Part 1 - Introduction to First Aid Principles of First Aid In Australia, first aid has been as much a part of the culture as billy tea. In the early towns and on the goldfields, caring volunteers and individuals performed a much-needed service to the sick and injured, and laid the foundations for the traditional first aid organisations. The period between the World Wars saw an increased awareness in the community of the benefits of first aid and the combining of other activities, such as surf life saving, with first aid training. It was not until the 1960's and 1970's that the general public became involved by attending first aid classes and using this newfound knowledge to their benefit. First aid training has now become virtually indispensable to industry and for an active social life. WHAT IS FIRST AID? First aid is the initial care of the injured or sick. It is the care administered by a concerned person as soon as possible after an accident or illness. It is this prompt care and attention prior to the arrival of the ambulance, that sometimes means the difference between life and death, or between a full or partial recovery. First aid has limitations, as not everybody is a paramedic or doctor, but it is an essential and vital element of the total medical system. FIRST AID SAVES LIVES! ...ask any person who works in the emergency medical field. IMMEDIATE ACTION As in most endeavours, the principle to be adopted in first aid is immediate action. Bystanders or relatives not knowing what to do, or being too timid to try, have unwittingly contributed to unnecessary deaths and chronic injuries. If a pe rson is sick or injured, then they need help — and they need it immediately. It is important that any action taken by the first aid provider is commenced as quickly as possible. Quick action is necessary to preserve life and limb. A casualty who is not breathing effectively, or is bleeding copiously, requires immediate intervention. If quick effective first aid is provided, then the casualty's has a much better chance of a good recovery. It should be re membered though that any action undertaken is to be deliberate, and panic by the first aid provider and bystande rs will not be beneficial to the casualty. Try to remain calm and think your actions through. A calm and controlled first aider will give everyone confidence that the event is being handled efficiently and effectively. WILL I HARM THE CASUALTY? It is unlikely that the casualty being treated by a trained first aid provide r will come to any additional harm, provided that the care and treatment is rendered in accordance with the provider's level of training. Many ho rror stories abound of we ll meaning first aide rs causing irreversible injuries to their casualties, but these are usually just that — stories! If first aid is administered quickly, effectively, and with due care, then the casualty will not suffer any additional harm. The Australian legal system recognises that everyone has a 'duty of care' towards othe rs. Courts take a benevolent view towards first aid providers. Provided that any care and treatment was undertaken for the good of the casualty, that no delibe rate harm was caused, and that the incident was handled as if by 'a reasonable person', then the first aid provider should have no fear of litigation. HOW DO I GET HELP? To get expert medical assistance, call an ambulance on '000 ' (emergency number for Australia, check your local emergency number) as early as possible. If you are attending a casualty, get a bystander to telephone for help. If you are on your own then you may have to leave the casualty mome ntarily to make a call. It's common sense, the decision is yours! If you are calling from a mobile phone, you can dial '112' to call for assistance! ( number for Australia, check your local emergency number) 'MEDIC ALERT' Some individuals suffer from certain medical conditions that may cause them to present with serious signs and symptoms at any time. As a form of assistance and notification, these people may wear a form of medical identification, usually a special bracelet, or less commonly, a necklace. These devices are commonly referred to as 'Medic Alert' bracelets, but other types are available, such as 'Vial of Life' and 'SOS Talis man'. They are imprinted with the person's identity, the relevant medical condition, and other details which may include allergies, drugs required, or specialised medical contact. Medical conditions that may be notified vary from specific heart diseases, to diabetes, epilepsy, asthma, and serious allergies. Human Anatomy The human body is composed of a number of 'systems', each with a specific role in the function of the body as a whole. The function of these individual systems is known as the body's physiology. It is impo rtant that, as a first aid provider, you are aware of the major systems and their functions. A basic knowledge of hu man anatomy will assist you in your firs t aid diagnosis, and will provide a firm basis for the care and treatment of a casualty. Essentially, there are ten (10) anatomical systems, with some mo re important to the first aid provider than others. This section will address those systems that are important in the management of first aid. The Nervous System The nervous system is considered in two main parts. The brain and the spinal cord are known as the Central Nervous System. Th is is the control centre for all functions of the body. The motor and sensory nerves, which involve movement, are known as the Peripheral Nervous System, and these function as directed by the brain. So me peripheral nerves function without conscious thought, and these are known as autonomic nerves. Blin king and breathing are two functions that are attributable to these nerves. The Cardiovascular System This system involves the heart, blood vessels and bl ood. The heart is the pump that drives the circulat ion of the blood around the body. The body's blood vessels are quite comp licated, and include arteries, wh ich take the blood fro m the heart, and veins, wh ich return the blood to the heart. There are s maller blood vessels such as arterioles, venules and capillaries, most of which are located at the body's extremities and usually close to the skin. Blood is the mediu m that transports oxygen fro m the respiratory system to the body's cells. As the heart pumps blood a pulse beat can be felt at various locations in the body, and each pulse beat corresponds to one heartbeat. The heart rate of the average adult at rest is between 60 to 100 beats per minute, depending on age, medical conditions and general fitness. The most accessible pulse points are the radial and carotid arteries. A working knowledge of the locations of these pulse points is essential for the first aid provider. The Respiratory System This system is co mposed of the airway and the lungs. Its function is to provide oxygen to the blood. Oxygen is ext racted fro m the air that is inhaled via the airway, and is passed into the blood stream through memb ranes of the lungs. For the first aid provider, the maintenance of a casualty's airway is of primary importance. The Musculoskeletal System This system involves the bones and muscles of the body. Most muscles that cause movement work by contracting and relaxing in conjunction with a bone. The action of raising your leg involves the contraction of several muscles creating an opposing force in the leg, causing it to move upwards. So me muscles, such as the diaphragm that makes the lungs expand and contract, do not need bones to work with, but function attached to large masses of tissue. The Lymphatic System This system provides lymphatic flui d that drains fro m the body's tissues. This is important as a 'flushing' mechanis m, and most toxins and infections absorbed or injected into the tissues are collected by the ly mphatic system and 'strained' through lymph nodes in the armp its, neck and groin. The ly mphatic flu id eventually drains into the blood stream. The ly mphatic system is where to xins like snake venom accumulate after the bite has occurred. The Digestive System This system includes the oesophagus, stomach and intestines. Drink and food are passed to the stomach via the oesophagus, where it is processed into suitable nutrients. It is then absorbed into the body through the membranes of the intestines. Some organs, such as the liver and pancreas are considered accessories to the digestive system as they assist in the processing of food into various chemical substances used by the body. The Urinary System This is an important system wh ich flushes waste products suspended in fluid fro m the body. It includes the kidneys, bladder and urinary tract, and plays a vital role in maintain ing the body in a healthy state. Should the urinary system, (especially the kidneys) fail, then the affected person requires external assistance to get rid of the waste products by 'flushing' the blood. This is called haemodialysis or, more commonly, 'dialysis'. The Reproductive System This is linked to the body's endocrine system, through the female's ovaries and the male's testes. These are known as the gonads, or 'sex glands'. The female reproductive system consists of the ovaries which produce the human egg, the uterus (or 'womb'), where the fertilised egg is lodged for growth, and the vagina with the associated 'birth canal'. The male reproductive system is composed of the testes, which produce sperm, the seminal vesicle that provides the fluid medium for the sperm, and the penis. The Integumentary System This is the system that includes skin, hair, fingers and toenails. Their pigmentation (colour) and growth are linked to the endocrine system. Infectious Disease & First Aid Hygiene INFECTIOUS DISEASES are those diseases that cause infections to the human body, and in some cases are transmitted by contact or by cross -infection. Infection may be due to bacteria, v iruses, parasites or fungi. The usual methods of communication are; direct contact (contact with an in fected person), indirect contact (through faeces, air condit ioning, or similar), or through a host (insects, worms). Many deadly infectious diseases have been eradicated in Australia, but several, such as polio myelitis (a virus), are again on the increase. Many are preventable by immunisation. So me, such as the Human Immunodeficiency Virus (HIV), have no cure or medical prevention. Examples of infectious diseases are: BACTERIAL INFECTIONS. Throat infections, whooping cough, diphtheria, rheumatic fever, tuberculosis strains, cholera, staphylococcus infection, and some forms of meningitis. VIRAL INFECTIONS. Measles, mumps, rubella, hepatitis, influenza, chicken pox, HIV, common cold, bronchitis. PARAS ITIC INFECTIONS. Malaria, tapeworm, hookworm, itch mites, pubic and body lice. FUNGAL INFECTIONS. Ringworm, tinea ('Athlete's Foot'), thrush. The human body has natural defences against infection, and remains immune to certain types. Immunity is usually achieved by previous exposure to a particular infect ion, with resultant chemical antibodies being produced. The blood contains leucocytes (white b lood cells), wh ich assist in the production of anti bodies. The leucocytes and antibodies combat any infection which invades the body. Unfortunately, whilst the body responds quickly to infection, the in itial defences can be overwhelmed if the infectious agent is present in large numbers. When this happens the casualty develops the disease caused by the inv ading organism. It is at this stage that the body requires help in the form of medically prescribed antibiotics or similar drugs. GENERAL PRECAUTIONS Advice that can be offered by the first aid provider are: care of the susceptible, ie., the ill, the elderly, the very young care in nutrit ion and preparation of food maintenance of personal hygiene maintenance of sanitary standards avoi d direct contact wi th i nfecti on avoi d transmitting infection Whilst there is little that the first aider can do to cure an infection, there is a great deal that you can do to limit the risk of infection, and to treat the symptoms of minor infections. However, the first aid provider should be familiar with the signs and symptoms of the co mmon diseases, and provide advice t o the infected person to seek appropriate medical attention. FIRST AID HYGIENE It is impo rtant that first aid procedures be conducted with due regard for the danger of cross infection. Simp le rules of personal hygiene and wearing gloves, if available, are sufficient to guard both the first aid provider and the casualty fro m contamination. PRIOR TO TREATME NT wash hands with soap and water, or rinse with antiseptic ensure that hands are washed thoroughly between fingers and under nails al ways wear gloves if available take care not to touch any unclean object when wearing gloves or once hands are washed if possible, use a protecti ve cloth over clothing cover any adjacent areas likely to produce i nfecti on DURING TREATMENT use a face shiel d or mask with one-way-val ve, if avail able, when doing acti ve resuscitation use only clean bandages and dressings avoi d coug hing, breathing, or s peaking over the wound avoi d contact with body flui ds avoi d treating more than one casual ty without washing hands and changing gloves AFTER TREATMENT clean up both casualty and yourself clean up the i mmedi ate vicinity dis pose of dressings, bandages, gloves and soiled clothing correctly by burning wash hands with soap and water thoroughly even if gloves were used If possible - dispose of material contaminated by body fluids by burning or by a hazard disposal The 'CHAIN OF SURVIVAL' Sudden cardiac arrest is the unexpected collapse of a casualty whose heart has ceased to function. Card iac arrest occurs suddenly and is closely linked with sudden chest pain. In fact cardiac arrest is still the major single killer of people in Australia, and the casualty in cardiac arrest has only minutes fro m collapse until death is inevitable. Successful resuscitation of such a casualty depends on quick decisive action taken in sequence like the lin ks in a chain. The `Chain of Survival' is the term applied to a series of actions which can be instrumental in resuscitating a casualty in cardiac arrest. While each lin k or individual action in the chain is unlikely on its own to revive a casualty, all of them used effectively together will provide the best chance for a successful outcome. `The `Chain of Surv ival' is a description of the steps or links in the medical t reatment needed to successfully save the life of a card iac arrest patient. You, as the first aider, are responsible for the most important links in this `Chain o f Surv ival'. Without your quick action the casualty has little chance of survival no matter how good the paramedics or doctors are. 1st LINK - Earl y Access Call first - Call fast. Get to the cardiac arrest casualty quickly and call fo r an ambulance or other med ical assistance. You need professional help as soon as possible. 2nd LINK - Early CPR Probably the most important first aid action is early CPR performed by a trained rescuer on a casualty who is in card iac arrest. After getting help start CPR immed iately and continue it until the ambulance arrives. The Chain of Surv ival provides you with a clear guide to the steps y ou must take if the casualty is to have a chance of survival. 3rd LINK - Early Defi brillation This is where the ambulance crew or other specially trained first aiders apply an external electric shock to the casualty's heart using a device called a defibrillator. It is this lin k which usually has the most dramat ic and positive effect, however it is useless if the first two lin ks have not been initiated. 4th LINK - Early ALS Somet imes called `A CLS - Advanced Card iac Life Support'. This action is taken by ambulance paramedics or doctors who administer specific drugs to the casualty which stimulates the casualty's heart. The Chain of Surv ival is dramatically imp roved by the use of Automated External Defibrillators (AED) within the first 8-10 minutes of the cardiac arrest - provided that all links have been acted upon! AUTOMATED EXTERNAL DEFIBRILLATION In Australia, ambulance crews carry sophisticated equipment which can be used to resuscitate casualties in cardiac arrest. Unfortunately, ambulances are sometimes not always immediately available, so some industries and large public event co-ordinators provide a similar, less sophisticated, but effective emergency service. At certain venues and industrial workplaces, automatic electronic devices called Automated External Defibrillators are used to provide essential immed iate treat ment to any casualty in cardiac arrest. Automated External Defi brillati on is the emergency procedure where specially t rained first aiders apply an electronic device to the chest of a cardiac arrest casualty, and the device automatically delivers a controlled electric shock to the casualty's heart. In most instances of sudden cardiac arrest, the casualty's heart has ceased to function normally and is fibrillat ing or `quivering' uselessly. While this is happening, the heart is not pumping, so no oxygenated blood is reaching the brain. Application of an AED to the casualty's chest delivers controlled shocks to the heart, causing the fibrillation to cease and allows the heart to either start functioning spontaneously, or provides a basis for effective CPR and medicat ion to restart the heart. As discussed previously, defibrillation is an important lin k in the Chain of Su rvival, and statistically, a casualty's chances of successful resuscitation are improved dramatically by the first aid use of AEDs. First aiders should be aware that defibrillators, whether AEDs or the more sophisticated types, only revert certain cardiac condit ions, and there are cardiac arrest casualties who will not respond t o electric shocks. Part 2 - Essential First Aid DRABC! DRABC is the prime consideration for everyone involved in the care and treat ment of casualties. Experienced first aid providers, ambulance crews, nurses and medical specialists, are all -aware of the importance of Danger, Response, Airway, Breathi ng and Circulation. DANGER to yourself: don't put yourself in danger! to others: don't allow bystanders to be exposed to danger! to the casualty: remove the danger fro m the casualty, or the casualty from the danger! RESPONSE gently 'shake and shout' at the casualty. Do not shake young children or infants. is the casualty alert? is the casualty drowsy or confused? is the casualty unconscious, but reacting? is the casualty unconscious with no reaction? if unconscious, place the casualty in the stable side position AIRWAY is the airway open and clear? is there noisy breathing? are there potential obstructions such as blood? if so, open and clear the airway! BREATHING look to see if the chest rises! listen for the sound of breathing! feel, by putting your hand on the lower part of the chest if not breathing give 2 effective breaths and commence EAR CIRCULATION is there a carotid pulse? is it strong? is it regular? is there major blood loss? if no pulse present start CPR If the casualty is conscious, then treat the injuries or illness according to the signs and symptoms. Remain with the casualty and call for assistance. If the casualty is unconscious, and breathing spontaneously, leave him or her in the stable side position, then treat any injuries.
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