, breathing, skin, temperature)
• Determine diagnostic signs and relate those to possible injuries or sudden illnesses that require emergency care.
• Perform the necessary ABC’S of emergency care:

1. Open air way.
2. Breathing (breathlessness- provide artificial ventilation).
3. Circulation (pulseless- provide one and two rescuer cardiopulmonary resuscitation).
4. Bleeding control (haemorrhage controlled by direct pressure and elevation, pressure points and tourniquets).

• Diagnosis and care for shock.
• Diagnosis and care for open and closed fractures, sprains (tearing of ligaments), strains (muscle injured by overstretching) and dislocations, including cold treatment and basic splinting techniques.
• Diagnosis and care for soft tissue and internal injuries including basic dressing and bandaging techniques.
• Detect and care for poisoning including alcohol and drug abuse.
• Diagnosis and care for heart attack, stroke, diabetes, coma, insulin shock, and epileptic or other seizures. 
• Diagnosis and care for facial injuries, head injuries, neck and spinal injuries and chest injuries including fracture ribs and penetrating chest wounds
• Diagnosis and care for burns and smoke inhalation.
• Diagnosis and care for exposure to heat and cold, which includes heat exhaustion, heat cramps, heat stroke, hypothermia and frostbite.
• Assist in child birth and care of the new born.
• Psychological and proper emergency care to victims of crisis and disasters.
• Perform proper transformation techniques.