Download Course Workbook - First Aid Institute Australia

Pre-Course Workbook
Provide First Aid
Melbourne Training Centre
Level 6 | 250 Collins Street Melbourne 3000 Victoria | T 03 9639 5551 | F 03 9639 5600 | Email: [email protected]
Sydney Training Centre
Level 6 | 770 George Street Sydney 2000 NSW | T 02 9281 4111 | F 02 9281 4110 | Email: info@ faa.edu.au
Parramatta Training Centre
Level 2 | 11 Aird Street Parramatta 2150 NSW | T 02 9281 4111 | F 02 9281 4110 | Email: info@ faa.edu.au
Chatswood Training Centre
Level 2 | 1 Railway Road Chatswood 2057 NSW | T 02 9281 4111 | F 02 9281 4110 | Email: info@ faa.edu.au
©2013 First Aid Institute of Australia. All rights reserved.
No part of this publication may be reproduced, repackaged, stored in a retrieval system or
transmitted in any form or by any means whatsoever without the prior written permission of
the copyright owner.
This resource was produced by Rory Barns, Steve Roussac and
Bart Arundell and published by First Aid Institute of Australia:
Level 6, 250 Collins Street
Melbourne 3000 Victoria
Telephone: 03 9639 5551
Facsimile: 03 9639 5600
Email: [email protected]
Internet: www.faa.edu.au
The information presented in this publication is intended only for use in teaching and
assessment activities conducted by First Aid Institute of Australia. The use of this
publication or reference to this publication in any other context or circumstances is strictly
prohibited.
Every effort has been made to ensure that the information contained in this publication is
free from error or omission. However, you should conduct your own enquiries and seek
professional advice before relying on any fact, statement or matter contained in this
publication. First Aid Institute of Australia is not responsible for any injury, loss or damage
that may result from the application of the material included or omitted from this
publication.
The information presented in this resource is current at the time of publication, and may be
subject to change from time to time.
This Document: Apply First Aid Pre-Course Workbook V2014.02
2
Apply First Aid
Table of Contents
A Message from the Authors
4
First Aid Starts Here
5
Definition and Principals of First Aid
Responsibilities of a First Aider
Basic Care
5
5
7
The Recovery Position
7
Managing the Airway
8
Cardiopulmonary Resuscitation (CPR)
11
The Basic Life Support Chart
13
Bleeding
14
Amputation
15
Angina
16
What is the relationship between Angina and a Heart attack? 16
Diabetes
17
Choking
18
Allergies and Anaphylaxis
19
Asthma
20
Fractures
20
Stroke
21
Seizures
22
Fainting
24
Head Injuries
25
Burns
27
Bites and Stings
27
Exposure
28
HLTAID003 Provide first aid
Bibliography
First Aid Institute of Australia | www.faa.edu.au
30
30
3
A Message from the Authors
A
t First Aid Institute of Australia, we believe that learning to Apply First Aid is one of the most important and
selfless life skills that anyone can gain. As a parent or carer, work colleague, classmate, family member,
partner or friend; you have chosen to do something that prioritises the welfare of others with no
measurable or immediate benefit to yourself. The only people who will be rewarded by your decision to learn
first aid are those who may one day come to rely on you in an emergency. So we think your decision to do this
course should be applauded, and you should somehow be rewarded for the selflessness you have
demonstrated.
It’s not much, we know; but the best we could concoct as a reward was an informative, challenging, and fun first
aid course for you to complete. It’s made up of an online component of self-paced study and assessment, as
well as a practical component in the classroom with a qualified instructor and others who, like you, might be a
little nervous about the prospect of maybe saving a life one day. It’s serious business for sure, but there’s no
reason why it can’t be rewarding and enjoyable along the way, which is what we hope it turns out to be.
Oh, and we hope the qualification you gain fills you with a sense of accomplishment; and that it takes pride of
place somewhere on your living room wall!
We also hope that throughout the course you ask lots of questions, share your thoughts, and a joke or two if you
have some – especially if some of the content does get a little heavy on the detail. Remember, the best First
Aiders are the ones who act right away, and not always the ones who act the right way. Nobody expects you to
learn all the minute details – so relax and enjoy yourself while you try.
The course itself covers all of the requirements for the following industry competency standards –
+ HLTAID001 Provide cardiopulmonary resuscitation;
+ HLTAID002 Provide basic emergency life support; and
+ HLTAID003 Provide first aid.
Those that successfully complete the course and relevant assessments will receive a nationally recognised
Statement of Results and a Level 2 (Senior) First Aid qualification.
Don’t forget though, that learning about first aid is a little like bathing – if you do it only once, soon you’ll start to
stink! It’s important that you update your skills and qualifications regularly to ensure that both are current, and
to build your confidence in preparation for the time when you may need to put your skills to work. So in
accordance with the Australian Resuscitation Council guidelines, the qualification you receive will expire in three
(3) years time, and it is recommended that you refresh your CPR qualifications every twelve (12) months.
And of course, we hope you don’t leave it quite so long, between baths.
So congratulations on your decision to attend this course and to gain the skills and qualifications you need in
first aid. In all sincerity, we trust that you will learn some valuable skills, and we hope they NEVER come in
handy!
Bart Arundell, Rory Barns and Steve Roussac
First Aid Institute of Australia
4
Apply First Aid
First Aid Starts Here
Definition and Principals of First Aid
Throughout this course, First Aid Institute of Australia uses the term first aid to mean;
‘The initial care given to an ill or injured person until more qualified medical treatment can be provided’
A First Aider is defined to be:
‘A person who has undertaken a recognised course of study into the provision of first aid, and who
chooses to Apply First Aid assistance to others’
The 5 P’s or Principles of first aid are to:
+ Preserve life;
+ Protect the unconscious casualty;
+ Prevent further injury;
+ Promote recovery; and
+ Practise a safe environment at all times.
Fundamentally, the principles of first aid are the same principles applied to all forms of Hippocratic medicine
and healing. Two general principals apply –
+ Do no harm: Do not do anything that will further harm the casualty and do not put yourself in danger; and
Rest the part: Any diseased or injured body part will begin to recover or will not get worse if it is made
still or let to rest.
Responsibilities of a First Aider
A First Aider should:
+ Assess the situation;
+ Ensure safety;
+ Identify the injury or illness;
+ Manage the patient;
+ Organise others;
+ Get help; and
+ Gather information and keep records.
Each of these responsibilities is explained in more detail below.
Assess the situation
When faced with a first aid emergency, avoid the temptation to ‘rush in’ and help others in need. Instead, an
effective First Aider will always STOP; LOOK; and LISTEN; and will quickly but thoroughly assess a situation
before attempting to assist others.
Where a situation is thought to be unsafe, an effective First Aider will immediately get more qualified emergency
assistance.
First Aid Institute of Australia | www.faa.edu.au
5
Ensure safety
As a First Aider, your personal health and safety must be your highest priority. Only then should you act to
prevent further danger to the casualty and other bystanders, and only if it safe to do so.
If safe, a First Aider must, at the very least, prevent the patient's condition becoming worse.
Identify the injury or illness
Using observational techniques learned through first aid training, an effective First Aider will attempt to
accurately identify the nature of an injury or illness. The observations and information gathered will then assist
emergency services when they arrive, but also to determine the most appropriate first aid assistance to apply, in
accordance with the training the First Aider has received.
Manage the patient
An effective First Aider will use the skills they learned in their first aid training to apply techniques intended to
stabilise the casualty in preparation for the arrival of more qualified emergency medical assistance.
Organise others
An effective First Aider will enlist the assistance and support of bystanders in an emergency. Teamwork
increases the likelihood of a successful outcome. But remember:
+ Many will be willing to assist, but some may not. It is best to ask for help and give clear and confident
instructions if you want others to cooperate with you.
+ Do not threaten or become aggressive with those that do not comply with your instructions. Confrontation
with bystanders could make the situation worse.
+ For the safety and wellbeing of all present, the First Aider should remain calm and assertive
Get help Telephone Triple Zero (000) from a landline or mobile telephone for emergency service assistance.
Triple Zero is the primary national emergency service dispatch service in Australia. Triple Zero (000) works
from both landline and mobile telephones.
6
Apply First Aid
Basic Care
Basic Life Support
Regardless of the type of incident, injury or illness you attend, your immediate first aid response should always
be to follow the procedure for providing Basic Life Support. The Basic Life Support procedure prioritises the
preservation of life above other factors that a First Aider may confront in a first aid emergency.
The Basic Life Support procedure is most commonly explained and remembered by the use of the acronym DRS
ABCD, where:
D is for Danger;
R is for Response;
S is for Send for Help;
A is for Airway;
B is for Breathing;
C is for CPR; and
D is for Defibrillator.
An effective First Aider is someone who knows and understands the importance of each stage of the Basic Life
Support procedure, including the use of a variety of first aid techniques such as:
+ The Recovery Position;
+ Managing the Airway;
+ Rescue Breathing;
+ Cardiopulmonary Resuscitation (CPR); and
+ The Automated External Defibrillator (AED).
Before we explore the application of the Basic Life Support procedure and DRS ABCD in detail, we must first
learn more about these basic first aid techniques.
The Recovery Position
If a casualty is in a safe location, and they are conscious and breathing, the best any First Aider can do is ensure
that the casualty stays safe and comfortable until more qualified help arrives.
If the casualty is unconscious however, it is generally accepted that the Recovery Position is the position that
best minimises the potential for airway or breathing complications to arise.
To move someone into the Recovery Position:
+ Kneel beside the casualty, lay their nearest arm out on the ground at right angles to their body;
+ Raise the casualty’s far leg so that their ankle meets the knee of their near leg and the raised knee is at a
right angle to their body;
+ Lay their far arm across their body so that the hand rests on their shoulder nearest to you;
First Aid Institute of Australia | www.faa.edu.au
7
Figure 1: Prepare the casualty for the Recovery Position
+ Roll the casualty toward you by placing one hand on their raised knee and the other on their far shoulder
and pulling both toward you simultaneously to avoid twisting the alignment of their back.
+ Once on their side, reposition the casualty so they will not fall onto their front, and tilt their head back
allowing fluid to drain freely from their mouth.
+ Continue to monitor any casualty that is lying in the recovery position to ensure they continue to breathe
normally, and to ensure they don’t roll on to their front or back.
+ If the casualty stops breathing the priority is to roll them onto their back quickly and safely.
+ When there is more than one person helping to roll the casualty, care should be taken to ensure the head
and body move at the same time, meaning there is no bending or twisting of the neck or back.
Figure 2: Roll the casualty toward you
Managing the Airway
When people are unconscious they lose their ‘gag reflex’ – the reflex that triggers coughing and swallowing. If
the gag reflex is compromised, it could obstruct the airway and cause the casualty to stop breathing altogether.
An obstructed airway can lead to other complications, and can be life threatening.
Normal breathing usually involves a controlled and rhythmic intake and exhaling of breath. If a casualty is
unresponsive and their breathing appears abnormal, some attempt to open the airway should be made, or
resuscitation provided.
At times however, it can be difficult to determine if someone is breathing normally. For example: witnessing
abnormal gasping (or agonal gasps) after a cardiac arrest or the isolated movements of the upper abdomen
(lower chest) when no air is accessing the lungs can be mistaken for normal breathing. To avoid deception, an
effective First Aider will look for a combination of responsiveness, movement and breaths to determine if a
casualty is or is not breathing normally.
The management of an unconscious casualty’s airway takes priority over any other injury they may have
sustained, including the possibility of a spinal injury. Do not hesitate to try to clear an obstructed airway.
8
Apply First Aid
The ‘Head Tilt and Chin Lift’
The airway extends from the mouth and nostrils down the throat to the lungs. When a casualty is unconscious
and lying awkwardly or on their back, there is an increased likelihood that the airway can become blocked by
the tongue or other objects in the mouth (ref. Figure 8).
Figure 3: The weight of the tongue or other obstructions in the mouth can block the airway of an unconscious casualty.
To open the airway, apply a ‘chin lift’ and ‘head tilt’:
+ form a ‘pistol grip’ with your hand, place your thumb over the casualty’s chin (below the lip) and support
the tip of their jaw with the knuckle of your middle finger (ref. Figure 9); then
+ place your other hand on the casualty’s forehead and tilt their head back to open the airway
Figure 4: Gently tilt the head to open the airway.
Sniffing the morning air
With infants (children less than 1 year of age) there is less of a requirement to perform the ‘Head Tilt and Chin
Lift’ technique. Due to the fact that infants are still developing the trachea (windpipe) is still quite pliable and
easily manipulated. This means that if you were to perform a head tilt on an infant you may in fact block
passage of air not enhance it.
For this reason when assessing an infant’s airway it is suggested that the head be maintained in a neutral
position, not falling forwards or backwards.
However there may be some situations where a neutral head position is not enough to keep the infant’s airway
open. In this situation the First Aider is suggested to provide the ‘Sniffing the morning air’ technique, in which
the infant’s head tilted slightly so that the nostrils appear as though they are sniffing the morning air (ref. Figure
9a).
First Aid Institute of Australia | www.faa.edu.au
9
Figure 9a: Sniffing the morning air position for an infant.
Look, Listen and Feel
Given that it can be difficult to see if a casualty’s airway is obstructed or not, use the ‘Look, Listen and Feel’
method to determine if they are breathing normally:
+ apply a chin lift and head tilt to open the airway;
+ lean over the casualty and turn your head to look along their body;
+ LOOK for the rise and fall of the lower chest (upper abdomen);
+ LISTEN for breath escaping the casualty’s nose or mouth; and
+ FEEL for the casualty’s breath by placing your hand or cheek above (but not touching) the casualty’s
mouth (ref. Figure 10).
Figure 5: Look, Listen and Feel for signs that the casualty is breathing normally.
Clear Airway
To clear an obstructed airway:
+ Kneel beside the casualty and LOOK inside their mouth for any obstructions such as vomit, blood, teeth,
dentures, food etc.
+ if the airway appears obstructed, roll the casualty into the Recovery Position, open their mouth and turn
their head slightly downwards to allow it to drain or fall out; or carefully scoop obstructions from their
mouth with your fingers.
+ with a clear airway and remaining in the Recovery Position, TILT the casualty’s head to assist with keeping
the airway open.
+ Once the airway is clean you need to apply the head TILT and chin LIFT technique to open the airway to
start mouth to mouth.
10
Apply First Aid
Cardiopulmonary Resuscitation (CPR)
When a heart stops beating, the blood stops moving to all the parts of the body that need it. Within five (5)
minutes of the heart stopping and the blood stagnating in the arteries, veins and capillaries; the body begins to
die. Until help arrives, attempting cardiopulmonary resuscitation could be the only way of preventing this from
occurring – so any attempt at shifting the casualty’s blood at this stage is better than no attempt at all.
A variety of events can result in a casualty needing cardiopulmonary resuscitation, including:
+ an allergic reaction;
+ an ineffective heartbeat;
+ asphyxiation caused by choking, drowning or an obstructed airway;
+ drug reactions or overdose;
+ electric shock;
+ exposure to cold; or
+ severe shock or trauma.
Cardiopulmonary resuscitation, or CPR, is a term derived from three words:
+ Cardio, relating to the heart;
+ Pulmonary, relating to or affecting the lungs; and
+ Resuscitation, meaning to revive or to bring back to life.
As the name suggests, attempting CPR involves manually delivering a flow of air into the lungs (rescue breaths)
and assisting the flow of blood through the heart (chest compressions) in an attempt to revive a casualty, or
preserve life until help arrives.
As the second of the links in the Chain of Survival, early provision of CPR has been shown to increase the
likelihood of survival for a casualty who has experienced a sudden cardiac arrest.
CPR for an adult or teenager
To commence CPR, deliver two (2) rescue breaths in quick succession, then Look, Listen and Feel for signs of
normal breathing. If normal breathing does not return, it is time to deliver compressions.
Make sure that the casualty is lying on a firm surface, then:
+ kneel beside the casualty;
+ place the heel of one hand on the lower half of the sternum. (ref. Figure 13) if unsure place hand in the
centre of the chest on the breastbone;
Figure 6: Locate the compression point on the breastbone, between the nipples.
+ place the heel of the other hand on top of the first and keep the fingers off the ribs;
+ relax your fingers and point them across the chest, slightly raised, to avoid putting pressure on the ribs;
First Aid Institute of Australia | www.faa.edu.au
11
+ with straight arms and a straight back, position yourself over the casualty so that your shoulders are
squarely over the point of compression (ref. Figure 14); and
+ depress the breastbone rhythmically and vertically (ensuring the pressure is exerted through the heel of
the bottom hand only)
Figure 7: Position yourself on your knees with arms straight above the point of compression.
CPR should be delivered at a rate of thirty (30) chest compressions and two (2) rescue breaths. Other points to
remember when administering CPR include –
+ compressions should depress the chest to a depth of 1/3 of the casualty’s chest cavity;
+ chest compressions should be delivered at a rate of 100 per minute;
+ aim to deliver 5 cycles of ‘2 breaths and 30 compressions’ in 2 minutes;
+ at the end of 2 minutes check again for signs of life; and
+ if still no signs of life, continue with CPR.
CPR for a young child
(more than 1 year old)
CPR for a child is similar to CPR for an adult or teenager, with some notable differences:
+ less air is required to raise the chest of a child when delivering rescue breaths (do not over-inflate the
lungs);
+ less weight is needed to compress a child’s chest 1/3 of its depth (do use excessive force); and
+ use only one (1) hand for compressions for very small children.
CPR for an infant
(less than 1 year old)
CPR for an infant is similar to CPR for a child, with some notable differences:
+ keeping the head in a neutral/ horizontal position is required to open an infants airway - an infants airway
can be blocked by an excessive head tilt;
+ cover the infants mouth and nose when providing rescue breaths, and deliver only small puffs to raise the
chest;
+ use only 2 fingers of one hand to provide compressions; and
+ press the infant’s breastbone straight down 1/3 of the depth of the chest.
12
Apply First Aid
When to stop providing CPR
A First Aider may cease the provision of CPR when:
+ it is no longer safe for the First Aider to continue;
+ the casualty starts showing signs of life (normal breathing and responsiveness);
+ a more qualified First Aider or paramedic takes over;
+ the First Aider can no longer continue due to injury or physical exhaustion; or
+ an authorised person (usually a medical doctor or a police officer) legally pronounces the casualty to be
dead.
If the casualty starts breathing and shows responsiveness, roll them into the recovery position and continue to
monitor them closely until help arrives.
The Basic Life Support Chart
Figure 8: Basic Life Support Chart.
First Aid Institute of Australia | www.faa.edu.au
13
Bleeding
For most people, a minor bleed and minor blood loss is a condition treated easily and without complication.
Most minor bleeds will in fact stop and mend themselves within a short period of time, or with a minimal level of
intervention or first aid.
Complications can arise however, where a casualty or bystander suffers an adverse reaction to bleeding. For
some, just the sight of blood is enough to cause light-headedness, dizziness, or fainting; and for others, a preexisting condition such as haemophilia may mean that a minor bleed will require additional attention if the
bleeding can not be easily controlled.
It is important that the first aider is able to identify a serious bleed, and know how to respond accordingly.
External Bleeding
External bleeding is when the tissue and skin is broken and blood is able to leave the body. Common examples
include blood loss from a cut, scratch or skin puncture.
External bleeding may not always be easy to detect, particularly if the bleed is obscured by the position of the
casualty, their clothing or another obstruction. However, an effective First Aider will check a casualty for signs of
bleeding which may include:
+ dripping, spurting or pooling of blood on or near the casualty;
+ a pale skin colour, or cold and moist (clammy) skin; or
+ confusion or shock.
Upon locating the bleed, it may be helpful to paramedics that you estimate how much blood has been lost by
the casualty. However, sometimes the amount of blood lost can be deceptive and easily over-estimated. To
avoid this, think about how far a glass of milk would spread when spilled, and then compare this with the
amount of blood you can see. Given that extensive or rapid blood loss can be life threatening, check to see if
either is likely to present further complications before help arrives.
Managing an External Bleed
As with any situation involving the potential to come into contact with the bodily fluids of others, take
precautions to minimise the likelihood of infection. Use gloves and other Personal Protective Equipment (PPE)
where available. However, if PPE is unavailable and the casualty is conscious, instruct and guide the casualty on
what to do themselves.
To manage a casualty with an external bleed:
+ follow the Basic Life Support (DRS ABCD) procedure;
+ inspect the source of blood loss for an imbedded object; and
+ if no imbedded object is found, apply the ‘Pressure, Elevation, Rest & Reassurance’ (PER) method; or
+ if an imbedded object is in or protruding from the wound, apply the Indirect Pressure Method to stop the
bleed.
Common Bleeds
Applying the Pressure, Elevation, Rest & Reassurance method to manage blood loss can be awkward in some of
the following common circumstances.
Internal Bleeding
Internal bleeding occurs when blood vessels have been damaged but the skin remains intact. A bruise is a
common example of internal bleed.
Internal bleeding should be suspected in any injury involving the head, chest or abdomen.
14
Apply First Aid
Signs and symptoms of an internal bleed include:
+ pain, tenderness or swelling over or around the affected area;
+ cold, pale and sweaty skin;
+ nausea and vomiting;
+ rapid, shallow breathing;
+ confusion; or
+ signs of blood from the nose, mouth, ears or in the vomit.
To manage a casualty with signs or symptoms of an internal bleed (ref. Figure 20):
+ follow the Basic Life Support (DRS ABCD) procedure;
+ lie the casualty down with their head and legs raised (if possible);
+ keep them warm and loosen any tight clothing;
+ DO NOT give them anything to eat or drink; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Figure 20: Lying a casualty down who is suffering from internal bleeding.
Amputation
Amputation is said to have occurred when a limb, digit or appendage has been severed entirely. With quick and
effective first aid management, it may be possible for the casualty’s body part to be surgically reattached at a
later time.
Three main things to increase the likelihood of successful reattachment:
+ correct management of the severed limb;
+ prompt transport of the patient and the body part to a hospital; and
+ early hospital notification.
To manage a casualty with an amputation (ref. Figure 21):
+ follow the Basic Life Support (DRS ABCD) procedure;
+ apply the PER method for the casualty, the priority is always to control bleeding in the casualty and then
care for the amputated body part;
+ place the body part in an airtight clean plastic bag with a small amount of air and keep the part cold,
ensuring that the body part does not come into direct contact with the icy cold water as it can cause the
tissue to freeze and die; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
First Aid Institute of Australia | www.faa.edu.au
15
Figure21: Caring for an amputated body part. Keep body part cold and ensure no direct contact with body part and ice.
Angina
Angina occurs when there is insufficient blood flow from the coronary artery to meet the oxygen requirements of
the heart (ref. Figure 24). This in turn causes pain, and can lead to a heart attack. Most people diagnosed with
angina will be prescribed medication to help treat it. Most common angina medications are given under the
tongue in either a spray or tablet form.
What is the relationship
between Angina and a Heart
attack?
Figure 24: Angina is the narrowing of the coronary arteries.
Signs and symptoms of angina may include:
+ dizziness;
+ slow onset of pain in the chest usually brought on
by physical exertion;
+ pain can radiate to the neck, jaw, shoulders or
arms;
+ shortness of breath; or
+ pale clammy.
16
Both are caused by a lack of oxygen to
Heart muscle. In the case of a heart attack
it is caused by a blockage and will lead to
eventual death of the muscle. In the case
of Angina, the reduced blood flow is caused
by a spasm of the coronary artery which
starves oxygen to the heart muscle.
So both conditions can present very similar
symptoms and signs. For example chest
pain, shock symptoms etc.
In the case of Angina, the casualty is
usually aware of their condition and has
medication to ease it.
If the symptoms persist for longer than 10
minutes (in the case of angina, after the
administration of medication), you should
treat the casualty as if they are having a
heart attack. Call 000 immediately.
Apply First Aid
To treat a casualty who is known to have angina and appears to be having an angina attack:
+ rest the casualty in a comfortable position, preferably sitting upright;
+ assist the casualty to take any prescribed medication (putting medication within reach of the casualty);
and
+ if the chest pain does not dissipate after 10 minutes treat as though the casualty is having a heart attack
and call emergency services.
If the casualty loses consciousness at any stage:
+ treat as per heart attack guidelines; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Diabetes
Diabetes is a disease affecting the pancreas – the internal organ responsible for the production of insulin.
Insulin production is a vital process that allows the body to convert dietary sugars into energy for cell production
and growth. A diabetic is someone who requires insulin or medication to control or supplement the insulin
production necessary to maintain safe glucose (sugar) levels in their bloodstream.
There are generally two forms of diabetic illnesses:
+ ‘Type 1 diabetes’ is an ongoing condition caused by a loss of insulin production, requiring the diabetic to
need regular doses of insulin to survive; and
+ ‘Type 2 diabetes’ is an ongoing condition caused by a reducing of insulin production, requiring the diabetic
to need regular doses of insulin to stimulate the production of insulin.
Hold on readers cause this next lot of information can be very confusing. If you are in doubt speak to your First
Aid trainer or a trained professional.
Complications can arise for a diabetic whose blood glucose level is too low (hypoglycaemia), or too high
(hyperglycaemia). However, it is notoriously difficult for a First Aider to determine which condition may have
triggered a diabetic emergency, or ‘attack’.
Therefore, because hypoglycaemia is the most common type of attack and can be triggered by a wide variety of
causes the First Aider should not hesitate in providing some glucose (sugary food or drink) to a conscious
casualty. If the casualty is having a hyperglycaemic attack (blood glucose is too high) and more sugar is given no
additional harm will be done. For this reason an attack can be managed without the risk of compounding a
hyperglycaemic attack but will stabilise a hypoglycaemic attack.
In other words, the same first aid response should be provided regardless of the type of diabetic emergency you
may encounter.
Signs and symptoms of a diabetic emergency may include:
+ feeling hungry;
+ tiredness or fatigue;
+ altered consciousness or confusion;
+ change in behaviour;
+ slurred speech; or
+ loss of balance or coordination.
Given that some of these symptoms could be confused with drunkenness or intoxication, monitor the casualty
for any signs of rapid progression and manage the emergency accordingly.
To manage a diabetic emergency:
+ implement the Basic Life Support (DRS ABCD) procedure;
+ if the casualty is conscious, assist them with taking any prescribed medication they may have (only if
certain it is a hyperglycaemic attack);
First Aid Institute of Australia | www.faa.edu.au
17
+ otherwise (and in most cases) provide some sugar or glucose in the form of jellybeans, soft drinks or
cordial, a dessert spoon of honey, or some sugar dissolved in water Make sure when you give sugar etc. to
your patient that they have a ‘Gag Reflex’. This is identified by asking them to swallow their own saliva, If
they can’t, they cannot have any food – meds or drink anymore, as this will go down into their lungs; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Figure 25: Jellybeans are a good source of quick sugar for diabetic patients. Can you guess how many jellybeans are in this jar?
Choking
Choking is caused by an obstruction of a casualty’s airway (ref. Figure 26).
There are 2 different types of airway obstruction;
+ partial obstruction; and
+ complete obstruction.
A good way to understand Choking is to understand the function of the Larynx – also known as the “Voice Box”.
When air is pushed up out of the lungs a sound is made when the air passes through the Voice Box. This can be
a low or high pitched sound according to how tight we stretch the strings inside the Voice Box, just like Guitar
strings or the strings inside a piano.
If the airway is completely blocked, no air can come up from the lungs through the Voice Box.
Therefore a complete obstruction (no air moving through Voice Box) means that the person CANNOT SPEAK.
Also, they CANNOT COUGH – as coughing requires sound also.
A person who has a partial blockage (for example a peanut) can get some air in and out of the airway and thus
will be able to speak and cough – sometimes with great difficulty, depending on the irritation or size of the
object that is caught in the airway causing the blockage.
Figure 26: Obstruction in the airway.
Some of the more common causes of choking are:
18
Apply First Aid
+ foreign material (food, vomit, teeth, dentures, blood, etc);
+ trauma to the airway; and
+ anaphylactic reactions.
Signs and Symptoms of a partial obstruction:
+ difficulty breathing, the breathing may be laboured or noisy;
+ coughing;
+ loss of voice and only making sounds;
+ wheezing; and
+ anxiety.
To treat a casualty with symptoms of a partial obstruction to the airway:
+ reassure the casualty;
+ lean the casualty forward and encourage them to cough up the obstruction;
+ DO NOT slap the casualty on the back as doing so may cause the obstruction to lodge further in the airway
and cause a complete obstruction; and
+ if the obstruction does not come free contact emergency services or seek medical assistance.
Allergies and Anaphylaxis
An allergic reaction occurs when the body reacts to an allergen which causes an inflammatory response. This
inflammatory response is usually mild and should not cause more than slight discomfort in most people.
However anaphylaxis is an acute, severe allergic reaction which is life threatening if not treated properly. This is
due to the fact that the body enters what is known as the ‘mast cell-leukocyte-cytokine cascade’, in which
antibodies are released and cause inflammation and then release more antibodies which in turn cause
inflammation and release more antibodies… over and over again (hence the term cascade).
Anaphylaxis can be caused by a multitude of allergens but some of the more common ones include:
+ foods such as nuts, dairy, eggs and fish;
+ insect bites;
+ chemicals;
+ cigarette smoke; and
+ medications.
Signs and symptoms of Anaphylactic Shock include:
+ difficulty or noisy breathing;
+ swollen tongue, lips or face (angioedema);
+ difficulty talking or talking with a hoarse voice;
+ persistent cough
+ rash;
+ hives or welts; or
+ loss of consciousness.
Prevention and Management of Anaphylaxis will be discussed during face-to-face training.
First Aid Institute of Australia | www.faa.edu.au
19
Asthma
Asthma attacks are caused by a narrowing of the airways and a build up of secretions in the lungs. This can
make it extremely difficult for the casualty to breath, and can be fatal.
During a severe asthmatic attack the casualty’s lungs inflate properly but are not able to exhale as efficiently.
Try taking a big breath in and then try taking another smaller breath in, then exhaling that small breath and
repeating. This is similar to how an asthmatic feels when having a severe attack.
Certain factors can bring on asthma attacks, some of the more common ones are:
+ allergies;
+ exercise;
+ changes in the weather
+ stress; or
+ chemicals and smoke.
A Bricanyl Turbuhaler may be used in first aid treatment if a puffer and spacer are unavailable.
For more information regarding Asthma prevention and treatment visit www.asthma.org.au
To Treat a casualty with symptoms of an Asthma Attack:
1.
Sit the person upright, remain calm and provide reassurance. Do not leave the person alone.
2.
Give 4 puffs of a blue reliever puffer one puff at a time preferably through a spacer device. Ask the
person to take 4 breaths from the spacer after each puff.
3.
Wait 4 minutes
4.
If there is little or no improvement, repeat steps 2 and 3.
Fractures
Fractures are when a bone is broken or cracked, although in children (because the bones are more flexible) the
bone may bend resulting in a what is known as a greenstick fracture.
Some of the common causes of fractures are:
+ direct force, generally the bone will be broken at the site of impact;
+ indirect force, the bone is broken further along the limb from the site of impact due to the force travelling
up; and
+ abnormal muscular contraction, it is possible that someone’s muscles are contracting so hard they end up
pulling the bone in a direction it cannot go and the bone gives way (this will occasionally happen in
seizures).
The three (3) different types of fractures are categorised as follows:
+ closed fracture, the bone is still contained inside the tissue;
+ open fracture, the bone protrudes through the skin; and
+ complicated fracture, where the bone fragments and damages surrounding nerves or organs, this can be
very dangerous and cause long term problems.
To identify a fracture look for the following:
+ pain;
+ abnormal positioning;
20
Apply First Aid
+ swelling;
+ loss of movement or shape;
+ exposed bone; and
+ shock.
To treat a casualty who may have a fracture:
+ call emergency services (000);
+ follow the Basic Life Support procedure (DRS ABCD);
+ attempt to control bleeding, using indirect pressure if there is bone exposed (donut bandage);
+ stop the casualty from moving the limb or body part
+ immobilise the body part using a splint if possible, the best way to splint is by immobilising the joints
above and below the fracture;
+ check circulation regularly, squeeze the fingernail or toenail below the fracture, colour should return within
4 seconds;
+ never attempt to realign a fracture;
+ monitor and treat for shock.
Stroke
Strokes are also known as CerebroVascular Accidents or a CVA.
To break these terms down:
•
Cerebro means brain; and
•
Vascular means blood vessel.
So putting this together a stroke is an “accident” or condition that affects the brain and blood vessels of the
brain. There are generally two different types of strokes one is caused when the blood supply to the brain is
blocked and the other is where a blood vessel bursts and causes bleeding into the brain. Both of these mean
that the brain is not getting any or only a limited amount of oxygen to a that particular area.
A stroke may be brief only lasting a few seconds or much longer lasting hours.
Contrary to popular belief, Strokes DO NOT only occur in the elderly.
Signs and symptoms of a stroke include:
+ difficulty or loss of speech;
+ paralysis or weakness on one or both sides of the body, simply asking the casualty to raise their arms or
legs or squeeze your hands can help give an indication;
+ loss of facial control, there may be drooping on one side of the face, this can cause the casualty to drool
or slur their words, asking them to smile will help identify a loss of facial muscle control;
+ confusion;
+ unequal pupils;
+ nausea and vomiting; and
+ sudden or severe headache.
A good way of remembering the signs and symptoms of a stroke is to think FAST, hopefully this acronym helps:
F – Facial weakness;
A – Arm weakness;
S – Speech difficulty; and
T – Time to act fast.
First Aid Institute of Australia | www.faa.edu.au
21
To treat a CONSCIOUS casualty with symptoms of stroke:
+ call emergency services;
+ do not give the casualty anything to eat or drink;
+ sit the casualty in a position of comfort;
+ loosen any tight clothing
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
To treat an UNCONSCIOUS casualty with symptoms of stroke:
+ call emergency services
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Important Note
Even if the signs and symptoms have disappeared the casualty should still be assessed by medical
professionals. Stroke like symptoms that resolve on their own can be an indication that another one is imminent.
It is far better to prevent the casualty from having a stroke than to try and treat them once it has occurred.
Figure 33: FAST Acronym. For recognising signs of a stroke.
Seizures
Seizures are caused by a sudden interruption of the electrical activity within the brain. At any one time there are
millions of electrical impulses moving throughout the brain conveying messages. These impulses in essence
control the function and movement of the body. A seizure is a disruption in the normal flow of these impulses.
With a seizure the casualty will often fall to the floor and suffer from rigid or jerky muscular spasms. In the
medical world seizures are often further defined as tonic-clonic, absence or focal.
Causes of seizures can include:
+ epilepsy;
+ brain injury;
+ infection;
+ drugs and alcohol; and
+ poisoning.
Children under 5 years of age may suffer what is known as a febrile convulsion which is associated with a raised
temperature.
22
Apply First Aid
Often the casualty will lose control of their bladder and occasionally their bowels.
Signs and symptoms of a seizure:
+ the casualty may be able to tell you that they are about to have a seizure, especially if this is a common
occurrence the casualty may experience an “aura” which may be a feeling, smell or sound just before
having the seizure;
+ unusual sensations or movement;
+ fall to the ground;
+ jerky muscular spasms;
+ loss of consciousness;
+ blueness around the mouth or lips (cyanosis);
+ frothing saliva coming from the mouth; and
+ incontinence.
Seizures not resulting in loss of consciousness require little first aid other than reassurance and protection of
the casualty from injury, it is important that you try to maintain the dignity of the casualty as they may need to
change into clean clothes.
To treat a casualty who has had a seizure:
+ stay calm;
+ loosen tight clothing;
+ DO NOT restrain the casualty, doing so may cause more harm;
+ DO NOT place anything in the casualty’s mouth or between the teeth, this can lead to an airway
obstruction which is much more serious;
+ time the duration of the seizure, time the amount of seizures and what it looks like, this information will be
important for medical personnel;
+ protect the casualty from anything they may hurt themselves on, try to remove hard objects around them
and if possible place a pillow or rolled up towel under their head to stop them hitting it on the ground;
+ when the seizure has stopped provide reassurance and roll the casualty into the recovery position;
+ be aware the casualty may feel very embarrassed at having had a seizure, so if possible remove any
bystanders or people that do not need to be there; and
+ advise the casualty to seek medical advice.
Call emergency services if:
+ it is not known that the casualty has epilepsy;
+ the seizure lasts longer than 5 minutes
+ another seizure immediately follows the first one;
+ the casualty has difficulty breathing
+ the casualty does not full recover or regain consciousness;
+ the casualty is pregnant;
+ the casualty is diabetic; or
+ the seizure is different to the casualty’s previous seizures.
First Aid Institute of Australia | www.faa.edu.au
23
Important Note
If the seizure occurs in water, it is essential to protect the airway whilst moving the victim to a firm surface. The
victims head and shoulders should be supported to keep the face above the water
Figure 34: Someone who has had or is having a seizure should be laid on the ground and protected from further harm.
Fainting
Fainting is a brief loss of consciousness caused by a lack of blood flow to the brain. The body’s natural response
to a lack of blood flow to the brain is to ‘lie down’ to assist the blood flow. This is why people faint.
Fainting can be caused by many factors some of these include:
+ prolonged standing, especially when not able to move around;
+ emotional shock;
+ pain;
+ fatigue; or
+ sudden changes in posture such as getting up too quickly from lying down (this is called postural
hypotension)
With fainting the loss of consciousness should only last a short period of time and is generally no longer than 20
seconds. If the casualty loses consciousness for more than 20 seconds treat as though they are unconscious
and treat as per the Basic Life Support procedure (DRS ABCD).
Signs and symptoms of fainting include:
+ light headedness;
+ dizziness;
+ cold, pale, moist skin;
+ restlessness; and
+ numbness or tingling in the arms that goes away quickly.
24
Apply First Aid
To treat a CONSCIOUS casualty with symptoms of fainting:
+ lie the casualty down and elevate the legs;
+ loosen any tight clothing;
+ ensure the casualty has an adequate supply of fresh air;
+ reassure the casualty as they may confused for a while whilst they recover; and
+ check for any injuries that may have occurred if they fell.
Important Note
Brain damage or death may occur if the victim is left supported in an upright position such as in a chair or
jammed upright in a crowd. (low or no blood flow to the brain)
To treat an UNCONSCIOUS casualty with symptoms of fainting:
+ if there is no response after 20 seconds treat the casualty as though they are unconscious;
+ call emergency services; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
One of the most dangerous things with fainting is the potential for the casualty to injure themselves further
when falling. People have broken their spine from falling over and hitting their head simply from a standing
height.
Remember
“Always check to see if the casualty has injured themselves from the fall”.
Figure 35: Someone who has fainted should be laid down and legs elevated.
Head Injuries
The head is among the most important parts of our body, and it is important that we look after it. Someone that
has sustained a head injury can become unwell very rapidly, even if moments ago they appeared fine.
Head injuries may lead to damage to the brain, scalp, skull, ears, teeth, nose, eyes or spine.
Important Note
“The maintenance of a clear and open airway takes priority over any other injury”.
Signs and symptoms of a head injury include:
+ altered consciousness;
+ headache;
First Aid Institute of Australia | www.faa.edu.au
25
+ nausea and vomiting;
+ blurred or double vision;
+ casualty becomes drowsy or irritable;
+ slurred speech;
+ confusion and disorientation;
+ swelling or bruising especially around the eye;
+ fluid, blood or discharge from the ears or nose;
+ short term memory loss;
+ loss of co-ordination or power in the limbs; or
+ the casualty suffers a seizure.
Important Note
“With any head injury, you must always consider the possibility of an accompanying spinal injury”.
To treat a CONSCIOUS casualty with symptoms of a head injury:
+ call emergency services;
+ keep the casualty calm and support the head and neck, try to minimise any movement of the head or
neck;
+ if the casualty is bleeding from the ear lie them in a comfortable position where the fluid can drain out
easily;
+ treat any other injuries; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
To treat an UNSCONCIOUS casualty with symptoms of a head injury:
+ call emergency services;
+ control any bleeding;
+ treat any other injuries; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Figure 36: Some of the signs and symptoms of a head injury.
26
Apply First Aid
Burns
Burns are generally caused by exposure lo high heat such as flame, hot liquids, radiation or by exposure to
chemicals that are corrosive to the skin.
Serious bums always require medical attention and an
ambulance should be called as complications may result for up to 72 hours after a burn.
Additionally any patient who has inhaled smoke or chemicals should seek medical attention. Burns or soot
around the nose or mouth is an indication the casualty may have an inhalation burn. This means that their
insides (including the airway) could be burnt.
Burns are generally quite painful, however a lack of pain to a burn may indicate a burn so serious it has actually
destroyed the nerves and the burn may not feel painful at all.
To treat someone who has been burnt:
+ First Aiders must always ensure the situation is safe, if it is not safe emergency services should be called
immediately. This could be from fire, exposed electricity, dangerous animals or chemical spills;
+ heat burns should be actively cooled with running water for 20 minutes, do not apply ice as this can
actually freeze the tissue and cause an ice burn;
+ dry powdery chemicals should be brushed off the skin before actively cooling the burn, adding water to the
powder may cause more burning;
+ First Aiders should attempt to remove any clothing or jewellery from the burnt body part unless it is stuck,
over time the burn will swell and anything left on may lead to cutting off the blood supply;
+ once the burn has been cooled and jewellery and clothing removed a moist bandage or cling wrap should
be applied to the burn; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Bites and Stings
Envenomation occurs when the poison from an animal such as a snake, insect, jellyfish or spider enters the
body.
The venom can poison the body on a localised or entire body level. Most poisons travel through the lymphatic or
muscular system. Not via the circulatory (blood) system.
Snakes and Funnel Web Spider
To reduce the movement of this poison the Pressure Immobilisation Technique is recommended for venomous
bites such as snake or funnel web spider.
This involves rolling a crepe or elasticised bandage over the bite site as soon as possible. A second bandage is
then applied:
+ first, starting at the site of the bite apply a firm bandage and work your way to the fingers or toes;
+ second, with another bandage if necessary work your way up from the fingers or toes until the bandage
runs out or you reach the top of the limb;
+ third, restrict the movement of the casualty with splints, any movement will increase the chance the
venom will spread;
+ fourth; mark the site of the bite on the bandage; and
+ fifth, monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until
emergency service help arrives.
First Aid Institute of Australia | www.faa.edu.au
27
Figure 37: The pressure immobilisation technique.
Spiders, Bees and Wasps
A Pressure immobilisation bandage is not recommended for these bites as the venom moves more slowly and
restricting blood now will simply increase localised pain.
Remove the sting if applicable and apply an ice pack to the bite site.
Note that ice should not come in to direct contact with the skin and should not be applied for more than 10
minutes at a time.
If there is an anaphylactic reaction then you have to apply the PIT treatment.
Some bites are treated with vinegar or hot water. For more specific treatment per animal refer to the table
below.
Table 5: Specific treatment per animal.
Exposure
Heat Exhaustion and Heat Stroke
Heat Exhaustion occurs when the body's core body temperature rises to between 37 and 40 Degrees C.
Signs and symptoms of Heat Exhaustion:
+ feeling hot;
+ flushed and sweaty;
+ increased thirst;
+ headache; and
+ mental confusion or exhaustion.
If not handled, heat exhaustion can lead to a much more serious case of heat stroke.
Heat stoke occurs when the core body temperature rises above 40 Degrees C.
Signs and symptoms of Heat Stroke:
+ the casualty might stop sweating as they are now so dehydrated;
+ severe headache; and
+ altered or loss of consciousness.
28
Apply First Aid
Treatment of Heat Exhaustion or Heat Stroke:
+ move the casualty to a shaded or cool place;
+ remove any excess or unnecessary clothing;
+ gently cool the casualty by applying cold towels to the head and neck;
+ give the casualty cool water to drink;
+ in severe cases cold packs can be applied to the armpits and groin; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Hypothermia
Hypothermia is caused by a lowering of the body's core temperature. Any temperature below 35 Degrees C is
considered Hypothermic with core temperature below33 Degrees C considered dangerous to the patient. In all
cases the patient will be slow to react, will begin shivering but as the condition gets worse will cease to shiver,
will have poor coordination and will eventually lose consciousness if the condition continues.
Treatment of Hypothermia:
+ remove the casualty from the cold and place in a warm room if possible;
+ remove wet clothing and replace with dry clothing and blankets;
+ handle the casualty gently and lie them down;
+ large amounts of heat are lost through the head and feet so ensure these are covered and warm;
+ gently rewarm the casualty, do not expose them to large amounts of radiant heat, such as fires or hot
baths, as this can lead to shock;
+ give them warm sweet drinks to sip at, DO NOT give alcohol as this will cause the blood vessels to dilate
and the casualty will lose more heat quickly; and
+ monitor the casualty in accordance with the Basic Life Support (DRS ABCD) procedure until emergency
service help arrives.
Important Note
If the casualty has frost bite do not attempt to rewarm the body part, seek urgent medical assistance.
First Aid Institute of Australia | www.faa.edu.au
29
HLTAID003 Provide first aid
Bibliography
Australian Resuscitation Council. Correct as at April 2013.
Various guidelines ranging from section 1 through to 9 (inclusive) for a complete
reference please visit http://resus.org.au
Australian First Aid. (2011). St John Ambulance Australia. Barton ACT 2600.
www.stjohn.org.au
30
Apply First Aid
First Aid Institute of Australia | www.faa.edu.au
31
First Aid Institute of Australia
Melbourne Training Centre
Level 6 | 250 Collins Street Melbourne 3000 Victoria | T 03 9639 5551 | F 03 9639 5600
Sydney Training Centre
Level 6 | 770 George Street Sydney 2000 New South Wales | T 03 92814111 | F 02 9281 4110
Parramatta Training Centre
Level 2 | 11 Aird Street Parramatta 2150 New South Wales | T 03 92814111 | F 02 9281 4110