First Aid for Nurses TK Indrani
Page numbers followed by f refer to figure and t refer to table.
Abdominal hernia
first aid measures 200
or rupture 200
Abdominal wound 195
Accident victim, lifting 139f
Accidents involving dangerous substances 186
Airway, patency of 9f
Asphyxia 32
causes 32
rules for treatment of 33
signs 33
symptoms 33
Asphyxia and first aid 23
carbon monoxide poisoning 30
choking 31
drowning 26
fires 28
hanging, strangling and throttling 25
signs 25
smoke inhalation 27
suffocation 29
by poisonous gas 29
by smoke 29
symptoms 25
treatment 25, 30
ankle with triangular 153f
application of sling—elbow 157f
capeline 157f
elbow 157
foot 156
method 156
for back of chest 157
for chest 157
for elbow, roller 152f
hand 156
method 156
hip 157
large arm sling with triangular 146f
of triangular 154
other uses 157
roller 151
rules for application of roller 151
scalp/capeline 156
method 157
shoulder 157
St John's sling with triangular 155f
triangular 153
types of 151
Bandaging 149
for palm, roller 152t
for wrist joint connecting the forearm, roller 152f
arm with triangular bandage 145f
hip with triangular bandage 158f
joint 156
method 156
patterns used in 150
principles of 150
shifting patient after 158f
and first aid 99
arterial 99
capillary 99
first aid measures treatment 105
signs 103, 105
special forms of 107
symptoms 103, 105
types of 99
venous 99
Bleeding from ear 110
first aid measures 110
signs 110
symptoms 110
treatment 110
Bleeding from mouth 111
first aid measures 111
signs 111
symptoms 111
treatment 111
Bleeding in varicose veins 112
first aid measures 112
signs 112
symptoms 112
treatment 113
Bleeding internal 105, 106, 107
first aid measures 107
treatment 107
signs 106
symptoms 106
Bleeding major external 102
first aid measures 103
treatment 103
signs 103
symptoms 103
Bleeding minor external 105
first aid measures 105
treatment 105
signs 105
symptoms 105
Bleeding miscarriage 114
first aid measures 114
signs 114
symptoms 114
treatment 115
Bleeding nose bleeds 109
first aid measures 109
signs 109
symptoms 109
treatment 109
Bleeding scalp wounds 108
first aid measures 108
signs 108
symptoms 108
treatment 108
Bleeding vaginal 113
first aid measures 113
symptoms 113
treatment 114
Blood clots 100
Blood loss controlling 100
direct pressure 101
indirect pressure 101
pressure points 102
Boils 128
signs 128
symptoms 128
treatment 128
Bruises 121
first aid measures 121
signs 121
symptoms 121
treatment 121
area of 164
chemical 163
classification of 163
cold 163
depth of 164
deep 164
intermediate 164
superficial 164
dry 163
electrical 163, 170
first aid measures 172
signs 171
symptoms 171
treatment 172
radiation 163
rule of nines for assessment of 165
types of 162
Burn and scalds
first aid in 160
treatment of 162
Burn caused by corrosive chemicals, treatment of 162
Burn dry 165
first aid measures 166
signs 165
symptoms 165
treatment 166
Burn general approach 160
Burn in eye
chemical 169
first aid measures 169
signs 169
symptoms 169
treatment 170
Burn in mouth and throat 167
first aid measures 168
signs 167
symptoms 167
treatment 168
Burn in skin
chemical 168
first aid measures 169
signs 168
symptoms 168
treatment 169
Burnt, when face 161
Casualties in war, labeling of 218
Chest compression, external 70f
Civil defense 214
principles of first aid in war 214
Civil defense types of warfare 215
biological warfare 217
bombing 215
chemical warfare 216
nuclear weapons 215
Community resources 205
Crush injuries 126
first aid measures 126
signs 126
symptoms 126
treatment 126
Cyclone 211
after 212
approaches 211
before 211
Diabetic and insulin coma, signs of 83t
ambulance service in 234
causes of 224
effects of 227
fire prevention 226
first aiders, impact of 238
management 222, 227, 228
coordinated response of emergency services 232
phase of 228
principles of 230
mitigation 229
patient assessment 236
phases of 237
plan, principles of 229
preparedness 229
and planning 230
prevention 229
process 227
rescuers, tips for 245
scene 238, 239
shifting of patients 239
ambulance 239
triage 231
types of 223
victim, care of 231
Earthquake 208
after 209
before 208
during 209
Emergency in community and first aid 205
Emergency resuscitation 54
respiration: types and techniques 54
ventilation 69, 72
breathing 67
checking for circulation 70
circulation 69
drowning 64
electric shock 64
cardiac resuscitation 63
chest compression 69
chest compression steps 73
for children 73
Holger-Nielsen method 56
method of external chest compression 70
method 55
ventilation 67
ventilation and method 68
method 56
ventilation 69
obstruction in air passages, method of removing 56, 59, 61, 6365, 6773
infant or young child or adult 56, 59, 61, 6365, 6773
respiratory resuscitation 54
resuscitation 65
for children 72
with two first aiders 71
Schafer's method of artificial respiration 61
Sylvesters’ method of artificial respiration 59
treatment 64
Emergency service agencies 205t
contact details 205t
Epistaxis 109
Explosion 226
prevention 227
Eye, chemical burns of 201
first aid measures 201
Famine relief 247
Fire 226
prevention 226
First aid
action at emergency 7
calling for assistance 10
concept of emergency 7
determining priorities 8
examination and diagnosis 11
for bites and stings 35
bee, wasp and hornet stings 45
cone-shaped shells 46
coral cuts 46
effects of extreme temperature 48
effects of snake venom 43
examination of snakes and snake bites 40
frostbite 46
insects 35
jellyfish sting 45
portuguese man-of-war 45
rabies and antirabic treatment in India 49
scorpion sting 44
sea urchin sting 46
snake 37
snake bites 37
snow blindness 48
snow blindness, radiation 48
snow blindness, Welder's flash 48
spiders 36
treatment 38
getting others to help you 9
golden rules 6
history taking 15t
in injuries to joints and muscles 147
dislocation 149
sprain 148
strain 147
in special cases 23, 23t
choking 23
drowning 23
hanging 23
strangulation 23
in war, problems of 217
crush injury 217
gas poisoning/burns 217
injuries from blast 218
radiation sickness 217
informing relatives 18
kit 219
levels of responsiveness 14
management of case 5
multiple casualties and injuries 10
outline of 3
removing clothing 18, 19
boots or shoes 19
coat or jacket 18
full face helmet 19
removing crash helmets 19
shirt or vest 19
socks 19
trousers 19
scope of 4
to carry out an examination 11
treatment 16
Floods 210
after 210
before 210
during 210
Foreign body
from eye, removing 198f
in ear 199
first aid measures 199
in eye 198
treatment measures 198
in nose 199
first aid measures 199
in stomach 200
in throat 200
first aid measures 200
fish-bone in 200
injuries and first aid 197
Four-handed seat 129f
causes of 142, 143, 144
first aid
and bandaging 142
treatment of 143
of clavicle 145
of femur 147
of forearm 146
of lower leg 147
of patella 147
of pelvis 146
of ribs 144
of skull 144
of spine 144
of upper limb 145
signs of 143
symptoms of 143
treatment of 144
types of 142
Hemorrhage 99
Human crutch 136f
Insulin coma 83
treatment 83, 84, 85, 86, 87
Leg fracture, positioning for 147f
Lightning 213
indoors 213
outdoors 213
Mass casualty management 245
National and International Voluntary Agencies 206
Natural Calamities 206
Agencies 207
responsibilities 207
Open face helmet, removing 19
Palm bandaging with triangular bandage 145f
Person's clothing catches fire when 161
agricultural 190
treatment 190
and antidotes, common 181
corrosive 189
household 181
in India, common 191
industrial 186
irritants 189
mode of entry and action of 176, 177
nerve 190
signs 177
sources of various 194t
first aid measures 194t
swallowed 188
treatment of 188
symptoms 177
type of 189
aconite 193
symptoms 193
treatment 193
alcohol 184
first aid measures 185
signs 185
symptoms 185
treatment 185
and first aid 176
arsenic 191
symptoms 191
treatment 191
datura 191
symptoms 192
treatment 192
drug 183
signs 183
symptoms 183
treatment 184
food 187
first aid measures 188
rules for treatment of 178
signs 187, 188
symptoms 187, 188
treatment 188
Indian hemp 192
symptoms 193
treatment 193
salmonella 187
staphylococcal 187
Poisonous plants 182
first aid measures 182
Pulse checking
carotid 13f
radial 9f
Red Cross Society 206
Respiration, artificial 9f
Scalds 163, 165
Scalp 157f
signs of
primary 89t
secondary 89t
treatment 75
Sling 153
collar and cuff 154
improvised 154
large arm 153, 154
types 153
Snakes and snake bites, examination of 40
Snow blindness 174
first aid measures 174
signs 174
symptoms 174
treatment 175
Spinal injury patient, lifting of 144f
Splint using 159
Splinters 197
first aid measures 197
signs 197
symptoms 197
treatment 198
Splints 158
Stretcher by four bearers, carrying loaded 131f
Sunburn 173
first aid measures 174
signs 173
symptoms 173
treatment 174
Symbols for making casualties and interpretation 218t
Transport of injured persons 129
and first aid 129
carries for one first aider 135
cradle method 135
drag method 135
fireman's lift 136
human crutch 136
pick-a-back 136
carries for two first aiders 137
chair method 138, 139, 140, 141
fore and aft carry 137
hand seat 137
lifting casualty in wheelchair 138
carrying casualties 132
closing stretcher 140
different types 140
Fireman's lift and carry 132
fore and aft method 133
hand seats 133
human crutch 132
lifting casualties 134
in stretcher 139
methods adopted 129
opening stretcher 140
pick-a-back 132
scoop stretcher 141
standard stretcher 140
stick method 134
stretcher 134, 139
exercise 130
support by
single helper 129
two helper 129
testing stretcher 140
trolley bed 141
utila folding stretcher 141
Ulcer 127
acute 127
chronic 127
treat patient with 127t
treatment for acute 128
types 127
Unconsciousness 75
abdominal thrust 93
anaphylactic shock 87
treatment 88
apoplexy 79
treatment 79
causes of shock 89
treatment 89
choking casualty 91
common causes of 76
degrees of 75
diabetic coma and insulin overdose 83
treatment 83, 84, 85, 86, 87
epilepsy 79
treatment 80
fainting 83
treatment 84
for choking children 92
for conscious choking casualty 91
for infants 94
for unconscious
casualty 93
choking casualty 91
heart attacks 86
treatment for first kind 86
treatment for second kind 87
heat exhaustion 82
treatment 82, 83, 84, 85, 86, 87, 88
heatstroke 82
diabetic coma 83
diabetic coma and insulin overdose 83
treatment 82
hysterical attacks 80
treatment 81
infantile convulsions 81
treatment 81
shock 88
stroke 85
treatment 86
thrust for children 93
treatment 76
epilepsy 79, 80
hysterical attacks 80, 81
typical incident 94
Upper limb injury by one person, carrying patient of 136f
Welder's flash and radiation 174
Wound abdominal 124
first aid measures 125
signs 125
symptoms 125
treatment 125
Wound abrasions 116
signs 116
treatment 116
Wound and first aid 116
Wound contused 118
first aid measures 118
treatment 119
signs 118
symptoms 118
Wound eye 119
first aid measures 119
treatment 120
signs 119
symptoms 119
Wound gunshot 119
Wound incised 117
Wound infected 122, 123
first aid measures 122
signs 122
symptoms 122
tetanus infection 123
treatment 122
Wound lacerated 117
Wound penetrating chest 123
first aid measures 124
signs 123
symptoms 123
treatment 124
Wound punctured 117
signs 117
treatment 117
Wound to palm of hand 120
first aid measures 120
treatment 120
signs 120
symptoms 120
Chapter Notes

Save Clear


First Aid: IntroductionCHAPTER 1

First aid is the immediate and temporary care given to the victim of an accident or sudden illness. Its purpose is to preserve life, assist recovery and prevent aggravation of the condition until the services of a doctor can be obtained or during transportation to hospital or to the casualty's home.
The term ‘first aid’ was adopted officially in England for the first time in 1879 by the St John Ambulance Association. The expression ‘first aid’ had not come till 1894 and intended to designate any person who has received a certificate from an authorized association that he/she is qualified to render first aid.
The principles and practice of first aid are based on the principles of practical medicine and surgery, knowledge of which, in case of accident or sudden illness, enables trained persons to give such skilled assistance as will preserve life. Promote recovery and prevent the injury or illness becoming worse until medical aid has been obtained.
The term ‘medical aid’ is used to indicate treatment by a doctor either on the spot, in the home or in hospital. The first aider's responsibilities ends as soon as medical aid is available, but he/she should standby after making his/her report to the doctor in case he/she can be of further assistance.
First aid is definitely limited to the assistance rendered at the time of emergency with such material as may be available. It is not intended that the first aider should take the place of the doctor and it must be clearly understood that the redressing of injuries and other such after treatment are outside the scope of first aid.4
Throughout the manual standard methods of treatment are given for a number of defined conditions, which may occur in different circumstances, but the first aider will find that these conditions seldom conform to an exact pattern and that even in the same circumstances individuals may react in different ways. He/She must be prepared to sum up any situation with which he/she may be faced and adapt himself/herself to wide variation from the average or typical.
  1. To determine the nature of the case requiring attention so far is necessary for intelligent and efficient treatment—diagnosis.
  2. To decide on the character and extent of the ‘treatment’ to be given and to apply the treatment most suited to the circumstances until medical aid is available.
  3. To arrange for the ‘disposal’ of the casualty by removal either to his/her home or other suitable shelter, or to hospital.
In deciding nature of the case, first aider must consider its ‘history, symptoms and signs’.
History is the story of how an accident or sudden illness occurred. This may be obtained from the casualty (if conscious) or from witnesses. It may be information that a person is subject to a particular disease or the surroundings may suggest the cause, e.g. a broken bicycle.
Symptoms are the sensations of the casualty such as feeling cold or shivery, faintness, nausea, thirst pain, which can be obtained, if conscious casualty describes. Pain is a very helpful diagnostic point for the first aider as it draws his/her attention to the part, which is most probably in trouble and saves a great deal of time during his/her examination of the casualty.5
Signs are any variations from the normal conditions of the casualty such as pallor, congestion, swelling and deformity, which can be observed by the first aider. Signs are the most reliable indications on which to base diagnosis, but the circumstances of each particular case will determine the relative importance of history, symptoms and signs.
If the cause of the condition is still active, remove the cause if possible (e.g. a log of wood on leg), or remove the casualty from the cause of the conditions (e.g. gas-filled room). Give treatment to preserve life, promote recovery and prevent the condition becoming worse. Pay special attention to the treatment of failure of breathing, severe bleeding and shock. When there is the slightest doubt as to whether a casualty is dead or alive, continue treatment until medical aid has been obtained.
The speed with which a casualty is brought under medical care is of tremendous importance in his/her recovery. Unless the casualty is examined by a doctor on the spot, it is the responsibility of the first aider to see that he/she is conveyed to his/her home (or other suitable temporary shelter) or to hospital as soon as possible in the manner most suitable in the circumstances. A tactful message should be sent to the casualty's home or relatives indicating in a general way, ‘what has happened and the casualty's destination’.
The first aider must always:
  1. Respond quickly to calls for assistance, the saving of a life may depend on promptness of action.
  2. Adopt a calm and methodical approach to the casualty, quick and confident examination, and treatment, which will relieve pain and distress, lessen the effect of the injury and may save life. Time spent on long and elaborate examination of a casualty may be time lost in his/her ultimate recovery.6
  3. Treat obvious injuries and conditions endangering life such as failure of breathing and severe shock, before making a complete diagnosis.
  4. Take first aid material, if this is immediately available. If standard equipment is not available, the first aider must depend on material to hand, which will have to be improvised as required.
  5. Study the surroundings carefully. These may influence the action to be taken and therefore require careful consideration, for example:
    1. Danger: From falling building, moving machinery, electric current, fire, poisonous gases and similar hazards.
    2. Weather: If the accident occurs out-of-doors, the casualty may be treated in the open air if the weather is fine; if the weather is bad, he/she must be removed to shelter as soon as is reasonably possible.
    3. Shelter: Houses and buildings near at hand, whether occupied or unoccupied, and whether likely to be particularly useful (e.g. a chemist's shop), otherwise, temporary shelter may be provided by means of umbrellas, rugs, etc.
    4. Light: It is impossible to treat a patient satisfactorily without sufficient light, and the first aider must provide for this.
    5. Assistance: Crowds must be tactfully controlled. If a doctor is present, work under his/her direction. If not, ask if anyone with knowledge of first aid is present. If neither is available make use of bystanders to the best advantage.
    6. Reassure the casualty: By speaking encouragingly, warn him/her to be still and tell that he/she is in trained hands.
  1. Do ‘first things first’ quickly and without fuss or panic.
  2. ‘Give artificial respiration’, if breathing has stopped—every second counts.
  3. Stop any bleeding.
  4. ‘Guard against or treat for shock’ by moving the casualty as little as possible and handling him/her gently.
  5. ‘Do not attempt too much’—do the minimum that is essential to save life and prevent the condition from worsening.
  6. ‘Reassure the casualty’ and those around; so help to lessen anxiety.
  7. Do not allow people to crowd around as fresh air is essential.7
  8. Do not remove clothes unnecessarily.
  9. Arrange for the removal of casualty to the care of a doctor or hospital as soon as possible.
The basic principles of first aid apply to all injuries or illnesses regardless of severity. Whatever the incident, it is the first aider's responsibility to act quickly, calmly and correctly in order to:
  • Preserve life
  • Prevent deterioration in the casualty's condition
  • Promote recovery.
    These objectives are best achieved by:
  • A rapid, but calm approach
  • A quick assessment of the situation and the casualty
  • A correct diagnosis of the condition based on the history of the incident and the casualty's history, symptoms and signs
  • Immediate and appropriate treatment of any conditions diagnosed
  • Proper disposal of the casualty according to the injury or condition.
Approach should be speedy, but calm and controlled. Ensure that you are not placing yourself in any danger when approaching the casualty. On arrival at the scene of any incident, state that you are a trained first aider and, if there are no doctors, nurses or more experienced people present, calmly take charge.
General Rules
Whenever and wherever you come across an emergency, use common sense, know the limitations and do not attempt to do too much.
Assessing the Situation
As soon as you have taken control at an incident, it is crucial to make an accurate assessment of the situation and decide on the priorities of action. To do this you must consider:8
  • Whether you and the casualty are not in any danger
  • If the casualty has any life-threatening conditions
  • If any bystanders can help you
  • Whether you need to call for assistance.
You must minimize the risk of danger to yourself, the casualty and bystanders, and guard against any further casualties arising (for example, in the case of road accidents).
Road accidents
Instruct a bystander to control traffic, keeping it well away from yourself and the casualty. Watch out for life risks, especially from petrol spillage and switch off the ignition of the vehicles concerned (refer Chapter 5 for more details of ‘procedure at major incidents’).
  • In order to determine the condition of a casualty, ask him/her “What happened?”
  • A reply will help you to know what to look for
  • It also tells you that he/she is conscious; his/her airway is clear; he/she is able to breathe, if he/she does not respond to questioning or touch, perform the following checks immediately.
Airway, Breathing and Circulation
  1. Following the airway, breathing and circulation (ABC) rule quickly check that the airway is open and that the casualty is breathing. If not, commence artificial ventilation immediately (Figs 1.1A and B).
  2. Check pulse for circulation (Fig. 1.2). If absent, commence ‘external chest compression’. Check for any severe bleeding and control it.
Place an unconscious casualty or one whose breathing is noisy, in the recover position (refer Chapter 4, topic on ‘recovery position’) and assess the level of responsiveness (refer the topic ‘levels of responsiveness’).9
zoom view
Figures 1.1A and B: Artificial respiration. A. Head-tilt, chin-lift; B. Patency of airway.
If there is any possibility of spinal injury, do not turn the casualty and keep in spinal recovery position (refer the topic ‘examining the spine’) unless difficulty in breathing makes it essential, or vomiting is likely to occur:
  • Gas and poisonous fumes: If possible cut off the source and ensure adequate ventilation
  • Electrical contact: Break the contact, if possible, and take the necessary precautions against further contact
  • Fire and collapsing buildings: Move the casualty to safety immediately, if you can do so without endangering your own life.
Getting Others to Help You
Some bystanders can be extremely useful and may be able to assist with treatment. For example:
  1. Controlling severe bleeding or supporting a badly injured limb.
  2. Other bystanders may become nuisances so you must keep them occupied to prevent their interfering with your work. They can be asked to control traffic crowds, or be sent to telephone assistance.
zoom view
Figure 1.2: Radial pulse checking (three fingers method)
However, when sending bystanders to the telephone 10make sure that they understand the message that is to be sent. If possible, ask them to write it down, but in any case, ask them to repeat the message to you before actually sending it. Always make sure that they report back to you afterwards.
Keep the casualty warm, quiet and lying down until skilled help arrives.
Other Needs
Unless there is immediate danger to life from the surroundings, treat all fractures and large wounds before moving a casualty. If the casualty is in danger, support the injured part whilst moving (refer Chapter 9) or you suspect that the casualty has a fractured spine.
Once you decide that assistance is required, and this may include ambulance, police, fire brigade, gas or electricity boards, send for it immediately. Go to the nearest telephone booth for ambulance service required. Do not leave the casualty unattended. Whether you are giving the message yourself or instructing someone to do so make sure that the following information is passed on:
  1. Your telephone number.
  2. The exact location of the incident; if you can point out nearby road junctions for other landmarks.
  3. An indication of the type and seriousness of the incident, e.g. road traffic accident, two cars involved, three people trapped.
  4. The number, sex and approximate age of the casualties involved and if possible, the nature of their injuries.
  5. Request for special help and if you suspect a heart attack or childbirth.
Multiple Casualties and Injuries
Where there is more than one casualty, you must decide by rapid assessment, which one needs priority of treatment. Remember that the noisiest casualty is rarely the most severely injured. In first aid, common sense is almost as important as the actual knowledge of the subject.11
In real life, serious accidents rarely produce only a single injury, frequently two or more injuries occur so that the correct treatment of one may interfere with the correct treatment of the other. In such circumstances you must decide, which injury is the more serious one and treat that in the correct way. You should then deal with the other injuries correctly as possible under the conflicting circumstances.
Examination and Diagnosis
Examination and diagnosis means taking account of the casualty's history and that of the incident, the symptoms, signs and levels of responsiveness.
History is the full story of how the incident occurred or the illness began, and should be taken directly from the casualty and a responsible bystander wherever possible. Never hurry the casualty and remember to pass on all the information you have obtained when skilled help arrives.
Symptoms are sensations that the casualty feels and describes to you—the most useful of these is pain. If the casualty is unconscious or unreliable because dazed or in shock, their diagnosis cannot be based on symptoms, but has to be based on information obtained from bystanders and signs.
Signs are the details ascertained by you using your senses—sight, touch, hearing and smell. These may be signs of injury such as bleeding, swelling, deformity or signs of illness such as raised temperature and/or a rapid or one irregular pulse.
A general examination should be carried out quickly to discern any imminent threats to life whether the casualty is conscious or unconscious when examining a casualty. There are certain rules to follow:12
  • Move him/her as little as possible to avoid aggravating any injuries
  • Begin examination at the head and work methodically towards his/her feet
  • Remember to use all your senses—look, feel, listen and smell
  • Always compare one side of the casualty's body with the other as this makes it easier to detect any swellings or irregularities that require first aid.
Examining the Head
Recheck breathing, noting the rate, depth and nature (whether easy or difficult, noisy or quiet); note also any odor. Check inside of the mouth to ensure it contains no foreign matter, such as vomit, blood, food or loose teeth that might cause choking.
Examine the lips for any signs of burning or discoloration that might indicate corrosive poisoning. Look inside the lips for blueness, which might indicate asphyxia.
Check the teeth to make sure that any recently dislodged teeth have not fallen down into the back of the throat. Make sure that dentures are firm fitting (essential for resuscitation); if they are not, remove them.
Examine both together comparing the pupils (the black circular centers) and noting whether they are equal in size. Check the white orbit of the eye for bloodshot.13
Check for signs of blood, clear fluid or a mixture of both, which might come from inside the skull.
Look at the color—it may be pale, flushed or even bluish if breathing is affected. At the same time, feel the temperature of the face to check whether it is particularly hot or cold and note the state of the skin whether it is dry or clammy or even sweating profusely.
Check the ears for foreign bodies and traces of blood and/or clear cerebrospinal fluid that might indicate skull fracture. Speak into the casualty's ears to test hearing.
Gently run the hands over the scalp searching for bleeding, swelling or any indentation that might indicate a fracture.
Examining the Spine
Loosen clothing around the neck. Run your fingers over the spine from the base of the skull down to as far as you can reach between the shoulders, checking for any irregularity of the vertebrae that might indicate a fracture. Check round the neck, to see whether any warning medallion is being worn. Check the carotid pulse (Fig. 1.3), and note its rate, strength and rhythm. Note the presence or absence of movement or feeling in the casualty's limbs.
zoom view
Figure 1.3: Carotid pulse checking
Examining the Lower Spine
Pass hand gently under the hollow of the back and without moving the casualty or removing 14any clothing. Feel along the spine as high and as low as you can there by checking for irregularity of the vertebrae or swelling.
Examining the Trunk
  • Check the chest for evenness of rib movement or breathing and note any wounds that are ‘sucking air’
  • Check the ribs for irregularity or depression that might indicate a fracture and also feel along the line of the breast bone
  • Check both collarbones for irregularity and the shoulders for signs of deformity. Carefully feel either side of the pelvis looking for signs of fracture and note any indication of incontinence.
Examining the Arms
Examine the upper arm bones, then the bones in the forearm, wrists, hands and fingers. Check carefully for any deformity and swelling, which might indicate fractures. Check the forearms to see if the casualty is wearing a medical warning bracelet and for injection marks. Needle marks might indicate either drug abuse or diabetes.
Examining the Legs
Check the hips, thighs, knee caps, both bones of the lower legs, the ankles, feet and toes in the same way as the arms.
There are various stages through which a casualty may pass during progression from consciousness to unconsciousness. If the casualty responds well to stimulation then unconsciousness is only light (e.g. as in a faint). However, he/she is still in a potentially dangerous state. If the response is poor or absent, the unconsciousness is deeper and the risk is correspondingly greater.
Every 10 minutes you should recheck and note the casualty's response to the stimuli of noise (speak loudly into the ear), touch 15(try to arouse by shaking the shoulders gently) and pain (watch the face, while you pinch the skin, or hand (ankle). In addition, you should keep a similar check on the casualty's breathing, pulse and temperature. Your findings should be recorded.
Aids to Diagnosis
Your diagnosis will be based on information from various sources. By taking the history of the incident, asking the casualty for symptoms and examining him/her for signs, it should be possible to make an accurate diagnosis. The following chart is a summary of how to achieve this.
History (Table 1.1)
History is obtained from surroundings, casualty and bystanders.
Table 1.1   History taking
These are the sensations experienced by the casualty and obtained by asking tactful questions:
  • Pain
  • Loss of normal movement
  • Loss of sensation
  • Cold
  • Heat
  • Thirst
  • Nausea
  • Weakness
  • Dizziness
  • Faintness
  • Temporary loss of consciousness
  • Loss of memory
  • Sensation of breaking bone
These are noted by first aider, using his/her own senses:
  • Sight
  • Respiration
  • Bleeding (type and volume)
  • Wounds
  • Foreign bodies
  • Color of face
  • Swelling
  • Deformity
  • Bruising
  • Reflexes
  • Responses to touch and sound
  • Incontinence
  • Vomit
  • Needle marks
  • Containers
  • Hearing
  • Breathing
  • Groans
  • Crepitus
  • Touch
  • Dampness (bleeding incontinence)
  • Temperature
  • Pulse
  • Swelling
  • Deformity
  • Irregularity
  • Tenderness
  • Smell
  • Breath
  • Burning
  • Gas
  • Alcohol16
External Clues
If a casualty is unconscious, check their pockets, handbag or brief-case for possible clues. Appointment cards for a hospital or clinic or information cards may reveal that the casualty is on steroids or insulin or is liable to epileptic fits. Lumps of sugar or glucose present may even indicate that the casualty is diabetic (‘MedicAlert’). A locket for wrist or neck, a capsule, a neck chain or key ring containing a strip of paper may describe the casualty's condition.
Carry out the appropriate treatment for each condition found gently and quickly. It is most important that to reassure and encourage the casualty constantly. Work calmly and efficiently. Pay attention to any remarks or request that the casualty makes, and do not pester with questions. This is annoying for the casualty and is a sign of uncertainty on your part. After giving the necessary treatment, place the casualty in the appropriate position and keep a watchful eye until help arrives. Bear in mind your aim is to preserve life, prevent the condition worsening and promote recovery.
To Preserve Life
  • Maintain an open airway by positioning the casualty correctly
  • Begin resuscitation, if the casualty is not breathing and the heart is not beating17
  • Continue treatment until skilled medical aid is available
  • Control bleeding.
To Prevent the Condition Worsening
  • Dress wounds
  • Provide comfortable support for any large wounds and fractures
  • Place the casualty in the most comfortable position consistent with the requirements of treatment.
To Promote Recovery
  • Relieve the casualty of anxiety and encourage confidence
  • Attempt to relieve the casualty of pain and discomfort
  • Handle the casualty gently
  • Protect the casualty from the cold and wet.
After Treatment
Once you have carried out your treatment the casualty should normally receive attention from a qualified person (doctor or nurse) without undue delay. Depending on the severity of the condition and the availability of skilled help you should:
  1. Arrange transportation to hospital by ambulance (or by car for minor injuries and arm fractures).
  2. Handover the casualty to the care of a doctor or nurse at the scene.
  3. Take the casualty to a nearby house or shelter to await the arrival of the ambulance or doctor.
  4. Allow the casualty to go home and advise him/her to seek medical advice, if necessary.
    Note: Never send anyone home who has been unconscious even for a short time or who is in shock; seek medical aid.
Making Report
The casualty should always be accompanied by a brief written report when he/she leaves your care. If necessary, you should accompany the casualty yourself and prepare personal report. The need to supply complete information cannot be emphasized enough and it should include the following:18
  • History of the accident or illness
  • Brief description of the injury
  • The level of responsiveness and any changes
  • Any other associate injuries
  • The pulse and any changes
  • The skin color and any changes
  • Blood loss sustained
  • Any unusual behavior by the casualty
  • Any treatment is given and when?
Informing Relatives
You should also send a tactful message to the casualty's home stating what has happened and where he/she has been taken if this has not already been done by the police or other authority attending the incident. If the casualty is unconscious or unable to tell you where to contact his/her relatives, look for a diary or donor card, which may give the relevant details (refer the topic ‘external clues’).
Take care of any property belonging to the casualty and hand it over to the police or ambulance personnel.
Removing Clothing
Sometimes, it is necessary to remove clothing in order to expose injuries, make an accurate diagnosis or conduct a proper treatment. This should be done with the minimum of disturbance to the casualty and you should only remove as much as is actually necessary. Clothing should not be damaged unnecessarily. If very tight underclothing such as a girdle has to be cut, do this along the seams, if it is possible. Maintain sufficient privacy.
Removing a Coat or Jacket
Raise the casualty and slip the garment over his/her shoulders. Bend his/her arm on the sound side and remove the coat from that side first. Then slip the injured arm out of its sleeve, keeping the arm straight if possible. If necessary, slit up the seam on the casualty's injured side.19
Removing a Shirt or Vest
Remove a coat, if necessary slit it down the front or side.
Removing Trousers
Pull them down from the waist to reveal the casualty's thigh or raise the trouser leg to expose the calf and knee; if necessary slit up the inside seam.
Removing Boots or Shoes
Support the ankle, undo or cut any laces and carefully remove the shoe. If the casualty is wearing long boots, that will not unfasten, carefully slit them down the back seam with a sharp knife.
Removing Socks
If these are difficult to remove insert first two fingers between the sock and the leg. Raise the socks and cut it between the fingers with scissors.
Removing Crash Helmets
Whether or not you remove a protective helmet, such as motor cycle crash helmet, depends on the situation and condition of the casualty. It is best left on and should only be removed, if the casualty's condition warrants it. If possible, the helmet should be removed by the casualty. A full face helmet that encloses the head and face should only be removed, if it obstructs breathing, if the casualty is vomiting or if there are severe head injuries.
Removing an Open Face Helmet
Unfasten or cut through the chinstrap, if necessary. Take pressure off the head by forcing the sides apart, then lift the helmet upwards and backwards.
Removing a Full Face Helmet
To remove it safely, two people are needed, one to support the casualty's head and neck, while the other lifts the helmet:20
  1. Tilt the helmet back and gently lift until it is clear of the chin.
  2. Tilt the helmet forward to pass over the base of the skull, then lift it straight off.
  • Ensure that there is no further danger to the casualty or yourself
  • Act quickly, quietly and methodically giving priority to the urgent conditions
  • If the casualty is unconscious, open the airway, check for breathing and complete the ABC of resuscitation if required, and place the casualty in the recovery position
  • Control bleeding
  • Minimize shock
  • Determine the casualty's level of responsiveness
  • Reassure the casualty to lessen anxiety
  • Position the casualty correctly and comfortably, but do not move more unless and until there is absolutely necessary
  • Consider the possibility of internal bleeding and poisoning
  • Treat large wounds and fractures before moving the casualty
  • If necessary, arrange for urgent transportation to hospital or into a doctor's care
  • Watch and record any changes
  • Do not attempt too much
  • Do not allow people to crowd around; this hinders first aid and may cause anxiety or embarrassment to the casualty
  • Do not remove clothing unnecessarily
  • Do not attempt to give anything via mouth to a casualty who is unconscious, who has a suspected internal injury or who may shortly need an anesthetic.