You are on page 1of 111

10-Sept-05 St John Ambulance Brigade Zone 6 1

CONTENT PAGE
Lesson 1: Lesson 2: Lesson 3:
Principles & Practice
A B C of of First Aid
FirstFirst
Aid Aid Equipments

Lesson 4: Lesson 5: Lesson 6:


Wounds & bleeding
Fractures Shock

10-Sept-05 St John Ambulance Brigade Zone 6 2


Principles
&
Practice
of
First Aid
10-Sept-05 St John Ambulance Brigade Zone 6 3
bjectives
By the end of this lesson, you will be
able to:
Identify the principles of first aid;

Identify the practice of first aid.

10-Sept-05 St John Ambulance Brigade Zone 6 4


Principles of First Aid
1.1 What is First Aid
1.2 Aim of First Aid
1.3 Responsibility of First Aider
1.4 Protecting yourself as a First
Aider

10-Sept-05 St John Ambulance Brigade Zone 6 5


1.1 What is First Aid

It is immediate assistance or treatment


given to someone injured or suddenly taken
ill before the arrival of an ambulance,
doctor, or other appropriate qualified person

The person offering help must be:


 Calm

 Confident

 Willing to offer assistance whenever

necessary St John Ambulance Brigade Zone 6


10-Sept-05 6
1.2 Aim of First Aid

reserve life

revent condition from


worsening

romote
recovery

10-Sept-05 St John Ambulance Brigade Zone 6 7


1.3Responsibilitof First Aider
y
Assess a situation and summon help;

Protect casualties and others from danger;

Identify the injury or nature of the illness;

Give casualty early and appropriate


treatment,
treating the most serious conditions first.
10-Sept-05 St John Ambulance Brigade Zone 6 8
1.3Responsibilitof First Aider
y
Arrange for the casualty into the care of a
doctor
Remain with casualty until further care is
available;
Report your observations to those taking
over care of the casualty;

Prevent cross-infection.

10-Sept-05 St John Ambulance Brigade Zone 6 9


1.4 Protecting yourself as a First
Aider

Personal Safety, e.g assess the


situation
Protection from infection, e.g wash
hands
Prevent cross infection, e.g. dispose
waste
carefully

10-Sept-05 St John Ambulance Brigade Zone 6 10


Practice of First Aid

1. Assess the situation


2. Make the area safe
3. Give emergency aid
4. Get help from others

10-Sept-05 St John Ambulance Brigade Zone 6 11


1. Assess the
situation

Possible Risk? Approach Casualty


No
Yes Yes
Clearing of Clear Obstacle
obstacles Yes Reassess situation
possible? Safe?
No No

Call for help – Ambulance/ Fire engine


10-Sept-05 St John Ambulance Brigade Zone 6 12
2. Make the area safe

Protect the casualty from danger.


SURVEY the incident site to ENSURE
that
AREA IS SAFE.
Aware of your
limitations.

10-Sept-05 St John Ambulance Brigade Zone 6 13


3. Give emergency aid

Assess each casualty to determine


treatment priorities, and treat those with
life-threatening conditions first.

Perform initial assessment, or primary


survey.

Summon necessary help

10-Sept-05 St John Ambulance Brigade Zone 6 14


What is initial assessment?

Response Airway Breathing


> Consciousness > Open/ clotted > Chest rising/
breath blowing on
Gloves
are to be face
worn

Circulation
> Pulse and signs of
survival
10-Sept-05 St John Ambulance Brigade Zone 6 15
Making A Diagnosis, on the basis of:

 History & clues


 Full story of the incident
 How the injury was sustained
 How the illness began and
continued?
 Sign & symptoms
 Detailed examination

10-Sept-05 St John Ambulance Brigade Zone 6 16


Making A Diagnosis, on the basis of History
& Clues, some questions to ask:

 Last eat and drink


 Any illness or on any current
medication
 The amount of force
 The environment
 Age & state of health.
 Establish who is the casualty

10-Sept-05 St John Ambulance Brigade Zone 6 17


Signs & Symptoms

What is it???

Signs are details of a casualty’s


condition that you can see, feel,
hear or smell.

are sensations that the


Symptom casualty experiences, and
s may be able to describe, if
she is conscious.

10-Sept-05 St John Ambulance Brigade Zone 6 18


What senses???

Using your senses to look for the signs & symptoms.

Look : Observe the casualty

Listen : Listening to the casualty’s breathing


Feel : Feel for any swelling

Smell : Smell for any strange smells

10-Sept-05 St John Ambulance Brigade Zone 6 19


You may xxx some of these signs…

Seeing Feeling Hearing Smelling


Asking
 Anxiety & Deformity  Sucking Acetone  Loss of
Irregularity sounds Burning  sensation
 Painful
Dampness  Grating Urine  Abnormal
expression bone sensation
 Burns Nausea 

Stiffness

Pain 

Hot/Cold

10-Sept-05 St John Ambulance Brigade Zone 6 20


4. Get help from others
Make the area safe
Telephone for assistance;
Fetch the first aid equipment or first aid
box;
Control traffic and onlookers;
Control bleeding or support a limb;
Maintain the casualty’s privacy;
Transport the casualty to a safe place.
10-Sept-05 St John Ambulance Brigade Zone 6 21
10-Sept-05 St John Ambulance Brigade Zone 6 22
ABC
Of
First Aid

10-Sept-05 St John Ambulance Brigade Zone 6 23


bjectives
By the end of this lesson, you will be able
to:
Understand what is ABC in First Aid;
Perform an ABC examination on a
casualty;
Identify the need for a recovery
position;
Place
10-Sept-05
a casualty in a recovery
St John Ambulance Brigade Zone 6 24
1.What is ABC in First Aid

10-Sept-05 St John Ambulance Brigade Zone 6 25


Airway may become blocked by the tongue when
unconscious or lying flat.

Open airway by lifting the


casualty’s
Closed Open airway
chin with two fingers and airway
pressing
on the forehead to tilt back the
head.

Do not leave an unconscious


casualty lying face upwards.
10-Sept-05 St John Ambulance Brigade Zone 6 26
Check for 10 seconds !!!

Look Listen Feel


Movement in the sounds of casualty’s breath
chest or breathing on your cheek
abdomen

10-Sept-05 St John Ambulance Brigade Zone 6 27


The pulse indicates the condition of the
circulation,

Place to feel for a pulse: carotid pulse in the


neck.

10-Sept-05 St John Ambulance Brigade Zone 6 28


10-Sept-05 St John Ambulance Brigade Zone 6 29
2. What is recovery position
Meant for unconscious casualty who’s is still
breathing
Do not use on conscious or likely to regain
conscious casualty.

10-Sept-05 St John Ambulance Brigade Zone 6 30


10-Sept-05 St John Ambulance Brigade Zone 6 31
10-Sept-05 St John Ambulance Brigade Zone 6 32
First Aid
Equipment

10-Sept-05 St John Ambulance Brigade Zone 6 33


bjectives
By the end of this lesson, you will be able
to:
Recognize the different first aid
material;
Know the application of each first
aid
materials;
Identify the various type of
bandages;
10-Sept-05 St John Ambulance Brigade Zone 6 34
1. Types of material in
First Aid Kit

Materials are classified as follows:


 Dressings

 Bandages

 Other

10-Sept-05 St John Ambulance Brigade Zone 6 35


10-Sept-05 St John Ambulance Brigade Zone 6 36
2. How to use them
a) Plaster:
 Dry surrounding area of

wound.
 Peel back protective strips

without touching the pad.


 Place pad on the wound.

 Pull away protective strips.

 Press the end and edge

down.

10-Sept-05 St John Ambulance Brigade Zone 6 37


2. How to use them
b) Sterile dressing pad:
 Hold pad by the edge.

 Place it directly on the wound.

 Add a layer of cotton wool

padding on top.
 Secure it with adhesive tape

or
with a roller bandage.

10-Sept-05 St John Ambulance Brigade Zone 6 38


2. How to use them
c) Roller bandage:
 Place tail of bandage below
the
injury.
 Make 2 straight turns to
anchor
the bandage.
 Make a series of spiral turns
up
the limb covering the
injury.
 Finish off with 1 straight
turn
10-Sept-05 St John Ambulance Brigade Zone 6 39
d) Triangular bandage
A broad-fold bandage to
immobilise and support a limb;

10-Sept-05 St John Ambulance Brigade Zone 6 40


d) Triangular bandage

•A narrow fold bandage to


immobilise feet and ankles

10-Sept-05 St John Ambulance Brigade Zone 6 41


e) Reef knot
 Pass the left end over and under the
right.
 Bring both ends up.

 Pass the right end over and under the

left.
 Pull the ends firmly to tighten.

10-Sept-05 St John Ambulance Brigade Zone 6 42


10-Sept-05 St John Ambulance Brigade Zone 6 43
Untying reef
knot
 Pull one end of the bandage firmly
 It will become straighten
 Hold the knot and pull the straightened
end through it.

10-Sept-05 St John Ambulance Brigade Zone 6 44


3) Types of bandaging :
Scalp bandage
It is only use hold the
dressing on the scalp in
place.

They do not control


bleeding.

Check for foreign body


before bandaging.
10-Sept-05 St John Ambulance Brigade Zone 6 45
10-Sept-05 St John Ambulance Brigade Zone 6 46
3) Types of bandaging:
Arm sling
 It holds the forearm in a horizontal
position.
 It provides support to upper arm;
wrist; forearm or rib fracture.

10-Sept-05 St John Ambulance Brigade Zone 6 47


10-Sept-05 St John Ambulance Brigade Zone 6 48
3) Types of bandaging:
St. John Arm sling
 Support the forearm & hand in a raised
position.
 It helps to control bleeding; minimize

swelling and support chest in rib fracture.

10-Sept-05 St John Ambulance Brigade Zone 6 49


10-Sept-05 St John Ambulance Brigade Zone 6 50
3) Types of bandage:
Ring pad
 Used when there is an embedded
object.
 Vital to control bleeding;

 Vital to protect wound from infection;

 Vital to immobilize the affected area.

10-Sept-05 St John Ambulance Brigade Zone 6 51


10-Sept-05 St John Ambulance Brigade Zone 6 52
4. Principles of bandaging
Rules
Reassure the casualty and give clear explanation.

Make the casualty comfortable.

Keep the injured part supported

Always work at the front of the

casualty, and the injured side.

10-Sept-05 St John Ambulance Brigade Zone 6 53


4. Principles of bandaging
Rules
Pass the bandage under the body’s natural hollows at
the

ankles, knees, waist, and neck when lying down.

Apply bandages firmly, but do not interfere with


circulation.

Leave the fingers or toes exposed to check the


circulation.

Use reef knots to tie bandages.


10-Sept-05 St John Ambulance Brigade Zone 6 54
Checking circulation after bandaging

A swollen and congested limb

Blue skin with prominent veins

A feeling that the skin is painfully


distended

10-Sept-05 St John Ambulance Brigade Zone 6 55


10-Sept-05 St John Ambulance Brigade Zone 6 56
WOUNDS
&
BLEEDING

10-Sept-05 St John Ambulance Brigade Zone 6 57


bjectives
By the end of this lesson, you will be
able to:
Define what is wound;
Identify the types of wounds;
Identify the types of bleeding;
Recognize the signs and
symptoms;
Provide
10-Sept-05
the treatment for
St John Ambulance Brigade
wounds
Zone 6 58
1. DEFINITON OF WOUND
Wound is defined as:

Any abnormal break in the skin or body


surfaces.

Two types: - Open wound


blood and other body fluid lost
from
body, permit the entry of germs.
- Close wound
Skin is intact, bleeding occur
internally.
10-Sept-05 St John Ambulance Brigade Zone 6 59
2. TYPES OF WOUND
There are 7 types of wound.
1.Incised wound
2.Laceration
3.Abrasion / graze
4.Contusion / bruise
5.Puncture wound
6.Gunshot wound
7.Stabbed wound

10-Sept-05 St John Ambulance Brigade Zone 6 60


WOUNDS – Incised wound
Clean cut from a sharp
edge.
 Blood vessels at edges of

wound are cut straight


across and may cause
profuse bleeding.
 Injury on a limb may sever

underlying structures such


as tendons.
Causes: Sharp knife or broken glasses
10-Sept-05 St John Ambulance Brigade Zone 6 61
WOUNDS – Laceration
 Results from rough tear by
crushing or ripping forces.
 Usually bleed less
profusely than clean cut.
 More tissue damaged and
bruising.
 High risk of infection.
Causes: Machineries
10-Sept-05 St John Ambulance Brigade Zone 6 62
WOUNDS – Abrasion (graze)
 Superficial wound in which
top layers of skin are
scraped off leaving a raw
and tender area.
 Abrasion often contain
embedded foreign particles
that may cause infection.

Causes: Sliding fall or friction burn

10-Sept-05 St John Ambulance Brigade Zone 6 63


WOUNDS – Contusion
(bruise)
 Rupture capillaries beneath the
skin.
 Blood leaks into tissue causing
bruising.
 Skin may be broken but usually
unbroken.
 May indicate hidden damages
such as fracture or internal Blunt blow or punch
Causes:
injury.
10-Sept-05 St John Ambulance Brigade Zone 6 64
WOUNDS – Puncture
 A small site of entry but
a deep track of internal
damage.
 High risk of infection.

Causes: Standing on a nail or stabbed


or
jabbed with a needle.
10-Sept-05 St John Ambulance Brigade Zone 6 65
WOUNDS – Gunshot wound

 Will cause serious internal injury


and sucking in of contaminants.
 Wound at point of entry may be
small and neat but the exit may
be large and ragged.

Causes: A bullet or other missile


driven through the body
10-Sept-05 St John Ambulance Brigade Zone 6 66
WOUNDS – Gunshot wound

 May cause danger of injury


to vital organs or life-
threatening internal
bleeding

Caused : Gun

10-Sept-05 St John Ambulance Brigade Zone 6 67


WOUNDS – Stabbed wound
•May cause several internal
damage within the chest
and upper abdomen.
•Can cause pneumothorax

Cause: sharp object

10-Sept-05 St John Ambulance Brigade Zone 6 68


How to remember?
Incised Laceration Gunshot

I Like Going
to
Changi
Contusion Abrasion Punctur

AirPort.
e
10-Sept-05 St John Ambulance Brigade Zone 6 69
TYPES OF BLEEDING
There are three types of bleeding:

3. Arterial Name after the


blood vessel
4. Venous they are from:
Artery, vein,
5. Capillary
capillary

10-Sept-05 St John Ambulance Brigade Zone 6 70


Bleeding – Arterial
bleeding

 Blood richly oxygenated.


 Bright red.
 Under pressure from pumping
heart.
 Rapidly empty the circulation of
blood.

10-Sept-05 St John Ambulance Brigade Zone 6 71


Bleeding – Venous
bleeding

 Less oxygenated (oxygen already given


off).
 Dark red.
 Under less pressure than arterial blood.
 Blood from major vein may gush
profusely.

10-Sept-05 St John Ambulance Brigade Zone 6 72


Bleeding – Capillary
bleeding

 Most common for almost all sites of


injuries.
 Superficial – Blood loss only slight.
 Rupture of capillary under the skin –
bruises.

10-Sept-05 St John Ambulance Brigade Zone 6 73


SIGNS AND SYMPTOMS
Site Appearance Cause
s
Mouth Bright red, cough out blood xxxxxxxx

Vomited blood, red/ dark reddish brown, resembling coffee xxxxxxxx


grounds
Ear Fresh, bright-red blood; Thin watery blood xxxxxxxx

Nose Fresh, bright-red blood; Thin, watery blood xxxxxxxx

Anus Fresh, bright-red blood xxxxxxxx

Black, tarry, offensive smelling stool xxxxxxxx

Urethr Urine with red or smoky appearance and occasionally clots xxxxxxxx
a
Vagina Either fresh or dark red xxxxxxxx

10-Sept-05 St John Ambulance Brigade Zone 6 74


TREATMENT for bleeding
Direct pressure & Indirect
Pressure
 Direct Pressure = applied
over the wound directly using
a dressing.
 Indirect Pressure = applied at
the pressure points above
bleeding artery
 NEVER apply
10-Sept-05 St John Ambulance Brigade Zone 6 75
Direct Pressure Treatment
Remove or cut casualty’s
clothing to expose
wound
Apply direct pressure over
wound
Cover wound with sterile
dressing
Apply a pad

10-Sept-05 St John Ambulance Brigade Zone 6 76


Direct Pressure Treatment
Raise and support injured
part:

 Lie casualty down if


possible
 Raise injured part above
level of heart
 Handle gently if you
suspect
a fracture.

10-Sept-05 St John Ambulance Brigade Zone 6 77


Direct Pressure Treatment
Bandage wound:
 bandage firmly in place
 apply another dressing or pad if bleeding
continues.

10-Sept-05 St John Ambulance Brigade Zone 6 78


Direct Pressure Treatment

 Check the circulation below wound.


 Press till it turns white. It should turns pink
when the pressure is released.

10-Sept-05 St John Ambulance Brigade Zone 6 79


10-Sept-05 St John Ambulance Brigade Zone 6 80
10-Sept-05 St John Ambulance Brigade Zone 6 81
What is Pneumothorax?
When a sharp object penetrates the chest wall,
air can enter between the membranes and
exert pressure on the lung, thus the lung may
collapse.
Air
between
Lungmembrane Collapsed
Blood in the lung
Healthy
membrane lung
Layers of membrane
Ribcage
Diaphragm

10-Sept-05 St John Ambulance Brigade Zone 6 82


Fracture

10-Sept-05 St John Ambulance Brigade Zone 6 83


bjectives
By the end of this lecture, you will be
able to:
Define what is fracture
Know the different causes of fractures
Identify the different types of fractures
Identify the signs and symptoms of
open and closed fracture
Provide treatment for casualty with
open and closed the fracture
10-Sept-05 St John Ambulance Brigade Zone 6 84
1. What is a Fracture?

Fracture is
a break or a crack in a
bone.

10-Sept-05 St John Ambulance Brigade Zone 6 85


2. What causes a fracture
Direct force Indirect force
 Bone breaks at  Force travels from

the point where a the source of


heavy blow is impact to break
received the bone(s)
 Eg. A punch to elsewhere.
the upper arm  Eg. A fall landing

may fracture it. on the upper arm


may lead to a
fracture in the
collar (clavicle)
10-Sept-05 St John Ambulance Brigade Zone 6 86
bone
Other causes of Fracture
Old or diseased bones
Eg:
Osteoporosis
Congenital abnormalities
Tumours

10-Sept-05 St John Ambulance Brigade Zone 6 87


Types of Fracture
Open fracture
Closed fracture
Simple fracture
Comminuted fracture
Greenstick fracture

10-Sept-05 St John Ambulance Brigade Zone 6 88


 The skin near the
fracture site is broken.
 The bone may or may
not protrude out.

10-Sept-05 St John Ambulance Brigade Zone 6 89


 The skin surrounding
the skin is not
broken. The skin
around the fracture
site usually is swollen
or bruised.

10-Sept-05 St John Ambulance Brigade Zone 6 90


 A clean break or
crack in the bone

10-Sept-05 St John Ambulance Brigade Zone 6 91


 The bone is broken into
fragments.

10-Sept-05 St John Ambulance Brigade Zone 6 92


 An incomplete
break of the bone.
One side is
broken while the
other is bent.
 This fracture is
more common in
children.

10-Sept-05 St John Ambulance Brigade Zone 6 93


Signs and symptoms
Break may be felt or heard;
Intense pain is experienced around the site of
the break;
Deformity of the affected limb;
Painful, difficult or impossible normal movement;
Tenderness when gentle pressure is applied;
Swelling over the fracture;
Bruising;
Visible external bleeding in open fracture;
Possible shock;
Crepitus

10-Sept-05 St John Ambulance Brigade Zone 6 94


Aims for treating fracture
 Prevent blood loss, movement and
infection to the injured site.
 Arrange removal to hospital with
comfortable support.

10-Sept-05 St John Ambulance Brigade Zone 6 95


The DO NOT…
… move the person;
… move a person with an injured hip, pelvis, or upper
leg unless it is absolutely necessary;
… move a person who has a possible spine injury;
… attempt to straighten a bone unless blood circulation
appears hampered;
… try to reposition a suspected spine injury;
… test a bone's ability to move;
… test for crepitus;
… give the casualty any food or drink.

10-Sept-05 St John Ambulance Brigade Zone 6 96


Treatment xxx

Closed fracture
Control bleeding if there is any;
Cover the wound with a sterile dressing;
Secure with cotton wool or a soft, non-fluffy,
non-
adhesive material and bandage the
dressing.
Do not tie the bandage too tightly in case
you
impair the circulation;
Keep the injured limb still by supporting it
fully and
10-Sept-05 St John Ambulance Brigade Zone 6 97
Treatment xxx

Open fracture
Place a sterile gauze dressing or piece of
clean,
non-fluffy, non-adhesive cloth over the
wound;
Place a ring bandage around the open wound.
It
must be higher than the protruding bone;
Secure the ring bandage;
Keep the injured limb immobile until the
casualty
10-Sept-05 St John Ambulance Brigade Zone 6 98
Treatment
General principles
Upper limb fracture: support arm against
the trunk of the body. Use a sling if
necessary.
Lower limb fracture: bandage sound leg to
the uninjured one.
Dial 995 for an ambulance.
Prepare to treat for shock, if necessary
Check the blood circulation every 10
minutes. Loosen the bandages if
necessary.
10-Sept-05 St John Ambulance Brigade Zone 6 99
A condition with loss of the normal density of
bone and fragile bone. This weakens the bone
leading to an increase in the risk of breaking
bones (bone fracture).
Bones affected by osteoporosis can fracture with
only a minor fall or injury that normally would
not cause a bone fracture.
The spine, hips, and wrists are common areas

10-Sept-05 St John Ambulance Brigade Zone 6 100


10-Sept-05 St John Ambulance Brigade Zone 6 101
10-Sept-05 St John Ambulance Brigade Zone 6 102
Shock

10-Sept-05 St John Ambulance Brigade Zone 6 103


bjectives
By the end of this lesson, you will be able
to:
Understand what is shock
Identify the causes of shock
Identify the signs and symptoms of
shock
Provide the treatment for shock
casualty
10-Sept-05 St John Ambulance Brigade Zone 6 104
What is shock?
A serious, life-threatening condition, as the
amount of fluid in the blood vessels is
insufficient

Vital organs (brain, heart & kidneys) not able


to functioning properly

Thus shut down blood supply to the less vital


parts of the body, such as the skin and
intestines
10-Sept-05 St John Ambulance Brigade Zone 6 105
What Causes Shock
Heart attack
Blood loss
Fluid loss
Severe blood infection
(septicaemia)
Burns

10-Sept-05 St John Ambulance Brigade Zone 6 106


SIGNS & SYMPTOMS
Pale face, cold skin
Rapid and weak pulse
Fainting, dizzy or nausea
Extremities become blueish
Breathlessness
Severe thirst
Possible loss of consciousness
10-Sept-05 St John Ambulance Brigade Zone 6 107
Treatment
ABC
Treat any cause of shock you identify
Dial 995
Lay casualty down.
Provide reassurance. Stay alert
Raise and support casualty’s legs.
Loosen clothing.
Keep warm
Check and record breathing, pulse and level of
response.
Place in the recovery position.
Start AR or CPR as appropriate.
10-Sept-05 St John Ambulance Brigade Zone 6 108
Do not …….
.. let casualty smoke, eat, drink or move.
Moisten lips only.
.. leave the casualty unattended.
.. warm casualty with any direct source of
heat.
.. move the casualty unless it is absolutely
essential

10-Sept-05 St John Ambulance Brigade Zone 6 109


10-Sept-05 St John Ambulance Brigade Zone 6 110
10-Sept-05 St John Ambulance Brigade Zone 6 111