These notes are designed for students undertaking the Proficiency in

Medical Care course to assist with pre course preparation.

Course notes will be issued at enrolment.

BASIC FIRST AID

Objectives and Priorities of First Aid
Incident Management
Resuscitation
Shock
Bleeding
Heat Burns

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 FIRST AID PRIORITIES OF FIRST AID
First aid is defined as helping behaviours and initial care provided The priorities can be remembered by using DR AB(C)
for an acute illness or injury. It can be initiated by anyone in any
situation including self-care. D – is there any danger to you or the casualty?

R – does the casualty respond when you talk to them?

GOAL
A – is the airway open?
To recognise when help is needed and how to get it.
B – can the casualty actually breath?

OBJECTIVES
A third letter C is sometimes used to remind the rescuer of the next
The objectives of first aid can be encompassed in three short stage. This refers to circulation and can be interpreted in the
phrases. following ways.
 Preserve life If the casualty is not breathing C = chest compressions
required
 Prevent further harm
If the casualty is breathing C = is there catastrophic
 Promote recovery bleeding?
They are often referred to as the three “P’s”. These objectives
To assess the quality of the circulation C = check pulse
should be demonstrated at all times while you are dealing with a
casualty and not just initially.

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 MANAGING AN INCIDENT

At any incident the first aider will follow a plan of action. This will include assessing the situation and scene, assessing the casualty,
getting help, treating the casualty and dealing with the aftermath. The time it takes, and methods used, may change according to the
circumstances and the severity of the situation, but this process will always be carried out.

ASSESS THE SITUATION AND ASSESSING THE CASUALTY GETTING HELP DEALING WITH THE
SCENE AFTERMATH
The initial assessment of the Good communication is vital in
What has happened? Look for casualty is called the primary any first aid incident. When Dealing with the aftermath of
clues to tell you. Do not survey. This is the priority in calling for help the information any first aid situation
approach the casualty until you any first aid situation. Does the that will be required is: encompasses two aspects,
are sure it is safe to do so. You casualty have an Airway? Is the  the location of the practical issues and emotional
must recognise and manage any casualty Breathing? incident issues. Practical issues include:
dangers to yourself and the  what has happened
casualty at all times. What injuries are there? What  what help is required  completion of accident
can the casualty tell you? reports or log book
 how many casualties
there are entries
 what injuries sustained  restocking the first aid
Remember that the danger to kit and returning it to its
you may not be obvious. Think storage point
TREATING THE CASUALTY
about the immediate space  cleaning up any body
around your casualty. eg fluid spills safely
spillages on deck, broken glass, Constantly be aware of danger
to you and your casualty.  participation in any
wood splinters. Think about the accident investigation
dangers peculiar to your own Everything you do must comply
with the 3P’s. Whilst treating  disposal of contaminated
working environment.
the casualty you must always be materials
aware of their “ABC”

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 RESUSCITATION 2015

The full resuscitation guidelines may be found at www.resus.co.uk.

The initials DR ABC are used to First make sure that you, the casualty and any bystanders are safe.
remember the sequence of events.
Shout at the casualty as you approach them and see if they respond. They should be told to stay
D is for Danger: still. If there is no response to shouting, you should kneel by the casualty. Shout again while
A is for Airway gently tapping and shaking their shoulders. If there is still no response, turn the casualty onto
B is for Breathing their back if they are not already in that position. At this point, if you have not already done so,
C is for Circulation (compressions) you should shout for help.

OPEN THE AIRWAY

Make sure the casualty has an open airway. Keep one hand on their forehead and gently tilt the
head back. Place fingertips under the chin and lift the chin up. This action opens the airway by
moving the tongue away from the airway entrance.

CHECK FOR BREATHING

With your head next to the face of the casualty, keep the chin supported and look, listen and
feel for evidence of normal breathing for no longer than 10 seconds. Can breath be felt on your
cheek? Is there chest rise and fall? Can any sounds be heard?
In the first few minutes after cardiac arrest, a casualty may be barely breathing, or taking
infrequent, noisy, gasps. This is often termed agonal breathing and must not be confused with
normal breathing. Agonal gasps are present in up to 40% of cardiac arrest casualties
If breathing is not normal, or if you have any doubts, act as if it is not normal, raise the alarm
and ask for help including an AED if there is one available.

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COMMENCE COMPRESSIONS
Kneel by the side of the casualty placing the heel of one hand in the centre of their chest. Place
the heel of the other hand on top of the heel of the first. Interlock fingers and raise them off
the chest ensuring no pressure is applied on the ribs. No pressure should be put on the lower end
of the breast bone or the upper abdomen.

Positioned vertically over the casualty, and with arms locked straight, with hand, elbow and
shoulder in line, press down on the breastbone to a depth of 5 - 6 cm. After each compression
release all the pressure on the chest, letting it return to its original position, but do not remove
hands from the chest. Repeat this at a rate of 100 – 120 compressions per minute. Complete 30
compressions.

DELIVER BREATHS
(VENTILATIONS)
After 30 compressions, open the airway using the head tilt chin lift method. Pinch the soft part
of the nose using thumb and index finger of one hand. Maintain chin lift with the other hand
keeping the mouth open. Take a normal breath and place your lips around the casualty’s mouth
making sure there is a good seal. Blow steadily in the mouth and watch for the chest to rise as in
normal breathing. This takes about 1 second. Take your mouth away and watch for the chest to
fall as the air comes out. Repeat this once more. This completes two effective rescue breaths.

CONTINUE WITH CPR

Return to the chest without delay and give 30 more compressions. Continue with a ratio of 30
compressions to 2 breaths If you are unable to do rescue breaths give continuous chest
compressions only

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IF AN AED ARRIVES
Switch on the AED
 Attach the electrode pads on the casualty’s bare chest
 If more than one rescuer is present, CPR should be continued while electrode pads are
being attached to the chest
 Follow the spoken/visual directions
 Ensure that nobody is touching the casualty while the AED is analysing the rhythm

If a shock is indicated, deliver shock

 Ensure that nobody is touching the casualty
 Push shock button as directed (fully automatic AEDs will deliver the shock automatically)
 Immediately restart CPR at a ratio of 30:2
 Continue as directed by the voice/visual prompts

If no shock is indicated, continue CPR immediately and continue as directed by the voice
prompts

WHEN TO STOP CPR

Do not interrupt resuscitation until:
 You are told to stop by a health professional (or the master)
 You become exhausted
 You are in danger
 The casualty is definitely waking up, moving, opening eyes and breathing normally

It is rare for CPR alone to restart the heart. Unless you are certain the person has recovered
continue CPR. If you are certain the casualty is breathing normally, but is still unresponsive,
place them in the recovery position

DROWNING
Where a casualty has been rescued from drowning, they have not been breathing and do not
have oxygen in their blood to be circulated. In drowning incidents, after discovering the casualty
is not breathing, give 5 rescue breaths and then continue with compressions and ventilations at
a ratio of 30:2. If you are on your own, perform CPR for 1 min before going for help.

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 MANAGEMENT OF THE UNCONSCIOUS CASUALTY

RECOVERY POSITION
There are several variations of the recovery position, each with its own advantages. No
single position is perfect for all casualties. The position should be stable, near a true lateral
position with the head dependent, and with no pressure on the chest to impair breathing.

The Resuscitation Council (UK) recommends this sequence of actions to place a casualty in the recovery position:

o Remove the casualty’s spectacles

o Kneel beside the casualty and make sure that both his legs are straight
o Place the arm nearest to you out at right angles to his body, elbow bent with the hand palm uppermost
o Bring the far arm across the chest, and hold the back of the hand against the casualty’s cheek nearest to you
o With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground
o Keeping his hand pressed against his cheek, pull on the far leg to roll the casualty towards you onto his side
o Adjust the upper leg so that both the hip and knee are bent at right angles
o Tilt the head back to make sure the airway remains open
o If necessary, adjust the hand under the cheek, to keep the head tilted and facing downwards to allow liquid material to drain
from the mouth
o Check breathing regularly
o Be prepared to start CPR immediately if the casualty stops breathing

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 SHOCK

DEFINITION CAUSES SIGNS AND SYMPTOMS MANAGEMENT

Shock is a lessening of the vital Shock may happen as a result of: These result from the effect of  maintain airway
activities of the body caused by reduced blood supply to vital  deal with the cause
injury or illness. It is a physical  pain organs and the body’s own  lay down if injuries allow
condition and should not be  injury efforts to compensate.
confused with emotional shock.
 elevate legs if injuries
 allergy allow
Its speed of onset will vary and  pale colour
may not depend on the severity  infection  loosen tight clothes
 fluid loss  skin cold and clammy
 reassure
of the injury. It may result in
 profuse sweating
 don’t allow to drink or
unconsciousness and death if not eg bleeding, diarrhoea,
managed immediately. vomit, burns  feel cold eat: they may vomit
 medical conditions  feel faint or dizzy and their airway is at
eg heart attack  anxiety or confusion risk.
 feel thirsty  moisten lips only
 nausea  no smoking or alcohol
 pulse rapid, weak and  do not move unless
may be irregular absolutely vital
 breathing rapid and  protect from the
shallow elements
 may be evidence of  cover with blanket
injury

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 EXTERNAL BLEEDING

TYPES OF BLEEDING SIGNS AND SYMPTOMS MANAGEMENT

 arterial is bright red and  visible bleeding The standard method for first aiders to control open bleeding is to
spurting APPLY DIRECT PRESSURE to the bleeding site. The pressure
 evidence of injury needed for an arterial bleed should never be underestimated.
 venous is dark red and Bandaging alone does not provide sufficient pressure.
flows, gushes or pools  signs of shock There is no evidence to support the use of elevation of an
extremity, or the use of pressure points to control bleeding. (2015
 capillary oozes ILCOR systematic review)

 identify wound location and type of bleeding

The type of bleeding will dictate
the severity of the injury and the  do not remove penetrating objects
speed with which it needs to be
controlled.  wear gloves before blood contact if possible but don’t delay

 apply direct pressure to wound or to base of penetrating

object

 apply appropriate wound dressings and continue direct

pressure

 monitor dressing and circulation beyond injury

A tourniquets may be used in initial care when direct pressure is

not possible, during a mass casualty situation, or in an unsafe
environment. The first aider should be trained in their use.

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 HOT BURNS

CAUSE DEPTH MANAGEMENT SPECIAL CONSIDERATIONS

 dry heat  Superficial  remove from source of  do not remove burnt on

red, tender, no blisters heat clothing this may
 wet heat further damage tissue
 Partial  cool for at least 20 - 30
 electrical red, tender, blisters minutes  monitor airway can swell
quickly and stop
 Deep  remove constrictions breathing
 Chemical
all layers, appearance
 radiation
varies (eg white,  cover with non-fluffy  rinse with cold water for
charred) dressing mouth burns
 friction
AREA
SEVERITY The palm of the casualty is
considered to be approximately
This is defined as the depth in 1% of their body surface. Its
relation to the area of burn. size can be used as a template
to measure the total body area
The complexity of a burn is burnt.
affected by where it occurs on
the body.

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