HLTAID004 Provide an emergency first aid
response in an education and caring setting
Learner Guide & Pre-Quiz
www.firstaidpro.com.au 1300 029 132 3/368 Main South Rd, Morphett Vale, SA, 5162.
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Explain in your own words the primary purpose and objective of being a First Aider. Student Must write a paragraph to explain in their own words
1. First Aid and Emergencies
An emergency is defined as a situation where there is an immediate risk to health, life, property or environment and urgent action is needed to try to stop the situation from worsening.
TRUE / FALSE
2. Legal, Workplace and Community Factors
You must try to gain consent from a casualty before proceeding with first aid.
TRUE / FALSE
3. Risk Management
The best way to avoid risks and hazards is to leave the task to another person so you do not get hurt.
TRUE / FALSE
4. Assess the Scene and Casualty
When conducting a visual assessment, you should be checking for risk in the immediate environment and looking for conscious state, breathing, skin colour and appearance of the casualty.
TRUE / FALSE
5. Reassure the Casualty
The best way to reassure a casualty is to discuss how critical the situation is and start phoning family members.
TRUE / FALSE
6. Maintain Hygiene
In order to prevent any infection from blood, and other bodily fluids before attempting first aid, you would follow standards precautions such as washing hands and wearing gloves.
TRUE / FALSE
7. Use Manual Handling Techniques
Where there is an immediate threat of danger you may need to do an emergency move. Emergency moves may be done with one person or two or more people.
TRUE / FALSE
8. Provide First Aid Management
To be a good first aider, you must be physically strong.
TRUE / FALSE
9. DRS ABCD Action Plan
The Action Plan refers to Do not Attempt, Rescue, Send, Airway, Circulation, Danger.
TRUE / FALSE
10. CPR Compression Rate
CPR consists of 30 chest compressions and 2 rescue breaths. If you have given a total of four (4) rescue breaths to a patient, you would have given 60 chest compressions in total?
TRUE / FALSE
PRE-KNOWLEDGE QUIZ – HLTAID004
Version: 1.1 | Date: 20/11/2019
11. Principles of First Aid
The principles of first aid is to preserve life, protect from further harm, prevent condition worsening and promote recovery.
TRUE / FALSE
12. Shock
Shock can be associated with a fall in blood pressure.
TRUE / FALSE
13. Chest Pain
Angina is chest pain having a sensation of heaviness and squeezing whereas heart attack is the blocking of an artery.
TRUE / FALSE
14. Angina
A casualty had chest pain at 4:25 pm, you assist ed them administering their Angina medication at 4:30pm, you should call the ambulance at 4:55pm if there is no relief or change observed.
TRUE / FALSE
15. Skeletal Injuries
The best form of splint/sling for Injuries to the arm or hand is called a swinging splint.
TRUE / FALSE
16. Altered Consciousness
A seizure is the interruption to the electrical activity of the brain, and if the casualty falls, this can cause concussion.
TRUE / FALSE
17. Respiratory Distress/Conditions
A casualty is experiencing an asthma attack. You administer their asthma medication with the 4x4x4 method. Did the casualty receive 26 puffs of the medication in total?
TRUE / FALSE
18. Bleeding, Wounds and Injuries
Haemorrhage is a common term for blood loss.
TRUE / FALSE
19. Burns
When treating chemical burns, a first aider should apply cool running water for 42 minutes to the affected area.
TRUE / FALSE
20. Environmental Impact
The casualty is experiencing a heat stroke. Their temperature has reached 41°C. Normal temperature is 37°C. This is an increase in temperature of 6°C.
TRUE / FALSE
21. Envenomation
Funnel Web Spider bites are venomous and require use of the pressure immobilisation technique.
TRUE / FALSE
22. Poisons
Poisons can enter the body by contact with the skin or being ingested, injected, or inhaled.
TRUE / FALSE
23. Monitor and Respond to Casualty’s Condition
When monitoring vital signs, you should look at the colour of the causality’s eyes.
TRUE / FALSE
24. Finalise First Aid Treatment
You have a legal obligation to maintain confidentiality after an incident.
TRUE / FALSE
25. Evaluate Your Performance
Everybody reacts differently to traumatic situations. Crying, difficulty sleeping, and excessive alcohol consumption can be a sign of post-traumatic stress disorder.
TRUE / FALSE
26. National Peak Bodies in Child Care
The Australian Children’s Education & Care Quality Authority (ACECQA): The purpose is to establish and maintain the national standard for the care and education for all children in Australia.
TRUE / FALSE
27. Education and Care Services Regulations
In education and care services, First Aiders should update their First Aid training and skills every 5 years.
TRUE / FALSE
28. Psychological impact on children after an emergency
Debriefing and evaluation discussions provides an opportunity to discuss your feeling to help minimise the impact of the trauma.
TRUE / FALSE
29. Anatomical differences between adults and children
The anatomical differences between adults and children and the implications for provision of first aid is that a child’s airway is larger, making it easier to administer rescue breaths
TRUE / FALSE
30. Strategies to minimise risk
Completing a risk management plan is a strategy to reduce future risks.
TRUE / FALSE
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Table of Contents
Preface ................................................................................................................................. 5
Introduction: Understanding the law and first aid ............................................................ 6
A.1 What is First Aid?..................................................................................................... 7
A.2 Legislations and regulations .................................................................................... 7
A.3 Work Health and Safety (WHS) ............................................................................... 8
A.4 Anti-discrimination laws ........................................................................................... 9
A.5 First aid provider’s duties ....................................................................................... 11
A.6 Infection control principles and procedures ............................................................ 12
A.7 Requirements for currency of skill and knowledge ................................................. 13
Emergency Numbers ........................................................................................................ 15
The Human Body and Medical Terminology ................................................................... 16
B.1 The systems that make up the human body........................................................... 16
B.2 Common terminology ............................................................................................. 17
B.3 The Recovery Position ........................................................................................... 18
Section 1: Responding to an emergency ........................................................................ 20
1.1 Recognising an emergency .................................................................................... 21
1.1.1 Types of emergencies ......................................................................................... 21
1.1.2 Emergency action plan ........................................................................................ 21
1.1.3 Emergency management flowchart ..................................................................... 22
1.2 Identify, assess and minimise immediate hazards to health and safety of self and others ............................................................................................................................. 25
1.2.1 Managing hazards and risks associated with attending an emergency ................ 25
1.2.1 Risk and hazard management............................................................................. 25
1.3 Assess the casualty and recognise the need for a first aid response ................. 27
1.3.1 Obtaining information .......................................................................................... 27
1.3.2 Secondary examination (visual and verbal survey) .............................................. 28
1.3.3 Establish level of care ......................................................................................... 29
1.4 Assess the situation and seek assistance from emergency response services. 30
1.4.1 Specific management of a person in need at a Road Accident ............................ 30
Section 2: Applying emergency first aid procedures ..................................................... 32
2.1 Performing cardiopulmonary resuscitation (CPR) ................................................ 33
2.1.1 Recognise the difference ..................................................................................... 33
2.1.2 The chain of survival ........................................................................................... 33
2.1.3 Performing Cardiopulmonary Resuscitation (CPR) .............................................. 34
2.2 Provide first aid according to established first aid principles.............................. 37
2.2.1 General first aid triage principles ......................................................................... 37
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2.2.2 Abdominal Injuries ............................................................................................... 38
2.2.3 Allergic Reactions and Anaphylaxis .................................................................... 39
2.2.4 Asthma ................................................................................................................ 40
2.2.5 Bleeding Control and Basic Wound Care ............................................................ 43
2.2.6 Burns .................................................................................................................. 45
2.2.7 Cardiac Conditions .............................................................................................. 49
2.2.8 Crush Injuries ...................................................................................................... 50
2.2.9 Diabetes .............................................................................................................. 51
2.2.10 Drowning ........................................................................................................... 52
2.2.11 Envenomation ................................................................................................... 53
2.2.12 Australian Snake Bite ........................................................................................ 54
2.2.13 Spider Bite ........................................................................................................ 55
2.2.14 Tick Bites and Bee, Wasp and Ant Stings ......................................................... 58
2.2.15 Jellyfish stings ................................................................................................... 59
2.2.16 Blue-ringed octopus and Cone shell .................................................................. 62
2.2.17 Fish stings ......................................................................................................... 62
2.2.18 Environmental Impacts ...................................................................................... 63
2.2.19 Eye and Ear Injuries .......................................................................................... 70
2.2.14 Febrile Convulsions ........................................................................................... 71
2.2.20 Fractures and Dislocations ................................................................................ 72
2.2.21 Head, Neck and Spinal Injuries ......................................................................... 73
2.2.22 Minor Skin Injuries ............................................................................................. 77
2.2.23 Needle Stick Injuries ......................................................................................... 78
2.2.24 Poisoning and Toxic Substances ...................................................................... 79
2.2.25 Seizures ............................................................................................................ 79
2.2.26 Shock ................................................................................................................ 81
2.2.27 Soft tissue injuries ............................................................................................. 82
2.2.28 Stroke ............................................................................................................... 83
2.3 Ensure casualty feels safe, secure and supported ............................................... 85
2.3.1 Reassurance ....................................................................................................... 85
2.3.2 Cultural Awareness ............................................................................................. 85
2.3.3 Children, the elderly, and the disabled ................................................................ 85
2.3.4 Do Not Revive/Resuscitate (DNR) ...................................................................... 86
2.4 Obtaining consent from a casualty, caregiver, medical practitioners and
emergency services ...................................................................................................... 87
2.4.1 Consent for Treatment ........................................................................................ 87
2.4.2 Treatment without Consent ................................................................................. 87
2.5 Making the casualty as comfortable as possible .................................................. 88
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2.5.1 First aid kit........................................................................................................... 88
2.6 Operating first aid equipment according to manufacturer’s instructions ........... 90
2.6.1 Background information on AEDs ....................................................................... 90
2.6.2 Who should use an AED? ................................................................................... 91
2.6.3 Public Access to AEDs ........................................................................................ 91
2.6.4 Using the defibrillator .......................................................................................... 91
2.7 Monitoring the casualty’s condition ....................................................................... 93
2.7.1 Monitor and respond by first aid principles .......................................................... 93
Section 3: Communicate details of the incident ............................................................. 94
3.1 Convey incident details to emergency services .................................................... 95
3.1.1 Conduct an accurate assessment ....................................................................... 95
3.2 Reporting details of an incident to your supervisor ............................................. 96
3.2.1 When to report a workplace incident ................................................................... 96
3.3 Completing relevant workplace documentation .................................................... 97
3.3.1 Reporting details of an incident ........................................................................... 97
3.3.2 Reporting details of incidents involving babies and children to parents and caregivers .................................................................................................................... 98
3.3.3 Reporting serious incidents to the regulatory authority ........................................ 99
3.4 Maintaining confidentiality of records and information ...................................... 101
3.4.1 The Privacy Act 1988 ........................................................................................ 101
3.4.2 Organisational policies and procedures ............................................................. 102
Section 4: Evaluating the incident ................................................................................. 104
4.1 Evaluating the possible psychological impacts when providing first aid ......... 105
4.1.1 Recognising the possible impact on yourself and others following an emergency 105
4.2 Talking with children about their emotions and responses to events ............... 107
4.2.1 Dealing with children’s emotions in an emergency ............................................ 107
4.3 Participating in a debriefing session with your supervisor ................................ 109
4.3.1 Critical Incident Stress Debriefing (CISD) .......................................................... 109
4.3.2 Organisational debriefing process ..................................................................... 110
Acknowledgments .......................................................................................................... 111
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Preface
This learning resource provides you with the information needed to assist you
with completing the assessments for the unit of competency.
This material has been divided into section which align to the training package rules,
including the knowledge and performance criteria which are necessary to complete
the activities and tasks provided to you by your training provider.
It is recommended that you read through this material before you commence your
assessments to familiarise yourself with the information and knowledge you need to have to
complete the various activities and tasks you are given.
Included in this learner guide is a series of review questions to complete. The questions are
designed to reinforce your understanding of the unit of competency and identify areas you
may need to re-read.
Note: This guide contains the required information to complete the following units of competency:
• HLTAID001 Provide cardiopulmonary resuscitation • HLTAID002 Provide basic emergency life support • HLTAID003 Provide first aid • HLTAID004 Provide an emergency first aid response in an education and
caring setting
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Introduction: Understanding the law and first aid
The ability to provide first aid in an emergency is an invaluable skill, one that can save lives
and prevent permanent disability. Basic first aid doesn’t mean you need a medical
background or that you should study for hours to understand the human body. Sometimes
it’s enough to assess a scene and relay the information to responders while you keep a
casualty company until those responders arrive, or it could be your skill at performing CPR
to keep a person from suffering brain damage through lack of circulating oxygen. Your skills
as a first aider will assist responders manage a scene more effectively if they are free to
attend to more severe cases.
This guide details the most common events that will require first aid – how to recognise
conditions and how to treat the symptoms. As with any skill, first aid becomes second nature
only if you practice rescue techniques, such as the ability to identify the cause of
envenomation or giving CPR.
After you have completed this guide, you will be able to manage most emergencies calmly,
and instil confidence in bystanders so that they also remain calm and able to help you
manage the scene. You will be able to identify common cases of environmental, health, and
trauma-related incidents with minimal equipment.
In the workplace, your skills will help those who sustain industrial injuries and you can assist
with implementing a risk management plan. Proper and timely first aid care can prevent
many workplace fatalities or permanent disabilities; first aid promotes faster recovery and
saves lives.
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A.1 What is First Aid?
Quick intervention in an emergency can save a life or prevent permanent disability. The
action could be as simple as placing the casualty in the recovery position, or giving CPR
until medical help arrives.
First aid is simple medical treatment given as soon as
possible to a person who is injured or who suddenly
becomes ill.
Collinsdictionary.com
A.2 Legislations and regulations
There are two organisations within Australia who provide the guidelines and Codes of
Practice which the first aid practioner should understand and apply. The two organisations
are listed below and will be referred to throughout this guide.
As part of your duty of care as a qualified first aid provider you will need to have a good
understanding of the guidelines and safety. Take some time to read through the guidelines
and Code of Practice to ensure you fully understand your responsibilities when providing first
aid to others.
The Australian Resuscitation Council: They represent all major groups involved in the
teaching and practice of resuscitation; the Royal Australasian College of Surgeons and
the Australian and New Zealand College of Anaesthetists sponsor them. Their guidelines
develop uniformity in techniques and terminology which are applied to first aid in Australia.
ARC Guidelines PDF document provided by Safe Work Australia to manage first aid in the
workplace.
Click here for more
Safe Work Australia: They are an Australian Government statutory agency established in
2009. The Safe Work Australia Act 2008, established Safe Work Australia with the primary
responsibility to lead the development of policy to improve work health and safety and
workers’ compensation arrangements across Australia. The Model Code of Practice for
First Aid in the Workplace is part of that mandate.
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Model Code of Practice for First Aid in the Workplace PDF guide on how to manage first aid in the workplace.
Click here for more
As well as the two legislations outlined above, you also need to have knowledge of the peak
clinical bodies which impact first aid services and the laws related to administering first aid to
infants and children:
National Peak Clinical Bodies: There are several peak clinical bodies which provide
information on the guidelines required when administering first aid.
The following resource provides you with information on two key peak clinical bodies
who assist with the development of first aid in Australia:
List of Peak Bodies National Stroke Foundation (NFS) & National Heart Foundation (NHF)
Click here for more
The Australian Children’s Education & Care Quality Authority (ASECQA): The purpose
of this law is to establish and maintain a national standard for the care and education for all
children in Australia. If you must provide first aid to a child or infant, or work with children as
part of your job, you will need to have a sound understanding of these laws and regulations.
Guide to the Education and Care Services National Law Information on the Education and Care Services National Acts
Click here for more
A.3 Work Health and Safety (WHS)
In the workplace, all workers must follow the legislative and regulatory requirements for
health and safety. It is part of every worker’s duty of care to ensure the safety and wellbeing
of themselves and others.
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You will need to check with your workplace to identify the WHS responsibilities you
have regarding your general workplace activities and as a trained first aider.
The Model Code of Practice for First Aid in the Workplace, point 1.2 specifies the duties of a
person who conducts a business or undertaking (PCBU) and the duties their employees
have towards their own health and safety as:
A person conducting a business or undertaking has the primary duty under the
WHS Act to ensure, so far as is reasonably practicable, that workers and other
persons are not exposed to health and safety risks arising from the business
or undertaking.
The WHS Regulations place specific obligations on a person conducting
a business or undertaking in relation to first aid, including requirements to:
• provide first aid equipment and ensure each worker at the workplace
has access to the equipment • ensure access to facilities for the administration of first aid • ensure that an adequate number of workers are trained to administer
first aid at the workplace or that workers have access to an adequate
number of other people who have been trained to administer first aid.
A person conducting a business or undertaking may not need to provide first
aid equipment or facilities if these are already provided by another duty holder
at the workplace and they are adequate and easily accessible at the times that
the workers carry out work.
Officers, such as company directors, have a duty to exercise due diligence to
ensure that the business or undertaking complies with the WHS Act and
Regulations. This includes taking reasonable steps to ensure that the business
or undertaking has and uses appropriate resources and processes to eliminate
or minimise risks to health and safety.
Workers have a duty to take reasonable care for their own health and safety
and must not adversely affect the health and safety of other persons. Workers
must comply with any reasonable instruction and cooperate with any
reasonable policy or procedure relating to health and safety at the workplace,
such as procedures for first aid and for reporting injuries and illnesses.
Source: Safe Work Australia
A.4 Anti-discrimination laws
Anti-discrimination laws have been introduced in Australia to ensure that all persons
regardless of age, sex, race, gender or disability are treated equally and equitably. The
Acts are designed to protected everyone for unfair discrimination, and this includes the
provision of first aid treatment. It is unlawful to refuse treatment to a person on the grounds
which are stipulated in the anti-discrimination legislations.
You will need to research your state or territory for specific legislations related to
discrimination. The following table outlines some of the key anti-discrimination legislations
which apply in Australia:
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Legislation and grounds of Areas covered
discrimination
Age Discrimination Act 2004 Discrimination by age – protects both younger and older Australians.
Also, includes discrimination by age-specific characteristics.
This includes discrimination related to employment, education, and the provision of
goods, services and facilities.
Disability Discrimination Act 1992 Discrimination based on any physical, intellectual, psychiatric, sensory, neurological or learning disability,
The Act also covers discrimination involving harassment related to employment and education.
Racial Discrimination Act 1975 Discrimination based on race, colour, descent or national or ethnic origin and in some
circumstances, immigrant status.
Racial hatred, defined as a public act/s likely to offend, insult, humiliate or intimidate based on
race, is also prohibited under this Act unless an
exemption applies.
Discrimination in all areas of public life including employment, provision of goods and services,
right to join trade unions, access to places and
facilities, land, housing and other
accommodation, and advertisements.
Sex Discrimination Act 1984 Discrimination based on sex, marital or relationship status, pregnancy or potential pregnancy, breastfeeding, family responsibilities, sexual orientation, gender identity, and intersex status.
Sexual harassment is also prohibited under this Act.
Discrimination in employment, including discrimination against commission agents and contract workers, partnerships, qualifying bodies, registered organisations, employment agencies, education, provision of goods, services and facilities, accommodation, disposal of land, clubs, administration of Commonwealth laws and programs, and superannuation.
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A.5 First aid provider’s duties
As a first aider, you will require a clear understanding of what your specific duties are
and under what circumstances you are obliged to provide first aid.
General duties
The current legislation does not stipulate that a trained first aid provider (or any other
person) is legally obligated to provide first aid care under all circumstances; the Good
Samaritan and Volunteer laws in each state protect bystanders and trained first aiders
against litigation under the “duty of care” definition.
Australian Red Cross Defining first aider duty of care
Click here for more
When we look at the duty of care concerning first aid, means that the person should provide
first aid care appropriate to their training and that they should take reasonable care when
they assist.
The four general considerations concerning the provision of first aid are:
• Obtain consent • Provide a duty of care • Don’t be negligent – act in good faith to the best of your abilities • Record your actions and outcomes
Duties in the workplace
The Model Code of Practice (Topic A.2: Legislations and regulations), detail the risk
management steps that you should follow when you assess the first aid requirements in
your workplace. It also describes the common workplace hazards that may cause injuries
that require first aid.
In summary, the risk management for first aid is as follows:
1. identifying hazards which have the possibility to result in workplace injury or illness
and the assessment of the type, severity and likelihood of injuries and illness
2. providing the appropriate first aid equipment, facilities and training
3. reviewing your first aid requirements on a regular basis or as circumstances change.
Some of the more common workplace hazards which may require assessment and
the provision of first aid treatment are listed in the table below.
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The Model Code of Practice (Table 1, page 6) - common workplace hazards states:
Hazard
Potential harm
Manual tasks Overexertion can cause muscular strain.
Working at Slips, trips and falls can cause fractures, bruises, lacerations, dislocations,
height concussion.
Electricity Potential ignition source could cause injuries from the fire.
Exposure to live electrical wires can cause shock, burns and cardiac arrest.
Machinery Being hit by moving vehicles, or being caught by moving parts of machinery and can cause fractures, amputation, bruises, lacerations, dislocations. equipment
Hazardous Toxic or corrosive chemicals may be inhaled, contact skin or eyes causing
chemicals poisoning, chemical burns, irritation.
Flammable chemicals could result in injuries from fire or explosion.
Extreme Hot surfaces and materials can cause burns. Exposure to heat can cause
temperatures heat stress and fatigue. Exposure to extreme cold can cause hypothermia
and frostbite.
Radiation Welding arc flashes, ionising radiation and lasers can cause burns
Violence Behaviours including intimidation and physical assault can cause nausea,
shock and physical injuries
Biological Infection, allergic reactions
Animals Bites, stings, kicks, scratches
A.6 Infection control principles and procedures
Following your duty of care responsibilities providing first aid, treatment includes the need to
ensure that you minimise the risk of transmission of any disease to yourself, bystanders, and
the casualty.
To achieve this, you need to implement the standard precautions and procedure, ensuring
that a basic level of infection control is established and maintained.
Regardless of the casualty's infection status, you need to make sure that these practices
are followed.
The ways in which disease can be transmitted include:
• droplet transmissions – this can be from coughing or sneezing
• direct transmission - contact with body fluids – such as blood, saliva and other body
fluids
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• airborne transmission – via ventilation systems and air conditioners • contaminated objects – including needle stick injuries
Standard principles:
When providing first aid, you must always assume that you could be exposed to infection,
so it is essential that you wash your hands with soap and water or apply an alcohol-based
hand solution before proceeding with your treatment.
Where possible, wear appropriate personal protective equipment (PPE) to eliminate or
reduce the risks associated with fluid/body contact. This could include disposable
gloves, masks and eye protection.
Procedure:
When preparing for first aid treatments:
• wash your hands • always use PPE such as disposable gloves • ensure any cuts or wounds on your hands are covered
When providing first aid treatments:
• replace torn or damaged gloves • use a resuscitation mask if possible • wash any body fluids as soon as possible and seek medical advice
Following first aid treatments:
• dispose of all used items including dressings, gloves and bandages safely and
according to WHS hazardous material guidelines
• wash your hands thoroughly with soap and water
For the use of resuscitation, masks refer to Topic 2.1 Performing
cardiopulmonary resuscitation (CPR)
A.7 Requirements for currency of skill and knowledge
Once you have completed your first aid training and received your certificate, it is important to note that it has an expiry date. In Australia, your first aid certificate is valid for three (3) years, and you will need to undertake a refresher course before its expiration.
In some industries, however, such as the energy sector, there may be a requirement to complete refresher courses every twelve months.
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If you have completed training in a CPR program, you will need to update your skills every twelve months before your certificate expiring.
Only provide first aid which you have been trained in and are confident in carrying out. Know your personal limitations and level of skills and refer an emergency to the appropriate emergency services and an experienced responder if you have any concerns.
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Emergency Numbers
In Australia, there a several numbers which can be accessed and used in an emergency. It
is important that these numbers are only used for emergencies, and all minor incidents or
first aid situations are referred to a medical practitioner or local hospital for further evaluation
and treatment.
Emergency
Access and usage
Number
000 Works on any phone across Australia, including some Voice over Internet Protocol (VoIP) services
112 GSM mobile phones
106 106 connects to the text-based relay service for people who have a hearing or speech impairment, if you are incapacitated, or when you
are in such danger that you cannot speak
1800-088-200 DAN Diving Emergency Service Hotline – within Australia
+61-8-8212 9242 From outside Australia
Visit the Attorney General's web page "Using other emergency numbers” for more details
on the various emergency contact methods.
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The Human Body and Medical Terminology
To effectively administer treatment as a first aider you need to understand the human body
systems and their critical functions. You will require knowledge of the standard medical
terminology which is used when applying and reporting of first aid treatments.
B.1 The systems that make up the human body
Ten (10) systems make up the human body:
Human Body
Overview
System
1 Nerves Central nerve system comprises the brain (it controls all functions
in the body) and spinal nerves (it delivers the messages from the
brain).
2 Cardiovascular This system is made up of the heart, blood vessels and blood
• Arteries: Deliver the blood from the heart to the body
• Veins: Return the blood to the heart
• Venules, capillaries, arterioles: Located close under the skin in the extremities.
3 Respiratory This system comprises the airway (mouth, nose, trachea, larynx,
bronchi, and bronchioles) and lungs (small air sacs called alveoli).
The system provides the blood with oxygen and eliminates carbon dioxide.
4 Musculoskeletal This system is made up of the bones, ligaments, tendons and
muscles. Together they keep the body upright, rigid, and enable motion.
5 Digestive This system comprises the oesophagus, stomach, and intestines.
The liver and kidneys are accessories to the digestive system
because they convert the nutrients necessary for the body to
survive.
6 Endocrine Organs and glands that secrete hormones make up this system.
The hormones stimulate the body’s functions.
7 Urinary The kidneys, bladder and urinary tract, make up the urinary
system. It eliminates waste products and toxins.
8 Reproductive The female reproductive system comprises the ovaries, uterus, and
vagina.
The male reproductive system includes the testes, seminal vesicle, and penis.
The system in both men and women are linked to the endocrine system.
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9 Integumentary Skin, hair, fingernails and toenails make up this system and are
also linked to the endocrine system, which determines the rate of
growth and colour.
10 Lymphatic This system collects and eventually flushes out any toxins through
lymph nodes that are in the armpits, neck, and groin. The fluid drains into the bloodstream.
B.2 Common terminology
Throughout this guide, reference will be made to standard medical and first aid
terminology. It is recommended that you become familiar with their meaning and refer to
this table if you're unsure about any phrases throughout this guide.
Term
Meaning
AED Automated External Defibrillator (used with CPR).
Casualty A person who was killed or injured in a war or accident.
A casualty who has suffered terribly as a result of an event or situation.
NOTE: The terms "Casualty", and "patient" may be used interchangeably throughout this document, but they mean the same thing and should be read within context.
CPR Cardio Pulmonary Resuscitation
30 chest compressions to 2 breaths
DRSABCD Danger
Response
Send for help
Airway
Breathing
CPR
Defibrillation
Hyper- Above, more than, in excess
Hypo- Below, less than, deficient
Medical Sudden illness, such as cardiac arrest or heart attack. emergency
Injury Trauma caused to the body by a violent act, such as a hammer blow to a finger while doing DIY around the house.
Poisonous A toxic substance swallowed, inhaled or transferred through the skin (e.g. poison-dart frog, chemical gas, nettle)
Page 17 of 111
TBSA Total Body Surface Area
Venomous An animal or plant that injects its venom into the body (e.g. teeth, fangs, thorns, barbs).
The following resource provided by the ARC details the medical terminology which may be
used as part of first aid procedures:
The Australian Resuscitation Council First Aid Glossary of Terms
Click here for more
B.3 The Recovery Position
When providing first aid treatment, you may need to place the casualty in the recovery
position. By putting someone into the recovery position, you will clear and open their airway.
This procedure will also ensure that any vomit or fluid won't cause them to choke.
There are specific steps which need to be followed when placing a casualty into the recovery
position.
Standard recovery position
If a person appears to be unconscious, yet still breathing, and present with no other
life-threatening conditions or symptoms, place them in the recovery position.
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To place someone in the recovery position follow these steps:
• put the person on their back, kneel on the floor at their side and • put the arm nearest you at a right angle to their body with their hand upwards,
towards the head • tuck their other hand under the side of their head, so that the back of their hand
is touching their cheek • bend the knee farthest from you to a right angle • carefully roll the person onto their side by pulling on the bent knee • the top arm should be supporting the head, and the bottom arm will stop you rolling
them too far • open their airway by gently tilting their head back and lifting their chin, and check
that nothing is blocking their airway • stay with the person and monitor their condition until help arrives
Epilepsy Society Recovery Position: Step by Step Guide
Click here for more
Recovery position with a suspected spinal injury
If you suspect a spinal injury, do not attempt to move them until you are assisted by
trained emergency service personnel.
If you need to open their airway, place your hands on either side of their head and gently
lift their jaw with your fingertips to open the airway. Take care not to move their neck.
The signs which may indicate a suspected spinal injury include instances where the person:
• has been involved in an incident that's directly affected their spine, such as a fall from
a height or they have been struck directly in the back and are complaining of severe
pain in the neck or back region • cannot move their neck • have feelings of weakness, numbness or paralysis • have lost control of their bladder and bowels
Page 19 of 111
Section 1: Responding to an emergency
The ability to recognise an emergency, calmly attend to casualties and manage the scene
until medical responders arrive, help casualties and bystanders deal with the situation.
Your ability to recognise the signs and symptoms of an immediate medical crisis
instils confidence that you can manage the situation and command action from
bystanders.
The topics that will be covered in this section include:
1.1 Recognising an emergency
1.2 Identifying, assessing and minimising immediate hazards to the health and safety of
self and others
1.3 Assessing the casualty and recognising the need for first aid response
1.4 Assessing the situation and seeking assistance from emergency response services
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1.1 Recognising an emergency
An emergency can arise at any time – at work, out shopping or do chores at home. A
favourable outcome depends on the proper assessment of the situation and giving
the correct treatment.
Not all emergencies are life-threatening, and some injuries may seem superficial but could, in
fact, be life-threatening. The first thing you should NOT do is panic. Your training and
knowledge in first aid will help you determine the best course of action for any situation.
1.1.1 Types of emergencies
A medical emergency is a sudden illness, such as cardiac arrest or heart attack and an
injury are a trauma caused to the body from a violent act, such as a hammer blow to a finger
while doing DIY around the house.
The symptoms and reactions of the casualty will determine the severity of the situation, but
make sure you can determine what unseen injuries the person may have suffered.
As an example, you see a person slip, fall and hit their head. The person may get up
immediately, but they may not be able to recall their name or other relevant information –
this would indicate concussion although there wasn't any blood and they were conscious
always.
1.1.2 Emergency action plan
The recognised acronym to help you remember the steps of an action plan is DRSABCD
and is also referred to as, The Basic Life Support Flow Chart).
The table below explains each part of the acronym and the steps which must be followed:
DRSABCD
Danger
Evaluate the scene and make it safe for yourself and the casualty Keep yourself safe by using the correct PPE (e.g. gloves, mask,
apron) Response
Check for response Obtain consent to administer first aid if responsive
Evaluate signs and symptoms, injuries, and vital signs
Determine need for further assistance
Send for help
If required, call emergency services Describe the scene and give all available information, e.g. cause of
the accident and if there is any leaking fuel Airway
Clear the airway of any obstructions and place casualty in recovery position
Breathing
Check if breathing is normal If regular, put casualty in recovery position
If not normal, apply CPR CPR
30 Chest compressions 2 breaths
Continue until medical help arrives
Defibrillation
Apply defibrillator by following voice instructions
Continue until medical help arrives
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1.1.3 Emergency management flowchart
When identifying and assessing the emergency, there is a process which should be followed
when assessing the casualty. The following is a sample of an emergency management
flowchart which can be used:
1
MANAGE AIRWAY
2
CHECK BREATHING
3.1 APPLY COMPRESSIONS APPLY FULL 3.2 ONLY CPR
4
MANAGE APPLY DEFIBRILLATION
TRAUMA
4.a
MEDICAL 4.b EVENT
ENVIRONMENTAL
4.c EVENT
ENVENOMATION 4.d
POISONING 4.e
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The following table outlines the steps which should be taken when implementing the
emergency management procedures:
Step Actions 1. Management of the airway takes precedence over everything else (Refer to ARC
Guideline 9.1.6 concerning spinal injuries).
• Clear the airway of obstructions, such as vomit and foreign objects
by following the proper procedures.
2. Check for normal breathing. Look-Listen-Feel. • Look to see if the chest rises and if it does so with a regular rhythm.
• Listen for sounds of gurgling or sighing, and short raspy breaths.
• Feel for air against your cheek if breathing is faint.
3.1 Apply chest compressions only.
• Place the heel of your hand on the breastbone at the centre of the person's
chest. Place your other hand on top of your first hand and interlock your
fingers.
• Using your body weight (not just your arms), press straight down on their
chest by one-third of the chest depth.
• Repeat this until help arrives or the person recovers.
• Try to give 100 chest compressions per minute.
(Source: heath direct)
3.2 Apply full CPR
• If you are on your own, then do 30 chest compressions (almost two
compressions per second) followed by two rescue breaths.
• If there is more than one responder available then make sure:
o one person calls triple zero (000) for an ambulance
o one person starts chest compressions immediately.
• Then, one person does the compressions, and the other person does the
rescue breaths, continuing the cycle of 30 compressions followed by two
rescue breaths.
• It is very tiring doing CPR, so if possible swap between doing rescue breaths
and compressions, so you can keep going with effective compressions.
Apply defibrillation
Prompt defibrillation is a critical part of the resuscitation process, in conjunction
with effective CPR. Some safety points to remember including:
• AEDs must only be used for casualties who are unresponsive and not breathing normally.
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• You must continue with CPR until the AED is switched on the pads have been placed on the torso.
• Follow all instructions when positioning the pads, ensuring they are
not touching each other.
• The responder should follow all AED instructions.
• Care should be taken always to ensure that anyone present does not touch the person during the delivery of the shock by the AED.
• The use of standard adult AEDs and pads can be used for children
aged eight years and over.
• For children aged between one and eight years of age, paediatric pads and an AED with a paediatric capability should be used.
• The positioning of the paediatric pad is placed as per an adult. Follow
the diagram included with your AED instructions to locate where the pads should be positioned on the chest.
• If the AED does not have a paediatric mode or paediatric pads, then
the standard adult AED and pads can be used.
• Do not use an AED on children under one year
4. The various topics in this guide detail the management of the following events – please refer to the specific sections in this guide for more information to address points (4a) to (4e).
4.a
Trauma includes – bleeding, burns, head injury, harness suspension incidents,
spinal injury, crush casualty, workplace injuries.
4.b
Medical events include – heart attack, stroke, shock, seizure, asthma,
anaphylaxis, hyperventilation, electrical shock.
4.c
Environment emergencies include – drowning, hypothermia, hyperthermia, cold
injuries, divers and compressed gas.
4.d
Envenomation includes – snake bite, spider bite, insect bites (bees, ticks, wasps,
ants), jellyfish, blue-ringed octopus and cone snails, fish stings.
4.e
Poisoning includes – hazardous chemicals through ingestion, skin punctures,
inhalation of gases.
ACT Ambulance Service Sample Basic Life Support Flow Chart
Click here for more
Page 24 of 111
1.2 Identify, assess and minimise immediate hazards
to health and safety of self and others
Before you move to attend any casualties, it is important to survey the scene. Identifying,
assessing and minimising any immediate hazards takes priority over any treatment.
An unsafe scene will cause additional casualties and pose a health and safety threat your
you as the responder and others who are assisting.
1.2.1 Managing hazards and risks associated with attending an emergency
The ARC guidelines on managing an emergency outline the priorities in an emergency
which include:
• quickly assessing the situation
• ensuring safety for the responder, person in need and bystanders (this may mean moving the person in need)
• sending for help (call an
ambulance)
Where more than one person requires attention, THE CARE OF AN
UNCONSCIOUS PERSON HAS PRIORITY.
1.2.1 Risk and hazard management
Once you have surveyed the scene and identified any hazards, you need to manage the
safety of the emergency scene by implementing a risk management plan.
NOTE:
A Hazard is defined as, anything that is likely to cause an injury or an illness.
A Risk is, the likelihood and consequences of an injury or illness resulting from the
hazard.
The process which you need to follow when implementing the risk management plan
involves:
• Identifying the hazard – anything that will cause injury or illness
• Identifying the risks – check to see if there is more than one risk factor
• Assess the risks – use appropriate safety precautions
• Control the risks – apply appropriate controls to eliminate or minimise the risks
• Review the controls – ensure that the controls are working and confirm it is safe
to proceed.
There are additional steps you can take when assessing an emergency and establishing the
most reliable approach for providing first aid treatment:
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Step 1: Hazards and dangers
When you survey the scene, look for the following hazards and risks (includes
workplace hazards):
Hazards and Risks
Broken glass/sharp edges Other traffic
Power cords/live wires Unstable structures
Sharp objects Damaged vehicles
Fuel Biohazards
Hot water Bombs
Electricity Bullets
Tools Smoke
Chemicals Falling objects (e.g. masonry, rocks)
Fumes/gases Slippery surfaces
Fire Flammable material
Body fluids Aggressive bystander
Climate (e.g. heavy rain, lightning) Drugs (incl. needles/pipes)/alcohol
Step 2: Take charge
If you are the first person on the scene, mobilise any bystanders to help secure the scene. If
somebody else is already in charge, assess their competence (they might have taken on
the role because they were there first but might not necessarily be the best person to
manage the scene).
If another competent person is in charge, very quickly introduce yourself and tell them that
you can render first aid, then follow their directions.
Step 3: Get consent
Introduce yourself and if the person is conscious, ask if you can help them. If it is a child or
infant, get permission from the parent or guardian before you touch the casualty.
If an adult is unconscious, the implication is that they need your help. Refer to the ARC
Guideline 10.5 concerning Legal and Ethical Issues Related to Resuscitation.
Once you have secured the scene and obtained consent to proceed with first aid, assess
the responsiveness of the casualty and decide if you need to call for assistance.
Approach to an Incident The safest way to assess the scene and apply triage
Click here for more
Page 26 of 111
1.3 Assess the casualty and recognise the need for a
first aid response
It is impossible to train for every emergency because each situation is unique. However, the
basic principles discussed in this section will help you decide if the casualty needs first aid,
or to what extent they need medical attention.
Always keep the DRSABCD actions as well as the Emergency Management Flowchart in
mind when you assess a person.
1.3.1 Obtaining information
Successful treatment of a casualty depends on the information you gather about:
• the incident scene • the events that preceded the incident • information about the casualty and treatment.
Ask the casualty and bystanders for as much detail and write down as much information as
you can; don't rely on your memory. You will have to relay the information to medical
personnel, Work Health and Safety (WHS) officer and police so accurate and detailed notes
will help you recall the events surrounding the incident. Although recording information is
vital, the treatment of the casualty is more important.
Important details to remember:
• Don't disturb the scene – police, other safety officers, and medical personnel need the
evidence. If it might be a crime scene, prevent bystanders from contaminating
possible evidence.
• Record information – write down and photograph as much as you can, including: o Location of the casualty at the time of the event o Position of the casualty when you found them
o Any weapons, tools, and obvious causes such as bloody power tools
o Evidence of drugs, alcohol, or medication
o Environmental conditions at the time of the incident, e.g. temperature, weather
o Contact details and accounts of witnesses to the event
• Record state of the casualty (primary examination) – pulse, breathing, consciousness,
skin colour
• Record treatment and the casualty’s response to the treatment
NOTE
Reassure the casualty as you work. Tell them what you are doing
and what sensation(s) they can expect.
Reassure the family and other bystanders through your calmness and command of the situation. Work methodically and deliberately.
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1.3.2 Secondary examination (visual and verbal survey)
Once you have done the primary examination of pulse, breathing, consciousness, and skin
colour and applied the necessary interventions to stabilise the casualty, you can examine
the casualty systematically to establish further interventions.
Using the no-touch technique, gain consent to assess the casualty and explain what you will
be doing. Listen carefully to any information they give you and the responses they provide to
you questioning.
If the casualty is unconscious follow the triage procedure (Topic 2.2.2)
• Look for deformity, swelling, pain, discoloration, tenderness, open wounds, cerebral
spinal fluid from the ears (a clear colourless fluid that may have some blood specks),
jaw fracture
• Systematically check from head to toe – o Head
o Neck
o Shoulders, chest and back
o Abdomen
o Arms
o Legs
The following table can be used to help record the casualty’s state:
General Appearance
Pulse
Breathing –
sounds
effort
rhythm
rate
Skin condition
Consciousness
Pain level
At arrival During treatment After treatment
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1.3.3 Establish level of care
The following guideline which has been adapted from BayCareUrgentCare.org will help you
decide which level of emergency care you need to provide:
When to use Urgent Care or Emergency Room/Call and Ambulance
Urgent Care Emergency Room/Call Ambulance
Allergies Chest pain/discomfort
Colds/flu/fever High fever
Ear pain/infection Shock
Insect bites Severe burns/cuts
Minor asthma Severe headaches
Minor cuts/burns Severe trauma/injuries
Rashes Shortness of breath/difficulty breathing
Sprains/strains/simple fractures Sudden paralysis/slurred speech
Sore throat/cough Unconsciousness
Urinary tract infections Uncontrollable bleeding
Visible fractures
Industrial accident involving chemicals
Severe vaginal bleeding, especially when
pregnant
Electrical shock
Anaphylaxis
Stroke
Inability to dislodge object in throat
Seizures, fitting, or convulsions
Drowning or swimming/scuba accident
Vehicle accidents
Hyper- and hypothermia
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1.4 Assess the situation and seek assistance
from emergency response services
Emergencies can happen anywhere and at any time, with the most common categories
being:
• Domestic – 28% cuts; 21% falls off one metre or less; 18% hitting/being hit
by something
• Work – 30% sprains or strains; 18% muscle conditions; 16% cuts or open wounds
• Road transport deaths accounted for 1,296 in 2016 of which included: o Alcohol-induced deaths – 89% road; 41% suicide; 27% assault o Alcohol-related injuries – 52% serious injuries; 32% hospital admissions due
to violence
For more information, you can go to the following website: https://bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins.aspx
1.4.1 Specific management of a person in need at a Road Accident
As can be seen from the statistics above, road accidents account for most injuries and
deaths. As a first aider, you will probably attend to more road-related incidents than any
others.
It is also important to know when the situation is beyond your training and ability to control
the scene, e.g. you don't have the right equipment, or there is nobody to help you make the
scene safe.
For information on how to determine and manage emergencies, you can access the
ARC guidelines.
If you are the first respondent at a road accident there are some critical steps you
should take to ensure that you maintain the safety of all those at the scene:
• Approach with caution and make the accident scene as safe as possible.
• Do not touch a vehicle, or attempt to rescue a person from within ten metres of a fallen power line unless an appropriate electrical authority has declared the area safe.
• Use hazard lights, road triangles, or torches to warn oncoming traffic of the accident scene. Use bystanders where it is safe to do so.
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• Turn off the ignition of a crashed vehicle and activate the parking brake. If unable
to activate the parking brake, place a chock under a wheel. Be cautious that
airbags that have not deployed may activate following a crash.
• Remove a motorbike helmet from a person if it is necessary to manage the
airway, assist breathing or control bleeding, otherwise leave the helmet on.
• If you can manage an unconscious breathing person within the vehicle, do not
remove them from the vehicle unless there is a threat to life. Clear the airway of
foreign material; maintain head tilt and jaw support and continuously reassess the
airway and breathing.
• If the person in the vehicle is unconscious and not breathing normally despite
opening the airway, remove the person from the vehicle if possible and
commence CPR immediately following the DRSABCD steps.
Surveying an accident scene Applying appropriate emergency process
Click here for more
Page 31 of 111
Section 2: Applying emergency first aid
procedures
This section sets out the procedures to ensure first aiders are legally protected when they
provide any assistance.
The topics that will be covered in this section include:
2.1 Perform cardiopulmonary resuscitation (CPR)
2.2 Provide first aid according to established first aid principles
2.3 Ensure casualty feels safe, secure and supported
2.4 Obtain consent from casualty, caregiver, registered medical practitioners or medical
emergency services where possible
2.5 Making the casualty as comfortable as possible
2.6 Operating first aid equipment according to manufacturer’s instructions
2.7 Monitor the casualty’s condition
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2.1 Performing cardiopulmonary resuscitation (CPR)
You can save the life of a person who had suffered a heart attack or cardiac arrest by
giving full cardiopulmonary resuscitation (CPR) or chest compressions only; both methods
save lives.
The ARC (and other medical authorities) recommend that casualties that need CPR take
priority during an emergency (ARC Guideline 8).
2.1.1 Recognise the difference
The purpose of CPR is to keep the blood moving around the body to deliver oxygen to the
brain (mainly) and the heart to minimise damage. The brain can survive a maximum of four
minutes without oxygen, and heart muscle suffers damage immediately during a heart
attack (i.e. blood clot damages the cells).
There are some fundamental differences between a cardiac arrest and a heart attack:
Cardiac arrest Heart attack
• Doesn’t breathe • Is breathing
• No pulse • Has a pulse – erratic and weak
• Unresponsive • Responsive
If you witness someone going into cardiac arrest, mouth-to-mouth breathing isn't necessary.
The reason for this is that there is enough oxygen stored within their blood to keep them
going for a while.
2.1.2 The chain of survival
The Chain of Survival is a series of critical steps which are completed, providing the casualty
with the best opportunity of survival from a heart attack, cardiac arrest, stroke and foreign
body airway obstruction.
The links in the Chain of Survival include:
Early
Early Early
Early CPR Advanced Access Defibrilation Care
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The four links in the Chain of Survival can be summarised in the following way:
Early Access: this includes early recognition of the cardiac emergency and
immediate notification to emergency services by calling 000. If available request the
defibrillator.
Early CPR: this will require immediate assessment and support of the airways and
commencement CPR by applying the appropriate chest compressions and breaths.
Early Defibrillation: as soon as possible commence using the AED by following the
prompts. If a shock is advised, you must ensure that no one is touching the casualty
so check before proceeding.
Early Advanced Care is the care which can be provided by highly trained
paramedics who can provide the casualty with drugs, advanced airway procedures
and medical protocols.
2.1.3 Performing Cardiopulmonary Resuscitation (CPR)
Having assessed the casualty and establishing they are non-responsive, you must
immediately commence CPR:
Step 1:
The first step is clearing the airway and positioning the casualty on their back to open
the airway:
Adults: Place one hand on the forehead and the other hand on the chin using your
thumb and fingers in a pistol grip. Gently tilt the head back ensuring that the neck
is not moved. The jaw should be held slightly open and tilted away from the chest
Infants: If the infant is less than 12 months old it is important to keep the head in a
neutral position. This is done by providing gentle support to the lower jaw at the
point of the chin. This will assist in keeping the mouth open.
Step 2:
Once you have cleared the airway, apply the Look-Feel-Listen method to see if there
is any movement from the upper abdomen or lower chest and feel for air which is
escaping from the nose and mouth.
Step 3:
Commence CPR continuously until the defibrillator arrives, someone else takes over, or
you are advised by a medical professional to cease.
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The internationally accepted compression to ventilation ratio when performing
CPR is; (30) compressions to (2) breaths at a rate of (100 – 120) compressions
per minute. You should only pause the compressions to give breaths.
DRSABCD procedure:
It is also important when performing CPR, to apply the DRSABCD procedure:
DRSABCD Procedure
Danger Evaluate the scene and make it safe for yourself and the casualty
Keep yourself safe by using the correct PPE (e.g. gloves, mask, apron)
Response Check for response
Obtain consent to administer first aid if responsive
Evaluate signs and symptoms, injuries, and vital signs
Determine need for further assistance
Send for help If required, call emergency services
Describe the scene and give all available information, e.g. cause of the accident and if there is any leaking fuel
Airway Clear the airway of any obstructions and place casualty in recovery position
Breathing Check if breathing is normal
If normal, place casualty in recovery position
If not normal, apply CPR
CPR 30 Chest compressions
2 breaths
Continue until medical help arrives
Defibrillation Apply defibrillator by following voice instructions
Continue until medical help arrives
What if the casualty is pregnant?
CPR can still be performed if the casualty is pregnant. The pregnancy causes the woman’s
uterus to place pressure on the abdominal area if lying flat. Place the casualty on her back
by placing padding under the right buttock. This creates a pelvic tilt to the left side, enabling
effective CPR to be conducted.
Multiple responders
In situations where there is more than one responder is available the following steps should
be taken:
• One responder starts CPR while the other –
Page 35 of 111
o Calls an ambulance – dial 000
o Obtains all available equipment (e.g. AED)
• During multiple responder CPR, it is recommended that you change between
responders every two minutes to prevent fatigue WITHOUT interrupting the rhythm.
When to stop CPR
It is important to continue CPR until:
• the person starts to respond, or breathe normally • continue until you can be replaced or can no longer continue due to exhaustion • a medical officer arrives and takes over CPR procedures • a healthcare professional directs you to cease CPR
Training Aid Australia DRSABCD Process
Click here for more
The use of a resuscitation mask
When performing CPR, there are standard precautions and infection control principles which
must be applied to offer the responder protection against body fluids.
A resuscitation mask is a device that is placed between the responder and the casualty to
avoid contact with saliva, vomit or the transmission of infectious diseases. It is important to
note, however, that transmission from CPR is very low and this should not be a reason to
avoid the process. If the responder does refuse then the use of compression, only CPR
will need to be applied.
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2.2 Provide first aid according to established first aid
principles
Being able to give first aid is an invaluable skill. The initial action of giving first aid saves
a life or prolongs it until qualified medical assistance arrives.
The fundamental principles of first aid are to:
Fundamental First Aid Principles
Preserve life Yourself: keep yourself safe and out of harm’s way
The casualty: Assess and apply first aid
Prevent Further injuries/harm/condition deteriorating
Promote Recovery by giving first aid
2.2.1 General first aid triage principles
When you arrive at a situation that requires first aid, no matter to what extent, it is important
to follow these principles based on first aid triage:
Survey the scene
Take charge
Implement triage
• How many casualties? • What type of trauma/medical conditions? • What hazards can you see – electrical cables,
gases, fuel? • Call for help – dial 000 • Organise assistance from bystanders • Check medical identification bracelets/necklaces
NOTE: If you have triage tape/tags, use it to identify the casualties
to medical responders
MINOR DELAYED IMMEDIATE DECEASED Injured but moving Serious but non- Life threatening Not breathing –
around – assess life threatening Unconscious check airway
wounds and vital Respirations Unresponsive No pulse signs <30/min Blocked airway
Capillary refill Respirations
>2 seconds >30/min
Breathing – give CPR Bleeding – stop bleeding
Conscious – place in recovery position
Page 37 of 111
UNMC Heroes Triage Basics
Click here for more
It is important to apply the principles outlined above when administering first aid treatment
to casualties, but there are also specific procedures for each type of medical situation.
In the following sub-sections of this topic, we will look at the principles and procedures
when applying first aid for each listed scenario.
2.2.2 Abdominal Injuries
The abdominal cavity is located below the ribs and above the pelvis area. There are no
bones to protect the abdomen making any injury, high risk including damage to the
liver, spleen or stomach.
The types of abdominal injuries you may be faced with include:
Blunt trauma – resulting from an accident, fall or an assault
Penetrating injuries – due to a knife injury, other object or impaled
Infection and illness – caused by infections, internal bleeding or illnesses such as
appendicitis.
Symptoms include:
• bleeding wound or another injury, possibly with visible intestines • severe pain and possible muscle spasm across the abdominal wall • nausea or vomiting • bruising of the skin • patient unable to stand and holding the injured area for pain relief • the patient shows other indications of internal bleeding
First Aid Treatment:
• Check the casualty responses and assess them for shock • Call an ambulance on 000 • Assist the patient to lay in a comfortable position and support them with pillows
and blankets for comfort and warmth • Control bleeding by using direct pressure bandages and if any organs are
protruding, DO NOT touch or try to push them back. • If the injury is the result of an embedded object leave it in place and provide padding
around the object to stop any bleeding.
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2.2.3 Allergic Reactions and Anaphylaxis
In most cases, allergic reactions are mild to moderate and are not considered life-
threatening. Common allergies include hay fever, hives or small localised rashes.
In most minor cases of an allergic reaction, the casualty can take an over the
counter antihistamine, eye drops or apply cold compresses on itchy rashes.
In more severe cases a life-threatening reaction known as Anaphylaxis can develop.
Anaphylaxis Anaphylaxis is the most severe form of an allergic reaction and could be life threatening if
not treated. This type of reaction should be treated as a medical emergency, and
immediate treatment is required.
A severe allergic reaction will usually occur within 20 minutes of exposure to the trigger.
Anaphylaxis is characterised by rapidly developing breathing and circulation issues. It
is usually associated with swelling, redness or itching skin, eyes, nose, throat or mouth.
Many substances can cause anaphylaxis but those that are more common include:
• foods (e.g. peanuts, eggs, wheat, seafood) • drugs (e.g. penicillin) • venom from bites (ticks) or sting (e.g. bees, wasps or ants)
Symptoms include:
Anaphylaxis encompasses a variety of symptoms and signs; history and physical findings
will help with diagnosis. The onset of this type of reaction can commence from a minute
to hours following exposure to the substance.
Signs are highly variable and may include one or more of the following:
• difficult/noisy breathing • wheeze or persistent cough • swollen face and tongue • swelling/tightness in throat • difficulty talking and hoarse voice • persistent dizziness/loss of consciousness and collapse • pale and floppy (young children) • abdominal pain and vomiting • hives, welts and body redness
First Aid Treatment:
People who have been diagnosed with an allergy should avoid any trigger agents and
allergens and have an easily accessible action plan and medical alert device. Whenever
possible, look for this information and implement it as soon as you can, provided it doesn't
delay emergency treatment and getting medical assistance.
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Emergency Treatment
The injection of adrenaline (epinephrine) is the first-line drug treatment in life-threatening anaphylaxis and is a safe and effective management of anaphylaxis.
People who have had a prior episode of anaphylaxis often have prescribed medication, which may include adrenaline (epinephrine) which can be self-administered with the use of an EpiPen.
If the casualty’s symptoms and signs suggest anaphylaxis,
manage the casualty as follows:
• Lay the casualty flat; do not allow them to stand or walk. If breathing is
difficult, enable them to sit (if possible). • Prevent further exposure to the triggering agent if possible. • Administer adrenaline (epinephrine) via intramuscular injection, preferably into
the side of the thigh: • Child less than five years – 0.15 mg • Older than five years – 0.3mg • Call an ambulance – dial 000. • Administer the asthma medication for respiratory symptoms. • Administer a second dose of adrenaline (epinephrine) by auto-injector to casualties
with severe anaphylaxis whose symptoms were not relieved by the initial dose.
Give the second dose if there is no response 5 minutes after the initial dose. • If an insect bite or sting caused the allergic reaction or anaphylaxis,
follow Envenomation-Tick Bites and Bee, Wasp and Ant Stings. • If the casualty becomes unresponsive and not breathing normally, give resuscitation
following the DRSABCD steps.
2.2.4 Asthma
Asthma affects the small airways of the lungs. Those diagnosed with asthma are sensitive to
conditions which can narrow the airway, when exposed to certain "triggers", leading to
difficulty in breathing.
Three main factors cause the airways to narrow:
1. The muscle around the airway tightens (bronchoconstriction).
2. The inside lining of the airways becomes swollen (inflammation).
3. The lungs may produce extra mucus (sticky fluid).
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Certain “triggers” worsen asthma symptoms. Every person's asthma is different and not all
people will have the same triggers. Triggers can include:
• Respiratory infection • Irritants (e.g. cigarette, woodfire or bushfire smoke, occasionally perfumed
or cleaning products) • Inhaled allergens (e.g. dust mites, mould spores, animal dander, grass/tree pollen) • Cold air, exercise, laughing/crying • Non-steroidal anti-inflammatory agents (NSAIDs) (e.g. aspirin, ibuprofen) • Sulphite additives (food preservatives) – more common in those with
poorly controlled asthma • *Food allergy – while usually accompanied by other symptoms such as rash or
vomiting, isolated severe asthma may occur as the only presentation and may
result in death • Food colours and flavours • Emotional triggers such as stress
*Most fatal cases of food-induced anaphylaxis occur in those with asthma. In patients with
asthma known to be at risk from anaphylaxis, it is appropriate to administer an adrenaline
auto-injector first, followed by asthma reliever medication. No harm is likely to occur by
doing so in a patient having asthma without anaphylaxis.
Symptoms include:
• A dry, irritating, persistent cough, particularly at night, early morning, with exercise
or activity • Chest tightness • Shortness of breath • Wheeze (high-pitched whistling sound during breathing)
In the event of a severe asthma attack some or all the following symptoms may be
presented:
• Gasping for breath
• Severe tightening of
• the chest
• The inability to speak more than one or two words per breath
• Feeling distressed and anxious
• Little or no improvement after using “reliever” medication
• "Sucking in" of the throat and rib muscles, use of shoulder muscles or bracing with
arms to help to breathe
• Blue discolouration around the lips (can be hard to see if skin colour also changes)
• Pale and sweaty skin
• Symptoms rapidly getting worse or using reliever more than every two hours
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As well as the above symptoms, young children appear restless, unable to settle or become
drowsy. A child may also “sucked in” muscles around the ribs and may have problems eating or
drinking due to shortness of breath. A child also may have severe coughing and vomiting.
An asthma attack can take anything from a few minutes to a few days to develop.
First Aid Treatment:
If the casualty has a personal written asthma action plan, then follow it before any
other intervention.
Asthma First Aid Plan
If a casualty has any signs of a severe asthma attack, call an ambulance straight
away and follow the Asthma First Aid Plan while waiting for the ambulance to arrive.
The most common reliever medication is salbutamol. Try to use the casualty's reliever medication, otherwise, use salbutamol.
If there is no action plan in place, then use the following Asthma First Aid plan.
NOTE: Australia and New Zealand have their action plans with only one variation, but
the basic approach is the same.
It is unlikely that “reliever” medication given to somebody without asthma will harm them.
If oxygen is available and you are trained to use it (or call someone who is trained) and
follow the Use of Oxygen in Emergencies (ANCOR Guideline 10.4).
If you suspect a severe allergic reaction follow Anaphylaxis – First Aid Management and if
they become unresponsive and not breathing normally, follow the DRSABCD steps.
The following is a sample Asthma First Aid Plan which can be followed:
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Asthma First Aid Plan
1 Sit the person comfortably upright.
Be calm and reassuring. Do not leave the person alone.
2 Administer a “reliever” via a spacer
device
Australia 4x4x4 New Zealand 6x6x6
Four separate puffs Six separate puffs Four breaths after each puff Six breaths after each puff
If a spacer is not available, simply use the inhaler. Where available use the casualty's inhaler or borrow on from a
bystander.
3 3 Wait 4 minutes
If little or no improvement, give
another four puffs and breaths
Wait 6 minutes If little or no improvement, give another six puffs and breaths
4 If there is no or little improvement, 4 call an ambulance
Australia New Zealand 000 111
Keep giving four puffs every 4 Keep giving six puffs every 6 minutes until the ambulance minutes until the ambulance
arrives arrives
Adapted from ANZCOR Guideline 9.2.5 –First Aid for Asthma
2.2.5 Bleeding Control and Basic Wound Care
Our bodies need the correct amount of blood circulating the body to maintain our organs
and keep our body functioning normally. There are many causes of bleeding which can be
both external and internal
Severe external bleeding
External bleeding can usually be controlled by applying pressure on or near the wound. This
will assist with stemming the bleeding until help arrives. The main aim is to reduce blood
loss from the casualty.
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The use of direct pressure is usually the fastest, easiest and most effective way to stop
bleeding, but if that doesn’t work, you might have to use other methods to control
severe bleeding.
In some circumstances, indirect pressure may be used. If there is an apparently
embedded object, use indirect pressure.
First Aid Treatment:
• It is important to use standard precautions (e.g. gloves, protective glasses) if readily
available. • Apply sustained direct or indirect pressure on or near the wound as appropriate. • Lie the patient down if bleeding from the lower limb or for any other severe bleeding. • If the above measures don't control severe bleeding, use a haemostatic dressing
or Tourniquet if available, and you are trained in its use. • Call an ambulance by dialling 000 • If the casualty is unresponsive and not breathing normally, follow the
DRSABCD steps.
The need to control the bleeding is paramount. The risks associated with the use of haemostatic
dressings or a tourniquet are less than the risk of uncontrolled severe bleeding, though these
are temporising measures and transfer to hospital remains of high importance.
Severe internal bleeding
Internal bleeding may be difficult to recognise, but should always be suspected where there
are symptoms and signs of shock (ANCOR Guideline 9.2.3). It includes bruising,
haematomas and the internal bleeding associated with fractures. Severe bleeding may occur
from complications of pregnancy.
Symptoms include:
• Pain, tenderness or swelling over or around the affected area. • The appearance of blood from a body opening –
o Bright red and frothy blood coughed up from the lungs o vomited blood which may be bright red or dark brown "coffee grounds." o blood-stained urine o vaginal bleeding or bleeding from the penis o rectal bleeding which may be bright red or black and "tarry."
First Aid Treatment:
• Internal bleeding may be life-threatening and requires urgent treatment in a
hospital so call an ambulance by dialling 000. • Check their response and conduct a verbal survey listening carefully to what they
are saying about their injury • Look for signs of shock, keep them warm and provide reassurance and comfort • Do not give the casualty any food or liquids • If they vomit or become unconscious, place them on their side • Monitor until emergency services arrive
Nose Bleed (Epistaxis)
Nosebleeds are common and can easily be treated.
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First Aid Treatment:
• apply pressure over the soft part of the nostrils, below the bridge of the nose. • the casualty should lean the head forward to avoid blood flowing down the throat. • the casualty should remain still for at least 10 minutes. On a hot day or after
exercise, it might be necessary to maintain pressure for at least 20 minutes. • If bleeding continues for more than 20 minutes seek medical assistance by dialling
000.
Closed bleeding in limbs - If there is severe bruising to a limb and there is no external
bleeding, use a cold pack with pressure if available.
First Aid Treatment:
Apply the following measures until an ambulance arrives:
• Reassure the casualty. • Assist the casualty into a position of comfort. • Monitor the signs of life at frequent intervals. • Administer oxygen if available, and you are trained to do so. • Do Not allow any food or liquids
Basic Wound Care
When attending a wound always wash your hands and use gloves. Follow all standard
infection control precautions and avoid breathing or coughing over the wound. In the event
of serious bleeding from a wound, provide pressure to stop the blood flow and seek medical
assistance.
First Aid Treatment:
For basic wound care, you should:
• Clean the wound with non-fibrous materials or sterile gauze • Do not scrub the wound as you could embed dirt • Apply an antiseptic and cover with a non-stick sterile dressing
2.2.6 Burns
A burn is an injury caused by heat, cold, electricity, chemicals, gases, friction and radiation
(including sunlight). A medical practitioner should assess all infants and children with burns.
A significant burn for this document includes:
• Burns greater than 10% of total body surface area (TBSA). • Burns of special areas – face, hands, feet, genitalia, perineum, and major joints. • Full-Thickness Burns are greater than 5% of TBSA. • Electrical burns. • Chemical burns. • Burns with an associated inhalation injury. • Circumferential burns of the limbs or chest. • Burns in the very young or aged. • Burns in people with pre-existing medical disorders that could complicate
management, prolong recovery, or increase mortality.
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• burns with associated trauma.
Symptoms include:
The general symptoms associated with a burn include:
• Blistering • Red to black marks • Coughing and breathing difficulties if
exposed to inhalation burns • Reduced responsiveness • Reduces circulation • Shock • Weak vital signs • Airway obstruction resulting from swollen
airways
First Aid Treatment:
Before you treat a burn, you need to follow steps to ensure your safety:
• Guarantee the safety of the responders, bystanders and the casualty. • Do not enter a burning or toxic atmosphere without appropriate protection. • Stop the burning process:
o Stop, Drop, Cover and Roll o Smother any flames with a blanket
• Move away from the burn source to a safe environment as soon as possible. • Assess the adequacy of airway and breathing. • Check for other injuries. • If safe, and if trained to do so, give oxygen to all casualties with smoke inhalation
or facial injury, following The Use of Oxygen in Emergencies (ANCOR
Guideline10.4). • Call for an ambulance by dialling 000.
The aims of first aid treatment of burns should be to stop the burning process, cool the burn
and cover the burn. This will provide pain relief and minimise tissue loss.
The treatment which should be given for burns include:
Heat/Thermal/Contact Burns
• These include flames, scalds, blasts (hot gas), inhalation injury and direct heat contact
• IMMEDIATELY cool burns with cool running water for 20 minutes.
• If possible, remove all rings, watches, jewellery or other constricting items from
the affected area without causing further tissue damage.
• Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat.
• Cover the burnt area with a loose and light non-stick dressing, preferably clean, dry, lint-free (non-fluffy) material, e.g. plastic cling film.
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• Cover unburnt areas and keep the rest of the casualty warm to reduce the risk of hypothermia.
• Where feasible, elevate burnt limbs to minimise swelling.
• DO NOT peel off clothing that is stuck to the body or substances that are burning
• DO NOT use ice or ice water to cool the burn as further tissue damage may result
• DO NOT break blisters
• DO NOT apply lotions, ointments, creams or powders other than hydrogel.
Inhalation Burn
Always assume inhalation injury if there are burns to the face, nasal hairs, eyebrows or
eyelashes, or if there is evidence of carbon deposits in the nose or mouth. Coughing of
black particles in sputum (spit), hoarse voice and breathing difficulties may indicate damage
to the airway.
Suspect an inhalation burn when an individual has been trapped in an enclosed space for
some time with hot or toxic gas, steam or fumes produced by fire, chemicals, etc. An
inhalation injury may result from irritant gases such as ammonia, formaldehyde,
chloramines, chlorine, nitrogen dioxide and phosgene. These agents produce a chemical
burn and an inflammatory response.
Do not assume the burn casualty is stable following an inhalation injury merely because they
are breathing, talking and able to get up. Some agents produce delayed pulmonary
inflammation, which may develop up to 24 hours later.
• Move the casualty to fresh air
• Assess and manage the airway.
• Give oxygen if available and trained to do so, following The Use of Oxygen in
Emergencies (ANCOR Guideline 10.4).
• Call for an ambulance by dialling 000.
Electrical Burns
Electrical burns (including lighting strike) might cause other injuries to cardiac and
respiratory systems, cause loss of consciousness, and result in trauma.
The priorities in the management of the electric shock casualty are to:
• Isolate/turn off the power supply without touching the casualty.
• Commence CPR if required following the DRSABCD steps NOTE: Lightning may
cause cardiac arrest so do CPR on the casualty regardless.
• Cool burns if safe to do so, with cool running water for 20 minutes.
• Give oxygen if available and trained to do so, following The Use of Oxygen in
Emergencies (ANCOR Guideline 10.4).
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• Call an ambulance by dialling 000.
Radiation Burns
Radiation burns may be caused by:
• solar ultraviolet radiation (sunburn) • welder’s arc • lasers • industrial microwave equipment • nuclear radiation.
Cover radiation burns with a clean, dry dressing to prevent infection.
Chemical Burns
Government regulations on hazardous substances and WHS require the manufacturer or
importer of a hazardous chemical to prepare a Safety Data Sheet (SDS) for the chemical. A
supplier must provide an SDS to a workplace at the time of first supply or upon request.
These SDS’s provide first aid information specific to each chemical and include information
relevant to eye contact, skin contact, inhalation and ingestion.
The aim of first aid for chemical burns is not to cool the burn but to dilute the chemical.
• Avoid contact with any chemical or contaminated material, using
appropriate personal protection equipment (PPE).
• Remove the casualty to a safe area.
• Remove the chemical and any contaminated clothing and jewellery as soon as
practical.
• Brush powder chemicals from the skin.
• Without spreading the chemical to unaffected areas, IMMEDIATELY run cool running
water directly onto the area for one hour or until the stinging stops.
• Apply a non-adherent dressing even if no burn mark is evident.
• If the chemical enters the eye, open and flush the affected eye(s) thoroughly with
water for as long as tolerated and refer the casualty for urgent medical attention. If
only one eye is affected, then flush with the head positioned so as the affected eye is
down to avoid the spread of the chemical to the unaffected eye. It is more important
to flush the eye than an immediate transfer for medical care.
• Refer to instructions on the container for further specific treatment.
• If available, in hard copy or on the internet, refer to Safety Data Sheets (SDS)
for specific treatment.
• Call the Poisons Information Centre for further advice – dial 13 11 26
• DO NOT attempt to neutralise either acid or alkali burns, because this will increase
heat generation which may cause more damage.
• DO NOT apply cling wrap or hydrogel dressings to chemical burns.
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2.2.7 Cardiac Conditions
A heart attack is when one of the coronary arteries that supply the heart muscle is suddenly
blocked – partially or completely. Because of the interruption of the blood supply, there is an
immediate risk of life-threatening changes to the heart rhythm. If not corrected quickly there
is also a risk of serious, permanent heart muscle damage. To reduce the chance of sudden
death from heart attack, urgent medical care is required – "every minute counts".
A heart attack is different from but may lead to, cardiac arrest. Cardiac arrest is when the
heart ceases its action (it stops beating).
Survival after a heart attack can be improved by first aid treatments and clot-dissolving
medications that clear the blocked artery, restore blood supply to the heart muscle and
limit damage to the heart.
First aid and medication are most effective if provided as soon as possible after the onset of
symptoms; these benefits decline with delays in treatment.
For some casualties, sudden cardiac arrest may occur as the first sign of heart attack
– however most experience some warning signs.
It is important to note:
• a heart attack can occur without chest pain or discomfort as one of the symptoms
• the most common symptom of a heart attack without chest pain is shortness
of breath
• a person who experiences a heart attack may pass off their symptoms as "just
indigestion."
If the warning signs are severe, get worse quickly, or last longer than 10 minutes,
act immediately.
Symptoms include:
The casualty may experience one or a combination of these symptoms:
• pain or discomfort • pale skin • shortness of breath • nausea or vomiting • sweating • feeling dizzy or light-headed
Discomfort or pain in the centre of the chest may start suddenly, or come on slowly over
minutes. It may be described as tightness, heaviness, and fullness or squeezing. The pain may
be severe, moderate or mild. The pain may be limited to or spread to, the neck, throat, jaw,
either or both shoulders, the back, either or both arms and into the wrists and hands.
Atypical chest pain is defined as pain that does not have a heaviness or squeezing
sensation (typical angina symptoms), precipitating factors (e.g., exertion), or usual location.
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First Aid Treatment:
Manage a heart attack/cardiac arrest as follows:
• Encourage the casualty to stop what they are doing and to rest in a
comfortable position.
• If the casualty has been prescribed medication such as a tablet or oral spray to treat
episodes of chest pain or discomfort associated with angina, assist them to take this
as they have been directed.
• Call an ambulance if symptoms are severe, get worse quickly or last longer than 10
minutes.
• Stay with the casualty until the ambulance or on-site resuscitation team arrives.
• Give aspirin (300 mg); dissolvable aspirin is preferred. Only withhold if the casualty
is known to be anaphylactic to aspirin.
• Administer oxygen if there are visible signs of shortness of breath, and you are
trained to do so, following The Use of Oxygen in Emergencies (ANCOR
Guideline 14.2).
• If practical and resources allow, locate the closest AED and bring it to the casualty.
If the casualty is unresponsive and not breathing normally, commence resuscitation
following the DRSABCD steps.
2.2.8 Crush Injuries
Many situations can cause crush injuries, including being trapped in a vehicle, falling
debris, industrial accident or by prolonged pressure to a part of the body due to an
immobile person's body weight.
Crush syndrome refers to the multiple problems that may subsequently develop, most
commonly because of crush injuries to the limbs, particularly the legs. A disruption of the
body’s chemistry causes crush syndrome and can result in kidney failure, heart attack and
other problems.
The likelihood of developing acute crush syndrome is directly related to the compression
time; therefore, the casualty should be released as quickly as possible, irrespective of
how long they had been trapped.
The management of crush casualties include:
• Ensure the scene is safe, and that there is no risk of injury to the responder or
bystanders.
• Call an ambulance – dial 000
• If it is safe and physically possible, remove all crushing forces from the casualty
as soon as possible.
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• A casualty with a crush injury may not complain of pain, and there may be no external
signs of injury. All casualties who have been subjected to crush injury, including their
body weight, should be taken to hospital for immediate investigation.
• Keep the casualty warm and treat any bleeding.
• Continue to monitor the casualty’s condition (topic 1.3.2). If the casualty becomes
unresponsive and is not breathing normally, follow the DRSABCD steps and
Secondary Examination.
DO NOT leave the casualty except if you need to call an ambulance.
DO NOT use a tourniquet for the first aid management of a crush injury.
NOTE: Crushing force to the head, neck, chest or abdomen can cause death from heart
failure or being unable to breathe so you need to remove the cause of the crushing
immediately. Although the casualty may appear to be alert and not distressed, there is a risk
of deterioration, so you need to monitor the casualty's condition until medical help arrives.
2.2.9 Diabetes
A person with diabetes does not produce insulin properly which results in the blood glucose
levels being higher. Treatment for diabetes may be necessary if the sugar levels are too
low or they are producing too much insulin.
Symptoms Include:
• Confusion • Light-headedness • Dizziness • Weakness • Trembling or shaking • Sweating • Headaches • Lack of concentration
If not treated symptoms could elevate to include:
• Slurred speech • Confusion • Loss of consciousness • Fits
First Aid Treatment:
• DRS ABCD & Call 000. • Give the casualty a sugary drink such as soft drink or fruit juice. • If no improvement after 5 minutes, give more. • If they are unconscious, do not put anything in the mouth.
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2.2.10 Drowning
Drowning is when a person is unable to breathe because they are submerged/immersed in
liquid. Drowning outcomes are classified as death, morbidity and no morbidity – the latter
two now referred to as "non-fatal drownings". ("Morbidity" is the undesirable side effect or
rate of illness associated with an event).
The most serious consequence of drowning is an interruption of the oxygen supply to the
brain. Early rescue and resuscitation by trained first responders or first aiders at the scene
offer the casualty the best chance of survival.
First Aid Treatment:
• Remove the casualty from the water as soon as possible but do not endanger your
safety. Throw a rope or something to provide buoyancy to the casualty. Call for
help; plan and effect a safe rescue.
• In minor incidents, the casualty will cough and spontaneously resume breathing after
they are removed from the water.
• In more severe incidents, assess the casualty. If unconscious or not
breathing normally, commence resuscitation following the DRSABCD steps.
• Place the casualty on their back with their head at the same level, rather than in a
head down position. This decreases the likelihood of regurgitation and vomiting
and is associated with increased survival.
• The casualty should generally not be rolled onto their side to assess their airway and
breathing. The advantage of assessing the casualty’s airway without turning them onto
their side (i.e. leaving them on their back or in the position in which you found them) is
that it takes less time to perform, avoids movement and is easier to teach.
• The exceptions to this would be where fluid (blood or water) obstructs the airway or
other foreign matter (sand, debris, vomit). In this instance, roll the casualty onto their
side to clear the airway. Open the mouth and turn it slightly downwards to allow
gravity to drain any foreign material
• A drowned casualty will often vomit and regurgitate. Reassess the casualty if they
are on their side. If they start breathing again, leave them on their side with
appropriate head tilt. If they aren’t breathing normally, roll the casualty onto their
back and start resuscitation.
• Don’t delay or interrupt CPR. Do not empty a distended stomach by applying
external pressure. Do not attempt to expel or drain clear water or frothy fluid that may
re-accumulate in the upper airway during resuscitation.
• Carefully monitor any casualties who appear to have been successfully rescued
and resuscitated to detect a relapse into cardiopulmonary arrest. This can occur in
the minutes or hours following return of spontaneous circulation and breathing, due
to persisting lung damage and hypoxic injury (lack of oxygen) to the heart.
• Call an ambulance (dial 000) for all casualties of an immersion event, even if
seemingly minor or the casualty appears recovered.
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2.2.11 Envenomation
Envenomation is the term used to describe the bites or stings which are given by poisonous
insects (e.g. bees, spiders and ticks) and venomous animals including snakes and jellyfish.
Pressure Immobilisation Technique
The Pressure Immobilisation Technique (PIT) was introduced for the treatment of
Australian snakebites and is suitable for other elapid snakebites. It is also recommended for
envenomation by many other animals. Applying the PIT stems the flow to the lymph system – this is how venoms gain access to the circulation.
It has also been shown that there may be inactivation of certain venoms and venom
components when the injected venom remains trapped in the tissues by the
pressure bandage.
When applying the Pressure Immobilisation Technique (PIT) follow the recommendations
below:
Recommended NOT Recommended
To manage bites and stings by the following For the first aid management of: creatures:
All Australian venomous snakes, Other spider bites including Redback
including sea snakes
Jellyfish stings
Funnel-web spider
Fish stings including stonefish bites
Blue-ringed octopus
Stings by scorpions, centipedes or
Cone shell beetles
Immediate and intense local pain
Local redness and swelling
Management
If resuscitation is needed it takes precedence over the PIT (refer to ARC Guideline 8).
However, the resuscitation team should apply PIT as soon as possible to potentially
minimise further venom flow.
If on a limb, apply a broad pressure bandage over the bite site as soon as possible.
Elasticised bandages (10-15cm wide) are preferred over crepe bandages, if neither are
available, use clothing or other material. The bandage should be firm and tight – you
should be unable to easily slide a finger between the bandage and the skin.
To further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further
pressure bandage, commencing at the fingers or toes of the bitten limb and extending
upward covering as much of the limb as possible. Apply the bandage over existing clothing
if possible. The purpose of this bandage is to further restrict lymphatic flow and assist
immobilisation. (Alternatively, use a single bandage to achieve both pressure on the bite site
and immobilisation of the limb. In this method, apply the bandage initially to the fingers or
toes and extend it up the limb as far as possible including the bite site).
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Splint the limb, including joints, on either side of the bite, to restrict limb movement.
Incorporate the splint material under the layers of the bandage. For the upper limb, use a
sling.
Keep the casualty and the limb completely at rest. Bring transport to the casualty if possible.
Transport the casualty to medical care, preferably by ambulance. If alone, the casualty should
apply the pressure immobilisation bandage as completely as possible over the bite site and
affected limb. They should keep immobile until assistance arrives. If they are unable to obtain
urgent help to come to them, then apply local pressure if possible, immobilisation is
contraindicated, and they should move themselves to seek immediate help.
DO NOT remove the bandages or splints before evaluation in an appropriate
hospital environment.
If the bite is not on the limb, firm direct pressure on the bite site may be useful.
DO NOT restrict breathing or chest movement and do not apply firm pressure to the neck or
head.
Note:
DO NOT cut or excise the bitten area, or attempt to suck venom from the bite site.
DO NOT wash the bitten area.
DO NOT apply an arterial tourniquet. (Arterial tourniquets that cut off circulation to the limb, are potentially dangerous and are not recommended for any bite or sting in Australia.)
The following are some standard treatments for envenomation.
2.2.12 Australian Snake Bite
Many of the snakes found in Australia are capable of lethal bites to humans. These include Taipans, Brown snakes, Tiger Snakes, Death Adders, Black snakes, Copperhead snakes, Rough Scaled snakes and many sea snakes.
Snakes produce venom in modified salivary glands, and the venom is forced out under
pressure through paired fangs in the upper jaw. Snake venoms are complex mixtures of
many toxic substances that can cause a range of effects in human casualties. The life-
threatening early effect in Australian snakebite is neurotoxic muscle paralysis, which kills
by causing breathing failure.
Other significant effects include:
• bleeding due to the blood, not clotting • muscle damage causing kidney failure
Symptoms Include:
The bite may be painless and without visible marks. Other symptoms and signs may include:
• paired fang marks, but often only a single mark or a scratch mark may be present
(localised redness and bruising are uncommon in Australian snake bite) • headache • nausea and vomiting
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• occasionally, initial collapse or confusion followed by partial or complete recovery • abdominal pain • blurred or double vision, or drooping eyelids • difficulty in speaking, swallowing or breathing • swollen tender glands in the groin or axilla (cavity) of the bitten limb • limb weakness or paralysis • respiratory weakness or respiratory arrest
NOTE
You may not see life-threatening effects for several hours. However when massive envenomation occurs, especially in children,
symptoms and signs may appear within minutes.
First Aid Treatment:
The responder should:
• Keep the casualty calm and at rest, reassured and under constant observation
• commence resuscitation if necessary, following the DRSABCD steps
• apply the Pressure Immobilisation Technique
• transport the casualty to a medical facility, preferably by ambulance
• DO NOT cut or incise the bite
• DO NOT use an arterial tourniquet
• DO NOT wash or suck the bite
Snake identification
Identification of venomous snakes can be made from venom
present on clothing or the skin using a Venom Detection Kit. For
this reason, do not wash or suck the bite or discard clothing.
DO NOT kill the snake for purposes of identification, because medical services do not rely on visual identification of the snake species.
Antivenom is available for all venomous Australian snake bites.
2.2.13 Spider Bite
The bites of many different Australian spiders may cause pain, but only bites from some
spiders are an immediate threat to life.
If serious symptoms or signs develop from any spider bite, transport the casualty to hospital.
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Funnel-web spiders
A bite from a large (more than 2cm), dark-coloured spider, especially in the regions of
Sydney, Blue Mountains, the central-, northern-, and southern highlands or south coast of
NSW, or south-eastern Queensland, should be considered as a dangerous bite and
treated immediately.
Symptoms Include:
Symptoms and signs of Funnel Web spider bite may include:
• pain at the bite site, but a little local reaction • tingling around the mouth • profuse sweating • copious secretion of saliva • abdominal pain • muscular twitching • breathing difficulty • confusion leading to unconsciousness
NOTE
Life-threatening effects may occur within 10 minutes.
First Aid Treatment:
The responder should:
• call an ambulance • apply Pressure Immobilisation Technique immediately
If the casualty is unresponsive and not breathing normally, follow DRSABCD steps.
NOTE
Antivenom is available for treatment of Funnel-web spider envenomation.
Red-back spiders
This spider (approximately 1cm body length) has a characteristic red, orange or pale stripe
on its back. A bite may threaten the life of a child, but apart from pain, is rarely serious for
an adult.
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Symptoms include:
Symptoms and signs may include:
• immediate pain at the bite site which becomes hot, red
and swollen • intense local pain which increases and spreads • nausea, vomiting and abdominal pain • profuse sweating, especially at the bite site • swollen tender glands in the groin or armpit of the
envenomated limb
NOTE
Local pain develops rapidly at the bite site and may become
widespread, but the venom acts slowly, so a serious illness is
unlikely in less than 3 hours. Pain can be treated with antivenom in
a hospital where resuscitation facilities are available. A related
species, the Cupboard Spider (resembles the red-back spider
without the stripe) may be treated with the Red-back spider
antivenom.
First Aid Treatment:
The responder should:
• keep the casualty under constant observation • apply an ice or cold compress to lessen the pain (for periods of no longer
than 20mins) • transport the casualty to a medical facility, preferably by ambulance, if the casualty
is a young child, or has collapsed, or pain is severe.
NOTE
The Pressure Immobilisation Technique is not used because the
venom acts slowly and any attempt to retard its movement tends to
increase local pain. Antivenom is available for Red-back spider
envenomation.
White-tailed spiders
Although the bite of the White-tailed spider may cause severe inflammation, it has created,
contrary to popular opinion, very few cases of severe local tissue destruction. Other
causes of necrotic ulcers should be sought especially when a spider has not been seen.
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NOTE
The Pressure Immobilisation Technique is not used because the
venom acts slowly and any attempt to retard its movement tends to
increase local pain. Antivenom is available for Red-back spider
envenomation.
Other Australian spider bites
All other spider bites should be treated symptomatically (Apply ice or cold compress to
lessen the pain.)
2.2.14 Tick Bites and Bee, Wasp and Ant Stings
Single stings from a bee, wasp or ant, while painful, seldom cause serious problems except
for persons who have an allergy to the venom. Multiple insect stings can cause severe pain
and widespread skin reaction. Stings around the face can cause serious envenomation and
difficulty breathing even if the person is not known to be allergic.
It is important to remember that bee stings with the venom sac attached continue to
inject venom into the skin, while a single wasp or ant may sting multiple times.
Ticks can inject a toxin that may cause local skin irritation or a mild allergic
reaction, however, most tick bites cause few or no symptoms.
In susceptible people, tick bite or other bites/stings may cause a severe allergic reaction or
anaphylaxis, which can be life-threatening. This can also occur in casualties with no
previous exposure or apparent susceptibility.
Symptoms include:
Minor Major/Serious
Immediate and intense local pain Allergic reaction/anaphylaxis
Local redness and swelling Abdominal pain and vomiting in the case of allergic reaction to insect venom
First Aid Treatment:
• If the casualty is unresponsive and not breathing normally, commence resuscitation,
follow the DRSABCD steps • If the casualty has signs of anaphylaxis, follow Anaphylaxis Guideline • In the case of a bee sting, remove the sting, by any means, as quickly as possible • In the event of tick bite, if there is no history of tick allergy, immediately remove the
tick • If the casualty has a history of tick allergy, the tick must be killed where it is,
rather than removed • If in a remote location, consult a healthcare professional • Move casualty to a safe place • Apply a cold compress to help reduce pain and swelling
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• Monitor the casualty for signs of allergic reaction (difficulty speaking, breathing
difficulties, collapse and generalised rash) • Refer the casualty to hospital if sting is to the face or tongue
2.2.15 Jellyfish stings
Jellyfish discharge their venom through thousands of microscopic stinging capsules called
nematocysts. These are located on the surface of tentacles and in some species on the
body of a jellyfish. Nematocysts contain coiled threads (tubules) loaded with venom. Upon
contact, the nematocysts “discharge” their tubules into the casualty’s skin like mini-
harpoons. The more tentacles that contact the skin, the more venom is injected.
Stings cause immediate, sharp pain and an acute inflammatory skin reaction at the sting site
consisting of redness, wheat and swelling which may progress to local skin destruction.
Some stings cause rapid collapse.
In Australia, life-threatening stings generally occur in tropical areas, with few in the southern
regions. Because of their smaller body size, children are at greater risk of the effects of
envenomation.
Most stings are not serious, and you should avoid over-treating minor stings. Wearing a full-
body Lycra suit or equivalent provides excellent protection from stings.
Tropical envenomation
Two types of jellyfish in Australian waters cause potentially fatal envenomation.
1. Box Jellyfish
The Australian Box Jellyfish, (Chironex fleckeri), has a large (box-like) bell up to 20 x 30 cm
and multiple tentacles. It inhabits estuarine and on-shore coastal waters. Contact with
tentacles causes severe immediate pain and whip-like marks on the skin. A sting with
several metres of tentacles can cause respiratory and cardiac arrest within a few minutes.
2. Jellyfish causing Irukandji syndrome
There are approximately ten offshore and onshore jellyfish (including Carukia Barnes and
species of the Carybdea, Malo, Alatina, Gerongia and Morbakka genera) are known or
suspected to produce an "Irukandji syndrome". These jellyfish have only four tentacles, and
some are too small to be seen by the casualty.
A minor sting on the skin with no tentacle visible is followed in 5-40 (typically 20-30) minutes
by severe generalised pain (often cramping in nature), nausea and vomiting, difficulty
breathing, sweating, restlessness and a feeling of "impending doom". Casualties may
develop heart failure, pulmonary oedema (accumulation of fluid) and hypertensive stroke.
Symptoms include:
Since it is usually difficult to recognise which species of jellyfish caused a sting,
management is based on the risk of serious stings in the known geographical distribution of
dangerous species.
Tentacles on the skin:
• Long lengths of easily visible large tentacles on the skin in association with
severe pain should be regarded as Box jellyfish tentacles.
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• If there are large numbers of blue jellyfish washed up on the beach or floating on the
surface of the water, tentacles are probably of a Physalia species (“Bluebottle”).
• Tentacles from hundreds of other species of jellyfish in Australian waters are
difficult to identify. Often no tentacles remain.
Skin markings:
A variety of skin markings are associated with the stings of various jellyfish species
and could include the following:
• an inconspicuous mark which may develop a red flare • an inconspicuous mark with goose pimples or an orange-peel appearance • an inconspicuous mark with profuse sweating only at the sting site • an irregularly shaped blotchy wheal • white wheals with a surrounding red flare • multiple whip-like wheals on the skin or a “frosted ladder pattern” suggest a sting by
a box jellyfish • later blistering or darkening of the sting pattern.
Pain:
• skin pain is generally immediate and varies in intensity from mild irritation to
severe sharp or burning pain • generalised muscle aches • severe muscle cramps in the limbs, chest and abdomen
Other symptoms include:
• difficulty breathing, or cease breathing • cardiac arrest • severe pain • restlessness and irrational behaviour • nausea and vomiting, headache • physical collapse • profuse sweating, sometimes only in the sting area
First aid treatment:
• No standard nationwide recommendation for first aid can be made because
of differences between jellyfish species around Australia.
• In most cases, first aid providers would unlikely be able to identify the jellyfish.
• In the tropics, because of the risk (even if small) that a potentially lethal jellyfish
has stung the casualty, the priority must be to preserve life.
• If the species causing the sting cannot clearly be identified as harmless, or due to a
“Bluebottle”, it is safer to treat the casualty with vinegar.
• Outside the tropics, where huge numbers of non-life-threatening stings occur, the
primary objective is pain relief with heat or cold.
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Treatment in Tropical Australia
• Remove the casualty from the water and restrain if necessary.
• If casualty has more than a localised single sting, or if they look/feel unwell, call an
ambulance – dial 000 and seek assistance from a lifesaver/lifeguard if available.
• Assess casualty and commence resuscitation as necessary following the DRSABCD
steps.
• Liberally douse/spray the stung area with vinegar for 30 seconds to
neutralise invisible stinging cells, then pick off remaining tentacles.
• If the casualty has apparently been stung by a "Bluebottle" (see above) and is
assessed as having a localised sting, is stable and not requiring an ambulance, do
not apply vinegar and manage the casualty as per stings in non-tropical Australia.
• If vinegar is unavailable, pick off any tentacles (this is not harmful to the
responder) and rinse the stung area well with seawater.
• Apply a cold pack or ice in a dry plastic bag to relieve pain. Do not allow or apply
fresh water directly onto the sting because it may cause discharge of undischarged
nematocysts.
• Antivenom is available for Chironex fleckeri and other multi-tentacled box jellyfish
stings. In tropical coastal areas, hospitals and ambulances carry antivenom.
• Patients who initially appear stable but experience severe symptoms in the following 30
minutes may be suffering Irukandji syndrome and need urgent medical care.
Treatment in non-tropical Australia
• Keep the casualty calm and resting, reassure and keep under constant observation.
• Do not allow rubbing of the sting area.
• Pick off any tentacles (this is not dangerous to the responder) and rinse sting area
well with seawater to remove invisible nematocysts.
• Place the casualty’s stung area in hot water (no hotter than the responder can
comfortably tolerate) for 20 minutes.
• If the local pain is not relieved by heat, or if hot water is not available, apply a cold
pack or ice in a dry plastic bag.
• If pain persists or is generalised, if the sting area is large (half of a limb or more),
or involves sensitive areas (e.g. the eye) call an ambulance – dial 000 and seek
assistance from a lifesaver/lifeguard if available.
NOTE
For advice concerning any marine envenomation contact Australian Venom Research Unit 1300 760 451
Or Poisons Information Centre 13 11 26
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2.2.16 Blue-ringed octopus and Cone shell
Blue-ringed octopuses (Hapalochlaena spp) inhabit all Australian coastal waters and are
often found in tidal pools. If handled, these small animals may inflict a potentially fatal bite,
injecting venom stored in salivary glands.
Many species of cone shell (Conus spp) are found in tropical waters. They fire a dart-like
barb to deliver venom when handled.
Although different, venoms from both these creatures can cause paralysis and death from
respiratory failure within 30 minutes. Treat casualties by following the DRSABCD steps.
Symptoms include:
• a painless bite: a spot of blood visible • lips and tongue become numb • the progressive weakness of muscles of respiration leading to inadequate or
cessation of breathing.
First aid treatment:
• Call an ambulance – dial 000 • Keep the casualty calm and at rest, reassured and under constant observation. • Use the Pressure Immobilisation Technique • Transport the casualty to a medical facility, preferably by ambulance. • If the casualty is unresponsive and not breathing normally, follow the
DRSABCD steps.
NOTE: Despite being unable to move, the casualty may be able to hear.
2.2.17 Fish stings
Many fish have spines with attached venom glands. When trodden upon, the spines of the
marine Stonefish (Synanceia spp) and the freshwater Bullrout (Notesthes robusta) penetrate
deeply and deposit venom causing excruciating pain.
General cardiovascular toxic effects can occur but are rare. Handling these or similar fish
is also potentially dangerous.
The barbed spines on the tails of stingrays can inflict a severe gash or penetrate stab injury
with subsequent venom-induced tissue death. Organs and blood vessels may be damaged,
and fragments of the spine may remain in the wound requiring surgical removal. Injuries
usually occur when the casualty stands on an unseen fish, pulls a captured fish into a boat
or swims too closely over a fish on the sea floor.
AUSTRALIAN VENOM RESEARCH UNIT
For urgent advice concerning any marine envenomation, call the Australian Venom Research Unit 24 hour advisory line
1300 760 451
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Symptoms include:
• intense pain, leading to irrational behaviour • swelling • sometimes a local grey/blue discolouration • an open wound • bleeding
First aid treatment:
• Call an ambulance – dial 000.
• If the sting is in the trunk (chest, abdomen), assess the casualty for signs of bleeding
and treat for bleeding.
• If there is an embedded object (e.g. a barb from a stingray sting), do not remove it as
it may be plugging the wound and restricting bleeding. Place padding around or
above and below the object and apply pressure over the pads.
• If the sting is on a limb, place the casualty's stung hand or foot in hot water (no hotter
than you can comfortably tolerate).
• Transport the casualty to a medical facility.
If the casualty is unresponsive and not breathing normally, follow the DRSABCD steps.
NOTE
DO NOT use the Pressure Immobilisation Technique. Antivenom is available for stonefish envenomation
2.2.18 Environmental Impacts
Prolonged exposure to cold and heat can result in the body being affected externally
(frostbite, sunburn, etc.) and internally (dehydration, organ failure). In severe cases, early
treatment is critical to survival.
Hypothermia
For the human body to function normally, it needs to maintain its temperature at about 37⁰C.
Hypothermia is when the body’s temperature falls below 35⁰C. As the body’s temperature
falls, systems and organs progressively fail until death occurs, usually from cardiac arrest.
Infants and elderly people are at greater risk.
Hypothermia may develop acutely (suddenly), for example falling into icy water, or
gradually (being in cold conditions for a long time).
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Causes of Hypothermia include:
Cause Description
ENVIRONMENTAL Exposure to cold, wet, or windy conditions; cold- water immersion/submersion; exhaustion.
TRAUMA Trauma, immobility and burns.
DRUGS Alcohol and sedatives.
NEUROLOGICAL Stroke and altered consciousness.
ENDOCRINE Impaired metabolism.
SYSTEMIC ILLNESS Severe infections, malnutrition.
Adapted from: ARC Guideline 9.3.3: Hypothermia First Aid Management
Symptoms include:
• Mild hypothermia:
o casualty shivering o pale, cool skin o impaired coordination o slurred speech o responsive but with apathy or confusion
• Moderate to severe hypothermia:
o the absence of shivering o increasing muscle stiffness o progressive decrease in consciousness o slow irregular pulse o hypotension
In more severe cases, the casualty may have dangerous cardiac arrhythmias (a change
in the heartbeat), cardiac arrest, and fixed dilated pupils. The casualty may appear dead,
particularly if they have a weak, slow pulse.
First aid treatment:
• Call an ambulance – dial 000. • Remove from the cold environment. • General and supportive treatment with application of basic life support where
appropriate; this must continue until the casualty has warmed up. • Remove sources of heat loss such as wet clothing, contact with cold surfaces and
move them out of the wind. Do not remove wet clothing if there is no dry blanket or
another cover. Apply insulation between body and the environment (e.g. blanket).
• Dry the casualty if wet.
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• Give warm oral fluids (not alcohol) and only if the casualty is fully conscious and
able to swallow. • If the casualty is in a remote location and not shivering the responder should
initiate active rewarming. • Cautiously apply a source of external heat such as heat pack or body-to-body
contact. • To avoid burns, ensure that any heat source is warm or tepid but not hot • Do not place the casualty in a warm bath.
Hyperthermia (Heat Induced Illness)
The very young and aged are more prone to heat-induced illness, and the causes of Hyperthermia include:
• excessive heat absorption from a hot environment • excessive heat production from metabolic activity • failure of the cooling mechanism • an alteration in the body’s set temperature
Factors that may contribute to heat-induced illness include:
• excessive physical exertion • hot climatic conditions with high humidity • inadequate fluid intake • infection (particularly a viral illness) • inappropriate environments (e.g. unventilated hot buildings) • wearing unsuitably heavy, dark clothing on hot days • drugs that affect heat regulation
To prevent hyperthermia on warm, humid or hot days:
• keep infants and the elderly in cool, ventilated areas and provide ample oral fluids • wear a hat and light coloured, loose-fitting clothing during physical exertion and
outside activities • take adequate fluids during exertion on hot days and don’t wait until you’re thirsty
If you are participating or organising sporting events:
• allow six weeks for acclimatisation with progressive exercise before a competition • avoid vigorous exercise during a viral illness • plan to conduct events in the early morning or late evening or the cooler months
of the year • provide regular drink stations • follow the support guidelines relevant to specific activities
At no time should children or the elderly be left unattended in parked cars.
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For workers in outdoor or potentially hot environments, refer to occupational health
guidelines relevant to the environment. Work environments that may be particularly prone to
causing hyperthermia and heat-induced illness include those in which:
• there is a high ambient temperature with reduced air movement
• the worker is exposed to radiant heat, and there is difficulty in maintaining adequate
hydration (refer to Work Safe Australia's Model Code of Practice: First Aid in the
Workplace
Symptoms include:
The body usually controls mild elevation in body temperature with sweating, which allows
cooling by evaporation.
Once a person becomes too dehydrated to sweat, their body temperature can rise
rapidly and dramatically.
The following chart lists the symptoms which casualties may experience:
Heat Exhaustion
Heat Stroke
• Fatigue with a headache, nausea, vomiting, malaise and
dizziness • Might collapse • Body temperature BELOW 40°C • Conscious state will become normal once the casualty
is lying down
MAY LEAD TO UNCONSCIOUSNESS AND DEATH
• All organs may be affected • Lack of sweating • Body temperature ABOVE 40°C • Altered conscious state • Hot, dry skin (sometimes excessive sweating) • Collapse
First Aid Treatment:
The management of heat-induced illness is aimed at removing the cause and assisting the
normal cooling mechanisms of evaporation, conduction, radiation and convection.
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• lie the casualty down in a cool environment or the shade
Heat • loosen and remove excessive clothing Exhaustion
• moisten the skin with a moist cloth or atomiser spray
• cool by fanning
• give water to drink if fully conscious
• call for an ambulance (dial 000) if not quickly improving
LIFE THREATENING Heat Stroke
• call for an ambulance
• resuscitate following the DRSABCD steps (topic 1.1.2)
• place the casualty in a cool environment
• moisten the skin with a moist cloth or atomiser spray and
fan repeatedly
• apply wrapped ice packs to neck, groin and armpits
• Give 3-8% carbohydrate electrolyte fluid (any commercially available "sports drink") for the treatment of exertion related heat stroke. If fluid is unavailable, provide water
Febrile • treat as for seizure
Convulsions
Compressed Gas – Divers
“Compressed gas” divers breathe gas (usually air) while under water. Most commonly,
divers use SCUBA (Self-contained Underwater Breathing Apparatus) and breathe from
cylinders carried underwater, but the breathing gas can also be supplied from the surface
(hookah supply).
Whichever method is used to provide the gas, breathing compressed gas underwater can
lead to several unique medical problems, the most significant being decompression illness
(DCI) and pulmonary barotrauma (rupture of small airways).
Also, divers may suffer from the same aquatic mishaps as swimmers, snorkelers and
boating enthusiasts.
Decompression illness and pulmonary barotrauma require special first aid considerations,
including the prompt and continued administration of near-100% oxygen.
Diagnosis of the exact problem in an ill or injured diver is often unnecessary for effective first
aid; it is, however, important to also consider non-diving-related causes of the presenting
condition.
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Symptoms include:
Decompression Illness Pulmonary Barotrauma
extreme fatigue chest pain
numbness/tingling or altered sensations difficulty breathing
a headache or other body pain, coughing especially at or around joints
the blueness of lips and tongue
poor balance or coordination (cyanosis)
irritability, confusion or reduced voice changes consciousness
difficulty swallowing
weakness, paralysis, physical collapse
“crackly” skin around neck (crepitus)
rash
reduced responsiveness
speech, visual or hearing disturbances
signs/symptoms of decompression
illness may also be present
First aid treatment:
• If the casualty is unconscious, manage as per DRSABCD steps. A casualty of DCI
may regain consciousness and appear to have recovered, but you still need to
maintain them for suspected DCI because they might relapse.
• Promptly provide as close to 100% oxygen as possible and continue to do so until
the ambulance arrives and takes over management.
• If you suspect DCI, lay the casualty flat on their back, if possible.
• Seek immediate diving medical advice by calling the DAN Diving Emergency
Service hotline on 1800-088-200 (from within Australia) and +61-8-8212 9242 (from
outside Australia).
• Aid with any transfer to a recompression chamber if requested.
• If the casualty is alert and stable, but you suspect they are suffering from DCI, they
may drink non-alcoholic fluids, such as water or isotonic/electrolyte fluids (as long
as they have no stomach cramps, nausea, urinary retention or paralysis).
• Record details of the dive(s), what first aid you gave and the casualty’s response
to first aid.
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NOTES
• The Divers Alert Network (DAN) Diving Emergency Services
(DES) is a 24-hour emergency hotline which is available to for all
diving related injuries. The hotline will provide emergency advice
and management processes to treat diving injuries and illness.
• Entonox (50% nitrous oxide gas in oxygen) must not be used
in diving accidents
Cold Injuries
Exposure to cold conditions can lead to a generalised cooling of the body (hypothermia) or
localised cold injury. The latter may be either cold Injury (frostbite) or Non-Freezing Cold
Injury (NFCI or trench foot).
Causes of frostbite
The formation of ice crystals, which blocks small blood vessels causes frostbite. The
area's most commonly affected are those exposed to cold, windy conditions (e.g. the face,
incl. ears), and those with the most peripheral blood supply (e.g. fingers and toes).
The two simple classifications of frostbite are:
a) superficial frostbite in which only the skin is frozen and can still be moved about the
underlying tissue (and is most cold injury cases in Australia)
b) deep frostbite which involves deeper tissues.
First Aid Treatment:
Superficial Frostbite Deep Frostbite
Get out of the cold weather by seeking Seek shelter. Get out of the cold and
shelter wind.
DO NOT rub the frozen tissue. Remove any constrictive or damp wet clothing and replace with clean, dry
DO NOT use radiant heat to rewarm the clothing if available.
part.
Wrap in warm blankets and give warm
It is important to re-warm any affected fluids by mouth.
areas immediately by gently placing
fingers in the opposite armpit or placing If the tissue is still frozen when
a warm hand on the frost-nipped cheek presented, the best tissue survivability
or ear. Feet can be reheated on the results from placing the injured part in a
warm abdomen (under clothing) of a warm water bath with circulating water
companion. Rewarming can be very (40-42°C, that is, comfortably hot to the
painful. back of a responder's hand) until the
affected part thaws. This may take 30
Ensure that re-freezing does not occur. minutes or more. Such management is
Once the colour and consistency of the best achieved under hospital conditions
skin have been restored, the person can where infection-control and adequate
safely resume normal activity provided pain relief can be provided.
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they increase their insulation and are If the tissue has spontaneously thawed especially vigilant against recurrence. by the time of presentation (as is often
the case) the 40-42°C water bath is not required, but affected tissue can be cleaned and bathed at a more comfortable temperature (30-35°C). Rewarming can be very painful.
Elevate the affected part.
DO NOT use radiant heat to rewarm the part.
DO NOT break blisters.
NEVER thaw a part of the body if there is a likelihood of it being refrozen. The thawing and refreezing results in more tissue damage than if left frozen for several hours.
Causes of non-freezing cold injury
The prolonged exposure to temperatures which are above freezing can result in the
limbs being affected by trench foot. When first observed, the injured area will appear
pale, pulseless and immobile, but not frozen.
First aid treatment:
The treatment of Non-Freezing Cold Injury is still controversial, as there isn't a single
method of treatment which has demonstrated higher rates of tissue survivability.
• Dry the foot well. Keep the body warm but the foot cool.
• DO NOT let the casualty walk on affected feet. Rather let them lie down with their
feet elevated.
• DO NOT use radiant heat to rewarm the part.
2.2.19 Eye and Ear Injuries
Eye injuries can occur as the result of trauma, foreign objects, chemicals, or a direct contact.
Ear injuries are the result of several causes including foreign objects, trauma, ruptured
ear drums and illness including ear infections.
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Symptoms Include:
Eyes Ears
Redness Nausea
Swelling Dizziness
Bruising around eye area Fever
Pain Bruising
Bleeding
Swelling
Redness
Earache
Severe pain and loss of hearing
First Aid Treatment:
Eyes Ears
For black eyes, apply cold compresses Call an ambulance
For minor foreign objects flush with a mild Reassure and monitor the casualty until
saline solution medical attention is received
If the object cannot be removed with the Do not block any drainage from the ear
above method seek medical attention
Do not try to remove the object using sharp Do not put liquid in the ear or try to clean or
objects such as tweezers wash the affected area
For major foreign objects, cover the eye
and call for an ambulance by dialling 000
2.2.14 Febrile Convulsions
Febrile convulsions only occur in a minuscule percent of children aged between 6 months
and six years of age and are caused by fevers which rise rapidly.
For mild cases, all that is required is reassurance and protection from injury.
Symptoms in severe cases Include:
• Shaking or jerking • Fever • Clamminess
First Aid Treatment:
• Place casualty on side until jerking ceases
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• Do not restrain the casualty • If seizure lasts more than 5 minutes’ call for an ambulance by dialling 000
2.2.20 Fractures and Dislocations
A fracture is caused by the breaking or bending of a bone which also has damage to the soft
tissue around the break.
Symptoms Include:
• Closed or simple fractures – where the bone is broken, and there is no opening to
the exterior through a wound and no injury to other body organs
• Open or compound fractures – where broken bones have exposed the air as a result
of being pushed through the skin or the wound leads to the bone. This type of fracture
is considered serious due to any associated bleeding and the increased possibility of
infection.
• Complicated fractures – which includes damage to the veins, arteries, nerves and the
lining of the bone
First Aid Treatment:
Use of splints
The use of a splint in situations where an ambulance will be at the scene within a reasonable
period say an hour or so is not required.
Wooden splints are also not recommended because they are: • Hard to find at accidents, • They will cause pressure sores if not properly padded, • They are painful to apply, and • The ambulance officers will have to remove them to use their equipment
Treatment of limb when ambulance is not available
o Approach incident o Call ambulance immediately o Check circulation below injury (pulse and skin) o Obtain materials for splinting and bandaging
o If the casualty experiences severe muscle spasm
• talk to and reassure the casualty regularly • take hold of the foot of injured limb and • gently pull foot down from hip • straighten limb • hold limb
o Apply the bandages and splint between the legs, remembering to pad the area.
• Broad bandage above the fracture • broad bandage below the fracture • broad bandage to the joint above the fracture • broad bandage to the joint below the fracture
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• tie all knots over padding
o Frequently check circulation below bandages o Reassure casualty and treat poor perfusion
Dislocation usually occurs when a bone shifts out of place because of twisting, forcing or
pulling motions.
Symptoms include:
• Abnormal or no movement • Deformity - (sometimes) • Swelling • Bruising • Shortening of limb (Legs) • Crepitus - a coarse grating sound which should be prevented • Loss of power, movement or control • Pain • Tenderness
First aid treatment:
• Approach incident • Take history and examine injury • If necessary call ambulance immediately • Rest the casualty and the limb but do not try to straighten the limb • Check circulation below injury (pulse and skin) • Keep casualty warm and provide comfort and reassurance • Do not let them eat or drink anything until medical assistance has been sought
2.2.21 Head, Neck and Spinal Injuries Head neck and spinal injuries may be caused in several ways including, falls, assaults,
motor vehicle crashes, sporting injuries and, less commonly, penetrating injuries.
A casualty may sustain a significant head injury without loss of consciousness or loss of
memory (amnesia). Therefore, do not use unconsciousness or memory loss to define
the severity of a head injury or to guide management.
Head Injury
For a casualty with a head injury, the initial first aid treatment should include an assessment
and check the airways, making sure the neck is kept still until help arrives – refer to
DRSABCD and Secondary Examination. Advise all casualties of head injuries to seek
assessment by a health care professional or at a hospital.
Suspect a brain injury if the casualty sustained a blow to the head, has signs of injury to the
head or face such as bruises or bleeding, or is confused or unconscious. A brain injury may
be present without external signs of injury to the head or face. Serious problems may not
be evident for several hours after the initial injury.
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First Aid Treatment:
• Call an ambulance (dial 000) if the person has lost consciousness or has displayed altered consciousness at any time, no matter how brief.
• A casualty who has sustained a head injury, whether there has been a loss of consciousness or altered consciousness, should be assessed by a health care professional.
• Manage an unconscious casualty
according to the DRSABCD steps.
• Ensure that the airway is clear.
• Protect the neck while you maintain
a clear airway.
• Identify and control any significant bleeding with direct pressure if possible.
Suspected Spinal Injury
The spine is made up of 33 separate bones, known as vertebrae, extending from the base
of the skull to the coccyx (tailbone). Each vertebra surrounds and protects the spinal cord
(nerve tissue).
Always suspect a spinal injury in the overall management of trauma casualties. The risk of
worsening the spinal injury in the prehospital period is probably less than previously thought,
yet to minimise the extent of the secondary injury, be cautious when you move a casualty.
Spinal injuries can occur in the following regions of the spine:
• the neck (cervical spine) • the back of the chest (thoracic spine) • the lower back (lumbar spine)
The most vulnerable area of injury is the cervical spine. This type of injury should be
suspected in any casualty presenting with injuries above the shoulders. More than half of
spinal injuries occur in the cervical region.
Suspected spinal injuries of the neck, particularly if the casualty is unconscious, pose a
dilemma for the responder because correct principles of airway management often cause
some movement of the cervical spine.
The most common causes of spinal cord injury are:
• a motor vehicle, motor cycle or bicycle incident as an occupant, rider, or pedestrian • an industrial accident (i.e. workplace) • a dive or jump into shallow water or water with obstacles or being "dumped" in the
surf • a sporting accident (e.g. rugby, falling from a horse) • a fall from greater than a standing height (e.g. ladder, roof)
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• falls in the elderly population • a significant blow to the head • a severe penetrating wound (e.g. gunshot)
The symptoms of a spinal injury can be determined by two factors: firstly, it is important to
determine the location of the injury and secondly the seriousness of the injury. You will need
to assess if there is a bone injury or associated spinal cord injuries including whether the
spinal cord is complete. It is important to allow the qualified medical service to make this
assessment, especially in those with an altered state of consciousness.
Symptoms include:
• pain, • tingling and numbness in the limbs • Weakness or inability to move the limbs • nausea • headache or dizziness • altered or absent skin sensation
Signs of spinal injury include:
• head or neck in an abnormal position • signs of an associated head injury • altered conscious state • breathing difficulties • shock • change in muscle tone, either flaccid or stiff • loss of function in limbs • loss of bladder or bowel control • priapism (erection in males)
If a spinal injury is suspected:
1. Call an ambulance – dial 000
2. Manage the airway, breathing and circulation
3. Manage the spine
Being aware of potential spinal injury and handling the casualty carefully, with attention
to spinal alignment, is the key to minimising harm.
The Conscious Casualty
Tell the casualty to remain still but do not physically restrain them if they are uncooperative.
Those with significant spinal pain will likely have muscle spasms, which act to splint their
injury. Keep the casualty comfortable until help arrives.
If it is necessary to move the casualty from danger (e.g. out of the water, off the road),
carefully support the injured area and restricting movement of the spine in any direction.
Only qualified first aid personnel and health care professionals who are trained in the area
of spinal injuries and car should move the casualty.
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The Unconscious Casualty
Management of the airway takes priority over any suspected spinal injury. Move the
head GENTLY into a neutral position to obtain a clear airway. If the casualty is breathing
but remains unconscious, place them in the recovery position.
Handle the casualty gently without twisting. Aim to maintain spinal alignment of the head and
neck with the torso, both during the turn and afterwards. If you need to open the airway, use
manoeuvres that are least likely to cause the cervical spine to move. Try the jaw thrust and
chin lift before you try to tilt the head.
Spinal Immobilisation Techniques and Devices
a) Cervical Collars
NOTE
As stated by ANCOR:
All responders in the pre-hospital environment review their approach to the
management of suspected spinal injury regarding SR (semi rigid) cervical
collars. Consistent with the first aid principle of preventing further harm,
the potential benefits of applying a cervical collar do not outweigh harms
such as increased intracranial pressure, pressure injuries or pain and
unnecessary movement that can occur with the fitting and application of a
collar. In suspected cervical spine injury, ANZCOR recommends that the
initial management should be manual support of the head in a natural,
neutral position, limiting angular movement. In healthy adults, padding
under the head (approximately 2cm) may optimise the neutral position. (ANCOR Guideline 9.1.6 – Management of Suspected Spinal Injury)
The potential adverse effects of SR cervical collars increase the longer it is used and
include:
• movement of the neck and head while sizing and fitting of the collar • discomfort and pain • restricted mouth opening and difficulty swallowing • airway compromised if the casualty vomits • any pressure on the neck veins causing cranial pressure. • hiding potential life-threatening conditions
b) Spinal Boards
Rigid backboards placed under the casualty can be used by first aiders should it be
necessary to move the casualty. The benefits of stabilising the head will be limited unless
you control the motion of the trunk effectively during transport. DO NOT leave the casualty
on rigid spinal boards. Otherwise healthy persons left on spine boards develop pain in the
neck, back of the head, shoulder blades and lower back and are at risk of pressure
necrosis. Conscious casualties may attempt to move around trying to get more comfortable
which could cause further injury.
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Paralysed or unconscious casualties are at higher risks of developing pressure necrosis due
to their lack of pain sensation. Strapping restrict breathing and should be loosened if
compromising the casualty. Casualties might be more comfortable on a padded spine board,
air mattress or bead-filled vacuum bed; some ambulance services use these devices
successfully.
c) Log Roll
The log roll is a manoeuvre performed by a trained team, to roll a casualty from a supine
(face up) position onto their side, and then flat again, so that the person can be examined
or a back board placed underneath their back, or to remove a back board.
d) Children
After road traffic accidents, leave conscious infants in their rigid seat or capsule until
ambulance personnel can assess them. If possible, remove the infant seat or capsule
from the car with the infant/child in it. Children under eight years of age may require
padding under their shoulders (approximately 2.5cm) for neutral spinal alignment.
2.2.22 Minor Skin Injuries
Luckily, most of these injuries are not serious and can be handled with some simple first-aid
interventions at home. Bumps and bruises are damage that occurs in the soft tissue under
the skin.
Under the following conditions, there is no need to call for medical assistance when a person
suffers a cut, scrape, bump, or bruise:
• The injury is small (less than 1/2 inch around). • There is no bleeding or only slight bleeding. Make sure you follow the universal
guidelines, such as wearing protective gloves, preventing the spread of HIV or any
other dangerous infections. (See How to Treat Wounds and Stop Bleeding for first
aid care for bleeding.) • The victim is not in excessive pain. • The victim does not feel numbness or tingling. • The person is not suffering any paralysis. • The victim does not seem to have any broken bones or dislocation at the joints.
However, there are times when a physician's care is needed. In general, call your physician
for skin injuries that are:
• Bleeding heavily and do not stop after five to 10 minutes of direct pressure. • Deep or longer than 1/2 inch. • Located close to the eye. • Large cuts on the face. • Caused by a puncture wound or dirty or rusty object. • Embedded with debris such as dirt, stones, or gravel. • Ragged or have separated edges. • Caused by an animal or human bite. • Excessively painful. • Showing signs of infection such as increased warmth, redness, swelling, or drainage.
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Symptoms Include:
• Cuts slice the skin open which causes bleeding and suffering. Scrapes are not as
severe but are more painful due to nerve endings being affected.
• Punctures are stab wounds. This causes pain, but may not result in bleeding.
Bruises cause black and blue or red skin. As they heal, the skin turns yellowish-
green. Pain, tenderness, and swelling also occur.
First aid treatment:
For Minor Cuts and Scrapes
• Clean the wound carefully and thoroughly using soap and water. • Apply pressure for up to ten minutes to halt any bleeding, sing a sterile gauze which
has been moistened. • If bleeding persists, lift the part of the body with the cut higher than the heart, if
practical. • When the bleeding has ceased, you can apply appropriate first aid cream if available. • Place one or more bandages on the cut with the edges of the cut skin touching but
not overlapping. If possible use a butterfly bandage to • keep the area clean
For Punctures that Cause Minor Bleeding
• Allow the wound to bleed to clean itself. • Remove the object (e.g., splinter) using clean tweezers. • Two to four times a day, clean the wound area with soapy water. Dry well and apply
an antibacterial cream. • For Bruises
For bruising
• apply a cold back to the area as soon as you can, using the cold pack for 10 minutes
with 30 to 60-minute intervals. • It is important to • rest the bruised area and keep elevated above the level of the heart if able to. • There is no need to bandage a bruised area.
2.2.23 Needle Stick Injuries
If you suffer a needle stick injury (i.e. a contaminated needle penetrates the
skin), immediately wash the area with soap and water.
If water is not available, clean the area with hand wipes followed by an alcohol-based liquid
or gel if available.
Immediately report to your GP or local emergency department.
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2.2.24 Poisoning and Toxic Substances
Poisons can enter the body several which includes:
• Ingestion – swallowing poisonous substances • Injection – drug use • Absorption – via contact with skin • Inhalation – breathing in toxic gases, fumes, vapours
Symptoms Include:
The types of symptoms will vary depending on the type of poison or toxic substance but
includes:
• Unconsciousness • Nausea • Vomiting • Burning sensation in mouth and throat • Headaches • Blurred vision • Seizures • Respiratory arrest • Cardiac arrest
First Aid Treatment:
• Open their airway • Wash poison from face and if inhaled, allow a sip of water to wash out mouth • Using a mask commence CPR • Only use compressions if a face mask is not available • If poison is inhaled avoid breathing the fumes and seek fresh air for the casualty
immediately • If swallowed, wash out the mouth – DO NOT make them vomit • If contact with skin, remove contaminated clothing, wash skin with running cold water
2.2.25 Seizures
A seizure is a sign of abnormal brain activity, which can be caused by many problems. Up to
10% of the population is likely to experience a seizure at some time in their life.
A seizure may occur when the normal pattern of electrical activity of the brain is disrupted.
This can cause changes in sensation, awareness and behaviour, or sometimes
convulsions, muscle spasms or loss of consciousness.
Seizures vary widely, and most are over in less than 5 minutes. Not all seizures are due
to epilepsy and can be associated with:
• lack of oxygen (hypoxia) • onset of cardiac arrest • medical conditions affecting the brain, e.g. low blood sugar, low blood pressure, head
injury, neurological diseases, epilepsy • trauma to the head • some poisons and drugs • withdrawal from alcohol and other substances of dependence
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• fever in children under six years
Symptoms include:
Seizures can take many forms including:
• muscle spasms which can produce rigidity; if the casualty is standing this could
cause them to fall • arm, leg and head jerking motions • shallow breathing • biting of the tongue or dribbling • incontinence of urine and/or faeces • changes in conscious state from being fully alert to confused, drowsy, or total loss of
consciousness • changes in behaviour where the casualty may make repetitive actions like
fiddling with their clothes
Generalised seizures usually involve the entire body and cause a loss or marked alteration
in consciousness. Some generalised seizures result in life-threatening problems with airway
or breathing, or risk of trauma from muscle spasms or the casualty loses normal control of
posture and movement.
Febrile convulsions are usually associated with a fever and will resolve without the need
for treatment. Febrile convulsions occur in about 3% of children aged between six months
and six years. Children who suffer a febrile seizure are not at increased risk of epilepsy.
First aid treatment:
If the casualty is unresponsive and not breathing normally, follow the DRSABCD steps.
If the casualty is unconscious and actively seizing, you should:
• follow the casualty’s seizure management plan, if there is one in place • manage the casualty according to DRSABCD guidelines • call an ambulance by dialling 000
Further actions:
• manage the casualty as for any unconscious person DRSABCD • remove the casualty from danger or remove any harmful objects which might
cause secondary injury to the casualty • note the time the seizure starts • protect the head • avoid restraining the casualty during the seizure unless this is essential to
prevent injury • lay the casualty down and turn the casualty on their side when practical • maintain an open airway • reassure the casualty who may be dazed, confused or drowsy • call an ambulance – dial 000 • monitor the casualty
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Putting a child in a bath during a convulsion is dangerous so do not
undertake this process
Do not insert any objects into the child's mouth during the seizure
A seizure in water is life threatening. If the seizure occurs in water:
• support the casualty in the water with the head tilted, so the face is out of the water • remove the casualty from the water as soon it is safe to do so • call an ambulance – dial 000 • if the casualty is unresponsive and not breathing normally, follow the
DRSABCD steps.
2.2.26 Shock
Shock is a loss of effective circulation, which results in inadequate tissue oxygen and
nutrient delivery and causes life-threatening organ failure. Some conditions that may cause
shock include:
a) Loss of circulating blood volume (hypovolaemic shock):
• severe bleeding (internal and/or external) • primary or multiple fractures or major trauma • severe burns or scalds • severe diarrhoea and vomiting • severe sweating and dehydration
b) Cardiac causes (cardiogenic shock):
• heart attack • dysrhythmias (abnormal heart rhythm)
c) Abnormal dilation of blood vessels (distributive shock):
• severe infection • allergic reactions • serious brain/spinal injuries • fainting
d) Blockage of blood flow in or out of heart (obstructive shock)
• tension pneumothorax • cardiac tamponade • pulmonary embolus • in pregnancy, compression of large vessels by the uterus
Symptoms include:
The symptoms will vary, depending on the severity, nature an underlying cause.
Symptoms can include:
• dizziness • thirst • anxiety • restlessness • nausea
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• breathlessness • feeling cold • collapse • rapid breathing • the rapid pulse which may become weak or slow • cold, sweaty skin that may appear pale • confusion or agitation • decreased or deteriorating level of consciousness • vomiting
First aid treatment:
1. Lay the on their back. If they are unconscious place, place them in the recovery
position
2. Control any bleeding promptly
3. Call an ambulance – dial 000
4. Administer treatments relevant to the cause of the shock, e.g. electrical shock
5. Administer oxygen if available and trained to do so (ARC Guideline 10.4)
6. Maintain body temperature (prevent hypothermia)
7. Reassure and constantly re-check the casualty’s condition for any change.
8. If the casualty is unresponsive and not breathing normally, follow DRSABCD steps
9. For individuals with shock who are lying on their back and who have no trauma, use
PLR (passive leg raises) to provide a transient (less than 7 minutes) improvement.
Specific Management of Electric Shock
If there are any concerns about electricity when assessing the situation apply the following:
• When power lines are in contact with a vehicle or a person, do not approach until the
authorities declare the situation safe. All bystanders must remain at least ten meters
clear of any material which is electrified including metal and water.
• In domestic situations, it is essential that you separate the person in need quickly
from the electricity supply. Switch off the power supply and if safe to do so,
unplug the appliance from the electrical outlet. Until the power is off, avoid direct
skin contact with the person or any conducting material.
• If the person is unresponsive and not breathing normally, follow the
DRSABCD steps.
• Anyone suffering from an electrical shock must be referred to medical authorities for
assessment and treatment if needed.
• If a person has been struck by lightning conduct an assessment. If unresponsive
and not breathing normally, follow the DRSABCD steps.
2.2.27 Soft tissue injuries
Soft tissue injuries vary in type and severity and include sprains and strains. The cause of
soft tissue injuries includes sudden jolts or twisting which causes the fibres to overstretch.
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Symptoms Include:
• tearing of ligaments • swelling • bruising • pain • unable to bear weight
First Aid Treatment:
For the treatment of soft tissue injuries apply the RICE procedure:
Rest – Make the casualty comfortable and restrict/stop movement
Ice – For first 24 to 48 hours use ice or cold packs every two hours for 15 minute
periods
Compression – Bandage the area firmly with a roller bandage. Ensure you
extend the bandage above and below the injury
Elevation – If possible elevate the injured area above the level of the heart
2.2.28 Stroke
Stroke is considered the second most common cause of death in Australia. As stroke
occurs, when the blood supply to part of the brain is suddenly disrupted or when there
is spontaneous bleeding from a blood vessel within the skull.
An acute blockage of a blood vessel within the brain causes approximately 80% of strokes. Stroke is a medical emergency.
When the blood supply to a part of the brain is interrupted, that area of the brain is damaged
and may die. The surrounding brain tissue is also affected and is at risk of dying. However,
if the blockage can be cleared quickly and blood supply restored, the amount of damage to
brain tissue can be significantly reduced.
Rapid recognition, protection and support of the airway, breathing and circulation, and
rapid access to definitive stroke care can all contribute to reducing deaths and long-term
damage from stroke.
Symptoms include:
A sudden blockage of blood flow to an area of the brain, or bleeding, will produce symptoms
of stroke. Symptoms may seem to improve, but you should still consider it as a stroke.
First aid providers can use stroke assessment systems such as FAST for individuals with
suspected acute stroke. FAST is an easy way for remembering the signs of stroke.
• Facial weakness – can the person smile? Has their mouth or eye drooped?
• Arm weakness – can the person raise both arms?
• Speech difficulty – can the person speak clearly and understand what you say? • Time to act fast – seek medical attention IMMEDIATELY. Call an ambulance
by dialling 000.
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Other common symptoms of strokes include:
• numbness of the face, arm or leg on either or both sides of the body • difficulty swallowing • dizziness, loss of balance or an unexplained fall • loss of vision, sudden blurred or decreased vision in one or both eyes • headache, usually severe and of abrupt onset or unexplained change in the
pattern of headaches • drowsiness • confusion • reduced level of consciousness
Other conditions may also show the same symptoms of stroke, such as epilepsy, migraine
or diabetes with low blood sugar. If you are trained to check a blood sugar level, it can
improve the accuracy of stroke diagnosis when you use it in conjunction with a stroke
assessment tool.
When there is doubt over diagnosis, manage the casualty as having a stroke until
proven otherwise.
A casualty with stroke symptoms will need to be transported by a medical team because of
ongoing treatment which is necessary to manage the stroke. Paramedics can also notify
the receiving hospital, reducing time to the start of treatment.
First aid treatment
• Regardless of how briefly symptoms appear, call an ambulance if any signs of
stroke occur.
• Do not allow the consumption of food or drink.
• Administer oxygen if available and trained to do so (ANCOR Guideline 10.4). If a
pulse oximeter is available, provide oxygen only to casualties with oxygen saturation
of less than 94%.
• Reassure the casualty.
• If the casualty is unconscious but breathing, place them in the recovery position
• If the casualty is unresponsive and not breathing normally, start resuscitation by
following the DRSABCD steps.
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2.3 Ensure casualty feels safe, secure and supported
As the person, responsible for providing first aid, you need to be aware of the value of non-
physical care to the casualty and bystanders.
Any event that requires first aid causes stress in the casualty as well as those who are
unable to provide the necessary care, whether they are bystanders or one who is mildly
injured but unable to assist. Be aware of the stress on yourself as well – (we look at this
in more detail in Topic 4 of this guide).
2.3.1 Reassurance
The psychological value of reassurance is as important in first aid as the treatment that you
give. It is important to comfort and reassure the casualty, as in some cases, all the casualty
needs are emotional support and reassurance.
A calm approach by the first aider and keeping the casualty informed of what is happening
will also assist in the reassurance process not only for the casualty but bystanders as well.
It is important to consider all the people who have aided in the care of a casually as they
too, may need reassurance and comfort.
Following an incident, take the time to recognise the contribution which was made
by everyone and highlight the fact that it is a team effort.
2.3.2 Cultural Awareness
Cultural awareness is when you understand the impact your behaviour can have on the care
provided to others. It is important to have an awareness of cultural values, and you need to ensure that you
address any differences when approaching a casualty. For example, it is disrespectful for
a male to touch a female in some cultures, so you need to ask their permission to examine
them or provide treatment.
If they cannot give you their consent, try and find out about give you the consent. If nobody
else is available, saving the person's life takes priority, but do so with sensitivity to their
culture, for instance, don't remove clothing without providing alternative covering.
Always treat the casualty with respect and observe their rights not to be touched or handled.
Be empathetic, unbiased and non-judgemental. Don't allow your beliefs and values interfere
with saving a life – discrimination in all its forms is illegal.
2.3.3 Children, the elderly, and the disabled
When assisting children, the elderly or disabled the following considerations will need to be
factored into how you manage the emergency:
Children: A child will be frightened, especially if the first aider is a stranger. Ask the
parent/relative/friend to calm the child and direct your questions to that person (if
possible).
Distract them by giving them something to do, such as holding a dressing or
stethoscope (but no sharp objects). Ask permission to remove clothing if they are a
casualty, especially if they're of school-going age and aware of their modesty.
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Elderly/disabled: Be aware of their difficulty in moving (elderly need assistance)
or disabilities that need assistance (e.g. wheel-chair bound, visually impaired).
The elderly may have fragile bones and thin skin, so be gentle when you need to
handle them.
Support them when you need to position them and make sure they’re comfortable
wherever you position them.
When you apply CPR on an elderly person, remember that you can easily break a
rib or sternum. CPR could also cause trauma such as spinal, liver and spleen
injuries, damage to airways, cause internal bleeding, or heart contusions (ruptured or
bruised capillaries).
Check for medical emergency bracelets or necklaces for “Do Not Revive”.
2.3.4 Do Not Revive/Resuscitate (DNR)
The ARC gives clear directives in their Guideline 10.5: Legal and Ethical Issues Related to Resuscitation, specifically as it pertains to first aid:
‘Do Not Attempt Resuscitation’ Orders
In out-of-hospital circumstances, emergency services are often activated for patients
in cardiac arrest who are chronically ill or have a terminal illness. Responders need
to establish there is an advanced care directive in place if a decision maker is
available.
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2.4 Obtaining consent from a casualty, caregiver,
medical practitioners and emergency services
The ARC’s Guideline, 10.5: Legal and Ethical Issues Related to Resuscitation, is clear about
the issues governing consent for treatment given by medical professionals and first aiders.
2.4.1 Consent for Treatment
Before treating a casualty, a first aider must obtain their consent. Failure to obtain consent
potentially constitutes "medical trespass" (assault), and the casualty could recover
damages without the requirement of proof of injury, causation or negligence. If the casualty
has impaired decision-making capacity, obtain the consent from a substitute decision-maker
whenever possible, particularly in the case of an infant or child.
The parents or guardians of minors have the overwhelming right of autonomy and self-
determination unless they are deemed as incompetent.
A person is considered to have impaired decision-making capacity (incompetent) if they are
not capable of understanding, retaining, using or communicating any information relevant
to making a healthcare decision.
Adults are assumed to be competent unless they have impaired decision-making capacity
while children are deemed to have impaired decision-making ability until they are 18 years of
age. However, most states permit younger persons to make decisions if they can
understand the issues involved.
In the case of infants and other children who are not capable of understanding the issues,
refusal to receive treatment can be difficult to interpret. In general, the parent/guardian
should decide whether the advantages outweigh the burden of any distress caused by
treatment. In the absence of a parent/guardian, responders should regard children as having
impaired decision-making capacity.
2.4.2 Treatment without Consent
Although treatment requires consent, you should not deprive an injured or ill person of
treatment merely because they lack decision-making capacity.
The key legal factors that determine whether treatment can be given without consent are:
• whether the casualty does or doesn’t have decision-making capacity • whether an advance care directive exists • the degree of urgency of the situation and • whether a substitute decision-maker is present, willing and able to consent.
If the casualty is unable to give consent and no substitute decision maker is present, the
legal requirement to obtain consent before assistance or treatment is waived under Common
Law and Statute Law.
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2.5 Making the casualty as comfortable as possible
As a first aid provider, you will need some resources if you have to perform first aid on your
own and provide treatment. You cannot transport the contents of an ambulance, but you can
carry with you a selection of items that you can use in most emergencies.
The greatest tool is your knowledge and training – if you are in a situation where you don’t
have access to your equipment, you will be able to use available resources as a substitute.
For example, you can use a tree branch as a temporary splint or roll up a jumper to make a
pillow.
2.5.1 First aid kit
Healthdirect Australia provides the following checklist for the contents which should be
included in a first aid kit. Your first aid kit can also be customised, depending on the activities
you are involved in or specific needs to meet your workplace.
Some of the common items which should be included in a basic first aid kit are:
First Aid Items
crepe bandages of varying widths disposable gloves
hypoallergenic (skin) tape stainless steel pointed splinter
forceps (tweezers)
triangular bandages shock (thermal) blanket
adhesive dressing strips (such as safety pins
band aids) in different sizes
gauze swabs notepad and permanent marker
combine dressing pads (10cm x sterile saline tubes/sachets
10cm)
non-stick dressing pads (7.5cm x disposable resuscitation face shield
10cm)
sterile eye pad antiseptic skin swabs
alcohol swabs stop itch cream
stainless steel scissors (sharp/blunt) first aid booklet
12.5cm
Once you have assembled a basic first aid kit, you can customise it according to its intended
use. For example, if it is:
• for use at home, add extra items according to the number of people in your home
and their age, such as thick crepe bandages if you have older children who play a
sport or for use as a pressure immobilisation bandage
• for the car or caravan, add a highly reflective (day/night) safety triangle and vest as
you may be near a road and traffic
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• for camping, add thick crepe bandages, instant cold packs, disposable
poncho, plastic bags, whistle, compass, torch and glow stick
• For use on a boat, add a disposable poncho, plastic bags, whistle and glow stick. If
you are boating in waters where marine stingers are present, include vinegar to
pour over potential stings
• for babies, add extra items such as a digital thermometer, basic pain reliever
medications (such as paracetamol or ibuprofen) and plastic syringes for
accurate dosing
• for known medical conditions, add extra items, such as medicines and/or equipment
you normally use to manage the condition.
Note: Workplace first aid kits would have items unique to the workplace conditions and risk assessment outcomes. When you have collected all the articles for your first aid kit, you will need a bag or
container to store them safely. The storage container you choose does not have to be
expensive or designed especially for first aid supplies, but it should be:
• large enough to contain all the contents
• labelled as a first aid kit
• made of material that protects the contents from dust, moisture and contamination.
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2.6 Operating first aid equipment according
to manufacturer’s instructions
The most common piece of equipment that a first aider (and any untrained person) will use
to save a life is an Automated External Defibrillator (AED). The technology has advanced to
the point where it gives voice prompts when in its use so that any person who understands
simple English will be able to follow its instructions.
2.6.1 Background information on AEDs
An AED detects lethal heart rhythms which stop the heart from pumping efficiently and then
allows a responder to deliver a measured shock to a revert these rhythms so that the heart
can pump effectively again.
The importance of defibrillation has been well established as part of overall resuscitation,
along with effective cardiopulmonary resuscitation (CPR). An Automated External
Defibrillator (AED) must only be used for persons who are unresponsive and not
breathing normally. CPR must be continued until the AED is turned on and pads are
attached. The responder should then follow the AED prompts.
The time to defibrillate is a key factor that influences survival. For every minute defibrillation
is delayed, there is approximately 10% reduction in survival if the casualty is in cardiac
arrest due to Ventricular Fibrillation (VF), CPR alone will not save a person. Hence, a
defibrillator should be applied to the person in need as soon as it becomes available so that
a shock can be delivered if necessary.
The development of AEDs has made defibrillation part of basic life support. AEDs can
accurately identify the cardiac rhythm as “shockable” or “non-shockable”.
Australian First Aid Interesting facts about using an AED
Click here for more
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2.6.2 Who should use an AED?
The use of an AED should not be restricted to trained personnel. Allowing the use of an
AED by individuals without prior formal training can be beneficial and may be lifesaving.
While it is recommended that training in the use of AEDs be provided, the voice will allow
an untrained person to use the equipment safely. Even minimal exposure or training in the
speed of use or the correct pad placement can increase the rate of successful first aid
treatment.
The use of an AED by trained first aiders is recommended as this will increase survival
rates in those who have presented with cardiac arrest.
2.6.3 Public Access to AEDs The implementation of AED programs in public settings should be based on how effective it will
be. Because population and program characteristics affect survival, when implementing an
AED program, community and program leaders should consider factors, such as
• Location • Development of a team with responsibility for monitoring and maintaining the devices • Training and retraining programs for those who are likely to use the AED • Coordination with the local Emergency Services, and • Identification of a group of paid or volunteer individuals who are committed to using
the AED on those who are in cardiac arrest. Deployment of home AEDs for high-risk persons who do not have an implantable
cardioverter defibrillator (ICD) is safe and feasible, and may be considered on an individual
basis, but has not been shown to change overall survival rates.
Use of AEDs in public settings (airports, casinos, sports facilities, etc.) where witnessed
cardiac arrest is likely to can be useful if an effective response plan is in place. An AED can
and should be used on pregnant women who are in cardiac arrest.
2.6.4 Using the defibrillator
The AED will guide you through the entire process until help has arrived by providing
you with both visual and voice prompts.
If you are using the AED on a child aged between 1 - 8 you will ensure that the AED has
paediatric capabilities such as the correct voltage for children in this age range.
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You will also need paediatric pads which must be used when defibrillation on a child aged
between 1 – 8 is conducted.
Follow the visual and voice prompts of the AED and:
1. Call 000 If you see someone collapses, immediately call 000 and get the
paramedics en route. If there are other people around, choose
someone specific and instruct them to call 000 and explain the
situation. This decreases confusion about who should do what and
ensures that the call is being placed.
2. Check the If someone has collapsed, you should immediately determine casualty's whether they are breathing. If the casualty is breathing, you know
breathing and that they have a pulse. If the casualty is not breathing, check the
airway
airway is clear then begin CPR by giving 30 chest compressions at a
depth of one-third (1/3) of the chest thickness and then give two
breaths.
3. Locate an AED If there is an AED nearby, ask a bystander to bring the AED to you
while you continue CPR. Apply the AED electrode pads to the bare
chest of the casualty and follow the prompts as instructed.
Uninterrupted CPR is an important factor in increasing the recovery
rate of cardiac arrest patients.
4. Turn on the Follow the visual and voice prompts of the AED AED
5. Attach the First, ensure that the adhesive AED pads are attached to a cable,
electrode pads to which is plugged into the AED machine. Then bare the casualty's the casualty's chest including females and attach the adhesive AED pads in the
bare chest
appropriate locations. The AED should include a diagram (typically
(Expose the
on the adhesive pads themselves) indicating where each pad placed patient's bare
on the patient’s chest. It is important not to touch the casualty while chest, male or
the AED is "analysing" as it may detect your heart rhythm. female)
Always follow the instructions of the AED.
NOTE: CPR should not be interrupted while the adhesive electrode pads are being applied.
Source: Australian Defibrillators
How to perform CPR & use an iPad AED (defibrillator)
Click here for more
Page 92 of 111
2.7 Monitoring the casualty’s condition
Once you have provided the appropriate first aid treatment to a casualty, you need to
monitor their condition to ensure their condition remains stable.
2.7.1 Monitor and respond by first aid principles
Unconscious casualties take precedence over those who can communicate their condition;
it usually means they are responsive and that their condition is stable. However, you still
need to monitor their vital signs to ensure they aren’t deteriorating.
The four vital signs that require monitoring every five minutes are:
Vital Sign
Monitoring required
Pulse
• Adult 60-80 per minute
• Children (1-8 years) 70-140 per minute
• Infants (under one year) 90-160 per minute
Needs attention when the pulse is:
• Irregular
• Weak
• Too fast/slow
Breathing • Adult 12-18 per minute
• Child (1-8 years) 16-30 per minute
• Infants (under one year) 25-50 per minute
Needs attention when breathing is:
• Gasping
• Noisy
• Too slow/fast
• Painful
Consciousness Use the acronym AVPU to determine the level of consciousness:
A – Alert and responds to stimulus and voice.
V – Responds only to voice, no response to a stimulus.
P – Responds only to a small amount of pain, e.g. pin prick on hand
U – Unresponsive to all stimuli, unconscious
Skin colour/ • Skin colour is abnormal, e.g. blue or dark patches, grey skin overall, redness, abnormal temperature, sweating.
condition
• Check colour around the lips and under fingernails.
• Check capillary refill – should be less than 2 seconds.
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Section 3: Communicate details of the incident
Keeping accurate records of an incident has more than one face including:
• a record your assessments of the scene and casualties so that you can convey the
information to medical responders and maintain workplace emergency
documentation
• communicate certain details to medical staff, paramedics, carers and family
Confidentiality of those records should be a priority in all circumstances, and this topic
details the procedures for keeping records safe.
The topics that will be covered in this section include:
3.1 Convey incident details to emergency services
3.2 Reporting details of an incident to your supervisor
3.3 Completing relevant workplace documentation
3.4 Maintaining confidentiality of records and information
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3.1 Convey incident details to emergency services
As the first person on the scene of an incident that requires first aid assistance, your
accurate and detailed assessment of the scene will help the operator taking your call relay
your message to the most appropriate responders.
When you first arrive on the scene, assess and make notes as accurately as you can. If
possible, take photos and video with your cell phone, but not if it will drain your battery –
you need it to phone emergency services.
3.1.1 Conduct an accurate assessment
Using the triage principles (Topic 2.2.1) as the basis for your assessment, note the following
information to be given to the emergency service operator and responder:
Information for emergency service operator and responder
Quick Check if there is any danger to yourself, the casualty and assessment bystanders.
Check hazards and calculate risk posed by hazard.
Remove casualty from danger OR remove/eliminate danger.
NOTE: Electricity is the single biggest risk when providing first aid – make sure there aren’t any live electrical cables or danger of being electrocuted.
Identify the Check consciousness. nature of illness
Determine triage level or injury
Communicate Provide an accurate description of your location; if you have GPS information location give the coordinates.
Give the street address, closest cross street, landmarks.
Arrange to meet the emergency services at a particular point.
If you are travelling and saw an incident, mention the highway/main road, your direction of travel, what you remember about the location of the incident, and the last exit or town you went through.
The information you gather from your initial assessment will help the emergency
personnel provide the best response.
For example, if the casualty fell a deep ravine and could not be reached easily, the
emergency personnel will have specialised equipment to reach the casualty and place air
transport on notice.
Also, if you report that the casualty is trapped underneath a car and you can smell petrol,
the operator will notify the fire brigade who will dispatch the appropriate emergency
response team.
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3.2 Reporting details of an incident to your supervisor
If you are in a workplace situation, it is important that you follow your organisation's WHS
procedures when reporting any emergency incidents.
3.2.1 When to report a workplace incident
Part of the reporting procedures you should follow in the event of an emergency, injury or
illness will be reporting the incident to your supervisor as soon as possible.
If your organisation doesn’t have such procedures, you still must report the incident to the
correct authorities.
Safe Work Australia Incident Notification Information Sheet
Click here for more
Under the Workplace Health and Safety Act must ensure that:
• a “notifiable incident” be reported to the regulator immediately after becoming
aware it has happened
• if the regulator asks, written notification within 48 hours of the request, and
• the incident site to be preserved until an inspector arrives or directs otherwise (subject to some exceptions).
Failing to report a “notifiable incident” is an offence and penalties apply.
A “notifiable incident” is the death of a person, a “serious injury or illness”, or a “dangerous
incident” arising out of the conduct of a business or undertaking at a workplace.
“Notifiable incidents” may relate to any person, whether an employee, contractor or
member of the public.
The WHS Act also specifies the duties of the PCBU and its employees as follows:
Workplace duties relating to first aid
PCBU’s, such as company directors, have a duty to exercise due diligence to
ensure that the business or undertaking complies with the WHS Act and
Regulations. This includes taking reasonable steps to ensure that the
business or undertaking has and uses appropriate resources and processes
to eliminate or minimise risks to health and safety.
Workers have a duty to take reasonable care for their health and safety and
must not adversely affect the health and safety of other persons. Workers must
comply with any reasonable instruction and cooperate with any reasonable
policy or procedure relating to health and safety at the workplace, such as
procedures for first aid and for reporting injuries and illnesses.
Source: Safe Work Australia
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3.3 Completing relevant workplace documentation
During your induction, your supervisor should have given you the organisation’s
compendium of policies and procedures, including the incident reporting form. Make sure the
form is easily accessible should you need to report an incident.
3.3.1 Reporting details of an incident
As a first aid officer in the workplace, you are responsible for keeping records of all
incidents, whether they are notifiable or not. This protects the company from fraudulent
claims and safeguards you should a worker sue you for negligence.
A typical incident report will have the following information:
Inclusions in a typical incident report
Dates and times When did the incident occur?
Was the worker on official duty?
Work status Did the injured/ill person stop work (dates)?
Did the person return:
• To standard/previous work
• To alternative work
Was the person:
• Treated by a doctor
• Managed by a first aid officer on site
• Hospitalised
Did the worker claim compensation (details)?
Did the worker need rehabilitation?
Comments Observations on the incident, what caused it, what tools were used, environmental factors, the health status of the casualty, whether they were intoxicated/on drugs, etc.
Risk assessment Likelihood of incident occurring again.
Severity of outcome (on a predetermined scale).
Measures to prevent recurrence (training, change in process, etc.)
Dates and times the measures were implemented.
Report details Name and signature of persons dealing with the case (first aid officer, supervisor, witnesses, etc.)
Dates and times of signature.
Contact details of above persons.
Details of WHS review, if applicable (meetings, officers, representatives, etc.)
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3.3.2 Reporting details of incidents involving babies and children to
parents and caregivers
Any incident that involves a child or infant is traumatic, and if the child is in the care of
somebody other than the parents/guardians/caregivers, the incident must be reported
to them and the authorities.
Verbally reporting minor incidents* (cuts, abrasions) to the parents/guardians/caregivers
is adequate, but for serious incidents, the law stipulates that you need to report the details
to the authorities as well.
If you are operating an education and care service, you must adhere to the entire Education
and Care Services National Law Act. The following section deals specifically with reporting
an incident to the authorities.
Education and Care Services National Law Act 2010, No. 69 of 2010
174 Offence to fail to notify certain information to Regulatory Authority
(2) An approved provider must notify the Regulatory Authority of the following information
about an education and care service which is operated by the approved provider—
(a) any serious incident at the approved education and care service;
(5) In this section - serious incident means an incident or class of incidents prescribed by
the national regulations as a serious incident.
Source: Victorian Legislation and Parliamentary Documents
For more information on the legislations and regulations which must be followed if providing
care to infants and children go to the following websites:
State or Territory Legislation Application Act
Victoria Education and Training Victoria
New South Wales Children (Education and Care Services National Law Application) Act 2010
Australian Capital Education and Care Services National Law Territory
Education and Care (ACT) Act 2011
Northern Territory Services National Law
Education and Care Services (National Act 2010
Uniform Legislation) ACT 2011
South Australia Education and Early Childhood Services (Registration and Standards) Act 2011
Tasmania Education and Care Services National Law (Application) Act 2011
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State or Territory Legislation Application Act
Queensland Education and Care Services National Law (Queensland) Act 2011
Western Australia Education and Care Services National Law
(WA) Act 2012
From: Australian Children’s Education and Care Quality Authority
3.3.3 Reporting serious incidents to the regulatory authority
Each industry has its procedure to report serious incidents, but the WHS Act governs the law
that requires workplace incident reporting.
If a notifiable incident occurs, the WHS Act specifies that:
• immediate notification of a “notifiable incident” to the regulator, after becoming
aware of it • if the regulator asks—written notification with 48 hours of the request, and • preservation of the incident site until an inspector arrives or directs otherwise.
Notifiable VS Non-Notifiable Incidents: What’s the Difference?
Click here for more
For more information on notifiable incidents, please contact your work health and safety
regulator.
If you need to report a workplace incident contact the regulator in your jurisdiction (see table
below).
Jurisdiction
Regulator
Telephone
Website
New South Wales Safe work NSW 13 10 50 safework.nsw.gov.au
Victoria Victorian WorkCover 1800 136 089 worksafe.vic.gov.au
Authority
Queensland Workplace Health and 1300 362 128 worksafe.qld.gov.au Safety Queensland
South Australia SafeWork SA 1300 365 255 safework.sa.gov.au
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Western Australia WorkSafe WA 1300 307 877 worksafe.wa.gov.au
Australian Capital WorkSafe ACT 02 6207 3000 worksafety.act.gov.au
Territory
Tasmania WorkSafe TAS 1300 366 322 worksafe.tas.gov.au
(Within Tasmania)
03 6233 7657 (External)
Northern Territory NT WorkSafe 1800 019 115 worksafe.nt.gov.au
Commonwealth Comcare 1300 366 979 comcare.gov.au
From: Safe Work Australia: Workplace Incidents Reporting
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3.4 Maintaining confidentiality of records and information
A first aid provider is in a position of trust: the casualty trusts you to save their life or at
least alleviate their suffering.
That measure of confidence extends to details about the incident – their health status, the
care you gave them, medication, and recuperation. They trust you to keep their records safe
and confidential. In addition to that trust, as a practitioner in the medical profession, you are
bound by law to keep records private and confidential.
3.4.1 The Privacy Act 1988
The Australian Privacy Act 1988 regulates the handling of personal information about
individuals. Personal information is information or an opinion about an identified individual,
or an individual who is reasonably identifiable.
The Privacy Act includes thirteen Australian Privacy Principles (APPs). The APPs set out
standards, rights and obligations for the handling, holding, use, accessing and correction of
personal information (including sensitive information).
With reference to “health service providers”, the Act describes the responsibilities in
keeping records safe and confidential:
As stated in the Privacy Act 1988, a "health service" includes any activity that involves:
• assessing, maintaining or improving a person's physical or psychological health • where a person’s health cannot be maintained or improved – managing the person’s
physical or psychological health • diagnosing or treating a person's illness, disability or injury • recording a person’s physical or psychological health for the purposes of
assessing, maintaining, improving or managing the person’s health • dispensing a prescription drug or medicinal preparation by a pharmacist.
This includes activities that take place during the provision of aged care, palliative care
or care for a person with a disability.
Examples of organisations providing a health service include:
• traditional health service providers, such as private hospitals, day surgeries, medical
practitioners, pharmacists and allied health professionals • complementary therapists, such as naturopaths and chiropractors • gyms and weight loss clinics • child care centres and private schools.
The Privacy Act regulates how these organisations collect and handle personal
information, including health information. It also includes provisions that allow an individual
to access information held about them. The Office of the Australian Information
Commissioner (OAIC) also regulates the handling of health information held in an
individual's My Health Record, and the handling of healthcare identifiers.
The OAIC has developed privacy fact sheets, and business resources to help individuals and
organisations providing a health service understand their rights and responsibilities. Further
information about health and medical research is also available on the FAQS for individuals — Health and FAQs for health service providers.
Source: Office of the Australian Information Commissioner
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3.4.2 Organisational policies and procedures
Australian businesses are required to keep records prescribed by federal law. Apart from
the usual business requirements, WHS legislation specifies how you should deal with
medical information and privacy as follows:
Health and medical information are a central concern of the Commonwealth
privacy law that covers Australian businesses. The Privacy Act 1988 aims to
protect the privacy of individuals and to enable people to have their complaint
investigated if they believe the privacy of their personal information has been
compromised. Under the Act, a set of privacy principles known as the
Australian Privacy Principles (APPs) regulates the handling of personal
information, including medical information.
Sensitive information
Information or an opinion about an individual’s health falls into the category of
‘sensitive information’, together with other matters including the person’s
genetic or biometric information, racial or ethnic origin, sexual preferences and
political or religious opinions, beliefs or affiliations. Health and medical
information collected by employers may consist of the results of pre-
employment medicals, periodic medicals to assess fitness for duty, health
monitoring for exposure to hazardous chemicals, workers’ compensation
claims and retirement medicals.
Sensitive information is given a higher level of protection than general
personal information of the type that employers often collect about their
employees, such as the content of their personnel files, referees’ reports and
similar material.
However, the handling of an individual's personal information, including
health information, by a private sector employer is exempt from the Privacy
Act if it is directly related to that person's employee record or current or
former employment relationship.
Source: Workplace OHS
Storing employee records
Apart from the legal requirements, personal information, especially relating to health,
should be kept confidential and in a way, that designated personnel can access them
quickly. The two methods to maintain confidential records are generally:
• Paper-based – o Ensure proper policies and procedures are in place o Keep documents locked in a fireproof cabinet/room o Give access only to designated personnel o Maintain a paper document management system
• Electronic – o Investigate the advantages and disadvantages of electronic recordkeeping o Ensure proper policies and procedures are in place o Keep an electronic document management system
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Private first aid providers
Privacy and confidentiality are basic human rights, and we all have the essential need to
keep our medical information private.
As a first aider, you need to keep all information of the incident private and confidential
(refer to Topic 3.1) and not speak to media, unauthorised people, and even family; ask
permission from the casualty to discuss the details. Not only is confidentiality good ethics,
but sharing information without permission is also illegal.
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Section 4: Evaluating the incident
First aid providers risk mental and physical stress due to ongoing traumatic incidents. The
adrenaline rush of saving a life is in stark contrast to losing a casualty whose life you saved
only to have them pass away shortly after, or being unable to save a life at the scene.
It is easy to work through the impact of one event, but it becomes difficult the more incidents
you attend to; you need emotional and mental support to ensure you don't become a
medical emergency yourself.
First aid isn’t just about the physical application of your skills and knowledge; first aid also
means supporting those affected by a traumatic incident and such support also takes its toll
on you.
The topics that will be covered in this section include:
4.1 Evaluating the possible psychological impacts when providing first aid
4.2 Talking with children about their emotions and responses to events
4.3 Participating in a debriefing with your supervisor
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4.1 Evaluating the possible psychological impacts when
providing first aid
Stress is defined as mental, physical, or emotional strain caused by ongoing negative
external events, activities, or another stimulus, which can be a chemical or biological agent,
and environmental condition.
4.1.1 Recognising the possible impact on yourself and others following
an emergency
The psychological impact of providing first aid has many physical consequences and if
left untreated could mean that you might need first aid yourself.
Some of the more common signs and symptoms are provided in the table below:
Signs and symptoms
Inability to ward off colds and flu Irritable
Depression Eating disorders
Anger Swearing
Decreased memory Anxiety
Muscle aches Frequent/uncontrolled crying
Impatience Muscle cramps
Loss of sense of humour/don’t laugh Impatient
Change in general behaviour Too much alcohol
Poor judgement Unable to focus
There are also physical signs that you are suffering from stress, and if you are concerned,
you should seek advice as soon as possible to avoid the issue from escalating.
Stress Symptoms, Signs, and Causes The harmful effects of stress and what you can do about it.
Click here for more
Page 105 of 111
Consequences of stress
Stress affects all parts of the body, and if you don't manage the effects, the body's defence
mechanisms break down so that you are no longer able to fight off diseases and illnesses
that you would normally be able to fight off, obesity or anorexia from changed eating habits,
heart problems, and diabetes.
Managing stress
To counteract the effects of stress:
1. Recognise that there is a problem 2. Discuss the problem 3. Implement stress-management techniques
a. Counselling or group therapy b. Improve diet and boost immune system c. Partake in relaxation techniques, such as yoga, tai chi, meditation d. Do exercise unrelated to your first aid environment, e.g. golf
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4.2 Talking with children about their emotions
and responses to events
Children experience and express the effects of stress differently to that of adults, and the
stressors that are “normal” for adults become overwhelming for children. The reason being
that they have no point of reference to which they can compare the event. If the child doesn’t
deal with the emotional impact of the event, it could affect their brain development and
cause health problems.
4.2.1 Dealing with children’s emotions in an emergency
According to Kids Matter, a mental health promotion, prevention and early intervention
initiative set in primary schools and early childhood education and care (ECEC) services –
like preschools, kindergartens and day care centres, kids experience three types of
stress.
How kids experience stress
1. Positive stress response - is considered as a normal part of healthy
development, for example, going to school camp or starting at a new school.
When experienced in a supportive environment, it can provide important
opportunities to learn and practise healthy responses to life changes.
2. Tolerable stress response – activates the body’s alert systems to a greater degree because of more severe, longer-lasting stressors, for example, parental divorce, illness or injury, or bullying at school.
3. Toxic stress response – can occur when a child experiences robust and prolonged multiples stressful events without adequate adult support, for example, physical or emotional abuse, chronic neglect, parental mental illness, or exposure to violence. It can disrupt early brain development and lead to many health problems.
The good news is that the damaging effects of toxic stress can be prevented or
reversed if the child is placed in a supportive environment with caring adults as
early in life as possible. Children experiencing tolerable (and especially toxic)
stress may require the support from a mental health specialist who can provide
ongoing therapeutic support and counselling. Telephone and online counselling
services like Kids Helpline can also be helpful for children (and parents).
Source: Kids matter
The loss of a loved one or severe disability resulting from a traumatic event cause post-
traumatic stress disorder (PTSD) in children. An organisation called Women’s and Children’s
Health Network are committed to providing health and parenting information based on the
latest research and best practice by offering:
• support to parents in areas of parenting • health services for infants, children and young people
• support for families and children with additional needs • up-to-date health information for parents, children and young people.
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Their website outlines the support interventions for children with PTSD; although they focus
on parents’ support, as the first aid provider, you need to step into that role to provide the
best care for the child (where you can).
Kids Matter The signs, symptoms, and management of trauma in children
Click here for more
Armed with the appropriate information you are also able to support the parent/guardian so
that they can support the child further. The following information has been adapted from the
Women’s and Children’s Health Network and will be useful when dealing with how children
respond to events:
What you can do
• Let your children know you are there for them, keep them close and hug them
• Allow the child to talk when they feel ready
• Ask older children how they would like you to help or support them
• Talk to the child’s brothers and sisters about what is happening/has happened and listen to their feelings as well
• Sometimes reading stories about a child or animal in a similar situation can help children feel more in control
• Keep the child's normal routine going as much as possible, this provides a feeling of safety
• Protect children from adults who are insensitive or do not understand
• Be patient and don’t expect too much too soon
• Don't expect too much too soon.
• Remember to let the child's teacher or child care worker know what has happened so they can be ready to support your child.
It may be helpful to minimise the amount of extra stress your child must deal with, e.g. from television, newspapers.
Adapted from: Women and Children’s Health Network
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4.3 Participating in a debriefing session with your
supervisor
Dealing effectively with an emergency can be quite detailed, so it is important to discuss the
event once you have completed your hand over to the appropriate emergency services. It is
important that debriefing sessions are completed as soon as possible so that any additional
support which may be needed can be provided.
Debriefing consists of two (2) major actions which involve:
• Discussing the incident and making sure you have the proper psychological support
• Working as part of a team it is important to debrief others who were witness to or
were involved in in the incident
4.3.1 Critical Incident Stress Debriefing (CISD)
If you have had to manage a critical incident, it is important to manage this by conducting
or participating in a Critical Incident Stress Debriefing (CISD).
The primary objectives of this type of debriefing are to:
• Mitigate or reduce the impact of the incident • Provide facilitation of the standard recovery process. This includes restoring the
normal, healthy psychological functions, following a distressing and disturbing event
• Identify anyone who may benefit from additional support services and referral to
professional care if needed.
To complete a CISD debriefing, there are seven (7) phases, plus follow-up, consisting of:
Phase
Process
1. Introduction In this phase, the team members introduce themselves and
describe the process.
2. Facts Only extremely brief overviews of the facts are requested.
3. Thoughts The thought phase is a transition from the cognitive domain
toward the affective domain.
4. Reactions The reaction phase is the heart of a Critical Incident Stress
Debriefing.
5. Symptoms Team members ask questions and listen carefully for common
symptoms associated with exposure to traumatic events.
6. Teaching The team conducting the Critical Incident Stress Debriefing
normalises the symptoms brought up by participants.
7. Re-entry The participants may ask questions or make final statements.
Follow-up The CISD is usually followed by refreshments to facilitate the beginning of monitoring services.
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Critical Incident Stress Debriefing (CISD) The CISD process
Click here for more
4.3.2 Organisational debriefing process
It is important that you follow your organisation’s debriefing procedures to ensure you
applied first aid according to legal and organisational guidelines. Ensure you have all the
correct documents and that you filled them in according to the information at your disposal.
When you are preparing for the debriefing with your supervisor, ask yourself the
following questions:
• Did you provide first aid within you current training and mandate?
• Did the organisation provide appropriate training for the type of incident you had to
attend, and did you complete that training?
• Did you follow the organisation’s procedures and action plans? If not, why not? (Discuss possible improvements from lessons learned.)
• Was there a problem with communication?
• Was there a problem with communication technology?
• Was all the required first aid equipment available?
Private capacity
If you provided first aid in your personal capacity, talk to the medical responders whenever
it is convenient so that you can identify areas for improvement.
You could also follow up with medical staff if the person you rescued had to be hospitalised.
Take any constructive criticism as an opportunity to learn from what you did wrong as well
as acknowledge the praise for what you did right.
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Acknowledgments
Australian https://resus.org.au/guidelines/
Resuscitation Council https://resus.org.au/glossary/
Safe Work Australia https://www.safeworkaustralia.gov.au/doc/model-code-practice-first-aid-workplace
The Department of http://www.health.gov.au/internet/publications/publishing.nsf/Content/cardio-pubs-
Health review~cardio-pubs-review-08-currentprograms~cardio-pubs-review-08-
currentprograms-1-pb
Australian Children’s http://files.acecqa.gov.au/files/National-Quality-Framework-Resources-Kit/NQF-
Education & Care Resource-02-Guide-to-ECS-Law-Regs.pdf
Quality Authority
Collins Dictionary https://www.collinsdictionary.com/
Australian Red Cross http://redcross.e3learning.com.au/content/sfademo/topic2/page2/
Attorney-General’s https://www.triplezero.gov.au/pages/usingotheremergencynumbers.aspx
Department
Epilepsy Society https://www.youtube.com/watch?v=dv3agW-DZ5I
ACT Emergency http://cdn.esa.act.gov.au
Services Agency
Sydney Uni Sport and https://www.susf.com.au/files/Chapter_2_Approach_to_the_Incident.pdf
Fitness
Adapted from: https://s-media-cache-
BayCare’s Helpful Tips ak0.pinimg.com/236x/c3/7f/86/c37f86573a6895c600946880d8a26110.jpg
on ER vs. Urgent Care
Life Saving Solutions https://www.youtube.com/watch?v=ItI6KQknee8
Training Aid Australia https://www.youtube.com/watch?v=BjKb_hNNeTM
UNMC HEROES https://www.youtube.com/watch?v=9QHDs10e-G0
Australian First Aid http://www.australianfirstaid.com.au/defibrillators/facts-you-should-know/
Australian (http://www.aeds.com.au/use-an-aed.html)
Defibrillators U Tube https://www.youtube.com/watch?v=7lhSd5ONbNY
Victorian Legislation http://www.legislation.vic.gov.au
and Parliamentary
Documents
Office of the Australian https://www.oaic.gov.au/privacy-law/privacy-act/health-and-medical-
Information research#health-service-providers
Commissioner
Kids Matter https://www.helpguide.org/articles/stress/stress-symptoms-causes-and-effects.htm
Women and Children’s http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=160
Health Network 8
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