Essential First Aid MANUAL

Transcription

1 Essential First Aid MANUAL

2 Calling for help If you are not sure whether the Emergency Services are needed, call anyway; they can help you decide. Remain calm. Take a deep breath, call ambulance 111. Always call for help as soon as possible to get help on the way. The following information will be required by the medical controller: Where it happened The telephone number you are calling from What has happened The number of people who are ill or injured Quick assessment If you are able to quickly assess the casualty, obtain the following information: Is the casualty awake? Can the casualty talk to you? Is the casualty breathing normally? Is the casualty bleeding severely? Tell the ambulance service what you find during your quick assessment. This can give them an indication of how severe the injury or illness is. If you feel you are unable to do anything, send for help.

3 Essential First Aid New Zealand Red Cross teaches New Zealanders to cope in a crisis and has been teaching first aid for many years. All the topics covered in first aid and emergency care courses are contained in this book which provides a vital reference for all people. What do you do when? TR (2017) Your father collapses after complaining of indigestion all day. Your daughter gashes her foot on broken glass. You re first on the scene when a pedestrian is hit by a car. One of your team mates sprains an ankle during practice. Your toddler chokes on a piece of apple.

4 This book contains first aid information and is intended to supplement and revise information learned on New Zealand Red Cross First Aid courses. Published by authority of the National Board of New Zealand Red Cross. Published by the New Zealand Red Cross. 69 Molesworth Street, Thorndon, Wellington. This book is copyright. Except for the purpose of fair reviewing, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Infringers of copyright render themselves liable to prosecution. ISBN New Zealand Red Cross. The author asserts its moral rights in the work. First published Reprinted annually with new information as required. Printed Written and designed by New Zealand Red Cross. Photographs and illustrations courtesy of American, Australian, New Zealand, Samoa, Tuvalu and Papua New Guinea Red Cross, Pacific Delegation IFRC, New Zealand Resuscitation Council and National Heart Foundation of Australia. All rights reserved in all countries.

5 Contents What is first aid? 1 First aider 1 First aid aims 2 First aid action plan 2 First aid steps 3 When to call Primary assessment 4 Using DRSABCD 5 Dangers 2,6 Response Levels of consciousness (AVPU) 7 Airway 8 Breathing 8,12 15 Breathing difficulties 9 Circulation / CPR 9 Unconsciousness 10 Stable Side Position (recovery position) 11 DRSABCD Resuscitation Basic Life Support Flowchart 14 Resuscitation Chain of Survival 15 Resuscitation Adult 16 CPR Action Checklist 16 DRSABCD Resuscitation adult 17 Defibrillation and AEDs 18 Resuscitation Child / Infant 19 CPR Action Checklist 20 DRSABCD Resuscitation child / infant 21 Drowning 22 Choking Adult 24 Conscious Back blows / Chest thrusts / Obstructed airway Unconscious Obstructed airway 27 DRSABCD Choking adult / child 28 Infant Conscious Infant Unconscious 31 DRSABCD Choking Infant 31 Bleeding 32 External bleeding Wounds Embedded objects in wounds 34 Internal bleeding 35 DRSABCD Bleeding 35 Shock and fainting Check for other conditions and injuries Vital signs Consciousness (AVPU) 40 Check for injuries / MedicAlert 41 Medical conditions Heart attack Angina 43 Heart health 44 Heart attack action plan 45 Stroke Diabetic emergency 48 Seizures / Febrile convulsions 49 50

6 Hyperventilation 51 Asthma DRSABCD Medical conditions 53 Injuries Fractures Dislocations 56 Soft tissue injuries / bruising DRSABCD Fractures and soft tissue injuries 58 Spinal injuries 59 DRSABCD Spinal injuries 60 Head injuries Concussion Brain compression 62 DRSABCD Head injuries 63 Fractured nose 63 Stable Side Position for head or spinal injuries Log roll 64 Amputations 65 Chest injuries 66 Abdominal injuries 66 Crush injuries 67 Nose bleeds 68 Ear injuries 68 Knocked out permanent teeth 69 Eye injuries Burns and scalds DRSABCD Burns and scalds 75 Poisons DRSABCD Poisons 78 Tick bites, bee, wasp and ant stings 79 Severe Allergic Reaction Anaphylaxis 80 Anaphylaxis action plan 81 DRSABCD Severe allergic reaction 81 Environmental conditions Hyperthermia Heat exhaustion 82 Heat stroke 83 DRSABCD Hyperthermia 84 Hypothermia DRSABCD Hypothermia 86 Other useful information Casualty reporting 87 Handwashing and hygiene 87 Applying slings 88 First Aid kits 89 Essential Emergency Management Handbook 90 Hazard App 90 Household Emergency Plan Useful numbers 93 Workplace accidents 94 Suicide information 95 Psychological First Aid 96 Glossary Index Mission statement

7 What is first aid? First aid is the immediate assistance provided to the sick or injured person until professional help arrives. WHAT IS FIRST AID? It is concerned not only with physical injury or illness but also with other initial care, including psychosocial support for people suffering from emotional distress caused by experiencing or witnessing a traumatic event. First aid interventions seek to preserve life, alleviate suffering, prevent further illness or injury and promote recovery. 1 This manual refers to the person requiring care as a casualty and the layperson, with their basic first aid knowledge and skills, provides the assistance and is referred to as the first aider. Further emergency care information for Basic Life Support and First Aid can be found in the Guidelines documents found on the New Zealand Resuscitation Council website nzrc.org.nz. New Zealand Red Cross acknowledges the NZ Resuscitation Council Guidelines. 1 International Liaison Committee on Resuscitation (ILCOE),

8 FIRST AID AIMS ACTION PLAN First aid aims In emergency situations, injuries or medical conditions can kill: in minutes within hours, or not at all. General principles of management of the collapsed or injured casualty. After ensuring scene safety for the rescuer, casualty and bystanders, the management of the collapsed or injured casualty involves: Prevention of further harm or injury Checking response to verbal and tactile stimuli Sending for help Care of airway, breathing, circulation Control of bleeding Protection from the environmental elements Other first aid measures depending on the circumstances Gentle handling Reassurance Continued observation First aid action plan In first aid the DRSABCD cycle is used to assist the first aider to identify, prioritise and treat any problems. What is DRSABCD? DRSABCD is an abbreviation for the casualty primary assessment process used by the New Zealand Red Cross and stands for: Dangers, Response, Send for help, Airway, Breathing and Circulation / CPR, Defibrillation Many countries use the DRSABCD casualty assessment process at all levels of care. DRSABCD places the Dangers / Safety of the rescuer, casualty and bystanders as the first priority. The rescuer then checks for a Response from the casualty and considers Sending for help at an early stage in the assessment. The casualty is then assisted by using simple and logical steps to ensure a clear Airway, and assessing and ensuring Breathing Circulation / CPR and use of a Defibrillator if needed. The purpose of DRSABCD is to assist rescuers to identify these injuries or medical conditions and treat the casualty until the ambulance or advanced care arrives. DRSABCD is used as the guide for first aid given to casualties in all situations. The DRSABCD sequence can be repeated as required until help arrives. 2

9 First aid steps The steps of first aid are to: Recognise an emergency exists Decide to act Stay calm Check for dangers Ensure the safety of the scene, yourself, casualties and bystanders Assess the seriousness of the injuries or illness: Consider sending for help call ambulance 111 immediately Assess ABCs Expose injuries Identify the injuries or illness: Listen to or look for the history of the incident Look for signs of illness or injury, and Listen to the casualty for symptoms Manage the injuries using the methods outlined in this book. When to call ambulance111 Send for help know when to call for an ambulance. For life threatening illness or injury call ambulance 111 immediately. Collapsed or unresponsive. Absence or difficulty breathing. Chest pain. Severe bleeding. ɠ ɠ Signs of stroke (e.g. face droop, arm weakness, speech changes). ɠ ɠ Signs of shock (e.g. anxious, pale, cold, sweaty, feeling sick or faint). ɠ ɠ Severe allergic reaction (e.g. facial swelling, wheezing, nausea, vomiting). Repeated or first time seizures. Severe fractures and burns. MedicAlert conditions. If in doubt, find out; always call ambulance 111 immediately if unsure. The ambulance staff will advise the right care, in the right place, at the right time. For more advice and information, call Healthline or a Medical Centre. FIRST AID STEPS WHEN TO CALL 111 3

10 PRIMARY ASSESSMENT DRSABCD DRSABCD Following the simple DRSABCD process below, the first aider makes a PRIMARY ASSESSMENT to locate any immediately life-threatening conditions. The findings will indicate any action to be taken. Depending on your findings you may need to commence CPR. Repeat the DRSABCD sequence as needed. D DANGERS OBSERVE/CHECK Check for hazards and risks. Check scene safety for: yourself the casualty bystanders ACTION If possible, remove risks and dangers from scene. (Or remove casualty from risk.) R RESPONSE (AVPU) S SEND FOR HELP A AIRWAY B BREATHING C CIRCULATION/ CPR D DEFIBRILLATION Check for response. Consider airway obstruction. If not breathing normally. If breathing normally. If not breathing normally. If bleeding. If showing signs of shock. Vital signs. If not breathing normally. Shout and tap. Send for help. Call ambulance 111 immediately if no response. Consider AED. If no response open airway (Head tilt/chin lift). Commence CPR. Make sure breathing is easy and not obstructed. Commence CPR. Control bleeding. Manage shock and observe. Use AED if needed. 4 GENERAL CARE When/if breathing normally position the casualty in the Stable Side Position.

11 Using DRSABCD A practical example Below is a practical example of how first aiders can use DRSABCD. You are walking through the park when you see an elderly man stumble and fall. When you go to help you notice he is trying to get up and has blood coming from a wound on his hand. You decide to act. USING DRSABCD DANGERS RESPONSE (AVPU) SEND FOR HELP AIRWAY BREATHING CIRCULATION/CPR DEFIBRILLATION SPECIFIC CARE GENERAL CARE Check for hazards and risks. Ensure safety for self, casualty and bystanders. You check the scene for obvious danger and note the presence of blood. You put on gloves. (See AVPU, p7) You ask him if he is OK. He speaks to you. He is alert. You introduce yourself and ask if you can help him. Send or shout for help. You ask bystander for help. Consider AED. The casualty talks easily and has no obvious airway problem. You ask if he is OK. Breathing is rapid. Casualty appears pale and says he feels light headed. You send bystander to call ambulance 111 immediately, because of the signs of shock. Consider AED. If needed, attach and follow prompts. You lie the casualty in the shock position. You treat the hand wound. You check that the ambulance is on the way. You ask if the casualty has a history of heart-related problems, they say yes. You check for other injuries and cannot find any. You keep the casualty warm and reassure him. You stay until the ambulance arrives. 5

12 DANGERS Dangers Ensure scene safety Movement from dangers Movement can worsen the casualty s condition by increasing pain, injury, blood loss or shock. Only move a casualty if there is a clear reason to do so (to ensure safety; in extreme weather or on difficult terrain where movement is essential; to make possible the care of ABCs, perform CPR or control of severe bleeding). Stay with the casualty and send others to seek assistance. The one person drag The one person drag is the best way for the lone rescuer to move the casualty from danger. A blanket may also be used. 6

13 Response Levels of consciousness The casualty s response is a measure of their Level of Consciousness. An initial check of consciousness is performed in the Primary Assessment using the Shout and Tap method. More detailed assessment of a casualty s level of consciousness should be made as part of the Secondary Assessment. The check should be repeated at regular intervals and medical personnel should be advised of any patterns. Patterns may show changes in the casualty s condition. RESPONSE LEVELS OF CONSCIOUSNESS A ALERT and responsive V Drowsy but responds to VOICE P Unconscious, does not respond to voice but responds to PAIN U UNRESPONSIVE Unconscious RESPONSE Talks and responds to questions appropriately. What time of the day is it? What sport were you playing? What town are you in? Talks, but may be anxious, irritable or confused. May repeat questions several times, forgetting that answers have been provided. May start to become drowsy. Obeys instructions: move your arms open your eyes or responds to instructions by grunting, groaning, moving the head or similar attempts to acknowledge. Does not speak or respond to instructions. Moves away from painful stimuli. Moves head away or grimaces when tapped on the shoulder. Does not speak. Does not respond in any way to pain or voice. Consider calling ambulance 111 Consider calling ambulance 111 Consider calling ambulance 111 Send or shout for help call ambulance 111 immediately 7

14 AIRWAY BREATHING Airway If a casualty is unconscious they will be unable to maintain an open airway to allow air to enter the lungs. Opening the airway of a non-breathing unconscious casualty may be the only step required to save their life. Open their airway using Head tilt/ Chin lift as follows: Head tilt/chin lift Breathing When we breathe, the body uses only part of the oxygen we breathe in, so there is still oxygen in the air when we breathe out. This is why the first aider s breath can be used to provide a casualty s oxygen needs. Look, listen and feel for breathing for up to 10 seconds. If a casualty is breathing adequately, position the casualty in the Stable Side Position. See the Stable Side Position, p11 The normal adult breathing rate is breaths per minute (about 2-3 breaths in 10 seconds). Children and infants breathe at a faster rate. Place one hand on the forehead and two fingers of the other hand on the bony part of the chin. Tilt the head back using the hand on the forehead, and at the same time lift the jaw upwards with the fingers of the other hand. 8

15 Breathing difficulties SIGNS AND SYMPTOMS BREATHING DIFFICULTIES: difficulty breathing difficulty speaking anxiety inappropriate or lack of speech noisy breathing, wheezing, coughing MANAGE BREATHING DIFFICULTIES: Call ambulance 111 immediately. Monitor ABCs. Make as comfortable as possible. Encourage casualty to take their medicine. Rest and reassure casualty. Position the casualty in the Stable Side Position. Circulation / CPR The heart beats to pump blood around the body. Breathing is a sign of circulation. If there is no circulation, normal body activity will cease. Commence CPR. If there is no circulation, normal body activity will cease. If not breathing normally: Commence CPR. Call ambulance 111 immediately. Send or call out for the defibrillator (AED). Major bleeding must be managed early to prevent shock developing as the blood volume lowers. Use direct pressure and elevation to control severe bleeding. See Bleeding and Wounds, pp32 34 Minimise shock by laying the casualty down, keeping them warm and reassuring them. Pale, cold sweaty skin, a weak rapid pulse, and rapid breathing indicate shock. BREATHING DIFFICULTIES CIRCULATION/CPR See Shock, p36 9

16 UNCONSCIOUSNESS Unconsciousness Unconsciousness may occur for a number of reasons. Head injury, low blood sugar in diabetes, epileptic seizures and strokes can all result in unconsciousness. You do not need to know the cause to treat unconsciousness. Before the loss of consciousness the person may experience yawning, dizziness, sweating, have changes in skin colour, blurred vision or nausea. MANAGE UNCONSCIOUSNESS: Obtain help. Send someone to call ambulance 111 immediately. Position the casualty in the Stable Side Position. Check for any injury or illness during the Secondary Assessment. Promptly stop any bleeding. DO NOT give the casualty any food or drink. Stay with the person. Identify and assess unconsciousness There are degrees of unconsciousness. A deeply unconscious casualty will not be able to speak or respond to what you say. The level of consciousness AVPU chart on page 7 provides methods to check levels of consciousness. Initially you will have identified unconsciousness during the Primary Assessment using the Shout and Tap method. Assist the unconscious person to the ground and position on their side. Ensure the airway is open. DO NOT leave the person sitting in a chair nor put their head between their knees. Any person who fails to respond or shows only a minor response to simple commands such as open your eyes; squeeze my hand; let it go should be managed as if unconscious. 10 The major danger to an unconscious casualty is airway obstruction from the tongue. Position the casualty in the Stable Side Position (side lying recovery position).

17 Stable Side Position (Recovery Position) The Stable Side Position (a side lying recovery Position) is designed for unconscious, breathing casualties. It helps to maintain an open airway and allows vomit and other fluid to drain freely from the mouth. The Stable Side Position (recovery position) STABLE SIDE POSITION If a casualty is unable to be aroused, is unresponsive (does not respond to your shout and tap i.e. talk and touch commands such as open your eyes or squeeze my hand ), groans without opening their eyes, or does not react to you grasping and squeezing their shoulders firmly to elicit a response, then gently position the casualty in the Stable Side Position (recovery position) while being careful to avoid any twisting or forward movement of the head and spine. The Stable Side Position is sometimes referred to as the recovery or lateral position. Where you suspect neck or spinal injuries in an unconscious casualty, log roll them on their side, supporting their head and keeping the spine in line. See Log Roll, p64 11

18 DRSABCD RESUSCITATION DRSABCD CPR wallet card information DRSABCD Continue CPR until normal breathing returns. Check for DANGERS Check for RESPONSE (Shout and Tap) SEND for help (Dial 111 Consider AED) Open the AIRWAY (Head tilt/chin lift) Check for BREATHING ( Look, listen and feel for breathing for 10 seconds) CIRCULATION/CPR/DEFIBRILLATION (AED) Attach Automated External Defibrillator (AED) as soon as possible. No (Breathing abnormal or absent) Yes (Breathing present) Child (under 8 years) + Infant (0-1 year) Start CPR* (30:2) If alone, go for help after one minute of CPR Defibrillation Attach AED as soon as possible and follow voice prompts Continue CPR until responsiveness or normal breathing returns Adult (over 8 years) Go for help if alone Start CPR* (30:2) Defibrillation Attach AED as soon as possible and follow voice prompts Continue CPR until responsiveness or normal breathing returns The Stable Side Position If not fully responsive or unconscious Monitor ABCs Stop Bleeding Treat Shock Look for other injuries or casualties * See chart opposite 12

19 Resuscitation Open Airway. Check for Breathing. Commence CPR. If available attach AED. Follow voice prompts. DRSABCD RESUSCITATION Adult (over 8 years) Child (1-8 years) Infant (0-1 years) Start with Compressions, push hard Compressions Compressions Compressions 1/3 depth of chest 2 hands centre of chest 1 hand centre of chest 2 fingers just below nipple line Compressions to breaths 30:2 30:2 30:2 Compressions per minute For all your First Aid training needs nationwide phone 0800 RED CROSS ( ) redcross.org.nz 13

20 BASIC LIFE SUPPORT FLOWCHART Basic Life Support Flowchart 14

21 Resuscitation The aim of CPR is to provide oxygen to the brain and heart until appropriate advanced Cardiac Life Support can restore normal heart beat and breathing. Most adults require CPR as a result of a heart problem so an emphasis is placed on calling the ambulance 111 and early CPR. For the purpose of resuscitation an adult is anyone over 8 years of age. Resuscitation should be commenced where the person is unresponsive and not breathing normally. New Zealand Resuscitation Council website nzrc.org.nz Chain of Survival Most sudden cardiac arrests occur outside of hospital with death occurring within minutes of onset. The Chain of Survival lists the priorities and actions to be followed to give the casualty the best chance of surviving sudden cardiac arrest. Prevention Early Recognition Early Access RESUSCITATION CHAIN OF SURVIVAL TO GREATLY IMPROVE THE CHANCE OF SURVIVAL: Get access to advanced care as early as possible (call for help; call ambulance 111 immediately). Start CPR fast. Use an AED (defibrillator) as quickly as possible. Continue CPR until advanced care help arrives. Early CPR Early Defibrillation Early Advanced Care 15

22 RESUSCITATION ADULT 16 Resuscitation Adult CPR action checklist 1 Check for dangers and hazards. Consider safety. 2 Response: Shout and tap the casualty to see if they respond. 3 Send for HELP. Call ambulance 111 immediately. 4 Airway open Position casualty using Head tilt/chin lift. 5 Breathing: Check for normal breathing Look, listen and feel for breathing airflow at the mouth and nose (check for no more than 10 seconds). If not breathing normally, commence CPR. If breathing and unconscious. Position the casualty in the Stable Side Position. Monitor for breathing, treat for shock. Go for help if alone. 6 Circulation / CPR Commence CPR Position casualty laying on their back on a hard, flat surface. Compressions give 30 Compressions. Push hard, push fast (but not too fast). Hands on centre of chest (use heels of hands). Depth: 1/3 depth of chest (5+ cm adult / 5cm child / 4cm infant). Rate of compressions: per minute. Smooth up and down pressure. Minimise pauses. 7 Give two effective rescue breaths, over one second each. An effective breath is completed when the chest begins to rise. 8 Continue CPR at a ratio of 30:2 Give 30 compressions to 2 breaths until help arrives or the casualty begins to breathe. 9 Defibrillation Get and attach AED as soon as possible and follow voice prompts. Use AED as soon as possible for all ages. Open airway Head Tilt Chin Lift Look, listen and feel for breathing (no more than 10 seconds) CPR ratio 30:2 30 compressions: 2 rescue breaths Attach AED as soon as possible Photos courtesy Tracey Kearns

23 Resuscitation Adult DRSABCD CPR (i.e. chest compressions and rescue breathing) is provided for circulation. In some cases, rescuers will not be able to give rescue breaths but should still provide continuous chest compressions at a rate of per minute (for an adult push hard and fast). D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Shout and tap, if unresponsive. S SEND FOR HELP Send or shout for help. Send bystander to call ambulance 111 immediately. Consider AED. A AIRWAY Open airway by using Head tilt/chin lift. B BREATHING Look, listen and feel for breathing for 10 seconds. If not breathing normally COMMENCE CPR. If ALONE, go for help before commencing CPR. RESUSCITATION DRSABCD ADULT C CIRCULATION/CPR Commence CPR: 30 compressions / 2 rescue breaths. Depth: compressions at least 1/3 of the chest depth using two hands centre of chest. Rate: per minute. Each rescue breath delivered over one second. D DEFIBRILLATION If NOT BREATHING NORMALLY, continue with CPR. Attach AED as soon as possible and follow voice prompts. GENERAL CARE Position the casualty in the Stable Side Position. Keep the casualty warm and reassure them. Stay until the ambulance arrives. 17

24 Defibrillation and AEDs DEFIBRILLATION AND AEDS 18 A defibrillator is an electronic device that sends an electrical shock through the casualty s chest in an attempt to restore a normal heart rhythm. Early defibrillation significantly improves the chance of survival. Defibrillators located in places like shopping malls, supermarkets and other public facilities are usually an automatic, easy to use, voice-guided device and are therefore called an Automated External Defibrillator (AED). These can be used by members of the public, even without training. Start CPR on an unresponsive, nonbreathing casualty as soon as the AED is available. Simply turn on the device and follow the voice instructions on how to perform each step that is required. The AED checks the casualty s heart rhythm, decides if a shock is needed and provides step-by-step instruction for CPR. You cannot accidentally shock the casualty as the AED decides on, and delivers, the shock process. It will not shock someone who does not need a shock. If paediatric specific pads are available they can be used on children under the age of 8 years however if they are not available use standard adult pads ensuring the pads do not touch each other. For smaller children, place one pad on the centre of the chest and the other pad on the upper back between the shoulder blades. Pad location is shown on the AED. Modern AEDs are easy to use and can be purchased through New Zealand Red Cross. buy-first-aid-products/buypowerheart-aeds/

25 Resuscitation Child (and infants under 1 year) For the purposes of resuscitation a child is considered to be aged 8 years and below. Unlike adults, children are rarely affected by cardiac arrest due to heart attack. Most non-breathing children are the result of Airway and Breathing problems. When you are alone and the child or baby is not breathing, COMMENCE CPR for one minute then call ambulance 111 immediately. RESUSCITATION CHILD/INFANT CALL FAST When you are alone and the child or baby is not breathing, COMMENCE CPR for one minute then call ambulance 111 immediately. 19

26 RESUSCITATION CHILD/INFANT Resuscitation Child under 8 years (includes infant) CPR Action Checklist 1 Check for Dangers/safety. 2 Check for Response. Shout and tap, pick infant up. 3 Send for help ask bystanders to call ambulance 111 immediately. IF ALONE, stay with the child. Consider AED. Infant (under 1 year) Open Airway. Move head into neutral position 4 Airway open Child Head tilt/chin lift See Adult, p16 Infant Move head into neutral position and support lower jaw as pictured. 5 Check for Normal Breathing. Look, listen and feel for breathing (no more than 10 seconds). IF NOT BREATHING NORMALLY, commence CPR. IF ALONE, go for help after one minute CPR. 6 Circulation / CPR Commence CPR 30 Compressions. Rate of Compressions: per minute. Smooth up and down pressure. Child 1 8 years Position one hand on the centre of the chest. Depth of compressions 1/3 of the chest depth. Infant under 1 year two fingers just below the nipple line. Depth of compressions 1/3 of the chest depth. Look, listen and feel for breathing (no more than 10 seconds) CPR RATIO 30:2 30 compressions: 2 rescue breaths 7 Give two effective rescue breaths (an effective breath is completed when the chest begins to rise). Each rescue breath delivered over one second. 8 Continue CPR at a ratio of 30:2 IF ALONE, go for help after one minute of CPR. Give 30 compressions to 2 breaths until there is either a response from the child or until help arrives. 9 If child begins to breathe position in the Stable Side Position and monitor breathing. Child (1 8 years): Attach AED as soon as possible (use paediatric pads if available) 20 Photos courtesy Tracey Kearns

27 Resuscitation Child under 8 years (includes infant) DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) If casualty is unresponsive. S SEND FOR HELP Send or shout for help. Send bystander to call ambulance 111 immediately. IF ALONE, stay with the child. Consider AED. RESUSCITATION DRSABCD CHILD/INFANT A AIRWAY Child 1 8 years Open airway by Head tilt/chin lift. Child under 1 year Open airway by moving head into neutral position. B BREATHING Look, listen and feel for breathing for 10 seconds. IF NOT BREATHING normally; COMMENCE CPR. IF ALONE, go for help after one minute of CPR. C CIRCULATION/CPR Continue CPR 30 compressions : 2 rescue breaths (30:2). Rate of compressions: per minute. Child Compressions 1/3 of the chest depth. Infant Compressions 1/3 of the chest depth. Each rescue breath should be delivered over one second. IF ALONE, go for help after one minute CPR. D DEFIBRILLATION Attach AED as soon as possible and follow voice prompts. For smaller children, place pad on the centre of the chest and the other pad on the upper back between the shoulder blades. GENERAL CARE Position the casualty in the Stable Side Position. Keep the casualty warm and reassure them. Stay until the ambulance arrives. 21

28 Drowning (Including non-fatal drowning and incidents involving water) DROWNING Always consider your own safety before attempting to enter the water. Deep and moving water e.g. rivers and surf, are additional risks for the first aider. Rescue from land or a craft such as a boat and noncontact rescues are preferred. Providing floatation to the casualty in distress is a priority especially when immediate removal from the water is not possible. Items such as rugby balls, empty 2L milk/soft drink bottles and chilly-bin/s can be used as improvised flotation aids. Where possible, reach out to the casualty with a branch, pole or beach umbrella from land or no deeper than waist-depth water. Throw a rope if one is available. Only enter water above waist depth with some form of flotation for yourself. Recognising a person drowning can be difficult; if you are unsure call out to the person Are you okay? Most drowning persons are unable to call out or wave for help. SIGNS AND SYMPTOMS DROWNING: difficulty in breathing or breathing stopped frothing around the mouth/nose little or no response altered level of consciousness after incident involving water Be prepared If regurgitation occurs, quickly roll the person onto their side and clear the airway. Once the airway is clear, roll them onto their back and re-commence CPR. Do not interrupt CPR for more than a few seconds to do this. All non-fatal drowning casualties (i.e. anyone who has experienced water-related distress) must be seen by a medical professional. Drowning Chain of Survival A call to action 22 Ref: Szpilman, D et al. (2014)

29 MANAGE DROWNING: Call for help as soon as possible. Remove any unconscious person from the water as safely and quickly as possible. Suspected spinal injury must not delay removal from the water or starting CPR. Assess the person on their back with the head and body at the same level. Only attempt CPR when the person is on a flat, firm surface. DROWNING DRSABCD: Dangers check for safety/ hazards/risks. Ensure safety for self, casualty and bystander. Response (AVPU) check response. Shout and tap. Send for help call for ambulance 111 immediately. Call for AED. Airway Head tilt/chin lift. Breathing If not breathing normally, start CPR 30:2 immediately. Be aware that the person may have swallowed water and may vomit, or regurgitation may occur (see note). If breathing, position the casualty in the Stable Side Position. Circulation/CPR Drowning casualties require full CPR with rescue breaths AND chest compressions. Defibrillation use AED if not breathing normally. General Care Position the casualty in the Stable Side Position when breathing on own again. Keep warm. Seek medical assessment. Choking Any person who indicates they are choking or are clutching their neck should be considered as possibly having a foreign body airway obstruction, i.e. choking. They may suddenly stop breathing and fall unconscious for no apparent reason. The management of choking will depend on the degree of airway blockage and whether the casualty is conscious or unconscious. SIGNS AND SYMPTOMS CHOKING: The choking casualty is often identified by the history surrounding the event: an adult eating a meal begins to cough and wheeze a child playing tag and eating lollies is found unconscious and not breathing an infant sitting by a brother or sister eating peanuts stops breathing In these situations a foreign body airway obstruction should be suspected. In addition, the choking casualty may: clutch at their neck be unable to talk, cough or breathe CHOKING 23

30 Choking Adult CHOKING ADULT 24 MANAGE ADULT CHOKING: Dangers, check for hazards and risks, consider safety. Responsiveness ask the casualty; Are you choking? Send for help ask bystander to call ambulance 111 immediately. If the casualty is coughing they should be encouraged to continue with attempts to expel the foreign body. If the casualty is unable to talk, cough or breathe, the obstruction should then be managed using Back Blows and, if needed, Chest Thrusts. The Heimlich Manoeuvre is no longer common practice in this situation. BACK BLOWS: If the airway is completely obstructed, give up to 5 back blows to attempt to clear the airway. Back blows should be performed as follows: Stand to the side and slightly behind the casualty. Support his/her chest with one hand and lean or bend him/ her well forward, so that when the obstructing material is dislodged, it comes out of the mouth rather than going further down the airway. Give up to 5 sharp blows between the shoulder blades with the heel of your other hand. Each individual blow should be a separate action, with the intent of relieving the obstruction. If the obstruction is not relieved by back blows, give up to 5 chest thrusts. Chest thrusts Chest thrusts create an artificial cough intended to move and expel the foreign body obstructing the airway. Chest thrusts should only be performed on conscious casualties. If the casualty becomes unconscious, commence CPR.

31 CHEST THRUSTS IF CONSCIOUS: Deliver up to 5 chest thrusts if necessary. Stand behind the casualty, place your arms under the casualty s armpits and wrap or encircle the casualty s chest. Make a fist with one hand and place the thumb side of the fist against the middle of the sternum, i.e. over the breastbone, avoiding the lower tip. (The location is the same as that used in the chest compressions for CPR.) Grasp the fist with the other hand. Give a quick inward thrust by pulling the fist towards you in a quick movement. Administer up to 5 chest thrusts until the object is dislodged or the casualty becomes unconscious. Back blows and chest thrusts aim to remove the obstruction with each action rather than deliver all five each time. If unconscious start CPR. CHOKING ADULT MANAGEMENT OF FOREIGN BODY AIRWAY OBSTRUCTION (CHOKING) Assess Ineffective Cough Severe airway obstruction Effective Cough Mild airway obstruction Unresponsive Send for help Start CPR Responsive Send for help Give up to 5 back blows If not effective Give up to 5 chest thrusts Encourage coughing Continue to check casualty until recovery or deterioration Send for help (Ref NZRC) 25

32 OBSTRUCTED AIRWAY CONSCIOUS Obstructed airway Conscious Obstructed airway cycle adult / child 1 8 years conscious The complete actions for dealing with choking in a conscious adult are as follows: Encourage them to cough If the adult / child casualty becomes unconscious or is found unconscious If foreign body obstruction is suspected, then follow the standard DRSABCD sequence for child / adult CPR. If solid material is visible in the mouth remove with a gentle finger sweep. Repeat the sequence of airway examination/attempted rescue breaths/chest compressions until the object becomes dislodged or advanced help arrives. 5 chest thrusts 5 back blows CONTINUE CYCLE until obstruction is removed. If casualty becomes unconscious begin CPR. 26

33 Obstructed airway Unconscious Obstructed airway cycle adult / child 1 8 years unconscious Follows DRSABCD sequence for adult / child. The actions for dealing with choking in an unconscious adult are as follows: Notes OBSTRUCTED AIRWAY UNCONSCIOUS Commence 30 chest compressions per minute (as for CPR) Unsuccessful Look for obstruction in mouth, remove if object is visible Attempt 2 rescue breaths CONTINUE CYCLE until breathing or medical help arrives. 27

34 CHOKING CHILD DRSABCD AUDULT/CHILD Choking Child There are some changes made to choking techniques when dealing with a child or baby. The major differences are outlined below. CHILDREN: Open the mouth. If a foreign body is seen, remove it: only finger sweep if a foreign body is seen. Children aged 1 8 years who are choking and conscious are to be treated the same as adult choking. Choking Adult and child 1 8 years DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Check for response. S SEND FOR HELP Send / shout for help. Send bystander to call ambulance 111 immediately. Consider AED. A AIRWAY If RESPONSIVE use choking manoeuvres. Encourage casualty to cough or use back blows and chest thrusts. B BREATHING Continue choking manoeuvres until casualty is breathing. If casualty becomes unconscious commence CPR. C CIRCULATION/CPR If UNRESPONSIVE and not breathing, commence CPR. D DEFIBRILLATION 28

35 Choking Infant (baby under one year) Infant choking the sequence for conscious infants is quite different and is stated below: INFANT (UNDER 1 YEAR): CONSCIOUS CHOKING INFANT (UNDER 1 YEAR): UNCONSCIOUS CHOKING CHOKING INFANT 1 Place the infant down straddling your arm with the head lower than the trunk and the head supported with the hand around the jaw. 2 Deliver 5 back blows between the shoulder blades with the heel of your hand. 3 Sandwich the infant between your arms (all the while supporting the neck of the infant). Turn the infant over and deliver 5 chest thrusts using two fingers, just below the nipple line. 4 Check the airway. If you see a foreign body, gently hook it out, but avoid blind finger sweeps. 5 Repeat as necessary. 1 Place the baby on a firm surface (e.g. table). 2 Open the airway to a neutral position, look for and remove any foreign objects using a finger sweep; and look, listen and feel for breathing (no longer than 10 seconds). 3 Give 30 compressions. 4 Reposition head, give 2 small gentle rescue breaths (puffs). 5 Continue CPR 30:2 cycle, until object is dislodged and baby is breathing, or medical help has arrived. See Infant CPR, p20 29

36 CHOKING CONSCIOUS INFANT Choking Conscious infant (baby under one year) Conscious infant with obstructed airway The actions for dealing with choking in a conscious infant are as follows: 5 back blows Sandwich turn 5 chest thrusts Head is held lower than the body and is firmly supported at all times. Check mouth, remove object if visible. If unsuccessful, repeat cycle. SANDWICH TURN If the casualty becomes unconscious, follow the standard sequence for infant (baby under one year) CPR, checking airway for obstruction (opposite page). 30

37 Choking Unconscious infant (baby under one year) Place infant on firm surface Open airway to neutral position, check for normal breathing. Look for and remove foreign objects. 30 compressions per minute 2 small gentle rescue breaths (puffs) REPEAT THE SEQUENCE Deliver CPR rescue breaths / chest compressions until the object becomes dislodged or advanced help arrives. Choking Infant (baby under one year) DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Check for response. S SEND FOR HELP Send / shout for help. Send bystander to call ambulance 111 immediately. Consider AED. A AIRWAY If RESPONSIVE use choking manoeuvres. Clear by encouraging casualty to cough or use back blows and chest thrusts. B BREATHING Continue choking manoeuvres until casualty is breathing. If casualty becomes unconscious commence CPR. C CIRCULATION/CPR If UNRESPONSIVE and not breathing commence CPR. D DEFIBRILLATION If available, attach AED and follow the prompts. CHOKING UNCONSCIOUS INFANT DRSABCD INFANT 31

38 Bleeding Wounds BLEEDING WOUNDS Identify and assess bleeding Blood loss may occur either internally or externally. In internal bleeding there may be no visible blood, and it will be the signs and symptoms of shock that alert the first aider to the loss of blood. In external blood loss the quantity and colour of blood will vary depending on the type of blood vessel damaged. Blood vessel type ARTERY VEIN CAPILLARY Characteristics of bleeding Bright red blood, spurting in response to heart beat. Dark red in colour, flows steadily. Blood oozes gently. SIGNS AND SYMPTOMS BLEEDING: pain bleeding cold sweaty skin, feeling cold pale appearance signs of shock Wounds in areas with a good blood supply will bleed a lot. A large amount of blood can be lost from a very small cut in areas such as the scalp. The first aider, using standard precautions (such as gloves and protective glasses) should always expose the wound site to determine the seriousness of the injury. If the wound is covered by clothing, remove clothing from the affected area to see the wound. If necessary, cut clothing. Protect yourself from infection by wearing gloves when blood is present. When possible encourage the casualty to apply direct pressure using their own hand to limit your contact with blood. The use of tourniquets and haemostatic dressings may be used in first aid when direct wound pressure fails to control severe bleeding or cannot be applied, and the first aider is trained in their use. If gloves are not available, using plastic bags as makeshift gloves is a good alternative. 32

39 THINK RED Rest & Reassure Expose Dressing & Direct Pressure MANAGE EXTERNAL BLEEDING: Put on gloves to ensure your personal safety. If possible, lay the casualty down comfortably and rest the injured area. Expose the wound to determine the extent of the problem. Carefully and gently cut away clothing if necessary. Attempt to stop the bleeding by applying sustained and direct (or indirect) pressure. Cover the wound. Place a clean non-fluffy dressing pad or bandage over the wound and apply firm sustained direct pressure, or apply indirect pressure on or near the wound. If there is a foreign object embedded in the wound, DO NOT remove it, use indirect pressure over bandages. See Embedded objects in wounds, p34 DO NOT remove clots that have formed. If blood comes through the first dressing, place another pad over the first without removing the original pad or apply a tighter dressing. If bleeding continues check pressure is being applied directly on the wound. Continue to control bleeding by direct or indirect pressure with compression bandage if necessary. The need to control bleeding is paramount. Restrict movement and immobilise the part. Monitor ABCs. Total rest and reassure the casualty. Treat for shock, use the DRSABCD Basic Life Support Flowchart. See p4 DO NOT give anything to eat and drink. CALL AMBULANCE 111 IMMEDIATELY IF: Bleeding is severe. Bleeding is not controlled. Is not breathing normally or is unresponsive. TO HELP CONTROLL BLEEDING: Restrict movement. Immobilise the bleeding part. Advise the person to remain at total rest. Use a cold pack and pressure to a bruised limb which has no signs of external bleeding. If life threatening, severe and uncontrolled bleeding, a tourniquet or haemostatic bandage may be used if the first aider is trained to do so. WOUNDS 33

40 EMBEDDED OBJECTS IN WOUNDS MINOR WOUNDS Embedded objects in wounds Foreign bodies that are clearly on the surface and not sticking to the wound may be removed. However DO NOT remove embedded objects. MANAGEMENT OF ALL BLEEDING: Apply direct or indirect pressure. Reassure the person and assist to rest in a comfortable position. Monitor DRSABCD regularly. DO NOT give anything by mouth (including medications or alcohol). Minor wounds CLEANING A MINOR WOUND: Cover the wound and seek medical treatment if the wound looks dirty. Clean the wound if it will not require medical treatment. Carefully clean around wound with mild soap and water. Clean wound with running, clean, lukewarm water. DO NOT rub the wound itself. Dry with a clean pad. Cover with a Band-aid type dressing or gauze pad and bandage. Leave embedded objects where they are as they may be plugging the wound. Closed bleeding in limbs Use a cold pack and apply pressure on bruised limbs with no external bleeding. Pad beside, below and around the object and apply pressure over pads to prevent direct pressure being applied over the object. 34

41 Internal bleeding Is difficult to recognise but always consider this if there are signs and symptoms of shock. Includes bruises, hematomas, bleeding with fractures, severe bleeding from pregnancy. SIGNS AND SYMPTOMS INTERNAL BLEEDING: pain, swelling, tenderness over or around the area, blood from body opening bright red, frothy blood, coughed up from lungs bright red or dark brown vomited blood blood stained urine genital bleeding bright red or black rectal bleeding MANAGE INTERNAL BLEEDING: Internal bleeding may be life threatening and require urgent hospital treatment. Call ambulance 111 Bleeding DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. Wear gloves. R S RESPONSE (AVPU) Check for response. SEND FOR HELP Consider calling ambulance 111. Consider AED. A AIRWAY Check airway. B BREATHING Check breathing. C CIRCULATION/CPR Control bleeding, treat for shock. D DEFIBRILLATION Consider AED for severe bleeding. SPECIFIC CARE Think RED Rest and Reassure. Expose. Dressing and Direct or Indirect Pressure. Add more bandages if blood seeps through. Monitor ABCs. Restrict movement, immobilise the injury, keep casualty at total rest. GENERAL CARE Keep casualty warm and reassured. DO NOT give anything to eat or drink. INTERNAL BLEEDING DRSABCD 35

42 Shock SHOCK Shock occurs when not enough oxygen-rich blood reaches parts of the body, and causes life-threatening organ failure. Shock may be seen in most serious injuries involving fluid loss such as severe bleeding, major trauma, burns or illness involving diarrhoea, dehydration, vomiting, an allergic reaction, heart attacks or heart problems. Shock is considered life threatening. Call ambulance 111 immediately. SIGNS AND SYMPTOMS SHOCK: The signs and symptoms apparent in shock may include the following: irritability, restlessness, confusion or anxiety pale, cold, moist skin weak, rapid pulse rapid breathing feeling sick, vomiting feeling faint, dizziness collapse, unconsciousness may develop MANAGE SHOCK: If conscious, lay casualty down on their back. If unconscious, lay the casualty down on their side. Call ambulance 111 immediately. Where possible, treat the cause of the shock; promptly stop bleeding, cool burns. Keep the casualty warm. Reassure the casualty. Loosen restrictive clothing. DO NOT give food, drink, or cigarettes. Monitor vital signs and ABCs. Follow the Basic Life Support Flowchart. See p14 Most injuries and many illnesses give some degree of shock. 36

43 Fainting Fainting is the brief loss of consciousness caused by a temporary decrease in blood flow to the brain. Some people faint at the sight of blood or as a reaction to pain or bad news. A common reason for fainting is standing in one position without moving for a long period of time. SIGNS AND SYMPTOMS FAINTING: A casualty who has fainted may feel giddy, unsteady and weak and may: fall to the floor or slump in a chair and become unconscious have pale, sweaty skin have a slow pulse MANAGE FAINTING: Lie the casualty down and raise their legs for a few minutes. Loosen tight clothing. Position the casualty in the Stable Side Position if unconscious. Call an ambulance if the casualty remains unconscious for more than five minutes. Reassure casualty on recovery. FAINTING 37

44 Check for other conditions and injuries CHECK FOR OTHER CONDITIONS AND INJURIES History Recheck vital signs Check for other conditions and injuries HISTORY Question casualty and bystanders RECHECK VITAL SIGNS Vital signs are the level of consciousness and breathing CHECK FOR INJURIES Continue to monitor DRSABCD 38

45 History HISTORY: Ask the casualty and / or bystanders what happened, record if possible. Observe evidence at the scene, e.g. pill bottles, chemical containers. Notes Recheck vital signs and act as required Check vital signs as detailed below, until an ambulance arrives. LEVEL OF RESPONSE AND BREATHING: Check the breathing rate of the casualty by counting breaths taken over one minute. The rate of breathing can be controlled at will, so do not advise the casualty of your check. Remember the absence of response and absence of normal breathing is all that is required to indicate that CPR should be given. Begin CPR immediately by delivery of chest compressions, ask for a defibrillator (AED) and follow the voice prompts. HISTORY VITAL SIGNS The vital signs check should be repeated and recorded at 10 minute intervals. 39

46 Consciousness Notes LEVEL OF CONSCIOUSNESS RESPONSIVENESS: Determine the casualty s level of consciousness. Levels of consciousness CONSCIOUSNESS A ALERT Fully responsive or may be confused or become drowsy V Responds to VOICE, drowsy P Responds to PAIN, is unconscious U UNRESPONSIVE, unconscious 40

47 Check for injuries The human body is fairly similar on both sides. This allows us to compare the two sides when inspecting for injury. The body check is carried out head to-toe. If you find an injury it will be necessary to remove clothing to know the size, type and severity of injury. DO NOT remove or damage more clothing than necessary. Ensure the casualty s privacy. Check for MedicAlert emblem MedicAlert is a worldwide organisation which provides protection for 125,000 New Zealanders with life-threatening medical conditions. Members are issued with a metal emblem engraved with the member s number, emergency telephone number and medical conditions; plus a plastic wallet card providing more detailed personal and medical records. Paramedics have immediate access to the database for special care. In an emergency look for the MedicAlert emblem, e.g. on a bracelet, necklace or anklet. CHECK FOR INJURIES MEDICALERT medicalert.co.nz Always ask the casualty s permission to do a body check and explain what you are doing. 41

48 Heart attack HEART ATTACK The heart, like any other muscle in the body, needs a blood supply to provide it with oxygen. A heart attack occurs when there is a reduction in the blood supply to a part of the heart muscle, damaging the heart. SIGNS AND SYMPTOMS HEART ATTACK: The casualty may think they just have indigestion. Some or all of the following symptoms may be present: pale appearance heavy pressure, tightness, vice-like crushing pain or unusual discomfort in the centre of the chest pain may spread to the shoulders, neck, jaw, arms or back profuse sweating, cold sweaty skin sudden fainting or dizziness; feels light-headed shortness of breath, with rapid breathing and gasping for air; difficulty speaking lips turning blue anxiety collapse, unconsciousness HEART ATTACK Call ambulance 111 immediately. MANAGE HEART ATTACK: Encourage the casualty to rest quietly, in a comfortable position; reassure them. Call ambulance 111 immediately. Ask the casualty if they are allergic to aspirin. If not, give casualty one tablet (300 mg) to chew, or take soluble aspirin dissolved in a small amount of water. Monitor ABCs and vital signs. A heart attack may lead to cardiac arrest. Be prepared to perform resuscitation. Locate the closest AED; bring it to the person ready to use if needed. 42

49 Angina Angina is the pain felt when there is temporarily insufficient blood flow to the heart to meet the heart s needs. Permanent heart muscle damage does not result. Most angina attacks will be managed by the casualty by rest and medication. If the casualty does not respond to resting and taking their medication consider and treat as a heart attack. SIGNS AND SYMPTOMS ANGINA: Angina is characterised by: pain in the chest, neck, jaw or arms brought on by effort or excitement sweaty, pale skin shortness of breath; difficulty speaking anxiety MANAGE ANGINA: Most people with a history of angina carry medication with them. This medication may be a spray or tablet, which is taken under the tongue. Encourage the casualty to rest quietly. Help the casualty loosen tight clothing. Call ambulance 111 immediately. If the casualty has medicine they should take it. Make as comfortable as possible. ANGINA ANGINA Occurs on effort or excitement. May be relieved by rest or medication. HEART ATTACK May occur at rest. Not relieved by rest or medication. 43

50 Heart health A healthy lifestyle will promote heart health and reduce the risk of heart disease. Use the table on the next page to determine your risk of heart disease and identify areas where lifestyle modifications may improve your heart health. HEART HEALTH RISK GUIDE HEART HEALTH RISK FACTORS YOUR SCORE Cigarette smoking Non-smoker 15 or less daily Over 15 daily Blood pressure Low or normal Raised or not known Cholesterol and fat levels in blood High 4.5 mmol/l mmol/l Over 5.5 mmol/l Weight Normal Overweight Obese Diabetes No diabetes Family history of diabetes Exercise Behavior type & stress Family history Vigorous, on most days Easy going, contented, rarely tense No premature heart disease Vigorous, once or twice weekly Often hurried, anxious, intolerant Heart disease before age 55 Diabetic Usually inactive Hurried, competitive, aggressive Age Under 40 yrs yrs Over 50 yrs TOTAL POINTS 44 HOW DID YOU SCORE? 0 2 points Low risk 3 5 points Moderate risk 6 9 points Excessive risk 10 or more High risk MODIFY LIFESTYLE When modifying your lifestyle consideration should firstly be given to stopping smoking, having your blood pressure checked regularly and reducing fat intake in your diet. For a fuller risk assessment, or further advice, see your doctor.

51 Heart attack action plan Does the person feel any PAIN PRESSURE HEAVINESS TIGHTNESS In one or more of their CHEST NECK JAW ARM/S BACK SHOULDER/S They may also feel NAUSEOUS A COLD SWEAT DIZZY SHORT OF BREATH 1 STOP stop the person from what they are doing and tell them to rest. 2 TALK ask them what they are feeling. If they take angina medicine: Take a dose of medicine. YES Wait five minutes. Does the casualty still have heart attack symptoms? Take another dose of angina medicine. Wait five minutes. Does the casualty still have heart attack symptoms? Or access: Are symptoms severe? Getting worse quickly? Have lasted for 10 minutes? HEART ATTACK ACTION PLAN YES 3 CALL an ambulance now administer aspirin (300mg) if available. In New Zealand: Call 111 In Australia: Call 000 (or 112) Don t hang up. Wait for the operator s instructions. Adapted with permission from the National Heart Foundation of Australia. Warning signs action plan. Melbourne: National Heart Foundation of Australia, 2012 ANZCOR Guidelines January

52 Stroke STROKE A stroke occurs when the blood supply to the brain is impaired by a blood clot or burst blood vessel. Call for medical help. Call ambulance 111 immediately. SIGNS AND SYMPTOMS STROKE: The specific symptoms of a stroke will vary depending on the part of the brain affected. Some or all of the following will be present: sudden severe headache signs of weakness or paralysis, loss of movement on one side confusion, dizziness, loss of balance or an unexpected fall drowsiness loss of vision, sudden blurred or decreased vision in one or both eyes inability to speak or inappropriate words chosen noisy breathing wheezing / coughing the casualty may be conscious but unconsciousness may develop 46

53 Quick recognition and response makes all the difference Chances of survival and prospects of recovery from a stroke dramatically increase when casualties receive emergency support within three hours of having a stroke. Therefore, rapid recognition of warning signs and the immediate call of emergency services is crucial. MANAGE A STROKE: Call ambulance 111 immediately. If conscious lie down with head and shoulders supported by pillows. If unconscious position the casualty in the Stable Side Position. Monitor ABCs, level of consciousness and vital signs. Rest and reassure the casualty. Reduce risk of stroke There are 8,000 strokes nationwide each year; on average, this is one every hour. To reduce the risk of a stroke and get the most out of life, the following seven steps are recommended for all New Zealanders. 7 steps to reducing your risk of stroke 1. Get your blood pressure checked and if necessary treated. 2. Stop smoking. 3. Exercise regularly. 4. Limit the amount of alcohol you drink. 5. Eat a healthy balanced diet, control your weight and reduce your salt intake. 6. Get your cholesterol checked and if necessary treated. 7. Find out if you have Atrial Fibrillation (rapid, irregular contraction of the heart) STROKE 47

54 Diabetic emergency DIABETIC EMERGENCY In diabetes the body is unable to control the blood sugar level. This may result in the blood sugar level being too high or too low. High blood sugar (hyperglycaemia) Hyperglycaemia develops slowly and is unlikely to be a first aid emergency. Low blood sugar (hypoglycaemia) SIGNS AND SYMPTOMS LOW BLOOD SUGAR: Will result in: headache, hungry, tired pale appearance cold, sweaty skin the shakes aggression or confusion unconsciousness may develop many diabetics wear MedicAlert emblem bracelets, necklaces or anklets signs of shock MANAGE LOW BLOOD SUGAR IF CONSCIOUS: Give sugary food: glucose, jelly beans, honey, sugar or sugary drink. Improvement should occur within five minutes. Rest and reassure casualty. Monitor ABCs. IF UNCONSCIOUS: Check ABCs. Position the casualty in the Stable Side Position. Call ambulance 111 immediately. 48

55 Seizures Seizure could be result of: excessive heat head injury pregnancy epilepsy cardiac arrest other medical conditions Epileptic seizures occur as the result of a sudden, brief electrical discharge taking place in the brain. They can take several different forms. The form that is most well known and most frequent is called tonic clonic seizures. These seizures usually occur in people who have epilepsy, but also occur in young children who have an infection associated with a high temperature. SIGNS AND SYMPTOMS EPILEPTIC SEIZURES: In tonic clonic seizures the following pattern is generally seen: the person loses consciousness the body stiffens briefl muscular contractions begin muscular contractions cease consciousness is regained the person may feel sleepy or be confused During the seizure saliva may appear at the mouth. If the tongue or mouth has been injured the saliva may be bloodstained. Bladder or bowel control may be lost. Do not restrain the person, nor put anything in their mouth. SEIZURES 49

56 SEIZURES MANAGE SEIZURES: Make the area safe. Protect the person from harm or injury. Keep bystanders away. Maintain privacy. Check for a MedicAlert bracelet or necklace. DO NOT restrain person, or put anything in the mouth. When muscular contractions end, position the casualty in the Stable Side Position. Ensure the airway is clear. Follow DRSABCD sequence. Rest and reassure casualty. Call ambulance 111 immediately if: the muscular contractions last longer than five minutes or more than one seizure occurs casualty has head injury casualty is pregnant if this is their first seizure other injury has occurred if the seizure is in water Convulsions due to excessive heat Convulsions in young children often occur due to high temperature during an illness (febrile convulsions) but can occur in adults also. The management aim is to reduce the high temperature: If unconscious ensure airway is clear and position the casualty in the Stable Side Position. Remove excess clothing. Sponge skin with lukewarm water. Seek medical advice as hospitalisation may be required. 50

57 Hyperventilation Asthma Hyperventilation, or over-breathing, is when the breathing rate or depth is increased, which can sometimes be triggered by anxiety. SIGNS AND SYMPTOMS HYPERVENTILATION: Includes: numbness tingling spasm of the hands MANAGE HYPERVENTILATION: Reassure the casualty. Sit them down and stay with them. Encourage them to breathe slowly with deep breaths. Ask the casualty to breathe with you, slowly and deeply. People with asthma have sensitive airways which may require daily medication to keep it under control. When an asthma attack occurs the sensitive airways are irritated by triggers which causes the muscles surrounding the airways to tighten, swell, narrow and make extra mucus making breathing very difficult. Triggers are individual to the person and may include things like; respiratory infection; irritants (smoke, perfume, cleaning products); allergens (dust, mould, grass, pollen); cold air, exercise, laughing, crying, emotions; nonsteroidal anti-inflammatories (aspirin); food allergy, food colours and flavours. Most people with asthma carry a reliever and often have a Asthma First Aid Plan. SIGNS AND SYMPTOMS ASTHMA: The casualty may experience: difficulty breathing wheezing, noisy breathing ɠ ɠ sucking in of throat and ribs coughing, tight chest difficulty speaking in sentences anxiety, feeling distressed pale, sweaty skin blueness around the mouth HYPERVENTILATION ASTHMA 51

58 MANAGE ASTHMA: A ASSESS Mild short of breath, wheeze, cough, chest tightness responds quickly to reliever inhaler. Moderate loud wheeze, breathing difficulty, can only speak in short sentences. Severe distressed, gasping for breath, difficulty speaking two words, blueness around the mouth. (If the person has severe asthma or is frightened, call ambulance 111 immediately.) S SIT Sit the person upright and stay with them. If a mild attack treat with two doses of reliever inhaler. ASTHMA T TREAT Treat with a reliever inhaler giving one puff at a time. Use a spacer if one is available. If the casualty does not have a reliever inhaler it is OK to use someone else s if there is one available. H HELP If the casualty is not improving, call an ambulance. Continue to use the reliever inhaler giving six doses every six minutes until help arrives. Remember 6:6:6. Six puffs of reliever given one at a time through a spacer. Six breaths per puff. Six minute wait. In this situation you will not overdose the person by giving them the reliever every few minutes. M MONITOR If breathing is improving, monitor the casualty. If necessary repeat the dose of reliever inhaler. A ALL OK When free of wheeze, cough or breathlessness keep the casualty calm and return to a quiet activity and advise them to see their doctor. Monitor ABCs. 52

59 Medical conditions drsabcd D R HEART ATTACK ANGINA STROKE DIABETES (HYPOGLYCAEMIA) SEIZURE INFANTILE CONVULSION ASTHMA DANGERS Safety Safety Safety Safety Safety Safety Safety RESPONSE AVPU AVPU AVPU AVPU AVPU AVPU AVPU S SEND FOR HELP Call ambulance 111 immediately. Consider AED Call ambulance 111 immediately. Consider AED Call ambulance 111 immediately. Consider AED Consider 111 Consider AED Consider 111 Consider AED Consider 111 Consider AED Consider 111 Consider AED A B AIRWAY Check Check Check Check Check Check Check BREATHING Check Be prepared to do CPR Check Check Check Check Check Check C CIRCULATION/ CPR Check Check Check Check Check Check Check D DEFIBRILLATION Check Check Check Check Check Check Check SPECIFIC CARE Aspirin Nitrolingual spray GENERAL CARE Rest and reassure Rest and reassure The Stable Side position if unconscious Rest and reassure Give sugar / carbohydrate if conscious Stay with casualty until recovered Protect from injury Stay with casualty until recovered Cool casualty Position as most comfortable for breathing. Assist with medications Keep casualty cool Reassure MEDICAL CONDITIONS DRSABCD 53

60 Musculoskeletal fractures A fracture describes a break or crack in the bone. Different types of fractures can occur: MUSCULOSKELETAL FRACTURES Open fracture A wound is present at the fracture site. Often the bone will come out through the skin. Complicated fracture The broken bone damages neighbouring organs, nerves or blood vessels, e.g. ribs damage the lung. Closed fracture A bone is broken but the skin is not broken. In children, whose bones are more flexible, the bone may not break completely, it may just bend or splinter on one side of the bone. 54

61 SIGNS AND SYMPTOMS FRACTURES: A fracture may be indicated by: pain at the injury site swelling and tenderness deformity of the injured area inability to use the injured area normally, loss of movement bleeding, blood loss, internal or external, resulting in shock and pale appearance Fractured nose, see p63 MANAGE FRACTURES: Use gloves. Call ambulance 111 immediately, except for minor fractures (e.g. fractured fingers). Treat bleeding with pressure around the wound if possible. Check every 10 minutes for colour, warmth and swelling. Apply dressing. Cover bone ends with clean non-fluffy material. Support and stabilise the injured area (pillow/blanket). Apply sling if arm injury. DO NOT splint fractures unless ambulance assistance is delayed or you must move the casualty. Check and treat for shock. Make as comfortable as possible. Keep warm, rest and reassure casualty. MUSCULOSKELETAL FRACTURES Apply pressure to bleeding. Support and immobilise the injured area. 55

62 Dislocations DISLOCATIONS A dislocation occurs where bones meet at joints. In a dislocation the bones are moved from their normal position. Common sites for dislocations are the shoulder, knee, elbow and fingers. SIGNS AND SYMPTOMS DISLOCATIONS: A dislocation may be indicated by: severe pain deformity of the affected joint swelling loss of movement If you are not sure whether a fracture or dislocation has occurred, treat the injury as a fracture. MANAGE DISLOCATIONS: Stabilise and support the area in its injured position. Apply a cold pack to reduce swelling. Call an ambulance except for minor dislocations e.g. fingers. DO NOT try to reposition into original position. Do not try to reposition the bones to their original position. 56

63 Soft tissue injuries / bruising The muscles, ligaments, tendons and skin of the body are collectively known as soft tissue. Soft tissues are able to be stretched slightly, but they can be injured by overstretching or tearing. SIGNS AND SYMPTOMS SOFT TISSUE INJURIES: Soft tissue injuries (sprains and strains) may cause: pain swelling and bruising decreased ability to perform normal movement skin discolouration MANAGE SOFT TISSUE INJURIES R.I.C.E. TREATMENT: Stop the activity when injury occurs, sit casualty down. Rest the area for 48 hours. Apply an Ice pack wrapped in a towel, or a cool-pack for 20 minutes at 3 4 hour intervals. Apply a firm Compression (stretch) bandage to the area between ice applications. Elevate the area (use pillow or blanket). Rest Ice Compression Elevation Diagnosis SOFT TISSUE INJURIES Ice can burn. Never apply ice directly to the skin; always wrap the ice in material. Where available apply oil to the skin before applying an ice pack. 57

64 Fractures and soft tissue injuries DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. FRACTURES AND SOFT TISSUE INJURIES DRSABCD R RESPONSE (AVPU) Check for response using AVPU. S SEND FOR HELP Call ambulance 111 immediately for severe fractures. A AIRWAY Check airway clear. B BREATHING Check for breathing. C CIRCULATION/CPR Treat for shock. D DEFIBRILLATION SPECIFIC CARE Stabilise fractures. Apply R.I.C.E. for sprains and strains. Seek medical advice if: Injury does not improve in 48 hrs. Injury does not respond to R.I.C.E. GENERAL CARE Keep casualty warm. Reassure. 58

65 Spinal injuries The bones of the spine protect the delicate spinal cord which lies within. The spinal cord is the nerve link from the brain to the body. Spinal injuries can damage the spinal cord permanently. SIGNS AND SYMPTOMS SPINAL INJURIES: Spinal injuries should be suspected when the casualty has: fallen from a height or fallen awkwardly experienced direct force to the head or neck, or gunshot suffered a head injury a sporting injury (e.g. rugby or falling from horse) experienced a deceleration accident, e.g. motor vehicle or bicycle accident dived or jumped into shallow water Apart from a careful examination of the history, spinal injury should also be suspected when the casualty experiences: Loss of (or abnormal) sensation, e.g. tingling or numbness in limbs. Loss of (or abnormal) movement, weakness or paralysis. Pain in the spinal area. Breathing changes, changes in pain or muscle tone. Headache or dizziness, nausea, altered conscious state. Loss of bladder or bowel control. MANAGE SPINAL INJURIES: Where possible and if conscious the casualty with suspected spinal injuries should be left in the position they are found in. Call ambulance 111 immediately. It may be necessary to move a casualty in the following circumstances: They are in real and immediate danger. They are unconscious or become unconscious. They require CPR. Always support the head and neck manually to keep a neutral position that limits angular movement; semi rigid cervical collars are not recommended in first aid. SPINAL INJURIES 59

66 Spinal injuries DRSABCD SPINAL INJURIES DRSABCD 60 Children Conscious infants should be left in their rigid seat or capsule until the ambulance arrives. If possible remove the seat with baby / child under eight years still in it. Children may need padding under their shoulders to keep neutral spine alignment. Keep the spine in line. D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. Only move casualty if in danger or for airway management. R RESPONSE (AVPU) Check casualty using AVPU. S SEND FOR HELP Send or shout for help. Call ambulance 111 immediately. Consider AED. A AIRWAY Check airway. B BREATHING Check breathing. C CIRCULATION/CPR Check. D DEFIBRILLATION SPECIFIC CARE Manually support head in a neutral position, limiting angular movement. If conscious keep still until ambulance arrives. If unconscious roll on to side, supporting the casualties head. GENERAL CARE Reassure and keep warm. DO NOT use cervical collars. Only use rigid backboards if transport is essential. DO NOT leave casualty on spine boards as this causes pressure necrosis.

67 Head injuries Concussion The brain is a delicate organ which lies within the skull for protection. The skull acts as a rigid container, allowing little room for the brain to move or swell. Head injury can occur due to falls, crashes, sporting injuries, assaults or bumps to the head. Always get head injuries assessed by a medical professional including minor head injuries. Untreated head injuries can have serious consequences several hours after the initial injury. Anyone who has had a head injury should be assessed by medical personnel. Concussion is brain shake. It occurs when there is a blow to the head, and is a frequent sporting injury. SIGNS AND SYMPTOMS CONCUSSION: Concussion may result in: unconsciousness, often only briefly memory loss of the events leading to and during the injury nausea and vomiting dizziness headache thumping or pounding blurred vision seizures may also occur See Seizures, pp49 50 MANAGE CONCUSSION: If the casualty is unconscious, roll casualty onto their side supporting their head. Apply DRSABCD following the Basic Life Support Flowchart, p14 Call ambulance 111 immediately, if you suspect neck or spinal injuries or the casualty does not regain consciousness. Call an ambulance if there is any altered or loss of consciousness no matter how brief. Get all head injuries assessed by a medical professional. HEAD INJURIES CONCUSSION 61

68 Brain compression BRAIN COMPRESSION Pressure on the brain can result from bleeding or swelling of the brain. Among other things this may follow a head injury caused by a skull fracture. SIGNS AND SYMPTOMS COMPRESSION: The casualty s signs and symptoms may show: bleeding from the ear or nose may be present deteriorating level of consciousness (becomes unconscious) noisy slow breathing skin may become red, flushed and dry pulse may initially be rapid, but then becomes slower MANAGE COMPRESSION: Call ambulance 111 immediately. If the casualty is unconscious, roll casualty onto their side supporting their head. Monitor ABCs and vital signs. 62

69 Head injuries DRSABCD Fractured nose D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Check using AVPU. Brief memory loss or loss of consciousness may occur. S SEND FOR HELP Send or shout for help. Call ambulance 111 immediately. A AIRWAY Check airway. B BREATHING Check breathing. C CIRCULATION/CPR Treat bleeding. D DEFIBRILLATION SPECIFIC CARE If condition deteriorates, call ambulance 111 immediately. Consider spinal injury. Medical assessment is required for a casualty that has been unconscious. GENERAL CARE Rest, reassure and keep warm. ALL head injuries including mild, should be assessed by a medical practitioner. If you believe the casualty has a fractured nose they need to be referred to medical help. The following need to be considered: The airway may be obstructed. Control of bleeding. The casualty may suffer concussion. If the casualty is conscious encourage them to tilt the head forwards and breathe through the mouth. HEAD INJURIES DRSABCD FRACTURED NOSE 63

70 Stable Side Position for suspected spinal injury Log Roll If spinal injury is suspected roll the casualty onto their side, supporting their head and using a Log Roll. Notes 1 STABLE SIDE POSITION SPINAL INJURY One person (the Stable Side Position) 2 Two person (the Stable Side Position) 64

71 Amputations If a body part has been amputated always call an ambulance 111 and tell them that an amputation has occurred. Manage bleeding using pressure and elevation. See Manage external bleeding, p33 Care for the amputated body part in the following way: DO NOT WASH DO NOT wash or clean the amputated part. Carefully place the body part into a plastic bag and seal it with air around it to protect it. Place inside a second bag or container with water and ice cubes. AMPUTATIONS 4 Label the bag with the casualty s name and the date and time of the accident. Send the bag with the casualty to the hospital. 65

72 Chest injuries Abdominal injuries CHEST/ABDOMINAL INJURIES Chest injuries may be caused by blunt or penetrating objects. Any injury that damages the chest wall will have a direct effect on the casualty s ability to breath. MANAGE CHEST INJURY: Cover any sucking chest wounds. Preferably use a plastic-sided dressing, taped down on three sides. If conscious, incline the casualty towards the injured side. If unconscious turn the casualty onto the injured side. Abdominal injuries may be caused by a blunt or penetrating instrument, both of which may result in severe or fatal internal bleeding. MANAGE ABDOMINAL INJURY: Cover any wounds with a dressing. Preferably use clear plastic food wrap or a clean supermarket bag. Lie the casualty down. Bend the knees if there is a large crosswise wound. DO NOT touch or try to move any internal organs that are showing, instead cover the wound with clear plastic food wrap or a wet dressing. Abdominal injuries 66

73 Crush injuries When a casualty has been trapped under a heavy object for a long period, toxic substances build up in the muscles which can cause further complications. A casualty with a crush injury may not complain of pain, and there may be no external signs of injury. All casualties who have been subjected to crush injury should be taken to hospital for immediate treatment. MANAGE CRUSH INJURY: Call ambulance 111 immediately. Ensure the scene is safe. If it is safe and physically possible, all crushing forces should be removed from the casualty as soon as possible, irrespective of how long they have been trapped. Treat the person s injuries and treat any bleeding by applying firm pressure. Keep the casualty warm. Assist the person into the position of greatest comfort. Continue to monitor the casualty s condition. If the casualty becomes unresponsive and is not breathing normally, follow DRSABCD. Treat other injuries, immobilise any limbs that are injured. CRUSH INJURIES Crush injuries 67

74 Nose bleeds Ear injuries NOSE BLEEDS EAR INJURIES MANAGE NOSE BLEEDS: Sit the casualty down, leaning forward. Keep the casualty at total rest for at least 10 minutes to avoid blood flowing down the throat. Advise them to pinch the nose firmly over the soft part of the nostril just below the bridge (bony part). This will help to stop the bleeding and still allows the casualty to breathe. Maintain pinch and nostril pressure for at least 10 minutes, while at total rest. Release pressure after 10 minutes. If bleeding is not controlled reapply pressure for a further 10 minutes. On a hot day or after exercise it might take 20 minutes. An ice pack applied to the nose area may be useful. When bleeding has stopped don t blow the nose for four hours. If bleeding continues for more than 20 minutes, seek medical assistance. See Fractured Nose, pp61 63 Wounds to the outer ear may bleed profusely. Foreign objects or insects may enter the ear. MANAGE EAR INJURIES: DO NOT try and remove any object that is wedged in the ear canal. Get professional help. Never use any sharp object to remove any foreign body from the ear as this can cause further injury. If bleeding or yellowish fluid is leaking from the ear, consider head injury. Lay person on their side so that the affected ear drains onto a dressing. If ear ache or ear pain, keep ear warm. DO NOT administer drops or probe. Seek medical attention. 68

75 Knocked out permanent teeth Notes MANAGE KNOCKED OUT TEETH: Pick the tooth up by the crown, not the root. If a tooth is dirty, rinse in milk. DO NOT use soap or chemicals, scrub the tooth or let it dry out. It is important to keep the tooth root moist and alive. Place in milk or saline solution if available. If not available, wrap tooth in cling film or plastic wrap. Otherwise, place the tooth under bottom lip of the casualty. DO NOT store the tooth in water. DO NOT wrap it in tissue paper or a cloth. KNOCKED OUT PERMANENT TEETH Time is critical. See a dentist as soon as possible, ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more. 69

76 Eye injuries The eye is a delicate object which can become badly damaged by foreign bodies and chemicals. Wear eye protection whenever there is a risk of eye injury. SIGNS AND SYMPTOMS EYE INJURIES EYE INJURIES: Depending on the seriousness of the injury and the object causing injury some or all of the following may be present: watering of the eye redness of the eye pain excessive blinking loss of vision blood or clear fluid leaking from inside the eye flattening of the normal round eye shape 70

77 MANAGE EYE INJURIES: Never attempt to remove a foreign body that is embedded in any part of the eye, or located over the coloured part of the eye (iris) or pupil. In either of these cases, stabilise any object, cover only the affected eye with pads and seek hospital treatment. If the object is on the white part of the eye, moving as the casualty blinks, it can be removed. Always seek medical advice. WHEN CHEMICALS HAVE ENTERED THE EYE: Call an ambulance. Gently separate the eyelids to open the eye. Ask person to remove contact lenses if possible. Flush eye with a gentle stream of water until help arrives. Flush corrosive chemicals for up to one hour until symptoms gone. Always obtain a medical assessment to check for damage. EYE INJURIES Rinse it out with water Lift it out using a corner of material. 71

78 Burns and scalds BURNS AND SCALDS Burns are generally caused by heat, but chemicals, gases, friction, radiation (including sunlight, welding arc, lasers, nuclear), electricity, and even extremely cold substances such as ice, can also cause burns. In serious burns there may be no pain because nerve endings have been damaged. Identify and assess burns and scalds To decide how serious or significant a burn is, look at the following: Size Cause Age of casualty Location Depth Seek medical help for: Burns to the head, neck, eyes, hands, feet, over a joint or genital area. Burns in infants or children under five years and the elderly or those with other medical problems. A burn larger than the size of the casualty s palm. Burns associated with trauma. Call an ambulance (111) immediately if casualty has: Chemical or electrical burns. Inhalation burns (smoke or fumes that have been inhaled) as the casualty s airways may be injured. Cool (tepid) running water is the best initial first aid for burns and scalds. 72

79 SIGNS AND SYMPTOMS BURNS: hot to touch severe pain if superficial (deep burns may not give pain) red, peeling, blistering, charring or discolouring of skin watery fluid weeping from area swelling of area signs and symptoms of shock Notes MANAGE CHEMICAL, ELECTRICAL AND INHALATION BURNS: CHEMICAL BURN ensure personal safety when dealing with chemical / corrosive materials. Wear personal protective equipment. Read chemical container or SDS (safety data sheet) for emergency care instructions. ELECTRICAL BURNS (including lightning strike) may not look big, but the underlying tissue is often damaged and the heart rhythm can be affected. This may cause collapse, cardiac arrest or respiratory problems. Turn off the power supply without touching the person. Commence CPR. The wounds may not be easily seen. Check for entry and exit wounds and dress. INHALATION BURNS can occur in a small space with gas, steam, fumes, chemicals etc, also burning face, nostrils, eyebrows and eyelashes. Respiratory problems can occur up to 24 hours after exposure. Move to fresh air, manage airway. EYE BURNS flush eye immediately. FLASH BURN treat as heat contact burn. Call ambulance 111 immediately. DO NOT attempt to neutralise acid or alkali burns this will increase heat generation. DO NOT apply cling wrap or hydrogel dressings to chemical burns. BURNS AND SCALDS 73

80 Remember COOL, CLEAR, COVER for burns and scalds BURNS AND SCALDS MANAGE HEAT / THERMAL / CONTACT BURNS AND SCALDS: For flames, scalds, blast (hot gas), inhalation, direct contact, aim to stop the burning process, cool the burn and cover the burn. COOL the burned area immediately with cool, running water (tepid 8-15 degrees celsius) for at least 20 minutes. For chemical burns cool the affected area for up to an hour (or more if container says). Keep the casualty warm whilst cooling the burn. Where possible elevate limb to decrease swelling. CLEAR the area of anything that may keep burning: jewellery, watches, clothing that isn t sticking (cut around stuck clothing). Remove wet clothes if soaked with hot liquids. In chemical burns it is important to remove clothing contaminated with chemicals (use gloves). COVER the burnt area with loose clean, non-fluffy material. Plastic cling film is ideal. In serious (significant) burns, shock will be present. Call ambulance 111 immediately for all serious burns and inhalation, chemical, electrical and eye burns. Monitor responsiveness and treat shock. DO NOT: DO NOT peel off stuck clothing or burning substances. DO NOT use ice to cool the affected area as ice burns tissue. DO NOT break blisters. DO NOT apply lotions, ointments, creams and powders (except hydrogel). (Ref:ANZBA) 74

81 Burns and scalds DRSABCD D DANGERS Check for hazards and risks. Ensure safety from burning material, hot liquids or steam, chemicals, electricity, smoke, sun etc, for self, casualty and bystanders. DO NOT enter burning or toxic atmosphere. Stop the burning process; Stop, Drop, Cover, Roll. Smother any flames with a blanket. Wear gloves. R RESPONSE (AVPU) Check for response using AVPU. S SEND FOR HELP Send or shout for help. If serious, call ambulance 111 immediately. Consider AED. A AIRWAY Check airway, consider damage to nose and mouth. B BREATHING Check for breathing. Ensure fresh air (eg: if inhalation burn). SPECIFIC CARE Cool heat burns for 20 mins minimum, flush eye. Flush chemicals for up to one hour (until all symptoms have gone). Clear area (take off jewellery, clothing that is not sticking). Cover with clean, non-fluffy dressing plastic cling wrap is ideal. GENERAL CARE Keep casualty warm and protect from cold. Reassure. Call ambulance 111 immediately for all serious burns. eg: burn area is longer than the casualty s hand deep burns all electrical, chemical, inhalation and eye burns Seek medical advice for small burns. BURNS AND SCALDS DRSABCD C CIRCULATION/CPR Treat for shock. Treat wounds. D DEFIBRILLATION Consider AED for serious burns. 75

82 Poisons A poison is a substance that causes harm when it enters the body. Poisons can enter the body through the skin by absorption or injection, the lungs or through the mouth. SIGNS AND SYMPTOMS POISONING: The signs and symptoms of poisoning will vary according to the type of poison and how the poison has entered the body. Look for: nausea vomiting burning pain on the lips, mouth or throat headache, blurred vision skin rash or swelling breathing difficulties altered level of consciousness seizures cardiac arrest What? When? How much? POISONS Find out what, when and how much poison has been taken. Always save any remaining poison, poison container or vomit for medical personnel to check. Seek medical advice after significant exposure to a poison even if symptoms are initially mild or absent. Urgent advice always phone 111. Non-urgent advice phone 0800 POISON or DO NOT make the casualty vomit, unless instructed to by medical personnel. 76

83 Prevention of poisoning to others Remove the casualty from the poison or the poison from the casualty. Ensure your own personal safety by using protective equipment. If life threatening, call ambulance 111 immediately. (e.g. bleeding, unconsciousness or breathing difficulties). If unconscious or not breathing normally, always follow DRSABCD. If more than one person simultaneously appears affected by a poison, there is a high possibility of dangerous environment contamination. If in an industrial, farm or laboratory setting, suspect particularly dangerous agents and take precautions to avoid accidental injury. THE NATIONAL POISONS CENTRE Phone or 0800 POISON (24 hours), or for general information their website is toxinz.com (Poisons Centre database). MANAGE POISONING DECONTAMINATION / CARE: Prevention of poisoning or contamination to the first aider and bystanders is a priority and personal protective equipment may be needed. If not in immediate danger, call 0800 POISON for prompt medical advice for specific poisons from the Poisons Centre. Check the poison container for type of poison and any instructions on managing poisoning. Keep container for medical personnel. If the casualty has burns around the mouth, use mouth to nose technique if resuscitation is required. If the poison has entered through the lungs or been swallowed, keep your head clear of the casualty when they exhale during rescue breathing. If the casualty is in a confined space ventilate the area well before approaching. If poison enters the eye: Flush the eye with cold water from a running tap or a cup/jug. Continue to flush for 15 minutes, holding the eyelid open. DO NOT give casualty water or milk unless a corrosive agent (such as acid or alkaline) has been taken and unless you are instructed by a Poisons Centre Advisor. DO NOT induce vomiting. Do not use Ipecac syrup. POISONS 77

84 POISONS DRSABCD Poisons drsabcd INHALED INGESTED ABSORBED INJECTED D DANGERS Ensure safety Ensure safety Ensure safety Ensure safety R RESPONSE Check using AVPU Check using AVPU Check using AVPU Check using AVPU S SEND FOR HELP Consider calling 111 or 0800 Poison Consider calling 111 or 0800 Poison Consider calling 111 or 0800 Poison Consider calling 111 or 0800 Poison A AIRWAY Check Check Check Check B BREATHING Check Check Check Check C CIRCULATION/ CPR Check Check Check Check D DEFIBRILLATION Check Check Check Check SPECIFIC CARE Move casualty to fresh air. Avoid breathing fumes (use protection). If safe to do so, open doors and windows wide. DO NOT make casualty vomit. Give nothing by mouth; can wash mouth out with a sip of water. Remove contaminated clothing. Flood skin with running cold water. Wash gently with soap and water and rinse well. Wash area, seek advice. GENERAL CARE Reassure Reassure Reassure Reassure 78

85 Tick bites. Bee, wasp and ant stings. Single stings from a bee, wasp or ant can be painful but seldom cause serious problems except for people who are allergic to the venom. Multiple insect stings can cause severe pain and widespread skin reaction. Stings around the face can cause serious reaction and difficulty in breathing even if the person is not known to be allergic. Bee stings with the venom sac attached continue to inject venom into the skin, whilst a single wasp or ant may sting multiple times. Tick toxins may cause local skin irritation or allergic reaction. In susceptible people a tick bite or other bites or stings may cause severe allergic reaction or anaphylaxis, which is life threatening. This can occur in people with no previous exposure or apparent susceptibility. Refer to a hospital if sting is to face, eye, mouth, throat, neck or genitalia. SIGNS AND SYMPTOMS MINOR: immediate and intense local pain local redness and swelling MAJOR / SERIOUS: anaphylactic shock abdominal pain and vomiting airway obstruction can be caused by swelling of the face and tongue due to anaphylaxis or insect stings around the mouth. This can occur immediately or over several hours and always requires urgent medical care. MANAGE BITES AND STINGS: Follow the DRSABCD Basic Life Support Flowchart if casualty unresponsive or not breathing properly. If signs of anaphylaxis follow the anaphylaxis treatment plan. If allergic to ticks, DO NOT remove the tick; otherwise remove the tick immediately. If the person is in a remote location, consult a medical professional. Scrape off the bee sting (using a ruler or piece of paper), do not pull out. Move the person to a safe place (e.g. away from the bees / wasps). Apply a cold compress to site to help for swelling and pain relief. Monitor ABCs and for signs of allergic reaction (difficulty speaking and/or breathing, collapse and generalised rash). Continue DRSABCD and give CPR if necessary. TICK BITES, BEE, WASP AND ANT STINGS 79

86 Severe allergic reaction (Anaphylaxis) SEVERE ALLERGIC REACTION 80 Anaphylactic shock is a severe allergic reaction to a substance that affects the whole body. It is a medical emergency and may occur within minutes of exposure to the trigger. Common allergies are to insect bites and stings, drugs and foods. Call ambulance 111 immediately. Allergic reactions affect The skin (rash and hives). The respiratory system (short of breath). The gastrointestinal system (vomiting, diarrhoea and/or abdominal pain). The cardio vascular system (rapid pulse, swelling and possible cardiac arrest). AIRWAYS, BREATHING, CIRCULATION Call an ambulance and the nearest doctor. SIGNS AND SYMPTOMS ALLERGIC REACTION: Symptoms may occur within minutes to several hours after exposure to the allergen. Generally the more rapid the onset of symptoms after exposure, the more serious the reaction will be. Severe allergic reaction may result in: difficult, noisy breathing, wheeze or cough swelling of the neck, face and throat eg. lips, face, eyes, tongue tingling feeling around mouth, difficulty talking, hoarse voice rash, hives or welts nausea and vomiting, abdominal pain persistent dizziness, loss of consciousness, sudden collapse pale and floppy (young children) medication may be carried a MedicAlert bracelet or necklace may be worn signs of shock

87 MANAGE SEVERE ALLERGIC REACTION: Lay the person flat. DO NOT stand or walk, if breathing is difficult allow casualty to sit. Seek help immediately. Immediately remove trigger agents (allergens e.g. food, the sting, pollen, etc.). Assist with administration of adrenaline auto-injector medication and assist to administer asthma medication (eg. EpiPen ). This medication is carried by many people who know they are likely to have a severe allergic reaction. Call ambulance 111 immediately, and the nearest doctor. If unconscious position the casualty in the Stable Side Position. Monitor ABCs and vital signs. Follow DRSABCD. If breathing stops follow the Basic Life Support Flowchart, p14. Administer further adrenaline if no response in five minutes. Anaphylaxis Action Plan People and children with known allergies have often got a full Anaphylaxis Action Plan. The plan outlines actions to be taken in case of exposure to the allergy for those who are at risk. Follow this plan when child shows signs and symptoms or has been exposed to the allergy. Severe allergic reaction DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. Remove allergen. R RESPONSE (AVPU) Check using AVPU. S SEND FOR HELP Send or shout for help. Get bystanders to call ambulance 111 immediately. Consider AED. A AIRWAY Check. B BREATHING If breathing difficult consider sitting up. C CIRCULATION/CPR If shocked treat for shock. D DEFIBRILLATION Use AED if needed. SPECIFIC CARE Assist casualty with their medication. GENERAL CARE Reassure, keep warm. allergy.org.nz SEVERE ALLERGIC REACTION DRSABCD 81

88 Hyperthermia Heat exhaustion The human body works best at a core body temperature of about 37 C. The outer parts can get much colder and still function effectively. If the core body area, containing vital organs, lies outside this temperature it ceases to function effectively and is life-threatening. Heat exhaustion occurs due to excessive loss of body fluid and body salts. This may occur due to a hot environment, metabolic issues, failure of cooling mechanisms, excessive physical exertion, inadequate fluids, lack of ventilation, heavy and hot clothing or drugs. The very young and very old are more prone to heat exhaustion. SIGNS AND SYMPTOMS HEAT EXHAUSTION: Heat exhaustion is seen as: Fatigue associated with headache, feeling sick, vomiting, dizziness or malaise. Casualties may also have: pale, sweaty skin rapid, weak pulse rapid breathing muscle cramps body temperature normal or near normal tiredness and restlessness HYPERTHERMIA MANAGE HEAT EXHAUSTION: Rest in a cool place, lying down. Remove excess clothing. Moisten the skin with a moist cloth or atomiser spray. Cool by fanning. If conscious give plenty of cool plain water to sip. If unconscious monitor ABCs, position the casualty in the Stable Side Position. Call ambulance 111 immediately. 82

89 Hyperthermia Heat stroke Heat stroke (or sun stroke) occurs when the temperature-regulating centre in the brain overheats and fails. All body organs may be affected. This is a lifethreatening condition. SIGNS AND SYMPTOMS HEAT STROKE: hot, flushed, dry skin may have a lack of, or profuse sweating body temperature above normal, 40 C plus headache full and bounding pulse falling level of consciousness unconsciousness may develop seizures and blurred vision Call 111 for an ambulance as soon as possible. MANAGE HEAT STROKE: Call ambulance 111 immediately. Give carbohydrate electrolyte fluids (sports drink) or water. Rest in a cool place and position the casualty in the Stable Side Position if unconscious. Moisten the skin with a moist cloth or atomiser spray and cool the person by spraying with water. Keep cooling, use a fan. Apply wrapped ice packs to neck, groin and armpits. Follow the Basic Life Support Flowchart, p14. HYPERTHERMIA 83

90 Hyperthermia DRSABCD D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Check using AVPU. S SEND FOR HELP Send or shout for help. Bystanders to call ambulance 111 immediately. Consider AED. A AIRWAY Check. B BREATHING Check. C CIRCULATION/CPR Treat for shock. HYPERTHERMIA DRSABCD D DEFIBRILLATION Use AED if needed. SPECIFIC CARE Move to cool environment. Remove excess clothing. Cool sips of water. For heat stroke, spray casualty with water or use ice packs. Position the casualty in the Stable Side Position. GENERAL CARE Reassure, monitor temperature. 84

91 Hypothermia Hypothermia occurs if the core body temperature falls below 35 C. Hypothermia most often occurs outdoors, where wet, cold and wind combine to create a cooling effect. It can also occur in poorly heated homes, and is more likely to affect the elderly and infants. Normal body temperature Intense shivering SIGNS AND SYMPTOMS HYPOTHERMIA: Early warning signs of hypothermia are: feeling cold, numbness and shivering (fumbles) tiredness, slurred speech (mumbles) loss of coordination, stumbling and clumsiness (stumbles) changes in behaviour such as anxiety, apathy, irritability and irrational behaviour (grumbles) Later signs indicating a serious condition are: shivering stops unconsciousness Unconsciousness Irritability / irrational behaviour HYPOTHERMIA If hypothermia is not treated death will occur 85

92 Hypothermia DRSABCD HYPOTHERMIA DRSABCD ACT QUICKLY. ACT EARLY. Hypothermia can progress quickly with as little as 30 minutes between the initial symptoms and unconsciousness. MANAGE HYPOTHERMIA: Management of hypothermia focuses on preventing further heat loss and gentle rewarming. Stop and seek shelter. Remove wet clothes, and replace with dry, warm clothes. Put a woollen hat on the casualty s head. Give warm, sweet drinks if conscious. Keep the casualty lying down. Rewarm by placing the casualty in a (preferably) pre-warmed sleeping bag or blankets, and provide warmth. If the casualty is unconscious position them in the Stable Side Position. D DANGERS Check for hazards and risks. Ensure safety for self, casualty and bystanders. R RESPONSE (AVPU) Check using AVPU. S SEND FOR HELP Send or shout for help. Consider calling ambulance 111. Consider AED. A AIRWAY Check. B BREATHING Check. C CIRCULATION/CPR Check. D DEFIBRILLATION Use AED if needed. SPECIFIC CARE Move to shelter and warmth. Remove wet clothing. Cover and insulate casualty including head. GENERAL CARE Reassure and keep warm. 86

93 Casualty reporting Handwashing and hygiene While you wait for emergency services to arrive, write down the following information about the casualty: 1 Hand hygiene with soap and water 2 Casualty s name, address and contact number. Age: This is important, especially if the casualty is a young child or elderly person. Gender. What happened, when and how it happened, past medical history, medications, allergies etc. Injuries. Observations, vital signs. Treatment given. Remove jewellery. Wet hands with warm water. 3 Rub hands together to create a lather. 5 Clean knuckles, back of hands and fingers. 4 6 Add soap to palms. Cover all surfaces of the hands and fingers. Clean the space between the thumb and index finger. 7 Work the finger tips into the palms to clean under the nails. 9 Dry with a singleuse towel and then use towel to turn off the tap. 8 Rinse well under warm running water. Minimum wash time: seconds. CASUALTY REPORTING HANDWASHING 87

94 Applying slings Reef knot Arm sling Elevation sling APPLYING SLINGS 88

95 New Zealand Red Cross First Aid Kits Arm yourself for a potential emergency with official New Zealand Red Cross First Aid Kits. These kits are durable, showerproof, light and are suitable for all purposes. For first aid kits and refills: Call 0800 REDCROSS ( ) All New Zealand Red Cross First Aid Kits meet the Department of Labour s 2011 First Aid for workplaces a good practice guide. Compact Portable First Aid Kit (140mm l x 120mm w x 210mm d) ORDER CODE EF Large Portable First Aid Kit (270mm l x 140mm w x 210mm d) ORDER CODE EF Essential First Aid Kit (220mm l x 140mm w x 60mm d) ORDER CODE EF Litre First Aid Kit (235mm l x 175mm w x 80mm d) ORDER CODE EF Litre First Aid Kit (265mm l x 240mm w x 120mm d) ORDER CODE EF Litre First Aid Kit (350mm l x 235mm w x 120mm d) ORDER CODE EF Refills available for all kits Available from all New Zealand Red Cross locations or purchase online at redcross.org.nz FIRST AID KITS 89

96 ESSENTIAL EMERGENCY MANAGEMENT HANDBOOK 90 Essential Emergency Management Handbook Disaster plans start here! New Zealand is vulnerable to floods, earthquakes, storms and other emergencies. Disaster can strike any community at any time and the results can be devastating. However, there are steps you can take to prepare for and manage the effects of a disaster in your home. The Essential Emergency Management Handbook clearly explains the steps, skills and supplies that will prepare you to cope with a disaster. Call 0800 REDCROSS ( ) to find out more. STOP. THINK. ACT. Further information Everyone should be prepared for disasters. You may be required to look after yourself and your family for three or more days. For more information on how to prepare for a disaster, check out the following website: getthru.govt.nz Hazard App The Hazard App is a life-saving smartphone app that helps us identify, prepare and respond to hazards in New Zealand. Download free from Google Play Store or Apple App Store today! FREE TO DOWNLOAD Red Cross Hazard App Identify hazards Reduce risk Stay informed

97 Household Emergency Plan For general preparedness, every household should create and practice a Household Emergency Plan and assemble and maintain Emergency Survival Items and a Getaway Kit. For everything you need to get ready, go to: getthru.govt.nz Core action messages Keep listening to local radio or television stations. If authorities tell you to evacuate immediately, take your Getaway Kit and go. If you have more time, prepare your home and critical buildings. Prepare to be self-sufficient for at least three days. Stay put until authorities say you can leave. Follow your plan. Stay alert to hazards. DO NOT use candles. Download the Household Emergency Plan Template from: getthru.govt.nz Keep a record of the following information with this manual. Address: YOUR HOUSEHOLD Name: Name: Name: Name: Name: Name: PHONE NUMBERS HOUSEHOLD EMERGENCY PLAN 91

98 1 If we can t get home or contact each other we will meet or leave a message at: Name: Contact details: Name (back-up): Contact details: Name (out of town): 2 The person responsible for collecting the children from school is: Name: 24-hour contact number: 3 Emergency Survival Items and Getaway Kit. Person responsible for checking water and food: Name: Items will be checked and replenished on: Date: (check and replenish at least once a year) The Getaway Kits are stored in the: 4 The radio station (inc AM/FM frequency) we will tune in to for local civil defence information during an emergency: HOUSEHOLD EMERGENCY PLAN 92 5 Friends / neighbours who may need our help or can help us: Name: Address: Phone: Name: Address: Phone:

99 Useful numbers Your important Emergency Household Plan telephone numbers. Fill this out: CONTACT Local authority emergency helpline DETAILS Insurance company 24-hour contact number Insurance number and policy number Local radio station (Frequency ) School Family and neighbours Bank phone number and details Work phone numbers Medical centre / GP Local police station Vet / kennel / cattery Local hotel or B&B Gas supplier and meter number Electricity supplier and meter number Electrician Plumber Builder USEFUL NUMBERS 93

100 Workplace accidents First Aid WORKPLACE ACCIDENTS 94 Obtain your copy of First Aid for workplaces a good practice guide, from Department of Labour (Ministry of Business, Innovation and Employment). business.govt.nz/worksafe Accident registers All accidents must be recorded in the workplace accident register, including non-injury accidents. Investigating accidents Internal investigation of accidents should occur whenever an accident is recorded in the accident register and should focus on further management to minimise, eliminate or isolate the hazards. Accidents which cause serious harm to a person, may be investigated by WorkSafe New Zealand. Accident scenes must not be disturbed except to the extent necessary to: Provide first aid or save life. Maintain public access to essential services. Prevent serious property damage or loss. Accident notifications The Health and Safety Act 2015 states that when someone dies or when a notifiable incident, illness or injury occurs, the regulator (WorkSafe New Zealand) MUST be informed as soon as possible after becoming aware of a notifiable event by calling: A full list of notifiable incidents and injuries are listed on the WorkSafe New Zealand website, and workplace first aiders should familiarise themselves with the list. First Aid for workplaces a good practice guide The Department of Labour 2011 publication First Aid for workplaces a good practice guide provides information on good practice to be followed in defined circumstances by those responsible for first aid in the workplace, including a first aid needs assessment. First aiders: Complete accident documentation and administration. Restock supplies. Ensure all equipment is returned to operational readiness. Report all accidents to management as required. Know and help implement the 2011 good practice guide. More information about workplace accidents is available on the WorkSafe New Zealand website: business.govt.nz/worksafe

101 Suicide information If someone is talking about suicide, take it seriously. What to look for and do Most people with thoughts of suicide don t truly want to die, but they are struggling with pain in their lives. By their words and actions, they invite help to stay alive. A person at risk may say they feel alone, a burden, have no purpose, or want to escape. They may sound or talk about feeling desperate, hopeless, helpless, worthless, numb or ashamed. They may have had a recent rejection, loss, humiliation, relationship breakup or bereavement. Depression Helpline , any time 24/7 Trained counsellors will respond immediately and triage your call. Or phone your local DHB Mental Health Crisis Team, any time 24/7. Know this number, programme into your phone. In an emergency, if you are concerned for someone s immediate safety, call POLICE 111. Police are trained to triage these calls. Stay with the person until police or ambulance arrives. DO NOT leave them, but do not put yourself in danger. Suicide is a very complex issue. Increase your skills and confidence by attending a local suicide training course. 6 STEPS TO INCREASE THE PERSON S SAFETY 1. Talk to the person about what you have noticed that makes you think they might be at risk. 2. Ask directly about suicide thoughts Are you thinking about suicide? 3. Listen without judgment listening and caring are your best tools right now. Talking about suicide helps to increase their safety. DO NOT give advice or try to be a counsellor. 4. Take any indication of suicide seriously and refer the person to appropriate help. It is not your responsibility to determine how serious a situation might be. If suicide thoughts are present, it is serious, help is needed and your responsibility is to refer to appropriate help. 5. Connect the person at risk with professionals do this together take the person to a GP or to your local Emergency Department, call your local helpline or call Helpline to talk about what you can do. 6. Asking someone about suicide does not put the idea of suicide in their head and does not increase the risk they might make an attempt. Do whatever is possible to make the environment safe, e.g. secure firearms, remove ropes, medication, poisons and vehicle keys. Keep yourself safe. In an emergency call 111 immediately. SUICIDE INFORMATION 95

102 Psychological First Aid Training He Whakarauora Hinengaro PSYCHOLOGICAL FIRST AID TRAINING 96 WHAT IS PSYCHOLOGICAL FIRST AID? Psychological First Aid (PFA) builds the capacity of people who find themselves supporting and assisting affected people shortly after a disaster or any other traumatic event. This training promotes natural recovery by providing techniques to help people feel safe, connected to others, able to help themselves and access physical, emotional and social support. THE EIGHT-HOUR INTERACTIVE COURSE COVERS: The what, who, why, when and where of PFA The PFA action principles Ethics and adaption of PFA Self-care FOR MORE INFORMATION pfa@redcross.org.nz

103 Glossary AED Automated External Defibrillator. Allergic reaction having an abnormal immune system response to a substance (eg. a food) that does not normally cause a reaction. Amputation the complete loss of a part of the body, usually due to an accidental injury. Anaphylaxis a severe allergic reaction. Angina chest pain due to an inadequate supply of oxygen to the heart muscle. Artery a blood vessel that takes blood away from the heart and into the body. Asthma a reversible obstruction of the airways in the lungs. Brain compression pressure on the brain and surrounding structures, often due to a head injury or bleed inside the head. Bruise a closed wound caused by blunt force. Cardiac arrest when the heart stops beating or is unable to produce an output of blood. Choking a difficulty breathing, or a complete inability to breathe, caused by an item blocking the airway. Cholesterol a fat in the blood which has been associated with a higher risk of heart disease and stroke. Consciousness the state of being aware of and responsive to one s surroundings. Convulsion an abnormal, involuntary contraction of the muscles typically seen with certain seizure disorders. CPR CardioPulmonary Resuscitation an attempt to bring life back to a person in cardiac arrest, using rescue breathing and chest compressions. Crush injury compression of a body part, often a limb, causing loss of blood flow and resulting in tissue damage. Defibrillator a device that corrects abnormal heart rhythms by delivering electrical shocks to the heart. Diabetes the inability to properly control one s blood sugar level, leading to abnormally high sugar levels. Dislocation bone or bones moving out of position from a joint. Drowning breathing impairment due to immersion in water (or other liquid). DRSABCD a primary response system that guides rescuers to appropriately manage injuries and medical conditions in order of priority until advanced care arrives. Epilepsy a pattern of repeated seizures is referred to as epilepsy. Fainting temporary loss of consciousness due to inadequate blood to the brain. Febrile having a higher than normal body temperature. First aiders people who provide initial care for an acute illness or injury. Trained first aiders learn how to use a first aid action plan (DRSABCD). Fit an abnormal and uncontrolled electrical activity in the brain (same meaning as seizure). GLOSSARY 97

104 GLOSSARY 98 Flu a viral infection of the body causing fever, cough, muscle aches and tiredness (same as influenza). Fracture a broken bone. Heat exhaustion tiredness, dehydration and overheating. Heat stroke (sun stroke) a core body temperature that rises above 40 C accompanied by loss of consciousness and dehydration. Heart attack the damage caused to the heart muscle when an artery in the heart blocks. Hyperglycemia high blood sugar. Hyperventilation over-breathing. Hyperthermia heat-induced illness an unusually high body temperature. Hypoglycemia low blood sugar. Malaise feeling of illness, a general feeling of illness or sickness of no diagnostic significance. Necrosis death of cells in tissue or organ caused by disease or injury. Poison a substance which is harmful to the body. Resuscitation the process of attempting to restore life to someone in cardiac arrest. Seizure an abnormal and uncontrolled electrical activity in the brain (same meaning as fit). Shock lack of oxygenated blood to the body organs. Soft tissue skin, muscles, tendons and ligaments. Spinal injury an injury to the bones of the spine, the spinal cord or spinal nerves. Sting entry of a toxin from an animal or plant into the body. Stroke loss of blood supply to the brain caused by either a blockage or a rupture of an artery. Unconsciousness a state in which there is loss of awareness and responsiveness to one s surroundings. Vein a blood vessel that brings blood from the body back into the heart.

105 Index A B C Abdominal injuries 66 AEDs / Defibrillation 9,14,18 Airway 2,4,8,12,14,23,27 Allergic reaction (severe) 3,79,80,81 Amputations 65 Anaphylactic reaction 80,81 Anaphylaxis action plan 81 Angina 43 Arm sling 88 Asthma 51 AVPU (Levels of consciousness) 7,40 Back blows / Chest thrusts 24,28,29,30 Bandages 34,88 Basic Life Support Flowchart 14 Bee / wasp stings 79,80 Bleeding 2,3,4,9,32 34 Body check for injuries 38,41 Brain compression 62 Breathing 2,3,4,8,12 15 Breathing difficulties 3,9 Bruising 57 Burns and scalds Cardiac arrest Resuscitation 15 18,42,49,80 Casualty reporting 87 Chain of survival 15 Check for injuries 38,41 Chemical burns 73 Chest compressions 12 14,16 Chest pain 3,42 44 Chest thrusts 24 26,28 29 Chest injuries 66 Choking 23 Adults Children Circulation 2,4,9,53 Concussion 61,63 Convulsions 50 CPR 2,4,9,12 16,20 22 D E F CPR action checklist child / infant 20 Crush injuries 67 Dangers 2 6 Defibrillation, (AEDs) 2,5,9,15 18,21 Diabetic emergency 48 Dial (call) Disaster preparedness tips Dislocations 56 Drowning 22 DRSABCD 4,5 Bleeding 34 Burns and scalds Fractures / soft tissue injuries 58 Head injuries 63 Heat stroke / hyperthermia 84 Hypothermia 86 Medical conditions 53 Poisons 78 Severe allergic reaction 81 Spinal injuries 60 DRSABCD Choking Adult / Child Choking Baby 30,31 Resuscitation Adult 17 Resuscitation Child 21 Wallet card 12,13 Ear injuries or earache 68 Electrical burns 73 Elevation sling 88 Environmental conditions Epilepsy Essential Emergency Management Handbook 90 External bleeding Eye injuries Chemicals in eye Fainting 37 Febrile convulsions 50 Finger sweep 26,29,31 First aid action plan 2 INDEX 99

106 INDEX 100 F H I K L M N O P First aid aims 2 First Aid kits 89 First aid steps 3 First aider 1 Flu pandemic 93 Foreign bodies in wounds Foreign body in the eye ear 68 Fractures 54,55,58 nose 63 Hand washing 87 Hazard App 90 Head injuries 10,49,59,61 64 Healthline 93 Heart attack 42 Heart attack action plan 45 Heart health Heat exhaustion 82 Heat stroke 83 History 38 39,87 Household Emergency Plan Hyperthermia Hypothermia Hyperventilation 51 Hypoglycaemia / diabetes 48 Inhalation burns 73 Injuries Insect bites and stings Knocked out teeth 69 Level of Consciousness 7,10,40 Log roll 64 Low blood sugar 10,48 MedicAlert 3,41 Medical conditions Medical conditions DRSABCD 53 Nose bleeds 68 Nose fracture 63 Obstructed airway cycle Adult / child Child under 1 year 29 30,31 Poisons R S T U V W Primary Assessment DRSABCD 2,4 5 Pandemic planning 93 Psychological first aid 96 R.I.C.E. 57,58 Recovery (The Stable Side Position) 8,10,11,64 Reef knot 88 Response (AVPU) 2,5,7,11,40 Resuscitation 12,13 21 Adults Children & infants 13,19 21 Risk factors for the heart Scalds Secondary Assessment other conditions or injuries 7,10,38 40 Seizures Severe allergic reaction Shock 3,4,9, 32 33,36 Slings 88 Soft tissue injuries 57,58 Spinal injuries 59,60 Stable Side Position 11,64 Stings, bee / wasp / ant 79,80 Strains and sprains 57,58 Stroke 3,10,46 47 Suicide first aid 95 Teeth 69 Tick bites, bee, wasp and ant stings 79 Triangular bandages 88 Training courses Back Cover Unconsciousness 7,10,36,42,45,48,61 Vital signs (response and breathing) 4,36,38,39,42,46,81,87 Wallet card DRSABCD 12 Resuscitation 13 When to call Workplace accidents Employer responsibilities 94 First Aid responsibilities 94 The Good Practice Guide 94 Wounds Wounds minor 33

107 Training Courses Emergency Care For First Aiders New Zealand Red Cross is a leading provider of First Aid and Pre-Hospital Emergency Training in your area. Call 0800 REDCROSS ( ) for a course near you. Or visit redcross.org.nz Mission Our mission is to improve the lives of vulnerable people by mobilising the power of humanity and enhancing community resilience. The Fundamental Principles of the International Red Cross and Red Crescent Movement guide us in all we do. Humanity: The International Red Cross and Red Crescent Movement, born of a desire to bring assistance without discrimination to the wounded on the battlefield, endeavours, in its international and national capacity, to prevent and alleviate human suffering wherever it may be found. Its purpose is to protect life and health and to ensure respect for the human being. It promotes mutual understanding, friendship, co-operation and lasting peace amongst all peoples. Impartiality: It makes no discrimination as to nationality, race, religious beliefs, class or political opinions. It endeavours to relieve the suffering of individuals, being guided solely by their needs, and to give priority to the most urgent cases of distress. Neutrality: In order to continue to enjoy the confidence of all, the Movement may not take sides in hostilities or engage at any time in controversies of a political, racial, religious or ideological nature. Independence: The Movement is independent. The National Societies, while auxiliaries in the humanitarian services of their governments and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the Movement. Voluntary service: It is a voluntary relief movement not prompted in any manner by desire for gain. Unity: There can only be one Red Cross or one Red Crescent Society in any one country. It must be open to all. It must carry on its humanitarian work throughout its territory. Universality: The International Red Cross and Red Crescent Movement, in which all Societies have equal status and share equal responsibilities and duties in helping each other, is worldwide.

108 New Zealand Red Cross First Aid & Emergency App A free comprehensive pocket guide from the world s largest first aid training provider. EMERGENCY GUIDE Get simple step-by-step guides to help you deal with first aid emergencies. KNOWLEDGE AND ADVICE Learn first aid using easy-tounderstand animations and videos. M-LEARNING Use the learning in the app to put towards a workplace first aid certificate. GLOBAL MODE Get local emergency numbers and help phrases as soon as you touch down in another country. FREE TO DOWNLOAD redcross.org.nz/first-aid-app National Office PO Box Thorndon Wellington RED CROSS ( ) NewZealandRedCross NZRedCross redcross.org.nz TR (2017)