First Aid — Primary Survey, CPR, and Common Emergencies

This is the topic most likely to matter outside the course. Read it, and then — more importantly — attend a hands-on session. CPR cannot be learned from text: the depth and rate have to be felt on a manikin. Most colleges, the Red Cross and St John Ambulance run short certified courses. Take one.

What first aid is

The immediate care given to an injured or ill person before professional help arrives.

The three aims:

1. Preserve life.
2. Prevent the condition worsening.
3. Promote recovery.

Qualities of a good first aider

Calm and in control; observant; acts quickly but not hastily; works within their competence; is reassuring; and — first, always — ensures their own safety.

Never become the second casualty. This is not caution for its own sake: an injured rescuer cannot help, and now two people need attention. In the electrical shock case of the workshop course, this is exactly why you switch off rather than grab.

The primary survey — DR ABC

Before anything else, in this order:

D — Danger. Is the scene safe? Traffic, electricity, fire, gas, water. Make it safe or do not approach.

R — Response. Speak loudly and tap the shoulders. "Are you all right?" If there is no response, shout for help now — do not wait until later to call.

A — Airway. Open it by head tilt, chin lift: one hand on the forehead tilting the head back, two fingers under the chin lifting it. This lifts the tongue off the back of the throat, which is the commonest airway obstruction in an unconscious person.

B — Breathing. Look, listen and feel for up to 10 seconds. Look for chest movement, listen at the mouth, feel breath on your cheek.

Occasional gasping is NOT normal breathing. Agonal gasping occurs in the first minutes of cardiac arrest and is frequently mistaken for breathing — bystanders withhold CPR because "he was still breathing". If breathing is not normal and regular, treat it as absent.

C — Circulation / CPR. If not breathing normally, begin CPR immediately.

Call for an ambulance — 108 in India — and, if available, send someone for an AED.

CPR

Compressions:

• Position: heel of one hand on the centre of the chest (lower half of the breastbone), the other hand on top, fingers interlocked.
• Depth: 5–6 cm in an adult. This is deeper than people expect, and inadequate depth is the commonest fault.
• Rate: 100–120 per minute.
• Allow full recoil between compressions — the chest must come all the way back for the heart to refill.
• Minimise interruptions.

Compressions to breaths: 30 : 2 if trained and willing to give rescue breaths.

If you are untrained, or unwilling to give rescue breaths, do compression-only CPR. Continuous chest compressions are far better than nothing, and hesitating over mouth-to-mouth is a common reason people do nothing at all. Doing something is the point.

Continue until professional help takes over, an AED is attached and instructs otherwise, the person shows clear signs of life, or you are physically unable to continue.

On breaking ribs: it happens, and it is not a reason to stop or to compress too shallowly. A survivable rib fracture is preferable to death from an inadequate compression depth.

Choking — the Heimlich manoeuvre

Assess first.

Mild obstruction — the person can cough, speak or breathe. Encourage coughing. Do not intervene; coughing is more effective than anything you can do.

Severe obstruction — cannot speak, cough or breathe; may clutch the throat; face may become blue.

1. Five back blows — lean them forward, strike firmly between the shoulder blades with the heel of your hand.
2. If unsuccessful, five abdominal thrusts (Heimlich) — stand behind, place a fist thumb-side in just above the navel and below the ribs, grasp it with the other hand, and pull sharply inward and upward.
3. Alternate five and five until the obstruction clears or the person becomes unresponsive.
4. If they become unresponsive, begin CPR.

Not for infants under one year — use back blows and chest thrusts instead. Not for pregnant or very obese adults — use chest thrusts.

Anyone who has received abdominal thrusts should be examined by a doctor, because internal injury is possible.

Common injuries

Cuts and scrapes. Wash hands. Apply direct pressure with a clean cloth to stop bleeding. Clean the wound with running water. Cover with a sterile dressing. See a doctor for deep wounds, embedded objects, bleeding that will not stop, or animal bites — and check tetanus status.

Bruises. Cold pack for 15–20 minutes, wrapped in cloth, not applied directly to skin.

Sprains and strains — the standard sequence is RICE:

• Rest
• Ice, 15–20 minutes at a time, wrapped
• Compression, with an elastic bandage, firm but not tight enough to numb or discolour
• Elevation above heart level

Avoid heat, massage and vigorous movement in the first 48 hours.

Fractures. Do not move the person unnecessarily and do not attempt to straighten the limb. Immobilise using a splint or sling, supporting the joints above and below. Control bleeding in an open fracture with pressure around, not on, the protruding bone. Get medical help.

Burns. Cool with clean running water for at least 20 minutes. Remove rings and watches before swelling starts. Cover loosely with clean non-fluffy material or cling film.

Do not apply ice, toothpaste, oil, butter, turmeric or ash. These traditional remedies trap heat, introduce infection and make the wound harder to assess and treat. Do not burst blisters.

Seek medical help for burns that are large, deep, on the face, hands, feet or genitals, or caused by chemicals or electricity.

Nosebleed. Sit the person leaning forward — not back, which sends blood into the throat and may cause vomiting. Pinch the soft part of the nose for 10 minutes without releasing to check. Seek help if bleeding continues beyond 20 minutes or follows a head injury.

Sports injuries

Classification of soft tissue injuries, as the syllabus lists:

• Abrasion — scraping of the skin surface.
• Contusion — a bruise, bleeding beneath intact skin.
• Laceration — a tear with irregular edges.
• Incision — a clean cut with straight edges.
• Sprain — injury to a ligament, which joins bone to bone.
• Strain — injury to a muscle or tendon.

The distinction to keep straight: sprain = ligament, strain = muscle or tendon. It is asked routinely.

Applying a sling — for arm and shoulder injuries. Support the forearm across the chest, place the triangular bandage between the arm and chest with the point at the elbow, bring the lower end up over the forearm, and tie at the side of the neck on the uninjured side. Check circulation in the fingers after tying — they should stay warm and pink.