First aid

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The universal first aid symbol ISO 7010 E003 - First aid sign.svg
The universal first aid symbol
A US Navy corpsman gives first aid to an injured Iraqi citizen. US Navy 030322-M-6270B-010 A U.S. Navy Corpsman assigned to the 15th Marine Expeditionary Unit (Special Operations Capable) gives first aid to an injured Iraqi citizen.jpg
A US Navy corpsman gives first aid to an injured Iraqi citizen.

First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, [1] with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health, [2] while psychological first aid is used as early treatment of people who are at risk for developing PTSD. [3] Conflict first aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in Canada.

Contents

There are many situations that may require first aid, and many countries have legislation, regulation, or guidance, which specifies a minimum level of first aid provision in certain circumstances. This can include specific training or equipment to be available in the workplace (such as an automated external defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. Generally, five steps are associated with first aid:

  1. Assess the surrounding areas.
  2. Move to a safe surrounding (if not already; for example, road accidents are unsafe to be dealt with on roads).
  3. Call for help: both professional medical help and people nearby who might help in first aid such as the compressions of cardiopulmonary resuscitation (CPR).
  4. Perform suitable first aid depending on the injury suffered by the casualty.
  5. Evaluate the casualty for any fatal signs of danger, or possibility of performing the first aid again.

Early history and warfare

Skills of what is now known as first aid have been recorded throughout history, especially in relation to warfare, where the care of both traumatic and medical cases is required in particularly large numbers. The bandaging of battle wounds is shown on Classical Greek pottery from c.500 BC, whilst the parable of the Good Samaritan includes references to binding or dressing wounds. [4] There are numerous references to first aid performed within the Roman army, with a system of first aid supported by surgeons, field ambulances, and hospitals. [5] Roman legions had the specific role of capsarii, who were responsible for first aid such as bandaging, and are the forerunners of the modern combat medic. [6]

Further examples occur through history, still mostly related to battle, with examples such as the Knights Hospitaller in the 11th century AD, providing care to pilgrims and knights in the Holy Land. [7]

Formalization of life saving treatments

During the late 18th century, drowning as a cause of death was a major concern amongst the population. In 1767, a society for the preservation of life from accidents in water was started in Amsterdam, and in 1773, physician William Hawes began publicizing the power of artificial respiration as means of resuscitation of those who appeared drowned. This led to the formation, in 1774, of the Society for the Recovery of Persons Apparently Drowned, later the Royal Humane Society, who did much to promote resuscitation. [8] [9]

Napoleon's surgeon, Baron Dominique-Jean Larrey, is credited with creating an ambulance corps, the ambulance volantes , which included medical assistants, tasked to administer first aid in battle. [10]

In 1859, Swiss businessman Jean-Henri Dunant witnessed the aftermath of the Battle of Solferino, and his work led to the formation of the Red Cross, with a key stated aim of "aid to sick and wounded soldiers in the field". [7] The Red Cross and Red Crescent are still the largest provider of first aid worldwide. [11]

Esmarch bandage showing soldiers how to perform first aid Esmarch original.jpg
Esmarch bandage showing soldiers how to perform first aid

In 1870, Prussian military surgeon Friedrich von Esmarch introduced formalized first aid to the military, and first coined the term "erste hilfe" (translating to 'first aid'), including training for soldiers in the Franco-Prussian War on care for wounded comrades using pre-learnt bandaging and splinting skills, and making use of the Esmarch bandage which he designed. [4] The bandage was issued as standard to the Prussian combatants, and also included aide-memoire pictures showing common uses.

In 1872, the Order of Saint John of Jerusalem in England changed its focus from hospice care, and set out to start a system of practical medical help, starting with making a grant towards the establishment of the UK's first ambulance service. This was followed by creating its own wheeled transport litter in 1875 (the St John Ambulance), and in 1877 established the St John Ambulance Association (the forerunner of modern-day St John Ambulance) "to train men and women for the benefit of the sick and wounded". [12]

Also in the UK, Surgeon-Major Peter Shepherd had seen the advantages of von Esmarch's new teaching of first aid, and introduced an equivalent programme for the British Army, and so being the first user of "first aid for the injured" in English, disseminating information through a series of lectures. Following this, in 1878, Shepherd and Colonel Francis Duncan took advantage of the newly charitable focus of St John, [4] and established the concept of teaching first aid skills to civilians. The first classes were conducted in the hall of the Presbyterian school in Woolwich (near Woolwich barracks where Shepherd was based) using a comprehensive first aid curriculum.

First aid training began to spread through the British Empire through organisations such as St John, often starting, as in the UK, with high risk activities such as ports and railways. [13]

Aims of first aid

The primary goal of first aid is to prevent death or serious injury from worsening. The key aims of first aid can be summarized with the acronym of 'the three Ps': [14]

It is important to note that first aid is not medical treatment and cannot be compared with what a trained medical professional provides. First aid involves making common sense decisions in the best interest of an injured person.

Setting the priorities

Protocols such as ATLS, BATLS, SAFE-POINT are based on the principle of defining the priorities and the procedure where the correct execution of the individual steps achieves the required objective of saving human life.

Basic points of these protocols include the mnemonic ABCDE or cABCDE:

A major benefit of these protocols is that they require minimum resources, time and skills with a great degree of success in saving lives under conditions unfavourable for applying first aid.

ABCDE method

Source: [15]

Key basic skills

In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway. Tongue blocking airway.svg
In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation. [16] The same mnemonic is used by emergency health professionals. Attention must first be brought to the airway to ensure it is clear. An obstruction (choking) is a life-threatening emergency. If an object blocks the airway, it requires anti-choking procedures. Following any evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary.

Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients.

Some organizations add a fourth step of "D" for Deadly bleeding or Defibrillation , while others consider this as part of the Circulation step simply referred as Disability. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments or examination, as required if they possess the proper training (such as measuring pupil dilation). [17] Some organizations teach the same order of priority using the "3Bs": Breathing, Bleeding, and Bones (or "4Bs": Breathing, Bleeding, Burns, and Bones). While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of both artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway.

Skills applicable to the wider context are reflected in the mnemonic AMEGA, which refers to the tasks of "assess", "make safe", "emergency aid", "get help" and "aftermath". The aftermath tasks include recording and reporting, continued care of patients and the welfare of responders and the replacement of used first aid kit elements. [18]

Preserving life

The patient must have an open airway—that is, an unobstructed passage that allows air to travel from the open mouth or uncongested nose, down through the pharynx and into the lungs. Conscious people maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to do so, as the part of the brain that manages spontaneous breathing may not be functioning.

Whether conscious or not, the patient may be placed in the recovery position, laying on their side. In addition to relaxing the patient, this can have the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked by a foreign object. To dislodge the object and solve the choking case, the first aider may use anti-choking methods (such as 'back slaps' and 'abdominal thrusts').

Once the airway has been opened, the first aider would reassess the patient's breathing. If there is no breathing, or the patient is not breathing normally (e.g., agonal breathing), the first aider would initiate CPR, which attempts to restart the patient's breathing by forcing air into the lungs. They may also manually massage the heart to promote blood flow around the body.

If the choking person is an infant, the first aider may use anti-choking methods for babies. During that procedure, series of five strong blows are delivered on the infant's upper back after placing the infant's face in the aider's forearm. If the infant is able to cough or cry, no breathing assistance should be given. Chest thrusts can also be applied with two fingers on the lower half of the middle of the chest. Coughing and crying indicate the airway is open and the foreign object will likely to come out from the force the coughing or crying produces. [19]

A first responder should know how to use an Automatic External Defibrillator (AED) in the case of a person having a sudden cardiac arrest. The survival rate of those who have a cardiac arrest outside of the hospital is low. Permanent brain damage sets in after five minutes of no oxygen delivery, so rapid action on the part of the rescuer is necessary. An AED is a device that can examine a heartbeat and produce electric shocks to restart the heart. [20]

A first aider should be prepared to quickly deal with less severe problems such as cuts, grazes or bone fracture. They may be able to completely resolve a situation if they have the proper training and equipment. For situations that are more severe, complex or dangerous, a first aider might need to do the best they can with the equipment they have, and wait for an ambulance to arrive at the scene.

List of injuries and diseases that require first aid

Many accidents can happen in homes, offices, schools and laboratories, and require immediate attention before the patient is attended by the doctor.

First aid kits

A first aid box A first aid box.jpg
A first aid box

A first aid kit consists of a strong, durable bag or transparent plastic box. They are commonly identified with a white cross on a green background. A first aid kit does not have to be bought ready-made. The advantage of ready-made first aid kits are that they have well organized compartments and familiar layouts.

Contents

There is no universal agreement upon the list for the contents of a first aid kit. The UK Health and Safety Executive stress that the contents of workplace first aid kits will vary according to the nature of the work activities. [25] As an example of possible contents of a kit, British Standard BS 8599 First Aid Kits for the Workplace [26] lists the following items:

  • Information leaflet
  • Medium sterile dressings
  • Large sterile dressings
  • Bandages
  • Triangular dressings
  • Safety pins
  • Adhesive dressings
  • Sterile wet wipes
  • Microporous tape
  • Nitrile gloves
  • Face shield
  • Foil blanket
  • Burn dressings
  • Clothing shears
  • Conforming bandages
  • Finger dressing
  • Antiseptic cream
  • Scissors
  • Tweezers
  • Cotton

Training Principles

First aid scenario training in progress Suicide-prague.jpg
First aid scenario training in progress

Basic principles, such as knowing the use of adhesive bandage or applying direct pressure on a bleed, are often acquired passively through life experiences. However, to provide effective, life-saving first aid interventions requires instruction and practical training. This is especially true where it relates to potentially fatal illnesses and injuries, such as those that require CPR; these procedures may be invasive, and carry a risk of further injury to the patient and the provider. As with any training, it is more useful if it occurs before an actual emergency. And, in many countries, calling emergency medical services allows listening basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes.

1.Junior level certificate Basic Life Support

2.Senior level certificate

3.Special certificate

Types of first aid which require training

Shown here is an example of a way for people to practice CPR in a safe and reliable manner. Resusci Anne - CPR dummy.jpg
Shown here is an example of a way for people to practice CPR in a safe and reliable manner.

There are several types of first aid (and first aider) that require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

First aider of the British Red Cross accompanies parade of morris dancers at the Knutsford Royal May Day, Knutsford, Cheshire, England, 2012 First aider in parade.jpg
First aider of the British Red Cross accompanies parade of morris dancers at the Knutsford Royal May Day, Knutsford, Cheshire, England, 2012

First aid services

Some people undertake specific training in order to provide first aid at public or private events, during filming, or other places where people gather. They may be designated as a first aider, or use some other title. This role may be undertaken on a voluntary basis, with organisations such as the Red Cross society and St. John Ambulance, [27] or as paid employment with a medical contractor.

People performing a first aid role, whether in a professional or voluntary capacity, are often expected to have a high level of first aid training and are often uniformed.

Symbols

Although commonly associated with first aid, the symbol of a red cross is an official protective symbol of the Red Cross. According to the Geneva Conventions and other international laws, the use of this and similar symbols is reserved for official agencies of the International Red Cross and Red Crescent , and as a protective emblem for medical personnel and facilities in combat situations. Use by any other person or organization is illegal, and may lead to prosecution.

The internationally accepted symbol for first aid is the white cross on a green background shown below.

Some organizations may make use of the Star of Life, although this is usually reserved for use by ambulance services, or may use symbols such as the Maltese Cross, like the Order of Malta Ambulance Corps and St John Ambulance. Other symbols may also be used.

Related Research Articles

<span class="mw-page-title-main">Emergency medical services</span> Services providing acute medical care

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

<span class="mw-page-title-main">Cardiopulmonary resuscitation</span> Emergency procedure for cardiac arrest

Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

<span class="mw-page-title-main">Asphyxia</span> Severely deficient supply of oxygen

Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects all the tissues and organs, some more rapidly than others. There are many circumstances that can induce asphyxia, all of which are characterized by the inability of a person to acquire sufficient oxygen through breathing for an extended period of time. Asphyxia can cause coma or death.

A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified person, as some of these emergencies, such as cardiovascular (heart), respiratory, and gastrointestinal cannot be dealt with by the victim themselves. Dependent on the severity of the emergency, and the quality of any treatment given, it may require the involvement of multiple levels of care, from first aiders through emergency medical technicians, paramedics, emergency physicians and anesthesiologists.

<span class="mw-page-title-main">Mouth-to-mouth resuscitation</span> Artificial ventilation using exhaled air from the rescuer

Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own. It is used on a patient with a beating heart or as part of cardiopulmonary resuscitation (CPR) to achieve the internal respiration.

<span class="mw-page-title-main">Choking</span> Mechanical obstruction of the flow of air from the environment into the lungs

Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen deprivation. Although oxygen stored in the blood and lungs can keep a person alive for several minutes after breathing stops, choking often leads to death.

<span class="mw-page-title-main">Abdominal thrusts</span> First aid procedure

Abdominal thrusts, also known as the Heimlich maneuver or Heimlich manoeuvre, is a first-aid procedure used to treat upper-airway obstructions by foreign objects. American doctor Henry Heimlich is often credited for its discovery. To perform abdominal thrusts, a rescuer stands behind a choking victim and using the hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on the object lodged in the trachea in an effort to expel it.

<span class="mw-page-title-main">First aid kit</span> Collection of supplies and equipment that is used to give medical treatment

A first aid kit or medical kit is a collection of supplies and equipment used to give immediate medical treatment, primarily to treat injuries and other mild or moderate medical conditions. There is a wide variation in the contents of first aid kits based on the knowledge and experience of those putting it together, the differing first aid requirements of the area where it may be used, and variations in legislation or regulation in a given area.

<span class="mw-page-title-main">Recovery position</span> First aid technique

In first aid, the recovery position is one of a series of variations on a lateral recumbent or three-quarters prone position of the body, often used for unconscious but breathing casualties.

<span class="mw-page-title-main">Automated external defibrillator</span> Portable electronic medical device

An automated external defibrillator or automatic electronic defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them through defibrillation, the application of electricity which stops the arrhythmia, allowing the heart to re-establish an effective rhythm.

<span class="mw-page-title-main">Battlefield medicine</span> Treatment of wounded combatants and non-combatants in or near an area of combat

Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.

Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers. It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders.

<span class="mw-page-title-main">Internal bleeding</span> Medical condition

Internal bleeding is a loss of blood from a blood vessel that collects inside the body, and is not usually visible from the outside. It can be a serious medical emergency but the extent of severity depends on bleeding rate and location of the bleeding. Severe internal bleeding into the chest, abdomen, pelvis, or thighs can cause hemorrhagic shock or death if proper medical treatment is not received quickly. Internal bleeding is a medical emergency and should be treated immediately by medical professionals.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

Outdoor emergency care (OEC) was first developed by the National Ski Patrol in the 1980s for certification in first aid, and other pre-hospital care and treatment for possible injuries in non-urban settings. Outdoor emergency care technicians provide care at ski resorts, wilderness settings, white-water excursions, mountain bike events, and in many other outdoor environments.

<span class="mw-page-title-main">ABC (medicine)</span> Mnemonic for Airway, Breathing, and Circulation

ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective: a viable Airway is necessary for Breathing to provide oxygenated blood for Circulation. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.

The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.

The following outline is provided as an overview of and topical guide to emergency medicine:

<span class="mw-page-title-main">Basic airway management</span>

Basic airway management is a concept and set of medical procedures performed to prevent and treat airway obstruction and allow for adequate ventilation to a patient's lungs. This is accomplished by clearing or preventing obstructions of airways. Airway obstructions can occur in both conscious and unconscious individuals. They can also be partial or complete. Airway obstruction is commonly caused by the tongue, the airways itself, foreign bodies or materials from the body itself, such as blood or vomit. Contrary to advanced airway management, basic airway management technique do not rely on the use of invasive medical equipment and can be performed with less training. Medical equipment commonly used includes oropharyngeal airway, nasopharyngeal airway, bag valve mask, and pocket mask. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.

Choking rescue training devices are choking simulation equipment used by first aid learners to prepare for dealing with real world choking scenarios. They have been approved and used by the European Resuscitation Council, St John Ambulance, and International Red Cross and Red Crescent Movement. The simulation devices are used to demonstrate choking rescue techniques such as abdominal thrusts and backslap method and practice choking rescue protocols by American Heart Association and Red Cross.

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