First Aid Medical Guide

F i r s t a i d

IntroductionPrioritiesGeneral principles of firstaidGeneral assessment ofthe situationDressings, bandages,slings and splintsFirst aid satchels andboxesSevere bleedingUnconscious casualtyBurns and scaldsSuffocation (asphyxia)StrangulationChokingEpileptic fitsShockBleedingWoundsFracturesDislocationsHead injuriesChest injuriesBlast injuriesTransportation

CHAPTER 1

5

Introduction

When a ship is in port, or near to port where hospital andother expert medical attention are available, the first aidtreatment necessary aboard ship is similar to that practisedashore. At sea, in the absence of these facilities, trained ships’officers are required to give types of treatment beyond thataccepted as normal first aid.The content of this chapter covers the knowledge of firstaid necessary for the safe and efficient immediate treatmentof casualties before they are transported to the ship’shospital or to a cabin for any necessary definitive treatmentof the type described in Chapter 4.However, anyone aboard ship may find a casualty andevery seaman should know three basic life-saving actions tobe given immediately while waiting for trained help toarrive. These are:

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to give artificial respiration by the mouth to nose/mouthmethod;

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to place an unconscious casualty in the unconsciousposition;

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to stop severe bleeding.

Priorities

On finding a casualty:

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ensure your own safety;if necessary, remove the casualty from danger or dangerfrom the casualty (but see the note below on enclosedspaces);

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give immediate treatment to the casualty who is notbreathing and/or whose heart has stopped, is bleedingseverely or unconscious – others can be treated later;

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send for help.If there is more than one unconscious or bleeding casualty:

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send for help;

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treat the most serious injury first in the order of:• not breathing and/or heart stopped;• unconsciousness.• serious bleeding;If the casualty is in an ENCLOSED SPACE:

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DO NOT enter the enclosed space unless you are a trainedmember of a rescue team acting under instructions;

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send for help and inform the master.It must be assumed that the atmosphere in the space ishostile. The rescue team MUST NOT enter unless wearingbreathing apparatus which must also be fitted to the casualtyas soon as possible. The casualty must be removed quickly tothe nearest safe adjacent area outside the enclosed spaceunless his injuries and the likely time of evacuation makessome treatment essential before movement.

6

THE SHIP CAPTAIN’S MEDICAL GUIDE

General principles of first aid on board ship

The general principles are:

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make a rapid examination of the patient to assess responsiveness and the extent of theinjury;

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check breathing, heart and look for serious bleeding;• if breathing has stopped, give artificial respiration;• if the heart has stopped, give heart compression and artificial respiration;• arrest serious bleeding;

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handle the patient as little and as gently as possible so as to:• prevent further injuries; and• prevent further shock;

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see that the patient is put in the most comfortable position possible and loosen tightclothing so that he can breathe easily;

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do not remove more clothing than is necessary and, when you do, remove it gently. With aninjured limb, get the sound limb out of the clothing first and then peel the clothes off theinjured limb, which should be supported by another person during the process. If cuttingclothes is indicated to expose the injured part, do so. In removing a boot or shoe remove thelace and, if necessary, cut the upper down towards the toecap; keep onlookers away.

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always remember that shock can be a great danger to life and one of the main objects offirst aid is to prevent this;

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you may have to improvise splints, bandages etc. (Figure 1.23);

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do not give alcohol in any form;

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do not move the patient until he is fit to be moved. Bleeding should be arrested, fracturesimmobilised and shock treated. See that the necessary personnel and equipment forsmooth and efficient transport are available;

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never consider anyone to be dead until you and others agree that:• breathing has stopped;• no pulse is felt and no sounds are heard when the examiner’s ear is put to the chest;• the eyes are glazed and pupils are dilated;• there is a progressive cooling of the body.(For a further description of the diagnosis of death Chapter 12).

General assessment of the situation

Once it has been established that there is no immediate threat to life there will be time to takestock of the situation. Reassurance and quick and effective attention to injuries andcompassionate treatment of the injured person will alleviate his condition. Remember:

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a calm and systematic approach should be adopted;

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give nothing by mouth;

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protect the casualty from heat or cold, remembering that in the tropics open steel decks canbe very hot;

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never underestimate and do not treat as minor injuries:• unconsciousness• suspected internal bleeding• stab or puncture wounds• wounds near joints (see fractures);• possible fractures• eye injuries

Chapter 1 FIRST AID

7

Dressings, bandages, slings and splints

Standard dressing

A standard dressing consists of a thick pad of gauze which is attached to a bandage, leavingabout 30cm of tail. The dressing is packed in a paper cover and is sterile. Therefore, when thepackage is opened, it is important that the gauze pad should not be allowed to touch anything(including your fingers) before it is applied to the wound.Standard dressings are available in three sizes:

Small

Gauze pad measures 7.5 cm by 10 cm.

Medium

Gauze pad measures 10 cm by 15 cm.

Large

Gauze pad measures 15 cm by 20 cm.Always select a dressing with a pad which is larger than thewound which you have to cover up.In use the pad is placed upon the wound, the tail is takenround the limb and held, the bandage is held taut as it istaken round the affected part so as to `lock’ the tail inposition. The bandaging can then be continued to hold thedressing firmly in place by making turns above and belowthe pad so that they overlap it (Figure 1.1).

Bandages

Bandages are required to apply and maintain pressure on a wound to stop bleeding, to keep adressing in place, to provide support, and to prevent movement. Wherever a standard dressing isnot used it is customary to cover a wound in the following ways:

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dry dressing – sterile gauze or lint covered by a layer of cotton wool and held in place by aroller or triangular bandage;

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non-stick dressing – sterile paraffin gauze covered by sterile gauze or lint and cotton wooland held in place as above.NOTE: Never use cotton wool as the first layer of a dressing. When using lint always put thesmooth surface next to the skin.

Tube gauze finger bandage

Cut off a piece of tube gauze bandage60 cm long. Lay this on a flat surface andmake a longitudinal cut at one end10 cm long through both thicknesses ofthe bandage (Figure 1.2). The tails soformed, ‘B’, will be used to secure thebandage.Insert the applicator into thebandage at end ‘B’, then push all thebandage on to it. Then pull 2.5 cm ofthe bandage off the end of theapplicator (Figure 1.3). Tuck this inside.Hold the finger dressing in place.Insert the finger into the applicator andpush it gently towards the base of thefinger. Hold the bandage in place withyour thumb and withdraw theapplicator with a slight turning motion.The bandage will slip off the applicatorand will mould firmly to the finger(Figure 1.4).

Figure 1.1

A60 cm10 cmB1B2

Figure 1.3

B1B2

Figure 1.4Figure 1.2

Category:	How-To Guides/Manuals
Rating:	(2 Ratings)
Upload Date:	06/30/2009
Copyright:	Attribution Non-commercial
Tags:	Medicine Medicine (fewer)

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