CHAPTER EIGHT: FIRST AID

Introduction
This chapter describes the concept of first aid. The following topics are discussed under this chapter:
history of first aid, responsibilities of first aider, the legal aspects of providing first aid, primary survey,
secondary survey, the first aid management of a bleeding patient, first aid kits and first aid needs
assessment.

History of first aid

The first recorded history of first aid dates to 1099, when a religious order of knights trained to administer
medical treatment was formed. The Order of St John to which the modern-day St. John Ambulance
organization traces its roots in the specialized in the treatment of battlefield injuries. In 1792, the French
Army Surgeon General, formed the first official army medical corps in the treatment of injured soldiers.
During the 1860s, the first Geneva Convention and the International Red Cross came into being to protect
and deal with sick and injured soldiers on the battlefield.
Definition of first aid
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 qualified personnel.
Aims of first aid
The aims of first aid include; a. To
save life
b. To prevent the situation from worsening.
c. To promote recovery.

Who is a first aider?

A first aider is a person who takes this action while taking care to keep everyone involved safe and to cause
no further harm when doing so.
The responsibilities of a first aider
a) Assess the situation quickly and safely summon appropriate help.
b) Protect casualties and others at the scene of danger.
c) To identify, as far as possible, the nature of illness or injury affecting casualty.
d) To give each casualty early and appropriate treatment, treating most serious conditionfirst.
e) To arrange for the casualty’s removal to hospital or in the care of a doctor.
f) To remain with a casualty until appropriate care is available.
g) To report your observations to those taking care of the casualty, and to give furtherassistance if
required.
Principles of First Aiders
• Be useful and methodically.
• Calm and take charge don’t fear anything.
• Do first things first.
• Be firm and fair.
• Control the situation.
• Communicate with other helpers.
• Co-ordinate tasks.
• Command, delegate responsibilities and duties.
• Give confidence to conscious casualties.
• Don’t move casualties unless to eminent danger until you know what is wrong and it is safeto do so.
Priorities of the casualties are;
• Save the unconscious casualties before the conscious one as they have a higher chance ofrecovery
• 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 do not endanger your own in theprocess of rendering
first aid. Legal aspects of providing first aid
The Good Samaritan principle prevents someone who has voluntarily helped another in need from being
sued for wrongdoing. Since governments want encourage people to help others, they pass specific Good
Samaritan laws or apply principles of common law. You are generally protected from liability as long as;
• You are reasonably careful.
• You act in good faith (not for a reward).
• You do not provide care beyond your skill level.

BASIC MEASURES FOR FIRST AID

1. Action at an emergency
In any emergency one must follow a clear plan of action. This will enable a person prioritize demands that
may come upon him or her, and help decide of the response. The principal steps include:
• Assessing the situation- Evaluating the scene accurately is one of the most importantfactors in the
management of an incident. You should stay calm if there are no medical personnel in attendance calmly
take charge. All incidents should be handled in a similar manner
• Safety- What are the dangers and do they still exist? Is it safe for you to approach? Scenewhat factors are
involved in the incident? How many casualties are there?
• Situation- What happened? How many people are involved? Are they young or old
• Making the area safe- The conditions that give rise to an incident may still present a dangerand must be
eliminated if possible. If not safe or at any time becomes unsafe call for emergency help and stand clear
of the incident.
• Giving emergency help- Once an area has been made safe use the primary survey toquickly carry out an
initial assessment of the casualty attends those with life threatening conditions first 2. Primary survey
The primary survey is a quick systematic assessment of a person to establish if any conditions or
injuries sustained are life threatening. In this survey the first aider should follow the ABC rule of first
aid. ABC rule of first aid
A-Airways- The first step is to check that a casualty’s airway is open and clear. If the casualty is alert and
talking to you, it follows that the airway is open and clear. If unconscious, open and clear the airway do not
move to the next stage until it is open and clear. The tongue is the single most common cause of an airway
obstruction in most cases using head- tilt/chinlift technique can clear the airway. This action pulls the
tongue form the air passage in the throat. If foreign material is present in the mouth, it should be removed.
The airway can also be opened using the jaw thrust technique. This may be accomplished by the first aider
grasping the angles of the casualty’s lower jaw and lifting with both hands, one on each side displacing the
jaw forward and up. The jaw thrust is the safest first approach to opening airway of a casualty with
suspected neck injury because in most cases it can be accomplished without extending the neck.
B -Breathing- check whether the casualty is breathing. Look, listen and feel for breathing. Always maintain
airway as you check for breathing. Often the act of opening the airway will allow the casualty to breathe
properly failure to maintain airway will prevent the casualty from receiving adequate oxygen. If breathing
has stopped apply artificial respiration immediately. Normal breathing rate is 12 to 20 breaths per minute.
C- Circulation of blood- Conditions that affect blood circulation can also be life threatening. Injuries that
cause blood loss from the circulatory system must be treated immediately to minimize the risk of life-
threatening condition known as shock. Check whether there is blood circulation by feeling the casualty’s
pulse. Pulse is the wave of pressure that passes along arteries indicating the pump of the heart. Normal
pulse pump rate is 60 to 80 pumps per minute.

3. Secondary Survey
Secondary survey is the head-to-toe examination of casualty. This is the survey that identifies injuries. This
survey can only be done after a primary survey. In this survey the casualty’s facial expressions may help the
first aider to identify injuries. It includes the following for each body part:
Bleeding
• Do a quick head to toe check for bleeding.
• Check the hidden area such as under the arch of the back.
• Control any major bleeding that you find.Head and neck
• Clues to injury could be bruising, swelling, deformity or bleeding.
• Check the whole head and face.
• Feel the back of the neck.
Shoulders and chest
• Place your hands on opposite shoulders and compare them.
• Run your fingers down the collar bones checking for signs of a fracture.
• Gently squeeze and rock the ribs.
Abdomen
• Push the abdomen with the palm of your hand to check for and pelvis abnormality orresponse to pain.
• Gently check the pelvis for signs of a fracture.
• Look for incontinence or bleeding.Legs and arms
• Feel each leg for the signs of a fracture.
• Feel each arm for the signs of a fracture.
• Look for other clues (medic alert bracelets, needle marks etc)
• Look for clues and make sure nothing will injure the patient as you roll them into therecovery position.
• Have a witness if you remove items from pockets.
• Be very careful if you suspect there could be sharp objects such as needles.
• Loosen any tight clothing.

4. Bandages
Bandages are a length of cotton material used to wrap injuries.
Types of bandages
i. Triangle bandage ii.
Roller bandages iii.
Adhesive bandages
Uses of bandages
a. To hold dressings in place
b. To apply pressure in stopping bleeding
c. To immobilize fractured limbs
d. To cover wounds against infection
e. To support injured joins
f. To prevent swellingGeneral rules for bandaging
i. Explain to casualty what you are going to do.
ii.Ensure the casualty is comfortably seated or lying down.iii. Support the injured part. iv.
Always work from the injured side or in front of the casualty.
v. Apply bandages firmly. A tight bandage can stop blood circulation whilst a loose bandage is useless. vi.
If possible, expose fingers and toes of bandage limbs so that blood circulation can be easily checked. vii. If
you are to bandage limbs together ensure that there is enough padding in between, especially around
joints. viii. When using knot to secure a bandage always use a reef knot.

5. Management of chocking •
Ensure safety.
• Encourage the casualty to cough.
• If the obstruction dislodges you may be able to remove it by your fingers
• Re-assure the casualty.
• Prevent shock.
• Get medical help.

6. Wounds and bleeding

A wound is an abnormal break in the skin.

Dangers of wounds
• Hemorrhage/ bleeding
• Infection
• Shock
Management of wounds
• Ensure safety.
• Thoroughly wash your hands and/or wear gloves.
• Control bleeding if any.
• Remove clothing from the injured part if necessary.
• Avoid spreading germs to the wound and the equipment to be used.
• Do not remove any foreign objects stuck on the wound. This may lead to further bleedingand infection.
• Clear around and away of the wound using a clean or sterile dressing or swab, if possible,soak in clean
cold, soapy water. Use a fresh dressing/swab for each stroke.
• Place a sterile dressing over the wound and cover with a clean bandage.
• Prevent shock by providing warmth.
• Re-assure the casualty.
• Get medical help.

7. Bleeding
Bleeding is blood flowing out of the circulation system. This can be either internal or external.

Organs involved
• The heart pumps blood to various parts of the body
• Veins carry deoxygenated blood from the body to the heart• Arteries carry oxygenated
blood from the heart to the body
Ways of stopping bleeding
i. Direct pressure- Apply pressure on the wound/injury using a sterile pad and bandagefirmly.
ii. Indirect pressure- Apply pressure away from the injury. For arterial bleeding, applypressure at
the side of the heart and seize for venous bleeding. iii. Elevation- Slightly lift the injury above the level
of the heart.

Management of nose bleeding •

Ensure safety.
• Sit the casualty in open air with the head slightly bent forward.
• Loosen any tight clothing around the neck.
• Ask the casualty to firmly pinch the soft part of the nose.
• Apply cold compress on the casualty’s forehead.
• Advise the casualty to breathe through the mouth.
• Release pressure at ten minutes intervals.
• If bleeding does not stop after thirty minutes, quickly refer for medical help.
• Prevent shock by providing warmth.
• Re-assure the casualty.
• If bleeding stops, advise casualty not to blow or pork the nose for the next four hours.

Bleeding from the ear •

Ensure safety.
• Sit the casualty with the head slightly inclined to towards the bleeding ear to allow blood tocome out.
• Cover the ear with a clean pad.
• Secure the pad lightly with a bandage.
• Do not plug the ear.
• Prevent shock.
• Re-assure the casualty.
• Get medical aid.
8. Burns and scalds
Burns are injuries caused by dry heat whilst scalds are caused by moist heat.
Dangers of burns and scalds • H-
hemorrhage/loss of body fluids.
• I-infection.
• Shock.

Signs symptoms of burns scalds

• Blisters.
• Swelling.
• Pain.
• Redness.
• Numbness.
• Skin peeling off.

Management of burns or scalds.

• Ensure safety.
• Open and maintain a clear airway.
• Apply cold compress, put the burn/scald under clean, cold running water.
• Cover the injury with a light wet cloth or bandage.
• Maintain body temperature to prevent shock.
• Re-assure the casualty.
• Do not prick blisters.
• Do not apply lotion, eggs, butter or urine.
• Do not apply stick bandages.
• Do not remove stuck clothing.
• Refer for medical help.

Types of burns
• Burns caused by heat
• Scalds caused by moist heat
• Frictional burns
• Chemical burns by chemicals
• Radiation burns caused by the sun rays
• Electrical burns caused by electricity
Signs and symptoms of burns
• Severe burns
• Damage to the skin
• Blisters may start to appear
• Swelling and tenderness

Management
• Ensure safety
• Remove cause from casualty or casualty from cause
• Check A, B, C
• Immense burnt part in cold water for 10min

Dangers of burns
• Paralysis
• Disabilities
• Shock
• Skin damage
• Constriction of the limbs

9. Recovery position
This is the most comfortable position for breathing unconscious casualties whose hearts are still beating. If
you suspect neck injury, get someone to help you keep the head in line with the body as you turn the
patient. Be careful not to cause further damage to any suspected injuries.
Reasons for the recovery • To
rest properly.
• To avoid the falling back of the tongue.
• To awake up easily.
• To allow vomiting without choking.
• To maintain open airway.

10. Poisoning
Poison- Is any substance which when taken into contact with the body may destroy life or impair health.
Ways of poisoning
• Ingestion- swallowing through the mouth.
• Inhalation- breathing in through the mouth and nose.
• Injection- taken under the skin.
• Absorption- taken through skin contact.

Signs and symptoms of poisoning •

Vomiting.
• Diarrhea.
• Burnt lips or skin.
• Unconsciousness.
• Pain.
• Nausea.
• Sweating.
• Difficulty in breathing
How to prevent poisoning
• Keep all poisonous substances out of reach of children.
• Wear protective clothing when using poisonous chemicals.
• Do not put poisonous substances in food containers.
• Do not use poisonous substances without instructions.

Management of poisoning
1. Swallowed poison are divided into two categories namely burning poisons and nonburning poisons.
a) Non-burning poisons
• Ensure safety.
• If the casualty is conscious dilute the poison by giving the casualty milk or water drink.
• If conscious induce vomiting by touching the back of his throat.
• If container is available, follow first aid tips on the label.
• Prevent shock.
• Continue giving milk or drinking water.
• Re-assure.
• Quickly refer for medical help and if possible, take container with the casualty.b) Burning poisons
• Ensure safety.
• If the casualty is conscious dilute the poison by giving the casualty milk or water drink.
• If conscious induce vomiting by touching the back of his throat.
• If container is available, follow first aid tips on the label.
• Prevent shock.
• Continue giving milk or drinking water.
• Re-assure.
• Quickly refer for medical help and if possible, take container with the casualty.

2. Inhaled poisons
• Ensure safety.
• Lie casualty down in free air.
• Check for breathing.
• Open and maintain a clear airway.
• If the casualty is unconscious, place him/her in the recovery position.
• Prevent shock.
• Re-assure the casualty.
• Quickly refer for medical help.

3. Contact poisons
• Ensure safety.
• Remove clothes and jewelry if necessary.
• Rinse the poisoned part with plenty of cold water.
• Prevent shock.
• Re-assure the casualty.
• If container is available, follow first aid tips on the label.
• Quickly refer for medical help and if possible, take container with the casualty.
4. Injection poisons
• Ensure safety.
• Immediately lie down the casualty. This slow down poison circulation in the body.
• Prevent shock.
• Re-assure the casualty.
• If container is available, follow first aid tips on the label.
• Quickly refer for medical help and if possible, take container with the casualty.

FIRST AID KITS

The first aid kit should be easily accessible; preferably near somewhere the first aider can wash their hands.
The kits should be easily identified by a large white cross on a green background. The container should
protect the contents from dust and damp. First aid kits should be available at all workplaces. However,
larger sites will need more than one first aid kit to cover the greater amount of people. The kits should
contain the following, as a guide only:
• A leaflet with general guidance on first aid.
• 20 individually wrapped sticking plasters of assorted sizes and absorption, suited to thetype of work.
• Hypoallergenic plasters
• 2 sterile eye pads.
• 4 individually wrapped triangular bandages, preferably sterile.
• 6 safety pins.
• 6 individually wrapped medium, sterile wound dressings• 2 individually wrapped large, sterile wound
dressings
• pair of disposable gloves.

FIRST AID NEEDS ASSESSMENT

Employers must carry out a first aid needs assessment, which should answer the following questions:
• What is the nature of the work?
• What are the hazards and risks of the workplace?
• What is the size of the organization?
• What is the nature of the workforce?
• What is the organization’s history of illness and accidents?
• What are the needs of travelling, remote or lone workers, if applicable?
• What are the work patterns (such as shift work)?
• What is the distribution of the workforce?
• How far away is the closest emergency medical service?
• How many employees are there working on shared or multi-occupied sites?
• Are there enough first aiders to cover each other over annual leave and other absences?
• Is there first aid provision for non-employees?