First Aid for Appointed Persons - HSE recommended - Course Notes

1. ABC First Aid Ltd First Aid for Appointed Persons - HSE recommended - Course Notes © ABC First Aid Ltd 2005

2. Introduction This booklet provides brief, general information on a range of injury and illness problems commonly encountered in the workplace. It is intended to be used as a memory aid and an accompaniment to your course - it does not replace the need for formal first aid training. First aid skills are not practiced regularly and are quickly forgotten. You should keep this booklet after your course and take time to familiarise yourself with its contents.You are being trained in First Aid in order to fulfill your Employers Duty of Care – you are required to act promptly, reasonably and to the best of your ability if anyone at work becomes injured or ill - maintaining your awareness of the subjects shown in the following pages could save vital minutes in an emergency. Please remember the limitations of first aid - you are not expected to diagnose illness or offer long-term treatment; your objectives are to deal with the immediate problem, call an ambulance if necessary, record details of the incident and your actions, then refer all instances of injury and illness for professional medical follow-up - any decision not to seek medical advice must always be the casualty's own decision, not yours. Following the guidance in this booklet and maintaining a high degree of awareness regarding Health, Safety and Confidentiality issues will ensure that you are a safe, effective first aider. © ABC First Aid Ltd 2005

3. Primary Survey Primary Survey Danger - make sure that it is safe to approach before following the sequence shown below R - RESPONSE - Firm grasp both shoulders - Verbal command “What happened?” A - AIRWAY- Remove visible obstructions - Extend: chin lift, head tilt B - BREATHING- Look } - Listen } adequate? normal? - Feel } no more than 10 seconds C - CIRCULATION- Check for obvious signs such as breathing, movement or coughing for no more than 10 seconds - Any major bleeding? © ABC First Aid Ltd 2005

4. Basic Life Support - Adult Ensure scene safety then follow the procedures below: Observe, treat as necessary then refer on… Response Grasp and shout command Yes No Airway Shout for help, chin-lift/head-tilt Breathing no more than 10 seconds look, listen and feel for NORMAL breathing (not gasping) Yes Recovery position continue checking Breathing… No Call 999 30 compressions Hands on centre of chest, 100 per minute, Approx 4-5cm chest depth 2 breaths : 30 compressions Chest compressions should be given at a rate of 100 per minute and to a depth of approximately 4-5cm. If unwilling or unable to achieve effective breaths, carry on with continuous chest compressions only. If victim shows obvious signs of life such as movement or coughing, place into the Recovery position. Otherwise, continue without pauses and do not interrupt to check for signs of life. Basic Life Support should continue until qualified help arrives and takes over, the casualty shows any signs of recovery or until the rescuer becomes physically unable to continue. The above procedures comply with Resuscitation Council (UK) Adult Basic Life Support Guidelines 2005. © ABC First Aid Ltd 2005

5. Unconsciousness If a person is found to be collapsed, unresponsive and breathing, they are said to be Unconscious. Unconsciousness may result from a whole variety of medical conditions, for example: stroke, epilepsy, drug overdose, head injury, poisoning, low blood sugar, etc. For a person who is deeply unconscious, the most immediate danger is airway obstruction caused by their tongue relaxing against the back of the throat and/or other obstructions such as vomit, mucus, blood, etc. When dealing with someone who is unconscious, therefore, the First Aiders main concern remains the maintenance of a clear airway at all times. Having conducted the initial Primary Survey (airway clear, breathing adequate, any major bleeding controlled) the First Aider should ensure that the casualty is in a position of continued airway safety – this may entail moving them if they are on their back. The most effective position is lying propped on the side with the mouth and head positioned to allow drainage. This is commonly known as The Recovery Position (see below). The First Aider should obviously be very careful if neck or other injury is suspected but remember airway always comes first! Once the first aider is satisfied that the ABC’s are under control, the Emergency Medical Services should be summoned and the First Aider may – if appropriate – conduct a quick assessment to see if there are any other obvious major injuries or clues as to the cause of the unconsciousness. This is known as a Secondary Survey. The First Aider should only proceed with caution though - there are few, if any, circumstances in which a physical ‘examination’ of the casualty is warranted by a First Aider. Often the best clue as to the presence of other injuries will come from the background circumstances – the Mechanism of Injury and the History. The First Aider should be careful not to draw conclusions or make assumptions from their findings – remember we are not qualified or expected to diagnose anything, no matter how obvious the cause may seem. All information should be passed on to the Emergency Medical Services for definitive medical assessment and follow-up. Whilst waiting for the arrival of the Emergency Medical Services the First Aider should: ·Monitor ABC’s continuously: it may change ! ·Monitor casualty’s temperature: maintain normal ! ·Monitor fluctuating levels of consciousness using the AVPU scale. This is an assessment tool used by the Emergency Medical Services to describe a casualty’s level of response: A – Alert: fully lucid, eyes open and focussed, coherent speech, coordinated movement.. V – responds to your Verbal command: eyes open but glazed, speech slurred or incoherent, disorientated, on ‘autopilot’.. P – responds to Pain stimulus: localises, moves or pulls away when earlobe pinched (or other - sternal rub, etc, etc).. U – Unresponsive: no response to any stimuli.. ·Handover: pass all known information to ambulance service or someone with medical authority ·Report: record all details in accordance with Accident Report procedures © ABC First Aid Ltd 2005

6. Allergic reactions Can be caused by a vast range of substances. In the pre-hospital environment, insect bites, stings and foodstuffs such as nuts, egg and shellfish are common triggers. Early signs include a blotchy, raised-up, itchy rash. A cold flannel may be sufficient for soothing the itching and controlling the problem at this stage. However, the sufferer should be observed closely as more serious signs may develop quickly. Look for swelling and puffiness, especially around the mouth, throat and eyes. The victim may develop raised-up, blotchy lumps on their skin (hives) and complain of feeling sick, dizzy or tingling around the lips, mouth or throat. If available, anti-histamine medication is urgently required at this time. If any of these signs seem to be getting worse, if the victim starts to wheeze, have difficulty breathing, talking or swallowing, you must call 999 immediately. Lie the victim down and elevate their legs (unless this worsens their breathing), reassure them and monitor their breathing closely. If the sufferer has their own allergy medication (Epinephrine auto-injector such as the Epipen or Anapen) you must prepare it for immediate self-administration. Asthma Can be caused by a variety of triggers such as dust, smoke, exercise, cold, etc. Recognised by wheezing, coughing, laboured breathing and anxiety. As the attack worsens the casualty will become very fatigued and pale and the chest will ‘tighten’ making breathing increasingly difficult. Collapse and respiratory arrest may follow shortly unless immediate action is taken. Remove the sufferer from the source of the attack and try to calm them. If necessary, assist with self-administration of their medication. This is most commonly carried in the form of a blue-coloured inhaler. Asthma sufferers will also commonly carry a brown or red inhaler. This is a steroid – a slow acting anti-inflammatory which will be of no immediate help once an attack is in progress. After removal from the trigger and administration of the medication, the casualty should be observed closely. If the breathing shows no improvement or seems to be getting worse after 5 minutes - if the sufferer is unable to speak clearly and without difficulty, is whispering, breathless, becoming pale, tired and distressed - or if you have any concerns regarding the use of the medication, call 999 immediately. NB - The ‘paper bag over the face’ treatment should never be used as this will worsen the genuine asthma attack. Bleeding Small cuts and grazes should be bathed with water to remove superficial grit and dirt, then covered with a clean - preferably sterile - non-fluffy dressing. Plasters can be used providing the casualty has no known sensitivity but do not use antiseptic creams or lotions as these do not guarantee the wound is clean. Larger wounds should not be washed as this may worsen bleeding by dislodging blood clots. Immediately apply pressure directly over the wound (unless there is an imbedded object), fully cover with a suitably sized dressing and bandage this firmly in place. If blood soaks through, do not remove the first dressing - place another directly over the top and again bandage in place. Elevate limb injury above the level of the heart if possible. Call 999 and treat for Shock (see following pages). Broken bones Most commonly occur following a heavy fall or blow. Signs and symptoms include pain, swelling, bruising, deformity, inability to move the injured site. The casualty will naturally tend to adopt the position which causes least discomfort and will avoid unnecessary movement. Reassure the victim and, if necessary, assist by gently supporting the limb using an improvised sling. Application of a cold compress over the injury site may help reduce some of the pain and discomfort. Remember! - the victims ability to move an injured limb - fingers or toes - does not mean a break hasn’t occurred - all such injuries need to be assessed by a Doctor as x-rays may be needed. © ABC First Aid Ltd 2005

7. Burns Before treating any burn, ensure there is no further danger to rescuer or victim from fumes, electricity, heat sources, etc. Remove the casualty from the source of burn. Soak the injured area with water for at least 10 minutes. After the burn has been thoroughly cooled, cover the area with a non-sticky, fluff-free dressing - kitchen clingfilm is ideal but do not wrap it tightly around an arm or leg in case the limb swells. For large burns, be aware of Shock (see below) and if there are any burns to the face, neck, chest or if there are breathing difficulties, ring 999 for an ambulance immediately. Chest pain The classic heart attack will present as central, crushing chest pain, radiating into the left arm, possibly up into the neck and between the shoulders. The pain sometimes starts gradually and in the early stages is often mistaken for indigestion and other common complaints. However, it will usually get worse as time passes (15-30 mins), becoming increasingly severe. The sufferer often feels sick, dizzy and anxious and will commonly sweat profusely. Marked colour changes (blue, grey, pale) are seen, particularly around the lips, nostrils and eyes. They will often gasp and pant for air. An ambulance must be called immediately to any episode of chest pain if any of the signs above are noted. The victim must be kept at rest as any exertion could make the situation worse. A single aspirin tablet (300mg) can be offered to the victim, provided they are not allergic or on any other heart medication. This should be sucked or chewed so as to be absorbed quicker. If the victim becomes unconscious they should be placed into the recovery position, breathing should be monitored as resuscitation may be needed. Choking Encourage the victim to cough: if this fails to clear the obstruction, follow the sequence below: 2) 1) Abdominal Thrusts (not on babies!) - up to 5 times - Back slaps - up to 5 times - If the abdominal thrusts fail to clear the obstruction, call 999 immediately and carry on repeating the cycle of 5 slaps + 5 thrusts. If the victim becomes unconscious, start chest compressions in accordance with the Basic Life Support guidelines. Seek medical advice even if the obstruction is cleared as airway problems may develop later. Diabetic emergency (Hypoglycaemia) Signs will include confusion, aggression, slurred or nonsense speech – the sufferer may appear to be drunk. They must be given sugar as quickly as possible. If possible this should be in liquid form as this will be absorbed more quickly into the bloodstream than a solid. Fruit drinks or milk are ideal but should have at least 2 or 3 spoonfulls of sugar added to maximise the effect. They should be encouraged to drink or eat as they maybe unaware of their own symptoms. A quick intake of sugar will result in a quick improvement – they will appear sober again – and should then be given more complex carbohydrates such as bread or pasta so as to give some duration of effect. If the sugar intake is delayed the victim will become increasingly aggressive and confused, they will often fit and convulse before becoming unconscious. An ambulance should be called if the situation appears to be getting worse as more advanced intervention will be needed. © ABC First Aid Ltd 2005

8. Electrocution Electricity is a Mechanism of Injury which causes a variety of injury patterns. High voltage electric shock may cause immediate cardiac arrest or may render the victim unconscious and cause fracture, head and soft tissue injury when the victim is physically thrown. It also causes full thickness, entry and exit burns. Even low-voltage, domestic electricity can cause small burns and disruption of the hearts normal rythmn. Electricity will remain a danger to the rescuer until the flow has been isolated and the victim ‘earthed’. For this reason it is vital that the rescuer observe the Primary Survey. If there is any doubt regarding the safety of scene, the victim should not be approached (the safety cordon for high voltage electricity is 20m). Once safe to touch the victim, consciousness and breathing must be assessed first, even in the presence of obvious other injury such as burns or breaks. If the victim is not breathing, resuscitation must be started immediately. If they are breathing but unresponsive they must be placed into the recovery position and monitored closely whilst treating other injuries. Neck injury must be assumed if there is evidence of being physically thrown. Eye injury For a casualty who has rubbed, scratched or had something splashed into their eyes, the eyes should be bathed immediately with copious amounts of water for at least 10 minutes. Chemical eyewash preparations are not necessary - ordinary tap water is ideal - and eye-baths should never be used. If only one eye is affected, take care to ensure that the water flows down and away without splashing into the unaffected eye. After bathing, the eye can be covered with a damp dressing or eye pad. Medical advice should always be sought following an eye injury. Fainting Can be caused by blood loss, allergic reaction, high temperature, low blood sugar, low blood pressure, etc. Place the victim on their back with legs elevated above the level of the head. This will assist blood return to the brain and vital organs. In most simple fainting episodes, the casualty will normally recover quickly once the circulation to the brain is restored. A sugary drink and / or cooling the victim may assist recovery. However, if after being placed on the back they remain drowsy or unresponsive, or if the breathing becomes noisy or gurgly, immediately place onto the side (see Unconsciousness) and check the Airway, Breathing and Circulation. Fits and convulsions Can be caused by head injury, epilepsy, low blood sugar, etc. The sufferer may become completely rigid or may thrash arms and legs spasmodically. Commonly, the eyes will roll back and the teeth will clench together. The episode may last a few seconds or several minutes and is often distressing to witness. Clear the area and place something soft under the head to protect from further injury. Do not restrain or attempt to force the mouth open but try to support the victim on their side as the Airway could be at risk from vomit, saliva, etc if they stay on their back. Following the fit, the sufferer is commonly disorientated and drowsy (post-ictal). Call 999 in all circumstances, reassure the victim and keep re-assessing Response, Airway and Breathing. Head injury Most commonly the result of collisions, objects falling from height, etc. If there is a cut - see Bleeding. If there is a swelling, cover with a cold, wet dressing to ease pain and discomfort. If the casualty has a nosebleed, pinch the nostrils together at the tip and lean them forwards for 10 minutes. Head Injury complications may only arise many hours after the original injury. For this reason, all incidences of Head Injury should be referred for medical assessment as a period of formal observation may be required. If the victim complains of headache, dizziness, feeling sick, if they become drowsy or show any signs of abnormal behaviour, call 999 immediately. If they begin to fit or convulse, see Fits and Convulsions and if they become unresponsive, see Unconsciousness. © ABC First Aid Ltd 2005

9. Poisoning Symptoms may include nausea, vomiting, headache, drowsiness, stomach pains, skin reaction. If the casualty has swallowed something poisonous do not induce vomiting as this could endanger the Airway, but encourage them to drink sips of water or milk. If a substance has been inhaled, quickly get the casualty into the fresh air; if it is a chemical splashed onto the skin, wash the affected area with water for at least 20 minutes. Call 999 in all circumstances and if the victim becomes drowsy or unresponsive, treat for Unconsciousness (previous). Shock Must be anticipated following blood loss, allergic reaction, etc. Place the victim on their back with legs elevated above the level of the head. This will assist blood return to the brain and vital organs. If they become drowsy or unresponsive, or if the breathing becomes noisy or gurgly, immediately place onto the side (see Unconsciousness) and check Airway, Breathing and Circulation. Soft Tissue injury (Sprains and strains) Commonly caused by falls, trips and blows. The victim may be in pain and the injured area may become swollen and bruised. Movement may be restricted. However, these signs can vary considerably from person to person and injury to injury. A cold pack may be bandaged in place over the injured area and injured limbs elevated if possible. These measures will help reduce the pain and inflammation but should not be applied for more than 10-15 minutes in the first hour. Caution! - sprains and strains may be disguising more serious injury - all such injuries need to be assessed by a Doctor as x-rays may be needed. Contents of a First Aid box • The Health and Safety (First Aid) Regulations 1981 legally oblige Employers to provide a suitably stocked first aid box. The box should be dust and damp-proof, it should be identified by a white cross on a green background and should be placed, if possible, near to hand washing facilities. • There is no statutory list of items that must be included in the box as it is up to each Employer to decide the contents based on their own first aid Risk Assessment (i.e number of staff and visitors, previous history of accidents, children with special medical requirements, allergies, etc). However, the Health and Safety Executive’s Approved Code of Practice does suggest a minimum list of items if there are no special risks or requirements: • A first aid guidance leaflet • 20 plasters of assorted sizes • 4 triangular bandages • 6 safety pins • 6 medium non-medicated dressings (12cm x 12cm) • 2 large non-medicated dressings (18cm x 18cm) • 2 eyepads • 1 pair disposable gloves • This is a suggested list only – equivalent but different and additional items including scissors, blankets and moist, non-medicated wipes are acceptable. Simple first aid kits for the home can be bought quite cheaply ‘off-the-shelf’ at Boots, Superdrug, etc but they should not contain antiseptic creams, eye drops, burn lotions, aspirin or paracetamol preparations – ‘medicated’ items are not considered acceptable for general use. Problems of skin sensitivity and allergy should be considered when using gloves and plasters. • All first aid incidents and use of first aid items should be formally recorded in a suitable accident report book (BI 510 or similar). © ABC First Aid Ltd 2005