FIRST AID SERIES

PART 2: MEDICAL FIRST AID

 FIRST AID SERIES
PART 2: MEDICAL FIRST AID

A VIDEOTEL PRODUCTION
The Producers would like to acknowledge the assistance of:

International Maritime Organization (IMO)

Shell International Ltd
Warsash Maritime Academy
Casualties Union
St John Ambulance

CONSULTANT: SANDRA ROBERTS

FRASER BETTS
PRODUCER: KATHREIN GÜNTHER
DIRECTOR: STEPHEN SAUNDERS

WARNING
Any unauthorised copying, lending, exhibition diffusion, sale, public performance or other exploitation of this
workbook and accompanying video is strictly prohibited and may result in prosecution.

COPYRIGHT © VIDEOTEL 2009

This video and accompanying workbook training package is intended to reflect the best available techniques and
practices at the time of production. It is intended purely as comment. No responsibility is accepted by Videotel,
or by any firm, corporation or organisation who or which has been in any way concerned, with the production or
authorised translation, supply or sale of this training package for accuracy of any information given hereon or for
any omission here from.
CONTENTS HOW TO USE THIS WORKBOOK
HOW TO USE THIS WORKBOOK 5 This workbook has been written to accompany the second video in the First Aid series,
INTRODUCTION 6 Medical First Aid (STCW Code Section A -VI/4-1).

MUSCULO – SKELETAL SYSTEM 7 The video and this workbook will assist with the underpinning knowledge of first aid but
► FRACTURES 7 it is important to remember that first aid requires practical skills. This programme
► DISLOCATION 13 supports, but does not replace, statutory first aid training required by seafarers under
► SPRAINS AND STRAINS 13 the STCW code.
► SPINAL INJURY 14

INJURIES 16
USER GUIDANCE
► HEAD INJURY 16
► EYE INJURY 18 ★ The programme may be used by individuals, or in small groups for training
► CHEST INJURY 19
► ABDOMINAL INJURY 20 ★ It is essential to work through the programme systematically and NOT to miss any
► CRUSH INJURY 21 section
► BLAST INJURY 21
► IMPALEMENT 21 ★ Do not proceed to the next topic until everything watched and read has been
► AMPUTATION 22 understood
MEDICAL EMERGENCIES 22 ★ If something is not understood, replay the video section and read the relevant
► CHEST PAIN 22 chapter in the book again
► DIABETES 23
► ASTHMA 24 ★ To fully understand the contents it will usually be necessary to watch the video more
► SEIZURES 25 than once as well as re-reading the supporting workbook
► POISONING 25
★ At the end of the workbook there are questions to test your knowledge
ENVIRONMENTAL CONDITIONS 26
HYPOTHERMIA 28
HEAT EXHAUSTION 29
HEAT STROKE 29
TEST QUESTIONS 32
TEST ANSWERS 36

FIRST AID SERIES » PART 2: MEDICAL FIRST AID 5

INTRODUCTION MUSCULO – FRACTURES

SKELETAL SYSTEM Causes

The first part in the First Aid Series, Elementary First Aid, dealt with the basic immediate A broken bone is known as a fracture or a
first aid that all seafarers need to be familiar with, and will have undertaken training in, break. Fractures can have a number of
The musculo – skeletal system comprises
to satisfy the first aid training requirements in accordance with the STCW code. (STCW causes. Violence is the word used to
bones, tendons, ligaments and muscles.
Code Section A -VI/1-3). indicate impact or trauma. Causes are:
The skeleton provides the framework for
It showed the first aid that all seafarers need to know to be able to manage a situation the body and gives some protection to ★ direct violence e.g. a blow to a limb
when it occurs and take the necessary actions to potentially save a life. These are: internal organs.
★ indirect violence e.g. falling on an
★ Managing the incident Muscles move the skeleton. They are outstretched arm breaks the collar
★ Resuscitation techniques attached to each other or to the bones by bone
tendons. Ligaments bind bone ends ★ muscular action - it is the muscular
★ The unconscious casualty
together in joints and support internal movement that breaks the bone
★ Monitoring a casualty
organs.
★ disease - the bones are weakened by
★ Shock
When describing injuries it is best to refer underlying disease
★ Bleeding
to them using simple words. Do not use
Types
★ Burns names to identify bones, unless you are
There are different types of fracture. They
★ Moving a casualty absolutely sure you are correct. For
can be defined as:
example, describe an injury to the leg as
upper leg and not femur. ★ Closed – the skin is intact and no
This second part in the series looks at a variety of injuries and illnesses that seafarers
bone is visible
may need to have knowledge of. It includes major and minor injury as well as dealing Some of the bones in the body are shown
with sudden illness. It covers first aid training requirements in accordance with the ★ Open – bone is visible or may even be
on the diagram of the skeleton.
STCW Code (STCW Code Section A -VI/4-1). protruding
Injuries detailed in this section are:
★ Complicated – these may be open or
It is important to remember that some first aid situations will always need immediate
★ Fractures closed but damage has been done to
action to be taken, but that the continuing first aid will be carried out by officers on
★ Dislocation underlying organs, nerves or blood
board ship who have completed additional first aid and medical training. The first aider
vessels
then becomes an assistant in the situation and follows instructions given. In some ★ Sprains and Strains
instances action may not be taken until Radio Medical Advice (RMA) has been sought. ★ Unstable – the bone ends move freely
★ Spinal injury
risking further damage
In all the examples shown in the accompanying video, the first aider will always carry
The Skeleton ★ Stable – the broken bone ends do not
out DR ABC. They will assess the scene to establish what happened and to ensure it is
See page 8. move
safe, and they will assess, treat, and monitor the casualty.

6 FIRST AID SERIES » PART 2: MEDICAL FIRST AID FIRST AID SERIES » PART 2: MEDICAL FIRST AID 7
THE SKELETON Recognition
It is important to be able to recognise that
a fracture may have taken place and to
identify where, because of the possible
complications. The history of an injury as
well as a number of other features will
help in making the diagnosis of fracture.
There may be pain at the site of injury as
well as tenderness, bruising, redness or
even bone in an open fracture. A lump or
other deformity may be visible, which may
include shortening of a limb. There could
be loss of movement or power.
Broken bones may cause internal injury or
bleeding that may be serious and life
threatening. When a fracture of the thigh
bone (femur) occurs, the bone itself can
bleed causing a very swollen thigh, the
casualty will appear shocked. This is a
serious injury. The femur also lies close to
the femoral artery and if the broken bone
moves, it may damage the artery causing
life threatening bleeding. Unless there is
an open fracture this can only be
recognised by the seriously shocked
casualty and an increase in girth of the
thigh. A fractured pelvis may also cause
life threatening bleeding.
Management
Fracture management includes
immobilisation. This reduces the pain,
prevents further injury from bone
movement and makes moving the
casualty easier. Different fractures and
methods of immobilisation are
demonstrated in the video.
8 FIRST AID SERIES » PART 2: MEDICAL FIRST AID FIRST AID SERIES » PART 2: MEDICAL FIRST AID
Control of bleeding and wound management
will also be required in an open fracture. If
the bone is protruding, bleeding should be
managed as for a wound with a
penetrating object. To stop bleeding put
pressure on the wound at the base of the
protruding bone. Never put any pressure
on the bone itself or attempt to push or
pull it back into place. Dressings should
be built up around the bone and secured.
A sterile non fluffy dressing should be
placed lightly over the bone but it should
be labelled so as to identify it is over bone.
This reduces the chance of pressure
being placed on it in error.
An injured limb needs to be monitored to
check its circulation below the level of the
fracture. Is the limb warm and a good
colour? Is a good pulse present? Is there
any damage to nerve supply? Is the
casualty complaining of loss of sensation,
numbness or tingling?
A fracture of the arm in the area of the
elbow may result in the nerve and artery
which pass through the elbow being
compromised. This is an example of a
complicated fracture. Below the elbow the
arm may have poor colour, and feel cold.
The casualty may complain of loss of
sensation or tingling, pins and needles or
numbness. This is a fracture where urgent
Radio Medical Advice is required, as it
could potentially lead to loss of the limb.
Immobilisation
There is time when managing a fracture to
9

A QUICK GUIDE TO RECOGNISING A FRACTURE
Sign or symptom Detail
The casualty will be able to describe their accident. This
History
description often includes that they heard or felt a crack.
This may be sudden and occur at the time of injury or may
Pain increase as time progresses. It may be worsened when the
casualty moves the affected body part.
Any pressure over the injury site causes pain. However, do
Tenderness
not apply pressure around the injury to discover this.
It may take some time for obvious bruising to develop. Even
Bruising or redness
if bruising is not visible there may still be a fracture.
A limb may look distorted because the broken bone has
Deformity
moved position and no longer gives a smooth line to the limb.
If a bone end is pushing against the skin it may appear as a
lump. Any movement may allow the bone end to break the
skin and become an open fracture.
Lump
Swelling around a broken rib may appear as a tender lump
on the chest wall.
When long bones are broken they may be pulled out of
alignment by muscle action. The effect is that the limb looks
Limb shortening shorter. This may be quite marked. When the thigh bone
(femur) neck is broken the leg may appear considerably
shortened.
Movement may be lost for a number of reasons including
Loss of movement nerve damage. However remember that pain alone will
restrict a casualty’s movement.
With some breaks, the casualty may still have movement but
Loss of power
there is a loss of power.
This is the crunching noise that may be heard as bone ends
Crepitus
or fragments rub together. It may also be felt.
10 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
consider the options available and These illustrations show the high (or
whether the casualty needs pain relief elevation) sling and the low (or broad) sling.
before immobilisation of the affected body
The Low (Broad) Sling
part and moving the casualty. A number of
immobilisation methods are available.
They include:
★ support with a pillow
★ using slings and bandages
★ using splints
It is important that the first aider uses
simple immobilisation techniques only until
the casualty has been assessed by the
person in charge of medical care on
board. That person will decide the best
form of immobilisation to be used
according to the injury, whether
evacuation is imminent or how the
The low sling is used to support and
casualty is to be moved. Splints should
immobilise shoulder, elbow, upper arm
only be used by someone who has been
and lower arm injuries. It may also be
trained in their use as they may be harmful
useful where ribs are broken to remove
if not used properly.
the weight and movement of the arm.
Immobilisation – Upper Limb
The High (Elevation) Sling
The upper and lower arm can be
immobilised by using a sling. Injuries of
the chest, collar bone and shoulder may
also be managed by using a sling. The
purpose of a sling is to support and
immobilise. This can be achieved by using
a number of different types of sling that
are available commercially, by using a
simple triangular bandage from the first
aid kit or by adapting materials that are
available even a casualty’s own clothing.
Methods of using a triangular bandage to
create a sling are demonstrated in the video.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID 11
 The high sling is used to elevate the hand
and lower arm to control swelling or
bleeding. It is also used when the collar
bone is fractured.
Neither of these slings prevents movement
of the shoulder. To achieve immobilisation
of a shoulder joint, once the basic sling
has been applied, triangular bandages
can be used to secure the arm to the
body (as shown in the video). Padding
should be placed between the arm and
the body for comfort.
An Improvised Sling using Clothing
Immobilisation – Lower Limb
Legs may be immobilised by using a
commercially available splint, every day
items, basic first aid dressings and even
the other leg. When splinting legs using
triangular bandages, the following needs
to be considered:
★ padding should be placed between
the legs to prevent knees and
ankles rubbing together and to fill
the naturally occurring gap between
the legs
12 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
★ the feet should be secured first.
Even on its own this will provide
some immobilisation of the legs
★ after the feet, ties should be placed
at the joint above and below the
injury and then immediately above
and below the fracture. Additional
ties can be placed as required
The video shows immobilisation of a lower
leg injury using triangular bandages only.
This diagram shows how triangular
bandages have been used in conjunction
with wooden splints along the outer edge
of the legs and body to immobilise
fractures of the upper leg when both legs
have been injured.
Numerous splints are available
commercially. A number of these may be
found on board ship. They will include
small malleable splints suitable for hands
and arm.
Splints in different sizes will be available
for full/half leg and full/half arm. These are
most commonly of the vacuum type.
Inflatable splints may still be on board
some ships but they are gradually being
replaced. Also available may be padded
box type splints, again in differing sizes for
arm and leg use. severe, even resulting in paralysis if major
nerves are involved.
The video shows an example of a padded
box splint being used for a fracture of the This is an injury where pain relief may be
lower leg. required, so the person in charge of
medical care on board ship should be
In addition to these splints, a traction
involved. They will also obtain Radio
splint to manage a fracture of the thigh
Medical Advice about the best way to
bone will be on board. There are many
manage the dislocation after the initial first
types available, some more complicated
aid.
to use than others. They are often known
by their brand names. Examples are To immobilise a dislocated shoulder it is
Donway, Davis, Sager and Thomas splints. not always possible to raise the arm into a
sling. In that case padding should be
It is important to remember that applying
placed between the affected arm and the
a splint incorrectly may be harmful and
body and the arm then be tied to the body
that it should only be done if training has
to support it. This is demonstrated in the
taken place. The casualty is in pain and it
video.
may be necessary for the person in charge
of medical care to provide pain relief before
any attempt to apply a splint is made. SPRAINS AND STRAINS
Cause and Recognition
DISLOCATION Sprains and strains are injuries to the soft
tissues surrounding bones and joints,
A dislocation is a joint injury in which the
caused by overstretching or sudden
bones are partially or completely pulled
violent movement. They result in restriction
out of position. It can be caused by direct
of movement, swelling, bruising and pain.
violence or muscle contraction.
It can be difficult sometimes to tell if an
As with fractures, the immediate aim ankle is sprained or broken.
should be to immobilise the limb. Take
A strain involves muscles and tendons.
care of any associated wound, monitor
Tendons are strong but inelastic fibrous
the circulation and treat the casualty for
cords joining muscle to bone or muscle to
shock. No attempt should ever be made
muscle.
to relocate the dislocation.
A sprain involves ligaments which are
Be aware that there may also be
tough fibrous, partially elastic tissue. They
associated torn ligaments. The
bind bone ends together in joints and also
consequences of a dislocation can be
support internal organs.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID 13
 Treatment
For simple sprains and strains the
management can be remembered by
using the word RICE. This treatment
helps reduce swelling and pain.
R is for rest
I is for ice
C is for compression
E is for elevation
Sprained Wrist
For a sprained wrist the casualty does not
have to be confined to bed, but the limb
may be rested by supporting it in a sling.
This sling should also elevate the injury to
reduce the swelling so a high or elevation
sling as previously demonstrated in the
fracture section of the accompanying
video should be used.
An ice pack may be applied but it should
always be fabric covered and never left in
place for longer than 10 minutes every hour.
A bag of frozen peas will work just as well.
Rings, watches and jewellery should be
removed from the injured limb before
swelling becomes too severe. To give full
support a compression bandage should
be applied from the knuckles at the base
of the fingers up to the elbow. Check the
bandage is not too tight by monitoring the
circulation and sensation to the fingers. If
not wearing a sling, the casualty should
keep the wrist elevated on a pillow when
resting.
14 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
Sprained Ankle
For a sprained ankle the casualty should
be rested in bed with their leg and foot
elevated on pillows. An ice pack should
be applied. Until the foot can be placed
comfortably at a 90º angle to the leg, a
compression bandage should not be
applied. When in position it should reach
from the base of the toes up to the knee,
that is “from joint below to joint above” the
injury. Check the bandage is not too tight
by monitoring the circulation and sensation
to the toes.
Unless the correctly measured size is
available, together with an applicator, it is
better not to use a tubular support
bandage. If not positioned correctly it may
cause further harm. Using an elastic crêpe
support bandage is best. A sport support
should not be used as it will not provide
sufficient compression.
Application of compression bandaging to
wrist and ankle are demonstrated in the
video.
SPINAL INJURY
Injuries involving the spine are serious.
When a spinal injury occurs on board it is
both time and labour intensive to deal
with. Management of a suspected spinal
casualty should never be rushed.
Causes
The most important indicator of spinal
injury is what is known as the mechanism
of injury i.e. how it occurred. For example
a blow to the top of the head may result in
injury to the cervical spine. If a casualty has
fallen from a height a spinal injury should
always be suspected. Injury may be
caused by abnormal force on the back or
neck or violent twisting and bending. The
most vulnerable areas are the neck (cervical
spine) and lower back (lumbar spine).
Spinal injuries may involve bones, discs,
muscles and ligaments. They are most
serious when damage is done to the
spinal cord and nerves, the pathway for
messages between the brain and the rest
of the body. If the cord is severed the
result will be paralysis or even death.
Damage may be temporary or permanent.
A neck injury can result in a casualty not
being able to breathe.
Recognition
Signs and symptoms will vary but injury to
the spine may be indicated if any of the
following are present:
★ pain either at the spine or
elsewhere
★ tenderness and bruising over the
spine
★ the casualty is lying at an odd angle
★ there is weakness or loss of control
of movement
★ there is burning, tingling or
heaviness anywhere
★ loss of sensation
★ difficulty breathing
FIRST AID SERIES » PART 2: MEDICAL FIRST AID
★ loss of bladder or bowel control
(incontinence)
★ continuous spontaneous erection in
the male
Management
Ensure there is no danger when
approaching the casualty – for example, if
they have fallen there may be other falling
debris. Assess the response of the casualty
and their airway and breathing. Remember
if they are talking they are breathing.
It is vital to tell the casualty not to move at
all. The alarm should be raised. Only if the
casualty is in immediate danger should
they be moved at this stage.
While waiting for help to arrive the first aider
should keep the casualty still by holding
the head in a neutral position. Breathing
and level of consciousness should be
checked and obvious injuries noted.
If the casualty is unconscious and help
has not arrived the first aider’s priority is
the airway. The casualty must be placed in
the recovery position keeping the head
and neck as still as possible.
Once help arrives the full extent of injuries
can be assessed. A casualty who has
fallen will most likely have other injuries
such as fractures or wounds that will need
attention.
The key to managing a spinal casualty is
immobilisation of the spine and
coordinated teamwork. Usually the person
who is holding the head still will control
15
 the situation, but it is important for all
helpers to follow the instructions of the
chosen team leader and not work
independently. The most experienced
person, who will usually be the person in
charge of medical care on board, should
coordinate the management of the
situation as team leader.
The casualty should not be moved until
Radio Medical Advice has been sought.
Immobilising the casualty on a stretcher or
spinal board will need to be done prior to
movement or evacuation. The equipment
used and method of movement should be
agreed with the evacuation rescuers. In
some situations they may prefer the
casualty to be placed on their own spine
board or rescue stretcher.
The video shows a method of moving a
casualty in a log roll to get them onto a
spinal board.
Only someone trained to use a cervical
collar should fit one on to the casualty.
It is important to remember that a collar is
only an aid to keeping the head and neck
immobilised and that a casualty wearing a
collar is still able to move their head.
Immobilisation of the head by the first
aider should still be maintained after a
collar is positioned. Only when the head is
strapped to a spinal board will it be
immobilised.
The casualty needs to be continually
monitored while being prepared for
16 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
evacuation. As well as routine skull during the incident and may swell, or Breathing is noisy, pulse is strong and
observations, any changes to the specific bleeding may occur. The skull may be slow, and if the casualty is conscious they
spinal symptoms the casualty is fractured. The result may be mild will complain of severe headache and
complaining about should be noted. concussion or the serious condition of nausea.
compression. Injuries to the face or neck
Treatment for this serious condition is only
may also be present. Any casualty
available in a hospital so it is vital it is
INJURIES receiving a head injury should always be
recognised early. The first aider will be
treated with caution and monitored closely.
supporting the person in charge of
The first aider will always: Concussion medical care on board by helping to
★ manage the scene in accordance with The symptoms of concussion are monitor the casualty.
DR ABC dizziness, nausea, loss of memory and
The frequency of observations will usually
headache. There may have been a brief
★ manage the injury be every 10 – 15 minutes unless indicated
loss of consciousness. If a casualty
★ treat any shock otherwise on Radio Medical Advice. The
cannot remember whether they were
first aider will:
★ place the casualty in an appropriate knocked out they probably were.
position ★ check pulse strength, regularity and
Concussion is not usually associated with
★ monitor the casualty rate
lasting brain injury and usually lasts only a
★ check breathing rate, depth and
The workbook details the specific short time with full recovery. The casualty
sound
managements required for a number of should always have their breathing, pulse,
types of injury including: level of consciousness and pupil reactions ★ check pupil size and reaction
monitored. If they develop severe ★ check level of consciousness using
★ head injury
headache or vomiting their condition may “AVPU”
★ eye injury have become more serious and urgent
In addition to these observations the
★ chest injury Radio Medical Advice will need to be
person in charge of medical care will be
★ abdominal injury sought.
monitoring other things like blood
★ crush injury Compression pressure.
★ blast injury Compression is a serious, life threatening
Urgent evacuation is required but it should
condition requiring urgent medical
★ impalement be remembered that this casualty may not
attention. It may appear soon after injury
★ amputation survive if there is a delay in evacuation.
or be delayed, so close observation and
monitoring of a casualty with a head injury Fractured Skull
HEAD INJURY is vital. If a casualty has a fractured skull as a
result of a head injury it may be possible
All head injuries are potentially serious and A key feature of compression is
to identify a lump or a soft area on the
may result in impaired consciousness. The deterioration in the level of consciousness.
head when checking for injury. No
brain will have been shaken inside the Pupil size and reactions will be unequal.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID 17
 pressure should be placed on a possible
fracture of the skull.
If the base of the skull is fractured this
cannot be felt or seen. It may result in fluid
leaking from the ear or nose. This fluid
surrounds the brain and is usually crystal
clear. However when passing through
injured tissues contact with blood may
either make it straw coloured or heavily
blood stained. This is evidence of a
serious head injury. The first aider should
place a sterile dressing over the leaking
ear and if the casualty becomes
unconscious they should be placed in the
recovery position with this ear to the
ground.
General Treatment
A head injury casualty should never be laid
flat and, if they become shocked, be
placed in the shock position with legs
raised. Their head and shoulders should
also be raised slightly.
Evidence of cervical spine injury should
always be checked for when a casualty
has received a blow to the head, especially
to the top of the head, when they have
fallen from a height or suffered whiplash.
There may also be other facial injuries to
consider which may affect the airway and
breathing.
EYE INJURY
Causes
Eye injuries may be the result of foreign
18 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
bodies in the eye, chemicals, burns or
direct trauma.
Recognition
There will be a history of injury as well as
evidence. The casualty may be in pain
and complaining of vision loss or
disturbance. There may be redness and
swelling around the eye which may also
be watering copiously. There may be
visible wounds. As well as pain the
casualty may complain their eye feels
gritty and is light sensitive.
Treatment
The casualty will be frightened of being
permanently blind. As well as undertaking
general and specific first aid, the first aider
will always need to reassure the casualty.
On board ship, eye injuries will be
managed initially by the first aider.
Secondary management will then be
undertaken by the person in charge of
medical care on board, who will have had
training in further procedures. Radio
Medical Advice should always be sought
by them.
The video demonstrates the initial first aid
only, which should be commenced
immediately.
The affected eye should be washed out
with eye wash solution or tap water
immediately. Washing should always be
from the centre of the face outwards to
prevent contamination of the other eye or
further injury to other tissue of the face
and neck if a chemical is involved. chest cavity. This is known as a sucking
chest wound. Air can be heard moving
The casualty should be placed in a
through the wound when the casualty
comfortable and safe position to do this.
breathes and bleeding may froth up
This may be sitting and leaning over a
because of the air passing through it.
basin. It is often easier to lay the casualty
Tissue surrounding the wound may have
down to wash out an eye. Lie the casualty
air in it which can be felt when the skin is
on the edge of a table or bed with the
pressed gently. The casualty may have
head tilted over the edge slightly. Place a
difficulty breathing and their skin colour
container below the casualty and wash
may be pale or blue tinged (cyanosed).
the affected eye.
Blood may be coughed up.
Washing should take place for a minimum
General Management
of 20 minutes in a case of a chemical
Position the casualty according to their
splash to the eye or ten minutes in other
injury and level of shock or
cases. The first aider should ensure they
consciousness. The principle is always to
do not touch the eye or skin where a
place the casualty leaning towards the
chemical is present.
side of injury. This enables the unaffected
The aim is to get the casualty to open lung to expand more easily and aids
their eye if possible to ensure washing of breathing. It also limits the effect of
the eye itself takes place and not just the bleeding into the good side of the chest
external eyelids. A casualty in pain will be cavity.
reluctant to do this. After washing has
Monitor observations closely and treat for
taken place an eye pad should be placed
shock. The shock position should be
over the injured eye only.
modified. Once the casualty has been laid
flat and their legs raised, their head and
CHEST INJURY shoulders should be raised slightly and
they should be rotated towards the injured
An injury to the chest may be open or
side.
closed.
Open Chest Injury Management
Recognition
Air entering the chest cavity through a
There will be a history of trauma with
wound will collapse the lung. To try and
evidence of injury. The nature of this will
limit this, the wound should be sealed to
depend on the extent of the injury.
prevent air entry. Initially the casualty or
Evidence may be redness or bruising on
rescuer should place their hand over the
the chest. There may be a superficial
wound. The next step is to provide a
wound or a deep wound leading into the
FIRST AID SERIES » PART 2: MEDICAL FIRST AID 19
 wound cover that lets air out but not in to
the cavity, thus creating a one way valve.
This can be done by placing a covering
over the wound that won’t stick. The
plastic wrappings on first aid dressings
are ideal for this. The dressing should then
be sealed on three sides only leaving the
bottom edge open. As the casualty
breathes in, the dressing is drawn into the
wound preventing air entering the chest
cavity. On breathing out air in the cavity
can escape from the bottom of the
dressing. This is a temporary measure
only to help prevent the situation from
worsening and urgent Radio Medical
Advice will be required.
ABDOMINAL INJURY
An injury to the abdomen may be open or
closed.
Recognition
There will be a history of trauma with
evidence of injury. The nature of this will
depend on the extent of the injury.
Evidence may be visible redness or
bruising. There may be a superficial
wound or a deep wound where bowel
may be exposed or protruding.
General Management
Position the casualty according to their
injury. If they are conscious but not
shocked this should be sitting up,
propped up from behind, with knees bent
and slightly pulled up towards the chest.
This is sometimes called the “W” position
20 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
because of the shape the casualty makes.
The purpose is to relieve the tension on
the abdominal muscles and make the
casualty more comfortable.
Monitor observations closely. Even when
the injury to the abdomen seems slight
there may be internal injuries which
manifest themselves as shock (see
‘Internal Bleeding’ in Part 1). If in shock,
place the casualty in the standard shock
position (see ‘Shock’ in Part 1).
Open Abdominal Injury Management
If bowel tissue can be seen, whether just
visible in a wound or actually protruding,
no attempt should be made to handle it
and no pressure placed on it as this could
cause further damage. The aim is to cover
the bowel and protect it from infection and
also prevent it from drying out. A sterile
dressing or clean fabric should be soaked
in warm water or eye wash solution and
placed over the bowel. It should then be
covered in plastic to prevent it drying out.
Cling film is useful for this. The dressing
should be held in place lightly with no
pressure being exerted on the bowel.
If a casualty with visible bowel goes
unconscious, care must be taken when
placing them in the recovery position, so
that no pressure is placed on the bowel
by them lying on it.
If a wound is present without evidence of
bowel involvement, a standard firm
dressing may be applied.
CRUSH INJURY
Crushing may result in:
★ internal bleeding
★ external bleeding
★ fractures
★ impaired circulation
★ serious complications
General Management
A golden rule when managing a crush
injury is to consider the length of time the
casualty has been trapped. If this has been
longer than 15 minutes (or is assumed to
be) no attempt to release the casualty
should be made. They should be treated
where they are found if this is possible.
Urgent Radio Medical Advice should be
sought before the casualty is released.
There may be rapid life threatening shock
on release because of leaking fluid in
tissue. Crush syndrome may occur where
a build up of toxins in the damaged
muscles has occurred. When being
released into the circulation it may cause
kidney failure.
If the time limit of 15 minutes has not been
reached, and it is possible to do so, the
casualty may be released. It should be
noted though that by the time the help
arrives, possibly with lifting gear, the 15
minutes deadline may have passed.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID
BLAST INJURY
Although a rare occurrence on board, it is
important to understand some basics
when dealing with a casualty who has
been involved in a blast.
External injuries will be obvious and will
need to be treated. There may however
be less obvious affects of the blast or
there maybe no outward sign of injury at
all. For example:
★ explosion and distance from a blast
may cause a unique pattern of injuries
★ explosion in confined spaces is linked
to greater mortality
★ the casualty may be deafened so
communication is an issue
★ 10% of blast casualties have
significant eye injuries that may only
show with days, weeks or even
months delay
★ recognition of injury can be delayed.
Lung injury has been noted as late as
48 hours after a blast
IMPALEMENT
No attempt should ever be made to free a
casualty. Their body weight should be
supported if needed, to prevent further
harm and for casualty comfort. Bleeding
around the impaling object should be
controlled by applying pressure at the
base of the object (see External Bleeding
in Part 1).
21
 AMPUTATION
When an amputation has happened the
rescuer must manage the casualty and
the amputated body part.
Bleeding may not always be as severe as
expected if blood vessels have been
sealed off during the amputation and it
should be managed as for any external
bleeding (see External Bleeding in Part 1).
Management of the Severed Body Part
Do not wash or clean the body part but
wrap it in plastic, then padding, and then
place in ice. Never allow the ice to be in
direct contact with the tissue.
The body part should be labelled and
always evacuated with the casualty. The
time the amputation occurred should be
noted.
MEDICAL
EMERGENCIES
The first aider will always:
★ manage the scene in accordance with
DR ABC
★ manage the illness
★ treat any shock
★ place the casualty in an appropriate
position
★ monitor the casualty
The workbook details the specific
22 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
managements required for a number of
medical emergencies including:
★ chest pain
★ diabetes - hypoglycaemia
★ asthma attack
★ seizures
★ poisoning
CHEST PAIN
Cause
When the blood vessels supplying blood
to the heart become narrowed or blocked
the supply of oxygen to the heart muscle
is affected, this results in pain.
If oxygen supplies are restricted by a
partial blockage the resulting pain is
known as angina. If the blockage is
complete the heart muscle dies causing
pain. This is a heart attack (myocardial
infarction).
Recognition
The casualty may have pain in the chest,
radiating to the left arm, jaw, upper
abdomen or back. They may be having
difficulty breathing, be sweating and
looking pale. Nausea or vomiting may also
be present.
Management
Chest pain is always a medical emergency
requiring urgent Radio Medical Advice and
evacuation of the casualty. The first aider
should not try to identify whether the
chest pain is caused by angina or a heart
attack. They should raise the alarm
immediately and always be prepared to
resuscitate if required (see Resuscitation
in Part 1).
Position the casualty sitting up and
supported. Loosen clothing at neck and
waist to aid breathing. Monitor breathing
and pulse closely. If the pain goes when
the casualty is resting it is most likely it
was caused by angina.
When the person responsible for medical
care on board arrives they will give
medication to the casualty. The casualty
will be given Glycerin Trinitrate as a spray
under the tongue. This dilates narrowed
arteries in the heart increasing blood flow
and if the cause is angina the pain may
subside.
If the pain persists it may indicate a heart
attack. Check that the casualty is not
asthmatic or allergic to aspirin then tell
them to crush one tablet in the mouth and
hold it in the mouth under the tongue.
This will allow the aspirin to be absorbed
quickly into the blood stream for rapid
action. It must not be swallowed. The
casualty should be told that the aspirin is
given to reduce blood clotting, not to
reduce pain.
Urgent Radio Medical Advice must be
sought and the casualty will be given an
injection of morphine for the pain and an
anti-sickness injection. Urgent evacuation
is required. The casualty should not be left
alone and should be monitored closely.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID
DIABETES
In diabetes the body is unable to control
its sugar levels because of a complete
lack of, or insufficient insulin being
produced. There are two types of
diabetes: Type 2 can usually be controlled
by medication and diet, while a person
with Type 1 is insulin dependent.
A medical emergency may arise in
diabetics when their blood sugar levels fall
too low. This is known as a “hypo” and is
an abbreviation for hypoglycaemia, which
means low blood sugar. This can happen
very quickly and the first aider needs to
recognise it and manage it before the
casualty becomes unconscious.
This fall in blood sugar may also happen
in non-diabetics, for example after a
seizure or as a result of excessive alcohol
consumption or withdrawal from alcohol.
Recognition
The behaviour of the casualty changes
and may become erratic. Speech may be
incoherent and level of consciousness
impaired. This behaviour change is often
mistaken for drunkenness. Sweating may
be apparent.
Management
The treatment is to get sugar into the
casualty quickly. If this is not done they will
lose consciousness and become more
difficult to treat. Give the casualty a
sweetened milky drink, a chocolate bar,
sweet biscuits or even sugar lumps to eat.
23
 If the casualty has become too drowsy to
swallow safely, smear jam or honey
around their gums and inside their cheeks.
The sugar will be absorbed into the blood
stream through the tissues in the mouth.
Once consciousness returns the casualty
should have something to eat.
If a hypo is not recognised the casualty
will become unconscious. They should be
placed in the recovery position and urgent
Radio Medical Advice must be sought.
The gums and inside of the cheeks should
be smeared with honey or jam.
ASTHMA
Asthma is a common condition affecting
breathing. In an asthma attack the small
tubes in the lungs constrict and become
inflamed, so that air cannot move freely
through them. An attack may be triggered
by a number of things including stress,
pollen, smoke, perfumes, animals,
temperature extremes, pollution, dust
mites, chest infections and some
medicines. Having mild asthma does not
normally prevent someone from serving at
sea.
Recognition
Wheezing can be heard as the casualty
breathes out. An asthma attack is very
frightening for the casualty who is unable
to breathe freely and may be unable to
speak.
They may be pale or have a blue tinge to
24 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
the skin and become increasingly
exhausted and distressed with the effort
of breathing.
Management
When treating the casualty it is important
to reassure and calm them. Allow them to
sit in the position which is most
comfortable for them. This will be sitting
upright or possibly sitting up and leaning
forward. This upright position aids
breathing. Never lay the casualty down
flat.
If a known trigger is present remove it and
ventilate the area thoroughly. Do not
crowd or hug the casualty.
The casualty may have medication with
them and they will need to take it. This
medication will be in an inhaler and is
known as a reliever as it relieves the
symptoms of the attack. Help the casualty
take one or two puffs of their medication.
It is important to raise the alarm at the
start of the attack so the person in charge
of medical care on board can attend with
medication from the medical locker if the
casualty does not have their own. They
can also give oxygen. Only someone who
is trained to use medical oxygen should
give it to the casualty. Radio Medical
Advice should always be sought.
A casualty suffering from smoke inhalation
will have the same symptoms and may be
treated in the same way as a casualty
having an asthma attack.
SEIZURES
Seizures are also known as fits or
convulsions. They are involuntary
contraction of the muscles due to a
disturbance in the electrical activity in the
brain.
Cause
While a person known to have seizures
will not be employed at sea, a seizure can
happen to anyone at any time. Possible
causes include head injury, stroke,
epilepsy, poisoning, alcohol (too much or
withdrawal from), lack of oxygen, low
blood sugar, infection and high
temperature.
Management
Protect the casualty from dangers while
they are having a seizure but never
restrain them or attempt to put anything in
the mouth. Note the duration of the fit and
whether it has involved the whole or only
part of the body.
Once the seizure has stopped and if the
casualty remains unconscious, place them
in the recovery position and monitor their
breathing and pulse. After recovery from a
fit the casualty will feel exhausted and may
wish to sleep.
POISONING
A poison is any substance that, if taken
into the body in sufficient quantity, may
cause temporary or permanent damage
to health, or in some cases, death.
FIRST AID SERIES » PART 2: MEDICAL FIRST AID
Poisoning may occur intentionally or
accidentally.
Poisons enter the body in a number of
ways. They may be ingested (taken in
through the mouth), inhaled (breathed in),
injected in (through bites and stings) or
absorbed through the skin. Once in the
body they will enter the bloodstream and
be distributed around the body.
Recognition
The signs and symptoms of poisoning are
variable. It is important to recognise
possible signs of poisoning so the first
aider does not place themselves in danger.
The level of consciousness may be altered.
Seizures may happen. There may be
breathing difficulties or sudden vomiting.
There may be visible evidence such as
skin burns. There may be visual clues
such as chemicals present in the area.
The job the casualty was doing at the time
of becoming ill or where they were actually
working on board ship could give clues as
to what poisoning has occurred.
Management
The International Maritime Dangerous
Goods Code gives specific advice on
managing poisoning with regard to
antidotes and treatment. These are
detailed in the Code Supplement which
contains a Medical First Aid Guide specific
for dealing with dangerous cargoes. This
treatment will be managed by the person
in charge of medical care on board and
Radio Medical Advice will always be sought.
25
 The first aider will:
★ manage the casualty in accordance
with DR ABC – danger, response,
airway, breathing and circulation
★ position the casualty according to
their condition and monitor their
pulse, breathing and level of
consciousness
★ try to find out what the casualty has
been exposed to and when, and the
extent of exposure
SPECIFIC POISONS
MANAGEMENT
Swallowed poison
If the substance swallowed was corrosive
there may be evidence of burns around
the mouth. It is important not to make the
casualty vomit. This would cause further
tissue damage as well as compromise the
airway. The initial first aid after checking
the ABC is to dilute the swallowed
chemical. Give the casualty sips of milk or
water slowly but stop if they feel
nauseated.
Skin Contamination
Wash the contaminant off the skin using
water, ensuring that further skin does not
become affected. Remove contaminated
clothing. When doing this the first aider
should take care that they do not come in
contact with the contaminant. An eye wash
bottle can be used to start the washing
process if there is no water present.
26 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
Inhaled Poison
Monitor the airway and breathing closely. TREATMENT CONSIDERATIONS FOR BITES AND STINGS
The casualty may be coughing, wheezing
and have streaming eyes and nose. Place
Sign or symptom Detail
the casualty in a position that will aid their
breathing. If they are conscious this will be
Insect sting Scrape sting off sideways – the non cutting side of a knife
sitting upright possible leaning slightly blade is useful for this.
forward. Loosen tight clothing at the neck
Don’t use tweezers it increases the chance of venom getting
and waist that may restrict breathing. Do
into the blood stream.
not allow the casualty to rub their eyes.
Reduce pain and swelling with an ice pack. If in the mouth
Mouth to mouth ventilation should not be
suck an ice cube or ice lolly.
done during any resuscitation attempt if
inhalation of a poison is suspected, or
Snake bite Keep the casualty still and immobilise the limb and keep it
there is evidence of corrosion burns on
lower than the heart. DO NOT ELEVATE IT. Place a
the face. compression bandage above the bite. These actions slow
Bites and Stings down the circulation of the poison around the body.
These may be caused by a variety of Being able to describe the snake will aid medical treatment,
creatures marine or otherwise. as the appropriate anti-venom can be used.
Recognition will depend on the cause.
There may be a local reaction with pain Sea creatures
and swelling or a systemic reaction e.g. eg coral, jelly fish, As for snake bites
extreme allergic response (anaphylaxis). anemones
See table opposite for summary of the
specific treatment considerations for Tropical jelly fish Wash with vinegar or sea water. Immobilise the limb. Place a
different types of bites and stings. compression bandage above the sting.
Marine puncture
ENVIRONMENTAL wound Immerse in hot water for 30 minutes. Do not bandage the
wound.
e.g. weever fish,
CONDITIONS sea urchin
Being on board ship can expose workers Animal bite Bleeding control. Radio Medical Advice if rabies is a
to many different environmental possibility.
conditions. There can be extreme cold,
heat or humidity. Extremes of body
FIRST AID SERIES » PART 2: MEDICAL FIRST AID 27
 temperature can be life threatening.
The first aider will always:
★ manage the scene in accordance with
DR ABC
★ manage the condition
★ treat any shock
★ place the casualty in an appropriate
position
★ monitor the casualty
This workbook details the specific
management required for a number of
environmental emergencies including:
★ hypothermia
★ heat exhaustion
★ heat stroke
HYPOTHERMIA
Hypothermia is when the core body
temperature is 35º C or lower.
It can happen after exposure to a cold
environment or immersion in cold water. It
may also happen as the result of the effect
of drugs and alcohol, poor nutrition and
some medical conditions.
Recognition
In the early stages the casualty will be
shivering. This sign disappears as the
body temperature falls. The casualty feels
cold and miserable, and their skin is pale
and cold to touch. Muscle coordination is
poor and speech becomes slurred.
Behaviour becomes more irrational and
28 FIRST AID SERIES » PART 2: MEDICAL FIRST AID
confused. Pulse and breathing slow
down. As the body temperature continues
to fall the casualty will become
unconscious, and pulse and breathing
may not appear to be present. If left
unrecognised the casualty will die.
Management
Removal from the cold environment is
essential. Re-warming is a slow, passive
process. If the casualty is conscious they
may be put in a bath of warm water kept
at 40º C. If placed in a shower they should
always be sitting on the floor supported and
never standing. Warm drinks may be given.
If the casualty is unconscious they should
be placed in the recovery position and
kept warm with blankets. Heat will be lost
from the body through the surface the
casualty is lying on, so it is important to
put insulation beneath them as well as
cover them with blankets and also ensure
extremities are covered.
The heart when cold is susceptible to
develop an irregular heart beat which may
lead to cardiac arrest. It is important that
the casualty is handled as carefully as
possible – careless handling may lead to
fibrillation and cardiac arrest.
Immersion Hypothermia
On rescue from the water the treatment of
immersion hypothermia is the same as for
non immersion hypothermia. To prevent a
fatal sudden lowering of the blood
pressure the casualty should be rescued
horizontally from the water.
While in the water the casualty may have
inhaled water and it is important to
monitor them for evidence of secondary
drowning for up to 3 days after the
incident. It may be as much as 5 days
before secondary drowning becomes
evident. The casualty will be coughing up
copious amounts of pink tinged watery
sputum. This is a serious condition
requiring urgent hospital care.
HEAT EXHAUSTION
Heat exhaustion is a loss of salt and fluid
from the body which results in the
collapse of the circulation. It is caused by
excessive fluid loss. Although it may be
through severe diarrhoea and vomiting,
the primary cause is excessive sweating.
It is seen in those working in hot and
humid climates especially when they are
unaccustomed to the environment.
Recognition
Importantly the casualty does not look or
feel hot. Their temperature is not raised
and skin is pale. They look shocked. The
casualty may feel exhausted but restless,
feel faint and dizzy, and may have a
headache and muscle cramps. Breathing
will be fast and shallow and the pulse fast
and weak.
Thirst is a late symptom of the
dehydration and may not be present
initially.
Management
FIRST AID SERIES » PART 2: MEDICAL FIRST AID
Lay the casualty down in a cool place and
elevate their legs. If they are conscious
and able to protect their airway, drinks
should be given to replace lost fluid.
Drinks should not be gulped down as this
may lead to vomiting. The casualty should
never be given salt as it will induce
vomiting. Water, fruit juice soft drinks, and
isotonic drinks are suitable, but fizzy soda
drinks should be avoided.
Although the casualty may appear to have
recovered it is important that Radio
Medical Advice is sought and that the
casualty does not return to work for at
least 24 hours.
HEAT STROKE
Heat stroke occurs when the body loses
its ability to control high temperature by
sweating. Its “thermostat” is broken and
the core body temperature is 40ºC or
greater. It may occur quite quickly and is a
life threatening condition requiring urgent
medical advice and treatment.
The causes vary but it can follow on from
heatstroke, when there is a feverish
illness, or may be caused by some
medications. It is often seen when the
environmental conditions are hot and
humid. The humidity prevents adequate
sweating and cooling.
Recognition
The casualty looks and feels hot. They are
red but usually the skin is dry to touch.
29
 Other signs and symptoms are headache, moisture on the sheet evaporate and in so
dizziness and restlessness. The pulse is doing cools the casualty – it mimics the
full and bounding and breathing is noisy. effect of sweating. Cooling is maintained
until the core body temperature is 38º. Ice
The condition can develop and progress
should never be used to aid cooling as
very quickly with the casualty soon
this may cause tissue damage and cold
becoming unconscious. Death will happen
burns.
if the condition is not recognised and
treated quickly. If the casualty is alert enough and able to
take oral fluids they should be given cool
Management
water to drink, but slowly so as not to
This life threatening condition will require
cause vomiting. Fluid replacement in an
urgent Radio Medical Advice and the
unconscious casualty, and their longer
person in charge of medical care on board
term management will be carried out by
will manage the casualty.
the person responsible for medical care
The casualty should be moved to a cool on board.
environment if possible, but if this is not
As well as cooling the casualty, the first
immediately possible, cooling the casualty
aider will be positioning the casualty
should not be delayed. If unconscious
appropriately and making sure the airway
place them in the recovery position.
is maintained. They will be monitoring
Clothing should be removed and cooling
breathing, pulse and consciousness level.
commenced by covering the casualty in a
wet sheet, with fanning if possible. The
heat from the casualty’s body makes the

TEST YOUR KNOWLEDGE

AND UNDERSTANDING BY COMPLETING
THE TEST QUESTIONS FOR PART 2.

30 FIRST AID SERIES » PART 2: MEDICAL FIRST AID FIRST AID SERIES » PART 2: MEDICAL FIRST AID 31

PART 2 - TEST Sitting up and leaning towards the
left
QUESTIONS
5. When applying a dressing to a
sucking chest wound it should be
1. A sprain is an injury to:
Non stick and sealed with top edge
bone
open
muscle
Non stick and sealed with bottom
tendon
edge open
ligament
Dressing pad secured on all sides
Dressing pad secured with bottom
2. When a casualty has a dislocated
edge open
shoulder you must:
Attempt to get the arm back in
6. A casualty has fallen from a height
position and appears to be unconscious.
Bend the arm and place it in an What would you do first ?
elevation sling
Check their breathing
Bend the arm and place it in a low
Check their pulse
sling
Place them in the recovery position
Tie the arm to the side of body
Leave them and phone for help
3. Which of the following injuries is
7. When a casualty has a fractured
best treated using an elevation sling?
base of skull they may have:
Fractured collarbone
Blood stained fluid leaking from the
Fractured upper arm
ears only
Dislocated elbow
Blood stained fluid leaking from the
Fractured lower arm
ears or nose
4. How would you position a conscious Blood stained fluid leaking from the
nose only
casualty with a sucking wound on
the left side of their chest? Blood stained fluid leaking from the
mouth only
Sitting up and leaning toward the
right
8. A complicated fracture is one where:
In the recovery position lying on the
There is a wound and bone is visible
right
There is a wound and the bone is
In the recovery position lying on the
protruding
left
There is excessive bleeding from an
open wound
There is damage to underlying tissue
9. In a concussed casualty you will find:
One pupil slower to react to light
than the other
One pupil larger than the other
Neither of the pupils react to light
Both of the pupils react to light
10. In compression the following
observations will be found:
Shallow breathing with strong and
slow pulse
Shallow breathing with strong and
fast pulse
Noisy breathing with strong and
slow pulse
Noisy breathing with strong and fast
pulse
11. A casualty has a chemical splash in
the eye. The action you take will be
to:
Immerse their head in a basin of
warm water
Sit them down and open the eye to
note any damage
Wash the eye out with the casualty
lying down
Place a pad over the eye
12. A casualty has a wood splinter in
their eye. How long do you take to
wash it out?
At least 5 minutes
At least 10 minutes
At least 15 minutes
At least 20 minutes
13. A casualty has an abdominal wound
and bowel can be seen in the wound.
What action would you take?
Place a dry dressing pad firmly over
the wound
Place a non stick dressing firmly
over the wound
Place a damp dressing lightly over
the wound
Place a damp dressing firmly over
the wound
14. If a casualty has been trapped by
crushing of their leg the rescuer
should:
Not release them if trapped for
longer than 10 minutes
Not release them if trapped for
longer than 15 minutes
Only release them after 15 minutes
Only release them after 10 minutes
15. An amputated finger is to be
preserved in ice. Before placing it in
ice you will:
Wash the finger and wrap it in
plastic
Wrap the finger in plastic and then
padding
Wrap the finger in padding
Wrap the finger in padding and then
plastic

32 FIRST AID SERIES » PART 2: MEDICAL FIRST AID FIRST AID SERIES » PART 2: MEDICAL FIRST AID 33
 16. A casualty with chest pain should be: Lie the casualty down and place a 25. A casualty with heat stroke is:
Laid down and have their legs pillow under both knees Red with a strong pulse
elevated Place a pillow between the knees Red with a weak pulse
Placed in the recovery position and tie the knees together Pale with noisy breathing
Sat on the floor with legs out Place a pillow at the side of the Pale with shallow breathing
straight injured knee for support
Sat on the floor with knees bent
21. What position would you place a
17. A hypoglycaemic casualty is: casualty in who is shocked after an
eye injury?
One whose blood pressure is too low
One whose pulse rate is too slow Laid down flat on their back, legs
One whose temperature is too low raised.
One whose blood sugar is too low Laid down flat on their back, legs
raised and head slightly raised
18. A casualty having an asthma attack Sitting upright.
will have: In the recovery position
Pale skin, normal breathing and fast
22. In hypothermia the casualty will be:
pulse
Red skin, fast breathing and slow Pale, sweating with a fast pulse
pulse Red, sweating with a fast pulse
Normal skin, normal breathing and Pale, with a slow pulse
fast pulse Red with a slow pulse
Pale skin, noisy breathing and fast
23. On rescue a hypothermic casualty
pulse
is extremely drowsy. Would you:
19. A casualty has swallowed cleaning Give them hot drinks
fluid. You will: Wrap them in blankets
Give them lots of water to drink Put them in a warm bath
Not let them drink anything at all Get them to walk around
Give them salty water to drink
24. A casualty with heat exhaustion is:
Give them sips of water to drink
Red and breathing slowly
20. A casualty has dislocated their knee Pale and breathing fast
cap and is in shock. Which Pale and breathing slowly
treatment would you choose? Red and breathing fast
Lie the casualty down and raise
their legs to treat the shock

34 FIRST AID SERIES » PART 2: MEDICAL FIRST AID FIRST AID SERIES » PART 2: MEDICAL FIRST AID 35
 PART 2 – TEST
ANSWERS
1. d 22. c

2. d 23. b

3. a 24. b

4. d 25. a

5. b

6. a

7. b

8. d

9. d

10. c

11. c

12. b

13. c

14. b

15. b

16. d

17. d

18. d

19. d

20. d

21. b

36 FIRST AID SERIES » PART 2: MEDICAL FIRST AID

NOTES
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