first aid, resuscitation, and education guidelines · 2020. 12. 2. · first aid, resuscitation,...

2020 Clinical and Education Updates for Canada

First Aid, Resuscitation, and Education Guidelines

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada 2

Introduction

Each day CRC responds to health inequities, social emergencies, and natural disasters. Often overlooked within health systems, first aid education is uniquely positioned to build resiliency—equipping communities/individuals with knowledge, skills and attitudes to address emergencies of acute illness/injury. We achieve this through creation and delivery of innovative learning interventions which build learner confidence, increase likelihood to act and ease pressure on our health systems while reducing health disparities.

This critical work is supported by the International First Aid, Resuscitation, and Education Guidelines—coauthored by clinical and education specialists via the Global First Aid Reference Centre. Comprised of representatives from the IFRC, ICRC, Center for Evidence-Based Practice, and more than 50 national societies, these guidelines provide industry-specific expertise designed to support meaningful learning for millions of people around the world.

INCREASING GLOBAL ACCESS TO EVIDENCE-BASED PRACTICES IN FIRST AID EDUCATION

The International First Aid, Resuscitation, and Education Guidelines provide learner-centred, evidence-based guidance on best practice in first aid education. Our team of medical, academic, and educational experts have systematically reviewed a wide range of first aid and resuscitation-related topics and have considered clinical best practice, environmental considerations, and educational techniques to help ensure first aid courses meet the needs of learners.

The guidelines are intended primarily for those developing first aid programming but should also be used by instructors and program managers to ensure that their delivery aligns with the scientific foundations. CRC will continue to revise our programs to reflect the latest Guidelines, and we will be actively contributing to Strategy 2025.

The Canadian Red Cross recognizes the excellent work of our peers and domestic contributors! Thank you for sharing your t ime and talents to continue advancing first aid education!

ABOUT THIS DOCUMENT This document is a summary of the 2020 Canadian Guidelines on First Aid, Resuscitation, and Education. The full Guidelines consist of a detailed worksheet on each of the topics that is summarized here.

This summary document focuses on key content and examples from the full content contained in the individual topic worksheets, with special focus on the changes to medical science (clinical evidence base) and educational science (how we engage learners).

Individual worksheets for each topic will be available at https://www.firstaideducation.net. They will include: • Enhanced considerations for education (as learning modalities & considerations for specific clinical topics)• Considerations for unique contexts: conflict, disaster, mass casualty situations, water safety (aquatics) remote, and pandemic• Fluid links between themes and resources• Intentional links between the Chain of Survival Behaviours and specific clinical topics• Background on the guidelines process• Considerations for local adaptation• Guidelines for effective water safety and rescue training for laypeople (including four emerging research questions)• Each worksheet will include the following elements:

o Key actiono Introductiono Guidelineso Good practice pointso Education considerations

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o Scientific foundationo References

ACKNOWLEDGEMENTS The Canadian Red Cross would like to thank the following for their amazing contributions to the development this document: Michael Nemeth, Lyle Karasiuk, Domenic Filippelli, Dr. Andrew Macpherson, Joanna Muise, Meghan Riley, Carolyn Tees, and George Hill.

ETHICS Ethics behind first aid are not found in scientific publications or in randomized controlled trials. They are found in greater principles, such as the Fundamental Principles of the Movement: Humanity, Impartiality, Neutrality, Independence, Voluntary Service, Unity, and Universality. In serving these principles, we strive to treat affected people in the most humane and ethical manner. (Guidelines 2016)

PROCESS National first aid guidelines have been developed by Red Cross and Red Crescent national Societies for more than 100 years. For more than 20 years, several Red Cross and Red Crescent national societies have had evidence-based processes and published guidelines based on the same. In 2011, the IFRC published its first evidence-based guidelines based on the Red Cross and Red Crescent national societies’ experiences. Work on the 2020 version began in 2016 through identifying subject matters experts, determining the list of topics to address, identifying evidence reviews, cataloguing existing evidence-based processes, and working together to review new clinical and education science.

The 2020 Guidelines are developed based on the principles of evidence-based practice:

First, the best available scientific evidence is collected from databases of scientific studies. Next, this is integrated with the practical experience and expertise of experts in the relevant fields and the preferences and available resources from the target groups (such as first aid providers and people receiving first aid) in order to formulate recommendations.

Figure 1. Evidence-based Practice

First Aid, Resuscitation, and Education Guidelines 2020 Clinical and Education Updates for Canada

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The worksheet for each topic in the Guidelines was generated through collaboration between members of the clinical and education sub-committees, with adequate opportunity for input and review by both teams to best meet the needs of our stakeholders. After the content was established, editors reviewed and revised the entire worksheet in conjunction with other stakeholders in order to ensure common, simple language was used. More detailed information about the process of developing these Guidelines will also be available at https://www.firstaideducation.net.

EDUCATION

Education is represented in two ways within the Guidelines: • As individual learning modalities (supported by a scientific foundation)

• As education considerations within each clinical topic

The 2020 Guidelines continue to recognize two key concepts presented in 2016:

a) The Chain of Survival Behaviours (Figure 2).b) Utstein Formula for Survival

Figure 2. Chain of Survival Behaviours


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CONTEXT FOR CANADIAN RED CROSS FIRST AID EDUCATION In 2017 the Canadian Red Cross articulated a new vision for meaningful, learner-focused first aid education. This context is the backbone of our programs—it drives our learning design and showcases how our program approach is distinct from that of other training agencies in Canada and around the world. In adopting this learning philosophy, we recognized the need to support

our instructional personnel through a comprehensive Instructor Development Program, designed to prepare them to support dynamic, learner-centred classroom environments.

All CRC first aid programming is planned and delivered in accordance with the following Context for Canadian Red Cross First Aid Education, released in 2017:

Building your participants’ confidence in their ability to provide first aid is one of your main goals as a Canadian Red Cross First Aid & CPR Instructor. As an Instructor, you can increase your participants’ confidence by:

• Helping them understand the causes of injuries and illnesses.• Giving them tips on how to avoid injuries and illnesses.

• Teaching them the latest in first aid skills and knowledge.

Backed with this foundation of know-how, participants are likely to be more confident in their first aid skills and more willing to act in an emergency. As a practice, first aid should prevent further suffering, protect life, and promote recovery. First aid training should support communities and people—whether or not they are certified First Aiders—in caring for others and should provide individuals with the confidence to:

• Recognize illnesses and injuries.• Provide care.• Recognize personal limitations and the need for more advanced care.

The curriculum focuses on the needs and interests of your participants—the learners—to increase their confidence and understanding of the content. The safe, enjoyable, meaningful, and cooperative aspects of our classrooms create a supportive environment that allows people to increase their self-confidence and understanding of first aid behaviours and techniques. Each in-class learning activity or intervention should offer opportunities to build the participants’ confidence and connect the content to the underlying principles of first aid. The Canadian Red Cross is committed to developing our Instructors in a way that supports a learner-centred approach to education.

In addition to assessing the scientific foundation for the Guidelines, reviewers were asked to provide guidance based on the following lenses (when appropriate), which help to strengthen the learning intervention by helping program developers customize the approach to the learner audience and local environment:

Learner audience: Identifies factors that program developers should consider about learners (e.g., how you might teach the topic depending on the learner's age or language use).

Facilitation tips: This section includes teaching approaches, adaptations, and points to emphasize. Reviewers were also permitted to add in novel teaching ideas or provide resources which could be valuable to others when facilitating.

Facilitator tools: This section includes tools to strengthen learning (e.g., using the acronym FAST as a cognitive aid when exploring care for a person experiencing a stroke).

Learning connections: This section includes connections to other first aid topics or general concepts of care (e.g., some clinical topics will not make sense to learners unless they have previously explored other topics).


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2020 Education Topics

Please note, full worksheets will be available directly from the Guidelines website: redcross.ca/firstaidguidelines

Topic Key Action Introduction Guidelines Good Practice Points (sample) Education Considerations

(sample)

Motivation to Learn First Aid

Consider the individual’s specific motivation to learn and use this to inform the planning and content included in first aid education.

People have different motivations to learn first aid, the strongest being a requirement to attend (e.g., for work). Other motivations include if the learner has a family member at risk of illness or injury, or if they live far away from healthcare services. When people are motivated to learn, they will likely be more engaged with the process.

• First aid program designersshould advocate that decisionmakers should make first aidlearning a requirement forspecific groups, such as schoolchildren, new drivers, andemployees.

• Self-led learning completed in afamiliar context (e.g., at home)may improve individuals’motivation to successfullyachieve the learning outcomes.

• Certain factors, such as cost,location, and method of learning,might influence the decision tolearn. These factors should beadapted to meet the needs of eachgroup and encourage learning.

• For maximum engagement,learning opportunities should beadapted to meet learners’ needsand preferences. The contentshould be limited to what is relevantand necessary for the learners.

• When learners’ motivations areunderstood, program designerscan adapt first aid programs tofocus on different aspects of theChain of Survival Behaviours.For example, parents with youngbabies may want to be preparedif their baby starts Choking.Someone living with an elderlyrelative may want to be able torecognize the signs of Stroke.

• Encourage learners to sharetheir first aid experiences as thiswill help you to understand theirmotivation for attending andresolve any concerns they haveabout providing care in anemergency.

• Avoid overwhelming learnerswith too much information as thiscould weaken their confidenceand demotivate them.

First Aid Education for Children

Encourage children to develop their first aid knowledge and skills and become lifelong learners.

First aid education refers to developing first aid knowledge and skills in children. This topic explores how to develop first aid abilities in children of different ages and the methods to help them retain their

• First aid program designersshould refer to the educationalpathway provided by the Centrefor Evidence-Based Practice(CEBaP) to create contextuallyrelevant educational programsaccording to children’sintellectual, social, andbehavioural abilities.

• Relevant, engaging scenarios thatencourage children to apply theirlife experiences should be used tosupport learning.

• Considerations when developingprogramming for children whosecontexts make access to caredifficult:

• Avoid using overly medical termsor high-level language todescribe illnesses and injuries.Language should be appropriateto the age and experiences ofthe children.

• Start by asking young learnerswhat they know about how the

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(sample)

knowledge, skills, and attitudes in both high- and low-resource settings.

• When combined with asecondary method (e.g.,educational songs), hands-ontraining may help children toretain knowledge and skills aswell as increase theirconfidence and willingness toact.

• Training teachers to facilitatefirst aid education may be moreproductive, time-efficient, andrelevant than bringing inmedical facilitators.

o Though the educationalpathway recommends teachingchildren how to access medicalcare at ages seven to eight, werecommend waiting until theyare ages nine to ten. Reinforcethis information regularly untilthey are 18 years old.

o Due to the presence ofinfectious diseases, facilitatorsshould teach children to washtheir hands before and afterproviding first aid. Repeat thisskill until they are 18 years old.

o Children may be taught torecognize their role in a first aidemergency with age-appropriate activities such asassessing the scene and callingfor help. This approach will alsoencourage them to learn aboutthe importance of scenemanagement.

body works and why providing first aid is important.

• Build on children’s interest tolearn first aid by incorporatingfirst aid education into differentsubjects and activities, such asbiology class or sports.

Online Learning (Adults)

Use online learning to develop learners’ first aid knowledge.

Online learning refers to self-directed or facilitator-led interactive learning tools accessed on digital devices, such as tablets, phones, and computers. Approaches include digital education programs, mobile apps, online games, and multimedia. Online learning is suitable for a variety of audiences because of its accessibility and flexibility.

• Online learning is a beneficialtool and could be as effectiveas face-to-face learning foradult audiences.

• Online learning may improvelearners’ knowledge of asthmatreatment, burns treatment, andCPR techniques, but may notlead to an improvement inskills.

• Given the increased use ofsocial media and smartphones,as well as technologicalexpertise, online learning maybe a cost-effective method to

No specific good practice points were identified for this topic.

• Online learning is most effectivewhen the appropriate technicalresources are available. Thisfactor may present a barrier inareas without these resources orwhen regulation exists forlimiting access. Consider howlearners will access onlinelearning, including the availabilityof offline access (e.g., throughan app).

• Adequate safeguardingmeasures should always beimplemented, especially for morevulnerable learners. Consider

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(sample)

spread public information campaigns to a broad audience.

how you will maintain a safe online learning environment.

• Online learning can have socialbenefits if learners can interactand collaborate.

Online Learning (Children)

Use online learning to increase children’s first aid knowledge.

Online learning refers to self-directed or facilitator-led interactive learning tools accessed on digital devices such as tablets, phones, and computers. Approaches include digital education programs, mobile apps, online games, and multimedia. Online learning is suitable for a variety of audiences because of its accessibility and flexibility.

• Online learning may be mostbeneficial when paired withface-to-face learning.

• Online learning could be aseffective as face-to-facelearning to develop first aidknowledge for conditions suchas heart attack, stroke, lifestylefactors, and using adefibrillator.

• Online learning may be useful whenthe child has a preferred location inwhich they like to learn, or whenthere are limited time andresources.

• Safeguarding measures are crucialfor online learning and national andorganizational protocols forprotecting children online shouldalways be followed.

• Learners’ cultural andsocioeconomic backgroundsmay influence their confidenceand ability to complete onlinelearning.

• It is important to determine howyou will protect children as theyengage in online learning.Consider how they will interactwith the tool and who caninteract with them while they areusing it. Research the data andchild protection laws for yourcontext and organization (e.g.,school) and follow theregulations and guidelinescarefully.

• You can deliver online learningin a variety of ways such asmobile apps, games, andmultimedia (e.g., 3D videos orvirtual reality). Children learnthrough play, so gamification isan important method toconsider.

Blended Learning

Use blended learning to increase the flexibility of first aid learning.

Blended learning is a formal educational method that consists of two parts: 1. A self-guided or

independent learningwhere the person has

No specific guidelines were identified for this topic.

• Self-directed components should bepaired with a facilitated session thatfocuses on learning and practisingfirst aid skills with the support of atrained facilitator (this could beface-to-face in a classroom or

• This approach can be used witha variety of audiences (e.g.,youth or older adults, people inthe workplace, those travelling orliving in remote areas, or thosetraining to be professionalresponders). It is important that

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(sample)

some control over the time, place, path, and pace.

2. A supervised sessionled by a facilitator.

The modules within a blended learning course are connected to provide a unified learning experience. The recommendations and considerations included for this topic apply to both adults and children unless specified otherwise.

facilitated virtually in real time through video communication).

• The optimal “blend” of learningmethods and the order mosteffective for different audiences isunknown. Regardless of thecombination, blended learning mayprovide an opportunity to reinforcelearning through repetition.

• The self-led learning segment maycome before or after the facilitator-led segment but must be a separatesession (i.e., playing a video duringthe facilitator-led segment is notblended learning. Learners mustwatch the video before or after theirtime with the facilitator for it to beconsidered blended learning.)

the self- and facilitator-led methods have a meaningful, integrated connection and form an enhanced learning experience. We advise program designers to consider which elements need reinforcement based on the learners’ needs.

• Prepare facilitators on how tobring the self-guided andsupervised learning componentstogether. Time with a facilitatorshould enhance learning, notrepeat it.

• Encourage learners to revisit theself-guided learning componentsas this may increase theirretention of the content.

Media Use media to raise awareness, change attitudes and beliefs, and motivate people to learn or recall basic first aid knowledge and skills.

We have defined “media” as communication outlets such as television, radio, newspapers, magazines, posters, and the internet. Media should be used to reach local, regional, national, or global audiences and share first aid information. The media outlet should be appropriate for the audience, and the message should contain authentic, relevant content that is engaging, entertaining, and educational.

• Media may be used to:o Increase awareness of first

aid or the motivation tolearn it

o Change attitudes andbeliefs about first aid

o Increase first aidknowledge

• Media may not be an effectivemethod to improve skills orspecific actions associated withproviding first aid.

The following recommendations are for first aid program designers and the marketing and communications teams with which they work: • Media may be used intensively

over time to repeat multiple,

• Media may be used to reach abroad audience for a relatively lowcost.

• Radio may provide the opportunityto engage with audiences who areharder to reach.

• Narrowcasting may be an effectivemethod to communicate veryspecific messages.

• Consider the audience’s literacylevel and select the media outletthat will best engage people.Consult the target audience onwhich media outlets they preferto use.

• Use testimonials from peoplewho have seen or heard first aidmedia content and intend tochange their behaviour becauseof it. This may encourage othersto change too.

• Consult with the target audiencewhen developing key messagesand media content to ensurethey resonate with them and areculturally appropriate.

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(sample)

refined messages aimed at a target audience.

• Messaging may be mosteffective when it is specific to atarget audience andcommunicated through theappropriate outlet.

• Collaboration between programdesigners or marketing teamsand a target audience mayproduce authentic and relevanteducational content.

Gamification Apply gamification techniques to first aid education to reach a broader range of learners, repeat learning over time, or reinforce learning from other sources (e.g., facilitator-led sessions).

Gamification is the application of game elements (e.g., collecting achievements, earning points, or team play) to first aid education with the intent to increase learner engagement. An example of this is a mobile application that tests the ability to assess various scenes for hazards. Gamification in electronic and non-electronic forms can captivate learners’ interest and provide the opportunity to re-engage with the content on a regular, independent basis. Given the increased popularity of mobile technology, electronic gamification offers the chance to reach a much broader audience, and as


• Gamification may be used to deliverfirst aid content eitherindependently or as part of acomprehensive educationalstrategy.

• Gamification should be purposefuland supported by an educationalapproach that identifies its benefitsto the intended learning outcomes.

• Consider how gamification willbest serve learners’ needs andpreferences. Some gamificationelements may be inappropriatein certain contexts. For example,competition between individuallearners may be irrelevant forsome age groups or religiousbackgrounds, or in cultures thatstrongly value unity. The use ofgamification should respect thelocal context in which it is used.

• Ensure the learning outcomesare clear and the gamificationelements are directly applicableto the learning process (e.g.,evaluate the gamificationelements using test and retest orlearning to prioritize actions). Ifthey are not, learners maybecome disinterested with thecontent.

• Evaluate the effectiveness of thegamification elements bymeasuring key learningoutcomes such as first aid

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(sample)

such, is the focus of this topic.

knowledge, skills, and attitudes. Secondary outcomes may include an increase in the rate with which learners re-engage with the content or the number of individuals they encourage to complete first aid education.

Peer Learning Use peer learning to add extra value to education, as it allows users to support each other and provide different perspectives, adding extra value to the educational experience.

Peer learning is a term that has many interpretations and includes a wide variety of learning approaches. It has no universally agreed definition, nor is there a standard method to its delivery. All at once, it is an approach, a communication channel, a method, a philosophy, and a strategy. Other terms used to describe peer learning include co-learning, cooperative learning, peer tutoring, peer-led instruction, peer-mediated instruction, peer evaluation, peer coaching, and reciprocal learning.

For these Guidelines, peer learning can be divided into the following two categories: 1. Cooperative learning:

Peers learn alongsideone another (i.e.,reciprocal learning).


• Peer-led learning or cooperativelearning may encourage individualsto share their first aid experiences,which may benefit the learning ofothers. When a peer shares insightor experience, they bring valuableauthenticity to the subject matter,supporting the learning (e.g., inconflict contexts or working withvulnerable people).

• Although peers bring value to thelearning experience, they shouldnot be considered a substitute forprofessional facilitators.

• Where peers are encouraged toprovide some form of facilitation(peer-led learning), they should notbe viewed as interchangeable withprofessional educators or trainers.The peer relationship should enrichthe learning experience and benefitboth the learner and facilitator.

• While cooperative learningtypically requires few resourcesto develop (human and financial),developing people to becomeeffective peer facilitators can taketime and effort, and care shouldbe taken to do this sensitively.

• Either cooperative or peer-ledlearning can be used with avariety of audiences where theinfluence of likeness is valued.Some examples include:o Young children (pre-school

and elementary ages)o Aging populationso Those with a specific shared

influence (new parents,grandparents/caregivers,homeless persons, thosestruggling with substanceabuse, etc.)

o Those living in similarconditions (rural, remote,conflict, etc.)

• Engage peer facilitators inprogram development to ensurethat the programs are connectedwith the content, approach, andaudience.

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(sample)

2. Peer-led learning:Peers play a facilitatorrole and share theirknowledge andexperience withothers.

A peer is defined as someone from a “like group” who shares some (or all) of the following characteristics: gender, age, cultural background, religion, and socioeconomic circumstances. Peer learning is often used with youth or other specific audiences who may not recognize themselves (or their values and experiences) in a traditional facilitator. The familiarity of a peer can create new opportunities to share knowledge or change behaviour because the relationship is often based on trust and openness. It is especially beneficial to reach audiences who may be underserved by traditional forms of education.

Video Learning

Provide learners with skill demonstration videos ahead of face-

Video learning consists of individuals watching a video to learn about a

• If the learner has access to apersonal mannequin, videos

• Video learning could be effective insituations where there wouldotherwise be no training.

• The opportunities to meetindividuals’ learning needs arechanging due to continuous

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(sample)

to-face sessions to improve the time spent with the facilitator.

specific topic. This method is an easy way to address diverse audiences and provide them with standardized information. There are two basic approaches to video learning: 1. Individuals watch a

video and learn fromit.

2. Individuals watch avideo and apply whatthey learned usingfirst aid equipment.

can be an effective tool to learn CPR.

• Videos may encourage learnersto respond to an emergencyand start CPR or other first aidcare.

• Video learning may strengthenfacilitator-led training but shouldnot replace it.

• Video learning can provide a viewof realistic scenarios which situatethe first aid skill within the context ofan emergency.

advances in technology. Educators increasingly use social media and online learning, and therefore the role of videos has expanded as well. Consider which platforms your audience uses to consume content and what type of first aid education video will resonate with them.

• Use video learning to supportface-to-face facilitation, but notto replace it. (Exceptions includerefresh and retrain sessions or ifface-to-face learning is not anoption.)

• Provide the opportunity forlearners to practise what theysee in the video.

Feedback Devices

Use automated feedback devices to teach first aid skills, such as CPR.

Feedback devices are tools that provide feedback to the learner through auditory, visual, or physical (i.e., tactile) cues. For example, there are devices that give feedback on the depth and rate of chest compressions. These devices are most useful when tailored to how a learner best receives feedback. For example, an auditory-only device may be suitable for a learner with a visual impairment, but is less effective for one who is deaf or hard-of-hearing.


• Devices that provide immediatefeedback may be used during CPRtraining to improve the quality ofperformance.

• Feedback devices may be used toimprove learners’ skills by providingindividualized feedback in realtime.

• Feedback devices should beselected to serve the needs of thelearners (e.g., selecting a devicethat provides visual feedback maybe better suited for learners withhearing difficulties).

• Feedback devices may provideeffective learning opportunitieswhen a facilitator is absent.However, they may be lesseffective in contexts wherelearners respect or expectfacilitator-led programming.

• Consider the learner audienceand their intended learningcontext (e.g., devices that maywork for first aid providers maynot fit the needs of professionalresponders.)

• Train facilitators to set up thedevices, introduce them tolearners, monitor and supportthe feedback provided, andresolve any technical difficulties.

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(sample)

Refresh and Retrain

Provide opportunities for learners to maintain their knowledge and skills after completing an initial first aid education session.

“Refresh” refers to strengthening or reminding learners of first aid knowledge and skills, while “retrain” means re-learning skills that they may have forgotten after the initial educational experience. Methods can include face-to-face, online, or video learning, or a combination (see Blended Learning). A refresh and retrain strategy supports all learners in maintaining their first aid knowledge and skills over time.

• Knowledge and skills declinedramatically over time,especially more than a yearafter completing an initial firstaid education session. Refreshand retrain strategies should beconsidered to maintain first aidlearning outcomes.

• All methods reviewed(video learning, feedbackdevices, face-to-face learning,etc.) may be considered asappropriate refresh and retrainmethods.

• Refresh and retrain sessionsmay be delivered between threeand six months after the initialeducational experience. Waitinglonger will lead to less effectivelearning.

• While there is no recommendedsession length, refresh andretrain interventions of 45-minutes or less could bevaluable.


• Plan to provide refresh andretrain opportunities three to sixmonths after the initial educationsession to improve retention.

• There is little evidence tosuggest the most suitablemethod for implementing arefresh and retrain strategy.However, posters, flashcards,video lectures, feedbackdevices, and videos oranimations viewed on mobilephones may effectively improveknowledge and skill retention.

• Digital methods used to deliverrefresh and retrain sessions canbe scaled and made available tomeet the needs of the learner(e.g., sending periodic textmessages or emails with first aidtips to refresh learners’knowledge.)

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Contexts For Learning

In addition to modalities, the Guidelines considered how location, environment, access to resources, and other local factors may influence how a topic is taught. Each of these contexts is included for the first time in 2020. It is important to recognize that these contexts can look very different for Canadian audiences compared to other countries and could even differ between different domestic regions. While we may not experience all contexts in Canada, we continue exploring the urban, rural, and remote learning environments.

Topic Key Action Introduction Guidelines Good Practice Points (samples) Education Considerations

(samples)

Conflict Emphasize that first aid providers must consider their own safety and security before giving life-saving first aid care.

Conflict areas are common and ever-changing; preparing people for the injuries they may encounter in these situations is important across cultural, political, and societal divides. Any group that faces conflict situations will benefit from this type of first aid education.

• First aid education may beadapted to the type of conflictlearners will experience.

• Exposure to the relevant conflict,as well as practising the skillsthey will need, can be critical tothe success of the first aid carelearners will provide.

• First aid education within a conflictcontext should acknowledge thatsafety, security, and military tacticalobjectives (if applicable) often takepriority over providing care.

• First aid education should focus onthe needs of the learners, such asthe kinds of resources they haveaccess to (they may not have astandard first aid kit) or thedangerous situations they are inwhen providing care.

• Program designers should worktogether with learners (or those whorepresent them) to develop context-specific programs, rather thanrelying on a predetermined set ofknowledge and skills.

• In general, there are three distinctconflict phases that educationshould cover: highly dangerous,medium safety, safe to act.

• Emphasize the aim of the first aidtechnique, rather than thetechnique itself. For example,emphasize the need to stopbleeding, rather than how to tie abandage. While this is true forany first aid education, thisapproach will help to address thekind of stress a learner mightexperience in a conflict context.

• Emphasize that first aid providersmust assess their own safetyfirst. In conflict contexts, the ill orinjured person plays a bigger rolein responding to an emergency.For example, if the providercannot reach the person, theycan instruct the person to applypressure to the wound.

Disaster Develop the preparedness of individuals, families, communities, and emergency services to respond to disaster situations.

Disasters can be natural (earthquakes or flooding), man-made (explosions or chemical spills), or a combination of both (fires). The unexpected nature and


• First aid education shouldemphasize the hazards in differentdisaster settings, as well as whathelp might be available and how toaccess it.

• First aid providers should be flexibleand able to adapt to the disaster's

• Make time to explore theresponses people might have toa disaster such as experiencinghigh emotions or filming it oncamera. Discuss how to manageemotions and the positive or

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(samples)

scale can affect large numbers of people and all aspects of a community. People in disaster situations often suffer injuries and require life-saving first aid. Communities with the confidence and willingness to act and the skills to provide care will be better prepared to respond to a disaster.

context and any limitations they might face (such as reduced access to water or equipment).

• First aid education should focus onlife-saving skills (e.g., puttingpressure on a severe bleed) and theuse of improvised equipment (e.g.,using a shirt to stop the bleeding). Itshould also include content onrecovery and minimizing furtherinjury and the risk of infection.

negative outcomes of behaviours.

• Concentrate on bleeding control,maintaining an open airway, andcaring for shock. A focus onsimple steps for stabilizing life-threatening conditions isparamount.

• Emphasize the importance ofinfection prevention, especially asfirst aid supplies may not bereadily available.

Mass Casualty

Acknowledge that first aid providers can be essential to the survival and care of people injured in mass casualty incidents.

A mass casualty incident is an event that results in multiple injured people, outnumbering and overwhelming emergency medical services. In this context we include road traffic accidents, terror attacks, mass shootings, and natural disasters. While there are personal safety issues to consider, first aid providers who are first to the scene can provide life-saving care. Their contribution should be considered within official preparedness plans, and communities should be educated to act accordingly.

• First aid providers trained in firstaid skills may feel confident toprovide first aid in a masscasualty incident.

• Simulations are an educationaltool that may be used to developcritical-thinking skills,awareness, and preparednessfor a mass casualty incidentamong first aid providers andhealthcare professionals.

• A lack of first aid equipment shouldnot be a barrier to providing care;first aid providers should usewhatever resources are available tothem.

• Filming a mass casualty incident isinappropriate and problematic,particularly if it blocks the path ofprofessional responders. First aideducation should raise awarenessof this fact.

• First aid providers should learnBleeding control as it is a key skillfor a mass casualty context.

• First aid education shouldprepare learners for the type ofmass casualty incidents they aremost likely to encounter. Forexample, in areas where thereare frequent motor vehiclecollisions, learning shouldreference these and identify thelevel and availability ofemergency services.

• In preparing people for eventssuch as terror attacks, includeindividual safety measures andlocal regulations in the first aideducation.

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(samples)

Water Safety (Aquatics)

Develop a culturally inclusive program with key water safety messages that address local risk factors.

Rivers, lakes, pools, seas, and oceans provide people with their livelihoods, places of leisure, and vital resources for daily life. However, drowning is the third leading cause of unintentional injury-related death worldwide. Over 320,000 people die from drowning annually. Over 90% of these deaths occur in low- and middle-income countries where there is less access to drowning prevention and learn-to-swim programs and people carry out daily activities on the water. Children are disproportionately affected by drowning, and in many countries drowning is the leading cause of death in children between the ages of one and four.

• Delivering water safetymessages to children should bepart of a layered approach thatincludes engaging andeducating caregivers ondrowning prevention with aparticular focus on theimportance of close supervision.

• When developing and teachingwater safety messages,Stallman et al.'s watercompetencies concept should beintegrated into activities thatpromote learning a broadspectrum of physical and mentalaquatic competencies.

• Once evaluated as appropriatefor the local context, theInternational Task Force onOpen Water DrowningPrevention's guidelines can beconsidered to develop watersafety messages.

• The development of water safetymessages should be based onevidence of local risk factors fordrowning and be mindful of the risk-reduction measures to implement ateach phase of a drowning event.

• Messages should be developed anddelivered using appropriate theoriesto change behaviours.

• Owing to the lack of evidence onthe effectiveness of water safetymessaging, organizations shouldconsider developing an evaluationframework that allows them tomonitor the effects of themessaging on children andcaregivers’ behaviour whenexposed to an aquatic environment.This framework should ensure themessaging does not increase risk-taking behaviour.

• Water Safety Education shouldbe developed in the framework ofthe Haddon Matrix. This involvesevaluating personal, equipment,and environmental factorsassociated with aquatic activities,which in turn allows you todetermine the knowledge andskills learners need to reducetheir risk, stay safe during aquaticevents, and survive aquaticincidents. This approach supportsthe ongoing development ofsafety-conscious attitudes andsafe behaviours in, on, andaround the water.

• Create educational opportunitiesthat engage the learner withcontent appropriate to thedevelopmental milestones(mental and physical) of thelearner.

• Introduce and reinforce skills andknowledge using a variety ofinstructional approaches toengage the learner in decision-making activities to apply riskreduction strategies using watersafety education and skills.

• Apply water safety education tothe variety of aquaticenvironments that the learner islikely to encounter (e.g., flatwater, moving water, cold water,frozen water, swimming pools,decorative water features).

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(samples)

Remote Differentiate first aid education according to the learners’ context (e.g., the program for those living in a remote community should differ from one aimed at people visiting a remote area).

Examples of remote contexts include wilderness environments, isolated communities, and rural areas with limited resources. Advanced medical care may be limited or take a long time to access in this context. Additionally, individuals and communities may experience longer wait times for medical help and have to consider extra factors—such as environmental hazards—compared to those living in urban areas.


• First aid programs should reflect thedifferences between visiting andliving in a remote location.

• Where possible, learners should beinvolved in the development ofeducational content.

• If learners plan to visit a remoteplace, they should be advised toplan their route, as well as informfamily and friends of where they aregoing and when they expect toreturn.

• Base educational content for remote contexts on the risks posed in those specific environments. For example, where medical assistance is limited or requires longer travel times, learners need to know how to prioritize and provide carefor life-threatening injuries.

• Draw attention to context-specific illnesses such as Hypothermia, Hyperthermia, and Altitude Sickness. Provide general advice such as avoiding alcohol, drinking plenty of water, and developing ways to protect against the weather (e.g., by building a shelter or starting a fire) to help learners prepare for such conditions.

• Encourage learners to improvise when they do not have appropriate first aid equipment. Help them to understand the purpose of the equipment, rather than the need for something specific. For example, if they are in a cold environment and do not have a blanket, encourage them to think about building a shelter or a fire instead.

Public Health Emergency

Develop an understanding of how to offer first aid knowledge and apply skills safely during times of a public health emergency such

COVID-19 is transmitted from person to person through close contact by airborne droplets. It is possible that a person could catch the virus by touching a surface or


• Proper use of personal protectiveequipment (PPE) is extremelyimportant; improper use couldpotentially increase the risk ofinfection, especially when providingfirst aid care.

• Learners should be advised thatthey must be wearing a facemask or face covering and glovesto enter the classroom andcomplete training if they areunable to maintain a two-metre(six-foot) distance between

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(samples)

an outbreak, epidemic, or pandemic.

object on which the virus is found, and then touching the mouth, nose, or eyes. The most effective defense against the transmission of this disease is maintaining a two-metre (six-foot) distance between individuals and the use of gloves and a face mask/covering. Providing first aid during the COVID-19 pandemic can raise questions around safety and transmission. Outlined to the right are the first aid protocols that should be followed when attending to an ill or injured person.

• It is recommended that first aiderstake training on preventing diseasetransmission that includes how andwhen to use PPE, donning anddoffing PPE, and disposing of allPPE.

• Maintain a physical distance of twometres, unless it is medicallynecessary to be near the person.

themselves and all others in the space at all times.

• Easy, visible access to sanitization stations must be provided near the classroom space. Sanitization stations must include a space to wash hands(either with soap and water or an alcohol-based hand rub (ABHR) with at least 70% alcohol) and paper towels instead of cloth towels.

• Have learners reduce exposure by working with the same partners and groups for the entire class or course. Avoid mixing up groups and partners for activities.

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Clinical

1.0 General Approach

Topic Current Guidelines 2020 Canadian Guidelines Good Practice Points (GPP) Educational Considerations

De-escalation Techniques

Nothing noted in 2016 Guidelines • Identify individuals and situations that maybecome dangerous due to other people’sbehaviour.

• Call for help or extra support when needed.

• Decide to stop care due to potential or imminentdanger.

• Practice first aid inemotionally stressful contextsto develop competencies.

• Learn means to de-escalatevolatile situations.

• Anticipate stress due tocontext and recognize cuesgiven by ill/injured people orbystanders.

• Violence at all levels can disturbhealthcare provision whenservices are most needed, be itduring first aid/stabilization orreferral and access tohealthcare facilities.

• Organizations need toundertake a comprehensiveassessment of situations wheretrainers or volunteers mightencounter violent or aggressivebehaviour and provide trainingon de-escalation techniques.Potential situations mightinclude training within prisons ormental health facilities.

Oxygen Administration

Nothing noted in 2016 Guidelines • The use of supplemental oxygen should belimited to first aiders with specific training inoxygen administration.

• Supplemental oxygen should only be given to apatient with normal, spontaneous breathing.

• Until emergency medical care is available, it isreasonable for specially trained first aiders toprovide supplemental oxygen to scuba diverssuffering from decompressions illness.

• Giving supplemental oxygen by a specificallytrained first aid provider for patients withadvanced cancer having dyspnea and/orhypoxemia may be reasonable.

• When oxygen is given, it is ideal to titrateoxygen supplementation to keep the patient’sSpO2 at 94 percent (at sea level) if the first aidresponder has been trained in transcutaneous

No specific good practise points were identified for this topic.

• Oxygen administration may notbe feasible for some learners,depending on their line of workor activities in which theyparticipate. For example, a ruralrescue team may not be able tocarry the required equipment toprovide supplementary oxygenand, therefore, are less likely touse this skill.

• Stress the importance ofunderstanding the logisticalaspects of the equipment,including how to maintain andstore it, as well as how to carefor the compressed gascylinders. Learners should also

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pulse oximetry and has a proper tool for measurement.

• Until emergency medical care is available, it isreasonable for specially trained first aiders toprovide supplemental oxygen to patients whoare suffering from carbon monoxide exposure.

be aware of and follow any local regulations around testing and inspections.

• Emphasize that it is critical thatlearners take extra precautionswhen using oxygenadministration equipment as itcan be a fire hazard. Learnersmust complete the necessarytraining on how to use theequipment if it is relevant tothem.

• The SpO2 reading from a pulseoximetry reading oftendetermines the use of oxygen.Therefore, learners may berequired to complete additionaltraining on the use of pulseoximetry equipment.

• Provide time for learners topractise using the differentdevices associated withadministering oxygen, such asnasal prongs, simple masks,and partial rebreather masks.

• Develop scenarios that assesslearners on their ability to:o Determine when

supplemental oxygen isindicated.

o Identify the potentialbenefits of oxygenadministration.

o Demonstrate how toadminister oxygen safely.

o Store oxygen administrationequipment properly.

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2.0 Medical


Poisoning For ingestion poisoning: • The casualty should preferably be laid

on their left side.

For gaseous poisoning: • Flammability warning: In rooms which

are potentially filled with carbonmonoxide, all sources of ignition suchas naked flames, electrical equipment,oxidizing chemicals, and smokingtobacco products should beprevented.

• Move the casualty out of the area withgas immediately, but only if this can bedone without endangering the first aidprovider. In most cases the rescue hasto be carried out by professionalrescue service.

• Only trained first aid providers shouldadminister oxygen to casualties ofcarbon monoxide and carbon dioxidepoisoning.

• Poisoning occurs when a person is exposed toa substance that can damage their health orendanger their life. Most poisons are swallowedor inhaled; however, they can also be injectedor absorbed through the skin. Many poisonoussubstances are found in homes andworkplaces. Examples include some cleaningproducts, illicit drugs, medications, and certainplants. Worldwide, international organizationsare working to remove toxins such as lead,mercury, and asbestos from paint and otherbuilding supplies.

• The first aid provider shouldstop or limit further effects ofthe poison by stoppingcontinued exposure. In thecases of inhalation of toxicgas, the person should beremoved from the area, butonly if it is safe for the first aidprovider to do so.

• If life-threatening conditionsare present, the first aidprovider should accessemergency medical services(EMS) and start CPR or otherfirst aid as necessary.

• If only non-life-threateningconditions are present, thefirst aider should access andfollow the instructions of thepoison control centre (or localequivalent) or EMS.

• Establish with learners whatsubstances and sources aremost likely to lead to poisoningin their context, and discussways to reduce the likelihood ofpoisoning. For example, discussliving or work conditions andhow to store harmfulsubstances.

• Give learners opportunities toassess danger through photos orscenarios, for example of achemical spill or a gas-filledroom. Discuss what signs theyshould look for. Explore howthey keep themselves safe. Thismay be particularly relevant tosome workplaces.

• Tailor education to specificlearning needs. For example,child first aid courses aimed atparents and care providers mayrequire more content onprevention.

Breathing Difficulties

The 2016 Guidelines only included considerations related to asthma under this topic.

• First aid providers may help the person to situpright and lean forward.

• If the person is experiencing severe breathingdifficulties (as well as a change in mental statusand poor perfusion) the first aid provider shouldaccess emergency medical services (EMS) andcontinue to observe and assist the individualuntil help arrives.

• In certain cases, a specially trained first aidprovider can give supplementary oxygen to theperson having breathing difficulties.

1. Help the person into acomfortable position (usuallyseated) and reassure them.

2. Help them to use theirmedication if they have any.Loosen any tight clothing.

3. Access EMS immediately if:o the person’s medication

is ineffective.o the person is

experiencing severebreathing difficulties.

• Educators should be mindful ofthe cultural, gender, and age-based factors that may influencelearners' understanding ofbreathing difficulties andseverity. Ensure first aidprogram content is inclusive.

• Non-emergency medical supportservices can treat breathingdifficulties that occur slowly overtime. First aid education should

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o the person has a changein mental status, such asconfusion, aggression orunresponsiveness.

o the person’s breathingbecomes slow.

include advice about the local options available.

• In remote areas, it may bebeneficial to drive towards thenearest medical facility and meetthe EMS vehicle en-route. Firstaid program designers shouldknow the availability andresponse time of pre-hospitalservices in their areas.Education should emphasizethat early recognition ofpotentially time-critical situationsis essential.

Asthma

Attack

• First aid providers may help theperson to sit upright leaning forward.

• It is reasonable to expect that first aidproviders are familiar with thecommonly used bronchodilatorinhalator devices and able to assist aperson in using these devices if theyexperience breathing difficulties.

• A first aid provider who is carrying abronchodilator inhaler and specificallytrained to use it may administer thebronchodilator at their discretion, iflocal regulations allow this.

• People with breathing difficulty should bemoved to a comfortable position (usuallysitting), and any restrictive clothing should beloosened.

• A first aid provider familiar with the commonlyused bronchodilator inhaler devices (inhaler)may assist a person in using the person’s owninhaler if local regulations allow.

• A first aid provider specifically trained mayadminister a bronchodilator at their discretion, iflocal regulations allow.

• Specifically-trained first aidproviders can givesupplementary oxygen to aperson having an asthmaattack, if local regulationsallow this. If the person hasno inhaler or the inhaler isineffective, or if the person isexperiencing severebreathing difficulties (changein mental status, slow andless noisy breathing), the firstaid provider should accessemergency medical services(EMS) and continue toobserve and assist theperson until help arrives.

• The first aid provider shouldmove the person away fromthings that may be triggeringthe attack, such as smoke ordust.

• In both high- and low-resourcesettings, a person with asthmamay not have an inhaler withthem. Give learners theopportunity to practise what todo when there isn’t an inhaleravailable. This may includeactions to calm the person orhelp them breathe more easily,such as loosening clothing andhelping them to sit up. You mayalso move the person away fromthe trigger causing the asthmaattack (such as smoke).

• In areas where EMS servicesare extremely limited or non-existent, individuals should learnstrategies that can help to easebreathing until the attack passes.

• Check legal restrictions thatgovern the help first aidproviders can give and educatewithin these. If necessary,

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include these laws in the educational content.

Croup • The child may lie in any position that iscomfortable for them and ideallyenables easy breathing.

• If there is a significant shortness ofbreath, EMS should be activated,otherwise the child should be taken toa healthcare provider or medicaldoctor.

• The child may lie in any position that iscomfortable and enables easy breathing.

• If there is a significant shortness of breath,advanced medical care should be accessed,otherwise the child should be taken to theirregular healthcare provider.


No specific educational considerations were identified for this topic.

Chest Pain • Patients experiencing chest pain,believed to be cardiac in origin, shouldchew 1 adult or 2 low-dose aspirinswhile waiting for health-careprofessional assistance to arrive,unless there is a contraindication,such as an allergy or bleedingdisorder.

• If a heart attack is suspected, emergencymedical services (EMS) should be accessedimmediately.

• While waiting for EMS to arrive, the personsuspected of having heart attack should take asingle oral dose of 150–300 mg chewableaspirin expect in the following cases: there is aknown reason that the medication would causethe person harm (e.g., they are allergic or havea bleeding disorder), or the person takes aspirinregularly and has just taken the recommendeddose.

• The first aid provider should help the person getinto a comfortable position (usually semi-sitting);the person should refrain from physical activity.

• If the person has medication,is diagnosed with angina, andis showing signs of acutechest pain, the first aidprovider should help themtake their medication. Themedication should take effectwithin a few minutes.

• Accessing medical careshould always be considered.Urgent access is necessary ifthe pain is intense, theperson has shortness ofbreath, the person is clammy,pale, or has a bluish colour totheir skin, nails, or lips, or ifthe pain does not subsideafter a few minutes.

• If EMS is delayed, get anautomated externaldefibrillator and keep it closeto the person in case it isneeded.

• If trained to do so and localprotocols allow, the first aidprovider may give the person

• In places with ambulances, EMScan provide treatment duringtransport to the hospital, whichcan improve the person’soutcomes.

• Be aware of the recommendedmedications available in yourregion or jurisdiction, forexample glyceryl trinitrate forangina or aspirin for a heartattack. Additionally, be aware ofthe laws surrounding whether afirst aid provider can assist withor administer medication.

• Emphasize that sitting in acomfortable position eases thestrain on the heart, and if theperson collapses, they are lesslikely to injure themselves.

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aspirin and instruct them to chew it.

Stroke • Use of a stroke assessment system,such as FAST, should be employed.o Face, Arms, Speech, Time

• First Aid providers should note thetime of stroke symptoms/signs onset.

• First aid providers should use a strokeassessment system, such as FAST, torecognize the symptoms of a stroke.

• Mild stroke-like symptomsthat last less than a fewminutes indicate a transientischemic attack (TIA) or “ministroke”. The personexperiencing these symptomsshould seek advancedmedical care as soon aspossible to decrease the riskof more permanentoutcomes.

• For a person showing strokesigns and/or experiencingstroke symptoms, EMS mustbe accessed as soon aspossible.

• First aid providers shouldhelp the person into acomfortable position. There islimited evidence in favour ofsupine position or sittingposition.

• Learners’ access to care,available transport, and distanceto the nearest medical facility willvary depending on their localcontext. Work with learners todefine what EMS access lookslike in their community. In somesettings, an ambulance willarrive within minutes after EMSis called, while in others the ill orinjured person may need to waitfor a medical professional tocome to them. In some cases,the first aid provider musttransport the person to themedical facility by car, boat, orother means.

• A quick response time is criticalto caring for someone who ishaving a stroke. Understandingthe EMS in their communitybuilds learners’ confidence to actquickly and determine the fastestmethod to transport the personto a medical facility.

• In many homes there are waysto measure blood glucosebecause a family member hasdiabetes. If possible, the first aidprovider may be able to performa blood glucose test for theperson who has had a strokeand may use a stroke scaleassessment including glucosemeasurement in relation with theEMS system.

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Dehydration First aid providers could use three percent to eight percent carbohydrate-electrolyte drinks for exertion-related dehydration.

If three percent to eight percent carbohydrate-electrolyte drinks are not available or not tolerated, alternative beverages for rehydration include water, 12 percent carbohydrate-electrolyte solution, coconut water, two percent milk, tea, tea-carbohydrate-electrolyte, or caffeinated tea beverages.

• First aid providers should rehydrate the personusing either commercially prepared oralrehydration salts (ORS) or a pre-prepared saltpackage that complies with the World HealthOrganization's recommendations for ORSsolutions.

• First aid providers could use three to eightpercent carbohydrate-electrolyte drinks forexertion-related dehydration. If these are notavailable or not tolerated, alternative beveragesinclude water, 12 percent carbohydrate-electrolyte solution, coconut water, two percentmilk, tea-carbohydrate-electrolyte drinks, andcaffeinated or non-caffeinated tea.

• Emergency medical services (EMS) should be called if the person's responsiveness is altered (trouble waking up, confusion) or if the person becomes unresponsive.

• First aid providers should seek medical advice if they are in doubt, or if the person:o Is a baby or older adult.o Loses more fluid than

they take (e.g., severe vomiting).

o Urinates very little(especially if the urine is a dark colour) or does not urinate at all.

o Has fever or signs of heat exhaustion. (See Hyperthermia.)

• Ask learners to identify thosemost at risk of dehydration intheir own lives and how to helpto prevent it.

• Help learners recognize thatdehydration can also occur incold settings when people weartoo many layers and overexertthemselves.

• Provide learners with visual,written, or verbal informationabout how to recognizedehydration.

Abdominal Pain

Nothing noted in 2016 Guidelines • Paracetamol may be effective to relieve mildperiod pain. Non-steroidal anti-inflammatorydrugs (ibuprofen, diclofenac, naproxen, etc.)may also be effective, however, they may haveside effects (e.g., upset stomach or conflict withother medications). The person should takepainkillers with regularity on the days with painaccording to the recommended dose and timeinterval.

• Even mild cases ofabdominal pain may require amedical examination althoughthe need is not necessarilyurgent.

• Reassurance and ensuringthe person is comfortable areimportant: lying on the groundwith both legs up can relievepain.

• A hot water bottle or heatedwheat bag held against theabdomen may relieve thepain, anxiety, or nausea.

• Incorporate prevention educationaround food hygiene and handwashing.

• Explore different causes ofabdominal pain and focus onwhich instances are consideredemergencies and when medicalcare is required.

• Draw on learners’ ownexperiences of stomach pain tocontextualize their learning.

Unresponsive-ness

• First aid providers should start CPR ifneeded. Be aware that sometimes a

• If a person is found motionless, usually lying onthe ground and/or in an unusual position,

• The level of responsivenesscan be determined with theAVPU scale: Alert—Verbal—

• A person can becomeunconscious suddenly (e.g., dueto a stroke, electrocution, or

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person in cardiac arrest may initially present a short seizure-like activity.

• Consider other causes such aspoisoning, diabetic emergency, headinjury, etc.

• First aid provider should put theperson in the recovery position andcall for EMS.

In 2016 this topic was listed as “Unresponsive and Altered Mental States.”

unconsciousness should be assumed and checked immediately: o Shout and shake the person gentlyo Open the person’s airwayo Check for normal breathing for no longer

than 10 secondso If the person does not breathe normally,

start chest compressions (seeResuscitation)

• If normal breathing is present, but the persondoes not respond, he or she is very likelyunconscious

• If the person reacts only to Pain, or isUnresponsive, airways should be kept opened:o If cervical spine injury is suspected, by jaw

thrust only, if not:o By head tilt-chin lift maneuver or by

establishing recovery position,o Checking regularly whether normal

breathing is still present

Pain—Unresponsive, describing what kind of stimulus the patient reacts to, if any.

head injury) or gradually (e.g., in certain poisonings or progressive hyperglycemia).

• An altered mental status mayprecede unconsciousness, andthe first aid provider mayintervene before loss ofconsciousness occurs, as incases of hypoglycemia.

• An altered mental state may bea forerunner ofunconsciousness, but the personmay also experience normalresponsiveness or evenhyperactivity following an alteredmental state.

Feeling Faint • If the person is breathing normally butremains unresponsive, maintain apatent airway by considering head-tilt/chin-lift, or recovery position.

• If there is abnormal or no breathing,resuscitation should be startedimmediately.

• An unresponsive person should berapidly assessed for breathing/signs ofcirculation and perfusion (if trained todo this assessment).

• If the person is face down andunresponsive (prone position), the firstaid provider should turn their face up(supine position) to check breathing.

• The first aid provider should activateEMS for a person who loses

• First Aid providers should assist the person indoing physical counterpressure manoeuvres.

• While in a safe and comfortable position, peoplefeeling faint can perform counterpressuremanoeuvres on their own to lessen the feeling.

• A person who is feeling faintshould be helped into a safeand comfortable position,such as sitting or lying on thefloor, so they cannot fall andto lessen the faint feeling.

• The first aid provider shouldimmediately assess anunresponsive person’sbreathing and circulation.

• Advanced medical careshould always be accessedfor a person who losesconsciousness as the causecould range from minor tolife-threatening (see DiabeticEmergency, Stroke, Head

• Fainting is a commonoccurrence, particularly in warmclimates and in areas with littlefresh air. Ask learners forexamples of when they have feltfaint. What was thetemperature? Were theyhungry? Tired? Stressed?

• Individuals who regularlyencounter or interact withpregnant women should learnhow to support and lay thewoman on her left side if she isfeeling faint.

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consciousness as causes can range from not serious to life-threatening.

• First aid providers should consider thatany person who loses consciousnessmay have had a stroke or seizure, ormay have low blood sugar or anotherserious condition.

and Spine Injury, and Poisoning.)

Earache Nothing noted in 2016 Guidelines • First aid providers should provide paracetamolfor pain relief.

• Medical advice should besought when there is fever,fluid draining from the ear,vertigo, or loss of ordecreased hearingassociated with ear pain.

• The person should seekmedical advice if thesymptoms don’t get better (orget worse) within 48 hours.

• A source of heat can be heldagainst the affected area andmay reduce pain.

• Individuals who look afterchildren or spend time in watercontexts (e.g., public swimmingpools) could benefit fromlearning about earaches.

Sore Throat Nothing noted in 2016 Guidelines • Paracetamol should be considered to reduce thepain caused by a sore throat.

• Nonsteroidal anti-inflammatory drugs (such asaspirin and ibuprofen) can be used as second-line treatment for sore throat, should paracetamolbe ineffective.

• A single nighttime dose of honey may have asmall positive effect on a cough and sleep inchildren over a year old.

• The first aid provider should encourage the person to drink water in small amounts.

• Harsh or high-pitched breathing sounds, the inability to swallow, or drooling may indicate epiglottitis. All cases of epiglottitis should receive urgent medical care.

• If a first aid provider suspects the person has epiglottitis, they should help the person rest in a comfortable position until they can access medical care.

• Emphasize that while sorethroats are usually not serious,they may be a symptom of amore severe condition andlearners must recognize thesituations in which to accessadvanced medical care.

• It can be difficult for people toidentify the cause of a sorethroat (viral, bacterial, orenvironmental). Early actions,such as giving the ill person adrink, can help to eliminate somecauses and help the learner toidentify if the condition is moreserious.

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• Encourage learners to look forother signs and symptoms, and toconsider causes, such aswhether the person has beennear another person who has acold or flu, as this will help toinform treatment.

Headache Nothing noted in 2016 Guidelines 1. Reduce anything that may worsen the headache (such as direct sunlight or noise).

2. Advise the person to rest in a dark, quiet room with an ice-pack or cold towel applied to the affected area.

3. Seek medical care if :o The pain follows a Head and Spine Injury.o The person is also showing signs of a

Stroke.o The person is experiencing a severe

headache for the first time.o The headache is severe and happens very

quickly with no known cause, and the person feels sick.

o The headache is serious and the person also has a fever, a sore or stiff neck, or drowsiness, or is vomiting.

o The headache started suddenly within the last three months of pregnancy.

• Emphasize rest, hydration,relaxation techniques, and a coolcloth on the forehead or neck aseffective first aid support for mildheadaches.

• Emphasize that while aheadache is usually not serious,it may be a symptom of a moresevere condition and learnersmust recognize the situations inwhich to access advancedmedical care.

Hiccups Nothing noted in 2016 Guidelines • Harmless home remedies such as holding thebreath for a short time, breathing into a paperbag, sipping ice-cold water, swallowing somegranulated sugar, biting into a lemon, or tastingvinegar may be effective and could beattempted.

• The use of gripe water is notrecommended.

• A person with hiccups shouldseek immediate medical helpif hiccups last longer than 48hours or if they have othersymptoms in combination

• This topic does not usually formpart of first aid education,however it may be useful forsome audiences such as schoolnurses, new parents, or otherpeople who care for children.

• Paracetamol and otherpainkillers should only beused if a headache resultsfrom minor causes such asflu, tiredness, or stress, butnever in emergencysituations.

• Applying an ice pack or coldcompress to the head or backof the neck may provide relieffrom migraine symptoms.

• Bright lights (e.g., from anoffice or phone screen) maymake a headache or migraineworse. If the individual witheither condition is sensitive tolight, they should sit or lie in adark or dimly lit room.Individuals with a headacheshould get fresh air, enoughsleep, regularly drink water(see Dehydration), and taketime to relax.

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with hiccups, such as chest pain, weakness in their limbs or face, headache, or trouble keeping their balance.

• Define what a hiccup is and howit happens, and discuss differentsafe home remedies.

Back Pain Nothing noted in 2016 Guidelines • Paracetamol does not relieve the symptoms oflower back pain but may provide short-termrelief for osteoarthritis.

• Nonsteroidal anti-inflammatory drugs (NSAIDs)may be as effective as paracetamol at relievingacute lower back pain.

• Heat wrap therapy may provide some short-term pain relief and reduce disability in thosewith a combination of acute and subacute lowback pain. There is insufficient evidence on theeffects of applying a cold source to reduce lowback pain.

• The person should sit or laydown in the position mostcomfortable to them.

• Emphasize that lower back painhas many different causes(some are common and mildwhile others can be serious).Helping the person to accessprofessional medical advice isan important first aid action as itwill help them learn how tomanage their pain.

• Use scenario-based learning topractise recognizing andmanaging back pain (e.g.,participants could recognize thatsomeone who has back painmay have been involved in amotor vehicle collision in thepast).

• Learners may have differentbeliefs as to what lower backpain is and what causes it.Facilitate a discussion to betterunderstand these beliefs.

Fever • If the person is suffering from fever,paracetamol or acetaminophen shouldbe given to them.

• Paracetamol or acetaminophen can becombined with sponging with tepidwater (from 29°C to 33°C) as long as itdoes not cause the person to getupset or to start shivering.

• Do not use cold water for sponging asthis results in more discomfort.

• Paracetamol or acetaminophen should be given to the person with a fever.

• Paracetamol or acetaminophen should be combined with sponging the person with warm water (29°C to 33°C, or 84.2°F to 91.4°F) as long as it does not make them upset or start to shiver.

• When sponging, cold water should not be used as it will cause more discomfort.

• When sponging, cold water should not be used. It can either cause the blood vessels to constrict and prevent the body from giving off heat or cause the person to produce more heat by shivering.

• A person with a fever requires immediate care if they also have:

• Since fever can indicate a moreserious illness or trigger aSeizure, it is important forlearners to understand their rolein looking out for signs thatindicate the need to accessmedical care.

• Discuss clothing in the context ofyour climate—what clothing orlayers will make the person most

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• Do not use cold water for sponging asthis can have the opposite reaction,i.e., heat the body more.

• The infant, child, or adult should bereferred to a healthcare professionalas soon as possible, if the:o infant under two months of age

has fevero children up to two years of age

has fever higher than 39°C or102.5°F

o person is over 65 years of ageo person suffering from fever has

cancer, a weakened immunesystem, sickle cell disease,medications which affect immunesystem

o fever does not decreaseo fever is accompanied by a rasho fever is accompanied with a

persistent cougho fever is accompanied with

abdominal pain• The person requires immediate care in

cases of:o fever with change in mental statuso fever with difficulty breathingo fever with headache or stiff necko fever with severe abdominal paino fever with any signs of shock

• Persons with fever should rest anddrink fluids to replace the loss of fluidsdue to sweating.

• Persons with fever should dress lightlyand one should avoid covering themwith excessive blankets or coverings.

o A rasho A persistent cougho A change in mental statuso A headache or stiff necko Difficulty breathingo Severe abdominal paino Signs of shock

• A person with a fever shouldrest and drink fluids toreplace the loss caused bysweating.

• A person with a fever shoulddress lightly, and the first aidprovider should avoidlayering them with excessiveblankets or coverings.

comfortable and not cause them to overheat or feel cold?

• Consider which fluids will bestkeep the person hydrated andcool (e.g., a baby should havetheir breast or bottle milk whilean adult will benefit more fromcool water).

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Seizure • First aid providers may place a personexperiencing a seizure on the floor toprevent them from being injured.

• Once the seizure has ended, first aidproviders should assess the airwayand breathing and treat accordingly.

No specific guidelines were identified for this topic • Protect the person from harmby moving any nearby objectsthat may hurt them. Avoidmoving the person unlessthey are in immediate danger(e.g., they are in oncomingtraffic).

• Place soft padding under theperson's head to protect it.Remove eyeglasses andloosen any restrictive clothingfrom around their neck. Donot restrain the person.

• Access emergency medicalservices (EMS) or the nextavailable higher level of careif the person has hurtthemselves, it is the person’sfirst seizure, the seizure lastsfor more than fiveconsecutive minutes, or theyhave repeated unexpectedseizures. If further care is notavailable, follow the first twobullet points above as this willhelp the person.

• Note the start and stop timeof the seizure, as well as if itreoccurs. Communicate thisinformation to EMS ifavailable.

• When the episode is over,check the person's breathing.If they are breathing normally,move them on to their sideand ensure their airway isopen. If they have irregularbreathing, seeUnresponsiveness or the

• Address any misconceptionsabout epilepsy and seizures toreduce stigma and prejudice.

• Discuss learner’s experienceswith seizures and address anybarriers to providing care.

• Acknowledge common mistakeswhen caring for a personexperiencing a seizure, such astrying to:o Open the person’s moutho Put something in the

person’s moutho Restrain the person

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Adult or Child, Infant, and Neonatal CPR sections.

Notes • Do not put anything in the

person’s mouth.• If you do not know the

person, look for any medicalinformation they may have onthem, such as a medicalbracelet with details of theircondition, before accessinghelp.

• If present, ask a familymember or caregiver if theperson has any anti-seizuremedication. There are manyways this medication can beadministered, including orally,a spray in the nose, aninjection, or rectally. Assistthe caregiver if you feelcomfortable doing so.

• Protect the person’s dignity.For example, movebystanders along or coverany signs of accidentalurination.

• If the person has a mildseizure, stay calm and keepthe person safe. Stay withthem until the seizure haspassed.

Babies and Children • In addition to the steps

above, check the baby orchild's temperature. If theyare too hot, cool them by

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removing any excess clothing and expose them to fresh, cool air. Treat any Fever if necessary.

Diabetic Emergency

• First aid providers should use 15 g to20 g glucose tablets for treatingsymptomatic hypoglycemia inconscious individuals.

• First aid providers should use 15 g to20 g glucose tablets for treatingsymptomatic hypoglycemia inconscious children and infants.

• Glucose may be repeated if symptomspersist after 15 minutes.

• If glucose tablets are not available,various forms of dietary sugars suchas Skittles, Mentos, sugar cubes,jellybeans, and orange juice can beused to treat symptomatichypoglycemia in conscious individuals.

• If uncertain whether the symptomsdisplayed are for hypoglycemia orhyperglycemia, it is reasonable to treatfor hypoglycemia.

• 15 g to 20 g of glucose tablets should be usedto treat symptomatic hypoglycemia in consciousadults, children, and infants.

• Glucose should be repeated if symptomscontinue after 15 minutes.

• If glucose tablets are unavailable, other forms ofdietary sugars such as candy (e.g., jellybeans,Mentos), sugar cubes, or orange juice may beused to treat symptomatic hypoglycemia inconscious individuals.

• If it is unclear if the person ishypoglycemic orhyperglycemic, the first aidprovider should care forhypoglycemia.

• Introducing the termshyperglycemia and hypoglycemiais important, however, you mayconsider keeping language to“high blood sugar” and “lowblood sugar”, particularly whenthe learners are children.

• Emphasize the importance ofrecognizing hypoglycemia as itrequires immediate care. If thebrain is deprived of sugar, this canlead to Seizures and possiblebrain damage.

• Affirm that providing care forhypoglycemia will rarely worsenhyperglycemia and may preventor treat life-threateningconditions. Also seeUnresponsiveness, Seizures,and Stroke.

Shock • For a person experiencing or

threatened by shock, bodytemperature should be maintained bypreventing heat loss.

• First aid providers should place theperson in shock in the supine (lying onback) position.

• First aid providers should position theperson who is unresponsive andbreathing normally on their side whileensuring that their airway is open(recovery position).

• First aid providers should prevent heat loss for aperson experiencing (or with potential toexperience) shock.

• The person in shock should be placed in asupine position (lying on their back).

• If the person is unresponsive and breathingnormally, the first aid provider should place theperson on their side in the recovery position,ensuring their airway is open.

• Advanced medical care shouldbe accessed if it appears theperson may experience orshows symptoms of shock.

• If a known heart attackcauses shock, a supineposition with the upper bodyslightly elevated should beconsidered.

• If the person has difficultybreathing or is uncomfortablein a supine position, they maybe placed in the position most

• As many of the sudden illnessesand injuries that are covered in aFirst Aid course can lead toshock, it is recommended thattreatment for shock be facilitatedearly in the course (with thebasic steps of First Aid) and re-emphasized throughout thecourse

• Since there are a variety of signsof shock, draw on learnerexperiences and stories of whatthey might have observed to

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• First aid providers may raise the non-injured person’s legs 30 degrees to 60degrees if it makes them feel better;this may improve the vital signs for afew minutes.

• First aid providers should activateEMS if the person seems to bethreatened by shock or shows signsand symptom of shock.

• For people experiencing shock causedby a known heart infarction, differentpositioning (like supine position withslight elevation of the upper body)should be considered.

• If the person is having breathingdifficulties and will not tolerate beingsupine, first aid providers may help theperson to get in a position being mosttolerable or comfortable for them(usually semi-sitting or sitting positionleaning forward).

comfortable to them, such as semi-sitting or sitting while leaning forward.

underline the need to be alert to different ways to recognise shock.

Motion Sickness

Nothing noted in 2016 Guidelines • Controlled breathing and distracting the illperson with an activity (e.g., listening to music)may help to reduce symptoms.

• Looking straight ahead at a central point maydecrease nausea.

• If possible, stopping themeans of transport maydecrease nausea.

• Those that have usedmedications such asantihistamines to relievemotion sickness in the pastshould continue to use them.

• Either looking outside andfixing the gaze on a centralpoint on the horizon orrestricting one’s view (e.g.,closing one’s eyes) may help toprevent motion sickness.

• Include the types of transport andrelated first aid care that arerelevant to learners and theirenvironment.

• Some areas may have safetyconsiderations that preventlearners from stopping theirvehicles. The first aid educationshould acknowledge and discussthese considerations in a learningactivity.

• People who may travel withchildren (teachers, parents,coach drivers) may find it useful tolearn about motion sickness.

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3.0 Injury


Burns • Burns should be cooled with cold wateras soon as possible for a minimum often minutes.

• As clean water is available in manyareas of the world, clean tap watershould be used.

• Ice and ice water should NOT beapplied to burn wounds.

• After cooling, it is recommended thatburn wounds should be dressed with asterile dressing dependent on the localburn treatment policies. (Good PracticePoint)

• In cases of minor burns that will not beseen by a medical health professional,honey or aloe vera may be applied tothe wound.

• NO remedies should be applied beforea medical practitioner has reviewed thewounds.

• Care must be taken when cooling largeburns or burns in infants and smallchildren so as not to inducehypothermia. A first aid provider shouldNOT burst the blister(s).

• The burn should be cooled with running waterfor 10 minutes.

• After the burn has been cooled, a dressing likehydrogel that maintains a moist environment,contours easily to the wound, and is non-stickshould be used.

• Chemical burns of the skin and/or eyes shouldbe rinsed with drinking water and, if available,with diphoterine.

• Further injury should beprevented where appropriateby dealing with the source ofdanger, for example bycovering a pot of hot oil.

• Clothing and jewellery incontact with or close by theburned skin should beremoved to support coolingand reduce additionaldiscomfort.

• After a burn has beencooled, covering it in a cleancloth or plastic film canprotect it during transit tofurther medical care.

• Prevention is a key focus ofburns. Consider the context oflearners and adapt theirprevention material accordingly,identifying the source of burnsthat learners are most likely toexperience.

• Approach topics which havemyths or incorrect informationattached to them, such as thebelief that only people withlighter skin can be sunburned.Using sunscreen and avoidinglong periods in direct sunlight isimportant across all ethnicitiesand skin types to reduce burningand the increased risk of skincancer that accompanies it.

• Emphasize that cooling the burnis important to reduce thedamage to tissue. The cookingeffect continues even after theskin has been removed from thesource of heat.

Friction Burns

Nothing noted in 2016 Guidelines • Keeping a blister intact may decrease the risk ofbacteria entering the body and causing aninfection, compared to draining it (aspiration) orremoving the top layer of the blister (deroofing).

• Draining a friction blister thatis filled with fluid willimmediately reduce the painassociated with the blister. Ifdrained, the blister should becovered with a steriledressing to ensure the roofattaches to the underlyingskin and that the blister doesnot refill with fluid.

• Antibiotic ointments areadvocated for the immediate

• Emphasize prevention andpreparedness as these are themost effective strategies formanaging blisters.

• Explore dressings that might beused to treat blisters.

• Education may also cover theremoval of dressings whichshould, if possible, not damagethe blister. Adhesive-removalsprays are available in some

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treatment of friction blisters only.

• Friction blisters can lead toopen wounds, bleeding, andinfection, limiting anindividual’s mobility. In thesesituations, the person shouldstop the activity causing theblister, cover the blister witha sterile dressing and seekmedical advice.

pharmacies and may make removing dressings easier.

Abrasions/ Wounds

• Superficial wounds and abrasions should be irrigated with clean water, preferably tap water because of the benefit of pressure.

• First aid providers may apply antibiotic ointment to skin abrasions and wounds to promote faster healing with less risk of infection.

• First aid providers may apply an occlusive dressing to wounds and abrasions with or without antibiotic ointment.

• The use of triple antibiotic ointment may be preferable to double- or single-agent antibiotic ointment or cream.

• If antibiotic is not used, antiseptic could be used.

• There is some evidence that traditional approaches, including applying honey, are beneficial and may be used on wounds by first aid providers.

• People with wounds that become red, warm, or painful, or that are accompanied by a fever, should seek assessment from a healthcare provider.

• Superficial abrasions and wounds should becleaned with potable water, preferably from atap to provide pressurized water flow.

• An antibiotic ointment may be applied to skinabrasions and wounds to help them heal fasterand lessen the risk of infection.

• An occlusive dressing (an air- and water-tightdressing) may be applied to abrasions andwounds with or without antibiotic ointment.

• If warmth, redness, or paindevelops around the woundarea, or if the persondevelops a fever, this is anindication of Infection andthe person should seekmedical advice immediately.

• Particular local risks, as well asaccess to clean water anddressings, need to be consideredwhen teaching this topic.

• Different populations respond towounds (particularly minorabrasions) in differentways. While children can react tothe shock of the injury bydemonstrating high levels ofpain, adults might beembarrassed to ”cause afuss.” Educators can establishhow different learners mightrespond by discussingexperiences with differentwounds of different severities,and how they would approachproviding care.

• There are myths and socialconventions around woundtreatment. It is important to letlearners share these in order tobuild knowledge about what themost appropriate and availabletreatment might be.

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Bleeding • First aid providers must control externalbleeding by applying direct pressure.

• The use of pressure points andelevation is NOT recommended.

• When direct pressure fails to controllife-threatening external limb bleedingor is not possible (e.g., multiple injuries,inaccessible wounds, multiplecasualties), tourniquets could beconsidered in special circumstances(such as disaster, war-like conditions,remote locations, or instances wherespecially trained first aid providers areproviding care).

• Localized cold therapy with or withoutpressure may be beneficial inhemostasis for closed bleeding inextremities. Caution is advised whenapplying this recommendation tochildren due to a potential forhypothermia.

• The out-of-hospital application of atopical hemostatic agent to control life-threatening bleeding not controlled bystandard techniques and in situationswhere standard techniques could notbe applied could be considered withappropriate training.

• External bleeding should be controlled byapplying direct pressure.

• Pressure points and elevation should not beused to stop bleeding.

• When direct pressure fails to control life-threatening bleeding from an external limb or itis not possible to apply (e.g., due to multipleinjuries, inaccessible wounds, or when injuredpeople outnumber first aid providers),tourniquets may be used in certaincircumstances, such as disaster events, war-likeconditions, or remote locations.

• Tourniquets may be used by specially trainedfirst aid providers.

• With or without pressure, the application of coldtherapy may be beneficial to achievehemostasis for closed bleeding in extremities.

• When it is impossible to apply standardtechniques, or when they are not working, theapplication of a topical hemostatic agent couldbe considered to control life-threateningbleeding, so long as the first aid provider hasthe appropriate training.


• The inclusion of topicalhemostatic agents in thecurriculum should be based onthe availability of thesesubstances and the question ofwhether laypersons are legallyallowed to use them.

• If tourniquets and/or topicalhemostatic agents are includedin first aid education, training inthe application techniques andproper assessment of severebleeding is required. Learnersshould be aware that thesetechniques should only beapplied in life-threateningsituations where direct pressurecould not be applied or is noteffective. See Shock.

Head and Spine Injury

• First aid providers may suspect a spinalinjury if an injured person displays anyof the following risk factors:o over 65 years of ageo driver, passenger, or pedestrian in

a motor vehicle, motorized cycle, orbicycle crash

o fall from a greater than standingheight

o tingling in the extremities

• Any person suspected of sustaining trauma (aforceful bump, blow, or jolt to the head or bodythat results in the rapid movement of the headand brain), along with any of the symptoms of aconcussion, must be presumed to have a minortraumatic brain injury (mTBI) or concussion.

• Any person with a mTBI or concussion muststop any activity and seek advanced medicalcare from a healthcare professional qualified toevaluate and manage a concussion.

• If the person has an alteredmental status (e.g.,Unresponsiveness), ablocked airway or abnormalbreathing, a seizure,impaired vision, abnormalfunctioning anywhere in thebody, or bleeding from thenose, ear, or mouth,advanced medical care mustbe accessed immediately.

• If your region has specificprograms for sport contexts,consult with local experts todetermine if first aid providersshould be taught specificscreening tools to identify aconcussion.

• Correct application of a cervicalcollar requires training andregular practice; thereforeemphasize the first aid provider’s

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o pain or tenderness in the neck orback

o sensory deficit or muscle weaknessinvolving the torso or upperextremities

o not fully alert or is intoxicatedo other painful injuries, especially of

the head and necko children with evidence of head or

neck trauma• For layperson first aid providers the

routine application of cervical collars isNOT recommended.

• First aid providers should NOT strapthe head or neck.

• In the case of suspected cervical spineinjury it is recommended to manuallysupport the head in a position limitingangular movement until experiencedhealthcare provision is available.

• The person may have a spinal injury if they haveany of the following risk factors:o Over 65 years oldo Driver, passenger, or pedestrian in a motor

vehicle or bicycle crasho Fall from higher than standing heighto Tingling in the extremitieso Pain or tenderness in the neck or backo Sensory deficit or muscle weakness in the

torso or upper extremitieso Altered mental status, possibly intoxicated

• If the sports concussionassessment tool (SCAT3) hasbeen used to assess a personwith a suspected concussion,healthcare professionals mayuse this assessment asrecognition of the concussionfor further care.

• If a cervical spine injury issuspected, the head shouldbe manually supported to limitmovement until advancedmedical care is available.

role in differentiating between high-and low-risk individuals when a collar might have to be applied.

Chest Injury and Abdominal Injury

• For open chest wounds, first aidproviders may leave the wound freewithout applying a dressing.

• If a wound dressing is necessary, non-occlusive wound dressings could beused (that is, one that does not seal thewound).

• For chest and abdomen injuries, firstaid providers should manage shock andplace the person in a comfortableposition.

• For open abdominal wounds, first aidproviders may place a sterile dressingon the wound.

• First aid providers should not push backviscera (internal organs).

• First aid providers should stabilizeimpaled objects.

• An open chest wound may be left open, withoutthe application of a dressing.

• If a wound dressing is necessary, a non-occlusive dressing could be used.

• First aid providers shouldcare for Shock and place theperson in a comfortableposition.

• A sterile dressing may beplaced on open abdominalwounds.

• Internal organs should not bepushed back into the body.

• Impaled objects in the bodyshould be stabilized.

• If there is significant externalbleeding from a chestwound, direct pressureshould be applied, providingit does not completely sealthe wound. (See Bleeding.)

• In high-resource settings thismay be delivered withpresentationsoftware/video/simulationmannequins. These tools can beespecially useful in providing theopportunity to practice directpressure and the application ofdressings aroundimpaled/embedded objects.

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• If there is significant external bleeding,direct pressure to the chest wound witha hand and/or a dressing should beapplied. Care must be taken that it doesnot become occluded.

Fractures, Sprains, and Strains

• A first aid provider could cool a sprained joint or soft-tissue injury.

• First aid providers should assume that any injury to an extremity could include a potential bone fracture and manually stabilize the extremity injury in the position found.

• There is insufficient information to make recommendations for straightening an angulated fracture. For remote situations, wilderness environments, or special circumstances with a cool and pale extremity this may be considered by a trained first aid provider.

• Ice or cooling should NOT be applied for more than 20 minutes.

• First aid providers should assess for hemorrhage in all fractures and treat for shock in fractures involving long bones, especially femur, due to possibility of significant internal hemorrhage.

• Based on training and circumstance, providers may need to move an injured limb or person. In such situations, providers should protect the injured person. This includes splinting in a way that limits pain, reduces the chance for further injury, and facilitates safe and prompt transport.

• Ice or cooling may be applied to sprained jointsand soft-tissue injuries.

• Early recognition of theinjury, early transport to amedical facility, andstabilizing the injury tominimize pain should beencouraged.

• It should be assumed thatany injury to an extremity(limb) could include apotential bone fracture andshould be manuallystabilized in the positionfound.

• When in a remote orwilderness environment (orone with limited resources)and the angulated fracture iscool and pale, the first aidprovider may considerstraightening it if trained todo so.

• Ice or cooling should beapplied for 20 minutes orless.

• All fractures should beassessed for internal andexternal bleeding and theinjured person treated forShock, especially if thefracture involves a long bonesuch as the femur.

• Individuals may benefit fromlearning how to take the pulse ofthe injured person and use theirfindings to identify more severeinjuries. While program designersmay consider including this intraining, it should not deterlearners from helping the injuredperson in other ways if they areunable to take a pulse properly.

Facilitation Tips • Spend more time practising

immobilisation techniques,especially improvised splints andbandages, and less time reviewingthe key concepts behind fractures,sprains, and strains.Focus on application.

• Make note that even when ice isnot available, applying a splint orsling to an injured limb may help toreduce the pain.

• Brainstorm as a group what youcould use as an improvisedbandage. Provide time forlearners to practise bandaging.

• Use scenario-based learning topractise accessing medical careand minimizing pain duringtransportation.

• Facilitate discussions on learners'experiences with fractures,sprains, and strains

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and expand on the learning outcomes as they come up in conversation. This activity can help build learners' confidence.

Dental Avulsion

The avulsed tooth may be placed in Hank’s Balanced Salt Solution. If not available, the tooth may be placed (in order of preference) in propolis, egg white, coconut water, Ricetral, whole milk, saline, or Phosphate Buffered Saline.

• The tooth may be placed in Hank’s balancedsalt solution. If this is not available, the preferredorder of solutions is: propolis, egg white,coconut water, Ricetral, whole milk, saline,phosphate-buffered saline.

• First aid providers may notre-implant the tooth.

• The tooth should be held atthe crown, not the root. (Thecrown of a tooth is the areathat sits above the gum.)

• The tooth should not becleaned as this coulddamage vital tissues stillattached to the tooth.

• The person should bereferred to a dentist as soonas possible.

• The use of the solutionsmentioned in the Guidelinesdepends on local laws,regulations, and processes—including liability protection. Insome regions you may need tovary the list of recommendedsolutions according to theeducational opportunities withinthe local context.

4.0 Environmental


Hypothermia Nothing noted in 2016 Guidelines • A person experiencing hypothermia who isresponsive and shivering vigorously should bewarmed passively with a polyester-filledblanket.

• If the person is responsive and shivering but apolyester-filled blanket is not available,alternative equipment may be used including adry blanket, warm, dry clothing, andreflective/metallic foil.

• If the person is not shivering, and if resourcesare available, first aid providers should activelywarm the person.

• People experiencinghypothermia should betreated with care. Theyshould be removed from thecold source and have theirwet clothes removed. If theperson is moderately toseverely hypothermic,clothes should be cut off tominimize their movement.

• Care should then be taken toinsulate the person byplacing a barrier betweenthem and the ground (e.g., atarp and sleeping bag) to

Key topics to cover when planning and delivering a first aid program should include: • How to prevent hypothermia and

Frostbite in cold environments.• How to reduce the risk of

experiencing an avalanche,including familiarizing learnerswith local avalanche warningsigns and safe behaviours tofollow (e.g., avoid closed skislopes).

• How to access help in rural orremote environments.

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minimize conductive heat loss. The head and body should be covered to minimize convective and evaporative heat loss.

• For all cases of hypothermia,EMS should be activatedand the person’s airway,breathing, and circulationshould be reassessedfrequently.

• The fact that hypothermia canalso occur in the home (e.g., inolder people who are unable orwho choose not to turn on theheat in cold weather, or peoplewho slip on icy steps and cannothelp themselves up).

• The fact that hypothermia caneven occur in warm temperaturesif a person is wet and inactive.

Snow Blindness

Nothing noted in 2016 Guidelines Snow blindness, also called arc eye or flash eye, is a painful condition in the eye caused by overexposure to ultraviolet (UV) light. It is like the cornea (the transparent outer layer of the eye) has a sunburn. Snow blindness is most likely to happen to people who take part in outdoor sports or activities in relatively high altitudes or at sea, where surfaces reflect light into the eyes. However, artificial sources of UV radiation, such as a welder's torch or sun lamp, have the same effect.

• If applicable, the personshould remove their contactlenses.

• The person should stayindoors and wearsunglasses to relieve pain ordiscomfort.

• The person’s eyes should bekept moist (e.g., using salinesolution or eye drops).

• A cool, damp cloth overclosed eyelids may becomforting.

• The person should avoidrubbing their eyes.

• If symptoms last longer thana day, or if they worsen, theperson should seekadvanced medical care.Depending on the cause,this could be an eye doctoror emergency care (in thecase of a welding accident).

• Learners who are at a higher riskof snow blindness, for examplethose who weld, work with or usesunbeds, or spend time in thesnow or at the sea, may benefitfrom learning about this topic.

• Use relevant or local terminologyfor this condition. For example,welders may refer to thecondition as arc eye or flash eye,whereas learners who spendtime in the snow may call it snowblindness.

Hyperthermia Nothing noted in 2016 Guidelines • The person should stop all physical activity andbe removed from the heat source.

• The person should be immersed in ice-coldwater. If this is unavailable, they should be

Heat Exhaustion 1. Help the person rest in a

cool place and remove anyexcess clothing.

• Combine this topic with other firstaid emergencies (such asBreathing Difficulties or Seizures)so learners can recognize and

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cooled with water or ice packs placed in the armpits or on the neck and groin area.

• Drinking water or a water and salt/sugarsolution may be beneficial.

2. Give them some water todrink. Sport drinks or waterwith sugar or salt may alsobe helpful.

3. Reassure the person andmonitor their breathing andtemperature. If theircondition worsens, accessemergency medical help.

Heat Stroke 1. Help the person rest in a

cool place and remove anyexcess clothing.

2. Cool the person down byimmersing them in ice-coldwater. If this is not available,wet the person with coldwater and place ice packson their neck and groin.Fanning them may alsoincrease the cooling action.

3. Access emergency medicalservices (EMS).

4. Give the person some waterto drink. Sport drinks orwater with sugar or salt mayalso be helpful.

5. Monitor the person’sbreathing and temperature.Try to reduce theirtemperature to 38°C.

Access Help If the person shows signs of severe hyperthermia, access advanced medical care immediately.

differentiate the symptoms of hyperthermia.

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Radiation Injuries

• Avoid touching suspected radioactiveitems.

• Keep distance and do NOT approachsuspected radioactive items oraccident scenes.

• Remove casualties from the scene asquickly as possible.

• Avoid the smoke within 100 metres ofa fire or explosion that involves apotentially dangerous radioactivesource.

• Keep your hands away from yourmouth and do NOT smoke, eat, ordrink until your hands and face arewashed (to avoid inadvertentingestion).

• Exposure to sealed sources does notrequire decontamination. To limitexposure, stay away or place anappropriate shield (lead apron forexample) between the source and theexposed persons.

• Special trained forces should takecare of the decontamination processbut potentially contaminated personsshould be instructed to remove anyclothing while awaiting such teams,which may be of benefit.

• Medical specialists must examine allpersons who might have beenexposed to radioactivity as soon aspossible.

Nothing noted in 2020 Guidelines • Avoid touching orapproaching suspectedradioactive materials oraccident scenes.

• The injured person shouldbe removed from the sceneas quickly as possible .

• First aid providers shouldstay more than 100 metresaway from smoke caused bya fire or explosion involving apotentially dangerousradioactive source.

• To avoid accidentallyingesting radioactivematerial, you should washyour hands and face aftertouching them and beforesmoking, eating, or drinkingif you have been exposed tosuspected radioactivematerials.

• To limit exposure toradioactive sources, stayaway or place a shieldbetween the source andthose who may be exposed(e.g., a lead apron).

• Exposure to a sealed sourcedoes not requiredecontamination.

• The decontaminationprocess should be handledby those specially trained todo so. Everyone who mayhave been exposed shouldreplace any clothing on theirpersons while waiting forspecialists to arrive.

• Encourage learners to becomefamiliar with the “radioactive”symbol and be aware ofemergencies that are dangerousdue to potential radioactivity.

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• Everyone who may havebeen exposed to radiationmust be examined bymedical specialists as soonas possible.

Altitude Nothing noted in 2016 Guidelines • People experiencing AMS, HACE, or HAPEshould stop their ascent immediately and startto descend safely, with support, until theirsymptoms lessen.

• First aid providers trained in its use mayadminister oxygen to individuals experiencingAMS, HACE, and HAPE.

• If a person has prescribed medication foraltitude illness with them (such asacetazolamide, nifedipine, or dexamethasone),the first aid provider may assist them in taking itbased on the label instructions.

• Where local laws, regulations, or protocolspermit, specially trained first aid providers maygive medications (such as acetazolamide ordexamethasone) to individuals experiencingaltitude illness.

• People experiencing altitude illnesses shouldbe kept from getting cold or overheated.

• Ascending to higher altitudes more graduallycan reduce the risk of altitude illness.

• Adequate hydration should be maintained(though not forced) as symptoms ofDehydration can mimic those of AMS.


• Emphasize how to prevent andrecognize the symptoms ofaltitude illnesses as often theperson affected may not realizethey have it.

• Use visual materials (pictures andvideos) to illustrate signs andsymptoms of the different types ofillness that high altitudes cancause.

Decompression Illness

Nothing noted in 2016 Guidelines • In case of suspected decompression illness,first aid providers should administer oxygen atthe highest concentration available (e.g.,through a non-rebreather mask) which mayreduce the symptoms substantially. Theoxygen should be continued until definitivetreatment is obtained.

• Oxygen is a widely acceptedfirst aid measure for cases ofdecompression illness. Insome countries, laws make itmandatory for professionaldiving operations to haveoxygen readily available(e.g., diving traininginstitutions). Therefore, the


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• In cases of cardiac arrest after resurfacing,CPR should be administered with rescuebreathing.

• First aid providers should call EMSimmediately, then the Divers Alert Network(DAN), and indicate the likelihood ofdecompression illness so that transport of theperson to a recompression chamber can bearranged as soon as possible (definitivetreatment is often hyperbaric oxygen providedin a recompression chamber.)

• In locations requiring extended or complicatedtransport to a recompression chamber, rapidtransport to a nearby emergency departmentcapable of resuscitation should be prioritized sothe person can be stabilized prior to beingtransported to the chamber.

• Scuba diving is a special circumstance forwhich oxygen during resuscitation may behelpful despite the measurement of adequateoxygenation.

likelihood of oxygen being available is high at dive sites and likely immediately available if called for by the first responder.

• First aid learners should beinformed about the NationalFirst Aid Guidelines fordecompression illness, aswell as the local proceduresfor care.

Frostbite • People experiencing severe bleedingor major trauma should be kept warm.

• When providing first aid to a personexperiencing frostbite, rewarming offrozen body parts should be done onlyif there is no risk of refreezing.

• Rewarming should be achieved byimmersing the affected part in waterbetween 37ºC (i.e., body temperature)and 40ºC (98.6ºF and 104ºF) for 20 to30 minutes.

• For severe frostbite, rewarmingshould be accomplished within 24hours.

• Chemical warmers should NOT beplaced directly on frostbitten tissuesince these can reach temperatures

• Frostbite is damage to the skin and othertissues caused by extreme cold. When it is cold(at or below 0ºC) or there are strong winds, thehuman body tries to preserve its core bodytemperature by narrowing the blood vesselsclose to the skin. In extreme cases, this canreduce the blood flow in some areas of thebody to dangerously low levels, resulting infrostbite. The fingers and toes are mostvulnerable. Frostbite can lead to permanentdamage but this can be avoided if it isrecognized and treated quickly.

• Warming should be achievedby immersing the affectedarea in water between 37ºC(i.e., body temperature) and40ºC (98.6ºF and 104ºF) for20 to 30 minutes.

• Chemical warmers shouldnot be placed directly onfrostbitten tissue becausethey can reach temperatureshigher than the targettemperature and may causeburns.

• Warming frozen body partsshould be done only if thereis no risk that they mightrefreeze.

• As frostbite is relativelyuncommon, help learnersrecognize it by including imagesin your education material.

• Help learners to identify how theywould get medical help in anemergency if extreme cold wasdisrupting normalcommunications and/or EMSactivities.

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that result in burns and exceed the targeted temperatures.

• After rewarming, efforts can be madeto protect frostbitten parts fromrefreezing and to quickly transport theperson for further care.

• Affected body parts may be dressedwith sterile gauze or gauze placedbetween digits until the personconcerned can reach medical care.

• The use of non-steroidal anti-inflammatory drugs for treatment offrostbite as part of first aid is NOTrecommended based on potential sideeffects of these drugs (e.g., allergies,gastric ulcer bleeding).

• After warming, the frostbittenarea should be protectedfrom refreezing and theperson should seek medicalcare as soon as possible.

• Affected body parts shouldbe dressed with sterilegauze until the person canreach medical care. If fingersor toes are affected, thegauze should be placedbetween them.

5.0 Animal-Related Injuries


Marine Animal Injuries

• Topical application of seawater,baking soda, vinegar, or heat can beapplied for nematocyst deactivation.Fresh water may cause furtherenvenomation. The choice of agentmust be individualized to thegeographic area and species ofjellyfish:o For most jellyfish, remove

tentacles and rinse the injury inseawater.

o For jellyfish species, sea nettleand mauve stinger, apply bakingsoda paste.

o For box jellyfish stings, douse theinjured area in vinegar for 30seconds.

• Seawater, baking soda, vinegar, or heat (e.g.,hot water) should be topically applied to treat amarine animal sting. Fresh water may causefurther stinging. The choice of agent must bespecific to the species of jellyfish:o For most jellyfish, remove the tentacles and

rinse the site with seawater.o For specific types of jellyfish such as sea

nettles and mauve stingers, apply a bakingsoda paste.

o If the jellyfish is positively identified as abluebottle, do not use vinegar as it willcause further stinging.

• The sting site should be immersed in hot waterfor at least 20 to 30 minutes until the pain isgone.

• First aid providers shouldwear proper protection(gloves) and may either usetheir fingers or a flat object,such as a credit card, toremove any tentacles on theskin.

• First aid providers shouldprevent the person fromrubbing the sting site.

• In areas with lethal jellyfish,advanced medical careshould be accessedimmediately. First aidproviders should assess theperson’s airway, breathing,and circulation while

• Emphasize preventativemeasures, such as identifyingwarning signs at the beach andwearing protective suits whenpartaking in aquatic activities inthe ocean or sea.

• Share photos of local jellyfish andprovide basic information such aswhere they can be found.

• Share photos of local jellyfishstings to help learners identifywhat these look like.

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o If the jellyfish is positivelyidentified as a bluebottle orPhysalia utriculus, do NOT usevinegar, as it triggers furtherenvenomation.

• The hot water immersion shouldcontinue until pain is resolved or atleast for 20 to 30 minutes.

• Pressure bandages should NOT beused for the treatment of jellyfishstings.

• Topical application of aluminiumsulphate, meat tenderizer, or watershould NOT be used for the relief ofpain.

• After treatment to remove and/ordeactivate nematocysts, hot waterimmersion could be used to reducepain.

• Any adherent tentacles may be pickedoff with fingers or can be scraped offwith a flat object, such as a creditcard. The rescuer must wear properprotection. The stung area should berinsed well with seawater to removestinging cells that can be seen.

• Stop the person from rubbing the stingarea.

• For areas with lethal jellyfish, first aidproviders should immediatelysummon EMS and assess and treatairway, breathing, and circulationwhile providing other therapies.

• Pressure bandages should not be used to treatjellyfish stings.

• Aluminium sulphate, meat tenderizer, andwater should not be used for pain relief.

• After removing the stinger and treating the stingsite, hot water immersion may be used toreduce the pain.

providing care for any other symptoms caused by the sting.

Insect Bites and Stings

• Use of gasoline, petroleum, and otherorganic solvents to suffocate ticks, aswell as burning the tick with a match,must be avoided.

• The following tick-removal methods must beavoided: using gasoline, petroleum, or othersolvents to suffocate the tick, and burning thetick with a match.

• A bee’s sting should be removed from the skinas soon as possible.

• The bitten or stung areamust be thoroughlydisinfected with alcohol oranother antiseptic solution.

• If warmth, redness, or paindevelops around the area, or

• Ask learners to shareexperiences of being bitten orstung, including how it feels andhow they responded, to developthe group’s confidence to handlethis type of injury.

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• In case of a bee sting, the stingshould be removed as soon aspossible.

• To remove a tick, grab the tick asclose to the skin as possible with avery fine forceps or tweezers and pullit gradually, but firmly, out of the skin.

• In case a commercial tick removaldevice, such as a hook with slipdevice, is available, the tick may beremoved with the removal deviceaccording to the manufacturer’sinstructions.

• The bitten area must be thoroughlydisinfected with alcohol or anotherskin antiseptic solution. First aidersshould avoid squeezing the tick duringremoval since this may injectinfectious material into the skin.

• If a rash, warmth, or pain developsaround the bitten area or the biteleads to fever, the person should seea physician in case antibiotics orvaccinations are needed.

• The first aid provider should recognizesigns of an allergic reaction or signs ofanaphylaxis and treat.

• The first aid provider may grab the tick as closeto the skin as possible with very fine forceps ortweezers and pull it gradually and firmly out ofthe skin.

• If a commercial tick removal device, such as ahook with a slip, is available, the tick may beremoved with the device according to themanufacturer’s instructions.

the person develops a fever, this is an indication of infection and the person should seek medical advice immediately. Antibiotics or vaccinations may be needed.

• First aid providers shouldrecognize the symptoms ofan allergic reaction oranaphylaxis and provide theappropriate care.

• The person should avoidscratching the area as thiscan cause an infection,especially if the fingernailsare dirty.

• Travellers should check tosee what insect-related risksare prevalent in the areathey are travelling to andseek medical advice. Theymay need vaccinations ormedication before leavinghome.

• Demonstrate how to usetweezers to effectively remove atick and credit cards to remove asting.

• Help learners identify how a rashfrom an insect bite differs fromother types of rashes byemphasizing the symptomsassociated with an insect bite,distinctive visual differences, andthe context of where the personwas when the rash developed.

Facilitation Tools • Share photos of local insects and

their associated injuries orinfections to help learners identifythem.

• Bring a variety of tick removaltools to show learners.

Snake Bites • Suction should NOT be applied tosnake envenomation because it isineffective and may be harmful.

• Tourniquet should NOT be applied tosnake envenomation because it is noteffective and may result in prolongedhospitalization.

• The extremity injuries may be kept stillas much as possible or beimmobilized by applying a non-elasticbandage.

• The extremity injuries may either be kept still asmuch as possible or be immobilized byapplying a non-elastic bandage.

• The person should not walk on an immobilizedleg unless no other option is available.

• It is reasonable to keep the injured area at orlower than the level of the heart.

• Specially trained first aid providers may usecompression for special situations such asremote locations and wilderness environments.

• It is reasonable to wash the wound if this doesnot delay hospital transport.

• The person should limitphysical activity.

• A cold compress should notbe applied to a snake bite.

• Washing the wound is notconsidered a routine first aidmeasure.

• Emphasize the importance ofgetting treatment quickly: even ifthe snake is not venomous, thebite can quickly become infected.

• Use pictures of the most commonsnakes in the region to increaselearners’ ability to identify snakesand raise awareness of thedanger.

• Use pictures of the signs andsymptoms to help learners

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• Specially trained providers may usecompression for special situationssuch as remote locations andwilderness environments.

• The casualty should limit physicalactivity.

• Suction should not be applied to a snake bitebecause it is ineffective and may be harmful.

• A tourniquet should not be applied in cases ofsnake envenomation because it is not effectiveand may result in an extended hospital stay.

• The pressure immobilisation technique is notrecommended following bites from a pit viper.

• If properly trained to do so, first aid providersmay consider the pressure immobilisationtechnique, using an elastic bandage, followingthe bite of a suspected coral snake (providingthis does not delay transport time to thehospital).

understand the seriousness of snake bites.

• Be clear about when to usepressure bandaging withimmobilization, what it is, andhow to apply it.

• Dispel myths about snake bites ifthey are prevalent among thelearner audience:o Do not cut or incise the bite.o Do not use an arterial

tourniquet.o Do not suck the bite.

6.0 Resuscitation


Choking (FBAO)

• Chest thrusts, back blows, andabdominal thrusts are equallyeffective for relieving foreign bodyairway obstruction (FBAO) inconscious adults and children olderthan one year.

• In adults and children older than oneyear, the unconscious person shouldreceive chest compressions forclearance of the foreign body.

• Unconscious infants up to one yearold should receive either acombination of back blows followedby chest compressions, or chestcompressions alone for clearance ofFBAO.

• Combination of back blows followedby chest compressions may be usedfor clearance of FBAO in consciousinfants up to one year old.

• In responsive adults and children who arechoking, chest thrusts, back blows, andabdominal thrusts are equally effective.

• If an adult or child is unresponsive, they shouldreceive chest compressions to clear the objectfrom their airway.

• Unresponsive infants should receive chestcompressions, back blows, or a combination ofthe two to clear the object from the airway.

• Responsive infants may receive back blowsfollowed by chest compressions to clear theobject from the airway.

• The finger sweep method may be used inunresponsive adults and children, providing theobject is solid and visible in the airway.

• There is not enough evidence to suggest adifferent approach for an obese adult orpregnant woman who is choking.

• When helping a responsive person, first aidproviders must be able to recognize the signs

• A person with partial chokingshould be monitored untilthey improve as it coulddevelop into completechoking.

• Although injuries have beenreported after using anabdominal thrust, there is notenough evidence todetermine whether chestthrusts, back blows, orabdominal thrusts should beused first on responsiveadults and children.

• Chest thrusts, back blows,and abdominal thrustsshould be applied in quicksuccession until the objecthas been cleared from theairway. More than one

• Because choking often happenswhile eating, a chokingemergency could happen in apublic place. Program designersmay consider framing this as a"helping behaviour" topic as it isone where the bystander effectcould result in people feelinguncomfortable stepping forwardto help. Emphasize that the firststep is asking the person if theyare choking.

• Learning to give back blows canbe challenging as it is notpossible to practice this onanother person for fear of hurtingthem. Stress that a gentle slapwill not expel an object stuck insomeone’s throat: force is

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• The finger sweep could be used inunconscious adults and children olderthan one year with an obstructedairway if solid material is visible in theairway.

• There is insufficient evidence for adifferent treatment approach for anobese adult or pregnant woman withFBAO.

• Although injuries have been reportedwith the abdominal thrusts, there isinsufficient evidence to determinewhether chest thrusts, back blows, orabdominal thrusts should be used firstin conscious adults and children olderthan one year.

• These techniques should be appliedin rapid sequence until the obstructionis relieved; more than one techniquemay be needed in conscious adultsand children older than one year.

Mild Airway Obstruction • In the case of a conscious person, the

first aid providers must be able torecognize signs of a complete airwayobstruction (the person is unable tospeak, has a weakening cough, isstruggling or unable to breathe) andsigns of a mild obstruction (the personis able to speak, cough, and breathe).

• The person with a mild airwayobstruction should remain undercontinuous observation until he or sheimproves since severe airwayobstruction may develop.

of partial choking (the person is able to speak, cough and breathe) and complete choking (the person is unable to speak, has a weakened cough, and has difficulty breathing).

Note • “Child” refers to someone who is a year or

older. ”Infant” refers to someone who is lessthan a year old.

technique may be needed in responsive adults and children.

needed to dislodge the object even if this might hurt the person.

• Learners practising back blowsand chest thrusts for a chokingbaby should sit or kneel.Although it can be easy to hold amannequin baby in one arm(straddle arm technique), it canbe more challenging with a realbaby, especially for youngerlearners. Supporting the baby ontheir lap can be safer and moreeffective.

CPR • All dispatchers must be trained torecognize cardiac arrest over thephone.

• If a person is unresponsive with abnormal orabsent breathing, it is reasonable to assumethe person is in cardiac arrest.

• First aid providers shouldperform chest compressionsfor all adults who are

• The tools, locations, andmethods you choose to use whenteaching first aid should be

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• All dispatchers should consider aperson described as beingunconscious with abnormal or nobreathing to be in cardiac arrestduring a calling.

• All dispatchers must provide CPRinstructions to callers who report aperson in suspected cardiac arrest.

• The first aid provider should determine if aperson is unresponsive with abnormalbreathing.

• Palpation of the pulse as the sole indicator ofthe presence or absence of cardiac arrest isunreliable.

• First aid providers who are trained, able, andwilling to give rescue breaths and chestcompressions may do so for all unresponsiveadults with abnormal breathing.

• CPR should start with compressions ratherthan rescue breaths.

• Chest compressions may be performed on thecentre of the chest (i.e., the lower half of thesternum or breastbone) on adults who areunresponsive with abnormal breathing.

• Chest compressions should be performed at arate of 100 to 120 per minute.

• Chest compressions must be done to a depthof approximately 5 cm; a compression depth ofmore than 6 cm should be avoided.

• First aid providers should avoid leaning on thechest between compressions to allow fullchest-wall recoil.

• A ratio of 30 compressions to 2 rescue breaths(30:2) should be used on people who areunresponsive with abnormal breathing.

• If in doubt whether a person is experiencingcardiac arrest or not, the first aid providershould start CPR without concern of causingadditional harm.

• Interrupting chest compressions to deliver tworescue breaths should take less than tenseconds.

• First aid providers should continue to performCPR while the defibrillator is set up and pauseonly when it is ready for analysis and, ifindicated, provides a shock.

• In any setting, chest compressions can beresumed immediately after shock delivery for

unresponsive with abnormal or absent breathing.

• To achieve more effectivechest compressions, thedominant hand should beplaced against the sternumwith the non-dominant handover the first.

selected based on what will be accessible for learners in an emergency and on their needs and abilities.

• Prioritize training for communitymembers most likely toencounter cardiac arrestemergencies. Members includebut are not limited to medics,police officers, firefighters, andlifeguards. Also, consider thatthese groups, given their statusand role in the community, mightmake effective educators for thegeneral public.

• Previous studies noted thatbystanders have concerns aboutdisease exposure andtransmission through standardCPR, which has caused asignificant decrease in theirwillingness to provide it to bothstrangers and family members.Compression-only CPR is thepreferred method in these cases.

• Consider the gender makeup of agroup of learners. There is limitedevidence to demonstrate thatwomen-only learner groups arebeneficial to women learners, butthere is evidence to support theposition that men are more likelyto learn in mixed groups.

• Emergency medical dispatchersplay a critical role by promptlyrecognizing cardiac arrest,providing CPR instructions byphone, and dispatching EMSpersonnel with a defibrillator.

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adults who are unresponsive with abnormal breathing. Total pre-shock and post-shock pausing between compressions should be as short as possible.

Consider as part of the education for this role: o The use of scripted protocols

as a helpful way to confirmwhen a person is in cardiacarrest.

o Additional training around therecognition of abnormalbreathing.

o How to provide CPRinstructions to an adult.

o How to provide instructionsfor both rescue breaths andcompressions if the person incardiac arrest is a baby,child, or adult.

• Dispatchers who communicateusing video-assisted emergencycalls may need more training forthis tool to be effective andwidespread within CPReducation.

Adult • For an adult, chest compressiondepth should be approximately 5 cmbut not more than 6 cm.

• First aid providers should NOT leanon the chest between compressionsso that the chest is allowed to recoilfully.

• If a person is unresponsive with abnormal orabsent breathing, it is reasonable to assumethe person is in cardiac arrest.

• The first aid provider should determine if aperson is unresponsive with abnormalbreathing.

• Palpation of the pulse as the sole indicator ofthe presence or absence of cardiac arrest isunreliable.

• First aid providers who are trained, able, andwilling to give rescue breaths and chestcompressions may do so for all unresponsiveadults with abnormal breathing.

• CPR should start with compressions ratherthan rescue breaths.

• Chest compressions may be performed on thecentre of the chest (i.e., the lower half of the

• First aid providers shouldperform chest compressionsfor all adults who areunresponsive with abnormalor absent breathing.

• To achieve more effectivechest compressions thedominant hand should beplaced against the sternumwith the non-dominant handover the first.

• Emphasize that time is critical toa successful outcome for theunresponsive person. Evidenceindicates survival relies upon:o Immediate recognition that

someone is unresponsivewith abnormal breathing.

o Early access to help andaccess to EMS.

o Early high-quality CPR.o Early defibrillation with an

automated externaldefibrillator.

• Emphasize the importance of thefirst aid provider, otherbystanders, and EMS workingtogether to provide quick andeffective care.

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sternum or breastbone) on adults who are unresponsive with abnormal breathing.

• Chest compressions should be performed at arate of 100 to 120 per minute.

• Chest compressions must be done to a depthof approximately 5 cm; a compression depth ofmore than 6 cm should be avoided.

• First aid providers should avoid leaning on thechest between compressions to allow full chestwall recoil.

• A ratio of 30 compressions to 2 rescue breaths(30:2) should be used on people who areunresponsive with abnormal breathing.

• If in doubt whether a person is experiencingcardiac arrest or not, the first aid providershould start CPR without concern of causingadditional harm.

• Interrupting chest compressions to deliver tworescue breaths should take less than tenseconds.

• First aid providers should continue to performCPR while the defibrillator is set up and pauseonly when it is ready for analysis and, ifindicated, provides a shock.

• In any setting, chest compressions can beresumed immediately after shock delivery foradults who are unresponsive with abnormalbreathing. Total pre-shock and post-shockpausing between compressions should be asshort as possible.

• Help learners understand that thedesired outcomes of CPR—topump blood around the body(chest compressions) and getoxygen into the lungs (rescuebreaths)—keep the brain andvital organs functioning untildefibrillation and advanced carecan take place.

• Define proper compression rateand depth and highlight thatthese are critical factors in thehealth outcomes of the patient.

• Emphasize that starting CPRearly has a significant impact onthe likelihood of achieving thereturn of spontaneous circulationfor people experiencing cardiacarrest.

• Ensure that learners understandthe fundamental components ofstandard CPR before beingtaught compression-only CPR.

• Some massive multiplayer virtualworlds allow learners to play arole and experience “real life”scenarios and environments inwhich to practise their CPR skills.If implementing this tool, ensurefacilitators understand how to useit and that the technology is nottoo complex (see Gamificationand Online Learning [adults].)

• Providing CPR instructions usingvideo-assisted technology doesnot significantly improve theoverall quality of bystander CPRcompressions or rescue breaths.

• For learners who train regularlyand are knowledgeable in CPR,

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extend skills training to include performing CPR in different settings and situations (e.g., in noisy or distracting environments, with anxious relatives present, in crowds or small spaces with restricted access). Such training exercises stimulate team-based approaches and lateral thinking.

• Use film clips to improve learners’ability to recognize agonalbreathing.

Child, Infant, and Neonatal

• All dispatchers must be trained torecognize cardiac arrest over thephone.

• All dispatchers should consider aperson described as beingunconscious with abnormal or nobreathing to be in cardiac arrestduring a calling.

• All dispatchers must provide CPRinstructions to callers who report aperson in suspected cardiac arrest.

• In situations when a first aid provideris performing CPR and followingtelephone instructions from adispatcher when treating an adult,compression-only CPR should beused. In children and infants it shouldbe full CPR.

• Chest compressions should beperformed on the centre of the chest,i.e., the lower part of the breastbone.

• Compression rate should be 100 to120 per minute.

• First aid providers should NOT leanon the chest between compressionsso that the chest is allowed to recoilfully.

• First aid providers should use a responsecheck and breathing check to ascertainwhether a baby or child is unresponsive andnot breathing normally. Checking for a pulse isnot needed.

• In babies and children who are unresponsivewith abnormal breathing, CPR should beperformed with rescue breaths.

• Chest compressions on children may beperformed with one or two hands.

• In babies or newborns, chest compressionscan be performed with the two-thumb-encirclinghand method or with the two-finger technique.In newborns, the former approach is preferred.

• For babies and children, rescue breaths shouldbe given before compressions. Either two orfive initial rescue breaths may be given.

• In instances where there is one first aidprovider only, a compression-to-rescue-breathratio of 30:2 may be used.

• In instances where there are two first aidproviders, a compression-to-rescue-breath ratioof 15:2 may be used.

• For a child, chest compression depth should beone-third of the depth of the chest(approximately 5 cm but not more than 6 cm).

• First aid providers who areunwilling, untrained, orunable to perform rescuebreaths can performcompression-only CPR.

• Focusing on prevention is criticalfor the survival of babies andchildren.

• Emphasize the importance of thefirst aid provider, otherbystanders, and EMS workingtogether to provide care quicklyand effectively.

• Consider providing training inboth the two-finger and two-thumb techniques whenfacilitating baby CPR. When in astressful situation, learners maychoose the one with which theyare most comfortable.

• Change management requiresnot only highlighting positivechanges to practise, but alsoexplicitly noting when techniquesare to be removed from practice(and the reasons for theirremoval).

• If using mannequins, ensure theyare realistic in terms of size,weight, and features so learnerscan get a sense of how toperform the skill correctly.

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• Interruption of chest compressions togive breaths should be less than tenseconds and pre- and post-shockpauses should be as short aspossible.

• For a person in cardiac arrest an AEDshould be used and as early aspossible.

• The first aid provider should alwaysask if an AED is available.

• When an AED is available the first aidprovider must always do CPR whilewaiting for the AED to be availableand made ready for use.

• A standard AED should be used foradults and children aged eight yearsand over.

• For infants and children up to eightyears of age, a pediatric AED must beused. If not available, a standard AEDshould be used with pediatric pads. Ifthat is not available, a standard AEDshould be used.

• For infants, children and casualties ofdrowning the preferred method ofCPR is compressions with breaths.

• For infants and children in cardiacarrest being treated by unwillinguntrained or people unable to doconventional CPR, compression-onlyCPR should be used.

• First aid providers may use acompression-ventilation ratio of 30:2in cardiac arrest for adults and forchildren and infants with one provider.

• First aid providers may use acompression-ventilation ratio of 15:2in cardiac arrest for children andinfants with two providers.

• For a baby, chest compression depth should beat least one-third of the chest’s depth(approximately 4 cm).

• The rate of chest compressions for babies andchildren should be 100 to 120 per minute.

• All emergency medical dispatchers shouldprovide CPR instructions (referred to asdispatcher-assisted CPR) to first aid providerswho call regarding an unresponsive baby orchild with abnormal breathing, including whenno bystander CPR is in progress.

• Help learners understand that thedesired outcomes of CPR—topump blood around the body(chest compressions) and getoxygen into the lungs (rescuebreaths)—keep the brain andvital organs functioning untildefibrillation and advanced carecan take place.

• Emphasize that rapid andcontinuous compressions arecritical for a positive outcome.Have learners practise keepingthe time it takes to give rescuebreaths or find the right personalprotective equipment to aminimum.

• Emphasize that the goal ofresuscitation remains the samefor all ages and that only theapproach is modified. However,first aid providers who know howto perform adult CPR, but do notknow baby or child CPR, mayuse the same sequence as isused for adults.

• Highlight that the decision to startCPR should be immediate andwithout delay. Time is critical to apositive outcome.

• Learners can gain knowledgeand some basic skills throughself-directed learning. Theimproved efficiency of the self-directed curriculum may allowfacilitators to use in-personsession time on criticalinterpersonal interaction betweenlearners.

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• For infants and children the anterior-posterior placement of AED pad maybe preferred.

• For infants, children and in drowningcases breaths should be given beforecompressions. Either two or fivebreaths may be given.

AED • For a person in cardiac arrest an AEDshould be used as early as possible.

• When an AED is available the first aidprovider must always do CPR whilewaiting for the AED to be availableand made ready for use.

• For an unmonitored cardiac arrest, a shortperiod of CPR should be provided until thedefibrillator is ready for analysis.

• In any setting, chest compressions shouldresume immediately after shock delivery foradults in cardiac arrest.

• Self-adhesive defibrillation pads are safe,effective, and an acceptable alternative tostandard defibrillation paddles.

• Paddles or pads should be placed in ananterior (front) position on the chest.Acceptable alternatives include an anterior-posterior position (for either paddles or pads) oran apex-posterior position (for pads only).

• For large-breasted individuals, the leftelectrode paddle or pad should be placedlateral to or underneath the left breast, avoidingbreast tissue.

• Fast removal of excessive chest hair can bedone before the application of paddles or pads,so long as the delay to shock delivery isminimal.

• For optimal external defibrillation in adults, apaddle or pad size greater than 8 cm as aspecific electrode size should be used.

• After the defibrillator administers a singleshock, the first aid provider should resumechest compressions immediately and not delayfor rhythm reanalysis or a pulse check.

• Automatic defibrillation is preferred overmanual defibrillation because it is easier to useand may deliver fewer inappropriate shocks.

1. Ask bystanders to accessemergency medical services(EMS), or if you are aloneaccess EMS yourself. Ifusing a phone, activate thespeaker function.

2. Ask a bystander to bring adefibrillator as quickly aspossible, or get one yourselfif you are alone.

3. Begin CPR immediately.4. Use the defibrillator as soon

as it is ready and follow thevoice prompts. Only pausechest compressions when itis absolutely necessary.

5. Continue CPR unlessinstructed to pause (eitherby the defibrillator or aprofessional responder).Pause CPR if the personshows signs of recovery,such as breathing normally,coughing, opening theireyes, speaking, or movingpurposefully.

Note • Pediatric pads have

attenuators that willautomatically lower thedelivered energy, so

• Advocate that public accessdefibrillators should have clearsignage and be placed in highlyvisible locations.

• Ensure learners are familiar withdefibrillator signage or icons andcan identify where to find one intheir local context.

• Use scenario-based learning toprovide learners with theopportunity to practise using adefibrillator. Practising willincrease their confidence andwillingness to act in anemergency.

• Have learners practise providingcontinuous CPR, minimizing anyinterruptions, while a partner setsup the defibrillator and appliesthe chest pads. Have thempractice resuming CPRimmediately after the shock.

• Emphasize that time is critical toa successful outcome for theunresponsive person. Evidenceindicates survival relies upon:o Immediate recognition that

someone is unresponsivewith abnormal breathing.

o Early access to help andaccess to EMS.

o Early high-quality CPR.

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• First aid providers should take precautions tominimize sparking during defibrillation (e.g.,pay attention to pad or paddle placement).

• In an oxygen-rich atmosphere (where high-flowoxygen is directed across the chest), first aidproviders should ensure that defibrillation doesnot take place.

• For analysis of electrocardiographic rhythmsduring CPR, the routine use of artifact-filteringalgorithms is not recommended.

• For analysis of electrocardiographic rhythmsduring CPR, artifact-filtering algorithms shouldbe used and assessed in clinical trials orresearch initiatives.

• The implementation of public-accessdefibrillation programs is recommended toimprove the outcomes for people with out-of-hospital cardiac arrests.

• For adults and children (eight years or older), astandard defibrillator should be used.

• For babies and children up to eight years ofage, a pediatric defibrillator should be used. Ifone is not available, a standard defibrillator withpediatric pads should be used.

• For babies and children up to eight years ofage, if a pediatric defibrillator and pediatricpads are not available, a standard defibrillatorand pads should be used.

• For babies or children in cardiac arrest, aninitial dose of 2 J/kg of defibrillation waveformsmay be considered.

• For babies or children in cardiac arrest, self-adhesive defibrillation pads can be used aspaddles.

• For babies and children, the anterior-posteriorplacement of self-adhesive pads may bepreferred.

• In an out-of-hospital setting, CPR should beginimmediately (with chest compressions) after a

pediatric pads should not be used on an adult patient.

o Early defibrillation with anautomated externaldefibrillator.

• It is suggested that bystandersusing video-assisted dispatcherdefibrillator support do not needto be previously defibrillator-trained in order to use adefibrillator successfully, due tolive video feed allowing thedispatcher to monitor and correctthe actions of the first aidproviders in real time.

• Emphasize that anyone can usean automated externaldefibrillator, even someone whohas never used one before.There are voice prompts that willtell you what to do.

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single shock strategy for children in cardiac arrest.

• When compared with monophasic waveformsand for terminating ventricular fibrillation,biphasic waveforms are more effective. In theabsence of biphasic defibrillators, monophasicdefibrillators are acceptable.

• With a BTE waveform for defibrillation ofpulseless ventricular tachycardia or ventricularfibrillation cardiac arrest, a selected energylevel of 150 to 200 J should be used to startdefibrillation.

• For any other biphasic waveform, a selectedenergy level of at least 360 J should be usedfor both initial and subsequent shocks. Forsecond and subsequent biphasic shocks, thesame initial energy level is acceptable. It isreasonable to increase the energy level whenpossible.

Narcotic Poisoning

Nothing noted in 2016 Guidelines • Based on the outcome of the initial assessmentof the casualty, First Aid measures likerecovery position of unconscious person orCPR in any unconscious person not breathingnormally should be started without delay.

• The search for and application of naloxone(narcotic antidote) may be used by lay rescuersin suspected opioid-related respiratory orcirculatory arrest. Naloxone should not delaybasic first aid measures.

• Specially-trained First Aiderslike social workers and peersupport/outreach workersshould be familiar withnaloxone.

• Symptoms can vary basedon the chemical substanceand dose taken, but cluesmay be found on the scene(e.g., empty bottles, emptyblisters of drugs, syringes,needles, spoons forpreparing injections.) Theseitems may point in thedirection of a narcoticpoisoning.

• CPR should be startedwithout delay in anyunresponsive person notbreathing normally, and

• It is important to mention theemerging problem of drug/opioidaddiction. Information about localhelplines and support centersshould be given.

• Social workers and peersupport/outreach workers shouldbe trained in the usage andpotential side effects of naloxone.This is not just a matter for socialworkers and peersupport/outreach workers,however, but a global epidemicaffecting everyone.

• First aid instructors shouldeducate participants in a first aidcourse on the following:1. How to recognize opioid

poisoning

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naloxone should be used by lay rescuers in suspected opioid-related respiratory or circulatory arrest.

• It is recommended that thosewhose job may involveresponding to opioidpoisoning (e.g., peersupport/outreach workers)be trained in full CPRprotocols to the in BLS leveland have access to bothNaloxone and proper PPE.

2. How to react to an emergencyinvolving opioid poisoning

3. How to effectively administernaloxone

4. How to connect people whohave experienced opioidpoisoning with communitysupport resources (simplyproviding information aboutnaloxone will be less effectivethan linking the person tocommunity resources that canhelp them)

5. How to provide criticalmessaging, such as theimportance of never usingopioids when the user isalone

Note First aid providers are not counsellors, but they often know the local community resources. Just as they would to treat a psychological emergency, first aid providers can provide life-saving care and be able to direct someone, possibly families, to external resources.

7.0 Psychological First Aid


Traumatic Event

Nothing noted in 2016 Guidelines • Single-session debriefings may be harmful tothose who have experienced a traumatic event.They are not recommended.

• There is wide support by expert consensus forthe benefit of PFA. The following interventions

• The following interventionsare recommended to supportthose who have experienceda traumatic event:o Engage in conversation

• Consider the different types ofvulnerabilities learners are mostlikely to encounter. For example,are they most likely to providesupport to young children? In this

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are recommended for those who have experienced a traumatic event: o Engaging in conversationo Listening to the person’s concernso Offering empathic supporto Maintaining contacto Connecting to support

o Listen to the person’sconcerns

o Offer empathetic supporto Maintain contacto Connect to additional

support resources ornetworks

• Psychological first aid canhelp during or in theimmediate aftermath of adistressing event and shouldbe provided to those whoneed it.

• Psychological first aid canalso help in the days, weeks,months and even years afteran event has taken place.

case, first aid education should focus on the particular vulnerabilities of children and acknowledge the link to potential mental and emotional health challenges children may face later on in life as a result of a traumatic event. Conversely, if interacting more with older adults who have experienced multiple bereavements and traumas (including significant changes in their health), learners should be aware that this group of people may have increased loneliness, isolation, anxiety and depression.

• Emphasize the importance ofself-care. Learners mustunderstand that supportingothers in crisis can beoverwhelming. They need tolearn to recognize their own cuesand have strategies in place tomaintain their own emotional,mental, and physical health.

• Have learners practise activelistening. This involves beingattentive to the verbal andnonverbal cues (facialexpressions and body language)of a person.

• Have learners work together tobuild case studies in which theyhave to support individuals incoping with traumatic events.

• A key factor in successfulprogramming is creating a safelearning environment, startingwith the creation of a group

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charter that is inclusive and culturally safe.

• This curriculum is intended to bevery fluid and driven by learners'desire to understand the topics intheir own context/environments.The role of the facilitator is toguide the learning journey in asafe way: The focus should beless on steps and protocols andmore about attitudes anddiscussions.

• Utilizing a two-facilitator methodis key to both facilitator andlearner safety. It gives thefacilitators space to be able toprivately support a learner that isopenly emotional and also checkin with each other (facilitators) oneducational process within thecontext of the learning (and alsoemotionally).

• Have a plan of communication tolet the facilitator or peers knowsomething needs to beaddressed.

• Interactive activities enable thelearners to openly explore theconcept of grief and loss with oneanother. Think-pair-share.

• Truth or Myth discussionactivities will allow learners toexplore their preconceptions ofgrief and encourage them toconsider the impact of commonphrases associated with grief andgrieving.

• Learners will all come with a backstory or history and will have

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likely experienced elements of trauma, distress, and loss more than those in any other first aid programming. It is very important to acknowledge this early and plan for disclosure and emotions as a facilitation team.

Suicidal Ideation

• If a person is considered to havesuicidal ideation, trained first aidproviders should directly ask themabout the suicidal thoughts. Inquiryabout suicidal thoughts will NOTprecipitate a suicide attempt. Instead,the person will feel being cared for ifthe inquiry is performed appropriately.

• If a person is considered to havesuicidal ideation, a trained mentalhealth provider should evaluate themimmediately or EMS should beactivated.

• There is wide support by expert consensus forbenefit for Mental Health First Aid and PFA.

• There is limited evidence with benefit forstaying connected to and befriending theperson at risk.

• The following interventions are recommendedfor suicidal ideation:o Engaging in conversationo Listening to the person’s concernso Evaluating the risk of suicideo Offering empathic supporto Ensuring safetyo Maintaining contact

• Be aware of and attentive forsignals of suicidal ideationand suicide risk.

• Ensure physical safety incases of imminent threat.

• Be aware that witnesses to afrightening event, and theirrelatives or others close tothem, may also be stronglyaffected and need PFA.

• Approach calmly andpromote calmness.

• Speak clearly and softly.• Acknowledge the event.• Express concern.• Listen with empathy and

accept the feelings shared.• Offer practical help.• Be direct: ask about and talk

openly about suicidalthoughts.

• Evaluate the suicidal threat,as well as the threat to youand others.

• Respect privacy but do notpromise confidentiality.Never agree to keep a planfor suicide a secret.

• Provide honest and reliableinformation.

• Promote contact with lovedones or other social support.


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• Collaborate on problemsolving.

• Encourage professional helpand/or take immediateactions (e.g., removingdangerous objects) whensuicidal threat or threat toothers seems imminent toensure the person's safety,your safety, and safety ofothers. Undertake necessaryactions supportively.

• Avoid leaving a person whois actively suicidal alone. Askthe person’s relatives orfriends to accompany themto the hospital or othermedical facility, or notifyEMS.

• Remember the followingpoints:o People do not all react at

the same time or in thesame way to a criticalincident.

o Some people are calmand do not react stronglyat the time of an event,but may have strongreactions later.

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Index

2020 Education Topics Blended Learning, p. 8 Feedback Devices, p. 13 First Aid Education for Children, p. 6 Gamification, p. 10 Media, p. 9 Motivation to Learn First Aid, p. 6 Online Learning (Adults), p. 7 Online Learning (Children), p. 8 Peer Learning, p. 11 Refresh and Retrain, p. 14 Video Learning, p. 12

Contexts for Learning Conflict, p. 15 Disaster, p. 15 Mass Casualty, p. 16 Public Health Emergency, p. 18 Remote, p. 18 Water Safety (Aquatics), p. 17

Clinical

1.0 General Approach

De-escalation Techniques, p. 20 Oxygen Administration, p. 20

2.0 Medical

Abdominal Pain, p. 26 Asthma Attack, p. 23 Back Pain, p. 30 Breathing Difficulties, p. 22 Croup, p. 24 Chest Pain, p. 24 Dehydration, p. 26 Diabetic Emergency, p. 34 Earache, p. 28 Feeling Faint, p. 27 Fever, p. 30 Headache, p. 29 Hiccups, p. 29 Motion Sickness, p. 35 Poisoning, p. 22 Seizure, p. 32 Shock, p. 34 Sore Throat, p. 28 Stroke, p. 25 Unresponsiveness, p. 26

3.0 Injury

Abrasions/Wounds, p. 37 Bleeding, p. 38 Burns, p. 36 Chest Injury and Abdominal Injury, p. 39

Dental Avulsion, p. 41 Fractures, Sprains, and Strains, p. 40 Friction Burns, p. 36 Head and Spine Injury, p. 38

4.0 Environmental

Altitude, p. 45 Decompression Illness, p. 45 Frostbite, p. 46 Hyperthermia, p. 42 Hypothermia, p. 41 Radiation Injuries, p. 44 Snow Blindness, p. 42

5.0 Animal-Related Injuries

Insect Bites and Stings, p. 48 Marine Animal Injuries, p. 47 Snake Bites, p. 49

6.0 Resuscitation

AED, p. 57 Choking (FBAO), p. 50 CPR, p. 51 Adult, p. 53 Child, Infant, and Neonatal, p. 55 Narcotic Poisoning, p. 59

7.0 Psychological First Aid

Suicidal Ideation, p. 63 Traumatic Event, p. 60


The Canadian Red Cross Society (CRCS) has made reasonable efforts to ensure the contents of this publication are accurate and reflect the latest in available scientific research on the topic as of the date published. The information contained in this publication may change as new scientific research becomes available. Certain techniques described in this publication are designed for use in lifesaving situations. However, the CRCS cannot guarantee that the use of such techniques will prevent personal injury or loss of life.

Copyright © 2020 The Canadian Red Cross Society ISBN: 978-1-55104-914-4

first aid, resuscitation, and education guidelines · 2020. 12. 2. · first aid, resuscitation,...

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