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AED Usage 58
Amputation 32
Anaphylaxis 18
Angina 24
Asthma 19
Bleeding 30
Burns 34
Chest Injury 21
Choking 16
6-8
CPR
Croup 19
Crush Injury 32
Diabetes 46
Drowning 20
Epilepsy 48
Eye Injury 31
Fainting 27
Febrile Convulsions 49
Fitting 48
Fractures 37
Frostbite 44
Head Injuries 12
Heart Attack 24
Heat Exhaustion 44
Heat Stroke 45
Hyperventilation 20
Hypothermia 43
Internal Bleeding 32
Poisoning 33
Recovery Position 11


Resuscitation
6-8
Shock 26
Spinal Injury 39
Sprains and Strains 37
A comprehensive first aid Stroke 13
manual and reference guide. Unconsciousness
Nigel Barraclough SR Para CertEd
9
Contents and Introduction ..
Contents
Introduction
Poisons, Burns and Scalds
First Aid
Introduction 3 Poisons 33
The Aims of First Aid 4 Estimating Severity of a Burn 34
Priorities of Treatment 4 Causes of Burns and Treatment 35
Emergency Action Plan 5 The Skeletal System 36
Chain of Survival 6 Causes of Injury 37
Types of Fracture 37
Injuries to Bones, Muscles and Joints
Resuscitation
Cardio Pulmonary Resuscitation (CPR)
6-8
Child and Baby CPR 8 Dislocations 37
Chest Compression only CPR 8 Sprains and Strains 37
Sprains and Strains – Treatment 39
Unconsciousness
Definition and Causes 9 Fractures – Signs and Symptoms 38
Levels of Response 9 Fractures – Treatment 38
Primary and Secondary Survey 10 Spinal Injuries
Recovery Position ” Effects of Heat and Cold
Head Injuries
12-13
This manual has been designed by
an experienced paramedic instructor
to guide you through your first aid
course, and to provide you with 0
reference for future years.
Most people will find the information
in this book useful and informative,
but it cannot replace ‘hands on’
training in the vital skills of dealing
with on emergency situation.
Effective emergency treatment
before professional help arrives
con go a long way to reducing the
effects of illness and injury, and
indeed save someone’s life.
39-41
Body Temperature 42
Stroke 13 Hypothermia 43
Hypoxia (Iow oxygen) 14 Frostbite 44
Heat Exhaustion 44
Heat Stroke 45
Taking a Temperature
Taking part in a first aid course and
using this manual may be the most
important decisian you make in
your life. . .
45
Airway and Breathing Problems
The Respiratory System
Choking
15
16-17
Anaphylaxis 18 Other Serious Conditions Asthma and Croup 19 Diabetes 46-47
Hyperventilation 20 Epilepsy 48-49
Drowning 20 Seizures 48-49
Chest Injuries 21 Febrile Convulsions 49
The Digestive System 50
Circulation Problems
The Circulatory System 22-23 Health and Safety Angina 24-25 Employer’s Responsibilities 51
Heart Attack 24-25 First Aid Kits 51
Left Ventricular Failure 25 First Aid needs assessment 52
Shock: – Hypovolaemic 26 Typed of Fi rst Aider 53
Cardiogenic 27 Reporting of Incidents (RIDDOR) 53
- AnaphylactiC 27 Accident Book 54
27 Patient Report Form 55

Fainting
Hygiene 28 Resuscitation Child 56
Types of Wound 28 Resuscitation Baby 57
Blood Loss 29 Resuscitation with an AED Treatment of Bleeding 30 Glossary Embedded Objects 31 Notes Nose Bleeds 31 Glossary Eye Injuries 31 Amputation 32 Crush Injury 32
Internal Bleeding 32
58-60
tf you suspect illness or injury, you should
atways seek professional medical advice.
Whilst every effort has been made
to ensure the accuracy of the information
contained within this manual,
the author does not accept any liability
for any inaccuracies or for any
subsequent mistreatment of
any person, however caused.
61-64
65
First Aid Quiz
First Aid Quiz
IMPORTANT
This manual is designed as a learning
guide to a full first aid course,
it cannot replace ‘hands on’ training in
the vital skills of dealing with an
emergency situation.
DISCLAIMER
Appendix
Wounds and Bleeding
Edition 7.1
66
o 2008. Qualsafe limited. All Rights Reserved.
No part of this publication maybe reproduced,
stored in a retrieval system, or transmitted
in any form or by any means, electronic,
mechanical,
p hotocopying,
recordin g
or
the prior written permission
of the copyright owner.
Tel: 0845 644 3305 www.qualsafe.com
otherwise, without
‘”
N
0
0
0
M



_ First aid
The aims of first aid
Preserve Life
Not only the casualty’s life, but your own as well. Far too often only one person’s life
is in danger when the emergency services are called, but by the time they arrive there
are more. If you put your life in danger, you can end up fighting for your OWN life
instead of the casualty’s.
Prevent the situation from Worsening
The skilled first aider must take action to prevent the whole situation from becoming
worse (e.g. removing dangers such as traffic or fumes), as well as acting to prevent the
casualty’s condition from deteriorating.
Promote Recovery
The actions of a first aider should, after preventing things from getting worse, help
the casualty to recover from their illness or injury.
Priorities of treatment
All animal life needs a constant
supply of oxygen to survive. If
that oxygen is token away for
any reason, brain cells will start
to die within 3 to 4 minutes.
The priorities of treatment ore
therefore aimed firstly at getting
oxygen into the blood stream,
ensuring that the blood is
The first priority with any patient is to make sure the Airway is open and then to check they
are Breathing normally (A and B). If the patient is breathing normally, this means that their
heart must also be beating, so blood is being circulated around the body. As the A and B
check is carried out first, we call it the ‘primary survey’.
Once you are happy that the casualty is Breathing normally and oxygen is being circulated
around the body, the next priority is to deal with any major Bleeding, because you need to
maintain enough blood to circulate the oxygen around. After these steps, the next priority
is to deal with any broken Bones (BB8). The check for bleeding and then broken bones is
called the ‘secondary survey’.
circulating around the body, and
then preventing the loss of that
blood. If this aim is achieved, then
the majority of casualties will still be
olive when the ambulance arrives.
Primary Survey
0

-0 Breathing
Airway

�� 0
�Q
8-
I In
-.:=

MuWp/e casualties
The BBB rule can be used for
multiple casualties, to decide who
needs treatment first. A rough ‘rule
of thumb’ is that the casualty who
is the quietest needs treatment
first, where os the one making
the most noise (trying to get your
attention) is the least serious!
Bleeding
(0< Bums)

Bones
Emergency action plan ..
It is important to have an action plan for emergencies. This flow chart guides you through the actions to be taken when dealing with
a patient. All the topics, such as the recovery position and resuscitation are covered later in the book.
Remove
Danger
Make the scene safe.
Do not take risks.
DANGER?
look for any further danger.
C)
Response?
History
Shout and gently shake
Find out what has happened.
or tap the casualty.
..
Signs and Symptoms
Help!
1
How does the patient feel or look?
Shout for help but don’t Try to work out what’s wrong.
leave the casualty yet ..
Treatment
Remember
Ai rway
-
if you’re not sure, always
seek professional medical advice.
Open the airway by tilting the
head back and lifting the chin.
Normal
Breathing?
Secondary Survey
Check for bleeding, injuries
and clues (see page 10).
look, listen and feel for
no more than
1 0 seconds.

If you’re not sure if
Recovery Position
breathing is normal, treat it
not.
11).
Recovery position (see page

as though it is
• Dia l 999 if not already done.
• Monitor Airway and Breathing.
• Keep the casualty warm.
Dial 999 Now
(If not already done)
Resuscitation
• Give 30 chest compressions, then 2 rescue breaths.
• Continue giving cycles of 30 compressions to 2 rescue breaths.
• Only stop to recheck the patient if they start breathing
normally
-
otherwise do not interrupt resuscitation.
• If there is more than one rescuer, change over every 2 minutes to prevent fatigue.
_ Resuscitation
The chain of survival
In order to maintain the oxygen supply to the body a person must be breathing, and their heart
must be ‘pumping’. If either of these two functions stop, the brain and other vital organs will
quickly deteriorate, and brain cells will start to die within 3 to 4 minutes. Unless urgent action is
taken to circulate oxygen around the body, this will inevitably result in death.
The most common cause of cardiac arrest in adults is ‘ventricular fibrillation’. In these
circumstances the best chance of restarting the heart is by using a ‘defibrillator’, which is carried
on all emergency ambulances in the UK. For this reason, an emphasis is placed on summoning
help and dialling 999 as soon as possible. Of course, the heart and brain must be kept
oxygenated until the defibrillator arrives; so early Cardio Pulmonary Resuscitation (CPR) is vital if
a casualty is to recover. These actions form the ‘links’ in the chain of survival (see diagram).
Airway
blocked
by the
tongue
Airway
cleared
by tilting
the head
)
-
Cardio Pulmonary Resuscitation (CPR) – Primary survey:
CD
Danger
-
+
make sure it’s safe and find out what’s happened
• Check that it is safe for you to help the casualty. Do not put yourself at risk in any way.
• If possible remove any danger from the casualty, or if not, can you safely move the
casualty from the danger?
• Find out what’s happened – and make sure you are still safe.
• Check how many casualties there are. Can you cope?
Gentfy shake the
shoulders and shout.
Cl)
Response
-
are they conscious?
• Gently shake the shoulders and ask loudly ‘Are you alright?’
• If there is no response, shout for help immediately, but do not leave the casualty yet.
o
Airway
-
open the airway
• Carefully open the airway by using ‘head tilt’ and ‘chin lift’:

Place your hand on the forehead and gently tilt the head back.
• With your fingertips under the point of the casualty’s chin, lift the chin to open the
airway (see diagram).
Gently tip the head back and lift
the chin to open the airway.
WARNING: In the first few minutes
after cardiac arrest, a casualty
may be barely breathing, or taking
infrequent, noisy. gasps. Do not
confuse this with normal breathing.
If you are in doubt, start CPR.
o
Breathing
-
check for normal breathing
Keeping the airway open, check to see if the breathing is normal. Take no more than 1 0
seconds to do this:
• Look at the chest and abdomen for movement.
• Listen for the sounds of breathing (more than the occasional gasp).
• Feel for air on your cheek or movement of the chest or abdomen.
If the casualty Is breathing normally, carry out a secondary survey and place them in the
recovery position (pages 1 1 and 1 2).
Resuscitation _
If the casualtx is not breathing normally:
Ask someone to dial 999 for an ambulance Of, jf you are on your own, do this yourself; you
may need to leave the casualty. Start chest compressions as follows:
o
Place the heel of one hand in the centre of the casualty’s chest, then place the heel of
your other hand on top and interlock your fingers (see diagram).
• Position yourself vertically above the casualty’s chest with your arms straight.
o

Press down on the breastbone 4 to 5cm (1 ‘/1 to 2 inches) then release the pressure
without losing contact between your hands and the chest (chest compression). Ensure that
pressure is not applied over the casualty’s ribs. Don’t apply pressure over the upper
abdomen or the bottom end of the breastbone.
Look, listen and feel
for normal breathing.
Compression and release should take an equal amount of time.
• Do 30 chest compressions at a rate of 1 00 per minute.
• Now combine chest compressions with rescue breaths (below).
NOTE: Ideally the casualty needs to be on a firm flat surface to perform chest compressions (not
o bed). One way to remove someone from a low bed is to unhook the bed sheets and use them
to slide the casualty carefully to the floor. Get help if you can and be very careful not to injure
yourself or the casualty. Do not move the casualty if you do not think it’s safe to do so – remove
the pillows and attempt ePR on the bed instead.
Place the heel of one hand in
the centre of the chest, then
the other hand on top.
Combine chest comp’ression with resc.u .:; b::: e a t::,;,-
� :: e.: r ;:: :s __________.,
� �h :
o Open the airway again, using head tilt and chin lift.
o Nip the soft part of the casualty’s nose dosed. Allow the mouth to open, but maintain
chin lift.
• Take a normal breath and seal your lips around the casualty’s mouth.
o
o
Blow steadily into the casualty’s mouth, whilst watching for the chest to rise (rescue
breath). Take about one second to make the chest rise.
Keeping the airway open, remove your mouth. Take a breath of fresh air and watch for
the casualty’s chest to fall as air comes out.
o Re-seal your mouth and give another rescue breath (two in total).
o
Arms straight and shoulders
above your hands,
depress the chest 4 to Scm.
Return your hands without delay to the correct position on the breastbone and give
another 30 chest compressions (then 2 more rescue breaths).
• Continue repeating cycles of 30 chest compressions and 2 rescue breaths.
o
Only stop to recheck the casualty if they start breathing normally – otherwise don’t
interrupt resuscitation.
If your rescue breaths don’t make the chest rise effectively, give another 30 chest
compressions, then before your next attempt:
• Check the casualty’s mouth and remove any visible obstruction.
o Recheck that there is adequate head tilt and chin lift.
o Do not attempt more than two breaths each time before returning to chest compressions.
Nip the nose and seal your mouth
around the casualty’s mouth.
NOTE: If there is more than one rescuer, change over every two minutes to prevent fatigue.
Ensure the minimum of de/ay as you change over.
Continue resuscitation until:
o Qualified help arrives and takes over.
o The casualty starts breathing normally, or
• You become exhausted.
Slowly breathe just enough
air to make the chest rise.
Resuscitation
-
+
Resuscitation for children and babies
Recent studies have found that many children do not receive resuscitation because potential
rescuers fear causing them harm. It is important to understand that it’s far better to perform
‘adult style’ resuscitation on a child (who is unresponsive and not breathing) than to do
nothing at all.
For ease of learning and retention, first aiders can use the adult sequence of resuscitation
(see previous pages) on a child or baby who is unresponsive and not breathing. The following
minor modifications to the adult sequence will, however, make it even more suitable for use
in children:
• •
For a child over
1 year, use one or two
Give five initial rescue breaths before starting chest compressions
(then continue at the ratio of 30 compressions to 2 breaths).
If you are on your own, perform resuscitation for about 1 minute before going for help.
• Compress the chest by about one-third of its depth:

one third of its depth.
For a baby under 1 year, use two fingers.

hands to compress the chest by about
For a child over 1 year, use one or two hands (as needed) to achieve an adequate
depth of compression (about one third of the depth).
The full sequence of child or baby resuscitation is given in detail on pages 56 and 57.
-
+
Chest com pression only resuscitation
When an adult casualty suffers a cardiac arrest, it is likely that there is residual oxygen left
in the blood stream.
If you are unable (or unwilling) to give rescue breaths, give ‘chest compressions only’
resuscitation, as this will circulate any residual oxygen in the blood stream, so it is better
than no CPR at all.

If chest compressions only
minute.
are
given, these should be continuous at
a
rate of 100 per
• Stop to recheck the casualty only if they start breathing normally – otherwise do not
For a baby under
1 year, use two
fingers to compress the chest by
about one third of its depth.
interrupt resuscitation.

If there is more than one rescuer, change over every two minutes to prevent fatigue.
Ensure the minimum of delay as you change over.
-
Vomiting
+
It is common for a patient who has stopped breathing to vomit whilst they are collapsed.
This is a passive action in the unconscious person, so you may not hear or see it happening.
You might not find out until you give a rescue breath (os the air comes back out of the patient
it makes gurgling noises).
• If the patient has vomited, turn them onto their side, tip the head back and allow the
vomit to run out.

Turn them onto their side and
Clean the face of the patient then continue resuscitation, using a protective face barrier
if possible.
allow the vomit to run out.
Hygiene during resuscitation:

Wipe the lips clean.
• If possible use a protective barrier such as a ‘face shield’. (This is particularly important if
the patient suffers from any serious infectious disease such as TB, Hepatitis or S.A .R.S.).

As a last resort some plastic with a hole in it, or a handkerchief, may help to prevent
direct contact.
• •
Using a protective barrier during (PR.
If you are still in doubt about the safety of performing rescue breaths, give ‘chest
compression only’ resuscitation (see above).
Wear protective gloves if available and wash your hands afterwards.
Unconsciousness _
The main causes of unconsciousness
The causes of unconsciousness can be remembered by using
‘FISH SHAPED .

Each of these causes are dealt with individually elsewhere in this manual.
Fainting Stroke
Imbalance of heat Heart Attack
Asphyxia
Poisoning
Head Injury
Epilepsy
Diabetes
Levels of response
In order to accurately measure a casualty’s conscious level, we can use a scale of
consciousness called the ‘AVPU’ scale:
Alert
The casualty is fully alert
They are responsive and fully orientated (a casualty in this
category will usually know what month it is).
Voice
Confused
The casualty is not fully orientated but asks and answers
your questions.
Inappropriate Words
The patient is able to speak words, but cannot put them
together into logical sentences.
Utters Sounds
The casualty i s not able to speak words but makes noises,
often in response to painful stimuli.
No Verbal Response
The casualty makes no noise.
Pain
Localises Pain
The patient is able to localise where painful stimuli is being
applied.
Responds to (but does not localise) Pain
The patient responds to painful stimuli, but is unable to
localise it.
Unresponsive
Unresponsive
The casualty is u n responsive to pain and speech stimuli.
Unconsciousness con be defined
as an interruption in the normal
activity of the brain. Unlike sleep,
unconsciousness con disable
the body’s natural reflexes such
as coughing. Therefore if the
unconscious patient is laying an
their back the tongue may fall
back blocking the airway, or they
may even drown themselves if
they vomit.
You should take immediate action
to treat an unconscious casualty.
This will involve protecting the
airway, calling an ambulance and
possibly treating the underlying
cause of the condition.
_ Unconsciousness
The Primary and Secondary Survey
methods of checking a patient
give us 0 systematic order in
which to deal with the most urgent
problems first, then move on to
find other clues – helping with
diagnosis and treatment.
Primary survey
When you check for Danger, Response, Airway and Breathing this is cal led the ‘Primary
Survey.’ This can be found in the ‘resuscitation’ section of this manual (see page 6).
The primary survey ensures that the patient is breathing, so it should be carried out first.
Once you are sure that the patient is breathing effectively, it is safe to move on and carry
out a secondary survey:
Secondary survey
If a casualty is unconscious you are concerned about the airway for any reason (e.g.
vomiting), place them in the recovery position immediately (page 1 1).
The Secondary Survey should be done quickly and systematically, first checking for major
bleeding and then broken bones.
Bleeding
• Do a quick head to toe check for bleeding.
• Check the hidden area such as under the arch of the back.
• Control any major bleeding that you find (page 3 0).
Head a n d neck
• Clues to injury could be bruising, swelling, deformity or bleeding.
• Check the whole head and face.
• Feel the back of the neck.
Primary Survey –
• Has the patient had an accident that might have injured the neck?
(page 39).
Shoulders
and chest
• Place your hands on opposite shoulders and compare them.
• Run your fingers down the collar bones checki ng for signs of a
fracture (page 38).
• Gently squeeze and rock the ribs.
Abdomen
and pelvis
• Push the abdomen with the palm of your hand to check for
abnormality or response to pain.
• Gently check the pelvis for signs of a fracture.
• Look for incontinence or bleeding.
Remember the priorities
of treatment?
(page 4)
Legs and arms
• Feel each leg for the signs of a fracture.

Feel each arm for the signs of a fracture.
• look for other clues (medic alert bracelets, needle marks ete).
Pockets
• Look for clues and make sure nothing will injure the patient as you
roll them into the recovery position.
• Have a witness if you remove items from pockets.
• Be very careful if you suspect there could be sharp objects such
as needles.
• loosen any tight clothing.
Recovery
• Place the patient in the recovery position (page 1 1).
• If you suspect neck injury, get someone to help you keep the
head in line with the body as you turn the patient (see page 41
f haw ta da this).
or
• Be careful not to cause further damage to any suspected injuries.
Unconsciousness •
Mech anics of injury
Before you move a patient, it is important to consider the ‘mechanics of injury’.
This involves trying to work out what happened and what injuries this could have caused
the patient.
• If you suspect neck injury, get someone to help you keep the head in line with the
body a t all times (see page 41 f how to do this).
or

If you have to use the recovery position, try not to move any suspected injuries.
-
+
The recovery position
When a person is unconscious and lying on their back, the airway can become
compromised by the tongue touching the back of the throat, or vomit if the patient
is sick. Placing the casualty in the recovery position protects the airway from both of
these dangers – the tongue will not fall backwards and vomit will run out of the mouth.
o
• Remove the casualty’s glasses and straighten both legs.

Move the arm nearest you outwards, elbow bent with
palm uppermost.
• Bring the far arm across the chest,
and hold the back of that hand against the cheek.
o
• With your other hand, grasp the far leg just above the
knee, and pull it up, keeping the foot on the ground.
• Keeping the casualty’s hand pressed against their
cheek, pull on the leg to roll them towards you,
onto their side.
• Adjust the upper leg so that the hip and knee are bent at
right angles and tilt the head back to keep the airway open.
• Call 999 for an ambulance.
• Check breathing regularly. If breathing stops, turn the
casualty onto their back again and perform CPR.
NEVER place anything in an unconscious casual ty’s mouth . NEVER place a pillow under the head w ilst the casualty is on their back.
h
NEVER move a casualty without checking the m first. NEVER move the casualty unnecessarily.
_ Unconsciousness
Hyp oxia
The medical term ‘hypoxia’ means ‘Iow oxygen in the blood’,
A low level of oxygen in the blood is potentially fatal, so it is very important that the First
Aider recognises the signs and symptoms of this condition and takes immediate action to
treat the casualty.
The causes of h ypoxia can be separated into 5 areas:
Possible signs and symptoms
0
External causes:
Not enough oxygen in the surrounding air, such as:
• Pale clammy skin (for dark
skinned casualties look at the
colour of skin inside the lips).
• Suffocation b y gas or smoke. • Suffocation by sand, earth or a pillow ete.
• Drowning. • High altitude.
• Blue tinges to the skin and lips
(cyanosis).
Airway causes:
• Increase in pulse rate. Blockage, swelling or narrowing. Caused by: • Weakening of the pulse. • The tongue. • Strangulation.
• Vomit. • Hanging.
• Choking. • Anaphylaxis.
• Nausea or vomiting.
• Increased breathing rate
(caused by oxygen deficiency).
• Burns.
Breathing causes:
• Lowered breathing rate
(look for control centre causes).
• Distressed breathing or gasping.
Inability of the lungs to function properly. Caused by:
• Crushing of the chest. • Poisoning.
• Confusion or dizziness. • Collapsed lung. • Asthma.
• Lowering levels of consciousness. • Chest injury. • Disease or illness.
• Clues from the cause of the
Circulation causes:
hypoxia (i.e. bleeding, injury,
chest pain etc).
Inability of the blood to take up oxygen, a fall in blood pressure, or failure to circulate the
blood around the body. Caused by:
• Heart attack. • Severe bleeding.
• Cardiac arrest. • Poisoning.
• Angina. • Anaemia.
Control centre causes:
Failure of the respiratory control centre in the brain or the nerves connecting it to the lungs.
Caused by:
• Stroke.
Treatment of hypoxia
0
• Maintain Airway and Breathing
(pages 6 to
8).
• Remove or treat the cause of
the hypoxia.
• Do not allow the patient to eat,
drink or smoke.
• Spinal injury.
• Drug overdose.
Pale clammy skin and cyanosis.
• Poisoning.
• Head injury. • Electric shock.
The body’s response to hypoxi a
If the body detects low levels of oxygen in the blood ADRENALINE is released. The effect of
adrenaline on the body is to:
• Increase the heart rate.
• Increase the strength of the heart beat (and blood pressure).
• Divert blood away from the skin, intestines and stomach.
• Divert blood towards the heart, lungs and brain.
• Dilate the air passages in the lungs (bronchioles).
The effect of adrenaline being released in the body produces dramatic signs and symptoms
that the first aider must be able to recognise.
Can you tell which of the signs and symptoms are caused by adrenaline?
Airways and breathing problems GI
Air ;s drawn in through the mouth and
nose, where it is wormed, filtered and
moistened.
The respiratory system
r -.::: —-jL- ——–
_ :-”\
Air then travels through the throat and
past the epiglottis (the protective flap
of skin that folds down to protect the
airway when we swallow).
N
asal
� “-l– -_f——– MouthCavityy
.::: -
-
Cavit

�– +—– – — -
-fungue
Air now enters the larynx (more
commonly known as the voice box or
‘Adorn’s apple? It passes between the
vocal cords in the larynx and down
into the trachea.
The trachea is protected by rings of
cortilage that surround it to prevent
kinking.
I?-+—-I�— Epiglottis
��–+-Larynx
\ 1-
—-.:, ——– Oesophagus
..
The trachea divides into two ‘bronchi’
that supply air to each lung.
-W���-hachea
The bronchi then divide into smaller air
passages called ‘bronchioles’.
\\—–+– Pleural Membrane
�’{C:”…”=—-li\_—_4- Bronchus
At the end of the bronchioles are
microscopic air sacks called ‘alveoli’.
The walls of the alveoli are only one
cell in thickness, so oxygen can pass
through into the blood, which is carried
in capillaries that surround
the alveoli.
�-’,—-I+—-__\– Bronchioles
—–1.\—–4- Heart
11—–_4- Alveoli
11——-1
–#–…—-\- Left Lung
Carbon dioxide (a waste gas from the
body) passes from the blood into the
alveoli, and is then breathed out.
�§;::��.JJr—�- Diaphragm
The trachea, bronchi, and lungs are
contained in the ‘thoracic cavity’ in the
chest.
co2
JI’
4- �—- Bronchiole
__
‘-
_____
Capillary
d—— Alveolus
To draw air down into the thoracic
cavity, the diaphragm flattens and the
chest walls move out. This increases the
size of the thoracic cavity, creating a
negative pressure which draws air in.
Oxygen passes from the
alveoli into the blood, whilst
carbon dioxide passes in the
opposite direction to be
breathed out.
• Capillary carrying oxygenated blood
o Capillary carrying
Each lung is surrounded by a two
layered membrane called the ‘pleura’.
Between the two layers of the pleura is
a thin layer of ‘serous’ fluid, which
enables the chest walls to move freely.
The thoracic cavity is protected by
the ribs, which curl around from the
spine and connect to the sternum
(breast bone) at the front of the body.
deoxygenated blood
What’s in the air that we breathe?
Air that we breathe in:
Air that we breathe out:
‘Normal’ Respiratory Rates
Oxygen 20% Oxygen 16% Carbon Dioxide Trace Carbon Dioxide 4% Adult 12 – 20 breaths
Nitrogen 79% Nitrogen 79% Child 20
Other Gases 1% Other Gases 1% Baby 30 – 60 breaths
I minute
- 40 breaths I minute
I minute
.. Airway and breathing problems
Choking
One of the most successful skills that can be learned by the first aider is the treatment of a
casualty who is choking. Objects such as food, sweets or small objects can easily become
lodged in the airway if they are accidentally ‘breathed i n’ rather than swallowed.
Possible signs and symptoms
@
• The patient is unable to speak or cough. • Congestion of the face initially.
• Grasping or pointing to the throat. • Pale skin and cyanosis in later stages.
• Distressed look on the face. • Unconsciousness in later stages.

Choking adult or child
+
(over 1 yeor)
Firstly, encourage the patient to cough. If the choking is only mild, this will clear the
obstruction and the patient should be able to speak to you.
If the obstruction is not cleared:
o Back blows
• Shout for help, but don’t leave the patient yet.
• Bend the casualty forwards so the head is lower
than the chest. For a smaller child you can place
them over your knee to do this.
• Give up to 5 firm blows between the shoulder
blades with the palm of your hand. Check between
blows and stop if you clear the obstruction.
Back blows performed
on a smaller child.
If the obstruction is still not cleared:
6 Abdominal thrusts
• Stand behind the casualty (or kneel behind a small
child). Place both your arms around their waist.
• Make a fist with one hand and place it just above
the belly button (below the ribs) with your thumb
inwards.
• Grasp this fist with your other hand, then pull
sharply inwards and upwards. Do this up to 5
times. Check between thrusts and stop if you
clear the obstruction.
Abdominal thrusts performed
on a smaller child.
If the obstruction is still not cleared:
()
Repeat steps 1 and 2
• Keep repeating steps 1 and 2.
• If the treatment seems ineffective, shout for help. Ask someone to dial
999 for a n
ambulance, but don’t interrupt the treatment whilst the patient i s still conscious.
Abdominal thrusts can
cause serious internal
injuries, so send
the patient to see a doctor.
After successful treatment,
patients with a persistent
cough, difficulty swallowing
or with the feeling of an
‘object still stuck in the
throat’ should 0/50 see
a doctor.
Airway and breathing problems •
-
Choking – baby (under 1 year)
+
The baby may attempt to cough. If the choking is only mild, this will clear the obstruction
- the baby may cry and should now be able to breathe effectively.
If t h e obstruction is not cleared:
Back blows
• Shout for help, but don’t leave the baby yet.
• Lay the baby over your arm, face down, legs either side of
your elbow with the head below the chest (see diagram).

Give up to 5 blows between the shoulder blades with the
palms of your fingers. Check between blows and stop if
you clear the obstruction.
If the obstruction is still not cleared:
6 Chest thrusts
• Turn the baby over, chest uppermost (by laying them
on yo ur other arm) and lower the head below the level
of the chest.

Using two fingers on the chest, give up to 5 chest
thrusts. These are si milar to chest compressions, but
sharper in nature and delivered at a slower rate. Check
between thrusts and stop if you clear the obstruction.
NEVER perform abdominal thrusts on a baby
If the obstruction is still not cleared:
€) Repeat steps 1 and 2
• Keep repeating steps 1 and 2.

If the treatment seems ineffective, shout for help. Ask someone to dial 999 for an
ambulance, but don’t interrupt the treatment yet.
If the

casualty becomes unconscious:
+
Support the casualty carefully to the ground (or a firm fat surface f a baby).
l
or
• START CPR as follows:
• Adult – follow the sequence on page 7 after the heading ‘if the casualty is not
breathing normally’.
• Child
• Baby – follow the sequence on page 57 after the heading ‘if the baby is not breathing
- follow the sequence on page 5 6 after the heading ‘if the child is not breathing
normally’.
normally’.

Continue CPR until the child starts breathing normally on its own, help arrives to take
over, or you become exhausted.
If th e c asualty becomes unconscious – start (PR.
ID Airway and breathing problems
Anaphylaxis
Anaphylaxis is an extremely dangerous allergic reaction. The name ‘anaphylaxis’ means
‘without protection’ and indeed, the condition is caused by a massive over-reaction of the
bod/s protection (immune) system.
Severe anaphylactic reactions are very rare. The most common reactions are to drugs (such as
penicillin). Other common allergies are to things such as insect stings, peanuts, seafoods etc.
The main chemical that the immune cells release if they detect a ‘foreign protein’ is
histamine. H istamine has several effects on the body when it is released in massive
quantities:
• It makes blood vessels dilate.
• It constricts the bronchioles in the lungs.
• It makes blood capillary walls ‘leaky’, causing severe swelling and shock (pag e 26).
• It weakens the strength of the heart’s contractions.
• It makes the skin itchy.
• It makes the skin come out in a rash.
Possible signs and symptoms
The allergic reaction can happen in seconds, so fast recognition is essential:
• Sudden swelling of the face, tongue, lips, neck and eyes.
• Hoarse voice, ‘lump in the throat’, developing into loud pitched noisy breathing (which
may stop altogether).
• Difficult, wheezy breathing, tight chest (the patient may have the equivalent of o n asthma
attack as well as a swollen air way).
• Rapid weak pulse.
• Nausea, vomiting, stomach cramps, diarrhoea.
• Itchy skin.
• Red, blotchy skin eruption.
• Anxiety – a feeling of ‘i mpending doom’.
This chifd has swelling of the
tongue and lips and Q red
blotchy rash on his chest.
Treatment
• Dial 999 for an ambulance.
o
• Lay the casualty in a comfortable position:
• If the casualty has Airway or Breathing problems they may prefer to sit up as this will
make breathing easier.
• If the casualty feels faint however – do not sit them up. Lay them down
immediately. Raise the legs if they still feel faint (page 21).
• The casualty may carry an auto-injector of adrenaline. This can save the casualty’s life
if it’s given promptly. The patient should be able to inject this on their own but,
if necessary, assist them to use it.
• If the casualty becomes unconscious – check
Airway and Breathing (pages 6 t o 8) and
resuscitate as necessary.
• The dose of adrenal ine (epinephrine) can
be repeated at 5 minute intervals if there
is no improvement or symptoms return.
P icture: many thanks to the
Anaphylaxis Campaign.
www.anophylaxis.org.uk
© MedicalMed
iaKils.com
‘Epi-Pen’ and ‘Ana-Pen’ are types of
adrenaline auto-injectors.
Airway and breathing problems a
Asthma
Asthma is a condition caused by an allergic reaction in the lungs, often to substances such
as dust, traffic fumes, or pollen. Muscles surrounding the bronchioles (see page 15) go into
spasm and constrict, making it very difficult for the patient to breathe.
Most asthma patients carry medication around with them, usually in the form of an inhaler.
Ask the patient, but usually the blue inhaler is for relieving an attack, dilating the
bronchioles to relieve the condition.
An asthma attack is a traumatic experience for the patient, especially a child, so reassurance
and a calm approach from the First Aider is essential. If the patient is not reassured and
calmed down by the First Aider, an attack can lead on to ‘hyperventilation’ (see page 20)
after the inhaler has relieved the constricted airways.
Possible signs and symptoms
Difficulty breathing.
• Wheezy breath sounds, originating from the lungs.
o
Difficulty speaking (will need to take a breath in the middle of a sentence).
• Pale, clammy skin.
o
Grey or blue lips and skin (cyanosis).
• Use of muscles in the neck and upper chest to help the casualty breathe.
• Casualty will become exhausted in a severe attack.
• May become unconscious and stop breathing in a prolonged attack.
o
An upright sitting position usually helps
the patient to breathe more easily.
Treatment of asthma attack
o
Help the casualty to sit upright, leaning on a table or chair if necessary.
• Help the casualty to use their reliever inhaler. This can be repeated every few minutes if
the attack does not ease.
Try to take the casualty’s mind off the attack – be calm, reassuring and make
light conversation.
o
If the attack is prolonged, severe, appears to be getting worse, or the casualty
is becoming exhausted; dial 999 for a n ambulance.
• Cold winter air can make an attack worse, so don’t take the casualty outside for fresh air!
o
Keep the casualty upright – even if they become too weak to sit up on their own. Only
lay an asthma attack patient down if they become unconscious.
o
Be prepared to carry out resuscitation (page 6 to 8).
o
Some asthma patients need to use 0
‘spacer device’ because they can’t take
their inhaler alf in one breath.
Croup
Croup is a condition usually suffered by very young children, where the larynx and trachea
become infected and swollen. The attacks, which often occur during the night, can appear
very alarming, but nearly always clear without causing the child any lasting harm.
Possible signs and symptoms
• Difficult distressed breathing.
A loud pitched, or whistling noise as the child breathes.
o A short ‘barking’ type cough.
• Pale, clammy skin.
o
Blue tinges to the skin (cyanosis).
o
Use of muscles in the neck and upper chest to help the child breathe.
o
Treatment of croup
• Keep calm – panic will distress the child and make the attack worse.
• Sit the child up and reassure them.
o
Call the doctor.
• If the attack is severe, does not ease, or the child has a temperature,
dial 999 for a n ambulance.
NEVER put your fingers down the
throat of a child that appears to
be suffering from croup. There is
a small chance that the condition
could be ‘epiglottitis ‘. If this is the
case, the epiglottis may swell even
more, totally blocking the airway.
ID Airway and breathing problems
“The contrasting difference between
asthma and hyperventilation is the
large volumes of air that con be
heard entering the lungs of the
hyperventilating patient, compared
with the tight wheeze of the
asthmatic”
Hyperventilation
‘Hyperventilation’ means ‘excessive breathing’. When we breathe in, there is only a trace of
carbon dioxide in the air. When we breathe out, we breathe out 4% carbon dioxide.
Hyperventilating results in low levels of carbon dioxide in the blood, which causes the signs
and symptoms of this condition.
A hyperventilation attack can often result from the patient being very anxious, from a panic
attack or sudden fright. The condition of hyperventilation is often mistaken for ‘asthma’.
Asthmatics may hyperventilate after their inhalers have taken effect (opening the airways),
The contrasting difference in the two conditions is the large volumes of air that can be heard
entering the lungs of the hyperventilating patient, compared with the tight wheeze of
the asthmatic.
Possible signs and symptoms
• Unnaturally deep, fast breathing,
• Attention seeking behaviour.
• Dizziness, faintness.
Feeling of a ‘tight’ chest.
• Cramps in the hands and feet.
• Flushed skin, n o cyanosis.
• Pins and needles in the arms and hands.
• The patient may think they cannot breathe.
• If the attack is prolonged, the casualty may pass out and stop breathing for up to 30 seconds,
Treatment of hyperventilation
• Be firm and calm, but reassuring with the casualty.
o
Move them to a quiet place with few people around.
Explain to the casualty that they are hyperventilating,

‘Coach’ the casualty’s breathing,
• Asking the patient to take tiny sips of water will reduce the number of breaths they can take,

Breathing through the nose will reduce the loss of carbon dioxide, but the casualty will
need lots of reassurance.
• Call for medical advice if the attack is prolonged or you are in doubt.
Drowning
Contrary to popular opinion, a casualty who drowns does not usually inhale large amounts
of water into the lungs. 90% of deaths from drowning are caused by a relatively small
amount of water entering the lungs, interfering with oxygen exchange in the alveoli ( wet
drowning), The other 1 0% are caused by muscle spasm near the epiglottis and larynx
blocking the airway (dry drowning), The casualty will usually swallow large amounts of
water, which might then be vomited as they are rescued or resuscitation takes place.
It should be remembered that other factors may contribute to the cause of drowning -
for example hypothermia, alcohol, or an underlying medical condition such as epilepsy or
heart attack,
Secondary drowning
If a small amount of water enters the lungs, irritation is caused and fluid is drawn from the
blood into the alveoli. This reaction could be delayed for several hours, so a casualty who
has been resuscitated and ‘apparently recovered’ might relapse into severe difficulty
breathing at a later stage. It is for this reason that any casualty who recovers from ‘near
drowning’ should be taken to hospital immediately.
NEVER enter the water to rescue a
drowning cosualty unless you have
been trained to do so, Try to reach
them with a rope or stick, ar throw
them an object that will float.
“Reach or throw – don’t GO”
Treatment of drowning
Do not put yourself at risk, ‘Reach or throw – don’t GO’ ,
• If possible keep the casualty horizontal during rescue, as shock can occur.
• Check Airway and Breathing, – Perform CPR if necessary (page 6 to 8).
• Dial 999 for an ambulance, even if the casualty appears to recover.
o
Airway and breathing problems fJI
Collapsed lung / sucking chest wound
Each lung is surrounded by 2 layers of membrane called the ‘pleura’. Between these
2 membranes is the ‘pleural cavity’, containing a very thin layer of ‘serous fluid’, which
enables the two layers to move against each other as we breathe.
In a penetrating chest injury, where the outer layer of the pleura is damaged, air can be
sucked from the outside of the chest into the pleural cavity, causing the lung to collapse
(pneumothorax).
In any serious chest injury, the inner layer of the pleura could become perforated. Air may
then be drawn from the lung into the pleural cavity, again causing the lung to collapse .
Collapsed lung.
If air continues to be sucked into the pleural cavity, but cannot escape, pressure in the
collapsed lung can build (tension pneumothorax). This pressure build up can squeeze the
heart and the uninjured lung, making it difficult for both to function.
Possible signs and symptoms
• Severe difficulty breathing. • Cyanosis of lips and skin.
• Painful breathing. • Pale, clammy skin.
• Fast, shallow breathing. • Uneven chest movements – the injured
side of the chest may not rise.
If there is a sucking chest wound:
• Sound of air being drawn into the
wound, with bubbling blood.
• Crackling feeling of the skin around the
injury (because of air entry).
Treatment
• Immediately cover a sucking chest wound with your hand (or the casualty’s hand if they
are conscious) to prevent air entry.

Dial 999 for an ambulance – send someone to do this if possible.
• Place a sterile pad over the wound, then cover it with plastic, cling film, kitchen foil or
other air tight covering.
• Tape the air tight covering on 3 sides. The dressing should prevent air from entering the
wound, but still allow air to get out.
• If the casualty becomes unconscious: open the Airway, check Breathing and resuscitate
if necessary. Place them in the recovery position with the injured side lowest. This will
help to protect the uninjured lung.
T
ape the air tight covering on 3 sides.
The dreSSing should prevent air from
entering the wound, but still allow
air to get out.
Flail chest
This is a condition where the ribs surrounding the chest have become fractured in several
places, creating a ‘floating’ section of the chest wall.
As the casualty breathes, the rest of the chest wall moves out, but the flail segment moves
inwards. As the chest wall moves back in, the flail segment moves outwards. These are called
‘paradoxical’ chest movements.
Possible signs and symptoms
• Severe difficulty breathing.
• Shallow, painful breathing.
• Signs and symptoms of a fracture (page 38).
• ‘Paradoxical’ chest movements (see above).
Treatment
• Dial 999 for an ambulance.
• Place the casualty in the position they find most comfortable – sat up, inclined towards
the injury if possible.
• Place large amounts of padding over the flail area.
• Place the arm on the injured side in an elevated sling. Squeeze the arm gently against
the padding to provide gentle, firm support to the injury.
Place padding over the flail area and
place the arm on the injured side in an
elevated sling.
• Circulation problems
The circulatory system
Deoxygenated Blood
D
Head & Arms

Oxygenated Blood
_
_
JugularVein from Head _ _ _ _
-’>.
_
_
_
_
::…- _ _ _
_ Carotid Artery to Head
,
_
_
_
_
Subclavian Vein from Arlms _ _ _ _ –.:
,£-
Superior Vena <:.ava _ _ _ _ _
_
_
_
_

+
_
_
_
_
Pulmonary Artery _ _ _ _
� – – – – Subclaviian Artery to Arms
- – – – -
—’ -I
‘r-
_
r-If——’�- Aorta

_
\-
_
_
_
_
_
_
_
_
_
_
_
Right Lung

_
_
_
Pulmonary Veins _ _ _ _
Right Atrium
_
_
_
_
_
_
_
_
_
L’ert Lung
Left Atrium
_
_
_
_
_
_
_
_
Right Ventricle _ _ _ _
_ _ _ -’
Inferior Vena Cava

;:- – – – – Desce,nding Aorta
- – – -
f—— Hepatic Artery
-+ J
–+
_
_
_
_
Hepatic Vein _ _ _ _
{��I;��
Intestines
Hepatic Portal Vein
Renal Vein
-t
-t
-
-
-
-
-

-
-
-
-
-
� =-
=
-
f—– Mesenteric Artery

f—– Renal Artery
Femoral Vein
Capillaries
–.J
‘-
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
/
Femoral Artery
Circulation problems •
The circulatory system
The circulatory system consists of a closed network of tubes (arter
ies, veins and capillaries)
connected to a pump (the heart).
Arteries
Veins
Carry blood away from the heart. They have strong, elastic, muscular walls
which are able to expand as blood from the heart beating surges through.
The largest artery, which connects directly to the heart, is called the ‘aorta’.
Carry blood towards the heart. They have thinner walls than arteries because
the blood in them is under less pressure. They have one-way valves, which
keep blood flowing towards the heart. The largest veins, which connect to the
heart, are called ‘vena cava’.
left
Atrium
Right
Atrium
left
Ven tr
icle
Right
Ven tr
icle
Capillaries Are the tiny blood vessels between the arteries and veins which allow the
transfer of oxygen, carbon dioxide and nutrients in and out of the cells of the
body.
The Heart
How blood flo ws thoug h the f
our
chamb ers of the heart.
Is a four-chambered pump. The left and right sides of the heart are separate.
The left side takes blood from the lungs and pumps it around the body. The
right side takes blood from the body and pumps it to the lungs.
The two sides of the heart are separated into two chambers called the ‘atria’
and the ‘ventricles’. The atria are the top chambers which collect blood as it
returns from the lungs and the body and pump it to the ventricles. The
ventricles then pump the blood out of the heart, to the lungs and around
the body.
The blood
60% of the blood consists of a clear yellow fluid called plasma. Suspended within the plasma
are red blood cells, white blood cells, platelets and nutrients.
Red Cells
Contain haemoglobin, which carries oxygen for lIse by the cells of the body.
Red cells give the blood its colour.
Feeling the carotid pulse.
White Cells Fight infection.
Platelets Trigger a complicated chemical reaction if a blood vessel is damaged, forming
a clot.
N utrients Are derived from the food by the digestive system. When combined with
oxygen in the cells of the body, they provide vital energy, keeping the cell
alive.
• The blood carries carbon dioxide (the waste gas produced by the cells) mainly in the form
of ‘carbonic acid’. Carbonic acid is diluted within the plasma.
• The blood also circulates heat (generated mostly by the liver) around the body. Heat is
carried to the skin by the blood if the body needs to be cooled.
Feeling the radial pulse.
The pulse
Every time the heart contracts a pulsation of blood is pumped through the arteries.
The walls of the arteries are elastic and expand as the blood flows rhythmically through. This
expansion can be felt at the points where arteries come close to the skin.
When checking a pulse use the pads of the fingers, not the thumb (which has i ts own pulse).
The First Aider should make a note of the following:
Rate Is it fast or slow? How many beats are there per minute?
Rhythm Are the beats regular? Are there any ‘missed’ beats?
Strength Does the pulse feel strong or weak?
Feel
ing the brachial pulse
on a baby:
The main pulse locations for first aid use are in the neck (carotid pulse), the wrist (radial pulse)
and the upper arm (brachial pulse).
Capillary refill
Circulation to the end of an arm or leg can be checked by squeezing the tip of a finger or toe.
The skin will become pale when it is squeezed – if the circulation is effective, the colour should
return within 2 seconds of releasing it (this may take longer if the hands or feet ore cold).
90 – 1 10 beats / minute
1 1 0 – 140 beats / minute
ID Circulation problems
Angina
Angina (angina pectoris) is a condition usually caused by the build up of a cholesterol plaque
on the inner lining of a coronary artery. Cholesterol is a fatty chemical which is part of the
outer lining of cells in the body. A cholesterol plaque is a hard, thick substance caused by
deposits of cholesterol on the artery wall. Over time, the build up of the plaque causes
narrowing and hardening of the artery.
During exercise or excitement, the heart requires more oxygen, but the narrowed coronary
artery cannot increase the blood supply to meet this demand. As a result an area of the heart
will suffer from a lack of oxygen. The patient will feel pain in the chest (amongst other
symptoms) as a result.
Angina.
Typically, an angina attack occurs with exertion, and subsides with rest. If the narrowing of the
artery reaches a critical level, angina at rest (called ‘unstable angina’) may result. A patient with
angina, especially ‘unstable’ angina has a high risk of suffering a heart attack in the near future.
Blood clot
Heart attack
Heart attack (myocardial infarction) is often caused when the surface of a cholesterol plaque
in a coronary artery cracks and has a ‘rough surface’. This can lead to the formation of a
blood clot on the plaque, which completely blocks the artery resulting in the death of an
area of the heart muscle.
Heart attack.
Unlike angina, the death of the heart muscle from heart attack is permanent and will not be
relieved by rest.
Possible signs and symptoms
It should be remembered that every heart attack is different. Only a few of the signs and
symptoms may be present, indeed up to a quarter of heart attacks suffered are ‘silent’
without any chest pain.
Angina
Coronary
“”‘ ,”,”” – Artery
� -
Sudden, usually during
Onset
Blood Clot
“‘; ,, /t-
“-I �

Area of
dying heart
muscle
Heart Attack
exertion, stress
Sudden, can occur at rest.
or extreme weather.
‘Vicelike’ squashing pain,
Pain
V
icelike’ squashing pain,
often described as ‘dull’, often described as ‘dull’,
‘tightness’ or ‘pressure’ ‘tightness’ or ‘pressure’
on the chest. Can be
A typical heart attack.
on the chest. Can be
mistaken for indigestion. mistaken for indigestion.
Central chest area.
Location of Pain
Duration
Skin
Central chest area.
Can radiate into either arm Can radiate into either arm
(more commonly the left), (more commonly the left),
the neck, jaw, back, the neck, jaw, back,
or shoulders. or shoulders.
Usually lasts 3 to 8 Usually lasts longer
minutes rarely longer. than 30 minutes.
Pale, may be sweaty.
Pale, grey colour.
May sweat profusely.
Variable, depending on which area has a lack of
oxygen. Often becomes oxygen. Often becomes
irregular, missing beats.
Pulse
Variable, depending on
which area has a lack of irregular, missing beats.
Other Signs Shortness of breath,
and Symptoms weakness, anxiety.
Factors Resting, reducing stress,
Giving Relief taking ‘G.T.N.’ medication.
Shortness of breath, dizziness,
nausea, vomiting. Sense of
‘impending doom’.
‘G.T.N.’ medication
may give partial
or no relief.
Circulation problems .,
Treatment of angina and heart attack
• Sit the casualty down and make them comfortable. Do not allow them to walk around.
A half sitting position is often the best.
• Allow the casualty to take their own glyceryl tri-nitrate (G. T.N.) medication if they have it.
• Reassure the casualty. Remove any cause of stress or anxiety if possible.
• If you suspect heart attack – check the casualty is not allergic to aspirin, older than 1 6
and not already taking ‘anti-coagulant’ drugs (such as warfarin). If this is the case,
allowing them to chew an aspirin tablet slowly may be beneficial. If you are unsure
however, wait for the ambulance crew to arrive (see note, below right).
NOTE:
Aspirin reduces the clotting ability of the blood. Chewing the tablet allows the drug to
absorb quickly into the blood through the skin of the mouth, so it works faster. The ideal dose is
a 300mg aspirin, but ony strength will do.
• Monitor the casualty – if a heart attack victim becomes unconscious it is very likely that
the heart has stopped altogether, so be prepared to perform CPR! (See pages 6 and 7).
Dial
999 for
an ambulance if:
• You suspect a heart attack.
• The casualty has not been diagnosed as having angina.
A half sitting position
is often the best.
NOTE: A first aider is not allowed
to ‘prescribe’ drugs to a patient.
A fully conscious adult casualty
is, however, more than capable of
deciding whether or not they want to
take medication that may help them.
• The symptoms are different, or worse than the patients’ normal angina attacks.
• Angina pain is not relieved by the patients’ medication and rest after 1 5 minutes.
• You are in any doubt.

Left vent ricular failure
Left ventricular failure (LVF) is a condition where the left ventricle of the heart (see page 23)
is not powerful enough to empty itself. The right chamber of the heart is still working
properly and pumping blood into the lungs. This results in a ‘back pressure’ of blood in the
pulmonary veins and arteries of the lungs. Fluid from this back pressure of blood seeps into
the alveoli (see page 15) causing severe difficulty in breathing.
The condition can be caused by heart attack, chronic heart failure or high blood pressure.
Patients with chronic heart failure often suffer attacks during the night.
Possible signs and symptoms
• Severe difficulty in breathing.
• Crackly, often wheezy breathing (fluid on in the lungs).
• Pale sweaty skin.
• Cyanosis (blue grey tinges to skin and lips).
• Coughing frothy, blood stained sputum.
• Possibility of the signs and symptoms of heart attack.
• The patient needs to sit up to breathe.
• Anxiety, confusion, diuiness.
Treatment
• Sit the patient up, feet dangling.
o
• Dial 999 fo r an ambulance.
• Allow the patient to take their own glyceryl tri-nitrate (G. T.N.) medication if they have it.
• Be prepared to resuscitate – the condition can quickly deteriorate.
Typical G. T.N. medication that an
angina patient may carry.
ID Circulation problems
Shock
To most people the word shock means an unpleasant surprise, an earthquake, or what
happens if you mess about with the electrics!
The medical term shock is defined as ‘inadequate tissue perfusion, caused by a fall in blood
pressure or blood volume.
r
‘Inadequate tissue perfusion’ means an inadequate supply of oxygenated blood to the tissues
of the body.
Now that you understand what shock is, you can understand why it can quickly result in
death if not treated.
The more common causes of ‘life threatening’ shock are:
• Hypovolaemic Shock
• Cardiogenic Shock

Normal Circulation
Anaphylactic Shock
Hypovolaemic shock
Hypo means low
aemic means
vol means volume
blood
This type of shock is caused by loss of body fluids, which results in a low volume of blood.
Typical causes of hypovolaemic shock are:
• External bleeding (pages 29 and 30).
• Internal bleeding (page 32).
• Burns (pages 34 and 35).
• Vomiting and diarrhoea (loss of body fluids).
• Excessive sweating.
Hypovolaemic Shock
Possible signs and symptoms
(see also blood loss: page 29)
The first response is release of adrenaline – this will cause:

A rise in pulse rate.
• Pale, clammy skin (for dark skinned casualties
look at the colour of skin inside the lips).
As the condition worsens:
• Fast, shallow breathing.
• Nausea or vomiting.
• Rapid, weak pulse. • Dizziness, weakness.
• Cyanosis (grey blue tinges to skin and lips). • Sweating.
As the brain suffers a lack of oxygen:
• Deep, sighing breathing (oir hunger).
• Unconsciousness.
• Confusion, anxiety, even aggression.
Treatment
• Treat the cause of the shock (e.g. external bleeding).
o
• •
lay the casualty down
and raise the legs in the air.
Lay the casualty down and raise their legs in the air, returning blood to the vital organs
(take core if you suspect 0 fracture).
Dial 999 for an ambulance.
• Keep the casualty warm. Place a coat or blanket under the patient if they are on a cold
surface, but take care not to overheat them (as that would dilate blood vessels, causing the
blood pressure to fall even more).

NOTE: lay a heavily pregnant patient
down leaning towards her left hand
side, to prevent the baby restricting
blood flow back to the heart.
Do not allow the patient to eat, drink or smoke.
• Loosen tight clothing around the neck, chest or waist.
• Monitor breathing, pulse and levels of response.
• Be prepared to resuscitate.
Circulation problems ..
Cardiogenic shock
This is a fall in the blood pressure, caused by the heart not pumping effectively. This is the
most common type of shock.
Typical causes of cardiogenic shock are:
• Heart attack (page 24). • Tension pneumothorax (page 21).
• Cardiac failure (page 25). • Cardiac arrest (page 6).
• Heart valve disease.
Possible signs, symptoms and t reatment
Cardiogenic Shock.
See ‘Heart Conditions’ (pages 24-25).
Anaphylactic shock
Anaphylaxis is an extremely dangerous allergic reaction caused by a massive over-reaction
of the body’s immune system (see page 1 8).
An anaphylactic reaction can cause shock because the large quantity of histamine released
in the body makes:

C-r-
f

J
-
Blood vessels dilate (causing a fall in blood pressure).
• Blood capillary walls become ‘Ieaki (causing a fall in blood volume).
• The strength of the heart’s contractions weaker (causing a fall in blood pressure).
Possible signs, symptoms and treatment
Anaphylactic Shock.
See ‘Anaphylaxis’ (page 18)
Fainting
Fainting is caused by poor nervous control of the blood vessels and heart.
When a casualty faints, the blood vessels in the lower body dilate and the heart becomes
slow. This results in the blood pressure falling and the patient has a temporary reduction in
blood supply to the brain.
Typical causes of fainting are:

Pain or fright.
• Lack of food.
• Emotional stress.

Long periods of inactivity
(such as standing or sitting).
• Heat exhaustion (page 44).
Possible signs and symptoms
• Temporary loss of consciousness,
falling to the floor.
• Slow pulse.
• Pale, clammy ski n.
• Before the faint the casualty may have
suffered nausea, stomach ache, blurred
vision or dizziness.
Fainting:
The heart slows and
blood vessels dilate.
• Quick recovery.
Treatment of fainting
• Lay the casualty down and raise their legs in the air, returning blood to the vital organs.
• Check Airway and Breathing (page 6).
• Remove causes of stress, crowds of people and allow plenty of fresh air.
• Reassure the casualty as they recover. Do not allow the � to sit up suddenly.
• If they feel faint again, repeat the treatment. Look for an underlying cause.

If the casualty does not recover quickly or you are unsure: check airway and breathing again
(page 6), place them in the recovery position (page 1 1) and dial 999 for an ambulance.
Fainting – lay the casualty dawn
and raise the legs in the air.
• Circulation problems
Hygiene when dealing
with wounds
Wounds and bleeding
o Protect yourself by covering your A wound can be defined as an abnormal break in the continuity of the tissues of the body.
own cuts and abrosions with a Any wound will to some extent result in bleeding, either internally or externally. If blood
waterproof dressing, especially loss is severe, this could result in shock (page 26), so urgent treatment would be necessary.
on your arms and hands. This chapter deals with the different types of wound, the complications that may occur and
their treatment.
o Wear disposable protective gloves Types of wound and basic treatment
and an apron when you are
giving first aid.
o
o
o
o
Use specialised cleaning agents
for cleaning up body fluid
spillages. Follow the instructions
on the container and use
disposable towels.
Dispose of soiled dressings in
a yellow ‘clinical waste’ bag.
Destroy by incinerotion (send
the bag to hospital with the
casualty if you have no clinical
waste facilities).
Wash your hands thoroughly
before and after dealing with
a patient.
If you regularly deal with body
fluids, ask your doctor about
vaccinations against Hepatitis ’8′.
Contusion
A brui se. Ca used by rup tured capillaries bleeding under the skin . T s may
hi
have been the cause of a blunt blow, or by bleeding from under/ying
damage, such a s a frac ture.
• Cool the area with an ice pack or running water as soon as possible.
Abrasion
A groze. The top layers of skin are scraped off, usually as the resul t of a
friction bum or sliding f
all. Often containing particles of dirt, which could
cause infec tion.
• Dirt that is not embedded should be removed using clean water and
sterile swabs.
• Clean from the centre of the wound outwards, so as not to introduce
more dirt into the wound.
Laceration
A rip or tear of the skin . More likely to have particles of dirt than a clean cut,
although usually bleeds less.
o
Incision
A clean cut. Usually caused by a sha rp object such a s a knife. Deep w
ounds
may involve complication s such a s severed ten dons or blood vessels. T s
hi
type of w
ound could ‘gape open ‘ a n d bl eed profusely.
o
Puncture
Treat for bleeding (page 30) and prevent infection.
Treat for bleeding (page 30) and prevent infection.
A stabbing w
ound. C
ould be as 0 resul t of standing on a nail or being
s tabbed. T
he wound could be very deep and yet appear ver y small in
diameter. Damage may be caused to underlying orga n s such as the heart or
l ungs and severe in ternal bl eeding may occur.
o
Dial 999 for an ambulance if you suspect damage to underlying
organs or internal bleeding.

Gun Shot
Never remove an embedded object – it may be stemming bleeding
and further damage may result.
Ca used by a bullet or other missile, which may be travelling a t such speed
a s to dri ve into a n d then exi t the body. A small entry w
ound could be
accompanied by a large ‘cra ter’ exi t w
ound. Severe bleeding and damage to
organs usually resul ts.
o Dial 999 for Police and Ambulance.
o Treat Airway and Breathing problems first (pages 6 to 8).
• Pack the wound with dressings and try to prevent bleeding.
Amputation
Complete or partial severing of a limb.
o
De-gloved
See treatment of amputation (page 32).
S evering of the skin from the body, resulting in ‘creasing’ or a flap of skin,
l eaving a bare a rea of tissue. Ca used by the f ce of th e injuring objec t
or
sliding along the length of the skin .
o
Put the skin back in place if possible.
• Arrange urgent transport to hospital.
Wounds and bleeding •
Blood loss
How much blood do we have?
The amount of blood in our body varies in relation to our size. A rough rule of thumb is that
we have approximately one pint of blood per stone in body weight (0.5 litre, per 7kg), so
the average adult has between 8 and 12 pint’ (4.5 to 6.5 litre,) of blood, dependent on their
size (but the rule doesn’t work for someone who is overweight).
Remember that children have less blood than adults, and as ,uch cannot afford to loo,e the
same amount – a baby only has around 1 pint of blood, ‘a can only loose 1 /3 of a pint
before the blood pressure falls (,ee below).
Types of bleeding
Arterial Blood in the arteries is under direct pressure from the heart pumping and
spurts in time with the heart beat. A wound to a major artery could result in
blood ‘spurting’ several metres and the blood volume will rapidly reduce.
Blood in the arteries is rich in oxygen and is said to be ‘bright red’, however this
can be difficult to assess. The most important factor is how the wound bleeds.
Venous Veins are not under direct pressure from the heart, but veins carry the same
volume of blood as the arteries. A wound to a major vein may ‘ooze’ profusely_
Capillary Bleeding from capillaries occurs in all wounds. Although the flow may appear
fast at first, blood loss is usually slight and is easily controlled. Bleeding from a
capillary could be described as a ‘trickle’ of blood.
Effects of blood loss
8/umi
\’(>ssf’ls
The table below show the effects, signs and symptoms of blood loss. Volumes of blood lost
are given as a percentage, because we all have different amounts of blood.
1<.
Hellr! 120
As you can see, a loss of 300 0 of blood volume is critical – the patient’s condition rapidly
/
deteriorates from this point onwards. Blood vessels cannot constrict any further and
the heart cannot beat any faster, so blood pressure falls, resulting in unconsciousness and
then death.
R(lft’
100
“”�===:;:
t
8/00/1
“resSllre
• Any patient with blood loss over 1 0% should be treated for shock (page 26).
See also: Hypovolaemic shock (page 26)
Hypoxia (page 14)
Hiuml Luss ..
Consciousness Nonmal May feel dizzy stood up Lowered levels of
consciousness. Restless,
anxious
Skin Nonmal Pale Cyanosis (blue grey tinge,
to the lip’ and ,kin),
cold and clammy
Nonmal
Pulse (this is the amount Slightly raised Rapid (over 100 per min)
normally donated) hard to detect
Breathing Nonmal Slightly raised Rapid
ID Wounds and bleeding
-
Treatment of exte rnal bleeding
+
The aims of treatment for external bleeding are firstly to stop the bleeding, preventing the
casualty from going into shock (page 26), and then to prevent infection.
S.E.E.P. will help you to remember the steps of treatment:
Sit or lay
Examine
Elevate
Pressure
NEVER try to stop bleeding by
tying a band around the limb
(a tourniquet) – it may cause tissue
damage or make the bleeding worse.
Sit or lay the casualty down. Place them in a position that is appropriate
to the location of the wound and the extent of their bleeding.
Examine the wound. Look for foreign objects and note how the wound is
bleeding. Remember what it looks like, so you can describe it to medical
staff when it’s covered with a bandage.
Elevate the wound. Ensure that the wound is above the level of the heart,
using gravity to reduce the blood flow to the injury.
Apply direct or indirect pressure to stem bleeding:
Direct p ressure
The best way to stem bleeding is by applying direct pressure over the wound. Immediate
pressure can be applied with the hands, however you should take precautions to prevent
yourself from coming into contact with the patient’s blood, preferably by wearing
disposable gloves. The pressure should be continuous for 1 0 minutes. A firm bandage (not
so tight as to stop circulation to the limb altogether!) is usually sufficient to stop bleeding from
most minor wounds. If there is an embedded object in the wound, you may be able to apply
pressure at either side of the object.
Indirect pressure
If direct pressure for a wound on a limb is not possible or effective, indirect pressure can be used
as a last resort. Pressure can be applied to the artery supplying the limb, squashing it against a
bone and reducing the blood flow. Apply indirect pressure for a maximum of 1 0 minutes.
The two main indirect pressure points are:
Brachial Pressure is applied to the brachial artery, which runs on the inside of the
upper arm. One way of doing this is to get the patient to make a fist with
their opposite hand, place it under their arm pit and squeeze the injured
arm down onto the fist.
Femoral Pressure is applied to the femoral artery, which is located where the thigh
bone (femur) crosses the ‘bikini line’. Take care to explain your actions.
One way of doing this is to use the heel of your foot to apply the pressure.
Indirect Pressure Points
Dressings
A dressing should be sterile and just large enough to cover the wound. It should be
absorbent and preferably made of material that won’t stick to the clotting blood (a ‘non­
adherent’ dressing).
A firmly applied dressing is sufficient to stem bleeding from the majority of minor wounds,
but the dressing should not restrict blood flow to the rest of the limb (check the circulation
with a ‘capillary relill’ test, page 23)
Extra pressure ‘by hand’ and elevation may be necessary for severe bleeding. If the dressing
becomes saturated with blood, keep it in place and put another larger dressing on top. If
this doesn’t work take the dressings off and start again.
Wounds and bleeding G
-
Embedded objects
+
Objects embedded in a wound:
An object embedded in a wound (other than a small splinter) should not be removed as it
may be stemming bleeding, or further damage may result.
Use sterile dressings and bandages to ‘ build up’ around the object. This will apply pressure
around the wound and support the object. Send the casualty to hospital to have the object
removed.
Splinters:
If a splinter is embedded deeply, difficult to remove or on a joint, leave it in place and follow
the advice for embedded objects above. Other splinters can be removed as follows:
• Carefully clean the area with warm soapy water.
• Using a pair of clean tweezers, grip the splinter as close to the skin as possible. Gently
pull the splinter out at the same angle that it entered.
• Gently squeeze around the wound to encourage a little bleeding. Wash the wound
again, then dry and cover with a dressing.
• Seek medical advice to ensure the casualty’s tetanus immunisation is up-ta-date.
Objects embedded in the nose, ear or other orifice:
Do not attempt to remove anything that someone has got stuck in their ear, nose or other
orifice. Take them to hospital where the professionals can remove it safely.
-
Nose bleeds
+
Weakened or dried out blood vessels in the nose can rupture as a result of a bang to
the nose, picking or blowing it. More serious causes could be high blood pressure or a
fractured skull.
• Sit the patient down, head tipped forward.
• Nip the soft part of the nose. Maintain constant pressure for 1 0 minutes.
• Tell the patient to breathe through the mouth.
• Give the patient a cloth to mop up any blood whilst the nose is nipped.
• Advise the patient not to breathe through or blow their nose for a few hours after
bleeding has stopped.
• If bleeding persists for more than 30 minutes, or if the patient takes ‘anti�coagulant’ drugs
(such os warfarin), take or send them to hospital in an upright position.
• Advise a patient suffering from frequent nosebleeds to visit their doctor.
-
Eye injury
+
Small particles of dust or dirt can be washed out of an eye with cold tap water. Ensure the
water runs away from the good eye.
For a more serious eye injury:
• Keep the casualty still and gently hold a soft sterile dressing over the injured eye. This can
be carefully bandaged in place if necessary.
• Tell the casualty to close their good eye, because any movement of this will cause the injured
eye to move also. If necessary bandage the good eye to stop the casualty using it. Lots of
reassurance will be needed!
• Take the casualty to hospital. Dial 999 for an ambulance if necessary.
For chemicals in the eye:
• Wear protective gloves. Wash with copious amounts of clean water, ensuring the water
runs away from the good eye. Gently but firmly try to open the casualty’s eyelid to
irrigate the eye fully. Dial 999 for an ambulance.
D Wounds and bleeding
-
+
Amputation
Amputation is the complete or partial severing of a limb, and is extremely traumatic for the
casualty. Your priorities are to stop any bleeding, to carefully preserve the amputated body
part and to reassure the casualty.
• Treat the casualty for bleeding (page 3 0)
and for shock (page 26).
• Dial 999 for a n a mbulance.
• Dress the casualty’s wound with a
‘Iow-adherent’, non-fluffy dressing.
• Wrap the amputated part in a plastic
bag, and then put the package on a
bag of ice to preserve it.
Do not allow the amputated part to
come into direct contact with the ice
or get wet.
Crush injury
Crush injuries most commonly occur as a result of building site or traffic accidents. If the
blood flow to a limb (e.g. an arm or a leg) is impaired by the weight of a crushing object,
there is a danger of toxins building up in the muscle tissues below the site of the crushing.
If the blood flow to the limb is impaired for 1 5 minutes or more, the toxins will build up so much
that if they are released into the rest of the body (which will happen when the crushing object is
removed) they may cause kidney failure. This is called ‘crush syndrome’ and may result in death.
Expert medical care is needed when releasing the patient if the blood flow has been
impaired for 1 5 minutes or more.
Treatment for crushing less than 1 5 minutes
o
• Release the casualty as quickly as • Treat for shock if necessary (poge 26),
possible if you can. taking care not to move injuries.
• Dial 999 for an ambulance. • Monitor Airway and Breathing until
help arrives.
• Control any bleeding and cover
open wounds.
Treatment fo r crushing more than 1 5 minutes
• DO NOT release the casualty.
• Dial 999 for an ambulance. Give clear
information about the incident.
o
• Monitor Airway and Breathing until
help arrives.
Inte rnal bleeding
Internal bleeding is a very serious condition, yet can be very difficult to recognise in its early
stages. Internal bleeding can be as a result of injury, such as lung or abdominal injuries, yet
can also happen ‘spontaneously’ to an apparently well patient, such as bleeding from a
stomach ulcer or a weak artery.
Although blood may not actually be lost ‘externally’ from the body, it is lost out of the
arteries and veins, so shock can quickly develop.
Other serious life threatening complications can occur from internal bleeding, such as a
brain haemorrhage or bleeding into the lungs.
Possible signs and symptoms
You should suspect internal bleeding if signs of shock (see pages 26 and 29) are present,
but there is no obvious cause, such as external bleeding.
There may be:
• Signs of SHOCK (page 26). • Bruising and/or swelling.
• Pain, or a history of recent pain at the • Other symptoms related to the site of
bleeding (e.g. difficulty breathing if the
bleeding is in the lung).
site of bleeding.
Treatment of internal bleeding

Dial 999 for an ambulance.
• Treat the casualty for shock as
necessary (page 26).
o
Poisons, burns and scalds •
Poisons
A poison can be described as any substance (solid, liquid or gas) that causes damage when
it enters the body in a sufficient quantity.
Poisons can enter the body i n 4 ways, they can be:
Ingested Swallowed, either accidentally or on purpose.
Inhaled Breathed in, accessing the blood stream very quickly as it passes through
the alveoli.
Absorbed Through the skin (see chemical burns, page 35).
Injected Through the skin, directly into tissues or a blood vessel.
A poison can either be:
Corrosive
Such as: acids, bleach, ammonia, petrol, turpentine, dishwasher powder, etc.
OR
Non-Corrosive Such as: tablets, drugs, alcohol, plants, perfume ete.
Possible signs and symptoms
The signs and symptoms of poisoning are wide, varied and dependent on the substance.
Look for clues such as:
• Containers or bottles. • Syringe or drug taking equipment.
• Tablets or drugs. • Smell on the breath.
Other signs that can accompany poisoning may be:
• Vomiting or retching. • Confusion or hallucination.
• Abdominal pains. • Headache.
• Burns (or burning sensation) around the • Unconsciousness, sometimes fitting.
entry area.
• Breathing problems.
• Cyanosis.
Treatment
o
For a corrosive substance:
Get the casualty to rinse out their
mouth, then give frequent sips
of milk or water.
• Don’t endanger yourself – make sure it’s safe to help.
• Dilute the substance or wash it away if possible:
• Substances on the skin – see chemical burns (page 35).
• Ingested Substances – get the casualty to rinse out their mouth, then give frequent
sips of milk or water.
• Dial 999 for an ambulance. Give information about the pOison if possible.
Take advice from the ambulance operator.
• If the casualty becomes unconscious – open the Airway and check for Breathing.
Resuscitate as necessary using a protective face-shield (pages 6 to 8). If the casualty is
breathing effectively, place them in the recovery position, then dial 999 for an
ambulance.
For a non-corrosive substance:
• Dial 999 for an ambulance. G ive information about the poison if possible.
Take advice from the ambulance operator.
• If the casualty becomes unconscious – open the Airway and check for Breathing.
Resuscitate as necessary using a protective face-shield (pages 6 to 8). If the casualty is
breathing effectively, place them in the recovery position, then dial 999 for an
ambulance.
NEVER make the patient vomit.
This may put the airway in danger
It helps the Paramedics if you:
• Pass on containers, or other
information about the substance.
• Find out how much has
been taken.
• Find out when it was taken.
• Keep samples of any vomit for
D Poisons, burns and scalds
Burns and scalds
Estimating the severity of a burn
There are 5 factors that combine to affect the severity of a burn:
S ize
Cause
Age
An area equal to the size of the palm
of the patient’s opened hand
(including fingers) is equal to
1 % of their body area.
Location
Depth
The larger the area of the burn, the more severe. The size of the burn is
given as a percentage of the body’s surface area. An easy way to work this
out is to compare the size of the burn with the patient’s hand. An area
equal to the size of the palm of the patient’s opened hand (including
fingers) is equal to 1 % of their body area.
The cause of the burn, as previously described in this chapter, will
influence the overall severity – for example, electrical burns may leave a
patient with deep internal burns. Some chemicals (such as hydrofJuoric
acid) could cause poisoning i n addition to burns.
The age of the patient will affect the recovery rate and severity. Babies and
young children will burn at lower temperatures than adults. Elderly patient’s
burns take longer to heal and they may be more susceptible to infection.
The location of the burn can affect the severity – in particular burns to the
airway of a patient by inhaling hot gasses can be an instant killer. Burns to
the eye may result in blindness.
The deeper the burn, the more severe. See depth of burns below.
Depth of burns
The skin consists of 3 layers – the ‘epidermis’ on the outside, the ‘dermis’ beneath, which lies
on a layer of ‘subcutaneous’ fat.
The depth of burns can be defined as:
Superficial This involves only the outer epidermis layer, and most commonly occurs
from scalds. The burn looks red, sore and swollen.
I ntermediate This affects both the epidermis and the dermis layers of skin. The burn
looks raw and blisters will form.
Ful! Thickness The layers of skin are burned away to the subcutaneous fat layer or
beyond. The burn may look pale, charred or waxy. The nerve endings will
be burned away, so pain in this area may be absent, misleading both you
and the patient.
Causes of burns and treatment
+
The different causes of burn can be separated in to 5 areas. The treatment for the burn
can differ slightly depending on the cause:
Electric burns
NEVER burst blisters (the layer of
skin is protecting against infection)
NEVER touch the burn.
NEVER apply lotions, ointments
or fats – they might introduce
infection, and would need to be
removed in hospital.
NEVER apply adhesive tape or
dressings – the burn may be
larger than it first appears.
NEVER remove clothing that has
stuck to the burn.
Caused by heat that is generated by an electrical current flowing through the tissues of the
body. You may be able to see a burn where the current entered the body, and at the point of
exit. There may be deep internal burns which are not visible along the path of the current flow.
The extent of the internal burns can be estimated by the severity of the entry and exit wounds.
An electric shock may cause cardiac arrest. In this case, Airway and Breathing become
the priority.
• Ensure your own safety – make sure contact with the electricity is broken.
• Ensure Airway and Breathing are maintained (pages 6 to 8).
• Irrigate the area of the burns, including the path between entry and exit, for at least
1 0 m inutes.
• Dial 999 for an ambulance.
• Continue treatment as you would for a ‘dry heat’ burn.
Poisons, burns and scalds Cl
Dry heat bums
Any direct contact with a dry heat source or friction.
• Do not put yourself in danger.
• Ensure that Airway and Breathing are maintained (page 6).
• Cool the burn immediately with cold (preferably running) water, for at least 1 0 minutes.
If water is not available, any cold harmless liquid (e.g. milk) is better than no cooling at
all. Do this first then move quickly to a water supply if you can. Take care not to cool large
areas of burns so much that you induce hypothermia.
• Remove watches, rings ete. during cooling, as burned areas will swell. Clothing that has
not stuck to the burn may be removed very carefully.
Cool the burn for 70 minutes.
• Dress the burn with a sterile dressing that won’t stick. Cling film is one of the best dressings
for a burn – discard the first two turns from the roll and apply it lengthways (don’t wrap it
tightfy araund a limb). Secure with a bandage.
• Alternative dressings could be a new, unused plastic bag, low adherent dressings or
specialised burns dressings (do not rely on burns dressings to coof 0 burn – use cold water).
• See note (below right) on when to seek medical advice.
• Dial 999 for an ambulance if the burn appears severe, or the casualty has breathed in
smoke or fumes.
Wet heat (scalds)
Scalds are most commonly from hot water, but may be from hot fats or other liquids that
can reach higher temperatures than water.

Remove jewel/ery and LO05E clothing.
Treat as a dry heat burn.
Chemical bums
Caused by chemicals which either corrode the skin or create heat (or both).
It is important to learn the correct first aid treatments for any chemicals used in your
workplace – different chemicals can have different first aid treatments.
• Make the area safe – contain the chemical if possible and protect yourself from coming
into contact with it.
• Dry powder chemicals can be carefully brushed off the skin before irrigating. Take care
to protect yourself.
• Irrigate the burn with lots of running water to wash the chemical away. This should be
done for longer than a thermal burn – at least 20 minutes. Take care not to wash the
chemical onto unaffected areas of the body. Ensure pools of contaminated water do not
collect underneath the casualty.
Dress the burn. Cling film is one of the
best dressings for a burn.
• Dial 999 for an ambulance. Make a note of the chemical, and give this information to
the ambulance operator if possible.
• Remove contaminated clothing carefully whilst irrigating the burn.

If an eye is contaminated, i rrigate as above, and ensure that the water runs away from
the un-affected eye (see page 3 1).
• Some chemicals in the workplace cannot be safely diluted with water – health and safety
regulations require an ‘antidote’ to be available in an emergency. You should be trained
in the use of the antidote.
Radiation burns (sun burn)
Most commonly seen as sunburn.


• Cool the burn with cold water. If the area affected is extensive, cool the burn under a
gentle cold shower or in a bath of cold water for 1 0 minutes.
If there is extensive blistering, or you are not sure, seek medical advice.
• If the sunburn is mild, after-sun cream or calamine lotion may soothe the area.
:+
The burn is larger than
I -inch square.
• The patient is a child.
• The burn goes all the way
around a limb.
Remove the casualty from exposure to the sun; indoors if possible.
• Give the casualty frequent sips of water to ensure that heat exhaustion does not take
effect (page 44).

Seek medical advice if:


Any part of the burn appears
to be fuff thickness.
The burn involves hands, feet,
genitals or the face.
D Injuries to bone, muscles and joints
The skeleton consists of 206 bones,
the functions of which are to:
• Provide support for the soft
tissues of the body. This gives
the body its shape.
• Provide protection for important
organs such as the brain,
lungs and spinal cord.

The skeletal system
Allow movement, by incorporating
different types of joints and
attachment for muscfes.

Produce red blood cells, some
white blood cells and platelets
in the marrow of bones such
as the femur.
-�r—– Skul/
::-�;q…—- Mandible
• Provide a store of minerals and
-t H – – – Scapula
,.., r- – -
energy such as calcium and fats.
..
1����t��—–
Sternum
T”- I-t +-’ – – Ribs
7j, -+ \– – -
1+ – – – Humerus
-+ – -
.J=t;—”\’!J,….,-t-h:\’t— Spinal Vertebrae
.>fI,.
�=
Ulna
Sacrum
-.yf–+-\-\\+-+—- Pelvis
H+-
Radius
Carpals
Metacarpals
Phalanges
+-f—– Femur
EltH—– PateI/o
-fl-H-
Tibia
I�+—– Fibula
Tarsals
,..— Metatarsals
.—— Phalanges
Injuries to bone, muscles and joints •
Causes of inju ry
Injury can be caused to the bones, muscles and joints by different types of force:
Direct Force
Damage results at the location where the force was applied, e.g. as the
result of a blow or kick.
Indirect Force Damage occurs away from the point where the force was applied,
e.g. a fractured collar bone, as a result of landing on an outstretched arm.
Twisting Force Damage results from torsion forces on the bones and muscles, Force
e.g. ‘twisting an ankle’.
Violent
Movement
Pathological
Injury results from a sudden violent movement, such as injuring
the knee joint by kicking violently.
Injury results because the bones have become brittle or weak, due to
disease or old age.
Types of fractu re

H
_
_
A fracture can be defined as a ‘break in the continuity of the bone’. The basic categories of
fracture are:
Closed The skin has become broken by the bone which may (or may not) still be
protruding from the wound. This type of injury has a high risk of
infection.
Complicated With this type of injury, there are complications which have arisen as a
result of the fracture, such as trapped blood vessels or nerves.
Green Stick This type of fracture occurs more commonly in children, who have
young, more flexible bone. The bone is split, but not totally severed.
Green Slick fractures are often mistaken for sprains and strains, because
only a few of the signs and symptoms of a fracture are present.
Dislocations
A dislocation is where a bone becomes partially or fully dislodged at a jOint, usually as a
result of wrenching movement or sudden muscular contraction. The most common
dislocations are the knee cap, shoulder, jaw, thumb or a finger.
There may also be a fracture at or near the site of the dislocation, and damage to ligaments,
tendons and cartilage. It can be difficult to distinguish between a fracture and a dislocation.
_
_
_
Closed Fracture
This is a clean break or crack in the bone, with no complications.
Open
__
�-
Open Fracture
‘�

L
_
_
Complicated Fracture
Never attempt to manipulate a dislocated joint back into place. This is a job for the experts -
the procedure can be extremely painful for the patient, and you may cause further damage.
Sprains and st rains
A sprain is defined as an injury to a ligament at a jOint. A strain is defined as an injury to
muscle. Usually caused by sudden wrenching movements, the joint overstretches, tearing
the surrounding muscle or ligament.
Minor fractures are commonly mistaken for sprains and strains. If you are not sure, you
should treat the injury as if it was a fracture. The only way to rule out a fracture is by x-ray.
For treatment of sprains and st ra ins – see page 39
Green Stick Fracture
Injuries to bone, muscles and joints
Support sling
o
Possible signs and symptoms of a fracture
Pain At the site of the fracture. Strong pain killers, nerve damage or
dementia may mask the pain, so beware.
Loss of Power e.g. not being able to lift anything with a fractured arm .
U nnatural movement This type of fracture is classed as ‘unstable’ and care should be
taken to prevent the fracture from moving.
Swelling or bruising Around the site of the fracture.
Deformity If a leg is bent in the wrong place, it’s broken!
Irregularity Lumps or depressions along the surface of the bone, where the
broken ends of the bone overlap.
Crepitus The feeling and sound of bone grating on bone, when the
broken ends rub on each other.
Tenderness At the site of the injury.
Treatment of a basic fracture
See also:
Head Injuries (pages 12 to 13)
F l ai l Chest (page 21)
Spinal Injuries (pages 3 9 to 40)
Elevated sling
o
• Reassure the casualty, tell them to keep still.
• Keep injury still with your hands until it is properly immobilised. The casualty might be
able to do this on their own.
• Don’t move the casualty until the injury is immobilised, unless they are in danger.
• Don’t try to bandage an injury if you have called an ambulance, just keep it still (cover
open wounds with a sterile dressing).

Don’t let the casualty eat or drink – they may need an operation.
For an upper limb injury:

Carefully place the arm in a sling against the trunk of the body. Arm fractures are
normally placed in a support sling. Collar bone fractures are normally supported by an
elevated sling (keep the elbow down at the patient’s side when using an elevated sling for a
collar bone fracture).
• If the casualty is in severe pain, circulation or nerves to the arm are affected, the casualty
has breathing difficulties, or you are unsure, dial 999 for an ambulance.
• Arrange transport to hospital.
For a lower limb injury:
• Keep the casualty warm and still. Dial 999 for an ambulance.
• If the ambulance arrival will be delayed (e.g. remote countryside) immobilise the injury by
bandaging the sound leg to the injured one.

Check circulation beyond the injury and any bandages. Loosen bandages if necessary.
Injuries to bone, muscles and joints Cl
Treatment of sprains and strains
The best treatment for a sprain or strain is to follow the RICE mnemonic:
Rest
Rest the injury. e.g. don’t allow a sports player to carry on playing
(it’s better to take time out now than miss the next ten matches!).
Ice
Apply an ice pack to the injury as soon as possible. This will help
reduce swelling, which will speed recovery. Place a tea towel or
triangular bandage between the skin and the ice pack. Do this for 1 0
minutes, every 2 hours, for 24 hours for maximum effect.
Compression
Apply a firm (not constrictive) bandage to the injured area. This helps
to reduce swelling. The bandage can be applied over a crushed ice
pack for the first 1 0 minutes.
Elevation
Elevate the injury. This also reduces swelling.
Remember: minor fractures can easily be mistaken for sprains and strains. The only way to
rule out a fracture is by x-ray, so take or send the casualty to hospital.
CAUTION: To prevent frostbite always wrap the ice pack in a cloth and apply it for a maximum
of 1 0 minutes. Allow the skin to return to normal temperature before repeat applications.
Spinal inju ries
1 Cervical
Vertebrae
Spinal injury occurs with approximately 2% of trauma (injury) patients. Although this figure
appears relatively low, suspecting and correctly treating the injury is essential, because poor
treatment of a patient with a spinal injury could result in them becoming crippled for life
or even death.
The spinal cord is an extension of the brain stem, and travels down the back of the spinal
vertebrae. Vital nerves, controlling breathing and movement of limbs travel down the spinal
cord (see diagram). The weakest part of the spinal column is the neck, and indeed a neck
injury can be the most severe type of spinal injury, because the nerves controlling breathing
may become severed.
72 Thoracic
Vertebrae
5 Lumbar
Vertebrae
Suspect spinal injury if the casualty has:
• Sustained a blow to the head, neck or back (especiof/y resulting in unconsciousness).
5 Fused Sacral
Vertebrae
• Fallen from a height (e.g. fall from a horse).
• Dived into shallow water.
• Been in an accident involving speed (e.g. car accident or knocked down).
• Been involved in a ‘cave in’ accident (e.g. crushing, or collapsed rugby scrum).
• Multiple injuries.

Pain or tenderness in the neck or back after an accident (pain killers or other severe injuries
may mask the pain – beware).
• OR: if you are in any doubt.
The spinal cord travels through
the centre of the spinal column.
Nerves emanate from each
vertebrae in pairs.
ID Injuries to bone, muscles and joints
Possible signs and symptoms of spinal injury
Remember – If some of these signs and symptoms are present, nerves may already be
damaged. You should treat a patient who you � has a spinal injury to IlW’ID1 these
signs and symptoms from developing.
• Pain or tenderness in the neck or back.
• Signs of a fracture in the neck or back (page 38).
• Loss of control of limbs at or below the site of injury.
• Loss of feeling in the limbs.
• Sensations in the limbs, such as pins and needles or burning.
• Breathing difficulties.
• Incontinence.
Treatment of spinal injury
o
If the patient is conscious:
• Reassure the patient. Tell them not to move.
• Keep the patient in the position you find them. Do not allow them to move, unless they
are in severe danger.
• Hold their head still with your hands. Keep the head and neck in line with the upper body
(see diagram).
• Di al 999 for an ambulance. Keep the patient still and warm until it arrives.
Holding a patient’s head still in a car.
If the patient is unconscious and breathing normally:
• Do not move the patient unless they are in severe danger.
• If the patient is breathing normally this means the airway must be clear, so there is no
need to tip the head back. The ‘jaw thrust’ technique can be used to keep the airway
open without moving the head (this is explained on page 4 1). Constantly monitor
breathing.
• Di a l 999 for an ambulance.
• Hold the head still with your hands. Keep the head and neck in line with the upper body
(see diagram).
• If you have to leave the casualty, if they begin to vomit, or if you are concerned about
their airway in any way, place the casualty in the recovery position. Keep the head, neck
and upper body in line as you turn the patient. Doing this effectively takes more
than one rescuer, so get local help if you can (see page 4 1 for methods of turning a spinal
injury patient).
Keep the head, neck and
upper body in line.
• Keep the casualty warm and still. Constantly monitor Airway and Breathing until
help arrives (page 6).
If the patient is not breathing normally:
• If the patient is not breathing normally, the airway will need to be opened. Head tilt may
be used, but the tilt should be the minimum that is required to allow unobstructed rescue
breaths.
• Only if you are trained and confident, you can try the ‘jaw thrust’ technique to open the
airway, but if you find the patient is still not breathing normally, you should then open
the airway using the head tilt method before carrying out resuscitation (page 6).
• Re-check breathing once the airway has been opened.
• If the casualty is still not breathing normally, dial 999 for an ambulance, then carry out
resuscitation (pages 6 to 8).
• Obtain the help of others to support the head as you resuscitate.
Remember – successful resuscitation that results in paralysis from a neck injury is a tragedy,
but failing to maintain an adequate airway will result in death.
Injuries to bone, muscles and joints GI
-
Managing the airway with spinal injuries
+
If a patient is unconscious and laid on their back, the airway can be in danger from vomit
or the tongue falling back.
A patient who has not been injured can simply be turned into the recovery position to
protect the airway, but if spinal injuries are suspected, great care must be taken not to move
the spine.
If a patient is already on their side (not on their back) you may not have to move them at all.
Is the airway in danger from vomit or the tongue falling back? If not, the patient can be kept
still in the position you find them.
If you can continually monitor that the patient is breathing normally, you may be able to
keep them still until the ambulance arrives, even if they are on their back.
Fig. 7 : Keeping the patient’s head and
neck in line with the body.
If the tongue begins to fall back or the patient vomits however, immediate action will be
needed to protect the airway:
Jaw thrust
If the patient is breathing but the tongue is starting to obstruct the airway (usually makes
snoring type noises) the jaw thrust technique can be used to keep the airway open:
• Kneel above the head of the patient, knees apart to give you balance.
• With your elbows resting on your legs (or the floor) for support, hold the patient’s head
with your hands to keep their head and neck in line with the body (see fig. 7).
• Place your middle and index fingers under the jaw line of the patient (under their ears).
• Keeping the head still, lift the jaw upwards with your fingers (see fig.2). This gently lifts
the tongue from the back of the throat.
DO NOT attempt
Fig. 2: The jaw thrust technique. Use
your middle and index fingers to lift the
jaw whilst you keep the head still.
the jaw thrust technique during (PR – tilt the head to open the airway instead
(page 6).
Log roll
If you have to leave the casualty, if they begin to vomit, or if you are concerned about their
airway in any way, the patient will have to be turned onto their side. The head, neck and
upper body must be kept in line as you turn the patient.
The best method of turning a spinal injury patient is the log roll technique, but you will need
at least three helpers to roll the patient.
• Support the head of the patient, keeping the head, neck and upper body in line
(see fig. 7).
• Your helpers should kneel along one side of the patient. Get them to gently straighten
the patient’s legs and arms.
• Making sure that everyone works together, the helpers should roll the patient towards
them on your count. You gently move the head to follow the body as the patient is rolled.
(see fig. 3).
Fig. 3: Log roll.
• Keep the head, neck, body and legs in line at all times. If you can, keep the patient in this
position until the ambulance arrives.
Recovery position
If the patient has to be turned onto their side and you don’t have three helpers, you will
need to use the recovery position method when turning the patient. Keep the head, neck
and body in line as best as you can as you roll the patient over. Have some padding (e.g. a
folded coat) to support the patient’s head when they are on their side.
Fig. 4: Get your helper(s) to position
the patient’s arm and legs ready for
the recovery position.
If you have one or two helpers, you can support the head as your helper(s) turn the patient.
• Start by supporting the head of the patient, keeping the head, neck and upper body in
line (see fig. 7).
• Get your helper(s) to gently move the patient’s arms and legs into position, ready to turn
the patient into the recovery position (see fig.4).
• Making sure that everyone works together, the helper(s) should roll the patient into the
recovery position. The helper(s) should pull equally on the patient’s far leg and shoulder
as they turn the patient, keeping the spine in line. You gently move the head to keep it
in line with the body as the patient is moved (see fig.5).
Fig. 5: Get your helper(s) to turn the
patient whilst you keep the head in line
with the body.
• Effects of heat and cold
This chapter covers the effects of
over exposure to heat or cold on
the body:
Severe Hypothermia or Heat Stroke
are potentially fatal conditions, and
need skilful treatment from the
First Aider.
The people who are most at risk
from the effects of heat and cold
are the elderly or infirm, babies and
children, or people who take part
in outdoor activities such as hiking
or sailing.
Body temperature
The body works best when its temperature is close to 37″C (98.6°F). This temperature is
maintained by an area in the centre of the brain called the ‘hypothofamus’.
If the body becomes too hot we produce sweat, which evaporates and cools the skin.
Blood vessels near to the skin dilate (flushed skin) and the cooled blood is circulated around
the body.
If the body becomes too cold we shiver, which creates heat by muscle movement. Blood
vessels near to the skin constrict (pole skin), keeping the blood close to the warmer core of
the body. Hairs on the skin become erect, trapping warm air (goose pimples).
Injuries resulting from exposure to extremes of temperature can be ‘localised’ (such as
sunburn or frostbite), or ‘generalised’ (such os hypothermia or heat stroke).
Signs and symptoms of body temperature change
The symptoms of over-exposure to heat or cold are demonstrated by the diagram below. As
the temperature of the body becomes too hot or too cold, the area of the brain that
regulates temperature (the hypo thalamus) stops working, and the condition rapidly
becomes worse as the body no longer fights the condition:
Cramps in stomach / arms / legs
Heat Exhaustion
Pale sweaty skin
Nausea / Ioss of appetite
37
Normal
35
Mild Hypothermia
93.2
34
Normal Body Temperature
Fatigue, slurred speech
Confusion, forgetfulness
Shivering stops, muscle rigidity
Very slow, very weak pulse
Noticeable drowsiness
Severe reduction in
response �ets
Unconsciousness
Dilated pupils
Pulse undetectable
Severe Hypothermia
Appearance of death
Death
See Also:
T
aking a temperature (page 45)
Effects of heat and cold a
Hypothermia
The onset of hypothermia occurs when the body’s core temperature falls below 35°C.
A patient suffering hypothermia in its mildest form who is treated effectively will usually
make a full recovery. If the body’s core temperature falls below 26°C the condition will most
likely be fatal, however resuscitation has been successful on people with temperatures as low
as 1 0°(, so it is always worth attempting.
The underlying cause of hypothermia is over exposure to cold temperatures, however
different conditions and types of patient will increase the risk:
• The hypothalamus (temperature control centre) of a baby or young child is under
developed, and hypothermia can result from as little as being in a cold room.
• Elderly or infirm patients do not generate as much body heat, so prolonged periods in a
cold environment can lower the core temperature.
• Wet clothing, or immersion in cold water results in the body cooling much faster than it
would in dry air. Water conducts heat away from the body.
• A person who is not clothed properly in windy conditions will have cold air continually
in contact with the skin, resulting in faster cooling of the body.
Possible signs and symptoms
• Pale skin, cold to touch.
• Shivering at first, then muscle stiffness as the body cools further.
• Slowing of the body’s functions – including thought, speech, pulse and breathing
(the pulse can fall lower than 40 beats per minute).
• Lethargy, confusion, disorientation (con be mistaken for drunkenness).
• Lowered levels of response, eventually unconsciousness, then death.
Treatment
If the casualty is unconscious:
o
• Open the Airway and check Breathing. Resuscitate if necessary (pages 6 to 8).
• Dial 999 for a n ambulance.
• Gently place the patient in the recovery position (page 1 1). Do not move the patient
unnecessarily, because the slightest jolt can stop the heart.
• Place blankets or other insulating materials under and around the patient. Cover
the head.
• Constantly monitor breathing. The pulse may be hard to find – it is safe to assume the
heart is beating if the casualty is breathing normally.
For a conscious casualty:
• If you can shelter the casualty, remove any wet clothing. Quickly replace with dry, warm
garments. Cover the head.
• If the casualty is fit, young and able to climb into a bath without help, bathe them in
warm water (400( / 1 04°F). Don’t allow an elderly patient to bathe.
NEVER give a patient alcohol
(it dilates blood vessels, which
will make the patient colder).
NEVER place direct sources of heat
on or near the patient (they draw
blood to the skin, causing a fall in
blood pressure and place stress on
the heart).
NEVER warm babies or the elderly
too quickly (e.g. by placing them
in a warm bath).
• If a bath is not possible, wrap them in warm blankets. Heat the room to a warm
temperature (25°( / 7JOF) if indoors.
• A casualty outdoors should be insulated from the environment and ground. Use a survival
bag and shelter if available. Share your body heat with them.
• Give the casualty warm drinks and food.
• Seek medical advice if the patient is elderly, a child, or if you are in any doubt about
their condition.
• If the condition seems severe. Dial 999 for an ambulance.
BEWARE: A hypothermic heart
is in grave risk of ‘ventricular
fibrillation � which causes cardiac
arrest. Handle hypothermic patients
with care – the slightest jolt can
induce the condition.
• Effects of heat and cold
T
rench Foot
This is caused by prolonged
exposure to wet, cold conditions.
The cells do not freeze, so full
recovery is usual. The symptoms
and treatment are similar
to frostbite.
Chilblains
The most common cold injury,
caused by exposure to dry cold.
Again the cells do not freeze. There
may be itching, reddish-blue skin
and swelling. With time, blisters
may form. Treat as frostbite.
F rostbite
Frostbite is a condition caused when an extremity (such as a finger or an ear) is subject to
cold conditions. The cells of the limb become frozen. Ice crystals form in the cells, which
causes them to rupture and die. Frostbite may also be accompanied by hypothermia, which
should also be treated. Serious frostbite can result in the complete IOS5 of a limb, particularly
fingers or toes.
Possible signs and symptoms
• Pins and needles, followed by numbness.
• Hardening and stiffening of the skin.
• Skin colour change – first white, then blue tinges, then eventually black.
• On recovery, the injury will become hot, red, blistered and very painful.
Treatment
• Gently remove rings, watches ete.
o
• Stop the freezing becoming worse if the casualty is still outdoors – place the limb under
their arm or hold it with your hands.
NEVER rub the affected area.
• Don1t rub the injury – this will cause damage.
NEVER use direct or dry heat to • Don’t re-warm the injury if there is a risk of it refreezing. Move the patient indoors before
warm the injury you treat them.
NEVER re-warm the injury if there • Place the injury in warm water (test the temperature with your elbow os you would for 0
is a danger of it refreezing. baby’s bath – not with a frozen hand!).
• An adult casualty can take two paracetamol tablets for intense pain.
• Take the casualty to hospital as soon as possible,
Heat exhaustion
Heat exhaustion is the body’s response to loss of water and salt through excessive sweating.
The most common cause of this condition is working or exercising in hot conditions (such
as hiking on a very hat day).
Heat exhaustion occurs when the core body temperature raises above 38°C. If the problem
is not treated, it can quickly lead to heat stroke (apposite).
Possible signs and symptoms
• Confusion, dizziness,
• Pale, sweaty skin.
• Nausea, loss of appetite, vomiting.
• Fast, weak pulse and breathing.
• Cramps in the arms, legs, abdomen,
• The casualty may say that they ‘feel cold’, but they will be hot to touch.
Treatment
• Take the casualty to a cool place.
o
• Remove excessive clothing and lay them down.
• Give the casualty plenty of water to re-hydrate them. Oral rehydration solutions (such as
‘Dioro/yte’) or isotonic drinks are best as they also replace lost salt.
• Obtain medical advice, even if the casualty recovers quickly.

Give the casualty drinks of water
to re-hydrote them.
If the casualty’s levels of response (page 9) deteriorate – place them in the recovery
position and dia l 999 for an ambulance. Monitor Airway and Breathing (page 6).
• Treat for heat stroke (opposite) as necessary,
Effects of heat and cold .,
Heat stroke
Heat stroke is a very serious condition. It results from failure of the hypothalamus
(temperature control centre) in the brain. The sweating mechanism fails, the body is unable
to cool down and the core temperature can reach dangerously high levels (over 40°C) within
1 0 to 1 5 m inutes.
The condition can be caused by a high fever or prolonged exposure to heat and often
follows heat exhaustion (previous page).
Possible signs and symptoms
• Severe confusion and restlessness.
• Flushed, hot, dry skin (no sweating).
• Strong, fast pulse.
• Throbbing headache.
• Dizziness.
• Nausea, vomiting.
• Reduction in levels of response (page 9) leading to unconsciousness.
• Possibility of seizures if unconscious.
o
Treatment

Move the casualty to a cool, shaded area.
• Dial 999 for an a mbulance
.
• Cool the casualty rapidly, using whatever methods you can:

Remove outer clothing, and wrap the casualty in a cold, wet sheet. Keep it wet
and cold until the casualty’s temperature falls to normal levels, then replace with
a dry sheet.
• Other methods of cooling can be:
• Continually sponging with cold water, and fanning the casualty to help it evaporate.
• Placing in a cool shower if they are conscious enough to do
50.
• Spraying with cool water from a garden hose.
Cool the casualty rapidly.
• If the casualty has a seizure, treat as you would for a febrile convulsion (page 4 9).
‘Recreational’ Drugs
Taking a temperature
Modern, easy to use thermometers are now available, such as disposable strips that can
be placed on the tongue or forehead. For these thermometers follow the manufacturers
instructions. If you only have an ‘old fashioned’ mercury thermometer however, the
following advice may help:
• Take care when handling the thermometer. The mercury centre is poisonous.

Ensure that it has been properly cleaned.
• Hold the thermometer at the opposite end to the silver mercury bulb.
• Shake the thermometer until the mercury falls well below the 35·C mark.
• Place under the tongue of an adult (who is fully conscious), or the armpit of a child.
• Keep in place for 3 minutes.
• Read the temperature at the level to which the mercury has risen.
In recent years ambulance
services have seen an increase
in the use of ‘recreational’ drugs
such as ecstasy (or ‘e’).
A casualty under the influence
of such a drug may dance
continually for long periods,
which couses them to sweat
excessively, and thus become
hot and dehydrated.
The effects of dehydration,
combined with the drug
affecting ‘normal’ thought,
con lead to heat exhaustion
and heat strake.
• Other serious conditions
Diabetes
Diabetes is the name for a condition suffered by a person who does not produce enough of
a hormone called insulin.
Insulin breaks down the sugar that we digest, so that it can be used by the cells of the body
or stored for later use. In summary, insulin reduces the amount of sugar in the blood.
If diabetes goes untreated, the level of sugar in the blood will climb dangerously high over
1 to 2 days (depending on the severity of the condition).
There are 3 different types of diabetes, which are categorised by their method of treatment:
Diet Controlled This patient still produces some insulin naturally, so can control the
condition by reducing the amount of sugar that they eat.
Tablet Controlled This patient still produces a small amount of insulin naturally, but
needs to take tablets to help reduce the level of sugar in the blood,
as well as diet control.
Insulin Dependent This patient produces little or no insulin, and has to inject
themselves with insulin 2 or more times a day in order to keep
sugar levels under control.
High blood sugar
-
(hype rglycaemia)
Hyperglycaemia is the condition that occurs if diabetes has not been treated effectively with
the methods mentioned above.
The sugar levels in the blood become higher and acids build up. The signs and symptoms
in the table (opposite) are as a direct result of the body trying to excrete this acid build up.
Low blood sugar
-
(hypoglycaemia)
Low blood sugar occurs mainly with diabetic patients who are insuli n dependent, because
the level of insulin in the body is now a ‘fixed’ amount because it is injected.
Because the patient has injected this ‘fixed’ amount of insulin, they have to balance it with
the amount of food that they eat.
The blood sugar levels will fall low if:
• The patient does not eat enough food.
• The patient over exercises (burning off sugar).
• The patient injects too much insulin.
Why is low blood sugar dangerous?
Unlike other cells in the body, the brain can only use glucose (sugar) as its source of energy.
If the sugar in the blood becomes low therefore, the brain cells are literally starved.
The signs and symptoms of low blood sugar in the table (opposite) are as a result of the
hungry brain cells becoming disordered, and the release of adrenaline that the disorder in
the brain causes. (see also ‘the body’s response to hypoxia’- page 1 4).
Other serious conditions ..
Possible signs and symptoms
Low Blood SU9a r
(hypoglycaemia)
High Blood Sugar
(hyperglycaemia)
Onset Slow Levels of Deter Deteriorate rapidly:
Response iorate slowly during the
onset • Weakness, dizziness
• Confusion, memory loss
• lack of coordination
-
1 2 to 48 hours
• Drowsy, lethargic behaviour
• Unconsciousness if the
condition is left untreated
Fast
-
2 minutes to 1 hour
• Slurred speech
• Bizarre, uncharacteristic,
uncooperative, possibly
violent behaviour

Unconsciousness within
1 hour
Skin Dry and warm Pale, cold and sweaty
Breathing Deep sighing breaths Normal, or shallow and rapid
Pulse Rapi d Rapid
Other Excessive urination Beware – the signs and symptoms
Symptoms
Excessive thirst can be confused for drunkenness
Hunger
Fruity odour on the breath
o
Treatment of high blood sugar
• Arrange for the patient to see a doctor as soon as possi bl e
• If the patien t becomes unconscious, maintain
dial 999 for an ambulance (see pages 6 to 8).
.
Airway and
Breathing,
Treatment of low blood sugar
and
o
For a conscious casualty:
• Sit the casualty down.
• Give the casualty a sugary drink (isotonic sports drinks are best), sugar lumps, glucose
tablets, chocolate, or other sweet foods.
• If the casualty responds to treatment quickly, give them more food or drink.
• Stay with the casualty and let them rest until the level of response is ‘fully alert’
(see page 9).
• Tell the patient to see their doctor
-
even though they have fully recovered.
• If the patient does not respond to treatment within 1 0 m i nutes, or they are
unmanageable, dial 999 for an ambulance.
• Consider if there is another cause for the patient’s symptoms.
For an unconscious casualty:
• Open the Airway and check for Breathing. Resuscitate as necessary (pages 6 to 8).
• Place the casualty i n the recovery position if they are breathing effectively.

Dial 999 for an ambulance.
Give the casualty a sugary drink ­
isotonic sports drinks are best.
DO NOT attempt to give the
casualty anything to eat or drink
if they become unconscious.
.. Other serious conditions
Epilepsy
A person diagnosed with epilepsy has a tendency to have recurrent seizures (fits) that arise
from a disturbance in the brain. This chapter does not only deal with patients who are
diagnosed with epilepsy however, because one person in 20 will have a seizure at some
point in their lives.
There are many causes of seizure (including epilepsy), such as hypoxia, stroke, head injury or
even the body’s temperature becoming too high.
Babies and young children commonly suffer seizures from becoming too hot due to illness
and fever. This is covered in the topic ‘febrile convulsions’, opposite.
Minor seizures
Minor epilepsy is also known as ‘absence seizures’ or ‘petit mal’ seizures. The patient may
appear to suddenly start day dreaming (even mid sentence). This may last just a few seconds
before recovery, and the patient might not even realise what has happened. Sometimes a
minor seizure may be accompanied by unusual movements, such as twitching the face, jerking
of an individual limb, or lip smacking. The patient may make a noise, such as letting out a cry.
Treatment of minor seizures
• Remove any sources of danger, such as a knife or hot drink in their hands.

o
Help the patient to sit down in a quiet place and reassure them.
• Stay with the patient until they are fully alert (page 9).
• If the patient is unaware of their condition, advise them to see a doctor.
Major seizures
This type of seizure results from a major disturbance in the brain, which causes aggressive
fitting, usually of the whole body.
Witnessing a major seizure can be frightening for the first aider, but calm, prompt action is
essential for the patient.
Possible signs and symptoms
A major seizure usually goes through a pattern:
Aura If the patient has had seizures before, they may recognise that they are
about to have one. The warning sign may be anything from a strange
taste in the mouth, a smell, or a peculiar feeling. The aura may give
the patient chance to seek help, or simply lie down before they fall.
‘Tonic’ Phase Every muscle in the body suddenly becomes rigid. The patient may let
out a cry and will fall to the floor. The back may arch and the lips may
go blue (cyanosis). This phase typically lasts less than 20 seconds.
‘Clonic’ Phase The limbs of the body make sudden, violent jerking movements, the
eyes may roll, the teeth may clench, saliva may drool from the mouth
(sometimes blood-stained as a result of biting the tongue) and breathing
could be loud like ‘snoring’. The patient may lose control of the bladder
or bowel.
This phase can last from 30 seconds to hours, although most seizures
stop within a couple of minutes. Any seizure (or series of seizures)
lasting more than 1 5 minutes is a dire medical emergency.
Recovery Phase
The body relaxes, though the patient is still unresponsive. Levels of
response (page 9) will improve within a few minutes, but the patient
may not be ‘fully alert’ for 20 minutes or so. They may be unaware of
their actions and might want to sleep to recuperate.
Other serious conditions Cl

Treatment of major seizures
+
(fitting)
During the seizure:
• Help the patient to the floor to avoid injury if possible.
• Gently cushion the patient’s head to help avoid injury. This can be done simply with your
hands or a folded coat.
• Loosen any tight clothing around the neck to help the patient breathe.
• Move any objects from around the patient that may harm them and ask bystanders to
move away.
• If you are concerned about the Airway, roll the casualty onto their side.
• Take note of the exact time the seizure started and its duration.
Gently protect the head.
• Look for identification if you don’t know the patient.
Dial 999 for an ambulance if:
• The seizure lasts more than 3 minutes.
• The patient’s levels of response (page 9) don’t improve after the seizure within
1 0 minutes.
• The patient has a second seizure.
• The patient is not diagnosed as epileptic or this is their first seizure.
• You are unsure.
NEVER place anything in the
casualty’s mouth (especially
your fingers!).
NEVER try to hold the patient
down or restrain them.
NEVER move the casualty
(unless they are in danger).
As soon as the seizure stops:
• Check Airway and Breathing. Resuscitate if necessary (pages 6 to B).

Place the patient in the recovery position
(page 12).
• Keep the patient warm (unless temperature caused the seizure) and reassure them.
• Monitor Airway and Breathing.
• Move bystanders away before the casualty awakes and protect modesty.
• Check the levels of response regularly (page 9). Dial 999 if they don’t improve within
1 0 minutes (or for any of the reasons mentioned above).
Febrile convulsions
In young children and babies the area of the brain that regulates temperature (the
hypotha/amus) is not yet fully developed. This can lead to the core temperature of the body
reaching dangerously high levels (page 42) and commonly a child in this situation may fit.
A febrile convulsion can be very frightening for the parents of the child. During the ‘tonic’
phase of the fit (page 4B) the child may stop breathing, because the diaphragm goes rigid,
and the lips and face may go blue (cyanosis). It goes without saying therefore, that calm
reassurance will be necessary.
The child may have been unwell over the past day or so and will be hot to touch.
Treatment of febrile convulsions
• Remove clothing and bedclothes. Provide fresh, cool air to cool the child down.
Take care not to cool the child too much.
• Place the child on their side if possible to protect the Airway.
• Remove nearby objects and use padding to protect the child from
injury whilst fitting. Pay particular attention to protecting the head.
• Dial 999 for an ambulance.
• If the child is still fitting – sponge them with tepid water to help the cooling
process, but take care not to cool them too much.
• Constantly monitor Airway and Breathing until the ambulance arrives.
If the chifd is still fitting – protect the chifd
from injury and sponge with tepid water.
ID Other serious conditions
The digestive system
Food enters the body through
the mouth, where it is
mechanically broken down
by chewing, and the salivary
.,

::l
glands secrete saliva, which
helps break down starches
(amongst other substances).
.5:
E

0

Q.
:;)
As we swallow, the epiglottis
._–.$;)—-;– Salivary Gland
folds down to prevent food
Tongue
entering the airway, and the
1-+—/— Salivary Gland
11′-+–+— Epiglottis
����—- Larynx
‘bolus’ of food enters the
oesophagus.
The bolus of food is pushed
through the oesophagus
(and the rest of the digestive
system) by waves of muscle
contractions.

.”
c:
0
v
.,

0
M

Food enters the stomach,
where acidic gastric juices are
secreted to help break down
the bolus of food to a soup
like consistency.
/-J’——….::.�- Oesophagus
..
::l
0

..,.
0

N
-+ Liver
—H—-+ Stomach
- -1
- ..
-
-
-
–�r—–t Gall Bladder
� – ….. – t Duodenum
- � –
–+–’1—+ Pancreas
The food then enters the
duodenum, which is Q duct
into which enzymes from the
–11— Small Intestine
,..,f— Large Intestine
pancreas, gall bladder and
liver ore secreted. These
enzymes enable food to be
broken down further, as it
continues into the small

intestine.
Although it is called the ‘small’
intestine, this duct is around 5
..
::l
0

-0
0

N
metres in length, and coils
around in the centre of the
abdominal cavity.
The small intestine completes
the digestion process by
absorbing nutrients from the
food into the blood stream for
use by the body:
Undigested food now passes
into the large intestine (calon),
where water is absorbed into
the body, before being
excreted from the anus.
o �


� .”
::l -
o ..
� :;
o >
e(

‘—–+—- Appendix
0——;– Rectum

\-
‘- – _
- – _
_
_
Anus
Health and safety ..
Health and safety (first aid) regulations 1 981
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 where, how many and what type of First Aiders
are needed, following guidance from the Health and Safety Executive.
• Providing training and refresher training for those First Aiders.
• Providing sufficient first aid kits and equipment for the workplace.
• Ensuring that all staff are aware of how and where to get first aid treatment.
This chapter gives some guidance on these responsibilities, although first aid training
organisations are always willing to give advice.
First aid kits
First Aid kits should be easily accessible, preferably placed near to hand washing facilities
and clearly identified by a white cross on a green background. The container should protect
the contents from dust and damp.
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:
1
leaflet giving general guidance on first aid.
20 individually wrapped plasters of assorted size and appropriate to the type of
work (e.g. blue detectable plasters should be provided for food handlers).
Hypoallergenic plasters can be provided if necessary.
2 sterile eye pads.
4 triangular bandages, individually wrapped and preferably sterile.
6 safety pins.
6 medium wound dressings (approx. 1 2cm x 1 2cm), individually wrapped
and sterile.
2 large wound dressings (approx. 1 8cm x 1 8cm), as above.
1 pair of disposable gloves.
The list is not mandatory, so equivalent items may be used. Additional items may be
required, such as scissors, adhesive tape, disposable aprons and individually wrapped moist
wipes. They may be stored in the first aid kit if they will fit, or kept close by for use.
Other items that may need to be considered are such things as blankets to protect casualties
from the elements, or protective equipment such as breathing apparatus if a First Aider had
to enter a dangerous atmosphere.
Eye wash
If mains tap water is not readily available for eye irrigation, at least 1 litre of sterile water or
‘saline’ should be provided in sealed disposable container(s).
Travelling first aid kits
First Aid kits for travelling workers should typically include:
1 leaflet giving general guidance on first aid.
6 individually wrapped sterile plasters.
1 large wound dressing (approx. 1 8cm x 1 8cm).
2 triangular bandages.
2 safety pins.
Individually wrapped moist cleansing wipes.
• Health and safety
First aid needs assessment
All employers must carry out a first aid needs assessment which should consider:
• the nature of the work and workplace hazards and risks.
• the size of the organisation.
• the nature of the workforce.
• the organisation’s history of accidents and illness.
the needs of travelling, remote and lone workers.
work patterns such as shift work.
the distribution of the workforce.
• the remoteness of the site from emergency medical services.
• employees working on shared or multi-occupied sites.
• annual leave and other absences of first aiders.
• first-aid provision for non-employees.
Wo rkplace hazards and risks
One of the more complicated areas of the first aid needs assessment is considering ‘the
nature of the work and workplace hazards and risks’.
An employer should consider the risks and identify what possible injuries could occur in
order to ensure sufficient first aid provision is available.
The following table, compiled using information from the Health and Safety Executive,
identifies some common workplace risks and the possible injuries that could occur:
Risk
Possible Injuries Requiring First Aid
Manual Handling
o
Slip and trip hazards
o



.
Machinery
Work at height
Workplace transport
0
• •
o
0

injury, loss of consciousness, spinal
and strains.

.
.
injury,
fractures,
i
Crush injuries, fractures, sprains and strain s, sp n al i nju ries .
Electricity Electric shock, bums.
Chemicals Poisoning, loss of consciousness, burns, eye injuries .
The employer should use these considerations to ensure that the correct level of first
aider is trained to deal with the possible injuries or illness that could occur in the workplace
(see below).
First aiders
The selection of a first aider depends upon a number of factors. The person best suited to
be a first aider will volunteer, and will have:
o good reliability, disposition and communication skills.
o an aptitude and ability to absorb new skills and knowledge.
o an ability to cope with stressful and physically demanding emergency procedures.
o
normal duties in the workplace that can be left, to respond immediately and rapidly to
an emergency.
From October 2009 there is a new training regime for first aiders. The Health and Safety
Executive have introduced two levels of first aider;
• First Aider at Work; and
• Emergency First Aider at Work.
Health and safety CD
Contents of HSE First Aid Courses:
EFAW ; Emergency First Aid at Work (1 day course)
FAW ; First Aid at Work (3 day course)
Acting
safely, promptly and effectively in an emergenc
I
EFAW
h�”)
1
(6
I
FAW
(1� ��”)
HSE Recommended Sequence
of Training
First Aid Needs
Assessment
Cardia Pulmonary Resuscitation (CPR)
Treating an unconscious casualty (Induding seizure)
Wounds and �eeding
Shod<
I
Minor injuries
ChoIUng
Pl”eventing cross infection. recording inddents and action.s and the use
of available equipment
First Aid Emergency
At Work First Aid
(FAW) At Work
(EFAW)
3 Days 1 Day
(18 Hours) (6 Houf”l)
Fractures
Spra
ins and strains
Spinal injuries
Chest injuries
Severe bums and SGlIlds
Eye injuries
Poisoning
I
I
These topics are not
covered on the HSE
Emergency First Aid
at Work syllabus. The
employer should ensure
that the correct level
of training is provided
for f
irst aiders to ensure
Heart attack
Stroke
E,,;iepsy
that they can deal with
the possible injuries or
illness that could occur
in the workplace.


Asthma
Diabetes
If the first aid needs assessm ent iden tifi es the need for First Aid at Work (3 day) train ing,
i t is not acceptable to provide Em ergency First Aiders.
NOTE:
Annual refresher training
The HSE now recommend that all First Aiders and Emergency First Aiders attend annual
refresher training due to the wealth of evidence on the severity of ‘first aid skill fade’.
The flow chart, above right, shows the HSE’s recommended sequence of training.
Reporting of incidents at work
Any accident at work, no matter how small, must be recorded in an accident book
(see overleaf). The incident may also need to be reported directly to the Health & Safety
Executive under RIDDOR regulations:
RIDDOR 1995 regulations
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1 995.
These regulations state that it is the responsibility of the Employer or person in control of
the premises to report the following occurrences directly to the Health and Safety Executive:

Deaths (report immediately).
• Major injuries (report imm edi ately).
• Dangerous occurrences (report immediately).
• Incidents resulting in a person being off work (or unable to do full duties)
for more than 3 days (report within 1 0 days).
ID Health and safety
Accident book
Any accident at work, no matter how small, must be recorded in an accident book. The
accident book may be filled in by any person on behalf of the casualty (or indeed by the casualty
themselves).
The information recorded can help the employer identify accident trends and possible areas of
improvement in the control of health and safety risks. It can be used for future first aid needs
assessments and may be helpful for insurance investigative purposes.

+
ACCIDENT RECORD
Filling in the accident book is often done by the First Aider, so the following notes are given
for your advice:
• An accident book is a legal document.
• Anything that has been written down at the time of an incident is usually considered to
be ‘stronger evidence’ in court than something recalled from memory.
• Complete the report all at the same time, using the same pen (not pencil).
• To comply with the Data Protection Act, personal details entered in accident books must
be kept confidential, so the book should be designed so that individual record sheets can
be removed and stored securely.
…. -.–�–”‘:” -
• A member of staff should be nominated to be responsible for the safekeeping of
completed accident records (e.g. in a lockable cabinet). Hand the completed accident
. … . – .. �- ,-” “” ” – ,,,.�
record to that person.
-
.
_ … -
,

,
—-_._-­
– – -
• The person who had the accident may wish to take a photocopy of the report. If this is
the case, they can do this before it is handed in. They should keep a record of the
accident report number.
You should include in the report:
A typical accident record form.
• The name, address and occupation of the person who had the accident.
• The name, address, occupation and signature of the person who is completing the report.
The date, time and location of the accident.
• A description of how the accident happened, giving the cause if you can.
• Details of the injury suffered.
Fi rst aid patient report form
It is useful for a first aider to complete a patient report form for every patient treated. Please
note that this does not replace the accident book, which would still have to be completed
for an accident at work.
A copy of a patient report form is opposite. You can make copies of this for your own use.
The patient report form is designed so the first aider can keep a record of the exact
treatment provided. It is particularly useful if a patient refuses treatment against the advice
of the first aider.
• If a patient refuses treatment, make sure they are capable of making that decision (e.g.
fully conscious adult). Seek medical advice if they are not.
Q
• Follow the advice given for completing the accident book (above) when completing the
form.
• A copy of the form can be given to ambu lance or hospital staff, as it will contain valuable
information about the incident and treatment of the patient. Ask the nurse to take a copy,
so you can keep the original.
• To comply with the Data Protection Act, personal details on the report form must be kept
confidential, so the report should be stored securely (e.g. in a lockable cabinet).
AVPU score
A simple way to record the conscious level of a patient is to use the ‘AVPU’ scale. A detailed
explanation of the scale is given on page 9.
Picture: Thanks to HSE Books.
Crown copyright material is
reproduced by permission of
the Controller of HMSO.
The scale is listed on the patient report form so you don’t have to remember it. There is a
score provided next to each level of consciousness. Write the score in the observations chart
each time you measure it.
First aid patient report form
Date
_
_
_
_
_
_
_
_
_
_
Patient Name
TIme
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
Patient’s Address I Job details
Location of Incident
First Aider
Sex
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
Date of Birth
TIme of incident
_
_
_
_
_
_
_
(record at least every 1 0 minutes)
Breathing
Rate
TIme
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
__
Patjent O bserva i ns;
to
Age
_
_
_
_
_
_
_
_
Pulse Rate
AVPU SCORE
SCORE:
AVPU SCORE:
Alert
6
Fully Alert (usually knows the month).
Confused. 4
3
localises Pain.
Pain
S
Inappropriate Words. Utters Sounds.
Voice
2
Responds to (but does not localise) Pain
Unresponsive
1
Unresponsive to speech and pain stimuli. 0
A M . P. l. E
Aller ies
g
Medication
Past Medical
History
Last Eaten
Events
Leading
to Incident
R
L
‘[
Treatment I
Comments
R
).
/I� ,JI�
1″‘ ‘-’

-./
,
L
.J \.

,
What
happened
afterwards?
The patient went:
D home
D to hospital
D to GP
D in ambulance
other I details
Patienfs Signature: Date:
First Aider’s Signature: Date:
D back to work
ID Appendix: Resuscitation – Child (over 1 year)
NOTE: The minor modifications to the adult sequence of resuscitation (page 8) that con make
it even more suitable for children have been included below.
REMEMBER: If you are unsure, it is better to perform the adult sequence of resuscitation on a
child (who is unresponsive and not breathing) than to do nothing at 011.
Child resuscitation
(D Danger
Gently tap the shoulders and shout.
+
• Check that it is safe for you to help. Do not put yourself at risk.
(} Response
• Gently tap the shoulders and shout ‘are you alright?’
• If there is no response, shout for help, but don’t leave the child just yet.
” Airway
Carefully open the airway by using ‘head tilt’ and ‘chin lih’:
• Place your hand on the forehead and gently tilt the head back.
• With your fingertips under the paint of the chin, lift the chin to open the airway.
Open the airway.
o Breathing
Keeping the airway open, look, listen and feel to see if the breathing is normal. Take no
more than 1 0 seconds to do this.
• If the child is breathing normally, carry out a secondary survey and place them in the
recovery position (page 11).
Check for normal breathing.
If the child is not breathing normally:
• Ask someone to dial 999 for an ambulance immediately, but if you are on your own, and
you have to leave the child to dial 999, carry out resuscitation for about 1 minute first:
• Keep the airway open by tilting the head and lifting the chin.

Nip the nose and seal your mouth around the child’s mouth.
• Give 5 initial rescue breaths (blow in just enough air to make the child’s chest visibly rise).
Combine rescue breaths with chest compressions:
• Use 1 or 2 hands as required to depress the chest a third of its depth.
Rescue breaths.
• Give 30 chest compressions at a rate of 1 00 per minute.

Open the airway again by tilting the head and lihing the chin, then give 2 more
rescue breaths.
• Continue repeating cycles of 30 compressions to 2 rescue breaths.
• Only stop to recheck the child if they start breathing normally – otherwise do not
interrupt resuscitation.
If your rescue breaths don’t make the chest rise effectively:
Give another 30 chest compressions, then before your next attempt:
• Check inside the mouth and remove any visible obstruction (but don’t reach blindly into
the back of the throat).

Recheck there is adequate head tilt and chin lih.
• Do not attempt more than 2 breaths each time before returning to chest compressions.
Use 1 or 2 hands to depress the
chest by one third of its depth.
NOTE: If there is more than one rescuer, change over every two minutes to prevent fatigue.
Ensure the minimum of delay os you change over.
Appendix: Resuscitation – Baby (under 1 year) •
NOTE:
The minor modifications to the adult sequence of resuscitation (page 8) that can make
it even more suitable for children and babies have been included below.
REMEMBER: If you are unsure, it is better to perform the adult sequence of resuscitation on a
baby (who is unresponsive and not breathing) than to do nothing at all.
-
Baby resuscitation
+
o Danger
Check that it is safe for you to help. Do not put yourself at risk.

o Response
Gently tap the shoulders and shout to try and wake the baby.

• If there is no response, shout for help, but don’t leave the baby just yet.
Open the airway.
” Airway
Carefully open the airway by using ‘head tilt’ and ‘chin lift’:
• Place your hand on the forehead and gently tilt the head back. Do not over-extend
the neck.
• With your fingertips under the point of the chin, gently lift the chin to open the airway.
o Breathing
Check for normal breathing.
Keeping the airway open, look, listen and feel to see if the breathing is normal. Take no
more than 1 0 seconds to do this.

If the baby is breathing normally, consider injuries and place them in the recovery
position (page 1 1).
If the baby is not breathing normally:
• Ask someone to d ia l 999 for an ambulance immediately. but if you are on your own,
and you have to leave the baby to dial 999, carry out resuscitation for about 1 minute
first:
• Keep the airway open by tilting the head and lifting the chin (do not over-extend the
neck).

Seal your mouth around the baby’s mouth and nose.
• Give 5 initial rescue breaths (blow in just enough air to make the chest visibly rise). Take
care not to over inflate the lungs.
Rescue breaths.
Combine rescue breaths with chest compressions:

Use 2 fingers to depress the chest a third of its depth.
• Give 30 chest compressions at a rate of 1 00 per minute.
• Open the airway again by tilting the head and lifting the chin, then give 2 more rescue
breaths.
• Continue repeating cycles of 30 compressions to 2 rescue breaths.

Only stop to recheck the child if they start breathing normally – otherwise don’t
interrupt resuscitation.
If your rescue breaths don’t make the chest rise effectively:
Give another 30 chest compressions, then before your next attempt:
• Check inside the mouth and remove any visible obstruction (but don’t reach blindly into
the back of the throat).
• Recheck there is adequate head tilt and chin lift.
• Do not attempt more than
2 breaths each time before returning to chest compressions.
Use 2 fingers to depress the
chest by one third of its depth.
Appendix: Resuscitation with an AED
-
Automated External Defibrillation
.,
The most common cause for a heart to stop (cardiac arrest) is a ‘heart attack’ (page 24).
It is worth noting that a heart attack does not always cause a cardiac arrest. The majority of
people who suffer a heart attack stay conscious and survive.
If a heart attack (or other cause) results in a cardiac arrest, it is usually because it has
interrupted the heart’s electrical impulses. When this happens the heart quivers chaotically
instead of beating in a co-ordinated rhythm. This is called ‘Ventricular Fibrillation’ (VF).
The definitive treatment of Ventricular Fibrillation is to deliver a controlled electric shock
through the heart, to stop the ‘quivering’ and enable it to beat normally again. This is called
‘defibrillation’ .
Some examples of AEDs.
An Automated External Defibrillator (AED) is a safe, reliable, computerised device that can
analyse heart rhythms and enable a non-medically qualified rescuer to safely deliver the life
saving shock with a small amount of training.
The use of an AED can dramatically increase the chances of survival if a patient’s heart stops
beating, but it must be used promptly – for every one minute delay in delivering the shock,
the patient’s chance of survival reduces by up to 1 0%.
-
Resuscitation with an AED
.,
Danger
• Check that it is safe for you to help the casualty. Do not put yourself at risk.
• Consider the safety implications of using an AED in this situation (page 60).
Response
• Gently shake the shoulders and ask loudly ‘Are you alright?’
If there is no response:
• Shout for help immediately.
• If possible, ask one helper to dial 999 and another to get the AED, but do not leave
the casualty yourself just yet.
Airway
• Carefully open the airway by using ‘head tilt’ and ‘chin lift’.
Breathing
Open the airway.
Keeping the airway open, look, listen and feel to see if the breathing is normal. Take no
more than 1 0 seconds to do this.
• If the casualty is breathing normally, consider possible injuries and carefully place them
in the recovery position (page 1 1).
If the casualty is not breathing normally:
Look, listen and feel
for normal breathing.
• If you are on your own, dial 999 for an ambulance and get the AED – you may need to
leave the casualty to do this.
• If you have help – start CPR immediately whilst your helper(s) get the AED and dial
999. Continue CPR until the AED arrives (see pages 6 and 7).
Appendix: Resuscitation with an AED Cl
When the AED a rrives:
• If you have a helper, ask them to continue ePR whilst you get the AED ready.
NOTE: If the helper is untrained it may be easiest for them to give chest compressions only
- see page 8.
Switch on the AED immediately and follow the voice prompts:
• Attach the leads to the AED if necessary and attach the pads to the victim’s bare chest
(do this whilst your helper performs CPR if possible).
• You may need to towel dry or shave the chest so the pads adhere properly.
Only shave excessive hair and don’t delay defibrillation
if a razor is not immediately available.
• Peel the backing from one pad at a time and place
firmly in position, following the instructions on
the pads.
• Place one pad below the victim’s right collar bone.

Place the other pad on the victim’s left side, over
the lower ribs. Place this pad vertically if possible
(see below).
DO NOT remove the pads if you have placed them
the wrong way around – the AED will stiff work.
• Whilst the AED analyses the rhythm – stop CPR and
ensure that no one touches the casualty_
If a shock is advised:

Ensure that nobody touches the casualty (check from top to toe and shout ‘stand clear!’)
• Push the shock button as directed (fully·automatic AEDs will deliver the shock automatically).
• Continue as directed by the voice / visual prompts.
If a shock is NOT advised:

Immediately resume ePR using a ratio of 30 chest compressions to 2 rescue breaths.
• Continue as directed by the voice / visual prompts.

Placement of the pads
V
Wet chest
If the patient’s chest is wet (perfuse sweating for example),
it must be dried before applying the pads so they adhere
to the chest properly. Also dry the chest between the pads
so electricity does not ‘arc’ across the wet chest.
Pads too close together:
Electricity flows across the chest.
Excessive chest hair
Chest hair will prevent the pads adhering to the skin and
will interfere with electrical contact. Only shave the chest
if the hair is excessive and even then spend as little time as
possible on this. Do not delay defibrillation if a razor is not
immediately available.
Pad positioning
Correct pad positions:
Electricity flows through the heart.
Recent studies have found that the position of the pad on the lower left chest can affect
the effectiveness of the shock. Ensure the pad is placed around the side of the chest (not
on the front) and place i t vertically (see picture). This ensures the maximum electricity
flows through the heart rather than across the chest surface. Until manufacturers update
them, some AED pads will have diagrams showing horizontal placement – ignore this
and place the pad vertically.
Lower left pad positioned vertically.
Appendix: Resuscitation with an AED
-

AED safety considerations
Electrical shock Jewellery
Recent tests have shown that if the patient’s chest is dry ijrtd the Take care not to place the pads over
pads are stuck to the chest correctly, the risk of electrical shock jewellery such as a necklace. This
is very low, because the electricity only wants to travel from one would conduct the electricity and
pad to the other, not to ‘earth’ like mains electricity. To be extra burn the patient. There,is no n eed
safe however, briefly check that nobody is touching .the patient to remove pierced jewellery, but try
. to avoid placing the pads over it.
before delivering a shock.
DO NOT delay delibrillation because the patient is on 0 wet or metal Implanted devices
surface – providing the chest is dry it is safe t? d�live� the shock.
,
Medication patches
Some patients wear a patch to
deliver medication (such as a
nicotine patch). Some heart
patients wear a ‘glyceryl tri-nitrate’
(G TN) patch. This type of patch
can explode if electricity is passed
through it, so remove any visible medication patches as
a precaution before delivering the shock.
Certain heart patients may have a
pacemaker or defibrillator
implanted. You can often see or feel
them under the skin when the chest
is �xpos�d and there may be a scar.
They are usually implanted just
below the leh collar bone, which is not in the way of the AED
pads, but if a device has been implanted elsewhere, try to
avoid placing the pad directly over it.
,
Inappropriate shock
Highly flammable atmosphere
There is a danger of the AED creating a spark when the shock
is delivered, so it should not �e used in a highly flammable
atmosphere (in the presence of petrol fumes for example).
AEDs are proven to analyse hea rt rhythms extremely
accurately, however the patient needs to be motionless whilst
the AED does this. Do not use an AED on a patient who is
fitting (violent jerking movements) and ensure vehicle engines
or vibrating machinery are switched off whenever possible.
-

AED use on children
Normal ‘adult’ AED pads are suitable for a child older than 8 years. Smaller pads that reduce the current. delivered are available
for children aged 1 to 8. These should be used for that age range where available. Some AEDs have a ‘paediatric’ setting.
If the child is older than 1 year and you only have adult pads, use the AED as it is. The use of adult pads on a child under
1 year is not recommended.
Most paediatric pads are
designed to be placed with one
pad in the centre of the child’s
chest and the other pad in the
centre of the back. The pads
will have a diagram showing
the correct positions.
Some paediatric pads are designed to
be placed in the same location as adult
pads. Always follow the diagrams on
the pads to ensure correct placement.
Glossary CI
Abdomen The area between the lowest ribs and the pelvis. Hepatic Relating to the liver.
Acute Sudden onset. Hyper. . . High.
Hypo. . . Low.
Hypotha/amus Area of the brain that controls body temperature.
Hypovo/aemic Low volume of blood, a type of shock.
Hypoxia Low levels of oxygen in the blood.
exchange of gases takes place. Inferior Below.
Deficiency of oxygen caused by an interruption in the Insulin Hormone secreted by the pancreas that enables the
Adrenaline
Hormone secreted by the body in times of shock
(see
page 14).
. . . aem. .. Referring to the blood.
Airway The passage from the mouth and nose to the lungs.
Alveoli Minute air sacks in the lungs, through which the
Asphyxia
passage of air to the lungs.
Atrium
usage and storage of sugar.
Top, ‘collecting’ chamber of the heart
(of which there
Jaw Thrust
are two).
Manoeuvre to open the airway without moving the
head, by thrusting the jaw forwards.
Baby Person under 1 year old.
Breathing Inspiration and expiration of air into and out of the
Mesenteric
lungs.
Relating to an area of the intestines.
Nausea Feeling sick.
Neurogenic Concerned with the brain and nervous system.
Bronchioles Small air passages in the lungs, leading to the alveoli. Cardiac / Concerned with the heart. Cell Smallest structural living unit of an organism. Cerebra-spinal Fluid cord, to cushion it and provide nutrients ete. Pneumothorax Air entry into the pleural cavity of the lung.
cardiogenic fluid (CSF)
Cerebrum The largest part of the brain. Pulmonary Concerned with the lungs.
Cervical Concerned with the neck. Regurgitation Vomiting, being sick.
Child Person between 1 year old and puberty. Rescue Breath
that
surrounds
Perlusion
Supply of oxygen and nutrients, and the removal of
waste gases and products.
the
brain
and
Pleura
A two layered membrane surrounding the lungs,
between which is a Iserousl fluid.
spinal
Blowing air into a patient’s lungs, sufficient to make
the chest rise.
Chronic long term. Circulation The movement of blood around the body. Respiration Breathing.
Bleeding or swelling in the cranial cavity, exerting Seizure Fit or Convulsion.
Compression
pressure on the brain.
Concussion
Shock
Shaking of the brain, causing temporary loss of
consciousness or function.
Consciousness Alertness, ‘normal’ activity of the brain.
Constrict To close down, become narrower.
Convulsion Fit or Seizure.
CPR
Inadequate supply of oxygen to the tissues as a result
of a fall in blood pressure or volume.
Spinal cord
Cardia Pulmonary Resuscitation. Manually squeezing
Group of nerves which emanate from the brain and
pass down the spinal column.
Spine The column of vertebrae which form the back.
Strake Bleed or blockage of a blood vessel within the brain
(see page 13).
the heart and breathing for a patient.
Superior Above.
Symptoms The feelings of a patient e.g. “I feel sick.”
Syncope Faint.
The delivery of a large electric shock to the chest in an Tension Air entry into the pleural cavity of the lung that has
attempt to re-start the heart. pneumothorax Cranium The cavity in the skull in which the brain lies.
Cyanosis Blue grey tinges to the skin, especially the lips, due to
lack of oxygen.
Defibrillation
Dilate
Enzyme
Become wider, open up.
Substance that enables a biological reaction to
happen.
Epistaxis
Face shield
Thoracic The area within the rib cage containing the lungs.
Tourniquet A tight band placed around a limb which was used to
Nose bleed.
Protective mask with a one-way valve for performing
stop blood flow. No longer used in first aid.
Ventricle
mouth-to-mouth rescue breaths.
Febrile Relating to fever or high body temperature.
Haemothorax Bleeding into the pleural cavity of the lungs.
become pressurised, impairing the function of the
good lung and the heart.
Lower, larger ‘pumping’ chamber of the heart
(of which there are two).
Ventricular Quivering, vibrating movement of the ventricles of
Fibrillation the heart, producing no effective pumping action.
First aid quiz
The following questions are provided so you can test your knowledge of first aid. Discuss with your first aid instructor which
questions are best to revise. Write your answers on a separate sheet of paper.
Answer the questions as best as you can from memory, then have a look in the book to mark yourself (or improve your answers).
The page numbers in red italics indicate where to look for the correct answer.
1. What is the order of priorities when dealing with a patient? Page 4
2. What ratio of chest compressions to rescue breaths would you do when performing ePR? Page
3. What modifications can you make to the adult sequence of CPR to make it even more suitable for a child? Page 8
4. What are the
S. How would you treat a patient who is unconscious because of head injury? Page 1 3
6. What are the signs and symptoms of hypoxia? Page 1 4
7. Try to remember as many of the causes of hypoxia as you can. Page 1 4
8. Someone starts to choke on some food. What should you do? Pages
9. Someone is suffering from anaphylaxis and they are struggling to breathe. How will they look? Page 1 8
10. How would you treat a patient having an asthma attack? Page 1 9
11. What are the average pulse rates of:
12. What are the si gns and symptoms of a heart attack? Page 24
1 3. How would you treat a patient suffering from heart attack? Page 25
14.
2 main dangers facing someone who is unconscious and on their back.
a) an adult.
b) a child.
16
or
Page
7
11
17
c) a baby. Page 23
Someone has cut their arm on some sharp metal. The metal isn’t stuck in the wound but it is bleeding badly.
What should you do? Page 30
15.
Someone i n the kitchen has slipped with a sharp knife and amputated thei r finger. Describe your actions.
Pages
16.
30 and 32
Someone has scalded the whole of their hand on some hot water. What should you do? What percentage
of burn is that? Pages 34 and 35
1 7. Can you remember some signs and symptoms of a fracture? Page 38
18. A patient has fractured their wrist. How would you treat the patient? Page 38
19. A patient has fallen from a horse and they are unconscious. You check breathing and they are breathing normally.
What should you do now? Page 4 0
20. Someone has been working outside in very cold rainy weather all day. You suspect they are hypothermic. How
should you treat them? Page 4 3
21. A diabetic patient i s suddenly acting strangely a n d not making sense. What is probably wrong?
What should you do? Pages 46 and 47
22. How would you treat a patient having an epileptic seizure? What should you do after the seizure stops? Page 49
First Aid
Made Easy






Updated with the latest resuscitation guidelines.
Approved for use with HSE first aid at work courses.
A logical and easy to understand layout.
Simple, accurate information with lots of pictures and diagrams.
Includes ‘test yourself’ questions.
Written by an experienced Paramedic and First Aid Instructor.
RRP £6.99
f,;S
FSC
Mixed
Sources
Product group from Wl.’1I-managed
forests �nd other tontrolled SOUJas
www.hUll.g C�rtno.SGS<O(-006290
0 1996 Forts! Slewardsh-, Coulld
9
ISBN-l 3: 978-0-9552294-0-4
ISBN-l 0: 0-9552294-0-5

About author
A #globalrevolution enthusiast. Twitter: @AliceKhatib
1 comment on this postSubmit yours
  1. of course :)

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