Theme - 4
First aid in Emergency
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Contents
It's an old saying that ”An Ounce of Prevention, is Worth a Pound of Cure”, especially in an emergency situation
when seconds count. Here are a few selected first aid tips that may be useful in a disaster situation!!
1. Why it is needed
-2
2. What is First aid
-3
3. Principles of First aid
-5
4. Emergency situations
-7
Warning about the module
This module is made to educate the readers who are involved in chemical emergency
management. This module does not recommend any one to take first aid steps what
have been discussed herewith unless he/she is trained first aid trainer or volunteer
after having qualified training from either Red Cross or St. Johns ambulances or any
other govt approved agency.
4.1. Respiration
-7
4.2. Asphyxia
-8
4.3. Poisoning
- 15
4.4. Burns
- 18
5 First aid kit
- 22
6 Elements of training in First aid
- 25
6.1. Teaching Methods
- 25
6.2. Assessing the scene and the Victim(s)
- 25
6.3. Responding to Life-Threatening Emergencies
- 26
6.4. Responding to Non-Life-Threatening Emergencies
- 27
7 Conclusion
- 28
8. Glossary
- 30
9. References
- 31
1
1. Why it is needed
First aid is emergency care provided for injury or sudden illness before emergency medical treatment is
available. The first-aid provider in the workplace is someone who is trained in the delivery of initial medical
emergency procedures, using a limited amount of equipment to perform a primary assessment and
intervention while awaiting arrival of emergency medical service (EMS) personnel. A workplace first-aid
program is part of a comprehensive safety and health management system that includes the following four
essential elements:
Management Leadership and Employee Involvement
Worksite Analysis
Hazard Prevention and Control
Safety and Health Training
The purpose of this module is to present a summary of the basic elements for a first-aid program at the
workplace. Those elements include:
Identifying and assessing the workplace risks that have potential to cause worker
injury or illness.
Designing and implementing a workplace first-aid programme that:
-Aims to minimise the outcome of accidents or exposures
-Complies with essential provisions of regulations
-Includes sufficient quantities of appropriate and readily accessible first-aid supplies and first-aid
equipment, such as bandages and automated external physical and medical support.
-Assigns and trains first-aid providers, who receive first-aid training suitable to
the specific workplace and receive periodic refresher courses on first-aid skills
and knowledge.
2
-Instructs all workers about the first-aid programme, including what workers
should do if a co-worker is injured or ill. Putting the policies and programme in
writing is recommended to implement this and other programme elements.
-Provides for scheduled evaluation and changing of the first-aid programme to
keep the programme current and applicable to emerging risks in the workplace,
including regular assessment of the adequacy of the first-aid training course.
2. What is First-aid
First aid is the immediate care given to a person who is injured or ill. Sudden illness or
injury can often cause irreversible damage or death to the victim unless proper care is
initiated as soon as possible. First aid includes identifying a life-threatening condition,
taking action to prevent further injury or death, reducing pain, and counteracting the
effects of shock. Because life-threatening situations do occur, everyone should know
how to provide emergency care until a victim can be treated or transported to a
medical facility. First aid is not intended to replace care by a physician or surgeon. Its
intent is to protect the victim until medical assistance can be obtained.
The primary purpose of first aid is to:
Care for life-threatening situations
Protect the victim from further injury and complications
Arrange transportation for the victim to a medical facility
Make the victim as comfortable as possible to conserve strength
Provide reassurance to the victim
An accident can occur at any time or any place where hazardous chemicals are being
used and the working conditions are not safe. If you are the first person to arrive and
3
see some accident, there are a few basic principles you should follow to protect yourself
and the victim. The following steps are required immediately:
1. Survey the Scene. Before you help the victim, determine if the scene is safe. If
anything dangerous is present, don't put your own life at risk to try and help the victim;
you will be of no aid if you become a victim too. Summon help and wait for trained
people to resolve the situation. If the scene is safe, try and determine what happened
and how many victims there may be. Never move the victim unless an immediate, life
threatening danger exists, such as a fire or the threat of a building collapse.
2. Primary Victim Survey. After ensuring the scene is safe, you can turn your
attention to the victim. Begin by performing a primary survey to determine if the
victim:
A) is conscious
B) has an open, unobstructed airway
C) is breathing
D) has a heartbeat
E) is not bleeding severely
To check for consciousness, gently tap the person and ask if they are okay. If there is no
response, this in an indication that a possible life-threatening situation may exist. If
the person is responsive and can talk or
cry, this indicates they are conscious,
breathing, have an unobstructed airway,
and a pulse. If the victim is unconscious,
kneel down next to the head and check
for the ABC's:
Airway,
Breathing, and
Circulation.
To check the Airway (clear and
maintain
an open airway), Breathing (restore
breathing), and Circulation (restore
circulation), place your ear next to
the victim's mouth and
listen/feel for breath sounds while
looking for a rise and fall of the
chest.
While doing this, check for a pulse
by
placing your fingers on the neck,
just
below the angle of the jaw, and feel
for the pulse from the carotid
artery.
These three steps will determine if
cardiopulmonary resuscitation (CPR)is needed.
4
3. Principles of First aid
The Gurumantra (thumbrule) of First aid is
opting the point wise followings:
R is for Responsiveness which means that we have to check the following:
Is the victim conscious?
Touch their shoulder, ask if they are
alright. Ask if they need help.
If they say no, then proceed no
further.
If yes, or no response, then
proceed to A
breathing, they may need their head repositioned. If they are still not breathing
they need rescue breathing, do not give unless you are trained, instead, find an
adult.
RAPABCH. To make it convenient we are C is for circulation
If there is not a pulse, then this person needs CPR. The best place to check for a
pulse is the carotid artery along the side of the neck along the
windpipe. If you are not trained in CPR, then find someone who
is.
H is for hemorrhaging
If the victim is bleeding, then provide the necessary care. If not,
then begin a secondary assessment.
A summary of the first aid can be briefed in Fig-1:
A is for Activate Emergency Management Services (EMS), in India recently
the 108 has started in jointly with health and police department. Please see
what emergency
management services number is available in your area.
What are the four things you need to remember when making an EMS call? And
therefore the following points are suggested:
YES
IS THE CASUALTY CONSCIOUS?
Your name and contact
number The emergency
The location of the emergency condition of the victim
Check the victim for responsiveness. If he do not respond or if he tells
you that he need help, ask what need, to be contacted, when and
where? Some very basic
question and stay till EMS arrives to take care of victim
NO
5
IS THE CASUALTY BREATHING?
NO
P is for Position
IS THERE PULSE?
Only re-position the victim if the victim is in further danger in their present
location
and / or there does not seem to be spinal injury and additional care
requires
moving
them.
NO
DIAL FOR HELP.
GIVE ARTIFICIAL
RESPIRATION AND
EXTERNAL
MASSAGE
ARRIVES.
Explain when an injured person should and should not be moved? If there
are
suspected
spinal injuries, do not move the victim (except when the victim is in a life
threatening
situation).
Four Steps of Victim Assessment is important and it should be conducted
by
the
use
of
the “ABCH”
A is for airway and check to see if the airway is blocked by:
Use your finger to sweep the mouth to remove any seen object. If this
fails, then perform the Heimlich manoeuvre or abdominal thrusts.
B is for breathing
Look, listen and feel by watching the chest and placing your cheek a
few
inches
above the mouth of the victim to sense any movement of air. If the
victim is not
6
TILL
CARDIAC
HELP
TREAT ANY INJURIES
GET HELP IF NECESSARY
YES
IS THE CASUALTY
BREATHING NOISILY?
YES
OPEN AND CLEAR AIRWAY
NO
YES
TREAT ANY LIFE
THREATENING INJURIES. PLACE CASUALTY IN
RECOVERY POSITION
AND CALL FOR HELP.
GIVE BREATHS OF
ARTIFICIAL RESPIRATION DIAL FOR HELP
CONTINUE
RESPIRATION
ARRIVES
Fig-1
TILL
ARTIFICIAL
HELP
7
4. Emergency situations
Now in the following paragraphs some of the emergency situations
are being discussed from first aid angle:
4.1 Respiration
Respiration means breathing in and breathing out of air. It helps in supply
of oxygen (of the air) to all parts of the body.
Breathing contains three phases: Breathing
in
(inspiration).
Breathing
out
(expiration).
Pause.
Respiratory system:
Air
passage.
Lungs.
Air passage:
Air passage consists of nose, mouth, throat (pharynx), the windpipe
(trachea), and the air tubes (bronchi). The bronchi divide in to minute
branches (bronchioles), which end in the lung substance (alveoli).
Lungs:
Two in number.
Situated on right & left sides of chest
cavity. Made up of small sacs (alveoli).
Covered by a membrane called pleura, which lines the inner wall of the chest cavity.
Mechanism of respiration:
Inspiration:
-Diaphragm contracts and flattens.
(this increases chest cavity, above
downwards)
-Ribs move upward and forward due to contraction of intercostals
muscles.
(this increases the chest cavity from and to back).
-Due to this lungs expansion, volume of the lungs increases and pressure
inside
the
lungs decreases. At a point when the pressure in lungs is less than the
atmospheric
pressure, air enters from atmosphere in to the
lungs. Expiration:
-Diaphragm relaxes and comes back to its original state.
=Intercostal muscle relaxes and ribs also come back to the
original state.
-Lungs being elastic and spongy, it comes back to the original state.
-Volume of lungs decreases and pressure in lungs increases. So air is pushed out.
Exchange of gases:
This occurs in capillaries surrounding the alveoli. Oxygen is absorbed by red blood corpuscles (RBC) and
water vapour and carbon-dioxide is let out from the blood plasma into the alveoli, which is expelled during
expiration.
Respiratory centre:
Lungs are supplied with nerves, which are connected to the respiratory centre in brain. This controls
respiration. It determines the rate and depth of respiration.
Respiratory rate:
Average adult- 16 to 18 times (per minute). Children - 20 to 30 times
(per minute).
This varies during stress, exercise, injury, illness, etc.
Heart rate will accordingly increase to carry the extra oxygen around the body.
CLINICAL DEATH
BIOLOGICAL DEATH
- O MINUTES.
BREATHING AND CIRCULATION STOPS. LETHAL BRAIN DAMAGE
- 4 TO 6 MINUTES.
- 10 MINUTES.
BRAIN CELLS DIE.
4.2 Asphyxia
Asphyxia is a condition where lungs do not get sufficient supply of air for breathing.
Causes:affecting air passages.
Spasm:
Food, water, irritant gases (coal gas, exhaust fumes, smoke, etc.), sewage gas, gas in unused wells,
etc., entering air passage, bronchial asthma.
8
Obstruction:
Due to foreign body, falling back of tongue in case of unconscious patient,
swelling of tissues of throat (scalding, burns, corrosives, etc.).
Continue till normal breathing sets.
Prevent damage to brain and other vital
organs. Artificial respiration.
External cardiac
compression. Keep body
warm by light blanket.
Provide shelter.
Compression:
Strangulation, smothering, throttling.
Affecting respiratory mechanism:
Epilepsy, tetanus, rabies.
Paralysis of chest wall, diaphragm (polio, poisoning, etc).
Different kinds of asphyxia:
Drowning:
Water (any other liquid) enters in to air passage and clogs the lungs.
Affecting respiratory centre:
Morphine, sleeping tablets, electric shock, stroke, etc.
Management:
Drain the fluid from
lungs.
Give
artificial
respiration.
Compression of chest:
Fall on earth, wall, etc.
Crushing against wall (stampede, etc).
Lack of oxygen at higher altitude and lower atmospheric
pressure. Acclimatisation (gradualascent is necessary).
Treatment:
Act quickly.
Remove foreign bodies from throat and
nose.
Start artificial respiration (even while in
water).
Put the casualty face down and head to one side and arms stretched
beyond
his
head.
Infants or child can be held upside down for a short period.
Raise middle part of the body with your hands round the belly. This
will help in draining out water.
Give artificial respiration till breathing becomes
normal. Remove wet clothing.
Keep body warm.
If conscious, give hot
drinks. Don't allow to sit.
Shift to hospital as stretcher case.
Signs and symptoms:
First phase:
Breathing
rate
increases.
Short
breathing.
Swollen neck veins.
Face, lips, nails, tongue, and toes turning blue
(cyanosis). Fast and feeble pulse.
Second phase:
Semiconsciousness
or
unconsciousness. Froth in mouth and
nostrils and Fits.
Management:
Remove the cause or remove the casualty from the
cause. Ensure open airway. This enables air to reach
the lungs. Open airway
Support the nape of neck on your palm and press the head
backwards. Press the angle of the jaw forward from behind.
(this extends the head on the neck and lifts the tongue to clear off the
airway). If airway is clear, the casualty gasps and starts to breathe.
Give 3 or 4 inhalations by 'mouth-to-mouth method.
Strangulation, hanging, throttling:
Pressure from outside the air way and obstructs air way.
Hanging:
Suspension of body by a noose.
It can also cause fracture in spine causing damage to spinal cord.
Strangulation and throttling:
Airway is blocked due to tight contraction or intentional squeezing of person's throat.
9
10
Management:
Cut and remove the band contracting the throat, supporting the weight of the body
in case of hanging (cut below the knot).
'ABC' of resuscitation.
Put in recovery position after recovery.
Shift to hospital.
Choking:
It is due to obstruction of windpipe.
Common in children.
Signs and symptoms:
-General signs of asphyxia.
-Unable to speak or breathe.
-Gripping of throat.
-Congestion of face and neck, etc. With prominent veins.
Grasp your fist with the other hand.
Pull both hands towards you with quick inward and upward thrust so that upper
abdomen is compressed.
Repeat 4 times if needed.
In case of unconscious patient:
-Lay the patient back with head in open airway position.
-Kneel astride the patient's thigh.
-Place heel of one hand in the centre of patient's upper abdomen and cover with
other hand, with fingers clear of abdomen.
-Press with both arms straight into the abdomen with quick inward and upward
thrust.
-Repeat if needed, for 4 times.
In children:
Make the child sit on your lap.
Give abdominal thrust with one hand, with less pressure.
Infant:
-Place on firm surface.
-Press the upper abdomen with two fingers, with less pressure.
Management:
Remove the obstruction.
Shift to hospital.
Treatment:
Remove any visible obstruction by hooking out with your fingers.
Encourage patient to cough.
If not cleared, bend the casualty head lower than lungs. Slap between shoulder
blades with the help of hands, four times.
Check the mouth and remove the foreign body if dislodged.
If not, perform abdominal thrust four times.
Remove the foreign body, if dislodged.
If not, repeat slapping, checking mouth & abdomen thrusts, till obstruction is removed.
Swelling within throat:
Due to drinking of very hot liquids, corrosive poisons and inflammation.
Management:
Give ice to suck or cold water sip.
Give butter, olive oil and liquid paraffin, orally.
Apply cloth wrung out of hot water, to the front of neck.
Give artificial respiration if needed.
Suffocation by smoke:
Protect yourself by a towel or wet cloth over mouth and nose.
Keep low and remove the casualty quickly.
Give artificial respiration if breathing stops.
In children:
Hold upside down and smack on the back 2 or 3 times.
If not successful lay the child prone with head hanging over the knee & give sharp
smacks, between the shoulder blades.
Induce vomiting by introducing two fingers into the throat.
Abdominal thrust:
Applying series of thrust to upper abdomen, to force air out of choking lungs.
Stand or kneel behind the casualty.
Put one arm around the patient's abdomen and clench your fist and place it with
your thumb inwards in the centre of upper abdomen
11
Suffocation by poisonous gases:
Carbon monoxide [CO] (lighter then air)
-Ensure fresh air.
-Opening doors and windows if there is no fire.
-Before entering to rescue the patient, take deep breath and hold.
-Crawl along the floor.
-Remove to fresh air.
-Loosen clothing.
-Give artificial respiration.
Carbon-dioxide [CO2](heavier then air)
12
In coal-mines, deep unused wells, sewages, other gases emitted
from leaking refrigerators, LPG, etc.
Continue artificial respiration till normal breathing
resumes.
Note:
Artificial respiration can be given even if breathing is there, but not normal.
Management:
Same as above
Bronchial asthma:
Due to sudden contraction of air way, due to allergy, infection, anxiety.
If heart also not
working:
Signs:
Face will be pale or
blue. Dilated pupils.
Heart beat and pulse will be absent.
Management:
Reassure the patient to sit up and lean forward with a table or
pillows to lean. Open windows for fresh air.
Shift to hospital.
Management:
Lay casualty on back on a hard surface (bench, table, etc).
Give a hit, with edge of your hand on the lower and left angle of the
sternum. This usually stimulates the heart.
If heart does not work, persist striking for 10-15 times, at the rate of 1
strike/second. If hear beat starts, then stop striking.
Continue artificial respiration side by
side. If heart does not function, start
ECC.
Artificial respiration:
Best method - mouth to mouth or
-Mouth
to
nose
breathing.
Other
methods are:
-Sylvester's method.
-Holger nelson method.
-Schafer's method.
Mouth to mouth method:
Place the casualty on his
back. Hold the head tilted
back.
Take deep breath with your mouth wide
open. Keep the casualty's nose pinched.
Cover the mouth of casualty with your mouth smugly. (cover mouth with
clean cloth if possible).
Blow on to the lungs and watch chest raise.
Withdraw your mouth and watch chest falling
back.
Repeat at the rate of 15 to 20 times per
minute.
Note:
In case of small children, the open mouth should cover the mouth and
nose and blow gently. Rate 18-22 per minute.
If chest does not rise on blowing:
Suspect
obstruction.
Ensure open air
way.
Remove any obstruction by thumping on back, etc.
If mouth-to-mouth is not possible, use mouth to nose method, but mouth
should be kept closed.
13
External Cardiac Compression (ECC):
Note: - thumping the heart or ECC should not be done until the heart
has stopped beating.
Feel and mark the lower part of sternum.
Place heel of hand, two fingerbreadth above the joint of rib margin and
breastbone. Place heel of other hand over it.
With arms straight, press sternum backward (about 4 to 5 cms. In adults)
and release. Compression must be regular, smooth, not jerky or jabbing.
Rate: Adults - above 60 per minute.
Children (2 to 10 years)
- above 80 to 90 but with one hand.
Children (0 to 2 years)
- 100 per minute only with finger.
If two trained people are there:
Person giving artificial respiration should be on right side, near the
head and one giving ECC on the left, at the level of the middle of the
chest.
Give two inflation and check.
If there is no heartbeat, give 5 compressions at rate of 80 compressions
per minute. Give single inflation on the upstroke of every fifth
compression.
Continue till recovery.
14
Signs of effective treatment:
Colour will become
normal.
Pupils
will
contract.
Carotid pulse is felt.
If only one trained person is available:
Artificial respiration and ECC is done alternatively by shifting position.
15 compressions at the rate of 80 per minute, followed by two breaths of
mouth-tomouth method.
Check pulse after first minute and then every three minutes, till
pulse is felt. Stop ECC, as soon as pulse is felt.
Continue, mouth-to-mouth respiration till breathing becomes
normal. Put in recovery position after the recovery.
4.3 Poisoning
Poison:
A poison is a substance that, if taken into the body in sufficient quantity,
can cause temporary or permanent damage.
Types of poisons:
1. Ingested poison: eating or drinking poisonous substances. (Rat
poison,
poisonous
plants, etc.)
2. Absorbed poison: Absorbed through skin. (Insecticides)
3. Inhaled poison: Chemical vapours. (Sprays, cleaning fluids, etc.)
Fumes
from
fire,
stoves, exhausts, sewer gases, etc.
4. Injected poison: Insect bites. (Spiders, wasps, etc.), Snake bite, etc.
5. Drugs.
Signs and symptoms:
-Unconsciousness or altered behaviour.
-Shortness of breath.
-Cough.
-Abnormal pulse.
-Burning eyes, mouth, nose, throat, chest, etc.
-Severe headache.
-Nausea & vomiting.
-Reddening of lips. (in carbon monoxide poisoning)
Treatment:
-Remove the patient from the spot.
-Open airway.
-CPR if needed.
-Remove contaminated clothing, carefully.
-Provide intensive First aid, if possible.
-Shift to hospital.
Acts as
Corrosive or irritant.
Suffocating agent displacing oxygen.
symptoms
Treatment:
-Open airway.
-Dilute poison with water or milk.
-Induce vomiting with syrup ipecac, soap & water, etc. (except if
patient
is
unconscious, ingested corrosives, gasoline products, etc.)
-Ensure patient does not aspirate vomitus.
-Give one tablespoon of powdered charcoal or white of egg.
-Antidote, if known & available, can be given.
-Transport to hospital in lateral recumbent position.
Inhaled poison:
Effects:
Depends on the nature, concentration and how it enters the body.
Signs,
-Unusual odours of breath, on clothing or at the scene. (garlic smell rat poison)
-Abnormal breathing.
-Abnormal pulse.
-Sweating.
-Dilated or contracted pupils.
-Excess salivation or foaming from the mouth.
-Painful swallowing.
-Distension, pain & tenderness of abdomen.
-Nausea & vomiting.
-Diarrhoea.
-Convulsions.
-Altered state of consciousness.
and
management: Ingested poison:
Signs and symptoms
-Burns and stains around the mouth.
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Injected poison:
Absorbed poison:
Signs and symptoms:
-Noticeable stings or bites.
-Localised pain or itching or burning sensation.
-Swelling or blistering at the site.
-Weakness or collapse.
-Abnormal pulse and breathing.
-Headache.
-Dizziness.
-Nausea & vomiting.
-Muscle cramps, chest tightening & joint
-Excessive salivation, sweating, etc.
-Anaphylactic shock.
Signs and symptoms:
-Skin reactions.
-Itching.
-Irritation of eyes.
-Headache.
-Increased relative skin temperature.
-Anaphylactic shock.
Treatment:
-Remove the patient from the spot.
-Brush off any dry material.
-Wash the area with plenty of water and soap, if available.
-Remove all contaminated clothing, shoes, jewellery, etc.
-Shift to hospital.
Treatment:
-Treat for shock.
-Scrap away bee or wasp stingers & veno
-Place ice bag over the sting area.
Points to be remembered while handling poisonous cases:
Look for evidence.
Get details from the patient or others.
Retain any left over poison, bottle or any container, etc. This
will help in identification.
Retain the vomitus, stained clothing, dead snake, insects etc. This
will help to identify the poison.
While rescuing a person, take all safety precautions, before attempting.
In snake bite:
Signs and symptoms:
-Noticeable bite on skin.
-Pain & swelling over the bite area.
-Rapid pulse & laboured breathing.
-Progressive general weakness.
-Vision problems.(dim or blurred)
-Nausea or vomiting.
-Convulsions.
-Drowsiness or unconsciousness.
-Bleeding (in viper bites)
4.4 Burns
Burns are caused by extremes of temperature (hot or cold), chemicals or radiation.
Types of Burns:
Treatment:
-Keep patient calm.
-Clean the area with soap & water.
-Treat for shock.
-Remove constrictive items on the bitten extremities.
-Immobilise bitten extremities.
-Keep bite area at the level or at a lower level from the heart.
-Apply constrictive band above and below the wound.
-Avoid cutting over the wound and shift to hospital.
1.Dry burns:
Caused by dry heat, like fire, flame, hot metal, high tension electric current,
lightening, friction, etc.
2.Scalds:
Caused by moist heat like boiling water, steam, oil, hot tar, etc.
3.Cold Burns:
Caused by metals in freezing condition, liquid oxygen, liquid nitrogen, etc.
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4.Chemical Burns:
Caused by strong acids like Sulphuric Acid, Nitric Acid, etc., strong Alkalis
like Caustic Soda, Potash, Quick Lime, etc.
5.Electrical Burns:
Caused by high tension electric current.
6.Radiation Burns:
Caused by exposure to Sun, X-Rays, and radiation after Nuclear explosion, etc.
Second Degree Burn
Classification of Burns:
First degree (Superficial Burns)
-Skin reddening seen.
Second degree (Intermediate Burns)
-Blister formation is seen.
Third degree (Deep Burns)
-Destruction of deeper tissues and scaring seen.
Severity of Burns:
This is judged by the area of burns rather than the degree of burns.
Superficial
burns
affecting
larger area is more dangerous than third degree burns affecting a smaller
area. Area of
burns is judged by “rule of nines”.
Burns are considered to be critical, when:
-Area of second degree burns is > 30 %.
-There is third degree burns of face, groin, hand, feet or major joints.
-Third Degree Burns > 10 %.
-It is associated with other complications affecting respiration, etc.
The photos as shown below and in next page show the types of burns. First, second and
third degree burns need to be reviewed
in the chemical (industrial) emergency before any type of medical treatment. Victims
should be decontaminated first.
Third Degree Burn
Complications due to burns:
Damage to tissues. Scars & disfigurement seen later.
Loss of plasma, resulting in decrease in blood volume.
Shock.
Respiratory problems.
Sepsis.
Death.
Dangers due to fire
How to help a person whose clothes have caught fire?
Put out flames using water or whatever means available.
Water is best since it quenches the flames & also cools the burnt area
so that the damage is minimised.
Don't allow the person to run about.
Hold a wet rug in front of you, while approaching.
Lay him down & wrap tightly with a cloth so as to smother the flames.
If the clothes in front have caught fire, lay him on his back & vice versa, till suitable
material is brought to smother the flame.
First Degree Burn
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How to rescue a person from fire?
Clean air will be at ground level. So crawl along the floor to pull out the person.
Tie a wet kerchief round your face, to prevent inhalation of smoke.
Act quickly.
Don't open the windows.
Management:
In minor cases:
Pour cold water. If water is not available, use any cold harmless liquid like milk, etc.
Remove any material of constrictive in nature, like rings, watches, belts, shoes, etc.
Apply clean dressing.
Don't break blisters or remove any loose skins.
Don't apply any ointments.
Don't apply adhesive dressings.
In Severe Cases:
Lay casualty down.
Pour water.
Protect the burnt area from contact with the ground.
Gently remove any rings, watches, etc.
Carefully remove any clothing soaked in boiling liquid.
Cover the injured area with sterile dressing and secure.
Don't remove anything that is sticking to the burnt area.
Don't break blisters.
Don't apply ointments,
Immobilise badly burnt limbs.
Give oral rehydration fluids, if person is conscious.
If unconscious, open airway & check breathing. Complete “ABC” of resuscitation and
then put in recovery position.
Shift to hospital.
Burns in the mouth and throat:
(Usually Chemical Burns or Scalds)
Swelling of mouth, tongue, throat, etc. Can cause airway obstruction. So treat
accordingly.
Sun burns:
Remove to shady cool place & bathe with cool water.
Cover with sterile dressing.
Treat for general effects of over heating.
Shift to hospital.
Prevention of burns:
Stoves should be kept at a higher level.
Avoid free hanging clothes.
Avoid using clothes made of nylon or similar fibres, which can catch fire quickly.
Better use cotton.
Never open Fire unattended in hazardous area.
Restrict entry of local ignition sources in hazardous area.
Never keep combustible material near to open or direct flame or sources of heat.
Keep Inflammable materials safe.
5. First aid kit
Tips for making First aid kit
Container To keep all first aid items in one common container.
Gauze Pads -To cover wounds and prevent infection.
Roll Bandage -To stabilize strains and sprains and cover wounds.
Triangular Bandage -To cover wounds and prevent infection .
Bandages -To stop minor bleeding and prevent infection.
Adhesive Tape -To secure bandages to wounds.
Antibacterial Ointment -To prevent infection on small cuts.
Calamine Lotion -To prevent itching.
Soap -To clean minor wounds and cuts and to prevent infection.
Latex Gloves -To protect the rescuer from infection and blood pathogens.
Bandage Scissors -To cut gauze and bandages.
Tweezers -To pull splinters.
Moleskin -To protect blisters and prevent infection.
Antiseptic lotion - To prevent infections.
Analgesic - Pain killer
Anti-inflamatory - pyretic/ painkiller
Chemical burns:
Wash the chemical with large quantities of water.
Ensure that the washings does not flow over normal areas.
Cut out and remove contaminated clothing.
Treat as for burns.
Burns of eye:
Wash immediately with cold water.
Ensure washing do not flow over other eye.
Caution the patient against rubbing the eye.
Shift to hospital.
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Establish where extra items are kept to restock the kit.
Make up an inventory list. One copy with the kit, one copy with
the
troop.
Show everyone the kit, what is in it, and how to find/use the
contents.
Define clear responsibility for maintaining the kit.
What should be in first aid kit
We recommend the following items must be in kit
essentially:
Coban - Also called selfadhering bandage.
Carry the 1/2 inch size and one larger
size like 2 or 3 inch. Once applied it
keeps
most dirt out, is flexible, and will stay on
if wet. Very useful for use in the
outdoors.
Wound wash - How about a small bottle
of
contact lens saline solution? It is near
sterile and can be used to wash a cut or
rinse the eye.
It should be placed in a visible location near the centre of the activities
and clearly signposted. Everyone should be aware of its location.
Steps to make a first aid kit
The following points need to be addressed before making a first aid kit:
Identify how kit will be used and where it will be kept (determines size
and type of container).
Analyse what type of injuries are expected (determines what
to carry). Select and obtain the bag, box, or container for the
kit.
Obtain the contents, repackage them if necessary, and pack the kit.
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3
Gloves - Carry medium and large size, which should fit just
about everyone. Replace them periodically if they age and
break down.
Antibiotic
Carry
the
triple
antibiotic
type.
Band
Aids
Have
both
small
and
large
sizes.
Check them periodically, as they will age
and become unusable.
Gauze
Pads
You
can
purchase
the
"semi-sterile" type that come in bulk
packages. Transfer them to plastic bags
to put in the kit. 4x4 inch and 2x2 inch are useful sizes.
Ace
Bandages
Also
called
elastic
bandages.
You
may
need the 3 inch size for wrists and the 6 inch size for
larger joints.
Triangular Bandages - They can be used as slings, dressing, and ties for
splints
Scissors - Obtain an inexpensive pair of small medical scissors. It cuts
bandages, ties, tape, clothing, whatever. Very useful to have.
Mouth Barrier Device - We recommend a pocket mask type…the one that
comes in a hard plastic case.
Small splints - A few wooden tongue depressors or popsicle sticks work as
finger splints, scrapes, or as a tongue depressor.
Side cutters (pliers) - If you are active with fishing activities this is needed
to cut fish hooks.
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2
5
Thermometer - Good to know just how high the
fever
is.
Aspirin - You can carry this in the kits for cardiac
issues.
Ibuprofen - Used for ailments such as joint and
muscle
pain, etc.
Chap stick - Dehydration can lead to
cracked lips. Throat Lozenges - Helpful for
a sore throat.
Antacid - Helps with some of that camp cooking
or for stomach illness or disorder.
Sanitiser - In the field a quick way to wash up
before and after treatment.
Soap - J and J shampoo mixed with water works well
to clean cuts. Small soap bars are available in the
travel section.
6. Elements of Training in first aid
6.1 Teaching methods
Training programmes should incorporate the following
principles:
Having appropriate first-aid supplies and equipment
available;
Exposing trainees to acute injury and illness settings as well as to the
appropriate response through the use of visual aids;
Including a course information resource for reference both during and after
training; Allowing enough time for emphasis on commonly occurring
situations;
Emphasising skills training and confidence-building over classroom
lectures; Emphasising quick response to first-aid situations.
6.2 Assessing the scene and the victim(s)
The training programme should include instruction on the following:
Assessing the scene for safety, number of injured, and nature of the event;
Assessing the toxic potential of the environment and the need for respiratory protection;
Establishing the presence of a confined space and the need for respiratory protection and
specialised training to perform a rescue;
Prioritising care when there are several injured;
Assessing each victim for responsiveness, airway patency (blockage), breathing, circulation, and
medical alert tags;
Taking a victim's history at the scene, including determining the mechanism of
injury;
Performing a logical head-to-toe check for injuries; Stressing the need to
continuously monitor the victim; Emphasising early activation of EMS;
Indications for and methods of safely moving and rescuing victims; Repositioning ill/injured
victims to prevent further injury.
6.3 Responding to Life-Threatening Emergencies
The training program should be designed or adapted for the specific worksite and may include first-aid
instruction on the following:
Establishing responsiveness;
Establishing and maintaining an open and clear airway; Performing rescue
breathing;
Treating airway obstruction in a conscious victim; Performing CPR;
Using an AED;
Recognising the signs and symptoms of shock and providing first aid for shock due to illness or injury;
Assessing and treating a victim who has an unexplained change in level of consciousness or
sudden illness;
Controlling bleeding with direct pressure; Poisoning;
Recognising asphyxiation and the danger of entering a confined space without appropriate
respiratory protection. Additional training is required if first-aid personnel will assist in the rescue
from the confined space.
Responding to Medical Emergencies
-Chest pain;
-Stroke;
-Breathing problems;
-Anaphylactic reaction;
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7. Conclusion
-Hypoglycemia in diabetics taking insulin;
-Seizures;
-Pregnancy complications;
-Abdominal injury;
-Reduced level of consciousness;
-Impaled object.
6.4 Responding to Non-Life-Threatening Emergencies
The training programme should be designed for the specific worksite and
include
firstaid instruction for the management of the following:
Wounds
-Assessment and first aid for wounds including abrasions, cuts,
lacerations,
punctures, avulsions, amputations and crush injuries;
-Principles of wound care, including infection precautions;
-Principles of body substance isolation, universal precautions and use
of
personal
protective equipment.
Burns
-Assessing the severity of a burn;
-Recognising whether a burn is thermal, electrical, or chemical and the
appropriate
first aid;
-Reviewing corrosive chemicals at a specific worksite, along with
appropriate
first
aid.
Temperature Extremes
-Exposure to cold, including frostbite and hypothermia;
-Exposure to heat, including heat cramps, heat exhaustion and
heat stroke. Musculoskeletal Injuries
-Fractures;
-Sprains, strains, contusions and cramps;
-Head, neck, back and spinal injuries;
-Appropriate handling of amputated body
parts. Eye injuries
-First aid for eye injuries;
-First aid for chemical
burns. Mouth and Teeth
Injuries
-Oral injuries; lip and tongue injuries; broken and missing teeth;
-The importance of preventing aspiration of blood and/or
teeth. Bites and Stings
-Human and animal bites;
-Bites and stings from insects; instruction in first-aid treatment of
anaphylactic
shock.
Many deaths and impact of injuries can be prevented with First Aid if
causalities
are
treated immediately. First aid is the initial care given to an injured person.
Mostly,
this
timely care prior to the arrival of the medical help means the difference
between
life
and death.
It must start immediately when the injury or illness occurs and continue
until medical help arrives or the casualty recovers.
The basic aims of first aid are:
To save life
To protect the casualty from getting more
harm To reduce pain and
Priorities of Casualty Treatment
Priorities of Casualty Treatment
Asphyxia
Cardiac Arrest
Severe
Haemorrhage
(Bleeding)
Other
Injuries/Illnesses
Shock
Immediate Requirement
Critical four minutes
One of the most common causes of an accidental death is due to loss of
oxygen supply. This is mostly caused by a blocked airway. Normally it takes
less than four minutes for a blocked airway to cause death.
The 'golden hour'
In emergency medicine, the golden hour is the first 60 minutes after the
occurrence of a major multisystem trauma. It is widely believed that the
victim's chances of survival are greatest if he or she receives definitive care
within the first hour. First aid is the first step to save a victim.
The first aid steps can be summarised again as in next Fig-2.
Training should be imparted by qualified trainers only and repeated in regular intervals.
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27
8. Glossary
DANGER
Consequence: Outcome or impact of an event.
RESPONSE
Event: Occurrence of a particular set of circumstances.
Air
Yes
Manage bleeding, shock
they Breathing
and other injuries
First aid: Is an attempted to a ill person to provide health care
immediately after sudden health problems.
Frequency: A measure of the number of occurrences per unit of time.
AIRWAY
Roll
to
side,
supporting
head and neck.
Clear airway
Hazard: A source of potential harm or a situation with a potential to cause loss.
Health Loss: Any negative consequence or adverse effect on human health.
Health Risk: The chance of something happening that will have an impact
upon the huma health.
BREATHING
Looks, listen and Feel
DANGER
Health treatment: Process of selection and implementation of measures
to
modify
risk.
Place in lateral
Yes position,
monitor
ABCs,
treat other injuries
Likelihood: A general description of probability or frequency.
Roll onto back,
supporting head and
neek, 5 full breaths
in 10 seconds
CIRCULATION
Yes
Do
they have a
pulse?
Commence Ear
(not
breathing,
pulse
present)
No
Commence CPR
(not breathing, no pulse)
Fig-2
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30
9. References
Notes
1. Best Practices Guide: Fundamentals of a Workplace First-Aid
Programmes, U.S.
Department of Labor Occupational Safety and Health Administration
OSHA 331706N 2006.
2. Best Practices Guide: Fundamentals of a Workplace First-Aid
Programmes, Indian Red Cross Society.
3. www.hrdp-idrm.in
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