FIRST AID

MANUAL
For more information please call
0800 310 2300 or visit our website
at firstresponsetraining.com
Page Topics

3 Introduction

4 Priorities of First Aid

5 Primary Survey: DRABC

6 CPR

7 Cardiac Arrest and AED

8 Unresponsive

9 Spinal Injuriy

10 Fainting

11 Choking

13 Anaphylactic Shock

14 Asthma

15 Hyperventilation

16 Life Threatening Bleeding

17 Wounds & Bleeding

19 Hypovolaemic Shock

20 Head Injuries

21 Eye Injuries

22 Burns

23 Fractures

25 Chest Pain

26 Strokes

27 Poisons

28 Effects of Heat

29 Hypothermia

30 Seizures

32 Sepsis

33 Diabetes

34 Paediatrics

36 Employer’s Responsibilities

37 Index
INTRODUCTION
First Response Training & Consultancy
Services Ltd is an established
organisation specialising in the provision
of professional, friendly training and
education in First Aid, Health & Safety,
and much more.

Commitment & Expertise

We believe that health and safety is more
than just legal compliance and that a
properly trained workforce can add to
productivity and reduce illness and
downtime. We have an exceptional team
of training and support staff that work
closely together with our clients to
ensure that they receive a first class
training experience.

Our Trainers
We have an extensive team of highly
experienced, qualified trainers who are
skilled at delivering informative,
interesting and dynamic training
sessions. As a national provider, our
trainers are based throughout the UK and
are able to deliver in-house courses at
your premises or venue of your choice, ROLE OF A FIRST AIDER
offering total convenience and flexibility. Protect yourself
Assess the scene
Experience Decide who is in danger and who to help
Established in 1997, First Response first
Training now offers over 200 different Warn bystanders of dangers
course types to over 70,000 learners To call the emergency services
annually. We provide first class training Give treatment to those who need it
for health and social care, early years, Use all available equipment
childcare and schools and all industry Prevent cross infection
sectors Record all incidents and actions

This Manual
The purpose of the First Aid Manual is to
provide an authoritative collection of INFECTION PREVENTION
information for delegates on First Aid Remember to wash your hands
courses. It is yours to keep - providing a Wear gloves
reminder of the information taught on the Avoid touching blood or vomit without
course, as well as a reference point for gloves
the future. First aid is the immediate care Dispose of clinical waste safely
or the 'first aid that is given to a casualty Clean the area after the incident
as soon as possible after an illness or
injury has occurred’. Although first aid
has its limitations, it plays an essential
part in the overall care and management
of the sick and injured.

It is important to remember the need for

interaction between Ambulance control,
the first aider or bystander, and the early
deployment of a defibrillator. 3
PRIORITIES OF FIRST AID

Preserve life
Prevent the condition worsening
Promote recovery

In order to manage situations appropriately

and fulfil the aims of first aid, it is important to DANGERS
understand the concept of priorities of Chemical Incidents
treatment. This can be easily remembered by Incidents involving hazardous
'Doctor ABC' or 'D.R.A.B.C.' substances.

Check Danger, then Response, then Airway, Incidents Involving Fire

then Breathing. Maintaining Airway and Fire spreads faster than we appreciate,
Breathing will go a long way to preserving life. but smoke is the main killer. Sound the
alarm, evacuate the building and then call
Once you are satisfied that a casualty has the emergency services.
adequate Airway and Breathing, your priorities
move to treating other injuries and aiming to
prevent their condition from deteriorating.
Clothing On Fire
Aim to safely get the casualty to the
ground. If possible, wrap the casualty in
something non-flammable. Rolling on the
floor will help put the flames out.
Remember AMAGA:
1. Assess what has happened Domestic Electricity
2. Make the area safe Isolate the power supply by switching it
3. Administer emergency first aid off at the mains and disconnecting the
4. Get help 999 or hospital plug from the outlet.
5. Aftermath: handover and report
High Voltage
It is essential that everyone is kept a
minimum distance of 20 metres away until
The priorities of first aid are: it is guaranteed that the electricity
Life threatening bleeding company has isolated the supply.
Breathing
Carbon Monoxide
Bleeding Colourless and odourless, it is quickly
Burns absorbed into the bloodstream. It is
essential that you do not put yourself at
Breaks (fractures)
risk.

MENTAL HEALTH AFTERMATH

After a first aid needs assessment, it is Dealing with an emergency can be an
important to understand if someone might be emotional experience. After handing over
experiencing a mental health issue. the patient and ensuring the scene is
clear, take time to process the
Signs: Low mood, withdrawn, negative
experience. Discuss it with someone,
thoughts, emotional outbursts, anxiety, fear or
perhaps over coffee, or seek formal
panic.
counselling, which your employer may
Ways you can support: Reassure them, do not arrange for you. Don’t bottle up your
force it, offer your time to listen, make sure feelings.
they are safe and not a risk to themselves, if
Bystanders and witnesses may also need
they are at immediate risk to themselves call
support. 4
999.
 PRIMARY SURVEY: DRABC
D - DANGER
Ensure that it is safe to help the casualty. Approach with care and ensure that there is no
continuing danger.

SAFE NOT SAFE

Remove any danger if possible.

R - RESPONSE
Speak loudly and clearly ask a question, such as "Can you hear me?"
Gently tap the casualty's collarbone. An unresponsive casualty will not respond.

NO RESPONSE RESPONSE
LIFE THREATENING
BLEEDING Call for help Ensure Airway and
from bystanders. Breathing are
Take immediate action. Apply maintained. If safe,
pressure to the wound and use do not move the
additional treatments as needed casualty. Check for
(page 16). obvious injuries and
treat as appropriate.

A - AIRWAY
Is the Airway clear and open? The Airway is the route from the mouth and nose down to the
lungs. A casualty who is unresponsive is at risk of their Airway becoming obstructed. This
could be by: the tongue, saliva vomit, food, loose dentures, etc.

CLEAR NOT CLEAR

Head tilt and chin lift or jaw thrust (page 7).

B - BREATHING
Check for normal Breathing: Look for movement of the chest, listen by placing your cheek
near the casualty's mouth, feel for breaths on your cheek. Checking for Breathing should take
no more than 10 seconds. Check for Agonal breathing (irregular, short gasps) which is
common in the first minutes after a cardiac arrest and should not be mistaken for normal
breathing.

NOT BREATHING BREATHING

C - CPR
Call 999 and inform them the casualty is not Breathing. Ask Place in the
bystanders for help unless you are alone. Use speakerphone. recovery position
Begin CPR (page 6). (see page 8).

5
 CPR
Chest Compressions: Kneel by casualty’s side, place heel of
your hand in centre of chest, do not apply pressure to ribs,
bottom of breastbone or abdomen, place heel of your other
hand on top of the other and interlock fingers, straighten your
arms vertically above chest, press down 5-6cm and release,
allow chest to recoil completely, repeat at the rate of 100-120
compressions per minute.

Rescue Breaths: There may be face shields or packet masks in

the first aid kit; use these to reduce cross contamination. Tilt
head and lift chin or jaw thrust (page 7), pinch nostrils and place
your lips around mouth, ensure a good seal, blow steadily for 1
second, repeat at the ratio of 30 compressions to 2 breaths.

Continue until help arrives to take over. If you become

exhausted, ask bystanders to take over. If the casualty begins to
breathe on their own, place them in the recovery position and
monitor Airway and Breathing. Be prepared to resume CPR.

If Airway is not clear: Use only compressions and continue to

check Airway.

CPR IN Infants Children Adult

CHILDREN Under 1 year old 1 year - puberty

Head tilt Minimum tilt Head tilt and chin lift or jaw thrust

Chin lift 1 finger 2 fingers

Compression
Centre of chest
landmark

1 or 2 hands (based
Compression method 2 fingers 2 hands
on size of child)

Compression depth 1/3 depth of chest 5-6 cm

Compression rate 100-120 per minute

Mouth to mouth and

Rescue breaths Mouth to mouth
nose

5 initial breaths with

Initial breath 5 initial breaths None
air from cheeks

Breathing rate Every 1 second

Ratio 30 compressions to 2 breaths

6
HEAD TILT AND CHIN LIFT OR JAW THRUST
Head tilt: Place one hand on the casualty's forehead.
Gently tilt the casualty's head back.

Chin lift: Place the fingertips of the other hand under

the point of the casualty's chin. Lift the chin.

Jaw thrust: If you suspect the casualty has a neck or

spinal injury, avoid extending the neck. Place your
fingers under the jawbone and tilt slightly upwards.

Remember the airway may become obstructed again.

CARDIAC ARREST: CHAIN OF SURVIVAL

Early Early
Early Early
Recognition Advanced
CPR Defibrillation
999 Care

The most common cause of a cardiac arrest is disordered electrical activity in the heart (ventricular
fibrillation). A defibrillator is required to resolve the electrical problem in the heart. CPR keeps the
body oxygenated until a defibrillator arrives. The quicker the casualty moves through the chain of
survival, the better their chances of recovery.

AUTOMATED EXTERNAL DEFIBRILLATOR

AEDs administer an electric shock to correct the
heart rhythm. They can be used on adults and
children over the age of 1. When you call 999, they
will tell you where the nearest AED is. The machine
analyses the heart rhythm and then tells you what to
do. It will not administer a shock to a casualty who is
not in cardiac arrest.

Switch AED on if required, as some will

automatically turn on when opened
Remove pads from packaging
Remove/cut clothing, wipe sweat, shave excess
chest hair from pads location
Remove pads from back paper, place under their
right collarbone and left armpit
Pause CPR as instructed by machine, ensure no
one is touching the casualty
Follow the voice/visual prompts until help arrives,
ensure no one is touching the casualty

The AED may say a shock is advised - ensure

everyone is clear and press the button as prompted.
It may say no shock is advised and ask you to
commence CPR. It will reanalyse every 2 minutes.
You may need to perform CPR between shocks.
7
 UNRESPONSIVE
Use the ACVPU scale to assess the casualty’s level of responsiveness.
ALERT - Are they able to hold a conversation?
CONFUSION - Confused, but awake
VOICE - Do they respond to simple questions/commands (e.g. “move your finger”)?
PAIN - When stimulated with pain, does the casualty respond (e.g. move eyes or fingers)?
UNRESPONSIVE - Casualty is unresponsive

RECOVERY POSITION
This helps a casualty maintain an open Airway. There is a modified
recovery position for spinal injuries (see page 9).
1. Ensure they have an open Airway
2. Remove glasses/bulky items from pockets
3. Kneel by their left side (if possible), place arm nearest to you at a right
angle from the body - never force arm to lie flat
4. Bring arm farthest from you across the chest, hold back of hand
against their cheek
5. Grasp leg furthest from you just above the knee with your other hand
and pull into a bent position
6. Pull leg, their body will turn
7. Adjust leg so hip and knee are at right angles
8. Tilt head back gently, ensure hand is placed under their cheek
9. Ensure ambulance has been called, observe the casualty, check
breathing regularly, consider recording observations

SECONDARY SURVEY
The secondary survey is a rapid but thorough head-to-toe examination assessment to identify all
potentially significant injuries. It should be performed after the primary survey. You may not have
time to complete a secondary survey before advanced help arrives. Remember SAMPLE:
SIGNS & SYMPTOMS - Look, listen, feel. Do they have any signs of swelling/deformity/ bleeding?
Ask the casualty simple questions about how they are feeling. Do you have pain? Where is the
pain? Is the pain getting worse?
ALLERGY - Does the casualty have any allergies to medication or anything else?
MEDICATION - Do they take any regular medication (e.g. asthma inhalers) or have they recently
been prescribed something new?
PREVIOUS MEDICAL HISTORY - Do they have any previous medical conditions? Are they wearing
a medical alert tag or bracelet?
LAST MEAL - When did they last eat or drink?
EVENT HISTORY - What and where? Was the incident due to an accident or illness? Can any
witnesses help with clues as to what happened?
VITAL SIGNS HEAD TO TOE EXAMINATION
Body temperature Head and face
Pulse rate Neck
Respiration rate Chest - Equal rise and fall
Blood pressure Abdomen - Rigid or soft (gently press
Glasgow coma scale Extremeties - Difference in arms, shoulders or legs
Pelvis - Gently press (if you suspect a pelvic injury, do not press)
Skin - Needle marks
There should be an indication that an injury has occurred to justify the secondary survey before you
touch a casualty’s body. You should maintain dignity and avoid exposing their skin unless
necessary. You can also carry out a secondary survey of a responsive casualty with their consent.
Always wear protective gloves when examining the head, face and neck. 8
 SPINAL INJURY

SIGNS
Pain or tenderness in the neck or back - Loss of sensation or feeling in the limbs
sometimes the pain may be masked by Inability to move arms or legs (paralysis)
pain from other injuries Casualties feel they “have been cut in half”
Signs of a fracture Loss of bladder/bowel control
Abnormal sensations in the limbs, e.g. Unnatural posture or shape of the spine.
burning, tingling, pins and needles Shock
Limbs may feel heavy and stiff Breathing difficulties

TREATMENT IF RESPONSIVE
Leave the casualty in the position you found them,
even if it looks uncomfortable
Do NOT move them unless in EXTREME danger
Call an ambulance
Advise them to keep still
Offer plenty of reassurance
Support their head with your hands and aim to
maintain the head, neck and spine in a straight line
(neutral alignment)
Maintain this position until medical assistance arrives
Keep the casualty warm

TREATMENT IF UNRESPONSIVE
Call an ambulance
Leave them in the position you found them
Where possible, support their head with your hands, aiming to maintain their head, neck and
spine in a straight line, until medical assistance arrives

If the casualty's Airway or Breathing is affected, use the jaw thrust technique to clear the Airway
(page 7). If you cannot maintain an open Airway, place them in the recovery position. The following
methods can be used if assistance is available:

SPINAL RECOVERY POSITION SPINAL LOG ROLL

If no assistance is available and the Airway is at risk then the casualty must be placed in the
recovery position in the normal manner. Use padding such as clothing to support the casualty's
head when they are on their side. 9
CAUSES OF
UNRESPONSIVENESS FAINTING
Remember: A faint is a brief loss of responsiveness, resulting from a temporary
“Fish Shaped” reduction in the flow of blood to the brain. This usually only lasts a
few seconds and is followed by a full recovery.
Fainting

CAUSES
Infantile Pain
convulsions Standing for a long time, particularly in a warm environment
Imbalance of heat Standing quickly from a seated or lying position
(page 28, 34) Exhaustion
Fear - this may include phobias
Emotional events and stress
Shock: Lack of food
hypovolaemic Pressure on the neck, such as a tight collar
shock due to life Internal bleeding
threatening
bleeding (page 19)

SIGNS
Head injury (page Brief loss of responsiveness Before faint:
20) Possible fall Nausea
Slow pulse Blurred vision and dizziness
Pale, cold clammy skin with Ringing in ears
Stroke (page 26)
signs of sweating Stomach pains
If they feel faint, suggest that they lie down.
Heart attack (page
25)
TREATMENT
Asphyxia (choking) Maintain Airway and Breathing
(page 11) Raise the legs in the air to return the blood to the vital organs
Allow them plenty of fresh air by opening windows and doors
Remove any bystanders and the cause of the faint, if possible
Poisons (page 27) Reassure the casualty as they recover
Ensure they have not sustained any injuries
Gradually sit them up after they have regained responsiveness
Epilepsy (seizures) If they feel faint, lie them back down
(page 30) If the casualty does not regain responsiveness quickly proceed
with the treatment of an unresponsive casualty
If you have any suspicion that it is not a faint, or you are unsure
Diabetes (page 33) of the cause, then summon medical assistance

10
 CHOKING

1. ASSESS THE SEVERITY

Ask “Are you choking?”

THEY CAN NOT ANSWER THEY CAN ANSWER

Encourage to keep coughing and monitor

for deterioration.

2. ARE THEY RESPONSIVE?

Assess using the ACVPU Scale (page 8).

RESPONSE NO RESPONSE

Follow primary survey (page 5).

3. BACK BLOWS
Deliver back blows (page 12).

OBSTRUCTION CLEARED NOT CLEARED

No further treatment required, monitor for

deterioration.

4. ABDOMINAL THRUSTS
Deliver abdominal thrusts (page 12).

OBSTRUCTION CLEARED NOT CLEARED

No further treatment required. Monitor for

deterioration. Be aware abdominal thrusts
can damage the diaphragm.

5. GET HELP
Repeat steps 3 and 4 up to 3 times. If the obstruction is still not cleared, call an ambulance.
Continue to repeat steps 3 and 4 until help arrives.

If the casualty becomes unresponsive at any time, immediately call an ambulance and begin CPR.

11
BACK BLOWS

Deliver back blows:

Support the chest

Lean casualty forward

Give up to 5 sharp blows

between the shoulder blades
with the heel of your hand,
whilst pushing in an upward
motion

Check to see if each back blow

has relieved the Airway
obstruction

ABDOMINAL THRUSTS

Deliver abdominal thrusts:

Stand behind the casualty

Put both arms around their

waist

Make a fist and place it over the

abdomen, between the navel
and the bottom of the
breastbone, with knuckles
facing the ceiling

Grasp your fist with your other

hand

Thrust sharply inwards and

upwards taking care not to
damage the end of the
breastbone

Repeat up to 5 times

Check to see if each abdominal

thrust has relieved the Airway
obstruction
12
ANAPHYLACTIC SHOCK

Allergies are sensitivities to specific

substances, which may be swallowed, inhaled,
injected or contracted through the skin. The
effects of allergies are generally mild. However,
anaphylaxis (severe allergic reaction) can result
in rapid and serious reactions of various parts
of the body. This may rapidly prove fatal
unless recognised and treated promptly.

Examples of allergens include:

Bee stings
Various foods, such as fish and peanuts
Medications, such as penicillin
Pollens

SIGNS
Difficulty Breathing, wheezing sounds, A hoarse voice, swelling of tongue and
tightness in the chest throat
Anxiety, fear of impending doom Dizziness, faintness
Confusion, slurring of speech Nausea, vomiting
Abdominal pain, stomach cramps, Increased pulse rate
diarrhoea Itchy skin with red blotchy eruptions, like a
Swelling of the skin, particularly eyelids, rash
lips, neck Deterioration in their level of
Cyanosis responsiveness

TREATMENT
Maintain Airway and Breathing Auto-injectors:
Call an ambulance and tell them you A casualty who has suffered previously
suspect anaphylactic shock from anaphylaxis should carry 2 auto-
Assist the casualty into the most injectors
comfortable position to aid Breathing These contain adrenaline to counteract the
Be prepared for deterioration in the effects of anaphylaxis
casualty's condition and respond to these Assist in locating and preparing the drug
changes for the casualty to administer themselves

13
 ASTHMA

Asthma is a condition that affects the airways of the lungs. An

asthma attack is when these air passages go into spasm
resulting in them narrowing.

There are certain recognised triggers that may cause this spasm
and lead to an attack:
Exposure to known allergies e.g. dust, pollen, pets
Viral infections
Exposure to irritants, e.g. perfumes or smoke
Certain drugs e.g. aspirin
Exercise
Emotional upset or stress

When an asthma attack occurs:

1. The Airway lining starts to swell
2. Mucus is secreted
3. The muscles surrounding the Airway tighten

This causes leads to narrowing of the air passages, making it

difficult to breathe. The casualty needs their medication to
relieve the symptoms.

SIGNS OF AN ASTHMA ATTACK

Shortness of breath, difficulty Breathing
Feeling of a tight chest
Wheezing sound from the chest
Difficulty speaking
Use of muscles other than those normally we used during
Breathing (e.g. neck and upper chest)
Pale, cold, clammy skin
Increased pulse rate.
Anxiety, distress, panic
In severe cases: silent chest, cyanosis, exhaustion, collapse,
Breathing may stop

TREATMENT
Maintain Airway and Breathing
Reassure the casualty
Encourage to sit comfortably, preferably upright, leaning
forwards, possibly leaning on a table or chair
Encourage to relax, breathe slowly and deeply
Encourage to use inhaler every 2 minutes, 1 or 2 puffs, for
up to 10 puffs
If the inhaler has no effect after 15 minutes, or the attack is
severe, call an ambulance
After 15 minutes, if there is no change and no ambulance
has arrived, administer another round of treatment
If unresponsive, see pages 5 and 8

14
 HYPERVENTILATION

Hyperventilation is usually a response that individuals have to certain situations. For example:
during panic and anxiety attacks, following a sudden fright, or following an emotional experience.

SIGNS
Unnaturally deep/ rapid Breathing
The patient may feel that they are unable to breathe
Feeling the pressure or tightness in the chest
Anxiety and possibly attention seeking behaviour
Dizziness, faintness and possibly blurred vision
Flushed skin
Pins and needles and sometimes trembling, usually in the hands
Increased pulse rate

TREATMENT
Your main aim is to restore a normal breathing pattern:
Speak calmly but firmly to the casualty and offer reassurance
Establish a quiet environment for the casualty
Encourage the casualty to slow the rate of their Breathing
Advise the casualty to speak to their General Practitioner for advice on ways to prevent and
control panic attacks in the future

15
LIFE THREATENING BLEEDING
 enerally, life threatening bleeding is sufficient blood loss to result in a rapid collapse,
G
unconsciousness and death, if left untreated. Immediate action is required. If in doubt, it is better to
manage aggressively to save a life. Life threatening bleeding is part of the primary survey (page 5).

TYPES OF BLEEDING INTERNAL BLEEDING

Capillary: Comes from capillaries (small blood The casualty will look very unwell with no sign
vessels), sometimes described as a trickle of external life threatening bleeding. Examples:
Venous: Comes from veins, blood pools, looks Chest: Stab wound or significant blunt trauma
darker in colour leading to bleeding in and around the lungs -
Arterial: Comes from arteries, blood spurts or manage as a chest injury (page 18)
gushes, looks bright red Abdomen: Stab wound or significant blunt
trauma damaging the liver or spleen
Pelvis: Fall from height or road traffic collision

EQUIPMENT
When direct pressure (see page 17) isn't effective in stopping the blood flow further techniques and
equipment will need to be used.

HAEMOSTATIC DRESSINGS
Dressing that contains an agent to promote blood clotting
Always inform the emergency services which haemostatics
have been used
The point of bleeding must be in contact with the gauze -
pack it into the wound, not on top or around it
Do not blindly pack into the wound - first locate the bottom
of the wound

WOUND PACKING TOURNIQUET

Packing dressing into a wound can promote A tight band used on limbs
clotting and control bleeding Place 2-3cm above the wound edge between
Dressing must be tightly packed to apply the location of the heart and the wound
pressure down to the bottom of the wound Be aware application is extremely painful for
Do not blindly pack into the wound - first the casualty
locate the bottom of the wound Avoid applying over a joint if possible
Use dressings, gauze, bandages or Application:
haemostatic gauze Use hook and look system to tightly apply
Beware of sharp foreign bodies or bone around the limb
fragments within the wound Secure in place
Application: Tighten until bleeding stops
Scoop out clotted blood and soak up Reassess and repeat until bleeding stops -
pooled blood you may need to apply an additional
Insert appropriate dressing and wound tourniquet above the original
packing materials Record time applied
Apply firm pressure and add additional You can improvise a tourniquet using a
materials triangular bandage or belt if necessary
Repeat until the wound is fully packed to Do not remove the tourniquet
above skin level
Apply pressure dressing to wound
Maintain firm pressure until bleeding stops
If bleeding does not stop, consider a
tourniquet 16
 WOUNDS AND BLEEDING
Wounds and bleeding can look dramatic, this should not however distract from checking the Airway
and Breathing. Always conduct the primary survey first (see page 5). Remember to wear gloves!

TYPES OF WOUNDS

Incision Laceration Abrasion Contusion Puncture Gunshot

Clean cut by Rip or tear to Top layers of Bleeding Stab wounds, Entry and
sharp object skin skin scraped under skin - dog bites, etc larger exit
off - graze bruise wound

MINOR WOUNDS EXTERNAL BLEEDING

E.g. abrasions and minor incisions. Remembered SIP:
If dirty, rinse under running water, pat the S - Sit or Lie Down: Sit or lie the casualty
dry using a gauze swab down, aim to lie the casualty down, even if this
Check for particles, such as grit cannot be done immediately, once the
Clean around wound with soap and water bleeding is controlled, raise their legs to treat
using gauze swabs shock
Use clean swab for every stroke, working I - Inspect: Expose the wound and see if there
from the centre outwards are any objects embedded in the wound
Apply non-stick dressing or a light, dry P - Pressure: Apply pressure directly over the
dressing for grazes and an adhesive wound
dressing for cuts
Seek medical aid if:
The bleeding will not stop
NO PROTRUDING OBJECT
There are particles remaining in the wound
The casualty has not had a tetanus Maintain Airway and Breathing
injection in the last 10 years Use a dressing large enough to cover the
wound
Apply dressing to put pressure directly
Don’t waste time looking for dressings if a over the wound
casualty is bleeding: ask them to use their Apply firmly enough to maintain pressure
own hand, use a non-fluffy clean pad, or but not too tight that it impairs circulation
wear gloves and use your hand. Check the colour and temperature of the
limb beyond the wound, if it is cold or blue
the bandage is too tight
PROTRUDING OBJECT Press the nail beds, if they do not regain
Maintain Airway and Breathing colour immediately the dressing is too tight
Build up padding using sterile dressings When applied correctly a dressing will stop
around the protruding object bleeding from most wounds
Apply pressure on either side of the object If bleeding comes through, remove the
and support it in position dressing and reapply a new dressing,
Maintain the pressure to control bleeding ensuring that pressure is applied at the
If necessary bandage the padding in place, point of bleeding
ensuring that the pressure is applied on Support the limb in a raised position
either side of the object and not directly Treat for shock
onto it Arrange for medical assistance
Support in a raised position Constantly monitor and record your
Arrange for medical assistance observations
Constantly monitor and record your
observations
Never remove the object 17
CONTUSION (BRUISE) PENETRATING CHEST INJURY
Use a cold compress, this can be made by There may be:
wrapping ice in a cloth (take care not to let A history of the incident
ice touch the skin) An object still embedded or protruding
Apply cold compress for at least 5 minutes A wound or fracture in the chest area
Be aware a bruise may be a sign of internal Increased pain when breathing or coughing
bleeding
Signs of shock
NOSEBLEEDS Bright red
Nosebleeds can be caused by trauma to the Frothy blood coughed up
nose, sneezing/, high blood pressure, Sounds of air being sucked in through the
fractured skull (if blood is watery), etc. wound as the casualty breathes in
Sit the casualty down and tilt their head If the wound is obviously bleeding, control
forwards bleeding with direct pressure using the
Ask them to pinch the soft part of the nose casualty's hand or your hand (with gloves on).
Instruct them to breathe through their Apply a dressing if necessary.
mouth and not to speak, cough or sniff
Release every 10 minutes to see if the Call an ambulance. Maintain, monitor and
bleeding has stopped record vital signs: Airway and Breathing.
If the bleeding persists for more than 30 Treat any other injuries. If the casualty
minutes arrange for the casualty to receive becomes or is unresponsive place in the
medical attention recovery position on the injured side so that
Do not tilt the head back. The blood will run to the healthy lung can work effectively.
the back of the throat and may cause the
casualty to vomit AMPUTATION
When a limb is either partially or completely
INTERNAL BLEEDING severed:
Internal bleeding is a serious condition, Maintain Airway and Breathing
especially as it can go unnoticed for several Control bleeding with a dressing
hours. It requires urgent medical attention. Call an ambulance
It is difficult to diagnose, as the bleeding is not Treat any other injuries and shock
always evident. Internal bleeding can occur as Wrap severed limb in a plastic bag then
a result of an injury, a stomach ulcer, a rupture wrap in a soft material, e.g. towel
(e.g. appendix), an ectopic pregnancy, etc. Place in a container full of ice or packaged
frozen foods - the severed body part must
Signs of internal bleeding: not touch ice or frozen food directly
Trauma to the body Label the container with the name of the
Recent illness, e.g. an ulcer casualty and the time the injury occurred
Previous internal bleeding
Shock CRUSH INJURIES
Pain or discomfort When a casualty is trapped by a compressing
Bruising force, restricting blood flow and building up
Bleeding from body orifices toxins.
Fainting
Crushed for less than 15 minutes:
Treatment Release the casualty quickly
Arrange for urgent medical assistance Ensure safety
Maintain Airway and Breathing Maintain Airway and Breathing
Treat any other injuries Call an ambulance
Treat for shock Treat any injuries and shock
Monitor and record observations Monitor and record your observations
SPLINTERS Crushed for more than 15 minutes:
Clean area around splinter with soap and DO NOT RELEASE THE CASUALTY
water Ensure safety
Remove splinter if possible Maintain Airway and Breathing
Make the wound bleed after removing Call an ambulance
splinter Give clear details of the incident as rescue
Clean and cover services will need to be arranged
If splinter is below skin, do not attempt to Treat any obvious, accessible injuries
remove - seek medical advice/assistance Monitor and record your observations 18
HYPOVOLAEMIC SHOCK
Hypo'-low, Vol'-volume, 'Aemic-blood
Hypovolaemia refers to a loss of body fluids, resulting in the tissues not being provided with an
adequate supply of oxygen. Therefore, this condition is known as hypovolaemic shock. This type of
shock is one of the most common.

Typical causes of hypovolaemic shock include:

Internal bleeding
External bleeding
Excessive sweating
Burns and scalds
Severe diarrhoea and vomiting

SIGNS
Signs and symptoms of hypovolameic shock vary
as the condition deteriorates.

Initial response:
An increase in the pulse rate
Pale, cold and clammy skin
Sweating
As the condition deteriorates:
Pulse becomes weaker and faster
Cyanosis, particularly inside the lips
If the fingernails are pressed they do not
regain colour immediately
Breathing rate increases and becomes shallow
Nausea, vomiting
Weakness, dizziness
Yawning, gasping for air
Restlessness, anxiety, confusion, aggression
Unresponsiveness
Cardiac arrest

Do: Do NOT:
Maintain Airway and Breathing Do not use hot water bottles
Treat any obvious cause of the shock, such as severe or any form of direct heat
bleeding or burns Do not allow the casualty to
Call an ambulance eat or drink -if the casualty
Treat any other injuries complains of a dry mouth and
If the condition allows, lie the casualty down and raise thirst, moisten their lips with a
their legs - this will return blood to the vital organs, but little water
may not be possible if there are other injuries such as Do not allow the casualty to
leg fractures, or injuries to the chest, where Breathing smoke
will be made worse if the casualty is lying on their back Do not allow the casualty to
Maintain a normal temperature move unnecessarily
Lie the casualty on something that will insulate them Do not leave the casualty,
from the cold ground -clothing or blankets may be except to call for an
useful ambulance
Loosen constricting clothing
Continually give reassurance
Monitor and record your observations
Prepared for deterioration in the casualty's condition
and respond to changes accordingly 19
 HEAD INJURIES

COMPRESSION CONCUSSION

Bleeding within the skull, swollen brain tissue A shaking of the brain within its surrounding
or tumours can cause build-up of pressure on fluid causes concussion. This shaking disturbs
the brain, known as compression. the normal activity and functions of the brain.

SIGNS SIGNS
Deterioration in the level of Brief or partial loss of responsiveness
responsiveness, either immediately or followed by a gradual improvement
over hours or days Often blow to the head or injury
Often blow to the head or injury Short-term memory loss
Drowsiness Confusion
Irritability Unsteady on feet
May complain of an intense headache Blurred vision
Flushed, dry skin May complain of a mild headache
Slow, deep, noisy breathing Pale and clammy skin
Slow and strong pulse Rapid and weak pulse
One or both pupils may dilate Nausea and vomiting
Possible seizures
Weakness or paralysis on one side of the
face or body

TREATMENT
Maintain Airway and Breathing
Always suspect a possible spinal injury
Call an ambulance
Control bleeding, and be aware of
discharges from the ear
Treat any other obvious injury
Monitor the casualty 20
 EYE INJURIES

Eye injuries can be particularly distressing to the casualty mainly through fear of permanent damage
and loss of sight. Injuries to the eye should receive expert medical attention.

CHEMICAL BURNS EMBEDDED OBJECT

These can be caused by splashes from Minor particles in the eye, such as a speck of
chemicals and can lead to permanent damage dust or a loose eyelash, can usually be rinsed
unless treated quickly and effectively: off with clean water. However, larger objects or
Lean the casualty to the side affected by anything embedded should be left and referred
the burn for medical attention.
Run cold water over the casualty's affected Make sure the casualty is comfortable,
eye for at least 10 minutes either sit or lie them down
Use a clean glass or jug to pour the water Lightly apply a sterile dressing, usually an
if this is easier eye pad
In workplaces that use chemicals, there A dressing can be applied to both eyes if it
should be 'eyewash stations' where sterile is necessary to prevent eye movement
water should be available for use Offer plenty of reassurance and guidance
Ensure that the water runs away from the to the casualty
face to prevent the other eye becoming Call an ambulance if you consider the
contaminated injury to be serious
Make sure that you do not come into direct Do not attempt to remove an embedded
contact with the chemical or the water object
running from the eye
Loosely cover the affected eye with a
sterile dressing
Arrange medical attention
Do NOT touch or allow the casualty to
touch or rub the eye 21
BURNS
Burns can be caused by electricity, chemicals, dry heat, wet heat, radiation and cold (frostbite).

CLASSIFICATION
Superficial, 1st degree:
Outer layer of the skin (epidermis) is damaged
Skin is red, slightly swollen and painful
No blisters
Partial thickness, 2nd degree:
Epidermis and the layer beneath (dermis) are damaged
Skin is blotchy and will become swollen and blistered
Can be very painful or painless
Full thickness, 3rd degree:
Epidermis, dermis and the deeper layer of fat and tissue (subcutis) are damaged
Skin can be burned away or dry, white, brown or black with no blisters
It may be painless

GENERAL TREATMENT
Do: Do NOT:
Maintain Airway and Breathing Do not remove anything that is sticking to
Prioritise and treat any other serious the wound, such as clothing
injuries, such as bleeding Do not touch the area
Cool the burn area with cold, preferably Do not burst blisters
running water, for 20 minutes to stop the Do not apply creams or lotions
burning and provide pain relief Do not use adhesive tape directly on the
The time may be extended if further pain skin
relief is required, but ensure that the Do not use cling film until the area of the
casualty is not overcooled burn has been cooled
Arrange for medical assistance
Carefully remove anything constricting, Burns should receive hospital treatment if:
such as jewellery, rings or watches before The burn affects the face, neck, hands,
swelling occurs feet or genital area
Once the burn is cooled, cover it to prevent The burn extends all around a limb
infection It is a full-thickness burn
Use either a sterile dressing, a clean sheet A partial-thickness burn covers more 1%
of cling film, or a clean plastic bag to cover of the body surface (equal to size of palm
a hand or foot of casualty’s hand)
Reassure the casualty and make them A superficial burn covers more than 5% of
comfortable the body surface
Constantly monitor and record your A burn involves varying depths
observations Seek medical advice if you are unsure.

CHEMICAL BURNS
Ensure that the area is safe and that you are protected from contact with the chemical
If indoors, ventilate the area affected by the substance only if it is safe to do so
Flood the burn area for at least 20 minutes, preferably with running water
Ensure that the water runs away from the area and does not come into contact with you or the
casualty
Remove contaminated clothing while flooding the area, making sure your skin does not come
into direct contact with the chemical
Obtain information regarding the chemical such as COSHH data sheets, to pass on to the
emergency services 22
FRACTURES SIGNS
Pain and tenderness at the site of the injury
which is made worse with movement
Difficulty or inability to move the affected
CAUSES area
A fracture is a break or a crack in a bone. Swelling and bruising
There are five main ways in which a fracture Crepitus: grating of ends of bones against
can be caused: each other which can be heard or felt
Direct force - The fracture results from a Abnormal lumps under the skin where
force being directly applied to a bone, such bones overlap
as a kick, or being struck by a car Limb appears bent or has an abnormal
Indirect force - A fracture occurs away shape
from the point where the force was Limb twisting, shortening or appearing in
applied, such as a fractured collarbone the wrong place
resulting from a fall where the casualty has Shock
put their hand out and the force is applied A wound which may have a bone
at the hand, and then transmitted through protruding
the arm to the collarbone
Pathological - The elderly or those with RIB FRACTURES
diseases of the bone are more vulnerable A history of trauma to the chest
to sustaining fractures Pain at the site of the fracture.
Twisting Increased pain when Breathing or
Violent movement coughing
Shallow Breathing
'Guarding' or protecting the area from
being touched
TYPES Pale, cold and clammy

TREATMENT
Maintain Airway and Breathing
Control any bleeding
Reassure the casualty and aim to keep
them as still as possible
Steady and support a fracture to prevent
movement using your hands, a pillow,
blankets, etc - be guided by what the
casualty finds comfortable and provides
Greenstick fractures occur in children. relief of pain
Do NOT move the casualty unless they are
A fracture is described as 'open' when a in danger
broken end of bone has pierced the skin or if Do NOT allow the casualty to eat or drink
there is a wound near the point where the
fracture has occurred. Where the wound has RIB FRACTURES
been caused by the bone, it may, or may not, Maintain Airway and Breathing
still be protruding from the wound. As this type Assist the casualty to find the most
of fracture has a wound site the risk of comfortable position: this will usually be in
infection is high. a half-sitting position
Place the arm on the injured side in an arm
A closed fracture is where a bone is broken sling if further support is required
but the skin remains intact. These can be Treat any other injuries
difficult to spot.

Both open and closed fractures can create

further complications by damaging blood
vessels, nerves or underlying organs.

Complicated fractures involve vessels, nerves

or internal organs. 23
DISLOCATIONS
A dislocation occurs when a bone becomes
dislodged from its original location at a joint.

SIGNS
Swelling, bruising and obvious abnormality at
the joint affected - compare the opposite
joint
Severe pain that makes the casualty feel
nauseous
Tenderness
Difficulty and increased pain in moving the
area
Bending or twisting at the joint

TREATMENT
Dislocations should be dealt with in a similar way
to fractures:
DO NOT attempt to put back in place
Advise the casualty to remain still
Steady and support the injured part using
your hands, pillows, blankets, etc. - be
guided by what the casualty finds
comfortable and provides relief of pain
Apply bandages only if further support is
required

If in doubt, treat it as a fracture.

SPRAINS AND STRAINS

SPRAINS
Sprains involve injury to a ligament at, or near a
joint due to it being wrenched or torn. A common
injury is a sprained ankle, which results from a
wrenching motion, pulling bones too far apart at
a joint, and so tearing a ligament.

STRAINS
A strain involves injury of a muscle or tendon
resulting from being overstretched or torn by a
violent or sudden movement.

TREATMENT
Remember RICE:
Rest
Ice (or a cold compression) for max. 20 minutes
Comfortable support
Elevate

24
 CHEST PAIN

Generally, a person who suffers from angina knows what brings on the pain and how to deal with it.
If an angina sufferer asks for help - it probably is not angina.

Angina Heart Attack

Partial or total blockage of a coronary

Cause Narrowing of a coronary artery artery by a blood clot

Permanent damage occurs, unless the

Damage to Does not usually result in permanent blockage can be removed quickly by
heart muscle damage
appropriate medication

Usually during exercise or excitement

Onset of pain Stress and cold weather can also Sudden, can occur at any time
cause angina to start

Squashing pain, often described as "like a vice tightening around the chest" or
Type of pain "a heavy load on the chest", the pain can vary in intensity and can occasionally
be mistaken for indigestion

Location of Centre of the chest, may radiate into the arms (usually the left), the neck, jaw
pain and back

Clutching of chest
Clutching of chest Rapid and weak pulse, which may be
Rapid and weak pulse, which may be irregular
irregular Shortness of breath
Other signs
and symptoms Shortness of breath Nausea and vomiting
Anxiety A fear that they may be dying
Weakness Pale, grey colour
Pale and may be sweating Profuse sweating
Collapse without warning

TREATMENT
Heart attack: Angina:
Reassure the casualty Reassure the casualty
Maintain Airway and Breathing Assist to sit on a chair
Call an ambulance Suggest they take their
Assist the casualty into the most comfortable medication
position for them, a half-sitting position with the
shoulders well supported may be beneficial for The attack should ease in a few
suspected heart attacks minutes. If the pain does not ease:
Loosen any constricting clothing to ease Breathing Call an ambulance
Constantly monitor and record your observations Monitor
Be prepared for deterioration in the casualty's
condition and respond to these changes accordingly
If possible assist the casualty to take 300mg of
aspirin and advise them to chew it, not swallow,
ensuring that the casualty is not allergic to Aspirin 25
 STROKES

A stroke is when the supply of blood to the brain is either blocked or interrupted. It usually occurs
as a result of a clot or a ruptured blood vessel. Many of the signs and symptoms of a stroke are a
direct result of the brain's inability to function normally due to a lack of oxygen. These will vary
according to the area of the brain affected.

FAST
The FAST test assesses three specific symptoms of stroke.

Facial weakness: Can the person smile? Has their mouth or eye
drooped?
Arm weakness: Can the person raise both arms, and keep them
raised for a few seconds?
Speech problems: Can the person speak clearly and understand
what you say?
Time to call an ambulance

If the person has failed any one of these tests, you must call an
ambulance

We acknowledge the Stroke Association for allowing us to

include the FAST test. You can obtain further information on
their website www.stroke.org.uk

Other signs and symptoms may include:

Difficulty swallowing
Difficulty maintaining balance
Headache
Dizziness
Slow, strong pulse
Slow, deep, noisy Breathing
Unequal pupil size
Warm, flushed, dry skin
Vomiting
Loss of bowel and/or bladder control
Change in behaviour: confusion, agitation
or aggression
Crying
Gradual or sudden loss of responsiveness
Possible convulsion

TREATMENT
Check Airway and Breathing
Call an ambulance
Place an unresponsive casualty in the recovery position
Lay the responsive casualty down with the head and shoulders raised slightly
Reassure the casualty
Monitor
26
 POISONS
How poisons can enter the body:

Instilled or Splashed
Poison enters through the eye. Inhalation
Poison is inhaled when
Ingestion Breathing in and passes
Poison enters through the through the respiratory tract to
mouth (swallowing). This can the lungs and then to the
be accidental (contaminated bloodstream.
food) or intentional (overdose).
Absorption
Injection Poison makes contact with
Poison is injected into the skin skin and is absorbed into the
or blood vessels. This may be bloodstream.
by a needle, bite or sting.

CLASSIFICATION SIGNS
Corrosive Poisons Signs and symptoms depend on the type of poison, route of
These are usually poisons entry, amount of poison, etc. Determining what has happened
that burn. They destroy the will help you deliver effective treatment. Pass any information on
tissues that they come into to the emergency services. Look for clues:
contact with. Examples Smells in the air, odour on the breath
include bleach, paint Cyanosis
stripper, petrol, etc. Difficulty breathing or speaking
Burning pain the mouth or throat
Non-Corrosive Poisons Information from bystanders
Nearby tablets, medicine bottles, syringes, etc.
These are usually poisons
General signs and symptoms include retching, nausea, vomiting,
that do not burn. Examples
diarrhoea, abdominal pains, hallucinations, drowsiness,
include tablets, alcohol,
unresponsiveness, and possible seizures. Lowering levels of
food, poisonous plants, etc.
responsiveness may lead to headaches blurred vision and
confusion.

TREATMENT
Do not attempt to induce vomiting. Non-corrosive substances:
Maintain Airway and Breathing
Corrosive substances: Identify the substance
Ensure your own safety If CPR is required use a protective face
Identify the substance mask
Maintain Airway and Breathing Call an ambulance
If CPR is required use a protective face Monitor and record your observations
mask
If the substance is on the skin, treat it as a Useful information for the emergency
chemical burn (page 22) services:
If the substance has been swallowed,
Information about the substance, e.g.
instruct the casualty to rinse out their
containers or information sheets
mouth and they may take frequent sips of
The time that the substance was taken or
water or milk
the casualty was affected by the substance
Call an ambulance
How much was taken
Monitor and record your observations
How the poison entered the body 27
 EFFECTS OF HEAT

HEAT EXHAUSTION
Heat exhaustion results from the loss of salt
and water from the body, due to excessive
sweating.

SIGNS
Pale, cold, clammy skin
Sweating
Loss of appetite, nausea, vomiting
Thirst
Inability to produce urine
Muscular cramps, particularly in the limbs
and abdomen
Increased Breathing rate
Rapid, weak pulse
Faintness, dizziness
Lethargy, exhaustion

TREATMENT
If possible, move the casualty to a cool
place e.g. shade, ventilated building
Lie them down
Ask them to remove any excessive
clothing, maintain dignity
Give plenty of water, add rehydration salts
if possible
Arrange for medical advice, even if they
recover quickly
Call for an ambulance if their condition
deteriorates

HEAT STROKE
If heat exhaustion is not treated rapidly it may TREATMENT
lead to heat stroke, where the body is unable Take immediate action
to regulate its temperature. Call an ambulance
Maintain Airway and Breathing
CAUSES If possible, move the casualty to a cool
Prolonged exposure to heat or extreme hot place
weather Remove any excessive clothing, maintain
Untreated dignity
High fever Cool them down - sponge them down with
Use of certain drugs, such as ecstasy cold water or wrap them in a damp sheet
Be prepared for deterioration and respond
SIGNS accordingly
Flushed, hot, dry skin Once a normal temperature has been
Not sweating achieved, attempt to maintain it
Strong pulse Do not use excessive continued cooling to
Nausea, vomiting the extent they become hypothermic
Headache, dizziness
Confusion, restlessness
Rapid deterioration in responsiveness
Possible seizures
Body temperature above 40°C 28
 HYPOTHERMIA

Hypothermia: low core body temperature.

CAUSES
Wet clothing, following immersion in water
or prolonged exposure to the rain
Inadequate clothing, particularly outdoors,
with prolonged exposure to cold air
Poorly heated houses

SIGNS
Pale skin, which is cold to touch
Shivering initially
Muscles appear stiff, rigid
Slow, shallow respirations
Slow, weak pulse, may be difficult to
detect
Speech becoming slow, slurred
Confusion, disorientation
Lowering level of responsiveness
Pupils may not react
May have a death-like appearance
In severe cases, they may suffer a cardiac
arrest

TREATMENT
If the casualty is responsive and indoors:
Replace damp and wet clothing with something dry and warm
Pay particular attention to covering the head
Wrap the casualty in warm blankets
Give them warm drinks and food
Arrange medical assistance

If the casualty is responsive and outdoors:

Move to shelter if possible

If this is not possible:

Protect them from the ground and environment - use newspaper, blankets, clothing, etc
Provide shelter from wind and rain - improvise with what you have at the time
Share your body heat with them by keeping close
Give them warm drinks and food if possible
Arrange medical assistance
29
 SEIZURES
Epilepsy is the most common cause of seizures is not the only cause. Other causes include:
Shortage of oxygen to the brain Infections Rise in body temperature
Shortage of glucose to the brain Infantile convulsions Certain poisons, including alcohol
Strokes and brain tumours Head injury On rare occasions, pregnancy
Never assume epilepsy is the cause. Medic alert bracelets and necklaces may be carried giving an
indication that the casualty suffers from epilepsy.

MAJOR SEIZURES

SIGNS 1. AURA
This type of seizure causes This is a feeling that the casualty often has just before
involuntary contractions of muscles, the seizure. Those who have had seizures previously
sometimes leading to aggressive recognise this as a warning that a seizure is likely to
shaking of the body. It is sudden and start. The signs may include a certain smell, taste in the
dramatic and can be very frightening mouth or a strange feeling that they usually have.
to witness. In the majority of cases Occasionally this warning allows them time to call for
the following sequence is followed: help and lie down before they fall.

2. TONIC STAGE 3. CLONIC STAGE 4. RECOVERY

Rigidity of the body Convulsive muscle spasms Muscles relax
Sudden Violent jerking movements Breathing returns to
unresponsiveness of the body normal
The casualty may give Jaw clenches Response level improves
out a cry Eyes roll although they feel dazed,
Back arches Noisy Breathing disorientated and
Flushed face and neck Saliva from the mouth unaware of their
Blueness around the May bite their tongue surroundings
lips making the saliva blood May behave strangely or
stained react in a violent manner
Loss of bowel and/or Tiredness and may fall
bladder control asleep

TREATMENT
Do: Do not:

If a person is falling, try to support or ease the fall and lie them Try to move the casualty
down gently, without putting yourself in danger. Only do so if unless they are in
you are trained and practised in the 'controlling a fall' technique. immediate danger
Attempt to restrain the
Prevent injuries to the casualty. Clear a space and move any casualty
objects that may cause harm from around them and use clothing Put anything in the
or padding to soften the blow from the seizure. Pay particular casualty's mouth,
attention to protecting the head. particularly your fingers
Give anything by mouth
Loosen tight clothing around the neck. until recovery is complete
Try to wake the casualty
Ask bystanders, that you cannot use, to leave. during the seizure

Constantly monitor and record your observations. In particular,

make a note of the time that the seizure started and its duration. 30
AFTER A MAJOR SEIZURE

Manage them as an unresponsive casualty:

Maintain Airway and Breathing (Primary survey)
Check for major injuries (Secondary survey)
Place them in the recovery position
Offer reassurance
Protect their modesty: they may feel embarrassed, particularly if they have been incontinent
Constantly monitor and record your observations

Call an ambulance if:

It is the first ever seizure or the first you know of
If the casualty is known to be epileptic, but the seizure continues for more than 5 minutes, or
there is no improvement in the level of response within 10 minutes
The casualty is having repeated seizures
If they have injured themselves during the seizure
You are in any doubt: remember there may be underlying causes of the seizure, it is far better to
call an ambulance even if you are unsure

MINOR SEIZURES

SIGNS
Minor seizures are otherwise known as TREATMENT
absences. They occur in people who suffer a Usually these seizures will only last for a few
milder form of epilepsy. seconds.
Assist the casualty to rest in a quiet
Convulsive movements and unresponsiveness environment with plenty of space
rarely occur during a minor seizure although a Remove any objects that may cause harm
major seizure may follow. They can be from around them, such as hot drinks,
mistaken for daydreaming or lack of knives or glasses
concentration. Offer reassurance, but do not question the
casualty until the seizure is over
The signs of a minor seizure may include: Remain with the casualty until the seizure
Staring blankly has ended and they have fully recovered
Slight jerking or twitching of an individual On recovery, if the casualty is unaware of
limb, the face, head or eyelids their condition, advise them to consult their
Strange behaviour including smacking of doctor
the lips, chewing and making strange Be prepared in case a major seizure
noises develops 31
SEPSIS
Sepsis is a life-threatening complication
that can occur when the body's response
to an acute infection leads it to harm its
own tissues and organs. Five people die
from sepsis every hour in the UK (Sepsis
Trust).

It is crucial to differentiate between

infection, which is common, and sepsis,
which is an uncommon complication that
may arise when an infection does not
respond to treatment.

Sepsis can affect anyone, but it is most

prevalent in very young and elderly
individuals, as well as those with
compromised immune systems.

Early signs and symptoms of sepsis are

often nonspecific, making it challenging to
recognise.

Early recognition and treatment are crucial.

Sepsis carries high mortality rates, with the

delay in recognition and treatment directly
impacting survival.

SIGNS
If an individual has a confirmed or possible infection and shows any of these signs, they may have
sepsis.
Severe breathlessness and/or rapid, shallow Children may show signs of:
breathing Rapid breathing
Extreme pain or discomfort Mottled, blue, or pale skin
The casualty has not urinated throughout the day Cold hands and feet
The skin appears pale, mottled and discoloured No recent wet nappies
Cold hands and feet Seizures
A feeling of impending death Extreme tiredness, difficult to wake
Slurred speech, confusion and drowsiness

TREATMENT
Call for an ambulance immediately
Maintain Airway and Breathing
Reassure the casualty
Address symptoms of fever (page
34) by maintaining body
temperature
Monitor and record observations

32
 DIABETES
Diabetes is a condition in which a person does not produce enough insulin. Insulin works by
breaking down the sugars you eat.

Hypoglycaemia (low blood sugar) Hyperglycaemia (high blood sugar)

Causes Not eating enough food, excessive The body makes too little insulin or does
exercise, injecting too much insulin not use insulin efficiently
Warning History of diabetes, the casualty may Progressively feeling unwell, see
signs recognise the symptoms symptoms below
Onset Rapid, within minutes Slow, gradual, many hours or days
Skin Pale, cold, sweating Flushed, warm, dry
Pulse Increased rate, weak Increased rate, strong
Breathing Normal to fast Deep breaths

Rapid deterioration
Noticeable change in character/behaviour Lowers slowly
Confusion, irritability, uncooperative Drowsy
Response Restless
Lack of coordination
Speech slurred Unresponsiveness if not treated
Unresponsiveness if not treated

Weakness, faintness Fruity/sweet odour on the breath

Other signs Muscle tremors Excessive thirst
Seizures (in later stages) Need to frequently urinate
May be mistaken for drunkenness

Medic alert bracelets or necklaces

Other clues Diabetic warning cards
Glucose replacements, such as glucose tablets or gel (hypostop)
Medication, such as tablets or insulin syringes

Primary and secondary surveys (pages 5

and 8)
Give the casualty food or drink to raise
their
blood sugar level, e.g. sugary drink,
dextrose tablets, sugar, chocolate, sweet Primary and secondary surveys (pages 5
food and 8)
Do not give food or drink if They should seek medical advice as soon
Treatment responsiveness is impaired as possible
Advise them to visit their doctor In severe cases, call an ambulance
Call an ambulance if: Monitor their condition
Their condition does not improve
within 10 minutes
The casualty becomes unresponsive.
You are unable to manage the
casualty, or have any concern about
the treatment

You can have low blood sugar

without being a diagnosed diabetic. 33
 PAEDIATRICS
Children are NOT miniature adults. There are some important differences that need to be
considered when dealing with sick and injured children:
Smaller body - sustain more injuries than an
adult from the same amount of force Age Respiratory rate Heart rate
Large head (infants) - more likely to land on
their head when falling from a height 0-11 months 30-49 RPM 110-159 BPM
More elastic skeleton - more likely to suffer
12-23 months 25-39 RPM 100-149 BPM
internal injuries without fracturing a bone
Smaller volume of blood - relatively small loss
2-4 years 20-34 RPM 90-139 BPM
of blood is potentially serious
Difficulty regulating heat (young children) - 5-11 years
excessive heat may cause seizures 20-29 RPM 80-129 BPM
Lower body fat - lose heat quicker, prone to Over 12 years 15-24 RPM
hypothermia 70-109 BPM

FEVER INFANTILE SEIZURES

An infantile (febrile) seizure occurs when a
The body's mechanism to fight against
child has a very high temperature. These are
infection with heat. A temperature above 38°C
fairly common in children between six months
can be dangerous to a child.
and four years of age.
SIGNS SIGNS
Raised body temperature
Recent history of an infection
Pale face
Eyes roll back, squint, fixed in one direction
Feeling chills
Flushed, hot appearance
Goose pimples
Sweating
Shivering
Arched back
In severe cases: Shaking movements
Hot, flushed skin Clenched fists
Sweating Cyanosis
Headaches Saliva from the mouth
Aches, pains
Refuse fluids, seem too ill to drink enough TREATMENT
Dehydration Maintain Airway and Breathing
Confused, delirious Clear a space, remove any objects that
Seizures may cause harm, use clothing or padding
to soften the blow from the seizure and
TREATMENT protect the head
If possible, take the child’s temperature Allow an adequate supply of cool fresh air
using a thermometer under the armpit Cool them by removing outer clothing,
Make the child comfortable sheets
Remove excessive clothing If unresponsive, place in the recovery
Give the child plenty to drink: water, juice position
Ensure they are in a cool environment Monitor and record your observations,
Seek medical advice if the temperature note the time and duration of the seizure
continues to rise or the child's condition Call an ambulance
deteriorates
DO NOT:
Do not overcool the child
Do not move them unless they are in
immediate danger
Do not attempt to restrain them
Do not put anything in their mouth,
particularly your fingers
Do not try to wake them during the seizure
Usually, once the child is cooled the
seizure will stop 34
CROUP APPENDICITIS
Croup is caused by a narrowing of the main Appendicitis is an inflammation of the
Airway due to infection. It usually affects appendix.
children between the ages of 6 months and 3
years. SIGNS
Sudden onset of intermittent pain (waves
SIGNS of pain) starting in the naval
Barking cough Pain moving to the lower right side of the
Difficulty Breathing abdomen
Noisy Breathing, especially Breathing in Mild fever
Hoarse voice Loss of appetite
Nausea, vomiting
In severe cases there may be: Frequent passing of water
Use of other muscles when Breathing - Diarrhoea
nose, neck, shoulders, abdomen
Cyanosis TREATMENT
Take immediate action
TREATMENT Make the child comfortable
Make them child comfortable Call an ambulance
Sit them up to assist Breathing Do NOT give the child anything to eat or
Take them to a steamy atmosphere - use a drink - if it is appendicitis it is likely that the
bath or a boiled kettle to create steam child will need an operation
(keeping safe distance from the child)
Talk to a doctor for advice
Do not panic as this will make their
condition worse
In severe cases, call an ambulance

SICKLE CELL DISORDER

Sickle Cell Disorder (SCD) is associated with
the 'sickling' in the shape of red blood cells
which can block the flow of oxygen around the
body. Examples include: Sickle Cell Anaemia,
Haemoglobin Sickle Cell Disease, Sickle Beta- MENINGITIS
Thalassaemia. Meningitis is the inflammation of the tissues
that surround the brain.
Those with SCD may experience 'crisis' bouts
of pain, anaemia, infection or jaundice. SCD SIGNS
may also cause brain damage, blindness, renal Fever
failure, mobility problems and even death. Nausea, vomiting, appetite
Headache
Pain in the eyes caused by light
FOREIGN OBJECTS Red or purple rash that does not fade
Maintain Airway and Breathing when pressure is applied (glass test)
Build up padding using sterile dressings Pain, stiffness in the neck
around the protruding object Joint pains
Apply pressure on either side of the object Dislikes being moved or handled
and support it in position Drowsiness
Maintain the pressure to control bleeding Seizures
If necessary bandage the padding in place,
ensuring that the pressure is applied on TREATMENT
either side of the object and not directly Maintain Airway and Breathing
onto it Make the child comfortable
Support in a raised position Call an ambulance
Arrange for medical assistance
Constantly monitor and record your A child who is very ill needs medical help even
observations if there is no rash or if the rash does fade
Never remove the object during the glass test. 35
 EMPLOYER'S RESPONSIBILITIES
Under Health and Safety law, an employer has a responsibility to ensure that first aid provision in
the workplace is sufficient. This includes:
Carrying out an assessment to decide how many First Aiders are needed and where they should
be located
Providing training and requalifying training for their First Aiders
Providing sufficient first aid kits and equipment for the workplace
Ensuring that staff are aware of how and where to get first aid treatment

Further information: www.hse.gov.uk

FIRST AID KITS

First Aid kits should be easily accessible and clearly identified by a white
cross on a green background. The container should protect the contents
from dust and dampness. A first aid kit should be available at every work
site. Larger sites may need more than one first aid kit. The following list of
contents is given as guidance only:

General first aid guidance Sterile wound dressings of This list is not mandatory, so
leaflet assorted size equivalent items may be
Adhesive dressings Disposable gloves used. Other items should be
(plasters) of assorted size, Burn dressings provided if necessary. They
individually wrapped, sterile Tape may be stored in the first aid
Blue plasters for food Scissors kit if they will fit, or kept close
handlers Sterile eye pads by for use.
Triangular bandages, Face shield
individually wrapped, sterile Foil blanket

ACCIDENT BOOK
All accidents must be reported to employers and recorded. An accident book is a legal document
and should be provided by the employer. An accident book will contain the following details:
Information regarding the person who had the accident.
Information regarding the person who completed the accident record in the book. Details
regarding the incident, including where when and how the accident happened.
A record of whether the employer has reported the accident to the HSE under the Reporting of
Injuries, Diseases and Dangerous Occurrences Regulations.

REPORTING OF INJURIES, DISEASES & AND DANGEROUS OCCURRENCES

(RIDDOR)
Under Employers must report to the Health and Safety Executive:
Death Injuries requiring resuscitation or
Fractures, other than to fingers, thumbs admittance to hospital for more than 24
and toes hours
Amputation Injuries resulting in a person being away
Any injury likely to lead to permanent loss from work/unable to do their normal work
of sight or reduction in sight for more than seven days
Serious burns (including scalding) which Carpal tunnel syndrome
Covers more than 10% of the body or Occupational dermatitis
causes significant damage to the eyes, Occupational asthma
respiratory system or other vital organs
Any loss of responsiveness caused by Dangerous Occurrences
head injury or asphyxia RIDDOR should be consulted, to establish
Scalping what is required to be reported: riddor.gov.uk
Injuries leading to hypothermia or heat- 36
induced illness
 INDEX

A D N
Abdominal Thrusts, 12 Dangers, 4 Nosebleed, 18
Accident Book, 36 Defibrillator, 7
AED, 7 Diabetes, 33 P
Airway, 5 Dislocation, 24 Paediatrics, 34
Allergic Reaction, 13 DRABC, 5 Penetrating Chest Injury, 18
Amputation, 18 Poison, 27
Anaphylactic Shock, 13 E Primary Survey, 5
Effects of Heat, 28 Priorities of First Aid, 4
Angina, 25
Employer's Responsibilities, 36 Protruding Object, 17
Appendicitis, 35
External Bleeding, 17
Asthma, 14 R
Eye Injuries, 21
Asthma Attack, 14 Recovery Position, 8
Automated External F Reporting, 36
Defibrillator, 7 Fainting, 10 Response, 5
B Fever, 34 RIDDOR, 36
Back Blows, 12 First Aid Kit, 36 Role of a First Aider, 3
Bleeding, 16 Foreign Objects, 17, 35
Breathing, 5 Fractures, 23 S
Bruise, 17 Secondary Survey, 8
Burns, 22 H Seizures, 30
Haemostatic Dressings, 16 Sepsis, 32
Bystanders, 4
Head Injuries, 20 Sickle Cell Disorder, 35
C Head Tilt, 7 Spinal Injury, 9
Cardiac Arrest, 7 Heart Attack, 25 Spinal Log Roll, 9
Chain of Survival, 7 Heat Exhaustion, 28 Spinal Recovery Position, 9
Chemical Burns, 22 Heat Stroke, 28 Splinters, 18
Chest Injury, 18 Hyperglycaemia, 33 Sprains, 24
Chest Pain, 25 Hyperventilation, 15 Stroke, 26
Chin Lift, 7 Hypoglycaemia, 33 Strains, 24
Choking, 11 Hypothermia, 29
Compression, 20 Hypovolaemic Shock, 19
T
Tourniquet, 16
Concussion, 20 I
Contusion, 18 Infantile Seizures, 34 U
CPR, 6 Infection, 32 Unresponsive, 8
CPR in Children, 6 Infection Prevention, 3
Croup, 35 Inhaler, 14 W
Crush Injuries, 18 Witnesses, 4
Internal Bleeding, 18
Wound Packing, 16
M Wounds, 17
Major Seizures, 30
Meningitis, 35
Minor Seizures, 31
Minor Wounds, 17

First Response Training and Consultancy Services Limited. All Rights Reserved. No part of this
publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any
other means, electronic, mechanical, photocopying or otherwise, without the prior written
permission of the copyright owner. Tel: 0870 850 1411

Important: This manual is designed as a learning guide to a first aid course. If you suspect illness or
injury, you should always seek professional medical advice.

Disclaimer: Whilst every effort has been made to ensure the accuracy of the information contained
in this manual, the author does not accept any liability for any inaccuracies or for any subsequent
mistreatment of any person, however caused. 37