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THE ORANGE CROSS BOOK THE OFFICIAL GUIDEBOOK FOR FIRST AID Commissioned by and under the supervision of the Dutch ‘Stichting Koninklijke Nationale Organisatie voor Reddingwezen en Eerste Hulp’ (the Royal Dutch Foundation for Rescue and First Aid), ‘The Orange Cross’

Colophon author Hans van der Pols (The Orange Cross) editor Marijke van Ooijen, Utrecht graphic design inside pages Jean Klare, Deventer

ThiemeMeulenhoff develops study materials for primary education, secondary education, vocational and adult education and for higher vocational training. ISBN 978 90 06 92174 8 26th edition, second issue, 2011 Š ThiemeMeulenhoff, Amersfoort, 2011

layout inside pages PrePressMediaPartners, Wolvega cover design Jean Klare, Deventer translation Josephine E. Bruijn, Leiden photographs cover and inside pages Fotostudio Lighthouse, Breda other photographs ANP Foto, Rijswijk: p. 13, 23 CDC/James Gathany: p. 111(o) Hollandse Hoogte, Amsterdam: p. 17(lo) ImageSelect, Wassenaar: p. 33, 35 (2x), 76, 113(o) Science Photo Library / ANP Foto, Rijswijk: p. 85 Wikimedia Commons: p. 108 p. 36 p. 55 p. 14 onder p. 17(ro) anatomical drawings Myrthe Boymans, Geleen: p. 28(o), 85 Rogier Trompert, Maastricht ( p. 28(b), 29, 38, 76, 84

All rights reserved. No part of this book may be reproduced, stored in an automated data file or published in any form or in any way, be it electronically, mechanically, by means of photocopies, recordings or in any other way without prior permission in writing from the publisher. In so far as making reproductions of this book is allowed on the basis of section 16B of the Dutch Copyrights Act 1912 jo the Decree of the 20th of June 1974, Dutch Bulletin of Acts and Decrees 471 and section 17 Dutch Copyrights Act 1912, the legally payable indemnities should be paid to Stichting Reprorecht (PO box 3060, 2130 KB Hoofddorp, The Netherlands). Those who want to include a part or parts of this book in anthologies, readers or other compilations (section 16 Dutch Copyrights Act 1912) should contact the publisher. The publisher has aimed at registering the copyrights in accordance with the legal provisions. Those who are of the opinion that they, in spite of this, are in a position to exercise certain rights, can as yet contact the publisher.

Preface to the first edition The Koninklijke Nationale Bond voor Reddingwezen en Eerste hulp bij Ongelukken (The Royal Dutch Foundation for Rescue and First Aid), ‘The Orange Cross’ have decided to compile this book with a dual objective: 1 to further first aid training by means of issuing a new, Dutch manual with numerous clear illustrations; 2 to contribute to the uniformity of the training by means of providing such a book, which should be edited very meticulously, so that it may become popular with many people. It gave the Executive Board great pleasure when it became aware of the fact that the need for a new manual was also felt in the heart of the Dutch Advisory State Committee concerning measures to further the education in first aid in the case of industrial accidents, established by Royal Decree of 10 December 1910. The Executive Board highly appreciated the fact that this Committee, which had already accomplished so much to further the training in first aid to be given in the case of in-company accidents, was willing to co-operate towards this intended purpose, by expressing her opinion about the initial concept. The Committee, which was appointed by the Executive Board to compile the manual, consisted of the following gentlemen: Dr. P.J. Barnouw, secretary of the North-Holland Association ‘Het Witte Kruis’; Dr. R.S. Hermanides, former chairman of the Dutch Association of Railway physicians; Prof. Dr. J.A. Korteweg, professor of medicine; Dr. C.J. Mijnlieff, secretary of the Royal National Society ‘The Orange Cross’; G. Oosterbaan, physician, member of the aforementioned State Committee, member of the general board of the Society for the advancement of Medicine; W. Poolman, physician, secretary of the Provincial South-Holland Association ‘Het Groene Kruis’; General-Major A.A.J. Quanjer, physician, inspector of the Royal Dutch Army Medical Corps, member of the general committee of the association ‘The Dutch Red Cross’; Dr. G.J. Teljer, medical inspector at the railway services; Dr. C.B. Tilanus, chairman of the Dutch Association ‘First Aid’. After consultations about the route to be followed for the compilation of this book, the following gentlemen have made the actual compilation: Prof. Dr. J.A. Korteweg, Dr. C.J. Mijnlieff, G. Oosterbaan, and General-Major A.A.J. Quanjer, who eventually presented the fruit of their labour for approval to the entire committee and to the State Committee. The ‘Manual’, which is now published, is the result of the mutual consultation that ensued. The aforementioned State Committee have expressed their willingness to take this manual as the basis for the education for the courses that are organized under her supervision. May this book, which was compiled and published with great meticulousness, prove to be a useful manual for instruction in first aid, and for those who received the instruction may it be a welcome means to imprint the instructions received, more deeply on their memory. Mr W.K. de Bruin in The Hague made the drawings, the majority of which are original. Amsterdam, December 1912.


26th edition of the Orange Cross Book Foreword Since its inception in 1909 The Orange Cross has set itself the task of ensuring that as many people as possible are knowledgeable with respect to first aid and are informed and trained to such an extent that they can give adequate first aid. As of 1912 the Orange Cross Book has played an important part in disseminating this knowledge and in training first aiders. Means of communication have changed enormously since those days. The Orange Cross is grateful to be able to utilize these means and tries to reach (parts of) the general public through its website, its e-learning programme MijnEHBO (Dutch My First Aid), through iPhone and through social media. And even in 2011, there is of course a demand for the printed version of the trusted Orange Cross Book. The course material in this 26th edition has not only been brought into conformity with the new resuscitation guidelines issued by the Dutch Resuscitation Board; reactions to the 25th edition, frequently asked questions and general social, medical, technical or other external developments have been included as well. The design and layout were in part based on the advice of three user panels and the information from a survey among a number of First Aid instructors. Board and directors of The Orange Cross wish to thank the participants in the panels and those who contributed towards the realization of this book. The Hague, August 2011 E.G. van Ankum Briggen, MD chairman

B.A.J. Jongejan, MD director


Composition of the board of experts R.H. Baas G.H.M. Bouten E. Crone-Kraaijeveld J. Frederiks W.E. Korterink P. Lasschuijt P.A. van Luijt M.G.M. Scot W.L.M. ten Wolde

Dutch Organization of Teachers in First Aid (NODE) Organization LOTUS General Practitioner, chairman Dutch Society of Cardiologists Ministry of Defence Professional Association V&VN Ambulance Care Dutch Society for Traumatology Dutch Society for Anaesthesiology Ambulance Care the Netherlands


Table of contents Preface IX PART I

General 11 Introduction 12

1 1.1 1.2 1.3 1.4 1.5

Giving first aid: five important points 13 Be aware of any danger 13 Assess the situation and the victim 14 Reassure the victim and provide protection 15 Get professional help 16 Help the victim at the place where he lies or sits 19 – The Rautek rescue manoeuvre from the ground 19 – The Rautek rescue manouevre from a car seat (or chair) 21 – Moving the victim while providing support 22


Emotional reactions 23


Providing first aid and the risk of infection 25

PART II Impairment in vital body functions 27 Introduction 28 1 1.1 2


Impaired consciousness 30 – Approaching a victim who is lying down 31 – Turning an unconscious victim from the stomach onto the back 31 Injuries and diseases that cause impaired consciousness 32 Breathing difficulties 37 – Loss of consciousness in cases of airway obstruction 40 – Back blows 40 – Abdominal thrusts for a standing or sitting victim 41 – Assessment of breathing in a victim who is unconscious 43 – Turning the victim from the back into the recovery position 44 – Checking victim’s breathing when he is in the recovery position 45 – Turning the victim from the recovery position to the back 45 Injuries and disorders that cause breathing difficulties 45



Resuscitation 49 – Chest compressions 50 – Rescue breaths 51 – Combining chest compressions and rescue breaths: resuscitation 52 – Use of the AED 53 – Inspecting and clearing the mouth 56 – Second rescuer takes over resuscitation 56 – Rapidly turning from the back onto the side 57 – Use of CPR face shield 58 – Use of CPR breathing mask 58 – The Rautek rescue manoeuvre from bed or couch 59


Active blood loss 61 – Applying pressure on the wound 61 – Applying a bandage 63 – Applying an emergency bandage 64


Shock 66

PART III Injuries 69 Introduction 70 1

Wounds 71 – Applying suture strips 74 – Applying a sterile compress 80


Electrical injuries 81


Bruises and sprains 83

4 4.1

Bone fractures and dislocations 85 Fractures 85 – Open fractures 86 4.2 Spinal injuries 87 – Stabilizing the victim’s head 88 4.3 Dislocations 89 4.4 Provide comfort and support to an injured part of the body 89 – Applying an arm sling 90 – Applying a broad-fold triangular bandage 91 – Bandaging hand and wrist 92 – Bandaging foot and ankle 94


5 5.1

Injuries of the eye, nose and ear 96 Eye injury 96 – Removing dust from the eye 97 – Flushing the eye 98 5.2 Nose and ear injuries 98 – Pinching the nostrils closed 99 6

Tooth injuries and tooth through the lip 101 – Knocked out tooth 101


Overheating (hyperthermia) 103


Hypothermia 106


Frostbite 108


Poisoning 109


Stings and bites 111

PART IV Dressings, bandages and other materials 115 1

Dressings and bandages 116


Other materials 121

Index 126


Preface Every person has the duty to provide help according to his abilities to fellow human beings who are in distress. Citizens who take a certificate First Aid of The Orange Cross improve the quality of the aid they are able to give. This book contains descriptions of all first aid actions that pertain to the attainment targets of this certificate. Studying the content of this edition will provide sufficient preparation for the examination First Aid by The Orange Cross, on condition that this study is combined with sufficient practical training. First Aid is based on the following assumptions: – laypersons should be able to perform the actions – the number of tools used is kept to a minimum (only tools that are available everywhere) In addition this book is also: – as general as possible with respect to target groups and situations – contains only information that is relevant to the actions of the first aider – is directed towards the attainment targets of the examination First Aid of The Orange Cross This means that first aid actions where recognition is difficult, for the professional as well as for the layperson, and where the risks of interventions are greater than those of refraining from acting, are not within the scope of this book. This also means that certain actions that you as a voluntary carer perform (partner, relative, colleague) have not been included in this book. This concerns first aid actions that require specific tools or that occur so seldom that it is not useful to include them as a standard in the attainment targets of the First Aid Certificate. This includes action such as the use of an epipen (adrenalin auto-injector) or giving rescue breaths to a victim without vocal chords through a tracheostoma. The general practitioner (GP) is responsible for teaching these actions to the patient or his surroundings. The contents of this course book have been established by the Board of Experts of The Orange Cross. The course material starts as much as possible from the current state of the art in science and is consistent with the guidelines from other experts such as the resuscitation guidelines of the Dutch Resuscitation Council (Nederlandse Reanimatie Raad) and the European Guidelines for First Aid. Changes in the course material and the attainment targets will be announced through the website and through the other official publications by The Orange Cross. Therefore we recommend you to visit this website at regular intervals. This book consists of four parts. Part I contains the general principles of first aid. Part II discuss impairments in the vital body functions. In part III injuries are addressed. In part IV eventually, dressings, bandages, and other materials are discussed. It is essential for the first aider to respond to what he observes and to the information provided by the victim. Therefore the majority of the subjects start with a description of the situation with the possible signs or symptoms accompanied by: – the question: ‘What is the matter?’ – a description of the aim of the first aid in this situation – the first aid actions required in this case For effective care it is important that the objective of the action is clear. Therefore we always explain why an action is performed in a certain way. In places which could give rise to uncertainty we mention whether first aid suffices or whether medical professionals should be called in.


The five important points and the approach outline have been printed on the inside of the front and back covers. You can fold them out, so that you can place them beside each action. The most important differences as to content in comparison with the 25th edition are: – the compliance with the resuscitation guidelines of the Dutch Resuscitation Council 2011 – the inclusion of the course material AED (since 2009 part of the attainment targets of the First Aid Certificate) – the inclusion of the course material Bandaging Skills and Minor Accidents – the first aid actions in cases of poisoning and burns Everywhere where it says ‘he’, ‘him’, or ‘his’, ‘she’ or ‘her’ is intended to be included. In order to show the first aid actions in a clear way the first aider is often depicted beside the victim where he actually is in front of the victim. This book is intended for the situation in the Netherlands, where the emergency number is 1-1-2. This is also the emergency number in the other EU countries. If you want to use this book elsewhere, please note the local emergency number below.



General > Introducti0n

Introduction What is first aid? First aid is the help required that the first aider, according to his assessment, should give to a victim in a way that is consistent with professional care, whether or not medical professionals have been called in. What is a first aider? A first aider is the person who is able and willing to give the first aid required to a victim with the knowledge, skills and experience that are available to him. What is a victim? A victim is a person who has an acute, possibly life-threatening impairment of his physical or mental health and needs help according to his own assessment or that of bystanders. First link in the chain of emergency care The first aider is the first link in the chain of emergency care. He sees to it that a victim is transferred to the care of medical professionals in the best possible condition. He accomplishes this by preventing that victim’s condition deteriorates and that the disorders and injuries become more severe and by diminishing the risk of complications. He will not undertake actions that interfere with the treatment to be given by medical professionals. The actions described in this book have been assessed with respect to this aspect by the Board of Experts. The first aider himself takes care of minor injuries and signs/symptoms and refers the follow-up care to the victim.


When giving first aid you ensure that the victim’s condition does not deteriorate. Therefore it is necessary that you stay calm and try to understand the situation quickly. The following five points will help you do this: 1 Be aware of any danger 2 Assess the situation and the victim 3 Reassure the victim and provide protection 4 Get professional help 5 Help the victim at the location where he lies or sits

1.1 Be aware of any danger When you provide care you particularly have to be aware of possible risks to yourself, to bystanders and to the victim(s). This risk may be caused by objects that lie around, moving machine parts, traffic that rushes by, fire, high-voltage cables or (impending) collapse of for example grandstands, but also panic, aggression or fights that may break out in crowds. In these cases you need to warn the police and the fire brigade as well as the ambulance service. If it is not safe for you, you cannot provide help. You have to postpone the care until the fire brigade or the police have declared it is safe to access the place of the accident. In the first instance your help is restricted to calling 1-1-2. Ensure that you yourself, bystanders and the victim are not at risk. Take precautions if necessary. These may consist of putting on a safety vest, diverting traffic, having cigarettes or a starting fire extinguished, switching off the car engine and putting the car on the handbrake (be careful with air bags, they can yet be activated, stay outside of the car as much as possible), switching off the power supply and removing clothes that have been in contact with corrosive substances. Follow the instructions given by the police, the paramedics, fire fighters or road inspectors as soon as they are present.

General > Giving first aid: five important points

1 Giving first aid: five important points


General > Giving first aid: five important points

1.2 Assess the situation and the victim First establish what has happened. Assess the situation by observing and posing questions. Ask the victim or the bystanders what has happened if you have not seen the accident when it occurred. Information about the way in which the accident occurred (the accident mechanism) and the assessment of the (mechanical) forces to which the victim has been exposed provide indications about possible injuries. This information is important for the medical professionals. How severe the injuries are, is not always directly visible. Think for example of electrical injuries. Next you establish what is wrong with the victim. You begin the assessment of the victim by assessing his level of consciousness. An unconscious victim is in immediate danger of life. Possible threats are: airway obstruction, breathing difficulties and ineffective blood circulation. Conversely, disturbances of the so-called ABC may lead to unconsciousness. The A refers to airway. The B refers to breathing. The C refers to circulation. You first have to address the most life-threatening factors. The ABC-approach provides the order of assessment and actions. The victim has a greater risk of dying from severe airway obstructions (choking/asphyxiation) than of not being able to breathe normally or of severe blood loss. If the victim responds adequately the ABC are not (yet) in danger and you can examine whether he has any injuries, such as wounds, contusions or fractures. Do, however, remain alert to changes in the level of consciousness and (corresponding) changes in other vital body functions. If there are several victims you give first priority to unconscious victims (keeping the airway open) and next to victims with active blood loss. Resuscitation is not possible if there are several victims with severe injuries and if there is not enough help. You may know the victim and therefore be able to pass on personal details to the medical professionals. As a first aider you do not look in the clothing for personal details and you do not ask the victim for medication use or medical history. For reasons of privacy you leave this to the medical professionals. If you think the victim is about to loose consciousness, you are allowed to ask the victim’s name and date of birth, so that the medical professionals can obtain medical information quickly. Information carriers (medical alert pendant) It is possible that you come across a medical alert pendant or similar information carriers. For you as a first aider the information in such pendants or bracelets is not useful, because this information will not influence the type of care you will give. However, for the medical professionals this information is of importance. Therefore it is useful to point out the presence of a medical pendant.


1.3 Reassure the victim and provide protection Reassuring Victims are often anxious and frightened, sometimes they are irritated or aggressive as well. They need someone who provides relief and reassurance. A great amount of blood looks frightening and may provoke a panic reaction in the victim and in bystanders. Therefore it is best to immediately cover wounds that bleed with a dressing. Make the victim feel that he is in good hands. Be calm and friendly. Show concern and respect. Show understanding towards fearful and angry reactions, from bystanders as well. Ensure that the victim can see you, kneel beside him if he’s lying down, make (eye) contact, and mention your name. In case of a severe accident, however, do not shake hands in order to avoid movement. Always tell the victim what you are doing or what you are going to do, especially if the victim cannot see you (for example in the case of back injuries). Always respond to questions and observations and take the victim seriously. Ask, if this is applicable, whether someone should be notified. If necessary hold the victim’s hand. Always try to stay close to him. Speak quietly and in understandable language. Talk with the victim, also if you think he is unconscious. He may be able to hear you. If the victim is a child and it has a cuddly toy with him, try to place this in a position where it can be seen or felt. Most children will indicate what they are or are not capable of. Therefore do not induce him to sit up or stand up. You do not need to tell everything, but what you tell, must be true. Never say that things are not so bad, when they are. Therefore never say anything about injuries, (including injuries of other victims) or about prognosis. Make no promises that you cannot fulfil. Protection Always ensure that the victim has sufficient protection. In cold weather, rain and wind and after a stay in the water, he may have developed hypothermia. Hypothermia after a severe accident diminishes the chances of survival. Therefore protect the victim from cold, rain and wind. Cover him with a (rescue) blanket or a coat and do not forget to cover the head but leave the face uncovered. Much heat is lost through the head.

General > Giving first aid: five important points

You always begin by giving first aid and calling in professional rescuers. In emergency situations where you do not need to call in professional assistance you can use this information for example to retrieve contact details. This may be necessary if the victim cannot communicate properly, due to his age or if he has a physical or mental handicap.



Do you want to learn how to give first aid in an emergency?

2 3 4 5

The Orange Cross Book contains the official course material for the First Aid Certificate. Step by step and guided by clear illustrations you learn what to do and why. For almost a century the Orange Cross Book has been a household name and it is indispensable for people who take a First Aid course. This new edition is a true 21st-century book and complies with the current resuscitation guidelines for first aid.

The Orange Cross Book  

The Orange Cross Official Guidebook For First Aid. Should you wish to learn First Aid life-saving techniques in case of emergency, this guid...