First aid

First aid is the immediate and temporary aid provided to a sick or injured person until medical treatment can be provided. It generally consists of series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform with minimal equipment.

History

The Knights Hospitaller were probably the first to specialize in battlefield care for the wounded. St. John Ambulance was formed in 1877 to teach first aid (a term devised by the order) in large railway centres and mining districts. The order and its training began to spread throughout the British Empire and Europe. Around the same time, the Red Cross movement began to grow. Developments in first aid and many other medical techniques have been fueled in large by wars: the American Civil War prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote first aid, such as the Military and the Scouting movement. New techniques and equipment have helped make today's first aid simple and effective.

Training

It is best to obtain training in first aid before a medical emergency occurs. One needs hands-on training by experts to perform first aid safely, and recommendations change, so that training should be repeated every two years or so. Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance. In many countries in the Commonwealth of Nations, St. John Ambulance provides first aid training and in some countries operates Ambulance services. In the United States, the American Heart Association and American CPR Training also offer first aid training.

Basic First Aid

This is intended as a quick guide only. Effective CPR and first aid require hands-on training that is best accomplished by attending a class in person. (See list above for organizations).

This section summarizes one common formula for performing first aid.

  1. Survey the scene What's going on? Is it safe for me to approach?
  2. Do a primary patient survey Airway, Breathing, Circulation
  3. Call for emergency services
  4. Do a secondary patient survey, and provide appropriate emergency first aid

Survey the scene

Survey the scene and approach the victim. Determine whether the scene is safe. Look for dangers, such as downed powerlines, traffic, unstable structures or swift-moving water. Determine what may have happened, how many victims are involved, and if any bystanders can help.

If several persons appear to be injured, perform Triage.

Survey the patient

Perform an initial assessment. Get consent from a conscious victim (parent/guardian if the victim is a minor) before providing care. If the victim is unconscious, consent is implied. Use infection control precautions and check for signs and symptoms of any life-threatening conditions and care for them. To perform an initial assessment:
  • Check the victim for consciousness and obtain consent if the victim is conscious;
  • Check the ABCs (airway, breathing and circulation); and
  • Check for severe bleeding.

One should provide brief care for the conditions. If the patient lacks air or circulation, they will die in three to four minutes. This means clearing the airway, and briefly attempting to restart their breathing or circulation with rescue breathing or CPR. This step is crucial, because an unconscious persons' airway can be blocked by a normal, comfortable-looking head position (i.e., on their back with a pillowed head). Often, simply tilting the head back will open the airway and restart their breathing. Likewise, many people recovering from a blocked airway vomit, and if they are unconscious, they can drown in the vomit. The standard prevention for both these issues is to turn a breathing, unconscious patient on their side, turning their head and spine in the same movement to prevent spinal injury, pillowing their head on one of their arms.

Do not move victims unless it is necessary to remove them from danger, or to make treatment possible (such as onto a hard surface for CPR).

Calling for emergency medical services must take priority over extended care such as long term rescue breathing or extended CPR, since these techniques are intended to gain time for emergency services to arrive as part of the chain of survival. However, if bystanders are available, both can be pursued at the same time.

Call for emergency services

The next step is to activate Emergency Medical Services by calling for help using a local Emergency telephone number, such as 911 in Canada or the United States, 999 in the UK, 112 in most of continential Europe, 000 in Australia and 111 in New Zealand. Operators will generally require the caller's name and location and some information on person that is being called about (level of conciousness, injuries, name if known, chronic medical illnessess if known).

If you ask bystanders to call an ambulance for you, make sure they report back to you once released by the emergency operator to confirm that the call has been made. See Call for help.

Also note that in some circumstances, such as in remote areas or on the battlefield, outside help may be unavailable. The skill of wilderness first aid covers other measures including evacuation, but is no substitute for a medical professional if one can be located.

Do a secondary survey and begin extended care

The secondary survey is to gather information about conditions or injuries that may not be life threatening, but may become so if not cared for.

A properly trained and certified first aider performs three stages in the secondary survey:

  1. Interview
  2. Vitals
  3. Head-to-toe examination

Perform a secondary survey only if you are sure that the victim has no life threatening (ABC) conditions.

It is also essential that stages be performed in order, especially with the interview first, in case the patient looses consciousness.

1) Interview the victim

  • Signs and Symptoms - Visible indications of injury and patient reported sensations (e.g. pain)
  • Allergies - especially those relevant to injury (i.e. allergy to latex, pencillin, etc.)
  • Medications - what current or recent medications the patient is taking
  • Past Medical History - any related history, or medical conditions that could complicate treatment (e.g. heart condition)
  • Last meal - last food and/or drink
  • Events - confirm how injuries most likely occurred

(Note - interview should include bystanders as well to supplement info from the patient)

2) Vitals

(Most certifications at the first-aid level include only the following 3 or 4 vitals)
    • LOC - Level of Conciousness description (e.g. - alert, aware, disoriented, confused, unresponsive
    • Breathing Rate - Number of breaths per minute. Calculate by counting breaths for 10 seconds and multiplying by six, or 15 seconds and multiplying by four.
    • Pulse Rate - Number of heartbeats per minute. Calculate by counting pulse for 10 seconds and multiplying by six, or 15 seconds and multiplying by four. Pulse for an unconscious person is taken on the neck (carotid pulse) and on the wrist (radial pulse) for a conscious person.
    • Skin Condition - Pale vs. normal, cool/cold vs. hot, clammy/sweaty vs. dry

3) Head-to-toe examination

  • Perform a head-to-toe examination (for a child, toe-to-head)
    • Look for medical alert bracelets or medallions.
    • Compare one side of the patient against the other
    • Look for pain, or deformity

Wilderness (or mass emergency) First Aid

Wilderness first aid is the provision of first aid (q.v.) under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.

In the United States, Wilderness First Aid (WFA) is the name of a certification in Wilderness Medicine that covers wilderness first aid; depending on the laws applicable where it is practiced, it may impose specific responsibilities and confer specific immunities on duly-diligent practitioners. For instance, the practicing of certain rules of WFA, by someone certified in the usual "street" First Aid discipline but not in WFA (or a higher Wilderness Medicine qualification), could result in civil liability or perhaps even criminal prosecution.

A classic problem is whether to leave an injured person or stay if only one person is ambulatory. Barring special circumstances, the injured one should be stabilized, placed in shelter, and marked in a way visible from the air (usually a single, long line of cut brush or trampled snow). Then the injured one should be left alone, while the other goes for help.

If there are three or more, the healthy group should be split into halves by speed, with the fastest going for help, and the others remaining to make the preparations. (In a party of four, it would be a rare hiker who would be better sent for help alone, rather than sent in a sub-party of two.)

Ensuring the rescuers can find the injured person is crucial. If a personal locator beacon is available, it should be triggered and placed with the injured person. If enough help is available, air-visible markings may be worthwhile. Where surveyor's tape is available within the party (and assuming clear trails are available), it should be used by the sub-party going for help, to back up memory and notes with tape-flagging of the toward-the-injury-location choices of trail at intersections. (When an injury location is off clear trails, by distances that make it impractical to keep blazes of tape within sight of each other, forks in watercourses should be treated as substitutes for trail intersections.)

See Medical emergency for a list of medical emergencies and specific guidance directed towards first-aiders, Outdoor Emergency Care technicians and EMTs, often including Evacuation criteria.

Training in wilderness first aid is available. Any group of persons traveling in wilderness should have at least one person trained in wilderness first aid and carry a First aid kit designed for the area they are traveling in.

Nursing care is not part of normal first aid but is part of wilderness first aid.

CPR (Cardiopulmonary resuscitation)

Sometimes CPR should not be performed, particularly if other persons are injured and need immediate help. CPR takes a lot of effort, and may keep care providers from helping others. See Triage.

CPR is often portrayed in movies and television as being highly effective in rususcitating a person who is not breathing and has no circulation. A 1996 study by the New England Journal of Medicine showed that CPR success rates in television shows was 75%. The reality is that CPR administered outside hospitals has a 2-15% success rate on its own, and is most importantly used to sustain oxygen supply to the brain until specialized medical equipment and personel can reach the scene (see Defibrillator).

Care providers performing CPR in the wilderness are advised to stop:

  1. when a competent health professional takes responsibility for the patient;
  2. if the patient is stiff and is obviously dead;
  3. after twenty minutes of CPR with no pulse or breathing, and professional medical assistance will not be available for some time; in this case the patient survival in the wilderness is unlikely, unless hypothermic (then the patient needs to be warm, pulseless and unresponsive before being declared dead); or
  4. when the rescuers are in danger.

Conditions that often require first aid

Also see Medical emergency
  • Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.
  • Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of Epinephrine.
  • Bone fracture a break in a bone initially treated by stabilizing the fracture with a splint.
  • Burns, which can result in damage to tissues and loss of body fluids through the burn site.
  • Choking, blockage of the airway which can quickly result in death due to lack of Oxygen if the patient's trachea is not cleared, for example by the Heimlich maneuver.
  • Childbirth.
  • Cramps in muscles due to lactic acid buildup caused either by inadequate oxygenation of muscle or lack of water or salt.
  • Diving disorders resulting from too much pressure.
  • Gastrointestinal bleeding.
  • Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
  • Heat stroke, also known as sunstroke or Hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
  • Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
  • Hemorrhage, or heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
  • Hyperglycemia, or Diabetic coma.
  • Hypoglycemia, or insulin shock
  • Hypothermia, or exposure, occurs when a person's core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rythm.
  • Insect and animal bites and stings.
  • Muscle strain.
  • Poisoning, which can occur by injection, inhalation, absorbtion, or ingestion.
  • Sprain, a temporary Dislocation of a joint that immediately reduces automatically but may result in ligament damage.
  • Stroke a temporary loss of blood supply to the brain.
  • Sucking chest wound, a life threatening hole in the chest which can cause the chest cavity to fill with air and prevent the lung from filling, treated by covering with an occlusive dressing to let air out but not in.
  • Toothache, which can result in severe pain and loss of the tooth but is rarely life threatening.
  • Wounds and Bleeding, including laceration, incision and Abrasion, and Avulsion, which present risk of infection and should be irrigated with sterile normal saline and may require Antibiotic medication.

Providing first aid

Techniques and procedures of first aid

Ferdinand Habsburg   Index

This page is based on the Wikipedia article ''First aid''. It is licensed under the GNU free documentation license.

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