What is First Aid?
First aid is emergency treatment for illness or injury while waiting for medical help. At one time or another almost everyone is called upon to render first aid. Unless he or she has taken a course on the subject, there is usually confusion and doubt as to what should be done. Statistics show that in most cases it is better for the person untrained in first aid to do too little than too much. This is particularly true in urban and suburban areas where medical help can easily be obtained. If it is not possible to reach a doctor, police or firemen are better equipped to give first aid than are the uninitiated. It is advisable for at least one member of the family to take a First Aid course, and it is a necessity for each household to have a good emergency medical manual and a first-aid kit. Consult your local Red Cross for First Aid instructions, and ask your physician to advise you which of the many medical manuals to buy. This booklet is designed to be used only as a quick reference during an emergency. Therefore it contains only the basiclife support techniques. Always keep in mind that first aid does not replace the doctor but merely attempts to keep the victim alive and in the best condition possible until medical aid arrives. Telephone operators usually know how to obtain help in the quickest way. Dial O and tell the operator that it’s an emergency. Be sure the operator has your right address. But to be prepared, one should have a list of emergency telephone numbers handy.
The First Aid Kit
You can buy a pre-assembled commercial kit, or you can put together your own kit. You should have also one for your car. If you go hiking or camping, special snakebite kits are available. A basic kit should contain:* First-aid manual • Small box of absorbent cotton • Box of adhesive strip bandages, assorted sizes (such as BandAids or Curads) • Rolls of adhesive tape, ½”, 1”, 2” wide • Rolls of gauze bandage, 1”,2”, 3” wide • Box of cotton-tipped swabs • Large triangular bandages • Small boxes of gauze pads, 3X3-inch, 2X4-inch • Sterile eye pads • Wood arm splint • Sturdy cloth 2” wide and 20” long for tourniquet • Wood tongue depressors • Tweezers • Bandage scissors (sharp scissors with rounded ends) • Paper cups • Measuring cup • Measuring spoons • Thermometer • Small bottle of 70% alcohol (to be used as a disinfectant) • Ammonia inhalant (in case of fainting) • Tube of antibiotic ointment • Tube of antibiotic eye ointment • Box of salt tablets (in case of heat exhaustion) • Calamine lotion • Hydrogen peroxide • Petroleum jelly • Oil of cloves (in case of minor toothache) • Safety pins • Sharp needles (must be sterilized before removing splinters)
There are four basic life-threatening conditions in which correct and immediate first-aid procedures are in the true sense a question of life and death. They are: impaired breathing, heart failure, severe bleeding and shock, Seconds count in the recognition and correction of these conditions. Emergency treatment should be given in this order, as necessary: 1. Clear the air passage. 2. Restore breathing and heartbeat. 3. Stop bleeding. 4. Administer treatment for shock. Do not move an injured person until you have a clear idea of the injury and have applied first aid, unless the victim is exposed to further danger at the accident site. If the injury is serious, if it occurred in an area where the victim can remain safely, and if medical aid is readily obtainable, it is sometimes best not even to attempt to move the person, but to employ such emergency care as is possible at the site until more highly qualified emergency personnel arrive.
The causes of impaired breathing could be: (a) Suffocation; (b) Electrical shock ; (c) Gas poisoning ; (d) Drowning ; (e) Heart failure. The symptoms are easily recognizable: The chest or abdomen does not rise and fall; air cannot be felt exiting from the nose or mouth. Actions to take: If a patient stops breathing you must assist him immediately. The situation will dictate the method to be used. The respiratory failure can be caused by blockage of the air passages by foreign matter such as water
(drowning), mud, food particles etc. In an unconscious patient in the supine position (lying on the back), the tongue may drop back and block the throat. The cardiovascular system may fail to circulate red blood cells, which can be caused by heart failure. Regardless of the cause, however, immediate steps must be taken to clear the airway. When the airway is cleared, if spontaneous breathing does not resume, artificial respiration must be applied immediately. There are two methods of artificial respiration; mouth- to-mouth or mouth-to-nose resuscitation and a manual method. The manual method is not recommended except when the rescuer is unable to perform mouth-to-mouth or mouth-to-nose resuscitation; for example, when massive facial injuries absolutely prevent it. In cases of heart failure, mouth-to-mouth resuscitation in combination with cardiac compressions should be administered. However, the cardiac compressions should be executed only by a person with special training in this method.
ARTIFICIAL RESPIRATION FOR ADULTS Mouth-to-Mouth (-Nose) Technique
1. Place the patient on his back. If it is necessary to roll the victim over, try to roll him over as a single unit, keeping the back and neck straight to avoid aggravation of any spinal injury. 2. Loosen all tight clothing. 3. Clear the upper airway by running your fingers behind his lower teeth and over the back of his tongue. Remove dentures or foreign material. 4. Turn his head face up. Tilt the head back so that the neck is stretched and the chin is up. 5. Adjust the lower jaw so that it juts out. This positioning moves the base of the tongue away from the back of the throat, thus clearing or enlarging the air passage to the lungs. 6. Seal the airway opening (either the nose or the mouth) that is not being used. The seal must be secure to keep air from leaking during inflation. Pinch the nostrils shut with your free fingers (if you use mouth-to-mouth resuscitation) or seal the mouth by placing two fingers lengthwise over the patient’s lips (if you use mouth-to-nose resuscitation). 7. Take a deep breath. Open your mouth wide and make an airtight seal around the patient’s mouth or nose by placing your mouth over his mouth or nose. Breathe into the victim’s mouth or nose until his chest rises. 8. Breathe into the patient a total of four times as quickly as possible. If you feel or hear no air exchange, retilt his head and try again. If you still feel no air exchange, again sweep the mouth of foreign objects and breathe again into the victim. If you still have no air exchange, turn the victim on his side and slap him on the back between the shoulder blades. This should free anything blocking the throat. Again sweep his mouth to remove foreign matter. (If none of the above steps clear the air passage, repeat the blows to the back and retilt the head.) 9. Repeat breathing. Remove mouth each time to allow air to escape. If the exhalation is noisy, elevate his jaw further.
10. This procedure should be repeated twelve times per minute. Use deep breaths. As the victim begins to breathe, maintain head tilt.
Back Pressure Arm Lift Method
If it is impossible because of severe facial injuries to administer mouth-to-mouth or mouth-to-nose resuscitation try the following: 1. Place the victim face down, after first having cleared his mouth. Bend his elbows and place his hands one upon the other at eye level under his head. Turn the victim’s head to one side, making sure the chin juts out. 2. Kneel at the victim’s head. Place your hand on his back so that palms lie just below an imaginary line between his armpits. 3. Rock forward until your arms are vertical and the weight of your body exerts steady pressure on your hands. 4. Rock back, grasping victim’s elbows, and draw victim’s arms up toward you until you feel resistance at the shoulders. 5. Lower victim’s arms to the ground. Repeat about twelve times per minute (every 5 seconds). Keep checking to see if the mouth is clear, the airway is open, and the heart is beating. Note, In both methods of artificial respiration, continue your efforts until the victim breathes normally or a doctor pronounces him dead, or a more qualified person takes charge, or you are physically unable to continue. If the patient must be moved, continue artificial ventilation.
ARTIFICIAL RESPIRATION FOR CHILDREN AND INFANTS
The method is similar with slight modifications. 1. Clear mouth with finger. 2. Place child on his back. 3. Lift jaw so it juts out as with adults. 4. Place your mouth over both mouth and nose of the child to make an airtight seal. 5. Gently blow puffs of air, about twenty per minute. Otherwise the procedure is the same with one exception: instead of the slaps between the shoulder blades to remove foreign matter, hold the infant by the ankles upside down and give several sharp pats between the shoulder blades to free the air passage.
The Cause: In most cases food particles or bones caught in the windpipe instead of going into the esophagus. The symptoms: The victim gasps for breath or has violent fits of coughing; quickly turns pale then blue, and cannot talk. Actions to take: If the victim is still able to cough, don’t interfere. It is quite possible that he will cough up the foreign object. If any of the other symptoms occur, open the victim’s mouth and grasp the
foreign object with your index and middle finger, trying to remove it. If you can’t reach the obstruction with your fingers, use the following method: 1. Stand behind the chocking victim, with your arms around him, thumb side of your fist against his stomach, just above the navel and below the ribcage. 2. Grasp your fist with your other hand and make four quick upward thrusts. This will force air out of the lungs and may expel the obstruction. Repeat this procedure if necessary.
The causes: Insufficient oxygen supply to the heart or the brain, blockage of blood vessels of the heart, heart disease, embolism (foreign particles in the bloodstream), or overdose of certain drugs. Respiratory arrest is the most common cause of cardiac arrest. The heart stops within minutes after breathing ceases. The symptoms: No breathing, no pulse, unconsciousness, dilated pupils of the eyes, limp body, and flaccid skin. Action to take: 1. Roll the victim on his back. 2. Loosen all tight clothing. 3. Check the airway and remove any obstruction. 4. Hyperextend the neck and lift the lower jaw for mouth-to-mouth artificial respiration. 5. Give the patient five quick puffs of air by mouth-tomouth. *6. Place the heel of your hand on the lower half of the breastbone and press down until the breastbone is depressed about 2 inches. Repeat the compression about 15 times, about once per second. (To determine the pressure point for cardiac compressions, locate the bony tip of the breastbone with your ring finger and place two fingers just above that point.) 7. Return to mouth-to-mouth artificial respiration and give the victim two respirations. 8. Repeat this 15-¬2 cycle until help arrives or the patient is pronounced dead. 9. If help is available, one person should give the cardiac compressions and the other should give mouth-to-mouth artificial respiration. The ratio with two operators should be five compressions to one artificial respiration. The compressions should not be interrupted, even for respirations. When respiration is being applied, the compressions must be stopped only momentarily. 10. The cardiac compressions should equal about
60 per minute, the respirations about 12 per minute.
Acute hemorrhage is a rapid loss of blood from the blood vessels. In the event of an acute severe hemorrhage (loss of at least 2 pints of blood) an emergency is present. If the bleeding is not stopped, the patient will die. 1. Arterial Bleeding The symptoms: Spurting blood, bright red in color. The blood leaves the heart through the arteries under pressure. If an artery is opened, blood will spurt out forcefully. With each beat of the heart there will be a corresponding spurt of blood. The larger the artery, the more rapid the blood loss. 2. Venous bleeding The symptoms: Continuous flow of blood, dark red in color. Blood flowing through the veins is under less pressure than in the arteries. However, a break in a vein will allow blood to flow out of it. The rate of blood loss depends upon the size of the opened vein. 3. Capillary bleeding The symptoms: Blood oozing from a wound. The blood loss is usually not serious, as the bleeding is limited. Actions to take: Control of hemorrhage is primarily mechanical and consists of closing off the opened blood vessel. 1. Direct pressure: Cover the wound with the cleanest cloth immediately available or with your bare hand, and apply direct pressure on the wound. Most bleeding can be stooped this way. 2. Digital pressure (in case of arterial bleeding and if direct pressure does not do the trick). Apply your fingers to the appropriate pressure point - a point where the main artery supplying blood to the wound is located (see diagram). The three pressure points
in the head and neck should be used only as a last resort if there is a skull fracture and direct pressure cannot be used. If direct pressure can be used, it will stop bleeding on the head in about 95 percent of injuries. The pressure-point method is not recommended if pressure must be maintained for a long period of time, but it may be useful temporarily until a pressure dressing can be applied. 3. Elevation: If bleeding from a wound is only venous or capillary, elevation of the wound above the heart may slow the flow of blood. However, elevation is of no value in control of arterial bleeding, and it may aggravate fractures. 4. Tourniquet: Applying a tourniquet to an arm or a leg should be done only as a last resort when all other methods fail. A tourniquet is applied between the wound and the point at which the limb is attached to the body, as close to the wound as possible but never over a wound or fracture. Make sure it is applied tightly enough to stop bleeding completely. Although the tourniquet will stop the bleeding by compressing all the vessels, it is potentially dangerous, because it deprives the uninjured tissues of blood. Patients who have tourniquets applied should be clearly identified with a “T” on the forehead. Once applied, a tourniquet should never be loosened or removed except under the supervision of a doctor. In the case of an improvised tourniquet, the material should be wrapped twice around the extremity and half- knotted. Place a stick or something similar on the half-knot and tie a full knot. Twist the stick to tighten the tourniquet only until the bleeding stops-no more. Secure the stick or level in place with the loose ends of the tourniquet, another strip of cloth, or other improvised material. Note: A tourniquet can be improvised from a strap, belt, handkerchiefs, necktie, cravat bandage, etc. Never use wire, cord, or anything that will cut into the flesh. INTERNAL BLEEDING The symptoms: Cold and clammy skin, weak and rapid pulse, eyes dull and pupils enlarge, nausea and vomiting, pain in the affected area, especially the abdomen and chest. Actions to be taken: 1. Treat victim for shock (see below). 2. Anticipate that victim may vomit; therefore give nothing by mouth. 3. Keep the patient still to allow maximum flow of blood to vital organs and prevent further internal damage. 4. Get the patient to professional medical help as quickly and safely as possible.
The causes: Shock is a complex subject, but basically the causes may be : Loss of blood, breathing impairment, heart failure, or burns. The most common cause is hemorrhage, when blood escapes from the vascular system and consequently does not reach the tissues. Shock can kill; treat as soon as possible, and continue until medical aid is available. The symptoms: Shallow breathing, rapid and weak pulse, nausea, collapse, vomiting, shivering, pale and moist skin, mental confusion, drooping eyelids. Actions to take: 1. Establish and maintain an open airway. 2. Stop the bleeding and insure that the patient is breathing adequately. 3. Place the patient on his back with his head down (by elevating the feet with a pillow or blankets) to improve the flow of blood to the brain. Exceptions: head and chest injuries, heart attack, stroke, sunstroke. If there is no spine injury, the victim may be more comfortable and breathe better in a semireclining position. If in doubt, keep the victim flat. 4. Make sure the patient is comfortable and reassure him. This can help to prevent worsening of the shock. 5. Maintain normal body temperature. Place blankets under and over the victim. 6. Give nothing by month, especially stimulants or alcoholic beverages. 7. Always treat for shock in cases of serious injuries, and watch for it in minor ones.