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SAFETY MANUAL NO.

3
FIRST AID
by
Linda H. Byers

and
Marilyn Hutchison, M. D.

UNITED STATES DEPARTMENT


OF THE INTERIOR

Thomas S. Kleppe, Secretary


Jack W. Carlson, Assistant SecretaryEnergy and Minerals

MINING ENFORCEMENT AND


SAFETY ADMINISTRATION

For sale by the Superintendent of Document.

U.S. Government Printing Office. Washington D.C. 20402


Stock Number 024-019-017.9

,.

PREFACE
This is one of a series of man uals prepared by the

technical staff of the Mining Enforcement and


Safety Administration (MESA) to acquaint the
reader with a subject of interest to miners. This

manual provides an explanation of first aid

techniques to be used before medical help arrives


in the event of an accident. The first section
includes instructions on how to perform critical
life saving procedures such as clearing the victim's

upper airway, giving artificial ventilation and


external heart compressions, stopping bleeding,

and controllng shock. The second section de-

scribes special measures to apply to specific


injuries. A list of references (Bibliography) is

included at the end for those interested in additional information on first aid and emergency care.
Other manuals available

in this series are listed on

the inside back cover. Individual copies may be


obtained from any MESA Training Center or from

the National Mine Health and Safety Academy,


Beckley, W. Va.

Michael G. Zabetakis
Superintendent
National Mine Health and
Safety Academy

-.
CONTENTS

Page
Introduction ............................ 1
Basic procedures for first aid ............ 2
First aid procedures for life threatening con-

ditions ................................. 4
Impaired breathing ................. . .. 5

Circulatory failure. . . . . . . . . . . . . . . . . . . .. 10
Bleeding ............................. 15

Shock. . . ... . .... .. . .. . .., .. . .... . . ... 18


Introduction to specific injuries. . . . . . . . . . .. 21
Burns - heat ..................... . . ., 23

Burns - chemical .....................


Chest wounds ........................
Diabetic emergencies ..................
Epileptic seizure ......................
Eye injuries ..........................

24
25
26
27
28

Fractures - dislocations. . . . . . . . . . . . . .. 30
Frostbite ............................. 34
Heart attack ......................... 35

Heat cramps . . . . . . . . . . . . . . . . . . . . . . . . .. 36
Heat exhaustion ...................... 37

Heat stroke. . . . . . . . . . . . . . . . . . . . . . . . . .. 37
Hypothermia (exposure) ............... 38
Insect bites and stings ............... .. 39

Open wounds .........................


Poisons ..............................
Protruding intestines ..................
Rib fractures .........................

40
44
44
45

Skull fracture . . . . . . . . . . . . . . . . . . . . . . . .. 46
Snakebite ............................ 47
Spine fracture or dislocation ......... 48

Sprains ............................ 54
Strains ............................ 54
Stroke ............................... 55

Transportation . . . . . . . . . . . . . . . . . . . . . . . .. 56
Bibliography .......................... 66

.
INTRODUCTION
What should you do if a coworker or family
member is suddenly injured or becomes il? Right
after an accident or ilness occurs and before

medical help can take over, there is a critical period

in which the availabilty of a person skiled in first


aid techniques can mean the difference between
life and death for the victim.

There is an urgent need for first aid treatment at

mining sites where medical help is usually not

readily obtainable. Therefore, it is the duty of

every miner to be able to give proper emergency


assistance until the victim is under professional
medical care.
First aid does not replace the physician but it

does attempt to keep the victim alive and in the


best condition possible until medical aid arrives.
All first aid trainees are taught to send for medical
assistance in cases of serious injury and to instruct
the victim to visit a physician as soon as possible
in the case of minor injury.

This pamphlet is designed to be used as a quick


reference during an emergency and for periodic
review. Therefore, it contains only the basic, life-

support techniques with all extraneous material


stripped away.

BASIC PROCEDURES FOR FIRST AID


When a person is injured or il, someone must
take charge, send for a doctor, and apply first aid.
The person taking charge must make a rapid but
effective examination to determine the nature of
the injuries.
Do not move the injured person until you have a

clear idea of the injury and have applied first aid,


unless the victim is exposed to further dangr at

the accident site. If the injury is serious, if it


occurred in an area where the victim can remain

Once respiratory arrest and severe bleeding

have been alleviated, attention should be focused


on other obvious injuries-open chest or abdomi-

nal wounds should be sealed, open fractures


immobilzed, burns covered and less serious
bleeding wounds dressed. Again remember to
handle the victim carefully.

Once the obvious injuries have been treated, the


secondary survey can be made to detect less easily

noticed injuries that can be aggravated by

mishandling. If a victim with a spinal injury is


mishandled, he could suffer spinal damage,

medical aid is readily obtainable, it is

leading to paralysis. Also a closed fracture can

sometimes best not to attempt to move the person,

become an open fracture if not immobilized. The

safely, and if

but to employ such emergency care as is possible at

the place until more highly qualified emergency


personnel arrve.

When making an initial survey, a first aider wil


consider what witnesses to the accident tell him
about the accident, what he observes about the

secondary survey is a head to toe examination.

Start by examining the victim's head, then neck,


trunk, and extremities looking for any type of
abnormalities such as swellng, discoloration,

lumps, and tenderness that might indicate an


unseen injury.

victim, and what the victim tells him.

The first aider must not assume that the obvious


injuries are the only ones present because less

noticeable injuries may also have occurred. Look


for the causes of

the injury, this may provide a clue

as to the extent of physical damage.

While there are several conditions that can be


considered life-threatening, respiratory arrest and
severe bleeding require attention first.
In all actions taken during the initial survey the
first aider should be especially careful not to move
the victim any more than necessary to support life.

Any unnecessary movement or rough handling


should be avoided because it might aggravate
undetected fractures or spinal injuries.
2

IMPAIRED BREATHING

CAUSES
1. Suffocation
2. Gas poisoning

3. Electrical shock
4. Drowning
5. Heart failure

SIGNS/SYMPTOMS

FIRST AID PROCEDURES FOR LIFETHREATENING CONDITIONS


This section outlines the first aid measures that
should be used when life-threatening conditions
exist. These conditions include: impa~red
breathing, heart failure, severe bleedmg,

and shock. Obviously, of first and paramount


concern is immediate recognition and correction of
these conditions. Emergency treatment should be

given in this order, as necessary:

THE AIR PASSAGE.


2. RESTORE BREATHING AND HEARTBEAT.
3. STOP BLEEDING.
1. CLEAR

4. ADMINISTER TREATMENT FOR


SHOCK.

1. The chest or abdomen does not rise and falL.

2. Air cannot be felt exiting from the nose or


mouth.

FIRST AID TREATMENT


There are several methods of artifical ventilation. Mouth-to-mouth is the most effective. Use the

mouth-to-nose method if the victim has a severe

jaw fracture or mouth wound, or has his jaws


tightly closed. Simply breathe into his nose
instead of his mouth.

Use back pressure method only when mouth-to-

mouth cannot be used: for example, if the victim


has severe facial injuries, is trapped or pinned face
down, or when you are in a toxic environment and
both you and the victim are wearing masks which
do not contain a resuscitation device.

MOVE FAST
Seconds count when a person is not breathing.
Start artificial ventilation at once. Don't take time
to move the victim unless the accident site remains

unsafe.

-4. Check for breathing by bending over the

MOUTH-TO-MOUTH (NOSE)
TECHNIQUE

victim, placing your ear close to victim's mouth

and nose. For at least 5 seconds listen and feel for

1. Position victim on his back. If it is necessary

air exchange and look for chest movements.

to roll the victim over, try to roll him over as a


single unit, keeping the back and nec~ strai~ht.

This is to avoid aggravation of any possible spmal


injury.

2. Kneeling at the victim's side, tilt victim's


head back so chin is pointing up by placing one

hand under the neck and the other hand on the


forehead.

If the person is not breathing, pinch the nose


closed, form an airtight seal by placing your
mouth over the victim's mouth and breathe
into the victim's mouth until the chest rises.
5. If no breathing is present, pinch the nose

closed with the hand that is resting on the


3. Quickly glance in victim's mouth for any
obstruction

(e.g., food, tobacco, blood, dentures).

if

an obvious obstruction is present, carefully turn

forehead, form an airtight seal by placing your


mouth over the victim's mouth, and breathe into
the victim's mouth until his chest rises. (If using
the mouth-to-nose method, seal the victim'smouth

with your hand and breathe in through his nose.

the victim on his side, tilt his head down, and

sweep his mouth out with your fingers. When the


mouth is clear move the victim onto his back again
and tilt his head back.

6. Breathe into the patient a total of four times

as quickly as possible. If you feel or hear no air


exchange, re-tilt his head and try again. If

you stil

feel no air exchange, again sweep the mouth of


foreign objects (Step 3), and breathe into the victim

again. If you stil have no air exchange, turn


victim on side and slap the victim on the back

between his shoulder blades. Again sweep his

mouth to remove foreign matter. (N ote: If none of

the above steps clears the air passage, repeat the


blows to the back and tilt the head.)

For at least 5 seconds listen and feel for air


exchange and look for chest movements.
6

7. Repeat breathing. Remove n:outh each.time

to allow air to escape. Repeat 12 times per mmute


for an adult - 20 times for a small child or infant.

Use deep breaths for an adult, less for a child,


gentle puffs of the cheeks for.infants. A~ the vi~ti~

3. Rock forward until arms are vertical and the

weight of your body exerts steady pressure on your


hands. (Count 2)

begins to breathe, maintam head tilt. If it is

impossible to do mouth-to-mouth or mouth-to-nose,


use the following:

BACK PRESSURE ARM LIFT METHOD


1. Place victim face down. Clean mouth. Bend
his elbows and place his hands one upon the other
at eye level under victim's head. Turn his head to

one side, making sure the chin juts out. This


method wil be done on a five beat count.

Rock back grasping the victim's elbows.


4. Rock back grasping victim's elbows (Count
3) and draw victim's arms up toward you until you

feel resistance at his shoulders. (Count 4)

Kneel at the victim's head, place your hands


on the victim's back.
2. Kneel at victim's head. Place your hands on
victim's back so palms lie just below an imaginary

line between armpits. (Count 1)

5. Lower victim's arms to the ground.

(Count

5)

Repeat about 12 times per minute (every 5


seconds). Keep checking to see if mouth is clean,
airway open, and the heart is beating. If hear~ is
not beating, begin external cardiac compreSSlOn

(circulatory failure).
DON'T

STOP

Continue artifical ventilation until victim

breathes normally, a doctor pronounces him dead,


a more qualified person takes charge, or you are

physically unable to continue. If he must be

Rock forward until your arms are verticaL.


8

moved, continue artificial ventilation.

FOREIGN OBJECTS IN THE THROAT


SIG NS/SYMPTOMS
1. The victim gasps for breath

FIRST AID TREATMENT


D~m't Waste Time! Cardiac .arrest (heart stops
beatmg) means certam death if CPR (cardiopul-

monary resuscitation) is not attempted.

2. Has violent fits of coughing

If you have been trained in CPR:

3. Quickly turns pale then blue


4. Cannot talk or breathe.

FIRST AID TREATMENT

1. CHECK FOR RESPONSE - Gently shake

the victim and shout "Are you OK."

1. Open victim's mouth and grasp foreign object

with fingers (index and middle), trying to


remove obstruction.

2. Place head lower then body or roll victim on

.2. CHECK AIRWAY - Open the victim's

airway by tilting his head back. (Victim should be


on his back.)

his side and slap him on the back.


3. If these methods do not work, try this third
method:

a. Rescuer stands behind the choking victim


with arms around the victim just above the
navel and below the rib cage.
b. Lean the victim forward at the waist with
his head and arms hanging down.

c. The rescuer grasps his wrist then exerts

sudden strong pressure against the victim's abdomen. This wil force air out ofthe
lungs and may expel the obstruction.

Check for breathing.


3. CH~CK BREATHING - For at least 5

seconds listen and feel for air exchange and look


for chest movements.

CIRCULATORY FAILURE
CAUSES
1. Heart attack
2. Impaired breathing
3. Shock
4. Electrical shock
SIG NS/SYMPTOMS
1. No breathing

2. No pulse
10

If

not breathing, give four quick full breaths.


11

4. IF NOT BREATHING - Give four quick

full breaths using the mouth-to-mouth technique.

point for cardiac compressions, locate the bony tip


of the breastbone (sternum) with your ring finger
and place two fingers just above that point. Place
the heel of one hand adjacent to your fingers and

the second hand on top of the first.

Check pulse.
5. CHECK PULSE - After giving four quick
breaths, check the pulse using the carotid artery in
the neck. To find the carotid artery, locate the voice

box and slide two fingers into the groove between


the voice box and the large neck muscle. Press

firmly but gently to feel for the pulse and hold for at
lest 5 seconds. If a pulse is not present, begin

cardiac compressions immediately.

Place the heel of your hand adjacent to your

fingers and the second hand on top of the


first.

Position your shoulders directly over victim's


breastbone and press downward, keeping arms
straigh t. Depress the stern um 1112 to 2 inches for an

adult. The time spent depressing and releasing the


sternum should be equal.
If there is only one rescuer, compressions should
be at a rate of 80 per minute with 2 breaths

(artificial ventilation) after each 15 compressions.

Remember, after the two breaths, check your hand

position on the sternum before resuming compressions.

To determine the pressure point for cardiac


compressions, locate the bony tip of the

breastbone with your ring finger and place


two fingers just above that point.
6. CARDIAC COMPRESSIONS - Kneel at

the victim's side near his chest. (Victim should be


on a hard, flat surface). To determine the pressure
12

If there are two rescuers, they should be on

opposite sides of the victim. One rescuer should


perform compressions at a rate of 60 per minute,

while the second rescuer is interposing a breath


(artificial ventilation) after every fifth compression. Compressions should not be interrupted to
breathe for the victim.

13

CARDIOPULMONARY RESUSCITATION
FOR INFANTS AND SMALL CHILDREN
1. Airway - be careful not to overextend the

infant's head when tilting it back; it is so pliable


that you may block breathing passage instead of
opening it.
2. Breathing - you can cover both mouth and

nose with your mouth and use less volume of air;

BLEEDING
SIG NS/SYMPTOMS

Blood coming from an artery, vein, or capilary:


a. Artery - spurting blood, bright red in color

b. Vein - continuous flow of blood, dark red in


color

give a breath every three seconds.

c. Capilary - blood oozing from a wound


3. Circulation - In both infants and small

children only one hand is used for compressions.

For infants, use only the tips of the index and


middle fingers to depress the mid-sternum 1/2 to % of
an inch at a rate of 80 to 100 compressions per

the
hand to depress the chest at mid-sternum and
minute. For small children, use only the heel of

depress the mid-sternum % to 1112 inches, depending on the size of the child. The rates should be 80
to 100 compressions per minute.

In both small children and infants, breaths


should be interposed after every fifth chest com-

pression.

Cover the wound with the cleanest cloth


immediately available.

FIRST AID TREATMENT


1. Cover wound with the cleanest cloth immediately available or your bare hand and apply direct
pressure on the wound. Most bleeding can be

stopped this way.


2. Elevate the arm or leg as you apply pressure,
if there is no broken bone.
3. Digital pressure at a pressure point is used

if it is necessary to control bleeding from an

arterial wound (bright red blood spurting from it.)

Apply your fingers to the appropriate pressure


point - a point where the main artery supplying

blood to the wound is located (see diagram). Hold


pressure point tightly for about 5 minutes or until

bleeding stops. The three pressure points in the


14

15

bleeding on the head in about 95% of the injuries.

(f
@
~

used as a last resort


if there is a skull fracture and direct pressure can't
be used. If direct pressure can be used, it wil stop

head and neck should only be

()
~
$

A tourniquet should be applied to an arm or


leg only as a last resort.

4. A tourniquet should be applied to an arm or

leg only as a last resort when all other methods

faiL. A tourniquet is applied between the wound


and the point at which the limb is attached to the
body, as close to the wound as possible but never
over a wound or fracture. Make sure it is applied
tightly enough to stop bleeding completely.

In the case of an improvised tourniquet, the

material should be wrapped twice around the

extremity and halfknotted. Place a stick or similar


object on the half knot and tie a full knot. Twist the
stick to tighten the tourniquet only until the

Apply pressure to the pressure point closest


to the wound and between the wound and the

heart.
16

bleeding stops- no more. Secure the stick or level


in place with the loose ends of the tourniquet,

another strip of cloth, or other improvised materiaL.

17

Once the tourniquet is put in place, do not

SIGNS/SYMPTOMS

1. Shallow breathing

loosen it. Mark a "T" on the victim's torehead and

2. Rapid and weak pulse

get him to a medical facilty as soon as possible.

3. Nausea, collapse,' vomiting

Only a doctor loosens or removes a tourniquet.


Note: A tourniquet can be improvised from a
strap, belt, hankerchiefs, necktie, cravat bandageol
etc. (Never use wire, cord or anything that wil cut
into the flesh.)

4. Shivering
5. Pale, moist skin

6. Mental confusion
7. Drooping eyelids, dilated pupils

FIRST AID TREATMENT

INTERNAL BLEEDING
SIG NS/SYMPTOMS
1. Cold and clammy skin

1. Establish and maintain an open airway.


2. Control bleeding.
3. Keep victim lying down.
Exception: Head and chest injuries, heart
attack, stroke, sun stroke. If no spine injury,

victim may be more comfortable and breathe


in doubt,
better in a semi-reclining position. If
keep the victim flat.

2. A weak and rapid pulse


3. Eyes dull and pupils enlarged
4. Possible thirst
5. Nauseous and vomiting
6. Pain in affected area

FIRST AID TREATMENT


1. Treat victim for shock

2. Anticipate that victim may vomit, give

nothing by mouth
3. Get the victim to professional medical help as
quickly and safely as possible
SHOCK
Shock may accompany any serious inJury:
blood loss, breathing impairment, heart failure,
burns.
Shock can kil - treat as soon as possible and

continue until medical aid is available.


18

Elevate the feet unless injury would be


aggravated.

Maintain normal body temperature. Place


blankets under and over victim.

19

4. Elevate the feet unless injury would be


aggravated by this position.

5. Maintain normal body temperature. Place


blankets under and over victim.
6. Give nothing by mouth, especially stimulants

or alcoholic beverages.
7. Always treat for shock in all serious injuries
and watch for it in minor injuries.

INTRODUCTION TO SPECIFIC INJURIES

This section describes special methods which


you should follow for specific injuries or ilnesses
other than the four life threatening 'conditions
in Section 1. For quick reference this
discussed

section has been arranged alphabetically by the

injury.

20

21

BURNS- HEAT
FIRST DEGREE
SIG NS/SYMPTOMS
Reddened Skin

FIRST AID TREATMENT

Reddened skin.

Immerse quickly in cold water or apply ice until


pain stops.

SECOND DEGREE
SIG NS/SYMPTOMS
Reddened Skin, Blisters

FIRST AID TREATMENT


1. Cut away loose clothing
2. Cover with several layers of cold moist

dressings or if limb is involved immerse in


cold water for relief of pain.
3. Treat for shock.

Reddened skin, blisters.

THIRD DEGREE
SIGNS/SYMPTOMS
Skin destroyed, tissues damaged, charring
FIRST AID TREATMENT
1. Cut away loose clothing (do not remove

clothing adhered to skin.)


2. Cover with several layers of sterile, cold,
moist dressings for relief of pain and to stop
burning action.
3. Treat for shock.

Skin destroyed, tissues damaged, charring.


22

23

CHEST WOUNDS

BURNS - CHEMICAL
FIRST AID TREATMENT
1. Flood affected area with water for at least 20
minutes until all chemical is removed.
2. Remove victim's clothing because chemical
may be retained in clothing.

~
..

:.

r
1.

!;
: :

Cover with an airtight materiaL.


.FIRST AID TREATMENT

1. Cover wound with an airtight material


(aluminum foil or plastic wrap) after the
victim has exhaled. If no airtight material is
available, use your hand.

Flood affected area with water until all


chemical is removed.

2. Place the victim on the injured side to allow

expansion room for the uninjured lung.

3. Get the victim to the hospital as soon as


possible.

GENERAL CARE FOR ALL BURNS


1. Administering Liquids - If medical help is

not available within an hour and the victim is

conscious and not vomiting and requests

something, give him 1/2 glass solution of 1/2


teaspoon salt, 1/2 teaspoon baking soda to a

quart of water, every 15 minutes.


2. Separate any burned areas that might come

in contact with each other when bandaging.


(fingers, toes, ear and head)
3. Get medical attention as soon as possible.
4. Do not break blisters.
5. Do not use ointments.
24

25

EPILEPTIC SEIZURE

DIABETIC EMERGENCIES
DIABETIC COMA

SIG NS/SYMPTOMS
1. Loses consciousness
2. Convulsions

SIG NS/SYMPTOMS
1. Skin: red and dry
2. Temperature: lowered

3. Sickly sweet odor of acetone on breath


4. Breathing: rapid and deep

FIRST AID TREATMENT


1. Treat as you would for shock
2. Place in a semi-reclining position.

3. In case of vomiting turn head to one side.

4. Do not give sugar, carbohydrates, fats or


alcoholic beverages.

INSULIN SHOCK
SIGNS/SYMPTOMS
1. Skin: pale, moist, clammy and covered with
cold sweat.
2. Breathing: normal or shallow.

3. No odor of acetone

3. Severe spasms of

the

muscles ofthejaw(may

bite tongue)
4. Victim may vomit

5. Face may be livid, with veins of the neck


swollen.
6. Breathing may be loud and labored with a
peculiar hissing sound.

7. Seizure usually lasts only a few minutes but it

may be followed by another.

FIRST AID TREATMENT


1. Keep calm.

2. Do not restrain victim; prevent injury by


moving away any object that could be dangerous.
3. Place light padding under victim's head to

protect from rough ground. (jacket, shirts,


rug)

4. There is a danger of the victim biting his


tongue so place a padded object between his
his mouth. A shirt tail and

jaws on one side of

FIRST AID TREATMENT


This is a hurry situation and should be done

quickly.

1. If the victim is conscious, give him sugar


(sugar, candy bar or orange juice)

2. If unconscious, put sugar under the tongue.


Because it is often diffcult to determine the

difference between the diabetic emergencies, sugar


should be given to any unconscious or semi-

conscious diabetic even though he may be suffer-

ing from diabetic coma (too much sugar). The

reason for giving sugar is that an insulin reaction


(too little sugar) resulting in unconsciousness can
quickly cause brain damage or death.
26

a stick can be used for the padded object.

However do not try to force jaws open if they


are already clamped shut.

5. When the seizure is over loosen clothing


around the neck.

6. Keep the victim lying down.


7. Keep victim's airway open.
8. Prevent his breathing vomit into lungs by
turning his head to one side or by having him
lie on his stomach.
9. Give artificial respiration if breathing stops.

10. After the seizure, when consciousness is


regained allow the victim to sleep or rest.

27

IMPALED OBJECTS

EYE INJURIES

FOREIGN BODIES IN THE EYE


FIRST AID TREATMENT
1. Never rub eyes.
2. Try to flush out with clean water.
3. If object is on upper lid, lift eyelid, and remove
object with sterile gauze.

4. If foreign object is on the eye and can't be


washed out, cover eye and take victim to a
doctor.

Cover with paper cup to protect the eye and


prevent object from being further driven into

it.

If object is on upper lid, lift eye lid, and


remove object with sterile gauze.

FIRST AID TREATMENT

1. Leave object in victim; it should only be


removed by a doctor;

2. Place sterile gauze around eye, apply no


pressure.

3. Cover with paper cup or cardboard cone to


protect it and prevent object from being
further driven into eye.
4. Cover both eyes, and

explain to victim why

both eyes are covered, one eye cannot move

without the other eye moving. Calm and


reassure the victim - he may panic with both
eyes covered.

For chemical burns to the eyes see Burns Chemical

28

29

FRACTURES - DISLOCATIONS

CLOSED FRACTURE (simple): broken bone

DISLOCATION: separation of two bones


that come together to form a joint.

SIGNS/SYMPTOMS

TURES AND DISLOCATIONS1. If fracture is suspected immobilize.


2. "Splint them where they lie."

but no open wound.


FRACTURES

FIRST AID TREATMENT FOR FRAC-

a. Deformity
b. Irregularity
c. Swellng

3. Handle as gently as possible. This work

d. Discoloration

should be done in pairs, one person to immobilze


the limb and one to apply the splint.

e. Grating sound
f. Exposed bone (open fracture)
g. Pain

as possible by applying slight traction. Traction is


applied by grasping the affected limb gently but

..
OPEN FRACTURE (compound): broken
bone with open wound

DISLOCATIONS
SIG NS/SYMPTOMS
a. Deformity

b. Pain

c. Loss of function

30

4. Place a fracture in as near normal position

firmly with one hand above and below the

locatin of the fracture, and pulling the limb


between your hands. This is maintained until the
splint is secured in place. Caution: never try to
straighten if a joint of spine is involved.
5. Immobilize dislocated joints in the position
they are found, do not attempt to reduce or

straighten any dislocation.


6. Splints
a. Should be long enough to support joints
above and below fracture or dislocation.

b. Rigid enough to support the fracture or

dislocation.

c. Improvised splints should be padded


enough to insure even contact and pressure

between the limb and the splint and to protect all

bony prominences.
31

d. Types of splints: air splint, padded boards,


rolled blanket, tools, newspapers, magazines.
7. Applying improvised splints
a. Apply slight traction to the affected limb.

8. Applying inflatable splints


a. Inflatable splints can be used to immobilize
fractures of the lower leg or forearm.
b. To apply an air splint gather splint on your

b. A second person (if available) should place


the padded splint under, above or alongside the
limb.

own arm so that the bottom edge is above your


wrist.
c. Help support the victim's limb - or have
someone else hold it.

d. Inflate by mouth only to desired pres-

sure. It is inflated to the point where your thumb


would make a slight indentation.

e. If it is a zipper type air splint lay the

victim's limb in the unzipped air splint, zip it and


c. Tie the liinb and splint together with

bandaging materials so the two are held firmly

together. Make sure the bandaging material is


not so tight that it impairs circulation. Leave
fingers and toes exposed, if they are not

involved, so that the circulation can be checked


constantly.
32

inflate. Traction cannot be maintained when


applying this type of splint.

f. Change in temperature can effect this type


of splint - going from cold area to warm area

wil cause the splint to expand. It may be


necessary to deflate the splint until proper

pressure is reached.
33

FROSTBITE

HEART ATTACK

Most frequently frostbitten: toes, fingers,


nose, and ears.
CAUSE
Exposure to cold

SIGNS/SYMPTOMS
1. Skin becomes pale or a grayish-yellow color

2. Parts feel cold and numb


3. Frozen parts feel doughy

FIRST AID TREATMENT


1. Unti victim can be brought inside, he should

be wrapped in woolen cloth and kept dry.


2. Do not rub, chafe or manipulate frostbitten
parts.
3. Bring victim indoors.

4. Place in warm water (102 to 105) and make


sure it remains warm. Test water by pouring
on inner surface of your forearm. Never thaw

if the victim has to go back out into the cold

which may cause the affected area to be


refrozen.
5. Do not use hot water bottles or a heat lamp,

and do not place victim near a hot stove.


6. Do not allow victim to walk iffeet are affected.

7. Once thawed, have victim gently exercise

1. Shortness of breath

2. Anxiety
3. Crushing pain in chest, under breastbone, or
radiating down left arm.
4. Ashen color
5. Possible perspiration and vomiting.

FIRST AID TREATMENT


1. Place victim in a semi-reclining or sitting
position.
2. Give oxygen if available.
3. Loosen tight clothing at the neck and waist.
4. Administer nitroglycerine pil if victim is

carrying them and asks you to get them (they


are adminstered by putting one under the

tongue).

parts.

5. Keep onlookers away.

thawing because pain wil be intense and

6. Comfort and reassure him.


7. Do not allow him to move around.

8. For serious frostbite, seek medical aid for


tissue damage extensive.
34

SIGNS/SYMPTOMS

8. Give no stimulants.
35

.
HEAT

CRAMPS

HEAT EXHAUSTION

~
Pale and clammy skin, perspiration.
SIG NS/SYMPTOMS
1. Pale and clammy skin

2. Profuse perspiration
Affects people who work or do strenous exercises in

a hot environment.

SIG NS/SYMPTOMS
1. Painful muscle cramps in legs and abdomen.
2. Faintness
3. Profuse perspiration

FIRST AID TREATMENT


1. Move victim to a cool place
2. Give him sips of salted drinking water (one
teaspoon of salt to one quart of water)

3. Rapid and shallow breathing

4. Weakness, dizziness, and headache


FIRST AID TREATMENT
1. Care for victim as if he were in shock.
2. Remove victim to a cool area, do not allow
chiling.
3. If body gets too cold, cover victim.

HEATSTROKE

3. Apply manual pressure to the cramped

muscle

PREVENTION
1. Men at hard work in high temperatures

should drink large amounts of cool water.

2. Add a pinch of salt to each glass of water.

Red and flushed, skin hot and dry.


SIGNS/SYMPTOMS
1. Face is red and flushed

2. Victim becomes rapidly unconscious


3. Skin is hot and dry with no perspiration
36

37

FIRST AID TREATMENT


1. Lay victim down with head and shoulders

raised.
2. Reduce the high body temperature as quickly
3. Apply cold applications to the body and head.
4. Use ice and fan if available.
5. Watch for signs of shock and treat accord-

ingly
6. Get medical aid as soon as possible.

I
.___
__J
L.~~.
---,,'" -. - - -~
- - ---- ~- ..
..--~."
, ,
""""

FIRST AID TREATMENT


1. Bring victim into a warm room as quickly as
possible.
2. Remove wet clothing.
3. Wrap victim in prewarmed blankets, put in a
warm tub of water, or next to one or between
two people for body warmth.
4. Give artificial respiration, if necessary.
5. If victim is conscious, give warm drink (N 0
alcohol).
6. Get medical help as soon as possible.

INSECT BITES AND STINGS

I .."" - - - ~ - ~ --~ - )

-....~
~.~

",

Qi
I

..Q..
(from bees, wasps, yellow jackets, hornets, mosqui-

HYPOTHERMIA

( Exposure)

Chils the inner core of the body so the body can't

generate heat to stay warm.

SIG NS/SYMPTOMS
1. Entire body affected

2. Shivering

3. Numbness
4. Low body temperature
5. Drowsiness, mumbling, incoherence
6. Muscular weakness
38

toes, ticks, fleas, and bedbugs)


SIG NS/SYMPTOMS
1. Local irritation and pain
2. Moderate swellng and redness
3. Itching and/or burning, may be present
FIRST AID TREATMENT
1. If stinger is left in the wound, withdraw it.
2. Apply paste of baking soda and water.
3. Immediate application of ice or ice water to
the bite or sting relieves pain.

4. For people who are allergic to certain insects,


use a constricting bandage (if on an extremity) and ice. Get medical help immediately.
39

Open wounds

WOUNDS
FIRST AID TREATMENT
OPEN

1. Stop bleeding.

2. Cover with cleanest cloth immediately available. (Preferably a sterile dressing)

3. Wash with soap and water - those wounds


which involve surface area with little bleeding.

Puncture

Abrasion

:: '\ ""
Do not remove imbedded objects.

Cut clothing from injury site.


Avulsion

Laceration

::t\ ,.
Stabilze object with bulky dressings.

l 3;
Incision

Apply paper cup, if available, to prevent


movement.

40

41

.
PRINCIPLES OF BANDAGING

4 Impaled Objects .
. a. Do not remove embedde~ o)JJects:
b. Cut clothing away from inJury sit.e.

c. Stabilize objects with bulky dress~ng. .

d. Apply bandage and paper cup (if available) to prevent movement.

e. If large object, cut off o~l~ enough to allow


for transportation of victim.

1. Never tie a tight bandage around the neck.

it

may cause strangulation.


2. A bandage should be tight enough to prevent
slipping, but not so tight as to cut off circulation.

3. Leave fingers and toes exposed, if uninjured,


to watch for swelling or changes of color and
feel for coldness, which signal interference
with circulation.

.
4. Loosen bandages immediately if victim
complains of numbness or a tingling sensa-

Bandages and dressings


42

tion.
5. Once a dressing is in place do not remove. If
blood saturates the dressing, put another on

top of it. 43

POISONS

FIRST AID TREATMENT


1. Dilute by drinking large quantities of water.

2. Induce vomiting except when poison is


corrosive or a petroleum product.

3. Call the poison control center or a doctor.

RIB FRACTURES
SIG NS/SYMPTOMS

1. Pain is usually localized to site offracture. By

asking the victim to place his hand on the

exact area of pain (if he is conscious), the first


aider can determine the location of
the injury.
2. Possible rib deformity or lacerations.
3. Deep breathing, coughing or movement is
painfuL.

4. The victim often leans toward the injured side


with his hand held over the injury site in an

attempt to ease the pain and immobilze the


chest.

PROTRUDING INTESTINES
FIRST AID TREATMENT
1. Do not try to replace intestine.
2. Leave organ on the surface.
3. Cover with non-adherent material (alumi-

num foil or plastic wrap).


4. Cover with outer dressing to hold it in place.

Bind arm to chest with two medium cravats.


FIRST AID TREATMENT
1. Bandage should be tightened during exhala-

tion.

2. Place arm of injured side across chest.


3. Bind arm to chest with two medium cravats.
4. Repeat with two additional cravats, overlapping bandages slightly.
5. Tie fourth cravat along angle or arm for
support.

6. It is important to make certain that the

Cover with nonadherent materiaL.


44

binding is not too tight, as a fractured rib


might puncture a lung.
45

SKULL FRACTURE

SNAKEBITES

( suspected)

SIG NS/SYMPTOMS
1. Unconsciousness

2. Deformity of the skull


3. Open wound

4. Blood or clear water-like fluid coming from


ears or nose

5. Pupils may be unequal in size.

FIRST AID TREATMENT


1. Maintain an open airway.
2. Check for spinal injury.
3. Keep victim quiet.

SIG NS/SYMPTOMS
1. Puncture marks
2. Severe burning, pain and spreading swellng
3. Nausea and vomiting
4. Respiratory distress
5. Shock

~ =

Puncture marks at the site of the bite.

Raise head and shoulders. If there is no

suspected neck injury turn head so it does not


rest on fracture. . .

FIRST AID TREATMENT

1. Immobilize the victim immediately with


injured p~rt lo~er t?an the rest of th~ body.

Any activity will stimulate spread of poison.


2. Remove rings, watches, and bracelets.

3. Apply a constricting band above swellng

c.aused by the bite. It should be tight, but not


tight enough to stop arterial circulation.

4. Make an incision, no more than 1/8 inch deep

. . . Or place in a three-quarter prone position.


there is no suspected neck injury, turn head
so it does not rest on fracture.

4. If

5. Raise head and shoulders or place in a three


quarter prone position.

6. Use ice pack to stop severe bleeding.


7. Do not stop bleeding from ears or nose.
46

nor more than 1/2 inch long, lengthwise

through fang marks. Press around cut to


make it bleed.

5. Suction wound with device found in snakebite

kit. If no kit is available, use your mouth (if


you have no open sores in your mouth or on
you~ lip~) and spit out the blood. Cutting and
suctlOn is of no value unless done immediate-

ly. Do not cut if bite is near a major vesseL.


47

6. If swellng continues past the constricting

band, put another past the swellng and

Check upper extremities for paralysis of


neck.

loosen the first band.


7. Treat the victim for shock. Do not give the
victim any stimulants or alcohoL.

8. Identify snake if possible. If snake can be


kiled, take it to the hospital with the victim.

9. For persons who frequent regions infested

with poisonous snakes, it is recommended


that any of the pocket-size snakebite kits be

retained.

Can victim feel your touch?

SPINE FRACTURE OR DISLOCATION

Can victim grasp your hand?

(back and neck)

SIG NS/SYMPTOMS
1. Pain in back or neck
2. Paralysis
3. Deformation

4. Cuts and bruises


5. Swelling

SURVEY - for a conscious victim


1. Ask if the victim feels pain in the back.
2. Look for cuts, bruises, and deformation.
3. Feel along back for tenderness to your touch.

Can victim raise arms and wiggle fingers?

4. Check for paralysis by having victim move


fingers and toes.
48

49

Check lower extremities for paralysis of


back.

SURVEY - for an unconscious victim


1. Look for cuts, bruises, and deformation.
2. Feel along back for deformation.

3. Ask others what happened.


4. Gently jab victim (with something sharp)
lightly on the soles of

feet or ankles (for back)

or hand (for neck) - if cord is intact foot or


hands may react.

Can victim feel your touch?

Can victim press against your hand?

Lightly jab hands or feet with something

sharp.

Can he wiggle his toes?

50

A spine fracture or dislocation is diffcult to tell


if the
accident looks as if it could have produced a spinal
injury, treat for one even though there are no other
signs.
in the unconscious victim with any accuracy.

-~.

51

-FIRST AID TREATMENT


1. Do not try to straighten the deformity to make
splinting easier - straighten only to help open an

airway.
2. Apply traction to the head, supporting head
in line with the body. The head should be held until
the victim is secured to the splint.

3. Restore airway and make sure breathing is

adequate.

4. If there is a suspected neck fracture and the


victim is found on his face, apply traction to the
head and roll the victim over keeping the head in
line with the body. A minimum of three people is
needed for this.
5. Do not bend or twist back or neck. Support
head in line with body.

Apply traction to victim's head.

6. Control serious bleeding.

7. Immobilize before moving victim.


8. Lift victim only high enough to slide stretcher
under victim.

9. In case of a suspected neck fracture, the head


should be kept from moving after the victim has
been put on the stretcher - by rollng' a blanket

around the head and securing it to the stretcher


with two cravat bandages.

10. Do not move the victim until there are

enough rescuers and an adequate splint available.

11. The stretcher must be rigid, an ordinary

canvas stretcher is not suitable. An improvised


stretcher can be made from two long boards, 84 by
6 by 1 inch; and 3 short boards, each 22 by 4 by 11/2

inches. The three short boards wil be cross pieces

under the two long boards, nailed or tied at points


corresponding to where the person's shoulders,
hips, and heels wil be. Pad the long boards with
blankets and secure in place. The victim is then
placed on the stretcher and tied on with fifteen

cravat bandages.
52

V ictim is secured to an improvised stretcher

board with 15 cravat bandages.

53

SPRAINS
Overstretching of a muscle or tendon

SIG NS/SYMPTOMS

1. Intense pain
2. Moderate swelling

3. Pain and diffculty in moving

Ligaments or other tissues around joints are


torn or stretched.

SIG NS/SYMPTOMS

FIRST AID TREATMENT


1. Rest
2. Apply mild dry heat.

1. Pain on movement.

2. Swellng

STROKE

3. Discoloration

FIRST AID TREATMENT


1. Elevate injured part.

~~

2. Apply cold compresses.


3. Treat as a fracture.

Note: Sprains present basically the same signs


and symptoms as fractures. Because of

this factor,

treat all injuries to the bones and joints as


fractures.

STRAINS

Pupils are unequal in size. There may be


paralysis on one side of the body.

(a blood clot or rupture of a blood vessel in the

brain)

SIG NS/SYMPTOMS
1. Usually unconscious.
2. Face flushed and warm but may sometimes
appear ashen gray.

3. Pulse first slow and strong; later rapid and


weak.

Strains are caused by overstretching of a


muscle or tendon.
54

4. Respiration slow with snoring.


5. Pupils unequal size.
6. Paralysis on one side of face andlor body.
55

FIRST AID TREATMENT


1. Keep an open airway; do not allow tongue or
saliva to block air passage.
2. Keep the victim warm.

3. Place victim in a semi-reclining position if


breathing is satisfactory.

4. Keep the victim quiet.


5. Reassure victim if he is conscious.

If the person must be pulled or dragged to

the long axis of

safety, pull in the direction of

the body.

TRANSPORTATION
After receiving first aid care, a seriously injured
person often requires transportation from a mine,
to a hospital, to a physician's offce or to his home.

It is the responsibilty of the first aid person to


insure that the victim is transported in such a
manner as to prevent further injury and is

If a person is in a life threatening situation and


must be pulled or dragged to safety, he should be
pulled in the direction of

the long axis of

his body,

preferably from the shoulders, not sideways.

Avoid bending or twisting the neck or trunk.

subjected to no unnecessary pain or discomfort. No

matter how expert the first aid care has been,


improper handling and careless transportation
often add to the severity of the original injuries,

increases shock, and frequently endangers life.

N ever move a victim until a thorough examina-

tion has been made and all injuries have been


protected by proper dressings. (Unless the victim

and the first aider are in immediate danger at the


accident site.)

Seriously injured persons should be moved only


in a lying down position. If proper transportation

is not immediately available, continue care of the


victim to conserve his strength until adequate

means of transportation can be found.


56

If available use a blanket, board or cardboard to move the victim.

Various carries can be used in emergencies, but


the stretcher is the preferred transportation

method. Carrying in the arms, carrying over the


back, and the two-man carry should be used only
when it is positively known that no injury wil be
aggravated by such handling of the victim.

57

-Various carries can be used in emergencies.

The Two-Man Carry.

58

59

~
THREE OR FOUR MAN LIFT
CARRY
AND

An injured person can be moved or carried with a


minimum of further injury or discomfort with the
three or four man lift and carry. It is used where an
injured person is to be carred a short distance,

transported through narrow passageways, or


where a stretcher is not available.

Position of hands: neck and shoulders,

thighs and small of back, ankles and knees.

The lift is used also when an injured person is


being placed or removed from a stretcher.

Three persons are required for this lift and a


fourth is desirable (a fourth is necessary for a

spinal injury to hold the head). Proper lifting must

be done by commands of a leader or one of the


bearers, usually the one at the victim's head.

Each of the three men kneels (on his knee

nearest the victim's feet) one opposite the victim's


shoulders, another opposite his hips, and the third
opposite his knees. Unless the nature of the

Bearers slowly lift the victim and support


him on their knees.

victim's injuries makes it undesirable, the bearers


kneel by the victim's uninjured or least injured
side.

Position of the hands: First man - hands under


shoulders and neck; second man - hands under
thighs and small of the back; third man - hands

under victim's ankles and knees; fourth man -

helps support trunk from opposite side, to prevent

rollng.

Step 1: The leader wil tell the bearers "Prepare


to lift victim."

Step 2: The leader wil then say "Lift victim."

The bearers slowly lift the victim and support him


on their knees. If a stretcher is available, stop in
this position and slide stretcher under the victim.
Then lower the victim on command of the leader.

60

if

Place the stretcher under the victim.


61

--

.
Types of stretchers.

If stretcher is not available, the bearers will


have to rise with the victim and carry him
away from the scene of the accident.

Robinson

Stokes

stretcher is not available and cannot be brought to

the victim go to Step 3.

Step 3: The leader wil tell the bearers "Prepare


to rise with victim." Bearers turn victim slowly to
his side until he rests against their chests.

Step 4: When the leader says "Rise with


victim," the bearers rise slowly with the victim.
STRETCHERS

Stretcher should be tested before placing victim


on it. Use a person of about equal weight as the
victim. The person should be face down so that if
the stretcher should break or tear when it is picked

up, the person wil be able to catch himself.


62

Long board

o
Short board
63

~
IMPROVISED STRETCHERS
A stretcher may be improvised with a blanket,
brattice cloth of similar size, a rope, or a strong

.;;
i.

sheet and two poles or pieces of pipe each 7 to 8 feet

y.

Improvised Blanket Stretcher, partly folded

long. Place one pole or pipe about 1 foot from the

center of the unfolded blanket. Fold the short side


of the blanket over the pole toward the other side.
Place the second pole or pipe on the two thicknesses of blanket about 2 feet from the first pole
and parallel to it. Fold the remaining side of the
blanket over the second pole toward the first pole.
When the inj ured person is placed on the blanket,

the weight of the body secures the folds.

~
Stretcher Board (with foot rest)

STRETCHER BOARDS
Stretcher boards can be made from a wide board,

approximately one and one-half inches thick, or


from laminated plywood, about three-quarters of
an inch thick. They are usually about 78 inches in

length and about 18 inches in width. They have


slots about 1 inch wide placed along the edges,

through which cravat bandages are passed to


secure the victim to the board. .The slots may also

serve as hand holds. Some variations have


additional slots in the center of the boards so that
each leg may be secured separately to the board.
64

65

-BIBLIOGRAPHY
1. The American National Red Cross. Standard
First Aid and Personal Safety. Doubleday &
Company, Inc., New

York, 1st

Ed., 1973,

268

pp.

ABOUT THE AUTHORS 2. The Committee on Injuries, American Academy


of Orthopedic Surgeons.' Emergency Care and

Transportation of the Sick and Injured. George


Banta Co., Inc., Menasha, Wisconsin, 1971,293
pp.

3. Grant, H. and R. Murray. Emergency Care.


Robert J. Brady Co., Bowie, Maryland, 1971,

334 pp.

Linda H. Byers
Mrs. Byers is an instructor with Education and

Training, Mining Enforcement and Safety Administration pf the U.S. Department of the Interior at
Arlington, Virginia and holds a BS degree from

the University of Maryland.


Marilyn Hutchison, M.D.

4. Henderson, John. Emergency Medical Guide.

McGraw-Hil Book Co., New York, 2nd Ed.,


1969, 556 pp.

5. The Journal of the American Medical Associ-

ation (A Supplement). Standards for Cardio-

pulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). v. 227, No.7, Feb.
18, 1974, pp. 833-851.

Dr. Hutchison is currently the Acting Director,


Division of
Occupational Health Services, N ation-

al Institute for Occupational Safety and Health

(NIOSH), Center for Disease Control, of the U.S.


Department of Health, Education, and Welfare at
Rockvile, Maryland. She is a commissioned

offcer with the U.S. Public Health Service and


holds an AB degree from the University of
Missouri at Kansas City and an MD degree from

6. U.S. Bureau of Mines. First Aid for the Mineral

and Alled Industries. A Bureau of Mines

Instruction ManuaL. 1971, 191 pp.

66

the University of Kansas.

Notes
MESA Safety Manuals

Accident Prevention
Coal Mining
Comm unica tions

Diesel Equipment
Dust
Electrical Hazards
Emergency Procedures
Explosives and Blasting

Fire Prevention
First Aid
Ground Control

Health Hazards
Hydraulics
Mine Gases
Mine Ilumination

Mine Machinery
Mine Maps
Mine Ventilation
Noise
Roof and Rib Control

Safety Fundamentals
Transportation and Haulage

tlU.S. GOVERNMENT PRINTING OffiCE: 1976-618-469