First aid

First aid is a series of simple, life-saving medical procedures that a
layman can be trained to perform in emergency situations, before the
intervention of emergency medical technicians or doctors. It is best to
obtain training in first aid before a medical emergency occurs. Supplies
useful in giving first aid are often kept together in a first aid kit.

Training in first aid is often available through community organizations
such as the American Red Cross or the American Heart Association and is a
standard part of military basic training. (In many British Commonwealth
countries the Order of St. John provides first aid training and operates
Ambulance services.)

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.

First: Check, Call, Care

The American Red Cross suggests "Check, Call, Care" as the sequence of
events. First, the scene must be checked for safety, and then the victim
must be checked for signs and symptoms. Next, professionals must be called
to help, and then first aid is given as much as it is practical.

The first step, if at all possible, is to contact professional aid by
calling for help. Ideally, the first aider sends someone else to call for
help; this may not always be possible. Some interventions can be done
reasonably simply before leaving a patient to call for help; other times, it
can be a difficult choice. Sometimes, the victim must be left somewhere in
order to obtain treatment.

If there is more than one person injured, it may be necessary to perform
triage. In triage the victims must be rapidly surveyed and treated according
to the severity of their injuries.

Consent

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:

   * Unconscious
   * Intoxicated
   * Irrational (i.e. delusional, insane or confused due to the injuries)
   * Not an adult (parent or guardian must give consent if present and able,
     otherwise consent is implied)

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.

Life-threatening medical emergencies

There are a number of medical emergencies that pose an immediate threat to a
person's life. Some of the most common and responses appropriate to persons
trained in first aid are listed below.

Stopped 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.

Stopped breathing

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

Choking

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.

Severe 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.

Internal poisoning

Internal poisoning may not be immediately apparent. Symptoms, such as
vomiting are sufficiently general that an immediate diagnosis cannot be
made. The best indication of internal poisoning may be the presence of an
open container of medication or toxic household chemicals. Check the label
for specific first aid instructions for that specific poison.

Call for help immediately as advanced medical care will be required. If
possible contact a poison control center and provide information about the
suspected poison. Depending on the type of poison, the poison control center
may suggest additional first aid measures pending the arrival of emergency
medical technicians. Tthese might include dilution with water or milk,
administration of syrup of ipecac or activated charcoal, or the use of other
common household products as improvised emergency antidotes. Do not apply
such measures without the benefit of expert advice.

Appropriate first aid measures vary depending on the type of poison. Induced
vomiting may do more harm than good, because the poison may harm the
alimentary canal or esophagus. Vomit may also block the airway. However,
induced vomiting may be necessary with some poisons to save the victim's
life. Expert advice and rapid tranport to advanced medical care is urgently
needed in poisoning cases.

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.

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 For 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.

Severe 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.

First Aid and Possible Spinal Injury

Most importantly, the possibility of a spinal injury must be investigated.
The spinal cord is a thick nerve that runs down the neck and back; it is
protected by bones called vertebrae. If the spinal cord is injured, this can
lead to paralysis. Since the vertebrae protect the spinal cord, it is
generally difficult to cause such an injury. Note that only an x-ray can
conclusively determine if a spinal injury exists. If a spinal injury is
suspected, the patient must be treated as though one does exist.

Signs of a spinal injury

   * Mental confusion (such as paranoia or euphoria)
   * Dizziness
   * Head, neck or back pain
   * Paralysis
   * Any fall of more than three times the patient's height

If a spinal injury may exist, the victim must be kept in the position he or
she was found in, if at all possible and safe, and told to move as little as
possible. A minor crack in the vertebrae can result in paralysis if the
patient moves in the wrong way, so all movement must be minimized. If
possible, one caregiver should hold c-spine stabilization. "C-spine" refers
to the part of the spine which is in the neck, called the cervical spine.
One person places his or her palms on the victim's ears, with fingers spread
open towards the chin. The person holding c-spine's job is to ensure that
the neck does not move and may not let go of the c-spine unless someone else
takes over or advanced equipment is used in place.

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 with
     gusto)
   * 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.

Routine First Aid Measures

Most first aid is performed to help with less serious injuries which do not
threaten life and may not even require medical attention.

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.

Joint Injuries

Joint injuries include strains and sprains. If 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

General First Aid for Seriously Injured Persons

All seriously injured persons should be treated for shock if their injuries
permit. Someone should stay with the injured person if at all possible and
provide comfort and emotional support. This person should watch carefully
for any changes in the person's condition and get help if their condition
worsens.

In the short term, injured or ill persons should not be given water or
anything by mouth. A notable exception is diabetic coma when other injuries
are absent. There are multiple reasons for nothing by mouth
(gastrointestinal lacerations or bleeding, lacerated esophagus, etc). The
main reason though, is that the victim (especially a trauma patient]] may
have to undergo surgery, and any substances by mouth can be vomited under
anaesthesia, and aspirated (inhaled into lungs). This can severely damage
lungs and cause massive infections.

An injured person should never drive to the hospital alone or with just a
driver; a third person should be present to care for them in an emergency.
This also helps to avoid a traffic accident and additional injuries to both
the patient and third parties.

The safe evacuation of injured persons requires training and technical
skills. Even basic tasks such as rolling a person over or putting them into
a vehicle require several helpers, special equipment and experience to avoid
aggravating the victim's injuries. These skills are an important part of the
training of emergency medical technicians. If you must improvise, remember
that an injured part should be splinted as it lies, that C-spine
stabilization should be maintained even if a patient must be transported
flat on their back as a result, and that a patient should be moved as little
as possible.

Long-Term and Wilderness First Aid

In some emergencies, such as earthquakes or an isolated accident, emergency
services may be unable to arrive for several days or longer. In this case,
responders may need to perform longer-term care. For long term treatment in
disasters, wound-care and cleanliness is the most important issue.

Proper bedding and dressings are preferable in order to prevent infection,
but fresh, unopened newspapers are clean and can be used to improvise
dressings, blankets and clean areas. Broken limbs should be splinted in an
effort to immobilize the bone (which should not be straightened due to the
possibility of a splintered bone cutting an artery). Antibiotics, if
available, should be used to prevent infection. Administer splints to broken
limbs with the intent to immobilize broken limbs. This can sometimes prevent
later amputation of infected limbs.

Do not remove existing bandages to put on new ones in the prehospital
environment, even if care is delayed several days, unless complete wound
cleaning and debridement is possible. A "bound-up" wound is less likely to
be infected and more likely to heal than one that is opened repeatedly and
inadequately cleaned each time. This is derived from World War II
prehospital military experience.

If medical care is likely to be delayed by more than a day, small amounts of
water may be given to patients unlikely to require surgery or to vomit.
Fluids other than water and foods should not be given unless injuries are
obviously minor. If there is any likelihood that surgery may be needed or
that the gastrointestinal system may have been damaged, only give small sips
of water that are entirely absorbed by the mucous membrane of the mouth.

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 high as 55F or as low as 95F can injure by exposure
for an hour -- this is a major hazard in longer term care.

See also: triage, medical emergency, emergency medical service, hypothermia,
heat stroke, hypoglycemia, hyperglycemia, diabetic coma, occlusive dressing,
tourniquet, sub-abdominal thrust, Cardiopulmonary resuscitation (CPR),
strain, sprain, fracture, laceration, avulsion, gastro-intestinal bleeding,
Good Samaritan law, childbirth wilderness first aid

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The rock and roll band Live used the name First Aid for a time before
achieving much success in the music world.

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