First Aid

Notices and Disclaimers

Please note that this text is still in the early stages of development 

This is a wiki textbook -- feel free to edit it, update it, correct it, and otherwise increase its teaching potential. To find out more about wikis, see the wikimd main page. This textbook grew out of the First Aid article at wikimd.

Legal Disclaimers

The contributions to this document reflect the best knowledge and intentions of the many and often anonymous authors contributing to the textbook. Many parts of first aid involve the use of detailed knowledge, motor skills and attitudes which can only be developed through proper training and practice. The practice of first aid is very serious business and prior training by a person trained in first aid instruction is strongly recommended.

No person or organization, including wikimd and Wikibooks, can assume any liability or take any responsibility for the content of this document. As is always true, any actions that might be taken in performing first aid are the sole responsibility of the first aider.

Persons in need of medical help should always obtain authoritative medical advice, support and care from trained professionals. First aid is a limited set of techniques and procedures for:  care for minor injuries not requiring a doctor's care, such as small cuts, minor bruises, and blisters use in the interval between the recognition of a medical emergency and the arrival of professional help use in austere settings such as developing countries, wilderness or the battlefield where professional help is delayed or unavailable  First aiders should know their limits and seek professional medical advice, support and care when it is available.

Laws regarding first aid vary around the world. Follow local laws. If providing advanced first aid or wilderness first aid, consistently following the guidelines in your training is your best defense from legal consequences.

This textbook was prepared by persons with training in various first aid curriculas from around the world, including copyrighted curricula prepared by various organizations including the American Red Cross and Medic First Aid. The mention of these organizations is not intended to and does not imply support, endorsement, or involvement in the preparation of this Wikibook text. Any accidental use of copyrighted training suggestions and curricula is unintentional and will be removed on request from an authorized member of any such organization(s).

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Chapter One - Introduction
The following are basic guidelines for how to perform first aid.

The most important rule is not to panic. Many people learn first aid and are then too frightened to use it when it becomes necessary. STOP (Stop, Think, Observe and Plan) is a helpful acronym that can be easily used to start first aid. It is important that the first aider calmly takes in what he or she sees and forms a plan based on the available information. Most importantly, the first aider must check for possible dangers so as not to increase the number of victims.

Consent
Consent can be written, oral or implied.

If the patient is conscious, it is important to ask for permission before proceeding. Touching another person without that person's permission is considered assault in most jurisdictions. Consent for treatment is implied if the patient is conscious and willing to be treated.

If a patient is:


 * Unconscious
 * Intoxicated
 * Irrational (i.e. delusional, insane or confused due to the injuries)

Then they can be treated as would is assumed to be in their best interests in most jurisdictions. Often this is limited to emergency treatment only.

If the patient is not an adult then the legal respnsible person, normally a parent or guardian must give consent if present and able, otherwise emergency treatment can be given as above.

Since the victim will likely be frightened, explaining your actions and talking in a calm, reassuring voice will have a beneficial effect in reducing stress and increasing the probability of survival.

Protective Precautions
It is necessary for the first aider to protect themselves against various diseases which can be transmitted through blood and other bodily fluids. In the United States, OSHA has established a Bloodborne Pathogens requirement for training those who are required in their job to perform first aid.

The best protection is to avoid contact with blood and bodily fluids. The next best protection, often very effective, is to use barrier methods such as gloves, masks and gowns. When performing CPR and/or rescue breathing, breathing barriers should be used if available.

Legal Liability
Good Samaritan laws in many countries protect people who give first aid without seeking financial compensation. Acting beyond or outside your training may have civil or criminal consequences. However, you are the person on the spot and you will need to make the best decision you can given the circumstances.

Laws regarding first aid vary around the world. Follow local laws. If providing advanced first aid or wilderness first aid, consistently following the guidelines in your training is your best defense from legal consequences.

Also remember to document what you do as if you were seeing the patient at work. You'll be greatful if you ever need to explain what you did several years later.

Diagnosis and First Aid
If the patient is breathing and has a pulse with no severe bleeding, the next step is to decide what the injury or illness is and form a plan of treatment. The "nature of illness" or "method of injury" is determined. Even if the first aider cannot help in the field, the collection of this information is invaluable to proper transport and treatment of the patient by emergency medical technicians and doctors.

In some cases such as abdominal pain it is difficult to determine the seriousness of an injury. Only advanced training and expert advice can help in these cases, and any error should be on the side of caution.

A person trained in advanced first aid may conduct a survey, which is a careful head to toe examination of the injured person for possible additional injuries and symptoms. Often a survey will reveal serious injuries which appear minor but are life-threatening, such as entry and exit wounds from gunshots, a flail chest or collapsed ribcage, or injuries consistent with internal bleeding. A survey at the first-aid level should not involve unnecessary touching of the patient or the removal of clothing unless trained in how to do so safely and with respect for the patient.

One advanced first aid diagnostic technique is to check for perfusion by depressing the fingernail and observing capillary refill. The tissue under a person's fingernail is normally full of blood and refills within 2 seconds after being pressed. In a person with serious blood loss (whether internal or external), the tissue under the fingernail remains white and bloodless. Such a person needs advanced medical care immediately.

First Aid and Mental Status
Sometimes an ill or injured person is disoriented or incoherent, which may mask serious medical conditions or injuries. A level of mental responsiveness can be determined by asking three questions:
 * What is your name?
 * Where are you?
 * What day of the week is it? (note: stressed patients, even totally coherent, tend to respond that it is the day during which they last woke up)

Patients' mental coherence will fall into one of four categories (the AVPU system)
 * A = alert, responds correctly to all three questions above
 * V = responds to verbal stimuli inappropriately
 * P = responds to painful stimuli only (such as rubbing the sternum)
 * U = unresponsive to any stimuli

A person with an altered mental status who does not recover quickly requires advanced medical care and should be carefully watched. Suspect concussion or other head injury if trauma is among the mechanisms of injury.

= Chapter Three - Basic Life Support =

A for Airway
An unconscious person's airway may be blocked when their tongue relaxes and falls across the airway. A technique used to open the airway is called the "head-tilt chin-lift" technique. The patient is lying on their back. With one hand on the forehead and the other hand under the chin, the victim's head is lifted to put the airway back into anatomical position. This simple procedure opens the airway and has saved many lives.

If the victim is choking on a foreign object lodged in the airway, the object must be removed. The Heimlich maneuver is the standard method for conscious victims. If the victim is unconscious, the object may be removed by reaching in the mouth (using the head-tilt-chin-lift technique from CPR), or with a modified form of the Heimlich maneuver. If the airway is cleared and breathing is not restored, rescue breathing should be applied.

B for Breathing
If a person has stopped breathing but still has a pulse, it is possible for someone else to breathe for them. In artificial respiration, the rescuer alternates breaths taken for his own benefit with breaths into and out of the victim's mouth.

C for Circulation
(also known as cardiac arrest)

Cardiopulmonary resuscitation (CPR) is a manual method used to induce artificial breathing and heartbeat in a victim who has suffered cardiac arrest. CPR may spontaneously restore natural breathing and heartbeat; if it does not, it may keep the victim alive until professional medical personnel arrive and administer more appropriate treatment. CPR is a manual skill that must be taught with the assistance of a training "dummy" or simulator.

Circulation can also include the consideration of severe bleeding, which can cause shock and even stop the heart.

= Chapter Four - Bleeding =

Bleeding is the most common reason for the application of first aid measures. Minor bleeding can be stopped with direct pressure over the wound, as the blood will naturally clot. In order to prevent infection, a sterile or clean bandage should be used.

Bleeding can be stopped with the following steps. In order, they are


 * Direct pressure on the wound
 * Elevation of the wound above the heart (depending on the location of the wound)
 * Pressure point (pressing down on an artery above the wound to keep blood from flowing to the wound)

In some special cases direct pressure may not be possible, as for a nosebleed. Seek expert medical help.

Life Threatening Bleeding
The key element in treating severe bleeding is the application of firm, direct pressure to the wound, using a surgical glove or other infection barrier if available. The wound may be elevated above the heart to reduce blood pressure, though this should not be done if there is a risk of disturbing fractures. Pressure may also be applied to pressure points where blood vessels run close to the surface upstream from the wound.

The use of a tourniquet is rarely taught in first aid because it is rarely required to control severe bleeding and poses life-threatening risks. Even wounds from amputated limbs can be controlled with direct pressure, pressure points and elevation.

= Chapter Five - Shock =

Internal Injuries and Trauma
Seriously injured persons often suffer hypovolemic shock which can be caused either by external or internal bleeding. Symptoms include rapid breathing (a normal adult rate is 12-20 respirations per minute) and cold, clammy skin. The patient should be kept warm and the patient's feet should be elevated approximately six inches off the ground (unless spinal or other injures preclude this). The object is to raise the blood pressure to their inner organs to prevent oxygen starvation of major tissues.

Persons with internal injuries or who have suffered traumatic injuries often require immediate surgery to save their lives. The most important way a first-aider can help these victims is to arrange for immediate rapid transport to a trauma center or other equipped facility for immediate transfusion and surgery. The best way to do is is to call for help and let the professionals decide where best to transport the victim.

Anaphylactic Shock
Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset. It can be triggered by insect bites as well as exposure to allergens in some people. Call for help immediately. First aid for anaphylaxis consists of obtaining advanced medical care at once; rescue breathing (a skill that is part of CPR is likely to be ineffective but should be attempted if the victim stops breathing. Look to see if a device such as an Epi-pen is available for administration of epinephrine by a layperson.

Blast Injuries
Blast injuries are caused by explosions and are most often seen in industrial accidents or through effects of military weapons such as grenades, explosives, and antipersonnel mines. Blast injuries may also be the result of bombings by terrorists. Great caution should be taken by the first aider to avoid becoming a casualty themselves, particularly in the event of a secondary blast or in a possible ambush.

Internal injuries are likely in direct proportion to the size of the blast and the distance from the victim. Whether or not the victim was shielded by any nearby object should be considered.

= Chapter Six - Soft Tissue Injuries =

Soft tissues include skin and muscles.

Cuts, Scrapes and Bruises
Cuts, scrapes and bruises should be washed with soap and water. Any foreign objects or dirt should be removed to avoid infection. Apply a clean dressing; it is worth the time to locate a sterile dressing for this purpose.

Any long cut or laceration may require stitches to heal properly, especially on the face and scalp. See medical attention in these cases, although this is not an emergency.

Avulsions and Amputations
An avulsion is a piece of skin or flesh which is separated from the person, for example a torn-off earlobe. An amputation is a body part that has been separated from the person.

Apply normal care for bleeding. Find the separated part and take it with the injured person to the hospital. Surgical reattachment is often possible if performed promptly. Do not ice the part.

Burns
First cool the burn with large quantities of water. Do not use ice. Then cover the burn with sterile or clean dressings. Then seek help for serious burns or burns that impair breathing, cause shock, or are caused by unusual means (radiation, chemicals, electricity).

Do not lance burn blisters.

Bandages and Dressings
A dressing is something used to cover a wound, typically a sterile or clean piece of cloth or gauze. A bandage is used to hold the covering over the wound, such as adhesive tape or wrapped cloth, gauze or elastic.

The skill of bandaging and dressing an injury is part of the performance of first aid.

= Chapter Seven - Bones, Joints, and Muscles =

Bone Injuries
A bone injury can be internal or external. Even internal bone injuries that do not break the skin can cause major bleeding and shock.

The primary first aid technique for bone injuries is splinting. Proper splinting can reduce pain and discomfort, especially if the victim must be moved, but should not be attempted if advanced medical help is on the way.

Joint Injuries
Joint injuries include strains and sprains. Some joint injuries occur when a joint is over-stressed. Sports trainers recommend following the acronym RICE for


 * Rest, which is essential to allow healing
 * Ice, intermittently applied
 * Compression, with an elastic bandage
 * Elevation, above the heart

Muscle Injuries
As with joint injuries, muscle injuries are often treated using RICE.

= Chapter Eight - Environmental Injuries =

Heat Injuries
Heat cramps. Heat exhaustion. Heat stroke.

Cold Injuries
Frostbite. Hypothermia.

Patients should be kept in a reasonably warm place. The stress of excessive heat or cold can stress an injured or ill body further, increasing the danger. Temperatures as low as 55 F (about 13 C) or as high as 95 F (35 C) can injure by exposure for an hour -- this is a major hazard in longer term care.

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Modified from Wikipedia's article on First Aid Licensed under GNU FDL