FIRSTAID &CPR
REFERENCEMANUAL
Inatructor’s Manual
SECONDEDITION2014
CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
CHAPTER 1
Introduction to
First Aid
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
The Need for First Aid Training
Emergencies are unexpected occurrences that may lead
to sudden death and incapacitating injuries, especially if
timely help is not readily available. Emergencies can be
due to accidents, sudden illnesses, natural and humaninduced disasters and situations of armed conflicts and
violence. Statistics show that accidents ranked fourth as
the cause of death for all ages in 2006. For children of
ages 5 to 14 years, accidents topped the list as the
leading cause of death during that same year. Deaths
due to heart disease and disease of the blood vessels
remain the foremost reason for the death of thousands
of Filipinos each year.
The Philippines is situated right in the path of most
typhoons in the Pacific Ocean. The country experiences
an onslaught of an average of 20 storms every year,
some of which are super typhoons which cause
catastrophic floods, flash floods, mudslides and
landslides. Earthquakes of tectonic and volcanic origin
as well as volcanic eruptions are also not uncommon
and are equally devastating. According to the 2011 UN
World Risk Index developed by the United Nations
University-Institute for Environment and Human
Security, the Philippines is ranked third among 173
countries in terms of vulnerability to disaster risks and
natural hazards. The study took into account such
factors as exposure to natural hazards, susceptibility
and coping, and adaptive capacities. As an archipelago
with several islands that are accessible only by sea,
maritime disasters are also becoming a common
occurrence.
In certain areas of the country, armed conflicts and
other situations of violence happen, often resulting to
deaths and injuries even among non-combatants. In
such situations where someone is injured or faces a lifethreatening medical emergency, quick response, relief
or rescue is very crucial and important to prevent
profound disabilities or even the loss of lives.
In order to be able to help effectively in any of these
situations, it is important that one should be adequately
trained in first aid and is willing to do it as promptly as
possible. Efficient and immediate application of
appropriate techniques make a difference when saving
lives.3 A trained first aider is a valuable resource during
emergencies at home, in the workplace, and in the
community. This is especially true when involved in
emergency and disaster response cases, situations where the Red Cross is often involved.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Definition
First aid is immediate help provided to a sick or injured
person until professional medical help arrives or becomes
available.
It is concerned not only with physical injury or illness,
but also with other forms of initial care, including psychosocial support for people suffering emotional distress due to
traumatic events.
While Basic Life Support are emergency procedure that
consists of recognizing respiratory or cardiac arrest or both
and the proper application of CPR to maintain life until a
victim recovers or advanced life support is available.
Objectives of First Aid
First aid aims to accomplish the following goals:
 Preserve life. The giving of first aid is in itself an attempt at saving a life or lives.
 Prevent further harm and complications. First aid protects patients from further
injuries and prevents injuries or illnesses from becoming worse.
 Seek immediate medical help. Care for a patient does not end with first aid.
 Provide reassurance. Psychological support is also as important as physical help.
Concepts and Principles
Scope and Limitation


First aid does not imply medical treatment and is by no means a replacement for it. Its
scope and limitations are generally based on the Concept of Protection.
Protection includes the application of basic techniques to ensure the comfort, safety, and
well-being of an ill or injured person.
Improvisation
Because emergencies are unexpected, first aid kits and other equipment may not always be
available at such time that they are needed. A first aider should therefore be able to “adapt,
improvise, and overcome!” He or she must have the ability to adapt to the situation and be able
to improvise materials and equipment until more help arrives.
Some common improvisations include:





Gloves - plastic bags, dish gloves, leather work gloves. (Wash your hands well with soap and
water especially after using these.)
Gauze - clean clothing, bedding or towels (but not paper products, such as paper towels or
toilet paper)
Splints - straight sections of wood, plastic, cardboard or metal.
Slings - the patient’s shirt hem pinned to the center of their chest will immobilize a forearm
or shoulder injury.
Stretcher - a heavy blanket that can be used to move a victim.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Chain of Survival
Survival of cardiac arrest
depends on a series of critical
interventions. If one of these
critical actions is neglected or
delayed, survival is unlikely.
The
chain
has
five
interdependent links: recognition of cardiac arrest and activation of emergency response
system; early cpr; rapid defibrillation; effective advanced life support; and integrated postcardiac arrest care.
Out of the five chains, three chains can be performed by the public; and most of the time,
would probably be carried out by the public as they are the ones who will most likely witness
the cardiac arrest on the scene. The emergency medical professionals cannot be in every place
every moment. If the public does not perform the first three chains properly, by the time the
patient reaches the hospital, even in the setting of best advanced life support care, and even if
the emergency team successful resuscitate the patient, the quality of life the patient would
probably be affected as he/she might have suffered brain damage due to lack of oxygen.
For best survival and quality of life, pediatric basic life support (PBLS) should be part of a
community effort that includes prevention, early cardiopulmonary resuscitation (CPR), prompt
access to the emergency
response system, and rapid
pediatric advanced life support
(PALS), followed by integrated
post– cardiac arrest care.
These 5 links form the
pediatric Chain of Survival, the
first 3 links of which constitute pediatric BLS.
This goes how vital public or community education and participation is to increase the
chance of survival of a cardiac arrest patient.
Legal Concerns
Consent
People have a basic right to decide what can and cannot be done to their bodies. They have the
legal right to accept or refuse emergency care. Therefore, before giving care to an injured or ill
person, you must obtain the person’s permission.
 When a conscious person who understands your questions and what you plan to do gives
you permission to give care, this is called expressed consent.
 Do not touch or give care to a conscious person who refuses care or withdraws consent at
any time. Instead, step back and call for more qualified medical personnel.
 Sometimes, adults may not be able to give expressed consent. This includes people who are
unconscious or are unable to respond, are confused, mentally impaired, seriously injured or
seriously ill. In these cases, the law assumes that if the person could respond, he or she
would agree to care. This is called implied consent.
 If the conscious person is a child or an infant, permission to give care must be obtained
from a parent or guardian when one is available. If the condition is life threatening and a
parent or guardian is not present, consent is implied. If the parent or guardian is present
but does not give consent, do not give care. Instead, call a local emergency number.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Duty to Act
This is the duty to respond to an emergency and to provide care. Failure to fulfill these duties
could result in legal action. This is an obligation that professional rescuers must observe
especially if they are officially on duty. Lay responders assume this accountability when they
start to give first aid care to a patient in an emergency.
Standard of Care
This is the public’s expectation that personnel summoned to an emergency will provide care
with a certain level of knowledge and skill.
Negligence
Pertains to the failure to follow a reasonable standard of care, thereby causing or contributing
to injury or damage.
According to the Article 12 no.4 of Act No.3815 of the
 A first aider can be held
Philippine Revised Penal Code Book One
liable for negligence
“any person who, while performing a lawful act with due care,
especially if his or her
causes an injury by mere accident without fault or intention of
actions
were
causing it” is exempt from criminal liability.
deliberately negligent,
reckless or if the first aider abandons the person after starting care.
 Currently, there is no legislation in the Philippines that specifically protects first aiders
from any legal actions that may arise from helping someone in an emergency, but for as
long as such person has acted the same way that a “reasonable and prudent person” would
in the same situation, that person may not be held criminally liable.
Abandonment
This refers to discontinuing
care once it has begun.
Care must continue until
someone with equal or
more advanced training
takes over.
Confidentiality
According to the Article 275 no. 1 & 2 of Act No. 3815
of the Philippine Revised Penal Code Book Two:
“Abandonment of person in danger and abandonment
of one’s own victim”.
1. Anyone who shall fail to render assistance to any person whom
he shall in an uninhabited place wounded or in danger of
dying, when he can render such assistance without detriment
to himself, unless such omission shall constitute a more serious
offense.
2. Anyone who shall fail to help or render assistance to another
whom he has accidentally wounded or injured.
This is the principle that
information learned while
providing care to a victim
is private and should not be shared with anyone except to those healthcare professionals
directly associated with the victim’s medical care.
Humanitarian Roles, Duties, and Rights of a Red
Cross First Aider
Roles of a Red Cross First Aider

Know and respect the distinctive emblems and basic rules protecting individuals.
o As a Red Cross first aider, it is not enough to be experienced in life-saving and healthprotection measures; you must also help at all times to ensure that the whole
population understands and supports the right of people to be protected and to receive
care, and the need to respect the distinctive emblems so that humanitarian aid is
delivered more efficiently, for the benefit of all.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
o Demonstrate explicitly, through your actions, the humanity, neutrality and impartiality
of the International Red Cross and Red Crescent Movement.

Strengthen your moral standing to uphold the image of the Red Cross.
o You are the image that other people have of your National Society and of the Red Cross.
o You must earn the respect of your interlocutors at all times through your attitude and
actions.
o The perception by the population of the National Society, its leaders, staff and
volunteers – including you – at all levels and at all times, can be a key factor that
contributes to greater protection.
o You can easily understand that any “bad” behavior on your part will negatively
influence perceptions and thus undermine assistance programmes. It will also affect
your National Society and the other components of the International Red Cross and Red
Crescent Movement.
o This influence can have short- and long-term effects and can rapidly take on a
countrywide or even worldwide importance, especially where there is instant media
coverage.
Duties of a Red Cross First Aider





As a first aider, you must:
o Help protect and save lives, and help others do so;
o Respect and preserve the dignity of casualties;
o Participate in the control of disease;
o Contribute to the health education of the general public and to other preventive
programmes, thus limiting injuries and the spread of disease;
o Be sufficiently flexible and versatile to respond to numerous and diverse tasks (logistics,
administration, etc.) beyond caring for casualties.
o Aid and assist solely on the basis of their needs;
o Dispense care without undue discrimination founded on race, colour, sex, language,
religion or belief, political or other opinion, national or social origin or status, wealth,
birth, or any other similar criteria;
Conform to the rules and procedures of your National Society and with International
Humanitarian Law.
Freely and without prejudice provide services required by medical ethics.
Reject any offers of compensation in the form of money and gifts from patients in exchange
for help given.
During an armed conflict, the duties incumbent on you are directly linked to the rights of
persons protected under International Humanitarian Law and placed under your care.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Rights of a Red Cross First Aider
During an armed conflict, as long as you are involved in your humanitarian work caring for the
wounded and sick, you benefit from the same legal protection under international
humanitarian law as the wounded and sick themselves. You have the right:
 To be respected;
 To not be attacked;
 To have access to the places where your services are needed, within certain limits (due for
example, to ongoing fighting, minefields, etc.);
 To be allowed to care for the sick and wounded, be they civilians or military personnel and,
if necessary, to remove them from the field and take them to a place where they can be
treated;
 To provide assistance in accordance with your training and using whatever means are
available;
 To not be compelled to provide services that are contrary to medical ethics;
 To not be prevented from performing services required by these medical ethics;
 To be repatriated if captured and if your care is not indispensable to other prisoners.
Health Hazards and Risks
Disease Transmission
Helping others is not without risks and hazards, most important of which is the risk of
contracting an infectious disease. Infectious diseases are those that can spread from one
person to another and develop when germs invade the body and cause illness.
The most common germs are bacteria and viruses. These can spread from one person to
another through the following ways:
 Direct contact. This occurs when a person touches an
infected person’s body fluids. This type of transmission
presents the greatest risk of infection for the first aider.
 Indirect contact. This occurs when a person touches
objects that have been contaminated by the blood or body
fluids of an infected person. These include soiled
dressings, equipment, and other surfaces with which an
infected person comes in contact.
 Airborne transmission. This occurs when a person
inhales droplets that have become airborne as an
infected person coughs or sneezes.
 Bites. Animals, including humans and insects, can also
spread diseases through bites. Acquiring a disease from a
bite is rare in any situation and uncommon when giving
first aid care.
Common Transmittable Diseases
As a first aider, it is important to be familiar with diseases that can have severe consequences if
transmitted, especially when responding to emergencies. These include the following:
 Herpes is a viral infection that causes eruptions of the skin and mucous membranes.
 Meningitis is an inflammation of the brain or spinal cord which is caused by a viral or
bacterial infection.
 Tuberculosis is a respiratory disease caused by bacteria.
 Hepatitis is a viral infection of the liver. It can be caused by any of the 3 variants of the
Hepatitis virus; HAV, HBV and HCV.
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CHAPTER 1 – Introduction to First Aid and CPR

Philippine Red Cross
First Aid and CPR Reference Manual
Human Immune Deficiency Virus (HIV) is the virus that destroys the body’s ability to fight
infection. The resultant state is referred to as Acquired Immune Deficiency Syndrome
(AIDS).
Prevention and Protection
Universal Precautions are a set of strategies developed to prevent transmission of blood
borne pathogens. These preventive measures focus on blood and selected body fluids such as
cerebrospinal fluid, pleural fluid and amniotic fluid. Body Substance Isolation (BSI) are
precautions taken to isolate or prevent risk of exposure from body secretions and any other
type of body substance such as urine, vomit, faeces, sweat, or sputum.
Regardless of the type of exposure risk, you must observe the following basic precautions
and safe practices each time you prepare to provide care:
 Avoid contact with blood and other body fluids or objects that may be soiled with them.
 Use barriers, such as disposable gloves, between the person’s blood or body fluids and
yourself.
 Use protective CPR breathing barriers.
 Before putting on personal protective equipment (PPE), like disposable gloves; cover all of
your own cuts, scrapes or sores with a bandage.
 Do not touch extremities like the mouth, nose or eyes when giving care. After care has been
given, wash hands prior to eating or drinking.
 Avoid handling any of your personal items, such as pens or combs, while giving care.
Ensure that you wash your hands prior to contact with these objects.
 Do not touch objects that may be soiled with blood or other body fluids.
 Be prepared by having a first aid kit handy and stocked with PPE, such as disposable gloves,
CPR breathing barriers, eye protection and other supplies.
 Wash your hands thoroughly with soap and warm running water when you have finished
giving care, even if you wore disposable gloves. Alcohol-based hand sanitizers allow you to
clean your hands when soap and water are not
readily available and your hands are not
visibly soiled. (Keep alcohol-based hand
sanitizers out of reach of children.)
 Tell advanced medical personnel at the scene
or your health care provider if you have come
into contact with an injured or ill person’s
body fluids.
 If an exposure occurs in a workplace setting,
follow your company’s exposure control plan
for reporting incidents and follow-up (post
exposure) evaluation.
Safety and Security
Types of Situations
There are two types of situations that may pose a security risk to Red Cross first aiders and
emergency responders.
 Situations of armed conflict – are armed confrontations which may be of an international or
non-international character.
 Situations of violence – includes internal disturbances and tensions such as riots, isolated
and sporadic acts of violence, and other acts of a similar nature.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
These situations have particular characteristics as follows:
 Specific rules and laws protecting individuals’
The golden rule of a First Aider in an
lives, health and dignity apply, such as the
armed conflict or any other situation of
International Humanitarian Law during
violence is to “make safe”: always
armed conflicts. During other situations of
protect yourself first, maintain selfviolence other relevant laws (national and/or
control, observe before taking any
international human rights and refugee laws)
action and proceed only if it really
apply.
seems safe to do so.
 Major hazards and risks caused by weapons
and by persons resorting to force or violence.
Weapons are meant to kill and injure and sometimes people use them indiscriminately.
These often have humanitarian consequences including the disorganization of society in
general and of the healthcare system in particular.
Personal Safety
Your safety depends to a large extent on how you behave and how you assess actual and
potential dangers. Always protect yourself first, maintain self-control, observe before taking
any action, and proceed only if it really seems safe to do so. Be aware of and act in accordance
with the basic rules protecting individuals in situations of violence while being mindful of the
Fundamental Principles of the International Red Cross and Red Crescent Movement.
Be respectful of local culture, traditions, taboos, and dress codes. Be sensible in terms of the
clothing you wear and do not show off. Be tactful about personal matters (e.g. sex-related
issues).
Be disciplined, obey rules and follow the orders of your
In a hazardous situation,
team leader. Maintain a polite and respectful attitude
remember that the best
whenever you enter into dialogue with people resorting to
option is often to stop what
force or violence. Take time to listen, and explain what you
you are doing.
are doing. Behave and act in an orderly and calm manner:
“more haste, less speed.”
Security Assessment
The basic components of your security assessment are:
 Assess hazards,
 Check safe access and evacuation paths, and
 Find safe shelters that you can use in case of danger.
Hazards specific to armed conflicts or other situations of violence have warning signs. You
must learn to pay attention to and assess what you hear and what you see.
Seek information from your team leader or other colleagues, people you meet on the way or in
the vicinity of the fighting (local residents, staff of local non-governmental organizations,
United Nations personnel, military or police personnel, etc.). Ask vital information on security
conditions to allow you to intervene safely, but be careful not to be mistaken for a spy.
At the scene, you must look and listen for the “sights and sounds of combat:”
 Look for persons resorting to force or violence, or preparing to do so (taking an aggressive
posture, ready to open fire, etc.).
 Look for smoke or tear gas.
 Scan the environment for suspicious looking objects like bombs. Do not touch them!
 Listen for screams, shots, explosions, etc.
Security conditions can change quickly. You must be prepared to adapt and be able to respond
to dangers that were not apparent earlier. Be ready for deployment to another location if
needed.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Safe Behaviour in Dangerous Situations
Basic Security Rules
 Comply strictly with military security directives. Never disobey the authorities in charge of
the area where you are assigned. Comply with curfews, ceasefires, truces, and other similar
rules.
 Night missions are allowed unless specifically forbidden by the authorities in charge, by the
team leader, or by the dispatch/command center.
 Never accept armed persons with you in a vehicle or
offer them shelter. Never store or transport arms or
ammunition.
 Stop at checkpoints and observe the following:
o Obey any signs or instructions but be firm in
refusing to hand over personal items or those that
are intended for patients.
o Remove sunglasses and hat.
o Keep your hands visible.
o Stay polite, friendly and confident.
o Do not be in a rush to continue your journey; accept discussion.
o Get out of the vehicle only if it is safe and necessary to do so.
o Do not drive off until instructed to do so.
 If not allowed to proceed, do not get angry and do not insist. Instead, report back to your
team leader as soon as possible.
 Never resist an attempt to rob you.
 Never collect or remove weapons (especially grenades or handguns) from a casualty by
yourself. Do not hold small arms or ammunition taken from the wounded or sick, or found
in a medical unit or establishment.
 Never touch suspicious or unknown objects from dead bodies without receiving the goahead from mine-clearance operators.
Actions in Hazardous Situations
A hazardous situation can happen when you find yourself in one or more of the following
situations:
 Interrogated by the police or military or other armed entities.
 Under shelling or gunfire;
 In the vicinity of an explosion;
 In a minefield (landmines, improvised explosive devices, booby-traps, etc.);
 In a burning or collapsing building;
 Surrounded by a crowd of bystanders.
In general, observe the following basic rules when in such situations:
 Avoid areas of violence: do not be in these places or assist people in need until the situation
becomes calmer.
 Use only paths or roads that you are familiar with or that have been recently used by
others.
 Determine quickly where it would be possible to take shelter nearby, if necessary.
 Determine quickly the best and safest path to reach casualties, and then take them to
shelter.
 Maintain contact with your team leader (who is in contact with the command or dispatch
center of the casualty-care chain) to obtain further information.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
If being questioned by “authorities:”
 Stay calm.
 Cooperate.
 Show your identity card and National Society card.
 Explain why you are there.
 Avoid any argument.
If you are actually fired upon:
 Take cover quickly. Find protection from fire and from view.
 Do not look out to see what is going on.
 If inside a building, stay away from windows. Do not look out.
 If in a vehicle, protect yourself as much as you can. If the vehicle stops, get out and take
cover quickly, putting the vehicle between you and the shooting.
 Stay under cover until firing stops. Wait at least 10 minutes before coming out.
In the event of an explosion:
 Stop.
 Do not rush in or investigate to help.
 Take cover on the ground or at the side, off the road.
 Keep down until the situation has stabilized. Then do what you can to help the casualties.
 Be careful after a bombing (of whatever kind): a second bomb may be set to explode after
people arrive at the scene of the first one. So wait before approaching the area and prevent
other people from doing so.
When security conditions appear to be under control:
 Look around carefully
 Ask for information
 Re-assess the risk, and
 Proceed, but only if it really seems safe to do so.
Remain calm and in control. If after an incident you are surrounded by an aggressive crowd of
bystanders, maintain your composure. This may create a calming effect on the situation and
people will then be more willing to help you.
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CHAPTER 1 – Introduction to First Aid and CPR
Philippine Red Cross
First Aid and CPR Reference Manual
Skill 1-1 Removing Gloves
After giving care, make sure to never touch the bare skin with the
outside of either glove.
1. Pinch the glove


Pinch the palm side of one glove
near the wrist.
Carefully pull the glove off so that
it is inside out.
2. Slip the two fingers under
the glove.


Hold the glove in the palm of the
remaining gloved hand.
Slip two fingers under the glove
at the wrist of the remaining
gloved hand.
3. Pull the glove off

Pull the glove until it comes off,
inside out, so that the first glove
ends up inside the glove just
removed.
4. Dispose gloves and wash hands.


Dispose of gloves in the appropriate biohazard container.
Do not reuse gloves.
Wash hands thoroughly with soap and warm running
water, if available. Otherwise, use an alcohol-based hand
sanitizer to clean the hands.
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CHAPTER 2
Emergency
Action
Principles
CHAPTER 2 – Emergency Action Principles
Philippine Red Cross
First Aid and CPR Reference Manual
An emergency scene can be overwhelming. In order for the first aider to help effectively, it is
important that actions have to be prioritized and planned well. The Emergency Action Steps
serves as a guide for responders to follow in situations that demand immediate but careful and
calculated response. It has four parts:
 Scene Size-up
 Primary Assessment
 Activating Medical Help
 Secondary Assessment
The Emergency Action Steps generally involve both scene and patient assessment. Scene
assessment focuses on scene and rescuer safety. Patient assessment follows the ABCDE
approach which stands for
 A – Airway
 B – Breathing
 C – Circulation
 D – Disability (mental status and peripheral nervous system)
 E – Extremities/Exposure (for further assessment)
Scene Size-up
Scene Safety
Before helping an injured or ill person, make sure
that the scene is safe for yourself and everyone else,
including bystanders.
 To determine if the scene is safe, check for
hazards that may pose an immediate or potential
threat to life such as poisonous gases, toxic and
corrosive chemicals, explosive materials, downed
electrical lines, fire, water, traffic, weapons, and
other dangers.
 If any of these are present, stay at a safe distance
and call the local emergency number
immediately.
 Do not move a seriously injured person at the scene unless:
o There is an immediate danger, such as fire, lack of oxygen, risk of explosion or a
collapsing structure.
o There is a need to move a person with minor injuries to reach someone needing
immediate care.
o There is a need to move the injured person to give proper care.
 If it is necessary to move the person, do it as quickly and carefully as possible and without
compromising your own safety.
 If there is no imminent danger, tell the person not to move. Inform bystanders not to move
the same person as well.
Rushing in without being minding of the danger may often lead to fatal consequences.
Leave dangerous situations to professional responders who are better equipped to
handle them. Once they make the scene safe, you can offer to help.
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CHAPTER 2 – Emergency Action Principles
Philippine Red Cross
First Aid and CPR Reference Manual
Knowing What
Happened
Careful evaluation of the
scene, including the possible
cause of injury and/or the
nature of the illness, along
with any other information
that you gather, will help
determine the condition of
the victim and what the next
possible action of the first
aider should be.
Knowing the cause of
injury allows you to predict
various injury patterns. Certain injuries are considered to be common to particular accident
situations. Injuries to bones and joints are usually associated with falls and vehicle collisions.
Burns are common to fires and explosions, while penetrating soft tissue injuries are often
associated with gunshot wounds.
Nature of illness is
often best described
by the patient’s chief
complaint: the reason
for providing care. In
order
to
quickly
determine the nature
of the illness, talk
with
the
patient,
family, or bystanders
about the problem.
But at the same time,
use your senses to check the scene for clues as to the possible problem.
Role of bystanders
The presence of bystanders does not often mean
that a patient is receiving help. They may have to
be asked to help. Bystanders may be able to tell
you what happened or make the call for help
while you provide care.
If a family member, friend or co-worker is
present, he or she may know if the person is ill or
has a medical condition and can also help to
comfort the person. The patient may be too upset
to answer your questions. Anyone who awakens
after having been unconscious may also be
frightened, especially if it’s a child.
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CHAPTER 2 – Emergency Action Principles
Philippine Red Cross
First Aid and CPR Reference Manual
Number of casualties
Look carefully for more than one person who might be injured. You might not spot everyone
who needs help at first. If one person is bleeding or screaming, you may not notice someone
who is unconscious. It also is easy to overlook a small child or an infant. In an emergency with
more than one injured or ill person, you may need to prioritize care (in other words, decide
who needs help first).
Asking permission or consent
Consent is a patient’s indication that a rescuer
To obtain consent, do the following:
may provide care. A first aider must have the
patient’s consent (permission) before giving  Identify yourself to the victim.
first aid, either verbally or by gestures.
 State your level of training.
Remember not to touch or give care to a  Ask the victim whether you may help.
conscious person who refuses care or  Explain what you observe.
withdraws consent at any time. If the parent or  Explain what you plan to do.
guardian is present but does not give consent, or
in the case of an infant or child whose guardians are not present to give consent, do not give
care. Instead, step back and call for more advanced medical personnel.
Primary Assessment
The purpose of the primary assessment is to check for
immediate life-threatening condition which includes
unconsciousness, absence of breathing, absence of
pulse and severe bleeding. Primary assessment can be
done with the patient in the position in which you find
him or her, and begins with checking the patient’s
responsiveness.
Assessing Responsiveness
A patient’s response level can be summarized in the
AVPU mnemonic as follows:
 A – Alert
 V – Responsive to Voice
 P – Responsive to Pain
 U – Unresponsive/Unconscious
For a visibly alert and talking patient, ask the patient
his or her name and what happened. If the patient
responds, then the patient is alert and, depending on
what you has asked, is also oriented (to time, person,
place and event).
For someone who appears to be not so active, you
can tap or gently shake the patient on the shoulder
and ask if he or she is okay. Use the person’s name if
you know it and speak loudly.
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If the person responds, leave the person in the position in which you found him or her,
provided there is no further danger, and then try to determine what is wrong with the person.
If the person does not respond in any way, assume that he or she is unconscious.
However, if the patient is found in a face-down position, you may have to position the patient
on his or her back to using log-roll technique facilitate opening of the airway and to check for
breathing.
Airway
An open airway allows air to enter the lungs for the person to breathe. If the airway is blocked,
the person cannot breathe. A blocked airway is a life-threatening condition: when someone is
unconscious and lying on his or her back, the tongue may fall to the back of the throat and
block the airway. To open an unconscious person’s airway, perform the procedure known as
the head-tilt/chin-lift technique. This moves the tongue away from the back of the throat,
allowing air to enter the lungs.
Sometimes you may need to remove food, liquid or other objects that are blocking the
person’s airway. These are called foreign-body airway obstructions and will be discussed in
detail in the next chapter.
But in cases of witnessed cardiac arrest, opening of airway is not a priority as the critical
initial element of BLS is chest compressions and early defibrillation.
Breathing
While maintaining an open airway, quickly check an unconscious person for breathing by doing
the LLF technique for no more than 10 seconds. Normal breathing is regular, quiet and
effortless. This means that when breathing normally, the person is not making noise, breaths
are not fast (although it should be noted that normal breathing rates in children and infants are
faster than normal breathing rates in adults) and it does not cause discomfort or pain.
If an adult is not breathing or is having irregular, gasping or shallow breath (also known as
agonal breath) and if the emergency is not the result of non-fatal drowning or other
respiratory cause such as a drug overdose, assume that the problem is a cardiac emergency. In
this case, the person needs CPR and chest compressions must not be delayed.
In some cases, the person may be unconscious but breathing normally. In such situations,
maintain an open airway by using the head-tilt/chin-lift technique as you continue to look for
other life-threatening conditions.
Generally, patients should not be moved from a face-up position, especially if there is a
suspected spinal injury. However, there are a few situations where you should move a person
into a recovery position whether or not a spinal injury is suspected, such as when:
 You are alone and have to leave the person (e.g., to call for help), or
 You cannot maintain an open and clear airway because of fluids or vomit.
There is no single recovery position that is perfect for all victims. The position should be stable,
near a true lateral position with the head dependent, and with no pressure on the chest to
impair breathing.
In an infant, this may require the support of a small pillow or a rolled-up blanket placed
behind his back to maintain the position.
The modified recovery or H.A.IN.E.S. (for High Arm IN Endangered Spine) position is designed
to reduce lateral cervical flexion for all unconscious patients suspected of spinal injury who
need airway and spinal protection, when there is a lack of spinal immobilization equipment
readily available. Placing a person in this position will help to keep the airway open and clear.
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The following sequence of actions to place a patient in the recovery position:
1. Kneel beside the patient and make sure that both his legs are straight.
2. Place the patient's arm nearest to you out at right angles to his body, elbow bent with
the hand palm-up.
3. Bring the farthest arm across the chest, and hold the back of the hand against the
victim’s cheek nearest to you.
4. Grasp the leg farthest from you and cross it over the other leg.
5. Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards
you on to his side.
6. Adjust the upper leg so that both the hip and knee are bent at right angles to support and
prevent the patient from rolling further.
7. Tilt the head back to make sure that the airway remains open. If necessary, adjust the
hand under the cheek to keep the head tilted and facing downwards to allow liquid
material to drain from the mouth.
Circulation
A. Bleeding
Quickly look for severe bleeding by looking over the person’s body from head to toe for signals
such as blood-soaked clothing or blood spurting out of a wound. Be meticulous. It is not always
easy to recognize severe bleeding. If there is a case of severe bleeding, it must be controlled as
soon as possible.
B. Shock
When someone becomes suddenly ill or is injured, normal body functions may be interrupted.
In cases of minor injury or illness, the interruption is brief and the body is able to compensate
quickly. With more severe injuries or illness, however, the body is unable to meet its demand
for oxygen.
The condition in which the body fails to circulate oxygen-rich blood to all the parts of the
body is known as shock. If left untreated, shock can lead to death.
Always look for the signals of shock whenever you are giving care. You will learn how to
recognize and treat a victim for shock in Chapter 4.
C.Skin color, temperature and moisture.
Assessment of skin temperature, color, and
condition can tell you more about the patient’s
circulatory system.
Normal body temperature is 98.6 °F (37 °C).
The most common way that a first aider takes
temperature is by touching a patient’s skin with
the back of the hand. This is called relative skin
temperature. It does not measure exact
temperature, but you can tell if it is very high or
low.
Skin color can tell you a lot about a patient’s heart, lungs, and other problems well. For
example:
 Paleness may be caused by shock or heart attack. It also may be caused by fright, faintness,
or emotional distress, as well as impaired blood flow.
 Redness (flushing) may be caused by high blood pressure, alcohol abuse, sunburn, heat
stroke, fever, or an infectious disease.
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Blueness (cyanosis) is always a serious problem. It appears first in the fingertips and
around the mouth. Generally, reduced levels of oxygen as in shock, heart attack, or
poisoning can be the cause.
 Yellowish color may be caused by a liver disease.
 Black-and-blue mottling is the result of blood seeping under the skin. It is usually caused by
a blow or severe infection.
If your patient has dark skin, be sure to check for color changes on the lips, nail beds, palms,
earlobes, whites of the eyes, inner surface of the lower eyelid, gums, and tongue. One way to
assess adequacy of circulation is by assessing capillary refill.
To assess capillary refill, you have to measure the time it takes for the color to return under
the nail. Two seconds or less is normal. If refill time is greater than two seconds, suspect shock
or decreased blood flow to that extremity.
Capillary refill is recommended only for children under six years of age. Research has
proven that it is not always accurate in adults. Capillary refill may be checked on infants by
squeezing the palm of the hand or sole of the foot and watching for color to return.

Activating Medical Help
Calling a local emergency number for help is the most important action you can take to help an
injured or ill person. Make the call quickly and return to the ill or injured person. If possible,
ask someone else to make the call.
Call First or Care First
If you are ALONE, it is important to know when to call during
emergencies. Call First situations are likely to be cardiac
emergencies, where time is a critical factor. In Care First
situations, the conditions often are related to breathing
emergencies.
Call First (the local emergency number before giving care) for:
 Any adult or child about 12 years of age or older who is
unconscious.
 A child or an infant suddenly collapses in your sight or
presence.
 An unconscious child or infant known to have heart problems.
Care First (give 2 minutes of care, then call the local emergency number) for:
 An unconscious child (younger than about 12 years of age) who you did not see collapse.
 Any drowning victim.
Local Emergency Numbers
Local emergency numbers vary in most cities and localities in
the Philippines (See Appendix – Local Emergency Numbers).
The national and official emergency hotline number in the
country is “117.” It however, does not compete with other
locally established emergency numbers or with local
responders, but complements their local operations. “117″ is
not a responder, but a call center that processes received
calls and relays emergency situations to the appropriate
responders.
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First Aid and CPR Reference Manual
One may call Patrol 117 during emergencies and life threatening situations that require
immediate response (ex: crime incidents, fire incidents, medical assistance, rescue operations),
public safety concerns, to report abusive officials and law enforcers, illegal activities and
crimes that do not require immediate assistance.
Information to be remembered in
activating medical help:






What happened?
Location of emergency?
Number of person injured or ill?
Cause and extent of injury and nature of illness and first aid given?
Telephone number from where call is made?
Name of person who called medical help (person must identify him/herself and hang
up the phone last).
If medical assistance is not available and if you decide to take the injured or ill person to a
medical facility,
 Ask someone to come with you to keep the patient comfortable.
 Be sure you know the quickest route to the nearest medical facility capable of handling
emergency care.
 Pay close attention to the injured or ill patient and watch for any changes in his or her
condition.
 Discourage an injured or ill person from driving himself or herself to the hospital.
Secondary Assessment
Secondary assessment involves the rest of the DE of the ABCDE If you determine that an
injured or ill person is not in an immediately life-threatening condition, you can begin to check
for other conditions that may need care. Checking a conscious person with no immediate lifethreatening conditions involves two basic steps:
 Interviewing the person and bystanders
 Checking the person from head to toe.
Interview
Ask the person and bystanders simple questions to learn more about what happened and to
learn more about the person’s medical history. Keep these interviews brief. Begin by asking for
the person’s name. This will make him or her feel more comfortable.
To gain essential information about the patient’s
medical history, ask the patient questions based on
the SAMPLE approach:
 S – Signs and symptoms (How do you feel? Do
you feel pain or discomfort anywhere? )
o Signs are physical manifestations of the
injury or illness that can be observed by the
first aider, i.e. bruising, swelling, fever, open
wound, etc.
o Symptoms are indicators that only the
patient can feel or experience, i.e. pain,
dizziness, chills, weakness, etc.
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




Philippine Red Cross
First Aid and CPR Reference Manual
A – Allergies (Do you have any known allergies or allergic reactions? Has there been any
recent exposure?)
M – Medications (What medications are you taking? Are they over-the counter or
prescription? What is the medication for? When was it last taken? Can you tell me where
the medication is so we can keep it with you?)
P – Pertinent past medical history (Has anything like this happened before? Are you
currently under a health care provider's care for anything? Could you be pregnant (if a
woman)?)
L – Last intake and output (When did you last eat or drink? How much? Are you cold,
hungry or exhausted? When did you last urinate and defecate? Were they normal?)
E – Events leading up to the injury or illness (What led to the illness or injury? When did
it happen? How did it happen, in order of occurrence?)
Write down the information you learn during the interview or, preferably, have someone else
write it down for you. Be sure to give the information to advanced medical personnel when
they arrive.
If the person feels pain, ask him or her to describe it and to tell you where it is located.
Descriptions often include terms such as burning, crushing, throbbing, aching or sharp pain.
Ask when the pain started and what the person was doing when it began. Ask the person to
rate his or her pain on a scale of one to ten (one being mild and ten being severe).
Remember to question family members, friends or bystanders as well. They may be able to
give you helpful information or help you to communicate with the person. Children or infants
may be frightened. They may be fully aware of you but still unable to answer your questions. In
some cases, they may be crying too hard and be unable to stop. Approach slowly and gently,
and give the child or infant some time to get used to you. Use the child’s name, if you know it.
Get down to or below the child’s eye level.
Head-to-toe exam
Check the patient head to toe during the hands-on
physical exam, going by the following order: head,
face, ears, neck, chest, abdomen, pelvis, genitals,
each arm, each leg and back.
Look for DOTS, which stands for deformity,
open injuries, tenderness and swelling. Do not
move any areas where there is pain or discomfort,
or if you suspect a head, neck or spinal injury.
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Skill 2-1 Log-Roll Technique
1. Kneel at the person’s side.
2. Extend the person’s arm that
is closest to you over his or
her head.
3. Place the other arm close to the
body and place the farthest leg
on top of the closest leg.
4. Hold the shoulder and hip that are farthest from you then carefully roll the
person towards you.
5. Reposition the arms at each side of the body once the victim is now in the faceup position.
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Skill 2-2 Head-Tilt/Chin-Lift Technique
1. Place your hand on the victim’s
forehead and gently tilt his or
her head back.
2. With your fingertips of your other
hand under the point of the victim’s
chin, lift the chin to open the airway.
Skill 2-3 Look, Listen and Feel Technique
Position yourself beside the victim and place your face near the person’s mouth
and nose. And then:



Look to see if the person’s chest and/or
abdomen clearly rises and falls,
Listen for escaping air, and
Feel for it against the side of your face.
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Skill 2-4 High Arm IN Endangered Spine
(H.A.I.N.E.S.)
1. Kneel beside the patient and
make sure that both his legs
are straight.
2. Lift the patient’s arm nearest
to you up next to the head
with the person’s palm facing
up.
3. Bring the farthest arm and
place it next to his or her
side across the chest, and
hold the back of the hand
against the victim’s cheek
nearest to you.
4. Grasp the leg farthest from
you and cross it over the
other leg.
5. Using your hand that is
closest to the person’s
head, hold the person’s
shoulder farthest from you.
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6. Place your other hand on the hip
farthest from you.
7. Using a smooth motion,
roll the person towards you
until the person is on his or
her side.
 Make sure the person’s head
remains in contact with the
extended arm.
8. Position the other arm in
front of the torso and
adjust the upper leg so
that both the hip and knee
are bent at right angles to
support and prevent the
patient from rolling further.
9. Stop all movement once the person is already in position.
Skill 2-5 Capillary Refill Check
1. Squeeze one of the patient’s
fingernails or toenails.

When squeezed, the tissue under the
nail turns white.
2. When you let go, the color
returns to the tissue.

To assess capillary refill, you have to
measure the time it takes for the
color to return under the nail.
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Skill 2-6 Head-To-Toe Examination
1. Check the person’s head by examining the scalp, face, ears, mouth and nose.
2. Look over the body.





Ask again about any areas that hurt.
Ask the person to move each part of the body that does not hurt.
Ask the person to gently move his or her head from side to side.
Check the shoulders by asking the person to shrug them.
Check the chest and abdomen by asking the person to take a deep breath.
3. Ask the person to move his or her fingers, hands and arms; and then the toes,
legs and hips in the same way.

Watch the person’s face and listen for signals of discomfort or pain as you check for
injuries.
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CHAPTER 3
Cardiac
Emergencies
and
Cardiopulmonary
Resuscitation
(CPR)
CHAPTER 3 – Cardiac Emergencies and
Cardiopulmonary Resuscitation
Philippine Red Cross
First Aid and CPR Reference Manual
The Circulatory System
The circulatory system works with the respiratory system to carry oxygen-rich blood to
everybody cell. It also carries other nutrients throughout the body, removes waste and returns
oxygen-poor blood to the lungs.
The circulatory system includes the heart, blood and blood vessels. The heart is a muscular
organ located behind the sternum (breastbone) and serves as a pump that pushes blood
throughout the body through veins and arteries. Arteries are large blood vessels that carry
blood away from the heart to the rest of the body. The arteries subdivide into smaller bl ood
vessels and ultimately become microscopic capillaries. The capillaries transport blood to all
the cells of the body and nourish them with oxygen.
After the oxygen in the blood is transferred to the cells, veins carry the blood back to the
heart. The heart circulates this blood to the lungs to pick up more oxygen before circulating it
to other parts of the body. This cycle is called the circulatory cycle.
Heart Attack
Heart attack, also called myocardial infarction, occurs when the blood and oxygen supply to the
heart is reduced causing damage to the heart muscle and preventing blood from circulating
effectively. It is usually caused by coronary heart disease.
The effects of a heart attack depend largely on how much of the heart muscle is affected.
Signs and Symptoms
The following are the signals of a heart attack:
 Chest pain, discomfort or pressure. The most common signal is
persistent pain, discomfort or pressure in the chest that lasts
longer than 3 to 5 minutes or goes away and comes back.
Unfortunately, it is not always easy to distinguish heart attack
pain from the pain of indigestion, muscle spasms or other
conditions. This often causes people to delay getting medical
care. Brief, stabbing pain or pain that gets worse when you bend
or breathe deeply usually is not caused by a heart problem.
 The pain associated with a heart attack can range from
discomfort to an unbearable crushing sensation in the chest.
 The person may describe it as pressure, squeezing, tightness,
aching or heaviness in the chest.
 Many heart attacks start slowly as mild pain or discomfort.
Often the person feels pain or discomfort in the center of the chest.
 The pain or discomfort becomes constant.
 It usually is not relieved by resting, changing position or taking medicine.
 Some individuals may show no signals at all.
 Discomfort in other areas of the upper body in addition to the chest. Discomfort, pain or
pressure may also be felt in or spread to the shoulder, arm, neck, jaw, stomach or back.
 Trouble breathing. Another signal of a heart attack is trouble breathing. The person may be
breathing faster than normal because the body tries to get the much-needed oxygen to the
heart. The person may have noisy breathing or shortness of breath.
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Philippine Red Cross
First Aid and CPR Reference Manual
Other signals. The person’s skin may be pale or ashen (gray), especially around the face.
Some people suffering from a heart attack may be damp with sweat or may sweat heavily,
feel dizzy, become nauseous or vomit. They may become fatigued, lightheaded or lose
consciousness. These signals are caused by the stress put on the body when the heart does
not work as it should. Some individuals may show no signals at all.
Differences in signals between men and women. Both men and women experience the most
common signal for a heart attack: chest pain or discomfort. However, it is important to note
that women are somewhat more likely to experience some of the other warning signals,
particularly shortness of breath, nausea or vomiting, back or jaw pain and unexplained
fatigue or malaise. When they do experience chest pain, women may have a greater
tendency to have atypical chest pain: sudden, sharp but short-lived pain outside of the
breastbone.
HEALTH STATISTICS
MORTALITY: Ten (10) LEADING CAUSES
NUMBER AND RATE/100,000 POPULATION
Philippines
5-Year Average (2001-2005) & 2006
5-Year Average
(2001-2005)
CAUSES
Number
Rate
1. Disease of the Heart
69,741
85.5
2. Disease of Vascular System
52,106
64.0
3. Malignant Neoplasms
39,634
48.6
4. Accidents**
33,650
41.5
5. Pneumonia
33,764
41.5
6. Tuberculosis, all forms
27,017
33.2
7. Chronic lower respiratory diseases
19,024
23.3
8. Diabetes Mellitus
15,123
18.5
9. Certain conditions originating in perinatal
13,931
17.2
period
10. Nephritis, nephritic syndrome and nephrosis
9,785
12.0
Note: Excludes ill-defined and unknown causes of mortality
*Reference year
**External causes of Mortality
2006
Number
83,081
55,466
43,043
36,162
34,958
25,860
21,216
20,239
Rate
95.5
63.8
49.5
41.6
40.2
29.7
24.4
23.3
12,334
14.2
11,981
13.8
source: http://www.doh.gov.ph/node/198
First Aid Management
If you suspect that someone might be having a heart attack, you should:
 Call the local emergency number immediately.
 Have the person stop what he or she is doing and rest comfortably. This will ease the
heart’s need for oxygen. Many people experiencing heart attack find it easier to breathe
while sitting.
 Loosen any tight or uncomfortable clothing.
 Closely watch the person until advanced medical personnel take over. Notice any changes
in the person’s appearance or behaviour. Monitor the person’s condition.
 Be prepared to perform CPR and use an AED, if available, once the person loses
consciousness and stops breathing.
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Philippine Red Cross
First Aid and CPR Reference Manual
Ask the person if he or she has a history of
heart disease. Some people with heart
disease take prescribed medication for
chest pain. You can help by getting the
medication for the person and assisting
him or her with taking the prescribed
medication.
Offer aspirin if it is prescribed by his/her
physician for his/her condition and only if
the patient can swallow.
Be calm and reassuring. Comforting the
person helps to reduce anxiety and eases
some of the discomfort.
Talk to bystanders and if to possible the person to get more information.
Do not try to drive the person to the hospital yourself. He or she could quickly get worse on
the way.
Giving Aspirin to Lessen Heart Attack Damage
You may be able to help a conscious person who is showing early signs of a heart attack by
offering the person an appropriate dose of aspirin when the signs first appear. However,
you should never delay calling the local emergency number to do this. Always call for help
as soon as you recognize the signals of a heart attack. You can then help the person become
comfortable before you give the aspirin.
The recommended dose is two chewable (81 mgs each) baby aspirins, or one 5-grain
(325 mg) adult aspirin tablet with a small amount of water. Do not use coated aspirin
products or products meant for multiple uses such as colds, fevers and headaches. You may
also offer the aspirin if the person regains consciousness while you are giving care and is
able to take the aspirin by mouth. Be sure that you offer only aspirin and not Tylenol®,
acetaminophen or nonsteroidal anti-inflamatory drugs (NSAIDs), such as ibuprofen,
Motrin®, Advil®, naproxen or Aleve®
Cardiac Arrest
Cardiac arrest occurs when the heart stops beating or beats too ineffectively to circulate blood
to the brain and other vital organs. The beats, or contractions, of the heart become ineffective if
they are weak, irregular or uncoordinated, because at that point the blood no longer flows
through the arteries to the rest of the body.
When the heart stops beating properly, the
body cannot survive. Breathing will soon stop,
and the body’s organs will no longer receive
the oxygen they need to function. Without
oxygen, brain damage can begin in about 4 to
6 minutes, and the damage can become
irreversible after about 10 minutes.
A person in cardiac arrest is unconscious,
not breathing and has no heartbeat. The heart
has either stopped beating or is beating
weakly and irregularly so that a pulse cannot
be detected.
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Cardiovascular disease is the primary cause of cardiac arrest in adults. Cardiac arrest also
results from drowning, choking, drug abuse, severe injury, brain damage and electrocution.
Causes of cardiac arrest in children and infants include airway and breathing problems,
traumatic injury, and a hard blow to the chest, congenital heart disease and sudden infant
death syndrome (SIDS).
Sudden cardiac arrest:
 Can happen at any time, to anyone, anywhere without warning;
 Most common mode of death in patients with coronary artery disease;
 Although pre-existing heart disease is a common cause, it may strike people with no
history of cardiac disease or cardiac symptoms;
 In sudden cardiac arrest or sudden cardiac death, the heart usually goes into a fatal
arrhythmia called “Ventricular Fibrillation” (VF) wherein it suddenly goes into very
irregular fast ineffective contractions, the heart stops beating, the victim loses
consciousness, and if untreated, dies.
Despite advances in Emergency Medical Systems and in the
technology of resuscitation, sudden cardiac arrest remains a
major public health problem. It is associated with low
survival rate, and major long term severe mental impairment
due to delays in cardiopulmonary resuscitation (CPR) and
treatment.
Majority of cardiac arrests occurs outside the hospital-at
home, in the workplace, in public institutions. Almost 80
percent of out-of-hospital cardiac arrests occur at home and
are witnessed by a family member. Unfortunately, less than
10 percent of sudden cardiac arrest victims survive because
majority of those witnessing the arrest are people who do not
know how to perform CPR.
It is important to know
that there are various
types of cardiac arrest. In
an emergency, however,
it is not necessary to
determine which type of
cardiac arrest is present.
Begin CPR immediately
when you recognize
cardiac arrest.
Cardiopulmonary Resuscitation (CPR)
A person in cardiac arrest needs immediate
CPR and defibrillation. The cells of the brain
and other important organs continue to live
for a short time—until all of the oxygen in the
blood is used. CPR is a combination of chest
compressions and rescue breaths. When the
heart is not beating, chest compressions are
needed to circulate blood containing oxygen.
Given together, rescue breaths and chest
compressions help to take over for the heart
and lungs. CPR increases the chances of
survival for a person in cardiac arrest.
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First Aid and CPR Reference Manual
Chest Compression Technique for Adults and Child
Proper hand placement is established by identifying the lower half of the sternum.
1. Place the heel of one hand in the center
of the chest between the nipples and the
other hand on top of the first, so that the
hands are parallel.
2. Be sure the long axis of the heel of your
hand is placed on the long axis of the
sternum. This will keep the main force of
compression on the sternum and
decrease the chance of rib fracture. Do
not compress over the lowest portion of
the base of the sternum (the xiphoid
process).
3. Your fingers may be either extended or
interlaced but should be kept off the
chest.
4. Lock the elbows in position, with the
arms straightened. Position your
shoulders directly over your hands so
that the thrust for each chest
compression is straight down on the
sternum. If the thrust is not in a straight
downward direction, the victim’s torso
has a tendency to roll; if this occurs, a
part of the force of compressions will be
lost, and the chest compressions may be less effective (Do not be a bender, rocker & jerker).
5. Depress the sternum at least 2 inches (5 cm). Push hard, push fast at a rate of at least 100
compressions per minute.
6. Release the pressure on the chest to allow blood to flow into the chest and heart. You must
release the pressure completely and allow the chest to return to its normal position after
each compression. Keep the heel of your hands in contact with the victim’s sternum to
maintain proper hand position, but fingers off the chest (Do not be a massager).
7. To maintain correct hand position throughout the compression cycle, do not lift your hands
from the chest or change their position in any way (Do not be a bouncer & double crosser).
However, do allow the chest to recoil to its normal position after each compression.
Chest Compressions Technique for an Infant
Proper hand placement is established by identifying the lower half
of the sternum.
1. Position the infant face up on a firm, flat surface. The infant’s
head must be on the same level as the heart or lower. Stand or
kneel facing the infant from the side.
2. Keep one hand on the infant’s head to maintain an open
airway. Use your other hand to give compressions.
3. To find the correct place to give compressions, imagine a line
running across the chest between the infant’s nipples. Place
your index finger on the sternum (breastbone) just below this
imaginary line.
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First Aid and CPR Reference Manual
4. Then place the pads of the two fingers next to your index finger on the sternum. Raise the
index finger. If you feel the notch at the end of the infant’s sternum, move your fingers up a
little bit.
5. Use the pads of two fingers to compress the chest. Compress the chest ½ to 1 inch, then let
the sternum return to its normal position.
6. When you compress, push straight down. The down-and-up movement of your
compressions should be smooth, not jerky.
7. Keep a steady rhythm. Do not pause between compressions. When you are coming up,
release pressure on the infant’s chest completely, but do not let your fingers lose contact
with the chest.
8. Keep your fingers in the compression position. Use your other hand to keep the airway
open using a head-tilt.
Ways to ventilate the lungs
1. Mouth-to-Mouth
Mouth-to-mouth rescue breathing is a
quick, effective way to provide oxygen
and ventilation to the victim. Your
exhaled breath contains enough oxygen
to supply the victim’s needs.
2. Mouth-to-Nose
The mouth – to -nose method of
ventilation is recommended when it is
impossible to ventilate through the
victim's mouth: the mouth cannot be
opened (trismus), the mouth is seriously
injured, or a tight mouth-to-mouth seal
is difficult to achieve.
To provide mouth-to-nose breathing,
tilt the victim’s head back with one hand
on the forehead and use the other hand
to lift the victim’s mandible (as in headtilt-chin lift) and close the victim’s
mouth.
Take a deep breath, seal your lips
around the victim’s nose and exhale into
the victim’s nose. Then remove your lips
from the victim’s nose, allowing passive exhalation. It may be necessary to open the victim’s
mouth intermittently and separate the lips with the thumb to allow free exhalation; this is
particularly important if partial nasal obstruction is present.
3. Mouth-to-Mouth-and-Nose
If the victim is an infant (1-year-old), place your mouth over the infant’s mouth and nose. A
variety of techniques can be used to provide rescue breathing for infants. During rescue
breathing attempts you must maintain good head position for the infant (head-tilt-chin lift to
maintain a patent airway) and create an airtight seal over the airway.
4. Mouth-to-Stoma
A tracheal stoma is a permanent opening at the front of the neck that extends from the surface
of the skin into the trachea. When a person with tracheotomy requires rescue breathing, direct
mouth-to-stoma ventilation should be performed.
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First Aid and CPR Reference Manual
Place your mouth over the stoma, making an airtight seal around the stoma. Blow into the
stoma until the chest rises. Then remove your mouth from the patient, allowing passive
exhalation.
Protective equipment used to ventilate the lungs
1. Mouth-to-Face Shield
Unlike mouth-to-mask devices, face
shields have only a clear plastic or
silicone sheet that separates the rescuer
from the patient.
Healthcare professionals and rescuers
with duty to respond should use face
shields only as a substitute for mouthto-mouth breathing and should use
mouth-to-mask or bag-valve mask
devices at the first opportunity.
2. Mouth-to-Mask
A transparent mask with or without a 1way valve is used in mouth-to-mask
breathing. The 1-way valve directs the
rescuer’s breath into the victim while
diverting the victim’s exhaled air away
from the rescuer. Some devices include
an
oxygen
inlet
that
permits
administration of supplemental oxygen.
Mouth-to-mask
ventilation
is
particularly effective because it allows
the rescuer to use 2 hands to create a
mask seal. There are 2 possible techniques for using the mouth-to-mask device. The first
technique positions the rescuer above the victim’s head (cephalic technique). A single rescuer
can use this technique when the patient is in respiratory arrest (but not cardiac arrest) or
during performance of 2-rescuer CPR. A jaw thrust is used in the cephalic technique, which has
the advantage of positioning the rescuer so that the rescuer is facing the victim’s chest while
performing rescue breathing.
In the second technique (lateral technique), the rescuer positioned at the victim’s side and
uses head tilt-chin lift. The lateral technique is ideal for performing 1-rescuer CPR, because the
rescuer can maintain the same position for both rescue breathing and chest compressions.
3. Using Bag-valve Mask Device.
Bag-valve mask devices used in the prehospital setting consist of a self-inflating bag and a
nonrebreathing valve attached to a facemask. These devices provide the most common method
of delivering positive-pressure ventilation in both the EMS and hospital settings.
If Two Responders Are Available
If two responders trained in CPR are at the scene, both should identify them as being trained.
One should call the local emergency number for help while the other performs CPR. If the first
responder is tired and needs help:
 The first responder should tell the second responder to take over.
 The second responder should immediately take over CPR, beginning with chest
compressions.
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First Aid and CPR Reference Manual
When to Stop CPR
Once you begin CPR, do not stop except in one of these situations:
 You notice an obvious sign of life, such as breathing.
 An AED is available and ready to use.
 Another trained responder or EMS personnel take over.
 You are too exhausted to continue.
 The scene becomes unsafe.
If at any time you notice that the person is breathing, stop CPR. Keep his or her airway open
and continue to monitor the person’s breathing and for any changes in the person’s
condition until EMS personnel takeover.
Criteria for Not Starting CPR
Scientific evaluation has shown that there are no clear criteria to predict the futility of CPR
accurately. Therefore, it is recommended that all patients in cardiac arrest receive
resuscitation unless:
 The patient has a valid “Do Not Attempt Resuscitation” (DNAR) order.
 The patient has signs of irreversible death: rigor mortis, decapitation, or dependent lividity.
 No physiological benefit can be expected because the vital functions have deteriorated
despite maximal therapy for such conditions as progressive septic or cardiogenic shock.
Continuous Chest Compressions
(Hands-Only CPR)
If you are unable or unwilling for any reason to perform full CPR (with rescue breaths), give
continuous chest compressions after calling the local emergency number. Continue giving chest
compressions until EMS personnel take over or you notice an obvious sign of life, such as
breathing.
International first aid and resuscitation guidelines
2011 of IFRC
Each National Society will need to determine the forms of CPR that are best suited for their
student populations. Factors that need to be considered include the individual Society’s
resources, training, educational programmes offered, legislation and regulation, liability
and scientific expert input, especially the EMS with the national chain of survival. notes p.78
Automated External
Defibrillation (AED)
If the heart is damaged by disease or injury, its electrical system
can be disrupted. This can cause an abnormal heart rhythm that
can stop the blood from circulating.
The most common abnormal heart rhythm that causes sudden
cardiac arrest occurs when the ventricles simply quiver, or
fibrillate, without any organized rhythm. This condition is called
ventricular fibrillation (V-fib).
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In V-fib, the electrical impulses fire at random, creating chaos and preventing the heart from
pumping and circulating blood. The person may suddenly collapse unconscious, and stop
breathing.
Another abnormal rhythm found during sudden cardiac arrest is ventricular tachycardia, or
V-tach. With V-tach, the electrical system tells the ventricles to contract too quickly. As a result,
the heart cannot pump blood properly. As with V-fib, during V-tach the person may collapse,
become unconscious and stop breathing. In many cases, V-fib and V-tach can be corrected by
an electrical shock delivered by an AED. AEDs are portable electronic devices that analyze the
heart’s rhythm and deliver an electrical shock, known as defibrillation, which helps the heart to
re-establish an effective rhythm.
For each minute that CPR and defibrillation are delayed, the person’s chance for survival is
reduced by about 10 percent. However, by learning how to perform CPR and use an AED, you
can make a difference before EMS personnel take over.
Early CPR and defibrillation within the first 3-5 minutes after collapse, plus early advanced
care can result in high (greater than 50 percent) long-term survival rates for witnessed
ventricular fibrillation (VF). If bystander CPR is not provided, a cardiac arrest victim’s chances
of survival fall 7% to 10% for every minute of delay until defibrillation.
Defibrillation
Is the treatment of irregular, sporadic or absent heart rhythms by an electrical current to the
heart. It is the only definitive treatment for sudden cardiac arrest (SCA). Defibrillation
administered within 3-5 minutes after collapse is most successful. Every minute a victim is
unconscious translates to approximately a ten percent decrease in the likelihood of
resuscitation. After ten minutes, very few resuscitation attempts are successful. Thus, the most
important element in the treatment of SCA is providing rapid defibrillation therapy. CPR may
help prolong the window of survival, but it cannot reverse SCA.
Principles of Early Defibrillation
Early defibrillation is critical for victims of sudden cardiac arrest for the following reasons:
 The most common initial rhythm in
witnessed sudden cardiac arrest is
ventricular fibrillation (VF). When VF is
present, the heart quivers and does not
pump blood.
 The most effective treatment for VF is
electrical defibrillation (delivery of a
shock to stop the VF).
 The
probability
of
successful
defibrillation decreases quickly over
time.
 VF deteriorates to asystole if not treated.
The earlier defibrillation occurs, the higher the survival rate. When VF is present, CPR can
provide a small amount of blood flow to the heart and brain but cannot directly restore an
organized rhythm. Restoration of a perfusing rhythm requires immediate CPR and
defibrillation within a few minutes of the initial arrest.
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First Aid and CPR Reference Manual
Without bystander CPR, the chance of survival from VF cardiac arrest declines by 7% to 10%
without defibrillation. Bystander CPR improves survival from VF cardiac arrest at most
defibrillation intervals. The use of AEDs increase the number of people (lay rescuers and
healthcare providers) who can perform CPR and attempt defibrillation, thus shortening the
time between collapse and defibrillation.
Structure and Functions of AEDs
AEDs are computerized devices that are
attached to a pulse less victim with
adhesive pads. They will recommend
shock delivery only if the victim’s heart
rhythm is one that a shock can treat.
AEDs give rescuers visual and voice
prompts to guide rescuer actions.
The word automated actually means
semiautomated,
because
most
commercially available AEDs will
“advise” the operator that a shock is
needed but will not deliver a shock without an action by the rescuer (ie, the rescuer must push
the SHOCK button). A small number of fully automated AEDs are now in use.
If a fully automated defibrillator detects a rhythm that a shock can treat, it will deliver a shock
without operator intervention. Adhesive electrodes attach the AED to the patient. Most AEDS
operate in the same way and have similar components. The following sections present common
aspects of AED function and operation, including troubleshooting information.
Inappropriate Shocks or Failure to Shock
Several factors can affect AED analysis:
 Patient movement (eg, agonal gasps)
 Repositioning the patient.
AEDs are extremely safe, especially when use properly.
The Universal AED: Common Steps to Operate All AEDs
Once the AED arrives, put it at the victim’s side, next to the rescuer who will operate it. This
position provides ready access to the AED controls and easy placement of electrode pads. It
also allows a second rescuer to perform CPR from the opposite side of the victim without
interfering with AED Operation.
AEDs are available in different models. There are small differences from model to model, but
all AEDs operate in basically the same way.
Using an AED on a Child
For unwitness, out-of-hospital cardiac arrest in children, perform 5 cycles or 2 minutes of CPR
before using and attaching the AED.
For any in-hospital cardiac arrest of a child or for any sudden collapse of a child out-ofhospital, use an AED as soon as it is available.
Choosing the AED Pads or AED Child System
Some AED systems have been designed to deliver both adult and child shock doses. If you use
an AED on a child and that AED can deliver a child shock dose, follow the AED instructions to
select the lower (child) shock dose. You may need to turn a child key/switch or use child-sizepads, or both, to reduce the shock dose.
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First Aid and CPR Reference Manual
You must be careful not to deliver the child shock dose for victims over 8 years of age because
the smaller dose may not be effective for the larger or older victim, you may use the adult pads
and deliver the adult dose. If an AED has optional child pads or a key or a switch to enable the
child dose to be delivered, it is important to select the pads and settings that are correct for the
victim.
Integrating CPR and AED Use
When arriving at the scene of a suspected cardiac arrest, rescuers must rapidly integrate CPR
with use of the AED. Most of the time 2 or more rescuers are at the scene. In this case the
rescuers can initiate these functions simultaneously:
 Activating the emergency response system and getting the AED
 Performing CPR
 Operating the AED
Lone Rescuer with an AED
In some situations one rescuer with immediate access to an AED may respond to a cardiac
arrest. The lone rescuer should quickly activate the emergency response system and get the
AED. The rescuer should then return to the victim and begin the steps of CPR. The AED should
be used only if the victim does not respond, has no pulse.
There are 2 exceptions to this rule:
 If the victim is an adult and a likely victim of an asphyxia arrest (eg, drowning), the rescuer
should give 5 cycles of CPR (about 2 minutes) before activating the emergency response
system and getting and AED.
 If the victim is a child and the rescuer did not witness the arrest, the rescuer should give 5
cycles of CPR (about 2 minutes) before activating the emergency response system and
getting the AED.
Special Situations
The following 5 special situations may require the operator to take additional actions when
using an AED:
 The victim is less than 1 year of age.
Currently there is not enough evidence to recommend for or against the use of AEDs in
infants less than 1 year of age.
 The victim has a hairy chest.
If a teen or adult has a hairy chest, the AED pads may stick to the hair and may not stick to
the skin on the chest. If this occurs, the AED will not be able to analyze the victim’s heart
rhythm. The AED will then give a “check electrodes” or “check electrode pads” message.
 The victim is immersed in water or water is covering the victim’s chest.
Water is a good conductor of electricity. Do not use an AED in the water. If the victim is in
water, pull the victim out of the water. If the victims’ chest is covered with water, water
may conduct the shock electricity across the skin of the victim’s chest. This prevents the
delivery of an adequate shock dose to the heart. If the water covers the victim’s chest,
quickly wipe the chest before attaching the electrodes. If the victim is lying on snow or in a
small puddle, you may use the AED. If the chest is covered with water, quickly wipe it first.
 The victim has an implanted defibrillator or pacemaker.
Victims who have a higher risk for sudden cardiac arrest may have implanted
defibrillators/pacemakers that deliver shocks directly to the myocardium. You can
immediately identify these devices because they create a lump beneath the skin of the
upper chest or abdomen. The lump is half the size of a deck of cards, with a small overlying
scar. If you place an AED electrode pad directly over an implanted medical device, the
device may block delivery of the shock to the heart
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If you identify an implanted defibrillator/pacemaker:
 Place the AED electrode pad at least 1 inch (2.5cm) to the side of the implanted device.
 Follow the normal steps for operating an AED.
Occasionally the analysis and shock cycles of implanted defibrillators and AEDs will conflict. If
the implanted defibrillator is delivering shocks to the patient (the patient’s muscles contract in
a manner like that observed after an AED shock), allow 30 to 60 seconds for the implanted
defibrillator to complete the treatment cycle before delivering a shock from the AED.
 The victim has a transdermal medication patch or other object on the surface of the
skin where the AED electrode pads are placed.
Do not place AED electrodes directly on top of medication patch (eg, a patch of nitroglycerin,
nicotine, pain medication, hormone replacement therapy, or antihypertensive medication).The
medication patch may block the transfer of energy from the electrode pad to the heart and may
cause small burns to the skin.
To prevent the medication patch from blocking delivery of energy, remove the patch and
wipe the area clean before attaching the AED electrode pad.
BASIC LIFE SUPPORT COMPONENTS
FOR ADULT, CHILD AND INFANTS
Component
Recognition
Adult
Child
Unresponsive (for all ages)
Breathing or no normal
No breathing or only gasping
breathing (i.e. only
gasping)
No pulse palpated within 10 seconds for all ages (HCP & PR ONLY)
CPR sequence
Compression-Airway-Breathing
Compression Rate
Compression depth
Chest wall recoil
Compressions Interruptions
Airway
Compression-to-ventilation ratio
(until advanced airway placed)
Ventilations: when rescuer
untrained or trained and not
proficient
Ventilations with advanced airway
(HCP)
Defibrillation
Infant
At least 100/min
At least 1/3 AP
At least 1/3 AP
diameter
diameter
About 2 inches (5cm)
About 1½ inches (4cm)
Allow complete recoil between compressions
HCPs & PRs rotate compressors every 2 minutes
Minimize interruptions in chest compressions
Attempt to limit interruptions to <10 seconds
At least 2 inches (5cm)
Head-tilt-chin lift (HCP & PR: suspected trauma: jaw thrust)
30:2
1 or 2 rescuers
30:2
Single rescuers
15:2
2 HCP rescuers
Compressions only
1 breath every 6-8 seconds (8-10 breaths/min)
Asynchronous with chest compressions
About 1 second/breath
Visible chest rise
Attach and use AED as soon as available. Minimize interruptions in chest
compressions before and after shock; resume CPR beginning with chest
compressions immediately after each shock.
Abbreviation: AED, automated external defibrillator; AP, anterior-posterior; CPR, cardiopulmonary resuscitation; HCP, healthcare provider;
PR, Professional Rescuer
*Excluding the newly born, in whom the etiology of an arrest is nearly asphyxia.
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First Aid and CPR Reference Manual
Simplified Adult/Child CPR Algorithm (Lay
Rescuer)
Unresponsive
No breathing or no normal
breathing (only gasping)
Activate
emergency
response
Get
Defibrillator
START
CPR
PUSH HARD
PUSH FAST
Check rhythm/
shock if indicated
Repeat every 2
minutes
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Simplified Adult/Child CPR Algorithm (Healthcare
& Professional rescuer)
Unresponsive
No breathing or no normal
breathing (only gasping)
Activate
emergency
response
Get
Defibrillator
Check PULSE
START
CPR
PUSH HARD
PUSH FAST
Check rhythm/
shock if indicated
Repeat every 2
minutes
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CHAPTER 3 – Cardiac Emergencies and
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Philippine Red Cross
First Aid and CPR Reference Manual
Skill 3-1 Cardiopulmonary Resuscitation (CPR) for
Adult and Child
1. Locate the correct hand position
for chest compressions.




Kneel beside the victim
Place heel of one hand on the centre of the chest.
Place the heel of your hand on top of the first hand,
and interlock your fingers, making sure the fingers
are kept off the ribs.
Leaning forward with arms straight
2. Give chest compressions.




Press down vertically on the breastbone and
depress the chest.
Compress an adult’s chest 30 times to a
depth of at least 2 inches.
Compress a child’s chest 30 times to a depth
of about 2 inches.
Compress at a rate of at least 100 chest
compressions per minute; the 30 chest
compressions should take about 18 seconds
to complete.
Skill 3-2 Cardiopulmonary Resuscitation (CPR)
for Infant
1. Locate the correct hand and finger position for
chest compressions.



Use the same technique that is used for
CPR.
Give 30 chest compressions at a rate of
at
least 100 chest compressions per
minute.
Each compression should be about 11⁄2
inches
deep.
2. Give ventilation

Give 2 rescue breaths. If the breaths do
not make the chest clearly rise, repeat
cycles of chest compressions, and rescue breaths.
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Skill 3-3 Using of Automated External Defibrillator
(AED)
1. Turn on the AED



Switch on the AED and take out the pads.
Remove or Cut through the cloth and quickly wipe
the chest for sweat.
Shave the excessive hair in the chest to prevent
delay.
2. Attaching the pads



Remove the backing paper from the pads.
Follow diagram in the pads for placement.
Attach pads as soon as possible
3. Analysis of the AED



Make sure that no- one is touching while the AED
analyse the victim’s condition.
It will indicate if you need to shock the victim.
Continue the Prompt of the AED until advance life
support or emergency services had arrived.
Skill 3-4 Two Man Cardiopulmonary Resuscitation
(CPR) for Adult and Child
1. Provider no.1-Locate the correct hand position
for chest compressions.




Kneel beside the victim
Place heel of one hand on the centre of the chest.
Place the heel of your hand on top of the first hand,
and interlock your fingers, making sure the fingers
are kept off the ribs.
Leaning forward with arms straight
2. Provider no. 2-Position on the top of the head
of the victim.



Position your hand in the lower jaw
Immobilize the head using the forearm
Use index finger to push forward on the angle of
the lower jaw to open the mouth.
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3. Provider no.1-Give chest compressions.



Press down vertically on the breastbone and
depress the chest.
Compress an adult’s chest 15 times to a
depth of at least 2 inches.
Compress a child’s chest 15 times to a depth
of about 2 inches.
Skill 4-5 Two Man Cardiopulmonary Resuscitation
(CPR) for Infant
1. Provider no.1-Locate the correct hand
position for chest compressions.



Proceed to the bottom of the infant
Place the thumb in the centre of the chest
Place the fingers to the side of the infant to hold.
2. Provider no. 2-Position on the top of the head
of the victim.



Position your hand in the lower jaw
Immobilize the head using the forearm
Use index finger to push forward on the angle of
the lower jaw to open the mouth.
3. Provider no. 1-Give chest compressions.



Press down vertically on the breastbone and
depress the chest.
Give 15 chest compressions at a rate of at
least 100 chest compressions per minute.
Each compression should be about 11⁄2 inches
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CHAPTER 4
Airway &
Breathing
Emergencies
CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
The Respiratory System
The respiratory system includes the airway and lungs. The airway, the passage through which
air travels to the lungs, begins at the nose and mouth. Air passes through the nose and mouth,
through the pharynx (the throat), larynx (the voice box) and trachea (the windpipe), on its
way to the lungs. Behind the trachea is the esophagus. The esophagus is a tube that carries food
and liquids from the mouth to the stomach. A small flap of tissue, the epiglottis, covers the
trachea when you swallow to keep food and liquids out of the lungs.
The lungs are a pair of light, spongy organs in the chest that provide the mechanism for
taking oxygen in and removing carbon dioxide during breathing.
Air reaches the lungs through two tubes called bronchi. The bronchi branch into
increasingly smaller tubes called bronchioles. These tubes eventually lead to millions of
microscopic air sacs called alveoli. Oxygen and carbon dioxide pass into and out of the blood
through the thin cell walls of the alveoli and microscopic blood vessels called capillaries.
Air enters the lungs when you inhale and leaves the lungs when you exhale. When the
diaphragm and the chest muscles contract, you inhale. The chest expands, drawing air into the
lungs. When the chest muscles and diaphragm relax, pushing air from the lungs, the chest
cavity becomes smaller and you exhale. This ongoing breathing process is involuntary and is
controlled by the brain.
The average adult breathes about 12 to 20 times per minute, and a child or infant,
depending on age, breathes between 20 to 40 times per minute.
Relatively, this airway, which comprises the mouth and nose are smaller in children and
infants compared to adults. As a result, they can be blocked more easily by small objects, blood,
fluids or swelling.
In breathing emergencies, the oxygen supply to the body is either greatly reduced or cut off
entirely. As a result, the heart soon stops beating and blood no longer moves through the body.
Without oxygen, brain cells can begin to die within four to six minutes. Unless the brain
receives oxygen within minutes, permanent brain damage or death will result.
Regardless of the reasons, it is important for the first aider to recognize when a person is
having trouble breathing or is not breathing at all. Signals of breathing emergencies include:
 Trouble breathing or no breathing
 Slow or rapid breathing
 Unusually deep or shallow breathing
 Gasping for breath
 Wheezing, gurgling or making high-pitched noises
 Shortness of breath
 Dizziness or light-headedness
 Pain in the chest or tingling in the hands, feet or lips
 Unusually moist or cool skin
 Flushed, pale, ashen or bluish skin
 Apprehensive or fearful feelings
In a breathing emergency, air must reach the lungs. For any person, regardless of age, it is
important to keep the airway open when giving care.
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CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Foreign-body Airway Obstructions
Foreign-body airway obstruction, also known as choking, is a
common breathing emergency that occurs when the person’s
airway is partially or completely blocked by a foreign object,
such as a piece of food or a small toy; by swelling in the mouth or
throat; or by fluids, such as vomit or blood.
Types


Mild airway obstruction occurs when there is only partial
blockage of the airway.
Severe airway obstruction happens when there is complete
or total blockage of the airway.
Causes
The most common cause of choking in adults is airway obstruction caused by food, such as
when:
 Trying to swallow large pieces of poorly chewed food;
 Drinking alcohol before or during meals (Alcohol dulls the nerves that aid swallowing);
 Wearing dentures (Dentures make it difficult to sense whether food is fully chewed before
it is swallowed);
 Eating while talking excitedly, laughing, or eating too fast;
 Walking, playing, or running with food or objects in the mouth;
 In infants and children, choking occurs while eating or by putting non-food items such as
coins or toys inside the mouth while playing.
In all cases, recognition of airway obstruction is the key to successful prevention.
Signs and Symptoms







It
Clutching the throat with one or both hands (also referred to as the universal sign of
choking)
Coughing, either forcefully or weakly (usually in mild airway obstruction)
Inability to cough, speak, cry or breathe (usually in severe airway obstruction)
Making high-pitched noises while inhaling or noisy breathing
Panic
Bluish skin color
Losing consciousness if blockage is not removed
is important that the patient is asked “Are you choking?” in order to elicit any verbal or
physical response.
First Aid Management
If the choking adult or child is coughing forcefully, let him or her try to cough up the object. A
person who is getting enough air to cough or speak is getting enough air to breathe. Stay with
the person and encourage him or her to continue coughing.
For Infants (≤1 year old) shows signs of mild airway obstruction continue to watch the
infant, but do nothing else. Patients with mild airway obstruction should remain under
continuous observation until they improve, because it may develop into a severe airway
obstruction.
48 | P a g e
CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
A
conscious
adult or child who
has a completely
blocked
airway
needs immediate
care. Using more
than one technique
often is necessary
to dislodge an
object and clear a
person’s airway. A
combination of 5
back blows followed by 5 abdominal thrusts
provides an effective way to clear the airway
obstruction.
If a conscious choking adult or child
becomes unconscious, carefully lower the
person to the ground, open the mouth and look
for an object. If an object is seen, remove it with
your finger. If no object is seen, open the
person’s airway by tilting the head and try to
give 2 rescue breaths. If the chest does not
clearly rise, begin the modified CPR technique
used for an unconscious choking person.
If you determine that an adult or a child is
unconscious, not
breathing and the
chest does not rise
with rescue breaths,
retilt the head and
try another rescue
breath. If the chest
still does not rise,
assume that the
airway is blocked.
Caring
for
a
conscious choking
infant who cannot
cough, cry or breathe, you will need to give a combination of 5 back blows followed by 5 chest
thrusts.
If a conscious choking infant becomes unconscious, carefully lower the infant to the ground,
open the mouth and look for an object. If an object is seen, remove it with your little finger. If
no object is seen, open the infant’s airway by retilting the head and try to give 2 rescue breaths.
If the chest does not clearly rise, begin a modified CPR technique used for an unconscious
choking infant.
If you determine that an infant is unconscious, not breathing and the chest does not rise with
rescue breaths, retilt the head and try another rescue breath. If the chest still does not rise,
assume that the airway is blocked.
49 | P a g e
CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Special Situations
If a conscious choking person is too large for you to reach
around, is obviously pregnant or is known to be pregnant, give
chest thrusts instead. Chest thrusts for a conscious adult are like
abdominal thrusts, except for the placement of your hands. For
chest thrusts, place your fist against the center of the person’s
breastbone. Then grab your fist with your other hand and give
quick thrusts into the chest.
If you are alone and choking, bend over and press your
abdomen against any firm object, such as the back of a chair, a
railing or the kitchens sink. Do not bend over anything with a
sharp edge or corner that might hurt you, and be careful when
leaning on a rail that is elevated. Alternatively, give yourself
abdominal thrusts, using your hands, just as if you were
administering the abdominal thrusts to another person. For a
choking person in a wheelchair, give abdominal thrusts.
Avoid use of a blind finger
sweep in adults and do not use
finger sweep in infants. Manually
remove solid material in the
airway only if it can be seen. If
advance medical help has not
arrived or been called, immediately
call for local emergency number.
Aftercare and referral for medical
examination:
 After successful treatment for
FBAO, foreign material may
nevertheless remain in the
upper or lower respiratory
tract and cause complications
later.
 Victims with a persistent cough, difficulty swallowing or the sensation of an object being
still stuck in the throat should be referred for a medical examination.
Another reason for medical examination is the possibility of serious internal injuries
resulting from abdominal thrusts or injury to the airway from the object that was lodged
and removed.
Asthma Attack
Asthma is an illness in which certain substances or conditions, called “triggers,” cause
inflammation and constriction of the airways (small tubes in the lungs through which we
breathe), making breathing difficult. Triggers of an asthma attack include exercise, cold air,
allergens or irritants, such as perfume.
People diagnosed with asthma can reduce the risk of an attack by controlling environmental
variables whenever possible. This helps to limit exposure to the triggers that can start an
asthma attack.
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CHAPTER 4 – Airway & Breathing Emergencies
Causes
A trigger is anything that sets off
or starts an asthma attack. A
trigger for one person is not
necessarily a trigger for another.
Signs and Symptoms







Philippine Red Cross
First Aid and CPR Reference Manual
Ashma triggers include the following
Dust and smoke
Air pollution
Respiratory infections
Fear or anxiety
Perfume
Exercise
Plants and molds
Medications, such as aspirin
Animal dander
Temperature extremes
Changes in weather
Hoarse whistling sound during exhalation (wheezing)
Trouble breathing or shortness of breath
Rapid, shallow breathing
Sweating
Tightness in the chest
Inability to talk without stopping for a breath
Feelings of fear or confusion
First Aid Management




Remain calm. This will help the person to remain calm and
ease breathing troubles.
Help the person to sit comfortably.
Loosen any tight clothing around the neck and abdomen.
Assist the person with his or her prescribed quick-relief
medication under the following conditions:
o The victim states that he or she is having an asthma attack
and has medications (e.g., a prescribed bronchodilator) or an inhaler.
o The victim identifies the medication and is unable to administer it without assistance.
Quick-Relief Medications
Quick-relief or rescue medications also called (short-acting
bronchodilators) are used to stop an asthma attack.
These medications work quickly to relieve sudden swelling in
the lungs. They lessen wheezing, coughing and chest tightness
which allows the person having an asthma attack to breathe
easier.
The most common way to take long-term control is through
the inhalation of quick-relief asthma medications. Inhalation
allows the medication to reach the airways faster and work
quicker. There also are fewer side effects.
A metered dose inhaler (MDI) sends a measured dose of
medicine in mist form directly into the person’s mouth. The
person gently presses down the top of the inhaler. This causes a
small amount of pressurized gas to push the medicine out
quickly. Sometimes a “spacer” is used to control the amount of
medication that is inhaled. The medicine goes into the spacer
and then the person inhales the medication through the mouthpiece on the spacer.
51 | P a g e
CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Hyperventilation
Hyperventilation occurs when a person’s breathing is faster and more shallow than normal.
When this happens, the body does not take in enough oxygen to meet its demands.
Hyperventilation is the body’s way of compensating when there is a lack of oxygen. The
result is an excess of carbon dioxide which alters the acidity of the blood.
Causes
Hyperventilation often results from fear or anxiety and usually occurs in people who are tense
and nervous. However, it also can be caused by head injuries, severe bleeding or illnesses, such
as high fever, heart failure, lung disease and diabetic emergencies. Asthma and exercise can
also trigger hyperventilation.
Signs and symptoms
People who are hyperventilating feel as if they cannot get enough air. Often they are afraid and
anxious or seem confused. They may say that they feel dizzy or that their fingers and toes feel
numb or tingly.
First Aid Management






Help the person rest in a comfortable
A person who is hyperventilating from
position. Usually, sitting is more comfortable
emotion may resume normal breathing
than lying down because breathing is easier
if he or she is reassured and calmed
in that position.
down.
If the person is conscious, check for other
conditions.
Remember that a person having breathing problems may find it hard to talk. If the person
cannot talk, ask him or her to nod or to shake his or her head to answer yes-or-no
questions. Try to reassure the person to reduce their anxiety. This may make breathing
easier.
If bystanders are present and the person with trouble breathing is having difficulty
answering your questions, ask them what they know about the person’s condition.
If the person is hyperventilating and you are unsure whether it is caused by emotion, such
as excitement or fear, tell the person to relax and breathe slowly.
If the person’s breathing still does not slow down, seek medical help immediately.
52 | P a g e
CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Skill 4-1 Care for Foreign-body Airway
Obstruction for a Conscious Adult or Child
1. Stand to the side and
slightly behind the victim.

Support the chest with one
hand and bend the victim
well forward so that when
the obstructing object is
dislodged, it comes out of
the mouth rather than
further down the airway.
2. Give up to five sharp blows
between the shoulder
blades with the heel of your
other hand.

Check to see if each back
blow has relieved the airway
obstruction. The aim is to
relieve the obstruction with
a blow/slap, not to
necessarily give all five.
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CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
3. If five back blows fail to relieve the airway obstruction, give up to five
abdominal thrusts as follows:
Stand behind the victim and put
both arms around the upper part
of the abdomen.
Lean the victim forward.
Clench your fist and place it
between the umbilicus and
xiphisternum.
Grasp this hand with your other
hand and pull sharply inwards
and upwards.
Repeat up to five times.
If the obstruction is still not
relieved, continue alternating five
back blows with five abdominal
thrusts.






3. If the patient becomes unconscious:
Support the victim, while carefully lowering him or her to the ground.
If advance medical help has not arrived or been called, immediately call for local
emergency number.


Skill 4-2 Care for Foreign-body Airway
Obstruction for a Unconscious Adult or Child
1. Locate the correct hand position for chest
compressions.
Use the same technique that is used for CPR.

2. Give chest compressions.



Compress an adult’s chest 30 times to a depth of at least 2
inches.
Compress a child’s chest 30 times to a depth of about 2
inches.
Compress at a rate of at least 100 chest compressions per
minute; the 30 chest compressions should take about 18
seconds to complete.
3. Look for a foreign object.


Open the person’s mouth. (Remove the
CPR breathing barrier if you are using
one.)
If you see an object, remove it with a
finger.
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CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Skill 4-3 Care for Foreign-body Airway
Obstruction for a Conscious Infant
1. Lay the infant face down along your
arm with the head lower than the body.



Support the infant in a head downward,
prone position, to enable gravity to assist
removal of the foreign body.
A seated or kneeling rescuer should be
able to support the infant safely across his
or her lap.
Support the infant’s head by placing the
thumb of one hand at the angle of the
lower jaw, and one or two fingers from the
same hand at the same point on the other
side of the jaw. Do not compress the soft
tissues under the chin.
2. Give up to five sharp blows between the
shoulder blades with the heel of your
other hand.


Check to see if each back blow has relieved
the airway obstruction.
The aim is to relieve the obstruction with a
blow/slap, not to necessarily give all five.
3. If five back blows fail to relieve the
airway obstruction, give up to five chest
thrusts as follows:



Turn the infant into a head downward,
supine position.
This is achieved safely by placing the free
arm along the infant’s back and encircling
the back part of the head with the hand.
Support the infant along your arm, which is
placed down (or across) your thigh.
4. Find your landmarks, two fingers below
the nipple line.



Give chest thrusts (compress
approximately 1½ of the depth of the
chest). These are similar to chest
compressions but sharper and delivered at
a slower rate.
Repeat up to five times.
If the obstruction is still not relieved,
continue alternating five back blows with
five chest thrusts.
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CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
5. If the victim becomes unconscious:


Support the victim, while carefully lowering him or her to the ground.
If advance medical help has not arrived or been called, immediately call for local
emergency number.
Skill 4-4 Care for Foreign-body Airway
Obstruction for a Unconscious Infant
1. Locate the correct hand and finger position for chest
compressions.



Use the same technique that is used for CPR.
Give 30 chest compressions at a rate of at least 100 chest
compressions per minute.
Each compression should be about 11⁄2 inches deep.
2. Look for a foreign object.


If the object is seen, remove it with your little finger.
Give 2 rescue breaths. If the breaths do not make the chest
clearly rise, repeat cycles of chest compressions, foreign
object check/removal and rescue breaths.
3. Do not stop except in one of these situations:





The object is removed and the chest clearly rises with rescue
breaths.
The infant starts to breathe on his or her own.
Another trained responder or EMS personnel take over.
You are too exhausted to continue.
The scene becomes unsafe.
4. If the breaths make the chest clearly rise, quickly check
for breathing.

Care for the conditions you find.
Skill 4-3 Assisting with Asthma Inhaler
1. Help the person sit up and rest in a
position comfortable for breathing.


Ensure that the prescription is in the
person’s name and is prescribed for
“quick relief” or “acute” attacks.
Ensure that the expiration date has not
passed.
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CHAPTER 4 – Airway & Breathing Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
2. Shake Inhaler and remove mouthpiece cover.


If an extension tube (spacer) is available, attach and use it.
Tell the person to breathe out as much as possible through the mouth.
3. Have the person place his or her lips
tightly around the mouthpiece and
take a long slow breath.




As the person breathes in slowly,
administer the medication by quickly
pressing down on the inhaler canister, or
the person may self-administer the
medication.
The person should continue a full, deep
breath.
Tell the person to try to hold his or her
breath for a count of 10.
When using an extension tube (spacer) have the person take 5 to 6 deep breaths
through the tube without holding his or her breath.
2. Note the time of administration and any change in the person’s condition.





The medication may be repeated once after 1 to 2 minutes.
Have the person rinse his or her mouth out with water to reduce side effects.
Stay with the person and monitor his or her condition and give CARE for any other
conditions.
Keep the person from getting chilled or overheated.
Call the local emergency number if trouble breathing does not improve quickly.
57 | P a g e
CHAPTER 5
Bleeding and
Shock
CHAPTER 5 – Bleeding and Shock
Philippine Red Cross
First Aid and CPR Reference Manual
Bleeding
When bleeding occurs, a complex chain of events is triggered in the body. The brain, heart and
lungs immediately attempt to compensate for blood loss to maintain the flow of oxygen-rich
blood to the body tissues, particularly to the vital organs. As the brain recognizes a blood
shortage in the body, it signals the heart to circulate more blood as it constricts blood vessels in
the extremities. The brain signals the lungs to work harder to provide more oxygen.
Other important reactions to bleeding occur on a microscopic level. Platelets collect at the
wound site in an effort to stop blood loss through clotting. White blood cells prevent infection
by attacking microorganisms that enter through breaks in the skin. Over time, the body
manufactures extra red blood cells to help transport more oxygen to the cells.
Blood volume is also affected by bleeding. Normally, excess fluid is absorbed from the
bloodstream by the kidneys, lungs, intestines and skin. However, when bleeding occurs, this
excess fluid is reabsorbed into the bloodstream as plasma. This re-absorption helps to
maintain the critical balance of fluids needed by the body to keep blood volume constant.
Bleeding that is severe enough to critically reduce blood volume is life threatening. This can
cause tissues to die from lack of oxygen. Life threatening bleeding can be either external or
internal. External bleeding occurs when a blood vessel is opened from the outside such as
through a tear in the skin.
Types of External Bleeding



Arterial bleeding – This occurs when an artery is severed or opened. Bleeding is often
rapid, severe and life threatening. Because arterial blood is under pressure, it usually spurts
from the wound, making it difficult for clots to form. And because clots do not form as
rapidly, arterial bleeding is harder to control. The high concentration of oxygen gives
arterial blood a bright red color.
Venous bleeding – This occurs when a vein is severed or punctured. Veins are damaged
more often because they are closer to the skin’s surface. Venous blood is under less
pressure than arterial blood and flows steadily from the wound without spurting. If the
damage to the veins occurs deep in the body, such as to the veins in the trunk or thighs, this
produces severe bleeding that is difficult to control. Because it is oxygen-poor, venous
blood is dark red or maroon.
Capillary bleeding – This is the most common type of bleeding. It is usually slow because
the vessels are small and the blood is under low pressure. Capillary bleeding is often
described as oozing from the wound. With this type of bleeding, clotting occurs easily. The
blood’s color is usually a paler red than arterial blood. This type of bleeding is expected in
all minor cuts, scratches and abrasions.
Techniques to Control Bleeding

Direct pressure
The pressure created by placing a sterile dressing
and then a gloved hand, or even a gloved hand by
itself on a wound, can control external bleeding.
This technique is called applying direct pressure.
Pressure placed on a wound restricts the blood flow
through the wound and allows normal clotting to
occur.
59 | P a g e
CHAPTER 5 – Bleeding and Shock

Philippine Red Cross
First Aid and CPR Reference Manual
Pressure bandage
Pressure on a wound can be maintained by applying
a bandage to the injured area. A bandage applied to
control bleeding is called a pressure bandage. If
blood soaks through the bandage, do not remove the
blood-soaked bandages. Instead, add more dressings
and bandages and apply additional direct pressure.
Shock
Shock is a condition in which the circulatory system fails to deliver enough oxygen-rich blood
to the body’s tissues and vital organs. The body’s organs such as the brain, heart and lungs do
not function properly without enough blood supply. This triggers a series of responses that
produce specific signals known as shock. These responses are the body’s attempt to maintain
adequate blood flow.
Causes
Shock is a spontaneously deteriorating process mainly caused by any of the following:
 Loss of blood volume
Blood or fluid loss from blood vessels decreases blood volume, usually as a result of
bleeding, and results in adequate perfusion. Common causes are trauma to vessels or
tissues, severe burns, and fluid loss from the GI tract. Vomiting/diarrhea can also lower the
fluid component of blood.
 Pump failure
Poor pump function occurs when disease or injury damages the heart. The heart does not
generate enough energy to move the blood through the system. This usually happens
during heart attacks or when there is profound trauma to the heart.
 Dilation of peripheral blood vessels
Even though the blood vessels dilate normally, it is inadequate to fill the system and
provide efficient perfusion. This can be due to infection, drug overdose (narcotics), or
spinal cord injury.
Shock is a life-threatening condition. If any of
these signals are present, assume that the victim
has a potentially life-threatening injury or
illness:
Be aware that the early signals of shock may
not be present in young children and infants. But
because children are smaller than adults and
may have less blood volume, they may be even
more susceptible to shock.
Signs and Symptoms







Restlessness or irritability
Altered level of consciousness
Nausea or vomiting
Pale, ashen or greyish color, moist skin
Rapid breathing
Rapid and weak pulse
Excessive thirst
First Aid Management


Make the person lie down. This often is the most comfortable position for lessening pain.
Helping the person rest comfortably can lessen the body’s stress signals and slow down the
progression of shock.
Control any external bleeding.
60 | P a g e
CHAPTER 5 – Bleeding and Shock




Philippine Red Cross
First Aid and CPR Reference Manual
For victims experiencing shock without evidence of spinal injury, the legs may be raised 6
to 12 inches. If unsure, leave him or her lying flat.
Help the person maintain normal body temperature. If the person feels cool to the touch,
cover him or her with a towel or blanket to avoid chilling.
Do not give the person anything to eat or drink even though he or she is likely to be thirsty.
The person’s condition may be severe enough to require surgery, in which case it is better if
the stomach is empty.
Reassure the person every so often.
Continue to monitor the person’s breathing and for any changes in the person’s
condition. Do not wait for signals of shock to develop before caring for the underlying
injury or illness.
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CHAPTER 5 – Bleeding and Shock
Philippine Red Cross
First Aid and CPR Reference Manual
Skill 5-1 Control Bleeding
1. Cover the wound with a dressing.

Cover the wound with a clean dressing.
2. Apply direct pressure.

Apply pressure over the dressing directly to the
wound.
3. Cover dressing with a bandage.




Check for tightness of the bandage (not to tight
not to loose).
Check for distal pulse.
Check for movement.
Check for sensory, warmth and skin color.
4. If bleeding does not stops.



Apply more dressing (do not remove the initial
dressing in place).
Apply more direct pressure.
Call local emergency number or transport patient to the hospital.
Skill 5-2 Proper Shock position
1. Place the patient lying on his back
2. If no evidence of spine injury raised leg for 612 inches.
62 | P a g e
CHAPTER 6
Soft Tissue
Injuries
CHAPTER 6 – Soft Tissue Injuries
Philippine Red Cross
First Aid and CPR Reference Manual
Soft tissues make up the inner layers of the skin. These are the fat and muscles beneath the
skin’s outer layer. Soft tissue damage may occur at the skin’s surface or deep within If this
happens, severe bleeding may occur either on the skin’s surface or underneath it, where
detection is hardest. Germs can also enter the body through wounds and become the cause of
infection.
The skin is composed of many layers. The two primary layers of the skin are the outer layer,
the epidermis, that provides a barrier to bacteria and other organisms which cause infection;
and a deeper layer, called the dermis, that contains the nerves, hair roots, sweat and oil glands
and blood vessels. Because the skin is well supplied with blood vessels and nerves, most soft
tissue injuries are likely to bleed and be painful. The hypodermis, located beneath the
epidermis and dermis, contains fat, blood vessels and connective tissues. This layer insulates
the body to help maintain body temperature. The fat layer also stores energy.
The muscles lie beneath the fat layer and comprise the largest segment of the body’s soft
tissues. Although the muscles are considered soft tissues, muscle injuries are discussed more
thoroughly in Chapter 8.
Wounds
A wound is any physical injury involving a break in the layers of the skin.
generally classified as either closed or open.
Wounds are
Complications
Wounds have the following complications:
 Bleeding (external and internal) and shock.
 Infection - Open injuries have a potential for serious bacterial wound infections or even
fatal illnesses.
 Tetanus is a severe infection that can result from a puncture or a deep cut. Tetanus is a
disease caused by bacteria. These bacteria produce a powerful poison in the body. The
poison enters the nervous system and can cause muscle paralysis. Once tetanus reaches the
nervous system, its effects are highly dangerous and can be fatal. Fortunately, tetanus often
can be successfully treated with medicines called antitoxins.
 Rabies is a disease caused by a virus transmitted commonly through the saliva of diseased
mammals, such as dogs and cats. If not treated, rabies is fatal. Anyone bitten by a wild or
domestic animal must get professional medical attention as soon as possible.
Closed Wound
A closed wound is a wound
where the outer layer of the skin
is intact and the damage lies
below the surface. It is usually
caused by the application of
external force, such as in motor
vehicle accidents, falls or from
blunt objects, resulting in
contusions or bruises. A closed
wound may bleed internally.
Signs and Symptoms







Tender, swollen, bruised or hard areas of the body,
such as in the abdomen
Rapid, weak pulse
Skin that feels cool or moist or looks pale or bluish
Vomiting of blood or coughing up blood
Excessive thirst
An injured extremity that is blue or extremely pale
Altered mental state, such as the person becoming
confused, faint, drowsy or unconscious
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CHAPTER 6 – Soft Tissue Injuries
Philippine Red Cross
First Aid and CPR Reference Manual
First Aid Management





Apply an ice pack to the area to decrease bleeding beneath the skin and to help control both
pain and swelling. Fill a plastic bag with ice and water, or wrap ice in a wet cloth and apply
it to the injured area for about 20 minutes. Place a thin barrier between the ice and the bare
skin. Remove the ice and wait for 20 minutes before reapplying. If the person is not able to
tolerate a 20–minute application, apply the ice pack on and off for periods of 10 minutes.
Keep the person from getting chills.
Elevating the injured part may help to reduce swelling. However, do not elevate the injured
part if it causes more pain. Be sure that a person with an injured lower extremity bears no
weight on it until advised to do so by a medical professional.
Do not assume that all closed wounds are minor injuries. Take the time to find out whether
more serious injuries could be present.
With all closed wounds, help the person to rest in the most comfortable position possible.
It is also helpful to comfort and reassure the person.
Open Wound
In an open wound, the outer layer of skin is broken. The break in the skin can be as minor as a
scrape of the surface layers or as severe as a deep penetration. External bleeding is often a
factor when treating open wounds. The amount of bleeding depends on the location and
severity of the injury.
Types, Causes and Signs and Symptoms





Abrasions are the most common type of open wound. These are usually caused by objects
rubbing roughly against the skin and thereby scraping the outer layers. Abrasions do not
bleed much but are usually painful due to the exposure of sensitive nerve endings.
A laceration is a cut in the skin which is commonly caused by an object such as a knife, a
pair of scissors or glass penetrating the skin. It can also occur when blunt force splits the
skin. Deep lacerations may cut layers of fat and muscle in the body which results in both
nerve and blood vessel damage. There may be heavy bleeding or none at all.
Lacerations are not always painful because damaged nerves cannot send pain signals to the
brain. But infections can easily occur through lacerations if proper care is not given.
An avulsion is a serious soft tissue injury. It happens when a portion of the skin and its soft
tissues is partially or completely torn. This type of injury often damages deeper tissues,
causing significant bleeding.
An amputation occurs when a violent force completely tears away a body part. In some
cases, bleeding is actually easier to control because the tissues close around the vessels at
the injury site. If there is violent tearing, twisting or crushing of the extremity, bleeding may
be harder to control.
Punctures usually occur when objects such as nails or gunshot pierce the skin. Puncture
wounds do not bleed much unless a blood vessel has been injured. However, an object that
goes into the soft tissues beneath the skin can carry germs deep into the body. These germs
can cause infections—sometimes serious ones. If the object remains in the wound, it is
called an embedded object.
First Aid Management
General care for open wounds includes controlling bleeding, preventing infection and using
dressings and bandages correctly.
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Minor Open Wounds
 Use a barrier between your hand and the wound. If readily available, put on disposable
gloves and place sterile dressings on the wound.
 Apply direct pressure for a few minutes to control the bleeding.
 Wash abrasions and other superficial wounds with clean, warm, running tap water for
about five minutes.
 Apply a Povidone-iodine (PVP-I) antiseptic solution or, if available, a triple antibiotic
ointment or cream. Make sure that the person has no known allergies or sensitivities to
these medications.
 Cover the wound with a sterile dressing, either with a gauze or with an adhesive bandage.
 Wash your hands immediately after giving care.
Major Open Wounds
 Call the local emergency number.
 Put on disposable gloves. Wear eye and face protection if you suspect that blood may
splatter from the open wound.
 Control bleeding by applying direct pressure or employing a pressure bandage.
 Monitor airway and breathing. Observe closely for signals that may indicate that the
person’s condition is worsening. Look closely at these signs: faster or slower breathing,
marked changes in skin color, and extreme restlessness.
 In cases where the injured party is in shock, keep him or her from experiencing chills or
feeling overheated.
 Have the person rest comfortably and provide reassurance.
 Wash your hands immediately after giving care, even if gloves were worn.
Special Considerations
Open chest wound






Call the local emergency number.
Put on disposable gloves.
Help the patient sit down properly. Encourage him to
lean towards the injured side and cover the wound
with the palm of his hand.
Place a sterile dressing or clean non-fluffy pad over
the wound and surrounding area. Cover with an
occlusive dressing (plastic bag, foil or kitchen film).
Secure firmly with adhesive tape on three edges only
so that the dressing is taut. A taped-down dressing
keeps air from entering the wound when the person inhales. See that there is an open
corner which allows air to pass through when the person exhales.
Take steps to minimize shock.
Monitor the person’s breathing.
An open chest wound is a life-threatening injury that occur when an object, such as a
knife or bullet, penetrates the chest wall, or when a fractured rib breaks through the
skin.
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Open abdominal wounds.








Put on disposable gloves or use another barrier.
Carefully position the person on his or her back with the knees bent, if that position does
not cause pain.
Do not apply direct pressure.
Do not push any protruding organs back into the open wound.
Remove clothing from around the wound.
Apply moist, sterile dressings loosely over the wound. Tap water that is clean and has been
warmed can be used to moisten the dressings.
Cover dressings loosely with plastic wrap, if available.
Take necessary steps to minimize shock.
Avulsion
If the victim has an avulsion in which a body part has been completely severed;
 Call the local emergency number.
 Put on disposable gloves.
 Wrap the severed body part in sterile gauze or any clean material, such as a washcloth.
Place the wrapped part in a plastic bag. Keep the body part cool by placing the bag on ice.
Do not place the bag on dry ice or in ice water.
 Make sure the part is transported to the medical facility with the victim.
Embedded object
If the victim has an embedded object in the wound:
 Call the local emergency number.
 Put on disposable gloves.
 Do not remove the object yourself.
 Use bulky dressings to stabilize the object.
 Any movement of the object can result in further tissue damage.
 Control bleeding by bandaging the dressing in place around the object.
 If the object is lodged in the airway of the injured party, transport the patient immediately
to the hospital if there is no medical help available.
 Wash your hands immediately after giving care.
Bullet wounds
Military assault rifles and handguns shoot bullets at high speed. Under International
Humanitarian Law, all bullets used by armies must be manufactured to prevent exploding or
fragmenting when these hit a human body. However, due to various factors such as ricocheting
off a wall, a tree, or the ground, some bullets do break up into fragments in the body.
Characteristics of bullet wounds:
 The amount of tissue damage varies according to the size and speed of the bullet, its
stability in flight, and the bullet’s construction.
 It is usually single.
 It is usually a small entry wound.
 There may or may not be an exit wound but, if there is, the size is variable.
Blast injury
The detonation of high-energy explosives creates a blast wave in the air that can travel around
objects such as buildings or walls. The wave causes rapid and large changes in atmospheric
pressure. As this blast of air circulates around the area where someone is passing through, this
action may affect parts of the body that normally contain air.
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There may be rupture of:
 an eardrum which can cause deafness and blood to ooze from the ear;
 the lung sacs (alveoli) which can cause respiratory distress;
 the intestines which can lead to the contents of the gut spilling into the peritoneum;
 solid organs, such as the liver, which can cause internal haemorrhage.
Things to Remember:
A blast victim may not have any external injury.
A single, large explosion may injure many people at the same time. Some injuries are due
to the blast wave itself, others are due to burning and fragments sent off by the explosion.
 The blast wave may also throw people against walls which may result in blunt injuries.
The secondary fragments from broken glass and debris caused by the blast wave may also
cause penetrating wounds.
 Finally, a blast may cause a building to collapse and people caught inside may suffer crush
injuries.


Burns
Burns are injuries to the skin and to other body tissues that is caused by heat, chemicals,
electricity, or radiation.
Prevention




Heat burns can be prevented by following fire safety practices. Being careful around
sources of heat is also a good deterrent against injury.
Chemical burns can be prevented by following safety practices on the use of chemicals and
following manufacturers’ guidelines when handling them.
Electrical burns can be prevented by following safety practices around electrical lines and
equipment. Vacating outdoor areas where lighting could strike may also help.
Sunburn can be prevented by wearing appropriate clothing and applying sunscreen to the
skin. Sunscreen should have a sun protection factor (SPF) of at least 15.
Classification
Generally, burns are classified according to its depth:
 Superficial (first-degree) burns
o Involve only the top layer of skin
o Cause skin to become red and dry
o Usually painful and swollen
o Usually heal within a week without permanent scarring
o Sunburn is a good example of a superficial burn.
 Partial-thickness (second-degree) burns
o Involve the top layers of skin
o Cause skin to become red
o Usually painful
o Have blisters that may open and weep clear fluid, making the skin appear wet
o May appear mottled and may often swell
o Usually heal in 3 to 4 weeks and may scar
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Full-thickness (third-degree) burns
o May destroy all layers of skin and some or all of the underlying structures—fat, muscles,
bones and nerves
o The skin may be brown or black (charred) with the tissue underneath sometimes
appearing white
o It can either be extremely painful or relatively painless (if the burn destroys nerve
endings)
o Healing may require medical assistance, and scarring is likely.
Critical burns
Critical burns are those burns that require immediate medical care. These are based on factors
such as depth, area and location. The following are considered critical burns:
 Full thickness burns that cover more than five percent of the body’s surface area. The Rule
of Nine and The Rule of Palm is used to determine the extent of injury of the affected area.
o The Rule of Nine assigns a percentage value to each part of an adult body and is modified
taking into account the different bodies of small children and infants.
o The Rule of Hand considers the victim’s hand proportions, with the exclusion of the
finger and thumb; to represent about one percent of his or her total body surface.
 Partial thickness burns that covers more than 10 percent of the body’s surface area or those
that can be found in multiple locations.
 Burns to the face, genitals, and injuries that completely encircle the hands or feet which
may cause possible constriction and prevent circulation.
 Burns caused by chemicals, electricity and explosives.
 Burns involving someone under five years old or older than five who have thinner skin and
often burn more severely.
 Burns involving people with chronic medical problems such as heart or kidney ailments.
People who may be undernourished. People who are exposed to burn sources who may not
be able to leave the area.
First Aid Management
Thermal burns
 Check the scene for safety.
 Stop the burning by removing the victim from the source of the burn.
 Check for life-threatening conditions.
 Cool the burn with large amounts of cold running water. Do not use ice or ice water except
on a small, superficial burn and then for no more than 10 minutes. Ice causes the body to
lose heat rapidly and further damages delicate tissues.
 Cover the burn loosely with a sterile dressing. The bandage should not put pressure on the
burn surface.
 Prevent infection. Do not break blisters. Do not touch a burn with anything except a clean
covering. Do not put ointments, butter, oil or other commercial or home remedies on
blisters, deep burns or burns that may require medical attention.
 Apply a triple antibiotic ointment if the person has no known allergies or sensitivities to the
medication.
 Take steps to minimize shock. Keep the victim from getting chilled or overheated.
 Comfort and reassure the victim.
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Chemical Burns
 Remove the chemical from the skin as quickly as possible. It is important to remember that
the chemical will continue to burn as long as it is on the skin. If the burn was caused by dry
chemicals, brush off the chemicals using gloved hands or a towel and remove any
contaminated clothing before flushing with tap water (under pressure). Be careful not to
get the chemical on yourself or on a different area of the person’s skin.
 Flush the burn with large amounts of cool running water. Continue flushing the burn for at
least 20 minutes or until advanced medical personnel take over.
 If an eye is burned by a chemical, flush the affected eye with water until advanced medical
personnel take over. Tilt the head so that the affected eye is lower than the unaffected eye
as you flush.
 If possible, have the person remove contaminated clothes to prevent the spread of infection
while you continue to flush the area. Be aware that chemicals inhaled can be potentially
damaging to the airway or lungs.
Electrical Burns
 Never go near the person until you are sure that he or she is no longer in contact with the
power source.
 Turn off the power at its source and be aware of any life threatening conditions.
 Call the local emergency number. Any person who has suffered from an electrical shock
needs to be evaluated by a medical professional.
 Be aware that electrocution can cause cardiac and respiratory emergencies. Therefore, be
prepared to perform CPR or use an automated external defibrillator (AED).
 Care for shock and thermal burns.
 Look for entry and exit wounds and give appropriate care.
 Remember that anyone suffering from electric shock requires advanced medical attention.
Radiation Burns
 Care for a radiation burn, i.e. sunburn, as you would for any thermal burn.
 Always cool the burn and protect the area from further damage by keeping the person away
from the burn source.
Bandaging
Definitions and Types



Dressings are pads placed directly on the wound to absorb blood and other fluids and to
prevent infection. They need to be kept sterile. Most dressings are porous which allow for
better air circulation. This helps promote healing. Larger dressings cover very large
wounds and even multiple wounds in one body area.
An occlusive dressing is a bandage or dressing that closes a wound or damaged area of the
body. It prevents the injury from being exposed to air or water.
A bandage is any material that is used to wrap or cover any part of the body. Bandages are
used to hold dressings in place, apply pressure to control bleeding, protect a wound from
dirt or infection, and to provide support to an injured limb or body part. Any bandage
applied snugly to create pressure on a wound or an injury is called a pressure bandage.
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Bandages are of different types:
o Adhesive compresses are available in assorted sizes and come with a small pad of nonstick gauze on a strip of adhesive tape which is directly applied to minor wounds.
o Bandage compresses are thick
gauze dressings attached to a
bandage that is tied in place.
Bandage
compresses
are
specially designed to help control
severe bleeding and usually come
in sterile packages.
o Roller bandages are usually made
of gauze or gauze-like material. A
roller bandage generally is
wrapped around the body part. It
can be tied or taped into place. A
roller bandage may also be used
to hold a dressing in place, secure
a splint or control external
bleeding.
o Elastic roller bandages, sometimes called elastic wraps, are designed to keep continuous
pressure on a body part.
o Triangular Bandages are pieces of cloth that are cut into triangles. These can be used as
slings to cover large areas. Folded into a cravat, it can be used just like a roller bandage.
It usually measures 40”x40”x56”.
General bandaging guidelines





Use a dressing that is large enough to extend at least one inch beyond the edge of the
wound.
Check for feeling, warmth and color in the area below the injury site. Observe fingers and
toes before and after applying the bandage.
A bandage should be snug, but not so tight as to interfere with circulation, either at the time
of application or later if swelling occurs.
Do not cover fingers or toes. By keeping these parts uncovered, you will be able to see if the
bandage is too tight. If fingers or toes feel cool to the touch or seem to look pale or blue, the
bandage may be too tight and should be loosened slightly.
Apply additional dressings and a supplementary bandage if blood soaks through the first
covering. Do not remove the blood-soaked bandages and dressings. Disturbing them may
disrupt the formation of a clot and restart the bleeding.
Square Knot
A square knot (or reef knot) is used to tie the ends of a triangular
bandage. It is easy and quick to tie and untie.
It is formed by tying a left-handed overhand knot and then a
right-handed overhand knot, or vice versa. A common mnemonic
for this procedure is "right over left, left over right, makes a
knot both tidy and tight."
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Skill 6-1 First Aid for an Abrasion or Minor Cut
1. Clean the Wound


Clean it by rinsing under warm running tap water
for about 5 minutes.
Pat the wound dry using a gauze swab.
2. Apply Antiseptic Solution if available


Use Povidone Iodine or a triple antibiotic
ointment or cream.
Sure that the person has a known allergies or
sensitivities to these medicines.
3. Cover the Wound

Cover the wound with a sterile dressing a bandage
or with and adhesive bandage.
Skill 6-2 Application of an Occlusive Dressing on a
Wound
1. Use a dressing that is large enough.

This is not too pulled or sucked into the chest cavity.
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2. Tape the dressing in place.

You may tape
the dressing
down on all
four sides, or
you may you
may create a
flutter valve, a
one-way that
allows air to
leave but not
return, by tapping only three sides of the dressing.
3. Carefully observe after placement of the occlusive dressing.
Skill 6-3 Technique for Stabilization an Impaled
Object
1. Do not
remove the
object
yourself.
2. Use bulky
dressings to
stabilize the
object.
3. Control
bleeding by
bandaging
the dressing
in place
around the object.
4. Wash your hands immediately after giving care.
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Skill 6-4 Tying and Untying of a Square Knot
Tying
1. Pass the right
end over and
under the left
end.
2. Bring both
ends up again.
3. Pass the left
end over and
under the right
end.
4. Pull the ends
firmly and
tighten; tuck
both ends.
Untying
1. Pull one end
and one piece
of bandage
apart.
2. Hold the knot;
pull the end
through it and
out.
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Skill 6-5 Folding a Triangular Bandage into a
Cravat
1. Bring the point (apex) of the triangular
bandage to the middle of the base.
2. Then fold
lengthwise
along the
middle.
3. To make it
narrower, fold it
again until you
obtain the
desired width.
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Skill 6-6 Bandaging Techniques-Using a Triangular
Bandage
Top of the Head
1. Fold a hem about 2 inches wide along
the base.
2. Put the bandage in place with the hem
on the outside.


Place the bandage on the head so that the
middle of the base lies on the forehead
and is close down to the eyebrows.
Make sure that the point hangs down the
back.
3. Carry the two ends
around the head
above the ears and
cross (do not tie)
them just below the
bump of the back of
the head.
4. Draw the ends
snugly, carry them
around the head,
and tie them in the
center of his or her
forehead.
5. Steady the head
with one hand and
with the other draw
the point down
firmly behind to
hold the compress
securely against the
head.
6. Pick up the point and tuck it in where the bandage ends cross.
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Forehead or Eye
1. Place the center of the cravat over the
dressing that covers the wound.
2. Carry the ends around to the opposite
of the head and cross them.
3. Bring them back to the starting point
and tie them.
Ear, Cheek or Jaw
1. Use a wide cravat.

Start with the
middle of the cravat
over the dressing
that covers the
cheek or ear.
2. Carry one end over
the top of the head
and the other under
the chin.
3. Cross the ends at the
opposite side,
bringing the short
end back around the
forehead and the
long end around the
back of the head.
4. Tie them over the
dressing.

Never use this
method for jaw
fractures when there is bleeding in the mouth or if the person is about to vomit.
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Chest
1. Place the center of the bandage on the
dressing with the point resting on the
shoulder at the side of the injured chest and
its base parallel to the ground.
2. Fold a hem about 2 inches outward along the
base then carry both ends firmly around the
body and tie them at the back.
3. Twist both ends together and bring them up
to the shoulder
where the point is
and tie them as
well.
4. Be sure to fold
outside hems at
each side of the
bandage before
tying the point.
Shoulder
1. Using a wide cravat, place a third of its length
on the dressing with the short end towards
the front.
2. Carry the other end passing down the armpit
and back to the shoulder, crossing the short
end and covering the dressing.
3. Continue bringing the same end around the
back, then the other armpit, and back to the
front where it is
tied with the short
end.
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Arm or Leg
1. With a cravat, place
it diagonally along
the arm or leg with
a third of its length
on the dressing.

The short end
should be towards
the upper part.
2. Starting below the
dressing, wrap the
other end around
the arm or leg.

Use overlapping
spiral turns upward
until it covers the
dressing and the
end reaches the
other end.
3. Fold the short end
back and wrap it
around the
extremity.

To reverse its direction, go opposite that of the other end.
4. Tie the ends as a square knot.
Elbow or Knee
1. Bend the elbow or
knees at a right
angle unless this
movement produces
pain.
2. Use a rather wide
bandage.

Start with the
middle of the
bandage over the
dressing at the
elbow or knee.
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3. Carry the ends
around in opposite
directions – one end
around the upper
arm or leg and the
other end around
the lower part –
crossing them in the
hollow.
4. Continue around
covering the dressing and then go back to the hollow and tie to the outside.
Palm
1. Place the center of
the cravat over the
dressing.

The palm should be
facing upward.
2. Starting with the end
on the thumb side of
the hand, carry this
end under and
around the hand.
3. Next, pass on the
wrist side of the
other end, and then
back to same side
where it started.
4. Carry the other end
under and around the hand twice, with the first wrap passing behind the
thumb and the second one between the thumb and the first end.
5. Cross both ends at the wrist and tie them.
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Hand or Foot
1. Place the hand or foot
on the center of the
bandage with the
point towards the
fingers or toes and
the base towards the
wrist or heel.
2. Bring the point
towards the wrist or
ankle to cover the
hand or foot in the
process.
3. Fold an outward hem
along the base then
bring and cross the
ends on top of the
hand or foot.
4. Cross the ends in
opposite directions
around the wrist or
ankle then tie them.
5. Draw the point
towards the wrist or
ankle and tuck it in
the folds where the
ends cross each other.
Skill 5-7 Bandaging Techniques-Using a Roller
Bandage
Anchoring
1. Place the end of the
bandage on a bias (or
offset) at the starting
point.
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2. Encircle the part
while allowing the
corner of the bandage
end to protrude.
3. Turn down the
protruding tip of the
bandage and encircle
the part again.
Tying off
(if without adhesive tape, retainers or clips)
1. Take the bandage end
in a direction away
from the body part
being covered.
2. Loop around the
thumb or finger and
continue back to the
opposite side of the
body part.
3. Encircle the part with
the looped end with
the free end and tie.
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Turns
Circular – This is done by simply encircling the part with each layer of
bandage superimposed on the previous one. Its use is limited to covering parts
of uniform width such as the head, chest or abdomen.
 Spiral (open or closed) – This method is used to encircle body parts with
varying diameters
such as the limbs. It
may be applied as
temporary bandage,
like a splint or as a
holder, to put a large
burn dressing in
place. It may be
closed simply by
encircling the part
until all gaps are
closed.
 Figure-of-eight
–
This is useful for
bandaging
body
joints such as the
wrist, shoulder, knee
or ankle.

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Poisoning
CHAPTER 7 – Poisoning
Philippine Red Cross
First Aid and CPR Reference Manual
A poison is any substance that can cause injury, illness or death when introduced into the body.
Poisons include solids, liquids, gases and vapors. A poison can enter the body through four
ways – ingestion, inhalation, injection and absorption.
I. Ingested Poisons
Ingestion means swallowing. Poisoning by ingestion may include any of the following:
Food poisoning
Food poisoning occurs when food or water that has been contaminated with certain types of
bacteria, parasites, viruses, or toxins is swallowed.
Most cases of food poisoning are due to common bacteria such as Staphylococcus or
Escherichia coli (E. coli). Another rare but deadly type of food poisoning is botulism which is
caused by the bacteria Clostridium botulinum. Even common root crops such as cassava
(kamoteng kahoy or balinghoy), which contains cyanide, taro (gabi) and yam (ube) can be toxic
if not properly processed and cooked. Another type of poisoning prevalent in the Philippines is
red tide or paralytic shellfish poisoning (PSP) caused by eating contaminated mussels
(tahong) and other shellfish. Eating puffer fish (butete) is also equally fatal as it also contains a
very potent neurotoxin (tetrodotoxin) that can cause paralysis of the breathing muscles and
instantaneous death.
Prevention
 Carefully wash your hands before cooking or cleaning. Always wash them again
after touching raw meat.
 Promptly refrigerate any food that will not be eaten. Keep the refrigerator set to 4.4
°C or below.
 DO NOT use outdated foods, packaged food with broken seals, or cans that have
bulges or dents.
 DO NOT consume foods that have an unusual odor or a spoiled taste.
 Only drink water that has been treated or chlorinated.
 DO NOT eat wild mushrooms.
 DO NOT eat fish that are known to be toxic or shellfish that have been exposed to
red tides.
Signs and Symptoms
The signs and symptoms of food poisoning, which can begin between 1 to 48 hours after eating
contaminated food, include nausea and vomiting, abdominal pain, diarrhea, fever, dehydration
and weakness. Paralytic shellfish poisoning may also result in tingling or burning lips, gums,
tongue, face, neck, arms, legs, and toes. Shortness of breath, dry mouth, a choking feeling,
confused or slurred speech and loss of coordination may be also noted as signs.
Caustics
Strong acids and alkalis when swallowed can burn the tongue, mouth, esophagus, and stomach.
These burns may cause perforation (piercing) of the esophagus or stomach. Food and saliva
leaking from a perforation can cause severe infection within the chest or abdomen. This can
prove to be deadly.
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Common sources of caustics include solid and liquid drain and toilet bowl cleaners, muriatic
acids, car battery fluids, rust removers, bleaches, detergents and ammonia-containing
products.
Industrial products are usually more concentrated than household products and thus tend to
be more dangerous.
Signs and Symptoms
For caustics ingestion, pain in the mouth and throat develops rapidly, usually within minutes.
This can be severe, particularly when swallowing. Coughing, drooling, an inability to swallow,
vomiting with or without blood, and shortness of breath may occur.
In severe cases involving strong caustic substances, a person may develop shock, difficulty in
breathing, or chest pain. This may even lead to death. Airway burns may cause coughing, rapid
breathing, or shortness of breath.
Hydrocarbons
Hydrocarbons include gasoline, diesel fuel, kerosene, lighter fluids, paints, lacquer, glue and
solvents. Swallowed hydrocarbons can enter and irritate the lungs and can lead to severe
pneumonia (chemical pneumonitis).
 Dancing Firecracker (Watusi)
Watusi is usually reddish in color, about 1 ½ inches in length and 1/10 inch in width. It is
usually ignited by friction to produce a dancing movement and a crackling sound.
Watusi is often mistaken by children for sweets. The firecracker when ingested may
explode in the gastrointestinal tract. This results in burns or even ruptures of the stomach
or intestines. More commonly, it causes serious and fatal chemical poisoning.
Watusi is made of yellow phosphorus, potassium chlorate, potassium nitrate and
trinitrotoluene (TNT). All these substances are toxic. Yellow phosphorus does the most
damage.
The symptoms of phosphorus poisoning include abdominal pain, vomiting, diarrhea,
garlic breath odor, burns in the mouth and throat, yellowing or jaundice of the skin (due to
liver damage), and heart rate irregularities. It also impairs the central nervous system,
causing restlessness, drowsiness, stupor, or coma.
 Pesticides
Pesticides, especially those that contain organophosphate and carbamate, can also be
deadly to humans when swallowed accidentally or used in suicide attempts. These
examples of organophosphates include malathion, parathion, diazinon, dichlorvos,
chlorpyrifos, and sar in. Some of these compounds are derived from nerve gases.
Organophosphate and carbamate insecticides make certain nerves “fire” erratically. This
causes many organs to become overactive and eventually to stop functioning.
The symptoms of Organophosphates and carbamates cause eye tearing blurred vision,
over salivation, sweating, coughing, vomiting, frequent bowel movements and urination.
There is difficulty in breathing. Muscles can twitch uncontrollably and weaken
considerably.
Drug overdose
Drug overdoses are sometimes caused intentionally to commit suicide or to inflict self-harm.
Intentional or unintentional misuses of medication also result too many drug overdoses. These
may involve the use of stimulants, sedatives, pain relievers, and even vitamins.
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Prevention
Keep all toxic chemicals and medicines locked up. Ensure that they are in their original
containers and are out of children’s reach.
 Use personal protective equipment when handling toxic chemicals.
 Use chemicals only for their approved and intended purpose. Dispose empty containers
promptly and properly.

First Aid Management
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If the person is in a toxic area, remove the person from the scene. Do this only if you are
able to do so without endangering yourself.
Check the person’s level of consciousness and breathing.
Check for any life-threatening conditions.
Ask questions to get more information if the person is conscious.
Look for any containers and take them with you to the telephone area.
Call the National Poison Management & Control Center (NPMCC) or the local/regional
poison control center. (See appendix for contact numbers in various regions and cities).
Follow the directions of the NPMCC or local/regional poison control center.
If unable to contact the NPMCC or local/regional poison center, bring the patient
immediately to the hospital.
DO NOT give the person anything to eat or drink. Do not induce vomiting unless instructed
by a medical professional.
Save some samples of the person’s vomit if you do not know how to classify the poison. The
hospital may analyze it to identify the poison.
A person who has swallowed a caustic substance should not be made to vomit. This is
because caustic substances can cause as much damage returning up the esophagus as they
did when swallowed.
DO NOT dilute acids with water, especially sulfuric acid. Sulfuric acid reacts vigorously with
water and produces excessive heat. This causes injuries to the gastrointestinal tract.
The Department of Health recommends giving six to eight egg whites to a child and eight to
twelve egg whites to an adult who has ingested a watusi. These egg whites slow down the
absorption of the poisonous substance to the body.
II. Inhaled Poison
Poisoning by inhalation occurs when a person breathes in toxic fumes. These may involve any
of the following:
Carbon monoxide
Carbon monoxide (CO) is a by-product of incomplete combustion and is found in fumes such as
those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges. This
can also be produced by burning charcoal and wood.
The gas is colorless, odorless and non-irritating. It is highly lethal and can cause death after
only a few minutes of exposure.
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Prevention
Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent,
or camper.
 Never leave the motor running in a vehicle parked in an enclosed or partially enclosed
space such as a garage.
 Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine
outside an open window, door, or vent where exhaust fumes can enter into an enclosed
area.

Signs and Symptoms
Exposure to carbon monoxide can cause loss of consciousness and death. The most common
symptoms of CO poisoning are headaches, dizziness, weakness, nausea, vomiting, and chest
pains. People who are sleeping or who have been drinking alcohol can die from CO poisoning
before ever having symptoms.
Cyanide
Cyanide is used in manufacturing paper, textiles, and plastics. It is present in chemicals used to
develop photographs. Cyanide salts (NaCN or KCN) are used in metallurgy for electroplating,
metal cleaning, and removing gold from its ore.
Breathing cyanide gas (HCN) causes the most harm, although ingesting cyanide can be toxic
as well. When cyanide is inhaled, its composition can prevent the cells of the body from getting
oxygen. When this happens, the cells die.
Cyanide is more harmful to the heart and brain than to other organs because the heart and
brain use a lot of oxygen.
Prevention
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First, get fresh air by leaving the area where the cyanide was released. Moving to an area
with fresh air is a good way to reduce the possibility of death from exposure to cyanide
gas.
If the cyanide release was outside, move away from the area where the cyanide was
released. If the cyanide release was indoors, get out of the building.
If leaving the area that was exposed to cyanide is not an option, stay as low to the ground
as possible.
Signs and Symptoms
Exposure to cyanide by any route may cause rapid breathing, restlessness, dizziness, weakness,
headaches, nausea, vomiting, and a rapid increase in heart rate. Cyanide In large amounts can
cause convulsions, low blood pressure, a slower heart rate, loss of consciousness and lung
injuries. Respiratory failure can even lead to death.
Chlorine
Chlorine (Cl) is an element use d in industry and is found in some household products. It can
also take the form of a poisonous gas.
It’s most important use is as a bleach in the manufacture of paper and cloth. Chlorine is
mostly found in drinking water which can kill harmful bacteria. It is also used as part of the
sanitation process for industrial waste and sewage. Household chlorine bleach can release
chlorine gas if it is mixed with other cleaning agents.
When chlorine gas comes into contact with moist tissues such as the eyes, throat, and the
lungs, an acid is produced that can damage these tissues.
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Prevention
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Leave the area where the chlorine was released and get to fresh air. Quickly moving to
an area where fresh air is available is highly effective in reducing exposure to chlorine.
If the chlorine release was outdoors, move away from the area where the chlorine was
released. Go to the highest ground possible. Chlorine is heavier than air and will sink to
low-lying areas. If the chlorine release was indoors, get out of the building.
Signs and Symptoms
During or immediately after exposure to dangerous concentrations of chlorine, the following
signs and symptoms may develop: coughing, chest tightness, burning sensation in the nose,
throat, and eyes, watery eyes, blurred vision, nausea and vomiting, burning pain, redness, and
blisters on the skin. If exposed to gas, skin injury similar to frostbite may occur. If exposed to
liquid chlorine, difficult breathing or shortness of breath may be experienced immediately.
Pulmonary edema (fluid in the lungs) may occur within the next two to four hours.
Tear gas
Tear gas (or lachrymatory agents) is the common name for substances that even in low
concentrations cause temporary incapacitation. This may result in painful eye irritation and
difficulty in breathing.
Tear gas is usually shot off through grenades. When thrown into a closed space, the gas
concentration can cause asphyxia and suffocation.(ref.1)
Prevention
If you see a tear gas coming or receive a warning that it is headed your way, try to move
away or get upwind. Put on protective gear, if available. Minimize skin and face exposure by
covering up as much as possible. A gas mask, if properly fitted and sealed, provides the best
respiratory protection. A bandanna soaked in water and tied tightly around the nose and
mouth may prove adequate.
Signs and Symptoms
Exposure to tear gas can cause the following: stinging and burning of the eyes, nose, mouth and
skin. Excessive watering of the eyes, runny nose, increased salivation, sneezing, coughing and
difficulty in breathing, disorientation, confusion and sometimes panic are just some of the
signs. Gagging and vomiting may also occur.
People with respiratory, skin or eye problems, even very old or very young people, may be
especially sensitive. The effects usually occur within seconds after exposure begins and
symptoms usually end within ten to sixty minutes after exposure stops. For some people,
symptoms can take a few days to clear up completely. The effects on skin may take longer to
recover.
First Aid Management
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Remove the victims from the toxic environment. Place them in fresh air immediately, but
only if this can be performed safely.
Open all doors and windows.
Maintain a patient’s airway if the victim is unconscious.
Seek medical attention.
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In the event of tear gas contamination:
o Remove contaminated clothing with hands protected with plastic bags or disposable
gloves.
o Wash the skin thoroughly with soap and clean water.
o If possible, shower with cool water.
o Irrigate the eyes with clean water from the inside corner of the eye towards the outside
with the casualty’s head tilted back and slightly towards the side being rinsed.
o Advice less seriously affected casualties to apply these measures to themselves.
o Clothes contaminated by tear gas should be washed separately from the rest of the
laundry.
III. Injected Poison
Injected poisons enter the body through the bites or stings of insects, spiders, ticks, snakes and
some marine life. It could also enter the body through the insertion of a hypodermic needle.
Snakebites
Snakebite is considered as an occupational disease among food producers in the Philippines as
w ell as in Southeast Asia. Many deaths from snakebite are not recorded because treatment is
usually done by traditional healers.
As such, there are no reliable estimates of mortality in the Philippines. Figures of 200 to 300
deaths each year have been suggested. Fatal envenoming can only be caused by cobras.
Over 98 percent of bite sites occur on the limbs, 85 percent of which can be found mainly on
the lower limbs. These are mostly "startled" bites or "defensive" bites where the victim does
not receive a full-fanged bite. “Full-fanged bites” are those which have a full load of venom
injected into the body of the victim.
There are two important families of venomous snakes in the Philippines: Elapidae and
Viperidae.
 Elapids have short permanently erect fangs. This family includes the cobras (ulupong,
agwason), king cobra (banakon), kraits, coral snakes and the sea snakes (sigwalo, walowalo). Common Philippine species are: the Northern Phillipine Cobra (Naja philippinensis)
found in Luzon, Mindoro, Catanduanes and Masbate; Southeastern Philippine Cobra (Naja
samarensis) in Mindanao, Samar, Leyte, Bohol, Camiguin, and in other nearby islands;
Equatorial Spitting Cobra (Naja sumatrana) in Palawan and Calamianes; King Cobra
(Ophiophagus hannah); Banded or Yellow-lipped Sea Krait (Laticauda colubrine); Striped
Coral Snake (Calliophis intestinalis) in Mindanao and Palawan and the Garman's sea snake
(Hydrophis semperi) found only in Taal Lake in southern Luzon.
 Vipers have long fangs which are normally folded up against the upper jaw, but when the
snake strikes these become erect. Vipers include the typical vipers (Viperinae) and the pit
vipers (Crotalinae). The crotalids have a special sense organ, the pit organ, to detect their
warm-blooded prey. Among the local species are the Philippine Pit Viper (Parias
flavomaculatus), found almost all over the country; the North Philippine Temple Pit Viper
(Tropidolaemus subannulatus) in Luzon and Visayas; and the South Philippine Temple Pit
Viper (Tropidolaemus phillipinensis) in Mindanao.
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Prevention
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Educate yourself. Know your local snakes. Know where they like to live and hide. Know
the times of the year, what kinds of weather, and what times of the day they are most
likely to be active.
Avoid snakes or be away from them as much as possible. Avoid watching “live” snake
shows from street snake charmers.
Wear protective clothing such as proper boots and trousers. Prepare clothing beforehand,
especially when travelling to areas which are dark and steeped in grass and undergrowth.
Be especially vigilant after rains, during flooding, harvest times in the fields, and when
travelling at night. Bring a light source such as a torch, flashlight or lamp during your
walk.
Never handle, threaten or attack a snake.
Signs and Symptoms
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Signs and symptoms vary according to the species of snake responsible for the bite and the
amount of venom injected. One common sign is the presence of fang marks.
Cobra envenomation is characterized by pain usually within ten minutes of the bite. It is
followed by localized swelling of slow onset, drowsiness, weakness, excessive salivation
and partial paralysis of the facial muscles, lips, tongue and larynx.
The pulse is often weak and respiration is labored. Tissue death is not an uncommon
consequence of cobra venom poisoning. The systemic manifestations may often be more
severe. Shock, marked respiratory depression, and coma may rapidly develop.
Crotalid envenomation is characterized by immediate and usually progressive swelling and
pain.
Viper venom poisoning is characterized by burning pain of rapid onset, swelling and edema.
There is also patchy skin discoloration and changes of color in the area of the bite. Regional
lymph nodes may be enlarged, painful and tender. There may be tingling or numbness over
the tongue and mouth or scalp. Certain numbness, tingling and pricking sensations may be
felt.
Sea snake poisoning is usually characterized by multiple pinhead-sized puncture wounds.
There is little or no localized pain. There is often tenderness and some pain in the skeletal
muscles, particularly in the larger muscle masses and neck area. This pain increases with
motion. The tongue feels thick and its motion may be restricted. There may be numbness,
tingling and pricking sensations about the mouth. Sweating and thirst are common
complaints. The patient may complain of pain when swallowing. Lockjaw, extra ocular
weakness or paralysis, dilation of the pupils, drooping eyelids and generalized weakness
may be present. Respiratory distress is common in severe cases.
First Aid Management
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Reassure the patient who may be very anxious.
Avoid any interference with the bite wound such as incising, rubbing, vigorous cleaning,
massaging or applying herbs or chemicals to it. This may introduce infection, increase
absorption of the venom to the body and increase local bleeding.
Immobilize the whole of the patient’s body by laying him/her down in a comfortable and
safe position. Remember to immobilize the bitten limb using the pressure-immobilization
method. Any movement or muscular contraction increases absorption of venom into the
bloodstream and lymphatics.
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Ideally, a broad elastic roller bandage should be used for the person. If this is not available,
long strips of material can be substitutes. The bandage is bound firmly around the entire
bitten limb, startingdistally around the fingers or toes and moving as high up the extremity
as possible. Ideally, this is up to the groin.
Do not remove the trousers as the movement of doing so will only assist the venom into
entering the blood stream. Keep the bitten leg still. The bandage is bound firmly, but not so
tightly that the peripheral pulse is occluded or that the patient develops severe pain in the
limb. Check the snugness of the bandaging—a finger should easily, but not loosely, pass
under the bandage. Apply a splint to the leg which will immobilize joints on either side of
the bite. Bind it firmly to as much of the leg as possible. Walking should be restricted. If
there are bites on the hand and forearm: bind to the axilla, use a splint to the elbow and
make e a sling.
As far as the snake is concerned - do not attempt to kill it as this may be dangerous.
However, bring the snake to along to the hospital if it has been killed. Do not handle the
snake with bare hands as even a severed head can still bite!
Bee Stings
Most of the time, bee stings are harmless. If the person is allergic however, it can lead to
anaphylaxis (severe allergic reaction), a life-threatening condition.
Signs and Symptoms:
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Presence of a stinger
Pain
Swelling
Signals of an allergic reaction
First Aid Management
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Remove any visible stinger. Scrape it away from the skin with a clean fingernail or a plastic
card. In some cases, you can use tweezers. In the case of a bee sting, if you use tweezers,
grasp the stinger, not the venom sac.
Wash the site with soap and water.
Cover the site with a dressing.
Apply a cold pack to the area to reduce pain and swelling.
Call the local emergency number if the person has any trouble breathing or shows any
other signals of anaphylaxis.
Marine Life with Poisonous Spines
Sea urchins (pana-pana, tuyom, swaki) are found normally on rocky foreshores and reefs. Most
sea urchins can be handled safely but a few species possess venomous spines capable of
delivering very painful injuries. Common species include Diadema setosum, Diadema savignyl,
Echinothrix calamari and Echinothrix diadema.
All species of scorpionfish possess a highly developed venom apparatus and should
therefore be treated with respect. The estuarine stonefish (Synanceia horrida, syn. S. trachynis)
is the most venomous scorpionfish known and can be found throughout the Indo-Pacific. The
reef stonefish (Synanceia verrucosa) resembles coral rubble and lies motionless in coral
crevices, under rocks, and in holes buried in sand or mud. Most divers mistake them for rocks.
The pain associated with stings by a stonefish is immediate, excruciating, and can last for days.
The lionfish and true scorpionfish are also venomous.
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Stingrays (pagi) tend to be partially buried in sandy or silty bottoms in shallow inshore waters.
Up to six venomous spines in their tails can stab unwary swimmers who happen to tread on or
unduly disturb them. All stingray wounds, no matter how minor, should receive medical
attention to avoid the risk of secondary infection. Some injuries caused by venomous stingrays
can be fatal for humans if the spine pierces the victim’s trunk.
Prevention
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Always wear suitable footwear when exploring intertidal area or wading in shallow
water.
Avoid handling sea urchins.
First aid management
Immerse the wound in 45ºC water, or as can be tolerated, for 30 to 90 minutes.
Many marine toxins are proteins which are destroyed by heat. A hot soak can
dramatically reduce the pain and the amount of damage caused by a sting.
Soak the affected area in vinegar. This inhibits bacterial infection and dissolves the spine
skeleton which is made of calcium carbonate––the same basic material as human bones.
This material fizzes and dissolves readily in any acid such as vinegar.
Leave an inaccessible spine alone and only if it hasn't penetrated a joint, nerve or blood
vessel.
Cleanse the wound with an antiseptic solution.
Washing out remaining venom and pieces of spine will help minimize damage, speed
healing and prevent infection.
IV. Absorbed Poison
An absorbed poison enters the body after it comes in contact with the skin.
Jellyfish Sting
Jellyfish (dikya, salabay) are usually found in shallow waters. They have a transparent bell or
cube-like body with a pale blue color. They move through gentle pulsations of the bell but are
frequently driven ashore and stranded by wind and currents. The true jellyfish are typically
pelagic and exist for the greater part of their life as medusae. Species of some genera may occur
in large groups or swarms.
All jellyfish are capable of stinging but only a few species are considered a significant hazard
to human health. The box jellyfish Chiropsalmus quadrigatus is known to cause a number of
deaths every year in the Philippines.
A box jellyfish can have many tentacles that can grow to a length of three meters or 10 feet
and are covered with stinging cells or nematocysts. Each tentacle on a box jellyfish can have up
to 5,000 of these nematocysts where the potent venom is stored. The box jellyfish uses these
tentacles to catch their prey which are usually small fish and crustaceans.
Prevention
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Avoid swimming in waters where jellyfish are concentrated. These are often indicated
by beached specimens.
Wear protective clothing such as a wet suit and a full length rash guard when swimming
in areas where jellyfish are prevalent.
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Signs and Symptoms
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Rapid onset of pain which varies from mild to severe.
A rash that is red, hot, swollen, and usually appearing in a straight line.
Frequent pustule and vesicle formation.
Anaphylaxis is possible in sensitized individuals.
Severe stings may cause muscle cramps, abdominal pain, fever, chills, nausea, vomiting,
respiratory distress, and cardiovascular collapse.
Although most stings register a short-lived burning sensation, some can be lethal. Examples
of these are: If the swimmer has a severe allergic reaction to the sting or if the jellyfish is
one of those rare species where the stings can be fatal.
Fatalities are increased if there are pre-existing cardiac and respiratory conditions in the
victim.
First Aid Management
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Limit further discharge by minimizing patient movement.
Wash out wounds or injury with vinegar. This inhibits the stinging cells and prevents them
from releasing more venom.
Remove any remnant of allergen such as jellyfish tentacles and other foreign materials by
scraping them off.
Keep the patient warm.
Stinging Nettles or Nettle Trees
Stinging nettles are perennial plants belonging to the Urticaceae family and are found almost
throughout the world. It is usually in the form of an herb, shrub or small tree. It has white and
greenish blossoms which look inconspicuous.
Its leaves and leaf stalks are covered with stinging hairs. The common varieties are the
lingatong (Urtica spp) and the lipa or lipang-kalabaw (Dendrocnide spp.).
The plant has many hollow stinging hairs called trichomes on its leaves and stems. These act
like hypodermic needles that inject histamine and other chemicals which produce a severe
burning, stinging, or itching when it comes into contact with skin. Skin reddening and
blistering can also occur.
To care for a victim who has come into contact with a poisonous plant:
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Remove contaminated clothing and jewellery which may constrict circulation when
swelling occurs.
Rinse the affected area immediately. Do it thoroughly.
Seek medical advice if a rash or weeping lesion (oozing sore) develops.
Soothe the area with medicated lotions.
Stop or reduce itching with antihistamines that will dry up the lesions.
Advice the victim to see a physician if the condition worsens and large areas of the body or
the face are affected. .
Give care for severe allergic reactions if it does develop.
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Skill 7-1 Compression and Immobilization of
Extremities in a venomous snakebite
1. Ideally, a broad elastic roller bandage should be used for the person.

If this is not available, long strips of material can be substitutes.
2. The bandage is bound firmly around the entire bitten limb, starting distally
around the fingers or toes and moving as high up the extremity as possible.


Ideally, this is up to the groin.
Do not remove the trousers as the movement of doing so will only assist the venom into
entering the blood stream.
3. Keep the bitten leg still.
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The bandage is bound firmly, but not so tightly that the peripheral pulse is occluded or
that the patient develops severe pain in the limb.
Check the snugness of the bandaging—a finger should easily, but not loosely, pass under
the bandage.
Apply a splint to the leg which will immobilize joints on either side of the bite.
Bind it firmly to as much of the leg as possible. Walking should be restricted.
If there are bites on the hand and forearm: bind to the axilla, use a splint to the elbow
and make a sling.
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Spine Injuries
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Head, neck and spinal injuries are not very common, but these may cause the most long-lasting
damage to the body. Paralysis, speech impairment, and brain trauma are just some of the
possible effects of these injuries. Not only are these disabilities permanent, but they may also
be life-threatening.
The Nervous System
The nervous system is the most complex and delicate of all body systems. Its main function is
to transmit internal and external information throughout the sensory organs in order to assist
the body in regulating and coordinating its activities.
The brain is the master organ of the nervous system. It regulates all body functions
through its work with the respiratory and circulatory systems. Its primary functions include
facilitating the communication of the senses to the motor system, synthesizing consciousness,
integrating memory, and enabling speech.
The brain transmits and receives information through a network of nerves. This is made
possible through the spinal cord. The spinal cord is a large bundle of nerves that extends from
the brain and passes through the backbone.
The nerves transmit information from one area of the body to another through electrical
impulses. These electrical impulses are conducted by the senses from the body to the brain,
thus enabling a person to see, hear, smell, taste and feel. Nerves are also responsible for motor
functions and movement.
Causes and Prevention
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Vehicular crashes, falls, acts of violence and active sports are the leading causes of spinal
cord injuries. Prevent injuries to the head, neck and back by practicing these safety
guidelines:
Wear safety belts (lap and shoulder restraints) and place children in car safety seats.
Wear approved helmets, eyewear, faceguards and mouth guards.
Climb steps carefully to prevent slipping or falling.
Obey rules in sports and recreational activities
Avoid inappropriate alcohol use
Inspect work and recreational equipment regularly.
Think and talk about safety.
Types
Head injury
Any head injury is potentially dangerous. If not properly treated, injuries that seem minor
could become life threatening. Head injuries include scalp wounds, skull fractures, and brain
injuries.
Skull fractures belong to two categories: open or closed. An open head injury has an
accompanying scalp wound, while a closed head injury does not have an accompanying scalp
wound.
A brain injury is trauma to the brain which causes bleeding inside the skull. Blood build-up
causes pressure, resulting to more damage to the brain.
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It is important to remember the following:
 Assume that all victims with a head injury may have an injury to the spine.
 Call immediately for medical help when a person loses consciousness for more than one
minute. This could be a sign of head trauma. A person with head trauma must receive
emergency medical evaluation and care.
 Take note of victims with minor closed head injuries and those who lost consciousness for
at least a minute. They should also be evaluated and observed by a healthcare professional.
 Observation of the victims should be done in the office, clinic, emergency department,
hospital or home of a competent caregiver.
 Monitor airways and breathing passageways of victims with head injuries.
Concussion
A concussion involves a temporary loss of brain function from a blow received by a victim to
the head. Loss of consciousness may not always occur, but its aftereffects can be easily
recognized. These can range from sleep and mood changes to increased light and noise
sensitivities. Cognitive disturbances may also be present. Some effects may not appear for a
long period of time, and this is why observation of the victim is needed.
Persons with concussions should:




Rest their minds and bodies until their symptoms have dissipated;
Be evaluated on a regular basis by a health care professional who is skilled in concussion
management;
Present a medical clearance before engaging in sports or any strenuous physical activity;
Refrain from playing or engaging in sports on the same day of the concussion even when
there are no signs of injury.
Spinal injury
Spine injuries often fracture the vertebrae and sprain
the ligaments. These injuries usually heal without
problems. In severe injuries, the vertebrae may shift
and compress or may even be severed from the spinal
cord. Both occurrences may cause temporary or
permanent paralysis and may even lead to death. The
areas where paralysis may occur depend on the area
where the spinal cord was damaged.
Spinal motion restriction is the procedure for early
treatment of spinal injuries. Spinal motion restriction is
the limiting of spinal motion through manual spinal
stabilization.
Signs and Symptoms
To identify a victim who may be susceptible to spinal injuries after an accident, here are the
following risk factors to look for:
 Anyone who is at least sixty five years old ;
 Anyone driving a motor vehicle or motorcycle;
 Anyone falling from a greater than standing height;
 Anyone who feels tingling sensations in their extremities;
 Anyone experiencing pain or tenderness in the neck or back;
 Anyone experiencing sensory deficit or muscle weakness involving the torso or upper
extremities;
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First Aid and CPR Reference Manual
Anyone experiencing decreased alertness;
Anyone experiencing painful injuries, especially to the head and neck;
Anyone less than three years old with evidence of head or neck trauma.
Scan and look for any swollen or bruised areas when you are checking a victim with suspected
head, neck or back injuries. Do not apply direct pressure on any area that is swollen, depressed
or soft. You may also find certain signals that indicate a serious injury.
These signs include—














Changes in the level of consciousness of the individual;
Severe pain or pressure in the head, neck or back;
Tingling or loss of sensation in the extremities;
Partial or complete loss of movement of any body part;
Unusual bumps or depressions on the head or neck;
Sudden memory loss;
Blood or other fluids oozing from the ears or nose;
Profuse external bleeding of the head, neck or back;
Seizures on a person who does not have any nervous disorder;
Impaired breathing or impaired vision as a result of injury;
Nausea or vomiting;
Persistent headaches;
Loss of balance;
Bruising of the head, especially around the eyes or behind the ears.
These signs and symptoms may be obvious or may develop at a later time. Head, neck or back
injuries should not be taken lightly, even when the victim seems to function in a normal
manner. Regardless of the situation, it is best to alert medical professionals of head, neck, back
and injury cases.
First Aid Management







Call the local emergency number.
Minimize movement of the head, neck and back. Excessive movement can damage the
spinal cord irreversibly. Keep the victim as still as possible until advance medical personnel
arrive. Use a technique called manual stabilization to minimize movement of the head and
neck.
Check for life-threatening conditions.
Maintain open airways.
Monitor consciousness and breathing.
Control any external bleeding with direct pressure unless the bleeding is located directly
over a suspected fracture. Wear disposable gloves or use another barrier.
Help victim maintain normal body temperature.
Head and Spine Immobilization
Techniques
Manual Head Stabilization
Manual stabilization is a technique used to minimize
movement of the victim’s head and neck. In this way, the
spine is protected as the first aider is giving care.
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Try to keep the person from moving his or her lower body. This helps prevent movement that
may change the position of the head and neck causing more injury. Keeping the head in the
position where you find it helps prevent further damage to the spinal column. The way by
which you perform this technique depends upon the position in which you find the victim.
Manual stabilization can be performed while victims are lying down, sitting or standing.
DO NOT attempt to align the head and lower body. If the head is sharply turned to one side,
DO NOT move it. Support it in the position found. Place the person in a modified recovery or
H.A.IN.E.S. position if you are unable to maintain an open airway. Do this also if you have to
leave to get help.
Removal of Helmet
Helmets are worn to protect the head in the event of
impact from a fall during sports or activities involving
motorcycle use.
The helmet is a vital accessory. It decreases the severity of
head injuries, lessens the likelihood of death, and even
prevents possible medical care. They are designed to
cushion and protect riders' heads from the impact of a
crash. Helmets can’t provide total protection against
injury, but they do help minimize the occurrence of both.
The NHTSA in the U.S. estimates that motorcycle helmets
reduce the likelihood of crash fatalities by thirty seven percent.
The Motorcycle Helmet Act of 2010 requires all motorcycle riders, including drivers and
back riders in the country, to wear standard protective helmets.
There are different kinds of helmets. Sport helmets are typically open in front and offer easier
access to the airways. Motorcycle helmets are either half or full-faced and may have a face
shield for added protection. Check that this does not impede airway assessment.
First aiders should be able to quickly assess whether or not patients need to have their
helmets removed. Leave the helmet in place if the following conditions exist:
 Little or no movement of the patient's head within the helmet;
 Obstructions or impediments to airways and breathing are not present;
 Removal would cause further injury to the patient;
 Proper spinal immobilization may be performed even with the helmet in place;
 There is no interference with the first aider’s ability to assess and reassess airway and
breathing.
Removal of the helmet is necessary when there
is:





Uncontrollable and excessive head movements;
Restriction of airway or breathing;
Inability to assess and/or reassess the patient’s airway
and breathing;
Proper spinal immobilization cannot be performed
because of the helmet;
Patient needs to be resuscitated, such as when having a
cardiac arrest.
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Skill 8-1 Evaluating a victim with a suspected
spinal cord
Evaluate the victim’s condition



Check responsiveness
while
avoiding
movement of the head
and spine.
Examine for pulse;
motor and sensory of
the extremities.
Look for any signs of
spinal injuries.
Skill 8-2 Manual stabilization of the head and neck
To perform manual stabilization, place your
hands on both sides of the victim’s head.



Gently hold the person’s head.
Ensure that the position in which you found the victim
remains static.
Support this position until medical personnel arrive.
Skill 8-3 Two-person log roll technique
1. A first aider kneels at the victim’s side, while the other above the victim’s
head.
2. The first aider
above the head will
perform manual
stabilization.
3. The first aider at the side of will extend the arm over victim’s head.
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4. Place the other arm
close to the body
and place the
farthest leg on top
of the closest leg.
5. Hold the shoulder
and hip that are
farthest then
carefully roll the
person towards
you.
6. Reposition the arms at each side of the body once the victim is now in the faceup position.
Skill 8-4 Four-person log roll technique
1. The three first aider’s kneel at the victim’s side, while the other above the
victim’s head.
2. The first aider
above the head will
perform manual
stabilization.
3. Position the victim before log roll.



The first aider at the side of the head will extend the
arm over victim’s head.
The center first aider will place the farthest arm close
to the body.
The last first aider will place the farthest leg on top of
the closest leg.
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4. Hold the farthest
shoulder and hip
then carefully roll
the person towards
first aider with the
synchronized
command of the
first aider
performing the
manual stabilization.
Skill 8-5 Securing a patient’s to a long spine board
1. Position the device just beside the patient, who should be in a lying position.
2. Log-roll the patient onto the device, with one first aider maintaining the inline immobilization of the head and spine.



A first-aider situated at the head of the patient should direct the movements, while two
or three other first aiders position themselves at the side of the patient opposite the
device. They will control the rest of the body’s movement.
Once the command is given, the other first aiders should roll the patient towards them
onto a side-lying position.
Once the patient is lying on his or her side, have a first aider position the backboard
under the patient.
3. At the command, place the patient onto the board. Use the logroll and slide
technique or a proper lift to maintain in-line immobilization.



This limits patient movement to the minimum.
The best method to
use must be decided
based
upon
the
situation, scene and
available resources.
Pad voids between
the patient and the
board, taking care not
to make unnecessary
movements.
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Pad under the head and under the torso in the case of adult victims. Pad under the
shoulders and up to the toes in the case of infants and children in order to establish a
neutral position.
4. Use cravats to immobilize the torso.


Use cravats to immobilize the victim’s legs, thigh, hip, chest then the head to the board.
Support the head by using a blanket roll.
Can also use a commercial strap in securing the victim to the board.
5. Reassess the patient’s pulse, motor and sensory functions.
Skill 8-6 Helmet removal technique
The technique for removing a helmet depends on the type worn by the
patient. Here are some guidelines. Note that this will require two first
aiders:
1. Stabalize the Helmet

One
first
aider
stabilizes the helmet
by placing his/her
hands on each side of
the victim’s helmet,
with the fingers on
the
mandible
to
prevent
movement.
Take any eyewear off
the patient.
2. Loosens the Helmet

A second first aider
loosens the helmet
strap, then places one
hand on the mandible
at the angle of the jaw
and the other hand at
the back of the head.
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3. Removal of Helmet
 The first aider who is
stabilizing the helmet
pulls the sides of the
helmet apart and gently
slips
the
helmet
halfway
off
the
patient’s head.
4. Supports the Head


The second first aider repositions, so that the hand
supporting the back of the neck now supports the head
to prevent it from falling back after complete helmet
removal.
Remove the helmet completely.
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CHAPTER 9
Bones, Joints
and Muscle
Injuries
CHAPTER 9 –Bones, Joints and Muscle Injuries
Philippine Red Cross
First Aid and CPR Reference Manual
The Musculoskeletal System
The musculoskeletal system is made up of muscles, bones, ligaments and tendons. These
structures are primarily responsible for supporting the body, allowing its movement, and
protecting its internal organs. It also aids the body in storing minerals and assists it in
producing blood cells and heat.
Components
Muscles and Tendons


Muscles are made of special tissue that can contract and relax. When muscles are used, this
results in movement. Tendons are tissues that attach muscles to bones.
Bones and Ligaments
The body has over 200 bones. A Bone is a dense, hard tissue that forms the skeleton. The
skeleton makes up the framework that supports the body. Where two or more bones join,
they form a joint. Bones are usually held together at the joints by fibrous bands of tissue
called ligaments.
Types




A strain or pulled muscle is caused by the overstretching and tearing of muscles or
tendons. This usually involves muscles in the neck, back, thigh or the back of the lower leg.
A sprain is the tearing of ligaments at a joint. The joints most easily injured are the ankle,
knee, wrist and fingers.
A dislocation is the movement of a bone at a joint away from its normal position. This
movement usually is caused by a violent force tearing the ligaments that hold the bones in
place.
A fracture is a complete break, a chip or a crack in a bone. In general, fractures are not life
threatening. However, a breakage in the large bones, a severed artery, and difficulties in
breathing are dangerous signals to look out for. A fracture is either closed or open.
 In a closed fracture the skin is not broken. Closed fractures are the most common
injuries. Open fractures are more dangerous than closed fractures due to its exposure to
infection. An open fracture can also cause severe bleeding.
 An open fracture involves an open wound. It occurs when the end of a bone tears
through the skin. An object that goes into the skin and breaks the bone, such as a bullet,
can also cause an open fracture.
Causes
Musculoskeletal injuries may occur from several specific causes and are categorized as follows:
 Direct force – A direct force is the force of an object striking the body and causing injury at
the point of impact. An example is a fist striking the chin, which can break the jaw. The
penetration of objects such as bullets or knives can injure structures beneath the skin at the
point where they penetrate.
 Indirect force – Indirect force is a force that travels through the body and causes injury to
a body part away from the point of impact. An example is a fall on an outstretched hand
resulting in an injury to the shoulder or collarbone.
 Twisting force – One part of the body twists while another part of the body turns. This may
force a bone or a joint beyond its normal range of motion, leading to injury.
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Signs and Symptoms
It can be difficult to tell if an injury affects a muscle, a bone or a joint. Severe injury may happen
when any of the following signals are present:
 Pain
 Significant bruising and swelling
 Significant deformity
 Inability to use affected body part normally
 Bone fragments sticking out of a wound
 Grating sensations after hearing a bone pop or snap
 Cold, numb and tingly sensations on the injured area
 When the cause of injury suggests that it may be severe.
First Aid Management
The general care for injuries to muscles, bone and joints includes following the mnemonic
RICE:
 R – Rest. Do not move or straighten the injured area.
 I – Immobilize. Stabilize the injured area in the position it was found. Put a splint on the
injured part only if the person must be moved or transported in order to receive medical
care, and only if this does not cause more pain. Minimizing movement can prevent further
injury.
 C – Cold. Fill a plastic bag with ice and water or wrap ice with a damp cloth and apply it to
the injured area for a period of twenty minutes. Place a thin barrier between the ice and
bare skin. Apply it for a period of ten minutes if a twenty minute application cannot be
tolerated. Remove the pack for twenty minutes and then replace it, if needed. The cold pack
reduces internal bleeding, pain and swelling. DO NOT apply heat as there is no evidence
that applying heat helps muscle, bone or joint injuries. DO NOT apply an ice pack directly on
an open fracture.
 E – Elevate. Elevate the injured part only if it does not cause more pain. Elevating the
injured part may help reduce swelling.
Splinting Rules
Splinting is a method of immobilizing an injured part to minimize movement and prevent
further injury. It should be used ONLY IF there is a need to move or transport the person to the
hospital, and only if it does not cause more pain. Leave the victim in the position found with
the injured part supported by the ground if splinting is not possible.
When applying a splint, the following rules apply:
 Splint an injury in the position in which you find it.
 Splint the joints above and below the site of the injury for fractures.
 Splint the bones above and below the site of the injury for sprains or joint injuries. Do not
attempt to replace a dislocated bone into its socket as this may cause further injury.
 Splint both the bones and the joints above and below the point of injury if unsure whether it
is a fracture or a sprain.
 Cover the wound with a sterile dressing and apply pressure around the injury to control
bleeding, but be careful not to press on a protruding bone to treat open fractures. Build up
pads of clean, soft, non-fluffy material around the bone until you can bandage over it
without pressing on the injury if a bone end is protruding. Secure the dressing and
immobilize the injured part appropriately.
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Splinting materials should be soft or padded for comfort.
To check for blood circulation, see how the patient is feeling, record his temperature, and
observe his skin color. Do this before and after splinting to make sure that the splint is not
too tight.
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Skill 9-1 Applying a Sling and Binder
After checking the scene and the injured person:
1. Get consent to treat the victim.
2. Support the injured part of the
body.


Manually stabilize both above and
below the site of the injury.
If there is a need, ask a helper to
do this until splinting is done.
3. Check for blood circulation.

See how the victim is
feeling, record his
temperature, and
observe his skin
color.
4. Position the sling.

Place a triangular
bandage under the
injured arm and over
the uninjured
shoulder to make the
sling.
5. Secure the sling.


Tie the ends of the
sling at the side of
the neck.
Pad the knots at the
neck and side of the
binder for comfort.
6. Bind with cravat.

Bind the injured body part to the chest with a folded triangular
bandage.
7. Recheck blood circulation.

Recheck how the victim feels, note body temperature, and
observe skin color.
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Skill 9-2 Applying an Anatomic Splint
After checking the scene and the injured person:
1. Get consent from the victim.
2. Support the injured part.


Manually stabilize both above and below
the site of the injury.
If need be, ask a helper to do this until
splinting is done.
3. Check for blood circulation.

See how the victim is feeling, note body
temperature, and observe skin color.
4. Position the cravats.

Place several folded triangular bandages
above and below the injured body part.
5. Align the body parts.


Place the uninjured body part next to the
injured one.
Apply padding in between the body parts,
if possible, to minimize pressure areas
and maintain a natural position.
6. Tie the cravats securely.
7. Recheck blood circulation.


Recheck how the victim feels, record
temperature, and observe skin color.
If you are not able to check temperature
and skin color because of an obstruction
like a sock or a shoe, check for feeling.
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Skill 9-3 Applying a Soft Splint
1. Get consent from the victim.
2. Support the injured part.


Manually stabilize both above and below
the site of the injury.
If there is a need, ask a helper to do this
until splinting is done.
3. Check for blood circulation.

Check for feeling, warmth and color
beyond the injury.
4. Position the cravats.

Place several folded triangular bandages
above and below the injured body part.
5. Wrap with a soft splint.



Gently wrap a soft
object around the
injured body part.
This could be a
folded blanket or a
pillow.
Tie cravats
securely.
6. Recheck blood
circulation.

See how the victim
feels, note body temperature, and observe skin color.
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Skill 9-4 Applying a Rigid Splint
1. Get consent from the victim.
2. Support the injured part.


Manually stabilize both above
and below the site of the injury.
If there is a need, ask a helper
to do this until splinting is
done.
3. Check for blood circulation.

See how the victim is feeling,
note body temperature, and
observe skin color.
4. Place the splint.



Place an
appropriately sized
rigid splint (e.g.,
padded board, sticks,
etc.) under the
injured body part.
A rigid splint can be
made of padded
boards or sticks.
Place padding such as
roller gauze or folded cravats
in voids between the splint and
the injured part to keep it in a
natural position.
5. Tie cravats securely.
6. Recheck circulation.

Recheck how the victim is feels,
note body temperature, and
observe skin color.
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CHAPTER 10
Medical
Emergencies
CHAPTER 10 – Medical Emergencies
Philippine Red Cross
First Aid and CPR Reference Manual
Stroke
A Stroke is a disruption of blood flow to a part of the brain which may cause permanent
damage to the brain tissue. This is also called a cerebrovascular accident (CVA).
According to Philippine Health Statistics, stroke incidents killed some 61.8 per 100,000
people in the country in 2004. It is the second leading cause of mortality in the Philippines after
heart disease.
The World Health Organization estimates that 15 million people worldwide will suffer from
strokes each year while five million will die and another five million will be permanently
disabled.
Causes
Most commonly, a stroke can be caused by the following:
 A blood clot, called a thrombus or embolus, that forms or lodges in the arteries that supply
blood to the brain.
 Bleeding from a ruptured artery in the brain caused by a head injury, high blood pressure
or an aneurysm, which is a weak area in the wall of an artery that balloons out and can
rupture.
 Fat deposits lining an artery (atherosclerosis) may also cause stroke.
 Less commonly, a tumor or swelling from a head injury may compress an artery and cause
a stroke.
Risk factors and prevention
The risk factors for stroke, or what can make a stroke more likely, are similar to those for heart
disease. Some of these risk factors are beyond one’s control. These are age, gender, family
history of stroke, and records of cardiovascular disease in the family. Other risk factors,
however, can be controlled through diet, changes in lifestyle or medication. A person’s chances
of having a stroke increases if the person has a history of high blood pressure, previous
histories of strokes or mini-strokes, is diabetic, or is confirmed to have heart disease.
A stroke can be prevented by controlling blood pressure. The following actions may help:
quitting smoking, eating healthy meals, and exercising regularly. Regular exercise reduces the
chances of a stroke by strengthening the heart and improving blood circulation. Being more
physically active also helps in weight control.
Signs and Symptoms
The possibility/probability of stroke can be recognized easily via the following warning signs:
 Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
 Sudden confusion, trouble speaking or understanding.
 Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, loss of balance or coordination.
 Sudden, severe headache with no known cause.
Transient Ischemic Attack (TIA)
Is often referred to as a “mini-stroke,” is a temporary episode that, like a stroke, is caused by a
disruption in blood flow to a part of the brain. However, unlike a stroke, the signals of TIA
disappear within a few minutes or hours of its onset. Although the indicators of TIA disappear
quickly, the victim is not out of danger at that point. In fact, someone who experiences TIA has
a greater chance of having a stroke in the future than someone who has not had a TIA.
Because you cannot distinguish a stroke from a TIA, remember to call the local emergency
number immediately when any signs of a stroke appear.
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Assessment
For stroke assessment, think F.A.S.T., which stands for the following:
 F – Face. There is weakness, numbness or drooping on one side of the face. Ask the person
to smile. Does one side of the face droop?
 A – Arm. There is weakness or numbness in one arm. Ask the person to raise both arms.
Does one arm drift downward?
 S – Speech. Slurred speech or difficulty speaking. Ask the person to repeat a simple
sentence. Are the words slurred? Can the person repeat the sentence correctly?
 T – Time. Try to determine when the signals first began. Time is critical if these signals
suddenly occur. Call the local emergency number right away.
First Aid Management
Recognize the “signals” and take action:
 Call the local emergency number immediately. Minutes count!
 Have the person stop what he or she is doing and have them rest comfortably by sitting or
lying down.
 Give the victim supportive care and reassurance.
 Be prepared to perform CPR if the victim becomes unresponsive.
Diabetic Emergencies
Diabetes is the inability of the body to change sugar (glucose) from food into energy.
The cells in your body need glucose as a source of energy. The cells receive this energy
during digestion or from stored forms of sugar. The sugar is absorbed into the bloodstream
with the help of insulin. Insulin is a hormone produced in the pancreas and is necessary for the
proper utilization of sugar by the muscles, fat and liver.
For the body to properly function, there has to be a proper balance between insulin and
sugar. Diabetes occurs when the pancreas does not adequately produce insulin. It also happens
when the body cannot properly use insulin.
Diabetes can lead to other medical conditions such as blindness, nerve disease, kidney
disease, heart disease, and stroke. In fact, it is the ninth leading cause of death in the
Philippines. According to the Department of Health, an estimated four million Filipinos are now
afflicted with the disease, and about five hundred new Filipino diabetic patients are identified
per day. If the disease is not properly managed, serious complications may arise.
Types & Causes
A diabetic emergency is
caused by an imbalance Glucometer
between sugar and insulin in Is a device that is used to monitor blood sugar levels.
the
body.
A
diabetic Diabetics are required to monitor their blood sugar levels
emergency can happen when several times a day and to record the results. These results
there is:
are needed by their doctors to determine if their treatments
 Too much sugar in the
need to be modified. Using a glucometer properly along with
blood
(hyperglycemia): maintaining a controlled diet and regular exercise can help
The person may not have maintain healthy blood sugar levels.
taken enough insulin or
may be reacting adversely to a large meal that is high in carbohydrates.
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Too little sugar in the blood (hypoglycemia): The person may have taken too much insulin,
eaten too little, or has suffered from overexertion. Extremely low blood sugar levels can
quickly become life threatening.
Signs and Symptoms
Although hyperglycemia and hypoglycemia are different conditions, their major signals are
similar. These include:
 Changes in level of consciousness, including
It is not important to differentiate
dizziness, drowsiness and confusion.
between hyperglycemia and
hypoglycemia
in an emergency. The
 Irregular breathing.
basic care for both of these is the
 Abnormal pulse (rapid or weak).
same.
 Feeling or looking ill.
First Aid Management
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First, check and determine if there are any life-threatening conditions.
A person with diabetes who is experiencing a diabetic emergency must be instructed to test
his or her blood glucose level.
A victim experiencing a diabetic emergency due to hypoglycemia must be encouraged to
treat himself/herself with food or drink that contains sugar. The same action is advised if
the condition still is to be determined or still remains unknown (Are they hypoglycaemic or
hyperglycaemic?).
If the diabetic person is conscious and is able to swallow and then states that they need
sugar, give a glucose tablet of 20 grams. If a tablet is not available, give the following
instead: glucose gel, orange juice (340 g or 1/3 L) or granular table sugar (20 g). (These
dosages are ordered according to decreasing effectivity).
If the patient’s problem is low blood sugar, the sugar you give will help quickly. If the
victim’s blood sugar level is already too high, the additional sugar will do no further harm.
If the person is unconscious or is about to lose consciousness, call the local emergency
number. Maintain an open airway and do not give anything by mouth.
Blood Glucose Level
> 800 mg/dl
400-800 mg/dl
120-400 mg/dl
80-120 mg/dl
40-80 mg/dl
< 40 mg/dl
Descriptions
Diabetic Coma
DKA (Diabetic Ketoacidosis) /
HHNC (Hyperosmolar Nonketotic Coma
Hyperglycemia
Normoglycemia
Hypoglycemia
Insulin Shock
Seizures
When the normal functions of the brain are disrupted by injury, disease, fever, poisoning or
infection, the electrical activity of the brain becomes irregular. This irregularity can cause a
loss of body control known as a seizure.
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Types and Causes
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
Chronic - This condition occurs suddenly and without warning. It manifests through a
convulsion with powerful contractions that shake the body. It can also appear as a sudden
and brief change in thinking, attention, sensation or behaviour.
Febrile - This condition brings about a rapid increase in body temperature. It is most
common in children who are younger than five years old. Febrile seizures are often brought
about by infections of the ear, throat or digestive system. It is most likely to occur when a
child or an infant runs a rectal temperature of over 39 °C.
Signs and Symptoms
When assessing the victim, these are the signs to look out for:
 Unusual sensations or feelings such as visual hallucination (the patient is experiencing an
aura)
 Irregular breathing patterns
 Drooling
 Upward rolling of the eyes
 Rigid body
 Sudden, uncontrollable, rhythmic muscle contractions and convulsions
 Decreased level of responsiveness.
 Loss of bladder or bowel control.
First Aid Management
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Reassure the victim that you are going to help.
Remove nearby objects that might cause injury.
Protect the victim’s head by placing a thinly folded towel or piece of clothing beneath it. Do
not restrict the airway in doing so.
Do not hold or restrain the patient when a seizure is in progress.
Do not place anything between the victim’s teeth or put anything in the victim’s mouth.
Take care to ensure that the victim will not swallow his/her tongue.
Loosen clothing and fan the victim if the seizure was caused by a sudden rise in body
temperature. Do not cool the victim by splashing cold water or rubbing alcohol on his/her
body.
Ensure that the victim’s airway is open and check for breathing and other injuries once the
seizure is over.
Stay and watch over the victim until the victim is fully conscious.
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Call the local emergency number immediately if:
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The seizure lasts longer than five minutes.
The seizure is repeated.
The seizure is followed by a quick rise in temperature (in the case of children).
The victim does not regain consciousness.
The victim has diabetes or is injured.
The patient is pregnant.
The victim has never had a seizure before.
Any life-threatening condition is found.
A child has a fever along with the seizure.
The victim has a known seizure disorder, but the seizure is of a different type or is
occurring more frequently.
Anaphylaxis
An allergy is caused by the over-activity of the immune system against specific antigens. An
antigen is a foreign molecule that enters the body and triggers the production of antibodies by
the immune system.
Allergies are relatively common. Yet, an emergency situation can arise in a small proportion
of people with allergies. Anaphylaxis is a severe allergic reaction that is usually lifethreatening.
Causes
The most common antigens that often cause reactions for allergic people are the following:
 Bee or insect venom
 Pollen
 Animal dander
 Latex
 Certain antibiotics and drugs
 Certain foods like nuts, peanuts, shellfish and dairy products
Signs and Symptoms
Anaphylaxis usually occurs suddenly
and within seconds or minutes after
contact with the substance. The skin
or area of the body that comes in
contact with the substance usually
becomes swollen and turns red.
Other signals include the following:
First Aid Management
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Difficulty in breathing, wheezing or shortness of breath
Tight feeling in the chest and throat
Swelling of the face, throat or tongue
Weakness, dizziness or confusion
Rashes or hives
Low blood pressure
Shock
If you suspect anaphylaxis,
 Call the local emergency number.
 Calm and reassure the person.
 Help the person to rest in the most comfortable position for breathing. This is usually via a
sitting position.
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Monitor the person’s breathing. Look for any changes in their condition.
Assist the person with the use of a prescribed epinephrine auto-injector. Give this to the
individual if available. Do this only when permitted by local and national regulations.
Give care for life-threatening emergencies.
Document any changes in the person’s condition over time.
Fainting
Fainting is a partial or complete loss of consciousness
resulting from a temporary reduction of blood flow to the
brain.
Fainting usually is a harmless self-correcting
condition. When the victim collapses, the normal
circulation to the brain resumes and the person usually
recovers quickly with no lasting effects. However, what
appears to be a simple case of fainting may also actually
be a symptom of a more serious condition.
Causes
Fainting can be triggered by:
 An emotionally stressful event;
 Pain;
 Specific medical conditions such as heart disease;
 Standing for long periods of time or overexertion.
 Pregnant women and the elderly are more likely than others to faint when suddenly
changing positions. This could occur when moving from a sitting or lying position or when
standing up.
Signs and Symptoms
Fainting may occur with or without
warning. The following are possible
warning signs:
 Light-headedness or dizziness.
 Signs of shock, such as pale, cool
or moist skin.
 Nausea and numbness or
tingling in the fingers and toes.
Other signals include the following:

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
Sweating
Vomiting
Distortion or dimming of vision
Head or abdominal pain
The feeling that everything is going dark.
First Aid Management
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Position the victim on his or her back. Elevate the legs about twelve inches to keep blood
circulating to the vital organs.
Keep the victim in a lying position, especially when unsure of the victim’s condition or if
movement is painful to him/her.
Loosen any restrictive clothing, such as a tie or a buttoned-up collar.
Check for any other life-threatening and non-life-threatening conditions.
Do not give the victim anything to eat or drink. Do not slap the victim or splash water on
his/her face. Splashing water on the victim could cause the victim to suck in water through
the
mouth.
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CHAPTER 11
Environmental
Emergencies
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Regulating and Maintaining Body Temperature
The human body must maintain a constant temperature of 98.6º F (37º C) in order to work
efficiently. It does this by balancing heat loss and heat production internally and externally.
The difference in temperature between the body and the environment determines the amount
of heat exchanged with the environment.
Body heat is generated primarily through the conversion of food to energy. It is also
produced through contracting muscles in activities like swimming or even in the simple act of
shivering. Because the body is usually warmer than the surrounding air, it tends to lose heat to
the air. The heat produced in routine activities is usually enough to compensate for normal
heat loss.
In a warm environment, a part of the brain called the hypothalamus detects a rise in blood
temperature and sets a series of events in motion. Blood vessels dilate or widen to bring in
more blood to the skin’s surface. The body then cools itself by sweating.
When the body reacts to cold temperatures, the blood vessels near the skin constrict
(narrow) and move warm blood to the center of the body. In this way, blood heats the areas
where it is needed the most. Shivering happens when the body needs to produce more heat to
warm itself. Three main factors affect how well the body maintains its temperature. These are
air temperature, humidity, and wind.
To prevent heat-related illnesses and cold-related emergencies, follow these
guidelines:
 Avoid being outdoors in the hottest or coldest parts of the day.
 Dress appropriately for the environment.
 Change your activity level according to the temperature.
 Take frequent breaks by removing yourself from the environment.
 Drink large amounts of nonalcoholic or decaffeinated fluids before, during and after an
activity.
Exposure to extreme heat or cold can make a person seriously ill. The likelihood of illness
also depends on factors such as physical activity, type of clothing, wind flow, humidity,
working and living conditions, and a person’s age and state of mind.
Heat-related Emergencies
Heat Cramps
Heat cramps are painful involuntary muscle cramps that can occur
during and after exercise or work in a hot environment.
Causes
Heat cramps result from the loss of large amounts of salt and water
from heavy sweating through exercise or work. This commonly
happens when water in the body is restored
without replacing the
lost salt or potassium.
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First Aid Management
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Remove the patient from the hot environment.
Encourage the patient to drink a beverage containing salt. If available, have the patient
drink an Oral Rehydration Solution (ORS).
If ORS packets are not available, make an oral rehydration solution: Mix 1 liter of clean
water (about 5 cupfuls at 200 ml per cup), ½ of a level teaspoon of salt and 8 level
teaspoons of sugar (raw sugar or molasses can be used instead). Stir the mixture until the
sugar and salt dissolves.
Stretch the affected muscle and massage the area once the spasm has passed.
If there is a cramp in the foot – Let the patient sit. Instruct them to alternately point the toes
and flex the foot. This stretches the affected muscles.
If there is a cramp in the calf muscles – With the patient sitting, straighten the patient’s knee
and support his foot. Flex his foot upward towards his shin to stretch the calf muscles.
If there is a cramp in the front of the thigh – While lying down, raise the leg and bend the
knee to stretch the muscles.
If there is a cramp in the back of the thigh – While lying down, raise the leg and straighten
the knee to stretch the muscles.
Heat Exhaustion
Heat exhaustion is a milder form of heat-related illness that can develop after exposure to high
temperatures. This may also be a result of inadequate fluid intake or the insufficient
replacement of fluids.
Signs and Symptoms
Warning signs of heat exhaustion include the following:
 Heavy sweating
 Headache
 Paleness
 Nausea or vomiting
 Muscle cramps
 Fainting
 Tiredness and weakness  Cool, moist skin
 Dizziness
 Fast, weak pulse rate
First Aid Management


Remove the patient from the hot environment. Fan the body, place ice bags, or spray water
on the skin.
Start oral rehydration with a beverage containing salt, or make them drink an Oral
Rehydration Solution. (ORS)
Heat Stroke
Heat stroke is a form of hyperthermia. Prolonged
exposure to high temperatures can contribute to failure
of the body’s temperature control system. Since the body
is incapable of dissipating heat in the entire system, the
body temperature goes up. Body temperatures could rise
up to 41.1 ºC (106 ºF) or even higher.
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Signs and Symptoms
Signs and symptoms of heat stroke include:
 Strange behavior, headaches, dizziness, hallucinations, confusion, agitation, disorientation,
and coma.
 High body temperature.
 Absence of sweating.
 Red, hot, dry and flushed skin.
 Rapid pulse and difficulty breathing.
 Nausea, vomiting, fatigue and weakness.
First Aid Management

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Call or have someone call the local emergency number.
Move the person into a cool place, a shaded area, or an air-conditioned room.
Cool the patient immediately by immersing him/her in water. Make the water level reach
the patient’s chin. Steep the patient in water until his/her condition improves. Use
circulating water if possible.
If water immersion is not possible or is delayed, the following actions can be performed:
Douse the patient with copious amounts of cold water, spray the patient with water, fan the
patient, or cover the patient with ice towels or surround the patient with ice bags.
Respond to any life-threatening conditions that may come about.
Cold-related Emergency
Hypothermia
Hypothermia is the general cooling of the entire body. In hypothermia,
body temperature drops below 35º C. As the body cools, an abnormal
heart rhythm (ventricular fibrillation) may develop and the heart
eventually stops. The victim will die if not given prompt care.
The air temperature does not have to be below freezing for people
to develop hypothermia. Elderly people and those with medical
conditions, such as an infection, insulin reaction, stroke or a brain
tumor, are more susceptible to hypothermia.
Certain substances such as alcohol and barbiturates can also
interfere with the body’s normal response to cold. This causes
hypothermia to occur more easily. Anyone remaining in cold water or
wet clothing for a prolonged period of time may also be susceptible to
hypothermia.
Signs and Symptoms
The signals of hypothermia include:
 Shivering (may be absent in later stages of
hypothermia)
 Numbness
 Glassy stare or a blank expression
 Apathy or decreasing level of consciousness
 Weakness
 Impaired judgment.
In cases of severe hypothermia,
the victim may become
unconscious. Breathing may
slow down or stop. The body
may feel stiff as the muscles
become rigid.
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First Aid Management
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Gently move the person to a warm place.
Care for any life-threatening conditions.
Call the local emergency number.
Remove any wet clothing and dry the person.
Warm the person by wrapping him/her in blankets or by replacing the person’s clothes
with dry clothing (passive re-warming)
If available, apply heat pads or other heat sources to the body. Hot water bottles and
chemical hot packs may be used, but first wrap these in a towel or blanket before applying.
Do not warm the person too quickly, such as by immersing him or her in warm water. Rapid
warming may cause dangerous heart rhythms.
If the person is alert, give warm liquids that do not contain alcohol or caffeine. Monitor
ABCs and continue to warm the victim until EMS personnel arrive. Be prepared to perform
CPR if necessary.
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CHAPTER 12
Special
Situations
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Disasters and emergency may strike quickly and without warning. These events can be
frightening for adults, but they are traumatic for children if they don’t know what to do. During
a disaster and emergency, your family may have to leave your home and daily routine. You and
your family will probably be in a state of panic when disaster happens. It is important that you
have already prepared the things that you and your family will need to survive.
Emergency Preparedness
Emergency Evacuation Drill
A physical or mental exercise aimed at perfecting facility or skill especially by regular practice.
One good example of earthquake drill is performed by children in grade school.
Three Types of Drill
1. Scheduled Drill
All participants know that a drill will be held, are aware of the procedures, and must engage
in prior rehearsals.
2. Unannounced Drill
The participants do not know that a drill will be held and must therefore be notified at the
time it begins. In order to carry out a drill of this type, all participants must have full
advance knowledge of their missions and functions. Such drill must not be carried out
without prior scheduled drills having taken place.
3. In-Services Drills
An in-service drill is held only when the entire system has engaged in a number of
scheduled and/or unannounced drills and the staff is well-trained.
Evaluation of the Drill
In planning and carrying out a drill, provision should be made for an evaluation group
composed of persons who are knowledgeable and experienced in the type of activity to be
Duties and Roles of the First Team
 Ensure all members review skill application.
 Determined area for establishing medical station.
 Ensure all first aid/medical supplies and equipment is available.
 Maintains a list of other first responder in nearby institution if need assistance.
 Provides first aid care to injured and ill patient
 Coordinate with other responding unit.
Mass Casualty & Triage
A situation of mass casualties results in an imbalance between assistance needs and the help
available. The number of casualties and the severity of their injuries exceed the human and
material resources available in the casualty-care chain. The management of such a situation is
based on common sense; there cannot be strict rules, only general guidelines.
Triage is a management process for sorting casualties into groups based on their need for
priority treatment or evacuation to definitive care. It precedes more advanced care.
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Concepts and Principles
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The decisions involved in triage are the most difficult in all health care. However, choices
are made to achieve the greatest good not for any particular individual but for the
greatest number of people.
Adherence to general guidelines will ensure the best matching of patient conditions with
available resources.
Triage decisions must not be questioned to avoid confusion.
Triage is only a “snapshot” of the casualty’s condition at the time of assessment. Priority
categories may change as time goes by.
The most experienced first aider arriving at the scene becomes the triage officer.
Triage Categories and Priorities
There are four common triage categories. They can be remembered using the mnemonic IDME,
which stands for:
 Immediate (red-tag) – These are life-threatening conditions that are treatable at least for a
time. This is achieved through immediate and simple measures such as airway and gross
hemorrhage control. Immediate case signs include: airway and breathing difficulties,
uncontrolled or severe bleeding, decreased mental status, patients with severe medical
problems, shock (hypoperfusion), and severe burns.
 Delayed (yellow-tag) – These are major but not immediately life-threatening conditions
where some delay is acceptable. Delayed case signs include: burns without airway
problems, major or multiple bone or joint injuries and back injuries with or without spinal
cord damage.
 Minimal (green-tag) – These minor injuries require minimal surgical care. These are
injuries for which an indefinite wait is possible, if not desirable. Casualties are often
classified as the walking wounded. These casualties should be transported to a space away
from the main triage and immediate treatment area to avoid crowding and confusion.

Expectant (black-tag) – These are severe conditions that medical and/or surgical cares can
no longer help. These conditions are often classified as having little hope of recovery.
Patients who have injuries with open skull fractures and are unconscious, those with extensive
and deep burns and people with imminent cardiac arrest and major torso trauma are
examples. The dead or the dying are part of this group.
This is the order of priority for the treatment and transport of patients in a multiple casualty
situation.
Triage Types

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

Primary Triage
Primary triage is the initial triage done in the field. It aims to determine which patients
are prioritized for treatment.
Secondary Triage or Retriage
Secondary triage is often done at the designated treatment area to reassess all remaining
patients, to upgrade the triage category, and to decide which patients are prioritized for
evacuation.
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The START Method
The START method, which stands for Simple
Triage and Rapid Treatment, is one of the
easiest triage methods which may be used
when performing primary triage. It uses a
limited assessment of the patient's condition.
The following factors are checked: the
victim’s ability to walk, respiratory status,
hemodynamic status (pulse), and neurologic
status.
These can be remembered by the A-RPM mnemonic, which stands for:
 A-able to walk
 R-respirations
 P-perfusion, and
 M-mental status.
Additional guidelines include:

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
Begin where you stand.
Move through the patients in an orderly fashion.
Assess each casualty you come to and mark the category using triage ribbons.
Maintain a count of casualties by marking on two to three inch tape on your thigh, or by
saving small piece of triage ribbon.
Give only minimal treatment.
Keep moving!
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Emergency Childbirth
The following information is provided only for the very rare occasion when delivery occurs
unexpectedly and you cannot get medical help in time. During childbirth, the contractions of
the uterus dilate (open) the cervix and help the mother as she pushes the baby down the
vagina (birth canal) and out of the vaginal opening. Usually the baby is born head first, facing
down. After the baby is delivered, the placenta (after birth) detaches from the uterus and is
also expected.
The early stages of labor can last many hours. During this time, the cervix expands and the
baby begins to move down the birth canal. Once the mother is actively pushing out the baby,
delivery proceeds quickly.
Causes of Emergency Childbirth
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
Rupture tubal pregnancy with concealed hemorrhage into the abdominal cavity.
Unusual bleeding from the vagina at any stage.
Convulsions associated with pregnancy.
Miscalculations in the anticipated delivery.
Premature onset of labor after an accident.
Delay in transportation.
Other factors which may abbreviate delivery.
Signs and Symptoms




If labor contractions are approximately 2 minutes apart.
If the woman is straining or pushing down with contractions.
If the woman is crying out constantly.
Warning from the woman that the baby is coming.
Materials and supplies needed:
At home en route to the hospital:
 Assemble clean cloth, plastic bags or other materials to protect bed clothes or car
upholstery.
 Clean towels, one or two folded sheets.
 Set of sterile cord ties or sterilized shoelaces.
 New razor blade in protective paper.
 Diaper
 Alcohol
 Sanitary napkins
 Receiving blanket for the baby.
 Safety pins.
For a long automobile ride:
 The mother should wear a nightgown, or slip and a robe (no other underclothing) and place
a sanitary napkin or clean folded towel between her tights if the bag of waters has broken
or if the blood and mucous are draining from the birth canal.
 Take along a flashlight, if the trip will be at night.
 Blanket and pillow.
 Container of some sorts for the after birth.
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Aquatic Emergencies
An emergency can happen to anyone in, on or around water. Regardless of how good a person
is at swimming, anyone can get into trouble because of a sudden illness or injury. Skilled or not,
a person playing even in shallow water can be knocked down by a wave or pulled into deeper
water by a rip current. In such situations, drowning often occurs as a result.
Causes of Drowning
The major causes of drowning include the following:
 Panic
 Exhaustion in the water
 Losing control and getting swept into water that is too
deep
 Losing support (as in a sinking boat)
 Getting trapped or entangled in the water
 Using drugs or alcohol before getting into the water
 Suffering from a medical emergency while in the water
 Using poor judgment while in the water
 Hypothermia
 Trauma
 Having a diving accident.
Personal Water Safety
The best thing anyone can do to stay safe in, on and around the water is learn how to swim. The
Philippine Red Cross, through its Learn-To-Swim program, offers swimming courses. To enroll
in a swimming course, contact a local Red Cross chapter.
Recognizing an Aquatic Emergency
The key to effectively recognizing an emergency is by staying alert and by knowing the signals
that indicate that an emergency is happening.
A distressed swimmer may be too tired to get to shore
or to the side of the pool but is nevertheless able to stay
afloat and breathe and may be calling for help. The victim
may be floating, treading water or clinging to a line for
support. Someone who is trying to swim but making little or
no forward progress may be in distress. If not helped, a
person in distress may lose the ability to float and become a
drowning victim.
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An active drowning victim is vertical in the water but unable to move forward or tread
water. The victim’s arms are at the side pressing down in an instinctive attempt to keep the
head above water to breathe.
All energy is going into the
struggle to breathe, and the
victim cannot call out for help.
Such a person has only about
20 to 60 seconds before
submerging.
A
passive
drowning
victim is someone who is not
moving and may be floating
face down in the bottom or near the surface of the water.
Follow these general guidelines whenever you are swimming in any body of
water (pools, lakes, ponds, rivers or oceans):
Always swim with a buddy; never swim alone.
Read and obey all rules and posted signs.
Swim in areas supervised by a lifeguard.
Children or inexperienced swimmers should take extra precautions, such as wearing
approved life jackets when near bodies of water. Adults should keep an eye on children
at all times.
 Watch out for the “dangerous too’s”—too tired, too cold, too far away from safety, too
much sun, too much strenuous activity.
 Be knowledgeable of the water environment and the potential hazards (deep and shallow
areas, currents, depth changes, and obstructions) and know where the entry and exit
points are located.
 Know how to prevent, recognize and respond to emergencies.
 Use a feet-first entry when entering the water.
 Enter headfirst only when the area is clearly marked for diving and has no obstructions.
 DO NOT mix alcohol with swimming, diving or boating. Alcohol impairs judgment,
balance and coordination. It affects swimming and diving skills and reduces the body’s
ability to stay warm.




Emergency Actions
Near-Drowning






Make sure that the scene is safe. DO NOT rush into a dangerous situation where you too
may become a victim.
Always check first to see whether a lifeguard or other trained professional is present before
helping someone who may be having trouble in the water.
DO NOT swim out to a victim unless you have the proper training, skills and equipment.
If the appropriate safety equipment is not available and there is a chance that you cannot
safely help a person in trouble, call for help immediately.
If you must assist someone who is having trouble in the water, you must have the
appropriate equipment both for your own safety and the victim’s.
Send someone else to call the local emergency number while you start the rescue.
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Submerged Victim
If a victim is at or near the bottom of the pool in deep water, call for trained help immediately.
 If the victim is in shallow water that is less than chest deep, carefully wade into the water
with some kind of flotation equipment.
 Reach down and grasp the victim.
 Pull the victim to the surface.
 Turn the victim face-up and bring him or her to safety.
 Remove the victim from the water.
 Provide emergency care.
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Skill 12-1 Steps in Performing the START process
in triage
1. The first step of the START triage system is performed on arrival at the scene
by calling out to patients at the disaster site, "If you can hear my voice and
are able to walk…" and then directing patients to
an easily identifiable landmark.


The injured persons in this group are the walking
wounded and are considered minimal (green) priority,
or third-priority patients.
Ask all those that can walk to move to a designated
area away from immediate danger and outside of the
initial triage area.
2. The second step in the START process is directed toward non-walking
patients.




You move to the first non-ambulatory patient and assess the respiratory status.
If the patient is not breathing, you should open the airway by using a simple manual
maneuver.
A patient who still does not begin to breathe is triaged as expectant (black).
If the patient begins to breathe, tag the patient as immediate (red) and place him or her
in the recovery position. Move on to the next patient.
3. If the patient is breathing, a quick estimation of the respiratory rate should be
made.


A patient who is breathing faster than thirty breaths
per minute or slower than ten breaths per minute is
triaged as an immediate priority (red).
If the patient is breathing from ten to twenty nine
breaths per minute, move to the next step of the
assessment.
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4. The next step is to assess the hemodynamic status of the patient by checking
for bilateral radial pulses.


An absent radial pulse implies that the patient is
hypotensive and should be triaged as an immediate
priority.
If the radial pulse is present, go to the next
assessment.
5. The final assessment in the START triage is to assess the patient's neurologic
status.




This simply means assessing the patient's ability to
follow simple commands, such as "show me three
fingers."
This assessment establishes that the patient can
understand and follow commands.
A patient who is unconscious or cannot follow simple
commands is an immediate priority patient.
A patient who complies with a simple command
should be triaged in the delayed category.
Skill 12-2 Delivery Procedures during Emergency
Childbirth
1. Position the patient
Remove underclothing that may interfere with delivery.
The woman should be lying down on her back with knees bent, feet flat and thighs
separated widely on the floor, the seat of a vehicle, the ground or any other flat surface.
 At home, the woman may lie across a bed in the same position as mentioned above with
her feet resting on two straight chairs and her thighs and abdomen covered with clean
towels or sheets.
 In public places, quickly arrange for as much privacy as possible by having some people
stand around the woman with their backs turned to her to shield the scene from others.
 Place clean cloth or any clean materials under the woman’s buttocks.
 First aider should wear gloves before handling the delivery procedure.


1. Inspection of the Presenting Part:



Inspect the opening of the woman’s birth canal (vagina) to determine whether the
baby’s head is visible at the time of construction.
The back of its head is usually the presenting part, a wrinkled scalp and hair may be
noted, although the head may still be enclosed in the bag of waters.
If the woman has had previous pregnancies, and the exposed area of the baby’s head is
approximately the size of a 1 peso or larger, delivery will probably occur within a few
minutes during the next two or three contractions.
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If the woman is having her first child and the exposed area of the baby’s head is smaller
than 1 peso coin, proceed to the nearest hospital, if it is not more than 20 minutes away.
 Encourage the woman not to bear down or strain with contractions but instead to
breathe in and out rapidly with short, panting breath.
Some Don’ts:
 Don’t try to hold back the baby’s head or tell the woman to cross her legs to delay
delivery.
 Don’t place your hands or fingers into the birth canal at anytime, because of the danger
of infection.
 Don’t interfere by not allowing the delivery to proceed until the baby’s head has
emerged fully.

3. Delivery of the head






As the infant’s head emerges, guide and support it with your hands to prevent its
becoming contaminated with blood, mucus or fecal material.
If the baby’s head passes through the birth canal to the outside with the bag of water
still unbroken, tear it with your fingers to let the fluid escape and prevent aspirations as
the infant takes its first breathe.
When the head emerges, check it to see whether the umbilical cord is wrapped around
the infant’s neck. If so, gently but quickly slip it over the baby’s head with your
forefinger between its neck and the cord.
If the cord is wrapped around the infant’s neck more than once, or you cannot slip it
over the baby’s head, it must be cut immediately to prevent strangulation.
Squeeze the cut ends with gauze cloth or your fingers until ties can be applied.
If any part of the baby, other than its head, is seen at the opening of the birth canal,
proceed immediately to the nearest hospital.
4. Cutting the Cord




Though there will be no harm if the infant is left attached to the afterbirth by the
umbilical cord until the mother can be taken to the hospital, the cord must be cut if it is
strangling the baby as its head emerges. This is waiting for contractions to resume to
expel the placenta. Wait until all pulsation of the cord has stopped, maybe for about 5
minutes. See Figure 10 - 19
Use a new razor blade one-edge if possible or boil scissors or soak them in rubbing
alcohol, or after-shave lotion, or other alcohol-based preparation, for 20 minutes. Boil
new white shoelaces or narrow strips of clean white cloth for 20 minutes; it can be
applied wet.
The cord must not be cut closer than 4 inches from the infant’s navel.
Tie square knot or two or three simple knots 4 to 6 inches from the baby and a second
knot 8 inches from the baby.
3. Expulsion of the Afterbirth



Shortly after the birth of the baby, the mother’s contractions resume in preparation for
expelling the afterbirth (placenta), as it detaches from the wall of the womb (uterus).
Do not pull on the cord and do not push hard the mother’s lower abdomen, severe
damage to the uterus may result.
As afterbirth emerges, place your hand over the mother’s lower abdomen and massage
the uterus to contract and will help control bleeding. Repeat every 5 minutes for at least
the next hour or until the mother is seen by a physician. Save the afterbirth and take it
to the hospital with you.
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6. Care after delivery










After a home delivery, gently cleanse the vaginal opening with a clean, moist towel, or
pour soapy water over the vaginal opening.
Lay a sanitary napkin or other suitable clean cotton material across the vaginal opening.
Give the mother tea, coffee, or other fluids and keep her warm.
Keep the infant warm.
Do not attempt to cleanse the infant of the white, greasy protective coating covering its
skin.
Do not wash infant’s eyes, ears and nose.
Check to be sure that the infant’s breathing is normal and that it is kept warm during
transfer to the hospital.
If the afterbirth is not expelled, there is danger of hemorrhage. Medical care should be
sought without delay.
Do not pull on the afterbirth or on the cord.
If there are tears in the birth canal, with serious bleeding, treat as an open wound by
applying direct pressure to the bleeding area with a pad of sterile or clean cloth.
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CHAPTER 13
Lifting and
Moving
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Lifting and carrying are dynamic processes. A patient can be moved to safety in many different
ways, but no one way is best for every situation. The objective is to move a patient to safety
without causing injury to either the patient or the first aider.
Emergency Move
Is the movement of a patient to a safe place before initial assessment and care is provided,
typically because there is some potential danger. Emergency moves are usually done by one or
two people and without any equipment.
Non-emergency Move
Is the movement of a patient when both the scene and the patient are stable. Carrying devices
are often used and the procedure is not necessarily urgent.
Limitations
The manner and technique by which patients are moved and carried depends on certain
limitations that are prevalent during any given situation. Considering these limitations before
lifting or moving a patient will help the first aider decide what method is best and how to
proceed safely with the transfer. These limiting factors are:
 Dangerous conditions at the scene
 The size and weight of the victim
 Physical ability of the first aider
 Presence of other rescuers
 The victim’s condition
 Available carrying device
 Terrain and distance to travel.
Generally, DO NOT move an injured or ill person while giving care except in
the following situations:



When faced with immediate danger such as fire, lack of oxygen, risk of explosion or a
collapsing structure. Give care only when it can be done safely.
When there is a need to get to another person who may have a more serious problem.
In this case, a person with minor injuries may be moved to reach someone needing
immediate care.
When it is necessary to give proper care. For example, if someone needs CPR, he or
she might have to be moved from a bed because CPR needs to be performed on a firm,
flat surface. If the surface or space is not adequate for giving the necessary care, the
person should be moved.
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Lifting and Moving Guidelines
Follow these general guidelines to ensure safety when lifting and moving patients:
 Only attempt to move persons who you are sure you can comfortably handle.
 Bend your body at the knees and hips.
 Lift with your legs, not with your back.
 Walk carefully using short steps.
 When possible, move forward rather than backward.
 Always look where you are going.
 Support the victim’s head, neck and back, if necessary.
 If supine, lift and carry the patient’s entire body as one unit.
 Avoid bending or twisting a victim with a possible head, neck or back injury.
 Use the log-roll technique when placing a blanket or a spine board under the patient in
preparation for a carry.
Rescuer Distribution
To ensure that no individual suddenly bears an unexpectedly dangerous weight and to reduce
the risk of injury to the rescuers and the patient, it is important to position the rescuers
accordingly:
 When a patient is in a horizontal position, between 68 and 78 percent of the patient’s
weight is in the torso. Therefore, the strongest rescuers should be positioned at the
head area of the carrying device.
 However,
remaining
rescuers
should
still
position themselves in
such a way that each
person, including the
rescuers at the patient's
head, bears an equal
amount of the patient's
weight.
Traversing Stairs and Inclines
Carrying a patient down a flight of stairs or other incline poses a significant risk of injury to the
rescuers and/or patient if not performed in a safe, coordinated manner. Unlike carrying a
patient across flat terrain in an open area, the patient is carried down an incline and within the
confines of the walls on either side.
 Ensure that the patient is anatomically secured to the device in such a way that he or she
will not slide when the carrying device is at an angle.
 When the patient is carried down stairs on a stretcher or a backboard, make sure that the
device is carried with the foot-end first so that the head-end is higher than the foot end.
 Regardless of whether the stairs are straight or has turns, the key is to ensure that each
move is coordinated and that all rescuers are aware of what is happening at all times.
Communication among all rescuers is absolutely critical to safely carry a patient.
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Commands
To safely lift and carry a patient, rescuers must anticipate and understand every move, with
each move being executed in a coordinated manner:
 The team leader should indicate where each team member is to be located and rapidly
describe the sequence of steps that will be performed to ensure that the team knows what
is expected of it even before any lifting is initiated.
 Orders that will initiate the actual lifting or moving or any significant changes in movement
should be given in two parts: a preparatory command and a command of execution. For
example, if the team leader says "All ready to lift. LIFT!" The "All ready to lift" will get the
rescuers’ attention, identify who should act, and prepare them to act, while the declarative
"LIFT!" will indicate the exact moment for execution.
 Other commands may include “KNEEL!”, “STAND!”, “WALK!”, “STOP!” and “LOWER!” As much
as possible, other rescuers should acknowledge the team leader’s preparatory
command by saying “READY!”
 Commands of execution should be delivered in a louder voice. Often, a countdown is helpful
when you need to lift a patient. To avoid confusion when performing a countdown, always
clarify whether "three" is to be a part of the preparatory command or whether it is to serve
as the order to execute. You can say "We're going to lift on three. One-two-THREE!" or "I'm
going to count to three and then we're going to lift. One-two-three-LIFT!”
Methods and Techniques
Walking assist
The most basic emergency move is the walking assist. Either one or two rescuers can use this
method with a conscious victim. This assist is not appropriate if you suspect that the victim has
a head, neck or back injury.
Armpit or clothes drag
The clothes drag is a one-person technique. This can be used to move a conscious or
unconscious person with a suspected head, neck or spinal injury. This technique helps keep the
person’s head, neck and back stabilized. Be aware that this action is exhausting and may cause
back strain for the responder, even when done properly.
Ankle drag
Use the ankle drag (also known as the foot drag) to move a person who is too large to carry or
move in any other way.
Cradle carry
This is a one-person technique to be used only in the case of light victims or children.
Pack-strap carry
The pack-strap carry uses one rescuer and can be used with conscious or unconscious persons.
Using it with an unconscious person requires a second rescuer to help position the injured or
ill person on your back.
Firefighter's carry
To be used by a single rescuer and only when the patient is not too heavy for the bearer.
Extremity carry
The extremity carry is a two-rescuer technique. It may be used to move an unconscious person.
This is not applicable to situations where there are serious injuries to the trunk or when
fractures are present.
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Swing carry (two-handed seat or arms-as-litter)
The two-handed seat carry requires a second rescuer. This carry can be used for any person
who is conscious and not seriously injured.
Chair carry
This method utilizes two rescuers and is satisfactory for going up and down stairs, through
narrow corridors, and around corners.
Hammock carry
This technique may be used with a minimum of three and up to around six rescuers, with the
victim on his or her back (supine).
Flat lift and carry
The flat lift is used for patients with no suspected spinal injuries and who are found lying
supine on the ground.
 This technique is used when there is a need to lift and carry the patient to be placed on a
stretcher or in bed. It is also used to unload a stretcher.
 Ideally, the flat lift should be performed by three rescuers; however, it can be done with
only two depending on the size of the patient and the physical strength of the rescuers.
 The flat lift is performed the same way as the hammock carry, only that all rescuers are
positioned on one side of the patient and there is no interlocking of hands.
Blanket carry
If transfer is necessary before a lifter can be provided, a blanket can be placed under the
patient for lifting and carrying over a short distance. It can be performed by four to six
rescuers. A blanket should never be used if there is a suspected fracture of the neck or back.
Stretcher Techniques
Commercial stretchers
Commercial stretchers come in different forms and materials, but all of them have the same
purpose of providing the patient with adequate support. Commercial stretchers make it easier
for the rescuers to perform patient transfers.
It is important that first aiders should familiarize themselves with the operation of such
equipment so that it becomes reliably useful when needed.
 Before using any stretcher for the victim, be sure to test it first by lifting someone at least as
heavy as the victim.
 Ensure that the patient is secured to the device with straps or cravats to prevent falling or
sliding off the stretcher.
 It is preferable to have four bearers: one at the patient’s head, one at the feet, and one at
each side, all facing the direction of intended movement. Each rescuer at the sides holds the
side of the stretcher with the hand closest to the patient.
Improvised stretchers
In remote areas where commercial stretchers are not available, an improvised stretcher may
have to be used to transport a patient to a location. This could be to a place where motorized
transport is available or even to the medical facility itself.
 A stretcher may be improvised from clothing or it could be a blanket placed over wooden or
bamboo poles.
 A hammock can also be fashioned out of a blanket and a bamboo pole.
 A tabletop or a door may also be used as a makeshift carrying device.
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Skill 13-1 Steps in assisting a victim lying supine
on the ground or floor to stand
1. Flex victim’s legs at the knees and fold arms on chest.
2. Kneel beside the victim.


Using the hand closest to the victim’s head, insert under the shoulders in a scooping
manner.
Cradle the head with your arm.
3. Lift the shoulders so that the victim can sit.

Immediately support the victim by placing your leg that is closest to the head as a
backrest.
4. Hold on to the arms through the armpits and squat behind the victim with the
body upright.
5. Stand and lift the victim by straightening legs.
Skill 13-2 Steps in Performing Walking assist
1. Place the victim’s arm upon your shoulders and hold it in place with one hand.
2. Support the victim with your other hand and place the other hand around the
victim’s waist.
3. In this way, your body acts as a crutch, supporting the victim’s weight while
you both walk.
4. A second rescuer, if present, can support the victim in the same way. This can
be done on the other side.
Skill 13-3 Steps in Performing Armpit or Clothes
drag
1. Grasp the person’s armpit or clothing behind the neck (gathering enough to
secure a firm grip).
2. Pull the person (headfirst) to safety.
3. During this move, the person’s head is cradled by clothing. It can also be
protected by the responder’s arms.
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Skill 13-4 Steps in Performing Ankle drag
1. Firmly grasp the person’s ankles and move backward.
2. The person’s arms should be crossed on his or her chest.
3. Pull the person in a straight line, being careful not to bump the person’s head.
Skill 13-5 Steps in Performing Cradle Carry
(Carry-in-Arms)
Lift the victim by passing one of your arms well beneath the victim’s two knees
and the other around the victim’s back.
Skill 13-6 Steps in Performing Pack-Strap Move
1. Have the person stand or have a second rescuer support the person.
2. Position yourself with your back to the person, back straight, knees bent, so
that your shoulders fit into the person’s armpits.
3. Cross the person’s arms in front of you and grasp the person’s wrists.
4. Lean forward slightly and pull the person up and unto your back.
5. Stand up and walk to safety.
6. Depending on the size of the person, you may be able to hold both of his or her
wrists with one hand.

The objectives is to leave your other hand free to help maintain balance, open doors and
remove obstructions.
7. Do not use this assist if you suspect that the victim has a head, neck or spinal
injury.
Skill 13-7 Steps in Performing Firefighters Carry
1. Help the patient to rise and move to an upright position.
2. Grasp his right wrist with your left hand.
3. Bend down with your head under the extended right arm so that your right
shoulder is level with the lower part of his abdomen, and place your right arm
between or round his legs.
4. Taking his weight on your right shoulder, rise to the erect position.
5. Pull the patient across both shoulders and transfer his right wrist to your
hand.

The objective is to leave your left hand free.
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Skill 13-8 Steps in Performing Extremity Carry
1. One rescuer holds position near the victim’s head and helps the person sit
while supporting him or her.

Once the victim is seated, the rescuer squats behind the victim and then holds the arms
from behind so as to be ready to lift.
2. The other rescuer flexes the victim’s legs at the knees and then separates them
at an adequate distance.


This allows the rescuer to kneel between the legs, facing away from the victim.
The second rescuer then holds each of the victim’s legs just below the knees to be ready
to lift the body.
3. At the signal, both rescuers lift and carry the victim.
Skill 13-9 Steps in Performing Swing Move
1. Put one arm behind the person’s thighs and the other across the person’s back.
2. Interlock your arms with those of a second rescuer behind the person’s legs
and across his or her back.
3. Lift the person in the “seat” formed by the rescuers’ arms.
4. Rescuers should coordinate their movement as they walk together.
5. Do not use this assist if you suspect that the victim has a head, neck or spinal
injury.
Skill 13-10 Steps in Performing Chair Carry
1. Assist the patient to sit on a strong chair.
2. One rescuer holds each post of the chair’s backrest.
3. The other rescuer positions in front of and facing away from the patient and
holds each of the chair’s front legs.
4. This technique is not suitable for victims with neck, back or leg injuries.
Skill 13-11 Steps in Performing Hammock Carry
with Three Rescuers
1. Rescuers are positioned alternately and as much as possible equally on both
sides of the patient.
2. Each rescuer kneels on his or her knee.

The location should be close to the victim’s feet.
3. The rescuer closest to the patient’s head cradles the victim's head and
shoulders with his top arm.

The other arm is placed under the victim's lower back.
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4. The next rescuer on the opposite side slides an arm under the victim's back
and the other arm just below the victim's buttocks.

The hands should be alternated from the two sides.
5. The rescuer close to the patient’s legs at the opposite side slides his arm under
the victim's thighs and the other arm under the victim's legs below the knees.

NOTE: The rescuers with hands that are under the patient’s body should place their
hands only about halfway under the victim at this stage.
6. The command "All ready to lift!" is followed by the command "LIFT!" and the
patient is lifted to the rescuers' knees.

It is rested there while their hands are slid far enough under the victim to allow rotation
of their hands inward so that they can create two interlocking grips by holding each
other’s wrists.
7. The command "All ready to stand!" is followed by the command "STAND!" and
all carriers stand erect with the victim.
8. To lower the victim to the ground or unto a carrying device, reverse the
procedure.
Skill 13-12 Steps in Performing Blanket Carry
1. Allow about two-thirds of the blanket to fall in folds or pleats beside the
patient.

Then, place the folded (not rolled) portion snugly against the body.
2. Grasp the patient at the hips and shoulders and roll gently about one-eighth of
a turn away from the blanket as far under the patient as possible.



Roll back over the folds approximately one-eighth of a turn in the opposite direction.
Pull the blanket on through.
This procedure places the patient in the middle of the blanket.

Their lower hands would be situated just below the knees.
3. Roll the blanket tight at the sides until it fits the contours of the patient's body.
4. Two rescuers at the victim's shoulders grasp the blanket with their top hands
at the shoulders and their bottom hands at the lower back.
5. The two rescuers at the lower part of his body grasp the blanket with their top
hands at the hips and their lower hands at the legs.
6. At a signal, the rescuers holding the blanket lean back (away from the patient),
using their back muscles and body weight.


This action lifts the victim about six to eight inches from the floor or ground so that a
lifter can be slid underneath.
This will also test if the blanket can be strong enough to be used as a carrying device.
1. All parts of the victim's body should be supported and the patient’s entire
body should be kept level during the move.
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CHAPTER 14
Psychological
First Aid
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CHAPTER 14 – Psychological First Aid
Philippine Red Cross
First Aid Reference Manual
Stress
Is a normal response to a physical or emotional
challenge and occurs when demands are out of balance
with resources for coping.
A stressor is an event or condition that triggers the
stress response.
Types of stress



Day-to-day stress
Cumulative stress
Critical stress
Causes of Stress
Stressors may be as varied as taking a test, speaking
in public, experiencing poverty, feeling loneliness, Some of the physical indicators
thinking poorly of the self, being stuck in traffic or of negative stress include:
even when winning a prize. A stressor for one person
 Severe headaches
may not be a stressor for another, although some
 Sweating
stressors, such as injury or loneliness, tend to create
 Lower back pain
stress for everyone.
 Weakness
Positive or “good” stress is productive. Good stress
 Sleep disturbance
is the force that produces, among other things,
 Shortness of breath
enhanced thinking abilities, improved relationships
with others, and a greater sense of control. It can be part of the experience of being in a play,
making a new friend, or succeeding at a difficult task. Good stress can help you perform better
and be more efficient. Stress judged as “bad’’ (distress) can result in negative responses, such
as sadness, fatigue, guilt and disease.
Most stressful situations involve harm and loss, threat or challenge. Harm and loss
situations may include the death or loss (end of
relationship) of a loved one, physical assault or physical
Becoming aware of how the
injury, illness or disability, and loss of property or
body reacts to stress can help in
livelihood. Threat situations, real or perceived, can be
recognizing stressful situations
frightening or menacing and make it more difficult to
and conditions.
deal with life. Losses can be sudden and occur without
any warning.
Signs and Symptoms
The first step in learning to deal with stress is to become aware of the accompanying physical
and mental signals.
Other indicators, both emotional and mental, include:
 Shock
 Religious and spiritual beliefs getting
 Anger
challenged
 Guilt
 Goals and plans getting re-evaluated
 Depression
 Irritability
 Despair
 Denial that a problem exists
 Hopelessness
 Inability to concentrate or relax
 Searching for meaning  Feelings of unreality
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CHAPTER 14 – Psychological First Aid
Philippine Red Cross
First Aid Reference Manual
Self-care
Looking after one’s self means remaining fit to help others and to keep on doing so. Self care
techniques include:
 Remembering that you may have a quite normal and unavoidable reaction.
 Taking good care of one’s self by eating well, limiting the intake of alcohol and tobacco, and
exercising to relieve tension.
 Remembering that it takes time to process things that have happened.
 Not trying to self-medicate, and seeking professional advice if reactions are still difficult to
deal with after a few weeks.
Four Elements of Psychological First Aid
1. Stay close
A person in crisis temporarily loses his or her basic sense of security and trust in the world.
Volunteers can help rebuild trust and security by staying close and not becoming alarmed by
the person’s anxiety or extreme show of emotions.
2. Listen attentively
It is important to take time to listen carefully in order to help someone who is going through a
difficult time, listening without hurrying him or her, and showing active listening by asking
questions to clarify what the affected person is talking about. There may not be much time at
the scene of an accident, but it is still important to listen and be there for the person until the
ambulance personnel take over. For many people, interference can seem intrusive. It is,
therefore, important to maintain a balance and listen carefully without intruding.
3. Accept feelings
Keep an open mind about what is being said and accept the affected person’s interpretation of
the events. Acknowledge and respect feelings. Do not correct factual information or the
affected person’s perception of the sequence of events. Be prepared to encounter violent
outbursts of feelings. The person might even shout or reject help. It is important to be able to
see beyond the immediate facade and maintain contact in case the person needs to talk about
what has happened. At the scene of an accident this could mean moving away slightly, while
keeping an eye out for any signs that the person might need help.
4. Give general care and practical help
When someone is in a crisis situation, it is a great help if another person lends a hand with the
practical things. Contact someone who can be with the affected person, arrange for children to
be looked after, or drive the person home or to the medical facility. This practical help is a way
to show care and compassion. Follow the wishes of the affected person. Avoid taking more
responsibility for the situation than the person actually needs.
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CHAPTER 14 – Psychological First Aid
Philippine Red Cross
First Aid Reference Manual
Immediate First Aid Management
In a situation where an individual needs support immediately after a critical event has
occurred, the following steps could be pursued: 4
 Establish contact with the person by introducing yourself and offering assistance.
 If at all possible, remove the person from the stressful situation.
 Limit their exposure to sights, sounds and smells.
 Protect them from bystanders and the media. Give the person adequate food and fluids but
avoid alcohol.
 Make sure that someone stays with the person at all times.
 Ask the person what happened, how they are doing and allow them to talk about their
experiences, concerns and feelings.
 Do not force anyone to talk.
 Reassure the person that any reactions are normal.
 Help the person with decision-making if necessary.
 Ask the affected person if he or she has a place to go to. If not, help the person find shelter.
 Ask the affected person if he or she has someone to stay with or someone to talk to after
getting home. If not, help in establishing contact with family members or others.
 Give information about where and how to locate specific resources.
 If assistance is not enough, refer the person to professional help.
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Appendix
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Appendix 1 – Basic First Aid Kit Supplies
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Basic First Aid Kit
The following contents are recommended for personal use (good for 1 to 2
persons) only. These suggested quantities, units and items will depend on their
intended use in the house or workplace. Customize the contents by increasing the
number of supplies/disposables to suit the number of persons who may benefit
from these.
Qty.
Unit
1
10
10
20
2
2
1
1
20
1
2
2
20
1
1
1
20
1
1
20
piece
pieces
pieces
pieces
pieces
pieces
bottle
piece
pieces
piece
piece
piece
pieces
pack
piece
piece
pieces
bottle
piece
pieces
Items
Pen light (AA battery)
Gauze 2 x 2
Gauze 3 x 3
Gauze 4 x 4
Elastic roller bandage 2”
Elastic roller bandage 6”
Povidone Iodine 120ml
Tissue forceps (standard)
Tongue depressor sterile
Bandage scissor 5 ½ “
Adhesive tape 1”
Roller gauze 2” x yards.
Surgical glove medium 100pcs/box
Cotton buds 100pcs/pack
N95 mask
Power scissor (shear)
Sterile tipped 6” 100pcs/pack
Isopropyl Alcohol 70% (500ml)
Hot water bag (1liter capacity)
Plastic strip (band aid)
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Appendix 2 – Basic Family Survival Kit
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Basic Family Survival Kit
The basic family survival kit is specially designed for every family which shall be used only
during calamity/disaster. It contains basic but important things for survival as preparedness
spells the difference in the crucial first 72 hours of a disaster as they wait for assistance to
arrive.
Survival Kit
It is a 72-hour survival kit which contains basic materials and life saving measures that can be
used whenever families have no access to basic goods because of a disaster or an emergency.
Store these in a location that’s easily accessible but safely out of reach for young children.
Remember to get the entire family involved in preparation because disaster preparedness is
everybody’s business. The following are basic contents:
 Battery powered/crank radio (1pc.) – for gathering information on the updated news and
events.
 Flash lights (2pcs.) – for signal purposes during night and power failures.
 Whistle (1pc. per person) – for emergency signals to call attention
 Pocket knife/multi-purpose tool – for cutting and opening of pack food items.
 Lighter or box of matches (1pc.) – for starting fire for boiling; cooking or lighting.
 Extra clothes for each member of the family – for change of clothes especially under
garments.
 Dust mask – for protection against dust, dirt and bad stench.
 Spare batteries – for support in times of power failure for radios & flashlights, etc.
 Blankets and mats – protection from the weather. Keeps the person warm.
 Trash bag – for disposal of waste materials or also can be used as rain cover.
 Spon, fork, plates, cup – for food preparation.
 Utility rope and cord – for tying of materials and equipment
 Potable water (5gallons/bottle) – water enough for your family that can be used for
drinking and cooking. Water should be stored in a plastic sealable container.
 Ready to eat food & food with long shelf life – this minimizes foods that take a long time to
prepare.
o 10 kilos of rice
o 10 cans canned goods (2 cans meatloaf, 2 cans corned beef, 6 can sardines)
o 7 pouches instant noodles
o 1 kilo sugar
o ½ kilo of salt
o 1 liter vegetable oil
o 1 pack assorted biscuits
o 1 pack candies or chocolates
 Hygiene kit items
o 2 bars soap
o 5 pieces toothpaste (225 grams)
o 2 pieces sanitary napkin
o 5 pieces personal towel (14”x27”)
o 2 rolls toilet paper
o 1 pack cotton buds
o 1 bar detergent soap
 First aid kit –for treatment or immediate care of injured individuals. (refer to first aid
appendix 1)
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Appendix 2 –Basic Family Survival Kit
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Include important documents placed on a waterproof envelope like:
 Will, insurance policies, contracts deeds, stocks and bonds.
 Passports, birth certificates, social security cards, immunization records.
 Bank account numbers, credit card account numbers and companies.
Also include special items for family members, infants and elderly or physically
challenged individuals:
 Diaper, toys
 Extra eye glasses, contact lenses and supplies, denture needs.
 Prescription medications
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Appendix 2 – Road Safety
Philippine Red Cross
First Aid and BLS-CPRReference Manual
Road Safety deals with reducing traffic accidents. It is also about arresting
injuries sustained during those accidents.
Facts and Figures
 1.2 million people worldwide are estimated to be killed each year on the roads
– more than 3,000 people every day, including 500 children.
 50 million people worldwide are estimated to be injured in road crashes each
year, 15 million seriously.
 For men aged 15 to 44, road traffic injuries rank second (behind HIV/AIDS) as
the leading cause of premature death and ill health worldwide.
 The majority of road crash victims (injuries and fatalities) in developing
countries are not the motor vehicle occupants, but PEDESTRIANS,
MOTORCYCLISTS, BICYCLISTS and NON-MOTOR VEHICLE (NMV)
OCCUPANTS.
 In Metro Manila alone, deaths from road accidents reached 380 in 2010
according to the Metropolitan Manila Development Authority Metro Manila
Accident Reporting and Analysis System.
 From January to October of 2010, the Philippine National Police Highway
Patrol Group has recorded a total of 14,487 vehicular accidents across the
country.
(ref:http://globalnation.inquirer.net/news/breakingnews/view/20110512336125/Philippines-joins-global-road-safety-drive)
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Appendix 2 – Road Safety
Philippine Red Cross
First Aid and BLS-CPRReference Manual
Causes of Traffic Accidents
Causes
Drive Error
Speeding
Overtaking
Mechanical Defects
Turning
Overloading
Self Accident
Road Defects
Hit and Run
Drunk Driving
Using Cellular Phones
Number
4,222
2,908
2,042
2,003
1,543
1,174
806
783
673
94
47
Reference: 2003 Asian Development Bank Report
How Can Road Accidents Be Prevented
1. Obey traffic signs and signals.
2. Stop, look “left-right-left” before crossing.
3. Be alert, especially in bad weather.
4. Walk on sidewalks.
5. Always cross the streets at intersections or crosswalks.
6. Don’t assume a vehicle is going to stop for you.
7. Children should avoid:
 Darting between cars;
 Playing in the streets;
 Running across intersections;
 Getting on or off a school bus; and
 Running across the street without looking.
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Appendix 2 – Road Safety
Philippine Red Cross
First Aid and BLS-CPRReference Manual
Road Safety Commitments
Below is a list of ten road safety commitments. This list is produced by IFRC for
use by National Society governance leaders, staff, volunteers, partners in road
safety, and the general public. It is a way to protect people in their daily life and
to encourage them to set a good example.
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Appendix 3 – Occupational Safety and Health
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Occupational Safety and Health (OSH) is the promotion and maintenance of the
highest degree of physical, mental and social well-being of workers in all
occupations. It calls for the prevention of any impairment in the health and wellbeing of workers caused by their working conditions or work environment. OSH
stands for the protection of workers from risks and hazards that could adversely
affect their health and well-being and for their placement in an occupational
environment adapted to his/her physiological ability. (ref: National Profile on
Occupational Safety and Health, Occupational Safety and Health Center (OSHC),
Manila, September 2006)
For the year 2009-2010, the Institute for Occupational Health and Safety
Development (IOHSAD) recorded at least 511 deaths and 791 injured in workrelated incidents in the Philippines.
(ref:http://bulatlat.com/main/2011/04/29/neglect-of-occupational-health-andsafety-results-in-death-injuries-of-workers/) Most of these deaths and injuries can
be prevented if workplace safety is adequately promoted and rules are strictly
observed and enforced.
P.D. 442: The Labor Code of the Philippines
The Philippine Labor Code devotes Book IV to prevention and compensation of
work-related injuries and illnesses. This chapter describes the health and safety
standards and who should be responsible for defining and enforcing these
standards. All employers are covered whether operating for profit or not,
including the Government and any of its political subdivisions and governmentowned or controlled corporations, which employ in any workplace one or more
workers. As a rule, every employer shall keep and maintain his or her workplace
free from hazards that are causing or likely to cause physical harm to the workers
or damage to property. (ref: National Profile on Occupational Safety and Health,
Occupational Safety and Health Center (OSHC), Manila, September 2006)
According to Article 156 of the Labor Code, “every employer shall keep in his
establishment such first-aid medicines and equipment as the nature and
conditions of work may require, in accordance with such regulations as the
Department of Labor and Employment shall prescribe” and that “the employer
shall take steps for the training of a sufficient number of employees in first-aid
treatment.” This ensures that trained personnel will be available and can
immediately respond when an emergency arises, and thus prevent unnecessary
deaths and disabilities due to possible neglect and delays in obtaining medical
help.
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Appendix 3 – Occupational Safety and Health
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Article 157 further specifies that “it shall be the duty of every employer to furnish
his employees in any locality with free medical and dental attendance and
facilities consisting of … the services of a full-time registered nurse when the
number of employees exceeds fifty (50) but not more than two hundred (200)
except when the employer does not maintain hazardous workplaces, in which
case, the services of a graduate first-aider shall be provided for the protection of
workers, where no registered nurse is available.”
The Labor Code’s implementing rules and regulations define the following in the
context of OSH:
 "First aid treatment" means adequate, immediate and necessary medical
and dental attention or remedy given in case of injury or sudden illness
suffered by a worker during employment, irrespective of whether or not
such injury or illness is work-connected, before more extensive medical
and/or dental treatment can be secured. It does not include continued
treatment or follow-up treatment for any injury or illness.
 "First-aider" means any person trained and duly certified as qualified to
administer first aid by the Philippine National Red Cross or by any other
organization accredited by the former.
This implies that only PRC has the legal mandate in the country to train and
certify employees in first aid. Its Occupational First Aid course is designed to
provide workers with basic first aid competencies that address the need of any
and most common workplace emergencies.
Occupational Safety and Health Standards (OSHS) of 1978
Under Article 162 of the Philippine Labor Code, the OSHS was promulgated for
the guidance and compliance of those covered. The DOLE administers and
enforces the provisions of the Standards. Safety and Health rules may be
promulgated, modified or revoked covering 26 rules and 144 sub-rules, among
which are:
 training of personnel in OSH
 setting up of safety and health committees
 notification and keeping of records of accidents and/or occupational
illnesses
 occupational health and environmental control
 personal protective equipment and devices
 hazardous materials
 materials handling and storage
 underfired pressure vessels
 machine guarding
 fire protection and control
 pesticides and fertilizers
 occupational health services
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Appendix 3 – Occupational Safety and Health
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
“Zero Accident Program” (ZAP)
The Zero Accident Program is at the center of national efforts to bring OSH to
more and more workplaces and workers. It is a flagship program of the
government and part of the agenda of “Decent Work and OSH for All.” It is a longterm strategy to promote the safety and health of workers through advocacy,
capability building, compliance, network/linkages and productivity promotion.
(ref: National Profile on Occupational Safety and Health, Occupational Safety and
Health Center (OSHC), Manila, September 2006)
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Appendix 4 – Poison Control Center
Hospital or Facility
Luzon
National Poison Management and
Control Center
Philippine General Hospital
Taft Avenue, Manila
East Avenue Medical Center
East Avenue, Quezon City
Rizal Medical Center
Shaw Blvd., Pasig City
Batangas Regional Hospital
Batangas City
Visayas
Eastern Visayas Regional Medical
Center
Tacloban City, Leyte
Iloilo Doctors Hospital
Molo, Iloilo City
Philippine Red Cross
First Aid and BLS-CPR Reference Manual
Contact Number(s)
Landline: (02)524-1078; (02)404-0257
(02)521-5850 loc. 2311;
Mobile: (0928)713-0408
Fax: (02)526-0062
Landline: (02)434-2511
Landline: (02)671-9615, (02)671-9740
Landline: (043)723-3578
Landline: (053)321-3131
Fax: (053)337-7702
Landline: (033)337-7702
Mindanao
Northern Mindanao Medical Center
Cagayan de Oro City
Landline: (088)350-4325, (088)8587125
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