First aid

Radoslav Morochovič

Department of Trauma Surgery, School of MedicinePJ Safarik University, Košice

Percentage of the populationtrained in First Aid

IFRC: First aid for a safer future Focus on Europe, Advocacy report, sept 2009

Percentage ofEuropean countrieswith compulsoryfirst aid training

IFRC: First aid for a safer future Focus on Europe, Advocacy report, sept 2009

Injury location (UK)

IFRC: First aid for a safer future Focus on Europe, Advocacy report, sept 2009

• Emergency services’ response time in 90 per cent of cases rescuers arrive on the scene is in less than 13 minutes and 51 sec. (urban area)

• Response time is longer in rural/

mountain areas (several tens of minutes

up to hours)

First aid

It is a set of simple actions that lead to

1. saving lives

2. prevent complications

3. speed up the recovery

Aims of the rescuer

A Evaluate the situation withoutrisking lives

B Detect signs of injury or disease

C Provide first aid in an emergency

D Get specialists help and transmitvictim to EMS

Chain of survivalSpecificity of first aid

1.provide emergency assistance in life-threateningconditions at the place of accident, A) respiratoryand circulatory arrest B) major external bleeding,

C) unconsciousness D) shock

2.calling specialized assistance (Emergency MedicalService)

3. provide first aid for other injuries and conditions atthe place of accident

4. providing assistance during transport to hospital

Primary and secondarysurvey

No danger for rescuer

Examination

1. Primary survey

2. Secondary survey

Primary surveyThe primary survey is a process (“treat-as-you-go” ) carried out

to detect and treat life-threatening conditions. If the

person is conscious, that answers questions or responds to

shake and breathe alone, we can proceed to the re-

examination

Secondary surveyThe aim of a secondary survey is to detect medical and

injury-related problems that do not pose

an immediate threat to survival but that, if left

untreated, may do so.

It consists of interview and physical exam.

Life-threatening conditions

A) respiratory and circulatory arrest

B) major external bleeding

C) unconsciousness

D) shock

Major external bleeding

Haemorrhage is responsible for 30–40% of traumamortality and of these deaths, 33–56% occur during

the prehospital period.

• Aim: Find the source of and stop the bleeding

• Clinical signs 1. blood is spurting out of wound or oozes slowly or intermittently, 2. signs of shock

• Bleeding – Compressible and non-compressible

Compressible : direct, manual pressure on the

bleeding (180 mmHg), dressing (33 mmHg), elastic

adhesive dressing (88 mmHg) or tourniquet

• Technique : a) immediate manual

compression on the wound and than

application of gauze and a few turns of

compression bandage, b) immobilize above

the heart level, c) antishock measures , d)

re-check consciousness, respiration, e) call

the assistance

Non compressible bleeding

Fractures (femoral, pelvic), immobilisation –

reduction of blood loss by reducing the virtual

soft tissue space around the actual fracture, the

prevention of clot dislodgement, compression of

opposing bleeding bony surfaces and tamponade

of low pressure (venous) bleeding by volume

reduction of the pelvic cavity

Shock

• Cause: Any accident eventually may lead victim to shock

• Signs: 1. restlessness or weakness to sleepiness 2. blurry

vision 3. thirst 4. nausea, 5. Pale, cold, and clammy skin, 6.

Fast, shallow breathing

Technique : a) the body is laid flat on the back b) treat the

injuries, c) prevent from hypothermia covering the patient d)

place with head down and feet elevated (30 cm),

(Trendelenburg position autotransfusion = antishock position),

e) re-check consciousness, respiration, f) call the assistance

• Comments: Do not give fluids. Do not use antishock

position in head and chest injuries, in unconscious patients, in

heart and lung conditions

Electrical Injuries

• Current Resistance

• Voltage Type of circuit

( high/low-voltage ) (direct/ alternating current)

• 1-4 mA Tingling sensation/perception , 4-9 mA Let-go

current, 16 – 20 mA Skeletal muscle tetany, 20 -50 mA

Respiratory muscle paralysis, 50 – 120 mA Ventricular

fibrillation

Electrical injuries

• Signs: 1. small electrical burns, source contact point and the

ground contact point. 2. unconsciousness 3. heart arrest

The presence of surface burns does not accurately predict the

extent of possible internal injuries

Electrical Injuries

Rescuer safety:

• 1. Outside the building: the source voltage should be turned

off before rescuer enter the scene. Prevent to enter

dangerous zone for bystanders. High voltage (1000 V)

electrical arc may extend over several (18 metres )

• 2. Inside the building: switch off the circuit main breaker,

unplug undamaged electric cord

Electrical injuries

• Procedure: a) check the

consciousness, breathing, circulation,

CPR, b) management of burns c)

antishock measurements d) cervical

spine immobilisation

Blast injury

• Causes: explosion, fire of flammables

• Signs: 1. chocking, 2. pain and

bleeding from the ear drum,

deafness, 3.coughing up frothy

sputum 4. Cutting and lacerated

wounds, fractures , 5. abdominal pain

Blast injury

• Procedure: a) check the consciousness,

breathing, circulation, CPR, b) management

of burns c) antishock measurements d)

cervical spine immobilisation

• Comment: The first aid follows the

prevailing symptoms.

Poisoning from insecticides

Organophosphate (insecticides, herbicides )

Absorption: cutaneously, ingested, inhaled,

or injected

Signs:

1. headache, blurry vision, 2. cough,

3. nausea and vomiting, abdominal pain,

diarrhea

Poisoning from insecticides

• Procedure: a) Wash skin with soap and lukewarm

water, rinse eyes with clean water , b) after

drinking induce vomiting with finger irritation, or

drinking a glass of warm water with 2 teaspoons

salt , c) arrange transportation to the hospital

with the original packaging of chemicals

Comment: Rescuer safety: Prevention from

contact with chemicals is the most important.

Protection against infection

Procedeure:

a) wash your hands - as far as possible, wash your hands before

providing first aid (if it is possible) and ALWAYS wash your

hands after giving first aid. Rinse the eyes and mouth with

plenty of water after blood exposition

b) Protect your wounds and abrasions on the hands in first aid

use gloves, plastic bags

Protection against infection

c) Avoid unnecessary contact with blood. If

victim is bleeding, ask him to press the

wound himself, or cover it with gloves,

plastic bags or several layers of bandages.

d) Remove all bloody bandages. Put it in a

plastic bag and close it.

LITARATURE

1. Viliam Dobiáš, 2009, STRUČNÉ ZÁSADY POSKYTOVANIA PRVEJ POMOCI (Slovak language)

2. Geeraedts L.M.G. Jr. et al: Exsanguination in trauma: A reviewof diagnostics and treatment options, Injury, Int. J. CareInjured 40 (2009) 11–20