essential emergency care for first aiders - first aid … · essential emergency care for first...
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TR35.10/14v01300-300
ESSENTIAL EMERGENCY CAREFOR FIRST AIDERS
WHAT DO YOU DO WHEN?
Your father collapses after complaining of indigestion all day.
Your daughter gashes her foot on broken glass.
You’re first on the scene when a pedestrian is hit by a car.
One of your team mates sprains an ankle during practice.
Your toddler chokes on a piece of apple.
New Zealand Red Cross teaches New Zealanders to cope in a crisis and has
been teaching first aid for many years. All the topics covered in first aid and
emergency care courses are contained in this book which provide a vital
reference for all people.
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This book contains Emergency Care information and is intended to supplementand revise information learned on New Zealand Red Cross First Aid courses.
Published by authority of the National Board of New Zealand Red Cross.
Published by the New Zealand Red Cross,69 Molesworth Street, Thorndon, Wellington.
This book is copyright. Except for the purpose of fair reviewing, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Infringers of copyright render themselves liable to prosecution.
ISBN 978-0-908998-21-0
© 2014 New Zealand Red Cross.
The author asserts its moral rights in the work.
First published 1996.Reprinted Annually with new information as required.Printed 2014.
Written and designed by New Zealand Red Cross.
Photographs and illustrations courtesy American, Australian, New Zealand, Samoa, Tuvalu and Papua New Guinea Red Cross, Pacific Delegation IFRC, New Zealand Resuscitation Council and National Heart Foundation of Australia.All rights reserved in all countries.
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WHAT IS EMERGENCY CARE? ..............................................................................1 Emergency care aims ....................................................................................................................................................................2 Emergency care action plan ......................................................................................................................................................2 Emergency care steps; When to dial 111 ............................................................................................................................3
PRIMARY ASSESSMENT – DRSABCD ...................................................................4Using DRSABCD – example ........................................................................................................................................................5Dangers ...........................................................................................................................................................................................2,6Response – Levels of consciousness (AVPU).....................................................................................................................7Airway ..................................................................................................................................................................................................8Breathing ..............................................................................................................................................................................8,12-15Breathing difficulties .....................................................................................................................................................................9Circulation / CPR .............................................................................................................................................................................9Unconsciousness .........................................................................................................................................................................10 Stable Side Position (recovery position) .........................................................................................................................11DRSABCD – Resuscitation ...............................................................................................................................................12-14Basic Life Support Flowchart ................................................................................................................................................14Chain of Survival ..........................................................................................................................................................................15Resuscitation – Adult .........................................................................................................16CPR Action Checklist - Adult ..................................................................................................................................................16DRSABCD – Adult Resuscitation ...........................................................................................................................................17Defibrillator – AED’s ...................................................................................................................................................................18Resuscitation – Child / Infant .............................................................................................19CPR Action Checklist – Child / Infant ..................................................................................................................................20DRSABCD – Child / Infant Resuscitation ............................................................................................................................21Drowning .........................................................................................................................................................................................22Choking ............................................................................................................................................................................................23Choking – Adult ............................................................................................................................................................................24Choking – Conscious (Back Blows / Chest Thrusts) .............................................................................................25-26Choking – Unconscious ............................................................................................................................................................27DRSABCD Adult / Child ............................................................................................................................................................28Choking – Infant – conscious ..........................................................................................................................................29-30Choking – Infant – unconscious / DRSABCD ...................................................................................................................31DRSABCD – Infant .......................................................................................................................................................................31
BLEEDING ..........................................................................................................32External bleeding ..................................................................................................................................................................32-33Wounds .....................................................................................................................................................................................32-34Minor wounds ...............................................................................................................................................................................33DRSABCD – Bleeding .................................................................................................................................................................34
SHOCK & FAINTING ......................................................................................36-37
CHECK FOR OTHER CONDITIONS AND INJURIES ........................................38-41Vital signs ..................................................................................................................................................................................38-39Consciousness, APVU ................................................................................................................................................................40Check for injuries / MedicAlert®............................................................................................................................................41
MEDICAL CONDITIONS.................................................................................42-53Heart attack ............................................................................................................................................................................42-44Angina ...............................................................................................................................................................................................43Heart health ...................................................................................................................................................................................44Stroke .........................................................................................................................................................................................45-47Diabetic emergency ....................................................................................................................................................................48Seizures / Febrile convulsions .........................................................................................................................................49-50Asthma..............................................................................................................................................................................................51Hyperventilation ..........................................................................................................................................................................52DRSABCD - Medical conditions .............................................................................................................................................53
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TSINJURIES.......................................................................................................54-72Fractures................................................................................................................................................................................... 54-55Dislocations ....................................................................................................................................................................................56Soft tissue injuries / bruising ............................................................................................................................................ 57-58DRSABCD - Fractures and soft tissue injuries ................................................................................................................58Spinal injuries.................................................................................................................................................................................59DRSABCD - Spinal injuries .......................................................................................................................................................60Head Injuries ........................................................................................................................................................................... 61-64Concussion .............................................................................................................................................................................. 61-63Brain compression ......................................................................................................................................................................62DRSABCD- Head injuries ..........................................................................................................................................................63Fractured nose..............................................................................................................................................................................63Log roll, stable side position for head or spinal injuries ............................................................................................64Amputations ..................................................................................................................................................................................65Chest injuries .................................................................................................................................................................................66Abdominal injuries ......................................................................................................................................................................66Crush injuries .................................................................................................................................................................................67Nose bleeds ....................................................................................................................................................................................68Ear injuries ......................................................................................................................................................................................68Knocked out permanent teeth ..............................................................................................................................................69Eye injuries ............................................................................................................................................................................... 70-71
BURNS AND SCALDS ....................................................................................73-74DRSABCD - Burns and scalds .................................................................................................................................................75
POISONS ......................................................................................................76-77Poisoning .........................................................................................................................................................................................76DRSABCD - Poisons ....................................................................................................................................................................78Stings .................................................................................................................................................................................................79
SEVERE ALLERGIC REACTION ......................................................................80-81Anaphylaxis .....................................................................................................................................................................................80Anaphylaxis Action Plan ............................................................................................................................................................81 DRSABC - Severe Allergic Reaction .....................................................................................................................................81
ENVIRONMENTAL CONDITIONS ..................................................................82-86Heat exhaustion ...........................................................................................................................................................................82Heat stroke .....................................................................................................................................................................................83DRSABCD – Hyperthermia ......................................................................................................................................................84Hypothermia ..................................................................................................................................................................................85DRSABCD – Hypothermia ........................................................................................................................................................86
OTHER USEFUL INFORMATION ....................................................................87-94Casualty reporting .......................................................................................................................................................................87Handwashing .................................................................................................................................................................................87Applying slings ...............................................................................................................................................................................88First aid kits ....................................................................................................................................................................................89Essential Emergency Management Handbook...............................................................................................................90Household Emergency Plan ............................................................................................................................................. 91-92Useful Numbers ............................................................................................................................................................................93Workplace accidents ..................................................................................................................................................................94
INDEX ...........................................................................................................95-96GLOSSARY ....................................................................................................97-98
MISSION STATEMENT ..........................................................INSIDE BACK COVER
WHAT IS EMERGENCY CARE?Emergency care is the first aid and first help or treatment given to a sick or injured person (called a casualty) before the arrival of further medical assistance.
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EMERGENCY CARE AIMSIn emergency situations, injuries or medical conditions can:
Kill in minutes. Some within hours. Some not at all. General principles of management of the collapsed or injured casualty - After ensuring scene safety for the rescuer, casualty and bystanders, the management of the collapsed or injured casualty involves:
Prevention of further harm or injury. Checking response to verbal and tactile stimuli. Sending for help. Care of airway, breathing, circulation. Control of bleeding. Protection from the environmental elements. Other first aid measures depending on the circumstances. Gentle handling. Reassurance. Continued observation.
EMERGENCY CARE ACTION PLANIn emergency care the DRSABCD cycle is used to assist the first-aider to identify, prioritise and treat any problems. What is DRSABCD?DRSABCD is an abbreviation for the casualty primary assessment process used by the New Zealand Red Cross and stands for:
Dangers, Response, Send for help, Airway, Breathing and Circulation / CPR, Defibrillation
Many countries use the DRS ABCD casualty assessment process at all levels of care.
DRSABCD places the Dangers / Safety of the rescuer, casualty and bystanders as the first priority. The rescuer then checks for a Response from the casualty and considers Sending for help at an early stage in the assessment. The casualty is then assisted by using simple and logical steps to ensure a clear Airway, and assessing and ensuring Breathing Circulation / CPR and use of a Defibrillator if needed.
The purpose of DRSABCD is to assist rescuers to identify these injuries or medical conditions and treat the casualty until the ambulance or advanced care arrives. DRSABCD is used as the guide for emergency care given to casualties in all situations.
The DRSABCD sequence can be repeated as required until help arrives.
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EMERGENCY CARE STEPSThe steps of first aid are to: Recognise an emergency exists. Decide to act. Stay calm. Check for Dangers: Ensure the Safety of scene, self, casualties and bystanders.
Assess the seriousness of the injuries or illness: Consider send for help – Call ambulance 111 immediately. Assess ABC’s. Expose injuries.
Identify the injuries or illness: Listen to or look for the history of the incident. Look for signs. Listen to the casualty for symptoms.
Manage the injuries using the methods outlined in this book. WHEN TO CALL 111Send for Help – know when to call for an ambulance.
Life threatening illness or injury – Call ambulance 111 immediately. Collapse or unresponsive. Absence or difficulty breathing. Chest pain. Severe bleeding. Signs of stroke (e.g. face droop, arm weakness, speech changes). Signs of shock (e.g. anxious, pale, cold, sweaty, feeling sick or faint). Severe allergic reaction (e.g. facial swelling, wheezing, nausea, vomiting). Repeated or first time seizures. Severe fractures and burns. MedicAlert® conditions.
IF IN DOUBT, FIND OUT; always Call ambulance 111 immediately if unsure. For more advice and information, call Healthline 0800 611 116 or a Medical Centre.
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RECOGNISEDECIDESAFETYIDENTIFYASSESSMANAGE
PRIMARY ASSESSMENT – DRSABCDFollowing the simple DRSABCD process below, the first-aider makes a PRIMARY ASSESSMENT to locate any immediately life-threatening conditions. The findings will indicate any action to be taken. Depending on your findings you may need to commence CPR.
Repeat the DRSABCD sequence as needed.
Observe/Check Action
DANGERS Check for hazards, risks.Scene safety for:
yourself the casualty bystanders
If possible, remove risks and dangers from scene. (Or remove casualty from risk).
RESPONSE Check for response. Shout and tap.
SEND FOR HELP Send for help. Call ambulance 111 immediately if no response. Consider AED.
AIRWAY Consider airway obstruction.
If no response open airway (head tilt, chin lift).
BREATHING If not breathing normally.
If breathing normally.
Commence CPR.
Make sure breathing is easy and not obstructed.
CIRCULATION/CPR If not breathing normally.
If bleeding.
If showing signs of shock.
Commence CPR.
Control bleeding.
Manage shock and observe.
DEFIBRILLATION Vital signs. If not breathing normally.
Use AED if needed.
GENERAL CARE Position in a Stable Side Position.
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USING DRSABCD – A PRACTICAL EXAMPLE
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders.You check the scene for obvious danger and note the presence of blood. You put on gloves.
RESPONSE(AVPU)
(AVPU - see page 7).You ask him if he is OK.He speaks to you. He is alert. You introduce yourself and ask if you can help him.
SEND FOR HELP Send/shout for help. You ask bystander for help. Consider AED.
AIRWAY The casualty is talking easily and has no obvious airway problem.
BREATHING You ask if he is OK. Breathing is rapid.
CIRCULATION / CPR Casualty appears pale and says he feels light headed. You send bystander to Call ambulance 111 immediately, because of the signs of shock.
DEFIBRILLATION Consider AED. - If needed, attach and follow prompts.
SPECIFIC CARE You lie the casualty in the shock position.You treat the hand wound.You check that the ambulance is on the way.You ask if the casualty has a history of heart-related problems, they say yes. You check for other injuries and cannot find any.
GENERAL CARE You keep the casualty warm and reassure him. You stay until the ambulance arrives.
Below is a practical example of how First Aiders can use DRSABCD. You are walking through the park when you see an elderly man stumble and fall. When you go to help you notice he is trying to get up and has blood coming from a wound to his hand. You decide to act.
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DANGERSEnsure Scene Safety for yourself, casualty and bystanders.
MOVEMENT FROM DANGERSMovement can worsen the casualty’s condition by increasing pain, injury, blood loss or shock. Only move a casualty if there is a clear reason to do so (to ensure safety; in extreme weather or difficult terrain where movement is essential; to make possible the care of ABCs, perform CPR or control of severe bleeding).Stay with the casualty and send others to seek assistance.
The one person drag is the best way for the lone rescuer to move the casualty from danger. A blanket may also be used.
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Levels of Consciousness:
Response
A ALERT and responsive
Talks and responds to questions appropriately. What time of the day is it? What sport were you playing? What town are you in?
Talks, but may be anxious, irritable or confused. May repeat questions several times, forgetting that answers have been provided.May start to become drowsy.
V Drowsy but responds to VOICE
Obeys instructions move your arms open your eyes
or responds to instructions by grunting, groaning, moving the head, or similar attempts to acknowledge.
P Unconscious, does not respond to voice but responds to PAIN
Does not speak or respond to instructions. Moves away from painful stimuli. Moves head away or grimaces when tapped onthe shoulder.
U UNRESPONSIVEUnconscious
Does not speak. Does not respond in any way to pain or voice.
SEND / SHOUT FOR HELP – get someone to send for help – Call ambulance 111 immediately.
CONSIDERCALLING AMBULANCE 111
RESPONSE – LEVELS OF CONSCIOUSNESS
The casualty’s response is a measure of their Level of Consciousness. An initial check of consciousness is performed in the Primary Assessment using the Shout and Tap method. More detailed assessment of a casualty’s level of consciousness should be made as part of the Secondary Assessment.
The check should be repeated at regular intervals and medical personnel should be advised of any patterns. Patterns may show changes in the casualty’s condition.
CONSIDERCALLING AMBULANCE 111
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CONSIDERCALLING AMBULANCE 111
CONSIDERCALLING AMBULANCE 111
BREATHINGWhen we breathe, the body uses only part of the oxygen we breathe in, so there is still oxygen in the air when we breathe out. This is why the rescuer’s breath can be used to provide a casualty’s oxygen needs.
If a casualty is breathing adequately, put them in a Stable Side Position (recovery position).
The normal adult breathing rate is 12-20 breaths per minute. Children and infants breathe at a faster rate.
AIRWAYIf a casualty is unconscious they will be unable to maintain an open airway to allow air to enter the lungs. Opening the airway of a non-breathing unconscious casualty may be the only step required to save their life.
Open their airway using head-tilt, chin-lift as follows:
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HEAD-TILT, CHIN-LIFT:
Place one hand on the forehead and two fingers of the other hand on the bony part of the chin. Tilt the head back using the hand on the forehead, and at the same time lift the jaw upwards with the fingers of the other hand.
BREATHING DIFFICULTIES
CIRCULATION / CPR The heart beats to pump blood around the body. Breathing is a sign of circulation. If there is no circulation, normal body activity will cease. Commence CPR.
Major bleeding must be managed early to prevent shock developing. Use direct pressure and elevation to control severe bleeding. (Bleeding and Wounds - pages 32-34).
Minimise shock by laying the casualty down, keeping them warm and reassuring them.
Pale, cold sweaty skin, a weak rapid pulse, and rapid breathing indicate shock. (Shock - page 36).
If there is no circulation, normal body activity will cease. Commence CPR. Call ambulance 111 immediately. Send or call out for the defibrillator (AED).
SIGNS AND SYMPTOMS - BREATHING DIFFICULTIES Difficulty breathing. Difficulty speaking. Anxiety. Inappropriate or lack of speech. Noisy breathing, wheezing, coughing.
MANAGE BREATHING DIFFICULTIES Call ambulance 111 immediately. Monitor ABCs. Make as comfortable as possible. Encourage casualty to take their medicine. Rest and reassure casualty. Place in stable side position.
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UNCONSCIOUSNESSUnconsciousness may occur for a number of reasons. Head injury, low blood sugar in diabetes, epileptic seizures and strokes can all result in unconsciousness. You do not need to know the cause to treat unconsciousness.
IDENTIFY AND ASSESS UNCONSCIOUSNESS There are degrees of unconsciousness. A deeply unconscious casualty will not be able to speak or respond to what you say. The level of consciousness AVPU chart on page 7 provides methods to check levels of consciousness.
Initially you will have identified unconsciousness during the Primary Assessment using the Shout and Tap method.
MANAGE UNCONSCIOUSNESS Obtain help. Send someone to call ambulance 111 immediately.
Place casualty in a Stable Side Position (recovery position).
Check for any injury or illness using the Secondary Assessment.
Do not give any food or drink.
The major danger to an unconscious casualty is airway obstruction from the tongue.
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Stable side position (recovery position)
STABLE SIDE POSITION (RECOVERY POSITION)
The Stable Side Position (recovery position) is designed for unconscious casualties. It helps to maintain an open airway and allows vomit and other fluid to drain freely from the mouth.
If a casualty is unable to be aroused, is unresponsive (does not respond to your “shout and tap” i.e. talk and touch command such as “open your eyes” or “squeeze my hand”), only groans without opening their eyes, or does not react to you grasping and squeezing their shoulders firmly to elicit a response, then gently place them into a stable side position while being careful to avoid any twisting or forward movement of the head and spine.
The stable side position is sometimes referred to as the recovery or lateral position.
Where you suspect neck or
spinal injuries in an unconscious
casualty, log roll them on their
side, supporting their head and
keeping the spine in line.(See Log Roll
page 64).
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BASIC LIFE SUPPORT
Dangers?
Responsive?
Send for help
Open Airway
Normal Breathing?
Start CPR30 compressions : 2 breaths
if unwilling / unable to perform rescue breaths continue chest compressions
Attach Defibrillator (AED)as soon as available and follow its prompts
Continue CPR until responsiveness or normal breathing return
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RESUSCITATIONThe aim of CPR is to provide oxygen to the brain and heart until appropriate advanced Cardiac Life Support can restore normal heart beat and breathing.
Most adults requiring CPR are as a result of a heart problem so an emphasis is placed on early access to calling ambulance 111 and early CPR.
For the purpose of resuscitation an adult is anyone over 8 years of age.
Resuscitation should be commenced where the person is unresponsive and not breathing normally.
CHAIN OF SURVIVAL
Most sudden cardiac arrests occur outside of hospital with death occurring within minutes of onset.
The Chain of Survival lists the priorities and actions to be followed to give the casualty the best chance of surviving sudden cardiac arrest.
To greatly improve the chance of survival:
Get access to advanced care as early as possible (call for help; call ambulance 111 immediately).
Start CPR fast. Use an AED (defibrillator) as quickly as possible. Continue CPR until advanced care help arrives.
NZ Resuscitation Council Guidelines
www.nzrc.org.nz
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Prevention Early Recognition
Early Access
Early CPR
Early Defibrillation
Early Advanced
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OPEN AIRWAYHead Tilt Chin Lift
CPR ACTION CHECKLIST – ADULTRESUSCITATION FOR ADULTS
Look, listen, feel for breathing (no more than 10 seconds)
CPR RATIO 30:230 compressions
ATTACH AEDas soon as possible
CPR RATIO 30:22 rescue breaths
1. Check for dangers, hazards, consider safety.
2. Response: Shout and tap the casualty to see if they respond.
3. Send for HELP. Call ambulance 111 immediately.
4. Airway open Position casualty with head tilt and chin lift.
5. Check for normal breathing Look, listen and feel for breathing - airflow at
the mouth and nose (no more than 10 seconds). If not breathing normally, commence CPR.
If breathing and unconscious. – Put casualty into a Stable Side Position
(recovery position). – Monitor for breathing, treat for shock. - Go for help if alone.
6. Circulation / CPR - Commence CPR Position casualty laying on their back on a
hard flat surface. Compressions = 30 Compressions. Hands on centre of chest (use heels of hands). Depth: 1/3 depth of chest. Rate of compressions: 100 per 1 minute. Smooth up and down pressure.
7. Give two effective rescue breaths, over 1 second each. An effective breath is completed when the chest
begins to rise.
8. Continue CPR at a ratio of 30:2 Give 30 compressions to 2 breaths until help arrives or the casualty begins to breathe.
9. Defibrillation - Attach AED as soon as possible and follow voice prompts.
Photos courtesy Tracey KearnsRESU
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DANGERS Check for hazards, risks.Ensure safety for self, casualty and bystanders.
RESPONSE(AVPU)
Shout and tap.If unresponsive.
SEND FOR HELP Send/shout for help. Send bystander to Call ambulance 111 immediately. Consider AED.
AIRWAY Open airway by using head tilt chin lift.
BREATHING Look, Listen and Feel for 10 seconds.If NOT BREATHING NORMALLY; COMMENCE CPR.If ALONE, go for help before commencing CPR.
CIRCULATION / CPR Commence CPR: 30 compressions / 2 rescue breaths. Depth: compressions at least 1/3 of the chest depth using 2 hands centre of chest. Rate: 100 per minute. Each rescue breath delivered over 1 second.
DEFIBRILLATION If NOT BREATHING NORMALLY, continue with CPR. Attach AED as soon as possible and follow voice prompts.
GENERAL CARE Stable side position. Keep the casualty warm and reassure them. Stay until the ambulance arrives.
DRSABCD APPROACH - ADULT RESUSCITATIONIf a person is unwilling or unable to provide full CPR (i.e. chest compressions and rescue breathing) then provide continuous chest compressions at a rate of just over 1 compression per second.
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DEFIBRILLATION AND AEDSA defibrillator is an electronic device that sends an electrical shock through the casualty’s chest in an attempt to restore a normal heart rhythm. Early defibrillation significantly improves the chance of survival.
Defibrillators located in places like shopping malls, supermarkets and other public facilities are usually an automatic, easy to use, voice guided device and are therefore called an Automated External Defibrillator (AED). These can be used by members of the public, even without training.
Start CPR on an unresponsive, non-breathing casualty and as soon as the AED is available simply turn on the device and follow the voice instructions on how to perform each step that is required.
The AED checks the casualty’s heart rhythm, decides if a shock is needed and provides step by step instruction for CPR.
You cannot accidentally shock the casualty as the AED decides on, and delivers, the shock process. It will not shock someone who does not need a shock.
The pad location is shown on the AED (see photo below).
If paediatric specific pads are available they can be used on children under the age of 8 years however if they are not available use standard adult pads ensuring the pads do not touch each other. For smaller children, place one pad on the centre of the chest and the other pad on the upper back between the shoulder blades.
Modern AEDs are easy to use and can be purchased through New Zealand Red Cross.
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RESUSCITATION – CHILDChildren (and infants under 1 year)
For the purposes of resuscitation a child is consideredto be aged 8 years and below.
Unlike adults, children are rarely affected by cardiac arrest due to heart attack. Most non-breathing children are the result of Airway and Breathing problems.
When you are alone and the child or baby is not breathing, COMMENCE CPR for one minute then call ambulance 111 immediately.
CALL FAST
When you are alone and the
child or baby is not breathing,
COMMENCE CPR for one
minute then call ambulance
111 immediately.
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1. Check for Dangers/safety.
2. Check for Response. Shout and tap, pick infant up.
3. Send for HELP - ask bystanders to call ambulance 111 immediately. IF ALONE, stay with the child. Consider AED.
4. Airway open. Child – Head Tilt/Chin Lift (Adult - page 16). Infant – Move head into neutral position and support
lower jaw as pictured.
5. Check for Normal Breathing.
Look, listen and feel for breathing (no more than ten seconds).
IF NOT BREATHING NORMALLY, COMMENCE CPR. If ALONE, go for help after 1 minute CPR.
6. Circulation / CPR - Commence CPR 30 Compressions.
Rate of Compressions: 100 per minute. Smooth up and down pressure. Child 1–8yr – Position 1 hand on the centre of
the chest. Depth of compressions 1/3 of the chest depth.
Infant under 1yr – 2 fingers just below the nipple line. Depth of compressions 1/3 of the chest depth.
7. Give two effective rescue breaths (an effective breath is completed when the chest begins to rise) Each rescue breath delivered over 1 second.
8. Continue CPR at a ratio of 30:2 If ALONE, go for help after 1 minute CPR. Give 30
compressions to 2 breaths until there is either a response from the child or until help arrives.
9. If child begins to breathe place in a Stable Side position (recovery position) and monitor breathing.
UNDER 8 YRS (INCLUDES INFANT)
Infant (under 1yr): Open Airway Move head into neutral position
Photos courtesy Tracey Kearns
CPR ACTION CHECKLIST – CHILD / INFANTRESUSCITATION FOR CHILDREN
Look, listen, feel for breathing (no more than 10 seconds)
CPR RATIO 30:230 compressions: 2 breaths
Child (1-8yrs): Attach AED as soon as possible
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DRSABCD – RESUSCITATION – CHILD UNDER 8 YRS (INCLUDES INFANT)
DANGERS Check for hazards, risks.Ensure safety for self, casualty and bystanders.
RESPONSE(AVPU)
If unresponsive.
SEND FOR HELP Send / shout for help. Send bystander to call ambulance 111 immediately.IF ALONE, stay with the child. Consider AED.
AIRWAY Child 1-8yr – Open airway by Head Tilt / Chin Lift. Child under 1yr – Open airway by moving head into neutral position.
BREATHING Look, Listen and Feel for 10 seconds.If NOT BREATHING NORMALLY; COMMENCE CPR.If ALONE, go for help after 1 minute CPR.
CIRCULATION / CPR Continue CPR: 30 compressions : 2 rescue breaths. Child - Compressions 1/3 of the chest depth. Infant - Compressions 1/3 of the chest depth. Each rescue breath delivered over 1 second.If ALONE, go for help after 1 minute CPR.
DEFIBRILLATION 1-8 years only (Use Paediatric pads if available)
Attach AED as soon as possible and follow voice prompts.For smaller children, place on pad on the centre of the chest and the other pad on the upper back between the shoulder blades.
SPECIFIC CARE Continue with CPR until there is either a response from the casualty or until help arrives.
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Provision of buoyancy to the casualty in distress is important, however consider your own safety before entering the water to rescue a casualty, especially in deep water. Early or very late signs of drowning can be hard to recognise.
SIGNS AND SYMPTOMS - DROWNING
Difficulty in breathing or breathing stopped. Frothing around the mouth. Little or no response. Altered level of consciousness after incident involving water.
MANAGE DROWNING
Call for help as soon as possible. Dangers – check for safety. Response – check response. (Shout & tap). Send for help – call ambulance 111 immediately. Consider AED. Airway (head tilt / chin lift). If not breathing normally, start CPR 30:2
immediately. Beware that the person may have swallowed water and may vomit. Ventilations and warmth are important.
Put into a Stable Side Position (recovery position) when breathing on own again. Keep warm. All drowning casualties (ie anyone who has experienced water-related
distress) must be seen by a doctor.Notes: – Spontaneous breathing can occur as a person
becomes unconscious and their muscles relax. – Be prepared for vomiting.
(INCLUDING NON FATAL DROWNING, SUBMERSION AND IMMERSION)
DROWNINGD
ROW
NIN
G
22 Ref: Szpilman, D et al. (2014).
23
CHOKINGAny person who indicates they are choking or are clutching their neck should be considered as possibly having a foreign body airway obstruction, i.e. choking. They may suddenly stop breathing and fall unconscious for no apparent reason.
The management of choking will depend on the degree of airway blockage and whether the casualty is conscious or unconscious.
SIGNS AND SYMPTOMS - CHOKING
The choking casualty is often identified by the history surrounding the event:
An adult eating a meal begins to cough and wheeze. A child playing tag and eating lollies is found unconscious and not breathing. An infant sitting by a brother or sister eating peanuts stops breathing.
In these situations a foreign body airway obstruction should be suspected. In addition, the choking casualty may:
Clutch at their neck. Be unable to talk, cough or breathe.
CHO
KIN
G
23
CHOKING - ADULTMANAGE ADULT CHOKING
Dangers, check for hazards, risk, consider safety.
Responsiveness, Ask the casualty; ‘Are you choking?’
Send for help - ask bystander to call ambulance 111.
If the casualty is coughing they should be encouraged to continue with attempts to expel the foreign body.
If the casualty is unable to talk, cough or breathe, the obstruction should then be managed using Back Blows and, if needed, Chest Thrusts. (Heimlich Manoeuvre is no longer common practise in this situation).
BACK BLOWS
If the airway is completely obstructed, give up to 5 back blows to attempt to clear the airway. Back blows should be performed as follows:
Stand to the side and slightly behind the casualty. Support his/her chest with one hand and lean or bend him/her well
forward, so that when the obstructing material is dislodged, it comes out of the mouth rather than going further down the airway.
Give up to 5 sharp blows between the shoulder blades with the heel of your other hand. Each individual blow should be a separate action, with the intent of relieving the obstruction. If the obstruction is not relieved by back blows, perform chest thrusts.
CHEST THRUSTSChest thrusts create an artificial cough intended to move and expel the foreign body obstructing the airway. Chest thrusts should only be performed on conscious casualties. If the casualty becomes unconscious, commence CPR.
CHO
KIN
G –
AD
ULT
24
CHEST THRUSTS CONSCIOUS
Deliver up to 5 chest thrusts if necessary.
Stand behind the casualty, place your arms under the casualty’s armpits and wrap or encircle the casualty’s chest.
Make a fist with one hand and place the thumb side of the fist against the middle of the sternum, ie over the breastbone, avoiding the lower tip. (The location is the same as that used in the chest compressions for CPR.)
Grasp the fist with the other hand. Give a quick inward thrust by pulling the fist towards you in a quick movement. Administer up to 5 chest thrusts until the object is dislodged or the casualty
becomes unconscious. Back blows and chest thrusts aim to remove the obstruction with each
one rather than deliver all five each time. If unconscious start CPR.
MANAGEMENT OF FOREIGN BODY AIRWAY OBSTRUCTION (CHOKING)
Photos courtesy NZ Resus Council
(Ref NZRC) CHO
KIN
G -
BACK
BLO
WS
/ CH
EST
THRU
STS
25
Assess Severity
Ineffective Cough Effective Cough
Severe airwayobstruction
Mild airwayobstruction
Unconscious Conscious Encourage coughing
Continue to checkcasualty untilrecovery or
deterioration
Call ambulance 111immediately
Call ambulance 111immediately
Give up to 5 back blows
If not effectivegive up to 5 chest
thrusts
Call ambulance 111immediately
Commence CPR
26
OBSTRUCTED AIRWAY CYCLE – ADULT / CHILD 1-8 YRS - CONSCIOUS
The complete actions for dealing with choking in a conscious adult are as follows:
CONTINUE UNTIL OBSTRUCTION IS REMOVED.
IF CASUALTY BECOMES UNCONSCIOUS BEGIN CPR.
ENCOURAGE
TO COUGH
5 BACK
BLOWS5 CHEST
THRUSTS
IF THE ADULT / CHILD CASUALTY BECOMES UNCONSCIOUSOR IS FOUND UNCONSCIOUS
If foreign body obstruction is suspected, then follow the standard DRSABCD sequence for child / adult CPR. If solid material is visible in the mouth remove with a finger sweep.
Repeat the sequence of airway examination/attempted rescue breaths/chest compressions until the object becomes dislodged or advanced help arrives.
OBSTRUCTED AIRWAY – CONSCIOUSCH
OK
ING
-AD
ULT
-CO
NSC
IOU
S
26
27
OBSTRUCTED AIRWAY CYCLE – ADULT / CHILD 1-8 YRS - UNCONSCIOUSFollows DRSABCD sequence for adult / child.The actions for dealing with choking in an unconscious adult are as follows:
UNSUCCESSFUL
ATTEMPT
RESCUEBREATHS
LOOK FOR
OBSTRUCTION IN
MOUTH, REMOVE
IF OBJECT IS
VISIBLE
COMMENCE
CHEST
COMPRESSIONS
AS FOR CPR
30
CONTINUE CYCLE UNTIL BREATHING OR MEDICAL HELP
ARRIVES
2
NOTES
OBSTRUCTED AIRWAY – UNCONSCIOUS
CHO
KIN
G-A
DU
LT-U
NCO
NSC
IOU
S
27
CHOKING – CHILDRENThere are some changes made to choking techniques when dealing with a child or baby. The major differences are outlined below.
CHILDREN
Open the mouth. If a foreign body is seen, remove it: only finger sweep if a foreign body is seen.
Children aged 1-8 years who are choking and conscious – treat same as adult choking.
CHOKING – INFANT DRSABCD – CHOKING ADULT AND CHILD 1-8 YRS
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystander.
RESPONSE(AVPU)
Check for Response.
SEND FOR HELP Send / shout for help. Send bystander to call ambulance 111 immediately. Consider AED.
AIRWAY If RESPONSIVE use choking manoeuvres.Clear by encouraging to cough or use back blows and chest thrusts.
BREATHING Continue choking manoeuvres until casualty is breathing. If casualty becomes unconscious commence CPR.
CIRCULATION / CPR
If UNRESPONSIVE and not breathing,commence CPR.
DEFIBRILLATION
CHO
KIN
G –
OV
ER 1
YEA
R –
DRS
ABC
D
28
INFANT (UNDER 1 YEAR): CONSCIOUS CHOKING
INFANT (UNDER 1 YEAR): UNCONSCIOUS CHOKING
1. Place the infant down straddling your arm with the head lower than the trunk, and the head supported with the hand around the jaw.
2. Deliver 5 back blows between the shoulder blades with the heel of your hand.
3. Sandwich the infant between your arms (all the while supporting the neck of the infant). Turn the infant over and deliver 5 chest thrusts using two fingers, just below the nipple line.
4. Check the airway. If you see a foreign body, gently ‘hook’ it out, but avoid blind finger sweeps.
5. Repeat as necessary.
1. Place the baby on a firm surface (e.g. table).
2. Open the airway to a neutral position, look for and remove any foreign objects using a finger sweep; and look, listen and feel for breathing (no longer than 10 seconds).
3. Give 30 compressions.
4. Reposition head, give 2 small gentle rescue breaths (puffs).
5. Continue CPR 30:2 cycle, until object is dislodged and baby is breathing, or medical help has arrived.
(Infant CPR - page 20).
Infant choking – the sequence for conscious infants is quite different and is stated below:
CHO
KIN
G –
INFA
NT
29
30
INFANT – CONSCIOUS CHOKINGCONSCIOUS INFANT WITH OBSTRUCTED AIRWAY.
The actions for dealing with choking in a conscious infant are as follows:
Check mouth, remove object if visible.
If unsuccessful, repeat cycle.
Head is held lower than the body and is firmly
supported at all times.
Sandwich turn
5 back blows
5 chest thrusts
CHO
KIN
G –
INFA
NT
- CO
NSC
IOU
S
30
31
INFANT – UNCONSCIOUS CHOKING (UNDER 1 YR BABY)
PLACE INFANT ON FIRM SURFACE
Open airway to neutral position, check for normal
breathing. Look for, and remove foreign
objects.
COMPRESSIONS30
CONTINUE CYCLE UNTIL INFANT IS BREATHING OR MEDICAL HELP
ARRIVES
SMALL GENTLE RESCUE BREATHS
(PUFFS)
2
DRSABCD – CHOKING – INFANT (UNDER 1 YR BABY)
If the casualtybecomes
unconscious,follow the standard sequence for infant (under 1 year baby)
CPR, checking airway for
obstruction.
Repeat the sequence:
attempted rescue breaths / chest
compressions until the object becomes
dislodged or advanced help
arrives.
CHO
KIN
G –
INFA
NT
DRS
ABC
D
31
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystander.
RESPONSE (AVPU) Check for Response.
SEND FOR HELP Send / shout for help. Send bystander to call ambulance 111 immediately. Consider AED.
AIRWAY If RESPONSIVE use choking manoeuvres.Clear by encouraging to cough or use back blows and chest thrusts.
BREATHING Continue choking manoeuvres until casualty is breathing. If casualty becomes unconscious commence CPR.
CIRCULATION / CPR If UNRESPONSIVE and not breathing,commence CPR.
DEFIBRILLATION
BLEEDINGIDENTIFY AND ASSESS BLEEDINGBlood loss may occur either internally or externally.In internal bleeding there may be no visible blood, and it will be the signs and symptoms of shock that alert the first aider to the loss of blood.
In external blood loss the quantity and colour of blood will vary depending on the type of blood vessel damaged.
WOUNDSWounds in areas with a good blood supply will bleed a lot. A large amount of blood can be lost from a very small cut in areas such as the scalp.
The first aider should always expose the wound site to determine the seriousness of the injury.
If the wound is covered by clothing, remove clothing from the affected area to see the wound. If necessary, cut clothing.
Protect yourself from infection by wearing gloves when blood is present. When possible encourage the casualty to apply direct pressure using their own hand to limit your contact with blood.
Blood Vessel Type Characteristics of Bleeding
ARTERY Bright red blood, spurting in response to heart beat.
VEIN Dark red in colour, flows steadily.
CAPILLARY Blood oozes gently.
If gloves are not available, using plastic bags as makeshift gloves is a good alternative.
BLEE
DIN
G /
WO
UN
DS
32
33
MANAGE EXTERNAL BLEEDING Put on gloves to ensure your personal safety. If possible, lay the casualty down, and rest the injured area. If an arm or leg is injured, elevate the affected limb and keep it raised after
bleeding stops. Expose the wound to determine the extent of the problem.
Carefully and gently cut away clothing if necessary. Dress the wound. Place a clean non-fluffy dressing pad over the wound and
apply firm direct pressure. Use bandage. If there is a foreign object embedded in the wound, do not remove it.
(Foreign bodies in wounds - page 34). Do not remove clots that have formed. If blood comes through the first dressing, place another pad over the first
without removing the original pad. Continue to control bleeding by direct pressure with compression bandage if
necessary. Monitor ABC’s. Rest and reassure the casualty. Treat for shock.
CALL AMBULANCE 111 IMMEDIATELY IF:
Bleeding is severe. Bleeding is not controlled.
CLEANING A MINOR WOUND
Cover the wound and seek medical treatment if the wound looks dirty. If it will not require medical treatment clean the wound. Carefully clean around wound with mild soap and water. Clean wound with running, clean, lukewarm water.
Do not rub the wound itself. Dry with a clean pad. Cover with Band-aid type dressing or gauze pad and bandage.
THINK RED
Rest & Reassure
Elevate & Expose
Dressing & Direct
Pressure
SIGNS AND SYMPTOMS - BLEEDING Pain. Bleeding. Cold sweaty skin, feeling cold. Pale appearance. Signs of shock.
BLEE
DIN
G
33
34
DRSABCD – BLEEDING
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders. Wear gloves.
RESPONSE AVPU.
SEND FOR HELP Consider calling ambulance 111. Consider AED.
AIRWAY Check airway.
BREATHING Check breathing.
CIRCULATION / CPR
DEFIBRILLATION
Control bleeding, treat for shock.
Consider AED for severe bleeding.
SPECIFIC CARE Think RED - Rest and Reassure. - Elevation and Expose. - Dressing and Direct Pressure. Add more bandages if blood seeps through.Monitor ABC’s.
GENERAL CARE Keep casualty warm and reassure.
FOREIGN BODIES IN WOUNDS
Foreign bodies that are clearly on the surface and not sticking to the wound may be removed.
Pad around the object to prevent direct pressure being applied over the object.
If in doubt leave foreign bodies where they are.
BLEE
DIN
G –
DRS
ABC
D
34
35
NOTES
NO
TES
35
Shock occurs when not enough oxygen-rich blood reaches parts of the body.
Shock may be seen in most serious injuries involving fluid loss such as bleeding, burns or illness involving diarrhoea and vomiting or heart attacks.
Shock is considered life threatening. Call ambulance 111 immediately.
SIGNS AND SYMPTOMS - SHOCK
The signs and symptoms apparent in shock may include the following:
Irritability, restlessness or anxiety. Pale, cold, moist skin. Weak, rapid pulse. Rapid breathing. Feeling sick. Feeling faint. Unconsciousness may develop.
MANAGE SHOCK
Call ambulance 111 immediately. Where possible, treat the cause of the shock; stop
bleeding, cool burns. Lie the casualty down and raise the legs if injuries
don't prevent this. Keep the casualty warm. Reassure the casualty. Loosen restrictive clothing. Do not give food, drink, or cigarettes. Monitor vital signs and ABCs.
Most injuries and many illnesses give some degree of shock.
SHOCKSH
OCK
36
FAINTING
Fainting is brief loss of consciousness caused by a temporary decrease in blood flow to the brain.
Some people faint at the sight of blood or as a reaction to pain or bad news.
A common reason for fainting is standing in one position without moving for a long period of time.
SIGNS AND SYMPTOMS - FAINTING
A casualty who has fainted may feel giddy, unsteady and weak and may:
Fall to the floor or slump in a chair, and become unconscious. Have pale, sweaty skin. Have a slow pulse.
MANAGE FAINTING
Lie the casualty down and raise the legs. Loosen tight clothing. Call an ambulance if the casualty remains unconscious for more than
5 minutes. Reassure on recovery.
FAIN
TIN
G
37
38
CHECK FOR OTHER CONDITIONS AND INJURIES
HISTORY
RECHECK VITAL SIGNS
CHECK FOR INJURIES
Question casualty & bystanders
Continue to monitor DRSABCD
Vital Signs are Level of Consciousness and Breathing
HISTORY
RECHECKVITAL SIGNS
CHECK FOR OTHER CONDITIONS AND INJURIES
CHEC
K F
OR
OTH
ER C
ON
DIT
ION
S
AN
D IN
JURI
ES
38
39
HISTORY
Ask the casualty and / or bystanders what happened, record if possible.
Observe evidence at the scene, e.g. pill bottles, chemical containers.
RECHECK VITAL SIGNS AND ACT AS REQUIRED
Check vital signs as detailed below, until an ambulance arrives.
LEVEL OF RESPONSE AND BREATHING
Check the breathing rate of the casualty by countingbreaths taken over one minute. The rate of breathing canbe controlled at will, so do not advise the casualty of your check.
Remember the absence of response and absence of normal breathing is all that is required to indicate that CPR should be given. Begin CPR immediately by delivery of chest compressions, ask for a Defibrillator (AED) and follow the voice prompts.
NOTES
The vital signs check should
be repeated and recorded at 10 minute
intervals.
HIS
TORY
AN
D V
ITA
L SI
GN
S
39
40
LEVEL OF CONSCIOUSNESS – RESPONSIVENESS
Determine the casualty’s level of consciousness.
LEVELS OF CONSCIOUSNESS
ALERTFULLY RESPONSIVE
OR MAY BE CONFUSED, OR BECOME DROWSY
RESPONDS TO VOICE, DROWSY
RESPONDS TO PAIN, IS UNCONSCIOUS
UNRESPONSIVE, UNCONSCIOUS
NOTES
A
V
P
U
AVPU
CON
SCIO
USN
ESS
40
41
Always ask the casualty’s
permission to do a body
check and explain what
you are doing.
CHECK FOR INJURIESThe human body is fairly similar on both sides. This allows us to compare the two sides when inspecting for injury. The body check is carried out head to-toe.
If you find an injury it will be necessary to remove clothing to know the size, type and severity of injury. Do not remove or damage more clothing than necessary.
Ensure the casualty’s privacy.
CHECK FOR MEDICALERT® EMBLEM MedicAlert® is a worldwide organisation which provides protection for 125,000 New Zealanders with life-threatening medical conditions.
Members are issued with a metal emblem engraved with the member’s number, emergency telephone number and medical conditions; plus a plastic wallet card providing more detailed personal and medical records. Paramedics have immediate access to the database for special care.
In an emergency look for the MedicAlert® emblem, e.g. on a bracelet, necklace or anklet.www.medicalert.co.nz
CHEC
K F
OR
MED
ICA
LERT
41
42
MEDICAL CONDITIONS The heart, like any other muscle in the body, needs a blood supply to provide it with oxygen. A heart attack occurs when there is a reduction in the blood supply to a part of the heart muscle, damaging the heart.
SIGNS AND SYMPTOMS - HEART ATTACK
The casualty may think they just have indigestion. Some or all of the following symptoms may be present:
Pale appearance.
Heavy pressure, tightness, vice-like crushing pain or unusual discomfort in the centre of the chest.
Pain may spread to the shoulders, neck, jaw, arms or back.
Profuse sweating, cold sweaty skin. Sudden fainting or dizziness; feels light-headed. Shortness of breath, with rapid breathing and gasping
for air; difficulty speaking. Lips turning blue.
Anxiety.
Collapse, unconsciousness.
MANAGE HEART ATTACK
Encourage the casualty to rest quietly, in a comfortable position; reassure.
Call ambulance 111 immediately. Ask the casualty if they are allergic to aspirin. If not,
give 1 tablet (300 mg) to chew, or take soluble aspirin dissolved in a small amount of water.
Monitor ABCs and vital signs. A heart attack may lead to cardiac arrest.
Be prepared to perform resuscitation. Consider using AED.
HEART ATTACKCall ambulance 111 immediately.
HEA
RT A
TTA
CK
42
43
ANGINA Angina is the pain felt when there is temporarily insufficient blood flow to the heart to meet the heart’s needs. Permanent heart muscle damage does not result.
Most angina attacks will be managed by the casualty by rest and medication. If the casualty does not respond to resting and taking their medication consider and treat as a heart attack.
IDENTIFY AND ASSESS ANGINAAngina is characterised by:
MANAGE ANGINAMost people with a history of angina carry medication with them. This medication may be a spray or tablet, which is taken under the tongue.
HEART HEALTHA healthy lifestyle will promote heart health and reduce the risk of heart disease. Use the table on the next page to determine your risk of heart disease and identify areas where lifestyle modifications may improve your heart health.
ANGINA HEART ATTACK
Occurs on effort or excitement. May be relieved by rest or medication.
May occur at rest. Not relieved by rest or medication.
Pain in the chest, neck, jaw or arms brought on by effort or excitement. Sweaty, pale skin. Shortness of breath; difficulty speaking. Anxiety.
Encourage the casualty to rest quietly. Help the casualty loosen tight clothing.
Call ambulance 111 immediately.
If the casualty has medicine they should take it.
Make as comfortable as possible.
AN
GIN
A /
HEA
RT H
EALT
H
43
44
When modifying your lifestyle consideration should firstly be given to stopping smoking, having your blood pressure checked regularly and reducing fat intake in your diet. For a fuller risk assessment, or further advice, see your doctor.H
EART
HEA
LTH
44
Risk Factors 0 1 2 YourScore
CIGARETTESMOKING
Non-smoker 15 or less daily Over 15 daily
BLOOD PRESSURE Low or normal Raised or not known
High
CHOLESTEROL &FAT LEVELS IN BLOOD
4.5 mmol/L 4.6-5.5 mmol/L Over 5.5 mmol/L
WEIGHT Normal Overweight Obese
DIABETES No diabetes Family history of diabetes
Diabetic
EXERCISE Vigorous, on most days
Vigorous, once or twice weekly
Usually inactive
BEHAVIOR TYPE& STRESS
Easy going, contented, rarely tense
Often hurried, anxious, intolerant
Hurried, competitive, aggressive
FAMILY HISTORY No premature heart disease
Heart disease before age 55
AGE Under 40 yrs 40-50 yrs Over 50 yrs
TOTAL POINTS
HOW DID YOU SCORE??
0-2 POINTS Low risk
MODIFYLIFESTYLE
3-5 POINTS Moderate risk
6-9 POINTS Excessive risk
10 OR MORE High risk
HEART HEALTH - RISK GUIDE
45
STROKE A stroke occurs when the blood supply to the brainis impaired by a blood clot or burst blood vessel. Call for medical help immediately. Call ambulance 111 immediately.
SIGNS AND SYMPTOMS - STROKEThe specific symptoms of a stroke will vary depending on the part of the brain affected. Some or all of the following will be present:
Sudden severe headache.
Signs of weakness or paralysis, loss of movement on one side.
Confusion.
Inability to speak or inappropriate words chosen.
Noisy breathing - wheezing / coughing.
The casualty may be conscious but unconsciousness may develop.
STROKECall
ambulance 111
immediately.
STRO
KE
45
46
SPEAK ASIMPLE SENTENCE(slurred? Unable to?)
SPEECH
FACE
SMILE(is one side droopy?)
ARMS
RAISE BOTH ARMS(is one side weak?)
TIME
Lost time could be lost brain, get to hospital
FAST
Think ‘FAST’ IS IT A STROKE?Call ambulance 111immediately if someone can’t:
QUICK RECOGNITION AND RESPONSE MAKES ALL THE DIFFERENCE
Chances of survival and prospects of recovery from a stroke dramatically increase when casualties receive emergency support within three hours of having a stroke.
Therefore, rapid recognition of warning signs and the immediate call of emergency services are crucial.
MANAGE A STROKE Call ambulance 111 immediately.
If conscious lie down with head and shoulder supported by pillows.
If unconscious place in a Stable Side Position (recovery position).
Monitor ABCs, level of consciousness and vital signs.
Rest and Reassure the casualty.
NOTES
STRO
KE
46
47
REDUCE RISK OF STROKEWith 8,000 strokes nationwide each year, the incidence of stroke is increasing. To reduce the risk of stroke and get the most out of life, the following seven steps are recommended for all New Zealanders.
7 STEPS TO REDUCING YOUR RISK OF STROKE
1. Get your blood pressure checked and if necessary treated.
2. Stop smoking if you do.
3. Exercise regularly.
4. Limit the amount of alcohol you drink.
5. Eat a healthy balanced diet, control your weight and reduce your salt intake.
6. Get your cholesterol checked and if necessary treated.
7. Find out if you have Atrial Fibrillation (rapid, irregular contraction of the heart).
STRO
KE
47
48
DIABETIC EMERGENCYIn diabetes the body is unable to control the blood sugar level. This may result in the blood sugar level being too high or too low.
High blood sugar (hyperglycaemia)Hyperglycaemia develops slowly and is unlikely to be a first aid emergency.
Low blood sugar (hypoglycaemia)
SIGNS AND SYMPTOMS - LOW BLOOD SUGAR
Low blood sugar will result in:
Headache, hungry, tired.
Pale appearance.
Cold, sweaty skin.
The ‘shakes’.
Aggression or confusion.
Unconsciousness may develop.
Many diabetics wear MedicAlert® emblem bracelets, necklaces or anklets.
Signs of shock.
MANAGE LOW BLOOD SUGAR
IF CONSCIOUS:
Give sugary food: glucose, jelly beans, honey, sugar, or sugary drink. Improvement should occur within 5 minutes. Rest and Reassure casualty. Monitor ABC’s.
IF UNCONSCIOUS:
Check ABCs. Place in a Stable Side Position (recovery position).
Call ambulance 111 immediately.
DIA
BETI
C EM
ERG
ENCY
48
49
SEIZURES
Seizure could be result of:
Excessive heat. Head injury. Pregnancy. Epilepsy. Cardiac arrest. Other medical conditions.
Epileptic seizures occur as the result of a sudden, brief electrical discharge taking place in the brain. They can take several different forms. The form that is most well known and most frequent is called tonic clonic seizures.
These seizures usually occur in people who have epilepsy, but also occur in young children who have an infection associated with a high temperature.
SIGNS AND SYMPTOMS - EPILEPTIC SEIZURES
In tonic clonic seizures the following pattern is generally seen: The person loses consciousness. The body stiffens briefly. Muscular contractions begin. Muscular contractions cease. Consciousness is regained. The person may feel sleepy or be confused.
During the seizure saliva may appear at the mouth. If the tongue or mouth has been injured the saliva may be bloodstained.
Bladder or bowel control may be lost.
Do not restrain the person, nor
put anything in their mouth.
SEIZ
URE
S
49
50
MANAGE SEIZURES
Make the area safe. Protect the person from harm or injury. Keep bystanders away. Maintain privacy. Check for a MedicAlert® bracelet or necklace. Do not restrain person, or put anything in the mouth. When muscular contractions end, place the person in a stable side
position (recovery position). Ensure the airway is clear. Follow DRSABCD sequence.
Rest and Reassure casualty. Call ambulance 111 immediately if:
– The muscular contractions last longer than 5 minutes or more than one seizure occurs. – Casualty has head injury. – Casualty is pregnant. – If a first seizure. – Other injury has occurred. – If seizure in water.
CONVULSIONS DUE TO EXCESSIVE HEAT
Convulsions in young children often occur due to high temperature during an illness (febrile convulsions) but can occur in adults also.The management aim is to reduce the high temperature:
If unconscious ensure airway is clear and place in a Stable Side Position (recovery position).
Remove excess clothing. Sponge skin with lukewarm water. Seek medical advice as hospitalisation may be required.
SEIZ
URE
S / F
EBRI
LE C
ON
VU
LSIO
NS
50
51
ASTHMAAn asthma attack occurs when the air passages in the lungs become narrowed. Most asthmatics carry medication with them.
SIGNS AND SYMPTOMS - ASTHMA
The casualty may experience:
Difficulty breathing. Wheezing, noisy breathing. Coughing. Difficulty speaking in sentences. Anxiety.
MANAGE ASTHMA
Ask the casualty if they have asthma, and where their medication is. Help the casualty sit up, leaning forward slightly, resting for support on a
table or the back of a chair. Assist them to take their medication, often a blue inhaler.
Use a ‘spacer’ if available. Take one puff of the inhaler, followed by 6 breaths in and out. Repeat if needed.
Rest and Reassure the casualty. If the attack does not respond to medication.
Call ambulance 111 immediately. Monitor ABC’s - Stable side position if collapses.
AST
HM
A
51
52
NOTES
HYPERVENTILATIONHyperventilation, or over-breathing, is when the breathing rate or depth is increased, which can sometimes be triggered by anxiety.
Signs and symptoms include numbness, tingling and spasm of the hands.
MANAGE HYPERVENTILATION
Reassure the casualty. Sit them down and stay with them. Encourage them to breath slowly with deep breaths. Ask the casualty to breath with you, slowly and deeply.
HYP
ERV
ENTI
LATI
ON
52
53
DRS
ABC
D –
MED
ICA
L CO
ND
ITIO
NS
DRS
ABC
DH
eart
Att
ack
Ang
ina
Stro
keD
iabe
tes
(hyp
ogly
caem
ia)
Seiz
ure
Infa
ntile
con
vuls
ion
Ast
hma
DA
NG
ERS
Safe
tySa
fety
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tySa
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tySa
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edia
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e 11
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iate
ly.
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k
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pare
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kCh
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CU
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SPEC
IFIC
CA
RE
Aspi
rinN
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ingu
al sp
ray
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le S
ide
posit
ion
(r
ecov
ery
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ion)
if
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ous
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r /ca
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te if
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rom
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ryCo
ol c
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ltyPo
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n as
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t co
mfo
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r br
eath
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ist
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GEN
ERA
L C
AR
ERe
st a
nd re
assu
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st a
nd re
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st a
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assu
reSt
ay w
ith c
asua
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vere
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MED
ICA
L CO
ND
ITIO
NS
– D
RSA
BCD
53
54
MUSCULOSKELETAL FRACTURESA fracture describes a break or crack in the bone.Different types of fractures can occur:
OPEN FRACTURE
A wound is present at the fracture site. Often bone will come out through the skin.
CLOSED FRACTURE A bone is broken but the skin is not broken. In children, whose bones are more flexible, the bone may not break completely, it may just bend or splinter on one side of the bone.
COMPLICATED FRACTURE The broken bone damages neighbouring organs, nerves or blood vessels, e.g. ribs damage the lung.
INJURIESFR
ACT
URE
S
54
55
SIGNS AND SYMPTOMS - FRACTURES
A fracture may be indicated by:
Pain at the injury site.
Swelling and tenderness.
Deformity of the injured area.
Inability to use the injured area normally, loss of movement.
Bleeding, blood loss, internal or external, resulting in shock, pale appearance.
MANAGE FRACTURES
Use gloves. Call ambulance 111 immediately, except for minor fractures
(e.g. fractured fingers).
Treat bleeding with pressure around the wound if possible. Check every 10 minutes for colour, warmth and swelling.
Apply dressing. Cover bone ends with clean non-fluffy material. Support and stabilise the injured area (pillow / blanket).
Apply sling if arm injury. Do not splint fractures unless ambulance assistance is delayed or you must move the casualty.
Check and treat for shock. Make as comfortable as possible. Keep warm, rest and reassure casualty.
(Fractured nose - see page 63).
Apply pressure to bleedingSupport &
Immobilise the injured area
FRA
CTU
RES
55
56
DISLOCATIONSA dislocation occurs where bones meet at joints.In a dislocation the bones are moved from their normal position. Common sites for dislocations are the shoulder, knee, elbow and fingers.
SIGNS AND SYMPTOMS - DISLOCATIONS
A dislocation may be indicated by:
Severe pain. Deformity of the affected joint. Swelling. Loss of movement.
MANAGE DISLOCATIONS
Stabilise and support the area in its injured position. Apply a cold pack to reduce swelling. Call an ambulance except for minor dislocations
e.g. fingers. Do not try to reposition into original position.
If you are not sure whether a fracture or dislocation has occurred, treat the injury as a fracture.
Do not try to reposition the bones in their original position.
DIS
LOCA
TIO
NS
56
57
SOFT TISSUE INJURIES/BRUISINGThe muscles, ligaments, tendons and skin of the body are collectively known as soft tissue. Soft tissues are able to be stretched slightly, but they can be injured by over-stretching or tearing.
SIGNS AND SYMPTOMS - SOFT TISSUE INJURIES
Soft tissue injuries (sprains and strains) may cause:
Pain. Swelling and bruising. Decreased ability to perform normal
movement. Skin discolouration.
MANAGE SOFT TISSUE INJURIES – R.I.C.E TREATMENT
Stop the activity when injury occurs, sit casualty down. Rest the area for 48 hours. Apply an Ice pack wrapped in a towel, or a cool-pack
for 20 minutes at 3-4 hour intervals. Apply a firm Compression (stretch) bandage to the area
between ice applications. Elevate the area (use pillow or blanket).
REST
ICE
COMPRESSION
ELEVATION
DIAGNOSIS
Ice can burn. Never apply ice directly to the skin;
always wrap the ice in material.
Where available
apply oil to the skin
before applying an
ice pack.
SOFT
TIS
SUE
INJU
RIES
57
58
DRSABCD – FRACTURES AND SOFT TISSUE INJURIES
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders.
RESPONSE Check for response using AVPU.
SEND Send for help, Call ambulance 111 immediately for severe fractures.
AIRWAY Check airway clear.
BREATHING Check for breathing.
CIRCULATION/CPR Treat for shock.
DEFIBRILLATION
SPECIFIC CARE Stabilise fracturesApply “RICE” for sprains and strains.Seek medical advice if:- Injury does not improve in 48 hrs.- Injury does not respond to RICE.
GENERAL CARE Keep casualty warmReassure.
FRA
CTU
RES
/ SO
FT T
ISSU
E IN
JURI
ES –
DRS
ABC
D
58
59
SPINAL INJURIESThe bones of the spine protect the delicate spinal cord which lies within. The spinal cord is the nerve link from the brain to the body. Spinal injuries can damage the spinal cord permanently.
SIGNS AND SYMPTOMS - SPINAL INJURIES Spinal injuries should be suspected when the casualty has:
Fallen from a height. Experienced direct force to the head or neck. Suffered a head injury. Fallen awkwardly. Experienced a deceleration accident, e.g. a head-on motor vehicle accident. Dived into shallow water.
Apart from a careful examination of the history, spinalinjury should also be suspected when the casualty experiences:
Loss of (or abnormal) sensation, e.g. pins and needles in limbs.
Loss of (or abnormal) movement. Pain in the spinal area. Breathing changes, changes in pain.
MANAGE SPINAL INJURIESWhere possible, casualties with suspected spinal injuries should be left in the position they are found in, if conscious. Call ambulance 111 immediately. It may be necessary to move a casualty in the following circumstances:
They are in real and immediate danger. They are unconscious or become unconscious. They require CPR.
Support the head and neck to keep in position.
SPIN
AL
INJU
RIES
59
60
DRSABCD – SPINAL INJURIES
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders.
RESPONSE Check using AVPU.
SEND FOR HELP Send, Shout for help.Call ambulance 111 immediately. Consider AED.
AIRWAY Check airway.
BREATHING Check breathing.
CIRCULATION / CPR Check.
DEFIBRILLATION
SPECIFIC CARE If conscious keep still until ambulance arrives.If unconscious roll on to side supporting head.
GENERAL CARE Reassure, keep warm.
NOTES
Keep the spine in line.
SPIN
AL
INJU
RIES
– D
RSA
BCD
60
61
The brain is a delicate organ which lies in a sac of fluid within the skull for protection. The skull acts as a rigid container, allowing little room for the brain to move or swell.
CONCUSSIONConcussion is ‘brain shake’. It occurs when there is a blow to the head, and is a frequent sporting injury.
SIGNS AND SYMPTOMS - CONCUSSION
Concussion may result in:
Unconsciousness, often only briefly. Memory loss of the events leading to and during the injury. Nausea and vomiting. Dizziness. Headache - thumping or pounding. Blurred vision. Seizures may also occur. (Seizures - see pages 49-50).
MANAGE CONCUSSION
If the casualty is unconscious, roll casualty onto their side supporting their head.
Call ambulance 111 immediately, if you suspect neck or spinal injuries or the casualty does not regain consciousness.
Get assessment by medical personnel.
HEAD INJURIES
Anyone who has had a
head injury should be
assessed by medical personnel.
HEA
D IN
JURI
ES
61
62
BRAIN COMPRESSION
Pressure on the brain can result from bleeding or swelling of the brain.
Among other things this may follow a head injury caused by a skull fracture.
SIGNS AND SYMPTOMS - COMPRESSION
The casualty’s signs and symptoms may show:
Bleeding from the ear or nose may be present.
Deteriorating level of consciousness (becomes unconscious). Noisy slow breathing. Skin may become red, flushed and dry. Pulse may initially be rapid, but then becomes slower.
MANAGE COMPRESSION
Call ambulance 111 immediately. If the casualty is unconscious, roll casualty onto their side supporting
their head. Monitor ABCs and vital signs.
BRA
IN C
OM
PRES
SIO
N
62
63
DRSABCD – HEAD INJURIES
DANGERS Check for hazards, risks.Ensure safety for self, casualty and bystanders.
RESPONSE Check using AVPU.
SEND FOR HELP Send, Shout for help.Call ambulance 111 immediately.
AIRWAY Check airway.
BREATHING Check breathing.
CIRCULATION/CPR Treat bleeding.
DEFIBRILLATION
SPECIFIC CARE If condition deteriorates, call ambulance 111 immediately.Consider spinal injury.Medical assessment is required for a casualty that has been unconscious.
GENERAL CARE Rest, reassure, keep warm.
FRACTURED NOSEIf you believe the casualty has a fractured nose they need to be referred to medical help.
The following need to be considered:
The airway may be obstructed.
Control of bleeding.
The casualty may suffer concussion.
If the casualty is conscious encourage them to tilt the head forwards and breath through the mouth.
HEA
D IN
JURI
ES –
DRS
ABC
D –
FRA
CTU
RED
NO
SE
63
64
STABLE SIDE POSITION FOR SUSPECTED SPINAL INJURY - LOG ROLLIf spinal injury is suspected roll the casualty onto their side, supporting their head and using a Log roll.
One person – (Stable Side Position)
Two person – (Stable Side Position)
Log Roll – (Stable Side Position)
1.
2.
3.
Spinal injury using a Log Roll for Stable Side Position.
STA
BLE
SID
E PO
SITI
ON
– S
PIN
AL
INJU
RY
64
65
AMPUTATIONSIf a body part has been amputated always call an ambulance and tell them that an amputation has occurred.
Manage bleeding using pressure and elevation.
Care for the amputated body part in the following way:
2.
DO NOTWASH
1. Do not wash or clean the amputated part.
Carefully place the part into a plastic bag and seal it with air around it to protect it.
3.
Place inside a second bag or container with water and ice cubes.
4.
Label the bag with the casualty’s name and the date and time of the accident. Send with casualty to the hospital.
AM
PUTA
TIO
NS
65
66
CHEST INJURIESChest injuries may be caused by blunt or penetrating objects. Any injury that damages the chest wall will have a direct effect on the casualty’s ability to breath.
MANAGE CHEST INJURY
Cover any sucking chest wounds. Preferably use a plastic sided dressing, taped down on three sides.
If conscious, incline the casualty towards the injured side. If unconscious turn the casualty onto the injured side.
Abdominal injuries
ABDOMINAL INJURIESAbdominal injuries may be caused by a blunt or penetrating instrument, both of which may result in severe or fatal internal bleeding.
MANAGE ABDOMINAL INJURY
Cover any wounds with a dressing. Preferably use clear plastic food wrap or a clean supermarket bag.
Lie the casualty down. Bend the knees if there is a large cross-wise wound.
Do not touch or try to replace any internal organs that are showing, but cover with clear plastic food wrap or a wet dressing.
CHES
T / A
BDO
MIN
AL
INJU
RIES
66
67
Crush injuries
CRUSH INJURIESWhen a casualty has been trapped under a heavy object for a long period, toxic substances build up in the muscles which can cause further complications. A casualty with a crush injury may not complain of pain, and there may be no external signs of injury. All casualties who have been subjected to crush injury should be taken to hospital for immediate treatment.
MANAGE CRUSH INJURY
Call ambulance 111 immediately.
If it is safe and physically possible, all crushing forces should be removed from the casualty as soon as possible, irrespective of how long they have been trapped.
Keep the casualty warm, treat any bleeding.
Continue to monitor the casualty’s condition. If the casualty becomes unresponsive and is not breathing normally, follow DRSABCD.
Treat other injuries.
CRU
SH IN
JURI
ES
67
68
NOSE BLEEDS
Sit the casualty down, leaning forward.
Advise them to pinch the nose firmly just below the bony part, which will help to stop the bleeding and still allows the casualty to breathe.
Maintain pinch pressure for 10 minutes.
Release pressure after 10 minutes. If bleeding is not controlled reapply pressure for a further 10 minutes.
An ice pack applied to the nose area may be useful.
When bleeding has stopped don’t blow the nose for 4 hours.
If bleeding continues for more than 30 minutes, seek medical assistance. (Fractured Nose - see pages 61-63).
EAR INJURIESWounds to the outer ear may bleed profusely. Foreign objects or insects may enter the ear. General management principles:
Do not try and remove any object that is wedged in the ear canal, get professional help.
Never use any sharp object to remove any foreign body from the ear as this can cause further injury.
If bleeding or yellowish fluid is leaking from the ear, consider head injury. Lay person on their side so the affected ear drains onto a dressing.
If ear ache or ear pain, keep ear warm. Do not administer drops or probe. Seek medical attention.
NO
SE B
LEED
S - E
AR
INJU
RIES
68
69
KNOCKED OUT PERMANENT TEETH
Pick the tooth up by the crown, not the root. If a tooth is dirty, rinse in milk. DO NOT use soap
or chemicals, scrub the tooth, or let it dry out.
It is important to keep the tooth root moist and alive. Place in milk, or saline solution if available. If not available, wrap tooth in cling film or plastic wrap. Otherwise, place the tooth under bottom lip of the casualty.
DO NOT store the tooth in water. DO NOT wrap it in tissue paper or a cloth.
Time is critical. See a dentist as soon as possible, ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.
NOTES
KN
OCK
ED O
UT
TEET
H
69
70
EYE INJURIESThe eye is a delicate object which can become badlydamaged by foreign bodies and chemicals. Wear eye protection whenever there is a risk of eye injury.
SIGNS AND SYMPTOMS - EYE INJURIES
Depending on the seriousness of the injury and the objectcausing injury some or all of the following may be present:
Watering of the eye. Redness of the eye. Pain. Excessive blinking. Loss of vision. Blood or clear fluid leaking from inside the eye. Flattening of the normal round eye shape.
EYE
INJU
RIES
70
71
MANAGE EYE INJURIES Never attempt to remove a foreign body that is embedded in any part of the eye, or located over the coloured part of the eye (iris) or pupil. In either of these cases, stabilise any object, cover only the affected eye with pads and seek hospital treatment.If the object is on the white part of the eye, moving as the casualty blinks, it can be removed.
WHEN CHEMICALS HAVE ENTERED THE EYE:
Call an ambulance. Gently separate the eyelids to open the eye. Ask person to remove contact lenses if possible. Flush eye with a gentle stream of water until help arrives.
Flush corrosive chemicals for up to 1 hour until symptoms gone.
Always obtain a medical assessment to check for damage.
Always seek
medicaladvice
EYE
INJU
RIES
71
Rinse it out with water Lift it out using a cornerof material.
NOTESN
OTE
S
72
IDENTIFY AND ASSESS BURNS AND SCALDS
To decide how serious a burn is, look at the following:
Size. Cause. Age of casualty. Location. Depth. Burns to the head, neck,
eyes, hands, feet, over a joint or genital area should always be seen by medical personnel.
Burns in children under 5 years of age and the elderly should always be seen by medical personnel.
A burn larger than the size of the casualty’s palm should be seen by medical personnel.
Where smoke or fumes have been inhaled the casualty’s airways may be injured; an ambulance is required immediately.
Chemical and electrical burns require ambulance assistance. Electrical burns may not look big, but the underlying tissue is often
damaged and heart rhythms affected. The wounds may not be easily seen. Check for ‘entry’ and ‘exit’ wounds and dress.
Flash burn - treat as any other burn. Chemical burn - ensure personal safety when dealing with chemical/
corrosive materials. Wear personal protective equipment. Read chemical container or MSDS (material safety data sheet) for
emergency care instructions.
Cool (tepid) running
water is the best initial
first aid for burns and
scalds
BURNS & SCALDS Burns are generally caused by heat, but chemicals, electricity, and even extremely cold substances such as ice, can also cause burns. In serious burns there may be no pain because nerve endings have been damaged.
BURN
S &
SCA
LDS
73
74
(Ref:ANZBA)
MANAGE BURNS AND SCALDS Cool the burned area with cool (tepid) running water 8-15
degrees C for at least 20 minutes, for chemical burns up to an hour (or more if container says). Keep the casualty warm whilst cooling the burn.
Clear the area of anything that may keep burning: jewellery, clothing that isn’t sticking (cut around stuck clothing). In chemical burns it is important to remove clothing contaminated with chemicals.
Cover the burned area with clean, non-fluffy material. Cling film is ideal.
In serious burns, shock will be present. Call ambulance 111 immediately for all serious and electrical burns.
Monitor responsiveness and treat shock.
SIGNS AND SYMPTOMS - BURNS
Hot to touch. Severe pain if superficial (deep burns may not give pain). Red, peeling, blistering, charring or discolouring of skin. Watery fluid weeping from area. Swelling of area. Signs and symptoms of shock.
COOL
CLEAR
COVER
BURN
S &
SCA
LDS
74
75
DRSABCD – BURNS & SCALDS
DANGERS Check for hazards, risks. Ensure safety from burning material, hot liquids or steam, chemicals, electricity, smoke, sun etc, for self, casualty and bystanders. Wear gloves.
RESPONSE Check for response using AVPU.
SEND Send, Shout for help. If serious, call ambulance 111 immediately. Consider AED.
AIRWAY Check airway, consider damage to nose and mouth.
BREATHING Check for breathing.
Ensure fresh air.
CIRCULATION / CPR
DEFIBRILLATION
Treat for shock.
Treat wounds.
Consider AED for serious burns.
SPECIFIC CARE Cool heat burns for 20 mins minimum.
Flush chemicals for up to 1 hour (until all symptoms have gone).
Clear area (take off jewellery, clothing that is not sticking).
Cover with clean, non-fluffy dressing - cling wrap is ideal.
GENERAL CARE Keep casualty warm and protect from cold. Reassure.
Seek medical advice for small burns.
Call ambulance 111 immediately for all serious burns. eg:- burn area longer than hand - deep burns - all electrical burns
BURN
S &
SCA
LDS
– D
RSA
BCD
75
WHAT?
WHEN?
HOW MUCH?
POISONS A poison is a substance that causes harm when it enters the body. Poisons can enter the body through the skin by absorption or injection, the lungs or through the mouth.
SIGNS AND SYMPTOMS - POISONING
The signs and symptoms of poisoning will vary according to the type of poison and how the poison has entered the body.
LOOK FOR:
Vomiting. Burned lips and mouth. Skin rash or swelling. Breathing difficulties. Altered level of consciousness. Seizures.
Find out what, when and how much poison has been taken. Always save any remaining poison, poison container or vomit for medical personnel to check.
DO NOT make the casualty vomit, unless instructed to by medical personnel.
Urgent advice always phone 111.Non-urgent advice phone 0800 POISON or0800 764 766.
POIS
ON
S
76
MANAGE POISONING
Remove the casualty from the poison or the poison from the casualty. Ensure your own personal safety.
If life threatening, call ambulance 111 immediately. (e.g. bleeding, unconsciousness, breathing difficulties).
If not in immediate danger, call 0800 POISON for advice from Poisons Centre. Administer treatment advice.
If the casualty has burns around the mouth, use mouth to nose technique if resuscitation is required.
If the poison has entered through the lungs or been swallowed, keep your head clear of the casualty when they exhale, during rescue breathing. If the casualty is in a confined space ventilate the area well before approaching.
Check the poison container for type of poison and any instructions on managing poisoning. Keep for medical personnel.
DO NOT give casualty water or milk unless a corrosive agent (such as acid or alkaline) has been taken and unless instructed by a Poisons Centre Advisor.
DO NOT induce vomiting.
THE NATIONAL
POISONS
CENTRE, phone
0800 764 766 or
0800 POISON
(24 hours),
or for general
information
their website is
www.toxinz.com
(Poisons Centre
database).
POIS
ON
S
77
78
Inha
led
Inge
sted
Abs
orbe
dIn
ject
ed
DA
NG
ERS
Ensu
re s
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ety
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ety
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U
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OR
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108
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OIS
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ider
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ISO
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SPEC
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Rem
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AR
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POIS
ON
S –
DRS
ABC
D
78
79
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NG
ERS
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GEN
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L C
AR
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assu
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assu
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assu
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assu
re
STINGS Get away from the bees / wasps. Scrape off the bee sting, or remove as soon as possible, using a
ruler or piece of paper to limit venom injection. Do not pull out. Wash the area well. Rest and reassure the casualty. Apply ice pack / cold compress to site for swelling and pain relief. Monitor ABCs and give CPR as necessary. If allergic, call ambulance 111 immediately.
Any stings to the eye, mouth, throat, face, neck, or genitalia should be medically assessed.
NOTES
STIN
GS
79
SEVERE ALLERGIC REACTION(ANAPHYLAXIS)Anaphylactic shock is a severe allergic reaction to a substance that affects the whole body. It is a medical emergency and can occur within minutes. Common allergies are to insect stings, drugs and foods. Call ambulance 111 immediately.
SIGNS AND SYMPTOMS - ALLERGIC REACTION
Generally the more rapid the onset of symptoms after exposure to the allergen, the more serious the reaction will be.
Severe allergic reaction may result in:
Difficulty breathing and wheezing. Swelling of the neck and face eg. lips, face, eyes. Tingling feeling around mouth. Rash, hives or welts. Nausea and vomiting, abdominal pain. Sudden collapse. Medication may be carried. A MedicAlert® bracelet or necklace may be worn. Signs of shock.
ALLERGIC REACTIONS AFFECT
The skin (rash, hives). The respiratory system
(short of breath). The gastrointestinal
system (vomiting, diarrhoea, abdominal pain).
The cardio vascular system (rapid pulse, swelling, possible cardiac arrest).
Call an ambulance and the nearest doctor
AIRWAYS
BREATHING
CIRCULATION
SEV
ERE
ALL
ERG
IC R
EACT
ION
80
MANAGE SEVERE ALLERGIC REACTION
Seek help immediately.
Monitor ABCs and vital signs. Call ambulance 111 immediately, and the nearest doctor. If unconscious place in a Stable Side Position (recovery position). Assist with administration of medication. This medication is carried by many
people who know they are likely to have a severe allergic reaction. Apply ice packs to swelling.
DRSABCD – SEVERE ALLERGIC REACTION (ANAPHYLAXIS)
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders.
RESPONSE Check using AVPU.
SEND Send / shout for help. Bystanders to call ambulance 111 immediately. Consider AED.
AIRWAY Check.
BREATHING If breathing difficult consider sitting up.
CIRCULATION / CPR
DEFIBRILLATION
If shocked treat for shock.
Use AED if needed.
SPECIFIC CARE Assist casualty with their medication.
GENERAL CARE Reassure, keep warm.
www.allergy.org.nz
ANAPHYLAXIS ACTION PLANPeople and children with known allergies have often got a full Anaphylaxis Action Plan. The plan outlines actions to be taken in case of exposure to the allergy for those who are at risk. Follow this plan when child shows signs and symptoms or has been exposed to the allergy.
SEV
ERE
ALL
ERG
IC R
EACT
ION
– D
RSA
BCD
81
82
ENVIRONMENTAL CONDITIONSThe human body works best at a core body temperature of about 37 C̊. The outer parts can get much colder and still function effectively. If the core body area containing vital organs lies outside this temperature it ceases to function effectively.
HEAT EXHAUSTIONHeat exhaustion occurs due to excessive loss of body fluid and body salts.
SIGNS AND SYMPTOMS - HEAT EXHAUSTION
Heat exhaustion is seen as:
Pale, sweaty skin.
Headache.
Dizziness.
Rapid, weak pulse.
Rapid breathing.
Feeling sick.
Muscle cramps.
Body temperature normal or near normal.
Tired and restless.
MANAGE HEAT EXHAUSTION
If unconscious monitor ABCs, place in a Stable Side Position (recovery position). Call ambulance 111 immediately.
Rest in a cool place, lying down. Remove excess clothing. If conscious give plenty of cool plain water to sip.
HEA
T EX
HA
UST
ION
82
83
HEAT STROKEHeat stroke (or sun stroke) occurs when the temperature-regulating centre in the brain overheats and fails.
SIGNS AND SYMPTOMS - HEAT STROKE
Headache.
Hot, flushed, dry skin.
Full and bounding pulse.
Falling level of consciousness.
Unconsciousness may develop.
Body temperature above normal.
Seizures and blurred vision.
MANAGE HEAT STROKE
Call ambulance 111 immediately.
Rest in a cool place in a Stable Side Position (recovery position) if unconscious.
Cool the person by spraying with water or use ice packs.
Keep cooling, use a fan.
HEAT STROKECall 111 for
an ambulance as soon as
possible.
HEA
T ST
ROK
E
83
84
DRSABCD – HYPERTHERMIA
DANGERS Check for hazards, risks. Ensure safety for self, casualty and bystanders.
RESPONSE Check using AVPU.
SEND FOR HELP Send / shout for help. Bystanders to call ambulance 111 immediately. Consider AED.
AIRWAY Check.
BREATHING Check.
CIRCULATION/CPR
DEFIBRILLATION
Treat for shock.
Use AED if needed.
SPECIFIC CARE Move to cool environment.Remove excess clothing.Cool sips of water.For Heat Stroke spray with water or use ice packs.Stable side position.
GENERAL CARE Reassure, monitor temperature.
HEA
T ST
ROK
E / H
YPER
THER
MIA
– D
RSA
BCD
84
85
HYPOTHERMIAHypothermia occurs if the core body temperature falls below 35 C̊. Hypothermia most often occurs outdoors, where wet, cold and wind combine to create a cooling effect. It can also occur in poorly heated homes, and is more likely to affect the elderly and infants.
SIGNS AND SYMPTOMS - HYPOTHERMIA
Early warning signs of hypothermia are:
Feeling cold, numbness and shivering (fumbles). Tiredness, slurred speech (mumbles). Loss of coordination, stumbling, clumsiness (stumbles). Changes in behaviour such as anxiety, apathy, irritability,
irrational behaviour (grumbles).
Later signs indicating a serious condition are:
Shivering stops. Unconsciousness.
Normal body temperature
Unconsciousness
Intense shivering
If hypothermia is not treated death will occur
Irritability /irrational behaviour
HYP
OTH
ERM
IA
85
MANAGE HYPOTHERMIA
Management of hypothermia focuses on preventing furtherheat loss and gentle rewarming.
Stop and seek shelter. Remove wet clothes, and replace with dry warm clothes. Put on a woollen hat. Give warm sweet drinks if conscious. Keep the casualty lying down. Rewarm by placing the casualty in a (preferably) pre-warmed
sleeping bag or blankets, and provide warmth. If the casualty is unconscious place them in the
Stable Side Position (recovery position).
DRSABCD – HYPOTHERMIADANGERS Check for hazards, risks. Ensure safety for self,
casualty and bystanders.
RESPONSE Check using AVPU.
SEND FOR HELP Send / shout for help. Consider calling ambulance 111. Consider AED.
AIRWAY Check.
BREATHING Check.
CIRCULATION/CPR Check.
DEFIBRILLATION Use AED if needed.
SPECIFIC CARE Move to shelter and warmth.Remove wet clothing.Cover, insulate including head.
GENERAL CARE Reassure, keep warm.
ACT QUICKLY
ACT EARLY
Hypothermia
can progress
quickly with as
little as 30
minutes between
the initial
symptoms and
unconsciousness
HYP
OTH
ERM
IA –
DRS
ABC
D
86
87
CASUALTY REPORTINGWhile you wait for emergency services to arrive, write down the following information about the casualty:
Casualty’s name, address and contact number. Age: this is important, especially if the casualty is a young child
or elderly person. Gender. What happened, when and how it happened,
past medical history, medications, allergies etc. Injuries. Observations, vital signs. Treatment given.
HANDWASHING & HYGIENE Hand Hygiene with Soap and Water
1. Remove jewellery. Wet hands with warm water.
2. Add soap to palms. 3. Rub hands together to create a lather.
4. Cover all surfaces of the hands and fingers.
5. Clean knuckles, back of hands and fingers.
6. Clean the space between the thumb and index finger.
7. Work the finger tips into the palms to clean under the nails.
8. Rinse well under warm running water.
9. Dry with a single-use towel and then use towel to turn off the tap.
Minimum wash time 10-20 seconds.
Good hand washing is
your first line of defence
against the spread of infection.
OTHER USEFUL INFORMATION
CASU
ALT
Y RE
PORT
ING
/ H
AN
DW
ASH
ING
87
88
APPLYING SLINGS
ARM SLING
ELEVATION SLING
REEF KNOT
APP
LYIN
G S
LIN
GS
88
89
NZ RED CROSS FIRST AID KITSArm yourself for a potential emergency with an officialRed Cross First Aid Kit. These kits are durable, showerproof, light and are suitable for all purposes.
For First Aid Kits and Refills
Call 0800 REDCROSS
(0800 733 276)
All NZ Red Cross First Aid kits
meet the Department of
Labour 2011 First Aid for
workplaces – a good practice
guide.
FIRS
T A
ID K
ITS
89
Compact portable First Aid kitOrder Code - 4409 A
Large portable First Aid kitOrder Code - 35352 A
AED Ready kitFor use with automated external defibrillatorsOrder Code - 36341
2 litre First Aid kit(235mm L x 175mm W x 80m D)Order Code - 35418 A
5 litre First Aid kit(265mm L x 240mm W x 120m D)Order Code - 35417 A
7 litre First Aid kit(350mm L x 235mm W x 120m D)Order Code - 35416 A
Refills available for all kits
Available from all New Zealand Red Cross locationsor purchase online at www.redcross.org.nz
90
ESSENTIAL EMERGENCYMANAGEMENT HANDBOOKPLANS FOR A DISASTER START HERE!
New Zealand is vulnerable to floods, earthquakes, storms and other emergencies. Disaster can strike any community at any time, and the results can be devastating. However, there are steps you can take to prepare for and manage the effects of a disaster in your home. The Essential Emergency Management Handbook clearly explains the steps, skills and supplies that will prepare you and increase your ability to copewith a disaster. Call 0800 REDCROSS (0800 733 276) to find out more. To follow are some helpful hints to startoff your preparations for a disaster.
FURTHER INFORMATION Everyone should be prepared for disasters. You may be required to look after yourself & your family for 3 or more days. For more information on how to prepare for a disaster, check out the following website:
www.getthru.govt.nz
STOPTHINKACT
ESSE
NTI
AL
EMER
GEN
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AN
AG
EMEN
T H
AN
DBO
OK
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HO
USE
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LD E
MER
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LAN
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HOUSEHOLD EMERGENCY PLANFor general preparedness, every household should create and practice a Household Emergency Plan and assemble and maintain Emergency Survival Items and a Getaway Kit.
For everything you need to get ready, go to:www.getthru.govt.nz
CORE ACTION MESSAGES
Keep listening to local radio or television stations. If authorities tell you to evacuate immediately, take your Getaway Kit and go. If you have more time, prepare your home and critical buildings. Prepare to be self-sufficient for at least three days. Stay put until authorities say you can leave. Follow your plan. Stay alert to hazards. Do not use candles.
HOUSEHOLD EMERGENCY PLANCopy from your plan to keep a record with this manual.
YOUR HOUSEHOLD PHONE NUMBERS
Name:
Name:
Name:
Name:
Name:
Name:
Address:
Download the Household Emergency Plan Template from:www.getthru.govt.nz
92
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USE
HO
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1. If we can’t get home or contact each other we will meet or leave a message at:
Name:
Contact Details:
Name (back-up)
Contact Details:
Name (out of town):
Contact Details:
2. The person responsible for collecting the children from school is:
3. Emergency Survival Items and Getaway Kit. Person responsible for checking water and food:
Name:
Contact Details:
Name:
Items will be checked and replenished on:
Date: (check and replenish at least once a year)
The Getaway Kits are stored in the:
4. The radio station (inc AM/FM frequency) we will tune in to for local civil defence information during an emergency:
5. Friends / neighbours who may need our help or can help us:
Name:
Address:
Phone:
Name:
Address:
Phone:
93
USE
FUL
NU
MBE
RS
93
CONTACT DETAILS
Local authority emergency helpline.
Insurance company 24 hour.
Insurance number and policy number.
Local radio station (Frequency ).
School.
Family and neighbours.
Bank phone number and details.
Work phone numbers.
Medical Centre / GP.
Local police station.
Vet / kennel / cattery.
Local hotel or B&B.
Gas supplier and meter number.
Electricity supplier and meter number.
Electrician.
Plumber.
Builder.
USEFUL NUMBERSYour important emergency household plan telephone numbers. Fill this out:
94
Accident Registers – All accidents should be recorded in the workplace accident register, including non-injury accidents.
Investigating Accidents – Internal investigation of accidents should occur whenever an accident is recorded in the accident register and should focus on further management to minimise, eliminate or isolate the hazards. Accidents which cause serious harm to a person, may be investigated by Worksafe New Zealand. Accident scenes must not be disturbed except to the extent necessary to:
Provide first aid or save life.
Maintain public access to essential services.
Prevent serious property damage or loss.
Notifying Accidents – Accidents, which cause serious harm, must be notified to Worksafe New Zealand as soon as possible.
First aiders should consult the Health and Safety in Employment Act (1992) for more specific information.
First Aid for workplaces – a good practice guide The Department of Labour 2011 publication – First Aid for workplaces – a good practice guide provides information on good practice to be followed in defined circumstances by those responsible for First Aid in the workplace, including a First Aid Needs Assessment.
First Aiders: Complete accident documentation and administration. Restock supplies. Ensure all equipment is returned to operational readiness. Report all accidents to management as required. Know and help implement the 2011 “good practice guide”.
Full detail available on the Worksafe New Zealand website:www.business.govt.nz/worksafe
Obtain your copy of First Aid for workplaces – a good practice guide, from Department of Labour.business.govt.nz/worksafe
WO
RKPL
ACE
ACC
IDEN
TS –
FIR
ST A
ID
94
WORKPLACE ACCIDENTS - FIRST AID
95
F
Dial (call) 111 3Disaster preparedness tips 91-92Dislocations 56 Drowning 22DRSABCD 4,5- Bleeding 34- Burns and scalds 73-75- Fractures / soft tissue injuries 58- Head injuries 63- Heat stroke / hyperthermia 84- Hypothermia 86- Medical conditions 53- Poisons 78- Severe allergic reaction 81- Spinal injuries 60DRSABCD 12-14- Choking - Adult / Child 25-28- Choking - Baby 30,31- Resuscitation Adult 17- Resuscitation Child 21- Wallet card 12,13
Ear injuries or earache 68 Elevation sling 88Emergency care action plan 2Emergency care aims 2Emergency care steps 3Environmental conditions 82-86 Epilepsy 49-50Essential emergency management handbook 90External bleeding 32-34Eye injuries 70-71- chemicals in eye 70-71
Fainting 37Febrile convulsions 50Finger sweep 26,29,31First Aid kits 89Flu pandemic 93Foreign bodies in wounds 32-34Foreign body in the - eye 70-71- ear 68Fractures 54,55,58- nose 63
A
B
C
Abdominal injuries 66AED’s / Defibrillation 9,14,18Airway 2,4,8,12,14,23,27Allergic reaction (severe) 3,79,80,81Amputations 65Anaphylactic reaction 80,81Anaphylaxis action plan 81 Angina 43Arm sling 88Asthma 51AVPU (Levels of Consciousness) 7,40
Back blows / Chest thrusts 24,28,29,30Bandages 34,88Basic Life Support Flowchart 14Bee / wasp stings 79,80Bleeding 2,3,4,9,32-34Body – check for injuries 38,41Brain compression 62 Breathing 2,3,4,8,12-15Breathing difficulties 3,9 Bruising 57Burns and Scalds 73-75
Cardiac arrest - - Resuscitation 15-18 42,49,80Casualty reporting 87Chain of survival 15Check for injuries 38,41Chemical burns 73Chest compressions 12-14,16Chest pain 3,42-44Chest thrusts 24-26,28-29 Chest injuries 66Choking 23- adults 24-27- children 26-31Circulation 2,4,9,53Concussion 61,63Convulsions 50 CPR 2,4,9,12-16,20-22 CPR action checklist child / infant 20Crush injuries 67 Dangers 2-6Defibrillation, (AEDs) 2,5,9,15-18,21Diabetic emergency 48
D
E
IND
EX
INDEX A-H
95
96
INDEX H-ZHand washing 87Head injuries 10,49,59,61-64Healthline 93Heart attack 42Heart health 43-44Heat exhaustion 82Heat stroke 83History 38-39,87Household emergency plan 91-93Hypothermia 85-86Hyperventilation 52Hypoglycaemia / diabetes 48
Injuries 54-72
Knocked out teeth 69
Level of Consciousness 7,10,40Log roll 64Low blood sugar 10,48
MedicAlert® 3,41Medical conditions 42-60Medical conditions DRSABCD 53
Nose bleeds 68 Nose fracture 63
Obstructed airway cycle- adult / child 24-29- child under 1 year 29-30,31
Poisons 76-78 Primary Assessment DRSABCD 2,4-5Pandemic planning 93
R.I.C.E. 57,58Recovery (Stable Side) Position 8,10,11,64Reef knot 88 Response (AVPU) 2,5,7,11,40Resuscitation 12,13-21 - adults 13-17- children & infants 13,19-21Risk factors for the heart 43-44
L
M
K
N
O
P
Scalds 73-75Secondary Assessment 7,10,38-40- check for other conditions or injuriesSeizures 49-50Severe allergic reaction 80-81Shock 3,4,9, 32-33,36Slings 88 Soft tissue injuries 57,58 Spinal injuries 59,60Stings, bee / wasp 79,80Strains and sprains 57,58 Stroke 3,10,45-47
Teeth 69Triangular bandages 88Training courses Back Cover Unconsciousness 7,10,36,42,45,48,61
Vital signs (response + breathing) 4,36,38,39,42,46,81,87
Wallet card - DRSABCD 12 - Resuscitation 13
When to call 111 3Workplace Accidents - Employer responsibilities 94- First Aid responsibilities 94- Good Practice Guide 94Wounds 32-34Wounds - minor 33
Glossary 97-98
S
T
UV
R
W
HIN
DEX
I
96
97
GLOSSARYAED - Automated External Defibrillator.
ALLERGIC REACTION - having an abnormal immune system response to a substance (eg a food) that does not normally cause a reaction.
AMPUTATION - the complete loss of a part of the body, usually due to an accidental injury.
ANAPHYLAXIS - a severe allergic reaction.
ANGINA - chest pain due to an inadequate supply of oxygen to the heart muscle.
ARTERY - a blood vessel that takes blood away from the heart and into the body.
ASTHMA - a reversible obstruction of the airways in the lungs.
BRAIN COMPRESSION - pressure on the brain and surrounding structures, often due to a head injury or bleed inside the head.
BRUISE - a closed wound caused by blunt force.
CARDIAC ARREST - when the heart stops beating or is unable to produce an output of blood.
CHOKING - a difficulty breathing, or a complete inability to breathe, caused by an item blocking the airway.
CHOLESTEROL - a fat in the blood which has been associated with a higher risk of heart disease and stroke.
CONSCIOUSNESS - the state of being aware of and responsive to one’s surroundings.
CONVULSION - an abnormal, involuntary contraction of the muscles typically seen with certain seizure disorders.
CPR - Cardiopulmonary Resuscitation - an attempt to bring life back to a person in cardiac arrest, using rescue breathing and chest compressions.
CRUSH INJURY - compression of a body part, often a limb, causing loss of blood flow and resulting in tissue damage.
DEFIBRILLATOR - A device that corrects abnormal heart rhythms by delivering electrical shocks to the Heart.
DIABETES - the inability to properly control one’s blood sugar level, leading to abnormally high sugar levels.
DISLOCATION - bone or bones moving out of position from a joint.
DROWNING - breathing impairment due to immersion in water (or other liquid).
DRSABCD - a primary response system that guides rescuers to appropriately manage injuries and medical conditions in order of priority until advanced care arrives.
EPILEPSY - a pattern of repeated seizures is referred to as epilepsy.
GLO
SSA
RY
97
98
FAINTING - temporary loss of consciousness due to inadequate blood to the brain.
FEBRILE - having a higher than normal body temperature.
FIT - an abnormal and uncontrolled electrical activity in the brain (same meaning as seizure).
FLU - a viral infection of the body causing fever, cough, muscle aches and tiredness (same as influenza).
FRACTURE - a broken bone.
HEAT EXHAUSTION - tiredness, dehydration and overheating.
HEAT STROKE (Sun Stroke) - a core body temperature that rises above 40 C accompanied by loss of consciousness and dehydration.
HEART ATTACK - the damage caused to the heart muscle when an artery in the heart blocks.
HYPERGLYCEMIA - high blood sugar.
HYPERVENTILATION - over-breathing.
HYPOGLYCEMIA - low blood sugar.
HYPOTHERMIA - a core body temperature of less than 35 C.
POISON - a substance which is harmful to the body.
RESUSCITATION - the process of attempting to restore life to someone in cardiac arrest.
SEIZURE - an abnormal and uncontrolled electrical activity in the brain (same meaning as fit).
SHOCK - lack of oxygenated blood to the body organs.
SOFT TISSUE - skin, muscles, tendons and ligaments.
SPINAL INJURY - an injury to the bones of the spine, the spinal cord or spinal nerves.
STING - entry of a toxin from an animal or plant into the body.
STROKE - loss of blood supply to the brain caused by either a blockage or a rupture of an artery.
UNCONSCIOUSNESS - a state in which there is loss of awareness and responsiveness to one’s surroundings.
VEIN - a blood vessel that brings blood from the body back into the heart.
GLOSSARYG
LOSS
ARY
98
99
NOTES
NO
TES
99
100
NOTES
100
NO
TES