emergency first aidincluding

paediatric care

For all your Training Needs

Tel: 0845 226 2407www.enhanceservices.co.uk

eABOUT US

If you, or someone you know, are looking for First Aid or Health and Safety trainingthen Enhance Services can help.

Since 1998, we have provided professional trainers to organisations and groups.Enhance will come to you, on a date and time of your choosing and carry out thetraining in your venue. Enhance do this through a quick and simple booking processwith competitive pricing AND a service guarantee.

Some of the courses we offer are:

• 3 day HSE First Aid at Work

• 2 day HSE First Aid at Work Refresher

• 1 day HSE Emergency First Aid at Work

• 12 hour Paediatric First Aid

• 6 hour Emergency First Aid for Schools

• 6 hour Level 2 Food Safety in Catering

• 6 hour Level 2 Health and Safety in the Workplace

Why not call and find out how you can book your course with us.

Call us on 0845 226 2407

If you are not satisfied with your course after the first day, we will give you a full refund!

eIntroduction and Contents

ContentsIntroduction

Amputation 17

Anaphylaxis 30

Animal Bites 33

Asthma 29

Burns 20

Choking (Child) 12

Choking (Adult) 11

CPR 4

Diabetes 26

Effects of Heat & Cold 34

Electric Shock 33

Emergency Action Plan 2

Epilepsy & Convulsions 27

Eye Injury 18

Febrile Convulsions 28

First Aid Kits 31

Fractures 21

Heart Attack 24

Nose Bleed 17

Insect Stings 33

Meningitis 36

Poisoning 19

Prioritising & Survey 3

Resuscitation 7

Septicaemia 37

Serious Head Injury 23

Shock 18

Sickle Cell 35

Spinal Injury 22

Stroke 25

Vomiting 7

Wounds & Bleeding 15

This booklet has been designed by experiencedmedical staff to assist you in your first aid course andto provide you with a quick and easy reference for thefuture.

The information in this book will be useful; however itcan never replace proper instruction by staff trainedin the essential skills to deal with an emergency.

Effective emergency treatment prior to professionalhelp arrives can greatly improve the chances of avoidingserious injury or illness and can even save a life!

Enhance Services Ltd. - Edition 3.0

DISCLAIMERWhilst every effort has been made to ensure the accuracy of theinformation in this booklet, the authors do not accept any liability forany inaccuracies or for any subsequent mistreatment of any person,however caused.

© 2013. Enhance Training Services Ltd.All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or by anymeans, electronic, mechanical, photocopying, recording or otherwise,without the prior written permission of the copyright owner.

Tel: 0845 226 2407 www.enhanceservices.co.uk

1

eEmergency Action Plan

It is important to have an action plan for emergencies, so that you can perform themost important checks and give essential help first. The chart guides you throughthese steps. All the topics are covered later in the book.

BreathingCheck for normalbreathing – take nomore than 10 seconds.

If there is any doubt,treat as if they are notbreathing normally

2

DANGER?Are there any risksto the casualty or

yourself?

Response?Gently tap the

casualty and ask,“Are you OK?”

HistoryAsk the casualtywhat happened.

Help!Shout for help, butdo not leave.

Signs & SymptomsLook at the casualty,and ask them how

they feel.Try to diagnose whatmight be wrong

AirwayOpen the airway -tilt the head backand lift the chin.

Call 999 or 112 Now(If not already done)

ResuscitationDo 30 chest compressions, then 2 rescue breaths.Continue this cycle without interruption. Stop only ifthe casualty starts breathing normally. If you have

help, change over every 2 minutes.For a child or baby, give 5 initial rescue breaths

TreatmentIf you’re unsure ofthis, seek qualifiedmedical advice

Secondary SurveyCheck for bleeding,broken bones, otherinjuries, and clues.

Recovery PositionPut casualty intorecovery position.Call 999 or 112(If not already done)Monitor airway and

breathingKeep casualty warm

Remove DangerEnsure the area

is safe.Do not take risks

ÁNO

ÁÁYES

ÁYES

ÁNOÁ

Á

ÁÁ

Á

Á

Á

Á

YES

ÁNO

ePrioritisingWhen dealing with an ill or injured person you must prioritise treatment.The first priority is to ensure that the casualty can get air, and that they are breathing.If a person is deprived of oxygen (i.e. air) for only 3 or 4 minutes, their brain will startto die.

Primary Survey - ABEnsure that the casualty’s Airway is open and then check that they are Breathing.If they are breathing normally, then their heart must be beating and so blood will beCirculating.

If they are not breathing, then resuscitation will be necessary.If you are concerned about the casualty’s airway (e.g. because of vomiting), put thecasualty into the recovery position (see diagram) before moving on to the SecondarySurvey.

3

Please see page 8 for a detailed description of how to turn a casualtyinto the recovery position

eCardio Pulmonary Resuscitation – CPRBefore commencing CPR, follow the steps of the Emergency Action Plan (see page 2):

Danger – make sure it’s safe n Check that it is safe for you to help the casualty. Do not put yourself at riskn If necessary try to remove the danger from the casualty. If this is not

possible, can you safely move the casualty from the danger? n Find out what’s happened – and make sure you are still safen Check how many casualties there are. Can you cope?

Response – are they conscious?n Gently tap the shoulders and ask loudly, “Are you OK?”n If there is no response, shout for help immediately, but do not leave the

casualty.

Airway – carefully open the airwayn Place your hand on the casualty’s forehead and gently tilt the head backn With your fingertips under the point of the casualty’s chin, lift the chin to open

the airway.

Breathing – check for normal breathingKeeping the airway open, check to see if the breathing is normal. Take no more than10 seconds to this.n Look at the chest and abdomen for movementn Listen to the sounds of breathing (more than the occasional gasp).n Feel for their breath on your cheek, or use your hands to feel movement of

the chest or abdomen.

Note: In the first few minutes after cardiac arrest, a casualty may be barelybreathing, or taking infrequent, noisy gasps. Do not confuse this with normalbreathing. If in doubt, act as if it is not normal.

If the casualty is breathing normally, carry out a secondary survey (see page 9) andplace them in the recovery position.

If the casualty is not breathing normally, ask someone to dial 999 for an ambulanceand bring an aed if possible. If you are on your own, do this yourself; you may needto leave the casualty. Then perform resuscitation.

4

airway

breathing

response

e5

Cardio Pulmonary Resuscitation – CPRStart with chest compressions:n Place the heel of one hand in the centre of the casualty’s chest, then place

the heel of your other hand on top and interlock your fingers (see diagram).

n Position yourself above the casualty’s chest with your arms straight.n Press down on the breastbone 5 to 6cm (2 to 21/2 inches) then release the

pressure without losing contact between your hands and the chest. Ensure that the pressure is not applied over the casualty’s ribs. Use your upper body weight, not just your hands to apply the pressure. Don’t apply pressure over the upper abdomen or the bottom end of the breastbone.

n Compression and release should take an equal amount of time.n Do 30 chest compressions at a rate of 100 - 120 per minute.n Then combine chest compressions with rescue breaths (see next page).

Note: Ideally the casualty needs to be on a firm flat surface (not a bed) to perform chestcompressions. One way to move someone from a bed is to loosen the bed sheets and use them tocarefully slide the casualty to the floor. Get help if you can, and be careful not to injure yourselfor the casualty. Do not move the casualty if you do not think it is safe to do so – remove thepillows and attempt CPR on the bed instead.

chestcompressions

CPR

eRescue breathsn Open the airway again, using head tilt and chin lift.n Nip the casualty’s nose closed. Allow the mouth to open, but keep the chin

lifted.n Take a normal breath and seal your lips around the casualty’s mouth.n Blow steadily into the casualty’s mouth, watching for the chest to rise. Take

about one second to make the chest rise. n Keeping the airway open, remove your mouth. Take a breath of fresh air and

watch for the casualty’s chest to fall as the air comes out.n Re-seal your mouth to the casualty’s and give another rescue breath.n Return your hands without delay to the correct position on the breastbone

and give another 30 chest compressions.n Then give 2 more rescue breaths. Deliver the 2 rescue breaths in 5 seconds.n Continue repeating cycles of 30 compressions and 2 rescue breaths.n Only stop to recheck the casualty if they start breathing normally. Otherwise

don’t interrupt resuscitation.

If your rescue breaths don’t make the chest rise effectively, give another 30 chestcompressions. Then, before your next attempt:n Check the casualty’s mouth and remove any visible obstructionn Recheck that the head is tilted far enough back, and the chin is lifted.

Do not attempt more than two breaths each time, before returning to chest compressions.

If there is more than one rescuer, change over every two minutes to prevent fatigue.Ensure the minimum of delay as you change over.

Continue resuscitation until:n Medical help arrives to take overn The casualty starts breathing normallyn You become exhausted.

Chest compression only resuscitationIf you are untrained or unwilling, perform chest compressions only, this will circulateany residual oxygen in the blood stream, it is better than no resuscitation at all. n If chest compressions only are given, these should be continuous at the rate

of 100 - 120 per minuten Stop to check the casualty only if they show signs of regaining consciousness

AND are breathing normally.n If there is more than one rescuer, change over every two minutes to prevent

fatigue. Ensure the minimum of delay as you change over.

6

e7

VomitingIt is common for a casualty who has stopped breathing to vomit while they arecollapsed. This is a passive action in the unconscious person, and so you may nothear or see it happening. You might not find out until you give a rescue breath (as theair comes back out of the casualty it makes gurgling noises).n If the casualty has vomited, turn them onto their side, tip the head back and

allow the vomit to run outn Clean the casualty’s face then continue resuscitation, using a protective face

barrier if possible.

Hygiene during resuscitationn Wipe the lips cleann If possible, use a protective barrier such as a “resusci-aid” (This is particularly

important if the casualty suffers from any serious disease such as TB or SARS)n As a last resort, some plastic with a hole in it may help to prevent direct

contactn If you are still in doubt about the safety of performing rescue breaths, give

“chest compression only” resuscitation (see previous page)n Wear protective gloves if available and wash your hands afterwards.

Resuscitation for children and babiesOften potential rescuers are reluctant to perform CPR on children or babies becausethey are afraid they may harm them. It is important to understand that it is better toperform adult style resuscitation (see previous pages) on a child (who is unresponsiveand not breathing) than to do nothing at all. The following minor modifications will,however, make it even more suitable with children.

If the child is not breathing normally:

n Get someone to call for an ambulance and bring a defibrillator (AED) if available, if you are alone and have to leave the child to make the call, carryout resuscitation for approx 1 minute before leaving the child

n Keep the airway open by tilting the head and lifting the chinn Nip the nose and seal your mouth around the child's mouthn Give 5 initial rescue breaths (blow in just enough air to make the child's chest

visibly rise)

eCombine rescue breaths with chest compressions:

n Use 1 or 2 hands as required and depress the chest at least a third of itsdepth

n For a baby use 2 fingers to depress the chest at least a third of its depth

n Give 30 chest compressions at a rate of 100-120 per minuten Open the airway again by tilting the head and lifting the chin, give 2 more

rescue breathsn Continue repeating cycles of 30 compressions to 2 rescue breaths

Only stop if the child regains consciousness AND starts breathing normally - otherwisecontinue until help arrives. If there is more than one rescuer, change over everycouple of minutes to help prevent fatigue. Try not to interrupt chest compressionswhen swapping over.

If your rescue breaths don't make the chest rise effectively:

Give another 30 chest compressions, then before you start again:

n Check inside the mouth and remove any visible obstruction, do not reach into the back of the throat unless an object is visible

n Recheck there is enough head tilt and chin liftn Do not attempt more than 2 breaths each time before returning to chest

compressions

8

eMechanics of InjuryBefore moving a casualty, consider what happened and what injuries this may havecaused.If you think the casualty may have a neck injury, get someone to help you keep thehead aligned with the body at all times. If you are going to use the recovery position, try not to move any suspected injuries.Check the area that the casualty is to be rolled onto. Make sure that it is clear of anybits of debris or sharp objects, which may harm the casualty when being rolled.When an unconscious person is lying on their back, their airway may be blocked:n The tongue may be touching the back of the throatn Vomit might block the airway

Placing the casualty in the recovery position ensures that the tongue will not fall tothe back of the throat, and any vomit will run out of the mouth.

Recovery PositionTo place someone in the recovery position: n Straighten the casualty's bodyn Check from head to toe for any sharp objects that they may roll onto: pens

earrings, glasses, keys, watches etc. n Kneel next to the casualty, (between their hips and shoulders)n Lift the arm nearest to you, and put it out at a right angle to their body, with

the elbow bent and the palm facing upwardsn Lean over the casualty, take hold of their other hand and bring it up to their

cheek and then hold the back of their hand against their cheekn Use your other hand to take their far leg, just above the knee, and pull it up,

keeping their foot on the groundn Keeping their hand against their cheek, pull the far leg towards you from the

knee and roll them towards you, onto their siden Ensure that the upper leg is bent at right angles at both the hip and the kneen Tilt the head back to ensure that the airway remains openn If an ambulance has not already been called, call for it nown Continue to check breathing regularly. If it stops, return the casualty to their

back and perform CPR.

9

eThe next priority is to deal with any major bleeding, as the casualty must have enoughblood to circulate through the body and take oxygen to the brain. Then you shouldcheck for any broken bones. It should be done quickly and systematically.

n Bleeding Do a quick head to toe check for bleeding. Deal withany major bleeding. (see page 15)

n Head and Neck Has the casualty had an accident that could have injured the neck? (see page 22) Always check the head, front and back. Feel the back of the neck. Look for bruising, swelling bleeding or any other indications of injury.

n Shoulders and Chest Place your hands on the casualty’s shoulders and compare them. Run your fingers down the collar bones checking for signs of a fracture. Gently squeeze the ribs.

n Abdomen and Pelvis Push the abdomen with the palm of your hand to check for abnormality or reaction to pain. Visually check the pelvic area for signs of fractures (see page 21), incontinence or bleeding.

n Legs and Arms Check the legs and arms one at a time for signs offractures. Look for other clues (medic alert bracelet, needle marks, etc).

n Pockets and Clothing Check the casualty’s pockets to ensure that they willnot be injured by the contents if you roll them into the recovery position. Beware of any sharp objects(e.g. needles) in the pockets. Look for clues among the contents of the casualty’s pockets. (Try to havea witness present if you remove anything from the pockets.) Loosen any tight clothing.

n Recovery Position Put the casualty in the recovery position (see page9), taking care not to aggravate any suspected injuries.

10

eChoking - AdultDetermine if the person can speak or cough. A cough might clear the obstruction.If not:

1. Back Slaps

n Bend the casualty over until the head is lower than the chestn Use the palm of your hand to deliver a firm blow between the shoulder bladesn Repeat the blows up to five times, checking between blows to see if the

obstruction is cleared.

If the obstruction has not cleared:

2. Abdominal Thrusts

n Stand behind the person. Wrap your arms around the waist. Tip them forward slightly

n Make a fist with one hand. Position it slightly above the person's navel, withyour thumb inwards

n Grasp the fist with the other hand. Press hard into the abdomen with a quick,upward thrust — as if trying to lift the person up

n Repeat up to five times, checking to see if the blockage is dislodged.

If the obstruction has still not cleared:

n Repeat steps I and 2n Shout for helpn Ask someone to call 999 for an ambulance.

Don’t stop the treatment while the casualty isconscious.

If the casualty becomes unconscious:

n If safe to do so, support the casualty andcarefully lower them to the ground

n Call 999 for an ambulance (if not already done)n Start CPR (see page 4)

Abdominal thrusts can cause serious internal injuries. The casualty should be advisedto see a doctor. Casualties with a persistent cough, difficulty swallowing or feeling thatthere is still something in their throat even after successful treatment, should alsosee a doctor.

11

eChoking - Child (over 1 year)Encourage the child to cough. A cough might clear the obstruction. If not:

1. Back Slaps

n Shout for help. Don’t leave the child.n Bend the child over until the head is lower than the chest.n Use the palm of your hand to deliver a firm blow between the shoulder

blades.n Repeat the blows up to five times, checking between blows to see if the

obstruction is cleared.

If the obstruction has not cleared:

2. Abdominal Thrusts

n Stand or kneel behind the child. Wrap your arms around the waist. Tip themforward slightly.

n Make a fist with one hand. Position it slightly above the child's navel, with yourthumb inwards.

n Grasp the fist with the other hand. Press hard into the abdomen with a quick,upward thrust — as if trying to lift the child up.

n Repeat up to five times, checking to see if the blockage is dislodged.

If the obstruction has not cleared: n Repeat steps I and 2n Ask someone to call 999 for an ambulance. Don’t stop the treatment.

12

eChoking - Baby (under 1 year)If possible, this procedure should be performed sitting or kneeling down.A cough might clear the obstruction. If not:

1. Back Slaps

n Shout for help. Don’t leave the baby.n Lay the baby over your arm, face down, legs either side of your elbow with

the head lower than the chest.n Use your fingers, flat, to deliver a firm blow between the shoulder blades.n Repeat the blows up to five times, checking between blows to see if the

obstruction is cleared.

If the obstruction has not cleared:

2. Chest Thrusts

n Turn the baby over by laying it on your other arm, so that it’s chest is now facing you. Ensure the head is below the chest.

n Using two fingers, give up to five chest thrusts – like chest compressions, butsharper and performed at a slower rate.

n Check between each thrust to see if the blockage is dislodged.If the obstruction has still not cleared:

n Keep repeating steps I and 2n Ask someone to call 999 for an ambulance. Don’t stop the treatment.

13

eIf the child or baby becomes unconscious:n Place them on a firm flat surface.n Open the airway and look into the mouth. Pick out any visible obstructions.

(Do not try to reach in to the back of the throat if you cannot see theobstruction.)

n Give 5 rescue breaths.n Perform 30 chest compressions. Repeat cycles of 2 rescue breaths to 30

compressions.n Check the mouth for any visible obstructions each time before you give rescue

breaths. Pick out any visible obstructions. (Do not try to reach in to the backof the throat if you cannot see the obstruction.)

n If you are alone, give CPR for one minute then call 999 for an ambulance (ifnot already done).

n Continue CPR until the child starts breathing normally, help arrives or you become exhausted.

Abdominal thrusts run the risk for causing serious internal injuries, always recommendthe casualty see a medical professional after treatment.

Casualties with a persistent cough, difficulty swallowing or feeling that there is stillsomething in their throat even after successful treatment, should also see a doctor.

14

eWounds and bleeding

If possible, before you try to stop bleeding, wash your hands to avoid infection. Thenfollow these steps:

n Put on disposable gloves.n Apply direct pressure to the wound with a pad (e.g. a clean cloth) or fingers

until a sterile dressing is available.n Raise and support the injured limb. Take particular care if you suspect a

bone has been broken.n Lay the casualty down to treat for shock.n Bandage the pad or dressing firmly to control bleeding, but not so tightly that

it stops the circulation to fingers or toes. If bleeding seeps through the firstbandage, cover with a second bandage. If bleeding continues to seep through bandage, remove it and reapply.

n Treat for shockn Call 999 for an ambulance.

Objects in wounds

Where possible, swab or wash small objects out of the wound with clean water. Donot remove any large or more deeply embedded objects. Instead:

n Leave the object in placen Apply firm pressure on either side of it.n Raise and support the wounded limb or part.n Lay the casualty down to treat for shock.n Gently cover the wound and object with a sterile dressing.n Build up padding around the object until the padding is higher than the object,

then bandage over the object without pressing on it.n Depending on the severity of the bleeding, call 999 for an ambulance or take

the casualty to hospital.

15

eit or lay Have the injured person sit or lie down. If possible, position the person's

head slightly lower than the body or lift the legs. This position reduces the risk of fainting by increasing blood flow to the brain.

xamine Look at the wound. While wearing gloves, remove any obvious dirt or debris from the wound. Don't remove any large or more deeply embedded objects. Don't probe the wound or attempt to clean it atthis point. Your principal concern is to stop the bleeding. However itmight be useful to remember what it looks like in case you have to describe it to medical personnel later, when it might be covered witha dressing.

levate Lift the injured part of the body so that it is above the heart. This helps to reduce the flow of blood to the wound.

ressure Apply pressure directly on the wound where possible. Maintain pressureuntil the bleeding stops. Hold continuous pressure for at least 10 minutes without looking to see if the bleeding has stopped. You canmaintain pressure by covering the wound firmly with a dressing (or even a piece of clean clothing) and adhesive tape.

Remember: protect yourself from infection by wearing disposable gloves and coveringany wounds on your hands.

If blood comes through the dressing, do not remove it – bandage another over theoriginal.

If blood comes through both dressings, remove them both and replace with a freshdressing, applying pressure over the site of bleeding.

16

S

E

E

P

Objects embedded in the nose, ear or in other orifice:

Do not attempt to remove anything that a child has got stuck in their ear, nose orother orifice. Take the child to hospital where the professionals can safely remove itwithout causing further damage.

eAmputationn Treat the casualty for bleedingn Call 999 for an ambulancen Dress the wound with a non-adherent dressingn Place the amputated body part in a plastic bag, and then put it in a

container of ice to preserve it. Do not allow the ice to come into directcontact with the body part.

Nose BleedThese happen when weakened or dried out blood vessels in the nose rupture. Theycan be caused by a bang on the nose, or by picking or blowing it. They can occasionallyhave more serious causes such as high blood pressure or a fractured skull. To treata nosebleed:

n Sit the casualty down and tell them to tilt their head forward.n Pinch the nose. Use the thumb and index finger and tell the patient to

breathe through the mouth. Continue the pinch for 5 to 10 minutes.n Place an ice pack on the back of the neck making sure to not make direct

contact with the skin.n Give the casualty a tissue or disposable cloth to mop up any blood.n To prevent rebleeding after bleeding has stopped, advise the casualty not to

pick or blow the nose and not to bend down until several hours after the bleeding episode.

n If bleeding lasts for more than 30 minutes, or if the casualty is on anti-coagulantdrugs (e.g. warfarin), take or send them to the A & E (Accident and Emergency Department). Also check to see if the casualty is taking Aspirin. Advise them to stay upright.

n If the patient suffers from frequent nosebleeds they should be advised to make an appointment with their doctor.

17

eShockShock is a lack of oxygen to the tissues of the body caused by a fall in blood volumeor blood pressure. Shock can therefore be caused by severe bleeding and can be fatalas it can cause a reduction in blood supply to the brain. Remember that childrencannot afford to lose as much blood as adults. If there is major blood loss, get thecasualty to lie down, and raise their legs to help the flow of blood to the brain. Keepthe casualty warm and do not allow them to eat, drink or smoke.

Signs and Symptoms of shock:n Weakness, dizziness, fainting (This often happens when the casualty tries to

stand or even sit up.)n Skin that's cool to the touch, clammy and pale (if it has blue or grey tinges,

then the shock is severe)n A fast, weak pulsen Anxietyn Rapid, shallow breathing

Treatment:n Get the casualty to lie down n Raise their legs to help the flow of blood to the brainn Turn their head to one side if neck injury is not suspected n Keep the casualty warm n Do not allow them to eat, drink or smoken Continue to monitor the casualty’s response levels

Eye injuryParticles of dirt or dust in the eye can be washed out with cold tap water. Make surethat the water does not run into the good eye.

Chemicals in the eye should be treated in the same way, ensuring abundant amountsof water are used. Call for 999 an ambulance.

If the injury is more serious:

n Keep the casualty stilln Gently cover the eye with a soft sterile dressingn Tell the casualty to close their good eye, as movement of this will cause

movement in the injured eyen Take the casualty to A & E (Accident and Emergency) or call 999 for an

ambulance.

18

ePoisoningSwallowed poisons

Chemicals that are swallowed may harm the digestive tract, or cause morewidespread damage if they enter the bloodstream and are transported to other partsof the body.

Hazardous chemicals include common household substances. For example, bleach,dishwasher detergent, and paint stripper are poisonous or corrosive if swallowed.Drugs, whether they are prescribed or bought over the counter, are also potentiallyharmful if they are taken in overdose. The effects of poisoning depend on thesubstance that has been swallowed.

Signs and symptoms

Depending on the poison, but there may be:n Vomiting, sometimes bloodstained.n Impaired consciousness.n Pain or burning sensation.n Empty containers in the vicinity.n History of ingestion/exposure.

Treatmentn Maintain the airway, breathing, and circulation.n Remove any contaminated clothing.n Identify the poison.n Arrange urgent removal to hospital.

If the casualty is conscious:n Ask them what they have swallowed.n Try to reassure them.n Call 999 for an ambulancen Give as much information as possible about the swallowed poison. This

information will assist doctors to give appropriate treatment once thecasualty reaches hospital.

If the casualty becomes unconscious:n Open the airway and check breathingn Be prepared to give chest compressions and rescue breaths if necessary.n Place them into the recovery position if the casualty is unconscious but

breathing normally.n Use a face shield or pocket mask for rescue breathing if there are any

chemicals on the casualty's mouth.

NEVER encourage / make the casualty vomit as this may endanger the airway. If theydo vomit, then collect the vomit samples for hospital analysis.

19

eBurns

1. Cool the burn

n Immediately use cold (preferably running) water to cool the affected area.n Keep the affected area under the water for 10 minutes. n If water is not readily available, use a cold, harmless liquid (milk, cola, etc)

instead. Move to a water supply as quickly as possible after initially cooling with the other liquid.

n Be careful not to cool large areas of burns too much, or hypothermia may result.

2. Remove jewellery and loose clothing

n Remove items like rings and watches as swelling may occur.n Carefully remove loose clothing that is not stuck to the burn. Leave any

clothing that is not loose. If you have any doubt, leave the clothing. n If the burns are caused by chemicals, be careful not to endanger yourself, or

contaminate other parts of the casualty’s body when you remove the jewelleryand clothing

3. Dress the burn

n Use a sterile dressing that will not stick to the burn. Cling film is ideal as theinside of the roll should be sterile and it won’t stick to the burn.

n Do not wrap the dressing tightly.n If smoke or fumes have been inhaled, or if the burn appears severe, call 999

for an ambulance.

Refer the casualty to hospital if:

n The burn is larger that 1-inch square.n The victim is a child.n The burn goes right round an arm or leg.n Any part of the burn seems to be full thickness.n The burn affects the hands, feet, face or genitals.n You are in any doubt.

Do Not:n Touch the burn.n Burst blisters.n Remove clothing that has stuck to the burn .n Apply ointment lotion or fat (e.g. butter).n Apply adhesive tape or plasters.

20

eFractures

A fracture is a broken bone. It requires medical attention. If the broken bone is theresult of a major trauma or injury, call 999 for an ambulance. Also call foremergency help if:

n You suspect a bone is broken in the neck, head or back.n The bone has pierced the skin.n The person is unresponsive, isn't breathing or isn't moving. Begin CPR (page 5)

if there is no sign of normal breathing.n There is heavy bleeding.n Even gentle pressure or movement causes pain.n The limb or joint appears deformed.n The extremity of the injured arm or leg, such as a toe or finger, is numb or

bluish at the tip.n You would have difficulty getting the casualty to hospital while keeping the

injury immobilised.

Take these actions immediately while waiting for medical help:

n Keep the casualty warm.n Immobilize the injured area. Don't try to realign the bone, unless you've been

trained in how to splint and professional help isn't readily available.n Apply ice packs to limit swelling and help relieve pain until emergency personnel

arrive. Don't apply ice directly to the skin (wrap the ice in a towel, piece of cloth or some other material).

n Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and,if possible, elevate the legs.

21

eSpinal Injury

This might occur following:

n A fall from height (eg from a ladder or horse)n A dive into shallow watern An accident involving speed (e.g. a motor accident)n A blow to the head, neck or backn Multiple injuriesn A “cave-in” accident (e.g. crowd crushing or a collapsed rugby scrum).

If the patient is conscious:

n Give them reassurancen Tell them not to moven Do not move the casualty unless they are in severe dangern Hold their head still with your handsn Keep the head and neck in line with the upper bodyn Call 999 for an ambulancen Keep the casualty warm

If the casualty is unconscious:

n If they are breathing normally, the airway is clear. Do not move the head.n If they are not breathing, you may need to lift the chin gently to minimise head

tilt.n Call 999 for an ambulance.n Hold their head still with your hands. Keep the head and neck in line with the

upper body.n If the casualty begins to vomit or you are concerned about their airway, or if

you have to leave them, put them into the recovery position (see page 8). Get help to do this, so that you can hold the head and neck in line with thebody while you roll them into the recovery position.

n Do not move the casualty unless they are in severe danger.n Keep the casualty warm.n Monitor their breathing until help arrives.

22

eSerious head injury

A blow to the head may also cause a spinal injury:

n Call 999/112 for emergency help if the child has been unconscious, or if you suspect a fractured skull, or if their levels of unconsciousness deteriorate

n Maintain airway and breathingn If the patient is unconscious, keep them still and monitor their breathing at

all times. If you are having problems keeping the airway clear, place them inthe recovery position, but keep the head and body in line as you turn the child

n If the patient is conscious, help them lie down. Keep the head, neck and body in line in case there is a spinal injury

n Control any bleeding by applying gentle pressure around the wound, should there be bleeding or fluid from the ear, do not try and plug or stop thebleeding

Useful information:

n Always monitor and check breathing, pulse and levels of consciousnessn Don't allow a concussed child or adult who is playing sport to continue until

they have seen a doctorn Monitor the child or adult (even if they appear to be fully recovered), watch

for reduction in levels of consciousness as this may the onset of compression. It is normal for a child to wake up drowsy after a blow to the head; you should still be able to wake them

n Do not leave a child alone for 24 hours after the injuryn Always inform the child's parents of a bump, no matter how minorn Monitor the child for the next few days for signs of headache, nausea,

vomiting, visual problems, speech problems, seizures or confusion. If anysymptoms appear send the child to hospital immediately

23

eHeart Attack

Signs and symptoms include:

n A tightness or feeling of pressure or a vice-like pain in the centre of the chestn Pain spreading to the arm, neck, back, jaw or shouldersn Pale, cold clammy skinn Greyness or blueness of the lipsn Irregular pulsen Nausea or vomitingn Severe sweatingn Shortness of breathn Dizziness n Weakness.

Treatment

n Sit the casualty down, and make them comfortable. Don’t allow them to stand up or walk around.

n Call 999 for an ambulance.n Give them reassurance. Remove anything that might cause stress or

anxiety.n If the casualty already has angina medication, help them to take it.*n Check if the casualty is allergic to aspirin. If not, give them an aspirin tablet

and tell them to chew it slowly.* n Monitor pulse and breathing.

*Note: A first aider is not permitted to prescribe drugs to a casualty. However if thecasualty is fully conscious, they are capable of deciding whether to take medication tohelp them.

24

eStroke

Strokes are most commonly caused by a blood clot blocking a blood vessel thatsupplies part of the brain. This causes the affected part of the brain to die from lackof oxygen. These strokes tend to occur most frequently among elderly people.

Younger people, often with a history of high blood pressure, can suffer a differentform of stroke, which is caused by a blood vessel rupturing and bleeding into the braincavity. This exerts pressure on the brain, which becomes compressed.

The effects of a stroke depend on the area of the brain affected.

Signs and symptoms:

n Loss of consciousness (gradual or sudden)n Paralysis or weakness down one side of the bodyn Slurred speechn Agitationn Aggressionn Headachen Slow, strong pulsen Slow, deep, noisy breathingn Flushed, dry skinn Vomitingn Incontinence

Use the Face–Arm–Speech Test (FAST)Three simple checks can help you recognise whether someone has had a stroke ormini-stroke (transient ischemic attack – TIA).

Facial weakness: Can the person smile? Has their mouth or an eye drooped?Arm weakness: Can the person raise both arms?Speech problems: Can the person speak clearly and understand what you say?Test all three signs.

If you see any of these signs, call 999 immediately.

Treatment

n Check Airway and Breathing (see page 4).n Call 999 for an ambulancen If the casualty is unconscious, place them in the recovery position.n If they are conscious, lay them down, with the head and shoulders raised.n Reassure them.n Monitor and record breathing, pulse and consciousness.

25

eDiabetes

Diabetes is caused when a person does not produce enough insulin.

Insulin is a hormone that “burns off” the sugars that are consumed in food. In somecases, the patient requires insulin injections to manage their sugar levels. This isknown as being “insulin dependent”.

Diabetic casualties must ensure that their sugar consumption matches their insulinlevels. If they do not consume enough sugar (for instance, if they miss a meal), thenthe insulin that they have injected continues to burn off the low amount of sugar leftin the blood stream, and their sugar levels can drop dangerously low.

This is dangerous because brain cells need sugar to “fuel” them. The brain cantherefore be starved of energy.

Signs and symptoms

n Shallow, rapid breathing and fast pulsen Pale, cold, sweaty skinn Confusion, memory lossn Bizarre, uncharacteristic, uncooperative, possibly violent behaviour.n The casualty may wear a medic-alert bracelet, or carry a warning card, an

insulin pen or glucose tablets.

The condition usually starts and worsens suddenly.If untreated, the casualty will become unconscious.

Treatmentn Give the casualty sugar – this can be in the form of sugar lumps, glucose

tablets, a sugary drink (sports drinks are ideal) or other sweet food.n If they respond quickly, give them more food or drink. n Stay with them until they know what day it is.n If they are unmanageable, or do not respond to treatment in 10 minutes, Call

999 for an ambulance.n If they become unconscious, maintain Airway and Breathing (see page 3),

place them in the recovery position and call 999 for an ambulance.

If the casualty does not respond to treatment, there may be another cause for thesymptoms.

26

eEpilepsy and convulsions

There are many different causes for convulsions or seizures: such as epilepsy, stroke,head injury or even high body temperature (febrile fits – common in babies and youngchildren).

Convulsions (fits) often follow a pattern of four phases:

Aura The casualty may recognise that they are about to have a seizure. This may happen only a few seconds before the convulsion.

Tonic In these seizures, the person suddenly becomes stiff or theirmuscles relax. If standing the person falls to the ground. This phasegenerally lasts less than half a minute.

Clonic The casualty makes sudden jerking movements with their limbs. Theeyes may roll, the teeth clench, the patient may drool and breathingmay be loud, like snoring. The casualty may be incontinent. This phase generally lasts less than 2 minutes.

Recovery After the seizure, the casualty may go to sleep, or become veryconfused or agitated. This phase usually lasts a few minutes, and then the casualty comes round.

Treatment

During the seizure:n Lower the casualty gently to the floor to prevent injuryn Put something soft under the person’s head - like a jacket or cardigan n Note the time and duration of the seizuren Move things away from them if there is a risk of injuryn Loosen any tight clothingn Only move the casualty if they are in a dangerous place, such as in the road

or at the top of stairsn Do not attempt to restrain the convulsive movementsn Do not put anything in the person’s mouth

When the seizure has stopped:n Check Airway and Breathingn Roll the person onto their side into the recovery position (see page 9)n Do all you can to minimise embarrassment. (Wipe away any excess saliva. If

the person has been incontinent, deal with this as privately as possible. Tryto clear bystanders away before the casualty awakes.)

n Monitor Airway and Breathingn Stay with the person giving reassurance until they have fully recovered.

27

eMost seizures happen without warning, last only a short time and stop without anyspecial treatment. Injuries can occur, but most people do not come to any harm in aseizure and do not usually need to go to hospital or see a doctor.

Call 999 for an ambulance if:

n The person has injured themselves badly in a seizuren They have trouble breathing after the seizuren One seizure immediately follows another with no recovery in betweenn The seizure continues for longer than is usual for that personn The seizure is still on going after five minutes when it is not known how long

they usually last for that personn It is the person's first seizure.

Febrile Convulsions

For a child around the age of 4, the area of the brain that regulates the bodytemperature ( the hypothalamus ) is not fully developed, therefore if a child developsan infection such as measles this can lead to their core body temperature risingquickly. These convulsions most commonly affect children between the ages of oneand four; approx one in twenty children may have a convulsion. They can also affectchildren between six months and six years old.

A febrile convulsion can be extremely frightening for the parents or carers of the child.The child may appear to stop breathing and their lips turn blue. The word febrilemeans 'related to fever'; the majority of febrile convulsions are triggered by the child'stemperature rapidly rising to over 38 deg C.

n Protect the child from injury during the seizuren Protect the child's headn Provide plenty fresh air, and remove clothing and bed clothes, take care not

to chill the childn Call 999/112 for emergency helpn Once the seizure has stopped, open the airway and check breathing, if the

child is breathing place them in the recovery positionn Monitor airway and breathing until help arrives

28

eAsthma

People with asthma have extra-sensitive airways. Triggers like dust, pollens, animals,tobacco smoke and exercise may make their airways swell and narrow, causing wheeze,cough and difficulty breathing. Most asthma sufferers carry medication with them.

Signs and symptoms

n Breathing difficultiesn Wheezingn Difficulty speakingn Pale, clammy skinn Use of muscles in the neck and upper chest when breathingn Grey or blue lips and skin (in severe attacks)n Exhaustion (in severe attacks).

Treatment

Your aims during an asthma attack are to ease the breathing and if necessary getmedical help.n Be calm and reassuringn Assist the casualty to use their inhaler. n Give the casualty their medication to take - assist with spacers if necessary.n Try to distract the casualty from the attack.n Encourage the casualty to breathe slowly and deeply.n Encourage the casualty to sit in a position that they find most comfortable

(often leaning forward with arms resting on a table or the back of a chair).n Do not lie the casualty down

A mild asthma attack should easewithin 3 minutes, but if it doesn’tencourage the casualty to use theirinhaler again.

29

eCaution:

If this is the first attack, or if the attack is severe and any one of the following occurs:n The inhaler has no effect after 5 minutes.n The casualty is becoming worse.n Breathlessness makes talking difficult.n The casualty becomes exhausted.

Call 999 for an ambulance.

n Encourage the casualty to use their inhaler every 5 to 10 minutes.n Monitor and record the breathing and pulse rate every 10 minutes.

If the casualty becomes unconscious open the airway and check their breathing and beprepared to give emergency aid.

Anaphylaxis

Anaphylaxis is a severe allergic reaction that can produce shock and life-threateningrespiratory distress. In sensitive people, anaphylaxis can occur within minutes or upto several hours after exposure to a specific allergy-causing substance. Almost anyallergy-causing substance, including insect venom, pollen, latex, certain foods anddrugs, can cause anaphylaxis, but the commonest causes are peanuts, drugs(especially penicillin) insect stings and seafood. Some people have anaphylacticreactions from unknown causes.

Signs and symptoms

n Breathing difficultiesn Swelling of eyes, tongue or lips n Red, blotchy rashn Anxietyn Fast, weak pulse.

Treatment

n Call 999 for an ambulance n Lay the casualty down with their legs raised especially if they are looking pale

or feeling faint. If they are having breathing difficulties they may be morecomfortable sitting upright.

n Check for special medications that the person might be carrying to treat anallergic attack, for example, EpiPen. If the patient is unable to administer it himself or herself, then give assistance

n Monitor Airway and Breathingn If the casualty becomes unconscious begin CPR (see page 5).

30

eFirst Aid Kits

Employer’s ResponsibilitiesAn employer is responsible in law (under the Health & Safety at Work legislation) forthe provision of first aid in the workplace. These responsibilities include:n Deciding how many first aiders are required, and where they should be

based, following the guidance of the Health and Safety Executive.n Arranging the required training and refresher training for first aiders

(including payment for the applicable courses).n Providing sufficient first aid kits and equipment for the workplace.n Making sure that all workers are aware of the location of the first aid kit, and

the name of the relevant first aider.

Further information on first aid at work can be found at www.hse.gov.uk.

First Aid KitsA first aid kit should be available in every workplace (Larger sites may require morethan one). The box should protect the contents from dust and damp, and be greenwith a white cross on it to enable staff to find it easily. The kit should be regularlychecked and the contents topped up as required. Different situations require differentcontents, and so the contents are not mandatory. However the standard kit shouldcontain:

1 Leaflet giving general instructions on how to perform first aid1 Pair of disposable gloves1 Breathing barrier for performing rescue breathing and CPR20 Adhesive bandages (plasters) – individually wrapped, sterile in assorted sizes.

Blue plasters should be included for food handlers.6 Safety pins2 Large wound dressings, approx 18cm x18cm, with bandages attached

(individually wrapped and sterile) 6 Medium wound dressings, approx 12cm x 12cm as above4 Triangular bandages (individually wrapped and preferably sterile)2 Sterile eye pads1 Finger bandage and applicator (e.g. Tube-gauze)

Other items like a roll of adhesive tape, disposable aprons, and scissors should beprovided if necessary. These may be stored in the first aid kit, or kept nearby.

Do NOT put antiseptic wipes, creams, tablets or medicines in a first aid box for useon children. Wipes that do not contain antiseptic are allowed.

Eye wash

If mains tap water is not readily available on site, then at least one litre of sterile wateror saline should be provided, in sealed container(s).

31

eAccident Recording

It is important that when caring for someone else's child or infant you keep anaccurate record of any accident as soon as possible after the incident has occurred.The record provides and accurate log of the circumstances. This is critical should aninsurance claim arise. Even the very minor of accidents can sometimes develop intoa more serious condition, so it is imperative that the parents are informed of everyaccident, and ensure the parents have signed the accident book.

An accident should be recorded as soon as possible and should contain:

Name of child, name of person who dealt with accident, Date and time of accident,type of injury, nature of what happened, what treatment was given, what medical helpwas required, (if any), name of witnesses if any, a diagram of the incident area, drawa sketch of the area around the incident and the position of the child and any adults.

Planning for an emergency

The prevention of accidents is much more preferable to giving first aid. It isimportant that you make a plan for how you and your staff (if any) would deal with anemergency situation. Take into consideration a) what would you do if a child has aserious accident or sudden illness, or b) what if you as the carer has an accident orsudden illness.

Some action points to consider when doing your plan:

Telephone access, do you keep your mobile close by?Phone numbers list, Doctors surgery, parents number, emergency cover, Ofstedadvisor or NCMA coordinator.Do you have an action plan with the parents in case of emergencies?Where your first aid is box and is it fully stocked?Do you have the child records to hand to take with you to the hospital or doctor?

32

eElectric Shock

When someone is electrocuted, an electrical current has passed through their bodyto ‘earth’.

You may see burn marks where the current has entered and exited the body, butthere might also be deep internal damage which will not be visible.

The shock may also cause muscles to contract, which may prevent the child frombreaking contact with the electricity. If this is the case the child may still be 'live', soapproach with great care.

In the event of a child suffering an electrical shock, once it is safe to approach followthe sequence of resuscitation pages 4 - 8.

Call 999/112 for emergency help if the child has been unconscious or has electricalburns.

If the child is breathing effectively, treat the injury and take the child to hospital for acheckup even if they have fully recovered.

Animal Bites

Animal bites may be infected with bacteria and other germs, it is therefore veryimportant to ensure the wound is thoroughly cleaned to reduce the risk of infection:n Clean the wound thoroughly with soap and warm watern Treat for bleeding if required (see page 15)n Pat the wound dry and cover with a sterile dressingn Seek medical advice; take the child to hospital if the wound is deep or large

Insect Stings

n If the sting is visible carefully scrape it off the skin with a credit card orsomething similar

n Do not use tweezersn Elevate the injury if possible and apply an ice pack for approx 10 mins, (wrap

in a towel or similar)n If the swelling persists, seek medical helpn If the sting is in the mouth give an ice cube to suck on or cold watern Watch for allergic reaction. (see page 30)

33

eEffects of heat and cold

Heat exhaustionHeat exhaustion is the body's reaction to loss of water and salts through excessivesweating. Can be very common on a hot day where a child has been running around.The child may have symptoms that include confusion, dizziness and nausea, paleclammy skin, headache and profuse sweating.

n Move the child to a cool environment and remove excessive clothingn Give them water to re-hydrate them, isotonic drinks are best as they replace

lost body salts, (ensure you have the parents' permission). If you have icelollies these can also be given.

n Arrange medical attention, even if the child recovers quickly

Heat StrokeHeat Stroke is a very serious condition and is caused by a failure in the body'stemperature mechanism for regulating sweating. Can reach dangerous levels of over40 deg C.

n Move the child to a cool environmentn Call 999/112 for emergency helpn Cool the child as quickly as possible, remove outer clothing and wrap in a cold

wet sheet or towel. Keep it wet and cold until the child's temperature falls to normal levels, and then cover with a dry sheet. Be careful not to over-chill the child

n Should the child begin to fit, treat as a febrile convulsion (see page 26)

HypothermiaHypothermia occurs when the body temperature drops below 35 deg C. Themain cause is over exposure to cold temperatures; however other factors canincrease the risk.

n Wet clothing or immersion in cold watern Children under 4 years of age, due to the temperature control area of the

brain not being fully developedn Children who are not adequately dressed in cold, windy conditions

Possible signs and recognition:

n Shiveringn Cold pale skinn Apathy, lethargy, slurred speechn Dropping levels of consciousness

34

eTreatment of hypothermia:

n If possible move the child to a shelter and remove wet clothing, quickly replace with dry and warm garments and keep the head covered

n Wrap the child in warm blankets if possiblen Use a survival bag if availablen Share body heat to warm the childn Give the child a warm drinkn Do not leave on their ownn Seek medical advice

Should the child become unconscious?

n Maintain the airway and breathingn Carefully place the child in the recovery position, keep blankets and other

heat sources under and around the child, cover the headn Keep movement to a minimum

Sickle Cell

Sickle cell is a hereditary problem with red blood cells, if both parents have the'sickle cell trait' the child may develop what is known as sickle cell disease or 'sicklecell anemia'.

This is mostly common among people of African and Caribbean origins, but can befound among people originating from the Middle East, India and Pakistan.

Red blood cells carry oxygen around the body, with sickle cell some of the red bloodcells are distorted into a sickle shape, instead of their usual doughnut shape, thesickle shape can lead to blockages in the narrow blood vessels. A blockage can leadto damage to internal organs or even the brain and is known as a 'sickle cell crisis'.

To help prevent the common triggers the following should be avoided:

n Poor eating habitsn Stress or upsetn Infectionsn Getting cold or wetn Extreme fatiguen Dehydration, the child must drink regularlyn Extreme temperature changes from hot to cold

35

eSigns and symptoms of sickle cell crisis:n Pain or stiffness in the arms, legs, back, stomach, chest neck or jointsn Drowsiness, infection or jaundicen Swelling of the hands or feetn Face drooping, speech problems, arm weakness on one side

Treatment of sickle cell crisis:n Inform the child's parents immediatelyn Give previously agreed pain relief, if signed consent for medication is in placen If in any doubt seek medical advicen If the child is showing signs of lack of oxygen, or a blockage in the brain, call

999/112 for emergency help

Meningitis

Meningitis is a condition in which the membranes that cover the surface of brain andthe spinal cord become infected or inflamed. One danger is that signs of meningitiscan easily be mistaken for other common and much less serious infections.

A recent study identified that 50% of children with meningitis were initially sent homeby their GP. If you are in any doubt be persistent!

Possible signs:

Early stagesn Cold feet and handsn Pain in the limbs or jointsn Mottling of the skin

Later signsn Fever and sicknessn Blotches and skin rashn Severe headachen Neck stiffnessn Dislike of bright lights

Babies' symptomsn May refuse to feed, be irritable when picked up, high pitched cryn May be floppy or lifeless, fitting or too sleepy to wake upn Check the soft spot on the baby's head, it may be tense or bulging

Treatmentn Call the child's parents and doctorn If doctor is not available take the child to the nearest casualtyn If the rash is present, call 999/112 for emergency helpn Insist Insist Insist, if it is bacterial meningitis early treatment with antibiotics

is vital

36

eSepticaemia

Anyone suffering from Septicaemia may display all of the above signs, but in additionmay develop a distinctive rash. This may start anywhere on the body as a cluster ofsmall red spots, like pinpricks. Left untreated the rash will spread and the pinpricksmay join together to form purple blotches.

To help decide whether a rash may be due to septicaemia, press the side of a cleardrinking glass against the skin. Most rashes will fade under pressure but asepticaemia rash does not face when you press on it.

DO NOT WAIT FOR A RASH TO APPEAR, IT MAY BE THE LAST SIGN AND IN SOMECASES DOES NOT APPEAR AT ALL

37

eNOTES

38

eNOTES

39

eOther Courses Available

n Emergency Responder First Aid

n Child & Baby Emergency Responder First Aid

n Schools Appointed Person First Aid

n Sports Appointed Person First Aid

n 12 Hour Paediatric First Aid

n HSE First Aid at Work

n HSE First Aid at Work Re-Qualification

n First Aid at Work Instructor

n Moving & Handling in a Childcare Setting

n Safety & Security in a Childcare Setting

n Child Protection

n Manual Handling

n Manual Handling in a Care Home

n Fire Marshal

n Fire Risk Assessment

n Risk Assessment

n Health & Safety in the Workplace

n Food Hygiene

All of our courses can be tailored to meet your needs. We are constantly adding newcourses to our portfolio. Please contact us if you have a specific requirement.

40

Enhance Services Ltd.

www.enhanceservices.co.uk0845 226 2407