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FOR MORE INFORMATION: [email protected] Sending for help
If you are not sure whether emergency services are needed, call anyway. They can help you decide.
Remain calm. Take a deep breath, call an ambulance. In New Zealand, call 111. Know the emergency numbers for where you are or where you are going. Emergency numbers:
Always send for help as soon as possible. Once you have made contact, LISTEN carefully and answer the questions. The following information will be required by the dispatcher: ɠ Where the emergency happened ɠ The telephone number you are calling from ɠ What has happened ɠ The number of people who need help
Quick assessment If you are able to quickly assess the casualty, obtain the following information: ɠ Is the casualty awake? ɠ Can the casualty talk to you? ɠ Is the casualty breathing normally? ɠ Is the casualty bleeding severely? Tell the dispatcher what you find in your quick assessment.
If you feel you are unable to do anything, send for help. Essential First Aid New Zealand Red Cross helps people in New Zealand and across the Pacific to respond in a crisis and has been teaching first aid for many years. All the topics covered in first aid and emergency care courses are contained in this book, which acts as a primary reference.
What do you do when?
Your father collapses after complaining of indigestion all day. Your daughter gashes her foot on broken glass. You’re first on the scene when a pedestrian is hit by a car. One of your team mates sprains an ankle during practice. Your toddler chokes on a piece of apple. TR35-010-01(2021) This book contains first aid information and is intended to supplement and revise information learned on New Zealand Red Cross First Aid courses. Published by authority of the National Board of New Zealand Red Cross. Published by the New Zealand Red Cross. 69 Molesworth Street, Thorndon, Wellington. This book is copyright. Except for the purpose of fair reviewing, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Infringers of copyright render themselves liable to prosecution. ISBN 978-0-908998-29-6 © 2021 New Zealand Red Cross. The author asserts its moral rights in the work. First published 1996. Reprinted annually with new information as required. Printed 2021. Written and designed by New Zealand Red Cross. Photographs and illustrations courtesy of American, Australian, New Zealand, Samoa, Tuvalu and Papua New Guinea Red Cross, IFRC Pacific Delegation, New Zealand Resuscitation Council and National Heart Foundation of Australia. Additional photography: Richard Bartz, Munich aka Makro Freak, CC BY-SA 2.5, via Wikimedia Commons; Cugerbrant, CC BY-SA 4.0, via Wikimedia Commons. All rights reserved in all countries. Contents
Choking 23-31 Adult 24 What is first aid? 1 Conscious – Back blows / First aider 1 Chest thrusts / Obstructed airway 24–26 First aid aims 2 Unconscious – Obstructed airway 27 First aid action plan 2–3 DRSABCD – Choking adult / child 28 When to call an ambulance 3 Infant – Conscious 29–30 Infant – Unconscious 31 Primary assessment 4 DRSABCD – Choking infant 31 Using DRSABCD 5 Dangers 2,6 Bleeding 32 Response – Levels of consciousness External bleeding 32–33 (AVPU) 7 Wounds 32–33 Airway 8 Embedded objects in wounds 34 Breathing 8,12–15 Internal bleeding 35 Breathing difficulties 9 DRSABCD – Bleeding 35 Circulation / CPR 9 Unconsciousness 10 Shock and fainting 36–37 Stable Side Position (recovery position) 11 DRSABCD – Resuscitation 12–14 Check for other conditions and injuries 38–41 Basic Life Support Flowchart 14 Vital signs 38–39 Resuscitation 15-22 Consciousness (AVPU) 40 Check for injuries / MedicAlert® 41 Chain of survival 15 Resuscitation – Adult 16 Medical conditions 42–57 CPR action checklist 16 DRSABCD – Adult resuscitation 17 Heart attack 42–44 Defibrillation and AEDs 18 Angina 43 Resuscitation – Child / Infant 19 Heart health 44 CPR action checklist 20 Heart attack action plan 45 DRSABCD – Child / infant Stroke 46–47 resuscitation 21 Diabetic emergency 48 Drowning 22 Seizures / Febrile convulsions 49–50 Hyperventilation 51 Poisoning 80–85 Asthma 51-52 Snake bites 82 DRSABCD – Medical conditions 53 Fish and shellfish poisoning 82 Fever 54 DRSABCD – Poisoning 84 Malaria 55 Tick bites; bee, wasp and ant stings 85 Diarrhoea 56 Severe allergic Injuries 58–75 reaction 86–87 Fractures 58–59 Anaphylaxis 86 Dislocations 60 Anaphylaxis action plan 87 Soft tissue injuries / bruising 61 DRSABCD – Severe allergic reaction 87 DRSABCD – Fractures and soft tissue injuries 62 Environmental Spinal injuries 63 conditions 88–92 DRSABCD – Spinal injuries 64 Hyperthermia 88-90 Head injuries 65–67 Heat exhaustion 88 Concussion 65 Heat stroke 89 Brain compression 66 DRSABCD – Hyperthermia 90 DRSABCD – Head injuries 67 Hypothermia 91-92 Fractured nose 67 DRSABCD – Hypothermia 92 Stable Side Position for head or spinal injuries – Log roll 68 Amputations 69 Other useful Chest injuries 70 information 93–102 Abdominal injuries 70 Casualty reporting 93 Crush injuries 71 Handwashing and hygiene 93 Nose bleeds 72 Applying slings 94 Ear injuries 72 Hazard app 96 Knocked out permanent teeth 73 Household Emergency Plan 97–98 Eye injuries 74-75 Useful numbers 99 Workplace accidents 100 Burns and scalds 76–79 Suicide information 101 DRSABCD – Burns and scalds 79 Psychological First Aid 102 Glossary 103–104 Index 105-106 Mission statement What is first aid?
First aid is the initial help IS FIRST AID? WHAT provided to the ill or injured person until advanced care arrives. It is concerned not only with physical injury or illness but also with other initial care, including psychosocial support for people suffering from emotional distress caused by experiencing or witnessing a traumatic event. First aid interventions seek to “preserve life, alleviate suffering, prevent further illness or injury and promote recovery”.1 This manual refers to the person requiring care as a casualty. The responder, with their basic first aid knowledge and skills, provides the assistance and is referred to as the first aider.
Further emergency care information for Basic Life Support and First Aid can be found in the Guidelines documents found on the New Zealand Resuscitation Council website nzrc.org.nz. New Zealand Red Cross acknowledges the New Zealand Resuscitation Council Guidelines.
1 International Liaison Committee on Resuscitation (ILCOR), 2015 1 First aid First aid aims action plan ACTION PLAN ACTION |
In emergency situations, In first aid theDRSABCD cycle injuries or medical is used to assist the first aider to conditions can kill: identify, prioritise and treat any problems.
FIRST AID AIMS ɠ in minutes ɠ within hours, or What is DRSABCD? DRSABCD is an abbreviation for the casualty ɠ not at all. primary assessment process used by the New Zealand Red Cross and stands for: General principles Dangers, Response, Send for help, Airway, ɠ Ensuring safety of the first Breathing, Circulation / CPR, Defibrillation aider, casualty and bystanders Many countries use the DRSABCD casualty ɠ Preventing further harm assessment process at all levels of care. or injury DRSABCD identifies theDangers to the ɠ Checking response to verbal first aider, casualty and bystanders as the and tactile stimuli first issue to address. The first aider then ɠ Sending for help checks for a Response from the casualty ɠ Care of airway, breathing, and considers Sending for help at this circulation early stage of the assessment. Simple ɠ Control of bleeding and logical steps are used to ensure an open Airway, and to assess and manage ɠ Protection from Breathing and Circulation (bleeding and environmental conditions shock). If the casualty is unresponsive and ɠ Other specific first aid care not breathing, the first aider startsCPR relevant to the circumstances immediately and attaches a defibrillator ɠ Careful handling (Automated External Defibrillator) as ɠ Reassurance soon as possible. ɠ Ongoing monitoring The purpose of DRSABCD is to assist rescuers to identify injuries or medical conditions and treat the casualty until the ambulance or advanced care arrives. DRSABCD is used as the guide for first aid given to casualties in all situations. Repeat the DRSABCD cycle as needed until advanced care arrives. 2 When to call an ambulance
The first aid action plan For life threatening illness 111 TO CALL WHEN | involves: or injury – call an ambulance immediately. ɠ primary assessment (DRSABCD); Send for help – call an ambulance if ɠ specific care – identification and the casualty has: management of specific injuries
and medical conditions using the ɠ collapsed or is unresponsive. PLAN ACTION methods outlined in this manual; ɠ absence or difficulty breathing. ɠ general care – keeping the casualty ɠ chest pain. warm and comfortable, ongoing ɠ severe bleeding. monitoring, rest and reassurance. ɠ signs of stroke (e.g. face droop, Staying with them until advanced arm weakness, speech changes). care arrives; and, ɠ signs of shock (e.g. anxious, pale, ɠ handover of the casualty to the cold, sweaty, feeling sick or faint). next level of care. ɠ severe allergic reaction (e.g. facial swelling, wheezing, nausea, vomiting). ɠ repeated or first time seizures. ɠ severe fractures and burns. ɠ MedicAlert® conditions.
If in doubt, find out; always call an ambulance immediately if unsure.
The ambulance staff will advise the right care, in the right place, at the right time. For more advice and information, call Healthline 0800 611 116 (NZ) or a medical centre.
3 DRSABCD
Following the simple DRSABCD process below, the first aider makes a primary assessment to identify any immediately life-threatening conditions. The findings will indicate any action to be taken. Repeat the DRSABCD sequence until advanced care arrives.
OBSERVE/CHECK ACTION D DANGERS Check for hazards and risks. If possible, eliminate, isolate Check scene safety for: or minimise hazards and risks.
PRIMARY ASSESSMENTPRIMARY – DRSABCD ɠ yourself Only move the casualty if ɠ the casualty there is a clear reason to ɠ bystanders do so.
R RESPONSE Check for response. Shout and tap. (Alert Voice Pain Unresponsive)
S SEND FOR HELP Send for help. Call an ambulance immediately if no response. Consider AED.
A AIRWAY Consider airway If no response open airway obstruction. (Head tilt/Chin lift).
B BREATHING If unresponsive and not Start CPR. breathing normally. If unresponsive and Position the casualty on their breathing normally. side.
C CIRCULATION/ If not breathing normally. Start CPR. CPR If bleeding. Use direct pressure to control bleeding. If showing signs of shock. Treat shock.
D DEFIBRILLATION Attach AED ASAP if needed (if the casualty is not breathing normally). GENERAL CARE When/if breathing normally, position the casualty on their side. Monitor and reassure the casualty.
4 Using DRSABCD A practical example
Below is a practical example of how first aiders can useDRSABCD .
You are walking through the park when you see an elderly man stumble and fall. USING DRSABCD When you go to help you notice he is trying to get up and has blood coming from a wound on his hand. You decide to act.
DANGERS Check for dangers. Ensure safety for self, casualty and bystanders. You check the scene for obvious hazards and risks and note the presence of blood. You put on gloves. RESPONSE (See AVPU, p7) (AVPU) You ask him if he is OK. He speaks to you. He is alert. You introduce yourself and ask if you can help him. SEND FOR HELP Send or shout for help. You ask bystander for help. Consider AED. AIRWAY The casualty talks easily and has no obvious airway problem. BREATHING You ask if he is OK. Breathing is rapid. CIRCULATION/CPR Casualty appears pale and says he feels light headed. You send bystander to call for an ambulance immediately, because of the signs of shock. DEFIBRILLATION Consider AED. – If needed, attach and follow prompts. SPECIFIC CARE You lie the casualty in the shock position. You treat the hand wound. You check that the ambulance is on the way. You ask if the casualty has a history of heart-related problems, they say yes. You check for other injuries and cannot find any. GENERAL CARE You keep the casualty warm and reassure him. You stay until the ambulance arrives.
5 Dangers Ensure scene safety DANGERS Movement from dangers HOW TO HELP Movement can worsen the casualty’s condition by increasing pain, injury, The one person drag blood loss or shock. Only move a casualty if there is a clear reason to do so (to ensure safety; in extreme weather or on difficult terrain where movement is essential; to make possible the care of ABCs (Airway, Breathing, Circulation), perform CPR or control of severe bleeding). Stay with the casualty and send others to get help.
The one-person drag is the best way for the lone rescuer to move the casualty from danger. A blanket may also be used.
6 Response Levels of consciousness
The casualty’s response is a measure of their Level of Consciousness. An initial check of consciousness is performed in the Primary Assessment using the Shout RESPONSE and Tap method. More detailed assessment of a casualty’s level of consciousness should be made as part of the Secondary Assessment. The check should be repeated at regular intervals and medical personnel should be advised of any patterns. Patterns may show changes in the casualty’s condition.
LEVELS OF CONSCIOUSNESS RESPONSE A ALERT and Talks and responds to questions responsive appropriately. For example: ɠ What time of the day is it? ɠ What sport were you playing? ɠ What town are you in? Consider Talks, but may be anxious, irritable or calling an confused. ambulance May repeat questions several times, forgetting that answers have been provided. May start to become drowsy.
V Drowsy but Obeys instructions such as, responds to VOICE ɠ move your arms Consider ɠ open your eyes calling an or responds to instructions by grunting, ambulance groaning, moving the head or similar attempts to acknowledge.
Unconscious, does Does not speak or respond to P Consider not respond to instructions. Moves away from painful calling an voice but responds stimuli. Moves head away or grimaces ambulance to PAIN when tapped on the shoulder.
U UNRESPONSIVE Does not speak. Does not respond in Send or shout Unconscious any way to pain or voice. for help – call an ambulance immediately 7 Airway Breathing | BREATHING If a casualty is unconscious When we breathe, the body
AIRWAY they will be unable to uses only part of the oxygen maintain an open airway to we breathe in, so there is still allow air to enter the lungs. oxygen in the air when we Opening the airway of a breathe out. This is why the non-breathing unconscious first aider’s breath can be casualty may be the only step used to provide a casualty’s required to save their life. oxygen needs.
Open their airway using Head tilt/ Look, listen and feel for breathing for Chin lift as follows: up to 10 seconds. HOW TO HELP If a casualty is breathing normally, position the casualty on their side. Head tilt/Chin lift See Stable Side Position, p11.
The normal adult breathing rate is 12-20 breaths per minute (about 2-3 breaths in 10 seconds). Children and infants breathe at a faster rate.
Place one hand on the forehead and two fingers of the other hand on the bony part of the chin. Tilt the head back using the hand on the forehead, and at the same time lift the jaw upwards with the fingers of the other hand.
8 Breathing Circulation / difficulties Cardiopulmonary Resuscitation (CPR) CIRCULATION/CPR
The heart beats to pump |
SIGNS AND SYMPTOMS blood around the body. OF BREATHING DIFFICULTIES: Breathing is a sign of ɠ difficulty breathing circulation. If there is ɠ difficulty speaking no circulation, normal ɠ anxiety body activity will cease. ɠ inappropriate or lack of speech Commence CPR. ɠ noisy breathing, wheezing, coughing Unresponsive and not breathing normally = DIFFICULTIES BREATHING HOW TO HELP CPR + attach AED ASAP. Unresponsive and breathing MANAGE BREATHING normally = stable side DIFFICULTIES: position. ɠ Call an ambulance immediately. ɠ Monitor ABCs. In both situations send for help immediately. ɠ Make as comfortable as possible. ɠ Encourage casualty to take their Major bleeding must be managed medication. early to prevent shock developing ɠ Rest and reassure casualty. as the blood volume lowers. ɠ If the casualty is unresponsive Use direct pressure to control position them on their side. bleeding.
See Bleeding and Wounds, pp32–35.
Minimise shock by laying the casualty down, keeping them warm and reassuring them. Pale, cold sweaty skin, a weak rapid pulse, and rapid breathing indicate shock.
See Shock, p36.
9 Unconsciousness
Unconsciousness may occur Identify and assess
UNCONSCIOUSNESS for a number of reasons. unconsciousness Head injury, low blood There are levels of unconsciousness. sugar in diabetes, seizures A deeply unconscious casualty will and strokes can all result in not be able to speak or respond to what you say. The Level of unconsciousness. You do not Consciousness: AVPU chart on page need to know the cause to 7 provides methods to check levels of treat unconsciousness. consciousness. Initially you will have identified Before the loss of consciousness unconsciousness while checking the person may experience yawning, for response during the primary dizziness, sweating, have changes in assessment using the Shout and skin colour, blurred vision or nausea. tap method. HOW TO HELP All unresponsive/unconscious casualties should be positioned on MANAGE UNCONSCIOUSNESS: their side, ensuring that the airway is ɠ Obtain help. Send someone to open. Monitor breathing. call an ambulance immediately. DO NOT leave the person sitting in a ɠ Position the casualty in the chair or put their head between their Stable Side Position. knees. ɠ Check for any injury or illness Any person who fails to respond during the secondary assessment. or shows only a minor response to ɠ Quickly stop any bleeding. simple commands such as “open ɠ DO NOT give the casualty any your eyes; squeeze my hand; let it go” food or drink. should be managed as if unconscious. ɠ Stay with the person.
The major danger to an unconscious casualty is airway obstruction from the tongue. Position the casualty on their side.
10 Stable Side Position (Recovery position)
The Stable Side Position (a The Stable Side Position side-lying recovery position) (recovery position) POSITION SIDE STABLE is designed for unconscious, breathing casualties. It helps to maintain an open airway and allows vomit and other fluid to drain freely from the mouth. If a casualty is unresponsive (does not respond to your “shout and tap”, for example talk and touch commands such as “open your eyes” or “squeeze my hand”), groans without opening their eyes, Where you suspect neck or does not react to you grasping or spinal injuries in an and squeezing their shoulders firmly unconscious casualty, log to elicit a response, then gently roll them onto their side, position the casualty in the Stable supporting their head and Side Position (recovery position) keeping the spine in line. while being careful to avoid any twisting or forward movement of the See Log Roll, p68. head and spine.
The Stable Side Position is An unconscious, breathing sometimes referred to as the casualty who is obviously recovery or lateral position. pregnant should be placed on their left side.
11 DRSABCD Unresponsive and not breathing normally = CPR
DRSABCD – RESUSCITATION DRSABCD Continue CPR until normal breathing returns.
Check for DANGERS Check for RESPONSE (Shout and Tap) SEND for help (Dial 111 – Consider AED) Open the AIRWAY (Head tilt/Chin lift) Check for BREATHING ( Look, listen and feel for breathing for 10 seconds) CIRCULATION/CPR/DEFIBRILLATION (AED) Attach Automated External Defibrillator (AED) as soon as possible.
No Yes (Breathing abnormal (Breathing present) or absent)
Child (under 8 years) Adult (over 8 years) Position the casualty + Infant (0-1 year) in the Stable Side Position If not fully responsive or unconscious Start CPR* (30:2) Go for help if alone
If alone, go for help after one minute of Monitor ABCs CPR Start CPR* (30:2) Defibrillation Defibrillation Attach AED as soon as Attach AED as soon as Stop bleeding. possible and follow voice possible and follow voice Treat shock. prompts prompts Look for other injuries Continue CPR until Continue CPR until or casualties responsiveness or responsiveness or normal breathing returns normal breathing returns * See chart opposite
12 Resuscitation
Open Airway. Check for Breathing. Start CPR. DRSABCD – RESUSCITATION If available, attach AED. Follow voice prompts.
Adult Child Infant (over 8 years) (1-8 years) (0-1 years)
Start with Compressions. Compressions Compressions Push hard.
Compressions Two hands, centre One hand, centre Two fingers, just 1/3 depth of chest of chest. of chest. below nipple line
Compressions to breaths 30:2 30:2 30:2
Compressions per minute 100-120 100-120 100-120
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13 Basic Life Support Flowchart BASIC LIFE SUPPORT FLOWCHART SUPPORT LIFE BASIC
14 Resuscitation Chain of survival
The aim of CPR is to provide Most sudden cardiac arrests oxygen to the brain and heart occur outside of hospital CHAIN OFCHAIN SURVIVAL until appropriate advanced with death occurring within | cardiac life support can minutes of onset. restore normal heart beat The chain of survival lists the and breathing. priorities and actions to be followed Most adults require CPR as a result to give the casualty the best chance of surviving sudden cardiac arrest. of a heart problem so an emphasis RESUSCITATION is placed on calling the ambulance, early CPR and attaching an AED as soon as possible. For the purpose of resuscitation an adult is anyone over eight years of age. Prevention Resuscitation should be started where the person is unresponsive and not breathing normally. Early recognition For more information visit the New Zealand Resuscitation Council website nzrc.org.nz Early access
HOW TO HELP
TO GREATLY IMPROVE Early CPR THE CHANCE OF SURVIVAL: ɠ Get access to advanced care as early as possible (call for help; call an ambulance Early immediately). defibrillation ɠ Start CPR fast. ɠ Use an AED (defibrillator) as soon as possible. Early advanced care ɠ Continue CPR until advanced care help arrives.
15 Resuscitation Adult – CPR action checklist
HOW TO HELP
1 Check for dangers and hazards. Consider safety.
2 Response: Shout and tap the casualty to see if they respond. 3 Send for HELP. Call an ambulance immediately. Open airway Head Tilt Chin Lift RESUSCITATION – ADULT RESUSCITATION 4 Airway open ɠ Open the airway using Head tilt/Chin lift. 5 Breathing: Check for normal breathing. Look, listen and feel for breathing – airflow at the mouth and nose (check for no more than 10 seconds). ɠ If not breathing normally, start CPR. Look, listen and feel ɠ If breathing and unconscious. for breathing (no more – Position the casualty in the Stable Side Position. than 10 seconds) – Monitor for breathing, treat for shock. – Go for help if alone. 6 Circulation / CPR – Start CPR ɠ Position casualty laying on their back on a hard, flat surface. ɠ Compressions – give 30 compressions. ɠ Rate of compressions: 100–120 per minute. CPR ratio 30:2 ɠ Hands on centre of chest (use heels of hands). 30 compressions: ɠ Depth: 1/3 depth of chest (5cms or more on 2 rescue breaths an adult / 5cms for a child / 4cms for an infant). Smooth up and down pressure. ɠ Minimise pauses. 7 Give two effective rescue breaths, over one second each. ɠ An effective breath is completed when the chest begins to rise. 8 Continue CPR at a ratio of 30:2 Give 30 compressions to two breaths until help arrives or the casualty begins to breathe. 9 Defibrillation – Get and attach AED as soon as possible and follow voice prompts. Use AED as Attach AED as soon as possible for all ages. soon as possible
Photos courtesy Tracey Kearns 16 Resuscitation Adult – DRSABCD
CPR (i.e. chest HOW TO HELP compressions and rescue breathing) D DANGERS Check for hazards and risks. is provided for Ensure safety for self, casualty and bystanders. circulation. R RESPONSE (AVPU) Shout and tap, if unresponsive.
S SEND FOR HELP – DRSABCD – ADULT RESUSCITATION Send or shout for help. Send bystander to call an ambulance immediately. Consider AED.
A AIRWAY Open airway by using Head tilt/Chin lift.
B BREATHING Look, listen and feel for breathing for up to 10 seconds. If not breathing normally START CPR. If ALONE, go for help before starting CPR.
C CIRCULATION/CPR Commence CPR: 30 compressions / two rescue breaths. Depth: compressions at least 1/3 of the chest depth using two hands centre of chest. Rate: 100-120 per minute. Each rescue breath delivered over one second.
D DEFIBRILLATION If NOT BREATHING NORMALLY, continue with CPR. Attach AED as soon as possible and follow voice prompts.
17 Defibrillation and AEDs
A defibrillator is an electronic If paediatric- device that sends an specific pads are available they can electrical shock through the be used on children under the age of casualty’s chest in an attempt eight years. If they are not available use standard adult pads ensuring the DEFIBRILLATION AND AEDS DEFIBRILLATION to restore a normal heart pads do not touch each other. For rhythm. Early defibrillation smaller children, place one pad on significantly improves the the centre of the chest and the other chance of survival. pad on the upper back between the shoulder blades. Defibrillators located in places like Pad location is shopping malls, supermarkets and shown on the AED. other public facilities are usually an automatic, easy to use, voice-guided device and are therefore called an Automated External Defibrillator (AED). These can be used by members of the public, even without training. For all unresponsive casualties who are not breathing, start CPR and attach an AED as soon as one is available. The AED checks the casualty’s heart rhythm, decides if a shock is needed and provides step-by-step instructions. Simply turn on the device and follow the voice instructions on how to perform each step that is required. You cannot accidentally shock the Modern AEDs are easy to use casualty as the AED decides on, and and can be purchased through delivers, the shock process. It will not New Zealand Red Cross. shock someone who does not need redcrossshop.org.nz/aed a shock.
18 Resuscitation Child (and infants under one year old)
For the purposes of resuscitation a child is considered to be aged eight years and below. Unlike adults, children are rarely affected by cardiac arrest due to – CHILD / INFANT RESUSCITATION heart attack. Most non-breathing children are the result of airway and breathing problems. When you are alone and the child or infant is not breathing, perform CPR for one minute then call an ambulance immediately.
CALL FAST When you are alone and the child or infant is not breathing, perform CPR for one minute then call an ambulance immediately.
19 Resuscitation Child under eight years old (includes infant) CPR action checklist
HOW TO HELP
1 Check for dangers and hazards. Consider safety. 2 Check for response. Shout and tap, pick infant up. 3 Send for help – ask bystanders to call an ambulance Infant (under one immediately. year old) IF ALONE, stay with the child or infant. Consider AED. Open airway. Move head RESUSCITATION – CHILD / INFANT RESUSCITATION 4 Airway open into neutral position ɠ Child – Head tilt/Chin lift ɠ Infant – Move head into neutral position and support lower jaw as pictured. For how to resuscitate an adult, see p16. 5 Check for normal breathing. Look, listen and feel for breathing (no more than Look, listen and feel 10 seconds). for breathing (no ɠ IF NOT BREATHING NORMALLY, start CPR. more than 10 seconds) ɠ IF ALONE, go for help after one minute of CPR. 6 Circulation / CPR – start CPR ɠ 30 compressions. ɠ Rate of compressions: 100-120 per minute. ɠ Apply smooth up and down pressure. CPR RATIO 30:2 ɠ Child 1–8 years old – Position one hand on the centre 30 compressions: of the chest. Depth of compressions should be 1/3 of Two rescue breaths the chest depth. ɠ Infant under one year old – Two fingers just below the nipple line. Depth of compressions should be 1/3 of the chest depth. 7 Give two effective rescue breaths (an effective breath is completed when the chest begins to rise). Each rescue breath delivered over one second. 8 Continue CPR at a ratio of 30:2 IF ALONE, go for help after one minute of CPR. Give 30 compressions to two breaths until there is either a response from the child or until help arrives. Attach AED as soon as 9 If child begins to breathe, position on their side and possible (use paediatric monitor breathing. pads if available) 20 Photos courtesy Tracey Kearns Resuscitation Child under eight years old (includes infant) DRSABCD
HOW TO HELP D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders.
R RESPONSE (AVPU) If casualty is unresponsive.
S SEND FOR HELP Send or shout for help. Send bystander to call an ambulance immediately. IF ALONE, stay with the child. Consider AED. RESUSCITATION – DRSABCD – CHILD / INFANT RESUSCITATION
A AIRWAY Child (1–8 years old) – Open airway by Head tilt/Chin lift. Infant – Open airway by moving head into neutral position.
B BREATHING Look, listen and feel for breathing for 10 seconds. IF NOT BREATHING normally; START CPR. IF ALONE, go for help after one minute of CPR.
C CIRCULATION/CPR Continue CPR – 30 compressions : two rescue breaths (30:2). Rate of compressions: 100–120 per minute. Child compressions – 1/3 of the chest depth. Infant compressions – 1/3 of the chest depth. Each rescue breath should be delivered over one second. IF ALONE, go for help after one minute of CPR.
D DEFIBRILLATION Attach AED as soon as possible and follow voice prompts. For smaller children, place pad on the centre of the chest and the other pad on the upper back between the shoulder blades.
21 Most drowning persons are unable Drowning to call out or wave for help. (Including non-fatal SIGNS AND SYMPTOMS drowning and incidents involving water) DROWNING: ɠ difficulty in breathing or Always consider your own breathing stopped safety before attempting to ɠ frothing around the mouth/nose
DROWNING enter the water. Deep and ɠ little or no response moving water e.g. rivers and ɠ altered level of consciousness surf, are additional risks for the after incident involving water first aider. Rescue from land or a craft such as a boat and non- Be prepared – If regurgitation occurs, quickly roll the person contact rescues are preferred. onto their side and clear the Providing floatationto the casualty airway. Once the airway is clear, roll them onto their in distress is a priority especially back and re-start CPR. Do not when immediate removal from the interrupt CPR for more than a water is not possible. Items such as few seconds to do this. rugby balls, empty two-litre milk/ soft drink bottles and chilly-bin/s can All non-fatal drowning be used as improvised flotation aids. casualties (for example anyone who has experienced water- Where possible, reach out to the related distress) must be seen casualty with a branch, pole or beach by a medical professional. umbrella from land or no deeper Rescued casualties should be than waist-depth water. Throw a encouraged to seek medical rope if one is available. Only enter attention immediately if they water above waist depth with some develop a cough, form of flotation for yourself. breathlessness or any other Recognising a person drowning can worrisome symptom within be difficult; if you are unsure call eight hours of being in the water. out to the person “Are you okay?” Drowning chain of survival – A call to action
22 Ref: Szpilman, D et al. (2014) HOW TO HELP Choking MANAGE DROWNING: ɠ Call for help as soon as possible. ɠ Remove any unconscious person from the water as safely and Any person who indicates quickly as possible. Suspected they are choking or are spinal injury must not delay removal clutching their neck should from the water or starting CPR. be considered as possibly ɠ Assess the person on their back with the head and body at the same having a foreign body level. Only attempt CPR when the airway obstruction, for person is on a flat, firm surface. example choking. They may CHOKING suddenly stop breathing D DANGERS and fall unconscious for no Check for safety hazards and risks apparent reason. to self, casualty and bystanders. The management of choking will R RESPONSE (AVPU) depend on the degree of airway Check for response. Shout and tap. blockage and whether the casualty is conscious or unconscious. S SEND FOR HELP Send / shout for help. Send SIGNS AND SYMPTOMS bystander to call an ambulance immediately. Call for AED. CHOKING: The choking casualty is often AIRWAY A identified by the history Head tilt/Chin lift. surrounding the event: B BREATHING ɠ an adult eating a meal begins to If not breathing normally, start CPR cough and wheeze 30:2 immediately. Be aware that the ɠ a child playing tag and eating person may have swallowed water lollies is found unconscious and and may vomit, or regurgitation not breathing may occur (see note pg12-13). ɠ an infant sitting by a brother If breathing, position the casualty or sister eating peanuts stops on their side. breathing In these situations a foreign body C CIRCULATION/CPR airway obstruction should be Drowning casualties require full suspected. CPR with rescue breaths AND In addition, the choking casualty may: chest compressions. ɠ clutch at their neck D DEFIBRILLATION ɠ be unable to talk, cough or Use AED if not breathing normally. breathe 23 Choking Adult
HOW TO HELP
BACK BLOWS: If the airway is completely obstructed, give up to five back blows to attempt to clear the airway. Back blows should be CHOKING – ADULT performed as follows: ɠ Stand to the side and slightly behind the casualty. ɠ Support his/her chest with one hand and lean or bend him/ her well forward, so that when the obstructing material is HOW TO HELP dislodged, it comes out of the mouth rather than going further MANAGE ADULT CHOKING: down the airway. ɠ Dangers – check for hazards and ɠ Give up to five “sharp” blows risks, consider safety. between the shoulder blades ɠ Responsiveness – ask the with the heel of your other casualty: ‘Are you choking?’ hand. Each individual blow ɠ Send for help – ask bystander to should be a separate action, call an ambulance immediately. with the intent of relieving the obstruction. If the obstruction is ɠ If the casualty is coughing not relieved by back blows, give they should be encouraged to up to five chest thrusts. continue with attempts to expel the foreign body. ɠ If the casualty is unable to Chest thrusts talk, cough or breathe, the obstruction should then be Chest thrusts create an artificial managed using back blows and, cough intended to move and expel if needed, chest thrusts. the foreign body obstructing the airway. Chest thrusts should only be performed on conscious casualties. If the casualty becomes unconscious, start CPR.
24 HOW TO HELP
CHEST THRUSTS IF CONSCIOUS: ɠ Grasp the fist with the other hand. ɠ Deliver up to five chest thrusts if ɠ Give a quick, inward thrust by necessary. pulling the fist towards you in a ɠ Stand behind the casualty, place quick movement.
your arms under the casualty’s ɠ Administer up to five chest thrusts CHOKING – ADULT armpits and wrap or encircle the until the object is dislodged or the casualty’s chest. casualty becomes unconscious. ɠ Make a fist with one hand and ɠ Back blows and chest thrusts place the thumb side of the fist aim to remove the obstruction against the middle of the sternum, with each action rather than for example over the breastbone, deliver all five each time. If avoiding the lower tip. unconscious start CPR. (The location is the same as that used in the chest compressions for CPR.)
MANAGEMENT OF FOREIGN BODY AIRWAY OBSTRUCTION (CHOKING)
Assess
Ineffective cough Effective cough
Severe airway obstruction Mild airway obstruction
Unresponsive Responsive Encourage coughing Continue to check casualty until recovery or deterioration Send for help Send for help Send for help Start CPR Give up to five back blows If not effective Give up to five chest thrusts (Ref NZRC) 25 Obstructed airway Conscious
Obstructed airway cycle – If the adult / child casualty adult / child (1–8 years old) becomes unconscious or is conscious found unconscious The complete actions for dealing If foreign body obstruction is with choking in a conscious adult or suspected, then follow the standard child are as follows: DRSABCD sequence for adult or child CPR. If solid material is visible HOW TO HELP in the mouth remove with a gentle finger sweep.
OBSTRUCTED AIRWAY – CONSCIOUS AIRWAY OBSTRUCTED Repeat the sequence of airway Encourage them to cough examination/attempted rescue Essentialbreaths/chest compressions Life Support until andtheEssential objectManaging becomes Life dislodged SupportChoking or advanced help arrives. andwww.resus.org.nz Managing @nzresuscouncil Choking
www.resus.org.nzManaging Choking @nzresuscouncil - 5 5 Managing ChokingResponsive - Responsive Adult or Adult Child or Child back blows chest thrusts Managing Choking - Responsive Adult or Child
Give 5 Give 5 back chest blowsGive 5 Givethrusts 5 back chest CONTINUE CYCLE blows thrusts until obstruction is removed. If casualty becomes unconscious begin CPR.
If unresponsive follow the flowchart overleaf If unresponsiveManaging follow the Choking flowchart - overleaf Managing Choking - Responsive Infant ManagingResponsive Choking - Responsive Infant Infant
GiveGive 5 5 backback blowsblows
MouthMouth check. check. GiveGive 5 HookHook out out chestchest obstructionobstruction thruststhrusts onlyonly if seen if seen
26 If unresponsive follow the flowchart overleaf If unresponsive follow the flowchart overleaf Obstructed airway Unconscious
Obstructed airway cycle – Notes adult / child (1–8 years old) unconscious Follows DRSABCD sequence for adult or child. The actions for dealing with choking in an unconscious adult are as follows: HOW TO HELP OBSTRUCTED AIRWAY – UNCONSCIOUS AIRWAY OBSTRUCTED Start 30 chest compressions. 100–120 per minute (as for CPR)
Look for obstruction in Unsuccessful mouth, remove if object is visible
Attempt 2 rescue breaths
CONTINUE CYCLE until the casualty starts breathing normally. 27 Choking Choking Child Adult and child 1-8 years old DRSABCD
There are some changes HOW TO HELP made to choking techniques when dealing with a child or D DANGERS Check for hazards and risks. infant. The major differences DRSABCD – AUDULT/CHILD Ensure safety for self, casualty |
are outlined below. and bystanders.
R RESPONSE (AVPU) HOW TO HELP Check for response. CHILDREN: SEND FOR HELP Open the mouth. If a foreign body S Send / shout for help. Send is seen, remove it: only finger CHOKING – CHILD bystander to call an ambulance sweep if a foreign body is seen. immediately. Consider AED. Children aged 1–8 years old who are choking and conscious are to be AIRWAY treated the same as adult choking. A If RESPONSIVE use choking manoeuvres. Encourage casualty to cough or use back blows and chest thrusts.
B BREATHING Continue choking manoeuvres until casualty is breathing. If casualty becomes unconscious start CPR.
C CIRCULATION/CPR If UNRESPONSIVE and not breathing, start CPR.
D DEFIBRILLATION
28 Choking Infant (under one year old)
Infant choking – the sequence for conscious infants is quite different and is stated below:
HOW TO HELP HOW TO HELP
INFANT (UNDER ONE YEAR INFANT (UNDER ONE YEAR
OLD): CONSCIOUS CHOKING OLD): UNCONSCIOUS CHOKING – INFANT CHOKING 1 Place the infant down straddling your arm with the head lower than 1 Place the baby on a firm surface the trunk and the head supported (for example a table). with the hand around the jaw. 2 Open the airway to a neutral 2 Deliver five back blows between position, look for and remove the shoulder blades with the any foreign objects using a heel of your hand. finger sweep; and look, listen and feel for breathing (no 3 Sandwich the infant between your longer than 10 seconds). arms (all the while supporting the neck of the infant). Turn the 3 Give 30 compressions. infant over and deliver five chest 4 Reposition head to open the thrusts using two fingers, just airway, give two small gentle below the nipple line. rescue breaths (puffs). 4 Check the airway. If you see a 5 Continue CPR 30:2 cycle, until foreign body, gently ‘hook’ it out, object is dislodged and baby is but avoid blind finger sweeps. breathing, or medical help has 5 Repeat as necessary. arrived.
See Infant CPR, p20.
29 Choking Conscious infant (under one year old)
Conscious infant with obstructed airway The actions for dealing with choking in a conscious infant are as follows:
HOW TO HELP
5 back blows Sandwich turn 5 chest thrusts CHOKING – CONSCIOUS INFANT CHOKING – CONSCIOUS
Head is held lower than the body and is firmly supported at all times. Check mouth, remove object if visible. If unsuccessful, repeat cycle.
SANDWICH TURN
If the casualty becomes unconscious, follow the standard sequence for infant (under one year old) CPR, checking airway for obstruction (opposite page).
30 Choking Choking Unconscious infant Infant (under one (under one year old) year old) – DRSABCD DRSABCD – INFANT
HOW TO HELP HOW TO HELP |
D DANGERS Place infant on Check for hazards and risks. firm surface Ensure safety for self, casualty and bystanders.
RESPONSE (AVPU) Open airway to neutral R position, check for normal Check for response. breathing. Look for and remove foreign objects. S SEND FOR HELP Send / shout for help. Send bystander to call an ambulance immediately. Consider AED. CHOKING – UNCONSCIOUS INFANT CHOKING – UNCONSCIOUS 30 2 A AIRWAY compressions. small gentle If RESPONSIVE use choking rescue breaths 100–120 per manoeuvres. Clear by minute (puffs) encouraging casualty to cough or use back blows and chest thrusts. REPEAT THE SEQUENCE Deliver CPR rescue breaths / chest B BREATHING compressions until the object becomes Continue choking manoeuvres dislodged or advanced help arrives. until casualty is breathing. If casualty becomes unconscious start CPR.
C CIRCULATION/CPR If UNRESPONSIVE and not breathing start CPR.
D DEFIBRILLATION If available, attach AED and follow the prompts.
31 Bleeding Wounds
Identify and assess bleeding Wounds in areas with a good Blood loss may occur either internally blood supply will bleed a lot. or externally. A large amount of blood can With internal bleeding there may be lost from a very small cut be no visible blood, and it will be in areas such as the scalp. the signs and symptoms of shock that alert the first aider to the loss The first aider, using standard of blood. In external bleeding the precautions (such as gloves and quantity and colour of blood will protective glasses), should always vary depending on the type of blood expose the wound site to determine BLEEDING | WOUNDS vessel damaged. the seriousness of the injury. If the wound is covered by clothing, Blood vessel Characteristics of remove clothing from the affected type bleeding area to see the wound. If necessary, ARTERY Bright red blood, cut clothing. spurting in response to heart beat. Protect yourself from infection by wearing gloves when blood is VEIN Dark red in colour, present. When possible encourage flows steadily. the casualty to apply direct pressure CAPILLARY Blood oozes gently. using their own hand to limit your contact with blood. SIGNS AND SYMPTOMS The management of all bleeding starts with applying direct pressure. BLEEDING: The use of tourniquets and ɠ pain haemostatic dressings may be used in ɠ bleeding first aid when direct wound pressure ɠ cold sweaty skin, feeling cold fails to control severe bleeding or ɠ pale appearance cannot be applied, and the first aider ɠ signs of shock is trained in their use.
If gloves are not available, using plastic bags as makeshift gloves is a good alternative.
32 THINK RED Rest & Reassure Expose & Evaluate Dressing & Direct Pressure
HOW TO HELP
MANAGE EXTERNAL BLEEDING: ɠ Continue to control bleeding by ɠ Put on gloves to ensure your direct pressure with compression personal safety. bandage if necessary. The need to control bleeding is paramount. ɠ If possible, lay the casualty down comfortably and rest the ɠ Restrict movement. injured area. ɠ Monitor ABCs. WOUNDS ɠ Expose the wound to determine ɠ Rest and reassure the casualty. the extent of the problem. ɠ Treat for shock, use the DRSABCD Carefully and gently cut away Basic Life Support Flowchart. clothing if necessary. See p4. ɠ Attempt to stop the bleeding by ɠ DO NOT give casualty anything to applying sustained and direct pressure. Cover the wound. Place eat and drink. a clean, non-fluffy dressing pad or CALL AN AMBULANCE bandage over the wound and apply IMMEDIATELY IF: firm sustaineddirect pressure. ɠ bleeding is severe. ɠ If there is a foreign object ɠ bleeding is not controlled. embedded in the wound, DO ɠ casualty is not breathing normally NOT remove it, use indirect pressure around the wound or is unresponsive. supporting and holding the object TO HELP CONTROL BLEEDING: in place. ɠ Restrict movement. See Embedded objects in wounds, ɠ Advise the person to remain at p34. total rest. ɠ DO NOT remove clots that have ɠ Use a cold pack and apply pressure formed. to a bruised limb which has no ɠ If blood comes through the first signs of external bleeding. dressing, place another pad over If life threatening, severe and the first without removing the uncontrolled bleeding, a tourniquet original pad or apply a tighter or haemostatic bandage may be used if dressing. the first aider is trained to do so. ɠ If bleeding continues check pressure is being applied directly on the wound.
33 Embedded Minor objects in wounds wounds Foreign bodies that are clearly on the HOW TO HELP surface and not sticking to the wound may be removed. However DO NOT CLEANING A MINOR WOUND: MINOR WOUNDS MINOR remove embedded objects. ɠ Cover the wound and seek | medical treatment if the wound HOW TO HELP looks dirty. ɠ Clean the wound if it will not MANAGEMENT OF ALL BLEEDING: require medical treatment. ɠ Apply direct pressure to the ɠ Carefully clean around wound wound. with saline solution or clean ɠ Reassure the person and assist to water. rest in a comfortable position. ɠ Clean wound with running, clean, ɠ Monitor DRSABCD regularly. lukewarm water. DO NOT rub ɠ DO NOT give anything by mouth the wound itself. (including medications or alcohol). ɠ Dry with a clean pad. ɠ Cover with a Band-aid type
EMBEDDED OBJECTS IN WOUNDS IN EMBEDDED OBJECTS dressing or gauze pad and bandage.
Leave embedded objects where they are as they may be plugging the wound. Closed bleeding in limbs
HOW TO HELP Pad beside, below and around the object and apply compression over ɠ Use a cold pack and apply pads to prevent direct pressure compression on bruised limbs being applied over the object. with no external bleeding.
34 Internal Bleeding bleeding DRSABCD
Is difficult to recognise but HOW TO HELP always consider this if there D DANGERS are signs and symptoms Check for hazards and risks. of shock. Includes bruises, Ensure safety for self, casualty and hematomas, bleeding with bystanders. Wear gloves. fractures, severe bleeding R RESPONSE (AVPU) from pregnancy. Check for response.
SIGNS AND SYMPTOMS S SEND FOR HELP Consider calling an ambulance. INTERNAL BLEEDING: Consider AED.
ɠ shock BLEEDING | DRSABCD INTERNAL ɠ pain, swelling, tenderness over A AIRWAY or around the area, blood from Check airway. body opening ɠ bright red, frothy blood B BREATHING coughed up from lungs Check breathing. ɠ bright red or dark brown vomited blood C CIRCULATION/CPR Control bleeding, treat for shock. ɠ blood-stained urine ɠ genital bleeding D DEFIBRILLATION ɠ bright red or black ‘tarry’ Consider AED for severe bleeding. rectal bleeding SPECIFIC CARE Think RED HOW TO HELP – Rest and Reassure. – Expose and Evaluate. MANAGE INTERNAL BLEEDING: – Dressing and Direct Pressure. Internal bleeding may be life Add more bandages if blood seeps threatening and require urgent through. Monitor ABCs. hospital treatment. Restrict movement, keep casualty ɠ call an ambulance at total rest. ɠ lay the person down ɠ treat for shock GENERAL CARE Keep casualty warm and reassured. DO NOT give anything to eat or drink. 35 Shock
Shock occurs when not HOW TO HELP enough oxygen-rich blood reaches parts of the body, MANAGE SHOCK: and causes life-threatening ɠ If conscious, lay casualty down on their back. If unconscious, lay organ failure. the casualty down on their side. Shock may be seen in most serious ɠ Call an ambulance immediately. injuries involving fluid loss such as ɠ Where possible, treat the cause severe bleeding, major trauma, burns or of the shock. For example illness involving diarrhoea, dehydration, promptly stop bleeding, cool SHOCK vomiting, an allergic reaction, heart burns. attacks or heart problems. ɠ Keep the casualty warm. ɠ Reassure the casualty. Shock is considered life ɠ Loosen restrictive clothing. threatening. Call an ambulance ɠ DO NOT give food, drink or immediately. cigarettes. ɠ Monitor vital signs and ABCs. SIGNS AND SYMPTOMS ɠ Follow the Basic Life Support SHOCK: Flowchart. The signs and symptoms apparent See p14. in shock may include the following: ɠ irritability, restlessness, confusion or anxiety Most injuries and many ɠ pale, cold, moist skin illnesses give some degree ɠ shivering or chills of shock. ɠ rapid pulse which may become weak or slow ɠ rapid breathing ɠ breathlessness ɠ feeling sick, vomiting ɠ feeling faint, dizziness ɠ collapse, unconsciousness may develop ɠ thirst ɠ decreased urine output
36 Fainting
Fainting is the brief loss of Notes consciousness caused by a temporary decrease in blood flow to the brain. Some people faint at the sight of blood or as a reaction to pain or bad news. A common reason for fainting is standing in one position without moving for a long period of time. FAINTING
SIGNS AND SYMPTOMS
FAINTING: A casualty who has fainted may feel giddy, unsteady and weak and may: ɠ fall to the floor or slump in a chair and become unconscious ɠ have pale, sweaty skin ɠ have a slow pulse
HOW TO HELP
MANAGE FAINTING: ɠ Lie the casualty down. ɠ Loosen tight clothing. ɠ Position the casualty on their side if unconscious. ɠ Call an ambulance if the casualty remains unconscious for more than five minutes. ɠ Reassure casualty on recovery.
37 Check for other conditions and injuries
History HISTORY Recheck vital signs Question casualty and bystanders Check for other conditions and injuries RECHECK VITAL SIGNS
Vital signs are the level of consciousness and breathing
CHECK FOR INJURIES
Continue to monitor DRSABCD CHECK FOR OTHER CONDITIONS AND CONDITIONS INJURIES OTHER FOR CHECK
38 History Recheck vital signs and act as required
HOW TO HELP Check vital signs as detailed below, until an ambulance arrives. HISTORY: ɠ Ask the casualty and / or HOW TO HELP bystanders what happened, record if possible. LEVEL OF RESPONSE AND ɠ Observe evidence at the scene, BREATHING: e.g. pill bottles, chemical ɠ Check the breathing rate of the containers. casualty by counting breaths ɠ Ask SAMPLE questions: taken over one minute. The rate of breathing can be controlled at Signs and symptoms will, so do not advise the casualty Allergies of your check. Medication Past medical history ɠ Remember the absence of SIGNS | VITAL Last oral intake response and absence of normal (food, fluid, drugs) breathing is all that is required to indicate that CPR should be given. Events leading to the emergency HISTORY (what happened?) ɠ If the casualty is not breathing normally, start CPR immediately by delivery of Notes chest compressions. Ask for a defibrillator (AED) and follow the voice prompts.
The vital signs check should be repeated and recorded at 10 minute intervals.
39 Consciousness
HOW TO HELP Notes
LEVEL OF CONSCIOUSNESS – RESPONSIVENESS: Determine the casualty’s level of consciousness by checking for a response using shout and tap.
Levels of consciousness A ALERT Fully responsive or may be confused or become drowsy
V Responds to VOICE, drowsy CONSCIOUSNESS P Responds to PAIN, is unconscious
U UNRESPONSIVE, unconscious
40 Check for Check for injuries MedicAlert® emblem or The human body is fairly other identifier similar on both sides. This allows us to compare the two sides when inspecting In an emergency, while for injury. The body check is advanced care is on its way, carried out head to-toe. look for an emblem, bracelet, necklace, anklet, wristband or If you find an injury it will be any other identifier containing necessary to remove clothing to important medical information know the size, type and severity of MEDICALERT | injury. DO NOT remove or damage about the casualty. more clothing than necessary. ® MedicAlert is a worldwide Ensure the casualty’s privacy. organisation which provides protection for New Zealanders with life-threatening medical conditions.
Members are issued with a metal emblem engraved with the member’s number, emergency telephone INJURIES FOR CHECK number and medical conditions; plus a plastic wallet card providing more detailed personal and medical records. Advanced care have access to this information to support the care of the casualty.
Always ask the casualty’s To find out more visit permission to do a body medicalert.co.nz check and explain what you are doing.
41 Heart attack
The heart, like any other HEART ATTACK muscle in the body, needs Call an ambulance a blood supply to provide it immediately. with oxygen. A heart attack occurs when there is a reduction in the blood supply HOW TO HELP to a part of the heart muscle, MANAGE HEART ATTACK: damaging the heart. ɠ Encourage the casualty to rest quietly, in a comfortable position; SIGNS AND SYMPTOMS reassure them. ɠ Call an ambulance immediately. HEART ATTACK: ɠ Ask the casualty if they are allergic The casualty may think they just to aspirin. If not, give casualty one have indigestion. Some or all of the tablet (300 mg) to chew, or give following symptoms may be present: soluble aspirin dissolved in a small ɠ pale appearance amount of water. HEART ATTACK HEART ɠ heavy pressure, tightness, ɠ Monitor ABCs and vital signs. vice-like crushing pain or unusual ɠ A heart attack may lead to discomfort in the centre of the cardiac arrest. Be prepared to chest start CPR. ɠ pain may spread to the shoulders, ɠ Locate the closest AED. Bring neck, jaw, arms or back it to the person ready to use if ɠ profuse sweating, cold sweaty needed. skin ɠ sudden fainting or dizziness, feels light-headed ɠ shortness of breath with rapid breathing and gasping for air, difficulty speaking ɠ nausea or vomiting ɠ lips turning blue ɠ anxiety ɠ collapse, unconsciousness
42 Angina
Angina is the pain felt HOW TO HELP when there is temporarily insufficient blood flow MANAGE ANGINA: to the heart to meet the Most people with a history of angina carry medication with them. This heart’s needs. Permanent medication may be a spray or tablet, heart muscle damage does which is taken under the tongue. not result. ɠ Encourage the casualty to rest quietly. Most angina attacks will be ɠ Help the casualty loosen tight managed by the casualty by rest and clothing. medication. If the casualty does not ɠ Call an ambulance immediately. respond to resting and taking their medication consider and treat as a ɠ If the casualty has medicine they should take it. heart attack. ɠ Make casualty as comfortable as possible. SIGNS AND SYMPTOMS ANGINA
ANGINA: Angina is characterised by: ɠ pain in the chest, neck, jaw or arms brought on by effort or excitement ɠ sweaty, pale skin ɠ shortness of breath; difficulty speaking ɠ anxiety
ANGINA HEART ATTACK ɠ occurs on effort or excitement ɠ may occur at rest ɠ may be relieved by rest or medication ɠ not relieved by rest or medication
43 Heart health
We encourage people to get a cardiovascular risk assessment done by their GP. Some risk factors you can’t change, for example family history, personal history of heart disease, ethnicity, age. However, there are risk factors that you can change…
Source: NZ Heart Foundation Even small changes have a positive effect on your risk factors and your overall risk of heart attack and stroke. HEART HEALTH HEART
ɠ If you smoke, stopping smoking is the best thing you can do for For more information visit your heart. heartfoundation.org.nz ɠ Healthy eating for good heart health is all about balancing the different types of food you eat to get a range of nutrients. ɠ Getting active can be simple. ɠ Managing your weight is all about balancing what you eat and drink with the exercise that you do. ɠ Your doctor may talk to you about medications to help manage your risk.
44 Heart attack action plan
HOW TO HELP
Does the person feel any PAIN PRESSURE HEAVINESS TIGHTNESS
In one or more of their CHEST NECK JAW ARM/S BACK SHOULDER/S
They may also feel NAUSEOUS A COLD SWEAT DIZZY SHORT OF BREATH
YES
1 STOP – Stop the person from what they are doing and tell them to rest.
2 TALK – Ask them what they are feeling.
If they take angina medicine: Or assess: ɠ Give them a dose of medicine. ɠ Are symptoms severe?
ɠ Wait five minutes. Does the casualty ɠ Getting worse quickly? PLAN ACTION ATTACK HEART still have heart attack symptoms? ɠ Have lasted for 10 minutes? Give them another dose of angina medicine. ɠ Wait five minutes. Does the casualty still have heart attack symptoms?
YES
3 CALL – an ambulance now – administer aspirin (300mg) if available.
ɠ In New Zealand: Call 111 ɠ Don’t hang up. ɠ In Australia: Call 000 (or 112) ɠ Wait for the operator’s instructions.
Adapted with permission from the National Heart Foundation of Australia. Warning signs action plan. Melbourne: National Heart Foundation of Australia, 2012 ANZCOR Guidelines 9.2.1 January 2016 45 Stroke
A stroke occurs when the SIGNS AND SYMPTOMS blood supply to the brain is impaired by a blood clot STROKE: The most common symptoms of or burst blood vessel. Call stroke are covered by FAST. for medical help. Call an Face – Is their face drooping on one ambulance immediately. side? Can they smile? Arm – Is one arm weak? Can they raise both arms? Speech – Is their speech jumbled or slurred? Can they speak at all? Take action – Call 111 immediately. It’s believed that the FAST symptoms are present in 85 per cent of strokes. The signs and symptoms of stroke usually come on suddenly. The type STROKE of signs experienced will depend on what area of the brain is affected. Other signs of stroke may include one, or a combination of: ɠ Weakness or numbness or paralysis of a leg on either or both sides of the body ɠ Difficulty speaking or understanding ɠ Dizziness, loss of balance or an unexplained fall ɠ Loss of vision, sudden blurring or decreased vision in one or both eyes ɠ Headache, usually severe and abrupt onset ɠ Difficulty swallowing
46 Quick recognition and Reduce risk of stroke response makes all the Stroke affects thousands of people difference in New Zealand and the Pacific. However you can lower your risk Chances of survival and prospects of with regular blood checks, a recovery from a stroke dramatically healthy lifestyle and learning increase when casualties receive more about stroke. emergency support within three hours of having a stroke. Therefore, rapid recognition of For more information on warning signs and the immediate call reducing your risk of stroke to emergency services is crucial. visit stroke.org.nz
HOW TO HELP
MANAGE A STROKE: ɠ Call an ambulance immediately. STROKE ɠ If casualty is conscious, lie down with head and shoulders supported by pillows. ɠ If unconscious, position the casualty in the Stable Side Position. ɠ Monitor ABCs, level of consciousness and vital signs. ɠ Rest and reassure the casualty.
47 Diabetic emergency
In diabetes the body is unable HOW TO HELP to control the blood sugar level. This may lead to the MANAGE LOW BLOOD SUGAR blood sugar level being too IF CONSCIOUS: high or too low. ɠ Give sugary food such as glucose, jelly beans, honey, sugar or sugary drink. High blood sugar ɠ Improvement should occur (hyperglycaemia) within five minutes. Hyperglycaemia develops slowly and ɠ Rest and reassure casualty. is unlikely to be a first aid emergency. ɠ Monitor ABCs.
Low blood sugar IF UNCONSCIOUS: (hypoglycaemia) ɠ Check ABCs. ɠ Position the casualty in the SIGNS AND SYMPTOMS Stable Side Position. ɠ Call an ambulance immediately. LOW BLOOD SUGAR:
DIABETIC EMERGENCY DIABETIC Will result in: ɠ headache, hungry, tired ɠ pale appearance ɠ cold, sweaty skin ɠ the ‘shakes’ ɠ aggression or confusion ɠ unconsciousness may develop ɠ many diabetics wear MedicAlert® emblems or other types of identifiers ɠ signs of shock
48 Seizures
A seizure may occur when SIGNS AND SYMPTOMS the normal pattern of electrical activity of the brain SEIZURES: is disrupted. ɠ changes in sensations, awareness and behavior Seizure could be result of: ɠ convulsions ɠ confused drowsy or dizzy ɠ lack of oxygen ɠ loss of consciousness, sudden ɠ cardiac arrest collapse ɠ medical conditions ɠ uncontrolled muscular ɠ head injury contractions (spasms, jerking ɠ poisoning movements) ɠ withdrawal from alcohol and ɠ dribbling or frothy saliva, may be substances of dependence bloodstained. ɠ ɠ excessive heat loss of bladder or bowel control ɠ confused, tired or sleepy once SEIZURES consciousness returns ɠ casualty may wear a MedicAlert® emblem or other type of identifier ɠ during partial seizures the casualty remains conscious but may be frightened or confused
Do not restrain the person, or put anything in their mouth.
49 HOW TO HELP Convulsions due to excessive heat MANAGE SEIZURES: ɠ Make the area safe. Protect the Convulsions in young children person from harm or injury, often occur due to high especially the head. temperature during an illness ɠ Keep bystanders away. Maintain (febrile convulsions) but can privacy. occur in adults also. ɠ Note the time the seizure starts, write down if possible. The management aim is to reduce the ɠ Do not restrain a person or put high temperature: anything in the mouth. ɠ Loosen or remove clothing. ɠ When the seizure has stopped ɠ Sponge the skin with tepid water, place the casualty on their side. Make sure the airway is clear fan to keep cooling. following DRSABCD sequence. ɠ Do not put a child or infant in the
SEIZURES ɠ Rest and reassure casualty. bath to lower the temperature while they are having a convulsion ɠ Monitor ABC’s. as this is dangerous. ɠ If the seizure happens in water: support the casualty to ɠ Seek medical advice (for example keep their airway clear of the NZ Healthline 0800 611 116) as water, remove from the water further treatment may be needed. as soon as possible without compromising the safety of the first aider. ɠ Call an ambulance immediately if: ɠ The seizure lasts longer than five minutes or the casualty has more than one seizure ɠ Casualty has head injury ɠ Casualty is pregnant ɠ If this is their first seizure ɠ Other injury has occurred ɠ If the seizure is in water
50 Hyperventilation Asthma
Hyperventilation, or People with asthma have over-breathing, is when the sensitive airways which may breathing rate or depth require daily medication to is increased, which can keep it under control. sometimes be triggered When an asthma attack occurs the by anxiety. sensitive airways are irritated by triggers which causes the muscles SIGNS AND SYMPTOMS surrounding the airways to tighten, swell, narrow and make extra mucus HYPERVENTILATION: making breathing very difficult. Includes: Triggers are individual to the person ɠ breathing faster or deeper and may include things like: respiratory than normal, frequent sighing infection; irritants (smoke, perfume, | ASTHMA or yawning cleaning products); allergens (dust, ɠ feeling dizzy or light headed mould, grass, pollen); cold air, ɠ numbness or tingling exercise, laughing, crying, emotions; nonsteroidal anti-inflammatories ɠ hand spasms (aspirin); food allergy, food colours and flavours. Most people with asthma
HOW TO HELP carry a reliever and often have an HYPERVENTILATION “Asthma First Aid Plan”. MANAGE HYPERVENTILATION: ɠ Reassure the casualty. SIGNS AND SYMPTOMS ɠ Sit them down and stay with them. ASTHMA: ɠ Encourage them to breathe The casualty may experience: slowly with deep breaths. ɠ difficulty breathing ɠ Ask the casualty to breathe with you, slowly and deeply. ɠ wheezing, noisy breathing ɠ ‘sucking in’ of throat and ribs ɠ coughing, tight chest ɠ difficulty speaking in sentences ɠ anxiety, feeling distressed ɠ pale, sweaty skin ɠ blueness around the mouth
51 HOW TO HELP
MANAGE ASTHMA:
A ASSESS Mild – short of breath, wheeze, cough, chest tightness – responds quickly to reliever inhaler. Moderate – loud wheeze, breathing difficulty, can only speak in short sentences. Severe – distressed, gasping for breath, difficulty speaking two words, blueness around the mouth. (If the person has severe asthma or is frightened, call an ambulance immediately.)
S SIT Sit the person upright and stay with them. If a mild attack treat with two doses of reliever inhaler.
T TREAT Treat with a reliever inhaler giving one puff at a time. Use a spacer if one is available. If the casualty does not have a reliever inhaler it is OK to use someone else’s if there is one available.
H HELP ASTHMA If the casualty is not improving, call an ambulance. Continue to use the reliever inhaler giving six doses every six minutes until help arrives. Remember: Six doses of medication Six breaths after each dose Six minute wait, repeat cycle. In this situation you will not overdose the person by giving them the reliever every few minutes.
M MONITOR If breathing is improving, monitor the casualty. If necessary repeat the dose of reliever inhaler.
A ALL OK When free of wheeze, cough or breathlessness keep the casualty calm and return to a quiet activity and advise them to see their doctor. Monitor ABCs.
52 ASTHMA Safety AVPU Consider Consider ambulance. AED Consider Check Check Check Check as mostPosition comfortable for Assist breathing. with medications Reassure INFANTILE INFANTILE CONVULSION Safety AVPU Consider ambulance. AED Consider Check Check Check Check casualty Cool casualty Keep cool SEIZURE Safety AVPU Consider Consider ambulance. AED Consider Check Check Check Check from Protect injury Stay with casualty until recovered DIABETES (HYPOGLYCAEMIA) Safety AVPU Consider ambulance. AED Consider Check Check Check Check sugar / Give if carbohydrate conscious Stay with casualty until recovered STROKE Safety AVPU Call an ambulance immediately. AED Consider Check Check Check Check The Stable Side position if unconscious and Rest reassure drsabcd MEDICAL CONDITIONS – DRSABCD CONDITIONS MEDICAL NGINA A Safety AVPU Call an ambulance immediately. AED Consider Check Check Check Check own Casualty’s medication and Rest reassure HEART HEART ATTACK Safety AVPU Call an ambulance immediately. AED Consider Check Check to Be prepared do CPR Check Check Aspirin and Rest reassure
R HELP R ND DANGERS RESPONSE SE FO AIRWAY BREATHING CIRCULATION/ CPR DEFIBRILLATION CARE SPECIFIC CARE GENERAL S R B C A D D Medical conditions – Medical conditions 53 Fever
Fever is a common medical fever, or sudden high fever, severe sign with sweating and high headache, pain behind the eyes, muscle and joint pains, and rash. body temperature as the In rare cases Dengue Haemorrhagic body fights an infection. First Fever (DHF) is a potentially deadly aid treatment is making sure complication. the casualty is rested and Prevention of dengue fever given plenty of drinks (more ɠ Protect from mosquito bites than usual). – full sleeve clothes, mosquito Breastfeeding mothers should repellents. continue to breastfeed their baby as ɠ Keep all water containers covered much as possible. Patients should and clean water pots, barrels and also be encouraged to eat healthy buckets regularly. food such as soups, rice, and mashed ɠ Clean up standing water, drains, fruits and vegetables. roof gutters, vegetation in and FEVER If the fever is very high, sponge patient around house and empty pot plants. with water and fan them to reduce ɠ Get rid of objects where water temperature. Seek medical advice. collects such as plastic bottles, tins, tyres and coconut shells. Dengue fever Dengue fever is a disease spread by HOW TO HELP a mosquito bite. Dengue mosquitoes live in and around houses; they breed MANAGE DENGUE FEVER: in water. Dengue mosquitoes usually ɠ If dengue is suspected, contact a bite during daytime, mainly after health centre immediately. sunrise and before sunset. Check to ɠ Rest in bed to enable the body to see if dengue-carrying mosquitos are fight the disease. in the country that you either live in or are travelling to. ɠ Drink extra fluids to prevent dehydration. Dengue fever is a severe, flu-like illness ɠ Avoid medicines containing that affects babies, young children and aspirin. adults. It does not often cause death. Babies and young children may have a fever with rash. Older children and adults may have either a mild
54 Malaria
Malaria is a disease that Prevention of malaria causes fever, nausea, ɠ Use mosquito nets for sleeping and vomiting, headache, sweating avoid mosquito bites, full-sleeve and chills, joint and muscle clothes and mosquito repellents. pains, difficulty in eating ɠ Eliminate mosquito breeding by cleaning up standing water, drains, and drinking and sometimes and vegetation in and around house. convulsions. It is spread by the ɠ Remove objects where water bite of an infected mosquito. collects such as plastic bottles, tins, tyres and coconut shells. It can be especially harmful to babies, children and pregnant women. When it is not treated immediately, it may HOW TO HELP develop into a much more serious condition that can lead to death. TREATMENT OF MALARIA: ɠ Know signs and symptoms of Malaria mosquitoes breed in water, malaria (above). bite at different times of day, but MALARIA ɠ If malaria is suspected, get mostly during the evening and the medical help immediately as night. Check to see if malaria-carrying medication will be required. mosquitos are in the country that you either live in or are travelling to.
Also be aware of Zika virus and Chikungunya. Be familiar with the key health messages for the country that you live in or are travelling to.
55 Diarrhoea
This is the passing of three HOW TO HELP or more loose, watery bowel motions in one day. Diarrhoea MANAGE DIARRHOEA; ACT QUICKLY: can be a very serious illness. ɠ Drink lots of liquids (three or It is a common cause of baby more litres a day for adults) deaths worldwide. The loss ɠ A homemade solution can be of fluids through diarrhoea ‘made with a level 1/2 teaspoon can cause dehydration and of salt, eight teaspoons of sugar and one litre of clean water. You electrolyte imbalances. can add 1/2 a cup of coconut water or mashed ripe banana. Prevention of diarrhoea OR Wash your hands with clean water ɠ Use packets of oral rehydration salts (ORS). Carefully follow and soap: instructions for mixing with ɠ before preparing food or water clean water. DIARRHOEA ɠ before eating Take regular sips of these drinks ɠ after going to the toilet and keep eating many times a day: ɠ Mothers should continue to ɠ dispose of rubbish safely breastfeed their baby. ɠ ensure safe disposal of children’s If you vomit or feel too sick to eat: faeces and nappies ɠ Drink watery mush or broth of rice or potato. Good hygiene and clean ɠ Avoid fatty foods, fizzy drinks, drinking water are a good most raw fruits or highly prevention against diarrhoea. seasoned food.
If the diarrhoea lasts more than three days, OR if it gets worse (including; continuing vomiting, blood with diarrhoea, not wanting to drink or eat, being very thirsty, weak or tired.) Seek immediate medical help.
56 Notes
57 Fractures
A fracture is a broken bone. Depending on the location and severity, the area around the fracture may also be damaged (organs, nerves or Closed fracture blood vessels). Fractures can be described as: A bone is broken but the skin is not broken. In children, whose bones are more flexible, the bone may not break completely, it may just bend or splinter on one side of the bone. FRACTURES Open fracture Complicated fracture A wound is present at the fracture site. The broken bone damages The broken bone end may be visible neighbouring organs, nerves or in the wound or even protrude blood vessels, for example ribs through the skin. damage the lung.
58 SIGNS AND SYMPTOMS HOW TO HELP
FRACTURES: MANAGE FRACTURES: ɠ pain or tenderness ɠ Use gloves. ɠ deformity, irregularity ɠ Call an ambulance immediately, ɠ swelling, bruising except for minor fractures (for example fractured fingers). ɠ inability to use the injured area, unnatural movement ɠ Treat bleeding with pressure around the wound if possible. ɠ bleeding, exposed bone Check every 10 minutes for ɠ change of skin colour, cold, colour, warmth and swelling. numb or ‘pins and needles’ ɠ Apply dressing. Cover bone ends beyond the injury with clean, non-fluffy material. ɠ shock ɠ Support and stabilise the injured area (pillow/blanket). Apply sling Fractured nose, see p67. if arm injury. DO NOT splint fractures unless ambulance assistance is delayed or you must move the casualty. ɠ Check and treat for shock. FRACTURES ɠ Make casualty as comfortable as possible. ɠ Keep warm, rest and reassure casualty.
Apply pressure to bleeding. Support and stabilise the injured area.
59 Dislocations
A dislocation occurs where HOW TO HELP bones meet at joints. MANAGE DISLOCATIONS: In a dislocation the bones are moved ɠ Stabilise and support the area in from their normal position. Common its injured position. sites for dislocations are the shoulder, ɠ Apply a cold pack to reduce knee, elbow and fingers. swelling. ɠ Call an ambulance except for SIGNS AND SYMPTOMS minor dislocations such as fingers. DISLOCATIONS: A dislocation may be indicated by: ɠ severe pain Do not try to reposition the bones to their original position. ɠ deformity of the affected joint ɠ swelling ɠ loss of movement
If you are not sure whether a fracture or dislocation has
DISLOCATIONS occurred, treat the injury as a fracture.
60 Soft tissue injuries / bruising
Muscles, ligaments, tendons HOW TO HELP and skin are collectively known as soft tissue. They MANAGE SOFT TISSUE INJURIES – R.I.C.E. TREATMENT: are flexible and able to ɠ Stop the activity when injury stretch, but may be damaged occurs, sit casualty down. by blunt force (bruises) and ɠ Rest the area for 48 hours. over-stretching (sprains and ɠ Apply an ice pack wrapped in strains) or even torn. a towel, or a cool-pack for 20 minutes at three to four hour SIGNS AND SYMPTOMS intervals. ɠ Apply a firmcompression SOFT TISSUE INJURIES: (stretch) bandage to the area between ice applications. Soft tissue injuries (sprains and strains) may cause: ɠ Elevate the area (use pillow or blanket). ɠ pain ɠ swelling and bruising ɠ decreased ability to perform DO DO NOT normal movement Rest Heat ɠ skin discolouration Ice Alcohol Compression Running SOFT INJURIES TISSUE Elevation Massage
Ice burns: wrap the icepack in a cloth to avoid direct contact with the skin.
61 Musculoskeletal injuries DRSABCD
HOW TO HELP D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders.
R RESPONSE (AVPU) Check for response using AVPU.
S SEND FOR HELP Call an ambulance immediately for severe fractures.
A AIRWAY Check airway is clear.
B BREATHING Check for breathing.
C CIRCULATION/CPR Treat for shock.
MUSCULOSKELETAL INJURIES MUSCULOSKELETAL D DEFIBRILLATION SPECIFIC CARE Stabilise fractures. Apply R.I.C.E. for sprains and strains. Seek medical advice if: ɠ Injury does not improve in 48 hrs. ɠ Injury does not respond to R.I.C.E.
GENERAL CARE Keep casualty warm. Reassure. 62 Spinal injuries
The bones of the spine Apart from a careful examination protect the delicate spinal of the history, spinal injury should also be suspected when the casualty cord which lies within. The experiences: spinal cord is the nerve link ɠ loss of (or abnormal) sensation, from the brain to the body. for example tingling or numbness Spinal injuries can damage in limbs the spinal cord permanently. ɠ loss of (or abnormal) movement, weakness or paralysis ɠ pain in the spinal area SIGNS AND SYMPTOMS ɠ breathing changes, changes in pain or muscle tone SPINAL INJURIES: ɠ headache or dizziness, nausea, Spinal injuries should be suspected altered conscious state when the casualty has: ɠ loss of bladder or bowel control. ɠ fallen from a height or fallen awkwardly HOW TO HELP ɠ experienced direct force to the head or neck, or from a gunshot MANAGE SPINAL INJURIES: ɠ suffered a head injury Where possible, and if conscious the casualty with suspected spinal ɠ a sporting injury, for example INJURIES SPINAL injuries should be left in the rugby or falling from horse position they are found in. Call an ɠ experienced a deceleration ambulance immediately. It may be accident, for example a motor necessary to move a casualty in the vehicle or bicycle accident following circumstances: ɠ dived or jumped into shallow ɠ They are in real and immediate water danger. ɠ They are unconscious or become unconscious. ɠ They require CPR. Always support the head and neck manually to keep a neutral position that limits angular movement; semi-rigid cervical collars are not recommended.
63 Spinal injuries DRSABCD
Children HOW TO HELP Conscious children and infants should D DANGERS be left in their rigid Check for hazards and risks. Ensure safety for seat or capsule self, casualty and bystanders. Only move casualty until the ambulance if in danger or for airway management. arrives. If possible remove the seat with R RESPONSE (AVPU) infant / child still Check casualty using AVPU. in it. Children may need padding under S SEND FOR HELP their shoulders to Send or shout for help. keep neutral spine Call an ambulance immediately. Consider AED. alignment. A AIRWAY Check airway. Only move a casualty with BREATHING a suspected B Check breathing. spinal injury if they are in CIRCULATION/CPR immediate C Check. danger, are unconscious DEFIBRILLATION and breathing D SPINAL INJURIES – DRSABCDSPINAL normally or SPECIFIC CARE they need CPR. Manually support head in a neutral position, limiting angular movement. If conscious keep still until ambulance arrives. Keep the spine If unconscious roll on to side, supporting the in line. casualty’s head.
GENERAL CARE Reassure and keep warm. DO NOT use cervical collars. Only use rigid backboards if transport is essential. DO NOT leave casualty on spine boards as this causes pressure necrosis.
64 Head Concussion injuries
The brain is a delicate Concussion is a brain injury caused organ which lies by the brain shaking within the within the skull for skull. It may follow a blow to the protection. The head or result from sudden, violent skull acts as a rigid motion or deceleration. container, allowing little room for the SIGNS AND SYMPTOMS brain to move or swell. CONCUSSION: Head injury can occur due Concussion may result in: to falls, crashes, sporting ɠ unconsciousness, often only briefly injuries, assaults or bumps ɠ memory loss of the events leading to to the head. and during the injury Always get head injuries ɠ nausea and vomiting assessed by a medical ɠ dizziness professional. A casualty ɠ headache – thumping or pounding can sustain a significant ɠ blurred vision head injury without loss of consciousness or loss of ɠ seizures may also occur | CONCUSSION memory. Untreated head See Seizures, pp49–50. injuries can have serious consequences as serious problems may not be HOW TO HELP obvious for several hours MANAGE CONCUSSION: INJURIES HEAD after the initial injury. ɠ If the casualty is unconscious, roll casualty onto their side supporting their head. Anyone with a ɠ Apply DRSABCD following the Basic Life suspected head Support Flowchart, p14. injury should be ɠ Call an ambulance immediately, if you assessed by a medical suspect neck or spinal injuries or the professional. casualty does not regain consciousness. ɠ Call an ambulance if there is any altered or loss of consciousness no matter how For more information brief. on concussion: accsportsmart.co.nz ɠ Get all head injuries assessed by a medical professional.
65 Brain compression
Pressure on the brain can HOW TO HELP result from bleeding or swelling of the brain. MANAGE COMPRESSION: ɠ Call an ambulance immediately. Among other things this may follow a ɠ If the casualty is unconscious, head injury caused by a skull fracture. roll casualty onto their side supporting their head. SIGNS AND SYMPTOMS ɠ Monitor ABCs and vital signs. COMPRESSION: The casualty’s signs and symptoms may show: ɠ bleeding from the ear or nose may be present ɠ deteriorating level of consciousness (becomes unconscious) ɠ noisy, slow breathing ɠ skin may become red, flushed and dry ɠ pulse may initially be rapid, but then becomes slower BRAIN COMPRESSION BRAIN
66 Head injuries Fractured DRSABCD nose
HOW TO HELP If you believe the casualty has a fractured D DANGERS Check for hazards and risks. nose they need to be Ensure safety for self, casualty and referred to medical help. bystanders. The following needs to be considered: R RESPONSE (AVPU) Check using AVPU. ɠ the airway may be obstructed Brief memory loss or loss of ɠ control of bleeding consciousness may occur. ɠ the casualty may suffer concussion SEND FOR HELP S If the casualty is conscious Send or shout for help. encourage them to tilt the head Call an ambulance immediately. forwards and breathe through the mouth. A AIRWAY NOSE FRACTURED |
Check airway.
B BREATHING Check breathing.
C CIRCULATION/CPR Treat bleeding.
D DEFIBRILLATION
SPECIFIC CARE HEAD INJURIES – DRSABCD If condition deteriorates, call an ambulance immediately. Consider spinal injury. Medical assessment is required for any casualty who has been unconscious.
GENERAL CARE Rest, reassure and keep warm. ALL head injuries should be assessed by a medical practitioner. 67 Stable Side Position for suspected spinal injury – Log roll
If spinal injury is suspected Notes roll the casualty onto their side, supporting their head and using a log roll.
HOW TO HELP
1
One person Stable Side Position
2 STABLE SIDE POSITION – SPINAL INJURY – SPINAL POSITION SIDE STABLE
Two person Stable Side Position
68 Amputations
If a body part has been Care for the amputated body part in amputated always call an the following way: ambulance and tell them HOW TO HELP that an amputation has occurred. 1 DO NOT WASH Manage bleeding using direct pressure. DO NOT wash or clean the amputated part. See Manage external bleeding, p33. 2 Carefully place the body part Notes into a plastic bag and seal it with air around it to protect it.
3 AMPUTATIONS Place inside a second bag or container with water and ice cubes.
4 Label the bag with the casualty’s name and the date and time of the accident. Send the bag with the casualty to the hospital.
69 Chest injuries Abdominal injuries
Chest injuries may be caused Abdominal injuries may by blunt or penetrating be caused by a blunt or objects. Any injury that penetrating instrument, both damages the chest wall will of which may result in severe have a direct effect on the or fatal internal bleeding. casualty’s ability to breath. HOW TO HELP
HOW TO HELP MANAGE ABDOMINAL INJURY: MANAGE CHEST INJURY: ɠ Cover any wounds with a dressing. Preferably use clear ɠ Cover any ‘sucking’ chest plastic food wrap or a clean wounds. Preferably use a supermarket bag. plastic-sided dressing, taped down on three sides leaving the ɠ Lie the casualty down. Bend the bottom side untaped to allow knees if there is a large cross- the wound to drain. wise wound. ɠ If conscious, incline the casualty ɠ DO NOT touch or try to move towards the injured side. any internal organs that are showing, instead cover the ɠ If unconscious turn the casualty wound with clear plastic food onto the injured side. wrap or a wet dressing. CHEST/ABDOMINAL INJURIES
70 Crush injuries
Crush injuries should be HOW TO HELP suspected whenever part of the body is crushed MANAGE CRUSH INJURY: or compressed. Toxic ɠ Call an ambulance immediately. ɠ Ensure the scene is safe. substances build up in the ɠ If it is safe and physically possible, muscles which can cause all crushing forces should be further complications. removed from the casualty as soon as possible, irrespective of A casualty with a crush injury may how long they have been trapped. not complain of pain and there may ɠ Treat the person’s injuries and be no external signs of injury. All treat any bleeding by applying casualties who have been subjected direct pressure. to crush injury, including prolonged ɠ Keep the casualty warm. pressure to a part of the body due to their own body weight in an immobile ɠ Assist the person into the person, should be taken to hospital position of greatest comfort. for immediate treatment. ɠ Continue to monitor the casualty’s condition. If the casualty becomes unresponsive and is not breathing normally,
follow DRSABCD. INJURIES CRUSH ɠ Treat other injuries, support and stabilise any limbs that are injured.
71 Nose bleeds Ear injuries
HOW TO HELP Wounds to the outer ear may bleed profusely. MANAGE NOSE BLEEDS: Foreign objects or insects ɠ Sit the casualty down, leaning forward. may enter the ear. ɠ Keep the casualty at total rest for at least 10 minutes to avoid blood flowing down the throat. HOW TO HELP ɠ Advise them to pinch the nose firmly MANAGE EAR INJURIES: over the soft part of the nostril just ɠ DO NOT try and remove below the bridge (bony part). This any object that is wedged will help to stop the bleeding and still in the ear canal. Get allows the casualty to breathe. professional help. ɠ Maintain pinch and nostril pressure for ɠ Never use any sharp object at least 10 minutes, while at total rest. to remove any foreign body ɠ Release pressure after 10 minutes. from the ear as this can cause If bleeding is not controlled reapply further injury. pressure for a further 10 minutes.
EAR INJURIES EAR ɠ If bleeding or yellowish fluid is On a hot day or after exercise it | leaking from the ear, consider might take 20 minutes. head injury. Lay person on ɠ When bleeding has stopped don’t their side so that the affected blow the nose for four hours. ear drains onto a dressing. ɠ If bleeding continues for more than ɠ If ear ache or ear pain, 20 minutes, seek medical assistance. keep ear warm. DO NOT NOSE BLEEDS NOSE administer drops or probe. See Fractured Nose, p67. Seek medical attention.
72 Knocked out permanent teeth
HOW TO HELP Notes
MANAGE KNOCKED OUT TEETH: ɠ Pick the tooth up by the crown, not the root. ɠ If a tooth is dirty, rinse in milk. DO NOT use soap or chemicals, scrub the tooth or let it dry out. ɠ It is important to keep the tooth root moist and alive. Place in milk or saline solution if available. If not available, wrap tooth in cling film or plastic wrap. Otherwise, place the tooth under bottom lip of the casualty. ɠ DO NOT store the tooth in water. DO NOT wrap it in tissue paper or a cloth. KNOCKED OUT PERMANENT TEETH
Time is critical. See a dentist as soon as possible, ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.
73 Eye injuries
The eye is a delicate object which can become badly damaged by foreign bodies and chemicals. Wear eye protection whenever there is a risk of eye injury.
SIGNS AND SYMPTOMS
EYE INJURIES: Depending on the seriousness of the injury and the object causing injury some or all of the following may be present: ɠ watering of the eye ɠ redness of the eye ɠ pain ɠ excessive blinking
EYE INJURIES EYE ɠ loss of vision ɠ blood or clear fluid leaking from inside the eye ɠ flattening of the normal, round eye shape
74 HOW TO HELP Always seek medical advice.
MANAGE EYE INJURIES: Never attempt to remove a foreign HOW TO HELP body that is embedded in any part of the eye, or located over the WHEN CHEMICALS HAVE coloured part of the eye (iris) ENTERED THE EYE: or pupil. In either of these cases, ɠ call an ambulance stabilise any object, cover only the affected eye with pads and seek ɠ gently separate the eyelids to hospital treatment. open the eye If the object is on the white part ɠ ask the casualty to remove of the eye, moving as the casualty contact lenses if possible blinks, it can be removed. ɠ flush eye with a gentle stream of water until help arrives ɠ flush corrosive chemicals for up to one hour until symptoms gone ɠ always obtain a medical assessment to check for damage EYE INJURIES EYE
Rinse it out with water
Lift it out using a corner of material.
75 Burns and scalds
Burns are generally caused by Seek medical help for: heat, but chemicals, gases, ɠ Burns to the head, neck, eyes, friction, radiation (including hands, feet, over a joint or sunlight, welding arc, lasers genital area. and nuclear), electricity, ɠ Burns in infants or children under five years and the elderly or those and even extremely cold with other medical problems. substances such as ice can ɠ A burn larger than the size of the also cause burns. In serious casualty’s palm. burns there may be no pain ɠ Burns associated with trauma. because nerve endings have Call an ambulance been damaged. immediately if casualty has: ɠ chemical or electrical burns ɠ inhalation burns (smoke or fumes that have been inhaled) as the casualty’s airways may be injured
Cool (tepid), running water is the best initial first aid for burns and scalds.
BURNS AND SCALDS Identify and assess burns and scalds To decide how serious or significant a burn is, look at the following: ɠ Size ɠ Cause ɠ Age of casualty ɠ Location ɠ Depth
76 SIGNS AND SYMPTOMS HOW TO HELP
BURNS: MANAGE CHEMICAL, ELECTRICAL ɠ hot to touch AND INHALATION BURNS: ɠ severe pain if superficial (deep ɠ CHEMICAL BURN – ensure personal burns may not give pain) safety when dealing with chemical / ɠ red, peeling, blistering, corrosive materials. Wear personal charring or discolouring protective equipment. Read chemical of skin container or SDS (safety data sheet) for emergency care instructions. ɠ watery fluid weeping from ɠ area ELECTRICAL BURNS (including lightning strike) may not look big, ɠ swelling of area but the underlying tissue is often ɠ signs and symptoms of shock damaged and the heart rhythm can be affected. This may cause collapse, cardiac arrest or respiratory problems. Turn off the power supply Notes without touching the person. If the casualty is unresponsive and not breathing normally start CPR. The wounds may not be easily seen. Check for ‘entry’ and ‘exit’ wounds and dress. ɠ INHALATION BURNS can occur in a small space with gas, steam, fumes and chemicals etc, also burning face, nostrils, eyebrows and eyelashes.
Respiratory problems can occur up BURNS AND SCALDS to 24 hours after exposure. Move to fresh air, manage airway. ɠ EYE BURNS – flush eye immediately. ɠ FLASH BURN – treat as heat contact burn. ɠ Call an ambulance immediately. ɠ DO NOT attempt to neutralise acid or alkali burns – this will increase heat generation. ɠ DO NOT apply cling wrap or hydrogel dressings to chemical burns.
77 Remember COOL, CLEAR, COVER for burns and scalds
HOW TO HELP
MANAGE HEAT / THERMAL / DO NOT: CONTACT BURNS AND SCALDS: ɠ DO NOT peel off stuck clothing For flames, scalds, blast (hot gas), or burning substances. inhalation or direct contact aim to ɠ DO NOT use ice to cool the stop the burning process, cool the affected area as ice burns tissue. burn and cover the burn. ɠ DO NOT break blisters. ɠ COOL the burned area immediately with cool, running ɠ DO NOT apply lotions, water (tepid 8-15 degrees ointments, creams and powders celsius) for at least 20 minutes. (except hydrogel). For chemical burns cool the affected area for up to an hour (or more if container says). Keep the casualty warm whilst cooling the burn. Where possible elevate limb to decrease swelling. ɠ CLEAR the area of anything that may keep burning: jewellery, watches, clothing that isn’t sticking (cut around stuck clothing). Remove wet clothes if soaked with hot liquids. In chemical burns it is important to
BURNS AND SCALDS remove clothing contaminated with chemicals (use gloves). ɠ COVER the burnt area with loose clean, non-fluffy material. Plastic cling film is ideal. In serious (significant) burns, shock will be present. Call an ambulance immediately for all serious burns and inhalation, chemical, electrical and eye burns. Monitor responsiveness and treat shock. (Ref:ANZBA)
78 Burns and scalds DRSABCD
HOW TO HELP D DANGERS SPECIFIC CARE Check for hazards and risks. Ensure safety Cool heat burns for 20 mins from burning material, hot liquids or steam, minimum, flush eye. chemicals, electricity, smoke, sun and so on, Flush chemicals for up for self, casualty and bystanders. to one hour (until all DO NOT enter burning or toxic atmosphere. symptoms have gone). Stop the burning process: stop, drop, cover, Clear area (take off jewellery, roll. Smother any flames with a blanket. clothing that is not sticking). Wear gloves. Cover with clean, non-fluffy dressing – plastic cling wrap R RESPONSE (AVPU) is ideal. Check for response using AVPU. GENERAL CARE S SEND FOR HELP Keep casualty warm and Send or shout for help. protect from cold. Reassure. If serious, call an ambulance immediately. Call an ambulance immediately for all serious Consider AED. burns. For example: AIRWAY ɠ The burn area is larger A than the palm of the Check airway, consider damage to nose and casualty’s hand. mouth. ɠ Deep burns. B BREATHING ɠ All electrical, chemical, Check for breathing. inhalation and eye burns.
Ensure fresh air Seek medical advice for BURNS AND SCALDS – DRSABCD (eg: if inhalation burn). small burn
C CIRCULATION/CPR Treat for shock. Treat wounds.
D DEFIBRILLATION Consider AED for serious burns.
79 Poisoning
A poison is a substance that SIGNS AND SYMPTOMS causes harm when it enters the body. Poisons can enter POISONING: the body through the skin by The signs and symptoms of poisoning will vary according to the absorption or injection, the type of poison and how the poison lungs or through the mouth. has entered the body. Look for: ɠ nausea ɠ vomiting ɠ burning pain on the lips, mouth or throat ɠ headache, blurred vision ɠ skin rash or swelling ɠ breathing difficulties ɠ altered level of consciousness ɠ seizures ɠ cardiac arrest
What? When? How much? Find out what, when and how much poison has been taken. Always save any remaining poison, poison
POISONING container or vomit for medical personnel to check. Seek medical advice after significant exposure to a poison even if symptoms are initially mild or absent.
For urgent advice always DO NOT make the call an ambulance. casualty vomit. For non-urgent advice call 0800 POISON or 0800 764 766.
80 Prevention of poisoning HOW TO HELP to others MANAGE POISONING – ɠ Remove the casualty from the DECONTAMINATION / CARE: poison or the poison from Prevention of poisoning or the casualty. Ensure your contamination to the first aider and own personal safety by using bystanders is a priority and personal protective equipment. protective equipment may be needed. ɠ If life threatening, call an ɠ If not in immediate danger, call ambulance immediately. 0800 POISON for prompt medical (for example bleeding, advice for specific poisons from the unconsciousness or breathing Poisons Centre. difficulties). If unconscious ɠ Check the poison container for type or not breathing normally, of poison and any instructions on always follow DRSABCD. managing poisoning. Keep container ɠ If more than one person for medical personnel. simultaneously appears ɠ If the casualty has burns around the affected by a poison, there is mouth, use mouth-to-nose. a high possibility of dangerous ɠ If the poison has entered through the environment contamination. lungs or been swallowed, keep your ɠ If in an industrial, farm or head clear of the casualty when they laboratory setting, suspect exhale during rescue breathing. particularly dangerous agents If the casualty is in a confined space, and take precautions to avoid do not let anyone enter and call accidental injury. emergency services. ɠ If poison enters the eye: Flush the eye with cold water from a running tap POISONING THE NATIONAL or a cup/jug. Continue to flush for 15 POISONS CENTRE minutes, holding the eyelid open. Phone 0800 764 766 or ɠ DO NOT give casualty water or 0800 POISON (24 hours), milk unless a corrosive agent (such or for general information as acid or alkaline) has been taken their website is toxinz.com and unless you are instructed by a (Poisons Centre database). Poisons Centre Advisor. ɠ DO NOT induce vomiting. Do not use Ipecac syrup.
81 Fish and shellfish Snake bites poisoning
When keeping fish, make sure it is Different poisonous properly refrigerated, or kept on ice, snake’s venom may not exposed to warm temperatures have different effects or sunlight for long periods of time. on various parts of the body, including the Ciguatera – Fish poisoning heart, blood and body Ciguatera is the most common cause of tissues and may result seafood-toxin poisoning and is most prevalent in tropical and subtropical areas. This is in breathing paralysis caused by toxic microscopic coral algae that and death. concentrate up the food chain and are eaten ɠ Treat all snake bites as by larger and larger reef fish. The fish that potentially lethal and call are commonly associated with ciguatera ambulance 111 immediately. poisoning are barracuda, coral trout and groper, but any large reef fish could be at risk. SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS SNAKE BITES: CIGUATERA POISONING: SNAKE BITES SNAKE May appear quickly but | Common signs and symptoms of ciguatera effects may be delayed for poisonings happen 1–24 hours following several hours. eating and may include: ɠ fang mark/s in the skin ɠ nausea and vomiting ɠ nausea, vomiting and ɠ diarrhoea headache ɠ tingling or numbness and itching ɠ altered level of ɠ hot-cold sensory reversal, where hot consciousness objects feel cold and cold objects feel hot ɠ double or blurred vision ɠ difficulty speaking or Treatment consists of maintaining fluid swallowing intake – see diarrhoea p56 – and in some ɠ weakness in the cases medication may be needed. Everyone extremities FISH AND SHELLFISH POISONING with ciguatera poisoning should get medical ɠ breathing difficulty advice. Healthy adults will make a complete ɠ blood–clotting defects recovery, although symptoms may remain ɠ cardiac arrest for days or months.
82 HOW TO HELP
MANAGE SNAKE BITES – ARM BITES – bandage the arm PRESSURE IMMOBILISATION with the elbow bent and leave the TECHNIQUE: tips of the fingers unbandaged to (not for bites or stings from other allow circulation to be checked. New Zealand venomous creatures) Bind a splint to the forearm and ɠ Reassure the casualty and ensure immobilise with a sling. the casualty remains still at all LEG BITES – leave the tips of times. the toes unbandaged to allow ɠ Call ambulance 111 immediately. circulation to be checked. Immobilise the leg by bandaging ɠ Remove any jewellery from the a splint to the limb to prevent bitten limb. movement. ɠ Apply a compression bandage ɠ Mark on the overlying bandage over the bitten area (see the location of the bite with a pen. bleeding, p32). Elasticized bandages are preferable, but Transport the casualty, preferably crepe bandages, clothing strips, by ambulance, to hospital. If this towels or pantyhose will suffice cannot be done, the casualty should in an emergency. The bandage be carried rather than walk. should be wrapped upward Do not give alcohol, fluid, or food from the lower portion of the by mouth. If the casualty will not limb. Apply the bandage as reach medical care for a long far as possible up the limb. A period, only water should be given compression bandage should by mouth. be applied over clothing – to minimise movement of the limbs. SNAKE BITES SNAKE
The casualty must keep the limb still at all times.
The bite site should not be Tourniquets should not be washed, cleaned, cut, sucked used. or treated with any substance.
Source: New Zealand National Poisons Centre
83
Ensure safety Ensure Check using AVPU calling an Consider ambulance or 0800 Poison Check Check Check Check seek advice. area, Wash Reassure INJECTED
Ensure safety Ensure Check using AVPU calling an Consider ambulance or 0800 Poison Check Check Check Check contaminated Remove Flood skin with clothing. Wash water. running cold gently with soap and water and rinse well. Reassure ABSORBED
make casualty make Ensure safety Ensure Check using AVPU calling an Consider ambulance or 0800 Poison Check Check Check Check DO NOT nothing by Give vomit. mouth; can wash mouth out with a sip of water. Reassure INGESTED
drsabcd POISONING – DRSABCD Ensure safety Ensure Check using AVPU calling an Consider ambulance or 0800 Poison Check Check Check Check fresh casualty to Move breathing Avoid air. fumes (use protection). open do so, If safe to wide. doors and windows Reassure INHALED ND FOR HELP ND FOR DANGERS RESPONSE SE AIRWAY BREATHING CIRCULATION/ CPR DEFIBRILLATION CARE SPECIFIC CARE GENERAL S R B C A D D Poisoning – Poisoning 84 Tick bites; bee, wasp and ant stings
Single stings from a bee, SIGNS AND SYMPTOMS wasp or ant can be painful but seldom cause serious MINOR: problems except for people ɠ immediate and intense local pain ɠ local redness and swelling who are allergic to the venom. Multiple insect MAJOR / SERIOUS: ɠ anaphylactic shock stings can cause severe ɠ abdominal pain and vomiting pain and widespread skin ɠ airway obstruction can be caused by reaction. Stings around the swelling of the face and tongue due to face can cause a serious anaphylaxis or insect stings around the mouth. This can occur immediately or reaction and difficulty in over several hours and always requires breathing even if the person urgent medical care. is not known to be allergic. HOW TO HELP Bee stings with the venom sac attached continue to inject venom MANAGE BITES AND STINGS: into the skin, whilst a single wasp Follow the DRSABCD Basic Life Support or ant may sting multiple times. Flowchart if casualty is unresponsive or Tick toxins may cause local skin not breathing properly. irritation or allergic reaction. In ɠ If signs of anaphylaxis follow the susceptible people a tick bite anaphylaxis treatment plan. or other bites or stings may ɠ If allergic to ticks, DO NOT remove cause severe allergic reaction the tick; otherwise remove the tick or anaphylaxis, which is life immediately. threatening. This can occur in ɠ If the person is in a remote location, people with no previous exposure consult a medical professional. or apparent susceptibility. ɠ Scrape off the bee sting (using a ruler or piece of paper), do not pull out. ɠ Move the person to a safe place (for example away from the bees/wasps). ɠ Apply a cold compress to site to help for swelling and pain relief.
ɠ Monitor ABCs and signs of allergic AND ANT STINGS BITES; BEE, WASP TICK reaction (such as difficulty speaking and/or breathing, collapse and Refer to a hospital if sting is generalised rash). to face, eye, mouth, throat, ɠ Continue DRSABCD and give CPR if neck or genitalia. necessary.
85 Severe allergic reaction (Anaphylaxis)
Anaphylactic shock is a severe allergic reaction to a substance that affects the whole body. It is a medical emergency and may occur within minutes of exposure to the trigger. Common allergies SIGNS AND SYMPTOMS are to insect bites and stings, drugs and foods. Call an ALLERGIC REACTION: ambulance immediately. Symptoms may occur within minutes to several hours after exposure to the allergen. Generally Allergic reactions affect the more rapid the onset of ɠ the skin (rash and hives) symptoms after exposure, the more serious the reaction will be. ɠ the respiratory system (short of breath) Severe allergic reaction may result in: ɠ the gastrointestinal system ɠ difficult, noisy breathing, wheeze (vomiting, diarrhoea and/or or cough abdominal pain) ɠ swelling of the neck, face and ɠ the cardiovascular system throat for example lips, face, (rapid pulse, swelling and possible eyes, tongue cardiac arrest) ɠ tingling feeling around the mouth, difficulty talking, hoarse voice Remember to check airways, ɠ rash, hives or welts breathing and circulation. ɠ nausea and vomiting, abdominal pain ɠ persistent dizziness, loss of Call an ambulance and the consciousness, sudden collapse nearest doctor. ɠ pale and floppy (young children) SEVERE ALLERGIC REACTION ALLERGIC SEVERE ɠ medication may be carried ɠ a MedicAlert® emblem or other identifier may be worn ɠ signs of shock
86 Severe allergic
HOW TO HELP reaction DRSABCD MANAGE SEVERE ALLERGIC REACTION: HOW TO HELP ɠ Lay the casualty flat. Do not get casualty to stand or walk, D DANGERS if breathing is difficult allow Check for hazards and risks. casualty to sit. Ensure safety for self, casualty ɠ Seek help immediately. and bystanders. Remove allergen. ɠ Immediately remove trigger RESPONSE (AVPU) agents (allergens for example. R food, the sting, pollen and so on). Check using AVPU. ɠ Assist with administration SEND FOR HELP of adrenaline auto-injector S medication and assist to Send or shout for help. administer asthma medication Get bystanders to call an (for example EpiPen®). This ambulance immediately. medication is carried by many Consider AED. people who know they are likely to have a severe allergic reaction. A AIRWAY ɠ Call an ambulance immediately, Check. and the nearest doctor. ɠ If unconscious, position the B BREATHING casualty in the Stable Side Position. If breathing difficult consider ɠ Monitor ABCs and vital signs. sitting up. ɠ Follow DRSABCD. If breathing CIRCULATION/CPR stops follow the Basic Life C Support Flowchart, p14. If shocked treat for shock. ɠ Administer further adrenaline if DEFIBRILLATION no response in five minutes. D Use AED if needed.
Anaphylaxis Action Plan SPECIFIC CARE Assist casualty with their People and children with known medication. allergies have often got a full Anaphylaxis Action Plan. The plan GENERAL CARE outlines actions to be taken in case Reassure, keep warm. of exposure to the allergy for those SEVERE ALLERGIC REACTION – DRSABCD REACTION ALLERGIC SEVERE who are at risk. Follow this plan when To find out more visit casualty shows signs and symptoms allergy.org.nz or has been exposed to the allergy. 87 Hyperthermia Heat exhaustion
The human Heat exhaustion occurs due to excessive body works best loss of body fluid and body salts. at a core body This may occur due to a hot environment, temperature of metabolic issues, failure of cooling mechanisms, about 37˚C. The excessive physical exertion, inadequate fluids, lack outer parts can of ventilation, heavy and hot clothing or drugs. get much colder The very young and very old are more prone to and still function heat exhaustion. effectively. If the SIGNS AND SYMPTOMS core body area, containing vital HEAT EXHAUSTION: Heat exhaustion is seen as fatigue associated organs, lies outside with headache, feeling sick, vomiting, dizziness this temperature it or malaise. ceases to function Casualties may also have: effectively and is ɠ pale, sweaty skin life-threatening. ɠ rapid breathing ɠ muscle cramps ɠ body temperature normal or near normal ɠ tiredness and restlessness
HOW TO HELP
MANAGE HEAT EXHAUSTION: ɠ Rest in a cool place, lying down. ɠ Remove excess clothing. ɠ Give carbohydrate electrolyte fluids (sports drink) or water. ɠ If unconscious develops monitor ABCs, position HYPERTHERMIA the casualty in the Stable Side Position. Call an ambulance immediately.
88 Hyperthermia Heat stroke
Heat stroke (or sun Call for an ambulance as soon stroke) occurs when the as possible. temperature-regulating centre in the brain overheats HOW TO HELP and fails. All body organs may MANAGE HEAT STROKE: be affected. This is a life- ɠ Call an ambulance immediately. threatening condition. ɠ Rest in a cool place, lying down. ɠ Remove excess clothing. SIGNS AND SYMPTOMS ɠ Moisten the skin with a moist cloth or atomiser spray and cool HEAT STROKE: the person by spraying with water. ɠ hot, flushed, dry skin ɠ Keep cooling, use a fan. ɠ may have a lack of, or profuse ɠ Apply wrapped ice packs to neck, sweating groin and armpits. ɠ body temperature above normal, ɠ If conscious rehydrate with water 40 degrees Celsius plus or sport drink. ɠ headache and/or blurred vision ɠ If unconscious monitor ABCs, position the casualty in the ɠ falling level of consciousness Stable Side Position. ɠ seizures ɠ Follow the Basic Life Support ɠ unconsciousness may develop Flowchart, p14. HYPERTHERMIA
89 Hyperthermia DRSABCD
HOW TO HELP D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders.
R RESPONSE (AVPU) Check using AVPU.
S SEND FOR HELP Send or shout for help. Ask bystanders to call an ambulance immediately. Consider AED.
A AIRWAY Check.
B BREATHING Check.
C CIRCULATION/CPR Treat for shock. Notes D DEFIBRILLATION Use AED if needed.
SPECIFIC CARE Move to cool environment. Remove excess clothing. Give cool sips of water. For heat stroke, spray casualty with water or use ice packs. Position the casualty on their side if unresponsive and breathing normally.
HYPERTHERMIA – DRSABCD HYPERTHERMIA GENERAL CARE Reassure, monitor temperature.
90 Hypothermia
Hypothermia occurs if the core body temperature falls below 35 degrees celsius. Normal body Hypothermia most often temperature occurs outdoors, where wet, cold and wind combine to create a cooling effect. It can also occur in poorly heated homes and is more likely to Intense affect the elderly and infants. shivering
SIGNS AND SYMPTOMS
HYPOTHERMIA: Early warning signs of hypothermia are: Irritability ɠ feeling cold, numbness and / irrational shivering (fumbles) behaviour ɠ tiredness, slurred speech (mumbles) ɠ loss of coordination, stumbling and clumsiness (stumbles) ɠ changes in behaviour such as anxiety, apathy, irritability and irrational behaviour (grumbles) Later signs indicating a serious condition are: Unconsciousness ɠ shivering stops ɠ unconsciousness HYPOTHERMIA
If hypothermia is not treated death will occur
91 Hypothermia DRSABCD
ACT QUICKLY. ACT EARLY. HOW TO HELP Hypothermia can progress D DANGERS quickly with as little as Check for hazards and risks. 30 minutes between the Ensure safety for self, casualty initial symptoms and and bystanders. unconsciousness. R RESPONSE (AVPU) Check using AVPU. HOW TO HELP SEND FOR HELP MANAGE HYPOTHERMIA: S Send or shout for help. Management of hypothermia focuses on preventing further heat Consider calling an ambulance. loss and gentle rewarming. Consider AED. ɠ Stop and seek shelter. A AIRWAY ɠ Remove wet clothes, and replace Check. with dry, warm clothes. ɠ Put a woollen hat on the B BREATHING casualty’s head. Check. ɠ Give warm, sweet drinks if conscious. C CIRCULATION/CPR ɠ Keep the casualty lying down. Check. ɠ Rewarm by placing the casualty in a (preferably) pre-warmed D DEFIBRILLATION sleeping bag or blankets and Use AED if needed. provide warmth. ɠ If the casualty is unresponsive SPECIFIC CARE and breathing normally place Move to shelter and warmth. them on their side. Remove wet clothing. Cover and insulate casualty including head.
GENERAL CARE
HYPOTHERMIA – DRSABCD HYPOTHERMIA Reassure and keep warm.
92 Casualty Handwashing reporting and hygiene
While you wait for emergency Hand hygiene with soap and water services to arrive, write down 1 2 the following information about the casualty:
ɠ casualty’s name, address and Remove jewellery. Add soap to contact number Wet hands with palms. warm water. ɠ age: This is important, especially if the casualty is a young child or 3 4 elderly person ɠ gender ɠ what happened, when and how it Rub hands Cover all surfaces happened, past medical history, together to of the hands and medications and allergies etc create a lather. fingers. ɠ injuries 5 6 ɠ observations, vital signs ɠ treatment given Clean the space Clean knuckles, between the back of hands thumb and and fingers. index finger.
7 8
Work the finger tips into the Rinse well under palms to clean warm running under the nails. water.
9
Minimum Dry with a single- wash time: use towel and 10-20 seconds. then use towel to turn off the tap. | HANDWASHING REPORTING CASUALTY 93 Applying slings
Reef knot
Arm sling
Elevation sling APPLYING SLINGS APPLYING
94 Notes
95 Hazard App
The Hazard App is a life-saving smartphone app that helps us identify, prepare and respond to hazards in New Zealand.
TOFREE DOWNLOAD
redcross.org.nz/hazard-app
IF A DISASTER HAPPENED NOW, WOULD YOU BE READY?
Due to its location and environment, New Zealand faces many potential disasters. In some cases, such as a weather related or volcanic disaster, there may be time for a warning. But an earthquake or tsunami close to land could strike without warning. All disasters have the potential to cause disruption, damage property and take lives. So it’s vital that you prepare now.
THIS WEBSITE WILL SHOW YOU HOW TO GET READY, SO YOU’LL GET THROUGH. WWW.HAPPENS.NZ FURTHER INFORMATION FURTHER 96 Household Emergency Plan
For general preparedness, ɠ If authorities tell you to evacuate every household should immediately, take your getaway kit and go. create and practice a ɠ If you have more time, prepare Household Emergency Plan your home and critical buildings. and assemble and maintain ɠ Prepare to be self-sufficient for at emergency survival items and least three days. a getaway kit. ɠ Stay put until authorities say you can leave. For more information on a Household ɠ Follow your plan. Emergency Plan, emergency survival items and a getaway kit go to ɠ Stay alert to hazards. getthru.govt.nz ɠ DO NOT use candles.
Core action messages Download the Household ɠ Keep listening to local radio or Emergency Plan template television stations. from getthru.govt.nz
Keep a record of the following information with this manual.
Address:
YOUR HOUSEHOLD PHONE NUMBERS Name:
Name:
Name:
Name:
Name:
Name: HOUSEHOLD EMERGENCY PLAN 97 1 If we can’t get home or contact each other we will meet or leave a message at: Name:
Contact details:
Name (back-up):
Contact details:
Name (out of town):
2 The person responsible for collecting the children from school is: Name:
24-hour contact number:
3 Emergency survival items and getaway kit. Person responsible for checking water and food: Name:
Items will be checked and replenished on: Date: (check and replenish at least once a year)
The getaway kits are stored in the:
4 The radio station (including AM/FM frequency) we will tune in to for local civil defence information during an emergency:
5 Friends / neighbours who may need our help or can help us: Name:
Address:
Phone:
Name:
Address:
Phone: HOUSEHOLD EMERGENCY PLAN 98 Useful numbers
Your important Emergency Household Plan telephone numbers. Fill this out:
CONTACT DETAILS Local authority emergency helpline
Insurance company 24-hour contact number Insurance number and policy number
Local radio station (Frequency )
School
Family and neighbours
Bank phone number and details
Work phone numbers
Medical centre / GP
Local police station
Vet / kennel / cattery
Local hotel or B&B
Gas supplier and meter number
Electricity supplier and meter number
Electrician
Plumber
Builder USEFUL NUMBERS USEFUL 99 Workplace accidents First Aid
informed as soon as possible after Obtain your copy of First Aid for becoming aware of a notifiable event workplaces – a good practice by calling: 0800 030 040. guide from Department of A full list of notifiable incidents and Labour (Ministry of Business, injuries are listed on the WorkSafe Innovation and Employment)at New Zealand website, and workplace business.govt.nz/worksafe first aiders should familiarise themselves with the list. Accident registers First Aid for workplaces – All accidents must be recorded in the a good practice guide workplace accident register, including The Department of Labour 2011 non-injury accidents. publication – First Aid for workplaces – a good practice guide provides Investigating accidents information on good practice to be Internal investigation of accidents followed in defined circumstances should occur whenever an accident is by those responsible for first aid in recorded in the accident register and the workplace, including a first-aid should focus on further management needs assessment. to minimise, eliminate or isolate the hazards. Accidents which cause serious First aiders: harm to a person may be investigated ɠ complete accident documentation by WorkSafe New Zealand. Accident and administration scenes must not be disturbed except ɠ restock supplies to the extent necessary to: ɠ ensure all equipment is returned to ɠ provide first aid or save life operational readiness ɠ maintain public access to ɠ report all accidents to essential services management as required ɠ prevent serious property damage ɠ know and help implement the 2011 or loss “good practice guide” Accident notifications More information about The Health and Safety Act 2015 workplace accidents is states that when someone dies or available on the WorkSafe when a notifiable incident, illness New Zealand website: or injury occurs, the regulator business.govt.nz/worksafe
WORKPLACE ACCIDENTS WORKPLACE (WorkSafe New Zealand) MUST be 100 SIX STEPS TO INCREASE THE Suicide PERSON’S SAFETY information 1. Talk to the person about what you have noticed that makes you think If you are worried that they might be at risk. someone is thinking about 2. Ask directly about suicide thoughts suicide, take it seriously – “Are you thinking about suicide?” or “Are you thinking of killing yourself?” What to look for and do 3. Listen without judgment – listening Most people with thoughts of suicide and caring are your best tools right don’t truly want to die, but they are now. Talking about suicide helps to struggling with pain in their lives. By increase their safety. DO NOT give their words and actions, they invite advice or try to be a counsellor. help to stay alive. 4. Take any indication of suicide A person at risk may say they feel seriously and refer the person alone, a burden, have no purpose to appropriate help. It is not your responsibility to determine how or want to escape. They may sound serious a situation might be. If or talk about feeling desperate, suicide thoughts are present, it is hopeless, helpless, worthless, numb serious, help is needed and it is your or ashamed. They may have had a responsibility to refer the person to recent rejection, loss, humiliation, appropriate help. relationship breakup or bereavement. 5. Connect the person at risk with professionals – do this together – Free call or text 1737, take the person to a GP or to your anytime 24/7 local emergency department. Call the national helpline 1737 to get advice In an emergency, if you are about what you can do. concerned for someone’s immediate safety, call 111. Trained responders 6. Asking someone about suicide does will triage your call, and send not put the idea of suicide in their emergency services (police, head and does not increase the risk ambulance, Fire and Emergency). they might make an attempt. Stay with the person until emergency Do whatever is possible to make the services arrive. DO NOT leave them, environment safe, for example secure but do not put yourself in danger. firearms, remove ropes, medication, Suicide is a very complex poisons and vehicle keys. Keep issue. Increase your skills and yourself safe. confidence by attending a local In an emergency call 111 immediately. suicide training course.
Beautrais AL. (2019). Simple Skills. Managing Psychological Distress
and Suicide Risk. For Health and Social Service Providers INFORMATION SUICIDE 101 Psychological First Aid Training He Whakarauora Hinengaro
WHAT IS PSYCHOLOGICAL FIRST AID? THE INTERACTIVE Psychological First Aid (PFA) builds the COURSE COVERS: capacity of people who find themselves The what, who, why, supporting and assisting affected people when and where of PFA shortly after a disaster or any other traumatic event. The PFA action principles This training promotes natural recovery by providing techniques to help people feel Ethics and adaption safe, connected to others, able to help of PFA themselves and access physical, emotional Self-care and social support.
FOR MORE INFORMATION EMAIL: [email protected] PSYCHOLOGICAL FIRST AID TRAINING PSYCHOLOGICAL 102 Glossary
AED – Automated External Defibrillator. contraction of the muscles typically seen with certain seizure disorders. Allergic reaction – having an abnormal immune system response to a CPR – CardioPulmonary Resuscitation – substance (for example a food) that does an attempt to bring life back to a person not normally cause a reaction. in cardiac arrest, using rescue breathing Amputation – the complete loss and chest compressions. of a part of the body, usually due to an Crush injury – compression of a body accidental injury. part, often a limb, causing loss of blood Anaphylaxis – a severe allergic flow and resulting in tissue damage. reaction. Defibrillator – a device that corrects Angina – chest pain due to an abnormal heart rhythms by delivering inadequate supply of oxygen to the heart electrical shocks to the heart. muscle. Diabetes – the inability to properly Artery – a blood vessel that takes blood control one’s blood sugar level, leading to away from the heart and into the body. abnormally high sugar levels. Asthma – a reversible obstruction of Dislocation – bone or bones moving the airways in the lungs. out of position from a joint. Brain compression – pressure on Drowning – breathing impairment due the brain and surrounding structures, to immersion in water (or other liquid). often due to a head injury or bleed inside DRSABCD – a primary response system the head. that guides rescuers to appropriately Bruise – a closed wound caused by manage injuries and medical conditions in blunt force. order of priority until advanced care arrives. Cardiac arrest – when the heart Epilepsy – a pattern of repeated stops beating or is unable to produce an seizures is referred to as epilepsy. output of blood. Epistaxis – the medical term for Choking – a difficulty breathing, or a nosebleed. complete inability to breathe, caused by Fainting – temporary loss of an item blocking the airway. consciousness due to inadequate blood Cholesterol – a fat in the blood which to the brain. has been associated with a higher risk of Febrile – having a higher than normal heart disease and stroke. body temperature. Consciousness – the state of First aiders – people who provide being aware of and responsive to one’s initial care for an acute illness or injury. surroundings. Trained first aiders learn how to use a first
Convulsion – an abnormal, involuntary aid action plan (DRSABCD). GLOSSARY 103 Fit – an abnormal and uncontrolled Shock – lack of oxygenated blood to electrical activity in the brain (same the body organs. meaning as seizure). Soft tissue – skin, muscles, tendons Flu – a viral infection of the body and ligaments. causing fever, cough, muscle aches and Spinal injury – an injury to the bones tiredness (same as influenza). of the spine, the spinal cord or spinal Fracture – a broken bone. nerves. Heat exhaustion – tiredness, Sting – entry of a toxin from an animal dehydration and overheating. or plant into the body. Heat stroke (sun stroke) – a core Stroke – loss of blood supply to the body temperature that rises above 40 brain caused by either a blockage or a degrees celsius accompanied by loss of rupture of an artery. consciousness and dehydration. Unconsciousness – a state in Heart attack – the damage caused to which there is loss of awareness and the heart muscle when an artery in the responsiveness to one’s surroundings. heart blocks. Vein – a blood vessel that brings blood Hyperglycemia – high blood sugar. from the body back into the heart. Hyperventilation – over-breathing. Hyperthermia – heat-induced illness – an unusually high body temperature. Hypoglycemia – low blood sugar. Malaise – feeling of illness, a general feeling of illness or sickness of no diagnostic significance. Necrosis – death of cells in tissue or organ caused by disease or injury. Poison – a substance which is harmful to the body. Resuscitation – the process of attempting to restore life to someone in cardiac arrest. Seizure – an abnormal and uncontrolled electrical activity in the brain (same meaning as fit). GLOSSARY 104 Index
Concussion 65,67 Abdominal injuries 70 A Convulsions 50 AEDs / Defibrillation 9,14,18 CPR 2,4,9,12–16,20–22 Airway 2,4,8,12,14,23,27 CPR action checklist Allergic reaction adult 16 (severe) 3,85,86–87 child / infant 20 Amputations 69 Crush injuries 71 Anaphylactic reaction 86–87 Anaphylaxis action plan 87 Dangers 2–6 Angina 43 D Arm sling 94 Defibrillation, Asthma 51 (AEDs) 2,5,9,15–18,21 AVPU (Levels of Diabetic emergency 48 consciousness) 7,40 Dial (call) an ambulance 3 Disaster preparedness tips 97–98 B Back blows / Dislocations 60 Chest thrusts 24,28–29,30 Drowning 22–23 Bandages 34,94 DRSABCD 4–5,12–14 Basic Life Support Flowchart 14 Bleeding 35 Bee / wasp stings 85–87 Burns and scalds 79 Bleeding 2,3,4,9,32–35 Choking – adult / child 28 Body – check for injuries 38,41 Choking – infant 31 Brain compression 66 Fractures / soft tissue injuries 62 Breathing 2,3,4,8,12–15 Head injuries 67 Breathing difficulties 3,9 Heat stroke / hyperthermia 90 Bruising 61 Hypothermia 92 Burns and scalds 76–79 Medical conditions 53 Poisoning 83 C Cardiac arrest Resuscitation – adult 17 resuscitation 15–21,42,49,86 Resuscitation – child 21 Casualty reporting 93 Severe allergic reaction 87 Chain of survival 15 Spinal injuries 64 Check for injuries 38,41 Wallet card 12,13 Chemical burns 77 Chest compressions 12–14,16 E Ear injuries or earache 72 Chest pain 3,42–44 Electrical burns 77 Chest thrusts 24–26,28–30 Elevation sling 94 Chest injuries 70 Environmental conditions 88–92 Choking 23 Epilepsy 49–50 adults –27 24 External bleeding 32–34 children 26–31 Eye injuries 74–75 Circulation 2,4,9,53 Chemicals in eye 74–75 INDEX 105 F Fainting 37 P Poisoning 80–83 Febrile convulsions 50 Primary Assessment Finger sweep 26,29,31 DRSABCD 2,4–5 First aid action plan 2 Psychological first aid 102 First aid aims 2 First Aid kits Inside front cover R R.I.C.E. 61,62 First aider 1 Recovery (the Stable Foreign bodies in wounds 32–34 Side Position) 8,10,11,68 Foreign body in the Reef knot 94 eye 74–75 Response (AVPU) 2,5,7,11,40 ear 72 Resuscitation 12,13–21 Fractures 58,59,62 adults 13–17 nose 67 children & infants 13,19–21 Risk factors for the heart 44 H Hand washing 93 Hazard App 96 S Scalds 76–79 Head injuries 10,49,63,65–68 Secondary Assessment – other Heart attack 42 conditions or injuries 7,10,38–41 Heart attack action plan 45 Seizures 49–50 Heart health 44 Severe allergic reaction 86–87 Heat exhaustion 88 Shock 3,4,9, 32–33,36 Slings 94 Heat stroke 89 Snake bites 82 History 38–39,93 Soft tissue injuries 61–62 Household Emergency Plan 97–99 Spinal injuries 63–64 Hyperthermia 88–90 Stable Side Position 11,68 Hypothermia 91–92 Stings, bee / wasp / ant 85 Hyperventilation 51 Strains and sprains 61,62 Hypoglycaemia / diabetes 48 Stroke 3,10,46–47 Suicide first aid 101 I Inhalation burns 77 Injuries 58–75 Teeth 73 Insect bites and stings 85 T Tick bites; bee, wasp and ant stings 85 K Knocked out teeth 73 Triangular bandages 94 Training courses Inside back cover L Level of Consciousness 7,10,40 Log roll 68 U Unconsciousness 7,10,36,42,45,48,65 Low blood sugar 10,48 Vital signs (response and ® V M MedicAlert 3,41 breathing) 4,36,38–39,42,46,87,93 Medical conditions 42–56 Medical conditions DRSABCD 53 W Wallet card DRSABCD 12 N Nose bleeds 72 Resuscitation 13 Nose fracture 67 When to call an ambulance 3 Workplace accidents O Obstructed airway cycle Employer responsibilities 100 adult / child 24–28 First Aid responsibilities 100 child under 1 year 29–30,31 The Good Practice Guide 100
INDEX Wounds 32–34 106 Training Courses Emergency Care For First Aiders
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