First Aid

1. First Aid What are the main priorities for assessment and management of first aid patients? How should the major types of injuries and medical conditions be managed in first aid situations? What does the individual need to consider in administering first aid?

2. What are the main priorities for assessment and management of first aid patients? Summary of content: • Setting priorities for managing a first aid situation and assessing the casualty: - situational analysis - priority assessment procedures - DRABCD - STOP • Crisis management: - CPR - bleeding - shock - neck and spinal injury - moving the casualty - medical referral - care of the unconscious casualty

3. Setting priorities for managing a first aid situation and assessing the casualty The priority when assessing and managing first aid patients is minimising the harm to: - yourself - bystanders - the casualty When managing the first aid situation, it is important that the circumstances and eventual outcomes for the patient are improved as much as possible. Expediency and appropriate care here positively affect the individual’s quality of life.

4. Setting priorities for managing a first aid situation and assessing the casualty Situational Analysis There is a chance that some stage in our life we may be confronted with the need to resuscitate an individual in a number of different circumstances. It is important that you are able to deal with this quickly, effectively and without risk to yourself or others. To do so you need to: • Analyse the situation – observe what has happened and ask yourself: ‘What's the best I can do for this person in terms of the skills that I have?’ • Plan how to deal with the situation – prioritise your intended actions, dealing with the most important issues first. • The main issue with situational analysis is that you don't become a victim yourself in an effort to assist another person. Always put your safety first.

5. Setting priorities for managing a first aid situation and assessing the casualty Priority Assessment and Management Procedures Scenarios: Scenario 1 Scenario: Petrol leaking, dangerous wires, at least 4 casualties, injuries (for example, broken bones, dislocations, bleeding, spinal injuries), possible fatalities, other cars on the road. • Dangers: Risk of explosions (petrol and fire), other cars, danger of being electrocuted, broken glass, unstable structures, fumes, etc • Priority management – DRABCD • Call ambulance • Assess danger – to self, bystanders, casualties. • Other Traffic - Warn other vehicles, put on Hazard lights, use a bystander to warn oncoming traffic, park a car on the road a safe distance from the crash • Damaged Vehicle - be aware of airbags that haven’t gone off, put on handbrake, put vehicle in gear, put bricks or blocks against wheels to stop it rolling • Fallen or Damaged Overhead Power lines - Keep away from the cable – do not move, call emergency services. • Fire Risk - keep bystanders/casualty/self well away, no naked flames or smoking, switch off the ignition Check for conciousness/unconciousness Airway management/CPR Control bleeding

6. Setting priorities for managing a first aid situation and assessing the casualty Scenario 2 Scenario – panic, a variety of swimmers, weak swimmers and non swimmers. • Dangers – wave size, being caught in the rip as well, being pulled under by weak, non-swimmers or panicking swimmers. • Priority Management - Try to get assistance from lifeguards - Assess danger – you should only attempt a water rescue if you are a strong swimmer and the water is not too deep for you. - Consider the safest rescue options (for example, reach, throw, wade, row, swim, etc) - Priotisation/Triage (in a situation like this, this involve assisting those whose injuries/ condition can be treated quickly) - If possible, paddle to the victims on a board and with PFDs. The board and PFDs can be used to keep the victims afloat until help arrives.

7. Setting priorities for managing a first aid situation and assessing the casualty Scenario 3 • Scenario – broken glass, bleeding, lacerations, panicking, crying, etc • Dangers – stepping in/being cut by glass, being infected by blood, etc • Priority Management - Call the Ambulance - Assess dangers to self, casualties, bystanders - Move casualties away from the glass if possible - DRABCD - Manage bleeding

8. Setting priorities for managing a first aid situation and assessing the casualty DRABCD D check for DANGER • to you • to other people in the immediate area • to the casualty R check for RESPONSE • is the casualty conscious? • to check for consciousness ask questions, squeeze their hand A check AIRWAY • is the airway open and clear of objects? • clear and maintain the airway B check for BREATHING • is the chest rising and falling? • can you hear or feel air from the mouth or nose? • if breathing is absent give two initial breaths C give CPR • if there are no signs of life – unconscious, not breathing and not moving, apply CPR • CPR stands for cardiopulmonary resuscitation • CPR involves giving 30 compressions at a rate of approximately 100 compressions per minute, followed by two breaths D attach DEFIBRILLATOR (if available) • follow voice prompts

9. Setting priorities for managing a first aid situation and assessing the casualty STOP Stop Stop the person from moving. It may be necessary to stop the sport or activity. Are there any dangers? Talk Talk to the injured person. Ask them questions to ascertain the type and severity of the injury. Questions may include: • What happened? • Where does it hurt? • Can you move the affected area or body part? Observe Observe the patient and the injured area. Look for facial expressions of pain, look for swelling or deformity and feel for pain or tenderness. Ask yourself questions such as: • Does the patient look distressed? • Is there swelling, bleeding or bruising? • Are there any deformities? Prevent Prevent further injury by conducting a whole of body assessment and treating the injury with appropriate first aid.

10. Setting priorities for managing a first aid situation and assessing the casualty Whole of Body Assessment

11. Crisis Management Cardiopulmonary Resuscitation (CPR) Refer to pages 13 & 14 of your exercise booklet and read through the table.

12. Crisis Management Bleeding • Use DRABC action plan. • Apply direct pressure by holding a pad or dressing firmly over the site. • Lay casualty down and elevate injury. • Rest the injured area. • Do not give patient anything by mouth, particularly asprin as this tends to increase the rate of bleeding. • Loosen tight clothing. • Seek medical advice.

13. Crisis Management Shock Is a condition where the body closes off the blood supply to the extremities (arms, legs and skin) to ensure enough oxygen reaches vital organs. Causes: - Blood loss. - Fluid loss e.g. Dehydration. - Being involved in an accident. Symptoms: - Paleness and cold clammy skin. - Weak rapid pulse. - Rapid shallow breathing. - Nausea and faintness. Management: 1. Utilise DRABCD action plan. 5. Dress any wounds or burns. 2. Reassure the patient. 6. Loosen restrictive clothing, particularly around the neck. 3. Seek medical advice. 7. Keep casualty comfortable. 4. In the absence of a fracture raise legs above the level of the heart.

14. Crisis Management Neck and Spinal Injury Signs and Symptoms: • Loss of movement in the hands and/or legs. • Pain in the neck and/or back, tingling sensation in the hands or feet. • Altered sensation, movement or strength in the limbs or trunk. • Irregular bumps on the neck or back and slow pulse. Management Procedures: • Reassure patient. • Loosen any tight clothing. • Do not move them. Support head and apply a cervical collar if one is available. • Seek medical attention. Monitor casualty closely until help arrives. • If casualty is unconscious, treat patient as if they have a neck and spinal injury and use the DRABCD procedures.

15. Crisis Management Please refer to page 16 of your exercise booklet and read through the following: • Moving the Casualty http://www.youtube.com/watch?v=VSyuBMEwfrk http://www.youtube.com/watch?v=4UBIxtyoxok http://www.youtube.com/watch?v=vMkDtw_5yaY http://www.youtube.com/watch?v=MWs3rMXt2hA • Medical Referral • Care of the Unconscious Casualty

16. How should the major types of injuries and medical conditions be managed in first aid situations? Individuals can sustain a wide range of injuries. It is important to be able to identify the symptoms for each type of injury and be familiar with the appropriate management techniques. You need to pay attention to the environment, listen to the patient (if conscious) and assess the injured area(s) to determine the best management technique. How much do you Know??? Complete the Emergency Care Quiz on pages 18-19 of your work booklet,

17. Management of Injuries Cuts and Lacerations • Abrasions, open wounds and penetrating wounds. Signs and Symptoms • Scraped skin caused by a fall on a hard surface. • Incisions or lacerations. • Deep wound from an object, e.g. From a bullet. Management • DRABCD • Control bleeding using pressure. • Cleanse thoroughly. • Apply clean dressing. • Seek medical attention.

18. Management of Injuries Fractures • These can be closed (under the skin), open (through the skin) or complicated (where organs are damaged). Signs and Symptoms • Sound from the bone breaking. • Localised pain. • Swelling and deformity. • Tenderness. • Loss of power. • Difficult to achieve normal range of motion. Management • DRABCD • Control bleeding (if any) • Immobilise with a sling or a splint. • Observe for shock and treat if necessary. • Seek medical attention.

19. Management of Injuries Dislocations • Refers to the bone being dislodged from the joint. Signs and Symptoms • Swelling, discolouration. • Pain and deformity. • Tenderness with an inability to move. Management • DRABCD • Support the area. • Apply ice. • Elevate if possible. • Seek medical attention.

20. Management of Injuries Head Injuries and Concussion • Trauma to the head Signs and Symptoms • Blurred Vision. • Loss of memory, headache. • Change in size of the pupil. • Bleeding from nose or ears. • Abnormal response to commands. Management • DRABCD. • Support the head or neck. • Keep airway open. • If conscious lay in the lateral position. • Do not apply pressure to a bleeding head if a skull fracture is suspected. • Seek medical attention.

21. Management of Injuries Eye Injuries Signs and Symptoms • Irritation to the eye. • Watering. • Redness. • Pain to the eye itself. • Inability to open. Management • Rubbing and removal of embedded objects must be avoided. • Lay in the lateral position. • Cover both eyes. • Seek medical attention.

22. Management of Injuries Nasal Injuries Signs and Symptoms • Pain, swelling, deformity and bruising. Management • Instruct casualty to breath through the mouth. • Blowing the nose should be avoided. • Assume sitting position with head and shoulders leaning forward. • Apply pressure with the index finger and thumb to the soft part of the nose just below the bone. • Apply pressure for approx 10 minutes or until bleeding stops. • Seek medical attention.

23. Management of Injuries Burn Injuries • These can be caused by fire, chemicals, electricity and radiation. Signs and Symptoms • Severe pain, possible swelling. • Redness, blistering and shock. Management • Remove the casualty from the danger or the danger from the casualty. • DRABCD. • Hold burnt area under cold running water. • Remove jewellery and clothing only if it is not stuck to the skin. • Seek urgent medical attention. • Do not brak blisters or apply creams, lotions or adhesive dressings.

24. Management of Injuries Teeth Injuries Signs and Symptoms • Bleeding from the mouth. • Dislodged tooth. Management • If the tooth has been loosened keep it in place and seek immediate dental advice. • If the tooth has been knocked out, re-implant and splint to an adjacent tooth using aluminium foil. If not possible, place in milk or clean with the casualties saliva and seek urgent dental assistance. • Most teeth can be saved if the root is not handled.

25. Management of Injuries Electrocution Signs and Symptoms • Unconsciousness. • Electrical wires may be visible. Management • DRABCD. • Cool burnt area under running water. • Seek urgent medical advive.

26. Management of Injuries Chest Injuries • These may range from bruised or fractured ribs to lung injuries. Signs and Symptoms • Pain usually on breathing and coughing. • Difficulty in breathing. • Tenderness when touched. Management • Place in a comfortable position. • Encourage shallow breathing. • Pad the injured area. • Seek urgent medical advice.

27. Management of Injuries Abdominal Injuries • These are injuries to the stomach and pelvis caused in such instances such as car crashes and tackles in sport. Signs and Symptoms • Shock, pain in the region. • Nausea or possible vomiting. • Difficulty in breathing. • Possible blood in the urine or coming from the anus. Management • DRABCD. • Loosen clothing in the area e.g. Belts. • Lie patient on their back, slightly elevate shoulders and bend the knees. • Do not allow casualty to consume food or drink. • Seek urgent medical attention.

28. Management of Injuries Activity • Apply your new-found knowledge to the case studies on pages 21-23 of your exercise work booklet.

29. Management of Medical Conditions Heart Attack Signs and Symptoms • Shortness of breath, difficulty in breathing, excessive perspiration, irregular heart beat, pain in the chest that can extend down the neck and arm. Management Techniques • DRABCD, seek urgent medical assistance, loosen tight clothing.

30. Management of Medical Conditions Stroke Signs and Symptoms • Numbness in the face, arm or leg, slurred speech, disorientation, blurred vision, loss of consciousness. Management Techniques • DRABCD, seek urgent medical assistance, make patient comfortable.

31. Management of Medical Conditions Diabetes Signs and Symptoms • There are two medical conditions relating to diabetes, hypoglycaemia and hyperglycaemia. • The signs and symptoms of hypoglycaemia (low blood sugar) include nausea, confusion, sweating, rapid pulse, shallow breathing. • Signs and symptoms of hyperglycaemia (high blood sugar) include drowsiness, rapid pulse, thirst, increased urination, breath has a ‘fruity’ smell. Management Techniques • The management techniques for hypoglycaemia include DRABCD, if unconscious do not give anything by mouth, if conscious patient should be encouraged to eat or drink glucose e.g. fruit juice, jelly beans. • The management techniques for hyperglycaemia include DRABCD, seek medical assistance if the patient is conscious allow them to administer insulin.

32. Management of Medical Conditions Epilepsy Signs and Symptoms • Muscle spasms, rigid body, frothing at the mouth, loss of bladder control, loss of consciousness. Management Techniques • DRABCD, clear obstacle that may cause injury e.g. tables and chairs, once the seizure has finished, place in recovery position, monitor patient and reassure them, seek medical assistance.

33. Management of Medical Conditions Asthma Signs and Symptoms • Breathlessness or difficulty in breathing, wheezing and coughing, tightness in the chest, rapid pulse, paleness and sweaty skin. Management Techniques • The four-step Asthma First Aid is: • Sit the person upright and give reassurance – do not leave them alone. • Without delay, give the person four separate puffs of your blue reliever medication (Airomir, Asmol, Bricanyl, Epaq or Ventolin). This should be taken one puff at a time via a spacer. Ask the person to take four breaths from the spacer after each puff of medication. • Wait four minutes. If there is little or no improvement, repeat steps 2 and 3. • If there is still no improvement, call an ambulance immediately. Dial triple zero (000). • Repeat steps 2 and 3 continuously while waiting for the ambulance to arrive.

34. Management of Medical Conditions Anaphylaxes Signs and Symptoms • Difficulty breathing, swelling of the tongue, swelling/tightness in the throat, difficulty talking/hoarse voice,wheezing or persistant coughing, loss of conciousness and / or collapse, young children may appear pale and floppy. • Abdominal pain or vomting (when associated with an allergic reaction to an insect sting or bite). Management Techniques • Adrenaline is given as an injection using an autoinjector.

35. Management of Medical Conditions Poisoning Signs and Symptoms • Headache, drowsiness, vomiting, pain, rapid pulse, breath smells of fumes. Management Techniques • DRABCD, in most cases do not induce vomiting, if possible consult poisoning information on product, seek urgent medical assistance.

36. Management of Medical Conditions Bites and stings Snake bite Signs and Symptoms • Puncture marks, pain, swelling, headache, rapid pulse, difficulty in breathing. Management Techniques • DRABCD, reassure the patient, apply a compression bandage over the site and along the limb, immobilise the site, seek medical assistance. Funnel-web spider Signs and Symptoms • Puncture marks, pain, sweating, difficulty in breathing, nausea, shock. Management Techniques • DRABCD, reassure the patient, apply a compression bandage over the site and along the limb, immobilise the site, seek urgent medical assistance. TBC.....

37. Management of Medical Conditions Redback spider Signs and symptoms • Pain, sweating, nausea, joint pain, rapid pulse. Management Techniques • DRABCD, reassure the patient, apply ice to the bite site, seek medical assistance. Bee sting Signs and symptoms • Pain at site, swelling. Management Techniques • Remove by scraping away stinger (do not squeeze), apply ice to the bite site, seek medical assistance if allergic reaction occurs.

38. Management of Medical Conditions Exposure to extreme heat can result in hyperthermia Signs and Symptoms • Cramps, exhaustion, dizziness, nausea, headache, rapid pulse, unconsciousness. Management Techniques • Place patient in cool shaded area, give sips of water, reduce body temperature by use of fan or wet towel, seek medical assistance.

39. Management of Medical Conditions Exposure to extreme cold can result in hypothermia Signs and Symptoms • Shivering, fatigue, slurred speech, slow reaction time, slow pulse, cold skin. Management Techniques • Remove wet clothing, wrap the patient in warm clothing, blankets, sleeping bag etc., use body heat of another person, do not try to raise body temperature too quickly, provide warm drinks to sip, seek medical assistance.

40. What does the individual need to consider in administering first aid? Summary of Content: • Physical Environment - traffic accidents - water environments - electricity • Infection Control and Protection - HIV/AIDS - blood-borne viruses (Hepatitis B and C) • Legal and Moral Dilemmas - legal implications e.g. OH&S - moral obligations e.g. duty of care & responsible citizenship - common sense versus heroics • Support following first aid situations - debriefing - counselling

41. Physical Environment The nature of the physical environment may, in part have been responsible for the occurrence of the accident in the first place. E.g. A drowning may have occurred as a result of a rapidly rising water level. Or a traffic accident may be due to an oil spill on the road. Whatever the circumstances, it is important that protective measures be observed and strategies put into place so that a further injury does not occur. Read through the information and complete the relevant activities on pages 28-32 of your exercise booklet.

42. Infection Control and Protection There is a risk of cross infection (passing infection from one person to another) when administering first aid. This is particularly so when giving CPR or managing wounds. There are many illnesses that can be transferred, some more serious than others e.g. Colds and influenza, HIV/AIDS, glandular fever, measles, chicken pox, mumps, herpes and hepatitis B and C to name a few. Administration of first aid requires measures to be taken to avoid transmission of infection under any circumstances. The first aider must apply hygienic practices and create a barrier so that the infection cannot pass from one person to another. YOU CAN NOT TELL JUST BY LOOKING AT SOMEONE IF THE HAVE AN INFECTIOUS DISEAS OR NOT! The situations that cause most concern are in relation to HIV/AIDS and blood-borne viruses such as hepatitis B and C. Read through the information and complete the activities on pages 32-33 of your exercise booklets.

43. Legal and Moral Dilemmas The legal and moral dilemmas of a first aider giving first aid is of great concern as it can implicate the practice of providing first aid to a casualty in need. There are many questions raised in relation to when a first aider is required by law to provide assistance and in fact if they are legally required at all. Plus if you do, are you then liable for any personal damage or further injury (that often happens) whilst providing first aid and saving a casualty’s life? What seems truly difficult is the moral obligation to assist a fellow human being in need, particularly when your life is at risk in the situation too. The question raised is when are you morally obligated? If you are not legally required to assist, are you then expected to provide first aid from an emotional perspective? What would a responsible citizen do? And if you were to assist, what emotional impact would it have on you as an individual? Who is there to support you following a first aid situation? To find out more on the above issues, please read through the information on pages 33 and 34 of your exercise booklets.

44. Support Following First Aid Situations Regardless of the severity and the outcome of a first aid situation, the action of providing another person or a group of people with first aid, can have an emotional impact on you. Not everyone will be affected the same after an incident. Some will be traumatised emotionally (traumatic stress) straight away, whilst others may not feel the entire emotional affects until days or even weeks later. This is why it is integral that anyone involved in assisting during a first aid situation is provided the opportunity to debrief and then follow up their account with counselling. First aiders all need to be given the opportunity to deal with their trauma after the situation in their own way, however, it is important that a supportive safety net has been created around them to ensure their own health and well-being, particularly after a traumatic experience. Please read through page 36 of your exercise booklet.

45. END OF UNIT So, what’s your perspective on moral obligations to providing first aid now????