Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia university
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It is the immediate assistance or care given to a person who has been injured or suddenly became ill, from the moment of the accident until availability of specialized medical care.
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 or address form which you are calling
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The nature of emergency
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The number of people involve
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The precise location of the emergency
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Don’t hang up until you certain that the person on the line has all the necessary information and you telephone number
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To restore and maintained vital functions (ABC)
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To prevent further injury or deterioration
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To reassure the victim and make him or her as comfortable as possible
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Assess victims for signs of life
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Restore respiration
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Restore heart action
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Stop bleeding
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Treat the shock
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The victim should not be moved but should be treated where he lies.
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In certain circumstances injured person must be moved to prevent further injury from fire , an expulsion…etc.
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Various dressings, wire splints, tape, Band-Aids, tourniquets, skin pencils, and other first aid supplies are included in these boxes. Each box is secured with a wire or plastic seal that can be easily broken.
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The seals are used to identify whether the kit has been opened. A broken seal indicates that the first aid box must be inventoried( complete list of first aid
) and restocked. The standard first aid box has three compartments. Each compartment should have a plastic bag that is complete with the basic first aid supplies. Take one of these bags with you on your way to the casualty. Failure to take a bag to the scene( location at which an event or action happens
)may result in you having to go back for supplies.
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The box does not contain needles, syringes, or medications; but does contain the proper supplies needed to render first aid until medical assistance arrives. First aid boxes are for emergency use only! Report all broken seals to medical personnel as soon as possible. It is important that you know the contents and locations of these boxes.
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A dressing is a protective covering for a wound and is used to control bleeding and prevent contamination of the wound. A compress is a sterile pad that is placed directly on the wound. A bandage is material used to hold a compress in place. When applying a dressing, ensure that it remains as sterile as possible. The part of the dressing that is placed against the wound must never touch your fingers, clothing, or any un-sterile object. If you drop, a dressing across the casualty's skin or it slips after it is in place, the dressing should not be used.
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Battle dressings are used most often aboard ship and in the field. Each dressing is complete (no other materials are needed) with four tabs which help in applying and securing the dressing. They have "other side next to wound" marked on the outer side. This will help you in (Fig. 5-2) placing the sterile side against the wound. Unless contraindicated, to assist in controlling the bleeding, tie the knot of the dressing over the wound.
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Emergencies may occur when it is not possible to obtain a sterile compress. During these situations, use the cleanest cloth available, a freshly laundered ( washed
) handkerchief ( square of cloth or absorbent paper
), towel, or shirt. Unfold the material carefully so that you do not touch the part that will be placed against the wound. The compress should be large enough to cover the entire wound and extend at least 1 inch beyond its edges.
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If a compress is not large enough, the edges of the wound will become contaminated. Materials that will stick to a wound or may be difficult to remove should never be used directly on a wound. Absorbent cotton, adhesive tape, and paper napkins are examples of materials that should never come in contact with a wound.
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Bandages are strips or rolls of gauze or other materials that are used for wrapping or binding any part of the body and to hold compresses in place. It is not necessary to take time to ensure that the bandage resembles the textbook pictures. However, it is important that the dressing controls the bleeding, prevents further contamination, and protects the wound from further injury. Some of the most commonly used bandages are the roller bandage and the triangular bandage.
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The roller bandage consists of a long strip of material (usually gauze, or elastic) that is rolled and is available in several widths and lengths.
Most are sterile, so pieces may be used as a compress on wounds. A strip of roller bandage can be used to make a four-tailed bandage by splitting the cloth from each end, leaving as large a center as needed. This type of bandage is used to hold a compress (Fig. 5-4B) on the chin, or (Fig. 5-4C) the nose.
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Triangular bandages (Fig. 5-5) are usually made of muslin ( thin cotton cloth
). They are useful because they can be folded in a variety of ways to fit almost any part of the body. Padding can be added to areas that may become uncomfortable.
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The triangular bandage can be folded to make a cravat bandage, which is useful in controlling bleeding from wounds of the scalp or forehead.
To make a cravat bandage, bring the point of the triangular bandage
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Roller Bandage for the Hand and Wrist
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) (1) to maintain an open airway,
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(2) maintain breathing, and
(3) to maintain circulation. During this process you will also:
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 control bleeding, and reduce or prevent shock.
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You must respond rapidly, stay calm, and think before you act. Do not waste time looking for ready-made materials, do the best you can with what is at hand. Request professional medical assistance as soon as possible.
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When responding to a casualty (victim), take a few seconds to quickly inspect the area. Remain calm as you take charge of the situation, and act quickly but efficiently. Decide as soon as possible what has to be done and which one of the injuries needs attention first.
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1. Safety - Determine if the area is safe. If the situation is such that you or the casualty is in danger, you must consider this threat against the possible damage caused by early movement. If you decide to move the casualty, do it quickly and gently to a safe area where proper first aid can be given. You cannot help the casualty if you become one yourself.
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2. Mechanism of injury - Determine the extent of the illness or injury and how it happened. If the casualty is unconscious, look for clues. If the casualty is lying at the bottom of a ladder ( steps
), suspect that he or she fell and may have internal injuries.
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3. Medical information devices - Examine the casualty for a MEDIC ALERT (Fig. 1-1) necklace, bracelet, or identification card. This medical tag, provides medical conditions, medications being taken, and allergies about the casualty. The VIAL OF LIFE, a small, prescription-type bottle, also contains medical information concerning the casualty. This bottle is normally located in the refrigerator.
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4. Number of casualties - Look beyond the first casualty, you may find others. One casualty may be alert, while another, more serious or unconscious, is unnoticed. In a situation with more than one casualty limit your assessment to looking for an open airway, breathing, bleeding, and circulation, the life-threatening conditions.
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5. Bystanders - Ask bystanders to help you find out what happened. Though not trained in first aid, bystanders can help by calling for professional medical assistance, providing emotional support to the casualty, and keeping onlookers from getting in the way.
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6. Introduce yourself - Inform the casualty and bystanders who you are and that you know first aid. Prior to rendering first aid, obtain the casualties consent by asking is it "OK' to help them. Consent is implied if the casualty is unconscious or cannot reply.
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1. Keep the casualty lying down, head level with the body, until you determine the extent and seriousness of the illness or injury. You must immediately recognize if the casualty has one of the following conditions that represent an exception to the above.
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 a. Vomiting or bleeding around the mouth - If the casualty is vomiting or bleeding around the mouth, place them on their side, or back with head turned to the side. Special care must be taken for a casualty with a suspected neck or back injury.
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 b. Difficulty breathing - If the casualty has a chest injury or difficulty breathing place them in a sitting or semi-sitting position.
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 c. Shock - To reduce or prevent shock, place the casualty on his or her back, with their legs elevated 6 to 12 inches. If you suspect head or neck injuries or are unsure of the casualty's condition, keep them lying flat and wait for professional medical assistance.
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2. During your examination, move the casualty no more than is necessary. Loosen restrictive clothing, at the neck, waist, and where it binds.
Carefully remove only enough clothing to get a clear idea of the extent of the injuries. When necessary, cut clothing along its seams ( line of stitching
).
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Ensure the casualty does not become chilled, and keep them as comfortable as possible.
Inform the casualty of what you are doing and why. Respect the casualty's modesty, but do not jeopardize( put at risk
) quality care. Shoes may have to be cut off to avoid causing pain or further injury.
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3. Reassure the casualty that his or her injuries are understood and that professional medical assistance will arrive as soon as possible. The casualty can tolerate pain and discomfort better if they are confident in your abilities.
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4. Do not touch open wounds or burns with your fingers or un-sterile objects unless it is absolutely necessary. Place a barrier between you and the casualty's blood or body fluids, using plastic wrap, gloves, or a clean, folded
cloth. Wash your hands with soap and warm water immediately after providing care, even if you wore gloves or used another barrier.
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5. Do not give the casualty anything to eat or
drink because it may cause vomiting, and because of the possible need for surgery. If the casualty complains of thirst, wet his or her lips with a wet towel.
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6. Splint all suspected, broken or dislocated bones in the position in which they are found.
Do not attempt to straighten broken or
dislocated bones because of the high risk of causing further injury. Do not move the casualty if you do not have to.
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7. When transporting, carry the casualty feet
first. This enables the back carrier to observe the casualty for any complications.
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8. Keep the casualty comfortable and warm enough to maintain normal body temperature.
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You will probably render first aid to someone you know - family member. For this reason you will probably know your risk of contracting an infectious disease. Adopt practices that discourage the spread of blood-borne diseases
(Hepatitis and HIV) and air-borne diseases such as influenza when performing first aid
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1. Wear gloves or use another barrier.
2. Wash your hands with soap and warm water immediately.
3. When possible, use a pocket mask or mouthpiece during rescue breathing.
The risk of contracting infections from a casualty is very remote (distant). Do not withhold rendering first aid because of this rare possibility.
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Scene assessment
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Primary survey
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Secondary Survey
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Reporting of data
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Make a quick assessment of the overall situation at an accident scene. Concentrate on the big
“big picture.”
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Consider three things:
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Environment
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Hazards
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Mechanism of injury
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Look for anything that may threaten your safety and the safety of others, such as downed power lines, falling rocks, traffic, fire, smoke, etc.
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Do not move a casualty unless he or she is in immediate danger, If you must move the casualty, do so as quickly as possible.
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The mechanism of injury can alert you to the possibility that certain types of injuries may be present. For example, fractured bones are usually associated with falls and motor vehicle accidents, burns with fires, and soft tissue injuries with gunshot wounds.
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Remember, however, that for every obvious injury, there may be a number of hidden ones.
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The primary survey is conducted once dangers at the scene have been neutralized. It is the first step in the physical assessment and consists of the following:
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Check of level of consciousness (LOC) as you approach the patient.
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Check of DABC (Delicate spine, Airway,
Breathing, and Circulation)
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Rapid body survey (RBS) for external blood loss and deformities
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While conducting the primary survey, you may discover life- threatening emergencies such as obstructed airways, respiratory difficulties, external bleeding, and obvious shock. Treat these problems immediately.
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For your protection, wear disposable gloves whenever you might be handling blood, body fluids, or secretions.
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To perform a primary survey, you must be able to do the following:
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Assess level of consciousness (LOC) using the
AVPU method.
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Manage a delicate spine.
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Clear obstructions from the patients mouth.
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Open the airway.
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Correctly use an oral airway for unconscious.
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Suction the mouth cavity if required.
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Place unconscious patients and patients with compromised airways in the recovery position and monitor breathing.
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Determine when a patient is not breathing adequately.
Use a pocket mask to ventilate patients with inadequate breathing.
Ventilate an infant using a pocket mask, connected to oxygen, and mouth-to-mask ventilation's.
Use the bag-valve-mask-oxygen reservoir unit to ventilate patients with inadequate breathing.
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Perform a rapid body survey (RBS).
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Give oxygen at high flow (10 L/min) with a standard face mask.
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Describe the pathophysiology of hypoxic drive and the management of a COPD patient.
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Check for LOC as you approach the patient.
The A,V,P,U method is a short and simple way to assess the LOC:
A - patient is Alert
V - patient responds to Verbal (Voice) stimuli
P - patient responds to Pain
(Use a trapezoidal squeeze to administer a painful stimulus.)
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A change in the level of consciousness is the first sign of a brain injury or other serious medical conditions.
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Manage A Delicate Spine
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Always assume that the patient has a neck or spine injury (delicate spine). You may rule it out after considering the mechanism of injury, bur always check for a delicate spine if the patient must be moved.
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Approach the patient from the head.
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Tell the patient, “If you can hear me, don’t move.”
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Stabilize the head in the position found.
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Do not move the patient unless absolutely necessary to maintain an open airway.
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When using the various grips remember to use the principles of STABLE to UNSTABLE
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Airway management involves three things:
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Opening the airway
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Maintaining the open airway
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Helping the patient breathe effectively
(ventilation)
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Look, listen, and feel for the movement of air at the mouth and/ or nose. After an injury, a patient’s airway may become closed or blocked by teeth, the tongue, or foreign objects. “check for
5 seconds”
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Before taking steps to open the airway, make sure you have ruled out a delicate spine or protected the neck. The technique you use will depend on whether or not the mechanism of injury indicates a delicate spine.
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Clear obstructions from the patient's mouth.
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Open the airway.
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Correctly use an oral airway for unconscious patients.
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Suction the mouth cavity if required.
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Place unconscious patients and patients with compromised airway in the recovery position and monitor breathing.
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Clear Obstructions From The Patient’s Mouth
And Throat.
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Make sure your patient’s airway is clear before trying to open it. Remove foreign materials such as broken teeth, vomitus, fluid and mucus before attempting any further treatment. Use a
crossed-over finger technique to open the patient's mouth, and do a visual check.
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Opening The Airway
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Open the airway after clearing foreign materials form the mouth. The tongue can easily act as a lid, closing down onto the back of the throat and making breathing impossible. To open your patient’s airway, you must lift the tongue up and off the back of the throat.
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Use the Head-Tilt/Chin-Lift Method
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Do not use this procedure on any patient with neck or spinal injuries.
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Use the jaw thrust or modified jaw thrust
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If you suspect a neck injury, take care not to move the neck.
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Oral Airways
Once the airway passage is clear and open, you must keep it open, especially if the patient is unconscious and cannot do it himself or herself.
The oral airway (oropharyngeal airway), a hard plastic tube, is the ideal tool for this. Inserted correctly, it prevents the tongue from falling back and blocking
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Moving Patients
A general principle for First Responders is that patients should be cared for in the position found. This principle is based on the assumption that certain conditions or injuries (such as a neck fracture in an unconscious patient) can be hidden so that it is missed during initial assessment, and unnecessary movement may make the situation worse. However, there are three situations in which you, the First Responder, will have to move the patient:
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Repositioning the patient to manage immediate
ABC’s.
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Moving patients as quickly as possible out of hazardous areas.
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Rescuing and transporting patients.
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Repositioning The Patients To Manage
Immediate ABC’s
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Many patients are found in unusual or difficult positions. It may be necessary to move them in order to effectively assess or manage their
ABC’s.
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If you must move a patient, follow these principles:
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Moves are best done with the help of two or more people.
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Although managing the ABC’s is always a priority, try to minimize movement during urgent repositioning.
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Movement of the neck and spine is potentially more dangerous than moving an extremity.
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In an awake patient, increased pain with movement should limit your repositioning.
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In most cases, positioning of the patient is determined by patient comfort. If possible, the patient should be left in the position found.
However, if moving the patient results in better patient care, consider the following options:
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Semi-sitting
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Shortness of breath; obese patients; chest pain.
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Supine
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Suspected neck injuries; patient with no radial pulse; hip fractures.
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Prone or Recovery Position
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All unconscious patients with no neck injury.
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All patients with airway problems that cannot be controlled by suctioning.
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Suctioning the mouth cavity is another procedure used to keep the airway clear.
Secretions and other debris are removed by applying negative pressure through a hollow tube. If you do not remove the debris, you may force it into the patient’s lungs during ventilation.
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A patient may be breathing on his or her own but not doing so adequately. Do not wait for respiratory arrest before ventilating the patient.(below 10, and over 30).
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Determine when a patient is not breathing adequately.
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Use a pocket mask to ventilate patients with inadequate breathing.
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Ventilate an infant using pocket mask, connected oxygen, and mouth-to-mask ventilation's.
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Use the bag-valve-mask-oxygen reservoir unit to ventilate patients with inadequate breathing.
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A patient is not breathing adequately if he or she has fewer than 10 respirations per minute and/ or shows some or all of the following signs of hypoxia (low oxygen level in the blood): agitation irritability drowsiness headache
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 decreased level of consciousness
 rapid pulse
 labored breathing
 abdominal breathing
 bluish skin color
 irregular heartbeat
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The rapid body survey will help you to locate and expose injury sites, stabilize fractures, and control bleeding.
You should be able to accomplish the following:
Perform a rapid body survey.
Give oxygen at high flow (10 L/min) with a standard face mask.
Describe the pathophysiology of hypoxic drive and the management of a COPD patient.
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Check for bleeding, deformity, and your patient’s response to pain by systematically running your hands over and under the following: head and neck chest and abdomen back lower extremities upper extremities
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You should take no more than 30 seconds to perform a rapid body survey. It should be interrupted only long enough to provide intervention for life-threatening injuries.
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5 Litres per minute
COPD Patients (No Trauma)
10 Litres per minute
All trauma patients
Medical emergencies
15 Litres per minute
Smoke and/ or gas inhalation
Carbon monoxide poisoning
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Assist patients with inadequate respiration's.
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Hyperventilate unconscious patients with head injuries
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Circulation - Radial Pulse
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Circulation - Carotid Pulse
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Pocket Mask
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CPR-on-the-move.
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Infant ventilation's.
 when resuscitation from BVM does not create an effective seal.
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Victims of smoke and/ or gas inhalation.
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Victims of carbon monoxide poisoning
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Patients with adequate respiration's.
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As a first responder, you should use a standard
face mask to give oxygen at 10 L/min to:
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All trauma patients
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All medical patients except those with a history of chronic obstructive pulmonary disease
(COPD)
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Oxygen therapy for the
patient is 5 L/min through a standard adult oxygen mask. But at a 10 L/min flow for
patient’s.
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In normal people, the breathing reflex is triggered by high level of carbon dioxide (CO2) in the blood.
Patients with emphysema, chronic bronchitis, and chronic asthma may have a condition know as Chronic
Obstructive Pulmonary Disease (COPD). They retain
CO2 and thus have a chronically high level of this gas.
Their breathing reflex is triggered only when the oxygen level in their blood is low. This mechanism is known as
hypoxic drive. By giving COPD patients oxygen, you may suppress their breathing reflex.
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Give the patient with
, 5 L/min through a standard adult oxygen mask. Closely monitor the patient’s respiratory rate, depth, and volume. Assist the patient’s ventilation's if necessary.
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The purpose of a secondary survey is to identify problems that, while not immediately lifethreatening, may threaten the patient’s survival if left undetected.
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Medical history (chief complaint and history of chief
complaint)
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Vital signs (LOC, pulse, respiration's, and skin colour
and temperature)
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Head-to-toe physical examination (if time permits)
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The information you gather here will be vital for the patient’s later care. You should be able to report it accurately and concisely to ambulance personnel when they arrive.
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The chief complaint is what the patient says is wrong with him or her. Record and report it using the patient’s own words. This will help you avoid interpreting what was said, which may obscure or change the nature of the problem.
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Most chief complaints are characterized by pain or abnormal function. Find out what is bothering the patient most. For example, a victim of a motor vehicle accident may have an obvious leg fracture but his chief concern may be,”I can’t breath.” This may help you discover an unsuspected chest injury.
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The history of the chief complaint examines the chief complaint in greater detail. Get a description of the events that caused the chief complaint. If pain is the chief complaint, use the
PQRST method to help you organize your questioning.
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Position of the pain.
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Quality of the pain.
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Does the pain Radiate?.
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Severity of the pain.
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Timing of the pain.
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P - Position
Where is it located? Can you point to it?
Q - Quality
What does it feel like? Is it sharp, dull, throbbing, or crushing?
R - Radiation
Does it radiate anywhere? or Does it stay in one place or move around? Does anything relieve it?
What makes it worse?
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S - Severity
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How would you rate the pain on a scale of 1 to
10
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(10 being the worst)?
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T - Timing
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When did it start? What brought it on? Have you had it before? How long does it last?
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Allow the patient to answer in his or her own words.
Avoid suggesting answers. (“What provoked the pain?”
Not “Does the pain come after exertion?”)
Use open-ended questions. Avoid asking questions that can be answered with yes or no.
To pinpoint responses, give the patient alternatives.
(Does the pain stay in one place or does it move around?
Reassure the patient frequently.
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Baseline vital signs are one of the most important aspects of patient assessment. They are taken after the primary survey and the medical history.
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Based on them, ambulance personnel and receiving hospital staff can tell whether or not the patient’s condition is deteriorating.
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As a First Responder you should record the following:
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LOC (using the AVPU method)
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Skin - colour, condition and temperature
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Pulse - rate, rhythm, and strength
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Respiration's - rate, rhythm, and volume (quality)
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Monitor the LOC, take the pulse, and count the respiration's
Check whether the patient’s skin is:
 cool or warm
 moist or dry
 pale or normal in colour
 condition
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Recording and reporting data is the last major component of the patient assessment model.
Your report will help guide the ambulance personnel and hospital staff in treating the patient.
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Mechanism of injury
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Chief complaint
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History of chief complaint
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LOC, pulse, respiration's, and skin colour and temperature
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Treatment given
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All relevant physical findings
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Follow up your oral report with a completed copy of the
First Responder Report. (within 24 hours of the incident)
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