FIRST AID

BLEEDING
 ⚫ Hemorrhage = bleeding
⚫ Body cannot tolerate greater
than 20% blood loss.
⚫ Blood loss of 1 L can be
dangerous in adults; in children,
loss of 100-200 mL is serious.

External Bleeding
⚫ The body will not tolerate an acute blood
loss of greater than 20% of the blood
volume.
⚫ In the typical adult, 20% is 1 liter or 2
pints.
⚫ A 1-year-old infant typically has 800 mL.
A loss of 200 mL is significant.

The Significance of Bleeding

Conditions With Possible
Serious Bleeding
⚫ Significant mechanism of injury
⚫ Poor general appearance of patient
⚫ Assessment reveals signs of shock
⚫ Significant amount of blood loss
noted
⚫ Blood loss is rapid.
⚫ You cannot control external
bleeding.
 ⚫ Arterial
◦ Blood is bright red and spurts.
⚫ Venous
◦ Blood is dark red and does not spurt.
⚫ Capillary
◦ Blood oozes out and is controlled
easily.

Characteristics of Bleeding (1 of
2)
Characteristics of Bleeding (2 of
2)
 ⚫ Bleeding normally stops within 10
minutes.
⚫ Some medications interfere with
clotting.
⚫ Some injuries will be unable to clot.
⚫ Patients with hemophilia lack clotting
factors.

Blood Clotting
⚫ With significant bleeding, provide
high-flow oxygen.
⚫ Control bleeding.
⚫ Using multiple methods to control
bleeding usually works best.
⚫ Treat aggressively for shock.
⚫ Provide rapid transport.

Interventions
 Ongoing Assessment

⚫ Reassess interventions and treatment.

⚫ With severe bleeding, take vital signs
every 5 minutes.
⚫ Communication and documentation
◦ Recognize, estimate, and report amount of
blood loss and how rapidly and during what time
it occurred.
◦ Paperwork must reflect all injuries and care you
provided.
Direct Pressure and
Elevation
⚫ Direct pressure is the most
common and effective way
to control bleeding.
⚫ Apply pressure with gloved
finger or hand.
⚫ Elevating a bleeding
extremity often stops
venous bleeding.
⚫ Use both direct pressure
and elevation whenever
possible.
⚫ Apply a pressure dressing.
 ⚫ If bleeding
continues, apply
pressure on
pressure point.
⚫ Pressure points are
located where a
blood vessel lies
near a bone.
⚫ Be familiar with the
location of pressure
points.

Pressure Points
Location of Pressure Points
UPPER AIRWAY
OBSTRUCTION

FIRST AID
HEAD TILT–CHIN LIFT
Kneel beside patient’s head.
Place one hand on forehead.
Apply backward pressure.
Place tips of finger under lower jaw.
Lift chin.
JAW-THRUST MANEUVER
Kneel above patient’s head.
Place fingers behind angle of lower jaw.
Use thumbs to position the lower jaw.
ASSESSMENT OF THE AIRWAY (1of 2)

4
ASSESSMENT OF THE AIRWAY (1of 2)

5
ASSESSMENT OF THE AIRWAY (2 OF 2)
• Assess whether breathing has returned using look,
listen, and feel technique.
– Listen by placing your ear about 10 inches above patient’s
nose and mouth.
– Feel and listen for movement of air.
– Watch the patient’s chest and abdomen.
– Place a hand on patient’s chest to feel for movement.

6
 Severe Airway Obstruction

• There will be no movement of air.

• Chest and abdomen may rise and fall with
patient’s attempts to breathe.
• Chest wall movement alone does not indicate
breathing.
• Always use three-part approach: look, listen, and feel
for movement of air.

7
RECOVERY POSITION

8
CAUSES OF FOREIGN BODY OBSTRUCTION
Relaxation of the tongue
Vomited stomach contents
Blood clots, bone fragments, damaged
tissue
Swelling caused by allergic reactions
Foreign objects

9
RECOGNIZING AN OBSTRUCTION (1 OF 2)
Obstruction may be mild or severe.
Is patient able to speak or cough?
If patient is unconscious, attempt to
deliver artificial ventilation.

10
REMOVING AN OBSTRUCTION (2 OF 2)
Perform Heimlich maneuver.
Use suction if needed.
If attempts to clear the airway are
unsuccessful, transport rapidly.

11
First Aid Care
First Aid is the initial assistance or
treatment given to a casualty for any injury
or sudden illness before the arrival of
ambulance, doctor, or other qualified
personnel.

AIMS OF FIRST AID

Preserve life
Prevent the casualty’s condition
from becoming worse
Promote recovery
RESPONSIBILITIES AS A FIRST AIDER

• Assess the situation quickly and safely and

summon appropriate help
• Protect casualties and others at the scene from
possible danger
• To identify, as far as possible, the nature of
illness or injury affecting casualty.
• To give each casualty early and appropriate
treatment, treating the most serious condition
first.
• To arrange for the casualty’s removal to hospital
or into the care of a doctor.
• To remain with a casualty until appropriate care
is available.
• To report your observations to those taking care
of the casualty, and to give further assistance if
required.
PRIORITY OF CASUALTIES

• Save the conscious casualties before the

unconscious ones as they have a higher chance of
recovery.
• Save the young before the old.
• Do not jeopardize your own life while rendering
First Aid. In the event of immediate danger, get out
of site immediately.
• Remember: One of your aims is to preserve life,
and not endanger your own in the process of
rendering First Aid.
• Casualties should always be treated in the order
of priority, usually given by the “3 Bs”:
– Breathing
– Bleeding
– Bones
FIRST AID
FRACTURE
FRACTURE
a break or crack in a bone
open fracture
 STATISTICS

70% 20%
Medical consultations Patients
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A burn is tissue damage from contact with:

flames
very hot water (scalding)
corrosive chemicals
electricity
radiation (including sunburn)

The first step in treating a burn injury is determining whether the

burn is a minor or major one. That determination will direct action
and treatment. Read on to learn the difference and how to treat
both types.

Cool the burn with cool or lukewarm running water

for 20 minutes as soon as possible after the injury.

NEVER use ice, iced water, or any creams or greasy

substances like butter. Keep yourself or the person
warm. Use a blanket or layers of clothing, but avoid
putting them on the injured area.
First-degree Burn

A first-degree burn, also called a superficial burn,

only affects the epidermis, or outer layer of skin.

The burn site appears red, painful, dry, and absent

of blisters. Scarring is rare or minimal. The most
common type of first-degree burn is mild sunburn.
2nd-degree Burn

This type of burn affects both the epidermis and

the second layer of skin (dermis). It may cause
swelling and red, white or splotchy skin.

Blisters may develop, and pain can be severe.

Deep second-degree burns can cause scarring.
RULE OF 9

The front and back of the head and neck equal 9% of

the body's surface area. The front and back of each arm
and hand equal 9% of the body's surface area.

The chest equals 9% and the stomach equals 9% of the

body's surface area. The upper back equals 9% and the
lower back equals 9% of the body's surface area.
RULE OF 9

The rule of nine is a tool used to estimate a burn's

percentage of your total skin.

It divides your body into sections by multiples of

9% each.
RAPID
EXTRICATION
RAPID EXTRICATION
TECHNIQUE
designed to move a patient in a series of
coordinated movements from the sitting position to
the supine position on a long backboard while
always maintaining stabilization and support for
the head/neck, torso, and pelvis
 PURPOSE OF EXTRICATION

EXTRICATION

the entire process from fire protection,

power unit disengagement, vehicle
security, patient security and
treatment, removal of vehicle from
patient, removal of patient, and transfer
to ambulance.
 PURPOSE OF EXTRICATION

AUTO EXTRICATION

process of removing a vehicle from

around a person who has been involved in
a motor vehicle crash, when conventional
means of exit are impossible or inadvisable
due to injuries suffered.

A delicate approach is needed to minimize

injury to the victim during the extrication.
 PURPOSE OF EXTRICATION

EMERGENCY
MEDICAL SERVICE
Ambulance/paramedic is responsible
for medical examination and triage.

One personnel participates in the

transportation out of the motor vehicle
wreckage.
VEHICLE EXTRICATION
 EMERGENCY/
MEDICAL SERVICE

MAIN GOAL

All rescue personnel:

coordinate their work,
communication
cooperate and understand each
others roles on-scene.
RAPID EXTRICATION

is indicated when the scene is

unsafe, a patient is unstable, or a
critical patient is blocked by another
less critical patient.
WHAT TO DO DURING
EXTRICATION PROCEDURE?
The rescuer mantra for rapid extrication of an
unconscious or critical victim: Be Safe, Be Fast.

“Be Fast” means move and extricate quickly as

possible while being safe

“Be Safe,” means do no harm to the victim or the

rescuers throughout the extrication/rescue process.
RAPID EXTRICATION

The only indication for performing a rapid

extrication is if the patient is not entrapped and is
in cardiac arrest.

B. Rapid extrication involves the use of heavy

equipment to disentangle a patient from his or her
crashed vehicle.
4 BASIC METHODS OF EXTRICATION
Rescuers will extricate victims using
manipulative extrication
disassembly
cutting
forcing.

3 TYPES OF EXTRICATION
litter-
drag-
roll-type
IMPORTANCE OF VEHICLE
EXTRICATION

Extrication of victims after automobile accidents has

become one of the most important life saving
functions of emergency medical personnel.

Rescuers are responsible for setting up a safe

working area, evaluating possible hazards, and
treating the victims' injuries.
GOLDEN RULES OF
EXTRICATION
Rule # 1 – Never put any part of your body
between the tool and the vehicle.

Rule # 2 – Never lean any part of your body into

the tool

Rule # 3 – Let the tool do the work

Rule # 4 – Listen to your back up partner

WHAT IS THE COMMON HAND
TOOL USED FOR EXTRICATION?

Most common examples of extrication tools are

spring-loaded center punches and glass hammers

cutters, spreaders, kits, off road rescue supplies and

other heavy rescue.
EXTRICATION DEVICE USED IN
VEHICLE EXTRICATION TO REMOVE
VICTIMS
The Kendrick Extrication Device (KED) is a device
that is used in vehicle extrication to remove a
patient from a motor vehicle.

A KED is generally only used on stable patients;

unstable patients are extricated with rapid
extrication techniques without applying a KED.
5 BASICS OF EXTRICATION

Stabilization
Glass removal
Taking doors
Roof removal
Dash displacement
7 STEPS OF EXTRICATION

-Overview of the Scene

-Stabilization of the Scene and any Hazards
-Access to Patients.
- Access to Patients
- Initial Emergency Care
- Patient Disentanglement
-Preparation to Patient Removal
-Patient Removal
WHEN TO USE RAPID
EXTRICATION TECHNIQUE

Vehicle or scene is unsafe

Patient can't be properly assessed
Patient requires immediate care
Patient's condition requires immediate
transport
Patient is blocking access to another
seriously injured patient
 Iloilo Doctors’ College
College of Nursing
West Avenue, Molo, Iloilo City

SAFE LIFTING AND MOVING

PERFORMANCE CHECKLIST

Student’s Name: ______________________________Score/ Equivalent: ________________

Year & Section: _______________________________Date Performed: _________________

PERFORMANCE RATING
3 – Consistently demonstrates high level of performance.
2 – Satisfactorily achieves and perform according to standards.
1 – Quality of performance is made inadequate.

Procedure 3 2 1
General Considerations
1 Considered the patient’s weight and personal limitations before lifting
Identified the patient’s condition and environment/ location where patient is to be
lifted and moved out.
2 Established a plan on how to safety lift and move the patient.
3 Communicated and explained the plan to the fellow responder.
4 Assigned one person to take the lead.
5 Identified proper lifting and moving techniques to be performed basing on the
confronted situation.
6 Identified possible lifting equipment to be used.
7 Used verbal commands effectively.
Followed safety rules on body mechanics for lifting and moving: 3 2 1
8 Positioned feet properly into a stable, wide stance at least shoulder-width or
15 inches apart
9 Locked lower back in its natural S-curve, kept head up, and the shoulders
squared.
10 Used legs appropriately. Checked conditions for the best footing such as a
curb or potholes.
11 Minimized twisting by selecting the best starting position.
12 Lifted with both legs, and not the back.
13 Used both hands in lifting.
14 Kept weight as close as possible to the body.
Basic Techniques
A. Power lift and power grip 3 2 1
15 Lowered body by bending the knees and squatting down to the patient.
16 Grasped the patient or stretcher palms up, all fingers at same angle and fully
supported the patient /handle on curved palm
17 Looked straight ahead, and kept the back straight, chest out, and shoulders
squared.
18 Lifted the patient by raising the upper body and arms and straightened legs until
on a standing position
19 Kept the weight as close to the body as possible.
B. Lifting the patient by a sheet or blanket: 3 2 1
20 Placed the patient on the center
21 Tightly rolled up excess fabric on the sides.
 Iloilo Doctors’ College
College of Nursing
West Avenue, Molo, Iloilo City
22 Used the rolled cylindrical handle to grasp the fabric and lift the patient.
C. Safe Reaching and Pulling
I. Body Drag 3 2 1
23 Knelt on the floor with the back kept locked and straight.
24 Extended arms not more than 15″ to 20″ in front.
25 Pulled patient across the ground with elbows extended just beyond the
external torso.
II. Log rolling a patient onto his or her side 3 2 1
26 Knelt as close to the patient’s side as possible.
27 Kept back straight when leaning forward.
28 Rolled the patient by slowly pushing without stopping until the patient is
resting on his or her side.
29 Placed patient in a safe environment and made comfortable.
30 Documented patient’s response and condition after safe lifting and moving.
Total

Student’s Signature: _________________ Instructor’s Signature: _______________

 Iloilo Doctors’ College
College of Nursing
West Avenue, Molo, Iloilo City

Basic First Aid to Manage Bleeding

PERFORMANCE CHECKLIST

Student’s Name: ______________________________Score/ Equivalent: ________________

Year & Section: _______________________________Date Performed: _________________

PERFORMANCE RATING
4 – Demonstrates a very high level of performance
3 – Consistently demonstrates high level of performance.
2 – Satisfactorily achieves and perform according to standards.
1 – Quality of performance is made inadequate.

Procedure 4 3 2 1
1 Surveyed the scene and safety of the location by checking for hazards or
personal dangers.
2 Anticipated if the victim is at risk for unexpected bleeding, including traumatic
injury.
3 Prepared multiple thickness gauze, adhesive tape and elastic roller bandage.
4 Looked for visible presence of blood.
5 Assessed patient’s anxiety level.
6 Obtained patient’s baseline vital signs before the onset of heavy bleeding.
7 Performed hand hygiene and applied clean gloves.
8 Identified external bleeding site. Turned patient, log roll if necessary.
9 Used hands and pressed as hard as possible to apply immediate manual
pressure to the bleeding site with multiple thickness gauze.
10 Placed adhesive strips 7-10 cm beyond the width of gauze dressing with even
pressure to the central bleeding source.
11 Secured tape on the distal end.
12 Placed and pulled tape across dressing and kept firm pressure.
13 Elevated affected body part if possible.
14 Washed hands and discarded used materials.
15 Continued in observing the dressing for control of bleeding.
16 Evaluated adequacy of circulation (distal pulse, skin temperature and color)
17 Estimated volume of blood loss.
18 Evaluated patient’s response to management.
19 Monitored vital signs.
20 Documented and recorded the following:
a. Location of bleeding
b. Application and type of pressure dressing
c. Effectiveness of applied pressure dressing
Total

Student’s Signature: _________________ Instructor’s Signature: _______________

 Iloilo Doctors’ College
College of Nursing
West Avenue, Molo, Iloilo City

Basic First Aid to Manage Fractures

(Conscious Casualty with Lower Limb Fracture)

PERFORMANCE CHECKLIST

Student’s Name: ______________________________Score/ Equivalent: ________________

Year & Section: _______________________________Date Performed: _________________

PERFORMANCE RATING
4 – Demonstrates a very high level of performance
3 – Consistently demonstrates high level of performance.
2 – Satisfactorily achieves and perform according to standards.
1 – Quality of performance is made inadequate.

Procedure 4 3 2 1
1 Surveyed the scene and safety of the location by checking for hazards or
personal dangers
2 Anticipated patient at risk for traumatic injury including fractures.
3 Prepare materials to be used.
4 Kept the casualty to remain still and instructed not to move.
5 Performed hand hygiene and applied clean gloves.
6 Controlled bleeding, and applied firm pressure to the wound with multiple
thickness gauze (if necessary).
7 Did not touch the fracture and left it in place
8 Covered exposed bone with a dressing
10 Applied broad / thick bandages (where possible) to immobilize the fracture.
11 Placed a padded splint along the injured limb then bandaged above and
below the fracture site, leaving a five (5) cm gap either side of the fracture to
prevent movement.
12 Used the good leg to immobilize the fractured leg if splint is not available.
13 Evaluated adequacy of circulation (distal pulse, skin temperature and color)
Placed the victim on his most comfortable position
14 Washed hands and discarded used materials.
15 Documented and recorded casualty’s response to management
Total

Student’s Signature: _________________ Instructor’s Signature: _______________