Basic principles of First Aid
Basic principles, such as knowing to use an adhesive bandage or applying direct pressure on a bleed,
are often acquired passively through life experiences. However, to provide effective, life-saving first
aid interventions requires instruction and practical training. This is especially true where it relates to
potentially fatal illnesses and injuries, such as those that require cardiopulmonary resuscitation
(CPR); these procedures may be invasive, and carry a risk of further injury to the patient and the
provider. As with any training, it is more useful if it occurs before an actual emergency, and in many
countries, emergency ambulance dispatchers may give basic first aid instructions over the phone
while the ambulance is on the way.
Direct Pressure to Stop Bleeding
The adhesive bandage protects the cut, e.g. from friction, bacteria, damage, or dirt. Thus, the
healing process of the body is less disturbed. Sometimes they have antiseptic properties.
An adhesive bandage is usually covered by woven fabric, plastic, or latex rubber which has an
adhesive. Adhesive bandages usually have an absorbent pad, which is sometimes medicated with an
antiseptic solution. Some bandages have a thin, porous-polymer coating over the pad to keep it from
sticking to the wound. The bandage is applied such that the pad covers the wound, and the fabric or
plastic sticks to the surrounding skin to hold the dressing in place and prevent dirt from entering the
Applying direct pressure on a bleed
A wound that is deep, bleeding heavily, or has blood spurting from it (caused by bleeding from an
artery), may not clot and may not stop bleeding.
Call out for someone to get help, or call 911 yourself. Elevate the wound and apply direct pressure.
Direct Pressure for Bleeding
1. Elevate the wound above the heart and apply firm pressure with a clean compress (such as a
clean, heavy gauze pad, washcloth, T-shirt, or sock) directly on the wound. Call out for
someone to get help, or call 911 yourself. Do not remove a pad that is soaked through with
blood; you will disturb any blood clots that have started to form to help stop the bleeding. If
blood soaks through, place another pad on top of the soaked one and continue applying
2. When the bleeding slows or stops, tie the pad firmly in place with gauze strips, a necktie,
strips of sheet, or a shoelace. Do not tie so tightly that blood flow to the rest of the limb is
cut off. Stay with the person and keep the wound elevated until medical help arrives.
Pressure Points for Severe Bleeding
If severe bleeding does not stop with direct pressure and elevation, apply direct pressure to an
artery. Use direct pressure on an artery along with elevation and direct pressure on the wound.
There are specific major arteries in the body where pressure should be placed (see illustration on
When you apply pressure to an artery, you stop bleeding by pushing the artery against bone. Press
down firmly on the artery between the bleeding site and the heart. If there is severe bleeding, also
apply firm pressure directly to the bleeding site.
To check if bleeding has stopped, release your fingers slowly from the pressure point, but do not
release pressure at the bleeding site. If bleeding continues, continue to apply pressure to the artery.
Continue until the bleeding stops or until help arrives. After bleeding stops, do not continue to apply
to an artery for longer than 5 minutes.
Pressure Points for Bleeding
The circles show places to apply direct pressure on an artery in order to stop the flow of blood from
1 Be sure that BOTH you and the patient are in a safe location before continuing. If an AED is
available, also check to ensure that the patient is not in standing water and is not located near
flammable materials. Do not make yourself another patient!
2 Check the patient. Tap the ground and shout.
3 If there is no response, call 911 or whatever the local emergency number is immediately!
4 Check the ABCs.
A-(Airway). Give two rescue breaths. Is the patient's airway clear? If not, it must be cleared by
performing chest compressions and finger sweeps in the patient's mouth (only if an object is visible)
before continuing with any type of care
B-(Breathing). Look, listen, and feel for breathing like this for no more than 10 seconds.
C-(Circulation). A patient in Cardiac arrest (full arrest, or cardioplumary arrest) has no pulse and is
not breathing. Pulse checks takes time and are unreliable under the stress you will be feeling. If the
victim is not breathing and not responding -- just start and continue with CPR.
Using the AED
1 Look around your immediate area for an AED (Automated
External Defibrillator) such as the one seen at right. The
location of AEDs may be marked with the symbol shown in the
image in the introduction of this article.
2 If you cannot locate an AED, proceed with CPR. You should
instruct bystanders to call emergency services and search for
an AED. Staff members in public places such as railway stations
or airports will be able to provide instructions and alert any
emergency response units or first aid teams that may be
present to assist with CPR and Defibrillation.
3 Turn on the AED unit. Depending on the model of the AED
you may have to pull a handle or push the on button.
4 Follow the AED's voice prompts.
5 Remove all clothing from the chest, abdomen, and arms (male or female).
6 Peel the pads off and place them exactly as shown. Accuracy is more important than speed when
7 Usually the AED will start to immediately analyze the patient's heart rhythm. If it does not, you
might have to push the analyze button. Do not touch the patient during this or any other part of the
8 If the AED has a shock advised prompt, push the button. When you shock, make sure no one is
touching the patient. Also, the patient must not be touching metal and there must not be large
amounts of water on the chest (sweat is okay). The patient must not be wearing a nitro patch. If the
patient has a pacemaker, try not to place the pads directly on the unit.
The AED will shock up to 3 times. Usually one shock is needed. Newer AEDs following recent
guidelines will shock only once on the highest energy setting, after which they should prompt you to
immediately perform two minutes of CPR.
Some pulseless heart rhythms cannot be treated by defibrillation. If the AED does not advise a shock,
check the pulse, and if there is none, continue CPR.
1 Determine what is needed. If there is no breathing and no pulse, do breathing and chest
treatment. If there is a pulse but no breathing, just do breathing treatment. A person will always
have a pulse if he or she is breathing, but one can have a pulse and not be breathing.
2 If the person only needs breathing treatment, blow every 5 seconds. After 2 minutes, check for
breathing. If there is no breathing, continue breathing treatment (rescue breathing). If there is
breathing, put the patient in the recovery position.
3 If the person needs both treatments, blow 2 times (each breath for 2 seconds)while holding nose
shut, then follow up the rib cage and find the top of the rib cage and place down two fingers and
start your compressions. 30 times and continue until you have completed 5 cylces. cycles (2 min)
then check for breathing and pulse. No breathing and no pulse?...Continue. Breathing and
pulse...recovery. Pulse no breathing...rescue breaths.
Simple secondary survey , (also known as a secondary assessment) used after the initial
assessment after you have ruled out or taken care of any life-threatening conditions. You might or
might not have already called 911.
(Remember, don't have them move any body part you suspect is injured and if you suspect a spinal
injury you would be manually protecting the spine/neck from movement and would not want them
to tilt their head yes or no in the process of answering questions.)
If you did not do so already, introduce yourself, ask permission to give care, get victim's name. (At
any point while you are taking this brief history or during the head-to-toe exam, if you find
something that requires emergency medical personnel, stop the survey to call 911 immediately,
then continue the survey.)
Interview victim (write notes, including negative answers) and give the information to EMS
personnel when they arrive.
use SAMPLE as an easy way to remember the questions
Signs and symptoms
What happened to you?
Do you feel pain anywhere?
Do you feel any numbness, tingling or loss of sensation? (If yes, where?)
Are you experiencing any lightheadedness, nausea?
Sometimes ask for details about pain:
Onset (What were you doing when it started hurting? Resting or active? What made it start hurting?
Was it severe at first or did it get this bad over time?)
Provokes (What makes it worse/better? Does it only happen after you eat? Does it only hurt when
you breathe deeply?)
Quality Ask them to describe the pain. (Is it a sharp pain, stabbing, cramping, aching, burning, dull?)
Radiates / or another source says Region/Radiates (Does it start in one place, and move to another?
What makes it move? (spleen injury pain can be felt in the shoulder, heart attack chest pain can
radiate to the neck and jaw, kidney stones are associated with severe back/flank pain radiating to
the groin, gallbladder pain can be felt in the right shoulder blade, a slowly bleeding abdominal
aneurysm can cause abdominal pain radiating to the back)
Severity (Where is the pain on a scale of one (least) to ten (most))
Time (When did it start hurting? How frequently does it occur? How long does it last? Does it come
and go? Get better or worse?) (Intermittent, hard to locate pain is common with problems of the
(If the onset and time categories seem to be redundant, think of the onset as WHY and the time as
Do you have any allergies, (including food, plants, insects and medications)? What type of reactions
have you experienced when you were exposed? Any recent exposure?
Do you have any medical conditions or are you taking any medications? If so, what conditions do you
have or what medications are you taking? Have you taken any in the past 12 hours?
(including prescription, over-the-counter, herbal)?
Don't ask if they are taking any drugs, as they may misunderstand and think you are accusing them
of illegal activities. But if that might be the reason they are having problems, you certainly need to
Diabetic? Cardiac history? Epilepsy? Asthma? Pregnant? Check for medic alert tag.
Example: if they are taking Viagra, giving them nitroglycerin could have serious side effects.
Pertinent past medical history
Have you experienced any recent falls, accidents or blows to the head? Have you ever been in any
medical, surgical or trauma incidents? Are you under a doctor's care for anything? If appropriate:
Have you experienced anything like this before?
(history of high blood pressure? recent surgery/illness? (complications?) Dehydrated? Didn't eat any
breakfast? Lack of sleep? Substance abuse? Previous injury to same site? Same type of pain
previously - was there a diagnosis? Same location of pain previously - is the pain the same this time?)
Last oral intake
When did you last eat or drink anything? What did you last eat or drink? (Don't ask the victim "when
was your last oral intake?").
Perhaps ask if oral intake over the past few days has been normal for them. Perhaps ask if urination
and defecation have been normal.
Events leading to the incident
What were you doing before the accident happened? What were you doing when the incident
occured? Why do you think this happened? (As in, why do you think you just fainted?)
Finally, you could ask: Is there anything else I should know?
Write down all the answers.
Then do a head to toe exam, starting by telling the victim what you are going to do. Keep explaining
as you go along.
Head to toe exam
(in a simple secondary survey you hardly touch the victim, they do the moving around, but only if
you do not suspect a spinal injury)
Visually inspect the body, including the scalp, face, ears, eyes, nose and mouth for cuts, bumps
bruises and depressions.
(DOTS: Deformity, Open injuries, Tenderness, Swelling)
(DCAP BLTS deformities, contusions, abrasions, penetrations,
burns, lacerations, tenderness, swelling)
Look at face and lips (unusually wet or dry, pale, bluish, flushed, ashen; note abnormalities).
Check eyes (pupils - big, tiny, uneven size) ears, nose, ask them to open mouth; look for fluid or
blood (don't try to control fluid coming from ears)
A significant percentage of people normally have pupils of slightly different size, but both should
react to light the same way if, for example, you shine a flashlight in their eyes.
Determine skin appearance and temperature. Feel person's forehead with back of your hand to
determine if it is cold or hot.
Write down all observations, including anything that does not look right.
Don't do the following if you suspect a spinal injury or move any body part you suspect was injured.
- Ask person to move head from side-to-side if there is no discomfort and if an injury to the neck is
Note pain, discomfort or inability to move the neck.
- Ask person to shrug shoulders.
- Ask person to take a deep breath and blow out air.
Listen for changes in breathing and ask victim if he or she is experiencing pain during breathing.
Breathing (gasping, unusual noises, fast or slow, labored, noisy, gurgling, shallow or deep, pain when
breathing, dry or productive cough)
Stridor = high pitched noise when breathing in; wheezing = high pitched noises when breathing out.
Ask if any pain in abdomen (which quadrant?)
(If they are vomiting, describe what is vomited, if diarrhea, describe the consistency.)
- Ask person to move hands, fingers, bend arm. Compare grip strength.
- Ask person to move feet, ankles, bend leg. Check one limb at a time.
Multiple casualty and emergency scene management
Every emergency is different, so the amount to be done in each of the steps that will follow may
Assess hazards and make the area safe – Your safety comes first! If you cannot enter the area
without risking your safety, don’t do it, call Emergency Services immediately and wait for them. If
you think you can safely enter the area, look around the emergency scene for anything that can be
dangerous or hazardous to you, the casualty or anyone else at the scene. Do whatever you can to
make the area safe as long as the result will not be more hazardous or more of a risk to people at the
scene. Bystanders can help with making the area safe.
Take charge of the situation – If you are the first aider on the scene act fast. If someone is already in
charge, briefly introduce yourself and see if that person needs any help. If there is any chance the
casualty could have a head or spinal injury, tell them not to move!
Get Consent. Always identify yourself as a first aider and offer to help. Always ask for consent before
touching a conscious adult casualty and always ask for consent from a parent or guardian before
touching an unconscious or conscious child or infant. With an unconscious adult casualty consent is
implied as it is generally accepted that most people want to live.
Assess Responsiveness. Is the casualty is conscious or unconscious? Note their response while you
are asking them for their consent. If they respond continue with the primary survey, and if they
don’t respond, be aware that an unconscious casualty is or has the potential of being a breathing
Call out for help – this will attract bystanders. Help is always useful in an emergency situation.
Anytime you need help just call out. Someone can be called over to phone for medical help. Others
can bring blankets if needed, get water etc. A bystander can help with any of the following:
- Make the area safe
- Find all the casualties
- Find a first aid kit, or any useful medical supplies
- Control the crowd
- Call for medical help
- Help give first aid, under your direction
- Gather and protect the casualty’s belongings
- Take notes, gather information, be a witness
- Reassure the casualty’s relatives
- Lead the ambulance attendants to the scene of the emergency
You must always notify Emergency Services as soon as you can. Either send a bystander or call
yourself. Emergency professionals never get involved in an emergency scene without back-up and
neither should you.
First Aid for Shock
Shock is a life-threatening condition in which the body's vital functions are threatened due to lack of
sufficient blood or oxygen flow to the tissues. Shock is one of the primary consequences you are
trying to avoid when administering first aid.
Symptoms: Pale or bluish skin, lips, and fingernails; moist, clammy skin; weakness; weak, rapid pulse
(more than 100 beats per minute); increased breathing rate; irregular breathing; restlessness,
anxiety; thirst; vomiting; dull look in eyes; dilated pupils; unresponsiveness; blotchy or streaked skin;
possible unconsciousness in severe conditions.
1 Make certain victim's airway is open, using head-tilt chinlift to open airway, even if back, neck, or
head injury is suspected (see ABCs).
2 Seek medical assistance immediately. Call for EMS.
3 Until EMS arrives:
If back, neck, or head injury suspected, DO NOT move victim (see back or neck injury). If no back,
neck, or head injury suspected, lay victim faceup and elevate feet about 12 inches. DO NOT place
victim in position that is uncomfortable.
4 Loosen any tight clothing.
5 Look for injuries, and control any bleeding (see bleeding,external).
6 Cover victim lightly with blanket.
7 DO NOT give victim anything to eat or drink. If victim vomits, roll the victim onto their side and
clean out victim's mouth.
8 Put an unresponsive victim or a stroke victim in the Recovery Position.
Emergency child birth.
1 Call for help if possible. That way, even if you have to deliver the baby yourself, help will arrive
soon if you experience complications. The dispatcher should also be able to either talk you through
the delivery or connect you to someone who can.
2 Determine how far along the labor is. The first stage of childbirth, where the body is getting ready
to deliver by dilating the cervix, can take a long time, especially if this is the woman's first child. Time
the contractions from the beginning of one to the beginning of the next.
If they're five minutes or more apart, there's probably time to get the mother to a hospital.
First time mothers are likely to give birth when contractions are three to five minutes apart and last
40 to 90 seconds, increasing in strength and frequency for at least an hour.
If they're two minutes or less apart, buckle down and get ready to deliver the baby, especially if the
mother's had other children and they were fast labors! Also, if the mother feels like she's going to
have a bowel movement, the baby is probably moving through the birth canal, creating pressure on
the rectum, and is on its way out. 
3 Clean your hands and arms well with soap (preferably antibacterial) and water. If soap and water is
not available, you can use an alcohol-based hand sanitizing product or rubbing alcohol. Whatever
you can do, try to get your hands as clean as possible to prevent giving the mother or baby an
infection. Wear sterile gloves if available.
4 Find and prepare a birthing area. Have the mother remove lower clothing. Let her do whatever
feels comfortable - lie in bed, walk around, or sit in a chair - until she feels a very strong need to
push. While waiting for the cervix to fully dilate, she might feel panicky and irrational. Use this
time to make sure the area is as clean as possible. Have several clean towels, sheets, or blankets on
hand. In a pinch, you can use newspapers.
5 Guide the mother in pushing. The area around the vagina will bulge out until you start to see the
top of the baby's head (crowning) at which point you should encourage the mother to push the baby
out gently (she'll want to push out hard) in a position that's comfortable for her (lying down on her
back or squatting). Encourage the mother to push between contractions, not at their peak, to
attempt to slow down the birth. Instruct her to blow through her mouth at the peak of each
contraction to help her resist the urge to push.
Instruct the mother to take deep, slow breaths. Pain can be controlled to different extents through
mental relaxation and by concentrating on deep breathing instead of panicking or being distracted
by everything that is going on. Different people have different levels of mental control, but deep,
slow breathing is always a benefit during childbirth.
6 Support the baby's head as it emerges. If the cord is wrapped around the neck, gently lift the cord
over the baby's head or loosen it carefully so the baby can slip through the loop created by the
cord. Make sure to never pull the head, as this can cause nerve damage. When the baby's head
rotates to one side (it will do this on its own) be prepared for the body to come out with the next
push. If this doesn't happen, gently guide the side of the baby's head towards the mother's back so
that a shoulder emerges with the next push. Then lift the body gently towards the mother's
stomach to deliver the other shoulder. The rest of the body should follow quickly, along with a lot
of reddish water. The baby will be slippery! Keep supporting the head!
If the feet come out first, see the section on "Breech Birth" below.
Hold the delivered baby with two hands, keeping its head down (about 45 degree angle) to allow
fluids to drain. Its feet should be above its head, but do not hold the baby by the feet.
If the head comes out and the rest of the body doesn't come out after she pushes three times, have
the mother lie on her back, put two pillows under her bottom, instruct her to grab her knees at her
chest, and have her push hard with each contraction.
7 Place the baby on the mother's chest and stomach area, ensuring full skin contact, and cover them
both with towels or blankets. Lay the baby face down so fluids drain from the mouth. The skin-to-
skin contact on the mother's stomach encourages further contractions to expel the placenta.
If the baby's not crying, rub its back firmly over the blanket. If that doesn't help, turn the baby so it's
looking at the ceiling, tilt the head back to straighten the airway, and keep rubbing the body. It might
not cry, but doing this ensures that the baby gets the air it needs.
If the baby gags or turns blue, wipe fluids out of the mouth and nose with a blanket or other clean
cloth. If that doesn't do the trick, squeeze a bulb syringe, put the tip in the nose or mouth, and
release to suck fluid into the bulb. Repeat until all the fluid is cleared, squeezing the bulb between
uses to empty it. If you don't have a bulb, you can use a drinking straw; you can also try flicking
the soles of its feet with your fingers, or slapping its bottom as a last resort. If none of this helps,
8 The placentaPrepare for the placenta. It will arrive anywhere between a few minutes to a half hour
after the baby is delivered. Put a bowl close to the vagina. Right before it emerges, blood will come
out of the vagina and the cord will get longer. Have the mother sit up and push the placenta into the
Rub the mother's stomach below her belly button firmly to help slow down the bleeding. It'll hurt
her but it's necessary. Keep rubbing until the uterus feels like a large grapefruit in the lower belly.
Letting the baby breastfeed can help slow bleeding but is not necessary, especially if the cord
would get pulled tight by doing so. Stimulating the nipples can also help if breastfeeding is not an
When the placenta is on its way, don't pull the cord. It can break. Let it come out on its own or aided
by mom's expulsive efforts.
9 Cut the umbilical cord only if necessary. Generally, it's advised that you leave the umbilical cord
alone, just making sure that it's not pulled tight, unless you're hours away from professional medical
If you do need to cut the cord, here is the basic procedure: Feel it gently for a pulse; after about ten
minutes, the pulse will stop, and you shouldn't cut the cord before it stops. Cutting the cord will not
cause pain because there are no nerve endings in it, so take your time and be careful, as it's very
slippery. Tie a lace around the cord tightly (use a double knot) about three inches from the baby (if
the baby cries when you do this, it's because it's cold from being exposed, not because the cord
hurts). Tie another lace tightly about two inches further away from the first lace and cut, using a
knife or scissors that have been boiled in water for 20 minutes, between the two knots. Don't be
surprised if it's rubbery and tough to cut. Cover the baby again.
Put the placenta in a trash bag. Double bag it and bring it to the hospital. If you can't make it there in
four hours, put the placenta in a container with a lid and put it in the freezer.
10 Keep the mother and baby comfortable and clean. Put an ice pack on the mother's vagina for the
first 24 hours to ease soreness and pain. Offer her Tylenol® or Advil® if she's not allergic. Instruct and
if necessary help her pour warm water over the vagina every time she goes to the bathroom in order
to keep it clean. Give her something light to eat (crackers and cheese, or peanut butter and jelly
sandwich) and a drink. Put a diaper on the baby, making sure it's below the umbilical cord. If the cut
cord smells bad (signaling an infection) clean it with alcohol until it doesn't smell anymore.
Replace any wet bedding and keep mother and baby warm.
11 Get medical attention as quickly as possible. Once delivery is complete, proceed to the nearest
hospital or await the ambulance you called. It is good for the mother to empty her bladder but due
to blood loss it may be best to have her urinate in a pan or on a cloth you can move from under her
so she does not have to get up.
1 Have the mother sit at the edge of a bed or other surface and pull her legs to her chest. As a
precaution, put down pillows or blankets where the baby is likely to fall.
2 Do not touch the baby until the head comes out. You'll see its back and bottom hang down and
you'll want to grab it, but don't. If the baby comes out feet first, you want to avoid touching the
baby until the head is delivered because your touch could stimulate the baby to gasp while the head
is still submerged in amniotic fluid.
Try to make sure the room is warm, as a drop in temperature could also cause the baby to gasp.
3 Once the head is delivered, grab the baby under the arms and bring it up to the mother. If the
head doesn't come out in the push after the arms come out, have the mother squat and push.
Source: Internet Various Websites.