First aid

Overview

First aid is the provision of limited care for an illness or injury, which is provided, usually by a lay person, to a sick or injured patient until definitive medical treatment can be accessed, or until the illness or injury is dealt with (as not all illnesses or injuries will require a higher level of treatment). It generally consists of series of simple, sometimes life saving, medical techniques, that an individual, either with or without formal medical training, can be trained to perform with minimal equipment. First aid can also be performed on animals other than humans, although this article refers specifically to human first aid.

Historical Perspective

The Knights Hospitaller were probably the first to specialize in battlefield care for the wounded. Similarly, knights founded the Order of St. John in the 11th century to train other knights specifically how to treat common battlefield injuries.[1] St. John Ambulance was formed in 1877 to teach first aid (a term devised by the order) in large railway centres and mining districts. The order and its training began to spread throughout the British Empire and Europe.[2] As well, in 1859 Henry Dunant helped organize villagers in Switzerland to help victims of the Battle of Solferino. Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross. Developments in first aid and many other medical techniques have been fueled in large by wars: the American Civil War prompted Clara Barton to organize the American Red Cross.[3] Today, there are several groups that promote first aid, such as the military and the Scouting movement. New techniques and equipment have helped make today’s first aid simple and effective.

Aims

The 3 main aims of first aid, commonly referred to as the “3 Ps” are:

  • Preserve life
  • Prevent further injury
  • Promote recovery
  • In addition, some trainers may also advocate a 4th ‘P’ – Protect yourself, although this is not technically an ‘aim’ of providing first aid, and some people would consider that it is adequately covered by ‘Prevent further injury’ as this is to the casualty, yourself or others.

Training

Much of first aid is common sense, and people are almost certain to learn some elements as they go through their life (such as knowing to apply an adhesive bandage to a small cut on a finger).

However, effective life-saving first aid requires hands-on training by experts, especially where it relates to potentially fatal illnesses and injuries, such as those that require Cardiopulmonary resuscitation (CPR), as the procedures may be invasive, and carry a risk of further injury to the patient – which the ‘3 aims’ of first aid above, clearly try to avoid.

As with any training, it is more useful if it occurs before an actual emergency, although in many countries, emergency ambulance dispatchers will give basic first aid instructions over the phone while the ambulance is on its way.

To be adequately trained, a person must attend a course (hopefully leading to a qualification recognised in their country), but then, due to regular changes in procedures and protocols, based on updated clinical knowledge, must attend regular refresher courses or re-certification in order to ensure they are doing the best for their patient (and in some countries, to minimise the chance of being held liable for further injury or deterioration).

Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organisations, such as the ones above, also provide a commercial service, which complements their community programmes.

Key First Aid Skills

There are certain skills which can be regarded as core, regardless of where or how first aid is taught. First aiders are taught to focus on the “ABC”s of first aid before giving additional treatment:

  • Airway
  • Breathing
  • Circulation

This means any first aider should first evaluate and attempt to treat problems with a casualty’s airway. If the airway is open the first aider should then evaluate and attempt to treat problems with breathing followed by circulation (circulation of blood). Some instructors add a fourth step of “D” for Deadly Bleeds which is technically already included in the circulation check. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured first aiders can begin more advance treatment.

Some countries teach the same order of priority using the “3 Bs”:

  • Breathing
  • Bleeding
  • Bones

This means that any first aider should first seek to treat any problems with Breathing, before attempting to deal with a bleed or broken bone (which is not to say that they should not be considered at the time – such as in the case of a spinal injury, where a variation on the technique can be used to open the airway).

Preserving Life

As the key skill to first aid is preserving life, the single most important training a first aider can receive is in the primary diagnosis and care of an unconscious or unresponsive patient. The most common mnemonic used to remember the procedure for this is ABC, which stands for Airway, Breathing and Circulation.

In order to preserve life, all persons require to have an open airway – a clear passage where air can move in through the mouth or nose through the pharynx and down in to the lungs, without obstruction. Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to maintain a patent airway, as the part of the brain which autonomously controls in normal situations may not be functioning.

If an unconscious patient is lying on his or her back, the tongue may fall backward, obstructing the oropharynx (sometimes incorrectly called “swallowing” the tongue). This can be easily rectified by a first aider tipping the head backwards, which mechanically lifts the tongue clear.[4]

If the patient was breathing, a first aider would normally then place them in the recovery position, with the patient leant over on their side, which also has the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked through a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as agonal breathing, the first aider would undertake what is probably the most recognised first aid procedure – Cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting Recovery

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or broken bones. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Conditions That Often Require First Aid

  • Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.
  • Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
  • Battlefield First aid – This protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by large scale weaponry, such as a bomb blast or other terrorist activity.
  • Bone fracture, a break in a bone initially treated by stabilizing the fracture with a splint.
  • Burns, which can result in damage to tissues and loss of body fluids through the burn site.
  • Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient’s trachea is not cleared, for example by the Heimlich Maneuver.
  • Childbirth.
  • Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
  • Joint dislocation.
  • Diving disorders resulting from too much pressure.
  • Near drowning or asphyxiation.
  • Gastrointestinal bleeding.
  • Gender-specific conditions, such as dysmenorrhea and testicular torsion.
  • Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
  • Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
  • Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
  • Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
  • Hyperglycemia, or diabetic coma.
  • Hypoglycemia, or insulin shock.
  • Hypothermia, or Exposure, occurs when a person’s core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.
  • Insect and animal bites and stings.
  • Muscle strain.
  • Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
  • Seizures, or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc) and petit mal (which usually features twitching, rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
  • Sprain, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage.
  • Stroke, a temporary loss of blood supply to the brain.
  • Sucking chest wound, a life threatening hole in the chest which can cause the chest cavity to fill with air and prevent the lung from filling, treated by covering with an occlusive dressing to let air out but not in.
  • Toothache, which can result in severe pain and loss of the tooth but is rarely life threatening.
  • Wounds and bleeding, including laceration, incision and abrasion, and avulsion.

Attribution

This article incorporates public domain material from Wikidoc and MedlinePlus. Please see licenses for further details.

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