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Trainers manual on First Aid

Prepared by

Dr. Shantha De Silva


(International First Aid Trainer)

INDEX
PART I
Page
Session 1
Session 2
Session 3
Session 4
Session 5

Session 6 Session 7 Session 8 Session 9 Session 10 Session 11 Session 12 Session 13 Session 14 Session 15 Annexes -

Introduction to Human Body


Introduction to First Aid
Incident Management
Casualty Management and Primary Survey
Management of Breathing but unconscious patient
- Recovery position
Non-breathing Adult Rescue Breaths
Management of an adult with no Heartbeat CPR
Choking
Secondary Survey, observing and recording
Circulatory Disorders - Fainting, Shock, Heart attack and Angina
Wounds and Bleeding
Burns and Scalds
Soft tissue Injuries, Fractures and Head injuries
Poisoning
Transportation of Casualties

15-17
18-19
20-22
23-25
26-29
30-33
34-37
38-46
47-50
51-52

I
II
III
IV
V
VI

53-55
56-58
59-60
61
62
63

Pre-test
Post-test
Course Evaluation
Trainers Evaluation
First Aid Box
Transparencies and handouts

01-05
06-07
08-09
10-12
13-14

PART II
Trainers guide

1. Sessions 1 to 2
2. Sessions 3 to 8
3. Sessions 9 to 13
4, Sessions 14 to 15

01
02
03
04

PART I
SESSION 01
Topic

Learning Objectives -

Introduction to Human Body


At the end of the session participants will be able to
know the different parts of the body, their functions, interrelationship
and normal parameters of life.

Contents

1.1

Describing parts of the body

1.2

Describing the functions of the body parts

1.3

Explaining the inter-relationship of body parts

1.4

Explaining normal parameters of life

Methodology

Lecture Discussion

Visual Aids

Pictures, Dummy, Dimmy papers, Marker pens, Blue


Tack, OHP, Transparencies

Time

30 minutes

Evaluation

Questioning

01. INTRODUCTION TO HUMAN BODY


1.1
(a)

Parts of the Body


Skeleton

(b)

Major bones
i Skull & Spine (back bone) 33 vertebrae

iii Shoulder and upper limb

ii Ribs and breast bones 12 pairs of


curved bones

iv Pelvis and lower limbs

(c)

Boundaries and contents of the cavities of the trunk


I
Chest cavity
II

Lung

Abdominal cavity

Stomach
Gall Bladder
Kidney
Intestines

Heart

(d) Skin

(e)

(f)

Respiratory system

Nose to lungs

Circulatory system Heart, Arteries, Veins and Capillaries

(g)

Nervous system Brain, Spinal cord, Peripheral Nerves

(h)

Digestive system Mouth to Anus

(i)

Genito-urinary system Kidneys, Bladder, Ureters, male/female, Genito-Urinary organs

1.2

Functions of the body


(a)

(b)

Skeleton -

Skull
*

gives shape and firmness

Provides levers for muscles to work

Protects important organs

Protects the brain

Spine (back bone): Cartilage between the vertebrae allow


movement and absorb shock
Spine bound together by ligaments

Ribs and breast bone: Protect Heart and lungs in the chest
cavity

Shoulder blade, Bones of the upper limbs and lower limbs


movable joints e.g. elbow joint, shoulder joint, hip joint
knee joint, foot

(c)

Pelvis: Support and protect lower abdominal contents

Chest cavity - Accommodate lungs and heart, gullet and major blood
vessels

(d)

Skin i Covers the whole body


ii Protects underlying structure from injury and infection
iii Regulate temperature of the body

(e)

Respiratory system: Respiration (breathing) is the process which oxygen passes to the
blood while carbon dioxide a waste product is expelled which takes place in the lungs.
6

(f)

Circulatory system: Includes Heart and blood vessels (arteries, veins, and capillaries)
and blood

Heart pumps blood

Arteries carry blood away from heart

Veins carry blood and return to heart

Capillaries Very small blood vessels, which has a very thin wall that allows
exchange of fluids and gases to and from tissues of the body.

Blood - A fluid contains red blood cells, white blood cells and
platelets.
- Blood carries oxygen, nutrients from digestive organs
and carries waste products to excretory organs.

(g)

Nervous system: Activities are controlled by the peripheral Nervous


System involves sensation.

(h)

Digestive System: Food we take travel along this tract and digestion take place.

(i)

Genito-urinary System: Includes genital organs (sexual activities) and excretory


organs (excretion of waste products)

1.3

Inter-relationship of body parts


Functions of the different body parts/organs are inter linked. Therefore malfunctioning of a
part of the body/organ may affect the function of another part/organ. Eg. Heart
Heart

1.4

Kidneys

Lungs

Normal Parameters of life


Normal Respiratory rate Adult 16 times/minute
Child 20 to 30 times/minute
Normal Heart rate

- Adult 60 80 beats/minute
- Child 80 100 beats/minute

SESSION 02
Topic

Learning Objectives -

Introduction to First Aid


At the end of the session the participants will be
able to define First aid, describe the aims of first aid and explain the
responsibilities of a first aider.

Contents

2.1

Define first aid

2.2

Aims of first aid

2.3

Responsibilities of a first aider

Methodology

Discussion

Visual Aids

Pictures, Dimmy papers, marker pens, Blue tack, OHP,


Transparencies

Time

30 minutes

Evaluation

Questioning

02. INTRODUCTION TO FIRST AID


2.1

Definition of First Aid


The skilled application of accepted principles of treatment on the occurrence of an injury or
illness, using the available resources at that time; until handed over to a doctor or to other
skilled person and removal to hospital if necessary.

2.2

2.3

Aims of First Aid


(a)

To preserve life

(b)

To prevent the condition becoming worse

(c)

To promote recovery

Responsibilities of a first aider


*

Allow casualty feel secure and in safe hands

Speak firmly and kindly

Act calmly and logically

While examining, explain the casualty what you are going to do

Answer the questions honestly

Continue to reassure the casualty

Protect against infection

SEESION 03
Topic

Incident Management

Learning Objective

To be able to plan and implement activities during an


emergency.

Contents

3.1

Assessing the situation

3.2

Making the situation safe

3.3

Giving Emergency aid (Casualty management)

3.4

Getting help

3.5

After the incident

Methodology

Explain Discussion, Role play

Visual Aids

Pictures, Dimmy papers, marker pens, Blue tack, OHP,


Transparencies

Time

30 minutes

Evaluation

Questioning

10

03. INCIDENT MANAGEMENT


3.1

3.2

3.3

3.4

3.5

Assessing the situation


*

Look for danger

See what has happened

Look for people who are hurt

Look for people hidden from view or trapped somewhere

Making the situation safe


*

Before going to the site you may need to send for emergency help

Remove or reduce danger

If this is not possible remove the casualty from danger

Giving Emergency aid (casualty management)


*

Assess the casualties

Decide on the action needed

Provide aid to casualties

Getting help
*

Sooner the better

Send a bystander to contact medical aid and transport if necessary

After the incident


*

Tidy up the site

Remove cause to prevent further accidents (if possible)

Restock the First Aid kit

Talk to a friend or relative about your thoughts and feelings after dealing with an
accident.

11

SESSION 04
Topic

Learning Objectives -

Casualty Management and Primary Survey


At the end of the session the participants will be able to
know the primary survey and treatment priorities in casualty
management

Contents

Steps in the Primary Survey


4.1

Checking for Danger

4.2

Checking Response

4.3

Checking the Airway

4.4

Checking for Breathing

4.5

Checking for Circulation

4.6

DRABC

Methodology

Explaining, Demonstrating, Practicing

Visual Aids

Dummy or a participant / mat, OHP, Transparencies

Time

01 hour

Evaluation

Practical assessment

12

04. CASUALTY MANAGEMENT AND PRIMARY SURVEY


4.1

4.2

Checking for Danger


*

Check for danger to you and to the casualty.

If possible remove the danger

If not, move the casualty to a safer place

Checking for Response


By checking response, consciousness is assessed.
To check response following steps are important:

4.3

Call the casualty Hello

If no response give a command Open the eyes

If no response gently shake the casualty.

Checking the Airway


Oxygen is essential for the life
Oxygen is inhaled with the air during inspiration and is
circulated through the blood.
If oxygen is not available to brain for more than
three minutes, brain cells will begin to die.
In an unconscious casualty the tongue will slip back
and obstruct the airway. This will impair the oxygen supply to the tissues.
To prevent this:
Quickly check for any obvious obstruction
Open the airway by lifting the chin and tilting the head back, carefully.

13

4.4

Checking for Breathing


If the airway is blocked breathing will also stop.
When the airway is opened casualty starts breathing again
*

Open the airway

Look

Listen and

Feel for breathing

Check for ten seconds

Now decide what action to be taken

4.5

If there is somebody with you, send for help

If the casualty is unconscious and breathing turn to the Recovery Position

If the casualty is unconscious and is not breathing, start resuscitation.

Checking the Circulation


*

Check the heart beat by checking pulse in the


neck (carotid pulse) for ten seconds

*
4.6

Observe for severe bleeding

I DRABC
The steps in the Primary Survey and treatment priorities in casualty management can be
remembered as DRABC
Danger
Response
Airway
Breathing
Consider your action now
Circulation

II Findings of the Primary Survey


*
Conscious and Breathing casualty
*
Unconscious or semiconscious Breathing casualty
*
Unconscious casualty with no Breathing
*
Unconscious casualty with no breathing and no heart beat
14

SESSION 05
Topic

Recovery position

Learning Objective

To Maintain an open airway of an unconscious


casualty

Contents

5.1

Explaining recovery position

5.2

How to turn a casualty to the recovery position

5.3

Allow the participants to practice

Methodology

Explaining, Demonstration and practicing

Visual Aids

Dummy or a Participant as a casualty.


Dimmy paper, marker pen, Bed sheet/mat

Time

01 hour

Evaluation

Skills assessment (Practical)

15

05. RECOVERY POSITION


5.1

An unconscious casualty may have a blocked airway. This will results in death.
To prevent, the casualty should be placed in the Recovery Position.
1

5.2

How to turn to the recovery position?


Aim: is to maintain an open airway.
Actions to be performed:
-

Primary Survey - DRABC

Open the airway Head tilt, chin lift method

Position the casualtys arm nearest to you at right angle and palm upward.

(Picture 1)

Keep the other arm placing the back of the hand on the cheek on your side

(Picture 2)

With your other hand pull the back of the hand on the cheek, on your side.

Gently roll the casualty to your side keeping hand pressed to


the cheek to support head and neck.

(Picture 3)

Gently tilt head backwards and position mouth towards floor.


(Picture 4)

Keep upper leg to position hip and knee in right angles

Recheck ABC

4
3

5.3

Practice
Everybody should practice this simple measure to save a life.

16

SESSION 06
Topic

Non Breathing adults Rescue Breaths

Learning Objective

To provide oxygen to the body to facilitate breathing

Contents

6.1

Recognition features

6.2

Action if some others are around

6.3

Action if you are alone

Methodology

Explaining, Demonstrating, Imitation and Practicing

Visual Aids

Dummy, Tissue papers, cleaning liquid, Bed-sheet/mat,


Dimmy papers, Marker pens

Time

01 hour

Evaluation

Skills assessment

17

06. NON BREATHING ADULT AND RESCUE BREATHS


6.1

6.2

Recognition features

The casualty is unconscious

There is no signs of Breathing

Blue or grey colour of the casualtys skin

Action if some others are around

Send some one for help immediately

Start giving rescue breaths

Steps in giving rescue breaths


-

See whether the casualty is flat on their back,

check whether anything obstruct the airway


(in the mouth) if so clear carefully

Open the airway by chin lift, Head tilt method(Picture. a & b)

Pinch the casualtys nose properly

Take a full breath

Place your mouth on the casualtys mouth and


make a good seal.
(You may use polythene with a whole in centre to be kept on the casualtys mouth
to protect you from any possibility of danger)
Breath into the casualty until the chest wall rises
(for 02 seconds)

(Picture c)

Get back and allow the chest wall to fall (for 04 seconds)(Picture d)

Provide 10 breaths per minute

Check pulse every 10 breaths and repeat until help arrives

18

6.3

Action if you are alone

Follow the above sequence

Go for help

Reassess DRAB if still no breathing repeat rescue breaths

If there is no help, continue giving rescue breaths until


-

Casualty starts breathing

Or the pulse stops

Or you are tired and no longer could proceed.

19

SESSION 07
Topic

The adult with no Heart Beat


Cardio Pulmonary Resuscitation - (CPR)

Learning Objectives -

To maintain circulation adequately to the vital organs

Contents

7.1

Recognition features

7.2

Action when some others are around

7.3

Action when alone

Methodology

Explain, Demonstrate, Practice

Visual Aids

Dummy, tissues and cleaner liquid, mat / bed-sheet.

Time

01 hour

Evaluation

Practical/skills assessment

20

07. THE ADULT WITH NO HEART BEAT AND


CARDIO PULMONARY RESUSCITATION (CPR)
7.1

7.2

Recognition features
-

The casualty is unconscious

There is no signs of bleeding

There is no pulse

Pupils are wide open

Very pale in appearance

Skin colour increasingly blue or green.

Action when some others are around

Primary survey DRAB

If casualty is not breathing send some one to get


help

Commence resuscitation
-

Locate the correct place where you should


compress
the chest

Compress 4 to 5 cm. (keep the elbow straight)

Repeat 15 times (at a speed of 100 per minute)


and give two breaths

7.3

Continue 15 compressions to two breaths until casualty is improving

Action when alone

Perform 01 minute of CPR

Go for help

When you return reassess DRABC

Continue CPR until you are tired, if there is no


help.

21

SESSION 08
Topic

Choking

Learning Objective

At the end of the session the participants should be able


to recognise features of a choking person, and to implement action to
remove the obstruction to facilitate breathing.

Contents

8.1

Recognition features of choking

8.2

Objectives of first aid

8.3

Actions to be taken

Methodology

Explaining, Demonstration and practicing

Visual Aids

Dummy, participant as a casualty, pictures.

Time

45 minutes

Evaluation

Practical assessment

22

08. CHOKING
8.1

8.2

Recognition features of choking

Difficulty in breathing or speaking

Grasping at the neck

Pointing at mouth and throat

Purple/red colour around the face and neck

Blue coloured lips

Objectives of First Aid


To remove obstruction and to facilitate breathing

8.3

Action to be taken
Give back slaps.
Reassure and bend the casualty forward and give
back slaps 5 times between shoulder blades.
Ask to cough, try to remove any obstruction.
failing with
-

Abdominal thrust five times

If unsuccessful
Call for help
Repeat back slaps and abdominal thrusts until the
airway is clear or help arrives.
If the casualty becomes unconscious
-

Check for breathing

Start Rescue breaths

If still unable to get breathing


23

Check mouth and try to remove the obstruction.


If still unsuccessful
-

Start CPR.

If still unsuccessful repeat the above.

24

SESSION 09
Topic

Secondary Survey; Observing and Recording

Objective

To be able to identify any other injuries or


problems the casualty may have.

II

To be able to observe the casualty and record


vital parameters

Contents

9.1

Actions performed in secondary survey

9.2

Observation and recording

Methodology -

Explain, Demonstrate and practice

Visual Aids

Dummy, a participant as a casualty

Dimmy papers, marker pens, mat, OHP, Transparencies


Time

45 minutes

Evaluation

Practical Assessment

II

Questioning

25

09. SECONDARY SURVEY


9.1

Actions performed in the secondary survey


Secondary survey is a systematic examination of the casualty, to identify any other injuries or
problems.
If the casualty is unconscious they may vomit and obstruct the airway, therefore it is better to
place the casualty in the recovery position before starting the secondary survey.

Without moving the head and neck slowly and feel gently for bleeding, any injury,
swelling and deformity from scalp to foot.

Check the pupils

Check the rate and depth of breathing and also for any smell.

Check the mouth for any obstruction.

Check skin colour and the temperature of the skin

Attend and treat any problems you may find, once you complete the secondary
survey.

9.2

Also record the findings to be handed over to the next level along with the casualty.

Observations and recording


Constantly check the casualty and note down the findings every ten minutes
The result will show whether the casualty is improving or deteriorating.
If casualty is stabilizing check for every 30 minutes.

26

Observation chart
1.

Date

2.

Name

3.

Address (if available)

Male/Female

1.Time
2.Level of response
3.Pulse/minute
4.Respiration/minute
5.Pupils
6.Skin
7.Temperature

Observe following and record appropriately


*

Level of response AVPU


A Alert
V Responds to Voice
P Response to Pain
U Unresponsive

Pulse and Respiration Count for 01 minute

Pupils Normal -

Unequal-

Dilated -

Constricted-C
*

Skin - Cold and clammy


Cold and dry
Hot and dry
Hot and sweaty
Pale
Flushed
Blue

Temperature

27

SESSION 10
Topic

Circulatory Disorder

Objective

I To be able to recognize fainting, shock, angina and


heart attack.
II To be able to provide appropriate first aid to each condition

Contents

10.1

Fainting

10.2

Shock

10.3

Heart attack

10.4

Angina

Methodology

Lecture discussion, Demonstration, Practice

Visual Aids

Dimmy papers, marker pens,


Participant as a casualty, mat or a cloth
Two pillows, Bed sheet

Time

01 hour

Evaluation

I Questioning
II Practical Assessment

28

10. CIRCULATORY DISORDERS


10.1 Fainting:
*

Due to inadequate blood supply to brain for a very short period of time

Recognition by:
- Collapse and loss of consciousness
- Pale or grey, cold, clammy skin
- Slow pulse

Aims of First aid:


To improve blood supply to the brain and to reassure the casualty.

Actions to be performed:
- Assess DRABC
- Lay down the casualty and gently raise and support the legs.
- Provide fresh air
- Reassure casualty, keep on lookers away
- When recovers slowly sit them up
- If does not regain consciousness quickly reassess RABC, turn to
recovery position and send to a hospital.

10.2 Shock
*

Due to impaired blood supply to vital organs


E.g. brain, heart, lungs, etc.
Shock can be fatal if not treated promptly.
E.g. Due to heavy bleeding from a wound

Recognised by:
- Pale, cold, clammy skin
- Rapid pulse, becoming weaker
29

- Fast shallow breathing


- Weak
- Feeling thirsty
- Yawning for air
- Consciousness will get altered, may become unconscious
- Breathing may fail and heart may stop.
*

Aims of First Aid


- Attend any obvious cause
- Increase the blood supply to the brain, heart and lungs
- Get urgent medical help

Actions to be performed:
- DRABC and treat priorities.
- Lay down the casualty. Keep head low position (no pillows)
and raise the legs gently.
- Loosen tight clothing around neck, chest and waist
- Cover with a blanket/bed sheet
- Call for help to transport as quickly as possible
- Check breathing, pulse and level of consciousness.
- If unconscious turn to recovery position.

10.3

Heart Attack

Due to unavailability of blood supply to a part of the Heart muscles.

Recognition features:
- Continuous crushing pain in the centre of the chest, spreading to
arm, neck and jaw mostly.
- Pain does not relieve by rest
30

- Burning sensation in the abdomen


- Restless
- Cold clammy (sweaty) grey skin
- Blue coloration of lips
- Rapid pulse become weaker and irregular
- Faintishness, giddiness
- Casualty may collapse with no breathing and no pulse suddenly
*

Aims of First Aid


- to rest
- to provide urgent medical aid

Actions to be performed
- Assess DRABC
- Keep casualty in half sitting position with knee bent
- Call for help
- Cover with a bed sheet to keep warm
- If conscious give a tablet of Aspirin (To avoid further damage to
Heart)

10.4

Maintain pulse, respiratory rate

If unconscious place in the recovery position

Immediate transfer to a Hospital

Angina
This often causes with exercise and subsidise with rest
Recognition features are same as of in Heart Attack.
-

These patients may have their own medication. Let the casualty have the medication
and rest.
31

If the pain persists then treat as of a Heart Attack.

SESSION 11
Topic

Wounds and Bleeding

Learning Objective

i. To be able to identify various types of wounds


ii. To be able to understand the aims of providing first
aid for a bleeding wound.
iii. To be able to provide basic first aid to a casualty
with bleeding wounds.

Contents

Methodology

11.1

Types of wounds

11.2

Minor Bleeding

11.3

Major Bleeding

11.4

Bleeding from scalp

11.5

Bleeding from nose

11.6

Contusion (bruise)

Lecture, Discussion
Demonstration, Practice

Visual Aids

Pictures, Roller bandages, gauze (or piece of clean


cloth) gloves/polythene bag

Time

01 hour

Evaluation

Questioning and Practical assessment

32

11. WOUNDS AND BLEEDING


Any damage in skin surface is a wound.
11.1

Types of wounds
(a) Incised wounds
(b) Lacerations
(c) Contusion (bruise)
(d) Abrasion
(e) Puncture wound

Aims of providing first aid:

11.2

To control blood loss

To treat for shock

To prevent infection

To transport to hospital

Minor Bleeding
Actions to be performed:
If it is a small wound

11.3

Apply direct pressure for a few minutes

Clean with water and allow to dry if it is a dirty wound

Cover with a clean dressing

If particles remain even after washing send to a doctor.

Major Bleeding
Actions to be taken:
33

Carefully expose the wound

Apply direct pressure on the wound

If there is an embedded object, apply pressure around the sides of the wound

Raise the limb and lay the casualty down

Use a clean pad

Keep the pressure for ten minutes

If blood seeps through, keep another dressing on top without removing the first
dressing

When bleeding is stopped apply a sterile dressing and bandage. (Be careful not to
bandage too tightly)

11.4

Treat for shock

Check breathing and pulse

Send to hospital as soon as possible

Bleeding from scalp


Actions to be taken
-

Assess DRABC

Apply direct pressure with the palm of your hand using a clean pad
(Do not use fingers)

Keep on pressure for ten minutes

If a conscious casualty, lay down, keep head and shoulders slightly raised.

If unconscious, place the casualty in the recovery position.

Send to hospital as quickly as possible if the wound is serious or the casualty is


unconscious.

11.5

Bleeding from Nose


Following steps should be followed:
34

Ask the casualty to bend forward and preferably let them sit.

Pinch their nose just below the bridge for ten minutes. Ask them to breath
through mouth.

11.6

Advise casualty not to blow the nose

Release the nose after ten minutes

If still bleeding pressurise for another ten minutes

If bleeding persists more than 30 minutes send to a doctor/hospital

When the bleeding stops gently clean around with lukewarm water.

Advise the casualty to rest for some time.

Contusion (bruise)
Caused by a direct blow or injury to the area resulting internal bleeding and accompanying
swelling.

Aims of Fist Aid:


To reduce blood supply to the injured area
To reduce pain and swelling

Actions to be taken:
-

Assess DRABC

Lay the casualty down and raise the injured part

Apply cold compress to the area for15 minutes.

If suspect of a fracture or other injuries send to the hospital.

35

SESSION 12
Topic

Learning Objectives -

Burns and Scalds


To be able to understand the causes of burns and scalds,
recognition features and first aid measures.

Contents

12.1

Causes of burns and scalds

12.2

Recognition features

12.3

Aims of First Aid

12.4

First aid measures

Methodology

Lectures, Discussion

Visual Aids

Dimmy paper, Marker pens, Blue tack and Pictures,


OHP, Transparencies

Time

30 minutes

Evaluation

Asking questions

36

12. BURNS AND SCALDS


12.1

12.2

Causes of Burns and scalds


-

Burns and scalds are caused by Heat

Burns by dry heat e.g. fire, chemicals, friction, electricity, extreme cold

Scalds by moist heat e.g. Steam

Recognition features
All burns and scalds have a depth and also have a size (extent) of burn.
Any burn more than the size of the casualtys hand is to be sent to a hospital.
-

When depth is concerned there are three types.


(A) Superficial

(B) Partial thickness (C) Full thickness

(A) Superficial only the skin surface is affected.


Redness
Tenderness
Swelling are the features

(B) Partial thickness goes to a medium depth


Redness
Tenderness
Swelling
Blistering can be seen
(A)

(B)

(C)

(C) Full thickness deep burns


Pale and waxy
Charred tissue
37

12.3

Aims of first Aid


(D) To stop burning
(E) To relieve pain and swelling
(F) To minimise the risk of infection
(G) To maintain an open airway
(H) To arrange transport to hospital if severe

12.4

First Aid
(I) Assess DRABC
(J) Wash the burn area with running cold water at least for ten minutes, until the pain
subsides. Do not overcool the casualty.
(K) Gently remove rings, wrist watch etc. from the affected area.
(L) Lay casualty down, treat for shock
(M)

Cover the area with a sterile dressing, or a clean non-fluffy towel.

(N) If burns in mouth and throat ensure adequate air supply, if conscious give sips of
cold water
(O) Transport to a hospital
(P) In electrical burn resuscitate, treat for shock prior to transfer.
(Q) In flash burns to eye e.g. welding, prolong glare there may be intense pain,
redness, tearing and sensitivity to light etc.
Do Not
(R) Use adhesive dressings/fluffy materials
(S) Burst the blisters
(T) Apply creams, lotions or fat to the burn area
(U) Touch the burn area
38

(V) Remove anything sticking to the burned area.


Urgent medical care needed in
(W)

If the airway involved

(X) All full thickness burns


(Y) Partial thickness burn with a minimum of casualtys palms size or more
(Z) Superficial burns covering skin area resembling 5 times the casualtys palm size
or more.

39

SESSION 13
Topic

Learning Objectives -

Soft tissue Injuries, fractures and Head injuries


1.

To be able to understand the types of soft tissue


injuries, recognition features and first aid measures for soft
tissue injury.

2.

To be able to recognize a fracture and


application of first aid knowledge to treat a fracture.

3.

To be able to understand the types of head


injuries, recognition features and apply the knowledge on first
aid to practice in head injury.

Contents

13.1 (a)

Types of soft tissue injuries

13.1 (b)

Recognition features

13.1 (c)

Aims of first aid

13.1 (d)

First aid measures

13.2 (a)

Describing a fracture

13.2 (b)

Types of fractures

13.2 (c)

Recognition features

13.2 (d)

Aims of first aid

13.2 (e)

First aid measures for fractures

13.3 (a)

Types of Head injuries

13.3 (b)

Recognition features of each type

13.3 (c)

Aims of first aid

13.4 (d)

First aid measures

Methodology

Explain, Demonstrate, Practice

Visual Aids

Pictures, Dimmy papers, Marker pens, Blue tack,


Triangular bandages, OHP, Transparencies.

Time

02 hours

Evaluation

Questioning, Practical assessment.

40

13. SOFT TISSUE INJURIES, FRACTURES AND HEAD INJURIES


13.1 (a)

Types of soft tissue injuries


Two types
Strains Injury to muscle or tendon*
* muscle is connected to bone by tendons
Sprains Injury to a ligament*
Ligaments provide support to joints.
Sprains always occur at a joint.

13.1 (b)

13.1 (c)

13.1 (d)

Recognition features
*

History of a recent fall

Difficulty in moving the limb

Severe pain and tenderness over the site of injury

Swelling and deformity.

Aims of providing first aid:


*

To reduce pain and swelling

To send for medical care if necessary

First aid measures


*

Primary survey

Lay the casualty down

Rest and support the injured area.


If injury in a limb elevate

If recent injury apply cold compress


(wrap ice in a towel if ice is used)

Ice compress should be bandaged properly.

Elevate the limb. Check every 10 minutes whether the bandage


41

is not too tight.


*

If no response after 15 to 20 minutes or if unsure about the severity of the


injury send to a hospital.

In summary treatment for soft tissue injury is:


Rest
Ice
Compression
Elevation
13.2 (a)

Describing a fracture
A fracture is a break or a crack in a bone

(b)

Types of fractures
* Open fractures

* Closed fractures

Broken ends will mostly

Broken ends of the bone remains inside

protrude through the skin.


A wound is visible.

(c)

Recognition features:
History of a recent fall
Difficulty in moving the limb
Severe pain and tenderness
Deformity or swelling
Sign of shock (in severe injury)
42

(d)

(e)

Aims of First Aid:


-

To immobilize the fracture site

To send to a hospital while supporting the fracture

(I) First aid measures for closed fractures:


-

Primary survey DRBAC

Advise casualty not to move

Attend any priorities in Primary Survey

If fracture in the upper limb


-

Let the casualty support the affected limb in the most comfortable position

Collar bone fracture


-

Apply elevation sling

Pad between elbow and body

Support with a broad fold bandage around the arm and body.

Lower limb fracture


-

Carefully move good leg to the injured, put


padding between legs.

Apply figure of eight bandage around feet and


ankle broad fold bandage around the knees.
Also one above and below the fracture site.

Transfer to the hospital

In fracture jaw
-

Place a soft pad under the jaw

Allow casualty to support

Sit with head tilted forward

Transfer to hospital
43

In rib fractures
-

Sit the casualty in the most comfortable position

Ask the casualty to support the arm on the injured side

Put an elevation sling


(see pictures application of elevation sling)

In pelvic fractures
-

Place soft support under the knees

Pad between legs

Apply figure of eight around feet and ankles

Apply broad fold bandage around the knees

Neck/Spine fracture
-

Do not move neck

Support head and neck carefully

Ask a bystander to place some


support around the neck and shoulder

Treat for shock

If unconscious, place the casually in the


recovery position by moving very carefully and providing good support to the
fracture site.

(II)

For open fracture


Aims of First Aid:
-

To prevent blood loss

To prevent infection

To immobilize the injury site


44

To transfer to hospital

First aid measures:


-

Primary survey and attend priorities

Advise casualty not to move

Control bleeding from the fracture site


(apply pressure to sides of the wound)

Cover the wound with a sterile dressing

Place padding on either side of the protruding bone

Bandaging

Apply sling/bandages for the upper and lower limbs as described


before.

13.3

Types of Head Injuries


I

Concussion

II

Compression

III

Skull fracture

Concussion
Due to a violent blow to the head, the brain tends to shake. This will result the person to lose
consciousness briefly.
Recognition features:
-

History of a blow to the head

Loss of consciousness over a short period

Dizziness

Loss of memory (just before the incident)

Headache

Aims of First aid:


45

To check whether the casualty recovers fully and safely

To send for medical attention

Aims to be performed:

II

Initial assessment DRABC

If unconscious turn to the recovery position

Control any bleeding from the scalp

Monitor the level of consciousness, pulse and breathing

Send to a doctor for examination

Compression
Bleeding or swelling cause pressure on the brain due to a violent blow to head. May be a life
threatening condition.
Recognized by:
-

recent head injury

confused

intense headache

slow, noisy breathing

slow, strong pulse

hot, flushed appearance

unequal pupils

weakness/paralysis in one side of the body

Aims of First aid:


To provide urgent medical care.
First aid steps:
*

Primary survey
46

Turn the casualty to the Recovery position

Monitor breathing, pulse and level of consciousness

Send to a hospital urgently.

III

Skull Fracture
Skull fracture occurs by a blow to head or following a fall from a height.
Concussion and compression may associate with a skull fracture.
Even without a history of loss of consciousness, casualty may have a skull fracture.

13.3(b) Recognized by:


-

History of a fall and head injury

Wound in the head

Soft area or a dent in the scalp

Altered consciousness

Clear or blood stained fluid coming out from nose, ear etc.

Blood seen in the whitish part of the eye

Aims of First Aid:


-

Maintain an open airway

Send for urgent medical care

Actions to be performed
-

Initial assessment - DRABC

If unconscious and breathing casualty place in the recovery position, monitor pulse, BP
every ten minutes.

If conscious casualty, lie the casualty down, raise the head and shoulder gently and support
them.

47

If any discharge through the ear, position to easy drainage from the ear, cover with a clean
pad and bandage.
Do not plug the ear.

Control any scalp bleeding.

Send to a hospital urgently.

48

SESSION 14
Topic

Poisoning

Objectives

At the end of the session participants should be able to


I

Explain about what a poison is, route of entry, recognition


features and first aid for poisoning.

Contents

14.1

Definition of a poison

14.2

Routes of entry

14.3

Recognition features

14.4

First aid in Poisoning

Methodology

Lecture, Discussion

Visual Aids

Pictures, Dimmy papers, Blue tack, Marker pens, OHP,


Transparencies

Time

30 minutes

Evaluation

Questioning

49

14. POISONING
14.1

Definition of a poison
A poison is a substance causing harmful effects to living beings including human. The
minimum dose causing harmful effects is called the toxic dose.
Poisoning can be acute (sudden) or chronic. (over a period of time
Eg. in occupational poisoning exposure to chemicals).

14.2

14.3

Route of Entry
-

Through mouth (Ingestion)

Through inhalation

Through skin

Through eye and other orifices.

Recognition features
Depend on the route of entry
Inhalation - Difficulty in breathing
Blue colouration of skin
Cough
Ingestion -

Nausea, vomiting, abdominal pain, Diarrhoea


Headache, Altered pupil size
Smell from the mouth, Excessive salivation

Skin

Discolouration, burns

50

14.4

First aid in poisoning


Aims of first aid:
-

To maintain an open airway, breathing and circulation

To ensure safety to casualty and to you

To send for urgent medical attention

To identify the poison if possible (container, bottle or the label) and send along with
the patient to hospital.

(a)

(b)

Inhaled poison:

Make sure you and the casualty are safe

Remove casualty to a place with open air

Assess RABC of the patient (Primary Survey)

Try to cut off the source of poison

If casualty is breathing but unconscious turn to recovery position and check RABC

If no breathing start CPR

Urgently transport to a hospital

Swallowed Poison

Primary survey

If unconscious turn to recovery position, monitor RABC

If conscious try to find out what was taken. Keep the casualty in the recovery
position.

Never induce vomiting if the poison is

a corrosive (acids, alkalis)

a Hydrocarbon (Petrol, Kerosene oil etc.)

Unknown
51

Also do not induce vomiting if the patient is fitting or having altered consciousness or
unconscious.

(c)

Skin contact
First aid actions
-

Primary survey

Wash the casualty properly with running water. Take care not to get splashed
into you or into casualtys eyes, mouth and nose. Wash at least for 20 minutes
especially in corrosive burns.

Remove contaminated clothing

If unconscious, turn the casualty to the recovery position. Monitor RABC. Use a
polythene or plastic shield for resuscitation if the face is contaminated.

52

SESSION 15
Topic

Transportation of Casualties

Objectives

At the end of the session participants should be


able to move a casualty to a safer place and for medical attention
without making the injury worse.

Contents

15.1 Lifting a casualty


15.2 Alone
15.3 Accompanied with a helper
15.4 With three helpers

Methodology

Explain, Demonstrate, Imitation and Practice

Visual Aids

Blanket, three participants as helpers, one participant as


a casualty and a stretcher.

Time

01 1/2 hours

Evaluation

Skills assessment

53

15. TRANSPORTATION OF CASUALTIES


15.1

Lifting a casualty

Always use the thigh, hip and shoulder muscles

Stand very closer to the casualty spacing your feet widely.

Bend your knees, straighten the back.


Do not bend the knees too much.

15.2

15.3

Grasp the load firmly

Raise your head once you start to lift

Lift with the legs smoothly

Avoid straining the neck and shoulder-muscles.

Hold the load closer to the body

Always keep the front view clear.

Alone

Picture 1

Picture 2

Human crutch method (Picture 1)

Drag method (Picture 2)

Pick a back method

Accompanied with one helper


The two handed seat (Picture 3)

15.4

Picture 3

With three helpers


Using the stretcher. (Picture 4)
Person at rear right side gives
command to lift and lower.

Picture 4

54

ANNEXURE I
PreTest
Time: 15 minutes
Mark with a circle on the correct answer (05 marks to each question)

1. Mark the correct sequence of actions regarding the incident management plan,
I

Get help, make safe, assess, give emergency aid, pack back.

II Make safe, get help, give emergency aid, assess and pack back.
III Assess, make safe, give emergency aid, get help, pack back.

2. Mark the correct sequence of the Primary Survey.


I

Check the Airway, Circulation, Breathing, Response and Danger

II Circulation, Airway, Response, Breathing and Danger.


III Danger, Response, Airway, Breathing, Circulation.

3. What is the recovery position?


I

A position which is used to keep a conscious casualty seated.

II A position which is used to keep an unconscious casualty to ensure an


open airway.
III A position which is used to place a casualty standing.

4. Rescue Breaths are given to


I

Keep an open airway

II Prevent fresh air (oxygen) going to the brain


III Maintain a good supply of fresh air (oxygen) to the body.

5. When giving rescue breaths how many breaths can be given per minute?
I

10

II

15

III

20

6. How many times does an adult breathe per minute?


I

25-30

II

72-80

III

16-18

55

7. How many chest compressions has to be given for two breaths during cardio-pulmonary
resuscitation?
I

30 compressions

II

15 compressions

III 10 compressions

8. What is the normal Heart rate of an adult?


(i) 18/minute

(ii) 40/minute

(iii) 72/minute

Write the correct answer/s


9. Mention the aim of First aid in fainting.

.. (05 marks)

10. What is shock?


.
(05 marks)

11. Mention three aims of providing first aid to a casualty with a bleeding wound.
I

(03 marks)

II (03 marks)
III (03 marks) (09 marks)

12. Mention the first aid treatment for soft tissue injuries
I

(03 marks)

II (03 marks)
III (03 marks)
IV (03 marks) (12 marks)

13.

What is the first aid measure for closed fractures?


(08 marks)

56

14.

Name the ways of entry of poison in to the body.


I

(03 marks)

II (03 marks)
III (03 marks)
IV (03 marks) (12 marks)

15.

Name the types of Head Injuries.


I

(03 marks)

II (03 marks)
III (03 marks) (09 marks)

Total marks obtained ..

57

ANNEXURE II
PostTest
Time: 15 minutes
Mark with a circle on the correct answer (05 marks to each question)

1. Mark the correct sequence of actions regarding the incident management plan.
I

Get help, make safe, assess, give emergency aid, pack back.

II Make safe, get help, give emergency aid, assess and pack back.
III Assess, make safe, give emergency aid, get help, pack back.

2. Mark the correct sequence of the primary survey.


I

Check the Airway, Circulation, Breathing, Response and Danger

II Circulation, Airway, Response, Breathing and Danger.


III Danger, Response, Airway, Breathing, Circulation.

3. What is the recovery position?


I

A position which is used to keep a conscious casualty seated.

II A position which is used to keep an unconscious casualty to ensure an


open airway.
III A position which is used to place a casualty standing.

4. Rescue Breaths are given to


I

Keep an open airway

II Prevent fresh air (oxygen) going to the brain


III Maintain a good supply of fresh air (oxygen) to the body.

5. When giving rescue breaths how many breaths can be given per minute?
I

10

II

15

III

20

6. How many times does an adult breathe per minute?


I

25-30

II

72-80

III

16-18

58

7. How many chest compressions has to be given for two breaths during cardio-pulmonary
resuscitation?
I

30 compressions

II

15 compressions

III 10 compressions

8. What is the normal Heart rate of an adult?


(i) 18/minute

(ii) 40/minute

(iii) 72/minute

Write the correct answer/s


9. Mention the aim of First aid in fainting.

.. (05 marks)

10. What is shock?

(05 marks)

11. Mention three aims of providing first aid to a casualty with a bleeding wound.
I

(03 marks)

II (03 marks)
III (03 marks) (09 marks)

12. Mention the first aid treatment for soft tissue injuries
I

(03 marks)

II (03 marks)
III (03 marks)
IV (03 marks) (12 marks)

13. What is the first aid measure for closed fractures?


(08 marks)

14. Name the ways of entry of poison in to the body.


I

(03 marks)

II (03 marks)
59

III (03 marks)


IV (03 marks) (12 marks)

15. Name the types of Head Injuries.


I

(03 marks)

II (03 marks)
III (03 marks) (09 marks)

Total marks obtained

60

Annex III (a)

Course Evaluation
1.

Up to what extent the objectives of the training were achieved ?


(i) 25%

2.

(ii) 50%

(iii) 75%

(iv)

100%

(Please appropriately)
Success of the
presentation
25% 50% 75% 100%

Success of the Contents


25%

50%

75%

100%

Success of the lecture


25%

50%

75%

100%

First Aid Theory


Practicals

3.

Time allocated is adequate / inadequate

4.

Evaluation of other facilities. Put relevantly.

Facilities
1.
2.
3.
4.
5.
6.

Weak
1
2

Very good
4
5

Remarks

Lecture Hall
Audio Visual
Audibility
Meals
Lodging
Handouts
5.
Comments
..
..
..
..
..
..

61

Annex III (b)

Trainers Evaluation by the Participants

1.
2.
3.
4.
5.
6.

Trainers Name:

..

Topic

..

Time

: From to .. Date

Activity
Presentation
Audio visual used
Participatory ability
Eye contact and Audibility
Session planning and time management
Overall evaluation

Very good

Good

Fair

Weak

Remarks :

..
..
..
..
..
..
..
..
..
..
..
..
..
..
..

62

Annex IV

Trainers Evaluation
1. Nature of participation:

Attentive, Silence, Responding

2. Obstacles faced during the training sessions: Silence, Dominant, Lack of response

3. Trainers satisfaction about the programme:


Poor

Fair

Good

Very Good

4. Objective is clearly understood by the participants

Yes / No

5. Content is clearly understood

Yes/Partially/Not

6. Evaluation

Satisfactory/Not

Training programme:
Trainers Name:
Trainers signature: ..
Date:.

63

Annex V
First Aid Box

The following should be included in a first aid box.


1. Drugs:

Paracetamol tablets
TNT tablets
Anti bacterial liquids
Normal Saline
Surgical spirit
Gentian violet
Anti biotic cream

2. Dressings and Bandages:


Sterilized gauze and cotton wool
Roller Bandages
Triangular Bandages
3. Equipment: Thermometer
Scissor
Small knife
Artery forceps
4. Others:
Glucose
Water bottle
Gloves
Small torch
Note book and a pen
Splints

64

Annex VI

Transparencies and Handouts

65

PART II
TRAINERS GUIDE
This Trainers manual on First Aid consists of 15 sessions. It is very important to go through the
trainers guide before the training. Each session has its session plan at the beginning of the content.
Session plan consist of:
(1)
The topic of the session
(2)
Objective of the topic
(3)
Contents
(4)
Methodology
(5)
Visual aids
(6)
Time allocated
(7)
Evaluation at the end of the session.
Session plan is followed by the text of the contents.
In the text: The condition is described. Its recognition features, aim of intervention and steps of the
first aid actions to be taken are clearly mentioned. Use the pictures and transparencies where
necessary.
Methodology is the EDIP method. First you explain. Then demonstrate. Let the participants imitate
and allow them to practice.
At the beginning of the first day give the Pre-test to participants. Time allocated is 15 minutes.
Collect the papers after 15 minutes.
Session 01:

Introduction to Human Body


Ask participants to draw a picture of the body and to name the body parts, and
systems of the body. Then take the picture of a body and compare. Refer 1.1
Discuss the function of each system.
Discuss about normal pulse rate, respiratory rate of adult and children.
Discuss how the functions of the body are inter related.
E.g. Heavy bleeding cause shock
66

Heart rate/Pulse rate increase (Circulatory system)


Breathing fast and shallow (Respiratory rate)
Altered level of consciousness (Nervous system)
Refer 1.2 to 1.4
At the end of the session ask some questions to assess the knowledge gained.
Session 02:

Introduction to First Aid


Discuss and define first aid, (Refer 2.1)
Explain aims of providing first aid (Refer 2.2)
Describe responsibilities of a first aider (Refer 2.3)
At the end of the session ask some questions to assess the knowledge gained.

Session 03

Incident Management
Let the participants think about a scenario of an accident.
E.g. I
Cut injury in a workshop
II
Road traffic accident
Discuss what actions to be taken
Refer 3.1 to 3.5. A role play would be ideal.

Session 04:

Casualty management and Primary Survey.


Explain the steps of DRABC in Primary Survey. Refer 4.1 to 4.6 I
Demonstrate and let the participants imitate.
Then let them practice DRABC and closely supervise how they do it.
Discuss the findings of the Primary Survey.
Refer 4.6 II. At the end, assess how the participants perform DRABC.

Session 05:

Recovery Position
Explain the objective of the session clearly. (Refer 5.1)
Demonstrate the steps mentioned in 5.2.
Let the participants imitate each step.
Then let them practice turning casualty to recovery position.
Finally assess how they turn a casualty to recovery position.

Session 06:

Non Breathing adult Rescue Breaths


Explain the situation and objective of the session.
Explain sections 6.1 to 6.3.
Demonstrate each step, let the participants to imitate and let them practice.
Asses the skill at the end of the session.

Session 07:

Adult with no Heart Beat.


Cardio Pulmonary Resuscitation (CPR)
Explain the objective. Explain the recognition features as in 7.1 and actions to be
performed. (Refer 7.2 and 7.3)
Demonstrate, let the participants imitate and allow them to practice.
At the end assess the skill.

Session 08:

Choking
Explain the recognition features by referring 8.1, objectives of first aid (8.2) and
actions to be performed as in 8.3.
Then demonstrate, allow the participants to imitate and practice.
Assess the skill at the end of the session.
67

Session 09:

Secondary survey, observing and recording.


Explain the objectives of the session.
Then explain actions to be carried out in secondary survey as in 9.1 and demonstrate.
Let the participants imitate and practice.
Explain how to perform observations and maintain records as in 9.2 and 9.2
(b).Describe the observation chart in the class room.

Session 10:

Circulatory Disorders
Explain the objectives of the session.
Explain Fainting, Shock, Heart attack and Angina and describe the recognition
features, aims of first aid and actions to be performed in providing first aid.
Refer 10.1 to 10.4 Demonstrate the actions and let the participants imitate and
practice.
Ask questions and assess skills at the end of the session.

Session 11:

Wounds and Bleeding


Explain 11.1 to 11.6
Demonstrate Pad and Bandaging and let the participants imitate. Allow them to
practice later.
At the end of the session ask some questions and also assess relevant skills.

Session 12:

Burns and Scalds


Explain the causes of Burns, recognition features, aims of first aid and first aid
measures.
Refer 12.1 to 12.4
At the end of the session verbally question from the participants to assess the
knowledge.

Session 13:

Soft tissue Injuries, Fractures and Head Injuries.


13.1 Soft tissue injury:
Explain the types of soft tissue injuries, recognition features, aims of first aid
and first aid measures. Summarize as RICE. Demonstrate the procedure and
allow the participants to imitate and practice.
Evaluate RICE
13.2

Fracture:
Explain what a fracture is. 13.2 (a)
types of fractures 13.2 (b)
recognition features 13.2 (c)
aims of first aid 13.2 (d)
Explain and demonstrate first aid measures in various
types of fractures by referring 13.2 (e)
Allow the participants to imitate and practice.
Evaluate the knowledge and skills at the end of the session.

13.3

Types of Head Injuries:


Explain concussion, compression and skull fractures, recognition features,
aims of first aid and first aid measures in each situation. Refer 13.3 I, 13.3 II
and 13.3 III.
Demonstrate first aid steps and allow the participants to imitate and practice.
68

Evaluation by questioning and skills assessment.


Very Important to remember:
Any injury causing loss of consciousness can cause injury to neck/spine. So when
dealing with Head injury advise to keep all movements minimally.
Whenever movement is needed, support head and neck well while moving.

Session 14:

Poisoning
Define what a poison is (14.1)
Discuss how a poison enters into a human body.
Refer 14.2
Explain the recognition features of poisoning by referring 14.3.
Explain the Aims of First aid in poisoning and specific first aid measures for inhaled
swallowed and skin contacted poisons.
Evaluate by questioning.

Session 15:

Transportation of Casualties
Explain the aim of the session to the participants.
Then explain how to lift a casualty safely by referring 15.1.

15.1
15.2

Alone: Explain methods of moving a casualty when alone.


Human Crutch method can be used when the casualty can support his/her own
weight.
Drag method For short distance move quick and effective
Pick-a-back method Moving over fairly longer distances.
Casualty should be conscious and be able to hold on to the rescuer.
Demonstrate each method and let the participants imitate and practice.

15.3

Accompanied with one helper


Two handed seat method
This is used when the casualty cannot walk and is not able to hold on for themselves.
Explain as follows. Get a volunteer to be the casualty and another as the helper.
Squat facing each other on either side of the casualty. Cross arms behind and grasp
the waist band.
Pass the other hands under the casualtys knees and grasp each ones wrists.
Place the linked arms at the middle of the casualtys thighs.
Move closer to the casualty. Keep your back straight, get up slowly and move off
together. Then demonstrate and allow them to practice.

15.4

With three helpers


69

Few people carry the stretcher.


Person at rear on the right side commands to lift and lower.
Explain and demonstrate.
Let the participants practice.
Evaluate the skill at the end of the session.

70