First aid

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First aid is the first and immediate assistance given to any person with either a minor or serious

Further examples occur through history, still mostly related to battle, with examples such as the Knights Hospitaller in the 11th century AD, providing care to pilgrims and knights in the Holy Land.^[7]

Formalization of life saving treatments

During the late 18th century,

In 1870, Prussian military surgeon Friedrich von Esmarch introduced formalized first aid to the military, and first coined the term "erste hilfe" (translating to 'first aid'), including training for soldiers in the Franco-Prussian War on care for wounded comrades using pre-learnt bandaging and splinting skills, and making use of the Esmarch bandage which he designed.^[4] The bandage was issued as standard to the Prussian combatants, and also included aide-memoire pictures showing common uses.

In 1872, the

Also in the UK, Surgeon-Major Peter Shepherd had seen the advantages of von Esmarch's new teaching of first aid, and introduced an equivalent programme for the British Army, and so being the first user of "first aid for the injured" in English, disseminating information through a series of lectures. Following this, in 1878, Shepherd and Colonel Francis Duncan took advantage of the newly charitable focus of St John,^[4] and established the concept of teaching first aid skills to civilians. The first classes were conducted in the hall of the Presbyterian school in Woolwich (near Woolwich barracks where Shepherd was based) using a comprehensive first aid curriculum.

First aid training began to spread through the British Empire through organisations such as St John, often starting, as in the UK, with high risk activities such as ports and railways.^[13]

Aims of first aid

The primary goal of first aid is to prevent death or serious injury from worsening. The key aims of first aid can be summarized with the acronym of 'the three Ps':^[14]

• Preserve life: The overriding aim of all medical care which includes first aid, is to save lives and minimize the threat of death. First aid done correctly should help reduce the patient's level of pain and calm them down during the evaluation and treatment process.
• Prevent further harm: Prevention of further harm includes addressing both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed from becoming dangerous.
• Promote recovery: First aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound.

It is important to note that first aid is not medical treatment and cannot be compared with what a trained medical professional provides. First aid involves making common sense decisions in the best interest of an injured person.

Setting the priorities

Protocols such as

Basic points of these protocols include the mnemonic ABCDE or cABCDE:

• catastrophic bleeding (massive external bleeding, added in some protocols)

• Airway (clearing airways)
• Breathing (ensuring respiration)
• Circulation (ensuring effective cardiac output)
• Disability (neurological condition), and/or Defibrillation (cardio-respiratory failure, which can be also included as 'Breathing' or 'Circulation')
• Exposure (overall examination, environment)

A major benefit of these protocols is that they require minimum resources, time and skills with a great degree of success in saving lives under conditions unfavourable for applying first aid.

ABCDE method

Source:^[15]

• Airway (clearing airways): If the patient responds in a normal voice, then the airway is patent. Airway obstruction can be partial or complete. Signs of a partially obstructed airway include a changed voice, noisy breathing (e.g., stridor), and an increased breathing effort. With a completely obstructed airway, there is no respiration despite great effort (i.e., paradox respiration, or "see-saw" sign). A reduced level of consciousness is a common cause of airway obstruction, partial or complete. A common sign of partial airway obstruction in the unconscious state is snoring. Untreated airway obstruction can rapidly lead to cardiac arrest. All health care professionals, regardless of the setting, can assess the airway as described and use a head-tilt and chin-lift maneuver to open the airway. With the proper equipment, suction of the airways to remove obstructions, for example, blood or vomit, is recommended. If possible, foreign bodies causing airway obstruction should be removed. In the event of a complete airway obstruction, treatment should be given according to current guidelines. In brief, first aid for conscious patients of choking uses anti-choking procedures (usually five back blows, alternating with five abdominal thrusts, or alternating with five chest thrusts in the case of the pregnant and the very obese victims, until the obstruction is relieved). If the victim becomes unconscious, it is required, according to guidelines, to call for help to emergency medical services and to any useful people that is near and to start cardiopulmonary resuscitation for unconscious victims of choking (attempting to extract the object, with extreme care, from time to time). In modern times, some commercial anti-choking devices have been invented to simplify the solution of choking. Importantly, high-flow oxygen should be provided to all critically ill persons as soon as possible.
• Breathing (ensuring respiration): In all settings, it is possible to determine the respiratory rate, inspect movements of the thoracic wall for symmetry and use of auxiliary respiratory muscles, and percuss the chest for unilateral dullness or resonance. Cyanosis, distended neck veins, and lateralization of the trachea can be identified. If a stethoscope is available, lung auscultation should be performed and, if possible, a pulse oximeter should be applied. Tension pneumothorax must be relieved immediately by inserting a cannula where the second intercostal space crosses the midclavicular line (needle thoracocentesis). Bronchospasm should be treated with inhalations. If breathing is insufficient, assisted ventilation must be performed by giving rescue breaths with or without a barrier device. Trained personnel should use a bag mask if available.
• Circulation (internal bleeding): The capillary refill time and pulse rate can be assessed in any setting. Inspection of the skin gives clues to circulatory problems. Color changes, sweating, and a decreased level of consciousness are signs of decreased perfusion. If a stethoscope is available, heart auscultation should be performed. Electrocardiography monitoring and blood pressure measurements should also be performed as soon as possible. Hypotension is an important adverse clinical sign. The effects of hypovolemia can be alleviated by placing the patient in the supine position and elevating the patient's legs. An intravenous access should be obtained as soon as possible and saline should be infused.
• Disability (neurological condition): The level of consciousness can be rapidly assessed using the AVPU method, where the patient is graded as alert (A), voice responsive (V), pain responsive (P), or unresponsive (U). Alternatively, the Glasgow Coma Score can be used.16 Limb movements should be inspected to evaluate potential signs of lateralization. The best immediate treatment for patients with a primary cerebral condition is stabilization of the airway, breathing, and circulation. In particular, when the patient is only pain responsive or unresponsive, airway patency must be ensured, by placing the patient in the recovery position, and summoning personnel qualified to secure the airway. Ultimately, intubation may be required. Pupillary light reflexes should be evaluated and blood glucose measured. A decreased level of consciousness due to low blood glucose can be corrected quickly with oral or infused glucose.
• Exposure (overall examination, environment): Signs of trauma, bleeding, skin reactions (rashes), needle marks, etc., must be observed. Bearing the dignity of the patient in mind, clothing should be removed to allow a thorough physical examination to be performed. Body temperature can be estimated by feeling the skin or using a thermometer when available.

Key basic skills

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "

Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients.

Some organizations add a fourth step of "D" for

injuries when ensuring an open airway.

Skills applicable to the wider context are reflected in the mnemonic AMEGA, which refers to the tasks of "assess", "make safe", "emergency aid", "get help" and "aftermath". The aftermath tasks include recording and reporting, continued care of patients and the welfare of responders and the replacement of used first aid kit elements.^[18]

Preserving life

The patient must have an open airway—that is, an unobstructed passage that allows air to travel from the open

GCS

of less than 8) may be unable to do so, as the part of the brain that manages spontaneous breathing may not be functioning.

Whether conscious or not, the patient may be placed in the recovery position, laying on their side. In addition to relaxing the patient, this can have the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked by a foreign object. To dislodge the object and solve the choking case, the first aider may use anti-choking methods (such as 'back slaps' and 'abdominal thrusts').

Once the airway has been opened, the first aider would reassess the patient's breathing. If there is no breathing, or the patient is not breathing normally (e.g.,

agonal breathing), the first aider would initiate CPR

, which attempts to restart the patient's breathing by forcing air into the lungs. They may also manually massage the heart to promote blood flow around the body.

If the choking person is an infant, the first aider may use anti-choking methods for babies. During that procedure, series of five strong blows are delivered on the infant's upper back after placing the infant's face in the aider's forearm. If the infant is able to cough or cry, no breathing assistance should be given. Chest thrusts can also be applied with two fingers on the lower half of the middle of the chest. Coughing and crying indicate the airway is open and the foreign object will likely to come out from the force the coughing or crying produces.^[19]

A first responder should know how to use an Automatic External Defibrillator (AED) in the case of a person having a sudden cardiac arrest. The survival rate of those who have a cardiac arrest outside of the hospital is low. Permanent brain damage sets in after five minutes of no oxygen delivery, so rapid action on the part of the rescuer is necessary. An AED is a device that can examine a heartbeat and produce electric shocks to restart the heart.^[20]

A first aider should be prepared to quickly deal with less severe problems such as

grazes or bone fracture

. They may be able to completely resolve a situation if they have the proper training and equipment. For situations that are more severe, complex or dangerous, a first aider might need to do the best they can with the equipment they have, and wait for an ambulance to arrive at the scene.

List of injuries and diseases that require first aid

See also: Medical emergency

• lungs.^[21]
• Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
• Asphyxiation.
• Battlefield first aid—This protocol refers to treating shrapnel, gunshot wounds, burns and bone fractures as seen either in the traditional battlefield setting or in an area subject to damage by large-scale weaponry, such as a bomb blast.
• Bites
  and stings by insects and animals.
• pressure bandage
  ) to the wound site and elevating the limb if possible.
• Bleeding (internal), about internal wounds.
• splint
  .
• Burns
  , which can result in damage to tissues and loss of body fluids through the burn site.
• Cardiac arrest, which leads to death in minutes, so it needs to call to the emergency medical services, and to keep the patient alive by using cardiopulmonary resuscitation (CPR), preferably combined with the use of an AED defibrillator
  , that would be requested soon. Even calling to the emergency services, there is often no time to wait for them to arrive, as 92 percent of people suffering a sudden cardiac arrest die before reaching hospital (according to the American Heart Association).
• Childbirth.
• Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient's trachea is not cleared. If an object blocks the airway, it can be removed by the anti-choking techniques.
• Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
• Diarrhea.
• Diving disorders.^[22]
• Drowning, including related asphyxia.
• Dysmenorrhea.
• Electrical injury
• Gastrointestinal bleeding.
• Hair tourniquet a condition where a hair or other thread becomes tied around a toe or finger tightly enough to cut off blood flow.
• Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
• Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the patient has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
• Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
• Hyperglycemia (diabetic coma).
• insulin shock
  ).
• arrhythmia, an irregular heart rhythm.^[24]
• Joint dislocation.
• Muscle strains.
• Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
• Seizures
  , or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc.) and petit mal (which usually features twitching, rapid blinking, or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
• Shock and electric shock - electrical injury.
• joint
  that immediately reduces automatically but may result in ligament damage.
• Stroke, a temporary loss of blood supply to the brain.
• Sucking chest wounds (pneumothorax), treated with an occlusive dressing with an opened side that lets air go out but not in.
• Testicular torsion.
• Toothache, which can result in severe pain and loss of the tooth but is rarely life-threatening, unless over time the infection spreads into the bone of the jaw and starts osteomyelitis.
• abrasions
  .
• Wounds with internal bleeding, about internal wounds.

Many accidents can happen in homes, offices, schools and laboratories, and require immediate attention before the patient is attended by the doctor.

First aid kits

A first aid kit consists of a strong, durable bag or transparent plastic box. They are commonly identified with a white cross on a green background. A first aid kit does not have to be bought ready-made. The advantage of ready-made first aid kits are that they have well organized compartments and familiar layouts.

Contents

There is no universal agreement upon the list for the contents of a first aid kit. The UK Health and Safety Executive stress that the contents of workplace first aid kits will vary according to the nature of the work activities.^[25] As an example of possible contents of a kit, British Standard BS 8599 First Aid Kits for the Workplace^[26] lists the following items:

• Information leaflet
• Medium sterile dressings
• Large sterile dressings
• Bandages
• Triangular dressings
• Safety pins
• Adhesive dressings
• Sterile wet wipes
• Microporous tape
• Nitrile gloves
• Face shield
• Foil blanket
• Burn dressings
• Clothing shears
• Conforming bandages
• Finger dressing
• Antiseptic cream
• Scissors
• Tweezers
• Cotton

Training Principles

Basic principles, such as knowing the use of 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 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, calling emergency medical services allows listening basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the

St. John Ambulance

, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes.

1.Junior level certificate

Basic Life Support

2.Senior level certificate

3.Special certificate

Types of first aid which require training

There are several types of first aid (and first aider) that require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

• Aquatic/Marine first aid is usually practiced by professionals such as
  MedEvac
  .
• armed conflict
  .
• Conflict First Aid focuses on support for stability and recovery of personal, social, group or system well-being and to address circumstantial safety needs.

• Hyperbaric first aid may be practiced by underwater diving professionals, who need to treat conditions such as decompression sickness.
• hypoxia
  . It is also a standard first aid procedure for underwater diving incidents where gas bubble formation in the tissues is possible.
• emergency responders
  or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.
• Mental health first aid is taught independently of physical first aid. How to support someone experiencing a mental health problem or in a crisis situation. Also how to identify the first signs of someone developing mental ill health and guide people towards appropriate help.

First aid services

Some people undertake specific training in order to provide first aid at public or private events, during filming, or other places where people gather. They may be designated as a first aider, or use some other title. This role may be undertaken on a voluntary basis, with organisations such as the

Red Cross society and St. John Ambulance,^[27]

or as paid employment with a medical contractor.

People performing a first aid role, whether in a professional or voluntary capacity, are often expected to have a high level of first aid training and are often uniformed.

Symbols

Further information:

Emblems of the Red Cross § Use of the emblems

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

International Red Cross and Red Crescent

, and as a protective emblem for medical personnel and facilities in combat situations. Use by any other person or organization is illegal, and may lead to prosecution.

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

Some organizations may make use of the

Maltese Cross, like the Order of Malta Ambulance Corps and St John Ambulance

. Other symbols may also be used.

• 
  ISO First Aid Symbol
• 
  ISO First Aid Symbol (Crescent variant)
• 
  Emblem of the Red Cross
• 
  Emblem of the Red Crescent
• 
  Emblem of the Red Crystal
• 
  Maltese or Amalfi Cross
• 
  Star of Life
• 
  Civil defense

References

External links

Look up first aid in Wiktionary, the free dictionary.

Wikibooks has a book on the topic of: First Aid

Wikivoyage has a travel guide for First aid kit for travellers.

• First Aid Guide at the Mayo Clinic
• First aid from the British Red Cross – including first aid tips and first aid training information
• First aid from St John Ambulance – first aid information and advice