EMERGENCY FIRST AID Hashoo Group Oil &

TRAINING BOOKLET Gas Division

Emergency First Aid is a quick reference manual. It provides what-to-do

action plans for the treatment of potentially life threatening injuries and
illnesses.
 FIRST AID TRAINING BOOKLET
TERMS & CONDITIONS OF USE

This document is property of Hashoo Group O&G Division. All rights are reserved, except as
permitted under the copyright law in Pakistan copyright ordinance 1962 and 2000.

You can only use this document for the personal, non-commercial purpose for which it has
been provided. You may not share any part of this document by sending it to someone else or
using it for commercial purpose.

You cannot use the document in any way or for any purpose without prior written permission.

These protocols are developed with all care to take updated First Aid information. However you
should remember that this product is correct at the time of distribution.

This document is a quick reference manual and the Group is not responsible to you or anyone
else for any loss, damage, liability, cost or expense suffered in connection with your use of this
document.

It provides ‘what to do’ action plans for the treatment of potentially life-threatening injuries
and illnesses, ranging from unconsciousness and bleeding to asthma and heart conditions.

With this first aid training, you will have the skills, knowledge and confidence to provide first aid
care to you family, friends, colleagues and whole community.

This document is your tool to assist you with that care. It will aid your management of a patient,
as well as help you to prepare and protect yourself as a first aider.

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 FIRST AID TRAINING BOOKLET
1 Introduction to First Aid ____________________________________________________ 4
1.1 Goals of this course __________________________________________________________ 4
1.2 Aim of the First Aid___________________________________________________________ 4
1.3 Legal Importance ____________________________________________________________ 4
1.4 Standard First Aid Kit _________________________________________________________ 4
1.5 14 elements of First Aid _______________________________________________________ 5
1.6 Responsibilities of First Aider __________________________________________________ 5

2 Handling an Emergency ____________________________________________________ 6

2.1 Check for Danger (SETUP) _____________________________________________________ 6
2.2 Assess Response _____________________________________________________________ 7
2.3 Send for Help _______________________________________________________________ 7
2.4 Attend Patient ______________________________________________________________ 8

3 Burn Management _______________________________________________________ 13

3.1 Types of Burns _____________________________________________________________ 13
3.2 Rule of Nines_______________________________________________________________ 13
3.3 Critical Burns: Indications to hospitalize _________________________________________ 14
3.4 First Aid of Severe Burns _____________________________________________________ 15
3.5 First Aid of Minor Burns ______________________________________________________ 15
3.6 Eectrical Burns _____________________________________________________________ 16
3.7 Cold Contact Burns __________________________________________________________ 17

4 Heat Emergencies ________________________________________________________ 18

4.1 Heat Exhaustion ____________________________________________________________ 18
4.2 Heat Stroke ________________________________________________________________ 19
4.3 Frost Bite__________________________________________________________________ 20

5 Fracture, Dislocations, Sprains and Strains ____________________________________ 22

5.1 Types of Fractures __________________________________________________________ 22
5.2 First Aid of Fractures ________________________________________________________ 23
5.3 Dislocations _______________________________________________________________ 24

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5.4 Sprain and Strain ___________________________________________________________ 25
5.5 Splinting __________________________________________________________________ 26

6 Wounds, Bleeding and Shock _______________________________________________ 27

6.1 Bleeding __________________________________________________________________ 27
6.2 Types of bleeding ___________________________________________________________ 27

7 Chocking _______________________________________________________________ 30
7.1 Signs and Symptoms ________________________________________________________ 30

8 Drowning _______________________________________________________________ 31
9 Angina _________________________________________________________________ 31
9.1 Signs and symptoms _________________________________________________________ 31

10 Heart Attack __________________________________________________________ 32

10.1 Signs and Symptoms ________________________________________________________ 32

11 Stroke ________________________________________________________________ 33
12 Snake bite ____________________________________________________________ 33
12.1 Signs and Symptoms ________________________________________________________ 33

13 Unconsciousness _______________________________________________________ 35

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 FIRST AID TRAINING BOOKLET
1 Introduction to First Aid

1.1 Goals of this course

The goal of this training is to help you gain the knowledge, skills, and confidence necessary to manage a
medical emergency until more advanced help is available.

First aid does not require making complex decisions or having in-depth medical knowledge. It is easy to
learn, remember, and perform.

1.2 Aim of the First Aid

Broadly, there are three main aims when administering first aid:

• Preserve life
• Prevent worsening of the condition (if possible)
• Promote recovery

For example, applying a plaster is preventing the condition (a cut) from worsening by stopping infection

1.3 Legal Importance

• Who can administer First Aid - “Someone who has been trained in first aid, has an up to date
first aid certificate and is registered First Aider”
• There must be at least one First Aid Box for every 150 people
• There must be at least one name qualified Fist Aider for every 150 people
• There must be a responsible person in charge of First Aid

1.4 Standard First Aid Kit

First Aid Box must contain the following items as a minimum:

• Sterile dressings
• Wound Dressings
• Adhesive Plasters
• Pressure bandages
• Safety pins, scissors, eye bath and tweezers
• Rubber/latex gloves
• Triangular bandages.

First Aid Boxes must be regularly checked for their content. First Aid boxes must easily accessible

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1.5 14 elements of First Aid
OSHA has identified 14 treatment elements. If an illness or injury treatment is limited to these 14
elements it shall be declared a First Aid Case. If treatment is beyond these elements than it becomes
medical treatment case and is reportable by law.

1.6 Responsibilities of First Aider

A first aider has various roles and responsibilities. They should:

•Recognize a Medical Emergency

•Make the Decision to Help. Prioritize casualties based upon medical need

•Identify Hazards and Ensuring Scene Safety (safety of themselves, bystanders and the casualty)

•Activat the Emergency Medical Services

•Provid Supportive, Basic First Aid

•Provide a handover when further medical help arrives

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2 Handling an Emergency

Check for Assess

Danger > Response > Send for Help > Attend Patient

2.1 Check for Danger (SETUP)

Check for danger to yourself, bystanders and the patient.

Action
1 Before approaching the patient look and listen for any signs of danger
2 Once you have carefully checked to make sure the area is safe, you can approach the patient
and check for a response.

• Whatever the job you are performing, you should stop doing it
S
• Observe environment around you and try to find out the cause of the incident in a
E while

• Take special care of the traffic while moving around the roads and vehicles
T
• Try to assess unknown hazards because some secondary effects or aftershocks may
U originate

• Protect yourself and the patient. Dislocate the casualty only in dire need.
P Otherwise, leave.

Examples of dangers and immediate threats can include:

• Electric wires
• Toxic fumes
• Wet and slippery surfaces
• Unstable structures

Make sure that you don’t become a patient too. You are no help to the patient if
you become injured yourself.
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2.2 Assess Response
As soon as you have determined that the situation is safe, you need to check if the patient is conscious
by checking if they can respond to you.

Action
1 Voice Command
 Give a voice call to the casualty by introducing yourself
 Ask a small question loudly
- Can you hear me?
- What is your name?
- Open your eyes!
 Don’t touch the casualty without giving voice command
2 Touch Command
 If you don’t see any signs of life, then tap on the shoulder
and give voice command again as well.
 Don’t touch anywhere else especially in case of gender
difference.

2.3 Send for Help

For an unconscious patient, it is important to get help as quickly as possible.

Action
1 Activate Emergency response by calling Company Emergency Contacts:
 Plant Emergency Clinic/ Office Doctor
 Operator/ Trained First Aider
 Your Supervisor
 Ambulance Driver
2 Based on requirement, call Local Public Emergency Management Services:

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Rescue Services Fire Brigade Edhi Ambulance Rescue Police

1122 16 115 15

3 Give clear, precise information about:

 Type of incident
 Exact location or address
 Number of causalities/ people involved
 Nature of injuries (fractures, burns, etc.) with indication of the seriousness (breathing
or not)
 What First Aid has been provided
 Telephone number where you can be called
 Special help required

Do not hang up until you are sure that the person at the other end has all the
information and have them repeat the address to send assistance.

2.4 Attend Patient

2.4.1 Opening the Airway
The patient’s airway must be clear and open so that the patient can breathe. If the patient is not
breathing, there are chances of airway obstruction. Ensure it is open before you treat any other injury.
The airway may be blocked by:
• The back of the patient’s tongue
• Solid or semisolid material such as food, vomit or blood
• Swelling or injury of the airway
• Position of the neck (e.g. chin on the chest)

Action
1 If the patient is lying on back, leave in that position. If
the patient is lying face down, turn them into recovery
position.

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2 With the victim lying flat on his back, place your hand
on his forehead and your other hand under the tip of
the chin. Gently tilt the victim's head backward. In this
position the weight of the tongue will force it to shift

3 Open the patient’s mouth and look for any blockage

4 If there is any blockage,
 Turn the patient into recovery position
 Tilt the patient’s head back with the mouth slightly
downward
 Clear the blockage with your fingers
5 If a patient is found unconscious in a seated position
(e.g. car accident or slumped in chair), simply tilting the
head back, lifting the chin and moving the jaw forward
will open the patient’s airway.

2.4.2 Recovery Position

Unconscious casualties who are breathing and whose hearts are beating should be placed in the
recovery position. This position will ensure that an open airway is maintained since: the tongue cannot
fall to the back of the throat; the head and neck remain in an extended position so that the air passage is
widened, and vomit or other fluid can drain freely from the casualty's mouth.

Action
1 With the patient on their back, kneel besides
the patient and position their arms
 Place the patient’s furthest arm directly
out from their body
 Place the patient’s nearest arm across
their chest

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2 Position patient’s legs
 Lift the patient’s nearest leg at the knee
and place their foot on the floor so the leg
is bent
3 Roll patient into position
 Roll the patient away from you onto their
side carefully supporting their head and
neck
 Keep the patient’s leg bent with their knee
touching the ground to prevent the patient
rolling onto their face
 Place the patient’s hand under their chin
to stop their head from tilting and to keep
airway open

2.4.3 Check Breathing and Determine Heartbeat

After you have ensured that the airway is open and clear you should check that the patient is breathing
normally. This will tell you whether or not to start CPR.

Action
1 Look and feel for chest movement
 Listen and feel for sound of air from mouth
 Take no more than 10 seconds (2-3 breaths) for this
2 Place 2 finger tips on victim’s carotid artery
3 If the patient is not breathing and there is no pulsation, roll
them onto their back and start CPR

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2.4.4 Cardio Pulmonary Resuscitation (CPR)
CPR is given to patients when they are unconscious and not breathing normally and means revival of
heart and lungs.

CPR is needed when there are no signs of life and the victim is unconscious and not responding to the
first aider, not breathing normally and not moving.

CPR is a repeated action of 30 chest compressions with 2 breaths to collapsed patients to facilitate his
body with artificial heart and lungs to try to maintain viability of vital organs (e.g. heart, lungs and brain).

Remember:

• Give CPR with the patient on a firm space

• CPR is a combination of chest compressions and breathings
• Depth of compressions should be 1.5 to 2 inches
• 2 hands – 2 inches
• Give 30 compressions for one cycle
• Rate of compressions should be 3 compressions / 2 seconds
• The first aider should minimize interruptions to chest compressions

Action
1 Get into position
 Place the patient on their back
 Kneel besides the patients’ chest
 Locate the lower half of the sternum in the center of
chest
 Place one hand on the top of other hand
 Interlock your fingers and raise fingers of the lower hand
 Lock your elbows
 Use your body weight
2 Complete one cycle of chest compressions (30
compressions)
 Position yourself vertically above the patients’ chest
 With your arms straight, press down on the patients’

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chest
3 Give Breaths
 ONCE THE A/W IS CLEAR, gently support the chin to lift it
up
 Keep the head tilted back
 Pinch the nostrils
 Open the patients’ mouth using thumb and index finger
over chin below the lip and give 2 Full Breaths
4 Give time lungs to relax
5 CHECK FOR CIRCULATION

An attempt to rescue is better than no attempt at all. If a first aider is unwilling

or unable to give breaths giving compressions only will be better than not doing
CPR at all.
A first aider should continue CPR until any of the following conditions has been met:

• The patient begins breathing normally

• You are physically unable to continue
• More qualified help arrives and takes over

Exercise: Incident Management

Think and Ask about emergency situation:

• What happened? • Sign & Symptoms

• When did it happen? • DRABC - First Aid Management
• How did it happen? • Transportation of patient
• Has it happened before?

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3 Burn Management
Burns may be caused by:
• Fire • Radiation
• Steam • Hot Water
• Chemical • Hot Cooking Oil
• Electricity

3.1 Types of Burns

3.1.1 First Degree

First-degree burns (usually referred to as superficial burns) involve only the
outermost layer of skin, called the epidermis. If treated quickly and blisters
do not form, first-degree burns usually heal very well. Sunburns are a
common form of first-degree burns.

3.1.2 Second Degree

Second-degree burns (usually referred to as partial thickness burns) are
more serious because a deeper layer of skin is affected and because they
are easily infected. Second degree burns are the most painful because more
tissue is damaged, but the nerve endings are still preserved.

3.1.3 Third Degree

Third-degree burns (usually referred to as full-thickness
burns) are the most serious burns, involving all of the layers of the skin. In
third-degree burns, the skin may appear white, black, and or leathery-
looking and there may be very little pain, although the areas surrounding
the burn might be extremely painful.

3.2 Rule of Nines

The rule of nines assesses the percentage of burn and is used to help guide treatment decisions
including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn-unit.
You can estimate the body surface area on an adult that has been burned by using multiples of 9.

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3.3 Critical Burns: Indications to hospitalize

• 2nd degree burns which are larger than the palm of the casualty
• All 3rd degree burns
• Burns on face, joint or genitals

If the area burnt is larger than 9% there is always possibility of shock!

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3.4 First Aid of Severe Burns

Action
1 Extinguish the cause of the burn with water or by
wrapping the injured person in a heavy towel,
coat, or blanket and rolling them on the ground.
2 Don’t remove any burnt clothing.
3 Call medical emergency services
4 Check for conscious level and ABCs as, clear the
airway if necessary, and begin CPR.
5 Cool the burned area with running water for at
least 15 - 20 min. Be careful not to overcool the
injured person. Never apply ice directly to the
skin.
6 Cover burnt area and shift to hospital.

3.5 First Aid of Minor Burns

Action
1 Remove or extinguish source (e.g. chemical, heat, fire etc.).
2 Cool the burn under running water; immerse the burn in cold water for at least 15 - 20
min. Never apply ice directly to the skin.
3 Remove all clothing or jewelry having contact with the chemical. Don’t remove clothes
stuck to burn area.
4 Cover the burn with a loosely wrapped sterile gauze bandage and shift to hospital.

Do Not:

• Break the blister. It will increase chance of infection

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• Use adhesive dressing, cotton wool, other fluffy material or a tape on the skin
• Apply lotions, ointments or fats to the injury
• Remove any thing sticking to the burn
• Apply ice directly to burn

3.6 Eectrical Burns

Human body is a very good conductor of electricity. Some
body parts like skin resist the electrical current.This
resistance produces heat, resulting in burn injuries.

3.6.1 Signs and Symptoms

Note for:
• Unconscious • Obvious burns on skin often on hands or foot
• Shock • Fracture
• Breathing difficulty • Heart arrest
• Weak irregular pulse • Respiratory arrest

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Action
1 Make the area safe, never approach until the
power is turned off and stay at least 6 meters
away
2 Follow ABC of resuscitation and be ready to
resuscitate
3 Cool the burns by flushing with water and
covering with sterile dressing
4 Treat shock and immobilize any fractures
5 If unconscious, put in recovery position

3.7 Cold Contact Burns

Cold contact burns are caused from contact with cryogenic liquid or cold gases.

3.7.1 Signs and Symptoms

• Affected part may swell and become painful
• Blisters may appear
• Affected part appear waxy and yellow
• General body temperature may reduce
• Shock

Action
1 Move the causality into a warm room
2 Make the causality comfortable
3 Remove any clothing that may restrict circulation to the frozen area
4 Immerse the affected part in warm water
5 Cover the part with sterile dressing and large protective bulky covering.
6 Treatment for shock
7 If massive exposure, immerse the whole body in to warm water.

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Remember!
• Never use dry heat or rub the affected part .
• Do not give any alcoholic drinks or allow the casualty to smoke
• Do not use any ointments
• Do not rewarm rapidly
• Handle carefully
• Always wear protective gloves
• Wear eye goggles or face shield
• Try to cover all exposed skin by wearing long sleeves ,cuff less pants, safety boots and gloves

4 Heat Emergencies
There are three categories of heat emergencies, increasing in severity: heat cramps, heat exhaustion,
and heatstroke. All three are preventable by taking precautions in hot weather. The most common
causes of heat emergencies are high temperatures or humidity and dehydration.

Predisposing factors are prolonged or excessive exercise, overdressing in hot temperatures, alcohol
consumption, medications (particularly diuretics and psychiatric medications), cardiovascular disease,
and sweat-gland dysfunction. Children, the elderly, and obese people are at increased risk of developing
heat illness, but anyone can develop heat illness by ignoring warning signs.

4.1 Heat Exhaustion

Heat exhaustion can occur after prolonged exposure to high temperatures and high humidity. It is a pre-
heat stroke condition. If it is not treated, it may progress into heat stroke.

4.1.1 Signs and Symptoms

• Body temperature normal or slightly above normal • Dizziness
• Pale and clammy skin • Headache
• Heavy sweating • Nausea
• Tiredness, weakness • Muscle cramps
• Fainting • Vomiting

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Action
1 Move the person to a cool, shaded area. Don’t leave the
person alone.
2 If the person is dizzy or light-headed, lay him on his back
and raise his legs about 6-8 inches. If the person is sick to
his stomach, lay him on his side.
3 Loosen and remove heavy clothing.
4 Have the person drink some cool water (a small cup
every 15 minutes) if he is not feeling sick to his stomach.
5 Try to cool the person by fanning him. Cool the skin with
a cool spray mist of water or wet cloth.
6 If the person does not feel better in a few minutes call for
emergency help

4.2 Heat Stroke

Heatstroke is a life-threatening emergency and can be fatal. Heat stroke is a potentially irreversible
response to exposure to extreme heat when the body is unable to maintain its normal regulation of
temperature. The victim is seriously dehydrated and no longer able to cool the skin surface by sweating
and to maintain normal body core temperature. As the internal body temperature rises, organ damage
occurs to the heart, brain and kidneys and toxins are released into the circulation as the major muscles
“melt down”.

It is a disturbance in the body’s heat regulating system caused by extremely high body temperature due
to exposure to heat and from an inability of the body to cool itself

4.2.1 Signs and symptoms

• Dry, pale skin, Sweating may be present • Seizures or fits
• Nausea and vomiting, confusion • Collapse (will not respond),
Unconsciousness
• Hot, red skin (looks like sunburn)
• High temperature (104 °F or higher)
• Irritability, confusion, and not making any sense
• Death

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Action
1 Call for emergency help
2 Move the person to a cool, shaded area. Don’t leave
the person alone.
3 Lay him on his back and if the person is having seizures,
remove objects close to him so he won’t hit them.
4 Remove heavy and outer clothing.
5 If conscious, give small amount of cool water
6 Try to cool the person by fanning him. Cool the skin
with a cool spray mist of water, wet cloth or sheet.
7 If ice is available, place ice packs in armpits and groin
area.

4.3 Frost Bite

Frostbite happens when tissues freeze after exposure to temperatures below the freezing point of skin,
commonly affecting the nose, cheeks, ears, fingers, and toes. Frostbite may be either superficial or deep.

4.3.1 Signs and Symptoms

Symptoms of superficial frostbite include burning, numbness, tingling, itching, or cold sensations and
the affected areas appear white and frozen, but if pressed on retain some resistance.

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Symptoms of deep frostbite include first a decrease and then a complete loss in sensation. Other
symptoms include swelling, blood-filled blisters, and white or yellowish skin that appears waxy and will
turn a purplish blue when rewarmed. The area will become hard with no resistance when pressed on,
sometimes looking blackened and dead.

Deep frostbite causes considerable pain when the blood flow is re-established. Symptoms include:

• Feeling of pins and needles at first

• Pallor, followed by numbness
• Hardening and stiffness of the skin

Action
1 Seek Medical Care Promptly
2 Restore Warmth
 Get the person to a warm place and remove any wet
clothing.
 Should not walk on frostbitten toes or feet.
 Warming and then re-exposing the frostbitten area
to cold air can cause worse damage.
 Gently warm the area in warm water (not hot) until
the skin appears red and warm.
 If no water is nearby, breathe on the area through
cupped hands and hold it next to your body.
 Do not use direct heat from heating pads, radiator,
or fires.
 Do not rub or massage the skin or break blisters.
3 Bandage the area.
 Loosely apply dry, sterile dressings.
 Put gauze or clean cotton balls between fingers or
toes to keep them separated

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5 Fracture, Dislocations, Sprains and Strains
When a bone breaks, it is called a fracture. Some fractures are complete, e.g. when a long bone snaps in
half, whereas other fractures may involve only part of a bone breaking, e.g. the “greenstick” fracture of
childhood.
Objective of the First Aid is to iImmobilize the injury and joints above and below the injury.

5.1 Types of Fractures

5.1.1 Closed Fracture

A closed fracture is a broken bone with no associated
wound on the skin.

5.1.2 Open Fracture

Is a broken bone with some kind of wound that allows
contaminants to enter into or around the fracture site.
Open fractures are more dangerous because of the risk of
severe bleeding and infection. Therefore, they are a higher
priority and need to be checked more frequently.

5.1.3 Complicated Open Fracture

where an underlying organ is involved, e.g. a fractured
skull with pressure on the brain, or when a broken rib has
injured the lung.

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5.2 First Aid of Fractures

Action
1 Closed fractures may require only splinting.

Step by Step First Aid of Open Fractures

1 Step-1: Control any bleeding

 Irrigate the wound thoroughly with clean water.
 If a wound is present, check for any bleeding. If bleeding is present it may not be severe
because of pressure on nearby blood vessels from the displaced bone and soft tissues.
 Apply padding around the wound, or above and below the wound.
 Do not apply direct pressure over the wound.
 Do not draw exposed bones back into tissue.
 Apply a sterile dressing loosely over the injured area and bandage it in place, but avoid
any direct pressure on the wound or broken bone
2 Step-2.Immobilize the injured part
 Reduce the pain and the risk of further injury by supporting and immobilizing the
injured area.
 Effective immobilization requires an injured body part to be splinted against an
uninjured body part, although this may not be necessary if an ambulance is likely to be
readily available.
 Splint fracture without disturbing wound.
 Apply elevation sling or arm sling to the fracture if necessary.

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3 Step-3 Make the victim comfortable
 Help the victim into the position of greatest comfort without any excessive movement.
Use blankets, pillows or cloth for general comfort and support.
 Do not move the victim or any injured part unnecessarily.
4 Step-4 See Conscious Level
 If unconscious check for ABC. If he breaths normally, place the victim on the side in the
recovery position, with the injured side downwards to assist with drainage of fluids
from the mouth.
 If no breathing and no circulation, call for help and start CPR.
5 Step-5 Transfer to Tertiary Hospital
 Once help and ambulance arrive transfer the victim to tertiary hospital.

DON’T GIVE TO EAT OR DRINK – SURGERY MAY BE REQUIRED.

5.3 Dislocations
An injury that forces the ends of your bones from their normal position is a dislocation. Injury to the
ligaments around a joint that is so severe that it permits a separation of the bone from its normal
position in a joint.
Dislocation is similar to those of a fracture, and that a suspected dislocation should be treated like a
fracture.
Don’t try to relocate a suspected dislocation!

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5.3.1 Signs and Symptoms
• Pain at the site of injury. • Deformity
• Inability to move or abnormal mobility • Tenderness
• Loss of power • Swelling

5.3.2 First Aid of Fractures

Action
1 Check Conscious level and follow ABC
2 Check pulse below fracture point.
3 Rest and support limb with soft padding and bandage.
4 Apply cold packs
5 Apply Splint or Sling to immobilize and comfort
6 Call for ambulance to shift to hospital

5.4 Sprain and Strain

5.4.1 Sprain
An Sprains Involves a stretching or tearing of ligaments at a joint and is usually caused by stretching or
extending the joint beyond its normal limits. It Is considered a partial dislocation, although the bone
either remains in place or is able to fall back into place after the injury

5.4.2 Strain
Strains involves a stretching and/or tearing of muscles or tendons. Strains most often involve the
muscles in the neck, back, thigh, or calf.

Sypmtoms of strain involve tenderness at injury site, swelling and/or bruising, restricted or loss of use.

Action
1 Check Conscious level and follow ABC
2 Check pulse below fracture point.
3 Rest and support limb with soft padding & bandage.
4 Apply cold packs

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5 Apply Splint or Sling to immobilize and comfort
6 Call for ambulance to shift to hospital.

When uncertain whether an injury is a strain, sprain or a fracture, treat the inury
as if it is fracture.

For sprains and muscle injury, use the R.I.C.E formula: Rest, Ice, Compression, and Elevation to reduce
pain and swelling and to help heal the affected muscle, tendons, ligaments, and tissues.

5.5 Splinting
Splinting is the most common procedure for immobilizing an injury.
Cardboard is the material typically used for “makeshift” splints but a variety of materials can be used.
Note: Cardboard are turned up to form a “mold” in which the injured limb can rest. Other possible items
for splinting include towerls, blankets, or pillows tied with bandaging materials or soft cloths.

Action Soft Splints

1 Support the injured area.
2 Splint injury in the position that you
find it.
3 Don’t try to realign bones.
4 Check for color, warmth, and
sensation.
5 Immobilize above and below the
injury.
Splinting Using a Towel
Splinting using a towel, in which the towel is
rolled up and wrapped around the limb,
then tied in place.
Pillow splint in which the pillow is
wrapped around the limb and tied.
Blanket as a Soft Splint using
a blanket in which the victim’s legs are
immobilized
by tying blankets at intervals from mid-thigh
to feet.

Anatomical Splints Created by

securing a fractured bone to an adjacent un-

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6 Wounds, Bleeding and Shock

6.1 Bleeding
When a blood vessel or vessels are damaged, bleeding occurs. Bleeding can be external, from a cut or
wound, or it can be internal, when the skin isn’t broken but blood vessels inside the body are damaged.
There are three different types of bleeding, depending on what kind of vessel is damaged. Arterial
bleeding from damaged arteries is bright red blood that gushes in a jet with each heartbeat.
Venous bleeding comes from damaged veins and causes dark red blood loss that may not be as severe
but may bleed steadily. Capillary bleeding comes from tiny blood vessels found throughout the body
and normally causes only slight blood loss. The seriousness of any injury depends in part on how deep a
cut is, how much bleeding there is, how long it takes to control the bleeding, and the type of blood
vessels that are damaged.

6.2 Types of bleeding

6.2.1 External bleeding
An open wound is any break in the skin. The amount of bleeding depends on the type and depth of the
wound and varies depending on the blood vessels that have been injured. If an artery has been amaged,
bleeding is generally severe with bright red spurts of blood.
If a vein has been injured, the blood is usually darker in colour and flows out constantly without any
spurting.
If a smaller capillary is involved following a surface wound, bleeding will vary depending on the location,
i.e. bleeding from the scalp often appears severe although the injury may be minor.

6.2.1.1 Signs and Symptoms

• A bleeding wound with, or without, an embedded foreign object
• Severe pain from skin surface wounds
• Bruising or discolouration under the skin
• Loss of normal function in the injured area
• Shock — see Shock

Action
When controlling severe bleed, arterial bleeding may be life threatening and is often difficult
to control. The first and most effective method to control bleeding is by applying direct
pressure. To do this, you should:

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1 Place a sterile dressing or clean cloth over the injury and secure it with tape, or tie
something around the wound just tight enough to control the bleeding.
2 If bleeding doesn’t stop, place another dressing over the first or apply direct pressure over
the wound.
3 Never remove a dressing once it has been applied to a severe wound.
4 Elevate an injured arm, leg, or head above the level of the heart to help control the
bleeding.
5 Don’t elevate or move an area of the body if you suspect a broken bone (fracture) until
you have applied a splint and you are sure that movement will cause no further injury.
6 Do not remove foreign object eg knife from the wound but apply padding on either side of
the object and build it up to avoid pressure on the foreign body.

6.2.2 Internal bleeding

A closed wound is where there is injury to the soft tissues underneath the skin.
Internal bleeding can be the result of such things as motor-vehicle accidents and domestic violence,
causing internal trauma and fractures; bleeding duodenal or gastric ulcers.

6.2.2.1 Signs and symptoms

• Bruises (contusions), which may indicate • Cold and clammy skin
deeper damage • Pale or bluish skin
• Anxiety and restlessness • Rapid and weak pulse
• Excessive thirst • Rapid and “gasping” breaths
• Nausea and vomiting • Increasing thirst
• Rapid breathing (tachypnea) • Blood in cough, vomit, stool or urine.

Action
1 Apply a cold pack or ice pack covered with a cloth to bruises in order to reduce pain and
swelling.
2 Call emergency and place the injured person with legs elevated if there is no chest injury.
3 In a case of chest injury, elevate the head and torso and keep the person warm until help
arrives.

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4 Manage shock as outlined in this document.
5 Don’t allow the person to eat or drink or take any medication unless you are advised to
do so by a doctor.

6.2.3 Shock
When the blood flowing to the vital organs (brain, heart, lungs, liver and kidneys) is insufficient to keep
them supplied with oxygen leading to a slowing down in their functions resulting in a life threatening
emergency is called SHOCK.
Preventing and managing shock is a matter of life and death in emergencies. If the heart beats
irregularly, if blood vessels become too dilated, or if a person is losing too much blood, shock may occur.

6.2.3.1 Causes
• Blood loss
• Loss of fluids
• Electrical injuries
• Allergic reactions
• Some poisoning
• Heart failure

6.2.3.2 Signs & Symptoms

• Skin is pale, cold and moist • May be anxious and restless
• Inner side of the lips are grey • May be thirsty or nauseous
• Has rapid and feeble pulse • May become unconscious and die
• Breathing is fast and shallow

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Action
1 If unconscious follow ABC & assess for CPR
need.
2 If conscious, reassure the patient.
3 Lower head and raise legs
4 Keep warm and comfortable (for Hypothermia
& coagulopathy)
5 Nothing to given by mouth if unconscious.
6 Frequently small amount of water, if conscious
and has no abdominal trauma.
7 Place in recovery position
8 Manage Underlying cause (Injury, burn,
dehydration etc)
9 Arrange the transport to the hospital
10 Stay with the casualty all the time

7 Chocking
Choking happens when a person cannot breathe properly because an object sticking at the back of
throat may either block the throat or cause a spasm.

Everely reduced oxygen intake to the body - Asphyxia

7.1 Signs and Symptoms
• Difficulty in speaking and breathing
• Cyanosis (bluish color) of face, lips or tongue
• Casualty points to throat or grasps neck
• Unconsciousness

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Action
1 Inn Remove any obstruction to breathing
or move the casualty into fresh air.
2 If he is unconscious check breathing and
pulse. Prepare for CPR
3 Place him in recovery position and call an
ambulance.
4 If he is conscious, reassure him and keep
under observation

8 Drowning
A drowning casualty can suffer from throat spasm, which prevents breathing.
Usually only small amounts of water enters lungs and should be allowed to drain naturally
Treat for hypothermia and asphyxia.

Action
1 Carry the casualty with his head lower than his chest
2 ABC - CPR if required
3 Recovery position with head low
4 FIRST AID for hypothermia
5 Send to hospital even if he appears to recover fully, because swelling and irritation of air
passages (secondary drowning) may develop some hours later

9 Angina
Angina is pain originating from heart due to low oxygen supply to heart muscles because of cardiac
arteries blockage.

9.1 Signs and symptoms

• Pain in chest often spreading down the left shoulder to arm and fingers.

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• Skin ashen or pale and lips may be blue.
• Shortness of breath
• General weakness

Action
1 Place the casualty in a W position/comfortable resting position
2 Reassure the casualty and loosen clothing around neck, chest and waist.
3 Do not waste time and call for help.
4 Monitor casualty’s breathing and pulse rate and be prepared to start CPR any time.
5 If he has medicine for angina like puffer or tablet help him take that..
6 If symptoms persist, arrange removal to hospital

10 Heart Attack
Most commonly occurs when blood supply to part of the heart muscle suddenly blocks, e.g., there may
be a clot in one of the coronary arteries.
The effect depends upon the extent of damage to the muscle.

10.1 Signs and Symptoms

• Persistent ,sharp, vice like central chest pain spread to left arm ,throat and jaw ,and at the back
between shoulder blades
• Breathlessness
• Abdominal discomfort
• Faintness or giddiness.
• Blueness at lips.
• Pulse may be rapid, weak or irregular.
• Person may collapse without any warning.

Action
1 Make casualty as comfortable as possible
2 W position
3 Do not waste time and call for help.
4 Monitor casualty’s breathing and pulse rate and be prepared to start CPR any time.
5 If he has medicine for angina like puffer or tablet help him take that.

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6 Give any aspirin to chew.
7 Arrange Proper transportation.

11 Stroke
Stroke occurs when the blood supply to part of the brain is suddenly and critically impaired
• Sudden severe headache, disorientation , giddiness
• A full, bounding pulse
• Corner of the mouth may droop, saliva may dribble and speech slurred
• Weakness and decreased sensation in one or both limbs
• Flushed face with hot, dry skin
• Pupils may be unequally dilated
• Loss of bladder and bowel

Action
1 If conscious, lay the casualty down with head and shoulders slightly raised and supported.
Position head on the side to allow saliva to drain from the mouth
2 Loosen any constricting clothing
3 Do not give casualty anything by mouth
4 If unconscious place in the recovery position
5 If breathing and heartbeat stop begin CPR.
6 Remove the casualty to hospital immediately. Transport as a stretcher case maintaining
the treatment position

12 Snake bite
Snake Poison Toxicity Occurs on two mechanisms:
• Neuro-Toxicity • Haemo-Toxcity

12.1 Signs and Symptoms

Russel Viper and Saw Scaled Viper Cobra and Krait Poisoning
• Haemotoxic • Mainly Neuro-toxic
• Local symptoms are prominent • General symptoms are prominent

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• Consumption of clotting factors  • Ptosis
coagulopathy • Creeping Paralysis
• Systemic Bleeding disorders  External / • Staggering gait
Internal Hmges. • In-coordination of speech
• Cardio – vascular Collapse • Drooping of head
• Multiple system organ failure • Dyspnea  Apnea  Cardio-pulmonary
• Shock Arrest  Death
• Death

Action
1 Immediate First Aid Treatment to limit the spread of venom to prevent it reaching the
central circulation and causing generalized poisoning.
 Reassurance to reduce anxiety
 Clean the wound
 Keep Calm & still
 Give pain killers (Paracetamol)
 Apply Crepe bandage
 Immobilize whole Limb

2 DO NOT:
 Apply tourniquet
 Incise the wound
 Apply Ice
 Give Disprine

3 Inj. ATT (by doctor only)

 Decision of ASV  Only if symptom appears
 Medevac  Take ASV along with
 Observe for at least 8 to 24 hours

4 Evacuate the patient

 The doctor/medic will accompany the casualty in the ambulance with the emergency
box, Anti Venom Serum (AVS) and oxygen cylinders to the hospital.

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13 Unconsciousness
Unconsciousness can be caused by a range of accidents and illnesses and can last for seconds (fainting)
or for long periods. Someone who is unconscious can still be murmuring or theirs eyes may be rolling.
One of the biggest concerns regarding someone who is unconscious is keeping the airway open. If
someone is unconscious and laid on their back they are at risk of the airway being blocked either by the
tongue or by vomit. They cannot respond and clear the airway because they are unconscious. This is
where the recovery position is useful because it puts the casualty on their side where these risks are
greatly reduced.

Action
The Recovery Questions
There are three recovery quetioins you need to ask yourself:
1 Are they conscious? Levels of consciousness can be assessed using the AVPU scale:

2 Are they breathing?

 Establish that they are still breathing, look listen and feel for breath. Tip the head back
first to open the airway.
 Look down the chest to see rise and fall.
 Listen at the mouth to hear breath.
 Feel with your ear/check air passing by.
 If they are not breathing commence CPR
3 Have they fallen from a height?
 Consider if the person has suffered an impact or blow (Just a one foot fall is high enough

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to be considered an impact.)
 If there has been an impact or if you are uncertain if there was an impact then do not
move the casualty unless airway is at risk.
 If you can stay with them and monitor their breathing then ONLY move them if the
airway becomes blocked. If you have to leave them; put them in the recovery position
so that the airway is safe while you are gone.

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