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In the event of an accident what should I do?
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 or 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 it is 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 the sleeves of 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
Pain for even a minor burn will last a long time. Keeping the burn site in cool water greatly reduces the pain.
Seek medical help if:
- the patient is a child, elderly or the burn is extensive
- the burn is on the face
- if the burn is through the third layer of skin (appears as a whitish or charred)
- the burn was caused by chemicals
- the person is in shock
Choking
Children:
- Lay the patient over your lap with the head down and give three or four sharp blows between the shoulder blades.
Adults:
- Lay an adult with the head inclined down and give three or four sharp blows between the shoulder blades.
Dehydration
If fluid output exceeds fluid input to the body then dehydration may occur. This condition, if prolonged, can be fatal.
Symptoms include:
- pale, cool clammy skin
- rapid breathing
- thirst
- profuse and prolonged sweating
- loss of skin elasticity
- sunken eyes especially in children
- disorientation
- head ache
- swollen tongue
Treatment:
- get the patient to shade and make sure they rest
- remove excess clothing
- drink cool water slowly, in sips rather than in gulps
Fractures
Simple fractures
This is bone damage that does not pierce the skin. It should be treated carefully to avoid further damage.
Symptoms include:
- swelling around the affected area
- skin discoloration
- pain
- loss of limb mobility
- a snapping sensation at the time of injury
Treatment:
- Immobilise the limb by using a splint and bandage.
- Finger - strap the damaged finger to an adjacent finger
- Lower arm - splint entire forearm and immobilise with a sling
- Upper arm - place the arm in a sling and bandage the upper arm to the chest
- Leg -splint the leg or strap legs together if the patient can be carried.
- Seek medical attention as soon as possible
Compound fracture
With a compound fracture bone pierces the skin and can result in serious bleeding. Do not apply pressure to a compound fracture to stop the bleeding.
Treatment:
- cover the injury with a sterile pad. Use any kind of padding if a sterile pad is unavailable but try to use clean cloth.
- apply a splint to keep the bone from causing further injury to the surrounding tissues
- get medical help
- avoid moving the person but keep them warm, comfortable and reassured.
A splint can be made out of:
- a straight piece of wood
- a rolled up newspaper or magazine
- a rolled up blanket if nothing else is available
- The splint should extend beyond both sides of the fracture.
- Elevate the limb to slow blood flow to the wound.
HEAT ILLNESS
There are three stages to heat illness:
Heat Cramps
Symptoms include:
- painful muscle cramps
- nausea and vomiting
- dizziness
- wet clammy skin
Treatment:
- get the patient to a cool place out of the sun
- lie the patient down and allow to rest
- replace lost fluids by giving water (preferably with glucose or sugar in small amounts.)
- use ice packs on cramped muscles
- gently stretch muscles but DO NOT massage
Heat Exhaustion
Heat exhaustion is caused by too much strenuous activity during hot or humid weather.
Symptoms include:
- pale, cool clammy skin
- rapid breathing or breathing difficulty
- profuse and prolonged sweating
- thirst, nausea and/or vomiting
- constant headache
- exhaustion and lethargy
- loss of appetite
- dizziness
Treatment:
- get the patient to shade and make sure they rest
- remove excess clothing
- wet clothing and sponge exposed skin with water
- give cool water once the nausea has passed
- seek medical aid if patient vomits or does not quickly recover
Heat Stroke
Heat stroke occurs when the body can no longer regulate its own temperature and can lead to brain damage and death if left untreated.
Symptoms include:
- flushed, hot, dry skin
- sweating stops
- rapid, weak pulse
- irrational or aggressive behaviour
- staggering, difficulty walking
- headache
- vomiting
- body temperature of 40C or more
- collapse and seizure
- coma leading to death
Treatment:
- get immediate medical assistance
- get the patient to shade and make sure they rest
- remove most clothing
- cool the person using ice packs to neck, groin and armpits
- cover them with a wet towel and fan to increase cooling
- if the patient is conscious get them to drink water with sugar or glucose
Leeches
Leeches are found in many ponds and running streams but in tropical areas they will even move to grass stems to catch a passing 'ride'. They bite the skin and inject an anaesthetic
and an anti-coagulant so you will probably be unaware of the initial bite.
Removing a leech:
- sprinkle the leech with salt and it will simply curl up and drop off
- wash the area to remove the anticoagulant
- disinfect the wound and apply a dressing until the bleeding stops
Seizures
Treatment:
- DO NOT restrict movement by forcefully holding the patient down
- remove any nearby objects if possible
- DO NOT place anything in the patient's mouth or try to open the jaws
- allow the patient to rest and recover once the seizure is over
Shock
Symptoms include:
- pale skin
- cold clammy skin
- dizziness
- weak rapid pulse
- nausea
- thirst
- rapid breathing
- limb extremities may turn blue
- patient may become unconscious
Treatment:
- loosen clothing
- DO NOT allow the patient to eat or drink for the first couple of hours and then only allow small amounts of water
- if there are no leg or back injuries raise the level of the patient's legs above the heart
- DO NOT allow the patient to overheat
- follow the D.R.A.B.C. procedure if required
- seek medical aid as soon as possible
- monitor pulse and breathing
Snake and spider bites
Symptoms include:
- puncture marks and a swollen or red area around the site
- pale, cool skin, sweating
- rapid, weak pulse
- breathing difficulties
- difficulty swallowing and speaking
- nausea, vomiting, headache
- drowsiness progressing to coma
Symptoms from snake bites may not appear for between 15 minutes and 2 hours.
Treatment:
- immediately apply a pressure bandage over the bite winding it up the limb towards the body
- immobilise the limb.
- get to medical help immediately
- The old advice in Australia and elsewhere was DO NOT wash the bite but this no longer applies as
a polyvalent anti venom is used for all snake bites.
- DO NOT apply a tourniquet
- DO NOT remove the bandage and splint
- DO NOT try to capture the snake or spider
Other Insect bites
Insect bites can cause a severe allergic reaction in some people. Antihistamine lotion (or tablets) should be used by those who are sensitive to these type of bites. Severe reactions
can include respiratory failure and this will require CPR.
Bee stings cause pain, swelling and itching. The sting should be removed quickly as it continues to pump venom into the wound. Use a finger nail or knife edge to scrape the sting away.
Avoid putting pressure on it as this will only cause more venom to enter the patient.
Some people have a severe allergic reaction to bee stings resulting in respiratory failure and heart failure. In these cases apply pressure immobilisation to the sting site and get medical help immediately.
There are a variety of creams and lotions that help reduce itching.
Sprains
A sprain is damage to ligaments at a joint or blood vessel, nerve and tendon damage. Ankle sprains are the most common sprains and in the case of such an injury keep footwear in place until treatment can be effected.
Symptoms include:
- sudden pain in a joint
- loss of weight-bearing ability
- bruising
- swelling
- tenderness in the area
Treatment:
- rest the injured limb
- apply a cold compress for at least 10 minutes
- use an firm bandage to support the joint
- elevate the limb
Ticks
Ticks are very small and difficult to see until they become engorged with blood. If you are in areas known to contain ticks conduct a thorough self-examination, especially around your groin and armpits at the end of each day. Paralysis ticks are most common between Queensland and Tasmania.
Symptoms include:
- local irritation
- lack of energy
- general weakness
- unsteady movement
- double vision
- breathing or swallowing difficulties
- Allergic reactions may include rapid local swelling, wheezing and breathing difficulties and collapse.
Removing a tick:
- spray with insect repellent or dab with kerosene
- remove the tick with tweezers by grabbing it as close as possible to where it is joined to the skin and pull gently upwards
- make sure you remove the head.
- wash the area thoroughly and apply antiseptic cream
- check your whole body for further ticks
The essential first aid kit
Basic Contents:
- band aids of differing sizes
- sterile wound dressings
- bandages (crepe and elastic)
- antiseptic fluid (Eg. Dettol)
- antiseptic cream (Eg. Savlon)
- eyebath and eye drops
- cotton buds
- adhesive surgical tape
- oral thermometer
- scissors
- safety pins
- tweezers
- 30+ SPF sunscreen
- insect repellent
- insect bite lotion (Stingose or calamine lotion)
- pain relief tablets
- antihistamine tablets
- tea tree oil
- note pad and pen
- vinegar
Remember to take extra supplies of your own regular medications.
Replace any used items before each trip.
Contact St. John Ambulance for more information of first aid courses, information and kits:
http://www.stjohn.org.au/
or phone
NSW (02) 9212 1088
VIC 13 13 94
QLD 1300 360 455
SA (08) 8274 0331
WA (08) 9334 1222
ACT (02) 6282 2399
TAS (03) 6223 7177
NT (08) 279 9111
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