ABC of First Aid, Asthma and Anaphylaxis

ABC of First Aid Asthma & Anaphylaxis International Emergency Numbers '#

Dr Audrey Sisman Contents

Essential First Aid Asthma & Anaphlaxis Unconscious ...... 2 Why Asthma is Dangerous ...... 34 DRSABCD ...... 3 Asthma Medications & Devices ...... 34 Basic Life Support Flow Chart ...... 3 Asthma Facts & Information ...... 35 CPR ...... 4 Allergy & Anaphylaxis Facts ...... 36 Choking / Positional asphyxia...... 6 About Anaphylaxis ...... 37 Drowning ...... 7 Risk Assessment Trauma Manage Anaphylaxis Risks...... 38 Soft Tissue Injury & Fracture ...... 8 Anaphylaxis Action Plans ...... 39 Upper Limb Injury ...... 9 Assessing Hazards & Minimise Risk ...40 Lower Limb / Pelvic Injury...... 10 Risk Assessment Matrix ...... 40 Bleeding...... 12 Risk Rating Table ...... 41 Shock...... 14 Asthma Risk Assessment ...... 42 Crush Injury ...... 14 Asthma Action Plans...... 43 Burns ...... 15 Education & Child Care Electric Shock ...... 16 Regulations, Codes & Proceedures .... 44 Multiple Casualties/ Prioritising...... 16 National Child Care Legislation ...... 44 Chest ...... 17 Communication Plans & Privacy ...... 45 Abdomen ...... 18 Normal Clinical Values for Children .....46 Eye ...... 19 AED for Child Care ...... 46 Head Injury ...... 20 Understanding Child Care Law...... 47 Spinal Injury ...... 21 General First Aid Medical Emergencies Principles of First Aid ...... 48 Heart Conditions ...... 22 Legal Issues ...... 48 Asthma ...... 23 Communication/ Reports ...... 49 Croup/ Epiglottitis ...... 24 Record Keeping / Self-Help ...... 49 Faint...... 24 Safe Work Practices ...... 50 Seizure/ Epilepsy ...... 25 Needlestick Injury / Hygeine ...... 50 Febrile Convulsion ...... 25 First Aid Kits Contents ...... 50 Diabetes ...... 26 Basic Anatomy & Physiology ...... 51 Stroke ...... 27 Casualty Assessment ...... 52 Hyperventilation ...... 27 Asthma/Anaphylaxis Managment Plan 53 Heat Exposure ...... 28 Risk Assessment Form ...... 54 Cold Exposure ...... 29 First Aid Incident Report Form ...... 55 Bites and Stings...... 30 World Map  Inside Back Cover Poisons ...... 32 Emergency Numbers  Allergy/ Anaphylaxis ...... 33 2 | Essential First Aid means call your country’s emergency number Essential First Aid | 3 Unconsciousness is a state of unrousable, unresponsiveness, where the casualty is unaware of their surroundings and no purposeful response can be obtained. Basic Life Support & AED © ABC Publications NO RESPONSE NO Breathing or Follow Basic Life Support Chart Abnormal Breathing Assess hazards and use Dangers? strategies to minimise risk. Breathing Normally Recovery Position, Call , monitor D Follow safe workplace practices Causes of an unresponsive (unconscious), breathing state: (head/spinal pg 20,21) Combinations of different Response? HAS RESPONSE (pg 25 ) (meningitis) causes may be present in R (Diabetes pg 26) an unconscious casualty eg Conduct Secondary Survey head injury and diabetes. (Poisons pg 32) (pg 27) If necessary !!(renal failure) NO RESPONSE Call for help NB.The sense of is usually the last sense to go, so be careful what you say near an unconscious casualty. hearing Stop Bleeding All unconscious casualties must be handled gently and every effort made to avoid any twisting Cool Burns or forward movement of the head and spine. for help. Call Support the Head, Neck & Spine (An unconscious, breathing woman in advanced pregnancy should be placed on her left side). S Send  Support Fracture(s) The recovery position: Pressure Immobilise Assist with medication(s) Maintains a clear airway - allows the tongue to fall forward. Facilitates drainage and lessens the risk of inhaling Airway foreign material (eg saliva, blood, food, vomit). A Permits good observation and access to the airway. Avoids pressure on the chest which facilitates Recovery position breathing. Airway management NO Breathing or Breathing & monitor Provides a stable position and minimises injury to casualty. takes priority over B abnormal breathing Normally Secondary Survey spinal injury Send or go for AED Call  Compressions C Start CPR Shock C Switch on 30 x Follow voice Compressions prompts

CPR No Shock 30:2 Shock Advised Advised Step 1 Step 2 Step 3 2 x Raise the casualty’s furthest Stabilise the casualty by Carefully tilt the head Rescue Breaths if able & willing arm above the head. \#$%' slightly backwards Place the casualty’s nearest when resting on the ground. and downwards. This AED arm across the body. Tuck the casualty’s hand facilitates drainage of Analyses Bend-up the casualty’s nearest under their armpit. saliva and/or stomach D use AED Rhythm leg. Ensure the casualty’s contents and reduces With one hand on the shoulder head is resting on their the risk of inhalation and the other on the knee, roll outstretched arm. which may cause In an EMERGENCY CALL or casualty away from you. pneumonia. 4 | Essential First Aid means call your country’s emergency number Essential First Aid | 5 CPR HAZARDS! Compressions ~'>>‚Q^|CPR CPR $+$\ Biohazards – {|}J~;<€= spills, fumes, fuel 30 Compressions Dangers QXYZ Chemicals – Q|}''<= Electricity – power-lines Place heel of one hand in centre of casualty’s chest Protect yourself (which is the lower half of the sternum) - use antiseptics Fire, explosion Place other hand on top, arms straight and press down and barrier Unstable structures on sternum at least 5 cm in adults protection: Slippery surfaces Allow complete recoil of chest after each compression gloves, mask, Broken glass Keep compressions rhythmical at a rate of 100 per min goggles. Sharp metal edges !}<[= Needle stick Aggressive behaviour 2 Rescue Breaths (RB) 2 breaths over 2 secs \? Response SPEAK LOUDLY – Don’t shout \ “Hello, can you hear me”? “Are you all right?” O into the stomach causing your eyes”. “Squeeze my hands”. regurgitation. Infants – perform mouth to Approach a collapsed casualty with caution, they JQ^\; NB. puff of air from cheeks. could be anxious, irrational or aggressive, so be ready to Use resuscitation mask or step back if necessary. Take a breath. Turn head after each RB. barrier protection if possible . Assess victim on the back with head Close casualty’s nostrils and for air Drowning <;[=? Listen feel If unwilling or unable to give and shoulders at the same level. This decreases the exhaled from mouth. RB, do chest compressions likelihood of regurgitation and vomiting. The casualty Mouth to mouth (good seal). Avoid inhaling re-expired air. \? only. for help. Call should be routinely rolled onto the side to assess Blow Send  not airway and breathing. CPR >QQ|€ Same ratio >$~'>;Q^<~'‚=|} for infant, >;$$;? 30:2 child, adult Airway $;;? Change rescuers every 2 mins to reduce fatigue.Stop CPR when: Do compression-only CPR, if unwilling or unable Casualty responds or begins breathing normally Chin lift Use pistol grip to achieve chin lift. Head To clear foreign material to give rescue breaths (RB). Exhaustion – you can’t continue. Watch that your knuckle doesn’t Continue CPR until responsiveness or normal Health professional arrives and takes over. tilt compress neck and obstruct airway breathing returns. Health professional directs that CPR be ceased and breathing. If foreign material is present, roll D {<#{[$= casualty onto the side and clear reverse abnormal heart rhythms. Not all heart rhythms are reversible [ Use AED when casualty is unconscious, not breathing normally. sweep method. Spinal injury and infants(<1yr): Keep head in a When there are 2 rescuers, continue CPR while one rescuer neutral position (i.e. minimise backward head tilt) organises and attaches AED pads: The airway takes precedence over any other injury including a possible spinal injury. Switch on AED & follow voice prompts of the AED. ;$;\<= Place pads on bare, dry chest - remove clothing, jewellery, medication patches, wipe chest dry, avoid piercings and pace- G ;J$ makers, remove chest hair with razor or scissors. Breathing G $ (< 12 months) O #Do not use an AED on infants #No contact.{]? O[‚ Take up to 10 Abnormal or NO Breathing? #No conduction.{]; $ An infant is under 12 months old seconds to A child is 1-8 years conductive material\+;? after the airway has been cleared and opened, An adult is over 8 years {]#? check for the rescuer must immediately commence chest #No explosion. breathing Children under 8, use with child pads if available, otherwise use adult pads. If pads touch compressions then rescue breathing (CPR). each other, position one pad on the front and the other pad on the back of the chest. Check ;$$+ continue with compression only CPR. manufactures instructions. Choose appropriate AEDs for child care. (pg 46) ]^?[;R+ NB. No harm to rescuers has occurred while using an AED in the wet sounds of gurgling, sighing or coughing may be present, but Chain of survival: is the key to improving the survival rate from cardiac arrest. Time is the this is ineffective breathing and CPR should be commenced. essence. The 4 steps required are: 1) Call  Early 2) Begin CPR immediately 3){[$4) Advanced cardiac life support by paramedics 6 | Essential First Aid means call your country’s emergency number Essential First Aid | 7 Choking Inhalation of a foreign body can cause partial or complete airway obstruction. Drowning Drowning is the process of experiencing respiratory impairment from immersion in liquid. Partial Airway Obstruction (Effective cough): Interruption of oxygen to the brain is the most important consequence of drowning so early SIGNS & SYMPTOMS FIRST AID rescue and resuscitation are the major factors in survival. Drowning can be fatal or non-fatal. > ƒZ coughing SIGNS & SYMPTOMS DO NOT attempt to save a {[$ Q >>O drowning casualty beyond your ]$ {]$$; >$ swimming ability. ^! Remove casualty from water as soon > cough is effective as possible. (blue skin colour) > If blockage doesn’t clear $  $Rescue Breathing in water if trained to do so (requires a Complete Airway Obstruction (Ineffective cough): A Drowning Victim \=# SIGNS & SYMPTOMS FIRST AID impossible. !$$+ {€$$;? Cardiac compressions in water are speak or cough >$;? $[Z J {€? not be attempted. „ >$;? ><$= $$; FIRST AID On land or boat: Q obstruction not relieved. Call consciousness > .   Assess the casualty on the back with +>Q (pg 4). head and body at same level. Back blows are delivered standing or {]$M Do routinely roll the casualty onto lying using the heel of the hand internal injury. NOT between the shoulder blades. the side to assess airway and breathing. Vomiting and regurgitation often occur during Lay an face are delivered standing or Commence CPR if required(pg 4) infant Chest thrusts resuscitation of a drowned casualty. After rolling down across the lap. ;;[ Roll into recovery position if or casualty onto their side to clear the airway, vomiting If after 5 back surface is required. Chest thrusts regurgitation occurs. reassess condition. If not breathing, promptly roll blows the airway is still are sharper and slower than chest {]distended the casualty on to their back and continue with obstructed, use chest thrusts. compressions (CPR). Check stomach by external compression. Check resuscitation. Avoid delays or interruptions to airway after each chest thrust. Treat for Hypothermia - often airway after each back blow. The aim CPR. (pg 29) Do not attempt to expel associated with immersion. is to relieve the obstruction with each Chest Thrusts \ water „ if available and trained. accumulates in upper airway. oxygen An obstruction in the airway will cause All immersion casualties, even if resistance when giving Rescue Breaths. seemingly minor, must be assessed in A foreign body in the airway can be hospital as complications often follow. removed later, if it is blown further into Back blows the airways during CPR. on infant Rescuing a Drowning Victim Positional Asphyxia Is where an airway is obstructed due to body position. If it is +;[ person, the restrained person must be continuously monitored. To prevent positional asphyxia Avoid face-down restraint unless absolutely necessary and reposition as soon as possible. # Never sit or lean on the abdomen. Identify persons at risk: over dose can lead to cardiac rhythm Psychosis and Drug If conscious: throw a buoyant aid (life jacket, surf board) or drag from water using an $$[?Obesity [$ umbrella, rope, towel, stick. face-down position. Physically disabled$[? If unconscious: Turn casualtyface up and remove from water. Pay close attention to a person saying they can’t breathe, gurgling or gasping sounds, Consider possibility of spinal injury – remove from water gently, maintaining spinal alignment lips and face turning blue, increased resistance or sudden tranquility. as much as possible. 8 | Trauma means call your country’s emergency number Trauma | 9

Arm Slings: Use a triangular Soft Tissue Injury & Fracture bandage or improvise. Upper Sprain:#‡;? Soft Tissue Strain:;[$? Injury Displacement of bone ends in a joint. Slings and splints Dislocation: can assist with Fracture (#):^$+[‚ support and Closed: Fractured bone doesn’t penetrate skin. immobilisation. If Open: Fracture is exposed through open wound or penetrates skin. casualty is at rest Complicated: Vital organ, major nerve or blood vessel is damaged by a broken bone. and comfortable The and for a fracture and soft tissue injury are very similar. these may not be Signs & Symptoms First Aid necessary. SIGNS & SYMPTOMS FIRST AID Control external bleeding or cover wound (pg 12) Q[M; Improvise: ‡ Support or Immobilise + By using a belt or R.I.C.E.R. ElevationElevation Sling Sling Q Medical Assistance: X-rays are the only sure way of buttons on shirt { The radius diagnosing the type of injury. ; always Call  if: Deformity as blood vessels and attaches to {ˆ the thumb. ˆ nerves can be damaged. Open Fracture: Risk of blood loss and FractureFrF actture MManagement:anagementt: infection. The main aim of fracture treatment $%' is to support or immobilise an X‹(pg 52, 56) injured part which: Rigid Splint: Rolled up newspaper, $ placed under the fracture, tied either end fracture becoming an open fracture. with triangular bandages. Support: G‡? Arm Sling Immobilise: !Splint, Sling or bandage to prevent movement. Fractured $‡$$;? humerus: $$$$;? Notice deformity >}€(pg 11). DO NOT elevate a suspected fracture until it has been immobilised. Note: If medical help is close by and the casualty doesn’t need to be moved, a splint may not be required to immobilise a fracture. However, where a casualty needs to be moved, especially over rough terrain or long distances a splint will help to immobilise a fracture. Soft Tissue Management: Do No HARM No Heat: No Alcohol: No Running: No Massage. Finger Splints: Immobilisation reduces Method used to treat soft tissue injuries (sprains/ strains) and fractures. pain. After splinting, apply an elevation Collar R.I.C.E.R. sling to minimise swelling. Rest: Rest casualty and injured part; this prevents further damage and reduces bleeding. & Cuff Sling Ice:Q+\;$$?; for 10 - 20 mins – do not place ice directly on skin. Ice pack or frozen peas can be placed Pain in: Could be: Management: over a bandage. Continue to cool injury three times/day for 2-3 days after the injury. O{ ; Shoulder Compression‚[$‡? OJ position of comfort. injured part and reduces bleeding and swelling. ;$ Elevation:Q‡$$?;\; Upper Arm OJ suits casualty. blood and reduces swelling.  Refer: Refer casualty to a doctor, in case there is other injury eg fracture. Record incident. Fore Arm/ OJJ elbow to reduce swelling Degree of pain is not a good indicator of injury type since pain tolerance varies in individuals. Wrist O$ Never manipulate a dislocation - there may be an associated fracture. ;‡ When in doubt, always treat an injury as a fracture. is a fracture or soft tissue Hand OJ Check circulation( pg 11) after immobilisation ie after bandaging, splinting, sling. OJ injury, treat as for fracture May need to slowly adjust position of limb if no circulation is present. J (pg 8) 10 | Trauma means call your country’s emergency number Trauma | 11

FIRST AID Call Immobilising Lower limb: Fracture site.  Bandaging and splints Pelvic Injury: Reassure casualty A body splint is an effective way may be required if Control any external bleeding. to immobilise lower limb fractures. the casualty needs to G\;$ The key to immobilising leg be transported. Use supported. [’$ triangular bandages, Place padding between legs and on either side around the feet. of hips (eg blanket, towel, pillow). Place padding in natural hollows broad bandages, ‘Figure-of-eight’ bandage around ankles and between legs. belts, clothing or feet. Stabilise joints above and below sheets to tie legs Apply broad bandage above knees. fracture site. together. Tie-off on Position all bandages before tying uninjured leg, above SIGNS & Don’t attempt to move casualty. off. and below fracture SYMPTOMS Discourage attempts to urinate. Maintain body temperature. Apply broad bandages above and Position splint underneath limb to site. support & immobilise fracture. Monitor vital signs below injured area. groin region (pg 52, 56) Tie bandages off on uninjured Splints$[‚ ; side of body. Uses uninjured, adjoining body part to [ is to prevent further injury by # $%*+ movement aim If using a rigid splint (eg stick) $‡?G;$+[ immobilizing the fracture. The casualty will usually $; ensure splint doesn’t extend commonly strapped together as body splints. (pg 14) support and immobilize the injury in the most further than length of legs. # *+ Folded blankets, towels, pillows comfortable position and a splint will not usually be Position splints under the injured Consider internal # %*+ Boards, sticks, metal strips, folded required, especially if an ambulance is available. Do limb to provide support. bleeding from magazines and newspapers ]+ Pad over splint to make more bladder, uterus, to maintain circulation. For suspected fractured comfortable. bowel damage. Checking Circulation: pelvis always consider spinal injury. Do not move the # Check circulation >$;‡+ casualty unless necessary. there may be impaired circulation. Left leg appears A 1.5 litre blood loss $$; shorter and is rotated can result from a SIGNS AND SYMPTOMS that level of injury. Compare to other side. If colder, there outwards. closed fracture of the a bandage is too tight: may be impaired circulation. ]$> Notice swelling over femur. In this case a 3 “Z[;?> hip due to internal litre blood loss could return within a few seconds. ;J$ bleeding. This is the result in shock (pg 14) >$;‡;; below injury typical position of the and death. absent, circulation may be impaired. leg with a fractured This type of injury is hip (fractured neck of [ femur) and is common Pain in: Could be: Management: accidents. in the elderly after a Hip/groin OO ; Hip Injury minor fall. {J adopt position of Thigh Injury comfort. O‚ ; R.I.C.E.R. for a Thigh R.I.C.E.R. <“=‚$<= injury is a fracture or sprained ankle: soft tissue injury, treat Rest: Casualty Support knee O{ as for fracture (pg 8). doesn’t move ankle in position Knee of comfort. > Ice: Cool injured area fracture after it has Compression: Use a Do not try to been immobilised. straighten Lower Leg/ O$O[$ crepe bandage Ankle {J X Elevation: Place foot knee if avoid further injury. higher than hip painful. OJJ > Foot Ankle Injury Refer and record Knee Injury {J immobilisation (above). 12 | Trauma means call your country’s emergency number Trauma | 13 Bleeding Embedded Object: eg knife, glass, stick or metal. Bleeding (haemorrhage) can be external and obvious or internal (within the body) and often Bleeding FIRST AID not seen. {]$‡$;? $%%according to the type of blood vessel damaged: Build up padding around the object. Arterial Bleed - damaged artery; bright red blood; spurting Apply sustained pressure over the pad (indirect pressure). Venous ^”$”\; ^[? Capillary - tiny blood vessels; bright red blood; oozing {]$‡? Types of wounds associated with bleeding are: {]$‡Z$? $G$$‡ Elevate, immobilise, restrict movement of the limb. Advise casualty to remain at rest. Major External Bleeding: Call  $ casualty. Signs, symptoms and management as for Shock (pg 14) {++ Internal Bleeding: easiest, most effective way to stop bleeding. Suspect internal bleeding if alarge blunt Concealed: Apply direct or indirect pressure on or near force [+ Spleen, liver, pancreas, brain (no the wound as appropriate. from a height; or a history ofstomach ulcers, bleeding visible). early pregnancy (ectopic pregnancy) or Revealed: penetrating injury. Lungs – Cough up frothy pink sputum. Internal bleeding may be concealed or revealed.Stomach – Vomit brown coffee grounds FIRST AID If a casualty is coughing up frothy blood, allow or red blood. >{+–$? casualty to adopt position of comfort – normally Kidneys/ Bladder – Blood stained urine. Direct Pressure half-sitting. Bowels – Rectal bleeding: bright red or !$$? First aiders can’t control internal bleeding but and Elevation black and “tarry”. early recognition and calling Direct Pressure Method:  can save lives. Uterus - Vaginal bleeding. —$$‡(pg 13) Used to control $[ TOURNIQUET: life-threating bleeding (eg pressure until bleeding stops. traumatic amputation of a limb). X; FIRST AID ! ‡$;$? pad (sterile dressing, tea towel or handkerchief). LAST RESORT. !;$<•€ Y;? ^[? wide). $? - apply another pad and a If bleeding continues above wound. X}'< tighter bandage. high be required after exercise, hot weather or if casualty has high “ $++ blood pressure or takes aspirin or warfarin tablets - maintain visible. pressure for at least 20 minutes). immobilise the part, advise casualty to rest $? $•'? >  ]” ? Q? write time of application on $;;? X(pg 52, 56) casualty. > „#$? Manage amputated limb as for major external bleeding (pg 12). pressure over wound. Amputation {]++? Amputation of a limb may require a tourniquet (pg 12) to control life-threatening bleeding. {]“ If major bleeding continues - remove all pads {];;“? to locate a bleeding point, then apply a more direct joint or wound. ƒZ;$? pressure over the bleeding point. {]“ $;; (pg 14) if required. until casualty receives specialist (The part should not be in direct contact with ice). care. ;? 14 | Trauma means call your country’s emergency number Trauma | 15 Shock Shock is a loss of effective blood circulation resulting in tissue/ organ Burns Burns may result from: heat<\++=+cold, friction, damage and is life threatening. chemical (acid, alkali), electrical or radiation (sunburn, welders arc). CAUSES FIRST AID {]$? DRSABCD Loss of blood volume:^\ {]$$? Cool affected area with water for as long Loss of blood pressure: Heart/ pump failure {]++ as necessary - usually 20 mins. or abnormal blood vessel dilatation. powders (except hydrogel). Remove rings, watches, jewellery from #$ {] bleeding affected area. X‡ substances. Cut off contaminated clothing – do not $ {]O\P$ remove clothing contaminated with \ (towels, tissues, cotton wool). Y The total blood volume in the body is chemicals over the head or face. Y about Blood loss of Elevate burnt limb if possible. Seek medical help for: 6 litres. >1 litre >$ $ (20%) may result in shock. Rapid Cover burnt area with a loose, non-stick abnormal dressing (sterile non-adherent dressing, $ O$ #<= blood loss leads to more severe dilatation of plastic cling wrap, wet handkerchief, Infant, child or elderly. ^J‡ blood vessels shock. sheet, pillow case). Burns to hands, face, feet, major joints, or {];? genital area. SIGNS & SYMPTOMS Hydrogel products are an alternative if ^Z•R? ++ FIRST AID >#$(pg 12) water is not available. Burns encircling limbs or chest. > Burns associated with trauma. O + Q+;$? lying down -/;''\'%(pg 14) ]J #$ > Maintain body temperature Q? Reassure Q+; X(pg 52, 56). Q+$< „$< internal abdominal bleeding). and/ or delay surgery). NB. In early stages of blood loss, children may have a normal pulse rate, but pallor is the warning sign. If Unconscious: '*$' Partial Thickness Burn Full Thickness Burn DRSABCD (pg 3) (1st degree) (2nd degree) (3rd degree) Reddening (like sunburn) Red and Blistering White or blackened Painful Very Painful Not painful Crush Injury A heavy, crushing force to part of the body usually causing Flame:+{Q+>‹Q+QGG\\; extensive tissue damage from internal bleeding, fractures, ruptured organs, or an impaired $+X> blood supply. Inhalation: (See also pg 32, Poisons)\ FIRST AID Crush Injury Syndrome: ;;$;${] {Q^>{;? Is a complication of crush injury $#;Q+ > usually involving a thigh or pelvis G‡> $? (ie not a hand or foot). #„#$> >#$ (pg 12). Toxins released from damaged =+#$^; {]“(pg 12) to manage a crush tissue may cause complications $;;{$$; injury. but the risk of sudden death > X‡? following removal of a crushing Bitumen:^;;~'{] >? force is extremely small. R$;$+$ X(pg 52, 56) It is recommended to remove the ;> NB - the casualty’s condition may deteriorate quickly crushing force as soon as safe Electrical:^; due to extensive damage. and possible. injuries (pg 16) Call  16 | Trauma means call your country’s emergency number Trauma | 17

Electric Shock Chest Major chest injuries include fractured rib, \ (multiple rib fractures, Electric shock may cause: #*@#=%@#$' \$=+sucking chest wound. A fractured rib or penetrating injury may puncture the lung. FIRST AID ]!QO›O›!QGO]{ FIRST AID BYSTANDERS. Fractured Rib/ Position casualty in position > Flail Chest: of comfort; half-sitting, leaning ;<$ toward injured side, if other box or main circuit breaker) SIGNS & SYMPTOMS injuries permit. X? Holding chest Encourage casualty to breathe >>Q“(pg 4). Pain at site with short breaths. [$(pg 15). Pain when breathing Place padding over injured area. Rapid, shallow breathing Bandage and sling may help to Bruising immobilise the injury. Tenderness If bandages increase discomfort, ^<\ touch casualty’s skin before electrical source is disconnected. loosen or remove them. DO NOT punctured lung) BEWARE: Water\metal materials can conduct electricity from casualty to you. Apply a ’Collar & Cuff’ sling to Flail Chest –section arm on injured side. of chest wall moves in ƒ are in contact with a vehicle Call for an ambulance POWER LINES opposite direction during  or a person, there should be no attempt at removal or breathing. Monitor for internal bleeding/ resuscitation of the casualty until the situation is declared (pg 14) shock (pg 13, 14) safe by electrical authorities. #If Unconscious: Recovery Q10 m[<$+ position, injured side down. pool of water, cable). ›;Zœ Protect yourself and others. Sucking Chest Wound: SIGNS & SYMPTOMS FIRST AID Multiple Casualties/ Prioritising You may be faced with the ”+ ;?;[+ ^[ leaning toward injured side. ; $‡+$; remember the goal is for the In all greatest good for the greatest number of people. when casualty breathes. around the wound. cases remember the principles of safety to yourself, bystanders and casualty. ^$$$ ;+; PRIORITIES: }|+€|; around wound when casualty pad taped on 3 sides: This allows air to escape breathes. from pleural cavity and prevents lung collapse Gƒ›!]>]>![?; >$ (pneumothorax). the casualty into the recovery position may be all that’s required initially. 1 frothy sputum. > for an ambulance . $<•}= Moderate bleeding (< 1 litre) (pg 14). X$J(pg 13, 14). 2 Crush injury 3 Spinal injury Shock Multiple fractures ; Burns (10-30% of body) $; OƒƒP Burns to 30% of body 4 Head injury, showing $M+ deterioration 5 massive head or torso injuries

Remember: A casualty is always in a changing, non-static condition. This is especially important in head and abdominal injuries in which deterioration can occur. 18 | Trauma means call your country’s emergency number Trauma | 19 Eye Types of eye injuries:#$'#X;%#[\'#;] An injury to the abdomen can be an open or closed wound. Even with a closed wound the rupture of an organ can cause serious (pg 13, 14), which results in Burns: internal bleeding shock FIRST AID (pg 14). With an open injury, abdominal organs sometimes protrude through the wound. Chemical - acids, caustic soda, lime UV -ƒR\+;$ QQ„;; FIRST AID (the eyes are red and feel gritty hours later) sterile eye (saline) solution for 20 -30 mins. > Heat -\ O? $;; remove if the ? and support Contact Lenses: DO NOT under head and shoulders $> G<=? under bent knees. ;G ? place in recovery If unconscious, initially protect the eye but if a chemical or position, legs elevated if possible. foreign body tracks under the lens, severe If chemical burn+{]Z; >#$;; injury may occur. other chemicals as this can create heat. dressing, plastic cling wrap or aluminium foil. „++++ ;$< Plastic cling wrap has been placed over an Foreign body: tightly). open abdominal wound and secured with FIRST AID surgical tape. Q? „;$‡M X(pg 52, 56). (saline) solution or gentle water pressure from hose/ tap. (pg 14). +;+ gently lift particle off using a moistened cotton bud or the {]$;$$ corner of a clean handkerchief. cavity. <{]M {] irrigate only) wound. +; {]$;;[ no pressure is placed over injured eye. (may cause spasm). ? {]< {];$? surgery for wound repair). Penetrating Injury: FIRST AID G\ Q > $$‡? +$ this will cause movement of injured eye. >+$$ anxious. {]$$‡? {]$‡?

Direct Blow: $;[“$ of the eye socket or retinal detachment. FIRST AID QQ; $ 20 | Trauma means call your country’s emergency number Trauma | 21 Head Injury Spinal Injury ^\ear may indicate a The key to managing a spinal cord injury: Protect airway & minimise spinal movement ruptured eardrum or skull fracture: ‡; Conscious: ;\? SIGNS & SYMPTOMS FIRST AID {]$? Cervical $? ‡$‹{]„ AIRWAY management takes priority of patient - leave this to the experts. body. ? over ALL injuries, including spine. ALL cases of unconsciousness, even ]$;? > if casualty was unconscious only !$? ? $\+$$? !? Q? Thoracic If casualty didn’t lose consciousness, (pg 14). X$? but later develops any of the following signs and symptoms (below), urgent Spinal Column QUICK CHECK Conscious Casualty: medical advice must be sought. >;[ Support the head and Monitor all casualties closely for the me? neck in a conscious [’‡? casualty with neck pain. Lumbar >[? All head injuries should be suspected Do not remove helmet as a spinal injury until proven >? and ask casualty to otherwise. >; remain still. and point them away? {;? FIRST AID SIGNS & SYMPTOMS Check (pg 3) >J? Headache or giddiness DRSABCD Nausea or vomiting Conscious: NB. If the casualty has neck or back pain- R$$? Drowsy or irritable treat as a spinal injury. The pain may be Q+? Slurred speech due to an unstable vertebral fracture which $\+ Blurred vision may result in spinal cord damage if handled cover with a dressing (do not plug). Confused or disorientated. incorrectly. >$;(pg 12). Loss of memory Unconscious casualty: {]? Suspect spinal injury with: Turn casualty onto their side, Swelling and bruising around eyes. motor vehicle accidents, motor bike and {]< maintaining head, neck, and spinal Bleeding into corner of eyes. cyclists, diving, falls from a height, minor bleeding within skull). alignment. Maintain an open airway. Bruising behind ears. falls in the elderly and sports injuries such $M$;+;? (Log roll technique). Use safe manual ;\$ as rugby and horse riding. ? handling techniques to avoid injuring yourself. from nose or ear. eg ask for assistance; bend your knees. Loss of power in limbs. Unconscious: Q;–? Unconscious: Loss of co-ordination. Any person found unconscious is potentially spinal injured until proven otherwise - turn > Seizure  casualty onto their side and maintain an open airway. X‹€}'$;? G+$\? J$? Helmet Removal: Helmets could FIRST AID ;;$? be preventing further spinal or head Q;– injuries. If a full-face (motorcycle) Concussion: “Brain Shake” is a $? > temporary loss or altered state of helmet is impeding proper airway X‹€}'(pg 52, 56) consciousness followed by complete Cerebral Compression: Brain swelling or bleeding management in an unconscious >$; recovery. Subsequent decline within the skull shows deteriorating signs and casualty and/ or you intend to perform J$ (see signs and symptoms above) symptoms (above). This is a serious brain injury and CPR, the helmet needs to be removed ;;$ suggests a more serious brain injury. could be life threatening. ?; $ removal to the experts. 22 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 23

Angina is a “cramping” of the heart muscle; relieved Asthma is a disorder of the airways that can cause respiratory distress. Heart Conditions by rest, with no permanent muscle damage. Asthma Spasm, \ and increased mucus production in the airways causes breathing Heart attack is caused by a blocked coronary artery, [?$;$;+ resulting in muscle damage which may lead to exercise, emotional stress, pollen, dust-mite, food preservatives, smoke, fumes or cold and complications such as cardiac arrest. \?;;? Cardiac arrest is a condition in which the heart stops beating and pumping effectively. The damage SIGNS & SYMPTOMS FIRST AID caused by a heart attack may cause abnormal rhythms Mild: Sit casualty comfortably upright. Calm and reassure - stay with casualty ( enticular ibrillation) which result in cardiac arrest. Dry persistent cough V F Wheeze Follow casualty’s Asthma Action Plan Some abnormal rhythms can be reversed by an AED. Breathless but speaks in sentences or give Cardiac arrest is fatal without basic life support (pg 3). Chest tightness Reliever Medication (4 puffs - 1 puff Severe: (Call ambulance straight away) “Heart attack” and “Angina” are heart conditions ]%;;‚ƒ „$<$= Borrow an inhaler if necessary which present with similar signs and symptoms. Wheeze inaudible (no air movement) If no improvement, repeat after 4 mins M+œ Cyanosis (blue lips) SIGNS & SYMPTOMS Skin pale and sweaty Call  if no improvement M$$>Y Central chest pain Exhaustion „#$<’GJ= Breathlessness[O$P Anxious/ Distressed Keep giving 4 puffs every 4 minsuntil Indigestion type pain in the upper abdomen (referred pain from the heart) Rapid pulse ambulance arrives or casualty improves spreading to the Pain #_]#`#'%# Collapse (respiratory arrest) [?$each puff. Heaviness or weakness in left arm If Collapse: Young Children may also demonstrate: Dizzy Casualties having a heart attack may present with Severe coughing and vomiting CommenceDRSABCD (pg 3) NB. Nauseous breathlessness alone while others may have heaviness Stop eating or drinking Pale and sweaty in the arm or believe they have indigestion. Restless or drowsy Rescue breaths may require more force Irregular pulse Muscles in throat and between ribs ‘suck in’ ;;?;\; steady pressure until chest begins to rise. Allow time for chest to fall during expiration. FIRST AID STOP and REST – in position of comfort (usually sitting). Using Puffer - with spacer If no spacer available QAre you on prescribed heart medication? - Do you have angina? Can you take Aspirin? $;$ – treat as for @{@{{@=}#=Q’ #/@*%%#€ prescribed heart medication<$„]=? €+give another dose of heart medication. SHAKE 1 PUFF 4 BREATHS ANGINA should be relieved by rest and medication (tablets or spray). REPEAT X 4 3 doses of medication over 10 mins, the pain has not diminished, Reliever Medication: Shake inhaler, remove cap andShake inhaler, remove cap. Put colour. then the condition should be considered a HEART ATTACK Blue - grey put inhaler upright intospacer . inhaler between teeth and seal Salbutamol puffers are thePlace spacer between teeth with lips. most common (eg Ventolin, and seal with lips. Administer 1 puff as casualty Warning signs: {]Rƒ Asmol, Airomir) also Pain lasts > 10 mins Call  Monitor vital signs Administer 1 puff and ask inhales slowly and steadily. >]ƒ Terbutaline (eg Bricanyl - casualty to breath in and out for Slip inhaler from mouth. Ask Pain gets suddenly worse supplied in a turbuhaler) 4 breaths through the spacer. casualty to hold breath for 4 sec It is not harmful to give „# Repeat until 4 puffs have been or as long as comfortable. „ if directed salbutamol to someone Aspirin (300mg) Breathe out slowly, away from by emergency services. who does not have given. Vital Signs inhaler. Before directing you to give Aspirin, Prepare for CPR asthma. Wait 4 mins and repeat if there (pg 52, 56) is no improvement. Repeat until 4 puffs have been emergency services will want to know if: Adults can use Symbicort given. in emergency: follow >Warfarin (blood thinning medication) Wait 4 mins and repeat if no SMART action plan, Call  if casualty does not >Asthma or Stomach ulcers improvement available from Asthma respond to medication. Say it Foundation is an asthma emergency 24 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 25 Croup/ Epiglottitis Seizure/ Epilepsy A seizure is caused by abnormal electrical activity in Croup and Epiglottitis are infections of the upper airways (larynx, pharynx and trachea) the brain. Types of seizure include brief lapses of attention (absence seizure) trance-like and occurs in young children. Both conditions start with similar signs and symptoms but wandering (partial-complex seizure) and rigidity followed by jerking (tonic-clonic seizure). A seizure can occur in a person with epiglottitis progresses to a life-threatening state. Croup: Viral infection #** #%„\' # #€ affecting upper airways in Fever<$= Hypoglycaemia <$=PoisoningAlcohol SIGNS & SYMPTOMS FIRST AID infants and children Drug Withdrawal. CROUP: examine DO NOT < 5 yrs. Slow onset, usually FIRST AID > child’s throat – this SIGNS & SYMPTOMS follows a cold or sore throat M$‡ ^ may cause complete Tonic-Clonic Seizure and lasts 3-4 days. Can also <;‚$ or protect head with cushion/ pillow. ]$ blockage. affect adults. taste, smell, sound or sight). ]? Mild >Q? >? ‹{ ƒ Epiglottitis: Bacterial > avoid injury. # $%' worse if child is upset. infection of the epiglottis (tonic phase – lasts few secs). {]R? # =†;'*‚ ? <\$= ;? QQ$? causing $< X‹(pg 52, 56). EPIGLOTTITIS: upper airway It occurs in phase – lasts few mins). Q; # ]] Call  obstruction. the age group and ^J supervision at end of seizure. # '‡%' >+ 4 - 7 yr has a rapid onset over 1-2 #  if: # ]% ? Severe hrs. $$ Z€? # ˆ G stained saliva. Z“;? # *' care until ambulance This is an emergency G$$;? >$? # \'% arrives. and requires urgent ambulance transport to ^M Z;? the hospital. Z[? R[Z? {[ {;;? >‡R$? [ A person known to have epilepsy may not require differentiate ambulance care and may get upset when one is called. between Q='* and Q* - further tests are usually required. Call  if you are not sure

(Normal body temperature = 37°C) Faint Febrile convulsions are associated with a high body temperature (>38°C). It is the rate of rise Fainting is a sudden, brief loss in temperature, not how high it gets, which causes the convulsion. They occur in 3% of all of consciousness caused by children between the age of 6 mths and 6 yrs. SIGNS & SYMPTOMS FIRST AID $\;$ {ZZ? G\ SIGNS & SYMPTOMS FIRST AID with full recovery. It often occurs ] ; (Similar to epilepsy + fever) XQZJ in hot conditions with long ; left side. O Epilepsy’. periods of standing; sudden Q Q +\ PLUS: postural changes (eg from consciousness within •;? Q# ^ sitting to standing); pregnancy a few seconds of lying give food or drink DO NOT ^ (lower blood pressure); pain \? to unconscious. forehead or emotional stress (eg sight +$ {]; ; >‡? recovery position after seizure O of blood). There could be X to occur underlying causes, which may Q# ^ embarrassment. medical assessment {]$ need medical assessment. clothing G; 26 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 27 Stroke {$$$;$? The blood supply to part of the brain is disrupted, resulting in damage to brain tissue. $Hypoglycaemia (Low blood sugar) or Hyperglycaemia This is caused by either a blood clot blocking an artery (cerebral thrombosis) or a ruptured (High blood sugar). Both conditions, if left untreated, result in altered states of artery inside the brain (cerebral haemorrhage). consciousness which are medical emergencies. The signs and symptoms of a “stroke” vary, depending on which part of the brain is damaged. SIGNS & SYMPTOMS - Both conditions share similar signs and symptoms: SIGNS & SYMPTOMS FIRST AID #@**;%'†ŠŠ‡%]‡'%‡%/'‚ >Z FAST tests, act #*%;#*%*'#' Y fast and Call  !“Z HYPOglycaemia (LOW) HYPERglycaemia (HIGH) ^ Q +; ƒ+ { Q Fast progression Slow progression X$ Y $<= {[;; „#$ $ ƒ X‹(pg 52, 56) ƒ “ side of body. Z ] New drugs and medical procedures can limit or

DIFFERENCES G$ $ $J$;? reduce damage caused by a stroke. Z Therefore, prompt action is essential for optimum $Y? recovery. Y+;;$ ! measures. TIA (Transient Ischaemic Attack) is a mini-stroke FAST is a simple way of with signs and symptoms lasting < 60 mins. FIRST AID Hypoglycaemia can occur if a remembering the signs of a The risk of a stroke subsequent to a TIA is high, Both conditions are (Hypo and Hyperglycaemia) person with diabetes: stroke: therefore early recognition and treatment is vital. ;$[? Facial weakness – Can the Conscious: O“ casualty smile? Has their mouth or „;J‚€Ÿ‡$+ #$ eye drooped? teaspoons of sugar or honey, glass of fruit juice faster than normal Arm weakness – Can casualty (not diet or low sugar type). ^M raise both arms? Repeat if casualty responds eg. diarrhoea and vomiting Speech – Can casualty speak ;high carbohydrate food: # clearly and understand what you sandwich, few biscuits, pasta or rice meal. stress say? > if no improvement within a few minutes of The reason sugar is given to Time to act fast - Call  giving sugar (could be hyperglycaemia or another diabetics with an altered state of Cerebral haemorrhage Cerebral thrombosis medical condition). consciousness is that most will be Unconscious: hypoglycaemic. The symptoms of hypoglycaemia progress more Hyperventilation syndrome is the term used to describe the signs and symptoms resulting > rapidly and must be addressed from stress-related or deliberate over-breathing. The increased depth and rate of breathing upsets the balance of oxygen and carbon dioxide which results {]M$ quickly. SIGNS & SYMPTOMS „‹]Y]„$ If the casualty is hyperglycaemic, Q$ in diverse symptoms and signs. the small amount of sugar given G NB. Other conditions $[;[ [ FIRST AID which may present with raise blood sugar levels and will do toes. >Q? rapid breathing: no harm. ^ ;$ - count breaths aloud. Y M# Y Don’t give diet or diabetic food/ drink [? medical condition. > ;[;M # $<= use a bag for this doesn’t correct low blood sugar. > DO NOT {$ Fruit Juice Sugar Jelly Beans Q rebreathing. 28 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 29

Heat Exposure Normal body temp = 37°C Cold Exposure Exposure to cold conditions can lead to hypothermia (generalised cooling of the body) or Heat Exhaustion: occurs when the body cannot lose heat fast enough. Profuse (localised cold injury). ;;$$\ decreased blood volume (mild shock). If not treated quickly, it can lead to heat-stroke. Hypothermia: is a condition where the body temperature drops below 35°C Y$+$? Heat Stroke: occurs when the body’s normal cooling system fails and the body ;cold, wet and windy, especially in the young temperature rises to the point where internal organs (eg brain, heart, kidneys) are damaged: and elderly\alcohol or drugs. Blood vessels near the skin’s surface dilate in an attempt to release heat, but the body is $+$; so seriously dehydrated that sweating stops (red, hot, dry skin). Consequently, the body require less oxygen. Hypothermia protects the brain from the effects of hypoxia so temperature rises rapidly because the body can no longer cool itself. resuscitation should be continued until the casualty can be rewarmed in hospital. This is a life-threatening condition. MILD Hypothermia MODERATE Hypothermia SEVERE Hypothermia 35°– 34°C 33°– 30°C <30°C Heat Exhaustion Organs cook at 42°C (Mild – Moderate Hyperthermia) FIRST AID X# ! X+ ++$ X > ^~Ÿ >M ' > Heat Stroke shaded, ventilated area. > [# SIGNS & SYMPTOMS (Severe hyperthermia) \ with legs elevated. ;$hard to ; ^• ' > Gexcess ; ; } detect > Pale, cold, clammy skin SIGNS & SYMPTOMS clothing. $ X Y NO Sweating Cool by: FIRST AID X Red, hot, dry skin ;;; > ] ice packs to neck, groin and # {];too quickly- can shelter – protect from wind chill. O ‹$ ; cause heart arrhythmias. Ygently to avoid heart arrhythmias. ] $J over body and fanning. # {]radiant heat <[ horizontal to avoid changes in blood Q J „cool water to drink if or electric heater) - re-heats too supply to brain. <\ Z fully conscious. quickly. Q;;? loss (pg 14) ! # {]$massage ƒblankets/ sleeping bag or space Profuse sweating may occur > if in doubt extremities- dilates blood vessels in blanket and cover head. Progresses to  skin so body heat is lost. „warm, sweet drinks if conscious. # {]alcohol – dilates O]Y‹Q]„‚ blood vessels in skin and impairs to groins, armpits, trunk Breeze or fan heat packs Heat radiates from the shivering. and side of neck. body, especially the head # {]hot bath Body-to-body contact can be used. into the surrounding air as monitoring and resuscitation if O!]>]>!‚ During breathing, cold air $[? is inhaled and warm air is DRSABCD (pg 3) - Check breathing/ pulse exhaled for 30- 45 secs as hypothermia slows down Frostbite: is the freezing of body everything. Heat Exhaustion and Heat Stroke are tissues and occurs in parts exposed to the no signs of life – commence CPR while Heat is lost through usually caused by over-exertion in hot, re-warming casualty. evaporation (sweat) on ;\? cold. the skin SIGNS & SYMPTOMSƒ+;#$ Heat is lost through convection ie warm FIRST AID air around the body is $$„ replaced with cold air Q;;$(rewarming can Heat is - worse on windy days be very painful){]$M conducted {]{]$$ from the NEVER thaw a part if there is any chance of it being re-frozen. Thawing and refreezing !! Frost bite results in far more tissue damage than leaving tissue frozen for a few hours. Body heat can be lost quickly in high, exposed areas 30 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 31 Bites/ Stings (Both found in tropical waters) Bites/ Stings LAND TYPE FIRST AID $-_ „'%\_ ANIMALS Snakes Pressure Immobilisation Technique (PIT) SIGNS & SYMPTOMS SIGNS & SYMPTOMS (see next page for PIT) immediate skin pain Mild sting followed 5-40 mins later by: Funnel web Spiders of skin marks FATAL Frosted pattern generalised pain Red back spiders/ others COLD COMPRESS/ ICE PACK > ]++; Cardiac Arrest >JRespiratory arrest Bees (Anti-venom available) (No anti-venom) Wasps Scorpion FIRST AID Red Back Spider {Q^>{Q; Q‹{$$ Ants Call  O;VINEGAR~'M SEA TYPE FIRST AID CREATURES rinse with seawater (NOT freshwater)+>Q Sea Snakes Blue-Ringed Octopus Pressure Immobilisation Technique (PIT) Non-Serious Bite/ Sticks: (see next page for PIT) Cone Shell Fish stings:$$;^;; $] VINEGAR Liberally apply vinegar for 30 secs (vinegar neutralises Red Back Spider:

FATAL stinging cells) then pick off tentacles. If no vinegar available, Bee/Wasp/ Ant/ Tick:G<$=Q $-_X

Tropics „'%\_X SEAWATER. Do not use fresh water because it can cause stinging +;#(pg 33) cells{O;? to discharge. Q BluebottlesFish Stings: Stingray HOT WATER - Use cold compress if no pain relief with + hot water Pressure Immobilisation Technique (PIT): This method is used to treat a variety of : Bullrouts $‚O;$^> Potentially Fatal Bite/ Sting:

Snakes Funnel web Spider Blue-Ringed Octopus Cone Shell 1. Apply a pressure SIGNS & SYMPTOMS: similar for all 4 species with death from Respiratory Arrest bandage over the bite area 2. Apply a second 3. Splint the bandaged within minutes to hours. <[] bandage[ limb, including joints either Painless bite{^{[;; [$; toes extending upwards side of bite site. ^[$]Y bandage and skin). covering as much of limb as Q$? J$;>> DO NOT wash bite site possible. DO NOT elevate limb. XO¡P$ ^ ^ (If only one bandage pants/ shirts as undressing >(pg 11) FIRST AID: start from causes unnecessary remove bandage {Q^>{ {];$<= available: DO NOT [J; movement and splint once it has been Q {]$ far up limb as possible XO¡P$ applied. > {]$  covering the bite). $“ {]“(pg 12) Q+ {]M[ PIT (Pressure Immobilisation Technique)""] priority over PIT species is made from venom on skin. !!$""% 32 | Medical Emergencies means call your country’s emergency number Medical Emergencies | 33

Poisons A poison is any substance which causes harm to body tissues. Allergy/ Anaphylaxis Anaphylaxis is a life-threatening allergic reaction A toxin is a poison made by a living organism (eg animal, plant, micro-organism). which can be triggered by nuts (especially peanuts), cow’s milk, eggs, wheat, insect A venom#;‡$<++[=? stings/bites (bee, wasp, ant, tick),‡‡ and certain drugs (eg Penicillin). The airways rapidly swell and constrict, interfering with and the blood vessels 13 11 26 - Poisons Information Centre Free Call, 24/7, Australia wide. breathing, widen, leading to shock (pg 14). Casualties need an immediate injection of adrenaline. Poisons can be ingested (swallowed), absorbed, inhaled or injected. The effect of a People who know they are at risk may wear a and carry their own poison will depend on what the substance actually is and how much has been absorbed. medical alert bracelet injectable adrenaline. FIRST AID Ingested: Swallowed substances can be broadly categorised into ‘corrosive’ eg dish G\+;?$ washer detergents, caustics, toilet/ bathroom cleaners and petroleums or ‘ ’ SIGNS & SYMPTOMS non-corrosive Can be highly variable and [; eg plants, medications (tablets/ liquids) and illicit drugs. Some drugs make people drowsy may include: „<;= or unconscious, others can cause panic or aggression others cause dangerous dehydration. Mild to moderate Allergic Call  Adverse drug experience - (‘bad trip’) indicated by FIRST AID reaction: # Administer oxygen if available confusion, hallucination, overcome by crowds, possibly “ ;++ „$ violent. Keep yourself safe, seek assistance. To help: (from container/ bottle). Y<+= [(pg 23) Stay calm yourself and talk calmly Reassure the person $? Further adrenaline should be given if no improvement Rest the person Reduce stimuli, move slowly, take to a {]unless advised. Abdominal pain, vomiting after 5 mins quiet place Encourage happy, positive, simple thoughts. {] give anything by mouth (severe if reaction to insects) >DRSABCD (pg 3). unless advised. SIGNS & SYMPTOMS of a corrosive Severe Allergic Reaction If in doubt give the autoinjector Drinking too much water can cause substance: J$ (Anaphylaxis): serious problems EpiPen ^J]J Mild allergy may not precede anaphylaxis Use adrenaline when symptoms become severe. {[$; {[J$ and Anapen are auto-injecting pens containing a measured dose of adrenaline (Epinephrine). It can take only Unconscious FOR ALL POISONING: ƒZ 1- 2 mins for a mild allergic reaction to escalate to anaphylaxis. {Q^>{ {[J $“+;; ƒ¢ƒ¢Y;X¢ Swelling/tightness in throat contamination from around the mouth. >> Persistent dizziness !$? advice or Call  \<= {] use Syrup of Ipecac to induce X‹(pg 52, 56) vomiting unless advised by Poisons J > Information Centre. notes with casualty to hospital. Swelling ; How to Use an EpiPen: How to Use an Anapen: Absorbed: hospital. Chemical splash from eg pesticide, weed killer. 1. 2. FIRST AID 1. 2. {]$M;++? ? O;;“ Pull off Black needle Pull off grey safety cap Inhaled: Toxic fumes from gas, burning solids or liquids. Inhaled poisons include: shield. from red button. carbon monoxide (car exhausts); methane (mines, sewers); chlorine (pool chemicals, cleaning products); fumes from paints, glues, and industrial chemicals. 3. 4. FIRST AID O[ Push orange end hard into SIGNS & SYMPTOMS X EpiPen and pull off outer thigh so it clicks and ^$Y G blue safety-release. hold for 10 secs Remove Epipen and ]{ZZ> „#$– massage injection site for > 10 secs [ Press red button so it Injected: As a result of a bite or sting (pg 30, 31) or may be injected with a needle. against outer mid-thigh clicks and hold for 10secs. The most common type of drug overdose via injection are narcotics which cause respiratory (with or without clothing) Remove Anapen and depression (slow breathing), respiratory arrest (no breathing) or unconsciousness. Seek NB. When the orange needle end is withdrawn from massage injection site for urgent medical assistance if breathing is slow or abnormal. The most common injection the thigh, the needle is automatically protected. 10secs ‚++$;+$;[?]^?]$ BEWARE of needle protruding from end after use. carriers of Hepatitis B, C, and/ or HIV (AIDS). 34 | Asthma & Anaphylaxis means call your country’s emergency number Asthma & Anaphylaxis | 35 {;;> is 2 Why Asthma is Dangerous trapped in the lungs during Asthma in the workplace - some occupations have higher risks of asthma The extra mucus that is produced during an asthma attack, can an asthma attack. Occupational Asthma<=‚ form a mucus plug in the air sacs (alveoli) in the lungs. The Flour, dust: (cooks, bakers, farmers) Sawdust: (builders, carpenters) mucus plug prevents the casualty from exhaling. This causes Animals: (vets, lab technicians) Detergents: (cleaners) Resins, > (carbon dioxide) in the lungs and blood 2 solvents, solder: (repairers, builders, electricians, Spray painters) which leads to acidosis. Acidosis is life threatening and needs advanced medical management, in hospital. When a person’s Managing Workplace Asthma - How to reduce the risk asthma can’t be controlled with reliever medication it is critical PPE (Personal Protective Equipment) Re-deploy that they receive urgent hospital care before carbon dioxide levels workers to lower risk area or duties Have Emergency build to an irreversible level. $[[ Inhalation Exhalation Seek less toxic alternatives Provide emergency asthma "'!(! management training * Metered Dose Inhaler = “puffer” Autohaler $ˆ Salbutamol brands are Ventolin, Airomir, Asmol. Manage asthma in aged care Names Terbutaline brand is Bricanyl. How to help people with asthma who have special Speed Fast acting. needs and circumstances Purpose Relax airway muscles. #Wheelchairs. Keep person in wheelchair; upright as Ventolin & Asmol Puffer. Airomir Autohaler. possible. (Unconscious - DRSABCD) ^+^J„ EMERGENCY Device ^$ˆ . Raise the bed head or use Ventolin puffer & spacer #In-bed asthma attack pillows or cushions to support upright. ) Asmol ^‚O#++—+ AccuhalerA #In shower or bath. Maintain client in bath or shower (on seat if Names Alvesco, Tilade, Intal Forte, Singulair possible) support sitting up. Empty the bath water. Keep client Speed Slow acting. Can take weeks for full effect. warm. Preserve client’s dignity - cover. Purpose Reduces the sensitivity to asthma triggers. #='%'. Use communication aids to reassure

+^; Device Puffer, Accuhaler, Turbuhaler,Tablet. and to give explanations. Symptom Controllers #Intellectual disability. Develop and maintain regular routines. Names # Speed Slower acting than relievers. About 30 minutes. Exercise Induced Asthma (EIA)

„ Purpose Relax airway muscles lasts up to 12 hours. AtA rest breathing is mostly through the nose. During exercise, air

FOR EMERGENCY Device Turbuhaler, Accuhaler is breathed through the mouth and air that enters the lungs '! Preventer plus a Symptom Controller +[?

NOT Name Seretide asthma attack. Without spacer With Spacer Speed Slower acting Exercise is an excellent activity for everyone including

Purple Purpose Prevention plus control of symptoms asthmatics as it helps to improve overall health and lung Device Accuhaler or MDI (Puffer). Taken twice a day. function. Exercise is one trigger that should not be avoided. Therefore it is '! Can be used in emergency for ADULTS important to manage EIA so people with asthma can continue to participate in Name Symbicort most sports. Speed Reliever is fast acting Purpose Prevention plus control of symptoms Children may need a Managing EIA Device $ˆX{<=? spacer with a mask Take reliever 5-20 minutes before exercise Warm-up before exercise Warm- Symbicort may be used for casualties over 12, ˆ$ down after exercise Always carry blue reliever medication in case needed Adult use only Adult use when prescribed. “in-breath”. This may not Red & White CAUTION Max 6 doses at a time. Max Tips for coaches: !O›Pmedical emergency. fully understood, but also causes severe life threatening reactions. Allergens What happens in an anaphylactic reaction? Causes of death from anaphylaxis Anaphylaxis Facts - Australia Ige antibody an allergy prone person runs across an 60% medications # { Allergies in Australia are very common, affecting allergen (peanuts for example), their immune system 20% insects about 1 out of 5 people. produces large amounts of peanut Ige antibody. As a 10% unknown Death from anaphylaxis is rare. 5% food result of this their body is sensitised to peanuts. About 12 die each year from anaphylaxis 5% other (latex, hair dye, etc) These Ige molecules attach themselves to mast cells. X]$??? this person comes into contact with „ # The second time Medications: IF anaphylaxis is fatal then death usually occurs very peanuts, the peanut Ige antibodies trigger the mast cells soon after contact with the trigger. to release granules of powerful chemical mediators, such < 5 min after injected medication as histamine and cytokines into the blood stream < 15 min after insect stings These chemical mediators (histamine etc) cause < 30 min after food Histamine etc Vasodilation What does adrenaline do? Fluid loss into tissues Adrenaline: Smooth muscle contraction Reverses vasodilation Increased mucus secretion Insect stings/ticks: Reduces swelling This causes the common anaphylaxis signs & symptoms Ants, Bees and Wasps are the most likely Increases heart output Redness, rashes and welts insects to cause anaphylaxis. Ticks also $[ Anaesthetics and injected medications ;+$[ cause anaphylaxis in some people; most Prevents mast cells from Shock such as antibiotics are the most reactions to tick occur when attempting to releasing chemicals Cardiac arrest common drugs to cause anaphylaxis. remove the tick. Some over-the-counter medications such Give Adrenaline Early \ (NSAIDS) If the mast cell response is slowed down quickly, with early use of can cause anaphylaxis. Some alternative adrenaline, the amount of histamine and mediators released by the and complementary medicines are based mast cells is greatly restricted, to the point where adrenaline can $\; effectively reverse the effects these chemicals have. known allergens. See ASCIA for info on ticks: www.allergy.org.au ;$<\ leaking into the tissues) can result in severe shock leading to Food: Food is the most common cause of anaphylaxis in children cardiac arrest. [#? It is very important to give the adrenaline autoinjector if the signs and symptoms of the casualty suggest anaphylaxis. Any food can cause anaphylaxis but If you are in doubt - give the autoinjector. these 9 Foods are the most common Peanuts Dairy OO # Call . The reaction could return when the effects of adrenaline ]„ wear off after about 20 minutes Eggs What is an autoinjector? Autoinjectors contain a pre-measured dose ?ƒ+[ medication is pushed out. Each Autoinjector can only be used once. EpiPen & Anapen are different BRANDS of autoinjector. Both brands contain What does all this mean? Most allergic reactions do not cause death. However when adrenaline. Each brand has different operating instructions! It is much better to anaphylaxis is life threatening it develops very rapidly and requires immediate treatment take a few seconds to read the instructions and administer the medication correctly than with adrenaline. First Aiders and carers must learn to identify signs of anaphylaxis and be to rush and make mistakes in a panic. In the past rescuers have injected themselves. prepared to act quickly Don’t make the same mistake. %'ƒ 38 | Risk Assessment means call your country’s emergency number Risk Assessment | 39 ASCIA has Action Plans and many Manage Anaphylaxis Risks Anaphylaxis Action Plans other resources: www.allergy.org.au There are four sectors that need to consider the risks of anaphylaxis. ASCIA is a professional medical organisation, comprised mostly of scientists and specialist +G{>+++ 1. Children in care. [? Y><Y=+O{>? provide useful information 2. Schools. Primary and Secondary ASCIA Personal Action Plans should be stored with medication. and resources about Allergy and 3. Workplaces. All workplaces, including the workers in child care employment. They contain: Anaphylaxis and also produce 4. Voluntary organisations, especially those working with minors. This includes # Individual’s details - name, age >$+›„>„+J„+^>$? ASCIA Anaphylaxis Action # Emergency contact details . Action plans provide Each of these sectors should have an anaphylaxis policy and an anaphylaxis Plans # Extra instructions important information to help all management plan (pg 53) and communication plan (pg 45) in place. For the Child Care # General signs and symptoms sector there are stringent legal requirements that impose obligations on the child care stakeholders reduce the risks of # Doctor’s signature - this is a medical document centres, the employees and the parents. anaphylaxis. # Instructions for using either Anapen or EpiPen Case study. Action Plans must be supplied to child care centres and schools$ˆ Voluntary Organisations - Duty-of-Care “Billy”, was a member of a local football who is diagnosed with Anaphylaxis. „ club and known to be allergic to wasps. In a workplace, although it is not compulsory to provide an action plan in a workplace duty-of-care responsibility when running While playing football “away” from the environment it is strongly recommended and employers should encourage workers to inform activities. “home ground”, some wasps were [;$# When a duty-of-care relationship exists there attracted to a plate of cut up oranges. ;[$? is responsibility to Billy was stung on the hand when he ate 1. Do what a person would do BDUJPO!QMBO!GPS reasonable one of the pieces of orange. Child details This is a sample 2. In circumstances www.allergy.org.au similar Billy’s adrenaline autoinjector was in his Date of birth Bobqizmbyjt Anaphylaxis For use with EpiPen® adrenaline autoinjectors 3. With the same level of training Name: sports bag, in the dressing room. Date of birth: ! NJME!UP!NPEFSBUF!BMMFSHJD!SFBDUJPO! action plan for An ambulance was called, and Billy was Child photo Swelling of lips, face, eyes Epipen. Hives or welts rushed to hospital. Tingling mouth Abdominal pain, vomiting (these are signs of a severe allergic The subsequent investigation revealed reaction to insects) What child is Photo the football club anaphylaxis policy ! BDUJPO Allergic to For insect allergy, flick out sting if visible. Do not remove ticks. What to do for helped Billy survive. Stay with person and call for help Locate EpiPen® or EpiPen® Jr mild reaction Parent/carer Give other medications (if prescribed) ...... Confirmed allergens: Dose: ...... Details Phone family/emergency contact Mild to moderate allergic reactions may œÀʓ>ÞʘœÌÊ«ÀiVi`iÊ>˜>« ޏ>݈à Organisations should Family/emergency contact name(s): Signed by Watch for any oneʜvÊÌ iÊvœœÜˆ˜}ÊÈ}˜ÃʜvÊ
˜>« ޏ>݈à What to do for # Conduct a risk assessment. anaphylaxis Doctor Work Ph: ! BOBQIZMBYJT!)TFWFSF!BMMFSHJD!SFBDUJPO*! Home Ph: Difficult/noisy breathing # Develop a policy Mobile Ph: Swelling of tongue Swelling/tightness in throat # Have communication plan Instructions Plan prepared by: Dr: Difficulty talking and/or hoarse voice printed on Signed: Wheeze or persistent cough If in doubt... Date: Persistent dizziness or collapse plan and on Pale and floppy (young children) give the A Risk Assessment should be part of the planning for every activity. Some risks can be Ipx!up!hjwf!FqjQfo© anticipated. For example a child playing sport could have an anaphylactic attack if they were autoinjector 1 2 ! BDUJPO! autoinjector 1 Lay person flat. Do not allow them to stand or walk. allergic to insect stings. The mid-outer thigh If breathing is difficult allow them to sit. ® ® is the BEST site for Form fist around PLACE ORANGE 2 Give EpiPen or EpiPen Jr EpiPen® and END against outer 3 Phone ambulance*- 000 (AU), 111 (NZ), 112 (mobile) PULL OFF BLUE mid-thigh (with or For privacy, Action Example: FASTEST absorption of SAFETY RELEASE. without clothing). 4 Phone family/emergency contact 5 Further adrenaline doses may be given if no response after Plans should be medication. 3 4 Billy’s club knew he was anaphylactic from questions on the . 5 minutes (if another adrenaline autoinjector is available) registration form If in doubt, give adrenaline autoinjector displayed discreetly The club policy members to “Let People Know”, so Billy’s After giving adrenaline: encouraged team mates PUSH DOWN REMOVE EpiPen®. UÊ œ““i˜ViÊ *,ʈvÊÌ iÀiÊ>ÀiʘœÊÈ}˜Ãʜvʏˆvi to enable rescuers HARD until a click Massage UʈÛiÊ>ÃÌ “>ʓi`ˆV>̈œ˜ÊˆvÊ՘ÃÕÀiÊÜ iÌ iÀʈÌʈÃÊ>ÃÌ “>ʜÀÊ>˜>« ޏ>݈à is heard or felt injection site for about his anaphylaxis and they all knew where his . EpiPen® is generally prescribed for adults and children over 5 years. knew autoinjector was located and hold in place 10 seconds. The difference between ® for 10 seconds. EpiPen Jr is generally prescribed for children aged 1-5 years. to recognise A communication plan was developed which included an awareness program. EpiPen Action Plan and *Medical observation in hospital for at least 4 hours is recommended after anaphylaxis. Instructions are also on the device label Additional information individuals and their Information for conditions like , asthma, epilepsy and diabetes and at www.allergy.org.au/health- posters anaphylaxis an Anapen Action Plan is professionals/anaphylaxis-resources Note: This is a medical document that can only be completed and signed by the patient's © ASCIA 2013. This plan was developed by ASCIA by developed This plan was © ASCIA 2013. treating medical doctor and cannot be altered without their permission. set of signs and were on the clubroom notice boards and articles were printed in the club newsletter. the instructions on how The communication plan made sure ‡%% were to use each device symptoms. all aware that Billy was anaphylactic and they were all properly trained. A copy of the Action Plan should be stored with medication. The policy required that an Anaphylaxis trained person was present at every activity. Throughout this book the word parent includes legal guardian 40 | Risk Assessment A sample Risk Assessment Plan is means call your country’s emergency number Risk Assessment | 41 available from www.acacqa.gov.au Assess Hazards and Minimise Risk *,*$- : A risk rating table can be customised to meet needs of an organisation Hazard Assessment is required for child care and most other workplaces. Use the matrix to Activity must not proceed while any risk is rated VERY HIGH evaluate the consequence of hazards, then develop strategies to reduce the level of risk. VERY HIGH Risk Assessment Matrix Consequence (C) ;Y„Y; HIGH $[X<= Hazard (eg Anaphylaxis) 1=Slight 2=Minor 3=Moderate '*+ 5=Severe Risk management plan must be in place before activity begins Death or MEDIUM No treatment 1st aid 1 or 2 1st aid >2 Hospital 1 or 2 Hospital >2 No further action required LOW Risk rating & Action Risk rating & 5 = Almost certain LOW MEDIUM HIGH VERY HIGH VERY HIGH Is expected during activity How to use the template to complete risk assessment. Two worked 4 = Very Likely LOW MEDIUM HIGH VERY HIGH VERY HIGH #?#;? Expected more often than not # 1 Sharing lunch, for an anaphylactic child who is allergic to food (eg egg products). After the “strategy” is put in place the residual risk is MEDIUM. The risk rating table (above) shows a 3 = Likely LOW MEDIUM HIGH HIGH VERY HIGH Will occur on occasion MEDIUM risk activity can proceed provided the risk management plan is in place. Although it is unlikely that the worker will get stung, the 2 = Unlikely # 5 Working alone outdoors. LOW LOW MEDIUM HIGH HIGH “$?Y„Y?$;Y„Y Likelihood (L) Likelihood May occur but more likely not to OP$$$[+ 1 = Very Unlikely LOW LOW LOW LOW LOW practicable steps have been taken to control the risk. Practically impossible to occur Risk Assessment for Anaphylaxis Risk Rating Residual Risk Person responsible Instructions to use this matrix: 1. Look up “Likelihood” score 2. Look up Strategy “Consequence” score 3. Read “Risk” from table. In schools and child care strategies must be No. Activity Hazard developed in consultation with parents. Name Done Risk Risk Type Each workplace should develop a set of strategies Likelihood Likelihood Consequence

Consequence that is suitable for that workplace Refer matrix above Refer matrix above Refer matrix above Children share lunches. Possible #1 BYO Lunches Develop and implement “No Sharing” policy. Eat inside under Room contamination. 3 5 VH 2 3 M Coordinator Individual Anaphylaxis Plan in room. Send info in newsletter. 2 Cooking activity Exposure to allergen. “Hidden” ingredient. Activity Accidental cross contamination of ingredients 3 5 VH parents to determine safe ingredients/brands. Separate utensils 1 3 L for different foods. Correct labelling & storage of ingredients. Coordinator Develop and initiate cleaning policy. Invite parents to assist. 3 Excursion Exposure to trigger, communication Advise all workers of child’s allergy. Ensure medication and Activity [+ 4 5 VH copy of emergency action plan is with child. Take mobile 2 5 H Coordinator/ Child Day Care Centre Child Day Care medication. ! Manager immediately available. Approved by Parent and Manager. 4 Catering for Accidental cross contamination of food Use only approved caterer. Advise caterers to prepare food Activity function platter, supplied by caterers for in-service 3 3 H separately, supplied on labelled platters. Nominate person to 2 4 H Coordinator/ training receive food. Advise all participants of risk and precautions. "# #5 Outdoor worker ƒ<= Uniform protects ankles. Inspect meters before approaching. Safety working alone works alone as a meter reader 2 5 H Carry mobile phone / radio as required. Establish monitored 2 5 H [ default SMS reporting. Utilise GPS monitoring. Carry Supervisor medication on person. Wear medi-alert. Workplace 6 Power line tree Worker allergic to bees Advise all co-workers. Medication immediately available. "# clearing 2 5 H $% 2 5 H Manager present. Establish alternative communication path if required. 42 | Risk Assessment means call your country’s emergency number Risk Assessment | 43 Asthma Risk Assessmentse sm Asthma Action Plans Common Asthma Triggers Possible Riskk Management Strategiest Asthma Management Plans and Asthma Action Plans are an integral part of an asthma policy and communication plan. There are a great variety of Asthma Action Plans available. A #Pollens from grasses, trees, shrubsbs Consider removing problem plants around schools, child sample of some of the range is presented here. care centres and work places. What to #Weather Changes especially sudden cold Careful planning of night time activities, camps, working or Wh changes; moving from hot to cold. overtime, plan for unexpected delays. Preheat rooms. Wheeze You may or mayd is usually hear     ______Completed by: are affected by wind rain and /______PPE* when gardening, potting or working with mulches. /_____ Cough #Moulds _____ Date: cough m eviewed in 6 months by your local doctor A dry ASTHMA ACTION PLAN To be r temperatures. Can be present in garden Scheduled cleaning of bathrooms, commercial laundries; Name / ID label Stop RELIEVER tigh Name:   Chest    An older chil Doctor: N with you when you visit   your doctor ASTHMA ACTION PLA ACTION PLAN ” mulches and wood chips. Take this ASTHMA use nontoxic cleaners. Continue “chest pain Green: DETAILS ellFeel Good CY CONTACT When W PREVENTER EMERGEN TAILS Feel Good Orange: CONTACT DE Shortnes   Short Wind DOCTOR’S Name Take Red: Bad Short Wind NAME Phone Feels like i

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Strategy Activity, No. infrastructure or Hazard Name Done Risk Risk

Type In schools and child care facilities, strategies must be environment (pg 40) (pg 40) developed in consultation with parents Likelihood Likelihood Refer page 40 Consequence Consequence

1 Lawn Mowing Grass pollens known trigger 4 3 H Arrange for gardening to be conducted on weekends. 2 3 M Manager 2 Hair spray, cosmetics, Child care workers trigger asthma in sensitive children Perfume and cosmetics policy. Communication plan to ensure 3 2 M 1 2 L Manager deodorant, perfumes 3 MSG, sulphites, Snack foods and lunches may contain ingredients that Food policy, no sharing policy. Treat alternatives provided by Coordinator/ Child Care 4 3 H 2 5 H salicylates trigger asthma parents. Communication plan. Manager 4 Employees triggered Cleaning and vacuuming disturb dust. Communicate with cleaners. Arrange cleaning to be done after Manager/ 4 4VH 2 4 H by dust work. Budget for carpet replacement with alternative coverings. "#

5 Work "%\ Occupational asthma caused by wood dust "# 5 4VH Dust extraction system. PPE. Positive pressure masks. 2 4 H Supervisor 44 | Education & Child Care means call your country’s emergency number Education & Child Care | 45 Regulations, Codes and Procedures Communication Plans First Aiders in the workplace need to have knowledge of and comply with, state and A Communication Plan is an essential part of territory regulations+[codes of practice (also called compliance codes) and managing anaphylaxis or asthma risks to identify- Stakeholders: workplace procedures?;;; # Who needs to know (the stakeholders) In an environment the comply. # The roles of each of the stakeholders stakeholders will include First Aiders # What information is needed Employers Regulations control a wide range of activities in the workplace such as # How the information will be distributed “[“ Co-workers # Where medication will be located $[ Managers / supervisors A card system can assist children to summon Caterers Codes of Practice give approved methods of how to comply with regulations for example help. The colour of the card, visible from a [ In a school setting stakeholders will # G;;[(pg 50) #;[ Medical Alerts communicate ttoo rerescuers include required for workplace Carers & Parents # Describes how to conduct a hazard assessment (pg 40) ANAPHYLACTIC O[ # There are many Codes of Practice/Compliance Codes covering a wide range of workplace EMERGENCY Teachers (also Relief & health and safety issues CALL 000 URGENT Temporary) and Teacher’s Aids ASSISTANCE BRING Speciality teachers including REQUIRED Sport, Drama, Music, Cooking and Workplace Policy & Procedures are instructions written by an employer on how to perform AUTOINJECTOR tasks safely. Some examples of tasks that should have a P&P Teachers on Yard Duty Food industry staff including ; In a factory the stakeholders will include # canteen and caterers Management Administration, Cleaning staff, Union representatives Maintenance, and Bus Drivers National Child Care Legislation O[–[ >[$;[ Health & Safety representatives School Camp Providers medications in child care settings. These are regulations 90 to 95. Canteen staff / Catering contractors Volunteers 90 Medical Conditions Policy. 92 Medication Record Co-workers / Supervisors This regulation requires education and This regulation is about medication records which )! Privacy is important. Personal information must be stored securely. The care services to have a written policy must record the following details: information can only be revealed to authorised people. The communication about medical conditions. Authorisation to administer plan should explain who would have access to this information. In a school this would Medication Dosage Name of #?;;[? 91 Medical conditions policy must child Method Time and Date A workplace must provide opportunity for new employees to reveal life threatening conditions be provided to parents. Name of who administered during the induction process. The employer must act on the information when it is supplied. This policy is very important for R

95 Procedure for administration of medication Seek permission Medication must be Administered from it’s original container, with child’s name on it Always seek permission from an employee before passing on medical information that has been “in date” Instructions must be followed. The dosage of the medication and the identity [?$;#how the information will of the child must be checked by another person (Family Day Care do not need to check be circulated, why the information will be circulated and who the information will be provided to. with another person) This information can be included on the medical form, at commencement of employment. 46 | Education & Child Care means call your country’s emergency number Education & Child Care | 47 !!!" Understanding Child Care Law Generally children and infants have different heart rates and respiration rates from The Australian Commonwealth National Child Care Regulations. adults. These differences vary, depending on many conditions. Government makes laws that apply ^>;–„ Adults 12-5 y 5-1 y <1 y to the whole of Australia (for example recognised it would be desirable to have In adults it is generally accepted that Pulse/min 60-100 80-120 95-150 100-180 taxation law.) uniform child-care regulations across Australia. Normal heart rate (at rest) is about 72 Breaths/min 12-20 20-25 25-35 40-30 State Governments make laws that only >;„ Normal breathing rate is about o 15 Temp C 36-37 36-37 36-37 36-37 apply to a state (for example health or legal jurisdiction to create this legislation, so Normal temperature is about o . 37 C Table shows approximate range of normal clinical values by age education.) +>„ Local Governments make laws that action to pass the same legislation in each Children and babies usually have about the same only apply to a council (for example use ?>>—; temperature (37oC) as adults of incinerators.) coordinate implementation of National Child The prohibits . Heart rate (pulse) and breathing rates are fastest in Australian constitution Care Legislation the Commonwealth government from infants and younger children and slow down as the child Since the introduction of the National Child passing laws about things not authorised ? Care Regulations the Child Care law in all AED’s are not recommended in The Constitution. and is because the Education States will now be very similar to other States for use on infants (under 12 months) health are matters for State legislation. devices are not reliable when checking if the heart rhythm but may have important is a normal rhythm. The faster heart rate of infants can cause the AED to give a false differences. reading. National Laws are not one single act of the WHO is COAG? Commonwealth Parliament but are the same The Council There are a number of other differences between smaller children and legislation passed separately in each state. of Australian adults. „ ]G;\ Cartilage in the trachea is not fully developed at birth which means <>„=; the airway is very soft and pliable and very easy to obstruct. with existing State laws. An example of created to oversee policy reforms which Infants skull bones are not fully knitted together, which can make this is laws about who can administer an require cooperative action by Australian them more vulnerable to head injury. autoinjector.ƒ\ „? >„]—O<]— Proportionally an infant’s head is much larger than an adult. A baby’s head is relevant State may change the wording of the nearly 20% of total body surface area, while an adult head is only about 10%. A burn to an National Law for that particular state. O;=>>— infant’s face is even more serious than a burn to an adult face. National Child Care Law and Regulations. So even though National Child Care Infants do not have fully developed which means infants National Child Care Regulations apply temperature regulatory systems Regulations are intended to be the same are more susceptible to hypothermia and hyperthermia. Children can become dehydrated +Y+ very quickly, especially if they are vomiting or have episodes of diarrhoea. across Australia they still vary from state to & family day care but do not apply to state. You need to check what the law is in schools. Regulations for schools are AED* for child care†;‚ your state. the responsibility of each of the State {[$$;$; Education departments. is over the age of 8 years old. Victoria’s Ministerial Order 90 is a For children under 8, use with paediatric (child) pads if available. If child pads are not ? available use adult pads. If the pads cannot be placed without touching States have similar legislation (pg 44) each other, position one pad on the front of the casualty’s chest and the WHO is ACECQA? The Australian Children’s $?[$‡ >— the size of the shock to the size of the casualty. Check manufactures <>>—=;$>„ instructions. national leadership in promoting continuous '%;†'%’“‚ƒ They are not improvement in early childhood education and reliable when checking infant heart rhythms. care and school age care in Australia. Care should be taken when purchasing an AED for an education or care setting to select a device that is suitable for the age group. ˆ{|#{[$(pg 5) >>—‚;;;?“?? 48 | General First Aid means call your country’s emergency number General First Aid | 49

Principles What is First Aid? It’s the immediate care of an injured or Communication suddenly sick casualty until more advanced care arrives. [? of First Aid X“$+“[ {%+ culturally appropriate ways of communicating that are courteous and clear. It may sometimes Preserve life – This includes the life of rescuer, bystander and casualty. be necessary to communicate through verbal and non-verbal communication and you may Protect from further harm – Ensure the scene is safe and avoid harmful intervention. \?[ Prevent condition worsening – Provide appropriate treatment. needs to maintain respect for privacy and dignity and pay careful attention to client consent Promote recovery – Act quickly, provide comfort and reassurance, get help, call . [? Helping at an emergency may involve: > Reports [ While waiting for help and if time permits, make a brief written report to accompany the ;+$[? casualty to hospital. This will reduce time spent at the scene for ambulance crew and further Reasons why people do not help: assist medical and nursing staff with initial patient management. A report can be written on a O;O!$ spare piece of paper and should include the following: ]‡<$++$$= Date, time, location of incident of bystanders (embarrassed to come forward or take responsibility) Casualty details]+{^+? The back inside page ›$?{M[ QX@%* Contact person for casualty - Family member, friend. Form,’ which can be torn [?;$[+ What happened - Brief description of injury or illness. %'%% appropriate care, even if you don’t know what the underlying problem is. Remember, at an First aid action taken – What you did to help the casualty. incident. emergency scene, your help is needed. Other health problems – Diabetes, epilepsy, asthma, heart problems, operations. – Current tablets, medicines. Getting Help: Medications/ allergies When casualty last ate or drank – Tea, coffee, water, food. Call $+[? from a mobile phone fails, call ‘112’. - Conscious state, pulse, breathing, skin state, pupils. Q$R;;‚ƒ# Observations of Vital Signs location First aider’s name/ phone number in case medical staff need any further information. ¢ƒphone number from which you are calling?>R What has happened?How many casualties?><= ?;;[ Record Keeping In the workplace, it is important to be aware of the correct documentation and record dispatch the ambulance and paramedics. DO NOT hang-up until you are told to do so or [?$ +[; [?  Every organisation has its own procedures and documentation so familiarize yourself with you that the call has been made and that the location is exact. the correct process. Legal Issues All documentation must be legible and accurate and must contain a description of the illness No ‘Good Samaritan’ or volunteer in Australia has ever been successfully sued for the or injury and any treatment given. Thorough and accurate medical records are essential in “?Q„R any court case or workers compensation issue. QR;#[;?Duty of care: In addition: In a workplace there is an automatic duty of care to provide help to staff and customers, ƒ<=]\M which means you are required to provide help to your best ability at your work place. In the [ +$[?Consent: Where $+;$[? 78"9; refuses help, you must respect that decision. When the casualty is a child, if feasible seek Each person reacts differently to traumatic events and in some instances strong emotions J?J[ may affect well being and work performance. Symptoms may appear immediately or sometimes months later after an event and may develop into chronic illness. aid should be given. In a situation, parents must notify the centre if the child has child care There is no right or wrong way to feel after an event. It is important for all people who have any medical conditions and also provide medications and instructions. Consent forms are been involved in an incident take part in a debrief. Workplaces must provide opportunity signed at enrolment. In an emergency, parents or a doctor can also provide authorisation $[? over the phone. (see also reg 94 on pg 44) =%+ Personal information about the +$$[; [? ?+$$[ and treatment provided. First aiders should only disclose personal information when performance may assist with self-improvement and prepare you better for any future events. handing-over to medical assistance eg paramedics. Currency requirements [ Some Reactions/ Symptoms>{[ skills & knowledge$;‡?[[ {[{$${{ candidate was assessed as competent on a given date. The accepted industry standard ##OJ#$ [”% and 1 year for O;O$Y$Y CPR.“;[“? X 50 | General First Aid means call your country’s emergency number General First Aid | 51 Safe Work Practices and Manual Handling Basic Anatomy and Physiology ƒ<+=R[ The science of the structure of the body The Skeleton protects vital organs, aider protects him/herself from injury eg using correct manual handling techniques; bending Anatomy: Physiology: The science of the functions of the body provides anchor points for muscles, the knees and using leg muscles to protect against back injury. Knowing your own skills and and a structure to the body. Bone is breathing in and out regularly limitations and asking for help when required will help prevent injury. Always adhere to safe Normal breathing marrow is an important source of ;?;<;[= about every 3-5 seconds. If a person is not blood cell production. Fractures there is a legal obligation to use supplied ersonal rotection quipment ( ). breathing normally, their body will not have enough P P E PPE of major bones can cause major oxygen to supply the brain and other organs Needle Stick Injury FIRST AID internal bleeding and impair blood The risk of catching a serious infection (Hepatitis B, C “Z$‡? cell replacement and HIV) from needle stick injury is very low. ƒ;;$? Reduce the risk of needle stick injury: ƒ? ]$ ] bottle or sharps container. ; Y^;; hospital for analysis. ;$J$\ <%$!$!,% , Sternum Hygiene Minimise the risk of cross infection to yourself, bystanders and casualty by Liver Ribs taking standard precautions to control infection: Prior to treatment: During treatment: After treatment: Stomach ƒ; !J >+ Large intestines and water, or rinse with mask, if available immediate vicinity. antiseptic. when performing + > resuscitation. bandages and disposable gloves with a waterproof dressing {]+ ƒ; Small intestines before putting on gloves. sneeze or breath and water, even if gloves were used. ƒ$? over a wound. Q[? between { Bladder Air Hip joint the linings of object when wearing ;$\? =]*% from Worksafe Vic Compliance code (ball and socket) the lungs (the gloves . {] ^[ 1 The Skeletonpleura) causes a ! more than one ^[ 1 pneumothorax - eye protection. casualty without Disposable gloves Bronchioles >‡ washing hands 2 are small tubes Individually wrapped sterile adhesive strips collapsed lung likely to produce infection. and changing 10 that carry air into Large sterile wound dressings 1 Windpipe gloves. the lungs Medium sterile wound dressings 1 (Trachea) Non-allergenic tape First Aid Kits 1 The Heart has four G[workplaces, vehicles Plastic bags for disposal 2 chambers. Valves and in the home in a clean, dry, dust-free Resuscitation mask or shield 1 inside the heart control location. Rubber thread or crepe bandage 2 ;$\;? X[accessible and Safety pins 5 The heart is located signage clearly indicates their location. Heart The aorta is the main Scissors 1 near the centre of the artery taking blood Check kits regularly for completeness and Small sterile wound dressings chest. valid dates. 1 Sterile coverings for serious wounds out to the organs and 1 Diaphragm >;vary depending on the number of Sterile eye pads (packet) tissues. employees, and the you work in. High 2 industry Sterile saline solution 15 ml 2 When we breathe-in the diaphragm contracts and risk industries may need extra modules. Triangular bandages 2 the muscles between the ribs contract. To breathe- A List in workplace kits. Coronary arteries. % Tweezers 1 out we relax these muscles. If there is pressure on heart attack is caused !State and Territory legislation[ aid kits are required in all workplaces. the abdomen (eg a person sitting on abdomen), by the coronary ?#@ this can prevent air exhaling when the person arteries becoming relaxes. This can cause “positional asphyxia” blocked 52 | General First Aid

Casualty Assessment When dealing with a person who is ill or Asthma/Anaphylaxis Management Plan injured, you need a clear Plan of Action: School/Employer: Radial pulse 1.Start with a Primary Survey (DRSABCD), (pg 3) ;$[ Phone: life-threatening conditions. Student/Employee name: 2.If there are no life-threatening conditions which Date of birth Age: Year level/Department: “[<$+ Severely allergic to: response) then proceed to Secondary Survey. 7!7= is a systematic check of the casualty involving J‚ #'#-#='X% to help identify any problems that may have Storage Location of Medication: been missed. Parent/carer/next-of-kin information 1 Parent/carer/next-of-kin information 2 If the casualty is unconscious, the secondary survey is conducted in the recovery position. You may need to look for external clues and ask bystanders some questions. Name:Nam Name:e: conscious start with questions followed by examination. Remember to Relationship: Relationship:ationship: introduce yourself, ask for consent to help and ask their name. Home phone: HomemeThis phone:ph one:management plan can be adapted to a workplace and should include: Questions Examination Work phone: Workork pphone: Locationhone: of workplace What happened? are indicators of body function and provide Type of work undertaken Vital Signs: Mobile:Mob Mobile: Layoutile: of workplace Do you feel pain or numbness a guide to the casualty’s condition and response to Location of medication anywhere? treatment. Address:Add Address:r Availabilityess: of emergency assistance Likelihood of working alone Can you move your arms and Conscious State: There are 3 broad levels – legs? >! <$$=‚ Do you have any medical |++ Medical practitioner contact: Phone: conditions? confused, drowsy. Emergency care to be provided at school/work: Q?‚ Do you take any medications? Pulse: The carotid pulse in the neck is the best pulse Do you have any allergies? to check. Feel for rate, rhythm, force, irregularities. „‡‚ When did you last eat? Normal pulse rates: Adults: 60-80 /min The anaphylaxis management plan has been put together with my knowledge and input (Bystanders may be helpful) Children: 80-100/min Communication plan actioned: Review date: External Clues Breathing: Look, listen and/or feel for breathing rate, depth and other noises eg wheezing, noisy breathing. Signature of parent/employee: Date: Medical Alert: casualties with medical conditions such Normal breathing rates: Adults 16-20 breaths/min Signature of principal/supervisor: Date: as diabetes, epilepsy or severe Children: 25-40 breaths/min allergy usually have a bracelet, (Check pulse/ breathing for 15 secs then x by 4 to RISK Q„›remove the risk if possible: otherwise reduce the risk ƒY get rate/min. Use a watch) pendant or card to alert people of Music Music teacher to be aware, there should be no sharing of wind instruments. e.g. Music their condition. Skin State: Look at face and lips. recorders. Speak with the parent about providing the child’s own instrument. teacher Red, hot skin – fever, heat exhaustion, allergy Medications: People on Canteen Staff (or volunteers) trained to prevent cross contamination of ‘safe’ foods Canteen regular medication usually carry Cool, pale, sweaty – shock, faint, pain, anxiety Child having distinguishable lunch order bag manager ^<=M;$++\ Restriction on who serves the child when they go to the canteen it with them. Photos of the “at risk” children in the canteen chest, collapsed lung, heart failure, hypothermia Encourage parents of child to view products available Carotid pulse Pupils: Unequal, reactive to light {J>{„?;;;??? Head to Toe: Sunscreen Parents of children at risk of anaphylaxis should be informed that sunscreen is Principal $ offered to children. They may want to provide their own. begin. Excursions Plan an emergency response procedure prior to the event. Excursion G$++ J? planner areas. Distribute laminated cards to all attending teachers, detailing the following: ;;? Location of event, Map reference (Melway), Nearest cross street. #;$ Procedure for calling ambulance advise: allergic reaction; requires adrenaline. Prior to event, check that mobile phone reception is available and if not, stage eg “I’m just going to move your arm”. consider other form of emergency communication eg radio. $O{ NB. The pulse is not checked hurt when I move your arm?” This and other resources available from: http://www.education.vic.gov.au/school/teachers/health/Pages/anaphylaxisschl.aspx during CPR means call your country’s emergency number Risk Assessment Form First Aid Incident Report Form Date (Complete this form as best as you can and give copy to paramedic and keep record in accordance with WHS procedures)

Date: / / Time: Location: Person Person Name

responsible Department: Casualty Details: Name: {^‚JJ M / F Risk Home Address: Consequence Risk use matrix Residual Likelihood Postcode:

Family Contact Name: Phone ][

Work department: Supervisor][ name:

Management:: ][

Work safe: ][

What Happened (a brief description): Strategy an acceptable level.

First Aid Action Taken: developed in consultation with parents Elimination / control measures Elimination / control In schools and child care centres strategies must be In schools and child care centres strategies explain steps to remove the risk or reduce the risk to explain steps to remove the risk or reduce J Risk : Date: Consequence Position: Risk Signature Rating use matrix Likelihood Comments: Ambulance called: yes Time: Referred to: Current Medications: Known health issues

Diabetes yes Epilepsy yes Known Allergies:

Asthma yes

Hazard Anaphylaxis yes Last ate or drank: What?

Attached: yes no Heart yes When? (pg 40) describe what could go wrong Medications given What Time Dose location Activity

USE WITH RISK ASSESSMENT MATRIX RISK ASSESSMENT USE WITH Plan prepared by: Communicated to:

In consultation with: enter the activity or enter the activity or Venue and safety information reviewed: and safety Venue yes no - cut here Casualty Examination: mark location of injuries on diagram and $\$‡+$++;+$?

Verbal Secondary Survey W-H-A-M-M-M-E-D What happened Hurt - where does it hurt Allergy Medications Medical conditions - alerts Move your arms and legs Eat or drink last Document the answers

Observations of Vital Signs: Time Conscious State Fully Conscious Drowsy Unconscious Pulse rate: description: Breathing rate: description: Skin State Colour: Temp: Dry/Clammy: Pupils

R L

First Aider’s Details: (In case the hospital needs to contact you for more information regarding the incident).

Name:(Print)______

Phone: Signature: cut here ABC of First Aid Asthma & Anaphylaxis is divided into ABC of seven main colour coded sections: 1. Essential First Aid 2. Trauma First Aid 3. Medical Emergencies 4. Asthma & Anaphlaxis Asthma & 5. Risk Assessment 6. Education & Childcare Anaphylaxis 7. General First Aid

In conjunction with an approved emergency situations.

guidelines and is written for Australian conditions. competency units: HLTAID001: Provide CPR HLTAID002: Provide Basic Emergency Life Support HLTAID003: Provide First Aid HLTAID004: aid response in an education and care setting 22024VIC: Course in Emergency Management of Asthma in 22099VIC: Course in First Aid Management of Anaphylaxis