HTM 038 LEC 4

COMMON EMERGENCIES AND THEIR CAUSES

ACTION AT AN EMERGENCY

In any emergency it is important that you follow a clear plan of action. This will enable you to

prioritize the demands that may be made upon you, as well as help you decide on your best

response.

ASSESSING THE SITUATION

Evaluating the scene accurately is one of the most important factors in the management of an

incident. You should stay calm. State that you have first aid training and, if there are no medical

personnel in attendance, calmly take charge of the situation.

Identify any safety risks and assess the resources available to you. Action for key dangers you

may face, such as fire, are dealt with in this chapter, but be aware, too, of trip hazards, sharp

objects, chemical spills and falling masonry.

MAKING AN AREA SAFE

The conditions that give rise to an incident may still present a danger and must be eliminated if

possible. It may be that a simple measure, such as turning off the ignition of a car to reduce the

risk of fire, is sufficient. As a last resort, move the casualty to safety. Usually specialist help and

equipment is required for this. When approaching a casualty make sure you protect yourself:

wear high-visibility clothing, gloves and head protection if you have them. Remember, too, that

a casualty faces the risk of injury from the same hazards that you face.
COMMON EMERGENCIES

1. TRAFFIC INCIDENTS

The severity of traffic incidents can range from a fall from a bicycle to a major vehicle crash

involving many casualties. Often, the incident site will present serious risks to safety, largely

because of passing traffic.

It is essential to make the incident area safe before you attend any casualties ; this not

only protects you, but also the casualties and any other road users. Once the area is safe,

quickly assess the casualty or casualties and prioritize treatment . Give first aid to

those with life-threatening injuries before treating anyone else. Call 999/112 for

emergency help, giving as much detail as you can about the incident, indicating the number

and age of the casualties, and types of injury. Do not put yourself or others in further danger.

Take the following precautions.

■■Park safely, well clear of the incident site, set your hazard lights flashing and put on a

high visibility jacket/vest if you have one.

■■Set up warning triangles (or another vehicle with hazard lights) at least 45m (49yd)

from

the incident in each direction; bystanders can do this while you attend to the casualty. Send

helpers who are wearing high-visibility jackets to warn other drivers to slow down.

■■Make vehicles safe. For example, switch off the ignition of any damaged vehicle and, if

you can, disconnect the battery. Pull the supply cut-off on large diesel vehicles; this is

normally found on the outside of the vehicle and will be marked.

■■Stabilize vehicles. If a vehicle is upright, apply the handbrake, put it in gear and/or place

blocks in front of the wheels. If it is on its side, do not attempt to right it, but try to prevent it
 from rolling over further.

■■Watch out for physical dangers, such as traffic. Make sure that no-one smokes

anywhere near the incident.

■■Alert the emergency services to damaged power lines

Warn other road users Ask a bystander to set up warning triangles in both

directions. Advise the person to watch for other vehicles while she is

doing this.

2. FIRES

Fire spreads very quickly, so your first priority is to warn any people at risk. If you are in a

building, activate the nearest fire alarm, call 999/112 for emergency help, then leave the

building. However, if doing this delays your escape, make the call when you are out of the

building. As a first aider, try to keep everyone calm. Encourage and assist people to evacuate

the area as quickly and calmly as possible. When arriving at an incident involving fire,

stop, observe, think: do not enter the area. A minor fire can escalate in minutes to a serious

blaze. Call 999/112 for emergency help and wait for it to arrive.

A fire needs three components to start and maintain it: ignition (a spark or flame); a

source of fuel (petrol, wood or fabric); and oxygen (air).

Removing one of these elements can break this “triangle of fire”.

■■Remove combustible materials, such as paper or cardboard, from the path of a fire,

as they can fuel the flames.

■■Cut off a fire’s oxygen supply by shutting a door on a fire or smothering the flames

with a fire blanket. This will cause the fire to suffocate and go out.
■■Switch off a car’s ignition, or pull the fuel cut-off on a large diesel vehicle (this is

normally marked on the outside of the vehicle), or switch off the gas supply.

If you see or suspect a fire in a building, activate the first fire alarm you see. Try

to help people out of the building without putting yourself at risk. Close doors behind you

to help prevent the fire from spreading. If you are in a public building, use the fire exits and

look for assembly points outside. You should already know the evacuation

procedure at your workplace. If, however, you are visiting other premises you are not

familiar with, follow the signs for escape routes and obey any instructions you are given by

their fire marshals.

LEAVING A BURNING BUILDING

When escaping from a fire:

■■ Do not re-enter a burning building to collect personal possessions

■■ Do not use lifts

■■ Do not go back to a building until cleared to do so by a fire officer

Fire precautions:

■■ Do not move anything that is on fire

■■ Do not smother flames with flammable materials

■■ Do not fight a fire if it puts your own safety at risk

■■ If your clothes catch fire and help is not available, extinguish the flames by wrapping

yourself up tightly in suitable material and rolling along the ground

■■ Do not put water on an electrical fire: pull the plug out or switch the power off at the

mains

■■ Smother a hot fat fire with a fire blanket; never use water
CAUTION

Evacuating other people

Encourage people to leave the building calmly but quickly by the nearest

exit. If they have to use the stairs, make sure they do not rush and risk

falling down

Clothing on fire

If a person's clothing is on fire always follow this procedure: Stop, Drop and Roll.

■■Stop the casualty panicking, running around or going outside; any movement or breeze

will fan the flames.

■■Drop the casualty to the ground. If possible, wrap him tightly in a fire blanket, or heavy

fabric such as a coat, curtain, blanket (not a nylon or cellular type) or rug.

■■Roll the casualty along the ground until the flames have been smothered. Treat any burns:

help the casualty to lie down with the burned side uppermost and start cooling the burn as

soon as possible.

Smoke and fumes

Any fire in a confined space creates a highly dangerous atmosphere that is low in oxygen

and may also be polluted by carbon monoxide and other toxic fumes. Never enter a smoke-

or fume-filled building or open a door leading to a fire. Let the emergency services do this.

■■When you are trapped in a burning building, if possible go into a room at the front of the

building with a window and shut the door.

Block gaps under the door by placing a rug or similar heavy fabric across the bottom of the

door to minimize smoke. Open the window and shout for help.
 ■■Stay low if you have to cross a smoke-filled room: air is clearest at floor level.

■■If escaping through a high window, climb out backwards feet first; lower yourself to the

full length of your arms before dropping down.

3. ELECTRICAL INCIDENTS

When a person is electrocuted, the passage of electrical current through the body may stun

him, causing his breathing and heartbeat to stop (cardiac arrest). The electrical current

can also cause burns both where it enters and where it exits the body to go to “earth”. An

electrical burn may appear very small or may not be visible on the skin, however, the

damage the burn causes can extend deep into the tissues

The factors that affect the severity of the injury are: the voltage; the type of current;

and the path of the current. A low voltage of 240 volts is found in a home or workplace, a

high voltage of 440–1,000 volts is found in industry and voltage of more than 1,000 volts

is found in power lines. The type of current will either be alternating (AC) or direct (DC),

and the path of the current can be hand-to-hand, hand-to-foot or foot-to-foot.

Most low-voltage and high-tension currents are AC, which causes muscular spasms (known

as tetany) and the “locked-on” phenomenon – the casualty’s grasp is “locked” on to the

object, which prevents him from letting go, so he may remain electrically charged (“live”).

In contrast, DC tends to produce a single large muscular contraction that often throws the

person away from the source of electricity. Be aware that the jolt may cause the casualty to

be thrown or to fall, which can result in injuries such as spinal injuries and fractures.

HIGH VOLTAGE CURRENT

Contact with a high-voltage current found in power lines and overhead cables, is usually

immediately fatal. Anyone who survives will have severe burns, since the temperature of the
 electricity may reach up to 5,000°C (9,032°F).

Furthermore, the shock produces a muscular spasm that propels the casualty some distance,

causing additional injuries. High-voltage electricity may jump (“arc”) up

to 18m (20yd) from its source. The power must be cut off and isolated before anyone

approaches the casualty. A casualty who has suffered this type of shock is likely to be

unresponsive. Once you have been officially informed that it is safe to approach, assess the

casualty, open the airway and check breathing

Caution

■■ Do not touch the casualty if he is in contact with the electrical current.

■■ Do not use anything metallic to break the electrical contact.

■■ Do not approach high-voltage wires until the power is turned off.

■■ Do not move a person with an electrical injury unless he is in immediate danger and is no

longer in contact with the electricity.

■■ If the casualty is unresponsive, and it is safe to touch him, open the airway and check

breathing
LOW VOLTAGE CURRENT

Domestic current, as used in homes and workplaces, can cause serious injury or even

death. Incidents are usually due to faulty or loose switches, frayed flexes or defective

appliances. Young children are at risk since they are naturally curious, and may put fingers

or other objects into electrical wall sockets. Water is also a very efficient conductor of

electricity, so presents additional risks to both you and the casualty. If you handle

an otherwise safe electrical appliance with wet hands, or when you are standing on a wet

floor, you greatly increase the risk of an electric shock.

BREAKING CONTACT WITH ELECTRICITY

1.Before beginning any treatment, look first, do not touch. If the casualty is still in contact

with the electrical source, she will be “live” and you risk electrocution.

2.Once you are sure that the contact between the casualty and the electricity has been

broken, perform a primary survey and treat injuries in order of priority. Call 999/112 for

emergency help.

3.Turn off the source of electricity, if possible, to break the contact between the casualty and

the electrical supply. Switch off the current at the mains or meter point if possible. Otherwise

remove the plug or wrench the cable free.

4.Alternatively, move the source away from both you and the casualty. Stand on

some dry insulating material, such as a wooden box, plastic mat or telephone directory.

Using a wooden pole or broom, push the casualty’s limb away from the electrical

source or push the source away from her. If it is not possible to break the contact using a

wooden object, loop a length of rope around the casualty’s ankles or under the arms, taking

great care not to touch her, and pull her away from the source of the electrical current
4.WATER INCIDENTS

Incidents around water may involve people of any age. However, drowning is one of the

most common causes of accidental death among young people under the age of 16.

Young children can drown in fish ponds, paddling pools, baths and even in the toilet

if they fall in head first, as well as in swimming pools, in the sea and in open water. Many cases

of drowning involve people who have been swimming in strong currents or very cold water,

or who have been swimming or boating after drinking alcohol.

There are particular dangers connected with incidents involving swimmers in cold water.

Open water around Great Britain and Ireland is cold, even in summer. Sea temperatures range

from 5°C (41°F) to 15°C (59°F); inland waters may be colder. The sudden immersion in cold

water can result in an overstimulation of nerves, causing the heart to stop (cardiac arrest).

Submersion in cold water may cause hypothermia and exacerbate shock

. Spasm in the throat and inhalation of water can block the airway (Hypoxia, p.92

and Drowning, p.100). Inhaled or swallowed water may be absorbed into the circulatory

system, causing water overload to the brain, heart or lungs. The exertion of swimming can

also strain the heart

Caution

■■ If the casualty is unresponsive, lift him clear of the water, supporting his head and neck; try

to keep him upright. When you reach land, lay him down and open the airway and check

breathing. Begin CPR if necessary

RESCUING A PERSON FROM WATER

1.Your first priority is to get the casualty on to dry land with the minimum of danger to
yourself. Stay on dry land, hold out a stick, a branch or a rope for him to grab, then pull him

from the water. Alternatively, throw him a float.

2. If you are a trained life-saver and the casualty is unresponsive, wade or swim to the casualty

and tow him ashore – try to keep him upright. If you cannot do this safely, call 999/112 for

emergency help

3. Once the casualty is out of the water, shield him from the wind, if possible. Treat him for

drowning and the effects of severe cold (hypothermia, pp.186–88). If possible, replace any wet

clothing with dry clothing.

3.Arrange to take or send the casualty to hospital, even if he seems to have recovered

5. FOREIGN OBJECTS, POISONING, BITES AND STINGS

FOREIGN OBJECT IN THE EYE.

Foreign objects such as grit, a loose eyelash or a contact lens that are floating on the surface of

the eye can easily be rinsed out. However, you must not attempt to remove anything that

sticks to the eye or penetrates the eyeball because this may damage the eye. Instead, make sure

that the casualty receives urgent medical attention.

WHAT TO DO

1.Advise the casualty not to rub her eye. Ask her to sit down facing a light.

2.Stand beside, or just behind, the casualty. Gently separate her eyelids with your

thumbs or finger and thumb. Ask her to look right, left, up and down. Examine every part of her

eye as she does this.

3.If you can see a foreign object on the white of the eye, wash it out by pouring clean

water from a glass or jug, or by using a sterile eyewash if you have one. Put a towel around the
casualty’s shoulders. Hold her eye open and pour the water from the inner corner so that it drains

on to the towel.

4. If this is unsuccessful, try lifting the object off with a moist swab or the damp corner of a

clean handkerchief or tissue. If you still cannot remove the object, seek medical help

Stand beside,

Poisoning

A poison is any substance that can cause illness or death when absorbed by the body. There are

poisonous substances all around us. Poisonous consumer products have poison symbols on their

labels, but there are many other poisonous substances that don’t carry warnings. Examples

include alcohol, some common household plants, contaminated food, and medications when not

taken as prescribed. Many substances that are not harmful in small amounts may be poisonous in

large amounts.

Poisons are classified according to how they enter the body:

• Swallowed poisons—through the mouth

• Inhaled poisons—through the lungs

• Absorbed poisons—through the skin and mucous membranes

• Injected poisons—through a hollow needle or needle-like device (e.g. a snake’s fangs)

An important part of the first aid for poisoning is telephoning your local or provincial poison

information centre for advice on what to do. Before calling, the first aider must quickly gather

as much information about the incident as possible. Use the history of the scene and the signs

and symptoms of the casualty to gather the information you’ll need to answer the questions
asked by the poison information centre.

History of the scene

You need to know four basic facts to give appropriate first aid for poisoning:

• What poison was taken–container labels should identify the poison; otherwise, save vomit and

give it to medical help for analysis.

• How the poison entered the body–first aid may differ for poisons taken by mouth, absorbed

through the skin, injected into the blood or breathed into the lungs.

• How much poison was taken–estimate the quantity that may have been taken based on what

you see or are told— the number of pills originally in the container, the amount

of chemical in the bottle, etc. Estimate the size/age of the casualty, the smaller the person the

more dangerous the dosage.

• When the poison was taken–the length of time the poison has been in the body will help

determine the first aid and medical care needed

Signs and symptoms of poisoning

If the history does not reveal what poison was taken, or by what means it was taken, signs and

symptoms may be helpful in answering these questions. Signs and symptoms depend on the

method of poisoning, however signs and symptoms common to most poisonings include:

• Change in the level of consciousness

• Difficulty breathing (usually shallow and rapid)

• Change in the heart rate

• Burned tissue at the route of entry

• Chest pain

Other signs and symptoms related to the method of poisoning include:

• Swallowed poisons usually cause nausea, abdominal cramps, diarrhea and vomiting. They may

discolour the lips, cause burns in or around the mouth or leave an odour on

the breath

• Poisons absorbed through the skin may cause a reddening of the skin, blisters, swelling and

burns

• Poisons injected through the skin usually irritate the point of entry

• Inhaled poisons may cause coughing, chest pain and difficulty breathing

Note that some poisonous gases (i.e. carbon monoxide) are colourless and odourless. They are

not to be easily detectable. Exercise extra caution if inhaled poisoning is suspected.

General first aid for poisoning

1. Perform a scene survey. Do a primary survey. Gather any information about the suspected

poison.

2. If the casualty is responsive, call the poison information centre in your region and follow their

advice.

3. If the casualty is unresponsive or having a seizure, call for medical help.

4. If the casualty is unresponsive but breathing, place in the recovery position.

5. Give ongoing casualty care until medical help takes over.

First aid for swallowed poisons

1. If CPR is required, check the area around the mouth for poisonous residue and wipe clear.

Always use a barrier device for added protection.

2. Perform a scene survey and a primary survey.

3. Do not dilute a poison that has been swallowed (do not give fluids) unless told to do so by the

Poison Information Centre.

4. If the casualty is conscious, wipe poisonous or corrosive residue from the casualty’s face and

rinse or wipe out the mouth.

5. Never induce vomiting except on the advice of the Poison Information Centre—many poisons

will cause more damage when vomited.

First aid for inhaled poisons

1. Perform a scene survey and a primary survey. Assess hazards with particular attention to the

possible presence of a poisonous gas or vapour. Ensure your safety; it may be

best to wait for professional rescuers.

2. Move the person to fresh air and away from the source of the poison.

3. If breathing is not present begin CPR. If the poison could affect you while giving first aid, use

a face mask or shield with a one-way valve.

4. If the casualty vomits, keep the airway open by clearing out the mouth and putting the casualty

into the recovery position.

5. If the casualty goes into convulsions, prevent them from injuring themselves.

6. Give ongoing casualty care. Get medical help.

First aid for absorbed poisons

Most poisons absorbed by the skin cause irritation at the place of contact, but don’t affect the rest

of the body. The irritation, called contact dermatitis, includes redness, itching and blisters. Some

chemicals, however, do affect the rest of the body when absorbed by the skin, and these can

cause life-threatening emergencies.

1. Perform a scene survey and a primary survey.

2. Flush the affected area with large amounts of cool water; if the poisonous substance is a

powder, brush off excessive amounts with a dry cloth before flushing.

3. Remove any clothing that has been in contact with the poison. Don’t touch the clothing until it

has been thoroughly washed.

4. Wash the affected skin thoroughly with soap and water.

5. Give ongoing casualty care until medical help takes over.

First aid for injected poisons

Follow the general first aid for poisoning. Injected poisons should be contained near the injection

site. Delay the circulation of the poison throughout the body by placing the casualty at rest and

keeping the affected limb below heart level. If you have been pricked with a needle with possible

transmissible disease contamination, then the site of the needle-stick injury should be vigorously

scrubbed with Iodine or similar disinfectant.

Bites and stings

Animal and human bites

Animal and human bites that cause puncture wounds or lacerations may carry contaminated

saliva into the body and are dangerous because of the risk of infection. The most common human

bites in adults are to the hand. All animal and human bites that break the

skin should be seen by a doctor. Rabies is an acute viral disease of the nervous system that is

always fatal if not treated. Rabies should be suspected in domestic animals

if they behave in an unusual way, and in all attacks by wild animals (bats, foxes, skunks,

raccoons, and more). The rabies virus can be transmitted to anyone who handles a diseased

animal or who touches the area of the wound that carries the virus. To be safe,
always give first aid for an animal bite as if the animal had rabies, until it is proved otherwise.

Be especially careful when giving first aid to anyone you suspect may have been exposed to

rabies and in handling the live or dead animal involved. Wear gloves and/or scrub your hands

thoroughly after contact to reduce the risk of infection.

Even if a person has been exposed to a rabid animal, full-blown rabies can be prevented if

immunization against the disease is given quickly.

First aid for animal/human bites

1. Perform a scene survey and a primary survey.

2. Examine the wound to see if the skin was broken.

3. If there is bleeding, allow moderate bleeding of the wound—this helps to cleanse the wound.

4. Wash the wound then apply a dressing and bandage.

5. Get medical help.

Snakebite

First aid for snakebite

1. Do a scene survey and primary survey.

2. Place the casualty at rest in a semi-sitting position and keep the affected limb below heart

level. By placing the casualty at rest, the venom won’t spread as quickly.

3. Flush the bite if possible. Wrap a large roller bandage around the entire length of the bitten

extremity, just tight enough that you can get your fingers under the bandage.

This is an effective and safe way to slow circulation of the venom.

4. Immobilize the limb.

5. Give ongoing casualty care.

Precautions when dealing with snakes and snakebite

• Most snakes will be within 10 metres of the place where the bite took place–be careful

• Do not let a snakebite casualty walk if there is any other method of transportation to medical

help

• Do not give the casualty alcoholic beverages

• Do not cut the puncture marks or try to suck poison out with your mouth

• Do not apply ice–this could cause more damage

• If the snake is killed, bring it to medical help for identification, but do not touch the snake

directly. Avoid the snake’s head—a dead snake still may have a bite reflex

Insect bites and stings

An insect bite or sting causes only a painful swelling with redness and itching at the site for most

people. But some people are severely allergic to these stings and being stung may cause a life

threatening allergic reaction.

Signs and symptoms of a localized reaction at the site of a bite or sting:

• Sudden pain

• Swelling

• Heat

• Redness

• Itching

Signs and symptoms of an anaphylactic reaction to a bite or sting:

• General itching, rash

• A bump on the skin that may be white, pink, reddish or blotchy

• Generalized swelling—especially of the airway

• Weakness, headache

• Fever

• Breathing difficulties that may be severe

• Anxiety, abdominal cramps, vomiting

First aid for an insect bite or sting

1. Do a scene survey, then a primary survey. Are there any signs of an allergic reaction?

2. Looking for a stinger that may still be in the skin. Honey bees leave their stinger and venom

sac attached to the skin. Other bees and wasps do not. If it is there, remove it by carefully

scraping it and the attached poison sac from the skin.

3. For the irritation at the site of the sting, apply rubbing alcohol or a paste of baking soda and

water. Ice can also be used. Don’t use alcohol near the eyes.