RAID Diver First Aid - Victim Assessment and

Resuscitation
INTRODUCTION
This section of the course outlines the role of the first aider and the priorities of first aid,
including managing an incident, prioritising treatment, treating breathing and non
breathing unconscious casualties, and carrying out a secondary survey

Objectives
• Understand the role and responsibilities of a
first aider.
• Understand how to assess an incident.
• Be able to treat an
unresponsive casualty
who is breathing
normally.
• Be able to treat an
unresponsive casualty
who is not breathing
normally.
• Understand how to
carry out a secondary
survey.
WHAT IS FIRST AID?
• First aid can be defined as “the first assistance given
• to a victim, or group of victims, for an injury or sudden illness, until professional help arrives”.
• It’s important to remember we are just “holding the fort” until the emergency services arrive to take
over. We must stay within the skills we have learned on our course.

Aims of first aid?

Preserve Life
• By giving CPR, managing catastrophic bleeding, etc.

Prevent the condition getting worse

• By dressing wounds, stabilising fractures, etc.

P – Promote recovery
• By positioning the victim, reassuring them, calling emergency services, etc.
THE ROLE OF THE FIRST AIDER?

As a first aider we need to take a calm approach to dealing with any

situation. We need to approach any first aid situation by completing
the following steps:

•Assessing the situation

•Making the area safe
•getting help
•Diagnosing and prioritising treatment
•Lower the risk of infection.
•Reporting and restocking
PRIORITIES OF TREATMENT

We need oxygen to survive. Most importantly, the brain

needs oxygen, and if starved of it, it will start to die
within minutes. Simply put, air goes in and out, blood
goes around and around – anything that detracts from
that is life threatening and needs to be dealt with as a
priority.
  Make sure that you, the victim and any bystanders are safe.
Remove any danger or remove the victim from the danger.
D
Danger
Check the victim to see if they are responsive. Shake and shout.
If the victim is unresponsive, shout for help.
R If the victim responds in any way, move onto a secondary survey (More about this later).
Response
Identify and treat any problems with the airway. This could be caused by any swelling, narrowing or blockage:
• The tongue • Strangulation
A • Vomit • Hanging
Airways • Choking • Anaphylaxis
• Water • Burns to the throat

Identify and treat any life threatening problems leading to the victim not breathing effectively. This could be
caused by:
• Asthma • Poisoning
B • Crushed or injured chest • Anaphylaxis
• Collapsed lung • Cardiac arrest
Breathing If the victim is not breathing effectively, summon emergency medical services, request an AED and start CPR.

Identify and treat any life threatening circulation problems potentially leading to the victim becoming
unconscious and not breathing effectively. This could be caused by:
C • Heart failure • Anaphylaxis
• Heart attack • Cardiac arrest
Circulation If the victim is clear of any airway, breathing or circulation problems, move onto a secondary survey (more
about this later)
The Unconscious Victim
Earlier we said air goes in and out, blood goes around and around.
Humans need oxygen to live, so to maintain the supply of oxygen, the
person has to be breathing effectively and the heart must be beating
correctly. Without oxygen the brain will start to die quickly.

Victim in VF and shocked within 3 minutes;

74% Survived
26% Die
THE CHAIN OF SURVIVAL
As we can see from the data above, time is crucial in saving someone’s life. Because of this, it is important that as
soon as we come across a victim who isn’t breathing, we start an important sequence of events called The Chain Of
Survival

EARLY RECOGNITION AND CALL FOR HELP

•Brain cells will start to die within 3-4 minutes of the body being starved of oxygen through breathing or circulation
problems. The sooner we can call for help, the sooner we can get an AED to the victim and the sooner we can get
them to hospital where more advanced treatment can be given. We don’t have to wait until the victim has become
unconscious, if we recognise that the victim
•is potentially suffering from a life threatening condition, then we should seek help as soon as possible.
•Early CPR
•If the heart is not pumping blood effectively, we need to take over that role. Chest compressions pump the blood
around the body and rescue breaths put oxygen into the blood. If the heart has been kept oxygenated, there is
more chance of it being restarted through defibrillation. “A blue heart is hard to start!”
•Early defibrillation
•We have already seen that the sooner we shock the heart, the greater the chance of survival. It is said that for every
minute we delay defibrillating the heart, the chance of survival reduces by up to 10%.
•Post-resuscitation care
•Getting the victim to hospital quickly is important so the causes of the cardiac arrest can be dealt with, and the long
term negative effects of the arrest can be reduced.
PRIMARY SURVEY & RESUSCITATION
Danger
• Check for any dangers to yourself,bystanders and the victim.
• Do not proceed until the dangers are eliminated.
Response
• Gently shake the victim’s shoulders and shout “ARE YOU OK?”
• If they respond, keep them still and carry out a secondary survey, calling for help if required.
• If the victim does not respond, shout for “HELP”.
Airway
• Turn the victim onto their back if necessary.
• Placing one hand on the forehead and the fingertips of the other hand under the chin, tilt
the head back to open the airway.
Breathing
• Check to see if the victim is breathing normally for up to 10 seconds by;
( look, listen, and feel)
• If the victim is breathing effectively, carry out a secondary survey (more about this later),
then place the victim into the recovery position. This position may need to be adapted if the
victim is in a restricted space or on a boat, but ultimately we need to get the victim’s airway
clear and open, with the mouth pointing down so if they vomit, it will run free.
Circulation
• Start CPR. Ensure the victim is on a hard surface like the floor, kneel alongside the
victim, and place the heel of interlocked hands in the centre of the chest. Keeping
the arms straight with your shoulders above your hands, give 30 compressions to a
depth of
• 5-6cm (approximately a third of the depth of the chest), at a rate of 100-120 per
minute (around two per second).
• After the compressions give 2 rescue breaths. Pinch the soft part of the victim’s
nose, take a normal breath and make a seal around the victim’s mouth with yours.
Blow steadily whilst watching to make sure the chest is rising. Take your mouth
away to allow the victim’s chest to fall and then repeat.
• After the rescue breaths, quickly return your hands to the victim’s chest and
continue chest compressions and rescue breaths at a ratio of 30:2.

CPR should be continued until:

• Told to stop by the emergency services
• You become exhausted
• The victim is definitely waking up, moving, opening their eyes and breathing
normally.
• If there is more than one person who knows how to give CPR you should swap
approximately every two minutes to prevent fatigue. This can be done whilst the AED is
analysing the heart rhythm, which takes place every two minutes. Fatigue can lead to a
deterioration in technique.
• In the likely event of the victim vomiting, you will hear the vomit gurgling in the airway as
you give rescue breaths. It is important that you clear the airway by turning the victim onto
their side, letting the vomit drain out. When the airway is clear, roll the victim back onto
their back, wipe the mouth and if there are still no signs of life, re- commence CPR.
• If you are unable to give the victim rescue breaths due to facial injuries, chemical burns, etc,
or if you do not feel willing to give rescue breaths, then the next best thing is hands-only
CPR.
• Although not as effective as CPR with rescue breaths, this is the next best thing and will
have some effectiveness. Give continuous compressions as before, but do not stop after 30,
just keep going.
• We can improve the hygiene of giving rescue breaths by using a barrier such as a face shield
or a pocket mask.
• Whether giving rescue breaths, securing a barrier, or dealing with vomit, the rescuer should
try to reduce the time delay between compressions to no more than 10 seconds.
 AUTOMATED EXTERNAL
DEFIBRILLATION
When a heart goes into cardiac arrest, the normal electrical impulses
are interrupted. This makes the heart quiver rather than pump
normally. This irregular rhythm is called Ventricular Fibrillation (VF) and
can be seen in the diagram below.
NORMAL RHYTHM

VENTRIKULAR VIBRILATION

The way to treat a heart in VF is to give it a controlled electric shock, which stops the
heart in the hope that it will restart in a normal rhythm. We should remember that it
may take a number of shocks to work. Ventricular Fibrillation is the only rhythm which is
shockable with an Automated External Defibrillator (AED).
Locating an AED
• It’s of paramount importance that we can gain the use of an AED quickly. AEDs are
becoming more common now. Some examples of where AEDs are commonly
available include leisure centres, supermarkets, shopping centres, marinas,
liveaboards and schools.
• Public Access AEDs are becoming more common in villages and towns, especially
where emergency medical services are not stationed nearby. Emergency Services
will direct you to these, and tell you how to access them.
• AEDs are normally identified by an electric shock within a heart, as seen in the
diagrams below.

USING AN AED
• Earlier we described how to give CPR. We also stressed the importance of asking
bystanders to go and find an AED.
When the AED arrives;
• If there is a bystander ask them to give CPR while
• you get the AED ready. If they are unsure how to do this, you could ask them to give
compression only resuscitation.
• Switch on the AED immediately and follow the voice prompts.
• Attach the AED leads (if required) and attach the pads to the victim’s bare chest, as
shown in the diagram on the pads, by pealing the backing off the pads one at a time and
pressing firmly into position. If the person is wet you may need to dry their chest. If the
person is excessively hairy you may need to shave the person’s chest. There may be a
towel and razor in the AED case.
• If a towel or razor is not available, do not delay defibrillation.
• Place one pad below the victim’s right collarbone and one around the victim’s left side,
over the lower ribs. If you place them the wrong way round don’t worry, leave the pads
in place, they will still work.
Whilst the AED analyses the victim’s heart rhythm, stop performing CPR and tell all other bystanders and rescuers to When the AED arrives;
• If there is a bystander ask them to give CPR while
• you get the AED ready. If they are unsure how to do this, you could ask them to give compression only resuscitation.
• Switch on the AED immediately and follow the voice prompts.
• Attach the AED leads (if required) and attach the pads to the victim’s bare chest, as shown in the diagram on the pads, by pealing the backing
off the pads one at a time and pressing firmly into position. If the person is wet you may need to dry their chest. If the person is excessively
hairy you may need to shave the person’s chest. There may be a towel and razor in the AED case.
• If a towel or razor is not available, do not delay defibrillation.
• Place one pad below the victim’s right collarbone and one around the victim’s left side, over the lower ribs. If you place them the wrong way
round don’t worry, leave the pads in place, they will still work.
• Whilst the AED analyses the victim’s heart rhythm, stop performing CPR and tell all other bystanders and rescuers to “STAND CLEAR”. Look up
and down the victim to check no one is in contact with the victim.
• If the AED advises a shock, state “SHOCKING, STAND CLEAR”, then carry out a further visual check of the whole victim to ensure no one is in
contact with them. If the victim is clear, press the shock button.
• Once the shock has been administered, if the victim is showing no signs of life, immediately start CPR as outlined earlier.
• Continue to follow the verbal prompts given by the AED.
• If a shock is not advised, quickly establish if the victim has started to breathe and respond to the shocks. If there is no change in the condition,
immediately start CPR as outlined earlier, and continue to follow the verbal prompts given by the AED.
• If the victim has started to recover, place into the recovery position.
• Following a resuscitation attempt, it will be useful to inform the emergency services of how many shocks the victim has received. In addition,
if the AED is equipped to do so, you should give the emergency services a download of the AED rescue data.
Secondary Survey
• The Primary survey was carried out to establish if the victim is suffering from any
immediate life threatening conditions. As we have already discussed, once it is established
that the victim is breathing, a secondary survey is carried out prior to the victim being
placed into the recovery position. The secondary survey is used to establish if the victim
has any further injuries or illnesses. A secondary survey can be carried out on either a
conscious or unconscious victim.
• Consent should always be gained from the victim prior to helping them. If the victim is
unconscious, implied consent is given, as it is assumed that an unconscious victim would
want you to help them. If the victim tells you they do not want your help you cannot force
it upon them. If you still feel they need assistance, contact the emergency services and
explain the situation.
• A secondary survey is carried out by collecting various information from the environment,
the victim and from bystanders. The more information that can be collected, the more
accurate the diagnosis may be. Remember that the best assessment is a reassessment!
• Carrying out regular checks of the victim, especially breathing, pulse and responsiveness
checks can indicate if a victim is improving or deteriorating.
History
• What has happened? – Establish what has happened by checking the surroundings as well as
asking the victim and bystanders. The environment can give the mechanism of injury, for
example, if you see a victim at the bottom of an upturned ladder, it might indicate a head injury,
fractures, spinal injury, and internal bleeding. What forces have been involved in the accident?
• Illness assessment can be assessed by checking AMPLE:
• Allergies – Does the victim have any known allergies or intolerances?
• Medication – What medication does the victim take? Has the victim taken their medication? Has
the victim taken any non- prescription medication or drugs?
• Past medical history – Does the victim suffer from any medical conditions?
• Last consumption – When did the victim last eat or drink and what did they have?
• Events leading up to the illness – Has anything happened that could have led to the victim being
ill, for
• example over-exerted? Has the victim previously been ill? If the illness has followed a dive or
dives, what was the previous dive
• profile/s?
Signs
• Carry out a Top to Toe survey.
• Head and neck - Do you suspect a spinal injury? Check the victim’s head and face for
bruising, swelling, deformity or discharge. Check the victim’s eyes to see if the pupils are
equal and responsive to light. Check the victim’s pulse and breathing
• rate.
• Shoulders and chest – Feel around both shoulders for signs of fracture. Ask the victim to
take a deep breath and look for signs of equal breathing on both signs as well as pain. Look
for stab
• wounds.
• Abdomen – Check the abdomen for pain when you press. Is the stomach stiff and distended
which could indicate internal bleeding? Are there signs of bleeding or incontinence?
• Legs and arms – Check the limbs for signs of fractures or wounds. Ask the victim to move
the limbs through the normal range of movement.
• Back and spine – Check the back and spine for puncture wounds or any obvious fractures.
• Clues – Look for clues such as medical alert necklaces or
Symptoms
• This is what the victim feels, and can obviously only be established with a conscious victim.
• Does the victim feel nauseous, dizzy, hot, cold, scared, etc?
• If the victim is experiencing pain, establish where the pain is. What does the pain feel like? How severe is it?
Does anything make the pain better or worse?

Speed of onset of the symptoms

• How quickly have the symptoms come on? Generally, the faster the symptoms have come on, the more life
threatening the condition.

Levels of response
• Measure the victim’s response levels using the AVPU scale.
• Alert – The victim is fully alert and responsive.
• Voice – How responsive is the victim to your voice?
• Confused – The victim is not orientated, but asks and responds to questions.
• Inappropriate words – Although the victim can speak, they struggle to form sentences, using wrong words.
• Utters sounds – The victim can’t speak and can only utter sounds.
• No verbal response – The victim is making no noise.
• Pain – The victim only responds to pain
• Localises pain – The victim responds to pain and recoils from pain stimuli, such as pulling away their hand when a pen is
pressed into the back of the finger nail.
• Responds to (but does not localise pain) – The victim’s face shows response to the pain but it is not localised.
• Unresponsive – The victim is fully unconscious and unresponsive.