C4 HEALTH

Workforce Development for the Health Sector

FIRST AID TRAINING MANUAL

NZQA UNIT STANDARDS

6400 – Manage First Aid in emergency situations

6401 – Provide First Aid

6402 – Provide resuscitation Level 2

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CONTENTS

Introduction 3 Spinal injuries 28

Primary assessment 4 Chest injury 29

DRSABC 4 Abdominal injury 30

CPR-Adult 8 Crush injury 30

CPR -Child 10 Nose bleeds 31

CPR - Infant 10 Ear injuries 31

Level of Consciousness 11 Eye injuries 32

Recovery Position 12 Head injuries 32

Choking - Adult 12 Skull fracture 33

Choking – Child 13 Angina 34

Choking – Infant 13 Heart attack 34

Secondary assessment 14 Stroke 36

Bleeding 14 Diabetes 37

Shock 16 Asthma 38

Fainting 17 Hyperventilation 40

Bleeding – external 17 Seizures 40

Wounds 19 Poisons 41

Burns 21 Stings 43

Bleeding –internal 23 Severe allergic reactions 43

Fractures 24 Hyperthermia 44

Dislocations 27 Heat exhaustion/stroke 44

Soft Tissue injuries 28 Hypothermia 46

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INTRODUCTION
Welcome to C4 Health and your Workplace First Aid course. Today you will learn new skills
which will assist you to manage emergencies, accidents and illnesses, both in your
workplace and out in the wider community. If you are doing a refresher course then today
will reinforce what you already know and give you even more confidence in being able to
manage these situations.

Remember…First Aid is just that. It enables you to keep an injured or unwell person safe
until trained personnel arrive. This is a valuable skill to possess and many people have
benefitted from having someone right there who knows just what to do.

We hope you enjoy today…learning should be fun…so let’s have fun.

NZQA ASSESSMENT
In order to achieve the standards required for NZQA we need to assess you throughout the
day. This will be done in several ways – filling in your workbook, demonstrating CPR and
choking technique, group work around accident scenes and practical demonstrations

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 LET’S GET STARTED

PRIMARY ASSESSMENT. (p4-6)

Scene assessment
This is a very important part of First Aid. Unless you can calmly assess the situation and
make good choices about what needs to happen, or what you need to do, you can put
yourself, the patient and others at risk.

A thorough scene assessment gives you good information about what you may need to do,
who you may need to call and what type of assistance the patient or patients may require.

Systematic assessment
Performing a systematic assessment is sometimes easier to do if you have a framework…a
guideline. It helps you to remember things in order and also helps to keep you calm as you
tick the important things off your list. There are several acronyms around for the steps you
need to take with First Aid but the one we like to use is DRSABC – Doctor’s ABC. This part of
the systematic assessment is known as the PRIMARY ASSESSMENT.

DANGER

RESPONSE

SEND FOR HELP

AIRWAY

BREATHING

CIRCULATION
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DANGER.
When you first arrive on the scene…stop…take a deep breath…then have a good look
around. Determine if this a safe place for you to be. Are there any hazards that may pose a
threat to you? Remember…initially you are the most important person at that scene….if
anything happens to you there may not be anyone else that can deliver the First Aid skills
that the patient or patients may need.

Major hazards

 Fire  Fuel
 Gas and other poisonous fumes  Rain
 Electrical contact  Time of day
 Traffic
 Snow
 Blood borne diseases
 Air temperature
 Glass

The next most important person is the patient. If they are conscious and able to move away
from any hazards, assist them to move to a safer area. If they are unable to move, and there
are hazards then enlist the help of a bystander or bystanders. Remember, if there are
imminent dangers it is far better to gently remove the patient from the scene rather than
leaving them in danger. If you do have to move the patient, mark the spot where you found
them in….this may assist police or ambulance with future enquiries.If it is impossible to
move the patient then try and protect them as much as you can. For example at an accident
scene get bystanders to redirect traffic. Or use their cars to make a safe cordon around the
patient but try not to block access for emergency vehicles. Always remember that you are
the most important person and that you should never put your safety at risk.

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Last but not least are the bystanders and their safety. If you have identified hazards at the
scene make sure you point these out to others. If there are enough people around, you
could ask someone to keep others away from the hazards. Not everyone will have First Aid
training and understand about scene safety.

RESPONSE.
In most First Aid situations your patient will be injured or unwell but they will be conscious.
In cases where the patient has collapsed or appears to be unconscious…touch the patient
firmly on the shoulder. Try to ascertain if they are able to respond. If there is no initial
response, it may be necessary to use slightly more force. If there is still no response then
move to the next phase.

SEND FOR HELP.

If there is a bystander or bystanders, ask them to dial 111 and request an ambulance. If
there are traffic issues or the patient is trapped, or there is a fire, other services may be
required. Your scene assessment will have given you a good idea of what or who you may
need. Ask them to report back to you after they have done it. That way you can be
confident that help is definitely on the way. Do this even if there is a General Practitioner or
Medical Centre close by. If you are on your own and have a cell phone it may be best to
assess the scene and the patient then call for help before starting any intervention that may
be necessary.

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AIRWAY (p10-11)
Once you have established that the patient is unresponsive the next thing to check is the
airway. Place your hand on their forehead and two fingers under the chin and gently tip the
head backward. Open the mouth and look for any foreign bodies that may be obstructing
the airway. If you can see something, perform a finger sweep and try and remove it. If you
cannot see anything do not attempt the finger sweep. Do not remove dentures unless they
are broken.

However in the majority of cases with adults, it will be the tongue that is obstructing the
airway. At this stage you need to tilt the head at the same time as you do a jaw thrust. This
both opens the airway and prevents the tongue from blocking it.

BREATHING
Now that you have an open airway, you can check to see if the patient is breathing. There
are several ways to do this and if you remember the simple sequence of Look, Listen and

Feel you will easily ascertain if the patient is breathing.

LOOK to see if the chest is rising and falling

LISTEN for breath sounds. Do this by placing your ear next to the patient’s mouth.
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FEEL for air moving in and out. You will normally feel warmth as the air has been warmed by
the lungs. Do this by gently cupping your hand over the patient’s mouth. Another technique
is to use a mirror which will fog up if the patient is breathing.

If the patient is breathing, place them in the recovery position, keep warm and monitor
breathing regularly.

If the patient is not breathing, and there are no other signs of life e.g. coughing or
movement commence CPR.

CPR and Rescue Breathing (Circulation)

Circulation describes the pathway of blood around the body. Blood carries oxygen to vital
organs and is essential to life. If there are no signs of life e.g. breathing, coughing or
movement, then you must start CPR.

Note: The NZRC no longer teaches checking for a pulse to First Aiders. The absence of any
signs of life is considered to be enough to warrant starting CPR.

CPR.
This stands for Cardio-Pulmonary resuscitation.

Cardio = heart

Pulmonary = lungs

CPR involves chest compressions and rescue breathing and the ratio for compressions to
breaths is:

30 to 2 no matter who!

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To perform compressions, place the heel of one hand in the centre of the chest and then
link your two hands together. Initially give 30 chest compressions then 2 effective breaths.
The rate is 100 compressions per minute which is quite fast. Keep this cycle up until the
patient shows signs of life, qualified help arrives or you are exhausted. If there is more than
one bystander who is able to do CPR, take turns to share the load. Performing CPR is tiring
but this can be exaggerated if you are using your wrists or arms to compress the chest. Lean
over the patient and let your body weight do the work.

Children and Infants (p12-14)

CPR is slightly different for children and infants although the 30 to 2 ratio is the same and
the rate is still 100 per minute. When performing CPR on children, use one hand in the
centre of the chest, and with infants, position them on a table or hard surface and place two
fingers just below the nipple line. Continue with 30:2 and 100 per minute until they are
breathing or qualified help arrives. If you are alone with a child or infant, it is possible to
take them to help rather than wait e.g.to a neighbour.

When breathing for the adult patient, pinch the nose to ensure that air will not escape and
using a protective shield form a tight seal around the patient’s mouth. Give two effective
breaths i.e. you should be able to see the chest rise.
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If you are unable to see the chest rise, make sure that the airway is open by retilting the
head and give up to 5 breaths. If you are still unable to see the chest rise it may be that the
airway is blocked and you may need to act as for a choking patient (Page 11)

With children and infants, the most common causes of non-breathing are rarely due to
cardiac problems, and are mainly as a result of airway or breathing problems. Therefore we
breathe first to try and restore function before we go to chest compressions. Always
perform rescue breathing and compressions for two minutes before sending for help. You
may be able to resuscitate an infant or child within that time.Opening the airway of a child is
the same as an adult – head tilt and chin lift. For an infant, the head position should be
neutral – this is known as the “sniffing” position. Tilting the head will have the effect of
blocking off the airway. Cover the infant’s nose and mouth with yours to form an effective
seal and initially give 5 rescue puffs. Remember that infants have tiny lungs which can only
take a small amount of air.

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The following chart describes the steps to take for CPR with children and infants.

ACTION CHILD (1-8YRS) INFANT (0-1YR)

Start with 5 Rescue breaths 5 Rescue puffs

Perform compressions One hand in the centre of 2 fingers just below the
the chest nipple line

Compression to breaths 30 : 2 30:2

Compressions per minute 100 100

LEVELS OF CONSCIOUSNESS.
There are a multitude of reasons why your patient may be unconscious and we will discuss
these throughout the course. A patient’s level of consciousness can easily be assessed using
the following four categories:

 Alert and responsive

 Drowsy and responds to voice
 Unconscious and responds to pain
 Unconscious and unresponsive

If your patient falls into the last two categories and is breathing, place them in the Recovery
Position and keep warm. Dial 111 for an ambulance and continue to monitor for signs of life
until help arrives. If signs of life become absent – start CPR and continue until

qualified help arrives.

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THE RECOVERY POSITION. (p10)
The Recovery Position involves placing the patient on their side which assists in maintaining
an open airway and also protects the airway if the patient vomits.

CHOKING (p11-12)
Choking can be a life-threatening event and is generally caused by food obstructing the
airway. With children and infants it can be caused by many things including small toys,
beads and so on.

If choking, an adult will clutch at their throat, and be unable to breathe, talk or cough. You
must act quickly while they are conscious as it will be easier to manage the situation and the
patient.

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First ask them if they are choking. If they nod ‘yes’, lean the patient forward slightly, place
the heel of your hand in the middle of their upper back and administer five back blows. If
this is unsuccessful, administer abdominal thrusts. This is done by standing behind the
patient and wrapping your arms around them. Make a fist of one hand and place it in the
centre of the abdomen just below the diaphragm. Place your other hand over the top and
pull towards you with a quick inward and upward movement.

Continue doing this until the patient has expelled the foreign body and is breathing normally
or until they lose consciousness. Abdominal thrusts are not suitable for pregnant women
and obese patients. In these cases use chest thrusts. This is the same technique as for
abdominal thrusts but place your fist over the same place you would position your hands for
chest compressions.

If the patient becomes unconscious, call an ambulance and start CPR. Perform 30
compressions then check the mouth to see if the obstruction has been dislodged. If you can
see it clearly you may remove it.

If the patient remains unconscious once the airway is clear, place them in the Recovery
Position and monitor for signs of life until qualified help arrives. If not, attempt two breaths
then perform 30 compressions. Continue this cycle until either the patient is breathing or
qualified help arrives.

Children and Infants. (p12, 13-14)

For choking children, continue in the same way you would for an adult i.e. 5 back blows and
5 abdominal thrusts repeating the cycle until the obstruction is expelled or the child
becomes unconscious. Then progress to CPR as for an adult. For choking infants, the process
is somewhat different. Straddle the infant over your arm as illustrated below.

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Give 5 back blows with the heel of your hand. If this does not dislodge the obstruction,
“sandwich” the infant between your two arms, turn the infant over and give 5 chest thrusts
using two fingers only. Check the airway and if you can see the foreign body gently hook it
out. If not, continue the cycle until either the obstruction is cleared and the infant is
breathing or until the infant becomes unconscious. If the infant becomes unconscious, dial
111 for an ambulance and commence CPR.

If you are the person choking and there is no one around to help you, it is possible to
perform the Heimlich Manoeuvre over the back of a chair

SECONDARY ASSESSMENT
Once you have performed your primary assessment and have determined that your patient
does not need CPR or immediate intervention for choking, you can then move on to the
Secondary Assessment. As with DRSABC, use a systematic head to toe assessment that
allows you to make sure you have checked out all areas of the patient that may be affected.

 Head to toe assessment

 Mechanism of injury
 History of current illness
 Past medical history
 Level of consciousness
 Special considerations e.g. family history

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BLEEDING.
Types of Bleeding.

Capillary: Tends to ooze and there is comparatively minimal blood loss. Grazes tend to fall
into this category.

Action: As for a graze.

Venous: A constant flow from the wound can be seen and as blood in the veins is on its way
back to the heart and lungs for more oxygen, it is usually darker red in colour.

Action: Venous bleeding must be stopped or controlled usually by applying compression.

This can take many forms e.g. the patient can hold something against the wound or the First
Aider can apply a compression dressing and bandage. Elevate the affected part if you are
able to as this will also help to decrease the blood flow.

Arterial: Arteries are big vessels under a lot of pressure and this causes the blood to “spurt”
from a wound. The blood is well oxygenated as it is travelling away from the heart and lungs
and therefore carries more oxygen. This makes it bright red in colour.

Action: Arterial bleeding is a serious situation and the one most likely to cause shock and
death if it is not stopped or controlled. Place several layers of dressing over the wound and
apply considerable force. If this does not control or stop the bleeding, apply strong, direct
pressure to the artery between the wound and the heart until help arrives.

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For the arms this is the brachial artery (under the arms) and for the legs it is the femoral
artery (in the groin). Place your fist or the heel of your hand over the artery and push hard.
This will slow down the bleeding but still allow some blood to get through to the limb. Do
this for 10 minutes then release for 10 seconds. If bleeding is still occurring, repeat the cycle
until qualified help arrives.

Remember - you can only do your best until qualified personnel arrive.

SHOCK.
Shock is a serious life threatening condition that occurs as a result of failure of the
circulatory system. It is a late sign of injury or illness and if your patient shows signs and
symptoms of shock, help is required immediately. The circulatory system is responsible for
transporting oxygen and nutrients around the body and an interruption to this can have
severe results including cardiac arrest and death.

There are several types of shock, the main ones being:

1. Hypovolaemic – from bleeding, dehydration, profuse sweating, vomiting and

diarrhoea, burns, crush injuries and fractures.
2. Cardiogenic – from a heart attack
3. Neurogenic – from a spinal injury
4. Anaphylactic – from a severe allergic reaction

Regardless of the cause, shock is always the result of some type of circulation failure and
the signs and symptoms are pretty much the same.

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 Signs and symptoms.

 Decreased level of consciousness and may be restless, drowsy or anxious.

 Tachycardia – a rapid heartbeat. May be “thready”
 Pallor – the patient may be pale – this can be difficult to assess with dark skinned
patients – however, there many other symptoms that will give you a clue.
 Sweating – patient will be cool and clammy to touch
 Rapid, shallow breathing
 Thirst and dry mouth
 Nausea
 Dizziness, light headedness

Treatment.

The main treatment for shock initially is to get fluid back into the circulatory system. As this
can only be done by ambulance or medical staff, there is little that a First Aider can do to
improve the situation if the patient is already in shock. However, there are some things that
can assist the patient until qualified help arrives.

1. Dial 111 for an ambulance.

2. If the shock is due to external bleeding, get this under control with compression and
elevation.
3. Stay with the patient and reassure them.
4. If possible, lay the casualty down and raise their legs slightly. This may help with
redirecting blood flow to the vital organs particularly the heart and brain.
5. Loosen tight clothing.
6. Keep the patient warm.

If shock worsens and your patient deteriorates to the extent of cardiac arrest
you will need to commence CPR.

FAINTING.
Fainting is very different to shock as it is only a temporary interruption of the circulation to
the brain. It often occurs as a result of an emotional shock, standing up too quickly and
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seeing or experiencing something that you may not like e.g. hospitals, blood, needles,
wounds and so on.

BLEEDING –external/internal (p6-7)

Bleeding can be internal or external. Whilst it is difficult for First Aiders to have a lot of
influence in cases of internal bleeding, there is much they can contribute to external
bleeding. When dealing with external bleeding, don’t forget to keep yourself safe. Either
wear gloves, get the patient to hold the compression dressing or alternatively, use a plastic
bag.

External bleeding.

External bleeding is easily identified / diagnosed and is generally caused by wounds or open
fractures. We will discuss fractures a little later in the course. Wounds can be categorized as
follows.

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Abrasions (Grazes).

This is where the top layer of skin has been scraped off due to contact with a hard surface.
The biggest risk here is infection.

Action: Clean and cover with a dressing. Leave covered and change dressing if it becomes
soiled or wet. Depending on the size of the graze, seek medical attention.

Lacerations and incisions (Cuts).

These can be caused by glass, knives, sharp edges (aluminium, tin), chain saws, lawn
mowers and so on. They can bleed a little or a lot depending on the depth and damage to
tissues, capillaries, veins or arteries.

Action: Control or stop bleeding, clean and apply a dressing or compression bandage. If
moderate to serious seek medical attention. If serious with major bleeding dial 111 for an
ambulance.

Puncture wounds.
Occur when any sharp object pierces the skin. This can include rusty nails, human or animal
bites, knives and so on. It can be difficult to assess these wounds as most of the damage is
on the inside. But the mechanism of injury can often give you a clue e.g. a nail will cause less
damage than a knife.

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Action: This is really dependant on the mechanism of injury and the state of the patient.
Next to bleeding, infection is the biggest risk with these injuries and it is advisable to seek
medical attention early. Often a tetanus shot will be necessary. At the very least, cleaning
and application of a dressing should occur. If the instrument is still in the patient, place
dressing around the object and compress from either side.

Note: If the instrument that caused the puncture wound is still in the patient…DO NOT
ATTEMPT TO REMOVE IT UNDER ANY CIRCUMSTANCE.

Amputation.

An amputation is the loss of any part of the body - this can be from fingertips
to limbs. Amputations are a little bit different in that there are two parts that need
attention…the stump and the severed part.

Action: The stump needs to be dealt with according to the type of bleeding and the size of
the wound.

The severed part requires special attention – there may be a chance that it can be
reattached and the chances of this increase dramatically when it has been transported
correctly. To do this you must keep the severed part cold, clean and dry. If at all possible
place the severed part in a plastic bag, wrap the bag in a damp cloth and then place in ice.

Do not let the severed part get wet or put the ice directly onto it. This will cause damage
and may mean reattachment is not possible.

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Avulsion (Skin Tear).

A skin tear occurs where a flap of skin (and possibly muscle) is lifted but remains attached to
the wound.

Action.

Replace the skin if you are able to, cover and apply compression. Do not attempt to detach
the flap even if it looks badly damaged. Elevate and seek help depending on the severity of
the injury i.e. either an Accident or Medical Centre or if severe and bleeding heavily, call an
ambulance.

BURNS (p15-16)
Burns can be categorised in three ways – first degree, second degree and third degree. They
are generally caused by heat but can also be caused by chemicals, electricity and extremely
cold substances. The seriousness of a burn can be determined by several factors

 Amount of area burnt

 Depth of burn
 Site of burn
 Cause of burn
 Age of patient


Regardless of the degree of burn always seek medical attention for the following:

 Children and elderly people.

 A burn larger than the size of the palm of the patient’s hand
 Burns to the face, head, genital area, eyes, over a joint, neck, hands or feet
 Where the patient may have inhaled smoke or fumes which may cause damage to
the airway

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 First degree burn Second degree burns

Third degree burn

Electrical entry burn

TYPE OF BURN LOOKS/FEELS LIKE ACTION

First degree (scald) Reddened area with no Cool with running water for at least 20
blistering / Very painful minutes. Cover with cling wrap. Seek
medical attention for children and
infants and if large area affected.
Reddened area with blistering Cool with running water for at least 20
Second degree and loose skin / Very painful minutes and seek medical attention.
(partial thickness) Cover with cling wrap. If large area
involved, dial 111 for an ambulance
Blackened skin , sometimes Cool with running water, remove
Third degree(full with outer layer missing / No anything around the area that may
thickness) or minimal pain keep burning e.g. clothing that isn’t
stuck, jewellery. Seek medical
attention and if large or the patient is
in shock dial 111 for an ambulance

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 Any one of the above or a
Chemical combination of all three /
pain is dependent on level of
burn
Often have entry and exit
Electrical
wounds but main damage is
beneath the surface / pain is
dependent on level of burn.
Patient may have heart
muscle damage
Flush burned area with water for at
least an hour. Remove any clothing
that may be contaminated and seek
medical attention. Remember to keep
yourself safe and avoid contamination
Switch off source of electricity before
touching patient. Cool with running
water for 20 minutes. Dial 111 for an
ambulance. If patient unconscious,
place in Recovery Position and
monitor for signs of life. If signs
become absent commence CPR and
continue until qualified help arrives.

Internal Bleeding.

Haematoma (Bruising)

Bruises form as a result of bleeding vessels under the skin. They can be minor, if not painful,
and do not generally require intervention from a First Aider. However, if there is substantial
bleeding, there is a risk of the bruise becoming infected and also a risk to the patient of
electrolyte imbalance as the clot breaks down. It may also be indicative of further internal
damage.

Action.

The mechanism of injury will give you a clue as to the severity of the injury, however all
large bruises should be checked out by a doctor to ensure that there is no infection or other
underlying damage.

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Internal organ injury.

When an organ is damaged it will bleed into the abdominal space. It is very difficult for a
First Aider to determine which organ might be damaged, and what the extent of the
bleeding might be. Internal bleeding generally occurs as a result of blunt trauma e.g. a road
traffic crash, or following a penetrating injury such as stabbing with a knife. The patient may
complain of abdominal pain and sometimes their stomach wall may be quite hard.

Action.

It is impossible to apply compression to internal bleeding. Observe the patient for signs of
shock and dial 111 for an ambulance immediately .Follow the steps for the management of
shock (page 14).

MUSCULO-SKELETAL INJURIES
FRACTURES. (p6-7)
A fracture is a break or crack in a bone and it can be open where bone ends are visible or
have punctured the skin, or closed where the skin is still intact. Large bones that fracture
can bleed copiously into the surrounding muscle e.g. blood loss from a thigh bone can be
upwards of one litre and pelvic fractures can be up to two litres.

Signs and symptoms

 Pain
 Deformity
 Shortening
 Swelling
 Loss of function
 Bleeding at site or internally

There are different types of fractures but treatment for most is the same.

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Greenstick fracture.

A Greenstick fracture generally occurs in children due to the softness of their bones. It is
basically a “buckling” of the outer layer of bone with or without a definite crack. Although
there may be no deformity, it can still be a painful injury.

Action

Support and immobilisation are the two most important actions prior to seeking medical
help. Often it is easier for the patient to do this unaided, but if they are unable to provide a
sling or wrap up in a jumper.

Closed fracture.

Closed fractures can be simple or complex and First Aid intervention can assist in preventing
further damage and pain to the patient. The fracture may be straight forward, but there
may be blood vessels and nerves trapped by the bone ends. The patient may complain of
numbness and the limb may be pale or bluish in colour below the level of the fracture. This
is an EMERGENCY and you must dial 111 for an ambulance. The only way to save the limb is
to have rapid intervention by medical staff to restore blood flow and nerve pathways.

Simple closed Complex closed

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Action.

More complex fractures require immobilisation, support and elevation to reduce swelling. If
qualified professionals are close, make the patient comfortable and leave the
immobilisation to them. If it is necessary to remove the patient for safety reasons, fashion a
splint out of available materials e.g. a cardboard box, rolled up newspaper and so on.
Remember to continue to check circulation and feeling beyond the fracture site.

Open fractures.

An open fracture is one where the bone ends have pierced the skin and may still be visible
or may have retracted into the wound.

Infection is a big risk with open fractures as is bleeding.

Action

Stopping the bleeding is the most important action and this should be done by applying a
pressure dressing to the site, and elevating the limb where possible. If the bone ends are
visible, cover them with a clean non-fluffy dressing and if bleeding is present, apply a
compression dressing to the wound around the bone ends. Support and stabilise the
affected limb and elevate if possible. Seek medical attention or dial 111 for an ambulance
for transport to a hospital.

For large bone fractures such as a femur or pelvis, make the patient comfortable and dial
111 for an ambulance.

Do not attempt to move the patient unless they are in imminent danger.
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DISLOCATIONS (p7)
A dislocation is where the bones that form a joint move out of position and this can be
partial or total. Shoulders, knees, ankles, fingers and toes are common sites for dislocations.

Signs and symptoms

 Pain
 Deformity
 Loss of function
 Swelling

Action

Immobilise and support the dislocation and position the patient comfortably. Dial 111 for an
ambulance or if possible arrange for transport to a hospital or medical facility.

DO NOT ATTEMPT TO PUT THE AFFECTED JOINT BACK INTO PLACE.

There may be bone chips broken off as a result of the dislocation injury and these may be
trapped in the joint and require an operation to fix. Relocation should only ever occur after
an x-ray has determined that it is safe to pull the bones back into their normal position.

Dislocations may be associated with fractures and there may be compression of blood
vessels and nerves. This is an orthopaedic emergency and requires transport to a hospital
immediately. Dial 111 for an ambulance, make the patient as comfortable as possible and
immobilise and elevate the limb if able to. Stay with the patient and reassure them that help
is on the way.

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SOFT TISSUE INJURIES (p8)
Soft tissue injuries refer to the stretching or tearing of ligaments, muscles and tendons
particularly around joints.

Action

ACC have developed an acronym for the treatment of soft tissue injuries and this is known
as RICE.

Rest – for at least 48 hours

Ice – apply an icepack wrapped in a towel for 20 minutes every 2 hours

Compression – apply a firm compression bandage to the area between applying the icepack.

Elevation – elevate the affected limb to decrease swelling.

If a fracture is suspected at the time of injury seek medical advice. If the injury has not
improved with 48 hours of RICE, then once again seek medical attention.

SPINAL INJURIES.
Spinal injuries can be serious as they may lead to spinal cord damage and paralysis or death.
The mechanism of injury can lead the First Aider to suspect that the patient may have a
spinal injury. If the patient has

 Fallen from a height

 Dived into shallow water
 Been involved in a high speed road traffic crash
 Received a direct blow to the head or neck
 Has a suspected head injury
 Is unconscious as a result of trauma

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If the patient is conscious they may complain of

 Loss of feeling or “pins and needles” in their limbs

 Loss of movement
 Back pain
 Laboured breathing

Action

All patients with suspected spinal injuries should not be moved unless they are in immediate
danger, are unconscious or become unconscious or if they require CPR. Dial 111 for an
ambulance and make the patient as comfortable as possible.

If the patient becomes unconscious or signs of life become absent and CPR is required,
maintaining the airway with the Head Tilt/Chin Lift is a calculated risk that should be
taken.

OTHER INJURIES
Chest injury.

Any injury occurring within the chest wall will impact on a patient’s ability to breathe and
must be treated seriously. Fractured ribs may puncture the lung(s) and bleeding and
breathing can become issues for the patient.

Action.

Cover any open wounds (known as sucking chest wounds) and place the patient on the
affected side. This allows the good lung to expand to its full capacity. Dial 111 for an
ambulance and observe patient for signs of shock. If patient’s condition deteriorates and
there are no signs of life….commence CPR.

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Abdominal injury.

Abdominal wounds can be closed or open. If closed, monitor for signs of shock and dial 111
for an ambulance if the patient is distressed, in pain or showing signs of shock.

Action

If the injury is open, cover with a dressing and lie the patient down with their knees drawn
up. Do not attempt to replace any internal organs that may be visible – cover with clear
plastic food wrap or a wet dressing. Call 111 for an ambulance immediately.

Crush injury.

Crush injuries require a special mention as they can be difficult to manage. Not only is there
the risk of wounds, fractures and internal organ damage, but there is a greater risk of
damage to their kidneys or even dying due to the release of toxins from the cells that have
been crushed.

Action.

With simple crush injuries follow the First Aid instructions for the nature of the injury i.e.
wound, fracture and so on. For serious crush injuries, Dial 111 for an ambulance. If the
patient has been crushed for less than an hour, they can be removed, however outside of
that do not attempt to remove them until qualified help has arrived. Keep the patient warm
and calm.

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Nose Bleeds.

Nose bleeds are a common occurrence for a First Aider, particularly at sporting events and
are generally easy to manage. However, it is essential that the bleeding is stopped as nose
bleeds can be fatal.

Action

Get the patient to lean forward over a towel or some type of container and with two fingers,
firmly press either side of the soft part of the upper nose. The reason for the towel /
container is to be able to estimate the amount of blood loss in the event that you are unable
to stop the bleeding. If the patient is able to, they can hold their own nose and this should
be done for 10 minutes. However, if the nose is painful or broken, the patient may not be
comfortable applying too much pressure and you will need to do this. If bleeding is heavy
and you are unable to stop it, dial 111 for an ambulance and observe and treat the patient
for signs of shock. If the nose is broken or you suspect that it may be, refer for medical
attention.

Ear Injuries.

Ears can bleed profusely and this must be controlled using compression. Depending on the
severity of the injury seek medical help or dial 111 for an ambulance. If the patient has a
foreign body in the ear do not attempt to remove it – seek medical help. Clear fluid or blood
leaking from the ear canal, can be a sign of a head injury. You may know this from how the
patient was initially injured.

Action

Lay the patient on their side and place a pad over the ear. This will allow the fluid to drain
onto the dressing and can assist the qualified personnel to determine what may be wrong
with the patient.

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Eye injuries.

Eye injuries can take many forms from a foreign body or a penetrating injury to a chemical
splash.

Foreign body

Do not attempt to remove the foreign body unless you can see it on the white of the eye
and it moves when the patient blinks. In this case, either rinse the eye or gently remove it
from the corner edge with a soft pad. Often a patient will describe feeling as if the object is
still there. This may indicate that they have a scratch on the cornea and this should be
checked by a doctor.

Penetrating injury.

If the foreign body is still in the eye do not attempt to remove it. Dial 111 for an ambulance
and keep the patient comfortable and calm. If no foreign body is visible and the eye is
bleeding or leaking clear fluid, cover both eyes with pads and either seek medical attention
or await the arrival of qualified personnel.

Chemical splash.

Chemicals in the eye can cause permanent damage and must be removed as soon as
possible. This is done through flushing the eye with water. Gently prise the lids apart and
flush the eye from the inner edge to the outer edge. This should continue for about an hour
and medical attention should be sought to check if any damage has occurred to the eye.

HEAD INJURY. (p7)

Head injuries can be simple or complex. The most common form of head injury is
concussion and these injuries occur mostly in the home and on the sports field.

Signs and symptoms

 Brief period of unconsciousness (knocked out)

 If knocked out there will be amnesia of the events leading up to and during the injury
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  Nausea and vomiting
 Headache
 Dizziness
 Blurred vision
 Repetitive questioning
 Irritability (short term) or personality changes (long term)

Action

Keep the patient calm and quiet and refer for medical follow up. If the patient remains
unconscious dial 111 for an ambulance. If unconscious always suspect a neck injury and
treat as for a spinal injury.

Skull fracture

Skull fractures occur as a result of trauma to the head. They can be simple requiring little
medical intervention or they can be life threatening requiring major surgical intervention.
This occurs when either there is bleeding into or swelling of the brain, or a piece of broken
bone presses on the brain tissue.

Signs and symptoms

 Bleeding or clear fluid leaking from the nose or ear

 Decreasing level of consciousness
 Slow noisy breathing
 Patient may be flushed in the face
 A slow, strong pulse
 Pupils may be unequal and slow to react to light
 Patient may be unconscious

Action

If the patient is conscious, make them comfortable by placing them in a half sitting position
and dial 111 for an ambulance. If they are unconscious, place them in the Recovery Position
and monitor for signs of life. If signs of life become absent, commence CPR. Remember to
consider a neck or spinal injury if the patient is unconscious.

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MEDICAL CONDITIONS. (p9-10)

ANGINA.
Angina is where there is a partial blockage or narrowing of the blood vessels in the heart
which may cause chest pain or discomfort. Blockages occur due to the build up of fatty
deposits (mainly cholesterol) on the lining of artery walls. Under normal circumstances the
arteries can supply enough blood to the heart muscle, but if it needs to work harder the
patient may experience this as angina. Angina does not usually last for very long and
patients often have a spray they use to will relieve the pain.

Treatment.

1. Rest
2. Reassurance
3. Spray – let the patient do this themselves.
4. If pain persists for longer than 20m and the patient has had no response to the
spray, dial 111 for an ambulance.

Over the years the blood vessels can become narrower and narrower until they are unable
to carry blood and oxygen to the heart muscle even in normal circumstances. This then may
lead to a heart attack.

HEART ATTACK.
A heart attack occurs when the heart muscle is not getting the oxygen it needs to perform
its job of pumping blood around the body. The heart has its own blood supply in order to
protect itself against events in other parts of the body e.g. fainting. The heart works by
electrical impulses and if the heart muscle becomes damaged it is then impossible for the
electrical impulses to follow their normal pathway.

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Risk factors for heart disease.

 Heredity  High Cholesterol

 Sex  Diabetes
 Age  Obesity
 Ethnicity  Lack of exercise
 Cigarette smoking.  Too much stress
 High Blood Pressure

Signs and Symptoms.

1. Clutching the chest. This is a classic sign of heart attack and the first indication you
may have as a First Aider.
2. Central crushing chest pain. When you ask the patient to describe the pain they may
tell you that they feel like they a heavy weight on their chest…like someone is sitting
on them.
3. Radiated pain. With a heart attack pain often radiates or travels down the left arm
and /or up to the jaw. It may travel to the back, neck and right arm as well, but this is
rare.
4. Heartburn. Many patients complain of a pain suggestive of indigestion or heartburn
However, heartburn does not usually cause the other signs and symptoms discussed
here and it is important that you treat it as a heart attack until the health
professionals are able to rule it out
5. Shortness of breath. The patient will describe feeling as if they can’t quite catch their
breath.
6. Sweating. You will be able to see that the patient is sweating heavily and will be cold
and clammy to touch.
7. Nausea and vomiting. The patient may feel sick and may vomit.
8. Palpitations. The patient may feel as if their heart is racing or that they have
palpitations.
9. Feeling of impending doom. Some patients have an overwhelming feeling that
something dreadful is about to happen.

35
Treatment.
1. Do not let this go on for any more than 5 minutes before calling for help.
2. Call an ambulance by dialling 111 and tell the dispatcher that you think the patient is
having a heart attack. Describe the signs and symptoms.
3. If the patient has had heart problems before, they may have a spray that they use
when they get angina. If they have a spray, get them to use this.
4. Ask the patient if they are allergic to aspirin – if not and you have access to aspirin,
give them half of one tablet (300mg as recommended by the National Heart
Foundation)) to chew, or dissolved in a small amount of water.
5. Stay with the patient and reassure them that the ambulance is on its way. Having a
heart attack can be very scary and they will appreciate your calm presence.
6. Heart attacks can sometimes lead to cardiac arrest and in this situation you will need
to start CPR.

STROKE.
A stroke is a condition that occurs as a result of a clot blocking a blood vessel in the brain
preventing oxygen from getting to the brain tissue. It can also occur as a result of a burst
blood vessel (aneurysm). If the patient is conscious, they may complain of a severe
headache, and may appear confused or unable to speak properly. They may have weakness
or paralysis on one side and often their face will appear to be drooping.

Action.

Dial 111 for an ambulance immediately. If the patient is unconscious but with signs of life,
place them in the Recovery Position and keep them warm until qualified help arrives.

TIA (Trans Ischaemic Attack)

This is where there is a temporary interruption to blood flow in the brain and it can often
mimic the signs and symptoms of a stroke. The patient may recover fairly quickly, but it is
important that they seek medical attention as the condition may put the patient at risk
particularly when driving.

36
DIABETES.
Diabetes is the body’s inability to control its sugar levels and this can result in too much
sugar or too little sugar in the bloodstream. Many diabetics wear Medic Alert bracelets,
necklaces, anklets or on medallions their shoes and this will give you further information to
assist your patient.

Hyperglycaemia (High blood sugar level)

This is not usually a First Aid emergency as it develops slowly and the patient may not
initially exhibit any signs or symptoms. However, if it does become severe, it can be life
threatening and needs medical intervention.

Signs and Symptoms

 Excessive eating
 Excessive thirst
 Excessive urine production
 Vomiting
 Dehydration
 Skin is flushed, warm and dry
 Breath sometimes smells “fruity” or like acetone
 Breathing can be slow and deep and if semi conscious or unconscious, the patient
may appear to be snoring.
 There will be a decreasing level of consciousness.

Action.

Severe hyperglycaemia is a medical emergency and must be treated immediately. Dial 111
for an ambulance and keep the patient calm and comfortable until qualified help arrives. If
unconscious place in the Recovery Position and monitor for signs of life. If signs of life are
absent commence CPR.

37
Hypoglycaemia (Low blood sugar)

Hypoglycaemia has a rapid onset and can be a First Aid emergency.

Signs and Symptoms

 The patient may be aggressive and show out of character behaviour.

 The patient may appear to be drunk.
 They may complain of a headache, hunger or tiredness
 They may complain of the “shakes”
 Skin is pale, cool and clammy
 Pulse is rapid and weak
 Breathing is fast and shallow

Action.

If the patient is conscious, initially give a very sweet drink e.g. sugar dissolved in water. Jelly
beans, honey or other sweet liquids can also be used. This will raise the blood sugar level
fairly quickly. Then if able, give the patient a sandwich or similar. This will prevent a sudden
drop in blood sugar once the sweet drink wears off. If the sweet drink is effective, and the
patient returns to normal, advise them to visit their doctor for a check up. It may be that
they are on too much insulin or that other life style factors are contributing to the
hypoglycaemia and this needs to be discussed with their GP. If the patient is unable or
unwilling to have the sweet drink, or if they are unconscious, dial 111 for an ambulance
immediately. If unconscious place the patient in the Recovery Position and keep them warm
until qualified help arrives.

DO NOT ATTEMPT TO GIVE ANY FOOD OR FLUIDS TO AN UNCONSCIOUS

PATIENT.

ASTHMA.
Asthma occurs due to three things – swelling of the airways, secretion of mucous which
plugs up the airways and spasm of the airways which causes them to be even narrower.
Asthma sufferers can breathe in without too much difficulty – it is breathing out that causes
the problem and air becomes trapped in the lungs. Most asthma attacks can be easily
treated, however if left untreated, asthma can be fatal.

Signs and symptoms

 Shortness of breath – patient has difficulty breathing out.

 Respiration rate will be normal or slightly slower
 There may be a wheezing sound when the patient breathes out.
38
  The patient may appear distressed
 The patient may have difficulty speaking. This can be divided into four categories -

1. speaks in full sentences

2. speaks in partial sentences
3. speaks in single words
4. unable to speak

Often the family or friends of the asthmatic will try and answer the questions for you. It is
important that you get the answers from the patient as this will allow you to assess them
under the 4 categories.

Action.

 Reassure the patient and try to keep them calm.

 Sit them upright and leaning slightly forward over a table or back of a chair. This
enables them to expand their lungs as much as possible.
 If they have medication, ask them to use this. It will generally be a blue inhaler.
 If they have forgotten or run out of their medication, seek medical attention
immediately.
 If the attack does not respond to medication or if it is severe dial 111 for an
ambulance.
 If the patient stops breathing commence CPR and continue until qualified help
arrives.

Sometimes it is difficult to perform rescue breathing on an asthmatic patient due to

the amount of air trapped in the lungs. In this situation continue with chest
compressions until qualified help arrives.

39
 HYPERVENTILATION.
Hyperventilation or over-breathing refers to a patient who is breathing faster or deeper
than normal. It can come about as the result of a psychological shock or panic attack and
is sometimes seen with cannabis smokers. The over-breathing results in too much
oxygen in the bloodstream and not enough carbon dioxide.

Signs and symptoms

 Rapid and panicky breathing

 Numbness or tingling in the hands, feet or lips
 Light-headedness and dizziness
 Headache
 Chest pain
 Slurred speech

Treatment

 Calm and reassure the patient.

 Remain with them until they recover
 Encourage them to breathe slowly and deeply
 If you are able, get the patient to breathe into a paper bag. This allows the Carbon
Dioxide level in the bloodstream to return to normal.
 If you are unable to calm the patient or if they become unconscious, place them in
the Recovery Position and monitor for signs of life.
 If signs of life become absent, commence CPR and continue until qualified help
arrives.

SEIZURES
Seizures are the result of abnormal brain activity and the most common form is Epilepsy.
Most seizures last for less than three minutes, but if the seizure lasts longer than this it is a
medical emergency.

Action.

Regardless of the cause, the treatment of seizures is the same

 Protect the patient from harm by moving hard objects

 Pad hard objects that cannot be moved.
 Protect the patient’s privacy by keeping bystanders clear of the area

40
  Check for a Medic Alert bracelet that may give you a clue as to why the seizure has
occurred.
 Once the seizure has stopped, place the patient in the Recovery Position and
monitor for signs of life.
 If signs of life become absent dial 111 for an ambulance and commence CPR
 Call an ambulance if the patient is pregnant, the seizure goes on for longer than five
minutes, the patient has sustained an injury during the seizure, or another seizure
commences shortly after the original seizure stops.
 Patients are often confused as they recover from a seizure. Remain calm, stay with
them and reassure them.

Seizures in children (Febrile Convulsions)

Children with high temperatures from an illness or infection may have a seizure as a result.
This is the body’s way of trying to bring the temperature down and is rarely seen in adults.

Action

Once the seizure has stopped, it is important to get the temperature down to prevent
further seizures. Remove the child’s clothing and sponge them down with tepid water. Do
not allow them to get too cool and start shivering as this is the body’s way of raising the
temperature. Medical advice should be sought to determine the cause of the high
temperature as treatment may be necessary. If the child remains unconscious once the
seizure has stopped, place them in the Recovery Position and monitor for signs of life. Dial
111 for an ambulance and calm and reassure the parents if necessary.

POISONS (p17)
Poisons are substances that are toxic to the body and can enter the system in several ways –
by ingestion (eating or drinking), inhalation (breathing in), through absorption (through the
skin) and injection (stings, insect bites).

Signs and symptoms.

 Altered level of consciousness (page 10)

 Vomiting
41
  Skin rash or redness
 Chemical burns – skin, lips and mouth
 Breathing difficulties
 Seizures

Always maintain your own safety particularly if there is a risk that you may also come into
contact with the poison. Try to ascertain what, when and how much poison the patient may
have been in contact with. Save any remaining poison or vomit (which may contain the
poison) for ambulance or medical staff.

Treatment

 Once safe to proceed either remove the poison or remove the patient to prevent
further contact.
 If the patient is unconscious, place in the Recovery Position and dial 111 for an
ambulance.
 If there are no signs of life, commence CPR. Continue until qualified help arrives.
 If the patient has chemical burns around the lips and mouth, either perform mouth
to nose breathing (close mouth and breathe through nose), or focus on
compressions.
 If you are performing rescue breathing, and if the poison has been inhaled or
ingested, turn your head away when the patient exhales to prevent contamination
from the poison.
 If the patient is conscious and does not appear to be in immediate danger, dial
0800POISONS. This is the number for the National Poisons Centre and they will have
information on the poison that will help you to decide what kind of intervention may
be required.

DO NOT INDUCE VOMITING AND DO NOT GIVE MILK OR WATER UNLESS

ADVISED BY THE POISONS CENTRE.

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STINGS (p18)

 If the patient has been stung and the sting is visible, remove the sting by scraping it
off with a piece of cardboard, ruler or similar.
 Wash the area and apply an icepack or cold compress.
 If the patient has a known allergy, is unconscious or there are no signs of life dial 111
for an ambulance and treat as for poisoning.

DO NOT REMOVE THE STING WITH YOUR FINGERS AS THIS MAY SQUEEZE
FURTHER POISON INTO THE PATIENT’S SYSTEM.

ANAPHYLAXIS (Allergic reaction)

Anaphylaxis is a serious reaction to a wide range of substances e.g. medication, poisons,
food, plants, cleaning products, garden chemicals, stings etc. It usually occurs at the second
contact or after consecutive contacts the patient has with the particular substance. This is
because the body has to have been in contact with the substance previously to have built up
a system that rejects the substance the next time it is encountered.

ANAPHYLAXIS IS A SERIOUS AND OFTEN LIFE THREATENING CONDITION THAT ADVANCES

RAPIDLY.

Signs and symptoms.

 Rash or hives
 Swelling of the face or neck
 Difficulty breathing and wheezing
 Nausea and vomiting
 Collapse
 Patient may have a Medic Alert bracelet

43
Treatment

 If you suspect anaphylaxis, or the patient has a history of allergy or anaphylaxis, dial
111 for an ambulance immediately.
 If the patient has a known allergy, is unconscious or there are no signs of life, dial
111 for an ambulance and treat as for poisoning.
 If the patient has medication for their allergy or anaphylactic reaction to a particular
substance, assist them to administer the same.
 Apply cold compresses or ice packs to swelling.
 If not an emergency situation, advise patient to seek medical attention – particularly
if this is the first allergic reaction they have had to a substance.

ENVIRONMENTAL ISSUES

HYPERTHERMIA

HEAT EXHAUSTION
This occurs due to excessive sweating and the loss of important body salts. Not all patients
suffering heat stroke will require medical attention, but if they remain unwell and you are
concerned, either call an ambulance or advise patient to seek medical attention.

Signs and symptoms

 Sweaty skin
 Tired and restless
 Muscle cramps
 Nausea
 Headache
 Dizziness
 Rapid breathing
 Rapid weak pulse
 Body temperature normal

Treatment

 If unconscious, place in Recovery Position, dial 111 for an ambulance and monitor for
signs of life.
 If signs of life become absent, commence CPR and continue until qualified personnel
arrive.
 If conscious, move patient into a shaded area and make comfortable
 Remove excess clothing
 Give sips of cool water
44
HEAT STROKE
Occurs when there is a failure in the brain’s heat regulating system due to prolonged
exposure to the sun or other forms of heat.

Signs and symptoms

 Body temperature above normal

 Falling level of consciousness
 Hot, flushed, dry skin
 Full and bounding pulse
 Headache
 Blurred vision
 Seizures
 Unconsciousness

Treatment

 If unconscious, place in Recovery Position, dial 111 for an ambulance and monitor for
signs of life.
 If signs of life become absent, commence CPR and continue until qualified personnel
arrive.
 If conscious, move patient into a shaded area and make comfortable
 Cool patient by spraying with water – a shower or hose works well
 Keep cooling using a fan

HYPOTHERMIA
Hypothermia occurs when a patient’s body temperature drops below 35 degrees Celsius and
this is more likely to affect the elderly and infants. It occurs mostly outdoors, where the
cooling effect is exaggerated by wet, wind and cold weather. It can occur in the home,

45
particularly during the winter where an elderly person falls, sustains an injury and is not
found for a prolonged period of time.

Signs and symptoms

 Irritability, anxiety and changes in behaviour

 Patient will complain of feeling cold with uncontrollable shivering
 Slurred speech
 Loss of coordination, stumbling or staggering walk
 As hypothermia increases patient may stop shivering and become unconscious

Treatment

 If unconscious, place in Recovery Position, dial 111 for an ambulance and monitor for
signs of life.
 If signs of life become absent, commence CPR and continue until qualified personnel
arrive
 Prevent further heat loss and start warming patient
 Remove any wet clothing and replace with dry clothing
 Heat is mainly lost through the head and feet so if you can, put a hat and socks on
the patient.
 If conscious, give warm sweet drinks.
 Place patient in a warm sleeping bag, wrap up in blankets or warm outside of
blankets with hot water bottles if available.


DO NOT PLACE HOT WATER BOTTLES NEXT TO PATIENT AS THIS MAY RESULT IN A BURN.

 If necessary, use your own body warmth to warm up the patient.



IT IS IMPORTANT TO WARM THE PATIENT GRADUALLY AS TOO RAPID A PROCESS MAY

RESULT IN FURTHER COMPLICATIONS FOR THE PATIENT.

46
Congratulations – you have now reached the end of your First Aid course or refresher. We
hope you have enjoyed the course and that you now feel more confident to manage First
Aid situations as they arise. Being a First Aider is a great service to both your community and
to your family and friends, and many lives have been saved due to the intervention of well
trained First Aiders.

Thank you for your attention.

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