Basic emergency first aid at the roadside
Alick Wheeler © 2000
The information contained on the following pages is provided as a general guide to the main principles of First Aid treatment and is based upon recognized basic medical principals. Knowledge alone while useful, can not substitute for proper regularized training. You are strongly recommended to enroll on a proper First Aid course with a reputable First Aid training provider.
None of us want to be involved in an accident but the fact is that if you travel enough, you will either come across one or be involved in one. While there is usually no shortage of bystanders, only a few are likely to have done any First Aid training and most of them are unlikely to have taken any form of re-training. So if you are thinking about learning First Aid, carry on. Don't let the seriousness of the subject put you off, saving a life is easy.
First Aid put simply “is the FIRST treatment given to a casualty at the scene of an accident prior to the arrival of a more medically qualified person". Originally First Aid was very simple. You reassured the casualty but did not move them, you dealt with what is known as the ABC of life by protecting the Airway, checking for Breathing and Circulation (i.e. heart beat), and dealing with any bleeding. Unfortunately, over the years, most training organizations have made the subject very complex by building in as much theoretical information as possible into their courses, which, last only a few hours or days. The result leaves most students confused or unsure of their abilities to do First Aid without doing something wrong.
The fact is that when you strip away all of the nice to know information and stop trying to deal with every single injury, First Aid reverts to being a very simple skill, the basics of which can be learnt in a few hours. The key is simple. You don't need to know all about how the body works, you just need to understand what effects a certain injury will have on a casualty and how you can help minimize the problem or compensate for it until the Ambulance crew take over. In terms of actual treatment, all you need to worry about is dealing with the ABC of Life.
Everyone knows you should not move a casualty if they have had a violent accident (such as being hit by a car, falling from a height) as the force of impact could have damaged their spine. So if you are not going to move the casualty, do you need to worry if they have broken their arm? If the Ambulance has been called, do you need to worry about trying to do complicated bandages to immobilize injured limbs? No, what you need to do is to concentrate on the things which will keep your patient alive like, protecting their Airway, checking for Breathing and blood Circulation and dealing with blood loss. These are the things which can kill your casualty before the Ambulance arrives, not a broken arm. Deal with the essentials and you could end up saving another persons life.
Fortunately the tide is changing and more organizations are now going back to the keep it simple approach. The next few pages provide basic First Aid information to help you deal with the more common life threatening conditions you are likely to meet at the road side. Remember knowledge alone is not enough and can not replace the need for proper organized hands on training. So go on, don't just read these pages, learn a life skill, get on a course and learn to save a life.
Accident scene management
Before you start to worry about treating any casualties, your first priority is to assess and secure the accident scene and prevent any one else (especially you) from getting hurt.
Firstly stop and assess the accident scene. Take a good look and try to work out what actually happened. Assess the forces involved and think about the injuries such forces could have caused (i.e. if the casualty's car has been badly damaged, try to imagine what the force of such an impact could have done to the occupants). Any person subject to a force which may have broken a bone or caused injury to the head, neck or spine must be treated as a trauma victim and MUST NOT BE MOVED.
Think about the dangers the accident site presents. Take notice of the layout of the accident scene and how it may affect your ability to deal with the patient safely. Is it safe /practical for you to approach the casualty? Can you clear a safe working area? Consider your own limitations and those imposed on you by the incident scene. Can you overcome any such limitations safely or is it too dangerous to proceed?
Look at the flow of traffic at the scene. Does it pose a danger to you or others, including the casualty? If so, can the traffic flow be safely controlled by bystanders or should it be stopped altogether? Before you stop the traffic, consider the effects this will have on Emergency vehicles trying to get to the scene. Think about the positioning of any vehicles involved in the incident and what possible risks they may pose (such as rolling forwards / backwards etc). Think safety, continuously re-assess the safety of the scene, particularly if relying on others to keep you safe.
Whenever possible protect yourself and the casualty from the risk of cross infection by using barriers such as gloves, resuscitation aids etc. People are naturally concerned about the risk of performing Mouth to Mouth resuscitation however there have been no recorded cases of any person contracting AIDS through carrying out Mouth to Mouth resuscitation, so do not delay resuscitation if a resuscitation aid is not available.
Remember safety always comes first! You will be of no use to the patient if you rush in and get injured or killed.
Basic casualty assessment
Once you have assessed the scene and made it safe, you must deal with the life threatening conditions in the order as shown below, rather than rushing in and dealing with the more visible (and gory) injuries such as bleeding, broken bones which, while serious, will not kill your casualty as quickly as an obstructed Airway etc.
· Assess the casualty's level of responsiveness. Tap the casualty hard on the collar bone (being careful not to cause any movement of the head or neck).
· Identify yourself to casualty, even if they appear unconscious. If the casualty does not respond and you are on your own, shout for help.
· Check the Airway / protect the spine. Where possible, get a bystander to support the casualty's head by placing their hands on either side of the casualty's head. If the casualty is unconscious, you must protect their airway as the tongue may fall back obstructing it. Place one hand on the forehead (to prevent head movement) and have a quick look in the mouth for any obvious obstructions.
NON TRAUMA PATIENTS! Keep your hand on the forehead and tilt the head back gently. As you do this, lift the chin by placing two fingertips of your other hand under the point of the chin. These actions will ensure the airway remains open.
TRAUMA PATIENTS. If the patient may have been subjected to a severe force which could have caused head / neck - spinal injuries / broken bones, DO NOT TILT THE HEAD. Use the chin lift only to maintain the Airway. Only use minimum head tilt if the chin lift fails to maintain the Airway properly.
· Check for breathing. Place the side of your face just above the casualty's mouth, looking down along their chest. Look for movement of the chest, feel and listen for breathing. Do this for up to 10 seconds.
· If the Emergency Services have not been called, send a bystander to call for an Ambulance. Make sure they know the exact location of the accident and can tell the Ambulance controller if the casualty is conscious or unconscious, breathing or not breathing.
Breathing but unconscious.
NON TRAUMA. If the nature of the incident is such that you do not believe the casualty has sustained trauma injuries (such as head / neck injuries, serious internal injuries, broken bones etc), place the casualty in the Recovery position (SEE RECOVERY PAGE).
TRAUMA. If there is any chance the casualty may have been exposed to a traumatic force, which could have broken bones and or caused injury to the head, neck, back or internal organs, DO NOT MOVE THE CASUALTY, treat them in the position found. Maintain an open airway using the chin lift only. Only use minimum head tilt if the chin lift fails to maintain the Airway properly.
- Check for a pulse. When checking for a pulse, use the carotid Artery in the neck, DO NOT check the pulse in the wrist as this can be unreliable. To find the pulse in the neck, run two fingers down the windpipe until you come to the voice box. Slide your fingers to the left or right and press in with your finger tips just as you come off of the windpipe. Check for a pulse for up to 10 seconds. Finding the pulse can be difficult so if you are having problems, check the pulse in both sides of the neck and look for other signs of life such as skin color / temperature, movement, coughing / breathing etc.
- Check for and treat serious bleeding. Carry out a full body scan for any signs of bleeding. If possible always put on a pair of disposable gloves before you start. Run your hand over and under the casualty's body. Feel for blood / other fluids and look at the casualty's clothing for any signs of discoloration caused by bleeding. As you pull your hand out from under the casualty, check your gloves for any signs of blood. If possible, expose any wounds and apply direct pressure with either your hand or with a suitable dressing. Do not worry if you can not tie the dressing in place, just keep the pressure on. If blood soaks through the first dressing, put another one on top of the first one. If there are any foreign objects imbedded in the wound, do not remove them and do not apply pressure (i.e. a dressing) on top. Instead, apply pressure to either side of the wound by squeezing the sides together. Never use tourniquets to control bleeding and never prevent blood / fluid from draining from the ear.
- Check for signs of and treat shock. Shock is the body's reaction to loss of fluids (normally blood). If a casualty is showing signs of shock they must be losing fluids either externally or more seriously, internally. The signs of shock are cold clammy skin and paleness or blueness of the lips and extremities. The pulse will become very rapid, well over a 100 beats per minute, but will get weaker and become irregular.
To check for skin temperature, place the back of your hand against your own forehead, then place it on the casualty's forehead and make a comparison. Check for color by turning the casualty's lip back and look at the inside edge (it should be a red / pinky color). Check the pulse in the wrist or the neck. The normal adult pulse rate at rest is between 70 and 80 beats per minute. Record the results of your checks (and the time you made them) and repeat every couple of minutes. Give the record of your observations to the Ambulance crew on their arrival.
If the casualty has serious wounds and or is showing signs of shock, treat them as follows. Lay the casualty down and if their injuries allow, raise their legs about 6-10 inches off the ground to improve blood flow around the body. Keep the casualty warm but do not overheat them as this will make the condition worse. Do not give them anything to eat or drink, in case they require an anesthetic.
· Continue to monitor the casualty's condition until the Ambulance crew arrives. Be aware that the casualty's condition may change so you must continue to repeat the above checks every couple of minutes.
Emergency resuscitation
The act of combining both mouth to mouth resuscitation and chest compressions is called Cardiopulmonary Resuscitation or CPR for short.
CPR must not be practiced or performed on a person who's heart is beating as it could cause serious damage to the heart. CPR training should only be performed on a training manikin as part of a recognized First Aid course.
· Assess the casualty's level of responsiveness. If the casualty does not respond to your tap on their collar bone and you are on your own, shout for help.
· Check the Airway / protect the spine. Place one hand on the forehead and have a quick look in the mouth. NON TRAUMA PATIENTS use head tilt with chin lift. TRAUMA PATIENTS use the chin lift only with no / minimum head tilt. Use minimum head tilt only if the chin lift fails to maintain the Airway properly.
· Check for breathing. Look, listen and feel for breathing for up to 10 seconds.
· If not already done, send a bystander to call for an Ambulance.
· Make sure the bystander tells the Ambulance controller that the casualty is not breathing.
· If you are on your own, you are advised to follow the Resuscitation Council (UK)'s phone fast / first protocol. This works on different casualty's needs for either quick medical assistance or immediate resuscitation.
· Phone Fast: If the casualty has sustained traumatic injury (car crash etc), has drowned or is a child, perform resuscitation for one minute before leaving the casualty to call for help.
· Phone First: If the casualty is an adult who has not been involved in a traumatic incident and has not drowned, leave the casualty at once and call for help.
· Give 2 INFLATIONS. Tilt the head back slightly (if not already done) and use the chin lift. Pinch the casualty's nose shut with one hand while maintaining the chin lift with the other. Take a deep breath, place your mouth over the casualty's mouth (making a good seal) and exhale slowly and steadily.
· Each inflation should last 1.5 to 2 second and the gap between inflations should be about 6 seconds. Your inflation should be sufficient to cause the chest to rise only as it would if the casualty was breathing normally. Come up away from the casualty's mouth, and look down along the chest to ensure that it did rise. At the same time take another breath and repeat the inflation as before.
· CHECK FOR A PULSE. Check for a pulse using the carotid Artery in the neck for up to 10 seconds. If you have problems finding the pulse, look for other signs of life.
YOU MUST ALWAYS CHECK FOR A PULSE BEFORE GIVING CHEST COMPRESSIONS.
It is imperative that you confirm the absence of a pulse before you start Chest compressions as serious damage could be caused to the heart if chest compressions are performed on a beating heart.
If there is a pulse, continue to give inflations only. Stop to check the pulse is still present, about every minute (around every 10 inflations) and continue with another 10 inflations. If pulse fails, continue with the procedure as outlined below.
If no pulse, carry out landmark check, position hands.
While kneeling by the side of the casualty, find the lower half of the breastbone by running your fingers under the rib cage and following the line of the ribs around to the centre of the chest where there is a notch where the ribs join. Place your middle finger in this notch and place your index finger above it on the breastbone.
Slide the heel of your other hand down along the breastbone until it touches the side of your index finger. Remove your middle and index fingers and place the heel of that hand on top of the other, interlocking the fingers, keeping them off of the chest wall. Lock your arms straight and bring your shoulders up, directly over the casualty's chest.
Give 15 chest compressions
Compress and release the breastbone 15 times at a rate of about 100 times per minute. You do not need to use much force, just press the breastbone down about 4-5cm (1 .5 -2 inches). To get the right speed count aloud One, Two, Three, Four etc. In between each compression, release the pressure on the breastbone but do not remove your hand or you may lose your hand placement.
Continue with full CPR.
Continue to give 2 inflations to 15 compressions as detailed above. DO NOT STOP to check breathing or pulse unless the casualty shows signs of life such as movement, coughing, etc. If they do, stop and check the pulse / breathing for up to 10 seconds. If life signs are sustained, and the person is a NON TRAUMA casualty, place them in the Recovery position. If they are a trauma patient, maintain their Airway using the chin lift method. If life signs are not sustained, re-start full CPR
Continue CPR until the casualty shows signs of life, someone takes over from you, you become exhausted or the Ambulance crew ask you to stop.
The recovery position
20% of all people who die as a result of a road traffic accident, do so because their Airway becomes obstructed either by a build up of fluid or vomit or by the tongue falling to the back of the Airway.
An unconscious patient who IS NOT a TRAUMA CASUALTY (i.e. has not been subjected to a severe force such as being hit by a car or falling from a height, and unlucky to have sustained injury to the head / neck or spine), should be placed in the Recovery position. This causes the tongue to fall forward, allows any fluid to drain out of the mouth and prevents the casualty from rolling onto their back. Some casualties will already be laying on their sides. In these cases you just need to modify their position to ensure the Airway is fully protected.
Positioning yourself, opening the Airway
Kneel beside the patient on the side to which you want to turn them on to. If they are wearing glasses, carefully remove them putting them in a safe place. Straighten the casualty's legs and open the Airway by tilting their head backwards slightly and lifting the chin (see page 3).
Positioning the casualty ready for the turn
Place the arm nearest to you, out at right angles to the casualty's body and bend the elbow so the upper arm is parallel to the head, palm upwards. Do not try to force the arm down or in to a position it does not want to go in to, just place it as above, as best you can. Bring the arm furthest away from you, across the chest and place it palm up, against the cheek nearest you. Hold the casualty's hand there with your left hand, palm to palm, otherwise it will drop down again.
With your left hand, grip the leg furthest away from you and placing your hand under the casualty's knee, bring the knee up so that the casualty's foot is resting on the floor, tucked in next to their other knee.
Turning the casualty, final positioning.
Keeping your left hand holding the casualties hand palm to palm, against their cheek, place your right hand on the knee of the raised leg. Move back slightly from the casualty and roll them towards you and on to their side, by pulling on the knee.
Once the casualty is over, gently lay their head on the floor. Tilt the head back (moving the casualty's hand under the check as required), ensuring the Airway stays open and is not obstructed by their own body. Move the upper leg so that the hip and knee are bent out at right angles to the body. This prevents the casualty from rolling backwards.
Recheck breathing, pulse and level of responsiveness, every couple of minutes. Continue to look for possible signs of bleeding which may have been hidden or only now becoming obvious.
Continue to check for and treat shock.
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