FIRST AID

Firstly don't panic. Remaining calm and thinking logically are very important in a crisis situation. The first thing to do is assess the situation. If there is immediate danger then the patient needs to be protected from the danger.

Moving badly injured patients is not usually desirable but if they are in immediate danger due to fire of something similar then the first priority is to get them away from the threat as quickly as possible.

The 'rule of thumb' as given by St. John's Ambulance is expressed as D.R.A.B.C.

D. Danger: Ensure the patient is not in danger and that you will not be exposed to danger by going to their assistance. Only move a patient if they are in immediate danger and avoid putting yourself in danger and becoming a casualty.

R. Response: Does the patient respond to verbal or physical stimulus?

A. Airway: If the patient does not respond turn them on their side check they have a clear airway by tilting their head back slightly.

B. Breathing: Look, listen and feel for breathing. If the patient is not breathing then roll them on their back and begin mouth to mouth resuscitation (5 breaths in 10 seconds).

C. Circulation: Feel for a pulse in the neck for 5 seconds and if present continue resuscitation at a rate of 15 breaths a minute. If there is no pulse begin CPR. Manage bleeding and other injuries as soon as possible.

Calling for help
 

When calling for help is it very important to give clear, concise information. First give your location as accurately as you can and then describe the injuries or the nature of the accident. It is important to stay calm and speak slowly. Your information is often relayed to a second party and therefore what you say has to be easily understood.

Checking symptoms

Symptoms may be obvious things like bleeding but they may be more subtle to begin with especially in the case of a head injury or a venomous bite.

If the patient is conscious and you did not see what happened then try to get them to relate what occurred. If they seem dazed or confused then they need to be directed to stay put for their own good.

Managing a patient while waiting for help to arrive

In some circumstances you may have to wait with a patient until rescue arrives and there are a number of things you need to do during this time.

• during the first 8 hours after a severe injury only allow the patient to moisten their lips or suck on small pieces of ice. Do not give any other food or water. After 8 hours allow small amounts of water. If vomiting occurs discontinue water. The reason for this is that a patient may require surgery and be given a general anaesthetic and if they have eaten or been drinking it can place them at risk.

• always reassure a patient and keep them in a comfortable position out of direct sunlight.

• observe breathing, check pulse and whether the patient shows any signs of shock.

• keep a fluid balance chart - measure any water consumed and any loss of fluid by vomiting or passing urine. Give this information to medical carers when they arrive. Similarly record pulse and skin temperature (cool, cold etc.) on the same chart. Check these things every 30 minutes.

• gently sponge exposed skin with cool water to reduce heat

• unless moving the patient would cause further injury, move them every couple of hours to prevent pressure sores

• maintain hygiene for the patient if they are unable to move

Normal pulse rate:

• 60 to 90 beats a minute at rest for adults

• 70 to 110 beats a minute for children

• 70 to 120 beats a minute for infants

Normal breathing rate:

• 16 to 20 breaths a minute at rest for adults

• 20 to 28 breaths a minute for children

• 28 to 40 breaths a minute for infants

Normal temperature range:

• 36.1C to 37.1C

Moving an injured patient

Try to avoid moving a patient unless it is absolutely necessary. If there is no choice but to move a patient then using the 'blanket lift' may be the best way to achieve it.

4 or 5 people are required to make the lift safe.

• Roll the patient on to a blanket that has been spread out next to them

• roll the sides of the blanket up until they touch the sides of the patient

• grasp the rolled edges firmly and lift slowly and carefully

• make sure the patient's head is well supported

Head supports can be improvised by wrapping a newspaper around the neck and tying it in place without obstructing the airway.

A stretcher can be improvised by making holes in a sleeping bag and passing poles through them or by turning a couple of coats or jackets inside out, passing poles through the arms and then buttoning or zipping the coats up.

If you have to drive the patient to medical help DO NOT speed or drive recklessly.

Rule of three

You may die if:

• you are 3 minutes without oxygen

• you are 3 days without water

• you are 30 hours without shelter in the heat of the outback

• you are 30 days without food

Bleeding
 

Treatment:

• wipe away any blood so you can see how bad the wound is

• apply direct pressure to the wound with a bandage or wad of clothing.

• if the blood soaks through do not remove the original bandage but add another bandage ON TOP of the first one.

• lie the patient down

• elevate the wound above the heart, to reduce blood flow (if possible)

• for less severe bleeding you should clean the wound, disinfect it and dress it with a bandage as soon as possible.

Severe bleeding:

If the wound bleeds excessively you may need to cut off the blood supply to the area by pressing the artery closest to the wound. To do this use the heel of your hand and press firmly to compress the artery against the bone behind it.

DO NOT use a tourniquet unless everything else has failed and the patient's life is at stake as it can result in the patient loosing the limb.

DO NOT wait for sterile dressings if they are not immediately available. Improvise, any cloth item can be used to apply pressure and stop bleeding, towels, clothing etc. If you have nothing else just apply pressure with your hand.

DO NOT attempt to remove foreign material from a wound if it is deeply imbedded.

DO NOT apply direct pressure to a wound with deeply imbedded foreign matter.

Burns
 

Treatment:

Speedy treatment of burns is essential.

• immerse the burn in cold water immediately and keep it there as long as possible

• remove burnt clothing unless it is sticking to the skin

• DO NOT puncture burn blisters

• cover the burn with a clean non-adherent burn dressing

• if the burn is minor then antiseptic can be used otherwise only use water to immerse the area