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SAFETY MANUAL NO.3 FIRST AID by Linda H. Byers and Marilyn Hutchison, M. D. UNITED
SAFETY MANUAL NO.3
FIRST AID
by
Linda H. Byers
and
Marilyn Hutchison, M. D.
UNITED STATES DEPARTMENT
OF THE INTERIOR
Thomas S. Kleppe, Secretary
Jack W. Carlson, Assistant Secretary-
Energy and Minerals
MINING ENFORCEMENT AND
SAFETY ADMINISTRATION
For sale by the Superintendent of Document.
U.S. Government Printing Office. Washington D.C. 20402
Stock Number 024-019-017.9

,.

PREFACE

This is one of a series of man uals prepared by the

technical staff of the Mining Enforcement and

Safety Administration (MESA) to acquaint the

reader with a subject of interest to miners. This

manual provides an explanation of first aid

techniques to be used before medical help arrives

in the event of an accident. The first section

includes instructions on how to perform critical

life saving procedures such as clearing the victim's

upper airway, giving artificial ventilation and

external heart compressions, stopping bleeding,

and controllng shock. The second section de-

scribes special measures to apply to specific

injuries. A list of references (Bibliography) is

included at the end for those interested in addition-

al information on first aid and emergency care.

in this series are listed on

Other manuals available

the inside back cover. Individual copies may be

obtained from any MESA Training Center or from

the National Mine Health and Safety Academy,

Beckley, W. Va.

Michael G. Zabetakis

Superintendent

National Mine Health and

Safety Academy

.

CONTENTS

Page

Introduction 1 Basic procedures for first aid 2 First aid procedures for life threatening con-
Introduction
1
Basic procedures for first aid
2
First aid procedures for life threatening con-
ditions
4
Impaired breathing
5
Circulatory
10
Bleeding
15
,
18
Introduction to specific
21
Burns - heat
., 23
Burns - chemical
24
Chest wounds
25
Diabetic emergencies
26
Epileptic seizure
27
Eye injuries
28
Fractures -
30
Frostbite
34
Heart attack
35
Heat cramps
.
.
.
.
.
.
.
.
.
.
36
Heat exhaustion
37
Heat
stroke.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
37
Hypothermia (exposure)
38
Insect bites and stings
39
Open wounds
40
Poisons
44
Protruding intestines
44
Rib fractures
45
Skull
fracture
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
46
Snakebite
47
Spine fracture or dislocation
48
Sprains
54
Strains
54
Stroke
55
Transportation
.
.
.
.
56
Bibliography
66
. INTRODUCTION What should you do if a coworker or family member is suddenly injured

.

INTRODUCTION

What should you do if a coworker or family

member is suddenly injured or becomes il? Right

after an accident or ilness occurs and before

medical help can take over, there is a critical period

in which the availabilty of a person skiled in first

aid techniques can mean the difference between

life and death for the victim.

There is an urgent need for first aid treatment at

mining sites where medical help is usually not

readily obtainable. Therefore, it is the duty of

every miner to be able to give proper emergency

assistance until the victim is under professional

medical care.

First aid does not replace the physician but it

does attempt to keep the victim alive and in the

best condition possible until medical aid arrives.

All first aid trainees are taught to send for medical

assistance in cases of serious injury and to instruct

the victim to visit a physician as soon as possible

in the case of minor injury.

This pamphlet is designed to be used as a quick

reference during an emergency and for periodic

review. Therefore, it contains only the basic, life-

support techniques with all extraneous material

stripped away.

i

BASIC PROCEDURES FOR FIRST AID

When a person is injured or il, someone must

take charge, send for a doctor, and apply first aid.

The person taking charge must make a rapid but

effective examination to determine the nature of

the injuries.

Do not move the injured person until you have a

clear idea of the injury and have applied first aid,

unless the victim is exposed to further dangér at

the accident site. If the injury is serious, if it

occurred in an area where the victim can remain

safely, and if

medical aid is readily obtainable, it is

sometimes best not to attempt to move the person,

but to employ such emergency care as is possible at

the place until more highly qualified emergency

personnel arrve.

When making an initial survey, a first aider wil

consider what witnesses to the accident tell him

about the accident, what he observes about the

victim, and what the victim tells him.

The first aider must not assume that the obvious

injuries are the only ones present because less

noticeable injuries may also have occurred. Look

for the causes of

the injury, this may provide a clue

as to the extent of physical damage.

While there are several conditions that can be

considered life-threatening, respiratory arrest and

severe bleeding require attention first.

In all actions taken during the initial survey the

first aider should be especially careful not to move

the victim any more than necessary to support life.

Any unnecessary movement or rough handling

should be avoided because it might aggravate

undetected fractures or spinal injuries.

2

Once respiratory arrest and severe bleeding

have been alleviated, attention should be focused

on other obvious injuries-open chest or abdomi-

nal wounds should be sealed, open fractures

immobilzed, burns covered and less serious

bleeding wounds dressed. Again remember to

handle the victim carefully.

Once the obvious injuries have been treated, the

secondary survey can be made to detect less easily

noticed injuries that can be aggravated by

mishandling. If a victim with a spinal injury is

mishandled, he could suffer spinal damage,

leading to paralysis. Also a closed fracture can

become an open fracture if not immobilized. The

secondary survey is a head to toe examination.

Start by examining the victim's head, then neck,

trunk, and extremities looking for any type of

abnormalities such as swellng, discoloration,

lumps, and tenderness that might indicate an

unseen injury.

any type of abnormalities such as swellng, discoloration, lumps, and tenderness that might indicate an unseen

3

IMPAIRED BREATHING CAUSES 1. Suffocation 2. Gas poisoning 3. Electrical shock 4. Drowning 5. Heart
IMPAIRED BREATHING
CAUSES
1. Suffocation
2. Gas poisoning
3. Electrical shock
4. Drowning
5. Heart failure
SIGNS/SYMPTOMS
FIRST AID PROCEDURES FOR LIFE-
THREATENING CONDITIONS

mouth.

1. The chest or abdomen does not rise and falL.

2. Air cannot be felt exiting from the nose or

This section outlines the first aid measures that

should be used when life-threatening conditions

exist. These conditions include: impa~red breathing, heart failure, severe bleedmg,

and shock. Obviously, of first and paramount

concern is immediate recognition and correction of

these conditions. Emergency treatment should be

given in this order, as necessary:

THE AIR PASSAGE.

2. RESTORE BREATHING AND HEART-

1. CLEAR

BEAT.

3. STOP BLEEDING.

4. ADMINISTER TREATMENT FOR

SHOCK.

FIRST AID TREATMENT

There are several methods of artifical ventila-

tion. Mouth-to-mouth is the most effective. Use the

mouth-to-nose method if the victim has a severe

jaw fracture or mouth wound, or has his jaws

tightly closed. Simply breathe into his nose

instead of his mouth.

Use back pressure method only when mouth-to-

mouth cannot be used: for example, if the victim

has severe facial injuries, is trapped or pinned face

down, or when you are in a toxic environment and

both you and the victim are wearing masks which

do not contain a resuscitation device.

MOVE FAST

Seconds count when a person is not breathing.

Start artificial ventilation at once. Don't take time

to move the victim unless the accident site remains

unsafe.

4

5

MOUTH-TO-MOUTH (NOSE)

TECHNIQUE

1. Position victim on his back. If it is necessary

to roll the victim over, try to roll him over as a

single unit, keeping the back and nec~ strai~ht.

This is to avoid aggravation of any possible spmal

injury.

2. Kneeling at the victim's side, tilt victim's

head back so chin is pointing up by placing one

hand under the neck and the other hand on the

forehead.

3. Quickly glance in victim's mouth for any

if

(e.g., food, tobacco, blood, dentures).

obstruction

an obvious obstruction is present, carefully turn

the victim on his side, tilt his head down, and

sweep his mouth out with your fingers. When the

mouth is clear move the victim onto his back again

and tilt his head back.

~

For at least 5 seconds listen and feel for air

exchange and look for chest movements.

6

4. Check for breathing by bending over the

victim, placing your ear close to victim's mouth

and nose. For at least 5 seconds listen and feel for

air exchange and look for chest movements.

If the person is not breathing, pinch the nose

closed, form an airtight seal by placing your

mouth over the victim's mouth and breathe

into the victim's mouth until the chest rises.

5. If no breathing is present, pinch the nose

closed with the hand that is resting on the

forehead, form an airtight seal by placing your

mouth over the victim's mouth, and breathe into

the victim's mouth until his chest rises. (If using

the mouth-to-nose method, seal the victim'smouth

with your hand and breathe in through his nose.

6. Breathe into the patient a total of four times

as quickly as possible. If you feel or hear no air

exchange, re-tilt his head and try again. If

you stil

feel no air exchange, again sweep the mouth of

foreign objects (Step 3), and breathe into the victim

again. If you stil have no air exchange, turn

victim on side and slap the victim on the back

between his shoulder blades. Again sweep his

mouth to remove foreign matter. (N ote: If none of

the above steps clears the air passage, repeat the

blows to the back and tilt the head.)

7

7. Repeat breathing. Remove n:outh each.time

to allow air to escape. Repeat 12 times per mmute

for an adult - 20 times for a small child or infant.

Use deep breaths for an adult, less for a child,

gentle puffs of the cheeks for.infants. A~ the vi~ti~

begins to breathe, maintam head tilt. If it is

impossible to do mouth-to-mouth or mouth-to-nose,

use the following:

BACK PRESSURE ARM LIFT METHOD

1. Place victim face down. Clean mouth. Bend

his elbows and place his hands one upon the other

at eye level under victim's head. Turn his head to

one side, making sure the chin juts out. This

method wil be done on a five beat count.

Kneel at the victim's head, place your hands

on the victim's back.

2. Kneel at victim's head. Place your hands on

victim's back so palms lie just below an imaginary

line between armpits. (Count 1)

Rock forward until your arms are verticaL.

8

3. Rock forward until arms are vertical and the

weight of your body exerts steady pressure on your

hands. (Count 2)

Rock back grasping the victim's elbows.

4. Rock back grasping victim's elbows (Count

3) and draw victim's arms up toward you until you

feel resistance at his shoulders. (Count 4)

5. Lower victim's arms to the ground.

(Count

5)

Repeat about 12 times per minute (every 5

seconds). Keep checking to see if mouth is clean,

airway open, and the heart is beating. If hear~ is

not beating, begin external cardiac compreSSlOn

(circulatory failure).

DON'T

STOP

Continue artifical ventilation until victim

breathes normally, a doctor pronounces him dead,

a more qualified person takes charge, or you are

physically unable to continue. If he must be

moved, continue artificial ventilation.

9

i

FOREIGN OBJECTS IN THE THROAT SIG NS/SYMPTOMS 1. The victim gasps for breath 2. Has
FOREIGN OBJECTS IN THE THROAT
SIG NS/SYMPTOMS
1. The victim gasps for breath
2. Has violent fits of coughing
3. Quickly turns pale then blue
4. Cannot talk or breathe.
FIRST AID TREATMENT
remove obstruction.
his side and slap him on the back.
method:
navel and below the rib cage.
his head and arms hanging down.
lungs and may expel the obstruction.
CIRCULATORY FAILURE

1. Open victim's mouth and grasp foreign object

with fingers (index and middle), trying to

2. Place head lower then body or roll victim on

3. If these methods do not work, try this third

a. Rescuer stands behind the choking victim

with arms around the victim just above the

b. Lean the victim forward at the waist with

c. The rescuer grasps his wrist then exerts

sudden strong pressure against the vic-

tim's abdomen. This wil force air out ofthe

CAUSES

1. Heart attack

2. Impaired breathing

3. Shock

4. Electrical shock

SIG NS/SYMPTOMS

1. No breathing

2. No pulse

10

FIRST AID TREATMENT

D~m't Waste Time! Cardiac .arrest (heart stops

beatmg) means certam death if CPR (cardiopul-

monary resuscitation) is not attempted.

If you have been trained in CPR:

1. CHECK FOR RESPONSE - Gently shake

the victim and shout "Are you OK."

.2. CHECK AIRWAY - Open the victim's

airway by tilting his head back. (Victim should be

on his back.)

by tilting his head back. (Victim should be on his back.) Check for breathing. 3. CH~CK

Check for breathing.

3. CH~CK BREATHING - For at least 5

seconds listen and feel for air exchange and look

for chest movements.

If not breathing, give four quick full breaths.

11

4. IF NOT BREATHING - Give four quick

full breaths using the mouth-to-mouth technique.

Check pulse.

5. CHECK PULSE - After giving four quick

breaths, check the pulse using the carotid artery in

the neck. To find the carotid artery, locate the voice

box and slide two fingers into the groove between

the voice box and the large neck muscle. Press

firmly but gently to feel for the pulse and hold for at

leåst 5 seconds. If a pulse is not present, begin

cardiac compressions immediately.

To determine the pressure point for cardiac

compressions, locate the bony tip of the

breastbone with your ring finger and place

two fingers just above that point.

6. CARDIAC COMPRESSIONS - Kneel at

the victim's side near his chest. (Victim should be

on a hard, flat surface). To determine the pressure

12

point for cardiac compressions, locate the bony tip

of the breastbone (sternum) with your ring finger

and place two fingers just above that point. Place

the heel of one hand adjacent to your fingers and

the second hand on top of the first.

Place the heel of your hand adjacent to your

fingers and the second hand on top of the

first.

Position your shoulders directly over victim's

breastbone and press downward, keeping arms

straigh t. Depress the stern um 1112 to 2 inches for an

adult. The time spent depressing and releasing the

sternum should be equal.

If there is only one rescuer, compressions should

be at a rate of 80 per minute with 2 breaths

(artificial ventilation) after each 15 compressions.

Remember, after the two breaths, check your hand

position on the sternum before resuming compres-

sions.

If there are two rescuers, they should be on

opposite sides of the victim. One rescuer should

perform compressions at a rate of 60 per minute,

while the second rescuer is interposing a breath

(artificial ventilation) after every fifth compres-

sion. Compressions should not be interrupted to

breathe for the victim.

13

CARDIOPULMONARY RESUSCITATION BLEEDING FOR INFANTS AND SMALL CHILDREN SIG NS/SYMPTOMS 1. Airway - be careful
CARDIOPULMONARY RESUSCITATION
BLEEDING
FOR INFANTS AND SMALL CHILDREN
SIG NS/SYMPTOMS
1. Airway - be careful not to overextend the
infant's head when tilting it back; it is so pliable
that you may block breathing passage instead of
opening it.
2. Breathing - you can cover both mouth and
color
nose with your mouth and use less volume of air;
give a breath every three seconds.
3. Circulation - In both infants and small
children only one hand is used for compressions.
For infants, use only the tips of the index and
middle fingers to depress the mid-sternum 1/2 to % of
an inch at a rate of 80 to 100 compressions per
the
minute. For small children, use only the heel of

Blood coming from an artery, vein, or capilary:

a. Artery - spurting blood, bright red in color

b. Vein - continuous flow of blood, dark red in

c. Capilary - blood oozing from a wound

hand to depress the chest at mid-sternum and

depress the mid-sternum % to 1112 inches, depend-

ing on the size of the child. The rates should be 80

to 100 compressions per minute.

In both small children and infants, breaths

should be interposed after every fifth chest com-

pression.

Cover the wound with the cleanest cloth

immediately available.

FIRST AID TREATMENT

1. Cover wound with the cleanest cloth immedi-

ately available or your bare hand and apply direct

pressure on the wound. Most bleeding can be

stopped this way.

2. Elevate the arm or leg as you apply pressure,

if there is no broken bone.

14

3. Digital pressure at a pressure point is used

if it is necessary to control bleeding from an

arterial wound (bright red blood spurting from it.)

Apply your fingers to the appropriate pressure

point - a point where the main artery supplying

blood to the wound is located (see diagram). Hold

pressure point tightly for about 5 minutes or until

bleeding stops. The three pressure points in the

15

~

~ @ \ () ~
~
@
\ ()
~

$

~

@

(f

@

~

Apply pressure to the pressure point closest

to the wound and between the wound and the

heart.

16

head and neck should only be

used as a last resort

if there is a skull fracture and direct pressure can't

be used. If direct pressure can be used, it wil stop

bleeding on the head in about 95% of the injuries.

A tourniquet should be applied to an arm or

leg only as a last resort.

4. A tourniquet should be applied to an arm or

leg only as a last resort when all other methods

faiL. A tourniquet is applied between the wound

and the point at which the limb is attached to the

body, as close to the wound as possible but never

over a wound or fracture. Make sure it is applied

tightly enough to stop bleeding completely.

In the case of an improvised tourniquet, the

material should be wrapped twice around the

extremity and halfknotted. Place a stick or similar

object on the half knot and tie a full knot. Twist the

stick to tighten the tourniquet only until the

bleeding stops- no more. Secure the stick or level

in place with the loose ends of the tourniquet,

another strip of cloth, or other improvised materi-

aL.

17

l

Once the tourniquet is put in place, do not

loosen it. Mark a "T" on the victim's torehead and

get him to a medical facilty as soon as possible.

Only a doctor loosens or removes a tourniquet.

Note: A tourniquet can be improvised from a

strap, belt, hankerchiefs, necktie, cravat bandageol

etc. (Never use wire, cord or anything that wil cut

into the flesh.)

INTERNAL BLEEDING SIG NS/SYMPTOMS 1. Cold and clammy skin 2. A weak and rapid pulse
INTERNAL BLEEDING
SIG NS/SYMPTOMS
1. Cold and clammy skin
2. A weak and rapid pulse
3. Eyes dull and pupils enlarged
4. Possible thirst
5. Nauseous and vomiting
6. Pain in affected area
FIRST AID TREATMENT
1. Treat victim for shock
2. Anticipate that victim may vomit, give
nothing by mouth
3. Get the victim to professional medical help as
quickly and safely as possible
SHOCK
Shock may accompany any serious inJury:
blood loss, breathing impairment, heart failure,
burns.
Shock can kil - treat as soon as possible and
continue until medical aid is available.
18

SIGNS/SYMPTOMS

1. Shallow breathing

2. Rapid and weak pulse

3. Nausea, collapse,' vomiting

4. Shivering

5. Pale, moist skin

6. Mental confusion

7. Drooping eyelids, dilated pupils

FIRST AID TREATMENT

1. Establish and maintain an open airway.

2. Control bleeding.

3. Keep victim lying down.

Exception: Head and chest injuries, heart

attack, stroke, sun stroke. If no spine injury,

victim may be more comfortable and breathe

better in a semi-reclining position. If

keep the victim flat.

in doubt,

Elevate the feet unless injury would be aggravated. -
Elevate the feet unless injury would be
aggravated.
-

Maintain normal body temperature. Place

blankets under and over victim.

19

4. Elevate the feet unless injury would be

aggravated by this position.

5. Maintain normal body temperature. Place

blankets under and over victim.

6. Give nothing by mouth, especially stimulants

or alcoholic beverages.

7. Always treat for shock in all serious injuries

and watch for it in minor injuries.

20

INTRODUCTION TO SPECIFIC INJURIES

This section describes special methods which

you should follow for specific injuries or ilnesses

other than the four life threatening 'conditions

in Section 1. For quick reference this

discussed

section has been arranged alphabetically by the

injury.

21

Reddened skin.

Reddened skin, blisters.

Skin destroyed, tissues damaged, charring.

22

BURNS- HEAT

FIRST DEGREE

SIG NS/SYMPTOMS

Reddened Skin

FIRST AID TREATMENT

Immerse quickly in cold water or apply ice until

pain stops.

SECOND DEGREE

SIG NS/SYMPTOMS

Reddened Skin, Blisters

FIRST AID TREATMENT

1. Cut away loose clothing

2. Cover with several layers of cold moist

dressings or if limb is involved immerse in

cold water for relief of pain.

3. Treat for shock.

THIRD DEGREE

SIGNS/SYMPTOMS

Skin destroyed, tissues damaged, charring

FIRST AID TREATMENT

1. Cut away loose clothing (do not remove

clothing adhered to skin.)

burning action.

2. Cover with several layers of sterile, cold,

moist dressings for relief of pain and to stop

3. Treat for shock.

23

BURNS - CHEMICAL CHEST WOUNDS
BURNS - CHEMICAL
CHEST WOUNDS

FIRST AID TREATMENT

1. Flood affected area with water for at least 20

minutes until all chemical is removed.

2. Remove victim's clothing because chemical

may be retained in clothing.

~

 

-

r

 

1.

 

!

;

:

.

:

:

Cover with an airtight materiaL.

Flood affected area with water until all

chemical is removed.

GENERAL CARE FOR ALL BURNS

1. Administering Liquids - If medical help is

not available within an hour and the victim is

conscious and not vomiting and requests

something, give him 1/2 glass solution of 1/2

teaspoon salt, 1/2 teaspoon baking soda to a

quart of water, every 15 minutes.

2. Separate any burned areas that might come

in contact with each other when bandaging.

(fingers, toes, ear and head)

3. Get medical attention as soon as possible.

4. Do not break blisters.

5. Do not use ointments.

24

.FIRST AID TREATMENT

1. Cover wound with an airtight material

(aluminum foil or plastic wrap) after the

victim has exhaled. If no airtight material is

available, use your hand.

2. Place the victim on the injured side to allow

expansion room for the uninjured lung.

3. Get the victim to the hospital as soon as

possible.

25

EPILEPTIC SEIZURE DIABETIC EMERGENCIES
EPILEPTIC SEIZURE
DIABETIC EMERGENCIES

DIABETIC COMA

SIG NS/SYMPTOMS

1. Skin: red and dry

2. Temperature: lowered

3. Sickly sweet odor of acetone on breath

4. Breathing: rapid and deep

FIRST AID TREATMENT

1. Treat as you would for shock

2. Place in a semi-reclining position.

3. In case of vomiting turn head to one side.

4. Do not give sugar, carbohydrates, fats or

alcoholic beverages.

INSULIN SHOCK

SIGNS/SYMPTOMS

1. Skin: pale, moist, clammy and covered with

cold sweat.

2. Breathing: normal or shallow.

3. No odor of acetone

FIRST AID TREATMENT

This is a hurry situation and should be done

quickly.

1. If the victim is conscious, give him sugar

(sugar, candy bar or orange juice)

2. If unconscious, put sugar under the tongue.

Because it is often diffcult to determine the

difference between the diabetic emergencies, sugar

should be given to any unconscious or semi-

conscious diabetic even though he may be suffer-

ing from diabetic coma (too much sugar). The

reason for giving sugar is that an insulin reaction

(too little sugar) resulting in unconsciousness can

quickly cause brain damage or death.

26

SIG NS/SYMPTOMS

1. Loses consciousness

2. Convulsions

3. Severe spasms of

the

muscles ofthejaw(may

bite tongue)

4. Victim may vomit

5. Face may be livid, with veins of the neck

swollen.

6. Breathing may be loud and labored with a

peculiar hissing sound.

7. Seizure usually lasts only a few minutes but it

may be followed by another.

FIRST AID TREATMENT

1. Keep calm.

2. Do not restrain victim; prevent injury by

moving away any object that could be danger-

ous.

3. Place light padding under victim's head to

protect from rough ground. (jacket, shirts,

rug)

4. There is a danger of the victim biting his

tongue so place a padded object between his

jaws on one side of

his mouth. A shirt tail and

a stick can be used for the padded object.

However do not try to force jaws open if they

are already clamped shut.

5. When the seizure is over loosen clothing

around the neck.

6. Keep the victim lying down.

7. Keep victim's airway open.

8. Prevent his breathing vomit into lungs by

turning his head to one side or by having him

lie on his stomach.

9. Give artificial respiration if breathing stops.

10. After the seizure, when consciousness is

regained allow the victim to sleep or rest.

27

IMPALED OBJECTS EYE INJURIES
IMPALED OBJECTS
EYE INJURIES

FOREIGN BODIES IN THE EYE

FIRST AID TREATMENT

1. Never rub eyes.

2. Try to flush out with clean water.

3. If object is on upper lid, lift eyelid, and remove

object with sterile gauze.

4. If foreign object is on the eye and can't be

washed out, cover eye and take victim to a

doctor.

be washed out, cover eye and take victim to a doctor. If object is on upper

If object is on upper lid, lift eye lid, and

remove object with sterile gauze.

28

Cover with paper cup to protect the eye and

prevent object from being further driven into

it.

FIRST AID TREATMENT

1. Leave object in victim; it should only be

removed by a doctor;

2. Place sterile gauze around eye, apply no

pressure.

3. Cover with paper cup or cardboard cone to

protect it and prevent object from being

further driven into eye.

4. Cover both eyes, and

explain to victim why

both eyes are covered, one eye cannot move

without the other eye moving. Calm and

reassure the victim - he may panic with both

eyes covered.

For chemical burns to the eyes see Burns -

Chemical

29

FRACTURES - DISLOCATIONS
FRACTURES - DISLOCATIONS

CLOSED FRACTURE (simple): broken bone

but no open wound.

FRACTURES

SIGNS/SYMPTOMS

a. Deformity

b. Irregularity

c. Swellng

d. Discoloration

e. Grating sound

f. Exposed bone (open fracture)

g. Pain

OPEN FRACTURE (compound): broken

bone with open wound

DISLOCATIONS

SIG NS/SYMPTOMS

a. Deformity

b. Pain

c. Loss of function

30

DISLOCATION: separation of two bones

that come together to form a joint.

FIRST AID TREATMENT FOR FRAC-

TURES AND DISLOCATIONS-

1. If fracture is suspected immobilize.

2. "Splint them where they lie."

3. Handle as gently as possible. This work

should be done in pairs, one person to immobilze

the limb and one to apply the splint.

4. Place a fracture in as near normal position

as possible by applying slight traction. Traction is

applied by grasping the affected limb gently but

firmly with one hand above and below the

locati¿n of the fracture, and pulling the limb

between your hands. This is maintained until the

splint is secured in place. Caution: never try to

straighten if a joint of spine is involved.

5. Immobilize dislocated joints in the position

they are found, do not attempt to reduce or

straighten any dislocation.

6. Splints

a. Should be long enough to support joints

above and below fracture or dislocation.

b. Rigid enough to support the fracture or

dislocation.

c. Improvised splints should be padded

enough to insure even contact and pressure

between the limb and the splint and to protect all

bony prominences.

31

d. Types of splints: air splint, padded boards,

rolled blanket, tools, newspapers, magazines.

7. Applying improvised splints

a. Apply slight traction to the affected limb.

b. A second person (if available) should place

the padded splint under, above or alongside the

limb.

c. Tie the liinb and splint together with

bandaging materials so the two are held firmly

together. Make sure the bandaging material is

not so tight that it impairs circulation. Leave

fingers and toes exposed, if they are not

involved, so that the circulation can be checked

constantly.

32

8. Applying inflatable splints

a. Inflatable splints can be used to immobilize

fractures of the lower leg or forearm.

b. To apply an air splint gather splint on your

own arm so that the bottom edge is above your

wrist.

c. Help support the victim's limb - or have

someone else hold it.

d. Inflate by mouth only to desired pres-

sure. It is inflated to the point where your thumb

would make a slight indentation.

e. If it is a zipper type air splint lay the

victim's limb in the unzipped air splint, zip it and

inflate. Traction cannot be maintained when

applying this type of splint.

f. Change in temperature can effect this type

of splint - going from cold area to warm area

wil cause the splint to expand. It may be

necessary to deflate the splint until proper

pressure is reached.

33

FROSTBITE HEART ATTACK
FROSTBITE
HEART ATTACK

Most frequently frostbitten: toes, fingers,

nose, and ears.

CAUSE

Exposure to cold

SIGNS/SYMPTOMS

1. Skin becomes pale or a grayish-yellow color

2. Parts feel cold and numb

3. Frozen parts feel doughy

SIGNS/SYMPTOMS

FIRST AID TREATMENT

1. Shortness of breath

1. Unti victim can be brought inside, he should

be wrapped in woolen cloth and kept dry.

2. Do not rub, chafe or manipulate frostbitten

parts.

3. Bring victim indoors.

4. Place in warm water (102° to 105°) and make

sure it remains warm. Test water by pouring

on inner surface of your forearm. Never thaw

if the victim has to go back out into the cold

which may cause the affected area to be

refrozen.

5. Do not use hot water bottles or a heat lamp,

and do not place victim near a hot stove.

6. Do not allow victim to walk iffeet are affected.

7. Once thawed, have victim gently exercise

parts.

8. For serious frostbite, seek medical aid for

thawing because pain wil be intense and

tissue damage extensive.

2. Anxiety

3. Crushing pain in chest, under breastbone, or

radiating down left arm.

4. Ashen color

5. Possible perspiration and vomiting.

FIRST AID TREATMENT

1. Place victim in a semi-reclining or sitting

position.

2. Give oxygen if available.

3. Loosen tight clothing at the neck and waist.

4. Administer nitroglycerine pil if victim is

carrying them and asks you to get them (they

are adminìstered by putting one under the

tongue).

5. Keep onlookers away.

6. Comfort and reassure him.

7. Do not allow him to move around.

8. Give no stimulants.

34

35

.

HEAT

CRAMPS

HEAT EXHAUSTION

~ Pale and clammy skin, perspiration. SIG NS/SYMPTOMS 1. Pale and clammy skin 2. Profuse
~
Pale and clammy skin, perspiration.
SIG NS/SYMPTOMS
1. Pale and clammy skin
2. Profuse perspiration
3. Rapid and shallow breathing
Affects people who work or do strenous exercises in
4. Weakness, dizziness, and headache
a hot environment.
FIRST AID TREATMENT
SIG NS/SYMPTOMS
1. Care for victim as if he were in shock.
1. Painful muscle cramps in legs and abdomen.
2. Faintness
chiling.
3. Profuse perspiration
3. If body gets too cold, cover victim.
FIRST AID TREATMENT
HEATSTROKE
1. Move victim to a cool place
2. Give him sips of salted drinking water (one
teaspoon of salt to one quart of water)
3. Apply manual pressure to the cramped
~
muscle
PREVENTION
1. Men at hard work in high temperatures
should drink large amounts of cool water.
2. Add a pinch of salt to each glass of water.
Red and flushed, skin hot and dry.
SIGNS/SYMPTOMS
1. Face is red and flushed
2. Victim becomes rapidly unconscious
3. Skin is hot and dry with no perspiration

2. Remove victim to a cool area, do not allow

36

37

FIRST AID TREATMENT

FIRST AID TREATMENT

1. Lay victim down with head and shoulders

raised.

2. Reduce the high body temperature as quickly

3. Apply cold applications to the body and head.

4. Use ice and fan if available.

5. Watch for signs of shock and treat accord-

ingly

6. Get medical aid as soon as possible.

1. Bring victim into a warm room as quickly as

possible.

2. Remove wet clothing.

3. Wrap victim in prewarmed blankets, put in a

warm tub of water, or next to one or between

two people for body warmth.

4. Give artificial respiration, if necessary.

5. If victim is conscious, give warm drink (N 0

alcohol).

I

J

6. Get medical help as soon as possible.

L.~~. ---- ---

,,'" -. - - -~ - - - - ~-

I

-

INSECT BITES AND STINGS --~."- - ~ - ~ --~ - ) I - ~
INSECT BITES AND STINGS
--~."-
-
~
-
~ --~ - )
I
-
~
",
Qi
~.~
I
Q
toes, ticks, fleas, and bedbugs)
HYPOTHERMIA
SIG NS/SYMPTOMS

1. Local irritation and pain

FIRST AID TREATMENT

¡ , """"

"",

( Exposure)
( Exposure)

(from bees, wasps, yellow jackets, hornets, mosqui-

2. Moderate swellng and redness

3. Itching and/or burning, may be present

1. If stinger is left in the wound, withdraw it.

2. Apply paste of baking soda and water.

3. Immediate application of ice or ice water to

the bite or sting relieves pain.

4. For people who are allergic to certain insects,

use a constricting bandage (if on an extremi-

ty) and ice. Get medical help immediately.

Chils the inner core of the body so the body can't

generate heat to stay warm.

SIG NS/SYMPTOMS

1. Entire body affected

2. Shivering

3. Numbness

4. Low body temperature

5. Drowsiness, mumbling, incoherence

6. Muscular weakness

38

39

40

Abrasion

Open wounds WOUNDS OPEN FIRST AID TREATMENT 1. Stop bleeding. ing. Puncture :: '\ ""
Open wounds
WOUNDS
OPEN
FIRST AID TREATMENT
1. Stop bleeding.
ing.
Puncture
:: '\ ""

2. Cover with cleanest cloth immediately avail-

able. (Preferably a sterile dressing)

3. Wash with soap and water - those wounds

which involve surface area with little bleed-

Do not remove imbedded objects.

Cut clothing from injury site.

Laceration

l

Avulsion

3;

Incision

::t\ ,.

Stabilze object with bulky dressings.

d

3; Incision ::t\ ,. Stabilze object with bulky dressings. d Apply paper cup, if available, to

Apply paper cup, if available, to prevent

movement.

41

.

4 Impaled Objects .

. a. Do not remove embedde~ o)JJects:

b. Cut clothing away from inJury sit.e.

c. Stabilize objects with bulky

d. Apply bandage and paper cup (if avail-

able) to prevent movement.

e. If large object, cut off o~l~ enough to allow

for transportation of victim.

~

.

Bandages and dressings

42

PRINCIPLES OF BANDAGING
PRINCIPLES OF BANDAGING

1. Never tie a tight bandage around the neck.

it

may cause strangulation.

2. A bandage should be tight enough to prevent

slipping, but not so tight as to cut off circula-

tion.

3. Leave fingers and toes exposed, if uninjured,

to watch for swelling or changes of color and

feel for coldness, which signal interference

with circulation.

for coldness, which signal interference with circulation. 4. Loosen bandages immediately if victim complains of

4. Loosen bandages immediately if victim

complains of numbness or a tingling sensa-

tion.

5. Once a dressing is in place do not remove. If

top of it. 43

blood saturates the dressing, put another on

POISONS RIB FRACTURES SIG NS/SYMPTOMS i 1. Pain is usually localized to site offracture. By
POISONS
RIB FRACTURES
SIG NS/SYMPTOMS
i
1. Pain is usually localized to site offracture. By
asking the victim to place his hand on the
exact area of pain (if he is conscious), the first
the injury.
aider can determine the location of
2. Possible rib deformity or lacerations.
3. Deep breathing, coughing or movement is
FIRST AID TREATMENT
painfuL.
1. Dilute by drinking large quantities of water.
4. The victim often leans toward the injured side
2. Induce vomiting except when poison is
with his hand held over the injury site in an
corrosive or a petroleum product.
attempt to ease the pain and immobilze the
3. Call the poison control center or a doctor.
chest.
PROTRUDING INTESTINES

FIRST AID TREATMENT

1. Do not try to replace intestine.

2. Leave organ on the surface.

3. Cover with non-adherent material (alumi-

num foil or plastic wrap).

4. Cover with outer dressing to hold it in place.

Cover with nonadherent materiaL.

44

Bind arm to chest with two medium cravats.

FIRST AID TREATMENT

1. Bandage should be tightened during exhala-

tion.

2. Place arm of injured side across chest.

3. Bind arm to chest with two medium cravats.

4. Repeat with two additional cravats, overlap-

ping bandages slightly.

5. Tie fourth cravat along angle or arm for

support.

6. It is important to make certain that the

binding is not too tight, as a fractured rib

might puncture a lung.

45

SKULL FRACTURE SNAKEBITES ( suspected) SIG NS/SYMPTOMS 1. Puncture marks 3. Nausea and vomiting 4.
SKULL FRACTURE
SNAKEBITES
( suspected)
SIG NS/SYMPTOMS
1. Puncture marks
3. Nausea and vomiting
4. Respiratory distress
5. Shock

SIG NS/SYMPTOMS

1. Unconsciousness

2. Deformity of the skull

3. Open wound

4. Blood or clear water-like fluid coming from

ears or nose

5. Pupils may be unequal in size.

2. Severe burning, pain and spreading swellng

FIRST AID TREATMENT

1. Maintain an open airway.

2. Check for spinal injury.

3. Keep victim quiet.

~ =

Raise head and shoulders. If there is no

suspected neck injury turn head so it does not

rest on

Or place in a three-quarter prone posi-

tion.

4. If

there is no suspected neck injury, turn head

so it does not rest on fracture.

5. Raise head and shoulders or place in a three

quarter prone position.

6. Use ice pack to stop severe bleeding.

7. Do not stop bleeding from ears or nose.

46

Puncture marks at the site of the bite.

FIRST AID TREATMENT

1. Immobilize the victim immediately with

injured p~rt lo~er t?an the rest of th~ body.

Any activity will stimulate spread of poison.

2. Remove rings, watches, and bracelets.

3. Apply a constricting band above swellng

c.aused by the bite. It should be tight, but not

tight enough to stop arterial circulation.

4. Make an incision, no more than 1/8 inch deep

nor more than 1/2 inch long, lengthwise

through fang marks. Press around cut to

make it bleed.

5. Suction wound with device found in snakebite

kit. If no kit is available, use your mouth (if

you have no open sores in your mouth or on

you~ lip~) and spit out the blood. Cutting and

suctlOn is of no value unless done immediate-

ly. Do not cut if bite is near a major vesseL.

47

6. If swellng continues past the constricting

band, put another past the swellng and

loosen the first band.

7. Treat the victim for shock. Do not give the

victim any stimulants or alcohoL.

8. Identify snake if possible. If snake can be

kiled, take it to the hospital with the victim.

9. For persons who frequent regions infested

with poisonous snakes, it is recommended

that any of the pocket-size snakebite kits be

retained.

Check upper extremities for paralysis of

neck.

Can victim feel your touch?

SPINE FRACTURE OR DISLOCATION Can victim grasp your hand? (back and neck) 1. Pain in
SPINE FRACTURE OR DISLOCATION
Can victim grasp your hand?
(back and neck)
1. Pain in back or neck
2. Paralysis
3. Deformation
4. Cuts and bruises
5. Swelling
1. Ask if the victim feels pain in the back.
2. Look for cuts, bruises, and deformation.
3. Feel along back for tenderness to your touch.
4. Check for paralysis by having victim move
fingers and toes.

SIG NS/SYMPTOMS

SURVEY - for a conscious victim

48

Can victim raise arms and wiggle fingers?

49

Check lower extremities for paralysis of

back.

Check lower extremities for paralysis of back. Can victim feel your touch? Can victim press against

Can victim feel your touch?

Can victim press against your hand?

victim feel your touch? Can victim press against your hand? Can he wiggle his toes? 50

Can he wiggle his toes?

50

SURVEY - for an unconscious victim

1. Look for cuts, bruises, and deformation.

2. Feel along back for deformation.

3. Ask others what happened.

4. Gently jab victim (with something sharp)

lightly on the soles of

feet or ankles (for back)

or hand (for neck) - if cord is intact foot or

hands may react.

Lightly jab hands or feet with something

sharp.

A spine fracture or dislocation is diffcult to tell if the

in the unconscious victim with any accuracy.

accident looks as if it could have produced a spinal

injury, treat for one even though there are no other

signs.

-~.

51

FIRST AID TREATMENT

1. Do not try to straighten the deformity to make

splinting easier - straighten only to help open an

airway.

2. Apply traction to the head, supporting head

in line with the body. The head should be held until

the victim is secured to the splint.

3. Restore airway and make sure breathing is

adequate.

4. If there is a suspected neck fracture and the

victim is found on his face, apply traction to the

head and roll the victim over keeping the head in

line with the body. A minimum of three people is

needed for this.

5. Do not bend or twist back or neck. Support

head in line with body.

6. Control serious bleeding.

7. Immobilize before moving victim.

8. Lift victim only high enough to slide stretcher

under victim.

9. In case of a suspected neck fracture, the head

should be kept from moving after the victim has

been put on the stretcher - by rollng' a blanket

around the head and securing it to the stretcher

with two cravat bandages.

10. Do not move the victim until there are

enough rescuers and an adequate splint available.

11. The stretcher must be rigid, an ordinary

canvas stretcher is not suitable. An improvised

stretcher can be made from two long boards, 84 by

6 by 1 inch; and 3 short boards, each 22 by 4 by 11/2

inches. The three short boards wil be cross pieces

under the two long boards, nailed or tied at points

corresponding to where the person's shoulders,

hips, and heels wil be. Pad the long boards with

blankets and secure in place. The victim is then

placed on the stretcher and tied on with fifteen

cravat bandages.

52

Apply traction to victim's head.

V ictim is secured to an improvised stretcher

board with 15 cravat bandages.

53

SPRAINS SIG NS/SYMPTOMS 1. Intense pain 2. Moderate swelling FIRST AID TREATMENT 1. Rest 2.
SPRAINS
SIG NS/SYMPTOMS
1. Intense pain
2. Moderate swelling
FIRST AID TREATMENT
1. Rest
2. Apply mild dry heat.
STROKE

Overstretching of a muscle or tendon

3. Pain and diffculty in moving

Ligaments or other tissues around joints are

torn or stretched.

SIG NS/SYMPTOMS

1. Pain on movement.

2. Swellng

3. Discoloration

FIRST AID TREATMENT

1. Elevate injured part.

2. Apply cold compresses.

3. Treat as a fracture.

Note: Sprains present basically the same signs

and symptoms as fractures. Because of

this factor,

treat all injuries to the bones and joints as

fractures.

STRAINS
STRAINS

~~

Pupils are unequal in size. There may be

paralysis on one side of the body.

(a blood clot or rupture of a blood vessel in the

brain)

Strains are caused by overstretching of a

muscle or tendon.

54

SIG NS/SYMPTOMS

1. Usually unconscious.

2. Face flushed and warm but may sometimes

appear ashen gray.

3. Pulse first slow and strong; later rapid and

weak.

4. Respiration slow with snoring.

5. Pupils unequal size.

6. Paralysis on one side of face andlor body.

55

.

FIRST AID TREATMENT

1. Keep an open airway; do not allow tongue or

saliva to block air passage.

breathing is satisfactory.

2. Keep the victim warm.

3. Place victim in a semi-reclining position if

4. Keep the victim quiet.

5. Reassure victim if he is conscious.

TRANSPORTATION
TRANSPORTATION

After receiving first aid care, a seriously injured

person often requires transportation from a mine,

to a hospital, to a physician's offce or to his home.

It is the responsibilty of the first aid person to

insure that the victim is transported in such a

manner as to prevent further injury and is

subjected to no unnecessary pain or discomfort. No

matter how expert the first aid care has been,

improper handling and careless transportation

often add to the severity of the original injuries,

increases shock, and frequently endangers life.

N ever move a victim until a thorough examina-

tion has been made and all injuries have been

protected by proper dressings. (Unless the victim

and the first aider are in immediate danger at the

accident site.)

Seriously injured persons should be moved only

in a lying down position. If proper transportation

is not immediately available, continue care of the

victim to conserve his strength until adequate

means of transportation can be found.

If the person must be pulled or dragged to

safety, pull in the direction of

the body.

the long axis of

If a person is in a life threatening situation and

must be pulled or dragged to safety, he should be

pulled in the direction of

the long axis of

his body,

preferably from the shoulders, not sideways.

Avoid bending or twisting the neck or trunk.

If available use a blanket, board or card-

board to move the victim.

Various carries can be used in emergencies, but

the stretcher is the preferred transportation

method. Carrying in the arms, carrying over the

back, and the two-man carry should be used only

when it is positively known that no injury wil be

aggravated by such handling of the victim.

-

57

Various carries can be used in emergencies.

58

The Two-Man Carry.

o

59

THREE OR FOUR MAN LIFT

AND

CARRY

An injured person can be moved or carried with a

minimum of further injury or discomfort with the

three or four man lift and carry. It is used where an

injured person is to be carred a short distance,

transported through narrow passageways, or

where a stretcher is not available.

The lift is used also when an injured person is

being placed or removed from a stretcher.

Three persons are required for this lift and a

fourth is desirable (a fourth is necessary for a

spinal injury to hold the head). Proper lifting must

be done by commands of a leader or one of the

bearers, usually the one at the victim's head.

Each of the three men kneels (on his knee

nearest the victim's feet) one opposite the victim's

shoulders, another opposite his hips, and the third

opposite his knees. Unless the nature of the

victim's injuries makes it undesirable, the bearers

kneel by the victim's uninjured or least injured

side.

Position of the hands: First man - hands under

shoulders and neck; second man - hands under

thighs and small of the back; third man - hands

under victim's ankles and knees; fourth man -

helps support trunk from opposite side, to prevent

rollng.

Step 1: The leader wil tell the bearers "Prepare

to lift victim."

Step 2: The leader wil then say "Lift victim."

The bearers slowly lift the victim and support him

on their knees. If a stretcher is available, stop in

this position and slide stretcher under the victim.

Then lower the victim on command of the leader.

60

if

Position of hands: neck and shoulders,

thighs and small of back, ankles and knees.

Bearers slowly lift the victim and support

him on their knees.

Place the stretcher under the victim.

61

.

If stretcher is not available, the bearers will

have to rise with the victim and carry him

away from the scene of the accident.

stretcher is not available and cannot be brought to

the victim go to Step 3.

Step 3: The leader wil tell the bearers "Prepare

to rise with victim." Bearers turn victim slowly to

his side until he rests against their chests.

Step 4: When the leader says "Rise with

victim," the bearers rise slowly with the victim.

STRETCHERS

Stretcher should be tested before placing victim

on it. Use a person of about equal weight as the

victim. The person should be face down so that if

the stretcher should break or tear when it is picked

up, the person wil be able to catch himself.

62

Types of stretchers.

Robinson

Long board

o

Short board

Stokes

63

.;;

i.

y.

Improvised Blanket Stretcher, partly folded

~

Stretcher Board (with foot rest)

STRETCHER BOARDS

Stretcher boards can be made from a wide board,

approximately one and one-half inches thick, or

from laminated plywood, about three-quarters of

an inch thick. They are usually about 78 inches in

length and about 18 inches in width. They have

slots about 1 inch wide placed along the edges,

through which cravat bandages are passed to

secure the victim to the

board.

.The slots may also

serve as hand holds. Some variations have

additional slots in the center of the boards so that

each leg may be secured separately to the board.

64

IMPROVISED STRETCHERS

A stretcher may be improvised with a blanket,

brattice cloth of similar size, a rope, or a strong

sheet and two poles or pieces of pipe each 7 to 8 feet

long. Place one pole or pipe about 1 foot from the

center of the unfolded blanket. Fold the short side

of the blanket over the pole toward the other side.

Place the second pole or pipe on the two thick-

nesses of blanket about 2 feet from the first pole

and parallel to it. Fold the remaining side of the

blanket over the second pole toward the first pole.

When the inj ured person is placed on the blanket,

the weight of the body secures the folds.

65

BIBLIOGRAPHY

1. The American National Red Cross. Standard

First Aid and Personal Safety. Doubleday &

Company, Inc., New

York, 1st

Ed., 1973,

268

pp.

2. The Committee on Injuries, American Academy

of Orthopedic Surgeons.' Emergency Care and

Transportation of the Sick and Injured. George

Banta Co., Inc., Menasha, Wisconsin, 1971,293

pp.

3. Grant, H. and R. Murray. Emergency Care.

Robert J. Brady Co., Bowie, Maryland, 1971,

334 pp.

4. Henderson, John. Emergency Medical Guide.

McGraw-Hil Book Co., New York, 2nd Ed.,

1969, 556 pp.

5. The Journal of the American Medical Associ-

ation (A Supplement). Standards for Cardio-

pulmonary Resuscitation (CPR) and Emer-

gency Cardiac Care (ECC). v. 227, No.7, Feb.

18, 1974, pp. 833-851.

6. U.S. Bureau of Mines. First Aid for the Mineral

and Alled Industries. A Bureau of Mines

Instruction ManuaL. 1971, 191 pp.

66

ABOUT THE AUTHORS -

Linda H. Byers

Mrs. Byers is an instructor with Education and

Training, Mining Enforcement and Safety Admin-

istration pf the U.S. Department of the Interior at

Arlington, Virginia and holds a BS degree from

the University of Maryland.

Marilyn Hutchison, M.D.

Dr. Hutchison is currently the Acting Director,

Division of

Occupational Health Services, N ation-

al Institute for Occupational Safety and Health

(NIOSH), Center for Disease Control, of the U.S.

Department of Health, Education, and Welfare at

Rockvile, Maryland. She is a commissioned

offcer with the U.S. Public Health Service and

holds an AB degree from the University of

Missouri at Kansas City and an MD degree from

the University of Kansas.

Notes

tlU.S. GOVERNMENT PRINTING OffiCE: 1976-618-469

MESA Safety Manuals

Accident Prevention

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Safety Fundamentals

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