SIMPLY FIRST AID - MAY20

A reference guide for first aid treatments Simply First Aid

Simply First Aid

The information in this book contains, at the time of printing, the most current guidelines of the Australian Resuscitation Council. This book is designed to be an information resource and is in no way a substitute for attending a rst aid course conducted by an approved provider. Many organisations and resources have been consulted in the compilation of this book to ensure its accuracy. However, it is impossible to cover all potential aspects in an emergency situation and the authors of this book accept no responsibility for any injury or damage that may occur as a result of any of these procedures. If you have any problems or queries regarding information contained in this book, please refer to the Australian Resuscitation Council: resus.org.au Allens Training Pty Ltd would like to thank the following organisations for their support, advice and contributions to the contents of this rst aid manual: Ÿ The Australian Resuscitation Council Ÿ Asthma Foundation Ÿ National Heart Foundation of Australia Ÿ Epilepsy Action Australia Ÿ Our network of trainers and assessors

Publication date: JANUARY 2020

Published by: Allens Training Pty Ltd Head Ofce: 1/6 Bottlebrush Ave Noosa Heads QLD 4567 1300 559 064 allenstraining.com.au

Authors:

Mardi Abernethy and Jim Allen

Cover design: Kylie Jackat Layout: Kylie Jackat

All rights reserved. Reproduction of this book, in part or entirely, without written permission is prohibited.

© Copyright Mardi Abernethy ISBN 9 780 980 380 507

Table of contents

CONSCIOUS CASUALTY ASSESSMENT

FIRST AIDER ROLES AND RESPONSIBILITIES About this book............................................................. Introduction................................................................... Workplace rst aid ...................................................... First aid kits.................................................................. Respond appropriately – Principles and ethics............ Steps for rst aid – Action plan..................................... Safety when providing rst aid...................................... Hazard and risk assessment........................................ Infection control............................................................ Safe manual handling................................................... Calling for help.............................................................. Multi-casualty incidents - Triage.................................... Chain of survival........................................................... Cardiopulmonary resuscitation (CPR).......................... DRSABCD action plan.................................................. Debrillation.................................................................. The unconscious state.................................................. Turning a casualty on to his/her side............................. RESUSCITATION

2 3 5 7 9

Indicators of the casualty's condition............................. Secondary survey..........................................................

29 31

MEDICAL

Allergic reaction............................................................. Anaphylaxis................................................................... Asthma.......................................................................... Diabetes – Hypoglycaemia (low blood sugar)............... Heart conditions............................................................. Heart attack.................................................................... Seizure........................................................................... Shock............................................................................. Stroke............................................................................. . Abdominal injuries......................................................... Roller bandages............................................................ Severe external – General management....................... Bleeding control – Direct pressure method.................... Bleeding control – Tourniquet ........................................ TRAUMA

33 34 37 40 41 42 43 44 45 47 48 51 52 53

10 11 12 13 14 15 16 19 20 21 23 25 26

Table of contents

ENVIRONMENTAL

TRAUMA

Bleeding - Internal.......................................................... Burns.............................................................................. Choking.......................................................................... Crush injury.................................................................... Ear injuries..................................................................... Electric shock - or lightning strike................................... Eye injuries..................................................................... Fractures & dislocations................................................. Immobilisation................................................................ Triangular bandages...................................................... Splints............................................................................ Arm slings - using triangular bandages.......................... Head injuries.................................................................. Motor vehicle accidents................................................. Needle stick injuries....................................................... Soft tissue injuries.......................................................... Spinal injuries.................................................................

54 55 57 59 60 61 62 63 64 65 65 66 67 69 71 72 73

Australian bites and stings............................................ Pressure Immobilisation Technique (PIT)..................... ENVENOMATION AND STINGS - Land creatures...... Bee, wasp & ant............................................................ Spiders ...................................................................... Snakes ...................................................................... Tick................................................................................ ENVENOMATION AND STINGS - Marine creatures.... Blue-ringed Octopus & Cone Shell............................... Fish stings/injury............................................................ Jellysh stings............................................................... ENVIRONMENTAL - Drowning..................................... ENVIRONMENTAL - Cold............................................. ENVIRONMENTAL - Hot - Hyperthermia...................... ENVIRONMENTAL - Hot - Heat stroke......................... Poisoning .....................................................................

75 77 78 78 79 81 82 83 83 84 85 86 87 89 90 91

OTHER

CHILD SAFETY............................................................. Incident report ..............................................................

95/96 97/99

Main title

About this book

Welcome to Simply First Aid. Firstly let's talk about how to use this manual. There are basic pages of written information and some ow charts. However, for most pages, infographics have been used to allow for quick understanding, action and response.

Infographics are visual representations of information in a graphic form e.g. chart or diagram. In a broad sense infographics condense larger amounts of information into a form where it will be more easily absorbed by the reader, making them suitable for all levels of literacy. Below is an explanation on how to use/read the infographics used in this manual. Whilst there are slight variations in size and layout, the basic concept is the same for each.

Each page has a colour coded banner with the section name, to remind you which section you are in.

Infographic ows from left to right, providing step by step information for rst aid.

Issues, Signs and Symptoms THE YELLOW BOX: Ÿ A list of signs and symptoms Ÿ Things to look out for HAZARD INFORMATION The light red box contains dangers to look out for RISK INFORMATION The light orange box contains information about the risk associated with the dangers

First Aid

Extra Information

START AT THE TOP Green arrow/box

THE LIGHT BLUE BOX: Ÿ Extra information about the topic and/or Ÿ Extra rst aid steps

READ IN ORDER Going down

FIRST AIDER ROLES AND RESPONSIBILITIES

THE BASIC STEPS And actions

DESCRIBING WHAT TO DO

A picture may be included to help understanding

2

Introduction

Privacy and confidentiality Disclosure of personal information without that person's written consent is unethical and may be illegal. Details of medical conditions, treatment provided and the results of tests must remain condential and be maintained in line with statutory and/or organisational policies. Recognise an emergency situation Indicators of an emergency might be distress sounds, spilled chemical container, unusual behaviour (e.g. panic), condition (signs and symptoms) of the casualty. Consent and refusal of treatment Ask first if it is OK to help….. Consent from an injured or ill person, or their carer, or the parent/legal guardian of a minor, must be obtained before providing assistance (unless the casualty is unconscious, where consent is implied). Legal action and damages may be taken against you if you act without obtaining consent. Adults are entitled to refuse treatment even if it is life-sustaining. Parents or legal guardians of minors, or those with a disability, can likewise refuse treatment but only if in the best interests of their charge. ARC Guideline 10.5 provides further information on these subjects.

About first aid First aid is the initial care provided to someone who has suddenly fallen ill or who has been injured, until more advanced care is provided or the person recovers. Any person providing rst aid should stay with the casualty unless it is necessary to leave to call for medical assistance, a rescuer of equal or higher ability takes over , or continuing to give aid becomes unsafe. First aid guidelines The Australian Resuscitation Council (ARC) develops guidelines for the provision of CPR and rst aid. These can be viewed on their website: www.resus.org.au Duty to provide first aid Most Australian States and Territories have some form of Good Samaritan or Common Law providing protection. In general, community rst aiders need not fear litigation if care is made in good faith, they try to avoid further harm using actions that are not reckless and within their skills and limitations. Workplace rst aid providers must act within the scope of activity of their organisation and according to instruction of the organisation. They must also perform their tasks to the standard expected of a reasonably competent person with similar training and experience. A trained workplace rst aid provider, when not on duty, would be regarded as a ' Good Samaritan' if deciding to provide rst aid.

FIRST AIDER ROLES AND RESPONSIBILITIES

3

Introduction

Making the casualty comfortable Make the casualty comfortable using available resources and equipment. This might mean placing pillows under broken limbs, covering them to keep warm or providing pain relief using hot or cold packs etc. Available resources are those found at the scene or close by. They could be rst aid kit items such as bandages, slings, gauze, emergency blankets etc. or make do items such as rolled up jumpers for a pillow, towels or large coat for a blanket, a t- shirt torn into strips for a bandage etc. Monitoring and reassuring Stay with the casualty and care for them until further help arrives. Monitor the casualty and respond to changes to his/her condition. Continuously observe their vital signs, such as how they are breathing, pulse rate, temperature, conscious levels (becomes drowsy, can't understand you or talk, becomes unconscious etc.). Reporting the incident Whether providing rst aid in the community or the workplace, you will likely be required to provide details of the incident. This might be to a supervisor, parent or carer, ambulance ofcers or other medical professional. If at all possible, take notes during or soon after providing rst aid. Areport form is provided at the back of this manual, which indicates the type of information you will need to remember. Having an ofcial form to ll out is of great benet however a note pad or paper will sufce. Workplace rst aid providers will be required to use their organisations ofcial forms and follow procedures for reporting.

Priorities Firstly, early recognition of an emergency to initiate early management, and safety for the rst aider, the casualty and bystanders. General principles include: prevention of further harm; checking responses; care of airway and breathing (priority over any other measures); control of bleeding; protection from the weather; other rst aid measures; gentle handling; reassurance; continual monitoring. Where there is more than one casualty, the care of those unconscious take priority. Communication Be calm but assertive, positive, and communicate in accordance with the situation i.e. to suit the elderly or a child, if the casualty is panicked or calm, incoherent or clear headed etc. Take control of the situation, get straight to the point and provide clear directions. Moving a casualty The condition of a collapsed or injured casualty may be worsened by movement, increasing pain, injury, blood loss and shock. However, a casualty lying in a hazardous area may need to be moved to ensure safety. Hazardous areas include: on a road or railway; unstable terrain or vehicle; extreme weather conditions; near re or electricity etc. If you must move the casualty, ensure safety rst. Do so with extreme care using correct manual handling techniques, try to have three people to assist (support head, neck, pelvis and limbs), avoid bending or twisting the casualty’s neck or back. Use spine boards where possible.

FIRST AIDER ROLES AND RESPONSIBILITIES

4

Workplace first aid First aid requirements vary from one workplace to the next. The chart below shows what needs to be taken into consideration when deciding on rst aid requirements and arrangements for the workplace. Blue boxes - items which must be consulted and adhered to when making decisions about the elements in the Green box .

CODES OF PRACTICE FIRST AID IN THE WORKPLACE A guideline which uses a risk management approach for providing rst aid . www.safeworkaustralia.gov.au POLICIES AND PROCEDURES Developed following relevant legislation i.e. Acts, Regulations

ARC GUIDELINES Must be followed. Included in policies and procedures. www.resus.org.au

WORKPLACE FIRST AID REQUIREMENTS Preventing incidents & accidents Providing First aid First aiders and training First aid kit: number, contents and location Facilities and signage Emergency plans Reporting Communication

THE WORKPLACE Nature of the work.

Type of hazards. Size and location. Number of workers.

FIRST AIDER ROLES AND RESPONSIBILITIES

and Codes of Practice. First aiders must locate,

SAFE WORK PRACTICES Minimise risks and hazards. www.safeworkaustralia.gov.au

understand and adhere to them. Example policy - Procedures for dealing

with major and minor accidents/incidents .

5

Workplace first aid

The exception – Medication may be administered without an authorisation in case of an anaphylaxis or asthma emergency. In all cases, if medication is administered, written notice must be given to a parent or carer of a child as soon as practicable. Providing rst aid for children, the aged or inrm Communicate and act in accordance to the age of the person being treated, for moral reasons and to gain acceptance and trust. Children and babies – Reassure with care and compassion. Use a soft kind voice. Provide a distraction e.g. give them something to hold like a band aid. Whether injured or sick themselves or concerned about a friend, children may feel affected by the incident. Someone should talk to children about feelings, emotions and responses and provide assistance to help recovery. Details of an incident involving children or babies must be reported to the parent/caregiver and recorded in an incident report. Serious incidents – An injury/illness requiring urgent medical treatment, involving emergency services, or the death of a child, must be notied to the regulatory authority. Another example of a serious incident is where a child is mistakenly locked in or out of the service premises. Aged or inrm – Respect and dignity are very important. Remember with older people they may be hearing impaired, have reduced ability such as trouble walking or moving, be fragile e.g. brittle bones, thin skin which damages or tears easily, etc. Be patient, gentle and provide support and assistance with movement, positioning andmaking comfortable.

Legislation and the workplace Legislation governs how rst aid should be provided in the workplace. This varies depending on the state or territory and the industry. The FIRST AID IN THE WORKPLACE code of practice provides guidelines that must be used by all workplaces in deciding upon rst aid requirements, policies and procedures. Other legislative examples: WHSAct and Regulations, Children's ServicesAct and Regulations. Children's services regulations National authority – TheAustralian Children's Education & Care Quality Authority (ACECQA) guides the implementation of the National Quality Framework (NQF) for Early Childhood Education and Care and ensures consistency in delivery. State and territory – A regulatory authority in each state and territory regulates and assesses children's education and care services. They administer the NQF, issue approvals and certicates, monitor and enforce the law and review and investigate complaints. They also provide further specic information in relation to the number of staff members trained in rst aid and anaphylaxis management, what the training must include and how training is to be undertaken. Administration of medication to a child – Medication cannot be administered unless the administration is authorised and done so in accordance with policy and procedures. The authorisation must be included in the child's enrolment record, or in the case of an emergency, verbally by the parent or carer authorised to give consent.

FIRST AIDER ROLES AND RESPONSIBILITIES

6

First aid kits

Kit design First aid kits can be any size, shape or type , but each kit should: Ÿ be large enough to contain all the necessary items Ÿ be immediately identiable with a white cross on green background that is prominently displayed on the outside Ÿ contain a list of the contents for that kit Ÿ be made of material that will protect the contents from dust, moisture and contamination

Contents At least one rst aid kit must be provided at a workplace. The contents should be based on a risk assessment. For example, there may be higher risk of eye injuries and a need for additional eye pads in a workplace where chemicals are used. Additional equipment may be needed for serious burns and remote workplaces. The contents should be checked regularly to ensure sufciency, use- by dates have not expired and that used items are replaced. The recommended content of a typical rst aid kit is provided in the: First Aid in the Workplace Code of Practice - Appendix C. www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/rst-aid-in-the- workplace Location Quick access to the kit is vital. First aid kits should be kept in a prominent, accessible location, able to be retrieved promptly and identied on emergency oor plans. Ideal locations are close to areas posing a higher risk of injury or illness. For example, a school with a science laboratory or carpentry workshop should have rst aid kits located in these areas. At least one kit should be located on every second oor of multi-story buildings. Portable rst aid kits should be provided in vehicles of mobile workers . For example, couriers, taxi drivers, sales representatives, bus drivers and inspectors. These kits should be safely located so as not to become a projectile in the event of an accident.

First aid kits are available from allenstraining.com.au

FIRST AIDER ROLES AND RESPONSIBILITIES

Other first aid equipment Other rst aid equipment should be considered as necessary to treat the injuries or illnesses that could occur as a result of a hazard. For example, providing an automated external debrillator (AED) can reduce the risk of fatality from cardiac arrest.

7

FIRST AIDER ROLES AND RESPONSIBILITIES

8

Respond appropriately – Principles and ethics ALL OF THESE ITEMS MUST BE FOLLOWED FOR THE PROVISION OF FIRST AID

DUTY OF CARE To provide rst aid:

SKILL LEVEL A rst aider must:

IN THE WORKPLACE Provide rst aid:

Without recklessness or expecting nancial or other reward.

Trying to avoid further harm, with reasonable care and skill. Stay with the casualty.

Only provide care appropriate to training and ability.

In accordance with industry size, type, location, legislation and the First Aid Code of Practice.

Follow procedures. Report incidents to supervisor.

Keep current. Refresh training. Be aware of changes to legislation and procedures.

RESPECTFUL BEHAVIOUR Towards the casualty by:

PRINCIPLES AND GUIDELINES A rst aider must:

Use available resources to provide comfort. Operate equipment according to manufacturer instructions.

Obtaining consent. Respecting beliefs. Providing dignity and privacy.

Being kind and reassuring. Providing comfort. Monitoring his/her condition and responding to changes.

Follow the Australian Resuscitation Council guidelines for CPR and rst aid.

FIRST AIDER ROLES AND RESPONSIBILITIES

INCIDENT DETAILS Report verbally or in writing:

DEBRIEF/EVALUATE Self and incident - discuss:

Stress. If identied, use stress management i.e. advice, support and counselling.

Accurate facts only, to emergency services, medical staff and/or family as appropriate.

Only disclose casualty condition and treatment provided to the appropriate authority. Keep records condential and restrict access.

Performance and conduct, to address need for help, advice, improvement.

9

Steps for first aid – Action plan THESE STEPS MUST BE TAKEN FOR ALL FIRST AID EMERGENCIES

1. ASSESS DANGERS

2. PROVIDE SAFETY

3. SEEK HELP

From emergency services. Call 000 .

In the area (don't proceed if unsafe).

Associated with the casualty (behaviour, blood etc).

Remove or minimise hazards.

Protect self (PPE) and casualty (from elements).

From bystanders .

FIRST RESPONSE PROVIDE ASSISTANCE AFTER FIRST AID Consent from conscious casualty .

4. ASK FIRST

5. ASSESS CASUALTY

6. FIRST AID

Injuries (visual/verbal survey).

Consent from parent or carer .

Response. Signs & symptoms.

ARC guidelines and rst aid principles.

Within skills and knowledge .

FIRST AIDER ROLES AND RESPONSIBILITIES

Stay with them.

Debrief and/or counselling .

7. MONITOR

8. COMMUNICATE

Make comfortable and reassure.

Respect privacy and condentiality.

Until hand-over to medical assistance or fully recovered.

Convey incident details to carer or authorities.

10

Safety when providing first aid

IDENTIFY HAZARDS

SAFETY IS A PRIORITY:

Look for anything that may cause harm to self, casualty or others at the scene. There may be more than one risk factor per hazard. How dangerous are the hazards? How can I make them safe? Make sure actions don't cause more danger. Remove or minimise dangers. Provide information. Direct others. Check the area again. Check safety. Still too dangerous, go back to Step 1 – IDENTIFY HAZARDS.

For the casualty, the rst aider, others assisting and bystanders.

IDENTIFY RISKS

A HAZARD Anything likely to cause an injury or illness.

ASSESS DANGERS

A RISK The likelihood and consequences of an injury or illness occurring from exposure to the hazard .

MANAGE SAFETY

REVIEW SAFETY

FIRST AIDER ROLES AND RESPONSIBILITIES

IF SAFE PROCEED. IF STILL UNSAFE WAIT FOR EMERGENCY SERVICES

Hazards at a car accident such as broken glass and traffic.

11

Hazard and risk assessment

Hazards

Risk the hazard may pose

Ways to make safer

Body fluids (e.g. blood)

Being infected.

Gloves, masks, eye wear, aprons etc.

Casualty body position (e.g. on back and unconscious)

Airway obstruction, choking, further injury.

Roll the unconscious on their side, do not pin down or restrain on their back, position for drainage if vomiting. Be calm, reassure, get assistance, don’t continue if they remain aggressive. Look for, move away from found needles, advise others, don’t pick up. Use safe techniques, get assistance, know your limitations, use devices i.e. back boards. Wait for professionals to declare safe, use PPE, shut down power, consult Safety Data Sheets. Use PPE, use barriers to prevent others from entering, turn equipment off for first aid. Move the animals away, contain them, wait for authorities or professionals. Move to a safer location, put up warning signs, position vehicles, and direct traffic. Wait until power is shut down, use non-conductive materials to remove casualty. Extinguish fire if trained, remove fire sources, move to a safer area, call 000, do not proceed if too unsafe. Protect with cover, move to a safer area, find shelter. Move to a safer area, follow safety procedures, call 000, do not enter confined spaces unless trained. Shut down or shield dangerous moving parts.

Aggressive behaviour

Being attacked, intimidation.

Needle stick injuries

Being stuck by the needle and becoming contaminated. Back and neck injuries, injury to the body, dropping a casualty. Being struck, hit or cut by moving equipment. Equipment failure. Being poisoned, burns, irritation, infection, allergic reaction. Welding arc flashes to eyes, burns from ionizing radiation and lasers.

Manual tasks (lifting or moving heavy objects or casualties, overexertion) Machinery and equipment

Chemical fumes/biological

Radiation

Animals

Bites, kicks, scratches.

Traffic

Being hit by a vehicle.

Electricity or fallen power lines

FIRST AIDER ROLES AND RESPONSIBILITIES

Electrocution, shock, burns, cardiac arrest, fire.

Fire

Being burnt, risk of explosion, building collapse, being trapped, smoke hazard. Slipping, being struck by objects, burns, heat stress, fatigue, cold injury. Falling, tripping, slipping, being trapped, unsafe atmosphere.

Environment (e.g. storms, snow, wind, rain, extreme temperatures) Location (e.g. rough terrain, heights, confined spaces)

12

Infection control

WASH HANDS

Wash hands with soap and water or apply an alcohol- based hand rub. Use and wear Personal

HOW TO MINIMISE THE RISK OF EXPOSURE AND CONTAMINATION From casualty to rst aider and from rst aider to casualty.

Protective Equipment (PPE): i.e. disposable gloves for all rst aid; masks for CPR; eye protection and plastic aprons to protect from splashing. Remove PPE carefully. Dispose of PPE, used dressings, bandages and infectious waste in an appropriate bin or container. Wash your hands thoroughly with soap and water.

USE PROTECTION

HAZARD = EXPOSURE Airborne - sneezing and coughing Direct contact - body uids or contaminated items .

CAREFUL DISPOSAL AND CLEAN UP

RISK = CONTAMINATION Being infected by a disease . Passing on a disease.

WASH HANDS

FIRST AIDER ROLES AND RESPONSIBILITIES

Listed above are Standard Precautions -

safe practices which should be applied for all rst aid, regardless of a casualty's infectious status.

Reduce exposure.

Wash your hands.

Disposable gloves.

Resuscitation mask.

13

Safe manual handling

PREPARE MENTALLY

Consider: Ÿ The weight and size of the casualty, where they are to be moved to, sudden movements and obstacles. Ÿ Lifting technique, the number of helpers, available resources and equipment (stretcher, backboard, lifting harness etc.) Feet - shoulder width apart. Bend at the knees. Hips - bend at hips, not waist. Arms and casualty - close to your body. Back - keep in alignment with shoulders and pelvis. Head - hold straight. Communicate - take charge, provide good instruction, talk to casualty. Team work - co-ordinate, work together. Grip load securely, use thigh and leg muscles, avoid twisting, rotating or jerking.

HOW TO SAFELY LIFT AND MOVE A CASUALTY Avoid using back muscles. Never lift a casualty while you are bent over them. Never manually lift a casualty from the oor or try to lift a casualty alone.

GET IN POSITION

HAZARD = HEAVY AWKWARD LOAD, TRIPPING

COMMUNICATE

RISK = DROPPING THE CASUALTY, INJURY Injuries are most commonly to the back, lower lumbar area.

CO-ORDINATE

FIRST AIDER ROLES AND RESPONSIBILITIES

LIFT & MOVE

Examples of equipment used for moving a casualty.

14

Calling for help

HOW TO CONTACT AND ARRANGE HELP FROM EMERGENCY SERVICES FOR ALL EMERGENCIES Triple Zero (000) – all phones. 112 – Mobile phones if 000 not available. 106 – Teletypewriter for hearing impaired. *Please note: you must have reception to make the call from a mobile phone.

DIAL TRIPLE ZERO - 000 -

If possible get someone else to make the call so you can tend to the casualty. Stay calm, speak clearly. The call operator will ask you if you need Police, Fire or Ambulance. The emergency service operator will take details of the situation. Give the details of where you are, i.e. suburb, street number, street name and nearest cross street. In rural areas, give the full address, distances from landmarks and roads, the name of the property. If possible, have someone wait outside at an arranged meeting point.

SELECT SERVICE REQUIRED

STATE TYPE OF EMERGENCY

FIRST AIDER ROLES AND RESPONSIBILITIES NOT CALLING AN AMBULANCE MAY BE LIFE-THREATENING Do not be afraid to call 000 in the event of a drug overdose - ambulance ofcers will not report you to the police.

PROVIDE THE LOCATION

If you make the call whilst travelling, identify the direction you are going in and the last exit or town you passed through. Stay on the line, speaking clearly answer the operator's questions, listen to what they tell you to do.

You should not be concerned about the costs* - saving a life is a priority. *Refer to Further information at the back of this book.

FOLLOW INSTRUCTIONS

15

Multi-casualty incidents - Triage

IDENTIFY INJURIES Count casualties. Call 000.

BASIC TRIAGE

Ensure safety Firstly – protect yourself or you can make the situation worse. Secondly – move if staying is more dangerous than moving e.g. from an unsafe building, a car with leaking fuel on a road or railway line etc. Move those who need most assistance rst. See if those with minor injuries can assist or help themselves. Drag the unconscious to safety. Prioritise in range from those needing immediate life-saving interventions such as obstructed airway, excessive bleeding or shock, then those who are stable but need monitoring and medical attention, to those who will require care but not urgently. First evaluations: 1. Check airway/breathing 2. Check bleeding/circulation The order may change if a casualty condition worsens whilst treating others.

The sorting of casualties in a multiple casualty incident by the severity of injury or illness. The goal - identify casualties who have obstructed airway, excessive bleeding or shock and treat them immediately.

EVALUATE INJURIES Gain assistance if possible.

HAZARD = UNSAFE SITUATION. MULTIPLE SERIOUS CASUALTIES

PRIORITISE Co-ordinate others.

RISK = FURTHER INJURY. NOT TREATING THE MOST APPROPRIATE CASUALTY FIRST A casualty who has suffered a cardiac arrest should only be given CPR if there are no other seriously injured casualties who would benet from life-saving treatment.

TREAT MOST SERIOUS Then others in order.

FIRST AIDER ROLES AND RESPONSIBILITIES

MONITOR Watch for changes in condition.

16

RESUSCITATION

17

RESUSCITATION (CPR)

Follow the rst aid principles and procedures as described in the roles and responsibilities section as the rst steps for undertaking resuscitation of a casualty.

RESUSCITATION

Ÿ Chain of survival Ÿ CPR

Ÿ DRSABCD Ÿ Debrillation Ÿ Unconscious

18

Chain of survival Cardiac arrest

Cardiac arrest is a term used to describe a collapsed casualty who is unconscious, unresponsive, not breathing normally or at all and not moving. Cardiac arrest is the largest cause of death. The best way to increase the chance of saving sudden cardiac arrest casualties outside of a hospital setting is to follow every link in the chain of survival.

RESUSCITATION

19

Cardiopulmonary resuscitation (CPR)

The CPR technique CPR is the combination of chest compressions and rescue breaths, alternately and continuously. CPR can be done with a single operator; however, it is more benecial with two rst aiders i.e. one person completing the rescue breaths and one person doing compressions. If there is more than one rst aider present, rotate approximately every 2minutes to reduce fatigue. Regurgitation or airway obstruction If airway becomes obstructed during CPR, promptly roll the casualty on to his/her side and clear. Reassess response and breathing, then recommence CPR as required. Resuscitation in late pregnancy In the obviously pregnant woman, the uterus causes pressure on the major abdominal vessels when she lies at on her back, reducing the venous return of blood to the heart. Position her on her back with shoulders at using padding under the right buttock to give pelvic tilt to the left side. An AED can safely be used on pregnant casualties. Protection during rescue breaths Whilst the risk of disease transmission during rescue breaths is very low, using a resuscitation mask reduces the risk even further. A mask prevents direct contact between the rst aider and the casualty, thus protecting from contact with vomit, blood and saliva.

There are many types of resuscitation masks available to use. Remember though: whilst masks should be used, they are not mandatory. Do not delay rescue breaths if you do not have a mask. If unwilling, or unable, to do rescue breaths, compressions only CPR is an option. Compressions only Follow all requirements for compressions continuously, only pausing if response or breathing returns, for debrillation or hand-over. Compressions techniques Adults - Two handed technique Children - Either a one or two handed technique can be used Infants - Two nger technique

RESUSCITATION

20

DRSABCD action plan

D ANGER Ensure there is nothing that can cause harm before proceeding .

R ESPONSE No response can be obtained.

S END FOR HELP Ensure 000 is called. Send for face mask, debrillator and assistance.

A casualty who is either not breathing, occasionally gasping or breathing abnormally and is unresponsive, is in cardiac arrest and requires immediate CPR.

CARDIAC ARREST: Ÿ Collapsed and not moving; and Ÿ Unresponsive, unconscious; and Ÿ Not breathing normally or at all; or Ÿ Gasping with no response

RESUSCITATION

The defibrillator location should be easily identified with signs. It will most likely be stored in a cabinet mounted on a wall. There may be an alarm to ensure the defibrillator is not misused.

HAZARD = NO CIRCULATING OXYGEN TO THE BRAIN. TIME Cardiac arrest is the leading cause of death in humans. Quick timing is vital.

RISK = BRAIN DAMAGE. DEATH To increase the chance of revival, follow every link in the Chain of Survival.

21

DRSABCD action plan

D EFIBRILLATION Attach AED* as soon as available , follow its prompts .

A IRWAY Open airway. If not maintained can cause obstruction.

B REATHING Not breathing or abnormal breathing.

C PR 30 Compressions / 2 Breaths. or Compressions only.

ADULTS AND CHILDREN

OVER 1 YEAR

Compressions - On a rm surface, with arms straight, use the heel of one hand, the other hand on top, rhythmically compress the centre of the chest (about half way along the sternum /breastbone) at a rate of 100 - 120 per minute (almost 2 per second), around 1/3 of the depth of the chest (5cm). Stop compressions to do rescue breaths and/or debrillation.

Rescue breaths - Mouth to mask/mouth (rarely, mouth to stoma - hole in the neck). Kneel beside his/her head. Keep airway open. Position mask, and hold in place, or seal your mouth over theirs. Blow into mask/mouth, inate the lungs. Look for chest rise. Remove your mouth. Turn your head, listen/feel for air release. If no chest rise - check head tilt/chin lift andmouth seal.

Assess breathing LOOK and FEEL for movement of the upper abdomen and lower chest. LISTEN for air escaping from the nose and mouth.

Backward head tilt, chin lift - One hand on the forehead. The other holds the chin up. Gently tilt the head backwards (NOT the neck). Mouth slightly open, jaw pulled away from the chest.

RESUSCITATION

* Debrillation is explained next page.

INFANTS

No head tilt - Neutral head position, support lower jaw, keep mouth open.

Rescue breaths - Mouth to nose, only use puffs.

Assess breathing - Look, listen, feel.

Compress the chest - 4cm deep using two ngers.

Repeat the sequence until the casualty is responsive or breathing normally, help arrives or you are too fatigued to continue.

22

Defibrillation Debrillation is the process in which an electronic device, called an automated external debrillator or AED, helps re-establish normal contraction rhythms in the heart of a casualty in cardiac arrest ( not conscious and not breathing normally ). There are many different types of AEDs and the storage, attachment of pads and cables and sequence of operation may vary between machines, however they all follow the same principle. Always follow themanufacturer's instructions. Debrillation should occur as soon as possible The Automated External Debrillator (AED) can accurately identify the cardiac rhythm as 'shockable' or ' non-shockable ' by reading the ECG from the pads applied to the chest. Some AEDs have screens that show the rhythms, some do not. TheAED provides brief, effective shock which hopefully re-starts the heart. Pad placement The pad covers have a diagram showing pad positioning. Adult pads are suitable for use in children older than 8 years. Ideally, for children between 1 and 8 years, paediatric pads should be used and positioned the same as the adults. However, if unavailable, adult pads can be used. If the pads are too large and there is a danger of charge arcing, use the front-back position. Avoid placing pads over implantable devices. If there is an implantable medical device the debrillator pad should be placed at least 8cm from the device. Pad to skin contact is important for successful debrillation. Skin should be clean and dry. Excessive moisture or hair may need to be removed (e.g. shave) remembering the importance of minimal delays in shock delivery. Having a debrillator in a workplace or shared between a number of workplaces is vital in giving a cardiac arrest casualty every chance of survival .

An AED in a case.

RESUSCITATION

Anterior-lateral pad positioning, under right collar bone – under left armpit

Anterior-posterior pad positioning, front and back.

23

Defibrillation Below is a general AED treatment plan

IMMEDIATELY ON ARRIVAL

SHOCK ADVISED

FOLLOW AED PROMPTS Do not touch the casualty during shock delivery. STAND CLEAR

Continue CPR until AED set up is ready. Check still unresponsive and not breathing normally.

Turn on AED. Check equipment quickly. Attach pads to bare chest. Attach leads to AED.

PRESS BUTTON TO SHOCK Follow prompts as advised.

RESUSCITATION

Respond to verbal/visual cues. Allow AED to analyse. (This may take up to 20 seconds)

STILL NO RESPONSE Perform CPR for 2 minutes. CONTINUE TO FOLLOW AED PROMPTS

Please note: An AED will not recognise if a person is breathing. The rst aider must assess breathing and only use the AED on a casualty who is not conscious and not breathing normally . Continue CPR and debrillation until responsiveness and normal breathing returns, health professionals arrive and take over, you can no longer continue due to fatigue, a health care professional directs you to stop or the situation becomes too dangerous to continue.

24

The unconscious state

CALL 000

Ensure safety . For no response – clear and open their airway with head tilt. LOOK & FEEL for rise and fall of the upper abdomen or lower chest. LISTEN for the escape of air from the nose and mouth. If breathing - gently roll on his/her side to keep the airway open and allow uid drainage.

THE HAZARD = CAUSES May be more than one - AEIOUTIPS: A lcohol (too much) E pilepsy (a seizure) I nsulin (too much / too little) O verdose (drugs) U raemia (renal failure - difcult for a rst aider to diagnose) T rauma (accidents, falls, hangings, severe blood loss) I nfections (to the brain) P retending (for attention) S troke (a rupture / blockage in the brain) History – Known allergy, current medications, disease or illness. Medic Alert bracelet. Evidence i.e. empty bottles, tipped ladder and spilled paint. Witnesses. NO RESPONSE BREATHING NORMALLY Unconscious - Cannot be woken. Is breathing. Has a pulse. Has no purposeful response.

LOOK, FEEL, LISTEN Check breathing.

TAKE ACTION BREATHING NORMALLY - ROLL ON SIDE - Obtain a history and monitor. NOT BREATHING NORMALLY OR AT ALL - IMMEDIATE CPR -

RESUSCITATION

If they recover - assess his/her conscious level and conduct a verbal secondary survey.

Treat a casualty with only a minor response, such as groaning without opening his/her eyes, as unconscious.

RISK = AIRWAY OBSTRUCTION, LUNGS FILLING WITH FLUID, CARDIAC ARREST, DEATH

25

Turning a casualty on to his/her side There are several methods for turning a casualty lying on his/her back on to his/her side. This is one method.

STEP 4 Ÿ Position yourself facing their front Ÿ Adjust them so that their head is gently tilted back to allow for uid drainage Ÿ The bent knee stops rolling Ÿ The bent arm provides stability

STEP 3 Ÿ Take care to

STEP 1 Ÿ Kneel beside the casualty Ÿ Bend the arm nearest to you, placing the hand on the ground beside their head Ÿ Bring the other arm across the chest and hold the hand against the closest cheek to you

STEP 2 Ÿ Bend the leg

provide support

furthest from you, keep their foot on the ground Ÿ Keeping their hand on their cheek, pull the bent leg and gently roll the casualty towards

Ÿ Avoid forward

movement to the head, neck and spine in case of spinal injury

RESUSCITATION

you until on his/her side

2 or more rst aiders makes it easier to maintain head support and spinal alignment.

RISK = AIRWAY OBSTRUCTION

From the muscles for swallowing becoming relaxed and the tongue falling to the back of the throat. From foreign material . From stomach contents entering lungs.

HAZARD = BODY POSITION Casualty lying on his/her back.

The airway must be cared for before any other injury , even a possible spinal injury and/or bleeding .

26

THE CONSCIOUS CASUALTY

27

CONSCIOUS CASUALTY ASSESSMENT

How to examine a conscious casualty

roles and responsibilities Follow the rst aid principles and procedures as described in the section as the rst steps for assessing a casualty.

THE CONSCIOUS CASUALTY

· Indicators of the casualty's condition · Common signs and symptoms · Secondary survey (verbal and visual)

28

Indicators of the casualty's condition

Some explanations to relevant terms: Signs – Visible signs of injury or illness e.g. bruising, bleeding, swelling, deformity etc. Symptoms – How the casualty feels e.g. headache, pain, dizzy, unwell etc. Pallor – Skin colour is paler or lighter than what the casualty’s skin colour would normally be. Vital signs – A measure of the body's basic functions, specically pulse rate (heart), body temperature, respiration rate (breathing) and blood pressure. (Other signs and symptoms of the injury or illness may also be present). In rst aid, signs, symptoms and vital signs can be assessed to help decide what the problem is and how the casualty should be treated. These can be assessed by observations of appearance, (visual survey) and/or asking the casualty how they feel (verbal secondary survey). A rst aider should only touch the casualty to assess body temperature and feel the skin.

Common indicators of serious conditions: (some or all of the signs and symptoms listed)

SHOCK

HYPOTHERMIA slow; irregular pallor; cold slow

SPINAL INJURY

Pulse Skin Breathing Feeling Conscious level THE CONSCIOUS CASUALTY 29

rapid; weak; fast heart cold; clammy; pallor; pale tongue fast; shallow thirst; headache; nausea; cold dizzy; collapse; confused; deteriorated

difcult pain; nausea; headache; tingling hands/feet; loss of feeling/movement in limbs dizzy; altered state

shivering stops; muscle stiffness low; unco-ordinated; dizzy; confused; xed dilated pupils

Blood pressure – Heart beats pump blood around the body to give it energy and oxygen. As the blood moves, it pushes against the sides of the blood vessels. The strength of this pushing is called blood pressure. Low blood pressuremay indicate blood loss. One simple test to assess blood pressure is to press and release pressure on a ngernail or skin: Ÿ For normal blood pressure, the colour immediately returns when you press and release. Ÿ For low blood pressure, if the area is still pale after 2 seconds it could indicate blood loss. Blood loss – When a person loses blood, the blood pressure falls and the casualty will have pale, cold, clammy skin. The pulse is usually faster than normal and they may become thirsty. Another indicator is a pale tongue. S Shock can occur after signicant blood loss. Shock hock – In rst aid, shock refers to a loss of effective circulating blood volume. can also occur fromheat stroke, major trauma, heart conditions and severe vomiting and diarrhoea. Blue skin colour – The ear lobes, lips and ngers may have a blue tinge – this may indicate reduced oxygen levels.

HEAD INJURY

HEART ATTACK

HEAT STROKE

THE CONSCIOUS CASUALTY

red/ushed; blue tinge; hot; dry; lack of, or profuse sweat

pallor; cold sweat short; difcult unwell; headache; nausea; vomiting; chest: pressure, heavy, tight; pain in: chest, neck, jaw, arm/s, back, shoulder/s dizzy; faint

fast; shallow sick; headache; vomiting; irritable; behaviour change dizzy; drowsy; pupil change; slurred speech; confused; memory loss; unco-ordinated

thirst; headache; fatigue impaired mental function; collapse; unconscious

30

Secondary survey – Casualty has been assessed as conscious

A systematic VISUAL and VERBAL examination looking for injuries or illness.

HEAD, FACE, EARS Say : “Don’t move your head.”

For each step, look for swelling, bruising, bleeding and deformity and ask about pain and feeling. Look for : Fluid coming out of the ears. Loose teeth. Inability to open the mouth or talk. Look for : Rise and fall of the chest (both sides). Deformity of the rib cage. Rapid breathing. Listen for: Noisy (obstructed) breathing. Ask : “Any pins and needles in the hands or feet?” “Can you move your limbs normally?” “Do any of your limbs feel weak?” Look for, in each limb: Loss of movement. Equal strength in both arms and legs. If sure there is no spinal injury, gently log roll onto his/her side to look at the back. Keep the body straight, avoid twisting. Support the head and neck.

HOW TO ASSESS A CONSCIOUS CASUALTY

HAZARDS = CASUALTY CONDITION i.e. serious injury or illness, panicked, scared etc. TIME FRAMES i.e. too rushed, too slow. RISKS = Not able to calm the casualty. Overlooking an issue. Not getting help soon enough. Observe/monitor vital signs as you go, watching for deteriorating condition. Only touch to feel skin temperature. Listen carefully to the casualty's responses . Observe and note the answers given.

NECK Say : “Don’t move your neck or head.”

CHEST & BREATHING Ask : “Any pain when moving or breathing?"

STOMACH & GROIN Ask : “Any pain, if so, where?”

THE CONSCIOUS CASUALTY

LIMBS - EACH ARM & LEG Ask: “Any numbness, coldness, tingling, or pain?”

BACK Ask : “Any tingling, numbness or pain. If so, where?”

31