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Occupational

First Aid David Olley


This handbook is ideal for use in support of a properly structured first aid course. It will also prove invaluable as ongoing reference for someone who has completed the course.

occupational

First Aid

Š2015 All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of Safety Publishing Ltd

Abdominal thrust Abrasion Agonal Breathing Airway Amputation Anaphylaxis Angina Assess casualty Assess situation Asthma A.V.P.U. scale Back blows Bandages Basic life support Bites and stings Bleeding Bones Burns Chain of survival Chemical burns Chest compressions Chest injury Chest pain Choking Cold, Effect of Collapsed lung Coronary C.P.R. Crush injury Defibrillator Diabetes Direct pressure Dislocation Dressings Electrical burns Eyes Face mask Face shield First aid kit Fractures

20 45 28 26 48 61 40 10 3 24 14 20 46 28 78 44 63 73 27 74 29 23 38 20 76 23 38 31 49 32 60 44 69 46 74 52 36 36 7 64

Gases, inhalation Gloves, disposable Heart attack Heat, effects of Hepatitis HIV / AIDS Hygiene Hypoglycaemia Hypothermia Incised wound Inhaler, asthma Insulin Internal bleeding Intervertebral disc Introduction Joints Kidney failure Laceration Ligaments M.O.I. Neck injury Obstructed airway Overdose Poisons Primary survey Pulse Recovery position Rescue breathing Resuscitation Secondary survey Seizures Shock Skeleton Sprains Strains Symptoms Unconsciousness Vertebrae Vital signs Wounds

77 45 38 75 4 4 4 60 76 45 24 60 47 66 2 69 49 45 70 11 13 20 78 77 10 12 62 26 28 10 59 57 63 70 70 10 14 66 10 45


Occupational first aid

2 Unit 1 – First Aid in the Workplace

1.1 Roles and responsibilities of the occupational first aider 1.2 Personal and scene safety 1.3 Standard infection control procedures 1.4 Legal and ethical issues, including confidentiality 1.5 Employers responsibilities 1.6 First aid boxes and first aid rooms 1.7 Calling emergency services 1.8 Critical incident Stress and post traumatic stress First aid is, quite simply, the initial treatment given to someone who suffers injury or sudden illness, usually at the scene and at the time. Occupational first aid is first aid that takes place in the workplace. If the injury or illness is minor then it may be the only help that casualty receives or needs. If the condition is more serious then first aid may be given until the casualty is handed over to the appropriate the medical practitioner who could be a paramedic, doctor or to the care of a hospital emergency department. The basic principle of first aid is to keep the casualty alive; to prevent their condition from deteriorating and to hand them over in the best possible condition in the circumstances.

Occupational first aider’s role and responsibilities An occupational first aider will be expected to deliver first aid in the workplace competently and within the scope of their training. This might include treating minor injuries which will receive no further treatment or treating major injuries and illnesses that may go on to require medical attention or hospitalisation. The first aider may also be responsible for the maintenance and restocking of first aid boxes as supplied in the workplace. In large organisations or where there are specific risks there may be an area set aside as a first aid room. The maintenance and restocking of equipment within this room would also be the responsibility of the occupational first aider. Following treatment of the casualty the first aider would be expected to keep accurate records in an accident record book. This would include personal details of the casualty, their injury and what treatment they received. The employer may also ask the first aider for assistance in completing accident reporting forms. Data protection legislation requires that these details are kept securely. The first aider also has a duty to their patients to maintain their confidentiality and not to discuss their condition or treatment with others. It is important for first aiders to allow their patients to retain their dignity and modesty and to respect their privacy at all times.


Occupational first aid

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Personal and scene safety First aiders should not knowingly place themselves in a dangerous situation. You cannot help the casualty if you become a casualty yourself.

Injuries in the workplace may occur as a result of dangerous occurrences. The problems that caused the accident may persist and offer a threat to first aiders and subsequent rescuers. It is vital that the first aider is aware of this when attending an accident scene.

As you approach the scene look for threats to your own safety. These may be obvious such as moving traffic, fire or unstable structures, or much less obvious such as escaping gas or possibly the electric cable that the casualty is laying on and hiding. Be alert, use all of your senses and remember that although it may be safe to approach now things can change quickly, so keep monitoring the situation. There may also be a human element to contend with. If, for example, the casualty has been a victim of assault the aggressor may still be in the area, bystanders may get in the way or may be tempted to try and help the casualty in inappropriate ways. Identify yourself as a first aider and if you feel that you are the best qualified person at the scene attempt to take control. Delegate tasks such as controlling traffic or keeping people back from the casualty to other bystanders. It may be possible to use technically qualified people such as electricians to ensure the area is safe. If there are multiple casualties then bystanders might be used to help in first aid duties or just to reassure casualties with minor injuries, although you must bear in mind that the bystanders may have witnessed the events themselves and may also be in need of reassurance. Take control of the safety of the casualty and if necessary protect them from the inexpert attention of untrained people who are only trying to help but may cause further damage. In general terms, the seriously injured casualty should only be moved if it is to save their life, at least initially.


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Occupational first aid Standard infection control precautions Blood Born Pathogens Pathogens are microorganisms that cause disease. Blood-borne pathogens are viruses or bacteria that are present in human blood and body fluids and which can infect and cause disease in humans. The two most important of these are Human Immunodeficiency Virus (HIV) and the Hepatitis B virus (HBV).

The most common spread is through sexual transmission or IV drug use. However, any contact with infected body fluids or blood could potentially carry the risk of infection.

Personal Protective Equipment Personal protective equipment (PPE) may include clothing and equipment worn by an individual when undertaking activities which could result in exposure to blood-borne pathogens. ▪ PPE always starts with gloves but could include aprons and pocket masks. ▪ Gloves and aprons protect your clothing and hands from coming into contact with blood. Vinyl or nitrile gloves are preferred to latex as there is a possibility of a serious allergic response to latex ▪ Pocket mask refers to any one of several types of devices that may be used whilst performing CPR or rescue breathing. Safe Working Practice ▪ Treat all blood and body fluids as if they were infectious. ▪ Wear appropriate personal protective equipment. ▪ When delivering rescue breaths use a pocket mask equipped with a one-way valve. ▪ Contain spills immediately, then clean up and disinfect the area. ▪ Clean up contaminated sharps or broken glass with tongs, forceps or a brush and dustpan.

▪ Handle all waste as if it contains sharps or infectious material. ▪ After removing PPE wash hands and other affected areas with soap and warm water. ▪ Place all potentially infectious materials and contaminated items in closable containers or bags, clearly marked as infected waste or biohazard.

If you think you have been exposed ▪ Flush the area with warm water and then wash vigorously with soap and water. ▪ If you have an open wound, squeeze it gently to make it bleed. ▪ Seek emergency medical treatment following an exposure incident. ▪ Seek counselling regarding the risk of HIV or HBV infection and any other follow-up treatment that may be needed.


Occupational first aid Legal and ethical issues Trespass to the person Trespass to the person means a direct or an intentional interference with a person's body or liberty without consent. The main forms of trespass are likely to be Assault and Battery. Assault is the threat to do harm to a person which makes the person apprehensive. You do not have to physically touch someone to assault them. Battery is the intentional and direct application of physical force to another person. To commit battery you have to touch them.

Consent There are two ways in which consent may be given: 1. Expressed consent 2. Implied consent Expressed consent ▪ The casualty actually tells you that they want you to provide treatment for them. ▪ This consent can be verbal and non-verbal. ▪ Consent must be “ informed” which means they must understand and be aware of the procedure prior to giving consent. ▪ The casualty must be of minimum legal age to give consent (16) Implied consent ▪ This assumes that the casualty is unconscious and you believe that they would provide consent if they were able. ▪ You should never hesitate to treat an unconscious casualty, once it is safe to do so.

Negligence ▪ When a casualty suffers further harm or injury as a result of improper care carried out by a first aider then negligence may be alleged. ▪ It is important that first aiders act within their level of competence and training.

Confidentiality ▪ All casualty information is strictly confidential. ▪ You may give casualty information to: q Ambulance service q Doctor at scene q Staff in A and E q Other personnel directly involved in the casualty’s care

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Occupational first aid

Employers responsibilities Employers must comply with the Occupational First Aid Regulations which are part of the Safety, Health and Welfare at Work (General Application) Regulations 2007 By having first aid equipment and properly trained first aiders in the workplace immediate treatment can be given to the victims of illness or injury with the potential to save lives. The requirement for first aiders in a particular workplace would be based on the employer’s Assessment of Needs or Risk Assessment. The risk assessment should consider: ▪ ▪ ▪ ▪ ▪

The numbers employed The nature of the work The degree of hazard The accident record Size and location of the workplace

▪ ▪ ▪ ▪

Distribution of employees Shift working Availability of occupational health service Distance and time from external medical services

Contacting the first aider Means must be made available to contact the first aider when required. This might include telephone, mobile phone, pager or radio. Contacting the emergency services The contact details of local emergency services must be clearly displayed in the workplace. Emergency plans and procedures must be in place and appropriate people designated to take responsibility for contacting the emergency services.

First aid rooms Premises should have one or more first aid rooms if the risk assessment shows that they are necessary. The risk assessment would be based upon the following criteria: ▪ The size of premises ▪ The type of activity ▪ The frequency and severity of accidents

▪ Existence of special hazards ▪ Distance from appropriate medical facilities

The factors to be considered when planning, designing and equipping of first aid room include: ▪ The location, including proximity to work areas and access to emergency services ▪ The size of the room to accommodate sufficient equipment. ▪ Entrance wide enough to accommodate an ambulance trolley

▪ Appropriate floor covering with easily cleaned surfaces ▪ Supply of hot and cold running water ▪ Telephone or other means of communication


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Occupational first aid First aid kits and boxes

The provision of first aid kits in the workplace is the responsibility of the employer. The number and contents of the first aid kits would depend upon the results of the employer’s risk assessment. First aid equipment should be contained in a closed dust proof box of suitable size, clearly marked with the symbol for first aid, a white cross on a green background. A first aid box should contain only first aid equipment. Levels of equipment may vary depending upon the type of industry or work being performed and the numbers of employees. There may also need to be extra first aid boxes if employees are spread over a wide area or on several different floors of the building. The table provides a guide to the recommended contents of occupational first aid boxes and kits, based on numbers employed. Quantities indicated are minimum quantities and can be increased.

Travel

1-10

11-25

26-50

Materials Kit

persons persons persons

Adhesive plasters

20

20

20

40

Sterile eye pads (No. 16) with bandage

2

2

2

4

Individually wrapped triangular bandages

2

2

6

6

Safety pins

6

6

6

6

1

2

2

4

1

2

3

4

Individually wrapped antiseptic wipes

10

10

20

40

Paramedic shears

1

1

1

1

Examination gloves, pairs

3

5

10

10

2X20mls

1X500

2X500

2X500

Pocket facemask

1

1

1

1

Water-based burn dressing (10X10cm)

1

1

1

1

Water-based burn dressing large

1

1

1

1

Crepe bandage 7cm

1

1

2

3

Sterile unmedicated wound dressings Medium (No. 8) (10cm X 8cm) Sterile unmedicated wound dressings Extra large (No. 3) (28cm X 17.5cm)

Sterile water


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Occupational first aid Calling the Emergency Services 112 or 999 are the free 24-hour numbers to call for emergency help When you get through the operator will ask you which service you require. (An Garda Siochaná, Fire Service, Ambulance Service or Coast Guard) If you ask for an ambulance they will then take details of why you need help. The initial questions are to prioritise just how urgent the problem is. In particular they will ask you if the person you’re calling about is unconscious, has breathing difficulties or chest pain as these may be life-threatening and need the fastest response. ▪ Try to stay calm and to pass on to ambulance control as much information about the casualty’s condition as you can. ▪ Only pass on information you know to be true, guesses or assumptions may mean you are given inaccurate advice. ▪ Give as much information about your location as possible to help the ambulance crew find you. ▪ Don’t hang up until the ambulance controller tells you to. ▪ In an emergency the controller is trained to talk you through procedures or to remind you to do checks that you may not have thought of. This can be reassuring at a very tense time. ▪ If you are calling from the street then stay with the casualty. ▪ If you are calling from home then make sure doors are open and pets shut away. ▪ At night leave all your lights on to make it easier for the ambulance to find you. ▪ In the workplace it is often a good idea to send someone to the gate to meet the ambulance and direct them to the scene of the accident.

Stay calm, stay focused and stay on the line

112 The EU Emergency Phone Number These days most people carry a mobile telephone and it is likely that the emergency call would be made from this. If this is the case then dialling 112 instead of 999 may have some advantages. ▪ Over 70 countries including all of Europe use 112 as an emergency number. ▪ If your mobile doesn’t have a signal, when you dial 112 it will automatically search for and use any other mobile service which does have a signal. ▪ If your P.A.Y.G. Mobile is out of credit it will still call 112. ▪ With most modern mobiles if you have to call from someone else’s phone which is locked, it will still call 112 even without the password. ▪ 112 will work just as well as 999 from a land line telephone.


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Occupational first aid After the Incident Thankfully most first aiders are not often involved in matters of life or death. However, this is always a possibility and the first aider should be aware of it and be prepared for it. The sad fact is that some people’s injuries or illness may not allow them to survive, regardless of the treatment they receive, at the time or later. As long as the first aider does the very best that they can within the scope of their training then they will not be held responsible for the outcome. Unfortunately, sometimes the first aider may feel responsible and this can lead to ongoing psychological and physical problems. This can lead to a condition known as Critical Incident Stress (CIS) It is important to discuss your feelings and not bottle them up. It helps to speak to someone who will not be judgemental but who will be supportive. This may be as simple and straightforward as talking to family or friends. An alternative is to speak to your general practitioner who may be able to advise on any further treatment that is needed. There are also private counsellors who specialise in traumatic stress. For advice on self-help you can go to the website www.cism.ie The National Ambulance Service CISM committee has recently published a booklet called “Critical Incident Stress Management for Emergency Personnel” which can be bought by emailing: info@cism networkireland.ie


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Occupational first aid Unit 2 – patient assessment 1.1 Primary and secondary survey 1.2 Obtaining and recording vital signs 1.3 Signs and symptoms 1.4 Methods of medical identification 1.5 Assess levels of consciousness 1.6 Assess AcBC in trauma victim 1.7 Mechanism of injury and spinal injury risk 1.8 Handover procedures and documentation

Primary and secondary survey The Primary Survey This is a rapid initial assessment to find and simultaneously treat conditions that are immediately life-threatening. If you find a conscious casualty, who looks and acts normally and is speaking to you in a normal fashion it is likely that this element of the survey will be completed quite quickly. However, if the casualty is unresponsive or their condition suggests a much more serious problem then you will probably have to spend some time before you can move on to the next stage of assessment. To conduct a primary survey the first aider will simply need to follow the emergency response guidelines.

The Secondary Survey This is a detailed examination of the casualty to determine what other conditions or injuries they may be suffering from. During the secondary survey the casualty will be checked methodically for any clues as to their current condition. Ideally these checks should take place with the casualty in the position found, at least until you have ascertained that it is safe to move them. Whenever possible make a note of your findings. This may be important to subsequent carers. There are three elements to the secondary survey: ▪ History/mechanism of injury (MOI) ▪ Symptoms ▪ Signs


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Occupational first aid History / mechanism of injury (MOI) This refers to what happened or how it happened and will give important information or clues as to what may be wrong with the casualty. History should include what happened (history of the event) and also any previous history of similar events or illnesses. The information may be given by the casualty or by witnesses at the scene. There may also be physical clues at the scene. Where possible ask the casualty about previous episodes and try to find out if they are currently taking any medication, if they have any allergies and when they last had anything to eat or drink.

Symptoms

S = Signs / symptoms A = Allergies M = Medications P = Past medical history L = Last oral intake E = Event

Symptoms are the feelings that the casualty experiences due to the accident, injury or illness. The most common symptom described by the casualty following an injury is probably pain. Remember that pain is a good indicator that there is a problem but it may be a poor indicator of the severity of the problem. Some minor injuries may be very painful whilst more major injury may cause little or no pain. Ask the casualty about the nature of the pain, is it sharp, dull, burning or crushing? Is it constant or does it come and go? Does anything make it feel better or does anything make it feel worse? Other feelings the casualty may describe could include feeling hot or cold, dizziness or sickness and thirst. Listen to the casualty and always remember, they know how they feel better than you do.

Signs A sign is something that you find for yourself using your own senses. It may be something that you see, feel, hear or smell. Signs may include swelling, bruising, deformity or blood on the skin or clothing. A smell of alcohol on the breath may explain a change in level of consciousness but always be aware that this could be masking a serious medical condition. Skin colour or appearance may be significant, the casualty who is seriously ill tends to look seriously ill. It is important to look for signs in a methodical manner, to avoid missing things. Physical evidence that may be found could include such things as medical alert lockets or bracelets, adrenaline auto injectors for anaphylaxis, insulin injecting equipment or possibly insulin pump, asthma inhalers or other medications carried by the casualty for their own use.

Examining the Casualty It is important that you look closely and methodically at the casualty so as to find any indications as to what may be wrong with them. Remember, even the casualty may be unaware of the extent of their injury. It is equally as important that this examination should not just consist solely of pressing on the casualty to see if they have a painful response, as is frequently done. We should not be causing the casualty pain. It is often suggested that first aiders should feel or palpate areas such as the neck, spine or abdomen looking for abnormalities. This approach can be potentially misleading and dangerous for the following reasons: Most first aiders will never have examined enough normal bodies to know what is abnormal and could therefore never discount the possibility of injury based on their examination, it would not be safe to do so.


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Occupational first aid If anything about the history, mechanism of injury, signs or symptoms suggest the possibility of a particular injury or illness then we have to assume that to be the case until somebody better qualified can discount it. ▪ ▪ ▪ ▪ ▪

Check their pulse ▪ ▪

First aiders should also remember that their actions may be misunderstood so it is important not to start removing clothing or feeling underneath clothing unless there is a very good reason for doing so and wherever possible, after you have explained your actions to the casualty and gained their permission.

Assess the speed or rate in beats per minute. Note whether it is heavy or weak. The pulse rate corresponds to the heart rate. The easiest place to find a pulse is at the wrist, just below the base of the thumb and about 1 cm in from the edge. Feel with the pads of your fingers rather than the tips, as the pads are more sensitive. Count the number of times you feel a pulse in 30 seconds, multiplied by 2 to get the heart rate in beats per minute. Make a note of your observations and include the time that you measured it. You may want to take it again and any differences would be more important if you know how quickly things are changing.

Assess their breathing

▪ It is difficult to get an accurate assessment of the casualty’s breathing if they are aware that you are measuring it. When they are aware they tend to control their breathing, so to get an accurate assessment you need to distract them. The best way is to measure the pulse for 30 seconds and keep your fingers in place for the next 30 seconds but instead of measuring the pulse just watch their breathing without them knowing. You will need to measure and record: ▪ The number of times they breathe in 30 seconds multiplied by 2 to give breaths per minute. ▪ Is it deep or shallow? ▪ Does it seem easy or laboured? ▪ Is it quiet or is it noisy? ▪ Are they coughing? If so are they coughing anything up?

Look at their face

▪ Look for blood or watery liquid, or possibly a mixture of both, leaking from the nose or ears. ▪ Look for bruising around the eyes particularly where there is no damage to the face. ▪ Look for damage inside and around the mouth which may later lead to airway problems. ▪ Look at the colour of the skin, in particular look for a blue or grey appearance of the lips or earlobes (cyanosis) which might indicate a shortage of oxygen. ▪ Look for obvious signs of blood or swelling around the head or in the hair. ▪ Check the pupils of the eyes to see if they are of equal size.


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Occupational first aid

Check the neck

Look at the chest

Check the abdomen

Loosen any tight clothing around the neck. Ask them to keep their head and neck still. Look for and remove any ligature. Look for bruises or abrasions that might suggest strangulation. Look for bruising and swelling around the neck. Ask the casualty if they have any pain in the neck. Ask them if they have any strange sensations in their arms and legs. ▪ Check for pins and needles or burning sensations in the extremities. ▪ Do not be tempted to press on the spine, if the history of the incident suggests spinal injury then assume it. ▪ ▪ ▪ ▪ ▪ ▪ ▪

▪ Look for signs of obvious injury such as blood on the clothing. ▪ Ask them to take a deep breath and watch their face for signs of discomfort. ▪ Listen for coughing or noisy breathing. ▪ Does the chest move equally on both sides? ▪ Listen for any unusual sounds particularly a sucking sound on breathing in or a bubbling sound on breathing out. ▪ Look at the collarbones for evidence of bruising, swelling or deformity. ▪ ▪ ▪ ▪ ▪

Ask the casualty if they have any abdominal pain. Is the pain in any particular area of the abdomen? Has the pain stayed in one place or moved? Do they feel sick or have they vomited? Do not be tempted to press on the abdomen to see if it is painful to touch.

Check their arms

Ask them if they have any pain in their arms. Ask the casualty if they can move their arms normally. Do they have full movement in their elbows and wrists. Look for signs of obvious injury such as blood, swelling or deformity. ▪ Ask the casualty if they have any strange sensations such as pins and needles or burning sensation in the arms and hands. ▪ Check the casualty’s grip by getting them to squeeze your fingers. ▪ Check both sides at the same time to compare.

Check the legs

▪ Ask them if they have any pain in the legs. ▪ Ask them if they can move their legs normally. ▪ Compare one leg with the other. Do they look the same size and shape? Are they pointing in the right direction? ▪ Do they have any odd sensations such as pins and needles in the legs and feet. ▪ If possible feel and look at the skin of the feet. If it is cold to touch or grey/blue in appearance it could indicate injury or circulatory problem.

▪ ▪ ▪ ▪


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Occupational first aid

Check beneath them

Check clothing and pockets

▪ Slide your hands gently underneath their torso as far as it is comfortable to reach. ▪ Start either side of the chest below the armpit and slide down towards the waist. ▪ Check for blood or dampness that might indicate injury. ▪ Do not press on the casualty and in particular do not press on the casualty’s spine. ▪ ▪ ▪ ▪

Look for any information that might explain the condition. Are they carrying any medication? Look for Medic alert or SOS Talisman lockets or bracelets. Remove sharp or bulky items from pockets, where they may cause a problem if the casualty is rolled or moved.

Check their level of consciousness Check the level of consciousness using the AVPU scale

A Alert

▪ Fully Conscious and Aware ▪ Eyes open spontaneously

▪ Reacting normally to events ▪ Reflexes are normal

V Verbal

▪ Appears sleepy with eyes closed ▪ Eyes open to speech or sound ▪ Speech may be slurred

▪ May make uncoordinated movements ▪ Reflexes are intact

P Pain

▪ Appears deeply asleep with eyes closed ▪ Does not open eyes to speech

▪ Little or no muscular coordination ▪ Functioning reflexes

U Unresponsive

▪ Appears deeply asleep with eyes closed ▪ Does not open eyes

▪ Does not respond to any stimulus ▪ Reflexes absent

Vital Signs - normal values Pulse rate The normal pulse rate for an adult at rest is said to be 60 to 100 beats per minute although some individuals may normally fall outside this range. The pulse rate, or heart rate may change with such factors as exercise, excitement, fear and illness. Breathing rate As with the pulse rate the normal breathing rate is a range of values, usually said to be between 12 – 20 breaths per minute. The factors that tend to increase heart rate will also tend to increase breathing rate. Temperature Most first aiders are not equipped to take a temperature but a rough estimation can be made by looking and touching. Does the casualty’s skin look flushed or red? If you touch it lightly with the back of your hand does it feel warm or cold? Is it dry, or damp and clammy?


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Occupational first aid Record-keeping

When you are examining or treating a casualty it can be very helpful to keep records of what you see and what you do. Wherever possible try to keep records as you go along. This is likely to be much more accurate than your memory after the event. When keeping records of events it is also very useful to note the time that certain things happened or when certain observations were made. By looking at the time scale it becomes not only easy to see how the casualties condition is changing but also how quickly or slowly their condition is changing. These records should be made available to the practitioner who takes over the care of your casualty. This can be in the form of your written records along with a verbal explanation of what you have seen and what you have done. Sometimes a simple observation that may not mean very much to you could be very important to a better trained or more experienced practitioner.

Accident Records All accidents and incidents that occur in the workplace should be reported and recorded. A book for this purpose can be bought from most stationers or first aid equipment suppliers. The records and the way they are kept should comply with the Data Protection (amendment) Act 2003 The record may be completed by anyone but should include: ▪ the date, time and location of the incident. ▪ the personal details of the injured party. ▪ details of the injury or illness and what first aid treatment was given.

▪ what happened to the casualty after treatment (went home, hospital etc.) ▪ the name and signature of the person completing the record.

Accident Reporting Some accidents should be reported to HSA General injuries involving employees and self-employed Accidents, where a person is injured at a place of work and cannot perform their normal work for more than 3 consecutive days, not including the day of the accident, are reportable. •Road traffic / vehicle accidents involving employees and self-employed Such accidents are reportable if the person was injured while driving or riding in the vehicle in the course of work, and cannot perform their normal work for more than 3 consecutive days, not including the day of the accident. General injuries involving members of the public Accidents related to a place of work or a work activity where a person requires treatment from a medical practitioner are reportable. Accidents related to medical treatment or a pre-existing medical condition are not reportable. Road traffic/vehicle accidents involving members of the public Road traffic accidents are only notifiable if they relate to vehicle loads or to the construction or maintenance of roads or structures adjacent to roads.


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Occupational first aid

Emergency Response The appropriate first aid response to an emergency may vary due to what has happened to the casualty. Has the casualty suffered accidental injury or trauma or has the casualty collapsed suddenly for no obvious reason, or possibly after complaining of feeling unwell?

Emergency Response - trauma Approach with care

▪ Be aware of potential danger to yourself, bystanders or the casualty. ▪ What have people told you about the nature of the incident? ▪ Think about the use of infection control procedures, particularly gloves, as you approach the casualty.

Control of catastrophic external haemorrhage

▪ If the casualty is bleeding uncontrollably, use pads and direct pressure to control the bleeding. ▪ Use others at the scene to apply direct pressure if appropriate.

Control cervical spine

Assess response Open airway If the airway is   obstructed

Check for normal breathing

Maintain care

▪ If anything about the incident suggests the possibility of spinal injury, then immobilise the head and neck. ▪ Use others at the scene to keep the head and neck immobilised where appropriate. ▪ If the casualty is unresponsive call 112/999 for help and request an AED if one is available. ▪ Open the airway with head tilt/chin lift. ▪ Take measures to clear the airway. ▪ If not breathing normally start CPR. ▪ If breathing normally but unresponsive, place them into the recovery position. ▪ If breathing normally and responsive look for and treat life-threatening conditions. ▪ Measure and record vital signs such as pulse, respirations and level of response. ▪ Gather together information and call 112/999 for ambulance assistance if required. ▪ ▪ ▪ ▪

Continue to monitor the casualty’s condition. Reassure continuously. Carry out first aid procedures as appropriate. Handover to appropriate practitioner.


Occupational first aid

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Emergency Response - sudden collapse

Approach with care

Assess response Open airway If the airway is   obstructed

Check for normal breathing

▪ Be aware of potential danger to yourself, bystanders or the casualty. ▪ What have people told you about the nature of the incident? ▪ Think about the use of infection control procedures, particularly gloves, as you approach the casualty. ▪ If the casualty is unresponsive call 112/999 for help and request an AED if one is available. ▪ Open the airway with head tilt/chin lift. ▪ Take measures to clear the airway. ▪ If breathing normally but unresponsive place them into the recovery position (see page 62) ▪ If not breathing normally: Telephone 112/999 for an ambulance. Commence chest compressions. ▪ Continue CPR at 30:2 until AED arrives, the patient shows signs of recovery or an appropriate practitioner takes over from you.


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Occupational first aid Unit 3 – Respiratory Emergencies 1.1 The respiratory system 1.2 Signs and symptoms of respiratory problems 1.3 Foreign body airway obstruction 1.4 Using barrier devices 1.5 Opening the airway 1.6 Rescue breathing 1.7 Asthma

The Respiratory System Nose

Bronchus

Bronchiole

Vein

Alveoili

Tongue Larynx Trachea Rib Sternum Lung

Diaphragm

Artery

Capillaries

Breathing Breathing is controlled by a collection of nerve cells in the brain called the respiratory centre. These respond to changes in the level of carbon dioxide dissolved in the blood; as the level rises it triggers a breath. The act of breathing is controlled by muscles, particularly the intercostal muscles between the ribs, and the diaphragm, a large dome shaped sheet of muscle which separates the chest cavity from the abdominal cavity.


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Occupational first aid When muscles are stimulated by the nervous system they contract. The contraction of the intercostal muscles has the effect of pulling the ribs upward and outward, whilst the dome shaped diaphragm flattens out and pulls downward like a piston inside a cylinder. The combined effect is to make the volume of the chest cavity larger, creating lower air pressure inside the chest than in surrounding air. This sucks air in via the nose and mouth, down the windpipe or trachea and into the lungs. In the lungs oxygen passes into red blood cells which are in the tiny capillaries surrounding the air sacs or alveoli. At the same time carbon dioxide is given off from the blood and passes into the lungs to be expelled as waste as we breathe out. We call this process gas exchange.

Oxygen and Respiration Oxygen is a gas that forms around 21% of the air that we breathe. It is essential to life, being used by every cell in the body to help convert fuel into energy (metabolism) Our bodies store very little oxygen, just a few minutes worth, so as we need a consistent supply we need to continuously replace it by respiration. If our bodies become short of oxygen, the condition is known as Hypoxia.

Causes of Hypoxia Environmental Could be due to a lack of oxygen in the ambient air, due to altitude or other causes. Impaired Ventilation Normal ventilation depends upon the mechanical effect of the contracting diaphragm and inter-costal muscles to alter the volume of the chest cavity, thus creating a difference in pressure and drawing air in, to be trapped in the lungs. Factors that could interfere with this might include damage to the chest wall or an obstruction to the airway preventing air from reaching the air sacs.

Recognition of hypoxia Hypoxia may be difficult to see in the early stages, as signs and symptoms may be absent or may vary from individual to individual. Signs ▪ ▪ ▪ ▪

Rapid breathing Cyanosis Lethargy Poor judgement

Symptoms ▪ ▪ ▪ ▪ ▪ ▪ ▪

Dizziness Headache Breathlessness Fatigue Nausea Visual impairment Euphoria


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Occupational first aid

Foreign Body Airway Obstruction

Recognition The problem often occurs whilst eating. They will often stand up and clutch their neck. They may look anxious or distressed. They may be attempting to cough. They will often attempt to leave.

Treatment Encourage them to cough. If the obstruction is not complete this will clear the airway. If they are coughing do not slap them on the back, this may encourage the object to drop further into the throat.

Back blows Give up to 5 back blows. Bend them forward supporting them on the shoulder. Give up to 5 blows with the heel of the hand between the shoulder blades. Check effectiveness after each blow.

Abdominal thrusts Stand behind the casualty and reach with your arms around the upper abdomen, between the belly button and the point of the breastbone.

Abdominal thrusts Make a fist with one hand and place the fist, thumb end first, against the soft part of their abdomen, just below the point of the breastbone. Grasp your fist with your other hand.

Abdominal thrusts Pull sharply backward and upward, bending from the elbows, at an angle of about 45° to the horizontal.

If the casualty is unconscious or becomes unconscious: ▪ ▪ ▪ ▪

Lower them carefully to the ground. Make sure an ambulance is called. Immediately start CPR with 30 chest compressions. Continue CPR until they are breathing normally.

Repeat up to 5 times, checking after each thrust.


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Occupational first aid Choking - Children and Infants

The majority of choking events occur whilst the child is eating or playing, often when a carer is present. If these events are witnessed, treatment is usually carried out quickly whilst the child is still conscious. When a child chokes the immediate response is coughing. This is likely to be the most effective and safest way of removing the obstruction. If coughing is not effective however, or the foreign body completely obstructs the airway, treatment needs to be immediate.

Awareness You might suspect choking on a foreign body if: ▪ the child develops very sudden breathing problems. ▪ there are no other signs of illness or other obvious explanation. ▪ the child was playing with small objects or eating immediately prior to the event.

General signs of choking Effective cough ▪ Loud cough ▪ Able to speak or cry ▪ Able to breathe before coughing ▪ Fully conscious

Ineffective cough ▪ Silent or quiet cough. ▪ Unable to speak or cry ▪ Unable to breathe ▪ Decreasing level of consciousness ▪ Blue colouration (cyanosis)

Treatment - child ▪ Follow the general guidelines for obstructed airway in an adult. ▪ Moderate the force required for back blows and abdominal thrusts. ▪ If not effective dial 999/112 for an ambulance.

Treatment - infant If the infant is unable to cry or breathe: ▪ Lay them down along one arm, supporting the head with the hand. Make sure the head is lower than the body. ▪ Give five blows in the middle of the babies back using the heel of the other hand. ▪ If the obstruction is relieved, it is not necessary to give all five blows. ▪ Check the baby’s mouth and remove any foreign material found. ▪ If back blows are unsuccessful, give five chest thrusts. ▪ Place two fingers on the breastbone about a fingers width above the point where the ribs meet. ▪ Give up to 5 sharp downward thrusts, similar to chest compressions but sharper and at a slower rate. ▪ The aim is to relieve the obstruction, not necessarily to give all five chest thrusts. ▪ Check the baby’s mouth for any foreign objects, which should be removed. ▪ If necessary repeat the sequence of back blows and chest thrusts three times, and if still unsuccessful take the baby with you to the telephone to call an ambulance.


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Occupational first aid

If the baby is unconscious ▪ Place them on a firm flat surface. Call or send for help if possible, but do not leave the baby. ▪ Open the mouth and look for any obvious foreign objects and remove them if possible. ▪ Attempt to give five rescue breaths. Assess the effectiveness of each breath, if the breath does not make the chest rises reposition the head before attempting the next breath. If the chest does not rise: ▪ Immediately start chest compressions combined with rescue breathing at a rate of 30 compressions followed by two breaths. ▪ When opening the airway to give rescue breaths, check the mouth for obstructions and remove them if possible. ▪ Continue until the baby is breathing normally or help arrives.

The Obstructed Airway/Choking Summary Signs of choking Ask Are you choking?

Prevent leaving

No

Effective cough?

Yes

Severe obstruction

Unresponsive?

Mild obstruction

Up to 5 back blows

Dial 112/999

Encourage cough

Not relieved?

Chest compressions

Up to 5 abdo thrusts

Continue CPR at 30:2 until obstruction is relieved and casualty is breathing normally

Continue to monitor for deterioration to ineffective cough or relief of obstruction

Alternate 5 back blows with 5 abdominal thrusts


23

Occupational first aid Penetrating Chest Injury

The inside wall of the chest and the surface of the lung are lined with a double skinned membrane called the pleura. If the chest wall is punctured the suction effect caused in normal breathing may draw air in through the puncture wound and into the space between the layers of the pleura– a pneumothorax. Air trapped in this space will prevent the lung from expanding or cause the lung to collapse on the affected side. If the puncture wound is large enough the suction effect at the nose and mouth will also decrease, leading to less air entering the good lung.

Pneumothrax

Collapsed lung

▪ History of injury to the chest. ▪ Blood on the clothing or skin. ▪ The injury may be on the front or the back of the chest. ▪ Sucking sound on breathing in (air being drawn in through the wound) ▪ Bubbling sound on breathing out (air being expelled from the wound) ▪ Shortness of breath/difficulty breathing. ▪ Pale skin, possibly cyanosed. ▪ May be coughing up frothy blood

Air is drawn in or expelled

Dial 999 / 112 for an ambulance. Place the casualty in a sitting or half sitting position, leaning towards the injured side.

Seal the wound with the palm of your hand or anything that will make an airtight seal.

Cover the wound with plastic or other airtight material. The plastic should be at least 2” wider than the wound all-round. Tape the plastic on three sides leaving the bottom edge open to allow for drainage of air and blood.


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Occupational first aid

Asthma Asthma is a condition which affects the lungs. In an acute asthma attack, the tiny air pipes which carry air to the air sacs become narrowed due to inflammation and muscle spasm of the wall of the pipe. This leads to difficulties in passing air through them, causing a feeling of tightness in the chest and difficulty in breathing. Normal Asthmatic As the air is forced through the narrow pipes it causes a bronchiole bronchiole wheezing sound. Most asthma sufferers will have been diagnosed by their doctors and will be receiving treatment in the form of drugs which suppress the condition (avoidance) and drugs which relax the spasm of the air pipes (treatment) These drugs are usually given in the form of an inhaler or puffer which squirts a mist of drug into the mouth. It is then inhaled into the lungs and passes into the bloodstream. If a patient is having an acute attack they require a drug which will relax their spasm. This will be in a blue inhaler.

Acute asthma attack - recognition Possible known history of the condition. Difficulty in breathing. Chest feels tight. May feel as if there is a heavy weight on the chest. ▪ Coughing. ▪ ▪ ▪ ▪

▪ ▪ ▪ ▪ ▪

Noisy, wheezing breathing. Difficulty in walking or talking. Breathing may get faster. Cyanosis (blue lips/complexion) Anxiety and distress.

Acute asthma attack - treatment ▪ ▪ ▪ ▪ ▪ ▪ ▪

▪ ▪ ▪

Place them at rest in a sitting position. Leaning forward on to a table or chair back can be helpful. Reassure. Encourage them to breathe slowly and deeply. Encourage them, or help them, to use their blue reliever inhaler. They should take one or two puffs immediately. If they do not start to feel better they should take two puffs of their reliever inhaler (one puff at a time) every two minutes They can take up to 10 puffs. If they do not feel better after taking their inhaler as above or if you are worried at any time, call 999/112. If an ambulance does not arrive within 10 minutes and they are still feeling unwell, they should resume using their inhaler, two puffs every two minutes, up to 10 puffs in total.


Occupational first aid

25

Respiratory arrest Respiratory arrest occurs when the casualty stops breathing. If may be associated with a cardiac arrest or it may occur following an upper airway obstruction. Other causes could include a lack of respiratory drive or paralysis or weakness of the respiratory muscles, If the heart stops beating (cardiac arrest) then the casualty will go into respiratory arrest at more or less the same time. Treatment would be cardiopulmonary resuscitation as for cardiac arrest. If circulation can be restored then it is likely that respiration will be restored along with it. A lack of respiratory drive refers to a condition where the impulses that make us breathe from the respiratory centre in the nervous system are not strong enough to trigger a breath. This could follow damage to the nervous system such as head injury or fractured cervical spine and often follows an overdose of certain types of drugs, particularly morphine-based drugs and some sleeping tablets. The overdose may be accidental or intentional. Weakness or paralysis of the respiratory muscles could result from damage to the spinal-cord or as a side-effect of certain drugs. The most common cause of respiratory arrest is likely to be upper airway obstruction. This may be foreign body airway obstruction or in the unconscious casualty it is most likely to be due to the tongue falling backward and blocking the airway. It may also because by blockage from blood, mucus or stomach contents.

Respiratory arrest - recognition Unresponsiveness Absence of spontaneous breathing No chest rise and fall Progressive colour change caused by lack of oxygen (cyanosis) ▪ Inability to feel air coming from the mouth and nose. ▪ ▪ ▪ ▪

Respiratory arrest - treatment Treat the foreign body airway obstruction Open the airway with head tilt/chin lift Ensure an ambulances is called Offer basic life support with chest compressions and rescue breaths as appropriate. ▪ Maintain basic life support until the arrival of the ambulance.

▪ ▪ ▪ ▪


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Occupational first aid

Open the AIRWAY ▪ Undo anything tight round the neck. ▪ Remove their glasses if worn. ▪ Place one hand on the forehead and two fingers of the other hand under the bony part of the jaw. ▪ Gently rotate the head backward and lift the jaw (head tilt / chin lift) ▪ This lifts the tongue and straightens the airway.

Deliver RESCUE BREATHS Air in the atmosphere contains about 21% oxygen. When we breathe we only use what we need, about 4%, so the air that we breathe out still contains around 17% oxygen. This is more than enough to maintain life in our casualty.

Use the fingers of the hand performing the head tilt to pinch the nose closed. Take a normal breath.

Seal your lips around their mouth and blow steadily until the chest rises. Each breath should be sufficient to cause the chest to rise as in normal breathing

Release the nose and keeping the airway open let them breathe out. Re-seal your lips and give another rescue breath. Give two breaths in total.

▪ Each breath should take about one second to deliver. ▪ Watch the chest as the breath is delivered to ensure that it rises. ▪ If you experience problems giving an effective breath it is probably because the airway is not clear. ▪ Recheck the mouth and remove any visible obstruction. ▪ Make sure the head is tilted and the jaw is lifted correctly and that you have a good seal around their mouth. ▪ Repeat your attempts to give effective breaths but do not attempt more than two breaths before returning to chest compressions.


27

Occupational first aid Unit 4 – Cardiac First Response 1.1 The chain of survival 1.2 Basic life support and C.P.R. 1.3 Using an AED 1.4 Heart attack 1.5 Stroke 1.6 Sudden cardiac arrest 1.7 Calling emergency services

The Chain of Survival The chain of survival demonstrates the steps that are necessary to increase the casualty’s chance of surviving sudden cardiac arrest. Their chances will be greatly improved when all of the links are in place.

Early access

Early CPR

Early defib

Advanced care

Early access Early access to ambulance control will allow the dispatcher to offer assistance in diagnosis of sudden cardiac arrest as well as offering telephone instruction on the performance of CPR. The ambulance controller may also be able to locate and dispatch the nearest AED. Early CPR CPR alone is not particularly effective in reversing sudden cardiac arrest but it may be helpful in keeping the brain and other organs better oxygenated until the arrival of the AED. Early defibrillation Modern AEDs are safe and effective and the sooner they are applied the better the outcome is likely to be. CPR should continue, with minimal interruption to chest compressions, while the AED is connected. Concentrate on listening to and following voice prompts. Early ACLS Advanced cardiac life support is essential to maintain life following cardiac arrest.


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Occupational first aid

Basic Life Support - Adult Sequence Approach with CARE Make sure that there is no danger to yourself, the casualty or bystanders.

Check response and breathing ▪ Check initially in the position that you find them. ▪ Speak loudly to them. ▪ Use their name or ask them to open their eyes. ▪ If no response, shake them gently by the shoulder. If they respond: ▪ Leave them in the position that you found them. ▪ Check to find out what might be wrong. ▪ Observe and reassess regularly. If they do not respond: ▪ Shout loudly for help.

▪ Whilst checking for response perform a quick check for normal breathing. ▪ It is not uncommon, immediately after a cardiac arrest, for the casualty to be taking what appear to be short irregular gasps for breath. (Agonal breathing) ▪ This should not be mistaken for normal breathing.

If they are BREATHING NORMALLY ▪ Examine them carefully for any immediately life-threatening injury such as severe bleeding and treat if possible. ▪ Turn them carefully into the recovery position as soon as it is practical to do so.

If they are NOT BREATHING NORMALLY ▪ Ensure that an ambulance has been called and that an AED has been sent for. ▪ Deliver 30 chest compressions

Call an AMBULANCE (999) ▪ If the casualty is not breathing normally, or you are unsure, dial 999 for an ambulance immediately. ▪ You could send somebody else to do this, should they be available but if you have a mobile phone and can call an ambulance without leaving the casualty, this may be a better idea. ▪ If your telephone has a speakerphone then switch it on. ▪ The emergency medical dispatcher will be able to reassure and support you as they talk you through the procedure for performing CPR. ▪ They will also ensure that the nearest available AED is sent to your location as quickly as possible.


29

Occupational first aid Deliver CHEST COMPRESSIONS

Chest compressions should be performed with the casualty laying flat on their back on a firm surface. It should not be necessary to undress the casualty or expose the chest, unless they are wearing very heavy outer clothing. (Clothing removed in illustrations for clarity)

Kneel by their side, level with the chest. Place the heel of one hand in the centre of the chest on top of the lower half of the breastbone.

Place the heel of the other hand on top of the first. Interlock your fingers to stop them pressing on the chest wall

Position yourself so that your shoulders are directly above their chest, the arms are straight and the elbows are locked.

Push straight down on their chest to a depth of 5 to 6 cm. Release the pressure completely between strokes, keeping your hand in contact with the chest. Movements should be smooth and not jerky. Erratic or violent movements may injure them and will not pump blood efficiently. ▪ Compress the chest at a rate of 100 to 120 compressions per minute. 5-6 ▪ It is important to maintain the quality, rate and depth of the cms compressions.

▪ ▪ ▪ ▪

Your performance is liable to deteriorate as you get tired, so for this reason it is recommended that if another rescuer is available and can perform chest compressions you should change over every two minutes.


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Occupational first aid

Open the AIRWAY ▪ Undo anything tight around the neck and remove their glasses, if worn. ▪ Place one hand on the forehead and two fingers of the other hand under the bony part of the jaw. ▪ Gently rotate the head backward and lift the jaw. ▪ This lifts the tongue and straightens the airway.

Deliver RESCUE BREATHS Air in the atmosphere contains about 21% oxygen. When we breathe we only use what we need, about 4%, so the air that we breathe out still contains around 17% oxygen. This is more than enough to maintain life in our casualty. Take no more than 10 seconds to deliver to rescue breaths

Use the fingers of the hand performing the head tilt to pinch the nose closed. Take a normal breath.

Seal your lips around their mouth and blow steadily until the chest rises. Each breath should be sufficient to cause the chest to rise as in normal breathing

Release the nose and keeping the airway open let them breathe out. Re-seal your lips and give another rescue breath. Give two breaths in total.

▪ Each breath should take about one second to deliver. ▪ Watch the chest as the breath is delivered to ensure that it rises. ▪ If you experience problems giving an effective breath it is probably because the airway is not clear. ▪ Recheck the mouth and remove any visible obstruction. ▪ Make sure the head is tilted and the jaw is lifted correctly and that you have a good seal around their mouth. ▪ Repeat your attempts to give effective breaths but do not attempt more than two breaths before returning to chest compressions.


Occupational first aid Cardio Pulmonary Resuscitation (CPR) CPR means combining chest compression with rescue breathing ▪ Give 30 chest compressions followed by two rescue breaths. ▪ Ratio 30:2. Continue until: ▪ The casualty shows obvious signs of recovery, such as opening their eyes or coughing. ▪ Someone else takes over from you. ▪ You are alone and too exhausted to continue.

Chest compression only resuscitation Research has shown that chest compression only resuscitation may be as effective as ventilation/compression in the first few minutes following a sudden cardiac arrest, if the cardiac arrest was not caused by a breathing problem. If you are unable or unwilling to give rescue breaths, continue with compression only resuscitation. Give chest compressions to a depth of 5 - 6 cm at a rate of 100 - 120 compressions a minute. Continue chest compressions without a break, stopping to check the casualty only if they show obvious signs of recovery.

Regurgitation during CPR Regurgitation is common during resuscitation attempts. If it occurs: ▪ Turn them on to their side, facing away from you. ▪ Support their weight on your legs to prevent them from rolling back. ▪ Ensure their head faces down and that their open mouth is at the lowest point to ensure drainage. ▪ Remove debris from the mouth with your fingers. ▪ Place them on to their back and resume CPR as soon as possible.

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Occupational first aid

When the A.E.D. arrives An AED can be used safely by almost anyone, so its use is not restricted to trained rescuers. However training is preferred to improve performance, leading to a better outcome. When using an AED keep interruptions to chest compressions to a minimum. Do not stop to check the casualty or discontinue CPR unless they show obvious signs of recovery, such as opening their eyes, speaking or starting to breathe.

The AED The appearance of individual AEDs may vary from maker to maker but they will all have similar layouts and properties. The essence of AED design and use is simplicity and so you should be able to use any AED in exactly the same sequence. One type of AED may be used for illustration but the instructions apply equally to all.

Activate the AED ▪ Some AEDs will automatically switch on when you open the lid. ▪ With others you may have to press the ON button.

Attach the pads ▪ Remove the pads from any outer packing. ▪ Look carefully at the instructions on the pads. ▪ Peel off any backing paper and stick the pads onto the casualty’s chest as shown. ▪ One pad should be placed below the right collar bone, next to the breastbone. ▪ The other pad should be placed below the left armpit, on the side of the chest wall, over the lower ribcage. ▪ It is not important which way round the pads are placed.

Pad placement ▪ The casualty’s chest should be exposed to enable correct pad placement. ▪ If the chest is wet it may prevent the pads from sticking and making a good contact. Towel dry is usually sufficient. ▪ Excessive chest hair may also prevent effective contact. The area where the pads are to be placed should be quickly shaved if possible. ▪ Do not delay defibrillation if a razor is not immediately available. ▪ It is important that the left side pad is placed well back to the side of the rib cage. ▪ If it is too close to the front, current travelling from pad to pad will travel across the front of the chest, missing the heart. ▪ With the pad placed well to the side the current will travel from pad to pad through the heart muscle.


Occupational first aid

Analyse ▪ Keep clear during analysis. ▪ Ensure that nobody touches the casualty whilst the AED is analysing the heart rhythm, as this may lead to inaccurate results. ▪ Do not stop chest compressions for more than 10 seconds during analysis. ▪ Follow voice prompts.

No shock indicated ▪ If the voice prompts direct you to start CPR, start chest compression and rescue breathing immediately. ▪ Maintain CPR for two minutes or until prompted to stop. ▪ Continue to follow voice prompts.

SHOCK INDICATED ▪ Ensure that everybody is clear of the casualty. ▪ Press the shock button as directed. ▪ After the shock is delivered continue CPR for two minutes, or until directed to stop. ▪ Allow the AED to analyse. ▪ Continue to follow voice prompts.

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Occupational first aid

AED flowchart AED Analyses rhythm

Shock advised

NO shock advised

Give one shock

Resume CPR For 2 minutes

Resume CPR For 2 minutes Continue until they start To breathe normally AED Safety An AED is like any other electrical appliance in that certain safety precautions should be observed to minimise the risk of injury to the operator, assistants or even the casualty. ▪ Keep the electrodes (pads) separate: do not allow them to touch when the machine is switched on. This could complete the circuit and could be dangerous. ▪ Never connect the pads to anyone except a casualty in suspected cardiac arrest: A live AED should never be connected to anyone for demonstration or training purposes. ▪ Be aware of patches on the skin: some medications, particularly GTN, may be administered via skin patches. Avoid placing the electrodes directly over the patch. ▪ Be aware of implants: Devices such as pacemakers or cardioverters may be implanted under the skin. Their presence is often marked by a scar or bump. They are most commonly found high on the left side of the chest and so are not often a problem for pad placement. Try to keep pads 10 cm away if possible. ▪ Be aware of inflammable environments: Because of the risk of sparks the casualty may have to be removed from an area containing inflammable vapours, before a shock is given. Pacemaker implant ▪ Risk of shock to others: if the pads are making good contact then there is very little risk of shock to others, even in a wet or conductive environment, as long as they are not in direct contact with the casualty. Current will travel from one pad to the other and not into the surrounding area.


Occupational first aid AED Storage ▪ The AED should be stored in a secure but easily accessible location. ▪ Storage should be clean and dry. ▪ If located in a public area security may be maintained by having the unit enclosed in a cabinet with a breakable seal arrangement. ▪ Cabinets should have a clear door so that the AED is clearly visible. ▪ They should also allow easy checking of the unit’s flashing “ready” light. ▪ Many cabinets will also have an alarm that is activated when the unit is removed or the door opened. ▪ This may be audible or visual, for example a flashing strobe light. ▪ The location of the AED should be clearly signed using the accepted international sign.

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Occupational first aid

Hygiene and Personal Protection Administering basic life support offers little threat to the rescuer. There is a perceived threat from blood-borne viruses such as HIV or hepatitis, but realistically this is a blood problem. They will not be transmitted giving or receiving rescue breathing. However, many people are reluctant to offer rescue breathing because of this perceived risk or because of contamination of the casualty’s face with vomit or blood. If this is the case they may be more comfortable using some form a barrier between themselves and the casualty. To be effective these barriers should contain a one-way valve. They come in two main forms: ▪ Face shields ▪ Facemasks

Face shields Face shields consist of a polythene or plastic sheet with a reinforced hole that fits over the casualties nose and mouth. The hole may be protected with non-woven material or may contain a simple one-way valve. The sheet is laid across the face of the casualty and the rescuer blows through the hole. The advantage of this equipment is that it is inexpensive, easy-touse and compact, so that it can easily be carried with the rescuer ready for use.

Facemasks Facemasks are larger and more substantial, often coming in a case. Most masks will have a one-way valve. Some may have an attachment for oxygen tubing. They require slightly more training and practice to be used effectively, but give a greater feeling of security to the rescuer. They fit over the nose and mouth of the casualty and the rescuer blows through the valve until the chest rises.

Keeping the airway open with head tilt and chin lift, the facemask is placed over the casualty’s nose and mouth.

The rescuer then blows through the one-way valve. The casualty’s expired air is deflected from the rescuer by the valve.

The mask may be held in place more easily using both hands in an “over the top” position with the rescuer at the head of the casualty


Occupational first aid

37

Resuscitation of Children People are often worried about performing basic life support techniques on children. The most important thing is to do something rather than to hesitate trying to remember different protocols or worrying about doing harm. If in doubt children should receive the same treatment as adults. The only change is that the chest should be compressed to one third depth. If you can remember the differences however then the following changes may be beneficial.

Open the airway with head tilt/ chin lift. Check for normal breathing. Take no more than 10 seconds

If they are not breathing normally start with 30 chest compressions. Continue CPR (30:2) for two minutes before calling for an ambulance

Continue CPR until the arrival of the AED or ambulance crew. Connect the AED and follow the voice prompts. If unable to ventilate, perform compression only CPR

AEDs and children Thankfully it is rare to have to use an AED on a child. Their use however can be life saving in some circumstances. There may be a potential problem with some AEDs as they are calibrated to recognise adult abnormalities and deliver a shock which is appropriate for an adult. The strength of this shock through a child’s heart may be sufficient to cause damage to the heart muscle, to the point of making resuscitation impossible. Therefore, if you are in a situation where there is a likelihood of having to treat a child, it would be a good idea to have a set of child pads stored with the AED. These pads and leads are designed to reduce the power of the shock delivered to the child and to limit any possible damage to the heart. In most cases the pads are designed to be placed in the same position as adult pads but if the child is very small and there is insufficient room on the chest wall then the pads can be placed centrally on the chest and upper back,directly opposite one another. Children over the age of 8 years can be treated with adult pads and protocol whilst children between 1 and 8 years should be treated with paediatric pads if available. If no paediatric pads are available use adult pads front and back. Although there may be some risk it is better than doing nothing.


38 Heart Attack

Occupational first aid How a heart attack forms (coronary thrombosis)

Plaque with fibrous cap

Cap ruptures

Blood clot forms around the rupture

Blocked coronary artery

Death of heart tissue due to blocked coronary artery

Heart Attack - recognition ▪ Central chest pain, often described as squeezing or crushing, or as a feeling of pressure in the chest. ▪ Pain may spread to the neck and one or both arms. ▪ Pain may start at any time with no obvious cause. ▪ Pain does not improve with rest. ▪ Casualty may look pale or grey. ▪ There may be blueness of the lips (cyanosis) ▪ Pulse may be rapid, weak and irregular. ▪ They may be sweating. ▪ They may complain of shortness of breath. ▪ They may feel dizzy or weak. ▪ Sudden collapse.


Occupational first aid Heart attack - treatment The primary aim is to reduce the load on the heart by placing the casualty at rest and then to urgently call for medical attention. ▪ Place the casualty at rest. ▪ Make them as comfortable as possible to ease the strain on the heart. ▪ A half sitting position with the head and shoulders raised and the knees bent and supported would be preferred, but be guided by the casualty. ▪ Support them with pillows or folded blankets. ▪ If the chest pain does not subside after a few minutes assume a heart attack. ▪ Reassure the casualty continuously. ▪ Anxiety and fear will increase the heart rate and increase the load on the heart and should be avoided. ▪ Dial 999/112 for an ambulance. ▪ Inform ambulance control that you suspect a heart attack. ▪ If the casualty has a previous history of chest pain and has angina medication such as tablets or spray then assist them to take their medication as prescribed. ▪ If available, give one aspirin tablet, chewed rather than swallowed. ▪ Monitor the casualty’s level of consciousness and breathing and if you have been trained to do so check their pulse frequently. ▪ Record your findings. ▪ Try to stay calm and matter of fact yourself.

Aspirin in cardiac chest pain Aspirin has a useful anticoagulant effect and one tablet given at the time of chest pain can reduce the risk of the blood clot in the coronary artery enlarging and causing further damage. However, there are some side effects of aspirin and it should not be used inpatients below the age of 16 or those who have known allergy to aspirin, history of gastric ulcers, particularly bleeding ulcers, or any other bleeding problem. To ensure rapid transfer into the blood the aspirin tablet should be chewed and absorbed from the mouth, rather than swallowed. Soluble aspirin may be used dissolved in water.

Heart attack in women Heart attack is a major killer of women, but the signs and symptoms may be slightly different to those seen in men and there is a danger that they may be missed or misunderstood. Women may suffer chest pain, like men, but very often it is not such an important or obvious feature. In particular, look out for: ▪ ▪ ▪ ▪ ▪ ▪

Indigestion or wind pain. Dizziness, nausea or vomiting. Unexplained weakness or fatigue. Pain between the shoulder blades. Recurring chest discomfort. Anxiety.

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Occupational first aid

Angina Angina is a condition caused by narrowing or spasm of the coronary arteries, the pipes that deliver freshly oxygenated blood to the heart muscle. This leads to less blood and therefore less oxygen reaching the heart muscle. There may be sufficient blood to feed the muscle when the heart is beating normally, but when the heart rate increases due to exertion or excitement the demand for blood increases with it, leading to demand outstripping supply. This can lead to a cramp like pain in the chest, often brought on by exercise and which goes away with rest.

Angina - recognition ▪ Central chest pain, often described as squeezing or crushing, or as a feeling of pressure in the chest. ▪ Pain may spread to the neck and one or both arms. ▪ Pain will often start with exercise or excitement. ▪ Pain will usually improve with rest. ▪ Pain will usually improve with GTN medication. ▪ Casualty may look pale or grey. ▪ Pulse may be rapid, weak and irregular. ▪ They may be sweating. ▪ They may complain of shortness of breath. ▪ They may feel dizzy or weak.

Angina - treatment The primary aim is to reduce the load on the heart by placing the casualty at rest . ▪ Place the casualty at rest. ▪ Make them as comfortable as possible to ease the strain on the heart. ▪ If the chest pain does not subside after a few minutes assume a heart attack. ▪ Reassure the casualty continuously. ▪ Anxiety and fear will increase the heart rate and increase the load on the heart and should be avoided. ▪ If the casualty has a previous history of chest pain and has angina medication such as tablets or spray then assist them to take their medication. ▪ Monitor the casualty’s level of consciousness, breathing and check their pulse frequently. ▪ Record your findings. ▪ Try to stay calm and matter of fact yourself. ▪ Be prepared to offer life support as appropriate. ▪ If their condition does not improve with rest call 999/112 for an ambulance, urgently.


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Occupational first aid Stroke Stroke is a condition in which the blood supply to part of the brain is interrupted leading to localised brain injury with death of brain cells.

Recognition May be severe headache or sudden loss of consciousness. General feeling of being unwell. Paralysis or weakness affecting one side of the body. Stroke is a medical emergency and responds well to urgent medical treatment. ▪ To help diagnose it quickly, remember the F.A.S.T. test ▪ ▪ ▪ ▪

Check their face Has the mouth drooped?

Can they lift both arms equally?

Is their speech slurred? Can they understand you?

Time is critical Call 999 now

If they fail any one of the tests call an ambulance immediately. Prompt medical care can reduce further damage to the brain and help them to recover more completely

Stroke - treatment ▪ ▪ ▪ ▪ ▪

Reassure Lay them down with the head slightly raised Place them in the recovery position if they are or if they become, unconscious Call urgently for medical attention Continue to monitor their condition until the arrival of the ambulance

Mini stroke or TIA (transient ischaemic attack) ▪ Some people may exhibit the signs of a stroke which then goes away, leaving them unaffected. This should not be ignored. ▪ Get medical help for them as soon as possible as this may lead to a major stroke and should always be investigated.


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Occupational first aid Unit 5 – Wounds and Bleeding 1.1 The Circulatory system 1.2 The functions of blood 1.3 Bleeding by type 1.4 Effects of serious bleeding 1.5 Wound by type 1.6 Control of bleeding 1.7 Application of a wound dressing and bandage 1.8 Internal bleeding 1.9 Crush injury 1.10 Head, Eye and Facial injury

The Circulatory System

Pulmonary capillaries Pulmonary artery Pulmonary vein Aorta Right atrium Left atrium Left ventricle Right ventricle Oxygenated blood De-oxygenated blood

Peripheral capillaries


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The Circulation The circulation is the transport system of the body. It is responsible for transporting nutrients and oxygen to the cells and for carrying waste product away from them. It is also part of the body’s defence against infection. The elements of the circulatory system are: The heart (pump) The arteries, veins and capillaries (pipework) The blood (the fluid being pumped) The heart The heart is a muscular pump about the size of your fist. It is found in the middle of the chest behind the breastbone and between the lungs. By squeezing and relaxing around 80 - 100 times a minute, its pumping action is responsible for circulating the blood. Blood vessels There are three types of blood vessels: Arteries which supply high pressure oxygenated blood from the heart to the body. Veins which return low-pressure de-oxygenated blood back from the body to the heart. Capillaries a fine mesh of pipes which feeds nutrients and oxygen to the individual cells. The Blood The blood is the liquid element of the circulatory system. An average adult will have 5 to 6 L of blood (10 to 12 pints) The blood is responsible for transporting oxygen and nutrients to the cells of the tissues and collecting and transporting waste away from them. The liquid part of blood is called plasma and is a pale yellow watery liquid. The solids in the blood consist mainly of blood cells, red cells that carry oxygen and white cells that fight infection. New blood cells are manufactured in the marrow of long bones and the body can switch production from red cells to white cells depending upon which is most needed at the time.

Blood pressure As the heart contracts it forces blood into the blood vessels at high pressure. This wave of high pressure blood travels down the arteries and can be felt near the surface of the body as a pulse. The pumping action of the heart produces pressure within the sealed system of pipes. This is known as blood pressure and is responsible for circulating the blood around the system. If for any reason there is a sudden drop in blood pressure then the circulation will fail to provide oxygen and nutrients to the cells. Having higher than normal blood pressure may offer certain health risks such as stroke or other cardiovascular disease over a period of years. Having a sudden drop in blood pressure may offer health risks over a period of minutes.


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Bleeding and Blood Loss Blood loss refers to blood lost from the circulatory system. It may be lost from the body – external bleeding, or it may be lost from the circulation but retained inside the body – internal bleeding.

Effects of blood loss Blood volume varies with the size of the individual, but the normal blood volume of an adult is around 5 to 6 L or 10 to 12 pints. A loss of around 10% of this total is unlikely to cause any problem. In fact this is the amount usually donated by blood donors. A 20 to 30% blood loss would produce significant symptoms including a serious drop in blood pressure and the onset of shock. Blood loss of 30% or more could be immediately life-threatening and 40% of circulating volume is almost sure to be fatal unless replacement is carried out quickly.

Bleeding by type Capillary

Bright red blood Steady oozing

Venous

Steady flow Could be heavy Darker red

Bleeding - recognition The casualty may exhibit some or all of the following signs and symptoms: ▪ Obvious bleeding wound. ▪ Pale cold clammy skin. ▪ Rapid weak pulse.

▪ ▪ ▪ ▪ ▪

Arterial

Spurting / pulsating Could be heavy and rapid Bright red blood

Rapid shallow breathing. Mental confusion/disorientation. Dizziness/faintness. Dry mouth/thirst. Cyanosis.

Control of bleeding Bleeding is controlled because blood congeals and forms blood clots. It is the blood clot which blocks the hole and stops the bleeding. The first aid treatment for bleeding is designed to encourage this to happen by slowing down the flow of blood. This involves the use of: ▪ Direct pressure ▪ Elevation


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Personal protection Before dealing with the bleeding injury it is advised that the first aider takes basic precautions against blood-borne viruses such as HIV and hepatitis. This should include wearing gloves from the first aid kit.

Wounds A wound may be defined as an abnormal break in the tissues which allows the escape of blood and the entry of germs. Some types of wounds are described below.

Incision This is a clean cut type of injury usually made by a sharp edged object such as a knife blade or broken glass. This type of wound has a tendency to bleed profusely due to the fact that the blood vessels have been sliced cleanly, Incised wound leaving an open end for the blood to escape. Infection is not common as the blood flow keeps the wound clean.

Laceration A laceration is a ripping or tearing injury, producing a jagged edged wound. Blood loss tends not to be so severe due to the stretching and then Lacerated wound contraction of the severed blood vessels, but infection is often a problem.

Puncture This is, as the name suggests, a stabbing or penetrating type of injury. Puncture wounds may seem the least dramatic, producing very little obvious bleeding and a very small surface wound, but they must always be treated Puncture wound seriously as it is impossible for the first aider to estimate the extent and severity of the internal damage.

Contusion

Contused wound

A contusion is a bruising type of injury, often the result of a blow with a blunt instrument. The contusion may be closed (bruising) or may be open, if the tissues split open at the point of contact.

Abrasion

Abrasion

Abrasions, often called grazes, are injuries that affect the surface of the skin. They are often caused by sliding falls or moving machinery. Although blood loss is usually limited they are very often dirty injuries, as debris is dragged into the wound.


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Control of bleeding Remember P.E.E.P. to control bleeding

P Posture

Sit or lay the casualty down (if their injuries permit)

E Expose

Remove or cut clothing to gain proper access to the injury

E Elevate

If the wound is on a limb and other injuries permit, elevate the wound above the level of the heart.

P Pressure

Apply direct pressure to the bleeding point using your hand or a wound dressing

Application of a wound dressing

Apply without touching the face of the dressing, to keep it clean.

Use the long end of the bandage to hold the dressing in place. Take care to cover all four edges of the dressing

Retain the short end of the bandage. Tie off by tying the two ends of the bandage together.

Wound dressing ▪ If blood soaks through the dressing, apply another one on top of the first. ▪ After applying the dressing and bandage make sure it is not too tight by checking the circulation below the bandage site. ▪ Remember that injuries swell, so you may have to go back and check again from time to time. ▪ Tell the casualty to look out for signs of swelling or puffiness below the site, as well as for numbness or pins and needles. ▪ If you can feel a pulse below the injury it means that the blood supply is adequate. ▪ Check the blood supply to the extremities with the fingernail test. The nail bed is normally pink due to the capillaries full of blood which lay beneath the nail. ▪ Squeeze the nail firmly between finger and thumb. ▪ This squeezes all of the blood out and the nail will go white. ▪ When you release the nail the capillaries should refill in 1 to 2 seconds and the nail should go back to looking pink. ▪ If it stays white for more than three seconds it means that the capillaries are refilling too slowly and the blood supply is reduced, so you will need to loosen the bandage without disturbing the dressing.


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Internal Bleeding Internal bleeding occurs when blood is lost from the blood vessels, but retained within the body, usually within one of the body cavities such as the skull, thorax, abdomen or large muscles. Internal bleeding may remain concealed or may subsequently become revealed by visible blood issuing from one of the body openings such as the mouth and nose or rectum.

Internal Bleeding - recognition ▪ History, may include a history of violent injury or ,medical conditions such as ulcers. ▪ Signs and symptoms of blood loss shock with no obvious bleeding. ▪ Pain and tenderness over the affected area. ▪ Bruising or discolouration over the affected area. ▪ The appearance of blood at one of the body openings.

Internal Bleeding - treatment ▪ Assess the situation and deal with any immediate danger. ▪ Assess their level of consciousness and treat appropriately. ▪ Lay them down with their limbs elevated, if their injuries permit. ▪ Reassure them and keep them calm. ▪ Keep them warm and loosen any tight clothing. ▪ Continue to monitor their pulse, respirations and level of consciousness. ▪ Give nothing by mouth, they may need emergency surgery and a general anaesthetic.

Minor cuts ▪ Wash carefully with clean water ▪ Dry thoroughly ▪ Apply a clean dry dressing Other types of minor injury such as grazes can be treated in the same way. If clean water isn’t available for cleansing then it may be possible to use non-alcohol-based cleansing wipes from the first aid kit. Advise them to observe the injury in case it shows signs of becoming infected, i.e. swelling, pain, redness or discharge. If so they will need to seek medical advice.


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Nosebleed Nosebleeds occur when the blood vessels in the nose are damaged or rupture spontaneously. Although nosebleeds are usually unpleasant rather than dangerous, they can occasionally lead to serious blood loss if not controlled. Sometimes recurrent nosebleeds may be associated with high blood pressure or arterial disease, or even allergies and infections. Repeated nosebleeds with no apparent cause should be investigated.

Nosebleed - treatment ▪ Sit the casualty down with the head leaning well forward. ▪ Encourage or help them to pinch the soft part of the nose, just below the bony part, for at least 10 to 15 minutes to allow for blood clot formation. ▪ If this is not successful then refer them to medical attention, maintaining pressure on the nose. ▪ If successful, as in most cases, tell them not to sniff hard, blow the nose or do anything which may disturb the blood clot, for at least six hours.

Amputation ▪ Traumatic amputation is the loss of a body part, usually a finger, toe, arm or leg that occurs as a result of an accident or trauma. ▪ Modern surgical techniques mean that in some places and in some cases, the lost part may be reattached. ▪ It is important therefore to retain any amputated part, keeping it as clean and dry as possible. ▪ It should be placed initially in a polythene bag or wrapped in plastic or clingfilm. ▪ The package should then be wrapped in soft material such as tissue or gauze to protect it. ▪ This may then be placed inside an ice pack, avoiding direct contact with the ice, and sent to hospital with the casualty ▪ Control bleeding with direct pressure and elevation. ▪ Apply a dressing and firm bandage . ▪ Anticipate and treat shock. ▪ Transfer them to hospital.


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Crush injury Crush injuries are particularly dangerous if the victim suffers crushing to a large muscle mass, such as the thigh. The effect will be to cause severe tissue damage and possibly fractures at the site of injury. There may also be reduced or absent circulation below the crush site. Prolonged entrapment Prolonged crushing would cause extensive soft tissue damage which may not be immediately obvious due to the pressure. Once the pressure is released the fluid loss may be sudden and dramatic leading to fluid loss shock. More seriously, toxic waste will build up in the damaged tissue and if this is released suddenly into the circulation these toxins may cause kidney failure. This process is called crush injury syndrome and it is potentially fatal.

Crush Injury - treatment ▪ ▪ ▪ ▪ ▪

If you can release them immediately, then do so Control bleeding and treat shock Get urgent medical attention If they have been trapped for longer than 15 minutes then do not attempt to release them Send urgently for medical assistance, reassure and monitor their condition until it arrives

Abdominal Injury A penetrating injury to the abdomen may cause a wound in the abdominal wall which opens directly into the abdominal cavity. This may lead to internal bleeding, contamination of the abdominal cavity or the escape of abdominal contents through the wound onto the surface of the abdomen.

Abdominal Injury - treatment ▪ ▪ ▪ ▪ ▪ ▪ ▪

Position the casualty so the wound does not gape This may be half sitting with the knees raised Carefully inspect the wound If abdominal contents have not escaped, apply a wound pad and firm bandage If abdominal contents have escaped, do not handle or attempt to replace them Cover them lightly with clean, soft and non-fluffy material Get urgent medical attention


50 Scalp Wound

Occupational first aid Scalp wounds are a relatively common injury, as the skin and underlying tissues are easily compressed against the skull lying just underneath, causing them to burst open. Because of the very rich blood supply to this area of the body, blood loss from the scalp wound may be greater than you would expect. The casualty’s real problem though may not be the visible wound, but what lies underneath it. If a casualty has been hit on the head hard enough to cause the wound they may well have a much more serious underlying fracture of the skull.

Any injury to the scalp or head carries with it a risk of underlying skull fracture, internal bleeding, a change in the level of consciousness and also injury to the neck if violence has been a factor. It is common for this type of injury to affect people who have fallen or possibly been fighting and it is often seen along with inebriation from alcohol or other drugs which may mask some head injury symptoms. All such injuries need to be treated with great care. If, at any time, the casualty exhibits a change in level of consciousness or becomes unconscious. then you must apply the treatment for an unconscious casualty. Check their ABC and if they are breathing normally place them carefully into the recovery position before dialling 999/112 for an ambulance.

Scalp Wound - treatment A bleeding scalp wound will respond to direct pressure over the wound to control bleeding. However, care must be taken because of the risk of underlying injury. If too much direct pressure is applied onto the injury and there were an underlying fracture as in the illustration it is easy to see how the fracture could be pushed inwards, potentially increasing the likelihood of damage to the brain underneath. In most cases it is better to spread the pressure using the flat of the hand over a large dressing and then to hold the dressing in place with a bandage. The casualty’s level of consciousness and response should be monitored continuously and should it change then you will have to apply the appropriate treatment for a head injury. Remember, in the unconscious casualty, maintenance of the airway takes priority.


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Occupational first aid Head Injury The problem with any head injury is not necessarily the injury that you can see but the potential damage to the brain that may be permanent and also the subsequent loss of consciousness. It should also be remembered that anyone with a head injury also has a potential neck injury and should be treated as if this were the case.

Concussion Injury Concussion occurs following a blow or sudden violent movement to the head and is caused by jarring of the brain. It is characterised by sudden loss of consciousness which is usually of fairly short duration. A concussion is a generally mild brain injury that normally resolves completely, however, a second concussion injury occurring before the first is completely healed could lead to permanent damage.

Concussion - recognition ▪ History of a blow to the head or fall from a height ▪ Possible scalp wound or swelling ▪ Sudden, but short term, loss of consciousness ▪ Headache

▪ ▪ ▪ ▪

Rapid weak pulse Pale cold skin Sweating Nausea / vomiting

Concussion - treatment ▪ Assess their level of consciousness, if they are unconscious check ABC. ▪ Place the unconscious casualty into the recovery position. ▪ Continue to monitor their vital signs.

▪ Call 999/112 for an ambulance if their condition deteriorates. ▪ Advise them to seek medical attention if there is any change in their condition after recovery.

Compression Injury In compression injury there may be a history of a blow to the head or a fall from a height. The casualty may complain of pain in the head but may not immediately lose consciousness. Either swelling of the brain or bleeding inside the head causes the problem.

Compression Injury - recognition ▪ History of a blow to the head or a fall from a height ▪ Possible scalp wound or swelling ▪ Pain in the head getting worse ▪ Possibly blood or fluid (CSF) appearing at the nose, ears or collecting around the eyes. (Black eyes with no evidence of damage to the face)

▪ One or both pupils in the eyes dilating, with sluggish or reduced response to light ▪ Flushed complexion with warm dry skin ▪ Dropping level of consciousness ▪ Slowing irregular breathing ▪ Seizures ▪ Slowing pulse

Compression Injury - treatment ▪ Assess the level of consciousness, if they are unconscious check their ABC ▪ Give life support as appropriate ▪ Dial 999/112 for an ambulance ▪ If they are conscious, place in a half sitting position with their head and shoulders elevated

▪ Support and immobilise the neck ▪ If they are unconscious and breathing, place them in the recovery position ▪ Keep the bleeding ear downward to encourage drainage ▪ Continue to monitor their condition


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Eye Injury It is probably true that in most cases of eye injury the victim will seek assistance from a doctor or other qualified person. There may be occasions however, when medical help is not immediately available or the casualty’s condition is such that it demands immediate attention. In these cases, first aid would be appropriate.

Blunt trauma - recognition ▪ ▪ ▪ ▪

History of a blow to the eye from a ball or fist. Bruising and swelling to upper and lower eyelids (black eye) Pain around the affected area Inability to open the eye

Blunt trauma - treatment ▪ Cold compress. ▪ Refer to medical attention

Corneal abrasion - recognition ▪ ▪ ▪ ▪

History of something sharp entering the eye. Severe pain. Blurred vision. Copious watering.

Corneal abrasion- treatment ▪ Ask the casualty to hold a pad over the eye or apply an eye pad from the first aid kit. ▪ Take them to hospital.

Loose foreign body- recognition ▪ History of dust or grit blowing into the eye. ▪ Small particles seen laying on the surface of the eye

Loose foreign body- treatment ▪ ▪ ▪ ▪

Sit the casualty down and lean the head backward. Attempt to wash the dust out with water. Use the damp corner of a handkerchief to lift the dust out. Do not attempt to remove anything, which is stuck to the surface of the eye.


Occupational first aid Embedded foreign body - recognition ▪ History of a splinter or similar material entering the eye. ▪ Foreign body is visible protruding from the front of the eye. ▪ Intense pain.

Embedded foreign body - treatment ▪ Reassure the casualty and try to prevent them from touching the eye. ▪ Dial 112 for an ambulance. ▪ Do not attempt to remove the object. ▪ Apply large amounts of soft padding around the object. ▪ Do not allow any pressure on the object. ▪ Lightly cover the unaffected eye, to prevent movement.

High velocity impact - recognition ▪ ▪ ▪ ▪

Casualty feels something strike the front of the eye. On examining the eye there may be little or nothing visible. There may or may not be much pain. A small object may have penetrated the surface and entered the eye, rather than bounced off.

High velocity impact - treatment ▪ The main threat is that the object has entered the eye and lodged within. ▪ If the history suggests it, we will assume it, even if there is no evidence to support this. ▪ Apply a light eye pad. ▪ Arrange transport to hospital.

Wounds to the eye - recognition ▪ ▪ ▪ ▪

History of injury. Open wound visible with possible bleeding. If the eyeball is punctured, visible leaking of jellylike substance. Intense pain.

Wounds to the eye - treatment ▪ Reassure the casualty and attempt to prevent them from touching the eye. ▪ Attempt to close the eye, but do not force. ▪ Apply light eye cover. ▪ Send or take them to hospital, possibly in an ambulance.

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Eye irrigation This is the preferred method of dealing with loose foreign bodies and chemical contamination. The casualty should be sat down and should lean toward the affected side so that the affected eye is at the lowest point. Water should be allowed to run across the surface of the eye from the nose side outward and to drain away to safety, making sure that contaminated water does not enter the good eye. In cases of chemical contamination this irrigation should continue for at least 10 minutes. After irrigation the eye should be carefully dried before taking the casualty to hospital.

Burns to the eye Burns to the eye may occur in one of three ways: ▪ Heat (thermal burns) ▪ Radiation ▪ Corrosive chemicals

Thermal burn to the eye - recognition ▪ History of exposure to heat source ▪ Dry scratchy eye or eyes. ▪ Pink or reddened skin to the face

Thermal burn to the eye - treatment ▪ Cool affected eyes with clean cool water ▪ Get the casualty to hold a loose cover over the eye or apply an eye patch from the first aid kit ▪ Seek medical attention

Chemical burn to the eye - recognition ▪ ▪ ▪ ▪ ▪

History of exposure to corrosive chemicals. Severe pain in the affected eyes. Redness and swelling around the eyes. Copious watering of the eye. The casualty may have their hands to their face, or may be rubbing the eye.

Chemical burn to the eye - treatment ▪ Sit the casualty down and prevent them from rubbing their eyes. ▪ Irrigate the eye with running water using a glass or cup. Use sterile eye wash bottles, if available. ▪ Irrigate for at least 10 minutes or until all trace of chemical is removed. ▪ Be careful that contaminated water does not affect the good eye. ▪ Arrange to take or send the casualty to hospital.


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Radiation burns to the eye Radiation burns to the eye are almost always caused by ultraviolet radiation in the form of sunlight or more probably a welder’s arc, often referred to as arc eye or welders flash. The casualty is often unaware of the exposure, feeling nothing at the time but effects will be felt some hours later, often waking the casualty in the early hours of the following morning.

Radiation burn to the eye - recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

History of exposure to U.V. Light. Often standing close to or assisting a welder Onset several hours after exposure. Both eyes affected. Burning, gritty sensation in the eyes. Intense pain in the eyes. Made worse by exposure to light. Profuse watering.

Radiation burn to the eye - treatment ▪ ▪ ▪ ▪

Cold compresses can help Seek medical attention with history Apply light eye patches to eyes, wear dark glasses or stay in a darkened room. Radiation burns usually resolve themselves within 24 - 48 hours

Facial Injury Facial injury can result from: ▪ Falls ▪ Road traffic accidents ▪ Assaults Any violence which causes injury to the face or head may also involve injury to the neck so this should always be taken into consideration. The main problems associated with facial injury are: ▪ Blood loss from open wounds ▪ Fractures to underlying bones ▪ Swelling and bruising to soft tissues ▪ Injuries around the mouth and potential fractures of the jaw may also pose a potential threat to the airway. Treatment should include: ▪ Immobilise the head and neck. ▪ Maintain the airway. ▪ Treat and cover any open wounds. ▪ Arrange for medical assistance.


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Occupational first aid Unit 6 – Altered Levels of Consciousness

1.1 Shock – recognition and treatment 1.2 The nervous system 1.3 Fainting 1.4 Diabetes 1.5 Seizures 1.6 The Recovery Position The Nervous System The function of the nervous system is to gather information, store information and send out directions to the body. It can conveniently be thought of in two main parts: ▪ The central nervous system. ▪ The peripheral nerves. The central nervous system comprises of the brain and spinal cord. The brain is like a computer which receives information from the body, stores or processes it and sends directions to the body. The spinal-cord is the cable that carries information and out of the brain. Central nervous Brain and spinal cord tissue are not repaired or replaced if they are damaged. system The central Nervous system Brain

Spinal cord

Peripheral nervous system The peripheral nerves are the nerves outside the central nervous system. There are 12 pairs of cranial nerves which originate directly in the brain and 31 pairs of spinal nerves which branch from the spinal cord at the level of each vertebrae. They comprise of bundles of nerve fibres which can carry both in coming signals (sensory nerves, or nerves of feeling) and outgoing directions (motor nerves, or nerves of movement)

Autonomic nervous system Some of the cranial nerves and some spinal nerves operate together and form the autonomic nervous system. They are concerned with the function and performance of some bodily organs such as heart rate and breathing. Many of the functions are outside the conscious control of the person and work automatically.

Peripheral nerves


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Occupational first aid Shock Shock occurs when the circulation is unable to supply sufficient oxygen to the tissues. It is often associated with a sudden drop in blood pressure.

Causes of shock Fluid or blood loss This will reduce the volume of the blood left in the circulation. As the volume drops the pressure within the system will drop, adding to the problem. There is now less blood at lower pressure and so the circulation begins to fail. The medical name for this type of shock is hypovolaemic shock. In the early stages the body will try to compensate for the low blood pressure and lack of circulation. It can do this by speeding up the pump (raising the heart rate) and by tightening or constricting the small blood vessels to raise the pressure within them. This is called the compensatory mechanism. In cases of minor shock it may be enough to maintain blood pressure but in many cases it is only of short-term benefit. The most important treatment would be to stop any further blood / fluid loss and if necessary replace some or all of the fluid that has been lost, possibly by blood transfusion. Heart failure If the pumping effect of the heart is reduced, possibly due to damage caused by heart attack then the pressure within the system (BP) is likely to drop. The effect of this will be reduced circulation and shock. Shock that originates from a heart problem is called cardiogenic shock. Nervous shock This results from stimulation of some parts of the nervous system. It could be associated with mechanical damage to nerves as might occur with a fractured spine and damage to the spinal cord or it may be stimulation caused by pain, fear. or a sudden unexpected, usually bad, occurrence. This type of shock that begins in the nervous system is called neurogenic shock. Allergic shock Sometimes shock may result from a severe allergic reaction (see anaphylaxis page 61)

Recognition of shock ▪ ▪ ▪ ▪ ▪

Appropriate history (cause) Pale cold clammy skin Cyanosis Rapid weak pulse Rapid shallow breathing

▪ ▪ ▪ ▪ ▪

Cold and shivery Thirst or dry mouth Confused and disorientated Change in their level of consciousness Dizziness, nausea and vomiting

▪ ▪ ▪ ▪ ▪

Nothing by mouth (until seen by Dr) Moisten their lips if they complain of thirst No smoking Do not give alcohol Do get urgent medical attention

Treatment of shock ▪ Treat the cause where possible ▪ Reassure ▪ Lay them down and elevate their legs if their injuries permit ▪ Keep them warm ▪ Do not use external heat sources such as hot water bottles


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Fainting Fainting is characterised by a brief loss of consciousness caused by a temporary reduction in blood supply to the brain, often associated with a drop in blood pressure. Although a simple faint is common and not usually dangerous it may indicate other more dangerous conditions such as heart disease.

Fainting - causes Most fainting events are caused by temporary malfunction of part of the nervous system. This may result from an external trigger such as: ▪ Exposure to an unpleasant sight or experience ▪ Standing still for long periods ▪ Spending time in hot or stuffy environments ▪ Sudden emotional upset ▪ Fear, anxiety or pain Fainting could occur when a bodily function or activity places a sudden strain on the nervous system. Possible causes could include: ▪ Coughing ▪ Sneezing ▪ Swallowing

▪ Laughing ▪ Eating ▪ Exercising

More seriously, some heart conditions such as abnormal heart rhythms or heart attack could cause a sudden drop in blood pressure leading to a faint.

Fainting - recognition Some people will not experience any warning signs before they suddenly lose consciousness. Others may only have a few seconds warning just before fainting, but most people will experience some of the following: ▪ Yawning ▪ Visual disturbances ▪ Sudden clammy sweat ▪ Ringing in the years ▪ Nausea ▪ Unsteadiness and loss of strength ▪ Fast, deep breathing ▪ Unconsciousness ▪ Feeling lightheaded

Fainting - treatment The aim of treatment is to restore blood flow to the brain and the best way to do this is to lay the patient flat and elevate their legs, higher than their heart. This uses gravity to drain blood from the legs and send more to the brain. If you sit the casualty down with their head between their knees there is a real risk that they may suddenly become unconscious and topple forwards, landing on their head. Laying down is much safer. The casualty should regain consciousness within a minute or two. Afterwards they may feel confused, disorientated or tired for a short while. They may not have any memory of what happened immediately prior to the faint. Assuming they are not injured they can probably resume normal activity after a period of rest. Anyone who does not wake up within 2 to 3 minutes is a medical emergency. Place them into the recovery position and call 999/112 for an ambulance.


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Seizure A seizure is most often caused by an abnormal electrical disturbance in the brain. It can cause changes in body movement or function, sensation, awareness or behaviour and can last from just a few seconds to a condition which will not stop. There are many different types of seizure with many different causes. Probably the most common type of seizure that would require first aid attention is called the tonic / clonic seizure.

Tonic / Clonic Seizure - recognition ▪ ▪ ▪ ▪ ▪ ▪

The casualty’s body goes suddenly stiff They lose consciousness They fall to the floor Their body may jerk or convulse They may be blue around the mouth They may foam at the mouth

Take ACTION

A Assess C Cushion T Time I Identify O Over N Never

Assess the situation – are they in danger of injuring themselves? Remove any nearby objects that could cause injury. Cushion the head (with a pillow or clothing) to protect them from head injury. Check the time – if the seizure lasts longer than five minutes you should call an ambulance. Look for a medical bracelet or ID card – it may give you information about the person’s seizures and what to do. Once the seizure is over, put them on their side (in the recovery position) Stay with them and reassure them as they come round. Never try to restrain the person, put something in their mouth or try to give them food or drink.

Call an ambulance if: ▪ ▪ ▪ ▪ ▪

You know it is their first seizure The seizure lasts for more than five minutes One seizure appears to follow another without the person regaining consciousness in-between The person is injured You believe they need urgent medical attention


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Diabetes This is a condition where the sufferer has a problem in burning up sugar due to the lack of the hormone insulin. This may lead to an imbalance in the sugar levels in the blood. Diabetes can start very slowly and may go unnoticed for a long time. Because of the slow onset it is seldom a problem for first aiders. As the condition progresses, the sufferer will seek medical advice from their doctor. Blood sugar level that is too low, (hypoglycaemia) is often caused when a diabetic injects insulin and then fails to take enough sugar to counteract the effect. As this condition is the most immediately dangerous it is the aspect that first aiders should be most familiar with.

Diabetes - recognition ▪ Weight loss with good appetite ▪ Thirst ▪ Passing large amounts of urine often ▪ Tired and listless ▪ Flushed dry skin* ▪ Strong smell of acetone on the breath* ▪ Dropping level of consciousness* *In later stages

Diabetes - treatment ▪ No real first aid is required, advise them to see their doctor. ▪ In later stages, or if unconscious, treat as a medical emergency and call an ambulance.

Hypoglycaemia - recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪

History of diabetes Receiving insulin or other hypoglycaemic drug May suddenly become confused, disorientated or aggressive Pale or grey appearance Profuse sweating Rapid and strong pulse Diminishing level of consciousness

Hypoglycaemia - treatment If conscious: ▪ Give sugar in the form of 6 to 8 teaspoons in a glass of water, sugary sweets, non-diet sweet drinks or whatever is to hand as quickly as possible ▪ If recovery is not swift, repeat ▪ Refer to medical help if appropriate, or if no rapid response If unconscious ▪ place them in the recovery position ▪ refer to medical help urgently, with history if available


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Anaphylaxis Anaphylaxis is an extreme and severe allergic reaction that may develop very rapidly following exposure to the substance to which the sufferer is sensitive. This may include nuts, fish and shellfish, dairy products and eggs. Non-food causes may include insect stings antibiotics and latex. The reaction affects the whole body and may start within minutes of exposure or may be delayed by several hours.

Anaphylaxis - recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

Swelling/puffiness of the face General flushing of the skin Swelling of the mouth and tongue Difficulty in swallowing or talking Alteration of the heart rate Widespread blotchy skin rash (hives) Severe asthma Feeling of weakness Indications of shock Abdominal pain Nausea and vomiting

Anaphylaxis - treatment ▪ Call 999/112 for an ambulance ▪ Pass on any information you may have on the casualty’s medical history or condition ▪ If the casualty is carrying an auto injector of adrenaline (Epi-pen or Jext injector) and is able to use it then help them to do so ▪ If you have been trained to use the auto injector then use it to inject the casualty* ▪ If the casualty has problems breathing, place in a half sitting position ▪ If they show signs of shock, then lay them down *Although the use of an auto injector is usually restricted to those who have received appropriate training, in a potentially life-saving situation anyone may use one by following the instructions.


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The Recovery Position The aim of the recovery position is to maintain and protect the airway by placing the casualty in a position on their side with the head lower than the chest.

Before moving the casualty ▪ check the area for dangerous objects. ▪ remove the casualty’s glasses, if they are wearing them.

Place the hand closest to you up and out of the way.

▪ remove sharp or bulky items from their pockets. ▪ remove any potential constriction from around the neck.

Bring the furthest arm across and hold the hand alongside the face.

Reach down to the further knee and pull it up keeping the foot flat on the floor

Pull gently on the knee to roll them toward you.

Pull up on the knee to prevent them from rolling back. Knee and hip should be at 90°

Adjust the head to keep the airway open


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Occupational first aid Unit 7 – Musculoskeletal Injury 1.1 The Skeleton 1.2 Fractures by type 1.3 Fracture recognition and treatment 1.4 Spinal injury 1.5 Dislocations 1.6 Sprains and strains 1.7 Back problems 1.8 Prolapsed intervertebral discs

The Skeleton

Skull Mandible

The musculoskeletal system consists of individual bones, supported and joined by ligaments, tendons muscles and cartilage. The skeleton has six functions: Shape and support – the skeleton forms a framework that supports us. Mobility – muscles pulling on bones around joints move us around. Protection – the bones in the centre contain and protect the internal organs. Storage – the bones act as a storage depot for mineral salts, particularly calcium. Attachment – the bones form attachment points for muscles, tendons and ligaments. Blood cell production – the bone marrow within the larger bones is where we manufacture new blood cells.

Cervical Vertebrae Clavicle Scapular Sternum Humerus Ribs Lumbar Vertebrae Radius Ulna Pelvis Sacrum Coccyx Femur

Bones Bones are living tissue with a blood supply and a nerve supply. They consist mainly of mineral salts such as calcium which gives them strength and rigidity. Should bones be damaged, they are able to generate new tissue and to repair themselves.

Patella Fibula Tibia Metatarsals Phalanges


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Fractures The word fracture simply means broken. This could mean a hairline crack or the bone could be in pieces. Fractures may be due to direct force or indirect force. With direct force the bone breaks at the point of impact, with indirect force the force of impact is transmitted along the bone causing a fracture some distance away. Fractures may be conveniently placed into one of four groups: ▪ Closed fracture ▪ Open fracture ▪ Complicated fracture ▪ Greenstick fracture

Closed fracture ▪ Occurs when the bone is broken but is not severely displaced and has not penetrated the skin or other organs.

Open fracture ▪ Occurs when the broken bone penetrates the skin causing a wound that may cause severe blood loss. ▪ Infection is also often a problem. ▪ Once bleeding is controlled the wound should be covered to keep it as clean as possible. ▪ The immobilisation of the fracture is less important and will probably wait until the arrival of the ambulance or other trained help, along with more advanced immobilisation equipment.

Complicated fracture ▪ A complicated fracture may be either one of the previous two. ▪ In this injury a broken bone has damaged or has allowed damage to occur to, other organs. ▪ A classic example would be a fraction of the spine which is complicated by damage to the spinal cord, or a pelvic fracture which has damaged the bladder.

Greenstick fracture ▪ Because children’s bones are softer and more pliable than adults, they tend to bend rather than break. ▪ Sometimes part of the bone breaks. ▪ This incomplete fracture is known as a greenstick fracture because it breaks like a green branch or twig.

Greenstick fracture


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Occupational first aid Fracture - recognition ▪ ▪ ▪ ▪

Swelling Bruising (later) Deformity Shortening of the limb

▪ ▪ ▪ ▪

Signs of shock Sound of bone breaking The feeling of bone breaking Pain and tenderness at the fracture site

Fracture - treatment Broken bones take 6 to 8 weeks to heal and nothing that first aiders do is going to make any difference to that. The injury occurred before we got there and we cannot heal it. Realistically, there is nothing we can do for the fracture. The aim of first aid for fractures is to minimise the damage that the fracture causes to the surrounding tissue and to deal with the effects of the fracture. In most cases, the only treatment required is to assist the casualty in keeping the fracture in a comfortable position and to call the emergency services. It is not usually necessary to start applying splints or other devices to fractured limbs. ▪ Deal with any more urgent problems first ▪ Do not move the casualty unless absolutely necessary

▪ Immobilise the fracture prior to movement ▪ Be prepared to treat shock ▪ Get medical attention

Fractured skull The skull is a bony box that contains and protects the brain. It is a strong rigid structure and it usually requires significant force to break it. Given this amount of force applied to the head there may well be other injury, particularly to the brain, or possibly to the neck. Fractures to the vault or roof of the skull are most often caused by direct force or violence, such as a blow to the head or striking the head against a solid object. The fracture may be pushed inward or depressed, like the shell of a boiled egg. A fractured base of skull is most commonly caused by a fall or jump from a height, landing on the feet. Force is transmitted from the feet, through the legs, into the spine and so into the base of the skull. There may be no obvious signs but the history should suggest it.

Fractured Skull - recognition ▪ ▪ ▪ ▪ ▪ ▪

History of a blow to the head or a fall from height Changed level of consciousness Possible scalp or facial wound Blood or watery fluid from the nose and ears Swelling and bruising around the eyes Neck stiffness

Fractured Skull - treatment ▪ Assess and monitor the level of consciousness ▪ Maintain an open airway ▪ Immobilise the head and neck

▪ Recovery position if unconscious ▪ Head and shoulders raised if conscious ▪ Give life support as appropriate


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The Spine The spine is a column of 33 bones called vertebrae stacked one on top of the other. The vertebrae are separated by pads of cartilage called intervertebral discs. The discs consist of a tough fibrous shell with a softer jelly like inner and they function as cushions or shock absorbers. Running in the space behind the vertebral bodies is the spinal cord. The spinal cord is the main cable that carries information from the body to the brain and directions from the brain to the body. Branching out from the spinal cord at the level of each vertebra there are spinal nerves that carry the information in and out of the cord. It is possible to injure the spine without damaging the spinal cord and it is also possible to damage the cord without fracturing the spine.

Vertebral Body Cervical Intervetebral disc

Spinal Nerve Thoracic Spinal Cord

Spinal Nerve

Lumbar

Spinous Process Sacrum Coccyx


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Occupational first aid Spinal Injury Fractures of the spine in themselves may be fairly moderate injuries. They become major problems if an injury to the spinal cord is Vertabral involved and in any injury to the spine this cannot be discounted. fracture Damage to the spinal cord may affect all those parts of the body below the site of the injury, so obviously the higher on the spine injury occurs the more potentially dangerous it is for the casualty. This is a condition where inappropriate handling could turn a small injury into a major problem. Do not rely on looking at or pressing on the casualty’s neck looking for abnormalities. Most first aiders are not skilled enough to detect or discount, spinal injury. If the nature of the incident suggests the possibility of a spinal fracture assume it to be the case and treat accordingly.

Spinal cord injury

Recognition ▪ ▪ ▪ ▪ ▪ ▪

History of violence Blow to the spine or fall from height Penetrating injury such as a stab wound Head injury Pain at site Change of sensation below site

▪ Numbness, pins and needles or burning sensation in arms or legs ▪ Lack of movement or uncontrolled movement below injury site ▪ Loss of bowel or bladder control ▪ Priaprism

Q. When should I suspect a spinal injury? A. Whenever you think of it. Something about the event or possibly the position of the casualty must have made the thought cross your mind. If you think to yourself “I wonder if he’s hurt his back?” then he has until somebody else proves differently. Most indicators of a spinal injury either come from the history/mechanism of injury or are what the patient describes or tells you. If the casualty is unconscious or unable to communicate then all you have left is the history or the mechanism of injury. Be suspicious. If it might have happened then it has happened until a properly equipped expert proves it hasn’t.

Treatment Do not move the casualty unless it is to save or preserve their life. If the casualty is unconscious, protection of the airway takes priority. Life over limb Do not wait until the unconscious casualty has started to vomit. ▪ Dial 999/112 for an ambulance. ▪ Keep the conscious casualty in the position found. ▪ Try to stabilise their neck and spine using rolled up blankets or clothing or, of course, your hands. ▪ Reassure the casualty continuously, tell them to keep still and not to attempt to move.

▪ Be prepared to place the unconscious casualty carefully into the recovery position if they have a problem maintaining their airway or start to vomit. ▪ Stabilise the neck first. ▪ Immobilise by supporting head trunk and legs. ▪ Roll the casualty like a solid log. ▪ Avoid twisting or bending.


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Upper Limb Fracture Although upper limb fractures are seldom life-threatening injuries of themselves, they may lead to serious blood loss and shock, so the casualties should always be closely monitored for the onset of this condition.

Recognition ▪ ▪ ▪ ▪ ▪

History of injury Pain and tenderness Swelling and bruising Deformity Crepitus

Treatment ▪ Treat any obvious wound or bleeding. ▪ Allow the casualty to support their own arm if they are happy to do so. ▪ Immobilise with the appropriate sling if required. ▪ Elevate where possible. ▪ Check circulation and sensation below fracture site. ▪ Refer to medical help.

Leg Fracture Due to the fact that the bones of the lower limb are much heavier and stronger it requires greater force or violence to break them. This leads to a greater likelihood of other injury, internal bleeding and shock.

Recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪

History of injury Pain and tenderness Swelling and bruising Rotational deformity Shortening of the limb Front of lower leg often an open fracture Signs and symptoms of shock

Treatment Treat any obvious wound or bleeding Check circulation and sensation below the fracture site Elevate where possible Do not move them unless absolutely necessary Be alert for and be prepared to treat shock Do not apply splints or tie the legs together unless moving the casualty to rescue them from danger ▪ Take or send the casualty to hospital ▪ ▪ ▪ ▪ ▪ ▪

Fractured Lower Leg


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Occupational first aid Dislocations

These occur when a joint has been pulled or twisted apart and the bones have not returned to their correct positions. The bones are then said to be dis-located or located wrongly. Dislocations may or may not be associated with a fracture.

Recognition ▪ ▪ ▪ ▪ ▪

History of injury Pain and tenderness Swelling and bruising Deformity at a joint Loss of mobility

Treatment ▪ ▪ ▪ ▪ ▪

Treat as a fracture Immobilise, ideally in the position found Be alert for and be prepared to treat shock Do not be tempted to try to ”pop it back in” Send or transport to hospital

Soft Tissue Injury The soft tissues are the muscles, ligaments tendons and cartilage that connect us together and move us around. ▪ Muscles provide the power ▪ Ligaments connect bone to bone around a joint ▪ Tendons connect muscle to bone and transmit power Ligament Soft tissue injuries are either: Muscle ▪ Strains ▪ Sprains

Tendon Bone


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Strain A strain occurs when a muscle or tendon has been overloaded or stretched, resulting in the tearing of some of the fibres.

Recognition ▪ Immediate and severe pain ▪ Muscle spasm over the affected area

Treatment ▪ Rest until the spasm subsides ▪ Apply ice packs over the affected area several times daily ▪ If pain does not improve advise to see GP

Sprain A sprain occurs when the ligaments that support a joint are overstretched and torn. It commonly results from rotating or twisting the ankle. It can be very difficult to tell the difference between a severe sprain and a fracture, so all doubtful injuries should be treated as fractures until an x-ray has been performed.

Recognition ▪ ▪ ▪ ▪ ▪

History of twisting the ankle or overstretching a joint Immediate pain Swelling Discolouration Bruising (later)

Treatment ▪ ▪ ▪ ▪

Sit the casualty down and elevate the injury Apply an ice pack if one is available Apply a firm support or elastic bandage Mobilise as the pain allows

R.I.C.E. ▪ ▪ ▪ ▪

Rest Ice Compress Elevate


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Occupational first aid Back pain

Back pain is very common. Four out of five of us are likely to experience one or more episodes of back pain at some time in our lives. Most sudden back pain is due to muscle spasm caused by tiredness or strain injury, but it may be due to a slipped disc, wear and tear on the joints or a trapped spinal nerve. A sudden attack of back pain may be very painful but it is not often very serious and it does not usually require medical attention. In most cases the best treatment is to keep as mobile as the pain will allow. Bed rest or lying still for days will make the muscles seize up and begin to waste away. This means that they will take much longer to recover. Things that may provoke back pain include: ▪ Heavy manual activity ▪ Lifting and carrying ▪ Poor posture ▪ Reaching, twisting and lifting ▪ Repetitive handling tasks ▪ Slips or trips Although back pain isn’t usually serious you should see a doctor if you have any of the following: ▪ You feel ill or have a high temperature as well as severe back pain. ▪ You feel numb or have pins and needles in both legs, around the genital area, the insides of the tops of the thighs or around your back passage. ▪ You become incontinent. ▪ The pain is getting worse for no apparent reason.

Slipped disc In this condition properly called a prolapsed intervertebral disk or P.I.D. the disc, usually in the lower back, ruptures and protrudes or bulges into the space occupied by the spinal nerves. The effect of this is often to cause pain, which may travel along the pathway of the nerve affected

Disc Spinal nerve

Spinal cord

Herniated Disc

Disc bulge


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Slipped disc - recognition ▪ Pain over the lower back. ▪ May come on suddenly or may have slow onset. ▪ It may be sharp and cutting, a dull ache or a feeling of pressure. ▪ Pain down the back of one or both legs (sciatica), caused by pressure on the sciatic nerve. ▪ Numbness or pins and needles over the lower legs or feet. ▪ Often made worse by standing. Although prolapses are more common in the lower back, they may also occur in the neck, causing the above symptoms in the neck, shoulders or arms.

Sciatic Nerve

Pain from sciatica follows the path of the nerve

Slipped disc - treatment ▪ ▪ ▪ ▪ ▪

If the pain is severe, the casualty will want to rest. The casualty should be encouraged to keep as mobile as the pain will allow. Ice packs or warmth over the affected area can help the pain. If the pain persists, the casualties should see their GP. Simple painkillers such as aspirin or paracetamol may help but sometimes anti-inflammatory drugs may be more effective.


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Occupational first aid Unit 8 – Burns, Poisons, Electric shock 1.1 The skin 1.2 Burn injury by type 1.3 Assessing severity of burn injury 1.4 General treatment of burn injury 1.5 Specific treatment 1.6 Electric shock 1.7 Poisons

Burn injury A burn is a wound, which results in destruction of mainly surface tissue or skin. Burns are usually typed according to source or cause. Different causes may produce different effects.

Burns by type Thermal burns: caused by the exposure of tissue to heat, often subdivided into two categories; dry heat and moist heat (scald) Dry heat can be at any temperature and damage is usually limited to the point of contact. Scald is often larger as the liquid spreads. It may not be as intense because the temperature is usually limited to the boiling point of the liquid. Electrical burns: contact with electricity may cause very severe burning, although there may well be other problems associated with electrocution, which would take priority. Chemical burns: caused by exposure to corrosive chemicals such as acids and alkalis. Radiation burns: could be any form of radiation but the most common is ultraviolet radiation, or sunburn.

Estimating severity ▪ Depth of the burn ▪ Extent of the burn ▪ Site of the burn

▪ The casualty’s health ▪ The casualty’s age ▪ The cause of the burn

Burns can be described as: ▪ Superficial - affect only the surface layers of the skin. They heal quickly with no scarring. ▪ Partial thickness - go into but not through, the skin. They may cause blistering and obvious fluid loss and are very painful. Shock is often a problem. ▪ Full thickness go through the skin , take longer to heal and tend to cause more long-term problems such as infection or scarring.


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Extent of burn It is of great importance to be able to accurately estimate the area of the burn as this is the is the primary indicator of the amount of fluid loss suffered by the casualty and therefore there the amount and type of fluid replacement required in their treatment. Any partial thickness burn that is larger than the palm of the casualty’s hand (about 1% of the total Body Surface Area) would require medical treatment. All deep burns regardless of size require medical attention. In addition, you should also send the patient for treatment for burns with a mixed pattern of depth or where you are unsure about the size or severity of the burn.

1% BSA

General burn treatment ▪ Remove the source of heat from the casualty, or the casualty from the source. ▪ Check for burns in the airway. ▪ Cool the burn with cool clean water or other clean liquid for up to 15 minutes. ▪ Cover the burn with a clean non-fluffy dressing. Plastic or cling-film is ideal.

▪ Avoid touching, coughing on or contaminating the burn. ▪ Do not burst blisters. ▪ Do not apply any creams, ointments or fats to the injury.

Corrosive burn Corrosive chemicals, whether acid or alkaline, will produce burns when brought into contact with the skin. The severity of the injury will depend upon factors such as the chemical, its strength, and the time it is allowed to remain in contact with the tissues. Treatment of chemical burns, however will follow the same regime, regardless of the chemical involved and consists of: ▪ Flood the affected area with copious amounts of water until all traces of chemical are removed. ▪ This has the effect of both diluting the chemical to a safer level and physically removing it. ▪ Do not waste time searching for specific neutralising agents, commence dilution without delay. ▪ Be aware that contaminated water from the site may cause burns to other areas of the casualty or to the rescuer, so care must be taken in positioning the casualty to make sure that this does not happen.

Electrical burn In the case of electrical burns, it should be remembered that the burn might well be the least of the casualty’s problems. With this injury various factors should be borne in mind: ▪ Danger to the rescuer ▪ Effect of electrocution ▪ Potential severity of the injury ▪ Possible other injuries ▪ There may be an exit wound, possibly on the foot ▪ There may be other injuries if, for example, the victim was thrown across the room Although electrical burns can appear to be very small on the surface, they invariably produce extensive and severe damage deep to the wound. All electrical burns should be assessed and treated by a doctor.


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Occupational first aid Effects of Temperature

Heat exhaustion is caused by loss of fluid and salts due to excessive sweating. It is commonly found in people working or exercising in hot humid conditions that they are not used to.

Heat exhaustion Recognition ▪ ▪ ▪ ▪ ▪ ▪

History of exposure to a hot environment Pale clammy skin Profuse sweating Headache Dizziness and nausea Temperature may be normal or even below normal due to the profuse sweating

Treatment ▪ Remove the casualty to a cool environment ▪ Lay them down and elevate their legs ▪ Give them copious cool drinks (isotonic sports drinks are preferred) ▪ Keep the casualty at rest and monitor vital signs ▪ Arrange for medical attention

Heat stroke Heat stroke often results from excessive exercising or heavy manual labour in a hot or humid environment. It is caused by the failure of the body’s Lay down and temperature regulating mechanism. elevate the feet Use a fan

Recognition ▪ ▪ ▪ ▪ ▪ ▪

Hot flushed and dry skin Headache and dizziness Rapid drop in level of response Restlessness and mental confusion Rapid, very strong or heavy pulse Body temperature above 40° C.

Use cold compresses

Treatment ▪ Remove the casualty to a cool area and remove all outer clothing ▪ Cool the casualty urgently with the application of cold, but not icy, water ▪ Dial 999/112 for an ambulance ▪ Wrap them in a cold wet sheet if available, to encourage evaporation

Give drinks if conscious

If the casualty stops sweating it is a critical emergency. Call 999/112 immediately


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Hypothermia Hypothermia occurs when the body temperature drops below 35° C. Moderate hypothermia (31° C to 35° C) can often be reversed, but severe hypothermia (lower than 30° C) is often fatal. However, low temperature reduces activity in the brain and therefore its requirement for oxygen, so casualties should never be considered beyond recovery. It is always worth persisting with life-saving procedures until the arrival of medical help. The onset of hypothermia may be quite sudden, as in accidental immersion in cold water, or may develop over several days, as in the case of an elderly person in an unheated room. Treatment will vary according to various factors such as the age and physical condition of the casualty, the cause of the hypothermia and the environment that the casualty is in.

38 37 36

36.5-37.5°C

35

34-36°C

Mild hypothermia

32-34°C

Moderate hypothermia

3-32°C

Deep hypothermia

<30°C

Critical hypothermia

Normal adult

34 33 32 31 30

Recognition ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪

Shivering Cold pale skin Apathy Disorientation Slurred speech Staggering gait Dropping level of consciousness Slow, shallow breathing

Treatment Young casualty/moderate hypothermia ▪ Remove the casualty to shelter. ▪ Remove wet clothing, if appropriate. ▪ If available, place the casualty into a warm bath or shower (40° C).*

▪ Do not leave a re-warming casualty alone. ▪ When the casualty feels normal and has stopped shivering, they may be gently dried and dressed in warm dry clothing or placed in bed with blankets or duvet. ▪ Give warm sugary drinks.

*After immersion in water and subsequent rescue, blood pressure may be low and may continue to fall as the casualty re-warms. (Post rescue collapse) Observe closely for signs of shock and be prepared to treat it. Casualties should be re-warmed sitting or lying, not standing.

Elderly Casualty (be aware that hypothermia may be disguising other serious medical conditions) ▪ Place the casualty in bed in a warm (not hot) room. ▪ Insulate the casualty with layers of blankets or duvet. ▪ Allow the casualty to re-warm slowly.

▪ Monitor their level of consciousness and vital signs. ▪ Be prepared to offer life support as required. ▪ Handle the casualty gently and keep movement to a minimum.


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Poisons A poison is defined as any substance that irritates, damages or impairs the function of the body’s tissues. Casualties tend to be exposed to poison in one of four ways: ▪ Ingestion or swallowing ▪ Inhalation of gases or vapours ▪ Injection, either accidental or intentional ▪ Absorption through the skin or membranes

General treatment for poisoning Although there are specific treatments for particular types of poisoning, it is probably true to say that the general procedure for dealing with poisoning cases follows the same steps. ▪ Remove the source ▪ Treat the effect ▪ Get medical help ▪ Assemble and pass on as much history / evidence as possible

Absorbed poison This type of poisoning, most often occurs accidentally as a result of chemical spillage etc. It is rare in the work environment due to the use of appropriate personal protective equipment. ▪ The contaminated area should be flooded with water to dilute and remove as much chemical as possible. ▪ Give life support as required (being aware of your own safety) and get the casualty to medical help with as much information as possible.

Injected poison Poisons may be injected both accidentally and intentionally. The most common type of intentional injection of poison would be intravenous drug abuse. This is rare in the work environment. Accidental injection could include standing on a spike or nail, which could cause infection. All puncture wounds require medical attention, and the casualty may need antibiotics and possibly tetanus protection

Inhaled poison Accidentally inhaled poisons may result from fire or industrial processes. There is a particular risk to rescuers from poisonous gas that may not be immediately obvious. Many dangerous fumes are colourless, odourless and tasteless and their presence may not be noticed until it is too late. The treatment for almost all inhalation poisoning is to remove the casualty to fresh air, if it is safe to do so and summon help urgently as the casualty will almost certainly benefit from being given oxygen. In some work situations where there is a known risk selected persons may be trained to act as rescuers and in the use of breathing apparatus whilst others may be trained to administer oxygen. In this case these personnel should be summoned urgently.


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69

Swallowed Poison Swallowed poisons probably account for more cases of poisoning than all others combined. They may be accidental or intentional. It may result from swallowing a toxic substance or from swallowing a larger than normal amount of a normally non-poisonous material such as alcohol or some types of medicine. Swallowed poisons occur in two forms, corrosive and systemic. The treatment will vary in each case. Corrosive The mode of action is to burn the tissues and the main danger results from chemical burns to the mouth and throat that may lead to swelling and obstruction of the airway. Treatment should be to limit the damage by washing out the mouth and encouraging the casualty to take continuous sips of a bland liquid. Under no circumstances should you attempt to induce vomiting as this may lead to further burning. Offer life support as appropriate, remembering to use personal protective measures as required. Get the casualty to medical help urgently and pass on as much history as possible Systemic These have an effect on the body’s systems and include such things as alcohol and some medicines. They are often taken intentionally and the effect is dose related. They have to be digested and so there is often a time delay between ingestion and effect. The best treatment for overdose or accidental poisoning by mouth is the general treatment for poisoning. ▪ Support and maintain ABC. ▪ Get to medical help with as much information as possible.

Bites and Stings A sting occurs when venom is injected through a hollow tube into the skin or underlying tissue. A bite does not inject venom but may still cause an allergic reaction. Most insect bites and stings in Ireland are likely to cause discomfort rather than danger but being stung or bitten is possibly painful and may be distressing.

Recognition The most common stinging insects in Ireland are the bee, wasp or hornet and the sting will often cause an immediate and possibly intense burning pain at the site, followed very quickly by swelling and redness around the sting. This will usually ease after a few hours. The biggest threat from such a sting would be a severe allergic reaction, or anaphylaxis. A less serious allergic response may lead to localised swelling. The swelling and redness may spread to be several centimetres across or may even involve a whole arm or leg. It will usually go away over a few days. It is not dangerous unless it affects the airway but in severe cases it may cause blister formation or infection if the skin breaks down. A wasp will not usually leave its sting behind and may sting more than once but a bee’s sting is barbed and will remain in the skin, with its venom sac attached. It is important not to press on this as it will push more venom into the wound.

Wasp sting

Bee sting


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Occupational first aid Treatment ▪ If the casualty has been stung by a bee and the sting is still in the skin it should be removed as soon as possible. Delay could lead to more venom being pushed into the tissues, ▪ It is important not to try to grip or squeeze the sting as this may squeeze more poison from the sac. ▪ The best method is to scrape the sting out using something like the edge of a card, the back of a knife or your fingernail. ▪ If you see any signs of a general allergic reaction then get medical help urgently. Phone 999 for an ambulance. Be alert for swelling in or around the mouth and lips. ▪ If the casualty has been stung multiple times they require the same urgent medical attention. ▪ Apply a cold compress to the site. Ice or frozen peas wrapped in a cloth or a cold wet flannel. Repeat as required. ▪ If there is a localised allergic reaction with swelling, redness and itching then they may benefit from an anti histamine either by mouth or as a cream or ointment. ▪ If there is a small local reaction (most commonly) then after the cold compress the itching and swelling will go away over time.

Removing a bee sting

Allergic response

Tick bites Ticks are transferred to the skin from leaves or grass and cling onto the skin with their jaws. As they feed on blood their bodies swell, often taking on a grey appearance. Tick bites tend to be painless. Ticks may carry a germ that could go on to cause Lyme’s disease which can be very serious. For this reason anyone who has suffered a tick bite should receive medical attention. Early signs of Lyme’s disease is a rash developing at the site of the bite a few days later, along with a raised temperature up to a month after the bite. Ticks should be removed with a pair of fine tweezers. This is probably best done by someone with experience as it is easy for the tick to break, leaving the head part embedded. This invariably leads Tick removal to a localised infection at the site.


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Occupational first aid

Electric Shock Electric shock occurs when a person comes into contact with a live electrical source. The severity of the outcome depends on various factors such as: ▪ The age and general health of the casualty. ▪ The strength of the electrical source. ▪ The time the casualty is in contact with the electrical source. Effects of the shock can include: ▪ Unconsciousness ▪ Respiratory and cardiac arrest ▪ Death of internal tissues ▪ Broken bones from muscle spasm ▪ Injuries from being thrown considerable distances. ▪ Severe burns, both at the point of entry and exit.

Safety Electric shock offers a serious potential threat to rescuers. You cannot see it, smell it or hear it and if you come into direct contact with the casualty who is still attached to an electrical source you may well experience a serious or even fatal shock yourself. Your first priority is to remove the source from the casualty, or the casualty from the source. Switch electricity off, ideally at a main fuse box or at a wall socket. Remember that in the heat of the moment it is easy to confuse which appliance is plugged into which socket so make sure you have isolated the correct source before approaching and touching the casualty. If you must touch the casualty as a last resort, handle only by the clothing and pull them away from the electrical source. Very high-voltage electricity such as is found in overhead power lines or around transformers, can arc or jump several feet. Do not attempt to rescue the casualty until you have been reliably informed by an appropriate agency that the electricity is in fact switched off and the area isolated. You cannot help the casualty if you become a victim.

Treatment Make sure help is called Check response If no response check for normal breathing If not breathing normally start CPR If unresponsive and breathing normally place in the recovery position and continue to monitor ▪ If conscious and breathing normally check for and treat other injuries People who have received an electric shock and appear to be unaffected afterwards will still require medical treatment and monitoring. ▪ ▪ ▪ ▪ ▪


Occupational

First Aid ▪ Contains simple, accurate and up-to-date information ▪ Conforms to all latest guidelines ▪ Filled with clear, easy to follow instructions ▪ Ideal as an ongoing reference book

Printed in Ireland

Ofa 2015 page turn  
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