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First aid

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This article is about the provision of immediate care. For the Transformers character, see

First Aid (Transformers).Wikibooks has a book on the topic of

First Aid

First Aid symbol

First aid is the provision of initial care for an illness orinjury. It is usually performed by a

lay person to a sick or injured casualtyuntil definitive medical treatment can be accessed.

Certain self-limiting illnesses or minor injuries may not require further medical care past the

first aid intervention. It generally consists of a series of simple and, in some cases,

potentially life-saving techniques that an individual can be trained to perform with minimal

equipment.

While first aid can also be performed on animals, the term generally refers to care of human

patients.

[edit] History

The instances of recorded first aid were provided by religious knights, such as the Knights

Hospitaller, formed in the 11th century, providing care to pilgrims and knights, and training

other knights in how to treat common battlefield injuries.[1] The practice of first aid fell

largely in to disuse during the High Middle Ages, and organized societies were not seen

again until in 1859 Henry Dunant organized local villagers to help victims of the Battle of

Solferino, including the provision of first aid. Four years later, four nations met inGeneva

and formed the organization which has grown into the Red Cross, with a key stated aim of

"aid to sick and wounded soldiers in the field".[1] This was followed by the formation ofSt.
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John Ambulancein 1877, based on the principles of the Knights Hospitaller, to teach first

aid, and numerous other organization joined them, with the term first aid first coined in

1878 as civilian ambulance services spread as a combination of 'first treatment' and 'national

aid'[1] in large railway centres and mining districts as well as with police forces. First aid

training began to spread through the empire through organisations such as St John, often

starting, as in the UK, with high risk activities such as ports and railways.[2]

Many developments in first aid and many other medical techniques have been driven by

wars, such as in the case of the American Civil War, which prompted Clara Barton to

organize the American Red Cross.[3]Today, there are several groups that promote first aid,

such as the military and the Scouting movement. New techniques and equipment have

helped make todays first aid simple and effective.

[edit] Aims

The key aims of first aid can be summarised in three key points:[4]

Preserve life - the overriding aim of all medical care, including first aid, is to save

lives

Prevent further harm - also sometimes called prevent the condition fromworsening, this covers both external factors, such as moving a patient away from

any cause of harm, and applying first aid techniques to prevent worsening of the

condition, such as applying pressure to stop a bleed becoming dangerous.

Promote recovery - first aid also involves trying to start the recovery process from

the illness or injury, and in some cases might involve completing a treatment, such

as in the case of applying a plaster to a small wound.

First aid training also involves the prevention of initial injury and responder safety, and the

treatment phases.

[edit] Key skills

In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend thehead and pull up the chin, so that the tongue lifts and clears the airway.
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Certain skills are considered essential to the provision of first aid and are taught

ubiquitously. Particularly, the "ABC"s of first aid, which focus on critical life-saving

intervention, must be rendered before treatment of less serious injuries. ABC stands for

Airway,Breathing, and Circulation. The same mnemonic is used by allemergency healthprofessionals. Attention must first be brought to the airway to ensure it is clear. Obstruction

(choking) is a life-threatening emergency. Following evaluation of the airway, a first aid

attendant would determine adequacy ofbreathing and provide rescue breathing if necessary.

Assessment ofcirculationis now not usually carried out for patients who are not breathing,

with first aiders now trained to go straight to chest compressions (and thus providing

artificial circulation) butpulse checks may be done on less serious patients.

Some organizations add a fourth step of "D" forDeadly bleedingorDefibrillation, while

others consider this as part of the Circulation step. Variations on techniques to evaluate andmaintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured,

first aiders can begin additional treatments, as required. Some organizations teach the same

order of priority using the "3Bs":Breathing,Bleeding, andBones (or "4Bs":Breathing,

Bleeding,Brain, andBones). While the ABCs and 3Bs are taught to be performed

sequentially, certain conditions may require the consideration of two steps simultaneously.

This includes the provision of both artificial respiration and chest compressions to someone

who is not breathing and has no pulse, and the consideration ofcervical spine injuries whenensuring an open airway.

.

[edit] Training

First aid scenario training in progress

Much of first aid is common sense. Basic principles, such as knowing to use an adhesivebandage or applying direct pressure on a bleed, are often acquired passively through life

experiences. However, to provide effective, life-saving first aid interventions requires
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instruction and practical training. This is especially true where it relates to potentially fatal

illnesses and injuries, such as those that requirecardiopulmonary resuscitation (CPR); these

procedures may be invasive, and carry a risk of further injury to the patient and the

provider. As with any training, it is more useful if it occurs before an actual emergency, andin many countries, emergency ambulance dispatchers may give basic first aid instructions

over the phone while the ambulance is on the way.

[edit] Specific disciplines

There are several types of first aid (and first aider) which require specific additional

training. These are usually undertaken to fulfill the demands of the work or activity

undertaken.

Aquatic/Marine first aid - Usually practiced by professionals such as lifeguards,

professional mariners or in diver rescue, and covers the specific problems which

may be faced after water-based rescue and/or delayed MedEvac.

Battlefield first aid - This takes in to account the specific needs of treating

wounded combatants and non-combatants during armed conflict.

Hyperbaric first aid - Which may be practiced by SCUBA diving professionals,

who need to treat conditions such as the bends. Oxygen first aid - Providing oxygen to casualties who suffer from conditions

resulting inhypoxia.

Wilderness first aid is the provision of first aid under conditions where the arrival

of emergency responders or the evacuation of an injured person may be delayed due

to constraints of terrain, weather, and available persons or equipment. It may be

necessary to care for an injured person for several hours or days.

[edit] Symbols

For more details on this topic, seeEmblems of the Red Cross#Use of the emblems.

Although commonly associated with first aid, the symbol of a red cross is an official

protective symbol of the Red Cross. According to theGeneva Conventions and other

international laws, the use of this and similar symbols is reserved for official agencies of the

International Red Cross and Red Crescent, and as a protective emblem for medical

personnel and facilities in combat situations. Use by any other person or organization is

illegal, and may lead to prosecution.

The internationally accepted symbol for first aid is the white cross on a green background

shown at the start of the page.

Some organizations may make use of theStar of Life, although this is usually reserved foruse by ambulance services, or may use symbols such as the Maltese Cross, like the Order of

Malta Ambulance Corps andSt John Ambulance. Other symbols may also be used.
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ISO First Aid Symbol

Symbol of the Red Cross

Maltese or Amalfi CrossStar of life

[edit] Conditions that often require first aid

Also see medical emergency.

Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000

feet, can cause potentially fatal swelling of the brain orlungs.[5]

Anaphylaxis, a life-threatening condition in which the airway can become

constricted and the patient may go into shock. The reaction can be caused by a

systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is

initially treated with injection ofepinephrine.

Battlefield first aid - This protocol refers to treating shrapnel, gunshot wounds,

burns, bone fractures, etc. as seen either in the traditional battlefield setting or in

an area subject to damage by large scale weaponry, such as abomb blast or other

terroristactivity.

Bone fracture, a break in a bone initially treated by stabilizing the fracture with a

splint.

Burns, which can result in damage to tissues and loss of body fluids through the

burn site.

Choking, blockage of the airway which can quickly result in death due to lack of

oxygen if the patients trachea is not cleared, for example by the Heimlich

Maneuver. Childbirth.

Cramps in muscles due to lactic acid build up caused either by inadequate

oxygenation of muscle or lack of water or salt.

Diving disorders,drowning orasphyxiation.[6]

Gender-specific conditions, such as dysmenorrhea and testicular torsion.

Heart attack, or inadequate blood flow to the blood vessels supplying the heart

muscle.

Heat stroke, also known as sunstroke orhyperthermia, which tends to occur during

heavy exercise in high humidity, or with inadequate water, though it may occur

spontaneously in some chronically ill persons. Sunstroke, especially when the victim

has been unconscious, often causes major damage to body systems such as brain,kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads

to permanent disability. Emergency treatment involves rapid cooling of the patient.
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Heat syncope, another stage in the same process as heat stroke, occurs under similar

conditions as heat stroke and is not distinguished from the latter by some authorities.

Heavy bleeding, treated by applying pressure (manually and later with apressure

bandage) to the wound site and elevating the limb if possible.

Hyperglycemia (diabetic coma) andHypoglycemia (insulin shock).

Hypothermia, or Exposure, occurs when a persons core body temperature falls

below 33.7C (92.6F). First aid for a mildly hypothermic patient includes

rewarming, but rewarming a severely hypothermic person could result in a fatal

arrhythmia, an irregular heart rhythm.

Insect and animalbites and stings.

Joint dislocation.

Poisoning, which can occur by injection, inhalation, absorption, or ingestion.

Seizures, or a malfunction in the electrical activity in the brain. Three types of

seizures include a grand mal (which usually features convulsions as well as

temporary respiratory abnormalities, change in skin complexion, etc) and petit mal

(which usually features twitching, rapid blinking, and/or fidgeting as well as altered

consciousness and temporary respiratory abnormalities).

Muscle strains and Sprains, a temporary dislocation of ajoint that immediately

reduces automatically but may result in ligament damage.

Stroke, a temporary loss of blood supply to the brain. Toothache, which can result in severe pain and loss of the tooth but is rarely life

threatening, unless over time the infection spreads into the bone of the jaw and starts

osteomyelitis.

Wounds andbleeding, including lacerations, incisions and abrasions,

Gastrointestinal bleeding,avulsions and Sucking chest wounds, treated with an

occlusive dressing to let air out but not in.

Emergency bleeding controlFrom Wikipedia, the free encyclopedia

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Minor traumatic bleeding from the head

Emergency bleeding control describes the steps or actions taken to controlbleeding from a

patient who has suffered a traumatic injuryor who has a medical condition which has led to

bleeding. Many bleeding control techniques are taught as part offirst aid throughout the

world,[1]although some more advanced techniques such as tourniquets, are often taught as

being reserved for use byhealth professionals, or as an absolute last resort, in order to

mitigate the risks associated with them, such as potential loss of limbs.[2] In order to manage

bleeding effectively, it is important to be able to readily identify both types of wounds and

types of bleeding.

[edit] Types of wounds

Main article: Wound

Wounds are normally described in a variety of ways. These may deal with a description of

wound size (length) and thickness, or also with the plainly visible wound characteristics.

Wounds may be categorized as open or closed, or as either acute or chronic in origin. [3]The

most common descriptors of wounds are these:

Incisions: Straight edges to the wound margins, as if sliced with a knife. These canvary in size, and may be caused by a variety of objects, including a scalpel, a knife,

any piece of straight, sharp metal, or a piece of glass. Tissue is rarely missing from

the wound site, and the margins of the wound may be easily matched from one side

of the wound to the other for the purposes of closure.[4]

Laceration: Jagged edges to the wound margins, more closely resembling a tear thana slice. The wounded tissue is random rather than straight in direction, and may have

multiple branches.[5] Most often caused by an object with a broken orserrated edge,

such as a piece of broken glass or metal, but may also be caused by a blow from a

blunt object to tissue with bone immediately behind it.

Puncture: Sharp object penetrates the tissue, and travels internally, but does notmove laterally in any direction from the point of entry. [6] Such wounds can be

misleading, as they may appear quite small on surface examination, but extend quite

deeply into the body; even damaging nerves, blood vessels, or internal organs. They

may cause substantial internal bleeding or secondary injuries, such as a collapsed

lung, which may not be readily evident during primary assessment. Occasionally,

the object causing the injury will remain in the wound as an impaled object. A stab

wound from a knife or other sharp object, or a bullet wound would be examples of

this type of injury. Medical professionals usually refer to this type of wound as

penetrating trauma.

Abrasion: A scraping or scratching. Generally quite superficial, and affecting only

the surface layers of the epidermis.

[7]

No internalorgans,nerves, orblood vesselsother thancapillaries, are affected. This may be the result of a fall, or of sliding

(friction) against rough surfaces. The road rash often suffered by fallingmotorcyclists is an example of this type of wound.
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Contusion: Simplebruising. In this type of injury, the capillaries in the epidermis

anddermisare damaged, without breaking the skin.[8] Blood oozes out of these

vessels into the spaces between cells orinterstitial space, causing swelling and

discoloration. Blood loss is generally limited, and not of serious consequence. It

may, however, act as a signpost, pointing to more serious injuries.

Avulsion: A full thickness laceration-type wound, often semi-circular in shape. This

creates aflap which, when lifted, exposes the deeper tissues to view, or extrudesthem from the wound itself.[9] Avulsions often occur in mechanical accidents

involving fingers (sometimes referred to as degloving), and on a more serious note,

may affect the orbit of the eye or theabdominal cavity, exposing the internal viscera.

Avulsions are difficult to repair, and no avulsion should ever be considered a minor

injury.

Types of wounds

LacerationAbrasion on the palm of the hand Contusion

[edit] Blood vessels affected

External bleeding is generally described in terms of the origin of the blood flow by vessel

type. The basic categories of externalbleeding are:

Arterial bleeding: As the name suggests, blood flow originating in an artery. Withthis type of bleeding, the blood is typically bright red in colour, due to the high

degree ofoxygenation. Blood typically exits the wound in spurts, rather than in a

steady flow. The amount of blood loss can be copious, and can occur very rapidly.[10]

Venous bleeding: This blood is flowing from a damaged vein. As a result, it will be

a darker red to burgundy in colour (due to the lack of oxygen being transported) and

will flow in a steady manner. Caution is still indicated; while the blood loss may not

be arterial, it can still be quite substantial, and can occur with surprising speed

without intervention.

[11]

Capillary bleeding: Capillary bleeding usually occurs in superficial wounds, such as

abrasions. The colour of the blood may vary somewhat (distal portion of circulation
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with oxygenated and unoxygenated blood mixing), and will generally ooze in small

amounts, as opposed to flowing or spurting.[12]

[edit] External wound management

The type of wound (incision,laceration, puncture etc.) will have a major effect on the way a

wound is managed, as will the area of the body affected and the presence of any foreign

objects in the wound. The key principles of wound management are:[13]

[edit] Elevation

Keeping the wound above the level of the heart will decrease the pressure at the point of

injury, and will reduce the bleeding. This mainly applies to limbs and the head, as it is

impractical (and in some cases damaging) to attempt to move the torso around to achieve

this. Most protocols also do not use elevation on limbs which are broken, as this may

exacerbate the injury.

[edit] Direct pressure

Placing pressure on the wound will constrict the blood vessels manually, helping to stemany blood flow. When applying pressure, the type and direction of the wound may have an

effect, for instance, a cut lengthways on the hand would be opened up by closing the hand

in to a fist, whilst a cut across the hand would be sealed by making a fist. A patient can

apply pressure directly to their own wound, if theirconsciousness level allows. Ideally a

barrier, such as sterile, low-adherent gauze should be used between the pressure supplier

and the wound, to help reduce chances ofinfection and help the wound to seal. Third parties

assisting a patient are always advised to use protectivelatex ornitrilemedical gloves to

reduce risk of infection or contamination passing either way. Direct pressure can be used

with some foreign objects protruding from a wound, and to achieve this, padding is applied

from either side of the object to push in and seal the wound - objects are never removed.

[edit] Pressure points

In situations where direct pressure and elevation are either not possible or proving

ineffective, and there is a risk ofexsanguination, some training protocols advocate the use

of pressure points to constrict the major artery which feeds the point of the bleed. This is

usually performed at a place where apulse can be found, such as in the femoral artery.[14]

There are significant risks involved in performing pressure point constriction, including

necrosis of the area below the constriction, and most protocols give a maximum time for

constriction (often around 10 minutes). There is particularly high danger if constricting the

carotid artery in the neck, as the brain is sensitive to hypoxia and brain damage can resultwithin minutes of application of pressure. Pressure on the carotid artery can also cause

vagal tone induced bradycardia, which can eventually stop the heart.Other dangers in use of
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a constricting method includerhabdomyolysis, which is a build up of toxins below the

pressure point, which if released back in to the main bloodstream may causerenal failure

[edit]Epistaxis

Epistaxisor a nosebleed is a special case, where almost all first aid providers train

the use of pressure points. The appropriate point here is on the soft fleshy part of the

nose, which should constrict thecapillaries sufficiently to stop bleeding, although

obviously, this will not stop bleeding which originates in the nasopharynx or the tear

ducts

] Clotting agents

Main article: Hemostatic agent

Some protocols call for the use of clotting accelerating agents, which can either by

externally applied as a powder, gel or pre-dosed in a dressing, or as an intravenous

injection. These may be particularly useful in situations where the wound is not clotting,

which can be due to external factors, such as size of wound, or medical factors such as

haemophilia.[16]

First Aid Equipment

First aid kit

From Wikipedia, the free encyclopedia


For other uses, seeFirst aid kit (disambiguation).This article does notcite any references or sources. Please helpimprove this

article by adding citations toreliable sources. Unsourced material may be

challenged and removed.(February 2008)
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First-aid kit of the French Army.

A first aid kit is a collection of supplies and equipment for use in giving first aid.[1]First aid

kits may be made up of different contents dependant on who has assembled the kit and for

what purpose. It may also vary by region due to varying advice or legislation between

governments or organisations.

Common contents include items to help controlbleeding, such asbandages,breathing

barriers for performing CPR (cardiopulmonary resuscitation), and may contain some

medicines.

[edit] Format

First aid kits can be assembled in almost any type of container, and this will depend on

whether they are commercialy produced or assembled by an individual. Standard kits often

come in durable plastic boxes, fabric pouches or in wall mounted cabinets. The type of

container will vary depending on purpose, and they range in size from wallet sized throughto large rucksacks.

It is recommended that all kits are in a clean,waterproof container to keep the contents safe

andaseptic.[2] Kits should also be checked regularly and restocked if any items are damaged

or out of date.
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[edit] Contents

Adhesive bandages are one of the most commonly used items in a first aid kit.

Plastic Tweezers

Disposable gloves are often found in modern first-aid kits.

Commercially available first aid kits available via normal retail routes have traditionally

been intended for treatment of minor injuries only. Typical contents include adhesive

bandages, regular strength pain medication, gauze and low grade disinfectant.

Specialized first aid kits are available for various regions, vehicles or activities, which may

focus on specific risks or concerns related to the activity. For example, first aid kits soldthrough marine supply stores for use in watercraft may contain seasickness remedies.
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[edit] Airway, Breathing and Circulation

First aid treats theABCs as the foundation of good treatment. For this reason, most modern

commercial first aid kits (although not necessarily those assembled at home) will contain a

suitable infection barrier for performing artificial respiration as part ofcardiopulmonary

resuscitation, examples include:

Pocket mask

Face shield

Advanced first aid kits may also contain items such as:

Oropharyngeal airway

Nasopharyngeal airway

Bag valve mask

Manual aspirator or suction unit

[edit] Trauma injuries

Trauma injuries, such as bleeding, bone fractures or burns, are usually the main focus of

most first aid kits, with items such as bandages and dressings being found in the vast

majority of all kits.

Adhesive bandages (band-aids, sticking plasters) - can include ones shaped for

particula body parts, such as knuckles

o Moleskin for blister treatment and prevention

Dressings (sterile, applied directly to wound)

o Sterileeyepads

o Sterile gauze pads

o Sterile non-adherent pads, containing a non-stickteflon layer

o Petrolatum guaze pads, used a an occlusive(air-tight) dressing for sucking

chest wounds, as well as a non-stick dressing

Bandages (for securing dressings, not necessarily sterile)

o Gauze roller bandages - absorbent, breathable, and often elastic

o Elastic bandages - used for sprains, and pressure bandages

o Adhesive, elastic roller bandages(commonly called 'Vet wrap') - very

effective pressure bandages or durable, waterproof bandaging

o Triangular bandages - used as slings, tourniquets, to tie splints, and many

other uses Butterfly closure strips - used like stitches to close wounds, usually only included

for higher level response as can seal in infection in uncleaned wounds.

Saline for cleaning wounds or washing out foreign bodies from eyes
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soap - used with water to clean superficial wounds once bleeding is stopped

Antiseptic wipes or sprays for reducing the risk of infection in abrasions or around

wounds. Dirty wounds must still be cleaned for antiseptics to be effective.

Burn dressing, which is usually a sterile pad soaked in a cooling gel

Adhesive tape,hypoallergenic

Hemostatic agents may be included in first aid kits, especially military or tactical

kits, to promote clotting for severe bleeding.

[edit] Personal protective equipment

The use ofpersonal protective equipmentor PPE will vary by kit, depending on its use and

anticipated risk of infection. The adjuncts to artificial respiration are covered above, but

other common infection control PPE includes:

Gloves which are single use and disposable to prevent cross infection

Goggles or other eye protection

Surgical maskor N95 mask to reduce possibility of airborne infection transmission

(sometimes placed on patient instead of caregivers. For this purpose the mask should

not have an exhale valve)

Apron

[edit] Instruments and equipment

Trauma shears, for cutting clothing and general use

Scissors are less useful but often included instead

Tweezers

Lighter, for sterilizing tweezers or pliers etc

alcoholpads for sterilizing equipment, or unbroken skin. This is sometimes used to

debride wounds, however some training authorities advise against this as it may kill

cells which bacteria can then feed on

Irrigationsyringe - with catheter tip for cleaning wounds with sterile water, saline

solution, or a weak iodine solution. The stream of liquid flushes out particles of dirt

and debris.

Torch (also known as a flashlight)

Instant-acting chemical cold packs

Alcohol rub (hand sanitizer) orantiseptichand wipes

Thermometer

Space blanket (lightweight plastic foil blanket, also known as "emergency blanket")

Penlight

[edit] Medication

Medication can be a controversial addition to a first aid kit, especially if it is for use on

members of the public. It is, however, common for personal or family first aid kits to
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contain certain medications. Dependant on scope of practice, the main types of medicine are

life saving medications, which may be commonly found in first aid kits used by paid or

assigned first aiders for members of the public or employees, painkillers, which are often

found in personal kits, but may also be found in public provision and lastly symptomatic

relief medicines, which are generally only found in personal kits.

Life saving

Aspirin

[2]

primarily used for central medical chest pain as an anti-coagulant Epinephrine auto-injector(brand name Epipen) - often included in kits for

wilderness use and in places such as summer camps, to treat anaphylactic shock.

Pain killers

Paracetamol (also known as Acetaminophen) is one of the most common pain

killing medication, as either tablet or syrup

Anti-inflammatory painkillers such asIbuprofen,Naproxenor otherNSAIDs can be

used as part of treatingsprains and strains

Codeine which is both a painkiller and anti-diarrhoeal

Symptomatic relief

Antidiarrhea medication such as Loperamide- especially important in remote or

third world locations where dehydration caused by diarrhea as a leading killer of

children

Oral rehydration salts

Antihistamine, such as diphenhydramine

Poison treatments

o Absorption, such as activated charcoal

o Emetics to induce vomiting, such assyrup of ipecac although first aid

manuals now advise against inducing vomiting. Smelling Salts (ammonium carbonate)

Topical Medications

Antiseptic ointment, fluid, moist wipe or spray, includingbenzalkonium chloride,

Neomycin,Polymyxin B Sulfate orBacitracinZinc.

o povidone iodine is an antiseptic in the from of liquid, swabstick, or towlette

Aloe vera gel - used for a wide variety of skin problems, including burns, sunburns,

itching, and dry skin; used as a substitute for triple-antibiotic gel to keep a wound

moist and prevent bandages from sticking

Burn gel - a water-based gel that acts as a cooling agent and often includes a mild

anesthetic such as lidocaineand, sometimes, an antiseptic such as tea tree oil
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Anti-itch ointment

o Hydrocortisone cream

o antihistamine cream containing diphenhydramine

o Calamine lotion

Anti-fungal cream

Tincture of benzoin - often in the form of an individually sealed swabstick, protects

the the skin and aids the adhesion of butterfly strips or adhesive bandages.
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