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
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.
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
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
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
20 to 28 breaths a minute for children
28 to 40 breaths a minute for infants
Normal temperature range:
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
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
Head supports can be improvised by
wrapping a newspaper around the neck and tying it in place without obstructing
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
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.
blood soaks through do not remove the original bandage but
add another bandage ON TOP of the first one.
lie the patient down
wound above the heart, to reduce blood flow (if
for less severe bleeding you should clean
the wound, disinfect it and dress it with a bandage as soon as possible.
If the wound
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.
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.
treatment of burns is essential.
immerse the burn in cold water
immediately and keep it there as long as possible
clothing unless it is sticking to the skin
DO NOT puncture burn blisters
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
if the burn is through the third layer of skin
(appears as a whitish or charred).
the burn was caused by
the person is in
If fluid output exceeds fluid input to the body then
dehydration may occur. This condition, if prolonged, can be fatal.
get the patient to shade and make sure they rest
drink cool water
slowly, in sips rather than in gulps
This is bone damage that does not pierce the skin. It should
be treated carefully to avoid further damage.
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
Leg -splint the
leg or strap legs
together if the patient can be carried.
Seek medical attention as soon as possible
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.
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
splint should extend beyond both
sides of the fracture.
the limb to slow blood flow to the wound.
There are three stages to heat illness:
painful muscle cramps
nausea and vomiting
wet clammy skin
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 is
caused by too much strenuous activity during hot or humid weather.
pale, cool clammy
or breathing difficulty
loss of appetite
get the patient to shade and make sure they rest
wet clothing and sponge exposed skin with
give cool water
once the nausea has passed
seek medical aid
if patient vomits or does not quickly recover
Heat stroke occurs when
the body can no longer regulate its own temperature and can lead to brain damage
and death if left untreated.
flushed, hot, dry
of 40C or more
collapse and seizure
coma leading to
get the patient to shade and make sure they rest
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 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
Removing a leech:
sprinkle the leech with salt
and it will simply curl up and drop off
wash the area to remove the
wound and apply a dressing until the
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
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
seek medical aid as soon as possible
monitor pulse and breathing
Snake and spider
and a swollen or red area around the site
pale, cool skin,
rapid, weak pulse
swallowing and speaking
progressing to coma
Symptoms from snake bites may not appear
for between 15 minutes and 2 hours.
immediately apply a pressure
bandage over the bite winding it up the limb towards the body
immobilise the limb.
get to medical
DO NOT wash the bite
- the venom identifies the snake/spider and therefore the appropriate
DO NOT apply a
DO NOT remove the
bandage and splint
DO NOT try to
capture the snake or spider
Other Insect bites
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
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.
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
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
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
Allergic reactions may include
rapid local swelling, wheezing and breathing difficulties and collapse.
insect repellent or dab
remove the tick
with tweezers by
grabbing it as close as possible to where it is joined to the skin and
pull gently upwards
you remove the head.
wash the area thoroughly and apply
whole body for further ticks
The essential first aid kit
of differing sizes
bandages (crepe and
eyebath and eye
30+ SPF sunscreen
insect bite lotion (Stingose
or calamine lotion)
pain relief tablets
tea tree oil
note pad and pen
Remember to take extra supplies of your
own regular medications.
items before each trip.
Contact St. John Ambulance for
more information of first aid courses, information and kits:
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