The 'Health and Safety (First Aid) Regulations 1981', define first aid as follows:-
Firstly, 'in cases where a person will need help from a medical practitioner or nurse,
first aid is defined as 'treatment for the purpose of saving life and minimising the consequences
of injury and illness until such help is obtained'.
Secondly, first aid can also be defined as the 'treatment of minor injuries which would
otherwise receive no treatment or which do not need treatment by a medical practitioner or nurse'.
All employers have a duty under the 'Health and Safety (First Aid) Regulations 1981' to
provide suitable first aid provision for the type of work in which they are involved.
The regulations state that:
'An employer shall provide, or ensure that there are provided
such facilities as are adequate and appropriate in the
circumstances for enabling first-aid to be rendered to his
employees if they are injured or become ill at work'.
The important stages that you must follow to be of help in an
accident are as follows:-
APPROACH:
When you approach the scene of an accident find out what has
happened and protect yourself and others from any danger.
Use onlookers to help make the scene safe.
EXAMINE:
Examine the casualty and assess what kind of first aid, if
any, is required.
TREAT:
When the you have assessed the situation and diagnosed the
extent and type of injuries the casualty has sustained, you
can then begin to treat the casualty.
SEEK MEDICAL HELP:
Send for qualified medical help if it is required, and then
report the accident using the standard procedure operating
in your place of work.
Dealing with Unconsciousness
The main causes of unconsciousness are: fainting, internal injuries,
shock, heart attack, epilepsy, stroke, head injuries, asphyxia,
poisoning and diabetes.
To make a rapid assessment of the level of unconsciousness proceed as follows:
Find out if the casualty is alert and able to respond in the
normal way by talking to them and asking questions.
If the casualty does not respond to normal questions, try to
communicate using a raised voice, and by gently shaking them on the shoulders.
If you get no responses from vocal stimuli, you can check the
casualty's response to pain by pinching the skin on the back of their hand.
If the casualty does not even respond to painful stimuli, then
you may assume that they are completely unresponsive.
The assessment of consciousness should be repeated about every ten
minutes and noted down.
When examining and treating the unconscious casualty, your aims are to:
Maintain an open airway.
Assess the level of responsiveness and note down your findings.
If unconscious, place in the recovery position and treat any injuries.
Arrange for the removal of the casualty to hospital if required.
On discovering an unconscious casualty, proceed as follows:-
Shout for help, and then check that the airway is clear.
Check to see if the casualty is breathing and again call for help.
If breathing is absent you may need to perform mouth-to-mouth breathing.
If the pulse is absent you may also have to perform external chest compression.
Keep checking the casualty's level of response, and examine them to identify any
signs of external bleeding or fractures.
If casualty is breathing, place them in the recovery position, and send for medical
assistance if the casualty has not regained consciousness within three minutes.
If the casualty recovers within the 3 minutes, and remains well for a further 10 minutes,
advise him or her to see a doctor.
Seek information about the incident (e.g. from bystanders & warning bracelets).
Never give an unconscious person food or drink.
Do not move the casualty unnecessarily.
Dealing with Respiratory Problems
Asphyxia is the term given for a condition in which the blood and tissues of the body
contain very little oxygen and begin to rapidly deteriorate.
The main causes of asphyxia can be divided into the following 4 categories.
Those conditions which affect the airways and lungs.
Things that affect the brain or nerves that control respiration.
Things which affect the amount of oxygen that is available for inspiration.
Substances that prevent the body from utilising oxygen.
To detect asphyxia in a casualty, you should look for the following symptoms.
The casualty's breathing will at first increase in rate, depth and difficulty, and will
then become noisy until it finally ceases altogether.
There will be a blueness of the casualty's skin.
Finally, the casualty will lose consciousness.
Once you have detected that the casualty is suffering from asphyxia, you should treat
them as follows:-
Remove them from the cause.
Open the airway, so that they can get adequate air.
If the casualty is not breathing, start artificial ventilation.
As soon as breathing is restored, place the casualty in the recovery position.
Circulatory Problems
The most common place of detection for a pulse in the conscious casualty is on the wrist
(radial pulse), but in the unconscious casualty, the neck pulse (carotid pulse) is used.
To find the radial pulse, proceed as follows:
Place three fingers in the hollow of the wrist, just below the base of the thumb.
Support the back of the wrist with your own thumb, and record the rate in beats per
minute, the strength, and the rhythm of the pulse.
To find the carotid pulse, proceed as follows:
Tilt the casualty's head back, and feel for the Adam's apple with two fingers.
Slide your fingers into the gap between the Adam's apple and the muscle running down
the side of the neck.
If you feel around this area for about ten seconds, but can find no sign of a pulse, you
may assume that it is absent.
The purpose of cardio-pulmonary resuscitation (or CPR) is to provide oxygen and
circulation, to keep the brain alive in a person who has stopped breathing, and whose heart
has ceased to function automatically.
CPR should be given at a ratio of 2 inflations followed by 15 chest compressions at a
rate of 100 chest compressions per minute.
To perform CPR, proceed as follows:
After the first two inflations, find the correct position on the chest to exert pressure.
Place the heel of your top hand on top of your other hand and lock your fingers.
Lock your elbows straight and lean over the casualty, pressing down about 1.5-2 inches (4-5cm).
Release the pressure from the casualty's chest without actually removing your hands
and repeat the compression 15 times.
Dealing with Wounds and Bleeding
The types of wound that people receive are split into the following six categories.
GRAZES: Caused by skin damage due to friction burns or sliding falls.
CONTUSIONS: Caused by blows to the body, leading to ruptured capillaries and bruising.
INCISED WOUNDS: Characterised by a clean cut of the skin, and in some cases tendons,
usually made by a sharp instrument like a knife or a piece of broken glass.
LACERATIONS: Lacerations are basically tear wounds in the skin.
PUNCTURE WOUNDS: Penetrating wounds, caused by sharp pointed instruments, such as nails.
GUNSHOT OR PROJECTILE WOUNDS: Characterised by a bullet or some other projectile driving
its way through the body, causing severe internal and external injuries.
Bleeding is categorised according to the type of blood vessel that is damaged, i.e.
ARTERIAL BLEEDING: Blood is rich in oxygen and bright
red, spurting out in time with the heart beat.
VENOUS BLEEDING: Blood is depleted of oxygen and dark
red in colour, and because it has lost most of its pressure, gushes or runs out.
CAPILLARY BLEEDING: Blood oozes out from the wound.
Bleeding can also be further categorised into whether it is internal or external.
EXTERNAL BLEEDING: Caused by most types of wound.
INTERNAL BLEEDING: Usually results from bad falls or crush accidents, causing blood to
collect in the body cavities or muscles.
To treat a bleeding external wound, the following steps should be taken.
Help the casualty into a chair, or if the bleeding is severe, lower onto the ground.
Raise the affected limb above the level of the casualty's heart.
Apply direct pressure onto the wound, or draw the sides of the wound together.
Apply a sterile dressing firmly over the wound, however if the wound has something
protruding from it, the pressure should be applied from around the object.
Maintain the elevation of the limb, and treat the casualty for shock.
If bleeding restarts, apply a further 2 dressings on top of the original one, and check the
dressing for tightness and seepage, loosening if necessary.
If it is impossible to apply direct pressure at the bleeding point, or the application of
the three bandages fails to maintain control, apply indirect pressure to stem the flow of blood.
The first signs that can be seen on a victim suffering from internal bleeding, are
shock, a rapid but weak pulse, possible pain, pallor, cold clammy skin, thirst and confusion.
Signs of internal bleeding that may become visible at a later stage, are swelling,
bruising, vomiting and bleeding from natural orifices such as the nose and ears.
To treat a casualty with internal injuries, proceed as follows:
Allow the casualty to rest, and treat for shock by raising the legs if possible.
Treat any other injuries that are visible and send for medical help as quickly as possible.
Remember, that it is important to record the pulse and any bleeding from orifices that the
victim has until the ambulance arrives, because undiagnosed internal bleeding is a killer.
Burns, Scalds, and the Effects of Heat and Cold
Burn injuries can be categorised into the following 3 different groups:
SUPERFICIAL BURNS - characterised by swelling, redness and soreness to the affected
area. In general, superficial burns will heal well if first aid is given quickly, so medical
attention is usually not required unless the burn covers a large part of the body.
PARTIAL THICKNESS BURNS - characterised by the skin becoming raw and blistered.
Require medical treatment if the burn covers an area of one percent or more of the body.
FULL THICKNESS BURNS - characterised by the skin looking waxy, pale or charred.
Fluid will tend to leak out of affected blood vessels and through the skin surface,
resulting in a drop in blood volume, and shock to develop in most cases. Full-thickness burns
always require urgent medical attention.
As well as assessing the depth of burn sustained by a casualty, it is also very
important to assess the extent of the area which the burn covers.
This is simply because of the fact that an increase in the burn area will result in a
greater fluid loss and risk of shock.
The assessment of the extent of the area of burn can be simplified by using a formula known
as the rule of nines, which divides the body into areas of about nine percent, to make the
assessment of the medical aid required easier.
E.g, a partial thickness burn covering one percent or more of the body will require a
doctor's treatment, and a burn covering nine percent or more could result in shock and therefore
requires hospital treatment.
To treat small superficial burns and scalds, proceed as follows:
Quickly cool the area by gently pouring a cold liquid over the affected area for at least
10 minutes, or longer until the pain subsides.
Quickly and carefully remove anything constrictive such as rings and watches before the
injured area begins to swell.
Once the area has been cooled, cover it with a clean non-fluffy, preferably sterile loose
dressing and never apply plasters.
Do not however cover burns and scalds if they occur on the victim's face.
Remember also that you should not burst any blisters that rise, or apply any sort of cream,
lotion or ointment to the burn.
To treat more severe burns, proceed as follows:
Send for an ambulance.
Cool the area with cold running water as quickly as possible, because the longer the burning
is allowed to continue, the worse the damage will be.
If the burn is over a large area, cool it by applying large wet coverings, which must be
changed regularly.
While waiting for the emergency services to arrive, look for signs of shock, difficulty
with breathing and fluctuations in pulse rates, as the casualty with severe burns may suffer
from a great deal of fluid loss.
If the casualty is suffering from shock, treat accordingly and report any changes in the
casualty's condition to the ambulance crew when they arrive.
Musculo-Skeletal Injuries
Fractures can be categorised according to the damage they cause to the surrounding tissues,
and by the way in which the bone breaks.
Fractures are categorised as follows:
Open fractures: Any fracture that causes the bone to stick through the skin, or any open
wound that leads down to a fracture.
Closed fractures: Fractures in which the skin is not broken by the bone, but some internal
injury to surrounding tissues still exists.
Open and closed fractures are further categorised as follows:
Simple fractures: Categorised by a clear break or crack in the bone, with minimal
surrounding tissue damage.
Complex fractures: Categorised by multiple bone fragments, with a large amount of
damage to surrounding tissues.
Green-stick fractures: Categorised by a split in the bone (common in young children).
Closed fractures should be treated in the following way:
Treat the casualty for shock if needed.
Try to keep the casualty still while you immobilise the injured limb.
Send for medical aid and keep checking that the circulation round the bandages is normal.
As with all fractures, the casualty should not be allowed to eat or drink, and should
not be moved until the injured limb is supported correctly, unless they are in danger.
Open fractures should be treated in the following way:
Put a sterile pad over the top of the wound and apply direct pressure to stop the
bleeding (do not press down directly onto the bone if it is sticking out).
Place clean padding over and around the dressing (if the bone is sticking out, use
rolled up dressings to give sufficient height above the protruding bone).
Secure the pads with bandages (avoid putting pressure on a protruding bone).
Immobilise the injured limb and send for medical aid.
Treat the casualty for shock if necessary, and keep checking the circulation around
the bandage.