Student Notes

First Aid is the provision of emergency care for an injured or ill person(s), prior to the arrival of professional medical personnel on the scene. It is important to remember you are not being trained as a paramedic, nurse or doctor. Your role is to provide basic support for the casualty, until you are relieved by professional assistance.

It is the initial care of the sick or injured prior to medical care; your ability to remain calm and in control is an important part of successfully managing a casualty situation. Gaining confidence in your own abilities to deal with the situations that may arise is the key focus of this course.

A major role in first aid treatment is reassuring the casualty, thereby gaining their trust through your ability to confidently manage an accident, illness or injury situation through effective and appropriate communication.

our commitment to client
first aid is from putting band aid on to being able to assist in a serious accident

You will also be providing accident scene management to ensure the further safety of the casualty, yourself, other rescuers and outside observers and bystanders. Part of accident scene management is the recording of details of the scene and the casualty’s conditions. This information is to be given to the professionals who arrive on scene.

First Aid can be split into to 2 segments, primary and secondary care.

Primary care teaches you to provide assistance in response to immediate life threatening situations. This includes topics such as:

Safety assessment of the accident scene

Arranging immediate medical aid

Assessing who at the scene may be able to assist you

Use of personal barriers for protection from communicable disease

Rescue Breathing

Cardiopulmonary Resuscitation (CPR) for adult and child and infants

Airway management for adult and children, including rescue breathing

Managing both a conscious and unconscious

Managing airway obstructions

Management of suspected spinal injury

Secondary care teaches you to provide assistance in response to non-immediate life threatening situations. This includes topics such as:

Injury and Illness Assessments

Obtaining the history of the casualty’s condition

Monitoring the casualty’s condition and reassuring them

Effective bandaging. (This segment will be conducted interactively with First Aid International instructors)

Splint making, for stabilising dislocations and fractures

Immobilization of the casualty

Bleeding

Burns

Breaks

Shock

Many other issues will also be addressed during this course including:

Allergic reactions, burns both chemical and non-chemical, electrical injuries, eye injuries, assembling a first aid kit, frostbite and hypothermia, heat exhaustion and heatstroke, heart attack, insect/rodent/snake bites and stings, poisoning and seizures.

REMEMBER, it is important for you to do something. This training will provide you with the state of mental preparedness to ACT when faced with an emergency situation. The quicker you respond, the better the chance the casualty will recover.

Easing of anxiety and discomfortis extremely important in provision of emergency aid. You are treating a person as well as an injury or situation. By combining calming reassurance with good First Aid management you will, in most cases, immediately reduce the pain, stress and anxiety levels of the casualty. This is vital in controlling and minimising the escalation of shock.

Remember, if you stay calm, they stay calm; if you panic, they will panic!

A lot of people are concerned with legal issues pertaining to the provision of First Aid. You will not incur any legal ramifications if you act to the best of your ability, following what you have learned in this First Aid course. The states have particular legislation and Acts to protect you as long as you stay within first aid guidelines, and within the training you have been given.

Legal Issues

The following guidelines should be utilized only as a reference point for rendering First Aid. If you have any specific concerns or issues, you consult with a legal professional. As a provider of First Aid you are not expected to perform as a medical professional. First Aid providers should act in a responsible, prudent manner. You are performing First Aid as a good faith act in the best interest of the victim. Remember, the quicker you act, the better the chance for the victim to fully recover.

As a non-medical professional provider, you will provide First Aid to the best of your ability. As a non-professional medical person, you are not expected to be perfect. It is also an unfortunate fact that not every situation will turn out as we all would like.

There are 4 main legal considerations involved with rendering First Aid, they are:

Duty of Care

Within the realm of Australian law, an individual, whether a qualified First Aid provider or not, is not legally required to stop and render assistance to an injured or ill person except in specific situations. Each individual provider’s personal moral code will play a decisive role in their personal decision as to whether they will render first aid. Common law principles do not place a duty on you to provide first aid in every situation you may encounter. Once you decide to provide first aid, you then owe that person/s a duty of care to provide that aid in a manner appropriate to the circumstances, according to the needs and wishes of that person/s. Furthermore, you must ensure your actions in treating and assisting the casualty will not result in further risk to the casualty, and that care continues until the casualty no longer requires your assistance, or medical aid takes over from you.

Legislation can, however, impose a duty of care, determined by the terms of your employment, if you have voluntarily taken on the role of the first aid officer in the workplace.

There are specific situations, which may arise, that require you to provide assistance. Some examples of these are:

If you are the driver of a vehicle involved in an accident, you must stop and render First Aid, to the best of your ability, to ANY injured person resulting from the accident. This rule applies even if you are NOT trained to provide First Aid.
As an employee of a given company, you have been trained and designated as the First Aid provider and are being compensatedaccordingly. If you function in this capacity within your workplace, you must render First Aid to the best of your abilities.

Within the work environment, your responsibility to provide First Aid is primary over any other duties. The Duty of Care takes precedence over any authority the employer may have over the First Aid provider or the victim.

If you have assumed responsibility for caretaking of another individual, i.e. a child, an invalid or a disabled individual, and that person requires First Aid; you must render First Aid to the best of your ability.

Once you have begun provision of First Aid services, you are obligated to continue rendering services until appropriately relieved by professional medical personnel. You may NOT avoid your responsibilities by terminating First Aid provision in the middle of the situation. Once you commence providing first aid, you must continue providing that aid until the casualty no longer requires your assistance, or medical aid relieves of that responsibility.

Quite naturally, once professional medical personnel have arrived on the scene, you will relinquish control of the situation to these professionals. You must however still maintain a presence to assist in providing First Aid in any manner which may be asked of you. When turning the victim over to the medical professionals, the items you have noted in your record keeping will be of great assistance.

If you have not had the chance to write down your observations, once relieved by the medical professionals, stay in the area and write them down. We will go into this further in the Record Keeping segment.

Negligence

Negligence of care provision can only be proven if ALL of the following requirements have been established:

The First Aid provider failed to act within the guidelines of Duty of Care
The proper level of care, as outlined within the Duty of Care, was not rendered
Further injury was incurred due to the provision of First Aid
The First Aid provider gave care, which exceeded their training level

Once again, all of the above must be established to prove negligence.

This brings up a question which is on all First Aid provider minds;

“What if the individual is in imminent further danger and must be moved at the risk of further injury, am I being negligent?” The answer is simply, NO. You have exercised your Duty of Care by prudently assessing the scene and determining that the casualty would be in more danger or possibly even under threat of loss of life, by leaving them in the situation. You have met your Duty of Care obligation by taking a reasonable and prudent, good faith act, with the best interest of the casualty in mind.

If you are hesitantto provide First Aid, remember that the individual will have a MUCH better chance for full recovery if you provide immediate assistance. As you may recall from the first lesson; “IT IS IMPORTANT FOR YOU TO DO SOMETHING”.

If the casualty is unconscious and not breathing, immediately commence CPR following the Australian Resuscitation Council guidelines. Immediate action substantially improves a casualty’s chance of not only survival but also of a better neurological outcome. A lot of providers worry about possibly breaking a rib when performing CPR. Is it better to break a rib or let the individual expire?

Consent

Australian law provides that an individual retains control of their own personal being and as such, that individual may bring charges if touched without consent.

The individual further maintains the right to accept or reject medical and/or First Aid treatment, assistance or advice. The individual may do this with either professional medical personnel or a First Aid provider. If rejected, DO NOT FORCE provision of First Aid on the individual. Make a note in your Records for the proper authorities.

The injured individual also maintains their right to consult with the medical professional of their own choosing.

‘Implied Consent’ may come into play with emergency situations. If the individual is unconscious or seriously injured, i.e. bleeding profusely, the law allows for ‘Implied Consent’. The application of ‘Implied Consent’ may only be allowed if the individual is in a life threatening situation or their future health is in peril.

In a situation that involves infants or small children, it is always best to obtain consent from a parent or guardian. If none are available and it is an emergency situation, the law allows the provider to take ‘reasonable action’ without formal consent.

Record Keeping

As has been stated throughout, keeping written records of incidents is extremely important. It will not only serve the provider when transferring responsibility to medical professionals, but also within the work environment. By law you are required to record all incidents in the work place, whether First Aid has been provided or not. Another side benefit of recording all incidents and accidents in the workplace is that it provides the employer with a means to evaluate safety procedures and implement more effective controls, as may be required.

In the event the incident ended up in a court of law, you would have detailed notes. There would be no question of your recollection of the incident, services rendered or services rejected. By recording vital details as soon as possible, you are recording information that is still clear and fresh in your mind. In stressful or difficult situations, important facts and details are easily missed or forgotten. Notes taken at the time of the incident or accident are called contemporaneous notes. Ensure you keep the information detailed and accurate, focusing on facts only, not speculation. Do not include opinions of other people in your notes.

CARDIOPULMONARY RESUSCITATION - D.R.A.B.C.D

When approaching any accident scene, you must endeavour to follow all safety guidelines to minimise risks to yourself, bystanders and any casualties, as well as removing the possibility of further danger or injury to all concerned. Another primary reason to implement these procedures is to ensure no steps are omitted.

Wherever possible, ascertain the history of the incident. This will assist in determining the nature of any risks or dangers to anyone involved at the scene. Look at the casualty or casualties for indications as to what may have occurred.

By focusing on a simple acronym, the steps to assist you will follow a very clear process. That acronym is DRABCD, and is the action plan for any situation where the casualty may be unconscious, or where life-threatening circumstances are immediately apparent.

D– Danger (to you, the bystanders, and the casualty)
R– Response (are they conscious/awake?)
A – Airway (look for obstructions, look for signs of life – call 000)
B– Breathing (give 2 rescue breaths if not breathing normally)
C– Compressions (commence compressions)
D– Defibrillation (attach AED if available and follow the prompts)

Of special importance, LIFE THREATENING SITUATIONS ARE ALWAYS IDENTIFIED AND HANDLED FIRST.

The steps involved in accomplishing the DRABCD action plan are also referred to as the Primary Survey.

The Secondary Survey, discussed later, is simply a complete physical head to toe examination of the individual to assess and treat injuries which are not immediately life threatening.

Primary Survey - DRABCD

In all emergency situations, the rescuer must;

Assess the situation quickly
Ensure safety for rescuer, bystanders and the casualty
Call for help
Follow the Basic Life Support guidelines and commence first aid procedures.

AssessDanger

This procedure includes looking at the accident scene to ensurethe rescuer, individual involved in the accident andbystanders are not in further danger. If the individual has suffered a snake bite, amphibious creature sting/bite or spider bite, you want to make sure the offending creature is not poised to hurt anyone else in the vicinity or harm the individual further.

To assist in identifying the nature of the bite/sting you can try to capture the creature, but only if it is safe to do so. If it was a snake, do not try to capture it; get a description of the snake, let it go on its way. Take extreme care with a medium to large sized spider, black or dark brown in coloring, as it may be a Funnel Web spider.

Other potential dangerscould include:

Live electrical wiring downed in the area from a storm or traffic accident
Fumes, chemicals, falling objects, gas leaks, storm debris or road traffic
Environmental dangers – the road or footpath on a very hot day, weather conditions, etc.

Whatever the danger presented, the rescuer should take every precaution to remove or minimize the Danger, prior to beginning the second step of the DRABCD procedure.

Be prepared to minimize the danger to yourself by following practical infection-control procedures. Implement the use of barriers such as face masks, lip shields, face shields, gloves, etc. for personal protection.

If the individual must be moved, be sure to utilize your safe lifting and manual handling skills to ensure you do not injure yourself lifting the individual. If in moving the individual and the possibility for personal injury exists, request help from bystanders. If you are unable to move them, then you may have to leave them.

Assess Responsiveness

An important point to remember when approaching the individual to assess their responsiveness is to NEVER SHAKE them. This can cause further injury. If there are multiple individuals involved, any unconscious people are of primary concern for attention. An individual who may be shouting or screaming IS breathing, focus attention on the unconscious individual(s), but don’t forget the quiet ones.

A simple method to remember for Assessing Responsiveness is the COWS method:

C– Can you hear me?
O– Can you open your eyes?
W– What is your name? Who are you? What happened?
S – Squeeze my hands

To check for consciousness on an infant, gently tickle the bottom of their feet with your finger- nail. If no reaction, they are either unconscious or have a possible spinal injury. Secondly, you can gently breathe on or gently brush their eyelids. If the eyelids flicker and flutter, they are conscious.

If the individual is CONSCIOUS and able to respond, calmly inform him or her of who you are and seek permission to help. If they tell you not to touch them, you can’t touch them. However, you do not need their consent to call an ambulance. If, in your assessment, an ambulance is needed, CALL 000. Wait with the casualty until medical assistance arrives. By remaining in the area, should the individual be rendered unconscious, cease or experience difficulties in breathing, appropriate First Aid procedures may be implemented.

If the individual is UNCONSCIOUS, call 000 immediately.

Assess theAirway

The easiest position in which to assess an individual’s Airway and Breathing is with the individual lying on the back or left in the position in which they were found. Look into the individual’s mouth. If you see any liquid or solid material, place them on their side in the recovery position and clear the airway.

Many versions of the recovery position exist; consider the following when rolling the person onto their side.

The casualty should be in as near a true lateral position as possible, with the face towards the ground to allow drainage of fluid.
The position needs to be stable
Any pressure to the chest that may impede breathing should be avoided
It should be possible to move the casualty to their side, and return to their back easily and safely to minimise risk of spinal damage.
Good observation of, and access to the airway should be possible
The position itself should not give rise to further injury
Women in late pregnancy should be rolled onto their LEFT side wherever possible, to minimise constriction of venous return.

There are exceptions where the individual should be immediately placed into the recovery position to clear the airway:

If the individual has experienced a submersion injury
The airway is obstructed with fluid such as vomit or blood
History shows they have an airway obstruction – e.g. choking.

To check the casualty’s airway, use one hand only to gently pull the lower jaw down. Look inside the mouth. DO NOT tilt their head back until you have made an initial check of the mouth, as this will lift the tongue and allow any fluid or objects in the mouth to enter the windpipe. If you see nothing in the mouth then tilt the head back gently to check further.

This is called the Head Tilt/Chin Lift technique:

Place one hand on the individual’s forehead
Place two fingers under the chin
Gently tilt the head back while gently lifting the weight of the head just slightly
Gently lift the chin with the two fingers opening the airway

Look, Listen and Feelby kneeling down and with your cheek and ear next to the individual’s mouth and nose area, looking down the body towards the toes:

Lookat the upper abdomen and chest to see if it is rising and falling
Listento hear if they are breathing, gasping or not breathing
Feelfor their breath on your cheek

Take NO MORE than 10 seconds to perform the Look, Listen and Feel evaluation. Time is extremely critical in these situations with every second counting.

Gasping is NOTconsidered normal breathing. Breathing MUST be normal. If you are not CERTAIN that breathing is normal, assume there is no breathing present.

If the individual is unconscious, breathing and not responding to touch or talk, place them into the Recovery Position. If rolling the person on their left side, you should;

Have their legs either crossed with the right leg over the left leg, or the right knee raised with the foot close to the buttocks.
The left arm should be somewhat straightened out to the side
The right arm should be crossed over to the left shoulder
Lift from under the casualty’s right shoulder, supporting the right knee to ensure the spine stays as straight as possible. Roll them evenly, smoothly, slowly.
Once on their side, bring the right knee up towards the chest to support the casualty and ensure the casualty is stable. The casualty’s head, neck and jaw should be positioned with the head slightly tilted back, face towards the ground, and the jaw positioned so the mouth is open for the individual to continue breathing with ease

Call 000 immediately, if not already done, or designate someone else to call 000. If a phone is not readily available or you are alone, shout for help. It may be necessary to momentarily leave the individual in the Recovery Position to seek help.

An alternate Recovery Position would be to put the arm on the side you are rolling the person onto, beside their head. To achieve this, draw the arm beside the body, and then move it straight up beside their ear as if doing the ‘back-stroke’ in swimming. Their other arm is placed across their chest, with their hand between their cheek and the other arm. This helps to support the head when rolling the person into the recovery position.

BEFORE rolling anyone into the recovery position, always check their side to make sure you are not rolling them onto keys, phones, pens, tools, etc. Remove spectacles and sunglasses. Check the ground to ensure there is nothing that can cause further injury. If removing items from the pockets for safety reasons, ensure they are kept safe until medical aid arrives.

Assess theBreathing

If the individual is breathing, leave them in the Recovery Position and ensure ambulance has been called. Ensure you closely monitor their breathing until medical assistance arrives. The unconscious, breathing casualty must remain in the recovery position to maintain a clear and open airway. They must not be left on their back.

If the individual is NOT breathing normally:

Position the individualon their back to receive rescue breaths by using the Head Tilt/Chin Lift procedure
In combination with the Head Tilt/Chin Lift, the nasal passage must be sealed by either pinching the nostrils or using your cheek to seal the nasal openings
Perform 2 rescue breaths
With a tight seal around the individual’s mouth, using a pocket mask, lip guards or your lips, blow for approximately 1 second while keeping notice of the chest rising out of the corner of your eye
If the chest does not rise with the first breath
- Repositionusing the Head Tilt/Chin Lift procedure
- Ensure thenasal passages are sealed
- Re-administerthe first rescue breath
If the chest rises with the first breath, prepare to perform the second rescue breath
Give the second rescue breath exactly as the first rescue breath was provided
Assess the individual’s Breathing
Ifbreathing normally:
- Place into Recovery Position
- Perform Secondary Survey, providing treatment as normally prescribed
- Monitor their breathing continuously
- Await arrivalof professional medical assistance
If not breathing normally, prepare for Chest Compressions immediately

Providing ChestCompressions

The combination of rescue breathing and chest compressions is quite often referred to as CPR or Cardiopulmonary Resuscitation. Remember your ABCs, the central components of the DRABCD procedures. This will allow you to easily and quickly move from Airway to Breathing to Compressions, thus ensuring circulation is restored to the body as quickly as possible.

If you are unwilling to perform rescue breathing, perform the chest compressions alone. REMEMBER it is better to do something rather than do nothing. The worst thing that could happen is YOU SAVE SOMEONE’S LIFE!

Positionthe individual on their back on a firm, solid surface.

Kneel down alongside the individualwith one knee at approximately shoulder height and the other at approximately mid-stomach height on the individual’s body. This should centre your head on the central portion of the individual’s chest area.

Place the heal of one of your hands in the centre of the individual’s chest, on the lower half of their sternum.
Position your other hand on top of the first hand, interlocking your fingers
Pull your fingers backso only the heal of your first hand is in contact with the individual’s chest area
Raise up on your knees so your arms are straight and vertical to the individual with your chest and shoulders above the compression point to allow you to apply your weight
Compress the chest to approximately 1/3 of the original depth of the chest.

Use your body weight, not your arm muscles to perform chest compressions. Using your arm muscles will tire you much quicker.

Chest compressionsneed to be performed at a fairly rapid pace (about two compressions per second). It helps to count out loud. The cycle for performing chest compressions is:

30 chest compressions
2 rescue breaths

Five of these cycles should be completed in approximately 2 minutes. It is a rapid pace and must be continued until:

Professional medical assistance arrives and relieves you
The individual begins to breath normally
It becomes too dangerous to continue
You become too exhausted to continue
Another First Aid Provider takes over for you
The individual begins to vomit or regurgitate, go back to the steps for clearing the Airway
A medical doctor pronounces the individual to be deceased

If performing CPR on a woman in the latter stages of pregnancy, left lateral tilt must be implemented to ensure effective circulation. To achieve this, either;

Put something under the woman’s right hip, such as a pillow, folded blanket or towel,

cushion, etc.

Make a fist with their right hand, and push this under the right buttock.

This ensures the baby is moved off the veins that return blood to the heart, as well as taking pressure off blood supply from to the foetus.

If you can’t do the rescue breaths, or if you are uncomfortable with doing the rescue breaths, do the compressions only. ANYTHING is better than NOTHING!

Defibrillation through the use of an Automated External Defibrillator (AED)

A machineutilized to provide a small electric shock to the body to return the electrical rhythm of the heart to normal is called a Defibrillator. While CPR has been proven to continue oxygen enriched blood circulation to the heart, brain and other vital organs, as a standalone remedy it may not always work. In these cases, the individual will need to be ‘shocked’ so that the heart and breathing may have the opportunity to begin normal functions.

Ifan AED is available, attach the pads to the casualty’s bared chest and follow the prompts. These machines have audio prompts which are designed to talk you through step by step instructions. The use of a Defibrillator is also not a standalone remedy to treat Cardiac Arrest. Each step in the ‘Chain of Survival’ must be performed to ensure the individual with the greatest chance of recovery and ultimately, survival.

Early access
Early CPR
Early defibrillation
Early advanced care

Infants and Children

Infants are classified as children up to 1 year of age. Children are classified as 1 through 8 years of age with all other individuals grouped from 8 years of age and up.

Most infants who go into cardiac arrest will do so from choking or submersion. If you know the infant has an airway obstruction, perform the procedures as outlined for choking and clear the airway. If you are not sure of an obstruction and the infant is not breathing perform CPR.

Provision of carefor both infants and children is basically identical however it differs in a few areas. Treatment consists of:

If the infant or child is breathing, put them in the recovery position.
- Infants - DO NOT perform a full head tilt,keep their head in a ‘neutral’ position and assist the airway by gently maintaining a slight jaw lifting position
- Children- perform a full, normal head tilt position

Monitor their Airway and Breathing, call 000 for ambulance or designate someone else to call.

If the infant or child is NOT breathing
Call 000 for ambulance or designate someone else to call.
Commence chest compressions
- For infants, use two fingers
- For children, use one hand
Perform the Chest Compressions to Rescue Breaths cycle at:
- 30 compressions to 2 Rescue Breaths
- 5 cycles should be performed every 2 minutes
Continue to performthe compression and rescue breath cycle until:
- Professional medical assistance arrives and relieves you
- The infant or child begins to breath normally
- It becomes too dangerous to continue
- You become too exhausted to continue
- Another First Aid Provider takes over for you
- The infant or child begins to vomit or regurgitate
- A medical doctor pronounces the infant or child to be deceased

Special Considerations when performing Rescue Breathing

In specific circumstances it may become necessary to modify ‘normal’ Rescue Breathing techniques. These can occur when:

An injury dictates an alternative method, such as a potential head or neck injury where the minimizing of movement of the areas is imperative,
Dealing with a pregnant woman
The individual has a STOMA in place
A pocket mask is being utilized
In water rescue situations
The First Aid provider decides an alternate method is more appropriate

One of the most common modifications associated with Rescue Breathing is Mouth to Nose. This method may have to be performed if the individual has sustained serious injury to the mouth area. To accomplish this:

Close the individual’s mouth with the hand supporting the jaw
Apply the Head Tilt and seal the mouth with the thumb
Blow into the individual’s nose
Turn your head to Look, Listen and Feel

Performing Mouth to Mask provides both the rescuer and individual involved in the accident the most hygienic means of performing Rescue Breathing. DO NOT DELAY performance of Rescue Breathing while waiting for a mask to arrive. To accomplish this method:

Position yourself at the head or side of the individual
Place the mask firmly sealed over the individual’s mouth and nose
Maintain the Head Tilt/Jaw Lift position of the individual
Breath into the mask
Turn your head to the side and Look, Listen and Feel

There are numerous people who have gone through surgery to remove the upper portion of their windpipe and must breathe through an apparatus implanted in their throat area. This device is called a STOMA. Rescue Breathing can be performed for an individual with this apparatus if they cease breathing.

If you unsure about, or uncomfortable with, breathing through the stoma, simply commence the cardiac compressions and continue with just the compressions.

In some cases you may not notice the STOMA until you have performed the Head Tilt. You may see a tube protruding from the STOMA enabling the hole to remain open so the individual can breathe. MAKE SURE THE TUBE STAYS IN PLACE. If you note a valve on the tube, the valve must be removed prior to Rescue Breathing so that the air may enter.

Rescue Breathing in this instance is accomplished as follows:

Ensure the STOMA or tube is not blocked
Seal your mouth around the STOMA
Sealthe individual’s mouth and nasal passages to ensure air does not escape
As you blow into the STOMA, observe the stomach area to ensure you are not blowing air into the stomach. If this does occur
Do not blow as hardas you have previously done, doing so may cause over inflation of the lungs thus forcing air into the stomach
Check to ensure you have proper Head Tilt
Of special note, if the stomach has become distended due to air being blown into it, do NOT push on the stomach to deflate, this may cause the individual to expel the contents of their stomach

As stated above, if you have any concerns with breathing through the stoma, simply commence the cardiac compressions and continue with just the compressions. ANYTHING is better then NOTHING!

Secondary Survey

Remember the secondary survey is NOT to be performed until all immediate life situations have been addressed. The steps involved in the Secondary Survey are designed to:

Provide a gentle, yet probing head to toe examination of the individual. This includes both visual observation and physical contact

As the First Aid Provider you are seeking to determine if the individual has:

Life threatening injuries
Signs or symptoms of shock
Injuries which may be treatedusing the methods taught throughout this course

The Secondary Survey is a head-to-toe physical check. Start at the top of the head, gently palpate (feel with the full length of your fingers) the skull area, working down around the ears and to the back of the head and neck. Continue feeling down the casualty’s body, especially their spine, looking for the following;

Fractures and dislocations
Bumps and bruising
Wet spots which could indicate a bleed or burn
Medi-alert bracelets which could provide a ‘history’ of what has happened
Signs of envenomation – bites or scrapes.
Most importantly – continually monitor their breathing!

Care and Management of Choking

Choking can be categorized under two headings;

Partial Obstruction of the Upper Airway
Complete Obstruction of the Upper Airway.

Both topics will be discussed here, including determining the history and identifying the signs and symptoms of the choking incident, and the necessary First Aid steps to be accomplished to assist the individual. Choking may occur in a conscious or an unconscious individual.

There are many causes which may lead to choking, the most common being;

Airway muscles have completely relaxed due to unconsciousness
The individual has inhaled or swallowed foreign matter which has become lodged in the upper airway
The individual has incurred some type of trauma to the upper airway
The individual is suffering an Anaphylactic reaction, Anaphylaxis is the immune system’s severe reaction to an allergen, typically bee venom, ant venom, peanuts, tree nuts, shellfish, soy, dairy, sesame or eggs
Compression of the larynx due to accidental strangulation (most commonly seen with small children and toddlers in the home)

Partial Obstruction

If the individual is experiencing a Partial Obstruction there is still some air flow. The victim is able to breathe, but NOT in a normal manner. The following signs and symptoms may be present:

Wheezing and coughing, a ‘raspy’ type of breathing
Strained or difficult breathing
A snoring type sound is being produced
Labored or rapid breathing
Face becoming grey or blue from lack of oxygen (asphyxia)

As the First Aid provider you should employ the following procedures:

As the individual is still able to breathe somewhat, have them lean forward with their mouth lower than their windpipe, and encourage them to cough or clear their throat in a forceful manner. This may cause the foreign object to be expelled and alleviate the problem.
Maintain your composure and provide reassurance to the individual. By remaining calm you help the individual to calm down, relax and gain control to possibly alleviate the problem.
If possible, gather history from the individual as to what may have been ingested, or if it is a suspected anaphylactic reaction what may have caused the reaction. If the individual is not able to respond, turn to their acquaintances which may be with them.
DO NOT perform back blows as this may cause the problem to worsen

If the individual is unable to clear the Partial Obstruction, it may become a Complete Obstruction.

Partial Airway Obstructions and Infants.

Infants, for whatever reason, tend to put things in their mouths. To remove an object that has become wedged at the back of the infant’s mouth, causing a partial obstruction, hold the infant in your arms with their head tilted down and to the side. Don’t try to scoop the wedged object out with your finger, it will trigger their gag reflex and they will most likely bite you.

Gently insert your little finger inside the ‘upper’ cheek, between the cheek and the gum line. Move the finger into the mouth until you get between the cheek and the obstruction, and gently lever it forward. It should fall out of the mouth. Follow this procedure with hugs and cuddles to comfort the infant further.

Complete Obstruction

If the individual is experiencing Complete Obstruction, there is NO airflow. The following signs and symptoms may be present:

Agitated and distressed, the individual maybe frantic, tense, and disconcerted
The individual may be unable to breathe, cough, talk or request help
Typically the individual will begin grasping around the throat area
Rapid loss of consciousnessmay occur due to lack of airflow
Lips, fingernails and general skin coloring may take on a bluish tint

As the First Aid provider you should employ the following procedures:

Call 000or direct an individual standing by to call 000
Help the individual to become calm, maintaining your composure will be of great assistance, reassure the individual
Let the individual know what you are doing and then administer up to 5 Back Blows. Check after each blow to see if the obstruction has been expelled. Have them lean forward, and in an upward motion between their shoulder blades use the heel of your hand to deliver the blows or ‘back slaps’.
As you deliver each of the 5 back blows, encourage the casualty to try to cough in time with the blows. The intent of the back blows is to dislodge the material in the airway; if the casualty can cough and bring air upwards it will increase the chance of expelling the obstruction.
If the individual is an infant*, you may place them in a head down posture, i.e. lying across your lap, prior to administering the Back Slaps. Ensure the infant’s head is fully supported on your thigh in a neutral position to minimize movement of the head. Don’t tilt the infant’s head back when delivering the back slaps.
If after 5 Back Blows the obstruction has NOT been cleared, let the individual know what you are doing and perform up to 5 Chest Thrusts**. Once again, you will check between thrusts to see if the obstruction has cleared.
If the obstruction still has not cleared, you will continue the cycle of administering 5 Back Blows and 5 Chest Thrusts until professional medical assistance has arrived or the individual loses consciousness
If the individual loses consciousness, place them in the recovery position; check their airway and breathing again. If the individual is not breathing, implement CPR procedures.

If at any point during the provision of First Aid the individual expels the foreign object or begins to breath normally, DISCONTINUE Back Blows and/or Chest Thrusts, put the individual into the recovery position and continue to help the individual maintain there calm while waiting for the medical professionals to arrive. While waiting for medical assistance, remember another important point of first aid … DO YOUR RECORD KEEPING.

* Infantsshould be positioned across the rescuer’s lap in a head down position. Back Blows and Chest Thrusts should not be administered as severely as if administering to an adult. For an infant, the back slaps shouldn’t be much firmer than if you were ‘burping’ the infant.

** To perform Chest Thrusts

Identify the same compression point/area as utilized in CPR
Chest thrust is delivered in sharper manner
Delivered at a slower rate than CPR compressions and be sure to check between each thrust to see if the obstruction has been cleared
To deliver chest thrusts to an infant, have the infant over you lap with the head lower than the body, bring your fingers underneath until they meet, and bring your fingertips back onto the sternum. With your thumbs around their back, gently pull back with your fingers in the centre of the infant’s chest.

Small Children and Accidental Strangulation

Immediate action to remove the constriction is necessary. Gently lift the child to take the strain of the material causing the strangulation. Whilst supporting the child, carefully loosen and then remove the constricting material by lifting it up and over the head.

Lay the child in the recovery position, they will most likely cough continuously and cry. Coughing and crying are indications of a clear airway, and are a good sign! Arrange urgent medical assessment.

If the child is unconscious, follow the CPR protocols until medical aid arrives.

Care and Management of Angina

Angina is best described as a decrease in the flow of oxygen enriched blood to the heart. Typically this is due to the constriction of the coronary arteries, a condition known as arteriosclerosis. An ‘Angina attack’ may be a pre-cursor for a heart attack and should be an indicator to the individual to seek professional medical testing.

Angina is a common symptom of heart disease, and is often described as an unpleasant feeling or discomfort, like a tightness or weight on the chest. It usually lasts only a few minutes and can be relieved by rest and/or medicines. Angina can affect people in different ways and the symptoms may vary at different times. It is usually felt across the centre of the chest but may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in the hands.

Some people experience it in only one of these areas and not in the chest at all. Others, in particular people with diabetes, can get very little pain and may just complain of breathlessness.

Angina is usually brought on by exertion, by emotion, after a heavy meal or in cold weather. It may even occur at rest or during the night. Many people find they experience it more often at particular times of the day, the most common being first thing in the morning or late afternoon.

There are many contributing factors which may cause the onset of Angina:

Smoking
Poor diet
High blood pressure
High cholesterol levels
Lack of exercise
Stress
Genetically inherited

In most cases, however, angina is caused by coronary artery disease. This occurs when fatty deposits build up under the inner lining of the coronary arteries, which supply blood, nutrients and oxygen to the heart muscle.

These arteries become narrowed with partial blockages, and the blood flow to the heart muscle is reduced. Angina occurs when the blood flow to the heart muscle is insufficient to meet the extra demands made on it. Generally there is no permanent damage to the heart muscle from an episode of angina.

Angina is very occasionally caused by spasms of coronary arteries alone, without any actual blockage.

Signs and Symptoms of Angina

It is easy to confuse an Angina attack with a Heart attack and if in doubt, treat as if it were a Heart attack. As with all first aid situations, seek the history of the symptoms from the casualty. Has the person had this pain before? Is the person on medication for this condition? Angina symptoms are associated with a temporary reduction in blood flow to part of the heart muscle leaving no damage to the muscle itself, whereas a heart attack results from a blockage in a coronary artery which causes permanent damage to the heart muscle. The pain associated with a heart attack usually lasts longer than 15 minutes, and is not relieved by nitrate tablets or spray. However, some heart attacks, particularly in people with diabetes, may be painless.

An individual suffering from an Angina attack will/may exhibit:

Pains in the chest area
Shortness of breath
A feeling of pressure, tightness, squeezing or heaviness in the chest or rib cage areas
The pain may spread into the shoulders, neck, arms and head areas
Weakness
Sweating, clamminess, cramping or nausea

Care and Treatment of Angina

Immediate and calm provision of First Aidwill provide the individual with the best possibility of complete recovery. The following describes the procedures for assisting an individual suspected of suffering an Angina attack:

Ask the individual about existing heart conditions
Check on any medications the individual may be using for a heart condition
Gently assist the individual into a comfortable, sitting position
Assist the individual in taking their heart medication, unless they have already taken it
If rest and medication do not resolve the problem within 2 minutes repeat, as per medication instructions, if still not relieving call for medical aid on 000.
Calm and re-assure the individual until professional medical help arrives or the episode ceases
If the individual loses consciousness, call 000, put them in the recovery position to maintain their airway and monitor their breathing. Follow the DRABCD action plan.

If an individual has already taken their medication DO NOT administer more unless directed by professional medical personnel. No more then 3 tablets/ or sprays.

You would need to escalate your level of care to calling an ambulance if the following occurred;

If the person has not shown clear signs of recovery within 2 minutes
A first-time occurrence of these symptoms
The symptoms are a lot worse than usually experienced
The symptoms are accompanied by weakness, nausea or fainting
Their condition is unchanged after taking their normal dose of medication (such as Anginine)
Happening at an unusual time, such as when resting.

Care and Management of a Heart Attack

A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die. Heart attack is a leading killer of both men and women throughout the world. However, there are now excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 30-40 minutes of the onset of symptoms.

Every second counts when you are dealing with an individual suspected of suffering a heart attack.

Heart attacks occur most often as a result of a condition called coronary artery disease. A fatty material called plaque builds up over the years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery. This part of the heart muscle will then deteriorate rapidly into a condition known as a Myocardial Infarction, or ‘death of heart muscle’.

If the blockage to the coronary artery isn’t treated quickly, the damaged part of the heart muscle will be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Severe problems linked to heart attack can include total heart failure, and life-threatening arrhythmias, or irregular heartbeats. Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.

As with Angina, contributing factors of a heart attack may be:

Smoking
Poor diet
High blood pressure
High cholesterol levels
Lack of exercise
Stress
Genetically inherited
Diabetes
Depression, social isolation and lack of social support

We have no say or control over our genetic make-up, but we can do much to minimize the other contributing factors.

Signs and Symptoms of a Heart Attack

Chest pains and pressure in the chest area are the most common symptoms of a heart attack. A variety of other symptoms may also be present:

Difficulty breathing
Pale, cool and clammy skin
Nausea, vomiting, indigestion or heartburn
Shooting pain thru the arms, particularly the left arm
Head, neck, jaw, rib cage and/or upper back pain
A general feeling of sluggishness
A feeling of impending peril or doom
Weakness, especially in hand grip
Puffiness in the hands, feet and abdomen due to diminished pressure in the circulatory system.

Heart attacks affect people of all ages, not just the elderly. Not all heart attacks begin with a sudden, crushing pain that is often shown on TV or in the movies. The warning signs and symptoms of a heart attack aren’t the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don’t have symptoms at all (this is called a silent heart attack).

Care and Treatment of a Heart Attack

Sometimes the signs and symptoms of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs. Know and look for the symptoms and the warning signs of a heart attack so you can act fast to get treatment for the individual. The sooner you get emergency help, the less damage there will be to the heart.

Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital. Remember - don’t drive yourself or anyone else to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Immediate and calm provision of First Aid will provide the individual with the best possibility of complete recovery. The following procedures should be immediately implemented for assisting an individual suspected of suffering a heart attack:

Don’t delay – call the ambulance! 000
Implement the DRABCD procedures
Ask the individual about existing heart conditions
Check on any medications the individual may be using for a heart condition
Gently assist the individual into a comfortable, sitting position
Assist the individual in taking their heart medication, unless they have already taken it
If the individual becomes unconscious, monitor their breathing and airway following the DRABCD protocols.
Be prepared for resuscitation
Calm, rest and re-assure the individual until professional medical help arrives
If the individual feels a need to empty their bowels, it is best they wait until medical aid arrives. If they insist, ensure they leave the door open in the event they collapse. Encourage them to resist any straining whilst emptying their bowels, the extra stress and strain on the heart muscle can have serious consequences.
Do NOT allow the individual to move about, keep them seated and calm.
If an individual has already taken their medication DO NOT administer more unless directed by professional medical personnel.

In summary, the things to remember are;

The warning signs of heart attack vary from person-to-person, and even in the same person who’s had a previous heart attack and experiences another one. That’s why it is very important to learn the above warning signs.
No two heart attacks are the same, be aware of ALL the possible signs and symptoms.
Knowing the warning signs of heart attack and acting quickly can reduce the damage to the heart muscle, and greatly increase the chance of survival.
A heart attack is an emergency. If you experience the warning signs of heart attack, get help fast. Call triple zero (000) and ask for an ambulance. If calling triple zero (000) does not work on your mobile phone, try 112.
Angina symptoms and heart attack symptoms are similar. If in doubt, treat it as a heart attack.

Care and Management of a Stroke

What is a stroke?

Stroke (also known as Cerebrovascular disease) occurs when the supply of blood to the brain is suddenly disrupted. Blood is carried to the brain by the arteries. The flow of this blood may stop moving through an artery because the artery is;

Blocked by a blood clot or plaque (Transient Ischaemic Attack or TIA)
The artery breaks or bursts (Haemorrhagic Stroke).

When blood flow to the associated regions of the brain is stopped, the affected part of the brain cannot get the oxygen it needs. The brain cells in the area die, and the brain can become permanently damaged. Brain cells usually die within an hour of the beginning of the stroke, however in some instances they can survive up to a few hours after the stroke starts.

Areas of brain where the blood supply is reduced, but not completely cut off, are areas that can survive for some hours. These cells are in a state of shock and can either recover or die, depending on what happens in the minutes and hours that follow. Without prompt medical treatment, this area of brain cells will also die.

The brain controls everything we do, such as how we move, think, speak, breath, and eat. These various functions are controlled by different parts of the brain. When a stroke happens, we lose the ability to do things that are controlled by that section of the brain. We may not be able to move one side of the body, or have trouble thinking or speaking, even to the point of losing bladder and/or bowel control.

The way in which people are affected by stroke depends not only on where in the brain the stroke occurs, but on the size and severity of the stroke. Someone who has a small stroke may experience only minor effects, whereas someone who has a larger stroke may be left totally paralysed on one side, in a coma or may die due to the extent of the damage.

Stroke is always a medical emergency. It is important to recognise the early signs of a stroke or TIA. Analysis by the National Stroke Foundation has correlated the following important information;

1.    Stroke is Australia’s second single greatest killer after coronary heart disease, and a leading   cause of disability.
2.    In 2010, Australians will suffer around 60,000 new and recurrent strokes – that’s one stroke every 10 minutes.
3.    One in five people having a first-ever stroke die within one month, and one in three die within a year.
4.    The number of strokes will increase each year due to the ageing population.

5.    In the next ten years more than half a million people will suffer a stroke.
6.    Stroke kills more women than breast cancer.
7.    About 88% of stroke survivors live at home, and most have a disability.
8.    Close to 20% of all strokes occur to people under 55 years old.
9.   Strokes cost Australia an estimated $2.14 billion a year.

Signs and Symptoms of a Stroke

An individual suffering a stroketypically exhibits a variety of signs or symptoms in a matter of seconds, or they may occur over a period of several minutes. Normally the symptoms only affect one side of the body, the side opposite from where the brain is incurring damage.

The signs and symptoms of stroke may be any one, or combination of the following:

Sudden and severe headache
Difficulties in swallowing
Inability to communicate, either speaking or understanding
A general appearance or feeling of being ill
Dizziness, lack of coordination, may even experience falling
Blurring vision, uneven pupil dilation or partial/complete vision loss
Weakness, numbness or partial paralysis
Lack of facial muscle control resulting in facial drooping
Incontinence of bowel movements
Dramatic changes towards aggressive behavior or mood
Inability to turn the head to one side
Inability to move the tongue, i.e. stick it out or wiggle it
Altered senses of taste or smell

The FAST test is an easy way to recognise and remember the signs of stroke. Using the FAST test involves asking three simple questions:

•    Face – Check their face. Has their mouth drooped?
•    Arms – Can they lift both arms?
•    Speech – Is their speech slurred? Do they understand you?
•    Time – Time is critical. If you see any of these signs call 000 now!

Care and Treatment of a Stroke

Immediate and calm provision of First Aid will provide the individual with the best possibility of complete recovery. The following procedures should be immediately implemented for assisting an individual suspected of suffering a stroke:

Call for an ambulance immediately – 000
Implement the DRABCD procedures
Gently assist the individual into a position of comfort, sitting up, leaning back, supporting the head and shoulders. Reassure them continuously, keep them calm.
DO NOT give them anything to eat or drink, as an operation may be required in hospital.
If the individual becomes unconscious, place them in the recovery position, affected side down, monitor their breathing and airway.
Be prepared for resuscitation
Calm, rest and re-assure the individual until professional medical help arrives.

When someone has a stroke, the doctors and the team will need to work out what has happened (diagnosis). Then the team works with the person and his or her family to make sure the best recovery happens. This is where first aid is so important, and implementing the FAST procedure is so vital.

Assess the condition of the person using FAST.
Record details as soon as you can, to pass on to medical personnel.
Details such as the following are critical in improving chances of recovery;
Time the stroke started
Exact signs and symptoms
What the casualty has told you
First time or recurrent stroke
Have they taken any medication
Have they eaten recently
What were they doing when the Stroke started

Above all, remember – STAY CALM.

Care and Management of Asthma

What is asthma?

People with asthma have sensitive airways in their lungs. When they are exposed to certain triggerstheir airways narrow, making it harder for them to breathe. Three main factors cause this airway constriction;

The inside lining of the airways becomes red & swollen, or inflamed.
Mucus builds up in the airways, causing further obstruction.
Bronchoconstriction occurs, which is the tightening of the muscles surrounding the airways.

Research by The Asthma Foundation has identified the following factors which contribute to the onset of asthma;

Genetic factors are involved, asthma can be hereditary.
Having a parent with asthma, eczema, or hayfeverincreases a child’s risk of developing asthma
Obesityincreases the risk of developing asthma
More boys have asthma than girls, but as adults, there are more women with asthma than men
Smoking during pregnancycan damage a baby’s lungs and lead to respiratory illness. Children of mothers who smoke are four times more likely to wheeze.
Infants who are breast-fed are less likely to wheeze than those who have cow or soy milk or formula
Children who have respiratory infections when they are infants may be up to 40% more likely to develop asthma
Indoor and outdoor air pollutionmay make asthma symptoms worse, although it is not clear whether pollution causes asthma
Exposure to certain substances in the workplace can cause occupational asthma.
Modern diets may have contributed to the higher levels of asthma and allergy.
Exposure to allergensmay have an impact on whether you will develop asthma, but this is still unclear.

Asthma is a chronic medical problem. As the air passages become constricted, inhalation becomes more difficult. Exhaling can also become difficult, trapping air in the lungs.

Australiahas one of the highest rates of Asthma in the world.

There are many things which may trigger an Asthma attack:

Colds and the associated infection
Drastic and sudden changes in the weather
Dust, pollen, grass and other allergens in the air
Tobacco smoke and perfume
Allergic reaction to consumed foods, i.e. seafood, nuts, milk products
Additives in common foods
Exertion, exercise or stress
Closeness to an industrial area where pollutants may be expelled
Hormone changes within the body, especially in young females
Exposure to heavy automobile traffic areas
Insect or aquatic animal stings or bites

Signs and Symptoms of Asthma

The most common sign is wheezing, which may disappear as the attack gets worse. Multiple other signs and symptoms include:

Feelings of exhaustion
Shortness of breath or inability to catch a breath
A dry or moist cough
Irritability
Lip coloring takes on a bluish tint
Difficulties in speaking
Feeling anxious
Increase in respiratory and heart rate
Chest pains
Loss of consciousness

Signs and symptoms of a severe Asthma attack include;

Severe breathing difficulties
Difficulty speaking more than a few words
Wheeze becomes very quiet
Sucking in of the diaphragm, abdomen, and the throat and rib muscles
Pale sweaty skin
Lips turning blue (hypoxia)
Distressed and very anxious

These signs and symptoms can develop within minutes, therefore the person affected by the asthma attack needs to be closely monitored for improvement in their condition.

Care and Treatment of Asthma

Immediate and calm provision of First Aid will provide the individual with the best possibility of complete recovery.

Generally, there are two types of medication for asthma – preventers and relievers.

Preventers essentially de-sensitise the mucous glands, minimising the risk of asthma and the severity of an asthma attack.
Relievers relax the muscles that have constricted around the bronchial tubes.

The dispensers for these medications are colour-coded to assist in identifying what should be used, and when. Preventers can come in dispensers that are earth-tone, such as red, yellow, orange, brown, and also purple. These are not used once the asthma attack starts.

Once the asthma attack has triggered, the blue or grey reliever needs to be used by the individual.

Relievers are fast acting medications that give quick relief of asthma symptoms (wheeze, cough, shortness of breath). They are bronchodilators, which means they relax the muscle around the outside of the airway, which opens the airway.

The following procedures should be immediately implemented for assisting an individual suspected of suffering an Asthma attack:

If they have their own Asthma plan, follow that.
Gently assist the individual into a comfortable sitting position, do NOT recline
Calm and reassure them, try to ease the feeling of panic.
If the individual has possession of a reliever inhaler (blue or grey dispenser) to treat Asthma, assist them in administering the medication.
If they don’t have the reliever with them, and another reliever is available, use it.
The person breathes in 1 puff, holds it for 4 seconds, exhales and takes 4 normal breaths. They need to repeat this 4 times in 4 minutes.
If after administration of the medicine no improvement is noted in approximately 4 minutes, seek urgent medical aid – 000.
Continue to administer the inhaler at 4 minute intervals until the attack subsides, the individual is rendered unconscious or professional medical assistance arrives
If the individual becomes unconscious, implement the DRABCD action plan
Be prepared to perform CPR and resuscitation as necessary

If the individual is not responsive to their inhaler, immediately call for medical aid.

In the case of an acute Asthma attack, silence is not golden…it’s deadly!

Medication best administered via spacer – see Asthma Foundation info

Care and Management of Shock

By definition shock is a breakdown in the body’s ability to effectively circulate blood. This failure to effectively circulate blood and thereby maintain a constant pressure in the circulatory system may affect or even stop the flow of oxygen rich blood to specific or all areas of the body. It is essential that blood circulation be to the entire body. In particular, when essential body organs are not receiving oxygen via the blood flow through effective flow and pressure, perfusion into these organs is severely inhibited and death may occur.

Common Types of Shock

Hypovolaemic Shock. This is a result of a sudden loss of blood, mostly caused be severe hemorrhage.
Cardiogenic Shock. Loss of blood pressure due to irregular or ineffective heart rhythm.
Septic Shock. Imbalance of toxins in the blood stream can cause severe and systemic dilation of the major blood vessels, causing very low blood pressure.
Neurogenic shock. The heart rate slows to a condition known as Bradycardia, resulting in very low blood pressure.
Anaphylactic shock. Severe loss of fluids due in part to the release of histamines by the immune system in response to allergens.

What might cause shock?

Typically and most commonly, shock is induced by some sort of trauma. Immediate and effective administration of First Aid intervention and proceduresis vital. Shock may also be induced by other means, including;

Profuse bleeding, vomiting and even diarrhea can result in the vital body organs losing essential fluids which could lead to a shut down of blood circulation. Infants and small children, in particular, are susceptible to shock from vomiting and diarrhea if fluid levels cannot be replaced effectively.
Heart attack, cardiac arrest or heart beat irregularities can cause the interruption of proper blood flow throughout the body
An injury to the spinal cord may interruptthe body’s ability to control the circulation of blood properly
Severe burnsto the body can lead to interruption of normal blood circulation. Once again, this is particularly vital to monitor with infants and small children as body size relevant to the size of the burn needs careful consideration.
Allergic reactions to the ingestion of, or contact with foreign material or common

triggers such as shell fish or bee venom, peanuts and tree nuts, soy and dairy, etc, may interrupt normal blood flow. These allergens may cause blood vessels to swell, restricting normal blood flow.

Severe sweating and dehydration,particularly associated with heat exhaustion leading to heat stroke
Injuries and blunt force trauma,such as suffered in an automobile accident or falls

Signs and Symptoms of Shock

The signs and symptoms of shock, while sometimes easily recognized, may not be apparent immediately. Sometimes the onset of shock is very subtle. Be prepared, if an injury or sudden illness has occurred, to observe and constantly monitor that individual for possible onset of shock. As a First Aid provider you need to be aware of any signs or symptoms which may indicate the individual is experiencing shock, or is starting to lapse into shock. The signs of shock include tachycardia/tachypnoea(irregular heart rate compensating to maintain blood pressure), and signs of poor tissue and organ perfusion (such as low urine output, confusion or loss of consciousness). Other signs should be looked for to establish the underlying cause for the shock to guide effective treatment.Establishing a history of the incident can assist greatly with assessment of the casualty’s condition.

The following provides a list of indicators:

Altered level of consciousness,the individual seems dazed and confused
The individual may become restless and easily irritated
Rapid, shallow breathingmay occur, a form of hyperventilation which affects the concentration of oxygen in the blood stream
Excessive thirst or even lack of perspirationin a warm environment may be an indicator that the level of shock (heat exhaustion) is deteriorating into an even more serious state of heat stroke.
Pale or bluish skincoloring with a ‘moist’ feel to the skin
A rapid and/or weak pulse
Nauseated feelings, or excessive expulsion of bodily fluidssuch as through vomiting and diarrhea.

Shock Management

Shock can be life threatening. Your calm, deliberate actions WILL provide the best possibility for the individual to fully recover and potentially incur no further serious injuries or illness. The following will provide you with the proper sequence of steps to assist the individual experiencing shock:

Perform your accident scene assessment. Look, listen, attempt to identify what may have happened. Seek a history of the incident from bystanders who may have witnessed what happened. Ensure the accident scene poses no danger to yourself, other rescuers or the individual experiencing the difficulties, follow your DRABCD procedure
If the individual is bleeding severely, your primary objective is to STOP the bleeding and initiate the Emergency Procedures. If alone, call for urgent medical assistance (000 or 112 on mobile phones) once you have the bleeding under control. If bystanders can assist, have them call for urgent medical assistance while you attempt to control the bleeding.
Assist the individual to lie downand if other injuries do not prevent you from doing so, elevate their legs. Injuries or suspected injuries which would stop you from elevating the individuals legs are; suspected spinal injury, broken bones or fractures, heart attack , cardiac arrest or heart tremors and head injuries.
Keep the individual warm. Cover them to maintain body temperature and slow the rate of shock, using whatever may be available. (Blankets, jackets, space blankets, etc)
Loosen any clothing which may be restrictingto the individual, i.e. neckties, buttoned collars, etc.
Continue your casualty assessment,and provide treatment for any other injuries or wounds
Talk with the individual in a calm, reassuring manner. Even if the individual is unconscious, it will help to keep you calm and focused on what you need to do. Also, bystanders will understand that you have the situation under control, averting the possibility of panic, and will be more willing to assist you if necessary.
Monitor the individual’s airway and breathing, initiate CPR procedures if appropriate
If the individual is rendered unconscious and it would cause them no further injury, put them into the recovery position as outlined in DRABCD
If the individual is complaining of thirst, moisten their lips but DO NOT provide them anything to eat or drink if it is obvious they may require a medical procedure or operation due to their condition.
If shock is brought on by heat exhaustion or excessive sweating, give the person sips of water slowly to commence the replacement of fluids until medical aid arrives. During shock, blood is partially withdrawn from the stomach as it is not considered a ‘vital organ’ when the body prioritises where fluids are needed. Too much water given rapidly will cause severe nausea when a person is dehydrated. Initially, the heart, brain, lungs and kidneys receive the priority of fluid allocation.

Care and Management of Bleeding

In this segment you will learn about bleeding and how to provide First Aid treatment in maintaining control of an individual who is bleeding. Simply put, bleeding is the loss of blood from the Circulatory System. As you may recall, loss of blood may result in shock. Constantly monitor the casualty’s condition whilst treating the bleeding, in order to maintain your observations for the onset of shock. An individual may be bleeding externally, which of course may be quite visible. If bleeding internally, however, that can be somewhat more difficult to detect. An individual may be bleeding from arteries, veins or capillaries.

Where the blood is coming fromis important, as it directs the First Aid provider to the management technique most appropriate for care. As a provider you will be able to distinguish bleeding from arteries, veins or capillaries primarily by the coloring, the amount and how the blood is being expelled. The core components of First Aid for bleeding are pressure, elevation and rest. These will be covered in more detail later in this segment.

As with any life threatening injury, initiate the Emergency Response Procedures by calling 000 (or 112 on mobiles. Not all phones have this number available) or designating someone else to call 000!

Arteries

Typically blood coming from an artery is bright red, as it is highly oxygenated
Blood spurts from the wound, in time with the casualty’s heart beat.

Veins

Typically somewhat darker than the bright red of the Artery, as the oxygen has been used by the cells and tissues of the body.
Blood tends to flow from the wound at a fairly steady rate, however the blood does not spurt

Capillaries

This is the darkest coloring of blood
Blood oozes from the wound at a steady rate, tends to coagulate (stop oozing) quickly and easily
There are arterial capillaries that ‘feed’ the cells and tissue of the body, and venous capillaries that take ‘used’ blood to the veins for return to the heart.

External Bleeding

Typically external bleeding is easily detected. Severe bleeding is normally the result of a laceration, deep gash or cut. If the individual is spurting bright, red blood they are bleeding from an artery. This is the most severe bleeding. This type of bleeding can lead to death if the left uncontrolled or cannot be stopped. Remember, it is better to do something rather than nothing. More than likely this type of bleeding will also lead to shock, so be sure to continually assess and monitor the casualty’s vital signs for the symptoms of shock.

You should note that minor bleeding from a wound should stop in approximately 10 minutes. If you are rendering aid and the wound continues to bleed beyond that period of time, re-evaluate the level of care and seek medical assistance.

Signs of Life Threatening External Bleeding

As previously stated, typically it is easy to diagnose external bleeding. Here are some signs to look for if bleeding has the potential to be life threatening:

Bleeding from artery, spurting blood
Remember minor bleeding normally stops within 10 minutes, if the wound is still bleeding after the 10 minutes and all efforts have been exhausted to stop the bleeding it could become life threatening
If the individual begins to exhibit signs of shock
Remember that fluid loss in infants and young children can become life threatening very quickly due to the much smaller amount of fluids in their bodies. You must take this into serious consideration when treating bleeds in infants and young children.

Bleeding can commence as the result of many different types of incidences ranging from dog bites, imbedding of foreign objects to nose bleeds. General First Aid provisioning for non-life threatening bleeding can be summed up as follows:

Perform a gentle inspection of the wound to make sure there is no foreign material in the wound, if the material is NOT imbedded or in some manner attached to the individual, gently remove the material, if the materialis imbedded or attached, LEAVE IT ALONE, you will have to bandage around it
Apply the dressing,improvise if no clean, sterile pads are available
Apply direct pressureto the wound
If the injury allows the individual to be placed lying down, lay them down gently and elevate the injured area if possible
Neversecure a bandage or padding too tightly (unless you are required to attach a tourniquet), check to ensure proper circulation before and after you apply the bandage or dressing to the wound.
To check for circulation after applying a bandage to a limb, gently squeeze the fingertips or press down on the nail bed. Colour will fade initially, but will return within 2-3 seconds. This is called capillary refill, as the blood returns to the capillary vessels. If there is no colour change during this process, the bandage may be too tight.
Perform your breathing and circulation checks
Monitorfor the signs and symptoms of shock and treat appropriately
Implementthe Emergency Response Proceduresif necessary by calling 000 or directing someone to call 000
Do your Record Keeping

Of special note is the utilization of multiple layers of dressings. If a wound continues to bleed after 10 minutes and the initial dressing has soaked thru, DO NOT REMOVE THE DRESSING. Add a second layer of padding or dressing over the initial one, and bandage to maintain pressure on the wound. If this doesn’t stem the blood loss, and the blood continues to seep into the upper layer of dressing, simply continue to replace the second dressing. DO NOT REMOVE THE FIRST DRESSING! At this point if you have not already done so, arrange for immediate medical aid.

Abdominal Wounds

If an individual is severely bleeding from an abdominal wound, the first thing you need to do is arrange urgent medical assistance by calling 000 or directing someone to call 000. Having accomplished this, position the casualty in the most appropriate position to minimise shock and further loss of blood.

Lay the person down on their back
Utilizepillows, jackets or whatever is available under the individual’s head and shoulders to slightly elevate
Utilizepillows, jackets or whatever is available to place under their knees, elevating the bend in the knees
Gently cover the woundwith a moist, clean, sterile dressing, if none are available improvise, you can use shirts, gowns, blankets, pillow cases even clear plastic wrap, remember, IT IS IMPORTANT THAT YOU DO SOMETHING!
If internal organs, (bowel or intestines) are protruding, DO NOT touch or attempt to push them back inside the abdomen. This is called an evisceration. Wet the eviscerated area to keep the exposed organs from drying out, cover with a wet dressing or plastic wrap to minimise risk of infection, and cover with a blanket to minimise the rate of shock.
Maintain your calm and reassurethe individual that help is on the way
Do your Record Keeping

Amputations

As with any emergency situation, the very first thing you want to do is arrange emergency medical assistance by calling 000 or directing someone else to call 000. Approach the individual suffering the amputation with a calm, direct attitude. Assure them help is on the way.

Control the bleedingby using the non-life threatening steps of Pressure, Elevation and Rest
With bleeding under control and the casualty positioned comfortably, retrieve the amputated part and seal it in a plastic bagto keep it dry. Float the plastic bag in a container of cold water or ice water. DO NOT place the amputated part into ice.
DO NOT wash or cleanthe amputated piece
Do your Record Keeping

Internal Bleeding

As was previously stated, internal bleeding is sometimes difficult to detect. There are several signs and symptoms which may be present. The individual may exhibit 1 or more of these signs and symptoms. It is imperative to inquire into the background of the injury. Hard impact injuries, perhaps resulting in external bleeding also, would be a good indication if any internal bleeding might be occurring. Monitor the individual for the following:

Pain and tendernessexaggerated in the injury area
The abdomen may become rigid, swollen or distended (enlarged)
Skin discolorationin the injured area, may occur rapidly
The skin exhibits a pale coloring and becomes clammy andcool
The individual may experience extreme thirst
The individual may begin rapid, shallow breathing
Nausea and vomitingmay occur
The individual may exhibit restless and confused behavior

Many of those signs and symptoms will be familiar. They are losing fluid… they may go into shock. Always look for these signs and symptoms when assessing the casualty. The body’s systems have ways of letting you know they are in trouble!

So how do we treat internal bleeding?

Implement DRABCD
Provide First Aidmanagement of any external bleeding
If injuries permit,lay the individual down with their legs slightly elevated
Be guided by the casualty in placing them in the most appropriate position, they will tell you what is, and what isn’t comfortable.
Remain calm and reassurethe individual that help is on the way
Monitor for shockand treat appropriately
Maintain the casualty’s body temperature – loosen tight clothes or use blankets, depending on the situation.
DO NOT provide anything to eat or drinkto the individual, moisten their lips with a wet cloth is necessary. Internal bleeding invariably requires an operation, and therefore becomes Nil by Mouth.
Arrange immediate medical aid by calling 000 or designating someone else to call 000
Do your Record Keeping

Penetrating Chest Wound

A penetrating chest wound is serious. In severe scenarios, a lung or the chest cavity may be punctured thus denying the lung the ability to expand. If a lung has been punctured, bubbly, frothy blood is usually expelled from the wound or by coughing. A ‘sucking’ sound can be heard as air is sucked into the cavity between the lungs and the chest wall (pleural cavity).That is why it is sometimes referred to as a ‘sucking chest wound’.

There are several other signs of a penetrating chest wound:

The individual experiences pain in the chest area
Difficulties in breathingarise
The skin may become pale, clammy and cool
The individual may experience extreme thirst
Nausea and vomitingmay occur
The individual may become disoriented, dazed or confused

If you suspect an individual has suffered a penetrating chest wound, arrange immediate medical aid by calling 000 or designating someone to call 000. Once this has been accomplished:

Approach the individual in a calm, deliberate manner
Place the individual into the correct recovery position
If conscious,have the individual sit in a chair leaning to the injured side to protect the ‘good side’
If unconscious,place the individual into the lying down recovery position as described within DRABCD, with the injured side down to protect the ‘good side’
If theobject is still imbedded,DO NOT REMOVE IT
Utilize an occlusive (non-stick, plastic is ideal) dressing taped on 3 sides to set up a seal or one-way valve around the wound. Leave the bottom side of the non-stick dressing open to allow blood to flow away from the wound. DO NOT seal the wound completely.
Monitor the individual’s airway and breathing
Monitorthe individual for shock
Initiate CPRas necessary
Do your Book Keeping

Prevention of transmission of blood borne pathogens and communicable diseases

When dealing with an injury which results in moderate to severe bleeding, there is the very real risk that you may come into contact with the casualty’s blood. For your own safety this risk must be kept to a minimum. To accomplish this you will need to implement effective barriers between you and the individual. Most common barriers would be gloves, face mask or face shield. If none are available improvise. For example, use a folded clean cloth, plastic bags for your hands, etc.

Do notexpel saliva, cough or sneeze when treating a casualty’s wounds. The risk of cross contamination of bodily fluids isn’t just from casualty to rescuer!

Application of Tourniquets

A tourniquet is a form of bandage to be utilized only in extreme emergencies when all other means of controlling the bleeding have failed and the individual is in immediate danger from loss of blood. Normally a tourniquet will be applied when the individual is bleeding from an artery, or has severed a limb opening up multiple blood vessels.

A wide bandage (at least 5cm wide) can be used as a tourniquet high above the bleeding point. The tourniquet should be tight enough to stop circulation to the injured limb, thereby controlling blood loss. The time of application of the bandage MUST be noted and passed on to the relieving medical personnel.

Once applied, a tourniquet should not be removed until assessed by medical personnel.

A tourniquet is a last-resort option only, should not be applied over a joint or the actual wound, and must not be covered up by other bandages or dressings.

Remember! To control bleeding, you must:

Direct Pressure
Pad and bandage
Elevate
Rest and assure
Treat for shock

Care and Management of Burns

In this module you will learn about burns and how to provide First Aid treatment in assisting an individual who has suffered a burn. Simply put, a burn is an injury resulting from heat or extreme cold. Sources of burns include fire, chemicals, electricity, friction, radiation, hot or cold liquids, hot or cold metal surfaces, and ice.

The skin, the largest organ of the body, has two key functions; protecting you from infection, and regulating body temperature. The skin’s ability to perform these key functions is severely affected by burns. Fluid loss as a result of burns can quickly put the casualty at risk of shock.

Even a minor burn can be very painful, and damage below the skin may not be immediately obvious. There are several important factors to be considered when determining the severity of a burn. They are:

The actual size of the burn;the more tissue affected the more trauma the individual has incurred, and the greater the risk of infection.
The type of burn incurred, whether the individual has suffered a chemical, electrical or heat/fire type of burn, or a cold burn (frostbite)
The age of the individual involved in the incident. While burns are serious for all ages, children younger than 5 years of age as well as the elderly will suffer the effects to a greater extent. You also need to take into account the size of the burn in relation to the size of the casualty.
The area of the body where the burn was inflicted. This is particularly of concern around the head, face and shoulders as this may cause a breakdown in airway control. These burns can cause swelling and drying of the airway, inhibiting the casualty’s ability to breathe.
The depth to which the burn has penetrated the skin. Is the burn superficial or has it gone through layers of the skin, affecting not just the skin tissue?

Happening most of the time unexpectedly, a burn can not only be life threatening but may cause permanent disabilities and disfigurements. The extent of immediate and/or lasting damage is in direct relationship to the depth and coverage area of the burn. Another point to remember with burns is that swelling will occur as part of the body’s response to the damage and fluid loss from the burn. Swelling generally occurs between 24-72 hours after the burn, and can be quite dramatic, resulting in medical intervention to relieve further tissue damage.

Burns are classified in the following three categories;

Superficial Burn. This will typically result in ‘splotchy’ red areas of the outer most layer of the skin, which will turn white in color when pressed upon. Though superficial, damage to the skin is occurring. and in infants in particular you need to take into account the area of the burn in relation to the size of the child. All burns will have some level of fluid loss.
Partial Thickness Burn.As the burn penetrates through the upper layers of the skin and damages blood and lymphatic vessels, the skin displays blistering, moistness and seepage. When touched, the area will turn white in color. As the partial thickness burn progresses towards Full Thickness, the skin takes on a ‘waxy’ look and may have open blistering.
Full Thickness Burn.These burns will vary from an initial white waxy colour to a black and charred area of the skin. Typically the individual experiences lack of feeling or a numbness of the affected area. These burns often penetrate through to the bone.

The depth of a burn is often difficult to determine and may take anywhere from 24 to 72 hours and in some cases, several weeks, to diagnose correctly. By taking a look at the cause of the burn as well as the appearance of the affected area, you will be able to obtain an initial diagnosis and provide appropriate, immediate treatment. Remember, doing something is better than doing nothing!

Treatment of Burns

As with all first aid procedures, assess the danger to you, the bystanders and the casualty when initially encountering a burn’s victim.

Provision of treatment for burns consists of several steps:

Determine if burn is serious enough to require medical aid, have someone call for medical aid while you start the immediate cooling of the burn. Avoid any delay to the cooling process. Remember, burns result in fluid loss, increasing the rate of shock.
Clothing.Any item of clothing which is burnt, hot or covered with chemicals and is not adhered to the skin should be removed or cut away immediately.

Note: DO NOT remove anything stuck to the burn, whether it be clothing, bitumen, jewelry, plastic, watches, etc.

Cooling. Start the cooling process as soon as possible with copious amounts of cool running water. Flood the affected area with the cool water for at least 20 minutes with water at the degree of 3 – 18 degrees is the best, assessing for signs of hypothermia. This should be avoided. Continue the cooling process to relieve pain, and minimise damage to the skin tissues.
Covering.Superficial burns may not always require covering or bandaging, but it is recommended you do so to protect the damaged area from infection. If the individual’s injuries are beyond the superficial level, use a moist sterile bandage, preferably non-stick, to gently and loosely cover the wound. If using a moist bandage, regularly wet this bandage to ensure the cooling process continues. This serves several purposes; inhibiting infection, maintaining the cooling process, absorbing any seepage and also providing some pain relief.
Comforting. Implement your procedure for assuring and comforting the individual, be especially aware of any signs or symptoms of shock or breathing problems and treat appropriately. Where possible, elevate the burn to minimise fluid loss.

When treating burns, be aware of the following points;

Do not clean the wound, leave this for the medical professionals
Do not apply any ointments, salves, oils or lotionsto the wound. Though they may feel ‘cool’ initially, application of these materials may actually impede the healing process by holding the heat in the skin. As well, they will stick to the burn and be difficult to remove afterwards.
Anything that has adhered to the affected skin must not be removed
Do not puncture or break open any blistering. This will only result in infection.
Do not apply ice or ice water, this will only damage the affected skin further.

Don’t forgetthe age old adage; if you are alone and your clothing catches on fire; ‘Stop, Drop and Roll’.

If an individual has suffered a scalding type burn, follow these procedures;

Ensure safety for yourself, and remove the risk of further burns to you or the casualty.
Remove the clothing from the affected skin area if it isn’t stuck to the skin. Leaving it in place will only hold heat in the burn site.
Cool the wound with cool running water and treat appropriately.

Facial Burns

Facial burns have the capacity to seriously affect the casualty’s airway. Sit the casualty up during the cooling process to assist with their breathing. Burns to the face, neck and upper body will likely have some form of airway swelling, resulting in obstruction and irritation to their airway.

Urgent medical aid must be arranged for the casualty with these types of burns.

Assure and comfort the individual, monitor for signs and symptoms of shock and breathing problems. Provide treatment for shock and/or breathing assistance, as appropriate.

Chemical Burns

Most people think that a chemical burn only occurs in a shop, factory or workplace environment. While these types of accidents certainly occur, a very common occurrence is a chemical burn at home. Common household items such as pesticides, bleach, lighter fluid, drain cleaners, paint strippers and many others contain acidic chemicals which, when applied to the skin, can cause a chemical burn. Care must be taken when dealing with these chemicals, as secondary dangers such as fumes, contamination, risk of fire or spread of chemical can put rescuers and bystanders in further danger.

Always be guided by the information on the Material Safety Data sheet (MSDS). In the workplace, familiarize yourself with safety procedures for chemicals in your workplace, to ensure you know what to do before an incident occurs. Ensure you wear appropriate protective clothing when dealing with chemical burns.

Removal of any affected clothing or covering should occur immediately, unless adhered to the skin. Removal of the clothing will help alleviate the source of the burn and prevent further exposure which will also eliminate chances of further damage.

In some instances common household cleaners, such as drain cleaners, come in a crystallized form. Be sure to ‘brush off’ all of these crystals as they are water activated. If you try to rinse off the area prior to removing these crystals, the problem will increase. Once again, wear appropriate personal protection to ensure you aren’t affected by the chemical.

If the individual has suffered a chemical burn to the eye, be sure to flush the eye, including underneath the eyelid, for at least 15 minutes or until medical professionals have arrived on the scene. Wash the eye in a way that ensures the other eye cannot be affected by the chemical by having the affected eye facing downwards.

Assure and comfort the individual, be especially aware of any signs or symptoms of shock or breathing problems and treat appropriately

Electrical Burns

An individual who has suffered an electrical burn may experience many difficulties beyond the actual burn itself. The extent of the injuries is directly related to the path through the body the electricity traveled, the duration and amperage of the electrical charge. Electrical wounds often penetrate deep into the body and may leave one or more entry and/or exit wounds.

If possible, the primary objective will be to remove the individual from the electrical source or the electrical source from the individual. Never ‘assume’ the power is off, and never endanger yourself or other rescuers when performing this task.

If you must wait for Emergency Crews to shut down the source, such as in a car accident when power lines are close to or touching the vehicle, keep yourself and all others at least 6-8 meters from the electricity source. .Verbally direct your instructions to the individuals affected; get them to remain in the vehicle unless there is an imminent fire or explosion danger. A major risk to you is the electrical potential in the ground. Stay back until appropriate authorities arrive.

An individual who has suffered an electrical trauma may be in life threatening danger. Electricity can make the heart beat abnormally or even stop! Ensure you pass all information on to emergency services when calling 000 (or 112 on mobiles) to ensure the most immediate response.

Signs and symptoms of a potential electrical burn may be:

Unconsciousness
Confused or erratic behavior
Burns on the skin, which are most commonly black and charred (full thickness)
Breathing difficulties
Weak, abnormal or lack of pulse
Entry and/or exit wounds, i.e. in through the hand and out through the leg or foot

Once the individual and the rescuers are assured there will be no further contact with the electrical source, treat the burns as previously instructed. Implement procedures to assure and comfort the individual. Watch for signs and symptoms of shock and/or airway problems and treat appropriately.

Victims of electrical burns may lapse into Cardiac Arrest, be prepared to provide CPR. Have someone assist you with continual cooling of the entry burn where possible. Always look for an exit wound when a casualty has suffered from an electrical burn. This wound will most commonly require padding and bandaging. All electrical burns require a medical assessment to ensure cardiac rhythm has not been affected.

Different forms of Chemicals

Phosphorus
Hydrofluoric Acid
Bitumen
Petroleum Products

Phosphorus - ignites in air, keep dressing soaked in saline

Hydrofluoric Acid - used as a cleaning agent in Industry. Is highly dangerous & corrosive, causing Full Thickness Burns,& excruciating pain.

Even a small area, or persistent pain , needs Urgent medical assessment , & may become Life threatening if untreated.

Requires copious irrigation with water,& if available, it is critical to apply Calcium Gluconate, if available.

Bitumen -should NOT be removed from the victim’s skin, as may cause more damage. Irrigate with cool water for at least 30 minutes. Consider scoring/cracking Bitumen ,if it is encircling a limb

Petroleum products -may also cause a chemical burn

Prolonged contact may result in Organ failure, & death. Irrigate copiously with water

As learned in previous modules, doing something is much better than doing nothing!

Do not forget to do your Record Keeping.

Bandages and Dressings

Material that is utilized to support other medical devices such as dressings or splints, or as stand-alone support for the body can be classified as a Bandage. Material which has been applied directly onto a wound to either protect the wound from infection, or to stem blood loss, is called a dressing.

Bandages are most commonly used with application of pressure to stop bleeding, provide a barrier from infection and provide support to muscles and bones throughout the body.

Bandages come in a wide variety of forms, from simple cloth strips up to ‘shaped’ bandages intended for use on specific areas of the body. Also available now are the liquid brush on and spray on ‘bandages’. Bandages and dressings can be improvised from a number of sources, depending on what may be readily available at the time.

Remember, as with all first aid procedures, it is better to do something rather than nothing. With bandages and dressings, this same principle applies. Use what is available.

General Bandaging Objectives

A bandage can be applied for several reasons;

To provide the reassurance of ‘there is something on there now’.
To secure sterile dressings in place
To provide compression which controls blood loss
To support joints, ligaments or muscles that have been injured, or to prevent injury
To support areas which are exposed to excessive or repeated stress
To provide a compression dressing to a wound to help stop bleeding
To slow the carriage of toxins through the lymphatic system
To stabilise embedded or protruding objects.

There are several types of bandages. These include;

Figure 8 Bandage – ideal for sprains and strains.
Spiral Bandage – most commonly used for bleeding.
Pressure Immobilisation Bandage – use this bandage to treat envenomation.
Bandana-style Bandage – head wounds

Bandaging Hints & Tips

Be organised by having all materials within easy reach. Plan the application before-hand.
Let the casualty know what you plan to do, and why it needs to be done. Be guided by what they feel comfortable with, and when you start the bandaging continually let them know what you are doing.
Look for indications of pain or discomfort when applying bandages and dressings, you may have to have a ‘plan B’ if your initial attempt is unsuccessful.
The duration of treatment is up to the casualty and the medical personnel. Once the bandage is applied, medical assessment may be required.
Following the application of a bandage always check skin colour, circulation, sensation and movement of the treated area prior to leaving the casualty. Continually assess how they feel.
If the patient complains of undue pain or discomfort the bandage should be removed and the injury and bandage application re-assessed.
When using adhesive products such as plaster strips (material or plastic) consider using a protective spray if the patient has delicate, or sensitive skin.
Bandage selection is important, be aware of the recommended use for a product and select your bandage accordingly.
Do not use continuous, circumferential wraps of rigid tape as this may adversely affect circulation. Either avoid overlapping the ends of the tape or use an elasticised product.
Excessive creasing, wrinkling or gaps between bandage wraps should be avoided as this may affect circulation or may create pressure points, blisters or skin breakdown.

Dressings

Dressings are used in first aid for application to wounds to promote healing and/or prevent further harm from the risk of infection. A dressing is designed to be in direct contact with the wound. There are many types and sizes of dressings, including non-stick pads, burns-specific dressings, eye pads, gauze dressings and spray-on dressings. At all times, avoid using cotton wool or tissues as dressings on open wounds.

Reasons for dressing wounds;

Stem blood loss- the dressing helps to seal the wound to encourage clotting.
Soak up blood, plasma and other fluids exuded from the wound, containing it in one place. This can be beneficial to the casualty when shown to medical personnel.
Dressings can have a pain relieving effect, acting as a placebo to calm the casualty.
Stabilising embedded or protruding objects.
Protection from infection.
Promote healing through the application of pressure

Care and Management of Hypothermia

In this module you will learn about Hypothermia and how to provide First Aid treatment in assisting an individual who is suffering from Hypothermia. Simply put, Hypothermia is the failure of a living organism to sustain bodily temperature, at a level sufficient to maintain normal bodily functions. In warm blooded beings such as people, body temperature is kept at a fairly constant level. When exposed to cold, especially water, the body’s heat is rapidly dissipated into the surrounding environment. Hypothermia occurs when the body’s core temperature reaches or drops below 35 degrees Celsius. Hypothermia can become life threatening without the casualty understanding the seriousness of the condition.

Common Causes of Hypothermia.

Environmental – exposure to extremes of climate, especially cold, wet and windy conditions; submersion or immersion in cold water which increases the rate of exhaustion
Trauma – severe blood loss due to trauma, burns, etc.
Drugs – alcohol and sedatives can lower the body’s core temperature without the casualty’s knowledge.
Neurological – stroke and altered levels of consciousness
Endocrine – impaired metabolism affecting normal body functions, including control of core body temperature.
Systemic Illness – severe infections, malnutrition

Core Body Temperature

Core bodytemperature refers to the fairly constant temperature, between 36.5 and 37.5 C, of vital body organs such as the heart, kidneys, lungs and brain. As normal body temperature is 37 C, even slight losses of 1 to 2 degreesof the core temperature can trigger the onset of Hypothermia. Progression most typically occurs in three stages.

Stage 1- mild to strong shivering begins to occur, and the hands and feet begin to numb due to the constriction of the capillary blood vessels. The body does this to minimize heat loss through the skin. Breathing begins to become shallow and rapid, the core body temperature has dropped to 35 degrees Celsius.
Stage 2- shivering increases, becoming concentrated in the upper torso to maintain heat and blood supply to the vital organs. The shivering becomes intense, to the point the casualty will start to have difficulty even talking. Coordination of muscle movement is becoming severely affected. The individual may exhibit signs of confusion, irritability, or become irrational. As the core temperature continues to drop and body systems start to shut down, the ability of the body to focus blood supply to the vital organs diminishes; the blood momentarily flows back out to the extremities giving the casualty a false sense of ‘warmth’. Body extremities such as the fingers and toes will eventually take on a bluish coloring, the core body temperature has now dropped 4 degrees.
Stage 3- shivering ceases, the individual has much difficulty speaking and may even experience a form of amnesia. The motor skills necessary to use their hands have diminished severely or may be totally absent, and the individual may be rendered unconscious. Skin will become puffy and take on an even more bluish coloring; the core body temperature has dropped by 5 C or more. Death can occur within an hour.

An excellent test to determine if the individual is progressing from Stage 1 to Stage 2 is to have them put their thumb and little finger, tip to tip. If they cannot perform this task, they are beginning to experience loss of muscle coordination and should be considered in Stage 2 or higher.

If an individual reaches Stage 3, death may occur unless appropriate and immediate action is taken to treat the individual for Hypothermia. In more severe cases there may be dangerous cardiac arrhythmias, fixed and dilated pupils, which can lead to cardiac arrest. The casualty may appear dead, with an extremely weak and slow pulse.

Care and Treatment for Hypothermia

Basic steps to assist someone suffering from Hypothermia are to ensure the individual is dry, sheltered and being gradually warmed. DO NOT vigorously rub the individual’s body, handle them gently. With these basic steps in mind, you should:

Implement your DRABCD steps, immediately!
Call for medical assistance immediately, or designate someone else to make the 000 call.
Handle the individual gently, provide assurance and comfort, even if they don’t appear to understand what you are saying to them
Provide the individual with some sort of sheltering from further exposure to wind, rain or cold
Remove any wet clothing and replace with warm dry clothing, if available. If not use your imagination and create a drier environment for the individual, use your body heat to assist the individual in warming. Blankets, towels, jackets, space blankets, sleeping bags or dressing gowns are all suitable.
If the individual is conscious, drinking warm, sweet beverages will greatly assist the recovery process. Do not give them alcohol, as it is a vaso-dilator and will only encourage further heat loss through the skin.
DO NOT try to warm the casualty too quickly, as this can create serious problems with the circulation of blood within the body.
DO NOT place the casualty in a warm or hot bath.

While all stages of Hypothermia should be treated with great concern, individuals experiencing stages 2 and 3 should be immediately evacuated. These individuals are at extreme risk of experiencing cardiac arrest. Be prepared to administer CPR. Ensure you are not affected by the conditions that created the hypothermia in the first instance!

CPR should continue to be administered until appropriate professional medical personnel can relieve you. A basic thought is an individual who has been exposed for a prolonged period to the conditions causing Hypothermia, may still be rescued even though exhibiting no signs of life. This has been proven, especially among children who have experienced prolonged submersion in extremely cold water.

Act quickly, calmly and to the best of your ability. Remember, it is better to do something rather than do nothing! Also, do not forget to do your Record Keeping.

Care and Management of Frostbite

In this module you will learn how to recognize and provide treatment for Frostbite. Frostbite results from prolonged exposure to a cold environment giving the individual damage to the outer layer of skin and, depending upon the length and severity of exposure, possibly the deep tissues. Frostbite results from the freezing of tissues, causing the formation of ice crystals in the tissues which then block the vital capillary blood flow.

The areas of the body most susceptible to frostbite are the extremities; hands and feet, the face, as well as the ears. There are two clear levels of severity;

Superficial Frostbite – the surface of the skin is frozen, but can still be moved across underlying tissue.
Deep Frostbite – the underlying tissues, as well as the skin, become severely affected.

Superficial frostbite is more common in Australia than deep frostbite.

Recognition of Frostbite

An individual experiencing Frostbite, or the onset of Frostbite, may exhibit the following characteristics:

Initially the affected area may feel dull and have a throbbing sensation
As the condition progresses, the affected area feels prickly, like being stuck with needles or pins, the area may feel numb and have no feeling as Frostbite continues to progress
Skin discoloration occurs, causing the skin to take on a pale look and become hardened. At this point pain increases quickly.
Skin may turn white in color and become very hard, indicating advanced stages of Frostbite. The skin and deeper tissues are indeed frozen; blood is not flowing to these tissues. As nerve endings are destroyed, the casualty may no longer feel pain in the affected area.
Skin may turn black in coloring, (necrosis or death of tissue), indicating extremely severe Frostbite and showing that the skin and underlying tissues have frozen to the point that the tissue is dead.

Treatment for Frostbite

As with all First Aid treatments, your calm and immediate response will greatly increase the potential for complete recovery of the injured individual. There are steps which will increase the potential for recovery:

Seek immediate shelter, remove the individual from the cold environment
Remove any wet clothing or restrictive jewelryand monitor the individual for signs of Hypothermia, treat Hypothermia appropriately
Begin re-warming the area by soaking in warm, NOT HOT, water, or wrapping in cloth which has been soaked in warm water. Continue this process for 20 to 30 minutes, or until sensation returns or professional medical assistance is available (re-assess and re-apply as appropriate). If the individual is soaking in warm water be sure to circulate the water (stir) to maximize the effects. If cloth soaked in warm water is being used be sure to re-soak the cloth to keep warm wraps on the area, warm water is best described as being between 40 to 42 C. Be guided by what the casualty feels, reassure constantly whilst warming the affected areas. Do not try to warm too quickly.
Once warming becomes effective, gently apply sterile dressings to the area. If fingers or toes have been affected, gently apply the dressing not only around the area but between the fingers and toes, this ensures they do not adhere to each other.
Movethe affected area as little as possible, it is best to immobilize and elevate the area
Arrange for urgent medical assessment – call or have someone else call 000.
Provide warm non-alcoholic drinks; remember that alcohol is contra-indicated for hypothermia as it only increases heat loss through the capillary vessels.

The Recovery Process.

Often, the tissue has spontaneously thawed at time of presentation. In this case the 40-42 degree Celsius water bath is unnecessary. The tissue in this case can be cleaned and bathed at a much lower temperature of 30-35 degrees C; however be cautious as re-warming can become very painful. Be guided by what the casualty is feeling.
Elevate the affected part once recovery has commenced.
Do NOT break blisters, as this will encourage infection.
Do NOT use radiant heat to warn the affected area.
Never warm the affected area if it is obvious further freezing will occur. This will only lead to far worse tissue damage.

As feeling and circulation begins to return, the individual may experience:

Tingling, the needles and pins feeling
The area may become red and extremely painful
The individual may experience a burning feeling
The affected area may swell

This is all normal and a good indication that circulation is being restored. When the skin has softened and feeling has returned, the warming process has been completed.

Remember the following key points;

Assess any immediate risks to yourself and the casualty.
Do NOT attempt to re-warm using dry or radiant heat, such as a hair dryer, campfire, radiator, etc.
Do NOT rub or massage any area which has been affected
If blistering has occurred, do not burst the blisters
Do NOT provide alcoholic beverages such as Brandy
Do NOT allow the individual to smoke
If the possibility of re-freezing of the affected area exists, it is best NOT to thaw the area until you can get the individual into a warm environment where re-freezing will not occur.

It is better to do something rather than do nothing, and do not forget to do your Record Keeping!

Care and Management of Heat Exhaustion and Heat Stroke

This module covers the recognition, evaluation and management of Hyperthermia, more commonly classified as Heat Exhaustion and Heat Stroke. This will include how to identify the signs and symptoms of each condition, and what steps to take to provide First Aid assistance for an individual suffering from these maladies. Heat related problems can be anything from simple cramps to life threatening Heat Stroke.

As with all first aid situations, the key to first aid for heat related conditions revolves around the three basic concepts of History, Signs and Symptoms. In other words, what happened, what they can tell you, and what you can see.

Heat related conditions are normally brought on by;

Excessive exercise, even in the water
The lack of fluid intake and excessive sweating.
Vomiting and diarrhea in infants and small children
Excessive heat absorption in a hot and humid environment
Failure of the cooling mechanisms in the body, often due to illness
Infection. The body’s natural response is to raise core temperature to fight an infection or virus, resulting in excessive sweating.
Inappropriate clothing in warm environments
Drugs which affect heat regulation.

Heat Exhaustion

The onset of this problem may occur slowly, but signs and symptoms are very noticeable. Quite simply, the body is starting the shock process, and you will see shock-like signs. Signs and symptoms of Heat Exhaustion can include:

Rapid, shallow breathing, due to the elevated heart rate.
The skin becomes very pale and moist and there may be a noticeable drop in skin temperature
The individual may feel nauseous, sick to their stomach
The pulse can rapidly increase and become weak
Headaches and some dizziness are likely to be experienced
Fatigue often sets in
Cramping throughout the body can signal the loss of essential fluids and minerals from the body
Excessive thirst, no matter the amount of fluids the individual intakes, they cannot quench their thirst
If an individual urinates, the urine may be dark and stained

Treatment for Heat Exhaustion

If you note any of the above signs/symptoms, your calm, immediate action will vastly improve the individual’s chance for recovery and prevent the problem from worsening into potentially deadly Heat Stroke. Steps to be performed include:

Get the individual out of the sun or hot environment, into the shade or even an air conditioned facility
Lay the person down, elevating the feet and legs slightly, as you would for shock.
Remove and/or loosen any restrictive clothing or jewelry (socks, shoes, hats)
Provide the individual with SMALL amounts of cool liquid, or crushed ice.
Do not give alcohol.
Provide overall body cooling by misting the individual, use a sponge and cool water, apply ice packs to the groin and armpit areas
Direct a fan at the individual or fan them yourself

Monitor the individual for further complications. Look for the following signs and symptoms which would indicate their level of hyperthermia is increasing;

Inability to retain fluids
They begin vomiting
Seizures
They become disoriented, or faint.
Their temperature rises in excess of 38.9 C

Immediately call for medical assistance, 000 (or 112 on mobile phones). Prepare to treat the casualty for the more serious condition of Heat Stroke.

Heat Stroke

Unlike Heat Exhaustion, Heat Stroke can occur very suddenly and without any signs or symptoms being displayed, prior to the onset. Heat Stroke is the most serious form of heat related illness, and can very quickly lead to unconsciousness and death.

Heat Stroke is the inability of the body to cool itself due to lack of fluids. Bodily functions will rapidly shut down, much like a car seizing up when the radiator boils dry. Heat Stroke, if not treated immediately, will result in the casualty experiencing convulsions, unconsciousness and finally death.

Signs and Symptoms

Even though the onset of Heat Stroke can happen very quickly, you will be able to identify it by the following:

Skin is hot and dry to the touch, there is a noticeable lack of sweating
The core temperature is at or above 40 degrees C
The pulse, at first quite strong and bounding, becomes exceedingly rapid, weak and unsteady
The individual exhibits severe signs of confusion, disorientation and dizziness
The individual may slip in and out of consciousness

Treatment of Heat Stroke

While there are several steps to be taken to assist an individual suspected of suffering Heat Stroke, it is always important to remember that your calm, immediate action provides the individual the best possible chance for a complete recovery. Assess the scene; don’t put yourself at unnecessary risk in hot humid environments.

Implement your DRABCD steps immediately!
Remove the individual from the sun or heat source and get them into the shade or a mildly air conditioned area. Do not overcool too quickly in a cold environment
Arrange urgent medical aid - call 000
Lay the individual down, with their feet slightly elevated
Remove any restrictive clothing and/or jewelry (socks, shoes, hats)
Begin cooling the body immediately. You will want to use ice packs if available, apply to the neck, groin and armpit.
You may even wrap the individual in a cool moist sheet and direct a fan towards them.
Remember to check the individual’s temperature at least once every 10 minutes. If the individual’s core temperature drops to the 38.3 C to 38.9 C range and ice packs have been employed, remove them and replace with cool damp cloths.
To avoid overcooling, continue to keep in shaded or mildly air conditioned area and monitor the individual for rapid increase/decrease of temperature and/or shock. Treat appropriately and await the arrival of professional medical assistance
Provide cool liquids if the individual is conscious, but give it to them slowly. The stomach will reject too much liquid as it will not be functioning effectively.
Be prepared to provide CPR

Avoiding Hyperthermia.

Simple steps can be taken if you identify the risk of Hyperthermia. Prevention is better than cure!

Humidity can be a major factor in the risk of heat related conditions.
Wear clothing appropriate to the weather conditions, or the activities you find yourself in.
Consume adequate amounts of water; avoid caffeine drinks on hot days.
Avoid vigorous exercise or activities if ill or suffering from a virus.
Always assess for the signs and symptoms of hyperthermia. It can deteriorate rapidly.

Remember, it is better to do something rather than do nothing and do not forget to do your Record Keeping!

Care and Management of Eye Injuries

Injuries to the eyes can have a number of causes, including an external physical force, the embedding of small particles or the splashing of liquids and chemicals. These injuries are not only painful but may lead to other complications. In the more severe cases of a penetrating wound or an eye being displaced from the socket, blindness may result. Your immediate, calm action will provide the best possible chance for the individual to completely recover.

To fully appreciate the delicate and at times serious nature of eye injuries, an understanding of the eye is necessary.

Structure of the Eye.

The eyes are intricate egg-shaped organs, firmly set in two sockets known as orbits. The orbit is the bony cavity that contains the eyeball, muscles, nerves, and blood vessels, as well as the tear ducts and structures that produce and drain tears. Each orbit is a pear-shaped structure that is formed by several bones. The relatively tough white outer layer of the eye is called the sclera, or ‘white of the eye’. Located near the front of the eye, the sclera is covered by a thin mucous membrane (conjunctiva), which runs to the edge of the cornea and also covers the moist back surface of the eyelids.

Light enters the eye through the cornea, a transparent dome on the front surface of the eye. The cornea serves as a protective covering for the front of the eye and also helps focus light on the retina at the back of the eye. After passing through the cornea, light travels through the pupil (the black dot in the middle of the iris), which is actually a hole through the iris. The iris is the circular, coloured area of the eye, and controls the amount of light that enters the eye; the pupil dilates (enlarges) and constricts (shrinks) like the aperture of a camera lens. Behind the iris sits the lens.

The eyeball is divided into two sections, each of which is filled with fluid. The front section extends from the inside of the cornea to the front surface of the lens. It is filled with a fluid called the aqueous humor, which nourishes the internal structures. The back section extends from the back surface of the lens to the retina. It contains a jellylike fluid called the vitreous humor. The pressure generated by these fluids fills out the eyeball and helps maintain its shape.

Eye Injuries

A foreign body is an object in your eye that shouldn’t be there. This could be a speck of dust, a small wood chip, metal shaving, insect, or small pieces of glass. Foreign bodies may be found under the eyelids or on the surface of the eye.

Don’t try to remove an embedded foreign body from your own eye. Go straight to your doctor or the nearest hospital emergency department for help.

Symptoms
The indications of a foreign body in the eye include:

Sharp pain in your eye, with burning sensation and irritation
Feeling that there is something in your eye
Watery and red eye
Uncomfortable scratchy feeling when blinking
Blurred vision or loss of vision in the affected eye
Sensitivity to bright lights
Bleeding into the white part of the eye

Complications of an Eye Injury

Most injuries are minor and usually heal without further problems given the right care. Be aware of the following signs and symptoms;

Infection and scarring– if the foreign body is not removed from your eye, it may lead to infection and scarring. Metal objects can react with the eye’s natural tears and rust forms around the metal. This is seen as a dark spot on the cornea of the eye and can cause a scar that may affect your vision. Once it is removed, symptoms should quickly ease.
Corneal scratches or abrasions– a foreign body may scratch the cornea, which is the clear membrane on the front of the eye. This often leaves the casualty feeling that the object is still in the eye. With the right care, most corneal abrasions – even large ones – heal within 48 hours.
Ulcer– sometimes a scratch on the cornea doesn’t heal. A defect on the surface of your eye (ulcer) may form in its place. This could affect your vision.
Penetration of the eye– sometimes an object can pierce the eye and enter the eyeball, causing serious injury and even blindness.
Corneal scarring – this can cause some degree of permanent visual loss.

Minor Eye Injuries

When an eye injury occurs, the body typically produces tears to wash away the foreign material. In the event the tear duct has been damaged or production of tears is not sufficient to wash away the material, you can flush the eye, including under the eyelid. Common tap water or sterile saline solution can be utilized. Many workplaces will have eye wash stations, or eye baths, if the risk analysis deems it as necessary.

If a chemical has been splashed in the eye, (liquid or powder form), flush continuously with cool running water until medical aid arrives. Be familiar with first aid responses for all chemicals in your workplace, this information will be found in the Material Safety Data Sheet that should be stored with the chemical, or in the first aid room.

It is best to have the individual look down when flushing to allow the material to be removed. The head should be turned to the affected side, to ensure the object or irritant isn’t flushed into the unaffected eye. If the material cannot be removed, do not persist in flushing. You should gently place a protective covering over the eye and seek immediate professional medical attention.

Medical treatment generally includes:

The medical personnel checking the eye.
Once the foreign body is found, it is gently removed. If it is central or deep, they will arrange for the person to see an ophthalmologist to have it removed.
The eye may be bathed in saline (sterile salt water) to flush out any dust and dirt.
X-rays may be done to check whether an object has entered your eyeball.
Your eye is patched to allow it to rest and any scratches to heal.

Major Eye Injuries with an Imbedded Object

If an individual has suffered a penetrating wound to the eye and an object has become imbedded, implement the following procedures:

Arrange immediate medical intervention – call 000
Place the individual in a comfortable position, lying down
Have the individual close the unaffected eye, and cover it with their hand initially.
Gently and loosely apply a dressing to the injured eye or if the object is protruding you can bandage a paper cup around the eye.
You may have to hold the eyelids open, if the embedded object can cut or lacerate the eyelids.
Provide reassurance to the individual and monitor for the signs and symptoms of shock, provide aid accordingly.

NEVER remove an embedded object. Leave the removal to the medical professionals.

Major Eye Injuries – Ruptured Eye

If an individual has suffered a rupture of the eye:

Arrange immediate medical intervention – call 000
Lay the individual down with support for the head and be sure to keep the head stable
Gently cover the eyes with moist dressings, and keep the dressings moist until medical aid arrives.
Provide reassurance to the individual and monitor for the signs and symptoms of shock, provide aid accordingly

Remember, it is better to do something rather than do nothing and do not forget to do your Record Keeping.

Care and Management of Head Injuries

An injury to the head can result in varying levels of seriousness, from minor confusion to brain damage or even death. As the onset of these conditions can be difficult to detect, all head injuries need to be taken seriously. Assessment of the casualty who has suffered a head injury needs to be ongoing, as signs and symptoms can develop and deteriorate hours after the initial incident. As well, the ‘weakest’ part of the spine contains the seven cervical vertebrae. For this reason, immediately consider the casualty may have a spinal injury.

When an individual has sustained a head injury, it is common to see a diagnosis of one of the following:

Concussion,the most common type of brain injury, mild concussion is typically non-fatal. However, the incidence of concussion can lead to the risk of more serious consequences.
Cerebral compression, a very serious condition where swelling or constriction occurs within the brain cavity, normally requiring surgical procedures to correct
Skull fracture,another very serious condition where there has been a break in the continuity of the skull structure.

Concussion

The concussion is a temporary interruption of normal brain activity and functions. Usually an individual suffering a concussion will not experience permanent impairment. The exception to this might be the incursion of multiple concussions over a period of time, such as a football player or boxer might experience. The scarring that may occur to brain tissue can eventually lead the person to a point where even a minor concussion can have serious consequences.

Signs and Symptoms of a Concussion

Signs and symptoms of a concussion typically occur fairly rapidly. Immediate and calm provision of First Aid gives the individual the best possible chance to have a complete recovery. Early symptoms may ease or disappear within minutes, hours, or sometimes days, but can resurface very quickly at a later time. The casualty needs to be closely monitored for changes in levels of consciousness, as well as the following;

Slipping in and out of consciousness
Blurring or double vision and seeing bright ‘bursting’ stars
Eyes may be sensitive to light
Dazed and confused behavior
Headaches, vomiting, numbness, ‘tingly’ feelings and dizziness
Lack of coordination
Ringing in the ears, tinnitus
Short term memory loss
Slurred Speech
No memory of what has happened

Of special note, anyone who has been rendered unconscious should immediately seek professional medical assistance, even if they regain consciousness fairly quickly. Minor bleeds within the brain are extremely difficult to detect, but have serious consequences.

First Aid Treatment of Suspected Concussion

Typically individuals suffering mild concussions see the symptoms completely disappear within a couple of days, and the normal therapy prescribed is rest. As the first responder on scene you should:

Immediately seek medical aid for the casualty – call 000.
Monitor the individual to determine the level of consciousness
Ask three simple questions – ‘What’s your name, what day is it, how many fingers am I holding up’, and take a mental note of how they respond to those questions. You now have a ‘baseline’ of their conscious level. Keep reassuring the casualty, monitoring their responses, and ask the same questions 10-15 minutes later. Compare how they answer the next time to how they responded initially. You can monitor their level of consciousness like this by regularly asking the questions, looking for deterioration or improvement in their responses.
If the individual is unconscious, place them in the Recovery Position
If the individual is conscious, place them in a comfortable position monitoring for any change in consciousness, or onset of shock, and treat appropriately
Monitor their breathing, continue to reassure the individual professional medical assistance arrives
Provide secondary assessment and treat any injuries as appropriate

Cerebral Compression

Signs and symptoms may occur immediately after the incident or could take days and even weeks to develop. Cerebral compression may be caused by:

Severe blow to the head, either by accident or sports related
Tumor or infection of the brain
Internal brain cavity bleeding or bruising

Signs and Symptoms of Cerebral Compression

An individual suspected of sustaining an injury resulting in Cerebral Compression must immediately seek professional medical assistance. As the First Aid provider you may note:

Slow yet strong pulse
A gradual improvement in their level of consciousness, followed by a sudden decline.
Partial paralysis or weakness on one side of the body
Pupils are unevenly dilated or unresponsive
Unusually aggressive or disoriented behavior
An altered state of consciousness, extreme drowsiness
Noisy breathing tending to become slower or more irregular than normal
High temperature and flushing in the face
Blood or Cerebrospinal Fluid (CSF) leaking from the ear/s. (Usually indication of a skull fracture as well as the cerebral compression)

CSF is the clear or light straw-coloured fluid that surrounds and protects the brain and spinal cord.

First Aid Treatment of Suspected Cerebral Compression

If you note the individual is displaying signs and symptoms of a Cerebral Compression injury, whether they are conscious or not step 1 is of primary importance:

Immediately arrange for medical assistance – call 000 or have someone call while you tend to the injured person.
If the individual is conscious, place them in a semi-reclining position restricting movement as much as possible in the event they have suffered a spinal injury as well
Always treat the casualty you suspect has cerebral compression as you would someone with a possible spinal injury – handle with great care.
If the individual is unconscious, gently place them into the Recovery Position, check the airway and be prepared to perform CPR
Monitor airway and breathing until medical aid arrives
Provide secondary assessment and treat any injuries as appropriate
In certain situations such as car accidents or contact sports, the CSF cannot protect the brain from making sudden contact with the inside of the skull. This causes hemorrhaging, which can quickly lead to brain damage and even death.
If blood or clear fluids are coming from the ear canal, gently place the individual into the recovery position with the ear that is discharging fluids downward to allow the fluids to drain. This is a clear indication of a skull fracture. You may loosely cover the ear which is draining, however DO NOT plug up the ear. DO NOT discard the pads you use to collect this fluid; medical personnel will most likely need to know how much fluid has been discharged to assist in their own casualty assessment.

Skull Fracture

This injury is of the most severe kind, as it involves damage in one or more of the bone structures in the cranial area. This injury most likely is indicative of a severe head trauma and raises concern of possible internal bleeding in the brain cavity.

Signs and Symptoms of a Suspected Skull Fracture

Onset of the signs and symptoms normally occurs fairly quickly. Some may be very obvious, such as in the case of a foreign object penetrating the skull. Others such as small hairline fractures, especially at the base of the skull, behind the ears (called Battle’s Sign) are very difficult to detect, even for professional medical personnel. Typical signs and symptoms may be:

Bleeding from the head area
Altered state or loss of consciousness
Irrational and/or aggressive behavior
Deterioration of coordination, responsiveness and reflexes
Blood and/or clear fluids (CSF) draining or seeping from the ear canals
Seizures or vomiting
Pupils unevenly dilated
Bloodshot eyes
Dark bruising under the eyes, often referred to as ‘raccoon eyes’, caused by the energy discharge of the impact to the skull damaging the capillaries.
Bruising behind the ears, often seen with the bruising under the eyes.

First Aid Treatment of Suspected Skull Fracture

Remember, immediate and calm provision of First Aid gives the individual the best opportunity for a complete recovery. As the first responder to the situation you should:

Immediately arrange medical assistance – call 000.
If the individual is conscious, sit them down, leaning back in a position of comfort.
If the individual is unconscious, gently put them into the recovery position
Monitor the casualty’s airway and breathing.
Provide secondary assessment for other injuries, and treat as appropriate
Continue to reassure and calm the individual until professional medical assistance arrives
Monitor and recordthe individual’s vital signs; pulse, breathing, temperature, etc.

If blood or clear fluids are coming from the ear canal, gently place the individual into the recovery position with the ear that is discharging fluids downward to allow the fluids to drain. You may loosely cover the ear which is draining, however DO NOT plug up the ear. DO NOT discard the pads you use to collect this fluid; medical personnel will most likely need to know how much fluid has been discharged to assist in their own casualty assessment.

Care and Management of Spinal Injuries

When managing a trauma casualty, always suspect the possibility of a spinal injury. Following trauma to, or fracture of the spinal column, the spinal cord can be damaged to the point of partial or total paraplegia / quadriplegia. Extra care must be taken if there is a need to move the casualty suffering from a spinal injury as not to cause further damage to the spinal cord. Further up the spine the worse the outcome.

Spinal injuries can occur in the following regions of the spine;

The neck – Cervical spine containing 7 vertebra
The upper back – Thoracic spine containing 12 vertebra
The lower back – Lumbar spine containing 5 vertebra

Running the length of an individual’s back, encased by the vertebrae, is the bundle of nerves which comprises the spinal cord. Any suspected or actual injury to the spinal cord should be treated with great care. Injuries could result in paralysis. Even if you only suspect an injury to the spinal cord, treat the individual as if the injury exists. Generally, the only way to determine if there is an actual injury or damage to the spine is by X-ray or other medical scans.

Signs and Symptoms of a Spinal Cord Injury

Sometimes an injury to the spinal cord is not easily determined. However, immediate and calm provision of First Aid will provide the individual with the best possibility of complete recovery. Several conditions may exist which assist you in making the correct determination. As with all first aid or medical aid situations, ascertain the history of the incident as quickly as possible. This will guide you in your casualty assessment.

Examine the history of the trauma,find out all the information you can about how the injury occurred. Ask bystanders as well as the casualty. Look for indicators – paint splashed around, ladder tipped over, etc.
Observe the positioningof the individual. An unnatural, twisted or sprawling posture may be clear indicators.
The individual may seem to be confused, or may even be acting in a euphoric manner
Any movement of the head should be minimized, be guided by the individual refusing to move these areas
Back or neck pain
Partial or complete loss of movement of extremities such as the arms or legs
Partial or complete loss of sensation in any part of the body, experiencing numbness, especially in the extremities
Pupils are unevenly dilated and they do not dilate when light is briefly shone directly into them
The individual is exhibiting signs of shock
Loss of bladder or bowel control
Sustained Priapism, the male casualty often not realising it has occurred.

Special note:

If an individual has suffered a fall, from even just a metre or two, they may have sustained a spinal injury and should be treated accordingly. Always suspect spinal injury in the following situations;

Sporting incidents such as a fall from a horse, or a collapsed rugby scrum
Motor vehicle, motor cycle or pushbike accidents, whether a driver, passenger, rider or pedestrian.
Any accident where the casualty is found unconscious
Jumping or diving into shallow water, being heavily upended in the surf
Any fall suffered by the elderly
Anyone found unconscious in water
Anyone who has fallen heavily down a flight of stairs

First Aid Treatment of Spinal Cord Injuries

Any suspected spinal cord injury should be treated as if an actual injury had been incurred. The following procedures need to be strictly followed when assisting an individual who you suspect of these types of injuries:

Arrange immediate medical aid by calling 000; or designating someone else to call 000
Without movingthe individual, ensure they are breathing. If not breathing, gently position the individual for CPR. Minimize movement of the spine as much as possible and begin CPR immediately
If the individual is conscious and not in danger of incurring further injury from remaining where they are, DO NOT move them.
If the individual is unconscious, and there is the immediate and imminent risk of further injury if left where they are, GENTLY move them away from the danger and place them in the recovery position. Ensure movement of the spine is minimized; utilize the assistance of others wherever possible.
Monitor the individual’s Airway, Breathing and level of Consciousness.
Continue to provide reassurance to the individual until professional medical assistance arrives

Special notes:

Maintaining a clear and open airway always has priority over a suspected spinal injury; if the casualty is unconscious and breathing, they must be carefully put into the recovery position

If you must move, roll or in any way reposition the casualty, be very gentle, keeping the movement of the spine to a minimum. You may even have to recruit onlookers to assist you in moving the individual.

Care and Management of Sprains and Strains

Common sprains and strains may occur as a result of over exertion or a sudden un-natural movement during any physical activity. Sprains and strains can be best described in the following manner;

A Sprain is the tearing, stretching or over-exertion of a ligament. Ligaments are the ‘connectors’ between bones. Typically this injury would occur in a joint like the wrist, elbow or ankle, or thumbs, and can damage the joint capsule.
A Strain is the tearing, stretching or over-exertion of a muscle or tendon. The term ‘pulled muscle’ is often associated with a strain. Generally a strain occurs in an area such as the muscle on the back of the thigh, the hamstring; the most commonly affected area is in the back. Tendons connect muscle to bone.

Sprains and strains are referred to as ‘soft tissue’ injuries

Soft tissue is composed of bundles of fibres. Certain cells within muscles and tendons monitor the degree of contraction and stretch of these fibres. In everyday use, muscles and tendons use soft contractions to resist overstretching. However, sudden twists or jolts can apply greater force than the tissue can structurally withstand. The fibres overstretch their capacity and tear. Bleeding from ruptured blood vessels into the surrounding muscle tissue causes the swelling, pain and discomfort.

Soft tissue injuries can be sudden (acute), or can deteriorate over time (chronic). Generally soft tissue injuries take between two and 12 weeks to heal. This healing time will depend on factors such as the severity and location of the injury, the initial and ongoing management, and the age and general health of the person.

These injuries can be painful and debilitating for the individual. Obtaining a history of the events leading up to the injury will give you a guide as to the severity of the injury. If in doubt as to the severity of the injury; sprain, strain, fracture or dislocation, always treat the injury as if it were a fracture.

Remember to never apply a compression type bandage to a suspected fracture or broken bone, as this may result in movement of the damaged bones.

Signs and Symptoms of a Sprain or Strain

As a ‘rule of thumb’, the more an individual is suffering from pain and swelling the more severe the injury. Several general conditions may be present, assisting you in making the correct determination. Always attempt to find out what happened, by asking the casualty or bystanders.

Look for the following signs and symptoms;

Rapid swelling of the affected area
Bruising
Tenderness to touch
Pain
Inability to bear weight
Loss of mobility in the joint or the area of the body

A sprainmay be classified as mild, moderate or severe.

Mild sprainsare typically a slight tearing or excessive extension of a ligament with the affected area being somewhat painful, particularly if moved; the individual is normally able to bear weight on the affected area
Moderate sprainsare a complete tearing of a ligament; however the ligament does not burst or completely come apart. The individual is unable to steadily bear weight on the affected area, and if an ankle or knee is injured they may have a feeling as if their leg may collapse underneath them. The area may become bruised or discolored very quickly, swelling occurs and the affected area becomes ‘stiff’ and resistant to movement.
Severe sprainsare typically very difficult to differentiate from a fracture or broken bone, and indicate at least one ligament has torn completely as well as ruptured. Often, the ligament may become completely separated from the bone, the area rapidly swells and discolors, becomes extremely uncomfortable to the touch and the individual is unable to bear weight on the affected area.

A Straincan also be mild to severe. The signs and symptoms are much the same as those for a sprain. The main difference between sprains and strains is that strains affect muscle and tendons. The muscle may not function at all due to rupturing or complete tearing, rapid bruising typically occurs and the area around the muscle may swell.

Care and Treatment of Sprains and Strains – ‘R.I.C.E.R’

Immediate and calm provision of First Aidwill provide the individual with the best possibility of complete recovery. Implement ‘RICER’ procedures when caring for an individual suspected of having a sprain or strain. These steps are:

Rest the affected area, and reduce movement
Ice. Gently apply an ice pack or cold pack to the affected area, if no ice is available apply a cool cloth to the affected area. Wrap ice into a cloth to create a temporary ice pack.
Compression. Apply a compression bandage to the affected area to provide stabilization, work the bandage over the affected area in a criss-cross pattern to further support the injury. Do NOT use a compression bandage if you suspect a fracture or broken bone
Elevate the affected area to reduce swelling and pain by restricting blood flow. This can be done by resting the ankle or lower leg in an elevated position, or in the case of an arm/hand/wrist injury rest the arm in an arm sling.
Referral to General Practitioner

Sprains and strains can be painful and debilitating, but with the correct initial first aid treatment the casualty will recover more effectively, and less painfully. When assessing a casualty for a sprain/strain or possibly a fracture, if unsure then treat the injury as a fracture and stabilize as best you can. Be guided by three key factors;

History. What happened? Look for indicators as to what may have happened, such as ladders tipped over, or indications of a trip or fall. Ask the casualty what exactly happened.
Signs. Look at the injury, assess for indications of soft tissue or bone damage. Swelling, discolouration, heat, bruising etc, at the joints, with some level of movement often indicates a sprain or strain. Check for circulation and skin temperature below the wrist or ankle injury by gently squeezing and releasing the finger tips or the toes. Look for capillary refill. (See module 5, Control of Bleeding) If the fingers or toes are cold to the touch with minimal capillary reaction, it is more likely to be a fracture.
Symptoms. What does the casualty feel in the affected area? Numbness? Pins and needles? If they can move it, how much movement is there?

Remember, if there is any doubt, treat it as a fracture.

Care and Management of Dislocations

A dislocation is an injury which occurs in a joint within the body. The result of the injury is the misalignment of bones which are connected by ligaments. Muscles and tendons, as well as the ligaments of the joint area are typically affected and may also cause pain.

Some dislocations, especially of the hip, are congenital, usually resulting from a faulty construction of the joint. The most common dislocations are of the fingers, thumbs and shoulders.

There are several types of dislocations.

Complete dislocation - one completely separating the surfaces of a joint.

Compound dislocation - one in which the joint is visible through an open wound.

Pathologic dislocation - one due to paralysis, infection, or other disease.

Simple dislocation – the dislocation does not have an open wound.

Subspinous dislocation - dislocation of the head of the humerus (upper arm bone) into the space below the spine of the scapula (shoulder blade).

Young patients with a shoulder dislocation are at a high risk of recurrence. When a joint is dislocated, it no longer functions properly. A severe dislocation can cause tearing of the muscles, ligaments and tendons that support the joint.

Causes of Dislocation

The most common causes are a blow, fall, or other trauma to the joint. In some cases, dislocations are caused by a disease or a defective ligament. Rheumatoid arthritis can also cause joint dislocation.

Signs and Symptoms of a Dislocation

Several general conditionsmay be present, assisting you in making the correct determination:

Loss of motion or movement
Temporary paralysis of the joint
Bruising
The onset of shock
Pain, tenderness to touch
Swelling in the joint area
Deformity or disfiguration of a joint

Care and Treatment of Dislocations – Reducing the Dislocation

Immediate and calm provision of First Aidwill provide the individual with the best possibility of complete recovery. The seriousness of the dislocation depends on the location of the joint. Some joints heal faster than others. Immediately after a suspected dislocation occurs;

Immobilize the injured area as much as possible, do not attempt to re-align the joint
Apply a cold pack or ice pack to the joint to minimize swelling.
Assist the individual into the most comfortable position possible
Support the affected area in the most comfortable position; be guided by what the casualty tells you.
Arrange for medical treatment, depending on the nature and severity of the dislocation.
Dislocations to the leg joints, from the hip to the ankle, require ambulance transport due to the inability of the casualty to bear weight.

Common dislocations

A kneedislocation occurs when the bones that form your knee are out of place. The bones of your lower leg (the tibia and fibula) get moved compared to the bone of your upper leg (the femur). The bones of your knee are held together by strong bands of ligaments. For a knee dislocation to happen, these bands have to tear. Placing ice on the injured area may help for some pain control and to decrease some of the swelling. But the most important treatment is to have a doctor assess the injury and relocate or put the knee back in place.

Fingerand thumb dislocations are a common injury. They occur when the bones of the digits are moved (dislocated) from their normal position. These dislocations can occur in any of the joints of any finger, but most commonly affect the middle knuckle of the fingers. Support the fingers on a simple splint, such as a book, and seek medical aid.

Shoulder dislocations are a common dislocation. However, there are potential complications of a shoulder dislocation, and there are possible complications of reducing a dislocated shoulder. If trained personnel are not available, reduction of the shoulder dislocation is best done in trained hands at a hospital. Support the casualty’s arm in a position of comfort, and arrange transport to hospital.

Ankle dislocation requires special care. Because of the large amount of force required to cause the injury and the inherent stability of the joint, dislocation of the ankle joint is rarely seen without an associated fracture. Stabilise the ankle with padding (towels, blankets, etc) in the position the casualty presents, and call for an ambulance.

An elbow dislocation occurs when the bones of the lower arm (the radius and ulna) move out of place compared with the bone of the upper arm (the humerus). The elbow joint, formed where these 3 bones meet, becomes dislocated, or out of joint. An extremely painful dislocation, support in the position the casualty finds most comfortable, arrange transport to hospital. Treat a dislocated wrist in a similar manner.

Motor vehicle accidents account for almost two thirds of traumatic hip dislocations. Falls from height and sports injuries are also common causes of hip dislocations. Life-threatening injuries to the pelvis, abdomen, chest, and head can be associated with the cause of the hip dislocation. Dislocation of the hip joint is an orthopaedic emergency, hence urgent ambulance intervention is a priority.

For proper treatment, joint dislocations must be examined by a doctor. Dislocations need treatment ASAP. Common treatment options are:

Initial X-ray to determine damage to the joint
Medication to reduce the pain and swelling
Surgery may be necessary to repair or tighten stretched ligaments
Physiotherapy may be recommended to minimize the risk of future dislocation of the joint.

Do NOT attempt to pull, manipulate or in any other manner re-align the injured area; wait for professional medical assistance. The casualty may ask you to ‘put it back’; remember, that is a medical procedure, not a first aid procedure.

Note: If you think someone has dislocated vertebrae due to a back or neck injury, don't move the person and call Emergency Personnel immediately!

Care and Management of Fractures

Bones can be best described as connective tissue, reinforced with calcium and bone cells. Bones have a soft centre, called marrow, and this is where the body’s blood cells are created. The main functions of the skeleton are to support, allow movement and protect the vulnerable internal organs.

There are many types of bone fractures, and they can vary greatly in severity. This variation is due to factors such as the degree and direction of the force involved, the particular bone, the person’s age and general health, and any pre-existing conditions.

Common sites for bone fractures include the wrist, lower arm, ankle and hip. Hip fractures occur most often in elderly people. Broken bones generally require between four to eight weeks to heal effectively, depending on the age and health of the individual, and the type of break.

A fracture is a break in the continuity of a bone. The most common types of fractures are stress fractures brought about by the application of external force or pressure. The results could be anything from a hairline crack in the bone to complete failure of the bone structure. If a bone is termed cracked, broken or fractured, the meaning is still the same; a failure in the integrity of the bone structure.

Fractures are classified as:

Closed. The bone has not pierced the skin
Open. Also referred to as a ‘Compound’ fracture. The broken bone juts through the skin, or a wound leads to the fracture site. The risk of infection is higher with this type of fracture.
Complicated. Additional injuries have been incurred as a result of the fracture. This could be a fractured rib-cage where a rib has punctured a lung.

Within these classifications a fracture may further be refined to include:

A stable fracture - The two ends of bone remain aligned with minimal damage to the surrounding tissue and muscle areas
An unstable fracture - The two ends of the bone are no longer in alignment, or could easily be displaced by movement.
Comminuted fracture – The bone is shattered into small pieces. This fracture tends to heal at a very slow rate.
Greenstick fracture – The bone sustains a small, slender crack. This type of fracture is

most common in children, due to the flexibility of their bones.

Pathological fracture – Various diseases (such as osteoporosis and cancer) have weakened the bones, making them more susceptible to fracturing due to their brittle nature.
Avulsion fracture– muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints.
Compression fracture– occurs when two bones are forced against each other. The bones of the spine, called vertebrae, are prone to this type of fracture. Elderly people, particularly those with osteoporosis, are at increased risk

With all fractures, the individual will experience great pain. This is due to the nerves around the broken bone becoming irritated. Another likely cause of pain increase is due to muscle constriction or contraction around the break. The muscles in the area of the break tend to ‘clench’ or go into spasms to re-align the break, thus causing further pain.

With an open fracture the individual is at a much greater risk of infection and slipping into shock. Several signs or symptoms may be present, assisting you in making the correct determination. These include;

Bruising and discolouration
Pain
Tenderness to touch
Swelling in the area of the injury
Deformity or disfiguration, including possibly a protruding bone
Loss of movement or feeling

The following complications can develop;

Blood loss– The bones have a rich blood supply, and a fracture can result in substantial blood loss.
Injuries to organs– Organs such as the brain (in the case of skull fractures) or chest organs (if several ribs break) can be affected, resulting in internal bleeding. That level of damage to the rib cage is called a Flail Chest, requiring urgent medical aid.
Growth problems– The fractured bone of a young child may not grow to its intended adult length if the injury is close to a joint, as bone tends to ‘fuse’ when it heals.

Care and Treatment of Fractures

Immediate and calm provision of First Aidwill provide the individual with the best possibility of complete recovery. Immediately after a suspected fracture occurs:

In an emergency dial triple zero (000) for an ambulance.
Do not move the person unless there is an immediate danger, especially in the case of a suspected fracture of the skull, spine, ribs, pelvis or upper leg
Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound.
Immobilize the injured area while gently assisting the individual in maintaining the most comfortable position possible. Utilise available resources such as slings, padding, blankets, towels, etc, to ensure a level of comfort for the casualty while waiting for medical aid.
Maintain spinal alignment by avoiding twisting or turning of the head, neck and back
Check circulation of the affected area beyond the fracture by gently squeezing the fingertips or the toes.
Do not attempt to straighten fractured bones.
If possible, elevate the fractured area and apply a cold pack to reduce swelling and pain.
Monitor the casualty for indications of shock
Don’t give the casualty anything to eat or drink, as surgery may be required.

Remember, do NOT attempt to manipulate, straighten or in any other manner re-align the injured area, wait for professional medical assistance.

If in doubt about the severity of the injury, always treat it as if it were an actual fracture.

Care and Management of Seizures and Epilepsy

Epilepsy is a common neurological condition which affects between 1-2% of the population. Although it is more likely to be diagnosed in childhood or senior years, it is not confined to any age group, sex, or race and can be diagnosed at any age.

Epilepsy is the disruption of the normal electrochemical activity of the brain, which then results in seizures. Under certain circumstances anyone can have a seizure. It is only when there is a tendency to have recurrent seizures (more than one) that epilepsy is diagnosed.

Easily comparable to a ‘short circuit’, a seizure may cause loss of consciousness, uncontrolled muscle constriction and strange sensations within the individual. While seizures can result from a multitude of reasons, the most common are:

Low blood sugar, such as in a diabetic seizure
Drug induced
Head trauma
Sudden lack of oxygen to the brain
Other medical problems such as tumors
Accidental poisoning
In young children, typically under 5 years of age, a sudden increase in temperature usually to 39C may initiate what is defined as a Febrile convulsion

There are currently 40 different types of seizures. Seizures can be divided into two major groups - partial seizures and generalised seizures.

Partial seizures
About 60% of people with epilepsy have partial seizures, also known as focal seizures. These seizures can often be subtle or unusual, and may go unnoticed or be mistaken for anything from intoxication to daydreaming. Seizure activity starts in one area of the brain and may spread to other regions of the brain. Types of partial seizures are;

Simple Partial (no loss of awareness)
Complex Partial (change in awareness and behaviour)
Secondarily Generalised Tonic-Clonic

Generalised seizures
Generalised seizures are the result of abnormal activity in the whole brain simultaneously. Because of this, consciousness is lost at the onset of the seizure. There are many types of generalised seizures.

Generalised Tonic-Clonic
Absence (mainly affecting children)
Myoclonic
Tonic
Atonic

Signs and Symptoms of Seizures and Epilepsy

While the most common signs or symptoms of a Seizure are uncontrolled convulsions and muscle spasms, there are several other indicators.

Prolonged staring, blank expression in the eyes and of the face
Sudden rigidity, stiffness throughout the body
Uncontrolled, rapid, jerky movements of the arms, head and legs
Incontinence of the bowels
Unconsciousness
Extreme salivation
Noisy breathing
Bluish tint to the skin coloring

If a seizure has occurred, the individual may experience drowsiness and disorientation or confusion following the episode.

Care and Treatment of Seizures and Epilepsy

Immediate and calm provision of First Aidwill provide the individual with the best possibility of complete recovery. While sticking your fingers or some other aid into the individual’s mouth makes for great drama on TV, you should NEVER insert any object into the individual’s mouth!

There are several steps you can take to assist the individual, depending on the type of seizure they experience.

TONIC CLONIC SEIZURE("Grand Mal")
Convulsive seizures where the body stiffens (tonic phase) followed by general muscle jerking (clonic phase).

Remain calm, stay with the person. Maintain the safety of the general area around the individual; ensure there are no objects which may inflict further harm in the immediate vicinity.
Time the seizure, and record the time.
DO NOT put anything in their mouth.
Talk to the casualty calmly, they can hear you even though they can’t respond.
Protect the individual’s head from striking the ground, place a cushion under their head

Once the seizure has stopped or diminished sufficiently:

Place the individual into the recovery position
Maintain their privacy and dignity. They can lose control of bodily functions.
Check airway integrity to ensure the individual is breathing and if not, initiate resuscitation
Allow the individual to sleep while monitoring them
Continue to re-assure the individual
Await arrival of professional medical assistance

COMPLEX PARTIAL SEIZURE(Focal)
Non-convulsive seizure with outward signs of confusion, unresponsiveness or inappropriate behaviour. The individual will lose touch with their surroundings, oblivious to dangers around them.

Remain calm
Stay with the casualty
Time the seizure
Gently guide them from danger
Do not restrain them
Reassure until fully recovered

ABSENCE SEIZURE('Petit Mal')
Mostly affects children. They are characterised by staring, loss of facial expression, unresponsiveness, cessation of activity and eye blinking or upward eye movements.

They start and end abruptly, and last approximately two to 20 seconds. Most people recover their mental function immediately and return to their previous activity, with no memory of the event.

Remain calm
Reassure the child
Let them know what has happened.

Febrile Convulsions

A Febrile Convulsion typically occurs in children aged 5 and under. This age is not a strict limit. The main reason a child would incur this type of convulsion is from a severe, quick rise in temperature, brought on by the body’s response to a virus or infection. Normally this would be to 39°C.

Care and Treatment of Febrile Convulsions

Keep the child safe, protect from injury whilst they have the seizure. (As you would for any seizure) Pad under the head with a pillow or soft material if necessary.
When the seizure is over, roll them into the recovery position to clear their airway.
Keep talking to them in a calm manner; reassure them with your voice.
Remove excess clothing from the child.
Cool the child down with moist cloths applied to the head, neck, armpit and groin areas
DO NOT place the child into a cold bath or shower.
Seek professional medical attention to determine the correct treatment of any potential underlying infection

With either an adult or child, immediately following a seizure the individual may fall into a deep sleep. They expend a lot of energy during the seizure; this is a natural consequence of the seizure. Allow the individual to sleep while monitoring them.

Do not provide food or water until the individual is completely awake and alert.

If the person is known to have Epilepsy, the seizure hasn’t lasted more than 3-4 minutes, and wasn’t the result of an injury, medical aid is generally not required. It is important to time seizures. In all other instances, medical aid should be sought quickly. These situations include;

Multiple seizures occur in succession
The convulsion is prolonged, lasting more than 4-5 minutes.
The individual is diabetic
The individual is pregnant
Further injury has resulted from the seizure
The individual has been rendered unconscious, even briefly
The seizure has occurred ‘in water’
It is a first occurrence of a seizure for the individual
There is a possible cause of the seizure, i.e. head trauma
The individual is a child or infant
They were eating something when the seizure started

With all instances of a seizure, if in doubt ‘call the ambulance out!’

Care and Management of Poisoning and Envenomation

Poisoningis the introduction of a foreign substance into the body which affects or prevents normal bodily functions. This substance may be introduced, either intentionally or unintentionally by:

Ingestionor swallowing
Inhalation -breathing in of fumes or vapors
Absorptionthrough the skin
Injectionthrough bites, stings, needle, sharp object – anything which may pierce the skin

The 2 groups most susceptible to poisoning are children under the age of 5 and the elderly.

17,500 cases of food poisoning are reported in Australia everyday. From that number 120 people die.

Signs and Symptoms of Poisoning

While signs and symptoms vary greatly, in general terms, an individual who may be suffering from Poisoning typically exhibits one or more of the following:

Nausea
Headaches and dizziness
Skin irritation
Raw, raspy, burning sensations in the throat
Profusely perspiring
Blurring vision
Stomach cramping, diarrhea
Chest pain
Convulsion, seizures
Irregular heartbeat
Cardiac arrest

Be aware of the surroundings. As with all first aid situations, focus initially on a history of what may have happened, taking note of plants, animals, sharp objects, medicine bottles, etc. All of these could be a clue as to the type and nature of poisoning affecting the individual. By noting these things, you may also prevent yourself from becoming a victim.

Care and Treatment of Poisoning

Always assess the scene; consider the risks to you, the bystanders and the casualty. Immediate and calm provision of First Aid will provide the individual with the best possibility of complete recovery. The following procedures should be immediately implemented for assisting an individual suspected of suffering from poisoning:

Initiate the DRABCD steps
Gently assist the individual into a comfortable position
Provide calming reassurance while maintaining responsiveness to life threatening situations
If rescue breathing is required, ensure a face mask or pocket mask protection is utilized.
The casualty may exhale toxins in their breath, which could affect you.

Call the Poisons Information Centreon 131126, or direct someone else to call the centre while you are monitoring the individual. If in any doubt as to the seriousness of the poisoning, call 000 immediately.

Do NOT induce vomiting unless directed to do so by medical personnel. This can cause further damage to the casualty’s esophagus, mouth and airway.

When initiating the emergency calls, be prepared to provide the following information to the responding professional personnel:

When, what and how much was taken, look for medicine bottles, syringes, drink cups
Note plants in the surrounding area which the individual may have eaten or brushed against piercing the skin, such as mushrooms or plants with sharp thorns
Look for animal life, such as snakes, spiders, scorpion, aquatic life which may have come into contact with the individual
Have the container or packet with you; give the details to the person at the Poisons Information Centre to ensure the most appropriate response.

Envenomationis the entry of venom into a person’s body, which may cause localised or systemic poisoning. While envenomation does not cause many deaths in Australia (approximately 2 to 3 each year), it may cause serious illness requiring admission to an intensive care unit.Venom is a poisonous secretion of an animal, such as a snake, spider, or jellyfish. It is usually transmitted into the victim by a bite or sting. There are many venomous creatures in Australia, both on land and in the sea.

The signs and symptoms of envenomation can vary greatly. Many types of venom have multiple components or toxins that affect the body’s systems. Most affect autonomic and skeletal nerves, but also may interfere with other parts of the nervous system and smooth muscle.

Most commonly, the following signs and symptoms will develop due to the body’s reaction to the venom or toxin;

Local tissue damage
Pain at the bite/ sting site.
Low blood pressure (hypotension)
Headache
Blurred vision
Nausea /vomiting
Abdominal pain
Abnormally large lymph nodes, or swollen glands
Abnormal clotting of the blood)
Acute renal failure due to the breakdown of muscles cells into the blood-stream.
Muscle weakness/ Muscular paralysis
Gross muscle twitching
Sudden collapse and death

The Pressure Immobilisation Technique (PIT) or Pressure Immobilisation Bandage (PIB) was developed and introduced for the treatment of Australian snake bites. It is also recommended for envenomation by a number of other animals, and for the severe allergic reactions (Anaphylaxis) to injected venoms. Venoms gain access to the circulatory system through the flow of lymph, the PIT will retard the flow of the venom in the lymph vessels.

The PIT is recommended for envenomation by;

All Australian venomous snakes
Sea snakes
Blue-ringed octopus
Cone shell
Bee, wasp and ant stings where the person is severely allergic
Funnel web spider

The PIT is NOT recommended for the following;

Other spiders, including red-backs
Jellyfish
Stone fish and other fish stings
Bites or stings by scorpions, centipedes or beetles.

Applying the Pressure Immobilisation Bandage (PIB);

If resuscitation is needed, it takes priority over the PIB.
If on a limb, firstly apply a broad pressure bandage over the bite site as soon as possible to protect venom sample.
Then starting at the fingers or toes of the affected limb, apply a firm pressure bandage upwards along the length of the limb. Bandage the entire limb if possible to further slow the carriage of the toxin through the lymph vessels.
Splint the limb to restrict movement
Keep the victim as still and calm as possible, lying down.
Bring medical aid to the casualty.
Do not remove the bandages
If the bite is not on the limb, firm direct pressure may be useful.
Mark the bite site.

DO NOT cut the bite area, or suck the venom out

DO NOT wash the bite area, or use a tourniquet.

Snake Bites

An interesting fact is this - the deadliest of all Australian animals, responsible for an average of 10 deaths per year, is the European Honey Bee.

Australian snakes, generally, are timid and prefer to avoid human contact. Snake bites are not a common occurrence in Australia. The circumstances involved in snake bites in Australia generally include;

- Males are most commonly bitten

- Many bites happen when people handle or try to kill venomous snakes.

- Many bites happen when a person inadvertently treads on a snake.

- Alcohol is involved in a significant number of snake bites.

Australiahas 19 of the world’s most venomous snakes. All snake bites should be treated immediately upon suspicion of a bite. Once the signs and symptoms begin appearing, any treatment is going to be less effective as the venom has already begun to spread through the body.

In Australia, no one has diedfrom a snake bite when the correct First Aid procedures have been immediately implemented.

Snakes will strike when startled, threatened, provoked or cornered with no means of escape. If you encounter a snake you should immediately leave the vicinity. Treat any snake as potentially dangerous, as not all venomous snakes are easily identified.

Signs and Symptoms of Snake Bite

Signs and symptoms vary, however the most common are:

Fang marks, puncture wounds (such as a thorn would leave), scratch marks or even a single scratch in the area thought to be bitten
Panic, fear or extreme emotions may be displayed
Nausea and vomiting may occur
Diarrhea
Skin may become cold and clammy
Dizziness and fainting may occur
Blurred vision
Difficulty speaking

Of special note, localized redness, swelling and bruising are not typical of snake bites in Australia. Even a non-venomous snake may cause harm and should be treated as if it were a venomous bite.

Care and Treatment of Snake Bites

The following procedures should be immediately implemented for assisting an individual suspected of suffering a Snake Bite:

Assess for danger to yourself, bystanders and the casualty.
Call 000 immediately.
Apply the Pressure Immobilisation Bandage
Immobilize the individual to the best possible extent, do not let them up to move around
Provide calming reassurance
Be prepared to implement the DRABCD steps

Maintain your diligence by watching for, and if possible identifying the snake.

DO NOT PUT YOURSELF OR OTHER RESCUERS IN FURTHER DANGER.

Funnel Web Spiders

Australian Funnel Web Spiders are extremely venomous. These spiders are medium to large sized and may be black to brown in coloring. Typically found on the eastern coast of Australia, many experts consider these spiders the most dangerous in the world.

Signs and Symptoms of Funnel Web Spider Bite

An individual suspected of being bitten by the Funnel Web Spider exhibits the following:

Severe pain at the bite area, due to the acidity in the bite as well as the size of the fangs
Facial muscle twitching
Tingling sensations around the mouth area
Extreme salivation and sweating
Vomiting and nausea
Abdominal cramping and pain
Disorientation and confusion
Shortness of breath or difficulty in breathing

Care and Treatment of Funnel Web Spider Bite

The following procedures should be immediately implemented for assisting an individual suspected of suffering a Funnel Web Spider Bite:

Assess for danger to yourself, bystanders and the casualty.
Call 000 immediately
Lie the casualty down and apply the Pressure Immobilisation Bandage
Immobilize the individual as comfortably as possible, do not let them up to move around
Provide calming reassurance
Be prepared to implement the DRABCD steps

Red Back Spiders

The Red Back Spider is native to Australia. The female spider has a bright red stripe on the underside. The bite from these spiders can be life threatening to children. Normally in an adult, the bite is extremely painful however it is NOT considered life threatening. There has been no deaths in 60+ years.

Signs and Symptoms of Red Back Spider Bite

An individual suspected of being bitten by the Red Back Spider exhibits the following:

Immediate and severe pain at the bite site, on occasion the bite may not cause extreme pain at first and may feel like a small pin prick, sting or burning sensation
Redness, heat and swelling occurs quickly, typically in the first hour, around the bite area
The redness, heat and swelling will expand from the bite area
Profuse sweating occurs, in particular around the bite area
Nausea, vomiting and stomach cramps occur
Headache and fever can occur
Trembling in the extremities may occur

In severe cases:

Respiratory system breakdown
Seizures
A coma may be induced

Care and Treatment of Red Back Spider Bite

Apply ice packs or a cold compress to the bite site for no longer than 20 minutes.
Keep the victim under constant surveillance
Seek urgent medical aid if the victim is a small child, pain becomes excessive or collapse occurs.

Bee Stings

Bee Stings occur quite frequently. Normally they are not harmful; however on average 10 people die of bee stings in Australia every year. These individuals have probably suffered an allergic reaction to the sting. This is called an anaphylactic allergic reaction. This allergic reaction typically occurs within minutes of the sting and is life threatening.

Signs and Symptoms of Bee Sting

An individual suspected of a Bee Sting exhibits the following:

Immediate, intense pain at the sting area
Localized swelling and redness, more noticeable in the facial area
Itching in the area around the sting

An individual who is suffering an allergic reaction to the sting may exhibit:

Extreme swelling and/or itching in the sting area
Constriction of the throat and airway
Definite breathing problems including wheezing, choking
Unconsciousness
Cardiac arrest

Care and Treatment of Bee Sting

The following procedures should be immediately implemented for assisting an individual suspected of a Bee Sting:

Remove the stinger as quickly as possible with a sideways scraping motion to avoid emptying the venom sac
Apply ice packs or a cold compress to the bite site.
Refer the victim to hospital if stung on the face or tongue
Commence resuscitation if necessary

If the individual is suffering an allergic reaction to the sting, perform the following additional steps:

Immediately call for an ambulance - 000
Immobilize the sting area by applying a pressure immobilization bandage
Administer an EpiPen if available and the EpiPen has been prescribed by a medical professional for the individual
Provide calming reassurance to the individual

Queen Fire Ant Bite

Fire Ants thrive in warm, sunny environments and avoid dark, shady areas. Be especially aware in open fields, yards and parks. Their mounds are seen to ‘spring up’ typically after rain showers. These ants are known to be aggressive and have a swarming behavior. Each individual ant is capable of producing multiple bites. These ants are a reddish brown in coloring with darker undersides. Be prudent, DO NOT disturb their nests.

Signs and Symptoms of a Queen Fire Ant Bite

An individual suspected of a Queen Fire Ant Bite exhibits the following:

Pain and burning sensation in the bite area
Swelling and possibly redness and/or itching
Bumps which form a ‘white pustule’ (like a blister)

If the individual suffers an allergic reaction, called an anaphylactic reaction, to the bite, they may exhibit:

A severe, itchy rash
Constriction of the throat and airway
Definite breathing problems including wheezing, choking
Unconsciousness
Cardiac arrest

Care and Treatment of Queen Fire Ant Bite

The following procedures should be immediately implemented for assisting an individual suspected of a Queen Fire Ant Bite:

Quickly wash the ants from the person with running water.
Gently wash with soapy water or disinfectant to aid in infection prevention
Apply an ice pack or cold compress to the affected area

If the individual is suffering an allergic reaction as a result of the bite:

Call for medical aid immediately - 000
Immobilize the sting area by applying a pressure immobilization bandage
Administer an EpiPen if available and the EpiPen has been prescribed by a medical professional for the individual
Provide calming reassurance to the individual

Tick Bites

Anyone who has spent time outdoors has come across these bugs. They attach themselves to not only animals but people as well. Once attached, they feed on their victim’s blood. Some ticks are extremely small and difficult to detect. Most species of ticks have been known to transmit diseases to both man and animal. Normally ticks are found in high grasses, brushy areas and around water.

Signs and Symptoms of a Tick Bite

An individual who has incurred a tick bite may exhibit the following:

Local irritation, a ‘crawling’ sensation on the skin
A lazy, sluggish or lethargic feeling
Muscle weakness
Uncoordinated, especially when walking
Vision may become doubled or blurred
Difficulties in swallowing or breathing
Allergic reactions

Note - severe allergic reactions are extremely rare.

Care and Treatment of Tick Bite

The following procedures should be immediately implemented for assisting an individual suspected of a Tick Bite:

Utilize curved forceps / splinter forceps (tweezers) to remove the tick
Place the points of the forceps on either side of the head of the tick
Remove by pulling straight out
Apply a disinfectant or gently wash the area with soapy water if disinfectant is not available

If the individual displays any signs or symptoms of an allergic reaction, seek medical aid immediately.

When removing the tick DO NOT twist or turn the body of the tick. This could result in the head of the tick remaining in the individual. Tick bites should be monitored for several weeks to ensure an infection has not occurred.

Blue Ring Octopus

The Blue Ring Octopus, even though it is only the size of an infant’s fist, is considered the most venomous octopus in the world. The body of the octopus is easily distinguished due to the blue rings around it. The bite of a Blue Ring Octopus is toxic enough to cause death in a human. Each octopus contains enough venom to kill up to 26 adults in a matter of minutes.

Signs and Symptoms of a Blue Ring Octopus Bite

The initial bite may be relatively painless. Signs and symptoms begin to occur within minutes of the bite. An individual suspected of incurring a bite from this octopus exhibits:

Numbness beginning around the lips and tongue within minutes of the bite
Progressive musculature paralysis will occur within 10 minutes of the bite
Total body paralysis will occur, with the individual unable to request help or signal distress, they may actually be completely aware as to what is happening
Paralysis of respiratory muscles causing breathing to cease
Cardiac arrest

Care and Treatment of Blue Ring Octopus Bite

Assess for danger to yourself, bystanders and the casualty.
Call 000 immediately.
Apply the Pressure Immobilisation Bandage
Prepare to perform rescue breathing
Be prepared to perform CPR

It is imperative that rescue breathing be performed even though the individual may not seem to be responding. Due to the paralysis in the body, in particular the muscles of the respiratory system, they may be completely aware of what is going on but unable to breathe or respond.

Assisted breathing may have to be continued for several hours to allow the toxins to be flushed from the individual’s system, allowing normal breathing to be resumed by the individual.

Continuous rescue breathing and calming reassurance until professional medical personnel arrive will provide the individual with the best possible chance at recovery. Normally an individual that survives the first 24 hours will experience complete recovery.

Cone Shell

Cone Shells are prolific throughout the world around reef areas. The Cone Shell feeds mainly on small fish by stinging their prey into a paralysis type state. They are not aggressive marine life however a Cone Shell will sting a human if they are disturbed. The sting is accomplished through the spiny, dagger like spine.

A small Cone Shell sting may only be as uncomfortable as a bee sting. The larger Cone Shells are capable of inflicting a sting which could result in death.

Signs and Symptoms of a Cone Shell Sting

Although the initial bite may be relatively pain free or show only a ‘spot’ of blood, look for the following, should you suspect an individual has incurred a Cone Shell sting:

Numbness beginning around the lips and tongue within minutes of the bite
Progressive musculature paralysis will occur within 10 minutes of the bite
Total body paralysis will occur with the individual unable to request help or signal distress, they may actually be completely aware as to what is happening
Paralysis of respiratory muscles causing breathing to cease
Cardiac arrest

Care and Treatment of a Cone Shell Sting

Assess for danger to yourself, bystanders and the casualty.
Call 000 immediately.
Apply the Pressure Immobilisation Bandage
Prepare to perform rescue breathing
Be prepared to perform CPR

It is imperative that rescue breathing be performed even though the individual may not seem to be responding. Due to the paralysis in the body, particularly the respiratory system, they may be completely aware of what is going on but unable to breathe or respond.

Assisted breathing may have to be continued for several hours to allow the toxins to be flushed from the individual’s system, thus allowing normal breathing to be resumed by the individual.

Continuous rescue breathing and calming reassurance until professional medical personnel arrive will provide the individual with the best possible chance at recovery. At present, there is NO antivenom available for the cone shell.

Try to make note of the coloring, size and overall description of the Cone Shell to provide to the medical personnel.

Box Jelly Fish

Box Jelly Fish are typically found in Northern Australia from Bundaberg QLD to Geraldton WA. Spawning occurs in late summer around the mouths of rivers, with the spawn remaining in that area until spring. During the spring rains the now ‘hatched’ Box Jelly Fish, float down stream entering environments frequented by humans, especially beach areas.

Signs and Symptoms of a Box Jelly Fish Sting

The Box Jelly Fish is a passive predator, preferring to wait until prey bumps into it. Humans normally come into contact with the Box Jelly Fish by accidently running into one. Depending upon the severity of the encounter the sting may result in extreme discomfort or even death. Be aware of an individual exhibiting the following:

Severe localized reddening, swelling and pain, whelp like formations on the body
Irrational behavior
Nausea, vomiting, headaches and severe sweating
Difficulties with speech, breathing and swallowing
Extreme musculature cramping
Loss of consciousness
Cardiac arrest

Care and Treatment of Box Jelly Fish Sting

When the venom is injected into the individual, immediate, severe pain is experienced. The tentacles of the jelly fish tend to stick to the skin. Any attempt at removal may cause the sting to become worse. The sting, if left untreated may cause severe scarring. The pain of the sting has been known to last for several weeks.

Remove the victim from the water and restrain if necessary
If more than a localized small sting, call for immediate medical aid – 000
Douse or spray the affected area with vinegar for 30 seconds to neutralise the nematocysts (stinging cells) in the tentacle, then pick them off remaining tentacles carefully
Take care not to expose yourself to a secondary sting
Be prepared to perform rescue breathing
Be prepared to perform CPR

DO NOT WASH THE STING AREA OR TENTACLES WITH WATER.

DO NOT USE A PRESSURE BANDAGE AROUND THE STING AREA.

Anti-venom is availableto counteract the sting.

Blue Bottle Jelly Fish

The Blue Bottle Jelly Fish, also known as the Portuguese Man ‘o War actually is a mass of polyps forming the larger entity. A portion of the entity exists above the water line acting as a sail for propulsion, with the remaining areas trailing under the water in the form of tentacles. During the months of June and July they are very prolific and can actually be found in ‘swarms’ consisting of thousands.

Signs and Symptoms of a Blue Bottle Jelly Fish Sting

Blue Bottle Jelly Fish, both in the water and those washed up on shore can sting an individual. The dead ones may be capable of producing stings for several hours after death. The sting produces paralysis in small fish. In a human the sting is very painful however complete recovery after several hours is typical. Look for the following:

Red, whelp like formations on the skin
Blue tentacles may still be clinging on the skin
Pain may exist for hours in some instances
Allergic reactions, although rare, may occur
Fever, shock, irregular heartbeat and trouble breathing may occur in severe instances

Care and Treatment of Blue Bottle Jelly Fish Sting

The following procedures should be immediately implemented for assisting an individual suspected of a Blue Bottle Jelly Fish Sting:

Calm and re-assure the individual, do not allow rubbing of the affected area.
Carefully remove the tentacles taking care not to expose yourself to a secondary sting
Place the affected area in hot water, as hot as the victim can tolerate, for 20 minutes or as long as possible.
If hot water is unavailable, ice packs may be applied to help alleviate the pain
If the sting area is larger than half the limb, or involves sensitive areas such as the eye, call 000 immediately.

Do NOT rub the sting area or use vinegar as it is known to activate the sting further.

Fish Stings

The Stone Fish, Stingray and Bull Rout are common to the waters around Australia. These aquatic creatures are known to produce extremely painful stings and even death in humans. Be aware of your surroundings when in or near the water. The Stone Fish is considered among the most venomous fish in the world, and is a member of the Scorpion Fish family. The Bull Rout is another member of the Scorpion Fish family which can cause extreme pain and even death.

Signs and Symptoms of a Fish Sting

These creatures inflict an extremely painful injury to an individual. Look for the following:

Immediate, extreme pain at the injury site
Bleeding, swelling, inflammation and skin discoloration around the injury
Weakness, paralysis, lack of coordination may occur
Panic or irrational behavior may be present

Care and Treatment of a Fish Sting

Calm and re-assure the individual
Immerse the sting or bite area in hot tap water, make the water as hot as the individual can tolerate
Seek medical aid or assessment.
Do not remove a stingray barb as they are serrated.

Pain may be so severe it has been known to induce heart attacks. Anti-venom is available so seek professional medical assistance immediately.

First Aid Kits

No matter the activityyou have planned, from scuba diving, hiking, bicycling or a day in the park, you should always have a well thought out First Aid Kit available. If you currently have a kit, when was the last time you went through it to check supplies? You not only need to make sure everything is still intact or not past the expiration date, you need to see what supplies should be replenished. Bandages, pads and saline can lose their effectiveness once past their expiry date, but can be used if no other options are available. Medications that have expired are also generally less effective, but in some cases, can poison the person who takes it. They should not be used.

You can put together your own kit or purchase one on-line. These kits are priced anywhere from $15 up to $800. The higher end kits are designed for excursions off shore or for areas in which professional medical assistance may be quite a distance away. Typically you will spend around $35 for a kit that is in a waterproof container.

These kits are designed to provide you with the ability to treat minor injuries. The contents of kits vary greatly, of course based on what you spend.

In Australia, 5,000 children each day require medical treatment as a result of accidents, 200 are admitted to hospital. For children under 5, home injuries account for 3 out of 4 non-fatal injuries and for half of unintentional deaths. The group most at risk -1 to 2 years old

First Aid Kits in the workplace need to conform to strict industry guidelines and requirements. These requirements include the type of industry, nature of possible injuries and accidents, number of people in the workplace and size of the workplace. These first aid kits are easily identified by a white cross on a green background.

Australian Standard 1319 specifies these signs should comprise of a white symbol or text on a green rectangle with white enclosure. These signs can also indicate the location of, or direction to emergency related facilities and first aid or safety equipment.

All workplaces are required to have a first aid kit. If you have a company car or vehicle, that is deemed a workplace and therefore you must have an appropriate first aid kit in that vehicle.

In the home, the contents of your first aid kit becomes a personal choice. Medications found in the home first aid kit in most cases are not permitted in the workplace first aid kit.

Typically your kit should contain:

Bandaging material, i.e. band aids, gauze dressings, tape
Cleansing solutions, i.e. saline, antiseptics, alcohol wipes
Ointments for applying to the wound, such as bite/sting spray and antiseptic creams
EpiPens if prescribed for someone in your family
Pain killers, i.e. aspirin, ibuprofen, paracetamol, etc
Symptomatic relief products, i.e. anti diarrhea, antihistamines, Asthma puffers
Personal protection devices, i.e. gloves, eye protection
Equipment, i.e. scissors, tweezers, splinter probes, thermometer
Instant ice pack
Any personal medications
A current manual on First Aid procedures

Have you ever browsed the First Aid manual? If not, go through the manual from your kit. You don’t have to memorize it, just know what information it contains and how to look things up quickly. Remember, the faster you act the better chance the injured party has for recovery!

Get your whole family involved in learning First Aid and how to best utilize your First Aid Kit! Also make sure everyone in your family knows the location of the kit!

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