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    What is First Aid?

    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 his or her trust through your ability to confidently manage an accident, illness or injury situation through effective and appropriate communication.

    • First aid ranges from applying an adhesive dressing to being able to assist in a life threatening emergency.

    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 condition.  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 careteaches 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
    • Cardiopulmonary Resuscitation (CPR) for adult and child and infants
    • Airway management for adults and children including obstructions
    • Managing both a conscious and unconscious casualty
      • Management of suspected head and spinal injury
      • Shock management

     

    Secondary careteaches 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 trainers)
    • Splint making, for stabilising dislocations and fractures
    • Immobilisation of the casualty
    • Bleeding
    • Burns
    • Breaks

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

    allergic reactions, burns both chemical and non-chemical, electrical injuries, eye injuries, assembling and maintaining 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, please 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 casualty.  Remember, the quicker you act, the better the chance for the casualty 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 casualty.

     

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

    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. You may NOT avoid your responsibilities by terminating First Aid provision in the middle of the situation.

    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 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 or the First Aid provider acted in a reckless or careless manner.

    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 they 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”.

    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.

    They further maintain the right to accept or reject medical and/or First Aid treatment, assistance or advice.  The casualty may do this with either professional medical personnel or a First Aid provider.  If rejected, DO NOT FORCE provision of First Aid on them. 

    Make a note in your records for the proper authorities that the casualty refused aid.

    The injured person also maintains his or her right to consult with the medical professional of their own choosing.

    ‘Implied Consent’ may come into play with emergency situations.  If the casualty 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 casualty is in a life threatening situation or their future health is in jeopardy.

    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 mandatory 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 which also help serve to protect you and others.  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.S.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 and to ensure the best possible outcome.

    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 DRSABCD 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, in order of priority, you, the bystanders, and the casualty)
    • R– Response (are they conscious / aware?)
    • S – Send for help (Call 000 – bystander calls ideally)
    • A – Airway (look for obstructions, make sure it is clear & then open)
    • B– Breathing (look, listen, feel for normal breathing)
    • C– Compressions (commence chest compressions)
    • D– Defibrillation (use Automated External Defibrillator,  if available, & follow the prompts)

     

    LIFE THREATENING SITUATIONS ARE ALWAYS IDENTIFIED AND HANDLED FIRST

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

    The Secondary Survey, discussed later, involves a complete physical head to toe examination of the casualty and further questioning to assess and manage injuries which are not immediately life threatening.


     

    Primary Survey - DRSABCD

    In all emergency situations, the first aider must;

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

     

    Assess Danger

    This procedure includes looking at the accident scene to ensure YOU, the casualty involved in the accident and bystanders are not in further danger.  If the casualty has experienced a snake bite, for example, you want to make sure the offending creature is not poised to hurt anyone else in the vicinity or harm the casualty further. 

    Other potential dangers could 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 first aider should take every precaution to remove or minimize the Danger, prior to beginning further steps of the DRSABCD procedure.

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

     

    Assess Responsiveness

    An important point to remember when approaching the casualty to assess their responsiveness is to NEVER SHAKE them. This can cause further injury. If there are multiple casualties involved, any that appear to be unconscious are of primary concern for attention.  A casualty who may be shouting or screaming IS breathing, focus attention on the unconscious casualties, 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

     

    If the individual is CONSCIOUS and able to respond, calmly inform him or her 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.  If unsure, never be afraid to call an ambulance.  Wait with the casualty until medical assistance arrives.  By remaining in the area, should the casualty become unconscious, appropriate First Aid procedures may be implemented.

    If the individual is UNCONSCIOUS, call 000 immediately.  Ideally, have a bystander make the call to free you up to continue to assess and manage the casualty as information is relayed.

     

    Assess the Airway

    The easiest position in which to assess an individual’s Airway and Breathing is with the individual lying on the back.  Look into the casualty’s mouth.  If you see any liquid or solid material, place him or her 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 the side, and return to the 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 restriction of circulation.

     

    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 (drowning / partial drowning)
    • 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. Stabilise the head with the other hand on the forehead to reduce movement. Look inside their 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

     

     

    Check for (Normal) Breathing

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

    • 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 and / or rise and fall of the chest with your hand on the diaphragm

     

    Take a FULL 10 seconds to perform the Look, Listen and Feel evaluation.  You need to be sure of what you are finding.

    Normal breathing is rhythmic, in & out, not one way. Normal breathing is usually 12 – 20 breaths per minute.

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

    If the casualty is unconscious and breathing NORMALLY, place him or her into the Recovery Position.  To do this:

    • Place the arm furthest from you straight out to the side
    • Place the other arm across their chest
    • Raise the knee nearest to you to its highest apex (foot as close to the buttocks as possible)
    • Using the shoulder and the knee nearest to you, gently roll them away from you, onto their side
    • Once on their side, continue to raise the knee so it is at right angles to their body to help stabilize them. Roll the uppermost shoulder forward slightly so that their face and mouth are directed to the floor for drainage.

     

    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 helpIt may be necessary to momentarily leave the individual in the Recovery Position to seek help.

    • Continue to closely monitor the casualty’s breathing until medical assistance arrives. The unconscious, breathing casualty must remain in the recovery position to maintain a clear and open airway. Unconscious casualties should NEVER be left on the back.
    • Perform Secondary Survey, providing treatment as normally prescribed
    • Await arrival of professional medical assistance

     

     

    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 DRSABCD 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 the casualty is NOT breathing normally:  Begin chest compressions immediately.

    Providing Chest Compressions

    If you are unwilling to perform rescue breathing, perform the chest compressions alone.  REMEMBER it is better to do something than do nothing. 

    Kneel down beside the casualtywith one knee at approximately shoulder height and the other at approximately mid-stomach height on the casualty’s body.  This should place you on the central portion of the casualty’s chest area.

    • Place the heel of one of your hands in the centre of the casualty’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 heel 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.  If unsure, press harder rather than softer.

     

    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 aloud.  The cycle for performing chest compressions is:

    • 30 chest compressions
    • 2 rescue breaths

     

    To perform Rescue Breathing

    • Open the casualty’s airway 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 nose
    • 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 the nasal 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

     

    • Only breathe hard enough to see some movement of the chest.  Do not overinflate the chest as this is less effective over time and could result in unnecessary and dangerous regurgitation.

     

    As a simple guide for pace, 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 casualty 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 casualty 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 vein that returns blood to the heart.

    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!

     

    Assess Defibrillation

    Defibrillation through the use of an Automated External Defibrillator (AED) should be performed as early as possible for the best chance of a positive outcome.

    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, it is not a standalone remedy. The casualty will need to be ‘shocked’ so that the heart and breathing may have the opportunity to return to normal functions.

    If an AED is available, turn it on, follow the prompts and attach the pads to the casualty’s bared chest. 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 increase the casualty’s chance of recovery.

    The four “links” in the Chain of Survival are:

    • Early access
    • Early CPR                                                                                        
    • Early defibrillation
    • Early advanced care (by professionals) 

     

    Infants and Children

    Infants are classified as children up to 1 year of age.  Children are classified as 1 through 8 years of age. For the purpose of First Aid, casualties over the age of 8 are classified as Adults. 

    Resuscitation for both infants and children is the largely the same process as for adults.  However, it differs in a few areas, based on where they are at in their development. 

    To ensure a seal to be able to deliver breaths to an infant, you will need to cover both the open mouth and nose with your mouth.  You need only “puff” from the cheeks to be able to deliver enough air.

    As an adult, the airway is fully formed and, therefore, supported by rings of cartilage.  That means when we give head tilt to an adult, because of those rings of cartilage, the airway stays in shape and does not narrow or collapse.

    Infants do not have rings of cartilage yet. So applying head tilt as a method of opening their airway will actually have the effect of “kinking” it, and they will be unable to breathe.

    If the infant or child is breathing, place 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 two hands (if required to achieve depth)
        • Ensure compressions achieve 1/3 depth of the chest.  Do not be afraid to apply sufficient pressure.
    • Perform the Chest Compressions to Rescue Breaths cycle at:
      • 30 compressions to 2 Rescue Breaths
      • 5 cycles should be performed every 2 minutes

     

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

     

    Performing Mouth to Mask provides both the rescuer and casualty the most hygienic means of performing Rescue Breathing.  To accomplish this method:

     

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

     

    DO NOT DELAY  performance of Resuscitation while waiting for a mask to arrive.

     

    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 STOMARescue 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 stated above, if you have any concerns with breathing through the stoma, simply commence the cardiac compressions and continue with just the compressions.

     

    ANYTHINGis better than NOTHING!

               

     


     

     

     

    Secondary Survey

    Remember the secondary survey is NOT to be performed until all immediately life threatening 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 trying to find out if the casualty has:

    • Any other life threatening injuries
    • Signs or symptoms of shock
    • Injuries which may be treated using the methods taught throughout this course

     

    The Secondary Survey is a head-to-toe physical and visual 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, including areas not easily visible, 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 medical ‘history’ of what may have happened
    • Signs of envenomation – bites or scratches.
    • Most importantly – continually monitor the airway and 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 casualty.

    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 casualty has inhaled foreign matter which has become lodged in the upper airway
    • The casualty has incurred some type of trauma to the upper airway
    • The casualty is having an Anaphylactic reaction, Anaphylaxis is the immune system’s severe reaction to an allergen (typical examples are bee venom, ant venom, peanuts, tree nuts, shellfish, soy, dairy, sesame or eggs)
    • Compression of the larynx due to strangulation

      

    Partial Obstruction

    If the casualty is experiencing a Partial Obstruction, there is still some air flow.  They are 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
    • Laboured 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 casualty is still able to breathe, 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 casualty. Byremaining calm you help the casualty 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 casualty is not able to respond, turn to witnesses who may be with them.

     

    DO NOTperform back blows as this may cause the problem to worsen

    If the casualty is unable to clear the Partial Obstruction, it may become a Complete Obstruction.  If the casualty is unable to clear the airway, call an ambulance.

     

    Complete Obstruction

    If the casualty 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 casualty will be unable to breathe, cough, talk or cry
    • Typically the casualty will begin clutching around the throat
    • Rapid loss of consciousnessmay occur due to lack of airflow
    • The face turns red initially due to effort
    • Lips, fingernails and general skin colouring may then take on a bluish tint

     

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

    • Call 000or direct a bystander to call 000

     

    • Help the casualty to become calm, maintaining your composure will be of great assistance, reassure the casualty

     

    • Let them know what you are doing and then administer up to 5 BackBlows.Check after each blow to see if the obstruction has been expelled. Ideally 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 casualty 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 casualty know what you are doing and perform up to 5 Chest Thrusts**.  Once again, you will check betweenthrusts 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 casualty loses consciousness, place them in the recovery position; check their airway and breathing again.  If the casualty is not breathing, implement CPR procedures.

     

     

    If at any point during the provision of First Aid the casualty expels the foreign object or begins to breath normally, DISCONTINUE Back Blows and/or Chest Thrusts, place them into the recovery position if unconscious or continue to help them maintain their calm if conscious 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.

     

    ** To perform Chest Thrusts

    • Identify the same compression point / area as utilized in CPR
    • Chest thrust is delivered in a sharper manner and, usually to less depth
    • 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, support along your arm in a neutral head down position. Place your palm on their back to correlate to the position of your palm on the chest and push palms together.  Alternatively, face up with head supported in a neutral position, and use two thumbs in the lower part of the sternum. Depress downwards for 5 sharp thrusts, pausing between each one to watch for signs of regurgitation.

     

    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 good signs!  Arrange urgent medical assessment via ambulance.

     

    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 casualty 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, 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. Have they had this pain before? Have they consulted a doctor about it?  Are they taking 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 fifteen 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 casualty with the best possibility of complete recovery.  The following describes the procedures for assisting a casualty suspected of having an Angina attack:

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

     

     

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

    • If they have not shown clear signs of recovery within a few minutes
    • It is a first-time occurrence of these symptoms
    • The symptoms are a lot worse than usually experienced
    • If the sensation or pain differs from that 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 a casualty suspected of having 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 casualty. 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 casualty with the best possibility of complete recovery. 

    Remember – the key to survival is getting medical aid URGENTLY.  If unsure if the problem is heart related, NEVER hesitate to call an ambulance.

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

    • Don’t delay – call the ambulance! 000
    • Ask the casualty about existing heart conditions
    • Check on any medications they may be using for a heart condition
    • Gently assist them into a comfortable, semi-reclined position
    • Assist the casualty in taking their heart medication, unless they have already taken it
    • If they become unconscious, monitor their breathing and airway following the DRSABCD protocols.
    • Be prepared for resuscitation
    • Calm, rest and re-assure the casualty until professional medical help arrives
    • If they feel 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 casualty to move about, keep them seated and calm.
    • If they have 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 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.
    • 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 or Cerebrovascular Accident) 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;

    1. Blocked by a blood clot or plaque
    2. The artery breaks or bursts

     

    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, breathe, 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.  Even parts of the brain responsible for the automatic functions of the body, required to sustain life, can fail.
     
    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. Analysis by the National Stroke Foundation has collected 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 experienced 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 have 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 having a stroke typically 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
    • Sudden inability to read and or write
    • A general appearance or feeling of being ill
    • Dizziness, lack of coordination
    • Blurred vision, unequal pupils or partial / complete vision loss
    • Weakness, numbness or partial paralysis
    • Lack of facial muscle control resulting in facial drooping or uneven smile
    • Incontinence of bowel and / or bladder
    • Dramatic changes towards aggressive behaviour 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. Is it lop-sided?  Is the smile even?

    •    Arms – Can they raise both arms above the head?Is strength even?
    •    Speech – Is their speech slurred, garbled, absent? Do they understand?
    •    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 casualty with the best possibility of complete recovery.  The following procedures should be implemented immediately:

    • Call for an ambulance immediately – 000
    • Implement the DRSABCD procedures
    • Gently assist the casualty into a position of comfort, typically 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 they may have difficulty swallowing and we don’t want to compromise the airway
    • If they become unconscious, place them in the recovery position, affected side down, monitor their airway and breathing.
    • Be prepared for resuscitation
    • Calm, rest and re-assure them until professional medical help arrives.


     

     

    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 tumours
    • 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
    • Unconsciousness
    • Extreme salivation
    • Noisy breathing
    • Bluish tint to the skin colouring

     

    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 casualty with the best possibility of complete recovery.  While sticking your fingers or some other aid into their mouth makes for great drama on TV, you should NEVER insert any object into the casualty’s mouth!

     

    There are several steps you can take to assist the casualty, 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 them. Maintain the safety of the general area around them; 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 casualty’s head from striking the ground, place a cushion or padding under their head

     

    Once the seizure has stopped or diminished sufficiently:

     

    • As soon as possible place the casualty into the recovery position
    • Maintain their privacy and dignity. They can lose control of bodily functions.
    • Check airway integrity to ensure the casualty has an clear and open airway and is breathing normally
    • Allow them to sleep while monitoring them
    • Continue to reassure
    • Await arrival of professional medical assistance

     

    COMPLEX PARTIAL SEIZURE (Focal)


    Non-convulsive seizure with outward signs of confusion, unresponsiveness or inappropriate behaviour. The casualty 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
    • Let them know what has happened.

     

    FEBRILE CONVULSION

    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 an increase of as little as 1.5 deg C from normal. 

     

    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 has subsided enough, roll them into the recovery position to clear their airway as soon as possible.
    • Keep talking to them in a calm manner; reassure them with your voice.
    • Remove excess clothing from the child.
    • Sponge the child with cool water once the convulsion has ended.
    • 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 casualty may fall into a deep sleep.  They expend a lot of energy during the seizure; this is a natural consequence of the seizure. Allow them to sleep while monitoring them.

     

    Do not provide food or water until they are 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 casualty is diabetic
    • The casualty is pregnant
    • Further injury has resulted from the seizure
    • The casualty has been rendered unconscious, even briefly
    • The seizure has occurred ‘in water’
    • The casualty has no history of seizures
    • There is a possible cause of the seizure, i.e. head trauma
    • The casualty is a child or infant
    • They were eating something when the seizure started

     

    With all instances of a seizure, if in doubt ‘ship them out!’ 

     

    Diabetes

    Diabetes is an incurable chronic disease.  It is a disorder in which the body cannot make proper use of carbohydrate in food because the pancreas does not make enough insulin, or the insulin produced is ineffective, or a combination of both.

     

    Glucose comes from the digestion of carbohydrates in food. Insulin is the hormone responsible for helping glucose move into the body’s cells where it is used for energy. Glucose is also stored in the liver ready for use, but if carbohydrate is overeaten then it is stored as fat. When insulin is not present or is ineffective, glucose builds up in the blood.  Higher levels of glucose in the blood may lead to health problems such as diabetes.

     

    If diabetes is undiagnosed (which can occur in type 2 diabetes) or diabetes is not correctly managed, it can cause heart attack, stroke, kidney failure, blindness, amputation and erectile dysfunction.

     

    What is Hypoglycaemia?

    Hypoglycaemia is when the blood glucose level has dropped too low, usually below 4.0 mmol/L, or when people have the signs and symptoms. Hypoglycaemia can occur in people who are on insulin or tablets that stimulate the pancreas to release insulin. Hypoglycaemia is uncommon in people who manage their diabetes through a healthy lifestyle alone. Other names for hypoglycaemia include hypo, low blood glucose and insulin reaction.

     

    Causes of hypoglycaemia

    Delaying or missing meals or snacks

    Not eating enough carbohydrate

    Engaging in extra strenuous or unplanned physical activity

    Alcohol consumption

    Too much insulin or too many diabetes tablets

     

    Symptoms and Signs

    Weakness, trembling or shaking

    Sweating

    Headache

    Dizziness/light-headedness

    Lack of concentration/behaviour change

    Irritability

    Hunger

    Numbness/tingling around the lips and fingers

    Rapid pulse

    If left untreated signs may continue to drowsiness, coma and seizures.

     

    First Aid Management

    If the casualty is conscious, give a sweet drink or some sugar (such as jelly beans, jelly babies etc).  If the casualty does not recover fully in 5 - 10 minutes or loses consciousness, call 000 for an ambulance.

    NEVER GIVE ANYTHING BY MOUTH TO THE UNCONSCIOUS CASUALTY

    If the sugar is effective, the casualty should then have something to eat.

    Hyperglycaemiaoccurs when your blood glucose level is too high. This can develop over hours or even days. It is possible for your blood glucose level to be high and not be aware of it.

     

    Symptoms and Signs

    Feeling constantly thirsty                                       Feeling tired

    Blurred vision                                                           Passing large volumes of urine, frequently

     

    Common Causes

    Illness                                                                        Infections

    Stress                                                                         Too much carbohydrate

    Not enough insulin or diabetes tablets                Other tablets or medicines e.g. steroids

     

    First Aid Management

    The casualty must self manage as directed by his or her medical professional.  The casualty should also drink large amounts of water.  If the casualty, for any reason, is incapable of self management (diminished consciousness, does not have his or her medication) call 000 for an ambulance.

     

    Care and Management of Asthma

     

    What is asthma?

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

    • 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 hay feverincreases 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.

    Australia has 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 their breath
    • A dry or moist cough
    • Irritability
    • Lips take on a bluish tint
    • Difficulties in speaking phrases / sentences
    • Feeling anxious
    • Increase in breathing and heart rate
    • Chest pains or tightness

    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
    • Loss of consciousness

     

    These signs and symptoms can develop within minutes, therefore the person affected by the asthma attack needs to be closely monitored for changes 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 casualty.

    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 casualty 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.  Ideally, use a spacer. If one is not available, improvise if possible, as this will increase effectiveness of the medication
    • Shake the puffer and deliver one puff into the spacer device.  Ask the casualty to take 4 breaths from the spacer. Repeat for 4 total puffs and then wait 4 minutes. If there is little or no improvement, repeat for 4 total puffs and then wait another 4 minutes
    • If the casualty insists that he or she does not want to use the spacer, to avoid unnecessary distress, do not insist.  Instead encourage the casualty to exhale fully before each puff and hold the breath for four seconds after the puff and, finally take four breaths of air.  Repeat for four total puffs
    • If after administration of the medicine little or no improvement is noted after the first four puffs, seek urgent medical aid – 000
    • Continue to administer the inhaler at 4 puffs every 4 minutes until the attack subsides, the individual is rendered unconscious or professional medical assistance arrives
    • If the individual becomes unconscious, implement the DRSABCD action plan
    • Be prepared to perform CPR 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!

     

    Care and Management of Hyperventilation

     

    Hyperventilation is abnormally fast or deep breathing, resulting in loss of carbon dioxide from the blood, causing a decrease in blood pressure.

    The rate of ventilation far exceeds what the body requires for the exchange of gases.

    It may be caused by psychogenic factors, such as acute anxiety (panic attack) or pain,

    but can also be brought on by a physiological condition.

     

    Causes of hyperventilation include asthma or early emphysema; increased metabolic rate caused by exercise, fever, hyperthyroidism, or infection; lesions of the central nervous system, as in cerebral thrombosis, encephalitis, head injuries, or meningitis; hypoxia or metabolic acidosis. Use of certain hormones and drugs, such as epinephrine, progesterone, and drugs that increase the sensitivity of the respiratory centres (such as high concentrations of salicylates) are also factors.

     

    Hyperventilation may also be associated with heart attacks, heart failure, pulmonary embolus, spontaneous pneumothorax, uncontrolled diabetes and poisonings.

     

    Signs and Symptoms of Hyperventilation

    The casualty may display signs and symptoms consistent with those of a panic attack:

    • Lightheaded
    • Short of breath
    • Chest discomfort
    • Feeling of panic, impending death
    • Blurred vision
    • Tingling fingers, toes, lips
    • Palpitations
    • Detachment, (depersonalisation)

     

    Care and Treatment of Hyperventilation

     

    As with all first aid management, your calm and immediate response will improve your casualty’s chances of a full recovery.

    It is important to:

     

    • Rest and reassure your casualty
    • Encourage them to slow down their breathing
    • Follow the Basic Life Support Flow Chart (DRSABCD)
    • If unresolved, Call 000

    Care and Management of Shock

    By definition shock is the body attempting to compensate for 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 haemorrhage.
    • 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 diarrhoea can result in the vital body organs losing essential fluids which could lead to a shutdown of blood circulation. Infants and small children, in particular, are susceptible to shock from vomiting and diarrhoea 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 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

     

    Automatically assume any casualty who has experienced trauma, whether physical, mental or emotional, will go into shock.

    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 go into shock.

    Watch for the following signs and symptoms:

    • Altered level of consciousness,the casualty seems dazed and confused
    • They may become restless and easily irritated
    • Light headedness or dizziness
    • Their breathing may become rapid and shallow,
    • Pale or bluish skinwith a ‘moist, clammy’ and cool feel to the skin
    • A rapid and / or weak pulse
    • Nausea and / or vomiting
    • Casualty experiences feeling cold

     

    Shock Management

    Shock can be life threatening.  Your calm, deliberate actions WILL provide the best possibility for the casualty 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 DRSABCD procedure
    • If the casualty 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 casualty to a position of comfort, ideally lying down, and 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, heart attack, cardiac arrest  and head injuries.
    • Manage the other injuries which typically contribute most to shock, i.e. Bleeding, Burns and Fractures.
    • Maintain a normal body temperature. Because they no longer have effective circulation, they are no longer able to maintain their own temperature.  Place a blanket or jacket over them to help reduce the effects of shock.
    • 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 to the casualty in a calm, reassuring manner. This will help to keep them calm, which will lower their heart rate and reduce the effects of shock.
    • If the individual is complaining of thirst, moisten their lips at most but DO NOT provide them anything to eat or drink, as this could cause shock symptoms to become worse.
    • If the casualty is rendered unconscious place them into the recovery position as outlined in DRSABCD
    • Monitor their airway and breathing, initiate CPR procedures if appropriate

     

    Fainting is a form of shock, precipitated by a drop in blood pressure. It can be brought on

    by long periods of standing in one place (eg: military on parade), or for people with low blood pressure, standing up quickly can cause them to become dizzy and faint.

     

    Once a fainting casualty has regained consciousness, they should be placed on their back with their legs raised, to encourage return of blood flow to the brain.

     

    Care and Management of Bleeding

    In this segment you will learn about bleeding and how to provide First Aid treatment to control bleeding.  Bleeding is the loss of blood from the Circulatory System.Loss of blood may result in shock. Constantly monitor the casualty’s condition whilst treating the bleeding, in order to be aware of the onset of shock.  An individual may be bleeding externally, which may be easily visible. If bleeding internally, however, it may be more difficult to detect.  Bleeding can occur 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 first aider you will be able to distinguish bleeding from arteries, veins or capillaries primarily by the colour, the volume and how the blood is being expelled.  The core components of First Aid management 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 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 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 but does not spurt

     

    Capillaries

    • Blood oozes from the wound at a steady rate
    • Tends to coagulate (stop oozing) quickly and easily

     

    External Bleeding

    Typically external bleeding is easily detected however it can sometimes be hidden by some types of clothing, the casualty’s position and other environmental factors.  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.

    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 assess 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 casualty 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 incidents, 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 imbeddedor 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 pressure to the wound
    • If the injury allows the individual to be placed lying down, lay them down gently and elevate the injured area if possible
    • Check to ensure proper circulationbefore 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 should return within 2-3 seconds. This is called capillary refill, as the blood returns to the capillary vessels.
    • Perform your breathing and circulation checks
    • Monitor for 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

     

    If a wound continues to bleed after 10 minutes and the initial dressing has soaked through, DO NOT REMOVE THE DRESSING.  Add a second layer of padding or dressing over the initial one, and bandage to increase pressure on the wound. If this doesn’t stop 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. 

    1. Lay the person down on their back
    2. Utilize pillows, jackets or whatever is available under the individual’s head and shoulders to slightly elevate
    3. Utilize pillows, jackets or whatever is available to place under their knees, elevating the bend in the knees
    4. 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!
    5. 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. To prevent exposed organs from drying out, and to minimise risk of infection, cover with a wet dressing or plastic wrap, and treat the signs and symptoms of shock.
    6. Maintain your calm and reassurethe casualty that help is on the way
    7. Do your Record Keeping

    Amputations

    As with any emergency situation, as soon as possible arrange emergency medical assistance by calling 000 or directing someone else to call 000.  Approach the casualty with a calm, direct attitude.  Reassure them help is on the way.

    • Control the bleeding by using the Pressure, Elevation and Rest
    • With bleeding under control and the casualty positioned comfortably, retrieve the amputated part, lightly wrap it in a dressing or clean cloth 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 directly into ice.
    • DO NOT wash or clean the amputated part
    • Do your Record Keeping

     

    Internal Bleeding

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

    • Pain and tenderness
    • Rigidity, swelling or distension of the abdomen
    • Bruising or discoloration of the affected area
    • Pale, cool and clammy skin
    • Rapid, shallow breathing
    • Nausea and vomiting
    • Restlessness and confusion
    • Extreme thirst

     

    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.

    So how do we treat internal bleeding?

    • Implement DRSABCD
    • Provide First Aid management of any external bleeding
    • Be guided by the casualty in placing them in the most appropriate position, they will tell you what is, and what isn’t comfortable (ideally, if their injuries permit, lying down with their legs elevated to help reduce the signs and symptoms of shock)
    • Remain calm and reassurethe casualty 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 drink, moisten their lips with a wet cloth is necessary.
    • Arrange immediate medical aid by calling 000 or designating someone else to call 000
    • Do your Record 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!

    In all cases, the risks to the rescuer are low.  Do not be afraid to help.  Still take all possible precautions.  Low does not mean zero.

    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.  It is rarely necessary to apply a tourniquet.

    To control bleeding, we use: Direct Pressure, Elevation & Rest wherever possible

    CRUSH INJURIES

     

    Crush injury is a term that can be applied to a body part pinned by a weight, being buried, having prolonged pressure to a body part due to unconsciousness and / or immobility.

    A crush can result in bleeding, fractures, cell damage, internal injuries and a range of other injury or damage dependant on the nature of the crush and the parts of the body involved.

    Management

    ALL crushing objects MUST be removed IMMEDIATELY if safe and physically possible.  This is especially important when the head or torso is involved but also applies to the limbs.

    Call 000 for an ambulance.

    Once the crush has been relieved, there may be conditions present such as bleeding and fractures.  Manage these as is appropriate.

     

    Care and Management of Burns

    In this module you will learn about burns and how to provide First Aid treatment in assisting a casualty who has experienced 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 experienced a chemical, electrical or heat / fire type of burn, or a cold burn
    • 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 problem with their airway and lungs. These burns can cause swelling and drying of the airway, inhibiting the casualty’s ability to breathe as well as damage to the lungs themselves.
    • 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?

     

    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 when pressed. Though superficial, damage to the skin is occurring. 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 vessels 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 casualty experiences lack of feeling or a numbness of the affected area. These burns often penetrate through to the bone.

     

    You don’t need to know exactly how deep a burn is, in order to provide first aid. 

    Treatment of Burns

    As with all first aid procedures, assess the danger to you, the bystanders and the casualty before approaching.

     

    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 is clothing, bitumen, jewellery, 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 up to 20 minutes. Burns are a soft tissue injury and as such, they retain heat even after the source of the heat has been removed. The cooling process is designed to relieve pain, and minimise damage to the skin tissues by reducing the burn time.
    • Covering.Superficial burns may not always require covering or bandaging, but it is recommended you do so to protect the damaged area from infection. By covering the burn, we are keeping the air out, which will help to reduce the pain. If the casualty’s injuries are beyond the superficial level, always apply a non-stick dressing to gently and loosely cover the wound.
    • Comforting.  Reassure the casualty, be especially aware of any signs or symptoms of shock or breathing problems and treat appropriately.

     

    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 as this will only damage the affected skin further. 

     

    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.  If the history indicates airway or inhalation burns are likely, do not hesitate to call an ambulance as breathing may be suddenly affected.

    Reassure and comfort the casualty, 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.  Be careful not to be contaminated yourself.

    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 casualty has experienced a chemical burn to the eye, be sure to flush the eye, including underneath the eyelid, for at least 20 minutes or until medical professionals have arrived on the scene. Have the casualty leaning towards the affected side. Start irrigating at the bridge of the nose to enable you to adjust pressure and irrigate away to protect the unaffected side.

    Reassure and comfort the casualty, be especially aware of any signs or symptoms of shock or breathing problems and treat appropriately.

     

    Electrical Burns

     

    A casualty who has experienced 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 travelled, 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 casualty from the electrical source or the electrical source from the casualty. 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.

    A casualty who has experienced 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 to ensure the most immediate response. 

    Signs and symptoms of a potential electrical burn may be:

    • Unconsciousness
    • Confused or erratic behaviour
    • Burns on the skin, which may be black and charred
    • 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 casualty and the rescuers are assured there will be no further contact with the electrical source, treat the burns as previously instructed.  Reassure and comfort the casualty.  Watch for signs and symptoms of shock and / or airway problems and treat appropriately.

     

    Casualty may experience Cardiac Arrest, be prepared to provide CPR. All electrical incidents require a medical assessment to ensure cardiac rhythm has not been affected.

    Burns and Medical Aid

     

    Seek medical aid for the following:

    • All superficial burns larger than 2.5 cm diameter
    • All deep burns due to risk of infection.  Deep burns larger than 2.5 cm require hospital treatment and an ambulance should be called.
    • Facial burns.
    • Burns to the genitals.
    • Suspected airway or inhalation burns
    • Electrical burns

    Bandages and Dressings

    Material that is used 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 restrict blood flow (as a last resort) to control 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 transportation 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

    1. Be organised by having all materials within easy reach.  Plan the application before-hand.
    2. 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.
    3. 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.
    4. The duration of treatment is up to the casualty and the medical personnel. Once the bandage is applied, medical assessment may be required.
    5. 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.
    6. If the patient complains of undue pain or discomfort the bandage should be removed and the injury and bandage application re-assessed.
    7. Bandage selection is important, be aware of the recommended use for a product and select your bandage accordingly.
    8. 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.
    9. 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.  They also prevent exposed nerve endings from coming into contact with air, a cause of pain.
    • Stabilising embedded or protruding objects.
    • Protection from infection.
    • Promote healing.

     

    Care and Management of Hypothermia

    In this module you will learn about Hypothermia and how to provide First Aid treatment in assisting a casualty who is Hypothermic.  Hypothermia is the failure of a living organism to sustain body temperature at a level sufficient to maintain normal bodily functions.  In warm blooded beings such as humans, 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, on average, 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 casualty 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 colouring, the core body temperature has now dropped 4 degrees.
    • Stage 3- shivering ceases, the casualty has great 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 they may be rendered unconscious. Skin will become puffy and take on an even more bluish colouring; the core body temperature has dropped by 5 C or more. Death can occur within an hour.

     

    An excellent test to determine if the casualty 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 a casualty reaches Stage 3, death may occur unless appropriate and immediate action is taken to treat them 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 a casualty with Hypothermia are to ensure they are dry, sheltered and being gradually warmed.  DO NOT vigorously rub their body, handle them gently.  With these basic steps in mind, you should:

    • Implement your DRSABCD steps, immediately!
    • Call for medical assistance immediately, or designate someone else to make the 000 call.
    • Handle the casualty gently, provide reassurance and comfort, even if they don’t appear to understand what you are saying to them
    • Provide them 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 casualty. Use your body heat to assist in warming them. Blankets, towels, jackets, space blankets, sleeping bags or dressing gowns are all suitable.
    • If the casualty 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, casualties 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.  It is believed that 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.

    Frostbite

    Frostbite results from prolonged exposure to a cold environment, damaging outer layers of skin and, depending upon the length and severity of exposure, possibly the deep tissue.  Frostbite results from the freezing of tissues, causing the formation of ice crystals in the tissues, which block capillary blood flow.

     

    The areas of the body that are most susceptible to frostbite are the extremities: hands and feet, the face, as well as the ears.  There are 2 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 then deep frostbite.

     

    Recognition of Frostbite

     

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

     

    • Initially the affected area may feel dull and throb
    • As the condition progresses, they may experience pins and needles, it may be numb
    • The skin may become discoloured, taking on a pale appearance, and become hardened. (At this point, pain increases significantly)
    • Skin may become white and hard (indicating advanced stages of frostbite). Tissues and frozen and blood is no longer flowing to these areas.  Nerve endings may be destroyed.

     

    Treatment for Frostbite

    As with all First Aid treatments, your calm and immediate response will greatly increase the potential for complete recovery. You should:

     

    • Seek immediate shelter, remove the individual from the cold environment
    • Remove any wet clothing or restrictive jewelry (rings etc) and monitor the casualty for signs of hypothermia (treat hypothermia appropriately)
    • Begin rewarming the affected area by using body heat (fingers in armpits, toes in someone else’s armpits)
    • DO NOTuse radiant heat or dry heat
    • DO NOTrewarm if further freezing is likely to occur
    • DO NOTrub or massage the area
    • DO NOTgive alcohol

     

    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 a casualty in this situation.  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 diarrhoea 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 the body’s ability to regulate heat

     

    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 nauseated, 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
    • The casualty may have seizures / convulsions

     

    Treatment for Heat Exhaustion

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

    • Get the casualty out of the sun or hot environment, into the shade or even an air conditioned facility
    • Lie them down, if possible, and elevate the feet and legs slightly, as you would for shock
    • Remove and / or loosen any restrictive clothing or jewellery (socks, shoes, hats)
    • Provide the casualty with frequent SMALL amounts of cool liquid, or crushed ice.
    • Do not give alcohol.
    • Provide overall body cooling by misting, use a sponge and cool water
    • Direct a fan at the individual or fan them yourself
    • Call an ambulance  (dial 000)

     

    Monitor the casualty 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. 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 casualty exhibits severe signs of confusion, disorientation and dizziness
    • They may slip in and out of consciousness

     

    Treatment of Heat Stroke

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

    • Implement your DRSABCD steps immediately!
    • Remove the casualty 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
    • Lie them down, with their feet slightly elevated
    • Remove any restrictive clothing and/or jewellery (socks, shoes, hats)
    • Begin cooling the body immediately. You will want to use ice packs if available, apply to the neck, groin and armpit.
    • Provide overall body cooling by misting, use a sponge and cool water
    • Avoid overcooling, continue to keep in shaded or mildly air conditioned area and monitor them. 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 are undertaking
    • Consume adequate amounts of water frequently; avoid caffeine drinks on hot days
    • Avoid vigorous exercise or activities if unwell
    • 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 casualty to completely recover.

    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.
    • Medications or ointments may be prescribed to reduce the risk of infections or other complications.

     

    Major Eye Injuries with an Imbedded Object

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

     

    • Arrange immediate medical intervention – call 000
    • Place the casualty in a comfortable position, lying down
    • Have the casualty 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.
    • Provide reassurance to the casualty 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 a casualty has a ruptured eyeball:

     

    • Arrange immediate medical intervention – call 000
    • Lie the casualty 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 casualty 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 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 skull.
    • Skull fracture,another very serious condition where there has been a break in the continuity of the skull structure.

     

    Concussion

    A concussion is a temporary interruption of normal brain activity and functions.  Usually a casualty with a concussion will not experience any discernable 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 behaviour
    • Headaches, nausea, 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

     

    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 casualties with 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 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 casualty is conscious, place them in a comfortable position monitoring for any change in consciousness, or onset of shock, and treat appropriately
    • If the casualty is unconscious, place them in the Recovery Position
    • Monitor their breathing, continue to reassure them until 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
    • Tumour or infection of the brain
    • Bleeding or bruising inside the skull

     

    Signs and Symptoms of Cerebral Compression

    A casualty 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 behaviour
    • 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 casualty 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 casualty.
    • If they are conscious, place them in a semi-reclining position restricting movement as much as possible in the event they have 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 ofthe skull. This causes haemorrhaging, which can quickly lead to brain damage and even death.
    • If blood or clear fluids are coming from the ear canal, gently place the casualty 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 and what type of 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.

    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 behaviour
    • Deterioration of coordination, responsiveness and reflexes
    • Blood and / or clear fluids (CSF) draining or seeping from the ear or nose
    • Seizures or vomiting
    • Pupils unevenly dilated
    • Bloodshot eyes
    • Dark bruising around or 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 around or under the eyes.

     

    First Aid Treatment of Suspected Skull Fracture

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

    • Immediately arrange medical assistance – call 000.
    • If the casualty is conscious, lie them down with their head and shoulders supported.
    • 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
    • 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.

     

    REMEMBER:All head injuries(or suspected head injuries) require assessment by competent medical personnel.


     

    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 this type of casualty so as not to cause further damage to the spinal cord. The further up the spine, the worse the outcome will typically be.

    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, Sacral spine containing 5 fused vertebra and Coccygeal spine containing 5 fused 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 or even death.  Even if, given the history, you only suspect an injury to the spinal cord, treat the casualty 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 casualty with the best possibility of complete recovery.  Several conditions may exist which assist you in making the correct determination. As with all first 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 casualty. An unnatural, twisted or sprawling posture may be clear indicators.
    • The casualty 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 casualty refusing to move these areas
    • Back or neck pain
    • Partial or complete loss of movement or feeling of arms or legs
    • Absence of pain in limbs in spite of injuries to these areas
    • Pupils are unevenly dilated and they do not dilate when light is briefly shone directly into them
    • The casualty is exhibiting signs and symptoms of shock
    • Loss of bladder or bowel control

    .

    If an individual has experienced 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 or has regained consciousness after trauma
    • Jumping or diving into shallow water, being heavily upended in the surf
    • Any fall when the casualty is 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 a casualty who you suspect of these types of injuries:

     

    • Arrange immediate medical aid by calling 000; or designating someone else to call 000
    • If the casualty is conscious and not in danger of incurring further injury from remaining where they are, DO NOT move them.
    • Support the head in a neutral position
    • If there is the immediate and imminent risk of further injury if left where they are, GENTLY move them away from the danger. Ensure movement of the spine is minimized; utilize the assistance of others wherever possible.
    • If they are unconscious, check airway and breathing.  If breathing NORMALLY, GENTLY place in recovery position and monitor while waiting for the ambulance.
    • Constantly monitor the casualty’s Airway, Breathing and level of Consciousness.
    • Continue to provide reassurance to them until professional medical assistance arrives

     

    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 have to recruit onlookers to assist you in moving the casualty.

     

    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-extension 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 twelve 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 casualty.  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 they are experiencing 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

     

    The history and mechanism of injury are usually the best indicators.

     

    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 discoloured 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 discolours, becomes extremely uncomfortable to touch and the casualty 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 casualty 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. (When applying ice to a casualty, remember to cover it first to reduce the risk of a freezer burn.  Apply for 20 continuous minutes every two hours.  If the casualty shows signs of redness in the affected area, remove ice as they may be sustaining a freezer burn.)
    • 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. Do NOT uses the compression bandage to hold the ice pack in place. Remove ice, apply compression, and reapply ice.
    • 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 appropriate medical professional

     

    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 humorous (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.  It can also result in a lack of circulation which can lead to severe tissue damage.

     

    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

    Immediate and calm provision of First Aidwill provide the casualty 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 casualty 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 usually via ambulance
    • 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, 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. 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 humorus). 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, urgent medical attention 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’; but 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 unless required to maintain the airway or to perform CPR 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, forearm, 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 casualty 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 casualty 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 casualty 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, 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 they may require surgery. 

     

    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.

     

    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 vapours
    • 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 every day. 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, diarrhoea
    • 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 casualty.  By noting these things, you may also prevent yourself from becoming a casualty.

     

    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 casualty with the best possibility of complete recovery.  The following procedures should be immediately implemented for assisting someone suspected of experiencing a poisoning:

     

    • Initiate the DRSABCD steps
    • Gently assist the casualty into a comfortable position
    • Provide calming reassurance

     

    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 oesophagus, 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 casualty
    • Have the container or packet with you; give the details to the person at the Poisons Information Centre to ensure the most appropriate response.

     

    **If rescue breathing is required, ensure a face mask or pocket mask protection is used - The casualty may exhale toxins in their breath, which could affect you**

     

     

    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 casualty 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 voluntary 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)  presenting as light headedness / dizziness
    • Headache
    • Blurred vision
    • Nausea / vomiting
    • Abdominal pain
    • 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. 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 snakes
    • Sea snakes
    • Blue-ringed octopus
    • Cone shell
    • Funnel web spider and mouse 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):

     

    1. If resuscitation is needed, it takes priority over the PIB.
    2. If on a limb, cover the bite site to preserve the venom sample. Then apply a firm broad pressure bandage over the bite site. 
    3. Then starting at the fingers or toes of the affected limb, apply a comfortably firm pressure bandage upwards along the length of the limb. Bandage the entire limb if possible to further slow the transportation of the toxins through the lymph vessels.
    4. Splint the limb to restrict movement
    5. Keep the casualty as still and calm as possible, lying down.
    6. Bring medical aid to the casualty.
    7. Do not remove the bandages
    8. If the bite is not on the limb, firm direct pressure may be useful, using a pad.
    9. Mark the bite site.

     

    DO NOTcut the bite area, or suck the venom out.

    DO NOTwash the bite area, or use a tourniquet.

     

    Snake Bites

    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.

     

    Australia has 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 died from 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 (not necessarily paired marks)
    • Panic, fear or extreme emotions
    • Nausea and vomiting
    • Diarrhoea
    • Skin may become cold and clammy
    • Dizziness and fainting
    • Blurred vision
    • Difficulty speaking

     

    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:

     

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

     

    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 colouring.  Typically found on the eastern coast of Australia, many experts consider these spiders the most dangerous in the world. They are known to be able to survive for a period under water, by trapping air in the hair follicles on their bodies. People have been bitten by standing on them in a swimming pool.

     

    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:

     

    • Assess for danger to yourself, bystanders and the casualty.
    • Call 000 immediately
    • Lie the casualty down and apply the Pressure Immobilisation Bandage
    • Immobilize the casualty as comfortably as possible, do not let them up to move around
    • Provide calming reassurance
    • Be prepared to implement the DRSABCD 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 have been no deaths in 60+ years.

     

    Signs and Symptoms of Red Back Spider Bite

    A casualty 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 can 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

    Immediate and calm provision of First Aid will provide the casualty with the best possibility of complete recovery.  The following procedures should be immediately implemented:

     

    • Wash the affected area with soapy water or disinfectant to reduce the risk of infection.
    • Apply ice packs for pain relief.
    • Keep the casualty under observation.
    • If symptoms occur, seek medical attention.

     

    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 had an allergic reaction to the sting.  This is called an anaphylactic reaction.  This allergic reaction is life threatening.

     

    Signs and Symptoms of Bee Sting

    A casualty 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 having 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 a casualty stung by a bee NOT displaying signs and symptoms consistent with allergic reaction:

     

    • 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 experiencing an allergic reaction to the sting, perform the following additional steps:

     

    • Immediately call for an ambulance - 000
    • Administer an EpiPen if available and the EpiPen has been prescribed by a medical professional for the casualty
    • Provide calming reassurance to the casualty

     

    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 behaviour.  Each individual ant is capable of producing multiple bites.  These ants are a reddish brown in colouring with darker abdomen.  If you disturb the nest, they will run up the stick and attack you.

    They swarm and attack, when one starts stinging, they all do.  They hang on with their mandibles and sting repeatedly with their tail. 

     

    Signs and Symptoms of a Fire Ant Stings:

    A casualty with Fire Ant Stings may display 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 casualty experiences an allergic reaction, called an anaphylactic reaction, to the sting, 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 Fire Ant Sting

    The following procedures should be immediately implemented for assisting a casualty suspected of a Fire Ant sting:

     

    • Quickly wash the ants from the person with running water (hose or tap)
    • Gently wash with soapy water or disinfectant to reduce the risk of infection
    • Apply an ice pack or cold compress to the affected area

     

    If the casualty is having an allergic reaction as a result of the sting:

     

    • Call for medical aid immediately - 000
    • Administer an EpiPen if available and the EpiPen has been prescribed by a medical professional for the casualty
    • Provide calming reassurance

     

    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.

    The mouth parts of the tick are on its head, this is the part it imbeds in you. The poison it carries is found in its body.

    DO NOTtry to kill the tick or make it back out on its own – this will cause it to release poison into the casualty. So NO alcohol, No cigarette lighters, NO sunscreen…..

     

    Signs and Symptoms consistent with ticks:

     

    A casualty who has been affected by a tick may display the following:

     

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

     

    Note - severe allergic reactions are extremely rare.

     

    Care and Treatment:

    The following procedures should be immediately implemented:

     

    • Remove the tick by using tweezers either side of its head.  Pull it straight out.  Don’t put pressure on the body, pull slowly and do not twist.
    • Wash the area with soapy water or disinfectant to reduce the risk of infection

     

    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 casualty. 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 small, (not more than 20cm from tentacle to tentacle) is considered the most venomous octopus in the world. They live in rock pools around the coastline and are a milky brown colour to blend in with their environment.  When they get agitated they flash their blue rings.  On the underneath side of the body are mouth parts, so if you pick one up, it can bite you.  The saliva is extremely toxic.  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.

     

    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.  A casualty suspected of incurring a bite from this octopus exhibits:

     

    • Numbness beginning around the lips and tongue within minutes of the bite
    • Progressive muscle 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

    Immediate and calm provision of First Aid will provide the casualty with the best possibility of complete recovery.  The following procedures should be immediately implemented for assisting a casualty suspected of a Blue Ring Octopus bite:

     

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

     

    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.

     

    At present, there is NO antivenom available for the Blue Ringed Octopus but treatment is available.

     

    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, harpoon like spine. (Radula Tooth) 

     

    Cone shells can vary in size from 1cm up to about 23cm.

     

    Signs and Symptoms of a Cone Shell Sting

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

     

    • Numbness beginning around the lips and tongue within minutes of the bite
    • Progressive muscle 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

    Immediate and calm provision of First Aid will provide the casualty with the best possibility of complete recovery.  The following procedures should be immediately implemented:

     

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

     

    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.

     

    At present, there is NO antivenom available for the cone shell but treatment is available.

     

    Try to make note of the colouring, 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.  Tentacles are up to 3 metres long and can still sting even when they are no longer attached to the body of the jelly fish.  A sting to more than half a limb would be considered a potentially fatal sting.

     

    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 behaviour
    • Nausea, vomiting, headaches and severe sweating
    • Difficulties with speech, breathing and swallowing
    • Extreme muscle 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.

     

    Immediate and calm provision of First Aid will provide the casualty with the best possibility of complete recovery.  The following procedures should be immediately implemented for assisting a casualty suspected of a Box Jelly Fish Sting:

     

    • Remove the victim from the water and restrain if necessary
    • 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 off remaining tentacles.
    • If vinegar is not available, pick off any tentacles.  This is NOT harmful to the rescuer.  Then flood the area with sea water.
    • Apply a cold compress to manage the pain.  Keep the compress dry in a plastic bag as fresh water may discharge any remaining nematocysts.
    • Be prepared to perform CPR

     

    DO NOTWASH THE STING AREA OR TENTACLES WITH FRESHWATER.

     

    DO NOTUSE A PRESSURE BANDAGE AROUND THE STING AREA.

     

    Anti-venom is availableto counteract the sting.

    Jellyfish causing Irukandji Syndrome

    Approximately 10 small to medium sized offshore and onshore jellyfish are known or suspected to produce Irukandji Syndrome. These jellyfish have only 4 tentacles and some are too small to be seen.

     

    A minor sting on the skin with no tentacle visible, is followed in 5-40 minutes (typically 20-30 minutes) by severe generalised pain (often cramping in nature), nausea and vomiting, difficulty breathing, sweating, restlessness and a feeling of ‘impending doom’.  Casualties may develop heart failure, pulmonary oedema and hypertensive stroke.

     

    Care and Treatment of Irukandji Syndrome

    Treat as Tropical Jelly Fish sting (Box Jelly Fish)

    • Remove the casualty from the water and restrain if necessary
    • 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 off remaining tentacles.
    • If vinegar is not available, pick off any tentacles.  This is NOT harmful to the rescuer.  Then flood the area with sea water.
    • Apply a cold compress to manage the pain.  Keep the compress dry in a plastic bag as fresh water may discharge any remaining nematocysts.
    • Be prepared to perform CPR

     

    DO NOTWASH THE STING AREA OR TENTACLES WITH FRESHWATER.

     

    DO NOTUSE A PRESSURE BANDAGE AROUND THE STING AREA.

     

    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.  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 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 a casualty suspected of a Blue Bottle Jelly Fish Sting:

     

    • Calm and reassure the casualty, do not rub 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 casualty can comfortably tolerate for twenty minutes.
    • If hot water is unavailable, ice packs may be applied to help alleviate the pain (cover first so that they are applied dry)

    If necessary, seek medical attention

     

    Do NOTrub 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 (puncture wound)
    • Bleeding, swelling, inflammation and skin discoloration around the injury
    • Weakness, paralysis, lack of coordination
    • Panic or irrational behaviour

     

    Care and Treatment of a Fish Sting

    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 a Fish Sting:

     

    • Calm and re-assure the individual
    • Immerse the sting or bite area in hot water, as hot as the casualty can comfortably tolerate.
    • If hot water is unavailable or proves ineffective, apply a cold pack.
    • 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.

     

    Waste Disposal

    After providing first aid to a casualty, there is always an element of cleaning up to do.  Generally, you will find you have two kinds of waste products.

    Firstly, there is routine waste.  This is the material that is left over from performing first aid on your casualty.  It may include:

    • Bandage wrappings
    • Off cuts from dressings and bandages etc

     

    These items generally carry no infection risks and can be disposed of easily by placing in a rubbish bin.

    Secondly, there is clinical waste.  This is anything which has the potential to cause sharps injury, infection or public offence.  It may include:

    • discarded sharps;
    • human tissue (excludes teeth, hair, nails, urine and faeces);
    • animal tissue;
    • materials which contain free flowing or expressible blood;
    • cytotoxic waste (unused portion of cytotoxic drugs)
    • pharmaceutical waste
    • chemical waste (eg: formalin, alcohol based formulations)
    • radioactive waste

     

    Due to the infection risk with these types of materials, special disposal requirements have been put in place.

    Under Australian Law, anything considered to be clinical waste is required to be disposed of in a Biohazard Bag. These containers are yellow and black in colour and are required under law to be disposed of by incineration. Any sharp implements are to be placed in a yellow and black Biohazard Sharps Container.

    What is not clinical waste? 

    Examples are clinical waste generated in the home (except hypodermic needles) or as a result of emergency first aid given by members of the public (not including ambulance attendants, police, doctors or nurses in the course of their work), by beauty care or ear / body piercing establishments, by animal bathing services or facilities having animals and some waste generated in first aid rooms.

    Consult state legislation for specific information as to whether or not your industry requires specific biohazard disposal measures. Also consult local council waste management services regarding local requirements for disposal of first aid waste.

    Needle stick injuries account for 80% of all Accidental Exposure to Blood.

    Reduce your risk of needle stick injury:

    • Are your immunizations up to date? (Including Hepatitis A & B)
    • Follow all safety precautions as set down in workplace guidelines.
    • Never bend or snap needles
    • Never recap needles
    • Always dispose of properly in approved, puncture-proof sharps containers.

     

    Care and Management of Needle Stick Injuries

    • Make it bleed
    • Wash with soapy water or disinfectant
    • Report the incident immediately
    • Refer the person immediately to a Doctor or Hospital Emergency department. They will assess the risk of transmission and discuss the options for testing and treatment
    • Make use of the counselling service 1800 Needle

     

    (They also have a cleanup service – use the hotline #)

    First Aid Kits

    No matter the activity you 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.  Kits are designed based on the area or activity for which they are intended, and how many people could potently require assistance. Some kits are designed for areas in which professional medical assistance may be quite a distance away. 

     

    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 Standards 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 content 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 personal kit should contain:

     

    • Bandaging material, i.e. bandages, 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 or sprays
    • 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 casualty 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!