hltaid004 provide an emergency first aid response in an ... assessments/2.2 hltaid004 … ·...

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HLTAID004

Provide an emergency first aid response in an education

and care setting

Learner’s Guide





HLTAID004 – Provide an emergency first aid response in an education and care setting – Learners Guide 1 | P a g e

Contents THE ICON KEY .................................................................................................................................................. 7

TERMS USED IN THIS UNIT ............................................................................................................................... 9

1. RESPOND TO AN EMERGENCY SITUATION ............................................................................................ 12

1.1 RECOGNISE AN EMERGENCY SITUATION ................................................................................................................ 12 What is First Aid? ......................................................................................................................................... 12 Emergency situations ................................................................................................................................... 13

Environmental hazards ............................................................................................................................................. 13 Human danger .......................................................................................................................................................... 13

Conditions that present as emergencies ...................................................................................................... 15 Learning Activity 1: ........................................................................................... Error! Bookmark not defined. Duty of care .................................................................................................................................................. 16 Learning Activity 2: ........................................................................................... Error! Bookmark not defined.

1.2 IDENTIFY, ASSESS AND MINIMISE IMMEDIATE HAZARDS TO HEALTH AND SAFETY OF SELF AND OTHERS ........................ 19 Hazards ........................................................................................................................................................ 19

Definition: Hazard ..................................................................................................................................................... 19 Common hazards can include: .................................................................................................................................. 19

Risk ............................................................................................................................................................... 22 Definition of risk ........................................................................................................................................................ 22

Figure 1: Hierarchy of control ....................................................................................................................... 24 Learning Activity 3: ........................................................................................... Error! Bookmark not defined.

1.3 ASSESS THE CASUALTY AND RECOGNISE THE NEED FOR FIRST AID RESPONSE .......................................................... 25 .......................................................................................................................... Error! Bookmark not defined. Figure 2: Primary Survey .............................................................................................................................. 27 .......................................................................................................................... Error! Bookmark not defined. Figure 3: Basic Life Support Flow chart ........................................................................................................ 28 Assessing a baby or toddler .......................................................................................................................... 29 The assessment process—first aid response ................................................................................................ 29 Skin appearance and condition .................................................................................................................... 29 Pain .............................................................................................................................................................. 30 Heart attack ................................................................................................................................................. 30 Shock ............................................................................................................................................................ 30 Other injuries or illness ................................................................................................................................. 31 Head injuries................................................................................................................................................. 32 Learning Activity 4: ........................................................................................... Error! Bookmark not defined.

1.4 ASSESS THE SITUATION AND SEEK ASSISTANCE FROM EMERGENCY RESPONSE SERVICES ............................................ 32 Assessing the type of emergency response assistance required .................................................................. 33 Notification of an emergency response ........................................................................................................ 34

Using available people until emergency personnel arrive ........................................................................................ 34 Learning Activity 5: ........................................................................................... Error! Bookmark not defined.

2. APPLY APPROPRIATE EMERGENCY FIRST AID PROCEDURES .................................................................. 35

2.1 PERFORM CARDIOPULMONARY RESUSCITATION (CPR) ..................................................................................... 35 Child CPR ...................................................................................................................................................... 36 Infant CPR ..................................................................................................................................................... 36 Figure 4: Rescue Breathing Rates: ................................................................................................................ 38 Figure 5: CPR Comparison: ........................................................................................................................... 38 Automatic External Defibrillator (AED) ........................................................................................................ 39 Conscious Choking Child ............................................................................................................................... 40

Abdominal thrusts: .................................................................................................................................................... 40 .......................................................................................................................... Error! Bookmark not defined. Learning Activity 6: ....................................................................................................................................... 40

2.2 PROVIDE FIRST AID IN ACCORDANCE WITH ESTABLISHED FIRST AID PRINCIPLES ....................................................... 41






First aid equipment ...................................................................................................................................... 41 National Regulations: Regulations 89, 168. .............................................................................................................. 42

Established first aid principles ...................................................................................................................... 42 Other legislation ........................................................................................................................................... 44 First aid management .................................................................................................................................. 45 Casualties ..................................................................................................................................................... 45 Learning Activity 7: ........................................................................................... Error! Bookmark not defined.

2.3 ENSURE CASUALTY FEELS SAFE, SECURE AND SUPPORTED .................................................................................. 47 Reassure the casualty ................................................................................................................................... 48 Learning Activity 8: ........................................................................................... Error! Bookmark not defined.

2.4 OBTAIN CONSENT FROM CASUALTY, CAREGIVER, REGISTERED MEDICAL PRACTITIONERS OR MEDICAL EMERGENCY SERVICES WHERE POSSIBLE

49 Implied consent ............................................................................................................................................ 49 Problems....................................................................................................................................................... 50 Learning Activity 9: ........................................................................................... Error! Bookmark not defined.

2.5 USE AVAILABLE RESOURCES AND EQUIPMENT TO MAKE THE CASUALTY AS COMFORTABLE AS POSSIBLE ....................... 50 Figure 6: First Aid kit requirements .............................................................................................................. 52 Resources: .................................................................................................................................................... 53

Spine management ................................................................................................................................................... 53 The auto-injector ...................................................................................................................................................... 54 Puffers/ inhalers ........................................................................................................................................................ 54 Resuscitation mask or barrier ................................................................................................................................... 55 Protection ................................................................................................................................................................. 55

First aid kits and other community resources .............................................................................................. 56 Making a casualty comfortable .................................................................................................................... 56 Manual handling .......................................................................................................................................... 57 Learning Activity 10: ......................................................................................... Error! Bookmark not defined. Lifting the casualty ....................................................................................................................................... 59 Stairs............................................................................................................................................................. 60 Pushing and pulling ...................................................................................................................................... 60 Emergency moves......................................................................................................................................... 60 Learning Activity 11: ......................................................................................... Error! Bookmark not defined.

2.6 OPERATE FIRST AID EQUIPMENT ACCORDING TO MANUFACTURER'S INSTRUCTIONS ................................................ 62 .......................................................................................................................... Error! Bookmark not defined. Figure 7: Oxygen therapy – oxygen mask .................................................................................................... 62 Figure 8: Ambu bag ...................................................................................................................................... 63 Figure 9: Example of a First Aid Kit ............................................................................................................... 63 Figure 10: Automated External Defibrillator - AED ...................................................................................... 63

Replacement ............................................................................................................................................................. 66 Learning Activity 12: ......................................................................................... Error! Bookmark not defined.

2.7 MONITOR THE CASUALTY'S CONDITION AND RESPOND IN ACCORDANCE WITH FIRST AID PRINCIPLES ........................... 66 Airway obstruction ....................................................................................................................................... 67 Figure 11: Recovery position: ....................................................................................................................... 67 External Wounds .......................................................................................................................................... 68

Abrasions .................................................................................................................................................................. 69 Lacerations ................................................................................................................................................................ 69

Puncture / Penetrating ................................................................................................................................. 69 Amputation .................................................................................................................................................. 69

Treatment for External Wounds ............................................................................................................................... 69 Internal Bleeding .......................................................................................................................................... 70

Signs and Symptoms ................................................................................................................................................. 70 Treatment for internal Bleeding................................................................................................................................ 70

Allergic Reaction (Anaphylaxis) .................................................................................................................... 71 Signs and Symptoms ................................................................................................................................................. 71

Itching/hives: ................................................................................................................................................ 71 Treatment for Allergic Reactions .............................................................................................................................. 71

Bites and Stings ........................................................................................................................................... 71






Snake Bites ................................................................................................................................................... 72 Signs and Symptoms ................................................................................................................................................. 72 Treatment for Snake Bites......................................................................................................................................... 72

Figure 12: Applying a pressure immobilisation bandage ............................................................................. 74 Tick Bite ........................................................................................................................................................ 75

Signs and Symptoms ................................................................................................................................................. 75 Treatment for Tick Bites ............................................................................................................................................ 75

Red-back Spider ............................................................................................................................................ 76 Signs and Symptoms ................................................................................................................................................. 76 Treatment for Red-back Spiders ............................................................................................................................... 76

Funnel Web Spider ....................................................................................................................................... 76 Signs and Symptoms................................................................................................................................................. 76 Treatment for Funnel Web Spider ............................................................................................................................ 77

Bee, Wasp and Ant Sting .............................................................................................................................. 77 Recognition ............................................................................................................................................................... 77 Treatment for Bee, Wasp and Ant Sting ................................................................................................................... 78

EpiPen ........................................................................................................................................................... 78 Figure 13: Design and features of Epi-Pen

® Auto-Injector ............................................................................ 79

Figure 14: EpiPen® User Guide ...................................................................................................................... 80

...................................................................................................................................................................... 80 Fire ants - Why are they a problem? ............................................................................................................ 81

Social impacts............................................................................................................................................................ 81 About the sting .......................................................................................................................................................... 81

First aid Treatment for Fire Ants .................................................................................................................. 81 .......................................................................................................................... Error! Bookmark not defined. Figure 15: Fire ant and it’s bite. .................................................................................................................. 81 Marine Stingers ............................................................................................................................................ 81

Tropical Jelly Fish ...................................................................................................................................................... 82 Irukandji Jellyfish .......................................................................................................................................... 82

Signs and Symptoms ................................................................................................................................................. 82 Figure 16: Irukandji Jellyfish ......................................................................................................................... 82 Chironex Box Jellyfish ................................................................................................................................... 83

Signs and Symptoms of severe stings........................................................................................................................ 83 Treatment for Irukandji Jellyfish and Chironex Box Jellyfish ..................................................................................... 84 Treatment for Non-tropical Bluebottle stings ........................................................................................................... 84

.......................................................................................................................... Error! Bookmark not defined. Figure 17: Other Jellyfish around Australia .................................................................................................. 84

Treatment for Other Jellyfish .................................................................................................................................... 85 Sea Snakes .................................................................................................................................................... 85

Signs and Symptoms ................................................................................................................................................. 85 Treatment for Sea Snakes ......................................................................................................................................... 85

Fish Stings ..................................................................................................................................................... 86 Signs and Symptoms................................................................................................................................................. 86

Treatment for fish stings .............................................................................................................................. 86 Poisoning ...................................................................................................................................................... 86

Signs and Symptoms ................................................................................................................................................. 86 Treatment for Poisoning............................................................................................................................... 87 Drug overdose .............................................................................................................................................. 87

Reasons for overdose ................................................................................................................................................ 88 Risk factors ................................................................................................................................................................ 88

First aid Treatment for Drug Overdose......................................................................................................... 88 Stroke ........................................................................................................................................................... 88

Recognition ............................................................................................................................................................... 89 Warning Signs ........................................................................................................................................................... 89 Treatment for Stroke ................................................................................................................................................ 89

Environmental Conditions ............................................................................................................................ 89 Heat Exhaustion ........................................................................................................................................... 90

Signs and Symptoms ................................................................................................................................................. 90






Treatment for heat exhaustion .................................................................................................................... 90 Heat Stroke ................................................................................................................................................... 90 Figure 18: Heat exhaustion and Heat stroke ................................................................................................ 91

Signs and Symptoms ................................................................................................................................................. 91 Treatment for Heat Stroke ........................................................................................................................... 91 Hypothermia ................................................................................................................................................ 92

Signs and Symptoms ................................................................................................................................................. 92 Treatment for Hypothermia ......................................................................................................................... 92 Figure 19: Hypothermia................................................................................................................................ 93 ...................................................................................................................................................................... 93 Frost Bite ...................................................................................................................................................... 94 Figure 20: Frostbite ...................................................................................................................................... 94

Signs and Symptoms ................................................................................................................................................. 94 Treatment for Frostbite ............................................................................................................................................ 95

Head Injuries ................................................................................................................................................ 95 Head Injury Symptoms & Signs ................................................................................................................................. 95 Treatment for Head injury ........................................................................................................................................ 96

Skull Fracture: First Aid ................................................................................................................................. 97 Figure 21: Management of foreign body and obstruction (choking) ........................................................... 98 ...................................................................................................................................................................... 98 Nosebleeds ................................................................................................................................................... 99

Symptoms ................................................................................................................................................................. 99 First aid treatment for Nose Bleed ............................................................................................................................ 99

Seek medical advice ................................................................................................................................... 100 Frequent nosebleeds............................................................................................................................................... 100 Where to get help ................................................................................................................................................... 100

Teeth Injury ................................................................................................................................................ 100 Baby teeth (deciduous teeth).................................................................................................................................. 100 Permanent teeth ..................................................................................................................................................... 101

Overview and Considerations with Fractured and Dislocated Jaw............................................................. 101 Signs and Symptoms ............................................................................................................................................... 102 Symptoms of a fractured (broken) jaw include: ...................................................................................................... 103 First Aid Treatment for Fractured and Dislocated Jaw ............................................................................................ 103

Spinal Injury ............................................................................................................................................... 103 Spinal column ............................................................................................................................................. 104 Figure 22: Spinal column. .......................................................................................................................... 104

Signs and Symptoms ............................................................................................................................................... 104 Treatment for Spinal Injury ..................................................................................................................................... 105

Concussion .................................................................................................................................................. 106 Signs and Symptoms ............................................................................................................................................... 106 Treatment for concussion ....................................................................................................................................... 106

Eye Injuries ................................................................................................................................................. 106 Signs and Symptoms ............................................................................................................................................... 106 Treatment for Eye Injury ......................................................................................................................................... 107

Chest Injuries .............................................................................................................................................. 107 Sucking Chest Wound ............................................................................................................................................. 107 Fractured Ribs ......................................................................................................................................................... 107 Flail Segment ........................................................................................................................................................... 108

Figure 23: Penetrating Chest wound ......................................................................................................... 108 Signs and Symptoms ............................................................................................................................................... 109

.......................................................................................................................... Error! Bookmark not defined. Figure 24: Pneumothorax. .......................................................................................................................... 109

Treatment for Chest Injuries ................................................................................................................................... 110 Abdominal Injury ........................................................................................................................................ 110

Signs and Symptoms ............................................................................................................................................... 110 Treatment for Abdominal Injury ............................................................................................................................. 111

Figure 25: Dressing an abdominal wound ................................................................................................ 111 Soft Tissue Injuries ...................................................................................................................................... 111






Sprain ......................................................................................................................................................... 112 Signs and Symptoms ............................................................................................................................................... 112

Muscle strain .............................................................................................................................................. 112 Signs and Symptoms ............................................................................................................................................... 112

Bruises ........................................................................................................................................................ 113 Signs and Symptoms ............................................................................................................................................... 113 What you can do ..................................................................................................................................................... 113 Treatment for Soft Tissue Injuries (R.I.C.E) ............................................................................................................. 113

Dislocations ................................................................................................................................................ 113 Signs and Symptoms ............................................................................................................................................... 114 Treatment for dislocations ...................................................................................................................................... 114

Slings using Triangular Bandages............................................................................................................... 114 Figure 26: Folding a Triangular Bandage ................................................................................................... 115 Fractures .................................................................................................................................................... 115 .......................................................................................................................... Error! Bookmark not defined. Figure 27: Skeleton .................................................................................................................................... 116

...................................................................................................................................... Error! Bookmark not defined. Signs and Symptoms ............................................................................................................................................... 117 Treatment for a simple fracture: ............................................................................................................................. 117

Treatment for Fractures ............................................................................................................................. 118 Pelvic Fracture ......................................................................................................................................................... 118 Collar Bone/Hand Injury .......................................................................................................................................... 118 Upper Arm Fracture ................................................................................................................................................ 118 Lower Arm and Wrist Fracture ................................................................................................................................ 119 Leg Fractures ........................................................................................................................................................... 120 Ankle Fractures ....................................................................................................................................................... 120 Treatment for Ankle fractures ................................................................................................................................ 120

Entrapment of casualty .............................................................................................................................. 121 Signs and Symptoms ............................................................................................................................................... 121 Treatment for Entrapped Casualty .......................................................................................................................... 121

Fainting ...................................................................................................................................................... 121 Signs and Symptoms ............................................................................................................................................... 121 Treatment for Casualty that Fainted ....................................................................................................................... 122

Fits and Seizures ......................................................................................................................................... 122 Epilepsy ...................................................................................................................................................... 122

What Causes Epilepsy?............................................................................................................................................ 122 Signs and Symptoms ............................................................................................................................................... 123 Treatment for Epilepsy Fitting................................................................................................................................. 123

.......................................................................................................................... Error! Bookmark not defined. Figure 28: Tonic and Clonic Phase .............................................................................................................. 123 Febrile Convulsion (younger children) ........................................................................................................ 124

Signs and Symptoms ............................................................................................................................................... 124 Treatment for Febrile Convulsion ........................................................................................................................... 124

Diabetes ..................................................................................................................................................... 124 Signs and Symptoms ............................................................................................................................................... 125 Treatment for Diabetes ........................................................................................................................................... 125

The difference between acute and chronic conditions ............................................................................... 126 Asthma ....................................................................................................................................................... 126

Signs and Symptoms ............................................................................................................................................... 126 Treatment for Asthma ............................................................................................................................................. 126 Asthma First Aid Plan .............................................................................................................................................. 127 Prevention of an Asthma attack .............................................................................................................................. 128

.......................................................................................................................... Error! Bookmark not defined. Figure 29: Normal and Asthmatic Bronchus ............................................................................................... 128 .................................................................................................................................................................... 129 Hyperventilation ......................................................................................................................................... 130

Signs and Symptoms ............................................................................................................................................... 130 Treatment for Hyperventilation .............................................................................................................................. 130

Figure 31: The Hyperventilation cycle ........................................................................................................ 130






Croup .......................................................................................................................................................... 131 Signs and Symptoms ............................................................................................................................................... 131 Treatment for Croup ............................................................................................................................................... 131

Figure 32: Croup triggers swelling of the windpipe .................................................................................... 131 Epiglottitis .................................................................................................................................................. 132

Signs and Symptoms ............................................................................................................................................... 132 Treatment for Epiglottitis ........................................................................................................................................ 132

Shock .......................................................................................................................................................... 133 Absolute Fluid Loss - low blood volume (Hypovolaemia) ........................................................................................ 133 Relative Fluid Loss ................................................................................................................................................... 133

Cardiac Failure (Cardiogenic Shock) .......................................................................................................... 134 The Body's Compensation Mechanism .................................................................................................................. 134 Signs and Symptoms of Shock ................................................................................................................................. 134 Treatment of Shock ................................................................................................................................................ 135 Head to Toe ............................................................................................................................................................. 135

Burns .......................................................................................................................................................... 135 Area of burns........................................................................................................................................................... 135

.......................................................................................................................... Error! Bookmark not defined. Figure 33: Rule of nines for body surfaces .................................................................................................. 136

Types of burns ......................................................................................................................................................... 137 Depth of Burns ........................................................................................................................................................ 137 Significant Burns...................................................................................................................................................... 137 ...................................................................................................................................... Error! Bookmark not defined. Signs and Symptoms of Partial Thickness Burns ..................................................................................................... 138 Signs and Symptoms of Full Thickness Burns .......................................................................................................... 138 Treatment of Burns ................................................................................................................................................. 138

Figure 34: 4 Degrees of Burns .................................................................................................................... 138 .................................................................................................................................................................... 139 Electric Shock .............................................................................................................................................. 140

Electrical burns ........................................................................................................................................................ 140 Cold burns ............................................................................................................................................................... 140 Chemical Burns and Splashes .................................................................................................................................. 140 Radiation Burns ....................................................................................................................................................... 140 Phosphorus Burns ................................................................................................................................................... 140 Hydrofluoric acid ..................................................................................................................................................... 141 Bitumen ................................................................................................................................................................... 141 Petroleum Products ................................................................................................................................................ 141 Smoke Inhalation .................................................................................................................................................... 141 Sunburn ................................................................................................................................................................... 142 The first thing to do in an emergency ..................................................................................................................... 142

Figure 35: Ultraviolet rays and sunburn ..................................................................................................... 142 Heart Conditions ......................................................................................................................................... 143

Cardiac Arrest .......................................................................................................................................................... 143 Heart Attack ............................................................................................................................................... 143

...................................................................................................................................... Error! Bookmark not defined. Signs and Symptoms ............................................................................................................................................... 144 Treatment for Heart Attack ..................................................................................................................................... 144

Angina ........................................................................................................................................................ 145 Signs and Symptoms ............................................................................................................................................... 145 Treatment for Angina .............................................................................................................................................. 145

Heart Failure............................................................................................................................................... 146 Signs and Symptoms ............................................................................................................................................... 146 Treatment for Heart Failure .................................................................................................................................... 146

Summary .................................................................................................................................................... 146 Learning Activity 13: ......................................................................................... Error! Bookmark not defined.

3. COMMUNICATE DETAILS OF THE INCIDENT ......................................................................................... 147

3.1 ACCURATELY CONVEY DETAILS OF THE INCIDENT TO EMERGENCY RESPONSE SERVICES WHERE REQUIRED ................... 147 Communicating with emergency services and/or relieving personnel ....................................................... 148






Improving the accuracy of information given to ambulance services. ....................................................... 149 Following emergency personnel takeover .................................................................................................. 149 Learning Activity 14: ......................................................................................... Error! Bookmark not defined.

3.2 REPORT DETAILS OF INCIDENT TO SUPERVISOR .............................................................................................. 150 Figure 36: Quality Area 2............................................................................................................................ 150 Learning Activity 15: ......................................................................................... Error! Bookmark not defined.

3.3 COMPLETE RELEVANT WORKPLACE DOCUMENTATION, INCLUDING INCIDENT REPORT FORM ................................... 153 Forms .......................................................................................................................................................... 153 Figure 37: Incident, injury, trauma and illness report ................................................................................ 154 Resources ................................................................................................................................................... 157 Learning Activity 16: ......................................................................................... Error! Bookmark not defined.

3.4 REPORT DETAILS OF INCIDENTS INVOLVING BABIES AND CHILDREN TO PARENTS AND/OR CAREGIVERS ....................... 157 Learning Activity 17: ......................................................................................... Error! Bookmark not defined.

3.5 FOLLOW WORKPLACE PROCEDURES TO REPORT SERIOUS INCIDENTS TO THE REGULATORY AUTHORITY ...................... 157 Figure 38: Standard 7.3.5. .......................................................................................................................... 159 Learning Activity 18: ......................................................................................... Error! Bookmark not defined.

3.6 MAINTAIN CONFIDENTIALITY OF RECORDS AND INFORMATION IN LINE WITH STATUTORY AND/OR ORGANISATIONAL POLICIES 159 Disclosure ................................................................................................................................................... 162 Information that can be disclosed .............................................................................................................. 162 Learning Activity 19: ......................................................................................... Error! Bookmark not defined.

4. REFLECT ON INCIDENT AND OWN PERFORMANCE .............................................................................. 163

4.1 RECOGNISE THE POSSIBLE PSYCHOLOGICAL IMPACTS ON SELF, OTHER RESCUERS AND CHILDREN .............................. 163 Common stress reactions ........................................................................................................................... 163 Personal limitations .................................................................................................................................... 164 Stress management .................................................................................................................................... 164 De-stressing strategies ............................................................................................................................... 166 .......................................................................................................................... Error! Bookmark not defined.

Seven simple strategies that work .......................................................................................................................... 167 Figure 39: Physical care program ............................................................................................................... 168 Learning Activity 20: ......................................................................................... Error! Bookmark not defined.

4.2 TALK WITH CHILDREN ABOUT THEIR EMOTIONS AND RESPONSES TO EVENTS ........................................................ 168 .......................................................................................................................... Error! Bookmark not defined. Figure 40: Talking to children ..................................................................................................................... 169

4.3 PARTICIPATE IN DEBRIEFING WITH SUPERVISOR ............................................................................................. 171 Debriefing limitations in stress management ............................................................................................ 171 Feedback .................................................................................................................................................... 172 Learning Activity 21: ......................................................................................... Error! Bookmark not defined.

DEFINITIONS ................................................................................................................................................ 173

BIBLIOGRAPHY ............................................................................................................................................ 174

The Icon Key

Key Points

Explains the actions taken by a competent person

Example






Illustrates the concept or competency by providing examples

Learning Assessment

Provides learning assessment activities to reinforce understanding of the action. This is called formative assessment

Formative assessment

The goal of formative assessment is to monitor your learning to provide ongoing feedback that can be used by your trainer to improve their teaching and so you can improve your learning. More specifically, formative assessments:

help you identify your strengths and weaknesses and target areas that need work

help your trainer recognise where you are struggling and address problems immediately

Chart

Provides images that represent data symbolically. They are used to present complex information and numerical data in a simple, compact format.

Intended Outcomes or Objectives

Statements of intended outcomes or objectives are descriptions of the work that will be done. These are also known as your Performance Criteria

Learning Activities

These activities allow the student to measure their own understanding of the information






Terms used in this unit Abdominal injuries: Caused by blunt or penetrating trauma and can involve internal bleeding or the exposure of the internal organs to air. Such injuries invariably affect vital organs.

Airway: The passage from the nose and mouth through which air passes to the lungs.

Airway obstruction: Partial or complete blockage of the breathing passages to the lungs.

Allergic reaction: Abnormal reaction of the casualty to a foreign substance, which may result in an itchy rash and puffy eyelids, general swelling, wheezing and breathing difficulty, or acute collapse.

Altered and loss of consciousness: (ALC) An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment.

Arousability: The amount of arousal. Arousal is a physiological and psychological state of being awake or reactive to stimuli. It involves the activation of the reticular activating system in the brain stem, the autonomic nervous system and the endocrine system, leading to increased heart rate and blood pressure and a condition of sensory alertness, mobility and readiness to respond.

Arteries: Blood vessels, which take blood from the heart.

Arterioles: Small arteries.

Asthma: a chronic disease of the airways of the lungs, which can be managed with proper treatment.

Anaphylaxis: is a serious allergic reaction that affects a number of different areas of the body at one time, and can be fatal.

Back Blow: A blow with the heel of the hand applied midline between the shoulder blades.

Basic Life Support (BLS): The preservation of life by the establishment of and /or maintenance of Airway, Breathing and Circulation and related emergency care without the use of equipment. Note: Ancillary devices such as a resuscitation face mask, face shield or gloves may be used to minimise cross-infection risks.

Brachial Pulse: The brachial pulse is the best pulse to feel in infants and is found in the inner aspect of the elbow.

Cardiac Arrest: This the cessation of heart action confirmed by the absence of the carotid pulse in an unconscious, non-breathing casualty.

Cardiopulmonary Resuscitation (CPR): The technique of inflation of the lungs and compression of the heart, used in an attempt to revive a person who has suffered a cardiac arrest.

Carotid Pulse: The pulse felt in the main artery on each side of the neck.

Chest pains: may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.

Choking: A blockage of the upper airway by food or other objects, which prevents a person from breathing effectively.

Circulation: Blood flow through the heart and blood vessels to provide oxygen and nutrients to the tissues.

Cyanosis: A bluish discolouration of the skin and lining of the mouth associated with inadequate oxygen in the blood. Dilated: Large, expanded.






Dehydration: This occurs when the amount of water leaving the body is greater than the amount being taken in.

Diabetes: A condition whereby the body is not able to regulate levels of glucose (a sugar) in the blood, resulting in too much glucose being present in the blood.

Dislocations: A dislocation is an injury in which the ends of your bones are forced from their normal positions

Distal: Remote, furthest from point of reference.

Duty of care: can be defined as "an obligation, recognised by law, to avoid conduct fraught with unreasonable risk of danger to others".

Drowning: Is a process resulting in primary respiratory impairment from submersion in a liquid medium.

Embolism: Blocking of an artery by a clot or bubble of gas. Endocrine: The body's system, which involves chemical-secreting glands.

Envenomation: The introduction to the body of poisonous substances produced by animals. This may result from bites, stings or penetrating wounds, e.g. Stonefish.

Environmental Impact: Any change that a project or activity may cause in the environment

Epilepsy: Sudden seizure is the hallmark of this illness. It may involve falling to the ground and twitching spasmodically, but not always.

Febrile: Fever, feverish.

Fractures: A fracture is a complete or incomplete break in a bone resulting from the application of excessive force

Guarding: Act of a casualty putting hands over the injury site.

Haemorrhage: Bleeding.

Heart Attack: damage to or death of port of the heart muscle because the supply of blood to the heart muscle is severely reduced or stopped. This may or may not result in cardiac arrest.

Heat Stroke: is caused by prolonged exposure to high temperatures or by doing physical activity in hot weather. You are considered to have heatstroke when your body temperature reaches 40oC or higher.

Hyperthermia: body temperature over the normal range of 36.1oC to 37.1oC

Hypothermia: body temperature under the normal range of 36.1oC to 37.1oC

Hyperventilation: Fast breathing.

Hypoventilation: Slow and/or shallow breathing.

Inflation: The movement of air from the environment into the casualty's lungs by a rescuer's expired air.

Intercostal (muscles): Between the ribs.

Jaw Support: Supporting the jaw at the point of the chin in such a way that there is no pressure on the soft tissues of the neck.

Jaw Thrust: The forward pressure applied behind the angle of the jaw to thrust the jaw forward and open the airway.

Lateral Chest Thrusts: Pressure applied over the ribs close to the armpits.

Left Lateral Tilt Position: The pregnant woman is positioned on her back with her shoulders flat and sufficient padding under the right buttock to give an obvious pelvic tilt to the left.

Near-Drowning: is the term used when an immersion casualty survives for 24 hours after arrival at a medical facility. It implies that while initial resuscitation was successful, full recovery has not occurred.






Overdose: an excess use of a drug resulting in adverse reactions ranging from and including mania and hysteria to coma and death. Specific reactions include changes in BP/HR, sweating, vomiting, and liver failure.

Palpate: To examine by touch.

Pancreas: The organ, which produces insulin.

Peripheral: Situated away from the centre.

Pneumothorax: Air in the chest cavity.

Poisoning: occurs when any substance interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed

Radial Pulse: Is the pulse on the wrist.

Respiration: The act of breathing, inhaling and exhaling during which the lungs are provided with air.

Respiratory distress: A person with respiratory distress has severe difficulty breathing. Left untreated, respiratory distress may lead to respiratory failure. Respiratory distress includes severe difficulty breathing, noisy breathing, rapid breathing, and rapid heart rate.

Resuscitation: The preservation or restoration of life by the establishment and/or maintenance of Airway, Breathing and Circulation and related emergency care given before definitive hospital care.

Seizures: A sudden attack, spasm, or convulsion, as in epilepsy or another disorder.

Shock: Life-threatening condition (usually) due to collapse of the circulatory system.

Side Position: A position in which an unconscious casualty lies on one side with the weight supported by the under shoulder, hip, and the upper knee which is at right angles to the hip. The face is turned slightly downwards to allow the tongue to fall forwards so that saliva or vomit will drain out.

Signs: What the Carer can see, touch, hear or smell. For example, the casualty is bleeding, has vomited, has noisy breathing etc. These signs are most important to note when the casualty is unconscious and unable to communicate with the Carer.

Sprains: refers to damage or tearing of ligaments or a joint capsule

Strains: refers to damage or tearing of a muscle

Stoma: a mouthlike opening, particularly an incised opening which is kept open for drainage or other purposes.

Stridor: High pitched crowing noise of breathing due to partial airway obstruction.

Stroke: Damage to the brain tissue caused by a blocked vessel or bleeding.

Substance Abuse: the deliberate, persistent, excessive use of a substance without regard to health concerns or accepted medical practices.

Substance misuse: the use of a substance for unintended purposes or for intended purposes but in improper amounts or doses

Supine: Lying on back with face upward.

Symptoms: This is the information provided by the casualty. It is what they tell the Carer e.g. where they have pain, how they feel etc.

Syndrome: A Group of symptoms that commonly occur to make up a distinct illness or condition.

Toxic substance: Means any chemical or mixture that may be harmful to the environment and to human health if inhaled, swallowed, or absorbed through the skin.

Triage: Assessment of casualties to decide the priority of treatment.






Unconsciousness: a state of complete or partial unawareness or lack of response to sensory stimuli as a result of hypoxia caused by respiratory insufficiency or shock; from metabolic or chemical brain depressants such as drugs, poisons, ketones, or electrolyte imbalance; or from a form of brain pathologic condition such as trauma, seizures, cerebrovascular insult, brain tumor, or infection. Various degrees of unconsciousness can occur during stupor, fugue, catalepsy, and dream states

Withdrawal: the condition produced when a person stops using or abusing a substance to which he/she is addicted.

1. Respond to an emergency situation

1.1 Recognise an emergency situation

1.2 Identify, assess and minimise immediate hazards to health and safety of self and others

1.3 Assess the casualty and recognise the need for first aid response

1.4 Assess the situation and seek assistance from emergency response services

1.1 Recognise an emergency situation

What is First Aid?

First aid is the provision of immediate care to a victim with an injury or illness, usually affected by a lay person, and performed within a limited skill range. First aid is normally performed until the injury or illness is satisfactorily dealt with (such as in the case of small cuts, minor bruises, and blisters) or until the next level of care, such as a paramedic or doctor, arrives.

The guiding key principles and purpose of First Aid, is often given in the mnemonic ―4Ps‖. These four points govern all the actions undertaken by a first aider.

Preservation of life

Preventing illness, injury or conditions from becoming worse

Promoting recovery—both short and long term

Protecting the casualty from further harm

Sometimes first aiders might be required to assist a casualty with taking medicine. First aid providers might have to help the casualty locate the medication (or locate it on their behalf), remove the cap from a pill bottle, count tablets or pour medicine and read labels to ensure correct dosage. Assisting, however, does not imply actually prescribing or






administering medication—which is an advanced level skill—beyond the training of a normal first aider. By providing the right level of assistance to a casualty the first aider might, however, help stabilise the casualty until further help has arrived or, simply by providing assistance, the problem might be resolved.

In the case where it is necessary to provide a child in an education and care service with help taking medication, there should be clear, written instructions from a parent or guardian.

Emergency situations

In general terms, the first thing that any first aider should be aware of when entering an accident or emergency situation is the potential for danger to them. Before offering or delivering first aid to another person/s the first aid provider should check for hazards that might cause harm or injury to themselves—and to any other bystanders.

Hazards can include:

Environmental hazards

Environmental hazards could include danger in the surroundings, such as falling masonry, broken glass, moving vehicles, chemical spillage, toxic gases, and fire or live electrical wires etc.

Human danger

Human danger from people at the scene (including the casualty) which can be intentional or accidental; bystanders in the way, uncooperative casualties, or dangerous or aggressive perpetrators; dangers can also include those related to infection. Bodily fluids, such as blood, vomit, urine, and faeces, all pose a risk of contamination as they can carry and act as a medium for transferring infection and diseases (contagion), including, but not limited to, HIV and hepatitis, measles and other vaccine preventable diseases etc. The victim might also carry dermatological infections or parasites.

First aid providers should also be aware that certain environments or accident sites have greater risks of injury than others.

First aiders must not place themselves in a situation which could result in injury to themselves. They must always safeguard themselves. You cannot help a victim if you become a victim yourself. It is necessary to properly assess the situation, not just rush in to help.

To protect themselves from harm the first aider should observe the scene and conduct a rapid hazard and risk assessment.

In the case where a violent perpetrator is on the scene or there is some threat to children from external sources, it might be necessary to notify security or call the police.

If there is an accident which appears to be a serious one, if the victim cannot be readily reached, or if there is ongoing danger to the victim, to bystanders or other people it might be necessary to call other emergency services. An appropriate assessment of the situation should enable the first aider to make a judgement of whether they are likely to be able to help the victim or whether it is necessary to call for other services—keeping in mind






that in the case of many injuries the first aider will assist the victim until an ambulance arrives.

Hazard identification and risk assessment is dependent on awareness of the surroundings, understanding of the current situation and understanding any possible situational changes that might occur.

Risk assessment involves determining the degree of risk and the likelihood that the identified hazards will cause harm—either, more harm to the victim or harm to the first aider. If there are no risks with their situation then it is possible to step in and provide immediate first aid.

If hazards are identified then it is necessary to eradicate, minimise or manage them so that treatment can be provided safely.

The first aider should only provide aid to the limits of their training—never beyond. It is important to do no harm and to do nothing that causes unnecessary pain or further injury unless to do otherwise would result in death.

Emergency action principles are the guiding rules that should be employed by the first person/s on the scene of an emergency, accident or injury or by the first aider. The nature of emergencies is such that it is impossible to prescribe a specific list of actions to be completed before rendering first aid, so principles form a framework on which to base forward actions. That is, each situation will be different so there are no hard and fast rules about exactly what should be done; however, a first aider must protect themselves and their own safety in order to provide appropriate assistance.

Once a primary check for danger has been undertaken, a first aider can then follow a set of principles, which are largely common sense.

They should identify the number of casualties, the history of what has happened and at what time. They should assess the location and possible access requirements for emergency services. They should determine what emergency services are likely to be required. There are several mnemonics which are used to help first aiders remember how to conduct this assessment, which include CHALET and ETHANE

CHALET

Casualties,

Hazards,

Access,

Location,

Emergency services,

Type of incident.

ETHANE

Exact location,

Type of incident,

Hazards,






Access,

Number of casualties,

Emergency services required

The first aider will usually conduct a first aid or medical assessment of the victim/s in order to gather information. The most widely used system is the ABC system and its variations, where the first aider initially checks the casualty for basics of life (primarily their breathing and pulse) then takes into account injuries or illness. Accurate reporting of a victim's condition will help emergency services dispatch appropriate resources to the incident and will help inform any action to be taken by ambulance or paramedic personnel.

Conditions that present as emergencies

A child who has fallen down and grazes a knee might require basic first aid and reassurance but this would not be regarded as an emergency. If the same child was stung by a bee and suffered a severe allergic reaction, this is an emergency situation, since the child's life might be at risk.

Emergency conditions might involve a casualty who is:

experiencing uncontrolled bleeding

not responding, or is not being properly conscious

not breathing normally

choking or has an airway obstruction (insect stings or food)

experiencing a severe allergic reaction

possibly suffering from head, neck or spinal injury

possibly poisoned or exposed to some toxic substance

suffering from exposure to prolonged or excessive heat or cold

drowning in the sea or in a swimming pool

Many other conditions can present as emergencies. In an education and care setting casualties might be adults—staff, visitors, parents—or children who have been involved in an accident or who have become ill.

It might be necessary to manage any of the following emergencies:

respiratory;

cardiovascular, neurological;

gastrointestinal;

renal and genitourinary;

endocrine;

infectious and communicable disease

toxicological, haematological;






envenomation; (poisoning)

ocular;

gynaecological

obstetric;

paediatric;

mental health;

violence—abuse and assault;

alcohol and other drug use;

orthopaedic and neurovascular;

burn.

Most emergencies require urgent intervention to prevent a worsening of the situation.

Some emergencies are not immediately threatening to life, but might have serious implications for the continued health and wellbeing of a person or persons and where immediate intervention is required if the person is to recover properly.

Environmental emergencies can threaten human life, with potential for affecting large numbers of people. Environmental emergencies could include natural hazards such as flood, bushfire, storms/ typhoons/ hurricanes etc, falling trees, a fire in a building etc. Threat to property, animals or the environment can all, potentially, lead to emergency situations.

Chemical spills, kitchen fires, an attack on a human (possibly a child) by an animal, a gas leak or release of toxic gases into the environment can all be considered emergency situations in which people might be injured and require basic emergency life-support.

Duty of care

In relation to your duty of care, there is no legal obligation for first aiders to provide first aid in a general public context. However, first aid officers in workplaces and school teachers have a duty of care.

Once a first aider begins to provide first aid, a duty of care is established and the first aider then has a legal obligation to fulfil the duty of care. If a road user is involved in an accident, there is a legal requirement to stay at the scene, assist the injured and report the incident to the police.

Not fulfilling a duty of care leaves the first aider open to questions of negligence.

Duty of care is part of the larger legal concept of negligence. Negligence is said to occur when damage occurs to another person as a result of someone failing to exercise reasonable care.

Duty of care requires that an acceptable standard of care that is reasonably practicable be provided to ensure the health and safety of those at the workplace and also to those affected by the work that you do.

Duty of care refers to the responsibility of each person to do everything within their power to ensure a safe and healthy environment. In your sector this includes community and






disability service workers, doctors, solicitors, financial advisors, drivers and local governments.

Duty of care places into a legal form a moral duty to anticipate possible causes of injury and illness and to do everything reasonably practicable to remove or minimise these possible causes of harm. This duty of care is written into the Workplace Health and Safety Act 2011 as obligations.

All adults in a workplace are legally responsible for workplace health and safety issues. Duty of care cannot be delegated. That means you cannot pass on that responsibility to anyone else.

The way the court interprets whether there was a breach of duty of care will depend on a range of factors and circumstances, including the following:

what would be expected of a reasonable person in the same situation

the worker‘s role and responsibilities within the organisation

the training and experience of the worker

the practicalities of the situation

current community values about acceptable practice

standards generally seen as applicable to the situation

other relevant laws such as the Workplace Health and Safety Act 2011

Duty of care is a common law requirement or a tort. A tort is a civil wrong recognised by law, which can be used as a basis for a lawsuit.






Duty of care is incorporated into health and safety legislation and many industry and teaching codes of practice, as well as applying to society generally and to trained people using their skills. Duty of care obliges first aiders to use protective actions when other people are at risk, so anyone attending an emergency scene to provide basic emergency life- support should be aware of their duty of care.

In identifying an emergency situation the particular issues that apply to the situation must be properly assessed and the risks of harm to involved individuals must also be assessed in order to provide appropriate and effective care, without further harm occurring.

The concept of duty of care requires that the person providing life-support take care for their own safety—you cannot help a casualty if you become a casualty yourself.

When entering or approaching what might be an emergency situation a person providing care should:

assess the situation;

determine whether it is an emergency;

determine who is involved;

determine what hazards are involved;

assess the hazards with regard to the possibility that they themselves might be harmed;

assess the situation in terms of further harm to the patient, to bystanders or to other;

personnel who might offer assistance;

determine the appropriate course of action to be taken;

act to provide basic emergency care.

Properly assess the situation for danger. Do not just rush in to help. Observe the scene and conduct a rapid hazard assessment to protect yourself and others from harm. A rescuer or first aider must not become a secondary victim or casualty, thus contributing to the emergency. Determine whether there is actually an emergency.

If there are other people at the scene, or witnesses, it will be necessary to ask appropriate questions to determine:

what the emergency is;

whether there actually is an emergency;

who is involved;

what degree of harm (injury, illness, danger) might be involved.

Emergencies generally relate to degree of harm and likelihood of ongoing or increasing danger to the life of anyone involved.






The process at an emergency scene is to:

A - Assess

C - Communicate

T - Triage, treat and transport

In education and care services a number of things need to be recognised:

children should be comforted and will be less upset if they can see a familiar face (e.g. educator with whom they are familiar)

reassurance is very important

parents or guardians must be notified of any emergency situation or if a child is ill or injured, as soon as is possible

1.2 Identify, assess and minimise immediate hazards to health and safety of self and others

The first thing that must be determined is whether it is safe for a responder to even enter the scene of an emergency. The scene must be scanned for immediate hazards, such as power lines, fire, potential assailants, dangerous animals, strong tides etc. Hazards relevant to each particular scene must be properly but rapidly assessed. Before any basic emergency life-support can be provided identified hazards must be controlled removed, mitigated or managed.

Hazards

Definition: Hazard

A hazard is any situation, substance, activity, event or environment that could potentially cause injury or ill health.

In other words a hazard is an item or situation with potential to cause harm. Harm can include ill health or injury, damage to property or environmental damage, and sometimes a combination of all three.

Hazard identification requires a person to:

stop and look carefully at the area surrounding the emergency

understand what has happened, and ask questions if appropriate

consider any possible changes in the current situation that might occur

Certain environments or accident sites will be more hazardous than others. Remember to look up, look down and around. Power lines, overhanging branches or unstable masonry can be missed if they are above normal eyesight height.

Common hazards can include:

Environmental hazards - danger in the surroundings, such as falling masonry, broken glass, moving vehicles, chemical spillage, toxic gases, fire or live electrical wires.






People hazards - danger from people at the scene (including the casualty) can be intentional or accidental; observers might be in shock, bystanders could be in the way, casualties and bystanders might be uncooperative, or the emergency might involve dangerous or aggressive perpetrators.

Infection hazards - bodily fluids such as blood, vomit, urine, and faeces, all pose a risk of contamination as they can carry and act as a medium for transferring infection and diseases (contagion), including, but not limited to, HIV, hepatitis, measles and other diseases. The victim might also carry dermatological infections or parasites.






People in the immediate area might be able to provide information that will help with understanding the situation, identifying hazards and determining potential risks especially if the situation is unfamiliar. Be prepared to ask questions and illicit useful information from other people. If other people are familiar with the area they might be able to point out any hazards that are not obvious.

Hazards might relate to:

Working environment. (for example)

– uneven or slippery floor surfaces;

– high noise levels;

– very high or very low temperatures;

– poor ventilation.

Machinery and equipment, e.g. entrapment and projectiles

Fire

Electricity

Hazardous chemicals, e.g. toxic or poisonous;

Biological waste;

Confined spaces;

Manual handling, for example;

– Pushing and pulling;

– Carrying;

– Lifting;

– Restraining

– Repetitive tasks

Airborne contaminants, for example;

– Fumes;

– Dusts;

– Vapours;

– Smoke.

Working at heights or over depth for example risk of falling;

Overexertion and physical stress;

Radiation exposure;

Psychological stress, for example;

– Conflict;

– Bullying;

– Harassment;






– Excessive workloads;

– Lack of support

Risk

Definition of risk

Risk is the likelihood of injury or harm resulting from exposure to a hazard.

To minimise immediate risk to the first aider, to the victim and to any bystanders it might be necessary to:

turn off machinery;

move equipment;

turn off water flows;

turn off electricity or gas;

turn off heating or cooling equipment;

erect signage;

erect barriers to protect the first aider, the victim or others;

direct traffic away from the scene;

remove the victim from a dangerous situation (using appropriate equipment where necessary) and taking into consideration the casualty's condition;

use extinguishers to put out a fire;

deploy appropriate crowd control techniques;

organise lighting to help illuminate the scene;

organise and provide some protection from weather conditions;

contact appropriate emergency services or other services to stabilise the environment.

It might be necessary to take into consideration, when conducting hazard identification and risk assessments, the area in which the accident or injury has taken place; for example, is it an area known for violent crime, or is it an area where there is a high degree of road traffic?

Weather conditions, time of day and the amount of light available should also be taken into consideration. Surrounding features - shops, public buildings, parks or other environmental features will contribute to an assessment of risk and the subsequent procedures that will be followed to control the risk.






First aiders will need to gather as much information as possible about the scene, about the accident or injury and about the victim. They should be observant and aware of conditions and of the likelihood that a casualty's injuries or illness are not immediately obvious. If there are witnesses they should ask what happened and listen carefully to the responses. If the victim is able to communicate they should find out from the victim what happened and how the victim feels.

All this information will contribute to the assessment and will help eradicate, minimise or manage any associated risk. If there are dangers which cannot be mitigated by the actions of the first aider (for example, falling masonry, an assailant or a structural fire), they should call emergency services. The first aider should stay within sight range of the scene but never put themselves in harm's way.

It might be necessary to utilise personal protective clothing or protective equipment such as:

Impermeable gloves (nitrile, latex or vinyl)—the first thing a first aider should do when approaching a casualty is put on their gloves;

safety glasses to protect eyes from splashes, spills or contamination by gases;

a CPR adjunct for helping perform safe mouth-to-mouth resuscitation;

an apron or gown—disposable;

filter breathing masks which filter out harmful chemicals or pathogens.

These items are generally found in a well-stocked first aid kit, along with appropriate bandages, gauzes, splints, tourniquets, creams and medications. Waterless hand cleaners, face masks, bio waste bags, bottled water, painkillers, tweezers and sharps containers might also be found in the first aid kit.

Often in an emergency situation there will be no first aid kit available and the person providing the first aid will not necessarily have access to protective equipment. A first aider might have to improvise materials and equipment, to minimise risk to their own health and safety and that of the casualty, using available materials until more assistance arrives.

For instance:

if gloves are not available it is possible to protect hands using plastic bags, dishwashing gloves, leather working gloves;

bandages and gauzes can be replaced by clean clothing or sheeting;

a splint can be made from straight sections of wood, rulers, plastic, cardboard or metal;

a sling can be made by pinning a casualty's shirt's bottom to the centre of their chest to immobilise an arm.






Hygiene is always an issue that first aiders must be aware of. They should, if there is no waterless hand wash available, use hot water and antibacterial soap or ordinary soap if necessary, drying their hands on disposable paper towel, to keep their hands clean and to prevent contamination from themselves to a casualty or from the casualty to themselves.

Work health and safety provisions address, with regard to controlling hazards and eliminating risk, the hierarchy of control which considers actions in terms of their ultimate importance and the likelihood that they will provide suitable hazard control measures.

Figure 1: Hierarchy of control






In most first aid or emergency situations it is necessary to look at eliminating risk—getting rid of a hazard—preventing any ongoing risk or utilising appropriate protective clothing. In most emergency situations substitution, engineering and administrative controls are not relevant. These control methods are, however, relevant to planning for safety and for the provision of safety in workplaces and in other situations in which hazard identification and risk assessment processes should be regularly performed.

The hierarchy of control can be taken into consideration when the emergency situation is over and it is possible to debrief and to determine procedures that can be followed to prevent such an emergency from occurring in future.

1.3 Assess the casualty and recognise the need for first aid response

Over time, changes might be made to recognised first aid procedures.

First aid is as easy as ABC – airway, breathing and CPR (cardiopulmonary resuscitation). In any situation, apply the DRSABCD Action Plan. DRSABCD stands for:

Danger – always check the danger to you, any bystanders and then the injured or ill

person. Make sure you do not put yourself in danger when going to the assistance of another person.

Response – is the person conscious? Do they respond when you talk to them, touch

their hands or squeeze their shoulder?

Unconscious casualties should be carefully handled, with every effort made to avoid any twisting or forward movement of the head or spine.

Assessment of the conscious state might also include an assessment of whether the casualty is confused, violent or agitated

Send for help – call triple zero (000) or 112 on mobiles. Don‘t forget to answer the

questions asked by the operator. Provide clear, concise and accurate appropriate details—location/ address, number of casualties, type of injuries, type of assistance currently being provided, access details—and indicate whether assistance from police or other emergency services, as well as an ambulance, is required

Airway – Is the person‘s airway clear? Is the person breathing?

If the person is responding, they are conscious and their airway is clear, assess how you can help them with any injury.

If the person is not responding and they are unconscious, you need to check their airway by opening their mouth and having a look inside. If their mouth is clear, tilt their head gently back (by lifting their chin) and check for breathing. If the mouth is not clear, place the person on their side, open their mouth and clear the contents, then tilt the head back and check for breathing.

Breathing – check for breathing by looking for chest movements (up and down).

Listen by putting your ear near to their mouth and nose. Feel for breathing by putting






your hand on the lower part of their chest. If the person is unconscious but breathing, turn them onto their side, carefully ensuring that you keep their head, neck and spine in alignment. Monitor their breathing until you hand over to the ambulance officers.

CPR (cardiopulmonary resuscitation) – if an adult is unconscious and not

breathing, make sure they are flat on their back and then place the heel of one hand in the centre of their chest and your other hand on top. Press down firmly and smoothly (compressing to one third of their

chest depth) 30 times. Give two breaths. To get the breath in, tilt their head back gently by lifting their chin. Pinch their nostrils closed, place your open mouth firmly over their open mouth and blow firmly into their mouth. Keep going with the 30 compressions and two breaths at the speed of approximately five repeats in two minutes until you hand over to the ambulance officers or another trained person, or until the person you are resuscitating responds. The method for CPR for children under eight and babies is very similar and you can learn these skills in a CPR course.

Defibrillator – For unconscious adults, who are not breathing, apply an automated

external defibrillator (AED) if one is available. They are available in many public places, clubs and organisations. An AED is a machine that delivers an electrical shock to cancel any irregular heart beat (arrhythmia), in an effort get the normal heart beating to re-establish itself. The devices are very simple to operate. Just follow the instructions and pictures on the machine, and on the package of the pads, as well as the voice prompts. If the person responds to defibrillation, turn them onto their side and tilt their head to maintain their airway. Some AEDs may not be suitable for children.

Injuries, illness or condition must be assessed to determine the severity of the incident and to determine what the most immediate treatment should be. Degree and type of injury must be assessed and the condition of the casualty, in terms of consciousness, breathing and likelihood of further deterioration must all be properly assessed. Only after a proper assessment can treatment be delivered.

For instance, if there is excessive bleeding this should be stemmed by using elevation and pressure. If the casualty appears to be going into shock they should be kept warm and calm. If there is a likelihood of neck or spinal injury the casualty should not, in most cases, be moved until there is appropriate equipment to assist with the move and qualified personnel are able to undertake the process.

If a child has a minor injury and is crying then the first aider might simply provide Band-Aids and comfort. If the casualty has an embedded object, for instance a nail, knife, piece of glass, a stick or piece of metal the first aider should not remove the object as it might be plugging the wound; they should build up padding and indirect pressure around the wound and help the casualty rest until help arrives. If the casualty appears to be excessively hot or excessively cold then action can be taken to cool them down or keep them warm.






Figure 2: Primary Survey

D Danger: Is there any danger (actual or potential) to self, bystander or casualty?

If there is danger, it is preferable to move the danger away from the casualty. In some circumstances this will not be possible e.g. fire etc. In these situations the casualty needs to be carefully moved away from the danger.

R Response: Is the casualty conscious or unconscious? If unconscious, the casualty needs to be placed in the side position.

S Send for Help

A Is the airway clear or blocked? If blocked, the airway needs to be cleared.

Opening the airway (look for signs of life - Call 000/resuscitation team)

B Normal breathing? (give two rescue breaths if not breathing normally);

C Give 30 chest Compressions: 2 breaths (if unwilling/unable to perform rescue breaths continue chest compressions

D Attach AED as soon as available and follow its prompts (If available) (AED – Automated External Defibrillator)






Figure 3: Basic Life Support Flow chart






Assessing a baby or toddler

Consciousness will be assessed in much the same way as that of an adult. Signs of unconsciousness and unresponsiveness might also include stillness, pale skin, possibly blue lips.

When dealing with a baby or young child it is important to handle them with care. If the casualty appears to be unconscious roll them gently onto their back with one hand, making sure the head is well cradled with the other hand.

To open airway place only one finger under the chin and tilt the head back slowly and gently.

Tipping the head too far back might cause damage to the neck.

Check to ensure the airway is clear and check for breathing for no longer than 10 seconds before taking further action.

The assessment process—first aid response

Assessing a casualty to identify injuries, illnesses and conditions therefore involves:

determining what is wrong

identifying dangers

making the area and casualty safe

providing first aid

getting help

When assessing the casualty the first aider is not only determining what treatment they should provide but are identifying the history, signs and symptoms that should be reported to emergency personnel when they arrive.

One of the most important things a first aider can do is take and record accurate observations.

They should observe and if possible make notes regarding:

Skin appearance and condition

The appearance of the skin can be a good indicator of the casualty's condition. Check colour, condition and temperature of the skin. Check to see whether the skin is dry or wet.

The first set of these observations, once taken and recorded, becomes the baseline observations. All changes in the casualty's observations are measured against this baseline for improvement or worsening of their condition.






Pain

Pain can be a difficult observation to make, therefore it will be necessary to ask the casualty to describe their pain. As pain is subjective it will be necessary to ask what brought the pain on, whether it is sharp, intermittent, dull, heavy or burning and how the casualty would have rated the pain on a scale of one to 10. The first aider should also assess and record the duration of the pain, that is, when it started.

Once these assessments have been made the first aider will look for deformity, damage, wounds and swelling. They might feel for tenderness and swelling.

It could be necessary to conduct a head-to-toes secondary examination to assess a casualty and identify injuries, illnesses and conditions, being sensitive to the age, gender and culture of the casualty. This involves looking for bleeding, fractures, possible leakage of cerebrospinal fluid from ears, injuries to teeth or jaw, numbness, pain, tingling, or rigidity.

Check for medical alert bracelets and necklaces.

Heart attack

Heart attacks—cardiac arrest—the chain of survival is a key concept to saving lives and is acknowledged in many countries around the world, including Australia.

It is described as:

early access (to get help)

early CPR (to buy time)

early defibrillation (to restart heart)

early advanced life support (to stabilise casualty)

Shock

Shock is a life-threatening condition which results from not enough blood circulating through the body, which means that vital organs do not receive enough oxygen. This condition will affect every cell, so the whole body goes into shock. The symptoms of shock are not always obvious immediately after an incident, but can develop over time. Injuries which have the potential to cause shock, such as heavy bleeding, might be immediately obvious. The responder should assess the casualty and determine the likelihood of a shock response and the resultant need for a first aid response.

Shock is also often brought on by pain and trauma and is commonly associated with emergencies. Bystanders can also suffer from shock, especially if the casualty is known to them.






Shock can occur through:

blood loss (hypovolemic shock);

severe head injury, traumatic brain injury (TBI);

severe infections (septic shock);

heart failure (cardiogenic shock);

severe burns;

severe trauma;

traumatising event;

dehydration;

severe allergic reaction (anaphylactic shock) - this might be due to drugs, foods, insect stings or snakebites.

Early signs of shock include pale cold and clammy skin, feeling faint or dizzy, feeling sick and being anxious. Severe shock includes a weak and rapid pulse, shallow and quick breathing, restlessness/drowsiness, vomiting, confusion and loss of consciousness. Infants and small children are particularly at risk, due to their smaller blood reserves.

If a casualty is suffering from or likely to suffer from shock try to keep their temperature regulated - warm but not hot or too cold. Monitor their condition closely - check pulse and heartbeat. If the casualty is conscious provide information and reassurance. If unconsciousness occurs be ready to give chest compressions and rescue breaths if required or to turn the casualty onto the recovery position if vomiting is likely - keep the airway free (move the casualty only if there is no neck or spinal trauma). Treatment for any injuries the victim might have must also be provided.

Other injuries or illness

A range of other injuries or illnesses will require first aid care. The person responding to the accident or incident must make an appropriate assessment to determine exactly what action should be taken.

For instance, while waiting for emergency services: a broken limb might be splinted; a wound from which a great deal of blood is escaping will require pressure and bandaging; a severely burned casualty will require fluid resuscitation and treatment for shock; a person suffering an asthma attack should be given their asthma medication, and if they have an EpiPen or AnaPen this should be used.






Head injuries

A hard blow to the head from a fall, knock or assault can injure the brain, even when there are no visible signs of trauma to the scalp or face. Symptoms of serious head injury include wounds, altered consciousness, clear fluid leaking from the eyes or nose, black eyes or bruises behind the ears, vision changes, nausea, and vomiting.

Head injuries can be classified as:

1. Open-with bleeding wounds to the face or head.

2. Closed - no visible signs of injury to the face or head.

If the injured person is conscious encourage them to minimise movement of the head or neck. Scalp injuries can bleed profusely, so control any significant blood loss from head wounds with direct pressure and a dressing. While examining the wound, avoid disturbing blood clots forming in the hair. Reassure the person and try to keep them calm.

If the injured person is unconscious do not move them unless they are in immediate danger. Any unnecessary movement may cause greater complications to the head injury itself, the spine or other associated injuries. Protect the injured person from any potential dangers at the scene, monitor their airway and breathing until the arrival of an ambulance. If the person's breathing becomes impaired due to a problem with their airway, it might be necessary to very carefully tilt their head back (and support it) until normal breathing returns. If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) might be required.

The key aims of the first aid response are to:

Preserve life- the overriding aim of all medical care, including first aid, is to save lives.

Prevent further harm-prevent the condition from worsening, or danger of further injury, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.

Promote recovery-trying to start the recovery process from the illness or injury, in some cases might involve completing a treatment, for example, applying a plaster to a small wound, or a bandage to a minor sprain etc.

The first aider must assess the scene, assess the casualty and identify any need for a first aid response.

Where the casualty is conscious it is necessary to reassure them and give them appropriate information about what is happening. Telling a person in pain that an ambulance is coming is very comforting. If the casualty is a child then they will want to know whether their parent/s or guardian/s is coming. Be aware of the position of the sun and shade them (or at least their face), or provide a windbreak if necessary. If the casualty appears conscious but does not understand English, the tone of voice and an appropriate gentle touch will reassure and comfort.

1.4 Assess the situation and seek assistance from emergency response services

In some cases it will not be necessary to call an ambulance. It might be possible to contact a doctor and to organise for a casualty to be seen by that doctor. Not all cases will require ambulance or emergency transportation. When contacting a doctor on behalf of the casualty the first aider should provide appropriately detailed information about the






situation and request that the casualty be seen by the doctor as soon as possible. Children should be accompanied by a responsible adult carer and their parents notified. If possible, the family doctor, as noted on client files, should be seen.

Assessing the type of emergency response assistance required

Medical support and equipment can be obtained by requesting emergency service ambulance and paramedic services. Most situations which involve anything other than minor first aid require further medical assistance - either by a doctor, emergency services or at a hospital. An effective assessment of the scene and of the condition of the casualty will indicate the type of emergency response required.

For instance:

Any incident involving traffic or the potential for access by vehicular traffic requires traffic control or the police (fire services and emergency response teams are trained in traffic control).

An incident involving high voltage power lines will require the electricity authority. If power is an issue in a building, an electrician is required.

Any spillage of chemicals or fuels requires the assistance of fire services.

If the casualty is trapped in a vehicle or as a result of an industrial accident, heavy liftingand metal cutting equipment might be needed - hydraulic rescue (jaws of life).

If a casualty has fallen and is trapped, for instance on a cliff, or if the incident hasoccurred in a remote and inaccessible area rescue services and helicopter removal mightbe needed.

If an incident involves crowds of people or is a result of violence and aggression and if the violence and/or aggression is likely to continue then police should be called to provide appropriate assistance.

Emergency fire services - both metropolitan and country fire services should be called if there is a fire or the likelihood of fire (where there has been a vehicular accident and fire is a possible result). Country fire service personnel will also assist with traffic control and in cleaning up at the scene of an accident.






State Emergency Services (SES) are the control agencies for flood, storm, tsunami, disaster rescue and earthquake. In the case where any of these things occur, these services can be contacted to manage responses to these emergencies.

Veterinarians and stock officers can be required if the incident involves animals, (for example, if an incident involves stock transport vehicles), especially if animals present a traffic risk or are themselves injured (including situations in which animals have escaped from paddocks and are loose on roadways, or where an animal owner/ handler has lost control of the animal, i.e. fallen from a horse or where horse and rider have been injured by a vehicle). Specialist large animal rescue groups are available in some areas. If there is an incident that involves a dog attack on a child or an adult, local government animal control services might be required.

It will be necessary to assess any emergency situation and seek assistance from relevant emergency response services.

Notification of an emergency response

In Australia the emergency response number is 000, or triple zero, for ambulance and police. On a mobile phone use 112.

In most cases it will be necessary to request the ambulance first, then additional emergency services as required. Appropriate information about the accident or incident should be given, along with relevant details and directions on the best way to access the site. Information to support ongoing communication - mobile numbers etc - should also be given.

Using available people until emergency personnel arrive

Calm unskilled people can provide much needed assistance until professional services arrive.

Staff members or parents, even though they are not first aid trained can assist the first aider by:

staying with and comforting a casualty (if there are multiple casualties - children need particular care and reassurance from an adult);

assisting the first aider as appropriate (noting the time to count a pulse);

directing traffic (if the accident has occurred outside of the centre);

guiding professional services into the area if it is not well marked;

providing a mobile phone and relaying information from the first aider, or at least requesting an ambulance;

providing crowd control and keeping the area accessible for the arrival of emergency vehicles.






2. Apply appropriate emergency first aid procedures

2.1 Perform cardiopulmonary resuscitation (CPR)

2.2 Provide first aid in accordance with established first aid principles

2.3 Ensure casualty feels safe, secure and supported

2.4 Obtain consent from casualty, caregiver, registered medical practitioners or medical emergency services where possible

2.5 Use available resources and equipment to make the casualty as comfortable as possible

2.6 Operate first aid equipment according to manufacturer‘s instructions

2.7 Monitor the casualty‘s condition and respond in accordance with first aid principles

2.1 Perform cardiopulmonary resuscitation (CPR)

Remember DRSABCD.

Check for danger. Look for danger to yourself, bystanders and the patient. If able to do so, remove the patient from danger or the danger from the patient without putting yourself at risk; for example, removing the patient away from a fire.

Check the casualty for a response, to determine whether they are conscious or not.

Send for help.

Check airway. Make sure the casualty's airway is open and clear, free from any obstruction. Check for any foreign material which could obstruct the airway and make sure that the casualty's tongue is not actually an obstruction. It might be necessary to place one hand on the casualty's forehead and gently tilt the chin back. Open the casualty's mouth and remove any obstructions.

If the patient is not breathing, the first aider should only roll the unconscious person onto their side if there is foreign material present in the mouth.

Check once for signs of breathing. Place your ear over the casualty's mouth.

For five to 10 seconds:






1. Look at the chest to see if it is rising - look for rise and fall of the lower chest/ upper abdomen.

2. Listen for sounds of breathing.

3. Feel for movement of the chest and escape of air coming from the casualty's mouth.

The first aider might need to assess and record the number of breaths per minute, the regularity of the breathing and whether there is any gasping, gurgling, wheezing or snoring.

First aiders are no longer required to check for a pulse when managing an unconscious patient who is not breathing.

Child CPR

1. Ensure that the scene is safe, follow the check-call-care procedure

2. Reposition the injured face-up (if needed), and take care of the neck, head and back;

3. Locate the position of the breast bone and position yourself correctly. Begin giving 30 chest compressions right away at a rate of a minimum of 100 compressions per minute.

4. Push 50mm deep in adults and children when giving compressions

5. Between chest compressions allow the chest to rise up completely and avoid stopping the chest compressions

6. Give 2 rescue breaths if not breathing, then check pulse ( take no more than 10 seconds)

7. If the chest does not rise and fall while giving rescue breaths, remove the object of obstruction from the airway

8. Continue this cycle (30 compressions and 2 rescue breaths) until AED or Help arrives. In infants and children each rescue breath should last for 1 second.

Infant CPR






The process for responding to an infant is the same as responding to a child except for the following:

1. The compression depth is 38mm deep for an infant.

2. Use 2-3 fingers when giving the chest compressions instead of using the heel of your hand.

3. Place your mouth over the mouth and nose of the infant, to avoid escape of air.

4. AED cannot be used on an infant who is less than 24 kilos.






Figure 4: Rescue Breathing Rates:

They should commence rescue breathing as follows:

Adult 2 breaths in about 2 seconds.

Child 2 breaths in about 2 seconds

Baby 2 breaths (puffs) in about 2 seconds

Ensure that the patient's chest rises and falls with each breath and commence CPR (cardiopulmonary resuscitation).

Figure 5: CPR Comparison:

Adult Position the heel of one hand on the centre of the lower half of breastbone (sternum) while grasping the wrist with your other hand.

Child Position the heel of one hand on the centre of the lower half of the breastbone (sternum).

Baby Position 2 fingers in the centre of the breastbone (sternum) just between the nipples.

Give 2 breaths to every 30 compressions (at 100 compressions per minute).

Compress chest to one-third of its depth.

If pulse returns but the person has no breathing, continue rescue breathing until ambulance arrives.

Always stay with the person until help arrives. Keep the 000 (ambulance dispatcher) informed of person's condition (if possible ask someone to do this for you).

Check for any visible signs of injury and if present, control severe bleeding by applying direct pressure to the affected area (take care to not come in direct contact with blood) and support broken bones (fractures) through immobilisation of the limb. Prevent further injuries to the casualty.

If a defibrillator is available follow the instructions for use.






Automatic External Defibrillator (AED)

1. Survival rate for a cardiac emergency patient increases to almost 30-70% if an AED is used in a timely manner.

2. Do not touch the person while the AED is analysing. When the device is defibrillating, you could be shocked, so be careful.

3. Do not use an AED on a person who is in contact with water. Be sure to move him or her away from the puddle of water, swimming pool, or rain before defibrillating.

4. An AED should not to be used on children under 24 kilos.

5. Follow the AED instructions given through voice commands. They should be self-explanatory.

6. An AED can be used on patients with an implant-device.

7. Take off visible nitroglycerine patches from the person using disposable gloves before defibrillating.

8. Shock pads should be used on clear skin (shave those parts if necessary), on the upper-right and lower left sides of the chest.

9. For children and infants- if pads are touching, place one pad in the front of the chest and one on the back of the chest.






Conscious Choking Child

1. For a child, seek the consent of the parent/guardian, Tell the person that you are trained in CPR, what you will be doing in the same way as you would for the adult.

2. If a person is getting enough air to breathe and cough, encourage him or her to continue to cough to get the object out.

3. When a person is coughing weakly and is having breathing difficulties, act at once. First, have someone call 000, because this may be a breathing emergency.

4. To care for a conscious but choking adult or child, give the person 5 abdominal thrusts. For a child kneel down to come to the same level as the child's height.

Abdominal thrusts:

1. Stand or kneel behind the person. Make a fist with one hand and place it on the person‘s abdomen just above the navel. Grab your fist with the other hand and give quick 5 upward thrusts.

2. Continue abdominal thrusts until the object is dislodged and the person can breathe or cough forcefully.

Learning Activity 6:

As part of your learning journey it will be necessary to practise CPR and to be observed performing CPR on an appropriate manikin, using any relevant equipment, by an assessor. You will need to show that you can perform CPR on an adult, a child and baby.

Did the Student for assessment perform the following tasks at a satisfactory level:

Yes/No

Assessing the scene and identifying hazards

Controlling risks, ie removing casualties from danger if necessary

Calling appropriate emergency services

Determining the appropriate first aid responses

Checking breathing and pulse

Checking for injuries

Checking airways and removing obstructions






Checking breathing

Commencing CPR when necessary

Following the CPR requirement: 2 breaths to every 30 compressions (at 100 compressions per minute)

Student name:

Assessor name:

Assessor signature:

Date:

Comments:

2.2 Provide first aid in accordance with established first aid principles

A first aider is trained in the correct use of specific equipment and procedures. Once the initial training is received, a first aid person is required to keep their qualifications current. This is because, over time, the approved methods might be updated and changed a little; also, over time, a person might, without knowing it, not be following the procedure exactly, and having another assess them is a good way to make sure they are following the steps exactly as required.

Identified first aid procedures include:

airway management

cardiopulmonary resuscitation (CPR)

controlling severe bleeding

providing assistance with self-administered medications, such as auto-injector, bronchodilator and spacer device in line with state/ territory legislation and regulations and any available medical/ pharmaceutical instructions

care of the unconscious person

safe manual handling of a casualty when and if required

First aid equipment

There is a range of equipment that is required for first aid management—including a properly equipped first aid kit. All equipment must be operated safely and according to manufacturer or supplier instructions. If proper procedures are not followed equipment will not operate properly and/or injury might be exacerbated. The operating life of equipment will also be reduced.






Some first aid equipment is developed for regular personal use, such as an inhaler for people with asthma. If a person is involved in an accident, such as breaking an arm, they may require assistance from the first aider to use their medication.

National Regulations: Regulations 89, 168.

“A centre-based service must provide an appropriate number of suitable first aid kits that are easily recognizable and readily accessible to adults. The service must have policies and procedures about the administration of first aid to children being educated and cared for by the service.

A family day care educator must provide a suitable first aid kit at the residence and cared by the service.

First aid kits should also be taken when leaving the service premises for excursions, routine outings or emergency evacuations.”

“A belt bag is one way of taking a modified first aid kit on an excursion or to the outdoor play space”

“First aid suppliers might advise about the contents of first aid kits. Kits should be checked regularly to ensure they are fully stocked, and no products have expired. For example, a service might keep a checklist of the contents inside each first aid kit, and initial each time the contents are checked.”

“When determining how many first aid kits are „appropriate‟, the service should consider the number of children in attendance as well as the proximity of rooms to each other and the distances from outdoor spaces to the nearest first aid kit. For example, larger services may require a kit in each room or outside space, whereas a kit between two rooms might be appropriate in a smaller service with adjoining rooms”

“Services might use data gathered from their incident, injury, trauma and illness records to determine the appropriate locations and contents for their first aid kits. First aid training providers may also be able to provide guidance”

Established first aid principles

Established first aid principles include:

1. First aid is the initial care and treatment given to the sick or wounded.

2. First aid must start immediately and continue until medical assistance is available.

The four basic principles are:

1. Preserve life.

2. Prevent deterioration of injury or illness.

3. Promote recovery.

4. Protect the unconscious.






These principles are supported by the following:

1. Check, clear, maintain airway.

2. Check, clear, maintain breathing.

3. Check, restore and maintain circulation.

4. Control bleeding (haemorrhage).

5. Treat shock.

6. Relieve pain.

7. Reassurance.

8. Gentle handling.

9. Protection from the elements.

10. Position casualty in lateral position (if relevant).

Remember:

D - DANGER

R- RESPONSE

A - AIRWAY

B - BREATHING

C - CIRCULATION

The rules of first aid are:

1. Do not get excited, determine whether casualty is conscious.

2. If conscious, ask what happened and what is wrong now.

3. Examine the casualty gently, examining back and front of casualty.

4. Remove clothing to expose wounds.

5. Keep casualty lying down with head level.

6. Examine for bleeding, shock and poisoning.

7. Keep the casualty warm and comfortable.

8. Act with quiet confidence. Reassure the casualty.

9. Do not give anything by mouth.

10. Do not move the casualty unless rescuer and casualty are at risk from further injury or it is required for first aid to occur.

Professionals working with vulnerable people have a duty of care, to ensure that actions that could harm others are identified, prevented and managed in ways that eliminate or reduce harm. In the context of first aid, the person who is in the role of first aider has a duty of care to act in the best interest of a casualty or patient.

Duty of care obliges first aiders to use protective actions when other people are at risk. They must act in the interests of the casualty, to protect and care for them. They must actively ensure that they cause no further harm to the casualty, but must also ensure that






no harm comes to a casualty as a result of their inaction, negligence or even incompetence.

They should provide safe and competent care, to the limit of their training. They should not overstep the boundaries related to their training and wherever there is uncertainty they should call in fully qualified emergency or medical personnel.

It is possible for a first aid provider who causes harm or who acts in a negligent manner to face litigation.

Negligence might:

be the legal consequence of a breach of the ethical principle of non-maleficence—the duty to do no harm

result from actions which could be reasonably foreseen as causing harm to a casualty

result from inaction when a casualty is at risk

It is even possible that the first aid provider follows the principle of beneficence - of doing good - but nonetheless, cause the client harm which is actionable in negligence. The law is not concerned with motives or good intentions, but the consequences of actions. Its intention is to compensate injured persons whose injuries result from the fault of others and, by its existence, to inhibit socially undesirable activities of the type likely to inflict injury.

Proper training and current qualifications will help protect first aid workers who should also be aware that the law will protect them to the best of its ability when they are carrying out first aid requirements in the field.

Key actions first aiders need to consider when facilitating the intervention of emergency medical help/ first aid treatment are:

assess and analyse the situation clearly and correctly

know the protocols with which they are expected to comply

know who should be contacted and how to contact them

proceed with delivering appropriate first aid treatment in order to prevent harm, relieve suffering, save lives

Other legislation

Legislation that first aid workers must be aware of and must comply with when delivering services includes:

anti-discrimination legislation;

anti-harassment legislation;

privacy law;

access and equity legislation;

legislation relating to social justice;

mandatory notification legislation (if relevant).

It is also necessary to ensure that the appropriate work health and safety legislation is complied with in the workplace, if that is relevant, or at the incident or accident scene.






First aid management

The provision of first aid management in accordance with established first aid principles and procedures will require appropriate leadership organisation and direction.

Where the first aid requirement is minor and no other emergency personnel are required, the first aider will generally manage alone, to assess the situation and to provide the required care. In a major incident or an incident involving a number of casualties there will be a requirement for proper coordination and management. It might be up to the first aider to take control of the situation and to organise other personnel. They might have to determine which emergency services are required, make the appropriate contact, and direct personnel to the correct areas.

First aid management must take into account applicable aspects of:

the setting in which first aid is provided;

workplace policies and procedures if relevant;

industry/ site specific regulations and codes if relevant;

state and territory health and safety legislation where relevant;

general health and safety legislation requirements that might affect the casualty and any other personnel, including the first aider;

location and nature of the incident or of the illness;

situational risks associated with, for example, electrical and biological hazards, weather, motor vehicle accidents;

location and availability of emergency services personnel;

accessibility for emergency personnel;

use and availability of first aid equipment and resources;

infection control;

communication mechanisms;

protection requirements;

the type of equipment required including that required for a major incident, e.g. jaws of life, helicopters etc.

Management procedures also relate directly to:

infection control and the utilisation of procedures that will prevent cross contamination of disease or medical conditions, e.g. measles, hepatitis, AIDS etc

the legal and social responsibilities of first aiders, with regard to providing first aid and to being protected from inappropriate repercussions

situational risks associated with, for example, electrical and biological hazards, weather, motor vehicle accidents

Casualties

There are a number of requirements that apply when dealing with casualties.






These are things that must come under consideration with regard to first aid management and they include:

not moving the casualty unless it is absolutely necessary - wait for emergency personnel with appropriate equipment

not attempting to manually lift a person from the floor/ground

not lifting a casualty unless there is assistance - the person could have suffered a stroke, a heart attack, an epileptic fit, a bleeding wound, or a fracture – further injury oftheperson can occur if manual liftingby a lone first aider is attempted; appropriateequipment should be used

A casualty's condition could be, depending on circumstances, assessed and managed for:

abdominal injuries;

allergic reactions;

altered and loss of consciousness;

bleeding;

body position;

burns - thermal, chemical, friction, electrical;

cardiac arrest;

chest pain;

choking/ airway obstruction;

crowning;

envenomation - snake, spider, insect and marine bites and stings;

environmental impact such as hypothermia, hyperthermia, dehydration, heatstroke;

injuries—cold and crush injuries, eye and ear injuries, head, neck and spinal injuries, minor skin injuries, needlestick injuries, soft tissue injuries including sprains, strains, dislocations, fractures;

medical conditions, including cardiac conditions, epilepsy, diabetes, asthma and other respiratory conditions;

poisoning and toxic substances (including chemical contamination);

respiratory distress;

seizures;

shock;

stroke;

substance misuse—common drugs and alcohol, including illicit drugs;

unconsciousness, not breathing or not breathing normally.

A first aider should not attempt to provide first aid treatment beyond their training. They should be aware, that in most cases, if they do not overstep the boundaries and they do






perform their duties in a responsible and competent manner, they will be protected by legislation.

The first aider will be protected if:

they do not deliberately cause harm to the casualty;

they provide the level and type of care expected of a reasonable person with the same;

amount of training and in similar circumstances.

No one (that is, the general public) is legally required to render first aid under normal circumstances. Exceptions include situations where a person's employment designates the rendering of first aid as a part of described job duties. Examples include lifeguards, law enforcement officers, park rangers, designated first aid personnel and safety officers in industry.

A duty to provide first aid also exists where an individual has presumed responsibility for another person's safety, as in the case of a parent-child or driver-passenger relationship.

Once care has commenced or responsibility has been assumed, there is a duty of care to continue until further help arrives (for example, ambulance).

It is the responsibility of the first aider to seek first aid assistance from others in an efficient and timely manner. While in many instances a first aid situation will be fairly readily resolved (minor cuts, burns etc) and in some instances a casualty can be sent or driven to a doctor, larger or more serious incidents will require that the first aider contact other emergency personnel (police, ambulance, fire services, rescue services). The initial observation of the scene should provide the first aider with sufficient information to make a determination of whether they should call other emergency services.

Once the decision is made the communication with emergency services should be timely and effective. Appropriate information about the accident or incident should be given, along with relevant details (irrelevant information should not be passed on) and directions on the best way to access the site. Information regarding ongoing communication - procedures, mobile numbers etc - should also be passed on to emergency personnel.

2.3 Ensure casualty feels safe, secure and supported

Following or during an emergency a conscious casualty will require reassurance from a calm and compassionate person. If the first aider's skills are required elsewhere, any calm adult should be able to provide at least basic comfort. The adult should be briefed to watch for signs of shock.

An individual's distress levels are not always proportional to the degree of trauma suffered or the circumstances surrounding the event. A subconscious childhood event, recent stress in the workplace/ home and many other non-related aspects, can contribute to a casualty's response, in addition to the emergency.

Aspects of the emergency which can further distress a casualty include:

pain;

loud noise, especially sirens;

bright or flashing lights;

smoke or strong smells;

being unaware of what is happening;






knowledge of the involvement of other parties, especially children and animals;

exposure to weather conditions, including wind and sun;

being left alone, even for very short periods;

being able to see elements of the accident or emergency, such as a smashed vehicle;

being conscious of still being in danger, such as a person trapped under fallen masonry or in a damaged vehicle and not yet freed; the smell of petrol or other inflammatory substances; or the knowledge that others are still in danger.

Reassure the casualty

Hearing the steady voice of a kind, calm person who is able to devote their time to the individual, comfort and reassure them, and explain what is happening if asked, and let them know that an ambulance is coming, is invaluable. Even if the casualty is unable to reply, the voice of another person helping brings comfort. If the casualty wants to talk, be a good listener.

It is also important to not give false reassurance and to remember that the casualty may not be thinking well and might ask for the same information several times. If the casualty can speak, ask if there is someone who should be contacted on their behalf. This can be an emotional time and the casualty may become angry and abusive, or weep.






2.4 Obtain consent from casualty, caregiver, registered medical practitioners or medical emergency services where possible

If a casualty is conscious they should be asked for consent to first aid treatment. Consent will, in many cases, be verbal but can also be written. In some cases it will be appropriate to complete a first aid commission permission. These might be included in the first aid kit.

In the case of a child who is in need of first aid treatment, consent from a parent or guardian might be required. In most instances, when a child is injured or in an emergency situation the parent or guardian will be notified, but when completing enrolment forms consent for appropriate treatment will have been given. Any special requirements should have been noted the child's file.

If it is necessary to consult with registered medical practitioners or medical emergency services it is possible to receive verbal advice regarding treatment and to use that advice in the educational and care setting. Appropriate notes regarding the advice received and the treatment undertaken should be filed.

In general terms, people have what is called a personal space and are often uncomfortable being touched by people they do not know. This varies with cultural and personal attitude, but touching another person can be considered rude, offensive or threatening, especially if they are the opposite sex. Before invading someone's personal space and touching them it is important to gain permission and to let the person know why it is necessary.

As most first aid treatment involves touching a casualty, gaining permission can avoid causing offense, distress or fear. It is, in fact, even possible that a first aider who touches a victim or casualty without permission be accused of interference or battery.

The simplest way to gain consent is to ask the casualty if they will allow treatment. Talking to the casualty and building rapport is, therefore, important. In the education and care setting, enlisting the assistance of a worker who is close to the child will help build the reassurance necessary.

When holding a conversation in order to seek consent there are a number of things the first aider should do:

identify themselves - offer their name and explain that they are trained in first aid;

find out the name (preferred name) of the casualty and address them by name

explain why they are there - most casualties are aware that they have an injury or illness although this cannot always be assumed for patients in emotional shock, young children or people with a cognitive disability;

explain that they would like to help with the injury or illness;

describe what they are going to do - some first aid procedures can be uncomfortable (such as the sting which accompanies cleaning a wound with saline), so it is important to be honest about what will be done and why it is important;

make sure that they have consent from a casualty who understands what will happen.

Implied consent

There are some cases where it is possible to assume consent.






Consent is implied if the casualty is unconscious or has a reduced level of consciousness. In such cases aid can be given to the level of the first aider's training; that is, they can perform any reasonable treatment within their level of training.

In some cases permission might have been granted in advance - by an employee who has signed a first aid permission form, by the parents of a school or preschool child who signed consent for emergency treatment forms, or by people undertaking high risk sports who have been asked to complete a permission form.

Problems

Casualties (and their parents or carers) do have the right to refuse first aid care and in these instances the rights of the casualty must be respected. First aid personnel cannot force care or treatment onto a person who does not want it.

There are cases which are not so clear-cut, for example, if a casualty refuses treatment but is:

intoxicated

affected by drugs

irrational (delusional, insane or confused due to the injuries)

a minor (a parent or guardian must give consent if present and able; otherwise consent can be considered implied and emergency first aid necessary to maintain life can be provided without parental consent)

suffering from cognitive impairment or disability, such as an elderly person who has Alzheimer's disease, or a person suffering from depression, who cannot be reliably trusted to act in their own best interests

a child who is panicked and does not understand what is happening

In these judgement cases, the first aider must make a decision about what to do, even if the victim is refusing treatment. If this occurs it is very important to make a note of the decision, why it was taken, and why it was believed that the person was unfit to refuse treatment. It is advisable to summon, if possible, professional medical assistance if the first aider believes that the person should be treated and is refusing. Medical professionals are experienced in dealing with people reluctant to accept treatment.

Spouses/ partners and relatives of adults deemed incompetent do not normally have authority to decline treatment of their loved one unless this has been given force by an appropriate legal directive (for example, power of attorney).

2.5 Use available resources and equipment to make the casualty as comfortable as possible

An individual needs to be aware of the resources that are available to be able to carry out first aid in their surroundings. The first aider should be familiar with all the equipment that is at hand such as first aid kits, stretchers, breathing apparatus, splints etc .and ensure that they are in full working order therefore all equipment should be checked on a regular basis. They should also be familiar with how to use the equipment should the need arise. An example of a typical on site first aid kit can be seen in the table below. If the institution has a predetermined first aid area, this area also needs to be checked regularly and kept free of clutter and obstacles. Prior knowledge of the location of all first aid resources and equipment is essential so that these resources can be utilised in an efficient and timely






manner thus saving valuable time which may be imperative in the treatment of certain injuries and conditions.

You may be required to assist in a first aid situation by getting resources such as:

first aid kit

blankets

mobile phone (to call for help)

torch

thermometer

ice pack

resuscitation mask or pocket face mask

space blanket

extra bandages

spacer device

gloves..

First aid kits should be properly stocked at all times. Anything that is used should be replaced. For the first aid kit to be a useful resource it needs to be located in a place where it can be accessed readily.

In most cases medication will not be stored in a first aid kit. Administration of inappropriate medication could result in allergic reactions and other negative results. It is also important that medication usage adhere to appropriate use-by dates (out of date medicines might not have any efficacy) and that medicines be stored where they cannot be accessed by unauthorised people; and in some cases in temperature controlled storage. For these reasons it is often impractical to keep medication in a first aid kit. Although medications can be used to improve comfort for a casualty, they should only be administered by people who know exactly what they are doing.






If you do need to assist by accessing any of these items, prepare yourself by becoming familiar with where these items are kept in the workplace. This will save time and speed up the first aid response, help to promote recovery and may prevent injuries from worsening.

Figure 6: First Aid kit requirements

First Aid Kits

Description of Appliance or Requisite

Contents

First Aid Kit

A B C

Adhesive plastic dressing strips, sterile, packets of 50 2 1 1

Adhesive dressing tape, 2.5cm x 5 cm 1 1 -

Bags, plastic, for amputated parts: small 2 1 1

Medium 2 1 1

large 2 1 -

Dressing, non-adherent, sterile, 7.5cm x 7.5cm 5 2 -

Eye pads, sterile 5 2 -

Gauze bandages 5cm 3 1 1

10cm 3 1 -

Gloves, disposable, single 10 4 2

Rescue blanket, silver space 1 1 -

Safety pins, packets 1 1 1

Scissors, blunt/short-nosed, minimum length, 12.5cm 1 1 -

Splinter forceps 1 1 -

Sterile eyewash solution, 10ml single use ampoules or sachets

12 6 -

Swabs, pre-packed, antiseptic, packs of 10 1 1 -

Triangular bandages, minimum 90cm 8 4 1

Wound dressings, sterile, non-medicated, large 10 3 1

First aid pamphlet (as approved by WorkCover) 1 1 1

First Aid Kit A - places of work at which 100 or more persons work.

First aid Kit B - places of work at which less than 100 or more than 10 persons work.

First Aid Kit C - for any place of work which 10 or less persons work.






Resources:

Spine management

If the injured person has neck pain, they are unlikely to be able to hold their head up properly, and will need assistance and support which holds the head and neck in a comfortable, stable and correct position that will prevent further harm. This is a situation where explaining to the casualty that they need to keep as still as possible can be helpful, but depending on consciousness or the level of stress, cannot be relied on. Someone to supervise them and explain what is happening, so that they have something to focus on and do not attempt to try to turn their head to see things, or to talk to other people, is important. If they are told about what is happening, they are less likely to flinch or turn at sudden noises or movements.

If a cervical collar is needed it should be carefully and competently fitted, so that the head of the injured person does not move while it is being fitted. Manual stabilisation once it is fitted will still be necessary for the person to remain completely still and protected.

Automated external defibrillators (AED)

An AED is a portable electronic device that automatically diagnoses the potentially life- threatening cardiac arrhythmias of ventricular fibrillation (uncoordinated contraction of the cardiac muscle of the ventricles in the heart) and ventricular tachycardia (fast heart rhythm), and is able to treat them through defibrillation. Defibrillation consists of delivering a therapeutic dose of electrical energy to the heart which stops the arrhythmia, allowing the heart to re-establish an effective rhythm.

When attaching electrodes, expose the chest then place the electrodes one on the left side, under the arm, and the other over the right breast. (Ideally hair should be shaved/ removed from the electrode location; however, in an emergency situation this might not be possible.)

The location of pad placement is clearly depicted on each pad; they must go exactly as shown in the picture. Once connected, the defibrillator wili automatically start monitoring the heart's electrical activity to determine whether a shock is appropriate.

If the casualty is under the age of eight years the AED should be used with paediatric pads.

CPR must stop while the defibrillator monitors the casualty's heart activity. In all cases, defibrillation has priority over CPR.

Do not touch the casualty or the AED while the unit is analysing.

The AED will shock the casualty. The operator might be required to press a shock button. Touching the casualty is potentially fatal when the shock is administrated. After the shock has been delivered, it is safe to touch the casualty; no electricity will remain in them. The defibrillator will advise you what to do next—usually you will be told to begin chest compressions and rescue breaths again.

Do not shock if the casualty:

is close to explosive or flammable material

is wet (dry the casualty off with a towel)

has a medicine patch on—remove this while wearing gloves

is touching an object that could conduct the charge to others, e.g. a metal bench






If necessary, protect the casualty from water and dry them, or move the casualty a few metres between each CPR cycle until the area is safe for defibrillation.

The auto-injector

An auto-injector is a medical device designed to deliver a single dose of a particular (typically life-saving) drug.

Most auto-injectors are spring-loaded syringes. By design, auto-injectors are easy to use and are intended for self-administration by patients, or administration by untrained personnel.

The site of injection depends on the drug loaded, but it typically is administered into the thigh or the buttocks. The injectors were initially designed to overcome the hesitation associated with self-administration of the needle-based drug delivery device.

Auto-injectors (for example, AnaPens, EpiPens) can be carried by people at risk of acute anaphylaxis (hypersensitivity reaction). These pens are commonly carried by persons with severe allergies and a risk of anaphylactic shock because they can be self-administered and are very fast-acting.

They contain a prefilled needle syringe combination which delivers adrenaline intramuscularly and, as regulated medical devices they require a medical prescription in all countries. A first aider might provide assistance to a person who carries such medication.

Puffers/ inhalers

An inhaler or puffer is a medical device used for delivering medication into the body via the lungs. It is mainly used in the treatment of asthma and Chronic Obstructive Pulmonary Disease (COPD).

An asthma spacer is an add-on device used to increase the ease of administering aerosolised medication from a metered-dose inhaler (MDI). The spacer adds space in the form of a tube called a chamber between the canister of medication and the patient's mouth, allowing the patient to inhale the medication by breathing in slowly and deeply for five to 10 breaths.

The spacer is a specially designed plastic or metal tube, although a spacer can be made from any suitable container, for example, polystyrene cups or plastic bottles. The back end of the chamber is closed off by a back-piece.






After removing the MDI's cap, the MDI is inserted into the back-piece. The front part of the chamber is closed off by either a face mask that covers both the patient's mouth and nose, or simply a mouthpiece that goes onto the patient's mouth.

To administer the medication, the patient brings the face mask to the face (or the mouth-piece to the mouth) and depresses the metered-dose inhaler once, resulting in the release of one dose of medication. The medication from the MDI is then briefly suspended in the spacer's chamber while the patient inhales the aerosolised medication by breathing in and out deeply at a slow rate of speed.

Some spacers are equipped with a whistle, which sounds as a warning when the patient is inhaling too quickly. Some spacers utilise a collapsing bag design to provide visual feedback that successful inhalation is taking place.

Resuscitation mask or barrier

A resuscitation mask helps protect rescuers in an emergency situation by preventing direct contact with a patient's mouth, nose and face and helps overcome hesitation to start resuscitation. Single use infant resuscitation masks are also available. Follow the manufacturer's instructions in order to prevent infection—from the patient to the first aider or from the first aider to the patient.

Protection

An injured person needs to be protected from the elements, as well as noise, debris and unnecessary movement. They also need to feel that they can breathe easily and see some daylight, so it is necessary to take care with the selection of soft protection.

Warmth might be a requirement, particularly where shock is an issue. Alternately, a person exposed to very bright sunlight or high-temperatures will require protection from the light and from the temperatures; that is, shade or some form of cooling or a borrowed pair of sunglasses.

It could also be important to put up some sort of barrier to protect them from scrutiny by the general public or bystanders.

If a casualty is in a position where they require some form of cutting equipment or machinery to be used to free them, they do not need to see it. Make sure they are aware of what is going to happen, including the potential for noise, heat or fuel smells. A casualty needs to be reassured that all appropriate safety precautions have been taken, and that they are protected from further injury. This reassurance may need to be repeated during the procedure. The first aider or person assigned to the casualty should be in a position to signal to the operator, if necessary through a third person, to stop if the casualty shows signs of panic.

When applying a mask, be aware that a casualty could be afraid of the mask. The first aider should explain what it is and how it will help.






First aiders should also take care where they put their equipment—blood pressure cuffs, oxygen tubes and other equipment can get damaged or kinked, and allowing oxygen bottles or other heavy equipment to come in contact with a casualty will not improve the injured person's condition.

Protect the casualty from harm that might be caused by equipment, conditions in the immediate surroundings, inappropriate movement and careless and inappropriate actions of others.

The first aider must select treatments, based on an effective examination of the situation and the casualty's injuries. Appropriate equipment should be used and the first aider must make allowance for the special needs of children and young persons.

First aid kits and other community resources

A first aid kit is should be available in the workplace. Sterile wound dressings including eye pads, various support bandages, antiseptics, burns casualty sheet, sting relief, sunscreen, eyewash, emergency shock blankets, hot and cold packs, painkillers and many other useful items can be available from first aid kits.

A first aider will need to use available resources and equipment to make the casualty as comfortable as possible.

Other community resources are sometimes available. For example, if children are on executions bottles of vinegar to help neutralise jellyfish stings are provided at many beach locations in tropical areas. In most instances a first aid kit will be taken if external excursions are undertaken.

Making a casualty comfortable

In the absence of a first aid kit or in addition to one, blankets, scarves or jumpers can be used to provide a pillow, protect from chill, or be tied in such a way as to provide shade.

On a hot day if the casualty cannot be moved, another person standing or sitting in a way which provides shade can bring relief. Splints can be made from anything long, straight and strong enough, including timber, hard plastic, and rolled up tough cardboard.

Bandages can be made from material that can be ripped, including a shirt. The elastic in waistbands can be useful.

A (safe) car might be parked to give shade or make a windbreak.

If the casualty was travelling to pick up a child, say from school, notifying the school or a person nominated by the casualty is important.

Small kindnesses add to the casualty's sense of wellbeing and being cared for. Gently wiping dirt from their face, or if appropriate, using an eyewash, can assist. Keeping flies away or applying a moistened towel to a person's face or loosening tight clothing all add to comfort.

At no time should the casualty's limbs or head and neck be moved until a first aider has checked for trauma.






Manual handling

When using available resources it is necessary to understand the manual handling techniques appropriate to different situations.

Manual handling is any activity involving the use of muscular force or effort to lift move, push, pull carry, hold or restrain an object, a person or animal.

While not all manual handling tasks will cause injury, hazardous manual handling can lead to many serious conditions, including:

muscle sprains and strains

back injuries

soft-tissue injuries to the wrists, arms, shoulders, neck or legs « abdominal hernias

chronic pain

Safe manual handling techniques will apply to the handling of bulky or heavy first aid equipment, any items on site that should be shifted to ensure safety and the lifting of casualties.

It should be noted that manual handling involves more than just the lifting and/or carrying of weights. It includes any activity requiring the use of force exerted by a person to lift, push, pull, carry or otherwise move or restrain any moving or stationary object. Only a very small number of manual handling injuries are caused by lifting heavy weights. Often, seemingly simple activities such as repetitive reaching, twisting and bending, as well as poor sitting, standing and typing postures can contribute to an injury occurrence.

Here are some general principles based on the laws of physics. They are:

Have a wide base of support - keep feet apart, point toes in the direction you are going to move, knees should be slightly flexed. This avoids using the small muscle in the back and uses the thigh muscles;

Keep object close to the body;

Keep object close to hip/pelvic area (centre of gravity);

The line of gravity should always be vertical and should remain perpendicular to the ground. In other words, keep back straight while lifting and carrying;

It is easier to push or slide an object than lift;

Transferring the lifter‘s weight during movement exerts less energy;

Size up the load to be carried and get help (human or mechanical) if the load is too big, heavy or awkward;

Bend the legs, keep back and arms straight, lift with leg muscles.






Based on these general principles, here are some important principles to remember when lifting or moving objects

Always use both arms and legs;

Turn in direction of movement;

Use smooth movements;

Bend knees, squat, and keep back straight and stand in front of object when lifting something from ground level;

Use appropriate lifting aides;

Avoid twisting, stretching and bending if possible;

Wear appropriate clothing which allows you to move comfortably;

Proper footwear is also vital to prevent injuries from slips and falls.

Prior to undertaking any lifting or carrying activity the first aider should conduct a rapid manual handling risk assessment - determine what is required, where it is required (loads and distances) and how it can be achieved effectively (other personnel, other equipment) and without injury.

Characteristics of loads and equipment to consider when assessing manual handling risk: dimensions

stability

rigidity

predictability

surface texture

temperature

grips

handles

weight

size

gradients

visibility

Lifting equipment can strain the lumbar vertebrae when done improperly. Ergonomic lifting techniques involve keeping loads close to the body and near the person's center of gravity, using diagonal foot positions, and moving loads at waist height rather than directly from the floor.

When climbing a ladder or stairs when carrying a load, safe manual handling includes maintaining contact with the ladder or stairs at three points (two hands and a foot or both feet and a hand). Loads should not be so bulky that they obscure vision. Bulky loads would require a second person or a mechanical device to assist.






Load handling could involve pushing or pulling. Pushing is generally easier on the back than pulling. It is important to use both the arms and legs to provide the leverage to start the push.

When moving loads such as first aid equipment, handlers are safer when pivoting their shoulders, hips and feet with the load in front at all times rather than twisting their back. The lower back is not designed to torque or for repetitive twisting.

Lifting the casualty

It might be necessary to move or to lift a casualty. This should be done with appropriate manual handling techniques so that the first aider is not injured.

When it is necessary to lift a casualty or to move the casualty onto a stretcher and carry them:

Consider the weight of the casualty together with the weight of the stretcher or other equipment being carried and determine if additional help is needed.

Know your physical ability and limitations. If absolutely necessary, you can ask bystanders to help. You must be in charge and give the orders, not the bystander.

Lift without twisting. Avoid any kind of swinging motion when lifting as well.

Position your feet shoulder width apart with one foot slightly in front of the other.

Communicate clearly and frequently with anyone who is assisting you.

If the casualty is conscious tell them what you will be doing ahead of time. A startled person could reach out or grab something and cause a loss of balance.

When lifting a stretcher a minimum of two people are usually required to lift. An even number of people will help maintain balance during the lift.

First aiders should know the weight limitations of the equipment they will use and what to do if a casualty exceeds the weight limitations of the equipment.

When lifting from ground level the first aider and assistants should use the power lift or squat lift position. Feet are shoulder width apart. Back is tight and the abdominal muscles lock the lower back in a slight inward curve. Distribute weight to the balls of the feet. Keep both feet in full contact with floor or ground. Flex at the hips, not the waist, and bend at the knees. While standing, keep the back locked in, as the upper body comes up before the hips. Use a power grip to get maximum force from the hands. Hands should be at least 10 inches apart. Palms face up and fingers in complete contact with the stretcher bar.

When lowering the stretcher, reverse the steps. Whenever possible, move casualties on devices that can be rolled. Minimise the distance needed to carry casualties.






Stairs

It might be necessary to carry a casualty up or down stairway. Try to carry heavy casualties up a stairway with two people at the top, shoulder to shoulder, and two at the bottom of the stretcher.

Carry casualties head first up the stairs and feet first down the stairs.

You can use a kitchen chair with the patient sitting on the chair or you might have to use an extremity lift if a stretcher is not available. Keep your back in the locked-in position. Flex at the hips, not at the waist, and bend at the knees. Keep the weight and your arms as close to your body as possible. Keep your back in locked-in position. Avoid stretching or overreaching when reaching overhead. Avoid twisting.

Pushing and pulling

Push whenever possible rather than pull. Keep your back locked-in. Keep elbows bent with arms close to sides. Keep the line of pull through the center of your body by bending your knees. Keep weight close to body. Push at a level between your waist and shoulders.

Use kneeling position if weight is below waist level. Avoid pushing and pulling from an overhead position.

Remember to take into consideration, when considering movement of a casualty, the possibility of neck or spinal injuries. Where these are likely the first aider should wait for emergency services to arrive before moving the casualty.

Emergency moves

A casualty should be moved immediately by an emergency move only when there is an immediate danger to the casualty or the first aid providers including:

fire/danger of fire

danger of explosives or other hazardous materials

inability to protect casualty from other hazards at the scene

inability to gain access to other casualties who need lifesaving care

inability to provide care due to location or position

weather conditions

hostile bystanders

uncontrolled traffic

rapidly rising flood waters

Emergency moves include the Clothing Drag:

Tie the casualty's wrists together if you have something quickly available. If nothing is available, tuck the hands into the waist band to prevent them from being pulled upwards.

Clutch the casualty's clothing on both sides of the neck to provide a support for the head.

Pull the casualty towards you as you back up, watching the patient at all times. The pulling force should be concentrated under the armpits and not the neck.






The Sheet Drag:

Fold or twist a sheet or large towel lengthwise.

Place the narrowed sheet across the casualty's chest at the level of the armpits.

Tuck the sheet ends under the armpits and behind their head.

Grasp the two ends behind the head to form a support and a means for pulling.

Pull the casualty toward you while observing them at all times.

The Blanket Drag:

Lay a blanket lengthwise beside the casualty.

Kneel on the opposite side of the and roll the casualty toward you.

As the casualty lies on their side while resting against you, reach across and grab the blanket.

Tightly tuck half of the blanket lengthwise under the casualty and leave the other half lying flat.

Gently roll the casualty onto their back.

Pull the tucked portion of the blanket out from under the casualty and wrap it around the body.

Grasp the blanket under the casualty's head to form a support and means for pulling.

Pull while backing up and while observing the casualty.

The Bent Arm Drag:

1. Reach under the casualty's armpits from behind and grasp the forearms or wrists.

2. Use your arms as a cradle for the casualty's head and keep the arms locked in a bent position by your grasp.

3. Drag the patient towards you as you walk backwards, observing the casualty at all times.

Usually these lifts should only be used when a spinal injury is not suspected and for short distances. However in the case of an emergency where it is vital to move the casualty out of extreme danger the first aider and emergency service personnel should determine what is appropriate at the time.






2.6 Operate first aid equipment according to manufacturer's instructions

There are a number of pieces of equipment that can be utilised in the administration of first aid. Life support equipment should be regular checked for deterioration, to ensure that it is functioning properly and cleanliness. The first aiders should be up to date on how to use the equipment and maintain it. There is little benefit in having up to date life support equipment available if no one knows how to use it. Manufacturers /suppliers instructions should be kept in an accessible place so that they can be referred to if needed. However, prior knowledge is the best as you don‘t want to have to go and read the instructions in an emergency.

First aid equipment refers to the first aid kit, the defibrillator and other equipment such as Epipens, puffers and spacers.

An automated external defibrillator (AED) is a portable automatic device used to restore normal heart rhythm to patients in cardiac arrest. An automated external defibrillator is applied outside the body. The AED automatically analyses the casualty‘s heart rhythm and advises the first-aider whether or not a shock is needed to restore a normal heart beat. If the casualty‘s heart resumes beating normally, the heart has been successfully defibrillated.

The defibrillator is very simple to use. The first-aider simply follows the instructions. However, it is strongly recommended that you complete a short course on using a defibrillator so you are well prepared should you need to use it.

Be aware of what you can and cannot use as there a number of pieces of equipment that require separate training to be able to use. An example of this is oxygen therapy.

Life Support Equipment that you may come in contact with

Figure 7: Oxygen therapy – oxygen mask






Figure 8: Ambu bag

Figure 9: Example of a First Aid Kit

Figure 10: Automated External Defibrillator - AED






There is a range of equipment that will be required for first aid management—including a properly equipped first aid kit. All equipment must be operated safely and according to manufacturer or supplier instructions. If proper procedures are not followed equipment will not operate properly and/or injury might be exacerbated. The operating life of equipment will also be reduced.

First aiders who have been properly trained should know what equipment to use in specific circumstances and how to use it effectively.

The standard first aid kit will usually be designed to provide first aid for injuries and illnesses such as:

cardiac arrest;

scratches, punches, grazes, splinters, animal bites;

minor and major burns;

fractures;

amputations;

bleeding wounds;

eye injuries;

head injuries;

headaches and other minor pains.

Equipment might include:

automated external defibrillators (AED);

an auto-injector;

an asthma spacer;

resuscitation mask or barrier;

thermometers, including ear thermometers folding, basket, pole stretchers etc;

eye baths;

blood pressure monitors;

spine boards;

blood sugar monitors/ glucose meters;

oxygen resuscitation equipment;

disposable resuscitators cold packs/ hot packs.






In a first aid kit other resources might include:

crepe bandages—10 cm x 1.5 m;

conforming bandages;

triangular bandages;

sterile wound dressings;

skin closures;

kidney dish;

nail brushes;

disposable towels;

antibacterial soap;

plastic splints;

non-adherent dressings;

eye pads - sterile (large);

hypo-allergenic tapes antiseptic/ disinfectant;

cotton wool/ cotton buds painkillers and anti-inflammatories;

adhesive strips;

universal dressings slings;

antiseptic skin preparation swabs;

saline steritubes;

scissors/ sharp/ blunt nosed;

sheers - trauma scissors;

tweezers;

forceps;

gloves - latex, non-powdered, vinyl, nitril;

resuscitation masks - disposable;

disposable goggles – clear;

emergency shock blankets;

biohazard waste bags;

safety pins;

burns casualty sheet;

alcohol swabs;

cold/ hot packs splinter probes;

sting and itch relief sachets;

sunscreen - zinc oxide;






plastic bags;

eye wash solution;

a DRSABCD Action Plan;

a work injury report;

a work injury/ illness register;

a notepad and pencil in a bag;

a First Aid Quick Reference Guide;

an AED – defibrillator;

a flashlight

Replacement

While all equipment must be operated safely and according to instructions, it should also be cleaned, disinfected or sterilised and replaced in its proper storage place after every use. One use items should be disposed of (in the appropriate containers and waste management receptacles) and replaced with new items.

2.7 Monitor the casualty's condition and respond in accordance with first aid principles

When utilising appropriate first aid principles, and responding to a casualty's first aid requirements:

1. Unresponsive patients without suspected spine injury should be placed in the recovery position on their left side.

2. Patients with chest pain or difficulty breathing should NOT be walked to the ambulance.

3. Patients with suspected spine injury should be fully immobilised on a long backboard.

4. Patients with signs and symptoms of shock should have their legs elevated 8-12 inches.

5. Place the pregnant patient with hypotension on her left side.

6. Load the pregnant patient whose delivery is imminent feet first into the ambulance to allow for more room to work.

7. Use, for transporting an infant who has been involved in a motor vehicle accident, the infant's own car seat if possible. It can be secured to a stretcher with the straps. It can also serve as an immobilisation device with padding and taping.

8. Patients with head injury and no suspected spine injury should be transported in a semi sitting position at about a 45 degree angle. This reduces pressure inside the skull and risk for increased bleeding.

9. Trauma patients with multiple injuries should always be transported on the long backboard to provide full body immobilization.

10. Use discretion when moving and positioning a disabled patient. Increased communication is necessary with visually or hearing impaired patients. Take extra






care when securing patients with physical deformities. Use pillows, rolled towels, or other supports and padding to create a more comfortable position.

11. Elderly patients should be placed in a position that will be as comfortable as possible for their condition. Extra time and care with patients with conditions such as arthritis, osteoporosis, or other conditions is important to reduce risk of further injury.

Other first aid principles include managing for:

Airway obstruction

A foreign object obstructing the airway can be life threatening. The airway can either be partially or completely blocked. The casualty usually has trouble breathing and might not be able to breathe at all.

Treatment for a partially obstructed airway:

1. Call for an ambulance;

2. Encourage the casualty to cough, and to relax;

3. If coughing does not remove the blockage, bend the casualty forward and give five back slaps between the shoulder blades with the heal of your hand;

4. Apply five chest thrusts, checking after each thrust to see if the blockage has been dislodged;

5. If not successful, alternate between back slaps and chest thrusts until an ambulance arrives.

Chest thrusts are applied at the same point on the chest that is used when providing chest compressions during CPR. They are sharper and slower than CPR compressions.

Support the back of the casualty. This can be achieved by placing your other hand on the patient's back. If the patient is sitting use your other hand to support the back of the chair. Have someone stand behind to provide support. Stand against a firm surface like a wall or place your hand behind their back for support.

If chest thrusts cannot be applied continue with back blows.

If the casualty is having difficulty breathing or if the casualty is unconscious, ensure that their airway is open and clear, free from any obstruction by:

placing the heel of your hand on the casualty's forehead, and the tips of your fingers under the bony part of the jaw or use a pistol grip;

gently tilting the head back while lifting up the chin to open the airway;

opening and checking the mouth to see if there is any foreign body obstructing the airway;

removing any foreign objects in the mouth If there is no foreign material present, leave the casualty on their back.

If there is foreign material present, place the casualty in the recovery position, open and clear the airway. The recovery position minimises the risk to the patient.

Figure 11: Recovery position:






As you can see a first aider should do the following:

1. Remove glasses if the casualty is wearing them.

2. Make sure the casualty's legs are straight.

3. Place the arm that is nearest to you at right angles to the casualty's body (you are kneeling next to them).

4. Bring the other arm across the chest; hold the back of their hand against their nearest cheek.

5. With your other hand, hold the casualty's thigh that is furthest from you and pull up the knee. Make sure their foot is flat on the ground.

6. Slowly pull down on the casualty's raised knee and roll them over towards you.

7. Move the upper leg slightly so that the casualty's hip and knee are bent at right-angles. This makes sure they do not roll back onto their face.

8. Gently tilt the head back so that the airway is kept open.

If the casualty becomes unconscious or the airway is completely obstructed, commence CPR. The obstruction will be blown down by breaths or heaved out by compressions.

The Australian Resuscitation Council does not recommend the use of abdominal thrusts as there is considerable evidence of harm caused by this procedure.

External Wounds






Abrasions

This is a graze. The blood vessels that are damaged are usually capillaries and the blood oozes. The causes of these types of injuries are generally from scraping of the skin on a rough surface.

Lacerations

This is an opening of the skin and underlying tissue. Either a blunt or sharp object can cause it. A sharp object causes an incision, which has even edges. Blunt objects cause a tearing of the skin with uneven edges to the wound. The blood will be bright red and spurting or dark red and flowing, depending on whether an artery or vein has been damaged.

Puncture / Penetrating

Knives, screwdrivers, gunshots and other objects often cause these types of wounds. These injuries can cause underlying damage to arteries, veins and underlying body parts as these injuries are more notably internal, there may not be a lot of external bleeding. A puncture / penetrating injury could cause substantial internal bleeding, especially if the wound has caused serious damage to the surrounding tissue and bone.

Amputation

This is a serious injury. This injury can be a complete loss of a limb or part of a limb. Normally there is a lot of blood loss because of the severed arteries along with the loss of the body part.

Treatment for External Wounds

DRSABCD;

Apply direct pressure to the wound, squeezing the edges of the wound together if possible. Be aware if you delay using direct pressure the patient can suffer from severe shock from blood loss;

Call 000 for an ambulance. (Call First and call Fast);

Protect yourself from coming into contact with blood and fluid by using gloves, eye protection, and face mask;

If possible make casualty comfortable by sitting or lying down;

Elevate the wound unless fractured;

Inspect the wound, checking for foreign materials. If foreign material is on the surface of the wound, lightly brush off using a sterile pad or if possible wash with saline solution;

DO NOT remove foreign materials that are embedded in the wound as this may increase bleeding and cause further injury to the casualty;

Apply a clean pad over the wound;

Apply a firm bandage around the bleeding wound;

DO NOT bandage the wound too tightly as this may cut off the circulation;

DO NOT apply pressure over or on a protruding object. Apply pressure by padding around the object;






Check circulation below the wound before and after applying pad and bandage;

If bleeding does not stop, remove the bandage, leaving the pad in place. Place a second pad over the first pad and re-bandage firmly;

DO NOT remove the first pad as this may remove any clotting blood and increase bleeding.

Note: An arterial tourniquet may control life-threatening bleeding but may also cause permanent irreparable damage to a limb. Use an arterial tourniquet only as a last resort where all other methods of controlling bleeding have failed.

Internal Bleeding

Internal bleeding can be difficult to recognise, but should be suspected after the Carer gathers a good history (what's happened) and observes the casualty's signs and symptoms.

Signs and Symptoms

Anxious;

Pain, tenderness or tension over or around the affected area;

Bleeding from the ear or nose after a head injury;

Bright red frothy blood coughed up from the lungs;

Pale, cold and clammy skin;

Dark brown blood (like coffee grounds) vomited from the stomach;

Passing of urine/faeces with blood;

Rapid and shallow breathing;

May have an altered level of consciousness;

Rapid and weak pulse;

Nausea and/or vomiting;

Restless;

Visible swelling.

Treatment for internal Bleeding

DRSABCD;


A Carer cannot control internal bleeding, therefore it is important to give the following treatment:

Place the casualty on their side if unconscious.

Lay the casualty in a flat position if conscious.

Raise the casualty's legs if injuries permit.

Monitor the Airway, Breathing and Circulation (ABC).






DO NOT give any medications or alcohol.

DO NOT allow the casualty to eat or drink.

Reassure the casualty even if unconscious. Some people can still hear when unconscious.

Protect the casualty from the environment

Check for any other injuries.

Allergic Reaction (Anaphylaxis)

Anaphylaxis is a severe Allergic Reaction that can be triggered by a variety of substances and can be life threatening. The signs and symptoms of an allergic reaction usually occur rapidly and within seconds to minutes.

A person who is diagnosed with allergies that may lead to anaphylaxis, often have prescribed medication (injectable adrenaline). This injection of adrenaline is often the lifesaving factor in anaphylaxis.

Signs and Symptoms

Abdominal cramps;

Bright red skin;

Difficulty breathing;

Fast pulse.

Itching/hives:

May collapse, leading to unconsciousness;


Sudden onset of weakness;

Swelling of the throat and tongue;

The airway may become blocked leading to respiratory arrest;

Wheezing.

Treatment for Allergic Reactions

DRSABCD

Call 000 for an ambulance. (Call First and call Fast)

If the casualty has his or her own medications, (injectable adrenaline), assist the casualty to administer the medication as per the doctor's instructions.

Rest and reassure the casualty.

Monitor the casualty's vital signs, Airway, Breathing and Circulation.

Be prepared to carry out CPR.

Bites and Stings






Bites and stings from venomous snakes and spiders can be fatal due to the venom poison and the effects it has on the nervous and respiratory system. The venom can cause an allergic reaction. Most of the bites and stings occur to the arms or legs of a casualty. If the casualty receives the correct first aid treatment it is unlikely that the casualty will die.

Snake Bites

Australia has some of the deadliest snakes in the world. Life threatening effects may not be seen for several hours. With large amounts of venom, symptoms can appear within minutes, especially in children.

Signs and Symptoms

Abdominal pain;

Fitting;

Difficulty breathing;

Headache;

Breathing stops (respiratory arrest);


Difficulty speaking and/or swallowing;

Loss of consciousness;

Dizziness and blurred vision;

Paired fang marks or a single mark/scratch;

Facial and limb weakness and/or paralysis;

The bite may be painless, without any visible marks.

Treatment for Snake Bites

DRSABCD;


Lie the casualty down;

Apply pressure to the bite site;

Apply a compression bandage to the affected limb. The pressure bandage is best applied initially over the bite site, then extending up the affected limb;

Splint the limb, including joints on either side of the bite;

Check the fingers/toes for adequate circulation;

Keep the casualty calm and at rest;

Mark the bite site on the bandage;

Monitor the casualty's pulse, respirations and levels of consciousness;

DO NOT cut the bite;

DO NOT use an arterial tourniquet;






DO NOT wash or suck the bite;

DO NOT remove bandages or splints;

DO NOT allow the casualty to walk or move the affected limb, even if the bite is on the hand get help to come to the casualty.






Figure 12: Applying a pressure immobilisation bandage






Tick Bite

In Australia, although there are a variety of ticks, it is only the scrub tick that will seriously affect people.

Ticks can be found anywhere on the body but are usually located in hairy areas, skin folds and crevices.

Signs and Symptoms

Blurred vision;

Breathing difficulties;

Lethargy;

Localised pain;

Muscle weakness (especially in children);

Paralysis (especially in children);

Swallowing difficulties;

Unsteady walk.

Allergic reactions rarely occur but when they do, the signs and symptoms are:

An itchy rash could appear;

The face and throat may swell;

The casualty may have breathing difficulties;

Bright red skin;

Rapid pulse;

The casualty can collapse, leading to unconsciousness.

Treatment for Tick Bites

DO NOT cut or squeeze the tick out;

Slide the open blades of sharp pointed tweezers on each side of the tick and lever it upwards;

Check the casualty's entire body, including the ears, hair and skin folds for further ticks;

Seek medical advice for any further treatment;

If the casualty has a history of allergic reaction or signs and symptoms of an allergic reaction;


Be prepared to carry out CPR;

Use a pressure bandage and splint the same as a snake bite






Red-back Spider

A Red-back spider bite may threaten the life of a child or a sick elderly person, but is rarely serious for an adult. The Treatment for the bite is also different than for a Funnel Web.

Signs and Symptoms

Immediate pain to the bite site.

Bite site becomes red, hot and swollen.

Intense localised pain.

Pain increases and spreads.

Nausea and/or vomiting.

Stomach pain.

Profuse sweating.

Swollen groin and armpit glands.

Treatment for Red-back Spiders

Rest and reassure casualty

Call 000 ambulance

Ice pack over bite area

Monitor Airway, Breathing, Circulation

DO NOT use the Pressure Immobilisation technique with Red Back Spider Bite as the poison spreads slowly and the pressure will increase pain

Funnel Web Spider

All spiders have fangs, but the only spider that is an immediate threat to life in Australia, is the Funnel Web. If signs and/or symptoms occur from any spider bite, call 000 for an ambulance.

Any bite from a large dark spider should be treated as if it is a dangerous spider bite and immediate Treatment should be provide

Signs and Symptoms

Pain to the bite site.

Tingling around the mouth.

Copious secretions of saliva.

Profuse sweating.

Stomach pain.







Confusion.

Breathing difficulties.

Loss of consciousness (Usually a sudden onset)

Treatment for Funnel Web Spider

DRSABCD


Lie the casualty down.

Apply pressure to the bite site.

Apply a compression bandage to the affected limb. The pressure bandage is best applied initially over the bite site, then extending up the affected limb as far as possible.

Splint the limb, including joints on either side of the bite.

Check fingers/toes for adequate circulation.

Keep the casualty calm and at rest.

Mark the bite site on the bandage.

Monitor the casualty's pulse, respirations and levels of consciousness.

DO NOT allow the casualty to walk or move the affected limb, even if the bite is on the hand; get help to come to the casualty.

DO NOT cut the bite.

DO NOT remove bandages or splints.

DO NOT use an arterial tourniquet.

DO NOT wash or suck the bite.

Bee, Wasp and Ant Sting

Introduction

These painful stings are a serious problem only for persons allergic to the venom. In particular, sting from several bee and ant species may cause severe allergic reactions.

Most wasp and ant stings, while painful, seldom cause serious problems.

Recognition

Symptoms and signs may include:

Immediate and intense local pain;

Local redness and swelling.

In allergic persons:

Itchy rash;

Facial swelling;

Wheezing and difficulty in breathing;

Collapse.






Note:

In an allergic person dangerous effects can occur within minutes. If stung in or around the mouth local swelling can result in airway obstruction and urgent medical care is required.

Treatment for Bee, Wasp and Ant Sting

Scrape a bee sting off sideways with a finger nail or sharp edge. The sac must not be squeezed or pulled because this will inject more venom.

Apply an ice compress to relieve pain

Commence resuscitation if necessary, following the Australian Resuscitation Council Basic Life Flow Chart.

If the victim has a history or signs of allergy:

Use the Pressure Immobilisation Technique immediately

Call the Ambulance urgently (Call First Call fast);

Assist casualty with medication if they have an EpiPen with Adrenaline

EpiPen

Using the EpiPen Auto-injector device (adrenaline, epinephrine) to treat severe allergies.

Adrenaline (epinephrine) is a natural hormone released in response to stress. It is a natural "antidote" to the chemicals released during severe allergic reactions triggered by drug allergy, food allergy or insect allergy. It is destroyed by enzymes in the stomach, and so needs to be injected. When injected, it rapidly reverses the effects of a severe allergic reaction by reducing throat swelling, opening the airways, and maintaining blood pressure.

Use of adrenaline for treating anaphylaxis is First Aid.

Note: Please make sure that you know how to use the Epi-Pen ahead of time. Read the instructions and aware of how to operate it and where to make the injection on the casualty.






Figure 13: Design and features of Epi-Pen® Auto-Injector






Figure 14: EpiPen® User Guide






Fire ants - Why are they a problem?

Fire Ants (Solenopsis invicta) are a serious insect pest in Australia. They have the potential to destroy our outdoor lifestyle, environment and agricultural production.

Social impacts

Fire ants are a social menace because of their sting. Encounters with fire ants may involve dozens of ants that may move quickly and remain undetected as they crawl up your leg. By the time they sting, there may be tens or hundreds of ants on your body, and they tend to all sting at once.

About the sting

Fire ants have a sting in their tail, similar to wasp and bees. However, unlike bees, fire ants can sting repeatedly. Stings from fire ants can cause a painful, burning and itching sensation, which can last for an hour. The sensation produced by multiple stings is that the body is on fire; hence, the name fire ant.

First aid Treatment for Fire Ants

Apply a cold compress or ice as soon as possible to the affected areas to reduce swelling and relieve pain.

After a few hours (or even a day or two), a small blister or pustule can form at the site of each sting. These may become very itchy and can take up to 10 days to heal. To prevent secondary infection, wash the blisters gently with soap and water and be careful not to break them.

Figure 15: Fire ant and it’s bite.






Marine Stingers

Tropical Jelly Fish

There are many types of jellyfish in the ocean. In Australia two of these are, the Chironex Box Jellyfish and Irukandji are classed as dangerous tropic jellyfish.

Irukandji Jellyfish

Irukandji Jellyfish are found in Australian tropical waters north of Agnes Waters (just south of Gladstone) in Queensland around to Western Australia south to Exmouth. However species are also found out to sea, and on the Great Barrier Reef. At times they may occur in epidemic proportions close to shore. The Irukandji Jellyfish is a small transparent box jellyfish 1-2 cm in diameter, usually never seen, some newly described species may be larger (up to 10 cm).

Signs and Symptoms

A sting from Irukandji Jellyfish typically causes an initial minor stinging sensation to the skin followed 20 to 40 minutes later by severe generalised muscle pain, headache, vomiting and sweating. The sting from some species cause very high blood pressure that may be life threatening. These symptoms are referred to as Irukandji Jellyfish Syndrome.

Figure 16: Irukandji Jellyfish






Chironex Box Jellyfish

Chironex Box Jellyfish is more commonly known as the ―Box Jellyfish‖. It is found in shallow Australian tropical waters north of Agnes Waters (just south of Gladstone) in Queensland around to Western Australia south to Exmouth. Stings from the Box Jellyfish have been recorded predominantly in coastal areas. The Box Jellyfish is a large but almost transparent jellyfish with a box shaped bell (with four corners) up to 30 cm diameter, Up to 15 ribbon like tentacles on each corner (up to 60 tentacles on each jellyfish. These tentacles may contract to 10 cm or extend to about 3 metres in length.

Skin Markings from various jellyfish to look out for:

An inconspicuous mark which may develop a red flare ;

An inconspicuous mark with goose pimples or an orange peel appearance;

An inconspicuous mark with profuse sweating only at the sting site;

An irregularly shaped blotchy wheel;

White wheals with surrounding red flare;

Multiple whip-like wheals on the skin;

Adherent tentacles on the skin;

A ‗frosted‘ ladder pattern‘ in the sting marks on the skin may be seen in the first few minutes;

Later Blistering or darkening of the sting pattern.

Signs and Symptoms of severe stings

Difficulty or cessation of breathing;

Cardiac arrest;

Severe pain;

Restlessness and irrational behaviour;

Nausea and vomiting, headache;

Collapse;

Profuse sweating only in the sting area.






Treatment for Irukandji Jellyfish and Chironex Box Jellyfish

Remove the casualty from the water;

Call for help from Lifesaver / Lifeguard or dial ―000‖ for Ambulance;

Pour Vinegar over sting area (flood the sting area in vinegar);

Start CPR if required;

Monitor vital signs and symptoms until Ambulance arrives.

The vinegar cannot relieve the pain that is already present. Other agents are promoted for pain relief in jellyfish stings BUT these should only be used after vinegar for the Box jellyfish or Irukandji stings or for unknown tropical stings

Treatment for Non-tropical Bluebottle stings

Pick off any adherent tentacles with fingers (this is shown as not harmful to the rescuer);

Rinse stung area well with seawater to remove invisible stinging cells;

Place the casualty‘s stung area in hot water (no hotter then what the rescuer can comfortably tolerate);

If local pain is unrelieved by heat, or if hot water is not available the application of cold packs or wrapped ice may be effective.

Figure 17: Other Jellyfish around Australia

Name Common name Location

Physalia

Bluebottle

Portuguese man-o-war

Pacific man-o-war

Australia wide and in most warm ocean waters

Catostylus Blubber Worldwide

Carybdea Rastoni Jimble

Australia wide but more common in southern areas and Western Australia

Cynea Hair Jelly, Snottie, Lions Mane

Worldwide

Tamoya Fire Jelly, Morbakka, Moreton Bay Stinger

Tropical Australian waters, all of Queensland and northern New South Wales coast – often an

Pelegia Little Mauve Stinger






open water jellyfish.

Treatment for Other Jellyfish

If casualty has any difficulties breathing phone ―000‖ (Phone FIRST phone FAST);

Put on Gloves if available;

Wash area with sea water;

Remove any adhering tentacles;

Apply ice pack for 10 minutes;

Re Apply ice pack if skin pain persists;

Call for help from Lifesaver / Lifeguard or dial ―000‖ for Ambulance if skin pain persists.

Note: In areas where dangerous tropical jellyfish are prevalent (i.e. Box jellyfish or Irukandji), if the species causing the sting cannot be clearly be identified as harmless, it is safer to treat casualty with vinegar.

Sea Snakes

Sea snakes are found in Northern Australian waters and are generally not aggressive, except during mating seasons. The sea snake bite looks the same as for a land snake.

A casualty can suffer from respiratory paralysis within 30 minutes.

Signs and Symptoms

A spot of blood visible at the bite site;

A single bite mark or two bite marks;

Numbness to the lips and tongue;

Bite can be painless;

Nausea and vomiting;

Progressive weakness of the respiratory muscles leading to respiratory arrest.

Treatment for Sea Snakes

DRSABCD;


Rest and reassure the casualty;

Monitor the casualty‘s ABCs;

Use pressure bandages and splints (refer to snake bite);

Be prepared to carry out CPR.

Note: Despite being unable to move, the casualty may be able to hear you speaking to them.






Fish Stings

Numerous types of fish can cause fish stings. Some of the more common ones are the Stonefish (seawater), Bullrout (fresh water) and the Stingray. Handling these fish can be potentially dangerous. The Stingray has a powerful tail with a barb and can inflict a serious injury to a person. These fish have excellent camouflage capabilities and stings usually occur when a person stands on them.

Signs and Symptoms

Intense pain to the site;

swelling;

an open wound;

bleeding;

panic and irrational behaviour due to pain.

Treatment for fish stings

Place the injured site in hot water (at a temperature the Carer can tolerate);

DO NOT use a pressure bandage;

Stop any bleeding;

monitor the casualty‘s vital signs, pulse, respirations and the level of consciousness;

allergic reaction;

Seek medical assistance if required.

Poisoning

Poisoning can be either accidental or intentional. Poisonous substances can enter the body via:

Absorption - through the skin;

Ingestion – swallowing;

Inhalation – breathing;

Injection - drug abuse, bites via snake / spider.

Signs and Symptoms

Burns to the mouth and airway;

Cardiac arrest;

Headaches and blurred vision;


Respiratory arrest;

Seizures.






Treatment for Poisoning

DRSABCD

Call 131126 for Poisons Information Centre. They will call an ambulance for you. (Call First and call Fast)

Be careful not to become contaminated yourself.

If a substance is swallowed give small sips of milk.

DO NOT induce vomiting.

If a substance is absorbed, protect yourself using gloves etc.

Wash the substance off.

Remove the affected clothing. DO NOT remove the clothing over the casualty‘s head.

If possible, ascertain the type of poison and follow Treatment as directed on the label.


Monitor the vital signs, pulse, respirations and levels of consciousness.

Be prepared to carry out CPR using a CPR mask.

Drug overdose

An overdose occurs when an excessive amount of a drug or poison is taken, leading to a toxic (poisonous) effect on the body. There are many drugs that can cause harm when too much is taken including alcohol, prescription drugs, over-the-counter drugs, illegal drugs and some herbal remedies.

Always call an ambulance if a drug overdose is known or suspected. Many overdoses DO NOT cause permanent damage and most people make a full recovery. Some overdoses can cause damage to certain organs such as the liver and kidneys. If the overdose was an attempt at self-harm, this requires careful ongoing treatment.

The symptoms vary widely

A wide range of symptoms can occur and everyone responds differently. Symptoms depend on the drug, the amount taken and the person‘s bodily constitution. Some poisons are weak and cause minor distress, while others are very strong and can cause more serious problems and possibly death. General symptoms of a drug overdose may include:

Nausea

Vomiting

Dizziness

Fitting

Drowsiness

Confusion

Coma

Breathing problems.






Reasons for overdose

The main reasons for taking an overdose include:

Accidental - a person takes the wrong drug or combination of drugs, in the wrong amount or at the wrong time, not knowing that it could cause them harm.

Intentional misuse - a person takes an overdose to get ‗high‘ or to deliberately inflict self-harm. The latter may be a cry for help or a suicide attempt. This may be caused by relationship problems with family and friends. On the other hand, the person may be suffering from a mental health condition such as depression or schizophrenia.

Risk factors

People of any age may take a drug overdose, though certain groups are at increased risk including:

Young adults

Middle aged people

Women, who are more likely to overdose than men;

Other risk factors include:

The risk is increased when more than one drug is taken at the same time;

The risk is increased when the body is not used to taking a certain drug.

First aid Treatment for Drug Overdose

If you think someone has taken an overdose, suggestions include:

Call the Poisons Information Centre on 131 126, even if the person seems okay. The centre is open 24 hours a day, everyday; Australia-wide;

Call 000 and ask for an ambulance. Ask for the police if the person is violent;

DO NOT try to make them vomit;

Bring the pill containers to hospital.

Stroke

Stroke (previously known as Cerebrovascular Accident) occurs when the supply of blood to part of the brain is suddenly disrupted. Blood is carried to the brain by the blood vessels called arteries. Blood may stop moving because the blood vessel is blocked by a blood clot or plaque or because the vessels have ruptured.

When the blood flow to a part of the brain is inadequate, that part cannot get oxygen it need and the brain cells in the area die and the brain becomes permanently damaged. Brain cells usually die within an hour of the onset of a stroke but may survive up to a few hours. Areas of the brain where the blood supply is reduced but not completely cut off can survive some hours. These brain cells can either recover or die depending on what happens in the minutes or hours the follow

Stroke is the second most common cause of death after heart disease. There is good evidence that the outcome can be improved through the urgent admission to hospital and specialized care highlighting the need for early recognition and management.






Recognition

Some people experience a mini stroke (Transient Ischaemic Attack or TIA) with the symptoms and signs generally not lasting longer the 60 minutes. However, the risk of stroke for people with TIA may be high as 28% within 90 days. Recognition and early assessment are therefore vital in preventing the progression form TIA to stroke.

Warning Signs

Stroke is a life threatening emergency and most people who suffer a stroke will experience some warning signs. Weakness in the face or arms and speech difficulties are the most common signs of stroke. Even if the warning signs have resolved it is still important to seek urgent medical assessment and management.

The Warning signs of stroke may include one or more of these symptoms:

Weakness, numbness or paralysis of the face , arm or leg on either side or both sides of the body;

Difficulty speaking;

Difficulty swallowing;

Dizziness, loss of balance or an unexplained fall;

Loss of vision, sudden blurred or decreased vision in one or both eyes;

Headache, usually severe and of abrupt or unexplained change in the pattern of headaches;

Drowsiness

FAST is a simple way for remembering the signs of stroke

Facial weakness - Can the person smile? Has their mouth or eye dropped?

Arm weakness - Can the person raise both arms?

Speech difficulty - Can the person speak clearly and understand what you say?

Time to act fast - Seek medical attention immediately (Dial 000 – call ambulance)

Treatment for Stroke

Call an ambulance (Dial 000) and stay with the casualty

If the victim is conscious provide reassurance, make the casualty comfortable and DO NOT give anything to eat or drink.

Stay with the casualty until ambulance arrives

Administer oxygen if trained to do so

If the person becomes unconscious commence DRSABCD

Environmental Conditions






When temperatures change there is a process your body goes through to adjust to these environmental changes. This happens when your skin feels that it is colder or hotter and sends messages through nervous system to the brain. The brain then adjusts different body systems to help control your body temperature.

Heat Exhaustion

Heat exhaustion is caused by exertion accompanied by heat and high exhaustion.

Signs and Symptoms

Dizziness and headaches

Hot, dry skin;

Nausea;

Pale, clammy skin;

Profuse sweating;

Rapid pulse and respirations;

Thirst;

Weakness/muscle cramps

Treatment for heat exhaustion

DRSABCD

Move the casualty to a cool, shaded area;

Rest and reassure the casualty;

remove outer clothing;

Give frequent small sips of water;

Sponge the casualty down with cool water;

Fan the casualty;

DO NOT cause shivering/goose bumps;

Apply ice compresses to the neck, groin and armpits;

Monitor the casualty‘s ABCs and level of consciousness;

If the casualty becomes unconscious then check DRSABCD;

Call 000 for the ambulance (Call First and Call Fast) if casualty condition worsens.

Heat Stroke

The normal body temperature is approximately 36.5 degrees Celsius. The brain controls and regulates the body's temperature. When the brain is overloaded or not functioning correctly, the body's temperature can rise. Hyperthermia is a continuing process, body temperature rises and can lead to heat cramp followed by heat exhaustion and then heat stroke if untreated.






Figure 18: Heat exhaustion and Heat stroke

Heat Stroke can be caused by:

Hot climates;

Infection and illnesses;

Insufficient fluid intake;

Overdressing for the climate;

Physical exercise.

Signs and Symptoms

Anxiety;

Confusion and feeling faint;

Hot dry skin;

Sweating ceased;

Irrational behaviour;

May collapse;

Possible seizures;

Respiratory and cardiac arrest;

Strong bounding pulse;

Unconsciousness;

Visual problems.

Treatment for Heat Stroke







Move the casualty to the shade;

Small, frequent sips of water to drink;

Cool with ice compresses;

Monitor Airway, Breathing, and Circulation.

Hypothermia

Hypothermia is when the body's core temperature is less than 35 degrees Celsius. Our normal body core temperature is approximately 36.5 degrees Celsius.

Some of the causes of Hypothermia are:

Elderly person may have fallen and not been found for some time;

Immersion in cold water;

Inadequate clothing for cold climates;

Prolonged exposure to cold climates.

If a casualty‘s core temperature drops to 25 degrees Celsius, their heart and lungs would most likely have ceased functioning.

Signs and Symptoms

Cold to touch;

Confusion and clumsiness;

Exhaustion;

Irrational behaviour;

Shivering;

Slow pulse and breathing;

Slurred speech;

Unconsciousness;

Possible death.

Treatment for Hypothermia

Be prepared to carry out DRSABCD in severe cases;


Cover with blankets, warm clothing etc;

Give sips of warm sweet drink;

Monitor the casualty's vital signs: pulse, respirations and levels of consciousness;

Remove the casualty from the cold to shelter;

Remove wet clothing and gently dry the casualty;

Share a sleeping bag with a companion;

DO NOT give the casualty alcohol (this restricts heat production);

DO NOT move the casualty unnecessarily until recovered;






DO NOT re-warm with direct heat;

DO NOT rub or massage the casualty.

Note: When there is a drop in core temperature, there is also a drop in the body‘s metabolic rate. The body therefore requires less oxygen. If CPR needs to be performed the casualty has an increased chance of survival once they are in hospital and have been re-warmed. DO NOT stop doing CPR.

Figure 19: Hypothermia






Frost Bite

Frostbite is the result of tissue freezing, the forming of ice crystals and the blocking of small blood vessels. The face, nose, ears, fingers and toes are the most commonly affected areas of the body because they are the parts that are exposed to the cold conditions.

Figure 20: Frostbite

Signs and Symptoms

Cold to touch;

Loss to sensation;

Numbness;

Pain whilst rewarming;

White or mottled blue skin.






Treatment for Frostbite

DRSABCD;


Place casualty in a warm area;

Protect the casualty from the cold;

Remove any wet clothing;

Treat hypothermia before frostbite;

DO NOT allow refreezing of the affected part;

DO NOT rub or massage the affected area as this can cause tissue damage;

DO NOT break blisters;

DO NOT give the casualty alcohol.

Head Injuries

A head injury is any injury to the head or face that involves the brain, internally or externally. An injury to the head can lead to a loss of consciousness, damage to the brain, eyes, ears, teeth, airway, mouth or jaw. A severe head injury can lead to irreversible brain damage and/or death. Once a head injury has been sustained, problems associated with the injury may not develop for several hours or days after the injury has occurred. The extent of the injury is determined by the amount of bleeding and/or swelling inside the brain/skull. It is therefore necessary to treat all head injuries as serious and seek ambulance assistance (000).

Head Injury Symptoms & Signs

The signs and symptoms of a head injury may occur immediately or develop slowly over several hours. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised (called a concussion) or damaged. The head may look fine, but complications could result from bleeding inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume that there is also injury to the spinal cord.

The following symptoms suggest a more serious head injury that requires emergency medical treatment:

Loss of consciousness, confusion, or drowsiness;

Low breathing rate or drop in blood pressure;

Convulsions;

Fracture in the skull or face, facial bruising, swelling at the site of the injury, or scalp wound;

Fluid drainage from nose, mouth, or ears (may be clear or bloody);

Severe headache;






Initial improvement followed by worsening symptoms;

Irritability (especially in children), personality changes, or unusual behaviour;

Restlessness, clumsiness, or lack of coordination;

Slurred speech or blurred vision;

Inability to move one or more of your limbs;

Stiff neck or vomiting;

Pupil changes;

Inability to hear, see, taste, or smell.

Treatment for Head injury


A victim who has sustained a head injury, whether or not there has been loss of consciousness or altered consciousness, should be assessed by a health care professional.

DRSABCD if unconscious (ARC Guideline 4)

Always suspect a spinal injury;

Protect the neck from movement (maintain in line spinal immobilisation) whilst maintaining a clear airway (ARC Guideline 9.1.6).

Identify and control any significant bleeding with direct pressure if possible (ARC Guideline 9.1.1).

Note: only apply a cervical collar if trained to do so.

If the casualty is unconscious and has blood or fluid coming from the ear, the casualty is to be placed on to the side with the affected ear facing down and a pad placed over the affected ear;

Monitor the casualty‘s pulse, respirations and level of consciousness closely for any deterioration;

Complete the secondary survey and treat any subsequent injuries.

Note: If a casualty has a skull fracture, DO NOT place any pressure to this area, as this can put direct pressure onto the brain and cause brain damage.






Skull Fracture: First Aid

1. Check the airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. Avoid moving the casualty (unless absolutely necessary) until medical help arrives. Instruct someone to call 000 for medical assistance.

3. If the casualty must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. DO NOT allow the head to bend forward or backward, or to twist or turn.

4. Carefully check the site of injury, but DO NOT probe in or around the site with a foreign object. It can be difficult to ascertain accurately if the skull is fractured or depressed (dented in) at the site of injury.

5. If bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.

6. If blood soaks through, DO NOT remove the original cloth. Rather, apply additional cloths on top, and continue to apply pressure.

7. If the casualty is vomiting, stabilize the head and neck, and carefully turn the casualty to the side to prevent choking on vomit.

8. If the casualty is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if he does not think medical assistance is necessary).






Figure 21: Management of foreign body and obstruction (choking)

(as per http://www.resus.org.au – accessed 28/11/2012)

http://www.resus.org.au/






Nosebleeds

The blood vessels in the septum (the firm tissue between the nostrils, which divides the nose into two halves) can break fairly easily and bleed. The most common area for a nosebleed is near the front of the nose, but occasionally the bleeding comes from the back, near the throat. Bleeding from the nose is common in children and is usually not severe. If the bleeding is very heavy, or does not stop with simple measures, take your child to a doctor or hospital emergency department.

Symptoms

The symptoms of a nosebleed include:

Bleeding from either one or both nostrils;

A sensation of flowing liquid at the back of the throat;

The urge to swallow frequently.

A range of causes

A nosebleed can be caused by a range of factors, including:

Fragile blood vessels that bleed easily, perhaps in warm dry air or after exercise;

An infection of the nose lining, sinuses or adenoids;

An allergy that causes hay fever or coughing;

Bumps or falls;

An object that has been pushed up the nostril;

Nose picking;

Rarely, a bleeding or clotting problem.

First aid treatment for Nose Bleed

Suggestions to treat a nosebleed include:

Reassure the child, as crying can bring more blood to the face and make the bleeding worse.

Sit the child up straight.

Ask the child to lean forward.

Use your thumb and forefinger and firmly squeeze the soft part of the nose - just above the nostrils - and hold for five to 10 minutes.

Encourage the child to breathe through the mouth while the nostrils are pinched.

Sometimes, it may help to place a cold cloth or cold pack over the forehead or bridge of the nose.

Release your grip slowly to see if the bleeding has stopped.






Tell the child not to sniff or blow their nose for at least 15 minutes and not to pick their nose for the rest of the day. (Having a nose full of clotted blood is unpleasant, and children will find it difficult to avoid sniffing or nose blowing for a few hours. Fifteen minutes will at least give some time for the clot to stabilise.)

Seek medical advice

You should take your child to the doctor or hospital emergency department if the bleeding doesn‘t stop after simple first aid treatment. The cause for ongoing bleeding needs to be found and treated.

Frequent nosebleeds

If your child keeps having nosebleeds, see your doctor for investigation and treatment. Bleeding that happens a lot can be treated by cautery (sealing) of the blood vessels that may be causing the problem. Cauterisation blocks the vessels, so they can no longer break open. If an ongoing infection is the cause, your doctor may prescribe an antibiotic ointment or medicine. Very occasionally, a child loses so much blood that it causes other health problems, such as anaemia.

Where to get help

Your doctor;

Nurse on Call Tel. 1300 606 024 - for expert health information and advice (24 hours, 7 days);

Hospital emergency department.

Things to remember

Bleeding from the nose is common in children and is usually not a sign of any underlying problem;

First aid treatment includes pinching the nostrils until the bleeding stops;

If the nosebleed won‘t stop, take your child to a doctor or hospital emergency department.

Teeth Injury

So, your face has come into contact with… a ball…, a bat…., the ground…, the car seat…, some bit of your friend, and you now have a gap in your smile! A tooth has been knocked out. If it's a baby tooth, that's not a big deal, but if it's a permanent tooth then you need to find it because you could just be able to put it right back where it came from.

Alert!

When teeth are damaged or dislodged, follow the first aid steps in this topic and get immediate dental care. Any injury which was bad enough to knock a tooth out may have also cracked the bone around the tooth. It is important to see a dentist so this can be checked.

Baby teeth (deciduous teeth)

If a baby tooth is knocked out, DO NOT place the tooth back into the socket.

You don't really need to find it - unless you want to save it for the tooth fairy!






Baby teeth which have been replaced tend to get stuck to the jaw bone, and there can be problems when it is time for the tooth to come out to make way for permanent teeth.

It is still important to see a dentist to make sure no other damage has been done.

Permanent teeth

If a permanent tooth is knocked out, it should be replaced into the socket immediately. The tooth has an excellent chance of living, but the chances of it living get worse with every minute that the tooth is out of its socket.

What to do

DO NOT allow the tooth to dry out.

DO NOT scrape or rub the root surface.

If the tooth is clean, immediately put it back into the socket and hold it there firmly with your finger.

If it is dirty, and if the person is calm enough, get him to clean the tooth with saliva (spit).

If he cannot clean the tooth, it is better to rinse it briefly with milk than water

DO NOT rinse the tooth in water for any longer than 1 to 2 seconds

Then put it back into the socket.

Keep holding the tooth in place with fingers, or press aluminium foil over the replaced tooth and the teeth near it. Or get the person to bite down on a soft cloth pad (gauze or a clean handkerchief) to hold the tooth in position. This also helps stop bleeding and reduces pain.

Get immediate dental treatment.

What to do if it cannot be put into the socket

Completely cover the tooth in milk, or wrap it in some plastic wrap, to stop it drying out

Get immediate dental treatment.

What to do if a tooth cannot be found

Have a careful search of the surrounding ground, the person's mouth and their clothes.

If the tooth cannot be found, still get immediate dental treatment, as there could be other damage to the jaw.

When you're a kid you get used to losing teeth and may even look forward to losing them (the tooth fairy again!)

As you get older, the last thing you want to do is lose any teeth, so try to avoid doing so. Wear a mouth guard when playing sports that include body contact or balls. Look after that great smile!

For adults - if your private dentist is not available, contact your local Public Hospital or Private Doctor Overview and Considerations with Fractured and Dislocated Jaw






A broken or dislocated jaw usually heals completely after treatment. Recurrence of a dislocated jaw is common. Complications may include:

Airway obstruction

Bleeding

Aspiration of foreign material (such as blood or food) into the lungs

Infection of the jaw or face

Recurrent dislocated jaw

Chronic temporal-mandibular joint problems (TMJ)

Difficulty talking (temporary)

Difficulty eating (temporary)

Imperfect closure (malocclusion) of the teeth

Signs and Symptoms

Symptoms of a dislocated jaw include:

Pain in the face or jaw; located in front of the ear on the affected side/s, worse with movement;

Inability to close the mouth;

Drooling because of inability to close the mouth;

Difficulty speaking;

Jaw may protrude forward;

Teeth may not align normally;

Bite feels ―off‖ or crooked.






Symptoms of a fractured (broken) jaw include:

Jaw tenderness or pain, worse with biting or chewing

Jaw stiffness Difficulty opening the mouth widely

Severe fracture may limit any movement of the jaw

Lump or abnormal appearance of the cheek or jaw

Numbness of the face (particularly the lower lip)

Facial swelling;

Facial bruising;

Loose or damaged teeth;

Bleeding from the mouth.

First Aid Treatment for Fractured and Dislocated Jaw

A broken or dislocated jaw is an acute condition that requires prompt examination by a health care provider because of the risk of breathing difficulty or profuse bleeding. A tube may need to be inserted into the airway (endotracheal tube) if the patient is having trouble breathing or bleeding profusely, or if facial swelling is severe and breathing difficulty is likely to develop. The jaw should be supported during transportation to the emergency room. This is most easily accomplished by holding the jaw gently in the hands.

Spinal Injury

Spinal injury must be considered in the management of all accident casualties. Following an injury to the spinal cord, the casualty may already be suffering with paraplegia or quadriplegic so extreme care must be taken in treating and moving the casualty to minimise further damage to the casualty's spinal cord.

The Treatment of the Airway, Breathing and Circulation (ABC) always takes precedence in the Treatment of a casualty with a suspected spinal injury.

Spinal injuries must be considered when the casualty has been involved in:

A diving accident into shallow water;

A dumping accident in the surf;

A fall from a height;

A sporting accident;

A motor vehicle/cycle accident;

Any accident where the casualty is unconscious or has been unconscious.

Spinal injuries can occur in different areas of the spine.






Spinal column

The segment of the spinal cord at which the damage occurs determines which parts of the body are affected. Damage at one segment will affect function at that segment and segments below it.

Figure 22: Spinal column.

Neck

Chest

Lower back

Tailbone

Signs and Symptoms

History of trauma;

Pulse can be irregular, weak, fast or slow;

The casualty can be pale, cold and sweaty;






The casualty may be unconscious or have an altered level of consciousness;

The casualty may complain of pain or an unusual sensation at or near the site of the injury;

The casualty may have difficulty breathing;

The casualty may have pins and needles to the hands and/or feet;

There may be a loss of movement to the limbs;

A male casualty may have a priapism (erection).

Treatment for Spinal Injury

DRSABCD. Always suspect a spinal injury.


Airway management always takes precedence over a suspected spinal injury.

Handle the casualty gently with no twisting and minimal head and neck movement.

Support the casualty's head and neck at all times.

Keep the casualty‘s head, neck and spine in alignment especially when placing casualty into the side position.

Use bystanders to assist in logrolling the casualty, supporting their head and neck at all times.

Monitor the casualty's pulse, respirations and level of consciousness.

DO NOT move the casualty unnecessarily.

Prevent heat loss by using a blanket if necessary.

Complete the secondary survey and treat any subsequent injuries.

Note: If Rescue Breaths are required it is preferable to use jaw thrusts to open the airway, as head tilt may increase any injury






Concussion

Concussion is a temporary loss of consciousness resulting from a head injury, followed by a rapid recovery. Casualties who subsequently have varying levels of consciousness are suffering from a more serious injury and require urgent medical assistance.

Signs and Symptoms

History of an injury;

A temporary loss of memory;

A temporary loss or decreased level of consciousness;

Anxiety;

Can have headaches;


Treatment for concussion

DRSABCD;

Call 000 for an ambulance (Call First and call Fast);

Reassure the casualty;

Complete the secondary survey and treat any subsequent injuries;

Monitor the casualty‘s pulse, respirations and level of consciousness.

Eye Injuries

The eye can be easily damaged. It is extremely important that the correct treatment is applied to the eye. An eye injury that has had the incorrect Treatment can result in irreversible eye damage.

Eye injuries can be sustained in a many ways. Examples include injuries from blunt objects, penetrating objects, foreign bodies, welder's flash, chemical or heat burns and ultra violet radiation (sun).

Signs and Symptoms

Bleeding into/from the eye;

Foreign substances in the eye such as sand, grit, dirt;

Inability to open the eye due to light or pain;

Object penetrating the eye;

Pain to the eye;

Redness of the eye;

Signs and symptoms of shock;

Swelling around the eye;

Watery eyes






Treatment for Eye Injury

DRSABCD;


Always explain what you are doing to the casualty;

Tell the casualty not to rub their eyes;

Reassure the casualty and sit/lay the casualty down away from bright lights or sunlight;

Ask the casualty to remove any contact lenses;

Ensure you irrigate under the eyelids;

If the eye injury is serious, lay the casualty down with head and shoulders slightly raised;

If the injury is caused by chemical or heat burns, irrigate the eye with cool clean water for approximately 20 minutes;

If the injury is minor (e.g. dirt, dust) gently wash with cool clean water;

If there is an object penetrating the eye, place padding around the object. This is to keep the eye from moving;

Pad both eyes to help reduce eye movement;

DO NOT apply pressure to the actual object;

DO NOT place any pressure on the casualty's eyes;

DO NOT remove any penetrating objects.

Note: When removing minor foreign bodies from the eye (e.g. dirt, dust, etc); only remove the foreign body if it is able to be washed out with gentle washing with cool water.

Chest Injuries

Chest injuries can be life threatening, especially if they involve an underlying organ such as the heart, lungs, major arteries and/or veins. These injuries are not always visible or obvious and a thorough examination is required. The casualty can deteriorate quickly, so they must be constantly monitored.

Sucking Chest Wound

This is where air and/or blood are getting into the chest cavity putting pressure on the lung and in more severe cases the heart. This type of injury can cause the lung to collapse resulting in breathing difficulties. These injuries can be caused from motor vehicle accidents, blunt or penetrating injury such as a gunshot/stabbing or even fractured ribs.

Fractured Ribs

The casualty with fractured ribs can be in significant distress and pain. This type of injury can reduce the effectiveness of breathing. In more serious cases a fractured rib may puncture a lung. This results in the air from the lung entering the chest cavity.






Flail Segment

This is when two or more adjacent ribs are fractured in two or more places. The affected area breaks away from the rib cage and moves in the opposite direction (paradoxical breathing) to the rest of the rib cage during inspiration and expiration. Generally there is an associated collapsed lung (pneumothorax).

Figure 23: Penetrating Chest wound

If wound is open, apply plastic or a non-stick pad; taped on three sides only leaving bottom side un-taped to allow for air to escape from the chest. A gloved hand can also be used to seal the wound until more suitable material is available.






Signs and Symptoms

Anxious and/or restless;

Decreased air movement to injured side;

Decreased level of consciousness leading to unconsciousness;

Difficult and/or noisy breathing;

Flail segment;

Frothy bloodstained saliva (sputum);

Obvious chest injury (e.g. gunshot, stabbing);

Pain increasing on breathing, movement and/or coughing;

Pale or blue skin;

Rapid deterioration of the casualty;

Sign and Symptoms Shock.

Figure 24: Pneumothorax.

Normal Pneumothorax. Tension Pneumothorax

Two sets of lungs showing two cases where air or gas has entered the pleural cavity: (left) normal pneumothorax and (right) tension pneumothorax.






Treatment for Chest Injuries

DRSABCD;


Place the casualty with their head and shoulders slightly elevated and leaning towards the injured side;

Support the injured area using a large pad or pillow;


Cover any entry wounds;

Cover the wound with an airtight dressing;

Tape the top and sides of the dressing;

DO NOT tape the bottom of the dressing. This acts as a one-way valve and reduces the air entering through the wound;

If the casualty is unconscious, place into the side position with the affected side down, unless an object is embedded in the casualty;

If an object is embedded in the chest: DO NOT remove object;

Apply padding around the object;

Stop any bleeding;

DO NOT apply pressure over the embedded object;


Monitor the casualty's pulse, respirations and levels of consciousness.

Note: If a sucking chest wound is suspected the casualty needs urgent hospitalisation to reduce the pressure on the heart and lungs.

DO NOT waste any time calling an Ambulance (Call First and Call Fast)

Abdominal Injury

These types of injuries can be caused by either a blunt (driver into steering wheel) or penetrating (stabbing) injury. The signs and symptoms can depend on the organs and other blood vessels that are involved.

Signs and Symptoms

Blood in the urine and/or faeces;

Blood loss, either internal/external (look for signs of shock);


Exposed intestines, (evisceration);

Fast pulse and/or respirations;

Guarding of the injury site;

Nausea;

Obvious pain;






Pale cold clammy skin;

Shock;

Swelling (internal bleeding);

Vomiting.

Treatment for Abdominal Injury

DRSABCD;

Always suspect a spinal injury;

Call 000 for an ambulance( Call First and Call Fast);

Control the bleeding;

Cover any protruding intestines with either a non-stick or wet sterile dressing. Use clean plastic wrap if nothing else is available;

lay the casualty down with their head and shoulders slightly raised and knees bent;



Monitor the casualty‘s pulse, respirations and levels of consciousness.

Figure 25: Dressing an abdominal wound

Care must be taken not to apply material to the wound that will stick to the organs. It should be noted that there is often little pain associated with this type of injury, and the casualty may walk around or even offer help.

Soft Tissue Injuries

Deformities caused by fractures, dislocations, and severe sprains

Fractures, dislocations, and severe sprains often cause a limb or joint to look twisted, bent out of shape, or out of its normal position. Fractures, dislocations, and severe sprains can also cause:

Severe pain;

Swelling and bruising;

A feeling that a bone popped or moved out of place;

A loose or unstable joint;






Abnormal movement of a limb or joint;

A locked joint (can't bend or straighten it);

Cool, pale skin or numbness and tingling at or below the injury, if nerves or blood vessels were injured or pinched by the injury.

A fracture may also cause a break or tear in the skin. The broken bone may poke through the skin in some cases. Skin bacteria can enter at the injured site and cause a deep joint or bone infection in addition to a skin infection.

A dislocated bone may also damage blood vessels, nerves, ligaments, tendons, and muscles that are close to the bone.

A sprain may cause so much swelling that it may be difficult to tell whether an additional underlying injury is present. Sprains can be mild, moderate, or severe.

Soft tissue injuries are caused when muscles or ligaments are either torn or stretched. It is also difficult to distinguish between a soft tissue injury and a fracture. If you are unsure, treat for a fracture until proven otherwise by x-rays etc.

Sprain

Sprains are injuries to (ligaments) a short band of tough flexible connective tissue linking bones together. If you have a severe sprain, your symptoms may not be much different from those you would have with a broken bone.

Signs and Symptoms

Bruising;

Pain, increasing on movement;

Swelling

Muscle strain

A muscle strain, also known as a pulled muscle, may be minor (such as an overstretched muscle) or severe (such as a torn muscle or tendon). Strains are caused by overstretching muscles.

Signs and Symptoms

Symptoms of a muscle strain can vary, depending on how severe the strain is, and may include:

Decreased mobility of the limb;

Swelling;

Tenderness and pain to the site;

Pain and tenderness that is worse with movement. Swelling and bruising;

Normal or limited muscle movement;

A bulge or deformity at the site of a complete tear.

Recovery time for a muscle strain can vary, depending on a person's age and health and the type and severity of the strain. While a minor strain often heals well with home treatment, a severe strain may require medical treatment. If a severe strain is not treated, a person may have long-term pain, limited movement, and deformity.






Bruises

Anyone who is rushing about doing heaps of things can bang into something (or someone) if they are in too much of a rush. Kids are often in a hurry to get somewhere, play sport, want to be first in line etc. and so kids often have bruises in many colours, decorating some parts of their bodies.

What is a bruise?

Bruises are caused by banging yourself against something or being hit by something like a ball, or being squeezed hard, eg. when someone pinches you hard or you trap your finger in the fridge door when you are trying to shut it quickly (you know, when you hear mum coming!)

Small blood vessels in the skin or just under it break so that some blood escapes from them. The blood vessels heal quickly so that they DO NOT go on bleeding, but the blood that has already leaked out stays under the skin, around the place that is hurt, for a few days.

Signs and Symptoms

It feels painful.

The bruised area swells up.

Your skin goes red and later black and blue, then yellow after a few days.

You feel sore all around the area of the bruise.

What you can do

As soon as you have hurt yourself stop further bleeding and swelling (bruising) by using R.I.C.E.

Treatment for Soft Tissue Injuries (R.I.C.E)

The Treatment for sprains and strains is summarised using the acronym

Rest the injured limb and reduce the movement and use of the limb.

Ice (cold) compresses the injured limb. Be aware not to over cool limb

Compression bandage the affected limb to help reduce swelling.

Elevate the limb to reduce swelling.

Cold compress can be made by placing ice into a plastic bag and then wrap the ice bag in a cloth. This can now be place onto a casualty. Reusable soft-fabric cold compresses that can be stored in freezer (at least 2 hours) and dual-purpose hot/cold packs are available and are ideal for the workplace Carer to have always available. Never place ice or any frozen object directly onto a casualty‘s skin because this can cause more damage than help.

Dislocations

Dislocations are where a bone has been pushed out of its normal position/joint. Dislocations can be difficult to distinguish from a fracture. A dislocation can result from trauma or in some cases occur spontaneously and be resolved spontaneously. Dislocations may cause damage to the tissue supporting the joint.






Signs and Symptoms

Deformity of the joint;

Loss of movement at the joint;

Severe pain and tenderness.

Treatment for dislocations

DRSABCD;

Call 000 for an ambulance ( Call First and Call Fast);

DO NOT attempt to put a dislocation back in place;

Allow the casualty to support the dislocation in a position of comfort;

try and splint it in this position;

apply an ice compress to help reduce the swelling.

Slings using Triangular Bandages

The purpose of splints and slings is to prevent movement of the fractured bone by immobilising the limb, restricting the movement in the joint above and below the fracture site and reducing the amount of bleeding and further injury.

How to Fold a Triangular Bandage

A triangular bandage can be used as a sling or a bandage;(a)

Fold the triangular bandage in half (apex to the base) and then in half again. This is called a broad fold bandage and can be used for bandaging or splinting of the upper legs;(c)

Fold in half again. This is now a narrow fold bandage and can be used for bandaging or splinting of the lower legs or arms.(d)






Figure 26: Folding a Triangular Bandage

Fractures

A fracture is any break in the continuity of a bone. It can be either a complete break (bone in 2 or more pieces) or incomplete (bone has bend or splintering of the bone but the bone has not completely come apart). The aim of treatment is to assist the bone to recover fully in strength, movement and sensitivity. Some complicated fractures may need surgery and/or surgical traction for best results.

Causes of fractures of healthy bones include incidents such as sporting injuries, vehicle accidents and falls. As we get older, our bones usually become more brittle. Osteoporosis and some types of cancer can also cause the bones to fracture more easily.

Closed fracture: the skin remains intact and there is little damage to surrounding tissue;

Open fracture: the bone is exposed to the outside environment;

Complicated fracture: - in addition to the fracture, there is injury to the surrounding structures. There may be damage to the veins, arteries or nerves and there may also be injury to the lining of the bone (the periosteum).

Fractures may be caused a number of ways:

Direct force; where sufficient force is applied to cause the bone to fracture at the point of impact;

Indirect force; where force or kinetic energy, applied to a large, strong bone, is transmitted up the limb, causing the weakest bones to fracture;

Spontaneous or spasm-induced; where fractures are associated with disease and/or muscular spasms.






These are usually associated with the elderly and people with specific diseases affecting the bones. Always exercise care when assessing an elderly casualty as the condition known as osteoporosis or ‗Chalky Bones' causes bones to fracture easily, often in several places. Always suspect a fracture if an elderly person complains of pain or loss of power to a limb.

Be especially aware of fractures at the neck of the femur (near the hip), a very common fracture in the elderly.

Young children are also prone to fractures. Arm and wrist fractures are common with children. As young bones DO NOT harden for some years, children's fractures tend to ‗bend and splinter', similar to a broken branch on a tree - hence the common name ‗greenstick fracture'.

Figure 27: Skeleton






Signs and Symptoms

Crepitus (Broken ends grinding together when moved);

Deformity;

Loss of function/power;

May be shortening of the limb;

Pain;

Swelling and tenderness;

Unnatural movement;

Casualty felt or heard a bone snap.

Treatment for a simple fracture:

1. Check for Danger

2. Call First Call Fast (Phone for an Ambulance)

3. Check for circulation to limb. If there is no circulation to the limb, light traction and realignment may be required.

4. Stop any bleeding if possible.

5. Immobilise the limb. (This means DO NOT move the limb if possible).

6. Make injured person comfortable and reassure them while waiting for the Ambulance

7. You should not transport any injured person until you have spoken to the Ambulance Service.

Caution: When splinting limbs together you should be very cautious not to cause any extra injuries. If the limb has good circulation leave it where it is. Support and reassure injured person.

Use your imagination if you need a splint. A straight piece of wood, a rolled up newspaper or magazine, even a rolled up blanket will do! The main aim is to keep the limb as immobile and comfortable as possible. Make sure the splint extends beyond both sides of the fracture and carefully elevate the limb to slow blood flow to the wound.






Treatment for Fractures

The treatments for fractures are listed on the previous page of this manual. You should use the guidelines ―Treatment for a simple fracture‖ and be cautious to look after the needs of the specific injury/injuries the causality has received.

Pelvic Fracture

DRSABCD;


If the casualty is conscious, place the casualty flat on their back with their knees slightly bent (remember all unconscious casualties go in the side position);

Remove everything from the casualty's pockets and give to relatives or friend;

Immobilise the legs by placing a broad fold bandage around the thighs and a narrow fold bandage around the ankles;

Treat the casualty gently, as they could have further fractures of the legs or internal injuries.

Collar Bone/Hand Injury

DRSABCD;


Use an upper arm sling;

Position the affected arm with the casualty‘s hand placed on the opposite shoulder;

Place a triangular bandage across the arm, with the point (apex) toward the elbow;

Bring the lower half of the triangular bandage up between the forearm and chest and then out behind the elbow, forming a pocket for the injured arm;

Bring the other end over the uninjured shoulder tying both ends together;

Twist the bandage at the elbow until firm and then tuck into the bandage;

Pad under the knot;

Check for a radial pulse (wrist) on the injured arm;

If required, you can place a broad fold bandage around the casualty to secure the arm to the casualty‘s chest. This is to prevent movement of the arm;

If the casualty has found a comfortable position with the fractured collarbone try and splint it in this position.

Upper Arm Fracture

DRSABCD;


Use a collar and cuff sling. This allows the weight of the arm to separate the fractured bone (traction), which helps reduce pain and grinding (crepitus);

Lay a narrow bandage down; make two loops with the bandage, with one end coming out on opposite sides of the middle;






Fold loops together, place the casualty‘s hand through the loops and gently tighten;

Raise the hand to the uninjured side, near the shoulder;

Tie off the ends around the casualty‘s neck;

Pad under the knot;


If the casualty has found a comfortable position with the fractured arm, try and splint it in this position;

Lower Arm and Wrist Fracture

DRSABCD;


Use a lower arm sling;

Place a splint under the lower arm (e.g. board or folded newspaper, etc);

Tie the splint with narrow fold bandages above and below the fracture;

Position the casualty‘s arm across their chest with a slight elevation;

Place the triangular bandage between their arm and chest, with the point (apex) of the triangular bandage at the elbow and the top over the shoulder, on the uninjured side;

Bring the bottom end of the triangular bandage up and over the fractured arm. Then place over the shoulder on the injured side;

Tie both ends together, tying the knot on the uninjured side;

Twist the end at the elbow until firm and then tuck in;


If the casualty has found a comfortable position with the fractured arm, try and splint it in this position.






Leg Fractures

DRSABCD;


Place a wooden padded splint between the legs and on the outside of the fractured leg. If not available, pad between the legs and use the good leg as the splint;

Apply a broad fold bandage around the top of the thigh;

Apply a bandage above and below the fracture site;

Place other bandages as necessary.

Ankle Fractures

Leave the shoe in place as this acts as the splint and provides compression to reduce the swelling. Slightly elevate the ankle with a pillow.

Treatment for Ankle fractures

DRSABCD;


A fracture may be an obvious injury, but DO NOT forget DRSABCD and the secondary survey;

Cover all wounds with a sterile or clean dressing;

DO NOT apply direct pressure to any protruding bone. Pad around the protruding bone;

DO NOT elevate the limb;

Apply a bandage around the pad.

Allow the casualty to support the injured limb in a position of comfort;

Always immobilise above and below the fracture;

Apply a cold compress to the fractured site to help reduce the swelling.






Entrapment of casualty

If someone is entrapped from an accident involving the main danger is that the entrapped limbs are crushed. If the limb is compressed and cannot be released immediately the casualty will most like suffer from crush injury syndrome.

Crush injury syndrome occurs when a compressive force is applied to a major part of the casualty and cuts off the circulation. The cells have no oxygen supply and produce a toxic substance. Medical intervention is required to treat a casualty with crush injury syndrome.

Signs and Symptoms

No pulse beyond the compressive site;

Pain and swelling around the injury site;

Bleeding to/or around the site;

There is usually a fracture to the affected site.

Treatment for Entrapped Casualty

DRSABCD;


If the compressive force has been in place for less than 1 hour and can be removed immediately and safely then remove it;

If the compressive force has been in place for longer than 1 hour, DO NOT remove it! Wait for the emergency services;

You now treat the casualty as you do for a casualty with fractured limbs;

Monitor the casualty's DRSABCD.

Fainting

Fainting is a term used to describe a condition of a sudden and brief loss of consciousness, with the potential for a full recovery. The loss of consciousness is usually brief, from seconds to one or two minutes. Brain damage can occur if the casualty is left supported in an upright position such as sitting in a chair etc.

Some of the reasons for fainting are:

Standing for long periods of time in hot weather.

Standing in a hot shower for a length of time.

The sight of blood, needles, trauma

Pain.

A drop in blood pressure.

Pregnancy.

Signs and Symptoms

Anxiety;






Light headedness/dizziness;

Nausea;

Pale and cold skin;

Sweating;

Tremors to the face and limbs just prior to fainting.

Treatment for Casualty that Fainted

DRSABCD;

Lay the casualty down flat on their back;

Position the casualty‘s legs raised above the heart;

All pregnant women should be placed on their left side;

Assess and treat any further injuries;

If the casualty does not recover quickly, consider another diagnosis and remember all unconscious casualties are to be placed into the side position;

If casualty is unconscious call 000 for an ambulance;

(Call First and call Fast).

Fits and Seizures

There are different reasons why people have fits and seizures. They can be caused by one of the following: Epilepsy, this is due to abnormal electrical activity within the brain.

Any condition affecting the brain, example: head injury, stroke, meningitis, brain tumours or lock of oxygen (hypoxia);

Some poisons or drugs;

Withdrawal from alcohol or drugs;

High temperature (Febrile Convulsion) in children under five (5) years old.

Epilepsy

A disorder of the central nervous system, particularly the brain, which means people sometimes have seizures. Epilepsy means you are likely to have more than one seizure. Not everyone who has a seizure has epilepsy.

What Causes Epilepsy?

People often wonder what causes epilepsy. In about 50 per cent of cases, doctors cannot find a cause - epilepsy just seems to come out of the blue. In the other 50 per cent of the cases, the cause can be identified, just like any injury or illness to the brain. Epilepsy is widespread and it can affect anyone. People with epilepsy come from all sections of the community and all nationalities. Two in every 100 Australians have some form of epilepsy. Although epilepsy can begin at any age, most people with epilepsy have their first seizure during childhood. About two thirds of people with epilepsy have had their first seizure by the time they complete their primary school years. This means that about 50,000 primary school students throughout Australia have epilepsy.






Signs and Symptoms

Blueness around the face and lips;

Confusion and disorientation when regaining consciousness;

Jerking movements of the body;

Loss of bladder control;

Muscle spasms, causing rigidity and the casualty to fall down;

Noisy breathing with frothing saliva from the mouth;

Symptoms lasting from a few seconds to minutes;

Unconsciousness.

Treatment for Epilepsy Fitting

DRSABCD;

Call 000 for an ambulance. If required;

Protect the casualty from danger and further injury;

Once the seizure stops, treat as for unconsciousness;

Place the casualty in the side position;

Allow the casualty to sleep with supervision;

DO NOT restrain the casualty;

DO NOT place anything in the casualty's mouth;

DO NOT force the casualty's jaw open.

Figure 28: Tonic and Clonic Phase






Febrile Convulsion (younger children)

A Febrile Convulsion is usually associated with a high body temperature in children younger than five years of age. Febrile Convulsions are brought on by a high fever usually caused by a viral infection.

Signs and Symptoms


Face/lips become blue;

Jerking body movements;

The child will become limp post seizure;

The child‘s back will arch;

The child‘s body will become stiff.

Treatment for Febrile Convulsion

DO NOT Panic;

DRSABCD;

Call 000 for an ambulance (Call First and Call Fast);

Remove the child‘s excess clothing to reduce temperature;

Sponge the child with tepid water;

DO NOT allow the child to shiver/goose bumps, as this will automatically cause the body to produce heat;

Infant Panadol can only be given if written permission from a doctor is given;

When the seizure has finished, place the casualty into the side position;

Monitor DRSABCD;

Lightly cover the child with wet sheet.

Diabetes

Diabetes is a condition, which is caused by an imbalance of insulin causing high or low sugar in the blood. Because all human cells require sugars as food, the body takes in complex sugars in a normal diet. So that the body's cells can use these sugars, the body, through an organ called the pancreas, secretes a protein hormone, called insulin, which attaches to the sugars. This allows the cells to recognise the sugars as food, and absorb the necessary glucose. Diabetes is due to an imbalance in the production of vital insulin. Diabetic emergencies appear in two forms:

High blood sugar, or Hyperglycaemia, is an imbalance of blood sugar, which usually requires the affected person to supplement his or her insulin requirements by periodic injections of the hormone. A casualty who is unable to obtain this supplement is liable to collapse into a serious state called diabetic coma. This condition is less common and has a slower onset than hypoglycaemia. Not all diabetics are dependent on supplementary insulin, and many live normally on a controlled diet






Low blood sugar, or Hypoglycaemia, is a dramatic imbalance where the tissues, especially the brain cells, become starved of essential blood sugar. This condition is the more common type and especially dangerous as its onset is rapid. The result of further deprivation of sugar is that the casualty becomes unconscious and death may follow within hours.

Signs and Symptoms

High Blood Sugar

Drowsiness;

Excessively thirsty;

Frequent need to urinate;

Hot, dry skin;

Smell of acetone (nail polish remover) on the breath;

Unconsciousness.

Low Blood Sugar

Confused or aggressive;

Hunger;

May appear to be drunk;

Pallor;

Profuse sweating;

Rapid pulse;

Seizures;

Unconsciousness.

First aid treatment for either type of diabetic emergency is the same. Treatment for the hyperglycaemic requires medical expertise. Low blood sugar is easiest to treat, and treatment generally rewards the first aid provider with dramatic results.

Treatment for Diabetes

DRSABCD;


If conscious, give sweet drink repeat if casualty responds;

On recovery, assist with medication and encourage ingestion of food high in carbohydrates e.g., biscuits;

Avoid putting fingers in the casualty's mouth;

Unconscious casualty should be placed on side;

DO NOT - attempt to give insulin injection;

DO NOT - give anything by mouth if unconscious;

DO NOT - give diet drink.






The difference between acute and chronic conditions

With many short term or acute illnesses, a quick fix can often be at hand. A visit to a doctor, a course of medication, maybe an operation will often cure or fix the immediate problem. The affected person can choose to be a relatively passive participant in this process: take the medications, undergo the surgery and follow the prescription of the health professional. Of course, a more active engagement in a healthy life-style including appropriate diet and exercise, can often do much to reduce the risk of such acute episodes.

Chronic long term conditions, such as arthritis, DO NOT respond to the quick fix approach. There simply isn‘t a quick fix; there is often, as yet, no cure. Part of the challenge for the person with a long term condition, is learning to live with the condition and its effects on a day to basis, over a considerable period of time and to maintain quality of life. This challenge can often seem insurmountable, affected people can feel depressed, angry, frustrated, helpless and uncertain.

Asthma

Signs and Symptoms

The onset of an attack can be recognised by one or more of the following symptoms and signs:

Shortness of breath;

Wheezing when exhaling, remember, not all asthma casualties‘ wheeze;

Dry or moist cough;

Thirst due to loss of water vapour from the lungs;

Increasing pulse rate;

Drawing in of the spaces between the ribs and above the collarbones with the effort of breathing;

Cyanosis;

Collapse.

Signs of deterioration include:

An inability to talk;

Exhaustion;

Cyanosis seen in the lips and tongue;

Collapse.

Assist the casualty to take up to four additional puffs of their "reliever" medication while waiting for trained help. If breathing stops, begin CPR promptly. Effort may be required to overcome the resistance to inflation.

Treatment for Asthma

If you know the casualty‘s management plan, follow its guidelines. Assist the casualty to:

Position of comfort - Normally sitting up. If severe attack, place casualty on side

Take any prescribed medication immediately.






Queensland health legalisation states that you must not use another person‘s puffer or prescribed medication.

Rest from any physical activity, even if this appears at first to make the attack worse.

Sit with arms supported on a table or bench to make breathing easier.

Constantly observe the casualty in case any deterioration occurs.

If there is definite improvement, normal activity can resume under close observation. Strenuous physical activity should be avoided unless a medical clearance has been given.

If there is no improvement after the initial steps have been taken, help the casualty to take two more puffs of the "reliever" medication, and then either contact the casualty's doctor or call for an ambulance.

If there are signs of deterioration, call for an ambulance immediately.

If there is no action plan in place then use the following Asthma First Aid plan. (ARC Guideline 9.2.5)

Asthma First Aid Plan

If a victim has any signs of a severe asthma attack, call an ambulance straight away and follow the Asthma First Aid Plan while waiting for the ambulance to arrive.

Step 1: Sit the person comfortably upright. Be calm and reassuring. Do not leave the person alone.

Step 2: Without delay give four separate puffs of a ―reliever‖. The medication is best given one puff at a time via a spacer device. If a spacer is not available, simply use the puffer.

Ask the person to take four breaths from the spacer after each puff of medication.

Use the victim‘s own inhaler if possible. If not, use the first aid kit inhaler if available or borrow one from someone else.

The first aid rescuer should provide assistance with administration of a reliever if required.

Step 3: Wait four minutes. If there is little or no improvement give another four puffs.

Step 4: If there is still no improvement, call an ambulance immediately. Keep giving four puffs every four minutes until the ambulance arrives.

No harm is likely to result from giving a ―reliever‖ puffer to someone without asthma.

If oxygen is available, it should be administered at a flow rate of at least at 8 litres per minute through a face mask, by a person trained in its use.

If breathing stops, give resuscitation following ARC Basic Life Support Flowchart (Guideline 8)

If a severe allergic reaction is suspected, refer to ARC Guideline 9.2.7 Anaphylaxis – First Aid Management.

See Figure 28below from the National Asthma Council with a flowchart on the correct use of devices with and without spacers






Prevention of an Asthma attack

People with asthma should have their lung function medically assessed. As part of their personal asthma management plan, many people will use a device called a peak flow meter, which measures their lung function. A reduced reading indicates the need for increased preventative medication; improved readings indicate that the asthma is under control.

Exercise-induced asthma (EIA) responds well to treatment if the person takes the prescribed medication appropriately. Generally the person with EIA is advised to take the prescribed medication 5 to 10 minutes before exercise

Figure 29: Normal and Asthmatic Bronchus






Figure 30: First Aid for Asthma

(accessed http://www.nationalasthma.org.au/ 28/11/2012)

http://www.nationalasthma.org.au/






Hyperventilation

Hyperventilation is defined as a rapid respiratory rate (fast breathing) and/or increased depth of breathing. The most common causes are:

Anxiety;

Deliberately over breathing.

Signs and Symptoms

A feeling of not getting enough air;

Anxiety;

Chest tightness;

Rapid breathing;

Hands and fingers can contract and twist;

Abdominal cramps;

Tingling to the fingers and lips;

Treatment for Hyperventilation

Reassure and calm the casualty;

encourage slow breathing;

it may take some time for the casualty to calm down and relax;

ask any bystanders who are aggravating the situation to move away;

if casualty does not improve call 000 for the ambulance

Figure 31: The Hyperventilation cycle

STRESS

Anxiety

Symptoms

HYPERVENTILATION

More Hyperventilation






Croup

Croup is the inflammation of the upper airway (throat). This inflammation causes narrowing of the upper airway and can be caused by a bacterial infection. It normally affects children aged between 2-4 years of age.

Signs and Symptoms

A seal like bark, worsening at night;

Difficulty in breathing;

Onset over hours to days;

Restlessness.

Sore throat, high temperature and a runny nose.

The child looks and is unwell.

Treatment for Croup

Reassure and calm the child;

Call 000 for an ambulance if the child has breathing difficulties and is in distress;

DO NOT look inside the child's mouth;

DO NOT take the child out into the night air;

Place child in a room full of moist/steam air (in the bathroom with the hot shower tap on to steam the room). Be careful not to place the child close to the hot water you DO NOT want to raise the child‘s temperature;

Remember to dry the child when leaving the bathroom, as they will be wet from the steam.

Figure 32: Croup triggers swelling of the windpipe






Epiglottitis

Epiglottitis is the inflammation of the flap (epiglottis) that sits above the windpipe and closes off the windpipe when something is swallowed. Normally this flap is open to allow breathing. Inflammation of the epiglottis can have a rapid onset, developing quickly and in severe cases blocking the airway. Epiglottis normally affects children aged between 2-4 years of age.

Signs and Symptoms

Harsh cough;

High temperature;

Lethargic;

Noisy breathing;

Pale;

Postural changes, example: leaning forward;

Rapid onset;

Sick looking child;

Sore throat that is too painful for the casually to eat, drink or even swallow.

Treatment for Epiglottitis

DRSABCD.

Call 000 for an ambulance. (Call First and call Fast).

DO NOT look into the casualty's mouth this could block the airway.

Rest and reassure the casualty. It is best to have a parent nurse the child for reassurance.

Sit the casualty upright. This assists with breathing and helps prevent the epiglottis from blocking the airway.

DO NOT force the casualty to drink or eat.

Note This is an extremely serious condition and ambulance assistance (000) is required. These casualties need to be monitored on the way to hospital at all times as their airway could become blocked at any time.






Shock

Shock is a term used to describe the result of the loss of an effective circulation. What this means is that the circulatory system (heart, lungs and blood vessels) are unable to circulate a sufficient supply of oxygenated blood to the cells of the body. This leads to the inability of the cells and tissue to function correctly. If untreated, shock can result in death. This is not to be confused with emotional distress/surprise which is not life threatening. The three main causes of shock (3) main categories:

Absolute fluid loss.

Relative fluid loss.

Cardiac failure.

Absolute Fluid Loss - low blood volume (Hypovolaemia)

Absolute fluid loss can result from either internal or external bleeding where there is damage to the circulatory system or loss of body fluids through severe burns, severe vomiting, or severe diarrhoea, etc. This can lead to an inadequate supply of oxygenated blood to the cells and tissue. The onset of shock starts to occur when a casualty loses approximately 15% (approximately 750ml for an adult) of the circulating blood volume.

Relative Fluid Loss

Relative fluid loss occurs when there is an abnormal increase in the size of the circulatory system (arteries, veins and capillaries) within the casualty‘s body.

This can be due to:

Severe allergic reaction (anaphylaxis).

Chemicals or drugs.

Severe infections.

Nervous responses.

Severe brain/spinal cord injury.

The volume of blood stays the same but the size of the circulatory system actually increases (arteries, veins and capillaries dilate). The effect of this increase in size can be a dramatic drop in blood pressure which can be life threatening.






Cardiac Failure (Cardiogenic Shock)

Cardiac failure occurs when the heart is suffering from either injury or disease and is unable to pump effectively or efficiently. The heart has its own blood supply coming from the coronary arteries. If this blood supply is interrupted by blockages or narrowing, as occurs in a heart attack, the heart will not be able to function correctly. The result is a lack of oxygenated blood to the cells and tissue.

The Body's Compensation Mechanism

When the supply of oxygenated blood to the cells and tissue is insufficient for the body to function correctly, the body automatically tries to compensate (homeostasis). Both the breathing rate (respirations) and the heart rate increase in an attempt to supply oxygenated blood to the cells and tissue. Blood vessels around the skin and muscles will constrict, directing the blood away from the body's extremities. This allows more of the oxygenated blood to be directed to the vital organs such as the heart, lungs, brain etc. By the body attempting to compensate in this manner, it is effectively reducing the size of the circulatory system to maintain the body's blood pressure and provide oxygenated blood to vital organs.

The body can only compensate, by how much the heart‘s ability responds to increased demand. When the body is unable to compensate any further, the cells, tissue and vital organs (heart, lungs and brain) will be unable to function efficiently or effectively. If the cause of shock in the casualty is not rectified the vital organs will cease to function causing death.

Signs and Symptoms of Shock

The casualty‘s condition will depend on the severity of the underlying cause and may include.

Increased breathing rate and depth;

Increased heart rate with a weak pulse;

Pale, cold and sweaty skin (caused by the blood vessels constricting);

Weakness and/or dizziness;

Nausea and vomiting;

Confusion leading to unconsciousness;

Slowing of the heart rate and respiration's as the condition deteriorates, leading to death.






Treatment of Shock

As a Carer, you can reduce some of the factors that lead to the shock process by:

Conducting DRSABCD (primary survey);

Controlling bleeding;

Conducting a secondary survey

Head to Toe

Laying the casualty down flat.

Elevating the casualty's legs unless they are fractured or cardiogenic shock is suspected.

Treating burns and other wounds.

Treating fractures.

Reassuring the casualty.

Loosening any restrictive clothing.

Protecting the casualty and keeping them comfortable.

Monitoring vital signs (respirations, pulse rates and level of consciousness) at regular intervals.

Calling 000 for an ambulance.

A burn can be life threatening, especially if it involves the face, airway and lungs. Burns can lead to shock and infection.

Burns

Area of burns

The rule of 'nines' is used to estimate the amount of burnt area. The body is divided into areas with a percentage for each area to assist in estimating the burnt area.

Chest 9%;

Abdomen 9%

Head 9%

Upper Back 9%

Lower Back 9%

Arm 9%

Genital Area 1%

Front Leg 9%

Back Leg 9%






Figure 33: Rule of nines for body surfaces






Types of burns

HEAT: Flames, steam and/or liquids.

ELECTRICAL: Damaged/faulty cable, power points or lightning.

CHEMICAL: Acids, caustic soda etc.

FRICTION: Any friction generating heat e.g. rope, carpet.

RADIATION: Sun.

There are two (2) methods used to determine the severity of a burn. Both these methods need to be used together.

Depth of Burns

The burn is classed as Superficial, Partial thickness or Full thickness.

Superficial Burn - where the top area of skin is damaged. E.g. light sun burn

Partial thickness - burns affect the outer layers of skin.

Full thickness - burns can affect all layers of skin, tissue, muscle and bone.

Significant Burns

A Significant Burn is considered as:

Burns greater than 10% of total body surface area

Burns of special areas - face, hands, feet, perineum, and major joints

Full thickness burns greater than 5% total body surface area of the casualty

Electrical burns

Chemical burns

Circumferential burns of the limbs of chest

Burns to a very young or very old casualty

Burns to a casualty with a pre-existing medical condition that would complicate management, prolong recovery or increase mortality

Burns with associated trauma

All infants or children with burns should be medically assessed.






Signs and Symptoms of Partial Thickness Burns

The affected area is red;

Blistering;

Pain around the affected area;

Skin may peel;

There may be clear fluid (plasma) oozing from the burn;

A hoarse voice if the airway is burnt;


Swelling of the airway, leading to a blocked airway.

Signs and Symptoms of Full Thickness Burns

The affected area can be black, charred in the middle and have a waxy centre with reddening on the edges;

Can have blisters;

There may be very little or no pain due to nerve damage. However, it may be painful on the edges of the burn;

There may be clear fluid (plasma) oozing from the burn;

Pale, cold or clammy skin;

A hoarse voice if the airway is burnt;


Swelling of the airway leading to a blocked airway.

Treatment of Burns

DRSABCD;

If the casualty is on fire, drop and roll the casualty or use a fire blanket or water;

Cool the burnt area with gentle running, clean, cool water for a minimum of ten (10) minutes;

Immediately remove any jewellery, rings, watches, etc;

Cover the burnt area with a clean sterile non-stick dressing or sheet;

Continue running water over the dressing if pain persists;

Monitor the casualty's vital signs, pulse, respirations and levels of consciousness;


Call 000 for an ambulance;

Figure 34: 4 Degrees of Burns






If the airway is burnt, give small sips of cool clean water;

You can apply cold compresses to the neck area.

DO NOT remove clothing that is stuck to the skin.

DO NOT over cool the casualty. If the casualty shivers or gets goose bumps, the body naturally starts to produce heat and we do not want this to happen!

DO NOT apply lotions, oils or butter.

DO NOT pull burning smouldering clothing over a casualty's head.

DO NOT use cotton wool or any adhesive tapes/plaster.

DO NOT underestimate burns, especially when the airway is involved.

DO NOT break any blisters.






Electric Shock

An electric shock occurs when a person comes into contact with an electrical energy source. Electrical energy flows through a portion of the body causing a shock. Exposure to electrical energy may result in no injury at all or may result in devastating damage or death.

Burns are the most common injury from electric shock

Electrical burns

Always be aware of danger to yourself, casualty and bystanders.

Look for and treat both entry and exit wounds.

Monitor the casualty's Airway, Breathing & Circulation closely, as the heart can stop at any time.

Treat as per burns.

Be aware that the casualty could have internal injuries caused by the electricity.

Complete a head to toes (Secondary Survey) if the casualty has been thrown, looking for other injuries.

Cold burns

Treat as per burns except use warm water to try and bring the cold burn back up to a normal temperature.

Chemical Burns and Splashes

Avoid contact with any chemical or contaminated material (e.g. use gloves)

If available, refer to the Material Safety Data Sheet (MSDS) for specific treatment

Refer to instructions on the container for specific treatment

Call Poisons Information Centre on 13 1126

Remove the chemical and contaminated clothing as soon as practical

Brush powdered chemicals from the skin

IMMEDIATELY run cool tap water directly onto the area for 20 minutes

If chemical enters the eye, open and flush affected eye(s) thoroughly with water for at least 20 minutes and refer the casually to urgent medical attention. (Call for Help)

Radiation Burns

The most common type is sunburn.

Remove the casualty from the sun.

Treat as for a burn.

DO NOT over cool the casualty.

Phosphorus Burns

Dress wounds from phosphorus injured casualties with saline soaked dressings to prevent ignition of the phosphorus by contact with air






Phosphorus may be found in flares, fireworks and weapons made in chemical laboratories. When exposed to air, phosphorus may ignite spontaneously.

Hydrofluoric acid

Hydrofluoric acid is used as a cleaning agent by jewellers, in glass etching and in other industries. It is one of the most dangerous and corrosive acids which cause a full thickness burn and excruciating pain: even a small area of persistent pain needs urgent medical assessment and may become life threatening if untreated.

Early and copious irrigation with water is needed. If available, it is critical to apply calcium gluconate as soon as possible. Calcium gluconate should be available at all worksites where hydrofluoric acid is used.

Bitumen

Bitumen should not be removed from the victim‘s skin, as this may cause more damage. Bitumen continues to hold heat therefore irrigation with water should continue for at least 30 minutes. Consider scoring or cracking the bitumen if it is encircling a limb of digit.

Petroleum Products

Petroleum (not flame) may cause chemical burn due to direct toxic effects. Prolonged contact has been associated with organ failure and death. Copious irrigation with water is required.

Smoke Inhalation

This can cause burns to the airway due to the heat of the air and smoke.

Smoke could contain toxic chemicals.

Ensure the casualty is removed from the smoky environment.

Place the casualty in an area with plenty of fresh air.

If the airway is burnt, give small sips of cool clean water.

Monitor DRSABCD.

Call 000 for an ambulance.

The body requires a constant supply of blood, which is pumped around the body via the heart through a closed system consisting of arteries, veins, and capillaries. When this system is damaged (internal/external bleeding) and not controlled, clinical shock can result which can be life threatening.






Sunburn

Australians love the outdoors but on a fine summer's day skin can burn in as few as 15 minutes. On average, 5.7million Australians get sunburnt every summer. It's the ultraviolet, or UV, rays that do the damage, and because the rays aren't influenced by temperature their levels can be high even on cool or cloudy days. When skin is affected, sunburn will show within two to six hours and continue to develop over the next 24-72 hours. Mild sunburn, which causes skin to redden, is called first degree sunburn. More serious reddening with blisters is second degree sunburn. Third degree sunburn requires medical attention.

The first thing to do in an emergency

Get the person out of the sun and sponge cold water onto the affected skin.

Give first aid for burns and scalds.

Figure 35: Ultraviolet rays and sunburn






Heart Conditions

Each year, thousands of people in Australia die from heart disease. Early Treatment may be able to reverse or reduce the damage to the heart and decrease the number of deaths from heart disease.

With today's life styles, the chances of heart disease are increased by:

Obesity;

Smoking;

Stress;

High cholesterol;

High blood pressure;

Family history;

Age and/or gender.

Cardiac Arrest

This is where the casualty's heart is not beating. The casualty would therefore present withNO SIGNS OF LIFE. Regardless of how this was caused, ifthe casualty has NO SIGNS OFLIFE then CPR must be commenced immediately.

Heart Attack

The heart requires oxygenated blood in order to function effectively, the chances ofsomebody having a heart related illness increase in older persons. People who have afamily history are also at higher risk. A lot of built up fatty deposits inside the bloodvessels causes a narrowing effect, which reduces the amount of blood flow to the heart,tissue and cells. This reduces the ability of the heart and other organs to function correctly. When blood flow to the heart muscle is interrupted, a person is said to be “having a heart attack”. A casualty who has a heart attack is also known as a “myocardial infarction”, this may or may not result in death. To reduce the chance of sudden death from heart attack urgent medical care is required. “Every minute counts. Dial 000”.






Signs and Symptoms

Medications and rest DO NOT relieve the pain.

Pain does not change on inhalation or movement.

Pain or heaviness to the chest radiating to the neck, shoulder and/or arm lasting for more than 10 minutes.

Pulse can be irregular, weak, fast or slow.

Sudden onset of pain, with or without exertion.

The casualty can be pale, cold and sweaty.

The casualty can be short of breath.

The casualty may have nausea or vomiting.

Special Consideration must be looked at in regards to the following two points:

1. Not all heart attacks are accompanied by chest pain some casualties just look and feel unwell.

2. People who experience a heart attack may pass off their symptoms as ‗just indigestion‘.

In the two above situations DO NOT think that they may not be having a heart attack. Always assume the worst, if you think there may be a ‗possibility‘ that the individual is having a heart attack, please follow the treatment for heart attack.

The Warning Signs for a heart attack usually last at least 10 minutes. But if the warning signs are severe, or get worse quickly, DO NOT wait act immediately.

Treatment for Heart Attack

DRSABCD


Rest and reassure the casualty, preferably in a sitting position.

DO NOT walk the casualty (this increases the load on the heart).

Encourage the casualty to stop what they are doing and rest in a position they feel comfortable

Loosen any tight or restrictive clothing.

Assist the casualty to self Administer his/her own medications, as per doctor's instructions.

The casualty must be seated or lying before taking their medication as this type of medication can cause the casualty's blood pressure to drop and cause a faint.

Monitor the casualty's vital signs: pulse, respirations, and level of consciousness.

If the casualty becomes unconscious commence DRSABCD immediately and if the casualty‘s breathing and pulse has stopped commence CPR.

While waiting for the ambulance, advice may be given by the ambulance control operator over the telephone.






If directed you are allowed to administer the casualty Aspirin (300mg). But only if directed to do so.

Angina

Angina is caused by a temporary lack of oxygen to the heart. The coronary arteries may have become narrow over time and therefore blood flow is reduced. This is a temporary condition resulting in chest pain, generally triggered by physical exertion resulting in an inability to supply sufficient oxygenated blood to the heart. Normally there is no damage to the heart once the casualty has been rested and has self-administered their medications. The casualty's medications are designed to dilate the arteries allowing more blood to reach the heart. They also help reduce the casualty's blood pressure, reducing the load on the heart. The most common medications are Nitro lingual spray and Arginine tablets.

Signs and Symptoms

Pain does not change on inhalation or movement.

Pain occurs on exertion.

Pain to the chest, radiating to the neck, shoulder or arm.

Pulse can be irregular, fast or slow.

The casualty can be pale, cold and/or sweaty.

The casualty can be short of breath.

The casualty can have nausea or vomiting.

The casualty's pain is relieved with rest and their ownmedications.

Treatment for Angina

DRSABCD


Assist the casualty to self-Administer his/her own medications as per doctor's instructions making sure the casualty is sitting or lying down before taking their medication as this type of medication can cause the

casualty‘s blood pressure to drop and cause a faint.

If the chest pain lasts longer than 10 minutes or if unsure, call 000.

Loosen any tight or restrictive clothing.

Monitor the casualty's vital signs: pulse, respirations, and level of consciousness.






Heart Failure

This is an inability of the left side of the heart to pump effectively, causing pressure to build up within the circulatory system. This pressure build up allows fluid to move from the blood vessels to the air sacs of the lungs (Alveoli). In severe cases this will lead to respiratory failure.

Signs and Symptoms

Onset is more common at night.

Shortness of breath that increases if lying down.

The casualty may cough up frothy fluid.

The casualty may have chest pain, radiating to neck and arms.

The casualty will generally have a long history of heart problems.

The Carer may hear gurgling sounds.

Treatment for Heart Failure

DRSABCD


Sit the casualty upright.

Reassure the casualty.

Assist the casualty with his/her own medications ifnecessary, following the doctors' directions on the medications.

Summary

In all of these situations the first aider must provide appropriate treatment, in accordance with established first aid principles and procedures. They should make the casualty comfortable and do what they can to ensure that both short- and long-term repercussions for the injury or illness are relieved.

To finalise casualty management according to the casualty's needs and to first aid principles and when handing over a casualty to ambulance officers, paramedics or doctors the first aider should provide comprehensive, accurate information about the accident/ incident and about the casualty's condition. Monitoring reports will be required.






3. Communicate details of the incident

3.1 Accurately convey details of the incident to emergency response services where required

3.2 Report details of incident to supervisor

3.3 Complete relevant workplace documentation, including incident report form

3.4 Report details of incidents involving babies and children to parents and/or caregivers

3.5 Follow workplace procedures to report serious incidents to the regulatory authority

3.6 Maintain confidentiality of records and information in line with statutory and/or organisational policies

3.1 Accurately convey details of the incident to emergency response services where required

To access emergency services from a landline dial 000, or 112 from a mobile phone. The person answering the phone will ask which service you require. In remote areas radio contact might be required or two-way radio might be used.

The first aider might ask for an ambulance, rescue services or police. Sometimes it might be necessary to ask for all of these services. Ambulance services/ paramedics might be needed to provide appropriate medical assistance.

The first aider could also request police attendance if there is, for example, a threat of aggression or violence from a casualty or from bystanders (possibly those involved in an incident or attack), if there is a need for traffic control/ direction or if there is a need for crowd control.

The first aider should be prepared to answer questions similar to these:

1. What is the exact location of the emergency?

2. What is your call back phone number?

3. What is the problem? (What exactly happened?)

4. How many people are hurt/ ill?

5. What is wrong with the person/s?

6. How old is the person/s?

7. Is the person/s conscious?

8. Is the person/s breathing?

9. Are you able to rouse the person?

10. Is there anyone else in attendance?






The answers given to questions might help, for instance, an ambulance service perform accurate triage by prioritising requests for assistance according to severity and urgency.

Where possible, the first aider should volunteer appropriate information.

If there are any barriers, obstacles or issues with regard to access for emergency vehicles and/or personnel or if there is any danger to these personnel the first aider should advise, over the phone, the nature of the issues so that personnel can be prepared. If there is difficult or unusual terrain this should also be explained.

It will be necessary to answer all questions put by the emergency services receptionist and to follow any instructions offered by the responding emergency service. Sometimes the service will ring back to ask for more details or better directions.

When calling for assistance speak clearly and give information that is concise and accurate.

Do not give irrelevant details and do not ramble on. Use a moderate tone—do not shout or speak too softly. Do not speak too quickly because you will not be understood. If the receptionist asks something you do not understand or cannot hear clearly ask them to repeat it until you are sure of what they have said. If necessary, paraphrase. If you are asked to repeat something make sure you speak clearly, with appropriate diction.

The first aider should remain with the casualty, providing first aid support and reassurance, until emergency services arrive. They should also, wherever possible, ensure that they can be contacted by emergency services. They should be available to welcome emergency services. If necessary, they should provide appropriate directions for service vehicles and personnel once they arrive.

Communicating with emergency services and/or relieving personnel

Once emergency services arrive on the scene it will be necessary to accurately convey an assessment of the casualty's condition and to summarise the management and monitoring activities that have been undertaken.

Information that should be provided could include:

the casualty's name and age

a brief summary or description of the accident/ incident

time frames relevant to the accident/ incident

a summary of the patient's history if it is relevant and known

a description of the casualty's condition (or of the condition of multiple casualties) a summary of the treatment applied and the management of the casualty

all monitoring information - indicators of worsening or improving condition

any other relevant information, e.g. the name of the casualty's GP or any other treating medical personnel whose services might be relevant

information about parents or family who might need to be contacted

It might be necessary to provide a full description of any injury or illness and to offer information regarding, for instance:

fluid intake/ output, including fluid loss via:






– blood;

– vomit;

– faeces;

– urine.

state of consciousness now and at various stages

first aid treatment and management procedures and the degree to whichthey weresuccessful

administration of any medication (time and dosage) including pain relief, or support with administration of medication

a summary of vital signs monitoring

any signs of recovery, e.g.from a bite or sting reaction

increased or decreased bleeding

increased or decreased pain

pain sites

any relevant communication from the casualty

advice regarding alcohol or drugs that might have been consumed by the casualty andcould affect treatment

any behavioural issues, e.g. aggression, violence or threats, hysteria

Improving the accuracy of information given to ambulance services.

The first aider can improve the usefulness of the information given about the casualty by making it as accurate as possible under the circumstances. If the first aider has time to locate a pen and paper (often supplied in a first aid kit), they can note information such as pulse rate, the time when medication was given, and any changes in the condition of the casualty. Even scratching numbers in the dirt with a stick can help later recall, if there is time to do it.

Following emergency personnel takeover

Once the first aider has briefed the relevant personnel and answered their questions, they should stay with the casualty to continue to offer comfort and security until the ambulance is ready to leave.

It could also be very useful if the first aider can quietly review the information given to make sure nothing was missed, and make some notes. This should be done as soon as possible after the incident, because details are easily forgotten.

First aid equipment should be packed away and someone given the responsibility to check and replace used items as soon as possible.

Any further work-based procedures should be followed, such as making the area secure, turning off equipment or switching on security lights and systems, and notifying management.






3.2 Report details of incident to supervisor

If you are providing first aid as part of your work and are not just as a member of the public, that is, if you are an identified first aider at work, as opposed to a bystander or observer at an out-of-work incident—then the organisation for which you work will probably require a detailed and documented report of the incident/ accident/ illness situation.

Reports are necessary because:

they provide details of an incident or accident that can be referred to at any time

in child care facilities this is a legal requirement

they will be incorporated into company or club records

the casualty might require records

they will become part of a WorkCover report—if the incident/ accident is work-related (note that even minor incidents and accidents must be included in WorkCover reports)

they will provide background information if the incident is queried or if the treatment provided is queried

they will provide background information in the case where there is any form of claim or litigation

they will provide evidence relating to public liability claims

In the workplace reports might also be used in hazard identification and risk assessment procedures.

Information contained in reports will be much the same as that provided to the emergency services personnel.

Figure 36: Quality Area 2

Standard 2.1

Each child’s health is promoted

Element 2.1.4 Steps are taken to control the spread of infectious diseases and to manage injuries and illness, in accordance with recognised guidelines.

Standard 2.3

Each child is protected

Element 2.3.3 Plans to effectively manage incidents and emergencies are developed in consultation with relevant authorities, practiced and implemented

Element 2.3.4 Educators, co-ordinators and staff members are aware of their roles and responsibilities to respond ro every child at risk of abuse or neglect






Standard/ Element

National Law (section) and National Regulations (regulation)

2.1.4 regulation 77 Health, hygiene and safe food practices

2.3.4 regulation 84 Awareness of child protection law

2.3.3; 2.3.4.

regulation 85 Incident, injury, trauma and illness policies and procedures

2.3.3; 2.3.4.

regulation 86 Notification to parents of incident, injury, trauma and illness

2.3.3; 2.3.4.

regulation 87 Incident, injury, trauma and illness record

2.1.4. regulation 88 Infectious diseases

2.1.4. regulation 89 First Aid kits

2.1.4. regulation 90 Medical conditions policy

2.1.4. regulation 91 Medical conditions policy to be provided to parents

2.1.4. regulation 92 Medication record

2.1.4. regulation 93 Administration of medication

2.1.4. regulation 94 Exception to authorisation requirement – anaphylaxis or asthma emergency

2.1.4. regulation 95 Procedure for administration of medication

2.1.4. regulation 96 Self-administration of medication

2.3.3. regulation 97 Emergency and evacuation procedures

2.3.3. regulation 98 Telephone or other communication equipment

Related requirements

2.3.3. regulation 160 Child enrolment records to be kept by approved provider and family day care educator

2.3.3. regulation 161 Authorisations to be kept in enrolment record

2.3.3. regulation 162 Health information to be kept in enrolment record

2.3. regulation 168 Education and care service must have policies and procedures






Standard/ Element

Related requirements

2.1.3; 2.3. regulation 168 (2)(a)

Policies and procedures are required in relation to health and safety, including matters relating to:

(i) nutrition, food and beverages, dietary requirements, and,

(ii) sun protection, and

(iii) water safety, including safety during any water based activities; and

(iv) the administration of first aid

2.1.4; 2.3.3.

regulation 168 (2)(b) Policies and procedures are required in relation to incident, injury, trauma and illness procedures complying with regulation 85

2.1.4. regulation 168 (2)(c) Policies and procedures are required in relation to dealing with infectious diseases, including procedures complying with regulation 88.

2.3.3. regulation 168 (2)(d) Policies and procedures are required in relation to dealing with medical conditions in children, including the measures set out in regulation 90.

2.3.3. regulation 168 (2)(e) Policies and procedures are required in relation to emergency and evacuation, including the matters set out in regulation 97.

2.3 regulation 168 (2)(h) Policies and procedures are required in relation to providing a child safe environment

2.1.; 2.3.3; 2.3.4.

regulation 178

Prescribed enrolment and other documents to be kept by approved provider:

(1)(b) an incident, injury, trauma and illness record as set out in regulation 87

(1)(c) a medication record as set out in regulation 92.

2.1.; 2.3.3; 2.3.4.

regulation 178

Prescribed enrolment and other documents to be kept by family day care educator:

(1)(b) an incident, injury, trauma and illness record as set out in regulation 87

(1)(c) a medication record as set out in regulation 92.

As you can see it is very important that you report any incident, injury, trauma and illness in your position as an educator in a child-care facility






Your report to your supervisor would have the following detail:

The date, time and place of the incident/ accident

The name/s of any casualties

The name/s of any treating or attending first aid personnel

The nature of the incident/ accident - occurrences, injuries

treatment provided - results of treatment

other emergency services called in

reasons for calling in other services

treatment by other providers - results of treatment prognosis

a list of involved personnel

a list of witnesses

any ongoing treatment requirements (if known) and other repercussions

The details of any incident must be documented correctly. They should be documented as soon as possible after the incident to ensure accuracy of the events. If too much time elapses before reports are made details can be forgotten.

Reports support debriefing and are used to evaluate the treatment provided—to ensure that it was correct and to identify any possibilities for improvements that might be made to treatments and to first aid processes. It is a good idea to hold debriefings after any major incidents or accidents. Allowing people to talk about what happened at an incident enables them to come to terms with it and also enables them to identify the things that went well and anything that should be performed better in future.

3.3 Complete relevant workplace documentation, including incident report form

Forms

In an education and care setting it will be necessary to complete an Incident Report form. Forms should be completed if any of the following things occur:

a person involved in an incident requires third party medical treatment, e.g.doctor,dentist, ambulance, hospital

a child is removed from care as the result of an incident

a claim or notice of intent to claim from a third party, e.g. a parent is received eitherverbally or in writing

Records of any injury to a child must be held (in most jurisdictions) until that child has turned 24 years of age, unless a claim has been brought and disposed of in the meantime.






Figure 37: Incident, injury, trauma and illness report






This report must be completed and returned to the Family Day Care office as soon as possible after the event.

Educators must also complete their Public Liability Incident Report and forward it to the insurance company if a third party is involved e.g. Doctor, Dentist, Hospital, etc.

Forms should be completed as soon after an incident or accident as is possible.






Resources

A list relating to any resources that were used should be made and documented. This enables assessment and analysis of the resources that were available; that is, were they adequate and appropriate—and a determination of whether new or improved resources are required.

The list can also be used to place an order or disbursement request for replacements. Any resources used (especially consumable resources) should be immediately replaced so they are available for future incident or accident situations.

3.4 Report details of incidents involving babies and children to parents and/or caregivers

Each education and care service will have policies and procedures relating to notifying parents in the case of an event or emergency situation.

The policy and procedure should include information that relates to how to record information that relates to the event/ emergency that has occurred as well as clear instructions on how to advise the parent/ caregiver. In emergency situations, medical assistance has been given to the child before the parent has been advised. Upon enrolling at the education and care service, parents/ caregivers are required to complete an authorisation declaration that states that the provider may administer medical first aid in the event that a parent is unavailable or is not contactable.

3.5 Follow workplace procedures to report serious incidents to the regulatory authority

In some situations, the event/ emergency must be reported to several regulatory authorities. In the event of serious injuries /incidents and dangerous occurrences involving children state/ territory WorkCover authorities must be notified. Such notifiable dangerous occurrences include damage to or failure of major types of plant and equipment, uncontrolled fire, explosion, escape of gas, dangerous goods or steam and electric shock. Dangerous occurrences also include the imminent risk of these events or of the death or serious injury to any person.

The purpose of Accident/ Illness/Injury Report Forms is to ensure an accurate tracking and appropriate follow-up of all serious incidents which occur in child care setting.

Notification of illness or injury is required by all states and territories regulators. Reportable incidents include:

unexpected illness and/or disease outbreak

unexpected death

fall, other injury

motor vehicle injury/ accident

aggressive/ unusual behaviour

poisoning

medication error






Education and care services should report all incidents that involve injury to parents, the regulators (ACECQA) as well as their insurance company.

Standard 7.3 of the National Quality Standards developed and regulated by ACECQA, outline that records and information are stored appropriately to ensure confidentiality, are available from the service and are maintained in accordance with legislative requirements. This relates to incident, injury, trauma and illness records and the recording of the death of a child while being educated and cared for by the service. Services must also ensure that practices are based on effectively documented policies and procedures that are available at the service and reviewed regularly (Standard 7.3.5).






Figure 38: Standard 7.3.5.

Standard 7.3

Administrative systems enable the effective management of a quality service.

Element 7.3.5. Service practices are based on effectively documented policies and procedures that are available at the service and reviewed regularly

Standard/ Element

National Law (section) and National Regulations (regulation)

7.3.5 regulations 168-172 Policies and procedures

3.6 Maintain confidentiality of records and information in line with statutory and/or organisational policies

If first aid delivery is part of the work you do, you will need to keep records of the event, the personnel involved and the actions taken. You will, during the treatment, have collected information about the casualty. This is not information that should be discussed with any unauthorised personnel. It is, in fact, protected by confidentiality requirements and by privacy legislation.

Privacy legislation, at Commonwealth and state legislation creates a single, nationally consistent framework for protecting privacy. Any person or organisation providing a health service must comply with its strictures at both Commonwealth and state levels. It stipulates that providing a health service includes any activity that involves assessing, recording, maintaining or improving a person's health; or diagnosing or treating a person's illness or disability; or dispensing a prescription drug or medicinal preparation by a pharmacist. It applies to private or public sector organisations that deliver these types of services and includes, therefore, any organisation or section of an organisation that provides first aid service.

Health information is personal information that attracts privacy protection because of its sensitivity. Personal information relating to a casualty's health history and to the current or recent first aid issue comes under the heading of health information.

A first aid record will be kept and a report might be generated but the information held in records and reports is private.

The organisation for which the first aider works will have its own methods of storing casualty files, but there are a number of other acts, regulations, administrative circulars and resources relevant to health information management in the various states and territories of Australia. Bodies that oversee and contribute to the development of these include the Australian Medical Association (AMA), Medical Record Advisory Units, Hospital Systems Units, Information Management Services, the Department of Human Services for use in the various states and territories. The type of organisation for which the first aider works and type of first aid services provided will determine which, if any, of these bodies is responsible for regulation of recordkeeping.

Privacy legislation, in combination with the other regulations overseen by the medical or human services boards in the various states, protects any information recorded about a person where their identity is known or could reasonably be worked out. Personal






information includes a person's name, address, Medicare number and any health information (including opinions, case notes, incident details, treatment etc) about the person. The legislation does not cover de-identified statistical data, where individuals cannot reasonably be de-identified.






Conditions that relate to the collection, solicitation, storage, access, alteration and disclosure of casualty information are summarised in the Information Privacy Principles (IPPs or NPPs - National Privacy Principles).

These specify that:

1. Agencies can only collect personal information for a lawful purpose that is directly related to their functions, if collecting the information is necessary for or directly related to that purpose.

2. If an agency asks people for personal information about themselves, it must tell the person or their authorised representative why it is collecting the information, whether it has legal authority to collect the information, how and by whom the information will be used. An agency must take reasonable care to check that personal information is accurate, up-to-date and complete before using it.

3. The agency must do its best to make sure that the information is relevant to the agency's reason for collecting it, up-to-date, of high quality, complete and protected from unauthorised access.

4. A person whose information is held by a government or a private agency has a right to expect that the agency will hold it securely and will ensure that access to the information is permitted only for legitimate purposes.

5. The individual concerned shall be entitled to have access to their records, under the principles of access dictated by the Freedom of Information Act 1982.

6. An agency must not use personal information for any purpose other than that for which it obtained the information, unless:

a. The person the information is about consents.

b. The use is necessary to protect against a serious and imminent threat to a person's life or health.

c. The use is required or authorised by law.

d. The use is reasonably necessary to enforce the criminal law or impose a pecuniary penalty or to protect public revenue.

e. The use is directly related to the purpose for which the agency obtained the information.

In essence, casualty information must not be misused or given inappropriately to others.






Disclosure

A casualty's personal information should not be discussed with any unauthorised personnel, including friends of the client or family members, with friends or even with co-workers who are not associated with the person's care. It should not be discussed in ways or in a place where the discussion can be overheard by unauthorised persons.

In the case where the casualty is a minor, their parents or legal guardians should have access to information. These people are responsible for the client's health and wellbeing, therefore, should be involved in first aid or medical decisions and fully advised about treatments.

First aiders need to be aware of their duty to maintain confidentiality and security of information at all times.

Information that can be disclosed

In some instances health services or first aid service providers can disclose information to lawfully authorised personnel.

Such instances might include:

the collection, use and disclosure of personal medical information in relation to the conduct of research, compilation and analysis of statistics relevant to public health, safety or health service management activities

circumstances where it is reasonably believed that the use or disclosure is necessary to lessen or prevent a serious and imminent threat to an individual's life, health or safety or a serious threat to public health or public safety

if there is reason to suspect that unlawful activity has been, is being or might be engaged in, information can be passed to lawful authorities in reporting concerns

if the use or disclosure is required or authorised by or under law

if it is reasonably believed that the use or disclosure is necessary for the prevention, detection, investigation, prosecution or punishment of criminal offences, breaches of a law imposing a penalty or sanction or breaches of a prescribed law

Medical information collected during a first aid episode can also be disclosed in the preparation for, or conduct of, proceedings before any court or tribunal, or implementation of the orders of a court or tribunal. This information in records or reports can also be accessed by the casualty.

WorkCover might also require access to first aid records if a claim is made or is likely. In such cases the casualty will be asked to allow access to records.






Incident data therefore cannot be disclosed unless:

the disclosure is made under compulsion of law, e.g. subpoena, mandatory reporting of child abuse;

the interests of the casualty require disclosure, i.e. shared with other emergency workers in the interests of the casualty;

there is a duty to the public to disclose, e.g. assisting the police in investigating a crime by warning of a risk posed;

the disclosure is made with the consent of the casualty

a guardian appointed by the Guardianship Board consents on behalf of the person

4. Reflect on incident and own performance

4.1 Recognise the possible psychological impacts on self, other rescuers and children

4.2 Talk with children about their emotions and responses to events

4.3 Participate in debriefing with supervisor

4.1 Recognise the possible psychological impacts on self, other rescuers and children

Many first aid incidents involve minor injuries and the first aider can see a happy resolution of the incident, often accompanied by an appreciative casualty. However, more serious emergency situations can have serious psychological effects, even for experienced first aiders. This is particularly true if the incident is traumatic, or involves multiple casualties, major injuries or fatalities. Many people find that the involvement of badly injured children, or injured animals, can be even more difficult to deal with.

All forms of emergency services know this and provide access to support services; however, the first step to using them involves recognising that there is a problem. A duty of care principle applies here also, which suggests that not only do you need to care for your own wellbeing, but also be alert to the common symptoms of traumatic stress in colleagues.

Common stress reactions

Stress reactions can be physical, emotional, include changes to normal behaviour, or relate to how a person thinks.

Physical reactions commonly include sleeping difficulties, headaches, feeling sick, aches and pains and can include a rapid heart rate. Sleeping difficulties are particularly serious and can lead to other chronic problems.

Emotional feelings commonly include guilt, anxiety and depression; they can also include fear, grief, anger and shock. Feelings of helplessness, powerlessness and isolation and sometimes feeling suicidal can also happen.






Behavioural changes can include excessive talking, humour or silence (compared to the person's normal behaviour), crying, withdrawing from company, eating much more or less than normal, and consuming a lot more alcohol, caffeine or sugar. Behavioural and emotional changes are the most likely ones to be noticed by caring colleagues.

Cognitive or thinking changes include distressing dreams or flashbacks, being unable to concentrate, experiencing difficulty in making decisions and not being able to think straight.

People react differently and can show a range of responses following an emergency, or symptoms can appear well after the event. Stress can build over time, and a comparatively minor incident might be the final load that results in a serious stress-related condition.

First aiders are not immune from feelings of fear and of grief and the impact of trauma situations can have physical, emotional, cognitive, physiological, sensory, and spiritual impacts.

These could manifest as:

shock symptoms

insomnia

loss of appetite

headaches

muscle weakness

elevated vital signs

depression, anxiety

numbing

guilt, shame, fear

intolerance of fear response

flashbacks, nightmares clinging

isolation

thrill seeking

re-enactments of the trauma

substance abuse

Personal limitations

Stress is a highly personalised condition, which to some people suggests weakness and makes them unwilling to admit to being stressed, even to themselves. Anyone can suffer traumatic stress at any time since it is a normal part of the human condition. Traumatic stress is real and has serious consequences, but can be dealt with professionally.

Stress management

Any person who thinks they might be suffering from work associated stress should seek help immediately. Organisations make available professional help which can be sought anonymously. Professional services contact details are usually available on a website or through posters and handouts. A person might prefer to approach their own doctor.






In addition to professional help, eating a healthy diet, exercising and talking to a trusted friend are recommended. Doing something enjoyable and relaxing like listening to music or reading, or taking up meditation or yoga, or spending time with family and loved ones can also help. Biofeedback devices and advanced audio recording systems, holophone recordings and Mozart piano recitals have shown lowering effects in some studies. Incident debriefing is also a very good tool to assist the first aider.

Stress is such a major factor in modern life that there are many different books, websites and professionals to assist. Since stress is a very individual problem, dealing with it also needs an individual approach. If one system seems not to be working, try another. A qualified specialist has a lot of experience with different people's reaction to stress and has a lot of different techniques and equipment (like biofeedback devices) to assist.

De-stressing strategies

De-stressing strategies can include:

debriefing the situation with a supervisor

writing down what happened and your feelings about it

talking with a friend or colleague about how it felt to be involved

doing some exercise to dissipate the adrenaline that might have built up in your system (Most of us have a classic fight or flight response to dealing with conflict and, as a result, have a surge of adrenaline in our systems that acceptable (rational) means of conflict resolution might not deal with.)

listening to a relaxation tape

spending time reflecting and getting back into balance by going for a bushwalk, sitting near the water or in the bush

doing something nice for yourself.

You will all know what works best for you. If your traditional ways of dealing with stress don‘t work, you might want to seek supervision or counselling yourself to help you to make sense of why the conflict has had a particular impact upon you.

Individuals can take responsibility for their own stress management by taking good care of their general physical and mental health. Improving health for stress management involves:

Reducing the physical impact of stress by relieving muscle tension, lowering heart rate etc., after stressful experiences;

Improving physical fitness and general health in order to prepare the body to deal effectively with stress next time.






Seven simple strategies that work

1. Slow down your breathing: Take a few deep breaths, exhaling slowly each time.

2. Use exercise to wind down: Physical activity releases the energy and muscle tension built up by stress.

3. Relax your muscles directly: The stress response produces muscular tension and this causes aches and pains. Relaxing your muscles could involve:

a. Tensing muscles before you consciously relax them. You can achieve this with simple activities such as shrugging the shoulders, rolling the neck from side to side, clenching and releasing your hand.

b. Massage. For deeper muscle relaxation - massage your own scalp, hands or feet. Or get someone else to give you an all over massage.

c. Warmth. Use warm water or hot packs to relax tense muscles.

4. Posture: Your body has to work harder if you are standing or sitting incorrectly. Check your posture regularly, especially if you have to perform the same task for extended periods of time. Change your position as often as possible, stretching your muscles as you move.

5. Release tension emotionally: Physical activity helps to use up the adrenalins created by stress. When physical activity is not possible, try releasing tension by sharing your feelings with someone else. Putting feelings into words helps to release pent-up emotions and assists in problem solving. Laughter has been called "the best medicine", and not without cause. Stress often makes us focus on the serious and negative aspects of our life. Laughter releases chemicals such as endorphins which help us to feel more relaxed and often enables us to see things from a more balanced perspective.

6. Slow down: Deliberately slow your movements down - walking, driving, working. The calmer pace will reduce the impact of stress on your body and help to prevent accidents.

7. Take a break: Allow for adequate rest breaks in your work day. Not taking breaks in order to save time increases the risk of accidents. When you take a break try to find a physical environment and an activity that are different from your usual work environment. This may mean something as simple as going for a walk. It could also mean temporarily switching from one job to another.

A program of physical care should include activities that occur before exposure to stress, during stressful periods, and afterwards.






Figure 39: Physical care program

Before During After

Activities for good health

On the spot relaxation

Activities that relax or that burn energy

Regular exercise

aerobic

weight

bearing

flexibility

Medical check ups

Diet

Sleep

Holidays

Posture

Controlled breathing

Muscle tense & relax

Venting emotion

Time out

Laughter

Slow down

Relaxation

Massage

Warm baths

Exercise

Dancing

Singing

Laughing

Venting emotion

A particular sort of stress may affect you after a violent incident - Post Traumatic Stress Disorder. This involves, for instance, anxiety, sleep problems and depression. This is a normal reaction to a traumatic incident, and is best dealt with by professional counselling

4.2 Talk with children about their emotions and responses to events

Talking with children about their emotions and responses to events can help them understand what's happened, feel safe and begin to cope. Not talking with children about the event might give children the sense that what happened is too horrible to talk about, which could make the event seem even more threatening or frightening.

When talking to children about the event, tell the truth. Focus on the basics, and avoid sharing unnecessary details. Don't exaggerate or speculate about what might happen. Avoid dwelling on the scale or scope of the event.

Listen closely to each child for misinformation, misconceptions and underlying fears. Take time to provide accurate information. Share your own thoughts and remind the child that you are there for them.

A child‘s age will play a major role in how they process information about an event. Before talking with children, consider:






Figure 40: Talking to children

Childs age:

Children under 4 Get down to your child's eye level. Speak in a calm and gentle voice using words your child understands. Explain what happened and how it might affect your child. For example, after a severe storm you might say that a tree fell on electrical wires and now the lights don't work. Share steps that are being taken to keep your child safe. Give your child plenty of hugs.

Preschool and early primary school children

Children in this age range might have more questions about whether they're truly safe. They may also need help separating fantasy from reality.

Upper primary and high school children

Older children will want more information about the tragedy and recovery efforts. They're more likely to have strong opinions about the causes, as well as suggestions about how to prevent future tragedies and a desire to help those affected.

Be prepared to repeat information that might be hard for a child to understand or accept. If a child asks the same question repeatedly, keep in mind that they might be looking for reassurance.

Encourage the expression of feelings. Explain to the child that it's ok to be upset or cry. Let the child write about or draw what they are feeling. Physical activity might serve as an outlet for feelings or frustration.

Often, young and older children are unaware of their feelings because they fail to appropriately process their reaction to an emotional situation.

Educators can help children recognise their feelings by asking questions such as 'What did you feel when your friend was hurt?' or by offering: 'I would have felt very frightened if my friend was rushed into an Ambulance'. Encouraging children to discuss the event can help process what they are feeling.

Identifying and labelling emotions is an important component of emotional regulation.

Children who have a large vocabulary of names for feelings are better able to express their emotions using language, rather than behaviours. Educators can help children learn names of feelings by:

name your feelings game—use games or creative ways to teach children the names of a range of emotions

using your words—redirect negative behaviours and remind children to use words to explain what they are feeling and need






suggest phrases—provide examples of phrases that children can effectively use in emotional situations

use books—there are lots of books and/or resources that focus on dealing with emotions for children of all ages. Books offer opportunities to discuss emotions from a safe distance

use posters with emotions faces—these posters help children learn how to recognise other people's emotions and facial expressions, an important component to identifying emotions in others and in oneself

Children often fail to express their emotions verbally because they lack the vocabulary, or are too emotional to use them, or are afraid of expressing them. To help children, educators can:

give permission to feel and express emotions—children need to feel they are safe in feeling and expressing negative emotions, especially with shy children

show and tell—guide each child and show them how they can express their feelings. Use examples, phrases and scenarios

use art—encourage children to draw, colour or sculpt their feelings

encourage writing—writing down feelings is a powerful way to express emotions






4.3 Participate in debriefing with supervisor

Debrief is a term which means having a general discussion about an incident with as many of the people involved as possible, and should occur soon after the incident.

A debriefing is important in the case of anything other than a minor first aid incident. It can be a very formal process, with a chairperson and a number of staff members present- including those involved in or affected by the incident. It might also be informal—just a roundtable discussion. Regardless of the process, each person should have the opportunity to talk, listen and to make suggestions regarding ongoing trauma management.

The value of a debrief session is threefold. Firstly it allows the group to look at the incident as a whole, and can result in suggestions to improve future responses or ways to reduce workplace hazards.

Secondly it gives the persons involved both the time and permission to go over the incident. Each person gets a chance to express their own point of view, and to see it through other people who were also involved. For example, a first aider spending time attending a casualty in a safe location might not have seen many other activities associated with the incident or other first aid givers. Discussing the incident from several points of view allows each person to see the incident as a whole, which helps to bring a sense of closure.

Another important role of the debrief process is that it allows people to talk about the feelings they experienced at the time or still do feel, and can help them deal with unresolved strong emotions. It is important to deal with the emotional issues of those involved and to provide support if necessary

An informal atmosphere, amongst colleagues, often encourages this type of discussion and talking about the incident in this way can offer important emotional release, rather than letting unresolved issues create a stress build up. It also allows people to notice which of their colleagues seem distressed so that they can watch out for them, and helps each person to realise how real stress is. In turn they know they can rely on the process and their colleagues to support them.

Debriefing limitations in stress management

Recent international crises and emergencies around the globe are starting to suggest the inappropriateness of the Western stress debriefing model for some cultures, especially those where talking about how a person feels is not usual in their society. Some psychologists believe that there is some evidence to suggest that a person of any culture should not be forced to attend a stress management debrief against their will, especially if they have a strong network of family and friends for support.






Feedback

Feedback can be used to support and reinforce a first aider's actions, or to help them improve responses in the future. Feedback is a term applied to the means by which a person looks at the result of a process, compares the actual result with the intended result, and uses any difference to adjust or modify the process.

Getting feedback about the role and the treatment you provided will enable the first aider to find out if they could improve treatment and management of the first aid situation in future.

It might be a good idea, therefore, for a first aider to ask for feedback from clinical experts to ensure they have done the right thing/s and that any treatment or medications were the most appropriate. If there were any issues or problems these could be discussed in feedback sessions and addressed by the clinical expert.

Feedback might refer to the medical treatments provided or it could be given in response to the first aider's communication style and their interactions with the casualty.

Feedback can be informal - a casual, verbal conversation - or it can follow a formal format where the person asking for feedback uses a form or set of survey style questions to elicit specific answers about a range of first aid activities.

Feedback might also be written. Once the first aider submits a report a clinical expert could provide written evaluations and responses.

It might also comprise part of a performance management process for the first aider, depending on their role and employment position.

Clinical experts who could provide feedback include:

a supervisor/ manager with first aid or medical qualifications and experience

an attending ambulance officer/ paramedic

an attending doctor

other emergency services personnel

services personnel, e.g. if the casualty is taken to a doctor in a hospital the attending personnel could provide feedback regarding the first aid provided before the casualty arrived

The feedback need not necessarily come from attending personnel—it might be provided as a result of examination of the records or as a result of verbal reporting relevant to the incident.

Feedback reinforces current good practice and outlines what went well and what did not. It offers information that can be used for ongoing improvement of procedures and first aid treatments.






Definitions

Term What it means What you understand it to be

toxic substance

respiratory

cardio-vascular

neurological

toxicological

renal

haematological

neurovascular

envenomation

endocrine

ocular

communicable disease






gynaecological

paediatric

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Australian Government Department of Education, Employment and Workplace Relations for the Council of Australian Governments; Belonging, Being and Becoming; The Early Years Learning Framework for Australia, Team Meeting Package, Canberra, 2009.

Australian Government: National Health and Medical Research Council, Staying Healthy; Preventing infectious diseases in early childhood education and care services, Canberra, 2013

Bailey, J. Functional Skills English – Childcare Workbook, Brisbane, 2014

Bailey, J. Functional Skills Maths – Childcare Workbook, Brisbane, 2014

Beaver, M, et al. Child Care and Education, Nelson Thomas, London, 2010.

Egle, Caron; A Practical Guide to Working with Children, Tertiary Press, 2008 n

Guide to the National Law and Regulations, Australian Children‘s Education and Care Quality Authority (ACECQA), Sept 2103

Kearns, K. Frameworks for learning and development, Pearson Australia, Frenchs Forest 2010.

Kuzemko, J. (1998) Is Your Child Allergic? Wellingborough, UK, Thorsons Publishers

Mosby. (2013) Mosby‘s dictionary of medicine, nursing and health professionals, 9th ed. Mosby, St Louis, P64.

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