First Aid - GUIDE & TIPS

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Epilepsy

Epilepsy is a very common condition, best described as a rogue electrical discharge across the brain. As the body's functions are controlled by electrical impulses this discharge can lead to a number of physical reactions. Many things may start a seizure (fit): tiredness, stress or flashing lights are common triggers.

Major seizure

This is what most people would recognise as epilepsy, and there are typically four stages:

Many people get a sense that a seizure is likely to occur.
The electrical impulses lead to a contraction in the muscles that causes the epilepsy sufferer to fall to the ground with a cry. This is known as the tonic phase. The casualty's muscles may then go into spasm. This is known as the clonic stage. During this stage the casualty will not be breathing.
When the convulsion is over, the casualty will be in a state of unconsciousness.
On recovery from unconsciousness, the casualty will be very sleepy and will want to rest for some time.
Minor fits

During a minor fit, somebody with epilepsy suffers a brief disturbance in the brain's normal activity, leading to a lack of awareness of his or her surroundings. To the observer it might seem like the person is daydreaming or has suddenly switched off.

There is little for you to do other than to guide the person away from danger and reassure him when he returns to normal.

If he is not aware of any similar episodes happening before, advise him to see a doctor.

First Aid Treatment for a major epileptic seizure
During the seizure, do not try to restrain the person. The muscular contractions are so strong during a fit that holding a person down may lead to broken bones - yours and his. Do not attempt to put anything in the mouth. Try to protect the casualty - move sharp objects out of the way, remove constrictions and, if possible, place a soft coat under the head.
Once the seizure has finished, check the casualty's airway and breathing and be prepared to resuscitate in the unlikely event that this is necessary. Place the person in the recovery position.
When the casualty comes round, reassure him. He may have lost control of bowel or bladder function so cover him up and, when he is steady on his feet, help him to find somewhere to clean up. He is likely to be very tired so, if possible, find him somewhere to lie down and sleep. Most of all, ask him what he wants to do - most epileptics manage the condition very well and will have their own coping strategies.
Infantile convulsions (Caused by heat)

Babies and young children may have seizures induced by a high temperature. This may be the result of an infection or because they are overwrapped and in a warm environment. The signs and symptoms are similar to a major epileptic seizure.

Treatment
Make sure that the child is protected from hitting himself on a bed or cot - do not attempt to restrain. Cool down by removing bedclothes and clothing where possible. Sponge the head and under the arms with a tepid flannel or sponge, re-soaking it regularly. When the convulsion is finished, check ABC and take action as appropriate. In most cases, the child will want to sleep. Dress him in dry clothes and let him sleep. Call a doctor for advice.

When to call an ambulance

Generally, neither epilepsy nor infantile convulsion are medical emergencies. However, you should be prepared to call an ambulance if:

The casualty is injured during the seizure.
The seizure lasts for longer than 3 minutes.
There are repeated seizures in a short period of time.
The casualty does not regain consciousness.
If it is the first seizure, advise the casualty to call his doctor or take him to hospital.

 

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Extreme Cold

Hypothermia, a condition that occurs when the body temperature falls below the normal range, is caused by a low surrounding temperature and can lead to death. Freezing temperatures cause frostbite, whereby ice forms in the body tissue and destroys it. The risk of frostbite is increased by windy conditions.

Causes of hypothermia
Hypothermia (low temperature) occurs when the body temperature falls below the normal range, and can lead to death. The average temperature of a healthy adult is 36-38°C (96.8-100.4°F). Hypothermia occurs when the body's core temperature falls below 35°C (95°F). Survival is unlikely, but not unheard of, below 26°C (79°F).

There are a number of factors that heighten the risk of becoming hypothermic. These include:

Age
The elderly are at greater risk from hypothermia: low mobility combined with poor circulation, a reduced sensitivity to the cold and a greater potential for slips and falls means that an elderly person may develop hypothermia in temperatures that a healthy younger adult could tolerate.

The very young are also at an increased risk as their mechanisms for controlling their own body temperature are poorly developed. They may look healthy but their skin will feel cold and their behaviour may be abnormally, quiet or listless.

Exposure to wind or rain
Immersion in cold water
Lack of food
Alcohol and drugs
Signs and symptoms of hypothermia
Early signs:

Shivering
Pale, cold skin
Cold environment
Presence of an increased risk factor as listed left
As the condition gets worse:

No shivering, even though the person is cold
Increasing drowsiness
Irrational behaviour and confusion
Slow, shallow breathing
Slow, weak pulse
Treatment
If the person is unconscious

Open the airway and check for breathing. Be prepared to resuscitate if necessary. Hypothermia slows the body's functions down before stopping the heart, and it is therefore not uncommon to hear of people with hypothermia being successfully resuscitated some time after the heart has stopped.

If the person is conscious

Improve the surroundings. If the person is outdoors, bring them in or take them to shelter. If the person is indoors, warm the room but do not overheat(25°C/ 77°F).
Replace wet clothes with dry warm clothing if possible.
A healthy adult may be best rewarmed by soaking in a warm bath of 40°F (104°F). Do not use this technique on an elderly person or a child.
Wrap the person up and give high energy foods and warm drinks. Remember that heat is lost through the extremities so cover the head, hands and feet.
Check for other conditions or injuries. The confusion caused by hypothermia may mask other signs and symptoms. If there is no improvement, or the level of consciousness deteriorates, seek medical advice. For young children and the elderly, who are particularly vulnerable, always seek medical attention if you suspect hypothermia. Rewarm them slowly.
Frostbite

Frostbite occurs in freezing conditions and is the freezing of body tissue at the extremities, most commonly the fingers, toes and earlobes. If it is not treated early enough it can lead to gangrene and to amputation. Frostbitten skin is highly susceptible to infection.

Signs and symptoms of frostbite
Freezing environment
Early signs

Pins and needles
Pale skin
As the condition gets worse

Numbness
Hardening of the skin
Skin colour changes to white, through blue and finally black
When thawed, the injured part is extremely painful and there may be blistering of the skin.

First Aid Treatment
Remove tight items such as rings and watches that may further damage circulation. Warm the injured part slowly by holding it.
Get the person to shelter. Do not attempt to thaw the injured part if it is liable to be re-exposed to cold, as this will do more damage.
Handle the injured part carefully as the tissue is very fragile and may be easily damaged. Do not apply direct heat to the injured part, rub it or allow the injured person to apply pressure to it (for example, do not let the person walk if the toes are affected). Place the injured part in warm water if available. Otherwise continue warming with your hand.
Pat dry and then cover with a light gauze bandage. Remember that the injured part will be exceptionally painful.
Raise the injured part to help alleviate pain and swelling and allow the injured person to take paracetamol if able to.
Watch for hypothermia and treat as appropriate.
Seek medical attention, particularly if the site of the freezing does not regain a healthy colour or is black.

 

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Extreme Heat

Heat exhaustion is a condition resulting from the loss of fluid and salt, usually through excessive sweating. Heatstroke generally occurs rapidly when the brain's temperature regulator fails to work effectively. This tends to occur when the casualty has been in a very hot environment or has a fever caused by a condition such as malaria.

Heat exhaustion

Heat exhaustion is very similar to shock in that fluid is being lost from the body. It most commonly occurs when a person has been exercising and not replacing fluid content: cyclists and joggers are common sufferers from the condition.

Signs and symptoms of heat exhaustion
History of exertion
Pale, cold and clammy skin
Fast, weak pulse
Fast, shallow breathing
Nausea
Dizziness and disorientation
Lapse into unconsciousness
Treatment
Lay the casualty down in a cool place and raise her legs.
If the casualty is conscious give sips of a weak salt solution (one teaspoon to one litre of water).
Maintain a check on the casualty's consciousness level. If it deteriorates, place the casualty in the recovery position and call for emergency help.
If the casualty's condition improves rapidly, advise her to see a doctor.
Heatstroke

In heatstroke, the body becomes very hot very quickly and this condition can be fatal. The signs and symptoms are very similar to those of a stroke.

Signs and symptoms
Hot, flushed and dry skin
Slow, full and bounding pulse
Noisy breathing
High body temperature
Headache
Disorientation
Lapse into unconsciousness
Treatment
Check airway and breathing. If unconscious, turn the casualty into the recovery position. Be prepared to resuscitate if necessary.
If the casualty is conscious, move to a cool environment. If this is impossible or the casualty is unconscious, try to cool the environment (use fans, open doors and keep crowds away).
Call for emergency help and reassure the casualty if he or she is conscious.
Remove outer clothes and wrap the casualty in a cold, wet sheet. Keep it wet. Continue the cooling process. If the body temperature drops, replace the wet sheet with a dry one.
Continue to monitor the casualty while you wait for help.
Slip slap slop

The three simple rules for prevention of sun-related problems are:

Slip into a T-shirt
Slap on a hat
Slop on the suncream

 

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Treatment of External Bleeding

Coming across somebody who is bleeding heavily can be very frightening. It may be reassuring to remember that many adults donate up to a pint (570ml) of blood with no ill effects, and yet if this same amount were tipped on to the floor it would look very alarming. Serious shock in an adult tends to develop only after 2 pints (roughly 1 litre) of blood or more is lost from the body, and even this can be effectively treated with good first aid and early hospital care.

First Aid Treatment
The three main principles of the treatment of external bleeding are:

Look
Apply direct pressure
Elevate
Look at the wound to check how large it is. Check that the wound has nothing in it (known as a foreign body).
Apply direct pressure to the wound. If the casualty is able to press on the wound, encourage him or her to do so. If not, then apply direct pressure yourself, initially with your fingers and eventually, if you have it to hand, with a sterile dressing or a piece of clean cloth. Applying direct pressure to the wound enables the blood to clot and therefore stems the blood flow from the cut. Once applied, a sterile dressing (or whatever you have to hand) should ideally be held in place with a firm bandage or improvised bandage such as a scarf or tie.
Elevate the wound. If the injury is on an arm or leg, raise the wound above the level of the heart. It is harder for the blood to pump upwards and this therefore reduces the blood flow to the wound and thus the fluid loss from the body.
Treat for shock. Keep the casualty warm and continually at rest. Reassure the casualty.
Protecting yourself

Where possible, you should avoid direct contact with blood or other body fluids such as vomit. This is to protect both you and the person that you are treating. There are several ways of doing this:

If available, use gloves. These come in many different sizes and materials (particularly useful if you have an allergy to latex) and should be kept in every first aid kit.
If the person bleeding is able, ask her to apply direct pressure to the injury herself.
Use bandages, dressings or other materials, such as a handkerchief or T-shirt, as a barrier between your hand and the wound.
Keep injuries on your own hands covered with plasters or dressings.
If you do get blood on your skin, simply wash off well with soap and hot water. Clear up spills of blood or vomit with a bleach and water solution. Clothing that has been stained by blood or vomit should be put through a hot wash in the washing machine. If you are concerned about the possibility of infection after dealing with body fluids, contact your doctor. It is important to remember that the risk of cross-infection is minimal and that in most instances where you are applying first aid you will be doing so for a member of your own family.

 

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Eye Wounds and Embedded Objects

Cuts to the eye can be very frightening and even small, difficult to notice injuries are potentially very serious. However, medical treatments mean that even injuries that appear to be very severe may not necessarily result in the loss of sight in the eye. Do not touch the afficted eye.

Signs and symptoms of eye wounds
Knowing that something has impacted with the eye - this could be as small as a grain of sand or a splinter
Pain in the eye
Loss or limitation of vision
Bleeding
Treatment
Prevent further injury and get medical help as soon as possible.

Lie the person down, on his back if possible, and hold the head to prevent movement and keep it stable.
Ask the person to try to keep his eyes still to prevent movement of the injured eye. Ask the person to focus on something to prevent movement.
Ask the casualty to hold a clean pad over the eye to help prevent movement and infection. lf the wait for an ambulance or other further help may take some time, you may wish to hold the pad for the person or to gently bandage it in place. However, as blood loss from the eye area is not likely to be life-threatening, any bandage should be used only to hold the pad in place and not to apply pressure.
Do not attempt to remove any object embedded in the eye. If the object is very long, then gently support it to prevent movement at its base. If small, ensure that the pad you place over the eye does not push it in any further.

Treating an object embedded in the wound

The first step in the treatment of any external bleeding is to check the extent of the injury and see if there is anything embedded in the wound.

Apply pressure around the edges of the wound using your hands or the casualty's hands without pressing on the object.
Replace this pressure with a dressing or clean material and bandage firmly in place, avoiding pressure on the object.
Raise the injured limb if possible to staunch the flow of blood.
Prevent longer objects from moving by supporting them with your hands or by packing around the base of the object with blankets, for example.
Treat for shock and reassure the casualty.
If the casualty is impaled on something which cannot be moved, support him or her to stop them from pulling on the impaled object and causing further damage. Where possible, treat the casualty as described above, and ensure that the emergency services are aware of the need for cutting equipment. For further information on impalement.

Warning
If there is something stuck into the injury, do not attempt to remove it because:

If the object went in at an angle, you may cause more damage pulling it out
You may leave splinters in the wound
The object may be pressing against a vein or an artery, reducing blood loss
You may have mistaken a broken bone for a foreign body
The principles of applying pressure and elevating and treating for shock still apply.

 

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Food Poisoning

There are several forms of food poisoning. Bacterial food poisoning is often caused by bacteria in food that has been poorly prepared. Salmonella is one of the most common culprits and is found in many farm products such as eggs and chickens. Toxic (potentially lethal) food poisoning such as botulism can be due to poisons caused by bacteria in certain types of food, including honey and fish. Some foods are entirely poisonous or have components that are poisonous if not properly prepared (crab and some fish being among the most common culprits).

When faced with suspected food poisoning, ask what food has been eaten in the last 48 hours. Food poisoning can take some time to show (however, toxic food poisoning tends to act much more quickly). Be alert to the possibility of food poisoning if there is any combination of the following:

Strange-tasting food or food that has been left out in the heat.
Several people with the same symptoms.
Undercooked or reheated food.
Signs and symptoms
Nausea and vomiting
Stomach cramp
Diarrhoea
Fever
Aches and pains
Signs of shock
Symptons of toxic poisoning are dizziness, slurred speech and difficulty breathing and swallowing.

First Aid Treatment
Monitor and maintain the person's airway and breathing. If there are breathing difficulties, call an ambulance.
Help the person into a comfortable position.
Call for medical advice on treatment and care.
Give plenty of fluids to drink, particularly if the person has vomiting and diarrhoea.
Support the person if he or she vomits, providing a bowl and towel as necessary.
Do not underestimate food poisoning, particularly in the very young or the elderly.

Common poisonous plants

Many plants have components that are mildly poisonous if eaten, or that may cause a reaction if they are touched. However, in the UK few are extremely poisonous.

Some other common poisonous plants

Daffodil (bulbs)
Deadly nightshade (roots and berries)
Mushrooms (many wild mushrooms and toadstools)
Rhubarb leaves
Treatment

If you suspect that somebody has eaten a poisonous plant, attempt to identify it and seek medical advice. If the person is having breathing difficulties or appears to be lapsing into unconsciousness, call an ambulance. Be prepared to resuscitate if necessary.

 

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Fractures of the Arm and Hand

There are three long bones in each arm - one in the upper arm and two below the elbow. These are among the most commonly broken bones in the body. There is also a number of small bones in the wrist that are vulnerable to breaks. Fractures to the hand or fingers can be extremely painful because of the many nerve endings.

The principles of treatment are, as for all broken bones, to provide support to the injured part and to stop it from moving too much. Most people with a broken arm will be able to make their own way to hospital or a health centre, so treatment focuses on providing support that is appropriate when walking and stabilises the injured limb. This can be done with an improvised sling using clothing, or by using a triangular bandage to form an arm sling.

How to make an arm sling

Gently place the bandage under the casualty's arm, placing the point underneath the elbow.
Pass the top end of the bandage around the back of the casualty's neck, leaving a short end to be tied by the collarbone on the injured side.
Bring the bottom end of the bandage up carefully, ensuring that it fully supports the injured arm. Tie into place with a reef knot or bow.
For additional support, you can tie another triangular bandage. Fold into three (a broad fold) around the arm, avoiding the site of the fracture, to stop the arm from moving.
Broken elbow or an arm that cannot bend

If the broken bone is on or near the elbow it may not be possible for the casualty to bend the arm, either because of the pain or because the joint is fixed. In this case you need to treat the arm in the position found - do not try to bend the arm.

Help the casualty into the most comfortable position; this will often be lying down on the ground, but it may also be standing up with the arm hanging straight down.
Place padding around the injured part, both between the arm and the body and on the outside of the arm.
The casualty will need to be transported by ambulance. Do not attempt to bandage the arm if help is on its way as this will cause further discomfort and may make the injury worse.
Fractured wrist

In older adults, the wrist may be broken by a fall on to an outstretched hand, causing a break very low down on the radius (one of the long bones in the lower arm) known as a Colles's or dinner fork fracture. Other injuries can break one of the small bones to the wrist or cause a sprain that is particularly difficult to distinguish from a break.

First Aid Treatment
Provide support and immobilisation in the same way as for a break to the upper or lower arm. Remove watches and bracelets as these may contribute to cutting off circulation to the hand if the injury swells.

Hand fractures

Direct impact may break one or two of the small bones in the palm or fingers. Crushing injuries may break several bones and cause considerable bleeding. In addition the thumb, and even some of the fingers, may become dislocated.

First Aid Treatment
Gently cover any open wounds with a dressing or clean, non-fluffy piece of material. Encourage the casualty to raise her arm. This helps to reduce swelling and bleeding and also provides some pain relief.
If possible, remove rings and watches before the injury starts to swell. If jewellery has been crushed into the hand or swelling prevents its easy removal, pass this information on as soon as possible to the medical staff as early treatment will be needed to prevent damage to the circulation in the fingers.
Cover the injured area with a pad of soft fabric or cotton wool (taking particular Care if there are open wounds not to get strands of material stuck into the injury). This padding can be held in place with a cover created from a triangular bandage, which can also be adapted for crush injuries to the foot and for burns to the hand or foot.

 

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Fractures, Dislocations and Soft Tissue Injuries

Fracture is just another word for a broken bone. A dislocation occurs at the site of a joint and is where a bone is fully or partially displaced. Soft tissue injuries include sprains, strains and ruptures. They are often caused in the same way as fractures, and generally, are hard to distinguish from broken bones.
Broken bones

There are two main types of broken bone. The first is a closed (simple) break or fracture, where the bone has broken but has not pierced the skin. A closed fracture is sometimes difficult to diagnose, even for experienced medical staff, who will usually rely on an X-ray to determine whether or not the bone is definitely broken. The second type is an open (compound) break or fracture, where the bone has either pierced the skin or is associated with an open wound. The greatest risk with open breaks is infection. Both open and closed breaks can result in injury to underlying organs or blood vessels and rnay also be unstable if the ends of the broken bone are moving around. In young children the bones are not fully formed and may bend rather than break (termed a greenstick fracture).

While it is possible to give some general guidance for the recognition of broken bones, no two people are identical in their response. The first general rule therefore is, if in doubt, assume that a bone is broken and treat as such. Be particularly aware of potential fractures if the accident involved a sharp blow, a fall, a rapid increase or decrease of speed, or a sudden twist.

Dislocations

The most common sites for dislocations are the shoulders, thumbs and hips. Dislocations are usually characterised by intense pain and an obvious deformity. There may be signs and symptoms similar to a broken bone, including feelings of pins and needles or numbness below the site of the injury, caused by trapped nerves or blood vessels. Do not attempt to replace the bone. Make the casualty comfortable and take or send him to hospital.
Soft tissue injuries

Strains are an overstretching of the muscle, leading to a partial tear. Ruptures are complete tears in muscles. Sprains are injuries to a ligament at or near a joint. The signs and symptoms of soft tissue injuries will be similar to the signs and symptoms of a fracture and will generally follow a sharp twisting or stretching movement.
Signs and symptoms of broken bones
Pain

This accompanies most, but not all, fractures and is caused by the broken bone ends pushing on to nerve endings.

Deformity

An injured part may appear deformed, particularly when compared to the uninjured side.

Swelling

Some swelling may be present at the site of a fracture.

Tenderness

This accompanies most broken bones and can often only be felt when the injured part is gently touched.

Shock

The signs and symptoms of shock will often accompany major fractures in particular. There may be reddening or bruising over the site of the break, but this often takes some time to appear. You may also hear the ends of broken bone rubbing together, a sound known as crepitus.

Another potential sign of a broken bone is a lack of feeling or a 'pins and needles' sensation below the fracture site. This may indicate nerve damage or a reduction in circulation caused by the bone pushing on either the nerves or the blood vessels. The treatment for injuries displaying these symptoms is the same as for any broken bone. However, if you have been trained, applying traction may alleviate the problem.

If your casualty is displaying any combination of these signs and symptoms or the nature of the accident suggests that a fracture is likely, assume that a bone is broken.

 

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Fractures of the Ribcage

Simple fractures, characterised by bruising and tenderness over the fracture site, are usually confined to one broken rib, with no underlying damage to the lungs or other internal organs. Multiple, or complicated, rib fractures will often result in the casualty having difficulty in breathing, as the chest wall is unable to move effectively. There may also be lung damage. Broken ribs are generally not strapped up because the chest needs to expand normally during breathing to reduce the risk of pneumonia.

Treating a simple broken rib
The best treatment for a simple fractured rib is to put the arm on the injured side into an arm sling and to advise the casualty to seek medical aid.

Multiple broken ribs

In a case of multiple rib fractures there may also be lung damage, where one or a number of ribs have punctured one or both of the lungs. There may also be an open break on the chest wall where ribs have sprung out. Remember that the ribs extend around the back of the casualty and there may be injuries here as well as on the front. Rib injuries may be accompanied by a sucking wound to the chest, creating a direct passage between the external environment and the lungs.

Signs and symptoms of multiple broken ribs
Chest rises on the injured side as the person breathes out (paradoxical breathing)
Swelling or indentation along the line of the ribs
Open breaks
Difficulty in breathing
Pain on breathing
Shock (as there is likely to be some degree of internal bleeding)
Bright red, frothy blood coming from the mouth and/or nose. (This is an indication of a punctured lung as oxygenated blood is escaping from the respiratory system. There may or may not be an associated sucking wound to the chest)
Sucking wound to the chest
First Aid Treatment
Treat any sucking wounds by covering, initially with a hand and then with plastic. Treat any open breaks.
If the casualty is conscious, lay him down. The casualty is most likely to find breathing easier in a half-sitting position.
Lean the casualty towards the injured side. This allows any blood to drain into the injured lung, leaving the good lung free to breathe. Place the arm on the injured side into an elevation sling.
Treat for shock.
If the casualty becomes unconscious, monitor the airway and breathing and place the person into the recovery position with the injured side upwards.

Warning
Do not give anything to eat or drink - the casualty may need a general anaesthetic in hospital.

 

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Fractures of the Skull Face and Jaw

A skull fracture is a very serious injury as it is often associated with some form of damage to the brain. Concussion and compression may both accompany skull fractures. If a casualty has a fracture to the bones of the face or jaw, the airway is your overwhelming priority.
Signs and symptoms of a skull fracture
Alongside these signs and symptoms consider what happened. Skull fractures may be caused by direct and heavy impact to the head or by indirect impact, for example a fall from a great height on to the feet that may have caused the force to move up the body, stopping when it hit the skull.

Bruising to the eye socket
Pain
A bump or a dent
Straw-coloured fluid coming from one or both ears
Deterioration in the level of consciousness of the casualty
Does the person respond slowly to questions or commands? Is he having problems focusing?

If any of these things is present, assume a skull fracture with a potential injury to the brain.

Treating a fractured skull
Keep the casualty still while she is conscious. Encourage her not to move her head.
Keep a constant check on the airway, breathing and circulation.
Be prepared to resuscitate or turn into the recovery position if necessary.
Call for emergency help as soon as possible.
How to treat fractures of the face and jaw

Ensure that any blood in the mouth is allowed to dribble out - encourage the casualty to spit into a bandage or handkerchief.
Gently remove any teeth or bits of broken bone from the mouth and give the casualty a pad to hold against the injured part for additional support and comfort.
A cold compress may help to reduce pain.
Get the casualty to hospital because she will require medical treatment.
Do not pinch a broken nose to control bleeding - hold a pad under it.

 

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Fractures of the Upper Body

The collarbone can be broken by direct impact. However, it is most commonly fractured by indirect force moving up the arm following a fall on to an outstretched hand, and often happens after a fall from a bicycle or a horse. A broken shoulder often follows a heavy impact to the site of injury. It is therefore important to do a careful examination to rule out back or rib injury.
Broken collarbone

Alongside potential swelling, bruising and tenderness above the site of the injury, the casualty is most likely to be supporting the injured arm, with the shoulder on the injured side slumped. As the collarbone is close to the skin it is particularly important to look for an open fracture.
Broken shoulder

If you are confident that the shoulder itself is broken then the treatment is to work with the casualty to find the best position. The application of an arm sling may provide some support, but more commonly the casualty will want no bandages, settling instead for steady support from another person if available. The pain of the injury may make it necessary to call for an ambulance rather than transporting the casualty to hospital in a car.
First Aid Treatment
If the bone has pierced the skin, place a light dressing over the wound. Bleeding is likely to be minimal and your main concern is to prevent infection.

Work with the injured person to find the most comfortable position for the arm and for the body as a whole. Generally this will be sitting up with the arm supported at the elbow. The casualty may wish to go to hospital in this position, but she should be offered the option of an elevation sling, which will help alleviate pressure on the collarbone and provide some comfort.

Applying an elevation sling

The elevation sling has a range of uses. As well as the treatment of a broken collarbone it also provides comfort in the treatment of crushed or broken fingers and hands, relief in the treatment of burns to the arm and is an aid in controlling bleeding through elevation.

Place the injured arm with Ihe fingers by the collarbone on the uninjured side.
Place the triangular bandage with the point resting at the elbow on the injured side.
Tuck the bandage underneath the hand and down underneath the injured arm.
Tie at the collarbone in a reef knot (or a bow).
Fasten the spare material at the elbow with a pin, or twist it and tuck it away.
Extra support can be gained by placing a triangular bandage folded into three (a broad fold) around the arm and body.
Warning
Do not give anything to eat or drink the casualty may need a general anaesthetic in hospital.

 

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Heart Problems

The heart is a muscle that pumps blood around the body, which it does with the help of the thick-walled and muscular arteries and the other vessels of the circulatory system. The heart is controlled by regular electrical impulses that tell it when to contract. Like all other muscles, the heart needs its own blood supply and this is provided by the coronary (heart) arteries. When this blood supply fails to run smoothly, the body starts to experience problems, such as angina Pectoris (angina) and heart attack. Either of these may lead to the heart stopping (cardiac arrest).
Angina

Throughout life, arteries are clogging up with fatty deposits. As these fatty deposits cause the coronary and other arteries to become narrower, it becomes increasingly difficult for blood to flow around the body. The clogged coronary arteries can just about supply blood to the heart when it is pumping at a normal rate but when the heart rate speeds up the arteries cannot cope with the demand. This leads to an angina attack, a frightening, severe, crushing chest pain that acts as a warning to the casualty to calm down or to rest.

Signs and symptoms of angina
Evidence of recent exertion
Previous history of angina attacks
Gripping chest pain, often described by the sufferer as vice-like
Pain spreading up into the jaw or down into the left arm
Feeling of pins and needles down the arm
Shortness of breath
Dizziness and confusion
Anxiety
Pale skin with possible blue tinges
Rapid, weak pulse
First Aid Treatment
Sit the casualty down and reassure her. This reduces the demands being placed on the heart.
Angina sufferers may have medicine that will help relieve an attack. This is often in the form of a puffer or a tablet that is placed under the tongue. The drug works by dilating the blood vessels, thereby increasing circulation to the heart. Help the casualty to take this medication.
Call an ambulance if the pain does not appear to ease or if the casualty is not a known angina sufferer.
If the casualty has regular attacks, listen to what she wants to do next.
Heart attack

If the coronary artery becomes completely blocked, the area of the heart being supplied by that particular blood vessel will be starved of oxygen and will eventually die. This blockage may be caused by a clot, a condition often referred to as a coronary thrombosis.

The development of advanced cardiac care in hospital and good post-hospital care means that heart attack patients have a good chance of making a full recovery. This is important information to remember when you are reassuring somebody having a heart attack.

Signs and symptoms of a heart attack
These signs and symptoms are generally the same as those of angina - indeed, the patient may initially suffer an angina attack that becomes a heart attack. The key difference is that heart attacks do not always follow physical exertion. While angina sufferers will recover from their attack on resting, heart attack patients do not tend to improve without medical treatment.

First Aid Treatment
Move the casualty into a semi-sitting position, head and shoulders supportedand knees bent, as this is generally the best position to breathe in.
Reassure the casualty and do not let her move, as this will place an extra strain on the heart.
Call for an ambulance as soon as possible because the casualty needs hospital care.
If the casualty has angina medication, let her take this. If you have an ordinary aspirin, give her one to chew (without water).
Keep a continual check on the breathing and pulse and be prepared to resuscitate if necessary.

 

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Injuries to the Lower Body

A broken bone in the lower body is a serious injury that requires hospital treatment. The pelvis is a large bone and is generally very difficult to break. Severe impact such as a fall from a height or a car accident are the most common cause in young, fit adults. In the elderly a broken pelvis (or hip) happens more often and can be caused by a relatively minor impact. In healthy adults it takes a major impact to break the thigh bone and there are likely to be other injuries.

Broken pelvis

The pelvis protects the urinary system and the biggest danger is that sharp bone ends may burst the bladder, creating the possibility of infection. Internal bleeding is another likelihood with a fractured hip, as the impact required to break the bone is likely to have caused other damage.

Signs and symptoms of a broken pelvis
Bruising and swelling over the hip area
Urge to urinate
Blood-stained urine
A sensation of falling apart: the pelvis is like a girdle and a break means that it may not be able to hold itself together
Legs rotate outwards as the support at the pelvis gives
As the pelvis can also be broken at the back, it is easy to mistake a pelvic fracture for a spinal injury. If in doubt, treat for a broken spine.

First Aid Treatment
Call an ambulance immediately and reassure the casualty while you wait.
This is a very serious condition and it is best not to move the casualty because you could easily make things worse.
If the ambulance will be some time, tie the legs gently together at the ankles and knees using triangular or improvised bandages.
Treat the casualty for shock.
Fractures of the upper leg

The key risk with fractures of the femur (thigh bone) in the upper leg is shock. The thigh bone protects the main artery in the leg, the femoral artery, and if broken may pierce it, causing severe internal bleeding.

A person with a broken thigh bone will require transportation by ambulance. The general treatment is therefore nothing more than to hold the injured part still and treat the casualty for shock. Do not bandage the leg if help is on its way as this is likely to cause more pain and potentially cause further damage.

Support the leg above and below the site of the fracture if possible, placing padding around the broken leg to further help to reduce movement of the injured limb.

If you have been trained in the use of traction then you may apply this gently to the leg to help to reduce pain and circulatory damage.

The injured person may benefit from immobilising the broken leg by using the good leg as a splint, particularly if there is a wait before medical help arrives.

Apply broadfold triangular bandages under the ankles, knees and above and below the site of the fracture.
Place padding between the legs to help immobilise them.
Gently but firmly tie the bandages on the injured side.
Take care to check the circulation below the bandages to ensure that they do not become too tight as the leg swells.
Warning
Do not give anything to eat or drink - the casualty may need a general anaesthetic in hospital.
Do not move the casualty unless he is in danger or needs resuscitation.

 

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Injuries to the Lower Leg

The long bones, the knee and the foot are often injured during sports. There are two long bones in the lower leg. The tibia (shinbone) lies very close to the surface and if broken will often pierce the skin, causing an open fracture. The fibula lies behind the tibia. It is more difficult to break this bone and may not obviously affect the ability to walk. The knee is a complex joint vulnerable to fractures of the patella (kneecap), dislocation, strains and cartilage (tissue) injury. It is unusual to break just one bone in the foot - generally, multiple fractures of the small bones in the foot and the toes are caused by crush injuries.

Treating broken long bones

Help the injured person into the most comfortable position - generally, lying down.
Examine the injury carefully to see whether there is an open break. If there is a wound, cover gently with a sterile dressing or clean, non-fluffy material, pad around the broken area and tie gently but firmly into place.
Gently support the injury above and below the site of the break. Place padding such as cushions or blankets around the site of the injury.
If you have been trained to do so, applying traction may help alleviate the pain and any potential damage to the circulation.
Treat for shock and reassure.
Treating a broken leg

A person with a broken leg is most likely to be transported to hospital by ambulance and the treatment in most settings is therefore limited to steady support and help with immobilisation.

Treating knee injuries

In addition to the normal signs and symptoms of bone and soft tissue injuries, there may be an obvious displacement of the kneecap or an inability to bend or straighten the leg.

Help the injured person into the most comfortable position. He will generally need to be transported to hospital by ambulance.
Check the injured area carefully for an open break and treat as appropriate.
Pad around and under the injured area to provide support, gently tying the padding in place if needed.
Treat for shock and reassure the casualty until help arrives.
Do not try to bend the leg because you may cause more damage. Keep it still.
Treating a broken foot
If possible, carefully remove the shoes and socks, tights or stockings as the foot is likely to swell and these items of clothing may damage the circulation.
Cover any wound with a sterile dressing or clean, non-fluffy material.
Raise the foot to reduce swelling and pain and support with a large comfortable pad such as a cushion or blanket.
Wrap the foot in padding. If necessary, this can be held in place with a cover bandage. A cold compress may further alleviate pain and swelling.
Take or send the injured person to hospital.

Warning
Do not give anything to eat or drink - the casualty may need a general anaesthetic in hospital.

 

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Miscarriage

A miscarriage is the loss of a pregnancy in the first 24 weeks. There are many causes of miscarriage, and for some parents the reason for their loss will never be known. About a fifth of all pregnancies end in miscarriage, most of these before the twelfth week.

Signs and symptoms
Bleeding - this may be light spotting over a number of days and/or a sudden heavy bleed
Period-like pain or pain in the lower back
Potential signs and symptoms of shock, caused by blood loss
Passing the foetus and other products associated with birth (this may just look like a heavy blood clot)
Many miscarriages can take several days from start to finish and may not start with a heavy bleed or severe pain. Some women who are miscarrying may not have realised that they were pregnant as many miscarriages take place in the first weeks after conception.

Pregnant women suffering a bleed should always seek early medical advice from their doctor or midwife. An investigation may show that the pregnancy has not ended or that miscarriage is threatened but not inevitable.

First Aid Treatment
Overall, listen to the wants and needs of the woman. She will often be very distressed and scared. Where possible, help her to a position of privacy and if possible, ensure that she is treated by another woman and has support from her partner or friend.
If bleeding or pain is severe, or there are signs of shock, call an ambulance.
Reassure the woman and offer her a sanitary pad or towel.
Keep anything that is passed from the vagina out of sight of the woman, for medical staff to examine.
Support groups

Most women who have a miscarriage do not have problems with subsequent pregnancies but a woman should take time to grieve and talk about her feelings before becoming pregnant again. Group therapy with others who have had the same experience is a good way of helping a woman come to terms with the loss of her baby. The woman's doctor should be able to provide details of appropriate support groups in her area.

Other emergency problems with pregnancy
Ectopic pregnancy

In this circumstance, the fertilised egg has become embedded in the Fallopian tube rather than the womb. As well as ending the pregnancy, this is a potentially lifethreatening condition for the mother. The woman will usually have severe pain in the abdominal area, with potential bleeding and signs of shock. Call an ambulance immediately.

Placenta praevia/placental abruption

A bleed in later pregnancy is more unusual. A painless bright red bleed may be an indicator that something is seriously wrong with the placenta, causing potential lifethreatening problems for both the mother and child. Support the mother in a position of rest, call an ambulance and treat for shock.

 

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Poisoning from Household Chemicals

Many everyday household substances are potentially poisonous if misused. Unfortunately, many admissions to hospital are the result of children drinking household chemicals while playing. Inside the home, cleaning materials are often the biggest risk, while in the garden weedkillers, pesticides and paint stripper are common culprits. Most household chemicals cause problems when they are swallowed. Many are corrosive and together with the effect of the poison also cause burns to the mouth and food canal (digestive tract).

Signs and symptoms
Signs of bottles, information from the casualty or from bystanders
Burns to the mouth
Vomiting
Pain
Impaired consciousness
Difficulty breathing
Managing swallowed poisons

First Aid Treatment
Make sure that it is safe for you to approach. Do not inadvertently kneel in chemicals or otherwise expose yourself to any risk.

Monitor and maintain the airway and breathing. Be prepared to resuscitate if necessary.
Monitor consciousness. If the person becomes unconscious, put into the recovery position.
Call an ambulance and tell the emergency services what has happened.
Treat any burns, wearing protective clothing if necessary.
Support the person if he is sick and place in the recovery position if necessary.
Reassure the person while you are waiting for the emergency services to arrive.
Identify the poison if possible because this will help medical staff determine what treatment is appropriate.
If there are mouth burns

If the person stops breathing you will need to give rescue breaths. However, if there are mouth burns because the poison was corrosive, you must take care not to put yourself at risk. Use a face shield or mask when giving the rescue breaths. This should be placed over the casualty's face and the oval tube placed between the teeth. The plastic shield forms a barrier as you give mouth-to-mouth.

If there is no shield available, consider giving rescue breaths mouth-to-nose. Tilt the head and lift the chin as you would normally. Then close the mouth (using a piece of material as a barrier against the poison if appropriate) and seal your mouth around the casualty's nose. Give rescue breaths at the same rate and ratio as you would when giving mouth-to-mouth. Take your mouth away after each breath and open the casualty's mouth between breaths to let the air out.

If the casualty is breathing and conscious, you may provide relief from the burning by giving frequent sips of cold water. This will help relieve pain and reduce swelling.

Prevention of poisoning from household substances
Put all household cleaning materials and medicines up high out of the reach of children
Consider putting any dangerous substances in a locked cupboard
Always read instructions for use carefully. Some household chemicals should be used only in a well-ventilated room or with some protective clothing
Always store chemicals in the container they came in or a clearly marked alternative. Never store chemicals in drinks containers or unmarked bottles
Keep gardening supplies securely in the shed or garage in a locked container
Where possible, buy medicines and cleaning materials in childproof containers
Do not

Do not try to make the person vomit. If a poison burns on the way down to the stomach, it will burn on the way up.

 

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Poisoning from Industrial Chemicals

The use of hazardous industrial chemicals is generally strictly controlled and regulated, and staff who work with such substances are aware of the specific first aid and safety requirements. For most people, contact with dangerous industrial chemicals will be through a chemical spill at a road accident or a problem at an engineering plant.

First Aid Treatment
Many industrial chemicals can be absorbed through the skin or inhaled so it is important not to approach an accident scene unless you are sure you can do so safely. If you are at all unsure of the risk, do not approach the scene. Instead, call the emergency services immediately, giving as much information about the incident as you can. Encourage casualties who can to move away from the source of any danger.

Inhaled poisons

Where possible, remove the casualty from the chemical. lf this is not possible, then ensure that the area is wellventilated (open doors and windows).

If in doubt, do not stay in the room yourself. Many chemicals have no odour or obvious effect and you may not be aware that you are being poisoned.

Monitor and maintain the casualty's airway and breathing and be prepared to resuscitate if necessary.
If the casualty becomes unconscious, place in the recovery position.
If the casualty is conscious, help into the most comfortable position. If there are breathing problems this position is most likely to be sitting up.
Call an ambulance and give as much information as you can.
Poisons on the skin

Do not contaminate yourself. Wear protective clothing if available.
Wash away the chemical with water, taking care to flush the contaminated water away from both yourself and the casualty.
Monitor and maintain the casualty's airway and breathing and be prepared to resuscitate if necessary.
Call an ambulance and reassure the casualty until help arrives.

 

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Poisoning

A poison is any substance that enters the body and causes temporary or permanent harm. Some substances, such as paracetamol or alcohol, only become harmful to the body when taken in a large quantity. Others, such as some strong weedkillers, need only to be taken in very small amounts to be harmful.

How do poisons affect the body

Different poisons have different effects. The effect is modified by the quantity and the time since exposure.

Potential effects of poisons

Vomiting This is a key response to many poisons, particularly those that have been
eaten, as the body tries to remove the poison from the system.

Impaired consciousness A person may be confused and slowly lapse into full unconsciousness.

Breathing difficulties Poison may eventually cause breathing to stop.

Change in heart rate Some poisons speed up the heart rate; others slow it down. Poisons may eventually cause the heart to stop.

Erratic and confused behaviour Always suspect poisoning in these instances.

Burns Some poisons burn the skin, some swallowed poisons burn the food canal, bringing the additional risk of swelling around the mouth and throat.

Pain Some poisons will cause pain.

Liver and kidney problems As the liver and kidneys struggle to remove poisons from the body they may become affected themselves.

Key first aid principles for dealing with poisons

Protect yourself and bystanders from the source of the poison by making the scene safe and wearing protective clothing if necessary.
Monitor and maintain the casualty's airway and breathing and be prepared to resuscitate if necessary.
Seek appropriate medical help and help from the emergency services to deal with dangerous substances.
Monitor the casualty's level of consciousness and be prepared to turn into the recovery position if necessary.
Support the casualty if he vomits and place in the recovery position until medical help arrives.
Treat any burns caused by corrosive poisons by flooding the affected area with running water.
Try to identify the source of the poison because this will help determine appropriate medical treatment.
Clues to identifying poisons

The early identification of a poison will help medical staff determine an appropriate course of treatment. Potential clues that you as the first person at the scene of the incident may be able to provide include:

Medicine bottles/pill containers (do not assume that an empty bottle means that all the pills were taken).
Samples of vomit: if the casualty is sick, keep the vomit for inspection.
Details of what happened from bystanders or from the casualty.
Identification of animal or insect: if the poisoning route was a bite, try to get a description of the creature. If it is safe to do so, take the poisonous animal or insect to hospital.
Chemical containers: be able to describe any hazchem symbol or label if you can get close enough to do so without putting yourself at risk. Do not touch these yourself. Remember that many household substances are toxic.

 

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Shock

The word shock can be used in a range of ways, but when used in a first aid context it describes a physical condition that results from a loss of circulating body fluid. It should not be confused with emotional shock that might occur, say, when a person has received bad news (although the external signs are very similar).

What happens in cases of shock

A severe loss of body fluid will lead to a drop in blood pressure. Eventually the blood's circulation around the body will deteriorate and the remaining blood flow will be directed to the vital organs such as the brain. Blood will therefore be directed away from the outer areas of the body, so the casualty will appear paler than previously and the skin will feel cold and clammy. As blood flow slows, so does the amount of oxygen reaching the brain.

The casualty may appear to be confused, weak and dizzy, and may eventually deteriorate into unconsciousness. To try to compensate for this lack of oxygen, the heart and breathing rates both speed up, gradually becoming weaker, and may eventually cease.

Potential causes of shock include: severe internal or external bleeding; burns; severe vomiting and diarrhoea, especially in children and the elderly; problems with the heart.

First Aid Treatment
Warmth
Air
Rest
Mental rest
Treatment
Help
Warmth

Keep the casualty warm but do not allow her to get overheated. If you are outside, try to get something underneath the casualty if you can do so easily. Wrap blankets and coats around her, paying particular attention to the head, through which much body heat is lost.

Air

Maintain a careful eye on the casualty's airway and be prepared to turn her into the recovery position if necessary, or even to resuscitate if breathing stops. Try to clear back bystanders and loosen tight clothing to allow maximum air to the casualty.

Rest

Keep the casualty still and preferably sitting or lying down. If the casualty is very giddy, lay her down with her legs raised to ensure that maximum blood and therefore maximum oxygen is sent to the brain.

Mental rest

Reassure the casualty but keep your comments realistic. Do not say that everything is going to be fine when it is obvious that there is something seriously wrong. Let the casualty know that everything that can be done is being done and that help has been called for. If she has other worries then try to resolve these.

Treatment

Treat the cause of the shock and aim to prevent further fluid loss.

Help

Ensure that appropriate medical help is on the way.

Signs and symptoms
Pale, cold and clammy skin
Fast, weak pulse
Fast, shallow breathing
Dizziness and weakness
Confusion
Unconsciousness
Breathing and heartbeat stopping
Shock kills, so it is vital that you can recognise these signs and symptoms. With internal bleeding in particular, shock can occur some time after an accident, so if a person with a history of injury starts to display these symptoms coupled with any of the symptoms of internal bleeding, advise her to seek urgent medical attention, or take or send her to hospital

 

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Sprains and Strains

Strains occur when the muscle is overstretched, leading to a partial tear. Sprains are injuries to a ligament, a tough band of tissue that links two bones together at or near a joint. Commonly sprained joints include the wrist, knee and ankle.

Signs and symptoms
The signs and symptoms of strains, and more particularly sprains, are very similar to those of a broken bone. There may be pain, particularly on movemenr, swelling and bruising (usually a little while after the accident). It is often impossible to tell if an injury is a sprain or a fracture without an X-ray and it is not unusual for sprains to take as long a time to heal as a simple break.

If in doubt, treat the injury as a broken bone and seek further medical help.

First Aid Treatment
The person suffering the injury may often sense that the area is not broken she may have suffered similar injuries before, particularly if the injury has occurred through sport. If both of you are confident that there is no other injury, then the best treatment is:

Rest
Ice
Compression
Elevation

Place the injured part at rest. This prevents any further damage. Help the person into a comfortable position - for a leg injury, this will usually be lying down with head and shoulders supported.
Apply a cold compress. Wrap some ice in a triangular bandage or other clean piece of material and hold gently on the site of the injury. This will help relieve pain and reduce swelling. Do not apply ice directly to the injury as this may damage the skin. Cool the injury for 10-15 minutes, keeping the compress cold with refills as necessary.
Apply a compressing roller bandage. This will help reduce pain and swelling and will provide support for the injury.
Elevate the injured part. Elevation will help reduce swelling and pain. If the arm is injured, use either the arm or elevation sling, as appropriate, to provide additional support.
Seek medical assistance and make sure the casualty keeps the limb raised and supported until help arrives.
Alternative cold compresses
If ice is not readily available, soak a flannel or other piece of material in very cold water, wring this out and apply to the injury. Replace this every 2-3 minutes as the material warms up. Alternatively, consider the contents of che freezer. Frozen peas, for example, make an excellent cold compress as the bag moulds to the shape of the injury.