Provincial Government of Bulacan

Provincial Disaster Risk Reduction and Management Office

STANDARD FIRST AID

TRAINING
PARTICIPANT’S HANDBOOK
 STANDARD FIRST AID TRAINING
Participant’s Handbook

FOREWORD

This training handbook would not have been possible without the leadership and
support of the Provincial Government of Bulacan thru its Governor
Hon. Wilhelmino M. Sy-Alvarado in the year 2017. The Local Disaster Risk
Reduction and Management Officer Ms. Felicisima L. Mungcal who have been
supportive for the development and drafting of this training handbook with whom
we have had the pleasure to work.
First aid saves lives: first aid trained people taking immediate action and applying
appropriate skills can make a major difference in saving lives. The emergency care
procedures outlined in this handbook reflect the standard of knowledge and
accepted emergency practices in the Philippines at the time this book was
published. It is the reader’s responsibility to stay informed of changes in
emergency care procedures.
The recipient is prohibited from revising, altering, adapting or modifying the
materials.
The recipient is prohibited from creating any derivative works incorporating, in
part or in whole, the content of the materials.
Any rights not expressly granted herein are reserved by the Provincial Disaster Risk
Reduction and Management Office of Bulacan. The PDRRMO does not permit its
materials to be reproduced or published without advance written permission from
the PDRRMO.
Copyright © 2017 by The Provincial Disaster Risk Reduction and Management
Office of Bulacan. All rights reserved.

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CHAPTER I
Early Response to Emergencies
__________________________
An unforeseen combination of circumstances or the resulting state that call for
immediate action. It is also a sudden bodily alteration that is likely to require
immediate medical attention.

In any emergency, it’s essential to stay calm if you are to help the individuals
involved. Here are the basic actions to take:
 Ensure that the scene is safe.
 Make sure there are no immediate dangers.
 Check victims for life-threatening conditions. Common ones are
unconsciousness, difficulty breathing, or severe bleeding.
 Activate the EMS system. Call EMS/9-1-1/044-791-0566 or another
designated emergency phone number in your localities and ask for
instructions from the emergency dispatcher.
____________________________________________
The emergency medical services (EMS) system is a network of community
resources and trained personnel, organized to give emergency care in cases of
injury or sudden illness. The system begins when someone sees an emergency and
decides to take action by calling EMS/9-1-1/044-791-0566.
_______________________________
The Chain of Survival Behaviors is a series of Steps that help ensure a positive
outcome for an ill or injured person. As a First Aider, your role is to prepare,
recognize emergencies, provide first aid and/or access help.

YOUR ROLE AS FIRST AIDER

First Aid is the immediate care that is given to an ill or injured person until more
advanced care can be obtained.
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Your role as a First Aider includes four basic steps:

1. Recognize the emergency.
2. Protect yourself, the ill or injured person, and bystanders.
3. Access help (e.g., call EMS/9-1-1/044-791-0566).
4. Act according to your skills, knowledge, and comfort level.

Responding to the scene of an emergency involves providing emotional support as

well as caring for injuries. When providing care, you should:
 Speak in a calm and reassuring manner. Ask for the ill or injured person’s
name and use it often.
 Communicate both verbally and nonverbally to reassure the person.
 Position yourself at eye level when you talk to the ill or injured person. Avoid
unnecessary physical contact and any body language that could appear
threatening.
 Actively listen to the ill or injured person. This involves four behaviors:
a. Making every effort to fully understand what the person is trying to say.
b. Repeating back to the person, in your own words, what the person said.
c. Avoiding criticism, anger, or rejection of the person’s statements.
d. Using open-ended questions (i.e., avoid questions that can be answered
with "Yes" or "No").

YOUR ROLE IN THE EMS SYSTEM

1. Recognizing that an emergency exists
2. Deciding to help/take action
3. Activating the EMS system
4. Giving care until EMS personnel take over

RISK OF INFECTION
Giving first aid care is a hands-on activity that can put you in close contact with
another person’s bodily fluids (such as saliva, mucus, vomit, and blood), which may
contain harmful pathogens (micro-organisms that can cause disease or infection).

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Mode of Transmission
Mode Definition Example
Direct
Contact Examples: HIV/AIDS, Hepatitis, Herpes
Indirect
Contact Examples: Meningitis, Influenza
Airborne
Transmission Examples: Measles, Tuberculosis
Vector-Borne
Transmission Examples: Dengue, Malaria

PREVENTION OF DISEASES
1. Personal Precautions
 Handwashing
 Hand Sanitizers
 Immunization

2. Equipment Precautions
 Gloves
 CPR Breathing Barriers

3. Environmental Precautions
 Cleaning and Disinfecting Surfaces and Equipment
 Managing an Exposure Incident

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CHAPTER II
Check, Call, Care
If you encounter an ill or injured person, there are three simple steps that you must
take:
CHECK
Once you recognize an emergency you must first check the scene, then check the
person.
 Check the Scene
 Is the scene safe for you, the ill or injured person, and any bystanders?
 What happened? How did it happen?
 How many ill or injured people are there?
 Is there someone to help?
 What is your initial impression of the ill or injured person?
 Check the Person (Primary Assessment)
 Check the person to see if he or she is responsive
 Check the person’s ABCs: Airway, Breathing, and Circulation
A = Check the Airway
Performing the Head-Tilt/Chin-Lift
B = Check Breathing
C = Check Circulation

Obvious signs of death include:

 Torso transection (torso cut into two pieces)  Decomposition
 Decapitation (detached head)

CALL
If you identify an unresponsive individual or an individual with a life-threatening
condition in your initial check, you must always activate EMS.

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If You Are Alone: Call First or Care First?

If you are alone without a phone and there is no one to send to call EMS/9-1-
1/044-791-0566, you may need to decide whether to call first or give care first.
Unless the situation specifically requires you to provide care before calling EMS/9-
1-1/044-791-0566, you should always activate EMS first so that help will arrive as
soon as possible.
You should provide care first in the following situations:
 The person is choking or is experiencing anaphylaxis and carrying epinephrine.
 The person has life-threatening bleeding
 The person is an unresponsive child or baby who is not breathing.
When You Call EMS/9-1-1/044-791-0566
When you call, the EMS dispatcher who answers will likely ask:
 Where is the emergency (e.g., the address, nearby intersections, or
landmarks)?
 What is the nature of the emergency (i.e., is police, fire, or medical assistance
needed)?
 What telephone number are you calling from?
 What is your name?
 What has happened?
 How many people are involved and what is their condition?

CARE
Care for any life-threatening conditions first. Give the care that is needed, within
the scope of your knowledge and training, and follow these general guidelines:
 Monitor the person’s breathing and level of responsiveness.
 Help the person rest in the most comfortable position. If necessary, roll the
person into the recovery position.
 Keep the person from getting chilled or overheated.
 Reassure the person by repeating that you are there to help and that EMS
personnel have been called (if this is true).
 Continue to watch for changes in the person’s condition.

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_________________________________
A person who is unresponsive or has an altered level of responsiveness should not
be left in a face-up position, as the airway can become blocked by the person’s
tongue or the person’s saliva or other bodily fluids.

When to Stop Giving Care

Once you begin providing care to an injured or ill person, you must continue to
give the appropriate care until:
 Another trained First Aider or EMS personnel takes over.
 You are too exhausted to continue.
 The scene becomes unsafe.

Guidelines for Helping an Ill or Injured Person with Medication

You should only help a person take his or her medication if:
 It is safe to do so.
 The person is responsive and has in some way expressed a need for help with
finding, preparing, and/or taking the medication.
1. Finding the Medication
2. Preparing the Medication
3. Guiding the Person in Taking the Medication
4. Giving Lifesaving Medication
5. Giving Ingested Medications

Secondary Assessment
After you have identified and cared for any life-threatening conditions found in the
primary assessment, you must check the person for other injuries and conditions
that may require care. This is called the secondary assessment.
If the person’s ABCs seem normal, do a secondary assessment to look for injuries
or conditions that were not identified in your primary assessment. The secondary
assessment consists of three steps:
1. Asking questions (SAMPLE)
2. Checking the quality of the person’s vital signs

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 Level of Responsiveness
 Breathing
 Skin
3. Doing an injury check
 Focused Examination
 Explain that the purpose of the examination is to identify injuries.
 Ask the person if anything hurts or feels uncomfortable.
 If the person indicates an area of pain, discomfort, or concern, look at the
area for signs of injury including discoloration (bruises) or deformities
(odd shapes). For privacy reasons, do not remove any of the person’s
clothing unless it makes providing first aid difficult.
 If there are no signs of any injury, ask focused questions about how the
person feels. The symptoms the person describes might help to
determine whether EMS/9-1-1/044-791-0566 needs to be called and what
kinds of care should be provided.
 If you find a medical identification product, be sure to read it carefully. It
may indicate what is wrong, who to call for help, and what care to give.
 If the person doesn’t complain of any pain or tenderness, and there are
no signs of injuries, ask the person to rest for a few minutes in a
comfortable position. Check the quality of the person’s vital signs and
ensure the ABCs are still unaffected. If there is no visible problem, help
the person to stand up slowly when he or she is ready.
 Based on your findings, decide whether you need to call EMS/9-1-1/044-
791-0566, and provide first aid care as needed.
 Hands-On Check
 Continual Care
 Have the person rest.
 Help the person maintain a normal body temperature.
 Monitor the person’s condition and ABCs.
 Move the person into the recovery position, if necessary.
 Give comfort and reassurance to the person

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Should You Transport an Ill or Injured Person to the Hospital?

 The person is a friend or family member.
 The person’s injuries are minor and non-life-threatening.
 There is no risk of the person’s condition getting worse.
 There is no risk of the person experiencing an altered level of responsiveness.
____________________
A person who is ill or injured may go into shock. Shock happens when the vital
organs do not get enough oxygen-rich blood. Shock is a life-threatening condition.

Causes of shock include the following:

 Significant blood loss  Infection
 Heart damage  Anaphylaxis
 Extensive burns  Severe infection (e.g., septicemia)

What to Look For

The following are signs and symptoms of shock:
 Anxiety  Excessive thirst
 Cool, clammy skin  Rapid breathing
 Skin that is paler than normal  Drowsiness or loss of
 Weakness responsiveness
 Confusion  Nausea and vomiting

What to Do
The best thing you can do when a person is in shock is to call EMS/9-1-1/044-791-
0566. While you are waiting for EMS personnel to arrive, provide care by:
1. Caring for the cause of the shock.
2. Having the person rest.
3. Keeping the person warm.
4. Monitoring the person’s ABCs.
5. Providing comfort and reassurance.

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CHAPTER III
Circulation Emergencies and
Cardiopulmonary Resuscitation (CPR)
Circulation emergencies are sudden illnesses or injuries involving the heart or the
blood vessels. Because every minute counts when a person is experiencing a
circulation emergency, the person’s survival often depends on First Aiders acting
quickly and giving appropriate care until EMS personnel arrive and take over.

Cardiovascular Disease
Cardiovascular disease is an abnormal condition that affects the heart and blood
vessels. It is one of the leading causes of death in Philippines, and it is the
underlying cause of many circulation emergencies.

Prevention
Cardiovascular disease has both controllable and uncontrollable factors.
Uncontrollable factors include age, sex, family history, and ethnicity.
Fortunately, many risk factors of cardiovascular disease are the result of lifestyle
choices and are therefore within a person’s control:
 Smoking  Weight
 Cholesterol  Stress
 Blood Pressure
______________________
A heart attack occurs when the heart muscle cannot get enough oxygen because of
a blockage in one of the arteries that feeds it.

What to Look For

The signs and symptoms of a heart attack vary from person to person, and can be
different in women and men.

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Signs and symptoms of a heart attack include the following:

 Discomfort or pain that spreads to one or both arms, the jaw, the shoulder,
the neck, or (more commonly in women) the back or the upper part of the
stomach
 Problems breathing (e.g., noisy breathing, shortness of breath, or breathing
that is faster than normal)
 Cold, sweaty skin
 Skin, lips, and fingers that are bluish, ashen (grey), or paler than normal
 Feelings of anxiety, denial, or impending doom

"Soft Signs" of a Heart Attack

 Mild, unfocused chest discomfort that:
 Comes and goes
 Does not necessarily feel painful
 Gets better with rest and worse with activity, or gets progressively worse
 Extreme fatigue (tiredness)
 Gastric discomfort, nausea, or vomiting
 Flu-like symptoms
 Dizziness or light-headedness

What to Do
Call
If you suspect a person is having a heart attack, call EMS/9-1-1/044-791-0566 and
get an AED immediately, if available.

Care
1. Have the person rest comfortably.
2. If the person has a prescribed medication to relieve chest pain (e.g.,
nitroglycerin), offer to locate the medication and help the person to take it. If
the person has nitroglycerin in a spray or pill form, ensure that the person
sprays or places the nitroglycerin under his or her tongue.
3. Reassure the person. Anxiety may increase the person’s discomfort.
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________________
Angina occurs when the heart requires more oxygen than it is receiving. This
occurs when two factors are combined:
1) the arteries are narrowed by cardiovascular disease, reducing blood flow; and
2) the heart’s oxygen needs are elevated (e.g., during times of physical activity or
emotional stress).
_________________
A stroke happens when the blood flow to part of the brain is interrupt ted,
resulting in the death of brain cells. Strokes can cause permanent brain damage,
but with quick action, the damage can sometimes be stopped or reversed.
Although strokes are most common in older adults, a person of any age, even a
child, can have a stroke.

Causes of Stroke
 Ruptured Aneurysm
 Blood Clot
 Brain Tumor

Prevention
Because the risk factors for stroke are similar to those for heart disease, the risk of
a stroke can be reduced by following the same lifestyle changes discussed for
preventing cardiovascular disease.

What to Look For

The signs and symptoms of strokes can vary from person to person. A person who
is having a stroke may suddenly develop one or more of the following signs and
symptoms:
 A sudden, severe headache
 Dizziness or confusion
 Unresponsiveness or temporary loss of responsiveness
 Sudden loss of bladder or bowel control
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FAST
When trying to determine if a person is having a stroke, remember the acronym
FAST:
F–
A–
S–
T–

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED immediately, if available.

Care
1. Have the person rest in a comfortable position. If the person prefers to lie
down, or is unresponsive, drooling, or having trouble swallowing, place the
person in the recovery position.
2. Note when the signs and symptoms first started (or, if you do not know when
the signs and symptoms started, note the last time the person was known to
be well).
3. Monitor the person’s condition and provide reassurance until EMS personnel
arrive; a stroke can be an extremely frightening experience.

Life-Threatening Bleeding
Life-threatening bleeding refers to a situation where large amounts of blood loss
occur either externally (outside the body) or internally (within the body). Life-
threatening bleeding can occur whenever one or more of the body’s blood vessels
are broken. It must be controlled immediately.

Prevention
The following precautions may reduce the likelihood of an injury that causes life-
threatening bleeding:
 Be familiar with your surroundings.
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 Keep all sharp objects, such as knives, in a safe place.

 Get proper training on machinery in the workplace.
 Always follow the outlined safety procedures when operating equipment.
 Wear and use appropriate safety equipment at work and at home.
 Only use equipment for its intended purpose.
 Stay alert when operating equipment.

Life-Threatening External Bleeding

What to Look For
The signs and symptoms of life-threatening external bleeding include:
 Blood spurting or flowing freely from a wound
 Blood that fails to clot after you have taken all measures to control bleeding
 Large amounts of blood loss

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED immediately, if available.

Care
1. Expose the wound.
2. Apply firm and direct pressure to the wound.
3. While maintaining direct pressure, apply a dressing and bandage, and then
secure them in place.
4. Reassess the wound to see if the pressure has stopped the bleeding. If not,
consider using a tourniquet if the wound is on a limb.

Life-Threatening Internal Bleeding

Internal bleeding is the escape of blood from arteries, veins, or capillaries into
spaces in the body. Life-threatening internal bleeding usually occurs in injuries
caused by a violent blunt force, such as when someone falls from a height.

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What to Look For

Signs and symptoms of life-threatening internal bleeding include the following:
 Bruising in the injured area  Pain
 Soft tissues (e.g., the abdomen)  Severe thirst, nausea, and vomiting
that are tender, swollen, or hard  Anxiety
 Blood in saliva or vomit

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED. You cannot provide first aid for life-
threatening internal bleeding as a First Aider. Life-threatening internal bleeding,
especially if it results from damage to an organ, requires in-hospital medical
intervention. Help the injured person rest in the most comfortable position and
provide continual care while waiting for EMS personnel.

CPR, or Cardiopulmonary Resuscitation, is a skill that is used when a person is in

cardiac arrest. CPR involves giving sets of 30 chest compressions followed by sets
of 2 rescue breaths; it keeps oxygenated blood moving to the brain and other vital
organs until advanced medical help arrives.
______________________
Cardiac arrest occurs when the heart stops beating or beats too ineffectively to
circulate blood to the brain and other vital organs.

Sudden Cardiac Arrest

Cardiac arrest can happen suddenly and without any warning signs; this is called
sudden cardiac arrest. People who have a history of cardiovascular disease or a
congenital heart disorder are at higher risk for sudden cardiac arrest.

Clinical and Biological Death

Clinical death occurs when breathing stops and the heart stops beating. A person
without a heartbeat is clinically dead. Because permanent brain damage does not

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begin for 4 to 6 minutes, clinical death is reversible with immediate care and
intervention.
Biological death occurs when the brain becomes irreversibly damaged, which occurs
after about 8 to 10 minutes without oxygen. This is also called "brain death."

Common Causes
Cardiovascular disease is the most common cause of cardiac arrest. Other
common causes include the following:
 Drowning  Severe chest injuries
 Severe blood loss  Commotio cordis
 Suffocation or complete choking  Other heart diseases and
 Electrocution abnormalities
 Drug overdose

What to Look For

When a person experiences cardiac arrest, signs and symptoms may include the
following:
 The person suddenly collapses.
 The person is unresponsive and not breathing, or is unresponsive with agonal
breaths.

What to Do
Call
Have someone call EMS/9-1-1/044-791-0566 and get an AED. If you are alone with
an adult, call EMS/9-1-1/044-791-0566 yourself, get an AED, and then return to care
for the person.

Care
Compression-Only CPR
Compression-only CPR uses chest compressions (without rescue breaths) to pump
the heart and circulate oxygen that is already in the person’s body. If you are
unwilling or unable to give rescue breaths for any reason (e.g., you do not have a

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barrier device or the ill or injured person has facial trauma), compression-only CPR
is acceptable.

CPR Hand Compression

Compress Breath Cycle
SUMMARY Position Rate
Just enough Rate of 100–
Adult
Two hands volume to make 120 per minute:
At least 5 30
on the the chest start 30
cm (about compressions
middle of to rise (1
2 in.) and 2 breaths compressions in
the chest second per about 15–18
breath) seconds.
Child Just enough Rate of 100–
Two hands At least volume to make 120 per minute:
30
on the 1/3 of the the chest start 30
compressions
middle of chest’s to rise (1
and 2 breaths compressions in
the chest depth second per about 15–18
breath) seconds.
Two fingers Gently, with
Baby Rate of 100–
on the just enough
At least 120 per minute:
middle of volume to make 30
1/3 of the 30
the chest the chest start compressions
chest’s
(just below to rise (1 and 2 breaths compressions in
depth about 15–18
the nipple second per
line) breath) seconds.

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CHAPTER IV
Automated External Defibrillation (AED)
USING AN AUTOMATED EXTERNAL DEFIBRILLATION (AED)
When a cardiac arrest in an adult occurs, EMS/9-1-1/044-791-0566 or local
emergency number and begin CPR immediately. Also, use an AED as soon as it is
available and ready to use. If CPR is in progress, do not interrupt until the AED is
turned on and the defibrillation pads are applied.

AED PRECAUTIONS
 When operating an AED, follow these general precautions:
 Do not use alcohol to wipe the person’s chest dry. Alcohol is flammable.
 Do not use an AED and/or pads designed for adults on a child younger than 8
years or weighing less than 55 pounds unless pediatric AED pads specific to the
device are not available.
 Do not use pediatric AED pads on an adult or on a child older than 8 years, or
on a person weighing more than 55 pounds.
 Do not touch the person while the AED is analyzing. Touching or moving the
person may affect analysis.
 Before shocking a person with an AED, make sure that no one is touching or is
in contact with the person or any resuscitation equipment.
 Do not touch the person while the device is defibrillating.
 Do not defibrillate someone when around flammable or combustible
materials, such as gasoline or free-flowing oxygen.
 Do not use an AED in a moving vehicle. Movement may affect the analysis.
 The person should not be in a pool or puddle of water when the responder is
operating an AED.
 Do not use an AED on a person wearing a nitroglycerin patch or other medical
patch on the chest.
 Do not use a mobile phone or radio within 6 feet of the AED.

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SPECIAL AED SITUATIONS

Some situations require you to pay special attention when using an AED. These
include using AEDs around water and on people with implantable devices,
transdermal patches, hypothermia, trauma and jewelry or body piercings.

AEDs Around Water

If the person is in water, remove him or her from the water before defibrillation. A
shock delivered in water could harm responders or bystanders. Once you have
removed the person from the water, be sure there are no puddles of water around
you, the person or the AED. Remove wet clothing to place the pads properly, if
necessary. Dry the person’s chest and attach the AED pads.

Pacemakers and Implantable Cardioverter-Defibrillators

Some people whose hearts are weak, beat too slowly, skip beats or beat in a
rhythm that is too fast may have had a pacemaker implanted. These small,
implantable devices are usually located in the area below the person’s left collar
bone, although they can be placed elsewhere. Other people may have an
implantable cardio verter-defibrillator (ICD), a miniature version of an AED. ICDs
automatically recognize and restore abnormal heart rhythms.

Transdermal Medication Patches

Some people have a patch on their skin that automatically delivers medication
through the skin, called a transdermal medication patch. A common medication
patch is the nitroglycerin patch, which is used by people with a history of cardiac
problems. Because a responder can absorb medication through the skin, remove
patches with a gloved hand before defibrillation.

Hypothermia
Hypothermia is a life-threatening condition in which the entire body cools because
its ability to keep warm fails. Some people who have experienced hypothermia
have been resuscitated successfully, even after prolonged exposure to the cold. If
the person is not breathing, begin CPR until an AED becomes readily available.

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Trauma
If a person is in cardiac arrest as a result of traumatic injuries, you still can use an
AED.

Chest Hair
Some men have excessive chest hair that may interfere with AED pad-to-skin
contact, although it’s a rare occurrence. Since time is critical in a cardiac arrest
situation and chest hair rarely interferes with pad adhesion, attach the pads and
analyze the heart’s rhythm as soon as possible.

Metal Surfaces
It is safe to deliver a shock to a person in cardiac arrest when he or she is lying on a
metal surface, such as bleachers, as long as appropriate safety precautions are
taken. Specifically, care should be taken that defibrillation electrode pads do not
contact the conductive (metal) surface and that no one is touching the person
when the shock button is pressed.

Jewelry and Body Piercings

You do not need to remove jewelry and body piercings when using an AED.
Leaving them on the person will do no harm. Taking time to remove them will
delay giving the first shock. Therefore, do not delay the use of an AED to remove
jewelry or body piercings.

AED MAINTENANCE
Although AEDs require minimal maintenance, it is important to remember the
following:
 Follow the manufacturer’s specific recommendations and your facility’s
schedule for periodic equipment checks, including checking the batteries and
defibrillation pads.
 Make sure that the batteries have enough energy for one complete rescue. (A
fully charged backup battery should be readily available.)

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 Make sure that the correct defibrillation pads are in the package and are
properly sealed.
 Check any expiration dates on defibrillation pads and batteries and replace as
needed.
 After use, make sure that all accessories are replaced and that the machine is
in proper working order.
 If at any time the machine fails to work properly or warning indicators are
recognized, stop using it and contact the manufacturer immediately. If the
AED stops working during an emergency continue performing CPR until EMS
personnel take over.

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CHAPTER V
Breathing Emergencies
A breathing emergency is any respiratory problem that can threaten a person’s
life. Breathing emergencies happen when air cannot travel freely and easily into
the lungs. In a breathing emergency, seconds count so you must react at once.

Respiratory Distress and Respiratory Arrest

Respiratory distress and respiratory arrest are types of breathing emergencies.
Respiratory distress is a condition in which breathing becomes difficult. It is the
most common breathing emergency. Respiratory distress can lead to respiratory
arrest, which occurs when breathing has stopped.

Common Causes
Respiratory distress and respiratory arrest may be caused by any of the following:
 Choking (a partially or completely  A heart attack or heart failure
obstructed airway).  Chest trauma
 Illness  Poisoning
 Hyperventilation  A drug overdose
 Asthma or chronic obstructive  Electrocution
pulmonary disease (COPD)  Certain mental health conditions
 Pneumonia or bronchitis (e.g., panic disorders)
 An allergic reaction  Drowning
 Anaphylaxis

What to Look For

The following are signs and symptoms of respiratory distress:
 Shortness of breath or gasping for breath
 Trouble speaking in complete sentences (due to difficulty breathing)
 Wheezing, gurgling, or high-pitched noises
 Breathing abnormally quickly or slowly

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 Unusually deep or shallow breathing

 Cool, moist skin
 Bluish or ashen (grey) skin
 Flushed or pale skin
 Feelings of fear
 Dizziness or light-headedness

What to Do
Call
Call EMS/9-1-1/044-791-0566.

Care
1. If the person carries medication for respiratory distress, offer to help the
person take his or her medication.
2. Encourage the person to sit down in a comfortable position (leaning forward
may help make breathing easier).
3. Provide reassurance, as this can help reduce anxiety and help the person
control his or her breathing. This may make breathing easier.
4. Remember that a person having breathing problems may find it hard to talk. If
the person cannot talk, ask him or her to nod or to shake his or her head to
answer yes-or-no questions.
5. Monitor the person’s condition and provide continual care until EMS
personnel arrive.
If an adult is unconscious and not breathing, the cause is most likely a cardiac
emergency. Immediately begin CPR starting with chest compressions.

_____________________
The airway is the passage that connects the nose and mouth with the lungs.
Choking occurs when the airway becomes partially or completely blocked by a
foreign object (e.g., a piece of food or a small toy), by swelling in the mouth or
throat, or by fluids, such as vomit or blood. If the airway is blocked by the person’s

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tongue or by swelling, this is called an anatomical obstruction. If it is blocked by a

physical object, this is called a mechanical obstruction.

Partial Choking
Partial choking happens when the airway is partially blocked. Coughing is the
body’s way of clearing the airway, and so it may indicate a partial airway
obstruction.

Complete Choking
Complete choking happens when the airway is completely blocked. When a person
is experiencing complete choking, he or she is unable to breathe and is in a life-
threatening situation.

Common Causes
Any medical condition that affects a person’s ability to chew and/or swallow
increases his or her risk of choking. So, can dental problems or poorly fitting
dentures that affect a person’s ability to chew food properly.
Common causes of choking include the following:
 Trying to swallow large pieces of food
 Eating while talking, laughing, walking, or running
 Eating too quickly

Prevention
The following may reduce the risk of choking in adults:
 Chewing food well before swallowing
 Eating slowly and calmly
 Avoiding talking, laughing, walking, and other kinds of physical activity while
chewing
The following may reduce the risk of choking in children and babies:
 When babies start eating solid food, begin with purées as opposed to solid
pieces.

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 Always supervise children and babies when they are eating.

 Teach children to eat calmly, chew properly, and not to speak with a mouthful
of food.
 Encourage children to sit while eating.
 Make sure that babies and young children cannot reach objects small enough
for them to swallow.
 Remember that children can choke on soft plastic (e.g., the cut-off corners of
milk bags) and rubber (e.g., burst balloons) as well as hard objects, so keep
these items out of reach.

Partial Choking
What to Look For
Typical signs of partial choking include the following:
 A look of panic, with wide eyes
 Forceful or weak coughing
 One or both hands clutching the throat

What to Do
Call
It is not usually necessary to call for help for partial choking, though you may need
to do so if the obstruction does not clear or the person’s condition worsens.

Care
1. If the person is coughing or can speak, encourage him or her to cough
forcefully, and do not interfere. Forceful coughing may be enough to clear the
obstruction on its own.
2. Encourage or assist the person to sit upright, if possible, as this will make
coughing easier and more effective.
3. Continue to monitor the person’s condition until either the obstruction clears
itself or the person’s condition worsens.

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Complete Choking
What to Look For
The signs and symptoms of complete choking include the following:
 An inability to speak, cough, or breathe
 High-pitched squeaking noises
 Flushed (red) skin that becomes bluish or paler than normal
 A look of panic with wide eyes
 One or both hands clutching the throat

What to Do
(Responsive Adult or Child Over 12 Months)
Call
 If possible, send someone to call EMS/9-1-1/044-791-0566 and get an AED
while you care for the person.
 If you are alone, immediately begin providing care for complete choking.
Shout for help to try to attract the attention of a bystander, but do not delay
care by calling EMS/9-1-1/044-791-0566 yourself.

Care
Try to dislodge the object by combining any two of the following three options:
back blows, abdominal thrusts, and chest thrusts. Continue alternating between
the two methods until the object comes out, the person begins to breathe, or the
person becomes unresponsive.

Special Choking Circumstances

Larger or Pregnant Responsive, Choking Adult
1. If you cannot reach far enough around a person to perform abdominal thrusts,
or if you are aiding a woman who is obviously pregnant, alternate between 5
firm back blows and 5 chest thrusts.
2. Continue until the object comes out, the person begins to breathe or cough, or
the person becomes unresponsive.

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Responsive, Choking Toddler

1. If the child is short enough, kneel on the floor with one knee raised.
2. Perform 5 back blows with the child leaning across your raised leg, alternating
with either 5 chest thrusts or 5 abdominal thrusts.
3. Continue until the object comes out, the child begins to breathe or cough, or
the child becomes unresponsive.

If You Are by Yourself and Choking

1. Dial EMS/9-1-1/044-791-0566 and leave the phone off the hook. This will tell
the dispatcher to send help.
2. If there are people nearby, move to a place where you can be noticed.
3. Attempt to dislodge the object by performing an abdominal thrust against a
safe object with no sharp edges or corners, such as the back of a chair or the
edge of a table.

Choking Baby (Less than 12 Months)

Call
 Shout for help.
 If the baby is making high-pitched noises, is wheezing, can no longer make a
sound, or becomes too weak to cough, have someone call EMS/9-1-1/044-
791-0566 and get an AED while you care for the baby.
 If you are alone, immediately begin care for complete choking. Shout for help
to try to attract the attention of a bystander.

Care
1. Sit or kneel holding the baby.
2. Position the baby face-down along your forearm, holding his or her jaw in your
hand.
3. Rest your forearm on your leg so that the baby’s head is lower than his or her
body.
4. Deliver 5 firm back blows between the shoulder blades with the heel of your
free hand.
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5. If the object has not been dislodged, turn the baby face-up, ensuring you
support the head.
6. Place 2 fingers on the middle of the chest just below the nipple line and
quickly deliver 5 firm chest compressions, pushing down 1/3 of the chest’s
depth.
7. Repeat the 5 firm back blows and 5 chest compressions until the object is
coughed up, the baby starts to cry, breathe, or cough, or the baby becomes
unresponsive.

After the Object Comes Out

An object lodged in the airway can cause damage to the sensitive tissues in the
trachea and the back of the throat. This can cause bleeding and swelling.
Any person who has suffered complete choking should always seek medical
attention, even if the object comes out. If you have done back blows, abdominal
thrusts, or chest thrusts, those procedures may have caused damage (in addition
to the damage caused by the choking itself), so any person given this care should
be assessed in a hospital.

Unresponsive Choking
If the choking person becomes unresponsive, lower him or her to the ground as
safely as possible and immediately begin CPR, starting with chest compressions.

_______________________
Hyperventilation is a condition in which a person is breathing much more quickly
than usual. This upsets the body’s balance of oxygen and carbon dioxide.

Common Causes
The following are common causes of hyperventilation:
 Strong emotions such as excitement, fear, or anxiety
 Asthma
 Injuries, especially injuries to the head
 Exercise
 Life-threatening bleeding
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Prevention
If you tend to hyperventilate due to anxiety, panic, or stress, relaxation techniques
such as breathing exercises may help. If you hyperventilate due to a diagnosed
medical condition, speaking to your doctor will help you learn how to treat or
control it.

What to Look For

The following are signs and symptoms of hyperventilation:
 Rapid, shallow breathing
 A feeling of suffocating or not getting enough air
 Fear, anxiety, or confusion
 A feeling of dizziness
 Numbness or tingling of the fingers and toes
 Muscle contractions, usually in the hands, feet, arms, and legs

What to Do
Call
It is not always necessary to call EMS/9-1-1/044-791-0566 for a person who is
hyperventilating. You should call EMS/9-1-1/044-791-0566 and get an AED if the
hyperventilation does not stop after a few minutes, the person becomes
unresponsive, or you suspect that the person is hyperventilating because of an
injury or illness.

Care
Encourage the person to take controlled breaths by breathing in slowly, holding his
or her breath for a few seconds, and then gradually exhaling.

_________________
Many people have asthma—a chronic illness in which certain substances or
conditions (i.e., triggers) cause inflammation and swelling of the bronchioles (i.e.,
the small tubes at the base of the lungs), making it harder for air to move in and
out of the lungs. Asthma is more common in children. People who have asthma

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usually know what can trigger an attack and take measures to avoid these triggers.
Asthma is usually controlled with medication.

Common Causes
Asthma can be triggered by:
 Air pollution or poor air quality (e.g., cigarette smoke)
 Allergies (e.g., to pollen, food, drugs, insect stings, or animals)
 Temperature fluctuations, extreme humidity, or extreme dryness
 Strong odors (e.g., perfume, cologne, scented cleaning products)
 Colds and flus
 Physical activity
 Respiratory infections
 Stress or anxiety

Prevention
If you have asthma, the following precautions may help to prevent attacks:
 Know what triggers your attacks and avoid them if possible.
 Ensure that prescribed medication is always easily accessible in case of an
attack.
If a child has asthma:
 Make sure that anyone who supervises the child knows about the asthma and
how to help give medication if necessary.

Asthma Medications
There are two main types of medication used by people with asthma: Long-term
control medication and quick-relief (rescue) medication.
What to Look For
The signs and symptoms of an asthma attack include the following:
 Wheezing or coughing, especially when exhaling
 Gasping for air
 Shortness of breath (feeling unable to get enough air into the lungs)

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 Rapid, shallow breathing (or trouble breathing)

 Anxiety and fear
 Tightness in the chest
 Tingling in the hands and feet
 Sweating
 Inability to say more than a few words without pausing to breathe

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED if the person is struggling to breathe,
the person’s breathing does not improve after taking his or her medication, or the
person becomes unresponsive.

Care
1. Eliminate any asthma triggers, if possible. If something in the environment is
causing the attack, move the person away from the area if it is safe to do so.
2. Help the person get into a comfortable position and provide reassurance.
3. Help the person to take any prescribed quick-relief asthma medication that he
or she has available.

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CHAPTER VI
Sudden Illness and Medical Emergencies
SUDDEN ILLNESS
It usually is obvious when someone is injured and needs care. The person may be
able to tell you what happened and what hurts. Checking the person also gives you
clues about what might be wrong. However, when someone becomes suddenly ill,
it is not as easy to tell what is physically wrong. At times, there are no signals to
give clues about what is happening. At other times, the signals only confirm that
something is wrong, without being clear as to what is wrong. In either case, the
signals of a sudden illness often are confusing. You may find it difficult to
determine if the person’s condition is an emergency and whether to call EMS/9-1-
1/044-791-0566 or the local emergency number.

What to Look For

When a person becomes suddenly ill, he or she usually looks and feels sick.
Common signals include:
 Rapid, shallow breathing
 Changes in level of consciousness, such as feeling lightheaded, dizzy, drowsy
or confused, or becoming unconscious.
 Breathing problems (i.e., trouble breathing or no breathing).
 Signals of a possible heart attack, including persistent chest pain, discomfort
or pressure lasting more than a few minutes that goes away and comes back
or that spreads to the shoulder, arm, neck, jaw, stomach or back.
 Signals of a stroke, including sudden weakness on one side of the face (facial
droop); sudden weakness, often on one side of the body; sudden slurred
speech or trouble forming words; or a sudden, severe headache.
 Loss of vision or blurred vision.
 Signals of shock, including rapid breathing, changes in skin appearance and
cool, pale or ashen (grayish) skin
 Sweating

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 Persistent abdominal pain or pressure

 Nausea or vomiting
 Diarrhea
 Seizures

What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency for any of the following
conditions:
 Unconsciousness or altered level of  Vomiting blood or passing blood
consciousness  Severe (critical) burns
 Breathing problems  Suspected poisoning
 No breathing  Seizures
 Chest pain, discomfort or pressure  Stroke
lasting more than 3 to 5 minutes  Suspected or obvious injuries to
that goes away and comes back or the head, neck or spine
that radiates to the shoulder, arm,  Painful, swollen, deformed areas
jaw, neck, stomach or back (indicates possible broken bone) or
 Persistent abdominal pain or an open fracture
pressure
 Severe external bleeding (bleeding
that spurts or gushes steadily from
a wound)

Care
Although you may not know the exact cause of the sudden illness, you should still
give care. Initially you will care for the signals and not for any specific condition. In
the few cases in which you know that the person has a medical condition, such as
diabetes, epilepsy or heart disease, the care you give may be slightly different. This
care may involve helping the person take medication for his or her specific illness.

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Care for sudden illnesses by following the same general guidelines as you would
for any emergency.
 Check the person.
 First care for life-threatening conditions such as unconsciousness; trouble
breathing; no breathing; severe bleeding; severe chest pain; or signals of a
stroke, such as weakness, numbness or trouble with speech.
 Help the person to rest comfortably.
 Keep the person from getting chilled or overheated.
 Reassure the person because he or she may be anxious or frightened.
 Watch for changes in consciousness and breathing.
 If the person is conscious, ask if he or she has any medical conditions or is
taking any medication.
 Do not give the person anything to eat or drink unless he or she is fully
conscious, is able to swallow and does not show any signals of a stroke.
 If the person vomits and is unconscious and lying down, position the person
on his or her side so that you can clear the mouth.
 If you know the person is having a severe allergic reaction or a diabetic
emergency, assist the person with his or her prescribed medication, if asked.

SPECIFIC SUDDEN ILLNESSES

_________________
Fainting is a brief period of unresponsiveness that happens when there is not
enough blood flowing to the brain. If a person suddenly becomes unresponsive
and then "comes to" after about a minute, he or she may have simply fainted.

Common Causes
Fainting is caused by a sudden decrease in blood flow to the brain. Usually the
cause of fainting is not serious. The following are common causes of fainting:
 Pregnancy
 Pain
 Heat
 Dehydration
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 Decreased blood sugar (e.g., from missing a meal)

 Standing in one position for too long without moving
 Intense emotion
 Traumatic information (e.g., news of someone’s death)

Prevention
The following tips help prevent fainting:
 Keep hydrated.
 Eat at regular intervals to maintain a consistent blood sugar level.
 Get up slowly from sitting or lying down.
Fainting may be preceded by paleness, dizziness, sweating, or nausea. If you think
that someone is about to faint, have the person sit or lie down.

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED if the person is unresponsive for
more than a few minutes, the person is pregnant, the person’s medical history is
unknown, or you suspect that the person fainted as a result of a serious injury or
illness. If you are unsure, call Call EMS/9-1-1/044-791-0566 and get an AED.

Care
1. Place the person in the recovery position.
2. Encourage the person to follow up with his or her healthcare provider.

_________________
A seizure is an episode of abnormal electrical signals in the brain that result in
temporary and involuntary disturbances in brain function, shaking or contraction
of limbs (convulsions), changes in sensation, shifts in behavior, and altered levels
of responsiveness.

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Common Causes
Seizures can have many different causes. One common cause is epilepsy, a chronic
seizure disorder that can often be controlled with medication. Other causes of
seizures include the following:
 Fevers or infections  Drug or alcohol withdrawal
 Head injuries  Diabetic emergencies
 Heat stroke  Audio-visual stimulation (e.g.,
 Poisons (including drugs) flashing lights)

What to Look For

The following are common signs and symptoms of seizures:
 Hallucinations  Drool or foaming at the mouth
 Uncontrollable muscle  Uncontrolled repetitive
movement motions (partial seizures)
 Eyes rolling upward into the head

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED if:
 You do not know the person  The person is experiencing a
or the person’s medical diabetic emergency.
history.  The seizure takes place in water.
 The seizure lasts more than a  This is the person’s first seizure, or
few minutes. the cause of the seizure is
 The person has several unknown.
seizures in a row.  The person does not wake up
 The person appears to be after the seizure or is
injured. unresponsive for an extended
 The person is pregnant. period.

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Calling EMS/9-1-1/044-791-0566 for People with Seizure Disorders / Epilepsy

Some people have multiple seizures during a day and will likely have a seizure
treatment plan in place. The treatment plan will outline when a seizure no longer
follows the normal pattern or duration for the person and when to call EMS/9-1-
1/044-791-0566. Follow the person’s seizure plan if you are familiar and
comfortable with it.

Care
During the Seizure:
1. Protect the person from injury by:
 Moving furniture and other objects that could cause injury out of the
way.
 Protecting the person’s head with a soft object (such as a blanket).
2. Do not try to hold the person down or stop the seizure from happening.
3. Roll the person onto his or her side, if you are able to do so safely

After the Seizure:

The person may be drowsy and disoriented for up to 20 minutes.
1. Check the person’s ABCs.
2. Place the person in the recovery position.

__________________________
Babies and young children may have seizures if their body temperatures suddenly
rise. These are called "febrile seizure" and are most commonly associated with
sudden high fevers, normally with temperatures over 39°C (102°F). In most cases,
these seizures are non-life-threatening and do not last long.
To reduce the risk of febrile seizures in a child or baby with a high fever, you must
lower his or her body temperature:
1. Remove any excess clothing or blankets.
2. Give the child or baby a sponge bath with water that is room temperature (not
icy cold).
3. Give the child or baby plenty of fluids to drink to help prevent dehydration.

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4. Consider giving the child or baby fever-reducing medication such as

paracetamol.
If these steps do not reduce the child’s or baby’s temperature, seek medical
attention.

What to Do
Call
Call EMS/9-1-1/044-791-0566 for a febrile seizure if:
 It is the first time that the child or baby has had a febrile seizure.
 The seizure lasts longer than 5 minutes or is repeated.
 The seizure is followed by a quick increase in body temperature.

Diabetic Emergencies
Diabetes is a chronic condition characterized by the body’s inability to process
glucose (sugar) in the bloodstream. An organ called the pancreas secretes insulin,
a hormone that causes glucose to move from the bloodstream into the cells,
where it is used for energy.

_______________________ is a condition in which lowered insulin levels result in

elevated blood sugar. Hyperglycemia can result if a person eats too much food,
takes too little medication, exercises less than usual, or experiences physical or
emotional stress.

_______________________ occurs when the insulin level is too high relative to

the level of sugar in the blood. The small amount of sugar in the blood gets used
up quickly. Hypoglycemia can result if a person misses a meal or snack, exercises
more than usual, vomits, or takes too much medication.

Common Causes
A diabetic emergency occurs when there is an imbalance between two or more of
the following:
 Exercise  Medication
 Food intake  Insulin production
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What to Look For

The following are signs and symptoms of a diabetic emergency:
 Changes in the level of responsiveness
 Changes in behavior, such as confusion, irritability, or aggression
 Rapid breathing
 Cool, sweaty skin
 Skin that is paler than normal
 Appearance of intoxication (e.g., slurred speech, difficulty walking)
 Feeling and looking ill
 Seizures

What to Do
Call
Call EMS/9-1-1/044-791-0566 if:
 You are unable to give the person sugar.
 The person is not fully awake.
 The person has a seizure.
 The person’s condition does not improve within 10 minutes of having sugar.

Care
If the person is unable to follow simple commands, unable to swallow safely, or is
unresponsive, ensure that EMS/9-1-1/044-791-0566 has been called and place the
person in the recovery position.
1. If the person is able to follow simple commands, answer questions, and
swallow safely, offer 15 to 20 grams of sugar. Check the label on packaged
products to determine how much of the package’s contents to give. The
following are the forms of sugar to give, listed in order of preference:
 Oral glucose tablets
 Chewable candy
 Fruit juice
 Fruit strips

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 Milk
 Other forms of sugar, such as a non-diet soft drink or a spoonful of sugar
mixed into a glass of water
2. Monitor the person’s condition for 10 minutes:
 If the person’s condition deteriorates or does not improve within 10
minutes, call EMS/9-1-1/044-791-0566 and administer more sugar if it is
still safe to do so.
 If the person’s condition improves, recommend that he or she eat a
complete meal.

Allergic Reactions
Normally, our immune systems help to keep us healthy by fighting off harmful
pathogens that can cause disease. In a person with an allergy, however, the
immune system can react to normally harmless substances to produce allergic
reactions.

Preventing Allergic Reactions in a Child You Are Caring For

Discuss the allergy with the parent or guardian before you begin caring for the
child, and ask at least the following questions:
 What is your child allergic to?
 What signs will tell us that your child is having an allergic reaction?
 What should we do if your child has a reaction?
 Has the doctor prescribed any allergy medication? For instance, should you
give us your child’s epinephrine auto-injector?

What to Look For

Signs and symptoms of an allergic reaction can range from mild to very severe and
include the following:
 Runny, itchy, or stuffy nose
 Sneezing
 Watery, itchy, red, or swollen eyes
 Nausea, vomiting, or diarrhea
 A rash or hives (raised, itchy areas of skin)
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 Tingling of the mouth

 Swelling of the lips, tongue, face, or throat
 Coughing, chest tightness, wheezing, or shortness of breath
 Weakness, dizziness, or confusion

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED if the reaction is severe, the person
is struggling to breathe, or the person loses responsiveness.

Care
1. Calm and reassure the person.
2. Try to identify the allergen and have the person avoid further contact with it.
3. Watch the person for signs of increasing distress.
4. If the person uses a medication to control allergic reactions (such as
antihistamines), help him or her to take it.

___________________
Anaphylaxis is a severe allergic reaction. While mild allergic reactions are localized,
anaphylaxis is a body-wide reaction and it can cause system-wide inflammation
and swelling.

Common Causes
Anything that causes other allergic reactions can also cause anaphylaxis, and the
causes vary from one person to another. The most common allergens that trigger
anaphylaxis include:
 Insect stings  Medications
 Food

Prevention
The following steps may help to prevent an anaphylactic incident:
 Avoid the substances, foods, or insects that cause reactions.
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 Wear a medical identification product and carry the appropriate medication at

all times.

What to Look For

The signs and symptoms of anaphylaxis may be similar to the signs and symptoms
of a mild allergic reaction, but they are more pronounced.
Anaphylaxis can affect a variety of body systems and can present in various ways.
If a person exhibits signs and symptoms from two or more of these categories—
especially after contact with an allergen—you should provide care for anaphylaxis:
 Skin (e.g., swelling of the lips, face, neck, ears, and/or hands, a raised, itchy,
blotchy rash, flushing, or hives)
 Breathing (e.g., a feeling of tightness in the chest or throat, coughing,
wheezing, or high-pitched noises)
 Alertness (e.g., weakness, dizziness, or unresponsiveness)
 Stomach (e.g., stomach cramps, nausea, vomiting, or diarrhea)

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED.

Care
1. If the person has an epinephrine auto-injector, help him or her to use it.
2. Provide reassurance and encourage the person to breathe normally.
3. Help the person get into a comfortable position.

__________________
A poison is a substance that has a harmful effect within the body if it is inhaled,
swallowed (ingested), absorbed, or injected. Poisons are immediately life-
threatening if they affect breathing or circulation.

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Types of Poisons
Enters the body through the mouth, lips, esophagus, or
Swallowed Poison stomach. Drinking bleach is an example of swallowed
poisoning.
Enters the body through the skin. Plants and chemicals
Absorbed Poison can cause absorbed poisoning.
Enters the body through bites or stings or as drugs
Injected Poison
injected with a needle.
Is breathed into the body. Breathing in carbon monoxide
Inhaled Poison from a car’s exhaust is an example of inhaled poisoning.

THE INTERNATIONAL HAZARD SYMBOLS

Flammable
These materials catch fire easily and burn quickly when exposed to any
form of ignition (such as fire or heat).
Toxic
These materials can harm the respiratory (breathing) system, nervous
system, and other systems if they are absorbed through the skin,
inhaled, or ingested.
Explosive
These materials can explode when exposed to heat, flame, or pressure.
Corrosive
These materials can burn the skin and cause permanent blindness.

Calling EMS/9-1-1/044-791-0566 or a Poison Control Center (02) 524-1078 is the

most important thing you can do if a poisoning of any type is suspected. Other
general first aid care tips for poisoning include the following:
 Limit further exposure by moving either the person or the source of the
poison.
 If the poison’s container is found nearby, give the information from the label
to the Poison Control Centre or EMS/9-1-1/044-791-0566 dispatcher.

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 Do not give the person anything to eat or drink unless an EMS dispatcher or
Poison Control Center staff member tells you to do so.
 If you do not know what the poison was and the person vomits, save a sample
to give to EMS personnel.

Swallowed Poisons
What to Look For
The following may indicate that a poisonous substance has been swallowed:
 An open container of poison nearby
 Burns around the mouth
 Increased production of saliva or saliva that is an abnormal color
 Abdominal cramps, vomiting, or diarrhea
 Seizures
 Dizziness or drowsiness
 Unresponsiveness
 A burning sensation in the mouth, throat, or stomach

What to Do
Call
If the person is responsive and alert and his or her ABCs are unaffected, call the
local Poison Control Center. Call EMS/9-1-1/044-791-0566 and get an AED if the
person has an altered level of responsiveness or has difficulty breathing.

Care
1. If the person is not breathing, start CPR. Use a barrier device so that you don’t
contaminate yourself with the poison.
2. Check the packaging of the poison, if possible, so that you know what it is.
3. Induce vomiting only if told to do so by the EMS dispatcher or the Poison
Control Center.
4. If the person needs to go to the hospital, bring a sample of the poison (or its
original container).

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Inhaled Poisons
What to Look For
The following may indicate that a poisonous substance has been inhaled:
 Breathing difficulties  Seizures
 Irritated eyes, nose, or throat  Bluish color around the mouth
 Dizziness  Unresponsiveness
 Vomiting  An unusual smell in the air

What to Do
Call
If the person is responsive and alert and his or her ABCs are unaffected, call the
local Poison Control Center. Call EMS/9-1-1/044-791-0566 and get an AED if the
person has an altered level of responsiveness or has difficulty breathing.

Care
1. If the person is not breathing, start CPR. Use a barrier device so that you don’t
contaminate yourself with the poison.
2. Get the person into fresh air but do not enter into a hazardous atmosphere in
order to do so.
Inhaled poisons can affect everyone in an area. Stay out of the area if you suspect
that the poison may still be in the air.

Carbon Monoxide Poisoning

Carbon monoxide (CO) is a gas that has no smell, color, or taste. CO poisoning is
often called a "silent killer" because it is not detectable to any of the body’s
senses. CO bonds to red blood cells 200 times better than oxygen, preventing
oxygen from attaching and therefore starving the body of oxygen.

Prevention
The following tips help prevent carbon monoxide (CO) poisoning:
 Have all fuel-based appliances and equipment installed and repaired by a
qualified technician.
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 Have all fuel-based appliances and equipment serviced annually by a qualified

professional.
 Use fuel-based appliances and materials as intended (e.g., do not use
generators indoors, do not burn charcoal indoors).
 Never run a car or truck inside an attached garage. For detached garages,
always leave the garage door open when running a car or truck inside.

What to Look For

Signs and symptoms include the following:
 Headache  Muscle cramps
 Dizziness or light-headedness  Nausea and vomiting
 Confusion  Chest pain
 Impaired hearing and vision  Altered level of responsiveness
 Weakness or fatigue

What to Do
Care
1. Treat the person as you would for any other type of inhaled poison.

Absorbed Poisons
What to Look For
The following signs and symptoms can indicate that a poisonous substance has
been absorbed:
 Rash or hives (raised, itchy areas of skin)
 Burning or itching skin
 Swelling
 Blisters
 Burns
 Unresponsiveness

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What to Do
Call
If the person is responsive and alert, and the person’s ABCs are unaffected, call the
local Poison Control Center. Call EMS/9-1-1/044-791-0566 and get an AED if the
person has an altered level of responsiveness or has difficulty breathing.

Care
1. If the person is not breathing, start CPR.
2. If the poison is a dry powder, brush it off the person’s skin. Be careful to avoid
contaminating yourself.
3. Remove any clothing or items covered in the poison.
4. Flush the skin with running water for at least 15 minutes. To prevent any
further injury, make sure the water flushes away from any unaffected areas of
the body.

Injected Poisons
What to Look For
Needles found nearby are a common sign that an injected poisoning has occurred.
The following are other signs and symptoms that indicate a poisonous substance
has been injected:
 One or more puncture wounds on the person’s skin
 Problems breathing
 Redness and swelling at the entry point on the person’s skin

What to Do
Call
If the person is responsive and alert, and the person’s ABCs are unaffected, call the
local Poison Control Center. Call EMS/9-1-1/044-791-0566 and get an AED if the
person has an altered level of responsiveness or has difficulty breathing.

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Care
1. Clean the puncture site with clean running water.
2. Keep the person as still as possible.

Bites and Stings

Bites and stings can range in severity from mildly irritating to life-threatening.
When a person is bitten or stung, proper first aid care can help to limit
complications and speed healing, and it may even be lifesaving.

________________________
Any animal that has teeth, whether domesticated (e.g., pets or livestock) or wild,
can be the source of a bite wound. If the person does not know the animal, rabies
may be a concern. Most animal bites carry a high risk of infection, so they should be
monitored closely in the hours and days after the incident.

What to Do
Call
Call EMS/9-1-1/044-791-0566 if bleeding is life-threatening. Call your local animal
control department if the animal is wild or a stray.

Care
1. Try to get the person safely away from the animal without putting yourself in
danger.
2. Do not try to capture the animal.
3. If the wound is bleeding heavily, provide care for external bleeding.
4. If the wound is minor:
 Wash the wound thoroughly with clean water, ideally by running it under a
tap, as the pressure from the running water lets it penetrate more deeply
into the wound.
 Control any bleeding.
 Encourage the person to apply antibiotic ointment or cream to the wound,
if they have no known allergies or sensitivities.
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 Cover the wound with a dressing or bandage.

 Seek medical attention if the animal is wild, stray, or unknown to you, or if
you suspect the animal might have rabies.
 Watch for signs and symptoms of infection and ensure that the person
continues to monitor the wound over the next several days.

_______________
Rabies is a serious infection that attacks the brain and spinal cord. It is fatal if it is
not treated. The virus that causes rabies is spread when an animal that has the
disease bites another animal or a person. Wild animals can carry rabies, as can
pets and livestock that have not been vaccinated against it. Only mammals can be
infected with rabies.

Insect Stings
Most of the time, insect stings are merely uncomfortable. However, allergic
reactions and anaphylaxis are always a concern. Some insects, such as bees, leave
their stingers embedded in the person’s skin. Others, such as wasps, can sting
multiple times, but leave no stinger behind.

Prevention
To reduce the risk of insect stings:
 Wear a long-sleeved shirt, long pants, and closed-toe shoes.
 Don’t wear perfume, cologne, or other products with strong scents.
 Remove or cover items that will attract insects, such as garbage or food.

What to Look For

The following can indicate an insect sting, especially if you see insects nearby:
 Quick, sharp pain at the site of the sting
 Pain, redness, or swelling at the site of the sting
 A stinger embedded in the skin

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What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED if there are any signs of a severe
allergic reaction.

Care
1. If the stinger is still in the person’s skin, remove it by scraping it away from the
skin. Use a plastic card (such as a debit card) to do this.
2. Wash the area with clean water.
3. Cover the site with an adhesive bandage.
4. Apply ice or a cold pack to help control swelling. Put a thin cloth between the
cold source and the person’s skin to avoid freezing the skin.
5. Continue to watch for signs of infection, an allergic reaction, or anaphylaxis.

Snakebites
In the wild, snakes like to occupy rock outcrops, swamps, undergrowth, and
abandoned human structures. When disturbed, some snakes can inject venom as
they bite.
Most deaths from venomous snakebites occur because:
 Too much time passed before the person received medical care.
 The person had an allergic reaction to the venom.
 The snake bite compounded an existing health condition in the person.

Prevention
The following steps will help prevent snakebites:
 Do not aggravate a snake.
 Wear proper footwear and watch where you put your feet when hiking.

A Snake’s Striking Range

A snake’s striking range is about two-thirds of its length forward and one-third
upward. (In water, snakes have a shorter striking range.) If you are within striking
distance, slowly back out of range.
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What to Look For

Signs and symptoms of a possibly venomous snakebite include:
 A pair of puncture wounds in the skin
 Localized redness of the skin
 Pain and swelling in the area of the bite

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED. If you are not sure whether the
snakebite was caused by a venomous snake, call EMS/9-1-1/044-791-0566
anyway. Do not wait for life-threatening signs and symptoms of poisoning to
appear.

Care
Before providing care, ensure that the snake is no longer present. If you see the
snake, remember what it looks like so that you can describe it to EMS personnel.
This information will help them provide the most appropriate treatment. Never
attempt to capture or handle a potentially venomous snake.
1. Keep the injured site still and level with the heart, if possible.
2. If the bite is on a limb, remove any jewelry or tight clothing from the limb and
watch for swelling.
3. Wash the wound with water.
4. Cover the bite with a clean, dry dressing.

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CHAPTER VII
Environmental Illness
How Body Temperature Is Controlled
The human body’s core temperature (i.e., the temperature of the heart, lungs, and
brain) is normally around 37°C (98.6°F) and is maintained by balancing heat loss
with heat gain.
The body generates heat by either converting food into energy or by contracting
muscles (e.g., shivering, exercising). The heat produced by routine activities such
as walking is usually enough to balance normal heat loss.

The Four Mechanisms of Heating and Cooling the Body

Heat moves from warmer areas to cooler ones through four mechanisms:
1. Radiation: (Warming or cooling) Involves the direct loss or absorption of heat
energy through electromagnetic waves.
2. Conduction: (Warming or cooling) Occurs through direct contact with a solid
or liquid.
3. Convection: (Warming or cooling) Occurs when air or liquid moves across the
skin.
4. Evaporation: (Cooling only) Occurs when a liquid change to a vapor.

Heat-Related Illnesses
Hyperthermia occurs when the body’s core temperature rises above the normal
range. It results when at least one of the four mechanisms that cool the body is
impaired by clothing, drugs, or disease, or is overwhelmed by internal heat
production and/or external heat exposure. Heat-related illnesses will get worse
without treatment and can change from one level to another very quickly.

Prevention
One of the most important actions a person can take to prevent heat-related
illnesses is to drink plenty of fluids. You should drink eight 250 mL (8 oz.) glasses of

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fluid a day for low-exertion, routine activities and more as exertion levels increase.
It is important to rehydrate regularly during longer events.
The following tips will also help to prevent heat-related illness:
 Maintain a healthy level of cardiovascular fitness.
 Prior to a major event in the heat, let the body gradually acclimatize by being
exposed to 1 to 2 hours of heat exertion for at least 8 days.
 Avoid being outdoors during the hottest part of the day.
 Reduce the intensity of activities as it gets hotter and don’t work or exercise
for too long at a time.
 Take frequent breaks in a cool or shaded area to cool off. This will help the
body cope with short periods of extreme heat.
 Dress for the heat and for the intended activity.
 Make adjustments to exertion levels and work/rest cycles on hot days (e.g.,
schedule soccer practices for cooler parts of the day).
 Wear a light hat when under the sun. Wear loose-fitting light clothing that
allows liquid and vapor to escape.
 Choose hydrating drinks, such as water or juice, over dehydrating ones like
alcohol.

Heat Cramps
Heat cramps are painful muscle spasms, usually in the legs and abdomen, caused
by loss of fluids and electrolytes as a result of sweating. While they are usually not
serious, they are often the first sign that the body is beginning to overheat.

What to Look For

The following signs and symptoms can indicate heat cramps:
 Mild muscle contractions that can become severe, usually in the legs and
abdomen
 Moist skin
A person with heat cramps will typically have a normal or slightly elevated core
temperature (37ºC or 98.6ºF).

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What to Do
Care
1. Reduce heat exposure (e.g., get into the shade) and, if possible, move the
person to a cooler environment.
2. Have the person slowly sip a cool electrolyte-replacement beverage (e.g.,
commercial sports drink, coconut water, fruit juice, or milk). If a drink
containing electrolytes is not available, have the person drink water.
3. Gently stretch and massage the cramped muscles.
When the cramps stop, the person can usually resume his or her activity as long as
there are no other signs or symptoms of illness.

Heat Exhaustion
Heat exhaustion occurs when the body begins to overheat, especially when it loses
more fluids and electrolytes through sweating than it gains through rehydration. It
usually happens after long periods of strenuous activity in a hot environment,
especially if it is humid or lacking in air circulation, as these conditions make it
difficult for sweat to evaporate.

What to Look For

The following signs and symptoms can indicate heat exhaustion:
 Normal or slightly raised core temperature (37to 39°C, or 98.6 to 102.2°F)
 Moist skin that is flushed (red) immediately after exertion, and then turns pale
or ashen (grey)
 Dehydration or intense thirst
 Headache, nausea, dizziness or fainting
 Weakness or exhaustion

What to Do
Call
Call EMS/9-1-1/044-791-0566 if the person is vomiting, has an altered level of
responsiveness, or is unable to drink fluids.

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Care
1. Reduce heat exposure (e.g., get into the shade) and if possible, move the
person to a cooler environment.
2. Loosen any tight clothing and remove any padded clothing or equipment.
3. Pour cool water on the person’s clothing and/or on towels or cloths and place
them on the person’s chest. Fan the person to increase evaporation.
4. Apply ice or cold packs to the armpits and chest.
5. If the person is responsive and able to swallow, have him or her slowly sip a
cool electrolyte-replacement beverage (e.g., commercial sports drink, coconut
water, fruit juice, or milk). If a drink with electrolytes is not available, have the
person drink water.
6. Advise the person not to do any more activities in the heat that day.

Heat Stroke
Heat stroke is the least common but most severe heat-related illness. It is a life-
threatening emergency that occurs when the body’s cooling system is completely
overwhelmed and stops working.

What to Look For

 High core temperature, above 40°C (104°F)
 Hot, dry skin
 Flushed (red) or pale skin
 Headache
 Altered mental status (e.g., confusion)
 Irritable, bizarre, or aggressive behavior
 Progressive loss of responsiveness
 Rapid, weak pulse that becomes irregular
 Rapid, shallow breathing
 Vision problems
 Seizures or coma

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What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED.

Care
1. Move the person to a cooler environment.
2. Quickly lower the person’s core temperature with one of the following
methods:
 Immerse the person in cool water from the neck down. Do not remove the
person’s clothing.
 Immerse the person’s forearms and hands in cool water.
 Pour cool water on the person’s clothing and/or on towels or cloths and
place them on the person’s chest. Fan the person to increase evaporation.
 Apply ice or cold packs to the person’s armpits and chest.
3. Continue to use the rapid cooling methods listed above until either the
person’s condition improves or EMS personnel arrive.
4. If the person is responsive and able to swallow, have him or her slowly sip a
cool electrolyte-replacement beverage (e.g., commercial sports drink, coconut
water, fruit juice, or milk). If a drink with electrolytes is not available, give the
person water.

Cold-Related Illness
Cold-related illnesses are any conditions that are caused by exposure to colder
temperatures.

Hypothermia
Hypothermia occurs when the body’s core temperature (i.e., the temperature of
the heart, lungs, and brain) drops to 35°C (95°F) or lower. Hypothermia becomes a
life-threatening condition when the core temperature drops below 28°C (82.4°F).
People with smaller body types, lower overall body weights, and lower body-fat
content are much more likely to experience hypothermia. Hypothermia can occur
at any time of year, with young children and the elderly being most at risk.

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Common Causes
The following may lead to hypothermia:
 Sweating while outdoors in cold weather
 Cold, wet, windy conditions
 Cold-water immersion, especially in water below 10°C (50°F)
 Dehydration
 Taking medications to eliminate water from the body

Prevention
The following tips will help to prevent hypothermia:
 Prepare for activities in cold environments by wearing appropriate clothing:
 Wear a hat and clothing made of tightly woven fibers (e.g., wool, fleece),
which provide insulation and allow moisture transmission from the skin to
the external environment.
 Avoid cotton because it soaks up water and stays wet.
 Wear clothing in layers so that they can be added or removed according to
the weather conditions and exercise intensity. Remove some clothing
before working to reduce the amount of sweat and keep clothing dry.
 Keep clothing dry. If clothing gets wet, change into dry clothing as soon as
possible.
 Carry and consume high-energy foods that have a lot of sugar.
 Drink plenty of warm, high-calorie drinks to help fuel heat production. If high-
calorie drinks are not available, drink plenty of water to at least keep from
becoming dehydrated.
 Do not drink alcohol.
 Take frequent breaks from the cold to let the body warm up.
 Increase your activity level, add insulation, add a heat source, or get out of the
cold if shivering occurs.
 Be careful around cold water and always wear a personal flotation device
(PFD).

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What to Look For

Levels of Cold Stress
Cold Stress (Not Hypothermic)
 Shivering
 Normal mental status
 Able to care for self
Mild Hypothermia
 Vigorous shivering; complaining of the cold
 Decreased physical function
 Difficulty taking care of self
Moderate Hypothermia
 Weak and intermittent shivering or shivering that later stops
 Sometimes complaining of the cold
 Lack of coordination or speech; confused or unusual behavior
 Impaired judgment
 Possible unresponsiveness
Severe Hypothermia
 Shivering has stopped
 Unresponsiveness; breathing has slowed down or stopped
 Body feels stiff
 No pulse

What to Do
Check
Hypothermia can slow a person’s breathing, so you may need to spend longer than
usual checking the person’s ABCs. If the person is unresponsive and you suspect
hypothermia, check for signs of breathing for 60 seconds.

Call
Call EMS/9-1-1/044-791-0566 and get an AED. Call EMS/9-1-1/044-791-0566 and
get an AED if the person has moderate to severe hypothermia.
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Care
1. Insulate the person (e.g., by applying a hypothermia wrap) to protect him or
her against further cold exposure.
2. Warm the person by applying warm water bottles, heating pads, or electric
blankets to the person’s upper torso (i.e., the armpits, chest, and upper back).
Body heat from yourself or a bystander can also work in an emergency. Never
put the person in a warm bath or shower or try to warm the person with a
fire, a stove, or hot rocks.
3. If the person is responsive, provide warm, sugary, non-alcoholic liquids to
drink.

Drowning
Drowning occurs when a person’s airway is submerged in water, cutting off the
oxygen supply to body. Drowning is a leading cause of death for children and
babies. Young children aged 1 to 4 and men aged 15 to 44 are at the greatest risk.

Prevention
The following tips will reduce the risk of drowning:
 Always wear a personal flotation device (PFD) when in a boat or other mode
of marine transportation.
 Supervise children in, on, and around any body of water.
 Those who do not swim or are weak swimmers should wear a PFD when in,
on, and around any body of water.
 Check water depth before swimming or diving.
 Have appropriate safety equipment available when in or on the water.
 Take PDRRMO Swimming and Water Safety lessons.

First Aider Rescue

To help rescue a person from water:
1. Talk – Instruct the person on self-rescue.
2. Throw – Throw a rope or buoyant object to the person.
3. Reach – Reach out to the person with a rigid object like a ladder, paddle, or
tree branch.
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Responsive Drowning Person

What to Look For
These common warning signs can indicate that someone is drowning:
 The person is vertical in the water, and is not using his or her legs to move
forward or tread water.
 The person may have an expression of fear.
 The person’s arms may be flailing up and down as he or she tries to rise out of
the water to breathe, rather than trying to swim forward.
 The person’s movements are uncontrolled.

What to Do
Call
Call for a lifeguard or other trained person (if one is nearby), or call EMS/9-1-
1/044-791-0566.

Care
1. Remove the person quickly and safely from the water, but do not put yourself
in danger. Follow the same steps you use to perform a First Aider Rescue for
cold-water immersion. Remember, any person rescued from cold water
should be treated for hypothermia.

Unresponsive Drowning Person

What to Do
Call
Call EMS/9-1-1/044-791-0566 and get an AED.

Care
If the person is not breathing and has no signs of life, begin CPR.

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CHAPTER VIII
Soft Tissue Injuries
WOUNDS
Soft tissues are the layers of skin and the fat and muscle beneath the skin’s outer
layer. An injury to the soft tissue commonly is called a wound.

Prevention
The following general tips will help you to avoid both serious and minor wounds:
 Develop safe habits, such as never running with sharp objects.
 Use proper safety equipment when playing sports or engaging in recreational
activities.
 Wear proper safety equipment in the workplace, and request training before
using any potentially dangerous tools or equipment.
 Stay alert and focused when engaged in any potentially risky activity.

Closed Wounds
The simplest closed wound is a bruise. A bruise develops when the body is
bumped or hit, such as when you bump your leg on a table or chair. The force of
the blow to the body damages the soft tissue layers beneath the skin.

What to Look For

Signals of internal bleeding include:
 Tender, swollen, bruised or hard areas of the body, such as the abdomen.
 Rapid, weak pulse.
 Skin that feels cool or moist or looks pale or bluish.
 Vomiting blood or coughing up blood.
 Excessive thirst.
 An injured extremity that is blue or extremely pale.
 Altered mental state, such as the person becoming confused, faint, drowsy or
unconscious.

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What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number if:
 A person complains of severe pain or cannot move a body part without pain.
 You think the force that caused the injury was great enough to cause serious
damage.
 An injured extremity is blue or extremely pale.
 The person’s abdomen is tender and distended.
 The person is vomiting blood or coughing up blood.
 The person shows signals of shock or becomes confused, drowsy or
unconscious.

Care
1. Apply an ice pack to the area to decrease bleeding beneath the skin. Applying
cold also can be effective in helping to control both pain and swelling.
Do not assume that all closed wounds are minor injuries. Take the time to find out
whether more serious injuries could be present.
2. Help the person to rest in the most comfortable position possible.
3. Keep the person from getting chilled or overheated.
4. Comfort and reassure the person.
Be sure that a person with an injured lower extremity does not bear weight on it
until advised to do so by a medical professional.

Open Wounds
In an open wound, the break in the skin can be as minor as a scrape of the surface
layers or as severe as a deep penetration. The amount of bleeding depends on the
location and severity of the injury.

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Abrasions
Abrasions are the most common type of open wound. They usually are caused by
something rubbing roughly against the skin. Abrasions do not bleed much. Any
bleeding that occurs comes from capillaries (tiny blood vessels).

Lacerations
A laceration is a cut in the skin, which commonly is caused by a sharp object, such
as a knife, scissors or broken glass. A laceration also can occur when a blunt force
splits the skin. Deep lacerations may cut layers of fat and muscle, damaging both
nerves and blood vessels.

Avulsions
An avulsion is a serious soft tissue injury. It happens when a portion of the skin,
and sometimes other soft tissue, is partially or completely torn away. This type of
injury often damages deeper tissues, causing significant bleeding.

Punctures
Punctures usually occur when a pointed object, such as a nail, pierces the skin. A
gunshot wound is a puncture wound. Puncture wounds do not bleed much unless
a blood vessel has been injured.

What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number immediately for any
major open wound.

Care
General care for open wounds includes controlling bleeding, preventing infection
and using dressings and bandages. Specific care depends on whether the person
has a minor or a major open wound.

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Infection
An infection occurs when dirt, foreign bodies, or other materials carrying germs
get into a wound. Infections can be localized (e.g., in a cut) or systemic
(throughout the body). Infections accompanied by nausea, fever, or general
malaise are typically systemic, and can be life-threatening.

Prevention
The following general tips help to minimize the risk of infection:
 Always wash your hands before and after giving first aid.
 Wear gloves whenever possible if you will be coming into contact with
someone’s bodily fluids.
 Keep your immunizations up to date. If you have been wounded and do not
know when your last tetanus shot was, seek medical attention.
 Keep any wound clean and wash it regularly. Change the dressing and
bandages if they become dirty or wet.
 Use sterile dressings whenever possible. If sterile dressings are unavailable,
use the cleanest option possible.

Using Dressings and Bandages

All open wounds need some type of covering to help control bleeding and prevent
infection.
Dressings are pads placed directly on the wound to absorb blood and other fluids
and to prevent infection. To minimize the chance of infection, dressings should be
sterile.
An occlusive dressing is a bandage or dressing that closes a wound or damaged
area of the body and prevents it from being exposed to the air or water.
A bandage is any material that is used to wrap or cover any part of the body.
Bandages are used to hold dressings in place, to apply pressure to control
bleeding, to protect a wound from dirt and infection, and to provide support to an
injured limb or body part. Any bandage applied snugly to create pressure on a
wound or an injury is called a pressure bandage.

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Bandaging Guidelines
 Use clean, preferably sterile, dressings.
 Check circulation below the injury before and after applying a bandage. If
circulation is reduced, loosen the bandage.
 If blood soaks through the bandage, place more dressings and another
bandage on top. The dressing that is in contact with the wound should remain
in place and not be removed.
 Dressings and bandages should be kept clean and dry to decrease the risk of
infection. Once bleeding is under control and the wound has begun to heal,
dressings that become wet should be replaced with dry dressings.

Triangular Bandages
Triangular bandages are useful in your first aid kit because they can be used both
to make slings and to make broad bandages to hold splints in place.

Folding a Triangular Bandage into a Broad or Narrow Bandage

1. Fold the tip of the triangle down to touch the base.
2. Fold the bandage in half lengthwise to make a broad bandage.
3. Fold it in half again to make a narrow bandage.

Specific Care Guidelines for Minor Open Wounds

In minor open wounds, such as abrasions, there is only a small amount of damage
and minimal bleeding.
To care for a minor open wound, follow these general guidelines:
 Use a barrier between your hand and the wound. If readily available, put on
disposable gloves and place a sterile dressing on the wound.
 Apply direct pressure for a few minutes to control any bleeding.
 Wash the wound thoroughly with soap and water. If possible, irrigate an
abrasion for about 5 minutes with clean, warm, running tap water.
 Apply an antibiotic ointment to a minor wound if the person has no known
allergies or sensitivities to the medication.

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 Cover the wound with a sterile dressing and a bandage or with an adhesive
bandage to keep the wound moist and prevent drying.

Specific Care Guidelines for Major Open Wounds

A major open wound has serious tissue damage and severe bleeding. To care for a
major open wound, you must act at once. Follow these steps:
 Put on disposable gloves. If you suspect that blood might splatter, you may
need to wear eye and face protection.
 Control bleeding by:
 Covering the wound with a dressing and firmly pressing against the wound
with a gloved hand until the bleeding stops.
 Applying a pressure bandage over the dressing to maintain pressure on the
wound and to hold the dressing in place. If blood soaks through the
bandage, do not remove the blood-soaked bandages. Instead, add more
dressings and bandages and apply additional direct pressure.
 Continue to monitor the person’s condition. Observe the person closely for
signals that may indicate that the person’s condition is worsening, such as
faster or slower breathing, changes in skin color and restlessness.
 Care for shock. Keep the person from getting chilled or overheated.
 Have the person rest comfortably and provide reassurance.
 Wash your hands immediately after giving care, even if you wore gloves.

Using Tourniquets When Help Is Delayed

A tourniquet is a tight band placed around an arm or leg to constrict blood vessels
in order to stop blood flow to a wound. Because of the potential for adverse
effects, a tourniquet should be used only as a last resort in cases of delayed care
or situations where response from emergency medical services (EMS) is delayed,
when direct pressure does not stop the bleeding or you are not able to apply
direct pressure.

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BURNS
Burns are a special kind of soft tissue injury. Like other types of soft tissue injury,
burns can damage the top layer of skin or the skin and the layers of fat, muscle and
bone beneath.
Burns are classified by their depth. The deeper the burn, the more severe it is. The
three classifications of burns are as follows: superficial (sometimes referred to as
first degree), partial thickness (sometimes referred to as second degree) and full
thickness (sometimes referred to as third degree). Burns also are classified by their
source: heat (thermal), chemical, electrical and radiation (such as from the sun).
A critical burn requires immediate medical attention. These burns are potentially
life threatening, disfiguring and disabling.

What to Look For

Signals of burns depend on whether the burn is superficial, partial thickness or full
thickness.
 Superficial burns:
 Involve only the top layer of skin.
 Cause skin to become red and dry, usually painful and the area may swell.
 Usually heal within a week without permanent scarring.
 Partial-thickness burns:
 Involve the top layers of skin.
 Cause skin to become red; usually painful; have blisters that may open and
weep clear fluid, making the skin appear wet; may appear mottled; and
often swells.
 Usually heal in 3 to 4 weeks and may scar.
 Full-thickness burns:
 May destroy all layers of skin and some or all of the underlying
structures—fat, muscles, bones and nerves.

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 The skin may be brown or black (charred), with the tissue underneath
sometimes appearing white, and can either be extremely painful or
relatively painless (if the burn destroys nerve endings).
 Healing may require medical assistance; scarring is likely.

What to Do
Call
You should always call EMS/9-1-1/044-791-0566 or the local emergency number if
the burned person has:
 Trouble breathing.
 Burns covering more than one body part or a large surface area.
 Suspected burns to the airway. Burns to the mouth and nose may be a sign of
this.
 Burns to the head, neck, hands, feet or genitals.
 A full-thickness burn and is younger than 5 years or older than 60 years.
 A burn caused by chemicals, explosions or electricity.

Care
Care given for burns depends on the type of burn.

Heat (Thermal) Burns

Follow these basic steps when caring for a heat burn:
 Check the scene for safety.
 Stop the burning by removing the person from the source of the burn.
 Check for life-threatening conditions.
 As soon as possible, cool the burn with large amounts of cold running water,
at least until pain is relieved.
 Cover the burn loosely with a sterile dressing.
 Take steps to minimize shock. Keep the person from getting chilled or
overheated.
 Comfort and reassure the person.

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 Do not apply ice or ice water to any burn. Ice and ice water can cause the body
to lose heat rapidly and further damages body tissues.
 Do not touch a burn with anything except a clean covering.
 Do not remove pieces of clothing that stick to the burned area.
 Do not try to clean a severe burn.
 Do not break blisters.
 Do not use any kind of ointment on a severe burn.

Chemical Burns
When caring for chemical burns it is important to remember that the chemical will
continue to burn as long as it is on the skin. You must remove the chemical from
the skin as quickly as possible. To do so, follow these steps:
 If the burn was caused by dry chemicals, brush off the chemicals using gloved
hands or a towel and remove any contaminated clothing before flushing with
tap water (under pressure). Be careful not to get the chemical on yourself or
on a different area of the person’s skin.
 Flush the burn with large amounts of cool running water. Continue flushing
the burn for at least 20 minutes or until EMS personnel take over.
 If an eye is burned by a chemical, flush the affected eye with water until EMS
personnel take over. Tilt the head so that the affected eye is lower than the
unaffected eye as you flush.
 If possible, have the person remove contaminated clothes to prevent further
contamination while you continue to flush the area.

Electrical Burns
If you encounter a person with an electrical burn, you should:
 Never go near the person until you are sure he or she is not still in contact
with the power source.
 Turn off the power at its source and care for any life-threatening conditions.
 Call EMS/9-1-1/044-791-0566 or the local emergency number. Any person
who has suffered an electrical shock needs to be evaluated by a medical
professional to determine the extent of injury.

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 Be aware that electrocution can cause cardiac and respiratory emergencies.

Therefore, be prepared to perform CPR or use an automated external
defibrillator (AED).
 Care for shock and thermal burns.
 Look for entry and exit wounds and give the appropriate care.
 Remember that anyone suffering from electric shock requires advanced
medical care.

Radiation Burns
Care for a radiation (sun) burn as you would for any thermal burn. Always cool the
burn and protect the area from further damage by keeping the person away from
the source of the burn.

Preventing Burns
 Heat burns can be prevented by following safety practices that prevent fire
and by being careful around sources of heat.
 Chemical burns can be prevented by following safety practices around all
chemicals and by following manufacturers’ guidelines when handling
chemicals.
 Electrical burns can be prevented by following safety practices around
electrical lines and equipment and by leaving outdoor areas when lightning
could strike.
 Sunburn can be prevented by wearing appropriate clothing and using
sunscreen. Sunscreen should have a sun protection factor (SPF) of at least 15.

SPECIAL SITUATIONS
Nosebleeds
Common Causes
Nosebleeds may be caused by the following:
 Forceful nose blowing
 High blood pressure
 Dry weather conditions

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 Trauma to the nose or head

 Bleeding disorders
If you know that the bleeding is caused by an object in the nose, refer to the care
for foreign objects in the nose.

Prevention
To prevent nosebleeds:
 Use a humidifier if the air indoors is dry.
 Wear protective athletic equipment when participating in sports that could
cause injuries to the nose.
 Practice gentle nose blowing.
 Teach children not to pick their noses.

What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number if the bleeding
continues for more than 15 minutes, the bleeding is the result of a head injury, or
the person is losing a large amount of blood.

Care
1. Have the person sit with the head slightly forward, pinching the nostrils, for 10
to 15 minutes. If the nosebleed was caused by a severe head injury, do not
pinch the nose.
2. Once you have controlled the bleeding, tell the person to avoid rubbing,
blowing, or picking his or her nose because this could start the bleeding again.
3. If the person loses responsiveness, place him or her in the recovery position to
allow blood to drain from the nose.

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Foreign Objects in the Nose

What to Look For
An object in the nose may be visible, and may also cause the following signs and
symptoms:
 Unusual noises when the person breathes through his or her nose
 Bleeding
 Nose deformity

What to Do
Care
1. If you can easily see and grasp the object, remove it.
2. If the object cannot be dislodged easily, leave it in place for a medical
professional to remove.
3. Prevent the person from attempting to remove the object and from blowing
his or her nose.

Knocked-Out Teeth
Common Causes
A tooth can be knocked out by any kind of blow that involves the mouth.

Prevention
The following tips may avoid an injury that results in knocked-out teeth:
 Wear appropriate equipment when playing sports, such as a mouth guard or
face mask.
 Always wear a seat belt while in the car and do not eat or drink in a moving
car.

What to Look For

Aside from a tooth that is visibly missing, signs and symptoms of knocked-out
teeth include the following:
 Bleeding (although this is often very minimal)
 Pain in the mouth
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What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number and get an AED if
the knocked-out tooth was caused by a forceful blow to the head, especially if the
person is unresponsive, or you suspect that there may be other more serious
injuries.

Care
1. Control any bleeding by having the person bite down on a clean dressing.
2. Carefully pick up the tooth by the crown (the whiter part), not the root.
3. Put the tooth in egg white, coconut water, whole milk, or saline, if available,
and keep it with the person. If none of these are available, wrap the tooth in
gauze (or a clean cloth) with some of the person’s own saliva. Seal the
container and label it with the name of the person, the date, and the time.
4. Get the person to a dentist as soon as possible. The greatest chance for repair
is during the first hour after the tooth is knocked out.

Eye Injuries
Eye injuries can have long-term consequences for a person’s vision, so they must
always be treated with extreme care. The eye is an extremely sensitive organ:
Avoid touching the eye or putting pressure on or around it, as this can cause
further damage. Wounds involving the eyelids or eye sockets should also be
treated as eye injuries.

Common Causes
An eye injury may be caused by the following:
 Foreign objects or particles in  Radiation or burns
the eye  Chemicals or other caustic materials
 An impact to the eye

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Prevention
The following may help to prevent an eye injury:
 Wearing appropriate equipment in the workplace (e.g., safety glasses)
 Wearing appropriate equipment when playing sports (e.g., wearing a helmet
with a visor or face protector when playing hockey)

What to Look For

An eye injury may include the following signs or symptoms:
 Pain and irritation in the eye  Problems with vision
 Redness of the eye  Watering of the eye
 Difficulty opening the eye  Deformities of the eye

What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number if there is an
impaled object in or near the eye, the eye is out of the socket, or the eye has been
exposed to a chemical or caustic substance.

Care
If an object is impaled in or around the eye:
1. Have the person lie on his or her back and keep as still as possible.
2. Stabilize the object with bulky dressings.
3. Cover both eyes with gauze or another light material.
4. Provide comfort and reassurance until EMS personnel arrive.
If there is a foreign object in the eye but it is not impaled:
1. Try to remove the foreign object by having the person blink several times. The
eye will produce tears that may wash out the object. An object that is not
touching the eye itself (e.g., in the corner of the eye) may be removed with a
moist cotton-tipped applicator.
2. Clean away any dirt around the eye and then gently flush the eye with running
water (letting the water run away from the unaffected eye).

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3. If these steps do not remove the object, the person should seek medical
attention.
If there is a chemical or other caustic substance in the eye:
1. Gently flush the eye with running water (away from the unaffected eye) for at
least 15 minutes, or until EMS personnel arrive.
If the eyes were flash burned (e.g., while welding):
1. Cover the eyes with a cool, wet cloth.
2. Make sure the person gets medical attention.

Ear Injuries
Prevention
The following tips can help prevent ear injuries:
 Wear proper protection when using loud equipment such as lawn mowers and
chainsaws.
 Wear a helmet and other recommended safety gear when participating in
sports and physical activities.
 Cover the ears when there is a risk of foreign objects or substances entering
the ear (e.g., wear a swim cap when participating in water activities).

Common Causes
An ear injury may be caused by the following:
 An impact to the head  Blast injuries
 Cuts or tears to the ear(s)  Foreign objects or substances in
 Loud noises the ear

What to Look For

Signs and symptoms of an ear injury include the following:
 Blood or other fluid coming from within the ear
 Hearing problems
 Sudden or intense pain in the ear
 Swelling or deformity of the ear

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What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number and get an AED if
there is blood or other fluid draining from the ear, or if the ear injury is the result
of an explosion or pressure (e.g., while scuba diving).

Care
1. If the injury is an external wound, treat it the same way you would treat a
wound on any other part of the body.
2. If there is a foreign object in the ear but you don’t suspect a head
and/or spinal injury, and it looks as if the object can be easily removed:
 Tilt the head to the affected side, then gently tap the ear to loosen
the object.
 Attempt to grasp the object and pull it out.

Bandaging Techniques
Triangular Bandage Elastic Bandage
1. Top of the Head 7. Arm or Leg 1. Circular
2. Chest or Back of Chest 8. Palm Bandage 2. Spiral
3. Hand or Foot 9. Sprained-Ankle 3. Figure of Eight
4. Forehead or Eye 10. Arm Sling
5. Ear, Cheek or Jaw 11. Underarm Sling
6. Shoulder

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CHAPTER IX
Head, Neck and Spinal Injuries
Traumatic events such as falling from a height, getting hit by a motor vehicle, or
sustaining a powerful blow to the head can cause head, neck, or spinal injuries.
Injuries to the head or spine can damage bones, such as the skull or vertebrae, and
tissues, such as the brain and the spinal cord. Head injuries are often accompanied
by spinal injuries, but a person with a superficial head wound may also have an
underlying head injury.

Common Causes
Many different situations can lead to head, neck, or spinal injuries:
 Motor vehicle collisions
 Recreation and sports injuries
 Falls
 Blow to the head or back
 Violent acts, such as assault
You should suspect a head, neck, and/or spinal injury in the following situations:
 A fall from any height greater than the height of the person
 Any diving injury (e.g., diving head-first into shallow water)
 A person found unresponsive for unknown reasons
 Any injury that involves a strong blow to the lower jaw, head, or torso (e.g.,
colliding with another participant while playing a sport)
 Any injury that causes a wound in the head or torso
 A motor vehicle collision or rollover
 Any injury in which a person’s helmet is damaged
 A person has been struck by lightning
 A person has been electrocuted

Prevention
The following tips help to prevent head, neck, and spinal injuries:
 Wear safety belts with shoulder restraints when in a vehicle.
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 Children and babies should always ride in approved safety seats. Make sure
the seat is designed for the child’s age and weight and make sure it is properly
installed.
 Wear all recommended protective equipment for the activity you are engaged
in (e.g., approved bicycle helmets).
 Never join in a new sport without knowing the rules and risks involved.
 Prevent falls around the home and workplace with non-slip floors, non-slip
treads on stairs, handrails on staircases, rugs secured with double-sided
adhesive tape, and handrails by the bathtub and toilet if necessary.
 Make sure that there is good lighting in stairways and hallways.
 If there are small children present, put gates at the top and bottom of the
stairways.
 Make sure that your workplace is clean and tidy. Keep floors and aisles
uncluttered and make sure that there is nothing blocking stairways, work sites,
or exits.
 Drink responsibly. Alcohol is often a factor in serious motor vehicle collisions
and water injuries. Alcohol slows down your reflexes and gives you a false
feeling of confidence.
 Prescription drugs and common drugstore medications can make driving or
operating machinery dangerous, so follow the directions on the package
carefully.
 Check equipment (such as warehouse forklifts, ladders, and scaffolding)
regularly for worn or loose parts.
 Use ladders carefully and correctly.
 Always be very careful around water:
 Before diving, make sure that the water is deep enough, and check for
objects below the surface, such as logs or pilings. Pools at homes, motels, or
hotels may not be safe for diving.
 Enter unknown water feet first.
 Enter above-ground pools feet first.
 When bodysurfing, keep your arms out in front of you to protect your head
and neck.

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What to Look For

The following signs and symptoms alone do not always indicate a serious head,
neck, or spinal injury, but you should call EMS/9-1-1/044-791-0566 if any of these
are present:
 Changes in level of responsiveness, awareness, and behavior
 Drowsiness, confusion, or disorientation
 Severe pain or pressure in the head, neck, or back
 Blood or other fluids in the ears or nose
 Heavy external bleeding from the head, neck, or back
 Unusual bumps, bruises, or depressions on the head, neck, or back
 Seizures
 Impaired breathing or vision
 Nausea or vomiting
 Unequal pupil size
 Persistent headache
 Partial or complete loss of movement of any body part without an obvious
traumatic cause (e.g., inability to move a limb that does not appear to be
injured)
 Back pain, weakness, tingling, or loss of sensation in the hands, fingers, feet,
or toes
 Unusually positioned neck or back
 Dizziness and/or loss of balance
 Bruising of the head, especially around the eyes and behind the ears
 Loss of bladder or bowel control
 Behavior similar to that of a person under the influence of alcohol or drugs
(e.g., stumbling, memory loss, speech problems)

What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number and get an AED.

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Care
1. Restrict movement of the head, neck, and spine as much as you can until EMS
personnel arrive:
 If the person is responsive, instruct him or her to keep as still as possible. If
the person is unable to do so, manually support the head in a position that
limits movement.
 If the person is unresponsive and breathing, manually support the person’s
head in the position found.
2. Keep the person in the position he or she was found, unless the person is in
immediate danger or has life-threatening conditions that need immediate
attention.
3. If blood or other fluid is in the ear canal or draining from the ear:
 Let the ear drain. Do not apply direct pressure. Do not move the person
unless it is absolutely necessary.
 Cover the ear loosely with a sterile dressing.

When to Move a Person with a Head, Neck, or Spinal Injury

You may need to move a person with a head, neck, and/or spinal injury in the
following situations:
 The person’s airway is blocked (for example, if the person vomits)
 The scene of the emergency becomes dangerous
 There is no organized EMS response in the region (for example, if the injury
occurs in a very remote area)

Concussion
A concussion is a subset of traumatic brain injuries (TBI) that involve a temporary
alteration in brain function.

Common Causes
A concussion may be caused by:
 A blunt force to the head or jaw
 An explosion
 Whiplash
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 A forceful blow to the body

 Shaking (in the case of a baby)

SIGNS AND SYMPTOMS OF A CONCUSSION

Thinking and
Physical Emotional Sleep
Remembering
 Confusion  Neck pain, headache, or  Irritability  Drowsiness
 Clouded or foggy pressure within the head  Sadness or  Sleeping
mindset  Fatigue, low energy, or feeling depression more or less
 Seeming stunned "foggy"  Heightened than usual
or dazed  Short-term loss of emotions  Difficulty
 Temporary responsiveness  Nervousness sleeping
memory loss  Dizziness or loss of balance or anxiety
regarding the  Double or blurred vision, or  Personality
event of the "seeing stars" changes
injury  Ringing in the ears
 Difficulty  Nausea or vomiting
concentrating  Mumbled or indistinct speech
 Difficulty  Sensitivity to light and/or
remembering or noise
recalling events  Not feeling “right”
 Slowed reaction  Seizure or convulsion
times

Concussion Signs and Symptoms in Children and Babies

The child or baby may exhibit the following signs, which are more specific to this
age group:
 Disturbed sleeping and eating patterns
 Excessive crying
 Disinterest in activities or favorite toys
Children may also express simply "feeling off" or "not feeling right" following a
physical impact. This is also a possible symptom of a concussion.

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What to Do
Call
Call EMS/9-1-1/044-791-0566 or the local emergency number and get an AED if
the person has the following more severe signs and symptoms of a concussion:
 Repeated or projectile vomiting
 Loss of responsiveness of any duration
 Lack of physical coordination (e.g., stumbling and unusual clumsiness)
 Confusion, disorientation, or memory loss
 Changes to normal speech
 Seizures
 Vision and ocular changes (e.g., double vision, dilated pupils, or unequal pupil
size)
 Persistent dizziness or loss of balance
 Weakness or tingling in the arms or legs
 Severe or increasing headache

Care
1. If you think a person has sustained a concussion, advise the person to stop the
activity he or she was engaged in when the incident occurred.
2. If the person sustains an injury that causes a jolt or blow to the head or body,
and then displays any signs and symptoms of a concussion, you should assume
that a concussion has occurred.
3. The person should follow up with a qualified healthcare provider as soon as
possible for a full evaluation.

Myth-Information
Myth: A person with a concussion who falls asleep could die.
It is generally considered safe for a person with a concussion to go to sleep.
However, the person’s healthcare provider may recommend that you wake the
person periodically to make sure that his or her condition has not worsened.

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Shaken Baby Syndrome

Shaken Baby Syndrome (SBS) refers to a variety of injuries that may result when a
baby or a young child is violently shaken. This causes the brain to move within the
skull, forcing blood vessels to stretch and tear.

What to Look For

While there may be no visible physical signs of injury, some signs of SBS include
the following:
 Unexplained injuries (e.g., bruising or broken bones, especially skull, rib, and
long-bone fractures)
 Bruising, usually in or around the eyes or mid-body area
 Bleeding or clear fluid coming from the ears and/or nose
 Minor neurological problems (e.g., irritability, lethargy, tremors, and vomiting)
 Major neurological problems (e.g., seizures, unresponsiveness, and death)

What to Do
Call
If you suspect a baby has SBS, Call EMS/9-1-1/044-791-0566 or the local
emergency number.

Care
Treat any injuries you find. Avoid accusations and interrogation.

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CHAPTER X
Bone, Joint and Muscle Injuries
Bones, muscles, and joints have many jobs:
 Supporting the body
 Protecting internal organs
 Allowing movement
 Storing minerals
 Producing blood cells
 Producing heat through movement

There are four basic types of bone, muscle, and joint injuries:
 Sprain: Occurs when a ligament is stretched, torn, or damaged.
 Strain: Occurs when a tendon or muscle is stretched, torn, or damaged.
 Dislocation: Occurs when the bones that meet at a joint move out of their
normal position.
 Fracture: A complete break, chip, or crack in a bone.

Muscle Cramps
A muscle cramp is a painful condition that can be caused by heavy exercise or
staying in the same position for too long. You can usually stop the pain by
stretching and massaging the area with the cramp, resting, or changing position.

Common Causes
Bone, muscle, and joint injuries can occur in many ways. The causes include the
following:
 Falls
 Awkward or sudden movements
 Direct blows to the body
 Repetitive actions or forces, such as jogging

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Prevention
The following tips help prevent bone, muscle, and joint injuries:
 Always wear seat belts and shoulder restraints when in a vehicle, and ensure
that all passengers do the same.
 Secure younger children in approved and properly installed child-restraint
systems (e.g., car seats and booster seats).
 Wear all safety equipment that is required or recommended (e.g., helmets,
goggles, and pads).
 Put non-slip adhesive strips or a mat in the bathtub and shower stall.
 Stretch before exercising.
 Avoid over-exertion and take breaks often. Children should learn their limits
and rest when they are too tired or frustrated to continue safely.
Falls are the leading cause of injuries among the elderly. Reduce the risk with
safety measures such as:
 Good lighting.
 Sturdy railings on staircases.
 Non-slip floors and rugs.

What to Look For

The signs and symptoms of bone, muscle, and joint injuries may include the
following:
 Pain, deformity, swelling, or bruising
 Limited or no use of the injured body part
 A broken bone or bone fragments sticking out of the skin
 A sensation or sound of bones grating
 Possible muscle cramps
 The sound of a snap or a pop when the injury happened

What to Do
The person may be anxious and in a lot of pain. In most cases, the best thing that
you can do is keep the person comfortable and prevent further injury until the

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person receives medical attention. To avoid damaging nerves, blood vessels, and
tissues, do not perform traction or any other manipulation.
When caring for an open fracture, your first priority is to stop any bleeding.
Provide care as you would for any other open wound.

Call
Bone, muscle, and joint injuries range from very minor to life-threatening, so you
must determine whether there is a need to Call EMS/9-1-1/044-791-0566 or the
local emergency number. In general, if the injury seems severe or the person is in a
significant amount of pain, you should call.
You should always call EMS/9-1-1/044-791-0566 and get an AED if:
 There is a problem with the ABCs.
 The injury involves the head and/or spine.
 You suspect that there may be multiple injuries.
 There are injuries to the thigh bone or pelvis.
 The area below the injury is pale, blue, or cold to the touch.
 The area below the injury is numb.
 The person has an altered level of responsiveness.
 A broken bone is protruding through the skin.
 It is not possible to safely or comfortably move the person to a vehicle for
transport to a healthcare facility.

Care
Treat the injury using the RICE method:
REST — Have the person stop any current activities and rest without
R moving or straightening the injured body part.
IMMOBILIZE — If you need to move the person or if EMS response will
be delayed, immobilize the injured area in the position in which it was
I found by creating a splint. Otherwise keep the person still and do not
splint the injury.

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COOL — If it does not cause the person any discomfort, cool the injured
area for 20 minutes of every hour to reduce swelling and pain. The part
should be cooled for 20 minutes of every hour for up to 48 hours. Do
C not rub the ice or cold pack on the injured area. If you use ice, put some
sort of thin, dry cloth or pad between it and the person’s bare skin to
avoid freezing the skin.
ELEVATE — Keep the injured area above the level of the heart, if
E possible. However, do not raise the injured area if moving it will cause
pain.

Splinting Guidelines
Splinting involves securing an injured bone or joint to keep it from moving, which
reduces the risk of further injury and helps reduce pain. However, you should
apply a splint only if you must move a person to get medical help or if the EMS
response will be delayed.

There are four types of splint:

 Soft splints are soft, bulky objects (e.g., a folded blanket, towel, pillow, or
bandage).
 Rigid splints are hard, fixed objects (e.g., a board, a rolled newspaper, a tree
branch).
 Anatomical splints use another body part for support (e.g., immobilize an
injured leg by securing it to the uninjured leg).
 Slings use cloth looped around the neck to support an upper extremity (e.g., the
arm or wrist).

Applying a Splint
No matter what type of splint you use, follow these steps:
 Check the temperature and color of the skin below the injured area before
and after splinting. The area should be warm, indicating good circulation.
 If the area is cold before splinting, call EMS/9-1-1/044-791-0566 or the
local emergency number if you have not already done so.

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 If the area is warm before splinting and cold afterwards, the splint may be
too tight. Loosen it gently, and reassess to see if circulation has been
restored.
 When possible, splint the injured part in the position in which it was found. Do
not try to straighten or move the body part.
 Make sure the splint is long enough to extend above and below the injured
area:
 For bone injuries, immobilize the joint above and below the site of the
injury.
 For joint injuries, immobilize the bones above and below the site of the
injury.
 If you are not sure what is injured, include both the bones and the joints
above and below the injured area in the splint.
 Always pad a rigid or anatomical splint to make the person more comfortable.
 Remove any jewelry (especially rings) that the person is wearing below the
site of the injury, as swelling is likely to occur.

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CHAPTER XI
Special Situations and Circumstances
In an emergency, it is helpful to be aware of any unique needs and considerations
of the person involved. For example, children, older adults, persons with
disabilities and persons who speak a different language than your own have
special needs and considerations that affect the care you give. In some
emergencies, special circumstances, such as an emergency childbirth or a hostile
situation, create additional challenges.

Childbirth
Childbirth is a natural process and the woman’s body knows what to do; your
primary role will be to provide comfort and reassurance and to facilitate the
process while you wait for EMS personnel to arrive. The labor and delivery process
will happen without much intervention on your part. Remember, the woman who
is pregnant delivers the baby. Be patient and let the birth happen naturally.

What to Look For

Signs and symptoms that signal imminent childbirth include the following:
 Contractions that are 2 minutes apart or less
 The woman says that the baby is coming
 The woman feels the urge to push
 The woman feels like she needs to have a bowel movement
 The baby is crowning

What to Do
Call
Have someone call EMS/9-1-1/044-791-0566 or the local emergency number, if
birth is imminent.

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Care
1. Clear the area of unnecessary bystanders.
2. Help the woman into a position of comfort.
3. Create a clean birthing area by placing clean blankets and/or towels under the
woman. For the sake of privacy, place a clean sheet or towel over the
woman’s abdomen.
4. As the baby is being birthed:
 Support the head as it is delivered. Do not push or pull the baby.
 Once the shoulders emerge, the rest of the baby will be delivered very
quickly.
 Newborns are slippery, so hold the baby firmly but do not squeeze him or
her.
5. Position the baby face-down and wipe any fluids or mucus away from his or
her mouth and nose.
6. Check the baby’s airway and breathing. Babies may not breathe and cry
immediately after they are born. Usually, actively drying them with a towel will
stimulate them to breathe and cry. If the baby does not begin to breathe or
cry following stimulation, begin CPR.
7. Keep the baby warm by placing him or her directly onto the mother’s chest
and covering with a blanket or towel, or by wrapping the baby in a clean towel
or blanket.
8. Let the placenta and cord drop onto a clean towel and keep this near the baby.
Do not cut the cord. Handle the placenta and cord as little as possible.
9. Record the time of birth.
10. If the mother is bleeding, you may need to apply gentle pressure to any
bleeding tears.
11. Provide continual care for both the mother and the baby until EMS personnel
arrive.

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Assisting with Childbirth: What Not to Do

When providing care for a woman during childbirth:
 Do not let the woman leave to use the restroom. (The woman could deliver
the baby into the toilet, putting the baby at risk for injury.)
 Do not try to physically delay delivery, as this can cause serious injuries to
both the mother and the baby.
 Do not place your fingers in the woman’s vagina for any reason. This can
introduce pathogens that can cause an infection.
 Do not pull on the baby.

Miscarriage
Miscarriage is the spontaneous end of a pregnancy any time during the first 20
weeks after conception. This occurs in about 1 in 10 pregnancies. The risk of
miscarriage drops as the pregnancy progresses.

Common Causes
There are a number of causes of miscarriage, including the following:
 Hormonal or genetic complications
 Abnormalities in the womb
 Infection and certain illnesses
 Trauma

What to Look For

The signs and symptoms of a miscarriage include the following:
 Anxiety and apprehensiveness
 Vaginal bleeding, which may be minor or profuse
 Cramp-like pain that is similar to labor or menstruation

What to Do
Call
Have someone call EMS/9-1-1/044-791-0566 or the local emergency number.

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Care
1. If possible, save any tissue from the miscarriage for EMS personnel.
2. Provide comfort and continual care until EMS personnel arrive.

Providing First Aid for Someone with a Disability

It is not uncommon to feel intimidated when providing first aid to a person who
has different abilities, because there is often uncertainty about how to care for the
person.

General Tips for Providing First Aid to a Person with a Disability

Remember the following tips when providing care for a person with any type of
disability:
 As with all first aid, you need permission to help and should explain what you
intend to do. These basic principles do not change because the person has
different abilities.
 Avoid stereotypes and make no assumptions about what abilities the person
has or does not have. Remember that not all disabilities are visible.
 Be confident and reassuring.
 If you cannot understand what the person is saying, politely ask him or her to
repeat it.
 Don’t touch or speak to service animals. They are working and have to pay
attention at all times.
 Get permission before touching assistive devices, including wheelchairs.

Providing First Aid for Someone with Vision Loss

Examples of vision loss include tunnel vision (where a person cannot see objects to
the side), lack of central vision, and total blindness, in which the person receives
no visual information from the world around them. Most people with vision loss
still have some degree of sight.
Keep the following in mind when providing first aid to an individual with vision
loss:
 If you need to leave the person, let him or her know that you are leaving and
will be back.
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 Narrate your actions so that the person can follow what you are doing.
 If you’re unsure about how to provide directions, simply ask the person how
he or she would like you to do so.

Providing First Aid for Someone with Hearing Loss

Keep the following points in mind when providing first aid to an individual with any
type of hearing loss:
 Get the person’s attention before speaking. The best way to do this is usually
by lightly touching the person’s shoulder or gently waving your hand.
 Ask the person how you can help. Don’t shout.
 If communication is difficult, ask if the person prefers to communicate in
another way, such as using a pen and paper.
 Be patient if you are using a pen and paper to communicate. Philippine Sign
Language may be the person’s first language and it has its own grammatical
rules and sentence structure.
 If the person uses a hearing aid and you are having trouble communicating,
minimize background noise or move to a quieter area, if possible.

Providing First Aid for Someone Who Is Deafblind

"Deafblind" describes people who have some degree of both vision and hearing
loss. Many people who are deafblind are accompanied by an intervenor (a
professional who helps with communication). If an intervenor is accompanying the
person, tell him or her who you are, but then speak directly to the ill or injured
person. Don’t touch the person abruptly and don’t touch the person without
permission.

Providing First Aid for Someone with a Physical Disability

There are many different types of physical disability, and not all of them are
visible. The important thing is not to diagnose the person: what matters is
determining whether the conditions you encounter are pre-existing or whether
they are signs of the injury or illness you are providing care for.

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Keep the following tips in mind when providing first aid to an individual with a
physical disability:
 Speak naturally to the person (physical and mental disabilities are not the
same thing).
 Adjust your position if necessary so that you can make eye contact with the
person while providing care.

Providing First Aid for Someone with an Intellectual or a

Developmental Disability
It may not be apparent that a person has an intellectual or developmental
disability unless this fact is communicated to you.
Keep the following points in mind when providing first aid to an individual with an
intellectual or a developmental disability:
 As much as possible, interact with the person as you would with anyone else
in the same situation.
 Use straightforward language when communicating.
 Give one piece of information at a time.

Providing First Aid for Someone with a Speech or Language Impairment

Speech and language impairments may affect a person’s ability to communicate
verbally, with written language or both. Assistive devices such as communication
boards are often used by individuals with severe speech or language impairments.
Keep the following tips in mind when providing first aid to an individual with a
speech or language impairment:
 If possible, ask questions that can be answered with "Yes" or "No."
 Give the person time to communicate and answer your questions.
 Wait for the person to finish speaking and do not try to finish his or her
sentences.

CRIME SCENES AND HOSTILE SITUATIONS

In certain situations, such as a giving care to a person in a crime scene or an
injured person who is hostile, you will need to use extreme caution.

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 Do not enter the scene of a suicide.

 If you happen to be on the scene when an unarmed person threatens suicide,
call EMS/9-1-1/044-791-0566 or the local emergency number.
 Do not argue with the person. Remain at a safe distance.
 Leave or avoid entering any area considered to be a crime scene, such as one
where there is a weapon, or the scene of a physical or sexual assault. Call
EMS/9-1-1/044-791-0566 or the local emergency number and stay at a safe
distance.
 A person’s rage or hostility may be caused by the injury, pain or fear.
 If a person refuses your care or threatens you, remove yourself from the
situation and stay at a safe distance. Never argue with or restrain an injured or
ill person. Call EMS/9-1-1/044-791-0566 or the local emergency number if
someone has not already done so. Never put your own safety at risk.
 Uninjured family members also may display anger. Try to remain calm and
explain what you plan to do in giving emergency care. If possible, find a way
that family members can help, such as by comforting the person.

Moving an Ill or Injured Person

Generally speaking, you should avoid moving an injured or ill person to give care.
Unnecessary movement can cause additional injury and pain and may complicate
the person’s recovery.
Three general situations require you to move a person:
1. There is an immediate danger (either a danger to you or to the person being
rescued).
2. You have difficulty accessing ill or injured people.
3. There is a barrier that makes it difficult to provide proper care.
Before you act, you must consider the limitations of the situation. Considering the
following factors will help you ensure that you move a person quickly and safely:
 Dangerous conditions at the scene
 The size of the person
 Your own physical ability
 Whether others can assist you
 The person’s condition
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To protect yourself and the ill or injured person, follow these guidelines when
moving someone:
 Attempt to move a person only when you are sure you can comfortably
handle the rescue.
 Walk carefully, using short steps.
 Walk forward with the person, instead of backward, wherever possible.
 Always take the shortest, most direct route to your destination, as long as it is
safe.
 Scan the pathway you want to use before moving so that you can identify
potential hazards (such as slip hazards or poor lighting).

Body Mechanics
To reduce the risk of personal injury, everyone involved in a lift or carry should use
proper body mechanics (also called “biomechanics”). The basic principles of body
mechanics that can be used for all lifts and moves include the following:
 Use your legs, not your back, to lift. When lifting, use the muscles of your legs,
hips, buttocks, and abdomen. Never use the muscles of your back to move or
lift a heavy load.
 Keep the weight as close to you as possible. Reduce the distance you have to
reach.
 Keep your body aligned. Imagine a straight line running from your shoulders
through your hips and d own to your feet, and then move them as a unit. This
will reduce twisting forces.
 Reduce the height or distance you need to move a weight and lift in stages, if
necessary.
 Keep your wrists and knees in normal alignment.

How to Move an Ill or Injured Person

There are many different ways to move someone to safety. The move is successful
as long as you can move the person without injuring yourself, causing further
injury to the person, or taking unnecessary risks.

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Emergency Moves
When there is a potential for danger, use an emergency move to drag or pull a
patient to a safe place before assessment and care are provided. The risk of
serious harm of death due to fire, explosives, or hazardous materials, your inability
to protect the patient from other hazards, or your inability to gain access to others
in a vehicle who need lifesaving care are all situations in which you should use an
emergency move.

Urgent Moves
An urgent move may be necessary to move a patient with an altered level of
consciousness, inadequate ventilation, or shock.

Non-Urgent Moves
When both the scene and the patient are stable, carefully plan how to move the
patient. If your patient move is rushed or poorly planned, it may result in
discomfort or injury to the patient, you and/or your team.

Assists, carries, and drags are the different ways you can safely move an injured
person. The most common of these moves include the following:
 Walking Assist  Extremity Carry
(One or Two-man)  Two-person Seat Carry
 Armpit or Clothes drag (Swing Carry)
 Cradle Carry  Hammock Carry
 Pack-strap Carry  Blanket Drag
 Firefighter’s Carry  Blanket Carry

Stretchers and Lifting Devices

There are many kinds of stretchers and lifting devices. The more common types
are:
 Commercial stretcher  Scoop stretcher (clamshell)
 Improvised stretcher  Backboard
Any of these lifting devices will carry a person’s entire body.

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