BASIC FIRST AID

It can never hurt to learn some basic and emergency first aid – there are lots of books on the subject but the best advice is to book a course through the Red Cross, St. John Ambulance or your local NHS Ambulance Service. In the following sections we have listed the most important steps in emergency first aid.

Primary Survey

Before you approach anyone who has been injured, you should conduct what is known as the Primary Survey. Remembering the acronym, DR ABC.

Danger/Response/Airway/Breathing/ Circulation, you should check the scene for danger to yourself and the casualty (e.g., if someone has suffered an electric shock, make sure that the electricity has been turned off or attempt to move the person to a place that will be safe for you both using a wooden broom handle, for example). Then see if the casualty responds by shouting, ‘Can you hear me? Open your eyes’ and gently shaking their shoulders (under no circumstances should you shake a baby or young child).

If the casualty responds and there is no further danger, you should leave them in the position found and summon help, if needed. Treat any conditions found e.g., cuts or burns and monitor their vital signs (level of response, pulse and breathing). Continue monitoring casualty until help arrives.

If the casualty does not respond, you should shout for help. If possible, leave the casualty in the position you found them and open the airway. If this is not possible, turn the casualty onto their back and open the airway.

This is done by placing one hand on the casualty’s forehead and gently tilting the head back, then lifting the chin using two fingers only. This will move the casualty’s tongue away from the back of their mouth.

Look, listen and feel for no more than ten seconds to see if the casualty is breathing normally. Look to see if the chest is rising and falling, and listen for breathing. You can also feel for breath against your cheek.

If the casualty is breathing normally, you should place them in the recovery position and check for other life-threatening conditions such as severe bleeding.

If the casualty is not breathing normally, or if you have any doubt whether breathing is normal, begin CPR.

Cardio-Pulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a first aid technique that can be used if someone is not breathing properly or if their heart has stopped.

Chest compressions and rescue breaths keep blood and oxygen circulating in the body. If someone is not breathing normally and is not moving or responding to you after an accident, call 999 or 112 for an ambulance. Then, if you can, start CPR straight away.

In cases of sudden cardiac arrest, the oxygen level in the blood will remain high for a few minutes so initially chest compressions will be more important than rescue breaths.

Remember, if your search for breathing and circulation yield nothing, have someone call 999 or call them yourself if you are the only conscious person in the room, and immediately begin compressions and artificial breathing.

Think ABC Airway, Breathing, CPR!

ABC is an acronym to help you remember the important first steps before performing CPR: airway, breathing, and circulation. Open the airway, check the victim’s breathing, and pulse (i.e., circulation).

• To open the victim’s airway, lift the chin carefully. This will move the jaw forward and tilt the head backward, allowing a path for air to travel to the lungs from the mouth and nose. 

• Remember, don’t push the forehead back in an effort to open the airway. If the victim has a neck or spinal injury this will only make it worse. 

• To check for breathing, watch the victim’s chest. If you can see it rise and fall even slightly, then they are breathing. 

• Whether or not you can see the chest rise and fall, listen with your ear to the mouth and nose. You are listening for breathing sounds. 

• If you can’t hear the victim breathing, but can feel their breath on your ear, then they are breathing. Use as many senses as possible and your best judgment. 

• To check circulation, feel for a pulse. Press two fingers gently on the victim’s `neck between the Adam’s apple and the muscle at the side of the neck. Don’t use your thumb, because your thumb has a pulse of its own. 

• To check an infant’s circulation, press two fingers between the armpit and elbow on the inside of the baby’s arm.

CPR for Babies, Birth to One Year Old 

• Confirm your baby is not breathing, complete the steps of the primary survey (DRABC) 

• If accompanied, send your helper to dial 999 or 112 for an ambulance (112 is recommended if you are calling from a mobile as it gives a clearer signal, although you can also reach this number from landlines and in many other European countries). 

• If you are alone, you will have to carry out rescue breaths and chest compressions for one minute before taking the infant with you to call an ambulance. 

• Carefully remove any obvious obstruction from the mouth of the infant (it is important not to touch the back of your child’s throat as this could cause swelling and further obstruction of their airway) and give five initial rescue breaths. 

• You do this by slightly tipping the infant’s head back. Seal your mouth over their mouth and nose and breathe gently into them, looking along the chest as you breathe. Fill your cheeks with air and use this amount each time. As the chest rises, stop blowing and allow it to fall. Repeat this five times. 

• Having done five rescue breaths, you’re now going to do chest compressions. 

• Using the tips of two fingers to compress the chest, place your fingers in the centre of the infant’s chest (imagine a line joining the nipples and place two fingers along the length of the breast bone below this line) and sharply depress the chest one third of its depth at a rate of 100-120 compressions a minute (above the speed of the song ‘Staying Alive’) At the speed, you’re going to give 30 chest compressions. 

• Alternate 30 chest compressions with two rescue breaths and keep repeating as necessary until help arrives or the child’s breathing is restored to normal. 

CPR for Children Between One Year and Puberty 

• Following your primary survey, you have already established that the child is not breathing normally. 

• At this point, if you are accompanied, send your helper to dial 999 or 112 for an ambulance. 

• If you are alone, you will need to do one minute’s worth of CPR before going to call for help yourself. 

• Carefully remove any visible obstruction from the mouth or nose of the child and give five initial rescue breaths. 

• Ensure you tip the head back, pinch the soft part of the nose closed, and put your mouth over the child’s mouth, forming an airtight seal. 

• Breathe into the child, ensuring the chest inflates. Do this five times. 

• Having done five rescue breaths, you are now going to do chest compressions. 

• Place one hand or two, as appropriate in the centre of the chest (this does depend on the size of the child). Use the heel of your hand and keep your arms straight. 

• Sharply depress the chest one third of its depth at a rate of 100- 120 compressions a minute. At this speed, you are going to give 30 chest compressions. 

• Alternate 30 chest compressions with two rescue breaths and keep repeating as necessary until help arrives or the child’s breathing is restored to normal. 

CPR for Adults 

• Carry out the Primary Survey - Danger, Response, Airway, Breathing, Circulation. 

• At this point, if you are accompanied, send your helper to dial 999 or 112 for an ambulance. 

• Open the casualty’s airway by placing one hand on the forehead and using two fingers to lift the chin. 

• Position your cheek close to their mouth and look, listen and feel for no more than ten seconds to see if the chest is rising and falling, listen for breathing and feel for breath against your cheek. 

• If you are on your own, you should call an ambulance at this stage and then commence chest compressions immediately. If the casualty is unconscious due to drowning, you should give five rescue breaths and perform CPR for one minute before making the call. 

• To perform rescue breaths, carefully remove any visible obstructions from the mouth or nose of the person and give five initial rescue breaths. 

• Ensure you tip the head back, pinch the nose firmly closed and put your mouth over the person’s mouth, forming an airtight seal. 

• Breath into the casualty, ensuring the chest inflates; then remove your mouth and allow the chest to fall. Repeat once more. 

• Place the heel of your hand in the centre of the chest. Place the other hand on top and interlock your fingers. 

• Keeping your arms straight and your fingers off the chest, press down by five to six centimeters and release the pressure, keeping your hands in place. 

• Repeat the compressions 30 times, at a rate of 100-120 per minute (about the speed of the song ‘Staying Alive’). 

• You should then do two rescue breaths (see steps 6-9). 

• Continue resuscitation at a rate of 30 compressions to two rescue breaths until emergency help arrives and takes over. 

• Only stop if the casualty shows signs of recovery such as coughing, opening eyes, speaking or moving purposefully, and breathing normally.

 

Recovery Position

Detailed below is a step-by-step guide to the recovery position: 

• Kneel on the floor to one side of the person. Place the person’s arm that is nearest you at a right angle to their body, so it is bent at the elbow with the hand pointing upwards. This will keep it out of the way when you roll them over. 

• Gently pick up their other hand with your palm against theirs (palm to palm). `Now place the back of their hand onto their opposite cheek (for example, against their left cheek if it is their right hand). Keep your hand there to guide and support their head as you roll them. 

• Now use your other arm to reach across to the person’s knee that is furthest from you, and pull it up so that their leg is bent and their foot is flat on the floor. 

• Now, with your hand still on the person’s knee, pull their knee towards you so they roll over onto their side, facing you. The person’s body weight should help them to roll over quite easily. 

• Move the bent leg that is nearest to you, away from their body so that it is resting on the floor (bent at a right angle to their body). 

• Lastly, gently raise their chin and their head back slightly, as this will open up their airway and help them to breathe. Check that nothing is blocking their airway. If there is an obstruction, remove this if you can do so safely. 

• Stay with them, giving reassurance, until they have fully recovered or until an ambulance arrives.

 

When dealing with an infant, St. John Ambulance recommend putting them in the recovery position by cradling the child in your arms with their head tilted downwards to prevent them choking on their tongue or inhaling vomit. (Information supplied courtesy of Epilepsy Society) 

Bleeding 

With all types of bleeding, it’s important to stop the flow of blood as quickly as possible.

Small cuts - Small cuts in the veins stop bleeding and clot within a few minutes. The area should then be washed, and a plaster placed gently on top.

Deeper cuts - Deeper cuts in the veins produce dark blood that seeps out slowly and steadily. It can be stopped by gentle pressure on the wound with a sterile or clean cloth, followed by the application of a clean or sterile bandage.

Often, these wounds need sewing or gluing, and therefore medical treatment will be necessary after first aid.

Arterial bleeding  - Arterial bleeding must always be treated by a doctor. Bleeding from an artery can cause death within a few minutes – so urgent first aid is essential.

This type of bleeding pulsates and squirts blood, as the pulse beats. The blood is often a light red colour.

To stop bleeding from an artery, apply hard pressure on the wound and keep this up until the patient receives medical treatment. Press with a sterile cloth or just use your hand, if nothing else is available.

Put a bandage on the wound if possible and if the blood soaks through the bandages, press harder until the bleeding stops. Do not remove the soaked bandages, but place another on top if necessary.

Do not attempt to clean the wound.

The person should be made to lie down, preferably with their head lower than the rest of their body. This will ensure that enough oxygen gets to the brain.

If possible, position the wounded area higher than the rest of their body so that the pressure, and therefore the bleeding, will be reduced. Take particular care if you suspect a bone has been broken.

Where possible, you should wear disposable gloves to cover any wounds on your hands and protect yourself from infection.

Objects in Wounds

Where possible, swab or wash small objects out of the wound with clean water. However, if there is a large object embedded you should leave it in place and apply firm pressure on either side of the object. Raise and support the wounded limb or part and lay the casualty down to treat for shock.

Gently cover the wound and object with a sterile dressing and build up padding around the object until the padding is higher than the object, then bandage over the object without pressing on it. 

Depending on the severity of the bleeding, dial 999 or 112 for an ambulance or take the casualty to hospital.

Fractures

Fractures are a complete or incomplete break or a crack in a bone due to an excessive amount of force. A fracture can cause other internal injuries and medical help should be sought as soon as possible. 

With fractures, you should look for the following symptoms: swelling; unnatural range of movement; immobility; grating noise or feeling; deformity; loss of strength; shock; twisting; shortening or bending of a limb. 

If you suspect a fracture, you should support the limb and immobilise the affected part before calling 999 or 112 for an ambulance. You should also treat the person for shock.

Shock

Shock is a life-threatening condition that occurs when the vital organs, such as the brain and heart, are deprived of oxygen due to a problem affecting the circulatory system. The most common cause of shock is blood loss but it can also be caused by other fluid loss such as vomiting or severe burns. Shock can occur when the heart has been damaged by heart attack or angina and is unable to pump an adequate supply of oxygen to the body. 

Look for the following symptoms to recognise shock: pale face; cold, clammy skin; fast, shallow breathing; rapid, weak pulse; yawning; sighing; and, in extreme cases, unconsciousness. 

If you think a person is in shock, you should attempt to treat any possible causes and help them to lie down. Raise and support their legs, loosen tight clothing and keep them warm and do not give them anything to eat or drink. 

Call 999 or 112 for emergency help as soon as possible. If there are bystanders, ask someone to call an ambulance. 

Burns 

When treating a major burn, you should start cooling the burn immediately by placing the affected area under cool running water for at least 20 minutes. Dial 999 or 112 for an ambulance and make the casualty as comfortable as possible. 

Whilst wearing disposable gloves, remove the casualty’s jewellery, watch or clothing from the affected area unless it is sticking to the skin. 

When cooling a large burn be aware that it may cause hyperthermia, especially in babies, children and older people. You may need to stop cooling the burn to avoid hyperthermia. 

Cover the burn using a clean, nonfluffy material to protect from infection. Cloth, a clean plastic bag or kitchen film all make good dressings. Treat for shock. 

For minor burns, hold the affected area under cold water for at least ten minutes or until the pain subsides. Remove jewellery etc. and cover the burn as detailed above. If a minor burn is larger than a postage stamp, it requires medical attention. 

All deep burns of any size require urgent hospital treatment. 

Never use lotions, ointments, creams or adhesive dressings on burns. You should also never break blisters. 

Head Injuries 

All head injuries are potentially serious and require proper assessment because they can result in impaired consciousness. Injuries may be associated with damage to the brain tissue or to blood vessels inside the skull, or with a skull fracture. 

A head injury may produce concussion, which is a brief period of unconsciousness followed by complete recovery. Some head injuries may produce compression of the brain (cerebral  compression), which is life-threatening. 

It is therefore important to be able to recognise possible signs of cerebral compression in particular, a deteriorating level of response. 

A head wound should alert you to the risk of deeper, underlying damage, such as a skull fracture, which may be serious. Bleeding inside the skull may also occur and lead to compression. Clear fluid or watery blood leaking from the ear or nose are signs of serious injury. 

Any casualty with an injury to the head should be assumed to have a neck (spinal) injury as well and be treated accordingly. 

Concussion

Concussion occurs when the brain is shaken by a blow to the head. The most common causes of concussion include traffic incidents, sports injuries, falls, and blows received in fights.

Concussion produces widespread but temporary disturbance of normal brain activity. However, it is not usually associated with any lasting damage to the brain. The casualty will suffer impaired consciousness, but this only lasts for a short time (usually only a few minutes) and is followed by a full recovery. By definition, concussion can only be confidently diagnosed once the casualty has completely recovered. 

A casualty who has been concussed should be monitored and advised to obtain medical aid if symptoms such as headache or blurred vision develop later. 

Concussion can be difficult to recognise but may be identified by a brief period of impaired consciousness following a blow to the head. The injured person may also experience dizziness or nausea on recovery; loss of memory of events at the time of, or immediately preceding, the injury; or a mild, generalised headache. 

To ensure that the casualty recovers fully and safely, they need to be in the care of a responsible person and receive medical aid if necessary. 

You should check the casualty’s level of response using the AVPU code. 

The AVPU Code 

• A - Is the casualty alert, eyes open and responding to questions?
• V - Does the casualty respond to verbal commands?
• P - Does the casualty respond to pain (e.g., eyes open or movement in response to being pinched)?
• U - Is the casualty unresponsive?

Regularly monitor and record vital signs, (level of response, pulse and breathing). Even if the casualty appears to recover fully, watch them for any deterioration in their level of response. When the casualty has recovered, place them in the care of a responsible person. If a casualty has been injured on the sports field, never allow them to ‘play on’ without first obtaining medical advice. 

Advise the casualty to go to hospital, if following a blow to the head they develop symptoms such as headache, vomiting, confusion, drowsiness or double vision.

Warning: if the casualty does not recover fully or, if there is a deteriorating level of response after an initial recovery, dial 999 or 112 for an ambulance. 

Cerebral Compression 

Cerebral compression is very serious and almost invariably requires surgery. Cerebral compression occurs when there is a build-up of pressure on the brain. This pressure may be due to one of several different causes, such as an accumulation of blood within the skull or swelling of injured brain tissues. Cerebral compression is usually caused by a head injury. However, it can also be due to other causes, such as stroke, infection, or a brain tumour. 

The condition may develop immediately after a head injury, or it may appear a few hours or even days later. For this reason, you should always try to find out whether the casualty has a recent history of a head injury. 

Cerebral compression can be recognised by a deteriorating level of response and the casualty may become unconscious. The casualty may have a history of a recent head injury or complain that they are experiencing an intense headache, as well as exhibiting noisy breathing, becoming slow; slow, yet full and strong pulse; unequal pupil size; weakness and/or paralysis down one side of the face of body; a high temperature; flushed face; and drowsiness. Noticeable changes in personality or behaviour, such as irritability or disorientation, are also signs of cerebral compression. 

You should arrange the urgent removal of the casualty to hospital, calling 999 or 112 at the first possible opportunity. 

If the casualty is conscious while you are waiting for the ambulance to arrive, keep them supported in a comfortable resting position and reassure them. Regularly monitor and record their vital signs, (level of response, pulse and breathing) until medical help arrives. 

If the casualty is unconscious, open the airway using the jaw thrust method and check breathing (Primary Survey). Be prepared to give chest compressions and rescue breaths if necessary. If the casualty is breathing, try to maintain the airway in the position the casualty was found. 

Skull Fracture 

If a casualty has a head wound, then you should be alert for a possible skull fracture. A skull fracture is serious because there is a risk that the brain may be damaged either directly by fractured bone from the skull or by bleeding inside the skull. 

You should suspect a skull fracture in any casualty who has received a head injury resulting in impaired consciousness. A casualty with a possible skull fracture may also have a neck (spinal) injury and should be treated accordingly. 

It may be possible to recognise a skull fracture by looking for the following signs: a wound or bruise on the head; soft area or depression on the scalp; bruising or swelling behind one ear; bruising around one or both eyes; clear fluid or watery blood coming from the nose or an ear; blood in the white of the eye; distortion or lack of symmetry of the head or face; or progressive deterioration in the level of response. 

If you suspect a skull fracture, you should aim to maintain an open airway and arrange for the urgent removal of the casualty to hospital. 

If the casualty is conscious while you are waiting for the ambulance, help them to lie down but do not turn the head in case there is a neck injury. Control any bleeding from the scalp by applying pressure around the wound. Look for and treat any other injuries. 

If there is discharge from an ear, cover the ear with a sterile dressing or clean pad, and lightly secure this with a bandage. Do not plug the ear. Monitor and record the casualty’s vital signs, (level of response, pulse, and breathing) until medical help arrives. 

If the casualty is unconscious, open the airway using the jaw thrust method, and check the casualty’s breathing (Primary Survey). Be prepared to give chest compressions and rescue breaths if needed. 

If the position in which the casualty was found prevents maintenance of an open airway or you fail to open it using the jaw thrust, place the person in the recovery position. 

Seizures 

Seizures are sudden, brief events. Sometimes called ‘fits’ or ‘attacks’, seizures can happen for many different reasons, such as diabetes, a heart condition or epilepsy. 

In epilepsy, an individual has a tendency to have repeated seizures that start in the brain. Epileptic seizures are caused by excessive electrical activity in the brain, which causes a brief change in the way the brain works. These seizures can affect the individual’s emotions, sensations, awareness or behaviour. 

What happens during a seizure depends on where in the brain the seizure happens and how much of the brain is affected by it. 

There are many different types of epileptic seizure. Some people become very confused during a seizure, and others may lose consciousness. How you can help someone depends on the type of seizure they have. Here are some examples of seizures, and how you can help. 

• Focal aware seizures: the person may have a strange feeling or taste, which can be intense and unsettling. This is sometimes called a ‘warning’ or ‘aura’ if the seizure spreads to become another seizure type (for example, see tonic clonic seizure below). Gentle reassurance many be appropriate. 

• Focal impaired awareness seizures: the person loses awareness, become confused and may act strangely (such as wandering around, mumbling or making chewing movements with their mouth) These seizures can last for a couple of minutes, and can easily be mistaken for other unusual behaviour. Gently guide them away from any danger and stay with them until they recover. 

• Tonic and atonic seizures: the person abruptly falls down but usually recovers quickly. Check that they are not hurt. 

• Absence seizures: the person becomes blank and unresponsive. If they are walking they may carry on walking, which can be dangerous. Gently guide them away from any danger and stay with them until they recover. 

• Tonic clonic (convulsive) seizures: the person goes stiff and may cry out. They fall to the ground and have convulsions (jerking of the body). Their breathing may be affected and may sound noisy or laboured. They may go pale or blue, particularly around their mouth. They may also bite their tongue, and there may be blood-stained saliva around their mouth. They may also become incontinent. 

During this type of seizure (Tonic clonic):

• Try to stay calm;
• Check the time to see how long the seizure goes on for;
• Only move the person if they are in a dangerous place, for example in the road. Instead, move any objects, such as furniture, away from them so that they don’t hurt themselves; •
• Put something soft under their head, or cup their head in your hands, to stop it hitting the ground;
• If they have tight clothing around their neck, or they are wearing a head scarf or veil, you might want to loosen this to help them breathe;
• Do not restrain them or hold them down allow the seizure to happen;
• Do not put anything in their mouth - they will not swallow their tongue;
• Try to stop other people crowding around;
• Note the times the seizure starts and finishes.

After the seizure ends (the shaking stops):

• Roll them on to their side into the recovery position;
• If their breathing sounds difficult or noisy, check that nothing is blocking their airway;
• Wipe away any spit from their mouth;
• Try to minimise any embarrassment. If they have wet themselves try to deal with this sensitively (for example, you could put a coat over them); and
• Stay with them until they have fully recovered. 

After this type of seizure the person is usually very confused and tired, and may want to sleep. Most people won’t need any special medical attention. However, if you are concerned for any reason that the person has hurt themselves or they are not recovering, you may need to call for help. 

(Information supplied courtesy of Epilepsy Society). 

When to call for help

Most epileptic seizures happen suddenly, last a short time and stop on their own, and the person will recover and not need any medical help. However, it is important to call for an ambulance in the following situations:

• it is the person’s first seizure;
• they have injured themselves or have trouble breathing after the seizure has stopped;
• one seizure immediately follows another with no recovery in between; the seizure lasts 2 minutes longer than usual; or
• the seizure lasts for more than 5 minutes if you don’t know how long their seizures usually last. 

When the seizure has ceased, open the casualty’s airway and check breathing. Be prepared to give rescue breaths and chest compressions if necessary. If the casualty is unconscious but breathing normally, place them in the recovery position and monitor and record their vital signs level of response, pulse and breathing. 

Strokes 

A stroke is caused by a portion of the brain being starved of oxygen. This can be due to a burst blood vessel or a clot blocking a blood vessel. The lack of oxygen causes damage to the brain. The long-term effects of a stroke depend on what part of the brain and how much tissue is affected. 

To recognise if someone has suffered a stroke, use the FAST test –

Face,

Arms,

Speech,

Time.

Do this by asking the person to smile, if they have had a stroke, they may only be able to smile on one side, while the other side of their face may droop. Ask them to raise both arms as if they have had a stroke, they may only be able to lift one arm. 

Next, ask the person to speak to you, a stroke often leaves people unable to respond appropriately.

Finally, it is time to call 999/112 for an ambulance. Explain to the operator that you have used the FAST test and suspect a stroke. 

Please note, that these tips are no substitute for formal first aid training. First aid procedures change from time to time, so the above information may be subject to change. Organisations such as St. John Ambulance now offer email alerts to notify people of changes in first aid procedures, as well as a comprehensive range of online advice and training courses.