APPLY FIRST AID. Blended Learning Workbook. Based on First Aid Quick Guide Version 4. HLTFA301B Apply First Aid. Name: Date: / /

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1 APPLY FIRST AID Blended Learning Workbook Based on First Aid Quick Guide Version 4 Name: Date: / / HLTFA301B Apply First Aid Version 4 Apr 2011

2 - 2 - Table of Contents Page Table of Contents... 2 About the Blended Learning Apply First Aid Course... 3 Outcomes... 3 Blended Learning Assessment... 3 Introduction to First Aid... 4 Principles of First Aid... 4 Infection Control and Hygiene... 4 Advisory Standard for First Aid in the Workplace... 5 Risk Assessment... 5 First Aid Kits... 5 Essential First Aid... 8 Emergency Action Plan... 8 Unconscious Casualty... 8 Rescue Breathing 7 Cardiopulmonary Resuscitation (CPR)... 8 Trauma Bleeding External Bleeding Internal Bleeding Shock Causes of Shock Management of Shock Reassurance Burns Fractures/Spinal Injuries and Soft Tissue Injuries Soft Tissue Injuries Fractures Immobilising Fractures Medical Emergencies Poisons/Bites/Stings Pressure Immobilisation Technique Exceptions to the use of the Pressure Immobilisation Technique Copyright 2006 by National First Aid Training Institute All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the National First Aid Training Institute National First Aid Training Institute has made every effort to ensure that the contents of this workbook are accurate and reflect current, generally accepted first aid techniques. NFTI will keep the material in this workbook under review, and subsequent editions will incorporate any amendments necessary to reflect changes in generally accepted first aid principles and techniques. This workbook has been prepared for use in connection with first aid training courses.

3 - 3 - About the Blended Learning Apply First Aid Course This Blended Learning Workbook is to be used as part of the nationally accredited HLTFA301B Apply First Aid Course. When you have completed all of the self-assessment questions, in your workbook, please remember to bring it with you to your practical session for the Trainer to review. Outcomes The outcomes are listed under each Section heading, this is to let you know what competencies you should achieve and understand before going on to the next section. Blended Learning Assessment In this workbook there are self-assessment questions. These questions have been designed to ensure you have read the required section and can now confidently progress onto the next section..

4 - 4 - Introduction to First Aid By the time you finish the course, you should be able to - Understand the principles of first aid Know how to get help Understand the requirements for first aid kits Recognise the importance of hygiene in first aid Principles of First Aid First aid is the initial assistance or care of an ill or injured person. The main aims are: Preserve life Protect the casualty from further harm Provide pain relief Prevent the injury from becoming worse Provide reassurance Getting Help In Australia, dial 000 for emergency assistance such as ambulance, fire or police services. You can dial 000 from any phone, fixed or mobile. 112 is the GSM international standard emergency number which can ONLY be dialled on digital mobile phones. THERE ARE THREE IMPORTANT THINGS TO REMEMBER WHEN CALLING FOR HELP. 1.State the emergency service you need ambulance, fire or police. 2. Stay on the line until connected with the emergency service operator and be the last to hang up. 3. Give as much information as possible about the location of the emergency. Exact address or location Street name and Number Suburb, city/town Nearest cross road or street Caller s name Phone number from where the call is being made What happened eg. Car accident Number and condition of the casualties Infection Control and Hygiene Ensuring cleanliness in all first aid situations is extremely important. A first aider should take all precautions to ensure that the risk of infection is minimised by practising where possible good first aid hygiene procedures. Good first aid hygiene practices include:

5 - 5 - washing and drying of hands before and after casualty management appropriate disposal of contaminated waste appropriate disposal of sharps wearing of gloves and other protective equipment Bacteria do not depend on another organism to survive, and can live outside the body. Viruses are dependant on another organism to survive and cannot live outside the body Advisory Standard for First Aid in the Workplace The Advisory Standard for First Aid in the Workplace is a QLD legislative guide for employers. The standard gives practical advice on the role and responsibilities of the First Aider and includes: Undertaking the initial management of injuries and illnesses occurring at the workplace; and Recording details of first aid given Responsibilities of a First Aider could also include: Recommending actions regarding use, contents, modifications and maintenance of a first aid kit. Ensuring a first aid kit is accessible whenever workers are at work Checking and replenishing kit contents Ensuring equipment and contents are within the use by dates Risk Assessment Before deciding what type of first aid kit or equipment you may need for your workplace, it will be necessary to conduct a risk assessment. A risk assessment should be based on the type of injuries that may occur, and the frequency of the injury occurring. For example, cuts, splinters, eye injuries etc, within the workplace, and whether they occur hourly, daily or weekly. Once a risk assessment has been conducted you can then select an appropriate first aid kit or first aid items for your workplace which will match the injuries that may occur. First Aid Kits A first aid kit may be of any size, shape or type, but should be large enough to hold all of the required contents. The first aid kit should be identified by a sticker which is white with a green background displayed on the outside of the first aid kit. The first aid kits should be checked regularly to identify any items that need replacing or for items that has use by dates that may have expired.

6 - 6 - Important to remember There are specific guidelines that state you may not keep any medications in the first aid kit. It is also recommended that to minimise the risk of cross infection wherever possible, items in a first aid kit should be disposable sterile items such as single use ampoules of saline. NOTES:

7 - 7 - Self-Assessment Questions- Introduction to First Aid Please complete the following assessment questions before moving onto the next section. Q1. Write in your own words what you think First Aid means. Q2. List the three important things to remember when calling for help. Q3 The normal emergency number on a mobile is 000. What is the alternative number you can ring from a mobile, in an emergency? A) 999 B) 112 C) 111 D) 911 Q4. If at all possible before managing a casualty who has a wound, you should: A) Wash your hands thoroughly B) Provide a barrier between yourself and the casualty s wound C) Wear gloves D) All of the above Q5. List three hazards that may be present at the scene of a motor vehicle accident.

8 - 8 - Essential First Aid You should be able to: Identify the steps in the Emergency Action Plan Identify techniques for CPR Rescue Breathing Note: Rescue Breathing and CPR can only be practised on manikins during the practical session. When you attend your practical session you will practise these techniques. In this section you will learn the Emergency Action Plan and procedures that will allow you to remain calm and use a systematic approach in an emergency situation. Emergency Action Plan (page 5) The Emergency Action plan consists of seven steps, Danger, Response, Send for help, Airway, Breathing, Compression and Defibrillation. These steps are also referred to as DRSABCD, and are the primary concern when you first approach a casualty who may be injured. Unconscious Casualty ARC Guideline 4 states in an unconscious victim, care of the airway takes precedence over any injury. Rescue Breathing Rescue breathing is the method by which a rescuer breathes for a casualty who is not breathing or not breathing normally The more common term is mouth-to-mouth, you will practice the skills in the practical session. Cardiopulmonary Resuscitation (CPR) Cardiopulmonary Resuscitation (CPR) is performed when the casualty is unconscious, unresponsive, not moving, and not breathing normally. These techniques will be practised in the practical session. Breathing To check to see if a casualty is breathing, use the following LOOK LISTEN FEEL LOOK to see if the chest rises LISTEN for the sound of normal breathing FEEL for the air against your cheek

9 - 9 - If you are in doubt as to whether the casualty is breathing normally, treat as if they are not breathing. When should you stop CPR 1. The scene become unsafe 2. Qualified help arrives and takes over 3. Signs of life return 4. You become physically unable to continue 5. An authorised person pronounces life extinct Useful resource is AUSTRALIAN RESUSCITATION COUNCIL More information will be discussed during your practical course. NOTES:

10 Self-Assessment Questions- Essential First Aid Please complete the following assessment questions before moving onto the next section. Note: You will need to attend a practical session to demonstrate competence in this unit of competency. Q1. Please complete the following: D R S A B C D Q2. What are the 3 methods you would use to check if the casualty is breathing normally?,, Q3. If you have performed a rescue breath on a casualty and you find there is no rise and fall of the chest. You should check that there is: A) Adequate head tilt B) A correct seal C) A clear airway D) All of the above Q4. What are four of the five conditions in which you would stop doing CPR? Q5. What is the maximum time allowed to check for effective breathing? A) 5 seconds B) 10 seconds C) 30 seconds D) 1 minute

11 Trauma When you have read and completed the Trauma section in the Blended Learning Workbook, you should be able to: Identify and manage Abdominal Injuries/Bleeding Identify and manage Shock Identify and manage Burns/Scalds Identify and manage Facial/Head/Spinal injuries Identify and manage Fractures/Soft Tissue Injuries Bleeding There are between five and seven litres of blood in the average adult body which makes up to 7-8% of the body weight and even less for children and babies. Blood is moved around the body under pressure by the heart and blood vessels. When a blood vessel is cut or torn, the body reacts automatically by: forming a clot to help seal off the wound. constricting the cut ends of blood vessels to reduce blood flow lowering blood pressure to reduce the force of bleeding maintaining blood supply to vital organs Therefore, in some cases, bleeding will tend to stop naturally as a result of these reactions. A healthy adult can lose up to 20% of their blood volume without serious effects. However, if bleeding continues, the casualty will develop progressive problems, including shock. If you are unable to stop the bleeding consider a constrictive bandage. This is a bandage that is applied firmly to a limb and tightened until bleeding stops. External Bleeding External bleeding is usually associated with wounds caused by tearing or cutting the skin. Serious wounds involve damage to blood vessels. Damage to an artery is bright red which can spurt with each heart beat. Damage to veins appears as darker red and tends to flow. Capillary damage is from wounds close to the skin and is a bright red and oozes Abdominal Bleeding Internal bleeding is bleeding into the tissues and cavities of the body. It may be as a result of injury or disease and may be visible or concealed.

12 Internal bleeding should always be considered to be serious and will require urgent medical attention. Evidence suggesting internal concealed bleeding may be obtained from the casualty s signs and symptoms. Internal Bleeding Detecting internal bleeding relies upon good observations. Look at the important observations that may indicate internal bleeding. These include a. skin appearance b. Conscious State c. Pulse d. Respiration Signs & Symptoms: Pale, cool clammy skin Thirst Rapid, weak pulse Rapid, shallow breathing guarding the abdomen Pain or discomfort Nausea and/or vomiting Visible swelling of the abdomen Gradually lapsing into shock More information will be discussed during your practical course. NOTES:

13 Self-Assessment Questions- Bleeding Please complete the following questions before moving onto the next section. When you attend your practical session you will be able to practice techniques for controlling bleeding. Q1. Four signs and symptoms of internal bleeding are: Q2. What will the bleed look like if an artery has been damaged? Q3 A casualty has fallen from his bike and has a laceration on his leg which is bleeding quite freely. You should: Q4. While playing soccer a young child comes off the field with a blood nose. Your first management should be to:- Q5. All methods of bleeding control have failed and a constrictive bandage must be applied. What kind of bandage should be used?

14 Shock The definition of shock is described as a lack of oxygen to all parts of the body. When vital organs do not receive enough oxygen rich blood, they fail to function correctly. This triggers a series of responses that lead to the condition known as shock. Causes of Shock Shock is almost always present where serious injury has occurred such as severe bleeding, pain or fluid loss from burns, vomiting and diarrhoea. When vital organs do not receive enough oxygen-rich blood, they fail to function properly. This triggers a series of responses that lead to the condition known as shock. These responses are the body s attempt to maintain adequate blood flow to the vital organs, and therefore prevent their failure. Management of Shock 1. DRSABCD 2. Manage the cause of the shock, for example severe bleeding 3. Calm and reassure the casualty and place in a position of most comfort. 4. Place some clothing or blanket on them to encourage normal body temperature NOTE: Do not give the casualty anything to eat or drink as they may either vomit or require surgery Reassurance Don t forget that a major part of the first aid management for shock is to reassure the casualty whilst waiting for medical aid to arrive. Reassuring the casualty not only helps to keep them calm, but keeps the first aider calm as well.

15 Burns Burns destroy the skin, the body s natural barrier against airborne bacteria and can carry a serious risk of infection, the deeper the burn the higher the risk. When giving first aid for a burn, it is important to consider the extent and depth of the burn, its cause and whether or not the airway has been affected. When approaching an accident resulting in a burn always apply the principles of the Emergency Action Plan. Types of Burns Burns can be caused by many different sources, including chemical, heat, electricity and radiation. They are also classified by the depth of a burn, so the deeper the burn the more severe it can be. -Superficial (first degree) A superficial burn involves only the top layer of the skin. The skin is red and dry, and the burn is usually painful and swollen. Superficial burns generally heal within 5-6 days without permanent scarring. -Partial Thickness (second degree) A partial thickness burn involves both the epidermis and the dermis. This burn is red and blisters may be open and weep fluid. The burn usually heals within 3 or 4 weeks, although there may be some scarring. -Full Thickness (third degree) A full thickness burn destroys both layers of the skin, as well as any or all of the underlying structures, for example fat, muscles, bones, blood vessels and nerves. These burns may look brown or charred (black), with the tissues underneath appearing white. Depending on whether or not the burn has destroyed the nerve endings, these burns can vary from extremely painful to painless. Full thickness burns can be life-threatening. Scarring occurs and may be severe. Many full thickness burn sites eventually require skin grafts. Signs & Symptoms of a burn Red blistered, white or blackened skin Pain in superficial and partial thickness burns Signs of shock Breathing Difficulties Hoarse voice and/or snoring sound when breathing

16 Care & Treatment Ensure Safety Call 000 for an ambulance Cool only with CLEAN WATER if possible For at least 10 minutes for thermal or radiation burns For at least 20 minutes for chemical burns For at least 30 minutes for bitumen burns More information will be discussed during your practical course. NOTES:

17 Self-Assessment Questions-Burns Please complete the following questions before moving onto the next section. Q1 The three classifications of burns are: Q2 What are three signs and symptoms of a burn? Q3 First aid management for burns is to:- A) Apply an ice pack B) Cover the burned area with a sterile dressing C) Cool the burned area with running water for at least 20 minutes D) Prick blisters and cover them with a non stick dressing Q4 You find a person collapsed on the floor with an electric drill in their hand. What should you do first? A) Turn off the power and unplug the drill B) Check for a response C) Ring for ambulance and check for breathing D) Commence CPR Q5 When managing a burn it is important to remember not to: A) Break any blisters B) Use oil based creams C) Remove any stuck clothing D) Do any of the above

18 Fractures/Spinal Injuries The musculoskeletal system involves the bones, ligaments, tendons and muscles which support the body, protect the internal organs, and enable movement. Although musculoskeletal injuries are almost always painful, they are rarely life-threatening. The skeleton forms the framework that supports the body. Where two or more bones meet, they form a joint. Bones are usually held together at joints by fibrous bands called ligaments. You will notice that bones vary in size and shape. This variation allows bones to perform specific functions. Broken bones heal by forming new bone cells; this is the only body tissue that can regenerate this way. Soft Tissue Injuries Soft tissue injuries are injuries affecting the muscles and joints of the limbs and are often referred to as sprains, strains or dislocations. The appropriate first aid management for soft tissue injuries is: Rest Ice Compression Elevation Do Not: Attempt to adjust the dislocation yourself Apply ice directly to the skin Fractures There are three types of fractures that can occur. They are: Open where the bone is protruding through the skin Closed where there is no bone protruding Compound (or complicated) where there is more than one injury, eg. a fractured rib has punctured the lung. If you are not sure whether or not the bone is broken, manage as if it is. Immobilising Fractures The purposes of support and immobilisation for an injury are to: Lessen pain Prevent further damage to soft tissues Reduce the risk of serious bleeding Reduce the possibility of loss of circulation to the injured part. Prevent a closed fracture from becoming an open fracture. More information will be discussed during your practical course.

19 Self-Assessment Questions Fracture/Soft Tissue Injuries When you have read the section on Fractures, Spinal Injuries and Soft Tissue Injuries, in your First Aid Quick Guide, please complete the following questions before moving on to the next section. When you attend your practical session you will be able to practice these techniques Q1. The letters in the RICE management below stand for: R, I, C, E Q2. List 3 signs and symptoms of a suspected spinal injury: Q3. There are three different types of fractures. They are: Q4. A casualty falls two meters from a ladder. The casualty complains of pain to the right ankle. On examination of the ankle you find mild pain, tenderness and a large amount of swelling. State the correct management for the casualty. Q5. Management for a fracture should include immobilisation using a splint. List three items you use as an improvised splint.

20 Medical Emergencies After completing this section of the Workbook, you should be able to: Identify and manage asthma Identify and manage a diabetic emergency Identify and manage epilepsy Identify and manage heart attack and stroke Disorders of Consciousness The nervous system is made up of the brain, spinal cord and nerves. Illness and disorders may be a result of: Stroke, diabetes, epilepsy, infection and high fever Remember: If a casualty is unconscious apply the Emergency Action Plan: D R S A B C D Danger Response Send for HELP Airway Breathing Circulation Defibrillation Respiratory Emergencies Any disturbance of the respiratory process is potentially fatal, since it may lead to suffocation caused by any condition that stops oxygen being taken up from the lungs to the blood. Some conditions that may cause impaired breathing and associated problems may be: Asthma, choking, near-drowning ASTHMA Signs & Symptoms.pale, cool, clammy skin.coughing especially at night.shortness of breath using all the chest and diaphragm muscles to breathe.wheezing.anxiety and distress.exhaustion.rapid, weal pulse.little of no improvement after using reliever medication.severe asthma attack: collapse leading to eventual respiratory arrest. More information will be discussed during your practical course.

21 Circulatory Emergencies The heart is about the size and shape of a clenched fist. It is located in the centre of the chest, behind and partly to the left side of the lower half of the breastbone. The heart pumps blood to all parts of the body. Sometimes the heart is compromised and serious cardiac conditions can develop. Factors such as, lack of exercise, poor diet, excessive alcohol, advanced age or chronic disease can affect the health of the heart. The major heart conditions are angina and heart attack. Signs and Symptoms of Hear Attack and Angina Heart attack and angina have very similar signs and symptoms.pale, cool skin.chest pai or discomfort.sweating.rapid, irregular or weak pulse.rapid, shallow respirations, or difficulty breathing.partial or full collapse.nausea and/or vomiting.may feel the need to go to the toilet.lethargy Care and Treatment. call 000 for an ambulance.rest, position of comfort which is usually the sitting position.if the patient has medication, assist them in taking it. Reassure.monitor vital signs DIABETIC EMERGENCY Diabetes is a condition which is caused by an imbalance of sugar or glucose in the blood. The most common type of diabetic emergency a first aider will need to treat is caused by low blood sugar. Signs and Symptoms of Low blood sugar. Pale.Profuse sweating.hunger.confused or aggressive.rapid pulse.may appear drunk.seizures.unconsciousness

22 Care & Treatment.Call 000 for ambulance. if conscious, give a sweet drink (not diet) or.5-7 jelly beans or. glass of fruit juice.repeat if casualty responds. On recovery, assist in medication if necessary and then encourage they eat some food high in carbohydrates such as a piece of fruit, sandwich or 2-4 dry biscuits. DO NOT attempt to give insulin injections GIVE NOTHING by mouth to an unconscious diabetic STROKE Two common causes of a stroke are: A blocked blood vessel to the brain A ruptured blood vessel causing bleeding into the brain Signs and Symptoms FAST F = Face A = Arm S= Speech T = Test F: Facial weakness can the person smile? A: Arm weakness can the person lift their arms S: Speech Problems can they speak clearly T: Test all three symptoms If they fail any one of these, call 000 for an ambulance Other symptoms: Sudden sever headache Sudden nausea and or vomiting Warm, flushed, clammy skin Slow full pulse May have distended neck veins Blurred vision Unequal pupils Paralysis, weakness or loss of coordination of limbs, usually on one side Loss of balance Difficulty swallowing Urinary incontinence Unconscious Seizures

23 Care and Treatment Call 000 for an ambulance Adopt a position of comfort always check to see if airway is clear Reassure Recovery Position if unconscious Maintain body temperature More information will be discussed during your practical course. NOTES:

24 Self-Assessment Questions Medical Emergencies When you have read the relevant pages in your First Aid Quick Guide please complete the following questions before moving onto the next section. Q1. List three sign and symptoms of an asthma attack Q2. An elderly friend has had an uncomfortable pain in the chest that is not relieved by rest. You should:- A) Give them a painkiller and see how they feel after 20 minutes B) Make an appointment with their doctor for later that day. C) Keep them at total rest, assist with any medication, reassure and seek urgent medical aid D) Suspect indigestion and give them a glass of milk Q3. A workmate, who is known to suffer from epilepsy, collapses with a seizure. Your immediate response should be to: A) Hold them down to protect them B) Give them their medication C) Place something in their mouth to stop them swallowing their tongue D) Clear the area; protect the casualty from injury and once the seizure finishes, monitor airway, breathing and circulation. Q4 A student, who is known to suffer from diabetes, appears grumpy, confused and restless. You should first:- A) Place them on their side and ring 000 B) Give them a sugary drink C) Suggest they take their insulin D) Give them a diet coke and get them to sit down Q5 You suspect a friend is having a stroke. They are having trouble speaking, feel numb down one side and have a terrible headache. Your first aid management should be to:- A) Calm, reassure, place in the position of most comfort and ring 000 B) Advise them to lie down and ring their doctor C) Put them on their side, clear their airway and ring 000 D) Give them 2 aspirin and advise bed rest

25 Poisons/Bites/Stings What is a poison? A poison is any substance that causes injury, illness or death when introduced to the body. Poisonous substances can be eaten, breathed in, injected or absorbed through the skin. A wide range of signs and symptoms may occur including unconsciousness, nausea, vomiting, burning pain, headache, blurred vision, seizures, respiratory arrest or cardiac arrest. Both the casualty and the suspected poison should be handled with care. If you are in any doubt as to what to do if poisoning occurs, ring the: Poisons Information Centre on Bites and Stings Insect and animal stings and bites are among the most common sources of injected poisons. These bites and stings can be serious when they involve envenomation, the natural process of the creature s injection of venom is to kill or immobilise its prey or enemy. Pressure Immobilisation Technique The pressure immobilisation technique was introduced for the treatment of Australian snake bites, but it is also recommended for envenomation by a number of other animals and for severe allergic reactions to injected venoms. If the limb is immobilised using bandages and a splint and the casualty is encouraged not to move or walk, research has shown that very little venom reaches the blood stream via the lymphatic system. It has also been shown that there may be inactivation of certain venoms and venom components when the injected venom remains trapped in the tissues by the pressure bandage. Exceptions to the use of the Pressure Immobilisation Technique The Pressure Immobilisation Technique should NOT be used for any of the following unless the casualty has an allergic reaction to the venom. Red-back or White Tailed spider or any other spider except Funnel Web spider Bee, wasp, ant stings, other insects, scorpions or centipedes Blue bottle or Portuguese Man-of War stings (all of the above bites and stings should be treated with an ice-pack unless severe allergies are present) Venomous fish stings e.g. Stonefish, Stingray, Catfish, Happy Moment (all fish stings should be treated with hot water)

26 BITES & STINGS This table shows which treatment should be used for certain bites and stings: Pressure Immobilisation Ice Pack Hot Fluids Vinegar Medical Attention Reassurance Snake Funnel Web Spider Red-Back Spider Blue-Ringed Octopus Bee Sting Wasp Sting Box Jellyfish/Irukandji Bluebottle Stingray Tick Stonefish/Bullrout Allergic reaction to any of the above Platypus Coneshell Ant More information will be discussed during your practical course. Notes:

27 Self-Assessment Questions Poisons/Bites/Stings Please complete the following questions. When you attend your practical session you will be able to practice these techniques. Q1. While walking in the long grass a friend is bitten by a snake. You should: A) Sit them down, reassure and wait for onset of symptoms B) Suck out the poison and apply a tourniquet C) Rest, reassure, apply pressure immobilization technique and seek urgent medical attention D) Kill the snake and take with the victim to hospital Q2. You suspect a person has accidentally swallowed some poison. They are conscious. Your first response is to: A) Ring Poisons Information Centre B) Ring their doctor C) Encourage them to vomit D) Give a glass of milk Q3 What is your immediate response to someone who has been stung by a box jellyfish? A) Flood the area with vinegar B) Soak stung area in the hottest water bearable C) Apply ice D) Apply Pressure Immobilization Technique and ring 000 Q4 While fishing your buddy is spiked by a catfish. Your immediate response is: A) Apply ice B) Use Pressure Immobilization Technique C) Immerse affected area in hottest water bearable D) Bandage and elevate affected area Q5 Which of the following bites and stings is best managed with an ice pack? A) Bees, ants and red back spiders B) Cone shell, funnel web spider and snake bite C) Box Jellyfish D) Stonefish, stingray and catfish