SINGAPORE RED CROSS SOCIETY
STANDARD
FIRST AID
TRAINING NOTES
Standard First Aid
Table of Contents
TABLE OF CONTENTS
LESSON 1:
Principles and Practice of First Aid
Management of Medical Emergencies
Introduction to Triangular & Roller Bandaging (Practical)
Page 4 to 9
LESSON 2:
Respiratory System
Breathing Difficulties
Adult Foreign Body Airway Obstruction (Choking)
Page 10 to 19
LESSON 3
Circulatory System
Perform Adult Cardiopulmonary Resuscitation
Manage Shock
Manage Bleeding
Manage Different Types of Wounds
Page 20 to 36
LESSON 4
Nervous System
Manage an Unconscious Casualty
Manage a Casualty with Chest, Spinal and Abdominal
Injuries
Page 37 to 49
LESSON 5
Musculoskeletal System
Manage Fractures
Manage Soft Tissue Injuries
Manage Muscle Cramps
Page 50 to 65
LESSON 6
Skin
Manage Burn Injuries
Manage Bites and Stings
Manage Poisoning
Manage Heat Disorders
Transport a Casualty
Page 66 to 77
LESSON 7
Types of Bandaging (Practical)
- Triangular Bandaging
- Roller Bandaging
Page 78 to 89
CPR (Practical)
- CPR Checklist (for layperson)
- One Man Adult CPR Practical Assessment Sheet
Page 90 to 92
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First aid book
Note Taking
Page 93 to 94
STANDARD FIRST AID
LESSON 1
Overview
This lesson looks at the principles and practice of first aid, its aims, the responsibilities and duties
of a first aider, ways to protect yourself, the management of medical emergencies and how to use a
first aid kit.
Topics Outline for Lesson 1
1
PRINCIPLES & PRACTICE OF FIRST AID
a) Definition of First Aid
b) Aims of First Aid
c) Role of a first aider
d) Your limitations
e) Ways to protect yourself
2
MANAGEMENT OF MEDICAL EMERGENCIES
a) Emergency Action Plan

Primary survey

Secondary survey

Recovery position
b) The First Aid Kit
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First aid book
1
PRINCIPLES & PRACTICE OF FIRST AID
Definition of First Aid
First aid is immediate help given to a person who is injured or has suddenly taken ill before medical
aid arrives.
a)
Aims of First Aid
The four aims of first aid are:
1. To preserve/save life - Prolong the life of a casualty by ensuring the airway is clear and
rendering resuscitation when necessary.
2. To prevent the condition from worsening - minimise any complications by rendering first aid to
the casualty
3. To promote recovery - to ensure that the casualty is comfortable by monitoring his conditions
until the arrival of medical professional.
4. To provide comfort and relief.
b)
Role of a first aider

Sustain life

Observe casualty

Get help

Organise care
Take note
1. Your knowledge and skills have limitations.
2. Your responsibilities begin when you arrive at the scene and continue until medical aid
arrives or the casualty recovers.
3. Identify yourself, get permission to give care, and explain the help to be given.
4. Make sure you practice what you have been taught.
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First aid book
c)
Ways to Protect Yourself
It is important for a first aider to ensure that there is no cross-infection when rendering first aid. As
such, a first aider should avoid being in contact with a casualty’s bodily fluids by:

Knowing the dangers eg. blood-borne pathogens

Covering open wounds

Using Personal Protective Equipment ( PPE ) - latex gloves and pocket mask
2
MANAGEMENT OF MEDICAL EMERGENCIES
a)
THE EMERGENCY ACTION PLAN



Primary survey
Secondary survey
Recovery position
Primary Survey
[I]
Assess the scene for Danger.
A first aider must be aware of any surrounding dangers and remove danger immediately if possible.
Remove the casualty from the danger as an alternative. Ask yourself these questions before
rendering assistance.
Priority of Treatment





Is there any danger to me?
Can I rescue the casualty from danger?
How do I deal with the danger?
How many casualties are there?
Who to treat first? Follow the priority of treatment.
1. Life threatening emergencies.
2. Bleeding wounds and
fractures.
3. Minor injuries.
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Assess casualty for Responsiveness
[II]
A first aider needs to determine the level of responsiveness by

Gently tapping the casualty at the shoulder, and

Asking if the casualty is alright.
[III]
Observe the casualty’s level of responsiveness as follows:

Alert – able to respond to simple questions and give answers.

Voice – able to respond to voice by moving body.

Pain – able to respond to pain.

Unresponsive – no response or movement.
[IV]
Shout for help
If there is no response from the casualty, shout for help and contact emergency service, call the
ambulance 995 immediately. Pass relevant information such as:






Your name and telephone
Casualty location and location landmarks
Briefly what happened
Number of casualties
Casualty’s condition
Other information e.g. traffic condition
Open and check the Airway
[V]

Head tilt chin lift, a technique to ensure clear airway.
[VI]
Check for Breathing

Look at the chest, listen to the air and feel the warm air for up to 10 seconds.

If no breathing, commence CPR
[VII]

Commence CPR
Commence CPR and continue until casualty begins to breathe, ambulance arrives, AED is
available, rescuer gets exhausted or someone takes over.

If breathing is present, check for signs of injuries.
# Footnote :
During your initial assessment, check also for severe bleeding, head and spinal injuries before ABC.
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First aid book
Secondary Survey
Once breathing is maintained, the first aider needs to conduct a head to toe secondary survey to
check whether there is any injury. The technique is perform in a systematic way :
C
Check for pain, any discomfort.
H
History – ask briefly what happened.
E
Examine head to toe for any missed injuries.
C
Compare opposite side for abnormality.
K 
Keep monitoring vital signs.
Recovery Position
Once there is no injury, the first aider needs to place the casualty to the recovery position or rest
the casualty in the most comfortable position, depending on the condition of the casualty.
Purpose
1. Prevents casualty’s tongue from falling back and blocking his airway.
2. Prevents any vomitus or secretions from choking the casualty
During recovery – Monitor the Vital Signs

Breathing

Level of response / level of consciousness
The Recovery Position
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First aid book
b)
Every home should have a First Aid Kit
Every home or workplace should have a first aid kit that must be readily available and accessible to
all. A well-maintained first aid kit will make the first aider more confident when rendering first aid.
A first aider must check for expiry dates on the items and replenish the items immediately.
Quantity
10 pieces each
4 packets
6 pieces
1 bunch
2 pairs
1 pair
1 roll
2 packets
1 packet
1 piece
5 tubes
2 rolls each
1 set
Quantity
1 each
1 each
2 packets
1 each
Basic Items
Adhesive dressing plasters in assorted sizes
Sterile gauze of various sizes
Triangular bandages
Safety pins
Disposable gloves
Scissor
Micropore or zinc oxide tape
Cotton balls
Antiseptic cleaning wipes ( 10 pieces/packet)
Face mask with one way valve
Normal saline (10 cc)
Crepe bandage ( 2.5, 5, 7.5, 10 cm )
Tweezers or forceps ( plastic or stainless steel )
Useful Addition Items
Notepad and pen
Torch and whistle
Instant cold pack
Thermometer
( clinical or digital )
* This is only a suggested list.
END OF LESSON 1
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
STANDARD FIRST AID
LESSON 2
Overview
This lesson looks at the respiratory system, the mechanism of breathing, recognition of breathing
difficulty, specific causes of breathing difficulty and how to clear foreign body airway obstruction
of a conscious to an unconscious adult.
Topics Outline for Lesson 2
1
THE RESPIRATORY SYSTEM
a) The Structure of the Respiratory System
b) Its Functions
c) The Mechanism of Breathing
2
RESPIRATORY DISTRESS OR BREATHING DIFFICULTY
a) Recognition of Respiratory Distress
b) Some Causes of Breathing Difficulty
 Choking – abdominal and chest thrust
 Unconscious choking
 Drowning
 Hyperventilation
 Bronchial Asthma
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
1
THE RESPIRATORY SYSTEM
a)
Structure
The respiratory system comprises of the:







b)
Nasal passage
Larynx
Trachea ( windpipe )
Bronchial tubes
Pleura
Alveoli
Diaphragm
Function
The functions of the respiratory system are:


To provide oxygen for use in the body.
To excrete carbon dioxide.
Respiration is the process in which the
body takes in oxygen and expels carbon
dioxide (a waste product from body
tissues).
The breathing process comprises the
actions of breathing in (inspiration /
inhalation), breathing out (expiration /
exhalation) and a pause.
c)
Mechanism of Breathing

During inspiration (breathing in) the chest cavity is enlarged, 21% of oxygen is inspired.

During expiration (breathing out) the lungs contract, the cavity returns to normal size and air
is forced out, 16 % of oxygen is expired.

Only 5% of oxygen is absorbed by the body.

The exchange takes place in the lungs at the alveoli (air sacs); the oxygen that we breathe in is
taken into the pulmonary capillaries; at the same time, carbon dioxide is released and expelled
as we breathe out.

The breathing rate of an adult is between12 to 18 breaths per minute.
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Mechanism of Breathing
2
RESPIRATORY DISTRESS OR BREATHING DIFFIFULTY
While normal breathing is effortless, steady, rhythmic, and occurs with little or no noise, abnormal
breathing is noisy and requires much effort. The brain will suffer permanent damage if deprived of
oxygen for more than four minutes.
Breathing difficulty is a condition where the casualty is having laboured breathing or respiratory
distress.
a)
Recognition

Difficulty in breathing and gasping for breath

Anxiety, restlessness, confusion, disorientation

Casualty’s skin is bluish in colour (cyanose)

Leading to unconsciousness
b)
Causes of breathing difficulty are:

Choking

Fumes inhalation

Drowning

Hyperventilation

Bronchial Asthma
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Respiratory Arrest
Respiratory arrest means absence of spontaneous breathing. It is a life-threatening condition
requiring immediate medical attention.
Common causes




Choking
Heart attack
Drug overdose
Prolonged asthmatic attack
Actions to take

DRSABC
ADULT FOREIGN BODY AIRWAY
OBSTRUCTION (CHOKING)
Choking is a respiratory distress that occurs when the
airway is partially ( mildly ) or totally ( severely )
obstructed by a foreign object or commonly the tongue
when the victim becomes unconscious.
Causes


Foreign body
Tongue (when unconscious)
Recognition



Difficulty in speaking, breathing & coughing
Universal sign
Cyanosis
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Actions to take for a Conscious casualty (not pregnant or obese)
Encourage the victim to cough until condition worsens.
STEP 1.
ASSESS WHETHER VICTIM IS CHOKING

Ask, “Are you choking? Are you pregnant?”(for
female casualty only).

If the victim is choking, the victim will not be able to
speak, breathe or cough but may nod his head.
STEP 2.
POSITION OF RESCUER

If the victim is standing, the rescuer stands behind the victim.

If the victim is sitting, the rescuer kneels down and positions himself behind the victim
STEP 3.
LOCATION OF LANDMARK

Put your arms around the victim’s abdomen.

Place 2 fingers’ breath above the navel and well
below the tip of the xiphoid process.

Make a fist with one hand.

Place the thumb-side of the fist against the
abdomen, midline and above the 2 fingers’
spacing.
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
STEP 4.
THE HEIMLICH MANOEUVRE

Lean the victim forward with one hand, while maintaining the
fist against the abdomen.

Grasp the fist with the other hand.

Give quick inward and upward thrusts in one motion into the
victim’s abdomen until the foreign body is expelled or the
victim becomes unconscious.
Actions to take for a Conscious casualty (pregnant or obese)
Encourage the victim to cough until condition
worsens.
STEP 1. ASSESS WHETHER VICTIM IS CHOKING
STEP 2. POSITION OF RESCUER
STEP 3. LOCATION OF LANDMARK

Place arms under the victim’s armpits,
encircling the chest.

Make a fist with one hand.

Place thumb-side of fist on the middle of the
victim’s breastbone.
STEP 4. CHEST THRUST

Grasp fist with the other hand and give quick
backward thrusts.

Deliver each thrust firmly and distinctly
with the intent of relieving the obstruction
until the foreign body is expelled or the
victim becomes unconscious.
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Actions to take for an Unconscious casualty
STEP 1. CHECK FOR DANGER
STEP 2. ASSESS UNRESPONSIVENESS
STEP 3. SHOUT FOR HELP. ACTIVATE THE
EMERGENCY MEDICAL SERVICE (EMS)

Shout loudly for help and immediately call 995 for an
emergency ambulance.
STEP 4. PERFORM CHEST COMPRESSIONS

Commence 30 chest compressions using the same
location and technique used as chest compression (refer
to Adult CPR).
STEP 5. OPEN THE AIRWAY

Perform a Head-Tilt Chin-Lift maneuver
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction

Remove visible foreign body if seen by using the
index finger

Do not perform blind sweeping.
STEP 6. CHECK BREATHING

Look,

Listen and

Feel for signs of breathing (up to 10sec).
STEP 7. MOUTH TO MOUTH BREATHING

If breathing is absent, attempt one ventilation.

If chest does not rise, this indicates that the
airway is still blocked.

Reposition the victim’s head and re-attempt
to ventilate.

If 2nd ventilation fails, suspect that the victim
is still choking.
STEP 8. CONTINUE CHEST COMPRESSIONS

If no foreign body seen, repeat Steps 4 to 7 until able to give two
successful ventilations, help arrives, or victim starts breathing,
coughing, moving or talking.

If breathing is present, check for injuries.

Position the victim in the recovery position if no injuries.

Continue to monitor the victim’s breathing and level of response every few minutes.
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Drowning
Death by drowning usually occurs not because the lungs are full of water, but because throat
spasms prevent breathing.
Causes



Fatigue
Poor swimming skills
Strong currents and waves
Actions to take



DRSABC
Keep casualty warm
Seek medical attention
Hyperventilation
Hyperventilation is a condition of over-breathing, which causes an excessive loss of carbon dioxide
from the blood, leading to a tingling sensation and numbness of the hands and legs.
Recognition




Unnaturally fast, deep breathing.
Dizziness, faintness, trembling or tingling in the hands.
Cramps in the hands and feet.
Seek medical attention
Causes




Anxiety
Hysteria
Panic attack
Fright
Actions to take



Lead casualty to a quiet place.
Ask casualty to breathe slowly.
Let him re-breathe his own expired air covering mouth and nose.
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Standard First Aid - Lesson 2
Breathing Difficulties & Adult Foreign Body Airway Obstruction
Bronchial Asthma
Bronchial asthma is a condition where there is difficulty in breathing due to the muscles of the air
passages going into spasm
Causes


Environmental triggers like cold air, pollen, cigarette smoke and perfumes.
Occupational exposures such as dust, fumes and industrial smoke.
Recognition





Difficulty in breathing.
Wheezing during expiration.
Blueness of the skin (cyanosis).
Distress and anxiety.
In severe attacks, the effort of breathing will tire out the casualty.
Actions to take




Let the casualty adopt the position that he finds most comfortable, which is often sitting
up. Do not lie down.
Ask him to breathe slowly and deeply.
Ask him about any asthma medication. Assist him to use the inhaler.
If condition worsens, rush victim to the nearest doctor or hospital or call ambulance 995.
END OF LESSON 2
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
STANDARD FIRST AID
LESSON 3
Overview
This lesson covers the circulatory system, shock, bleeding, wounds and cardiopulmonary
resuscitation.
Topics Outline for Lesson 3
1
THE CIRCULATORY SYSTEM
a) Structure of the circulatory system
b) The Heart
c) Blood Pressure
d) The Pulse
2
MANAGEMENT OF SHOCK
a) Causes of Shock
b) Recognise the signs and symptoms of shock and how to manage shock.
3
4
ADULT CARDIOPULMONARY RESUSCITATION (CPR)
a)
Heart Attack and Cardiac Arrest
b)
Importance of the Chain of Survival Concept
c)
Steps in performing CPR
MANAGEMENT OF BLEEDING
a) Recognise and manage different types of bleeding.
5
MANAGEMENT OF DIFFERENT TYPES OF WOUNDS
a) Recognise and manage different types of wounds including nose bleed.
b) Recognise and manage special types of wounds - embedded foreign body.
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
1
THE CIRCULATORY SYSTEM
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
a)
Structure
The circulatory system is made up of the heart and blood vessels. Four to six litres of blood
circulate around the body to distribute oxygen and nutrients to the tissues and carry waste
products away.

Blood Vessels
There are three types of blood vessels: arties, veins and capillaries.
Arteries – Strong, muscular, elastic-walled vessels which carry blood away from the heart
towards the tissues.
Veins – Thin-walled vessels which carry blood back to the heart. Blood is squeezed through the
veins by action of the surrounding muscles, and is kept flowing towards the heart through oneway valves.
Capillaries – Arteries subdivide to form a dense network of fine, thin-walled vessels called
capillaries within the body tissues. The thin capillary walls allow for exchange of gases and other
materials between cells of the body and the blood. The capillaries then rejoin to become veins.
b)
The Heart
Pulmonary artery carries
deoxygenated blood to
Pulmonary vein carries
oxygenated blood from lungs
The functions of the heart are to pump:
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
Deoxygenated blood to the lungs for
oxygenation.

Oxygenated blood to all parts of the body.
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
c)
Blood pressure
The heart’s pumping action makes the blood exert
pressure against the walls of the artery. This is called
blood pressure. As the artery walls are elastic, they
can expand or contract to maintain blood pressure at
normal levels. Blood pressure is a measurement of
your risk for hypertension and heart disease.
Blood Pressure (BP) is described by two numbers,
for example, if your BP is 120/80, the systolic BP
is 120mmHg and the diastolic BP is 80mmHg.
The systolic range for adult is
Hg
100 – 140 mm
The diastolic range for adult is 60 – 90 mm Hg
d)
The Pulse
This is the pressure wave along arteries, generated by the contraction of the heart. It can be felt
where the artery is close to the surface of the body.
Pulse rate for a normal adult
Pulse rate for an infant  1 yr is
Pulse rate for a child is
= 60 to 100 beats per min.
= 100 to 160 per minute
= 80 to 120 per minute
The pulse for an adult can be felt at the:
1.
Wrist (radial pulse)
2. Neck (carotid pulse).
Pulse – Normal versus Abnormal
Rate
Normal
60 to 100 beats per min
Rhythm
Strength
regular
strong
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Abnormal
> 100 ( fast heart rate or tachycardia )
< 60 ( slow heart rate or bradycardia )
irregular
weak ( in shock )
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
2
MANAGEMENT OF SHOCK
Shock may be defined as failure of the circulatory system to perfuse tissues of the body.
Shock is defined as a life-threatening condition which may be progressive and may lead to the
collapse of the circulatory system. Life in danger
Causes






Types
Severe blood loss eg. bleeding
Fluid loss eg. burns
Severe pain
Infection or poisoning
Heart attack or heart failure
Severe allergic reaction






Hypovolemic shock ( volume failure )
Hypovolemic shock ( volume failure )
Neurogenic shock ( spinal injuries )
Septicaemia shock ( vasodilation )
Cardiogenic shock ( pump failure )
Anaphyalactic shock ( vasodilation )
Recognition






Extreme thirst
Anxiety
Mental state changes
Rapid & shallow breathing
Rapid & weak pulse
Pale cold & moist skin
The signs and symptoms vary with the degree of severity of shock. Table below illustrates the
response of the body to blood loss.
Volume
300 to 500 ml of blood loss
Signs & Symptoms

Little or no effect
1500 to 2000 ml of blood loss
1.
2.
3.
4.
5.
6.
7.
More than 2000 ml
of blood loss
1. Pulse becomes undetectable
2. Loss of consciousness
3. Breathing may cease and heart may stop, impending
death.
Increased pulse rate
Shallow and rapid breathing
Sweating
Cold and clammy skin
Pallor
Nausea
Drowsiness
Actions to take






Reassure the casualty. Call ambulance 995.
Lay casualty down or put him in a comfortable position.
Elevate legs above level of heart (unless fractured).
Treat cause (e.g. stop bleeding).
Loosen visible tight clothing.
Monitor vital signs – breathing & response.
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Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
3
ADULT CARDIOPULMONARY RESUSCITATION (CPR)
a)
Heart attack
A heart attack occurs when there is an
insufficiency of blood supply to the heart
muscle.
Recognition

Chest pain / discomfort

Shortness of breath

Sweating

Nausea
Action to take






b)
Reassure the victim.
Call ambulance 995 and get the Automated
External Defibrillator (AED) if available.
Ask him if he has any medication to relief
the pain.
If so, ask him to take the medicine.
Monitor the victim.
Perform CPR if victim is not breathing and
is unconscious.
Cardiac Arrest
Cardiac arrest is a sudden cessation of heartbeat. When this occurs, the heart will stop pumping
and the circulation will also stop.
The casualty may have chest pain and may collapse suddenly, or he may be found unconscious
because his heart has stopped
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Page 25
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
c)
The Importance of the Chain of Survival Concept
Early Access
Early CPR
Early Defibrillation
Early Advanced
Cardiac Care
The chain of survival concept highlights the importance of understanding the four interconnected links that lead to the rapid recovery of cardiac arrest casualty.
The four links are:

Early Access – the first aider must recognise the symptoms and signs of life-threatening
conditions, such as chest pain and shortness of breath, which warrants a call to 995 before
the casualty collapses.

Early Cardio Pulmonary Resuscitation – it is a temporary intervention that provides
oxygen to the heart, brain and other vital organs. If no oxygen reaches the brain for 4
minutes, the casualty may become brain dead.

Early Defibrillation – the external electric shock ‘defibrillation’ will restore regular heart
rhythm. It improves survival rates for out-of-hospital cardiac arrest casualty.

Early Advance Cardiac Life Support – medical care provided by the ambulance medical
personnel that includes supporting ventilation, establishing intravenous access,
administering drugs, controlling arrhythmias and preparing the casualty for transport to
hospital.
Jubbalad medical training college
Page 26
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
d)
Steps in performing CPR
STEP 1. CHECK FOR DANGER
STEP 2. ASSESS UNRESPONSIVENESS


Call, tap or gently shake the person
“Hello! Hello! Are you OK?”
STEP 3. SHOUT FOR HELP. ACTIVATE EMERGENCY
MEDICAL SERVICE (EMS)

If victim does not respond, shout for help.

Call ambulance 995 and get the first aid kit and AED if
available.
STEP 4. POSITION THE CASUALTY

For CPR to be effective, the victim must lie on a firm, flat
surface.

If the casualty is lying face down, or on his / her side, you
will need to roll the casualty over onto his /her back.
Jubbalad medical training college
Page 27
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
STEP 5. OPEN THE AIRWAY

Perform a head-tilt chin-lift manoeuvre.
Airway
blocked
Tongue
falls back
With head-tilt
chin lift, the
airway is clear.
STEP 6. CHECK FOR BREATHING
LOOK at the chest movement
LISTEN for breathing sounds, and
FEEL for warm air against your cheek for signs
of breathing (up to 10sec).
Gasping is considered not breathing.
Jubbalad medical training college
Page 28
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
STEP 7. COMMENCE CPR. LOCATE HAND
POSITION FOR CHEST COMPRESSIONS

Maintain head tilt-chin lift.

Run your middle finger from the lower margin
of victim’s rib cage to sternal notch.

Place index finger next to middle finger
( landmark is lower half of the breastbone ).
Sternal
Notch
STEP 8. PERFORM CHEST COMPRESSIONS

Interlace fingers, and lift fingers off the chest
wall.

Straighten and lock elbows.

Position you shoulder directly over the
casualty’s chest

Use your body weight to compress down to a
depth of at least 5 cm and count loudly;
1 and 2 and 3 and 4 and 5 and,
1 and 2 and 3 and 4 and 10 and,
1 and 2 and 3 and 4 and 15 and,
1 and 2 and 3 and 4 and 20 and,
1 and 2 and 3 and 4 and 25 and,
1 and 2 and 3 and 4 and 30 and
followed by 2 ventilations.
Jubbalad medical training college
Page 29
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
STEP 9. FOLLOWED BY MOUTH TO MOUTH
BREATHING
 Followed by 2 ventilations.
 Maintain a head-tilt chin-lift.
 Pinch nose and give 2 quick ventilations ( 400600 ml/sec per breath ).
 Watch chest rise and release the pinch after
each breath.
 Continue good quality CPR.
Guidelines recommended by National Resuscitation Council ( NRC )

For layperson, no reassess.

To give effective chest compressions, rescuer should “push hard and push fast”.

Locating the correct hand position for chest compression should be done quickly.

The ratio of compression and ventilation is 30 : 2

Perform chest compression rate at 100 per minute.

Continue CPR till ambulance arrives or until AED is attached to casualty or the victim starts
breathing or rescuer becomes exhausted.

If breathing is present, check for injuries and position the victim in the recovery
position ( if no injuries ).

Continue to monitor victim’s vital signs every few minutes.
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Page 30
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
RECOVERY POSITION
STEP 1. POSITION THE VICTIM
A
B
STEP 2. ROLL THE VICTIM TOWARDS
THE RESCUER
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C
STEP 3. FINAL RECOVERY
POSITION
Page 31
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
4
MANAGEMENT OF BLEEDING
Types of Bleeding
Recognition
Arterial
Venous
Capillary
1. Bright red, oxygenated
blood.
1. Dark red, deoxygenated
blood
1. Blood loss usually slight
2. Spurts out, flowing under
pressure
2. Gushes profusely

2. Causes a bruise if bleeding is
into tissues
3. Slow ooze
External Bleeding
1. Protect yourself. Use disposable rubber or
plastic gloves.
2. Control bleeding with direct pressure.
3. Elevate affected part.
Jubbalad medical training college
Page 32
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
4. Do not apply a tourniquet.
5. When bleeding cannot be stopped by direct
pressure, apply Indirect Pressure.
•
Brachial pressure point

Femoral pressure point
6. Rest the affected part. Elevation slows bleeding.

Internal Bleeding
1.
2.
3.
4.
5.
6.
Reassure casualty
Lay casualty down
Elevate legs above level of heart (unless fractured)
Loosen visible tight clothing
Give nothing by mouth
Monitor vital signs – breathing & response
Jubbalad medical training college
Page 33
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
5
MANAGEMENT OF WOUNDS
Types of Open Wounds
Recognition and Actions To Take
Abrasions (Graze)

Superficial wound resulting from a sliding fall or a friction
burn.
 Often embedded with dirt that may result in infection.
 Remove debris.
 If dry, leave open; if wet cover with dry gauze dressing
(not cotton wool ).
Incised Wound




A clean cut by a sharp edge.
Vessels may be cut.
Control bleeding.
Seek medical attention.
Laceration





Tear in skin from example a barbed wire.
Edges are irregular.
Often contaminated and danger of infection is high.
Control bleeding.
Seek medical attention.
Puncture / Stab Wound




A deep wound caused by a nail or a sharp pointed object.
Risk of infection is high.
Do not remove any impaled object.
Seek medical attention.
Jubbalad medical training college
Page 34
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
Avulsion (Tearing Wound)





Caused by machinery or explosive devices.
Skin and underlying tissue torn off or left hanging.
Severe bleeding may occur.
Control bleeding.
Seek medical attention.
Amputation




Body part is cut or torn off and bleeding may be severe.
Control bleeding
Take all amputated parts to the doctor.
Preserve amputated body parts correctly
Preservation of an amputated finger
1. Wrap amputated part
in clean dry gauze to
absorb moisture.
2. Put wrapped
amputated body
part in plastic bag.
3. Place bag with the
wrapped part in another
bag of ice.
Nose bleed
Causes
 Spontaneous bleeding
 After an injury, sneezing or blowing hard on the nose
Actions to take
 Casualty to be seated
 Pinch soft part of nose and lean forward
 Breathe through the mouth
 Release after 10 minutes
 If bleeding has not stopped, reapply pressure for two
further periods of 10 minutes each
 Seek medical attention if bleeding persists
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Spontaneous bleedi
Page 35
Afte
Standard First Aid – Lesson 3
The Circulatory System, Perform Cardiopulmonary Resuscitation, Shock, Bleeding and Wounds
Special types of wounds:
Embedded Foreign Body
Recognition:
Actions to take:
Gravel, broken glass, plastic,
metal / wooden splinters or
a sharp metal object may be
embedded in the skin.
1. Do not attempt to remove a penetrating foreign body.
2. Place padding around the object or place a ring pad over
the object, and bandage over the ring pad.
End of Lesson 3
Jubbalad medical training college
Page 36
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
STANDARD FIRST AID
LESSON 4
Overview
This lesson covers the brain and the nervous system, disorders of consciousness
including head, orofacial, chest, spinal and abdominal injuries
Topics Outline for Lesson 4
1
MANAGEMENT OF AN UNCONSCIOUS CASUALTY
a) The Nervous System
b) Structure of the Brain
c) Definition of Unconsciousness
d) Recognize the different causes of Unconsciousness
- Head and Facial Injuries
- Fits
- Fainting
- Stroke
- Diabetes
2
MANAGEMENT OF CASUALTY WITH CHEST, SPINAL AND ABDOMINAL
INJURIES
a) Recognize spinal injuries
b) Recognize a penetrating chest injury
c) Recognize an abdominal injury
Jubbalad medical training college
Page 37
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
1
MANAGEMENT OF UNCONSCIOUS CASUALTY
a)
THE NERVOUS SYSTEM
The Nervous System consists of the:
1. Central Nervous System, mainly the


Brain
Spinal cord
2. Peripheral Nervous System, consisting of the

motor nerve moving from the spinal cord

sensory nerve going into the spinal cord
3. Autonomic nervous system which carries signals to and from the internal organs (e.g.
heart, stomach, intestines) and the brain.
b)
Structure of the Brain
Function of the brain is to control bodily functions. Disorder of the brain results in
unconsciousness.
The brain and spinal cord are covered by protective membranes (meninges).
The brain and spinal cord are bath in cerebrospinal fluid (CSF).
Jubbalad medical training college
Page 38
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
c)
Definition of Unconsciousness
Unconsciousness is defined as impairment of awareness. It can range from drowsiness and
confusion to total lack of response. It is a total or partial loss of ability to respond to external
stimulus like voice or pain.
The main causes of impaired consciousness are structural damage to the brain or a lack of
nutrients, oxygen and glucose (sugar) from reaching the brain. The first aider can assess
consciousness by checking the casualty’s level of responsiveness as follows:
a.
Alert – able to respond to simple questions and give answers
b.
Voice – able to respond to voice by moving body
c.
Pain – able to respond to pain
d.
Unresponsive – no response or movement
d)
Causes of Unconsciousness









Alcohol intoxication
Epilepsy
Insulin coma
Overdose of drugs eg. sedatives
Ureamia ( renal failure )
Trauma ( head injury )
Infection
Psychiatric condition eg. Hysteria
Stroke / Shock
Action to take

Apply Emergency Action Plan
DO NOT



Give anything by mouth.
Move the casualty unnecessarily.
Leave an unconscious casualty unattended at any time.
Jubbalad medical training college
Page 39
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
HEAD INJURY
A head injury may be caused by a direct or indirect force resulting in a scalp laceration, brain
concussion, brain compression, or skull fracture.
Types of head injuries
Scalp laceration
Recognition & Its First Aid
.
1. Apply direct pressure if
underlying skull fracture is
not suspected.
2. If a skull fracture is suspected,
apply pressure round the
edges of the wound. Use a
ring pad to do this.
3. Secure the dressing with a
scalp bandage.
4. Seek medical attention
Concussion
A concussion is a
“shaken brain” resulting
in a partial loss of
consciousness.
Compression ( Contusion )
Compression is
pressure exerted on
the brain
e.g. by a blood clot.
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1. Brief or partial loss of
consciousness
2. Dizziness, nausea or vomiting
3. Loss of memory
4. Generalised headache
1. Headache intensifies.
2. Breathing slow & noisy
3. Vomiting
4. Pupils unequal or dilated
5. Some weakness or paralysis
Page 40
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
Types of head injuries
Recognition
Skull fracture
A fracture of the skull
is the break, either
partly or completely of
a skull bone. A large
force is necessary to
cause such as injury
e.g. road traffic
accidents or a fall from
a height.
1. Progressive deterioration in
LOC
2. Blood & CSF coming out from
nose or ears usually indicates
a base of skull fracture.
3. Vomiting
4. Blood shot eyes
FACIAL INJURIES

Cheekbone and Nose fracture
Causes


Trauma
Fights
Regconition





Bloodshot eyes
Deformity and swelling around cheek,
jaw or nose.
Pain
Severe bruising
Loose or missing teeth
Actions to take



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Apply cold compress
Pinch nose foe nose bleed
Seek medical treatment
Page 41
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
Eye Injury
Injuries to the eye by trauma, fall, cut , flying objects or foreign
body can lead to pain, tearing, irritation, bleeding redness
or loss of vision
Recognition

Pain, visual loss and bleeding may be present.
Actions to take





Foreign body in the eye - Do not rub your eye
Cuts of the eye and lid -Cover with a sterile, dry pad over the
affected eye and bandage.
Tell the casualty to keep both eyes still.
Seek medical help immediately
Chemical burns - Flood the eye with water immediately
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Page 42
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
FITS ( Seizures/Convulsions )
A fit is a sudden loss of consciousness followed by uncontrolled movements of the limbs. It
generally lasts a few minutes and it cannot be stopped.
1. Tonic phase
(stiffening of the body)
2. Clonic phase
(the body jerks)
3. Post-convulsive phase
(exhaustion)
Causes
•
•
•
•
•
•
•
Head injury
High fever
Stroke
Brain tumour
Infection
High/low blood sugar
Epilepsy ( recurrent seizures )
Recognition
Actions to take
1. Sudden loss of
consciousness
1. If your casualty is falling - support or ease
his fall.
2. Shaking of limbs
2. Make space around him - ask bystanders
to move away. Prevent self-injury.
3. Clenching of
teeth, up-rolling
of eyes
4. Foaming around
the mouth
5. Drowsy, dazed or
confused
3. Loosen tight clothing around the neck.
4. Roll casualty onto his side to drain
secretions.
DO NOT
1. Move the casualty
unless there is
immediate danger
2. Use force to
restrain him
3. Put anything in his
mouth
5. After the fit is over, if casualty is drowsy,
place in the recovery position.
6. Call the ambulance 995.
Jubbalad medical training college
Page 43
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
Fainting ( Syncope )
Fainting is a brief loss of consciousness due to a temporary reduction in the blood flow to the
brain. Recovery is usually rapid and complete.
Causes
Actions to take
1.
Fright
1. Lay the casualty down.
2.
Hunger
2.
Loosen tight clothing.
3.
Exhaustion
3.
Check ABC.
4.
Severe pain
4.
Raise the casualty’s legs.
5.
Emotional upset
5.
Ensure plenty of fresh air.
6.
Prolonged standing
6.
Advise the casualty to seek medical attention.
Jubbalad medical training college
Page 44
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
Stroke
A stroke is a condition in which the blood supply to part of the brain is suddenly impaired by a
blood clot ( blockage ) or a ruptured vessel.
Blood clot
Ruptured vessel
Recognition
Actions to take
1. Altered level of consciousness.
1. Call for an ambulance 995.
2. Slurred or garbled speech.
2. Reassure the casualty.
3. Loss of movement, weakness and
feeling, usually on one side of the
body.
3. Ensure the ABC is present if he is unconscious.
4. Severe headache.
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4. Monitor vital signs every five minutes till the
ambulance arrives.
Page 45
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
Diabetic coma ( diabetes mellitus )
Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose
(sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream.
The pancreas then releases insulin to move the glucose from the bloodstream into the body cells
for use or storage.
People with diabetes are unable to fully use the glucose in their bloodstream due to:
- lack of insulin in the body
- insulin is ineffective
Loss of consciousness in diabetes can be due to low blood sugar or hypoglycaemia or excessive
blood sugar or hyperglycaemia.
Recognition
HYPOGLYCAEMIA
HYPERGLYCAEMIA
1. Rapid loss of Consciousness.
1. The casualty has been unwell
over the last few days.
2. The casualty has not taken any
food following diabetes
medication or injection.
3. Overdose of insulin injection.
Actions to take
Give a sweet drink if the casualty is
able to drink.
Jubbalad medical training college
1. Dry mouth and lips.
2. Undiagnosed diabetes mellitus.
3. Failure to take medications or
insulin.
Seek medical attention immediately.
Page 46
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
2
MANAGEMENT OF SPINAL, CHEST AND ABDOMINAL INJURIES
a)
Spinal Injuries
Causes:
-
Falling from a height.
-
Diving into shallow waters.
-
Being thrown off a horse or a motorcycle.
-
Sudden deceleration in a motor vehicle.
-
A hit across the back by a heavy object or force.
-
An injury to the head or face
Recognition
Actions to take:
1. Inability to move the lower
Do not move the casualty unless there is presence of
limbs.
danger.
2. Abnormal / loss of sensation.
For a conscious casualty:
3. Limb weakness / paralysis.
1. Reassure the casualty and advise him not to move.
4. Difficulty in breathing if the
2. Steady and support his head in the neutral position
injury is high up in the neck.
(head injury).
3. Call for an ambulance 995.
Jubbalad medical training college
Page 47
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
b)
Penetrating Chest Wound
Recognition:
Actions to take:
A wound with or without a
penetrating injury (entrance
and/or exit). A crackling feeling
may be felt in the skin around the
wound.
1. Call for an ambulance – dial 995.
2. Cover the wound immediately with the casualty’s own
hand or the palm of your gloved hand.
3. Place a sterile dressing or clean pad over the wound, and
cover the pad with a plastic bag or cling wrap film.
4. Secure firmly with adhesive strapping on four sides.
Leave a gap at the fourth side untapped to allow air
under pressure during expiration to escape.
5. Support the conscious casualty in a comfortable position,
inclined towards the injured side.
Position of the casualty after treatment
Keep the uninjured lung
uppermost
Jubbalad medical training college
Page 48
Standard First Aid – Lesson 4
Nervous System, Manage Unconscious Casualty, Chest, Spinal & Abdominal Injuries
c)
Abdominal wounds
Recognition:
Actions to take:
An open or closed wound to
the abdomen. The intestines or
other organs may be exposed.
1. Call for ambulance 995.
2. Lay the casualty down, bending and supporting his knees
if possible.
3. Put a large dressing over the wound, and secure it lightly
in place with a bandage or adhesive strapping.
4. Cover any exposed abdominal contents with a polythene
bag or cling wrap film.
5. Alternatively, use a sterile dressing.
6. Treat for shock and monitor the vital signs.
Raising and supporting
the knees may ease
strain on the injury
End of Lesson 4
Jubbalad medical training college
Page 49
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
STANDARD FIRST AID
LESSON 5
Overview
This lesson covers the musculoskeletal system, fractures and soft tissue injuries.
Topics Outline for Lesson 5
1
2
3
THE SKELETAL SYSTEM
a)
Structure
b)
Joint
MANAGEMENT OF FRACTURES
a)
Definition of fracture
b)
Types of Fracture
c)
Open and Closed Fracture
d)
Specific Bone Fractures
MANAGEMENT OF SOFT TISSUE INJURIES
a)
4
Sprain and Strain
MANAGEMENT OF MUSCLE CRAMPS
a)
Causes and Actions
JUBBALAND MEDICAL TRAINING COLLAGE
Page 50
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
1
THE SKELETAL SYSTEM
a)
Structure
The skeleton consists of 206 bones.
Functions

Protection

Locomotion

Support

Formation of blood cells
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Page 51
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
b)
A JOINT
A joint is the place where two bones come together. There
are three types of joints classified by the amount of
movement they allow: immovable, slightly movable, and
freely movable.
The structure of a movable joint consists of:

Ligament

Capsule

Bone

Cartilage

Synovial fluid (joint fluid)
An example of a slightly movable
An example of a freely movable joint
joint of the spine.
is a ball-and-socket joint of the
shoulder.
Another example of a freely movable
joint is a hinge joint of the elbow.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 52
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
2
MANAGEMENT OF FRACTURE
The human body contains more
than 650 individual muscles
which are attached to the
skeleton, which provides the
pulling power for us to move
around. The main job of the
muscular system is to provide
movement for the body.
a)
Definition of a fracture
Fractures are breaks or disruptions in bone tissue. These can be complete or partial breaks in
the bone.
b)
Types of Fractures
All fractures can be broadly described as:
1. Closed (Simple) fractures
2. Open (Compound) fractures
are those in which the skin is intact
involve wounds that communicate with
the fracture.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 53
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Other types of fracture





Complicated
Greenstick
Comminuted
Spiral
Transverse
Causes



Direct force
Indirect
Muscular contractions
Recognition

Deformity or shortening of the affected limb.

Open injuries or internal bleeding, (manifested as shock if severe).

Pain and tenderness of the injury site.

Swelling and bruising – from internal bleeding.

Loss of function of the limb.
Footnote :
The signs and symptoms of fractures can also be summarise as PLASTICS – Pain, Loss of
Function, Abnormality, Swelling, Tenderness, Infection, Crepitus and Shock.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 54
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Actions to take:
1. Lay the casualty down and minimise movement
2. Support the injured limb until it is immobilised.
3. Cover the wound ( for open fractures ) with a clean pad and apply pressure with a
bandage.
4. Immobilise the injured part with a splint or to the body.
5. Elevate the injured part, if possible.
6. Seek medical attention.
DO NOT

Press down directly on a protruding bone.

Move the casualty until the injured part is secured and supported.

Let the casualty eat or drink anything.
Types of splints
Splints can be made from many different materials.
1.
Improvised splint: folded newspapers, magazines
2.
Commercial splint: SAM splint™ (moldable splint), air splint, wooden splints
3.
Self splint: The injured part is tied to an uninjured body part
JUBBALAND MEDICAL TRAINING COLLAGE
Page 55
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
c)

Specific Bone Fracture

Upper limb
Collar bone (Clavicle) fracture
Recognition
Actions to take:
1. History of fall ( direct or indirect )
1. Support the arm of affected collar bone in
2. Pain, swelling and deformity
3. The casualty supports the elbow on the
injured side to relieve pain
4. Head inclined to injured side
an elevation sling.
2. Secure the arm to the chest with a broad
bandage.
3. Seek medical attention.
Upper arm (humerus) fracture
Recognition
1. History of fall directly on to the shoulder
or on to the outstretched hand
2. Pain and swelling
Actions to take:
1. Support the injured arm in an arm sling.
2. Secure the arm to the chest with 2 broad
bandages.
3. Difficulty in raising the arm
JUBBALAND MEDICAL TRAINING COLLAGE
Page 56
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps

Dislocations
Displacement of a bone at a joint caused by strong force wrenching the bone out of its joint,
or by a violent muscle contraction is called a dislocation.
Dislocated shoulder
Recognition
Actions to take:
1. History of fall
1. Sit casualty down.
2. Acute pain, swelling and flattening of
2. Apply a large arm sling to the affected arm.
shoulder.
3. The casualty’s head inclined to the
3. Immobilise the sling with a broad bandage.
4. Seek medical attention.
injured side.
4. Inability to raise the arm.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 57
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Fracture elbow
Actions to Take:
For an elbow that can be bent:
For an elbow that cannot be bent:
1. Treat as for a fracture of the upper arm.
1. History of fall on elbow.
2. Check for sensation at the affected wrist
2. Severe pain, swelling and deformity, unable
every 10 minutes.
3. If no sensation, gently straighten the
elbow until it returns and immobilise it in
that position.
4. Seek medical attention.
to bend elbow.
3. Do not attempt to forcibly bend or
straighten the elbow.
4. Lay the casualty down and place the injured
limb on his trunk.
5. Secure arm to the trunk of the body with 3
broad bandages.
6. Seek medical attention.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 58
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Fractures of the forearm and wrist
Recognition

History of fall on outstretched hand.

Pain, swelling and dinner fork deformity.
Actions to take:
SPLINT METHOD ( Picture A )
1. Place a splint on the injured side.
2. Or use a newspaper / magazine as an
improvised splint.
3. Secure the splint with a narrow bandage.
4. Support the arm in an arm sling.
SPLINTLESS METHOD ( Picture B )
1. Place a soft padding around injured
wrist/forearm
2. Support the arm in an arm sling.
3. Secure the arm to the chest with a broad
bandage.
5. Secure the arm to the chest with a broad
bandage.
6. Seek medical attention.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 59
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Fracture of the hand and fingers
Recognition
1. Pain and tenderness at the fracture site.
2. Swelling and bruising.
3. Deformity.
Actions to take:
1. Place soft padding around the
hand.
2. Support the injured arm in an
elevation sling.
3. Secure the arm to the chest
with a broad bandage.
4. Seek medical attention.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 60
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps

Lower limb
Fracture of the thigh (femur)
Recognition
Actions to take:
1. Severe pain, pallor and sweatiness.
1. Lay the casualty down.
2.
Bruising and swelling of fracture area.
2. Call ambulance 995.
3.
An outward turning of the knee and foot.
3. Bring the sound leg alongside the injured
4.
Shortening of the leg.
5.
Inability to stand.
4. Place soft padding between the legs.
6.
Signs of shock.
5. Slide 4 broad bandages under the legs
leg.
and secure both legs at the ankle, knee,
below and above the fracture.
6. Tie the knots at the uninjured side.
7. Seek medical attention.
Fracture of the pelvis
Recognition
Actions to take:
1. History of road traffic Injury with a direct
same as a fracture femur
force on the pelvis
2. Pain and inability to stand
JUBBALAND MEDICAL TRAINING COLLAGE
Page 61
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Fracture of the lower leg (tibia/fibula)
Recognition
Actions to take:
1. Deformity and shortening of the limb.
1. Lay the casualty down.
2. An open injury.
2. Call ambulance 995.
3. Severe pain and tenderness at the
3. Bring the sound leg alongside the injured leg.
fracture site.
4. Swelling and bruising.
4. Place soft padding between the legs.
5. Slide 4 broad bandages under the legs and
secure both legs at the ankle, knee, above and
below the fracture.
6. Tie the knots at the uninjured side.
7. Seek medical attention.
Fracture of the Ankle
Recognition
Actions to take:
1. History of severe twisting force
1. Help casualty to lie down
2. Pain and inability to put weight on
2. If a fracture is not suspected, apply the RICE
injured foot
3. Swelling
4. Deformity if there is a displaced
fracture
JUBBALAND MEDICAL TRAINING COLLAGE
procedure
3. If a fracture is suspected, immobilise the
fracture
4. Seek medical attention
Page 62
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Fracture of the jaw - Injuries to the face may break the jaw.
Recognition
Actions to take:
1. Pain when moving the jaw and
1. Sit the casualty up.
swallowing.
2. Distortion of the teeth and
2. Place a soft pad to support the jaw.
3. Secure the jaw with a
broad bandage or
dribbling.
3. Swelling, tenderness and bruising.
roller bandage as
4. A wound or bruising within the
shown.
mouth.
4. Call ambulance 995.
Fracture of the Ribcage
Causes
•
Direct or indirect force.
•
May be complicated by a penetrating wound or a “flail
chest” injury where breathing may be severely impaired.
Recognition
Actions to take:
1. Pain at the fracture site.
2. Reassure the casualty.
2. Pain on taking deep breaths or
3. Place a soft padding on the injured rib and secure
coughing.
3. Shallow breathing.
with a broad bandage.
4. Support the limb on the injured side in an elevation
4. Air being “sucked” into the chest
cavity.
sling.
5. Secure the sling with a broad bandage.
5. Shock.
6. Call ambulance 995.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 63
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
3
MANAGEMENT OF SOFT TISSUE INJURIES
Sprain:
Strain
A sprain is the over- stretching and / or tearing
A strain is an over stretching and / or tearing
of ligaments of a joint.
of muscle or tendons attached to the muscle.
Recognition:
Recognition:
1. Acute pain and tenderness at the joint.
1. Sudden sharp or severe pain
2. Swelling around the joint.
2. Tenderness when the area is touched.
3. Limited movement.
Actions to take - R.I.C.E. PROCEDURE
Support
& elevate
the
Injured
part
Compression
counteracts
swelling, and
gives the
injured part
support
An ice
pack
helps
relieve
pain
Rest
Ic e
Elevate
Elevation
reduces
swelling.
Compress
1. Rest injured area.
2. Ice area for 15 min @ 2-3 hr for first 24-48 hr.
3. Compress area for 24-48 hr.
4. Elevate area for first 24-48 hr.
5. Seek medical attention if pain and swelling persist.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 64
Standard First Aid – Lesson 5
The Musculoskeletal System, Fractures, Soft Tissue Injuries & Muscle Cramps
Cramps
A cramp is a sudden and very painful contraction of a muscle or a group of muscles.
Cramps in legs are very common.
Causes

Exercise soon after a meal

Chilled muscles

Sudden vigorous activity

Poor muscular coordination

Loss of body fluids and salt

During pregnancy
Actions to take

Gently stretch the contracted muscles e.g.
cramp in the calf

Straighten knee and pull the foot up towards
the shin.
End of Lesson 5
JUBBALAND MEDICAL TRAINING COLLAGE
Page 65
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
STANDARD FIRST AID
LESSON 6
Overview
This lesson covers the Integumentary system or the Skin, bites and stings, poisoning,
heat disorders and transportation of casualties.
Topics Outline for Lesson 6
1
MANAGEMENT OF BURN INJURIES
a)
b)
c)
d)
e)
f)
g)
2
Structure and Function of the Skin
Classification of Burns
Causes of Burn Injuries
Depth of Burn
Severity of Burn
Extent of Burn
Burns in Special Areas
 Burns to the Mouth and Throat
 Chemical burn
 Electrical Burn
MANAGEMENT OF POISONING
a) Common Routes of Poisoning
b) First Aid for Poisoning
3
MANAGEMENT OF BITES AND STINGS
a)
b)
c)
d)
e)
4
MANAGEMENT OF CASUALTY WITH HEAT DISORDERS
a)
b)
c)
d)
5
Bee and Wasp Sting
Scorpion Sting
Jellyfish and other marine stings
Dog and cat bites
Snake Bites
Types of Heat Disorder
Heat cramp
Heat exhaustion
Heat stroke
TRANSPORTATION OF CASUALTY
a)
b)
c)
One first-aider method
Two first aiders method
Three first aider methods
JUBBALAND MEDICAL TRAINING COLLAGE
Page 66
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
1
MANAGEMENT OF BURN INJURIES
a)
Structure of the Skin
Epidermis
Dermis
Subcutaneous
Functions
1.
2.
3.
Protects from injury
Protects from infections.
Regulates body temperature.
b)
1.
2.
3.
4.
Burns can be classified by:
Scalds
Causes ( types ) of burn
Depth of burn
Severity of burn
Area of burn
c)
Causes ( Types ) of burn injuries






Chemical
Dry burns
Scalds
“Cold” burns
Chemical burns
Electrical burns
Radiation burns
Electrical
JUBBALAND MEDICAL TRAINING COLLAGE
Page 67
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
d)
Depth of Burn
Depth of Burn

Recognition
Superficial burn
1. Injury involves only the outer layer
of the skin.
2. Redness, swelling, tenderness and
pain are present.
Depth of Burn


Partial-thickness burn
Full-thickness burn
Recognition
1.
Injury affects the deeper layers of
the epidermis.
2.
Formation of blisters.
3.
Pain is present.
1. Injury involves all layers of the skin;
damage may extend to nerve, muscle
and fat.
2. The skin appears pale, waxy and
sometimes charred.
3.
JUBBALAND MEDICAL TRAINING COLLAGE
Pain free.
Page 68
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
e)
Severity of burn
The severity of a burn depends on:




f)
Burn depth
Burn size
Burn site
Infant, child or adult
Extent of burn

The extent of a burn is expressed in terms of a percentage of the body’s total surface area.

The “rule-of-nines”.
Immediate Medical Attention for
severe burn injury

A partial-thickness burn of 9% or
more may lead to shock.

A full-thickness burn of any size.

Burns to the neck, nose or mouth.

Burns to the eye.

Any partial-thickness burn of 1%
or more (covering an area
approximating to that of the
casualty’s palm).
JUBBALAND MEDICAL TRAINING COLLAGE
Page 69
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
Superficial and Partial Thickness Burn
Actions to take
1. COOL the burn - Do not
apply anything to the burn.
2. CONSTRICTORS – remove
if any.
3. COVER the burnt area.
Full-thickness burn
Actions to take:
1. Cover the burnt area with a clean cloth for protection.
2. Treat the casualty for shock if present.
3. Perform DRABC. Watch for breathing difficulty involving burns on the face and neck.
4. Call for ambulance 995.
Important points to note
DO NOT
1. Apply butter or oils on a burn.
2. Apply ice or cool to near-freezing temperatures.
3. Neutralise a chemical burn with a reciprocal chemical.
4. Disregard an electrical burn.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 70
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
g)

Burns in Special Areas
BURNS TO THE MOUTH AND THROAT
Actions to take:
1. Call for ambulance 995
2. Take steps possible to facilitate the
casualty’s breathing.
3. Be prepared to resuscitate!

CHEMICAL BURN
This occurs when caustic or corrosive substances come into contact with the skin.
Actions to take:
1. Flush the area immediately with copious amounts of water for 15 – 20 minutes or
longer.
2. Remove the casualty’s contaminated clothing whilst flushing.
3. Cover the burned area with a dry clean dressing.
4. Seek immediate medical attention.

ELECTRICAL BURN
Actions to take:
1. Check DRSABC.
2. Check for fractures and spinal injury.
3. Treat the casualty for shock.
4. Cover entry and exit burns.
5. Seek immediate medical attention.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 71
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
2
MANAGEMENT OF POISONING
a)
Common routes of poisoning :
1.
2.
3.
4.
Ingestion
Inhalation
Absorption
Injection
-
taken by mouth
breathed in
through skin
needles, stings & bites
Actions To Take :

If swallowed, do not induce vomiting.

If inhaled, move to well-ventilated and open spaces.

If absorbed, wash with lots of water.

Seek medical treatment immediately.

Identify the poison if possible.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 72
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
3
MANAGEMENT OF BITES AND STINGS
Bee and wasp sting
Actions to take:
They are dangerous in these cases:
1. People who are allergic to
stings.
2. Stings in the mouth and throat.
3. Multiple stings can result in
death.
1. If the stinger is in the wound (this applies to a bee
sting only), flick it out with the edge of a card or knife.
2. Apply a cold compress.
3. For a sting in the mouth, give the casualty ice to suck
on or cold water to sip.
4. Seek medical attention.
Scorpion sting
Actions to take:
This causes severe pain and
burning sensation around the site,
followed by numbness or tingling
from the neurotoxin in the sting
1. Apply cold compress to relieve pain.
2. Immobilise the injured part.
3. Monitor for difficulty in
breathing.
4. Seek medical attention.
Jellyfish and other marine stings
Actions to take:
The venom is contained in special
stinging cells of the jellyfish that
stick to the skin. The aim is to
inactivate the stinging cells before
they release their venom.
1. Sit the patient down. Pour copious amounts of vinegar
or sea water to stop the stinging cells from releasing
venom.
2. Dust a dry powder over the affected skin. The stinging
cells stick to the powder.
3. Then brush off the powder with a clean pad.
4. Monitor the casualty for difficulty in breathing.
5. Seek medical attention.
Dog and Cat Bites
Actions to take:
For superficial bites
1. Wash wound.
2. Cover with a clean dressing
3. Seek medical attention.
For deeper bites
1. Control bleeding - direct pressure.
2. Cover the wound.
3. Seek medical attention.
JUBBALAND MEDICAL TRAINING COLLAGE
Page 73
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
Snake Bites
Actions to take:
Some poisonous snake venoms
causes bleeding in tissues and
organs (anticoagulant toxin eg
viper ) and paralysis of muscles
(neurotoxin eg cobra, krait).
Poisonous snakes usually bite
onlyin defense.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Call ambulance 995.
Lay casualty down
Tell the person to keep calm and still.
Not all bites from poisonous snakes contain venom
(called ‘dry bites’).
If there are no symptoms of poisoning, roller
bandaging is not needed.
A dry dressing over the wound will be enough.
If it is a suspected poisonous bite then apply a
roller bandage above the wound with the same
tightness as for a sprained ankle.
Do not use a tourniquet.
Immobilise the bitten leg.
Monitor vital signs.
Recognition
1. Look for fang marks (pair of puncture marks)
2. Symptoms that may suggest poisoning:
3. Redness and swelling, oozing of blood (viper).
4. Nausea and vomiting, laboured breathing and
disturbed vision (cobra, krait).
5. Muscle aches and blood in urine (sea snake).
Fang marks
JUBBALAND MEDICAL TRAINING COLLAGE
Page 74
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
4
MANAGEMENT OF CASUALTY WITH HEAT DISORDERS
Three stages of progressive severity:
Disorder
a.
HEAT CRAMP is painful
cramps due to excessive
sweating from a strenuous
activity. If the person
continues, heat exhaustion
may result.
2. HEAT EXHAUSTION is
severe tiredness due to loss
of body fluid through
excessive sweating from
strenuous activity. If the
person continues, heat
stroke may result.
Symptom
Actions to Take
1. Muscle cramp.
1. Sit in cool place.
2. Excessive sweating.
2. Drink enough water.
3. Seek medical attention
1. Tiredness.
1. Lay casualty in a cool
place.
2. Excessive sweating.
2. Elevate the legs.
3. Muscle cramps.
3. Give plenty of water
4. Rapid pulse and breathing.
4. Monitor vital signs.
5. Seek medical attention.
3. HEAT STROKE occurs
when the body is unable to
control its temperature.
When temperature rises,
the sweating mechanism
fails, and the body is
unable to cool down. It is a
life-threatening condition.
HEAT CRAMP
1. Confused.
1. Check DRABC.
2. Hot flushed and dry skin.
2. Call ambulance 995.
3. Body temp more than 40
degree Celsius.
3. Move the casualty to a
cool place.
4. Cool the casualty
rapidly with water.
HEAT EXHAUSTION
JUBBALAND MEDICAL TRAINING COLLAGE
HEAT STROKE
Page 75
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
5
TRANSPORTING A CASUALTY
Introduction

Move the casualty ONLY if the casualty is in immediate danger.

Do not move the casualty unnecessarily.

Do not leave the casualty alone.
Methods of transportation

Support

Hand seats

Chair

Blanket

Stretcher

Wheelchair
Principles of lifting

Know your capabilities.

Keep your back straight and bend your knees.

Apply a safe grip. Use as much of the palms as
possible.

balance, with one foot in front of the other.

When lifting, do not twist your back; pivot with
your feet.
Methods of Carrying
a)
Position your feet, shoulder width apart for
Shoulder drag
ONE FIRST AIDER METHOD

Shoulder Drag

Crouching Drag

Blanket Pull

Human Crutch

Cradle Carry

Fireman’s Lift

Pick-A-Back Carry
Pick-A-Back
Crouching drag
Blanket pull
Fireman’s Lift
Cradle Carry
JUBBALAND MEDICAL TRAINING COLLAGE
Human Crutch
Page 76
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
b)
TWO FIRST AIDERS METHOD

Two- Handed Seat Carry

Four-Handed Seat Carry

Fore-and-Aft Carry

Chair Carry
Chair Carry
Fore-and-Aft Carry
Four- Handed
Seat Carry
JUBBALAND MEDICAL TRAINING COLLAGE
Page 77
Standard First Aid – Lesson 6
Burn Injuries, Poisoning, Bites and Stings, Heat Disorders and Transport a Casualty
Two- Handed
Seat Carry
c)
THREE FIRST AIDERS METHOD
•
Three-person Carry
(i)
JUBBALAND MEDICAL TRAINING COLLAGE
(ii)
(iii)
Page 78